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PubMed2000

Coping strategies for women with urinary incontinence.

Incontinence is a common and complex condition affecting women of all ages, social and cultural backgrounds. 'Coping strategies' play an important role for managing incontinence and include changes in lifestyle, protection, aids, and catheters, whether they are indwelling or intermittent. By the time women seek medical advice for urinary incontinence they have usually tried various tactics to either limit the leakage or protect themselves from it. The most common tactics to limit leakage include fluid restriction, regular toileting, exercises and weight reduction. With medical advice, women can change concomitant medication that may be exacerbating the problem. Aids for mobilization can also have a dramatic effect on the ability to cope with urinary problems. Pads used for protection are often unsuitable and some even wear 'home-made' pads in the form of rolled up tissue, commonly to save money. Many different types of pads are available although women are often ignorant as to what is best for them. Catheters should only be used for intractable incontinence and following appropriate investigation. When possible intermittent catheterization should be considered. It is essential that all women are assessed and investigated before any form of containment becomes long-term management.

Adaptation, Psychological↗
PubMed2004

Friction melanosis: a clinical, histologic, and ultrastructural study in Jordanian patients.

BACKGROUND: Friction melanosis (FM) is an acquired pigmentary disorder mainly affecting young people. The primary skin regions affected are located over the osseous prominences, especially the clavicular zone and upper back. Our purpose in this study was to report the clinical spectrum, histologic findings, and ultrastructural features of FM in Jordanian patients. METHODS: Thirteen patients with FM (10 women and three men) were studied. The patients were seen at Princess Basma Teaching Hospital in north Jordan between 1999 and 2001. RESULTS: Eleven patients presented with asymptomatic, diffuse, brownish patches and two presented with mottled patches on the skin over the trunk bones and limbs. All had a history of rubbing their skin repeatedly with scrub pads (loofah) or bathroom towels. Ten of the 13 cases were studied histologically. Skin biopsies from four patients were examined ultrastructurally. Both histologic and electron microscopic examination of the biopsies from our patients showed a marked increase in melanin and melanin incontinence, with a lack of amyloid in the upper dermis. CONCLUSIONS: FM is infrequently seen in north Jordan. We believe that repeated frictional trauma from clothing or scrub pads against the skin overlying the bony protuberances is fundamental in its pathogenesis. Other factors, such as scrub pads made of rough material (loofah), dark skin type, and individual variability, may also play a role in the pathogenesis. We advise patients not to use rough scrub pads during bathing, to avoid rubbing the skin overlying the bony prominences, to avoid rubbing vigorously, and to use a soft cotton pad instead.

Administration, Topical↗
PubMed1995

Concomitant bladder neck closure and Mitrofanoff diversion for the management of intractable urinary incontinence.

In a 7-year period 28 patients 1 to 20 years old have undergone bladder neck closure in conjunction with Mitrofanoff diversion for the management of severe incontinence. Surgery was performed as a salvage procedure in 19 patients and as a primary anti-incontinence procedure in 9. At a mean followup of 29 months 27 of 28 patients (96%) were totally continent, requiring no pads. Bladder neck closure was primarily successful in 24 of 28 patients (86%) and 25 (89%) had stable upper tracts. Five patients had bladder calculi and 5 required stomal revisions. One child had a bladder perforation associated with blunt trauma. Bladder neck closure and Mitrofanoff diversion were done without bladder augmentation in 11 cases and augmentation was performed previously or concurrently in the remainder. Four patients who did not initially undergo augmentation required later augmentation (2 for hydronephrosis and 2 for persistent incontinence). We conclude that bladder neck closure in conjunction with Mitrofanoff diversion is highly efficacious in achieving continence in a highly complex subgroup of patients with intractable urinary leakage. With careful patient selection and diligent followup total continence can be achieved in this most difficult patient population.

Adolescent↗
PubMed1998

Collagen injection for intrinsic sphincteric deficiency in men: a reasonable option in selected patients.

