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Kinds of SUI Terms modified by SUI Selected AbstractsReducing sex under the influence of drugs or alcohol for patients in substance abuse treatmentADDICTION, Issue 1 2010Donald A. Calsyn ABSTRACT Aims In a previous report, the effectiveness of the Real Men Are Safe (REMAS) intervention in reducing the number of unprotected sexual occasions among male drug abuse treatment patients was demonstrated. A secondary aim of REMAS was to reduce the frequency with which men engage in sex under the influence (SUI) of drugs or alcohol. Design Men in methadone maintenance (n = 173) or out-patient psychosocial treatment (n = 104) completed assessments at baseline, 3 and 6 months post-intervention. Participants The participants were assigned randomly to attend either REMAS (five sessions containing information, motivational exercises and skills training, including one session specifically targeting reducing SUI) or human immunodeficiency virus (HIV) education (HIV-Ed; one session containing HIV prevention information). SUI during the most recent sexual event served as the primary outcome in a repeated measures logistic regression model. Findings Men assigned to the REMAS condition reporting SUI at the most recent sexual event decreased from 36.8% at baseline to 25.7% at 3 months compared to a increase from 36.9% to 38.3% in the HIV-Ed condition (tintervention = ,2.16, P = 0.032). No difference between the treatment groups was evident at 6-month follow-up. At each assessment time-point, sex with a casual partner versus a regular partner, and being in methadone maintenance versus psychosocial out-patient treatment, were associated with engaging in SUI. Conclusions Overall, a motivational and skills training HIV prevention intervention designed for men was associated with greater reduction in SUI than standard HIV education at the 3-month follow-up. [source] Drugs and violent death: comparative toxicology of homicide and non-substance toxicity suicide victimsADDICTION, Issue 6 2009Shane Darke ABSTRACT Aims To determine the comparative toxicology of death by homicide and suicide by means other than substance toxicity. Design Cross-sectional (autopsy reports). Setting Sydney, Australia. Cases A total of 1723 cases of violent death were identified, comprising 478 homicide (HOM) cases and 1245 non-substance toxicity suicide (SUI) cases. Findings Substances were detected in 65.5% of cases, and multiple substances in 25.8%, with no group differences. Illicit drugs were detected in 23.9% of cases, and multiple illicit in 5.3%. HOM cases were significantly more likely to have an illicit drug [odds ratio (OR) 2.09] and multiple illicits (OR 2.94), detected, HOM cases being more likely to have cannabis (OR 2.39), opioids (OR 1.53) and psychostimulants (OR 1.59) present. HOM cases were, however, significantly less likely to have benzodiazepines (OR 0.53), antidepressants (OR 0.22) and antipsychotics (OR 0.23) present. Alcohol was present in 39.6% of cases (median blood alcohol concentration = 0.12), with no group difference in prevalence. Conclusions The role drugs play in premature death extends far beyond overdose and disease, with illicit drugs associated strongly with homicide. [source] Change of sexual function after midurethral sling procedure for stress urinary incontinenceINTERNATIONAL JOURNAL OF UROLOGY, Issue 8 2008Duk Yoon Kim Objectives: To compare sexual function in women before and after the midurethral sling procedure for stress urinary incontinence (SUI). Methods: A total of 75 women undergoing surgery for SUI between September 2005 and September 2006 were recruited for this study. Those who completed the Female Sexual Function Index (FSFI) preoperatively and 6 months postoperatively were included in the analysis. The FSFI is a validated, 19-item questionnaire, which assesses six domains of sexual function, including desire, arousal, lubrication, orgasm, satisfaction, and pain. Results: Data were analyzed for 47 patients. Overall sexual function after the midurethral sling procedure was not significantly different. There were no significant differences in overall sexual function or any of the individual FSFI domain scores between patients with and without concomitant posterior colporrhaphy. There were no significant differences in sexual function between the transobturator and the retropubic surgical routes. Conclusions: There is no significant change in overall sexual function in women undergoing the midurethral sling procedure. Posterior colporrhaphy and operative methods do not affect overall sexual function. [source] Health-related quality of life and sexual function in women with stress urinary incontinence and overactive bladderINTERNATIONAL JOURNAL OF UROLOGY, Issue 1 2008Seung-June Oh Background: We evaluated the impact of stress urinary incontinence (SUI) and overactive bladder (OAB) on health-related quality of life (HRQOL) and sexual function. Methods: A total of 245 women (SUI; n = 123 and OAB; n = 122) from 21 to 79 years old (mean 50.4) were included in the primary analyses. To obtain HRQOL and sexual function assessments, patients were asked to fill in the ,Bristol Female Lower Urinary Tract Symptoms (BFLUTS)' and the ,Medical Outcomes Study Short Form (SF-36)' questionnaires. Results: Of the eight domains in the SF-36 questionnaire, only ,general health' was significantly different between the groups. Patients with SUI had a better general health than those with OAB (P = 0.016). When comparing the BFLUTS scores in the two groups, the score for ,BFLUTS-filling symptoms' was higher in the OAB group (P = 0.002) but that for ,BFLUTS-incontinence symptoms' was higher in the SUI group (P < 0.001). The score for ,BFLUTS-sex' was higher in the SUI group than in the OAB group but this was not statistically significant (P = 0.096). Of the 169 patients who had a sex life, the SUI group had experienced pain (P = 0.033) and leakage (P = 0.056) more frequently during intercourse than the OAB group. Conclusion: Both SUI and OAB have a detrimental impact on patient HRQOL in Korean women. In addition, our findings suggest that women with SUI had more frequently experienced pain during intercourse and coital incontinence than those with OAB. [source] Decrease in urethral pressure following repeated cough efforts: A new concept for pathophysiology of stress urinary incontinenceINTERNATIONAL JOURNAL OF UROLOGY, Issue 11 2007Xavier Deffieux Aims: To describe the decrease in maximum urethral closure pressure (MUCP) following repeated coughs in women with stress urinary incontinence (SUI). Methods: MUCP was recorded at rest and after seven cough efforts in 70 women under age 40 referred for urodynamic investigation (47 women with SUI and 23 women without SUI). Results: The intraclass correlation coefficient for repeatability was very good at 400 mL filling volume: 0.94 (95%CI: 0.85,0.98), as compared to the mean and standard-deviations of the MUCP measurements. A decrease