Management Of Incontinence In Women Research Articles

Evaluation and conservative management of urinary incontinence in women

The authors discuss the clinical symptoms, evaluation, and cost-effective nonsurgical, conservative management of urinary incontinence, a common condition affecting from 25% to 75% of women depending on age.

Place of the transobturator tape technique (TOT) in the management of stress urinary incontinence in women

Place of the transobturator tape technique (TOT) in the management of stress urinary incontinence in women

Current practice on the management of pre-operative urine dipstick results in women undergoing gynaecological surgery in Wales

A survey was circulated to consultant gynaecologists across Wales, to evaluate the management of pre-operative urine dipstick results. Questions were based on NICE guideline 171, regarding the management of urinary incontinence in women. Six respondents never checked their patient's urine dipstick results. Of the remaining 37 respondents, 70% always check and 30% sometimes check. Overall, 37.1% cancelled surgery when a urine dipstick was positive for either nitrite or leukocyte-esterase (LE). A significantly larger proportion cancelled surgery when symptomatic for urinary tract infection (p< 0.001), and when nitrite and LE positive compared to only LE positive (p< 0.05).This survey provides evidence that gynaecological operations are potentially being cancelled unnecessarily based on a screening test with limited sensitivity and specificity. Further research is needed into the outcomes of gynaecological surgery in women symptomatic of urinary tract infection to provide guidance on the use of pre-operative urinalysis and the management of test results.Impact statementWhat is already known on this subject? The strongest risk factor for postoperative urinary tract infections (UTIs) is a pre-operative recurrent UTI (Nygaard et al. 2011). This is the reason behind the urine dipstick being part of the pre-operative checklist for gynaecological surgery. Traditionally, a suspected UTI would mean postphoning surgery whilst treating the UTI. It is known that the sensitivity of the nitrite test and leukocyte-esterase test when used alone is low and cannot rule out UTI in most patients (Mambatta et al. 2015). Urine culture is therefore suggested for all patients with a suspected UTI (John et al. 2006). To our knowledge, there are no data available on whether we should be postphoning gynaecological surgery based on a urine dipstick result.What the results of this study add? Overall, 37.1% of respondents cancelled surgery when a pre-operative urine dipstick was positive for either nitrite or leukocyte-esterase. This provides evidence of variation in the practice of using the urine dipstick in women undergoing gynaecological surgery in Wales. These cancellations are potentially unnecessarily. Furthermore, 14% of respondents did not use a urine dipstick and the majority did not act on an abnormal results, implying clinicians have a low confidence in the test as a screening tool.What the implications are of these findings for clinical practice and/or further research? We propose removing the urine dipstick as a pre-operative screening test. Asymptomatic bacteriuria is common in women and routine screening for UTI pre-operatively will therefore inevitably lead to unnecessary intervention (i.e. cancellation). Further research is needed into the outcomes of gynaecological surgery in women symptomatic of UTI to be able to provide guidance on the use of pre-operative urinalysis and management of the test results.

A comparison of the National Institute for Health and Care Excellence (NICE) and European Association of Urology (EAU) guidelines for the assessment and management of urinary incontinence in women

Objective: The objective of this paper is to identify the similarities and key differences between the National Institute for Health and Care Excellence (NICE) and European Association of Urology (EAU) guidelines on the management of urinary incontinence (UI) in women. Methods: We reviewed the most recent iterations of both full guidelines to identify all key recommendations and their associated level/grade of evidence. Guidance on the management of urinary incontinence in men and neuropathic patients was excluded. Results: There is a significant overlap in the recommendations of both guidelines. Key differences include the indications for performing urodynamics, pharmacological agents in stress UI, the dose of botulinum toxin A (200 units by NICE, 100 units by EAU), the hierarchy of surgical options for primary stress UI and the role of the multi-disciplinary team (MDT). Conclusion: This review provides the various stakeholders involved in the management of female UI with a summary of the strength of evidence supporting the recommendations by these two key guidelines. We have provided an evidence-based framework to support clinical experience from which to base management decisions.

Outcomes of Surgical Management in Patients with Stress Urinary Incontinence and/or Neovesicovaginal Fistula after Orthotopic Neobladder Diversion

