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PubMed2003

Extracorporeal magnetic stimulation for the treatment of stress and urge incontinence in women--results of 1-year follow-up.

OBJECTIVE: To evaluate the clinical efficacy of extracorporeal magnetic stimulation for the treatment of stress and urge urinary incontinence in women. MATERIAL AND METHODS: A total of 35 patients with stress incontinence and 17 with urge incontinence were enrolled in this study. All patients were evaluated by means of a detailed history of incontinence, a gynecologic examination, urine culture, urinary system ultrasound and a urodynamic study. All patients were asked to keep a 3-day voiding diary. A pad-weighing test was done for each patient at their first visit. For treatment, the patients were seated on a special chair containing a magnetic field generator. Pelvic floor muscle stimulation was performed for 20 min (10 min at 5 Hz and 10 min at 50 Hz) twice a week for a total of 8 weeks. The mean follow-up period was 16.8 months (range 12-32 months). A total of 44 patients completed 1 year of follow-up and were re-evaluated by means of voiding diary, pad-weighing test and cystometric study. RESULTS: Of the 44 patients, 11 (38%) with stress incontinence and 6 (40%) with urge incontinence were cured 1 year after the treatment. In addition, there was an improvement in symptoms in 12 patients (41%) in the stress group and 7 (47%) in the urge group. Pad weight was reduced from 15.4 to 5.8 g in the stress group and from 12.4 to 4.7 g in the urge group (p = 0.000 and 0.001, respectively). Mean Valsalva leak point pressure was increased from 87.3 +/- 15.9 to 118.0 +/- 11.0 cmH (2) O in the stress group (p = 0.000). CONCLUSIONS: Extracorporeal magnetic stimulation therapy offers a non-invasive, effective and painless treatment for stress and urge incontinence in women.

Adult↗
PubMed1997

Collagen injection therapy for post-radical retropubic prostatectomy incontinence: role of Valsalva leak point pressure.

PURPOSE: We retrospectively evaluated the role of Valsalva leak point pressure as a predictor of successful management of post-radical retropubic prostatectomy incontinence with collagen injection. MATERIALS AND METHODS: Urodynamic studies and Valsalva leak point pressures of 31 men who received retrograde collagen injection for post-radical retropubic prostatectomy incontinence were reviewed. Patients were interviewed before and after treatment to assess pad use and the American Urological Association quality of life index (scale 0 to 6). Parameters for success were postoperative quality of life score 3 or less or 50% or greater decrease in pad use and that the patient would recommend collagen therapy to someone else. RESULTS: Of 31 patients 11 (35%) met the criteria for success, 2 (6%) were completely dry and 9 (29%) were improved. Successfully treated patients had a mean Valsalva leak point pressure of 64.0 cm. water compared to 42.2 cm. water in the failure group (p <0.01). Of patients with Valsalva leak point pressure of 60 cm. water or greater, 70% responded favorably to collagen injection (positive predictive value), while 81% with Valsalva leak point pressure less than 60 cm. water had treatment failure (negative predictive value) (p <0.02). There were no other statistically significant differences between those successfully treated with collagen injection and those in whom treatment failed, including mean age (62.7 to 68.1 years), mean volume of collagen (26.1 to 28.9 ml.), mean number of treatment sessions (2.45 to 2.65), mean followup (14.9 to 15.1 months), preoperative quality of life score (5.1 to 4.9), and preoperative pads per day (4.0 to 3.37). CONCLUSIONS: Our data suggest that collagen injection improves 35% but cures a minority of patients (less than 10%) with post-radical retropubic prostatectomy incontinence. A pretreatment Valsalva leak point pressure of 60 cm. water or greater has high predictive value for a beneficial outcome after collagen injection. We propose a role for Valsalva leak point pressure to select men cost-effectively with post-radical retropubic prostatectomy incontinence for therapy with collagen injection.

Adult↗
PubMed1996

The prevalence of urinary dysfunction in Hong Kong Chinese women.

