High Risk Of Urinary Incontinence Research Articles

Analysis of Risk Prediction Models to Identify Patients at High Risk of Urinary Incontinence

Introduction: Urinary incontinence (UI) is a common health problem and is often undiagnosed in hospital patients. UI can cause complications such as urinary tract infections, dermatitis, and decreased quality of life. This study aims to apply a risk prediction model to identify patients at high risk of experiencing UI at Tengku Peukan General Hospital, Southwest Aceh, Indonesia.
 Methods: This study used a prospective cohort design. Data was collected from 100 patients hospitalized at Tengku Peukan General Hospital, Southwest Aceh. A risk prediction model was developed using logistic regression. Model performance is measured by AUC-ROC values and accuracy.
 Results: The risk prediction model developed had an AUC-ROC value of 0.85 (95% CI: 0.78-0.92) and an accuracy of 82%. The most significant risk factors for UI are age, gender, history of UI, and use of diuretic medications.
 Conclusion: This risk prediction model can help nurses and doctors identify patients who are at high risk of experiencing UI at Tengku Peukan General Hospital, Southwest Aceh. Early intervention in high-risk patients can help prevent UI complications and improve the patient's quality of life.

Mental health and lower urinary tract symptoms: Results from the NHANES and Mendelian randomization study

BackgroundThe clinical observations suggest a correlation between lower urinary tract symptoms (LUTSs) and mental health problems. Nonetheless, establishing a direct causal relationship between them remains challenging. MethodsWe initially conducted a cross-sectional study using 2005–2018 the National Health and Nutrition Examination Survey (NHANES) data. Multivariable-adjusted logistic regression was the primary statistical approach. Additionally, we employed Mendelian randomization (MR) to reducing confounding and reverse causation. Genetic instruments were obtained from publicly available genome-wide association study (GWAS) databases. Inverse Variance Weighted was the primary statistical method. ResultsThe cross-sectional study involved 29,439 participants. Individuals with mental health problems had a higher risk of urinary incontinence (OR:4.38; 95%CI:3.32–5.76; P < 0.01) and overactive bladder (OR:2.31; 95%CI:2.02–2.63; P < 0.01). MR analysis then indicated a potential causal relationship between mental health problems and LUTSs. Depression symptoms was linked with urinary tract infection (UTI) (OR:1.005; 95%CI:1.003–1.008; PFDR < 0.01). Anxiety symptoms was related to the occurrence of UTI (OR:1.024; 95%CI:1.011–1.037; PFDR < 0.01) and bladder calcified/ contracted/ overactive (OR:1.017; 95%CI:1.007–1.027; PFDR < 0.01). The personality trait of neuroticism was related to the occurrence of cystitis (OR:1.072; 95%CI:1.022–1.125; PFDR = 0.02), extravasation of urine and difficulties with micturition (OR:1.001; 95%CI:1.001–1.002; PFDR < 0.01), and urinary frequency and incontinence (OR: 1.001; 95%CI:1.000–1.001; PFDR < 0.01). ConclusionsOur study provides various evidence for the correlation between mental health and LUTSs, emphasizing the significance of adopting a holistic approach to LUTSs management that incorporates both physical and psychological factors.

Knowledge, attitude and practice towards pelvic floor muscle training among childbearing women

This study aims to identify knowledge, attitude, and practice of pelvic floor muscle training (PFMT) and to identify the prevalence of urinary incontinence. The method used was a cross-sectional study. Self-administered knowledge, attitude, and practice questionnaires were distributed among childbearing women attending Maternal & Child Health Clinics in the East Coast region of Malaysia. The findings revealed that most respondents (N = 896) had good or moderate knowledge (80.1%) and attitudes (77.3%) regarding PFMT but most of them (87.2%) still lacked practice. However, there was no association between urinary incontinence and PFMT practice. On the contrary, married women showed a higher risk of urinary incontinence. The practice of pelvic floor muscle training should be recommended and emphasized to childbearing women by healthcare professionals.

