Cause Of Incontinence Research Articles

Sacral nerve stimulation for fecal incontinence

to analyze short-term outcomes and complications for our first fifty patients with fecal incontinence undergoing sacral root stimulation. fifty patients with fecal incontinence receiving sacral neuromodulation in 4 hospitals are reviewed. Discussed variables include: age, sex, incontinence duration, incontinence cause, prior surgery for incontinence, Wexner scale score, anorectal manometry parameters, and endoanal ultrasonographic findings. Following the procedure Wexner scale score, anorectal manometry parameters, and associated complications are reviewed. mean age of patients is 59.9 years, with females predominating. Most common causes of incontinence include obstetric procedures, idiopathic origin, and prior anal surgery. Mean follow-up is 17.02 months. Follow-up revealed a statistically significant reduction in Wexner scale score and increase in voluntary anal pressure. Technique-derived minor complications included: 2 surgical wound infections that led to stimulator withdrawal; 2 patients with pain who were managed conservatively; 1 case of externalization in a gluteal stimulator; and 1 broken tetrapolar electrode. sacral nerve stimulation is a simple technique that improves Wexner scores in a statistically significant manner with a low complications rate.

Urinary incontinence following surgery for BPH: the role of aging on the incidence of bladder dysfunction

The reported incidence of urinary incontinence (UI) due to bladder dysfunction following surgery of BPH is variable. We described the causes of incontinence in a large group of men that developed this unusual complication and analyzed the influence of age on the prevalence of bladder dysfunction. We evaluated a total of 125 patients with urinary incontinence following surgical treatment for BPH: Transurethral resection of the prostate (81 men) and open prostatectomy (44 men). A third group of 21 patients with incontinence following radical prostatectomy was used for comparison. All patients underwent urodynamic analysis. Urethral Sphincter Insufficiency (USI) was defined as involuntary loss of urine induced by Valsalva maneuver in the absence of a detrusor contraction. Bladder dysfunction was defined as detrusor overactivity and/or decreased compliance. Urethral sphincter insufficiency was the most common etiology of urinary incontinence in the three groups of patients. However, bladder dysfunction was observed in 59.3%, 56.8% and 57.1% of patients who underwent transurethral resection, open prostatectomy and radical prostatectomy, respectively. Median patient age was 69 and 75 years for patients with and without bladder dysfunction, respectively. A logistic regression model for the presence of bladder dysfunction showed that age was a statistically significant predictor. Urethral Sphincter insufficiency is the main cause of incontinence following surgery for BPH. Bladder dysfunction may be the isolated cause of incontinence in approximately 25% of patients. The chances of bladder dysfunction rises 5.3% for each year added to patient age. Patients older than 70 years have twice the probability of post procedural incontinence.

Urinary dysfunction: assessment and management in stroke patients

Continence care is a high priority during the rehabilitative process following stroke. Effective continence care can significantly improve the quality of life of patients and carers. A lack of knowledge and understanding of the likely causes of incontinence can lead to a failure to adopt the correct care strategies, which may in turn cause incontinence. Nurses are given little training and support in continence care, yet a basic level of training and the ability to assess potential problems may improve rehabilitation progress and outcomes.

Efficacy of the InVance™ Male Sling in Treating Stress Urinary Incontinence: A Three-Year Experience from a Single Centre

Introduction: The aim of this study was to evaluate the efficacy of the InVance™ male sling in treating stress urinary incontinence. Patients and Methods: We retrospectively reviewed operative logs from a single surgeon of 43 patients treated over a 3-year period (Feb. 2004 to Nov. 2006) for stress incontinence by implantation of a male bulbourethral bone-anchoring sling (InVance™). The mean follow-up time was 24.2 months (range 4–38). Radical prostatectomy was the most common cause of incontinence in this group (33/ 43 cases; 76.7%). Efficacy was evaluated objectively in terms of the number of pads used per day, while subjective patient satisfaction was also recorded. We also investigated a possible correlation between preoperative parameters and outcome. Results: Twenty-two patients (51.2%) were cured (totally dry: 30.2%; the remainder: 1 pad per day), while 8 (18.6%) patients improved but still required two pads per day. Overall, 30 of 43 patients (69.6%) were satisfied with the outcome of the operation. Postoperative infection was the most common complication (11.6%). The severity of preoperative incontinence correlated with the outcome of the operation, with mild incontinence giving better results. Conclusions: The bone-anchored male sling is an effective and minimally invasive treatment for mild-to-moderate male urinary incontinence.

