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PubMed1991

Symptoms analysis for the diagnosis of genuine stress incontinence.

OBJECTIVE: To determine the accuracy of an analysis of symptoms alone for the diagnosis of genuine stress incontinence. DESIGN: A comparison of results of symptoms analysis with urodynamic findings. SETTING: A gynaecological video-urodynamic unit. SUBJECTS: 252 consecutive patients referred for urodynamic investigations. INTERVENTIONS: A questionnaire of 20 symptoms of lower urinary tract dysfunction, midstream specimen of urine, pad testing, uroflowmetry, and video-cystourethrography. MAIN OUTCOME MEASURES: Using the urodynamic diagnosis as the 'gold standard', the accuracy of discriminant function analysis of symptoms was determined. RESULTS: Symptoms analysis achieved a correct classification of 81% with a false positive rate of 16%. Use of an accumulative probability curve defines patients who fall into the equivocal range. CONCLUSIONS: All women presenting with incontinence should undergo preoperative urodynamic studies.

Female↗
PubMed1996

Antegrade collagen injection for stress incontinence after radical prostatectomy: technique and early results.

This article describes the technique and early results of antegrade collagen injection into the bladder neck and proximal urethra of men with stress incontinence postprostatectomy. Twenty men underwent collagen injection under general anesthesia. Follow-up ranges from 5 to 15 months, with a mean of 9.5 months. A mean of 14.5 cc of collagen was injected (range 5-25 cc). According to a subjective self-grading system, preoperative and postoperative urodynamics, and pad usage before and after treatment, significant improvement was seen in 14 patients (70%), and subjective cure was reported by 5 (25%). Six patients (30%) had no subjective or objective improvement after the injection. The antegrade collagen injection technique is a promising and simple method of correcting postprostatectomy stress urinary incontinence. Further study and longer follow-up is necessary to determine its precise role in the treatment of men with this problem.

Aged↗
PubMed2001

Predicting continence following radical prostatectomy.

Stress urinary incontinence is a recognized complication following radical prostatectomy. Fortunately, in the hands of experienced surgeons, the overwhelming majority of men ultimately regain urinary continence following the procedure. Most men regain urinary continence 3 to 12 months after the prostatectomy. We have developed and validated a continence index that is administered at the time of catheter removal after radical prostatectomy. This index identifies those men who rapidly regain continence and men who will have permanent incontinence after prostatectomy. The study population was stratified into tertile groups based on the continence scores. At 3 months, 96%, 82%, and 68% of men in the highest, mid, and lowest tertile groups reported using no pads or one small pad. Based on these observations, we recommend initiating biofeedback immediately postoperatively in men with continence scores of 14 or less. At 1 year, 100%, 98%, and 87% of the men in the highest, mid, and lowest tertile group reported using no pads or only one small pad. Men who have continence scores greater than 14 can be assured that they will regain urinary continence within 1 year. To our knowledge, this index is the only validated instrument that predicts the return of urinary continence after radical prostatectomy.

Humans↗
PubMed1990

Management of urinary incontinence by bladder tube urethral lengthening and submucosal reimplantation.

We reviewed the first 25 urethral lengthening and reimplantation procedures done at our institution in 24 patients. All patients had failed to achieve dryness on medical or surgical therapy for total urinary incontinence. A total of 32 patients had neurogenic incontinence. The patients were followed for 1.5 to 7 years. Late complications included catheterization difficulties, vesicoureteral reflux, febrile urinary tract infection, calculi and peritonitis. Reoperations were required in 19 patients primarily because of our initial failure to recognize the necessity of providing a low pressure, high capacity reservoir. The reoperation rate on the continence mechanism was low. Of 24 patients 20 are continent and require no pads or diapers.

Adolescent↗
PubMed2003

Transvaginal radio frequency treatment of the endopelvic fascia: a prospective evaluation for the treatment of genuine stress urinary incontinence.

