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Genuine Stress Incontinence (genuine + stress_incontinence)
Selected AbstractsClinical and urodynamic features of intrinsic sphincter deficiencyNEUROUROLOGY AND URODYNAMICS, Issue 4 2003Cinzia Pajoncini Abstract Aims A prospective analysis of 92 patients with genuine stress incontinence was performed to identify the clinical and urodynamic features of intrinsic sphincter deficiency (ISD). Methods We divided the patients into two categories: 50 patients affected by pure ISD as they had severe stress incontinence and no urethral mobility; 42 patients suffering from stress urinary incontinence without ISD as they had mild stress incontinence and marked urethral hypermobility. Cystometry was normal in all patients. The presence/absence of ISD was considered the dependent variable and was correlated against the following independent variables: age, vaginal deliveries, menopause, previous urogynecological surgery and/or hysterectomy, supine stress test, irritative and/or obstructive symptoms, Valsalva leak point pressure (VLPP), maximum urethral closure pressure (MUCP), urethral functional length (UFL), and leakage during cystometry. Results The statistical analysis showed close correlations between ISD and age (P,<,0.001), menopausal status (P,<,0.001), previous surgery (P,<,0.0001), supine stress test (P,<,0.0001), leakage during cystometry (P,<,0.001), and UFL (P,<,0.01). The VLPP was below the cut-off value (,60 cm H2O) in 70% of ISD patients (P,<,0.0001), whereas the MUCP in 50% of ISD patients (P,<,0.0001). Multiple logistic analysis showed that lower VLPP, lower MUCP, and previous surgery correlate more significantly with ISD. After backward conditional stepwise logistic regression, the odds ratio of having ISD were VLPP,=,2.3, MUCP,=,7.7, VLPP + MUCP,=,62.8. Conclusions ISD is related to the presence of a more severe clinical picture and case history, but the most significant independent variables are the VLPP and MUCP. Neurourol. Urodynam. 22:264,268, 2003. © 2003 Wiley-Liss, Inc. [source] Urinary incontinence symptom scores and urodynamic diagnosesNEUROUROLOGY AND URODYNAMICS, Issue 1 2002Mary P. FitzGerald Abstract The aim of this study was to determine whether scores on two validated urinary incontinence symptom scales predicted eventual urodynamic diagnoses. Two hundred ninety-three patients undergoing multi-channel urodynamic testing rated their symptoms of urinary incontinence and/or pelvic organ prolapse (POP), using the Incontinence Impact Questionnaire, the Urogenital Distress Inventory, and an obstructive symptom subscale from the long form of the Incontinence Impact Questionnaire. Among the 202 (69%) patients without advance-stage POP, increasing scores on scale items related to stress and urge incontinence predicted increasing frequency of the diagnoses of genuine stress incontinence (GSI) and detrusor instability, respectively. Among the 91 (31%) patients with advance-stage POP, there was no association. Among all patients with GSI, the presence of intrinsic sphincter deficiency could not be predicted by responses to the symptom scales. Scores on the symptom scales were inadequate predictors of eventual urodynamic diagnoses, especially among women with advance-stage POP. Neurourol. Urodynam. 21:30,35, 2002. © 2002 Wiley-Liss, Inc. [source] Why do women have voiding dysfunction and de novo detrusor instability after colposuspension?BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 4 2002L. Bombieri Objective To investigate the causes of voiding dysfunction and new detrusor instability after colposuspension. Design Prospective, observational study. Setting Urogynaecology unit, district general hospital. Population Seventy-seven women undergoing colposuspension for genuine stress incontinence. Methods The following factors were investigated: 1. bladder neck elevation by magnetic resonance imaging before and after surgery; 2. urethral compression by measuring bladder neck approximation to the pubis with magnetic resonance imaging after surgery (anterior compression) and the distance between the medial stitches during surgery (lateral compression); 3. clinical and urodynamic factors. Main outcome measures 1. Post-operative voiding function (i.e. first day of voiding and day of catheter removal); 2. objective evidence of detrusor instability three months post-operatively. Results Pre-operative peak flow rate (P= 0.004), straining during voiding (P= 0.005), increasing age (P< 0.001), operative elevation (P< 0.001) and anterior urethral compression (P= 0.001) were associated with the number of days of post-operative catheterisation. Increasing age (P= 0.02), previous bladder neck surgery (P= 0.04), operative elevation (P= 0.049) and anterior urethral compression (P< 0.001) were associated with detrusor instability at three months. Conclusion Surgical factors (bladder neck elevation and compression) are associated with voiding dysfunction and detrusor instability after colposuspension. These findings have implications for prevention. [source] Pregnancy and delivery: a urodynamic viewpointBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 11 2000C. Chaliha Research Fellow (Urogynaecology) Objective The aims of this study were to establish prospectively the prevalence of objective bladder dysfunction