To our knowledge there are no guidelines for the evaluation and management of incontinence in women with an orthotopic neobladder. We propose a treatment algorithm based on our experience with treating this patient population. We identified women in whom orthotopic neobladder diversion and surgery for incontinence were performed from January 1, 1995 to January 1, 2014. Charts were reviewed for management, outcomes and complications within 30 days of surgery. At this institution 12 women with orthotopic neobladder diversion were treated with surgery for incontinence between 1995 and 2014. Six women (50%) had an undiagnosed neovesicovaginal fistula, of whom 3 (50%) underwent successful fistula repair. A total of 12 bulking agent injections were performed in 6women (50%). The outcomes were continued dryness after 1 injection (8%), transient improvement after 9 (75%), immediate failure after 1 (8%) and secondary fistula development after 1 (8%). Four transobturator slings and 4 pubovaginal slings were placed in a total of 6 patients (50%), of whom 1 (17%) was dry and 1 (17%) was improved. At a median followup of 22.9 months (IQR 11.1-46.4) 6 women (50%) were dry or improved and 6 (50%) had no improvement in leakage. Of the 6 (50%) women who were dry or improved 2 (17%) achieved planned intermittent catheterization after surgery and 2 (17%) underwent ileal conduit conversion. Bulking agents have low long-term efficacy and carry the risk of fistula formation. The efficacy of tension-free sling placement is low and continence requires an obstructing sling. Counseling should include acceptance of multiple procedures, which may be necessary to achieve continence, and consideration of conduit diversion.

Effectiveness of Pelvic Floor (PF) Rehabilitation by Recruiting Abdominals (global) vs Kegels in the Management of Stress Urinary Incontinence in Women

Effectiveness of Pelvic Floor (PF) Rehabilitation by Recruiting Abdominals (global) vs Kegels in the Management of Stress Urinary Incontinence in Women

Summaries for patients. Nonsurgical management of urinary incontinence in women: a clinical practice guideline from the American College of Physicians.

Summaries for patients. Nonsurgical management of urinary incontinence in women: a clinical practice guideline from the American College of Physicians.

Effects of urinary incontinence subtypes on women's quality of life (including sexual life) and psychosocial state

ObjectiveOur aim was to investigate the effects of urinary incontinence subtypes on women's quality of life (including sexual life) and psychosocial state. Study designThe patients, who applied to our clinic from March 2011 to August 2011, were identified and stratified into three groups: those with stress incontinence proved urodynamically (USI), those with urge incontinence (UI), and those with mixed incontinence urge incontinence (UI) proved by urodynamic and clinic evaluation. Scores on the Beck anxiety inventory (BAI), pelvic organ prolapse/urinary incontinence sexual questionnaire (PISQ-12), urogenital distress inventory (UDI-6), and incontinence impact questionnaire (IIQ-7) were compared between the urinary incontinence subtypes. ResultsAccording to urodynamic and clinical examination of 111 women with urinary incontinence, 59 (53%) had USI, 35 (32%) had UI, and 17 (15%) had MI. BAI-scores significantly differed between the USI and UI groups (p=0.030) and between the USI and MI groups (p=0.011) not between the UI and MI groups (p=0.597). UDI-6 scores did not significantly differ between the three groups (p=0.845). IIQ-7 scores significantly differed between the USI and MI groups (p=0.003) and between the UI and MI groups (p=0.006) but not between the USI and UI groups. Patients with USI had significantly lower PISQ-12 scores than those with UI (p=0.015). ConclusionsThese differences in the effects of incontinence subtypes should be kept in mind in the evaluation of patients with urinary incontinence. Psychiatric assessment may improve the management of incontinence in women, especially UI and MI.

The management of urinary incontinence in women

It is important to assess the severity of incontinence and its impact on patients’ quality of life, writes Dr Suneeta Kochhar

The management of stress urinary incontinence in women

Stress urinary incontinence is a common, but frequently unreported, problem for women. This article explores the management and treatment options that are available.

Currently performed continence surgery: How useful are hospital episode statistics?

SummaryThe aim of this study was to examine current trends in selecting continence operations for female patients in the UK. An online data search was carried out using the Hospital Episode Statistics website (www.hesonline.nhs.uk). Only operations performed on women were included. A request for more detailed information was submitted but no information was provided. Data were available for 4 years, from 2002–2003 until 2005–2006. It was difficult to establish trends regarding mid-urethral slings, including tension-free vaginal tape and transobturator tape, both inside out and outside in, as well as single incision slings. A respectable number of operations were coded as other specified and unspecified. The poor specificity of codes used and delayed availability of data precluded obtaining clear information about trends in the surgical management of urinary incontinence in women. There is a need to develop new codes that match changes in continence surgery and to provide data at the end of each financial year. This will help monitoring performance, audit as well as research.

Managing urinary incontinence in women

Angie Rantell and Riette Vosloo provide an overview of the conservative management of urinary incontinence in women

Special investigations for female incontinence

Urodynamics is the measurement of the ability of the bladders and urethra to store and expel urine. This article describes some of the investigations that are used in the diagnosis and management of incontinence in women and that come under the umbrella of ‘urodynamics’. Pad tests quantify the amount of urine loss and are also helpful in patient counselling and measuring the results of intervention. Urinary flow rates are assessed by uroflowmetry and help identify poor bladder emptying (the cause of which can then be determined by pressure-flow studies). Filling cystometry is the main test of the lower urinary tract’s ability to store urine and measures the capacity, stability and compliance of the bladder, as well as assessing the competence of the urethra. Pressure-flow studies are used to identify the cause of poor bladder emptying. In selected cases, it is necessary to image the lower urinary tract whilst simultaneously measuring pressure and flow; this is achieved by videourodynamics. When abnormalities cannot be demonstrated by any of these clinic-based investigations, ambulatory urodynamics provide a means of measuring the physiological function of the lower urinary tract over a long period of time, away from the hospital environment. The ability of the urethra to contain urine within the bladder can be quantified by a variety of techniques including urethral pressure profilometry, urethro retro-resistance pressure and leak point pressure, but currently, these tests have limited clinical value. Urodynamics is not necessary for every woman with urinary incontinence but is highly desirable before considering irreversible surgical intervention.

