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PubMed1999

Conservative treatment of female stress urinary incontinence with functional electrical stimulation.

BACKGROUND: Treatment of stress urinary incontinence with functional electrical stimulation (FES) is a recent and efficient method of conservative treatment. STUDY DESIGN: Before treatment, examinations determining the type of urinary incontinence should be made: patient history, pelvic and urologic examination, laboratory tests of urine, multi-channel urodynamic tests. The degree of urinary incontinence is assessed by pad tests. Only the patients with moderate stress urinary incontinence without or with a mild utero-vaginal prolapse, are treated by FES. The parameters of stimulation: the impulse is rectangular and biphasic, duration of impulse is 1 ms, frequency of impulse is 20 Hz, and intensity of current 35 mA. The chronic treatment with FES should be applied 1.5-2 h daily for 3 months. This long-term treatment requires appropriate motivation of the patient. RESULTS: Three months after terminated treatment 56 of the total 111 patients (50.5%) were cured, in 26 (23.4%) the condition improved, whereas in 29 patients (26.1%) the treatment failed. CONCLUSIONS: The efficiency of treatment depends on the patient selection, parameters of electrical stimulation, stimulator of the pelvic floor muscles, mode of stimulation--chronic stimulation, and on motivation of the patient.

Electric Stimulation↗
PubMed1998

A randomised controlled trial of antibiotic prophylaxis for vesico-vaginal fistula repair.

OBJECTIVE: To test the hypothesis that intravenous antibiotics given intra-operatively reduce the failure rate of vesico-vaginal fistula repair. DESIGN: A single blind, randomised controlled trial. SETTING: A district hospital in Benin, West Africa. POPULATION: Seventy-nine women undergoing repair of an obstetric vesico-vaginal fistula by a single surgeon at Hopital Evangelique; two women had repeat operations. METHODS: Participants in the treatment group (n = 41) received ampicillin 500 mg intra-operatively. Controls (n = 40) received no prophylactic antibiotics. MAIN OUTCOME MEASURES: Failure of fistula closure and objective incontinence (a positive pad test) at hospital discharge. Secondary outcomes included febrile morbidity, other antibiotic use and urinary infection. RESULTS: Antibiotic prophylaxis did not reduce the odds of failed repair (OR 2.1 95% CI 0.75-6.1) or of objective incontinence (OR 1.9; 95% CI 0.72-5.1). The women in the antibiotic prophylaxis group received less post-operative antibiotics and had less urinary infections at day 10. CONCLUSIONS: Prophylactic antibiotics should not be used in vesico-vaginal fistulae repair in the developing world outside randomised controlled trials.

Ampicillin↗
PubMed2003

A randomized controlled trial of the NEAT expandable tip continence device.

Urethral devices are one conservative management option for stress and mixed urinary incontinence, but there is little published data about their use. The aims of this study were to assess the safety and efficacy of a new urethral device (NEAT) and compare it with the Reliance Insert. The ease of use of both devices was then evaluated. Twenty-four women with mixed or stress urinary incontinence, patients at our tertiary care urogynecology unit and who met the inclusion and exclusion criteria, were enrolled in the study. Study subjects were blinded and randomly assigned to a device group. Device efficacy was assessed by pad weighing at 0 and 4 months. Success was defined as a 50% or greater reduction in urine loss using the formula 100[(pad weight without device -pad weight with device)/pad weight with device]. Safety was evaluated using urinalysis and urine cultures. Ease of use assessment scales were also completed. Eleven patients were randomized to the Reliance Insert and 13 to the NEAT device. There were no significant differences between the two groups in age, height, weight, duration of incontinence, pad weight, leakage score, parity or quality of life score. Based on the pad weight success formula, there was no significant difference in device success between the two groups at 4 months. Women who were postmenopausal had a trend towards a higher level of success in reduction of their pad weight. Previous treatment, diagnosis and hormone replacement therapy all had no relationship to device success. Leakage score data showed that subjects had a significant decrease in urine leakage when using either device. There was no statistically significant difference in ease of use between the two devices. Adverse symptoms most commonly noted were awareness of the device (62.5%), urgency (29.2%), and urethral discomfort or pain (20.8%). One urinary tract infection (UTI) was observed. The most common finding on urinalysis was trace hematuria (15.8%). Our conclusions are that the NEAT device appears to be at least as effective and safe as the Reliance Insert. Both devices are effective at decreasing urine leakage in patients with stress or mixed urinary incontinence. The risk of UTI is low, but these devices may cause trace hematuria.

