Onset Of Urinary Incontinence Research Articles

TRANSURETHRAL INJECTION OF BULKING AGENTS FOR STRESS URINARY INCONTINENCE FOLLOWING ORTHOTOPIC NEOBLADDER RECONSTRUCTION IN WOMEN

The clinical efficacy of transurethral bulking agents for the treatment of new onset urinary incontinence following radical cystectomy and orthotopic lower urinary tract reconstruction in women was evaluated. Between 1990 and 2002, 101 female patients with primary transitional cell carcinoma of the bladder were treated with radical cystectomy and orthotopic ileal neobladder reconstruction. Of the 101 patients 12 (12%) underwent treatment for new onset urinary incontinence following exenterative surgery with transurethral injection of bulking agents, including collagen in 11 and nonabsorbable pyrolytic carbon coated beads in 1. A total of 25 injections were administered to 12 female patients with a mean age of 75.4 years following orthotopic neobladder reconstruction. Mean followup was 22.5 months (range 2 to 51). Two of the 12 patients (16.7%) reported complete continence and were considered cured, although subjective complaints of urinary frequency persisted. Four patients (33%) had decreased objective average daily pad use (6.75 to 2.25) and 6 (50%) showed no subjective or objective improvement in symptomatology. Although injection of urethral bulking agents is a minimally invasive treatment for stress urinary incontinence following orthotopic neobladder reconstruction, long-term results in patients with severe disease show a less than optimal durable response.

Fecal and urinary incontinence after vaginal delivery with anal sphincter disruption in an obstetrics unit in the United States

Objective The purpose of this study was to estimate the incidence of urinary and bowel incontinence in relation to anal sphincter laceration in primiparous women and to identify factors that are associated with anal sphincter laceration in a unit that uses primarily midline episiotomy. Study design From January 1, 1997, to March 30, 2000, 2941 questionnaires concerning pelvic floor function 6 months after delivery were mailed to primiparous women who were delivered vaginally at the University of Michigan Medical Center. Charts were reviewed for 2858 deliveries to assess the use of episiotomy and the degree of perineal trauma, along with demographic and pertinent delivery variables. There were 943 women who completed the urinary function questionnaire and 831 women who completed the bowel function questionnaire. Univariate analysis was performed on all covariates. Multiple logistic regression was used for the analysis of the presence of third- or fourth-degree lacerations as the outcome. Results Nineteen percent of the women who completed the survey had sustained third- or fourth-degree lacerations during childbirth. The women in the sphincter laceration group were more likely (23.0%) to have bowel incontinence than the women in the control group (13.4%) ( P<.05). The incidence of worse bowel control was nearly 10 times higher in women with fourth-degree lacerations (30.8%) compared with women with third-degree lacerations (3.6%, P<.001). Macrosomia (odds ratio, 2.19; 95% CI, 1.61, 2.99), forceps-assisted delivery (odds ratio, 4.75; 95% CI, 3.43, 6.57), and vacuum-assisted delivery (odds ratio, 3.51; 95% CI, 2.64, 4.66) were associated with higher risks of third- and fourth-degree lacerations. Midline episiotomy (odds ratio, 2.24; 95% CI, 1.81, 2.77), but not mediolateral (odds ratio, 0.66; 95% CI, 0.375, 1.19), episiotomy was associated with anal sphincter lacerations. More than one half of the women had new onset of urinary incontinence after delivery and reported several lifestyle modifications to prevent leakage. Conclusion Women with third- and fourth-degree lacerations were more likely to have bowel incontinence than women without anal sphincter lacerations. Fourth-degree lacerations appear to affect anal continence greater than third-degree lacerations.

COLLAGEN INJECTION FOR THE TREATMENT OF INCONTINENCE AFTER CYSTECTOMY AND ORTHOTOPIC NEOBLADDER RECONSTRUCTION IN WOMEN

We determine the clinical efficacy of endoscopically injected collagen for the treatment of new onset urinary incontinence in women following cystectomy and orthotopic neobladder. Three women 58 to 74 years old underwent transurethral collagen injection for stress urinary incontinence following cystectomy and orthotopic neobladder. Before cystectomy 2 women denied having any stress urinary incontinence while 1 complained of mild incontinence. Onset of incontinence following cystectomy and neobladder formation ranged from 8 months to 3 years, and average pad use ranged from 3 to 5 per 24-hour period. All patients underwent video urodynamic evaluation before collagen injection. Neobladder capacity was 180 to 400 cc and Valsalva leak point pressures ranged from 30 to 60 cm. water. A total of 6 injections were given, including 3 injections in 1 patient, 2 in 1 and 1 in 1. All 3 women had significant improvement or became dry with initial injection but required repeat injections to maintain improved continence status. At 7 to 8 months after the last injection 1 woman was dry, 1 used 1 or no pad daily and 1 reported no durable change in stress urinary incontinence. Collagen injection appears to be a successful, minimally invasive treatment for new onset stress urinary incontinence following cystectomy and orthotopic neobladder in women.

