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PubMed2000

[Ultrasound-guided cryosurgery of the prostate: short- and long-term experience].

We have assessed 24 patients consecutively treated with cryosurgery and chosen according to the guidelines of the European Study Group of Urologic Cryosurgeons. Of the 24 patients (average age about 70, range 61-79), all were not considered candidates for radical prostatectomy, 9 (37%) were clinical stage cT2 N0M0, 15 (63%) cT3 N0M0 who had not received any prior treatment, except 1 patient (61 years old) who was treated with TCT and successive recurrence of the disease (cT2). Of the 24 chosen patients, 13 (55%) were over the age of 71, 11 (45%) had important factors of co-morbidity and an elevated risk of surgery (ASA 3). The average PSA was of 19.3 ng/ml (range 2.2-61). Gleason score was 2-5 in 9 cases, 6-7 in 14 and 8-10 in 1 case. In the follow-up, we evaluated serum PSA every 3 months and transrectal ultrasound and the echoguided prostatic biopsies at 6, 12 and 24 months. Post-operative complications included: ecchymosis and edema of external genitals (16/24), fever > 38 degrees C (1/24), sloughing syndrome (6/24), urinary tract infections (10/24) acute urine retention (1/24). In 2 cases, 6 months after treatment, a transrectal resection was carried out. After a follow-up at 6 months, the PSA was 0.4 ng/ml (range 0.1-0.9), in 1 case. In positive core biopsy out of 6 showed neoplastic cells with fibrous tissue; the patient had a PSA of 0.58 ng/ml. At 12 months there were 11 assessable patients. The average PSA was 0.3 ng/ml (range 0.1-0.9). At 24 months there were 4 assessable patients, 1 of 4 showed serum PSA level of 4 ng/ml and cancer in apical biopsy. Erectile dysfunction was assessed on 8 patients affective before surgery: 1 referred to sufficient erections at penetration (1/8, 12.5%). After removal of the catheter, 4 of the 20 patients suffered stress and urge incontinence with the use of 1 pad a day. In 1 case, 18 months from surgery, slight stress incontinence was found (1 pad/day). Cryoablation is an efficient method and is given to slight post-operative morbidity and no intra-operative mortality, also in patients with high risk for open surgery. Indications may be found in patients with the following conditions: older than 72 years, severe co-morbidity and high risk for surgery, neoplasia at high risk of progression, and disease recurrence after radiotherapy. Our case history is at the moment encouraging and a larger number of cases as well as longer follow-up are needed.

Aged↗
PubMed2006

Gynecologic symptoms and sexual function before and after liver transplantation.

OBJECTIVE: To determine gynecologic symptoms and sexual function in a group of patients awaiting liver transplantation and a second group after liver transplantation. STUDY DESIGN: A questionnaire was mailed to 524 women. Of these, 233 had had transplants, and 291 were on a waiting list. The Transplant Database was used to obtain demographic information regarding these patients, and data were analyzed based on population age, Child's classification, type of liver disease, and pretransplant or posttransplant status. RESULTS: The response rate was 53%. There was no difference in ethnic or age distribution between pretransplant and posttransplant patients. There were no significant differences in rates of amenorrhea, but there was a greater prevalence of amenorrhea in patients with hepatocellular vs. cholestatic diseases (60% vs. 19%, p = 0.009). There was a higher incidence of pad use for urinary incontinence in pretransplant vs. posttransplant patients (14% vs. 7%, p = 0.04). There was no difference in availability of a sexual partner, sexual activity, orgasm experience, dyspareunia, satisfaction with sex life, symptoms of organ prolapse or dysmenorrhea based on transplant status, disease etiology or Child's classification. CONCLUSION: Liver failure patients differed in some of their gynecologic symptoms depending on their disease etiology and transplant status, but sexuality remained unchanged.

Amenorrhea↗
PubMed1988

Total prostatectomy for clinically localized prostate cancer: long-term surgical results and current morbidity.

