Standing cough test stratification of moderate male stress urinary incontinence

ABSTRACT Purpose: Patient-reported history of pads per day (PPD) is widely recognized as a fundamental element of decision-making for anti-incontinence procedures. We hypothesize that SUI severity is often underestimated among men with moderate SUI. We sought to compare patient history of incontinence severity versus objective in-office physical examination findings. Materials and Methods: We retrospectively reviewed our single-surgeon male SUI surgical database from 2007-2019. We excluded patients with incomplete preoperative or postoperative data and those who reported either mild or severe SUI, thus having more straightforward surgical counseling. For men reported to have moderate SUI, we determined the frequency of upgrading SUI severity by recording the results of an in-office standing cough test (SCT) using the Male Stress Incontinence Grading Scale (MSIGS). The correlation of MSIGS with sling success rate was calculated. Failure was defined as >1 PPD usage or need for additional incontinence procedure. Results: Among 233 patients with reported moderate SUI (2-3 PPD), 89 (38%) had MSIGS 3-4 on SCT, indicating severe SUI. Among patients with 2-3 PPD preoperatively, sling success rates were significantly higher for patients with MSIGS 0-2 (76/116, 64%) compared to MSIGS 3-4 (6/18, 33%) (p <0.01). Conclusions: Many men with self-reported history of moderate SUI actually present severe SUI observed on SCT. The SCT is a useful tool to stratify moderate SUI patients to more accurately predict sling success.

Uso de estudio urodinámico simple, para diagnóstico de incontinencia urinaria de esfuerzo / Use of a simple urodynamic study to diagnose of stress urinary incontinence

INTRODUCCIÓN: La incontinencia urinaria es un problema muy frecuente. El diagnóstico diferencial incluye varias condiciones. La Incontinencia Urinaria de Esfuerzos es la más común y su tratamiento es fundamentalmente quirúrgico. Debido a que el diagnóstico de Incontinencia Urinaria de Esfuerzo no es confiable cuando se basa en la historia y las complicaciones asociadas a la cirugía son potencialmente complejas de manejar, se vuelve imperativo objetivar el diagnóstico. MÉTODO: Se presenta un descripción retrospectiva de los resultados obtenidos de la examinación de pacientes con incontinencia urinaria mediante evaluación urodinámica simple y estandarizada. RESULTADOS: Se evaluó a 303 pacientes, de las cuales el 75,3% finalmente fue sometida a cirugía antiincontinencia. En el resto de las pacientes se encontró desde evaluación normal a variadas disfunciones miccionales. CONCLUSIONES: Es importante la implementación de herramientas de evaluación objetivas y estandarizadas como medida de seguridad y de gestión de listas de espera. Nuestros resultados son similares a los reportados en la literatura.

INTRODUCTION: Urinary incontinence is a very frequent problem. The differential diagnosis includes some conditions. Stress urinary incontinence is the most common condition and its treatment is primarily surgical. Because the diagnosis of stress urinary incontinence is not reliable when it is based on the history and the complications associated with surgery are potentially complex to manage, it becomes imperative to objectively demonstrate the diagnosis. METHODS: We present a retrospective description of the results obtained from the examination of patients with urinary incontinence through simple and standardized urodynamic evaluation. RESULTS: A total of 303 patients were evaluated, of whom 75,25% were finally submitted to anti-incontinence surgery. In the rest of the patients it was found from normal evaluation to varied voiding dysfunctions. CONCLUSIONS: It is important to implement objective and standardized evaluation tools as a safety measure and management of the waiting lists. Our results are similar to those reported by literature.

Incontinencia urinaria de esfuerzo por osteocondroma familiar múltiple tardío / Urinary incontinence due to late multiple family osteochondroma

La osteocondroma múltiple familiar hereditaria es una enfermedad benigna, que por su posibilidad de malignización y el avance de sus deformaciones requiere controles periódicos. El objetivo del trabajo fue presentar un caso con diagnóstico de un tumor después de un largo periodo de tiempo de extirpación de su última lesión. Se presenta una paciente, de 62 años de edad, con antecedentes de osteocondroma múltiple familiar hereditaria desde los 8 años de edad. Es operada en varias ocasiones durante la infancia. Acude ahora por presentar incontinencia urinaria y aumento de volumen región vaginal, que aumentó en los últimos 8 meses. Antecedentes de la enfermedad en el padre, el hijo y la nieta. Se observan cicatrices en miembros y deformidades. Al tacto vaginal y rectal se encontró un tumor pétreo que ocupa la pared anterior y lateral derecha de la vagina. En estudios radiográficos y tomografía axial computarizada de abdomen se observa tumor en rama isquiopubiana derecha. La paciente fue operada y realizó la resección del tumor. La evolución fue satisfactoria. Anatomía Patológica informó tumor de 6 x 5 cm con actividad elevada de los condrotocitos. En la paciente destaca la aparición de un tumor de la misma enfermedad en la rama isquiopubiana, localización de baja frecuencia, el cual apareció 50 años después del último extirpado. La laparotomía extraperitoneal fue excelente para lograr la exéresis del tumor(AU)

