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At least 1,495 records · Page 83Linked to original sources
PubMed2005

Tension-free vaginal tape for the treatment of urodynamic stress incontinence with intrinsic sphincteric deficiency.

The purpose of this study was to evaluate the outcome of tension-free vaginal tape (TVT) procedure in women with urodynamic stress incontinence diagnosed as having intrinsic sphincteric deficiency (ISD). The combination of a maximal urethral closure pressure < 20 cm H2O and a Valsalva leak point pressure < 60 cm H2O was considered as diagnostic of ISD. Subjects with detrusor overactivity on preoperative urodynamics were excluded. A total of 35 patients with both low closure pressure and leak point pressure were enrolled. Bladder perforation occurred in three (8.6%) cases. Postoperative urinary voiding difficulties occurred in nine (25.7%) women. Two patients underwent surgical detension of the tape, with complete resolution of urinary retention and no relapse of incontinence. Women with postoperative voiding dysfunction had a significantly lower detrusorial pressure at the peak flow on preoperative urodynamics compared to those who voided efficiently after TVT. The mean (range) follow-up time was 12.5 months (3-36). The objective cure rate for stress incontinence was 91.4%. Two of the three (66%) patients in whom the TVT procedure failed had a fixed urethra. De novo urge incontinence was found in five (14.3%) patients.

Aged↗
PubMed2006

[Biofeedback therapy for urinary incontinence in children].

INTRODUCTION: We evaluated the efficacy of biofeedback (BFB) therapy in childrens with functional urinary incontinence refractory to conventional treatment. MATERIALS AND METHODS: 34 patients where included (26 girls and 8 boys). They received BFB therapy during the last year for daytime urinary incontinence. 27 patients had urge syndrome with detrusor overactivity, 3 presented giggle incontinence and 4 patients had dysfunctinal voiding. Mean age was 8,4 years. All cases were refractory to bladder training and/or anticholinergics, or recidived after supression. The BFB therapy was carried out with surface electrodes during bladder filling (29 patients) and during voiding (4 patients). One received both therapies. RESULTS: 15 patients (44%) achieved total continence (daytime and nightime) and 7 (20,5%) responded partially. 9 Patients (26%) didn't obtain any benefit and 4 were losed. CONCLUSIONS: In children with functional urinary incontinence pelvic floor muscles training with biofeedback is a simple and effective method. It should be used associated to other therapies, when these fails or repeats after an initial success.

Biofeedback, Psychology↗
PubMed2001

10-Year experience with artificial urinary sphincter in children and adolescents.

PURPOSE: We evaluate specific indications, patient selection and complications of the AMS800 artificial sphincter in children and adolescents with sphincteric incontinence. MATERIALS AND METHODS: Between 1987 and 1997, 39 males and 10 females with a mean age of 14 years (range 7 to 20) with sphincter deficiency underwent artificial urinary sphincter placement. The underlying etiology of incontinence was myelodysplasia in 38 patients, exstrophy-epispadias complex in 7 and urethral trauma in 4. All patients underwent preoperatively conventional urodynamic investigations. Augmentation cystoplasty was done in 9 patients before sphincter implantation and both procedures were performed simultaneously in 2 cases. The cuff was adjusted around the bladder neck in 37 patients and around the bulbar urethra in 12. Followup ranged from 2 to 11 years (mean 7.5). RESULTS: There were 54 sphincter implants in 49 patients. Of the 49 patients 33 (67%) achieved continence, 9 had substantial improvement and 7 remained unchanged after surgery. Erosion occurred in 10 patients due to sphincter infection in 2, mechanical failure in 6 and postoperative changes in bladder behavior in 2. Of these 10 patients with erosion 5 are incontinent and awaiting sphincter replacement, 2 required bladder neck closure and appendicovesicostomy, and 3 are dry without prosthetic replacement. Mean time to erosion was 24.9 months (range 1 month to 9 years), and 3 erosions occurred within 3 months of sphincter placement. Of the 6 patients with mechanical problems 5 regained continence after successful replacement of the sphincter. Only 2 of the 49 cases had postoperative detrusor overactivity requiring augmentation after surgery. Of the 29 patients who performed clean intermittent catheterization preoperatively 3 no longer needed it after implantation of the prosthesis. Finally, 25 (86%) of the 29 patients with a cuff placed around the bladder neck and with no previous surgical repairs at this site achieved continence after implantation whereas only 3 (37.5%) of 8 patients who had undergone prior bladder neck surgical procedures became continent. CONCLUSIONS: This study supports previous reports that the artificial urinary sphincter is effective therapy for sphincteric incontinence. Additionally, in our study previous surgical procedures on the lower urinary tract before sphincter placement increased significantly the rate of postoperative complications.

