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Article
POLYPROPYLENE MESH IN STRESS URINARY INCONTINENCE

Author: Liqaa R Al-Khuzaee لقاء رياض الخزرجي
Journal: IRAQI JOURNAL OF MEDICAL SCIENCES المجلة العراقية للعلوم الطبية ISSN: P16816579,E22244719 Year: 2011 Volume: 9 Issue: 4 Pages: 332-337
Publisher: Al-Nahrain University جامعة النهرين

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Abstract

BackgroundThe pubovaginal sling (PVS) is a safe and durable surgical procedure for stress urinary incontinence (SUI) of all types. Among numerous modifications of the procedure is using synthetic sling material to decrease surgical morbidity and increase long-term success.ObjectiveTo present the results of pubovaginal sling with a polypropylene mesh in women with SUI.MethodsWe studied 12 consecutive patients who underwent PVS procedure using polypropylene mesh for SUI between January 2008 and April 2009. Stress urinary incontinence was demonstrated by positive cough test, filling cystometry. Urethral hyper mobility was demonstrated with straining cotton swab (≥ 30◦), with different grades of vaginal wall prolapse. Urodynamic study was not performed. All these patients were treated with pubovaginal sling (PVS) with a low-cost polypropylene mesh confectioned by the surgeon. The sling was placed at the level of the proximal half of the urethra and tied with adequate tension, but not obstructing the bladder outlet. Postoperatively, the patients were evaluated at 6-month with a symptom questionnaire, physical examination, and postvoid residual volume determination. Demographic criteria, complications during surgery and post operative period, and subjective cure rate at three months were assessed.ResultsTwelve patients with mean age of 55.5 years and median parity of 4 years underwent bladder neck sling surgery using polypropylene mesh. Body weight range was 45-68 kg. No intraoperative or major postoperative complications were reported. Mean duration of surgery was 65.5 minutes (60-120 minutes). Concomitant procedures were performed, including cystocele repair (n= 10) rectocele repair (n=11). Mean duration of hospital stay was 2 days (1-5 days). Ten patients had complete cure of SUI, one patient had significant decrease in the severity of stress urinary incontinence. One patient had persistent SUI.ConclusionsThe construction of a pubovaginal sling using a low-cost polypropylene mesh is a safe and effective technique for the relief of SUI. It should be considered an alternative, especially in patients with weak rectus fascia.Key wordsstress urinary incontinence; pubovaginal slings; polypropylene


Article
PERINEAL ULTRASOUND FOR EVALUATING BLADDER NECK AND URETHRA IN STRESS URINARY INCONTINENCE

Authors: Liqaa R Al-Khuzaee لقاء رياض موسى الخزرجي --- Wassan IM Al-Saadi وسن ابراهيم مجيد السعدي
Journal: IRAQI JOURNAL OF MEDICAL SCIENCES المجلة العراقية للعلوم الطبية ISSN: P16816579,E22244719 Year: 2012 Volume: 10 Issue: 4 Pages: 367-374
Publisher: Al-Nahrain University جامعة النهرين

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Abstract

Background :Urinary incontinence is a silent epidemic severly affecting the quality of life of women. Urodynamic study is the gold standard investigation for assessing women with urinary incontinence. However it is invasive and unavailable in some hospitals. Ultrasound is safe, noninvasive and available in most units.Objective:To determine the role of perineal ultrasound for assessing the bladder neck mobility, pubo urethral angle and retrovesical angle during rest and straining in normal women and in those with stress urinary incontinence.Methods:Twenty patients with urodynamic stress urinary incontinence and twenty age-matched control patients were included in the study. Perineal sonography was carried out in both groups to evaluate the role of this technique in the diagnosis of stress urinary incontinence. By using the posterior edge of the symphysis pubis as a reference point, posterior urethra-vesical angle (PUVA) and the angle between the vertical axis and urethral axis (alpha angle) were measured at rest and on straining. Bladder neck mobility was evaluated only at the cephalocaudal plane by measuring the desensus diameter.Results:Posterior urethro-vesical angle (PUVA) was found to be significantly different between the study and control groups both at rest and on straining (P < 0.05). The pubo urethral angle (alpha angle) was found to be significantly different between study and control groups only on straining (P < 0.05).Cephalocaudal distance (desensus diameter) of urethra was longer in patients with stress urinary incontinence (P < 0.05).Conclusion:Perineal sonography has an important role in diagnosing patients with stress urinary incontinence.Key words:Perineal ultrasound, stress urinary incontinence, bladder neck


Article
Injectable Bulking Agents in the Treatment of Female Stress Urinary Incontinence due to Intrinsic Sphincter Deficiency

Authors: Ahmed H. Al-Shareef1 --- Yasamin Hamza Sharif Al-Shibany --- Alaq Saeed Abdulhussain
Journal: Karbala Journal of Medicine مجلة كربلاء الطبية ISSN: 19905483 Year: 2016 Volume: 9 Issue: 2 Pages: 2470-2478
Publisher: Kerbala University جامعة كربلاء

