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Intrinsic urethral sphincter deficiency

Allert M de Vries, Hendrikje M K van Breda, Jimmy G Fernandes, Pieter L Venema, John P F A Heesakkers
INTRODUCTION: Female stress urinary incontinence (SUI) is often treated surgically. Urethral bulking agents are a minimally invasive alternative, especially in patients suffering from intrinsic sphincter deficiency, but often with limited long-term efficacy. Urolastic® is a non-deformable, non-resorbable silicone elastomer that is used as an injectable. Its properties might result in a more durable response after injection. If this durability factor can be combined with a low complication rate, this can become a useful treatment option...
February 3, 2017: Urologia Internationalis
Edyta Wlaźlak, Volker Viereck, Jacek Kociszewski, Andrzej Kuszka, Oliver Rautenberg, Claudia Walser, Grzegorz Surkont, Marianne Gamper, Mathias K Fehr
AIMS: Intrinsic sphincter deficiency (ISD) is a known risk factor for therapy failure after tension-free vaginal tape (TVT) insertion. The purpose of this study was to investigate if the severity of ISD alone or other factors such as urethral mobility and tape localization influence outcomes. METHODS: One hundred and nine women with urodynamically determined ISD, a TVT insertion, and a 6-month follow-up visit were included. Urethral length, mobility, and tape localization were evaluated by pelvic floor sonography...
January 31, 2017: Neurourology and Urodynamics
Andrea Chua Santiago, Lieschen H Quiroz, S Abbas Shobeiri
OBJECTIVES: The aims of this study were to determine the association between x-ray funneling and ultrasound urethral sphincter complex measurements and to compare the reliability of funneling versus urethral volume measurement in the detection of intrinsic sphincter deficiency (ISD). METHODS: This was a retrospective analysis, which included 54 stress incontinent women dichotomized into those with (1) ISD and (2) no ISD. The presence of bladder neck funneling was diagnosed by fluoroscopic images obtained at the time of video-urodynamics testing...
January 24, 2017: Female Pelvic Medicine & Reconstructive Surgery
James Koudy Williams, Ashley Dean, Shannon Lankford, Tracy Criswell, Gopal Badlani, Karl-Erik Andersson
BACKGROUND: Cell therapy for intrinsic urinary sphincter deficiency (ISD) in women has been moderately effective, and improvements are needed. To improve treatment efficacy, it is important to better understand determinates of cell efficacy in the different patient cohorts. We have reported that in nonhuman primates the chronicity of ISD may affect cell efficacy, but additional factors (age, psychosocial stress, hormone status, body weight) can be associated with many disease/treatment outcomes in women - and these factors are the focus of this study...
January 6, 2017: Stem Cell Research & Therapy
Alaina Town Bennett, Emily Spencer Lukacz
We report the cases of 2 women who had urethral bulking injections with polydimethylsiloxane for stress urinary incontinence with intrinsic sphincter deficiency and reported initial improvement of symptoms followed by rapid return of stress urinary incontinence several weeks later associated with extrusion of the bulking material. We hypothesize this unique adverse outcome could represent immune rejection of this urethral bulking agent.
December 1, 2016: Female Pelvic Medicine & Reconstructive Surgery
J Koudy Williams, Gopal Badlani, Ashley Dean, Shannon Lankford, Kimberly Poppante, Tracy Criswell, Karl-Erik Andersson
BACKGROUND: Many factors may influence the efficacy of cell therapy for intrinsic urinary sphincter deficiency (ISD), including the route of administration of the cells and the condition of the sphincter. The goal of this study was to compare local versus intravenous administration of autologous skeletal muscle precursor cells (skMPCs) when administered to nonhuman primates (NHPs) with either acute or chronic ISD. METHODS: Thirty-two adult female monkeys were divided into eight groups (n = 4/group): (1) control; (2) surgically induced ISD/no treatment; (3) acute ISD (6-week duration)/local vehicle only; (4) acute ISD/local skMPC injection; (5) acute ISD/systemic skMPC; (6) chronic ISD (6-month duration)/local vehicle; (7) chronic ISD/local skMPC; (8) chronic ISD/systemic skMPC...