The outcome for the first 57 successive patients who underwent total perineal prostatectomy for clinically localized prostate cancer at the Virginia Mason Clinic and who have been followed up for a minimum of 15 years is reviewed for evaluation of the long-term impact of this operation on the disease. Twenty percent of the patients had pathologic stage C disease. Recurrence developed in 11 of the 55 patients (20%) who could be evaluated, and death from prostate cancer occurred in 6 (11%) during this interval. The actual observed overall survival at 15 years or more was 60%, the actuarial survival 67%, and the cause-specific survival 89%. The current morbidity of this operation was evaluated by review of the last 50 consecutive patients who underwent this procedure and had follow-up of at least 6 months. Operative time averaged 140 minutes, and blood loss averaged 660 ml; 22% of the patients required a transfusion. Average postoperative hospitalization was 5 days. Two patients required a temporary colostomy for unrecognized rectal injury, and 2 developed a stricture requiring more than one dilation. Three patients (6%) wear pads for mild stress incontinence. One patient died of a cerebral vascular accident.

Aged↗
PubMed2006

Nerve-sparing endoscopic extraperitoneal radical prostatectomy: University of Leipzig technique.

PURPOSE: To describe the various operative steps as well as the functional and oncologic results of nerve-sparing endoscopic extraperitoneal radical prostatectomy (nsEERP). PATIENTS AND METHODS: One hundred twenty preoperatively potent patients have been treated with bilateral nsEERPE in our department. The average age of the patients was 60.3 years (range 41-74 years), and the mean prostate weight was 48.6 g (range 24-117 g). RESULTS: The mean operative time was 136 minutes (range 75-210 minutes). No conversions to open surgery were necessary. The mean catheterization time was 5.7 days (range 4-20 days). Lymphadenectomy was performed in 26 patients. The pathologic stages were pT2 in 78 and pT3 in 42 patients. Positive margins were detected in 7.7% (N = 6) and 19% (N = 8) of the patients with pT2 and pT3 disease, respectively. Erections sufficient for intercourse were reported in interviews with 58 patients (48.3%) during the 6-month follow-up period. Follow-up of at least 1 year is deemed necessary to draw more definite conclusions about erectile function. One week postoperatively, 32 patients (26.7%) required a maximum of 1 pad, 59 patients (49.2%) 2 or 3 pads, and 29 patients (24.2%) more than 3 pads per day because of incontinence, whereas 3 and 6 months after the procedure, 98 (82%) and 106 (88%) of the patients required a maximum of 1 pad, respectively. CONCLUSION: Our results demonstrate that nsEERPE can be performed with equal efficacy and preliminary results similar to those of standard open radical prostatectomy as well as transperitoneal laparoscopic prostatectomy while completely avoiding intraperitoneal complications.

Adult↗
PubMed1991

A comparison between experienced and objectively demonstrated urinary leakage in 85-year old men and women.

The ability of 37 urinary incontinent 85-year old men and women to perform the 48-h pad test in their home environment was studied. Assessment of the magnitude of urinary incontinence by the 48-h pad test was compared with a subjective assessment, performed by the men and women themselves. Twenty-eight of the 37 men and women successfully performed the 48-h pad test. Early signs of dementia and defective vision were the main reasons for not completing the test successfully. The six women who considered their urinary incontinence to be slight had a maximum leakage per pad of 5.3 +/- 1.4 g. The corresponding figure for women with moderate incontinence was 48.8 +/- 12.3 g. None of the women considered their incontinence to be severe, even though eight of the women had a leakage per pad of greater than 30 g. Six men considered their incontinence to be moderate (25.0 +/- 8.1 g) and one man considered his incontinence to be severe (31 g/pad). Fourteen of the 28 men and women underestimated the magnitude of their urinary incontinence.

Aged↗
PubMed1996

[Anterior vaginal wall and pelvic floor sling for stress incontinence].

There is considerable doubt as to whether the intra-abdominal position of the urethra is the critical factor in maintenance of continence. Recent studies have suggested that a firm, supportive, suburethral layer is required for urethral closure during effort. The surgical procedure we describe is performed by vaginal approach and involves creation of a sling from the vaginal wall and underlying musculofascial layer, that provides compression and support for the urethra and resuspends the bladder neck. 20 women (37-70 years, mean 48.4) with severe stress incontinence (average of 5 wet pads per day) underwent the sling procedure between October 1994 and July 1995. 10/20 had had previous pelvic surgery (6 anti-incontinence procedures and 4 hysterectomies). 3/20 had intrinsic sphincter dysfunction and the rest a hypermobile urethra. The surgical technique was easily performed. Postoperative complications were minimal, and included blood transfusion in 3 and in 5 suprapubic pain which subsided spontaneously or after oral diclofenac. The cystostomy was closed after 10.5 days (range 3-49) when voiding resumed and urine residual became less than 60 ml. The median follow-up was 9.4 months (range 3-12). All patients were cured and satisfied. 2/20 reported onset of urge incontinence which was found urodynamically to be de-novo detrusor instability due to urethral obstruction. On the other hand, all 3 patients with associated urge incontinence reported its disappearance postoperatively. These results are encouraging and this surgical procedure seems to provide a good solution for all types and grades of stress incontinence. Long-term follow-up is required to determine persistence of the good results.

