Biomedical subjects

George D Webster

Publications and source records attributed to George D Webster.

At least 19 recordsLinked to original sources

PubMed2007

In patients undergoing neuromodulation for intractable urge incontinence a reduction in 24-hr pad weight after the initial test stimulation best predicts long-term patient satisfaction.

AIMS: To evaluate long-term patient satisfaction of sacral neuromodulation and to correlate satisfaction with incontinence parameters. METHODS: Patients at least 1-year remote from sacral neuromodulation were mailed a questionnaire to evaluate satisfaction and assess incontinence symptoms. RESULTS: Fifty-two patients were consecutively enrolled in the study. Forty-nine questionnaires (94.2%) were returned. The average interval between implantation and questionnaire completion was 27.2 (range 12-52) months. 83.7% of respondents were satisfied and 79.6% of patients would "do it all over again." Compared to dissatisfied subjects during test stimulation, the satisfied patients had a significant decrease in 24-hr pad weight (84.5% vs. 60.6%, P = 0.002) but did not differ in daily pad usage (4.5 fewer pads per day vs. 3.4, P = 0.190). At long-term follow-up, satisfied patients noted significantly greater improvement in their Incontinence Impact Questionnaire score versus dissatisfied patients (mean improvement 53 vs. 10 points, P = 0.0003). Using multiple logistic regression, change in 24-hr pad weight, but not change in average daily pad usage, was correlated with long-term satisfaction. CONCLUSIONS: Eighty-four percent of patients were satisfied with sacral neuromodulation at a mean of 27 months. An 84.5% reduction in 24-hr pad weight correlated with long-term patient satisfaction. In addition to lack of efficacy, device pain was a contributing factor to dissatisfaction.

Aged↗

PubMed2007

Predicting implantation with a neuromodulator using two different test stimulation techniques: A prospective randomized study in urge incontinent women.

AIMS: The purpose of this study was to determine whether a percutaneous needle electrode (PNE) technique or a surgical first stage lead placement (FSLP) better predicted whether a patient would progress to implantation of a pulse generator (IPG) in older urge incontinent women. METHODS: Thirty subjects > or =55 years with refractory urge incontinence who had been selected to undergo a test stimulation procedure were randomized to either PNE or FSLP. Thirteen underwent PNE placement and seventeen underwent FSLP placement. If during the test stimulation period subjects had greater than 50% improvement in their incontinence parameters they qualified for permanent lead and/or IPG implantation of the Interstim device. RESULTS: Twenty-one subjects (70%) responded to the test stimulation and underwent implantation, 15/17 (88%) in the FSLP group and 6/13 (46%) in the PNE group. Subjects who were randomized to the FSLP group were significantly more likely to proceed to implantation of the IPG (P = 0.02) than those in the PNE group. There was no significant difference in demographics, pre-test stimulation incontinence parameters or post-stimulation visual analog pain scores between the randomized groups or between test stimulation responders and non-responders. When comparing FSLP and PNE responders, there was no significant difference in the percent improvement in 24-hr pad weight, daily pad usage, or daily incontinence. CONCLUSION: FSLP better predicted progression to implantation of the IPG than a test stimulation with a PNE in an older urge incontinent cohort.

Aged↗

PubMed2007

A statistical comparison of pad numbers versus pad weights in the quantification of urinary incontinence.

AIMS: Pad per day (PPD) usage is a frequently utilized measure of urinary incontinence. The 24-hour pad weight test (24PWT) is a reproducible test for quantifying incontinence volumes. We investigated whether PPD validly reports the magnitude of urinary incontinence. METHODS: This was a retrospective review of patients undergoing stress incontinence surgery from July 2002 to 2005. Inclusion criteria were a documented 24PWT and patient-reported PPD usage. Grams of urine loss per pad (GPP) provided a third measure of incontinence. Descriptive statistics and correlations between all variables and significance were noted. Factor analysis was performed on the three measures of leakage and age for all patients over age 50. RESULTS: One hundred forty-five male and 116 female patients met inclusion criteria. Correlated against 24PWT, GPP has the strongest association with a correlation of 0.80 for males and 0.88 for females. PPD has a weaker correlation of 0.64 for males and 0.61 for females (R2 = 0.38 overall). Factor analysis identified two components associated with incontinence. A "leakage" component correlated best with 24PWT and GPP. Additionally, an "age" component implies that despite stable 24PWT values, older patients increase GPP while PPD decreases. CONCLUSIONS: Self-reported PPD is an unreliable measure of incontinence as this variable only measures 38% of the variation of urinary incontinence volume. Patients at a given PPD level present with a wide range of 24PWT values. Older patients have higher per-pad leakage. Future incontinence studies should report 24PWT to ensure the most reliable and uniform data.