Urological Management at Discharge from Acute Spinal Cord Injury Rehabilitation: A Descriptive Analysis from a Population-based Prospective Cohort

BackgroundThere is limited epidemiological evidence describing contemporary neuro-urological management of persons with acute spinal cord injury (SCI). ObjectiveTo describe neurogenic lower urinary tract dysfunction (NLUTD) management at discharge from SCI rehabilitation. Design, setting, and participantsThe population-based Swiss Spinal Cord Injury (SwiSCI) cohort study prospectively collected data from 602 adults undergoing specialized postacute SCI rehabilitation from 2013 to 2020. The management strategy was based on the European Association of Urology (EAU) Guidelines on Neuro-Urology. Outcome measurements and statistical analysisData were collected at discharge using the International SCI Lower Urinary Tract Function Basic Data Set. Multivariable logistic regression adjusting for demographics, SCI characteristics, and center, with inverse probability weighting accounting for sampling bias, was used to produce prevalence estimates and identify predictors of lower urinary tract symptoms (LUTS) and NLUTD management outcomes. Results and limitationsAt discharge (median time after SCI: 5.0 mo [Q1-Q3: 3.0–7.2]), the prevalence of LUTS or managed NLUTD was 82% (95% confidence interval [CI]: 79–85%). SCI completeness was the main predictor of LUTS and managed NLUTD. The risk of urinary incontinence was elevated in females (odds ratio 1.98 [95% CI: 1.18–3.32]) and with complete lesions (odds ratio 4.71 [95% CI: 2.52–8.81]). Voiding dysfunction was most commonly managed with intermittent catheterization (prevalence 39% [95% CI: 35–42%]), followed by indwelling catheterization (prevalence 22% [95% CI: 18–25%]). The prevalence of antimuscarinic or mirabegron use was 29% (95% CI: 26–33%). Urodynamic and renal function data were not collected. ConclusionsOur population-based description of urological management in Swiss SCI centers utilizing the EAU Guidelines on Neuro-Urology may be used as a reference for evaluation in other settings. Data further indicate a need for sex-specific neuro-urological management research. Patient summaryAt discharge from spinal cord injury (SCI) rehabilitation, a majority of patients have lower urinary tract problems, especially those with complete SCI. Women have a higher risk of urinary incontinence.

Narrative Review of the Post-Operative Management of Prostate Cancer Patients: Is It Really the End of Adjuvant Radiotherapy?

Simple SummaryAmong patients with prostate cancer who have been operated on, a subset harboring high-risk features will present with a biochemical recurrence (BCR). Adjuvant radiotherapy (aRT) was proven to significantly reduce the risk of BCR when compared to salvage radiotherapy (SRT) but suffered from several limitations: a lack of patient selection criteria, a higher treatment-related morbidity and an uncertain benefit for long-term clinical endpoints. In the same clinical setting, early SRT (eSRT) appears as non-inferior to aRT with a lower morbidity, replacing aRT as the preferred option. In this review, we insist on the need for multidisciplinary discussions to fully comprehend the individual characteristics of each patient and propose the best treatment strategy for every patient.Despite three randomized trials indicating a significant reduction in biochemical recurrence (BCR) in high-risk patients, adjuvant radiotherapy (aRT) was rarely performed, even in patients harboring high-risk features. aRT is associated with a higher risk of urinary incontinence and is often criticized for the lack of patient selection criteria. With a BCR rate reaching 30–70% in high-risk patients, a consensus between urologists and radiation oncologists was needed, leading to three different randomized trials challenging aRT with early salvage radiotherapy (eSRT). In these three different randomized trials with event-free survival as the primary outcome and a planned meta-analysis, eSRT appeared as non-inferior to aRT, answering, for some, this never-ending question. For many, however, the debate persists; these results raised several questions among urologists and radiation oncologists. BCR is thought to be a surrogate for clinically meaningful endpoints such as overall survival and cancer-specific survival but may be poorly efficient in comparison with metastasis-free survival. Imaging of rising prostate-specific antigen (PSA), post-operative persistent PSA and BCR was revolutionized by the broader use of MRI and nuclear imaging such as PET-PSMA; these imaging modalities were not analyzed in the previous randomized trials. A sub-group of very high-risk patients could possibly benefit from an adjuvant radiotherapy; but their usual risk factors such as high Gleason score or invaded surgical margins mean they are unable to be selected. More precise biomarkers of early BCR or even metastatic-relapse were developed in this setting and could be useful for the patients’ stratification. In this review, we insist on the need for multidisciplinary discussions to fully comprehend the individual characteristics of each patient and propose the best treatment strategy for every patient.

