ABSTRACT
La colpocleisis como técnica obliterante se va realizando desde el año 1823 y se ofrece como alternativa para tratamiento quirúrgico de prolapso tipo III y IV a pacientes sin deseo de vida sexual y con riesgos de morbilidad transquirúrgica. No existe mucha evidencia del grado de satisfacción post-quirúrgica de las pacientes Objetivo: determinar el grado de satisfacción de las pacientes sometidas a colpocleisis y los síntomas pélvicos más frecuentemente encontrados a lo largo del primer año post- quirúrgico. Método: studio transversal no experimental. Se aplicó cuestionario validado de satisfacción post-quirúrgica en pacientes sometidas a colpocleisis durante periodos 2013 a 2014, vía telefónica, dentro de su primer año post-quirúrgico. Se tabularon los datos obtenidos. Resultados: El total de pacientes encuestadas se encontraban entre satisfechas y muy satisfechas e indicaban que volverían a someterse a la cirugía. La edad promedio de las pacientes fue de 76 años. El 50% de las pacientes presentaron incontinencia urinaria de urgencia, 15% incontinencia anal, el restante 35% no presentó ninguna sintomatología. Los síntomas pélvicos se presentaron con más frecuencia en las pacientes con prolapsos tipo IV. Conclusiones: el nivel de satisfacción delas pacientes sometidas a colpocleisis es alto, se puede seguir ofreciendo como alternativa quirúrgica en mujeres sin actividad sexual, la sintomatología pélvica más frecuente fue incontinencia urinaria de urgencia e incontinencia anal, en las pacientes con mayor grado de prolapso.
The colpocleisis as obliterans technique is conducted since 1823 and is offered as an alternative to surgical treatment of prolapse type III and IV patients with no sexual desire for life and morbidity risks transsurgical. There is much evidence of the degree of post-surgical patient satisfaction Objective: to determine the degree of satisfaction of patients undergoing colpocleisis and urinary symptoms most frequently encountered throughout the first year post-surgery Methods:cross-sectional study is not experimental. validated questionnaire post-surgical satisfaction in patients undergoing colpocleisis during periods 2013-2014, by telephone, in his first post-surgical year was applied. The data obtained are tabulated Results: total patients were surveyed between satisfied and very satisfied and indicated they would undergo surgery. The average age of patients was 76 years. 50% of patients had urinary urge incontinence, anal incontinence 15%, 35% showed no symptoms. Patients who had type IV prolapses, presented some pelvic symptoms. Conclusion: The level of satisfaction delas patients undergoing colpocleisis is high, you can continue to offer as surgical alternative for women without sexual activity, the most common pelvic symptoms were urinary urge incontinence and anal incontinence in patients with higher degree of prolapse.
Subject(s)
Uterine Prolapse/surgery , Urinary IncontinenceABSTRACT
Objective To study the effect of point electric stimulation for urinary incontinence after postoperative cerebral hemorrhage.Methods Eighty patients with urinary incontinence after postoperative cerebral hemorrhage were randomly divided into treatment group and control group(n=40 case). Point electric stimulation was given to the treatment group, and Oxybutynin hydrochloride sustained release tablets was given orally to the control group. Index of urinary diary and bladder capacity in both groups before treatment and after 3 weeks of treatment were observed.Results After 3 weeks of treatment,the total effective rate(87.2%vs. 65.8%,χ2=4.916) in the treatment group were better than the control group (P<0.05). The times of voided (10.15 ± 2.21 times/24 hvs. 18.63 ± 3.42 times/24 h,t=12.956), the times of urinary incontinence (2.18 ± 1.04 times/24 h vs. 6.19 ± 2.16 times/24 h,t=10.421), the average voided volume (293.38 ± 16.32 mlvs. 180.82 ± 15.43 ml, t=31.083), the initial sensory capacity of bladder (276.73 ± 20.95 mlvs. 186.43 ± 21.14 ml,t=18.825), the maximum capacity of bladder (492.81 ± 23.72 mlvs. 293.81 ± 24.46 ml,t=36.244), the residual urine volume(13.25 ± 5.83 mlvs. 34.63 ± 6.25 ml,t=15.527) in the treatment group were significantly better than those in the control group (P<0.01).Conclusions The treatment of point electric stimulation can reduce the symptoms of urinary incontinence.
