Diagnosis Of Stress Urinary Incontinence Research Articles

Value of UVJ-M in the diagnosis of SUI in late pregnancy and postpartum

Stress urinary incontinence (SUI) is a common pelvic floor dysfunctional disorder in which leakage of urine occurs when there is abdominal pressure. The aim of the present study was to determine the value of stress urinary incontinences (SUIs) in late pregnancy and postpartum via detection of the mobility of the ureterovesical junction (UVJ-M) by using transperineal ultrasound. The study involved the continuous and random selection of 120 cases of early pregnant women and single births. The patients were divided into the SUI and non-SUI groups dependent on whether there was leakage of urine when abdominal pressure in the form of coughing, laughing and sneezing, was increased. UVJ-M was measured, the receiver operating characteristic (ROC) curve was drawn up and the threshold value was predicted. The results showed that, the SUI prevalence was 7.5 (9/120), 22.5 (27/120), 43.3 (52/120), and 5.8% (7/100), respectively, in 34, 36, and 38 gestational weeks, and 6 weeks after delivery. The SUI prevalence gradually increased with the gestational weeks, and differences were statistically significant. UVJ-M values increased with the gestational weeks, at 3.43±1.52, 6.77±0.98 and 2.35±1.04 mm, respectively. Statistically significant differences were identified. Results of the ROC analysis, based on measurement of UVJ-M between the late pregnancy and non-SUI groups, revealed that the optimal threshold was 8.66 mm, corresponding to a sensitivity of 89.5% and specificity of 66.7%. In conclusion, UVJ-M ≥6.59 mm was identified as the predicted value of SUI during late pregnancy, and UVJ-M ≥8.66 mm the predicted value of SUI after delivery.

Predictive value of clinical history compared with urodynamic study in 1,179 women.

to determine the positive predictive value of clinical history in comparison with urodynamic study for the diagnosis of urinary incontinence. retrospective analysis comparing clinical history and urodynamic evaluation of 1,179 women with urinary incontinence. The urodynamic study was considered the gold standard, whereas the clinical history was the new test to be assessed. This was established after analyzing each method as the gold standard through the difference between their positive predictive values. the positive predictive values of clinical history compared with urodynamic study for diagnosis of stress urinary incontinence, overactive bladder and mixed urinary incontinence were, respectively, 37% (95% CI 31-44), 40% (95% CI 33-47) and 16% (95% CI 14-19). we concluded that the positive predictive value of clinical history was low compared with urodynamic study for urinary incontinence diagnosis. The positive predictive value was low even among women with pure stress urinary incontinence.

Validation of the Brazilian version of the Gaudenz-Fragebogen used in the differential diagnosis of female urinary incontinence

Objective: To validate the Brazilian version of the Gaudenz-Fragebogen questionnaire, used in the differential diagnosis of female stress and urge urinary incontinence. Methods: Reliability was validated through the application of test-retest in 60 women. For the evaluation of the concurrent validity criterion, the diagnoses-based on the questionnaire's adapted scores-were compared to the urodynamic study (gold standard) in 116 women with urinary incontinence. Results: The questionnaire was found to be reliable and showed stability. The sensitivity and specificity for the diagnosis of stress urinary incontinence were 9.0% and 96.7%, and for urge urinary incontinence, 44.7% and 70% respectively. Conclusion: The questionnaire is reliable and stable, and it is suitable to be included in the phases that precede the final diagnosis. However, its use is not recommended as a single resource to determine the differential diagnosis of female urinary incontinence.

High definition urethral pressure profilometry: Evaluating a novel microtip catheter.

Urethral pressure profilometry (UPP) is used in the diagnosis of stress urinary incontinence (SUI). SUI is a significant medical, social, and economic problem, affecting about 12.5% of the population. A novel microtip catheter was developed for UPP featuring an inclination sensor and higher angular resolution compared to systems in clinical use today. Therewith, the location of each measured pressure sample can be determined and the spatial pressure distribution inside the urethra reconstructed. In order to assess the performance and plausibility of data from the microtip catheter, we compare it to data from a double balloon air charged system. Both catheters are used on sedated female minipigs. Data from the microtip catheter are processed through a signal reconstruction algorithm, plotted and compared against data from the air-charged catheter. The microtip catheter delivers results in agreement with previous comparisons of microtip and air-charged systems. It additionally provides a new level of detail in the reconstructed UPPs which may lead to new insights into the sphincter mechanism of minipigs. The ability of air-charged catheters to measure pressure circumferentially is widely considered a main advantage over microtip catheters. However, directional pressure readings can provide additional information on angular fluctuations in the urethral pressure distribution. It is shown that the novel microtip catheter in combination with a signal reconstruction algorithm delivers plausible data. It offers the opportunity to evaluate urethral structures, especially the sphincter, in context of the correct location within the anatomical location of the pelvic floor. Neurourol. Urodynam. 35:888-894, 2016. © 2015 Wiley Periodicals, Inc.

