Urinary incontinence in women

was included in the ICI 5 edition PFMT (24) vs PFMT + resistance device (28) 52 Women with SUI or MUI (stress predominant) PFMT: As below without device PFMT +resistance; 5 quick and 5 slow (sustained), high-intensity contractions daily. Advised to hold contractions as long as possible, relaxing their PFM for an equivalent time before repeating the process. Intravaginal resistance: instructions to use the Pelvic-Toner Device concurrently whilst exercising. Two clinic visits and one phone call Reported cure (based on the Q11 of the ICIQFluts) PFMT 0/13 PFMT+resistance 1/15 Non-sign. difference btw groups (p=0.429) Improvement (post-Tx) PFMT 10/19 PFMT+resistance 11/21 Non-sign. difference btw groups 16 weeks of treatment, outcomes assessed at post-Tx and at 6 month follow-up Dropouts (at 6 month) PFMT 9/24 PFMT + resistance 15/28

/pdf/adult-conservative-management-23g1y2j6gw.pdf

Adult conservative management

Data Synthesis: Compared with regular care, pelvic floor muscle training plus bladder training resolved urinary incontinence (pooled risk difference, 0.13 [95% CI, 0.07 to 0.20]). Pelvic floor muscle training alone resolved or improved urinary incontinence compared with regular care, although the effect size was inconsistent across studies. Different injectable bulking agents and medical devices were associated with similar continence and improvement rates. Electrical stimulation failed to resolve urinary incontinence. Oral hormone administration increased rates of urinary incontinence compared with placebo in most RCTs (1243 women). Transdermal or vaginal estrogen resulted in inconsistent improvement of urinary incontinence. Adrenergic drugs did not resolve or improve urinary incontinence. Oxybutynin or tolterodine resolved urinary incontinence compared with placebo (pooled risk difference, 0.18 [CI, 0.13 to 0.22]). Duloxetine compared with placebo improved (pooled risk difference, 0.11 [CI, 0.07 to 0.14]) but did not resolve urinary incontinence, with no significant dose–response association. Limitations: Inconsistent measurements of outcomes limited the findings. Predictors of better effect have not been identified in RCTs. Conclusions: Moderate levels of evidence suggest that pelvic floor muscle training and bladder training resolved urinary incontinence in women. Anticholinergic drugs resolved urinary incontinence, with similar effects from oxybutynin or tolterodine. Duloxetine improved but did not resolve urinary incontinence. The effects of electrostimulation, medical devices, injectable bulking agents, and local estrogen therapy were inconsistent.

Systematic Review: Randomized, Controlled Trials of Nonsurgical Treatments for Urinary Incontinence in Women

Stress 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. We 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. A 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. Understanding 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.

https://link.springer.com/content/pdf/10.1007%2Fs00192-013-2061-7.pdf

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

Sling surgery for stress urinary incontinence in women: a systematic review and metaanalysis.

The aim of this study was to assess pelvic floor muscle (PFM) strength and perception and its correlation with stress urinary incontinence (SUI). One hundred and one women were divided into two groups according to the presence (G1=51 patients) or absence (G2=50 patients) of SUI. Subjective [urine stream interruption test (UST), visual survey of perineal contraction and transvaginal digital palpation to assess pelvic muscle contraction] and objective evaluations of pelvic floor muscles in all patients were performed (vaginal manometry). During the UST, 25.5% of G1 patients and 80% of G2 patients were able to interrupt the urine stream (p<0.05). Digital evaluation of pelvic muscular contraction showed higher strength in G2 than in G1 patients (p<0.0001). Perineometer evaluation of PFM strength was significantly higher in the continent group (p<0.001). Pelvic floor muscle weakness in incontinent patients demonstrates the importance of functional and objective evaluation of this group of muscles.

Pelvic floor muscle evaluation in incontinent patients

Purpose: Vesicovaginal fistula (VVF) is one of the most devastating surgical complications that can occur in women. The primary cause remains an abdominal hysterectomy. Approach to this condition c...

/pdf/laparoscopic-repair-of-vesicovaginal-fistula-35jpgrevir.pdf

Laparoscopic repair of vesicovaginal fistula.

INTRODUCTION: Metabolic investigation in patients with urinary lithiasis is very important for preventing recurrence of disease. The objective of this work was to diagnose and to determine the prevalence of metabolic disorders, to assess the quality of the water consumed and volume of diuresis as potential risk factors for this pathology. PATIENTS AND METHODS: We studied 182 patients older than 12 years. We included patients with history and/or imaging tests confirming at least 2 stones, with creatinine clearance > 60 mL/min and negative urine culture. The protocol consisted in the collection of 2, 24-hour urine samples, for dosing Ca, P, uric acid, Na, K, Mg, Ox and Ci, glycemia and serum levels of Ca, P, Uric acid, Na, K, Cl, Mg, U and Cr, urinary pH and urinary acidification test. RESULTS: 158 patients fulfilled the inclusion criteria. Among these, 151 (95.5%) presented metabolic changes, with 94 (62.2%) presenting isolated metabolic change and 57 (37.8%) had mixed changes. The main disorders detected were hypercalciuria (74%), hypocitraturia (37.3%), hyperoxaluria (24.1%), hypomagnesuria (21%), hyperuricosuria (20.2%), primary hyperparathyroidism (1.8%) secondary hyperparathyroidism (0.6%) and renal tubular acidosis (0.6). CONCLUSION: Metabolic change was diagnosed in 95.5% of patients. These results warrant the metabolic study and follow-up in patients with recurrent lithiasis in order to decrease the recurrence rate through specific treatments, modification in alimentary and behavioral habits.

http://www.scielo.br/pdf/ibju/v31n1/v31n1a06.pdf

Metabolic assessment in patients with urinary lithiasis

Treatment of urinary stress incontinence (USI) by intravaginal electrical stimulation (IES) and pelvic floor physiotherapy represents an alternative to other therapies. The purpose of this work was to evaluate the effectiveness of this treatment inpatients with urinary incontinence. From January 1998 to May 2000, 30 women (mean age 54 years) were studied. All patients had USI and 70% urge incontinence; average follow-up was 7 months. Selection criteria were based on clinical history, objective evaluation of perineal musculature by perineometry, and urodynamics. The treatment protocol consisted of three sessions of IES per week for 14 weeks using INNOVA equipment. Physiotherapy was initiated in the fifth week of IES. A significant decrease in the number of micturitions and urgency was observed after treatment ( P<0.01). The pad test showed a reduction in urinary leakage from 13.9 to 5.9 g after treatment ( P<0.01). Objective evaluation of perineal muscle strength showed a significant improvement in all patients after treatment ( P<0.01). A positive correlation was observed between maximum flow rate (Qmax) and all three variables: urethral pressure profile at rest and on straining (stop test), and abdominal leak-point pressure (ALPP). A positive correlation was also observed between ALPP and the stop test. Over 100 different surgical and conservative treatments have been tried to manage USI. The majority of these procedures reveal that despite progress already made in this area, there is no ideal treatment. Satisfactory results can be achieved with this method, especially with patients who are reluctant to undergo surgery because of personal or clinical problems.

Treatment of urinary stress incontinence by intravaginal electrical stimulation and pelvic floor physiotherapy

Introduction and hypothesis
Physiological and anatomical changes of pregnancy are risk factors for lower urinary tract symptoms (LUTS). This study aimed to evaluate the prevalence and risk factors for urinary incontinence (UI) in healthy pregnant women.

João Luiz Amaro

Papers

Pelvic floor muscle evaluation in incontinent patients

Laparoscopic repair of vesicovaginal fistula.

Metabolic assessment in patients with urinary lithiasis

Treatment of urinary stress incontinence by intravaginal electrical stimulation and pelvic floor physiotherapy

Prevalence and risk factors for urinary incontinence in healthy pregnant Brazilian women.