Age Distribution↗

PubMed2006

The utility of magnetic resonance imaging for diagnosis and surgical planning before transvaginal periurethral diverticulectomy in women.

The objective of this paper is to report the value of magnetic resonance imaging (MRI) in the evaluation of urethral diverticulum in women. Medical records were identified by a query of urethral diverticulectomy billing data from January 1, 2000 through December 31, 2004. Patient demographics, preoperative evaluation data, and surgical outcomes were collected. Twenty-seven women were diagnosed with a urethral diverticulum during the study period. The cohort presented with a variety of symptoms. The mean time from onset of symptoms to diagnosis of a urethral diverticulum was 47 months. Seven (26%) women had a history of one or more prior diverticulectomies, and 8 (30%) had prior incontinence or other urethral surgery. Twenty-one (78%) had undergone a preoperative MRI, which detected the diverticulum in all cases. In three women, multiple other prior imaging studies had failed to identify the diverticulum despite clinical suspicion of its presence. MRI revealed an unsuspected intradiverticular carcinoma in one patient. Twenty-six women were treated with periurethral diverticulectomy, and one patient was treated with cystourethrectomy. Average follow-up was 9 (range 1-60) months. No patients had significant intraoperative complications. One patient was diagnosed (by MRI) with a recurrent diverticulum. The use of preoperative MR imaging altered the management in 15% of our patients. Furthermore, this study cohort had a long duration of complex symptoms with one-third having had prior urethral surgery. The use of MR imaging allows for accurate diagnosis and improved surgical planning.

Adult↗

PubMed2006

Bladder diary volume per void measurements in detrusor overactivity.

PURPOSE: We investigated the clinical usefulness of adjusting reference volume per void values for a recently reported strong tendency for volume per void to increase with increasing 24-hour volume in asymptomatic individuals. Our approach was to 1) test whether the adjustment increases the separation between volume per void measurements in patients with detrusor overactivity and an asymptomatic reference population, and 2) compare by regression analysis volume per void vs 24-hour volume relationships in patients with detrusor overactivity and asymptomatic volunteers. MATERIALS AND METHODS: We studied 3-day bladder diaries in 29 patients with detrusor overactivity and without genuine stress incontinence, an age matched control group of 29 asymptomatic women and a reference population of 161 asymptomatic women. Minimum, maximum and average volume per void measurements were calculated. The incidence of volume per void measurements below the 10th reference percentile was used as the measure of separation between the detrusor overactivity and asymptomatic populations. RESULTS: In patients with detrusor overactivity volume per void showed a highly significant positive relationship to 24-hour volume (p <0.0005). However, patient data points tended to lie below and parallel to control data points. Adjusting for the 24-hour volume relationship significantly increased the incidence of volume per void measurements below the 10th reference percentile in patients with detrusor overactivity (p <0.01). CONCLUSIONS: Adjusting for the 24-hour volume relationship increased the separation of patients with detrusor overactivity volume per void measurements from the reference population. Adjusting volume per void percentiles for the 24-hour volume relationship decreased the incidence of false-negative volume per void percentiles above the 10th percentile in patients with detrusor overactivity and false-positive volume per void percentiles below the 10th percentile in asymptomatic volunteers.

Adult↗

PubMed2006

Outcomes following erosions of the artificial urinary sphincter.