Adolescent↗
PubMed2006

Tension-free vaginal tape for the treatment of stress urinary incontinence in geriatric patients.

OBJECTIVE: To evaluate the safety and efficacy of tension-free vaginal tape (TVT) for the treatment of stress urinary incontinence (SUI) in geriatric patients. PATIENTS AND METHODS: Fifty-one women, aged 65-80 (mean 72.3) years, underwent a TVT procedure for genuine SUI from 2001 to 2004. A urodynamic test together with uroflowmetry were performed. The patients' SUI bother score was assessed using a visual analog scale (VAS). RESULTS: The mean operative time was 25 (range 14-29) min and mean hospitalization time was 1.2 (range 1-2) days. Bladder perforation occurred in 3 cases (5.8%) and was managed conservatively. Pre- and postoperative maximum flow rate were not significantly different (p > 0.05). The patients' SUI bother score estimated by the VAS was statistically significantly improved (p < 0.0001). After a mean follow-up of 35.6 (range 14-60) months, 49 patients (96%) had no SUI, while 2 patients (3.9%) had persistent SUI. Also, during the follow-up 5 patients (9.8%) were diagnosed with de novo urgency due to detrusor overactivity and 1 patient (1.9%) had persistent dysuria that was resolved with urethrolysis. CONCLUSIONS: SUI in elderly women can be safely treated with the TVT procedure in the vast majority of the patients. However, bladder perforation during surgery and de novo urgency postoperatively should be taken into account.

Aged↗
PubMed2005

Intraoperative recording of electroneurographic signals from cuff electrodes on extradural sacral roots in spinal cord injured patients.

PURPOSE: A safe and reliable method for monitoring intravesical pressure on a long-term basis is needed for conditional electrical stimulation to be feasible as a treatment option for neurogenic detrusor overactivity in patients with a spinal cord injury. Therefore, we investigated the possibility of recording afferent nerve activity related to mechanical activity of the bladder and other pelvic organs from the extradural sacral nerve root in human. MATERIALS AND METHODS: Nerve cuff electrodes were temporary placed on the extradural S3 sacral root in 6 spinal cord injured patients who underwent implantation of an extradural FineTech-Brindley Bladder System (Finetech Medical Lt., Welwyn Garden City, United Kingdom). The dorsal penile/clitoral nerve was electrically stimulated to evoke compound action potentials. Electroneurographic signals were recorded together with bladder and rectal pressure during mechanical stimulation of the dermatome rapid bladder filling and rectal distention, and during bladder contraction evoked by electrical stimulation of the contralateral sacral root. RESULTS: Compound action potentials and electroneurographic responses during stimulation of the dermatome and rectum were present in all 6 patients and during bladder filling in 5 of 6. However, recorded responses from the bladder and rectum were small and mainly phasic in nature. Nerve responses following bladder contractions were present in 4 of 5 stimulated patients. CONCLUSIONS: Afferent nerve activity from the dermatome, bladder and rectum can be recorded using cuff electrodes placed on the extradural S3 sacral root in humans but improvements in recording quality and sophisticated signal processing methods are needed for chronic application.

Action Potentials↗
PubMed1980

Urinary stress incontinence.

The clinical management of urinary stress incontinence requires, firstly, careful evaluation, and then careful individualization of treatment. Much more clinical and basic research is required in order to enhance our better understanding of the causes and treatment of detrusor overactivity.

Animals↗
PubMed2004

Intravesical resiniferatoxin versus botulinum-A toxin injections for neurogenic detrusor overactivity: a prospective randomized study.

