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At least 163 records · Page 9Linked to original sources

PubMed2005

Functional imaging of stress urinary incontinence.

Stress urinary incontinence (SUI) is defined as an involuntary loss of urine during increases in intraabdominal pressure such as coughing or laughing. It is often a consequence of weakness of the pelvic floor. Treatment of SUI consists of pelvic floor muscle training with EMG-biofeedback (PFMT) or contraction-exercises, with voluntary pelvic contractions in order to strengthen the pelvic floor. We investigated neuroplastic changes comparing PFMT with EMG-biofeedback before and after training in ten female patients with SUI using event-related functional Magnetic Resonance Imaging (fMRI). After a 12-week training a more focused activation in the primary motor and somatosensory cortical representation sites of the lower urogenital tract was found. In addition, reductions in brain activation in the insula, right frontal operculum and the anterior cingulate cortex suggest changes in emotional arousal in micturition after treatment. These changes are related to clinical improvement documented by decreased number of incontinence episodes and increased EMG-activity of the pelvic floor muscles after training. The changes in EMG-activity were correlated with heightened BOLD responses in the primary motor and primary sensory cortical representation sites of the lower urogenital tract.

Adult↗

PubMed1976

Unilateral and bilateral bladder neck suspension (modified Pereyra) operation for stress urinary incontinence.

Stress urinary incontinence can be corrected by a short, simple, minor suturing technique, a modification of the Pereyra operation. Success depends upon careful selection of patients, the proper tightness of the suture over a proper-size catheter and the use of intermittent endoscopy during the operation. Successful outcome up to 7 months has been achieved in 7 of the 8 patients but reoperation was necessary for the successful outcome in 1 of the 2 failures.

Adult↗

PubMed2005

Addressing the need for a simpler algorithm for the management of women with urinary incontinence.

AIMS: Urinary incontinence (UI) is a prevalent and bothersome condition for many women. However, few women convey the problem to primary care physicians (PCPs), and few PCPs proactively ask about it. One reason may be that available UI recommendations are too complex and difficult to implement. Simplification may encourage greater adaptation as long as a simplified algorithm does not compromise patient safety. I review the opportunity to develop a simpler UI algorithm based on the 3rd edition 2005 International Consultation of Incontinence (ICI) guidelines for the initial management of UI in women. METHODS: A literature search for scientific evidence supporting simplification was performed using PubMed, the Cochrane Database, the Agency for Health Care Policy and Research's (AHCPR) 1996 recommendations, and the ICI's 2005 Incontinence Book / CD-ROM. Each level in the ICI algorithm for initial assessment and treatment was evaluated to develop an updated and less complex management strategy. RESULTS: A simpler UI algorithm for PCPs should focus on considering reversible risk factors and identifying those who need specialized management. A short questionnaire may be sufficient to assess type and severity of UI, whereas a standard neurologic or comprehensive abdominal and pelvic examination seems unnecessary. Treatment should be restricted to a few evidence-based options. CONCLUSIONS: In conclusion, a simpler UI algorithm allows the initiation of evidence-based treatment after a simplified assessment in primary care.

Algorithms↗

PubMedDate not supplied

[Surgical therapy for stress urinary incontinence].

Stress urinary incontinence (SUI) is a common disorder among women of all ages, which compromises their quality of life. It may compromise self-esteem, restrict lifestyle, strain relationships, and may ultimately lead to social embarrassment and isolation. Therefore, SUI management does not only imply cure or improvement of SUI, but also includes psychological and social assistance to help sufferers to cope with their condition. In this regard, it is important to acknowledge the role of the patient in the selection of an appropriate treatment. Physicians and patients can choose between conservative, pharmacological, and surgical treatments. Surgical techniques for SUI have evolved over the last 150 years. Accurate diagnosis of SUI is essential before surgery is undertaken. Many surgical procedures have been employed, which can be divided into four basic types: anterior colporrhaphy, colposuspensions, suburethral sling procedures, including TVT, as well as suburethral bulking agents. This wide variety of surgical procedures indicates the lack of consensus on which procedure is best. In most continence surgery, the benefit of restoring continence often comes at the expense of instigating new symptoms or exacerbating existing lower urinary tract symptoms.