Equipment Design↗
PubMed1998

Long-term results and complications of augmentation ileocystoplasty for idiopathic urge incontinence in women.

OBJECTIVE: To assess the long-term (3-9 years) results of augmentation ileocystoplasty for non-neurogenic female urge incontinence in terms of continence, the need for intermittent self-catheterization and the need for additional or auxiliary treatment, to define the long-term complications and to assess the patients' satisfaction with the outcome. PATIENTS AND METHODS: The study comprised 51 women who underwent augmentation ileocystoplasty for non-neurogenic urge incontinence between November 1987 and December 1993; 27 patients had associated interstitial cystitis. All patients had exhausted conservative methods, with an unsatisfactory outcome. All patients were interviewed about the results of the procedure, and their charts reviewed and updated with relevant information. RESULTS: Within a mean (range) follow-up of 75.4 (36-109) months, 27 patients (53%) were completely continent, 13 (25%) had occasional leaks and nine (18%) continued to have disabling urge incontinence frequently requiring pads. Regular self-catheterization was needed by 20 (39%) patients while the rest emptied adequately with no or minimal residual volumes. Additional pharmacotherapy had to be used by 12 (24%) patients. Three patients later developed stress urinary incontinence and were managed with fascial sling procedures. The patch was revised in two patients and excised from four others because they had high residual volumes and uncontrollable infections. Two patients had an ileal conduit diversion for persistent incontinence. The most common complication was recurrent urinary tract infections, seen in 22 patients using intermittent self-catheterization. Mucus retention occurred regularly in 10 patients, six had chronic diarrhoea, four had latent bowel obstruction, one developed a bladder stone, one an incisional hernia and one developed patch necrosis and perforation. Twenty-seven patients (53%) were happy with the outcome of the procedure while 20 (39%) were not; four patients were unsure whether a change had occurred. CONCLUSION: Augmentation ileocystoplasty is a valuable alternative for women with intractable urge incontinence. However, these patients and their physicians should be aware of its limitations, specifically the possibility that incontinence may persist and the high probability of the need for self-catheterization, with potential subsequent urinary tract infection.

Adolescent↗
PubMed2005

Costs of managing urinary and faecal incontinence in a sub-acute care facility: a "bottom-up" approach.

AIMS: To measure accurately the direct costs of managing urinary and faecal incontinence in the sub-acute care setting. MATERIALS AND METHODS: Prospective observational study was undertaken in two sub-acute care units in a metropolitan hospital. A consecutive series of 29 consecutive patients with urinary and/or faecal incontinence, who were in-patients in a geriatric rehabilitation or sub-acute neurologic unit underwent routine timed voiding protocol, as per usual care. Face-to-face bedside recordings of all incontinence care, with detailed cost analysis, were undertaken. RESULTS: A total of 3,621 occasions of continence care were costed. The median time per 24 hr spent caring for incontinence per patient was 109 min (interquartile range 88-140). Isolated urinary incontinence episodes occurred in 28 patients (96.5%), mixed urinary/faecal incontinence episodes observed in 79.3%, and episodes of pure faecal incontinence were seen in 62%. The median costs of incontinence care in the sub-acute setting was $49AU per 24 hr, the major share ($41) spent on staff wages. The incontinence tasks of toileting assistance, pad changes, bed changes and catheter care were spread evenly across the three 8 hr shifts of duty. CONCLUSIONS: As our population demographics include an increasingly greater portion of the elderly, for whom long term institutional care is becoming relatively more scarce, provision of care in the sub-acute unit that may allow rehabilitation and return to home warrants scrutiny. This is the first study that delineates the costs of managing urinary and faecal incontinence in the sub-acute care setting. Such costs are substantial and place a heavy burden upon night-time carers.

