Speciality
Spotlight

 




 

Urology


 

 








Incontinence

 

  • V
    Khullar et al (King’s College, London).

    Prevalence of Faecal
    Incontinence Among women with Urinary Incontinence.

    Br J Obstet Gynaecol 105: 1211-1213, 1998

        

    Authors
    studied particular problem and came to the conclusion
    that denervation and myogenic injuries occurring in
    childbirth may be the common cause for genuine stress
    and fecal incontinence. 
    The occurrence of detrusor instability and
    fecal incontinence may be attributed to a different
    mechanism.

        

    Khullar
    et al have reported 30% and 21% incidence of fecal
    incontinence among women with detrusor instability and
    stress incontinence respectively.

         

  • Wright
    EJ, lselin CE, Cart LK, et al [ Duke Univ Med Ctr
    Durham, NC; Univ of Toronto]

    Pubovaginal Sling Using Cadaveric Allograft Fascia for
    the Treatment of Intrinsic Sphincter Deficiency

    J Urol 160: 759-762, 1998



    Introduction – For female patients with SUI (
    Stress Urinary Incontinence ] caused by intrinsic
    sphincter deficiency, the pubovaginal sling is the
    Gold standard for treatment.



    Autologous fascia harvest causes local discomfort and
    synthetic materials are associated with infection and
    erosion.



    Methods – Over a 28 month period, the allograft
    fascia technique was used in 59 patients and autograft
    fascia in 33.



    Preoperative video urodynamics were done in all
    patients. Consitence outcomes were assessed with the
    SEAPI score.



    Results — According to postoperative SEAP1
    score, both groups showed significant and similar improvement
    in consitence. 

    98% of allograft and 94% of autograft group were free
    of stress incontinence.



    Average operative time was 87 minutes in allograft
    group and 111 minutes in autograft group. Mean
    hospital stay was 1.67 days Versus 2.48 days
    respectively.



    Neither group had any problems with infection or
    erosion and both slings were well tolerated.



    Conclusion – The use of allograft fasci [
    fresh-frozen or freeze-dried] seems to be associated
    with similar success rates as  autogenous graft
    materials resulted in shorter operative time and
    hospital stay.



    There was no infection or transmissible diseases
    reported by this method.



    A longer follow-up is needed to assess the durability
    of this method.

  • Chaikin
    DC, Rosenthal J, Blaivas JG [ New York Hosp/Cornell
    Med Ctr ]

    Pubovaginal Fascial Sling for All types of stress
    Urinary Incontinence : Long-term Analysis

    J Urol 160: 1312-1316, 1998



    Introduction – In the past, surgical treatment
    of stress urinary incontinence depended on the type of
    incontinence.



    Experience with 251 patients who underwent pubovaginal
    sling for all types of SUI is discussed.



    Results – There were 63 patients with simple
    incontinence and 188 with complex incontinence. There
    was one postoperative death. Of the 231 women followed
    up for a median fo 3.1 years 183[73%] were cured and
    48[19%] were improved. Surgical complications included
    persistent urge incontinence [23%] or de novo urge
    incontinence [3%]. Prolonged and unexpected urinary
    retention occurred in 4 patients.

  • Wang
    AC, Lo TS [Chang Jung Univ, Tauvan, Taiwan]

    Tension-free Vaginal Tape – A Minimally Invasive
    Solution to Stress Uninary Incontinence in Women

    J Reprod Med 43 : 429-434, 1998



    *  A meshed polypropylene tape is used as a
    sub-urethral sling. The use of an introducing trocer
    facilitates placement in the 

       retropubic space on either side.



    * The tape is held in space at the retropubic space by
    barbs on the tape.



    * The potential advantage of the procedure include
    short operative time, minimal or no dissection in the
    retropubic space and

      the possibility that the TVT procedure can be
    performed with local or minimal anesthesia.



    * Potential disadvantage related to this procedure
    includes the presence of foreign body with
    possibilities of erosion, infection

      and rejcetion.

