Treatment Of Incontinence In Women Research Articles

Transobturator approach to suburethral sling placement in the treatment of stress urinary incontinence in women

Minimally invasive suburethral sling procedures have become a mainstay for the surgical treatment of stress urinary incontinence in women. The transvaginal tape sling is the urethral sling most commonly used today. Although the transvaginal tape procedure is safe and efficacious, complications such as bladder, bowel and blood vessel injury have been reported. The most promising recent innovation in minimally invasive surgery for stress urinary incontinence is the transobturator approach for sling placement. This review will cover the mechanism of continence, rationale for the use of suburethral slings in the treatment of stress urinary incontinence, characteristics of polypropylene, comparison of the slings that are commercially available and early data on the efficacy of the transobturator approach in the treatment of stress urinary incontinence.

Surgical treatment of stress urinary incontinence in women: is “clinical effectiveness” a valid concept?

Surgical treatment of stress urinary incontinence in women: is “clinical effectiveness” a valid concept?

Duloxetine: the long awaited drug treatment for stress urinary incontinence

Duloxetine is a newly licensed drug treatment for stress urinary incontinence in women. It is a combined noradrenaline and serotonin reuptake inhibitor and its adverse-effect profile can be attributed to its pharmacological action. It has clinically important interactions with other drugs including warfarin and antidepressants. Duloxetine is believed to act by increasing sphincter activity in the storage phase of the micturition cycle. A meta-analysis of phase II and III double-blind placebo controlled trials involving 1913 women (aged 22-83 years) with stress urinary incontinence symptoms demonstrated a highly significant difference in reduction of diary reported incontinence episodes per week, mean increase in time between voids and quality of life. However, we feel that first-line therapy remains physiotherapy. The availability of duloxetine in primary care should not deny referral and assessment for surgery for those women who would benefit.

Sexual Function Following Sphincteroplasty for Women With Third-Degree and Fourth-Degree Perineal Tears

Our goal was to evaluate sexual function following anal sphincteroplasty in women with third and fourth degree perineal tears secondary to birth trauma Our study was performed using a retrospective cohort design in a group of women (n = 32) who had experienced either third-degree or fourth-degree perineal tears during labor and then elected to undergo sphincteroplasty for fecal incontinence. We surveyed our patients with a questionnaire that was developed by the Obstetrics and Gynecology Epidemiology Center at Harvard Medica School and was previously used to survey women with obstetric injuries. Self-reported presphincteroplasty and post sphincteroplasty degree of physical sensation, sexual satisfaction, and likelihood of achieving orgasm were measured Also measured were libido, partner satisfaction, and presence of emotional or physical inability to engage in sexual behavior. Our results reaffirmed the findings of the Obstetrics and Gynecology Epidemiology Center's study that sexual function is compromised in women with third and fourth-degree perineal tears. For our patients with this degree of perineal tearing who underwent sphincteroplasty after primary repair, our survey showed consistent improvement in several parameters of sexual function. After sphincteroplasty, physical sensation was higher/much higher in 40 percent, sexual satisfaction was better/much better in 33.3 percent, and 28.6 percent of the patients were more/much more likely to reach orgasm. Libido was improved in 37.5 percent of the study population, and 20 percent reported increased partner satisfaction. Before surgery, 23.5 percent of patients were physically and 31.2 percent emotionally unable to participate in sexual activity because of fear of incontinence or intimacy; after surgery only 6.3 percent were physically unable and 0 percent were emotionally unable to engage in sexual activity. The response rate for our study was 18/32 (56 percent). Anal sphincteroplasty for the treatment of incontinence in women with third- and fourth-degree perineal tears improves physical and emotional sexual well-being and function.

Pharmacological agents used for the treatment of stress urinary incontinence in women

SUMMARYStress urinary incontinence (SUI) is the involuntary loss of urine associated with physical activities such as running, jumping, or lifting, or with sneezing and coughing. For many patients it can be a very bothersome symptom, causing social isolation, loss of self-esteem, and increased expenses. Although there is currently no single medication approved worldwide for the treatment of SUI, a variety of off-label agents are often prescribed. This paper reviews the current pharmacological treatment options for SUI, describing the mechanism of action, efficacy, and possible adverse effects of each. A new centrally-acting compound with dual activity as a balanced serotonin and norepinephrine reuptake inhibitor, duloxetine, may offer a promising new approach for treatment.