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Background@#Urinary incontinence is a common and distressful problem worldwide as well as in Mongolia. According to a survey conducted by Dr.Sanjsuren, 32.2% of participated woman were diagnosed with the urinary incontinence. To diagnose and treat this highly prevalent disease, it is important to know the most common types of incontinence in Mongolian woman and its risk factors. However, there is no known studies in Mongolia ultimately concentrated on the prevalence of common types of incontinence and its causes. Therefore, this study aimed at assessing the common types of incontinence among Mongolian woman and its key risk factors.@*Materials and Methods@#We used a cross sectional data collected from the urogynecological cabinet based on the first maternal hospital in Ulaanbaatar from June to November 2016. 117 woman aged 20-80, who has incontinence symptoms participated in this study. The type of urinary incontinence is checked by urodynamical equipment “Uromic Samba”. Participants also answered a questionnaire with a purpose of assessing the risk factors.@*Results@#Descriptive analysis shown that age, body weight, number of birth and type of delivery may be the key risk factors of incontinence. Foreinstance, the prevalence of incontinence was 6.8 % among woman aged 25-35 and increases with age 26.3 % at age 36-45, 36.4 % with age group 46-55, 30.5% with age 56-80 above respectively. According to the BMI, 81.2% percent of the participating woman with incontinence are obese. As a result of birth survey among total respondents, 59.3% had 3 or more deliveries. Association between incontinence and age, body mass index was found to be the strongest and type of the delivery was the weakest. 40% of total respondents have stress incontinence, 27% have mixed incontinence, 25% have urge incontinence, 8% have other type incontinance symptoms.@*Conclusion@#The most prevalent type of incontinence among Mongolian woman is stress incontinence followed by the urge incontinence. Delivery, body weight was associated with incontinence.
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Abstract The overactive bladder (OAB) has a significant negative impact on the quality of life of patients. Antimuscarinics have become the pharmacological treatment of choice for this condition. The objective of this systematic review and meta-analysis is to examine the evidence from randomized clinical trials about the outcomes of the antimuscarinic drugs available in Brazil on OABs. We searched MEDLINE and the Cochrane Central Register of Controlled Trials from the inception of these databases through to September 2015. The primary outcome measures were the mean decrease in urge urinary incontinence episodes and the mean decrease in the frequency of micturition. The results suggest that there is a moderate to high amount of evidence supporting the benefit of using anticholinergic drugs in alleviating OAB symptoms when compared with placebo. It is still not clear whether any of the specific drugs that are available in Brazil offer advantages over the others. These drugs are associated with adverse effects (dry mouth and constipation), although they are not related to an increase in the number of withdrawals.
Resumo A bexiga hiperativa determina um impacto negativo na qualidade de vida dos nossos pacientes. Os antimuscarínicos tornaram-se o tratamento farmacológico de escolha para essa condição. O objetivo desta revisão sistemática e metanálise é examinar as melhores evidências científicas sobre estas medicações disponíveis no Brasil no tratamento de mulheres com bexiga hiperativa. As bases de dados utilizadas foram MEDLINE e a biblioteca da Cochrane, das quais selecionamos os ensaios clínicos randomizados até setembro de 2015. Os principais desfechos analisados foram a diminuição dos episódios de incontinência urinária de urgência e a diminuição da frequência de micção. Os resultados sugerem que as drogas existentes no Brasil sustentam o benefício dos anticolinérgicos no alívio dos sintomas da bexiga hiperativa quando comparadas como placebo. Emtermos de eficácia, as medicações apresentam resultados semelhantes no controle dos sintomas. Essas drogas estão associadas a efeitos adversos importantes, tais como boca seca e constipação, e esses efeitos adversos não influenciaram no uso da medicação.
