Genuine Stress Incontinence In Women Research Articles

The Effectiveness of Pelvic Floor Muscle Exercises in Treating Genuine Stress Incontinence in Women: A Systematic Review

The Effectiveness of Pelvic Floor Muscle Exercises in Treating Genuine Stress Incontinence in Women: A Systematic Review

Functional Analysis of Active Urethral Closure Mechanisms Under Sneeze Induced Stress Condition in a Rat Model of Birth Trauma

We evaluated changes in the urethral closure mechanism under a sneeze induced stress condition in a rat model of birth trauma. Four days after vaginal distention induced by balloon catheter inflation in the vagina sneezing was induced while recording intravesical pressure with the rat under urethane anesthesia to evaluate sneeze induced leak point pressure, defined as the lowest pressure inducing fluid leakage from the urethral meatus during sneezing. Sneeze induced responses in the bladder and proximal or mid urethra were also measured using microtip transducer catheters. In 5 sham operated rats no leakage was observed from the urethral meatus during sneezing, which produced an increase in intravesical pressure of up to 34 cm H(2)O. However, in 5 of 6 rats with vaginal distention leakage during sneezing was observed with a sneeze leak point pressure of 26.2 cm H(2)O. In the mid urethra microtip transducer catheters revealed that pressure increases during sneezing were greater than those in the bladder but they were significantly decreased in the 5 incontinent vaginal distention rats. However, sneeze induced responses at the proximal urethra, which were similar to those in the bladder, were not different in sham operated and incontinent vaginal distention rats. Sneeze induced stress urinary incontinence in a rat model of birth trauma was caused by decreased active closure mechanisms at the mid urethra without affecting the passive transmission of abdominal pressure in the proximal urethra.

238: Non Surgical Radio Frequency Bladder Neck Suspension Procedure for Treatment of Genuine Stress Incontinence in Women

