[Female urinary incontinence: diagnosis and treatment]. / Die Urininkontinenz der Frau: Einführung in die Diagnostik und Therapie.

Female urinary incontinence: diagnosis and treatment Abstract. Urinary incontinence (UI) is a common condition that may affect women of all ages, with a wide range of severity and nature. Although rarely life threatening, UI may seriously influence the physical, psychological and social wellbeing of affected individuals. The two main types are Stress and Urge Urinary Incontinence. A new and important term is used, the overactive bladder syndrome (OAB), which is defined as urgency that occurs with or without urge UI and usually with frequency and nocturia. Stress Urinary Incontinence (SUI) is the result of weak urethral muscle and support. Urge Urinary Incontinence (UUI) is the result of over active bladder muscle. History and physical examination, including vaginal exam and measuring postvoidal residual volume establish the diagnosis, and a urinary tract infection should be ruled out. Therapy consists of behavioral modification. For SUI pelvic floor physiotherapy (Kegel exercises with or without aid of physical therapist) is important, also, devices such as a pessary or urethral insert can be used. When symptoms persist, surgery (typically a synthetic mesh sling) is indicated. In selected cases, transurethral bulking agent injections can be discussed. For OAB or UUI also physiotherapy as well as medications such as antimuscarinics or the recently released beta-3-adrenoreceptor-agonist Mirabegron are well established. In case of failure intravesical botox application is a good option.

Brucellosis and thrombosis of the inferior vena cava.

We describe the case of a 23-year old woman with a newly diagnosed thrombosis of the inferior vena cava associated with a Brucella melitensis infection. We suggest possible mechanisms leading to brucellosis-associated venous thrombosis and review 14 previously reported cases.
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[Female sexual dysfunction]. / Sexuelle Dysfunktion.

Female sexual dysfunction is common with a prevalence of 20 % to 50 %. Its etiology is multifactorial. Female sexual dysfunction is a complex neurovascular phenomenon, influenced by psychological, neurological, muscular and endocrine factors. In pelvic floor dysfunction sexual dysfunction is the result of anatomical und functional changes, as well as the therapy applied. Sexual dysfunction in urinary incontinence is frequent; its combination with prolaps has a negative cumulative effect. Pelvic floor surgery, irrespective of the surgical procedures, may lead to sexual dysfunction. An individualised approach to treatment is important when assessing and counselling women.

[Postartum urinary retention - without clinical impact?]. / Die postpartale Harnretention - klinisch bedeutungslos?

Postpartum urinary retention (PUR) continues to be a not very well understood clinical condition. The incidence varies in literature between 0.05 to 14.1%, after vaginal delivery, and between 3.3 to 24.1% after cesarean section, depending on the criteria used and reflecting differences in obstetrical practice. A commonly used definition is the lack of spontaneous micturition 6 hours after vaginal delivery or after removing an indwelling catheter. After helping measures, bladder drainage, which can be done in different ways is most important in the treatment. Though it is a distressing condition, prognosis is normally good, and there are only few published data on long-term sequelae. But overstretching the bladder wall during pregnancy or delivery can result in severe detrusor damage, followed by voiding dysfunction. There are different independent risk factors such as prolonged first and second stage of labor, isolated length of the second stage, forceps delivery or vaccum extraction, perineal laceration and nulliparity. Epidural analgesia may also increase the risk of PUR, but is controversially discussed in literature. The lack of guidelines is one of the major problems in treating women with PUR.