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1.
J. M. Choe 《International urogynecology journal》2001,12(2):122-128
The aim of the study was to assess the outcome of a 6-point fixation technique and weight-adjusted spacing nomogram for performing
sling surgery. Fifty women with stress incontinence underwent implantation of a Gore-tex patch sling. Sling tension was gauged
based on the patient’s body weight. Postoperative analysis was performed using cough stress tests, Q-tip tests, pelvic examinations
and patient satisfaction questionnaires. Urodynamics were performed for women with persistent incontinence. Mean follow-up
was 24 months (range 7–28). Mean age was 58 years (range 29–87). Stress incontinence was cured in 47/50 patients (94.0%).
De novo urge incontinence occurred in 1/23 (4.3%) patients. Mean time to suprapubic tube removal was 7 days (range 1–21).
No patients experienced urinary retention or urethral obstruction. Mean satisfaction score was 9/10 (range 7–10) and all patients
said they would undergo surgery again. The combination of a 6-point fixation technique and a weight-adjusted spacing nomogram
allows for a successful sling outcome without obstruction. 相似文献
2.
Perineal Pad Test in Evaluating Outcome of Treatments for Female Incontinence: A Systematic Review 总被引:3,自引:2,他引:1
D. Soroka H. P. Drutz C. M. A. Glazener E. J. C. Hay-Smith S. Ross 《International urogynecology journal》2002,13(3):165-175
Our objective was to systematically review clinical studies of incontinence treatments for women that used pad tests to assess
outcome, to determine how closely the ICS guidelines had been followed. Our review (Medline 1988–2000, plus referenced studies)
identified 75 relevant papers, carrying out pad tests in clinics (n= 53) or patients’ homes (n= 28). Clinic pad tests lasted between 60 seconds and 2 hours, with inconsistent starting bladder volumes, activities carried
out, other test details and presentation of results. Home pad tests lasted between 1.5 and 48 hours: the conduct and reporting
of these tests were also variable. Only 25 studies used pad tests that were apparently consistent with ICS guidelines. Pad
tests are important in identifying urine loss in clinical evaluations; however, we found wide variations in their conduct
and reporting. We recommend that the ICS should review the guidelines, and that further research should develop clinically
valid pad tests. Authors and journal editors should ensure that pad test details are fully reported. 相似文献
3.
P. E. Papa Petros 《International urogynecology journal》1999,10(6):356-360
The aim was to prospectively follow a group of 25 patients (mean age 60.5 years) presenting with double incontinence, urinary
and fecal. Other than endoanal ultrasound, no allowance was made for fecal incontinence. All patients were treated exclusively
according to an anatomical classification used for the management of urinary incontinence. Initially, all patients underwent
surgical reconstruction of their pubourethral neoligaments with intravaginal slingplasty. All 25 patients reported complete
cure of their fecal incontinence for a minimum of 6 months (mean 26 months, range 6–48 months) after surgery, and 22 patients
of their urinary incontinence as well. The external anal sphincter was normal in all 25 patients (100%). The internal anal
sphincter (IAS) was normal in 18 patients (72%). In 3 patients fecal incontinence recurred simultaneously with the occurrence
of herniations in the posterior and middle parts of the vagina. Subsequent surgical repair of the uterosacral and arcus tendineus
fasciae pelvis ligaments cured the recurrence. The results appear to indicate that non-traumatic (‘idiopathic’) fecal incontinence
may have the same cause as urinary incontinence. As only connective tissue was repaired, it is suggested that connective tissue
damage may be an important cause of fecal as well as urinary incontinence. 相似文献
4.
A. C. Diokno J. R. C. Catipay B. W. Steinert 《International urogynecology journal》2002,13(5):334-338
Thirty adult women with urge urinary incontinence were included in this study. After completing the basic evaluation, including
a self-administered incontinence questionnaire, patients were treated with a bladder relaxant preparation for 6–8 weeks. At
follow-up the incontinence questionnaire and a global assessment of outcome scale were administered. Data were analyzed using
the Mann–Whitney and Kruskal–Wallis tests, with a subsequent Tukey’s test.
After 6–8 weeks of therapy, 63% of patients reported that they were greatly or moderately improved, with a significant mean
decrease in their total urge score of 51%. Subjects slightly improved (12%) and unimproved/worse (20%) had no significant
change in their mean urge score. Most patients with great or moderate improvement continued with their initial drug treatment.
