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PubMed2004

Functional extracorporeal magnetic stimulation as a treatment for female urinary incontinence: 'the chair'.

OBJECTIVE: To evaluate, in a prospective study, the efficiency and applicability of functional magnetic stimulation (FMS) of the pelvic floor for treating urinary incontinence in women. PATIENTS AND METHODS: FMS was provided by a 'magnetic chair'; 24 patients were treated twice weekly for 8 weeks (12 with urge incontinence and 12 with a mixture of urge and stress incontinence). The outcome was assessed urodynamically, by a pad test, and by patient satisfaction. RESULTS: In 58% of the patients there was an objective improvement in incontinence; three patients were completely dry and 71% reported a subjective improvement (P < 0.001). CONCLUSION: FMS is a safe, noninvasive and painless treatment for urinary incontinence; it is effective and easy to administer as an outpatient treatment.

Electric Stimulation↗
PubMed2004

[Vesicovaginal fistula which arose postoperatively after removal of the ureter by the intussusception method for renal pelvic tumor: a case report].

A 64-year-old woman underwent right nephroureterectomy of the ureter by the intussusception method under the diagnosis of right renal pelvic tumor in December 2001. Stress incontinence appeared postoperatively, and though conservative treatment was performed, it did not improve. The result of the pad-weighting test was 56 g indicating serious incontinence. In chain cystography, contrast media from the posterior wall of the urinary bladder to the vagina leaked out by the lateral view, and in cystoscopy, a fistula of about 2 mm in diameter was recognized in the right ureteral orifice trace. Under the diagnosis of vesicovaginal fistula, we performed transvaginal repair of the vesicovaginal fistula in November 2003. The urethral catheter was removed on the 14th postoperative day. After removal of the urethral catheter, urge incontinence was recognized, but it improved gradually. The recurrence of fistula and tumor has not been recognized at present.

Female↗
PubMed2005

[Late effects following curative radiotherapy for prostate cancer].

In this study we report late bladder, gastrointestinal and sexual dysfunctions in 23 patients following radical radiotherapy (66Gy-70Gy/33-35fx, 5 fx/week) for prostate cancer. We interviewed the subjects by telephone and compared the results with those of 45 healthy population controls. In general, the patients' bladder function was well preserved. However, compared with the population controls, significantly more patients reported dysuria and hematuria. Twenty-six percent of the patients reported moderate distress from the gastrointestinal tract. Fecal urgency, incontinence and the use of sanitary pads, as well as diarrhoea, and blood and mucous were significantly more common among the patients. Thirty-nine percent of the patients reported moderate or worse distress upon sexual activity, and significantly more patients suffered from erectile impotence.

Aged↗
PubMed1996

The endoscopic fascial sling for treatment of female urinary stress incontinence.

PURPOSE: We describe a new technique, the endoscopic fascial sling, for the treatment of female urinary stress incontinence. MATERIALS AND METHODS: A total of 22 women 25 to 84 years old with urinary stress incontinence underwent this procedure. RESULTS: There were no urethral erosions or wound infections using the fascial strip. Of the women 16 (73%) are cured of incontinence and 4 (18%) are improved (use pads less frequently than preoperatively), and the procedure failed in 2 (9%). CONCLUSIONS: The endoscopic fascial sling offers a new alternative for the treatment of female stress incontinence, combining the reliability of sling procedures and the decreased morbidity of needle suspension techniques.

Adult↗
PubMed2001

Impact of urinary and climacteric symptoms on social and sexual life after surgical treatment of stress urinary incontinence in women: a long-term outcome.