Adult↗
PubMed2000

Orthotopic ileal neobladder in females: impact of the urethral resection line on functional results.

We present our functional experience with orthotopic bladder replacement in female patients dependent on the urethral resection line. Between November 1986 and July 1998 42 women underwent orthotopic urinary tract reconstruction with an ileal neobladder at our institution: 26 patients underwent radical cystectomy (RCx) with subsequent ileal anastomosis to the urethra, and 16 underwent simple cystectomy (SCx) with preservation of the bladder neck. Fourteen of 22 patients following RCx and 3 of 14 patients following bladder neck-sparing cystectomy void naturally. Clean intermittent catheterization is necessary in 8 of 22 and 11 of 14 patients, respectively. Perfect continence with no pads at 1 year postoperatively was achieved in 15 of 18 evaluable patients following RCx and 10 of 11 patients following bladder neck sparing. Incontinence requiring one or more pads is present in 3 of 18 patients and 1 of 11 patients, respectively. Subjectively satisfactory continence was achieved in 16 of 18 patients following RCx and in all patients following bladder neck-sparing surgery. Our conclusions are that radical cystectomy as well as a bladder neck-sparing cystectomy does provide satisfactory functional results in the majority of patients. However, the urethral resection line does slightly influence the rate of incontinence as well as the requirement for intermittent catheterization. RCx does translate into a lesser requirement for CIC, whereas bladder neck sparing results in slightly better continence rates.

Adolescent↗
PubMed2004

Continence following radical retropubic prostatectomy using self-reporting instruments.

PURPOSE: We performed a global self-assessment of continence following radical retropubic prostatectomy (RRP) and determined how this global self-assessment of continence correlates with commonly used definitions of continence. MATERIALS AND METHODS: Between October 2000 and February 2002 all men who underwent RRP were encouraged to complete the University of California-Los Angeles Prostate Cancer Index 3, 6, 12 and 24 months postoperatively. Beginning October 2002 a single question capturing the patient global self-assessment of continence status was added to the postoperative continence assessment. The study design was cross-sectional since only continence surveys submitted between October 2002 through February 2003 were evaluated. Sensitivity, specificity and kappa coefficient was determined for the relationship between the patient global assessment of continence vs the definition of continence based on pad requirement, problem due to incontinence and frequency of incontinence. RESULTS: Continence progressively improved 3 to 24 months following RRP for all continence outcomes. At 24 months following RRP 97.1% of men considered themselves continent, while 97.1%, 94.1% and 97.1% were considered continent using continence definitions, including the requirement of no or 1 pad in a 24-hour interval, no or slight bother due to incontinence and total control or occasional dribbling, respectively. Our 3 definitions of continence derived from responses to the University of California-Los Angeles Prostate Cancer Index had excellent agreement with patient global self-assessment of continence (kappa coefficients between 0.76 and 0.83). CONCLUSIONS: The majority of men achieve continence without invasive intervention following RRP. Final continence status should be ascertained at 24 months. The patient global assessment of continence provides face validity for other definitions of continence based on responses to validated self-administered questionnaires.

Adult↗
PubMed2005

Correlation of abdominal leak point pressure with objective incontinence severity in men with post-radical prostatectomy stress incontinence.