Successful pharmacotherapy for urinary urge incontinence may be assessed by a simple global scale which correlated well with
response to the MESA questionnaire. Moderate and greatly improved patients correlated with a 50% mean decrease in urge score
and continued their initial drug therapy. 相似文献
5.
A. M. Weber P. Abrams L. Brubaker G. Cundiff G. Davis R. R. Dmochowski J. Fischer T. Hull I. Nygaard A. C. Weidner 《International urogynecology journal》2001,12(3):178-186
The lack of standardized terminology in pelvic floor disorders (pelvic organ prolapse, urinary incontinence, and fecal incontinence)
is a major obstacle to performing and interpreting research. The National Institutes of Health convened the Terminology Workshop
for Researchers in Female Pelvic Floor Disorders to: (1) agree on standard terms for defining conditions and outcomes; (2)
make recommendations for minimum data collection for research; and (3) identify high priority issues for future research.
Pelvic organ prolapse was defined by physical examination staging using the International Continence Society system. Stress
urinary incontinence was defined by symptoms and testing; ‘cure’ was defined as no stress incontinence symptoms, negative
testing, and no new problems due to intervention. Overactive bladder was defined as urinary frequency and urgency, with and
without urge incontinence. Detrusor instability was defined by cystometry. For all urinary symptoms, defining ‘improvement’
after intervention was identified as a high priority. For fecal incontinence, more research is needed before recommendations
can be made. A standard terminology for research on pelvic floor disorders is presented and areas of high priority for future
research are identified. 相似文献
6.
The aim of the study was to find out which factors can predict the outcome of conservative treatment of urinary stress incontinence
in women. One hundred and four women with stress urinary incontinence were evaluated by recall, and by clinical and urodynamic
investigation and were given pelvic floor muscle exercises with or without the use of biphasic low-frequency electrostimulation
and visual biofeedback. Two groups could be distinguished. The first consisted of 37 patients in whom conservative therapy
proved successful; the second consisted of 67 patients in whom incontinence continued. The study investigated whether there
was a significant difference in patients’ characteristics between the two groups. The number of conservative treatment sessions
was not different between the two groups. The presence of a high body mass index, previous pelvic surgery, strong levator
muscles and urethral hypermobility appeared to be poor prognostic features. More research is required to evaluate which patients
can benefit from conservative treatment and which criteria can predict the outcome of pelvic floor physiotherapy in women
with stress incontinence. This way, patients selection is possible and excessive costs can be saved. 相似文献
7.
R. R. Dmochowski 《International urogynecology journal》1999,10(2):144-151
Voiding dysfunction associated with Parkinson’s disease has been well described in male patients. Few studies detail voiding
dysfunction in female Parkinson patients. Apparent differences between patients with Parkinson’s subtypes have also not been
sufficiently defined. The majority of female Parkinson patients who have urinary symptoms (>70%) will manifest symptomatic
urgency with or without urge incontinence. The remaining patients will have mixed irritative and obstructive or purely obstructive
symptoms. Urodynamic evaluation demonstrates detrusor hyperreflexia in 70%–80% of female patients. However, women with Parkinson-related
syndromes demonstrate detrusor hypocontractility or areflexia in 20%–30% of cases. Electromyography reveals sphincteric dysfunction
(pseudodyssynergia, bradykinesia) in 30%–50% of female Parkinson patients. Also, in patients with Parkinson-related syndromes
a high prevalence of peripheral denervation can be documented on electromyographic study of the pelvic floor. Voiding dysfunction
associated with Parkinson’s disease in female patients is complex and not always congruent with symptoms. Urodynamic evaluation
is crucial to fully elucidate lower urinary tract dysfunction in female patients with Parkinson’s and Parkinson-related disorders. 相似文献
8.
A. C. Steele N. Kohli P. Mallipeddi M. Karram 《International urogynecology journal》1999,10(2):106-110
The etiology of female urinary incontinence is complex and multifactorial. Many medications have adverse effects on the lower
urinary tract, including the promotion of incontinence in certain women. Medications may cause incontinence through three
main mechanisms: decreased intraurethral pressure, increased intravesical pressure, and indirect effects on the lower urinary
tract. Careful adjustments of a patient’s medications based on a knowledge of pharmacologic mechanisms of action may restore
continence in some women. 相似文献
9.
