[Clinical experience with the 1 hour pad weighing test for objective assessment of urinary incontinence. Clinical experiences].
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Adolescent↗
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Postprostatectomy urinary incontinence: a comparison of the cost of conservative versus surgical management.
OBJECTIVES: Post-radical prostatectomy stress incontinence occurs in up to 20% of patients. Postprostatectomy incontinence is initially treated with undergarments, pads, or drip collectors. Patients with persistent leakage are often treated with a transurethral bulking agent (Contigen) or placement of an artificial genitourinary sphincter (AGUS). We have compared the direct costs of each treatment at our institution over 10 years. METHODS: The Mayo Clinic estimating office provided the Medicare and non-Medicare charges for patients receiving both collagen injection (outpatient) and AGUS placement (2-day hospitalization) during August 1995. The Mayo Store provided the current price of all undergarments, pads, and drip collectors carried. Two local grocery stores provided the cost of Depends undergarments. RESULTS: The following items were the least expensive carried at the Mayo Clinic Store: Entrust undergarments, Active Style pads, and Conveen drip collectors at $0.99, $0.52, $1.05 each, respectively. The average cost of Depends undergarments was $0.52 each. The cost of wearing 5 of the least expensive undergarments or pads per day for 10 years is $9497. The average estimated Medicare and non-Medicare cost for outpatient (general anesthesia) collagen injection is $4300 and $5625, respectively. The average Medicare and non-Medicare cost for AGUS placement is $15,400 and $20,300, respectively. Factoring in our current 22.4% reoperation rate, the average per patient Medicare and non-Medicare cost for AGUS placement is $18,850 and $24,847, respectively. CONCLUSIONS: The cost of the AGUS placement compares favorably with the cost of transurethral collagen injection (under general anesthesia) in patients requiring several (more than three) collagen injection treatments or requiring the continued use of undergarments after collagen injection. Whereas the cost of transurethral collagen injection, when effective, compares favorably with conservative treatment, AGUS placement is significantly more expensive than conservative management for almost all patients except the exceedingly rare patient wearing more than 9 undergarments or pads per day. When the psychosocial benefit of urinary continence is considered, however, transurethral injection of collagen or AGUS placement often becomes the preferred treatment.
Ambulatory Surgical Procedures↗
[Urinary continence after retropubic radical prostatectomy: retrospective study with self-administered questionnaire].
OBJECTIVES: To precisely evaluate the incidence of urinary incontinence after radical prostatectomy and its impact on quality of life. MATERIAL AND METHODS: A self-administered questionnaire was sent to 116 patients operated between 1987 and 1996. Preoperative and postoperative urinary continence, the time until urinary continence was achieved, the presence of urgent micturition, the degree of discomfort caused by urinary incontinence and associated voiding disorders were assessed. RESULTS: The questionnaire response rate was 96.6%. The urinary incontinence rate (continuous use of pads) was 13.4%. No predictive factor for postoperative urinary incontinence was identified. Urge incontinence was present in 31.3% of cases. 85% of patients claimed to be satisfied with the operation and 95.4% declared that they would be willing to undergo radical prostatectomy again. CONCLUSION: The incidence of urinary incontinence after radical prostatectomy is acceptable and the morbidity that it generates is well tolerated and has little impact on quality of life.
Aged↗
Radical retropubic prostatectomy outcomes at a community hospital.
