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Voiding Diary (voiding + diary)
Selected AbstractsThe relationship between subjective and objective assessments of sacral neuromodulation effectiveness in patients with urgency-frequency,NEUROUROLOGY AND URODYNAMICS, Issue 8 2008Kenneth M. Peters Abstract Aims Global response assessment (GRA) has been used to evaluate patients' perceptions of treatment effectiveness. However, few studies have scrutinized the relationship between GRAs and objective voiding diary outcomes data. This study explores the relationship between self-reported symptom-specific GRA responses and objective changes in frequency, urgency and pelvic pain in patients with urgency-frequency with or without pelvic pain after implantation of a prosthetic sacral nerve stimulation device. Methods Patients scheduled for a staged procedure were enrolled in a prospective, observational, longitudinal study. Post implantation, patietns were grouped into "responders" or "non-responders" based on their answers to symptom-specific GRAs at three and six months. Treatment responders were defined as those reporting "moderately" or "markedly improved" on a 7-point scale, and all others were considered non-responders. Pre- and post-implant changes in mean 24-hour voiding frequency, voided volume, urgency and pelvic pain scores as recorded on voiding diaries were compared between groups using paired t-test. Results At three months, responders demonstrated corresponding statistically significant improvement in voiding frequency (P,<,0.001), average voided volume (P,=,0.003), urgency (P,=,0.022) and pelvic pain (P,=,0.039). At six months, responders demonstrated statistically significant improvements in frequency (P,=,0.025) and urgency (P,=,0.006). None of the symptom changes were statistically significant in treatment non-responders. Conclusions The GRA non-responders groups' perceptions of treatment response agreed with their objective changes in bothersome symptoms and responders' changes agreed with their perception of improvement in the majority of symptoms. Further study is needed to standardize the GRA, and explore its potential for use in clinical practice. Neurourol. Urodynam. 27:775,778, 2008, © 2008 Wiley-Liss, Inc. [source] Sacral nerve stimulation for voiding dysfunction: One institution's 11-year experience,NEUROUROLOGY AND URODYNAMICS, Issue 1 2007Suzette E. Sutherland Abstract Aim The purpose of this study was to review our institution's 11-year experience with SNS for the treatment of refractory voiding dysfunction. Dating back to 1993, it covers a span of time which describes the evolution of SNS as it includes PNE trials, non-tined (bone-anchored or fascial-anchored) leads, percutaneous tined leads with two-staged procedures, and even percutaneous pudendal trials. Methods A retrospective review was performed on SNS patients who received an implantable pulse generator (IPG) in our practice from 12/1993 to 12/2004. After Institutional Review Board approval, consents for chart review were obtained from 104 patients, representing 44% of this neuromodulatory patient population. Results Of our population, 87% were female and 13% were male. Average age at implant was 50 years,±,13.4 years. Duration of symptoms before implantation was 116 months (range 9,600 months). Eighty percent were implanted for a predominant complaint of urinary urgency and frequency (U/F). Overall, 22% had U/F only, 38% had concomitant urge incontinence (UI), and 20% had concomitant mixed incontinence (MI). Twenty percent were treated for non-obstructive urinary retention (UR), with half of these associated with a neurogenic etiology. Additionally, 46.2% had pelvic pain, 58.6% had bowel complaints, and 51% reported sexual dysfunction. In patients with U/F, mean voiding parameters as described by pre-implant voiding diaries revealed the following: 12.4 (±5.1) voids per 24 hr; 2.3 (±1.8) voids per night; 5.0 (±4.7) leaks per 24 hr; and 2.3 (±2.6) pads per 24 hr. Statistically significant improvements post-implantation were noted with mean decreases in the following: 4.3 voids per 24 hr; 1.0 void per night; 4.4 leaks per 24 hr; and 2.3 pads per 24 hr (all P,<,0.05). In the UR group a statistically significant improvement post-implantation was noted only in voids per night, with a mean decrease of 0.8 (P,<,0.05). With a mean follow up of 22 months (range 3,162 months), sustained subjective improvement was >50%, >80%, and >90% in 69%, 50%, and 35% of patients, respectively. By quality of life survey, 60.5% of patients were satisfied and 16.1% were dissatisfied with current urinary symptoms. Only 13% (14 patients) abandoned therapy, making up a