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At least 127 records · Page 7Linked to original sources
PubMed2002

External occlusive devices for management of female urinary incontinence.

OBJECTIVES: Urinary incontinence affects 11 million women in the United States and is most common in older women. There are several different forms of urinary incontinence, which can be distinguished by their associated pathophysiologic conditions and signs. Genuine stress incontinence is the instantaneous leakage of urine in response to raised intraabdominal pressure associated with such activities as lifting, sneezing, and coughing. Risk factors for development of this form of incontinence include vaginal delivery, vaginal surgery, inadequate estrogen levels, and advanced age. Surgery, the most effective curative treatment for stress incontinence, is invasive and expensive and can lead to impairment of normal urinary tract functions. Other management options include pelvic floor rehabilitation by means of exercise, pharmacotherapy, intravaginal and intraurethral devices, absorbent products, and external occlusive devices. METHODS: A review of publications on the effectiveness of available external occlusive devices is presented, with special emphasis on a new, single-use, disposable urethral cap device which offers women with stress incontinence an over-the-counter product that enables them to independently manage their incontinence according to their individual needs. RESULTS: Non-surgical methods of managing urinary incontinence are available, with newer methods providing a greater range of choices for women. CONCLUSIONS: External occlusive devices can be effectively used by women with urinary incontinence who will not or cannot have surgical correction of the problem.

Female↗
PubMedDate not supplied

Improving information for men with postoperative urinary incontinence.

Despite urinary incontinence being a recognised complication of prostate surgery, the physical and psychological needs of men with postoperative urinary incontinence are not well met and there is little written information specifically designed for this group of patients (Moore and Estey, 1999; Harris, 1997). Men rarely seek help for urinary incontinence and I used to feel frustrated at finding that some put up with a continence problem in secret for many years. I decided to explore the reasons for their failing to ask for help and what sort of information they would require if they were going to have prostate surgery. The information I elicited helped me to formulate a strategy to tackle this difficult issue.

Humans↗
PubMed2004

[Can transobturator tape for urinary incontinence cause complete urinary retention?].

The surgical management of stress urinary incontinence has been revolutionized with the development of minimally invasive suburethral tape techniques, which ensure a high continence rate by means of a rapid procedure with a short hospital stay. Although morbidity and adverse effects are uncommon, they must be kept in mind in order to adopt an appropriate strategy designed to prevent their development. Urinary retention is the most frequent postoperative complication of retropubic tape. The recent transobturator tape technique modifies the location of the tape with an angulation more close resembling that of fascial support tissues, thereby decreasing the theoretical risk of retention. The authors report the first case of complete urinary retention and discuss the mechanism and therapeutic strategy.

Aged↗
PubMed2004

Tissue engineering for urinary incontinence applications.

Urinary incontinence affects men and women of all ages, and may be present in nearly half of all elderly women. Current nonpharmacologic, pharmacologic, and surgical therapies often only offer short-term relief. This review focuses on the application of tissue engineering and regenerative medicine to the field of urinary incontinence. The principles of tissue engineering will be discussed as well as some current strategies for applying these principles in developing novel therapies for urinary incontinence.

Female↗
PubMed2001

A review of the psychosocial predictors of help-seeking behaviour and impact on quality of life in people with urinary incontinence.

Although urinary incontinence is common and can have a substantial impact on an individual's quality of life, few people seek help for this symptom. This paper examines a theoretical framework proposed by Shaw (1999) as a possible explanatory model for help-seeking and the impact of incontinence on a person's quality of life. Although aetiology and symptom severity are important predictors of behaviour and impact of symptoms, they did not explain all the variation and so other predictors proposed by the model were explored. Appraisals of illness and coping resources were found to be important moderating factors between the experience of symptoms and subsequent behaviour and outcome in urinary incontinence. In the appraisal of symptoms, lack of knowledge of the causes and treatments of urinary incontinence can be a barrier to help-seeking and successful outcome. Other factors such as personality, group differences, and social support can contribute to the appraisal process. Areas for future research and implications for clinical practice are discussed.