PURPOSE: We reviewed a 6-year experience performing radical retropubic prostatectomy at 2 community hospitals (for-profit and not-for-profit) to assess outcomes and to compare them to the published literature reflecting outcomes from major academic hospitals. MATERIALS AND METHODS: Charts of 116 patients who underwent radical retropubic prostatectomy (nerve sparing in select cases) between 1990 and 1996 were reviewed for clinical and pathological outcomes as well as hospital charges. Subjective patient reports of urinary continence, potency and satisfaction were evaluated postoperatively. RESULTS: Average patient age was 66.6 years and average preoperative prostate specific antigen level was 9.6 ng./ml. Of the patients 43% had T1c disease, 63% pT2 and 37% pT3. Positive margins were present in 17.2% of the specimens and 66% of the patients had Gleason scores of 5 and 6. No deaths occurred. Major complications occurred in 5.4% of patients and included deep venous thrombosis (1.8%), pulmonary embolism (1.8%), rectal injury requiring ileostomy (0.9%) and fascial dehiscence (0.9%). Mean blood loss was 872 cc and mean blood transfusion rate was 1.7 units (almost exclusively autologous blood). Hospital charges decreased at the not-for-profit hospital to $13,233 in 1996 from $17,743 in 1990 to 1995, whereas charges increased at the for-profit hospital to $25,979 in 1996 from $24,481 in 1990 to 1995. Mean length of stay decreased from 5 days in 1990 to 1995 to 3 days in 1996. Of the patients 80% were totally continent (pad-free), 12% wore a protective pad once per day for minimal incontinence and 8% wore 2 or more pads. Of the men who were potent preoperatively 18% retained potency and 46% remained sexually active postoperatively either spontaneously or with assistance. Of the patients 84% were satisfied with surgical outcomes, 11% were somewhat satisfied and 5% were dissatisfied. CONCLUSIONS: Radical retropubic prostatectomy can be performed safely and with acceptable clinical and pathological outcomes at a community hospital. Impotence continues to be one of the most bothersome morbidities, particularly in older men. Increasing cost awareness, coincident with the proliferation of managed care, has led to reductions in length of hospital stay and charges at certain hospitals.
Adult↗
Late side effects of short-course preoperative radiotherapy combined with total mesorectal excision for rectal cancer: increased bowel dysfunction in irradiated patients--a Dutch colorectal cancer group study.
PURPOSE: Preoperative short-term radiotherapy improves local control in patients treated with total mesorectal excision (TME). This study was performed to assess the presence and magnitude of long-term side effects of preoperative 5 x 5 Gy radiotherapy and TME. Also, hospital treatment was recorded for diseases possibly related to late side effects of rectal cancer treatment. PATIENTS AND METHODS: Long-term morbidity was assessed in patients from the prospective randomized TME trial, which investigated the efficacy of 5 x 5 Gy before TME surgery for mobile rectal cancer. Dutch patients without recurrent disease were sent a questionnaire. RESULTS: Results were obtained from 597 patients, with a median follow-up of 5.1 years. Stoma function, urinary function, and hospital treatment rates did not differ significantly between the treatment arms. However, irradiated patients, compared with nonirradiated patients, reported increased rates of fecal incontinence (62% v 38%, respectively; P < .001), pad wearing as a result of incontinence (56% v 33%, respectively; P < .001), anal blood loss (11% v 3%, respectively; P = .004), and mucus loss (27% v 15%, respectively; P = .005). Satisfaction with bowel function was significantly lower and the impact of bowel dysfunction on daily activities was greater in irradiated patients compared with patients who underwent TME alone. CONCLUSION: Although preoperative short-term radiotherapy for rectal cancer results in increased local control, there is more long-term bowel dysfunction in irradiated patients than in patients who undergo TME alone. Rectal cancer patients should be informed on late morbidity of both radiotherapy and TME. Future strategies should be aimed at selecting patients for radiotherapy who are at high risk for local failure.
Adult↗
The objective assessment of urinary incontinence in children.
OBJECTIVE: To assess urinary incontinence objectively in children. PATIENTS AND METHODS: Thirty-three children (mean age 8.2 years, range 5-12) were examined, of whom 23 suffered from incontinence and 10 did not. The first method of assessing incontinence was the 1-h pad-weighing test proposed by the International Continence Society in 1983 and the second was a test in which the pad was weighed between one urination and the next. At the end of the tests the volume of normally voided urine was measured and the total voided volume during the test calculated. The volume of urine lost during incontinence and the ratio [incontinence volume/(incontinence volume + voided volume)] were evaluated; the ratio was used because the bladder capacity in children differed with age. RESULTS: In both tests, no wetting occurred in any of the 10 patients not complaining of incontinence. In the 1-h pad-weighing test, no wetting occurred in 14 of the 23 patients complaining of incontinence but did in the nine remaining patients, the loss being 1-30 g, and the incontinence ratio 0.5-14.8%. In the second test, no wetting occurred in 12 of the 23 patients complaining of incontinence but did so in the 11 remaining patients, with losses of 2-50 g and incontinence ratios of 1.5-80.6%. CONCLUSIONS: There was no significant difference between the tests in the incidence of incontinence. However, the second method seemed to be more closely related to the clinical symptoms than was the 1-h pad-weighing test and may be useful in the assessment of incontinence in children.