Artificial Bowel Sphincter Implantation for Faecal Incontinence in Asian Patients

To evaluate the outcomes with the American Medical Systems artificial bowel sphincter (ABS) implantation for the treatment of intractable faecal incontinence in an Asian population. Six Asian patients who underwent ABS implantation between March 2004 and December 2007 for the treatment of faecal incontinence were reviewed. The ABS was successfully implanted in six patients [mean age 50 (20-73) years; 4 males]. The most common causes of incontinence were congenital anomaly of the anus (imperforate anus status post a pull-through procedure) and status-post ultralow anterior resection. Two patients required device explantation due to postoperative infection. One eventually required a colostomy. After a mean follow-up of 22 (4-36) months, four patients continued to have a functional artificial bowel sphincter. Faecal incontinence severity scores improved from a mean of 13 (12-14) to 6 (0-9) postactivation. Anal manometry showed an increase in mean resting pressures (19.2 +/- 7.5 mmHg vs. postimplantation with cuff inflated 45.0 +/- 12.0 mmHg). The comparative preoperative and postactivation faecal incontinence quality of life scores showed improvement in all aspects. Patients with successful ABS implantation benefited from improved outcomes in function and quality of life. Infection was the most common cause of failure in our patients.

A comparative study between continent diversion and bladder neck closure versus continent diversion and bladder neck reconstruction in children

Objective To assess the long-term outcome of continent diversion in children with structural or neurogenic cause of incontinence, with special interest in differences between closed and open bladder neck procedures. Patients and methods A cohort of 63 children with intractable incontinence treated with continent diversion between January 1998 and January 2008 were reviewed for underlying disease, type of surgery, complications and outcome. Results Forty patients had a continent diversion with open bladder neck (group 1) and 23 patients had their bladder neck closed (group 2: 11 primarily closed; 12 secondarily closed). There was no difference between the two groups in terms of patient characteristics, surgical re-interventions and stone formation. The continence rate however was significantly better in group 2 (95.6% vs 77.5%). Conclusion Bladder neck closure with continent diversion as primary or salvage procedure in children with intractable incontinence does not result in extra morbidity and has a high success rate. Thorough urodynamic evaluation of bladder function is the key to success in therapy planning for these children, to minimize the need for re-intervention.

Efficacy of the bulbourethral autologous sling in treating male stress urinary incontinence: a three-year experience from a single center

To evaluate the efficacy of the bulbourethral rectus autologous sling in treating male stress urinary incontinence. We retrospectively reviewed operative logs from a single surgeon of 32 male patients treated over a 3-year period (March 2001 to March 2004) for stress incontinence by implantation of a bulbourethral free rectus sling. The mean age of the patients was 46.4 (range 14-76); mean follow-up time was 29.5 months (range 24-52). Neurogenic dysfunction was the most common cause of incontinence in this group (17/32 cases; 53.1%). Efficacy was evaluated objectively in terms of the number of pads used per day, subjective patient satisfaction, and morbidity. We also investigated a possible correlation between pre-operative parameters and outcome. Ten patients (31.3%) were cured (totally dry, 15.6%; the remainder one pad per day), while five (15.6%) patients improved but still required two pads per day. Overall, 15 of 32 patients (46.9%) were satisfied with the outcome of the operation. In total, seven patients presented a mild complication (21.9%). De novo urgency was the most common complication presented in four of 32(11.6%). No case of urethral erosion was encountered. Univariate analysis failed to find any correlation between the final outcome and the following parameters: patient age, duration of incontinence, earlier anti-incontinence surgery, severity of pre-operative incontinence, pre-operative Valsalva leak point pressure, decreased compliance, decreased bladder capacity, and pre-operative evidence of detrusor overactivity. In conclusion, the free rectus fascia bulbourethral sling is a modestly effective technique for the treatment of male stress incontinence with mild morbidity. The use of this method seems that it is suitable for selected cases.