Hereditary family multiple osteochondroma is a benign disease that requires systematic control on account of its possible malignization and advance of deformations. The objective of this paper was to present a patient diagnosed with a tumor after a long period of time elapsed from the excision of her last lesion. Here is a female patient aged 62 years, with history of hereditary family multiple osteochondroma since she was 8 years-old. She had been operated on several times in her childhood. She went to the hospital because she suffered urinary incontinence and volume increase in the vaginal region for the last 8 months. Her father, son and niece had the same problem. Scars and deformities were observed in limbs. On the vaginal and rectal exam, a stony tumor was found, which occupied the right anterior and lateral wall of the vagina. The radiographic studies and the abdominal CT showed a tumor in the right ischiopubic ramus. The patient was operated on to remove the tumor and her progress was satisfactory. The pathological anatomy report confirmed a 6 x 5 cm tumor with high activity of chondrocytes. In this patient, a tumor of the same disease located in the ischiopubic ramus occurred 50 years after the last excision of another tumor. The extroperitoneal laparatomy was an excellent method to achieve tumor excision(AU)

Assessing variability of the 24-hour pad weight test in men with post-prostatectomy incontinence

ABSTRACT Purpose: Decision-making regarding surgery for post-prostatectomy incontinence (PPI) is challenging. The 24-hour pad weight test is commonly used to objectively quantify PPI. However, pad weight may vary based upon activity level. We aimed to quantify variability in pad weights based upon patient-reported activity. Materials and Methods: 25 patients who underwent radical prostatectomy were prospectively enrolled. All patients demonstrated clinical stress urinary incontinence without clinical urgency urinary incontinence. On three consecutive alternating days, patients submitted 24-hour pad weights along with a short survey documenting activity level and number of pads used. Results: Pad weights collected across the three days were well correlated to the individual (ICC 0.85 (95% CI 0.74–0.93), p<0.001). The mean difference between the minimum pad weight leakage and maximum leakage per patient was 133.4g (95% CI 80.4–186.5). The mean increase in 24-hour leakage for a one-point increase in self-reported activity level was 118.0g (95% CI 74.3–161.7, p<0.001). Pad weights also varied significantly when self-reported activity levels did not differ (mean difference 51.2g (95% CI 30.3–72.1), p<0.001). Conclusions: 24-hour pad weight leakage may vary significantly on different days of collection. This variation is more pronounced with changes in activity level. Taking into account patient activity level may enhance the predictive value of pad weight testing.

Does Preoperative Urodynamic Testing Improve Surgical Outcomes in Patients Undergoing the Transobturator Tape Procedure for Stress Urinary Incontinence? A Prospective Randomized Trial

PURPOSE: Urodynamic studies are commonly performed as part of the preoperative work-up of patients undergoing surgery for stress urinary incontinence (SUI). We aimed to assess the extent to which these urodynamic parameters influence patient selection and postoperative outcomes. MATERIALS AND METHODS: Patients presenting with SUI were randomly assigned to two groups: one undergoing office evaluation only and the other with a preoperative urodynamic work-up. Patients with unfavorable urodynamic parameters (detrusor overactivity [DO] and/or Valsalva leak point pressure [VLPP]<60 cm H2O and/or maximum urethral closure pressure [MUCP]<20 cm H2O) were excluded from the urodynamic testing group. All patients in both groups underwent the transobturator midurethral sling procedure. Evaluation for treatment success (reductions in urogenital distress inventory and incontinence impact questionnaire scoring along with absent positive stress test) was done at 6 months and 1 year postoperatively. RESULTS: A total of 72 patients were evaluated. After 12 patients with any one or more of the abnormal urodynamic parameters were excluded, 30 patients were finally recruited in each of the "urodynamic testing" and "office evaluation only" groups. At both the 6- and the 12-month follow-ups, treatment outcomes (reduction in scores and positive provocative stress test) were significantly better in the urodynamic testing group than in the office evaluation only group (p-values significant for all outcomes). CONCLUSIONS: Our findings showed statistically significantly better treatment outcomes in the urodynamic group (after excluding those with poor prognostic indicators such as DO, low VLPP, and MUCP) than in the office evaluation only group. We recommend exploiting the prognostic value of these urodynamic parameters for patient counseling and treatment decisions.