Criteria for therapeutic use of pelvic floor muscle training in women

Success in pelvic floor muscle training as a therapeutic modality for prevention or treatment of incontinence in women is dependent on appropriate patient selection. This article synthesizes data that supports 4 criteria to be met before beginning a program of pelvic floor muscle training: adequate alignment of pelvic organs, intact structural support, functional muscle activation ability, and absence of existing reversible causes for incontinence. Two components of pelvic floor muscle training are described: strengthening exercises and skill development. For each component, protocols of training and refined patient selection criteria are discussed. (J WOCN 2002;29:301-11.)

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.

Treatment of Exercise Incontinence With a Urethral Insert

ABSTRACTOBJECTIVE: This study sought to evaluate the short- and medium-term effectiveness of an intraurethral device (FemSoft Insert, Rochester Medical Corporation, Stewartville, Minnesota) in the treatment of exercise-induced incontinence in women.DESIGN: An unblinded, controlled trial of device efficacy during supervised exercise sessions (phase 1) was followed by a 3-month uncontrolled trial of device effectiveness (phase 2). The setting was a tertiary care center, and female participants were 6 community adults with symptoms of significant stress incontinence during exercise. Phase 1 consisted of four standardized exercise sessions, two with and two without the insert in place. In phase 2, patients performed unsupervised exercise using the insert during a 3-month period. The main outcome measure was change in urine loss during exercise sessions performed with and without the device, as measured by change in pad weight. Secondary outcome measures were results of satisfaction surveys and occurrence of adverse events.RESULTS: Median urine loss during standardized exercise sessions decreased from 20 g (range, 4.9 to 80.2 g) without the device to 2.6 g (range, 1.3 to 6.8 g) with the device (P=0.03). Five women used the device at home during unsupervised exercise; one subject had a urinary tract infection. At the end of 3 months, satisfaction and comfort were rated high on a 5-point scale.CONCLUSION: The FemSoft urethral device is an effective, safe, and comfortable treatment for exercise incontinence in women.

Conservative treatment of stress urinary incontinence in women: who will benefit?

The aim of the study was to find out which factors can predict the outcome of conservative treatment of urinary stress incontinence in women. One hundred and four women with stress urinary incontinence were evaluated by recall, and by clinical and urodynamic investigation and were given pelvic floor muscle exercises with or without the use of biphasic low-frequency electrostimulation and visual biofeedback. Two groups could be distinguished. The first consisted of 37 patients in whom conservative therapy proved successful; the second consisted of 67 patients in whom incontinence continued. The study investigated whether there was a significant difference in patients' characteristics between the two groups. The number of conservative treatment sessions was not different between the two groups. The presence of a high body mass index, previous pelvic surgery, strong levator muscles and urethral hypermobility appeared to be poor prognostic features. More research is required to evaluate which patients can benefit from conservative treatment and which criteria can predict the outcome of pelvic floor physiotherapy in women with stress incontinence. This way, patients selection is possible and excessive costs can be saved.

Minimally invasive techniques for the treatment of genuine stress incontinence in women

Minimally invasive techniques for the treatment of genuine stress incontinence in women

Incisionless cystourethropexy--the Intac device--an initial experience.

Our aim was to evaluate a new minimally invasive device for the treatment of genuine stress incontinence in women by both objective and subjective measures of outcome. Fifteen women with Type I or Type II urinary stress incontinence were treated with a new per vaginal bone anchor device designed to fix periurethral tissues to the pubic bone. No patients had significant operative morbidity. After 6-13 months a follow-up questionnaire and repeat urodynamic testing was performed for all the women. Subjectively 73% of patients had improvement in symptoms and on urodynamic testing 53% of patients were cured.

Burch colposuspension: a 10 to 12 years follow up

Burch colposuspension is considered to be the gold standard for the surgical treatment of genuine stress incontinence in women. Short-term cure rates are as high as 90%. (Jarvis, 1994). The long-term (10 or more years) cure rate of 62% in this study confirms the time dependent decline in efficacy.