PURPOSE: We evaluate transurethral collagen injection as a minimally invasive option in treating stress urinary incontinence in men and identify the prognostic factors for success or failure. MATERIALS AND METHODS: Transurethral collagen was injected in 35 men with grades III (22) and II (13) incontinence. RESULTS: Of the patients 7 became dry (20%), 11 improved (31.4%) and 17 were considered failures (48.6%). Abdominal leak point pressure increased and the number of pads needed decreased. In the failed group 4 patients had a history of pelvic irradiation, 5 urethral stricture disease and 3 bladder instability before injection. There was 1 case of temporary urinary retention as a complication. CONCLUSIONS: Transurethral collagen injection for male stress urinary incontinence is a reasonable option in select patients.

Aged↗
PubMed1996

Urinary incontinence and sexual impotence after radical prostatectomy.

Telephone interviews concerning urinary continence and sexual potency in 152 men who had undergone radical prostatectomy for localized cancer were conducted by an investigator who had not been involved in the patients' treatment. The obtained data were compared with the surgeons' recorded follow-up notes. Continence was defined according to ICS criteria and potency as the capacity for vaginal penetration. At the interviews, 74 men (49%) reported total continence and 39 others (26%) were acceptably dry; 32 required more than two small protective pads per day, five had received an artificial sphincter implant and two had supravesical urinary diversion (Kock pouch), making 39 (25%) classified as incontinent. The surgeons' records, however, showed an 89% continence rate and 87% of these men had regained continence within 24 weeks of the operation. Of 134 preoperatively potent men, only 21 (14%) remained potent in the first postoperative year. That earlier reported excellent results regarding continence and potency were not reproduced in our study, possible was partly due to our inclusion of more advanced tumours in somewhat older patients, but the fact that the interviewer was independent of the surgeon significantly influenced the results.

Aged↗
PubMed1997

The effect of postpartum pelvic floor muscle exercise in the prevention and treatment of urinary incontinence.

The aim of this study was to evaluate the effect of postpartum pelvic floor muscle exercise in the prevention and treatment of urinary incontinence. A prospective comparison design of 99 matched pairs (n= 198) of mothers, a training group and a control group, was used. Eight weeks postpartum the training group attended an 8-week intensive pelvic floor muscle exercise course, training in groups led by a physical therapist for 45 minutes once a week. In addition they were asked to exercise at home at least three times per week. The control group followed the ordinary written postpartum instructions from the hospital. Pelvic floor muscle strength was measured pretreatment at the eighth, and post-treatment at the 16th week after delivery, using a vaginal balloon catheter connected to a pressure transducer. Vaginal palpation and observation of inward movement of the balloon catheter during contraction were used to test the ability to perform correct the pelvic floor muscle contraction. Urinary leakage was registered by interview, specially designed instruments to measure how women perceive SUI, and a standardized pad test. At baseline (8 weeks postpartum) there was no significant difference in the number of women with urinary incontinence in the training group compared to the control group. At 16 weeks postpartum, after the 8-week treatment period, there was a significant (P<0.01) difference in favor of the training group. In addition, a significantly greater improvement in pelvic floor muscle strength between test 1 and test 2 was found in the training group compared to the control group. The results show that a specially designed postpartum pelvic floor muscle exercise course is effective in increasing pelvic floor muscle strength and reducing urinary incontinence in the immediate postpartum period.

Exercise Therapy↗
PubMed2007

Clinical experience with urethral retro-resistance pressure measurement: a prospective pre- and postoperative evaluation in women with stress urinary incontinence.

