Christer Edlund

A Longitudinal Population-based Survey of Urinary Incontinence, Overactive Bladder, and Other Lower Urinary Tract Symptoms in Women

BACKGROUND Female urinary incontinence (UI), overactive bladder (OAB), and other lower urinary tract symptoms (LUTS) are highly prevalent conditions with a profound influence on well-being and quality of life. There are a few studies describing progression as well as remission, in the short term, of UI in the general population as well as in selected groups; at present, there are very few population-based studies describing the natural course of other LUTS in the same women, and there are no long-term longitudinal studies. OBJECTIVE To describe the prevalence of UI, OAB, and other LUTS in the same women studied prospectively over time and, thus, to assess possible progression or regression. DESIGN, SETTING, AND PARTICIPANTS A longitudinal population-based study was performed in one primary health care district in the city of Gothenburg, Sweden. The participants were a sample of women aged > or = 20 yr who were randomly selected from the Swedish National Population Register, assessed in 1991 (n=2911), and available for reassessment in 2007 (n=1408). METHODS A self-administered postal questionnaire regarding UI, OAB, and other LUTS was returned by 77% of the contacted women in 1991. The same women who responded in 1991 and who were still alive and available in the Swedish National Population Register 16 yr later were reassessed using a similar self-administered postal questionnaire. RESULTS AND LIMITATIONS In 2007, 1081 of the available 1408 women responded to the questionnaire (77%). The overall prevalence of UI, OAB, nocturia, and daytime micturition frequency of eight or more times per day increased by 13%, 9%, 20% (p<0.001), and 3% (p<0.05), respectively, from 1991 to 2007. The incidence of UI and OAB were 21% and 20%, respectively, and the corresponding remission rates were 34% and 43%, respectively. Women with OAB symptoms were classified as OAB dry or OAB wet, depending on the presence or absence of concomitant UI. The prevalence of OAB dry did not differ between the two assessment occasions (11% and 10%, respectively), but the prevalence of OAB wet increased from 6% to 16% (p<0.001). CONCLUSIONS UI and other LUTS constitute dynamic conditions. In this study, there was a marked overall increase in the prevalence of UI, OAB, and nocturia in the same women from 1991 to 2007. Both incidence and remission of most symptoms were considerable.

Lower urinary tract symptoms: lack of change in prevalence and help‐seeking behaviour in two population‐based surveys of women in 1991 and 2007

To test the hypothesis that the overt prevalence and help‐seeking pattern for lower urinary tract symptoms (LUTS) might have changed over time, by comparing the prevalence of urinary incontinence (UI), overactive bladder (OAB) and other LUTS (principally storage symptoms) and help‐seeking pattern in two equivalent groups of women 16 years apart.

The Treatment of Sphincter Incontinence with Periurethral Silicone Implants (Macroplastique)

Objective: Patients with genuine stress urinary incontinence (GSI) refractory to conservative measures often undergo a colposuspension when the reason for urine leakage is hypermobility of the bladder neck. Patients who suffer from an insufficiency of the intramural sphincter are instead often suitable for pubovaginal sling procedures, implantation of an artificial sphincter or peri/intraurethral injection of some expansion substance. Here, we present our experience of periurethral injection of silicone microimplants (Macroplastique). Method: We studied 8 men and 22 women with urodynamically stable detrusor, and validated GSI on a standardized quantification test. Under direct endoscopic control Macroplastique was injected. Follow-up was performed by a questionnaire and a new standardized quantification test. Results: Nineteen of the 22 patients with follow-up in excess of 2 years reported a considerable amelioration and their subjective impressions were also validated by the postoperative standardized quantification test (preoperative 147 g, postoperative 9 g; p < 0.001). No side effects were reported except for mild dysuria for practically all the patients, in all cases transient. A few patients also reported a short initial sensation of incomplete bladder emptying. Conclusion: Considering the difficulty in treating sphincter insufficiency, particularly iatrogenic, the results in this study appear to justify the attempt of injection therapy. It may very well be performed as an outpatient procedure and, moreover, side effects are rare. If silicone microimplants are used there is no obstacle to proceed with artificial sphincter implantation, should the patients symptoms remain unaffected by the injection procedure.

