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Objetivos: Revisar o papel da avaliação urodinâmica pré tratamento cirurgico de incontinência urinária aos esforços (IUE) em mulheres. Métodos: Foi realizada revisão bibliográfica em maio de 2018 sobre estudo urodinâmico e incontinência urinária em mulheres nas bases de dados PubMed e Lilacs, utilizando como palavras-chaves na busca os termos urodynamics, women e urology, adotando como critérios de inclusão: data de publicação igual ou maior a janeiro/2013 (com exceção de um trabalho que foi incluído devido a relevância clínica no assunto); trabalhos redigidos em língua inglesa ou portuguesa; acesso livre ao texto integral e abordagem da avaliação urodinâmica (AUD) em mulheres com IUE. Os critérios de exclusão foram incontinência urinária (IU) em pacientes do sexo masculino e crianças, além de comorbidades neurológicas. Resultados: O estudo urodinâmico é um exame que avalia a função do complexo uretro-vesical nas fases de enchimento e esvaziamento do ciclo miccional. A AUD auxilia a detectar e a diagnosticar com maior precisão as disfunções do trato urinário inferior (DTUI) com base em sua fisiopatologia, podendo assim participar da tomada de decisão terapêutica. Conclusões: O estudo urodinâmico pré-operatório deve ser reservado para casos selecionados, como na incontinência urinária complicada, nos prolapsos genitais e disfunções neurológicas. Portanto, não deve ser solicitado de rotina em todas as pacientes com incontinência urinária.
Aims: to review the role of preoperative urodynamic assessment in the treatment of stress urinary incontinence in women. Methods: Bibliographic review was performed in May 2018 on urodynamic and stress urinary incontinence in the PubMed and Lilacs databases, using the key terms urodynamics, women and urology. The inclusion criteria used as reference were: publication date equal to or greater than January 2013 (except for two articles, which were included for clinical relevance in the subject); papers written in English or Portuguese; free access to the full text and approach to Urodynamic Assessment (AUD) in women with IUE. The exclusion criteria were IU in male patients, children and neurological comorbidities. Results: The urodynamic study is a test that evaluates the function of the urethral and bladder complex at the phases of filling and emptying of the voiding cycle. The AUD helps to detect and diagnose more accurately the lower urinary tract dysfunctions (DTUI) based on your pathophysiology, and thus participate in the therapeutic decision making. Conclusions: The preoperative urodynamic study should be reserved for selected cases, such as complicated urinary incontinence, genital prolapses and neurological dysfunctions. Therefore, it should not be done routinely in all patients with urinary incontinence.
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Urinary Incontinence, Stress/surgery , Urodynamics , WomenABSTRACT
Underactive bladder (UAB) is a hot research topic in the field of urinary continence.At present,the research on UAB is not in-depth,which brings many serious problems for the diagnosis and treatment of lower urinary tract dysfunction.In this paper,the definition,classification,risk factors,pathogenesis and diagnostic criteria of UAB are described.Some clinical problems related to UAB are discussed in details,such as the indications and surgical expectations of benign prostatic hyperplasia (BPH) and female stress urinary incontinence (SUI) with UAB,strategic issues in detrusor hyperactivity with impaired contractility (DHIC),oral anticholinergic drugs,and bladder wall injection of botulinum toxin A may lead to urinary retention.
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Objective To observe the clinical efficacy ofWuzi Yishen Oral Liquid for female stress urinary incontinence.Methods Ninety patients were randomized into treatment group (45 cases) and control group (45 cases). The treatment group was treated byWuzi Yishen Oral Liquid, while control group was treated bySuoquan capsule. After three-month treatment, the clinical efficacy was observed by 1 h pad-test and urinary incontinence questionnaire scores.Results Compared with before treatment, the quantity of fluid loss of 1 h pad-test of the two groups was reduced significantly, and the symptom scores of urinary incontinence questionnaire were improved after treatment (P<0.05). The symptom scores of urinary incontinence questionnaire of the treatment group were higher than the control group (P<0.05).ConclusionWuzi Yishen Oral Liquid has obvious clinical efficacy for the treatment of female stress urinary incontinence.