Aged↗
PubMed1995

Contigen Bard Collagen implant: the Japanese experience.

This was an open trial to evaluate the efficacy and safety of Contigen Bard Collagen Implant for the treatment of urinary incontinence in patients with either stress incontinence or true incontinence (intrinsic sphincter deficiency). Contigen was injected at two opposing sites in the submucosal tissues of the bladder neck or posterior urethra; this was repeated after 7 days if needed. Patients were evaluated in terms of the frequency and degree of incontinence, the number of pads used, quality of life and the pad weighing test. A global evaluation of the efficacy, safety, and usefulness of the procedure also was performed. Ninety-seven patients were enrolled, and 73 completed one-year of follow-up. At baseline, 66 patients, all females, had genuine stress incontinence (GSI), and 14 patients, 10 male and 4 female, had true incontinence (TI). Improvements in the degree of incontinence were observed in 61% of patients in the GSI group and 8% of patients in the TI group. The frequency of incontinence, number of pads used, and pad test (weight) were significantly (p < 0.0001) decreased in the GSI group. A global evaluation of efficacy found that 68% of patients in the GSI group were cured or improved, and 21% of patients in the TI group were cured or improved. Overall, 88% of the GSI group and 43% of the TI group found the procedure to be useful or slightly. Fifty adverse events were reported in 36 patients, but no patients discontinued treatment for adverse events. The most common adverse events were urinary retention in 24 patients, and difficulty voiding in 10 patients, although both side effects were transient.

Adult↗
PubMed2007

The tension free vaginal tape operation for women with mixed incontinence: Do preoperative variables predict the outcome?

AIMS: The aims of our study were (1) to investigate subjective and objective outcomes after tension free vaginal tape (TVT) operations in mixed incontinent women, (2) to detect if preoperative subjective and objective variables predict the outcome, and (3) to evaluate whether the surgical outcome is different for women who preoperatively find stress incontinence, urge incontinence, or urge and stress incontinence equally the predominant bother. METHODS: A prospective cohort study was performed on 450 mixed incontinent women. A short-form disease-specific validated questionnaire, 24-hr pad test, standardized stress test, residual urine, and maximum urinary flow were used before and after a TVT operation. "Cure" was defined as a condition where the women were very satisfied with the TVT operation and had negative stress- and 24 hr pad tests. RESULTS: Preoperatively 69% had stress incontinence, 7% urge incontinence, and 24% urge and stress incontinence equally as the predominant bother. Cure rates were 80%, 52%, and 60%, respectively, in these groups. Postoperatively 43% of the women had no urge incontinence, while 49% were less, and only 8% were more bothered by urge incontinence. A higher preoperative urge incontinence index was correlated with significantly higher postoperative bother for all indices and leakage during 24-hr pad test. CONCLUSIONS: Mixed incontinent women with predominant stress incontinence had a better cure rate than those with predominant urge incontinence and those who were equally bothered by urge and stress incontinence. This point needs to be addressed when informing mixed incontinent women before a TVT operation.

Aged↗
PubMed2003

Combined reporting of cancer control and functional results of radical prostatectomy.