PURPOSE: We evaluate the safety and efficacy of a new treatment modality for genuine stress urinary incontinence which was a transvaginal radio frequency applicator to deliver radio frequency energy to the endopelvic fascia. The purported mechanism of effect for this therapy is shrinkage of the collagenated tissue which composes the endopelvic fascia that supports the bladder neck and proximal urethra, thus stabilizing the proximal urethra and bladder neck. In prior animal trials and early pilot studies this therapy was shown to cause a reproducible thermal effect manifested by fascial shrinkage. Preliminary human trials indicated a therapeutic benefit of this therapy for women with genuine stress urinary incontinence. MATERIALS AND METHODS: To our knowledge this is the first multicenter study of a transvaginal approach for radio frequency of the endopelvic fascia for treatment of genuine stress incontinence. Between June 1999 and June 2000, 120 consecutive women (mean age 49.9 years) at 10 sites underwent transvaginal radio frequency treatment in a prospective trial to evaluate the overall efficacy and safety profile of this therapy. All patients had preoperative urethral hypermobility (average cotton swab change 38 degrees). Detrusor instability was excluded by cystometry. In all procedures precisely controlled radio frequency energy was applied to the endopelvic fascia to heat and shrink the tissue. The patients were evaluated postoperatively at 1 week and at 1, 3, 6 and 12 months using objective and subjective measures. Primary end points consisted of physician assessment of continence, patient reported pad use and the number of patient reported episodes. Safety was determined for acute (immediate postoperative) and chronic time frames. RESULTS: Of the 120 patients 96 completed 1-year evaluation. Average operative time was less than 30 minutes, and all patients were treated as outpatients. Preoperatively 101 patients (84%) averaged 1 or more episodes of urinary incontinence per day. At 3, 6 and 12 months 57%, 66% and 59% of patients, respectively, averaged 1 or no daily episodes of urinary incontinence. At 12-month followup 79 of 109 patients (73%) reported being continent or improved. Preoperatively, 43% of patients reported using 1 or no pads daily. At 3, 6 and 12 months 69%, 70% and 72% of patients, respectively, required 1 or no pads daily. On urodynamic evaluation at 12-month followup 76.0% of the patients did not leak with a Valsalva maneuver. A total of 30 cases were classified as failures and 11 women were lost to followup. There were no intraoperative complications, 3 (4%) minor postoperative complications which resolved, and no device related complications. CONCLUSIONS: The transvaginal radio frequency applicator demonstrated good efficacy and excellent safety at 1-year followup. Ongoing analysis of the data has indicated opportunities for improvement of this new surgical technique that could result in higher efficacy rates without compromising safety. Further long-term evaluation is being conducted to assess chronic durability of the procedure.

Catheter Ablation↗
PubMed2006

Impact of comorbidities on post-prostatectomy incontinence.

INTRODUCTION: The aim of this retrospective study was to evaluate various factors that may influence post-prostatectomy incontinence (PPI). PATIENTS AND METHODS: 1,088 men with prostate cancer underwent radical retropubic prostatectomy. 742 patients were evaluable for analysis. Continence was defined as usage of no or one pad daily. Mean follow-up was 45 months (12-143). RESULTS: Based on protective pad requirement 100% and 76% of men were continent at baseline and at the time of questionnaire evaluation (at least 12 months), respectively. Univariate analysis was performed to identify factors that may influence the return of continence. Age, body mass index (BMI), previous TUR-P, smoking, hypertension, diabetes and attempted nerve sparing did not predict postoperative continence status. CONCLUSIONS: In contrast to several reports, our analysis revealed that age, BMI, previous TUR-P, smoking, hypertension and diabetes do not have a statistically significant impact on continence after radical retropubic prostatectomy and are therefore not useful as predictors for PPI.

Adult↗
PubMed1991

The double-stapled ileal reservoir and ileoanal anastomosis. A prospective review of sphincter function and clinical outcome.