significant portion of those dissatisfied with current urinary symptoms. Good overall lead durability was seen (mean 22 months, range 1,121 months), with the first successful lead proving to be the most durable (mean 28 months, range 1.4,120 months). Lead durability decreased progressively with subsequent trials. Overall, 53% of patients experienced at least one reportable event (RE) attributable to either lead or IPG. A total of 126 REs were noted, with 97% mild-to-moderate in severity. REs included lack of efficacy, loss of efficacy, infection, hematoma/seroma, migration, pain, undesirable change in sensation, and device malfunction. In this population, 47.1% of leads were tined while 52.9% were non-tined. Tined leads had an overall lower RE rate as compared to non-tined leads: 28% and 73%, respectively. Conclusions SNS is an effective method for treating certain types of voiding dysfunction. Although 53% of patients experienced at least one RE, 97% were mild-to-moderate and did not appear to affect the continued use of this therapy. With improved technology, such as percutaneous tined leads, the RE rate is decreasing. Further analyses of subsets of this population are currently underway. Neurourol. Urodynam. © 2006 Wiley-Liss, Inc. [source] ORIGINAL RESEARCH,WOMEN'S SEXUAL HEALTH: Biofeedback, Electrical Stimulation, Pelvic Floor Muscle Exercises, and Vaginal Cones: A Combined Rehabilitative Approach for Sexual Dysfunction Associated with Urinary IncontinenceTHE JOURNAL OF SEXUAL MEDICINE, Issue 6 2009Massimo Rivalta MD ABSTRACT Introduction., Urinary incontinence (UI) is often associated with sexual dysfunction. We present our preliminary experience with a combined rehabilitative approach consisting of biofeedback, functional electrical stimulation, pelvic floor muscle exercises, and vaginal cones. Aim., The potential impact of such practice on UI and sexual function was analyzed in our case series and discussed. Main Outcome Measures and Methods., We evaluated three women affected by UI and sexual dysfunction. The patients underwent combined pelvic floor rehabilitation (PFR), kept voiding diaries, and filled out the Female Sexual Function Index (FSFI questionnaire) before and after the completion of PFR. We evaluated each domain score, including desire, arousal, lubrication, orgasm, satisfaction, and pain. Results., After the combined rehabilitation program, none of them had UI requiring pad use or referred urine leakage during sexual activity, including intercourse. Before PFR, FSFI score ranged from 16 to 21; after treatment, the FSFI score ranged from 22.1 to 29.3. There was an improvement in patients regarding desire, arousal, lubrication, orgasm, satisfaction, and pain. Conclusions., A complete rehabilitation can provide a beneficial effect on sexual function. A larger trial, on a more extended female population, is currently in progress, in order to confirm our findings. The effectiveness of a complete PFR scheme, together with the lack of side effects, makes it a suitable approach to sexual dysfunction that is associated with UI. Rivalta M, Sighinolfi MC, De Stefani S, Micali S, Mofferdin A, Grande M, and Bianchi G. Biofeedback, electrical stimulation, pelvic floor muscle exercises, and vaginal cones: A combined rehabilitative approach for sexual dysfunction associated with urinary incontinence. J Sex Med 2009;6:1674,1677. [source] Long-term efficacy and safety results of the two-stage implantation technique in sacral neuromodulationBJU INTERNATIONAL, Issue 9 2002W.A. Scheepens Objective ,To assess the long-term efficacy and safety of two-stage sacral neuromodulation with an implantable pulse generator (IPG) in patients treated for urinary urge incontinence (UI) and/or urinary retention (UR). Patients and methods ,The two-stage technique is used if patients have a good response during the acute phase of the percutaneous nerve evaluation (PNE) test, but have a poor response during the following 4,7 days (subchronic phase). In the first stage only the permanent electrode was implanted and connected to a temporary external stimulator, allowing patients to be assessed for longer. If the main symptoms improved by more than half the patient proceeded to the second stage, the insertion of the IPG. We reviewed all patients who underwent two-stage implantation; all had signed an informed consent and were asked to complete voiding diaries and a questionnaire to assess the subjective effects of the therapy. Safety was assessed from relevant medical events, management, and relative to the thera-py and resolution. Residual urine was assessed by self-catheterization. The long-term voiding diary results were compared with