Biofeedback Therapy in Constipation and Fecal Incontinence

Chronic constipation and incontinence are common symptoms especially in western countries.1 However, these problems are increasing among Asians probably due to the rise in aging population and westernization of diet. The pathogenesis of constipation varies in patients with colonic transit delay, dyssynergic defecation, or both, while the cause of incontinence is often weakening or structural defect of anal sphincters.2

Predictors of the outcome of percutaneous nerve evaluation for faecal incontinence

The aim was to identify patient-related and operative factors that might predict the outcome of percutaneous nerve evaluation (PNE). Demographic data (age, sex, body mass index), primary cause of incontinence, number and type of incontinence episodes, results of endoanal ultrasonography and manometry, and operative factors from 244 patients who underwent PNE for faecal incontinence were reviewed. Each factor was assessed according to the outcome, and explored by univariable and multivariable analysis to identify predictors. Some 191 patients (78.3 per cent) had a successful PNE. A low amplitude of sensory threshold during PNE (odds ratio (OR) 0.69 (95 per cent confidence interval 0.59 to 0.81); P < 0.001) and lead placement anterior to the sacral cortex (OR 9.06 (4.70 to 17.45); P < 0.001) were positive predictive factors for successful outcome of PNE. Neither a defect nor an abnormality of either the external (OR 0.88 (0.39 to 1.97); P = 0.749) or internal (OR 0.62 (0.27 to 1.42); P = 0.255) anal sphincter was a negative predictive factor. Demographic variables, number of incontinence episodes and the motor response threshold did not predict outcome. No preoperative predictor of PNE outcome could be identified. Predictors were limited to operative lead placement and sensory response during PNE.

A Comparative Study Between Continent Derivation and Bladder Neck Closure and Continent Derivation and Bladder Neck Reconstruction in Children

Purpose To assess the long-term outcome of continent diversion in children with structural or neurogenic cause for incontinence with special interest in differences between closed or open bladder neck. Material and Methods A cohort of 63 children with intractable incontinence treated with continent diversion between january 1998 and january 2008 was reviewed for underlying disease, type of surgery, complications and outcome. Results 40 patients have had a continent diversion with bladder neck reconstruction (group 1), 23 patients have had their bladder neck closed (group 2: 11 primarily closed=2A, 12 secondarily closed =Group 2B). There was no difference in patient's characteristics, in surgical complications or reinterventions or in stone formation ( table 1 ). The continence rate however was significantly better in group 2 (95.7% vs 78.5%). Table 1 . Surgical interventions following continent diversion with and without BN closure. Closed BN (n=23) #procedures (#patients) Open BN (n=40) #procedures (#patients) p-value Cystotomy for stones 2 (2) 3 (3) Ns Endoscopic stone treatment 4 (3) 6 (4) Ns Bladder neck revision 4 (4) 3 (3) Ns Open revision for stomal stenosis 6 (4) 13 (8) Ns Endoscopic revision for stomal stenosis 1 (1) 7 (5) Ns External stomal orifice revision 6 (5) 11 (8) Ns Revision for stomal leakage 2 (1) 7 (6) Ns Other related surgery (augmentation, ureter reimplantation, bladder perforation, …) 7 (2) 11 (10) Ns Total 31 (14) 61 (16) P=0,04 Conclusions In children treated with a continent diversion for intractable incontinence, bladder neck closure as primary or as salvage procedure does not result in extra morbidity and has high success ratio. Good urodynamic evaluation of bladder function is an important key to success in therapy planning for these children and thus minimizing the need for reintervention.

