Surgical management of urinary incontinence

Surgery for stress incontinence is selected according to specific problems in each patient. Patients with ISD can be identified and selected for sling surgery or collagen injection therapy. Other patients may be managed successfully by retropubic urethropexy, either open or laparoscopic. Diagnostic evaluation should be thoughtful and extensive, with good correlation of findings and presenting symptoms to apply therapy in a specific manner to each patient.     

Assessment and management of urinary incontinence among homebound older adults: a clinical trial protocol

Urinary incontinence is a common and costly problem among homebound older adults. This article describes the assessment and management protocols utilized in a clinical trial examining the effectiveness of behavioral interventions in treating urinary incontinence in homebound older adults. Individuals with urinary incontinence were identified and referred to the study by home care nurses from two large home health agencies. Following in-home assessment, eligible subjects were randomized to an immediate treatment group or a delayed treatment group (control group). Subjects who were cognitively intact were treated with biofeedback-assisted pelvic floor muscle training, while subjects with cognitive impairments were treated with a program of prompted voiding. Two nurse practitioners assessed and treated subjects participating in the study.     

Diagnosis and management of female urinary incontinence

Urinary incontinence affects an estimated 13 million Americans of which 85% are women. It is an embarrassing and lifestyle limiting condition for which effective treatment is available. Health care providers should be alert to the signs and symptoms of UI and pursue its etiology. Those patients who fail medical therapy, in whom the etiology for the incontinence is unclear, or those patients with concomitant cystocele, enterocele, or rectocele, should be referred to an incontinence specialist.     

Non-surgical management of urinary stress incontinence

This article reviews the non-surgical approach to urinary stress incontinence. As the cost of medical care increases and the waiting lists for surgical operations grow bigger, non-surgical management of incontinence takes on importance. The cure rates or improvement of quality of life with conservative management of urinary stress incontinence are not as good as with the surgical approach but it is an option which may be used in selected patients. Whenever a patient or the health care provider embarks upon the non-surgical options, consideration should be given to the success rates of the modality, either used alone or in combination. The motivation and compliance of patient is important, individuals who have realistic expectations from non-surgical management of urinary stress incontinence usually have the best result.Recent literature was reviewed and an attempt has been made to present an objective assessment for all the modalities currently available for the incontinent woman. It is necessary to stress the need for the use of a combination of modalities for better results when non-surgical approach is used as the first line option. It is also important to be empathetic and supportive of such women as they usually have an extremely poor self esteem, are depressed and reclusive.     

Emotional distress and urinary incontinence among older women.

Objective: Examined appraisals of interference and personal tolerance in the prediction of distress among women experiencing urinary incontinence (UI). Design: Interviewed women volunteering for a behavioral treatment for UI. Women were interviewed at baseline; follow-up assessments were conducted 6 weeks and 6 months later. Measures of perceived interference, tolerance, condition-specific emotional distress, symptom severity, general intelligence, and depressive symptoms were administered. Participants: 131 women (mean age = 66.6 years, SD = 8.4; range 55-90) with reported involuntary loss of urine at least once a week prior to participation. Main Outcome Measure: Emotional distress attributed to UI. Results: Path analyses indicated that greater tolerance was associated with less interference imposed by UI. Greater tolerance was also associated with less distress. Symptom severity (frequency of UI episodes, nocturia, and objectively determined fluid loss) indirectly influenced emotional distress through perceived interference. Cognitive appraisals of interference and tolerance were stable over time. Conclusions: These data indicate that appraisals of personal ability to tolerate the condition and interference of the condition on goal-directed behavior and expected activities have greater influence on emotional distress than does severity of condition-specific symptom. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A ten-year experience in the evaluation and management of patients with stress urinary incontinence

The surgical procedures used, the complications encountered and the results obtained in 549 patients with urinary stress incontinence with or without prolapse and 50 patients with prolapse without urinary stress incontinence are presented. Incontinence was cured in 347 patients, improved in 126, unchanged in 66 and worsened in ten. Seven patients operated on for uterine prolapse developed urinary incontinence after surgery. The overall recurrence of SUI was 12.75%. The introduction of suprapubic bladder drainage has practically eliminated postoperative urinary tract infections and reduced the length of hospitalization from 9.1 to 7.2 days. My experience in 214 patients with suprabpubic drainage demonstratedthe superiority of the Ansari method over the cystocath. The addition of Cantor's bladder neck plication improved the results (cured plus improved) from 80% to 100% in the Marshall-Marchetti-Krantz operation and from 81% to 86% when the Marshall-Marchetti-Krantz operation was associated with an abdominal hysterectomy.     