Valor do estudo urodinâmico no tratamento da incontinência urinária / Value of urodynamic study in the treatment of urinary incontinence

Estudo urodinâmico (EUD) designa um conjunto de exames com metodologia apropriada para avaliação da função e disfunção do trato urinário. O objetivo do EUD é reproduzir os sintomas urinários da paciente realizando o diagnóstico com dados objetivos. A expectativa do médico é que o exame seja capaz de detectar as anormalidades e fazer a distinção entre os vários mecanismos fisiopatológicos que causam a incontinência urinária (IU). O estudo urodinâmico é um exame invasivo devido à cateterização vesical e à introdução do balão retal, desconfortável e constrangedor. É exame que não é isento de efeitos colaterais, como infecção urinária. Entretanto, é necessário avaliar os riscos e benefícios antes de indicar o exame. O EUD é considerado o padrão-ouro na abordagem da IU de esforço. Entretanto, há controvérsias sobre as reais vantagens que o EUD oferece para o tratamento da IU. Este artigo de revisão da literatura visa avaliar as evidências que suportem a utilização do EUD na propedêutica da IU

Urodynamic study (UDS) designates a set of tests with appropriate methodology for evaluating the urinary tract function and dysfunction. The aim of UDS is to reproduce the patient's urinary symptoms making the diagnosis with objective data. The expectation is that the examination is able to detect abnormalities and to distinguish between the various pathophysiological mechanisms that cause urinary incontinence (UI). The UDS is an invasive test due to rectal and bladder catheterization, uncomfortable and embarrassing. It is not without side effects like infections. Therefore, it is necessary to weigh risks and benefits in the indication of examination. The UDS is considered the gold standard approach of UI. However, there is controversy about the real advantages that the UDS provides for the treatment of UI. This literature review aims to evaluate the evidence supporting the use of UDS in the treatment of UI

Cincha transobturatriz con anestesia local para incontinencia urinaria de esfuerzo / Tansobturator tape under local anesthesia for urinary stress incontinence

Evaluar la técnica de cura de incontinencia urinaria de esfuerzo con cincha transobturatriz bajo anestesia local. Estudio descriptivo y prospectivo en 22 pacientes con incontinencia urinaria de esfuerzo de la consulta de piso pélvico del Hospital Universitario de Caracas entre abril y noviembre de 2010, a las que se les colocó cincha transobturatriz con anestesia local y sedación consciente complementaria en la mayoría de los casos. El tiempo quirúrgico promedio fue 9,57 min. Dos pacientes toleraron el procedimiento quirúrgico con anestesia local exclusiva, mientras que las otras 20 (90,9 por ciento) requirieron sedación endovenosa, similar a lo descrito en la literatura. El dolor intraoperatorio en promedio fue de 3,18 puntos en la escala visual análoga. El 100 por ciento de las pacientes estuvo satisfecha con el procedimiento anestésico y el 95,5 por ciento lo recomienda. La anestesia local con sedación consciente constituye una técnica tolerable, segura, y rápida para la cura de incontinencia urinaria de esfuerzo con cincha transobturatriz

To evaluate the transobturator tape procedure for urinary stress incontinence under local anesthesia. Prospective and descriptive study of 22 patients with urinary stress incontinence from the Pelvic Floor Unit of Universitary Hospital of Caracas, between April and November 2010, in whom the transobturator tape procedure was performed under local anesthesia and sedation. Mean surgical time was 9.57 min. Two patients tolerated the surgical procedure with local anesthesia without sedation, while the other 20 (90.9 percent) required intravenous sedation, as described in most publications. Mean intraoperative pain was 3.18 points in the Visual Analogue Scale. One hundred percent of the patients were satisfied with the anesthetic technique, and 95.5 percent would recommend it. Local anesthesia with sedation is a well-tolerated, safe, and fast technique for the surgical treatment of urinary stress incontinence with transobturator tape

Incontinência urinária oculta: diagnóstico e tratamento / Occult urinary incontinence: diagnosis and treatment

A incontinência urinária oculta (IUO) pode ocorrer em casos avançados de prolapso dos órgãos pélvicos (POP), quando este acarreta compressão externa ou acotovelamento da uretra e, dessa forma, encobre a incontinência urinária de esforço (IUE). Contudo, uma vez corrigido o prolapso, a paciente pode tornar-se incontinente. O diagnóstico de IUO pode ser feito com a redução do POP utilizando pessário, tampão vaginal, espéculo de Sims, pinças diversas com gazes e/ou redução digital durante o estudo urodinâmico. A identificação pré-operatória dessas pacientes pode possibilitar o tratamento concomitante da afecção, evitando um segundo procedimento cirúrgico. Alguns autores recomendam a cirurgia para correção de IUE em pacientes com prolapso estágios III e IV, enquanto outros preconizam avaliar a perda urinária após o tratamento do POP. Todavia, não está bem determinado qual o melhor método para diagnosticar a IUO e se os riscos superam o potencial benefício da cirurgia profilática para IUE nestes casos. Assim, nosso objetivo foi discutir os aspectos controversos relacionados ao diagnóstico e tratamento da IUO.

