The prevalence of pure stress urinary incontinence (P-SUI) and the role of urodynamic investigation (UDI) prior to surgery for stress urinary incontinence (SUI) is debated. Since the exact prevalence of P-SUI is not clear, its clinical and economic impact is not well defined. The aims of this study were to evaluate the prevalence of P-SUI in a population of women who underwent UDI for urinary incontinence (UI), also assessing: 1) the correspondence between clinical diagnosis of P-SUI and urodynamic findings; 2) the analysis of costs in terms of UDI and eventually post-UDI avoided surgical procedures. A single cohort of women who underwent UDI for UI between January 2012 and July 2016 was prospectively collected and retrospectively analyzed. Clinical P-SUI was defined by the strict criteria of the International Continence Society. For each patient, history, physical examination and UDI were collected. The correspondence between clinical and urodynamic findings of P-SUI was analyzed. The rate of clinical P-SUI changed after performing UDI and the number of unnecessary intervention after UDI were reported. A wide cost analysis of UDIs, and the amount of surgical procedures that were believed unnecessary after UDI was reported. Stress urinary incontinence was present in 323/544 (59.4%) patients. The prevalence of clinical P-SUI was 20.7% (67/323), while the prevalence of complicated SUI (C-SUI) was 79.3% (256/323). After UDI, diagnosis of P-SUI decreased to 18.3% (59/232). In 10.2% of cases (6/59) the scheduled middle urethral sling (MUS) was suppressed after the UDI results because 3/6 cases had detrusor overactivity and urge incontinence, in 2/6 cases SUI was treated with a conservative management, in 1/6 case an important voiding dysfunction was detected. Considering the national reimbursement in our country, the cost of each UDI was 296.5 euros and the total amount was 17,493.5 euros. So far the surgery-related savings covered 61.7–105.0% of the costs of total number of UDIs performed in the uncomplicated patients. The prevalence of clinical P-SUI is relevant, involving about 20% of women with clinical SUI. Although the correspondence between clinical and urodynamic diagnosis was high, we demonstrated that UDI may help in some cases to avoid an inappropriate surgical treatment. Therefore, UDI prior to SUI surgery should be considered to achieve a correct diagnosis and a proper therapeutic strategy.

Overactive bladder (OAB) is subtyped into OAB-wet and OAB-dry, based on the presence or absence, respectively, of urgency incontinence. Although women with OAB frequently have a higher risk for sexual dysfunction, a systematic review on the impact of OAB-wet on female sexuality is lacking. This may be evaluated by measuring the effect of the bladder condition on sexuality per se, or by the effect of OAB treatment on female sexual dysfunction. To assess the role of OAB-wet on female sexual function. A systematic review of the literature was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement recommendations. Research on PubMed, EMBASE, and SCOPUS was performed and concluded on October 15, 2018. A systematic computerized search was conducted on published literature from January 1, 2000-2018. Meta-analysis was performed with a meta-analysis program. The following search terms were used: ((("female sexual function") OR ("female sexual dysfunction") OR ("female sexuality") OR ("dyspareunia")) AND (("overactive bladder") OR ("coital incontinence") OR ("detrusor instability") OR ("detrusor overactivity") OR ("urge urinary incontinence") OR (onabotulinumtoxinA) OR ("botulinum") OR ("sacral neuromodulation") OR (SNM) OR (PTNS) OR ("stoller afferent neuro-stimulation") OR ("SANS") OR ("antimuscarinic drugs") OR ("anticholinergic") OR ("peripheral neuromodulation") OR (beta-agonist))). 1,033 references were reviewed for inclusion and exclusion criteria. Final analysis identified 12 articles for systematic review. OAB-wet was reported as the most affecting factor on sexuality. OAB treatments showed improvement of both the OAB-wet and the sexual function. Results of the meta-analysis suggested that OAB therapies improving OAB-wet significantly reduced female sexual dysfunction (odds ratio 0.19; 95% CI 0.26-0.45). OAB-wet represents a risk for sexual dysfunction; however, data available show low-quality evidence of the impact of OAB-wet on sexual dysfunction. Balzarro M, Rubilotta E, Mancini V, et al. Impact of Overactive Bladder-Wet Syndrome on Female Sexual Function: A Systematic Review and Meta-Analysis. Sex Med Rev 2019;7:565-574.

Background: Laparoscopic sacrocolpopexy (LSC) is the gold standard for the treatment of apical prolapse, although dissection of the promontory may be challenging. Laparoscopic lateral suspension (LLS) with mesh is an alternative technique for apical repair with similar anatomical and functional outcomes, according to recent studies. The purpose of this study was to compare these operative techniques. Methods: Women with uterine Pelvic Organ Prolapse Quantification (POP-Q) stage 2 were enrolled in this prospective study and were randomly allocated to the LLS or LSC group. At the 12-month follow-up, primary measures included both anatomical and functional outcomes. Perioperative parameters and complications were recorded. Results: A total of 93 women were randomized, 48 in the LLS group and 45 in the LSC group, with 2 women lost to follow-up in both groups. LSC anatomic success rates were 81.82% for the apical compartment and 95.22% for the anterior compartment. LLS anatomic success rates for the apical and anterior compartments were 90% and 92.30%, respectively. The mean operative time for LLS was 160.3 min, while for LSC it was 168.3 min. The mean blood loss was 100 mL in both procedures. Conversion to laparotomy was necessary in three women. Mesh erosion was not observed in any of the cases. In terms of the complication, Clavien–Dindo grade 1 was observed in two patients in the LLS group and a complication rated grade 3b was observed in one patient in LSC group. Conclusions: LLS is a good alternative to LSC, with promising anatomical and quality-of-life results.