Different Types Of Urinary Incontinence Research Articles

Bladder neck incompetence could be an etiology of overactive bladder syndrome in women with stress urinary incontinence after anti-incontinence surgery: insights from transrectal sonography.

To investigate the prevalence of bladder neck incompetence (BNI) and the anatomic differences between different types of urinary incontinence (UI) and overactive bladder (OAB) by transrectal sonography, and to investigate these differences among those with stress UI (SUI) or mixed UI (MUI) who exhibited de novo or persistent OAB symptoms following anti-incontinence surgery. A retrospective analysis was conducted on a total of 184 patients with SUI, MUI, urge UI (UUI), or OAB dry who underwent transrectal ultrasound between 2017 and 2022. The presence of BNI and urethral incompetence assessed by transrectal ultrasound were recorded in all included patients, and recorded preoperatively and postoperatively among patients with SUI and MUI who underwent anti-incontinence surgery. Among the patients, 91%, 84%, 76%, and 71% exhibited BNI in MUI, SUI, UUI, OAB dry group, respectively. Significantly higher rate of patients with BNI were found in MUI than in OAB dry group. Patients with OAB symptoms after anti-incontinence surgery exhibited significantly higher rates of BNI and urethral incompetence than those who did not have postoperative OAB symptoms. Among MUI patients with preoperative BNI, significantly lower rate of postoperative BNI and urethral incompetence was observed in individuals who had improved OAB symptoms after surgery, compared to those without improvement. A higher BNI rate was observed in the MUI group. A significantly higher BNI rate was observed in women with OAB symptoms after anti-incontinence surgery. Patients with MUI had improved OAB symptoms if BNI was successfully corrected after anti-incontinence surgery.

PREVALENCE AND RISK FACTORS OF URINARY INCONTINENCE AMONG WOMEN

Aim: To identify prevalence of different types of urinary incontinence and risk factors associated with them. Study Design: This was a cross sectional study conducted between March 2021 to March 2022 at outpatient department of Obstetrics and Gynaecology at SMS medical college, Jaipur. 100 women with complaint of leakage of urine were enrolled in study and data was collected as face to face interview with questionnaires. The data is expressed as mean, median, standard deviation. P values are calculated and <0.05 are considered signicant. Results: Majority of women had stress urinary incontinence (48%) followed by urge and mixed incontinence (30%,22% respectively). Majority of women were housewives (83.3%). Socioeconomic status, BMI , education status (p value- 0.001, 0.024, 0.004) were found to be signicantly associated with urinary incontinence. Age, Duration, High BMI and Higher parity was signicantly associated with severity of urinary leakage. History of UTI/ cystitis has been signicantly associated with urge incontinence (p value of 0.021) and women with history of constipation has been signicantly associated with stress incontinence (p value of 0.01). Medical disorders did not show any signicant association in the study. Conclusion: Stress urinary incontinenec is found to have the highest prevlance. Age, BMI, parity, educational status, occupation and previous infections and surgical history are various risk factors for same

Comparison of patient characteristics, urinary incontinence behaviors, and quality of life among different types of urinary incontinence

