UROLOGICAL SURVEY
Choe JH; Lee JS; Seo JT
Department of Urology, Cheil General Hospital, Kwandong University College of Medicine, Seoul, Korea
Neurourol Urodyn. 2007; 26: 847-51
AIM: A prospective study was performed to determine the incidence of significant bacteriuria and to identify the risk factors for bacteriuria after urodynamic studies (UDSs) in women with urodynamic stress urinary incontinence (SUI).
METHODS: A total of 225 women with urodynamic SUI were evaluated. All women were negative on double-screened urine cultures, in clean-catch midstream urine (MSU) specimens, before UDS. Another urine specimen was obtained for urinalysis and culture at 3-7 days after UDS. Urinary culture with 10(5) CFU/ml or more was regarded as significant bacteriuria. To identify the risk factors for significant bacteriuria, the clinical characteristics of all patients including age, BMI, parity, medical and operation history, degree of pelvic organ prolapse, results of urinalysis, and UDS were evaluated.
RESULTS: The prevalence of significant bacteriuria was 6.2%. The most common identified microorganism was Escherichia coli (57.1%). Univariate analysis demonstrated that a history of recurrent urinary tract infection (UTI; P = 0.002) and urological surgery or procedure (P = 0.02) were significant predictors of significant bacteriuria. On multiple logistic regression analysis the past history of recurrent UTI was the only significant independent risk factor (OR = 28.5, 95% CI = 4.309-188.488, P = 0.009).
CONCLUSIONS: This study suggests that for most women with SUI it may be unnecessary to use preventive prophylactic antibiotics in UDS. However, our results suggest that in patients with a previous history of recurrent UTI or urologic surgery the risk for significant bacteriuria is increased and use of prophylactic antibiotics should be considered. Neurourol. Urodynam. 26:847-851, 2007. (c) 2007 Wiley-Liss, Inc.
Editorial Comment
Investigators performed a prospective study examining the prevalence of significant bacteriuria after urodynamic studies and to identify risk factors for same. It was noted that recurrent cystitis and previous urologic instrumentation or procedures were significant risk factors of bacteriuria. The authors obtained urine approximately one week before the urodynamics, at the time of the urodynamic studies, as well as 3-7 days after urodynamic studies were done. These investigators concluded that because the cultures were sterile for the procedure that all acquired infections within the week after the urodynamic studies were most likely due to the urodynamic studies. Of note is that the bacteriuria after the urodynamic studies was most likely non-nosocomial. It would have been or great interest if the authors had been able to query the patients on the frequency and intensity of coitus for the period immediately after the urodynamic studies to the time that the post-procedure urine studies were obtained. The existence of "honeymoon cystitis" is well known even in the mature or infirmed population.
Dr. Steven P. Petrou
Associate Professor of Urology
Chief of Surgery, St. Luke's Hospital
Associate Dean, Mayo School of Medical Education
Jacksonville, Florida, USA
Outcomes following repeat mid urethral synthetic sling after failure of the initial sling procedure: rediscovery of the tension-free vaginal tape procedure
Lee KS; Doo CK; Han DH, Jung BJ; Han JY; Choo MS
Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
J Urol. 2007; 178: 1370-4; discussion 1374
PURPOSE: We evaluated outcomes of the repeat mid urethral sling to treat recurrent or persistent stress urinary incontinence after failure of an initial mid urethral sling.
MATERIALS AND METHODS: We retrospectively analyzed data on patients who underwent the repeat mid urethral sling procedure due to persistent or recurrent stress urinary incontinence. Repeat slings were placed without removal of the previous sling. All patients were followed at least 1 year after the second mid urethral sling.
RESULTS: Of the 31 female patients with a repeat mid urethral sling 29 were followed, including 13 with a retropubic and 16 with a transobturator sling. For the first mid urethral sling 17 patients received a retropubic sling (tension-free vaginal tape) and 12 received a transobturator sling (6 inside out and 6 outside in procedures). Cure and improvement rates irrespective of the approach were 75.9% (22 of 29 patients) and 6.9% (2 of 29), respectively. Cure rates for the retropubic and transobturator slings were 92.3% (12 of 13 patients) and 62.5% (10 of 16), respectively, a difference that did not quite attain statistical significance (p = 0.089).
CONCLUSIONS: The repeat mid urethral sling for persistent or recurrent stress urinary incontinence has a lower cure rate than the initial sling. However, the retropubic approach tends to have a higher cure rate than the transobturator approach in repeat sling cases.
Editorial Comment
The authors review their very large experience with suburethral slings and report on patients who underwent a repeat suburethral sling. The study group included retropubic suburethral slings as well as the transobturator approaches. The surgeons noted that their repeat suburethral sling procedure that was a re-do operation had a lower success rate than the initial operation success rate. This has been noted as well for patients undergoing re-do pubovaginal slings using autologous fascia for operative failures (1). The trend towards a lesser cure rate with a repeat transobturator procedure versus a retropubic approach could potentially be explained by both the urethral angle theory as discussed by the authors as well as the level of suburethral support that can be provided by the different techniques. The diminished efficacy of transobturator slings in patients with lower Valsalva leak point pressures is currently being explored in the literature (2).
References
1. Petrou SP, Frank I: Complications and initial continence rates after repeat pubovaginal sling procedure for recurrent stress urinary incontinence. J Urol. 2001; 165: 1979-81.
2. Guerette NL, Bena JF, Davila GW: Transobturator slings for stress incontinence: using urodynamic parameters to predict outcomes. Int Urogynecol J Pelvic Floor Dysfunct. 2007, Jun 5; [Epub ahead of print].
Dr. Steven P. Petrou
Associate Professor of Urology
Chief of Surgery, St. Luke's Hospital
Associate Dean, Mayo School of Medical Education
Jacksonville, Florida, USA
Neurourology & Female Urology
Publication Dates
-
Publication in this collection
29 Feb 2008 -
Date of issue
Oct 2007