Occult urinary incontinence (OUI) can occur in advanced cases of pelvic organ prolapse (POP) when it causes external urethral compression or urethral kinking and, therefore, it hides the stress urinary incontinence (SUI). When the POP is surgically corrected, the patient may become incontinent. The diagnosis of OUI is made by the reduction of the POP using pessary, vaginal pack, Sims? speculum, several tweezers with gauze and/or digital reduction during urodynamic investigation. Preoperative identification of these patients allows the treatment of this pathology at the same moment of POP treatment avoiding a second surgery. Some authors recomend a prophylatic anti-incontinence surgery in patients with SUI stage III or IV and others prefer to evaluate urinary incontinence after POP repair. However, it is not determined which is the best method to diagnose OUI, as well as if the risks overtake the potencial benefits of SUI procedure in these cases. The objective of this article was to discuss the controversial aspects of diagnosis and the treatment of OUI.

[ relationship between stress, urge, and mixed urinary incontinence in females and urodynamic findings]

To investigate the relationship between clinical symptoms, severity of incontinence, and urodynamic findings in females suffering from mixed, urge and stress incontinence. One hundred and seventy three patients suffering from either urgency, urge incontinence, mixed or stress incontinence of those who were submitted to the urodynamic units in Aleppo University Hospitals between 1 January 2008 and 30 September 2009 were included in the study. Cystometric bladder capacity at maximal and first desire to void and bladder compliance, presence of overactivity or hypersensitivity, stress test according to the criteria of the International Continence Society were evaluated. The urodynamic study had a low sensitivity [54.5%,] and a high specificity [97.7%] in detecting genuine stress incontinence in women suffering from pure stress or mixed incontinence, and this sensitivity rose up to [87.5%] in women suffering from pure stress or stress-predominant mixed urinary incontinence. According to the parameters used in the study to put a diagnosis of urge incontinence on urodynamic study, the urodynamic study had a sensitivity of [87.7%] and a specificity of [90%] in detecting urge incontinence in women suffering from urinary pure urge or mixed incontinence. Some factors were statistically more common in the group of patients who had severe incontinence, and those factors were; old age, menopause, presence of urge incontinence in clinical history, presence of urge incontinence on urodynamic study, and presence of terminal overactivity on urodynamics. Subjective symptoms of urge and stress incontinence had good correlation with urodynamic findings in pure cases, and fair correlation in mixed cases. Severe incontinence correlated with a clinical history of urge and mixed incontinence

Human Umbilical Cord Blood Mononuclear Cell Transplantation in Rats with Intrinsic Sphincter Deficiency

To evaluate the effectiveness of the human umbilical cord blood (HUCB) transplantation for the treatment of intrinsic sphincter deficiency (ISD), we analyzed the short term effects of HUCB mononuclear cell transplantation in rats with induced-ISD. ISD was induced in rats by electro-cauterization of periurethral soft tissue with HUCB mononuclear cell injection after 1 week. The sphincter function measured by mean leak point pressure was significantly improved in the experimental group compared to the control group at 4 weeks. (91.75+/-18.99 mmHg vs. 65.02+/-22.09 mmHg, P=0.001). Histologically, the sphincter muscle was restored without damage while in the control group it appeared markedly disrupted with atrophic muscle layers and collagen deposit. We identified injected HUCB cells in the tissue sections by Di-I signal and Prussian blue staining. HUCB mononuclear cell injection significantly improved urethral sphincter function, suggesting its potential efficacy in the treatment of ISD.

Ultrassonografia uretrovesical como método eficaz de avaliação dos parâmetros prognósticos de tratamento cirúrgico da incontinência urinária de esforço / Urethrovesical ultrasonography as an effective method for evaluating prognostic parameters in the surgical management of stress urinary incontinence