PURPOSE: Artificial urinary sphincter urethral cuff erosion occurs in up to 5.0% of cases, presenting a complex management problem. We examine our experience with the eroded AUS, relating to preoperative risk factors, operative management and outcomes. MATERIALS AND METHODS: We reviewed the medical records of 637 patients undergoing bulbar urethral AUS implantation from 1990 to 2003 for demographic and surgical variables. RESULTS: Of the 637 records reviewed, 46 patients underwent 54 explantations of the AUS device for erosions, including 13 who had the primary implant performed at our institution and 33 being referred for management of erosion after implantation elsewhere. Our institution erosion rate was 2.2%. Mean followup after AUS reimplant following erosion was 27.8 months (range 1 to 180). Comorbidities were more prevalent in patients with erosions included hypertension (p = 0.006), coronary artery disease (p = 0.03), prior radiation therapy (p = 0.006) and prior AUS revisions (p = 0.0001). A majority of patients had persistent mild incontinence (0 to 1 pad daily in 29 or 56.8%), moderate (1 to 3 pads daily in 9 or 17.4%) and severe (more than 3 pads daily in 6 or 11.8%) incontinence after secondary AUS implantation. Patients who underwent reimplantation after AUS cuff erosions have a significantly higher rate of second erosions (in 16, 34.8%) within an average of 6.7 months (range 3 to 24), including our own 11.8% institutional rate (in 4). CONCLUSIONS: Our study suggests that patients with comorbidities including hypertension, coronary artery disease, prior radiation therapy and prior AUS revisions are more likely to have erosions of their AUS. Nevertheless, continence can still be salvaged using various strategies which optimize use of the remaining healthy urethral tissue.

Aged↗

PubMed2005

Obstruction after Burch colposuspension: a return to retropubic urethrolysis.

We compare our postoperative outcomes of a vaginal vs abdominal urethrolysis after an obstructed Burch colposuspension. We performed a retrospective review of all women who had undergone a Burch urethrolysis from 1997 through 2003. Data collected included pelvic examination, cystoscopic and urodynamic findings, surgical morbidity, and pre- and postoperative urogynecologic symptomatology. Sixteen women underwent Burch urethrolysis. Preoperative symptoms were obstructive in 6, overactive in 2, and both (obstructive/overactive) in 8. All had an acute retropubic angulation of the urethral axis as well as a retropexed urethra that prohibited sagittal rotation of a rigid cystoscope. Seventy-eight percent of the women with urodynamic information met urodynamic criteria for urethral obstruction. Average follow-up was 7 months, and of those undergoing a vaginal urethrolysis, three out of seven (43%) had resolution of their obstructive or overactive symptoms postoperatively. In contrast, seven out of nine women (78%) who underwent a retropubic urethrolysis had relief of their obstructive or overactive bladder symptoms. In our cohort study, an abdominal retropubic urethrolysis was more successful in relieving urethral obstruction than a vaginal urethrolysis.

Abdomen↗

PubMed2005

Patient characteristics and management of dermal allograft extrusions.

The objective of this study was to describe our rate of extrusion of dermal allograft material when used in anterior or posterior colporrhaphy and to review our success in treating extrusions with conservative management. A retrospective review of all subjects who underwent vaginal reconstruction using dermal allograft material from 1 January 2000 to 31 August 2003 was performed. Demographics, medical history, and follow-up were evaluated. For subjects who developed an extrusion, treatment details were recorded. Sixty-nine subjects underwent colporrhaphy using dermal allograft material during the defined time period: 21 anterior, 45 posterior, and 3 both. Five subjects did not appear for follow-up. Seven subjects (10.9%) developed an extrusion: three subjects anteriorly and four subjects posteriorly. There were no differences between subjects with and without extrusions based on recorded risk factors. Median time to the discovery of extrusion was 4 weeks (range: 1-6 weeks). All patients were managed with estrogen vaginal cream. Median documented healing time was 13 weeks (range: 5-40 weeks), and no serious morbidity was encountered. Graft extrusion is an uncommon complication when reinforcing vaginal tissue with dermal allograft material and can be safely and effectively managed with vaginal estrogen and expectant management.

Age Factors↗

PubMed2005

Abdominal sacral colpopexy with allograft fascia lata: one-year outcomes.

OBJECTIVE: The purpose of this study was to assess 1-year outcomes of sacral colpopexy with the use of allograft fascia lata. STUDY DESIGN: Records of all subjects who underwent sacral colpopexy with allograft fascia lata from May 1, 2001, to April 30, 2003, were reviewed. Subjects underwent pre- and postoperative evaluation of prolapse with the pelvic organ prolapse quantification system. The Fisher's exact test was used to analyze the results. RESULTS: Allograft fascia lata was used for 24 colpopexies during this period. No significant intraoperative or postoperative complications or graft erosions occurred. Five subjects were lost to follow-up after 3 months. Analysis was performed on the remaining 19 subjects. Prolapse of stage 2 or more in compartments Aa, Ba, Ap, Bp, and C was preoperatively 50%, 74%, 78%, 84%, and 68% and postoperatively 11%, 16%, 21%, 26%, and 5%, respectively. CONCLUSION: Allograft fascia lata may be a suitable alternative to permanent mesh for sacral colpopexy, but longer-term outcomes and larger studies are needed.

