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PubMed2004

The clinical and urodynamic effects of the tension free bladder neck sling procedure.

This study evaluated the clinical and urodynamic findings before and after tension-free bladder neck sling (TBS) procedure with Prolene tape. We enrolled 32 women who underwent TBS for genuine stress incontinence without intrinsic sphincter deficiency or severe uterovaginal prolapse. All subjects received 1-h pad test, Q-tip test, multichannel urodynamic testing, introital ultrasonography, and the Bristol Female Lower Urinary Tract Symptoms Questionnaires before and 1 year after surgery. Of the 32 subjects 27 were cured of stress incontinence, two improved, and three failed. The incidence of irritative symptoms and incomplete bladder emptying were significantly lower after surgery. The mean urethral straining angle showed a significant decrease from 73.8 degrees preoperatively to 30.1 degrees postoperatively. At rest the postsurgical position of the bladder neck (BN) was localized more cranially. During straining both ventral and caudal mobility of the BN decreased significantly following TBS, causing a more cranial and dorsal position of the BN. Urodynamic parameters including functional urethral length, maximal urethral closure pressure, and pressure transmission ratio showed significant increases after surgery. TBS could decrease the hypermobility of the BN and restore the BN support to prevent urinary leakage during straining, instead of urethral obstruction. The subjective and objective cure rate of stress incontinence is 84%, similar to those results reported after retropubic urethropexy and tension-free vaginal tape procedure. It is also worth emphasizing that no postoperative urinary retention occurred, although the limited number of cases makes it hard to confirm the significance of findings over the retention rate of tension-free vaginal tape.

Adult↗
PubMed1988

Functional reconstruction of exstrophied bladder. Timing and technique. Follow-up of 39 cases.

Thirty-nine cases of functional reconstruction of exstrophied bladder are reviewed. There were 20 females and 19 males. In a first group of 31 staging was planned and carried out in 26 while 3 are awaiting a second stage. In a second group of 8 a single operation was performed. Out of the 31 early cases there were 2 deaths and 10 failures, 16 show good or very good functional result. All 16 show moderate renal scarring from reflux pyelonephritis which occurred between I and II stage. Single operation consisted of innominate osteotomy, bladder and bladder neck and urethral reconstruction and anti-reflux procedure (osteotomy was omitted in a 3 days old baby). Three, operated upon when aged 8 mths., 1 year and 4 years, were breakdowns of previous closure. They are incontinent and will need further surgery at the bladder outlet. Four are dry in the morning and suffer from occasional stress incontinence and enuresis. One, now aged 4 years, still wears pads. These last 5 are awaiting final assessment of and eventually further surgery to improve continence. In all 8 cases pyelo-calyceal cavities are normal except for a moderate right dilatation in one because of kinking of the reimplanted ureter. Delay in bladder closure (mean age 5 mths.) and severe changes to the bladder wall and possibly staging seems to be responsible for most of the failures and for renal damage occurring, after closure, in bladders showing moderate compliance. Single operation allows full protection of upper tract and kidney and should be preferred in patients aged over 2 months. Better functional results may be obtained if operation is performed soon after birth.

Adolescent↗
PubMed2004

Treatment of primary bladder neck obstruction in women with transurethral resection of the bladder neck.

