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PubMed2001

Tension-Free vaginal tape (TVT) in women with mixed urinary incontinence--a long-term follow-up.

In a prospective long-term study we evaluated the effect of TVT surgery in 80 women suffering from mixed urinary incontinence. Their mean age was 59 +/- 11 years with a mean parity of 2 (range 0-6). Mean follow-up was 4 years (range 3-5). The preoperative evaluation included a 24-hour pad test, quality of life evaluation, gynecologic examination and urodynamic investigations, including simultaneous urethrocystometry. From the patient history 96 patients were initially tentative candidates for TVT operation. Sixteen of these had only minor symptoms and signs of stress incontinence but significant symptoms and signs of detrusor instability, and were not considered suitable for TVT surgery. In the remaining 80 women the urodynamic investigation with filling urethrocystometry demonstrated stress incontinence and urge incontinence concomitant with urethral relaxation and/or 'premature micturition' reflex. At the postoperative long-term follow-up 85% of the patients were completely cured. Another 4% were significantly improved. In 11% of the patients the operation failed. Few intra- or postoperative complications occurred. Based on these results, we conclude that TVT surgery can be used for treatment of female mixed urinary incontinence. A proper urodynamic assessment is recommended before surgery is performed.

Female↗
PubMed2002

Sacral neuromodulation as an effective treatment for refractory pelvic floor dysfunction.

OBJECTIVES: To determine the long-term efficacy and complications of sacral nerve stimulation as an alternative therapy for pelvic floor dysfunction. Pelvic floor dysfunction is a complex problem that can be refractory to current treatment modalities. Conservative therapy rarely results in a durable cure of patients, and various surgical procedures have significant side effects and less than optimal results. METHODS: Sixty-four patients, 54 women and 10 men, with various forms of voiding dysfunction for whom other forms of therapy had failed underwent placement of the Medtronic Implantable Pulse Generator sacral nerve implant. The mean age was 47 years. The presenting complaint was frequency, urgency, and urge incontinence in 44 patients and chronic nonobstructive urinary retention requiring self-catheterization in 20 patients. Forty-one patients also had chronic pelvic and perineal pain associated with their voiding symptoms. The mean duration of symptoms was 69 months. All patients underwent percutaneous nerve evaluation before the permanent implant and demonstrated more than 50% improvement in their symptoms. All patients were evaluated at 1, 3, 6, 12, and 24 months, and yearly thereafter. The assessment of the voiding symptoms was done both subjectively by patient symptoms and objectively using voiding diaries recorded for 3 days. A validated verbal rating pain scale was used to evaluate pain levels. RESULTS: Eighty percent of the patients had 50% or greater improvement in their presenting symptoms and quality of life after the procedure, with a mean follow-up of 24 months. Patients with frequency-urgency showed a reduction in the number of voids per day with a significant increase in voided volumes. Patients with urge incontinence showed a reduction in leaking episodes from 6.4 to 2.0/24 hr, with a decrease in the number of pads used from 3.5 to 1.2/day. Sixteen of 20 patients with urinary retention were able to void with a residual volume of less than 100 mL. Patients with chronic pelvic pain showed a decrease in the severity of pain from a score of 5.8 to 3.7. Complications were minimal and encountered in 18.7% of the patients. CONCLUSIONS: Sacral nerve stimulation is an effective and durable new approach to pelvic floor dysfunction with minimal complications. Test stimulation provides a valuable tool for patient selection.

Adult↗
PubMed2004

Improved urinary continence after radical retropubic prostatectomy with preparation of a long, partially intraprostatic portion of the membraneous urethra: an analysis of 1013 consecutive cases.