Adult↗

PubMed2005

Sacral neuromodulation for the treatment of refractory urinary urge incontinence after stress incontinence surgery.

OBJECTIVE: This study was undertaken to evaluate the response to sacral neuromodulation in women with refractory, nonobstructive urinary urge incontinence after stress incontinence surgery. STUDY DESIGN: We reviewed the medical records of women in whom sacral neuromodulation was performed for worsening or de novo urinary urge incontinence after a stress incontinence procedure. All patients had undergone preliminary test stimulation. Demographics, surgical and urogynecologic history, including bladder diary and pad weight test, and urodynamic parameters were evaluated. RESULTS: Of 34 women, 22 (65%) responded to the test stimulation and underwent permanent lead implant. There was no difference between responders and nonresponders with respect to type of stress incontinence surgery. Incontinence or urodynamic parameters were not different between responders and nonresponders. Factors that were predictive of a positive response were women aged less than 55 years (P = .01), the test stimulation performed within 4 years of the stress incontinence procedure (P = .01), and evidence of pelvic floor muscle activity (P = .03). CONCLUSION: Sacral neuromodulation is a viable option for the treatment of refractory urinary urge incontinence that occurs after stress urinary incontinence surgery. Older women with no pelvic floor activity who are remote from their incontinence surgery may have a suboptimal response.

Electric Stimulation Therapy↗

PubMed2005

Sacral neuromodulation for intractable urge incontinence: are there factors associated with cure?

OBJECTIVES: To determine the variables that affect the cure rate in patients with urge incontinence treated with sacral neuromodulation. METHODS: This prospective analysis of patients with refractory urinary urge incontinence who underwent placement of a neuromodulator lead and generator was undertaken between October 2000 and December 2003. Quantitative assessment of the severity of their urinary leakage was assessed by preoperative and postoperative 3-day bladder diaries documenting leakage episodes, number of pads used per day, and a 24-hour pad weight assessment. Cure was defined as no daily leakage episodes after permanent implantation. Subjective outcome was assessed using the Incontinence Impact Questionnaire. Two-sample independent t tests, two-way chi-square tests, and tests of two proportions were performed when appropriate, with P < 0.05 considered significant. RESULTS: The mean postimplantation follow-up was 29 months, and the average age was 60 years (range 29 to 83). The cure rate was associated with age, with individuals younger than 55 years having a statistically significant greater cure rate (65% versus 37% for older individuals; P < 0.05). Having three or more chronic conditions was associated with a lower cure rate in both younger and older individuals. Patients with a neurologic condition also had a lower cure rate, but no specific neurologic condition was associated. CONCLUSIONS: Age older than 55 years and more than three chronic conditions were independent factors associated with a lower cure rate in patients implanted with a sacral neuromodulator for refractory urge incontinence. A neurologic condition may be associated with a decrease in the cure rate.

Adult↗

PubMed2005

Outcomes following revisions and secondary implantation of the artificial urinary sphincter.

PURPOSE: Durable success with the artificial urinary sphincter (AUS) is common but device revision and replacement are often needed for various reasons. We examined indications and outcomes following these secondary procedures with comparisons to outcomes after primary procedures. MATERIALS AND METHODS: The medical records of all patients undergoing primary and secondary bulbar urethral AUS implantation and revision from January 1990 to September 2002 were reviewed for various demographic and surgical variables. Female patients and males with bladder neck cuffs were excluded from study. RESULTS: Of 554 men undergoing AUS implantation or revision 119 (21.4%) underwent a total of 159 secondary procedures. Reasons for revision were mechanical failure in 31 cases (25.2%) and nonmechanical failure in 88 (73.9%). The latter included recurrent incontinence due to urethral atrophy in 63 cases (52.9%) and erosion in 21 (17.6%). Total device replacement was performed in 75 cases (47.2%). Of 119 patients undergoing secondary implantation 91 (76.5%) needed no additional surgical intervention, while 28 (23.5%) required a total of 40 surgical revisions for new mechanical (15 or 37.5%) and nonmechanical (25 or 62.5%) problems. Five-year durability outcomes for primary and secondary AUS implantation were comparable at 80% and 88%, respectively. Similarly excellent continence outcomes (0 to 1 pad daily) were noted in 90% and 82% of patients undergoing primary and secondary AUS implantation, respectively. Secondary and tertiary AUS revisions resulted in the restoration of baseline continence in 106 cases (89%). CONCLUSIONS: Our study suggests that outcomes for secondary AUS reimplantation are comparable to those of primary AUS implantation and salvage of a good outcome is always probable, even following multiple prior revisions and cuff erosion.

