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1040 WORSENING URINARY STORAGE SYMPTOMS FOLLOWING SLING SURGERY IN STRESS-INCONTINENT WOMEN: INCIDENCE, ASSOCIATIONS, AND MANAGEMENT
Vol. 189, No. 4S, Supplement, Monday, May 6, 2013
METHODS: One hundred and thirty two patients who had MINIARCR were the subjects of this review. Preoperative and postoperative evaluation included; history [including pads used per day (PPD)], physical examination, and QOL [Incontinence impact questionnaire (IIQ), Urogenital distress inventory (UDI), and patient satisfaction visual analog scale (VAS)]. All patients had preoperative urodynamic studies and cystoscopy. RESULTS: The patients were divided in 4 groups. Group-1 (n⫽64) mean follow-up 6 (1-12) months, group-2 (n⫽36) mean follow-up 16 (12-24) months, group-3 (n⫽12) mean follow-up 25 (24-36) months, and group-4 (n⫽20) mean follow-up 51 (36-60) months. Preoperatively, group-1 QOL scores were IIQ 10.19, UDI 8.03, VAS 2.94, and PPD 2.03. Group-2 QOL scores were IIQ 10.25, UDI 9.22, VAS 3.44, and PPD 2.54. Group-3 QOL scores were IIQ 9.36, UDI 10.18, VAS 2.54, and PPD 2.0. Group-4 QOL scores were IIQ 9.11, UDI 9.44, VAS 2.85, and PPD 1.85. Postoperatively; group-1 reported incidence of SUI 12.5%, urge urinary incontinence (UUI) 15.62%, and PPD 0.36. QOL scores improvement for IIQ 74.97%, UDI 69.98% and VAS 181.97%. Group-2 reported incidence of SUI 16.6%, UUI 41.66%, and PPD 0.75. QOL scores improvement for IIQ 68.97%, UDI 63.88% and VAS 112.20%. Group-3 patients reported incidence of SUI 25%, UUI 33%, and PPD 0.58. QOL scores improvement for IIQ 50.21%, UDI 64.04% and VAS 127.16%. Group-4 reported incidence of SUI 40%, UUI 50%, and PPD 0.68. QOL scores improvement for IIQ 45.77%, UDI 52.11% and VAS 83.15%. CONCLUSIONS: These data demonstrate progressive decline in dry rates after MINIARCR-Single Incision Sling at more than 3 years follow-up, though patients’ satisfaction remains high. Higher rates at short and intermediate follow up support a successful technique. Further studies are needed to validate the long-term success of the MINIARCR-Single Incision Sling in the management of SUI. Source of Funding: American Medical Systems, Inc.
1040 WORSENING URINARY STORAGE SYMPTOMS FOLLOWING SLING SURGERY IN STRESS-INCONTINENT WOMEN: INCIDENCE, ASSOCIATIONS, AND MANAGEMENT Joshua P. Holstead*, Andrew McCall, Clifton F. Frilot II, Alexander Gomelsky, Shreveport, LA INTRODUCTION AND OBJECTIVES: The connection between a sling procedure for stress urinary incontinence (SUI) and postoperative urinary urgency incontinence (UUI) is inconsistent. Women with resolution or persistence of preoperative UUI, or those with de novo UUI have been frequently described. Women who developed worsened preoperative UUI after sling surgery are poorly characterized and our aim is to describe this population, their management, and ultimate outcomes. METHODS: After IRB approval, we retrospectively identified women with minimum follow-up of 12 months who underwent sling and developed worsening postoperative UUI. Pre- and postoperative assessment included SEAPI classification (Stress incontinence, Emptying, Anatomy (anterior vaginal wall descent), Protection (pad use), Inhibition (urge incontinence)), and quality of life (QoL) indices. UUI was considered worse when the SEAPI(I) subset worsened. Demographics and postoperative course were abstracted from the clinic charts. RESULTS: Of 1184 women meeting follow-up criteria, 122 (10.3%) developed worsened UUI after sling surgery. Fifty-five (45.1%) underwent a bladder neck sling (BNS), while 43 (35.2%) and 24 (19.7%) had retropubic (RP) and transobturator (TO) midurethral sling (MUS), respectively. The 3 sling groups were similar in age, BMI, parity, and preoperative pad use. More women in the BNS group had failed previous slings and women undergoing TO MUS had a higher valsalva leak point pressure (VLPP). Mean follow-up was 47.9 months. Prolonged urinary voiding symptoms occurred in 14.5%, 23.3%, and 8.3% of women undergoing BNS, RP MUS, and TO MUS, respectively. Recurrent anterior/apical prolapse requiring additional repair occurred
