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Petter Rodrigues M, Bérubé MÈ, Charette M, McLean L. Conservative interventions for female exercise-induced urinary incontinence: a systematic review. BJU Int 2024. [PMID: 39043585 DOI: 10.1111/bju.16474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
OBJECTIVE To systematically review and synthesise what is known about the effectiveness of non-pharmaceutical conservative interventions for the management of urinary incontinence (UI) experienced by women during physical exercise. METHODS A systematic search was performed in the following databases in September 2023: the Medical Literature Analysis and Retrieval System Online (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Excerpta Medica dataBASE (EMBASE), Scientific Electronic Library Online (SciELO), Latin American and Caribbean Health Sciences Literature (LILACS), and Physiotherapy Evidence Database (PEDro). Studies were deemed eligible if population consisted of females who reported symptoms of UI while participating in physical exercise, and the interventions involved any non-pharmaceutical conservative treatment to manage symptoms during exercise. The primary outcome was severity of UI signs and symptoms. The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO identifier: CRD42022379138). RESULTS Of the 3429 abstracts screened, 19 studies were retained. Pelvic floor muscle training (PFMT) and intravaginal devices were the most commonly investigated modalities. Only two randomised controlled trials (RCTs), both among volleyball players, compared PFMT with no PFM exercise, showing a reduction in pad weight gain after the intervention in the experimental groups only. PFMT with and without biofeedback randomised among soldiers demonstrated a reduction in the frequency of urine leakage episodes in both groups, while supervised and unsupervised PFMT randomised among athletes from different sports showed pad weight gain reduction in the supervised group only. Seven single-arm studies suggested that PFMT alone or combined with other modalities may reduce UI severity in active women based on questionnaires, bladder diaries, and self-reported symptoms. A single-arm and a crossover study found pessary use beneficial in reducing urine leakage based on questionnaires and pad weight gain, respectively. When comparing pessary, tampon, and no intervention, two repeated-measures studies found tampons may reduce leakage more than pessaries in CrossFit exercisers and women performing aerobic exercises. A vaginal sponge also reduced pad weight gain during aerobic exercises. Other modalities (i.e., an intraurethral device, photobiomodulation, and combined therapies) were investigated using case series or single case studies. While all interventions showed some evidence of effectiveness, the results must be interpreted with caution due to methodological limitations and high risk of bias. In particular, despite a high reliance on pad tests as a primary outcome, we identified inconsistencies in how pad tests were administered and interpreted. CONCLUSION Only the effectiveness of PFMT to reduce urine leakage during exercise has been evaluated through RCTs, with some evidence of effectiveness. We identified a clear need for higher quality studies, with better reporting on the interventions, and more judicious use and interpretation of outcome measures.
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Affiliation(s)
| | - Marie-Ève Bérubé
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Marylène Charette
- Population Health, Interdisciplinary School of Health Science, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Linda McLean
- Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
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Campbell P, Moran K, Boyle S, Gallagher C. Compliance with Uresta (CURE) study; a 12 month follow-up of 40 women. Int Urogynecol J 2023; 34:737-744. [PMID: 35624166 PMCID: PMC9139490 DOI: 10.1007/s00192-022-05234-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 05/02/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The Uresta bladder support is an effective management option for women with stress urinary incontinence (SUI), however, there is a lack of data assessing long-term compliance. The aim of this study was to assess compliance at 12 month follow-up in women using the Uresta bladder support for exercise related SUI. METHODS This was a prospective study advertised on social media, running clubs and gyms. Participants were fitted with a Uresta bladder support and followed up over a 12 month period. Power calculation recommended a sample size of 43. Ethical approval was obtained. Outcomes were assessed using the PUQ, ICIQ-FLUTS, UDI-6, IIQ-7, QUID and PGI-I questionnaires. RESULTS Forty-six women were recruited with an average age, BMI and parity of 42, 24 and 2.3 respectively. The most common activities were running (48%) and CrossFit (22%). Six participants withdrew after 2 weeks. Compliance was 90% at 12 months (n=40). Uresta insertion and removal was 'okay', 'easy' or 'very easy' for 86% and 75% respectively. Leakage was improved (n=13), greatly improved (n=12) or stopped (n=5) for 83% of participants, 75% were 'much better' or 'very much better' on the PGI-I scale, and 94% would recommend Uresta to a friend. There were no adverse events. CONCLUSIONS The Uresta bladder support is a safe, effective, user-friendly management option for women who experience SUI during exercise with excellent long-term compliance. Further studies are required to identify predictors of successful fitting and efficacy, compare outcomes with different devices, and develop a validated questionnaire assessing SUI with exercise.