Study ObjectiveTo assess the safety and efficacy of a new nonsurgical transvaginal device (The Solarant System, Solarant Medical, Livermore, CA) that delivers RF energy transvaginally to the endopelvic fascia (EPF) without incisions to treat GSI in women.DesignProspective single arm feasibility trial of 20 patients receiving treatment with the Solarant System.SettingMajor academic hospital in Guadalajara, Mexico.Patients20 women with GSI due to urethral hypermobility confirmed by urodynamic evaluation. Preoperatively all 20 patients had >1 urinary incontinence episode per day (average 3.8 episodes/day) and a positive cough Valsalva. Detrusor instability was excluded by cystometry.InterventionAll women underwent a procedure with the Solarant System. During this procedure, the system delivered precisely controlled RF energy bilaterally to the anterior vaginal wall, lateral to the urethra and proximal to the bladder neck causing the EPF to heat and shrink. Concomitantly, the system cooled the surface tissue layer of the vaginal mucosa.Measurements and Main ResultsProcedure time was less than an hour. All patients voided spontaneously within 2-5 hours and were discharged within 3-5 hours. No patient developed urge, frequency or retention. Several patients had vaginal mucosal tissue changes at treatment sites—most were asymptomatic and resolved with conservative management. At 3 month follow-up, 85% (17/20) were dry or <1 incontinence episode/day and 75% (15/20) had a negative cough Valsalva.ConclusionThis new nonsurgical RF system and procedure appears to be a safe and effective minimally invasive approach to treatment of GSI in women. Further follow-up is ongoing and additional clinical studies are planned.(NOTE: This is an investigational device; this study was sponsored by Solarant Medical, Inc., Livermore, CA.) Study ObjectiveTo assess the safety and efficacy of a new nonsurgical transvaginal device (The Solarant System, Solarant Medical, Livermore, CA) that delivers RF energy transvaginally to the endopelvic fascia (EPF) without incisions to treat GSI in women. To assess the safety and efficacy of a new nonsurgical transvaginal device (The Solarant System, Solarant Medical, Livermore, CA) that delivers RF energy transvaginally to the endopelvic fascia (EPF) without incisions to treat GSI in women. DesignProspective single arm feasibility trial of 20 patients receiving treatment with the Solarant System. Prospective single arm feasibility trial of 20 patients receiving treatment with the Solarant System. SettingMajor academic hospital in Guadalajara, Mexico. Major academic hospital in Guadalajara, Mexico. Patients20 women with GSI due to urethral hypermobility confirmed by urodynamic evaluation. Preoperatively all 20 patients had >1 urinary incontinence episode per day (average 3.8 episodes/day) and a positive cough Valsalva. Detrusor instability was excluded by cystometry. 20 women with GSI due to urethral hypermobility confirmed by urodynamic evaluation. Preoperatively all 20 patients had >1 urinary incontinence episode per day (average 3.8 episodes/day) and a positive cough Valsalva. Detrusor instability was excluded by cystometry. InterventionAll women underwent a procedure with the Solarant System. During this procedure, the system delivered precisely controlled RF energy bilaterally to the anterior vaginal wall, lateral to the urethra and proximal to the bladder neck causing the EPF to heat and shrink. Concomitantly, the system cooled the surface tissue layer of the vaginal mucosa. All women underwent a procedure with the Solarant System. During this procedure, the system delivered precisely controlled RF energy bilaterally to the anterior vaginal wall, lateral to the urethra and proximal to the bladder neck causing the EPF to heat and shrink. Concomitantly, the system cooled the surface tissue layer of the vaginal mucosa. Measurements and Main ResultsProcedure time was less than an hour. All patients voided spontaneously within 2-5 hours and were discharged within 3-5 hours. No patient developed urge, frequency or retention. Several patients had vaginal mucosal tissue changes at treatment sites—most were asymptomatic and resolved with conservative management. At 3 month follow-up, 85% (17/20) were dry or <1 incontinence episode/day and 75% (15/20) had a negative cough Valsalva. Procedure time was less than an hour. All patients voided spontaneously within 2-5 hours and were discharged within 3-5 hours. No patient developed urge, frequency or retention. Several patients had vaginal mucosal tissue changes at treatment sites—most were asymptomatic and resolved with conservative management. At 3 month follow-up, 85% (17/20) were dry or <1 incontinence episode/day and 75% (15/20) had a negative cough Valsalva. ConclusionThis new nonsurgical RF system and procedure appears to be a safe and effective minimally invasive approach to treatment of GSI in women. Further follow-up is ongoing and additional clinical studies are planned.(NOTE: This is an investigational device; this study was sponsored by Solarant Medical, Inc., Livermore, CA.) This new nonsurgical RF system and procedure appears to be a safe and effective minimally invasive approach to treatment of GSI in women. Further follow-up is ongoing and additional clinical studies are planned.

Intractable Chronic Pelvic Pain Relieved After Bone Anchor Removal

Operative cure of genuine stress incontinence remains a challenge. While no ideal technique has emerged, investigators have continued to modify available methods to be minimally invasive without significantly affecting long-term outcome. Transvaginal needle suspension is an established treatment for genuine stress incontinence in women. Suspension suture pull-through has been proposed as one of the possible causes of failure. While bone anchors provide a solid structure for fixation of suspension sutures, they have been associated with complications such as chronic pelvic pain, osteomyelitis and osteitis pubis.1 The associated pain can occasionally be intractable and difficult to manage. Although Graham and Dmochowski have reported severe pain following bladder neck suspension using bone anchors, to our knowledge chronic intractable pain in the absence of infection has not been reported thus far.2 We report complete resolution of intractable pelvic pain following extraction of bone anchors in a 40-year-old woman who had undergone human dermal allograft pubovaginal slingplasty.

Tension-free vaginal tape procedure on genuine stress incontinent women with coexisting genital prolapse.