October 7, 2016: Stem Cell Research & Therapy
Caroline Massot, Hichem Khenioui, Olivier Agnani, Marc-Alexandre Guyot, Patrick Hautecoeur, Cécile Donze
PURPOSE: To report the prevalence and risk factors of stress urinary incontinence (SUI) and the prevalence of intrinsic sphincter deficiency in women with multiple sclerosis (MS). METHODS: We conducted a retrospective study. Female patients with MS, followed for lower urinary tract symptoms (LUTS) during a 15-year period were included. Demographic data, MS history, expanded disability status scale (EDSS) score at the urodynamic visit, obstetrical past, birth weight, LUTS, and urodynamic findings were collected...
September 2016: International Neurourology Journal
Aparna Hegde, Vivian C Aguilar, G Willy Davila
INTRODUCTION AND HYPOTHESIS: To determine the prevalence of levator ani (LA) muscle subdivision defects in patients with SUI using three-dimensional endovaginal ultrasound (3D EVUS). METHODS: This is a prospective cohort study of 100 patients with pure or predominant urodynamic SUI who underwent 3D EVUS. The 3D cubes obtained were analyzed and the LA muscle was divided into three subgroups: the puboperinealis/puboanalis, the puborectalis, and the iliococcygeus/pubococcygeus...
January 2017: International Urogynecology Journal
Eu Chang Hwang, Sun Ouck Kim, Dong Deuk Kwon
PURPOSE: To assess the reproducibility of the Valsalva leak point pressure (VLPP) based on urodynamics in females with stress urinary incontinence (SUI). MATERIALS AND METHODS: From October 2008 to December 2009, 65 consecutive women with urodynamically confirmed SUI underwent duplicate VLPP measurements. The intra-individual reproducibility of the VLPP recording obtained by one urologist was determined. The two observations were separated by a 10-min interval. RESULTS: The differences between the repeated measurements were not significant (initial vs...
2016: Urology Journal
J Koudy Williams, Ashley Dean, Sherif Badra, Shannon Lankford, Kimberly Poppante, Gopal Badlani, Karl-Erik Andersson
PURPOSE: Mixed efficacy results of autologous skeletal muscle precursor cell therapy in women with chronic intrinsic urinary sphincter deficiency have increased interest in the therapeutic value of alternative regenerative medicine approaches. The goal of this study was to compare the effects of the cell homing chemokine CXCL12 (C-X-C motif chemokine 12) and skeletal muscle precursor cells on chronic urinary sphincter regeneration in chronic intrinsic urinary sphincter deficiency. MATERIALS AND METHODS: Five million autologous skeletal muscle precursor cells or 100 ng CXCL12 were injected in the urinary sphincter complex of adult female cynomolgus monkeys with chronic (6-month history) intrinsic urinary sphincter deficiency...
June 4, 2016: Journal of Urology
Romain Boissier, Jeremy Magalon, Florence Sabatier, Julie Veran, Laurent Giraudo, Sophie Giusiano, Stephane Garcia, Françoise Dignat-George, Laurent Arnaud, Guy Magalon, Eric Lechevallier, Stephane Berdah, Gilles Karsenty
PURPOSE: To evaluate the healing abilities of autologous stem cell therapy (stromal vascular fraction) prepared from adipose tissue we used an automated system without an ex vivo culture phase in a pig model of intrinsic sphincteric deficiency. MATERIALS AND METHODS: A total of 15 pigs underwent endoscopic section of the urethral sphincter. Animals were then randomly assigned to 3 groups, including 1) controls without stromal vascular fraction injection, 2) early injection with stromal vascular fraction 2 to 3 days after section and 3) late stromal vascular fraction injection delivery 30 days after injury...
September 2016: Journal of Urology
Hyeong Gon Kim, Hyoung Keun Park, Sung Hyun Paick, Woo Suk Choi
BACKGROUND: The aim of this study was to compare the two types of mid-urethral slings for stress urinary incontinence (SUI) with intrinsic sphincter deficiency (ISD). METHODS: This retrospective study included patients who underwent tension-free vaginal tape (TVT) procedure or transobturator tape (TOT) procedure by a single surgeon for SUI with ISD, defined as Valsalva leak point pressure (VLPP) < 60 cmH2O in a urodynamic study. Cases of neurogenic bladder, previous SUI surgery, and concomitant cystocele repair were excluded...
2016: PloS One
F A Valentini, P P Nelson, P E Zimmern, G Robain
AIMS: We assume that the voiding process in women is governed by the detrusor contractility and a "urethral resistance". The value of these 2 parameters, respectively named k and U in the VBN (Valentini-Besson-Nelson) mathematical model of micturition is deduced from the VBN analysis of pressure-flow recordings (PFs). Our objectives were to search for a correlation between these 2 parameters and clinically relevant variables such as chief complaint, urodynamic diagnosis (UD), and age by decades...