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Objective To observe the effects of Bupi-Guhuo decoction in treating astringent Ⅰ,Ⅱ degree of female stress urinary incontinence.Methods 70 Women patients with stress urinary incontinence in outpatient of urology of Xiyuan Hospital of CACMS from December 2012 to October 2011 were randomly divided into a treatment group and a control group,with 35 cases in each group.The treatment group was treated with Bupi-Guhuo decoction,twice daily,1package per time; while the patients in the control group were treated with pelvic floor muscle training therapy.Both groups were treated for 4 weeks.Results The score of ICS-Q-SF and the amount of urinary incontinence comparison:2 weeks after treatment [the treatment group was (6.42～0.79) and (8.85～ 1.07) g respectively; the control group was (6.81～0.91) and (9.35～ 1.23) g respectively].Both groups had obvious improvement than before the treatment [the treatment group (7.73 ～ 1.52) and (12.92 ～2.08) g respectively,the control group was (7.71～ 1.48)and (13.28～2.43) g respectively] (P＜0.01).4 weeks after the treatment [treatment group was(2.68～0.91)and(2.62～1.08) g respectively,the control group was (6.25～0.81) and (8.02～ 1.32)g respectively].Compared with the effects of 2 weeks after treatment,the difference was statistically significant (P＜0.01) in the treatment group,while with no significant change (P＞0.05) in the control group.At the 2 weeks,4 weeks treatment,the effects in the treatment group and the control group had statistical difference (P＜0.05 or 0.01).(②)Clinical curative effect comparison:After treatment,the total effective rate was 67.7％ (21/31) in treatment group and 37.0％ (10/27) in the control group,showing significant difference (P=0.000,P＜0.01).Conclusion Bupi-Guhuo decoction had better therapeutic effects than pelvic floor muscle training in the treatment of female Ⅰ,Ⅱ degree of stress urinary incontinence,also with a time-effect relationship.
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Objective To investigate the effectiveness of the combined electrical stimulation and nursing interventions for female stress urinary incontinence.Methods The study is qusi-experimental design.48 patients with stress urinary incontinence were allocated to the intervention group and the control group with 24 patients in each group.The control group was given electrical stimulation,the intervention group was given 12-week electrical stimulation and comprehensive nursing interventions.The outcome indicators were 1-hour pad test urine loss,pelvic floor muscle (PFM) strength,the grade of subjective urinary incontinence,quality of life (I-QOL).Results Compared with the control group,no significant subjective urinary incontinence score was seen,but pelvic floor muscle (PFM ) strength and the score of the QOL evidently improved and 1-hour pad test urine loss decreased in the intervention group.Conclusions Combined electrical stimulation and nursing interventions for female stress urinary incontinence is effective treatment.
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@# ObjectiveTo identify the relationship between urodynamic parameters and vaginal deliveries in women with genuine stress urinary incontinence(GSI).Methods56 women with vaginal delivery history who were diagnosed as stress urinary incontinence underwent urodynamic tests.Their abdominal leak point pressures(ALPP),maximum urethral closure pressure(MUCP) and functional urethral length(FUL) were recorded,and their Correlation to vaginal deliveries was tested using linear correlation coefficient.ResultsCorrelation between vaginal deliveries and ALPP showed a significant relationship(r=-0.349,P<0.05).Neither MUCP nor FUL showed a close relationship with vaginal deliveries(r=-0.219 and r=-0.178 respectively,P>0.05).ConclusionVaginal delivery plays an important role in the pathogenesis of GSI.The more vaginal deliveries,the more serious GSI.
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Several different methods of enhancing pelvic floor functions have been developed and modified. The aim of this study was to compare the efficacy of a new vaginal cone with conventional FES-Biofeedback therapy for female urinary incontinence, with respect to pelvic floor rehabilitation. One hundred and twenty patients, who required a non-surgical treatment for urinary incontinence, were divided randomly into two groups; (1) the Functional Electrical Stimulation (FES) - Biofeedback group (or BFB group) and (2) the new vaginal cone group (or cone group). For a period of six weeks, two training sessions each week were carried out on the BFB group. The new 150-gram dumbbell-shaped vaginal cone, made of fine ceramic material, was developed domestically. A therapist instructed patients in the cone group upon its use for pelvic floor exercise, and directed the exercise to be repeated at home daily; these patients had follow-up visits every week. Objective improvements were obvious in both groups. 88.3% and 91.6% of the cone and BFB groups showed an improvement after treatment, respectively. There was no significant difference in the improvement or dissatisfaction scores of the two groups. In conclusion, no significant differences in the therapeutic effects were observed between the FES- Biofeedback and the new vaginal cone groups. Considering improvements in the quality of life and objective symptoms, the therapeutic effects of the two techniques showed no significant differences. The new vaginal cone is relatively easy to use at home and aids in pelvic floor muscle exercises. Consequently, the new vaginal cone could be used as an alternative non-surgical treatment modality in female stress urinary incontinence.