A Population Based, Randomized, Controlled Trial of Conservative Treatment for Urinary Incontinence in Women

A Population Based, Randomized, Controlled Trial of Conservative Treatment for Urinary Incontinence in Women

A Population Based, Randomized, Controlled Trial of Conservative Treatment for Urinary Incontinence in Women

Background. Urinary incontinence remains a hidden and inadequately treated problem in a high proportion of women.Methods. Ninety women 50–74 years of age were recruited to a population-based, randomized, controlled clinical trial of conservative treatment for urinary incontinence, with delayed treatment for the control group. The study was performed in general practice in three north-Norwegian municipalities, in cooperation with two local departments of gynecology. Three patients were found protocol deviant and analysis was based on 87 patients.Intervention. Local estrogen, physiotherapy and electrostimulation combined with close follow-up.Main outcome measures. 1. Change in severity of incontinence from start of treatment (index range 0–8). 2. Change in impact from start of treatment (index range 0–4). 3. Quantitative measures in relation to micturition. 4. Criteria based classification into cured, improved, unchanged, worse.Results. Treatment reduced severity (index change 1.8 in the intervention group v...

Results of behavioral treatment for urinary incontinence in women

Recent research on pelvic muscle exercises, which are known to be effective in stress and mixed urinary incontinence, has demonstrated that this therapy has a durable effect. However, the mechanism that creates its efficacy remains unclear. Transvaginal electrical stimulation has been used to manage stress, urge and mixed urinary incontinence. Conflicting evidence exists concerning its efficacy in stress urinary incontinence, but its benefit to women with mixed and urge incontinence is well established.

Treatment of Urinary Incontinence in Women in General Practice: Observational Study

Objective-To examinewhatisattainable when treating urinary incontinence inwomeningeneral practice. Design-Observational studywith12months' followup.Interview andclinical examination before, during, andaftertreatment ofwomen seeking helpforurinary incontinence ingeneral practice. Setting-General practice intherural district of Rissa, Norway. Subjects-105 womenaged20ormorewithuri- naryincontinence. Interventions-Treatment withpelvicfloor exercises, electrostimulation, oestrogen, anti- cholinergic drugs, bladder training, andprotec- tivepads. Mainoutcomemeasures-Subjective andob- jective measures ofurinary incontinence; number ofpatients referred toaspecialist. Results-After 12months' follow up70%(69199) ofthewomen werecuredormuch better; the meanscoreona100mm visual analogue scale de- creased from37to20mm; andtheproportion of womenwhoweregreatly bothered bytheir incon- tinence decreased by62%.20%(20/98) ofwomen becamecontinent, andthepercentage ofwomen withsevereincontinence decreased from64% (63199) to28%(27198). Meanleakage per24hours measuredbyapadtestdecreased from28gatthe startoftreatment to13g after12months.The numberoflight weight padsorsanitary towels de- creased from1.6to0.6aday.Inall, 17/105 (16%) patients werereferred toaspecialist. Conclusions-Urinary incontinence inwomen canbe effectively managedingeneral practice withfairly simple treatment. Mostwomenwill be satisfied withtheresults.

Surgical Treatment of Sphincteric Incontinence in Women

There are many surgical options to correct sphincteric incontinence. The choice should take account of clinical features, urodynamic data and operation characteristics. Success should be evaluated both subjectively and objectively and it is desirable to have at least a two year follow-up. It is necessary to be aware of the complications of each procedure. Where new techniques are described it is important to use objective outcome measures.

Surgical Treatment of Sphincteric Incontinence in Women

Surgical Treatment of Sphincteric Incontinence in Women

Treatment of Urinary Incontinence in Women in General Practice

Treatment of Urinary Incontinence in Women in General Practice

A single transurethral Macroplastique injection as primary treatment for stress incontinence in women

Summary The clinical records of 102 women were analysed to estimate the success rate of a single transurethral Macroplastique (Uroplasty BV, Netherlands) injection for the treatment of stress incontinence. We then compared the results of those who had had the injection as primary treatment (71/102) with those women who had undergone previous failed incontinence surgery (31/102). The overall success rate was 68% following a single injection of Macroplastique at a mean follow-up period of 3.2 months; the success rate was obtained by including all patients who were either cured or markedly improved requiring no further intervention. The success rate of those who had had previous surgery was 71% and for the primary treatment group it was 66%. This difference was not statistically significant. These results suggest a potential role of Macroplastique transurethral injection as primary treatment for genuine stress incontinence in women.