Optimization of diagnostics and treatment of mixed and stress urinary incontinence in women

Cover Page


Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

Save or occurrence «de novo» of the bladder and urethra dysfunction in surgical correction of urinary incontinence (UI) among women is impotant problem of Urogynecology. Purpose: To evaluate the role of complex diagnostics in determination of the pathogenetically based tactics with mixed and stress incontinence among women. Materials and Methods: The study included 633 patients 22-88 years old with complaints of mixed (n = 356) and stress (n = 277) UI before treatment (medical, physiotherapy, sling surgery): 119 - clinically, 514 - complexly (clinical examination and complex urodynamic testing). Surgical correction of pelvic organ prolapse is performed to 270 patients. Complex examination was repeated to all of them in 1-3 and 12-36 months after treatment. Results: detrusor overactivity - DO (32.9 %) and urethral instability (23.1 %) before surgery is more common among patients with complaints of mixed incontinence, but among patients with stress complaints this pathology is also found in 5 %, and 8.3 % of cases, respectively. 55.9 % patients with complaints of mixed incontinence and 47.2 % - with stressful complaints were not operated in connection with full or significant reduction of complaints on the background of pathogenic conservative therapy. The efficacy of sling operations for stress and mixed incontinence is high but not statistically different and generally amounts to 97.1 % in 3-36 months after surgery. The frequency of postoperative dysfunction among clinically examined patients with complaints of mixed incontinence was in general 46 %, the frequency among complexely examined patients - 9.7 %. (OR 7,7, 95 % CI 2,9-20,3). Conclusion: Complex examination with the use of urodynamic testing, the therapy of bladder and urethra neuro-muscular dysfunction, the selection of patients for surgical treatment leads to a significant reduction of dysfunction number in early and late postoperative period and improve patients’ satisfaction with the treatment.

Full Text

Restricted Access

About the authors

Yelena Ivanovna Rusina

D. O. Ott Research Institute of Obstetrics and Gynecology, RAMS

Email: iagmail@ott.ru
PhD. Assistant professor of Operative Gynecology Department

