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PubMed2005

Plugs for containing faecal incontinence.

BACKGROUND: Faecal incontinence is a distressing disorder with high social stigma. Not all people with faecal incontinence can be cured with conservative or surgical treatment and they may need to rely on containment products, such as anal plugs. OBJECTIVES: To assess the performance of different types of anal plugs for containment of faecal incontinence. SEARCH STRATEGY: We searched the Cochrane Incontinence Group Specialised Register (searched 22 November 2004), MEDLINE (January 1966 to November 2004), CINAHL (January 1982 to November Week 3 2004), EMBASE (January 1996 to 2004 Week 47), INVERT (Dutch nursing database) (January 1993 to November 2004) and Web of Science (January 1988 to November 2004). Reference lists of identified trials were searched and plugs manufacturers were contacted for trials. No language or other limitations were imposed. SELECTION CRITERIA: Types of studies: This review was limited to randomised and quasi-randomised controlled trials (including crossovers) of anal plug use for the management of faecal incontinence. TYPES OF PARTICIPANTS: Children and adults with faecal incontinence. Types of interventions: Any type of anal plug. Comparison interventions might include no treatment, conservative (physical) treatments, nutritional interventions, surgery, pads and other types or sizes of plugs. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed methodological quality and extracted data from the included trials. Authors of all included trials were contacted for clarification concerning methodological issues. MAIN RESULTS: Four studies with a total of 136 participants were included. Two studies compared the use of plugs versus no plugs, one study compared two sizes of the same brand of plug, and one study compared two brands of plugs. In all included studies there was considerable dropout (in total 48 (35%) dropped out before the end of the study) for varying reasons. Data presented are thus subject to potential bias. 'Pseudo-continence' was, however, achieved by some of those who continued to use plugs, at least in the short-term. In a comparison of two different types of plug, plug loss was less often reported and overall satisfaction was greater during use of polyurethane plugs than polyvinyl-alcohol plugs. AUTHORS' CONCLUSIONS: The available data were limited and incomplete, and not all pre-specified outcomes could be evaluated. Consequently, only tentative conclusions are possible. The available data suggest that anal plugs can be difficult to tolerate. However, if they are tolerated they can be helpful in preventing incontinence. Plugs could then be useful in a selected group of people either as a substitute for other forms of management or as an adjuvant treatment option. Plugs come in different designs and sizes; the review showed that the selection of the type of plug can impact on its performance.

Adult↗
PubMed2001

[Reiterated intravesical instillation of capsaicin in neurogenic detrusor hyperreflexia: a 5-years experience of 100 instillations].

INTRODUCTION: Capsaicin is a topic and specific C-fiber afferent neurotoxic. After spinal-cord injury, C-fiber afferent proliferate in the bladder mucosae and are involving in detrusor hyperreflexia AIM OF THE STUDY: To investigate middle-term efficacy and tolerance of intravesical instillation of capsaïcin in spinal-cord injured patients presenting severe urinary incontinence refractory to usual therapy due to detrusor hyperreflexia. METHODS: Thirty patients receveid a first intravesical instillation of 1mMol/L Capsaïcin solution in 30% alcohol. The efficacy (voiding diary, pads, quality of life, maximum cystometric capacity, maximum detrusor pressure, first and normal desire to void) and tolerance were evaluated before, 1 month and 3 months after each instillation, completed by anual cystoscopy. In patients who responded favorably to this instillation, repeated instillations were proposed when symptoms recurred. RESULTS: 25 patients (83.3%) were improved after the initial instillation (decrease of incontinence-frequency-urgency, best quality of life, rise on maximal cystometric capacity), since the 15(th) day and for 3.2 months. 76 reiterative instillations were performed in 22 patients (2 to 9 instillations per patient). 91.2% of them remained successfull, during an average period of 4.2 months. It does not appear loss of benefits after iterative instillations. Transient and moderate adverse effects followed 86% and 79% of the first and reiterated instillation (exacerbation of incontinence, supra-pubic pain). Two patients have presented a begnin and transient inflammatory cystitis after reiterated instillation. DISCUSSION-CONCLUSION: Intravesical instillation of capsaïcin are an effective treatment for incontinence and associated symptoms caused by neurogenic detrusor hyperactivity. Propositions to improve immediate tolerance are debated.