  • Pycha
    A, Kingler CH, Haitel A, et al [ Univ of Vienna ]

    Implantable Microballons : An attractive
    alternative in the management of intrinsic sphincter
    Deficiency

    Eur Urol 33: 469-475, 1998



    In an innovative, minimally invasive approch to the
    treatment of stress urinary incontinence in females,
    these authors placed, “microballons” in a
    periurethral location in 19 patients.



    8 to 19 patients were dry at a mean follow-up of 14.4
    months.



    7 patients were improved



    Biocompatability was excellent with only 1 patient
    having extrusion of the ballons.



    Patients with urethral hypermobility and detrusor
    instability did not fare as well as those with ISD
    with parallels the clinical experience with other
    injectable bulking  agents such as collagen.



    The material is not degraded with time like collagen.

  • Elsergany
    R, Ghoniem GM [ Tulane Univ, New Orleans, La ]

    Collagen Injection for Intrinsic Sphincteric
    Deficiency in Men : A reasonable Option in selected
    patients


    J Urol 159 : 1504-1506, 1998



    Introduction – Most cases of persistent incontinence
    after prostatic surgery are the result of intinsic
    sphincteric deficiency.



    The FDA has approved the use of transurethral collagen
    of patients with intrinsic sphincteric deficiency.



    Methods – Mean age of patient was 68-64 years ; 22 had
    grade III and 13 had grade II incontinence.



    Additional injection were done between 1 to 3 months
    after procedure. Follow-up was at 1,3 & 6 months.



    Result – At a mean follow-up of 17.6 months 20% were
    cured, 31.4% improved and 48.6% were considered
    failures.



    Dry patients needed a mean of 2 treatment sessions and
    a mean of 10 cc of injected collagen.



    Conclusion – Men less likely to benefit from the
    procedure are those with a history of pelvic
    irradiation, urethral stricture disease or involuntary
    bladder contractions.

  • Elliott
    DS, Barrett DM [ Mayo Clinic, Rochester, Minn ]

    Mayo Clinic Long-term Analysis of the functional
    Durability of the AMS 800 Artificial Urinary Sphincter
    : A Review of 323 Cases

    J Urol 159 : 1206-1208, 1998



    The narrow backed cuff design introduced in 1987 had
    led to a decreased incidence of mechanical failure and
    non mechanical failure of this devices.



    Since introduction of the narrow backed off cuff, more
    than 83% of patients have not required reoperation
    over a mean follow-up of 5 and a half years. It is
    marked improvement over the reoperation rate of the
    original device.



    Unfortunately, the author did not define “
    Continence” [ i.e. in the absence of the use of
    pads ] in this study as it is well known that many
    patients who are quite satisfied with the functional
    result from artificial sphincter may nontheless have
    small degress of stress urinary incontinence with
    sudden increases intraabdomional pressure.

  • Cross
    CA, Cespedes RD, English SF, et al [ Univ. of Texas,
    Houston: Wilford Hall Med Ctr, Lackland Airforce Base,
    Tex ]

    Transvaginal Urethrolysis for Urethral obstruction
    After Anti-incontinence Surgery

    J Urol 159 : 1199-1201, 1998 



    Introduction – With patients undergoing a stress
    urinary incontinence procedure, 5% to 20% subsequently
    have urethral obstruction



    Conclusion – Postoperative urethral obstruction in the
    female should considered in patients with rersistent
    irritative lower urinary tract symptoms, high postvoid
    residuals or frank urinary retention after
    anti-incontinence surgery.



    Classic findings of urodynamic  obstruction are
    not seen in obstructed females [ i.e. high pressure,
    low flow ] . Persistent stress incontinence may be
    present despite apparent urethral obstruction.



    Transvaginal urethrolysis was associated with
    symptomatic cure rate of 72% and improvement rate 85%



    Majority of patients did not undergo a suspension
    procedure at the time of urethrolysis. Only patients
    complaining of SUI with obstruction were resuspended
    at the time of urethrolysis. Whether to resuspend all
    patients undergoing uretrholysis for obstruction
    remains somewhat controversial.

