Renuka Tyagi

Cost-effectiveness analysis of tension-free vaginal tape vs burch colposuspension for female stress urinary incontinence in the USA

To compare the cost‐effectiveness (CE) of tension‐free vaginal tape (TVT) with that of burch colposuspension (BC) for the treatment of female stress urinary incontinence (SUI).

Pathologic outcomes following urethral diverticulectomy in women

Purpose. Although most urethral diverticula in women are benign, there is a subset of patients who develop malignant changes. Limited studies report the pathologic findings associated with this relatively rare entity. We describe the clinicopathologic findings of women who underwent urethral diverticulectomy. Methods. A consecutive series of 29 women who underwent surgical resection of a urethral diverticulum were identified between 1992 and 2013. Clinical and radiographic data was collected by retrospective review of patient medical records. All pathological slides were rereviewed by a single urologic pathologist. Results. Of the 14 women with clinical data, 9 (64%) presented with urgency, 7 (50%) with urinary frequency, 3 (21%) with urinary incontinence, and 3 (21%) with dysuria. Mean diverticular size was 2.3 (±1.4) cm. Although one patient (3%) had invasive adenocarcinoma on final pathology, the remaining 28 cases (97%) demonstrated benign features. The most common findings were inflammation (55%) and nephrogenic adenoma (21%). Conclusions. Although most urethral diverticula in women are benign, there is a subset of patients who develop malignancy in association with the diverticulum. In this series, 97% of cases had a benign histology. These findings are important when counseling patients regarding treatment options.

What is the effect of menopausal hormone replacement therapy on urinary incontinence

DESIGN Between 1993 and 1998, the randomized, double-blind, multicenter Women’s Health Initiative (WHI) trials recruited post menopausal women aged 50 to 79 years by post or via media advertisement. The trials evaluated the effects of estrogen plus progestin in women with an intact uterus, and estrogen monotherapy in women who had undergone a hysterectomy. Exclusion criteria included breast cancer, other recent invasive malignancy, and thrombotic venous obstruction. Prior HRT was discontinued 3 months before randomization. The presence, type and severity of UI were assessed via self-administered questionnaire at baseline and after 1 year.

The use of synthetic mesh and the management of mesh extrusion in vaginal surgery

The authors present a review of the literature regarding the management of mesh extrusion in vaginal surgery. As used in traditional surgical techniques, the use of mesh theoretically allows for a broader base of support and eliminates the need to rely on pre-existing weakened fascia. In this article, the different physical properties and types of synthetic mesh used, and their respective advantages and disadvantages in terms of mesh extrusion, are reviewed.

Lower Urogenital Tract Dysfunction in Men and Women

Publisher Summary The components of the lower urinary tract in both men and women are the bladder and the urethra. Gender-specific differences in anatomy predispose men and women to different conditions. Women have a shorter urethra (3–4 cm), making them more prone to urinary tract infections and incontinence. The male urethra is much longer and has four parts: the penile urethra, bulbous urethra (which passes through the scrotum), membranous urethra (located at the external urethral sphincter), and the prostatic urethra. Due to its length the male urethra is more prone than the female urethra to traumatic injury and stricture formation. Conditions of the prostate comprise a significant part of lower urogenital dysfunction in men. Previously, lower urinary tract symptoms in aging men, such as weak stream and urinary frequency, were thought to be exclusively as a consequence of an enlarged prostate and were referred to as “prostatism.” It is clear now that these symptoms are not only a consequence of an enlarging prostate and obstruction, but also the effects of aging on the lower urinary tract. Furthermore, as men and women age, the prevalence of lower urinary tract symptoms (LUTS) increases. Paul Abrams has coined the phrase lower urinary tract symptoms to replace the misleading and gender-specific term “prostatism.” There are many classification systems for lower urinary tract dysfunction. One that is widely accepted is the International Continence Society (ICS) system. It is based on the distinction between the storage and voiding phases as well as between bladder and urethral function.