OBJECTIVE: To determine the prevalence of urinary dysfunction in Hong Kong Chinese women. METHODS: A telephone survey was conducted in the territory of Hong Kong. The subjects were a sample of women between the ages of 10 and 90 years. The main outcome determined was the prevalence of urinary dysfunction. RESULTS: We made 3248 calls, resulting in 819 evaluable responses. Stress incontinence was reported by 21% (174) of respondents, urgency or urge incontinence in 15% (120), urinary frequency in 19% (154), nocturia in 20% (166), bed-wetting in 4% (31), and voiding difficulties in 13% (109). Stress incontinence occurred as the only symptom in 7% (53), the combination of urgency and frequency in 1% (11), and mixed symptoms in 6% (52). Four percent required protective underwear or pads, with 2% wearing protective underwear continuously; 4% were incapacitated by their incontinence. Symptoms of urgency, urge incontinence, frequency, and nocturia increased with increasing age, but voiding difficulties and nocturnal enuresis were unrelated to age. Stress incontinence, urgency, urge incontinence, frequency, nocturia, and voiding difficulties increased with increasing parity to para 4. CONCLUSION: Urinary dysfunction and its patterns appear to be as common and incapacitating in Hong Kong Chinese as they are in other populations.

Adolescent↗
PubMed2006

Increasing costs of urinary incontinence among female Medicare beneficiaries.

PURPOSE: We measured the financial burden of urinary incontinence in the United States from 1992 to 1998 among women 65 years old or older. MATERIALS AND METHODS: We analyzed Medicare claims for 1992, 1995 and 1998 and estimated spending on the treatment of urinary incontinence. Total costs were stratified by type of service (inpatient, outpatient and emergency department). RESULTS: Costs of urinary incontinence among older women nearly doubled between 1992 and 1998 in nominal dollars, from $128 million to $234 million, primarily due to increases in physician office visits and ambulatory surgery. The cost of inpatient services increased only slightly during the period. The increase in total spending was due almost exclusively to the increase in the number of women treated for incontinence. After adjusting for inflation, per capita treatment costs decreased about 15% during the study. CONCLUSIONS: This shift from inpatient to outpatient care likely reflects the general shift of surgical procedures to the outpatient setting, as well as the advent of new minimally invasive incontinence procedures. In addition, increased awareness of incontinence and the marketing of new drugs for its treatment, specifically anticholinergic medication for overactive bladder symptoms, may have increased the number of office visits. While claims based Medicare expenditures are substantial, they do not include the costs of pads or medications and, therefore, underestimate the true financial burden of incontinence on the aging community.

Aged↗
PubMed2002

Acute and long-term outcomes of radio frequency bladder neck suspension.

PURPOSE: A new treatment modality for women with stress urinary incontinence secondary to urethral hypermobility is radio frequency bladder neck suspension. Radio frequency energy is a form of electromagnetic energy that is reliable and highly controllable. This thermal therapy can produce well-defined areas of tissue heating. The technology has been used extensively in dermatological and orthopedic surgery for tissue shrinkage and ablation. Radio frequency thermal therapy is now being applied to the endopelvic fascia at the bladder neck and urethra for treating hypermobility in patients with stress urinary incontinence. The purported mechanism is shrinkage of the collagenated tissue that supports the bladder neck and proximal urethra. We report our acute and long-term experience with laparoscopic radio frequency bladder neck suspension for stress urinary incontinence. MATERIALS AND METHODS: Enrolled in this prospective multicenter trial were 94 women with a mean age of 48.4 +/- 7.6 years who had urethral hypermobility with an average cotton swab angle change of 41 degrees and Valsalva leak point pressures greater than 90 cm. water at 250 ml. bladder capacity. Detrusor instability was excluded by cystometry. In all cases precisely controlled radio frequency energy was applied to the endopelvic fascia to heat and shrink the tissue. The primary end points were physician assessment of continence, patient reported pad use and the number of patient reported episodes of urinary incontinence daily 1, 3, 6 and 12 months after surgery. RESULTS: Average operative time was less than 60 minutes and 98% of the patients were discharged home from the recovery room. Treatment surface area decreased an average of 17% in length and 21% in width. Preoperatively 78% of patients had an average of 1 or more episodes of urinary incontinence daily. At 1, 3, 6 and 12 months there was an average of 1 or fewer episodes of urinary incontinence daily in 84.7%, 85.6%, 85.9% and 77.4% of patients, respectively, and at 12 months 83.5% reported being continent or improved. Preoperatively 41.2% of patients reported using 1 pad or less daily, while at 1, 3, 6 and 12 months 85.6%, 90.4%, 87.2% and 86.9%, respectively, required 1 pad or less daily. Urodynamic evaluation at 12 months showed no leakage during the Valsalva maneuver in 78% of cases. There were no major postoperative complications and the minor complication rate was 5.3%. CONCLUSIONS: Early results of thermal treatment of the endopelvic fascia indicate that radio frequency bladder neck suspension is safe and effective for improving stress urinary incontinence in women. The improvement in symptomatology appears to be durable in most patients at the 1-year followup. Longer followup is needed to assess the durability of results and it is currently in progress.

