Urethral Sphincter Incompetence Research Articles

FIRST EXPERIENCE IN VIDEOURODYNAMIC STUDY AT CIPTO MANGUNKUSUMO HOSPITAL IN 2012-2014

Objective: Accuracy of diagnosis is a fundamental thing in terms of plan of treatment. Nowadays, symptoms from lower urinary tract can be diagnosed accurately with videourodynamic study (VUDS). Videourodynamic combines a fluoroscopic voiding cystourethrogram with multichannel urodynamics, allowing anatomic and functional assessment of the bladder and outlet. Material & Methods: This research is a descriptive retrospective. Data was taken from the patients who underwent VUDS at Department of Urology Cipto Mangunkusumo Hospital from 2012 to 2014. Patient’s characteristics were gender, age, chief complaint, working diagnosis pre investigation, and diagnosis after VUDS was performed. Then, data was analyzed in a descriptive fashion and presented using tables and narative form. Results: There were 8 male patients (67%) and 4 female (33%) who underwent VUDS. Most of the patients were children (75%). Five patients (42%) complained about incontinence with or without other LUTS, only 1 patient (8%) had LUTS and disuria. Overall, working diagnosis pre investigation was neurogenic bladder with various causes. We found a variable diagnoses after VUDS. At filling phase, we found 7 patients (58%) with small bladder capacity, 5 patients (42%) with low bladder compliance then followed respectively by overflow incontinence (33%), detrusor overactivity (17%) and urethral sphincter incompetence (8%). At voiding phase, the most common abnormality detected were detrusor underactivity (42%), followed by infravesical obstruction (8%). VUR was found both at filling phase (42%) and voiding phase (33%). Conclusion: VUDS could be the first choice of modality for diagnosing dysfunction of lower and upper urinary tract especially in neurogenic cases.

Stress urinary incontinence in pregnant women: a review of prevalence, pathophysiology, and treatment.

Introduction and hypothesisStress urinary incontinence (SUI) is the most common type of urinary incontinence (UI) in pregnant women and is known to have detrimental effects on the quality of life in approximately 54.3 %. Pregnancy is the main risk factor for the development of SUI. This review provides details of the pathophysiology leading to SUI in pregnant women and SUI prevalence and treatment during pregnancy.MethodsWe conducted a PubMed search for English-language and human-study articles registered from January 1990 to September 2012. This search was performed for articles dealing with prevalence and treatment of SUI during pregnancy. In the intervention studies, we included studies that used a randomized controlled trial (RCT) design or studies comparing a treatment intervention to no treatment.ResultsA total of 534 articles were identified; 174 full-text articles were reviewed, and 28 of them met eligibility criteria and are reported on here. The mean prevalence of SUI during pregnancy was 41 % (18.6–60 %) and increased with gestational age. The increasing pressure of the growing uterus and fetal weight on pelvic-floor muscles (PFM) throughout pregnancy, together with pregnancy-related hormonal changes, may lead to reduced PFM strength as well as their supportive and sphincteric function. These cause mobility of the bladder neck and urethra, leading to urethral sphincter incompetence. Pelvic floor muscle exercise (PFME) is a safe and effective treatment for SUI during pregnancy, without significant adverse effects.ConclusionsUnderstanding these issues can be useful for health-care professionals when informing and counseling pregnant women to help prevent SUI during pregnancy and the postpartum period.

Urethral sphincter function before and after radical prostatectomy: Systematic review of the prognostic value of various assessment techniques

Urethral sphincter incompetence is generally considered to be the most important contributing factor to post-radical prostatectomy incontinence (PRPI). The value of various assessment techniques used to objectify urethral sphincter function before and/or after RP is unclear. Our review addresses the following questions: In men having to undergo RP, which measurement techniques that assess pre-operative and post-operative urethral sphincter function have predictive value for the post-operative continence status or correlate with the post-operative continence status. A systematic and comprehensive search was performed using the terms: urethral sphincter, radical prostatectomy (RP), and urinary incontinence. Results were restricted to English-language papers published between 1980 and March 2012. Only techniques described by at least two studies were included. Several assessment techniques for urethral sphincter function and anatomy were identified: sphincter electromyography, magnetic resonance imaging (MRI), perfusion sphincterometry and urethral pressure profilometry (UPP). A shorter urethral sphincter length on preoperative endorectal MRI might be associated with an increased risk of PRPI as well as longer time to achieve continence. UPP showed that both maximum urethral closure pressure (MUCP) and functional profile length (FPL) decrease significantly after RRP. Low preoperative MUCP and FPL are associated with an increased risk of PRPI. The other mentioned assessment techniques are not usable as preoperative diagnostic tools. MRI and UPP might be valuable preoperative diagnostic tools in patients waiting for RRP. However, more and larger studies are needed to show the exact role of MRI and UPP in the preoperative management of patients waiting for RRP and for whom post-operative incontinence is a big concern.