Administration, Intravesical↗
PubMed2006

An adjustable male sling for treating urinary incontinence after prostatectomy: a phase III multicentre trial.

OBJECTIVE: To evaluate the efficacy and safety of a new adjustable bulbourethral sling (Argus, Promedon SA, Cordoba, Argentina) in the treatment of male stress urinary incontinence (SUI) after prostate surgery. PATIENTS AND METHODS: In all, 48 patients with SUI because of prostatic surgery for prostate cancer (39) or benign prostatic hyperplasia (nine) had a new sling implanted in a multicentre trial at six institutions between April 2003 and September 2004. All patients were fully evaluated, including a questionnaire (International Consultation on Incontinence Questionnaire-Short Form, ICIQ-SF, range 0-21), endoscopy, and urodynamic evaluation. The Argus system comprises a 4.2 x 2.6 x 0.9 cm thick silicone foam pad for soft bulbar urethral compression. The pad is attached to the silicone cone columns that, after being passed with needles from the perineum to the abdominal wall, are adjusted with silicone washers to regulate and keep the desired tension against the urethra. The pad and washers are radio-opaque, which allows their position to be assessed during follow-up. The surgical technique was one described previously, with some modifications. RESULTS: At a mean (range) follow-up of 7.5 (1-17.5) months, 35 (73%) of the 48 patients were dry, five (10%) were improved, and eight (17%) were incontinent, including four (8%) who needed sling adjustment. The mean (range) ICIQ-SF improved from 19.2 (12-21) to 4 (0-21). There were three (6%) urethral perforations during surgery that were resolved by re-passing the needle. The sling was removed in three men (6%) due to erosion and in two (4%) due to infection. Seven (15%) cases of acute urinary retention resolved spontaneously, except for one that needed the sling loosening. No cases of chronic retention were reported. There was perineal discomfort and mild dysuria soon after surgery that resolved spontaneously after a few weeks. CONCLUSION: This new adjustable male sling safely and effectively controls sphincter incontinence in men after prostate surgery, with an acceptably low complication rate. The early results are encouraging; the Argus is a valid alternative to the artificial urinary sphincter, the standard therapy for this condition.

Aged↗
PubMed1996

Post-prostatectomy incontinence and the artificial urinary sphincter: a long-term study of patient satisfaction and criteria for success.

PURPOSE: We investigated patient satisfaction with the artificial urinary sphincter and established criteria for a successful outcome by inquiring about patient perceived satisfaction, continence achieved and comparison with the surgeon office records. MATERIALS AND METHODS: During 9 years 65 patients with post-prostatectomy incontinence underwent placement of the AMS800 artificial urinary sphincter. Review of charts and a telephone questionnaire were conducted to determine patient perceived satisfaction. RESULTS: A total of 50 patients participated in the survey. Median followup was 23.4 months. Preoperative incontinence was severe. Of the patients 90% reported continuous leakage, and 70% wore an average of 6 diapers and 24% wore an average of 7.4 pads daily. The long-term complete continence rate was 20%. Of the patients with wetness 55% had leakage of a few drops daily and 22% had leakage of less than a teaspoon. Of all patients 50% had leakage daily, 24% had leakage 1 or more times a week and wore an average of 1.5 pads per day, and 6% reported changing clothes due to wetness. A total of 90% of the patients reported satisfaction with the artificial urinary sphincter and 96% stated that they would recommend or had recommended the artificial urinary sphincter to a friend. In retrospect, 92% of the patients would have the artificial urinary sphincter placed again, 90% of those undergoing revision reported no change in satisfaction and 14% reported improved sexual activity. CONCLUSIONS: Patient satisfaction with the artificial urinary sphincter for post-prostatectomy incontinence is uniformly high. Although postoperative continence was not 100%, relative improvement in continence was the most significant factor affecting patient perceived outcome. Using these parameters criteria for a successful outcome can be established, and patient concerns regarding the artificial urinary sphincter can be dispelled.