before and after delivery by means of urodynamic investigations and to assess the effect of obstetric variables on bladder function. Design Prospective longitudinal study. Twin channel subtracted cystometry was performed in the standing and sitting position, with a cough stress test at the end of filling. The investigations were repeated three months postpartum. Participants Two hundred and eighty-six nulliparae with singleton pregnancies who were delivered between April 1996 and November 1997 attended for antenatal assessment after 34 weeks of gestation and 161 who returned postpartum. Setting Department of Obstetrics and Gynaecology in a London teaching hospital. Results The mean urodynamic values both in pregnancy and postpartum lower than values defined in a non-pregnant population. The prevalence of genuine stress incontinence and detrusor instability were antenatally 9% and 8%, respectively, and postpartum 5% and 7%, respectively. Obstetric and neonatal factors were not related to urodynamic variables. Conclusions Despite the reported high prevalence of urinary incontinence related to pregnancy and childbirth, neither pregnancy nor delivery resulted in any consistent effects on objective bladder function. Postpartum urodynamic measurements were not related to either obstetric or neonatal variables, but were dependent on antenatal values. [source] Randomised comparison of Burch colposuspension versus anterior colporrhaphy in women with stress urinary incontinence and anterior vaginal wall prolapseBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 4 2000Mario Colombo Senior Registrar Objective To compare the Burch colposuspension and the anterior colporrhaphy in women with both stress urinary incontinence and advanced anterior vaginal wall prolapse (cystocele). Design Prospective randomised study. Setting Secondary referral centre, Urogynaecology Unit, San Gerardo Hospital, Monza, Italy. Sample Seventy-one women undergoing surgery for primary genuine stress incontinence and concurrent grade 2 or 3 cystocele (descending at or outside the vaginal introitus). Methods Full urodynamic investigation performed pre-operatively and repeated six months after surgery. Clinical follow up continued for 8 to 17 years. Main outcome measures Subjective (patient history) and objective (negative stress test result) cure of stress incontinence. Assessment of cystocele recurrence. Results Thirty (86%) of the 35 evaluable women who had the Burch colposuspension and 17 (52%) of the 33 evaluable women who had the anterior colporrhaphy were subjectively cured (OR 5.6, 95% CI 1.6 to 21.6; P= 0.005). Objective cure rates were 74% (26 of 35) and 42% (14 of 33), respectively (OR 3.9, 95% CI 1.3 to 12.5; P= 0.02). A recurrent cystocele of grade 2 or 3 with or without prolapse at other vaginal sites was recorded in 34% (12 of 35) and 3% (1 of 33) of women, respectively (OR 16.7, 95% CI 2.0 to 368.1; P= 0.003). Conclusions The Burch colposuspension was better in controlling stress incontinence but it lead to an unacceptable high rate of prolapse recurrence. The anterior colporrhaphy was more effective in restoring vaginal anatomy but it was accompanied by an unacceptable low cure rate of stress incontinence. Neither of the two operations is recommended for women who are suffering from a combination of stress incontinence and advanced cystocele. [source] The efficacy of laparoscopic mesh colposuspension: results of a prospective controlled studyBJU INTERNATIONAL, Issue 4 2001T.A. El-Toukhy Objective To investigate the efficacy of laparoscopic mesh colposuspension as an equivalent approach to the ,gold standard' open Burch colposuspension. Patients and methods A prospective controlled study of laparoscopic mesh colposuspension was conducted over 2 years; 87 patients with genuine stress incontinence (GSI) were recruited. The preoperative evaluation included a history, examination, midstream urine analysis, urinary voiding diary, a Urilos pad test, and twin-channel subtracted cystometry, including urethral profilometry and measurement of the postvoid residual volume. The study included patients who had undergone previous incontinence surgery, but those with detrusor instability or neurogenic bladder were excluded. The patients were assessed at 6 weeks, 6 months and 1 year after surgery and then yearly thereafter. The urodynamic assessment was repeated 3 months after surgery. Results Forty-nine patients underwent laparoscopic colposuspension using Prolene mesh and titanium tacks to elevate the bladder neck, while 38 patients had open Burch colposuspension. There was no difference between the groups in age, parity, body mass index, menopausal status, medical history, previous bladder neck surgery and prolapse. At 6 weeks the cure rate was similarly high in the two groups (91% laparoscopic and 94% open). After a mean follow-up of 32 months, both groups showed a decline in efficacy, which was more marked in the laparoscopic group. Cure rates were 62% for laparoscopy and 79% for open surgery, and the improvement rates were 77% and 89%, respectively (P < 0.05). Conclusion Laparoscopic colposuspension using a mesh and tacker technique reduces the technical difficulty and operating time of the endoscopic procedure, but the long-term cure rates are inferior to open Burch colposuspension. [source] | ||||||||||