PURPOSE: To improve the rate of full continence in our patients, we performed, since June 1997, a careful preparation of the distally intraprostatic part of the membranous urethra to obtain a long urethral stump for the vesicourethral anastomosis. PATIENTS AND METHODS: In all, 610 patients without (group 1) and 403 patients with (group 2) a long intraprostatic stump of the urethra were asked by a self-administered questionnaire about their continence status. The rate of positive surgical margins were compared as a marker of local tumour control. RESULTS: Full continence (no pads) was achieved in 76.02% in group 1 and in 88.84%, of all patients in group 2. Stress incontinence (SIC) I degrees was found in 12.46% and 7.44% respectively, SIC II degrees was noted in 8.69 and 3.72% and complete incontinence was seen in 2.79% in group 1 and in two patients (0.5%) in group 2. Also the time to reach the final continence status was statistically and highly significantly (P<0.001) shortened. The rate of positive margins decreased in group 2, despite intraprostatic preparation. CONCLUSIONS: The preparation of a long, partially intraprostatic portion of the membranous urethra for vesicourethral anastomosis in radical retropubic prostatectomy leads to a statistically highly significant improvement of full continence and earlier continence in prostate cancer patients without compromising local tumour control.

Adult↗
PubMed2004

Duloxetine versus placebo in the treatment of European and Canadian women with stress urinary incontinence.

OBJECTIVE: To assess the efficacy and safety of duloxetine in women with stress urinary incontinence. DESIGN: Randomised double-blind, placebo-controlled clinical trial. SETTING: Fort-six centres in seven European countries and Canada. POPULATION: Four hundred and ninety-four women aged 24-83 years identified as having predominant symptoms of stress urinary incontinence using a clinical algorithm that was 100% predictive of urodynamic stress urinary incontinence in a subgroup of 34 women. METHODS: The case definition included a predominant symptom of stress urinary incontinence with a weekly incontinence episode frequency > or =7, the absence of predominant symptoms of urge incontinence, normal diurnal and nocturnal frequencies, a bladder capacity > or =400 mL and both a positive cough stress test and positive stress pad test. Subjects completed two urinary diaries prior to randomisation and three diaries during the active treatment phase of the study, each completed during the week prior to monthly visits. Subjects also completed quality of life questionnaires at each visit. Safety was assessed by the evaluation of treatment-emergent adverse events, discontinuation of treatment because of adverse events, serious adverse events, vital sign measurements, electrocardiograms (ECG) and clinical laboratory tests. INTERVENTION: After a two-week placebo lead-in, women received placebo or duloxetine 40 mg BD for 12 weeks. MAIN OUTCOME MEASURES: The percentage decrease in incontinence episode frequency and the change in the Incontinence Quality of Life (I-QOL) questionnaire total score were prespecified as co-primary outcome variables in the protocol. RESULTS: Incontinence episode frequency decreased significantly with duloxetine compared with placebo (median decrease of 50%vs 29%; P= 0.002) with comparable improvements in the more severely incontinent subgroup (those experiencing at least 14 incontinence episodes per week at baseline; 56%vs 27% decreases; P < 0.001). The primary analysis of I-QOL scores did not reveal a significant difference between treatment groups, due primarily to the carrying forward of low scores from patients who discontinued treatment very early due to duloxetine-associated adverse events. The increase in I-QOL scores was significantly greater for duloxetine than for placebo at each of the three postrandomisation visits after 4, 8, and 12 weeks of treatment. Discontinuation rates for adverse events were higher for duloxetine (22%vs 5%; P < 0.001) with nausea being the most common reason for discontinuation (5.3%). Nausea tended to be mild to moderate, not progressive, and transient. CONCLUSIONS: The findings support duloxetine as a potential treatment for women with stress urinary incontinence.

Adult↗
PubMed1987

Proctocolectomy and ileoanal anastomosis with an S pouch: functional results.

Patients with total colonic ulcerative colitis or familial polyposis traditionally require a proctocolectomy. In an effort to preserve the normal pathway for defecation and avoid the nuisance of an abdominal stoma, a continence-preserving procedure involving a pelvic reservoir has been performed at the University of Minnesota Hospitals on 120 patients. The majority were operated on for colonic ulcerative colitis. There were no deaths. The mean hospital stay after restorative proctocolectomy was 10 days and after ileostomy takedown the mean stay was 7 days. Functional results were assessed in 52 patients. Daytime bowel movements averaged 6.4 and night-time movements 1.4. Major daytime incontinence occurred in 6% of the patients, 21% had moderate soiling at night and 70% wore a perineal pad in the evening. Ninety-two percent of the patients expressed satisfaction with the procedure. The most serious complication was pelvic sepsis. It occurred in nine patients, six of whom required subsequent surgery. The Parks S pouch provides a means of maintaining anal continence. This series and others have shown that young, healthy, well-motivated persons will benefit most from a restorative proctocolectomy.