Adaptation, Psychological↗
PubMed2006

The sensitivity and specificity of a simple test to distinguish between urge and stress urinary incontinence.

BACKGROUND: Urinary incontinence is common in women. Because treatments differ, urge incontinence should be distinguished from stress incontinence. To make this distinction, current guidelines recommend an extensive evaluation that is too time-consuming for primary care practice. OBJECTIVE: To test the accuracy of a simple questionnaire to categorize type of urinary incontinence in women. DESIGN: Multicenter, prospective study of the accuracy of the 3 Incontinence Questions (3IQ) compared with an extended evaluation to distinguish between urge incontinence and stress incontinence. SETTING: 5 academic medical centers in the United States. PARTICIPANTS: 301 women enrolled from April to December 2004 who were older than 40 years of age (mean age, 56 years [SD, 11]) with untreated incontinence for an average of 7 years (SD, 7) and a broad range of incontinence severity. MEASUREMENTS: All participants included in the analyses answered the 3IQ questionnaire, and a urologist or urogynecologist who was blinded to the responses performed the extended evaluation. Sensitivity, specificity, and likelihood ratios were determined for the 3IQ. RESULTS: For classification of urge incontinence and with the extended evaluation as the gold standard, the 3IQ had a sensitivity of 0.75 (95% CI, 0.68 to 0.81), a specificity of 0.77 (CI, 0.69 to 0.84), and a positive likelihood ratio of 3.29 (CI, 2.39 to 4.51). For classification of stress incontinence, the sensitivity was 0.86 (CI, 0.79 to 0.90), the specificity was 0.60 (CI, 0.51 to 0.68), and the positive likelihood ratio was 2.13 (CI, 1.71 to 2.66). LIMITATIONS: Participants were enrolled by urologists and urogynecologists at academic medical centers. CONCLUSIONS: The 3IQ questionnaire is a simple, quick, and noninvasive test with acceptable accuracy for classifying urge and stress incontinence and may be appropriate for use in primary care settings. Similar studies are needed in other populations. We also need a clinical trial comparing the outcomes of treatments based on the 3IQ and the extended evaluation.

Adult↗
PubMed1979

Urodynamics in stress urinary incontinence.

Stress urinary incontinence was evaluated urodynamically in 86 women in private urologic practice. While 31 patients had failed prior surgical repairs and 58 patients (67.4 per cent) reported irritative symptoms of frequency, nocturia, urgency and urge incontinence unstable bladders were found in only 5 women (5.8 per cent) over-all, in 6.5 per cent of those patients failing a previous operation and in 8.6 per cent of those patients with irritative symptoms. Urethral pressure profiles were decreased mildly in patients with, compared to those without, stress urinary incontinence but considerable overlap existed and no improvement was seen in 20 patients cured with an operation. Excretory urography, post-voiding residual urine volumes and sphincter electromyography usually were normal. Women with stress urinary incontinence consistently showed poor transmission of cough to the urethra so that the intravesical pressure exceeded the intraurethral pressure.

Adult↗
PubMed1992

Management of type III stress urinary incontinence using artificial urinary sphincter.

Type III stress urinary incontinence due to severe intrinsic urethral weakness without significant urethrovesical descensus may be treated by periurethral injection, sling cystourethropexy, bladder neck reconstruction, or artificial urinary sphincter implantation. The rationale for procedure selection depends on a number of patient factors and the surgeon's experience. We herein report on 25 women who were identified as having such incontinence by evaluation which included videourodynamic study and lateral voiding cystography and who were managed by the implantation of an artificial urinary sphincter. The etiology of the severe intrinsic urethral weakness in most patients was multiple prior failed cystourethropexies. Postoperatively, 1 patient died of a cerebral vascular accident. The remaining 24 women had significantly improved continence and were completely satisfied at latest follow-up. No revisions have been required for patients receiving an artificial sphincter after 1983. No sphincter erosions or infections have occurred. Our experience and review of the literature shows that the artificial sphincter provides an excellent first option for women with type III urinary stress incontinence due to intrinsic urethral weakness of various etiologies.

Adult↗
PubMed1998

[Urinary incontinence in the elderly. 1: Forms of urinary incontinence--basic diagnosis--additional diagnosis].

