Treatment Of Female Urinary Incontinence Research Articles

An introduction to tension-free vaginal tape (TVT)--a new surgical procedure for treatment of female urinary incontinence.

An introduction to tension-free vaginal tape (TVT)- A new surgical procedure for treatment of female urinary incontinence.

Some Reflections on Tension-Free Vaginal Tape – A New Surgical Procedure for Treatment of Female Urinary Incontinence

Some Reflections on Tension-Free Vaginal Tape – A New Surgical Procedure for Treatment of Female Urinary Incontinence

Group Treatment of Female Urinary Incontinence: Literature review

Summary The purpose of this article is to review the evidence relating to the group treatment of female urinary incontinence, specifically relating to the theoretical framework and the effect of group treatment on the strength of pelvic floor muscles, bladder training and the improvement of patient knowledge. A literature search was performed using Medline, CINAHL, ASSIA, Embase:Physical Medicine and Rehabilitation, Physiotherapy Index, Rehabilitation Index and Complementary Medicine Index from 1987 to 1997. Eight articles were found which described the treatment of female urinary incontinence in a group environment. For group treatment to be effective the group itself must constitute an important element in the therapeutic process and consideration must be given to group dynamics. Analysis of the literature revealed that these processes had been poorly considered, despite the theoretical background of group treatment being well established. There were flaws in the design of several of the studies and also in the evaluation of the effect of group treatment on the strength of pelvic floor muscles, bladder training and improvement of patient knowledge. Further research is required, including the development of appropriate outcome measures and the use of control groups, to determine the effectiveness of this approach.

Practice patterns in the treatment of female urinary incontinence: a postal and internet survey

Objectives. To survey American urologists to assess practice patterns in treating female incontinence. Advances in the treatment of female incontinence have changed the way urologists practice. Methods. Postal and e-mail surveys were sent to 2502 members of the American Urological Association. Results. From the postal group (n = 1000), 419 (42%) responses were obtained; from the e-mail group (n = 1502), 160 (11%) responses were obtained. For types I, II, and III stress urinary incontinence (SUI), 239 (44%) of 546, 388 (68%) of 570, and 512 (94%) of 547 urologists, respectively, recommended a sling procedure. For type I SUI, 75 (53%) of the 143 respondents in practice for less than 10 years recommended a sling procedure. The sling was recommended by 62 (35%) of the 176 respondents in practice for longer than 20 years ( P <0.001). Most urologists (75%, 358 of 480) referred patients with significant vaginal prolapse to a gynecologist; however, urologists in full-time academic practice were more likely to offer surgical treatment (56%, 29 of 52). Most urologists recommended medical treatment for urge incontinence (94%, 461 of 491), and the medications most commonly selected were tolterodine (41%, 202 of 491), oxybutynin (26%, 129 of 491), and extended-release oxybutynin (25%, 125 of 491). Conclusions. Overall, a sling procedure was the most commonly recommended surgical procedure for all types of SUI. Most urologists referred patients with significant vaginal prolapse to a gynecologist. For type I SUI, older urologists were more likely than younger urologists to perform needle bladder neck suspension.

Physiotherapy Treatment of Female Urinary Incontinence (FUI): A randomised controlled trial of educational group sessions and individual management

Physiotherapy Treatment of Female Urinary Incontinence (FUI): A randomised controlled trial of educational group sessions and individual management

TVT for surgical treatment of female urinary incontinence

TVT for surgical treatment of female urinary incontinence

A Three-Year Postoperative Evaluation of Tension-Free Vaginal Tape

The aim of this study was to evaluate the outcome of tension-free vaginal tape (TVT) 3 years after surgery. Fifty-one women (mean age 52.9) with a genuine stress incontinence underwent the TVT operation. In 10 patients, a prolapse repair was also done simultaneously. The majority of the patients were operated under local anesthesia. All patients were evaluated 3 years after the procedure using a protocol for objective and subjective assessment of the outcome including an evaluation of quality of life related to urinary incontinence. According to the protocol, 46 women (90%) were successfully cured, another 3 patients (6%) were improved, whereas 2 patients (4%) were classified as failures. Few complications occurred. We conclude that TVT is a simple and well-accepted minimal invasive surgery for treatment of female urinary stress incontinence. The outcome 3 years after the operation showed no signs of deterioration compared to the results shortly after surgery. The cure rate of 90% is comparable with the best results of other surgical treatments for female urinary incontinence.