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in 7.3%, 4.7%, and 8.3% of women undergoing BNS, RP MUS, and TO MUS, respectively. Persistent or recurrent SUI developed in 45.5%, 44.2%, and 29.2% of women undergoing BNS, RP MUS, and TO MUS, respectively. QoL was significantly related to worsening UUI. All women were offered behavioral therapy, antimuscarinics, and biofeedback, but significant improvement was often seen only after repeat surgery for incontinence and pelvic prolapse, sling revision, and neuromodulation. CONCLUSIONS: Worsening UUI after sling causes a significant impact on QoL, and may be associated with de novo voiding symptoms, recurrent SUI, and prolapse. While conservative treatment options should be offered to all women, repeat surgical intervention may be necessary to ultimately improve UUI. Source of Funding: None
1041 THE EFFECTS OF REGULAR AND DECAFFEINATED COFFEE ON VOIDING SYMPTOMS IN YOUNG HEALTHY VOLUNTEERS Andrea Staack*, Brian Distelberg, Christopher Chung, Kirk Baker, Amy Schlaifer, Kirk Anderson, Herbert Ruckle, Loma Linda, CA INTRODUCTION AND OBJECTIVES: Objective: About 15% of the U.S. general population report having stopped drinking coffee altogether, citing concerns about side effects of caffeine. To our knowledge, no studies have been conducted that explore the effects of higher dosage coffee and decaffeinated coffee on lower urinary symptoms in a younger population. Therefore, the main purpose of this study is to compare decaffeinated with regular coffee and their effects on LUTS in young volunteers, who are not regularly exposed to caffeine, using water consumption as the internal control. METHODS: Methods: In this randomized prospective longitudinal study all subjects underwent a 5-day washout phase, were they were restricted from consuming any caffeinated products, followed by the 5-day coffee phase. During the treatment phase the subjects were randomly assigned to drink 24 oz. of either decaffeinated coffee (12 mg caffeine) or regular coffee (450 mg caffeine). The coffee was brewed blindly in a standardized fashion. The study concluded with a 5-day washout phase. Throughout the three phases of the study subjects filled out voiding logs, health surveys, UDI-6, interstitial cystitis problem and symptom indices (ICSI, ICPI) at eight different time points. Continuous variables were compared using the ANOVA and post hoc t-test comparison test. RESULTS: Results: Between April and June 2012, 49 healthy individuals between the ages of 18 and 45 years (mean age: 27) were enrolled and completed the study. 25 subjects were randomized into the regular coffee and 24 into the decaffeinated coffee arm and underwent a pre and post treatment washout phases. Consumption of 450mg caffeine produced significant increase in urine output at the first day of treatment (p⬍0.01), which normalized after three days of washout. The ICSI was elevated in the coffee arm (p⬍0.03). There was no difference between the decaffeinated treatment and the water phase (wash out) on any of the outcome measures. CONCLUSIONS: Conclusion: This is the first randomized prospective study, which showed a significant increase in LUTS and voided volume during consumption of high dosage coffee, when compared to decaffeinated coffee or water intake. Symptoms were normalizing three days after termination of coffee. Findings suggest consuming decaffeinated coffee instead of regular coffee to avoid LUTS and increase of urine out put. Further studies are warranted to assess effects of caffeine in patients presenting with overactive bladder symptoms to improve counseling. Source of Funding: None
