The aim of this review is to provide an update on the current status of evolving minimally invasive therapies for stress urinary incontinence. Bioinjectables have been available for some time and their current status is reviewed. The adjustable continence device has been used as a salvage procedure for females for a number of years in clinical trials, yet many are unfamiliar with it. Lastly, radiofrequency via a transurethral route has also been utilized in small numbers and will be updated. These later two emerging technologies need further exposure to better define their role in our clinical practice.

Simone Crivellaro

John J. Smith

Minimally Invasive Therapies for Female Stress Urinary Incontinence: the Current Status of Bioinjectables/New Devices (Adjustable Continence Therapy, Urethral Submucosal Collagen Denaturation by Radiofrequency)

An established standardized terminology is necessary for communication of scientific information, and for prevention of mistreatment and misdiagnosis. Terminology concerning the lower urinary tract has been much discussed; in particular, the meaning of terms like lower urinary tract symptoms (LUTS), urgency, frequency and nocturia, overactive bladder (OAB), and detrusor overactivity (DO). It is natural and desirable that all suggested definitions are subject to criticism, and it is important that discussions for improvement of the existing terminology continue.

Sonia Vishwajit

Karl-Erik Andersson

Terminology of Lower Urinary Tract Symptoms. Helpful or Confusing ?

Overactive bladder (OAB) is a common, costly, and treatable condition in older persons. There is a wide array of available antimuscarinics for the treatment of these conditions; however, their side effect profile and the limited number of studies that evaluate their effect in the elderly curb their use. This review article focuses on OAB and its treatment, with special attention to the use of antimuscarinics in the elderly.

Bhavin Patel

Tamara Bavendam

Gopal Badlani

Use of Antimuscarinics in the Elderly

Gopal H. Badlani

Update on Lower Urinary Tract Symptoms

The aim of this review is to provide an update on the use of neuromodulation using sacral nerve stimulation for the treatment of disorders of the lower urinary tract. Neuromodulation using the InterStim® system (Medtronic Inc.) is now accepted as an established therapeutic option for patients with detrusor overactivity, and for women with retention or severe voiding difficulties. However, the use of nerve stimulation in modulating lower urinary tract function has to be regarded as a technique that is in its infancy. Much has yet to be learned about the mechanism by which neuromodulation exerts its effects and there is a need to better define the clinical indications for the treatment. There is also work to be done in terms of optimising stimulation delivery, both in anatomical and electronic terms.

Zahid Hussain

Simon C. W. Harrison

Neuromodulation for Lower Urinary Tract Dysfunction – An Update

It has not yet been definitively demonstrated that preoperative evaluation of women with stress urinary incontinence (SUI) with urodynamic testing (UDS) enhances surgical outcomes. Nonetheless, UDS is frequently utilized in the assessment of women with SUI in the hopes that results will shed light on preoperative risk factors for failure or postoperative voiding dysfunction. Poorer outcomes for stress incontinence surgery are primarily attributed to intrinsic sphincter deficiency (ISD), detrusor overactivity (DO), and voiding dysfunction. The ability of UDS to identify and characterize those parameters reliably remains under investigation. Furthermore, debate continues regarding the association of each of those factors with postoperative success for various SUI procedures. Since UDS is invasive, costly, and not always available, it is imperative that its benefit be carefully explored. In this review, we discuss the value of UDS in identifying risk factors for poor outcome and how those risk factors are associated with surgical failure.

Sophie G. Fletcher

Gary E. Lemack

Clarifying the Role of Urodynamics in the Preoperative Evaluation of Stress Urinary Incontinence

Graft use in vaginal prolapse surgery has become more common secondary to high failure rates seen with traditional repairs. Mesh has been shown to be successful when suspending the upper portion of the vagina with sacralcolpopexy and its use vaginally is in an attempt to reproduce those results seen from the more invasive abdominal approach. A recent Cochrane review has supported its use in the anterior compartment vaginally as lower failure rates have been shown. Vaginal mesh “kits” have been developed in an attempt to make these surgeries less invasive, more standardized, and easier to perform. One of the problems that does seem to be emerging is the thought that, just because these procedures are now being produced in “kits”, they can be completed by any surgeon. This may not hold true, as these are still advanced techniques that require advanced pelvic surgery skills and, therefore, it is up to surgeons to also understand this and the limitations of these procedures. The current paper reviews the history of the development of mesh kits, the techniques utilized, and the data that have been published to date on results and complications, and recommendations on how to avoid these complications. Although initial studies are encouraging, more will need to be completed prior to the recommendations of general use of these kits in all prolapse patients. We need to have further investigation on proper patient selection, we must continue research on graft composition, and we must continue to develop techniques to minimize complications of needle passage or mesh placement. Even after we gain this knowledge, it will still require advanced surgical skills to complete these types of surgeries, and to help minimize complications and maximize results.

Robert D. Moore

John R. Miklos

Vaginal Mesh Kits for Pelvic Organ Prolapse, Friend or Foe: A Comprehensive Review

We present an overview of the current literature and management techniques for vaginal extrusion or urinary tract erosion of graft materials used in pelvic floor reconstruction. A MEDLINE search was performed to identify literature pertaining to the incidence and management of vaginal or urinary tract exposure of graft materials commonly used in anti-incontinence and pelvic floor reconstructive procedures. Dependent on the type of mesh material used, a vaginal extrusion rate of up to 77% has been reported. The currently accepted, loosely woven, monofilament type I polypropylene meshes appear to have acceptable lower exposure rates in the range of 1–3% for slings, but with the larger area of mesh used in prolapse repairs, the rate increases to up to 10%. With the current widespread use of graft materials to reinforce pelvic floor reconstructive techniques, it is imperative for surgeons to be familiar with potential complications related to the materials and proper management of these complications. Although it is beginning to appear that the benefit of using some synthetic materials may outweigh the risks, proper management and understanding of the risks is important in order to counsel our patients appropriately and responsibly prior to their surgeries.

Kathleen C. Kobashi

Management of Erosion of Graft Materials in Pelvic Floor Reconstruction

Botulinum toxins are well known for their ability to disrupt neurotransmission and cause muscle paralysis. Recently, urologists have discovered their beneficial effects in patients with neurogenic and overactive bladder conditions. This review is intended to provide a quick overview for urologists of the structure, function, and clinical uses of botulinum neurotoxin A in the lower urinary tract.

Shelby N. Morrisroe

Michael B. Chancellor

Botulinum Toxin Use in the Lower Urinary Tract

Female stress urinary incontinence, while not life threatening, can present with various social and economic implications. Biomaterials, primarily synthetic, are often utilized to augment surgical correction. Repair with biomaterials involves midurethral support to function against weakened connective tissue caused by injury, abnormal collagen metabolism, or genetic predisposition. Even though efficacy rates are high, the potential for complications, such as erosion, are great without comprehension of inherent characteristics of each graft material. Low-weight, macroporous, monofilament synthetic grafts and noncross-linked biologic grafts are examples of biomaterials that implant reasonably well with host tissue. This paper reviews the justification for biomaterial use, host reaction, and the various parameters of natural and synthetic grafts.

Kaytan V. Amrute

The Science behind Biomaterials in Female Stress Urinary Incontinence Surgery

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The Scientific World Journal | Hindawi

The Scientific World Journal

This Issue is now open for submissions.
Papers are published upon acceptance, regardless of the Special Issue publication date.

The Scientific World Journal

Update on Lower Urinary Tract Symptoms

Update on Lower Urinary Tract Symptoms

Articles

Minimally Invasive Therapies for Female Stress Urinary Incontinence: the Current Status of Bioinjectables/New Devices (Adjustable Continence Therapy, Urethral Submucosal Collagen Denaturation by Radiofrequency)

Terminology of Lower Urinary Tract Symptoms. Helpful or Confusing ?

Use of Antimuscarinics in the Elderly

Update on Lower Urinary Tract Symptoms

Neuromodulation for Lower Urinary Tract Dysfunction – An Update

Clarifying the Role of Urodynamics in the Preoperative Evaluation of Stress Urinary Incontinence

Vaginal Mesh Kits for Pelvic Organ Prolapse, Friend or Foe: A Comprehensive Review

Management of Erosion of Graft Materials in Pelvic Floor Reconstruction

Botulinum Toxin Use in the Lower Urinary Tract

The Science behind Biomaterials in Female Stress Urinary Incontinence Surgery