Response to urinary incontinence by older persons living in the community

PURPOSE: To investigate the responses to urinary incontinence (UI) of older persons living in the community. DESIGN: Detailed interviews were completed on a sample of 42 independent, community-dwelling persons who were at least 60 years of age. Nineteen participants reported UI, and their experiences are reported in detail. SETTING AND SUBJECTS: Subjects were recruited from 3 sources: volunteers who acknowledged having UI, those with known UI who were invited by their doctors to participate, and those who selected "Loss of bladder control" in a 20-card sort of common ailments. All interviews were conducted in a private setting at a seniors center or at participants' church or home. INSTRUMENTS: Twenty cards with a common ailment printed in large type and an interview schedule with questions relating to the ailment selected as having the most impact were used; demographic data were collected on a standardized form. METHODS: Interviews were recorded on audiotape and lasted from 20 to 60 minutes. These recordings were analyzed for themes with use of Ethnography software. MAIN OUTCOME MEASURES: Demographic and other data from the interview schedule were tabulated. The communication style of the 19 subjects with UI was analyzed to determine how freely they spoke about problems with bladder control to family and friends and their sources of information for managing urinary leakage. Analysis was done both by the researcher and a faculty member; an interrater reliability of 1.00 was achieved. RESULTS: There was little difference in the self-rating of health for those with or without UI. Subjects recruited by letters sent to doctors' patients ranked the impact of loss of bladder control higher than other subjects did. Of the 19 subjects with UI, 10 spoke freely to family and friends, but 9 seldom discussed the subject--and then only to a family member. Four of the 9 with a closed communication style reported no current source of information about UI or its management. CONCLUSION: Though UI had a major effect on the lives of these subjects, they were more willing to admit having "loss of bladder control" than "urinary incontinence." Communication style is related to prior sources of information about UI, but not its perceived impact on health. This relationship helps to determine the teaching methods that are most likely to influence elderly persons with UI who have either on open or closed communication style.     

Quality of life following bladder training in older women with urinary incontinence

The elaboration of new mortality tables by the Swiss statistical office has allowed to estimate the impact of different pathology or risk factors on the average life duration of the resident population in Switzerland. Thus, attributable death of the smoking habits have for effect to decrease the life expectancy of swiss citizens of 2.9 years for men and 0.7 years for women, for the period 1988/1993. The calculation of mortality rates attributable to this factor of risk shows nevertheless that the risk of death has decreased since the end of years 1960 for all quinquennial age groups between 35 and 74 years. The smoking habits would be responsible of approximately 16% of deaths observed in the swiss population and 20% of premature deaths (between 25 and 64 years). The present analysis shows furthermore that different evolutions of the mortality associated with the smoking habits characterize men and women.     

Diagnostic evaluation of urinary incontinence in geriatric patients

In most cases, the evaluation of urinary incontinence requires only a history, a physical examination, urinalysis and measurement of postvoid residual urine volume. The initial purposes of the evaluation are to identify conditions requiring referral or specialized work-up and to detect and treat reversible causes that may be present. If the patient does not appear to require referral and a reversible cause is not identified, the next step is to categorize the patient's symptoms as typical of either urge or stress incontinence and treat the patient accordingly. If treatment fails or a presumptive diagnosis of urge or stress incontinence cannot be reached, the final step would be to perform more sophisticated tests or refer the patient for testing to define the cause and determine the best treatment.     

The effect of bladder training on urinary incontinence in community-dwelling older women

Six patients presented with either entrapped fourth ventricles or noncommunicating cerebrospinal fluid collections of the posterior fossa requiring drainage. These collections were treated with shunt systems whose proximal catheter was placed into the fourth ventricle via a coronal burr hole using an endoscope guided by Eleckta's ISG Viewing Wand. The technique and its advantages are described as are the complications and early outcomes.     