Coital incontinence: Relation to detrusor overactivity and stress incontinence

The aim was to assess functional (demographic, clinical, and urodynamic) and anatomical (described by MRI) abnormalities associated with coital incontinence (CI). All consecutive sexually active women with urinary incontinence (UI) were invited. Women were asked if they experience urine leakage during sex; and its timing: during penetration (CIAP) versus during orgasm (CIAO). All women were studied with urodynamics. Pelvic MRI was done for selected group of women. MRI examination was done using 1.5 T superconducting magnet, supine, and during two phases: static and dynamic, using multiplanar T2-weighted turbo spin-echo and single short T2-wighted images. Ninety women with UI; 60 had CI while 30 had no CI. Prevalence of CI was significantly higher among women with stress incontinence (SUI) (89.4%) compared to those with detrusor overactivity (DOA) (33.3%); P = 0.000. Factors significantly associated with CI were parity, prolapse, and SUI. Among studied MRI variables, no factor was significantly associated with CI. CI showed significant positive correlation with severity of SUI (r = 0.327, P = 0.05) and significant negative correlation with Abdominal leak point pressure (r = -0.362, P = 0.01). Amplitude of unstable detrusor contraction as measured by urodynamics did not correlate with severity of CI. CI seems to be in the spectrum of SUI and POP. CI is almost invariably a symptom of SUI with urethral sphincter incompetence, even when it occurs during orgasm. Many women with DOA leak during sex; however, the potential role of associated urethral incompetence should be considered.

Traces: Making Sense of Urodynamics Testing - Part 7: Evaluation of Bladder Filling/Storage: Evaluation of Urethral Sphincter Icompetence and Stress Urinary Incontinence (Abstract Only)

The "Traces" series discusses how the urodynamic clinician generates usable data from a filling cystometrogram. Part 7 focuses on the question, "Is the urethral sphincter mechanism competent?" From a practical viewpoint, this question can be divided into two queries: 1) does this patient have observable urodynamic stress urinary incontinence (SUI), and 2) does this patient have intrinsic urethral sphincter incompetence, also referred to as intrinsic sphincter deficiency or a low pressure urethra? Signs of SUI include clinician observation of urine loss with coughing or during Valsalva's maneuver. Urodynamic SUI is the observation of urine loss with increased abdominal and intravesical pressures in the absence of a detrusor contraction. The most commonly used techniques for assessment of urethral sphincter function and SUI are the urethral pressure profile and the abdominal leak point pressure. Both are useful for answering these queries, but both tests are vulnerable to physiologic and technical artifacts that must be minimized to produce technically accurate and clinically meaningful results.

Repair of an Incompetent Urethral Sphincter in a Mare

To describe successful surgical treatment of urinary incontinence caused by a ruptured and/or transected urethral sphincter in a mare. Clinical report. A 7-year-old, Swedish Warmblood mare with urinary incontinence. The urethral sphincter, which had been damaged during removal of a cystic urolith, was repaired by apposing the ends of the disrupted urethralis muscle and tunica muscularis. The mare was no longer incontinent after repair of the defect by apposition of the ends of the urethralis muscle and tunica muscularis. Transection and/or rupture of the urethral sphincter of a mare may result in urinary incontinence. Apposition of the ends of the ruptured or transected urethralis muscle and tunica muscularis can correct urinary incontinence caused by this defect.

Influence of Urethral Sphincter Incompetence on Bladder Shape and Function in Myelodysplastic Children.

This study was undertaken to investigate the influence of the urethral function on bladder shape and function in myelodysplastic children. Of 39 myelodysplastic children, 30 were treated with intermittent catheterization. The diagnosis of internal sphincter incompetence (SI) was based on cystographic findings (open bladder neck) and that of external SI on urodynamic findings (underactive external sphincter identified on electromyography and maximum urethral closure pressure of less than 50 cm H2 O). Follow up included evaluation of bladder deformity and compliance. The mean observation period was 8.6 years. In the 11 patients with external SI, bladder deformity and compliance significantly improved as a result of intermittent catheterization. However, of 12 patients with overactive sphincter and/or closure pressure of 50 cm H2 O or more, eight showed deterioration or no improvement in bladder deformity, and three showed upper urinary tract deterioration. These results indicate that an increase in urethral resistance may lead to deterioration of bladder shape.

