Sunshine Murray

Urethral Distortion After Placement of Synthetic Mid Urethral Sling

PURPOSE We retrospectively compared preoperative characteristics in patients with new onset lower urinary tract symptoms after receiving a mid urethral sling who did (group 1) and did not (group 2) have radiographically confirmed urethral distortion during voiding. MATERIALS AND METHODS After receiving institutional review board approval we reviewed the charts of patients who underwent mid urethral sling excision for new onset lower urinary tract symptoms between January 2003 and July 2009. We collected demographic and questionnaire data, including the Urogenital Distress Inventory, Incontinence Impact Questionnaire and visual analog scale (score 0 to 10) for quality of life, and preoperative urodynamics data, including maximum flow, detrusor pressure at maximum flow and post-void residual urine. Lateral voiding cystourethrogram was done with the patient standing. RESULTS Of 87 operable patients 23 were excluded from analysis due to lack of a voiding cystourethrogram (16) or of the voiding phase on voiding cystourethrogram (7). Groups 1 and 2 consisted of 51 and 13 patients, respectively. Age, time to sling excision, and Urogenital Distress Inventory, Incontinence Impact Questionnaire and quality of life scores were not significantly different between the groups. Preoperative urodynamic parameters in 37 group 1 and 7 group 2 patients revealed a mean detrusor pressure at maximum flow of 31.1 and 22.2 cm H(2)O, respectively (p = 0.25). Mean preoperative maximum flow was 13.4 and 15.4 ml per second (p = 0.59), and median post-void residual urine was 45.5 and 8.3, ml respectively (p = 0.16). CONCLUSIONS Despite similar baseline symptoms and uroflow characteristics patients with urethral distortion had 50% higher detrusor pressure and greater post-void residual urine than those without urethral distortion. Flow rate alone may be insufficient to predict the impact of the mid urethral sling on bladder function in patients with new onset lower urinary tract symptoms.

Overactive Bladder and Mixed Incontinence

Mixed urinary incontinence (MUI) is a complex problem and a difficult one to treat. Successful outcome associated with treatment depends on alleviation of not one, but two symptoms. This review addresses the definition, etiology, workup, and treatment of MUI. It encompasses conservative, pharmacological, and surgical therapies along with their outcomes in these complicated patients.

Long-term outcomes of autologous pubovaginal fascia slings: Is there a difference between primary and secondary slings?

To report our long‐term pubovaginal slings (PVS) outcomes between primary (PVS1) and secondary (PVS2) autologous fascia PVS, with the hypothesis that outcomes in PVS1 will be better than in PVS2.

Defining the role of urodynamics in predicting voiding dysfunction after anti-incontinence surgery: a work in progress.

Purpose of review To evaluate the role of preoperative urodynamics in predicting postoperative voiding dysfunction in patients undergoing anti-incontinence surgery. Recent findings Voiding dysfunction after anti-incontinence procedures is not an uncommon finding, along with being a difficult one to treat. Many patients undergo preoperative urodynamics in an attempt to further characterize their incontinence preoperatively and possibly provide information regarding prognosis postoperatively. However, the role of routine urodynamics in patients undergoing anti-incontinence surgery is somewhat controversial, with mixed findings in regard to support of this practice being found in the literature. Summary The literature on the role of preoperative urodynamics in predicting voiding dysfunction after anti-incontinence surgery is reviewed.

Martius Labial Fat Pad Construction

The Martius labial fat pad (MLFP) is a pedicle graft of fatty tissue from the labia majora, which can be used as an interposition layer during a variety of vaginal procedures. First described by Martius, the procedure is fairly simple and quick, allowing the surgeon to harvest a well-vascularized fat pad of variable length (typically 8–12 cm) and transfer it where needed to enhance the repair of complex or recurrent urethral or vesical pathology. We will briefly cover the indications and technique for this versatile procedure. However, as with any surgical technique, complications can occur including hematoma, infection, pain or numbness, sexual dysfunction, and labial distortion. We aim to describe these complications as well as provide what information is available from the literature and our own experience on prevention and management when encountered.

Martius Fat Pad Construction

The Martius labial fat pad is a pedicle graft of fatty tissue from the labia majora which can be used as an interposition layer during a variety of vaginal procedures. First described by Martius [1], the procedure is fairly simple and quick, allowing the surgeon to harvest a well-vascularized fat pad of variable length (typically 8–12 cm) and transfer it where needed to enhance the repair of complex or recurrent urethral or vesical pathology. However, as with any surgical technique, complications can occur including hematoma, infection, pain or numbness, sexual dysfunction, and labial distortion. We aim to describe these complications as well as provide what information is available from the literature and our own experience on how to avoid them and manage them when necessary. To this end, we will also briefly cover the indications and technique for this versatile procedure.