Adenomatous Polyposis Coli↗
PubMed1985

Experience with the endorectal pull-through and S pouch for ulcerative colitis and familial polyposis in adults.

An experience is reported with 23 patients who underwent rectal mucosectomy, total colectomy, creation of S-type pouch, and ileoanal anastomosis for ulcerative colitis (21 patients) or familial polyposis (two patients). There were no deaths. There were 23 complications requiring 18 operations in 16 patients. Twenty-one patients have been followed an average of 17.8 months (range 2 to 34 months) Frequency of bowel movement averaged 9.8 per day initially and 6.2 per day at the time of follow-up. None of the patients consider themselves incontinent, although 15 have had some degree of perianal soiling and at least on occasion have worn a pad. One patient intubates the pouch regularly, six intubate it on occasion, and 14 do not intubate at all. The size of the outflow treat of the pouch has been shortened from 5 to 2 cm in the last seven patients; six of these patients do not intubate and four report no soiling at all. Eleven patients have made changes in their diet or eating habits to promote more predictable bowel function and 13 take a variety of antidiarrheal medications. Nineteen patients are satisfied with the procedure and prefer the pouch to a conventional ileostomy; the other two have since undergone conversion to a Brooke ileostomy. Despite frequent bowel movements, complications, and some problems with perianal soiling, patient acceptance remains high with the endorectal pull-through and S pouch in adults, and further study, particularly using a shortened outflow tract, appears warranted.

Adult↗
PubMed1988

Vaginal cones: a conservative method of treating genuine stress incontinence.

A set of weighted vaginal cones designed to exercise the pelvic floor muscles was used by a group of 39 premenopausal patients with genuine stress incontinence who were awaiting corrective surgery. The effectiveness of the exercises in reducing urinary loss was assessed with a standard urine pad test before and after 1 month of training. Of the 30 women who completed 1 month of the exercises 70% felt they were improved or cured and 90% found it an acceptable method of treatment. Of the 30 women only 11 (37%) opted for surgery after training. There was a highly significant correlation (P less than 0.001, rs = -0.21) between decreased urine loss and increase in retained cone weight.

Adolescent↗
PubMed2000

Laparoscopic Burch colposuspension for stress urinary incontinence: a randomized comparison of one or two sutures on each side of the urethra.

OBJECTIVE: To compare 1-year cure rates after laparoscopic Burch colposuspension using one double-bite or two single-bite sutures on each side of the urethra. METHODS: Consecutive women with primary stress urinary incontinence at one university hospital were included. Preoperative clinical and urodynamic evaluation included cystoscopy, cystouretrometry at rest and stress, and a standardized pad test. Immediately before surgery, the patients were randomized to have one or two polytetrafluoroethylene (GoreTex CV 2; W. L. Gore Inc., Flagstaff, AZ) sutures placed on each side of the urethra. During surgery, access to the space of Retzius was achieved by transperitoneal videolaparoscopic technique. Women were scheduled for postoperative interview and pad test 1 year after surgery. RESULTS: We included 161 women in the study; 78 were randomized to one suture (group A) and 83 to two sutures (group B). Median time for surgery was significantly shorter for group A than for group B (60 compared with 77 minutes; P < .001). We examined 158 women 1 year after surgery, at which time 148 performed a pad test. Objective cure rate was significantly higher in group B than in group A (83% compared with 58%; P = .001). CONCLUSION: Two single-bite sutures resulted in a significantly higher objective short-term cure rate than one double-bite suture on each side of the urethra.

Aged↗
PubMed2002

Effect of adding biofeedback to pelvic floor muscle training to treat urodynamic stress incontinence.