Catheter Ablation↗
PubMed2004

Transvaginal sling using acellular human dermal allograft: safety and efficacy in 253 patients.

PURPOSE: We evaluated the safety and efficacy of using human dermal allograft material for transvaginal slings to treat female stress urinary incontinence (SUI). MATERIALS AND METHODS: We present a prospective series of 253 patients with SUI treated with a transvaginal sling using a Repliform cadaveric human dermal allograft (LifeCell Corp., The Woodlands, Texas) and a bone anchor fixation kit. Clinical history, urogynecologic examination and videourodynamics were performed preoperatively. Results were assessed by a third party through validated quality of life questionnaires (Incontinence Impact Questionnaire and Urogenital Distress Inventory), overall impression and percent of improvement as perceived by the patients, and pad use. Scheduled followup examination were performed to rule out erosion, infection, obstruction, pain or recurrent incontinence. RESULTS: Complete followup was available on 234 of 253 patients. Average followup was 18 months. Of the patients 78% were cured or improved according to the questionnaires. The average improvement was 80%. At 18 months of followup incontinence average distress and scores decreased 10 and 7 points, respectively. Complications were de novo urgency in 5% of cases, recurrent SUI in 15% with no cases of persistent SUI, retention in 2% and slow vaginal wall healing in 1.7%. Of 156 patients 51 (22%) had persistent urgency. There were no cases of vaginal or urethral erosion, osteitis pubis or osteomyelitis. CONCLUSIONS: Our data indicate that use of human dermal allograft for transvaginal slings is associated with low complication rates and favorable outcomes at an average of 18 months of followup.

Adult↗
PubMed2004

Extracorporeal magnetic innervation treatment for urinary incontinence.

BACKGROUND: Extracorporeal magnetic innervation (ExMI) is a new technology used for pelvic muscle strengthening for the treatment of stress urinary incontinence. We explored whether this new technology is effective for patients with urge incontinence, as well as those with stress urinary incontinence. METHODS: We studied 20 patients with urge incontinence and 17 patients with stress urinary incontinence. The Neocontrol system (Neotonus Inc., Marietta, GA) was used. Treatment sessions were for 20 min, twice a week for 8 weeks. Evaluations were performed by bladder diaries, one-hour pad weight testing, quality-of-life surveys and urodynamic studies. RESULTS: Of the urge incontinence cases, five patients were cured (25.0%), 12 patients improved (60.0%) and three patients did not show any improvement (15.0%). Leak episodes per day reduced from 5.6 times to 1.9 times at 8 weeks (P < 0.05). Eight patients with urge incontinence recurred within 24 weeks after the last treatment (47.1%). Of the stress incontinence cases, nine patients were cured (52.9%), seven patients improved (41.1%) and one patient did not show any improvement (6%). In one-hour pad weight testing, the mean pad weight reduced from 7.9 g to 1.9 g at 8 weeks (P < 0.05). Three patients returned to the baseline values within 24 weeks after the last treatment (17.6%). No side-effects were experienced by any of the patients. CONCLUSION: Although the results for urge incontinence were less effective than for stress urinary incontinence, ExMI therapy offers a new option for urge incontinence as well as stress urinary incontinence.

Adult↗
PubMed1998

Implantable microballoons: an attractive alternative in the management of intrinsic sphincter deficiency.