Amaç: Çalışmanın amacı, stres üriner inkontinans (SÜİ), urgency üriner inkontinans (UÜİ) ve mikst üriner inkontinans (MÜİ) şikâyeti olan kadınlarda hasta özellikleri, inkontinans davranışları ve yaşam kalitesi arasındaki farkları karşılaştırmaktı. Yöntem: Çalışmaya üriner inkontinans şikâyeti olan toplam 642 kadın (191 SÜİ, 208 UÜİ, 243 MÜİ) dahil edildi. Katılımcıların demografik, obstetrik ve jinekolojik özellikleri kaydedildi. Üriner inkontinans davranışları ve yaşam kalitesi sırasıyla Üriner İnkontinans Davranış Skalası (ÜİDS) ve İnkontinans Yaşam Kalitesi Ölçeği (İYKÖ) ile değerlendirildi. Bulgular: Üç grup arasında demografik, obstetrik ve jinekolojik özellikler, ÜİDS-semptom skoru, ÜİDS-tedavi skoru ve ÜİDS-yaklaşım tutum skoru ortalamaları arasında anlamlı fark olmadığı bulundu (p>0,05). SÜİ grubunda ÜİDS-toplam skoru MÜİ grubundan daha yüksekti (p<0,05). ÜİDS-önleyici tutum skorunun en yüksek SÜİ grubunda olduğu bulundu (p<0,05). UÜİ grubunun ÜİDS-önleyici tutum skor ortalaması ise MÜİ grubundan daha yüksekti (p<0,05). Sonuç: Benzer fiziksel özellikleri olan farklı inkontinans tiplerine sahip kadınların inkontinansa karşı bazı tutumlarında farklılıklar (önleyici tutum) olabilmektedir. İnkontinans hakkında verilecek bilgi ve eğitim stratejileri, alt üriner sistem yönetimi konusunda farkındalığı artırabilir.

Frequency of Different Types of Urinary Incontinence and Their impact on Quality of Life of Pakistani Women

The International Continence Society (ICS) defines Incontinence of urine as involuntary loss of urine. Objective: To determine the frequencies of different types of incontinence of urine and their impact on quality of life of Pakistani women. Method: Descriptive observational study was conducted at outpatient department of five centers. Three validated questionnaires were used for quality-of-life assessment, International Consultation Incontinence Questionnaire Short Form (ICIQ-SF), Medical Outcome Study 36 items Short Form (SF-36) and King's Health Questionnaire (KHQ). Result: The study included 436 women. The most frequent type of incontinence of urine was mixed (n=281, 64.45%) followed by stress incontinence (n=129, 29.59%) and urge incontinence (n=26, 5.96%). The women suffering from mixed type of incontinence of urine had maximum effect on quality of life both general and specific. Conclusions: All types of incontinence of urine had an effect on quality of life but the mixed type had more impact.

MP52-18 EFFECTIVENESS OF APP- BASED YOGA OF IMMORTALS INTERVENTION IN URINARY INCONTINENCE

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Female Incontinence: Therapy II (MP52)1 Sep 2021MP52-18 EFFECTIVENESS OF APP- BASED YOGA OF IMMORTALS INTERVENTION IN URINARY INCONTINENCE Hari Siva Gurunadha Rao Tunuguntla, Renuka Tunuguntla, Himanshu Kathuria, and Sadhna Verma Hari Siva Gurunadha Rao TunuguntlaHari Siva Gurunadha Rao Tunuguntla More articles by this author , Renuka TunuguntlaRenuka Tunuguntla More articles by this author , Himanshu KathuriaHimanshu Kathuria More articles by this author , and Sadhna VermaSadhna Verma More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002082.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Yoga of Immortals (YOI) is a unique combination of specific yogic postures, breathing exercises, sound therapy, and meditation and is practiced by many for general well-being. This also targets pelvic floor muscles and focuses on the specific energy centers. We therefore studied the effectiveness YOI intervention in participants with UI of all types. METHODS: In this prospective, IRB approved, App-based cohort study, a survey was sent to all subscribers of the app. Those who identified with UI and consented to participate in the incontinence study were sent a set of questionnaires including ICIQ-UI, SF, and ICIQ-LUTS-QOL at baseline, 4 and 8 weeks. Mean symptom score and severity of UI were assessed by ICIQ-UI, SF. The impact of UI on QOL was assessed by disease specific ICIQ-LUTS-QOL. Pre- and post-intervention mean scores on ICIQ-LUTS-QOL and ICIQ-UI, SF were compared using paired t test. Effect of YOI intervention on the frequency and severity of urinary leak, daily life activity, and on different types of urinary incontinence were assessed using the ICIQ-UI, SF questionnaire. Global impression of improvement was assessed by PGI-I (participant global impression of improvement) scale. RESULTS: 258 out of 479 participants who completed the baseline, 4, and 8 week questionnaires were included in the study. Participants had significant decrease in mean scores on both the ICIQ-LUTS-QOL (Figure 1) and ICIQ-UI, SF (Figure 2). Significant improvement was also noted in the frequency of urinary leak (Table 1), severity of urinary leak (Table 2), and in the interference in daily life activity (Table 3) after YOI intervention. Improvement in the stress urinary incontinence was significant (Table 4). Sixty percent of the participants felt 'very much better', 16% 'much better', and 12% 'a little better' at 4 weeks on PGI-I scale. CONCLUSIONS: Yoga of Immortals (YOI) intervention resulted in significant improvement in the mean scores of ICIQ-LUTS-QOL, ICIQ-UI-SF, frequency and severity of urinary leak, daily life activity and stress urinary incontinence. Majority of the participants felt 'very much better' at 4 weeks on PGI-scale. YOI may be an adjunctive treatment option in those inclined towards these practices. Being app- based, it has the added advantage of the ability to be used any time anywhere. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e937-e937 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hari Siva Gurunadha Rao Tunuguntla More articles by this author Renuka Tunuguntla More articles by this author Himanshu Kathuria More articles by this author Sadhna Verma More articles by this author Expand All Advertisement Loading ...