  • Denys
    P, Chartier-Kastler E, Azouvi P, et al [ Reymond
    Poincare Hosp. Garches, France ]

    Intrathecal Clonidine for Refactory Detrusor
    Hyperreflexia in Spinal Cord Injured Patients : A
    Preliminary Report

    J Urol 160 : 2137-2138



    Conclusion – Reduction in bladder hyperactivity was
    dose dependent beginning 5 minutes after injection and
    continuing at least 3 hrs. Urodynamic measure and
    clionidine dosage was significantly correlated.



    Intrathecal clonidine appears to claim bladder
    hyperactivity in a dose dependent fashion in-patients
    with chronic spinal cord lesions.

Urinary Incontinence

     

  • MP Leonard, A Decter, K Hills et al [ Univ of Manitoba, Winnipeg, Canada; Univ of Alberta, Edmonton, Canada]


    Endoscopic Subureteral Collagen Injection : Are immunological Concerns Justified ?


    J Urol 160 : 1012-1016, 1998

       


    Conclusions- In 30% of adults treated with collagen for urinary incontinence, antibovine collagen antibodies develop. These patients are usually treated with large volumes of collagen, and there are no known clinical sequelae of this seroconversion.

       


    When collagen is injected for the treatment of reflux, smaller volumes are used, but the rate of seroconversion is the same.

       


    With short follow-up, antibodies cross-reacting with human collagen do not develop, and there are no known autoimmune outcomes in adults or children.

        


    Repeat skin testing between treatments may be appropriate, and urologists should watch for potential immune reactions.

  • KL
    Burgio, et al (Univ of Alabama, Birmingham; Univ of
    Pittsburgh, Pa: Allegheny Gen Hosp, Pittsburgh, Pa; et
    al)

    Behavioral vs Drug treatment
    for Urge Urinary Incontinence in Older Women: 
    A Randomized Controlled Trial
    .

    Jama 280: 1995-2000, 1998.

        

    About 38% of older community-dwelling women, age
    60 years and older have urinary incontinence, which
    contributes to depression and social isolation.

         

    They
    have studied women divided into 3 groups, there was a
    group with 197 women aged 55-92 yrs who had urge
    urinary incontinence or mixed incontinence with urge
    as the predominant pattern were studied.
    Patients were randomized to receive 8 weeks of
    biofeedback assisted behavior treatment, drug
    treatment with oxybutynin chloride, possible range of
    doses, 2.5mg daily to 5mg 3 times daily or a placebo
    control condition.

         

    Results
    ; Reduction of incontinence was most pronounced early
    in treatment and progressed more gradually thereafter
    in all 3 treatment groups.
    There was an 80.75 reduction of incontinence
    episodes with behavior treatment, a 68.5% reduction
    with drug treatment, and a 39.4% reduction with
    placebo control.

         

    It
    was concluded that as a first line treatment for urge
    and mixed incontinence, behavioral treatment is a safe
    and effective conservative intervention that should be
    more readily available.

         

    Editorial
    comments
    : 
    The only problem with behavioral treatments is
    that they are time-consuming and require dedicated
    professional teams.

          

  • F
    Zivkovic, et al (Univ of Graz, Austria)

    Body Mass Index and Outcome of
    Incontinence Surgery.


    Obstet Gynecol 
    93: 753-756, 1999

         

    The authors feel that the continence rate for
    anterior colporrhaphy at 5 years was 58%.
    The rate for anterior colporrhaphy with needle
    suspension of bladder neck was 51% at 5 years.
    The rate for Burch colposuspension at 5 years
    was 86%. There
    were no significant differences in the preoperative
    and postoperative body mass indexes of continent and
    incontinent women for each procedure.

          

    Conclusion
    : For failure of incontinence surgery, preoperative
    obesity was not a risk factor, but the power of this
    study was limited.

         

    Editor
    A Bergmann comments that Zivkovic et al indicate that,
    at least for the Burch operation, this is not the
    case.  These
    women need a “fixed anchor” when their
    stress incontinence is corrected, and the Burch
    procedure offers that type of correction, i.e.
    attaching the endopelvic fascia to a fixed bony
    structure.

         


       

Stress
Urianry Incontinence


     

  • A Pelvic Muscle Precontraction
    can Reduce Cough-related Urine Loss in Selected Women
    with Mild SUI
    .