Child↗
Suburethral sling at the time of radical prostatectomy in patients at high risk of postoperative incontinence.
OBJECTIVE: To evaluate the insertion of a urethral sling at the time of radical prostatectomy (RP) in men at high risk of urinary incontinence after RP. PATIENTS AND METHODS: Between 1998 and 2000, 49 of 871 men undergoing RP at The University of Texas M.D. Anderson Cancer Center, were identified as at risk of urinary incontinence after RP, based on their age (>65 years), previous transurethral resection of the prostate, previous radiation therapy, clinical stage, and obesity (body mass index of > or = 30 kg/m2). These 49 men had a suburethral sling inserted at the time of RP, and incontinence after surgery was evaluated using pad counts and patient-completed questionnaires. Retrospectively, incontinence rates and complications in these men were compared with 122 men also at high risk of urinary incontinence after RP who did not have a sling inserted at the time of RP (control group). RESULTS: In all, 29 of 49 men (59%) with a suburethral sling reported using either no pad or one pad per day for urinary leakage at 6 months after RP, compared with 83 of 118 (70%) in the control group. At 12 months after RP, 34 of 46 (74%) men with a suburethral sling reported using no or one pad, compared with 75 of 89 (84%) in the control group. Seventeen (35%) men were treated for urethral stricture in the sling group and 17 (14%) in the control group (P = 0.001). CONCLUSIONS: The urethral sling modification concurrent with RP is feasible, but does not decrease incontinence compared with a similar group of high-risk patients who did not have the sling modification. In addition, the stricture rate in the sling group was unacceptably high. Currently, we do not recommend the use of a urethral sling at the time of RP.
Aged↗
[Artificial sphincter implantation in women with urinary incontinence using a combined abdomino-vaginal approach].
OBJECTIVE: The artificial sphincter has been utilized for urinary incontinence due to intrinsic sphincteric insufficiency, with good fixation of the urethra and a maximum urethral closing pressure of 20-30 cms H2O, or after failed attempts at correction using other techniques. This procedure is difficult to perform since the patients have generally undergone several operations and it is necessity to prepare the cleavage between the urethra and vagina. We propose a modified combined vaginal and suprapubic approach of the technique described by Appell and Abbassian in 1988 for enhanced exposure of the urethra and bladder neck and easy access. METHODS: The modified combined abdominovaginal approach has been utilized in 18 females aged 16-62 years since 1995. RESULTS: 16 patients were continent (88%). One patient (5.5%) required removal of the artificial sphincter due to infection. Another patient (5.5%) has mild incontinence and requires 2 pads a day. Four patients (22%) with detrusor instability are receiving anticholinergics. Three patients (16%) with an underlying neurogenic incontinence require intermittent catheterization. Fourteen patients (77.7%) have type III stress urinary incontinence. We performed the Kelly procedure in 10 patients (55.5%), the Marshall-Marcetti-Kranz in 7 (38.8%), Gittes in 3 (16.6%), and 2 patients (11.1%) had a sling procedure. Two techniques were simultaneously performed in some patients. CONCLUSIONS: Although the number of patients in this series is small, the fact that only one case required removal of the artificial spincter due to infection indicates that this is a useful alternative approach that significantly facilitates implantation of the artificial sphincter in these patients.
Abdomen↗
Adapting incontinent patients incontinence aids to their leakage volumes.