The Onset of Urinary Incontinence in Different Subgroups and its Relation to Menopausal Status: A Hospital-based Study.

Numerous risk factors have been reported to influence the development of urinary incontinence (UI). In this study, we took a closer look on the different forms of UI and tried to identify differences in regard to potential risk factors. Of special interest was the onset of UI symptoms and its relation to menopausal status. This was a hospital-based analysis of patients who presented with urinary incontinence in the outpatient ward of a tertiary hospital. The diagnosis of urinary incontinence was based on the subjective complaints of patients. Data concerning menopausal status, hormone replacement therapy, prior hysterectomy were assessed. The mean age was 53.8 years in the SUI group, 62.7 years in the MUI group and 66.1 years in the UUI group, respectively (p<0.001). The proportion of patients with UUI was higher in the postmenopausal group, whereas the proportion of SUI was higher in the premenopausal group (p<0.001). The mean age in which complaints occurred was significantly lower in the SUI group (45.4 years) compared to the MUI (51.0 years) and UUI groups (54.7 years) (p<0.001). There was no correlation between menopausal status and onset of urinary incontinence (p=0.143). Additional anamnestic information help further characterize the different types of urinary incontinence that can lead to an optimization of treatment options. Younger age and premenopausal status were accompanied by milder forms of UI while menopausal status itself had no influence on the onset of UI symptoms indicating that age-related changes may lead to different types of incontinence.

Research progress on nursing devices in elderly stroke patients with urinary incontinence

Elderly stroke patients often suffer from different types of urinary incontinence due to injuries in different parts of the brain. Urinary incontinence not only affects the prognosis of these patients, but also imposes a workload on clinical caregivers. There are many urinary incontinence care devices in clinical practice, including built-in catheters, absorbent products, and external urine collection devices, and each type of care device has its own characteristics. The proper use of nursing devices according to the patient's characteristics of disease, type of urinary incontinence and lifestyle can effectively prevent the occurrence of complications such as incontinence-associated dermatitis, infection and skin damage, and is conducive to the recovery of bladder function. This article analyzes the characteristics and effects of urinary incontinence care devices use in clinical practice for elderly stroke patients, and provides a basis for nursing staff to apply urinary incontinence care tools, so that they can properly select urinary incontinence care devices for elderly stroke patients and improve patients' quality of life in clinical nursing work. Key words: Review; Aged; Stroke; Urinary incontinence; Nursing devices

Longitudinal change of comprehensive lower urinary tract symptoms and various types of urinary incontinence during robot-assisted radical prostatectomy.