Subject(s)
Humans , Muscarinic Antagonists/therapeutic use , Urinary Bladder, Overactive/drug therapy , Randomized Controlled Trials as Topic , Treatment OutcomeABSTRACT
Objective To probe the therapeutic effect of ginger-salt-partitioned moxibustion on urge incontinence after stroke. Methods 40 stroke patients following urge incontinence were randomly divided into control group (n=20) and experimental group (n=20). 2 groups all received the same treatment, routine acupuncture and rehabilitation. Additionally, the experimental group received ginger-salt-partitioned moxibustion at Shenque (CV8). The curative effect was compared after treatment (4 weeks). Results 36 cases finished the treatment, 17 in the control group and 19 in the experimental group. Total number of urination, urinary incontinence and nocturia reduced, and the average volume of each urine increased (P0.05). Conclusion The effect of ginger-salt-partitioned moxibustion at Shenque on poststroke following urination disorders is remarkable.
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@#Objective To probe the therapeutic effect of ginger-salt-partitioned moxibustion on urge incontinence after stroke. Methods 40 stroke patients following urge incontinence were randomly divided into control group (n=20) and experimental group (n=20). 2 groups all received the same treatment, routine acupuncture and rehabilitation. Additionally, the experimental group received ginger-salt-partitioned moxibustion at Shenque (CV8). The curative effect was compared after treatment (4 weeks). Results 36 cases finished the treatment, 17 in the control group and 19 in the experimental group. Total number of urination, urinary incontinence and nocturia reduced, and the average volume of each urine increased (P<0.05), and volume of bladder residual urine reduced in 2 groups after treatment (P<0.001), while the experimental group was better than the control group (P<0.05). The scores of modified Barthel Index increased in 2 groups after treatment, but there was no significant difference between 2 groups (P>0.05). Conclusion The effect of ginger-salt-partitioned moxibustion at Shenque on poststroke following urination disorders is remarkable.
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PURPOSE: Attention deficit hyperactivity disorder (ADHD) has been associated with impairments in frontal inhibitory function and the catecholaminergic system. ADHD is diagnosed in 3-5% of children. Children with ADHD seem develop various forms of urinary problems such as nocturnal enuresis, dysfunctional voiding, and diurnal incontinence. However, no data exist to confirm the presence of these problems in Korean children with ADHD. We investigated the clinical findings of voiding dysfunction in children with ADHD. METHODS: Between October 2009 and March 2011, a total of 63 children (33 with ADHD, 30 with an upper respiratory infection, as a control group) were enrolled. ADHD was diagnosed using the diagnostic and statistical manual of mental disorders (DSM)-IV criteria. A comprehensive survey of voiding and defecation was administered. RESULTS: The patient group included 28 boys and 5 girls; the control group comprised 20 boys and 10 girls. The mean age was 9.09+/-2.8 years in the ADHD group and 8.58+/-3.1 years in the control group. Children with ADHD had a statistically significantly higher incidence of urgency (P=0.017), urge incontinence (P=0.033), and constipation (P=0.045). There was no significant difference in the incidence of straining, intermittency, holding maneuvers, or nocturnal enuresis. CONCLUSION: Children with ADHD in Korea have significantly higher rates of urgency, urge incontinence, and constipation than those without ADHD.