AIMS: To determine if the abdominal leak point pressure (ALPP) correlates with objective incontinence severity in patients suffering from post-prostatectomy stress incontinence. METHODS: Twenty-nine men were evaluated for urinary incontinence after radical prostatectomy with videourodynamics and a 24-hr pad test. ALPP was determined with and without a 7-French urodynamics catheter and the lowest value was accepted. Six patients with urgency incontinence associated with detrusor overactivity or decreased bladder compliance were excluded leaving 23 patients for analysis. The relationship between the variables of ALPP, 24-hr pad weight, age and time from prostatectomy were examined with Pearson correlation. RESULTS: The mean age was 66.4 years (SD +/- 7.9, range: 45-81) and the median time from radical prostatectomy was 23 months (IQR = 14-64, range: 9-204). The mean ALPP was 92.8 cm H(2)O (SD +/- 42.4 cm H(2)O) and the mean pad weight was 279.1 g (SD +/- 238.3 g). There was only a weak inverse correlation between ALPP and 24-hr pad weight which was not statistically significant (r = - 0.191, P = 0.38). Age and time from prostatectomy did not significantly correlate with ALPP (r = - 0.122, P = 0.58 and r = - 0.23, P = 0.29, respectively). CONCLUSIONS: ALPP did not correlate significantly with the 24-hr pad test in patients with post-prostatectomy stress incontinence. This suggests that in this patient subset, the ALPP is a relatively poor predictor of incontinence severity and, therefore, has limited clinical value in the urodynamic evaluation of post-prostatectomy incontinence. The urodynamic assessment of these patients should focus on the presence or absence of stress incontinence and on the presence of associated bladder dysfunction.

Abdomen↗
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↗
PubMed2004

Role of bladder neck preservation in urinary continence following radical retropubic prostatectomy.

OBJECTIVE: To report our experience of the influence of bladder neck preservation on patient continence. MATERIAL AND METHODS: Radical retropubic prostatectomy with bladder neck preservation was performed in 131 patients (age range 48-73 years; mean 64.5 years). Urinary continence was evaluated using a validated questionnaire at follow-up visits and telephone interviews. All patients reporting incontinence were studied using a pad test and urodynamics. RESULTS: After a mean follow-up period of 21.7 months (range 4-47 months), 115 patients were continent (87%) and 16 incontinent. According to the International Continence Society criteria, three had severe, three moderate and 10 mild incontinence. Urodynamics revealed sphincter deficiency in 15 cases, which was associated with decreased bladder compliance in four, while decreased compliance was the only abnormality in one. Continence was recovered 0-27 months after surgery (mean 3.2 months): 40% of men were continent within the first month and 74% within the third. Histopathology revealed positive margins in 30/131 patients (22%), but exclusively at the bladder neck level in only seven (5%), and two also had positive nodes. Six patients (4.5%) presented bladder neck stenosis requiring transurethral incision. No statistically significant differences were found between the ages of continent and incontinent men or between the time to continence recovery with two different techniques of retropubic hemostasis; however, use of a nerve-sparing technique significantly reduced the time to continence recovery. CONCLUSIONS: Bladder neck preservation during radical retropubic prostatectomy does not improve the long-term results of urinary continence but does contribute substantially to its earlier recovery, thus improving the quality of life. With proper patient selection the risk of positive margins at the bladder neck level only is reasonably low.

Age Factors↗
PubMed2002

The effect of endoscopic injections of dextranomer based implants on continence and bladder capacity: a prospective study of 31 patients.

PURPOSE: A prospective study was conducted to assess the efficacy of dextranomer based implants as a new bulking agent for endoscopic treatment of pediatric structural incontinence. MATERIALS AND METHODS: A total of 33 children and adolescents 5 to 18 years old with severe incontinence due to sphincteric incompetence (exstrophy-epispadias in 13, neuropathic bladder in 16, bilateral ectopic ureters in 4) were enrolled in the study. All but 1 patient wore diapers. Preoperative evaluation consisted of medical history, pad test, urine culture, urinary tract ultrasound and videourodynamics. This evaluation was repeated 6 months and 1 year after treatment and then on a yearly basis. Of the patients 14 had 2 and 1 had 3 treatment sessions to achieve a definitive result. At each evaluation the patient was considered cured-dryness interval of 4 hours confirmed by pad test, significantly improved-minimal incontinence requiring no more than 1 pad a day with less than 10 gm. leakage during pad test; and no further treatment required, and treatment failure-no significant improvement. Videourodynamics were mainly useful to study the evolution of the bladder capacity, activity and compliance. Followup after the last injection ranged from 6 to 36 months (mean 18). RESULTS: The mean injected volume was 3.9 ml. (range 1.6 to 12) and the procedure lasted a mean of 30 minutes (10 to 60). In the postoperative period 2 patients had temporary dysuria and 10 had a nonfebrile urinary tract infection. At 1 month 24 of the 33 patients (73%) were dry or improved. Two patients were subsequently excluded from study for noncompliance with followup. At 6 months 17 of 31 patients (55%), at 1 year 13 of 28 (46%), at 2 years 10 of 23 (43%) and at 3 years 10 of 20 (50%) were dry or improved. Similar success occurred in cases of neuropathic bladder (57%) and exstrophy-epispadias complex (46%). Success rate of re-treated patients was 35%. Of 13 patients with a normal initial bladder capacity 3 had a bladder decompensation requiring augmentation after 6 months. Also an increase of at least 50% in capacity was observed in 12 of 18 patients with an initial small bladder. No side effect related to the substance was observed. CONCLUSIONS: Endoscopic treatment of pediatric structural urinary incontinence with dextranomer implant, a nontoxic, nonimmunogenic, nonmigrant synthétic substance, was effective after 3 years in half of our patients. It may also be beneficial for patients with small bladder functional capacity. As the success rate decreased during the first year of followup, the result observed at 1 year seems to remain stable subsequently.