AIMS: To identify possible correlations of urethral retro-resistance pressure (URP) with clinically and urodynamically proven stress urinary incontinence (SUI) and the outcome of anti-incontinence surgery. MATERIALS AND METHODS: URP was measured using the Monitorr system in women with clinically and urodynamically proven SUI without prolapse before and after anti-incontinence surgery (colposuspension n = 8, tension-free vaginal tape n = 6, tension-free transobturator tape n = 34). RESULTS: Forty-eight women (mean age 61.8 +/- 8.9 years) were evaluated preoperatively and on average 10 weeks postoperatively. Mean URP was 75.6 +/- 20.8 cm H(2)O preoperatively versus 75.4 +/- 17.9 cm H(2)O postoperatively (P = 0.898). The type of anti-incontinence surgery performed had no significant effect on postoperative URP. While no association was found between age and URP (P = 0.35), there was a positive correlation between URP and body mass index (BMI; r = 0.49, P = 0.0004). There was no correlation of URP with the preoperative pad test (P = 0.17) and urethral closure pressure at rest (P = 0.51). Finally, URP did not correlate significantly with the preserved length of the continence zone (0-1/3-2/3-3/3) as determined by the urethral stress profile (P = 0.37-0.72) or with the objective cure rate (negative pad test). CONCLUSIONS: Preoperative URP does not correlate with SUI in all women, has no predictive value, and does not correlate with the outcome of anti-incontinence surgery. However, there seems to be an association with biomechanical factors such as obesity, which may open up a new area of application for URP measurement in urogynecologic diagnosis.

Adult↗
PubMed2004

Pad tests and self-reports of continence in men awaiting radical prostatectomy: establishing baseline norms for males.

AIMS: In this study, we report normal pad weight gain in a group self-reported continent men and compare the self-report data with the 24-hr pad test and the International Prostate Symptom Score (IPSS). MATERIALS AND METHODS: Subjects awaiting radical prostatectomy were consecutively recruited. Exclusion criteria were a previous history of urologic surgery, reported urinary incontinence, or a medical problem which could affect bladder function. RESULTS: Two hundred forty five men were enrolled. All were Caucasian, mean age 62.7 years, mean Gleason score 6.5, and mean PSA 8.3. At initial interview, all described themselves as continent of urine and 26 declined the 24-hr pad test because they were emphatic that they were continent. Of the 220 remaining, mean pad weight gain was 4.0 g on 24-hr pad test (SD 3.8; range 0-35.0 g), mean IPSS score was 7.23; 95 subjects scored > or = 8 (moderate), 13 scored > or = 20 (severe). The IPSS single Quality of Life (QOL) question and the 24 hr pad weight were not correlated; the summary IPSS score and pad weight had a correlation of 0.16 (P = 0.02) and the QOL question and the summary IPSS score had a correlation of 0.63 (P < 0.001). IPSS QOL scores were worse for those recording > or = 8 (P < 0.001). CONCLUSIONS: The range of weight gain between 0 and 35 g suggests that self-report alone of urinary continence is an inaccurate measure of continence for research purposes. We propose that a pad weight gain of 8 g or less is indicative of urinary continence in men.

Aged↗
PubMed2003

Long-term functional results after ileal pouch anal restorative proctocolectomy for ulcerative colitis: a prospective observational study.