Salvage Versus Primary Robot-assisted Radical Prostatectomy: A Propensity-matched Comparative Effectiveness Study from a High-volume Tertiary Centre

BackgroundSalvage robot-assisted radical prostatectomy (sRARP) is a potential treatment option for locally recurrent prostate cancer (PCa) after nonsurgical primary treatment. There are minimal data comparing outcomes between propensity-matched sRARP and primary robot-assisted radical prostatectomy (RARP). ObjectiveThe primary objective is to compare perioperative, oncological, and functional outcomes of sRARP with primary RARP, and the secondary is to compare outcomes between sRARP after whole and focal gland therapy. Design, setting, and participantsA 1:1 propensity-matched comparison was carried out of 135 sRARP cases with primary RARP cases from a cohort of 3852 consecutive patients from a high-volume tertiary centre. Outcome measurements and statistical analysisPerioperative, oncological, and functional outcomes including complication rates, positive surgical margins, biochemical recurrence (BCR), continence, and erectile dysfunction (ED) were retrospectively collected. Results and limitationsThere were no significant differences in patient characteristics between sRARP and primary RARP groups. In the salvage and primary groups, median (interquartile range) follow-up periods were 521 (304–951) and 638 (394–951) d, grade III–V Clavien-Dindo complication rates were 1.5% and 0% (p = 0.310), BCR rates were 31.9% and 14.1% (p < 0.001) at the last follow-up, pad-free continence rates were 78.8% and 84.3% at 2 yr (p = 0.337), and ED rates were 94.8% and 76.3% (p < 0.001), respectively. Comparing the whole and focal gland groups, BCR rates were 36.7% and 29.1% (p = 0.687) at follow-up, pad-free continence rates were 53.1% and 89.3% at 2 yr (p < 0.001), and ED rates were 98% and 93% (p = 0.214), respectively. ConclusionsSalvage RARP has similar perioperative outcomes to primary RARP with inferior potency rates. Post–focal therapy sRARP has similar recurrence and continence rates to primary RARP. Post–whole gland therapy, complication, and recurrence rates are higher, and there is a higher risk of urinary incontinence. Patient summaryWe report the largest propensity-matched comparison of salvage robot-assisted radical prostatectomy (RARP) after focal and whole gland therapy. Salvage RARP is a feasible procedure for the treatment of locally recurrent prostate cancer in high-volume centres; however, patients should be counselled appropriately as to the different outcomes.

Delivery parameters, neonatal parameters and incidence of urinary incontinence six months postpartum: a cohort study.

Contradictory results have been reported regarding most delivery parameters as risk factors for urinary incontinence. We investigated the association between the incidence of urinary incontinence six months postpartum and single obstetric risk factors as well as combinations of risk factors. This study was based on the Norwegian Mother and Child Cohort Study, conducted by the Norwegian Institute of Public Health during 1998-2008. This substudy was based on 7561 primiparous women who were continent before and during pregnancy. Data were obtained from questionnaires answered at weeks 15 and 30 of pregnancy and six months postpartum. Data were linked to the Medical Birth Registry of Norway. Single and combined delivery- and neonatal parameters were analyzed by logistic regression analyses. Birthweight was associated with significantly higher risk of urinary incontinence six months postpartum [3541-4180 g: odds ratio (OR) 1.4, 95% confidence interval (CI) 1.2-1.6; >4180 g: OR 1.6, 95% CI 1.2-2.0]. Fetal presentation, obstetric anal sphincter injuries, episiotomy and epidural analgesia were not significantly associated with increased risk of urinary incontinence. The following combinations of risk factors among women delivering by spontaneous vaginal delivery increased the risk of urinary incontinence six months postpartum; birthweight ≥3540 g and ≥36 cm head circumference; birthweight ≥3540 g and forceps, birthweight ≥3540 g and episiotomy; and ≥36 cm head circumference and episiotomy. Some combinations of delivery parameters and neonatal parameters seem to act together and may increase the risk of incidence of urinary incontinence six months postpartum in a synergetic way.