Urinary Incontinence in Women

The International Continence Society (ICS) defines urinary incontinence (UI) as the complaint of any involuntary leakage of urine. The common pathophysiology of UI in women involves an overactive detrusor or an incompetent urethral sphincter. Therefore UI is categorized as stress urinary incontinence (SUI), urge urinary incontinence (UUI), mixed urinary incontinence (MUI) and overflow incontinence. SUI and UUI are the two most common types of UI in women. According to Korean national survey in 2005, the prevalence of UI is 24.4% and the prevalence of UI increased with age. Of those women, 48.8% reported SUI, 7.7% UUI, 41.6% mixed UI. Therefore the proper diagnostic work-up is needed to increase clinical outcome because many treatment options are being in women with UI. Non-invasive treatments include behavioral therapy, pharmacotherapy. Especially anticholinergics are the cornerstone of UUI treatment, whereas surgical treatments, such as TOT, TVT, are considered as a gold standard of SUI treatment. The cure rate of TOT or TVT surgery for SUI revealed 80-90% according to many studies and complication rate is reported about 5%. Therefore, by effectively identifying and treating incontinence it is possible to significantly improve patients’ quality of life.

Pharmacotherapy of urinary incontinence

The pathophysiology of urinary incontinence (UI) involves an overactive detrusor (DOA) or an incompetent urethral sphincter. Therefore, the three most common types of UI are stress urinary incontinence (SUI), urge urinary incontinence (UUI), or a combination of stress and urge known as mixed urinary incontinence (MUI). Pharmacotherapy represents a recognized option for the treatment of different types of UI. A literature search of Medline publications on pharmacological treatment of urinary incontinence until 2008 was performed. Relevant data from recently published literature were included. Anticholinergics are the cornerstone of UUI treatment, whereas serotonin and norepinephrine re-uptake inhibitors represent an option for SUI treatment. A significant percentage of patients with UI, mainly those with UUI and MUI, can be treated successfully with pharmacotherapy.

Wirksamkeit, Verträglichkeit und Akzeptanz von Incontex bei Hündinnen mit kastrationsbedingter Harninkontinenz

A clinical study about efficacy and acceptance of Incontex in spayed bitches with urinary incontinence was performed. In a randomised, double-blinded study the efficacy and acceptance of Incontex (Dr. E. Gräub AG, Bern, Schweiz) in bitches with urethral sphincter incompetence due to spaying was evaluated under field conditions. The active ingredient of the Incontex Syrup is phenylpropanolamine (PPA), an alpha1-adrenergic agonist. The study was performed using 24 spayed, incontinent bitches. Over a first period of treatment of 30 days the bitches received either Incontex, at 1.5 mg/kg twice per day, or a placebo. In the second period of 30 days all 24 bitches were treated with Incontex at the recommended dose. Any changes in the incontinence compared with the situation before the study were evaluated. Of 24 bitches 21 (88%) became continent and in 2 bitches (8%) urinary incontinence improved. In only 1 bitch (4%) the medication did have no effect. Five bitches (21%) showed side effects. The acceptance of Incontex was good. Incontex can be recommended as an efficient and well-tolerated medication for the treatment of bitches with urinary incontinence after spaying. The oral application of 1.5mg/kg BW phenylpropanolamine twice daily has been approved.

Evaluation of long-term effects of endoscopic injection of collagen into the urethral submucosa for treatment of urethral sphincter incompetence in female dogs: 40 cases (1993–2000)

To evaluate long-term success of endoscopic injection of collagen into the urethral submucosa in female dogs with urinary incontinence caused by urethral sphincter incompetence. Retrospective study. 40 incontinent female dogs. Medical records were reviewed for outcome and other results for dogs in which a cystoscope was passed into the urethra for deposition of 3 collagen deposits into the submucosa. 27 (68%) dogs were continent for 1 to 64 months (mean, 17 months) after the collagen injection. In another 10 dogs, incontinence improved and in 6 of these dogs, full continence was regained with administration of additional medication. In 3 dogs, incontinence was unchanged. As long as 12 months after injection, there was a deterioration in the initial result in 16 dogs, after which their condition stabilized. Mild and transient adverse effects developed in 6 (15%) dogs. Long-term success of endoscopic injection of collagen was satisfactory. Relapse of incontinence might be caused by flattening of the collagen deposits rather than resorption of the collagen.

