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Intrinsic Sphincter Deficiency (intrinsic + sphincter_deficiency)
Selected AbstractsImpact of urodynamic based incontinence diagnosis on quality of life in women,,NEUROUROLOGY AND URODYNAMICS, Issue 3 2009Alexandra L. Haessler Abstract Aims To characterize the effect of urodynamic diagnosis on degree of incontinence related bother and health related quality of life in a large, multi-ethnic population of women. Methods Effects of multichannel urodynamic diagnosis, urethral competency, and other patient characteristics on abbreviated Urogenital Distress Inventory (UDI6) and Incontinence Impact Questionnaire (IIQ7) composite scores were analyzed retrospectively. Results Six hundred eleven patients were included. Mean UDI6 and IIQ7 scores were significantly higher among patients with mixed incontinence, detrusor overactivity, urinary stress incontinence with overactive bladder, and negative studies compared to those with stress incontinence without OAB. The relative composite UDI6 and IIQ7 mean scores did not significantly differ between the mixed incontinence, detrusor overactivity, stress incontinence with OAB and negative study groups. UDI6 and IIQ7 scores were significantly higher among stress incontinent patients with intrinsic sphincter deficiency, but similar among mixed incontinent patients with intrinsic sphincter deficiency. Conclusion Urodynamic diagnoses of detrusor overactivity, mixed incontinence, and stress incontinence with overactive bladder are associated with significantly worse incontinence related bother and health related quality of life when compared to those with stress incontinence without OAB. These conditions appear to have similar degree of impact on incontinence related bother and quality of life. Patients presenting with symptoms of incontinence can suffer a similar compromise in quality of life despite a negative MCUD study. Neurourol. Urodynam. 28:183,187, 2009. © 2008 Wiley-Liss, Inc. [source] Clinical 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] 84 One year results of a French, multicentre, prospective clinical study of act® (adjustable continence therapy) for the treatment of female of stress urinary incontinence due to intrinsic sphincter deficiencyBJU INTERNATIONAL, Issue 2006E. CHARTIER KASTLER Introduction:, This Prospective, multicentre clinical investigation sought to assess the feasibility and efficacy of the adjustable balloons ACT® for treatment of female Stress Urinary Incontinence SUI with ISD. Materials and Methods:, The ACT® implant consists of a two-lumen conduit of variable length with an expandable silicone balloon (0.5,8 cc) on the proximal end and a distal subcutaneous titanium port. Two balloons were placed periurethrally at the bladder neck. Continence rate (no leakage during direct visual stress test with 250 ml placed in the bladder), improvement, failures, quality of life (I-QoL) and morbidity were assessed. Results:, Sixty-seven patients (62 ± 9.8-years-old) were implanted in France during 75 procedures (8 revisions). Average follow-up was 12 months. At baseline, urethral closure pressure was 22.5 ± 10.8 cm H2Oand 39 patients (58%) had previously undergone at least one surgery for SUI. Continence increased from 0% at baseline to 57% at1 year and I-QoL improved from 39.4 ± 19 at baseline to 63.7 ± 23.3 at one year. Balloon adjustment was required in 64% of patients. Complications included erosion (11%), spontaneously resolved retention (2%) and infection (4%). Conclusion:, ACT® offers a viable alternative for the treatment of SUI in female with ISD. The implantation is a minimally invasive and efficient procedure and stable over time therapy for patients with severe SUI with ISD. Implantation can be done under local anaesthesia. The positioning of ACT® treatment versus artificial urinary sphincter still needs to be determined. [source] Day-case sling surgery for stress urinary incontinence: feasibility and safetyBJU INTERNATIONAL, Issue 6 2005Subhasis K. Giri OBJECTIVE To prospectively assess the feasibility for discharge 10 h after a porcine dermal pubovaginal sling procedure (PVS), to examine the surgical factors (postoperative complications) affecting discharge, and to measure the short-term cure rate for stress urinary incontinence (SUI). PATIENTS AND METHODS Between June 2003 and December 2003, 40 consecutive patients with SUI and scheduled for treatment using a porcine dermal sling were enrolled in this prospective study. Patients were admitted with a planned overnight stay and returned to the ward with no urinary catheter. Outcome measures were bladder emptying efficiency (EE) at 10 h after surgery, time intervals to the first three spontaneous voids, EE of the first three voids, time required to achieve an EE of ,,75%, a visual analogue scale pain score, perioperative complications, and short-term cure rate of SUI. Patients were considered suitable for discharge from hospital when the EE was ,,75% or when they were self-catheterizing confidently with adequate pain control and no significant complication. All patients were followed for 6 months. RESULTS The median EE at 10 h was 61%; 16 patients (40%) achieved efficient emptying and were suitable for discharge 10 h after surgery. The median intervals to the first three spontaneous voids were 7, 10 and 17 h, and the median EEs for the first three voids 46%, 61% and 75%. The median visual analogue scale pain score was 3.5. Patients with intrinsic sphincter deficiency (ISD) were significantly less likely to achieve efficient emptying at 10 h (39% vs 70%). Overall SUI was cured or improved in 90% of patients at the 6-month follow-up. CONCLUSIONS In the present study only 40% of patients were suitable for day-case sling surgery. Early bladder emptying inefficiency was the main limiting factor. Exclusion of patients with ISD and possibly decreasing the EE threshold to 50% would improve the discharge rate. The short-term results of this PVS are similar to those obtained with the autologous fascial sling. [source] | ||||||||||