Treatment of female urinary incontinence with EMG-controlled biofeedback home training.

The aim of the study was to evaluate the efficacy of pelvic floor training with EMG-controlled home biofeedback in the treatment of stress and mixed incontinence in women. Subjects were recruited from the urodynamic outpatient clinic and performed pelvic muscle training with an EMG-controlled biofeedback device for 20 minutes daily for 6 months. The number of pads used per day, the number of incontinence and urgency episodes, voiding frequency, maximum urethral closure pressure, functional urethral length and pressure/transmission ratio during stress were assessed before and after treatment. Thirty-three patients (13 with stress and 20 with mixed incontinence) completed the study. There was a significant decrease in the number of pads used per day, the number of incontinence and urgency episodes, and the voiding frequency. Twenty-eight patients (85%) reported that they were cured or improved. Urodynamic parameters did not change significantly. It was concluded that home pelvic floor training with EMG-controlled biofeedback is efficient in 85% of patients in alleviating the symptoms of genuine stress and mixed incontinence without causing side effects.

The Mechanism of Action of Drugs Affecting the Lower Urinary Tract in the Treatment of Female Urinary Incontinence

Urinary incontinence (UI) is thought to affect more than one in ten women in the UK. Despite its prevalence the pathology of UI is poorly understood and its pharmacological treatment largely ineffective, surgical intervention remaining the most conventional treatment for many forms of incontinence. However, the possibility of effective drug therapy is an attractive alternative. The present review summarises the mechanisms by which drugs used to treat UI evoke direct effects on the organs of the lower urinary tract, and describes their clinical efficacy. The majority of these drugs act primarily by either reducing bladder pressure, inhibiting unstable contractions, or increasing outlet resistance during the filling process. The most commonly used drugs are anti-muscarinics, although the high incidence of side effects (including an increased residual volume) and the low level of improvement achieved, has heightened the need for the development of other drug therapies. However, due to the lack of information concerning the pathological causes of unstable detrusor contractions and other changes present in UI sufferers, no drugs are available which are specifically targeted at either treating the causative factors or the changes involved in UI. As pathological understanding increases, more effective pharmacological management may be achieved.

The “Femassist”: a new device for the treatment of female urinary incontinence

Objective: This study was undertaken in order to determine if the “Femassist” device is a safe and effective treatment for women with the diagnosis of urinary incontinence. Methods: The Femassist is a medical-grade silicon dome-shaped device, worn over the urethra and held securely via suction and a commercially available adhesive lotion. Women with a chief complaint of urinary incontinence responding to local newspaper advertisements were screened for inclusion. Potential candidates underwent medical history, physical (including gynecologic) examination, Papanicolaou test, urine culture and cytology, and multichannel urodynamic testing (including abdominal leak-point pressure measurements). A total of 38 women with documented genuine stress urinary incontinence (GSUI) or mixed incontinence were ultimately recruited into the study and fitted with either the standard or petite-sized Femassist device, according to their individual anatomy. Subjects were assessed before and after 1 month’s use. Subjective assessment included quality of life questionnaires, daily voiding and activity diaries, as well as ongoing patient comments retrieved through daily telephone contact with the study nurse. Objective assessment included blinded evaluation of bacteriuria and urinary infection rates and vulvar irritation and ulceration rates. Results: To date, of the 38 women who have completed the study, over 50% reported an improvement in their quality of life including comfort, convenience, and overall satisfaction. In total for all patients studied, the device was worn for a total of 886 days; 82% of these were dry days. Similar results were obtained for women with GSUI and mixed incontinence. Factors associated with successful experience with the device included degree of tissue estrogenization (either naturally or via a topical estrogen preparation), manual dexterity, and degree of motivation. One in five women reported vulvar irritation or urethral discomfort at some point; this was not correlated with percentage of dry days. There have been no reported significant increases in bacteriuria or urinary tract infection rates over patients’ baseline experiences. Conclusion: Our preliminary study suggests that the Femassist device is a safe and effective method for the management of female urinary incontinence.