To clarify longitudinal change of lower urinary tract symptoms (LUTS) and various types of urinary incontinence following robot-assisted radical prostatectomy (RARP) using validated questionnaires. The core lower urinary tract symptom score (CLSS) and the International Consultation on Incontinence Questionnaire (ICIQ)-Short Form (SF) questionnaires were administered to 607 consecutive, treatment-naïve men receiving RARP before and after surgery. The time course of comprehensive LUTS and various types of urinary incontinence, including stress-, urgency-, and urinary incontinence with no obvious reason, were evaluated. Continence recovery rates were compared for the different types of incontinence using Cox hazard regression analysis. After surgery, stress urinary incontinence (SUI) was reported most frequently (32% of cases) as the chief complaint with the most impact on daily life, as assessed by the CLSS questionnaire, followed by urgency urinary incontinence (UUI; 27% of cases). The rates of continence recovery differed among the different types of urinary incontinence, such as after urinating, when dressed, when asleep, when physically active or exercising, when coughing or sneezing, before reaching the toilet, and for no obvious reason. Incontinence for no obvious reason at 1 month after RARP was a strongest prognostic factor of delayed continence recovery (hazard ratio, 0.61; P < 0.0001), whereas patients reporting SUI and UUI gradually regained continence. Further time course on continent recovery after RARP would be more precisely predictable based on the incontinence status at one month postoperatively. Especially, incontinence with no obvious reason would be a significant factor for delayed recovery.

Medical rehabilitation of patients with urinary incontinence

The study objectiveis to evaluate the effectiveness of physiotherapy, therapeutic gymnastics and psychotherapy in the medical rehabilitation of patients with different types of urinary incontinence (UI).Materials and methods.In the departments of urology of the Kyrgyz Research Institute of Balneology and Rehabilitation were treated 164 patients with UI. Patients were divided into groups depending on the type of treatment: 132 patients were included in the treated group (UI developed as a complication of prostatectomy in 90 of them, as a complication of chronic cystitis – in 42), who used drug therapy and rehabilitation complexes. In 32 patients, only traditional drug therapy was performed, they formed a comparison group.Results.There was a significant improvement in the clinical characteristics: the severity of pain, frequent urination, UI decreased after rehabilitation treatment by 1.5–2.0 points, after traditional treatment – by 0.3–0.8 points. The average number of UI episodes decreased by 48 % compared to the baseline, the volume of urination increased by 37 %. Urination rate decreased by 55 %. The clinical effect of rehabilitation complexes was confirmed by subjective sensations recorded in the SF-36 questionnaire.Conclusion.Complex influence (the differentiated application of physiotherapy, physiotherapy in combination with psychotherapy, electrostimulation and magnetotherapy) caused high clinical level of rehabilitation.

233 Relationship between different types of urinary incontinence and coital incontinence in sexually active women

233 Relationship between different types of urinary incontinence and coital incontinence in sexually active women

Prevalence of Different Types of Urinary Incontinence and their Association with Age and Parity

Prevalence of Different Types of Urinary Incontinence and their Association with Age and Parity

Urine leakage during sexual activity among ethnically diverse, community-dwelling middle-aged and older women