in MUCP >20% after seven cough efforts was observed in 18(38%) patients in the SUI group and in just 1(4%) woman in the non-SUI group (P = 0.0069). Conclusions: Many women with SUI exhibit a sharp decrease in MUCP after repeated coughs. Many hypotheses may explain this phenomenon, including increased fatigue of the periurethral muscles. [source] Comparison of bone-anchored male sling and collagen implant for the treatment of male incontinenceINTERNATIONAL JOURNAL OF UROLOGY, Issue 9 2006RAHMI ONUR Aim: To compare the effectiveness of transurethral collagen injection and perineal bone-anchored male sling for the treatment of male stress urinary incontinence (SUI). Methods: Seventy-one men with SUI underwent either transurethral collagen injections (n = 34) or perineal bone-anchored male sling (n = 37) between June 1999 and October 2003. Most of the patients in each group had radical retropubic prostatectomy and/or external beam radiation therapy (EBRT) in relation to the cause of incontinence. There was one patient in both groups who only had EBRT for the cause. The mean duration of incontinence were 4.2 and 4.4 years, respectively. Collagen injections were carried out transurethrally either under regional or general anesthesia until co-aptation of mucosa was observed. The male sling was placed under spinal anesthesia with a bone drill using either absorbable or synthetic materials. Retrospectively, all patients were assessed for continence status and procedure-related morbidity, if present. The outcome of both procedures was also compared with the degree of incontinence. Results: Ten (30%) patients in the collagen group showed either significant improvement or were cured following injections. Preoperatively, the mean pad use in collagen group was 4.5 (SD 2.8) per day, whereas it was 2.2 (SD 1.1) after the injection(s). Collagen injection failed in 24 (70%) of the patients. Patients who received the male sling had a mean preoperative pad use of 3.7 (SD 1.5) and postoperatively, the number decreased to 1.6 (SD 1.2). Most of the patients in this group were either totally dry or significantly improved (n: 28, 76%). There was a statistically significant difference between two groups in respect to success rate (P < 0.05). Analysis of treatment outcome with the degree of incontinence revealed that the male sling is most effective in patients with minimal-to-moderate incontinence. Conclusions: Our results suggest that the male sling, a minimally invasive procedure, is more effective than collagen implant in the treatment of mild-to-moderate SUI in men. [source] Transobturatory tension-free composite sling for urethral support in patients with stress urinary incontinence: Favorable experience after 1 year follow upINTERNATIONAL JOURNAL OF UROLOGY, Issue 6 2006IVAN IGNJATOVIC Objective:, Symptomatic, anatomic and urodynamic results of a composite transobturatory tension-free sling with an absorbable middle part, in patients with stress urinary incontinence (SUI), were studied. Methods:, A prospective study in 40 women with SUI was performed. Symptoms, urodynamics and anatomical improvements were evaluated separately. Surgery was performed with the transobturatory approach. Results:, All patients had both clinically and urodynamically confirmed SUI. Clinical outcome was favorable in 36/40 (90%) patients, after 1 year. Operation improved the position of the bladder neck (2.8 cm and 1.4 cm below the pubic bone, respectively) and significantly decreased mobility of the bladder neck during abdominal straining (3.3 cm and 1.7 cm, respectively). Both symptoms and quality of life were significantly improved 1 month after the surgery. Postoperative maximum flow was lower than the preoperative one but with borderline significance (25.8 and 23.7 mL/s; P = 0.05). Pressure flow study showed unobstructed voiding both preoperatively and postoperatively. Detrusor pressure at the maximum flow was increased (20, 4 and 22, 8 cmH2O, respectively) but not significantly. Conclusion:, Our results confirmed a high objective cure rate, improvement of symptoms and quality of life, and at the same time, corrected position of the bladder neck and unobstructed voiding. [source] Long-term results of Burch colposuspensionINTERNATIONAL JOURNAL OF UROLOGY, Issue 4 2000Haluk Akpinar Abstract Background: We aimed to determine the long-term results of Burch colposuspension. Methods: Patients who had undergone Burch colposuspension due to stress urinary incontinence (SUI) in our department between 1991 and 1995 were asked to participate in the study by telephone or mail. Fifty of 78 patients (64%) responded and these formed the study group. Patients were evaluated by a detailed questionnaire, pelvic examination, uroflowmetry and postvoid residual urine determination. Provocative stress test and urodynamic evaluations were performed in those who claimed leakage. Additionally, follow-up charts were retrospectively reviewed from the patients' files. Results: Mean follow-up time was 50.6 months. The subjective cure rate was 52% and the surgical success rate was 84%. The patient satisfaction rate in terms of incontinence was 86%. No correlation was found between pre-operative patient characteristics (i.e. age, number of vaginal deliveries and pregnancies, menopause, previous anti-incontinence surgery and presence of detrusor instability) and outcome of surgery. Although no patient was performing clean intermittent catheterization in the long term, two patients had significant residual urine and obstructive flows. Three patients had severe pelvic prolapse that required surgical correction. Conclusions: Our results indicate that Burch colposuspension operation is an effective and durable choice of treatment with low complication rates for the treatment of SUI. [source] Comparative Toxicology of Intentional and Accidental Heroin Overdose*JOURNAL OF FORENSIC SCIENCES, Issue 4 2010Shane Darke Ph.D. Abstract:, The demographic and toxicological characteristics of deliberate (SUI, n = 50) and accidental (ACC, n = 927) fatal heroin overdose cases were examined. SUI cases were more likely to be female, had lower body mass indices, were more likely to be enrolled in treatment and less likely to have hepatic pathology. The median blood morphine concentration of SUI cases was significantly higher than that of ACC cases (0.70 vs. 0.40 mg/L, p < 0.001). Blood morphine concentrations of >1 mg/L were seen among 38.0% of SUI cases compared to 13.9% of ACC cases. Being a member of the SUI group remained a significant independent predictor of higher morphine concentrations after controlling for the effects of potential confounders (p < 0.001), other significant predictors being the absence of alcohol (p < 0.001), the presence of methadone (p < 0.05), and the presence of cocaine (p < 0.05). The current data are consistent with the view that suicide forms a small, but distinct, category of heroin overdose cases, rather than overdose being a parasuicidal phenomenon per