Female↗

PubMed1976

Stress Urinary Incontinence.

Stress urinary incontinence (SUI) was studied in 125 women who were subjected to simultaneous urodynamic and radiologic evaluation. This included cystometry, urethral pressure profiles, measurement of effective urethral length, estimation of urethral mobility, and alterations in the urethrovesical angles during stress. The most common abnormality was a hypermobility of the proximal urethra with loss of its intraabdominal position during stress, associated with changes in the urethrovesical angle. Fixation of the posterior urethra, loss of effective urethral length, low resting urethral pressure, and true neurovesical dysfunction were also found in some of the patients. Uninhibited bladder contractions were found in 22% of cases, but in most instances they were the result of SUI and ceased after surgical repair.

Adolescent↗

PubMed2002

[TVT: Revolutionary treatment of urinary incontinence].

Stress urinary incontinence represents an important, often unknown and, yet, certainly most unpleasant pathology. Over years, several different surgical techniques have been proposed and reported to have variable success. TVT, a simple and reproducible technique, aims at stabilizing mid-urethra, and not bladder-neck. Our own clinical experience amounts to 139 cases. All these patients were evaluated by clinical examination and, subjectively, by a questionnaire. 89.2% were cured and 6.5% improved. The most frequent complication was bladder perforation (6.5%), but it had no incidence on the final results. Morbidity was low. This revolutionary technique is very promising and our own results are similar to those reported by others.

Adult↗

PubMed2005

Suitability of different sling materials for the treatment of female stress urinary incontinence.

Stress urinary incontinence (SUI) is defined as leakage of urine with a sudden increase in intra-abdominal pressure, such as that seen with laughing, lifting, or changing position, without a concomitant rise in detrusor (bladder-generated) pressure. The proposed mechanism of SUI is that an increase in intra-abdominal pressure resulting from various activities causes the bladder pressure to rise above the urethral pressure. The pubovaginal sling remains the standard treatment for female SUI in the US. The market has been flooded with innumerable sling materials. This review discusses the currently available sling materials, surgical approaches, and clinical outcomes data. Long-term data on efficacy is lacking, but early results with new materials and delivery techniques indicate that excellent cure rates with minimal morbidity and high patient satisfaction may be achievable.

Biocompatible Materials↗

PubMed1990

Stress urinary incontinence.

Stress urinary incontinence due to urethral sphincter incompetence (genuine stress incontinence) afflicts some 5-15% of women. The mechanism of continence is imperfectly understood, as is the precise mode of its cure, whether conservative or surgical. The pathophysiology is a reduction in urethral resistance in the absence of detrusor activity. Aetiological factors include congenital malformation of the bladder neck, denervation of the pelvic floor and sphincter mechanism following childbirth, trauma causing disruption of the urethral sphincter mechanism, fibrosis associated with bladder neck surgery for prolapse, oestrogen deprivation at the menopause, and urethral relaxation or instability. Conventional investigations include urethral pressure measurement, urethral electric conductance, electrophysiological tests, and cystometry or videocystourethrography (the latter procedures diagnose by exclusion). A more precise evaluation of the role of urethral resistance is hampered by lack of suitable techniques for measuring urethral and sphincteric function. Treatments include pelvic floor exercise, drugs to increase urethral resistance, and surgery, either to evaluate the bladder neck or to increase urethral resistance.

Humans↗

PubMed2004

Novel injectable urethral bulking agents for the treatment of urinary incontinence.

Stress urinary incontinence is a highly prevalent disorder resulting from weak urethral closure mechanisms. Endoscopic injection of a urethral bulking agent (UBA) under the urethral mucosa increases coaptation, which improves continence. Collagen is an efficient agent, although its effects are limited in time. Other materials still suffer either from a short-lasting effect or migration in distant organs. We evaluated here novel UBAs using an ex vivo model, with respect to criteria of ease of injection, ability to form a high and stable tissue bulking, implant elasticity and tissue reaction. One approach involves solutions of polymers in water-miscible organic solvents that precipitates in situ. In this manner, high and stable bulks were routinely obtained using various commercial polymers. Selected solvents reduced the tissue reaction to the implant. Microsphere suspensions in hydrogels also proved to be efficient UBA, although less stable bulks were obtained. Thermosetting chitosan hydrogels showed promising results with respect to bulk stability and isoelasticity with surrounding tissues. Different strategies have thus been compared and optimised ex vivo. Further experiments are required to compare the ability of these materials to induce a sustained in vivo bulking effect.