Aged↗
PubMed2005

Absorbable versus nonabsorbable graft: outcome of bone anchored male sling for post-radical prostatectomy incontinence.

PURPOSE: We determined the outcome of the bone anchored male sling procedure for stress urinary incontinence in men regarding the graft material used. MATERIALS AND METHODS: A total of 39 men with post-radical prostatectomy incontinence received a perineal bone anchored male sling. Patients with previous salvage external beam radiotherapy and high serum prostate specific antigen, incontinence due to neurogenic or posttraumatic etiology, or previous benign prostatectomy were excluded. Urodynamic evaluation was performed preoperatively. The number of pads daily used by patients was recorded preoperatively and during postoperative visits. To compress the urethra 2 types of materials were used. Absorbable biomaterials were used in the first 12 patients and nonabsorbable material was used in the following 27. RESULTS: Mean patient age +/- SD was 67.3 years (range 50 to 79). The mean duration between radical prostatectomy and male sling surgery was 57.9 +/- 40.4 months (range 5 to 135). The procedure was successful in 26 patients (96.2%) in the nonabsorbable group and in 1 (8.3%) in the absorbable group at a mean followup of 18.9 and 28.8 months, respectively. CONCLUSIONS: The absorbable sling materials that were used for the bone anchored male sling demonstrated disintegration of the material. Autolysis of these absorbable materials removed active compression forces on the urethra after a short period. Nonabsorbable graft is associated with the best outcome following the perineal bone anchored male sling procedure.

Absorbable Implants↗
PubMed1998

[Conservative treatment of neurogenic fecal incontinence. Our experience with children].

OBJECTIVE: The objective of this study was to present the use of retrograde colon enema in myelodysplasic patients with fecal incontinence. PATIENTS AND METHODS: Thirty-three patients, 16 males and 19 females, 5 to 22 years old (average age 11.9 years) with spina bifida and fecal incontinence which obliged them to use a diaper. Retrograde colon enema procedures were performed in all of them. RESULTS: With the use of the retrograde enema the best rectal emptying was achieved and kept 32 children (97%) diaper free after a follow-up period of more than two years. Only one girl (3%) needed pads because she was not able to defecate in an appropriate place after administering the enema. CONCLUSIONS: The retrograde enema is the best conservative treatment for children with neurogenic fecal incontinence. This method achieves good rectal emptying allowing the children to be diaper free, resulting in better social adaptation and integration.

Adolescent↗
PubMed2004

Efficacy of polydimethylsiloxane injection to the bladder neck and leaking diverting stoma for urinary continence.

PURPOSE: Achieving urinary continence is a major goal in the treatment of patients with bladder exstrophy/epispadias, spinal dysraphism and other urological disorders. Endoscopic injection of bulking materials is an evolving, minimally invasive procedure that provides an attractive alternative to open bladder surgery to increase outlet resistance. We evaluated the efficacy of bladder outlet (bladder neck and diverting stoma) polydimethylsiloxane injection (BOMI) to achieve continence in children. MATERIALS AND METHODS: We retrospectively reviewed the continence status of 33 patients prior to and following BOMI for urinary incontinence. The variables evaluated as predictors of success were underlying disease, ambulatory status, voiding status, bladder capacity, type and time from previous bladder neck reconstruction, anticholinergic treatment, injection site, amount of polydimethylsiloxane used, detrusor leak point pressure and immediate or delayed clean intermittent catheterization. Improvement was considered a 2-fold increase in the dry interval or 4 hours between bladder emptying in patients on clean intermittent catheterization and a 2-fold decrease in the number of absorbent pads needed. RESULTS: Between 1998 and 2002, 25 male and 8 female patients 4 to 19 years old (mean age 12.4 +/- 3.9) underwent 42 BOMIs for incontinence. Mean followup was 13 +/- 9 months (range 3 to 42). Incontinence was via the urethra in 28 cases and via a diverting stoma in the remaining 5. Of the 28 patients with leakage via the urethra none were cured, 12 (42%) were improved and 16 (58%) had no change in continence status. However, 3 of the 5 inpatients (60%) with leakage via a diverting stoma were cured. No perioperative complications were recorded. Injecting to a diverting stoma was the only factor found to be predictive of success. Extrusion of polydimethylsiloxane during the procedure was the only factor predictive of failure (3 of 3 cases or 100%). New onset dilatation of the collecting system was noted in 2 patients and all had improved continence following injection. CONCLUSIONS: Injection to the bladder neck did not result in any cure and had a low improvement rate of 42%. BOMI is a good therapeutic option for patients with leakage from a diverting stoma. Although no perioperative complications were recorded, 2 patients had new dilatation of the upper tract on ultrasound. Hence, long-term followup is warranted.