New Treatment for Female Urinary Incontinence

New Treatment for Female Urinary Incontinence

A population study of urinary incontinence and nocturia among women aged 20-59 years. Prevalence, well-being and wish for treatment.

The aim was to study urinary incontinence (UI) and nocturia in a female population; prevalence, effect on well-being, wish for treatment and result of treatment in primary health care. A postal questionnaire was sent to all women aged 20-59 years who were scheduled for gynecological health examination by midwives in a primary health care district during one year. Questions concerning well-being were based on the Gothenburg QOL instrument. All women with incontinence were offered treatment by a midwife and a family doctor. Of the included 641 women, 491 (77%) answered the questionnaire. The prevalence of urinary incontinence was 27.7%, 3.5% having daily leakage. Nocturia occurred in 32 women (6.5%), 12 of whom were also incontinent. Self-assessed health, sleep, fitness and satisfaction with work situation decreased significantly with increased frequency of incontinence. Well-being was not correlated to type of incontinence. Nocturia correlated to poor health and sleep. About a quarter of the incontinent women started treatment when offered and 80% of those who completed the treatment program were subjectively improved. Wish for treatment was directly correlated to frequency of incontinence but not to type. Urinary incontinence and nocturia affect well-being in a negative way. Well-being and wish for treatment correlate to frequency of incontinence but not to type of incontinence. Most women with UI accept it, only about a quarter of incontinent women, or 6-7% of all women in the studied age group, want treatment. Treatment of female urinary incontinence in primary health care is successful.

An ambulatory surgical procedure under local anesthesia for treatment of female urinary incontinence.

The object was to study prospectively the results of a modified intravaginal slingplasty for the surgical treatment of female stress incontinence, carried out under local anesthesia as a day procedure. Seventy five patients with genuine stress incontinence were operated upon and followed for a 2-year period. All patients were diagnosed urodynamically to have genuine stress incontinence. Pad tests and quality of life assessments were carried out in all patients both pre- and postoperatively. There were no intra- or postoperative complications and 63 patients (84%) were completely cured throughout the 2-year follow-up period. Six patients (8%) were significantly improved, i.e. they did not loose urine apart from an occasional leakage during severe cold etc. In the remaining 6 patients (8%) no improvement was seen. These failures were obvious at the first postoperative check-up after 2 months. Thus, there were no relapses after 2 months. All but 5 patients were able to void properly directly after surgery. These 5 needed an indwelling catheter during the night directly after the operation. All 75 patients were released from the hospital the same day or the day after surgery without catheterization. Mean sick leave was 10 days and mean operation time 22 minutes. No defect healing or rejection of the sling occurred. It is concluded that the procedure described is a promising new technique for the surgical treatment of female stress incontinence. Prospective long-term studies including more patients are in progress to establish the definitive place of this technique in the clinical routine.

Intravaginal Slingplasty (IVS): An Ambulatory Surgical Procedure for Treatment of Female Urinary Incontinence

A new ambulatory procedure for treatment of female urinary incontinence (intravaginal slingplasty, IVS) was performed on 50 patients. In all patients the surgical procedure was carried out under local anaesthesia and without postoperative urinary catheterization. The technique has been elaborated from previous experimental and clinical studies and aims at restoration of the pubourethral ligament and the suburethral vaginal hammock. Thirty-eight patients suffered from genuine stress incontinence as objectively verified and 12 patients had symptoms and signs of both urge and stress incontinence. Thirty-nine (78%) patients were completely cured from their stress incontinence symptoms. Another six patients (12%) reported a considerable improvement of their urinary incontinence leaking only occasionally. Concerning urge incontinence symptoms a significant relief of the symptoms was obtained in 6 of 12 patients. No intra- or post-operative complications occurred.