Adult↗

PubMed2005

Anastomotic contracture and incontinence after radical prostatectomy: a graded approach to management.

PURPOSE: We present a heterogeneous group of men presenting with varying degrees of anastomotic contracture (AC) and associated stress urinary incontinence (SUI) following radical prostatectomy. It is particularly important that AC should be resolved before artificial urinary sphincter (AUS) implantation, because instrumentation through the AUS can risk erosion. MATERIALS AND METHODS: The records of 54 consecutive men who were referred for the management of AC and associated SUI were reviewed. Patient treatment and outcomes were stratified according to their unique characteristics. RESULTS: A total of 54 patients underwent radical prostatectomy alone (48), or in combination with radiation therapy (7) or cryotherapy (1). In group 1, 35 patients had previously undiscovered AC, or 1 or more prior contracture incisions (CIs) with SUI. CI and AUS were performed simultaneously in 33 patients and sequentially in 2. In group 2, 7 patients with intractable AC following multiple CIs/dilations and self-calibration, or an indwelling urethral or suprapubic catheter underwent simultaneous (3) or sequential (2) CI/AUS or CI only (2). Five patients required temporary self-calibration. In group 3, in 12 patients with total outlet obliteration recanalization was accomplished with combined antegrade/retrograde endoscopy and CI. Ten patients had re-obliteration, of whom 1 underwent suprapubic diversion and 9 underwent repeat recanalization with placement of a UroLume stent (American Medical Systems, Minnetonka, Minnesota) across the anastomosis. Eight patients underwent artificial urinary sphincter (AUS) placement 4 to 6 weeks later and 1 awaits an AUS. Of those implanted with an AUS 2 required repeat endoscopic procedures because of recurrent but manageable stent ingrowth. CONCLUSIONS: Most ACs are treated successfully with simultaneous, aggressive CI/AUS. A history of many CIs or long, dense contractures suggest the need for staged management. In those with obliterated outlets we prefer to reestablish patency and if rapid recurrence develops, we place a UroLume stent. Regardless of a history of radiation therapy, continence is restored with an AUS.

Anastomosis, Surgical↗

PubMed2005

Management of male incontinence following artificial urinary sphincter failure.

PURPOSE OF REVIEW: The artificial urinary sphincter has been used successfully for the treatment of stress urinary incontinence in both male and female patients. Its most common use, however, is in men suffering from postprostatectomy incontinence. RECENT FINDINGS: The success rates, long-term durability, and patient satisfaction for the artificial urinary sphincter are high. The incidence of complications and adverse events remains low although they are sometimes unavoidable. SUMMARY: We believe that continence can be salvaged in the majority of men in whom the device fails or requires explantation and we present the logical analysis for device revision and relocation in this review.

Adult↗

PubMed2004

Functional outcomes of primary and secondary repairs of vesicovaginal fistulae via vaginal cuff scar excision.

Hospital and office charts of patients who underwent vaginal cuff scar excision for vesicovaginal fistula (VVF) repair from February 1998 to December 2002 at our institution were reviewed. Preoperative demographics and fistula characteristics were gathered. Intraoperative data included use of tissue flaps, blood loss, OR time and anesthetic type. Postoperative review included time to discharge, successful repair and postoperative urinary or sexual dysfunction. Forty fistula repairs were identified. Ninety-three percent occurred after a hysterectomy and no subjects had a history of radiation. Forty-two percent had failed at least one surgical repair of their fistula and 12% had failed two or more attempted repairs. Twenty percent of the fistulae measured 1 cm or more in diameter and the remaining 80% were 5 mm or less. Peritoneal flaps and martius flaps were performed in 32% and 5%, respectively. Postoperatively, 100% of subjects were evaluated at 3 weeks when the suprapubic catheter was removed and 93% were evaluated at 3 months or later. All subjects were cured of their fistulae at last contact. At 3 months postoperatively, 94% percent denied any urinary dysfunction and 85% had resumed sexual intercourse. Two sexually active subjects reported mild deep dyspareunia. Transvaginal cuff scar excision is an effective method for the primary and secondary repair of vesicovaginal fistulae and does not appear to cause postoperative irritative voiding symptoms or dyspareunia.