OBJECTIVE: To compare the effect of individual pelvic floor muscle training with and without biofeedback in women with urodynamic stress incontinence. METHODS: The study was a single, blind, randomized trial. All women completed 6 months of pelvic floor muscle training comprising three sets of ten contractions three times per day, supervised by a physical therapist. One group trained with a biofeedback apparatus at home, the other without biofeedback. The primary outcome measures were pad test with standardized bladder volume and self-report of severity. RESULTS: A total of 103 women were randomized, and data from 94 women were analyzed. Mean age (range) was 46.6 (30-70) years, and mean (range) duration of symptoms was 9.7 (1-25) years. Seventy women had urodynamic stress incontinence alone, and 24 women reported additional urge symptoms. Women training with and without biofeedback showed a statistically significant reduction in leakage on pad test (P <.01) after 6 months of pelvic floor muscle training. Objective cure (2 g or less of leakage) in the total group was 58% in women training with and 46% in women training without biofeedback, and in the subgroup of women with urodynamic stress incontinence alone, 69% in women training with and 50% in women training without biofeedback. There was no statistically significant difference between the groups posttreatment in any outcome measure. CONCLUSION: Cure rate was high, and the reduction in urinary leakage after treatment was statistically significant in both groups. However, there was no statistically significant difference in the effect of individual pelvic floor muscle training with and without biofeedback.

Biofeedback, Psychology↗
PubMed2004

Urinary incontinence, pelvic floor dysfunction, exercise and sport.

Urinary incontinence is defined as "the complaint of any involuntary leakage of urine" and is a common problem in the female population with prevalence rates varying between 10% and 55% in 15- to 64-year-old women. The most frequent form of urinary incontinence in women is stress urinary incontinence, defined as "involuntary leakage on effort or exertion, or on sneezing or coughing". The aim of this article is to systematically review the literature on urinary incontinence and participation in sport and fitness activities with a special emphasis on prevalence and treatment in female elite athletes. Stress urinary incontinence is a barrier to women's participation in sport and fitness activities and, therefore, it may be a threat to women's health, self-esteem and well-being. The prevalence during sports among young, nulliparous elite athletes varies between 0% (golf) and 80% (trampolinists). The highest prevalence is found in sports involving high impact activities such as gymnastics, track and field, and some ball games. A 'stiff' and strong pelvic floor positioned at an optimal level inside the pelvis may be a crucial factor in counteracting the increases in abdominal pressure occurring during high-impact activities. There are no randomised controlled trials or reports on the effect of any treatment for stress urinary incontinence in female elite athletes. However, strength training of the pelvic floor muscles has been shown to be effective in treating stress urinary incontinence in parous females in the general population. In randomised controlled trials, reported cure rates, defined as <2g of leakage on pad tests, varied between 44% and 69%. Pelvic floor muscle training has no serious adverse effects and has been recommended as first-line treatment in the general population. Use of preventive devices such as vaginal tampons or pessaries can prevent leakage during high impact physical activity. The pelvic floor muscles need to be much stronger in elite athletes than in other women. There is a need for more basic research on pelvic floor muscle function during physical activity and the effect of pelvic floor muscle training in female elite athletes.

Exercise↗
PubMed1995

Transurethral collagen therapy in women.

PURPOSE: We evaluated our recent experience with transurethral collagen therapy in women. MATERIALS AND METHODS: A series of 44 women with video urodynamic evidence of intrinsic sphincter deficiency were treated with transurethral collagen therapy using local anesthesia. Median patient age was 72 years (range 41 to 94). Mean duration of incontinence was 72 months. Incontinence was grade 3 in 42 patients. Mean abdominal leak point pressure before treatment was 56 cm. water. Patient response to treatment was evaluated by the change in the number of pads required to effect significant improvement. RESULTS: Median number of pads used was 5 pretreatment (range 3 to 12) and 3 posttreatment. A total of 20 patients was cured and 8 others required only 1 pad daily after treatment (63% cured or needing no pads daily). Of the cured patients 4 had used greater than 10 pads daily before collagen injection. One treatment was given to 22 patients and 7 have not improved of whom 2 underwent only 1 treatment. Mean volume of collagen used to effect a cure was 9.1 cc. CONCLUSIONS: Collagen injection is a useful treatment for the severely incontinent female patient with intrinsic sphincter deficiency.