INTRODUCTION: The results of radical prostatectomy (cancer control, continence and sexual potency) are currently presented separately, while the success of this surgery depends on a combination of good cancer control with maintenance of continence and erections. We propose a score to jointly evaluate and report cancer control and functional results. METHODS: The results of 205 radical prostatectomies were studied at one year. Cancer control was evaluated by PSA. Continence and sexual potency were evaluated by a self-administered questionnaire. Each patient was attributed 0 or 4 points according to the presence of absence of biochemical progression (PSA>0.2 ng/ml), 0 or 2 points according to the presence or absence of urinary incontinence (use of pads) and 0 or 1 point according to the presence or absence of impotence (no erections). The sum of these points provided a score classifying the patient into 8 distinct categories, from 0 to 7, each corresponding to a specific status (from 0 (0+0+0): no cancer control-incontinence-impotence to 7 (4+2+1): cancer control-continence-sexual potency). RESULTS: One year after the operation, 175 (85%) of patients had a PSA less than 0.2 ng/ml, 135 (65.8%) were continent and 64 (32.7%) reported erections. All patients with a score > or =4 had good cancer control, with no functional disorders for a score of 7 (4+2+1) (20%), no disorders of continence for a score of 6 (4+2+0) (31.5%), no disorders of erection for a score of 5 (4+0+1) (8.3%), or with incontinence and impotence for a score of 4 (4+0+0) (21.9%). All patients with a score <4 had a PSA>0.2 ng/ml, but with no functional disorders for a score of 3 (0+2+1) (2.4%), no incontinence for a score of 2 (0+2+0) (8.3%), and no impotence for a score of 1 (0+0+1) (1.9%). 1.9% of patients were incontinent, impotent and showed signs of biochemical progression (score 0=0+0+0). CONCLUSION: This score allows analysis of the global (cancer control and functional) results of radical prostatectomy and would facilitate comparisons between various surgical techniques (type of approach, nerve-sparing techniques) and various centres.

Aged↗
PubMed2003

[How to present in a unique fashion the oncologic and functional results after radical prostatectomy].

INTRODUCTION: The results of radical prostatectomy (cancer control, continence and sexual potency) are currently presented separately, while the success of this surgery depends on a combination of good cancer control with maintenance of continence and erections. We propose a score to jointly evaluate and report cancer control and functional results. METHODS: The results of 205 radical prostatectomies were studied at one year. Cancer control was evaluated by PSA and continence and sexual potency were evaluated by a self-administered questionnaire. Each patient was attributed 0 or 4 points according to the presence or absence of biochemical progression (PSA > 0.2 ng/ml), 0 or 2 points according to the presence or absence of urinary incontinence (use of pads) and 0 or 1 point according to the presence or absence of impotence (no erections). The sum of these points provided a socre classifying the patient into 8 distinct categories, from 0 to 7, each corresponding to a specific status (from 0 (0 + 0 + 0): no cancer control-incontinence-impotence to 7 (4 + 2 + 1): cancer control-continence-sexual potency). RESULTS: One year after the operation, 175 (85%) of patients had a PSA less than 0.2 ng/ml, 135 (65.8%) were continent and 64 (32.7%) reported erections. All patients with a score > or = 4 had good cancer control, wit no functional disorders for a score of 7 (4 + 2 + 1) (92%), no disorders of continence for a score of 6 (4 + 2 + 1) (31.5%), no disorders of erection for a score of 5 (4 + 0 + 1) (8.3%), or with incontinence and impotence for a score of 4 (4 + 0 + 0) (21.9%). All patients with a score < 4 had a PSA > 0.2 ng/ml, but with no functional disorders for a score for 3 (0 + 2 + 1) (2.4%), no incontinence for a score of 2 (0 + 2 + 0) (8.3%), and no impotence for a score of 1 (0 + 0 + 1) (1.9%). 1.9% of patients were incontinent, impotent and showed signs of biochemical progression (socre 0 = 0 + 0 + 0). CONCLUSION: This score allows analysis of the global (cancer control and functional) results of radical prostatectomy and would facilitate comparisons between various surgical techniques (type of approach, nerve-sparing techniques) and various centres.