Subject(s)
Child , Female , Humans , Attention Deficit Disorder with Hyperactivity , Constipation , Defecation , Diagnostic and Statistical Manual of Mental Disorders , Incidence , Korea , Nocturnal Enuresis , Prevalence , Urinary Incontinence, UrgeABSTRACT
PURPOSE: The purpose of this study is to compare changes in voiding pattern after midurethral sling surgery (MUS) between the stress urinary incontinence (SUI) group and the overactive bladder (OAB)+SUI group. MATERIALS AND METHODS: From January 2008 to February 2011, a retrospective survey was conducted of 225 female patients who had been diagnosed with SUI and undergone MUS. The subjects were divided into the SUI group and the OAB+SUI group. Changes in the overactive bladder symptom score (OABSS) and American Urological Association-Symptom Index (AUA-SI) before and three months after the MUS were compared. RESULTS: Of the 225 patients, 165 patients (73.3%) were classified as SUI group, and 60 patients (26.7%) were classified as OAB+SUI group. The mean age of the subjects was 54.7 years (range, 31-80 years), and the mean age of patients was 53.9 years (range, 34-80 years), and 56.8 years (range, 31-78 years) in the SUI group and OAB+SUI group. In SUI group, voiding symptom and storage symptom among the AUA-SI were significantly increased (p<0.05). OABSS were slight increased, but was statistically insignificant (p=0.847). In OAB+SUI group, voiding symptom score and OABSS showed a significant increase (p<0.05), but storage symptom score showed an insignificant increase (p=0.790). CONCLUSIONS: OAB may occur in approximately 18% of SUI patients who undergo MUS surgery, and voiding dysfunctions with deteriorated voiding symptom and storage symptom may also occur. The deteriorated OAB was shown in 45% of SUI patients with OAB after the surgery.
Subject(s)
Animals , Female , Humans , Mice , Retrospective Studies , Suburethral Slings , Urinary Bladder, Overactive , Urinary Incontinence , Urinary Incontinence, UrgeABSTRACT
Objective To study the changes of urodynamics of middle-aged(35-55 years old)female patients with urinary incontinence and improve the diagnosis and treatment.Methods Analyze and compare the urodynamics between 56 cases of middle-aged female patients with urinary incontinence and 17 cases of normal control.Results Among the 56 patients,33 cases with stress incontinence(SUI group 58.93％),9 cases with urgency urinary incontinence(UUI group 16.07％),14 cases with mixed urinary incontinence(SUI/UUI group 25.00％).There was significant difference on maximum flow rate(Qmax[27.72 ± 5.21]ml/s vs[20.45 ±7.15]ml/s,P ＜0.05)between the SUI group and control group.The beginning of a sense of capacity(FS),normal urination feeling(ND),strong feeling of urination(SD)and urgent urination feeling(UD)were (135.65 ± 42.73)ml,(166.24 ± 51.42)ml,(315.75 ±42.34)ml,(320.24 ± 45.03)ml and(132.70 ±40.65)ml,(160.70 ± 50.44)ml,(320.75 ± 42.34)ml,(335.75 ± 51.98)ml in the UUI group and control group respectively.And there were significant differences on the four indexes between UUI group and control group(P ＜ 0.05).There was significant difference on ALPP([62.29 ± 25.40]cm H2O vs[88.30 ± 28.54]cm H2O,P ＜0.05)between the SUI group and SUI/UUI group.Pressure at maximum flow rate(Pdet-Qmax,[24.29 ± 6.24]cm H2O vs[34.45 ± 8.20]cm H2 O,maximum urethral pressure(M UP([68.20 ± 18.27]cm H2O vs[87.14 ± 17.26]cm H2O)and maximum urethral closure pressure(MUCP([74.24 ±35.75]cm H2O vs[90.66 ±30.10]cm H2O)in SUI group were significantly lower than those in control group(P ＜0.05)Conclusion There were large groups of middle-aged female urinary incontinence in patients and the classification is more complex.It shows important guiding significance for diagnosis and selecting proper treatments by detecting urodynamic.
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@#Objective To observe the effect of sigmoid colon enterocystoplasty on urge incontinence of neurogenic bladder. Methods 16 patients with urge incontinence without bladder-ureter reflux or hydronephrosis accepted the sigmoid colon enterocystoplasty. They were followed up for 3~24 months. Results No bladder-ureter reflux and hydronephrosis was found. The biochemical parameters were stable. Constipation relieved. All the patients could urinate with abdominal pressure and no urge incontinence happened. The residual urine volume was 10~40 ml. Conclusion Sigmoid colon enterocystoplasty is effective on urge incontinence of neurogenic bladder, as well as on constipation.