se. [source] Safety of Trans Vaginal Mesh procedure: Retrospective study of 684 patientsJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 4 2008Fréderic Caquant Abstract Aim:, To study peri-surgical complications after cure of genital prolapse by vaginal route using interposition of synthetic prostheses Gynemesh Prolene Soft (Gynecare) following the Trans Vaginal Mesh (TVM) technique. Methods:, The present retrospective multicentered study comprised 684 patients who underwent surgery at seven French centers between October 2002 and December 2004. All patients had a genital prolapse ,3 (C3/H3/E3/R3) according to International continence society (ICS) classification. According to each case, prosthetic interposition was total, or anterior only or posterior only. Patients were systematically seen 6 weeks, 3 months and 6 months after surgery. Multivaried statistical analysis followed a model of logistic regression applied to each post-surgical complication. Results:, The mean age of patients was 63.5 years (30,94). The mean follow-up period was 3.6 months. 84.3% of patients were post-menopause, 24.3% had hysterectomy, 16.7% previous cure of prolapse, and 11.1% cure of stress urinary incontinence (SUI). During the procedure, hysterectomy was combined in 50.3% of cases, cervix amputation in 1.5%, and cure of SUI in 40.9%. 15.8% were treated for a cystocele only. 14.8% had only a rectocele +/, elytrocele and 69.4% had a prolapse touching both compartments, anterior and posterior. In peri-surgical complications, (2%) were five bladder wounds (0.7%), one rectal wound (0.15%) and seven hemorrhages greater that 200 mL (1%). Among early post-surgical complications (during the first month after surgery) (2.8%) were two pelvic abscesses (0.29%), 13 pelvic hematomas (1.9%), one pelvic cellulitis (0.15%), two vesicovaginal fistulas and one rectovaginal fistula (0.15%). Among late post-surgical complications (33.6%) there were 77 granulomas or prosthetic expositions (11.3% [6.7% in the vaginal anterior wall, 2.1% in the vaginal posterior wall and 4.8% in the fornix]), 80 prosthetic retractions (11.7%), 36 relapse of prolapse (6.9%) and 37 SUI de novo (5.4%). Multivaried analysis shows that previous history of hysterectomy or placing of an isolated anterior prosthesis increase the risk of peri-surgical complication; preserved uterus and isolated posterior prosthesis lessen the risk of granulomas and prosthetic retractions; and association of a Richter's intervention increases the rate of prosthetic retractions. Conclusion:, Cure of genital prolapse with synthetic prostheses interposed by vaginal route is now reliable and can be reproduced with a low rate of peri- and early post-surgical complications. However, our study shows a certain number of late post-surgical complications after insertion of strengthening synthetic vaginal implants (prosthetic expositions and prosthetic retractions). These retrospective results will soon be compared to a prospective study. [source] Different estrogen sensitivity of urogenital tissue from women with and without stress urinary incontinence,,NEUROUROLOGY AND URODYNAMICS, Issue 6 2009Lena Edwall Abstract Aims Oral hormone replacement therapy (HRT) based on estradiol-17, (E2), E2 esters or conjugated equine estrogens gives rise to huge amounts of circulating estrone (E1) as a result of the first liver pass. E1 is an estrogen (ER) receptor agonist but has also been reported to act as a partial E2 antagonist in vitro. Our aim was to investigate the influence of circulating estrogens on estrogen sensitivity of urogenital tissue collagen turnover in patients with stress urinary incontinence (SUI) and in urologically healthy women, with and without HRT, in view of possible effects of E1 as a partial E2 antagonist. Methods Markers of collagen turnover, the carboxy-terminal propeptide of type I procollagen (PICP), the carboxy-terminal telopeptide of type I collagen (ICTP) and the amino-terminal propeptide of procollagen III (PIIINP) were assayed in urogenital tissue homogenates and E1 and E2 were analyzed in serum from 54 patients with SUI and 29 urologically healthy women. Results In the total control group only a significant positive correlation was found between E2 and T-PICP. Lowering the upper serum E1 limit resulted in significant positive correlations also between E2 and T-PIIINP and finally also between E2 and T-ICTP. This pattern was found also in subgroups of post- and premenopausal controls. No association between serum E2 and collagen turnover markers and no effects of lowering the upper serum E1 limit was found in the total and postmenopausal SUI patients, while the correlation pattern in premenopausal SUI patients showed some resemblance to that in the controls. Conclusion At physiological E1 levels E2 increases collagen turnover in urogenital tissue in urologically healthy women but not in women with SUI in general; however, there was a certain effect of E2 in premenopausal but not in postmenopausal SUI patients. Urogenital tissue in SUI patients and in urologically healthy women may differ in estrogen sensitivty and in SUI patients this difference may be related to menopause. Circulating E1, which is present in huge amounts during oral HRT, may act as an estrogen receptor agonist as well as a partial E2 antagonist also in humans in vivo. Neurourol. Urodyn. 28:516,520, 2009. © 2009 Wiley-Liss, Inc. [source] Reliability of dynamometric passive properties of the pelvic floor muscles in postmenopausal women with stress urinary incontinenceNEUROUROLOGY AND URODYNAMICS, Issue 8 2008Mélanie Morin Abstract The passive properties of the pelvic floor muscles (PFM) might play a role in stress urinary incontinence (SUI) pathophysiology. Aim To investigate the test,retest reliability of the dynamometric passive properties of the PFM in postmenopausal SUI women. Methods Thirty-two SUI postmenopausal women were convened to two sessions 2 weeks apart. In each session, the measurements were repeated twice. The pelvic floor musculature was evaluated in four different conditions: (1) forces recorded at minimal aperture (initial passive resistance); (2) passive resistance at maximal aperture; (3) five lengthening and shortening cycles (Forces and passive elastic stiffness (PES) were evaluated at different vaginal apertures. Hysteresis was also calculated.); (4) Percentage of passive resistance loss after 1 min of sustained stretching was computed. The generalizability theory was used to calculate two reliability estimates, the dependability indices (,) and the standard error of measurement (SEM), for one session involving one measurement or the mean of two measurements. Results Overall, the reliability of the passive properties was good with indices of dependability of 0.75,0.93. The SEMs for forces and PES were 0.24,0.67 N and 0.03,0.10 N/mm, respectively, for mean, maximal and 20-mm apertures, representing an error between 13% and 23%. Passive forces at minimal aperture showed lower reliability (,,=,0.51,0.57) compared with other vaginal openings. The aperture at a common force of 0.5 N was the only parameter demonstrating a poor reliability (,,=,0.35). Conclusion This new approach for assessing PFM passive properties showed enough reliability for highly recommending its inclusion in the PFM assessment of SUI postmenopausal women. Neurourol. Urodynam. 