Psychological investigation in female patients suffering from urinary incontinence

The available data about the hypothesis that psychological conditions cause urinary incontinence are contradictory. This study was based on a group of patients undergoing urodynamic investigation to define the type of incontinence. Patients were submitted to a battery of psychological tests, including STAXI, CES-D and IBQ (in their Italian version). Patients suffering from urge incontinence showed higher degrees of inner anger and anger trait than those suffering from stress or mixed incontinence. Neither group showed signs of depression. The conviction of illness was greatest in patients suffering from stress or mixed incontinence, whereas irritability and general hypochondria prevailed in patients suffering from urge incontinence. Such patients tend to develop psychosomatic reactions that may contribute to the severity of their symptoms.Editorial Comment: Understanding a patient's perception of their incontinence and ability to cope with symptoms is an important aspect of a clinician's ability to educate the patient and treat their incontinence successfully. This is particularly true when using behavioral therapies, where the patient's understanding of the cause of their incontinence and their own volitional control of the lower urinary tract directly affects success. The investigators find that patients with DI experience more internally driven rage, which is poorly expressed, and a higher incidence of irritability and hypochondria than patients with GSI or mixed incontinence. This overall increased inner frustration may stand in the way of learning to deal with and overcome uncontrolled activity. It behooves the clinician to address this frustration in a compassionate and caring yet direct manner to maximize the patient's compliance to therapy, thus improving their chance of regaining bladder control.     

Evaluation of female urinary incontinence device.

A new silicone rubber inflatable vaginal pessary has been evaluated in 33 patients with stress incontinence due to urethral sphincter dysfunction (genuine stress incontinence), confirmed by urodynamic assessment. Nine of 20 patients who used the device for one month showed subjective improvement and 2 patients have continued to use the device. Urodynamic changes include a marked increase in maximum urethral closure pressure and elevation of the bladder neck.     

Epidemiological aspects of urinary incontinence in a female population of an Italian region

Introduction and hypothesis  

The purpose of this study is to assess the incidence of female urinary incontinence (UI), risk factors, severity, and functional limitation using a cross-sectional survey in an Italian region.     

Evaluation of female urinary incontinence

The use of urodynamic testing must be selective and based on the particular patient's complaints. In today's cost-conscious health care environment, a diagnosis based on one or two tests is preferable to exposing each patient to the full battery of available tests. For most patients, a cystometrogram and voiding cystourethrogram can confirm a variety of clinical suspicions. A cystometrogram best indicates how the bladder is behaving during filling. The voiding cystourethrogram allows the physician to observe the bladder and urethra during voiding and offers an excellent view of the anatomic relations of the urologic organs in the pelvis. The other important benefit of urodynamics is the objective data made available in hardcopy as a baseline study to be utilized for comparison in the future. The normal sequence of testing is a noninvasive uroflow study to determine the baseline flow rate. The postvoiding residual volume of urine is then determined. A cystometrogram and electromyography can then be done, the latter if there is a suggestion of neurologic disease or if otherwise indicated to determine bladder behavior on filling. Variations that are helpful when a patient fails to have a bladder contraction include having the patient in an upright or seated position during the test. A bethanechol supersensitivity test may be indicated as well. The urethral pressure profile may be done as the catheter is withdrawn and the bladder is already filled. The filled invasive flow rate can then be compared with the free flow rate. Sometimes, one of these rates is abnormal, and there is a question about whether the abnormality is real. The residual urine volume can be determined by subtracting the volume the patient voids from the filling volume. In the end, the key to urodynamic evaluation is the interpretation of the test, which should be made only by the individual actually performing the test. It truly is necessary for the physician to be there in person. Selective use of urodynamics can target an appropriate treatment for most patients. The female patient who complains of incontinence in whom the history suggests detrusor instability may benefit from a trial of cholinolytic therapy if no anatomic defect is present. In this type of patient, a surgical procedure may not be of benefit, whereas the cholinolytic therapy probably will work. This is a good reason for always choosing the appropriate urodynamic tests for evaluating and planning treatment for patients with urinary incontinence.     

Psychiatric aspects of female incontinence

This paper describes a psychiatric survey of 169 female patients suffering from bladder dysfunction, mainly incontinence. The patients were surveyed using the General Health Questionnaire-60 and the Weissman Paykel Social Adjustment Schedule. A random subgroup of the patients underwent a standardized structured psychiatric interview, the Schedule for Affective Disorders and Schizophrenia — Life Time Version. In addition, the patients had urodynamic studies and padweighing tests. The results showed that 47.9% of the patients had significant psychiatric morbidity. The types of problem and the management implications are discussed.     

Value of the patient's case history in diagnosing urinary incontinence in general practice

What is the value of the case history in diagnosing urinary incontinence in general practice? A total of 103 women with urinary incontinence presented to their general practitioner (GP) and underwent a standard history-taking, physical examination and urodynamic testing. The urodynamic diagnoses were analysed against symptoms and symptom complexes. Symptoms of stress incontinence in the absence of symptoms of urge incontinence had a sensitivity of 78%, specificity of 84% and predictive value of 87%. Symptoms of urge incontinence in the absence of symptoms of stress incontinence excluded genuine stress incontinence. Information on age, parity, enuresis, nocturia, frequency, urgency, cystocele, prolapse and hysterectomy did not contribute to a correct diagnosis. It was concluded that urodynamics are unnecessary in most women presenting with urinary incontinence in general practice.     

Detrusor hyperreflexia in female urinary incontinence treated pharmacologically.