Surgical management of pelvic organ prolapse and stress urinary incontinence

Flow cytometry was used to compare the functional status of fluorescently stained sperm organelles from 12 Holstein bulls after storage for 24 h at 5 degrees C and after cryopreservation. The organelle-specific stains, SYBR-14 and LysoTracker Green DND-26, identified spermatozoa with intact plasmalemma and those with intact acrosomes, respectively. The mitochondria-specific stain, 5,5',6,6'-tetrachloro-1,1',3,3'-tetraethylbenzimidazolyl-carbocyan ine iodide (JC-1), identified two populations of spermatozoa. One population stained red-orange because the JC-1 accumulated in the mitochondria as aggregates (characteristic of cells exhibiting a high membrane potential); a second population stained green because of JC-1 monomers within the mitochondria (characteristic of cells exhibiting a lower membrane potential). Analysis of variance revealed that within bulls, the properties of sperm viability, intact acrosomes, and mitochondrial status differed in spermatozoa stored for 24 h (p < 0.001) but not in cryopreserved spermatozoa (p > 0.11). Linear regression analyses resulted in significant models in which the proportions of stained spermatozoa stored for 24 h were indicative of those proportions observed in the cryopreserved fractions. These findings suggest that the plasmalemma, the acrosome, and the mitochondria of unfrozen spermatozoa varied as to their functional status. The cryopreservation process, however, resulted in a more uniform status of sperm organelles.     

Treatment of urinary incontinence in homebound older adults: interface between research and practice

Urinary incontinence is one of the most common problems afflicting older adults and a major contributor to healthcare costs for homebound older individuals. The authors conducted a randomized controlled clinical study examining the effectiveness of biofeedback-assisted pelvic floor muscle training and prompted voiding in treating urinary incontinence in homebound older adults. This article briefly describes the assessment and treatment protocols utilized during this study and describes their subsequent application to clinical practice within a large urban home health agency.     

Evaluation of factors of female urinary incontinence and therapeutic indications

A good understanding of the factors involved in female urinary incontinence is essential for the therapeutic management of incontinent women. Urinary stress incontinence involves three variables which participate in the pressure equilibrium during effort: mobility of the urethrovesical junction, urethral resistance and the intensity of effort. The most appropriate treatment for each patient can only be selected by investigating all three of these factors and by determining their respective roles in incontinence. Urge incontinence is also multifactorial, but, very often, no cause can be found on the aetiological assessment, leading to the diagnosis of idiopathic instability. The factors of detrusor motor instability are discussed and their aetiological treatment is proposed.     

Stress induced urinary incontinence in patients with spinocerebellar degeneration

To better understand genetic alterations in atypical adenomatous hyperplasia (AAH) of the prostate, we examined the prevalence of allelic imbalance at 5 microsatellite polymorphic markers on chromosomes 7q31-35, 8p12-21, 8p22, 8q22.2, and 18q12.2 from 15 patients with AAH. DNA samples were obtained from formalin-fixed paraffin-embedded sections using tissue microdissection. We found allelic imbalance in 7 of 15 (47%) cases of AAH. Genetic changes that commonly occur in early prostatic carcinogenesis and prostate carcinoma are found in AAH. Current data provide evidence of a genetic link between some cases of AAH and carcinoma.     

Diagnosis and management of fecal incontinence in elderly patients

Fecal incontinence is a physically and psychologically disabling condition that affects millions of Americans, especially those over the age of 65 years. The pathophysiology is often multifactorial, with decreased anorectal sensation, reduced rectal compliance. anal sphincter dysfunction, altered stool consistency and immobility playing significant roles. A detailed history and a thorough physical examination are always necessary in patients with fecal incontinence and physiologic tests, including anorectal manometry, cinedefecography and electromyography, may be required for proper diagnosis and treatment. In most patients fecal incontinence is initially treated with conservative measures, such as biofeedback training or alteration of the stool consistency (if appropriate). If conservative management fails, surgical intervention, such as sphincteroplasty or gracilis muscle transposition, may be considered.     

Investigating urinary incontinence

Urinary incontinence and other bladder disorders belong to the most common female diseases. Investigation should always start with simple measures. A problem-oriented history and a differentiated clinical examination, eventually complemented with search for infection, miction calendar and assessment of residual urine most often lead to a rather precise diagnosis and to the initiation of a primarily conservative treatment. If primary therapy is unsuccessful stepwise integration of additional diagnostic measures like cystoscopy, ultrasound, X-ray and urethrocystometry is indicated. Surgical interventions in particular demand, in the authors' view a foregoing urodynamic examination. Execution of the investigations, interpretation of the results and their impact on recommendations for therapy are explained.