Involuntary Loss Of Urine Research Articles

Vibratory perineal stimulation for the treatment of female stress urinary incontinence: a systematic review.

The pelvic floor muscles (PFM) play an important part in the urinary continence mechanism. Changes in their structure and functionality may lead to a predisposition to pelvic floor dysfunction such as urinary incontinence (UI), which is the involuntary loss of urine. Some techniques for conservative treatment of UI are already well documented. However, new approaches have been found that require scientific proof of their effectiveness, such as vibratory stimulation (VS). Thus, we performed a systematic review of studies that investigated the use of perineal VS (PVS) for the treatment of stress UI. This study followed the recommendations of the Cochrane Collaboration for systematic reviews. Studies that used PVS for the treatment of female UI were eligible. A total of 56 studies were found, of which ten were duplicates and were excluded. Analysis of the titles and abstracts led to the exclusion of 30 studies, leaving 16 for detailed analysis. Of these, only three were included as they fulfilled all the eligibility criteria previously established for the present study. In spite of the heterogeneity of the protocols, all the studies had the goal of assessing the effects of vibration on the PFM, and the stimulation was found to be effective in reducing urinary leakage, improving muscle strength and consequently the patients' quality of life. Because of the heterogeneity and the small number of studies, it is not possible to draw a conclusion as to the effectiveness of PVS for the treatment of stress UI, and further studies are needed to provide scientific support for its use.

Predictors and reasons for help-seeking behavior among women with urinary incontinence.

The aim of the study was to evaluate the predictors and reasons for help-seeking behavior among women with urinary incontinence (UI) in Germany and Denmark. This international postal survey was conducted in 2014. In each country, 4,000 women of at least 18years of age were randomly selected. The questionnaires included validated items regarding help-seeking behavior and the ICIQ-UI SF. UI was defined as any involuntary loss of urine. Binary logistic regression analysis was used to assess factors predicting help-seeking behavior. Reasons for seeking or not seeking help were evaluated in terms of the severity of UI and as the most frequently reported. Of 1,063 Danish women with UI, 25.3% had consulted a physician compared with 31.4% of 786 German women with UI (p=0.004). The severity and duration of UI, and actively seeking information regarding UI, were significant independent predictors of help-seeking behavior. Women with slight/moderate UI did not seek help because they did not consider UI as a problem, whereas of women with severe/very severe UI, German women reported that other illnesses were more important and Danish women reported that they did not have enough resources to consult a physician. Only a small proportion of women with UI had consulted a physician, and the driving forces for help-seeking behavior were severity and duration of UI and actively seeking information regarding UI. Public information campaigns might enhance consultation rates providing that passively receiving and actively seeking information have the same effects on help-seeking behavior. We show for the first time that reasons for not consulting a physician for UI vary depending on the severity of the UI.

Evaluation of the safety and efficacy of a monopolar nonablative radiofrequency device for the improvement of vulvo‐vaginal laxity and urinary incontinence

Vaginal childbirth, natural process of aging, congenital factors, and surgical interventions are considered the main causes of vulvo-vaginal laxity driven by changes in collagen and elastin fibers. This causes a loss of strength and flexibility within the vaginal wall. As a result, women may experience lack of sensation and stress urinary incontinence (SUI)-the condition of involuntary loss of urine associated with activities that cause an increase in intra-abdominal pressure (eg, sneezing, coughing, and lifting). Both vaginal laxity and urinary incontinence significantly affect patients' quality of life (QoL). The aim of this study was to evaluate efficacy and safety of a noninvasive radiofrequency device when used to treat SUI and vulvo-vaginal laxity through its heating effect which stimulates collagen and elastin fibers. Twenty-seven women (average age 44.78±10.04 years) with indications of mild/moderate SUI as well as vulvo-vaginal laxity were treated with a monopolar radiofrequency device. The treatment course consisted of three once-a-week sessions. Each session included intravaginal treatment followed by treatment of labia majora and the perineum. Improvement in the SUI condition was evaluated by applying the International Consultation on Incontinence Questionnaire - Urinary Incontinence Short Form (ICIQ-UI SF). Data were collected at the baseline, after the last treatment and at 1-month follow-up visit. Vaginal laxity was assessed by subjective vulvo-vaginal laxity questionnaire (VVLQ). Data were collected before the 1st treatment and during the 1-month follow-up visit. Patient's satisfaction was recorded using a satisfaction questionnaire. Data were collected after the last treatment and at the 1-month follow-up visit. Any adverse events related to the treatments were monitored. On a scale of 0 to 5, the average frequency of urine leak improved from "2-3 times a week" (2.15±1.03 points prior to treatment) to "once a week" (1.00±0.78 points post-treatment), and on to "never" (0.44±0.51 points at the 1-month follow-up visit). Sixteen subjects (59.3%) reported decrease in the amount of leakage, with 15 women (55.6%) becoming completely leak-free at the 1-month follow-up. At the 1-month follow-up visit, 24 subjects (88.9%) expressed their condition's interference with everyday life decreased and 17 patients (62.9%) said the condition did not interfere with their everyday life at all as a result of the treatment. All results are statistically significant (P<.05). No adverse events were recorded. All subjects reported improvement in vaginal laxity, from average perception of "very loose" (2.19±1.08 points prior to treatment) to "moderately tight" (5.74±0.76 points at the 1-month follow-up visit). During the follow-up visit, 89% of the patients "agreed" or "strongly agreed" that their SUI condition improved, and 93% of the patients "agreed" or "strongly agreed" that their gratification during intercourse improved. None of the subjects reported dissatisfaction. The study confirmed the monopolar radiofrequency method as an effective and safe treatment of SUI and vulvo-vaginal laxity. The treatments were well tolerated by all subjects with no adverse effects.