     
    J
    Am Geriartr Soc. 46:870-874, 1998
    .

           

    Conservative treatment of stress urinary incontinence
    in women typically begins with repetitive
    strengthening, or Kegel exercises, for pelvic floor
    muscles.  Some
    women have reported decreased stress-related urine
    loss as early as 1 to 2 days after beginning these
    exercises.  Because
    pelvic floor hypertrophy cannot occur in such a short
    time span, these women have probably taught themselves
    a new skill – that of intentionally contracting the
    pelvic floor muscles just before and during an
    activity, which causes a rise in intra-abdominal
    pressure.  This
    exercise is called “the Knack”.

          

    The
    effect of the Knack was assessed at 1 week in 27 older
    women with mild-to-moderate SUI in a prospective,
    randomized, single-blind interventional trial to
    determine its effect on cough-related urine loss.

          

    It
    was concluded that selected older women with
    mild-to-moderate SUI can learn to effectively use a
    properly timed pelvic floor muscle contraction to
    significantly diminish urine leakage during a cough. 
    The Knack is a  simple and effective method for reducing stress-related urine
    loss in selected older women with mild SUI who are
    capable of performing pelvic floor muscle
    contractions.

         

    The
    Knack technique is simple and easy to learn. 
    In fact the 2 techniques (i.e. Kegel and the
    Knack) work differently. 
    While Kegel exercise is aimed toward
    strengthening the pelvic floor muscle and providing
    better support for the bladder, the current technique
    is aimed toward “self protection” by
    contracting the muscle before stress, rather than by
    permanently strengthening it.

            

  • An open
    study of
    the Bladder Neck support
    Prosthesis in Genuine Stress Incontinence
    .

    KH
    Moore et al (Univ of New South Wales, Sydney,
    Australia; Royal North Shore Hosp, Sydney, Australia)   Br
    J Obstet Gynaecol 106:42-49, 1999.

          

    It
    was found that the bladder support prosthesis
    (incontinence ring) maybe a good non-surgical option
    for some women with stress urinary incontinence
    However women with a scarred vagina after a previous
    operation or prolapse of more than one wall may find
    the device difficult to fit or keep in place.

            

  • Surgical Correction of Stress
    Incontinence in Morbidly Obese Women.


    JM
    Cummings, et al (Univ of south Alabam, Mobile; St.
    Louis Univ)  J.
    Urol 160:754-755, 1998.

         

    Authors
    conclude that Morbidly obese women with stress urinary
    incontinence can be successfully treated with surgery.  
    Sling operations appear to be the procedure of
    choice for this population.

     

 



 

  

Speciality Spotlight

 

 
Urology
 

 

Incontinence
 

  • V Khullar et al (King’s College, London).
    Prevalence of Faecal Incontinence Among women with Urinary Incontinence. Br J Obstet Gynaecol 105: 1211-1213, 1998
        
    Authors studied particular problem and came to the conclusion that denervation and myogenic injuries occurring in childbirth may be the common cause for genuine stress and fecal incontinence.  The occurrence of detrusor instability and fecal incontinence may be attributed to a different mechanism.
        
    Khullar et al have reported 30% and 21% incidence of fecal incontinence among women with detrusor instability and stress incontinence respectively.
         

  • Wright EJ, lselin CE, Cart LK, et al [ Duke Univ Med Ctr Durham, NC; Univ of Toronto]
    Pubovaginal Sling Using Cadaveric Allograft Fascia for the Treatment of Intrinsic Sphincter Deficiency
    J Urol 160: 759-762, 1998

    Introduction – For female patients with SUI ( Stress Urinary Incontinence ] caused by intrinsic sphincter deficiency, the pubovaginal sling is the Gold standard for treatment.

    Autologous fascia harvest causes local discomfort and synthetic materials are associated with infection and erosion.

    Methods – Over a 28 month period, the allograft fascia technique was used in 59 patients and autograft fascia in 33.

    Preoperative video urodynamics were done in all patients. Consitence outcomes were assessed with the SEAPI score.