Reassessing the Role of Urodynamics after Cerebrovascular Accident

Background and Purpose: To determine whether there is a gender difference in the need for urodynamics in the evaluation of urinary incontinence after cerebrovascular accident (CVA). Materials and Methods: We studied 72 consecutive post-CVA patients with new onset urinary incontinence documented by the patients or the persons who looked after them. Patients were evaluated between 4 and 6 weeks after their CVA and all had negative urine cultures and a postvoid residual urine determination. Exclusion criteria included narrow angle glaucoma, postvoid residual urine greater than 100 cm³ and radiographic evidence for a brainstem infarct. This left 30 male (mean age 65) and 30 female (mean age 67) patients evaluable. Patients were empirically started on anticholinergic medications and timed voids for 4 weeks after which cytoscopy and cystometry were performed. Results: 28/30 females (93%) reported subjective improvement in their continence with conservative measures. 1 (3%) was found to have a urethral diverticulum, and 1 (3%) had uninhibited detrusor contractions that did not improve with medications. In the male group, 20/30 (67%) reported subjective improvement, 5 (17%) developed elevated postvoid residual urine volumes, 3 (10%) were diagnosed with urethral strictures, 1 (3%) had a bladder neck contracture, and 1 (3%) had transitional cell carcinoma in situ in the bladder. Conclusion: In the patient with new onset urinary incontinence in the initial period after CVA, an empiric trial of anticholinergic medications and timed voiding may be warranted in a select population of female patients without urodynamic testing or cystoscopy. This conservative approach may not be appropriate in males because of their increased likelihood of having secondary urologic conditions.

Temporal pattern of cognitive decline and incontinence is different in Alzheimer's disease and diffuse Lewy body disease.

Incontinence is a hallmark of dementia, but little is known about its inception in different types of dementing disease. We recorded the dates of onset of dementia and of urinary incontinence in 73 demented patients followed for 5.6 +/- 2.5 years. The pathologic diagnosis was Alzheimer's disease (AD) in 29 cases, diffuse Lewy body disease (DLBD) in 11 cases, AD with Lewy bodies (AD+LB) in 13 cases, and AD with vascular lesions (AD+VL) in 20 cases. The onset of urinary incontinence was significantly earlier in DLBD cases (3.2 +/- 1.4 years after dementia onset) than in AD (5.9 +/- 2.5), AD+LB (5.8 +/- 2.4), and AD+VL (6.5 +/- 2.3) (p < 0.01). At the onset of bladder incontinence, the mean score in the Extended Dementia Scale was significantly higher (i.e., cognition was better) in DLBD cases (109.3 +/- 70.8) than in AD (21.3 +/- 40.4), AD+LB (45.6 +/- 45.1), and AD+VL (39.2 +/- 54.9) cases (p < 0.01). Urinary incontinence is associated with severe cognitive decline in pure AD but usually precedes severe mental failure in DLBD cases. This temporal pattern of cognitive decline and incontinence could be useful in differentiating these two dementing illnesses.

Age‐specific prevalence, thyroid dysfunction and depressive symptomatology in adults with down syndrome and dementia

AbstractTwo hundred and one adults with Down syndrome (DS) were investigated for differing aspects of clinical dementia. Age‐specific prevalence rates of 9.4% for age range 40–49 years, 36.1% for 50–59 years and 54.5% for 60–69 years were found. Findings associated with increasing severity of dementia were gait deterioration, onset of urinary incontinence, increased muscle tone and onset of seizures. No association was found between thyroid dysfunction or thyroid autoimmunity and dementia. However, depressive symptomatology of depressed mood, weight loss and reduced appetite were associated with dementia. These findings investigating Alzheimer's disease (AD) in adults with DS support findings reported for the non‐learning disability population of an association between age, depressive symptomatology and AD but no association between thyroid dysfunction and AD.

Effects of Oxybutynin on Vesicoureteral Reflux in Children

We reviewed retrospectively 40 children seen from 1980 to 1984 with vesicoureteral reflux in 53 ureters. All patients had a hyperreflexic bladder on urodynamic evaluation with or without vesicoperineal dyssynergia but they were otherwise neurologically normal. All except 1 child received prophylactic antibiotics. Of the children 37 received oxybutynin therapy for bladder hyperreflexia for 3 to 18 months.Reflux disappeared or became grade I in 62.3 per cent of the ureters. Of the children manifesting urinary incontinence at the time of urodynamic study reflux disappeared or became grade I in 78.6 per cent. Reflux resolved or became grade I in 20 per cent of the children with no urinary incontinence. Of those patients with recurrent reflux at the onset of urinary incontinence and bladder instability reflux resolved or became grade I in 80 percent.Oxybutynin therapy for hyperreflexic bladder resulted in an average increase in bladder capacity of 97cc (54.2 per cent), which was maintained after cessation of treatment.These data suggest that bladder instability can be an important factor in causing and perpetuating reflux. Therapy aimed at decreasing intravesical pressure will enhance resolution or downgrading of reflux.