PURPOSE: We investigated the effectiveness and safety of intravesical resiniferatoxin (Sigma Chemical Co., St. Louis, Missouri) and botulinum-A toxin injections into the detrusor muscle in a group of spinal cord injured patients with neurogenic detrusor overactivity unresponsive to conventional anticholinergic therapy. MATERIALS AND METHODS: A total of 25 patients were randomly assigned to receive intravesically 0.6 microM resiniferatoxin in 50 ml of 0.9% NaCl or injections into the detrusor muscle of 300 units botulinum A-toxin diluted in 30 ml 0.9% NaCl. Clinical evaluation and urodynamics were performed at baseline, and at 6, 12 and 18 months after treatment. RESULTS: In both arms there was a significant decrease in catheterization and incontinent episodes, and a significant increase in first detrusor contraction and maximum bladder capacity at 6, 12 and 18-month followup. There were no local side effects with either treatment. Botulinum-A toxin induced a significant decrease in the frequency of daily incontinence episodes (p <0.05), a significant increase in first uninhibited detrusor contraction (p <0.01) in maximum bladder capacity (p <0.01), and a significant decrease in maximum pressure of uninhibited detrusor contractions (p <0.01) compared to resiniferatoxin at 6, 12 and 18-month followup. CONCLUSIONS: In spinal cord injured patients with refractory neurogenic detrusor overactivity, intravesical resiniferatoxin and botulinum-A toxin injections into the detrusor muscle provided beneficial clinical and urodynamic results with decreases in detrusor overactivity and restoration of urinary continence in a large proportion of patients. Botulinum-A toxin injections provided superior clinical and urodynamic benefits compared to those of intravesical resiniferatoxin.

Administration, Intravesical↗
PubMed1998

[Electrostimulation in treatment of neurogenic and non-neurogenic voiding dysfunction].

UNLABELLED: The efficiency of transcutaneous and intravesical temporary electrostimulation were evaluated in patients with neurogenic and non-neurogenic voiding dysfunction. Non-invasive electrostimulation was performed in 42 children with voiding dysfunction, at the age of 4 months to 15 years. In 5 children rectal electrode and impulse frequency of 50 Hz was used because of incompetent urethral function. In 9 children with detrusor overactivity rectal electrode and impulse frequency of 5 Hz was used. In 12 girls with discoordinated voiding electrostimulation with rectal electrode was used in biofeedback training. In one case intravesical electrostimulation was used in a girl with lazy bladder syndrome. In 15 patients with neurogenic voiding dysfunction intravesical electrostimulation was used to improve bladder sensation. The efficiency of the treatment was evaluated on the base of urodynamic investigation and patients' observations. The improvement was observed in 3 children from the group with urethral incompetence, both in urodynamic parameters and subjective patients' observations. One girl claimed no change in continence despite improvement in cystometric and profilometric testing. In one girl no change in urodynamic evaluation and continence was observed. Good results were observed in the group of 9 girls in which electrostimulation with rectal electrode was a part of the biofeedback training in discoordinated voiding. In the group of 9 children in whom electrostimulation with rectal electrode was used because of detrusor overactivity in 5 cases improvement in cystometric capacity was estimated. The estimation of usefulness of the intravesical electrostimulation in patients with neurogenic voiding dysfunction is not possible because of too short time of observation and the age of patients. We had to stop stimulation with rectal electrode in one patient because of inflammation of the skin in perineal region caused by cystitis. In two children stimulated with intravesical electrodes a new infection of urinary tract was observed. CONCLUSIONS: 1. Electrostimulation is a non-invasive, save method in the treatment of voiding dysfunction. 2. Electrostimulation with rectal electrodes is an effective method of treatment in cases of urethral incompetence, and an alternative method of treatment for detrusor overactivity. 3. Electrostimulation with rectal electrodes is an additional tool in biofeedback training of discoordinated voiding.

Adolescent↗
PubMed2005

Chronic pudendal nerve neuromodulation in women with idiopathic refractory detrusor overactivity incontinence: results of a pilot study with a novel minimally invasive implantable mini-stimulator.

