Stress urinary incontinence 3 years after pregnancy: correlation to mode of delivery and parity

The aim was to estimate the incidence of stress urinary incontinence 3 years after delivery and its correlation to mode of delivery and parity. A longitudinal cohort study was conducted with 120 women at the Antenatal Clinic at the State University of Campinas. There was a significant difference in the incidence of postpartum stress urinary incontinence (SUI) among patients with SUI during pregnancy (p > 0.0001). Women that were asymptomatic during pregnancy and had vaginal delivery developed SUI 2.4 times more frequently than after c-section (19.2% and 8.0%, respectively). The incidence of SUI after delivery dropped significantly in the primiparous (p = 0.0073) and multiparous 2–3 (p < 0.0001), but not in the multiparous with four or more deliveries (66.7% to 60.0%) (p = 0.5637). A significant correlation has been observed between parity and SUI (p = 0.0299). Pregnancy possibly predisposes to SUI 3 years after delivery as well as parity. No significant correlation has been demonstrated between mode of delivery and SUI.     

Do preoperative cytokine levels offer a prognostic factor for polypropylene mesh erosion after suburethral sling surgery for stress urinary incontinence?

When polypropylene meshes are used in reconstructive urogynecological surgery, the erosion rates vary from 3.3% to 14% and causative factors for such erosions are still unknown in many cases. Therefore, the aim of our study was to establish the role of immunologic factors in the process of polypropylene tapes erosions after suburethral sling procedures. Serum concentrations of tumor necrosis factor α, interleukin (IL)-2, IL-4, IL-5, IL-10, and interferon (IFN)-γ were estimated in 123 patients suffering from stress urinary incontinence preoperatively and during 12 months follow-up using Human Th1/Th2 Cytokine Cytometric Bead Array I kit. The same immunological assessment was performed in each case of detected tape erosion. Statistical calculation was performed using UNIVARIATE, CORR, and NPAR1WAY procedures from Statistical Analysis System. The unpaired Student’s t test, nonparametric Mann–Whitney U test, and Wilcoxon tests were used. Preoperative IFN-γ concentration was significantly higher in women with subsequent polypropylene mesh erosion when compared to women with successful outcome (p < 0.05). Th1 cytokine profile may be related to the risk of the vaginal erosions following placement of polypropylene meshes. The way to lower erosion rate may involve exclusion of the patients immunologically prone to synthetic material erosion. The factor which can help to select such patients could be preoperative level of IFN-γ.     

InVance球部悬吊术治疗男性前列腺术后尿失禁（附5例报告）

目的探讨InVance球部悬吊术治疗男性尿失禁的安全性及有效性。方法2003年3月～2008年1月,应用InVance球部悬吊术治疗5例前列腺手术后尿失禁（经尿道前列腺电切术后4例,前列腺癌根治术后1例）。年龄62～76岁,平均67岁。尿失禁病程2～6年,平均4年。保守治疗无效。术前尿动力学检查平均漏尿点压力25.5cmH2O（20～32.5cmH2O）。截石位,会阴正中皮肤纵行切开3～5cm,显露尿道球部浅面球海绵体肌及双侧耻骨下支。采用InVance器械,电钻将带有1号不吸收合成线的钛螺钉分别在两侧的耻骨联合与耻骨下支连接部和其下约2cm处打钉6个。将聚丙烯筛网材料吊带裁剪成约3cm×4cm,将一侧耻骨下支上的三条合成线穿过吊网两角分别结扎固定,术中增加腹压后（下腹部加压等）咳嗽试验调节吊带的松紧度,或将逆行尿道漏尿点压调整为60cmH2O,留置导尿管。结果手术时间50～85min,平均60min。出血20～50ml,平均30ml。5天拔除气囊导尿管,均能自行排尿。5例随访6～24个月,平均12.6月,4例经尿道前列腺电切术后者尿失禁治愈,1例前列腺癌根治术后者尿失禁改善;尿动力学检查平均漏尿点压力65cmH2O（55～70cmHO）。结论InVance球部悬吊术是一种可治疗前列腺术后轻中度尿失禁的方法。     