Every geriatric patient should routinely be questioned about possible urinary incontinence. The basic diagnostic work-up comprises the clinical history, wherever indicated a geriatric assessment, a nursing care history, a physical examination and a micturition protocol. Furthermore, determination of postvoid residual urine, laboratory investigations and a urine-analysis should be done in all patients. Ultrasonography of the urinary tract is a simple non-invasive procedure that can exclude the presence of large tumors, stones in the bladder and urinary retention. Only selected patients require a greater diagnostic effort prior to treatment, for example, urologic and/or gynecologic investigations or a urodynamic evaluation.

Aged↗
PubMed1997

Female Stress Urinary Incontinence Clinical Guidelines Panel summary report on surgical management of female stress urinary incontinence. The American Urological Association.

PURPOSE: The American Urological Association convened the Female Stress Urinary Incontinence Clinical Guidelines Panel to analyze the literature regarding surgical procedures for treating stress urinary incontinence in the otherwise healthy female subject and to make practice recommendations based on the treatment outcomes data. MATERIALS AND METHODS: The panel searched the MEDLINE data base for all articles through 1993 on surgical treatment of female stress urinary incontinence. Outcomes data were extracted from articles accepted after panel review. The data were then meta-analyzed to produce outcome estimates for alternative surgical procedures. RESULTS: The data indicate that after 48 months retropubic suspensions and slings appear to be more efficacious than transvaginal suspensions, and also more efficacious than anterior repairs. The literature suggests higher complication rates when synthetic materials are used for slings. CONCLUSIONS: The panel found sufficient acceptable long-term outcomes data (longer than 48 months) to conclude that surgical treatment of female stress urinary incontinence is effective, offering a long-term cure in a significant percentage of women. The evidence supports surgery as initial therapy and as a secondary form of therapy after failure of other treatments for stress urinary incontinence. Retropubic suspensions and slings are the most efficacious procedures for long-term success (based on cure/dry rates). However, in the panel's opinion retropubic suspensions and sling procedures are associated with slightly higher complication rates, including longer convalescence and postoperative voiding dysfunction.

Clinical Trials as Topic↗
PubMed2005

[Clinical applications of the comprehensive theory of urinary incontinence].

Currently, urinary incontinence cannot be treated without taking into consideration the comprehensive theory of urinary incontinence. According to this theory, stress incontinence, urge incontinence and alterations in bladder emptying result from alterations in the elements of suburethral support, ligaments and muscles of the pelvis floor. Alterations in the forces applied by muscles and ligaments to the fascia adjacent to the vaginal wall and the urethra cause the vesical neck and the urethra to open or close. Alterations in the forces applied to the vagina can also cause premature activation of the micturition reflex, triggering involuntary contractions of the detrusor muscle. Knowledge of the anatomic substrate of the upper, intermediate and lower layers of the pelvic floor and of the main pubourethral, urethropelvic and uterosacral ligamentous elements is essential before any surgical approach of incontinence can be attempted. Depending on the location of the fascial or ligamental muscle lesion and of the sensitivity of the local nerve endings, stress incontinence, urge incontinence, altered bladder emptying or combinations of these conditions can develop. There are 6 basic defects which should be systematically investigated: defect in the suburethral support ("Hammock"), tethered vagina syndrome, distended pubourethral ligaments, distended uterosacral ligaments and support of the vaginal apex, lesions of vaginal insertion of pubococcygeal muscles, lesions of the striated muscles of the pelvic floor levator plate.

Female↗
PubMed2005

[Surgical treatment of female stress urinary incontinence].

Stress urinary incontinence is frequent in women, and can have a major impact on quality of life. Surgical treatment is the most effective option in many cases. The current reference treatment is urethral stabilization with the use of a free pelvic sling. Surgical management of female stress urinary incontinence is now effective and relatively complication-free.

Female↗
PubMed2005

[Duloxetine. A new preparation for patients with urinary incontinence].