Adult↗
PubMed2003

Vaginal electrical stimulation of the pelvic floor: a randomized feasibility study in urinary incontinent elderly women.

BACKGROUND: To evaluate the effectiveness of intravaginal electrical stimulation (ES) of the pelvic floor for urinary incontinence in elderly women, and to determine whether ES of the pelvic floor is a preferable treatment for urinary incontinence in elderly women. METHODS: Postmenopausal women (age 65 years or older) were enrolled in a randomized clinical trial and underwent every-other-day ES of the pelvic floor, or a daily Kegel exercise (KE) program. Objective outcome variables were: (1) Urinary leakage (during a standardized PAD test), (2) pelvic muscle strength (measured by a perineometer), and (3) detrusor instability (on ambulant urodynamic registration). Subjective outcome variables were women's subjective assessment of change in urinary symptoms based on the PRAFAB score. Twenty-four women treated with ES and 11 women treated with Kegel exercises completed the 8-week study program. The Chi-square test was used for statistical analysis. RESULTS: No significant improvement in objective outcome variables was observed in the population treated with ES compared with the population treated with KE (with 29.2% vs. 36.4% of the women showing objective improvement in measured urinary leakage). Neither was subjective improvement significant, with 29.2% vs. 27.3% of the women reporting improvement in the amount of urinary leakage. CONCLUSIONS: Although the number of enrolled women was very small this study shows that: 1. Treating elderly women with vaginal ES of the pelvic floor has a high physical and emotional cost for the individual. 2. The effectiveness of ES of the pelvic floor in urinary incontinent elderly women is low. 3. There is no great discrepancy between objective amelioration (PAD test) and subjective amelioration (PRAFAB score/quantity of urinary leakage), if the objective improvement is adequately defined. 4. It is not reasonable to advise elderly women with urinary incontinence to undertake this treatment procedure. The effectiveness of treatment does not compensate for the long-lasting and intense treatment protocol. 5. We terminated this study because of the negative outcome with ES.

Aged↗
PubMed1996

[The VIVA urethral plug: a sensible expansion of the spectrum for conservative therapy of urinary stress incontinence?].

OBJECTIVE: To evaluate applicability, acceptance, side effects and complications and the possible curative effect on female stress urinary incontinence of the treatment with the urethral plug VIVA (Braun Melsungen, Germany). DESIGN: Part I: Prospective clinical study. Part II: Ongoing prospective-longitudinal study. Additionally two case reports. SUBJECTS: Part II: 156 consecutive patients of the urodynamic out patient clinic. Part II: 21 patients with urinary stress incontinence (SUI). MAIN OUTCOME MEASURES: Part I: Ability to hold the plug while walking and standing, acceptance rate of plug therapy. Part II: Subjective improvement of SUI, pad-weighing test, cough test, urinary tract infections, other complications during four months of plug treatment. RESULTS: Part I: 62% of 156 patients were able to hold the plug. 40% of 53 patients with SUI accepted the plug treatment. Part II: 14 patients completed the study. 4 pat. were subjectively and objectively cured, 3 were improved, 7 unchanged. The cured patients all had a low grade SUI with a urine loss of 3 g in the pad-weighing test before treatment. 12/21 pat, showed 1-2 urinary tract infections and 1 patient dropped out from the study because of recurrent urinary tract infections. In one patient a plug migrated into the bladder and was removed cystoscopically. In two case reports the possibility of symptomatic plug treatment for patients with severe stress incontinence after surgical and radiological treatment of cervical cancer is demonstrated. CONCLUSIONS: Plug treatment is a broadening of the spectrum of conservative treatment of SUI as a symptomatic treatment in pat. with contraindications to anti-incontinence surgery and as a curative treatment in low grade SUI.

Adult↗
PubMed1987

Artificial urinary sphincter for recurrent female urinary incontinence: indications and results.