To study the efficacy of performing the tension-free vaginal tape (TVT) procedure concurrently with vaginal pelvic relaxation surgeries in the management of genuine stress incontinence with genital prolapse. Fifty-eight women were surgically managed. Various vaginal pelvic reconstructive surgeries for prolapses were completed before the TVT procedure. Pre-operative and postoperative urodynamic studies, 1-h pad tests and symptom analysis were evaluated 1 year postoperatively. Surgical procedures and patient outcomes are discussed. Objective data available for 55 patients. Fifty (91%) were dry 1 year postoperatively. The concurrent pelvic surgeries included vaginal total hysterectomies, anterior colporrhaphies, posterior colporrhaphies and sacrospinous ligament fixations. No major surgical complications occurred. The average blood loss was 134 ml, the average operating time for the TVT procedure was 21 min, and the average postoperative hospital stay was 3.4 days. All patients voided spontaneously with adequate volumes of postvoid residual urine before being discharged. Two patients had a recurrent prolapse. Urodynamic parameters showed no significant differences before and after the surgery, except that the parameters related to voiding dysfunction were improved in the patients with severe cystocele. De nova detrusor instability was observed in one patient. The tension-free vaginal tape procedure performed with concurrent vaginal pelvic relaxation surgery is safe and effective for genuine stress incontinence and pelvic prolapse. Concomitant procedures also appear to relieve bladder outlet obstructions caused by severe prolapse.

Tension free vaginal tape in the management of genuine stress incontinence in women - the Indian experience

Tension free vaginal tape in the management of genuine stress incontinence in women - the Indian experience

Tension-free vaginal tape procedure on genuine stress incontinent women with coexisting genital prolapse

Objective. To study the efficacy of performing the tension-free vaginal tape (TVT) procedure concurrently with vaginal pelvic relaxation surgeries in the management of genuine stress incontinence with genital prolapse. Materials and methods. Fifty-eight women were surgically managed. Various vaginal pelvic reconstructive surgeries for prolapses were completed before the TVT procedure. Pre-operative and postoperative urodynamic studies, 1-h pad tests and symptom analysis were evaluated 1 year postoperatively. Surgical procedures and patient outcomes are discussed. Results. Objective data available for 55 patients. Fifty (91%) were dry 1 year postoperatively. The concurrent pelvic surgeries included vaginal total hysterectomies, anterior colporrhaphies, posterior colporrhaphies and sacrospinous ligament fixations. No major surgical complications occurred. The average blood loss was 134 ml, the average operating time for the TVT procedure was 21 min, and the average postoperative hospital stay was 3.4 days. All patients voided spontaneously with adequate volumes of postvoid residual urine before being discharged. Two patients had a recurrent prolapse. Urodynamic parameters showed no significant differences before and after the surgery, except that the parameters related to voiding dysfunction were improved in the patients with severe cystocele. De nova detrusor instability was observed in one patient. Conclusions. The tension-free vaginal tape procedure performed with concurrent vaginal pelvic relaxation surgery is safe and effective for genuine stress incontinence and pelvic prolapse. Concomitant procedures also appear to relieve bladder outlet obstructions caused by severe prolapse.

Long term follow up of the cruciate fascial sling for women with genuine stress incontinence

Objective To determine the long term success of the cruciate fascial sling procedure for the treatment of genuine stress incontinence in women. Design In 1998, a pre-validated questionnaire was sent to all women who had a cruciate fascial sling between 1979 and 1996 under the care of the senior author at a District General Hospital and in private practice. Participants Questionnaires were sent to 246 women; 198 (80%) were returned. Results Overall, 142 women felt that they were much improved or cured. The success rate was 74% (95% CI 70%–81%) in women having the sling as a primary procedure and 67% (95% CI 54%–81%) in women having the sling as a secondary procedure. There was no relationship between symptom severity score and age at time surgery, duration of follow up, current weight or body mass index, previous surgery for stress incontinence or concomitant surgery. Of the 103 women with six or more years of follow up, 29 felt that their operation had failed, 16 of whom thought that it lasted between five and 10 years. Urgency was experienced by 29% of women, three needed to perform intermittent self-catheterisation, and 9% found it difficult to empty their bladder. Thirty-seven women (19%) experienced problems that they attributed to the abdominal wound. Conclusion Although inevitably there are some failures over time, the cruciate fascial sling has good long term success rates. Direct comparison with the literature is impossible, as few studies have relied on properly validated questionnaires.