Administration, Intravesical↗
PubMed1999

Periurethral collagen injection: a long-term follow-up study.

OBJECTIVE: To determine the long-term success of the periurethral injection of collagen (Contigen(R), Bard UK) in women with genuine stress incontinence. PATIENTS AND METHODS: Sixty-one women with genuine stress incontinence were enrolled in a trial of periurethral collagen injections between 1 September 1990 and 31 August 1992. They were assessed at 1, 3, 6, 12 and 24 months after the last collagen injection. In 1998, their notes were reviewed, and a standardized questionnaire was sent to 46 women who were still alive and had undergone no further anti-incontinence surgery. RESULTS: Of the 53 women who were either known failures or who had follow-up information beyond 5 years, 26% were subjectively improved. Women who had a maximum urethral closure pressure of >20 cmH2O and those who had urinary incontinence for <10 years before their first injection were more likely to have had long-term success. There was no correlation between long-term success and the number of previous operations, body mass index, age or preoperative pad loss. Neither the number of injection sessions, total volume of collagen injected nor perceived bulking at the time of surgery affected long-term success rates. Of the 14 women who considered themselves subjectively improved, seven had daily incontinence and only one was completely dry. Urinary retention and urinary tract infection were the most common complications. In addition, one woman reported a flare-up of her skin test and transient 'flu-like symptoms 2 weeks after the injection, and one woman developed a right upper lobe pneumonia 2 weeks after the collagen injection. CONCLUSION: The long-term results of periurethral collagen injections are disappointing. We found no evidence to support the use of periurethral collagen injections in women with intrinsic sphincter deficiency, who had a higher failure rate than those with hypermobility. Further research is essential to develop agents that are not immunogenic, produce minimal inflammatory response and yet are durable.

Adult↗
PubMed2000

Assessment and investigations for urinary incontinence.

Assessment of a woman complaining of urinary incontinence includes full urological, gynaecological, medical, surgical and drug histories. General, neurological, abdominal and pelvic examinations are undertaken and with the history, enable a presumptive diagnosis to be formulated. Investigations for incontinence should be selected to suit the individual woman's need. Non-specialist investigations include urine testing, completion of a urinary diary and symptom score, pad testing, measurement of residual urine volume and biochemical tests. Specialist investigations include uroflowmetry, conventional and ambulatory cystometry, urethral pressure profilometry and measurement of urethral electrical conductance and leak point pressure. Imaging using ultrasound, X-ray, magnetic resonance or isotopes is sometimes indicated. While neurophysiological testing has little clinical application, cystourethroscopy is of value in various subgroups of women. Thorough assessment and appropriate investigation together result in an accurate diagnosis which in turn allows appropriate treatment for urinary incontinence to be initiated.

Female↗
PubMed2001

Urodynamic techniques.

Appropriate investigation is essential to a full evaluation of any patient with urinary incontinence, as accurate diagnosis leads to correct treatment. This paper describes the various investigations for lower urinary tract dysfunction, and their main indications. They include the pad test, uroflowmetry, subtracted cystometry, and more complex investigations such as videocystourethrography, ambulatory urodynamics, urethral pressure profilometry, magnetic resonance imaging and electromyography. Although not every patient requires extensive investigation, appropriate use of tests of lower urinary tract function provides useful information on which to base appropriate treatment.