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PURPOSE: We wanted to identify factors predicting persistent urge urinary incontinence (UUI) after the transobturator tape (TOT) procedure in patients with mixed urinary incontinence (MUI). MATERIALS AND METHODS: Of 293 patients who underwent a TOT procedure from May 2007 to August 2010, 175 MUI patients had at least one 6-month follow-up visit. Preoperative evaluations including history taking, physical examination, urinalysis, urine culture, uroflowmetry, postvoid residual (PVR), urodynamic studies (UDS), and symptom questionnaire were performed. After the operation, surgical outcome and patient satisfaction were assessed by symptom questionnaire, uroflowmetry, PVR, and stress test. Statistical analysis was carried out to determine the possible factors influencing persistent UUI after the TOT procedure. RESULTS: Of 175 patients with MUI, 51 (29.1%) had persistent UUI after the TOT procedure. In a univariate analysis, age (p=0.012) and previous anticholinergic use (p=0.040) were found to be associated with persistent UUI. However, only age (adjusted odds ratio, 3.317; 95% confidence interval, 1.015-12.060; p=0.036) was an independent risk factor in the multivariate analysis. CONCLUSIONS: Our findings suggested that women who are older than 65 years may have an increased likelihood of persistent UUI after a TOT procedure. Clinicians should consider the possibility of persistent postoperative UUI in elderly women with mixed incontinence.
Subject(s)
Aged , Female , Humans , Exercise Test , Follow-Up Studies , Odds Ratio , Patient Satisfaction , Physical Examination , Risk Factors , Suburethral Slings , Urinalysis , Urinary Incontinence , Urinary Incontinence, Urge , UrodynamicsABSTRACT
Irritative urinary symptoms may suggest the possibility of bladder cancer. We report a case of metastatic bladder cancer that was discovered during a workup for urge incontinence in a 65-year-old woman with a history of stomach cancer. She had a medical history of gastrectomy due to stomach cancer 4 years previously. The patient complained of urgency unresponsive to anticholinergic therapy. Cystoscopy revealed the presence of suspicious bladder mucosal lesions that were biopsied. The pathology was consistent with metastatic signet-ring cell adenocarcinoma. This case suggests that irritative urinary symptoms can be the first clinical manifestation in patients with bladder cancer.
Subject(s)
Aged , Female , Humans , Adenocarcinoma , Cystoscopy , Gastrectomy , Stomach Neoplasms , Urinary Bladder , Urinary Bladder Neoplasms , Urinary Incontinence, UrgeABSTRACT
PURPOSE: This study aimed to determine whether symptoms of urinary urgency increase according to the severity of stress urinary incontinence (SUI). For this purpose, we recruited women with symptoms of mixed as well as pure SUI and compared the clinical characteristics of each subgroup. MATERIALS AND METHODS: A total of 241 female patients who were diagnosed with SUI and mixed urinary incontinence (MUI) were analyzed retrospectively. Patients with only SUI were categorized as group 1. Patients with MUI were categorized as group 2. Clinical and urodynamic differences between the 2 groups were compared. RESULTS: The proportion of Stamey grade was significantly different between the 2 groups: grade 1 SUI was higher in group 1, but grades 2 and 3 SUI were higher in group 2. The incidence of urgency was proportional to the degree of Stamey grade (23.5% in grade 1, 36.9% in grade II, and 60.0% in grade III). In the urodynamic study, the presence of detrusor overactivity was significantly higher in group 2 than in group 1 (25.9% vs. 49.4%). Other clinical parameters were also significantly different between the 2 clinical groups: Q-tip angle (group 1: 42.1degrees, group 2: 28.6degrees, p<0.05), maximal urethral closure pressure (group 1: 54.7 cmH2O, group 2: 44.1 cmH2O, p<0.05), maximal bladder capacity (group 1: 356.3 ml, group 2: 282.0 ml, p<0.05), and bladder volume at first desire (group 1: 144.6 ml, group 2: 123.2 ml, p<0.05). CONCLUSIONS: According to this analysis, the more serious the symptoms of SUI, the higher the incidence of urinary urgency.