PIH26 - Cost-Effectiveness Analysis of Surgical Management of Stress Urinary Incontinence With Single-Incision Mini-Sling Versus Tension-Free Vaginal Obturator in Spain

Objectives: Stress Urinary Incontinence (SUI) is highly prevalent, noticeably deteriorating quality of life. The current surgical treatment is performed through minimally invasive techniques that are quite rapidly evolving. The objective of this study is to analyze the comparative efficiency, from the perspective of the health system, of surgical treatments for patients with SUI through the use of the single-incision mini-sling (SIMS), MiniArcTM (American Medical Systems, Inc), in relation to the transobturator sling, TVT-O. Methods: Cost-effectiveness analysis based on the results of interventions performed with TVT-O (2005-2008) and MiniArcTM (2008-2011) in women with a diagnosis of SUI. The clinical result was an objective cure at 12 months (pad-test <1 g/h). The costs were the direct healthcare costs (diagnostic and surgical procedures, medical devices, medications, hospital stay times and staff). Later, different sensitivity analyses were conducted. Results: The two groups were homogenous regarding the principal base characteristics. No statistically significant difference in effectiveness between MiniArcTM (93.2%) and TVT-O (86.5%) was observed. The total annual cost per patient was less with MiniArcTM (2,059€, 95% CI: 1,914; 2,285; 2,543$, 95% CI: 2,364; 2,822) than with TVT-O (2,821€, 95% CI: 2,661; 2,997; 3,484$, 95% CI: 3,287; 3,701), causing an estimated savings of 762€, 95% CI: 516; 987 (-941$, 95% CI: -1,219; -637). The sensitivity analysis showed that the probability of association MiniArcTM with the lowest cost was close to 100% in almost all the cases. Conclusions: The use of MiniArcTM is associated with a 762€, 941$ per patient reduction in the average annual cost, compared to TVT-O, while maintaining a similar effectiveness.

Evaluation and Treatment of Persistent Stress Urinary Incontinence after Male Anti-Incontinence Procedure – AUS or Sling

The two most common anti-incontinence procedures performed for postprostatectomy incontinence (PPI) are placements of the artificial urinary sphincter (AUS) and male sling. While both procedures offer high success rates, 10-30 % of patients after AUS and 20-45 % of patients after male sling require evaluation for persistent PPI. The goals of evaluation for persistent PPI should be to verify the diagnosis of stress urinary incontinence (SUI) and to assess for concurrent bladder dysfunction. If the initial procedure was an AUS, and recurrent intrinsic sphincter deficiency is diagnosed, it is vital to distinguish among mechanical failure, urethral atrophy and erosion. If a repeat sling is considered, it is necessary to verify the degree of intrinsic sphincter deficiency (ISD) and assess for persistent or recurrent proximal urethral mobility. Because of diminished urethral compliance that results from prior AUS or male sling surgery, implantation of an AUS remains the treatment of choice for persistent SUI, as it is the most reliable method of providing the circumferential urethral compression necessary for adequate coaptation even in the setting of urethral fibrosis.

Transobturator Sling Compared With Single-Incision Mini-Sling for the Treatment of Stress Urinary Incontinence