Fifteen consecutive patients (nine males and six females) who underwent construction of a double-stapled ileoanal reservoir (DS-IAR) were prospectively evaluated. Mean and maximal resting pressures preoperatively, before ileostomy closure, and at 12 months, were 53 and 84 mm Hg, 39 and 62 mm Hg, and 62 and 81 mm Hg. Mean and maximal squeeze pressures at those same time periods were 96 and 153 mm Hg, 111 and 173 mm Hg, and 95 and 168 mm Hg. There were no significant decreases in either resting or squeeze pressure between preoperative values and those obtained 12 months after surgery. However, the length of the high pressure zone decreased from 3.8 cm preoperatively to 2.3 cm at 12 months. This reflects the sacrifice of the cephalad 1.5 cm of the internal anal sphincter necessary to effect this anastomosis at a mean of 1.4 cm from the dentate line. However, this maneuver did not result in poor continence. Eleven patients whose ileostomies were closed for a mean of 9 months, ranging from 3 to 15 months, were evaluated regarding functional outcome. Only one patient had any incontinence and this patient had incomplete circular-stapled tissue rings, which necessitated transanal suture repair of the anastomotic defect. Similarly, three of the four patients who sometimes or rarely use a pad at night had transanal-suture reinforcement. Ten of the 11 patients never wear a pad during the day. No pelvic or perianal sepsis occurred. Stratified squamous epithelium was found in 6 of the 13 distal stapler "donuts" that were examined. In addition, 10 patients underwent biopsy of the tissue immediately caudad to the circular staple line at the time of ileostomy closure; in five, only stratified squamous epithelium was noted. The DS-IAR is associated with excellent objective physiologic and subjective functional results.

Adenomatous Polyposis Coli↗
PubMed1993

Pelvic muscle exercises: when do they work?

OBJECTIVE: To identify urodynamic indices that can predict the outcome of pelvic muscle exercises in women with genuine stress urinary incontinence. METHODS: Thirty-six women with genuine stress urinary incontinence were evaluated during a 6-month period. Urodynamic studies were performed before and 3 months after completion of a program of Kegel pelvic muscle exercises. Subjective symptoms and objective loss of urine as well as pad count were used to evaluate the outcome of the exercise program. A receiver-operating characteristic curve was used to assess the prognostic value of the pressure transmission ratio between the abdomen and urethra. RESULTS: Twenty patients (56%) were cured or substantially improved 3 months after completing the pelvic muscle training, whereas 16 were unchanged. The urethral closure pressure significantly increased in the subjects cured or improved. After successful training, significant changes were noted in the pressure transmission ratio between the abdomen and urethra on cough. Six of seven subjects with mild incontinence responded favorably, whereas 13 of 15 with severe incontinence did not improve after the training. The pressure transmission ratio plotted on a receiver-operating characteristic curve was found to have optimal predictive value at the 80% level. CONCLUSION: Kegel pelvic muscle exercises give a better outcome in women with mild stress urinary incontinence and/or with a pressure transmission ratio between the abdomen and urethra of 80% or more.

Exercise Therapy↗
PubMed1994

Synchronous management of anastomotic contracture and stress urinary incontinence following radical prostatectomy.

Of 77 patients presenting for artificial urinary sphincter implantation due to incontinence following radical prostatectomy 26 had a significant associated urethrovesical anastomotic contracture. Synchronous endoscopic contracture incision with electrocautery and implantation of an artificial urinary sphincter (AMS800) were performed in all cases. A total of 25 patients void with a good subjective flow, with an average followup of 32 months. In 1 patient symptomatic stenosis recurred 6 months after incision and reincision was successful at the time of sphincter revision. No infection or erosion developed and 24 patients are socially continent (0 to 1 thin pad per day). During this time 5 patients underwent 8 revisions of the artificial sphincter. Synchronous contracture incision with electrocautery and artificial urinary sphincter implantation are safe and provide satisfying results in patients with complex post-prostatectomy incontinence.

Anastomosis, Surgical↗
PubMed2002

Tension-free vaginal tape versus laparoscopic bladder neck suspension for stress urinary incontinence.