Adolescent↗
PubMed1992

[Urinary managements of 332 stroke patients in the chronic phase].

Urinary managements of 332 stroke patients in the chronic phase were performed at Bobath hospital. Cerebrovascular accidents (CVA) were caused by cerebral infarction in 178 (53.6%), intracerebral hemorrhage in 123 (37.1%) and subarachnoid hemorrhage in 31 (9.3%). Voluntary urination appeared in 124 patients before treatment, however in 29 of them occasional incontinence were observed. One hundred forty-three patients used diapers and 64 were controlled by indwelling catheters. The remaining one patient was treated by intermittent catheterization. Sixty-two patients who seemed to have communicative abilities in daily living were assessed with regard to their cerebrovascular dementia by Hasegawa's Dementia Rating Scale. After treatment 235 patients (70.8%) were able to urinate voluntarily, and only 15 of them remained incontinent and could use small pads successfully. TURP was effective for the stroke patients with benign prostatic hypertrophy (BPH) or bladder neck sclerosis (BNS). Fifty-three patients (16.0%) with persistent urinary incontinence were managed by diapers or a system of condom drainage. Thirty-nine patients (11.7%) were kept dry with intermittent catheterization at home, and long-standing use of indwelling catheters were required in the remaining 5 patients (1.5%). These results indicate that the lower level of activity, mobility and mental state tended to prevent the stroke patients from improvement of urinary disorders.

Activities of Daily Living↗
PubMed1993

One hundred and fifty men with urinary incontinence. III. Psychosocial consequences.

OBJECTIVE: To investigate the psychosocial impact of urinary incontinence among men. DESIGN: Telephone interviews with men who had give their written consent to participate. SUBJECTS: 150 men were available for interviews out of 571 who had asked for information about urinary incontinence and free samples of pads by post. MAIN OUTCOME MEASURES: Questionnaire which mapped demographic data, occupational status, medical history, medication, and toilet habits. Duration, frequency, and amount of leakage were registered, and the incontinence was classified according to a symptom questionnaire. Consultations and other sources of help were also registered, together with use of control methods, emotional, practical, and social consequences. RESULTS: Twenty-four per cent stated that their incontinence was a negligible problem. Generally, increasing severity of the incontinence caused more mental distress and social restrictions. Younger men were more handicapped than the older men. Practical inconveniences and social restrictions increased with longer duration of the incontinence. A multiple regression analysis, using a severity index, duration, type, and age as explanatory variables for the degree of mental distress, practical inconveniences, and social restrictions could explain 7%, 12%, and 25% of the variation in these groups of consequences, respectively. CONCLUSION: Urinary incontinence is associated with negative psychosocial effects, the impact increasing with the severity of the incontinence and decreasing with age of the incontinent men.

Age Factors↗
PubMed2004

The standard 1-hour pad test: does it have any value in clinical practice?

