Use Of Incontinence Pads Research Articles

Flexible‐Dose Fesoterodine in Elderly Adults with Overactive Bladder: Results of the Randomized, Double‐Blind, Placebo‐Controlled Study of Fesoterodine in an Aging Population Trial

To assess the efficacy and safety of flexible-dose fesoterodine in elderly adults with overactive bladder (OAB). Twelve-week, randomized, double-blind, placebo-controlled trial. Sixty-one outpatient clinics in Europe, Israel, and Turkey. Seven hundred ninety-four individuals aged 65 and older (47% male) with OAB symptoms for 3 months or longer, mean of eight or more micturitions and three or more urgency episodes per 24 hours, at least some moderate problems on Patient Perception of Bladder Condition (PPBC), and Mini-Mental State Examination (MMSE) score of 20 or greater. Participants were randomized to fesoterodine or placebo for 12 weeks, with stratification according to age (>75 vs ≤ 75) and dosing time (morning vs evening). Participants receiving fesoterodine started on 4 mg and could increase to 8 mg at week 4 or 8 and de-escalate to 4 mg at week 8 (sham escalation for placebo). Changes from baseline in bladder-diary variables (primary endpoint, urgency episodes) and patient-reported outcomes including OAB Questionnaire, Treatment Benefit Scale (TBS), PPBC, Urgency Perception Scale (UPS), and OAB Satisfaction Questionnaire (OAB-S); all observed or reported adverse events. By week 8, 64% of fesoterodine-treated and 71% of placebo-treated participants opted for dose escalation. At week 12, the fesoterodine group had statistically significantly greater improvement than the placebo group in urgency episodes, micturitions, nocturnal micturitions, incontinence pad use, and OAB Questionnaire scores but not urgency urinary incontinence episodes. Responder rates on TBS, PPBC, UPS, and OAB-S were statistically significantly higher with fesoterodine. Improvements in most diary variables and participant-reported outcomes were greater with fesoterodine than placebo in participants in both age groups and when administered in the morning and evening. Rates of dry mouth and constipation were 34% and 9% with fesoterodine and 5% and 3% with placebo, respectively. Rates of adverse events and discontinuations were generally similar in participants in both age groups. There was no change in MMSE score. Fesoterodine was associated with significantly greater improvements in most diary variables and participant-reported outcomes than placebo and was generally well tolerated in older people.

Sakrale Neuromodulation als Zweitlinien-Therapie bei therapierefraktären irritativen Symptomen des unteren Harntrakts verschiedener Ätiologie: Erfahrungen einer deutschen Anwender-Klinik

Lower urinary tract symptoms (LUTS) are a common and multiform micturition disorder of various possible origins. Several second-line techniques are available in the event of first-line medicinal treatment failure. These include the intravesical injection of Botulinum toxin, bladder augmentation and sacral neuromodulation (SNM). This study presents current data and results from a prospective study of patients with LUTS of various aetiologies. Clinical success was investigated for all patients who underwent SNM for LUTS with or without urge incontinence caused by chronic pelvic pain syndrome, multiple sclerosis and idiopathic disease between May 2007 and December 2010. The preoperatively determined symptoms were compared with current follow-up data. Median follow-up time was 11 months (1 - 43). A total of 47 patients were indicated for SNM over the investigated period. 80.9 % were female, median patient age was 67 years (19 - 84). The testing phase was successful in 38 cases (80.9 %) with 9 electrodes being explanted (19.1 %). In the case of idiopathic LUTS we could show a statistically significant increase of micturition volume and reduction of incontinence pad use. There was no statistically significant improvement of any micturition parameter for patients with multiple sclerosis, patients with chronic pelvic pain syndrome showed a statistically significant reduction of micturition frequency and a subjective improvement of symptoms in 75 %. In the selected patient groups SNM is a promising and, in experienced hands, a low-complication second-line therapy for the treatment of LUTS of idiopathic aetiology. However, the general recommendation of SNM for multiple sclerosis and chronic pelvic pain syndrome patients cannot be given on the basis of our results. Further prospective, randomised multicentre studies are need to further refine the indications for SNM in LUTS of neurogenic and non-neurogenic origins.