OBJETIVO: Comparar parâmetros ultrassonográficos relacionados à junção uretrovesical e uretra proximal em pacientes curadas e não curadas, tratadas cirurgicamente pela técnica de Burch, com a finalidade de estabelecer se há correspondência com fatores prognósticos. MATERIAIS E MÉTODOS: Trinta pacientes foram selecionadas e divididas em dois grupos: 15 consideradas clinicamente curadas e 15 consideradas não curadas. As pacientes foram submetidas a ultrassonografia transvulvar no pré-operatório e aos 30 e 180 dias do pós-operatório. RESULTADOS: No pré-operatório, o deslocamento da uretra proximal foi maior nas pacientes curadas (15,87 ± 4,55 mm × 12,47 ± 3,52 mm - p < 0,05). No pós-operatório, no esforço, a distância vertical da junção uretrovesical e a uretra proximal foram maiores nas pacientes curadas (12,87 ± 5,80 mm × 5,13 ± 6,55 mm - p < 0,01; e 13,07 ± 6,44 mm × 6,20 ± 6,14 mm - p < 0,01), e o deslocamento vertical da junção uretrovesical e da uretra proximal foi maior nas pacientes não curadas (8,47 ± 3,98 mm × 5,13 ± 2,36 mm - p < 0,001; e 8,33 ± 4,54 mm × 5,20 ± 2,90 mm - p < 0,05). CONCLUSÃO: A ultrassonografia da junção uretrovesical e da uretra proximal pode ser considerada como um método eficaz de avaliação dos parâmetros prognósticos do tratamento cirúrgico de mulheres com incontinência urinária de esforço.

OBJECTIVE: To compare sonographic parameters related to the urethrovesical junction and proximal urethra in cured and not cured patients surgically treated with the Burch technique, for establishing a possible correlation with prognostic factors. MATERIALS AND METHODS: Thirty female patients were selected and divided into two groups: 15 patients considered as clinically cured and 15 not cured. The patients were submitted to preoperative transvulvar ultrasonography, with the examination being repeated at the 30th and 180th postoperative days. RESULTS: At the preoperative examination, the proximal urethra displacement was largest in the cured patients (15.87 ± 4.55 mm × 12.47 ± 3.52 mm - p < 0.05). At the postoperative examination, with strain, the vertical distance of the urethrovesical junction and the proximal urethra were largest in the cured patients (12.87 ± 5.80 mm × 5.13 ± 6.55 mm - p < 0.01; and 13.07 ± 6.44 mm × 6.20 ± 6.14 mm - p < 0.01), and the vertical displacement of the urethrovesical junction and proximal urethra was largest in the not cured patients (8.47 ± 3.98 mm × 5.13 ± 2.36 mm - p < 0.001; and 8.33 ± 4.54 mm × 5.20 ± 2.90 mm - p < 0.05). CONCLUSION: Ultrasonography of the urethrovesical junction and proximal urethra can be considered as an effective method for evaluating prognostic parameters in the surgical management of women with stress urinary incontinence.

Role of urodynamic studies in evaluation of lower urinary tract symptoms

To emphasize the role of urodynamic studies in the evaluation of lower urinary tract symptoms and to describe the technique and report results of tracings from a urodynamic center in a tertiary care settings. Descriptive Study. This study was carried out at Armed Forces Institute of Urology, Rawalpindi, over thirty months from January 2003 to June 2005. sixty seven patients referred to the urodynamic centre of AFIU, Rawalpindi with complaints of urinary incontinence or voiding disorders were evaluated with conventional urodynamic tests. During cystometry, the detrusor activity, bladder sensation, bladder capacity and bladder compliance were measured with simultaneous urinary flow measurement in those who were able to void. Results were grouped into eight different types of urodynamic diagnoses. There were 51 females [76%] and 16 males [24%] patients. Majority of patients [48%] were in age group of 20-50 years. Ages ranged from 5-84 with a mean of 41.3 +/- 17.3 years. Majority of the patients found to have neuropathic bladder [25.3%] followed by patients with pure stress incontinence [23.9%]. In 38 female patients who presented with urinary incontinence, majority of them i.e. 16 [42.1%] were found to have pure stress incontinence on urodynamic evaluation while 11 [28.9%] patients had normal cystometric findings and 5 patients [13.1%] had hypersensitive cystometrogram signifying sensory urge incontinence while motor urge incontinence implying detrusor instability occurred in 1 patient [2.7%]. Urodynamic studies are useful in evaluation of lower urinary tract symptoms not responding to conventional medical treatment as they help clinician in identifying the underlying causes for the symptoms, and to quantify the related pathophysiological processes. Treatment of the underlying pathophysiology facilitates better treatment of symptoms

Parâmetros da urofluxometria e do estudo fluxo/pressão em pacientes uroginecológicas / Uroflowmetry and flow pressure study parameters in urogynecology patients