    Results — According to postoperative SEAP1 score, both groups showed significant and similar improvement in consitence. 
    98% of allograft and 94% of autograft group were free of stress incontinence.

    Average operative time was 87 minutes in allograft group and 111 minutes in autograft group. Mean hospital stay was 1.67 days Versus 2.48 days respectively.

    Neither group had any problems with infection or erosion and both slings were well tolerated.

    Conclusion – The use of allograft fasci [ fresh-frozen or freeze-dried] seems to be associated with similar success rates as  autogenous graft materials resulted in shorter operative time and hospital stay.

    There was no infection or transmissible diseases reported by this method.

    A longer follow-up is needed to assess the durability of this method.

  • Chaikin DC, Rosenthal J, Blaivas JG [ New York Hosp/Cornell Med Ctr ]
    Pubovaginal Fascial Sling for All types of stress Urinary Incontinence : Long-term Analysis
    J Urol 160: 1312-1316, 1998

    Introduction – In the past, surgical treatment of stress urinary incontinence depended on the type of incontinence.

    Experience with 251 patients who underwent pubovaginal sling for all types of SUI is discussed.

    Results – There were 63 patients with simple incontinence and 188 with complex incontinence. There was one postoperative death. Of the 231 women followed up for a median fo 3.1 years 183[73%] were cured and 48[19%] were improved. Surgical complications included persistent urge incontinence [23%] or de novo urge incontinence [3%]. Prolonged and unexpected urinary retention occurred in 4 patients.

  • Wang AC, Lo TS [Chang Jung Univ, Tauvan, Taiwan]
    Tension-free Vaginal Tape – A Minimally Invasive Solution to Stress Uninary Incontinence in Women
    J Reprod Med 43 : 429-434, 1998

    *  A meshed polypropylene tape is used as a sub-urethral sling. The use of an introducing trocer facilitates placement in the 
       retropubic space on either side.

    * The tape is held in space at the retropubic space by barbs on the tape.

    * The potential advantage of the procedure include short operative time, minimal or no dissection in the retropubic space and
      the possibility that the TVT procedure can be performed with local or minimal anesthesia.

    * Potential disadvantage related to this procedure includes the presence of foreign body with possibilities of erosion, infection
      and rejcetion.

  • Pycha A, Kingler CH, Haitel A, et al [ Univ of Vienna ]
    Implantable Microballons : An attractive alternative in the management of intrinsic sphincter Deficiency
    Eur Urol 33: 469-475, 1998

    In an innovative, minimally invasive approch to the treatment of stress urinary incontinence in females, these authors placed, “microballons” in a periurethral location in 19 patients.

    8 to 19 patients were dry at a mean follow-up of 14.4 months.

    7 patients were improved

    Biocompatability was excellent with only 1 patient having extrusion of the ballons.

    Patients with urethral hypermobility and detrusor instability did not fare as well as those with ISD with parallels the clinical experience with other injectable bulking  agents such as collagen.

    The material is not degraded with time like collagen.

  • Elsergany R, Ghoniem GM [ Tulane Univ, New Orleans, La ]
    Collagen Injection for Intrinsic Sphincteric Deficiency in Men : A reasonable Option in selected patients
    J Urol 159 : 1504-1506, 1998

    Introduction – Most cases of persistent incontinence after prostatic surgery are the result of intinsic sphincteric deficiency.

    The FDA has approved the use of transurethral collagen of patients with intrinsic sphincteric deficiency.

    Methods – Mean age of patient was 68-64 years ; 22 had grade III and 13 had grade II incontinence.

    Additional injection were done between 1 to 3 months after procedure. Follow-up was at 1,3 & 6 months.

    Result – At a mean follow-up of 17.6 months 20% were cured, 31.4% improved and 48.6% were considered failures.

    Dry patients needed a mean of 2 treatment sessions and a mean of 10 cc of injected collagen.

    Conclusion – Men less likely to benefit from the procedure are those with a history of pelvic irradiation, urethral stricture disease or involuntary bladder contractions.