AIMS: To assess the results of chronic pudendal nerve neuromodulation with a novel technique in a pilot study on women with idiopathic refractory detrusor overactivity incontinence. MATERIALS AND METHODS: A percutaneous screening test (PST) was performed in patients with urodynamically demonstrated detrusor overactivity incontinence. Such a test includes the performance of a cystometrogram without and with percutaneous pudendal nerve stimulation and is considered positive if stimulation results in a more than 50% increase in the bladder volume at the first involuntary detrusor contraction or the maximum cystometric capacity. Patients with a positive PST qualified for the implantation of a mini-neurostimulator with an integrated electrode, a so-called bion(R), adjacent to the pudendal nerve at Alcock's Canal. Five-day voiding-incontinence diaries were the main tool for the evaluation of therapy. RESULTS: A PST was performed in 14 women. Six patients responded positively and received a bion. The degree of incontinence decreased significantly in this group, which also included patients in whom sacral neuromodulation had failed. There were no severe adverse events. CONCLUSIONS: Chronic pudendal nerve stimulation may reduce the degree of detrusor overactivity incontinence, even in patients in whom sacral neuromodulation fails. Bion therapy is relatively simple and minimally invasive and is well tolerated by the patient.

Adult↗
PubMed1998

Frequency urgency syndrome following urinary bladder suspension.

Bladder suspension for urinary incontinence secondary to bladder neck hypermobility is highly successful. Of those who fail, however, a subset will develop new onset or markedly worsened irritative voiding symptoms. A series of such patients were identified to study the associated urodynamic abnormalities of this symptom complex. The charts of female patients presenting for incontinence from 1992-94 were reviewed. Forty-six patients with a mean age of 59.4 (range 28-79) fulfilled the inclusion criteria of developing new onset or markedly worsened post-operative frequency, urgency and urge incontinence within two years of undergoing bladder suspension. All had been evaluated with thorough history, physical examination, and urodynamic testing. Seventeen patients were found to have recurrent hypermobility. Eighteen had a diagnosis of intrinsic sphincter deficiency (ISD), including six that also had another diagnosis. Four patients were diagnosed with detrusor overactivity and seven with other miscellaneous diagnoses. Patients presenting with this symptom complex should be evaluated so that treatment can be tailored appropriately.

Adult↗
PubMed1995

Urodynamic and other effects of tolterodine: a novel antimuscarinic drug for the treatment of detrusor overactivity.

Tolterodine, a novel compound intended for treatment of urgency and urge incontinence, has been characterized as a potent muscarinic receptor antagonist in pharmacological in vitro and in vivo studies. In cats, tolerodine was shown to reduce bladder pressure at doses significantly lower than those affecting salivation. To predict clinical effectiveness, an open pilot study was performed in healthy male volunteers. Efficacy was measured by cystometry and by spontaneously reported effects after administration of a single oral dose of tolterodine, 6.4 mg, given as a water solution. Tolterodine had distinct inhibitory effects on urinary bladder function, both at 1 and 5 hours post-dose. At 1 hour, but not at 5 hours post-dose tolterodine also significantly reduced stimulated salvation. In addition to the objectively demonstrated changes in urodynamic parameters, most volunteers experienced voiding difficulties. No significant changes in blood pressure, heart rate, or near point of accommodation were registered. Tolterodine, in the dosage used, was both objectively and subjectively shown to exert a marked inhibitory effect on micturition in healthy subjects, and the data suggest a more pronounced effect on bladder function than on salivation.

Adult↗
PubMed1985

Detrusor inhibition in suprasacral spinal cord injuries: is it due to sympathetic overactivity?

The authors report five patients with detrusor inactivity in suprasacral spinal cord lesions with perineal spasticity. In all of these cases with cervical or high thoracic lesions treatment with an alpha-blocking drug (Phenoxybenzamine) allowed bladder activity to return. These results suggest that the sacral parasympathetic centre is under the inhibitory influence of the sympathetic nervous system.

Administration, Oral↗
PubMed1995

Oxybutynin. A review of its pharmacodynamic and pharmacokinetic properties, and its therapeutic use in detrusor instability.