Female urinary incontinence—A symptom, not a urodynamic disease. Some theoretical and practical aspects on the diagnosis and treatment of female urinary incontinence

Female urinary incontinence-A symptom, not a urodynamic disease. Some theoretical and practical aspects on the diagnosis and treatment of female urinary incontinence.

Use of Mitek G II anchors in female pelvic surgery

— The surgical treatment of female urinary incontinence and cystocele consists of a Burch colposuspension, indirect colpopromontorysuspension and the Marshall-Marchetti-Krantz procedure. In these techniques non-reabsorbable monofilament sutures are used for fixing the periosteum. Since 1990 Mitek has been producing anchors for bony fixation and, lately, easy-to-handle mini anchors with drill and inserter, which are inserted through the guide into the prepared bone. The video shows the specific instruments, the anchor preparation and its bony fixation.

Vaginal surgery in female urinary incontinence: Physiopathological concepts

— The theoretical advantages and disadvantages of the vaginal approach for the treatment of female urinary incontinence are outlined on the basis of a literature review and personal experience. The need for a better understanding of the influence of the anatomy and function of the pelvic floor on the anatomy and function of the female bladder neck and urethra is highlighted. The main advantage of vaginal surgery is the simultaneous correction of anterior, central and posterior defects, restoring or preserving vesicourethral, sexual and rectoanal anatomy and function.

Perineal physiotherapy in the treatment of female urinary incontinence as an alternative to surgery

Perineal physiotherapy without electrostimulation was applied in 129 women with stress (59), urge (49) or mixed (15) incontinence (66 stable bladders and urethras, 22 unstable bladders. 46 unstable urethras), and in 10 women presenting only enuresis (7) or only pollakisuria (3). The exercises consisted of two parts: 1) awareness of the perineal muscles involved by biofeedback, and 2) thorough training of these muscles by individually adapted schemes. A large group of patients (26%) discontinued this treatment because of the active involvement it requires. 36% of patients are completely dry within 3 months, another 28% report some amelioration.

Pelvic floor rehabilitation for the treatment of female urinary incontinence. Our experience

The authors report their experience in the treatment of female urinary incontinence with pelvic floor rehabilitation. Electrostimulation and biofeedback technique is applied. Results are satisfactory both in stress incontinence and urge incontinence. In the latter case urine lass in non-elderly patients, must be reduced and out-patients’ rehabilitation must absolutely be carried out. Anticholinergic drugs have often been administered in urge incontinence.

Pelvic floor reeducation and body posture correction for treatment of female urinary incontinence: Results of comprehensive pre‐ and post‐treatment urodynamic testing

AbstractOf the conservative treatment modalities for stress urinary incontinence in females, the effectiveness of electric pelvic floor stimulation and exercise programs for reeducation of pelvic floor muscles are generally accepted and recognized. This prospective study reports on the analysis of subjective and objective pre‐ and post‐treatment parameters in 12 selected female patients with stress incontinence who were enrolled in a physiotherapeutical training program consisting of acute intrarectal electrostimulation, pelvic floor exercises, and body posture correction (Mensendieck). Patients' symptom scores, performance status of pelvic floor muscles, body posture alterations as well as standard urodynamic parameters (maximal urethral closing pressure, functional urethral length, and maximum cystometric capacity), and telemetric ambulatory urodynamic parameters (pad‐weighing test, urethral relaxations) were analyzed. This study shows the advantageous effect of pelvic floor reeducation and body posture correction for the treatment of female low‐urethral‐resistance urinary incontinence. A remarkable finding was the coalescence of genuine stress incontinence, proven on standard urodynamic investigation, and urethral instability on telemetric ambulatory urodynamic investigation in 10 of 12 patients (83%). This was very well treated by the training program. Pathophysiology of low‐urethral‐resistance urinary incontinence and the mode of action of the training program are discussed. © 1992 Wiley‐Liss, Inc.