OBJETIVO: Avaliar as taxas de fluxo no estudo urodinâmico (EUD) em pacientes com disfunção do trato urinário inferior e registrar os efeitos do diagnóstico final do EUD e da idade das pacientes sobre estas variáveis. MÉTODOS: Estudo retrospectivo que incluiu 205 mulheres. As pacientes foram divididas em três grupos: menos de 45 anos; entre 45 e 60 anos e mais que 60 anos. Estudamos os comportamentos dos fluxos máximo, médio e da pressão de abertura do detrusor (Padet) com o evoluir da idade. De forma semelhante, realizamos comparações das variáveis fluxos máximo e médio, Padet e vesical no fluxo máximo, consoante o diagnóstico final do EUD. RESULTADOS: Há forte declínio dos fluxos máximo, médio e da Padet com o evoluir da idade, sendo que a queda dos fluxos máximo e médio é significante quando comparamos as mulheres com mais de 65 anos (21,8 ml/s e 9,2 ml/s, respectivamente) com aquelas entre 45 e 60 anos (29 ml/s e 12,6 ml/s, respectivamente) e as demais (27,9 ml/s e 11,7 ml/s, respectivamente). Observamos redução significativa da Padet no grupo com mais de 60 anos (13,4 cmH2O) quando comparadas àquele com menos de 45 anos (21,2 cmH2O). A Padet teve redução significativa nas pacientes com incontinência urinária de esforço (IUE) associada a defeito esfincteriano (13,8 cmH2O) diagnosticados no EUD quando comparadas aquelas assintomáticas (20,7 cmH2O). CONCLUSÃO: Há diminuição das taxas de fluxo com o aumento da idade. Mulheres com IUE têm micção com menor Padet.

OBJECTIVE: The purpose was to evaluate urine flow rates in an urodynamic study (US) of patients with symptoms of lower urinary tract dysfunction and to record effects of final urodynamic diagnosis and age on these variables. METHODS: Retrospective analysis of 205 women who had undergone urogynecological investigation. Patients were divided into three age groups: A (< 45 years); B (45 - 60 years) and C (> 60 years). Comportment of urine flow rates and opening detrusor pressure with increasing age were studied and resulting charts recorded. Comparison of maximum and average urine flow rates, opening detrusor pressure and detrusor pressure at the maximal flow according to final urodynamic diagnostic were also made. RESULTS: There was a decline of urine flow rates with increase of age, which was more significant between groups A X C and B X C. There was also a decline in opening detrusor pressure with aging, which was significant between groups A X C. When analyzing opening detrusor pressure according to final urodynamic diagnosis, a significant decline of this variable was observed in patients with urinary stress incontinence and intrinsic sphincter deficiency in relation to those who were asymptomatic. CONCLUSION: Urine flow rates decreased with age. Women with urinary stress incontinence and intrinsic sphincter deficiency void at a lower detrusor pressure.

Nuevo sistema de medición urodinámica en la evaluación de la incontinencia urinaria femenina: experiencia preliminar con urodinamia monocanal con medición de presión de retro-resistencia uretral / New urodynamic testing for female urinary incontinence

Objetivos: Correlacionar el diagnóstico clínico de la incontinencia urinaria con los resultados de la cistometría, obtenidas por urodinamia monocanal y evaluar la tolerancia de las pacientes al examen. Método: Entre agosto y octubre de 2006, se realizaron 64 urodinamias monocanal con medición de presión de retro-resistencia uretral (URP), en pacientes que consultaron por diagnóstico clínico de incontinencia de orina (IO). Se correlacionó el diagnóstico clínico con los resultados de la urodinamia. Se aplicó una escala de tolerancia subjetiva del examen, donde O es la mayor tolerancia y 10 el máximo desagrado. Resultados: En 38 pacientes se indicó urodinamia con diagnóstico clínico de incontinencia de orina de esfuerzo (IOE), registrándose en la urodinamia: 9 tipo 0, 2 tipo I, 13 tipo II, 1 tipo III, 13 tipo ll+lll. De las 10 con IO mixta: 3 fueron normal, 1 tipo 0, 1 tipo II, 1 tipo III, 1 tipo ll+lll, 3 detrusor hiperactivo. De las 14 pacientes con urgeincontinencia: 1 normal, 1 tipo II, 6 tipo ll+lll y 6 con detrusor hiperactivo. En la tolerancia al examen todas registraron 2 a 3 puntos. Conclusiones: La urodinamia monocanal más la medición de la URP es un examen complementario de gran utilidad en el estudio de la incontinencia urinaria. Permite planificar la solución adecuada para cada caso y tiene un alto grado de tolerancia en las pacientes.