PURPOSE: We describe the presentation, clinical characteristics, treatment and followup of a series of women with primary bladder neck obstruction (PBNO). MATERIALS AND METHODS: A patient data base was searched for women who underwent transurethral resection for bladder outlet obstruction diagnosed by videourodynamic study (VUDS) according to the Blaivas-Groutz nomogram for female bladder outlet obstruction between 1993 and 2002. A total of 37 women with obstruction were identified. Patients with neurogenic, traumatic, anatomical or iatrogenic causes of obstruction were excluded. Seven patients remained who had been diagnosed with PBNO, of whom all underwent transurethral bladder neck resection. Office records were reviewed for history, presentation, surgical treatment and clinical outcome. RESULTS: Seven patients were diagnosed with PBNO. Age was 39 to 81 years. Six of 7 patients presented with symptoms of obstruction, including a weak or intermittent stream and urinary hesitancy. These 6 patients had unremarkable physical examination findings with normal perianal sensation, anal sphincter tone and lower extremity reflexes. One patient presented with abdominal swelling, which on physical examination was found to be a markedly distended bladder containing more than 1000 cc urine. All patients had overt urethral obstruction on VUDS. In 6 of 7 patients obstruction was clearly at the vesical neck and in 1 the obstruction site was equivocal. Three patients were treated or had previously been treated pharmacologically with alpha-blockers. All patients were subsequently treated with intermittent self-catheterization. All patients then underwent transurethral bladder neck resection at the vesical neck and proximal urethra. Surgical specimens weighed 1 to 5 gm and showed urethral fragments or fibromuscular tissue without specific pathological findings. Followup was 1 to 10 years (median 3) and it included physical examination, uroflowmetry, post-void residual urine measurement and videourodynamic study. Six patients considered themselves cured of lower urinary tract symptoms and 1 was improved. In 1 patient the obstruction site was not clear. One patient had mild stress incontinence under rare circumstances not severe enough to require protective pads. The average change in flow was 6 +/- 10 vs 30 +/- 17 ml per second (p <0.03). The average change in voided volume was 194 +/- 170 vs 416 +/- 206 ml per second (p <0.06). Average change in post-void residual urine was 680 +/- 445 vs 173 +/- 366 ml (p <0.05). CONCLUSIONS: PBNO is an exceedingly rare condition, which is easily treatable when properly diagnosed by VUDS. The presentation of patients in urinary retention in middle age suggests that PBNO may be more common in less apparent forms than has previously been recognized.

Adult↗
PubMed2000

Artificial urinary sphincter for post-prostatectomy incontinence: impact of prior collagen injection on cost and clinical outcome.

PURPOSE: We retrospectively reviewed our experience with the artificial urinary sphincter in men with post-prostatectomy incontinence to determine the impact of prior collagen injection therapy on surgical outcome and overall cost of treatment. MATERIALS AND METHODS: The records and preoperative urodynamic studies of 30 men with post-prostatectomy incontinence who underwent artificial urinary sphincter placement were reviewed. Of these patients 23 (76.6%) had undergone prior collagen injection (collagen group) and 7 had not (noncollagen group). Preoperative and postoperative severity of incontinence was assessed with the American Urological Association quality of life index (scale 0 to 6) and number of pads used daily. Using a Valsalva leak point pressure of less than 60 cm. water as a predictor of failure with collagen injection, we calculated the potential savings had these patients foregone collagen injection and chosen artificial urinary sphincter primarily. RESULTS: Of the 30 patients 24 (80%) were incontinent following radical retropubic prostatectomy and 6 (20%) after transurethral resection. Intrinsic sphincter deficiency was the sole etiology of incontinence in most patients (83.3%) and 5 (16.7%) had concomitant detrusor instability. Six patients alternated the use of pads with the use of clamps or a condom catheter to aid in controlling leakage. Mean number of collagen treatment sessions for the injection group was 2.9 (range 1 to 7). There was a significant difference in mean time from prostatectomy to artificial urinary sphincter between the noncollagen (25.3 months) and collagen (35.8 months) groups (p = 0.04). There were no other statistically significant differences between the groups, including mean age (66.2 years, range 45 to 83), mean followup (26.2 months), mean preoperative pads daily (5.8+/-3.4), median preoperative quality of life index (6, range 3 to 6), median preoperative American Urological Association symptom score (13, range 3 to 35) and mean preoperative Valsalva leak point pressure (42.7+/-21.4 cm. water). For all patients in the study the mean postoperative pads daily was 0.8, mean quality of life index 1 and surgical complication rate 13.3%. There were no statistically significant differences between the collagen and noncollagen groups in any of these parameters. Among the collagen group 17 patients (73.9%) had a Valsalva leak point pressure less than 60 cm. water. Considering the mean additional period of incontinence (time between prostatectomy and artificial urinary sphincter) to be 12.9 months and the additional treatment costs (including pads daily and mean number of collagen syringes per patient), the direct costs of treatment for the collagen group were 85.6% higher than those for patients who chose artificial urinary sphincter primarily. CONCLUSIONS: Prior collagen therapy did not adversely influence the surgical complication rate or compromise effectiveness of the artificial urinary sphincter. However, patients with Valsalva leak point pressure less than 60 cm. water have lower rates of success with collagen injection therapy and could benefit from a more successful, timely and cost-effective treatment of incontinence by choosing the artificial urinary sphincter as primary therapy.