baseline estimates and analysed statistically using the two-sided Student's t -test. Results ,Between 1991 and 1998, 15 patients (13 women and two men, mean age 53 years, range 44,66) underwent the two-stage technique; the mean (median, range) follow-up was 4.9 (5.2, 2.5,7.5) years. Seven patients had UI and seven had UR, with one having both. The mean (range) number of PNEs undertaken in each patient was 2.1 (1,4) and these all failed in the subchronic phase. All patients underwent a first- and second-stage implant after a mean (range) screening period of 12.2 (2,29) days. One patient was explanted after implantation of only the first stage, and two others explanted in a later phase because the IPG was ineffective during the follow-up. The voiding diary results of the remaining 12 patients showed improvement in all the main variables, and in the subjective assessment 11 reported an improvement and were satisfied with the therapy. There were 17 adverse events, 14 of which were resolved and seven of which required surgical intervention. Conclusion ,The long-term results of the two-stage implantation show clinically and statistically significant improvements, probably because the implantation of the lead (first stage) more closely resembles the final therapy. If a temporary PNE test is not optimal (lead migration, longer testing needed), the two-stage technique can offer a good and safe alternative of comparable efficacy in the long-term. If the two-stage technique had not been available to these 12 patients they would not have been offered neuromodulation. [source] Urodynamics, the supine empty bladder stress test, and incontinence severity,,§NEUROUROLOGY AND URODYNAMICS, Issue 7 2010Charles W. Nager Abstract Aims Determine whether urodynamic measures of urethral function [(valsalva leak point pressure (VLPP), maximum urethral closure pressure (MUCP), functional urethral length (FUL)] and the results of the supine empty bladder stress test (SEBST) correlate with each other and with subjective and objective measures of urinary incontinence (UI). Methods Data were collected preoperatively from subjects enrolled in a multicenter surgical trial of mid-urethral slings. Subjective measures included questionnaire scores from the Medical Epidemiological and Social Aspects of Aging Questionnaire, Urogenital Distress Inventory, and Incontinence Impact Questionnaire. Objective measures included a 24-hr pad weight test, incontinence episode frequency on a 3-day voiding diary, and a SEBST. Results Five hundred ninety-seven women enrolled. Three hundred seventy-two women had valid VLPP values; 539 had valid MUCP/FUL values. Subjective measures of severity had weak to moderate correlation with each other (r,=,0.25,0.43) and with objective measures of severity (r,=,,0.06 to 0.45). VLPP and MUCP had moderate correlation with each other (r,=,0.36, ,<,0.001). Urodynamic measures of urethral function had little or no correlation with subjective or objective measures of severity. Subjects with a positive SEBST had more subjective and objective severity measures compared to the negative SEBST group, but they did not have significantly different VLPP and MUCP values. Conclusions VLPP and MUCP have moderate correlation with each other, but each had little or no correlation with subjective or objective measures of severity or with the results of the SEBST. This data suggests that the urodynamic measures of urethral function are not related to subjective or objective measures of UI severity. Neurourol. Urodynam. 29:1306,1311, 2010. © 2010 Wiley-Liss, Inc. [source] Post void dribbling: Incidence and risk factors,NEUROUROLOGY AND URODYNAMICS, Issue 3 2010Tova Ablove Abstract Aims The primary aim of this study was to determine the incidence of post void dribbling (PVD) in women being evaluated for pelvic floor dysfunction. The secondary aim was to identify other conditions present in women with symptoms of PVD. Materials and Methods 163 consecutive women with complaints of PVD who underwent urodynamic testing were studied. Testing was performed to evaluate women scheduled for surgery for incontinence, irritative bladder, urinary retention and pelvic organ prolapse. Subjects completed a medical history and voiding diary. A complete pelvic exam was performed. Patients were questioned regarding symptoms of PVD, stress incontinence, urge incontinence and insensible urine loss. Menopausal status, hormone replacement therapy status, age, body mass index, residual urine volume, genital hiatus length, and evidence of pelvic organ prolapse were recorded. Maximal urethral closure pressure, urethral length, pressure transmission ratio, and documentation of detrusor overactivity or urodynamic stress incontinence were determined by urodynamic testing. Results 42% of patients had symptoms of PVD. The incidence of PVD decreased with age. In pre- and peri-menopausal women, there was an association between PVD and urge incontinence. In post-menopausal women, there was an association between age, body mass index, and genital hiatus length. Conclusions There was a significant correlation between PVD and urge incontinence in pre-menopausal patients. The overall incidence and causes of PVD relative to age require further study. Body mass index and genital hiatus length may play an important role in PVD, especially in post-menopausal women. Neurourol. Urodynam. 