Objective: To compare the clinical diagnosis of the urinary incontinence with the results obtained by mono-channel urodynamic and to evaluate the patient's tolerance to this examination. Method: Between August and October 2006, 64 urodynamic were made in patients with clinical diagnosis of urinary incontinence. The clinical diagnosis was compared with the urodynamic results. A subjective tolerance scale was applied (0 was greater tolerance and 10 was maximum discomfort). Results: In 38 patients with clinical diagnosis of stress urinary incontinence, the urodynamic registered 9 (type 0), 2 (type I), 13 (type II), 1 (I type II), 13 (type ll+lll). In 10 with mixed urinary incontinence, the urodynamic showed 3 (normal), 1 (type 0), 1 (type II), 1 (type III), 1 type (ll+lll) and 3 hyperactive detrusor. In 14 patients with urgency incontinence, urodynamic showed 1 normal, 1 (type II), 6 (type ll+lll) and 6 hyperactive detrusor. All patients expressed 2 and 3 de-gree tolerance. Conclusions: The monochannel urodynamic is a complementan/ examination very useful in the study of the urinary incontinence. It allows planning the solution adapted for each case and with a high degree of tolerance.

evaluation of use of Trans-Obturator Tape [TOT] sling procedure in the current surgical management of female stress urinary incontinence

To assess the role of TOT sling procedure in current surgical management of female Stress Urinary Incontinence [SUI] in terms of post-operative results, cost effectiveness, pt acceptance and complications. From June 2006 to September 2008, 30 patients of SUI were treated surgically by TOT-sling procedure. Pre-operatively the patients were evaluated by thorough history taking, clinical examination and different diagnostic test depending upon the individual clinical scenario. Patients were explained in their own language the nature of procedure and the principle behind it. Any complication[s] [intra/postoperative] were noted. After discharging the patients they were followed up by at least 3 visits [follow-up visits] at 1,3 and 6 month interval. Any complications of the procedure and patient acceptance were evaluated at each follow-up. The mean age of the total patients [n=30] was 39.5 yrs and 28 [93.33%] were multiparous. Involuntary loss of urine on straining was the most common complaint present in 25 [83.33%] patients and 22 [73.33] patients were having duration of symptoms less than 3 yrs. 9 [30%] patients were having mild cystocele pre-operatively which resolved after surgery. All the 30 [100%] patients were continent post-operatively while 7 [23.33%] were having lower urinary tract symptoms [LUTS]. No major intra/post-operative complication was seen but, urgency, dysuria, fever and haematuria was seen post-operatively which resolved after few days. The operative time was 24 +/- 3.8 months and catheter was removed on 2.7 +/- 1.7 days post-operatively. Hospital stay was 6 +/- 2.4 days [3-11] and app. Cost of the treatment was Rs 3253 +/- 360 [2700,3900]. TOT Sling procedure is currently the Gold Standard for management of female SUI. It is very important to diagnose SUI and rule out other causes of incontinence because only the former one [Genuine SUI] is improved by TOT sling and other types may be even worsened by this procedure

Análise dos parâmetros ultra-sonográficos empregados no diagnóstico da incontinência urinária de esforço / Evaluation of ultrasound parameters used as a diagnostic method for stress urinary incontinence

OBJETIVOS: verificar a sensibilidade, especificidade e acurácia de medidas ultra-sonográficas da bexiga e uretra no diagnóstico da incontinência urinária de esforço (IUE). MÉTODOS: o encurtamento da uretra, o abaixamento do colo vesical e a mudança da forma do trígono vesical, provocados pelo esforço miccional, foram medidos por ultra-sonografia transvaginal. A soma algébrica dos três indicadores foi utilizada como uma quarta medida para análise. A amostra era composta de 40 mulheres com IUE comparadas com 40 controles. Os casos diferiam dos controles com relação à idade, à paridade e ao número de gestações. Foram utilizados diversos pontos de corte para avaliar a sensibilidade, especificidade e acurácia diagnóstica do método. O diagnóstico urodinâmico da IUE e de controles serviu como padrão-ouro. Para a análise univariada dos dados, foram utilizados os testes chi2 de Yates e chi2 de Pearson. RESULTADOS: no melhor ponto de corte para o abaixamento do colo vesical, a sensibilidade foi de 40 por cento, a especificidade de 72 por cento e a acurácia de 57 por cento; no melhor ponto de corte para a medida do encurtamento da uretra, a sensibilidade foi de 40 por cento, a especificidade de 70 por cento e a acurácia de 55 por cento; no melhor ponto de corte para a mudança da forma do trígono vesical, a sensibilidade foi de 58 por cento, a especificidade de 48 por cento e a acurácia foi de 52 por cento; no melhor ponto de corte para soma das diferenças das três medidas, a sensibilidade do método foi de 32 por cento, a especificidade de 62 por cento e a acurácia de 48 por cento. CONCLUSÃO: a ultra-sonografia transvaginal, no presente estudo, não se mostrou um método válido para o diagnóstico da IUE.