OBJECTIVES: The aim of this study was to determine whether self subjective assessment of urinary incontinence as perceived by female patients could replace the standard 1-hour pad test in clinical practice. DESIGN: Prospective cohort study. SETTING: District General Hospital, South West of England. METHODS: Ninety women awaiting surgical treatment for urodynamic stress incontinence were recruited. They underwent 160 pad tests; on each test women were asked to classify themselves on a four point scale into one category (0: totally continent to urine, 1: mild/occasional urinary incontinence (UI), 2: moderate UI, 3: severe UI), to complete the King's Health Questionnaire (KHQ) and carry out the standard International Continence Society 1-hour pad test. A pad gain >1 gm was considered a positive result. MAIN OUTCOME MEASURES: Women perception for severity of UI, 1-hour pad gain, KHQ scores. RESULTS: Self subjective assessment of UI (continent vs. incontinent) had good correlation (r = 0.88) with the pad test result (negative vs. positive), and correlated well with the KHQ scores (r = 0.79). Poor correlation was seen between the pad gain and the KHQ scores (r = 0.48) and between the pad gain and the self subjective assessment of UI scale (r = 0.48). The self subjective assessment of UI (incontinent vs. continent) had sensitivity 95.65% and specificity 93.33% to detect the pad test results (positive vs. negative). CONCLUSION: This study suggest that, in either the pre- or postoperative phase, simply asking a woman if she is continent for urine or not was as good as doing the pad test and correlated better with the patient quality of life.

Adult↗
PubMed2006

Women's health 18 years after rupture of the anal sphincter during childbirth: I. Fecal incontinence.

OBJECTIVE: We studied the long-term outcome after an anal sphincter tear. STUDY DESIGN: From a cohort of 4569 women who gave birth in 1982 to 1983, we identified 445 (9.7%) who sustained a sphincter tear and 445 controls. Eighteen years after the delivery, we mailed them a questionnaire and graded fecal incontinence with the Wexner score, a summary of incontinence to flatus, liquid, or solid stools; need to wear a pad; and lifestyle alterations. We predefined severe incontinence as a score above 4 of 20. RESULTS: Five hundred forty of 890 women (61%) returned the questionnaire. Severe fecal incontinence was reported by 34 of 259 women (13.1%) after a sphincter tear and 22 of 281 controls (7.8%) (risk ratio 1.7, 95% confidence interval 1.0 to 2.8). Only 6.4% of the reports of fecal incontinence were attributable to a sphincter tear. CONCLUSION: Fecal incontinence is frequently reported, even by women who have not sustained an anal sphincter tear. Only a small fraction of fecal incontinence can be attributed to sphincter tears.

Adult↗
PubMed2001

[Clinical evaluation of urinary incontinence in the woman].

Clinical assessment of stress and urge incontinence in women is always necessary before making therapeutic decisions. During the full bladder examination stress incontinence triggered by cough may suggest cervicourethral hypermobility. Leakage during the Vasalva manoeuvre may reveal incontinence due to intrinsic sphincter deficiency. The pad test provides an objective quantitative measurement of the degree of incontinence. Symptom scores enable intra- and inter-individual comparisons. Psychosocial implications are studied with specific quality-of-life scales. Together, these tests improved therapeutic strategies for managing stress and urge incontinence, providing an objective evaluation of the different treatments and thus a better medico-economic approach to the problem.

Female↗
PubMed1994

Perianastomotic injection of autologous fat at the time of radical retropubic prostatectomy.

OBJECTIVES: The present study represents the first attempt to improve urinary continence following radical prostatectomy (RP) by perianastomotic injection of autologous fat at the time of the surgical procedure. METHODS: A total of 15 consecutive men with clinically localized carcinoma of the prostate underwent nerve-sparing radical retropubic prostatectomy (RRP) with perianastomotic injection of autologous fat. The autologous fat was obtained using a liposuction cannula connected to a power aspirator. The fat was harvested from the adipose tissue immediately adjacent to the lower midline incision. After the pelvic floor musculature was perforated, a total of 30 mL of autologous fat was injected through a 12 gauge angiocatheter under cystoscopic guidance. RESULTS: There were no complications resulting from the harvesting or injection of the autologous fat. All of the patients were evaluated for 6 months. Of the 15 patients, 12 (80%) achieved total urinary control within 6 months. The average time required to achieve total urinary continence was 89 days. None of the patients experienced total or nocturnal incontinence. Of the 3 patients with stress urinary incontinence (SUI), 2 required 2 small pads per day and 1 required 3 pads per day. Only 1 patient reported that the level of bother resulting from the incontinence was severe. CONCLUSIONS: The preliminary experiences with the perianastomotic fat injection at the time of RRP are encouraging. Determining the ultimate safety and effectiveness of this technique requires longer follow-up in expanded series of patients.

Adipose Tissue↗