The Use of Short-Form Quality of Life Questionnaires to Measure the Impact of Imipramine on Women with Urge Incontinence 总被引:1,自引:1,他引:0
Short-form questionnaires were used to measure the change in quality of life (QOL) of women with urge-predominant urinary
incontinence treated with imipramine hydrochloride. Short forms of the Incontinence Impact Questionnaire (IIQ-7) and the Urogenital
Distress Index (UDI-6) were integrated into a patient questionnaire, which was given to 25 patients with urge-predominant
urinary incontinence before and after treatment with imipramine. Demographic data and self-reports of the number of incontinent
episodes were also recorded. Total and subscale QOL scores and number of incontinent episodes were recorded and compared with
Wilcoxson’s signed ranks test, as well as correlated to the change in number of incontinent episodes with Pearson’s correlation
coefficient. Treatment with imipramine resulted in a clinical improvement or cure in 16/22 patients (72.7%), with an average
reduction in incontinent episodes of 78.7% (P<0.001). The average per cent improvement in QOL scores for total IIQ-7 was 42.1% (P<0.01) and total UDI-6 score was 44.1% (P<0.001). All subscale QOL differences were also significant (P<0.01). The incidence of side effects to imipramine was 41%, which resulted in dose changes. Fourteen per cent eventually
discontinued therapy. Neither total nor subscale QOL improvement scores were correlated with improvement in number of incontinent
episodes. The short form IIQ-7 and UDI-6 are effective tools to determine change in QOL, as evidenced by the effectiveness
of imipramine for the treatment of urge-predominant urinary incontinence. Significant reductions in incontinent episodes and
improvements in IIQ-7 and UDI-6 QOL scores were both seen, but were not correlated. Short-form QOL measures can easily be
integrated into a patient questionnaire to objectively measure a very subjective topic. 相似文献
10.
K. Glavind 《International urogynecology journal》2001,12(4):223-225
In a pilot study 6 women with stress urinary incontinence were treated with Geisha balls while performing pelvic floor muscle
exercises at home half an hour a day for 12 weeks. Subjectively 4 patients were cured and 2 had improved. Before the treatment
the 24-hour pad test was a mean 48 g and after the treatment a mean 10 g. There were no adverse effects. 相似文献
11.
L. L. Subak C. Johnson C. Johnson E. Whitcomb D. Boban J. Saxton J. S. Brown 《International urogynecology journal》2002,13(1):40-43
The aim of this study was to evaluate the effect of weight reduction on urinary incontinence in moderately obese women. This
prospective cohort study enrolled moderately obese women experiencing four or more incontinence episodes per week. BMI and
a 7-day urinary diary were collected at baseline and on the completion of weight reduction. The study included 10 women with
a mean (tSD) baseline BMI of 38.3 (t10.1) kg/m2 and 13 (t10) incontinent episodes per week. Participants had a mean BMI reduction of 5.3 (t6.2) kg/m2 (P<0.03). Among women achieving a weight loss of ≥5%, 6/6 had ≥50% reduction in incontinence frequency compared to 1 in 4 women
with <5% weight loss (P<0.03). Incontinence episodes decreased to 8 (t10) per week following weight reduction (P<0.07). The study demonstrated an association between weight reduction and improved urinary incontinence. Weight reduction
should be considered for moderately obese women as part of non-surgical therapy for incontinence. 相似文献
12.
The purpose of the study was to investigate the prevalence of urinary incontinence during pregnancy and the postpartum, and
to examine postpartum pelvic floor muscle strength. Eight weeks postpartum the prevalence of urinary incontinence and pelvic
floor muscle strength was registered. All women in a Norwegian community, delivering at the local hospital during a 1-year
period, were included in the study. The final study group consisted of 144 women (72%). Data concerning the prevalence of
urinary incontinence was collected by a structured interview and clinical assessment (pad test) 8 weeks postpartum. Pelvic
floor muscle strength was also measured. The prevalence of urinary incontinence during pregnancy was 42%. Eight weeks after
delivery the prevalence of self-reported urinary incontinence was 38%. There was a difference between self-reported symptoms
and urinary incontinence as assessed by the pad test. Symptoms of fecal incontinence postpartum were reported by 6 women (4.2%).