The importance of adapting incontinence aids according to the patients leakage volume and comfort was investigated in 28 urinary incontinent 85-year-old men and women who were living at home. The patients incontinence was quantified by a 48-hour pad test and was graded as slight (max. leakage per pad < 5 g; total leakage/48 h < 30 g), moderate (max. leakage per pad 5-15 g; total leakage/48 h 30-70 g) or severe (max. leakage per pad > 15 g; total leakage/48 h > 70 g). Four women had slight urinary incontinence, eight were moderately incontinent and nine were severely incontinent. The corresponding figures for the seven men were as follows: slight, one; moderate, one; severe, five. After the primary assessment, incontinence aids were prescribed based on the measured leakage volumes. The correctly selected and adapted incontinence aid brought the patient better comfort and security. The importance of careful information and instructions how to apply the pad is emphasised. There is also a need to see the patient again at intervals as leakage volumes may vary. Thus, smaller packages of pads should be supplied as the choice of pad may need to be modified. The latter is also important from a financial point of view as the expense of otherwise wasted pads would unnecessarily increase costs.
Adaptation, Psychological↗
Pelvic floor muscle training is effective in women with urinary incontinence after stroke: a randomised, controlled and blinded study.
AIMS: The aim of this study was to evaluate the effect of Pelvic Floor Muscle Training (PFMT) in women with urinary incontinence (UI) after ischemic stroke. MATERIALS AND METHODS: Three hundred and thirty-nine medical records of stroke patients were searched. Twenty-six subjects were randomised to a Treatment Group (14 subjects) or a Control Group (12 subjects) in a single blinded, randomised study. The intervention included 12 weeks of standardised PFMT. The outcome measures were: (1) diary recording the frequency of voiding, the number of incontinence episodes and used pads; (2) 24-hr home pad test; and (3) vaginal palpation of pelvic floor muscle evaluating function, strength, static and dynamic endurance. RESULTS: Twenty-four subjects with urge, stress and mixed stress/urge incontinence, completed the study, 12 in each group. A significant improvement in frequency of voiding in daytime (Treatment Group/Control Group: 7/8 at pre-test, 6/9 at post-test (median values), P=0.018), 24-hr pad test (Treatment Group/Control Group: 8/12 to 2/8 g P=0.013) and dynamic endurance of pelvic floor muscle (Treatment Group/Control Group: 11/20 to 20/8 contractions of Pelvic Floor Muscle, P=0.028) was demonstrated in the Treatment Group compared to the Control Group. A significant improvement in frequency of voiding in daytime (decreased from seven to six, P=0.036), pelvic floor muscle function (P=0.034), strength (P=0.046), static endurance increased from 9 to 30 sec (P=0.028) and dynamic endurance increased from 11 to 20 contractions (P=0.020) was also demonstrated within the Treatment Group, but not in the Control Group. CONCLUSION: PFMT had a significant effect in women with UI after stroke measured by diaries, pad tests and vaginal palpation.
Adult↗
Comparison of fascial and vaginal wall slings in the management of intrinsic sphincter deficiency.
OBJECTIVES: To compare safety and efficacy of fascial versus vaginal wall slings in the management of women with intrinsic sphincter deficiency (ISD). METHODS: The hospital and office records of 79 consecutive women with ISD were retrospectively analyzed from January 1991 to September 1995. There were 43 fascial slings (group A) and 36 vaginal wall slings (group B). Parameter of evaluation included efficacy based on postoperative presence of stress or urge incontinence and number of pads used, complications, and miscellaneous factors, including length of catheterization time, length of hospitalization, quantity of analgesics used, and loss of work days. RESULTS: Baseline clinical and urodynamic data were the same for both groups. Pad use decreased from 6.9 to 0.6 for group A and from 5.7 to 0.3 for group B. Persistent stress and urge incontinence was present in 5% and 16% of group A patients and in 3% and 11% of group B patients, respectively. Group A (89%) and group B (94%) patients were either very satisfied or satisfied with their surgical outcome. The operative time, hospital days, and days lost from work for group B patients (42.3 +/- 13.4 minutes, 1.4 +/- 0.9 days, 18.4 +/- 3.2 days, respectively) were significantly lower than for group A patients (84.2 +/- 17.8 minutes, 3.7 +/- 1.9 days, 28.4 +/- 7.8 days, respectively). CONCLUSIONS: Both fascial and vaginal wall slings are effective in treating women with ISD. However, the use of vaginal wall slings resulted in significantly shorter hospital stay, decreased catheterization time, decreased use of analgesics, and decreased loss of days of work compared with fascial slings. Therefore, the vaginal wall sling should be the preferred surgical method of treating sphincter deficiency.