Adult↗

PubMed2004

Heroic measures may not always be justified in extensive urethral stricture due to lichen sclerosus (balanitis xerotica obliterans).

OBJECTIVES: Strictures due to lichen sclerosus (LS) may affect the urethra as far proximally as the mid-bulb. For such strictures, a staged full-length repair is required and should use a nonpenile graft source such as buccal mucosa. Many cases occur in a population already accustomed to seated voiding, leading us to re-evaluate this approach and, in some circumstances, recommend definitive perineal urethrostomy alone. METHODS: We reviewed the medical records and retrograde urethrograms of all patients undergoing surgery for LS at our facilities between January 1991 and June 2002. RESULTS: A total of 63 patients, with an average age of 54.2 years, underwent surgery for LS stricture with an average follow-up of 38.5 months (range 4 to 117). Of the 63 patients, 19 underwent grafting in preparation for future reconstruction. Of these, 11 completed the second-stage repair, and 8 patients elected not to undergo the second stage of the repair, leaving a functional perineal urethrostomy. This led us to look more critically at definitive perineal urethrostomy alone for some patients. Parallel with the staged repairs, and subsequent to them, 44 patients underwent perineal urethrostomy alone. CONCLUSIONS: The often extensive nature of LS, the prevailing philosophy that urethroplasty must use nonpenile skin, the limited availability of such sources, and the acceptance of many patients for seated voiding makes definitive perineal urethrostomy alone a viable treatment option. In all our cases, this satisfied patients' quality of life concerns, leaving the anterior urethra dry and amenable to future repair. Younger men desirous of penile voiding should still be considered for staged repair using current techniques.

Adult↗

PubMed2004

Transvaginal endoscopic removal of eroded mesh after abdominal sacral colpopexy.

BACKGROUND: Abdominal sacral colpopexy with permanent mesh has become the preferred abdominal technique for correcting posthysterectomy vaginal vault prolapse. Although rare, mesh erosion after sacral colpopexy is often challenging to manage. We report on 3 cases of mesh erosion after abdominal sacral colpopexy managed by transvaginal endoscopic removal of the mesh. CASES: The cases involve patients who underwent an abdominal sacral colpopexy and had vaginal mesh erosions within 3 years of their surgeries. Conservative and traditional transvaginal techniques failed, and the patients continued to complain of vaginal discharge. All patients underwent transvaginal endoscopic removal of the mesh and are cured of their chronic discharges. CONCLUSION: Transvaginal endoscopic removal is an effective, minimally invasive option for removal of eroded mesh after abdominal sacral colpopexy.

Abdomen↗

PubMed2004

The effect of botulinum-A toxin on patients with severe urge urinary incontinence.

PURPOSE: We determined the effect of 150 units of botulinum-A toxin (Botox, Allergan, Irvine, California) on subjects with severe urge urinary incontinence (UUI). MATERIALS AND METHODS: This was an open label uncontrolled clinical trial. Subjects were recruited from the female urology and urogynecology clinics at Duke University. Inclusion criteria included evidence of UUI on 3-day bladder diary, a 24-hour pad weight of 100 gm or greater, absent or minimal stress leakage, absent detrusor dysfunction, and a history of failed anticholinergic and physical therapies. Exclusion criteria included evidence of a urinary tract infection, or other correctable or neurological etiology for UUI. The detrusor of each subject was injected with 150 units of botulinum-A toxin. Evaluations were performed at 2 weeks, 6 weeks, 3 months and 6 months after injection. Outcome measures included daily incontinence episodes, Urogenital Distress Inventory and the Incontinence Impact Questionnaire, 24-hour pad weights, daily pad usage and urinalysis at all visits. Urodynamic studies were performed at the 6-week and 3-month visits. RESULTS: Three subjects had uncomplicated urinary tract infections during followup. No other adverse effects occurred. Statistically and clinically significant decreases greater than 50% were seen in virtually all outcome measures at all visits up to 3 months. Most subjects showed signs of recurrent UUI by 6 months. All subjects reported remarkable subjective improvement in incontinence. No significant changes in maximal cystometric capacity, maximal detrusor pressure, peak flow or post-void residual volumes were seen. CONCLUSIONS: Botulinum-A toxin can significantly decrease urge urinary incontinence and improve quality of life for 3 months after injection. Additional studies are needed to determine ideal doses, dosing intervals, safety and cost-effectiveness of this therapy.

Aged↗