PURPOSE: to verify the sensitivity, specificity and accuracy of some ultrasonographic measurements in the diagnosis of stress urinary incontinence (SUI). METHODS: transvaginal ultrasound measurements of the bladder neck descent, urethral mobility and urethrovesical funneling caused by urination effort were performed in 40 women with SUI and in 40 women from a control group. Age, parity and the number of pregnancies were different in both groups. Several cut points were performed to evaluate the sensitivity, specificity and accuracy of these measurements as a diagnostic tool for SUI. The urodynamic results were used as gold standard. Univariated analysis was done using Yates chi2 Test and Pearson chi2 Test. RESULTS: in the best cut point for bladder neck descent measurements, sensitivity was 40 percent, specificity was 72 percent and accuracy was 57 percent; in the best cut point for urethral mobility measurements, sensitivity was 40 percent, specificity was 70 percent and accuracy was 55 percent; in the best cut point for urethrovesical funneling measurements, sensitivity was 58 percent, specificity was 48 percent and accuracy was 52 percent; in the best cut point for the addition of the differences of these three measurements, sensitivity was 32 percent, specificity was 62 percent and accuracy was 48 percent. CONCLUSION: vaginal ultrasonography was not a valid diagnostic method for stress urinary incontinence in the present study.

Aferição simultânea da pressão abdominal na avaliação ultra-sonográfica de mulheres com incontinência urinária de esforço / Intra-abdominal pressure measurement during ultrasound assessment of female patients with stress urinary incontinence

OBJETIVO: Determinar a influência da aferição da pressão intra-abdominal na avaliação ultra-sonográfica da junção uretrovesical (JUV) e da uretra proximal (UP) em pacientes com incontinência urinária de esforço (IUE). MATERIAIS E MÉTODOS: Estudo prospectivo de corte transversal realizado na Unidade de Pesquisa em Incontinência Urinária da Universidade Federal de Pernambuco, de janeiro de 2002 a janeiro de 2005. Trinta e seis pacientes com queixas de IUE foram submetidas a ultra-sonografia perineal para avaliação da JUV e da UP com a bexiga praticamente vazia (< 50 ml), com aferição simultânea de pressão intra-abdominal. Para as avaliações, foi utilizado aparelho de ultra-som com transdutor vaginal de 7 MHz e seletor eletrônico de mensuração de imagem real, equipado com computador e câmera fotográfica de resolução instantânea. Para a medida da pressão intra-abdominal, foi utilizado aparelho de urodinâmica com cateter de 10 fr retal acoplado a um balão de sensor para medida da pressão intra-abdominal. RESULTADOS: As pacientes tinham idade entre 25 e 69 anos (média de 46,4 ± 10,2 anos). A manobra de Valsalva, a pressão intra-abdominal variou entre 7 cmH2O e 193 cmH2O (média de 99,3 ± 51,8 cmH2O; mediana de 99,5 cmH2O). Oito das 31 (25,8 por cento) pacientes com hipermobilidade da JUV apresentaram pressão intra-abdominal inferior a 60 cmH2O. Não foi detectada relação estatisticamente significante entre a variação de pressão intra-abdominal e os parâmetros ultra-sonográficos em questão. CONCLUSAO: Há um índice específico de pressão de deslocamento uretral para cada mulher com IUE. Porém, não há associação significativa entre o aumento de pressão intra-abdominal e aumento de mobilidade da JUV e UP em mulheres com quadro clínico de IUE.

How to approach common urogynaecological problems?

Urogynaecology is dedicated to the treatment of women with pelvic floor dysfunction such as urinary orfecal incontinence and prolapse (bulging or falling) of the vagina, bladder and/or the uterus. Pelvic organ prolapse simply means displacement from the normal position. On average, 11% of women will undergo surgery for this condition. Pelvic organ prolapse quantification system (POP-Q) is an objective, site-specific system for describing the anatomic position that can be used to determine the stage of the prolapse. Urinary incontinence (leakage of urine) is a very common condition affecting at least 10-20% of women under age 65 and up to 56% of women over the age of 65. The most common subtypes of urinary incontinence are (1) stress urinary incontinence (SUI) ; (2) urge urinary incontinence (UUI) ; and (3) mixed urinary incontinence (MUI). Patients presenting with symptoms of pelvic organ prolapse or incontinence should undergo a thorough medical evaluation consisting of a targeted history (include bladder diary or voiding diary), physical examination, urinalysis and urine culture, and postvoid residual volume (PVRV) by pelvic ultrasound. Treatment options for patients with pelvic organ prolapse and urinary incontinence are nonsurgical (lifestyle interventions, pelvic floor muscle rehabilitation, and pessary placement) and surgical management.