OBJECTIVE: To determine the relationship between the clinical outcome of suburethral sling surgery for stress urinary incontinence and sling location on ultrasound examination. METHODS: This was a retrospective study of patients diagnosed with stress urinary incontinence who were treated with a suburethral sling by a single surgeon between January 2009 and October 2016. Four-dimensional volumes acquired on transperineal ultrasound at least 3 months postoperatively were analyzed and the gap between the sling and symphysis pubis (sling-pubis gap (SPG)) on Valsalva maneuver was measured. Continence was assessed on a cough stress test at follow-up. RESULTS: A total of 378 patients were included, with a mean follow-up of 14.3 months. The success rate of sling surgery was 89.4%. The mean ± SD SPG on Valsalva maneuver was 12.0 ± 2.5 mm in women who were clinically continent at follow-up and 14.1 ± 2.8 mm in those with failed surgery (P < 0.001). CONCLUSION: A shorter SPG on transperineal ultrasound imaging after suburethral sling surgery is associated with cure of stress urinary incontinence. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
PURPOSE: This large dose-ranging study explored the benefits of different combinations of mirabegron and solifenacin on health-related quality of life (HRQoL), based on patient-reported outcomes (PROs), and patients ('responders') achieving clinically meaningful improvements in efficacy and HRQoL. METHODS: SYMPHONY (NCT01340027) was a Phase II, placebo- and monotherapy-controlled, dose-ranging, 12-week trial. Adult patients with overactive bladder (OAB) for ≥3 months were randomized to 1 of 12 groups: 6 combination (solifenacin 2.5/5/10 mg + mirabegron 25/50 mg), 5 monotherapy (solifenacin 2.5/5/10 mg, or mirabegron 25/50 mg), or placebo. Change from baseline to end of treatment was assessed, versus placebo and solifenacin 5 mg in: PROs (OAB-q [Symptom Bother/total HRQoL] and Patient Perception of Bladder Condition score), and responders achieving minimally important differences (MIDs) in PROs and predetermined clinically meaningful improvements in efficacy (e.g. <8 micturitions/24 h). Changes in PROs and responders were analysed using an ANCOVA model and logistic regression, respectively. RESULTS: The Full Analysis Set included 1278 patients. Combination therapy of solifenacin 5/10 mg + mirabegron 25/50 mg significantly improved PROs versus solifenacin 5 mg and placebo, and significantly more responders achieved MIDs in PROs and efficacy. Micturition frequency normalization was approximately twofold greater with 10 + 25 mg (OR 2.06 [95 % CI 1.11, 3.84; p = 0.023]) and 5 + 50 mg (OR 1.91 [95 % CI 1.14, 3.21; p = 0.015]) versus solifenacin 5 mg. CONCLUSION: Combining mirabegron 25/50 mg and solifenacin 5/10 mg improves objective and subjective efficacy outcomes compared with placebo or solifenacin 5 mg.
- MeSH
- acetanilidy aplikace a dávkování MeSH
- dospělí MeSH
- dvojitá slepá metoda MeSH
- hodnocení výsledků péče pacientem MeSH
- hyperaktivní močový měchýř farmakoterapie MeSH
- kombinovaná farmakoterapie MeSH
- kvalita života * MeSH
- lidé středního věku MeSH
- lidé MeSH
- minimální klinicky významný rozdíl MeSH
- senioři MeSH
- solifenacin sukcinát aplikace a dávkování MeSH
- thiazoly aplikace a dávkování MeSH
- urologické látky aplikace a dávkování MeSH
- výsledek terapie MeSH
- zdravotní stav MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- klinické zkoušky, fáze II MeSH
- randomizované kontrolované studie MeSH
- MeSH
- estrogeny fyziologie nedostatek MeSH
- inkontinence moči etiologie patofyziologie MeSH
- lidé MeSH
- postmenopauza MeSH
- progesteron fyziologie nedostatek MeSH
- stresová inkontinence moči etiologie patofyziologie MeSH
- urogenitální systém fyziologie patofyziologie MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- přehledy MeSH
- MeSH
- dospělí MeSH
- farmakoterapie MeSH
- inkontinence moči terapie MeSH
- lidé MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- MeSH
- lidé MeSH
- stresová inkontinence moči terapie MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- MeSH
- antidepresiva terapeutické užití MeSH
- antikonvulziva terapeutické užití MeSH
- inkontinence moči etiologie farmakoterapie MeSH
- lidé MeSH
- parasympatolytika terapeutické užití MeSH
- sympatolytika terapeutické užití MeSH
- sympatomimetika terapeutické užití MeSH
- vápník antagonisté a inhibitory MeSH
- Check Tag
- lidé MeSH
- MeSH
- dospělí MeSH
- karcinogeny analýza MeSH
- kojení MeSH
- lidé MeSH
- mateřské mléko analýza MeSH
- tuková tkáň analýza MeSH
- znečištění životního prostředí MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- srovnávací studie MeSH