Animals↗

PubMed2006

Sexual function in women with urodynamic stress incontinence, detrusor overactivity, and mixed urinary incontinence.

OBJECTIVE: This study was undertaken to compare sexual function in sexually active women with urodynamic stress incontinence (USI), detrusor overactivity (DO), and mixed urinary incontinence (MUI). STUDY DESIGN: We reviewed the medical records of all women evaluated for urinary incontinence (UI) at our institution between March 2003 and August 2004. At the time of initial evaluation, all women completed the short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ-12). PISQ-12 scores of age-matched women with urodynamic diagnoses of USI, DO, and MUI were compared. Statistical analysis was performed with 1-way analysis of variance and chi2 contingency table analysis. RESULTS: Fifty women with USI, 50 with DO, and 48 with MUI were included in this study. Subject demographics were similar among the 3 groups. Mean PISQ-12 scores did not differ significantly among the 3 groups. CONCLUSION: Among sexually active women with urinary incontinence, sexual function as assessed by the PISQ-12 does not differ according to type of incontinence.

Adult↗

PubMed2000

Outcome results of transurethral collagen injection for female stress incontinence: assessment by urinary incontinence score.

PURPOSE: We assessed the results of collagen injection for female sphincteric incontinence using strict subjective and objective criteria. MATERIALS AND METHODS: We evaluated 63 consecutive women with sphincteric incontinence who underwent a total of 131 transurethral collagen injections. Sphincteric incontinence was confirmed by urodynamics. All patients were treated with 1 to 5 transurethral collagen injections and treatment outcome was classified according to a new outcome score. Cure was defined as no urinary loss due to urge or stress incontinence documented by a 24-hour diary and pad test, and patient assessment that cure was achieved. Failure was defined as poor objective results and patient assessment that treatment failed. Cases that did not fulfill these cure and failure criteria were considered improved and further classified as a good, fair or poor response. RESULTS: Mean patient age plus or minus standard deviation was 67.7 +/- 12.8 years. All women had a long history of severe stress urinary incontinence, 18 (29%) underwent previous anti-incontinence surgery, and 41% had combined stress and urge incontinence. Preoperatively diary and pad tests revealed a mean of 7.5 +/- 4.6 incontinence episodes and 152 +/- 172 gm. of urine lost per 24 hours. Overall 1 to 5 injections were given in 26, 17, 13, 3 and 4 patients, respectively. Mean interval between injections was 4.4 +/- 5.7 months, mean followup was 12 +/- 9.6 months, and mean interval between the final injection and outcome assessment was 6.4 +/- 4.9 months. There was a statistically significant decrease in the total number of incontinence episodes per 24-hour voiding diary after each injection session. Although there was a clear trend toward decreased urinary loss per 24-hour pad test, statistical significance was not established. Using the strict criteria of our outcome score overall 13% of procedures were classified as cure, 10%, 17% and 42% as good, fair and poor, respectively, and 18% as failure. CONCLUSIONS: As defined by strict subjective and objective criteria, we noted a low short-term cure rate after collagen injection in women with severe sphincteric incontinence. It remains to be determined how patients with less severe incontinence would fare using our outcome assessment instruments.

Aged↗

PubMed2001

Visual analogue scale, urinary incontinence severity score and 15 D--psychometric testing of three different health-related quality-of-life instruments for urinary incontinent women.