To determine the efficacy and safety of a single-incision mini-sling compared with a transobturator midurethral sling for stress urinary incontinence (SUI) treatment. This prospective single-center randomized controlled trial involved 130 women with a diagnosis of SUI. Primary outcomes were the objective and subjective cure rates, defined as negative cough stress and pad tests, and satisfaction rates. Quality of life assessed by the Incontinence Quality of Life Questionnaire and the Urogenital Distress Inventory Short Form, operation time, complications, and reoperation rates were also recorded. The efficacy was analyzed using a noninferiority test with a margin of 15%. For the noninferiority test, a P value >.05 rejects the noninferiority hypothesis of the mini-sling. Sixty-four patients in the mini-sling group and 56 in the transobturator group completed the 12-month follow-up. The objective cure rates for the mini-sling and the transobturator sling were 68.1% and 81.9% (absolute difference 13.8; 90% confidence interval [CI] 1.5-26.1; P=.439) and the subjective cure rates were 81.1% and 88.5% (absolute difference 7.4%; 90% CI 2.8-17.6; P=.110), respectively. There was a significant improvement in quality of life in both groups. Thigh pain was greater after the transobturator sling, four patients (7.1%) compared with zero (P=.045). The mean operation time was 5 minutes shorter for the mini-sling procedure (P=.000). Five patients (7.8%) in the mini-sling group and one patient (1.8%) in the transobturator group underwent surgical reintervention for persistent SUI (P=.213). The noninferiority of the mini-sling could not be demonstrated in this study at the 12-month follow-up. The mini-sling was associated with shorter operative time and less postoperative thigh pain. ClinicalTrials.gov, www.clinicaltrials.gov, NCT01094353.

Does glycopyrrolate at anesthesia induction increase temporary postoperative urinary retention after a midurethral sling?

Study ObjectiveTo determine whether patients receiving perioperative glycopyrrolate during midurethral sling surgery had more acute but temporary postoperative urinary retention. DesignRetrospective cohort from 2006 to 2011. SettingNorthern Virginia community urology practice. MeasurementsTo minimize variability in surgical technique and postoperative care, all cases were from a single fellowship-trained urologist who performed most of the female incontinence procedures. Inclusion criteria were charts of women, 18 years of age or older, who had a primary preoperative diagnosis of stress urinary incontinence (SUI) and who underwent a midurethral sling procedure. Of 151 patients charts, 135 met study eligibility: 57 (42.2%) patients received glycopyrrolate; 78 (57.8%) did not. The postoperative course of those who did and did not receive glycopyrrolate was compared and formed the basis of group allocation. Data collected included age, body mass index, incontinence type, smoking status, diabetes mellitus, surgery performed, anesthesia type, estimated blood loss, intraoperative fluids, surgery end time to void, and postoperative urinary retention. Main ResultsNo differences existed between the groups in baseline or surgical data. Seven patients (5.2%) had acute temporary postoperative retention, two of whom received glycopyrrolate and 5 did not (3.51% vs 6.41%; relative risk [RR] 0.55, 95% CI 0.11 -2.72, P = 0.70). Excluding those with continued persistent voiding dysfunction beyond 48 hours from surgery, only 3 patients (2.22%) had acute temporary postoperative urinary retention: one received glycopyrrolate and two did not (1.75% vs 2.56%; RR 0.68, 95% CI 0.064 - 7.36; P = 0.99). ConclusionAcute temporary postoperative urinary retention is rare after midurethral slings. Glycopyrrolate during anesthesia induction does not appear significantly to increase this rate.

Pad stress tests with increasing load for the diagnosis of stress urinary incontinence

The aim of the study was to test the ability of pad stress tests with increasing load (supine, jumping on the floor, and jumping on a trampoline) to document stress incontinence in subjectively stress incontinent women. In this prospective study 147 subjectively stress and mixed incontinent women performed consecutively the three pad stress tests with a bladder volume of 300 ml. Nineteen women performed a second trampoline pad stress test to test repeatability of the test. Nine continent women performed a trampoline pad stress test in order to determine if subjectively continent women would leak during the test. Seventy-two women (49%) leaked during the supine, 136 (93%) leaked during the jumping, and 146 (99%) leaked during the trampoline pad stress test. The differences between pad stress tests were significant with P < 0.005. Correlation between the two trampoline pad stress tests was high at 0.8. None of the nine continent women leaked during the trampoline pad stress test. The supine pad stress test has low sensitivity and is therefore often falsely negative. The jumping pad stress test is a simple test to perform and is satisfactory for everyday use. Subjectively stress incontinent women who do not leak during the jumping pad stress test may perform a trampoline pad stress test to document stress incontinence. The trampoline pad stress test is also simple to perform and detected leakage in 91% of the women who did not leak during the jumping pad stress test.

The urethra is a reliable witness: simplifying the diagnosis of stress urinary incontinence. Reply to Wagenlehner et al.

