Final diagnosis and therapeutic implications of mixed symptoms of urinary incontinence in women

Results of urine cytology testing and cystoscopy in women with irritative voiding symptoms

OBJECTIVE

The purpose of this study was to assess rates of urinary cytologic abnormalities and cystoscopic outcomes in women with irritative voiding symptoms who were examined at a urogynecology clinic.

STUDY DESIGN

All urinary cytology studies results that were sent between January 1, 2000, and July 31, 2003, for the evaluation of irritative voiding symptoms were reviewed. Data were then extracted from the charts of a subset of these patients to evaluate cystoscopic outcomes. Demographics, risk factors for urothelial cancer, laboratory results, and radiology imaging results were then analyzed and compared between patients with and without abnormal cytology and cystoscopic results.

RESULTS

Of the 1783 total urinary cytology that were reviewed, 1661 test results were read as normal (93.2%); 112 test results (6.3%) were read as atypical, and 3 test results (0.2%) were read as unsatisfactory. Seven cytologic test results were categorized as suspicious or malignant, which accounts for only 0.4% of all cytologic test results that were sent. Of the 564 consecutive women whose cases were chosen for subanalysis, cytology was normal in 91.5% and atypical in 8.5% of cases. No cytology were suspicious or malignant. Cystoscopic findings were normal in 548 patients (97.2%). Only 1 patient (0.2%) received a diagnosis of transitional cell carcinoma.

CONCLUSION

Urinary cytology and cystoscopy are low yield tests and should not be used routinely in the initial evaluation of women with irritative voiding symptoms.

Efficacy of oral doxepin and piroxicam treatment for interstitial cystitis

OBJECTIVE

To establish the efficacy of a multidrug oral treatment with the tricyclic antidepressant agent doxepin and the cyclooxygenase (COX) inhibitor piroxicam in patients with interstitial cystitis (IC), who had failed standard therapy in an open, prospective, nonrandomized study.

METHODS

A total of 37 patients diagnosed with IC received 75 mg doxepin and 40 mg piroxicam daily. The treatment was termed DOXCAM. Effectiveness of therapy was assessed with frequency-volume charts, an IC symptom score and with cystometry prior to treatment, 8 weeks after the start and 4 weeks after termination of drug treatment.

RESULTS

Medication was not tolerated by five patients. Twenty-six of 32 patients have experienced virtual total remission of symptoms (81%) and six patients had significant relief (19%). DOXCAM treatment resulted in a significant percent decrease in pain (65% versus 21%). Daytime frequency decreased from 17.6+/-5.7 to 11.3+/-3.6 voids while nocturia did not improve significantly. Twenty-three of the 26 patients who became symptom free and four of the six patients who showed significant improvement had a return of symptoms after cessation of therapy.

CONCLUSION

It is reasonable to consider oral treatment with DOXCAM in those patients who have failed first-line therapies.

Stress urinary incontinence in women. II. Abnormalities of glycogenolysis in tissues related to the lower urinary tract

The aim of the study was the investigation of the biochemical condition of elements likely to directly participate in active closing of the urethral lumen. We estimated glycogenolysis in urinary bladder, perivesical connective tissue and levator ani muscle (LAM) samples obtained intraoperatively from 80 stress incontinent women. Glycogen content as well as activities of active and total glycogen phosphorylase and acid exo-1,4-alpha-glucosidase were measured. Material from the urinary bladder and perivesical connective tissue was insignificantly altered, and glycogen contents in the bladder (2.03 +/- 1.38 g/100 g wet tissue) were considered to be normal. In the LAM glycogenolysis was much more activated than in other tissues (p < 0.001 by Fischer's exact test). Of LAM specimens 78% (22/28) revealed imbalanced biochemistry of glycogen with activation of hydrolytic decomposition. We conclude that stress urinary incontinence in women is frequently associated with metabolic alterations in the periurethral striated fibres. This study indirectly supports our recent hypothesis on the pathogenesis of the disease in terms of muscle fibre type transitions.

Stress urinary incontinence in women. III. Different tissue biochemistry in patients with concomitant detrusor instability. Preliminary report

The glycogenolysis markers (glycogen content, active and total glycogen phosphorylase [EC 2.4.1.1.] activities, and active and total acid exo-alpha-1,4-glucosidase [EC 3.2.1.3.] activities) in the urinary bladder muscle from two patients with stress urinary incontinence and concomitant detrusor instability were studied. Glycogen depletion and activation of glycogen phosphorylase were found.

Comparison of vaginal wall sling and modified vaginal wall sling for stress urinary incontinence

CONTEXT

There are several controversies about which is the best form of surgical treatment for stress urinary incontinence in women. The vaginal wall sling in its original and modified form were presented by Raz as new options for treatment of these conditions, but there is a lack of comparative clinical trials using both techniques.

OBJECTIVE

To compare the effectiveness of the original and the modified vaginal wall sling.

DESIGN

A comparative, prospective, non-randomized clinical trial.

SETTING

Public and private health care units (Urology Division, Faculty of Medicine of the ABC Foundation, and Universidade Federal de São Paulo / Escola Paulista de Medicina).

PARTICIPANTS

Twenty patients with anatomical and intrinsic sphincter deficiency stress urinary incontinence were surgically treated for evaluating the initial results of the vaginal wall sling, from February 5, 1994, to June 27, 1996.

INTERVENTIONS

The patients were divided into two groups. Group A (n = 10) were treated with the original vaginal wall sling. Group B (n = 10) were treated with the modified vaginal wall sling. Both groups were statistically similar according to clinical and urodynamic parameters.

MAIN MEASUREMENTS

Cure and complication rates.

RESULTS

Follow-up ranged from 19 to 43 months (median = 28) for group A. The overall cure rate was 70%. Fifty per cent of the patients had urinary retention of 7 to 35 days. There were no major complications. Follow-up ranged from 14 to 26 months (median = 18) for Group B. The cure rate was 80%. Two patients had urinary retention of 7 and 55 days. There were no major complications.

CONCLUSIONS

The vaginal wall sling is as effective as the modified vaginal wall sling but has a higher rate of urinary retention.

Managing acute and chronic urinary incontinence. U.S. Department of Health and human services

This Quick Reference Guide for Clinicians contains highlights from the Clinical Practice Guideline Update on Urinary Incontinence in Adults: Acute and Chronic Management, which was developed by a multidisciplinary panel of health care providers and a consumer representative. Findings and recommendations are presented for identification and evaluation of urinary incontinence (UI); use of behavioral, pharmacologic, and surgical treatment as well as supportive devices; long-term management of chronic intractable UI; and education of health care providers and the public. An algorithm is included to show the sequence of events related to the overall management of UI. Tables and forms are included to outline assessment and treatment options.