Identifying Patients With Vesicovaginal Fistula at High Risk of Urinary Incontinence After Surgery.

To develop a risk score to identify women with vesicovaginal fistula at high risk of residual urinary incontinence after surgical repair. We conducted a prospective cohort study among 401 women undergoing their first vesicovaginal fistula repair at a referral fistula repair center in Lilongwe, Malawi, between September 2011 and December 2014, who returned for follow-up within 120 days of surgery. We used logistic regression to develop a risk score to identify women with a high likelihood of residual urinary incontinence, defined as incontinence grade 2-5 within 120 days of vesicovaginal fistula repair, based on preoperative clinical and demographic characteristics (age, number of years with fistula, human immunodeficiency virus status, body mass index, previous repair surgery at an outside facility, revised Goh classification, Goh vesicovaginal fistula size, circumferential fistula, vaginal scaring, bladder size, and urethral length). The sensitivity, specificity, and positive and negative predictive values of the risk score at each cut point were assessed. Overall, 11 (3%) women had unsuccessful fistula closure. Of those with successful fistula closure (n=372), 85 (23%) experienced residual incontinence. A risk score cut point of 20 had sensitivity of 82% (95% confidence interval [CI] 72-89%) and specificity 63% (95% CI 57-69%) to potentially identify women with residual incontinence. In our population, the positive predictive value for a risk score cut point of 20 or higher was 43% (95% CI 36-51%) and the negative predictive value was 91% (95% CI 86-94%). Forty-eight percent of our study population had a risk score 20 or greater and, therefore, would have been identified for further intervention. A risk score of 20 or higher was associated with an increased likelihood of residual incontinence with satisfactory sensitivity and specificity. If validated in alternative settings, the risk score could be used to refer women with a high likelihood of postoperative incontinence to more experienced surgeons.

Identifying Patients With Vesicovaginal Fistula at High Risk of Urinary Incontinence After Surgery:

Identifying Patients With Vesicovaginal Fistula at High Risk of Urinary Incontinence After Surgery:

Frontal white matter hyperintensity predicts lower urinary tract dysfunction in older adults with amnestic mild cognitive impairment and Alzheimer's disease.

Lower urinary tract symptoms often limit activities of daily life and impair quality of life in the elderly. The purpose of the present study was to determine whether regional white matter hyperintensity (WMH) can predict lower urinary tract symptoms in elderly with amnestic mild cognitive impairment or Alzheimer's disease. The participants were 461 patients aged 65-85 years diagnosed with amnestic mild cognitive impairment or Alzheimer's disease. Patients and their caregivers were asked about symptoms of lower urinary tract symptoms (urinary difficulty, frequency and incontinence). Cognition, behavior and psychological symptoms of dementia and medication were evaluated. WMH and brain atrophy were analyzed using an automatic segmentation program. Regional WMH was evaluated in the frontal, parietal, temporal and occipital lobes. Patients with urinary incontinence showed significantly greater volume of WMH. WMH increased with age, especially in the frontal lobe. WMH in the frontal lobe was closely associated with urinary incontinence after adjustment for brain atrophy and classical confounding factors. Frontal WMH was a predictive factor for urinary incontinence in older adults with amnestic mild cognitive impairment or Alzheimer's disease. Urinary incontinence in demented older adults is not an incidental event, and careful insight into regional WMH on brain magnetic resonance imaging might greatly help in diagnosing individuals with a higher risk of urinary incontinence.

Organ and function preservation in urethral cancer

Primary urethral carcinomas are rare tumors that can occur both in men and women. Histological patterns of these tumors are mixed, urothelial tumors occur as well as squamous cell tumors or adenocarcinomas.There are different clinical factors that define clinical prognosis, and the 1- and 5-year cancer-free survival is 75% and 54%. Therapy of locally limited disease is surgical resection, and organ-preserving treatment is possible if negative frozen sections prove complete surgical resection. However, in men a perineal urethrostomy might be necessary, and in women there is a high risk of urinary incontinence if more than 2 cm of the distal urethra is resected.In case of locally advanced tumors or tumors of the proximal urethra, a radical urethrectomy with supravesical urinrary diversion is necessary. In some cases neoadjuvant (radio-)chemotherapy may be an option.