Urinary incontinence: prevalence, risk factors, impact on quality of life and treatment seeking behaviour among middle aged women

Background: Urinary incontinence (UI) is one of the priority health issue recognized by WHO. Urinary incontinence (UI) is defined by the international continence society as "a condition in which involuntary loss of urine is objectively demonstrable and is a social and hygiene problem. It is a common and distressing medical condition severely affecting quality of life (QOL). Urinary incontinence is a common health problem among women, with the prevalence varying from 8-45% in different studies.Methods: This study was based among the population around SRM-IMS, Bareilly. Total 464 women were interviewed out of 2860 total inhabitants.Results: Out of 464, 236 females were selected for this study. 28 women had urinary incontinence. The overall prevalence of urinary incontinence in our study was about 12%. There was significant association of increasing age and presence of urinary incontinence. Urinary incontinence does impact on quality of life of a woman having urinary incontinence. Impact of personal factors do not have much impact on urinary incontinence. 22% women had stress urinary incontinence, 38% had urgency incontinence and 38% had mixed type of urinary incontinence.Conclusions: Various obstetrical factors do contribute to urinary incontinence. Urinary incontinence is a significant health problem in the society leading to restriction in social and sexual activities. Almost 1 in 12 women suffering from urinary incontinence. Simple epidemiological tools such as a questionnaire can unveil the urinary incontinence subjectively. Further efforts are to be done to improve the quality of life and minimizing the urinary incontinence by pursuing them for treatment.

Prevalence of urinary incontinence among women and analysis of potential risk factors in Germany and Denmark.

Urinary incontinence (UI) is a prevalent condition that interferes with women's health-related quality of life. Prevalence rates from earlier studies are wide-ranging, due to heterogeneity in methodology, definition of UI and the populations included. We aimed to determine the prevalence of UI and associated risk factors in Germany and Denmark using the same methodology, definition and population. A postal survey was conducted in two regions in Germany and Denmark, including 8000 women aged 18+ years. UI was defined as any complaint of involuntary loss of urine. The questionnaire contained socio-demographic questions and the International Consultation on Incontinence Modular Questionnaire Urinary Incontinence Short Form (ICIQ-UI SF). The response rate in Germany and Denmark was 46.2 and 66.6% (p < 0.001) and the prevalence rate of UI was 48.3 and 46.4% (p = 0.188), respectively. Stress urinary incontinence dominated among younger women, and urgency urinary incontinence and mixed urinary incontinence among women 80+ years in Germany and Denmark, respectively. The subgroup of women with body mass index (BMI) ≥35 had the highest prevalence of UI (67.3%). The subgroup of women with BMI <35 were more likely to have stress urinary incontinence, and the subgroup of women with BMI ≥35 were more likely to have mixed urinary incontinence. UI was significantly associated with age as with BMI, vaginal delivery, chronic obstructive pulmonary disease, and having at least one co-morbidity. Prevalence rates in the two regions in Germany and Denmark were similar, despite significantly different response rates. This difference may reflect various attitudes towards answering a questionnaire, but the response rate on questions concerning UI seemed consistent.

