Complications of Female Incontinence Surgery
Kevin R. Loughlin in Complications of Urologic Surgery and Practice, 2007
When evaluating a woman with urinary incontinence, it is necessary to determine whether the leakage is due to bladder or outlet causes. One must consider the patient’s symptoms, the urologist’s findings, and the actual diagnosis. Symptoms are determined by the urologic history, and usually consist of stress incontinence, urgency incontinence, and/or leakage without sensation. The urologist must base his findings on the physical examination (with demonstration of leakage if possible), basic laboratory testing (urinalysis and culture if indicated) measurement of postvoid residual urine, and appropriate diagnostic studies (urodynamics and/or cystoscopy) if indicated. Determination must be made whether the incontinence is due to bladder causes—such as detrusor overactivity, diminished vesical compliance, or overflow incontinence; or due to outlet causes—such as urethral hypermobility or intrinsic sphincteric incompetence. Pelvic organ prolapse should also be identified in the incontinent patient, as prolapse and incontinence often coexist.
Urodynamic Investigations: Do They Make a Difference in the Outcome?
Victor Gomel, Bruno van Herendael in Female Genital Prolapse and Urinary Incontinence, 2007
As stated before, urodynamic tests are just one of several investigative methods and they should not stand alone. If a patient presents with urinary incontinence it is important to make a proper diagnosis as a result of the clinical assessment; in many cases sophisticated urodynamic tests are not necessary. A general assessment, frequency/volume chart, physical examination and proper stress tests will provide the physician with substantial information towards the diagnosis. If urinary tract infection is excluded and residual urine is absent, a presumptive diagnosis of stress, urge or mixed incontinence can be made and the patient started on conservative treatments such as pelvic floor physiotherapy, bladder training, life style adaptations and appropriate medications. However, it remains unclear if these data are sufficient to decide on undertaking surgery. One may argue that a patient with USI and no history of other symptoms or signs, corroborated with a complete diagnostic workout will have no strong need for urodynamic testing. However, there can be little doubt that urodynamic testing is necessary in patients who do not respond to conservative treatment or those who present with a more complex form of USI.
The urinary bladder
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie in Bailey & Love's Short Practice of Surgery, 2018
Overall, urinary incontinence occurs in 5% of men and 20% of women. Up to 40% of women over the age of 60 years and 50% of institutionalised elderly patients experience regular episodes of urinary incontinence. Health problems include skin breakdown and depression, and loss of esteem and sexual activity. Continence is dependent on normal mobility and brain function allowing a perception of when it is socially acceptable to void, normal bladder sensation, normal voluntary detrusor contraction producing good bladder emptying, a normally competent sphincter mechanism, which relaxes appropriately during a voluntary detrusor contraction allowing good bladder emptying, and good bladder capacity with normally low pressures during filling. This is clearly a fine balance and several factors can cause incontinence. In children, non-neurogenic incontinence is often associated with other dysfunctional conditions such as infections, constipation, psychological factors, increased fluid intake, intentional misconduct or an overactive bladder. Several investigations are required for diagnosis of urinary incontinence.
A consecutive case series analysis of a behavioral intervention for enuresis in children with developmental disabilities
Published in Developmental Neurorehabilitation, 2018
Joanna Lomas Mevers, Colin Muething, Nathan A. Call, Mindy Scheithauer, Shannon Hewett
An underlying medical cause could be another potential explanation for some participants failing to achieve long-term continence. Whereas the majority of participants achieved some degree of continence during treatment, it is possible that a subset had deficits in the physiological development of bladder control. As infants, humans have spontaneous bladder contractions, meaning that the release of urine is not under operant control.41 However, with development, the bladder becomes more stable, and most children become able to control contractions. For a small subset of children, this development may be delayed and operant control over the bladder may not occur.41 We did not assess for bladder control in our sample prior to starting treatment. However, it seems reasonable to hypothesize that this intervention would be unsuccessful for individuals who lack operant control over their bladder. Future research may consider involving a multidisciplinary team with professionals who can conduct a thorough medical examination to rule out any physiological causes of the incontinence that may be reversible. This research could also attempt to identify any physiological issues that may prevent voluntary control of the bladder [see 42, for details on medical management of urinary incontinence].
Epidemiological study of Spinal Cord Injury individuals from halfway houses in Shanghai, China
Published in The Journal of Spinal Cord Medicine, 2018
Feng-Shui Chang, Qi Zhang, Mei Sun, Hui-Jiong Yu, Long-Jun Hu, Jing-Hua Wu, Gang Chen, Lian-Ding Xue, Jun Lu
The symptoms of spinal cord lesions depend on the extent of the injury or non-traumatic cause, and they can include deficits in the ability to perform basic bodily functions, such as breathing, sensation, bowel and bladder control. Deficit in sensation, or sensory loss, refers to the loss of sensations such as pain, touch or temperature. Deficits in motion, or motor loss, refer to muscle weakness and the inability to use the body. We defined urination disorders as urinary retention, urinary incontinence or both, and disorders of defecation as constipation, fecal incontinence, or both. The SCI complications included bedsores, pain, urinary tract infections, and spasticity. The main medical and rehabilitation treatments received included surgery, medicine, traditional therapy (e.g., acupuncture, moxibustion, and massage), physical therapy, rehabilitation training, assistive devices (e.g., orthosis and prosthesis) and other methods appropriate for SCI individuals.
At-home genital nerve stimulation for individuals with SCI and neurogenic detrusor overactivity: A pilot feasibility study
Published in The Journal of Spinal Cord Medicine, 2019
Dennis J. Bourbeau, Kenneth J. Gustafson, Steven W. Brose
The primary goal of this pilot study was to determine the feasibility of at-home GNS to inform the design of a clinical trial by reporting on the ways in which subjects used a portable, user-controlled stimulator system and on the challenges that they faced. The secondary goal of this study was to add evidence to the literature in support of the effectiveness of at-home GNS to improve urinary continence, bladder capacity, quality of life and user satisfaction. The literature reports on urinary continence improvement in three subjects across two studies and this study adds to those data. This work improves our understanding of at-home GNS by reporting urinary continence data, user satisfaction, and impact on quality of life. These data provide justification for testing GNS over a one-year period measuring urinary continence and user satisfaction and inform study design of a one-year study.
Related Knowledge Centers
- Bladder Training
- Enuresis
- Geriatrics
- Kegel Exercise
- Nocturnal Enuresis
- Overactive Bladder
- Overflow Incontinence
- Quality of Life
- Urination
- Quality of Life
- Stress Incontinence