Changes in plasma gonadotropin concentrations and urethral closure pressure in the bitch during the 12 months following ovariectomy

Urinary incontinence due to acquired urethral sphincter incompetence is a common side effect of spaying, for which the underlying cause remains unknown. Spaying not only results in a significant reduction in the urethral closure pressure within 1 year but also in an increase in the plasma gonadotropin concentrations. To investigate the possible link between the post-ovariectomy changes in plasma gonadotropins and in urethral closure pressure, gonadotropin and urodynamic measurements were performed in 10 Beagle bitches before and for a period of 1 year after spaying. Plasma gonadotropin concentrations rose quickly after ovariectomy and peak levels were seen within 3–5 weeks, followed by a sharp drop until week 10. A steady increase was observed subsequently until week 42, when a plateau was reached. One year after spaying, the mean FSH concentration was 75.3±32.1 ng/ml, a 17-fold increase, and the LH was 8.3±3.8 ng/ml, an eightfold increase over the pre-spaying values. Ten months after spaying, the mean urethral closure pressure (9.7 cm H 2O) was significantly reduced when compared to the mean pre-operative value of 15.4 cm H 2O. However, there was no clear relationship between the gonadotropin concentrations and the urethral closure pressure. From these results it seems unlikely that chronically elevated gonadotropins are the underlying cause for reduced urethral closure pressure after spaying resulting in urinary incontinence.

The open bladder neck: a significant finding?

Women with lower urinary tract symptoms were retrospectively studied. They were all investigated using a urinary symptoms questionnaire, a frequency-volume chart and videocystourethrography. An open bladder neck was recorded at maximum cystometric capacity with the patient standing in the left lateral position, if contrast medium entered the proximal urethra at rest in the absence of a detrusor contraction or an increase in intra-abdominal pressure. Women with neurological disorders were excluded. Of 4500 women, 2,593 (57.6%) had a single urodynamics diagnosis and were included in the study: 1207 (46.5%) had urodynamics diagnosis of urodynamic stress incontinence, 558 (21.5%) had detrusor overactivity, 118 (4.6%) had sensory urgency, and 710 (27.4%) had a normal urodynamic study. Out of the 2,593 women included, 776 women (29.9%) had an open bladder neck at rest while 1817 (70.1%) had a closed bladder neck at rest. Only 45% (542/1207) of women with urodynamic stress incontinence had an open bladder neck at rest. Seventy percent (542/776) of women with an open bladder neck had a diagnosis of urodynamic stress incontinence whilst 73% of women with detrusor overactivity and 93% of those with sensory urgency had a closed bladder neck. An open bladder neck at rest is not diagnostic of urethral sphincter incompetence but is associated with urodynamic stress incontinence. It is not associated with urgency as few women with sensory urgency and detrusor overactivity were found to have an open bladder neck. Imaging the bladder neck at rest has questionable value.

Puboprostatic Sling Repair for Treatment of Urethral Incompetence in Adult Neurogenic incontinence

An incompetent urethral sphincter can be a significant factor contributing to urinary incontinence in patients with neurogenic bladders. We review our experience with 12 men who underwent a puboprostatic sling. The study included 12 men (mean age 37.1 years) with neurogenic bladder due to spinal cord injury in 9 and spina bifida in 3. All patients were diagnosed with urethral incompetence based on fluorourodynamic evaluation. Medical therapy failed in all 12 patients and all complained of urine leakage with activity. All patients underwent placement of an autologous fascial sling distal to the prostatic urethra via an abdominal approach. Ten patients also underwent simultaneous bladder augmentation to correct high intravesical pressures. Followup ranged from 1 to 39 months (average 14.25). All patients manage the bladder with intermittent catheterization. Of the patients 8 are completely dry between catheterizations and 2 had significant improvement with only minimal leakage (1 pad per day), with an overall success rate of 83%. One patient improved initially but subsequently underwent placement of an artificial urinary sphincter for residual stress incontinence. In 1 patient several external sphincterotomies failed despite adequate sling placement. There were no complications related to the placement of the sling and all patients are able to perform intermittent catheterization without difficulty. In select male patients the puboprostatic sling can be an effective and safe method to treat urethral incompetence secondary to neurogenic voiding dysfunction.