Female↗
PubMedDate not supplied

Twenty four-hour monitoring of incontinence and bladder function in a community hospital.

We wished to determine whether 24-hour monitoring of urinary incontinence without video urodynamics would provide adequate information for treatment. Twelve subjects with urinary incontinence (seven women and five men) were investigated, average age 75 years (range 44 to 89 years). Setting was a community hospital (80 beds), a nursing home, and a lodge, 60 miles from the nearest assessment center. Twenty four-hour monitoring consisted of 2 hourly preweighed pad changes, postchange weighing, Uroflow set-up in subject's bathroom, fluid intake record, and 1 postvoid residual ultrasonogram. All subjects had history and physical and evaluation of medications. Findings included probable urge incontinence, stress incontinence, chronic retention with overflow, and normal bladder function. Recommendations included oxybutynin chloride, timed toileting, timed fluid restriction, diuretic manipulation, intermittent catheterization, pessary, and surgery. At 6 weeks, 25% (4/12) were better (three with urge incontinence and one after operation for stress incontinence). Video urodynamics were conducted only for the patient with stress incontinence after operation. We suggest that 24-hour monitoring is noninvasive, is less disruptive and less expensive than video urodynamics, and provides adequate information for initial treatment in many patients with urinary incontinence.

Adult↗
PubMed1997

[Tolerance and effectiveness of propiverine hydrochloride in 752 patients with symptoms of detrusor hyperactivity and increased sensitivity and irritability of the urinary bladder: results of a study monitoring drug utilization].

In a post-marketing surveillance study of 752 patients suffering from urgent incontinence, mixed urgent-stress incontinence, reflex incontinence, urgency and enuresis were treated with propiverine hydrochloride. Clinical efficacy of propiverine hydrochloride was verified by the improvement of symptoms related to detrusor hyperactivity, hypersensitivity and hyperreflexia during a 12-week surveillance period: daytime and overnight urinary incontinence, as well as the frequency, nocturia, urgency in day time and at night decreased. These results are well demonstrated by decreased pad use and statistically significant decrease of Gaudenz urgency score during treatment, confirming the efficacy of propiverine hydrochloride already proved in clinical trials. The safety profile of propiverine hydrochloride displayed characteristic anticholinergic symptoms (dry mouth, accommodation disorders, constipation, tiredness, dizziness) with decreasing incidence during the 12-week treatment period. The residual urine volume decreased also. Serious adverse events were observed rarely and could be explained by the lack of consideration of contraindications, warnings and interactions with other drugs. The positive risk-benefit relationship of propiverine hydrochloride in the treatment of detrusor hyperactivity, hypersensitivity and hyperreflexia was reconfirmed in this post-marketing drug surveillance study.

Adolescent↗
PubMed2002

Type III stress urinary incontinence: response to interdisciplinary pelvic physiotherapy.

The purpose of this case study is to report one patient's outcome following a 10-week course of interdisciplinary pelvic physiotherapy. The patient was diagnosed with intrinsic sphincter deficiency (ISD), a subset of Type III stress urinary incontinence, and sensory urge with multichannel urodynamic evaluation. Subjective data were collected pre and post-therapy at 1-month and 3-month followup visits. Outcome data reflect a pad reduction of 70%, reduction of nocturia by 33%, and a 20% reduction in urinary frequency and sensory urgency events.

Biofeedback, Psychology↗
PubMed1989

Terodiline in the treatment of children with unstable bladders.

A double-blind study of terodiline compared with placebo was performed in 58 children aged 6 to 14 years with urgency or urge incontinence. All had an unstable bladder at cystometry. A bladder regimen was emphasised during the study. Continence was improved according to micturition charting and a pad test in both groups. Terodiline at 25 mg/day, however, gave significantly better results than placebo. In patients with a subnormal bladder capacity (less than or equal to 150 ml), a significant increase in capacity was recorded on cystometry during medication with terodiline but not with placebo. The improved continence seen in the placebo group was probably due to the non-specific bladder training achieved by the child's increased awareness and adult involvement during treatment. The even better results attained in the terodiline group shows this drug to be a valuable adjunct to a bladder regimen in children with urge incontinence, particularly since no important adverse effects were noted during an 8-week period.

