Current trends in the evaluation and management of female urinary incontinence

Smith, Phillip P.; McCrery, Rebecca; Appell, Rodney A.

doi:10.1503/cmaj.060034

Cited by 35 publications

(29 citation statements)

References 63 publications

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“…Stress urinary incontinence (SUI) and cystocele are representative disorders associated with lower urinary tract dysfunction in women 1,2 . High‐stage cystocele (HSC) or SUI may change voiding dynamics and cause voiding dysfunction 3,4 .…”

Section: Introductionmentioning

confidence: 99%

Voiding dynamics in women with stress urinary incontinence and high‐stage cystocele

et al. 2011

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Objectives:The aim of this study was to identify the urodynamic features of women with stress urinary incontinence (SUI) or with high-stage (stage 3 or greater) cystocele (HSC) as compared with symptom-free women. Methods: Fifty-six neurologically intact women with SUI and 47 women with HSC but without SUI were prospectively evaluated. All patients underwent full urodynamics, in addition to basic clinical evaluations. The urodynamic parameters of SUI and HSC were compared to the ones obtained from 78 urologically symptom-free normal women over the same period. Results: Patients with HSC, after correction of cystocele using a temporary vaginal pessary, had consistently lower maximum urinary flow rate with a lower detrusor pressure during micturition than the controls or those with SUI. On the other hand , patients with SUI had an equivalent to higher maximum urinary flow rate, normal detrusor contraction strength with a lower detrusor pressure during micturition than the controls. Both maximum Watts factor and bladder contractility index were significantly lower in the whole HSC cohort in comparison to the controls and patients with SUI. The urodynamic characteristics observed among the three groups were all maintained even after adjusting for age. Conclusions: Women with SUI demonstrate voiding with low-pressure, normal contraction strength with an equivalent to high urinary flow rate. Women with HSC demonstrate voiding with low pressures with weak contraction strengths and low urinary flow rates, suggesting a higher prevalence of detrusor underactivity. Chronically decreased or increased urethral resistance might alter voiding dynamics and performance.Key words: cystocele, lower urinary tract symptoms, urinary incontinence, urodynamics. IntroductionStress urinary incontinence (SUI) and cystocele are representative disorders associated with lower urinary tract dysfunction in women. 1,2 High-stage cystocele (HSC) or SUI may change voiding dynamics and cause voiding dysfunction. 3,4 However, there is a paucity of published data outlining the existing dysfunction, especially for HSC, with the quantified parameters obtained from the voiding phase for cohorts involving women with lower urinary tract disorders.In the present study, we attempted to identify the urodynamic characteristics of the lower urinary tract in adult women with SUI or with HSC, by comparing strictly with selected cohorts of symptom-free women who had urologically normal voiding. The urodynamic characteristics were focused on detrusor contractility, urethral resistance and pressure flow relationships. The information regarding these particular voiding dynamics of either SUI or HSC may give a beneficial contribution in a clinical setting, especially in predicting the outcome of surgery. Methods Control patientsAfter obtaining the patient's informed consent, which was approved by the ethics committee of our institution, 86 patients for whom simple or radical hysterectomy was scheduled from January 1999 to December 2006 were prospectively included in...

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Section: Introductionmentioning

confidence: 99%

Voiding dynamics in women with stress urinary incontinence and high‐stage cystocele

et al. 2011

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“…However, the method is laborious due to the need for motivation and continuous efforts. Bladder training can be administered together with pelvic floor muscle exercises [23,24].…”