27:819,825, 2008, © 2008 Wiley-Liss, Inc. [source] The correlation of voiding variables between non-instrumented uroflowmetery and pressure-flow studies in women with pelvic organ prolapseNEUROUROLOGY AND URODYNAMICS, Issue 6 2008Elizabeth Mueller Abstract Aims To (1) correlate peak and maximum flow rates from non-instrumented flow (NIF) and pressure-flow studies (PFS) in women with pelvic organ prolapse (POP); (2) measure the impact of voided volume and degree of prolapse on correlations. Methods We compared four groups of women with stages II,IV POP. Groups 1 and 2 were symptomatically stress continent women participating in the colpopexy and urinary reduction efforts (CARE) trial; during prolapse reduction before sacrocolpopexy, Group 1 (n,=,67) did not have and Group 2 (n,=,84) had urodynamic stress incontinence (USI). Group 3 (n,=,74) and Group 4 participants (n,=,73), recruited specifically for this study, had stress urinary incontinence (SUI) symptoms. Group 3 planned sacrocolpopexy. Group 4 planned a different treatment option. Participants completed standardized uroflowmetry and pressure voiding studies. Results Subjects' median age was 61 years; median parity 3% and 80% had stage III or IV POP. Based on the Blaivas,Groutz nomogram, 49% of all women were obstructed. NIF and PFS peak and average flow rates had low correlations with one another (0.31, P,<,0.001 and 0.35, P,<,0.001, respectively). When NIF and PFS voided volumes were within 25% of each other, the peak and average flow rate correlations improved (0.52, P,<,0.001 and 0.57, P,<,0.001, respectively). As vaginal prolapse increased, correlations between NIF and PFS peak and average flow rates decreased. Conclusion Peak and average flow rates are highly dependent on voided volume in women with prolapse. As the prolapse stage increases, correlations between NIF and PFS variables decrease. Neurourol. Urodynam. 27:515,521, 2008. © 2008 Wiley-Liss, Inc. [source] Are there differences between women with urge predominant and stress predominant mixed urinary incontinence?,NEUROUROLOGY AND URODYNAMICS, Issue 2 2007Jack B. Lewis Abstract Objective We sought to determine if there are differences in clinical and urodynamic parameters between women with urge predominant and those with stress predominant mixed urinary incontinence (MUI). Methods Charts of 99 female patients with complaints of MUI were reviewed. Patients were divided into two groups based on the subjective predominance of either stress incontinence (MSUI) or urge incontinence (MUUI). All patients completed a subjective evaluation including an AUA Symptom Index, Urogenital Distress Inventory (UDI-6), and Incontinence Impact Questionnaire (IIQ-7). Objective non-invasive measures included physical exam, 48-hr voiding diary, and a 24-hr pad test. Videourodynamics studies (VUDS), performed in all patients, were reviewed and the presence and characteristics of detrusor overactivity (DO) and stress incontinence were noted. Results There were no significant differences between groups with respect to symptom scores. MUUI patients had significantly higher pad usage, and lower maximum and average voided volumes than MSUI patients. They were also more likely to have lower urodynamic bladder capacities and demonstrable DO (70% vs. 26%) on VUDS with contractions occurring at lower bladder volumes and with higher amplitude. MSUI patients were more likely to have demonstrable SUI on physical examination (63% vs. 16%) and on VUDS (100% vs. 61%). Conclusions There do appear to be differences in clinical and urodynamic parameters between patients with stress predominant and urge predominant MUI. These may help to determine which component of the mixed incontinence is more problematic. Neurourol. Urodynam. 26:204,207, 2007. © 2006 Wiley-Liss, Inc. [source] Transobturator tape (TOT): Two years follow-up,NEUROUROLOGY AND URODYNAMICS, Issue 1 2007Saad Juma Abstract Aims The aim of this study is to report the functional results, patient satisfaction, and morbidity of the Transobturator tape procedure (TOT) in the treatment of stress incontinence (SUI). Methods One hundred and thirty patients were prospectively evaluated with history, physical examination, quality of life questionnaire including Incontinence Impact Questionnaire (IIQ), urogenital distress inventory (UDI), and analog global satisfaction scale (GSS), and urodynamic studies. Results One hundred and seventeen patients (90%) had history of SUI, and 78 (60%) had urge incontinence. Pads/day (PPD) used was 2.48,±,2.42, and the score of IIQ 16.13,±,7.86, UDI 10.95,±,3.4, and GSS 1.41,±,1.67. All patients underwent TOT using the ObTapeÔ. Hospital stay was 0.84,±,0.76 days and catheter duration was 1.42,±,2.08 days. At a follow-up of 16.85,±, 4.68 months, 13 patients (10%) have recurrent SUI, 21 (16.15%) persistent urge incontinence, and 1 (1.92%) de novo urge incontinence. The mean PPD is 0.15,±,0.56, IIQ 1.47,±,5.14, UDI 3.28,±,3.09, and GSS 8.29,±,1.64. Two patients (1.52%) developed urethral obstruction, five (3.84%) had vaginal extrusion of the tape, and two (1.52%) had intra-operative bladder perforation. Conclusions These results demonstrate the safety and efficacy of the TOT. The short hospitalization and catheterization, low incidence of de novo urge incontinence and obstructive voiding offers a distinct advantage over existing techniques. No significant difference in outcome between patients with VLPP ,60 cm H2O, and patients with VLPP >60 cm H2O was observed. Neurourol. Urodynam. © 2006 Wiley-Liss, Inc. [source] Presentation and management of major complications of midurethral slings: Are complications under-reported?,NEUROUROLOGY AND URODYNAMICS, Issue 1 2007Donna Y. Deng Abstract Aims Midurethral slings have become the mainstay of stress urinary incontinence (SUI) treatment due to their efficacy and low complication rates. The purpose of this study was to report the presentation and treatment of major complications from these minimally invasive treatments presented to a tertiary referral practice and to highlight a discrepancy in major complications between literature and the food and drug administration (FDA) device failure database. Methods From 2001 through 2005, we reviewed all cases of midurethral sling complications that presented to our institution. A literature review of all complications due to midurethral slings during the same time period was performed as was the FDA manufacturer and user facility device experience (MAUDE) database queried for self-reported complications. Results A total of 26 patients referred to UCLA with voiding dysfunction after sling placement was