Urinary incontinence is associated with decreased female sexual function, but little is known about the prevalence, predictors, and impact of urine leakage during sexual activity among women in the community. The purpose of this study was to evaluate the prevalence and impact of urine leakage during sex in ethnically diverse, community-dwelling midlife and older women. Urinary incontinence and sexual function were assessed by structured questionnaire in a multiethnic, community-based cohort of women enrolled in Kaiser Permanente Northern California, an integrated healthcare delivery system in California. All women were aged 40-80 years and sampled from 1 of 4 racial/ethnic groups (20% black, 20% Latina, 20% Asian, and 40% non-Latina white). Differences in frequency, bother, and fear of urine leakage during sexual activity were examined among women with monthly, weekly, and daily urinary incontinence and across different types of urinary incontinence (stress, urgency, mixed, and other type urinary incontinence), with the use of chi-square tests. Independent risk factors for urine leakage during sexual activity were identified through multivariable logistic regression. Of the 509 women who reported being sexually active and having at least monthly urinary incontinence, 127 of them (25%) reported experiencing any urine leakage during sex during the past 3 months. Nineteen percent of the women reported being subjectively bothered by leakage during sex, and 16% of them reported restricting sexual activity because of fear of leakage. Women with more frequent underlying urinary incontinence were more likely to report experiencing or being bothered by leakage during sex and restricting sexual activity because of fear of leakage (P<.001 for all). Participants with predominantly stress or mixed type urinary incontinence were more likely to report experiencing leakage during sex and being subjectively bothered by this leakage (P<.002 for all). Factors independently associated with leakage during sex were depression (odds ratio,1.96; 95% confidence interval, 1.20-3.20), symptomatic pelvic organ prolapse (odds ratio, 2.10; 95% confidence interval, 1.11-3.98), mixed vs urgency type urinary incontinence (odds ratio, 3.16; 95% confidence interval, 1.70-5.88), stress vs urgency type urinary incontinence (odds ratio, 1.94; 95% confidence interval, 1.01-3.70), and frequency of sexual activity (odds ratio, 1.6395% confidence interval, 1.05-2.55), but not age or race/ethnicity. Up to a quarter of women with at least monthly urinary incontinence in the community may experience urine leakage during sexual activity. Many incontinent women who leak urine during sex remain sexually active, which indicates that the preservation of sexual function should still be a priority in this population. Among incontinent women, depression, pelvic organ prolapse, and stress mixed-type urinary incontinence may be associated with urine leakage during sexual activity.

URINARY INCONTINENCE;

Background: Genitourinary fistula remains a major cause of morbidity worldwide.Approximately 2 million of women suffer from urinary leakage. Since the establishment ofGenito urinary Fistula center at Isra University Hospital –Hyderabad Sindh. We are able to shareour experience of fistulous women at the time of admission and at follow up visit. Objectives:To determine the different types of urinary incontinence in a woman after genitourinary fistularepair. Study Design: A Follow-up Descriptive study. Study Setting: This Study was done atFistula center Isra University Hospital Hyderabad GU – 11 from January 2011 to December2013. All the women who were admitted with true incontinence followed by Obstetrical andmajor gynecological surgeries were included. However women with stress incontinence andurge incontinence and women who are not willing to include in the study were excluded.Result: Out of one hundred and ten (110) women included in this study, 59 (53.6%) were foundto have obstetrical fistula, while 43 (39%) were suffering from Iatrogenic fistula. Continencestatus were explored at follow up visit. Out of 110 women, 108 (98.18%) &amp; 96 (87.27 %) werehaving no signs of incontinence on examination at first visit and after six week and secondvisit after three month respectively. Only 7 % women fell into incontinence grade 2 at six weekfollow up and only one percent had persistent symptoms of stress incontinence at 3 monthrespectively. Women fall on incontinence grade 3, 4 and 5 were completely cured at 3 month.Conclusion: Success rate of genitor- urinary fistula repair is 98 %. Majority of women (96 %)on short term follow up at 6 weeks showed improved urinary symptoms. Moreover on follow upvisit at 3 months, these women reported improved quality of life and social reintegration afterfistula closure.

MP31-08 IS OSTEOPOROSIS AN INDEPENDENT RISK FACTOR FOR URINARY INCONTINENCE? RESULTS FROM THE NATIONAL HEALTH AND NUTRITION EXAMINATION SURVEY

