Quality of life and objective outcome assessment in women with tape division after surgery for stress urinary incontinence.

BACKGROUND:Midurethral tapes may cause long-term complications such as voiding dysfunction, groin pain, de novo urgency or mesh erosion, which necessitate a reoperation. There is a paucity of data regarding health related quality of life in patients undergoing tape removal. The aim of the study was to evaluate quality of life (QoL) and objective outcome after midurethral tape division or excision. METHODS:All patients who underwent a midurethral tape division for voiding difficulties, pain or therapy resistant de novo overactive bladder between 1999 and 2014 were invited for follow-up. A control group with a suburethral tape without division was established in a 1:2 ratio and matched for age, tape used and year of tape insertion. Patients completed the Kings´ Health Questionnaire (KHQ), Incontinence Outcome Questionnaire, Female Sexual Function Index Questionnaire and the Patient Global Impression of Improvement score. RESULTS:Tape division or excision was performed in 32 women. Overall, 15 (60%) of 25 women who were alive were available for clinical examination and completed the questionnaires. Tape division was performed for voiding dysfunction (n = 7), overactive bladder (n = 2), mesh extrusion (n = 3) and ongoing pain (n = 3). Median time to tape division/excision was 10 months. Three women in the tape division group had undergone reoperation for stress urinary incontinence (SUI). At a median follow-up of 11 years (IQR 9-13) subjective SUI rate was 53% (8/15 women) in the tape division group and 17% (5/30) in the control group (p = 0.016), with no significant differences in objective SUI rates between groups. With regard to quality of life, the study group had significantly worse scores in the SUI related domains role limitation, physical limitation, severity measures and social limitations (KHQ) compared to the control group. CONCLUSIONS:Women needing tape division or excision have lower SUI related QoL scores compared to controls mostly because of higher subjective SUI rates

Results of the Kings Health questionnaire at study visit.

<p>Results of the Kings Health questionnaire at study visit.</p

Results of the FSFI-Questionnaire at study visit.

<p>Results of the FSFI-Questionnaire at study visit.</p

Demographic data of patients at the time of incontinence surgery.

<p>Demographic data of patients at the time of incontinence surgery.</p

Clinical data at time of follow up.

<p>Clinical data at time of follow up.</p

Urogynecological assessment at follow-up (n = 38).

<p>Urogynecological assessment at follow-up (n = 38).</p

Scatter plot—Correlations between quality of life and time intervals.

<p>A: General health perception (Kings Health questionnaire) versus time interval between initial surgery and revision. B: General health perception (King Health questionnaire) versus time since revision surgery and follow-up. C: Extended QoL (Incontinence Outcome Questionnaire) versus time interval between initial surgery and revision. D: Extended QoL (Incontinence Outcome Questionnaire) versus time interval between initial surgery and revision.</p

Management von Dammrissen dritten und vierten Grades nach vaginaler Geburt. Leitlinie der DGGG, OEGGG und SGGG (S2k-Level, AWMF-Register Nr. 015/079, Dezember 2020)

Purpose This guideline provides recommendations for the diagnosis, treatment and follow-up care of 3rd and 4th degree perineal tears which occur during vaginal birth. The aim is to improve the management of 3rd and 4th degree perineal tears and reduce the immediate and long-term damage. The guideline is intended for midwives, obstetricians and physicians involved in caring for high-grade perineal tears. Methods A selective search of the literature was carried out. Consensus about the recommendations and statements was achieved as part of a structured process during a consensus conference with neutral moderation. Recommendations After every vaginal birth, a careful inspection and/or palpation by the obstetrician and/or the midwife must be carried out to exclude a 3rd or 4th degree perineal tear. Vaginal and anorectal palpation is essential to assess the extent of birth trauma. The surgical team must also include a specialist physician with the appropriate expertise (preferably an obstetrician or a gynecologist or a specialist for coloproctology) who must be on call. In exceptional cases, treatment may also be delayed for up to 12 hours postpartum to ensure that a specialist is available to treat the individual layers affected by trauma. As neither the end-to-end technique nor the overlapping technique have been found to offer better results for the management of tears of the external anal sphincter, the surgeon must use the method with which he/she is most familiar. Creation of a bowel stoma during primary management of a perineal tear is not indicated. Daily cleaning of the area under running water is recommended, particularly after bowel movements. Cleaning may be carried out either by rinsing or alternate cold and warm water douches. Therapy should also include the postoperative use of laxatives over a period of at least 2 weeks. The patient must be informed about the impact of the injury on subsequent births as well as the possibility of anal incontinence.Ziel Die Leitlinie soll insbesondere durch Empfehlungen zu Diagnostik, Therapie und Nachsorge nach höhergradigen Dammrissen im Rahmen vaginaler Geburten das Management dieser Situationen verbessern und mitwirken, unmittelbare sowie langzeitige Folgeschäden zu reduzieren. Die Leitlinie richtet sich an Hebammen, an geburtshilflich tätige Ärztinnen und Ärzte sowie an Ärztinnen und Ärzte, die in die Versorgung von höhergradigen Dammrissen involviert sind. Methoden Es erfolgte eine selektive Literaturrecherche. Die strukturierte Konsensfindung der Empfehlungen und Statements erfolgte bei der Konferenz unter neutraler Moderation. Empfehlungen Nach jeder vaginalen Geburt soll ein Dammriss III°/IV° zunächst durch sorgfältige Inspektion und/oder Palpation durch den Geburtshelfer und/oder die Hebamme ausgeschlossen werden. Die vaginale sowie anorektale Palpation zur Evaluierung von Geburtsverletzungen sind dabei un- abdingbar. Im Operationsteam soll ein Facharzt mit ausreichender Erfahrung (vorrangig Facharzt für Frauenheilkunde und Geburtshilfe oder Facharzt mit koloproktologischer Expertise) zur Verfügung stehen. In Ausnahmefällen kann die Versorgung auch bis zu 12 Stunden postpartal durchgeführt werden, um eine fachgerechte Versorgung in den einzelnen, durch das Trauma einbezogenen Schichten, zu gewährleisten. Da weder die Stoß-auf-Stoß-Technik noch die überlappende Technik in der Versorgung des Risses des M. sphincter ani externus eine Überlegenheit gezeigt hat, soll der Operateur die Methode, bei der die größere Routine besteht, zur Anwendung bringen. Hierbei soll die Anlage eines Anus praeters im Rahmen der primären Versorgung nicht vorgenommen werden. Eine tägliche Reinigung mit fließendem Wasser, insbesondere nach dem Stuhlgang, wird empfohlen. Diese kann z. B. als Spülung oder Wechseldusche durchgeführt werden. Die postoperative Gabe von Laxanzien sollte über eine Therapiedauer von zumindest 2 Wochen erfolgen. Eine Aufklärung über das Vorgehen bei Folgegeburten wie auch einer potenziellen analen Inkontinenz soll erfolgen