Tension-free vaginal tape procedure after previous failure in incontinence surgery

Objectives. To study the efficacy of the tension-free vaginal tape (TVT) procedure for patients with recurrent genuine stress incontinence. Methods. Forty-one women, including 11 with urethral sphincter incompetence (mean age 49.6 years, range 37 to 66), were treated for recurrent genuine stress incontinence with TVT procedure under local or regional anesthesia. Urodynamic studies, a 1-hour pad test, introital ultrasonography on the urethra, a cotton swab test, and subjective symptom analysis were documented before the procedure and at 1 year postoperatively. Results. Of the 41 women, 34 (82.9%) were cured, 2 improved, and 5 (12.2%) had treatment failure. Among the women with failure, three had urethral sphincter incompetence with a fixed urethra. No major surgical complications occurred. Four bladder perforations were noted. The 1-hour pad test reduced from a mean of 27.3 to 1.7 g ( P <0.001). The operating time was 22 minutes (range 15 to 44), and the postoperative hospital stay was 22.4 hours (range 12 to 72). Spontaneous voiding with adequate postvoid residual urine volume was noted for all patients by the fourth day postoperatively. The preoperative and postoperative cotton swab result was 40.0° (range 10° to 80°) and 38.7° (range 10° to 76°), respectively, without statistically significant changes. Of the 36 cured and improved patients, 31 (86.1%) had a cotton swab test result of 30° or more before and after the TVT procedure. Urodynamic parameters related to the voiding dysfunction showed no significant difference before and after the surgery. Urodynamic assessment showed no significant difference in the filling, voiding, and urethral pressure profile (dynamic and static) variables, except for significant increases in the maximal flow rate, bladder volume at the first desire to void, and cystometric capacity, which were measured preoperatively and postoperatively. No de nova detrusor instability or micturition disturbances were found in the cystometric study. Conclusions. The TVT procedure for the treatment of recurrent genuine stress incontinence is a safe, effective, and minimally invasive option requiring only a short hospital stay. However, the immobile urethra seems to be a risk factor for failure. Long-term follow-up is needed to determine whether this surgery achieves long-lasting results.

Urethral pressure profile: is it affected by position?

The aim of this study was to investigate the difference between sitting and standing passive urethral pressure measurements, and to determine the accuracy of urethral pressure profilometry in each position. Urethral pressure profilometry was performed in the sitting and standing position in 98 women. Stress incontinence due to urethral sphincter incompetence was demonstrated in 59 of whom 6 also had detrusor instability. The others were normal volunteers (7), women with a normal cystometrogram (23), and women with detrusor instability (9). MUCP tended to be higher in the standing than the sitting position but this did not reach statistical significance. Urethral lengthening appeared to occur on standing with a mean increase of FUL of 5 mm on standing. For both FUL and MUCP, there was a wide variation in the difference between sitting and standing values. There was poor reproducibility of measurements of MUCP and FUL in the standing position, limiting its clinical applicability. The difference between sitting and standing MUCP and FUL was not affected by age, parity, weight, height, BMI, or oestrogen status. In women with genuine stress incontinence, there was less difference between sitting and standing MUCP, but this explained only a small part of the variability. The increase in FUL in the standing position was unaffected by diagnosis.

Correção da Incontinência Urinária de Esforço com Sling: Resultados Iniciais

Purpose: to analyze the surgical results after slings with vaginal wall, performed by the Urogynecology and Vaginal Surgery Sector of UNIFESP/EPM, for the treatment of incontinent women with hypermobility of the bladder neck, who show great risk of surgery failure with other techniques or in those with intrinsic sphincteric deficiency (ISD) and, also, surgery recurrence. Methods: we studied 21 patients submitted to surgery in order to correct urinary incontinence by the vaginal wall sling technique, in the period from December 1997 to February 1999, with postoperative follow-up which varied between 1 and 14 months (average 8.2). The mean age of patients was 56 years (39 to 77 years), 15 (71.4%) were in menopause and 6 (28.6%) in menacme. All patients were evaluated before the surgery through medical interview, physical examination, ultrasound and urodynamic study, the grade of urinary loss being high in 66.7% and moderate in 33.3% of the patients. All patients showed hypermobility of the bladder neck (more than 10 mm) and 12 patients had previous surgery to correct the urinary incontinence. Regarding the urodinamic study, the patients manifested urinary loss with maximum pressure of urethral closure (MPUC) varying from 20 to 124 cmH2O (average 55.2) and Valsalva leak point pressure (VLPP) varying from 18 to 128 cmH2O (average 60.3). The indications of surgery were: ISD (11 patients ¾ 52.4%), obesity (5 patients ¾ 23.8%), ISD and obesity (2 patients ¾ 9.5%), surgery recurrence (2 patients ¾ 9.5) and ISD and first grade womb prolapse (1 patient ¾ 4.8%). Results: as complications, 6 patients (28.6%) showed temporary urinary retention after surgery, 1 patient (4.8%) infection in the urinary tract, 1 patient (4.8%) presence of polypropylene suture in the vagina, 1 patient (4.8%) infection of the surgery wound, 4 patients (19%) developed urgency/incontinence, 1 (4.8%) urgency and 1 (4.8%) difficulty in urinating (high postvoiding residue). The grade of the patients' satisfaction was satisfactory, with 15 patients (71.4%) referring cure, 3 patients (14.3%) improvement, in 2 patients (9.5%) the urinary loss remained unchanged and in 1 patient (4.8%) the urinary loss got worse. Conclusions: the vaginal wall sling surgery is efficient for the treatment of specific cases of stress urinary incontinence, emphasizing intrinsic urethral sphincteric incompetence, surgery recurrence and predisposing factors to failure of other techniques.