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Non-neurogenic Voiding Dysfunction I1 Apr 2017MP31-08 IS OSTEOPOROSIS AN INDEPENDENT RISK FACTOR FOR URINARY INCONTINENCE? RESULTS FROM THE NATIONAL HEALTH AND NUTRITION EXAMINATION SURVEY Sarah Mozafarpour, Jessica Lloyd, Farsad Afshinnia, Libing Hu, and Howard Goldman Sarah MozafarpourSarah Mozafarpour More articles by this author , Jessica LloydJessica Lloyd More articles by this author , Farsad AfshinniaFarsad Afshinnia More articles by this author , Libing HuLibing Hu More articles by this author , and Howard GoldmanHoward Goldman More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.962AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES A higher prevalence of urinary incontinence has been reported in women with low bone mineral density (BMD). However, there are conflicting reports in the literature regarding whether stress or urgency incontinence predominates in this population. We examined the National Health and Nutrition Examination Survey (NHANES) to investigate the association of osteoporosis and different types of urinary incontinence. METHODS A retrospective review of all female subjects in the NHANES database between 2009-2010 was performed. Bone mineral density data was reviewed, along with the subjects’ responses to questions regarding stress and urgency urinary incontinence. Osteoporosis is defined as BMD of 2.5 SD below the mean peak bone mass of young, healthy adults. Analysis took into account the hidden variance and the weighting methodology pertinent to analysis of NHANES. A variety of clinical confounders, such as age, ethnicity, smoking, number of vaginal deliveries and body mass index were also collected. Descriptive statistics were calculated and a multivariable logistic regression was performed to assess the association of BMD with urinary incontinence. RESULTS Overall, 95,886,461 individuals were included with a diverse racial background including 64.2% non-Hispanic white, 12.7 % non-Hispanic black and 9.8% Mexican American. The mean age was 47.03 (SE=0.4). The prevalence of osteoporosis was 0.4% and 3.2% among non-Hispanic black and non-Hispanic white individuals, respectively. Stress urinary incontinence (SUI) and urgency urinary incontinence (UUI) were present in 33.6% and 35.5% of osteoporotic women, respectively. After adjusting for potential covariates, osteoporosis was found to be significantly associated with SUI (OR 1.5, confidence interval 1.1-2.3). No significant independent association was found between osteoporosis and UUI. CONCLUSIONS In the large, administrative NHANES dataset, we identified an independent association of osteoporosis with SUI in a diverse cohort of women. As connective tissue weakness is considered an underlying etiology for both osteoporosis and SUI, this study may serve as a guide for future investigation of the basic underlying mechanism. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e401 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Sarah Mozafarpour More articles by this author Jessica Lloyd More articles by this author Farsad Afshinnia More articles by this author Libing Hu More articles by this author Howard Goldman More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

An overview of urinary incontinence

Practice nurses need to find out about all the different types of urinary incontinence and how they can be treated, before they can offer help to patients showing symptoms, writes Alison Bardsley Urinary incontinence is a common problem that is often under-reported due to the embarrassing nature and social stigma attached. Urinary incontinence can have a considerable effect on an individual's quality of life, but can be significantly improved with correct assessment, treatment and management. Conservative treatment options, including pelvic floor exercises, bladder retraining and fluid modification, are recommended before referral to secondary services. This article provides an overview of the main types of urinary incontinence, and summarises recent guidelines for the assessment, diagnosis and effective conservative treatment options for them, and when a referral to specialist care is required.

The Correlation of Urethral Pressure Profilometry Data in Women with Different Types of Urinary Incontinence

Introduction: The aim of the study was to analyse the correlation of subjective complaints and urethral pressure profilometry (UPP) data in women with different types of urinary incontinence (UI): stress UI (SUI), urgency UI (UUI), and mixed UI (MixUI). Methods: A study group of 405 women with complaints about UI were surveyed (UDI-6; ICIQ-UI) to determine the subjectively dominant type of UI, and UPP was performed for all these women. The variables analysed by UPP were the maximum urethral closure pressure at rest (MUCPrest), maximum urethral closure pressure at cough stress (MUCPstress), functional urethral length at rest (FULrest), functional urethral length during cough stress (FULstress) test and pressure transmission ratio (PTR). The statistical variation between different groups of UI patients was calculated for all the analysed variables. Results: The value of PTR was statistically and significantly higher in the group of patients with isolated UUI, compared to the SUI and MixUI groups. The MUCPrest and MUCPstress values were consistently lower in women with isolated SUI, compared to isolated UUI. The FULrest and FULstress values showed no statistically significant difference between the groups with different types of UI. Conclusions: The PTR value is a result of UPP test that helps in distinguishing objectively between UUI, SUI, and MixUI. The PTR value can be used to characterise the hypermobility of urethra. The MUCPrest and MUCPstress values are consistently lower in women with isolated SUI, compared to those with isolated UUI. MUCP can be used as an objective criterion for differentiation of these 2 groups of patients.