BACKGROUND: Owing to their various advantages, including shortened hospital stays, faster recoveries, and satisfactory outcomes, laparoscopic bladder neck suspension (LBNS) and tension-free vaginal tape (TVT) have become 2 well-known minimally-invasive anti-incontinent procedures. The aim of this study was to demonstrate the outcomes of LBNS and TVT procedures for treatment of stress urinary incontinence. METHODS: From October 1997 to February 2000, 22 women with genuine stress incontinence underwent LBNS, and another 23 women underwent TVT. Estimates of operative time, blood loss, and time to resumption of spontaneous urination were recorded for each group. Surgical results were assessed by urodynamic studies, 1-h pad tests, and voiding diaries. RESULTS: There were no statistically significant differences between these 2 groups in terms of demographics and blood loss during the operation. When comparing operative time and time to resumption of spontaneous urination, the TVT group had significantly lower values than did the LBNS group for both parameters, at 31.9+/-6.0 vs. 111.7+/-15.6 min and 2.1+/-1.5 vs. 4.0+/-0.9 days, respectively. The cure rate was 86.9% in the TVT group and 86.4% in the LBNS group. CONCLUSION: Both TVT and LBNS have been proven effective in treating women with stress urinary incontinence. The TVT procedure, owing to its shorter learning curve, less intraoperative blood loss, and quicker resumption of spontaneous urination, is recommended to treat women suffering from pure stress urinary incontinence. Whereas, in cases that are complicated with concomitant adnexal disease or uterine pathology, LBNS is considered an alternative procedure.

Adult↗
PubMed2004

The short-term effects of physical therapy in different intensities of urodynamic stress incontinence.

PURPOSE: The aim of this study was to investigate and compare the short-term effects of a physical therapy program in patients with different intensities of urodynamic stress urinary incontinence (USI). SUBJECTS AND METHODS: 48 patients with USI were assigned to three groups according to the intensity of their incontinence: group I: 0-2 g (n = 17), group II (mild intensity: >2-10 g, n = 16) and group III (moderate intensity: >10 g, n = 15) as determined by the 1-hour pad test. A physical therapy program composed of Kegel exercises and interferential current was applied to all patients for duration of 5 weeks, with a total of 15 sessions. The number of pads used a day, frequency of voiding (times/day), amount of urinary leakage according to the 1-hour pad test (mg), severity of complaint (as centimeters on visual analogue scale) and pelvic floor muscle strength (cm Hg) were evaluated. Pre-treatment and post-treatment values of these data were compared in each group and among groups. RESULTS: Analyses of the data indicated that the number of pads used a day, frequency of voiding and amount of urinary leakage decreased and pelvic floor muscle strength increased significantly in each group (p < 0.05). Cure in USI was found in 88% of subjects in group I and 18% of subjects in group II (mild intensity). None of the patients in group III (moderate intensity) showed a cure effect. CONCLUSION: This physical therapy program was found to be more effective in mild and moderate intensities than severe USI.

Exercise Therapy↗
PubMed1977

Intermittent self-catheterization, and alternative in the treatment of neurogenic urinary incontinence in women.

Preservation of kidney function and management of incontinence are the main goals of urological rehabilitation in patients with neurogenic bladder disturbance. It is also the assumption of social intergration. Whereas in male patients this problem can be mostly solved, if need be, by a urinal, females still rely on pads or operative procedures with the risk of complications and failures. For this group of patients intermittent catheterization and, respectively, intermittent self-catheterization, is in selected cases a helpful and harmless method to achieve this goal. Contrary to operative procedures nothing is destroyed and all possibilities remain open for further and better treatment, hopefully soon available. This report presents our experience and results from 12 female patients with neurogenic urinary incontinence, who were treated with this method between 1972 and 1976.

Adolescent↗
PubMed2000

Effectiveness of the conveen continence guard (a disposable vaginal device) in the treatment of complicated female stress incontinence.