Aged↗
PubMed2006

Health care discussions and treatment for urinary incontinence in U.S. women.

OBJECTIVE: The objective of the study was to determine the proportions of women with urinary incontinence who had discussed their condition with a health care provider or received treatment and to identify factors associated with seeking health care. STUDY DESIGN: The study was a population-based, age-stratified postal survey of 6000 women aged 30 to 90 years enrolled in a large health maintenance organization in Washington state. RESULTS: The response rate was 64% (n = 3536) after applying exclusion criteria. Eighty percent (n = 1160) of women with urinary incontinence completed a detailed set of questions on care seeking and treatments. Fifty percent had discussed their incontinence with a health care provider, 21% reported receiving surgery or prescription medication, 10% reported performing Kegel exercises, and 48% reported wearing a pad to absorb urine daily or weekly. The following factors were significantly associated with odds of discussing urinary incontinence with a health care provider: age (50 to 69 years, adjusted odds ratio 1.5 [1.1 to 2.0]; 70 to 89 years, adjusted odds ratio 1.9 [1.4, 2.7]); duration of urinary incontinence (2 to 5 years, adjusted odds ratio 1.9 [1.3 to 2.8]; more than 5 years, adjusted odds ratio 2.8 [2.0,4.1]); severe urinary incontinence (adjusted odds ratio 1.7 [1.2 to 2.6]); and greater effect on daily activities (adjusted odds ratio 2.7 [1.9,3.8]). CONCLUSION: Among women with urinary incontinence, one half have discussed their incontinence with a health care provider and one third have received any form of treatment.

Adult↗
PubMed2004

Post-void residual urine volume in women with overactive bladder symptoms.

PURPOSE: Most patients with overactive bladder symptoms initially present to their primary care provider for treatment. It is currently recommended that post-void residual urine (PVR) should be measured during the assessment of women complaining of overactive bladder symptoms and anticholinergic medication should be used if PVR is low. However, many primary care providers are reluctant to measure PVR and, therefore, they may delay treatment or even inappropriately treat patients who have a high PVR. We identified clinical factors that are associated with increased PVR that could be used to select which patients are at risk for this. MATERIALS AND METHODS: The charts of women presenting to our clinic with complaints of urinary frequency, urgency and/or urge incontinence were retrospectively reviewed. Patient demographics, physical examination and PVR were analyzed to determine if any factor was associated with increased PVR (100 ml or greater). RESULTS: The charts of 201 patients with complete data were reviewed. Patient age was 20 to 90 years (mean 55). Overall 19% of patients were found to have elevated PVR. Univariate analysis identified that older age, prior incontinence surgery, history of multiple sclerosis, greater American Urological Association Symptom Score, vaginal parity greater than 2, greater pad use and stage 2 or greater vaginal prolapse were associated with elevated PVR. Multivariate analysis identified age older than 55 years, prior incontinence surgery, a history of multiple sclerosis and vaginal prolapse stage 2 or greater as independent predictors of elevated PVR. CONCLUSIONS: It is possible to identify patients with overactive bladder symptoms who are at risk for elevated PVR based on history and physical examination. This could result in fewer patients needing PVR measurement prior to initiating treatment.

Adult↗
PubMed1998

Cough-induced leak-point pressure--a valid measure for assessing treatment in women with stress incontinence.

BACKGROUND: Presently available urodynamic methods are of little use for assessing the severity of urinary stress incontinence or for evaluating of treatment, Cough-induced leak-point pressure may prove to be a more useful urodynamic method in these respects. A vaginal anti-incontinence device was used to validate this new urodynamic method. AIM: The primary aim was to determine the extent to which cough-induced leak-point pressure was affected by the vaginal device. Secondary aims were to study the short-term effects of the vaginal device on leakage and urinary flow, and to relate the change in cough-induced leak-point pressure to the change in leakage as expressed by a short-term pad test. METHODS: In a prospective study of 22 women with a history of stress incontinence, the effect of a new vaginal anti-incontinence device (Conveen Continence Guard) on cough-induced leak-point pressure, a short-term pad test and urinary flow was studied. RESULTS: Cough-induced leak-point pressure increased from 99.9 to 138.9 cm H2O, while leakage, measured by a short-term pad test, decreased from 22.7 to 3.3 g when using the device. Urinary flow was not significantly reduced by the device. CONCLUSIONS: Cough-induced leak-point pressure is a valid, quantitative, dynamic measure of urethral closure function which can be used to study the effects of treatment in patients with stress incontinence. The vaginal device is effective for treatment of stress incontinence in the short-term, without reducing urinary flow.