Risk factors for duration of urinary incontinence after radical prostatectomy

In this study, we examined risk factors for duration of incontinence after radical prostatectomy at our hospital. From April 1988 to March 2000, 45 patients with prostate cancer underwent retropubic radical prostatectomy at our hospital. Thirty-eight of 45 patients could be followed up. The patients' age, height, weight, body mass index (BMI), preoperative prostatic specific antigen level, clinical stage, nerve-sparing surgery or none, operation time, bleeding volume, resected prostate weight, cancer positive or negative at surgical margins, postoperative stage, radiation therapy or none, anti-androgen therapy or none, duration of postoperative incontinence, and follow-up period were examined. All patients had postoperative stress incontinence, and no one had urge incontinence. Medians of duration of postoperative incontinence and follow-up period were 5.5 and 12 months, respectively. When the patients were divided into 2 groups by the value of each parameter, postoperative anti-androgen therapy (chi 2 test, p = 0.0429) and high BMI (> or = 25.0 kg/m2, p = 0.0206) were related to the long duration (> or = 5.5 months) of postoperative incontinence. These results suggest that common factors are involved in the etiology of prolonged incontinence after radical prostatectomy and genuine stress incontinence in women. Therefore, both body weight control and pelvic floor muscle exercise might be also important for the treatment of incontinence after radical prostatectomy.

The basic understanding and clinical results of tension-free vaginal tape for stress urinary incontinence.

Since 1994, over 100,000 surgical reconstructions of the female lower urinary tract have been performed worldwide using tension-free vaginal tape (TVT). This technique, which differs from traditional methods, is effective against symptoms of stress urinary incontinence and may be performed as an ambulatory procedure with no need of indwelling catheterization. The primary indication is genuine stress incontinence, but it is also effective as a secondary procedure for relapse after other anti-incontinence measures such as the Burch procedure. The TVT operation was developed according to study results on the mechanisms of urethral closure in women and has become the primary surgical procedure at several Scandinavian clinics for combating genuine stress incontinence in women. It is also useful in reducing symptoms after prolapse repair for combined prolapse and stress incontinence and in cases of mixed stress and urge ("sensory") incontinence. The small incisions and canals involved with the TVT technique minimize surgical trauma and enable it to be performed under local anesthesia. By the same token, it makes fairly small demands on postoperative care and attendant costs. Here we describe the instrumentation, procedure, and risks of this minimally invasive operative technique.

Burch Procedure Compared With Sling for Stress Urinary Incontinence

In Brief Objective To compare the relative risks and benefits of Burch colposuspension and sling procedure for primary genuine stress urinary incontinence in women. Methods We developed a decision analytic model to compare Burch procedure and sling for primary surgical treatment of genuine stress incontinence with urethral hypermobility in women. Risks and benefits were estimated from published literature. The main outcome measure was effectiveness of treatment, defined as cure of incontinence after initial and secondary treatments. We considered four outcomes of primary surgical treatment: cure, persistent incontinence (either caused by intrinsic sphincter deficiency without urethral hypermobility or genuine stress incontinence with hypermobility), de novo detrusor instability, and permanent urinary retention. Secondary treatment included repeated surgery for genuine stress incontinence, collagen injection for intrinsic sphincter deficiency, medical treatment for detrusor instability, and urethrolysis for retention. One-way sensitivity analyses were used to estimate the effect of varying each characteristic through its range; all other characteristics were fixed at their baseline values. Results The overall effectiveness of Burch and sling operations (percentages of women cured after initial and secondary treatments) was similar (94.8% and 95.3%, respectively). In sensitivity analyses, the Burch arm of the model was more effective than sling when the risk of retention after sling was higher than 9.0% or when the risk of de novo detrusor instability after sling was higher than 10.3%. Conversely, when the risk of de novo detrusor instability after Burch was higher than 6.8%, the sling arm of the model was more effective. Conclusion The Burch and sling procedures are similarly effective for primary surgical treatment of genuine stress incontinence in women. Overall effectiveness is substantially influenced by relative rates of complications. Burch colposuspension and sling procedure are comparable for primary surgical treatment of genuine stress incontinence with urethral hypermobility.

