Sigurd Kulseng-Hanssen

Effects of anterior trocar guided transvaginal mesh surgery on lower urinary tract symptoms.

To assess the effects of trocar guided transvaginal mesh on lower urinary tract symptoms after anterior vaginal wall prolapse repair.

Reproducibility of a cough and jump stress test for the evaluation of urinary incontinence

Introduction and hypothesisThe study seeks to determine whether a urinary cough and jump stress test is reproducible and whether there is a relationship between a stress test and a 24-h pad test and our subjective Stress Incontinence Index.MethodsMulticenter prospective cohort study of women with subjective stress incontinence. Each patient completed a validated Stress and Urge Incontinence Questionnaire and a 24-h pad test and performed two standardized cough and jump stress tests.ResultsAll 108 women were incontinent during both the first and second stress tests. There was a large variation in leakage and the leakage was significantly larger during stress test 2 than during stress test 1 (P < 0.02). Correlations found between the stress test and the 24hour pad test and between the stress test and the Stress Incontinence Index were poor.ConclusionThe cough and jump stress test is reproducible and able to document stress leakage

Pad stress tests with increasing load for the diagnosis of stress urinary incontinence.

The aim of the study was to test the ability of pad stress tests with increasing load (supine, jumping on the floor, and jumping on a trampoline) to document stress incontinence in subjectively stress incontinent women.

Risk factors for long-term failure of the retropubic tension-free vaginal tape procedure.

To investigate potential risk factors for long‐term (10‐year) subjective and objective failure of the retropubic tension‐free vaginal tape procedure (TVT).

Sling mobilization in the management of urinary retention after mid-urethral sling surgery.

To compare intermittent catheterization, sling mobilization, and sling transection for treatment of urinary retention after mid‐urethral sling surgery.

Outcome of TVT operations in women with low maximum urethral closure pressure.

(i) To establish whether low maximal urethral closure pressure (MUCP) is associated with a poorer prognosis after TVT‐surgery, and if so to establish an MUCP cut‐off value for poor outcome. (ii) To characterize the population with a low MUCP.

Mid-urethral slings in young, middle-aged, and older women

To compare subjective and objective outcomes of mid‐urethral sling (MUS) surgery in women in different age decades and the utilization rates for MUS in Norwegian women.

Re: Petros P. A critical analysis of the trampoline test for diagnosis of SUI. Re: Rimstad L, Larsen ES, Schiotz HA, Kulseng-Hansen S, Pad tests with increasing load for the diagnosis of stress incontinence, Neurourol Urodyn. 2014;33:1135–39

Dear Editor, We thank Prof. Petros for his comments on our article ‘‘Pad Stress Tests with Increasing Load for the Diagnosis of Stress Urinary Incontinence’’ and would like to respond. First, we want to point out that the jumping pad stress test and the trampoline test are primarily aimed at detecting stress incontinence and not to assess the severity of stress incontinence. Prof. Petros claims that the cough test was omitted in our article. This is not correct; we did perform cough tests. In the methods part we write: the women were asked to perform three different pad stress tests of increasing load consecutively, in the same order. First, in the supine position, they coughed three times as vigorously as possible (the supine pad stress test). Secondly, standing on the floor they coughed three times as vigorously as possible and then performed 20 jumping jacks (jumping on the spot while abducting and adducting the legs), on the jumping pad stress test. In our study, only 49% of thewomenwere incontinent during the supine pad stress test, compared with 32% in Prof. Petros’ study where only 12/38 leaked during the cough test. A test with 50% false negative results is in our opinion not good enough. We feel that all women who are offered a stress incontinence operation must have their leakage documented properly. Prof. Petros asks: if the supine cough test performedwith a full bladderisnegative,isthisnotasignthattheconditionofSUIisnot sufficientlyseveretowarrantsurgeryandthatthepatientshould be observed following appropriate pelvic floor rehabilitation treatment?Wefeelthatanegativesupinecoughstresstestisnota sufficient basis for deciding for or against offering incontinence surgery. For instance, what about those women who have tried pelvicfloorrehabilitationandstillhavebothersomeincontinence, but a negative cough test? They need further testing. We agree thatmostwomen referred for SUI should be offered pelvic floor rehabilitation treatment, but this is a different discussion. In our study, the 75 women who did not leak during the supine pad stress test (the cough test) leaked a mean 27 g (SD 34) on the preoperative jumping pad stress test. Their subjective stress incontinence bother (stress incontinence index, range 0–12) was mean 8 (SD 1.6) (numbers not given in the article). In the whole group, the mean leakage on the jumping pad stress test was 26 g (SD 34). Ninemonths postoperatively, 97% of thewomenwho did not leak during the preoperative supine pad stress test (the cough test) did not leak during the jumping pad stress test. Their subjective postoperative stress incontinence bother score was mean 0.84 (SD 1.8) and 86%were very satisfied, 9%were a little satisfied, 2%were neither satisfied nor dissatisfied, and 2%were a little dissatisfied. This illustrates that the majority of women with subjective SUI who do not exhibit leakage on a supine cough test but who have SUI documented by the jumping pad stress test or the trampoline test will end up satisfied after undergoing a midurethral sling procedure. Kind regards,