Bjarne C. Eriksen

Long-Term Effectiveness Of The Burch Colposuspension In Female Urinary Stress Incontinence

Of 91 women who underwent Burch colposuspension, 86 were available for clinical, urodynamic and isotope renographic follow‐up examinations 5 years after surgery for evaluation of late complications and long‐term effectiveness in urinary stress incontinence. A repeat urodynamic examination was accepted by 76 patients. Stress incontinence was cured in 71 % of the patients with a stable bladder preoperatively, and in 57% with stress incontinence and detrusor instability (non‐significant difference). Cure rate was not significantly related to age, hormonal status or previous anterior vaginal repair. The urodynamic measurements at follow‐up showed a significant increase in the functional urethral length in the cured group, as compared with the improved group. The mean maximum urethral closure pressure was reduced in both groups. Symptomatic detrusor instability was found in 18% of the preoperative stable bladders, while 67% of the unstable bladders had become stable. Only 29% of the patients with a preoperative unstable bladder had a normal lower urinary tract function at follow‐up. Late voiding difficulties were observed in 3% of the study group; enterocele, requiring surgical repair, developed in 7%. One patient suffered a damaged kidney due to undetected ureteral obstruction after surgery. Irritative bladder symptoms such as urgency, frequency, stranguria and nocturia represent a long‐term problem after colposuspension. At the 5‐year follow‐up, only 52% of the study group were completely dry and free of complications, and about 30% needed further incontinence therapy. This may be due to some neurogenic factor which is not corrected by surgery.

A Study of Female Urinary Incontinence in General Practice: Demography, Medical History, and Clinical Findings

The aim of this study was to provide valid data on the demography, medical history and clinical findings among adult women presenting with urinary incontinence to general practitioners. In a rural community in Norway, all women > 20 years who consulted their general practitioner for urinary incontinence during a 3 year period were included in a prospective study. A thorough medical history and both a general and focused clinical examination were undertaken. Gynecological examination, stress provocation test, and 48 h frequency/volume chart and pad weighing test were also performed. 105 women were included (4.4% of women > 20 years in the total population). Mean age was 57 years, 64% were postmenopausal. A lot of comorbidity was reported. Duration of incontinence was > 5 years in 49%. By a severity index, 64% were classified as severe, 28% as moderate and 8% as having slight incontinence. 59% were using protective pads or garments. Mean leakage per 24 h was 31 g. 38% had significant genital prolapse. Contractility of the pelvic floor muscles was weak in 28%. Diagnostic classification revealed 50% stress incontinence, 10% urge and 40% mixed incontinence. 42% of the patients were a great deal or much bothered by their incontinence. Patients with stress incontinence were less bothered than others. Women presenting with urinary incontinence at a primary care level are prevalent, and often have significant incontinence. It is a challenge for the general practitioners to investigate and treat these patients optimally.

Validity of a scored urological history in detecting detrusor instability in female urinary incontinence

Background. Kauppila and co‐workers published in 1982 a detrusor instability score (DIS) for women with urinary incontinence. The aim of this study was to determine the validity of the DIS in an outpatient clinic for urogynecology.

Management of Urinary Incontinence in Women in General Practice: Actions taken at the First Consultation

The investigators set out to find out how Norwegian general practitioners (GPs) manage women suffering from urinary incontinence by using responses to a questionnaire containing six typical case histories. Questionnaires were sent to 191 GPs, of whom 139 (73%) replied. In 93% of all case histories the GPs responded that they would conduct some kind of investigation or treatment. Gynaecological examination and microscopy of the urine were the most frequent investigations stated. Drugs were prescribed in 41% of cases, mainly following appropriate indications. Instruction in pelvic floor exercises was predominant for the younger patients, while old patients were prescribed incontinence pads. Thus it seems that the therapeutic ambitions of the practitioner are reduced as the patients get older. Bladder training was only stipulated in 14% of cases. Adequate treatment is defined as relevant drugs and exercises in combination with pads, or referral. According to this definition 46% of the patients were treated adequately, 28% by the GPs themselves. Twenty five percent of the patients were referred to a gynaecologist.