Adult↗
PubMed1998

A conservative approach for a patient with traumatically induced urinary incontinence.

OBJECTIVE: To consider a conservative management plan for a patient suffering from diurnal enuresis. CLINICAL FEATURES: A 12-yr-old girl complained of left flank pain and involuntary urine loss that apparently began a short time after she fell backwards and landed on her coccyx. She had to wear a sanitary pad prophylactically throughout each day for more than a year because of unpredictable urinary incontinence. INTERVENTION: Manual adjusting procedures and soft tissue therapy were applied initially. Procedures were modified later to include an intrarectal technique. The quantity of urine loss decreased slowly with the initial treatment approach but never resolved completely. The flank pain also decreased somewhat but never ceased altogether. After the introduction of the intrarectal technique, additional progress was reported and both the flank pain and urinary incontinence resolved completely. A 4-yr follow-up confirmed complete resolution. CONCLUSION: Conservative care helped an adolescent girl suffering from traumatically induced urinary incontinence.

Accidental Falls↗
PubMed2004

The male sling for stress urinary incontinence: 24-month followup with questionnaire based assessment.

PURPOSE: Stress urinary incontinence after prostate surgery can be a bothersome problem, adversely affecting quality of life. We performed a prospective study of the male perineal sling for the treatment of stress urinary incontinence with a minimum 1-year followup. MATERIALS AND METHODS: A total of 36 patients (average age 67 years old) underwent male sling surgery. Patients underwent preoperative and postoperative evaluation for bother due to urinary incontinence using the UCLA Prostate Cancer Index urinary function section as well as pad score. RESULTS: Median followup was 25 months (range 12 to 42). After surgery 24 (67%) patients were pad-free, 5 (14%) used 1 pad, 4 (11%) used 2 pads and 3 (8%) continued to use 3 or more pads daily. Overall, mean pad use +/- SD decreased from 4.6 +/- 2.5 to 0.64 +/- 1.0 pads daily (p <0.001). A total of 30 (83%) patients reported a small to no bother from urine leakage after surgery, 3 (8%) considered leakage a moderate problem, while 3 (8%) continued to consider it a big problem. The median UCLA Prostate Cancer Index urinary function score was improved from 33 before surgery to 330 after surgery (p <0.001). There were no instances of erosion, infection or prolonged retention. CONCLUSIONS: Medium term results for the male sling demonstrate a success rate comparable to that of the artificial urinary sphincter (67% pad-free rate and 92% improvement). This technique has established a low morbidity and has not been associated with any significant complications. Longer followup will ultimately establish whether this technique represents a viable long-term alternative to artificial urinary sphincter for the treatment of bothersome stress urinary incontinence in men.

Adult↗
PubMed1998

The Stamey procedure for stress incontinence: long-term results.

OBJECTIVE: To assess the long-term results of the Stamey vesicourethral suspension for stress urinary incontinence. METHODS: A total of 72 case records of women who underwent the Stamey procedure in the years 1985-1991 was reviewed. Every patient had a full preoperative evaluation including filling cystometry, urethral pressure profilometry and imaging of the kidneys and bladder. The long-term subjective results were determined by a telephone interview with the patients, utilizing a standard questionnaire. A successful result was defined as no need for pads under any circumstances. Every patient who reported on persistent or recurrent incontinence was requested to return for reevaluation in the urology clinic. RESULTS: The long-term success rate of the Stamey procedure in 63 evaluable patients was 69.8% (mean follow-up: 90 months). In 19 women, the operation had failed. About 80% of the failures were evident within 2 years after surgery. The long-term success rate of surgery in 28 women with pure stress incontinence was 93%. When mild irritative symptoms were present before surgery (29 patients) the subjective success rate was 65.5%, and in 6 patients with severe urge symptoms the success rate was only 33%. The difference between these groups was highly significant (p = 0.003). No correlation was found between the age of the patient at surgery, the number of children delivered by the patient, the grade of stress incontinence, the duration of symptoms before surgery or a history of a previous operation for stress incontinence and the success rate of the operation. CONCLUSIONS: The Stamey vesicourethral suspension is characterized by a relatively high and long-standing success rate. This procedure has an important place in the treatment of women with urinary stress incontinence.

