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Seven cases of urinary incontinence treated by a free muscle transplant are reported. The incontinence was completely unaffected in 5. One patient was able to work without using diapers, while another albeit completely incontinent, could voluntarily stop the flow after the bladder was filled with water.
Five children with urinary incontinence were operated with a new method involving free autogenous muscle transplantation. Before transplantation a skeletal muscle (extensor brevis of the foot) is denervated and, 2 weeks later, it is transplanted and placed as a U-sling around the urethra in close contact with normally innervated muscles, which act as reinnervation sources. All patients showed improvement of continence and increasing bladder capacity from about 2 months after transplantation. Postoperative cine-micturition studies clearly demonstrated the functional properties of the transplanted muscle and estimation of urinary flow rate showed no signs of infravesical obstruction.
BACKGROUND: Urinary incontinence is highly prevalent among older women, affecting more than one-third of this population and significantly impairing quality of life, independence, and healthcare utilization. Older women often present with complex needs that may require broader rehabilitation strategies. METHODS: This systematic review evaluated randomized controlled trials of physical therapy interventions for urinary incontinence in older women. PubMed, Embase, and Scopus were searched to October 2025. Eligible studies included women ≥60 years and assessed interventions such as Pelvic floor muscle training (PFMT), bladder training, Yoga, Pilates, general resistance training, electrical stimulation, or multimodal programs. Methodological quality was appraised using the PEDro scale, and random-effects meta-analysis was performed where appropriate. RESULTS: Twenty studies involving 2002 women across 13 countries were included. Eleven trials were rated as good quality and nine as fair. Meta-analysis demonstrated that PFMT significantly reduced urinary incontinence severity compared with usual care (SMD = -1.27, 95% CI: -2.18 to -0.36, p = 0.006). Multimodal programs combining PFMT with mobility, strength, or fall-prevention training also showed significant benefits (SMD = -0.98, 95% CI: -1.60 to -0.36, p = 0.002). Comparative studies indicated that PFMT was similarly effective to Yoga and Pilates, while adjuncts such as general resistance training or tibial nerve stimulation provided additional improvements. CONCLUSION: Physical therapy interventions, particularly PFMT and multimodal programs, are effective in reducing urinary incontinence severity and improving functional outcomes among older women. These findings support prioritizing physical therapy as an important management strategy, with multimodal approaches offering added value for enhancing functional independence and fall prevention.
The incidence of different forms of incontinence is reported as a short survey. Particular attention is given to the various opinions on the effect of pregnancy, birth and diminishing ovarian function on the occurrence of closure insufficiency. Also the frequency of urinary incontinence arising from bladder conditions is variously assessed. The proportion is certainly high in "operation failure" or recurrent incontinence. Organic causes are only found in a bare fifth of patients with stress incontinence, Iatrogenic urinary incontinence is rare, but imposes particular demands on the attending doctor. Involuntary loss of urine is very widespread among women, but it is relatively seldom found to be troublesome and to require treatment.
Urethral pressure profilometry was done on 12 women with stress urinary incontinence and in 6 women with no history of incontinence, before and 1 to 2 hours after the administration of Ornade. Eleven of the 12 women with stress urinary incontinence had increases in the maximal urethral pressure of 20 per cent or more over the control value. Only 1 of the 6 control women exhibited an increase in the maximal urethral pressure of greater than 20 per cent after the administration of Ornade. It is believed that the phenylpropanolamine component of Ornade stimulates alpha-adrenergic receptors at the vesical neck and in the proximal urethra to achieve the therapeutic effect of reducing or eliminating stress urinary incontinence. This drug is preferred over ephedrine primarily because of its sustained release, allowing dosage twice a day, and because of its relative freedom from side effects.
The prevalence of recognised urinary incontinence in a community was found to be 1%; the prevalence of unrecognised incontinence was 3.3% in men and 8% in women in a group practice of 7000 patients. The approach to investigation and management of urinary incontinence in a urodynamic unit and the staffing of this unit are described.
A questionnaire with a new stress-score and urge-score is being presented, which is designed to differentiate with high statistical significancy between stress-urinary-incontinence (urethral-insufficiency with negative urethral closure pressure on sphincterometry) and urge-urinary incontinence (motor-urge-incontinence with uninhibited detrusor contractions on cystometry). With these scores we expect to facilitate the diagnostic screening, to indicate the way of therapy and to avoid unnecessary surgery for urinary incontinence in cases of motor-urge-incontinence (detrusor instability, unstable bladder), as long as a urodynamic examination is not feasible on every incontinent women.