Women's experience with severe overactive bladder symptoms and treatment: Insight revealed from patient focus groups

Research has focused on treatment of overactive bladder (OAB) symptoms in women with the goal of cure. The objective of this study was to assess women's perceptions of their OAB symptoms, treatment experience, and outcomes by conducting patient focus groups. Women seen in our academic center female urology referral clinics were identified by ICD-9 codes for OAB symptoms and recruited to participate in one of five focus groups, totaling 33 patients. Non-clinician moderators conducted the focus group sessions incorporating topics related to patients' perceptions of OAB symptoms, treatments, and outcomes. Data analysis was performed using grounded theory methodology. Qualitative analysis yielded several preliminary themes: impact of OAB on quality of life, strategies to control wetness, medications and side effects, and triggers. The majority of focus group participants reported only a partial response to medication and other physician-recommended treatments for OAB. Therefore, they developed self-reliant personalized strategies to improve their quality of life. These strategies included fluid restriction, preventive toileting, and, most importantly, the use of incontinence pads. The majority of the women who participated in the focus groups reported only a partial response to medical and other treatments for OAB. As a result, they developed personalized self-management strategies to improve their quality of life. Although most studies addressing the treatment of OAB aim at curing the condition, such a strategy may be unrealistic. Applying a chronic care model that uses a patient-centered symptom-management approach to OAB may optimize patient outcomes and improve quality of life.

Urinary Incontinence in Hospitalised Elderly Patients: Do Nurses Recognise and Manage the Problem?

This study examined to what extent nurses recognize urinary incontinence (UI) in elderly hospital patients, what UI interventions nurses realize, and if elderly inpatients are willing to raise the topic during their hospital stay. A convenience sample of 78 elderly inpatients in a Swiss hospital were screened for UI and asked if they were willing to be questioned about UI during hospitalisation. Nursing records were analysed as to whether UI had been recognized, and to collect data on interventions. Forty-one patients (51%) screened positive for UI, of whom 10 (24%) were identified as such in their nursing records. The single intervention documented was the use of incontinence pads. Only 5 patients preferred not to be asked about UI at hospital. Nurses in the study hospital should systematically ask elderly patients about UI and provide them with information on interventions.

Systematic review of the management of incontinence and promotion of continence in older people in care homes: descriptive studies with urinary incontinence as primary focus.

AimThis is a review of descriptive studies with incontinence as the primary focus in older people in care homes.BackgroundIncontinence is prevalent among residents of care home populations.Data sourcesMEDLINE and CINAHL were searched from 1996 to 2007 using the highly sensitive search strings of the Cochrane Incontinence Review Group for urinary and faecal incontinence including all research designs. Search strings were modified to enhance selectiveness for care homes and older people and exclude studies involving surgical or pharmacological interventions. Searching of reference sections from identified studies was also used to supplement electronic searches. The Cochrane Library was searched for relevant systematic reviews to locate relevant studies from those included or excluded from reviews. The search was limited to English-language publications.MethodsA systematic review of studies on the management of incontinence, promotion of continence or maintenance of continence in care homes was conducted in 2007–2009. This is a report of descriptive studies.ResultsTen studies were identified that reported on prevalence and incidence of incontinence (urinary with or without faecal), policies, assessment, documentation, management or economic evaluation of its management. Use of incontinence pads and toileting programmes comprised the most common management approaches used. No studies were identified that attempted to maintain continence of residents in care homes.ConclusionsStudies on maintaining continence and identifying components of toileting programmes that are successful in managing or preventing incontinence and promoting continence in residents of care home populations along with their economic evaluation are warranted.

Reducing incontinence dermatitis

Jackie Rees and Fania Pagnamenta discuss how the successful implementation of skin guidelines reduced the use of incontinence pads

The use of Duloxetine in the treatment of male stress urinary incontinence

Stress urinary incontinence (SUI) is a known complication after prostate surgery. To date no pharmacologic treatment is available. Currently Duloxetine, a serotonin and norepinephrine reuptake inhibitor, is available for women with SUI. This study investigates the effect of Duloxetine on men with SUI after prostate surgery. 56 patients were included in our study. 49 after radical prostatectomy and 7 after TURP. All patients were initially treated with pelvic floor exercises. Thereafter 40 mg Duloxetine was administered twice daily. When taking Duloxetine, the average use of incontinence pads decreased from 3.3 to 1.5 per day. 14 patients needed no and 18 a single pad per day. Most patients reported mild and temporary side effects, 13 patients assessed them to be moderate and 9 being severe. The results of this off-label use show that Duloxetine is effective in men with SUI after prostate surgery even if standard pelvic floor exercises have failed.