Relationship between dietary phytoestrogens and development of urinary incontinence in midlife women

Because exogenous estrogen treatment has been associated with a higher risk of urinary incontinence, our objective was to evaluate the longitudinal relationships of dietary phytoestrogen intakes (isoflavones, coumestans, and lignans) and the development of incontinence in midlife women transitioning through menopause. The Study of Women's Health Across the Nation (SWAN) Phytoestrogen Study was developed within SWAN, a community-based, multisite, multiracial/ethnic, prospective cohort study. SWAN interviewers administered a food consumption assessment at baseline and on follow-up visits 5 and 9. The SWAN Phytoestrogen Study created a phytonutrient database that allowed estimation of the usual daily intakes of four isoflavones, four lignans, and coumestrol. On an annual self-administered questionnaire, participants reported on the frequency and type of incontinence. We used discrete proportional hazards models to evaluate whether the estimated daily intake of each phytoestrogen class on the visit previous to the first report of incontinence was associated with the development of monthly or more incontinence versus remaining continent. We found no association or patterns of association between developing any, stress, or urge incontinence and the reported daily dietary intake of isoflavones, coumestrol, and lignans on the visit previous to the onset of incontinence. The results of this longitudinal study provide important information to better understand estrogenlike substances in the continence mechanism of midlife women. Our study shows that neither high nor low dietary intakes of isoflavones, coumestrol, and lignans prevent stress or urge incontinence. Future studies should evaluate whether serum levels of phytoestrogens or their metabolites impact incontinence symptoms.

Hip fracture and urinary incontinence – use of indwelling catheter postsurgery

Norway has a higher incidence of hip fractures than any other country. For older individuals, a hip fracture may cause dramatic changes in health status like incontinence and daily activities. Patients with hip fractures are at high risk of urinary incontinence (UI) after surgical repair. A urinary indwelling catheter (UIC) is inserted preoperatively, but should be removed within 24 hours. Our aims were to identify indicators that might predict clinical challenges related to urinary incontinence 1 year after hip fractures. Inclusion criteria were patients with hip fracture age 65 years or older. They were admitted form their own home to two acute-care hospitals during 2004-2006. We used the Resident Assessment Instrument for Acute Care. A total of 331 patients were included. Thirty-five (11%) had UIC 72 hours after surgery. These patients had more frequently experienced delirium, urinary tract infection, cognitive impairment and discouragement than their counterparts. After 12 months, patients with previous UI had lower functioning levels than those with no previous UI. They had moved four times more frequently to a nursing home and had over twice the mortality. Patient with UI should be followed up with a multidisciplinary team after discharged from hospital.

A incontinência urinária em mulheres e os aspectos raciais: uma revisão de literatura

Revisão bibliográfica que objetivou identificar as associações entre a incontinência urinária feminina e os aspectos raciais. Utilizaram-se as bases de dados MEDLINE e LILACS para pesquisa dos artigos publicados nos anos de 2003 a 2010. Analisou-se 30 publicações que apontaram diversas relações entre incontinência e raça. A prevalência de incontinência foi maior entre brancas. A incontinência urinária de esforço foi mais frequente entre brancas e a de urgência, entre negras. Brancas e asiáticas apresentam perda urinária em menor quantidade comparado a negras e hispânicas. O impacto na qualidade de vida esteve mais relacionado à severidade da perda urinária e outros fatores, do que especificamente à questão racial. Brancas apresentaram melhor conhecimento sobre incontinência e se submeteram mais frequentemente a tratamento cirúrgico para incontinência urinária de esforço. Brancas e latinas apresentam maior risco de incontinência urinária que negras e asiáticas. Ressalta-se a necessidade de estudos brasileiros para que os dados possam ser adequados à nossa realidade.