PURPOSE: All current bulking agents employed for treating stress urinary incontinence (SUI) have significant limitations due to various side effects, technical difficulties and inadequate long-term results. Implantable microballoons were therefore tested as a new therapeutic modality for female urinary incontinence. MATERIAL AND METHODS: The microballoons are implanted with a new system which consists of the self-detachable cross-linked silicone balloon, biocompatible filler material and a delivery system. Nineteen female patients (mean age 63.3 years) with SUI grade 1 or 2 were studied prospectively. Using the Blaivas-Olsson classification, 6 patients had stress incontinence type I, 4 had type II and 9 had type III. Three to seven balloons (mean 4.2) were implanted per patient. Patients were followed up with pad tests (g) and determination of leak point pressure (LPP; cm H2O) and maximal urethral closing pressure (Pura max; cm H2O) at 1, 3, 6, 12 and 18 months. RESULTS: The biocompatibility of the microballoons was excellent. No significant adverse events were associated with the procedure. With a mean follow-up of 14.4 months (range 10-18) 42.1% (8/19) of the women are dry. In the latter the pad test improved from a preoperative mean of 22.6 g (2-75) to 0 and the LPP increased from a preoperative mean of 38.5 cm H2O (25-60) to 80.5 cm H2O (68-106). 36.8% (7/19) of the patients showed significant improvement of their incontinence. In this group the pad test improved from a preoperative mean of 39.1 g (8-112) to 9.7 g (2-29) and LPP from a mean of 37.1 cm H2O (25-50) to 42.0 cm H2O (30-58). In 4 patients (21.05%) the technique failed. Seven of the 8 cured patients had type III incontinence; the eighth patient had type I incontinence. It failed in all patients with type II incontinence. CONCLUSION: The implantation of microballoons is a safe, well-tolerated and clinically effective modality for the treatment of type III SUI, i.e. intrinsic sphincter deficiency.

Adult↗
PubMed2004

A randomised trial comparing open Burch colposuspension using sutures with laparoscopic colposuspension using mesh and staples in women with stress urinary incontinence.

OBJECTIVE: To compare open Burch colposuspension using sutures with laparoscopic colposuspension using mesh and staples in women with stress urinary incontinence. DESIGN: Multicentre, prospective randomised trial. SETTING: Departments of Obstetrics and Gynaecology, Sahlgrenska University Hospital, Göteborg, Borås County Hospital and Orebro University Hospital, Sweden. POPULATION: Women with genuine stress urinary incontinence or mixed incontinence with a predominantly stress component were included, and were randomised to either open colposuspension (n= 120) or laparoscopic colposuspension (n= 120). METHODS: Women were randomised to open colposuspension with sutures or laparoscopic colposuspension with polypropylene mesh and staples. Anaesthesia/operation time, blood loss, complications and other related surgical parameters were compared. MAIN OUTCOME MEASURES: Objective and subjective cure rates from 48-hour frequency-volume chart, a 48-hour pad test and a subjective assessment of the woman's incontinence and quality of life performed one year after surgery. RESULTS: Objective and subjective cure rates were higher after open compared with laparoscopic colposuspension (P < 0.001). Quality of life was improved following surgery in both groups (P < 0.0001) and the improvement was significantly greater in the open colposuspension group (P < 0.05) with regard to physical activity. Performing an open colposuspension was less time consuming (P < 0.0001), resulted in more blood loss (P < 0.0001), longer catheterisation time (P < 0.01), greater risk of urinary retention (P < 0.01) and a longer hospital stay (P < 0.0001) compared with performing a laparoscopic colposuspension. The rate of serious complications was low in both groups. CONCLUSION: Open colposuspension had a higher objective and subjective cure rate one year after surgery but with a greater blood loss, greater risk of urinary retention and a longer hospital stay than laparoscopic colposuspension.

Adult↗
PubMed2002

Long-term results of the FemSoft urethral insert for the management of female stress urinary incontinence.

A 5-year ongoing, controlled multicenter study enrolled 150 women. Outcome measures included pad weight tests (PWT), voiding diary (VD), quality of life (QOL) and satisfaction questionnaires. Outcome measures during the baseline period were compared to evaluations during follow-up. Concurrent evaluations with and without device use were also performed. Safety evaluations included urinalysis and culture, leak-point pressure (LPP) and cystoscopy. Adverse events (AE) were recorded throughout the study. One to 2 years of follow-up were collected on all study participants (mean 15 months). Statistically significant reductions in overall daily incontinence episodes (P<0.001) and PWT urine loss (P<0.001) were observed with the device at all follow-up intervals, and 93% of women had a negative PWT at 12 months. Women were satisfied with ease of use of the device, comfort and dryness, and significant improvements in QOL were observed (P<0.001). Subgroup analysis revealed that the insert was effective, despite the presence of urgency, low LPP, failed surgery and advanced age. AE included symptomatic urinary tract infection in 31.3%, mild trauma with insertion in 6.7%, hematuria in 3.3%, and migration in 1.3% of women. The results of PWT and VD demonstrated device efficacy. Women were satisfied and significant improvements in QOL were observed. AE were transient and required minimal or no treatment. The urethral insert should be considered as an option for the management of SUI.