Dear Editor, Dr. Wagenlehner and colleagues commented on my editorial, “The urethra is a reliable witness: simplifying the diagnosis of stress urinary incontinence” [1] by proposing a unilateral midurethral anchor test to predict the outcome after midurethral sling surgery. They present ultrasound observations that this procedure can prevent “funneling” of the bladder neck and urine loss, and they present urodynamic urethral pressure profilometry observations that this procedure increases maximum urethral closure pressure and improves the cough pressure transmission ratio. Similar urodynamic observations were reported 30 years ago by Bhatia and Bergman with the Bonney test [2] and the Marshall–Marchetti test [3], and I suspect the observations by Wagenlehner and colleagues are correct. Whether this test accurately reproduces what happens during a midurethral sling surgery or how predictive it is for surgical outcomes would require studies involving a standardized preoperative performance of this test in a large number of patients who have a midurethral sling so that positive and negative predictive values for the midurethral anchor test could be calculated. I do disagree with the statement that Wagenlehner et al. made in their reply with regards to the standing cough stress test. They stated: “We agree, but in our experience, testing in the standing position confers no additional accuracy against testing in the supine position.” The experience of myself and many others is quite different. The symptom of stress urinary incontinence (SUI) in women is more likely to occur in the upright than the supine position. Bladder pressure is higher when standing than when supine. In the Outcomes following vaginal prolapse repair and mid urethral sling (OPUS) trial of women with prolapse but without symptoms of incontinence, 111 of 331 women had a positive preoperative reduction stress test, but in 33, this only became positive in the standing position [4]. When a positive stress test includes both supine and standing positive results, the test predicts a 72% rate of postoperative SUI at 3 months and a 60% rate at 12 months if a midurethral sling is not inserted at the time of vaginal prolapse surgery (Supplementary Table 5) [5]. To maximize the sensitivity of the stress test in detecting SUI, it should be done standing with a full bladder.

The urethra is a reliable witness: simplifying the diagnosis of stress urinary incontinence.

The urethra is a reliable witness: simplifying the diagnosis of stress urinary incontinence.

Comment on Nager: The urethra is a reliable witness: simplifying the diagnosis of stress urinary incontinence

Dear editor, Dr. Nager’s editorial [1], based on a major study in the New England Journal of Medicine, reduces the concept of urinary stress incontinence (USI) to one simple and obvious fact: it is, and always has been, a mechanical problem. No evidence for this is required other than that USI can be corrected surgically with a midurethral sling. As a mechanical problem, the diagnosis is, as Nager asserts [1], simply a matter of asking the patient to cough with a full bladder and observing urine escaping from the

The Utility Of Elastosonography For Assessing Suburethral Tissue Elasticity In Women With Stress Urinary Incontinence

SUMMARY Objective: To determine clinical and diagnostic value of elastosonography (ES) in women with stress urinary incontinence (SUI). Material and methods: Thirty subjects with SUI and 30 subjects without SUI were compared in terms of elastosonographic suburethral tissue elasticity. SUI and bladder neck hypermobility was determined by pad test, Q-tip and stress tests. Measurements points included under bladder (UB), subcutaneous fatty tissue (SC), and the urethra (U) points. Three indices were calculated using these measurements (UB/SC, U/SC and UB/U). The diagnostic value of ES indices were investigated using receiver operating characteristic (ROC) curve analyses. Results: ES UB/SC (AUC=0.962, P=0.001) and U/SC (AUC=0.953, P=0.001) were significant predictors for stress test positivity. ES UB/SC (AUC=0.883, P=0.001) and U/SC (AUC=0.885, P=0.001) were significant predictors for pad test positivity. ES UB/SC (AUC=0.877, P=0.001) and U/SC (AUC=0.857, P=0.001) were significant predictors for Q tip test positivity. In linear regression analysis, stress test positivity was significantly associated with the ES UB/SC (R2=0.84, beta=0.369, P=0.026) and ES U/SC (R2=0.84, beta=0.496, P=0.003). Conclusion: Elastosonographic tissue elasticity determination is a promising tool in bladder neck hypermobility and SUI diagnosis, and may be used as an adjunctive method in selecting patients appropriate for stress urinary incontinence surgery.

