Abrams P, Andersson KE, Birder L, Brubaker L, Cardozo L, Chapple C, et al.. Fourth International Consultation on Incontinence Recommendations of the International Scientific Committee: evaluation and treatment of urinary incontinence, pelvic organ prolapse, and fecal incontinence
Available from: Emanuele Montanari
- "Electrical stimulation for urinary incontinence performed according to the technique proposed by Walsh (2002), in the outpatient department of a teaching hospital in Milan (Italy). All patients were initially treated for urinary incontinence with pelvic floor exercises, according to the European guidelines (Abrams et al., 2010). They performed the exercises under the supervision of a nurse specialist, once a week in the outpatient department, and every day at home. "
[Show abstract] [Hide abstract]
ABSTRACT: Urinary incontinence is common after radical prostatectomy. Pelvic floor muscle training (PFMT) and functional electrical stimulation (FES) can be used to reduce urine leakage. Some patients have difficulty in performing PFMT, and do not obtain clinically significant results. FES might be helpful to them, but its role is unclear in the literature. To verify if FES can reduce urine leakage in patients who do not benefit from PFMT. To obtain mid-term data regarding the persistence of the results through FES or PFMT, associated with a maintenance programme. Prospective and retrospective study (104 PFMT patients, 34 FES) using 24-h pad-test to quantify leakage. Rehabilitation ended when patients obtained leakage <10 g/day. Rehabilitated patients followed a maintenance PFMT programme and performed a follow-up 24-h pad test after 3 months; 51% (PFMT) and 32% (FES) of patients reached leakage <10 g/day. Overall, 82.3% in the PFMT group and 82.3% in the FES group reduced leakage by at least 50% through rehabilitation. No significant difference existed between the two treatments (p = 0.32). After 3 months, 51 rehabilitated patients out of 56 (PFMT) and 11 out of 11 (FES), respectively, showed persistence of the results. PFMT cannot be replaced by machines, but FES can help those who are unable to execute PFMT to strengthen their sphincter and later learn PFMT. Even those who did not achieve rehabilitation had clinically relevant results in both groups. These methods seem useful for incontinent patients after prostatectomy.
- "We recruited a sample of consecutive patients with stress UI after RRP, performed for prostate-limited cancer. The type of incontinence was determined according to the definitions provided by the International Continence Society, thus considering stress UI as 'the complaint of involuntary leakage on effort or exertion, or on sneezing or coughing' (Abrams et al., 2010). We excluded patients undergoing adjuvant radiotherapy during the PFMT programme, or who required additional rehabilitation treatments (e.g. "
[Show abstract] [Hide abstract]
ABSTRACT: Urinary incontinence (UI) is a common complication of prostatectomy. International guidelines suggest using pelvic floor muscle training (PFMT) as a first-line intervention (grade A) to help patients reduce the involuntary urine leakages. In the literature it is hard to find a complete exercise scheme, with full details (e.g. body position during PFMT, how to avoid antagonist synergies), information on how to make exercises progressively more difficult, and data showing the efficacy of the whole programme. This study presents a complete PFMT programme, with full details and outcomes. A scheme of five progressive exercises was built, each with precise characteristics and times. Totally 131 patients with stress UI after radical retropubic prostatectomy were enrolled and followed a written scheme of PFMT with the five exercises. Leakages were quantified using the 24-h pad test. Rehabilitation ended when patients had leakages less than 10 g/d. Nine patients could not achieve results and decided to exit the programme after a median of five sessions (InterQuartile Range, IQR = [4;7]). Out of the 122 patients, 90 patients who followed the full programme achieved the rehabilitation (70.3%); they had median leakages of 150 g, IQR = [90;300]. Those who did not reach the result had higher leakages [540 g/d, IQR = (300;840)] but obtained clinically significant reduction and reached a median of 90 g/d, IQR = [90;157] after comparable rehabilitation times (median of 6 or 7 sessions, corresponding to 8 or 10 weeks, for rehabilitated and non-rehabilitated patients, respectively). Future studies will investigate the long-term results of this programme.
Available from: Bernhard Kiss
- "Sacral neuromodulation (SNM)
 has become a well-established and widely accepted treatment for patients with refractory LUTD such as non-obstructive chronic urinary retention, urgency frequency syndrome, and urgency incontinence
[2-6] and it has been incorporated into the guidelines of the European Association of Urology (EAU) (
http://www.uroweb.org), the International Consultation on Incontinence (ICI)
, and the National Institute for Health and Clinical Excellence (NICE) (
http://www.nice.org.uk). Originally, SNM was not considered an option for neurogenic LUTD but some studies suggested that it is also effective in neurological patients
[Show abstract] [Hide abstract]
ABSTRACT: BackgroundSacral neuromodulation has become a well-established and widely accepted treatment for refractory non-neurogenic lower urinary tract dysfunction, but its value in patients with a neurological cause is unclear. Although there is evidence indicating that sacral neuromodulation may be effective and safe for treating neurogenic lower urinary tract dysfunction, the number of investigated patients is low and there is a lack of randomized controlled trials.Methods and designThis study is a prospective, randomized, placebo-controlled, double-blind multicenter trial including 4 sacral neuromodulation referral centers in Switzerland. Patients with refractory neurogenic lower urinary tract dysfunction are enrolled. After minimally invasive bilateral tined lead placement into the sacral foramina S3 and/or S4, patients undergo prolonged sacral neuromodulation testing for 3–6 weeks. In case of successful (defined as improvement of at least 50% in key bladder diary variables (i.e. number of voids and/or number of leakages, post void residual) compared to baseline values) prolonged sacral neuromodulation testing, the neuromodulator is implanted in the upper buttock. After a 2 months post-implantation phase when the neuromodulator is turned ON to optimize the effectiveness of neuromodulation using sub-sensory threshold stimulation, the patients are randomized in a 1:1 allocation in sacral neuromodulation ON or OFF. At the end of the 2 months double-blind sacral neuromodulation phase, the patients have a neuro-urological re-evaluation, unblinding takes place, and the neuromodulator is turned ON in all patients. The primary outcome measure is success of sacral neuromodulation, secondary outcome measures are adverse events, urodynamic parameters, questionnaires, and costs of sacral neuromodulation.DiscussionIt is of utmost importance to know whether the minimally invasive and completely reversible sacral neuromodulation would be a valuable treatment option for patients with refractory neurogenic lower urinary tract dysfunction. If this type of treatment is effective in the neurological population, it would revolutionize the management of neurogenic lower urinary tract dysfunction.Trial registrationTrial registration number:http://www.clinicaltrials.gov; Identifier:
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.