June 2016: Progrès en Urologie
Farzaneh Sharifiaghdas, Farzam Tajalli, Maryam Taheri, Mohammad Naji, Reza Moghadasali, Nasser Aghdami, Hossein Baharvand, Vajihe Azimian, Neda Jaroughi
OBJECTIVES: To evaluate the effect of autologous muscle-derived cells injection in the treatment of complicated stress urinary incontinence in female patients. METHODS: Female patients presenting with severe and complicated stress urinary incontinence secondary to the bladder neck and/or urethral trauma or congenital epispadias (with or without exstrophy) were enrolled in this prospective study. They underwent transurethral injection of autologous muscle-derived cells...
July 2016: International Journal of Urology: Official Journal of the Japanese Urological Association
Jeremy B Myers, Erik N Mayer, Sara Lenherr
Neurogenic bladder is a very broad disease definition that encompasses varied disease and injury states affecting the bladder. The majority of patients with neurogenic bladder dysfunction do not have concomitant intrinsic sphincteric deficiency (ISD), but when this occurs the challenges of management of urinary incontinence from neurogenic bladder are compounded. There are no guidelines for surgical correction of ISD in adults and most of the literature on treatment of the problem comes from treatment of children with congenital diseases, such as myelomeningocele...
February 2016: Translational Andrology and Urology
Tsia-Shu Lo, Leng Boi Pue, Yiap Loong Tan, Pei-Ying Wu
INTRODUCTION AND HYPOTHESIS: To study the outcomes following repeat midurethral sling (MUS) surgery in patients with persistent or recurrent stress urinary incontinence after failure of primary MUS surgery and risk factors for surgical failure. METHODS: The medical records of 24 patients who underwent repeat MUS surgery at a single tertiary center from January 2004 to February 2014 were reviewed. The types of MUS used for the repeat surgey were transobturator, retropubic and single incision slings...
June 2016: International Urogynecology Journal
Katarzyna Jadwiga Macura, Richard Eugene Thompson, David Alan Bluemke, Rene Genadry
AIM: To define the magnetic resonance imaging (MRI) parameters differentiating urethral hypermobility (UH) and intrinsic sphincter deficiency (ISD) in women with stress urinary incontinence (SUI). METHODS: The static and dynamic MR images of 21 patients with SUI were correlated to urodynamic (UD) findings and compared to those of 10 continent controls. For the assessment of the urethra and integrity of the urethral support structures, we applied the high-resolution endocavitary MRI, such as intraurethral MRI, endovaginal or endorectal MRI...
November 28, 2015: World Journal of Radiology
Abigail A Ford, Joseph A Ogah
INTRODUCTION AND HYPOTHESIS: Stress urinary incontinence is a common problem affecting 12-46% of women. A cohort of women have a more severe form of stress urinary incontinence usually due to intrinsic urethral sphincter deficiency that has traditionally resulted in lower success rates with standard treatment modalities. We aim to address the question of whether transobturator sling insertion is more effective than retropubic sling insertion in the treatment of intrinsic sphincter deficiency-related stress urinary incontinence in women...
January 2016: International Urogynecology Journal
Odunayo Kalejaiye, Monika Vij, Marcus John Drake
INTRODUCTION: The relevant terminology for stress urinary incontinence (SUI) is affected by the context, namely the clinical assessment (the symptom of SUI elicited on history taking and the sign of SUI observed during examination) or diagnostic investigations (urodynamic stress incontinence). In some cases, SUI may only be observed after the reduction in coexistent prolapse (occult SUI). Classifying SUI often relies on distinguishing between intrinsic sphincter deficiency (ISD), and urethral malposition or hypermobility, although this potentially an over-simplification...
September 2015: World Journal of Urology
Christopher James Hillary, Nadir Osman, Christopher Chapple
PURPOSE: Intrinsic sphincter deficiency (ISD) is a common cause of stress urinary incontinence and is associated with more severe symptoms, often being associated with failed previous surgery. Due to the impaired sphincteric function, alternative surgical approaches are often required. The purpose of this review is to appraise the contemporary literature on the diagnosis and management of ISD. METHODS: A PubMed search was performed to identify articles published between 1990 and 2014 using the following terms: ISD, stress urinary incontinence and type III stress urinary incontinence...
September 2015: World Journal of Urology
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