Subject(s)
Female , Humans , Incidence , Retrospective Studies , Urinary Bladder , Urinary Incontinence , Urinary Incontinence, Urge , UrodynamicsABSTRACT
OBJECTIVE: Our purpose was to determine if women with mixed urinary incontinence (MUI) and urodynamic detrusor overactivity (DO) have less improvement in urinary symptoms after pubovaginal sling surgery (PVS), compared to MUI without DO. MATERIALS AND METHODS: Women with preoperative MUI symptoms prior to PVS were identified through retrospective review. DO was defined as a symptomatic 5 cm H20 detrusor pressure or greater rise during urodynamics. MUI patients with and without DO before PVS were divided into Groups A and B, respectively. All patients had returned a completed Urogenital Distress Inventory 6 (UDI-6) questionnaire and a 3-day diary of pad usage before surgery and at each postoperative visit. Study endpoints included change in total UDI-6 score, and change in number of pad use/day after PVS. RESULTS: 73 patients were identified, 31 in Group A and 42 in Group B. Mean follow-up after PVS was 15 and 16 months, respectively (p = 0.59). Preoperative total UDI-6 scores were 11.8 and 12.7 (p = 0.30) for Group A and B. Mean changes in total UDI-6 after PVS were - 8.0 and - 10.2 (p = 0.030), respectively. After PVS, both groups reported similar mean reduction in pad/day usage from preoperative baseline (-2.57 vs. --2.49, p = 0.83). There were no differences between the groups when comparing demographic, urodynamic, or operative data. CONCLUSION: MUI patients had improved continence and quality of life after PVS. However, MUI patients with DO had less improvement in UDI-6 scores after PVS, despite a similar reduction to pad use/day.
Subject(s)
Female , Humans , Middle Aged , Quality of Life , Suburethral Slings , Urinary Bladder, Overactive/surgery , Urinary Incontinence/surgery , Retrospective Studies , Treatment Outcome , Urinary Bladder, Overactive/complications , Urinary Incontinence/complicationsABSTRACT
@#Objective To observe the effect of magnetic stimulation of sacral roots on detrusor overactivity and urge incontinence after spinal cord disease.Methods 15 cases with detrusor overactivity and urge incontinence after spinal cord disease were treated with magnetic stimulation of sacral roots for 10 d.Voiding diary,quality of life scale and urodynamic investigation were applied to evaluate the effect.Results The mean frequency of voiding in 24 h after treatment decreased,urine volume increased,frequency of incontinence decreased and the quality of life score improved.Urge incontinence improved in 85.7% cases.The results of urodynamic investigation showed bladder capacity at first desire to void and maximum cystometric capacity significantly increased after stimulation,while the detrusor pressure at storage decreased.Conclusion Magnetic stimulation of sacral roots can improve urinary frequency and urge incontinence of patients with detrusor overactivity after spinal cord disease by inhibiting detrusor overactivity,increasing cystometric capacity.Magnetic stimulation of sacral roots may be an alternative promising rehabilitation technique.