METHODS: One hundred and thirty two patients who had MINIARCR were the subjects of this review. Preoperative and postoperative evaluation included; history [including pads used per day (PPD)], physical examination, and QOL [Incontinence impact questionnaire (IIQ), Urogenital distress inventory (UDI), and patient satisfaction visual analog scale (VAS)]. All patients had preoperative urodynamic studies and cystoscopy. RESULTS: The patients were divided in 4 groups. Group-1 (n⫽64) mean follow-up 6 (1-12) months, group-2 (n⫽36) mean follow-up 16 (12-24) months, group-3 (n⫽12) mean follow-up 25 (24-36) months, and group-4 (n⫽20) mean follow-up 51 (36-60) months. Preoperatively, group-1 QOL scores were IIQ 10.19, UDI 8.03, VAS 2.94, and PPD 2.03. Group-2 QOL scores were IIQ 10.25, UDI 9.22, VAS 3.44, and PPD 2.54. Group-3 QOL scores were IIQ 9.36, UDI 10.18, VAS 2.54, and PPD 2.0. Group-4 QOL scores were IIQ 9.11, UDI 9.44, VAS 2.85, and PPD 1.85. Postoperatively; group-1 reported incidence of SUI 12.5%, urge urinary incontinence (UUI) 15.62%, and PPD 0.36. QOL scores improvement for IIQ 74.97%, UDI 69.98% and VAS 181.97%. Group-2 reported incidence of SUI 16.6%, UUI 41.66%, and PPD 0.75. QOL scores improvement for IIQ 68.97%, UDI 63.88% and VAS 112.20%. Group-3 patients reported incidence of SUI 25%, UUI 33%, and PPD 0.58. QOL scores improvement for IIQ 50.21%, UDI 64.04% and VAS 127.16%. Group-4 reported incidence of SUI 40%, UUI 50%, and PPD 0.68. QOL scores improvement for IIQ 45.77%, UDI 52.11% and VAS 83.15%. CONCLUSIONS: These data demonstrate progressive decline in dry rates after MINIARCR-Single Incision Sling at more than 3 years follow-up, though patients’ satisfaction remains high. Higher rates at short and intermediate follow up support a successful technique. Further studies are needed to validate the long-term success of the MINIARCR-Single Incision Sling in the management of SUI. Source of Funding: American Medical Systems, Inc.
1040 WORSENING URINARY STORAGE SYMPTOMS FOLLOWING SLING SURGERY IN STRESS-INCONTINENT WOMEN: INCIDENCE, ASSOCIATIONS, AND MANAGEMENT Joshua P. Holstead*, Andrew McCall, Clifton F. Frilot II, Alexander Gomelsky, Shreveport, LA INTRODUCTION AND OBJECTIVES: The connection between a sling procedure for stress urinary incontinence (SUI) and postoperative urinary urgency incontinence (UUI) is inconsistent. Women with resolution or persistence of preoperative UUI, or those with de novo UUI have been frequently described. Women who developed worsened preoperative UUI after sling surgery are poorly characterized and our aim is to describe this population, their management, and ultimate outcomes. METHODS: After IRB approval, we retrospectively identified women with minimum follow-up of 12 months who underwent sling and developed worsening postoperative UUI. Pre- and postoperative assessment included SEAPI classification (Stress incontinence, Emptying, Anatomy (anterior vaginal wall descent), Protection (pad use), Inhibition (urge incontinence)), and quality of life (QoL) indices. UUI was considered worse when the SEAPI(I) subset worsened. Demographics and postoperative course were abstracted from the clinic charts. RESULTS: Of 1184 women meeting follow-up criteria, 122 (10.3%) developed worsened UUI after sling surgery. Fifty-five (45.1%) underwent a bladder neck sling (BNS), while 43 (35.2%) and 24 (19.7%) had retropubic (RP) and transobturator (TO) midurethral sling (MUS), respectively. The 3 sling groups were similar in age, BMI, parity, and preoperative pad use. More women in the BNS group had failed previous slings and women undergoing TO MUS had a higher valsalva leak point pressure (VLPP). Mean follow-up was 47.9 months. Prolonged urinary voiding symptoms occurred in 14.5%, 23.3%, and 8.3% of women undergoing BNS, RP MUS, and TO MUS, respectively. Recurrent anterior/apical prolapse requiring additional repair occurred