BACKGROUND: Treatment alternatives for women with stress urinary incontinence, complicated by prior unsuccessful surgery or concomitant diseases that prevent surgical intervention are limited. The aim of this study was to investigate the usefulness and effectiveness of a disposable vaginal device, the Conveen Continence Guard, in cases where surgery was not recommended for treatment of stress urinary incontinence. METHODS: Twenty-eight women, with a urodynamically proven stress urinary incontinence, were offered the use of a vaginal device during a prospective three-week treatment period. Objective and subjective prevention of urinary leakage was assessed by a 24-h pad-weighing test, by a visual analog scale and a quality of life questionnaire. At the end of the treatment period the women answered a questionnaire on the ease and comfort of use of the device. RESULTS: Of the nineteen women who completed the study, 89.5% were cured or improved according to subjective assessments, the respective figure being 84.2% according to objective assessment. CONCLUSION: The Conveen Continence Guard seems to be a promising treatment alternative for women for whom other treatment methods have failed. The device was well tolerated by the women and was regarded easy to use.

Adult↗
PubMed1998

Neuromodulation: urodynamic effects of sacral (S3) spinal nerve stimulation in patients with detrusor instability or detrusor hyperflexia.

The aim of this study was to determine the urodynamic effects of sacral (S3) nerve stimulation in patients with urge incontinence due to detrusor overactivity which has been refractory to conservative treatment. A total of 24 patients with idiopathic detrusor instability and five with neurogenic hyperreflexia were studied urodynamically before and 6 months after a permanent S3 foramen electrode implant. The urodynamic studies at follow-up were done with the stimulus on. Clinically, the average voiding frequency, the number of leakage episodes and pad use per 24 h decreased significantly. Improvement in several urodynamic parameters was noted. In the idiopathic as well as in the neurogenic group, the correlation between symptomatic and urodynamic improvement was incomplete. Neuromodulation leads to improvement of several urodynamic parameters in patients with urge incontinence due to detrusor overactivity which has been refractory to conservative treatment and appears to be a valuable treatment option in these patients.

Adult↗
PubMed2002

[Hydrogen expandable implants in the treatment of stress incontinence in women--a pilot study].

OBJECTIVE: The aim of the study was to evaluate the use of new-type implants for the treatment of female urinary stress incontinence. The patients with intrinsic sphincter deficiency were also included, the other were after previous surgery for GSI. DESIGN: Original article. SETTING: Departments of Obstetrics and Gynaecology, Faculty Hospital Na Bulovce and General Faculty Hospital, 1. Faculty of Medicine, Charles University, Prague, Institute of Macromolecular Chemistry, Czech Academy of Science, Prague. METHODS: We operated 9 patients, two of them with type III (McGuire) urinary stress incontinence the rest after operations for GSI in general anesthesia. Six to nine hydrogel swelling implants were introduced into the submucosa of proximal urethra under the transrectal ultrasound guidance. We evaluated the effect 6 to 9 months after the operation. RESULTS: Two patient were dry (negative stress-test and pad-weight test), one patient had substantial improvement, 4 had mild improvement and 2 did not notice any change. We found de novo urge symptoms in four patients, two of them were of the motor type. CONCLUSION: The new type of implants reached the success rate of other currently used materials. The improvement of stress incontinence was on the cost of de novo urge symptoms in some patients. The urgency was successfully managed with spasmolytic drugs.

Female↗
PubMed1997

Incisionless per vaginal bone anchor cystourethropexy for the treatment of female stress incontinence: experience with the first 50 patients.