Aged↗
Continence pessaries in the management of urinary incontinence in women.
OBJECTIVE: To evaluate the effectiveness of continence pessaries for the management of urinary incontinence in women. METHODS: A retrospective review of the records of 100 women who chose to try a pessary to treat their urinary incontinence. Demographic data, presenting symptoms, physical findings, results of objective testing (pad tests and urodynamics), and incontinence outcomes were abstracted. Factors such as age, pelvic prolapse, presenting symptoms, pessary type, and history of previous incontinence surgery were examined using the Student t-test, chi-square test, or Fisher exact test where appropriate. RESULTS: The mean age of the women was 56 years (range, 28-86 years) and mean parity was 2.5 (range, 0-13). Presenting complaints included stress incontinence in 41 women, mixed incontinence in 53 women, urge incontinence in 3 women, and combined prolapse and incontinence in 3 women. All 100 women returned for follow-up visits. Forty women had their pessary size or type adjusted at the first follow-up visit. At a mean follow-up time of 11 months (range, 2-42 months), 59 women continued to experience a complete resolution or decrease in their incontinence and chose to continue use of a pessary. Age, presenting symptoms, degree of pelvic prolapse, and type of pessary did not affect the success of pessary treatment. Women who had undergone incontinence surgery prior to pessary fitting had a higher failure rate, with relative risk (RR) of 1.6. CONCLUSION: Urinary incontinence pessaries are effective. More than 50% of women who try a continence pessary will continue to use it to manage their urinary incontinence.
Adult↗
[Incontinence after retropubic radical prostatectomy: correlation between ultrasonographic morphological data and urodynamic parameters].
OBJECTIVE: The aim of this study is to evaluate the relationships existing between transrectal ultrasound and urodynamics in patients undergone radical retropubic prostatectomy and affected by stress incontinence. MATERIALS AND METHODS: 78 patients were suitabe for the study. They have been divided in three groups: group A, 18 incontinent patients (at least 1 pad a day); group B, 30 patients with occasional dribbling (no incontinence device needed); group C, 30 continent patients. All the patients have undergone urethral pressure profile (UPP), abdominal leak point pressure (ALPP) and transrectal ultrasound (TRUS). ultrasound has been performed injecting saline solution in the spongious and bulbar urethra to dilate it and better visualize a collapsed tract corresponding to the distal sphincter, that was measured. Different doctors performed TRUS and urodynamics, and each ignored the results of the other tests. RESULTS: The mean value of TRUS length of the collapsed urethral segment was 5.47 mm (range 4.9-6.0) for group A, 11.5 mm (9.5-12.9) for group B, 13.8 mm (10.4-14.7) for group C. the mean value of rest FUL was 36.6 (range 23-52) for group A, 31.7 (range 21-37) for group B, 13.8 (range 10.4-14.7) for group C. The mean value of stress FUL was 20.3 (range 5-29) for group A, 20.7 (range 18-27) for group B, 25.0 (range 20-35) for group C. The mean value of VLPP was 61.9 cm H2O for group A, 83.6 cm H2O for group B, > 90 cm H2O for group C. CONCLUSIONS: The ranges of values of VLPP were narrower and showed less overlap among the groups than UPP. TRUS length showed a good correlation with VLPP and permitted to differentiate incontinent patients from continent patients and patients with occasional dribbling. These data correlate well with the possible role of the length of the urethral stump and of damage to genitourinary diaphragm in post-prostatectomy incontinence.
Humans↗
The intravaginal slingplasty operation, a minimally invasive technique for cure of urinary incontinence in the female.