OBJECTIVE: To document functional results in patients treated with an ileal pouch anal anastomosis (IPAA). SUMMARY BACKGROUND DATA: The restorative proctocolectomy with IPAA has become the procedure of choice for patients with ulcerative colitis, yet the long-term functional results are not well known. METHODS: We performed this prospective observational study in 391 consecutive patients (56% male; mean age, 33.7 +/- 10.8 years; range, 12-66 years) who underwent an IPAA between 1987 and 2002 (mean follow-up, 33.6 months; range, 0 to 180 months). RESULTS: The majority of patients underwent the procedure under elective circumstances with a hand-sewn ileal pouch anal anastomosis and a protective ileostomy. In 25 patients (6.4%), the procedure was performed under urgent conditions; in 137 patients (35%), the temporary ileostomy was omitted; in 117 patients (29.9%), the ileal pouch anal anastomosis was stapled. There was 1 hospital mortality (0.25%) and 1 30-day mortality. Mean length of stay was 9.2 +/- 5.6 days (3-68 days; median, 8 days) and was increased by the occurrence of septic complications (8.9 versus 13.6 days; P < 0.02) and by the omission of a temporary ileostomy (8.3 versus 10.4 days; P = 0.005). Complications included pelvic abscess (1.3%), anastomotic dehiscence (6.4%), bowel obstruction (11.7%), and anastomotic stenosis in need of mechanical dilatation (10.7%). Patients were asked to record their functional results on a questionnaire for 1 week at 3, 6, 9, 12, 18, and 24 months after the IPAA and yearly thereafter. Our data to 10 years show that median number of bowel movements (bms) was 6 bm/24 hours at all time intervals. The average number of bms increased by 0.3 bm/decade of life (P < 0.001). Throughout the entire follow-up, more than 75% of patients had at least 1 bm most nights, although fewer than 40% found it necessary to alter the time of their meals to avoid bms at inappropriate times. Depending on the time interval, between 57% and 78% of patients were always able to postpone a bm until convenient, and this ability was similar in patients with a stapled or hand-sewn ileoanal anastomosis; only up to 18% were able to always distinguish between flatus and stools, and this ability was similar in patients with a stapled or hand-sewn ileoanal anastomosis. Complete daytime and nighttime continence was achieved by 53-76% of patients depending on the time interval. The percentage of fully continent patients was higher following the stapled rather than the hand-sewn technique (P < 0.001), and this difference persisted over time. When patients experienced incontinence, its occurrence ameliorated over time (P < 0.001), and the occurrence of perianal rash and itching as well as the use of protective pads decreased over time (P < 0.008). At 5 years, patients judged quality of life as much better or better in 81.4% and overall satisfaction and overall adjustment as excellent or good in 96.3% and 97.5%, respectively. CONCLUSIONS: We conclude that the IPAA confers a good quality of life. The majority of patients are fully continent, have 6 bms/d on average, and can defer a bm until convenient. When present, incontinence improves over time.

Adult↗
PubMed2003

Experience of tension-free vaginal tape for the treatment of stress incontinence in females with neuropathic bladders.

STUDY DESIGN: Retrospective. OBJECTIVE: To evaluate the safety and efficacy of the tension-free vaginal tape (TVT) for the treatment of stress incontinence in females with neuropathic bladders. SETTING: London Spinal Injuries Unit, Stanmore & Institute of Urology, London, UK. METHODS: Twelve women (mean age 53.3 years; range 41-80 years) with neuropathic bladder dysfunction and stress urinary incontinence were treated with tension-free vaginal tape (TVT) between November 1997 and December 2000. The group consisted of women with: (i) traumatic spinal cord injuries (n=3); (ii) post lumbar spinal surgery (n=6); (iii) spinal stenosis (n=3). Four of the 12 patients had previously failed surgery for stress incontinence. All patients underwent pre- and post-TVT evaluation with video-urodynamic studies. RESULTS: Mean follow-up was 27.1 months (range 17-54 months). Three patients were voiding spontaneously (stress voiding) before surgery and continued to do so post-operatively. The remaining 9 were performing clean intermittent self-catheterisation before the insertion of TVT and continued to do so after the surgery. At follow up 10 patients (83.3%) were dry. The procedure failed in one patient and the other complained of mild leakage, but she reported a decrease in the number of pads used. One patient developed detrusor hyperreflexia on post-operative video-urodynamics but there was no evidence of stress incontinence. One patient had a bladder perforation on insertion of TVT, managed successfully with extended use of a urethral catheter post-operatively. Three patients developed post-operative urinary tract infection successfully treated with oral antibiotics. CONCLUSIONS: Tension-free vaginal tape insertion is minimally invasive, safe and effective for the treatment of stress incontinence in females with bladder neuropathy with intrinsic sphincter deficiency. Previous surgery for incontinence did not affect post-operative complications or outcome.

Adult↗
PubMed2004

The link between absorbent pads and pressure management products.