References

  1. Аполихина И. А. Клиническая эпидемиология, дифференциальная диагностика и консервативное лечение недержания мочи у женщин: Автореф. дис… д-ра мед. наук. М., 2006.
  2. Пушкарь Д. Ю., Гумин Л. М. Уродинамические исследования у женщин. М.: МЕД пресс-информ; 2006.
  3. Савицкий Г. А., Савицкий А. Г., Беженарь В. Ф. Уродинамические аспекты недержания мочи при напряжении у женщин. СПб.: Синтез Бук; 2008.
  4. Чечнева М. А. Рациональная концепция комплексного обследования женщин с синдромом тазовой дисфункции и мочевой инконтиненции. Автореф. дис… д-ра мед. наук. М.; 2011.
  5. Finazzi A.E, Frey J., Topazio L., Petta F., Musco S., Vespasiani G., Miano R. Urodynamic evaluation before surgery for female stress incontinence: In how many patients could it be considered unnecessary? 43rd Annual Scientific Meeting of the International Continence Society (ICS) 2013. Available at: http://www.ics.org/Abstracts/Publish/180/000159.pdf (assesed 02.05.2014).
  6. Guldberg R., Kesmodel U. S., Hansen J. K., Gradel K. O., Brostrøm S., Kærlev L., Nørgård B. M. Patient reported outcome measures in women undergoing surgery for urinary incontinence and pelvic organ prolapse in Denmark, 2006-2011. Int Urogynecol J. 2013 Jul; 24 (7):1127-34.
  7. Houwert R. M., Venema P. L., Aquarius A. E., Bruinse H. W., Kil P. J., Vervest H. A. Predictive value of urodynamics on outcome after midurethral sling surgery for female stress urinary incontinence. Am. J. Obstet. Gynecol. 2009; 200 (6):649.e1-12.
  8. Jain P., Jirschele K., Botros S. M., Latthe P. M. Effectiveness of midurethral slings in mixed urinary incontinence: a systematic review and meta-analysis. Int. Urogynecol. J. 2011; 22 (8):923-32.
  9. Kenton K., Richter H., Litman H., Lukacz E., Leng W., Lemack G., Chai T., Arisco A., Tennstedt S., Steers W. Risk factors associated with urge incontinence after continence surgery. J Urol 2009; 182:2805.
  10. Lee J. K., Dwyer P. L., Rosamilia A., Lim Y. N., Polyakov A., Stav K. Persistence of urgency and urge urinary incontinence in women with mixed urinary symptoms after midurethral slings: a multivariate analysis. BJOG. 2011; 118 (7):798-805.
  11. Nager C. W., Brubaker L., Litman H. J., Zyczynski H. M., Varner R. E., Amundsen C., Sirls L. T., Norton P. A., Arisco A. M., Chai T. C., Zimmern P., Barber M. D., Dandreo K. J., Menefee S. A., Kenton K., Lowder J., Richter H. E., Khandwala S., Nygaard I., Kraus S. R., Johnson H. W., Lemack G. E., Mihova M., Albo M. E., Mueller E., Sutkin G., Wilson T. S., Hsu Y., Rozanski T. A., Rickey L. M., Rahn D., Tennstedt S., Kusek J. W., Gormley E. A. A randomized trial of urodynamic testing before stress-incontinence surgery. N. Engl. J. Med. 2012; 366:1987-97.
  12. Nilsson C. G., Palva K., Aarnio R., Morcos E., Falconer C. Seventeen years’ follow-up of the tension-free vaginal tape procedure for female stress urinary incontinence. Int. Urogynecol J. 2013; 24 (8):1265-9.
  13. Panayi D. C., Duckett J., Digesu G. A., Camarata M., Basu M., Khullar V. Preoperative opening detrusor pressure is predictive of detrusor overactivity following TVT in patients with pre-operative mixed urinary incontinence. Neurourol Urodyn 2009; 28:82-5.
  14. van Leijsen S. A., Kluivers K. B., Mol B. W., Hout J., Milani A. L., Roovers J. P., Boon J., van der Vaart C. H., Langen P. H., Hartog F. E., Dietz V., Tiersma E. S., Hovius M. C., Bongers M. Y., Spaans W., Heesakkers J. P., Vierhout M. E. Value of urodynamics before stress urinary incontinence surgery: a randomized controlled trial. Obstet. Gynecol. 2013 May; 121 (5):999-1008.
  15. van Leijsen S.A., Kluivers K. B., Mol B. W., Vierhout M. E., Heesakkers J. P. The value of preoperative urodynamics according to gynecologists and urologists with special interest in stress urinary incontinence. Int. Urogynecol. J. 2012; 23:423-8.
  16. Visco A. G., Brubaker L, Nygaard I., Richter H. E., Cundiff G., Fine P., Zyczynski H., Brown M. B., Weber A. M. The role of preoperative urodynamic testing in stress-continent women undergoing sacrocolpopexy: the Colpopexy and Urinary Reduction Efforts (CARE) randomized surgical trial. Int Urogynecol J Pelvic Floor Dysfunct 2008; 19:607-14.
  17. Wai C. Y., Curto T. M., Zyczynski H. M., Stoddard A. M., Burgio K. L., Brubaker L., Rickey L. M., Menefee S. A. Patient satisfaction after midurethral sling surgery for stress urinary incontinence. Obstet Gynecol. 2013; 121 (5):1009-16.
  18. Ward R. M., Hampton B. S., Blume J.D, Sung V. W., Rardin C. R., Myers D. L. The impact of multichannel urodynamics upon treatment recommendations for female urinary incontinence. Int. Urogynecol. J. Pelvic Floor Dysfunct. 2008 Sep; 19 (9):1235-41.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2014 Rusina Y.I.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ № ФС 77 - 66759 от 08.08.2016 г. 
СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия Эл № 77 - 6389 от 15.07.2002 г.


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies