The Michigan Incontinence Symptom Index (M-ISI): a clinical measure for type, severity, and bother related to urinary incontinence.

Aims: To develop a clinically relevant, easy to use, and validated instrument for assessing severity and bother related to urinary incontinence.

Methods: Survey items were piloted and refined following psychometric principles in five separate patient cohorts. Patient and expert endorsement of items, factor analyses, Spearman rank correlations and response distributions were employed for item selection.

Treating stress urinary incontinence in female patients with neuropathic bladder: the value of the autologous fascia rectus sling.

Objective/background: The aim of this study was to evaluate the efficacy of the autologous fascia rectus sling in treating stress urinary incontinence in female patients with neuropathic bladder. Furthermore, correlations between preoperative parameters and outcome were evaluated.

Methods And Design: We retrospectively reviewed operative logs from a single surgeon (EM) of 33 female patients with neuropathic bladder treated over a 3-year period for stress urinary incontinence by implantation of an autologous fascia rectus sling.

Factors associated with urge urinary incontinence after surgery for stress urinary incontinence.

Objective: : The objectives of the study were to estimate the severity of urge urinary incontinence (UUI) after surgery for stress incontinence and identify factors associated with symptom severity.

Methods: : Four hundred thirty-eight women who underwent surgery for stress incontinence over a 10-year period completed a mailed questionnaire protocol that included validated instruments to assess lower urinary tract function and mental and physical well-being. Bivariate analysis and generalized linear models were used to identify factors associated with severity of UUI as measured by the urge incontinence domain of the Incontinence Symptom Index.

Long-term outcomes after primary failures of artificial urinary sphincter implantation.

Objectives: To assess our institutional outcomes after primary artificial urinary sphincter (AUS) failures.

Methods: From 1985 to 2010, a total of 149 patients underwent 318 primary and additional AUS procedures. We classified additional procedures as revisions, replacements, or explantations.

Efficacy and preoperative prognostic factors of autologous fascia rectus sling for treatment of female stress urinary incontinence.

Objective: To evaluate the efficacy of the autologous fascia rectus sling in treating female stress urinary incontinence.

Methods: A total of 264 patients treated during a 3-year period for SUI using the autologous fascia rectus sling were retrospectively reviewed. Efficacy was evaluated by the number of pads used daily.

Urodynamics of the neurogenic bladder.

Many patients with neurogenic bladders require careful monitoring in order to decrease the risk of infectious and renal complications. Urodynamic testing, with particular attention paid to detrusor pressures, is helpful for risk stratification in these patients and provides key information when assessing effectiveness of treatments. This article reviews the history, indications, and contemporary parameters for urodynamic testing in the neurogenic population.

Bone-anchored sling for male stress urinary incontinence: assessment of complications.

Objectives: To evaluate the complications associated with the male bone-anchored sling (BAS) to determine the appropriate preoperative counseling for men considering surgery. The BAS is a surgical option for the treatment of stress urinary incontinence (SUI) due to intrinsic sphincter deficiency.

Methods: We retrospectively reviewed 119 men who had undergone 140 BAS procedures for SUI from May 2000 to May 2009 at our institution.

Efficacy of the bulbourethral autologous sling in treating male stress urinary incontinence: a three-year experience from a single center.

Aim: To evaluate the efficacy of the bulbourethral rectus autologous sling in treating male stress urinary incontinence.

Patients And Methods: We retrospectively reviewed operative logs from a single surgeon of 32 male patients treated over a 3-year period (March 2001 to March 2004) for stress incontinence by implantation of a bulbourethral free rectus sling. The mean age of the patients was 46.

Management of difficult cases in female urology and neurourology at the Reed M. Nesbit society meeting. Festschrift in honor of Edward J. McGuire, MD.

This is a panel discussion of seven complex urologic cases in female urology and neurourology. Differences in diagnosis and management are discussed by this international panel of experts.

Long-term durability of pubovaginal fascial slings in women who then become pregnant and deliver.

Introduction And Hypothesis: Pubovaginal fascial slings are commonly performed after childbearing is completed. Limited data is available regarding women who become pregnant following a sling procedure.

Methods: Three hundred forty-one women of childbearing age underwent pubovaginal sling surgery at our institution from July 1993 to December 2005.

Combination drug therapy improves compliance of the neurogenic bladder.

Purpose: Typical management of increased bladder storage pressures and decreased compliance related to neurogenic bladder dysfunction consists of antimuscarinic therapy with or without clean intermittent catheterization. However, these measures are often unsuccessful. In this patient group we commonly use combination therapy consisting of antimuscarinics combined with imipramine and/or an alpha-blocker.

Multiple perineal abscesses and sinus tracts as a complication of vaginal mesh.

Understanding the occurrence and management of mesh kit complications has become increasingly important. A 54-year-old woman presented to our tertiary care center with complaints of constant perineal pain, and copious, foul-smelling vaginal discharge after anterior and posterior placement of a synthetic mesh and mid-urethral sling 3 months earlier. She was found to have two vaginocutaneous sinus tracts (to the left ischiorectal fossa and to the left labia majora), as well as bilateral abscess cavities within the ischiorectal fossae.

The association of Incontinence Symptom Index scores with urethral function and support.

Objective: The objective of this study was to establish categories of symptom severity based on Incontinence Symptom Index (ISI) scores and to show how these categories are associated with urethral function and support.

Study Design: Women with stress incontinence (n = 97) and asymptomatic controls (n = 98) completed the ISI. Asymptomatic women's scores were between 0 and 6; this range was designated as absent/mild (n = 104).

Urinary incontinence after stress incontinence surgery: a risk factor for depression.

Objectives: To determine whether urinary incontinence after stress incontinence surgery is a risk factor for concomitant symptoms of depression.

Methods: Women who underwent stress urinary incontinence surgery from 1993 to 2002 were given 2 validated quality-of-life questionnaires, the Incontinence Symptom Index and the Patient Health Questionnaire, to assess the severity of urinary incontinence symptoms after surgery and to identify moderate-to-severe depressive symptoms, respectively. Bivariate and multivariate statistical models were then constructed to determine the independent parameters associated with the reporting of moderate-to-severe depressive symptoms in this group of women.

"The cough game": are there characteristic urethrovesical movement patterns associated with stress incontinence?

This study was carried out to determine whether five experts in female stress urinary incontinence (SUI) could discover a pattern of urethrovesical movement characteristic of SUI on dynamic perineal ultrasound. A secondary analysis of data from a case-control study was performed. Ultrasounds from 31 cases (daily SUI) and 42 controls (continent volunteers) of similar age and parity were analyzed.

Complications requiring reoperation following vaginal mesh kit procedures for prolapse.

Objective: The objective of the study was to the characterize the symptoms and management of vaginal mesh-related complications requiring operative intervention.

Study Design: This was a case series of patients undergoing excision of vaginal graft material. Only women who had vaginal mesh placement for the correction of pelvic organ prolapse (POP) were included.

Long-term durability and functional outcomes among patients with artificial urinary sphincters: a 10-year retrospective review from the University of Michigan.

Purpose: The artificial urinary sphincter continues to be one of the most effective and commonly used surgical treatments for severe urinary incontinence. The long-term durability and functional outcome remains unclear. This study sought to report the artificial urinary sphincter complication rates, associated risk factors with complications, and long-term quality of life and durability.

Are persistent or recurrent symptoms of urinary incontinence after surgery associated with adverse effects on sexual activity or function?

We sought to determine if postoperative urinary incontinence (UI) symptoms are associated with (1) sexual activity status and (2) sexual function using validated health-related quality of life instruments. In this mailed cross-sectional survey of 687 women who underwent stress incontinence surgery, 437 (63.6%) completed a questionnaire protocol.

Transcutaneous mechanical nerve stimulation using perineal vibration: a novel method for the treatment of female stress urinary incontinence.

Purpose: We defined basic guidelines for transcutaneous mechanical nerve stimulation in modifying pelvic floor responses in women and determined the efficacy of transcutaneous mechanical nerve stimulation in treating stress urinary incontinence.

Materials And Methods: Perineal and clitoral transcutaneous mechanical nerve stimulation was performed in healthy volunteers while measuring changes in peak urethral pressure to determine optimal vibration amplitude and site of stimulation. Perineal transcutaneous mechanical nerve stimulation was then performed weekly for 6 weeks in a cohort of women with stress urinary incontinence (33).

Ileovesicostomy for adults with neurogenic bladders: complications and potential risk factors for adverse outcomes.

Aims: Risk factors for complications following ileovesicostomy have not been well defined. This study's purpose was to examine outcomes following ileovesicostomy in adults and identify possible risk factors that may contribute to post-operative complications.

Methods: Retrospective database review identified ileovesicostomy procedures from August 1999 to September 2003.

Comparative analysis of urinary incontinence severity after autologous fascia pubovaginal sling, pubovaginal sling and tension-free vaginal tape.

Purpose: Autologous fascia, Pelvicol implant and polypropylene are common materials used in suburethral anti-incontinence procedures. We explored the relative effectiveness of the autologous fascia pubovaginal sling, Pelvicol pubovaginal sling and Gynecare TVT on self-reported postoperative urinary incontinence.

Materials And Methods: The study was a mailed cross-sectional survey of health related quality of life 1 to 3 years after suburethral anti-incontinence surgery performed at our institution.

Pathophysiology of stress urinary incontinence.

All cases of stress urinary incontinence (SUI) are not the same; urethral pressures, prolapse conditions, and congenital and acquired sphincteric dysfunction all contribute to SUI pathophysiology. In order to optimally manage SUI, a thorough understanding of the pathophysiology behind the condition is necessary. Unsuccessful treatment of incontinence can result from the procedure itself or from a poor fit between the patient's condition and the treatment chosen.