Long-Term Results after Anterior Sphincteroplasty for Anal Incontinence

To assess the long term incontinence and quality of life (Qol) results after elective anterior sphincteroplasty for anal incontinence. Short and long term follow-up included respectively 28 and 25 of the 29 patients who were operated between 1989 and 1998 in our institution. Qol was assessed with gastro intestinal quality of life index (GIQLI). Incontinence was graded according to Parks score supplied with St Mark's score at long term follow-up. 21 (73%) patients had a history of obstetric sphincter tears. Mean age at operation was 45 years (range 6-77). Median time from operation to short term follow-up was 26 months (mean 38 months, range 2-113) and 84 months (mean 105, range 74-185) to long term follow-up. At short term follow-up 19 of 28 patients (68%) were continent for stool compared with nine of 25 patients (36%) at long term follow-up. Nine of 17 (53%) who were continent for stool at short term follow-up remained continent for stool at long term follow-up. Patients with a history of obstetric sphincter tear had less severe incontinence at long term follow-up compared to women with other causes of incontinence (St. Mark's score 8 and 16 respectively, p = 0,015). Patients with no incontinence or gas incontinence only, had higher quality of life score at both follow-ups than those who where incontinent for stool (p = 0,007 and p= 0,014 respectively). More than half of the patients remained continent for stool at long term follow-up. Continence for stool was associated with high Qol score.

Incontinence and Anal Sphincter Pressure Predicts Rectal Sensitivity During High Resolution Anorectal Manometry

Purpose: The etiology behind fecal incontinence has classically been interpreted as being secondary to a variation in the mechanical or neurological functionality of the anal sphincter. This has consequently been observed as decreased anal sphincter pressure utilizing anorectal manometry. While the clinical manifestation of reduced anal sphincter pressure is soiling, several patients with fecal incontinence complain of urgency as well. Whether this urgency is attributable to true rectal hypersensitivity or the perception of soiled material is not clear. The purpose of this study was to evaluate rectal sensitivity in patients with fecal incontinence. Methods: Consecutive FI patients referred to a tertiary care medical center presenting for high resolution anorectal manometry were eligible for analysis. Subjects were excluded if they reported a diagnosis of IBS meeting Rome I criteria, or contained possible inflammatory pathology of the rectum-including ulcerative colitis, HIV, and infection. After exclusion criteria were met, subjects were then divided into two groups: those presenting with clinical fecal incontinence and those who were not presenting for clinical fecal incontinence. Anorectal information and reason for the test was captured. The data were then compared between groups for maximum anorectal squeeze pressure, maximum resting anorectal pressure, balloon threshold for sensation of urge, and balloon threshold for first sensation. Results: 188 subjects were referred for high resolution anorectal manometry and entered into the database. Of the 188 subjects evaluated, 14 were excluded. Among the remaining 174 subjects, 83 (48%) were evaluated for clinical fecal incontinence or soiling, while 91 (52%) failed to present with this history. Incontinent subjects had significantly lower resting (49.6±3.2 vs. 69.3±3.1) and squeeze pressures (117.9±6.9 vs. 179.0±8.6) compared to control subjects in the anal sphincter (see Table 1). However, incontinent patients also manifested significant rectal hypersensitivity (see Table 1). Furthermore, only 8.7% of incontinent patients showed greater than normal volume for urge.Table 1Conclusion: Patients who reported clinical fecal incontinence manifested rectal hypersensitivity. This points to a possible adaptive rectal hypervigilance process and argues against sensorimotor neuropathy as a key cause of incontinence.

Evaluation of the Differences between the Urodynamic Findings of Neurogenic and Idiopathic Subtypes of Detrusor Overactivity

Aims: The aim of this study is to evaluate the differences between the urodynamic patterns and findings of the subtypes of detrusor overactivity(DOA). Methods: An analysis of the urodynamic data of 82 patients who presented for evaluation of symptoms of urinary frequency, urgency and/or urge incontinence was done. The diagnosis of DOA is based on urodynamic findings considering the classification of DOA by EAU. Of the 82 patients, 50 had idiopathic DOA and 32 had neurogenic DOA. The specific data included the frequency and amplitude of uninhibited contractions, complience, cystometric capacity, reflex volume, presence of uninhibited contraction that cause incontinence determined in urodynamy, sex and age. Results: There were 50 patients(28 women, 22 men) with a mean age of 45.0 ± 8.8 (ranging 20 to 65) years in idiopathic DOA group and 32 patients (10 women, 22 men) with a mean age of 39.7 ± 7.4 (ranging 22 to 61) years in neurogenic DOA group. The most frequent symptoms were urgency, urge incontinence, nocturia. There were no differences between 2 groups in frequence values of uninhibited contractions (0.77), reflex volume (0.665), and age (0.297). On the other hand, there were main differences in each group in terms of sex (p = 0.028 ), uninhibited contractions that cause incontinence (p = 0.00 ), amplitude (p = 0.00 ), cystometric capacity (p = 0.003 ), complience (0.004). Conclusion: DOA is a frequent cause of incontinence with symptoms of frequency, urgency and urge incontinence. The urodynamic findings of DOA is important to identify the subtypes of DOA.