Urinary leakage during coitus in women

During a 4-year period from 1993 to 1997, a total of 2153 women were referred to our urogynaecology clinic complaining of urinary incontinence. Of these women, 228 (10.6%) admitted to coital incontinence. Only 22 of these 228 women complained of this symptom without direct questioning. Urine loss occurred during penetration in 158 women, during orgasm in 45 women and during both in 25 women. Comparison of these groups showed few other differences in their presenting symptoms, examination findings, urodynamic data or diagnosis. Genuine stress incontinence was present in 79.8% of women with urinary leakage during penetration, in 93.2% with leak on orgasm and in 92.0% who leaked on both. Detrusor instability was uncommon. In most women who complain of urinary leakage during sexual intercourse, the underlying pathophysiological mechanism is urethral sphincter incompetence. Compared with women presenting with urinary incontinence in the absence of coital incontinence, women with coital leakage had a higher incidence of stress and urge incontinence, and a significantly greater incidence of anterior vaginal wall prolapse and demonstrable stress incontinence on examination.

Transurethral Injection of Silicone Microimplants for Intrinsic Urethral Sphincter Deficiency

In Brief Objective To assess the short-term efficacy of transurethral injection of silicone microimplants in women with intrinsic sphincter deficiency. Methods During January 1995 and December 1996, 32 women (mean age 64.3 years, range 39-85 years) with type III stress incontinence (intrinsic sphincter deficiency) underwent transurethral injection of silicone microimplants under general anesthesia. Twenty-eight had undergone previous continence surgery. Subjective and urodynamic assessments were made at 6 and 12 months after injection to evaluate success and short-term effects. Results Objective and subjective success rates were 75% and 59% at 6 and 12 months, respectively. Injections of silicone microimplants significantly increased maximum urethral closure pressure (maximum urethral pressure at rest: 34.40 ± 16.46 cm H2O, 95% confidence interval [CI] 28.55, 40.25 versus 25.35 ± 10.78 cm H2O, 95% CI 21.52, 29.18; P = .027). There were no complications after surgery up to 1 year. Conclusion Transurethral silicone injections were effective in 60% of cases of intrinsic sphincter deficiency, although there was a time-dependent decrease. Transurethral injection of silicone particles in women with intrinsic urethral sphincter incompetence is successful in about half of cases.

Incontinence in Elderly Women

Objective To determine whether periurethral collagen is an effective, safe and practical day-case procedure to control genuine stress incontinence (urethral sphincter incompetence) in the elderly female. Design Prospective longitudinal study using subjective and objective outcome measures with long term follow up. Setting A teaching hospital tertiary referral centre. Sample Thirty-two women over 65 years of age with a urodynamic diagnosis of genuine stress incontinence. Results At one year, 22 women (79%) were subjectively cured or improved, and 14 (50%) were objectively cured; at two years, 18 (69%) and 14 (54%), respectively. Symptoms of urgency, urge incontinence, frequency and nocturia improved, while voiding difficulty remained unchanged. Brief urinary retention was encountered in seven women. No long term side effects or complications were encountered. Urodynamic studies suggest that collagen works by preventing premature bladder neck opening through physical stress, rather than by obstruction. This would account for the slight increase in functional urethral length. Conclusion Contigen collagen is a simple and effective day case procedure as an alternative to major surgery and is without significant morbidity or complication. It is ideal for the elderly.