Mixed urinary incontinence- what should we treat first?

Mixed urinary incontinence (MUI) is defined as ‘the involuntary loss of urine associated with urgency and also with effort or physical exertion, or on sneezing or coughing’. It is highly prevalent, increases with age and affects women more than men. It has a significant negative impact on health-related quality of life (HRQL). Additionally, treatment of mixed urinary incontinence places a large financial burden on both individuals and the NHS. Optimal management of this common condition is contested – should we treat the urge urinary incontinence (UUI), stress urinary incontinence (SUI) or predominant symptom first? At the 2015 BAUS Section of Female, Neurological and Urodynamic Urology this subject was debated. Based on a common scenario, the authors of the debate present the arguments for treating the urge urinary incontinence component, stress urinary incontinence component or the predominant symptom of mixed urinary incontinence first, before making recommendations for current practice.

Relación entre actividad física, calidad de vida e incontinencia urinaria en una muestra de mujeres adultas mayores de la ciudad de Talca – Chile

Introducción: La incontinencia urinaria en el adulto mayor es definida como una condición en la que se produce una perdida involuntaria de orina que se constituye en un problema social/ médico. Es un síntoma heterogéneo que con frecuencia se puede encontrar en los adultos mayores y se asocia entre otras variables al tipo de actividad y la calidad de vida. Objetivo: Determinar la relación entre actividad física, incontinencia urinaria de esfuerzo y calidad de vida de las mujeres de tercera edad de la comuna de Talca (Chile). Metodología: Esta investigación fue de tipo descriptiva-correlacional, con un diseño transversal. Se incluyeron un total de 386 mujeres adultas mayores de diferentes sectores de la comuna de Talca. Se aplicaron tres instrumentos: cuestionario internacional de actividad física (IPAQ), el cuestionario de incontinencia urinaria y el cuestionario de evaluación de calidad de vida (AQoL). Resultados: El 61,9% de las mujeres tenía un bajo nivel de incontinencia urinaria, un 65% estaba entre un nivel alto o moderado de actividad física, y 87% de las mujeres reportó una muy buena calidad de vida. Conclusión: Los datos, en función del objetivo, reflejan que la incontinencia urinaria se asocia de forma significativa con las variables actividad física y calidad de vida.

Association between schizophrenia and urinary incontinence: A population-based study

BackgroundUrinary incontinence (UI) is defined as the involuntary loss of urine and can constitute a hygiene or social problem for affected patients. Whether the UI incidence is higher in patients with schizophrenia than in the general population remains undetermined. MethodsThe patients were selected from the Taiwan National Health Insurance Research Database, using claims data from 2005 to 2011. We compared the risk of UI between schizophrenia and nonschizophrenia groups. Logistic regression models were employed for analyzing the risk of UI after adjustment for sex, age, and comorbidities. ResultsThe adjusted odds ratio for UI in the schizophrenia group was 1.78-fold higher than that in the nonschizophrenia group. Furthermore, male patients with schizophrenia were more susceptible to UI than their female counterparts, and a higher risk of UI was observed among younger patients with schizophrenia. ConclusionCompared with the general population, the risk of UI was higher among the patients with schizophrenia. Early diagnosis and intervention can increase the quality of life among patients with schizophrenia.

LES EXSTROPHIES VESICALES : ASPECTS EPIDEMIOLOGIQUES, CLINIQUES ET THERAPEUTIQUES A PROPOS DE 21 CAS

SUMMARY Aims: Report epidemiological, clinical and therapeutic aspects of bladder exstrophy. Materials and Methods: Retrospective descriptive study of 21 bladder exstrophy between january 1990 and december 2004 in the urology service of a Senegalese hospital. The following parameters were analyzed: age, sex, consanguinity, reasons for consultation, clinical and paraclinical aspects, surgical modalities and treatment outcomes. Result: Mean age of patients was 5, 4 years (1 day and 37 years). The majority of patients were male. Consanguinity was revealed in 8 patients. The reasons for consultation were dominated by congenital anomalies of the external genitalia and permanent involuntary urine loss. The complete forms of bladder exstrophy were the most frequent at physical examination (90%). Diastasis of the symphysis pubis was demonstrated in 10 patients on radiography. There was one abstention while surgical treatment was initiated in 18 patients. At least one of the following surgical procedures was performed: a bilateral iliac osteotomy, parietal closure (bladder plate and anterior abdominal wall) and the making of a neo urethra or epispadias cure. Conclusion: Bladder exstrophy has a low incidence. The surgical management was difficult but we seemed necessary to control urine leakage. Key words: bladder exstrophy, hypogastric urinary leakage, surgical treatment

Factors associated with urinary incontinence in middle-aged women: a population-based household survey.