4 Do urethral pressure profilometry variables differ among female patient groups with different types of urinary incontinence?

4 Do urethral pressure profilometry variables differ among female patient groups with different types of urinary incontinence?

The “bother” of urinary incontinence

Patient reported measures are important for the evaluation of symptom-specific bother and the distinction between different types of urinary incontinence. The aim of the study was to assess the validity of physician administered visual analogue scales (VAS) for the bother from stress urinary incontinence (SUI) and urge urinary incontinence (UUI). In this prospective cohort study based at a tertiary urogynecological unit, women attending for investigation of lower urinary tract symptoms (n = 504) were asked to indicate their subjective bother from SUI and UUI on a 10-cm VAS. Clinical assessment, including multichannel urodynamic testing and 4D translabial ultrasound was performed for clinical diagnosis. Linear regression was used to model the average increase in VAS bother score of SUI and UUI for each explanatory variable. 74% (n = 375) reported symptoms of SUI, with mean bother of 5.7 out of 10 (SD 2.8), and 73% (n = 370) symptoms of UUI, with a mean bother of 6.5 out of 10 (SD 2.6). Bother from UUI was positively associated with the symptoms of nocturia (p < 0.0001) and frequency (p = 0.002), and the urodynamic findings of detrusor overactivity (p < 0.0001). Bother from SUI was positively related to the urodynamic diagnosis of USI (p < 0.0001) and a low abdominal leak point pressure (ALPP) (p = 0.002), as well as to the ultrasound findings of cystourethrocele (p < 0.0001) and funnelling (p = 0.04). All univariate associations remained highly significant on multivariate analysis, controlling for age, BMI, parity, previous incontinence/prolapse surgery and previous hysterectomy. Physician-administered VAS are a valid, reliable and practicable tool to measure bother related to SUI and UUI.

Electrical stimulation with non-implanted electrodes for urinary incontinence in men.

Electrical stimulation with non-implanted devices is used for patients with different types of urinary incontinence and symptoms of urgency, frequency and nocturia. The current review focused on electrical stimulation with non-implanted devices for the treatment of urinary incontinence in men. To determine the effectiveness of electrical stimulation with non-implanted devices for men with stress, urgency or mixed urinary incontinence in comparison with no treatment, placebo treatment, or any other 'single' treatment. Additionally, the effectiveness of electrical stimulation with non-implanted devices in combination with another intervention was compared with the other intervention alone. Finally, the effectiveness of one method of electrical stimulation with non-implanted devices was compared with another method. We searched the Cochrane Incontinence Group Specialised Trials Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, PreMEDLINE, and handsearching of journals and conference proceedings (searched 21 January 2012). We also searched other electronic and non-electronic bibliographic databases and the reference lists of the included studies as well as contacting researchers in the field to identify other relevant trials. Randomized and quasi-randomized controlled trials. Two review authors independently assessed all the identified trials for eligibility. Risk of bias was assessed using the Cochrane tool for determining bias. Disagreements were resolved by discussion, and a third review author was involved in the case of no consensus. Data were analysed using Cochrane methods. Six randomized controlled trials (five full papers and one abstract) were included. There was considerable variation in the interventions used, study protocols, types of electrical stimulation parameters and devices, study populations and outcome measures. In total 544 men were included, of whom 305 received some form of electrical stimulation, and 239 a control or comparator treatment. The trials were mostly small and generally there was not sufficient information to assess risk of bias; only two trials used secure methods of randomization.There was some evidence that electrical stimulation (ES) had a short-term effect in reducing incontinence compared with sham treatment (for example risk ratio (RR) at six months 0.38, 95% CI 0.16 to 0.87) but not at 12 months. Four trials evaluated the effect of adding PFMT to ES versus pelvic floor muscle training (PFMT) alone or with biofeedback. There was no evidence of a statistically significant difference in the number of men with urinary incontinence at three months (146/239, 61% for combined treatment versus 98/156, 63% with PFMT alone; RR 0.93, 95% CI 0.82 to 1.06). However, there were more adverse effects with combined treatment (23/139, 17% versus 2/99, 2% with PFMT alone; RR 7.04, 95% CI 1.51 to 32.94) and quality of life also seemed better with PFMT alone. One small trial did not detect statistically significant differences between two methods of administration of transcutaneous electrical stimulation (anal versus perineal) but the quality of life score was lower (better) in the anal stimulation group. There was some evidence that electrical stimulation enhanced the effect of PFMT in the short term but not after six months. There were, however, more adverse effects (pain or discomfort) with electrical stimulation.