ABSTRACT
PURPOSE: A lot of patients with stress urinary incontinence(SUI) have lower urinary tract symptoms. So we evaluated the changes of voiding pattern following transobturator tape(TOT) operation, and investigated the factors for predicting persistent urinary frequency after operation. MATERIALS AND METHODS: The items of preoperative evaluations consisted of history taking, physical examination, cystometrography, 3 day frequency-volume chart and symptoms questionnaire. Patients with anticholinergics or any neurologic diseases that affect the voiding pattern were excluded. Between January to November 2006, 46 patients with TOT operation were enrolled, and were reevaluated with physical examination, 3 day frequency-volume chart and symptom questionnaires, postoperatively. RESULTS: The patients who voided 8 or more times per day had shorter symptom duration and higher body mass index(BMI) than those who voided under 8 times per day(each p<0.05). In 30 patients who void 8 or moretimes per day preoperatively, 17(56.7%) patients became void under 8 times, postoperatively. In each patient who had urgency or urge incontinence symptoms preoperatively, respective 72.7 and 82.8% resolved their symptoms, postoperatively. No one complained de novo urgency or urge incontinence, postoperatively. In a multivariate analysis, the patient with a history of previous pelvic surgery or moderate to severe urge incontinence was tightly associated with an increased likelihood of persistent urinary frequency after TOT operation (odd ratio[OR] 24.8, 95% confidence interval[CI] 2.044-301.284, p=0.012 and OR 31.9, 95% CI 1.662- 613.619, p=0.022, respectively). CONCLUSIONS: The TOT operation can improve the symptoms of urinary frequency, urgency and urge incontinence in patients with SUI. However, the patients who had previous pelvic surgeriesor moderate to severe urge incontinence should be fully advised for the risk of sustaining frequency, postoperatively
Subject(s)
Female , Humans , Cholinergic Antagonists , Lower Urinary Tract Symptoms , Multivariate Analysis , Physical Examination , Suburethral Slings , Urinary Incontinence , Urinary Incontinence, Stress , Urinary Incontinence, UrgeABSTRACT
PURPOSE: We evaluated the changes of storage symptoms after tension-free vaginal tape(TVT) procedures in stress urinary incontinence(SUI) patients, and we investigated the factors predicting the changes of storage symptoms. MATERIALS AND METHODS: From January 2000 to August 2003, 713 patients with SUI were operated on with using suburethral sling procedures(TVT). A follow-up study was conducted for over a one year period with 495 patients. We analyzed the one year outcomes of TVT surgeries and the changes of storage symptoms after TVT. RESULTS: The rates of cure and improvements at one year after TVT were 80.8% and 12.3%, respectively. At one month after TVT, 59 of 180(33%) patients with urgency before TVT were improved, and 60 of 72(83.6%) patients with urgency incontinence before TVT were improved. In 86 of 180(47.8%) patients, the urgency is improved, and in 65 of 72(90.1%) patients, the urgency incontinence disappeared at one year after TVT procedure. Urgency developed in 65 of the 243(26.9%) patients who had no urgency before TVT, but after 1 year, only 28(10.2%, 25/243) these 243 patients had urgency. 102(31.6%) of the patients with frequency before TVT were improved after TVT. Of the 92 patients with nocturia, 22 (23.4%) patients were improved. There were no statically significant factors predicting the changes of the storage symptoms. CONCLUSIONS: The total improvement rate (cure+improvements) of stress urinary incontinence was 93.1% at one year. We can expect the improvement of urgency(47.1%) and urgency incontinence(90.1%) after TVT procedures, but not improvement of the frequency and nocturia.
Subject(s)
Humans , Follow-Up Studies , Nocturia , Suburethral Slings , Urinary Bladder, Overactive , Urinary Incontinence , Urinary Incontinence, UrgeABSTRACT
PURPOSE: The presence of urge incontinence may affect the results of stress urinary incontinence (SUI) treatment. In this study, women with SUI were divided according to their accompaniment with urge incontinence or not. The aim was to define a group in whom a urodynamic assessment was unnecessary prior to offering surgery. In other words, we wished to define a group where the treatment plan could be determined only with the clinical opinions based on the symptoms and physical examinations. MATERIALS AND METHODS: Two hundred and fifty five women with SUI between January 1997 and February 2001 were enrolled in this study. The women with SUI symptoms were divided into a group of patients who had symptoms of pure SUI, and those who had SUI as well as urge incontinence. The clinical and urodynamic variables were analyzed to identify the sub-groups of women where a urodynamic study was unnecessary before initiating treatment for SUI. RESULTS: Of the 101 women with symptoms of pure SUI, only 5 had a detrusor instability (DI). Of the 154 women with coexisting urge incontinence symptoms, only 33.8% (52/154) had DI, suggesting the poor predictability of urge incontinence symptoms for a diagnosis of DI based on the urodynamic study. An identification of SUI by the urodynamics were noted in 77.6% (198/255), which almost corresponding to the rate (76.9%) of positive urine leakage confirmed at the provocative stress test. CONCLUSIONS: If a patient has symptoms of pure SUI associated with a positive stress test, the SUI can be treated without a urodynamic study. For women with symptoms of mixed urinary incontinence, it may be better to undergo a urodynamic study before launching a definitive treatment.