Incontinence Pad Use in Patients Admitted to Medical Wards

The purpose of the study was to evaluate the incidence of incontinence pad use among patients admitted to medical wards, the reasons why nurses decide to use an incontinence pad, the extent to which the use of pads is avoidable, and the outcome of inappropriate pad use after discharge from the hospital. A prospective cohort study was conducted; patients admitted to medical wards were observed during hospitalization and a 7-day follow-up period after discharge. The study was conducted in 2 acute-care units in Northern Italy. All new patients admitted to the units were recruited. At the time of admission to the hospital, in addition to the 120 patients who already used incontinence pads, there was a 34% incidence of new cases (98/286). The most frequent reason why nurses decided to use this aid was incontinence caused by space-time disorientation, followed by limited mobility, incontinence, patient request, nursing shortage, and involuntary urine leakage not perceived by patient. Seventy patients out of 208 used incontinence pads unnecessarily for a total of 544 days. Decisions about the use of the incontinence pads are not always consistent with research-based or literature-based suggestions. Nurses should develop clinical guidelines or protocols for the appropriate use of incontinence pads.

Treatment Outcomes in the STAR Study: A Subanalysis of Solifenacin 5 mg and Tolterodine ER 4 mg

ObjectiveTo compare OAB symptom outcomes following initial randomised treatment with solifenacin 5mg or tolterodine ER 4mg at the 4-week clinic-visit and again at 12 weeks for patients choosing to remain on this treatment dose from 4 weeks. MethodsA prospective, double blind, double-dummy, two-arm, parallel-group, 12-week study (The STAR study) was conducted to compare the efficacy and safety of solifenacin 5/10mg and tolterodine extended release (ER) 4mg in OAB patients. ResultsAt 4 weeks mean improvements in OAB symptoms, including urgency, frequency (primary variable), incontinence and nocturia, were larger in patients randomised to solifenacin 5mg; with the difference for incontinence being statistically significant (mean reduction in incontinence episodes/24hrs in the solifenacin group of −1.30 vs. −0.90 (p=0.0181); the mean result for solifenacin 5mg amounted to a 44% additional improvement.) There was an associated significant reduction in pad use (reduced by −1.21 vs. −0.80; p=0.0089); the mean result for solifenacin 5mg amounted to a 51% additional improvement over that of tolterodine ER 4mg. For patients choosing to remain on these treatments improvements in favour of solifenacin were maintained at study end (12-weeks). Treatments were well tolerated. ConclusionsWithin 4 weeks solifenacin 5mg was statistically significantly better than tolterodine ER 4mg in improving incontinence and reducing incontinence pad use. Differences in efficacy in favour of solifenacin 5mg were maintained from 4 weeks for the duration of the study for patients choosing to remain on their starting dose.

Epidemiologic survey of lower urinary tract symptoms in Japan

Objectives A large-scale nationwide epidemiologic survey was performed to determine the prevalence of lower urinary tract symptoms (LUTS) and their impact on health-related quality of life (HRQOL) in Japan. Methods A self-administered questionnaire was mailed to 10,096 randomly selected Japanese men and women aged 40 years or older. The survey questions, developed by the Japan Neurogenic Bladder Society, encompassed four areas: demographic characteristics, LUTS, HRQOL, and treatment seeking. A modified King’s Health Questionnaire was used to evaluate HRQOL. Correlations among the response scores were analyzed by Spearman’s rank test. Results The responses from 4570 subjects (mean age 61 years) were analyzed. The prevalence rate for daytime urinary frequency of 8 and 11 times or more daily was 50% and 11%, respectively. The prevalence of nocturia occurring 1 and 3 or more times/night was 69% and 14%, respectively. For other symptom frequency (ie, weak urine flow, sensation of residual urine, bladder pain, urinary urgency, urgency incontinence, stress incontinence, and incontinence pad use), the prevalence rates ranged from 2% to 27% for 1 or more times/wk and 1% to 20% for 1 or more times/day. Emotions and sleep/energy were most affected by LUTS (10% each), followed by physical limitations (7%), role limitations (6%), social limitations (4%), and personal relationships (3%). Nocturia was most frequently (38%) reported to have the greatest impact on HRQOL. Of those who considered their daily life to be affected by LUTS, only 18% sought medical care. Conclusions Although LUTS are highly prevalent in Japan, few subjects seek treatment. Greater awareness and understanding of LUTS is needed to manage symptoms and their consequences appropriately.