1131 RADICAL PROSTATECTOMY IN ELDERLY PATIENTS, TEMPORAL TRENDS AND FUNCTIONAL RESULTS OF URINARY CONTINENCE ONE YEAR POSTOPERATIVE

You have accessJournal of UrologyProstate Cancer: Localized V1 Apr 20121131 RADICAL PROSTATECTOMY IN ELDERLY PATIENTS, TEMPORAL TRENDS AND FUNCTIONAL RESULTS OF URINARY CONTINENCE ONE YEAR POSTOPERATIVE Jens Hansen, Uwe Michl, Hans Heinzer, Alexander Haese, Thorsten Schlomm, Hartwig Huland, and Markus Graefen Jens HansenJens Hansen Hamburg, Germany More articles by this author , Uwe MichlUwe Michl Hamburg, Germany More articles by this author , Hans HeinzerHans Heinzer Hamburg, Germany More articles by this author , Alexander HaeseAlexander Haese Hamburg, Germany More articles by this author , Thorsten SchlommThorsten Schlomm Hamburg, Germany More articles by this author , Hartwig HulandHartwig Huland Hamburg, Germany More articles by this author , and Markus GraefenMarkus Graefen Hamburg, Germany More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1240AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Due to an increasing life expectancy, more men at advanced age seem to undergo radical prostatectomy (RP) for prostate cancer (PCa) in recent years. According to the literature, elderly patients (>70 years) seem to be at higher risk for urinary incontinence (UC) after RP, [Nilsson et al., BJUI 2011] although UC rates after RP have improved over the last years, due to innovations of surgical techniques. [Schlomm et al., Eur Urol 2011] The objective of the current study was to examine UC rates one year after RP in elderly patients in most recent years. METHODS Data of patients treated with RP for clinically localized PCa by five high volume surgeons at a single European tertiary referral center between 01/2006 and 07/2010 were examined. Patients were categorized in two groups according to age (≤70 years vs. >70 years). A validated questionnaire was routinely used 1 year after surgery. UC was defined as use of 0 pads or 1 security pad within 24 hours. Only patients with available questionnaire were included in the analyses. Statistical analyses consisted of descriptive analyses for assessment of temporal trends and of multivariable logistic regression models (MVA) predicting UC one year after RP. RESULTS A number of 3333 men were included in the analyses. Of those, 2997 (89.9%) were ≤70 years and 336 (10.1%) were >70 years. Within the study cohort, the rate of elderly patients treated with RP increased from 7.3% (n=39) in 2006 to 11.8% (n=46) in 2010 (p=0.09). UC rates in patients >70 years increased from 51.3% (n=20) in 2006 and 72.5% (n=50) in 2007 to 89.7% (n=70) in 2009 and 87.0% (n=40) in 2010. Even though, rates for younger patients were higher with 83.7% (n=412), 78.9% (n=532), 93.9% (n=642) and 94.8% (n=327), respectively. In MVA adjusting for BMI, prostate volume, pT stage, Gleason score, and NS, elderly men (>70 years) were less likely (Odds ratio: 0.51, p <0.001) to be continent one year after RP relative to younger men. Men treated in 2010 were 3.7-fold more likely to be continent one year after RP than men treated in 2006 (p<0.001). CONCLUSIONS An increasing rate of elderly patients undergoing RP for PCa could be observed over the last 5 years. Even if elderly men are still at higher risk of urinary incontinence one year after RP, UC rates in elderly patients improved over time. Anyhow, very good UC rates could be observed. These findings should be considered for treatment decision-making and patient counseling in elderly patients with newly diagnosed PCa. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e458 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jens Hansen Hamburg, Germany More articles by this author Uwe Michl Hamburg, Germany More articles by this author Hans Heinzer Hamburg, Germany More articles by this author Alexander Haese Hamburg, Germany More articles by this author Thorsten Schlomm Hamburg, Germany More articles by this author Hartwig Huland Hamburg, Germany More articles by this author Markus Graefen Hamburg, Germany More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Delivery Mode and Pelvic Floor Disfunction