The prevalence of urinary incontinence was found to be nearly the same 8 weeks postpartum as during pregnancy. This documents
the need for a strategy to prevent and treat urinary incontinence during these periods. 相似文献
13.
C. Pajoncini E. Costantini F. Guercini M. Porena 《International urogynecology journal》2002,13(1):30-35
A prospective analysis of 166 women with genuine stress incontinence was performed comparing Valsalva leak-point pressure
(VLPP) and maximum urethral closure pressure (MUCP) with age, previous urogynecologic surgery and/or hysterectomy, poor urethral
mobility, weight, menopause and vaginal deliveries, to find correlations with intrinsic sphincter deficiency (ISD). Cut-off
value for VLPP were 60 cmH2O and for MUCP 30 cmH2O. MUCP ≤30 cmH2O identifies a group of patients with more severe incontinence, a shorter urethral functional length (UFL) (P= 0.02), more previous urogynecologic operations and the menopause (P= 0.004 and P= 0.000), and older age (P= 0.000). VLPP ≤60 cmH2O identifies a group of patients with more severe incontinence, a shorter UFL (P = 0.005), more previous urogynecologic surgery (P = 0.006) and poorer urethral mobility (P= 0.004). As these two tests measure different components of urethral functions we can hypothesize that they detect different
pathogenic processes contributing to ISD. When one or both tests is abnormal incontinence is more severe and the incidence
of poor prognostic factors is increased. 相似文献
14.
Urodynamic Techniques 总被引:2,自引:0,他引:2
Appropriate investigation is essential to a full evaluation of any patient with urinary incontinence, as accurate diagnosis
leads to correct treatment. This paper describes the various investigations for lower urinary tract dysfunction, and their
main indications. They include the pad test, uroflowmetry, subtracted cystometry, and more complex investigations such as
videocystourethrography, ambulatory urodynamics, urethral pressure profilometry, magnetic resonance imaging and electromyography.
Although not every patient requires extensive investigation, appropriate use of tests of lower urinary tract function provides
useful information on which to base appropriate treatment. 相似文献
15.
The female lower urinary and genital tracts both arise from the primitive urogenital sinus and develop in close anatomical
proximity. Sex hormones have a substantial influence on the female lower urinary tract throughout adult life, with fluctuations
in their level leading to macroscopic, histological and functional changes. Urinary symptoms may therefore develop during
the menstrual cycle, in pregnancy and following the menopause. Estrogen deficiency, particularly when prolonged, is associated
with a wide range of urogenital complaints, including frequency, nocturia, incontinence, urinary tract infections and the
‘urge syndrome’. Estrogen supplementation subjectively improves urinary stress incontinence but there is no objective benefit
when given alone; however, estrogen given in combination with phenylpropanolamine may be clinically more useful. Hormone replacement
therapy does appear to treat postmenopausal irritative urinary symptoms such as frequency and urgency, possibly by reversing
urogenital atrophy, and there is also evidence to suggest that estrogens can provide prophylaxis against recurrent urinary
tract infections. However, the ‘best’ type of estrogen, route of administration and duration of therapy are at present unknown. 相似文献
16.
Incontinence surgery is rarely performed prior to the completion of a woman’s childbearing. The literature is sparse in regard
to women with prior incontinence surgery. There are no reports of pregnancy complicated by a sling procedure. A 26-year-old
gravida 3, para 2-0-0-2 with prior surgical history of a Pereyra urethropexy followed by a Vesica suburethral sling, was referred
at 18 weeks’ gestation for assessment of the sling. Her antenatal course was complicated by pyelonephritis and intermittent
urethral obstruction requiring Foley catheter placement. She delivered by scheduled cesarean section at 37 weeks’ gestation.
Three months following delivery she presented with pyelonephritis and recurrence of her incontinence. Pregnancy complicated
by prior suburethral sling procedure may result in urinary outlet obstruction, pyelonephritis and disruption of the surgical
repair. 相似文献
17.
Correlation of Urethral Closure Pressure, Leak-Point Pressure and Incontinence Severity Measures 总被引:4,自引:0,他引:4
C. W. Nager J. A. Schulz S. L. Stanton A. Monga 《International urogynecology journal》2001,12(6):395-400
The aim of this study was to determine whether water perfusion maximum urethral closure pressure (MUCP) correlates with Valsalva
leak-point pressure (LPP), and which of these best correlates with subjective and objective incontinence severity measures.