Kolposuspensionsplastik nach Burch in Kombination mit modifizierter sakraler Kolpopexie bei der Rezidivbelastungsinkontinenz

Surgical procedures for the treatment of stress urinary incontinence (SUI) due to pelvic organ prolapse have specific relapse rates, especially with regard to long-term results. The aim of this study was to investigate the efficacy of a combined surgical technique: sacrocolpopexy combined with a Burch procedure - in particular as an option for previously operated patients. From 9/2001 to 8/2004, 33 patients (mean age: 65 years) underwent a modified sacrocolpopexy combined with a Burch procedure. Thirty-six (93 %) patients had previous pelvic operations, nineteen (58 %) of them had failure of prior prolapse surgery. All women presented with urinary incontinence, cystocele and vault prolapse. SUI was classified grade II to III in 67 % (n = 22) cases. Grade II - III genital prolapse was associated in 88 % (n = 29) of the patients. They were screened by preoperative video-urodynamics. Surgery consisted of a Burch procedure and modified abdominal sacrocolpopexy. The mean follow-up was 18 months (range: 10 - 30 months). Follow-up investigations included a symptom score and an urogynaecological examination. A subgroup of ten patients had additional postoperative video-urodynamics. In all cases the operative procedure was performed successfully. During the follow-up 73 % (n = 24) of the patients were dry, another 18 % (n = 6) showed significant improvement. The number of diurnal/nocturnal micturitions decreased significantly from 9.4 to 6.9 (p < 0.005) and 2.2 to 1.1 (p < 0.005), respectively. The daily use of incontinence pads, as well as the amount of residual urine, decreased significantly from n = 5.1 to n = 1.1 (p < 0.005) and 60 mL to 6.0 mL (p < 0.005). Postoperative urodynamics showed that the bladder function remained unaffected by the procedure regarding de novo detrusor overactivity. After a mean follow-up of 18 months the modified sacrocolpopexy combined with a Burch procedure, as described above, is a promising technique for highly morbid and preoperated patients.

The Current and Future Burden and Cost of Overactive Bladder in Five European Countries

ObjectiveTo estimate and compare the current and future direct cost of overactive bladder (OAB) to the health care systems of five European countries. MethodA health economic model was created to estimate the number of people currently affected by OAB symptoms, the expected number to be affected in the future, and the resultant economic burden on health care systems in Germany, Italy, Spain, Sweden, and the United Kingdom. ResultsThe model estimated that in 2000, 20.2 million people over age 40 in the five countries experienced the symptoms of OAB; 7 million of these had urgency with urge incontinence. This figure is expected to rise to 25.5 million by 2020, including 9 million who will have urgency with urge incontinence. Average annual direct costs of OAB management ranged from €269 to €706 per patient per year. The largest cost was the use of incontinence pads, accounting for an average of 63% of the annual per patient cost of OAB management. Total cost to health care systems across all five countries was estimated at €4.2 billion in 2000, and by 2020, the expected total cost was estimated to be €5.2 billion, an increase of €1 billion (26%). ConclusionOAB is prevalent, with a substantial direct cost that is anticipated to increase in the future in line with aging populations. The overall burden, including indirect costs, may be considerably larger, and will fall predominantly on the elderly OAB population with urge incontinence. Recommended medical treatments could help manage those costs and should be evaluated.

