Outcome results of transurethral collagen injection for female stress incontinence: assessment by urinary incontinence score

PURPOSE: We assessed the results of collagen injection for female sphincteric incontinence using strict subjective and objective criteria. MATERIALS AND METHODS: We evaluated 63 consecutive women with sphincteric incontinence who underwent a total of 131 transurethral collagen injections. Sphincteric incontinence was confirmed by urodynamics. All patients were treated with 1 to 5 transurethral collagen injections and treatment outcome was classified according to a new outcome score. Cure was defined as no urinary loss due to urge or stress incontinence documented by a 24-hour diary and pad test, and patient assessment that cure was achieved. Failure was defined as poor objective results and patient assessment that treatment failed. Cases that did not fulfill these cure and failure criteria were considered improved and further classified as a good, fair or poor response. RESULTS: Mean patient age plus or minus standard deviation was 67.7 +/- 12.8 years. All women had a long history of severe stress urinary incontinence, 18 (29%) underwent previous anti-incontinence surgery, and 41% had combined stress and urge incontinence. Preoperatively diary and pad tests revealed a mean of 7.5 +/- 4.6 incontinence episodes and 152 +/- 172 gm. of urine lost per 24 hours. Overall 1 to 5 injections were given in 26, 17, 13, 3 and 4 patients, respectively. Mean interval between injections was 4.4 +/- 5.7 months, mean followup was 12 +/- 9.6 months, and mean interval between the final injection and outcome assessment was 6.4 +/- 4.9 months. There was a statistically significant decrease in the total number of incontinence episodes per 24-hour voiding diary after each injection session. Although there was a clear trend toward decreased urinary loss per 24-hour pad test, statistical significance was not established. Using the strict criteria of our outcome score overall 13% of procedures were classified as cure, 10%, 17% and 42% as good, fair and poor, respectively, and 18% as failure. CONCLUSIONS: As defined by strict subjective and objective criteria, we noted a low short-term cure rate after collagen injection in women with severe sphincteric incontinence. It remains to be determined how patients with less severe incontinence would fare using our outcome assessment instruments.     

Success of de novo reimplantation of the artificial genitourinary sphincter

PURPOSE: We evaluate our experience with de novo reimplantation of the artificial genitourinary sphincter with a particular emphasis on mechanical and nonmechanical failure rates. De novo reimplantation is defined as implantation of an artificial sphincter following removal of a previously placed sphincter for erosion and/or infection and a waiting period of several months. MATERIALS AND METHODS: A retrospective analysis of more than 400 patients with an artificial sphincter revealed 23 who underwent de novo reimplantation between January 1983 and October 1998. All patients were men with a mean age of 66.5 years (range 16 to 88) and all had a urethral cuff. Reasons for cuff removal were erosion in 12 cases (52.2%), infection in 10 (43.5%) and intraoperative urethral injury in 1 (4.3%). Mean waiting period was 6.8 months (range 1.5 to 32) between explantation and de novo reimplantation. Mean followup was 32.6 months (range 1 to 108). RESULTS: Of the 23 patients 20 (87%) had no mechanical or nonmechanical failures and 3 (13%) had nonmechanical failures, including 2 patients (8.7%) whose cuff eroded into the urethra and 1 (4.3%) who had recurrent urinary incontinence which was successfully treated with implantation of a tandem cuff. There were no mechanical failures or infections in this group of patients. CONCLUSIONS: Our study suggests that de novo artificial sphincter reimplantation is an excellent treatment option. It is safe and associated with complication rates that are comparable to those of primary implantation.     

压力性尿失禁初始发病时间分析

目的：对女性压力性尿失禁初始发病时间进行探讨，以便采取预防措施。方法：对我院2000年12月-2003年2月期间就诊的全部408例女性压力性尿失禁病例的初始发病时间做回顾性分析。结果：初始发病在分娩后12个月内者为166例，占40．69％，初始发病在更年期或绝经后2年者为115例，占28．19％。结论：分娩后12个月内及更年期或绝经后2年为患者初始发病比较集中的两个时期，应加强这两个时期的妇女保健。     

压力性尿失禁问卷评分对女性压力性尿失禁诊断的价值

目的:探讨压力性尿失禁问卷评分(SS)对女性压力性尿失禁(SUI)的诊断价值。方法:对我院妇科确诊为压力性尿失禁的44例患者进行压力性尿失禁问卷评分,分析1小时尿垫实验(1HPTV)与SS之间的相关性。结果:1HPTV与SS之间有相关性;Lg[1HPTV]与SS之间有非常明显相关性。SS评分对于中度SUI诊断的敏感性为70.0%,特异性为76.5%;对于诊断重度SUI患者,SS评分诊断的敏感性为75.0%,特异性为91.7%。身高、体重、年龄和Lg[1HPTV]是影响SS的主要因素。结论:SS是协助临床诊断女性压力性尿失禁的简捷、经济、无创、准确的一种新方法。     