Introduction: Pelvic floor disorders compromise quality of life for a lot of women of all ages. The prevalence of urinary incontinence (UI) is thought to range from 17 to 45% among adult women. The etiology is thought to be multifactorial. Traumatic damage to fascial and muscular support structures during childbirth may be, an important contributor to the development of UI and prolapse of pelvic organ (POP). The aim of this study is to consider the association between delivery mode and pelvic floor disorders (POP and UI) Materials and methods: A review of the literature was undertaken using the Medline and Popline CD Rom considering articles published from 1996 to 2011; additional sources were identified from references cited in relevant research articles. We studied articles concerning stress urinary incontinence, pregnancy, childbirth, pelvic prolapse were considered. Conclusion: Literature research confirms that anatomic and functional damages are linked with obstetric factors. Pregnancy may cause urinary incontinence and prolapse. However vaginal delivery is associated with a significant higher risk of urinary incontinence and pelvic defects. Caesarean section may protect from perineal risk of delivery but not from the damage due to the pregnancy itself. During pregnancy UI ranges from 31 to 39%, in post-partum ranges from 24,5 to 29% and from 5 to 8% after vaginal and caesarean respectively. Pelvic floor disorders ranges from 21 to 36% after instrumental operative delivery and from 9 to 21% in vaginal spontaneous delivery. Forceps is found out the most dangerous instrument for pelvic floor, followed by vacuum and vaginal delivery with tears. The consequences of a traumatic delivery affect quality of life and increasing late damages have to be considered.

Suburethral sling at the time of radical prostatectomy in patients at high risk of postoperative incontinence

To evaluate the insertion of a urethral sling at the time of radical prostatectomy (RP) in men at high risk of urinary incontinence after RP. Between 1998 and 2000, 49 of 871 men undergoing RP at The University of Texas M.D. Anderson Cancer Center, were identified as at risk of urinary incontinence after RP, based on their age (>65 years), previous transurethral resection of the prostate, previous radiation therapy, clinical stage, and obesity (body mass index of > or = 30 kg/m2). These 49 men had a suburethral sling inserted at the time of RP, and incontinence after surgery was evaluated using pad counts and patient-completed questionnaires. Retrospectively, incontinence rates and complications in these men were compared with 122 men also at high risk of urinary incontinence after RP who did not have a sling inserted at the time of RP (control group). In all, 29 of 49 men (59%) with a suburethral sling reported using either no pad or one pad per day for urinary leakage at 6 months after RP, compared with 83 of 118 (70%) in the control group. At 12 months after RP, 34 of 46 (74%) men with a suburethral sling reported using no or one pad, compared with 75 of 89 (84%) in the control group. Seventeen (35%) men were treated for urethral stricture in the sling group and 17 (14%) in the control group (P = 0.001). The urethral sling modification concurrent with RP is feasible, but does not decrease incontinence compared with a similar group of high-risk patients who did not have the sling modification. In addition, the stricture rate in the sling group was unacceptably high. Currently, we do not recommend the use of a urethral sling at the time of RP.

Factors predicting for urinary incontinence after prostate brachytherapy

Purpose To define risk factors that predict for urinary incontinence after 125I prostate brachytherapy. Methods and materials Urinary incontinence after 125I prostate brachytherapy was evaluated using a patient self-assessment questionnaire based on the NCI Common Toxicity Criteria (version 2). Grade 0 is defined as no incontinence; Grade 1 incontinence occurs with coughing, sneezing, or laughing; Grade 2 is spontaneous incontinence with some control; and Grade 3 is no control. One hundred fifty-three patients received monotherapy (145 Gy) 125I implants between October 1996 and December 2001, and 112 (75%) responded to our survey. Median follow-up was 47 months (range, 14–74 months). Patient characteristics included a preimplant prostate-specific antigen ≤10, Gleason score ≤6, and stage ≤T2b. CT-based postimplant dosimetry was analyzed approximately 30 days after the procedure, and dose–volume histograms of the prostate and the prostatic urethra were generated based on contoured volumes. Dosimetric parameters evaluated as predictive factors for incontinence included the prostate volume; total activity implanted; number of needles; number of seeds; seed activity; urethral D 5, D 10, D 25, D 50, D 75, and D 90 doses; prostate D 90 doses; and prostate V 100, V 200, and V 300. Clinical parameters evaluated included age, Gleason score, prostate-specific antigen, preimplant International Prostate Symptom Score (I-PSS), and length of follow-up. Results Urethral D 10 dose and preimplant I-PSS predicted for urinary incontinence on multivariate analysis ( p = 0.002 and p = 0.003, respectively). Twenty-eight patients reported Grade 1 incontinence (26%), and 5 patients reported Grade 2 (5%). Patients with Grade 1 and 2 incontinence were analyzed together, because of the small number of patients who experienced Grade 2. No patients reported Grade 3 incontinence. Mean urethral D 10 was 314 ± 78 Gy in patients with Grade 0 compared with 394 ± 147 Gy in patients with Grades 1, 2 incontinence ( p = 0.002). The incidence of incontinence doubled as the urethral D 10 dose increased above 450 Gy. Patients with Grade 0 had a mean preimplant I-PSS score of 6.6 ± 4.5 compared with 10.0 ± 6.4 for Grades 1, 2 ( p = 0.003). A significant increase in the incidence of incontinence was noted when the preimplant I-PSS was greater than 15. No relationship was noted between incontinence and prostate volume, total activity implanted, or the number of needles used ( p = 0.83, p = 0.89, p = 0.36, respectively). Conclusion Urethral D 10 dose and preimplant I-PSS are predictive for patients at higher risk of urinary incontinence. To decrease the risk of this complication, an effort should be made to keep the urethral D 10 dose as close to the prescribed dose as possible, and the preimplant I-PSS should be thoroughly evaluated in an attempt to select patients with scores less than 15.