PURPOSE: We evaluated the safety and efficacy of a new minimally invasive surgical procedure for the treatment of women with genuine stress urinary incontinence. MATERIALS AND METHODS: A total of 50 women (mean age 51 years) was treated for type I or II stress urinary incontinence. A miniature bone anchor and a staple like bone anchor driver were used for fixation of periurethral tissue to the public bone. RESULTS: The procedure was successfully performed in all patients without intraoperative bleeding. No significant persistent postoperative pain was noted and only 1 patient had urinary tract infection. Concomitant vaginal hysterectomy, cystocele repair or perineoplasty was performed in 33 cases. At 12-month followup 41 patients (82%) are completely continent, 7 patients (14%) reported more than 50% decrease in pad usage and 2 cases are considered surgical failures. Mean operative time was 28 minutes. CONCLUSIONS: Data suggest that our new minimally invasive procedure provides a safe, effective and easy to learn alternative for treatment of women with anatomical stress incontinence.

Adult↗
PubMed2000

Restorative proctocolectomy: operative safety and functional outcomes.

Restorative proctocolectomy (total proctocolectomy and ileal J pouch anal anastomosis) has been accepted as the operation of choice in the setting of chronic ulcerative colitis and familial adenomatous polyposis. The purpose of this study was to assess operative safety and functional outcome after restorative proctocolectomy. A total of sixteen patients underwent surgery between January 1996 and December 1999. Hand sewn anastomosis with diverting ileostomy was performed in 9 patients and double stapled anastomosis in 7 patients. The underlying disease was ulcerative colitis in 9 cases and familial adenomatous polyposis in 7. Postoperative complications developed in 8 cases (50%), and intestinal obstruction was found in 4 cases (2 cases were operated upon). Anastomosis related complications were stenosis (n=2), leak (n=1) and perianal abscess (n=1). All patients were followed up at the outpatient clinic using questionnaires, with a mean follow up period of 19.9 months. The frequency of bowel movement was 8.2 per day in hand sewn anastomosis (HS), and 12 per day in double stapled anastomosis (DS) 3 months after surgery (period 1). This frequency decreased to 5.5 per day in HS, and 4.6 per day in DS after one year (period 2). Day and night continence was shown in 12/15, and 5/15, respectively in period 1, but improved to 10/11, and 10/11, respectively in period 2. Night time incontinence was noted in 10 of 15 patients in period 1 (seepage 3/15, soiling 7/15). The need to take anti-diarrheal medication, and to use a pad was noted in 2/15, and 10/15, respectively in period 1, but no patient took antidiarrheal medication or wore a protective pad in period 2. Postoperative urinary function was satisfactory in 13/14 patients. Postoperative sexual function was analyzed in a total of 8 patients, who showed good erection (5/5), ejaculation (5/5) and satisfactory sexual life (5/5). In females, 3 patients showed a satisfactory sexual life. In conclusion, restorative proctocolectomy for chronic ulcerative colitis and familial adenomatous polyposis can be performed safely with excellent functional outcomes, including bowel movement, urinary and sexual functions one year after surgery.

Adenomatous Polyposis Coli↗
PubMed2004

A prospective multicenter randomized trial of tension-free vaginal tape and colposuspension for primary urodynamic stress incontinence: two-year follow-up.

OBJECTIVE: This study was undertaken to compare tension-free vaginal tape (TVT) with colposuspension as the primary treatment for stress incontinence. STUDY DESIGN: The trial was conducted in gynecology or urology departments in 14 centers in the United Kingdom and Ireland. Three hundred forty-four women with urodynamic stress incontinence were randomly assigned to groups: 175 to TVT and 169 to colposuspension. Patients were assessed using the Short Form-36 health status questionnaire, the Bristol Female Lower Urinary Tract Symptoms questionnaire, clinical examination, and a 1-hour perineal pad test. Unpaired and paired data were analyzed with the Wilcoxon rank sum and matched pairs tests, respectively, and proportions were compared with the Fisher exact test. RESULTS: When data were analyzed on an intention-to-treat basis, assuming patients with missing data to be treatment failures, 63% of the TVT group and 51% of the colposuspension group were objectively cured at 2 years (odds ratio 1.67, 95% CI 1.09-2.58). CONCLUSION: The TVT procedure appears to be as effective as colposuspension for the treatment of urodynamic stress incontinence at 2 years.

Female↗