AIM: The aim of the present study was to evaluate the long-term results of surgical treatment of stress urinary incontinence (SUI) using both subjective and objective methods. BACKGROUND: Few studies have focused on the influence of biological and social changes in a woman's life on the long-term outcome of surgical treatment of stress urinary incontinence. METHODS: The study included 45 women with genuine SUI treated with either retropubic urethrocystopexy (n=30) or puboccocygeal repair (n=15). The assessment included interviews, questionnaires, urinary diary, pad test, continence test and urodynamic investigation. RESULTS: The results were evaluated at intervals of 3 months, 1 year and 5--7 years after the treatment. One year after the surgical treatment 71% of the women in the urethrocystopexy group and 80% in the pubococcygeal repair group were subjectively cured, while 5--7 years after surgery the corresponding values were 43% vs. 60%. However, according to pad test a 67% of the women in the urethrocystopexy group and 47% in the pubococcygeal repair group had ceased to leak urine 1 year after the operation whereas at the long-term follow-up the corresponding values were 64% vs. 71%. According to the questionnaire at the long-term follow-up only 35% of the women in the whole group had genuine SUI whereas 21% had urge-incontinence. Moreover, 37% experienced sweating, 23% flushing and 44% vaginal dryness. The number of women with adiposity had increased significantly (P < 0.001) at the long-term follow-up. Twenty-eight per cent of the women decreased their activities whereas the majority experienced no impediment. Seventy-nine per cent reported that they were sexually active and the majority reported satisfaction with their sexual lives. CONCLUSIONS: Accurate assessment of postoperative results of SUI demands rigorous recording of subjective and objective data taking into consideration psychological and social factors, otherwise there is a high risk of bias in the interpretation of the results of the treatment for SUI. This study indicates that, in order to give women with SUI adequate treatment the nursing care should comprehend the women's divergent experiences of urinary incontinence and its impact on social and sexual life.

Activities of Daily Living↗
PubMed1997

Patient satisfaction with a reusable undergarment for urinary incontinence.

PURPOSE: We investigated patient satisfaction with a reusable undergarment for urinary incontinence. SUBJECTS AND SETTING: One hundred seventy-five participants with reported urinary incontinence from two urology-based clinics at large teaching hospitals and one prostate cancer support group participated in the study. METHODOLOGY: Each participant was given a minimum of one reusable undergarment for urinary incontinence. Participants used the undergarment for an average of 10 days (range 1 to 60 days). During the trial period, subjects alternated the reusable undergarment with their previous urine-containment devices, usually disposable pads, while the undergarment was being washed. Patient satisfaction was evaluated with a questionnaire. PRIMARY OUTCOME MEASURES: Patient satisfaction with the reusable undergarment was measured for six categories: (1) physical comfort, (2) ability to keep skin dry, (3) ability to prevent wet spots, (4) discretion, (5) odor control, and (6) confidence when wearing the garment versus previously used containment devices. RESULTS: Of the 175 subjects, 126 (33% female and 67% male) completed and returned the 7-page questionnaire. All respondents reported at least one urinary incontinent episode while wearing the reusable undergarment. Occurrence and degree of leakage by self-report varied from light leakage (33%) to moderate leakage (48%) and heavy leakage (17%). Patient satisfaction was measured as follows: (1) 83% rated the overall comfort of the undergarment as very good or excellent; (2) 52% said they felt very dry or dry when wearing the product after an incontinent episodes; (3) 75% rated the ability to prevent wet spots on outer clothing as adequate or excellent; (4) 75% rated the discretion of this product as excellent; (5) 80% rated the ability to control odor as adequate or excellent; and (6) 67% felt more confidence with this reusable undergarment than with other products with which they were familiar. CONCLUSION: The reusable garment provided effective containment from urine loss among this group of incontinent women and men.

Adult↗
PubMed1998

A randomized controlled trial of pelvic floor muscle exercises to treat postnatal urinary incontinence.