Equipment Design↗
PubMed2004

Safety and outcome of early catheter removal after radical retropubic prostatectomy.

OBJECTIVES: To assess the outcomes of patients who underwent radical retropubic prostatectomy (RRP) and had their indwelling urinary catheter removed on postoperative day 4 or later. METHODS: The medical records of 342 consecutive patients undergoing RRP by a single surgeon were retrospectively reviewed. None of these patients had received radiotherapy, transurethral resection, or simple prostatectomy before RRP. The 342 patients were categorized into two groups according to the length of catheterization. Group 1 (n = 127) had the urethral catheter removed on postoperative day 4, and group 2 (n = 215) had the catheter removed later than postoperative day 4. Removal of the urinary catheter was only done if control cystography failed to demonstrate anastomotic extravasation. In the case of acute urinary retention, home care nurses and emergency room personnel reinserted the urinary catheter without cystoscopic assistance. Incontinence was rated according to the number of protective pads used in a 24-hour period as follow: none, mild (1 pad/day), moderate (more than 1 but 3 or fewer pads/day), and severe (more than 3 pads/day). RESULTS: The mean age of the study population was 61.5 +/- 6.1 years. Acute urinary retention after catheter removal occurred in 11 patients (3%), 4 from group 1 and 7 from group 2. None of the patients requiring catheter reinsertion presented with complications related to this event. The overall continence rate was 58%, 85%, and 92% at 3, 9, and 12 months, respectively. The continence rates at 3, 9, and 12 months were higher for group 1 than for group 2 (P = 0.0002, P = 0.011, and P = 0.044, respectively). Bladder neck contracture was encountered in 14 patients (4%), 2 (2%) from group 1 and 12 (6%) from group 2. The only factor predicting continence was the duration of bladder catheterization. CONCLUSIONS: Bladder catheters can be safely removed on postoperative day 4 in patients with normal cystograms after RRP. The continence and anastomotic stricture rates were improved in patients with 4 days of indwelling catheterization.

Aged↗
PubMed2004

Comparison between porcine dermal implant (Permacol) and silicone injection (Macroplastique) for urodynamic stress incontinence.

The objective of this study was to compare the efficacy of porcine dermal implant injection (Permacol) and silicone injection (Macroplastique) in the treatment of female urodynamic stress incontinence (USI) in a prospective randomized trial. Fifty women with urodynamically proven stress incontinence were recruited and randomised to receive either Permacol or Macroplastique injection. Twenty-five patients were enrolled in each case. An International Continence Society (ICS) standard 1-h pad test was carried out prior to the injection and a subjective analysis of incontinence made using a Stamey scoring system. In addition, a Kings College Hospital Quality of Health Questionnaire (KCQ) was completed. The women were followed up at 6 weeks and 6 months and the same methods used to gauge the success or failure of the operation. Preoperatively there were no significant differences in pad losses, Stamey score or King's score between the two groups. The mean age of the women was 61 years (range 28-80 years). At 6 weeks there were significant reductions in the mean and median values in pad losses, Stamey score and King's score in both Permacol and Macroplastique patients but the effects were more pronounced in Permacol patients than Macroplastique patients. Of the Permacol patients, 64% were improved on quantified pad losses out of which 60% were dry whereas 54% of Macroplastique patients were improved on pad losses of which 41.6% were dry. Of the Permacol patients, 64% and 60% had reduction in Stamey and KCQ score, respectively, whereas Macroplastique patients had 46% reduction in one or more grades of Stamey scores and 42% reduction in KCQ scores. At 6 months the results in the Permacol patients appeared to be sustained but not for Macroplastique patients. This study has shown that Permacol injection when used as a urethral bulking agent appears to have a higher cure rate for urodynamic stress incontinence than Macroplastique and these results persist until the follow-up period of 6 months. The use of Permacol injection is an attractive alternative in the treatment of urodynamic stress incontinence.