Detrusor hyperreflexia was found in 54 patients or 14.6% of 369 consecutive patients referred for urinary incontinence and/or genital prolapse during a 2-year period. The dominant symptom was urge incontinence. The urological investigation consisted of a medium fill water cystometry in the supine position. 20 patients (37%) suffered from cerebral or pyramidal nervous disorders. The treatment of choice was pharmacological with parasympatholytica, methantheline bromide (Banthine). The follow-up examinations performed in 33 patients after 6 months treatment showed an improvement rate of 82%. The importance of performing a cystometry in all female patients referred for urinary incontinence is stressed.     

Clinical evaluation of female urinary incontinence

EXAMINATION: Clinical evaluation of stress and urge incontinence is always necessary before therapeutic decisions. Full bladder examination may reveal stress incontinence during cough when cervico-urethral hypermobility is suspected, and leak during Vasalva manoeuvre when incontinence is due to intrinsic sphincter deficiency. OBJECTIVE SCORES: Pad test objectives the quantitative importance of incontinence. Symptom scores allow intra and inter individual comparisons. Psychosocial implications are studied with specific quality of life scales. They allow better therapeutic strategies in the management of urge and stress urinary incontinence. Objective evaluation of the different treatments and medico-economic approach of incontinence are thus possible.     

Office management of female urinary incontinence

The majority of incontinent women are manageable using office-based techniques. This article reviews the basic causes of per urethram urinary incontinence, and summarizes how to optimally evaluate them from a clinical and urodynamic standpoint in the office setting. Emphasis is made on the progress and efficiency of the wide range of ambulatory treatment options, which include behavioral treatments, pharmacotherapy, periurethral injection of bulking agents, anti-incontinence devises, and the use of absorbent products. The economy-driven trend to decrease hospital management of disease and patient interest in noninvasive techniques will continue to increase the importance of the key role played by the office urologist in the management of female urinary incontinence.     

Sling-plasty in therapy of female urinary incontinence

Traditionally, women with type III stress incontinence (intrinsic sphincter deficiency) are treated with sling procedures, which have undergone multiple modifications during the last 90 years regarding surgical approach, sling course, and materials. The latest variation of the established sling concept is the tension-free vaginal tape (TVT) procedure. The choice of sling material influences the postoperative complication rate and reveals a conflict between unrestricted availability (alloplastic material) and optimal tissue compatibility (autologous material). Although valid information about the surgical outcome of sling procedures is rare, at least some evidence-based conclusions may be drawn from the meta-analysis of the published data: sling procedures and colposuspensions are more efficient and more durable than needle suspensions or anterior repairs in the treatment of female stress incontinence. The complication profile does not show a significant difference between slings and colposuspensions. The lack of long-term results for the TVT procedure precludes any definite assessment of this innovation. In any case, to meet the patient's interests, no surgical approach for correction of stress incontinence should be undertaken without complete diagnostic evaluation of the problem.     

Ultrasound evaluation of female urinary incontinence

Thirty women, 25 with incontinence and five asymptomatic volunteer control subjects, were evaluated urodynamically by a variety of techniques, including ultrasound cystourethrography. The ultrasound evaluation was found to be a helpful adjunct in diagnosis. In comparison with radiologic techniques it offers more safety, more comfort, more privacy, more viewing time, and less cost. Bladder and urethral morphology during voiding activity and the amount and direction of urethrovesical mobility are easily determined by utilizing ultrasound techniques.     

Basic evaluation of female urinary incontinence

Urinary incontinence is a common disorder that is frequently underreported because of its social implications. Although several types of urinary incontinence are recognized, they can be generally classified as failure of the bladder to store or failure of the urethral mechanism. A systematic approach for the evaluation of incontinence that includes history, physical examination, basic laboratory tests, and often urodynamic evaluation, offers the most comprehensive assessment of the etiology of incontinence.     

Medium-term efficacy of pelvic floor muscle training for female urinary incontinence in daily practice

The purpose of this paper is to assess the efficacy of physiotherapy and quality of life in women treated for urinary incontinence by specialized physiotherapists in daily community-based practices. Three hundred and fifty-five women were treated in five physiotherapy practices between January 2000 and December 2004. After a minimum follow-up of 12 months, these women received a questionnaire at home. With the questionnaire, we collected demographic data, data on the efficacy of treatment, satisfaction with the result, and the Urogenital Distress Inventory, and Incontinence Impact Questionnaire. Additional information was derived from the medical files. One hundred and eighty-seven women responded. Fifty percent of women were satisfied with the result of physiotherapy. After a mean follow-up of 32 months, 123 out of 130 women (94.6%), who only had physiotherapy, recorded to experience incontinence episodes daily to several times a week. Women who underwent additional incontinence surgery after insufficient physiotherapy recorded significantly less urinary incontinence symptoms and a better quality of life. Pelvic floor muscle training for urinary incontinence is effective in half of the women. If not successful, women seem to benefit significantly from incontinence surgery.     

Leakpoint pressures in female stress urinary incontinence

Patient selection is critical to achieving good results in the surgical management of stress urinary incontinence. The evaluation of urethral function in these women is of great importance, since the choice of operative technique often depends on the ability of the urethra to generate adequate resistance to the explusive forces of increased abdominal pressure. The Valsalva leakpoint pressure (VLPP) has been described as an easily performed, reproducible and accurate urodynamic test to assess the patient for the presence of intrinsic sphincter deficiency (ISD). Critical review of the VLPP demonstrates its reproducibility and correlation with other measures of ISD. However, more work needs to be done to identify the truly critical values of VLPP that would help in selecting the most appropriate procedure in surgery for stress incontinence.