Adult↗
PubMed1994

The effects of changing prompted voiding schedules in the treatment of incontinence in nursing home residents.

OBJECTIVE: To determine the effects of different prompted voiding schedules on urinary incontinence on a continence unit (CU) and the maintenance of benefits on normal nursing units. DESIGN: Multiphase study with both intra- and inter-subject comparisons. PARTICIPANTS: Subjects were 41 consenting incontinent nursing home residents. Based on clinical criteria, subjects were assigned to one of four treatment groups that varied as to the schedule of prompted voiding received. MEASUREMENT: The study used chart review, Katz ADL, and MMSE. Urologic status, self-initiated toileting, urine volumes voided, and incontinence assessed by pad/pants checks were measured by research nurses. Baseline pad check data were collected on residents' normal nursing units. Residents were transferred to the CU where baseline measurement was repeated, and the effects of different prompted voiding schedules were then assessed. Indigenous staff were trained to use prompted voiding, and nurse supervisors were instructed in special procedures for enhancing maintenance of the intervention. Residents were returned to their normal units and the maintenance of improvements in continence status was assessed at 2 weeks and 3 months post-CU discharge. RESULTS: One of the four groups showed significant improvement on the CU in response to the 2-hour schedule; two groups improved on the less intensive 3-hour schedule (P < 0.05). Two groups maintained this improvement on their normal nursing units (P < 0.05); one group showed a non-significant trend toward improvement. Self-initiated toileting decreased (P < 0.05) and volume voids in an appropriate receptacle increased (P < 0.05) during training. CONCLUSIONS: Prompted voiding is an effective treatment for urinary incontinence, and a less intensive 3-hour schedule may be superior to the standard 2-hour schedule for some residents. These improvements in dryness can be maintained by normal nursing home staff if formal staff management procedures are utilized by nurse supervisors.

Aged↗
PubMed2002

Prevalence of stress incontinence in nulliparous elite trampolinists.

During trampoline jumping the pelvic floor is exposed to high forces. There has been a general belief that physically fit women have a strong pelvic floor as a result of their regular training, thus preventing urinary incontinence. The aim of this study was to survey the prevalence of stress urinary incontinence in female elite trampolinists. The prevalence of urinary incontinence was assessed by a questionnaire, sent to all 35 elite trampolinists (mean age 15, range 12-22 years) in Sweden. Eighty percent of the trampolinists reported involuntary urinary leakage, but only during trampoline training. The leakage started after 2.5 (range 1-4) years of training. Age (P < 0.001), duration of training (P = 0.04), and training frequency (P = 0.01) were significantly associated with leakage. All women above 15 years of age (n = 23) reported urinary leakage (P < 0.001). Eighteen incontinent women continued the study and their leakage was verified by a pad test. The leakage averaged 28 g during a jump session. The muscle strength was measured with perineometry in 10 women and showed good strength in the pelvic floor muscles.

Adolescent↗
PubMed1996

Reproducibility of a new method to determine cough-induced leak-point pressure in women with stress urinary incontinence.

The aim of the study was to test the reproducibility of a new method of determining cough-induced leak-point pressure (CILPP). A cough-induced increased in intra-abdominal pressure was recorded vaginally in 26 women with stress incontinence and urinary leakage was detected electronically. CILPP determinations and short-term pad tests were carried out on two different occasions. Reproducibility is expressed by a coefficient of repeatability as limits of agreement. These indicate that, for 95% of the cases, a repeat measurement of CILPP will be between 0.72 and 1.28 times the first measurement. The coefficient of variation was 11.2%. There was a moderate inverse correlation between pad-test data and CILPP. It was concluded that the new method allows for an accurate determination of CILPP, which represents a quantitative and dynamic assessment of urethral function. The reproducibility of the method appears to be better than that of pad tests and standard urodynamic parameters. The correlation with pad-test data gives support to the validity of the method.