The aim was to evaluate the intravaginal slingplasty operation, a minimally invasive technique for cure of urinary incontinence. Fifty-four unselected patients, aged from 26 to 79 years, mainly with mixed incontinence symptoms, underwent this procedure. It works by tightening the suburethral vagina ('hammock'), and by creating an artificial pubourethral neoligament. Where indicated, repair of uterine prolapse (24 cases), or infracoccygeal sacropexy (17 cases) was also performed. Almost all patients were discharged on the day of, or day after surgery, without requirement for postoperative catheterization, and returned to fairly normal activities, including jobs, within 7 to 14 days. At a mean follow-up time of 15 months, the cure rates for preoperative symptoms were, frequency 88%, nocturia 77%, urge incontinence 89%, stress incontinence (SI) 85%, symptoms of abnormal emptying, 77%, and reduction of mean residual urine from 67.5 mL to 32 mL. The objective cure rate (exercise pad testing) for stress incontinence was 88.6%; taking the group as a whole, urine loss was reduced from a mean of 11.6 g preoperatively to a mean of 0.5 g postoperatively. Urodynamically diagnosed detrusor instability was not a predictor of surgical failure in this study. According to the concepts presented here, symptoms of urinary dysfunction are mainly symptomatic manifestations of abnormal laxity in the vagina or its supporting ligaments. The surgical methods used to correct these defects are fairly simple, safe and easily learnt by an practising gynaecologist.
Adult↗
Quality of life study in prostate cancer patients treated with three-dimensional conformal radiation therapy: comparing late bowel and bladder quality of life symptoms to that of the normal population.
PURPOSE: The goals of this study were twofold. First, differences were quantified for symptoms that impact bowel and bladder quality of life (QOL) in prostate cancer patients treated with three-dimensional conformal radiotherapy (3DCRT) alone to the prostate vs. whole pelvis with prostate boost. Second, bowel and bladder QOL measures for these patients were compared to those of the normal population of men with a similar age distribution. MATERIAL AND METHODS: Two health status surveys evaluating bowel and bladder functioning, along with the AUA Symptom Problem Index and the BPH Impact Index, were mailed to 195 prostate cancer patients treated with 3DCRT between 12/92 and 11/95 at Fox Chase Cancer Center by a single clinician (GH). No patient received hormonal management as part of his treatment. Ninety-five patients had pretreatment PSA levels <10 ng/ml, T1/T2A tumors with Gleason scores 2-6, and no perineural invasion. They were treated to the prostate alone and are referred to as Group I. The remaining 100 patients had one or more of the following characteristics: pretreatment PSA levels > or =10 ng/ml, T2B/T3 tumors, Gleason scores 7-10, or perineural invasion. These patients were treated to the whole pelvis followed by a boost to the prostate and are referred to as Group II. Frequencies were tabulated, and differences in percentages for the two groups were evaluated using the two-tailed Fisher's Exact Test. Overall percentages were compared to those for equivalent measures reported by Litwin (1999) based on a normal population of men with a mean age of 73 years (range 47-86). Comparisons to the normal population were also evaluated using two-tailed Fisher's Exact p values. RESULTS: The mailing yielded a high response rate of 71% (n = 139, 66 in Group I and 73 in Group II). The mean age was 67 (range 49-82), and the median ICRU dose levels for Groups I and II were 73 and 76 Gy, respectively. Responses relating to bladder symptoms were similar for Groups I and II, except for the degree of bother associated with trouble in urination over the last month. Percentages for no bother at all were 66% and 56% for Groups I and II, respectively. Observed differences in bowel functioning related to rectal urgency over the past year (22% vs. 40% for Groups I and II, p = 0.03), the use of pads for protection against bowel incontinence (0% vs. 10% for Groups I and II, p = 0.01), and bowel satisfaction (88% vs. 72% for Groups I and II, p = 0.03). There was no significant difference in the degree of bother bladder symptoms cause men treated with radiotherapy as compared to men without cancer. Few patients reported bowel dysfunction bother as a big problem, but patients do tend to have more very small to moderate bother from bowel dysfunction than the normal population (55% vs. 33%, p < 0.001). CONCLUSION: This is the first long-term study of QOL in men treated with high-dose 3DCRT for prostate cancer. It demonstrates that these men enjoy QOL related to bladder function similar to that of the normal population. Few patients report bother from bowel symptoms as a big problem but tend to have more very small to moderate bother than the normal population. Treatment of prostate cancer patients to the whole pelvis may result in decreased QOL as defined by rectal urgency, the use of pads for bowel incontinence, and satisfaction with bowel functioning. However, regardless of field size, men are generally satisfied with their bowel and bladder functioning three to six years post treatment.