Fifty-two women with previously diagnosed genuine stress incontinence (n= 46), or mixed incontinence with a minor and controlled urge component (n= 6), were assigned an incontinence status grade based on interview and diary review. These women then completed visually
observed standing LPPs at 250 ml bladder capacity, supine water perfusion MUCP determinations, pad tests and quality of life
questionnaires. The urodynamic and severity measures were compared with correlation analysis or analysis of variance. A modest
correlation exists between LPP and MUCP (r= 0.50–0.62, P<0.001). Both MUCP and LPP demonstrated significant decreases (P<0.01) with increasing severity of assigned incontinence grade. A very low and insignificant correlation existed for these
urodynamic parameters and pad loss or quality of life measures. MUCP and LPP correlate modestly with each other and both are
comparable in predicting incontinence severity. Either can be used as the urodynamic measure to assess intrinsic sphincter
deficiency. 相似文献
18.
Suture Injury to the Urinary Tract in Urethral Suspension Procedures for Stress Incontinence 总被引:4,自引:2,他引:2
The case histories of women attending the Urogynecology Department at the Royal Women’s Hospital and Mercy Hospital for Women
were reviewed between 1986 and 1998 to determine the incidence and postoperative morbidity caused by suture injury to the
urinary tract following urethral suspension surgery for stress incontinence. In our department 1103 Burch colposuspensions
and 61 Stamey urethral suspensions have been performed. Intraoperative cystourethroscopy was performed routinely for the early
detection and treatment of urinary tract injury. Intravesical sutures were found by routine intraoperative cystoscopy in 1
Stamey suspension, 1 open Burch colposuspension and 3 laparoscopic Burch colposuspensions. Ureteric suture ligation was diagnosed
in 2 women intraoperatively and 1 woman postoperatively after laparoscopic Burch colposuspension. Two women presented with
late complications from intravesical sutures following open Burch colposuspension. A further 7 women referred with urinary
symptoms were found to have intravesical sutures, 2 following Burch colposuspension, 4 following Stamey urethral suspension
and 1 following the Marshall–Marchetti–Kranz procedure. Seven of the 9 women diagnosed with intravesical sutures presented
with bladder or pelvic pain, frequency or urinary tract infection. Two women had recurrent stress incontinence and were found
to have a intravesical suture on routine cystoscopy at the time of stress incontinence surgery. Suture removal, with any accompanying
calculus, was achieved cystoscopically with almost immediate resolution of symptoms without loss of urinary control in all
cases. Non-absorbable intravesical sutures occurring as a result of suture misplacement or erosion is an infrequent but important
complication of stress incontinence surgery, but should be suspected if pain and irritative bladder symptoms or recurrent
urinary infection occur postoperatively. Cystourethroscopy performed intraoperatively or postoperatively is essential for
early diagnosis and treatment. 相似文献
19.
Translabial Color Doppler Urodynamics 总被引:5,自引:0,他引:5
Color Doppler ultrasound is a new method for documenting fluid leakage in the setting of videourodynamic testing. In order
to compare color Doppler ultrasound with traditional fluoroscopic imaging we performed a prospective blinded comparative clinical
study. Fifty-two consecutive patients undergoing urodynamic investigations for symptoms of incontinence or prolapse were examined
using fluoroscopy and translabial color Doppler ultrasound to document stress leakage. The investigators were blinded to each
other’s results. Both tests were performed at maximum bladder capacity and with an indwelling 5 Fr microtransducer catheter,
in both the supine and the erect positions. Equivalent results for both methods were obtained in 48 out of 52 patients (Cohen’s
κ= 0.82). It was therefore concluded that translabial color Doppler ultrasound imaging can reliably demonstrate leakage through
the female urethra on Valsalva maneuver or coughing. 相似文献
20.
Persistent urinary incontinence after failed surgical repair can be successfully treated with the artificial urinary sphincter.
The English literature was reviewed from 1985 to 1996. Eleven articles and abstracts addressing placement of the artificial
urinary sphincter in women were identified. Discussion includes two operative techniques. Success rates were in the range
of 91%–99%. Erosion rates were 7%–29%. The artificial urinary sphincter is an effective treatment for women failing other
procedures. Appropriate work-up and diagnosis for type III stress urinary incontinence is crucial. 相似文献