Long-term Clinical Outcomes of the Tension-free Vaginal Tape Procedure for the Treatment of Stress Urinary Incontinence in Elderly Women over 65

Purpose: The aim of this study was to assess the long-term clinical outcomes of the tension-free vaginal tape (TVT) procedure for stress urinary incontinence (SUI) in elderly women and to identify the factors influencing failure in these cases. Materials and Methods: Women with SUI who underwent a TVT procedure were studied. “Cure ” was defined as no urine leakage at all in any circumstances and “improvement ” was defined as some urine leakage but a score of over 4 points out of 5 in a satisfaction inquiry. Patients were divided into two groups (middle-aged, <65 years and elderly, ≥65 years) for comparison of clinical outcomes. In the elderly group, patients were subdivided into two groups (cure and no cure groups) and were compared to identify the factors influencing failure. Results: A total of 136 women (middle-aged group, 106; elderly group, 30) were enrolled in the study. The mean ages of the patients in the 2 groups were 53.5±5.9 and 72.0±5.0 years and the mean follow-up times were 50.5±9.4 and 48.8±9.1 months, respectively. The cure and improvement rates in the middle-aged and elderly groups were 80.2% vs. 66.7 % and 4.7 % vs. 3.3%, respectively (p>0.05). The satisfaction scores in the middle-aged and elderly groups were 3.8±1.1 vs. 3.3±1.5 points (p>0.05). In the elderly group, the body mass index of the cure and no cure groups were 24.6±3.3 kg/m 2 and 26.6±1.0 kg/m 2, and body mass index was the only factor that differed significantly between the two subgroups (p=0.028). Conclusions: Our long-term results suggest that TVT is an effective treatment even in elderly women. However, elderly women who are obese should be counseled carefully about the success rate. Key Words: Eldery; Stress; Suburethral slings; Urinary incontinence This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial Licens

Nonselective Blocking of the Sympathetic Nervous System Decreases Detrusor Overactivity in Spontaneously Hypertensive Rats

The involuntary dual control systems of the autonomic nervous system (ANS) in the bladder of awake spontaneously hypertensive rats (SHRs) were investigated through simultaneous registrations of intravesical and intraabdominal pressures to observe detrusor overactivity (DO) objectively as a core symptom of an overactive bladder. SHRs (n = 6) showed the features of overactive bladder syndrome during urodynamic study, especially DO during the filling phase. After injection of the nonselective sympathetic blocking agent labetalol, DO disappeared in 3 of 6 SHRs (50%). DO frequency decreased from 0.98 ± 0.22 min−1 to 0.28 ± 0.19 min−1 (p < 0.01), and DO pressure decreased from 3.82 ± 0.57 cm H2O to 1.90 ± 0.86 cm H2O (p < 0.05). This suggests that the DO originating from the overactive parasympathetic nervous system is attenuated by the nonselective blocking of the sympathetic nervous system. The detailed mechanism behind this result is still not known, but parasympathetic overactivity seems to require overactive sympathetic nervous system activity in a kind of balance between these two systems. These findings are consistent with recent clinical findings suggesting that patients with idiopathic overactive bladder may have ANS dysfunction, particularly a sympathetic dysfunction. The search for newer and better drugs than the current anticholinergic drugs as the mainstay for overactive bladder will be fueled by our research on these sympathetic mechanisms. Further studies of this principle are required

Transvaginal Cystocele Repair by Purse-String Technique Reinforced with Three Simple Sutures: Surgical Technique and Results

Purpose Different techniques for cystocele repair including the conventional anterior colporrhaphy and mesh technique are known. Our goal was to evaluate the anatomical success and safety of our method of transvaginal anterior vaginal wall repair by the purse-string technique reinforced with three simple additional sutures in the repair of cystocele over a 4-year follow-up period. Methods This was a retrospective review of 69 consecutive patients (grades 2 to 4) who underwent the above operations between 2001 and 2011, including their success rates as assessed by use of the Baden-Walker halfway classification system. Results Of the patients, 62 patients (98%) were completely cured of cystocele and 1 patient showed grade 2 cystocele recurrence that required no further treatment. Two patients with grade 4 cystocele were completely cured. There was no vaginal erosion related to the cystocele repair. Conclusions Transvaginal anterior colporrhaphy by a purse-string technique reinforced with simple additive sutures appears to be a simple, safe, and easily performed approach in cystocele repair. There is no need for other material for reinforcement, even in high-grade cystocele, which is an advantage of our technique

Effect of Anti-Siglec-F Antibody and Reactive Oxygen Species Blocking on Histamine Release in Urinary Bladder of Ovalbumin-Treated Mice

Purpose Sialic acid-binding Ig-like lectin (Siglec) is an immune inhibitory receptor that plays a role in the negative regulation of the activation of immune cells. This study aimed to evaluate the effects of anti-Siglec-F on plasma and urinary histamine levels in ovalbumin (OVA)-challenged urinary bladder in mice. Methods Thirty BALB/c mice were used. In group I (control group, n=5), mice were sensitized with OVA and challenged with saline. In group II (OVA challenge group, n=5), OVA was used for intraperitoneal sensitization and intravesical challenge. The challenged mice in group III (control immunoglobulin G [IgG] group, n=5) and those in group IV (anti-Siglec-F group, n=5) were intraperitoneally pretreated with rabbit control IgG or anti-Siglec-F antibody, respectively. In groups V (N-acetylcysteine [NAC] in OVA challenge group, n=5) and VI (control NAC only, n=5), mice were pretreated with NAC. Results Urinary histamine concentrations were significantly higher 7 days after intravesical OVA challenge (P<0.01), whereas plasma histamine levels were not. Pretreatment with anti-Siglec-F antibody significantly prevented the increase in urinary histamine release (P<0.05), whereas pretreatment with the IgG antibody control did not. Also, pretreatment of the OVA challenge group with NAC did not affect the histamine concentration in either urine or plasma. Conclusions Systemic anti-Siglec-F treatment showed anti-allergic effects at least on local histamine release, particularly in the lower urinary bladder