Meta-analysis of observational studies of ileorectal versus ileal pouch–anal anastomosis for familial adenomatous polyposis

Surgery for familial adenomatous polyposis (FAP) aims to minimize cancer risk while providing good functional outcome. Colectomy with ileorectal anastomosis and proctocolectomy with ileal pouch-anal anastomosis both offer this, but there is no clear consensus about which is better. This is a meta-analysis of comparative studies published between 1991 and 2003 reporting early and late postoperative adverse events, functional outcomes and quality of life. Twelve studies containing 1002 patients (53.4 per cent ileal pouch, 46.6 per cent ileorectal anastomosis) were identified. Bowel frequency (weighted mean difference 1.62 (95 per cent confidence interval (c.i.) 1.05 to 2.20)), night defaecation (odds ratio (OR) 6.64 (95 per cent c.i. 2.99 to 14.74)) and use of incontinence pads (OR 2.72 (95 per cent c.i. 1.02 to 7.23)) were significantly less in the ileorectal group, although faecal urgency was reduced with the ileal pouch (odds ratio 0.43 (95 per cent c.i. 0.23 to 0.80)). Reoperation within 30 days was more common after ileal pouch construction (23.4 versus 11.6 per cent; OR 2.11 (95 per cent c.i. 1.21 to 3.70)). There was no significant difference between the techniques in terms of sexual dysfunction, dietary restriction, or postoperative complications. Rectal cancer was a diagnosis only in the ileorectal group (5.5 per cent). Ileal pouch and ileorectal anastomoses have individual merits. Further research is needed to determine which most benefits patients with FAP.

Transobturator Versus Transabdominal Mid Urethral Slings: A Multi-Institutional Comparison of Obstructive Voiding Complications

In the last year TO slings have become an increasingly popular alternative to TA slings for the surgical treatment of SUI. Proposed advantages of the transobturator approach include improved speed, safety and the reduction of obstructive complications. We assessed outcomes of TO and TA slings in a large series of women treated at several institutions to compare the rate of obstructive complications from these procedures. We reviewed the charts of 504 consecutive women who had synthetic mid urethral sling procedures (154 TO or 350 TA) performed by 24 different urologists for SUI at 8 institutions from 2002 to 2004. Obstructive complications were defined as increased PVR (greater than 100 cc), or the need for CIC, prolonged Foley catheter drainage or urethrolysis. While TO and TA sling procedures appeared to be similarly efficacious in eliminating the need for incontinence pad use (TO 89%, TA 86%, p = 0.36), the transobturator approach was associated with fewer obstructive complications (TO 11.0%, TA 18.3%, p < 0.05). Urethrolysis was required in none of the 154 TO cases and 8 of 350 (2.3%) TA cases. Concomitant pelvic surgery did not significantly increase the likelihood of obstructive voiding complications in either group. Although TO and TA sling procedures had similar short-term results for decreasing pad use in patients with stress urinary incontinence, the transobturator approach is associated with fewer obstructive voiding complications.

Preliminary Results on the Off-Label Use of Duloxetine for the Treatment of Stress Incontinence after Radical Prostatectomy or Cystectomy

ObjectivesStress urinary incontinence (SUI) is a common compliant of patients after pelvic surgery. To date, no pharmacotherapy for men is available, but duloxetine, a combined serotonin and norepinephrine reuptake inhibitor, has been successfully introduced and tested for SUI in women. The aim of our study was to evaluate if duloxetine is safe and effective for men with stress incontinence after radical prostatectomy or cystectomy. MethodsTwenty patients were included in our study, 15 after radical prostatectomy and 5 after radical cystectomy and orthotopic ileal neobladder reconstruction. Each patient reported at least 3 wk of SUI despite doing consequent pelvic floor exercises. After exclusion of a urinary tract infection, we administered 40mg duloxetine twice daily for a mean of 9.4 wk (range: 1–35 wk). ResultsAfter duloxetine, the average daily use of incontinence pads was lowered significantly (p<0.001) from 8.0 (±6.5) to 4.2 (±5.9). Seven patients were completely dry or used one pad daily at most. Most patients reported mild side effects such as fatigue or a dry mouth, but these symptoms vanished after a short time. Six patients, however, had severe side effects, mainly massive fatigue or insomnia, and discontinued using duloxetine. ConclusionsOur preliminary results suggest that duloxetine is effective in men with SUI after prostatectomy or cystectomy. Further prospective studies with more patients included and a longer follow-up are recommended.