  • Elliott DS, Barrett DM [ Mayo Clinic, Rochester, Minn ]
    Mayo Clinic Long-term Analysis of the functional Durability of the AMS 800 Artificial Urinary Sphincter : A Review of 323 Cases
    J Urol 159 : 1206-1208, 1998

    The narrow backed cuff design introduced in 1987 had led to a decreased incidence of mechanical failure and non mechanical failure of this devices.

    Since introduction of the narrow backed off cuff, more than 83% of patients have not required reoperation over a mean follow-up of 5 and a half years. It is marked improvement over the reoperation rate of the original device.

    Unfortunately, the author did not define “ Continence” [ i.e. in the absence of the use of pads ] in this study as it is well known that many patients who are quite satisfied with the functional result from artificial sphincter may nontheless have small degress of stress urinary incontinence with sudden increases intraabdomional pressure.

  • Cross CA, Cespedes RD, English SF, et al [ Univ. of Texas, Houston: Wilford Hall Med Ctr, Lackland Airforce Base, Tex ]
    Transvaginal Urethrolysis for Urethral obstruction After Anti-incontinence Surgery
    J Urol 159 : 1199-1201, 1998 

    Introduction – With patients undergoing a stress urinary incontinence procedure, 5% to 20% subsequently have urethral obstruction

    Conclusion – Postoperative urethral obstruction in the female should considered in patients with rersistent irritative lower urinary tract symptoms, high postvoid residuals or frank urinary retention after anti-incontinence surgery.

    Classic findings of urodynamic  obstruction are not seen in obstructed females [ i.e. high pressure, low flow ] . Persistent stress incontinence may be present despite apparent urethral obstruction.

    Transvaginal urethrolysis was associated with symptomatic cure rate of 72% and improvement rate 85%

    Majority of patients did not undergo a suspension procedure at the time of urethrolysis. Only patients complaining of SUI with obstruction were resuspended at the time of urethrolysis. Whether to resuspend all patients undergoing uretrholysis for obstruction remains somewhat controversial.

  • Denys P, Chartier-Kastler E, Azouvi P, et al [ Reymond Poincare Hosp. Garches, France ]
    Intrathecal Clonidine for Refactory Detrusor Hyperreflexia in Spinal Cord Injured Patients : A Preliminary Report
    J Urol 160 : 2137-2138

    Conclusion – Reduction in bladder hyperactivity was dose dependent beginning 5 minutes after injection and continuing at least 3 hrs. Urodynamic measure and clionidine dosage was significantly correlated.

    Intrathecal clonidine appears to claim bladder hyperactivity in a dose dependent fashion in-patients with chronic spinal cord lesions.

Urinary Incontinence
     

  • MP Leonard, A Decter, K Hills et al [ Univ of Manitoba, Winnipeg, Canada; Univ of Alberta, Edmonton, Canada]
    Endoscopic Subureteral Collagen Injection : Are immunological Concerns Justified ?
    J Urol 160 : 1012-1016, 1998
       
    Conclusions- In 30% of adults treated with collagen for urinary incontinence, antibovine collagen antibodies develop. These patients are usually treated with large volumes of collagen, and there are no known clinical sequelae of this seroconversion.
       
    When collagen is injected for the treatment of reflux, smaller volumes are used, but the rate of seroconversion is the same.
       
    With short follow-up, antibodies cross-reacting with human collagen do not develop, and there are no known autoimmune outcomes in adults or children.
        
    Repeat skin testing between treatments may be appropriate, and urologists should watch for potential immune reactions.

  • KL Burgio, et al (Univ of Alabama, Birmingham; Univ of Pittsburgh, Pa: Allegheny Gen Hosp, Pittsburgh, Pa; et al)
    Behavioral vs Drug treatment for Urge Urinary Incontinence in Older Women:  A Randomized Controlled Trial.
    Jama 280: 1995-2000, 1998.
        
    About 38% of older community-dwelling women, age 60 years and older have urinary incontinence, which contributes to depression and social isolation.
         
    They have studied women divided into 3 groups, there was a group with 197 women aged 55-92 yrs who had urge urinary incontinence or mixed incontinence with urge as the predominant pattern were studied. Patients were randomized to receive 8 weeks of biofeedback assisted behavior treatment, drug treatment with oxybutynin chloride, possible range of doses, 2.5mg daily to 5mg 3 times daily or a placebo control condition.
         