found to have mesh in the urethra or bladder. Treatments required a combination of urethrolysis with mesh removal, urethral reconstruction with graft, and bladder excision. These were compared to major complications reported in the world literature of <1%. The MAUDE database contained 161 major complications out of a total of 928 complications reported for suburethral slings. There was significantly more major complications reported in MAUDE than in published literature. Conclusions Although rare, major complications of midurethral slings are more common than appear in literature. Devastating complications involving urethral and bladder perforations can present with mild urinary symptoms and thus are likely under-diagnosed and under-reported. Most of these cases need to be managed with additional reconstructive surgery. Neurourol. Urodynam. © 2006 Wiley-Liss, Inc. [source] Analysis of outcomes of single polypropylene mesh in total pelvic floor reconstruction,NEUROUROLOGY AND URODYNAMICS, Issue 1 2007Kaytan V. Amrute Abstract Aims A 2.5-year outcome analysis was performed on patients who underwent transvaginal repair of total pelvic organ prolapse with single polypropylene mesh. A description of the repair technique using a tension-free 4-point fixation is also reviewed. Methods After proper vaginal dissection, a specially fashioned "H" shaped polypropylene mesh is positioned and fixed at 4-points. With a single piece of mesh, the anterior arms provide mid-urethral and bladder neck support, the mid-portion of the mesh corrects anterior compartment defects, and the posterior arms aid in vaginal vault suspension. Initially, bone anchors were utilized for anterior fixation, but currently a tension-free method is used. A retrospective analysis using chart review was performed on 96 patients who underwent this procedure from January 2000 to June 2005. Additional information was gathered by a telephone survey using a questionnaire. Statistical analysis was performed using Student's t -test, with Sigma Stat®. Results Seventy-six patients (79%) were available with a mean follow-up time of 30.7,±, 1.7 months and mean age of 69.3,±,11.3. Among those with follow-up, 36 patients (47.4%) underwent concurrent hysterectomies. Recurrence of prolapse was reported by four patients (5.2%). Sixty-eight patients (89%) were completely dry or almost dry, defined as an occasional leak. For those with preoperative incontinence (n,=,36), average pad use per day decreased significantly from 2.1,±,0.4 to 0.8,±,0.2 (P,<,0.005) postoperatively. Twelve patients (15.7%) reported of de novo urgency. Six patients required reoperation including excision of vaginal mesh erosion (2), uretholysis for obstruction (1), removal of palpable vaginal suture (1), and recurrent SUI (2). Among the 21 patients who are sexually active, 19 denied any dyspareunia (90.4%). Patient satisfaction was high, as the mean value was 7.9,±,0.3 on a scale of 1 (least satisfied) to 10 (most satisfied). Conclusions Transvaginal repair of complete pelvic prolapse using polypropylene mesh is a safe and efficacious option, with minimal recurrence of prolapse and SUI. While two patients had vaginal erosions, no urethral or bladder erosions occurred. Patient satisfaction was overall favorable. Neurourol. Urodynam. © 2006 Wiley-Liss, Inc. [source] The role of angiotensin II in stress urinary incontinence: A rat modelNEUROUROLOGY AND URODYNAMICS, Issue 1 2007Hardeep Phull Abstract Aims Pharmacological treatment for stress urinary incontinence (SUI) is limited to the use of non-selective alpha-agonists, which are often ineffective. Non-adrenergic mechanisms have also been implicated in urethral closure, including angiotensin II (Ang-II), which has been demonstrated throughout the urinary tract. We investigate the role of Ang-II in urethral tone in a rat model of SUI. Methods Abdominal leak point pressure (ALPP) and retrograde urethral pressure profilometry (RLPP) were measured in 70 female virgin rats. Thirty rats underwent pudendal nerve injury (PNT), 30 had circumferential urethrolysis (U-Lys), and 10 had sham surgery. Rats received daily doses of Angiotensin Type 1 (AT-1) receptor inhibitor (20 mg/kg), Angiotensin Type 2 (AT-2) receptor antagonist (10 mg/kg), or Ang-II (2 mg/kg). Results Following U-Lys, RLPP and ALPP decreased from 21.4,±,2.0 and 39.2,±,3.3 mm Hg, to 13.1,±,1.5 and 21.6,±,1.9 mmHg, respectively (P<0.01). After PNT, RLPP, and ALPP decreased from 21.0,±,1.6 and 41.9,±,3.0 mmHg to 13.1,±,1.5 and 24.7,±,3.3 mmHg, respectively (P<0.01). AT-1 inhibitor caused significant decrease in RLPP and ALPP from 21.0,±,6.2 and 41.8,±,9.4 mmHg, to 12.0,±,3.8 and 25.6,±,6.6 mmHg, respectively (P<0.01). Likewise, AT-2 treatment reduced RLPP and ALPP from 21.4,±,6.3 and 40.1,±,1.7 mmHg, to 13.5,±,5.7 and 31.0,±,7.2 mmHg, respectively (P<0.01). Following surgery, Ang-II administration restored RLPP and ALPP to baseline presurgical values. Conclusions AT-1 and AT-2 receptor inhibition significantly lowers urethral resistance, comparable to either neurogenic or urethrolytic injury. Ang-II treatment restored urethral tone in rats with intrinsic sphincter dysfunction. Ang II appears to serve a functional role in the maintenance of urethral tone and stress continence. Neurourol. Urodynam. © 2006 Wiley-Liss, Inc. [source] Does condition-specific quality of life correlate with generic health-related quality of life and objective incontinence severity in women with stress urinary incontinence?NEUROUROLOGY AND URODYNAMICS, Issue 4 2006Seung-June Oh Abstract Aims We examined the impact of stress urinary incontinence (SUI) on health-related quality of life (QOL) and evaluated the relationships between incontinence-specific QOL and objective disease severity. Methods A total of 158 women (mean age 49.9) suffering from SUI were included in the study. The Medical Outcomes Study Short Form-36 (SF-36) and the King's Health Questionnaire (KHQ) were used to assess QOL in the patient and control groups. Results The SF-36 scores did not show any significant differences between the two groups except for one domain (physical functioning, P,=,0.005). The patient KHQ scores were significantly lower than those of the controls (P,<,0.001 for all domains). The scores of the KHQ domains correlated with those of the SF-36 domains, but the relationship was low to moderate, ranging from ,0.033 to ,0.686. However, they did not correlate with Valsalva leak point pressure (VLPP). When patients were divided into the low VLPP group (n,=,60) and the higher VLPP group (n,=,98), statistically significant differences were found between the groups for general health domains of the SF-36 (P,=,0.010) and of the KHQ (P,=,0.027). No statistically significant differences were found in other domains of both questionnaires. Conclusions The generic QOL instrument is not a sensitive tool for measuring QOL in women with SUI. In addition, our findings suggest that objective disease severity is not associated with generic or