The Efficacy of Pelvic Floor Muscle Exercise in Patients with Genuine Stress Incontinence / 대한비뇨기과학회지

In 1948, Kegel first described biofeedback therapy with perineometer for the treatment of genuine stress incontinence and reported a 90% improvement in 455 patients treated. After then, most urologists and gynecologist favored the anti-incontinence surgery in spite of the effectiveness of pelvic floor exercise. However, pelvic floor muscle exercise is regarded as ""something good to do"" before considering surgery, nowadays. This study evaluated the efficacy of the pelvic floor muscle exercise for the treatment of genuine stress incontinence patients with mild symptoms and pelvic relaxation. We treated 31 patients with pelvic floor muscle exercise with perineometer and followed up all of the patients for 3 months. Twenty seven out of thirty one cases improved incontinence symptom. Sixty five percent of cases showed less than 2 gm urine leak after one hour pad test and 48% of cases showed the increase of vaginal tone (mean 13.2mmHg) with perineometer. This study shows the improvement of genuine stress incontinence symptom is mainly due to perineal blockage just before the increase of intraabdominal pressure.

Correlation of Chain Cystourethrographic Findings with Grade of Incontinence and Duration of Postoperative Voiding Difficulty in Genuine Stress Incontinence(GSI) / 대한비뇨기과학회지

For recent 3 years, l8 GSI patients were followed for more than 6 months after surgical treatment with Raz procedure. Posterior urethrovesical angle(PUVA), urethral inclination angle (UIA), and bladder neck descent below the upper border of symphysis pubis(BN) on voiding chain cystourethrogram were measured preoperatively and postoperatively with respect to the grade of preoperative incontinence and postoperative period of voiding difficulty. UIA and BN in Stamey grade II group(N=9) were 57+/-14.6 degrees and 5.4+/-l.1cm, which were significantly higher than 39+/-7.6 degrees and 4.3+/-0.9cm in Stamey grade I group(N= 9) (P <0.05). Normal values of PUVA and UIA were defined as 90-l00 and 0-45. Depending on the duration of postoperative voiding difficulty, mean values of postoperative PUVA and UIA were normal(90+/-18.9' and 8+/-16.9') in the 1st week group(N=9), but lower than normal values(ie, overcorrected) in l-2 week group( 64+/-2l.3 and -l0+/-8.9 ) and in over 2 week group( 50+/-l0.0' and -11+/-2.2' ). Duration of postoperative voiding difficulty was 3.5+/-1.6 days in properly corrected Green type I group(N=6) and 8.3+/-l.2 days in properly corrected Green type II group(N=3), but it was much longer in overcorrected groups. From the above results, it is inferred that chain cystourethrography can be used as a useful means to predict the duration of postoperative voiding difficulty in GSI patients and prolonged postoperative voiding difficulty can be prevented by taking care not to overcorrect the bladder neck during Raz procedure.

Urodynamic Findings in Genuine Stress Incontinence / 대한비뇨기과학회지

From October 1990 through July 1991, 187 women who complained of urinary incontinence underwent investigation in the department of urology, especially urodynamically, compared with 42 women with female urethral syndrome as control group. The following results were obtained ; mean functional urethral length was 3.1+/-0.9cm and mean maximal urethral closure pressure was 80.2+/-2.4cmH2O in genuine stress incontinence patients. But each results of female urethral syndrome were 3.6+/-0.7cm and 121.1+/-3.8cmH2O, respectively, and were higher than those of genuine stress incontinence (p <0.05 ). The incidence of positive pressure equalization of genuine stress incontinence was higher than that of control group, as 85.6% and 14.3% (p<0.05). The findings of uroflowmetry and cystometry showed within normal limits in genuine stress incontinence and poor voiding pattern in female urethral syndrome. Conclusively. urodynamic study was important for diagnosis and follow up of genuine stress incontinence.