Urinary incontinence in prostate cancer patients treated with external beam radiotherapy

Background and purposeTo describe the incidence of urinary incontinence among prostate cancer patients treated with external beam radiotherapy (RT) and to investigate associated risk factors. Patients and methodsOne thousand and hundred ninety-two patients with ≥24 months follow-up were the subjects of this series. All patients received between 50 and 72Gy in 20–37 fractions (median 66Gy/33#). Post-RT urinary incontinence was scored by direct patient interviewing according to the modified RTOG/SOMA scale: Grade 1—occasional use of incontinence pads, Grade 2—intermittent use of incontinence pads, Grade 3—persistent use of incontinence pads, and Grade 4—permanent catheter. Risk-factors investigated were: age, diabetes, TURP prior to RT, elapsed time from TURP to RT, clinical stage, RT dose and presence of Grade ≥2 acute GU and GI toxicity. Non-parametric, actuarial univariate (Kaplan–Meier) and multivariate tests (MVA, Cox regression) were performed. ResultsMedian follow-up for the group is 52 months (24–109). Thirty-four patients (2.9%) had incontinence prior to RT, which was more common in TURP patients (7.8% vs 1.6% P<0.001). These are excluded from further analysis. Fifty-seven patients (4.9%) developed Grade 1 incontinence, 7 (0.6%) Grade 2, and 7 (0.6%) Grade 3. There was no Grade 4 incontinence. Actuarial rates for Grade ≥1 and ≥2 incontinence at 5 years are 7 and 1.7%, respectively. Risk factors on MVA associated with the development of Grade 1 or worse incontinence are pre-RT TURP (5-year rates 10% vs 6%, P=0.026), presence of Grade ≥2 acute GU toxicity (5-year rates 11% vs 5%, P=0.002). Age, diabetes, clinical stage, elapsed time from TURP to RT, RT dose or fraction size, acute GI toxicity were not significant. Patients who underwent post-RT TURP or dilatation for obstructive symptoms (4.3%), were more likely to develop Grade 2–3 incontinence (5-year rate 8 vs 1.5%, P=0.0015). ConclusionsGrade 2 or greater urinary incontinence is rare among patients who have been treated with external beam radiotherapy. Associated risk factors are pre-RT TURP and the presence of increased acute GU toxicity. Post-radiation TURP increases the risk of incontinence five-fold.

Incidence and determinants of sildenafil (dis)continuation: the Dutch cohort of sildenafil users.

Sildenafil utilization was prospectively evaluated among 153 men with a history of erectile dysfunction (ED)-prescription drug use prior to starting sildenafil and 164 men who were new starters of ED-prescription drugs. Further, some determinants of sildenafil discontinuation were identified. During a median follow-up period of 18 months 45% of all patients discontinued sildenafil treatment, regardless of earlier treatment history. However, patients with a history of drug treatment for ED were nearly eight times as likely to switch or re-start another ED-prescription drug after discontinuing sildenafil compared to previously untreated users. Age >60 y, diabetes medication, nitrate use, and use of incontinence pads (a proxy for disease/surgery in the pelvic region) were associated with an increased likelihood of discontinuing sildenafil. Although the introduction of sildenafil reduced the barrier to seek medical help for erectile problems, sildenafil treatment failure in previously untreated patients results in a high dropout rate from further ED drug treatment of any kind.

Why anti-incontinence surgery succeeds or fails.