incontinence-specific QOL. Neurourol. Urodynam. © 2006 Wiley-Liss, Inc. [source] Complications following surgical intervention for stress urinary incontinence: A national perspectiveNEUROUROLOGY AND URODYNAMICS, Issue 7 2005David A. Taub Abstract Aims Stress urinary incontinence (SUI) impacts many women. Treatment is primarily surgical. Post-operative morbidity considerably affects individuals and the health care system. Our objective is to describe complications following surgery for SUI and how they affect resource utilization. Methods Utilizing the Nationwide Inpatient Sample (a nationally representative dataset), 147,473 patients who underwent surgery for SUI from 1988 to 2000 were identified by ICD-9 codes. Comorbid conditions/complications were extracted using ICD-9 codes, including complication rates, length of stay (LOS), hospital charges, and discharge status. Results Overall complication rate was 13.0% (not equal to sum of complication sub-types, as each woman may have had,=,1 complication), with 2.8% bleeding, 1.4% surgical injury, 4.3% urinary/renal, 4.4% infectious, 0.1% wound, 1.1% pulmonary insufficiency, 0.5% myocardial infarction, 0.2% thromboembolic. The "gold standard" surgical technique for SUI, the pubovaginal sling, had the lowest morbidity at 12.5%. Mean LOS increased with morbidity: from 2.9 to 4.1 to 6.1 days for those with 0, 1, and =2 complications respectively (P,<,0.001). Similarly, inflation-adjusted hospital charges increased with morbidity: from $7,918 to $9,828 to $15,181 for those with 0, 1, and =2 complications respectively (P,<,0.001). The percentage of patients requiring post-discharge subacute or home care increased with morbidity: from 4.4% to 8.4% to 14.3% for those with 0, 1, and =2 complications (P,<,0.001). Conclusions A substantial percentage of women experience complications following surgery for SUI. Post-operative morbidity leads to dramatically increased resource utilization. Prospective studies are needed to identify pre-operative risk factors and intraoperative process measures to optimize the quality of care. Neurourol. Urodynam. © 2005 Wiley-Liss, Inc. [source] Relationship between urinary symptoms reported in a postal questionnaire and urodynamic diagnosisNEUROUROLOGY AND URODYNAMICS, Issue 2 2005G. Matharu Abstract Aims To describe the relationship between symptoms reported in a self-completed postal questionnaire and urinary disorders based on urodynamic investigation. Methods The study population was selected from women aged 40 years or over living in the community, who responded to a postal questionnaire. Following assessment and appropriate conservative interventions, those with a pre-defined level of severity of symptoms were offered urodynamic investigation. Logistic regression examined the association between urinary symptoms and the urodynamic diagnoses of detrusor overactivity (DO) and urodynamic stress incontinence (USI). Results Four hundred eighty-eight women completed urodynamic investigation; 29.1% (142/488) were found to have DO, 33.6% (164/488) USI, 20.7% (101/488) mixed incontinence, and 16.6% (81/488) no urodynamic abnormality. Stress incontinence (SI) and urge incontinence (UI) were included in the risk model for USI. SI reported monthly or more was associated with increased risk of USI, and UI reported weekly or more with decreased risk (sensitivity 76.9%; specificity 56.3%; positive predictive value (PPV) 67.8%). For DO, strong or overwhelming urgency, UI monthly or more, and nocturia once a night or more were all significantly associated with an increased risk while reporting of SUI monthly or more reduced the risk (sensitivity 63.1%; specificity 65.1%; PPV 63.1%). Conclusions Urinary symptoms reported in a postal questionnaire are able to predict urodynamic diagnoses with moderate accuracy. These models may be useful tools with which to categorize urinary disorders for epidemiological study and, with further development, allocate first line treatment. © 2004 Wiley-Liss, Inc. [source] Cesarean section: Does it really prevent the development of postpartum stress urinary incontinence? a prospective study of 363 women one year after their first deliveryNEUROUROLOGY AND URODYNAMICS, Issue 1 2004Asnat Groutz Abstract Aims Stress urinary incontinence (SUI) in young women is usually the result of pelvic floor injury during vaginal delivery. Whether cesarean section delivery may prevent such injury is questionable. We undertook a prospective study to compare the prevalence of SUI among primiparae 1 year after spontaneous vaginal delivery versus elective cesarean section, or cesarean section performed for obstructed labor. Methods Three hundred and sixty-three consecutive primiparae were recruited immediately after delivery and were followed for 1 year. Women were asked upon recruitment whether they had ever experienced SUI before pregnancy. Those who had SUI before pregnancy were excluded. Thus, only cases of de novo childbirth-associated SUI were analyzed. Patients were divided into three subgroups according to the mode of delivery: spontaneous vaginal delivery (n,=,145), elective cesarean section (n,=,118), and cesarean section performed for obstructed labor (n,=,100). Patients who underwent elective cesarean section were not given a trial of labor. Cesarean sections for obstructed labor were performed at a mean cervical dilatation of 8.7,±,1.6 cm and arrest of 184,±,24 min. Prevalence, frequency, and severity of postpartum SUI, as well as demographic and obstetric parameters, were analyzed in each subgroup. Results The three subgroups were comparable with respect to maternal age, weight, and height. Prevalence of postpartum SUI was similar after spontaneous vaginal delivery (10.3%) and cesarean section performed for obstructed labor (12%). However, SUI was significantly less common following elective cesarean section with no trial of labor (3.4%, P,<,0.05). Approximately half of the symptomatic patients in each subgroup reported either moderate or severe symptoms, however, only 15,18% expressed their desire for further evaluation. Conclusions Prevalence of postpartum SUI is similar following spontaneous vaginal delivery and cesarean section performed for obstructed labor. It is quite possible that pelvic floor injury in such cases is already too extensive to be prevented by surgical intervention. Conversely, elective cesarean section, with no trial of labor, was found to be associated with a significantly lower prevalence of postpartum SUI. Whether the prevention of pelvic floor injury should be an indication for elective cesarean section is yet to be established. Neurourol. Urodynam. 