Surgical management of stress incontinence in women: The role of the family practitioner Part 1: Pre-operative issues

AbstractThe surgical management of stress incontinence in women should encompass a combined approach by the family practitioner and the specialist. This review, in two parts, discusses the place of the family practitioner in this process. The continence mechanism, pre-operative counselling, appropriate surgical procedures, post-operative complications and aftercare are all discussed, to enable the family practitioner to provide adequate support to the patient.

Nursing management of stress urinary incontinence in women.

Although urinary incontinence is not a subject spoken about in general conversation, it is a cause of concern for many people. Stress urinary incontinence is common, being reported by 16.8% of women (Hunskaar et al, 2002). In the past, women with stress urinary incontinence were often dismissed as having an inevitable problem resulting from childbirth and the hormonal changes associated with ageing. They were often made to feel that they just had to put up with the problem--this is no longer the case. Conservative therapy is advocated as the primary intervention for those suffering with stress urinary incontinence and nurses are ideally placed to be a source of information and help. Furthermore, nurses can develop their skills in order to encompass therapies to become more specialist and effective. In 2000, the Department of Health (DoH) issued guidance on establishing integrated continence services (DoH, 2000). This becomes mandatory for older people from April 2004 (DoH, 2001a).

Questionnaire-based survey on obstetricians and gynaecologists’ attitudes towards the surgical management of urinary incontinence in women during their childbearing years

Objective: To determine the appropriate surgical management of incontinence in women who desire to maintain their childbearing capacity. Design: Questionnaire-based survey. Method: A postal questionnaire was sent to 251 (every fourth) consultant obstetricians and gynaecologists in the UK practising in both district general hospitals ( n=156) and teaching hospitals ( n=95). Main outcome measures: Clinical consensus in the management of incontinence in women who are interested in childbearing. Results: One hundred and thirty two (53%) consultants responded of which 22 (17%) were not involved in managing this group of women and were therefore excluded from analysis. Thirty-nine (36%) of the replies were from teaching hospital, 71 (65%) were from district general hospitals. Eighty-six (78%) consultants are prepared to perform a continence procedure on women who had not completed their families. One hundred (91%) would offer caesarean section to those continent pregnant women following their continence surgery. (Fisher’s exact test’ P=0.038). Interestingly, 67 (60.9%) of respondents still perform caesarean section to the pregnant women even if they are incontinent. Conclusions: The majority of UK consultants would perform a continence procedure in women who wish to maintain their childbearing capacity. Colposuspension is the favoured surgical procedure. If women are continent following surgery, most prefer them to be delivered by caesarean section.

Radiofrequency bladder neck suspension for the treatment of genuine stress urinary incontinence.

Radiofrequency energy has been used for numerous medical applications including orthopedic, oncologic, and ophthalmologic indications. Characteristics of this energy source also allow it to be used for precisely controlled thermal therapy directed at soft tissues so as to induce such changes as collagen deposition and tissue shrinkage. These soft tissue effects have recently been used for the treatment of genuine stress urinary incontinence in women. As experience with this modality has matured, improved and less invasive methods of energy application have been developed. Large-scale clinical trials using this energy modality via laparoscopic and transvaginal approaches have either recently been completed or are near completion. A completely noninvasive approach is presently undergoing early clinical trials. The efficacy and safety profiles of this therapy support radiofrequency treatment of the endopelvic fascia as an option for the management of stress urinary incontinence in women.

Strategies to promote continence in the community

Incontinence is a distressing and embarrassing health problem for many people living in the community and affects all age groups. This article outlines the prevalence, types and possible causes of incontinence with particular emphasis on the management of incontinence in women. Assessment, investigative and treatment strategies including pelvic floor exercises, the use of weighted cones, neuromuscular stimulation and oestrogen replacement therapy are examined. The author identifies that further training and education for healthcare professionals is essential to promote and develop continence strategies in the community.

Urogynaecology: The Investigation and Management of Urinary Incontinence in Women

Ed A R B Smith RCOG Press, pounds sterling16, pp 168 ISBN 0 902331 66 3 The Royal College of Obstetricians and Gynaecologists held a meeting on urogynaecology in 1994, and this book has been compiled almost directly from the presentations given on that day. The presenters included some of the most experienced practitioners of the “art” of urogynaecology (for chapter after chapter points out the woeful lack of controlled trials), and they review and give their personal views …