Defining success and failure in anti-incontinence surgery is becoming increasingly complex. Except in unusual cases, the impact of urinary incontinence is assessed by the degree of subjective bother to the patient. The amount, frequency, or volume of urinary incontinence is not necessarily related to the degree of bother and may be irrelevant to the patient. Large-volume urinary incontinence may be acceptable to some patients with the appropriate use of incontinence pads. Other women are socially incapacitated by losing a few drops of urine once per month. The amount of bother to the patient and not the amount of leakage is, in fact, what we treat with interventions for urinary incontinence. Success or failure in the treatment of urinary incontinence is tied to the patient's perception of success or failure and may differ from the surgeon's perception. New onset urgency and any unpredictable urgency incontinence may, in fact, be considered failure to the patient, despite the cure of "stress" incontinence. In the medical literature, success is defined by the surgeons (or authors). These definitions are variable and subject to bias. Recent reports showing differences between surgeon- and patient-defined success have refocused the evaluation of therapy for stress urinary incontinence (SUI).1,2 Success or failure in anti-incontinence surgery are increasingly being measured with quality of life questionnaires and outcome evaluations, which are strongly tied to patient satisfaction. The surgical objective for stress incontinence procedures is to create sufficient outlet resistance to prevent urine loss until a socially acceptable time and place. Unsuccessful surgeries fail to do this. Failure includes persistent SUI, de novo or worsened urge incontinence, obstructive or irritative voiding symptoms, urinary retention, and postoperative pelvic prolapse or surgical complications such as bleeding, fistula, infection, and/or dyspareunia. We will discuss the mechanisms for urinary continence and incontinence, describe a successful anti-incontinence operation, and finally discuss the etiologies of failed anti-incontinence surgery.

Doxycycline Sclerotherapy of a Symptomatic Paravaginal Mesonephric Duct Remnant

Background A Gartner's duct cyst associated with a vaginal ectopic ureter is a rarely reported finding in the literature. Treatments for this anomaly include observation or surgical excision when symptomatic. Sclerotherapy is frequently used in the management of recurrent pleural effusions. One author has described the use of tetracycline sclerotherapy to successfully treat vaginal and vulvar Gartner's duct cysts. Our objective was to evaluate the effectiveness of doxycycline sclerotherapy in the treatment of a symptomatic Gartner's duct cyst associated with a vaginal ectopic ureter. Case A 17 year old nulligravid white female was referred for evaluation of a congenital gynecologic anomaly and a heavy vaginal discharge. She had been evaluated previously for gross hematuria and was found to have a bicornuate uterus and congenital absence of the right kidney. Cystoscopic evaluation had revealed an ectopic right ureter that opened into a right paravaginal cavity. At laparotomy the ectopic ureter was ligated at the bladder, however, the paravaginal cavity could not be approached abdominally. The paravaginal mass was then explored, but not excised, via a vaginal approach. The patient subsequently experienced heavy vaginal leaking of a serous fluid from the ostomy that had been created vaginally. The drainage was sufficiently heavy to require continuous use of incontinence pads and to interfere with normal daily activities. At this point she was referred to our care. A Technetium-labeled Dimercaptosuccinic Acid (DMSA) renal scintigram demonstrated the absence of functional renal tissue around the paravaginal cavity, and communication to the bladder was ruled out by a fistulogram. This anomaly was believed to represent a Gartner's duct cyst that had previously been communicating with the bladder via an ectopic vaginal ureter. To avoid further surgical intervention. the symptomatic cavity was then treated medically with doxycycline sclerotherapy. One gram of doxycycline was mixed with 100 cc of normal saline and 20 cc of 1 % lidocaine to provide topical anesthesia. This solution was then infused into the paravaginal cavity via a hysterosalpingogram catheter where it remained for 1–2 hours on three separate occasions over a 3 month period. The patient noted a marked reduction in the amount of leaking from the paravaginal cavity, and did not experience any side effects or complications from this therapy. Conclusions We report for the first time the safe and successful use of Doxycycline sclerotherapy in the treatment of a Gartner's duct cyst associated with a vaginal ectopic ureter.

The Epidemiology of Pad Consumption among Community-Dwelling Incontinent Women

The aim of the study was to explore the use of incontinence pads among community-dwelling women in a well-defined area of western Norway (total female population 122,516). In Norway incontinence aids are prescribed by doctors and paid for by the national insurance. Data were collected at local insurance offices and through interviews with an age-stratified (20-89 years) random sample of incontinent women. Identified were 2,991 pad users (1-year period prevalence 2.4%). Prevalence rose sharply with advancing age, reaching a maximum of 30.1% in the 90+ age group. Median number of pads used per day was 1.8. Middle-aged women used fewer and smaller pads than the rest. When compared with the number of pads actually delivered, the incontinent women tended to overestimate their consumption.