Section: Behavioral Therapymentioning

confidence: 99%

Medical Therapy in Overactive Bladder of the Elderly

Bayrak

Mock

Dmochowski

2014

Curr Bladder Dysfunct Rep

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The number of patients exhibiting overactive bladder (OAB) symptoms and its associated medical, social, and economic problems will increase with the growing elderly population. The basic therapeutic approach in all elderly people should include the exploration of correctable factors to build a corrective approach for OAB. Lifestyle modifications and behavioral therapies should be attempted initially, but if the patients are persistently bothered by their symptoms with no benefit from initial therapy, pharmacological agents can be added to conservative therapies. Anticholinergics are the most studied and prescribed agents. In the end, treatment of OAB in the elderly requires a careful and holistic evaluation before deciding on the most appropriate management as a number of concomitant factors that can cause OAB symptoms in this age range."urgency, with or without urge incontinence, usually with increased frequency and nocturia." [1]. It is estimated to affect approximately one third of individuals over 65 years old [2,3]. Additionally, current population forecasts estimate a global increase in the proportion of people aged over 65 years, with the greatest rise being in those aged over 80 [4]. It would be reasonable to expect patients exhibiting OAB symptoms, and the subsequent medical, social, and economic burden associated with these patients to increase as well. In a large Japanese study, Homma et al. reported that OAB compromised healthrelated quality of life (QoL) in more than half (53 %) of respondents and affected emotions (42 %), sleep/vitality (37 %), and physical capability (34 %) [5]. The detrimental effects on the individual is closely related to the occurrence of urgency and urge urinary incontinence (UUI), which can make it difficult for them to maintain regular daily activities due to the need to be in close proximity to toilet and the possible embarrassment of urine loss [6••]. More concerning, OAB and especially nocturia has been linked to the rise in the risk of falls, fractures, and even death [3,[7][8][9]. Pathophysiology of Overactive Bladder in the ElderlyNormal bladder function involves a complex coordination of the urinary tract and nervous system. When the bladder fills, it functions as a compliant structure which is capable of relaxation and with pressure that remains lower than the urethral resistance. During normal micturition, a decrease in urethral resistance and tonic contraction of the detrusor smooth muscle occurs. OAB symptoms, on the other hand, are frequently caused by involuntary contraction due to detrusor overactivity (DO), either occurring idiopathically or after neurological insult. A distinction is generally made to distinguish DO from either of these causes, but in the elderly, it is often unclear as it can be a result of normal aging or a prior/ongoing neurological event which is sometimes clinical unapparent. By comparison,

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“…12 All the anticholinergic medications appear to have similar efficacy. 10 Behavior therapies are also effective, however, and they should be considered as first-line treatment.…”

Section: Other Than Age What Are the Predominant Risk Factors For Ui?mentioning

confidence: 99%

Toward Optimal Health: Approaching the Issue of Incontinence with Patients and Actively Managing the Condition

Godfrey¹,

Richter²

2009

Journal of Women's Health

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U rinary incontinence (UI) is typically viewed as a nuisance of aging, but its effects on women's lives can be profound. Usually a physiological dysfunction, it can cause women to restrict their activities of daily living, including physical activity, increases the risk of falls (when rushing to the bathroom), and often leads to withdrawal from social contact. The medical fallout from these lifestyle limits can have a significant adverse effect on overall health. There is also the possibility that complaints of incontinence may be a precursor for diabetes or multiple sclerosis. Why then does this female-specific medical condition get so little attention from women and you, their healthcare providers?For too long, the foremost source of information about bladder control has been television commercials for undergarment protection (adult diapers), which may help to contain urinary leakage but does nothing to engender a positive dialogue or to correct a treatable condition. Fortunately, there is a choice of products available that promise treatment for busy, often working, women who want to remain active and who need not live with the limitations UI imposes.Clinical recognition of urinary and fecal incontinence is hindered by a variety of factors, including embarrassment, social stigma, discomfort in disclosing symptoms, lack of awareness about intervention, patient's use of nonspecific language to describe concerns to practitioners, competing demands and limited time during care visits, poor continuity of care, and inadequate directness from practitioners when assessing continence status. 1 The need to bridge the gap in care will only increase as aging women remain active well into and beyond their 80s.UI affects nearly two thirds of women, yet its prevalence is underestimated in the clinical setting. Only 1 in 4 symptomatic women voluntarily mention concerns about urinary leakage to their physician, despite the significant impact it may have on their quality of life and the potential for complications that may arise, such as urinary retention, chronic lower urinary tract infection (UTI), and vesicoureteral reflux. 2 With behavioral, medical, and surgical interventions available, identifying women who have incontinence is important. Why should any of us willingly suffer through such symptoms as wet underwear after every sneeze or deep knee bend, a condition that persists or worsens over 40 years or more? Maybe, with gold medalist Bonnie Blair, the world's fastest speed skater, speaking out publicly about her struggle with UI and the availability of effective therapies, we will see women begin to acknowledge that they have bladder control issues and seek treatment. Although treatment options confer relief from urinary leakage in to up to 80% of patients, a thoughtful evaluation that provides a supportable diagnosis is essential before appropriate therapy can be initiated.Holly E. Richter, M.D., Ph.D., shares her recommendations for improving diagnosis in women who have incontinence and offers consideration of the bes...

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Current trends in the evaluation and management of female urinary incontinence

Cited by 35 publications

References 63 publications

Voiding dynamics in women with stress urinary incontinence and high‐stage cystocele

Voiding dynamics in women with stress urinary incontinence and high‐stage cystocele

Medical Therapy in Overactive Bladder of the Elderly

Toward Optimal Health: Approaching the Issue of Incontinence with Patients and Actively Managing the Condition

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