Stress Urinary Incontinence is a common symptom among women. The urethral closure is insufficient. Pelvic floor exercise can minish the symptoms, but many women need an operation. Duloxetine, a new drug, is believed to strengthen the contraction of the external urethral sphincter through central neuromodulation, resulting in enhanced urethral closure during the urine storage phase. In controlled studies a significant effect are found in women suffer from Stress Urinary Incontinence. Discontinuate rates for adverse events were high especially nausea and fatigue. The adverse event deminish after 4 weeks.

Adrenergic Uptake Inhibitors↗
PubMed2003

[Quality of life after mid-urethra polypropylene tape sling surgery (IVS, TVT) in female stress urinary incontinence].

INTRODUCTION: Urinary incontinence exerts a huge influence on women's quality of life in regard to hygienic problems. The great progress in female stress urinary incontinence (SUI) surgery was introduction of mid-urethra polypropylene sling procedures, which are characterized by very high efficacy, safety and minimal invasiveness. The aim of our study was to assess if functioning of lower urinary tract after minimum 1 year from TVT or IVS procedure has an impact on women's quality of life. MATERIALS AND METHODS: Analysis was done by means of King's quality of life questionnaire in Polish version from 1993. One hundred and sixty patients operated because of SUI in II-nd Department of Gynecology in Lublin in years: 1999-2001 were assessed. The mean time relapsed from surgery was 19 +/- 6 months. Eighty women were operated by TVT method (monofilament tape) and eighty by IVS method (multifilament tape. Statistical analysis was done by means of STATISTICA program, version 6. To estimate patient's quality of life according to King's questionnaire the mode value (Mo) and the frequency of mode value (fr Mo) were used in respective questions. The results in both groups were compared by Mann-Whitney test. RESULTS: Most of patients assessed the general health condition as good (fr Mo = 25; 36.9%). In TVT group Mo value indicated good health condition (fr Mo = 30; 37.5%), whereas in IVS group general health condition was estimated most commonly as satisfactory (fr Mo = 33; 41.25%). In respect to incontinence impact on life in TVT group 37.5% of patients (fr Mo = 30) reported some influence, while in IVS group 50% of women (fr Mo = 40) reported no influence (p = 0.16). Moreover, analysis revealed that in both groups the functioning of lower urinary tract does not influence their normal functioning, social contacts, physical activity, personal life, emotions or sleep. CONCLUSION: After modern incontinence surgery (TVT, IVS methods) the majority of patients reported that current bladder symptoms have no negative impact on their quality of life.

Adult↗
PubMed2006

A survey of Canadian websites providing information about female urinary incontinence.

OBJECTIVE: Urinary incontinence (UI) is a prevalent health issue that has significant detrimental effects on quality of life. The Internet offers a unique vehicle for incontinent women to access information that could facilitate conservative self-help therapy. An evaluation of Canadian websites offering female UI information was conducted to determine their quality and readability. METHODS: We evaluated websites using published general quality criteria for health sites and a quality assessment tool compiled by the authors for specific UI information derived from published, peer-reviewed clinical practice guidelines. Three health care professionals reviewed sites for quality, Canadian content, and interactivity. The readability of health information was also evaluated. RESULTS: Fifty-six Canadian sites (18 professional, 22 organizational, 16 commercial) were evaluated. Significant agreement was found among the raters' evaluations on all measures. For all sites, the mean scores were general quality, 9/14; specific UI quality, 30/122; reading ease, 37/100; grade level, 10.9. The median score for Canadian content was high, but for interactivity it was low. The only significant difference between site types was for general quality (F [2,165]=3.38, P=0.036). Post hoc Tukey's tests showed a significant difference between organizational and commercial sites, with organizational sites having higher general quality. CONCLUSION: Canadian websites providing female UI information have moderately high general quality, low specific UI information quality, minimal interactivity, and more than minimal Canadian content. The reading level of most sites is too high for average consumers. A webliography of the best sites has been developed to guide patients.

Canada↗
PubMed2004

Conservative management for postprostatectomy urinary incontinence.