Burch procedure compared with sling for stress urinary incontinence: a decision analysis

Objective: To compare the relative risks and benefits of Burch colposuspension and sling procedure for primary genuine stress urinary incontinence in women. Methods: We developed a decision analytic model to compare Burch procedure and sling for primary surgical treatment of genuine stress incontinence with urethral hypermobility in women. Risks and benefits were estimated from published literature. The main outcome measure was effectiveness of treatment, defined as cure of incontinence after initial and secondary treatments. We considered four outcomes of primary surgical treatment: cure, persistent incontinence (either caused by intrinsic sphincter deficiency without urethral hypermobility or genuine stress incontinence with hypermobility), de novo detrusor instability, and permanent urinary retention. Secondary treatment included repeated surgery for genuine stress incontinence, collagen injection for intrinsic sphincter deficiency, medical treatment for detrusor instability, and urethrolysis for retention. One-way sensitivity analyses were used to estimate the effect of varying each characteristic through its range; all other characteristics were fixed at their baseline values. Results: The overall effectiveness of Burch and sling operations (percentages of women cured after initial and secondary treatments) was similar (94.8% and 95.3%, respectively). In sensitivity analyses, the Burch arm of the model was more effective than sling when the risk of retention after sling was higher than 9.0% or when the risk of de novo detrusor instability after sling was higher than 10.3%. Conversely, when the risk of de novo detrusor instability after Burch was higher than 6.8%, the sling arm of the model was more effective. Conclusion: The Burch and sling procedures are similarly effective for primary surgical treatment of genuine stress incontinence in women. Overall effectiveness is substantially influenced by relative rates of complications.

Minimally invasive techniques for the treatment of genuine stress incontinence in women

Minimally invasive techniques for the treatment of genuine stress incontinence in women

An assessment of the early surgical outcome and urodynamic effects of the tension-free vaginal tape (TVT).

Fifty-two women underwent a tension-free vaginal tape (TVT) procedure for genuine stress incontinence (GSI). Preoperative assessment included a detailed medical history, pelvic examination, a 1-hour pad test with a comfortably full bladder, and urinary culture. Thirteen of the 52 women were excluded for various reasons. Both before and 12-24 months postoperatively all patients had a full urodynamic investigation using microtip transducer catheters. The study subjects were instructed to maintain a 1-week baseline urinary diary 1 week before the operation, and postoperative urodynamic assessment as well. The period of follow-up ranged from 12 to 24 months (median 19 months). Another 1-hour pad test with a comfortably full bladder and urinary culture were carried out thereafter. Comparisons of the 39 women pre- and postoperatively found a significantly improved 1-hour pad test (34.9 +/- 34.7 vs 8.3 +/- 24.0, P<0.001). Analyzing the urodynamic effects of surgery revealed no significant postoperative changes except for the maximal urethral closure pressure (MUCP) at rest. An objective assessment using a pad test revealed the success rate (cure plus improved) to be 90% (35/39) and the failure rate 10% (4/ 39). TVT can thus be considered a safe and effective procedure for GSI in women. Moreover, the urodynamic effects of surgery were not found to be critical to success.

Randomized controlled trial on the effect of pelvic floor muscle training on quality of life and sexual problems in genuine stress incontinent women

The purpose of the present study was to evaluate the effect of pelvic floor muscle exercise on quality of life, lifestyle and sex-life variables in genuine stress incontinent women. Fifty-nine women with clinically and urodynamically proven genuine stress incontinence were randomized to either pelvic floor muscle exercise or an untreated control group. The intervention group was asked to perform 8-12 close to maximum contractions in 3 series per day. In addition they were exercising 45 minutes per week in groups. The intervention period was 6 months, and the women in the exercise group met once a month for individual assessment of pelvic floor muscle strength and motivation. Outcome measures were the Norwegian version of the Quality of Life Scale (QoLS-N) and the Bristol Female Lower Urinary Tract Symptoms (B-FLUTS) questionnaire. The results showed that general quality of life measured by the generic quality of life questionnaire was not much affected by urinary incontinence. However, the disease specific questionnaire demonstrated that ability to participate in physical activity and some sex-life variables were affected by the condition. There was a statistically significant (p<0.01) reduction in number of women having problems with sex-life, social life, and physical activity in the exercise group after six months of pelvic floor muscle exercise. Pelvic floor muscle exercise showed some effect on quality of life and sex-life variables.

