The use of three different non-operative techniques for the treatment of female genuine urinary stress incontinence has bem assessd by objective means.One hundred and four patients complaining of stms incontinence werc allocated at random to four groups.Sixty-five per cmt of patients treated with pelvic floor exercises were significantly improved after 3 months, interfercntial therapy was effective in 32 per cent of cases. Oestrogcn treatment was initially bcncficiPl in 12 per cent of patients but rccurrcna of symptoms occurred won after stopping the treatment.The control group of patients did not show any significant changes according to perineal pad weight testing, which was used for the objective assessment of incontinence. Long tcnn follow up of these patients, after 9 months from commencing treatment still showed that pelvic floor excrciscs are the most effective nonsurgical treatment for this condition. @ lnaitute of Obstetrics and Gynaecology Trust, 1989 J Obstet Gynaecol Downloaded from informahealthcare.com by McMaster University on 02/05/15For personal use only.

The results of the pelvic floor exercises for the treatment of genuine stress incontinence of urine were compared between two different hospitals geographically 50 miles apart. A perineal pad weighing test was used to assess the quantity of urine lost during exercise before and after treatment. A similar percentage of patients in the two studies responded to treatment and became either completely dry or significantly improved at the end of 3 months interval; 69% at LCH and 65% at LGH. Overall, 67% of patients achieved complete continence or a significant improvement as a result of pelvic floor exercises alone.Stress urinary incontinence is the commonest form of female incontinence. Treatment has varied between conservative management with various forms of physiotherapy (Brown 1977) to a variety of surgical procedures (Stanton & Cardozo 1979). Previous reports have shown different success rates for treatment of stress urinary incontinence by pelvic floor exercises since Kegel (1951) introduced this idea. It is widely believed aniong clinicians that various Leicester General Hospital, Leicester LE5 4PW

This prospective study assesses the surgeon and patient acceptability of a new implantation device for transurethral Macroplastique injection, as well as the safety and effectiveness of the technique. Ten women with genuine stress incontinence were recruited at each of four participating urogynaecological centres. Treatment was performed in an outpatient or day case setting and follow up took place at six weeks and three months after treatment. Those in whom treatment had failed were offered re-treatment. The operator acceptance of the device was rated as excellent or acceptable in 95% after the first treatment and 100% after re-treatment. Urethral insertions were rated acceptable in 92.5%. Pain was scored as mild to moderate in 89% of all insertions. The overall success rate was 74.3% at three months with an implantation rate of 1.35 which appears to be comparable to published endoscopic data. We have concluded from this study that the Macroplastique implantation device is safe to use and provides simplified, yet effective alternative to the endoscopic implantation of urethral bulking agents.

No abstract