First scandinavian experience of electrical sacral nerve stimulation in the treatment of the overactive bladder

Objective: This study aimed to evaluate the efficacy of electrical sacral nerve stimulation (SNS) in the treatment of urinary incontinence and urinary retention refractory to conservative treatment, and to assess the impact of urodynamic abnormalities and electrode position. Material and methods: Thirty patients (10 men, 20 women) with a mean age of 59 years (range 21-79 years), all of whom had longstanding symptoms ranging from 2 to 46 years (mean 12.4 years), were subjected to a percutaneous test stimulation. Ten patients responded well, resulting in a permanent implant in nine patients. Electrode positions were determined by plain X-ray and computed tomography. Results: Radiologically, a variety of positions of the temporary electrodes was seen. In the implanted patients, long-term symptom reduction varied over time, ranging from total relief to partial or total recurrence of symptoms. Conclusions: SNS is a new promising option for the treatment of urge incontinence. Refined instruments for proper patient selection and the optimal way to position the electrode remain to be developed.

Continent cutaneous urinary diversion in patients with spinal cord injury

Study design:Retrospective study.Objective:To examine the functional results and effect on quality of life of continent cutaneous urinary diversion in spinal cord injured patients.Setting:Department of Urology, Sahlgrenska University Hospital, Göteborg, Sweden.Subjects:A total of 10 patients with spinal cord injury (SCI).Method:The patients were operated on with an ileal reservoir (Kock reservoir or T-pouch), Cr-EDTA clearance was determined preoperatively and at follow-up. The patients answered a questionnaire concerning reservoir function, various activities and quality of life. The patient charts were reviewed.Results:One patient died of pulmonary embolism 3 years after surgery. Two patients were reoperated on for reservoir perforation. All patients were satisfied/very satisfied with their reservoirs. Half of them reported improved ability to perform various activities. Eight out of nine patients reported improved quality of life.Conclusion:For a selected group of patients with SCI, continent cutaneous urinary diversion provides successful outcome with improved quality of life.

Sacral nerve stimulation for refractory urge symptoms in elderly patients

Objective: The presence of an overactive detrusor (OD) is becoming more prevalent in the elderly and may severely influence the social life and activities of daily living in the senior, otherwise healthy, person. There is a marked age‐dependent increase in OD above the age of 65 years, which is mainly attributed to dysfunction, with loss of voluntary control, of the micturition reflex and decreased perception of bladder fullness. Material and Methods: Herein, we evaluate the outcome of sacral nerve stimulation in five patients aged >65 years derived from a large, multinational, randomized, prospective study. Results: The effect on symptoms was excellent in two subjects. There was a moderate improvement in another subject and a variable but eventually small effect in the remaining two patients. The results appeared to be more favourable in younger patients. Conclusion: Our findings suggest that the outcome of sacral nerve stimulation is more unpredictable in the elderly, a fact that should be considered when counselling the patient. However, it should be remembered that, even for the older, active person, urge incontinence may have a severe impact on quality of life and that the majority of patients treated with an implant will benefit from this treatment.

Continent cutaneous urinary diversion is still a valid alternative after cystectomy for bladder carcinoma

Objective. We compared patient opinions concerning reservoir/bladder function as well as quality of life (QOL) after cystectomy for bladder carcinoma and continent cutaneous urinary diversion or orthotopic bladder reconstruction. Material and methods. Fifteen patients with Kock reservoirs (11 females, 4 males) and 11 men with orthotopic bladders answered the European Organization for Research and Treatment of Cancer quality-of-life questionnaire-C30 as well as specially constructed questions concerning reservoir/bladder function. The glomerular filtration rate (GFR) was determined using Cr–EDTA or iohexol clearance. Results. Functioning and global health/QOL scales did not differ between the two groups of operated patients or between diverted patients and gender- and age-matched groups from the general population. The majority of the patients were satisfied/very satisfied with their diversion but more patients were troubled by leakage in the orthotopic bladder group than in the Kock reservoir group. The GFR was similar in the two groups. Conclusion. Continent cutaneous urinary diversion is associated with fewer leakage problems than orthotopic bladder reconstruction after cystectomy for bladder carcinoma.