23:2,6, 2004. © 2003 Wiley-Liss, Inc. [source] Short-term Impact of Tension-free Vaginal Tape Obturator Procedure on Sexual Function in Women with Stress Urinary IncontinenceTHE JOURNAL OF SEXUAL MEDICINE, Issue 4pt1 2010Hui-Hsuan Lau MD ABSTRACT Introduction., The tension-free vaginal tape obturator (TVT-O) procedure is one of the most commonly used anti-incontinence surgeries, but little is known about its impact on sexual function. Aim., To evaluate sexual function after the TVT-O procedure at 6 months postoperatively. Methods., Fifty-six sexually active women who underwent the TVT-O procedure for severe stress urinary incontinence (SUI) were evaluated using the short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) before and 6 months after surgery. The perception of incontinence-related quality-of-life were also evaluated by the short form of the Urogenital Distress Inventory (UDI-6) and the Incontinence Impact Questionnaire (IIQ-7) to assess the effect of surgery on incontinence. Main Outcome Measures., Total score and score for each PISQ-12 item. Results., The mean total PISQ-12 score did not differ significantly before (24.0 ± 12.2) and after (23.0 ± 13.2) (P = 0.194) the TVT-O procedure. Scores for individual items on the PISQ-12 varied, with incontinence-related items improving but others, such as the frequency of achieving orgasm deteriorating for some women. The scores of UDI-6 and IIQ-7 were significantly improved by 6-month follow-up, indicating that the operation successfully resolved the incontinence. Conclusion., Despite successful amelioration of SUI by the TVT-O procedure, sexual function does not necessarily improve in the first 6 months after surgery. Lau H-H, Su T-H, Su C-H, Lee M-Y, and Sun FJ. Short-term Impact of tension-free vaginal tape obturator procedure on sexual function in women with stress urinary incontinence. J Sex Med 2010;7:1578,1584. [source] Long-term outcomes of patients who failed to attend following midurethral sling surgery , A comparative study and analysis of risk factors for non-attendanceAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 2 2010Kobi STAV Background and aims:, To assess long-term subjective cure and subjective complication rates of women who underwent midurethral sling (MUS) for stress urinary incontinence (SUI) in those who failed to attend (FTA) versus those who attended for postoperative follow-up. Predictive factors for non-attendance were identified. Methods:, A total of 1225 consecutive women with urodynamic SUI had a synthetic MUS at our institution between 1999 and 2007. Patients were interviewed via phone call with a structured questionnaire. Comparison between FTA and non-FTA patients was performed and multivariate analysis was utilised to identify risk factors for non-attendance. Results:, Univariate analysis revealed that the FTA rate was lower in patients who underwent concomitant prolapse surgery (29% vs. 84%, P < 0.001), FTA patients were younger (mean age 56 vs. 67 years, P < 0.001) and more depressed (14% vs. 4%, P < 0.05). At a mean follow-up of 50 ± 24 months, the subjective cure rate was similar between the two groups (84% vs. 86%, NS). The incidence of overactive bladder symptoms was significantly higher in the non-FTA patients (34% vs. 6%P < 0.001). Isolated sling procedure (OR = 2.71, P < 0.01) and age <50 years (OR = 3.15, P < 0.05) were significant predictors for failed attendance. Conclusions:, Our results indicate that the subjective cure rate is similar between non-FTA and FTA patients subsequent to a MUS procedure. However, the rate of overactive bladder symptoms is higher in the non-FTA patients. Isolated MUS procedure and younger age are significant risk factors of failure to attend in the longer term. [source] Comparison of TVT and TVT-O in patients with stress urinary incontinence: Short-term cure rates and factors influencing the outcome.AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 1 2009A prospective randomised study Background: Recently, mid-urethral slings have been commonly used in treatment of patients with stress urinary incontinence (SUI). Aims: To investigate tension-free vaginal tape (TVT) and tension-free obturator tape (TVT-O) for surgical treatment of SUI for cure rates (primary endpoint), complications and factors influencing cure rate (secondary endpoints). Methods: One-hundred and sixty-four patients were included in the study (n = 81 for TVT, n = 83 for TVT-O). The cure rates, complications, preoperative and postoperative urodynamic evaluation, Q-tip test, the Turkish version of Incontinence Impact Questionnaire (IIQ-7) and Urogenital Distress Inventory (UDI-6) scores were recorded. At three and 12 months, the patients were evaluated regarding outcome measures. Results: The cure rates were similar in TVT and TVT-O groups, 88.9% versus 86.7% respectively. Mean operative time was significantly shorter in TVT-O group (P = 0.001). The cure rate was significantly higher in both groups in patients with urethral hypermobility when compared with those with no hypermobility (P = 0.001). Conclusions: The TVT and TVT-O procedures appear to be equally effective for the treatment of SUI. Also, urethral hypermobility seems to be a factor influencing cure rate of mid-urethral slings. [source] A randomised trial of a retropubic tension-free vaginal tape versus a mini-sling for stress incontinenceBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 6 2010M Basu Please cite this paper as: Basu M, Duckett J. A randomised trial of a retropubic tension-free vaginal tape versus a mini-sling for stress incontinence. BJOG 2010; DOI: 10.1111/j.1471-0528.2010.02513.x. Objective, To compare a mini-sling with a retropubic tension-free vaginal tape (TVT) in the treatment of stress urinary incontinence (SUI) and urodynamic stress incontinence (USI). Design, Randomised trial. Setting, Urogynaecology unit in large UK district general hospital. Population, Women with USI resistant to conservative management and requiring a suburethral sling. Methods, A total of 71 women with SUI and confirmed USI were randomised to undergo treatment with either a retropubic TVT or mini-sling. Follow-up was at 6 weeks, with a history, examination and quality of life questionnaire, and at 6 months with further subjective evaluation and twin-channel subtraction cystometry and pressure-flow studies. Main outcome measures, The presence of SUI at 6 weeks and 6 months after treatment. Results, The mini-sling was associated with a significantly higher rate of persistent SUI at 6 weeks (OR 9.49, 95% CI 2.8,32.6) and 6 months (OR 8.14, 95% CI 2.7,24.7), and of USI at 6 months (OR 7.58, 95% CI 2.7,24.7). The rate of complication was similar in the two groups. Conclusions, The mini-sling is associated with a higher failure rate than a retropubic TVT. Longer term and multicentre outcome data are necessary to explore these findings further. Until this is available, the mini-sling should be used with caution. [source] Long-term outcome of tension-free vaginal tape for treating stress incontinence in women with neuropathic bladdersBJU INTERNATIONAL, Issue 6 2010Ahmad Abdul-Rahman Study Type , Therapy (case series) Level of Evidence 4 OBJECTIVE To evaluate the long-term safety and efficacy of the tension-free vaginal tape (TVT) for the treatment of stress urinary incontinence (SUI) in