The objective was to determine the prevalence of urinary incontinence (UI) and factors associated in a sample of Brazilian middle-aged women. A cross-sectional study was conducted between September 2012 and June 2013 with 749 women. UI was defined as any complaint of involuntary loss of urine. The independent variables were sociodemographic data and health-related habits and problems. Statistical analysis was carried out using Chi-squared test and Poisson regression. The mean age was 52.5 (±4.4) years. The prevalence of UI was 23.6%. Of these, 48 (6.4%) had stress urinary incontinence, 59 (7.8%) urinary urgency, and 70 (9.5%) had mixed urinary incontinence. In the final statistical model, self-perception of health as fair/poor/very poor (PR: 1.90; 95% CI, 1.45-2.49; P < 0.001), ≥1 vaginal deliveries (PR: 1.84; 95% CI, 1.35-2.50; P < 0.001), higher body mass index (PR: 1.04; 95% CI, 1.02-1.06; P = 0.001), vaginal dryness (PR: 1.60; 95% CI, 1.23-2.08; P = 0.001), current or previous hormone therapy (PR: 1.38; 95% CI, 1.06-1.81; P = 0.019), pre-/perimenopause (PR: 1.42; 95% CI, 1.06-1.91; P = 0.021), and previous hysterectomy (PR: 1.41; 95% CI, 1.03-1.92; P = 0.031) were associated with a greater prevalence of UI. Current or previous use of soy products to treat menopausal symptoms was associated with a lower prevalence of UI (PR: 0.43; 95% CI, 0.24-0.78; P = 0.006). Several factors are associated with UI in middle-aged Brazilian women. The results highlight the importance of carrying out interventions aimed at reducing modifiable factors.

Low serum Insulin Like Growth Factor - 1 in patients with Stress Urinary Incontinence.

ABSTRACTObjective:SUI, involuntary loss of urine, occurs when intra abdominal pressure exceeds urethral pressure in women. Recent animal study has shown that there are therapeutic effects of Insulin-like growth factors (IGF-1) on stress urinary incontinence in rats with simulated childbirth trauma. IGF-1 is an important mediator of cell growth, differentiation and transformation in various tissues and stimulates fibroblast proliferation and enhances collagen synthesis. The purpose of the current study was to determine the association between IGF-1 levels and SUI.Materials and Methods:All patients were evaluated for SUI and divided into two groups: 116 women with SUI and 76 women without SUI. Diagnosis of SUI was based on the International Consultation on Incontinence Questionnaire-Short Form (ICIQSF). Levels of IGF-1 were measured in serum by enzyme-linked immunosorbent assay. The relationship between IGF-1 levels and SUI in patients was evaluated statisticaly.Results:The mean age of patients wiyh SUI was 49.9±8.6 and 48.7±7.8 in control group. Plasma IGF-1 levels were significantly lower in SUI than in control group (106.5±26.4 and 133.3±37.1ng/mL, respectively, P <0.001). Body mass indexes were higher in women with SUI than women without SUI.Conclusion:In this study lower serum IGF-1 levels were found to be associated with SUI. Serum IGF-1 level appears to be a specific predictor of SUI, and it may be used in early prediction of SUI in female population.

Urinary incontinence: considering the physical and psychological implications.

This article looks at urinary incontinence (UI) from the perspective of the social stigma attached, the prevalence, assessment and types of UI and at the practical means of assistance available for those whose symptoms have not yet been resolved. The International Continence Society (ICS) defines UI as any involuntary loss of urine, but retain their previous definition of ‘involuntary loss of urine that is a social or hygienic problem’ (Abrams et al, 2010: 29). There is a social stigma around the symptoms of UI and people may be reluctant to seek help due to embarrassment, or because they do not construe UI as a suitably medical problem, considering it is a normal part of childbirth or ageing. It is important that nurses (or others involved) create opportunities to identify UI and give patients the opportunity to mention what some may feel is unmentionable (Norton, 2014; Strickland, 2014). The Bladder and Bowel Foundation (2016) estimates that in the UK, more than 14 million adults have problems with bladder control. UI is a symptom, not a diagnosis and management should commence with an assessment to investigate the cause (Nazarko, 2013). As urinary tract infection (UTI) can exacerbate UI, a fresh specimen of urine should be dipstick tested; if positive for nitrite and leucocytes and symptoms include dysuria, frequency and urgency of micturition, a midstream specimen of urine should be sent for culture and sensitivity (Reid, 2014; Bardsley, 2015). After any UTI has been treated, the patient should complete a frequency volume chart/bladder diary, indicating patterns in micturition, UI and fluid intake; National Institute for Health and Care Excellence (NICE, 2015) recommends that this is for a minimum of 3 days.