A randomized controlled trial was carried out to evaluate the extent to which a program of reinforced pelvic floor muscle exercises (PFME) reduces urinary incontinence 1 year after delivery. Two hundred and thirty women who were incontinent 3 months postpartum were randomized to either a control group doing standard postnatal pelvic floor muscle exercises (n = 117) or to an intervention group (n = 113) who saw a physiotherapist for instruction at approximately 3, 4, 6 and 9 months postpartum. Results collected 12 months after delivery included prevalence and frequency of incontinence and PFME, sexual satisfaction, perineometry measurements and pad tests. Twenty-six (22%) of the control group and 59 (52%) of the intervention group withdrew before the final assessment. The prevalence of incontinence was significantly less in the intervention group than in the control group (50% versus 76%, P=0.0003), and this group also did significantly more PFME. There were no significant differences between the groups as regards sexual satisfaction, perineometry measurements or pad test results.

Exercise Therapy↗
PubMed1995

[Tampons--an aid in stress incontinence?].

22 patients with stress incontinence who were waiting for operative treatment tested specially designed vaginal tampons. The tampons, ten per patient, were tested in situations where the patients normally would experience urinary leakage. 20 of the patients afterwards answered a questionnaire: 11 patients had experienced complete continence, and in seven patients the use of the tampon had reduced leakage. Nine patients wanted to continue using tampons until the operation. We believe that vaginal tampons, by eliminating odour and a feeling of wetness, may be a better aid than pads for certain women with stress incontinence.

Adult↗
PubMed2004

Physiologic outcome measures for urinary incontinence.

Physiologic outcome measures are divided into 2 groups: (1) measures that visualize, quantify, and analyze the reasons for urine loss and (2) measures that assess the anatomy and neuromuscular function of continence-related structures. Few of the frequently used physiologic outcome measures have been rigorously tested. The evidence in support of their use derives mainly from case series information and expert opinion. Perineal pad testing is used to quantify urine leakage associated with stress incontinence. One-hour pad tests are commonly used for clinical trials and office visits; 24- and 48-hour tests are more reliable and reproducible. Urodynamic testing simultaneously assesses bladder and urethral function during bladder filling and emptying to help guide therapy and identify patients who are at risk for surgical failure. Testing usually includes (1) uroflowmetry, an assessment of voiding without catheters in place; (2) cystometry, which assesses bladder sensation, capacity, compliance, and inappropriate detrusor activity during filling; (3) urethral pressure profilometry, to gauge urethral closing pressures and pressure transmission ratios; (4) leak-point pressure, the minimum intra-abdominal pressure required to cause incontinence, which serves as a measure of urethral function; and (5) pressure flow studies, which diagnose obstruction by evaluating detrusor pressure and flow rate during voiding. The cotton swab test is used to assess bladder neck mobility after surgical interventions. Using the Pelvic Organ Prolapse Quantification system, researchers can describe pelvic support in a standardized, reproducible fashion. Applications of ultrasonography and magnetic resonance imaging in urogynecology are promising but remain in the investigational stages.

Clinical Trials as Topic↗
PubMed2001

Anatomical and functional changes in the lower urinary tract during pregnancy.

OBJECTIVE: To assess the prevalence and the development of urinary incontinence in nulliparous pregnant women, both subjectively and objectively, and to investigate the relation of incontinence with the mobility of the urethro-vesical junction measured by perineal ultrasound. DESIGN: A prospective longitudinal study. SETTING: University Hospital and Martini Hospital Groningen, the Netherlands. POPULATION: A cohort of 117 nulliparous pregnant women and 27 nulliparous non-pregnant controls. METHODS: Urinary incontinence was measured by a questionnaire and by a 24-hour pad test. The position of the urethro-vesical junction and its mobility were measured by perineal ultrasound. MAIN OUTCOME MEASURE: Prevalence of urinary incontinence; mobility of the urethro-vesical junction, indicated by the displacement/pressure coefficient. RESULTS: Up to 35% of the women reported urinary incontinence in pregnancy, and 20% of the women had a positive pad test. The angle of the urethro-vesical junction angle at rest and the displacement/pressure coefficient during coughing showed a significant increasing trend during pregnancy, but no changes were seen during the Valsalva manoeuvre. No relationship was found between subjective and objective incontinence data and the position and mobility of the urethro-vesical junction. CONCLUSION: The prevalence of incontinence in nulliparous women as found by the pad test was significantly higher in pregnancy (20%) than in the non-pregnant control group (4%). Perineal ultrasound of the urethrovesical junction showed lowering of the pelvic floor occurring as early as 12-16 weeks of pregnancy. Serial measurements of the displacement/pressure coefficient suggest that the dynamic characteristics of the connective tissues of the pelvic floor remain unaltered,whereas a significant decrease in pelvic floor muscle contraction occurs. Since no relation was found between measurements of the urethro-vesical junction and incontinence, urinary incontinence in pregnancy is most likely explained by other factors.