Subject(s)
Female , Humans , Diagnosis , Exercise Test , Physical Examination , Urinary Incontinence , Urinary Incontinence, Urge , UrodynamicsABSTRACT
PURPOSE: The presence of urge incontinence may affect the results of stress urinary incontinence (SUI) treatment. In this study, women with SUI were divided according to their accompaniment with urge incontinence or not. The aim was to define a group in whom a urodynamic assessment was unnecessary prior to offering surgery. In other words, we wished to define a group where the treatment plan could be determined only with the clinical opinions based on the symptoms and physical examinations. MATERIALS AND METHODS: Two hundred and fifty five women with SUI between January 1997 and February 2001 were enrolled in this study. The women with SUI symptoms were divided into a group of patients who had symptoms of pure SUI, and those who had SUI as well as urge incontinence. The clinical and urodynamic variables were analyzed to identify the sub-groups of women where a urodynamic study was unnecessary before initiating treatment for SUI. RESULTS: Of the 101 women with symptoms of pure SUI, only 5 had a detrusor instability (DI). Of the 154 women with coexisting urge incontinence symptoms, only 33.8% (52/154) had DI, suggesting the poor predictability of urge incontinence symptoms for a diagnosis of DI based on the urodynamic study. An identification of SUI by the urodynamics were noted in 77.6% (198/255), which almost corresponding to the rate (76.9%) of positive urine leakage confirmed at the provocative stress test. CONCLUSIONS: If a patient has symptoms of pure SUI associated with a positive stress test, the SUI can be treated without a urodynamic study. For women with symptoms of mixed urinary incontinence, it may be better to undergo a urodynamic study before launching a definitive treatment.
Subject(s)
Female , Humans , Diagnosis , Exercise Test , Physical Examination , Urinary Incontinence , Urinary Incontinence, Urge , UrodynamicsABSTRACT
PURPOSE: Sling operation is applied to all types of the stress urinary incontinence (SUI) nowadays. We evaluated and compared the operation success rate and patient satisfaction between simple and complex types of SUI for patients who had undergone the modified fascial sling. MATERIALS AND METHODS: We reviewed 147 patients who were treated with the modified fascial sling for SUI. Patients were categorized into simple and complex types according to the classification of Chaikin et al. Surgical outcome and patient satisfaction were assessed by questionnaire. RESULTS: Of the 147 patients, 62 were simple type (42%) and 85 complex type (57%). In complex type, there were 76 cases of urge incontinence (89%), and 16 of grade 3 or 4 cystocele (19%). Mean duration of follow-up was 39.5 months (range 12-64). For operation outcome results, in simple type there were 56 cases of cure (90%) and 4 of improvement (6%), and in complex type there were 76 cases of cure (90%) and 6 of improvement (7%). The operation satisfaction rate of patients was 94% in simple type and 86% in complex type. Persistent urge incontinence was seen in 15 cases (20%) of 76 patients with preoperative urge incontinence. Complications were de novo urge incontinence in 5 cases (3%) and urinary retention in 7 cases (5%) of the sling operation. CONCLUSIONS: This study shows that the success rate of modified fascial sling in both simple and complex types of SUI was represented by the high result of 97%. However, the satisfaction rate for the surgery was somewhat different between the 2 types (94% vs. 86%). The main reason for the dissatisfaction was persistent urge incontinence.