Very little is known about the relationship between pressure management products (also known as pressure-relieving devices or pressure-redistributing devices) and absorbent continence products. However, a new project will focus on this little investigated yet important area of nursing research. The project is being carried out as part of a new award scheme that aims to enhance nursing research capacity by funding nurses to carry out doctoral level research (Box 1). A strong association between poor mobility and continence problems has been identified (Sgadari et al, 1997; Jirovec and Wells, 1990; McGrother et al, 1990; Ouslander et al, 1987) and reduced mobility is considered to be one of the intrinsic risk factors for the development of pressure ulcers (RCN, 2001). However, the relationship between incontinence and the development of pressure ulcers is not fully understood.

Absorbent Pads↗
PubMed2005

Effectiveness of functional magnetic versus electrical stimulation in women with urinary incontinence.

AIM: Urinary incontinence is one of the most common medical complaints in women. We here propose to evaluate and compare the effects of 2 conservative treatment modalities, functional electrical stimulation (FES) and functional magnetic stimulation (FMS). METHODS: We studied 22 female patients with urinary incontinence and divided them into 2 treatment groups (14 patients in the FES and 8 in the FMS group). The mean age of the patients in the FES group was 51.14+/-11.9 and in the FMS group 42.25+/-6.9 years. Functional electrical stimulation was applied continuously at 10 Hz and 30-50 Hz in urge and stress urinary incontinence respectively. In mixed urinary incontinence stimulation was applied at 10 Hz for 15 min and at 50 Hz for 15 min. The treatment sessions were for 20 min, 3 times a week for 6-8 weeks (12 with mixed, 2 with stress incontinence). FMS was applied by a magnetic chair, twice weekly for 6 weeks (6 with mixed, 1 with stress urinary and 1 with urge urinary incontinence). The efficacy of the treatment was judged from patient impressions, records in urinary diaries, results of 1 h pad test, perineometry value and digital palpation score. RESULTS: The perineometry value, digital palpation score increased significantly during stimulation compared with prestimulation levels in both groups (P<0.05). For the pad test significant improvement was also noted in both groups (P<0.05). The urinary diaries and frequency of micturition were significantly more cured or improved in the FES group (P<0.05). However, reduction of the frequency of nocturnal micturition wasn't significant in either group (P>0.05). CONCLUSIONS: Both FES and FMS treatments were effective. FMS does not involve intravaginal stimulation and it is twice a week. Although FMS is not often used it is more cost effective than FES. In order to have exact knowledge of this issue; more research than has been done in a greater number of subjects is required.

Adult↗
PubMed2006

Clinical and urodynamic features according to subjective symptom severity in female urinary incontinence.

AIMS: The aim of this study was to determine the relationship between subjective symptom severity and clinical or urodynamic parameters and to compare these parameters according to subjective symptom severity. METHODS: A total of 268 female patients with grade II (n = 94) and grade III (n = 174) according to the Ingelman-Sundberg scale were included in the study. Mean patient age was 55.9 years (range 28-80). Of 268 patients, 196 women (73.1%) complained of stress urinary incontinence (SUI) and 72 (26.9%) reported additional symptoms of urge urinary incontinence (UUI). Fifty-four (20.1%) women previously had hysterectomies and 12 (4.5%) underwent surgery for UI. RESULTS: Patients with severe incontinence (grade III) are older, have longer duration of symptoms, concomitant urgency or UUI, and low maximal urethral closure pressure and low Valsalva leak point pressure (VLPP). No difference in other characteristics including pad test loss and urethral mobility was observed in the two groups. In the multivariate logistic regression analysis, a longer duration of symptoms was associated with an increased likelihood of severe symptoms (P = 0.025). Patients with mixed incontinence were at five-fold increased risk of severe symptoms compared with those with SUI only (P = 0.011). In the same model, increasing VLPP was associated with a decreased likelihood of severe symptoms (P = 0.037). CONCLUSIONS: Longer symptom duration, mixed incontinence and low VLPP have independent effects on the severity of incontinence. Our findings suggest that incontinent patients with sphincteric impairment or urge component may have and increased probability of severe symptoms.

Female↗
PubMed1994

Periurethral injection of autologous fat for the treatment of sphincteric incontinence.