Effectiveness of Pelvic Floor Muscle Training for Urinary Incontinence: Comparison Within and Between Nonhomebound and Homebound Older Adults.

To compare the effectiveness of a biofeedback-taught pelvic floor muscle training (PFMT) intervention in reducing urinary incontinence (UI) and improving general health-related and UI-specific quality of life in homebound and nonhomebound older adults. We also compared adherence rates to the prescribed PFM exercises and strategies (urge and/or stress) in the 2 groups of subjects. Secondary data analysis of initial 6-week PFMT intervention data from a randomized controlled trial designed to examine the efficacy of a relapse prevention intervention in sustaining improvements in UI following PFMT. The sample comprised 93 homebound and 185 nonhomebound community-dwelling men and women 60 years and older with urge, stress, or mixed UI at least twice a week for a minimum of 3 months. The intervention consisted of 6 weekly in-home visits during which biofeedback via transcutaneous electromyographic patches was used to teach subjects pelvic floor muscle exercises and, as indicated, stress and/or urge suppression strategies to prevent involuntary urine loss. Incontinence severity was measured by a 1-week bladder diary at baseline and at the end of the 6-week intervention. Health-related quality of life was measured at baseline and postintervention using the Medical Outcomes Study Short Form-36 (MOS SF-36) (general health-related quality of life), and the Modified Incontinence Impact Questionnaire (MIIQ). Self-reported adherence data were collected at each intervention visit. At baseline, homebound subjects had significantly more severe UI, more comorbid conditions, and higher levels of functional impairment than nonhomebound subjects. Following the intervention, there was a significant reduction in the number of incontinent episodes in both homebound and nonhomebound subjects, with no significant group differences (P = .25) in the median percent reduction in UI (64.5% in homebound vs 70.4% in nonhomebound subjects). UI-specific quality of life (MIIQ total scores) improved significantly in both groups without any significant between-group differences (P = .83). There were no significant changes in health-related quality of life in either group. Pelvic floor muscle adherence rates were higher than adherence rates to strategies in both groups, with no significant group differences. The biofeedback-guided PFMT intervention was equally effective in reducing UI and improving UI-specific quality of life in homebound and nonhomebound community-dwelling older adults.

AB026. Relationship between post-voided dribbling and erectile dysfunction in men with lower urinary tract symptoms

BackgroundPost voided dribbling (PVD) in men is the symptom of experiencing involuntary loss of urine immediately after a person has finished passing urine, usually after leaving the toilet which distinguished from terminal dribbling. Researches on the PVD are very limited because no proper tool to evaluate PVD. This study was to assess the correlation between PVD and erectile dysfunction (ED) in men with lower urinary tract symptoms (LUTS).MethodsA total of 205 patients with LUTS were enrolled. Patients filled in international prostate symptom score (IPSS) and Hayllm PVD questionnaire (HPVDQ) that was made by authors. Prostate size, prostate specific antigen, uroflowmetry including Qmax & post voided residual urine, IPSS, and international index for erectile function-5 (IIEF-5) were also assessed.ResultsPatients were classified as ED (129 patients) and non-ED (76 patients) groups. HPVDQ was inversely well correlated with IIEF-5 (r=-0.244, P<0.001). Prevalence of ED was related to PVD severity (P=0.002). Predictive accuracy of HPVDQ for ED was not superior to that of other LUTS (each P>0.05). However, incorporation of HPVDQ into IPSS increased predictive accuracy of LUTS for ED (56.3% to 65.1%).ConclusionsIn men with LUTS, PVD was inversely well correlated with erectile function, and its severity was related with prevalence of ED.