Adult↗
PubMed1996

A study of female urinary incontinence in general practice. Demography, medical history, and clinical findings.

The aim of this study was to provide valid data on the demography, medical history and clinical findings among adult women presenting with urinary incontinence to general practitioners. In a rural community in Norway, all women > 20 years who consulted their general practitioner for urinary incontinence during a 3 year period were included in a prospective study. A thorough medical history and both a general and focused clinical examination were undertaken. Gynecological examination, stress provocation test, and 48 h frequency/volume chart and pad weighing test were also performed. 105 women were included (4.4% of women > 20 years in the total population). Mean age was 57 years, 64% were postmenopausal. A lot of comorbidity was reported. Duration of incontinence was > 5 years in 49%. By a severity index, 64% were classified as severe, 28% as moderate and 8% as having slight incontinence. 59% were using protective pads or garments. Mean leakage per 24 h was 31 g. 38% had significant genital prolapse. Contractility of the pelvic floor muscles was weak in 28%. Diagnostic classification revealed 50% stress incontinence, 10% urge and 40% mixed incontinence. 42% of the patients were a great deal or much bothered by their incontinence. Patients with stress incontinence were less bothered than others. Women presenting with urinary incontinence at a primary care level are prevalent, and often have significant incontinence. It is a challenge for the general practitioners to investigate and treat these patients optimally.

Adult↗
PubMed1991

Incontinence in the elderly: objective demonstration and quantitative assessment.

Subjective and objective methods of demonstrating incontinence and assessing its severity have been compared in a group of elderly patients with a high incidence of severe urge incontinence. It was found that 24-h in-patient monitoring of urine leakage was the most sensitive method of demonstrating incontinence, with videourodynamic testing almost as good. In comparison, a 1-h pad test was poor. Visual inspection during physical examination seldom demonstrated leakage. For quantitative assessment of severity, 24-h monitoring gave the most reproducible results; it was also able to reveal significant changes in severity in response to pharmaceutical treatment. A 1-h pad test was less reproducible and suggested changes that were only poorly consistent with 24-h monitoring. The subjective responses of the patients were not useful in assessing changes in the severity of incontinence. Twenty-four hour monitoring thus stands out as a superior method of demonstrating and assessing incontinence.

Aged↗
PubMed1994

One month maximal electrostimulation for genuine stress incontinence in women.

While awaiting surgery for genuine urinary stress incontinence, 51 women with were treated at home for 1 month with vaginal maximal electrostimulation. They were evaluated subjectively, urodynamically, and with two different pad tests. Six patients (12%) were cured and 17 (33%) were much improved, subjectively and objectively. Statistically significant improvement was observed for both pad tests. Successful treatment was significantly more likely in women with milder degrees of incontinence but was unrelated to age or urethral pressure. Patient acceptance was excellent and apart from some vaginal soreness no complications were seen. Sixteen patients (31%) elected not to be operated on. These 16 patients were reevaluated after 1 year and 13 (81%) had maintained their improvement. Three had disimproved but were still better than before treatment; 2 again refused surgery and 1 opted for surgery. Therefore, 15 of 51 (29%) operations were saved after 1 year. This conservative treatment for stress incontinence is safe, simple, inexpensive, and reasonably successful.

Adult↗
PubMed2006

Correlation between quality of life and voiding variables in patients treated with percutaneous tibial nerve stimulation.

OBJECTIVE: To investigate the relationship between quality of life (QoL) and voiding variables in patients with lower urinary tract dysfunction treated with percutaneous tibial nerve stimulation (PTNS), as it is assumed that improvements in voiding will lead to a better QoL in such patients. PATIENTS AND METHODS: The study included 30 patients with urge urinary incontinence who were treated with PTNS; 24-h bladder diaries and QoL questionnaires (Short Form, SF-36, and incontinence-specific QoL) were completed at baseline and after PTNS. RESULTS: There was a significant correlation (P < 0.05) between the number of pads used and the SF-36 domains of physical and vitality, between the number of incontinence episodes and the SF-36 domains of physical and role physical, between nocturia and the SF-36 domains of general and mental health, between the mean voided volume and the SF-36 domains of role physical and final, and between the mean voided volume and the incontinence-specific QoL score. CONCLUSIONS: PTNS is useful for treating refractory urge incontinence and should at least be considered as a therapeutic alternative before resorting to aggressive surgery, as voiding and QoL variables significantly and quantifiably correlate in patients with refractory urge urinary incontinence who are treated with PTNS. Patients must have a reduction of >or = two pads/day before their QoL improves, and this might be the best definition of successful therapy for patients with urge urinary incontinence.