The urethra is a reliable witness: simplifying the diagnosis of stress urinary incontinence

In 1970, Bates, Whiteside, and Turner-Warwick [1] wrote that: “...the bladder often proves to be an unreliable witness...” and this phrase has been used for more than 40 years as a justification for urodynamic studies (UDS) in the evaluation of urinary incontinence. However, two studies published this year in the New England Journal of Medicine have reported the predictive value of direct observation of fluid loss from the urethra in making the diagnosis of stress urinary incontinence (SUI) [2] and occult SUI [3]. The studies suggest that for SUI or occult SUI, appropriate management decisions can be made with an office evaluation that includes demonstrating urine loss from the urethra without additional UDS. It probably should not surprise us that SUI is not a condition that requires urodynamic testing. SUI is a urethral problem and current bladder investigations do not investigate urethral conditions very well. Valsalva leak point pressures only indirectly measure urethral pressure, and urethral pressure profilometry typically only measures urethral function at rest and not during SUI conditions. No quantitative or qualitative measure during urodynamics makes the diagnosis of urodynamic stress incontinence (USI); thus, the diagnosis of USI is still dependent on direct visualization or imaging of fluid loss per urethra with cough or Valsalva. The presence of a catheter in the bladder (UDS) adds nothing of value to the diagnosis of SUI, except that it can confirm the absence of a cough or Valsalva provoked detrusor contraction. One could argue, though, that this type of detrusor event would not produce simultaneous fluid loss with cough, because a detrusor smooth muscle is not a striated muscle and cannot contract fast enough to generate detrusor pressure at the same time as a cough. Thus, there seems to be a limited role for urodynamics for SUI in the setting of a comprehensive history, office evaluation, and examination. Unfortunately, the current medical model encourages diagnostic studies whether or not they are necessary. This editorial proposes that the diagnosis of uncomplicated SUI and occult SUI by an office stress test and the management of it does not require urodynamic testing in most patients.

Assessment of Clinical Effectiveness and Economic Viability of the Obturator Tension Free Vaginal Tape Method for the Treatment of Stress Urinary Incontinence by Cost Benefit Analysis

Stress urinary incontinence (SUI) is an important public health problem that significantly reduces quality of life. Today, there is a growing trend to change the current approach of surgical treatment of SUI in woman by using simple, effective and safe techniques that tend to significantly shorten the duration of hospitalization and reduce treatment cost with faster establishment of working capacity. According to that, the application of economic principles in healthcare has the task of comparison between the therapeutic methods that account their costs, benefit and health consequences. The aim of this study was to evaluate the clinical efficacy and economic viability of obturator tension free vaginal tape (TVT-O) method for treating SUI by using the cost – benefit analysis. The study was a retrospective-prospective study, which included 60 patients who were surgically treated after having a diagnosis of SUI in the period from January 2007 to August 2010 in the Regional Hospital in Bihac. The results identify TVT-O as a method of choice in the treatment of SUI, where the benefit of TVT-O method is up to 4.2 times higher in comparison to the vaginoplasty. Analyzing the clinical efficacy showed a shorter operative time, a shorter length of hospital stay and less complications by using TVT-O method. The outcome results showed that 83% of patients were considered to be cured and 17% had improved health status after TVT-O surgery. According to the parameters of quality of life, patients treated with TVT-O procedure showed a significantly faster return to their social activities and vitalities.