两种入路尿道中段悬吊术治疗女性压力性尿失禁的临床效果比较

目的 比较经耻骨后和闭孔入路经阴道尿道中段无张力悬吊术治疗女性压力性尿失禁的临床效果和并发症.方法 应用经阴道尿道中段无张力悬吊术治疗女性压力性尿失禁患者134例,根据手术入路的不同分为两组:耻骨后组(32例)和闭孔组(102例).对两组的手术时间、失血量、治愈率和有效率以及术后并发症进行比较.结果 耻骨后组和闭孔组的手术时间分别为(24±6)min和(22±5)min,术中失血量分别为(45±27)ml和(54±23)ml,治愈率分别为81.25%和78.43%,有效率分别为96.88%和98.04%,两组比较差异无统计学意义(P＞0.05).两组术后并发症的发生率分别为:新发尿急6.25%和5.88%,排尿困难:3.13%和2.94%,膀胱损伤:3.13%和0%,阴道损伤:0%和2.94%,两组比较差异无统计学意义(P＞0.05).术后腹股沟疼痛的发生率分别为3.13%和20.59%,两者差异有统计学意义(P＜0.05).结论 耻骨后入路和闭孔入路尿道中段悬吊术均是治疗女性SUI的有效术式.     

Radiofrequency energy delivery to the anal canal: is it a promising new approach to the treatment of fecal incontinence?

Background

The present study was conducted to assess the efficacy and safety of the delivery of radiofrequency energy to the anal canal (the SECCA procedure).

Methods

Eight patients with fecal incontinence underwent the SECCA procedure. The Fecal Incontinence Severity Index (FISI) score and the Fecal Incontinence-related Quality of Life (FIQL) scale were completed at baseline and after the procedure. Anorectal manometry and endoanal ultrasound also were conducted.

Results

Seven of the 8 patients were women, and the median age of the patients was 59 years (range, 28-73 y). The mean FISI score and all of the parameters in the FIQL scale with the exception of the embarrassment scale measured at 6 months after the procedure was not improved significantly. We observed no changes in the anal manometry and endoanal ultrasound parameters. Complications associated with the procedure developed in 7 of the 8 patients, including anal bleeding, anal pain, and anal mucosal discharge.

Conclusions

The FISI score and FIQL scale were not improved significantly after the SECCA procedure, and considerable complications were associated with the procedure.     

Preoperative urodynamic evaluation may predict voiding dysfunction in women undergoing pubovaginal sling

PURPOSE: We determine which urodynamic parameters can best predict postoperative voiding dysfunction following pubovaginal sling surgery. MATERIALS AND METHODS: The records of 98 consecutive women who had undergone pubovaginal sling surgery with allograft fascia lata between July 1998 and July 2000 were reviewed. Urodynamic and followup data were sufficient for evaluation for 73 patients. Urodynamic and clinical parameters were correlated with urinary retention, time to return of efficient voiding and development of postoperative urgency symptoms. RESULTS: Average time to return of efficient voiding was 3.92 days (median 3). Of 21 women who voided without a detrusor contraction urinary retention developed in 4 (23%) versus 0 of 48 who voided with detrusor contraction (p = 0.007). Urinary retention was defined as the need to perform even occasional self-catheterization. All 4 women with urinary retention had a detrusor pressure of less than 12 cm. H(2)O (0 in 3, 4 in 1). None of the women with a detrusor pressure of greater than 12 cm. H(2)O had urinary retention (p = 0.047). The presence of Valsalva voiding in women without a detrusor contraction did not affect the incidence of urinary retention (11.1%) compared to those who did not demonstrate Valsalva voiding (5.1%) (p = 0.603). Peak flow rate, detrusor instability on preoperative urodynamics and post-void residual urine volume were not associated with postoperative urinary retention. Finally, post-void residual urine volume predicted delayed return to normal voiding (p = 0.001). There were no other urodynamic parameters that were significantly associated with urinary retention, delayed return to normal voiding or postoperative urgency symptoms including peak flow rate, capacity or compliance. CONCLUSIONS: Women who void without or with a weak detrusor contraction are most likely to have urinary retention postoperatively. Therefore, we conclude that preoperative urodynamic evaluation may be used to counsel women regarding the risk of urinary retention following the pubovaginal sling procedure.     