The role of the care worker in continence assessment

Improved training and knowledge on the causes of incontinence can mean that care assistants are well placed to contribute to continence assessment. Wendy Keegan discusses the invaluable role of the care assistant.

NVQ explained, part 9: managing continence issues

Elizabeth Whitehead introduces HSC219, which looks at the carer's role in supporting people with continence issues. Understanding causes of incontinence can help carers to reduce episodes of incontinence and help residents to regain control, confidence and self-esteem.

Correlations between the ICIQ‐UI short form and urodynamic diagnosis

Urinary incontinence is a common symptom in many diseases as well as in general population. To measure the impact of urinary incontinence (UI) on individual's quality of life the English short form International Consultation on Incontinence questionnaire (ICIQ-UI Short Form) has been developed, which consists of three scored and one self-diagnostic question. Our aim was to translate the ICIQ-UI Short Form into Slovene, re-validate it, and test the diagnostic value of the questionnaire in determining the type of UI. ICIQ-UI Short Form was translated into Slovene and re-validated. In the validation process we included urology and gynecology outpatient clinics attendants, elderly institutionalized patients, and a community sample. One group of patients underwent urodynamic testing and the results were compared to their responses to question six of the ICIQ-UI Short Form. Both sets of answers were compared using the Kappa (kappa) statistics. The Slovene version of the ICIQ-UI Short Form was found to be valid (excellent test-retest reliability, good internal consistency, good responsiveness to change, and reflected well underlying theories). The questionnaire correlated well with urodynamic findings. The perceived cause of leakage (Question 6) was a good indicator of objectively proven cause of incontinence (Kappa value 0.77). We found that the Slovene version of the ICIQ-UI Short Form is a valid and reliable questionnaire for assessment of UI. In addition to its ability to assess the impact of UI on individual's quality of life it also has a diagnostic value of the cause of incontinence.

Pathophysiology and Management of Urinary Incontinence in Case of Distal Penile Epispadias

We evaluated boys with distal epispadias and urinary incontinence to determine the cause, and designed a simplified bladder neck reconstruction to restore urinary continence. Six boys with epispadias of the glans or distal penile shaft whose incontinence persisted after successful single stage epispadias repair were evaluated with cystoscopy and urodynamics after failed attempts at toilet training. Surgical management--simplified bladder neck reconstruction--involved suprapubic excision of an identified deformity of the roof of the bladder neck and posterior urethra, followed by reapproximation of the remaining normal bladder neck and posterior urethral tissues. All boys displayed a characteristic deformity of the roof of the bladder neck and posterior urethra, which extended distally through the membranous urethral sphincter toward the urethral meatus. Five of the 6 boys were treated surgically, and promptly achieved normal continence and urinary control that remained durable through a mean followup of 9.6 years. Histologically, the roof deformity exhibited abnormalities including attenuation and reduction of smooth muscle. The meatus is not the only site involved in distal epispadias, which presents as a field defect that deforms the roof of the urethra distal to the bladder neck. Incontinence in distal epispadias has a dual etiology, namely anatomical dilatation and distortion of the bladder neck and posterior urethra, and histological abnormality of the roof tissues. These conditions combine to affect adversely coaptive and constrictive functions of the posterior urethra and urinary sphincter. Excision and reapproximation of the roof deformity appears to be proof in principle of the cause of incontinence, and offers an alternative approach to treating incontinence in these patients without the need for more invasive surgical procedures.