Aged↗
A prospective study examining the association between the symptoms of anxiety and depression and severity of urinary incontinence.
OBJECTIVE: To investigate the association of the presence or absence of the symptoms of anxiety and depression compared with the 48 h pad test as an objective measure of incontinence. DESIGN: Prospective study. SETTING: Urodynamics clinic in a large teaching hospital. SUBJECTS: All patients with urinary incontinence attending for urodynamic assessment from 23.4.96 to 29.10.96. INTERVENTIONS: 48 h pad test, Hospital Anxiety and Depression scale (HAD scale). MAIN OUTCOME MEASURES: Urodynamic diagnosis of cause of incontinence. Urinary loss over 48 h as measured by weight change in pads. Presence of symptoms of anxiety or depression as defined by HAD scale score of 8 or more. RESULTS: Urodynamic investigation was performed for incontinence on 133 patients. Of these 127 (95.4%) completed the HAD scale questionnaire. Of the 43 patients (32.2%) who returned the pads 18 (41.8%) patients were found to have symptoms of anxiety and six patients (13.9%) had symptoms of depression. Patients with symptoms of anxiety had lower mean measured urinary loss over a 48 h period compared to women with no symptoms of anxiety (median loss 44.2 ml range 6.8-622.4 versus 97.1 ml range 8.2-4384.4 ml) (P=0.05). There was no significant association between symptoms of depression and pad test results. CONCLUSIONS: Patients presenting with incontinence who have symptoms of anxiety are on average less incontinent compared to than those without symptoms of anxiety. It suggests that anxious patients present with a lesser degree of incontinence than nonanxious patients.
Anxiety↗
Clinical value of vaginal cones for the management of female stress incontinence.
In women with mild stress incontinence (mean urine loss of 3.7 g/h), pelvic floor training using vaginal cones resulted in a subjective success rate of 70% (19/27), that is complete cure or reduction by >50% of the original severity. However, in women with severe stress incontinence (mean urine loss of 20.7 g/h) cone therapy was successful in only 14% (7/50). The predictive value of six parameters (age, parity, urine loss by pad test, frequency of incontinence, contractile strength of the vagina, and perceived problems) was analyzed and two showed significant prognostic values: a smaller amount of urine loss and less frequent incontinence. It is concluded that vaginal cone therapy is one physical treatment option for stress incontinence but is of no clinical effect for those with severe incontinence.
Adult↗
An evidence-based approach to the evaluation and management of stress incontinence in women.
PURPOSE OF REVIEW: The aim of this article is to use evidence-based criteria to review recent publications on the evaluation and management of stress urinary incontinence in women. RECENT FINDINGS: Longitudinal studies suggest that a familial predisposition towards stress urinary incontinence may exist. There is mounting evidence that cesarean section may play a protective role against pelvic floor damage due to labor, but this continues to be investigated. Objective parameters in the evaluation of stress urinary incontinence, such as questionnaires, pad test, and urodynamic studies, continue to undergo refinements to become more clinically relevant outcome tools. Non-invasive and minimally-invasive therapies for stress urinary incontinence are expanding. The search continues for the optimal non-autologous material in the pubovaginal sling procedure. Despite concerns over the use of synthetic material and better defined early complications, midurethral slings continue to enjoy popularity with short-term and intermediate success. SUMMARY: Further research into the cause of stress urinary incontinence is necessary. There is still no unified protocol in the evaluation of the condition and its severity. Mid-urethral slings appear to be as efficacious as more established procedures (bladder neck suspensions, pubovaginal slings), but long-term results on safety and efficacy remain scarce.
Delivery, Obstetric↗