Urinary incontinence in familial dysautonomia

The aim of this study was to determine the prevalence of urinary incontinence in women with familial dysautonomia (FD). A telephone survey was conducted on 68 known surviving female FD patients over 13 years of age registered with the Dysautonomia Centers in the USA and Israel. The mean age of the surveyed group was 27.1+/-9.8 years and 99% of the patients were nulliparous. The overall reported prevalence of urinary incontinence was 82% (n=56). Of the patients with incontinence, 59% (n=33) reported stress incontinence, 11% (n=6) reported urge incontinence, and 30% (n=17) reported symptoms of both, or mixed incontinence. In most women urinary loss was both small and infrequent, but 36% of women (n=20) with incontinence experienced a loss sufficient to necessitate the use of protection (panty liners, pads or diapers); in 7% (n=4) such loss occurred daily. Twelve per cent of all women with FD surveyed experienced primary nocturnal enuresis and 26% experienced nocturia. The prevalence of urinary incontinence is high in young female patients with familial dysautonomia. Neurophysiologic testing in this population may provide a better understanding of the role of the autonomic nervous system in urinary incontinence.Abbreviations FD familial dysautonomia - MI mixed incontinence - MRI magnetic resonance imaging - SI stress incontinence - UI urge incontinence Editorial Comment: The authors report the prevalence of urinary incontinence in familial dysautonomia. This is fertile area for investigation, given the paucity of information currently available. The subtypes of incontinence bear further comparison to populations without dysautonomia. Additional investigators may wish to study this fascinating area further.     

Women's knowledge, practises, and intentions regarding correct pelvic floor exercises.

AIM: Although research has demonstrated the efficacy of pelvic floor exercises (PFXs) for the prevention and treatment of female urinary incontinence (FUI), adherence to PFX regimens is commonly poor. There is some evidence that this finding is in part due to a lack of knowledge about how to perform PFXs correctly and misconceptions about the required frequency and duration of PFX regimens. METHODS: By using a sample of 720 postpartum women, this study investigates women's PFX regimens both before and during pregnancy and postpartum. RESULTS: Findings demonstrated that most women were aware of the required frequency for PFXs (at least every second day): just over half had done them this often during pregnancy and 91% intended to do so postpartum. However, few had done them at this level before pregnancy and less than half knew that PFXs should be carried out indefinitely throughout the lifetime. Moreover, only two thirds were confident that they were doing PFXs correctly. CONCLUSION: The findings suggest that, despite good knowledge of the required frequency of PFXs, few women practise them regularly over their lifetime, many apparently perceiving PFXs as relevant only to the childbirth years. Implications for health professionals in addressing these gaps in women's knowledge and practises are discussed.     

女性压力性尿失禁盆底赖氨酰氧化酶表达的研究

目的分析压力性尿失禁(SUI)女性盆底组织中赖氨酰氧化酶(LOX)的表达及血清Cu2 水平,探讨LOX在女性SUI发病中的作用。方法选取因SUI而行尿控手术治疗的患者25例,以同期因妇科良性疾病行全子宫切除术的患者25例作为对照。术前抽取空腹血采用原子吸收法测定Cu2 水平,术中取患者子宫主骶韧带,行HE染色及VG染色观察韧带中胶原纤维形态,免疫组化法观察LOX在组织中的分布,Western blotting免疫印迹法检测LOX在组织中的表达。结果SUI患者主骶韧带中胶原纤维排列松散,LOX主要在成纤维细胞胞质中表达,其表达水平明显低于对照组(P<0.01);血清Cu2 水平两组比较无显著性差异(P>0.05)。结论SUI患者盆底组织中LOX含量减少可能是SUI发病过程中的重要环节。