29:432,436, 2010. © 2009 Wiley-Liss, Inc. [source] Nocturia: An austrian study on the multifactorial etiology of this symptom,,NEUROUROLOGY AND URODYNAMICS, Issue 5 2009H. Christoph Klingler Abstract Aims To identify the different factors contributing to nocturia in a clinical setting. Patients and Methods Three hundred twenty-four patients (133 women, 191 men; mean age 63 years) were entered into this multi-institutional study. When presenting with nocturia we obtained detailed medical history and performed urine analysis, post-void residual volume and renal ultrasonography. Bothersome score and quality of life were evaluated using visual analogue scale and Kings' Health Questionnaire (KHQ), respectively. Patients were asked to complete a 48-hr voiding diary (VD). Nocturia and its associated problems were evaluated using KHQ and VD in conjunction with concurrent health variables. Results Mean nocturia was 2.8 in men versus in 3.1 women. Fifty percent of patients were aged >65 years, 60% had daytime lower urinary tract symptoms (LUTS) as well as nocturia, 33% had cardiac pathologies and 7% had peripheral edema. Principal causes for nocturia were global polyuria in 17%, nocturnal polyuria (NP) in 33% and reduced functional capacity <250 ml in 16.2%; 21.2% had mixed forms of NP and reduced bladder capacity and 12.6% suffered from other causes. Mean bothersome score was higher in women (P,<,0.001) and in patients with NP (P,=,0.012). Quality of life was significantly lower in women (P,=,0.001), in patients aged >65 years (P,=,0.029) and in those with reduced functional capacity (P,<,0.001). Mean voided 24-hr urine was higher in women (P,=,0.033) and in patients aged <65 years (P,=,0.019). Conclusions Nocturia had a high impact on bothersome score, strong associations with poor health and other LUTS. NP was the predominant cause of nocturia. Neurourol. Urodynam. 28:427,431, 2009. © 2009 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] The pathophysiology of lower urinary tract symptoms after brachytherapy for prostate cancerBJU INTERNATIONAL, Issue 6 2006Jerry G. Blaivas Brachytherapy for prostate cancer has many good effects, but is also associated, like every treatment, with side-effects, some of which have been previously reported in the BJU International. In this section, authors from New York assessed the pathophysiology underlying LUTS which persisted for at least 6 months after brachytherapy, and found a relatively high incidence of detrusor overactivity and other conditions affecting the lower urinary tract. OBJECTIVES To determine the spectrum of pathophysiology underlying the lower urinary tract symptoms (LUTS) persisting for ,,6 months after brachytherapy for localized prostate cancer. PATIENTS AND METHODS A database of men from two practice settings was searched for men who developed LUTS persisting for ,,6 months after completing brachytherapy for localized prostate cancer. Patients were evaluated with a structured history and physical examination, International Prostate Symptom Score (IPSS), 24-h voiding diary, noninvasive free-flow uroflowmetry, postvoid residual urine volume (PVR), cystoscopy and a video-urodynamic study. Specific data collected included symptoms, elapsed time since brachytherapy, Gleason score, IPSS, total number of voids/24 h, maximum voided volume, cystoscopic findings, and urodynamics findings (PVR, maximum urinary flow rate, Schaefer obstruction grade, Watts factor, incidence of detrusor overactivity (DO) urethral obstruction and low bladder compliance). These data were compared with those from a previous study of men with LUTS who did not have prostate cancer. RESULTS The study included 47 men (aged 54,88 years); the median (range) interval between brachytherapy and evaluation was 1.5 (0.5,13) years. Thirty-seven men complained of overactive bladder symptoms (79%), and 31 of incontinence (71%), 21 of obstructive symptoms (44%), and persistent dysuria in 12 (26%). Comparison of urodynamic findings in