A total of 15 women with stress incontinence and 6 men with post-prostatectomy sphincteric incontinence underwent periurethral injection of autologous fat while under local anesthesia. The fat was harvested from the abdominal wall by liposuction. Preoperative evaluation consisted of a micturition diary, questionnaire, semiquantitative pad test, cystoscopy and urodynamics. Sequential injections were performed at 1 to 3-month intervals. Results were assessed by subjective patient scores, pad tests and clinical evaluation performed at intervals. Followup was 12 to 30 months (mean 18). Only 1 man and none of the women with urethral hypermobility had lasting improvement. Of the 15 women 12 had intrinsic sphincteric deficiency (type 3 stress incontinence) and they were our most successful group. Of the 12 women 10 (83%) were improved (mean score of 8.8-7 before injection compared to 1.87 after injection) at 1 month following the initial injection. Of the 9 patients who continued with the treatment 7 (78%) noticed lasting improvement objectively and subjectively after 1 to 4 injections (mean 2.4). We believe that this technique shows sufficient promise as an alternative therapy for sphincteric incontinence to warrant continued clinical investigation.

Adipose Tissue↗
PubMed1999

Urinary incontinence after radical prostatectomy: a randomized controlled trial comparing pelvic muscle exercises with or without electrical stimulation.

OBJECTIVES: To assess the effectiveness of intensive conservative treatment on and the impact of urinary incontinence after radical retropubic prostatectomy. PATIENTS AND METHODS: Sixty-three men with urinary incontinence >/= 8 weeks after radical prostatectomy were randomized to one of three groups; group 1, standard treatment (control); group 2, intensive pelvic muscle exercises (PME); or group 3, PME plus electrical stimulation (PME+ES). Group 1 received verbal and written instructions about postoperative PME from their urologist and from the nurses at the pre-admission clinic. Groups 2 and 3 were treated by a physiotherapist for 30 min twice a week for 12 weeks and carried out home exercises three times a day on the days when they were not treated. Outcome was assessed using the 24-h pad test, two validated quality-of-life questionnaires and a urine symptom inventory, all obtained at baseline, 12, 16 and 24 weeks after enrolment. The final pad test was carried out approximately 8 months after surgery. RESULTS: Fifty-eight patients completed the study, 21 in group 1, 18 in group 2 and 19 in group 3; five discontinued, three with bladder neck contractures requiring dilatation, one with rectal pain when doing the exercises and one unable to complete therapy while on vacation. The mean (median) time elapsed from surgery to entry into the study was 19 (8) weeks. At 12 weeks from baseline, the mean overall urine loss had decreased from 463 g to 115 g but there were no differences among groups, nor were there significant differences in urine loss at 16 and 24 weeks (F=0. 16, P=0.69). There was a significant impact on quality of life during the early recovery. Despite preoperative instructions, many patients revealed little or no knowledge about catheter care, bladder spasms, rectal pain, incontinence and erectile dysfunction. Little of the preoperative education was retained because of the overwhelming nature of the diagnosis. CONCLUSIONS: From the initial assessment to the final pad-test at approximately 8 months after surgery, incontinence improved greatly in all three groups. This rapid improvement may have masked any treatment benefit. Further research should address incontinence in men whose urine loss has stabilized and who underwent surgery >8 months previously. Moreover, a telephone-based follow-up soon after discharge may alleviate many of the concerns expressed.

Aged↗
PubMed2005

[Pelvic floor muscle training with Plevnik's cones in women with urinary incontinence].

The aim of this study was to evaluate the effectiveness of the pelvic floor muscle training in the stress urinary incontinence. The standard protocol include forty eight treatment sessions all together, for sixteen weeks, three times a week with the using of Plevnik weighted vaginal cones and Kegel exercises. The effectiveness of this method in reducing urine loss was assessed through the "Pad-test" before and after exercises. A cohort of 75 women entered the study, aged between 28 and 66 years old, with mean aged 46 and light to moderate urinary incontinence. The results showed significant improvement with reduction in urine loss and increase in pelvic muscle tone in women that completed the whole treatment course.

