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EJ McGuire

Publications and source records attributed to EJ McGuire.

9 recordsLinked to original sources
PubMed1996

Evaluation of Female Urinary Incontinence.

History and physical examination, along with simple diagnostic tests, are the best means for evaluating urinary incontinence. History assesses the severity of the incontinence and its effect on the patient's life. Physical examination is necessary to evaluate the degree of incontinence and possible neurologic disorders. A cystometrogram can be used to evaluate bladder compliance. It is easy to perform and may be the most important and useful urodynamic test for this problem.

Journal Article↗
PubMed1996

Selecting the Best Surgical Option for Stress Urinary Incontinence.

Although there are many surgical procedures available to treat urinary incontinence, obtaining the best results depends on a thorough preoperative evaluation of the patient. Traditional urodynamic evaluation of stress urinary incontinence (SUI) focusing on maximum urethral closing pressures has been found to be less useful than the abdominal leak point pressure (ALPP) test in detecting intrinsic sphincter deficiency (ISD). An ALPP less than or equal to 60cm H2O indicates a significant degree of ISD, whereas a leak point pressure greater than or equal to 90cm H2O is usually associated with pure urethral hypermobility. When combined with the history, physical examination, and a filling cystometrogram, the additional objective data obtained from ALPP permit an accurate classification of the stress incontinence and are useful to the clinician in choosing the most appropriate treatment. Anterior colporrhaphy is still commonly used by gynecologists to treat SUI, but the narrow indications (type I SUI only) and poor long-term results have decreased its popularity. It is a poor choice for treating SUI related to urethral hypermobility. Retropubic urethropexy is the treatment standard for SUI procedures against which all other procedures have been compared. Five-year cure rates are in the range of 80% to 90%. Other procedures for treating SUI related to urethral hypermobility include laparoscopic bladder neck suspension, abdominal paravaginal repair, and needle bladder neck suspension. Surgical treatment for ISD differs from that for urethral hypermobility and includes pubovaginal sling procedures, injectable agents, and insertion of the artificial urinary sphincter. Concurrent pelvic prolapse conditions should be treated simultaneously and may dictate the surgical approach. When the proper procedure is utilized, good long-term results can be expected.

Journal Article↗
PubMed1996

Assessing and Managing Urinary Incontinence in Primary Care.

Incontinence generally results from a problem either with the urethra or with the bladder. The urethra can permit urine to leak when it moves incessantly due to poor support or when it closes poorly, as can occur with a neurologic disorder. In the bladder, hyperactivity due to involuntary contractions, or low compliance, can lead to urinary incontinence. A thorough history and physical examination guide management. The history should elicit information that can allow the clinician to assess how severe the problem is (eg, number of pads used per day, frequency of leakage) and factors that may cause or influence the problem, such as medications used, previous surgical and obstetric history, and urologic history including prior therapy for incontinence. Information about when leakage is at its worst is useful. Leakage that worsens in winter is typically associated with detrusor instability. Leakage that worsens at night can indicate a problem with bladder compliance. Incontinence that started after the onset of an antihypertensive or antipsychotic medication may be due to alpha-receptor antagonist effects of drugs such as prazosin or chlorpromazine. Difficulty emptying the bladder may be associated with medications that block cholinergic and calcium-channel activity, such as sedatives, antidepressants, antispasmodics, antiemetics, antipsychotics, antiarrhythmics, and anticonvulsants. Mild incontinence can be managed conservatively in a primary care setting, with pelvic-floor exercise, behavior therapy, or anticholinergic therapy. Patients with severe incontinence or an unclear etiology of incontinence should be referred to a specialist for urodynamic testing.

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