Adult↗
PubMed2003

Removal of urinary catheter on postoperative day 3 or 4 after radical retropubic prostatectomy.

OBJECTIVES: To determine the feasibility and safety of removing the urinary catheter on postoperative day (POD) 3 or 4 after radical retropubic prostatectomy (RRP). METHODS: Between January 2001 and August 2001, gravity cystography was performed on POD 3 or 4 after RRP by a single surgeon (H.L.) on 151 men. The urinary catheter was removed on POD 3 or 4 providing no extravasation was evident on cystography. Urinary catheters were replaced over a guidewire placed into the bladder under flexible cystoscopic guidance in cases of acute urinary retention (AUR). Continence was assessed at 3 months after RRP. RESULTS: Of the 151 cystograms performed on POD 3 or 4, 116 (76.8%) revealed no evidence of extravasation. The indwelling catheters were removed in 114 of these cases (98.3%). Twenty-two (19.3%) of the 114 men whose catheters were removed on POD 3 or 4 developed AUR within 48 hours of catheter removal, requiring catheter replacement. Two of these patients required repeated surgery secondary to complications related to AUR. At 3 months after RRP, 75% of the men whose catheters were removed on POD 3 or 4 required no pads or a single pad during a 24-hour interval, and 77.6% reported none or slight bother from incontinence. Of the 37 men whose catheters were removed on POD 7 or later, 1 patient (2.7%) developed AUR, and the catheter was replaced without complications. At 3 months after RRP, 65.7% of men whose catheters were removed on POD 7 or later required no pads or a single pad during a 24-hour interval, and 71.4% reported none or slight bother from incontinence. The incidence of anastomotic stricture in men whose catheters were removed on POD 3 or 4 and POD 7 or later was 12.1% and 22.6%, respectively. CONCLUSIONS: Most men will have a watertight anastomosis on POD 3 or 4 after RRP. Early catheter removal does not have a negative impact on continence or the rate of anastomotic strictures. Because of the high incidence of AUR, requiring replacement of the urinary catheter, and the potential for disruption of the anastomosis or bladder neck reconstruction, we currently recommend delaying catheter removal until POD 7 or later.

Anastomosis, Surgical↗
PubMed2006

Bulbourethral composite suspension for treatment of male-acquired urinary incontinence.

OBJECTIVES: We evaluated the efficacy of bulbourethral composite sling procedure in the treatment of male urinary incontinence after radical prostatectomy, transurethral resection of the prostate, or prostatic enucleation for benign prostatic hyperplasia, and posterior urethroplasty. METHODS: Between May 2000 and April 2005, a bulbourethral composite sling was performed in 26 patients with acquired urinary incontinence. Eight (30.8%) of these patients had severe urinary incontinence, and 18 (69.2%) had mild to moderate urinary incontinence. A polyester patch plus tension-free vaginal tape (TVT) device was used in the procedure. Prolene threads were attached to the two ends of polyester taper then passed from the perineal incision to a suprapubic incision with a TVT needle. The ends of the sutures and TVT were tied over the rectus fascia in the midline after repeated urethral pressure measurements reached 80-90 cm H2O. RESULTS: The follow-up period was 8-54 mo (mean: 28.3). The primary procedure failed in one patient. Of the remaining 25 patients, 1 patient died of cerebral hemorrhage 2 yr postoperatively, and 2 patients had recurrent stress incontinence in 1.5 and 2 yr postsurgery, respectively. The recurrent incontinence was severe in one patient and mild (one to two pads per day) in the other. The remaining 22 patients maintained urination and continence. The total success rate (cure and improved) was 92% (23 of 25). CONCLUSIONS: Bulbourethral composite sling procedure is a minimally invasive, safe, effective surgical option in the treatment of male patients with mild to moderate incontinence, but is not suitable for severe incontinence. Temporary perineal discomfort or pain is a common complication of the procedure.

Adolescent↗