Adult↗
PubMed2005

Serotonin and noradrenaline reuptake inhibitors (SNRI) for stress urinary incontinence in adults.

BACKGROUND: To date, standard recommendations for the management of stress urinary incontinence (SUI) would be either pelvic floor muscle training (PFMT) or surgery. A new form of drug treatment with a serotonin-noradrenaline reuptake inhibitor (SNRI), duloxetine, may now have a place in treatment of this condition. OBJECTIVES: To determine whether a SNRI is better than placebo (or no treatment, other pharmacological and non-pharmacological therapies, or surgery) in the treatment of women with SUI, or mixed urinary incontinence that includes stress incontinence (MUI), or both and which doses should be used. SEARCH STRATEGY: We searched the Cochrane Incontinence Group specialised register (searched 1 December 2004), (CENTRAL) (Issue 2, 2004), MEDLINE (January 1966 to September 2004), PREMEDLINE (11 March 2004), Dissertation Abstracts and the reference lists of relevant articles. SELECTION CRITERIA: All randomised or quasi-randomised controlled trials of treatment for SUI or MUI, in which at least one management arm involved a SNRI. DATA COLLECTION AND ANALYSIS: Two authors evaluated the trials for appropriateness for inclusion and methodological quality. Three authors performed the data extraction using predetermined criteria. Analyses were performed using the Cochrane Review Manager software, RevMan. MAIN RESULTS: Nine randomised trials were included, involving 3327 adults with predominantly SUI, randomised to receive duloxetine or placebo. Both arms in individual trials were comparable for various baseline characteristics. Treatment duration was between three weeks and 12 weeks. Duloxetine was significantly better than placebo in terms of improving patients' quality of life (WMD 5.26, 95%CI 3.84 to 6.68. P< 0.00001) and perception of improvement. Individual studies demonstrated a significant reduction in the Incontinence Episode Frequency (IEF) by approximately 50% during treatment with duloxetine. With regard to objective cure, however, meta-analysis of stress pad test and 24 hour pad weight change failed to demonstrate a benefit for duloxetine over placebo though data were relatively few. Subjective cure favoured duloxetine, albeit with a small effect size (3%). One trial suggested that duloxetine was better than pelvic floor muscle training alone in reducing IEF (P < 0.05) based on median percentage decrease in IEF per week. Although significant side effects were commonly associated with duloxetine, they were reported as acceptable. AUTHORS' CONCLUSIONS: The available evidence suggests that duloxetine treatment can significantly improve the quality of life of patients with stress urinary incontinence, but it is unclear whether or not benefits are sustainable. Adverse effects are common but not serious. About one in three participants allocated duloxetine reported adverse effects (most commonly nausea) related to treatment, and about one in eight allocated duloxetine stopped treatment as a consequence.

Adrenergic Uptake Inhibitors↗
PubMed1989

[Repair of the female urethra and its natural support. Another surgical concept. 224 cases over 9 years].

This technique has been applied to 224 female patients over 9 years with a mean follow-up to the last control of 2 years 3 months. The sub-urethral fold of the fascia, the inferior and infero-lateral aspects of the urethra are dissected, the length and the width of the tube are restored by direct resuture, the sub-urethral fascia is doubled by overlapping. No suspension nor foreign tissue. Genito-urinary ptosis is treated by the same time. Application to stress incontinence, diverticulae, abscesses, periurethritis and a few cases of non malignant pathology. In stress incontinence, selected by suprapubic expression test, full success in 76.3%, primary failure in 5.4% and imperfect result with no permanent or necessary padding in 18.2%. In these imperfect results and failures as well as in periurethral pathology the importance of relapsing inferior of the low tract suggests that sexual infections be more investigated and that mechanical causes of infection, such as reflux be more operated on. On the 224 cases, 1 fistula and 1 urethral avulsion, in particular conditions which do not affect the general principle. No fistula in 12 cases of urethral diverticulae and abscesses. The suprapubic expression test in simple and valuable in selecting before and testing after operation the static mechanical incontinence.

Adult↗