Adolescent↗
PubMed1995

The effect of study methodology on reported success rates of the modified Pereyra bladder neck suspension.

PURPOSE: We compared surgical results in a cohort of women after modified Pereyra bladder neck suspension using questionnaire based outcomes analysis versus a retrospective chart review. MATERIALS AND METHODS: Of 151 patients who underwent modified Pereyra bladder neck suspension 102 had complete questionnaire and chart data for review. Mean patient age was 56 years and followup was 25 months. RESULTS: According to outcomes analysis 48 patients (47.1%) were cured and in 65 (64%) stress urinary incontinence improved compared to 74 (72%) cured and 89 (89%) improved by retrospective review. Of the 102 chart review patients 10 (9%) reported daily pad use compared to 55 of the 102 (53%) in the questionnaire study. CONCLUSIONS: This study controls for patient selection, definition of cure and length of followup, and demonstrates that study methodology profoundly affects reported outcomes for the modified Pereyra bladder neck suspension.

Adolescent↗
PubMed2005

Clinical usefulness of pelvic floor reeducation for men undergoing radical prostatectomy.

INTRODUCTION: Urinary incontinence after radical prostatectomy is a significant clinical problem. We evaluated the clinical usefulness of early-onset pelvic floor reeducation (EPFR) as compared with later-onset pelvic floor reeducation (LPFR) in patients undergoing radical retropubic prostatectomy. PATIENTS AND METHODS: The continence status of 132 consecutive patients who underwent retropubic radical prostatectomy for clinically localized prostate cancer was assessed 1 year later by a standardized questionnaire. Fifty-eight patients started EPFR 7 days after surgery. Fifty-five patients attended LPFR 4 weeks after surgery. Forty-six patients received no pelvic floor retraining, 28 attended LPFR without EPFR, 27 patients received EPFR and LPFR, and 31 patients attended EPFR without LPFR. RESULTS: Overall, 87 men were continent, 37 patients felt moderately incontinent, and 8 men suffered from severe incontinence. We could not observe a statistically significant influence of any kind of pelvic floor reeducation on continence status, time to continence, frequency or volume of urine loss, or the use of pads. CONCLUSION: A routine prophylactic use of combined EPFR and LPFR in all patients does not seem to be justified.

Exercise↗
PubMed1997

Comparison of a 10-mg controlled release oxybutynin tablet with a 5-mg oxybutynin tablet in urge incontinent patients.

Oxybutynin has long been used for the treatment of patients with detrusor overactivity and urinary urge incontinence. The short half-life of oxybutynin administered as a conventional tablet formulation or syrup requires 2-3 times daily dosage to be effective. A new controlled release (CR) tablet for once-daily administration has been developed. The efficacy and tolerability of this new controlled release tablet was compared to that of a 5-mg conventional oxybutynin tablet administered twice daily. Seventeen female incontinent patients were studied in a double-dummy crossover trial. Efficacy and tolerability were assessed by using a voiding diary, pad-weighing test, visual-analogue scale (VAS), and questionnaire. Adverse events were recorded spontaneously on a questionnaire by the patients themselves throughout the study. Serum concentrations of oxybutynin and its active metabolite N-desethyloxybutynin were studied after both a single dose and multiple dosage. There was no difference in efficacy between the two formulations. Depending on the parameters tested, the change from baseline values in a positive direction ranged from 15 to 53%. The incidence of adverse events was similar with both formulations. Oxybutynin or its metabolite showed no cumulation during the multiple dosage with a 10-mg CR tablet. The controlled release tablet formulation is as effective and as well-tolerated as the conventional one, but has the advantage of only once-a-day dosage, enhancing treatment compliance.

Adult↗