Aged↗
PubMed1989

24-hour home pad weighing test versus 1-hour ward test in the assessment of mild stress incontinence.

Twenty-three normal volunteers and 31 women admitted for stress or mixed incontinence underwent two 24-hour home pad weighing tests. In the patients the test result was compared with the result obtained with the 1-hour ward pad weighing test. Median pad weight gain was 4 g/24-h, with an upper 99% limit of 8 g/24 h in normal women. The median urine loss was 17 g/24-h in the patients. Eighteen (58%) patients were classified as incontinent according to the result of the 1-h ward test, versus 28 (90%) according to the result of the 24-h home test. There was no significant correlation between the result of the 1-h test and the 24-h test. In the patients, test-retest analysis showed a significant variation in the result of the 24-h test. It is concluded that the better of two 24-h home tests is more sensitive for confirmation incontinence than is one 1-h ward test. Consequently, the 24-h home test is of practical use as a screening test for incontinence. The reproducibility of the test, however, seems insufficiently satisfactory to allow of its use in comparative scientific studies.

Adult↗
PubMed1996

Early results with antegrade collagen injection for post-radical prostatectomy stress urinary incontinence.

PURPOSE: Results of retrograde transurethral collagen injection for treatment of stress urinary incontinence have been generally disappointing for men with intrinsic sphincter deficiency following radical prostatectomy. We describe a new technique of antegrade transvesical collagen injection using suprapublic percutaneous bladder access. MATERIALS AND METHODS: Between October 1994 and January 1996, 20 patients underwent antegrade collagen injection for post-radical prostatectomy stress urinary incontinence. Evaluation by pad test, urodynamics and subjective scores was performed before and after injection. RESULTS: At a mean followup of 8.5 months 9 of 20 patients (45%) had significant subjective improvement and 5 (25%) were totally dry. CONCLUSIONS: Antegrade collagen injection is a promising and simple method of correcting post-radical prostatectomy stress urinary incontinence. Further study and longer followup are necessary to determine its precise role in the treatment of this condition.

Aged↗
PubMed2006

Adjustable continence therapy (ProACT): evolution of the surgical technique and comparison of the original 50 patients with the most recent 50 patients at a single centre.

OBJECTIVES: The desire for an adjustable surgery for male stress urinary incontinence that avoids further surgery has produced a percutaneous adjustable device. The adjustable continence therapy (ProACT) consists of two balloons, placed bilaterally at the bladder neck after prostatectomy. Titanium ports, attached via tubing to each balloon are placed in the scrotum allowing for volume adjustments of the balloons at any time perioperatively and postoperatively. This paper examines the evolution of the technique and the impact of this progression on patient outcomes. METHODS: Two groups, one representing the first 50 patients, the second consisting of the last 50 patients are compared for changes in pad use and incontinence quality of life (I-QOL) with a mean follow-up of 23 mo (range: 1-46 mo) in group 1 and 20 mo (range: 18-24) in group 2. A comparison of complications and retreatment is summarised. RESULTS: Pad usage was reduced significantly in both groups (p<0.001). Overall, group 2 patients obtained more consistent outcomes compared to group 1 (80% vs. 60% dry or >50% improved). I-QOL improved in both groups although more significantly in group 2 (p = 0.005). Operative time was reduced in group 2. The rate and range of complications experienced in group 1 as the technique evolved decreased dramatically in group 2. CONCLUSIONS: The evolution of technique and expertise has facilitated an efficient surgical implantation procedure with reproducible and effective objective and subjective outcomes. The implantation of this device is now conducted in >100 centres across Europe.

Aged↗
PubMed2006

Prospective study evaluating efficacy and safety of Adjustable Continence Therapy (ProACT) for post radical prostatectomy urinary incontinence.