SALVAGE PROSTATECTOMY WITH CONTINENT CATHETERIZABLE URINARY RECONSTRUCTION: A NOVEL APPROACH TO RECURRENT PROSTATE CANCER AFTER RADIATION THERAPY

Salvage prostatectomy after full dose radiation therapy is associated with a high risk of urinary incontinence. We evaluated the complications of salvage prostatectomy with continent catheterizable reconstruction and its impact on urinary incontinence. Between August 1995 and February 1999, 13 patients with biopsy proved, locally recurrent prostate cancer after radiation therapy underwent salvage prostatectomy with complete bladder neck closure and reconstruction with an appendicovesicostomy to the native bladder in 9 and ileovesicostomy in 4. There were no intraoperative complications. Four patients had serious complications necessitating reoperation, including a vesicourethral fistula requiring delayed cystectomy, wound dehiscence with disruption of the appendicovesical anastomosis, leakage from the small bowel anastomosis that resulted in sepsis and death, and stomal stenosis requiring delayed stomal revision in 1 each. Of 12 patients 2 (17%) used pads for incontinence, while 10 were dry during the day and night with a catheterization interval of 2 to 6 hours. Salvage prostatectomy with continent catheterizable reconstruction is a technically challenging operation with the potential for serious complications. The postoperative continence rate is excellent and appears superior to those in the literature for salvage prostatectomy and vesicourethral anastomosis.

Preoperative Urodynamic Evaluation: Does It Predict the Degree of Urinary Continence after Radical Retropubic Prostatectomy?

Preoperative evaluation of voiding patterns and detailed urodynamic evaluation before radical retropubic prostatectomy was carried out in an attempt to identify patients at higher risk of developing urinary incontinence postoperatively. Ninety-two men, mean age 64 years (range 54-72), who completed 1 year of follow-up after radical retropubic prostatectomy for clinically localized adenocarcinoma of the prostate were included in the study. According to the preoperative urodynamic findings, patients were divided into two main groups: group 1 (n = 64) patients with normal urodynamic findings, and group 2 (n = 28) patients with abnormal urodynamic findings. The latter group was further subdivided according to the abnormality: detrusor instability (n = 12), weak sphincter mechanism (n = 9), and detrusor and sphincter instability (n = 7). The degree and incidence of urinary incontinence were evaluated in both groups at the 1-year follow-up visit. There was a substantial difference in the incidence of urinary incontinence between the two main groups with only 2 patients with incontinence in group 1 (3%) versus 11 patients in group 2 (39%). In addition, the incidence of incontinence in group 2 differed depending on the type of abnormality: the lower incidence occurred in patients with detrusor instability (17%) and the higher incidence in patients with both detrusor and sphincter instability (71%). Identification of sphincteric and bladder dysfunction preoperatively may indicate a high risk of urinary incontinence after radical prostatectomy.