OBJECTIVE: The purpose of this study is psychometric assessment of disease-specific questionnaire, Urinary Incontinence Severity Score (UISS) and Visual Analogue Scale (VAS) in urinary incontinent women. We also investigated functional relationship between UISS, VAS and 15D-valid, generic health-related quality-of-life (HRQoL) instrument. MATERIALS AND METHODS: Eighty-two incontinent female patients were recruited for the study that included baseline investigation and re-evaluation 13 months (range 6-21 months) after treatment. Twenty-nine control women who had urinary incontinence but were not bothered by it completed the HRQoL measurements. RESULTS: Internal consistency and content validity of UISS was good. Both measures UISS and VAS were reproducible, Spearman's rank correlation between test-retest were 0.88 and 0.85 respectively. The control women's UISS, 15D and VAS scores were significantly lower than the patient's scores (p<0.001, Mann-Whitney U test) which proves to be a good discriminant. The changes in pad test correlated moderately well with those in the VAS and UISS. The UISS, VAS and 15D in the improved group had responsiveness (Guyatt's) statistics: 1.48, 1.74 and -0.80 respectively. CONCLUSION: The UISS and VAS proved to be valid, reproducible and responsive to treatment for UI women. The functionality of the 15D was good but it demonstrated less sensitivity to changes after treatment.

Adult↗

PubMedDate not supplied

Treatment of urinary incontinence with AMS 800 artificial urinary sphincter.

BACKGROUND: Urinary incontinence has a significant impact on the quality of life for patients. The introduction of the AMS 800 artificial urinary sphincter by American Medical Systems (Minnetonka, MN, USA) has revolutionized the treatment of urinary incontinence due to pure sphincteric incompetence. PATIENTS AND METHODS: From April 1989 to October 1997, a total of 52 patients (42 men and 3 women) underwent implantation of the AMS 800 artificial sphincter. Patient age ranged from 31 to 87 years (mean 69.5 years). They all were suffering from urinary incontinence caused by sphincteric damage, always of iatrogenic origin. Follow-up was 5-110 months, with a mean of 35 months. RESULTS: The restoration of continence was complete for 35 patients and allowed them all to return to their normal life. 7 of the patients who had a successful implant died because of other problems. For 2 patients follow-up was not available. Explantation was performed 8 times: in 5 male patients the device was removed because of periprosthetic infections; in 1 female patient with ileal neobladder, because of serious urethral necrosis; and in 2 male patients because of an urethral erosion. CONCLUSIONS: The AMS 800 artificial urinary sphincter is the most efficacious treatment currently available for urinary incontinence due to pure sphincteric incompetence. Implanted patients achieved acceptable urinary control. The implantation is associated with 2 distinct complications: surgical and mechanical.

Adult↗

PubMed2002

A systematic review of the literature on the prevalence of sexual impairment in women with urinary incontinence and the prevalence of urinary leakage during sexual activity.

OBJECTIVE: To provide a synthesis of the literature concerning the impact of urinary incontinence on sexual lives of women and the prevalence of urinary incontinence during sexual activity. METHODS: Medline and PsycInfo were searched for all primary epidemiological articles reporting the prevalence of sexual incontinence or the impact of urinary incontinence on sexual function in women. Only papers written in English since 1980 and prior to December 2001 were included. RESULTS: Two studies had assessed the prevalence of sexual incontinence in randomly selected community samples and reported population prevalences of 2%. Reporting in clinical samples were varied with prevalences ranging from 10 to 56%. Studies of impairment in sexual function were more varied and methodologically heterogeneous with reported prevalences of 0.6-64%. CONCLUSIONS: Further research is needed using standard definitions and measures of sexual incontinence and sexual impairment in order to establish reliable prevalence estimates.

Epidemiologic Studies↗

PubMed2002

Prevalence of anal incontinence in women with symptoms of urinary incontinence and genital prolapse.