Adult↗
PubMed2000

Cadaveric versus autologous fascia lata for the pubovaginal sling: surgical outcome and patient satisfaction.

PURPOSE: We report our initial experience with cadaveric fascia lata in pubovaginal sling procedures. MATERIALS AND METHODS: We compared 121 consecutive women who underwent a sling procedure using cadaveric fascia lata from February 1997 through June 1999 (group 1) with 46 consecutive women who underwent a sling procedure using autologous fascia lata from May 1994 through July 1997 (group 2). RESULTS: Mean followup was longer in group 2 (44 versus 12 months). A total of 104 of the 121 group 1 patients (86%) responded to the questionnaire, of whom 85% were cured of stress incontinence, 83% reported overall improvement in urinary control and 74% had no or minimal leakage not requiring pads. Median catheterization time was 9 days (range 4 to 120). Overall 89% of the women were satisfied with the results and 83% would recommend this surgery. A total of 30 of the 46 group 2 patients (65%) responded to the questionnaire, of whom 90% were cured of stress incontinence, 90% reported overall improvement in urinary control and 73% had no or minimal leakage not requiring pads. Median catheterization time was 14 days (range 6 to 180). Overall 90% of the women were satisfied with the results and 83% would recommend this surgery. CONCLUSIONS: Cadaveric fascia lata pubovaginal slings appear to be safe. Early experience suggests that cadaveric fascia lata may be considered an alternative to autologous fascia. Cadaveric and autologous fascia lata appear to have a high success rate.

Cadaver↗
PubMed2003

Correlation among maximal urethral closure pressure, retrograde leak point pressure, and abdominal leak point pressure in men with postprostatectomy stress incontinence.

OBJECTIVES: To assess the correlation among abdominal leak point pressure (ALPP), maximal urethral closure pressure (MUCP), and retrograde leak point pressure (RLPP) in the evaluation of men with stress urinary incontinence (SUI) after radical prostatectomy. METHODS: Patients were evaluated with a self-administered questionnaire regarding pad use and with multichannel videourodynamics. The ALPP, MUCP, and RLPP were compared with each other and with the severity of SUI. RESULTS: The mean ALPP was 49.4 +/- 24.4 cm H(2)O. The mean MUCP was 52.0 +/- 21.1 cm H(2)O. The mean RLPP was 48.0 +/- 13.5 cm H(2)O. No statistically significant difference in the mean values of the three parameters was found. Regression analysis revealed a statistically significant correlation among the three parameters: RLPP versus MUCP, r = 0.59, P <0.005; MUCP versus ALPP, r = 0.75, P <0.0001; and RLPP versus ALPP, r = 0.79, P <0.0001. ALPP, MUCP, and RLPP were each significantly related to pad use. CONCLUSIONS: Intrinsic sphincter deficiency is the primary cause of SUI after radical prostatectomy. Therefore, evaluation of intrinsic sphincter function is important in the treatment of postprostatectomy SUI. In incontinent men after radical prostatectomy, with a dysfunctional bladder neck and proximal sphincter unit, the intrinsic function of this distal sphincter may be assessed equally well by evaluating the resistance to antegrade leakage, retrograde leakage, or profilometric measurement of the urethral closure pressure. RLPP and MUCP offer reliable alternatives to ALPP for the evaluation of postprostatectomy SUI.

Adenocarcinoma↗
PubMed2005

Long-term anorectal dysfunction after postoperative radiotherapy for rectal cancer.