Nonsurgical treatment methods in urinary incontinence

While the young patients are predominant affected by stress urinary incontinence, on as you age, the causes of urinary incontinence include-menopausal hypoestrogenism and any vegetative and neuro-psychiatric disorders, generating a new pathologic entity - overactive bladder. Diagnosis urinary dyssynergia component (urodynamic studies, cistomanomentrie, cystoscopy, etc.) can avoid surgery that would enhance urinary incontinence. Treatment options for this disease are non-surgical and are designed to prevent involuntary loss of urine. The non-surgical treatment is perfectly indicated and effective on overactive bladder. The aim of this study is to analyze the importance and effectiveness of non-surgical methods of treatment of urinary incontinence caused by overactive bladder. We considered the following entities: behavioral changes, Kegel perineal exercises, biofeedback, electrical stimulation, bladder exercise (bladder “re-education”), vaginal cones, devices to maintain continence and pharmacological therapy, including treatment with botulinum toxin A and injection agencies for volume effect. Both micturition behavior modification with bladder “re-education” and Kegel exercises combined with bio-feedback, behavior changes and vaginal cones reported less incontinence and improved quality of life. Postmenopausal women should not receive oral hormonal therapy because it worses symptoms in women with incontinence and in those initial continent, increases the risk of this condition. But topical administration of estrogen has improved UI symptoms.

PREVALENCIA DE INCONTINENCIA FECAL EN PERSONAS QUE ACUDEN A POLICLÍNICOSDE UN HOSPITAL UNIVERSITARIO

Frequency of fecal incontinence in ambulatory patients background: Fecal incontinence (FI) affects quality of life and is a cause embarrassment, hampe- ring the collection of data about the problem. It is more common in older people and it is important to know risk the factors and scope of the problem. aim: Determine the prevalence and risk factors associated to FI in a population of patients consulting in a health center. material and methods: A self-applied questionnaire was answered by a randomly selected sample of 1136 ambulatory patients aged 50 ± 15 years (59% females), excluding those who consulted in colorectal surgery and gynecology. Demographic variables, obstetric history, history of anorectal surgery, anorectal symptoms, involuntary urine loss, and the FI Wexner or Cleveland Clinic Fecal Incontinence scores were recorded. results: Thirty one per - cent of respondents had some degree of FI. In multivariate analysis presence of anorectal pain, urinary incontinence and number of vaginal deliveries were significantly associated with FI. conclusions: Pre - valence of FI in this study is similar, though slightly higher, to data reported in national and international publications.

The Effect of Urinary Incontinence on Health-related Quality of Life: Is It Similar in Men and Women?

To compare the association between self-reported urinary incontinence (UI) and health-related quality of life (HRQoL) in men and women while taking chronic comorbidities into account, on the hypothesis that UI might negatively affect HRQoL differently in each sex. In 2006, a total of 10,723 men (aged 57-67 years) and 3777 women (aged 52-67 years) participating in the GAZEL cohort (www.gazel.inserm.fr) completed a self-administered questionnaire including the Nottingham Health Profile to assess HRQoL. UI was defined as self-reported involuntary loss of urine in the past 12 months. Adjusted logistic regression models were fitted to estimate the association between impaired HRQoL and UI, taking age, chronic conditions, and other confounders into account. For each QoL dimension, we compared the strength of the associations between UI and HRQoL between the sexes by tests of interaction. Women were more likely than men to report both UI (13.9% vs 2.7%) and impaired HRQoL. UI was associated with impaired HRQoL in both sexes, mainly in the dimensions of energy (OR = 3.17 in men [95% CI 2.49-4.04] and 2.11 in women [1.75-2.54]), social isolation (OR = 2.29 in men [1.74-3.02] and 1.75 in women [1.44-2.12]), and physical mobility (OR = 2.05 in men [1.62-2.60] and 2.27 in women [1.88-2.74]). There were no significant interactions between the sexes after adjustment. UI was associated negatively with HRQoL in both sexes, mostly in the dimensions of energy, social isolation, and physical mobility. The association was similar in men and women after we took age, sociodemographic characteristics, and chronic diseases into account. The cross-sectional design of the analysis prevents any conclusion that UI induced an impairment of HRQoL, and no causal relation can be inferred.