BACKGROUND: Urinary incontinence is common after both radical prostatectomy and transurethral resection. Conservative management includes pelvic floor muscle training, biofeedback, electrical stimulation, compression devices (penile clamps), lifestyle changes, extra-corporeal magnetic innervation or a combination of methods. OBJECTIVES: To assess the effects of conservative managements for urinary incontinence prostatectomy. SEARCH STRATEGY: We searched the Cochrane Incontinence Group trials register (searched 2 July 2003), MEDLINE (January 1966 to January 2004), EMBASE (January 1988 to January 2004), CINAHL (January 1982 to January 2004), PsycLIT (January 1984 to January 2004), ERIC (January 1984 to January 2004), the reference lists of relevant articles, handsearched conference proceedings and contacted investigators to locate studies. SELECTION CRITERIA: Randomised controlled trials evaluating conservative interventions for urinary continence after prostatectomy. DATA COLLECTION AND ANALYSIS: At least two reviewers assessed the methodological quality of trials and abstracted data. MAIN RESULTS: Ten trials met the inclusion criteria, eight trials amongst men after radical prostatectomy, one trial after transurethral resection of prostate and one after either operation. There was considerable variation in the interventions, populations and outcome measures. The trials were of moderate quality and data were not available for many of the pre-stated outcomes. Confidence intervals were wide: it was not possible to reliably identify or rule out a useful effect. There was some support from five trials for pelvic floor muscle training with biofeedback being better than no treatment or sham treatment in the short term for men after radical prostatectomy: relative risk for incontinence with pelvic floor muscle training and biofeedback versus no treatment: 0.74 (95% confidence interval 0.60 to 0.93). Analysis of other conservative interventions such as pelvic floor muscle training alone, transcutaneous electrical nerve stimulation and rectal electrical stimulation, or combinations of these interventions were inconclusive. There were too few data to determine effects on incontinence after transurethral resection of the prostate. The findings should be treated with caution as there were few studies, all of moderate quality. Men in one trial reported a preference for one type of external compression device compared to two others or no treatment. The effect of other conservative interventions such as lifestyle changes remains undetermined as no trials involving these interventions were identified. Men's symptoms tended to improve over time, irrespective of management. REVIEWERS' CONCLUSIONS: The value of the various approaches to conservative management of postprostatectomy incontinence remains uncertain. There may be some benefit of offering pelvic floor muscle training with biofeedback early in the postoperative period immediately following removal of the catheter as it may promote an earlier return to continence. Long-term incontinence may be managed by external penile clamp, but there are safety problems.

Biofeedback, Psychology↗
PubMed2006

Efficacy and safety of a neurokinin-1 receptor antagonist in postmenopausal women with overactive bladder with urge urinary incontinence.

PURPOSE: Urge urinary incontinence is the involuntary leakage of urine commonly occurring in older adults, particularly women. Preclinical evidence suggests that urge urinary incontinence may occur due to up-regulation of tachykinin mediated bladder/spinal reflex signaling. This study tested the hypothesis that aprepitant, a neurokinin-1 receptor antagonist, may be efficacious in the treatment of urge urinary incontinence. MATERIALS AND METHODS: This was a double-blind, randomized, placebo controlled, parallel group pilot study in which postmenopausal women with a history of urge urinary incontinence or mixed incontinence (with predominantly urge urinary incontinence) were assigned to receive a 160 mg capsule of aprepitant (61) or placebo (64) once daily for 8 weeks. The primary end point was percent change from baseline in average daily micturitions assessed by a voiding diary. Secondary end points included average daily total urinary incontinence and urge urinary incontinence episodes, and urgency episodes. RESULTS: Aprepitant significantly decreased the average daily number of micturitions compared with placebo at 8 weeks. The between-group treatment difference expressed as percent change from baseline was -6.8%, 95% CI (-12.5, -1.1) (p = 0.019). The average daily number of urgency episodes was also significantly reduced compared to placebo (p = 0.049). The average daily number of urge urinary incontinence and total urinary incontinence episodes were also reduced, although the difference was not statistically significant. Aprepitant was generally well tolerated and adverse experiences were generally mild. CONCLUSIONS: Results of this initial study suggest that neurokinin-1 receptor antagonism may represent a novel therapeutic approach to treating overactive bladder syndrome.

Adult↗