PURPOSE: Adjuvant radiotherapy in the treatment of rectal cancer has been shown to increase long-term morbidity causing severe anorectal dysfunction with physiologic changes whose interaction remains poorly understood. This study examines long-term anorectal morbidity from adjuvant postoperative radiotherapy. METHODS: In a prospective study, patients with Dukes B or C rectal carcinoma were randomized to postoperative radiotherapy or no adjuvant treatment after anterior resection. The long-term effect of radiotherapy on anorectal function in a subset of surviving patients was assessed from a questionnaire on subjective symptoms and from physiology laboratory evaluation and flexible sigmoidoscopy. RESULTS: Twelve of 15 patients (80 percent) treated with radiotherapy had increased bowel frequency compared with 3 of the 13 patients (23 percent) who did not have radiation therapy (P = 0.003). The former group had loose or liquid stool more often (60 vs. 23 percent, P = 0.05), had fecal incontinence more often (60 vs. 8 percent, P = 0.004), and wore pad more often (47 vs. 0 percent, P = 0.004). They also experienced fecal urgency and were unable to differentiate stool from gas more often. Endoscopy revealed a pale and atrophied mucosa and telangiectasias in the irradiated patients. Anorectal physiology showed a reduced rectal capacity (146 vs. 215 ml, P = 0.03) and maximum squeeze pressure (59 vs. 93 cm H2O, P = 0.003) in the radiotherapy group. Impedance planimetry demonstrated a reduced rectal distensibility in these patients (P < 0.0001). CONCLUSIONS: Adjuvant postoperative radiotherapy after anterior resection causes severe long-term anorectal dysfunction, which is mainly the result of a weakened, less sensitive anal sphincter and an undistensible rectum with reduced capacity.

Aged↗
PubMed1999

Validation of cough-induced leak point pressure measurement in the evaluation of pharmacological treatment of stress incontinence.

To improve routines in clinical practice and research, it is important that new tests are thoroughly evaluated before they gain widespread application. This includes establishing the reliability and validity of the new test. The purpose of this study was to establish the construct and criterion validity of cough-induced leak point pressure (CILPP) measurement. Data on CILPP, maximum urethral pressure (MUP), and a short-term pad test from a phase-I trial of a new pharmacological agent (LS 4416), developed for the treatment of stress incontinence, was used to test the validity of CILPP. Fifteen post-menopausal women with stress incontinence were studied. Phenylpropanolamine (PPA) was used as a positive control. Administration of PPA produced a statistically significant increase in MUP and CILPP. There was a significantly better effect of treatment, expressed as an increase in MUP at 1.5 hr, when PPA was used than with placebo or LS 4416. When CILPP was used to detect change after therapy, PPA produced a significantly greater increase in CILPP than did placebo (least square mean of difference 17.25, P = 0.0202). There was a moderate but statistically significant correlation between CILPP and the short-term Pad Test. Construct validity was demonstrated by the ability of CILPP to detect limited improvement in patients with stress incontinence. Criterion validity was established by the correlation of CILPP to a short-term Pad Test. We propose that, thanks to its greater methodological qualities, leak point pressure measurement should be adopted as a standard method to ascertain the effect of treatment in patients with stress incontinence. Neurourol. Urodynam. 18:591-602, 1999.

Aged↗
PubMed1991

A health care program for the investigation and treatment of elderly women with urinary incontinence and related urogenital symptoms.

The assessment and treatment of urinary incontinence and related urogenital symptoms using an algorithm model was evaluated in 364 elderly women complaining of urinary incontinence. The women (age 72.1 +/- 1.5 years, range 65-84 years) were assessed by a 48-hour pad test, a cough provocation test, micturition lists and a gynecological examination which included a smear test, measurement of vaginal pH and bacterial cultures. The diagnosis of urinary incontinence was confirmed in 346 women (stress 26.3%; urge: 32.7%; mixed: 41.0%). Women suffering from stress incontinence were younger (p less than 0.05) and had experienced a larger number of deliveries (p less than 0.05) than women with urge incontinence. All the women were treated with oral estriol, 3 mg daily for 4 weeks followed by 1-2 mg daily. The total urinary leakage per 48 hours (p less than 0.01) and maximum single leakage (p less than 0.05) were reduced in women with mixed incontinence, while the frequency of micturition decreased (p less than 0.05) in women with urge incontinence after 12 weeks treatment with oral estriol. There were no significant changes in any of the objective micturition parameters in women with stress incontinence following treatment. Karyopyknotic index and the presence of lactobacilli were increased (p less than 0.001), and vaginal pH decreased (p less than 0.001) following treatment in women with all types of incontinence. More than 70% of all the women treated in this algorithm model judged themselves to be improved, much improved or cured.

Aged↗