    Results ; Reduction of incontinence was most pronounced early in treatment and progressed more gradually thereafter in all 3 treatment groups. There was an 80.75 reduction of incontinence episodes with behavior treatment, a 68.5% reduction with drug treatment, and a 39.4% reduction with placebo control.
         
    It was concluded that as a first line treatment for urge and mixed incontinence, behavioral treatment is a safe and effective conservative intervention that should be more readily available.
         
    Editorial comments:  The only problem with behavioral treatments is that they are time-consuming and require dedicated professional teams.
          

  • F Zivkovic, et al (Univ of Graz, Austria)
    Body Mass Index and Outcome of Incontinence Surgery.
    Obstet Gynecol  93: 753-756, 1999
         
    The authors feel that the continence rate for anterior colporrhaphy at 5 years was 58%. The rate for anterior colporrhaphy with needle suspension of bladder neck was 51% at 5 years. The rate for Burch colposuspension at 5 years was 86%. There were no significant differences in the preoperative and postoperative body mass indexes of continent and incontinent women for each procedure.
          
    Conclusion : For failure of incontinence surgery, preoperative obesity was not a risk factor, but the power of this study was limited.
         
    Editor A Bergmann comments that Zivkovic et al indicate that, at least for the Burch operation, this is not the case.  These women need a “fixed anchor” when their stress incontinence is corrected, and the Burch procedure offers that type of correction, i.e. attaching the endopelvic fascia to a fixed bony structure.
         

       

Stress Urianry Incontinence
     

  • A Pelvic Muscle Precontraction can Reduce Cough-related Urine Loss in Selected Women with Mild SUI.
      J Am Geriartr Soc. 46:870-874, 1998.
           
    Conservative treatment of stress urinary incontinence in women typically begins with repetitive strengthening, or Kegel exercises, for pelvic floor muscles.  Some women have reported decreased stress-related urine loss as early as 1 to 2 days after beginning these exercises.  Because pelvic floor hypertrophy cannot occur in such a short time span, these women have probably taught themselves a new skill – that of intentionally contracting the pelvic floor muscles just before and during an activity, which causes a rise in intra-abdominal pressure.  This exercise is called “the Knack”.
          
    The effect of the Knack was assessed at 1 week in 27 older women with mild-to-moderate SUI in a prospective, randomized, single-blind interventional trial to determine its effect on cough-related urine loss.
          
    It was concluded that selected older women with mild-to-moderate SUI can learn to effectively use a properly timed pelvic floor muscle contraction to significantly diminish urine leakage during a cough.  The Knack is a  simple and effective method for reducing stress-related urine loss in selected older women with mild SUI who are capable of performing pelvic floor muscle contractions.
         
    The Knack technique is simple and easy to learn.  In fact the 2 techniques (i.e. Kegel and the Knack) work differently.  While Kegel exercise is aimed toward strengthening the pelvic floor muscle and providing better support for the bladder, the current technique is aimed toward “self protection” by contracting the muscle before stress, rather than by permanently strengthening it.
            

  • An open study of the Bladder Neck support Prosthesis in Genuine Stress Incontinence.
    KH Moore et al (Univ of New South Wales, Sydney, Australia; Royal North Shore Hosp, Sydney, Australia)   Br J Obstet Gynaecol 106:42-49, 1999.
          
    It was found that the bladder support prosthesis (incontinence ring) maybe a good non-surgical option for some women with stress urinary incontinence However women with a scarred vagina after a previous operation or prolapse of more than one wall may find the device difficult to fit or keep in place.
            

  • Surgical Correction of Stress Incontinence in Morbidly Obese Women.
    JM Cummings, et al (Univ of south Alabam, Mobile; St. Louis Univ)  J. Urol 160:754-755, 1998.
         
    Authors conclude that Morbidly obese women with stress urinary incontinence can be successfully treated with surgery.   Sling operations appear to be the procedure of choice for this population.
     

 

 

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