men with unselected causes of LUTS vs LUTS due to brachytherapy revealed the following comparisons: DO in 252 of 541 (47%) unselected vs 28 of 33 (85%) brachytherapy, (P < 0.001); and urethral obstruction in 374 of 541 (69%) unselected vs 24 of 33 (73%) brachytherapy (P = 0.85). CONCLUSION The pathophysiology and severity of persistent LUTS in men after brachytherapy differs from that of men with LUTS in the general population. Men after brachytherapy have a much higher incidence of DO, prostatic and urethral strictures and prostatic urethral stones. [source] Myogenic bladder decompensation in boys with a history of posterior urethral valves is caused by secondary bladder neck obstruction?BJU INTERNATIONAL, Issue 1 2005Philippos A. Androulakakis OBJECTIVE To investigate whether myogenic bladder decompensation in patients treated for congenital posterior urethral valves (PUV, the most serious cause of infravesical obstruction in male neonates and infants) may be secondary to bladder neck obstruction, as despite prompt ablation of PUV these patients can have dysfunctional voiding during later childhood or adolescence, the so-called ,valve bladder syndrome'. PATIENTS AND METHODS The study comprised 18 boys (mean age 14 years, range 6.2,18.5) who had had successful transurethral ablation of PUV between 1982 and 1996, and had completed a follow-up which included serial assessment of serum creatinine, completion of a standard voiding diary, ultrasonography with measurement of urine before and after voiding, a urodynamic examination with simultaneous multichannel recording of pressure, volume and flow relationships during the filling and voiding phases, coupled with video-cystoscopy at least twice. The mean (range) follow-up was 9.3 (6,17) years. RESULTS Urodynamic investigation showed myogenic failure with inadequate bladder emptying in 10 patients; five with myogenic failure also had unstable bladder contractions. On video-cystoscopy the posterior bladder neck lip appeared elevated in all patients but in those with myogenic failure it was strongly suggestive of hypertrophy, with evidence of obstruction. At the last follow-up one patient with myogenic failure who had had bladder neck incision and four others who were being treated with ,-adrenergic antagonists had a significant reduction of their postvoid residual urine. CONCLUSION Despite early valve ablation, a large proportion of boys treated for PUV have gradual detrusor decompensation, which may be caused by secondary bladder neck obstruction leading to obstructive voiding and finally detrusor failure. Surgical or pharmacological intervention to improve bladder neck obstruction may possibly avert this course, but further studies are needed to validate this hypothesis. [source] Posterior tibial nerve stimulation in patients with intractable interstitial cystitisBJU INTERNATIONAL, Issue 1 2004Jimao Zhao OBJECTIVE To evaluate the efficacy of intermittent percutaneous posterior tibial nerve stimulation (PPTNS) in patients with refractory interstitial cystitis. PATIENTS AND METHODS One man and 13 women (mean age 58.3 years) with suprapubic or perineal pain were enrolled in a prospective open study, in which they had 10 weekly sessions of PPTNS. Their mean duration of symptoms was 8.3 years. All patients were previously diagnosed as having interstitial cystitis according to the National Institute of Diabetes and Digestive and Kidney Diseases criteria. The response to the treatment were assessed using voiding diary, visual analogue scale diary for a pain index, and the Interstitial Cystitis Problem Index (ICPI), O'Leary/Sant Interstitial Cystitis Symptom Index (ICSI) and the 36-item short-form health survey (SF-36) quality-of-life questionnaire. RESULTS Of the 14 patients, 13 completed the 10 weeks of treatment with no complications; 12 continued treatment for a short period after the study. There were no statistically significant changes in pain scores, voiding frequency and volumes, or in the ICPI, ICSI and SF-36 scores. However, there was an improvement in some patients, with one having complete resolution of the pain. CONCLUSION Intermittent PPTNS in patients with refractory interstitial cystitis has no significant clinical effect over 10 weeks of treatment. [source] Transvaginal electrical stimulation in the treatment of urinary incontinenceBJU INTERNATIONAL, Issue 3 2004J.C.V. Barroso OBJECTIVE To determine the effectiveness of transvaginal electrical stimulation (TES) in treating urinary incontinence, and to assess the clinical improvement 6 months after ending the treatment. PATIENTS AND METHODS In a double-blind randomized controlled clinical trial, 36 women (24 patients