THE CHOICE OF TREATMENT OF STRESS URINARY INCONTINENCE IN WOMEN
Abstract
Background. The important factors for successful treatment of female stress urinary incontinence (SUI) are described: type of urinary incontinence (UI), degree of UI, pelvic floor relaxation and associated diseases (genital and extragenital). Indications for conservative and operative treatment are presented.
Methods. Conservative treatment: pelvic floor exercises – Kegel’s exercises and functional electrical stimulation (FES) are proposed to female patients with mild and moderate degree of SUI. Separate indications for vaginal and retopubic operations are quoted.
Results. With conservative treatment of SUI – pelvic floor exercises, 33.3% of female patients were cured and 36.7% were improved. With FES treatment of SUI, 50% of patients were cured and 23.4% were improved.
Results of operative treatment of SUI: vaginal approach – our modification of vaginal operation with preparation of pubovesico-cervical fascia and suburethral application – 97.5% of female patients were primary cured and recurrence after 2 years was found in 9% of female patients. In retropubic operation – Burch colposuspension – 99.1% of female patients were primary cured and recurrence after 2 years was found in 1.3% of female patients.
Conclusions. Although the results of classical operations for SUI are favourable, trends for SUI operations are nowadays in miniinvasive surgery, especially in TVT operation.
Downloads
References
Kralj B. Trattamento chirurgico dell’incontinenza urinaria. In: Atti 72. Congresso Societa Italiana di Ginecologia ed Ostetricia et 37. Congresso Associazione Ostetrici Ginecologi Ospedalieri Italiani, 1996: 948–52.
Kralj B. Preiskovalne metode urinske inkontinence pri ženskah. In: Urinska inkontinenca pri ženskah pod geslom Promocija kontinence. Ljubljana: Društvo fizioterapevtov Slovenije, Sekcija za varovanje zdravja žensk, 1998: 27–34.
Kralj B. Klasifikacija in najpogostejše vrste urinske inkontinence pri ženskah. In: Urinska inkontinenca pri ženskah pod geslom Promocija kontinence. Ljubljana: Društvo fizioterapevtov Slovenije, Sekcija za varovanje zdravja žensk, 1998: 15–20.
Lukanovič A. Pomen ultrazvočne preiskave v diagnostiki in zdravljenju stresne urinske inkontinence. Ljubljana: Inko društvo, 2000.
Kujansuu E. The effect of pelvic floor exercises on urethral function in female stress urinary incontinence. Ann Chir Gynaecol 1983; 72: 28–8.
Mouritsen L, Fridmot-Moller C, Moller M. Long-term effect of pelvic floor exercises on female urinary incontinence. Br J Urol 1991; 68: 32–2.
Iona LG, Giorgini T, Ellero E, Gierasimowicz A, Oretti R, Di Benedetto P. Long-term study on the effect of pelvic floor rehabilitation treatment on urinary incontinence. Urodinamica 1994; 4: 319–9.
Doyle TP, Edwards LE, Harrison NW et al. Treatment of urinary incontinence by external stimulating devices. Urol Int 1974; 29: 450–7.
Plevnik S. Šuhel P, Rakovec S et al. Effects of functional electrical stimulation on the urethral closing muscles. Med Biol Eng Comput 1977; 15: 155–67.
Fall M, Erlandson BE, Nilson AE et al. Long-term intravaginal electrical stimulation in urge and stress incontinence. Scand J Urol Nephrol 1977; 44: Suppl: 55–63.
Kralj B. Conservative treatment of female stress urinary incontinence with functional electrical stimulation. Eur J Obstet Gynecol Reprod Biol 1999; 85: 53–6.
Kralj B. Functional electrostimulation in the treatment of female urinary incontinence. It J Gynaecol Obstet 2001; 2: 37–41.
Kralj B. The treatment of female urinary incontinence by functional electrical stimulation. In: Ostergard DR, Bent AE eds. Urogynecology and urodynamics. 4th ed. Baltimore: Williams & Wilkins, 1996: 555–68.
Chaliha C, Stanton SL. Urethral sphincter incompetence. In: Stanton SL, Monga AK eds. Clinical urogynecology. 2nd ed. London: Churchill Livingstone, 2000: 201–18.
Smith ARB. The role of laparoscopy in urogynaecology. In: Stanton SL, Monga AK eds. Clinical urogynecology. 2nd ed. London: Churchill Livingstone, 2000: 565–74.
McLennan MT, Bent AE, Richardson DA. Evaluation of different surgical procedures. In: Ostergard DR, Bent AE eds. Urogynecology and urodynamics. 4th ed. Baltimore: Williams & Wilkins, 1996: 517–26.
Germain MM, Ostergard DR. Retropubic surgical approach for correction of genuine stress incontinence. In: Ostergard DR, Bent AE eds. Urogynecology and urodynamics. 4th ed. Baltimore: Williams & Wilkins, 1996: 527– 32.
Nilsson CG, Kuuva N, Falconer C, Rezapour M, Ulmsten U. Long-term results of the tension-free vaginal tape (TVT) procedure for surgical treatment of female stress urinary incontinence. Int Urogynecol 2001; 12: Suppl 2: S5–8.
Rezapour M, Ulmsten U. Tension-free vaginal tape (TVT) in women with mixed urinary incontinence – a long-term follow-up. Int Urogynecol 2001; 12: Suppl 2: S15–18.
Lukanovič A, Kralj B. TVT – advantages of microinvasiveness and costeffectiveness. Int Urogynecol J 2002; 13: Suppl 1: S76.
The Author transfers to the Publisher (Zdravniški vestnik/Slovenian Medical Journal) all economic copyrights following form Article 22 of the Slovene Copyright and Related Rights Act (ZASP), including the right of reproduction, the right of distribution, the rental right, the right of public performance, the right of public transmission, the right of public communication by means of phonograms and videograms, the right of public presentation, the right of broadcasting, the right of rebroadcasting, the right of secondary broadcasting, the right of communication to the public, the right of transformation, the right of audiovisual adaptation and all other rights of the author according to ZASP.
The aforementioned rights are transferred non-exclusively, for an unlimited number of editions, for the term of the statutory
The Author can make use of his work himself or transfer subjective rights to others only after 3 months from date of first publishing in the journal Zdravniški vestnik/Slovenian Medical Journal.
The Publisher (Zdravniški vestnik/Slovenian Medical Journal) has the right to transfer the rights, acquired parties without explicit consent of the Author.
The Author consents that the Article be published under the Creative Commons BY-NC 4.0 (attribution-non-commercial) or comparable licence.