Oxybutynin possesses anticholinergic and spasmolytic properties, which together form the basis for its use as a therapeutic option in patients with overactive detrusor function--either idiopathic detrusor instability (DI) or detrusor hyperreflexia. Of the symptoms of detrusor overactivity, urge incontinence is often the most distressing to the patient. Urge incontinence and other subjective parameters (urinary frequency, urgency) improve in tandem with objective (cystometric) measures (maximum detrusor pressure during filling, volume at first desire to void, maximum bladder capacity) in ambulatory, including elderly, patients treated with oxybutynin. However, on the basis of results of limited investigations, the drug appears ineffective in elderly institutionalised individuals. Relative to other anticholinergic drugs, oxybutynin appears at least as effective as propantheline and similar in efficacy to propiverine in small trials, although these results are not definitive. Further investigation of intravesical oxybutynin may lead to this route becoming an option in patients with pre-existing catheters. Adverse effects--dry mouth, constipation, blurred vision--related to the anticholinergic activity of oxybutynin occur frequently and can be sufficiently troublesome to necessitate treatment discontinuation in up to 25% of patients, depending on the dosage. Increases in residual urine volume suggesting urinary retention (undesirable in patients with idiopathic DI), also can develop in some oxybutynin recipients. In summary, oxybutynin is one of the few drugs proven to be beneficial in some patients with overactive detrusor function. Despite the occurrence of unwanted anticholinergic effects in many patients, and apparent lack of efficacy in the elderly institutionalised population, oxybutynin should be considered for the drug of first choice in patients with detrusor overactivity, including the elderly ambulatory population, when pharmacological therapy is indicated.

Animals↗
PubMed1998

Urodynamic parameters in scrapie-affected ewes and their modifications in the course of the disease.

The aim of this study was to determine the urological abnormalities linked to spontaneous spongiform encephalopathy and their occurrence in the course of the disease. The animals used in this were 11 healthy and 20 scrapie-affected ewes. The scrapie-affected ewes were studied at a rate of once a month (1 to 5 measures; mean, 2.55) until they died. Urodynamic explorations were performed. The bladder activity was explored using cystometry. The urethral activity was measured during cystometry and during a urethral pressure profile. Both were analyzed using International Continence Society recommendations. Results showed in scrapie-affected ewes a decrease in functional bladder capacity and an increase in detrusor contraction incidence during filling of the bladder and in the occurrence of significant urethral instability. Bladder abnormalities were seen only in scrapie-affected ewes and worsened during the course of the disease. Urethral instability was not typical of the disease but was significantly more frequent in scrapie-affected ewes. It was concluded that lower urinary tract dysfunction occurred in scrapie-affected ewes and worsened during the course of the disease. This dysfunction is in agreement with overactive detrusor function due to neurological lesions.

Animals↗
PubMed2005

Treatment of neurogenic detrusor overactivity in spinal cord injured patients by conditional electrical stimulation.

PURPOSE: The feasibility of automatic event driven electrical stimulation of the dorsal penile/clitoral nerve in the treatment of neurogenic detrusor overactivity (NDO) was evaluated in individuals with spinal cord injury. MATERIALS AND METHODS: The study included 2 women and 14 men older than 18 years with NDO, bladder capacity below 500 ml and complete or incomplete suprasacral spinal cord injury. Detrusor pressure (Pdet) was recorded during ordinary, natural bladder filling. In a similar subsequent recording Pdet was used to trigger electrical stimulation when pressure exceeded 10 cm H2O. RESULTS: Of the 16 patients enrolled in this study 13 had increased bladder capacity together with a storage pressure decrease as a result of automatic, event driven electrical stimulation. In 2 patients stimulation could not inhibit the first undesired contraction, leakage occurred and finally 1 could not tolerate stimulation. During stimulated filling Pdet never exceeded 55 cm H2O. Thus, storage pressure was sufficiently low to prevent kidney damage. An average bladder capacity increase of 53% was achieved. CONCLUSIONS: This study demonstrates the feasibility of automatic, event driven electrical stimulation in the treatment of NDO. Although the setup in this experiment is not suitable in a clinical setting, the treatment modality is promising and it warrants further investigation.

Adult↗