and 12 controls) with stress, urge or mixed urinary incontinence were chosen to use TES or placebo (identical equipment but with no electrical current). The patients had their treatment at home twice a day (20-min sessions) for 12 weeks. They completed a voiding diary and had a urodynamic study at the beginning and end of treatment. They were clinically re-evaluated after 6 months. RESULTS The mean time of use of TES was similar in both groups (, 40 h); the treatment group had a significant increase in maximum bladder capacity (P < 0.02), a significant reduction in the total number of voids (over 24 h; P < 0.02), in the number of episodes of voiding urgency (P < 0.001) and, importantly, in the number of episodes of urinary incontinence (P < 0.001). At the first evaluation, after ending the treatment, 88% of the patients had a significant reduction in symptoms or went into remission. At the 6-month re-evaluation, a third of the patients required another therapeutic approach. CONCLUSION TES is a practical alternative with few side-effects, and is effective for treating the main forms of female urinary incontinence. [source] A new intravaginal device for stress incontinence in womenBJU INTERNATIONAL, Issue 9 2001H. Thyssen Objective To compare two versions of the same type of disposable intravaginal device (the Conveen Continence Guard, CCG, and the Contrelle Continence Tampon, CCT, Coloplast a/s, Humlebæk, Denmark) for treating stress incontinence in women. Patients and methods Women with the predominant symptom of stress incontinence were recruited from four centres in Denmark, Australia and the UK. The women were assessed using a 24-h pad-test, uroflowmetry, postvoid residual urine volume and a voiding diary before treatment, and after 5 weeks using each of the two devices. Vaginal swabs and specimens of urine were sent for culture, and a questionnaire about the subjective effect and adverse events completed at each visit. In all, 94 women were recruited, of whom 62 (66%) completed the study. Results Both devices reduced the amount of leakage significantly, but the CCT reduced urine loss significantly more than the CCG. Uroflowmetry values and residual urine volume were unchanged when using the two devices. Vaginal culture showed no abnormality during the study period, and only one woman was treated for a urinary tract infection. Side-effects were few and not serious. The women found both devices easy to prepare, insert and use; two-thirds preferred the CCT to the CCG. Conclusion The new intravaginal device (CCT) is more effective for treating stress incontinence than the currently available version (CCG), and patient acceptability of the new device seems to be superior. [source] The efficacy of laparoscopic mesh colposuspension: results of a prospective controlled studyBJU INTERNATIONAL, Issue 4 2001T.A. El-Toukhy Objective To investigate the efficacy of laparoscopic mesh colposuspension as an equivalent approach to the ,gold standard' open Burch colposuspension. Patients and methods A prospective controlled study of laparoscopic mesh colposuspension was conducted over 2 years; 87 patients with genuine stress incontinence (GSI) were recruited. The preoperative evaluation included a history, examination, midstream urine analysis, urinary voiding diary, a Urilos pad test, and twin-channel subtracted cystometry, including urethral profilometry and measurement of the postvoid residual volume. The study included patients who had undergone previous incontinence surgery, but those with detrusor instability or neurogenic bladder were excluded. The patients were assessed at 6 weeks, 6 months and 1 year after surgery and then yearly thereafter. The urodynamic assessment was repeated 3 months after surgery. Results Forty-nine patients underwent laparoscopic colposuspension using Prolene mesh and titanium tacks to elevate the bladder neck, while 38 patients had open Burch colposuspension. There was no difference between the groups in age, parity, body mass index, menopausal status, medical history, previous bladder neck surgery and prolapse. At 6 weeks the cure rate was similarly high in the two groups (91% laparoscopic and 94% open). After a mean follow-up of 32 months, both groups showed a decline in efficacy, which was more marked in the laparoscopic group. Cure rates were 62% for laparoscopy and 79% for open surgery, and the improvement rates were 77% and 89%, respectively (P < 0.05). Conclusion Laparoscopic colposuspension using a mesh and tacker technique reduces the technical difficulty and operating time of the endoscopic procedure, but the long-term cure rates are inferior to open Burch colposuspension. [source] | ||||||||||