Psychometric personality questionnaires were used to test 100 patients with symptoms of urinary incontinence. The following findings were recorded: Accumulation with significance of increased psychasthenic values in patients with normal urogynaecological status was higher than that recordable from patients in pathological conditions. The group of patients with mere stress incontinence differed from the group with urge or combined urge-stress incontinence by statistically secured differentiated between means values recordable from neurosis-relevant, test scales, including psychosomatic disorders, depression, neuroticism, social introversion, and phobic disorders. Reference is made to psychogenic factors and their role within a set of multifactorial conditions conducive to functional urinary incontinence of women. Consequences regarding diagnosis and therapy are discussed.
One hundred female patients complaining of urinary incontinence without evidence of associated disease or urinary infection were assessed by clinical appraisal and by simple cystometrogram. Discrepancies were apparent between the two methods of patients assessment. Treatment was primarily based on cystometrogram patterns, and included the surgical correction of the urethrovesical defect, the institution of a program of micturition retraining, or a combination of both methods. Based on a short follow-up assessment period, of those 68 patients chosen for surgery, 78% were cured and 91% were markedly improved. Bladder retraining programs alone were instituted for 32 patients, and a marked (72%) improvement rate was demonstrated. It is suggested that the cystometrogram has an integral and essential place in the assessment of female urinary incontinence and may be easily integrated into practice. Bladder retraining programs may be most usefully employed for some patients found to have bladder dysfunction.
Two cases of urinary incontinence treated by electrical stimulation after failing the Leadbetter technique are presented. Both were first seen bearing imperforated anus. They suffered several operations for correcting this pathology and further attempting to relieve complete urinary incontinence. After a trial with intrarectal stimulation one of them received an implant. The other continued to use the anal plug. In both cases the result has been satisfactory. Cine radiological documentation of the sphincteric action of the stimulated muscles was performed.
The nonimplantable electrical stimulators are widely used as rehabilitation aids for correction of urinary incontinence. The advances in the field of the design of nonimplantable electrical stimulators such as automatic vaginal electrical stimulator VAGICON-X and anal pressure controlled electrical stimulator are described. The evaluation of VAGICON-X in patients suffering from stress and urge incontinence as well as preliminary results of acute application of anal pressure electrical stimulation in patients with stress incontinence as presented.
Nonneurogenic incontinence was observed in a 1-year-old Pekingese X Poodle with female pseudohermaphroditism. The dog had male external genitalia as well as a well-developed vagina, uterus, and ovaries. Urinary incontinence was caused by an anomalous communication of the prostatic urethra with the vagina. Ovariohysterectomy and surgical correction of the urethrovaginal fistula was followed by remission of urinary incontinence. Subsequently, the dog developed estrogen responsive urinary incontinence. Nonneurogenic incontinence to be a common finding in canine pseudohermaphroditism associated with abnormalities of the vagina or urethra (or both). Surgical correction should be considered to correct anomalous communications between the genital and lower urinary tracts.
A case of neurosurgical treatment of recurrent urinary incontinence caused by detrusor hyperreflexia is reported. The importance of cystometry in the diagnosis of recurrent urinary incontinence is stressed.
Detrusor hyperreflexia was found in 54 patients or 14.6% of 369 consecutive patients referred for urinary incontinence and/or genital prolapse during a 2-year period. The dominant symptom was urge incontinence. The urological investigation consisted of a medium fill water cystometry in the supine position. 20 patients (37%) suffered from cerebral or pyramidal nervous disorders. The treatment of choice was pharmacological with parasympatholytica, methantheline bromide (Banthine). The follow-up examinations performed in 33 patients after 6 months treatment showed an improvement rate of 82%. The importance of performing a cystometry in all female patients referred for urinary incontinence is stressed.
Ninety-eight patients with urinary incontinence have been treated with maximal electrical stimulation (MES) The MES method used is a modification of previously used similar methods of maximal stimulation with respect to reduced intensity of stimulation and reduced number of electrodes. Thus, discomfort to the patient during treatment is considerably lessened. Anal or vaginal MES produced temporary or sustained improvement or relief of incontinence in 47 of 98 patients.
An outline is given of simple urodynamic investigations applicable to elderly subjects. The type of patient presenting primarily to geriatric departments with urinary incontinence, whose management is aided by such studies, is described under various clinical groupings. The requirement for urodynamic studies and the best means of providing these for the elderly patient is discussed.
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A study to determine the prevalence of urinary incontinence in a random sample of a total elderly community is described. The prevalence of incontinence in women aged 65 years or more was found to be 17% and in men 11%. The findings show that the prevalence of incontinence is particularly high among residents of old people's homes and geriatric hospitals, but that the majority of cases occur within the general community. The prevalence increases with age in both sexes; associations with a history of cerebrovascular disease, certain surgical procedures, multiple hospital admissions and drug usage are described. The findings of a follow-up study suggest that, although the disorder is long-standing and severe in a proportion of subjects, it is transient in approximately a third of all elderly subjects with the condition.