The Additional Value of Cystoscopy with Urodynamic Study in the Assessment of Patients with Urinary Incontinence

Background: Urinary incontinence (UI) is generally defined as the involuntary loss of urine from the bladder through the urethral meatus. Filling cystometry is the method by which the pressure/ volume relationship of the bladder is measured during bladder filling. Purpose: To determine the value of diagnostic cystoscopy in addition to Urodynamic study (UDS) in patients with primary urinary incontinence. Material and Methods: 200 patients with primary incontinence studied prospectively from January 2013 to June 2014. Their age ranges from (14 - 93 years), 86.5% were female, and 13.5% of them were male. In addition to physical, neurological examination and bio-chemical investigations, urine analysis and urine culture with Ultra-sound and Post void residual volume (PVRV), all patients underwent diagnosticflexible cystoscopy under local anesthesia, and urodynamic study. Result: 43.5% of patients age were between (34 - 53 years), (39%) between (54 - 73 years), (9%) between (14 - 33 years) and (8.5%) were between (74 - 93 years). Atonic bladder on UDS were (40.5%), Detrusor over activity (29%), patients with normal UDS were (22%) and patients that had DSD (Detrusor Sphincter Dyssynergia) were (8.5%). Eighty-four cases (42%) were found to have normal cystoscopy, those with grade-I-II bladder wall trabeculations were (49%) and patients with grade-III were (8.5%). Sixty-one patients (30.5%) with normal diagnostic cystoscopy have abnormal UDS (Atonic bladder, over-active bladder and DSD) while twenty-one (10.5%) patients with normal UDS had bladder wall trabeculations (grade-I-III) on diagnostic cystoscopy. Conclusion: Diagnostic cystoscopy in addition to urodynamic study will put in further knowledge in the assessment of patients with urinary incontinence. To some extent, it can predict the diagnosis.

Surgical Management of Urinary Stress Incontinence

Urinary incontinence (UI) is defined by the International Continence Society as an “involuntary loss of urine which is objectively a demonstrable, social, and hygienic problem. Stress incontinence which constitutes nearly the half of all urinary incontinence cases, mainly depends on surgical treatment. There is not an optimal surgical procedure for treatement stress urinary incontinance. Treatment alternatives should be individualised for each patient. Assessment of patients presenting with urinary incontinence should include a focused medical history and examination and incontinence type should be determined. Preoperative, the type of incontinence should be determined and the optimal treatment should be planned. Several surgical techniques have been developed and long term outcomes published in recent years. Midurethral slings have become the most commonly performed procedures for urinary stress incontinence since they are safe, effective and have good long term outcomes. But it should be kept in mind that there is no single operation successful for the urinary stres incontinence.

Transvaginal tape or transobturator tape - what to opt for cure of female stress urinary incontinence

Background: Urinary incontinence is a very disturbing condition that affects quality of life. Stress urinary incontinence (SUI) is defined as the involuntary loss of urine associated with the sensation of urgency and is usually associated with exertion, sneezing or coughing. About 30-50% of women suffers from this condition and is conventionally treated with pelvic floor exercises, bladder drill, duloxetine and anticholinergic drugs with unsatisfactory results. Retro pubic and transobturator sub urethral slings such as TOT and TVT are the gold standard surgical treatment for women with USI. Methods: This is a prospective study conducted between May 2007 to March 2010 in RLJH hospital, Kolar in department of surgery under the guidance of urologist. Patients diagnosed with stress urinary incontinence were randomized by double blind technique, to the retropubic route (TVT) or the transobturator route (TOT) group. A total of 71 patients TVT = 36 and TOT = 35 patients were posted for respective operative procedures. The institutional ethical committee approved the study, and all women gave their written and informed consent after receiving full information about the study. Inclusion criteria were patients diagnosed with stress urinary incontinence and those who had recurrence after previous anti-incontinence surgery. Patients with mixed incontinence were excluded from our study. Results: The demographic data and pre and post-operative clinical parameters of all patients studied showed no significant differences between the two groups. Mean follow up was 30 months (24-48). Mean operative time was 36 (20-45) minutes in TVT and 20 (12-25) minutes in TOT. The post-operative urinary retention was seen in 13.8% (n = 5) in the TVT group and 2.8% (n = 1) in the TOT group. We had suprapubic haematoma 5.5% (n = 2) in the TVT group. Bladder perforation occurred in two cases of TVT. Two patients with previous failed incontinence surgery also did well in our study. Conclusions: Transobturator tape procedure has less complication, good postoperative outcome in terms of cure of stress urinary incontinence and improved quality of life and patient’s satisfaction. This technique is easy to learn and can be performed by general surgeons as day care surgery. This procedure has an advantage of easy performance in those patients who have a failed previous incontinence surgery.