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in 7.3%, 4.7%, and 8.3% of women undergoing BNS, RP MUS, and TO MUS, respectively. Persistent or recurrent SUI developed in 45.5%, 44.2%, and 29.2% of women undergoing BNS, RP MUS, and TO MUS, respectively. QoL was significantly related to worsening UUI. All women were offered behavioral therapy, antimuscarinics, and biofeedback, but significant improvement was often seen only after repeat surgery for incontinence and pelvic prolapse, sling revision, and neuromodulation. CONCLUSIONS: Worsening UUI after sling causes a significant impact on QoL, and may be associated with de novo voiding symptoms, recurrent SUI, and prolapse. While conservative treatment options should be offered to all women, repeat surgical intervention may be necessary to ultimately improve UUI. Source of Funding: None
1041 THE EFFECTS OF REGULAR AND DECAFFEINATED COFFEE ON VOIDING SYMPTOMS IN YOUNG HEALTHY VOLUNTEERS Andrea Staack*, Brian Distelberg, Christopher Chung, Kirk Baker, Amy Schlaifer, Kirk Anderson, Herbert Ruckle, Loma Linda, CA INTRODUCTION AND OBJECTIVES: Objective: About 15% of the U.S. general population report having stopped drinking coffee altogether, citing concerns about side effects of caffeine. To our knowledge, no studies have been conducted that explore the effects of higher dosage coffee and decaffeinated coffee on lower urinary symptoms in a younger population. Therefore, the main purpose of this study is to compare decaffeinated with regular coffee and their effects on LUTS in young volunteers, who are not regularly exposed to caffeine, using water consumption as the internal control. METHODS: Methods: In this randomized prospective longitudinal study all subjects underwent a 5-day washout phase, were they were restricted from consuming any caffeinated products, followed by the 5-day coffee phase. During the treatment phase the subjects were randomly assigned to drink 24 oz. of either decaffeinated coffee (12 mg caffeine) or regular coffee (450 mg caffeine). The coffee was brewed blindly in a standardized fashion. The study concluded with a 5-day washout phase. Throughout the three phases of the study subjects filled out voiding logs, health surveys, UDI-6, interstitial cystitis problem and symptom indices (ICSI, ICPI) at eight different time points. Continuous variables were compared using the ANOVA and post hoc t-test comparison test. RESULTS: Results: Between April and June 2012, 49 healthy individuals between the ages of 18 and 45 years (mean age: 27) were enrolled and completed the study. 25 subjects were randomized into the regular coffee and 24 into the decaffeinated coffee arm and underwent a pre and post treatment washout phases. Consumption of 450mg caffeine produced significant increase in urine output at the first day of treatment (p⬍0.01), which normalized after three days of washout. The ICSI was elevated in the coffee arm (p⬍0.03). There was no difference between the decaffeinated treatment and the water phase (wash out) on any of the outcome measures. CONCLUSIONS: Conclusion: This is the first randomized prospective study, which showed a significant increase in LUTS and voided volume during consumption of high dosage coffee, when compared to decaffeinated coffee or water intake. Symptoms were normalizing three days after termination of coffee. Findings suggest consuming decaffeinated coffee instead of regular coffee to avoid LUTS and increase of urine out put. Further studies are warranted to assess effects of caffeine in patients presenting with overactive bladder symptoms to improve counseling. Source of Funding: None