A retrospective review of our experience with the artificial urinary sphincter in 32 women is presented. All patients had a history of recurrent urinary incontinence after failed bladder suspension procedures. Of 32 devices 31 were functioning, with an average followup of 2.5 years, and 91 per cent of the patients were dry without pads. Mechanical complications requiring surgical repair occurred in 21 per cent of the patients. Indications for artificial urinary sphincter implantation in the female patient and technical aspects of the procedure are discussed. The artificial urinary sphincter appears to be an acceptable treatment modality for urethral sphincter deficiency resulting in recurrent urinary stress incontinence in female patients.

Adult↗
PubMed2002

Use of intravenous anesthesia for tension-free vaginal tape therapy in elderly women with genuine stress incontinence.

OBJECTIVES: To study the efficacy of the tension-free vaginal tape (TVT) procedure for elderly patients. METHODS: Forty-five women, 65 years old or older (mean 69.1; range 65 to 85), were treated for genuine stress incontinence with the tension-free vaginal tape procedure under intravenous anesthesia with heavy sedation. Urodynamic studies and 1-hour pad test were performed before the procedure and at 1 year postoperatively. Vigorous manual pressure against the abdominal wall and ensuring no lifting of urethra by intraoperative introital ultrasonography were used to position and adjust the vaginal taping. RESULTS: Forty-one (91%) were cured, one improved, and three failed. No major surgical complications occurred. Two bladder perforations were noted. The pad test disclosed a reduction in urine leakage from a mean of 28.9 to 1.6 g/hr (P <0.001). The average blood loss was 72 mL (range 30 to 250), operating time was 21 minutes (range 18 to 35), and postoperative hospital stay was 24.2 hours (range 12 to 72). Spontaneous voiding with an adequate volume of postvoid residual urine was noted for all patients by the fourth day postoperatively. Urodynamic parameters related to the voiding dysfunction showed no significant difference before and after surgery. De novo detrusor instability was observed in 2 patients. CONCLUSIONS: With modifications of the technique and the aid of intraoperative ultrasonography, the TVT procedure can be performed under intravenous anesthesia with heavy sedation. The procedure is safe, effective, and minimally invasive for elderly patients. However, long-term follow-up is needed to determine whether this surgery achieves long-lasting results.

Adult↗
PubMed1994

Sequelae of definitive radiation therapy for prostate cancer localized to the pelvis.

OBJECTIVES: To evaluate sequelae and estimate quality of life utilizing a survey instrument in 133 consecutive patients who have undergone definitive radiation therapy for localized prostate cancer. METHODS: All patients reported on have been followed for 14 to 60 months (median, 31 months) after radiation therapy and only patients with definitive prostate radiation therapy are included. Of the patients still alive at time of follow-up, 115 were mailed the questionnaire. Data regarding tumor grade and stage as well as treatment were extracted from patient files. RESULTS: Of the 91% of patients who returned the questionnaire, 11% used a pad and 13% leaked more than a few drops of urine daily. Of all the respondents, 9% stated that incontinence was a problem, and 31% found urinary leaking significantly worsened after radiation therapy compared with before their diagnosis of prostate cancer. With respect to sexual function, 77% recalled being able to have full or partial erections prior to radiation therapy. At some time after radiation therapy, 22% of previously potent respondents were able to have a full erection and 41% were able to have a partial erection. Twenty-nine percent of all patients who were able to establish an erection prior to radiation therapy reported that impotence was a problem at the time of follow-up. Forty-nine percent of patients had abdominal pain, diarrhea, or abdominal cramping during or after radiation therapy and 31% of all patients still had some intestinal symptoms at the time of follow-up. Eighteen percent of all patients were significantly bothered by one or more of these bowel problems. Overall, 31% of all patients reported a persistent degree of physical discomfort that they believed was secondary to their prostate cancer or the effect of treatment. Eighty-one percent were satisfied with radiation therapy and 97% of the patients said they would have radiation therapy again if faced with the decision. CONCLUSIONS: Utilizing a sensitive questionnaire on patients who had definitive radiation therapy for prostate cancer, we found the incidence of patients bothered by incontinence to be surprisingly frequent and higher than previously reported. The frequency of impotence is similar to previous studies. However, when our incontinence and impotence data were compared to Medicare patients who had undergone radical prostatectomy, the frequencies after radiation therapy were significantly lower. Despite the rates of sequelae, the patients were generally satisfied with the decision to undergo radiation therapy and with the medical treatment received.

