China
Africa
Explore chapters and articles related to this topic
Non-Neurogenic Lower Urinary Tract Dysfunction
Published in Karl H. Pang, Nadir I. Osman, James W.F. Catto, Christopher R. Chapple, Basic Urological Sciences, 2021
Two mechanisms for SUI which are not mutually exclusive. Most patients have both:Urethral hypermobilityWeakness in pelvic floor support structures.Caused by injury to pelvic floor structures of innervation.Intrinsic sphincter deficiencyDefective DUS.Caused by injury to the sphincter or innervation.
Urogynaecology and pelvic floor problems
Published in Helen Bickerstaff, Louise C Kenny, Gynaecology, 2017
Urethral sphincter weakness is associated strongly with a history of vaginal childbirth and various related risk factors, and with some non-obstetric factors. Obstetric risk factors act by a combination effect of stretching/damage to the pudendal nerves and overstretching, or even avulsion, of the pelvic floor muscles from their insertions on the pelvic side wall. Direct muscle damage results in loss of pelvic floor support and hence urethral hypermobility. Pudendal nerve damage causes both weakening of the pelvic floor muscles and urethral sphincter. It is now possible to identify levator muscle defects in symptomatic women by means of magnetic resonance imaging or transperineal/transvaginal ultrasound. Most risk factors may not be modifiable (with exceptions noted by asterisks below).
Urinary Incontinence in Older Adults
Published in K. Rao Poduri, Geriatric Rehabilitation, 2017
Nicole Strong, Sara Z. Salim, Jean L. Nickels, K. Rao Poduri
SUI occurs with activities such as sneezing that cause an increase in intra-abdominal pressure.1,9,30,32 The etiology of SUI is either hypermobility of the urethra when normal muscle supports at the urethral junction fail or due to intrinsic sphincter deficits.29 When either abnormality is present, total bladder pressure may exceed the urethral closing pressure and produce incontinence.30 Potential causes of urethral hypermobility include multiple vaginal deliveries or vaginal surgery, postmenopausal decrease in estrogen, prostate surgery, neurogenic disease, and age-related changes.29,30,32 Intrinsic sphincter deficit is a less common cause of SUI.29 It may be seen with the normal aging process, decreased estrogen, side effects of irradiation, meningomyelocele, prior vaginal surgery, sacral cord lesion, or trauma.29,33 The number one cause of SUI in men is iatrogenic during surgical treatment of benign prostatic hypertrophy (BPH) or prostate cancer due to damage of the sacral nerves or pelvic musculature.9 Radical prostatectomy is associated with the highest rates of SUI (approaching 50%),33 while transurethral resection of the prostate (TURP) has been reported to result in much lower rates of SUI (<0.5%).9,34
Advances in stem cell therapy for male stress urinary incontinence
Published in Expert Opinion on Biological Therapy, 2019
Fabrizio Gallo, Gaetano Ninotta, Maurizio Schenone, Pierluigi Cortese, Claudio Giberti
Stress urinary incontinence (SUI) is a rather common disorder among men, particularly following radical prostatectomy [1]. Generally, SUI can be divided into hypermobile stress incontinence (caused by anatomic defects), incontinence caused by intrinsic sphincter deficiency (wherein incontinence is due to a poorly functioning urethra) and mixed incontinence [2]. The distinction between the three types has become less clear with time. Urethral hypermobility derives from poor bladder neck support, which leads to incomplete transmission of intra‐abdominal pressure to the proximal urethra. SUI caused by intrinsic sphincter deficiency is characterized by the inability of urethral musculature to completely close the urethra [3]. However, most experts believe that, in many cases, each of the types of incontinence contributes to the development of the disease [4].
Management of stress urinary incontinence in spinal cord injured female patients with a mid-urethral tape – a single center experience
Published in The Journal of Spinal Cord Medicine, 2018
Vasileios I. Sakalis, Michael S. Floyd, Philippa Caygill, Chloe Price, Ben Hartwell, Peter J. Guy, Melissa C. Davies
Our study demonstrates that mid-urethral tapes should be included in the armamentarium of all neuro-urologist in the management of urinary incontinence in SCI female population. Our overall success was 52.6% with an additional 15.8% reporting an improvement; whilst this is lower than reported outcomes in the literature in non-neuropathic population (72.4% TVT and 78.2% TOT) it afforded our patient a minimally invasive day case procedure to correct their problem.22 Furthermore, most patients (33/36) had weak sphincter mechanism rather than urethral hypermobility. Our group's mean vesical leak point pressure was 26.1cmH2O. Nager et al. proved that low vesical leak point pressure increases the risk of failure regardless of sling route.23 A 31.5% reported that a tape didn't improve their QoL or even worsen it.
Safety and efficacy of robotic-assisted Burch for pure stress urinary incontinence: a large case series
Published in Journal of Obstetrics and Gynaecology, 2021
Toy G. Lee, Bekir S. Unlu, Victoria A. Petruzzi, Mostafa A. Borahay, Furkan Dursun, Antonio F. Saad, Gokhan S. Kilic
Diminished urethral support and urethral sphincter weakness are generally attributed to urethral hypermobility, which is the main cause of SUI. Urethropexy (retropubic colposuspension) is a traditional repair in women with incontinence secondary to urethral hypermobility. It was first described in 1961 (Burch 1961). Periurethral tissue is elevated and reinforced by a mini-laparotomy incision and open dissection of the retropubic space. Although a systematic review of 53 trials had reported success rates of 85−90% one year postoperatively and 70% five years postoperatively, the Burch procedure lost its popularity following the introduction of the mid-urethral sling (MUS) due to its surgical practicality (Lapitan and Cody 2012). Later, minimally invasive techniques for Burch described the advantages over open surgeries, such as shorter length of hospital stays, faster recovery, and faster return to activity (Tan et al. 2007). A recent Cochrane review of laparoscopic urethropexy included 22 randomised controlled trials (Dean et al. 2017). Cure rates of laparoscopic and open Burch urethropexy were similar, but this review revealed that laparoscopy was associated with a shorter length of hospital stays, lower morbidity, significantly fewer postoperative complications, lower estimated blood losses, shorter duration of catheterisation and significantly less pain (Dean et al. 2017). Another minimally invasive technique for Burch urethropexy is the robotic-assisted Burch urethropexy, which was first reported with two cases in 2007 by Khan et al. (2007). Our group published our initial experience with robotic retropubic urethropexy compared to open retropubic urethropexy in 2013 (Patel et al. 2013). As a result, the Burch procedure continues to have a place in the operative armamentarium of the gynaecologist and urologist.