Colposuspension for urinary stress incontinence in premenopausal and postmenopausal women

Sixty-nine premenopausal and 53 postmenopausal women had a colposuspension operation for urinary stress incontinence. A significant postoperative reduction (p less than 0.001) of symptoms of frequency, nocturia, urgency and urge incontinence was obtained in both groups. Postoperatively, 88.4 per cent of the premenopausal women were found to be dry compared with 66 per cent in the postmenopausal group (p less than 0.01). No differences were found preoperatively and postoperatively in the cystometric values or in the urethral pressure profiles at rest in both groups and between the groups. The pressure transmission ratios were significantly improved postoperatively in both groups. The postoperative transmission ratios in the premenopausal women were found to be significantly higher than those in the postmenopausal group, at the middle two-quarters of the urethra. Although surgical treatment for urinary stress incontinence in postmenopausal women results in lower cure rates than in younger women, it should be considered.     

Colposuspension and transvaginal bladder neck suspension in the treatment of stress incontinence

The present work was performed to evaluate the clinical usefulness of colposuspension in stress urinary incontinence without uterovaginal descent and bladder neck suspension in cases with uterovaginal descent. Modified Burch colposuspension was performed in 29 patients and modified Raz bladder neck suspension in 19 patients. The patients were examined clinically and urodynamically before and 8-12 months after operation. All patients in the colposuspension group regarded themselves as being totally continent postoperatively. In the bladder neck suspension group the respective figure was 58%, plus 21% showing improvement and 21% failures. Urodynamically, the cure rates (positive urethral closure pressure at stress) were 100% for colposuspension and 79% for bladder neck suspension. After colposuspension the urethral closure pressure at stress and the pressure transmission ratio were significantly increased whereas successful bladder neck suspension increased only urethral closure pressure at stress. The failed bladder neck suspensions did not induce any urodynamic changes. The present data confirms that Burch colposuspension is effective in stress urinary incontinence in women without simultaneous uterovaginal descent, whereas bladder neck suspension by the modified Raz technique did not appear to be optimal for the treatment of stress incontinence in patients with uterovaginal descent.     

Results of surgical treatment of urinary stress incontinence women]

OBJECTIVES: Analysis of early and late effects of surgical treatment at women suffering from the urinary stress incontinence. MATERIALS AND METHODS: There were examined 52 patients treated surgically with urinary stress incontinence, and treated with perineoplasty (group I), treated with Marshall-Marchetti-Krantz procedure (group II), or both types of operations at the same time (group III). Early results of treatment were estimated at the 8th-10th day after surgical procedure, and late after two-eight years considering clinical and ultrasound examinations, and individual feelings of the patient. RESULTS: A very good therapeutical effect of surgical treatment was obtained at 75% of patients, but the late one at 42% of patients. The early effect was the best within the group II (88%), whereas the late one within the group I, the worst results were obtained within the group III. The period between the procedure and repeated disorder was the longest within the group I. At women operated before menopause there were noted very good effects at 61% of them, but at those patients operated after menopause--at 38%, whereas the late repeated disorder often concerned the women operated before than after menopause (adequately 65 and 35%). CONCLUSION: The treatment of the urinary stress incontinence employing perineoplasty compared with Marshall-Marchetti-Krantz procedure proved slighter risk of recurrence, slighter intensity and longer period without disorders. The application of both perineoplasty and Marshall-Marchetti-Krantz procedures simultaneously are more ineffective than of those procedures applied individually. Early effects of surgical treatment of urinary stress incontinence are better at patients operated before menopause, however more stable effect was noted at women operated after menopause.     

Laparoscopic treatment of stress urinary incontinence

Patients with severe GSI owing to ISD should be identified before surgery. Standard anti-incontinence procedures such as the Burch, M-M-K, and needle suspension have unacceptably high failure rates in these cases. Careful patient selection for the procedure and tailoring the type of surgery for the patient's condition will improve the clinical outcome and reduce failure rates of anti-incontinence surgery.     

Surgical treatment of stress urinary incontinence in women

Stress urinary incontinence is a common problem with 13.6% of women requiring surgery for it in their lifetime. Surgical treatments either create suburethral support or augment urethral closure. Colposuspensions and autologous rectus fascial slings are effective first-line surgical options. The use of midurethral tapes is currently suspended due to concerns with chronic pelvic and vaginal pain.     

Surgical treatment of stress urinary incontinence in women

Stress urinary incontinence is a common problem with 13.6% of women requiring surgery for it in their lifetime. Surgical treatments either create suburethral support or augment urethral closure. Colposuspensions and autologous rectus fascial slings are effective first-line surgical options. The use of midurethral tapes is currently suspended due to concerns with chronic pelvic and vaginal pain.     

Surgical treatment of stress urinary incontinence.