Aged↗
PubMed2001

[Urodynamic behavior of intestinal neobladder: our experience].

OBJECTIVE: To analyze the urodynamic behavior of the intestinal neobladders in our series. METHODS: The study comprised 20 patients with a detubularized intestinal neobladder. The ileal segment was utilized in 15 (13 Melchior, 1 Camey and 1 Padovana), the ileocecal segment in 4 (3 Mainz, 1 Le Bag) and detubularized sigmoid in one patient. A urodynamic study was performed in all patients to determine neobladder capacity, presence of peristaltic waves, filling and voiding pressures, peak and mean urinary flow and postvoid residual urine. The patients were also asked about continence, if a collecting device was required and the overall degree of satisfaction. RESULTS: Mean neobladder capacity was 508 ml., mean reservoir accommodation was 38 ml/cm H2O and 66.7% presented significant peristaltic contractions. Maximum filling pressure was 27 cm H2O. All patients showed peaks in the flowmetry due to the abdominal pressure, with a mean maximum peak flow of 16.6 ml/sec. Mean postvoid residual urine was 43.6 ml. Eighty percent of the patients were continent during the day, 55% were continent during the night and 25% were completely continent. All patients used abdominal pressure for voiding and generally in the sitting position. The overall degree of satisfaction was moderate to high in all but two patients; one required self catheterization and the other had frequent interruptions during work due to leaks during the day, but refused to use a collecting device. CONCLUSIONS: If renal function is preserved and the criteria for radical oncologic treatment are observed, substitution of the compromised bladder should be attempted with a reservoir as physiological as possible. The ideal continent urinary diversion must meet the following prerequisites: adequate capacity, low pressure inside the reservoir, absence of pressure waves, continence and absence of postvoid residual urine. The mean capacity of the intestinal neobladders in this study, as well as the maximum pressure inside the reservoirs were found to be adequate. However, many patients presented peristaltic contractions with urinary leaks in some cases, and the percentage of patients with residual urine also appears to be high. Most of these patients do not require the use of pads during the day, while almost all of the patients require some type of collecting device at night for incontinence. Nevertheless, the patients in this series were generally satisfied with their neobladder.

Aged↗
PubMedDate not supplied

Pelvic floor exercises with biofeedback for stress urinary incontinence.

OBJECTIVE: Prospective study to objectively evaluate the benefits of pelvic floor strengthening exercises associated to biofeedback for the treatment of stress urinary incontinence. MATERIALS AND METHODS: Fourteen patients diagnosed with stress urinary incontinence (SUI) were selected for this study. All patients underwent a pelvic floor training associated to biofeedback for 12 consecutive weeks. Urodynamic tests, pad test and bladder diary were analyzed at the beginning of the study, at the end and after 3 months. The King's Health Questionnaire (KHQ) was applied before and after treatment to assess the impact in the quality of life. RESULTS: There was a significant reduction in the pad weight (from 14.21 g to 1 g), number of urinary leakage episodes (from 8.14 per day to 2.57 per day) and daytime frequency (from 7.93 per day to 5.85 per day). At urodynamics the authors observed a significant increase in Valsalva leak-point pressure (from 103.93 cm H2O to 139.14 cm H2O), cistometric capacity (from 249.29 mL to 336.43 mL, p = 0.0015) and bladder volume at first desire to void (from 145 mL to 215.71 mL). Those differences were kept during the first 3 months of follow up. The KHQ revealed significant differences except in the case of ''general health perception'', which covers health in general and not exclusively urinary incontinence. CONCLUSION: Treatment of SUI with pelvic floor exercises associated to biofeedback caused significant changes in the parameters analyzed, with maintenance of good results 3 months after treatment.

Adult↗