OBJECTIVES: To examine a new prosthesis, the Adjustable Continence Therapy (ProACT), to determine its ability to treat effectively post radical prostatectomy urinary incontinence. Urinary incontinence is one of the most significant complications of radical prostatectomy. Although the artificial urinary sphincter (AUS) is considered the standard treatment for this condition, many men seek a simpler and less expensive treatment option. METHODS: From November 2000 to March 2004, 25 patients with severe post radical prostatectomy urinary incontinence were treated using the ProACT device. The preoperative evaluation included pad count, Valsalva leak point pressure determination, and Incontinence Quality-of-Life scores. In the follow-up, the same parameters, as well as complications, were analyzed and compared with the baseline measurements to assess the efficacy. RESULTS: The follow-up period was 6 to 48 months (mean 22.4). Of the 25 patients, 23 had follow-up data available for analysis. The improvements in pad count, Incontinence Quality-of-Life score, and Valsalva leak point pressures from baseline to the last follow-up examination were all significant (P <0.05). Overall, of the 23 patients followed up, 15 (65.2%) were continent using 0 to 1 pad daily and satisfied, 3 (13%) were improved but unsatisfied, and 5 (22%) did not have any improvement. Balloon adjustments were performed in all patents to achieve continence. Revision surgery was required in 4 (17%) of 23 patients. CONCLUSIONS: The use of ProACT represents a safe and effective treatment for post radical prostatectomy incontinence with a good degree of patient satisfaction and a low complication rate. Postoperative adjustments were necessary in most patients and were undertaken as a simple outpatient visit.

Humans↗
PubMed2000

Long-term results of sacral nerve stimulation (S3) for the treatment of neurogenic refractory urge incontinence related to detrusor hyperreflexia.

PURPOSE: We assess clinical and urodynamic results of sacral nerve stimulation for patients with neurogenic (spinal cord diseases) urge incontinence and detrusor hyperreflexia resistant to parasympatholytic drugs. MATERIALS AND METHODS: Since 1992, 9 women with a mean age of 42.6 years (range 26 to 53) were treated for refractory neurogenic urge incontinence with sacral nerve stimulation. Neurological spinal diseases included viral and vascular myelitis in 1 patient each, multiple sclerosis in 5 and traumatic spinal cord injury in 2. Mean time since neurological diagnosis was 12 years. All patients had incontinence with chronic pad use related to detrusor hyperreflexia. Intermittent self-catheterization for external detrusor-sphincter dyssynergia was used by 5 patients. Social life was impaired and these patients were candidates for bladder augmentation. A sacral (S3) lead was surgically implanted and connected to a subcutaneous neurostimulator after a positive test stimulation trial. RESULTS: Mean followup was 43.6 months (range 7 to 72). All patients had clinically significant improvement of incontinence, and 5 were completely dry. Average number of voids per day decreased from 16.1 to 8.2. Urodynamic parameters at 6 months after implant improved significantly from baseline, including maximum bladder capacity from 244 to 377 ml. and volume at first uninhibited contraction from 214 to 340 ml. Maximum detrusor pressure at first uninhibited contraction increased in 3, stabilized in 2 and decreased in 4 patients. Urodynamic results returned to baseline when stimulation was inactivated. All patients subjectively reported improved visual analog scale results by at least 75% at last followup. CONCLUSIONS: Sacral nerve stimulation can be used as a reversible treatment option for refractory urge incontinence related to detrusor hyperreflexia in select patients with spinal lesions.

Adult↗
PubMed1998

The urethra (UPP, MUPP, instability, LPP).