women with neuropathic bladder dysfunction. PATIENTS AND METHODS Twelve women (mean age 53.3 years, range 41,80) with neuropathic bladder dysfunction and SUI confirmed by video-cystometrography (VCMG) were treated with a TVT in one institution by an expert neuro-urologist between November 1997 and December 2000. The patient's notes, clinical annual follow-up and VCMG after the procedure, and the incontinence impact questionnaire (IIQ) forms (Urinary Distress Inventory, and IIQ-7) were assessed during the long-term clinical follow-up for SUI, in addition to a health-related quality of life assessment. The cure of SUI was defined as no loss of urine on physical exercise, confirmed VCMG after the procedure, and by clinical assessment. RESULTS The mean (range) follow-up was 10 (8.5,12) years. Nine patients were using clean intermittent self-catheterization before the insertion of TVT and continued to do so afterward. At 10 years of follow-up, one patient had died (with failed TVT initially), and two were lost to follow-up at 5 years after surgery, but up to 5 years they did not complain of UI and VCMG did not show SUI. The remaining seven of the nine patients were completely dry, and two improved and were satisfied with using one or two pads/day. Two patients showed neurogenic detrusor overactivity confirmed on VCMG, with no evidence of SUI. One patient needed a transient urethral catheter for urinary retention after surgery, one had a bladder injury that required leaving the catheter for 5 days, but no urethral erosions were reported during the follow-up. CONCLUSIONS In women with neuropathic bladder dysfunction secondary to a variety of spinal cord pathologies, and who have SUI necessitating a definitive intervention, insertion of TVT should be considered a desirable treatment, with very good long-term outcomes. [source] Intermediate-term results, up to 4 years, of a bone-anchored male perineal sling for treating male stress urinary incontinence after prostate surgeryBJU INTERNATIONAL, Issue 4 2009Miguel Guimarães OBJECTIVE To examine the intermediate-term outcome (up to 4 years) of a bone-anchored perineal sling (InVanceTM, American Medical Systems, Minnetonka, MN, USA) in men with stress urinary incontinence (SUI) after prostate surgery. PATIENTS AND METHODS In all, 62 men with SUI were implanted with the InVance sling. SUI was diagnosed after radical prostatectomy in 58 patients and after benign prostatic hyperplasia (BPH) prostatectomy in four patients. Implantation of the InVance bone-anchored bulbourethral sling was conducted primarily under spinal anaesthesia. Patients were considered cured, if they stopped wearing continence pads and improved if the daily number of pads used decreased by at least half. The Incontinence Quality of Life questionnaire and a simple verbal question about patient satisfaction with the surgery were also used and complications were measured. RESULTS In all, 40 patients (65%) were cured and 14 (23%) were improved after a mean follow-up of 28 months. The UI cure rates at 3 and 4 years follow-up were 70% and 66%, respectively. The most common side-effect was transient scrotal or perineal pain or numbness, which affected 12 patients (19%). There was a prolonged postvoid residual urine volume of >100 mL in six patients (10%), which resolved within 2 weeks of indwelling catheterization. Explantation of the sling was required in two cases (3%) because of infection. In one patient (2%), revision was required for bone-anchor dislodgement. CONCLUSION The InVance sling offers good intermediate-term cure and improvement rates for SUI after prostatectomy. The procedure has an acceptably low rate of minor complications, and should be considered for treating men with less severe forms (,5 pads per day) of SUI. [source] Urinary nerve growth factor level could be a biomarker in the differential diagnosis of mixed urinary incontinence in womenBJU INTERNATIONAL, Issue 10 2008Hsin-Tzu Liu OBJECTIVES To measure urinary nerve growth factor (NGF) levels in women with stress urinary incontinence (SUI) and overactive bladder symptoms (OAB) and to assess whether urinary NGF levels can be a biomarker of detrusor overactivity (DO) in women with mixed urinary incontinence. PATIENTS, SUBJECTS AND METHODS Urinary NGF levels were measured in 38 women with urodynamic SUI (USI) with OAB, in 26 with urodynamic DO but no SUI, in 21 with persistent USI after anti-incontinence surgery, in 15 with de novo DO, and in 31 normal control subjects. All participants had a video-urodynamic study for the differential diagnosis of the underlying causes of UI. Urinary NGF levels were measured using an enzyme-linked immunosorbent assay and were compared among all subgroups, and corrected using urinary creatinine (Cr) levels. RESULTS The mean (sem) urinary NGF/Cr levels were low both in controls, at 0.06 (0.004) and in women with pure USI, at 0.056 (0.037) (P = 0.108). The NGF/Cr levels were significantly higher in women with mixed USI and DO, at 1.00 (0.244), than in controls (P < 0.001) and those with pure USI (P = 0.006), but were similar to the levels in women with pure DO, at 0.58 (0.17) (P = 0.058). The NGF/Cr levels were undetectable in women with persistent USI but were significantly higher in those with de novo DO, at 2.39 (0.90), after anti-incontinence surgery than in controls and those with USI. A urinary NGF/Cr level of >0.05 was found in 9% of women with USI, 77% with DO, 81% with mixed USI and DO, and 80% with de novo DO. CONCLUSION The urinary NGF level could be a potential biomarker of DO in women with mixed UI. [source] Angiogenic gene modification of skeletal muscle cells to compensate for ageing-induced decline in bioengineered functional muscle tissueBJU INTERNATIONAL, Issue 7 2008Dawn M. Delo OBJECTIVE To explore the effects of ageing on the viability of bioengineered striated muscle tissue in vivo, and if this viability can be enhanced by concurrent neovascularization, as its utility for the treatment of stress urinary incontinence (SUI) might be reduced if muscle cells are derived from old patients. MATERIALS AND METHODS Myoblasts were obtained and expanded in culture from young (2 weeks), mature (3 months) and old (24 months) mice, and were engineered to express vascular endothelial growth factor (VEGF) to stimulate neovascularization. Myoblasts were injected subcutaneously into male nude mice and after 2 and 4 weeks, the engineered muscle tissues were harvested. RESULTS Bioengineered muscle tissues were formed in all groups, but the engineered muscles formed by myoblasts from old mice were smaller and less contractile. However, the bioengineered muscles expressing VEGF had a greater mass and better contractility in all age groups. CONCLUSION This pilot study showed that there was an age-related decline in the size and function of bioengineered muscle; however, there was an improvement in volume and function when the muscle cells were expressing VEGF. [source] | ||||||||||||||||||||||||||||||||||