The treatment of stress urinary incontinence (SUI) is one of more controversial aspects of pelvic floor surgery. The indications for the surgical approach are related to the international classification as: Type 1 and Type 2 (Anatomical Incontinence), and Type 3 urinary incontinence (Intrinsic Sphincteric Dysfunction). The procedure of choice for Type 1 and Type 2 is Bladder Neck Suspension (BNS) that create a strong hammock against which the urethra can be compressed with sudden changes of abdominal pressure. Type 3 has to be treated by coaptation or compression of the deficient sphinteric unit (slings or injections). The mean cure rate after Marshall-Marchetti-Krantz is 77%, that of the Burch is 81%, and that of the Needle Suspension is 79%. Laparoscopy, Bone Anchors BNS and Tension-Free Vaginal Tape represent a promising option to the traditional techniques. The contribution of minimal invasive surgery consisting in: short recovery or possibility of day surgery, reduced trauma and pain, and success rate similar to the conventional techniques, is changing the SUI treatment.     

Porcine corium sling in the treatment of urinary stress incontinence

Porcine dermis was used for abdomino-vaginal urethroplasty in 53 women with urinary stress incontinence. The patients have been followed for periods ranging from 1.5 to 4 years; 47 of them were continent of urine both subjectively and on urodynamic testing. The postoperative complications were minimal and there has been no instance of foreign body reaction.     

Duloxetine versus placebo in the treatment of stress urinary incontinence

OBJECTIVE: The purpose of this study was to assess the efficacy and safety of duloxetine, a selective inhibitor of serotonin and norepinephrine reuptake, in the treatment of stress urinary incontinence. STUDY DESIGN: A double-blind, randomized, placebo-controlled study was conducted in 553 women aged 18 to 65 years with a predominant symptom of stress urinary incontinence. Subjects were randomized to placebo (n = 138 women) or duloxetine at one of three doses (20 mg/d, n = 138 women; 40 mg/d, n = 137 women; or 80 mg/d, n = 140 women). Outcome variables that were assessed after 12 weeks of treatment included incontinence episode frequency recorded in a real-time diary and answers provided to the Patient Global Impression of Improvement scale and the Incontinence Quality of Life questionnaire. RESULTS: Duloxetine was associated with significant and dose-dependent decreases in incontinence episode frequency that paralleled improvements that were observed in the Patient Global Impression of Improvement scale and the Incontinence Quality of Life questionnaire. The median incontinence episode frequency decrease with the use of the pooled diary analysis with placebo was 41% compared with 54% for duloxetine 20 mg per day (P =.06), 59% for duloxetine 40 mg per day (P =.002), and 64% for duloxetine 80 mg per day (P <.001). One half of the subjects at the 80 mg per day dose had a > or = 64% reduction in incontinence episode frequency (P <.001 vs placebo); 67% had > or = 50% reduction (P =.001 vs placebo). These improvements were observed despite significant concurrent dose-dependent increases in the average voiding interval in the duloxetine groups compared with the placebo group. Similar statistically significant improvements were demonstrated in a subgroup of 163 subjects who had more severe stress urinary incontinence (> or = 14 incontinence episode frequency per week; 49%-64% reduction in incontinence episode frequency in the duloxetine groups compared with 30% in the placebo group). Discontinuation rates for adverse events were 5% for placebo and 9%, 12%, and 15% for duloxetine 20, 40, and 80 mg per day, respectively (P =.04). Nausea was the most common symptom that led to discontinuation. None of the adverse events that were reported were considered to be clinically severe. CONCLUSION: This trial provides evidence for the efficacy and safety of duloxetine as a pharmacologic agent for the treatment of stress urinary incontinence.     

TVT tape usage in the treatment of stress urinary incontinence

Stress urinary incontinence is one of the most common gynecological complains. The frequency of its occurrence is from 12 to 25 and even 60%. It is most often observed in patients after menopause, but in a few percent is also found in twenty and thirty years old women. During several years of searching the effective methods of stress urinary incontinence treatment, many operative techniques have been worked out, but none of them became a perfect one. The operation with the use of TVT tape is one of the newest methods of the stress urinary incontinence treatment. The aim of our study was the attempt of the estimation the TVT operation effectiveness in the treatment of stress urinary incontinence in women treated in Surgical Gynecology Department of Polish Mother Health Centre Research Institute in years 2000-2002. Performed analysis of 60 patients at the age between 38 and 76 years revealed that stress urinary incontinence symptoms regressed after TVT operation, as evaluated 7 days after the procedure. In 51.7% of patients anterior colpoplasty or colpoperineoplasty was performed simultaneously to TVT operation. Control studies were performed a month and six months after the operation. Recurrence of the symptoms was observed in 11.7% of the patients. Revealed data let us show that the efficacy of this procedure is very high and reaches 88.3%.     

Uroflowmetry in diagnosis of urinary stress incontinence in women]

The authors' aim was to evaluate the range of uroflowmetry in diagnostics of stress urinary incontinence (sui) in women. The examinations were carried out in 59 women with sui, aged from 35 to 45 years (group I). The control group consisted of 20 asymptomatic women (group II). To evaluate volumes of urine voided during micturition in a unit of time a urological flowmeter UF-1 (produced by COTM, Bia?ystok) was used. Numeric data of flow were analysed, as well as registered curves of flow were ascribed to one of the following flow patterns: normal, multi-peak or interrupted. The conducted studies revealed statistically significant differences in flow values in group I, compared to group II. A more frequent incidence of multi-peak and interrupted flow patterns was found in women with sui, which could be related to a neurogenic component in etiology of the disease.