Propuesta de una nueva clasificación de consenso para la incontinencia fecal

Due to the complexities of the mechanisms involved in incontinence, there are many potential causes for this disorder. The causes of incontinence and the grouping of patients according to aetiological factors are described in the literature in various forms, without there being a consensus as such. Therefore, the objective of this review is to propose a new classification of faecal incontinence to the scientific community, which will enable criteria to be unified, which should lead to an improvement in the diagnosis and treatment of patients with faecal incontinence. It is an aetiopathogenic classification that can be obtained from the clinical history of the patient along with an endoanal ultrasound.

Valoración morfológica mediante resonancia magnética de la incontinencia fecal en pacientes con atresia anal corregida

To describe the findings obtained with magnetic resonance imaging (MRI) in patients with ano-rectal atresia, after treatment by posterior sagittal anorectoplasty (PSARP), who have fecal incontinence and to describe its usefulness in the evaluation of causes of incontinence. Twelve patients, 9 men and 3 women, with anorectal atresia were examined with 0.5T MRI after performing PSARP for imperforate anus. The study included T1-weighted, T2-weighted and proton-density, axial, sagittal and coronal planes. The location of descended neorectus and the degree of development of pelvic musculature were evaluated. Normal development of anus levator muscles and sphincterian complex were observed in six patients, with correct situation of neorectus between anus levator muscles and sphincterian complex in five of them and eccentric in the other one. Diverse grades of striate muscular complex underdevelopment were showed in the other six cases, moderate grade in four of them and severe hypoplasia in the other two. Spinal and urogenital congenital anomalies were found in these patients. Sagittal and coronal T1-weighted MR images were the most useful planes in evaluating the relationship between anus levator muscles and sphincterian complex and axial T1-weighted MR images in the evaluation of the level of development of striated muscle complex in the evaluation of patients. MRI is useful in the evaluation of patients with fecal incontinence after performing PSARP for anorectal atresia. Unsuitable neorectus position or striated muscle complex hypoplasia are causes of postoperative incontinence in these patients.

Carbon-Coated Microbeads Anal Injection in Outpatient Treatment of Minor Fecal Incontinence

Anal bulking agents are injected to pose a stronger obstacle to the involuntary passage of feces and gas. This prospective, multicenter study was designed to evaluate the safety and efficacy of Durasphere anal injection for the treatment of fecal incontinence. Thirty-three unselected patients with incontinence (24 females; mean age, 61.5 +/- 14 (range, 22-83) years) underwent anal bulking agent submucosal injection with carbon-coated microbeads (Durasphere) in the outpatient regimen. The causes of incontinence were obstetric lesions in 18.2 percent, iatrogenic in 36.4 percent, rectal surgery in 12.1 percent, and idiopathic in 33.3 percent. Previous unsuccessful treatments for fecal incontinence included diet and drugs in 16 patients, biofeedback training in 7 patients, sacral nerve modulation in 6 patients, sphincteroplasty in 2 patients, artificial bowel sphincter in 1 patient, and PTQ macroplastique bulking agent in 1 patient. Under local anesthesia and antibiotic prophylaxis, a mean of 8.8 (range, 2-19) ml of Durasphere were injected into the submucosa by using a 1.5-inch, angled, 18-gauge needle. After a median follow-up of 20.8 (range, 10-22) months, the median Cleveland Clinic continence score decreased significantly from 12 to 8 (P < 0.001) and the median American Medical System score from 89 to 73 (P = 0.0074), but the Fecal Incontinence Quality of Life did not change significantly (74 to 76, P = not significant). Anal manometry significantly improved (resting pressure increasing from 34 to 42 mmHg; P = 0.008) and squeezing pressure from 66 to 79 mmHg (P = 0.04). Two patients complained of moderate anal pain for a few days after the implant, one patient had asymptomatic leakage of the injected material through a mucosa perforation, and two had distal migration of the Durasphere along the dentate line. Anal bulking agent injection is a safe treatment and can mitigate the severity of fecal incontinence by increasing anal pressure but does not significantly improve the quality of life.