Adolescent↗
PubMed1996

The electrically stimulated gracilis neosphincter incorporated as part of total anorectal reconstruction after abdominoperineal excision of the rectum.

OBJECTIVE: The authors investigated the feasibility and effectiveness of combining electrically stimulated gracilis neoanal (ESGN) sphincter and a coloperineal anastomosis in selected patients after abdominoperineal excision of the rectum (APER). SUMMARY BACKGROUND DATA: The ESGN is effective in the treatment of idiopathic fecal incontinence. METHODS: Between March 1989 and September 1993, 12 patients (9 men, 3 women) with a median age of 59.25 years (range, 45-70) underwent the procedure. The underlying disease was adenocarcinoma in 10, anal malignant melanoma in 1, and a sweat gland tumor in the other. In all patients, a sphincter saving resection was contraindicated. The procedure was performed in stages. Stage 1 involved a conventional APER with the formation of a perineal stoma. Eleven patients underwent a vascular delay procedure. All patients were defunctioned. In stage 2, the gracilis was mobilized, transposed around the anal canal, and the electrodes and hardware needed for electrical stimulation were implanted. Once muscle conversion was complete, the defunctioning stoma was closed. RESULTS: Eight patients were closed successfully. In seven of the eight patients, complete physiologic measurements were taken. Median basal and maximum neosphincter pressures were 30 and 122 cm H2O, respectively, at the start of electrical stimulation and 22.5 and 76.2 cm H2O, respectively, after 1 year. Median functioning neosphincter pressure was 36 cm H2O at 1 year. All of the patients whose stomas were closed experienced episodes of incontinence to solid stool and wore pads for persistent fecal soiling. They all reported difficulty in evacuation. Despite imperfect continence, no patient wished to go back to life with a stoma. CONCLUSIONS: The incorporation of ESGN as part of total anorectal reconstruction is technically feasible. The majority of patients are satisfied with their function and pleased to avoid a permanent stoma.

Aged↗
PubMedDate not supplied

Preventing and managing perineal dermatitis: a shared goal for wound and continence care.

Perineal dermatitis is frequently encountered in patients with urinary and/or fecal incontinence, particularly when managed by a containment device such as a pad or containment brief. In addition to intervening to prevent or alleviate incontinence, a preventive perineal skin program in the high-risk patient and aggressive management of incontinence-related dermatitis are both essential for effective holistic management. A routine cleansing regimen that removes irritants and moisturizes while protecting the skin from additional irritation is effective for prevention of dermatitis and for managing mild cases. However, more aggressive care is required when perineal dermatitis occurs, especially when it is associated with epidermal erosion. Xenaderm ointment combines three active ingredients in a hydrophobic ointment that promotes healing while acting as a moisture barrier to prevent further irritation and damage.

Dermatitis↗
PubMed1994

Treatment of post-prostatectomy stress urinary incontinence with periurethral polytetrafluoroethylene paste injection.