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Adult , Aged , Female , Humans , Middle Aged , Biofeedback, Psychology , Comparative Study , Electric Stimulation Therapy , Exercise Therapy/instrumentation , Pelvic Floor , Prospective Studies , Urinary Incontinence, Stress/therapyABSTRACT
INTRODUCTION: Several different methods of enhancing pelvic floor functions have been developed and modified. The aim of this investigation was to compare the usage of a new vaginal cone (double cone) with conventional FES-Biofeedback therapy for female urinary incontinence cases with respect to the effects on pelvic floor rehabilitation. MATERIALS AND METHODS: It was performed on a multi-center based study. One hundred patients, who desired a non-surgical treatment for their urinary incontinence, were divided into two groups randomly. They were: (1) the FES-Biofeedback group (or BFB group); and (2) the new vaginal cone group (or cone group). For a period of six weeks, two sessions each week were carried out for the BFB group. The new 150-gram dumbbell- shaped vaginal cone, made up of fine ceramics material, was developed domestically. A therapist instructed these patients in the cone group for using the new cone for pelvic floor exercises and directed them to repeat the exercises at home daily, as these patients had follow-up visits every week. RESULTS: Objective improvements were obvious in both of these groups. 88% of the cone group and 92% of the BFB group showed an improvement after treatment. There was no significant difference in the improvement of dissatisfaction scores between the two groups. CONCLUSION: The new vaginal cone is relatively easy to use at home and aids in pelvic floor muscle exercises. Consequently, the new vaginal cone could be another treatment modality in non-surgical approaches to female stress urinary incontinence.
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Female , Humans , Ceramics , Exercise , Follow-Up Studies , Pelvic Floor , Prospective Studies , Rehabilitation , Urinary IncontinenceABSTRACT
This study's purpose was to compare the treatment efficacy and the effects on the patients' quality of life of the pelvic floor muscle (PFM) exercise and the functional electrical stimulation (FES)-biofeedback method. Ninety female incontinence patients were randomly selected and evenly divided into three groups: control, intensive PFM exercise, and FES-biofeedback groups. They were treated for 6 weeks. The subjective changes in the severity of incontinence and discomfort in daily and social life were measured using a translated version of Jackson's Bristol female urinary symptom questionnaire. Objective changes of pelvic muscle contraction force were measured by perineometer. Pre and post-treatment maximal pelvic floor muscle contractile pressure (PMC pressure) among the three groups showed statistically significant differences (p < 0.001). Especially the FES-biofeedback group showed significantly increased maximal PMC pressure compared with other groups (p < 0.001). From the questionnaire, pre and post-treatment changes in the severity of urinary incontinence and discomfort due to incontinence showed significant differences among the three groups (p < 0.001). The level of discomfort in daily life, social activity, physical activity, personal relations and discomfort due to urinary symptoms had largely changed and the FES-biofeedback group, in particular, showed a significant decrease after treatment. In conclusion, when PFM exercise and FES-biofeedback were compared in terms of their effects on the patients' quality of life, FES-biofeedback proved to be more effective than verbal explanation or simple PFM exercise.
Subject(s)
Adult , Aged , Female , Humans , Adolescent , Electric Stimulation , Exercise , Middle Aged , Pelvis/physiology , Prospective Studies , Quality of Life , Urinary Incontinence, Stress/prevention & controlABSTRACT
PURPOSE: The valsalva leak Point pressure(VLPP) has been suggested as an objective tool for diagosing female stress urinary incontinence(SUI) accompained by intrinsic sphictor deficiency(ISD) Our aims were to determine the predictive value of VLPP in patients with ISD and correlation between VLPP and other parameters as a diagnostic tool for ISD. MATERIAL AND METHODS: Sixty-seven patients with stress urinary incontinence were evaluated propectively with symptom grade(Stamey grade). Q-tip test, 1hr pad test, and VLPP. Correlations of VLPP and these clinical parameters were computed. VLPP of 60cm H2O was determined as a cut-off value of ISD and compared with other parameters(symptom grade, hypermobility). RESULTS: Of the total 67 patients, SUI was grade lin 20(29.8%) ll in 32(47.8%) and lllin 15(22.4%). Of the 67 patients, 48 had VLPP of more than 60cmH2O. Among these, SUI was grade l in 20(100%), ll in 26(81.3%) and lllin 2(13.3%). There were significant differences in the incidence between grade llland grade l or ll (P<0.01). Of the 19 patients with VLPP of 60cmH2O or less, SUI grade lllin 77 in 13(86.7%); where SUI was grade lin 0(0%) and ll in 6(18.7%) with statistical significance between grade llland grade l or ll. Urethral hypermobility was noted in 56(83.6%); this was l in 20(100%), ll in 26(81.8%) and lllin 10(67%). Among the SUI patients without hypermobility, none had symptoms of grade l: whereas 33.3% of grade lllpatients didn't show hypermobility. There appeared significant correlation(p<0.001) between the VLPP and symptom grade(correlation coefficient=0.68). Moderate correlations were present between either symptom grade or VLPP and amount of urine leakage(correlation coefficient=0.5). No statistically significant relationship existed between either VLPP or symptom grade and urethral hypermobility. CONCLUSION: subjective degree(such as symptom severity or amount of urine loss) of stress incontinence seems useful in predicting the likelihood of low valsalva leak point pressure which suggests intrinsic sphinctor deficiency. By the result that some women of grade ll incontinence with urethral hypermobility exhibited low VLPP, measurement of VLPP could be a valuable tool in choosing the treatment modality of stress urinary incontinence.