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Abstract

background and objectives: Stress urinary incontinence(SUI) has a significant impact on the quality of life for many women and it is caused by weakening of pelvic floor muscle that support the bladder and urethra. It affects (1 of 3 women) and it is often associated with childbearing and can be defined as a brief involuntary loss of urine due to increase abdominal pressure in the absence of detrusor activity.Injectable agents have been used to manage SUI for more than a decade but their application has been limited by placement, durability, antigenicity and other compatibility issues. Therefore, there is a continuous development of techniques and materials for newer bulking agents. Our study was to evaluate the efficacy and safety of the urethral injectable agent DEXELL SUI in women with stress urinary incontinence after 12 months follow up.Materials and Methods: A prospective, cohort study conducted in Iraq from January 2014 – January 2016 and data for the study was including 25 female patients (20 -52) years old with SUI due to intrinsic sphincter deficiency attending the department of Obstetrics and Gynecology, Urological department, out patients and privet clinic in Al-Diwaniya and AL-Najaf cities. All patients were treated with DEXELL SUI periurethral injection under local anesthesia. Patients were evaluated for efficacy and safety parameters at 6 weeks visit, 3 months and 12 months visit after injection.Results: The mean stamey incontinence grade significantly decreased from 1.92 at baseline visit to 0.28 at 12 months visit(P<0.001).None of the patients were dry at baseline,64% were dry at 6 week visit, 80% at 3 months visit and 72% at 12 months visit. There was significant reduction in number of pads used per 6 hours per day from 2.44 to 0.40 after 12 months visit(P<0.001). Eight patients (32%)developed minor complications related to injection procedure and all were treated successfully. Conclusion: DEXELL SUI is effective urethral bulking agents with moderate adverse effects used in the treatment of female SUI due to intrinsic sphincter deficiency with less invasive technique.


Article
Efficacy and Safety of Vaginal CO2 Laser Treatment in Female Stress Urinary Incontinence

Author: Saja Mohammed Jasim, Raed Younis Khalil Al‑Rawi1
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2018 Volume: 15 Issue: 3 Pages: 251-257
Publisher: Babylon University جامعة بابل

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Abstract

objective was to assess the efficacy and safety of vaginal Fractional CO2 laser treatment for mild‑to‑severe stages of female stress UI (SUI).Materials and Methods: A total of 60 women with a mean age of 47.6 ± 8 years suffering from SUI were included in this prospective,single‑center, nonrandomized, pilot study. Patients were clinically examined and assessed before treatment and at each follow‑up visitat 1, 3, and 6 months postvaginal fractional CO2 laser treatment by International Consultation on Incontinence Questionnaire‑UI ShortForm (ICIQ‑UI SF) questionnaire for assessing the degree of incontinence and its impact on the quality of life, Pelvic Organ Prolapse/UISexual Questionnaire (PISQ‑12) for assessing the quality of life in the area of sexuality, digital assessment of muscle strength, and Q‑tip testfor evaluating the mobility of the urethra and bladder neck. Two or three sessions of vaginal fractional CO2 laser treatment were performedfor each woman using SmartXide2 with V2LR laser. Pain during the treatment was measured at every session with a visual analog scale (VAS),any other possible adverse effect observed. Results: Significant improvement (P < 0.001) was found in ICIQ‑UI scores, PISQ‑12 scores,muscle strength, and Q‑tip angle, at all follow‑ups after treatment compared to baseline values. ICIQ‑UI scores decreased at 1, 3, and 6 monthsfollow‑ups by 6.5, 7.17, and 7.30 points, respectively (P < 0.001). PISQ‑12 scores increased at 1, 3, and 6 months follow‑ups by 6.2, 7.8, and9.1 points, respectively (P < 0.001). Muscle strength increased at 1, 3, and 6 months follow‑ups by 1, 1.5, and 2 points, respectively (P < 0.001).Q‑tip angle decreased at 1, 3, and 6 months follow‑ups by 11.7°, 18.5°, and 24.2°, respectively (P < 0.001). No adverse events were reportedby any patients during the procedure. Conclusion: This study demonstrated that vaginal Fractional CO2 laser treatment using SmartXide2 withV2LR configuration laser system is an effective and safe treatment option for patients with mild‑severe SUI.


Article
Effect of Simultaneous Cystocele Repair on Transobturator Tape Outcome in Female Patients with Pure Stress Urinary Incontinence

Author: Saad Dakhil F. Daraji*, Amina A. Al Ani**, Amina Fadhil Ridha***
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2017 Volume: 16 Issue: 4 Pages: 385-389
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Today; mid urethral slings are the first option for surgical treatment of stress urinary incontinence (SUI) due to high success rates and minimally invasive characteristics of the procedure. Concomitant prolapse surgery does not appear to have an effect on treatment outcomes according to previous studies predominantly evaluating tension-free vaginal tape (TVT) procedures.OBJECTIVE:To evaluate the efficacy of cystocele repair performed simultaneously with trans obturator tape (TOT) on the outcome of operation in patients with stress urinary incontinence (SUI) and pelvis organ prolapse (POP).PATIENTS AND METHODS:The data of patients who had SUI and cystocele were evaluated prospectively and Patients who underwent only TOT were classified as group 1 and the patients who underwent TOT simultaneously with cystocele repair (grades 1&2) were classified as group 2. The age, number of normal deliveries, number of pad used per day, cystocele grade, and duration of operation, pre- op International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) and postoperative complications were evaluated.RESULTS:It was observed that there was no significant difference between groups 1 and group 2 in terms of preoperative International Consultation on Incontinence Questionnaire-Short Form scores (16.08±0.32 and 16.71±0.31, respectively). It was observed that the postoperative ICIQ-SF scores decreased markedly in both groups (2.31±0.69 and 4.42±1.21, respectively, p=0.003).CONCLUSION:Cystocele repair performed simultaneously with TOT in patients with mild to moderate (grade 1&grade2) cystocele did not provide additional improvement on TOT alone in regard to treatment of SUI.

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