The Science behind Biomaterials in Female Stress Urinary Incontinence Surgery

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

MINIMALLY INVASIVE PROCEDURES FOR URETHRAL INCONTINENCE: IS THERE A ROLE FOR LAPAROSCOPY? , PAULOS YOHANNES

ABSTRACT This article focuses on the minimally invasive surgical approaches for the treatment of stress urinary incontinence (SUI). The role of laparoscopic suspension is reviewed and compared with other minimally invasive techniques, such as the pubovaginal sling procedure and injection of the urethral bulking agents. The role of laparoscopic Burch colposuspension remains ill defined in 2002. Once this minimally invasive technique is shown to duplicate the success rate of the open Burch procedure, it could be offered as a first-line therapy to patients with SUI. At this time, the pubovaginal sling (PVS) offers the best long-term results with acceptable low complication rates of urinary retention, urgency, and sling erosion or infection. These complications are rarely seen with the laparoscopic repair but the incidence of bladder injuries is higher. The PVS operation can be performed as a salvage procedure, in obese patients, and concomitant with cystocele and rectocele repair whereas data for laparoscopy in these conditions are lacking. Until the long-term efficacy of the laparoscopic repair is clearly defined, offering it to patients as a minimally invasive therapy denies them of procedures with superior efficacy

Use of Antimuscarinics in the Elderly

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