Tansvaginal Needle Suspension Operation: The Way We Do It

Objectives: To evaluate the long–term results of the transvaginal needle suspension operation for urinary stress incontinence. Materials and Methods: A total of 88 women with proved genuine stress incontinence were treated with transvaginal needle suspension with fixation of suspension sutures to the rectus fascia using the technique of crossing suspension sutures. By using this method the proximal end of suspension suture from one side is tied with the distal end of suspension suture from the other side. The suspension sutures fixed in this way ensure 3–4 cm of rectus fascia which is used as a carrier of the suspension sutures. The same urologist peformed 88 consecutive operations. Clinical and urodynamic evaluations were performed at 6 months, 1 year and 5 years after surgery with the same technique and the same equipment. Results: Analysis of the questionnaire showed that 81 patients (92.0%) were continent after 6 months while 78 (88.6%) patients were still continent after 1 year. After 5 years (n = 71) there were only continent 54 (76.0%) and incontinent patients (n = 17, 23.9%). Urodynamic analysis showed that 49 (69.0%) patients were continent after 5 years (n= 71). The increase in the number of incontinent patients is achieved at the cost of the previously continent patients. Of the 22 incontinent patients (after 5 years), 16 were still stress incontinent, while 6 (8.3%) patients had urge incontinence due to de novo detrusor instability. Three patients (n = 88, 3.4%) had undergone unilateral suture removal due to infection without influence on their continence status. In 2 patients (n = 88, 2.2%) the clinical pictures were highly suggestive of ilioinguinal nerve entrapment. Conclusions: Our results suggest that the transvaginal needle suspension operation is satisfactory for the management of genuine stress incontinence in women. However, we believe that the success of any suspension operation lies in adequate mobilization of the bladder neck and urethra (anterior vaginal wall) as well as in a surgeon’s familiarity with the procedure.

Incisionless cystourethropexy--the Intac device--an initial experience.

Our aim was to evaluate a new minimally invasive device for the treatment of genuine stress incontinence in women by both objective and subjective measures of outcome. Fifteen women with Type I or Type II urinary stress incontinence were treated with a new per vaginal bone anchor device designed to fix periurethral tissues to the pubic bone. No patients had significant operative morbidity. After 6-13 months a follow-up questionnaire and repeat urodynamic testing was performed for all the women. Subjectively 73% of patients had improvement in symptoms and on urodynamic testing 53% of patients were cured.

Short-term complications of pubovaginal sling procedure for genuine stress incontinence in women

Objectives. To evaluate the complication rate intraoperatively and within the first 30 postoperative days of the pubovaginal sling procedure. Methods. From January 1992 to September 1996, we prospectively analyzed 90 women with type II and III genuine stress incontinence (age 38 to 84 years, average Valsalva leak point pressure 57.5 cm H 2O) who underwent the pubovaginal sling procedure at our institute. Sixty percent of patients had no previous surgical treatment for their incontinence. Thirty-three percent of our patients have significant comorbidity (chronic obstructive lung disease, diabetes, coronary artery disease, peripheral vascular disease). Results. The complication rate within the first 30 postoperative days was 19%, which included pneumonia (1.1%), deep venous thrombosis (1.1%), urinary retention (3.3%), wound infection (7.7%), intraoperative bladder laceration (3.3%), urinary tract infection (1.1%), and superficial thrombophlebitis (1.1%). A similar complication rate was noted among our patients with no previous surgical treatment for their incontinence. Conclusions. The complication rate of our prospective series of pubovaginal sling procedures was comparable to that of the other surgical procedures for genuine stress incontinence reported in the literature. We conclude that even though the pubovaginal sling procedure is a relatively complex surgery, in view of its satisfactory long-term success rate reported in the recent literature, pubovaginal sling procedure should also be considered a primary surgical treatment for genuine stress incontinence in a selected population of women.

Burch colposuspension: a 10 to 12 years follow up

Burch colposuspension is considered to be the gold standard for the surgical treatment of genuine stress incontinence in women. Short-term cure rates are as high as 90%. (Jarvis, 1994). The long-term (10 or more years) cure rate of 62% in this study confirms the time dependent decline in efficacy.

Assessment of the tension-free vaginal tape as a minimally invasive surgical treatment of genuine stress incontinence in women

Assessment of the tension-free vaginal tape as a minimally invasive surgical treatment of genuine stress incontinence in women