Urethral function can be assessed using many different techniques and this is very important when applied to women with neurological abnormalities. Urethral pressure profilometry, although not diagnostic for urethral sphincter incompetence, can be used to detect strictures and the ostia leading to urethral diverticula. Urethral instability may be recorded using urethral pressure catheters. The significance of this finding is uncertain but it has been suggested that women with urethral instability and detrusor instability are less responsive to therapy with anticholinergic drugs than those with a stable urethra. Micturition pressure profilometry is useful for determining obstruction during voiding and enables the site of obstruction to be determined. Leak point pressures (LPP) can be classified as detrusor or abdominal. Detrusor LPP are useful in patients with neurological disease. Abdominal LPP are subdivided according to the method used to increase intra-abdominal pressure either the Valsalva manoeuvre or coughing. The technique used to obtain an LPP can alter the measurement obtained and a standardized technique is essential for consistent results. LPP correlate with the urinary incontinence of women with genuine stress incontinence undergoing a pad test but is of no value if the woman does not leak! Tests of urethral function during bladder filling, stress and voiding phases help in assessing lower urinary tract dysfunction in neurourology.

Female↗
PubMed2002

[Prolene mesh sling in the treatment of stress urinary incontinence. Integral treatment of pelvic floor anomalies. Long-term results].

OBJECTIVES: To evaluate the results of a comprehensive treatment of female stress urinary incontinence combining prolene mesh sling and proper gynaecologic repair depending on the kind of prolapse or pelvic floor dysfunction. To analyse short and long term clinical and urodynamic outcomes, and the effect on quality of life and economics associated with female urinary incontinence. METHODS: Prospective study including 102 consecutive patients with urinary incontinence; recruitment started in June 1996, ended in March 2002 for this analysis but it continues open currently. History of neurourologic disorders, radiotherapy, oncological diseases, gynaecological diseases and previous surgeries data were recorded in all subjects. History and physical examination were done evaluating urinary symptoms, duration of urinary incontinence, and urinary symptoms oriented examination (incontinence, urgency and urgency-incontinence), as well as gynaecological examination evaluating and grading cystocele, rectocele, uterine prolapse, enterocele and dome prolapse. Complete urodynamics were performed before and after surgery. Surgery was indicated as a complete pelvic floor dysfunction repair including prolene mesh sling in all cases with urinary stress incontinence, hysterectomy or not depending on the existence of prolapse, and anterior/posterior colpoperineorrhaphy with or without mesh. Results on urinary continence, complications and their treatment were evaluated in the postoperative period, on discharge, at 6 months and yearly thereafter. RESULTS: Average age was 63.8 years (27-82 years, SD 11.2). 39.3% of the patients were over age 70. Mean follow-up was 4.25 years (12-75 months, SD 11.9). The cost of pads for urinary incontinence was 2741.17 Euros per patient (456,117 pesetas). 32.3% of the patients had risk factors for urinary incontinence surgical treatment failure and 18.8% had a leak point pressure below 30 H20 cm. 22.3% cases presented with detrusor instability before surgery. 102 sling procedures, 20 hysterectomies, 26 anterior plasties, 14 posterior plasties, 10 mesh cystocele repair, 1 posterior mesh, and 2 enterocele sacral promontory fixation were performed, accounting a total of 173 surgical procedures during 102 anaesthesia procedures. 9 additional procedures were necessary for the treatment of complications. Stress continence was achieved in 99.01% cases. In half of the patients with preoperative urgency-incontinence it continued during the first postoperative year. 11 cases have postoperative bladder instability, 7 of which had it preoperatively and 4 were de novo. COMPLICATIONS: 5 cases needed sling section/reconfiguration because of excess tension (non effective sling). 3 cases needed sling tight stretching/reconfiguration because of less than adequate tension. 2 cases of accidental bladder performation were treated with primary closure and urinary diversion. One case of infection-abscess in the mesh left anchoring stitch was drained under local anaesthesia. There were 6 cases of suprapubic, inguinal and rectal pain (8.1%), in all of them it disappeared within 9 months. There were 2 cases of wound infection. CONCLUSIONS: The prolene mesh sling can offer long term cure for stress urinary incontinence in almost all cases (99.01%), including the complicated ones. 91.1% of the patients underwent one surgical procedure only, and 8.8% required additional procedures. Results stand the test of time with a clinical-urodynamic follow up of 4.25 years. The voiding urgency referred by 81% of the women with large prolapses is associated with demonstrated bladder instability in 63% of the cases. Voiding urgency as well as bladder instability disappeared in all cases but one, being this fact prolapse-correction dependent, so that pelvic prolapse correction plays a decisive role. De novo bladder instability is uncommon (3.9%) and appears randomly in this series.