Electrostimulation of the Pelvic Floor in Female Urinary Incontinence

Surgical correction of urinary stress incontinence by the colposuspension procedure has a cure rate of about 70% at a 5-year follow-up. In addition, about 20% had improved significantly. The cure seems to be related to a lasting increase in the functional urethral length. The colposuspension procedure aggravates posterior vaginal wall weakness and predisposes to development of symptomatic enterocele in 7% of the patients. The long-term results d o not seem to be related to age, hormonal status or previous anterior vaginal repair. In patients with combined stress and motor urge incontinence preoperatively, the cure rate was reduced to 57% and only 29% of this subgroup were free from lower urinary tract symptoms 5 years after surgery. Conservative therapy is therefore to be recommended for patients with mixed incontinence before surgery is performed. In patients with genuine stress incontinence, 18% developed symptomatic detrusor instability following colposuspension. The incontinence problem may thus be exacerbated by surgery for stress incontinence. About 50% of the patients had some sort of lower urinary tract dysfunction at follow-up, and about 30% were in need of further incontinence therapy. These findings are probably due to the fact that a majority of patients with urodynamic abnormalities have a demonstrable neurogenic component which is not corrected by surgery. This work demonstrates the need for new therapeutic methods in female lower urinary tract dysfunction. PART I1

Management Of Urinary Incontinence In Gynecological Practice In Norway

In order to investigate how Norwegian gynecologists manage female urinary incontinence in their daily practice, a questionnaire about six typical case histories was sent to the members of the Norwegian Gynaecological Association. The questionnaire comprised questions about investigations, use of laboratory tests and treatment options. Of 268 questionnaires sent out, 190 were returned (71%). Frequency‐volume charts were recommended by 42% of the doctors and pad‐weighing tests by 12%. Urodynamic examination was recommended for 55% of the cases, but mainly in mixed incontinence (76 and 77%). Pelvic floor exercises were suggested more often to younger patients than to the elderly. Drugs were infrequently suggested, mainly following appropriate indications. Drugs and pads were recommended especially for the elderly. The recommendation rate for surgical repair was higher for young age and greater degree of stress incontinence. The modest therapeutic ambition on behalf of the elderly women lacks basis in clinical research. A general management program for female urinary incontinence would possibly standardize and improve the quality of incontinence care by gynecologists in Norway.

Long-Term Effectiveness of the Burch Colposuspension in Female Urinary Stress Incontinence

Of 91 women who underwent Burch colposuspension, 86 were available for clinical, urodynamic and isotope renographic follow-up examinations 5 years after surgery for evaluation of late complications and long-term effectiveness in urinary stress incontinence. A repeat urodynamic examination was accepted by 76 patients. Stress incontinence was cured in 71% of the patients with a stable bladder preoperatively, and in 57% with stress incontinence and detrusor instability (non-significant difference). Cure rate was not significantly related to age, hormonal status or previous anterior vaginal repair. The urodynamic measurements at follow-up showed a significant increase in the functional urethral length in the cured group, as compared with the improved group. The mean maximum urethral closure pressure was reduced in both groups. Symptomatic detrusor instability was found in 18% of the preoperative stable bladders, while 67% of the unstable bladders had become stable. Only 29% of the patients with a preoperative unstable bladder had a normal lower urinary tract function at follow-up. Late voiding difficulties were observed in 3% of the study group; enterocele, requiring surgical repair, developed in 7%. One patient suffered a damaged kidney due to undetected ureteral obstruction after surgery. Irritative bladder symptoms such as urgency, frequency, stranguria and nocturia represent a long-term problem after colposuspension. At the 5-year follow-up, only 52% of the study group were completely dry and free of complications, and about 30% needed further incontinence therapy. This may be due to some neurogenic factor which is not corrected by surgery.