Periurethral injection of polytetrafluoroethylene (Teflon) paste was performed to treat moderate to severe stress urinary incontinence following prostatectomy. A total of 20 procedures was performed in 13 men, of whom 8 had previously undergone radical prostatectomy for prostate cancer and 5 had undergone transurethral electrocautery resection of the prostate for bladder outlet obstruction due to benign prostatic hyperplasia. All patients had significant stress urinary incontinence requiring a minimum of 2 pads wet daily. Between 16 and 20 cc polytetrafluoroethylene paste were injected initially transurethrally into the periurethral tissues in the region of the external sphincter. Of the 13 patients 7 underwent a second injection procedure with an additional 12 to 23 cc paste. Three men (23%) experienced a noticeable improvement in continence status, including 1 of 5 patients after transurethral electrocautery resection and 2 of 8 after radical prostatectomy. However, none of these men became completely dry or was able to eliminate completely the use of pads. Of the 13 patients 10 (77%) experienced no detectable improvement in continence status. Seven patients have now successfully undergone implantation of an artificial urinary sphincter without complication. With a minimum followup of 11 months in all patients and a maximum followup of 3 years, none has experienced any clinically detectable long-term side effects related to the polytetrafluoroethylene injection or evidence of particulate migration.

Aged↗
PubMed2005

Quality of life and disease severity in Korean women with stress urinary incontinence.

OBJECTIVES: To evaluate whether disease severity influences quality of life using the Incontinence Quality of Life questionnaire and to determine the factors that effectively reflect disease severity in women with stress urinary incontinence (SUI). METHODS: A total of 109 women (mean age 54.9 years, range 31 to 77) with UI were included in the primary analyses. Data from the responses to the Incontinence Quality of Life questionnaires, 1-hour pad testing, uroflowmetry, postvoid residual urine volume measurements, and videourodynamic study were included for analysis. Of the 109 patients, 24 (22.0%) were mildly, 53 (48.6%), moderately, and 32 (29.4%) severely affected, respectively, as determined by self-perceived severity. RESULTS: The Incontinence Quality of Life total scores were associated with several variables, including self-perceived disease severity (P < 0.001), type of UI (P = 0.009), number of UI episodes (P = 0.022), association with no specific activity (P = 0.017), and maximal flow rate (P = 0.027). Multiple linear regression analysis showed that self-reported disease severity (P < 0.001) was a potential risk factor of a poorer quality of life. The perceived severity of UI increased with stress pad weight (P = 0.010) and the number of UI episodes (P = 0.005). CONCLUSIONS: These findings suggest that self-perceived disease severity significantly influences the quality of life of patients with SUI. Although UI episodes or the number of pads used have been routinely used to evaluate SUI severity, strategies for assessing SUI should also incorporate self-perceived disease severity.

Adult↗
PubMed2005

Validation of the urgency perception scale.

OBJECTIVE: To ascertain the validity and responsiveness of the Urgency Perception Scale (UPS) as an indicator of perceived urinary urgency. PATIENTS AND METHODS: The UPS was developed to assess perceived urinary urgency in clinical studies evaluating the efficacy of the antimuscarinic drug, tolterodine, for treating the overactive bladder (OAB) syndrome. Secondary analyses of clinical and patient assessment data from three clinical studies of tolterodine were conducted to evaluate the UPS. Construct validity was assessed by correlations between the UPS and patient voiding diary variables and other patient assessments, including: perception of bladder condition; perception of treatment benefit; the Medical Outcomes Study Short-Form 36 health survey; the King's Health Questionnaire; the OAB Questionnaire; and the Overall Treatment Effect scale. RESULTS: The UPS correlated well with the patients' perception of bladder condition (correlation coefficients - 0.29 to - 0.46; all P < 0.001) and with the voiding diary variables, especially incontinence episodes (-0.30 to - 0.41) and pad usage (-0.25 to - 0.38; all P < 0.001). An improvement in UPS score at the end of treatment was consistently reflected by significant improvements among all voiding variables. CONCLUSION: Urinary urgency is a central symptom of OAB and is particularly bothersome because of its unpredictability and consequent impact on daily life. The UPS is a valid scale by which urinary urgency can be assessed subjectively, and provides a useful tool for research into urinary urgency.

Aged↗
PubMed2002

Effect of oral diazepam on anal continence after low anterior resection: a preliminary study.