1190 OUTCOMES OF TREATMENT OF STRESS URINARY INCONTINENCE ASSOCIATED WITH FEMALE URETHRAL DIVERTICULA

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Incontinence - Evaluation & Therapy II1 Apr 20121190 OUTCOMES OF TREATMENT OF STRESS URINARY INCONTINENCE ASSOCIATED WITH FEMALE URETHRAL DIVERTICULA Ahmed El-Zawahry, Ross Rames, and Eric Rovner Ahmed El-ZawahryAhmed El-Zawahry Charleston, SC More articles by this author , Ross RamesRoss Rames Charleston, SC More articles by this author , and Eric RovnerEric Rovner Charleston, SC More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1435AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Female Urethral diverticula (UD) may present with different symptoms (sx) including stress urinary incontinence (SUI). Surgical repair of SUI may be done concomitantly with urethral diverticulectomy. However, in some patients (pts) with UD, differentiation of SUI from post-void dribbling is difficult. Additionally, some surgeons may be reluctant to repair SUI at the time of transvaginal urethral diverticulectomy (TVUD) due to the additional surgical time required and potential morbidity of anti-incontinence surgery. We assessed surgical outcomes of the concomitant treatment of SUI at the time of TVUD. METHODS Following IRB approval, we identified pts with a concomitant diagnosis of SUI among 34 consecutive pts at Medical University of South Carolina who underwent TVUD between 2004 and 2009. Sx and the diagnosis of SUI were documented before and after surgery using subjective and objective parameters. Martius flap and autologous pubovaginal slings (APVS) were used selectively based on surgeon and pts preference. Postoperatively, all pts were imaged prior to catheter removal with voiding-cystourethrogram (VCUG). Pts were followed per standard office protocol with follow-up visits at a minimum of 1 week, 3 months (mo) and 15 mo postoperatively. Pts were followed selectively and expectantly thereafter. RESULTS There were 22 pts (65%) with UD and concomitant SUI. Mean age was 52 yo (range 35-77). There were 9 Caucasians, 12 African American and 1 Hispanic. Mean follow-up from TVUD was 18 mo (Range 1-71). Seven pts had previous surgery for SUI including bladder neck suspension (2), a pubovaginal sling surgery (1), transobturator mid-urethral sling +/− perirurethral bulking agent (4). 19/22 underwent APVS in addition to TVUD. 18/22 pts had improvement or resolution of SUI. 3/4 pts with postoperative SUI underwent subsequent APVS, One pt developed de-novo SUI following TVUD. Surgery resulted in the improvement or resolution of the majority of preoperative sx including recurrent urinary tract infection (UTI) (68% vs. 9.5%, p=0.00002), dyspareunia (72% vs. 9.5%, p=0.000004), and frequency (41% vs. 9.5%, p= 0.018) (preoperative vs. postoperative). Complications included one pt with urinary retention following APVS requiring sling lysis and one pt with a recurrent UD 18 mo postoperatively. CONCLUSIONS SUI is often associated with female UD. Surgical reconstruction of UD often results in satisfactory control of urinary sx including SUI when both are treated concomitantly. Treatment of SUI with APVS when undergoing TVUD is feasible with satisfactory outcomes. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e482 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ahmed El-Zawahry Charleston, SC More articles by this author Ross Rames Charleston, SC More articles by this author Eric Rovner Charleston, SC More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Impacto do treinamento dos músculos do assoalho pélvico na qualidade de vida em mulheres com incontinência urinária

OBJETIVO: Avaliar o impacto do treinamento dos musculos do assoalho pelvico (TMAP) na qualidade de vida (QV) em mulheres com incontinencia urinaria de esforco (IUE). METODOS: Ensaio clinico prospectivo com 36 mulheres com diagnostico medico de IUE conrmado no estudo urodinâmico. Nao foram incluidas mulheres com doencas neuromusculares, com uso de reposicao hormonal e com prolapso grau III e IV. O protocolo de exercicios para os musculos do assoalho pelvico foi constituido de contracoes lentas (bras tonicas), seguidas de contracoes rapidas (bras fasicas), realizadas nas posicoes de decubito dorsal, sentada e ortostatica, tres vezes na semana, por um periodo de tres meses. Avaliou-se o impacto do TMAP na QV por meio do King's Health Questionnaire (KHQ), diario miccional e palpacao digital para avaliar a funcao dos musculos do assoalho pelvico, durante a avaliacao inicial e apos os tres meses de tratamento. O resultado foi descrito em medias e desvios-padroes. Utilizou-se o teste de Wilcoxon para comparacao dos escores referentes ao KHQ para amostras pareadas, e adotou-se como nivel de signicância o valor de 0,05. RESULTADOS: Observou-se diminuicao signicativa das medias dos escores dos dominios avaliados pelos KHQ. Esses dominios consistem na percepcao da saude, impacto da incontinencia, limitacoes das atividades diarias, limitacoes fisicas, limitacoes sociais, relacoes pessoais, emocoes, sono/disposicao e tambem medidas de gravidade. Em concordância com esses resultados, foram observados diminuicao signicativa na frequencia urinaria noturna e na perda urinaria, bem como aumento signicativo na forca e endurance muscular. CONCLUSAO: O treinamento muscular do assoalho pelvico proporcionou melhora signicativa na QV de mulheres com IUE.