Pelvic Floor Dysfunction, the Role of Imaging and Reconstructive Surgery

ABSTRACT We are putting forward three novel concepts describing the pathophysiology concerning: • Micturition, factors that control urinary continence and different types of urinary incontinence. • Genital organs support and genital prolapse. • Defecation, causes of fecal incontinence (FI). I. Urinary continence depends on high urethral pressure (Pura) which depends upon two factors: One inherent and one acquired. 1. The inherent factor is the tough strong collagen layer constituent of the internal urethral sphincter (IUS), that creates the high wall tension necessary for keeping high urethral pressure (Pura). The IUS is a collagen-muscle tissue cylinder that extends from the bladder neck to the perineal membrane in both sexes. 2. The acquired factor, which is high alpha-sympathetic tone at the IUS gained from learning and training in early childhood, keeps it contracted and the urethra closes all the time until there is a need or a desire to void as social circumstances allow. Injury to one or both factors leads to urinary incontinence. II. The vagina is a cylinder of collagen-elastic-muscle tissues. The strong tough collagen sheet is responsible for the upright position of the vagina. The main function of the pelvic ligaments is to assign the pelvic organs to their anatomical site and keeps the pelvic organs in situ. Childbirth trauma damages the collagen layer due to overstretching of the vagina and leads to flabby and redundant vaginal walls with subsequent vaginal prolapse. When the pelvic ligaments suffer most of the trauma, the insult will lead to weakness of the pelvic ligaments, leading to vault and uterine prolapse. III. The integrity of both anal sphincters, internal anal sphincter (IAS) and external anal sphincter (EAS) is an essential factor in keeping fecal continence. Fecal continence also depends on strong pelvic floor muscles which keep an angle between the rectum and the anal canal. In addition, it depends on an acquired behavior, gained by learning and training in early childhood of maintaining high alpha-sympathetic tone at the IAS keeping the anal canal empty and closed all the time until there is a desire and/or a need to pass flatus and/ or stool and there are favorable social circumstances. The intimate relation of the IUS with the anterior vaginal wall and the IAS with the posterior vaginal wall exposes them to the childbirth trauma with subsequent damage. This will lead to stress urinary incontinence (SUI) and FI in addition to vaginal prolapse. Therefore, we have innovated an operation to treat SUI, FI and vaginal prolapse. ‘Urethro-ano-vaginoplasty’ repair operation. It consists of anterior and posterior sections. In the anterior section, we have corrected the SUI and the anterior vaginal wall descent through the following steps: 1. Expose the IUS and mend its torn wall. 2. Strengthen the anterior vaginal wall by overlapping the two vaginal flaps, and hence we can add extra support to the mended IUS and preserve the body collagen. In the posterior section, we have the following: 1. Exposed the IAS and mended the torn sphincter. 2. We have approximated the two-levator ani muscles. 3. Strengthened the posterior vaginal wall by overlapping the two vaginal flaps; as such, we would have also added extra support to the mended IAS and kept the natural body collagen. 4. We repaired the perineum. How to cite this article El Hemaly AKM, Mousa LA, Kurjak A, Kandil IM, Serour AG. Pelvic Floor Dysfunction, the Role of Imaging and Reconstructive Surgery. Donald School J Ultrasound Obstet Gynecol 2013;7(1):86-97.