The aim of the present study was to investigate the effect of oral diazepam on anal incontinence after low anterior resection for rectal cancer. Five patients with persistent incontinence after low anterior resection for rectal cancer (median level of anastomosis was 4.0 cm from the anal verge) were treated with oral diazepam (2 mg/day) 9-90 months after surgery. Grade and frequency of anal incontinence, the need for a protective pad and changes of lifestyle were recorded to the Cleveland Clinic's continence grading scale; anorectal manometry was performed before and after 3 months of treatment. All patients improved on treatment although occasional minor soiling persisted in two patients. Continence score improved from 14 (median, range 9-16) to 0 (range 0-12) after taking diazepam. Improvement occurred within a week after administration of diazepam. Although the patients improved symptomatically, anorectal manometry failed to demonstrate any significant changes. In conclusion, oral administration of diazepam may be worthwhile in the attempt to improve anal continence after low anterior resection.

Aged↗
PubMed1998

[Percutaneous urethral suspension with bone anchorage (Vesica) in the treatment of stress urinary incontinence. Results after a year of follow-up].

OBJECTIVES: Evaluation of efficacy of percutaneous bladder neck suspension with bone anchors in women with stress incontinence with no previous treatment. PATIENTS AND METHODS: Fourteen women (mean age 48, range 37-74) were operated. All had a stable bladder and objective leakage, either by pad test of by physical examination. Ten were evaluated by a incontinence questionnaire. Mean incontinence time before the procedure was 3.9 years. All needed pads (mean 3.3 pads/day). The surgical technique is described. RESULTS: Mean surgical time was 80 minutes. In three patients there was bladder perforation during the procedure, that was solved by delaying the catheter withdraw. Mean postoperative stay was 4.2 days, with good tolerance, and one patient was discharged with a cystostomy. After a minimum follow-up of one year (mean 17.5 months), eleven patients have improved their continence (6 dry, 5 socially acceptable incontinence < pads/day) and 3 have recurrence. Postoperative pad test was < or = 10 g in patients without improvement and over 20 g in patients who failed. Mean postoperative total score in the questionnaire decreased from 10.1 to 2.5 in patients who improved and didn't change in patients who failed. CONCLUSION: Percutaneous bladder neck suspension is a useful alternative to open interventions, due to its low morbidity and lower postoperative stay.

Adult↗
PubMed2006

Ejaculatory urine incontinence after radical prostatectomy.

OBJECTIVES: Urinary incontinence and erectile dysfunction remain the long-term complications that affect most patients' lives after radical prostatectomy. Previous reports evaluating incontinence have focused on volumes of urine loss and daily pad use to assess these issues. We have observed that small volumes of urinary incontinence during sexual activity can be just as disconcerting to patients. We attempt to further describe and assess the phenomenon of urinary incontinence with ejaculation in a series of patients. METHODS: We reviewed the experience of one physician who received referrals for the treatment of erectile dysfunction after radical prostatectomy from July 2002 to March 2005 and identified 26 men experiencing urine leak predominantly during ejaculation. Questionnaires assessing urinary incontinence were sent to all these patients. RESULTS: The mean age was 62 years (range 54 to 73). Sixteen patients underwent bilateral nerve-sparing, five unilateral nerve-sparing, and five nonnerve-sparing radical retropubic prostatectomy. At a median follow-up of 42 months (range 15 to 118), all patients had experienced urine leakage (volume 0.5 teaspoon to 1 cup) during ejaculation. The incontinence questionnaire revealed that most patients had mild incontinence; however, they experienced ejaculatory urine incontinence "most, or all of the time" and considered it a "big problem." CONCLUSIONS: Although the prevalence of ejaculatory urine incontinence is unclear, in our experience it occurs often enough to be considered a part of the routine postprostatectomy evaluation. A better understanding of the pathophysiology of postprostatectomy incontinence will lead to targeted therapy and an improved quality of life for the patient.

Aged↗