Impact of pelvic floor muscle training on the quality of life in women with urinary incontinence

To evaluate the impact of pelvic floor muscle (PFM) training on the quality of life (QOL) in women with stress urinary incontinence (SUI). Prospective clinical trial with 36 women with a diagnosis of SUI confirmed by urodynamic study. Women with neuromuscular diseases, using hormone replacement therapy, and with prolapse stage III and IV were not included. The exercise protocol for the PFM consisted of slow contractions (tonic fibers), followed by rapid contractions (phasic fibers) practiced in the supine, sitting, and standing positions, three times a week for a period of three months. We evaluated the impact of PFM on QOL using the King's Health Questionnaire (KHQ), a voiding diary, and digital palpation to assess the function of the PFMs during the initial evaluation and after three months of treatment. The result was described as means and standard deviations. We used the Wilcoxon test for comparison of the KHQ scores for paired samples, and the significance level was set at 0.05. There was a significant decrease in the mean scores of the domains assessed by the KHQ regarding the perception of health, impact of the incontinence, limitations of daily activities, physical limitations, social limitations, personal relationships, emotions, sleep/disposition, and measures of severity. In agreement with these results, significant decrease in nocturnal urinary frequency and urinary incontinence, as well as significant increase in muscle strength and endurance were observed. PFM training resulted in significant improvement in the QOL of women with SUI.

The argument for surgical therapy for stress urinary incontinence in females.

Stress urinary incontinence (SUI) affects 4% to 35% of women.1 Many patients find it difficult to bring up the topic of incontinence, so it is imperative that when the complaint is brought forward, we deal with it swiftly and in the most effective manner possible. In 2007, Harris and colleagues published that only 45% of women and 22% of men with incontinence disclosed it to a health care provider; of those, only 60% received treatment. Furthermore, half of those 60% felt that they continued to have daily leakage and remained frustrated.2 Surgery for SUI is fast and effective. Once the SUI diagnosis has been made and other significant dysfunction has been ruled out, the patient and provider must agree on an initial therapeutic approach. Surgery should not be offered immediately to: (1) women of childbearing age who have not completed their family planning; (2) women with significant comorbidities and high surgical risk; and (3) women with overactive bladder (OAB) and mixed urinary incontinence, where the OAB has not been first addressed. Notwithstanding these contraindications, surgery for SUI is often straightforward and the best option. All incontinence surgeons love the words, “Can’t I just have surgery?” Before we pour on the accolades for mid-urethral sling (MUS) surgery and declare it a winner (can you beat success rates of 77% cure rate at 11 years from Finland3 or the 85% cure rate at 7 years from Greece4), we are obliged to look at the alternatives. We all attempt to modify our patient’s behaviours, such as reduce their coffee intake, increase weight loss and suggest pelvic floor physiotherapy. Yet each surgeon wonders: “When will this fail and when can I book her surgery?” Behaviour modification is not successful because patients need to understand, learn about their condition, perform regular and intentional physical exercises and consciously make challenging lifestyle adjustments. Most people are incapable of taking on this responsibility or are unwilling to pay for uninsured services.

Comparison between two different neuromuscular electrical stimulation protocols for the treatment of female stress urinary incontinence: a randomized controlled trial

Neuromuscular electrical stimulation (NMES) is widely treatment for stress urinary incontinence (SUI) but there is no consensus in literature regarding the most effective treatment parameters. To compare two NMESintra-vaginal protocols for the treatment of SUI in women. The study included 20 volunteers with an average age of 55.55±6.51 years and with the clinical diagnosis of SUI. Volunteers were randomly divided into two groups: group 1 (G1) received NMES with medium-frequency current and group 2 (G2) received NMES with low-frequency current. Functional assessments of pelvic floor muscles (PFM) were performed by perineometry. The severity of signs and symptoms were objectively evaluated using the 1 hour pad test and subjectively evaluated using a visual analog scale that measured the discomfort caused by the SUI. Shapiro-Wilk test was used to analyze data normality, and the Friedman test was used to analyze nonparametric data. For analysis of symptoms related to SUI the Fisher exact test and the Mann-Whitney test were used. Significance level of 5% was set for all data analysis. No significant differences (p>0.05) were found between groups for any of the variable assessed. The within group analysis of initial and final evaluations (after NMES) demonstrated significant differences (p<0.05) in amount of urine lost, the discomfort caused by urinary incontinence and perineal pressure for both treatment groups. The two NMES protocols applied were equally effective in the treatment of SUI.