Adult↗
PubMed2003

Adrenergic drugs for urinary incontinence in adults.

BACKGROUND: Adrenergic drugs have been used for the treatment of urinary incontinence. However, they have generally been considered to be ineffective or to have side effects which may limit their clinical use. OBJECTIVES: To determine the effectiveness of adrenergic agonists in the treatment of urinary incontinence in adults. SEARCH STRATEGY: We searched the Cochrane Incontinence Group trials register (January 2002) and the reference lists of relevant articles. Date of the most recent searches: January 2002. SELECTION CRITERIA: Randomised or quasi-randomised controlled trials which include an adrenergic agonist drug in at least one arm for adults with urinary incontinence. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed eligibility, trial quality and extracted data. Data were processed as described in the Cochrane Collaboration Handbook. MAIN RESULTS: Fifteen randomised trials were identified, which included 832 women, of whom 506 received an adrenergic drug (phenylpropanolamine in 11 trials, Midodrine in two and Clenbuterol in another two). Of these, six were crossover trials. No trials included men. The limited evidence suggested that an adrenergic agonist drug is better than placebo in reducing number of pad changes and incontinence episodes, as well as improvement in subjective symptoms. The drugs also appeared to be better than pelvic floor muscle training in two small trials, possibly reflecting relative acceptability of the treatments to women but perhaps due to differential withdrawal of women from the trial groups. There was not enough evidence to evaluate the use of higher compared to lower doses of adrenergic agonists nor the relative merits of an adrenergic agonist drug compared with oestrogen, whether used alone or in combination. REVIEWER'S CONCLUSIONS: There was weak evidence to suggest that use of an adrenergic agonist is better than placebo treatment. There was not enough evidence to assess the effects of adrenergic agonists when compared to or combined with other treatments. Patients using adrenergic agonists may suffer from minor side effects, only occasionally leading them to stop treatment. Rare but serious side effects such as cardiac arrhythmias and hypertension have been reported, however.

Adrenergic Agonists↗
PubMed2000

Anterior approach bilateral sacrospinous ligament fixation for vaginal vault prolapse.

The sacrospinous ligament fixation (SSLF) was first described as a unilateral fixation; however, bilateral fixation, when possible, allows a symmetrical vaginal reconstruction and provides additional vaginal vault support. We evaluated the outcome of treating total vault prolapse using a bilateral SSLF through an anterior vaginal approach. From July 1996 to July 1999, 28 patients (mean age 67) underwent bilateral SSLF procedures through an anterior vaginal approach. All patients had either grade 3 or 4 vault prolapse, and all patients had associated enteroceles, cystoceles, and rectoceles. All patients underwent fluorourodynamic evaluation including an abdominal leak point pressure (ALPP) with reduction of the vaginal prolapse. A pubovaginal sling was performed in 25 patients and all 28 patients underwent an anterior colporrhaphy, rectocele, and enterocele repair. A vaginal paravaginal repair was performed in 22 cases. At a mean follow-up of 17 months (range 5 to 35), 27 of 28 patients were cured, 1 patient had an asymptomatic unilateral grade 1 vault prolapse, 2 patients had developed small asymptomatic cystoceles and there had been no recurrence of rectoceles or enteroceles. Stress incontinence had been cured in all patients; however, 2 patients continued to have mild urge incontinence requiring <1 pad per day. Two patients complained of transient gluteal pain. We believe the anterior approach bilateral SSLF is a safe procedure with excellent medium term results in women with grade 3 to 4 vaginal prolapse.

Aged↗