针刺治疗压力性尿失禁疗效国内文献的系统评价

目的：系统评价国内针刺治疗压力性尿失禁的疗效。方法：计算机检索CNKI、万方数据库、维普数据库,手工检索《中国针灸》等杂志及相关会议论文。检索时间截止至2013年11月,获取所有涉及针刺治疗压力性尿失禁的随机和半随机对照试验,由两名评价员独立提取资料并进行方法学评估。利用RevMan5．0软件对相关信息进行Meta分析和失安全数分析,漏斗图分析发表偏倚。结果：纳入10个随机对照试验,共669例压力性尿失禁患者。 Meta分析结果示,针刺与安慰剂比较的OR＝3．05,95％CI[1．59,5．84];针刺与西药比较的OR＝9．14,95％ CI[4．77,17．53];针刺与盆底肌训练比较的OR＝4．00,95％CI[2．51,6．39]。针刺组均优于对照组,失安全数分析显示评价结果较为稳定;漏斗图图形左右基本对称,发表偏倚不大。结论：针刺治疗压力性尿失禁有效,且优于西药和盆底肌训练,但仍需更多高质量的随机双盲对照试验来进一步证实针刺治疗压力性尿失禁的疗效。     

A narrative review of pelvic floor muscle training in the management of incontinence following prostate treatment

Background and ObjectiveUrinary incontinence following prostate treatment (IPT) is a common complication with corresponding negative impacts on quality of life. Pelvic floor muscle training (PFMT) is a non-invasive treatment strategy to treat combat this clinical issue, and has been recognized by medical associations globally and increasingly supported by large bodies of literature. Accordingly, many studies demonstrate a significant benefit of pelvic floor muscle training to continence status and quality of life in men with incontinence following prostate treatment. However, related research is limited by variety in treatment regimens, outcome measures, and study designs, with unclear impact on treatment success. We aim to provide a brief overview of pathology and incidence of incontinence following prostate surgery and an understanding how PFMT is currently used to treat and prevent this clinical consequence.MethodsA comprehensive literature search was conducted utilizing PubMed, Medline, and Google Scholar. Search criteria included systematic reviews and randomized control trials published in the year 2000 to present. References of resulting studies were further analyzed to identify further articles of relevance. Keywords searched included: “post-prostatectomy incontinence”, “pelvic muscle strengthening”, “Benign Prostatic Hyperplasia”, and “pelvic floor muscle training”. Peer-reviewed publications that demonstrated a novel addition to the existing body of literature on this subject were included.Key Content and FindingsUpon review of the current research landscape, PFMT is largely supported in treatment of IPT. Analysis of current literature on this subject demonstrates heterogeneity in protocols, measures of treatment success, and patient numbers. Nevertheless, benefits to continence and quality of life are noted across an expansive body of literature and as such, PFMT is therefore recommended as an important part of the treatment algorithm following radical prostatectomy.ConclusionsPFMT is an important and effective part of the treatment algorithm in the prevention and treatment of IPT. Additional research is needed to more extensively assess PFMT’s role in treating this clinical consequence, especially following other prostate surgeries.     

肾康宁胶囊联合用药治疗肾阳虚证导致排尿功能障碍的临床研究

目的:评价肾康宁胶囊联合用药治疗肾阳虚证患者的临床疗效和安全性。方法:选取2018年5月至2018年10月间黑龙江中医药大学附属第二医院等收治的肾阳虚型患者360例作为研究对象,以区组随机法均分为对照组、联合观察组和葡萄糖酸锌组,每组120例,并给予对应方案进行治疗。记录3组患者在治疗前、治疗4周后、治疗8周后的夜尿量、尿频(日尿)次数、尿失禁现象、尿急次数,进行中医证候的量化评分,评估3组的临床总有效率及单项症状的消失率、生命质量和不良反应等。结果:3组患者在治疗后其夜尿、尿失禁、尿频、尿急的中医证候量化积分均优于治疗前(P0.01)。患者的总有效率如下:治疗4周后分别为联合观察组74.34%、葡萄糖酸锌组59.32%、对照组56.25%,治疗8周后分别为联合观察组92.92%、葡萄糖酸锌组77.12%、对照组63.39%。结论:肾康宁胶囊联合用药治疗肾阳虚排尿疾病患者疗效显著,可以明显减少夜尿和日尿次数,改善尿失禁、尿频、尿急症状,提高患者生命质量,且安全可靠。     

自制蝶型网片吊带治疗老年女性压力性尿失禁的近期疗效观察

目的:探索蝶型网片治疗老年女性压力性尿失禁(SUI)的可行性及疗效。方法:用自行设计的蝶型网片,改进固定方法和部位,对65岁以上老年女性压力性尿失禁患者21例进行治疗。结果:21例手术后尿失禁均得到控制或减轻,经随访3～12月无一例出现尿失禁复发和加重现象。结论:蝶型网片治疗老年女性SUI疗效确切,具有费用低、手术创伤小、不损伤膀胱等优点。     

Incidence and Risk Factors for Pelvic Pain After Mesh Implant Surgery for the Treatment of Pelvic Floor Disorders

Study Objective

Our aim was to assess incidence and risk factors for pelvic pain after pelvic mesh implantation.