Lidocaine cystometry in the diagnosis of bladder overactivity.

The effect of intravesical lidocaine was studied in a group of patients with symptoms of urinary urgency with or without incontinence. Provocative water cystometry failed to demonstrate signs of unstable detrusor but all patients presented a continuous, steep rise of detrusor pressure at the end phase of filling. Repeat cystometry was performed after the bladder had been treated with 3 g lidocaine intravesically for 20 minutes. In the majority of patients, no change in configuration of the cystometrogram was noted. In a group of patients, a decrease of detrusor pressure occurred and there was also an influence on phasic bladder contractions. In three patients, phasic detrusor contractions developed after lidocaine. Thus, intravesical lidocaine seems to be a useful tool to increase the precision of the urodynamic diagnosis in bladder overactivity. Neurourol. Urodynam. 20:147–155, 2001.

Functional results after orthotopic bladder substitution: a prospective multicentre study comparing four types of neobladder.

Abstract Objective. The aim of this study was to evaluate enterocystometry, voiding pattern and urine leakage of four types of orthotopic bladder substitute. Material and methods. At eight urological departments, 78 consecutive men were studied: 66 with an ileal neobladder [30 Studer pouches (S), 24 Hautmann pouches (H) and 12 T-pouches (T)] and 12 with a right colonic [Goldwasser type (G)] neobladder. Enterocystometry, determination of residual urine, micturition protocol and 24 h pad weight test were performed 6 and 12 months postoperatively. Results. Colonic neobladders had higher pouch pressure at first desire, normal desire and strong desire than ileal neobladders (except at first and normal desire at 12 months) (p < 0.02) and contraction was present more often at both 6 and 12 months (p < 0.01 and p < 0.01). Compliance was good in all types of pouch. Intermittent self-catheterization was more common in H patients at 6 months (p = 0.033). All patients with colonic neobladders used pads during the day and night. In patients with ileal pouches 32% used pads during the day and 70% during the night at 12 months. Urine leakage was higher in patients with colonic bladders at 6 and 12 months during the day (mean/median of 98/31 ml and 82/16 ml versus 10/0 ml and 4/0 ml, p < 0.001). T-pouches had excellent day-time continence, but nocturnal leakage was high. Conclusions. The Hautmann pouch and the Studer pouch behaved similarly at enterocystometry and clinically, and continence was good in the majority of patients. The low number of patients with the other two types of pouch precludes definitive statements.

Stamey's abdominovaginal needle colposuspension for the correction of female genuine stress urinary incontinence--long-term results.

Objectives: To evaluate the long‐term continence rate, subjective satisfaction and treatment‐associated morbidity in a carefully selected group of patients undergoing Stamey bladder neck suspension. Material and Methods: We studied 24 women with objectively validated genuine stress urinary incontinence (GSI) who were treated using the Stamey needle colposuspension method. Follow‐up was performed by means of a questionnaire, a urodynamic assessment and a new standardized quantification test. Time to follow‐up ranged from 28 to 100 months (mean 63 months). Results: Of the 24 patients, 20 (83%) reported an improvement in clinical symptoms for a mean of 37 (range 12–84) months at the evaluation and 10 (42%) were completely continent after the Stamey procedure. Four patients (17%) reported a poor outcome of the operation, but in only one case could this be related to recurrent GSI. Treatment‐associated morbidity was low but the frequency of postoperative urgency symptoms was higher than that reported in other studies (21%). Conclusion: In a selected population of pure GSI patients with no demonstrable detrusor overactivity, the Stamey bladder neck suspension procedure appears a feasible therapeutic option with few complications.