OBJECTIVE: To investigate risk factors and prevalence of anal incontinence among women with pelvic floor dysfunctions. METHODS: We evaluated 881 women with symptoms of urinary incontinence and/or genital prolapse. Each completed a bowel questionnaire and underwent a detailed medical, surgical, obstetric, and gynecologic history, and a pelvic examination. Additional testing, when indicated, included office cystometry or multichannel urodynamic evaluation. Multivariable analysis using logistic regression was used to test the overall significance of all variables significantly associated with anal incontinence, using univariate analysis. RESULTS: A total of 178 women had anal incontinence (20%). These patients were on average older, had a greater body mass index, and had larger birth weight infants than their anal-continent counterparts; 511 were diagnosed with urinary incontinence, and 122 (24%) also had anal incontinence. Women with urinary incontinence were more likely to report anal incontinence events than women continent of urine (24% versus 15%, P =.002). The following associations were found with anal incontinence: infant with birth weight 3800 g or greater (odds ratio [OR] 1.5, 95% confidence interval [CI] 1.1, 2.2), rectocele greater than grade 2 (OR 1.9, 95% CI 1.1, 3.3), urinary incontinence (OR 1.9, 95% CI 1.3, 2.8), hemorrhoidectomy (OR 2.7, 95% CI 1.1, 7.0), irritable bowel syndrome (OR 6.3, 95% CI 3.5, 11.5). CONCLUSION: Among women with symptoms of urinary incontinence and pelvic organ prolapse, the prevalence of anal incontinence was 20%. Urinary incontinence and severe rectocele were found to be associated with anal incontinence.

Fecal Incontinence↗

PubMed2004

Surgical treatment of urinary incontinence in women.

Urinary incontinence affects many Americans, predominantly women. The majority of health care costs are spent on absorbent products, and diagnosis and treatment consume significant additional resources. Many factors interact with urinary incontinence-including medications, health conditions, and other pelvic floor disorders. There has been no meaningful research on prevention of urinary incontinence. The majority of research has focused on treatment, often with medical approaches or surgery. Surgery for urinary incontinence is largely limited to treatment of stress urinary incontinence. Nearly 300 procedures have been proposed, but very few have been the subject of significant, high-quality research. Three groups of surgical procedures (and their variants) have been utilized over the past decades: urethropexy, colposuspension, and the sling. Effective surgery appears to result from enhancing sphincteric closure during increases in intra-abdominal pressure. There are only a few studies that compare these procedures to one another. Many surgical procedures are adopted based on expert opinion and novel, untested concepts. A significant number of postoperative patients experience continued incontinence despite "cure" of stress incontinence. Research in the field of surgery for urinary incontinence can be facilitated by development of better diagnostic aids, better outcome measures, and techniques that allow standardization of interventions and testing procedures (including urodynamics). The role of industry needs close scrutiny-because novel, untested techniques and materials are frequently introduced without careful human subjects testing. Although surgery will continue to play an important role in the treatment of urinary incontinence for Americans, high-quality studies are urgently needed in this field.

Female↗

PubMed1999

Prevalence of anal incontinence in 409 patients investigated for stress urinary incontinence.

A clinical questionnaire concerning anorectal symptoms and urodynamic tests was used to investigate 409 women consulting for stress urinary incontinence. To compare urodynamic data, patients were divided into three groups of women who had either stress urinary incontinence associated with incontinence for formed and/or liquid stools or with gas incontinence, or isolated stress urinary incontinence. To take in account the patients'age for data interpretation, a Mantel-Haenszel test or covariate analysis was performed. Anal incontinence was reported in 114 (28%) of the 409 women investigated. The prevalence of incontinence for gas only, for liquid, or for solid stools was 18.3, 9.3, and 1%, respectively. The duration of gas incontinence was longer than that of fecal incontinence or stress urinary incontinence. Difficult defecation was more frequently observed in patients with double incontinence than in patients with only stress urinary incontinence, and the difference was significant between patients with gas incontinence and patients with stress urinary incontinence (53% versus 37%, P = 0. 03). There was no difference in the number of bowel movements per week among the three groups of patients. The number of vaginal deliveries was surprisingly lower in patients with fecal incontinence associated with urinary incontinence than in others. There was no urodynamic feature that could distinguish patients with urinary incontinence and patients with double incontinence. This study confirmed the close relationship between anal and stress urinary incontinence. Neurourol. Urodynam. 18:579-590, 1999.

Adolescent↗

PubMed1989

Diagnosing urinary incontinence in adults.

Urinary incontinence is a health problem for people of all ages and especially for the elderly. Urinary incontinence accounts for 3 to 8 percent of the total costs of nursing home care. This article focuses on the clinical picture in urinary incontinence and includes guidelines for the incontinence history, the physical examination, the psychological assessment and diagnostic studies. It serves as a useful guide for health care providers involved in diagnosing urinary incontinence.

Adult↗