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Affiliation(s)
- Patrick Campbell
- Kingsbridge Private Hospital, Maypole Clinic, Kingsbridge Healthcare Group, 5 Shore Road, Holywood, Belfast, BT18 9XH, UK.
| | - Kayleigh Moran
- Obstetrics & Gynaecology, Northern Ireland Medical and Dental Training Agency, Belfast, UK
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Vaginal Pessary Use and Management for Pelvic Organ Prolapse: Developed by the joint writing group of the American Urogynecologic Society and the Society of Urologic Nurses and Associates. Individual writing group members are noted in the Acknowledgments section. UROGYNECOLOGY (PHILADELPHIA, PA.) 2023; 29:5-20. [PMID: 36548101 DOI: 10.1097/spv.0000000000001293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
ABSTRACT Over the past 50 years, pessary use has increased in popularity and has become an essential pelvic organ prolapse (POP) management tool. However, evidence is lacking to define care standardization, including pessary fitting, routine maintenance, and management of pessary-related complications. This clinical consensus statement (CCS) on vaginal pessary use and management for POP reflects statements drafted by content experts from the American Urogynecologic Society and Society of Urologic Nurses and Associates. The purpose of this CCS is to identify areas of expert consensus and nonconsensus regarding pessary fitting, follow-up, and management of pessary complications to improve the safety and quality of care where evidence is currently limited. The American Urogynecologic Society and Society of Urologic Nurses and Associates' vaginal pessary for POP writing group used a modified Delphi process to assess statements that were evaluated for consensus after a structured literature search. A total of 31 statements were assessed and divided into 3 categories: (1) fitting and follow-up, (2) complications, and 3) quality of life. Of the 31 statements that were assessed, all statements reached consensus after 2 rounds of the Delphi survey. This CCS document hopefully serves as a first step toward standardization of pessary care, but the writing group acknowledges that improved research will grow the base of knowledge and evidence providing clinicians a foundation to manage pessary care effectively and confidently.
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Burton CS, Korsandi S, Enemchukwu E. Current State of Non-surgical Devices for Female Stress Urinary Incontinence. Curr Urol Rep 2022; 23:185-194. [PMID: 35997889 DOI: 10.1007/s11934-022-01104-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize and assess the current non-surgical devices for the treatment of stress urinary incontinence (SUI). RECENT FINDINGS Devices for SUI can generally be divided into two categories. One category is the augmentation of pelvic floor muscle training (PFMT), wherein devices such as vaginal cones, intravaginal biofeedback, and electrical or magnetic stimulation are used to strength the pelvic floor musculature, though none are more effective than traditional PFMT. The second category of devices mechanically occludes the outlet and includes incontinence pessaries, intravaginal occlusion devices, and urethral plugs and patches. While these are palliative rather than curative, they share similar rates of improvement in leakage. A number of novel devices exist for the treatment and management of SUI. Though no single device has been shown to be more effective than PFMT alone, they may be beneficial for women who have difficulty isolating their pelvic floor muscles, desire accountability, or prefer technology-based engagement. Outlet occlusion devices are less comfortable for the patient, but remain an option for women who do not desire surgery.
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Affiliation(s)
- Claire S Burton
- Department of Urology, Stanford University, Stanford, CA, USA
| | - Shayan Korsandi
- Department of Obstetrics & Gynecology, Stanford University, Stanford, CA, USA
| | - Ekene Enemchukwu
- Department of Urology, Stanford University, Stanford, CA, USA. .,Department of Urology, Stanford University, Center for Academic Medicine, Stanford, CA, USA.
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The Role of Pessaries in the Treatment of Women With Stress Urinary Incontinence: A Systematic Review and Meta-Analysis. Female Pelvic Med Reconstr Surg 2022. [PMID: 35420550 DOI: 10.1097/spv.0000000000001180.10.1097/spv.0000000000001180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
IMPORTANCE Pessaries are an important conservative therapy for stress urinary incontinence (SUI), but few studies have comprehensively evaluated their utility. OBJECTIVE The objective of this study is to evaluate the existing evidence on the efficacy and safety of pessaries for the treatment of SUI. STUDY DESIGN We searched for the terms "stress urinary incontinence" and "pessar/y/ies/ium" in PubMed, Embase, and Cinhal on June 10, 2020. Studies that characterized subjective and/or objective data were included. Studies performed in pediatric populations, pregnancy, and use of pessaries not for SUI were excluded. Two reviewers independently screened and assessed data quality and risk of bias according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS Ten studies, including 376 patients, were included. In terms of subjective outcomes, 76% of 72 patients reported feeling continent after pessary treatment compared with 0% of 86 patients surveyed before pessary use (P < 0.0001). Both Urinary Distress Inventory and Incontinence Impact Questionnaire scores decreased significantly by 46.7% (n = 155 baseline, n = 139 follow-up; P < 0.0001) and 67.8% (n = 139 baseline, n = 107 follow-up; P < 0.0001), respectively. Significant objective measures associated with pessary use included increased urethral closure pressure (n = 122; g = 0.56; 95% confidence interval [CI], -0.66 to 1.77; P < 0.049) and decreased pad weight (n = 129 baseline; n = 118 follow-up; g = -0.89; 95% CI, -1.986 to 0.19; P = 0.009). Adverse events significantly decreased at greater than 6 months follow-up compared with less than 6 months follow-up, including pain (31.5%, n = 29/92 vs 14.3%, n = 5/35; P = 0.0513) and discomfort (50%, n = 46/92 vs 29.3%, n = 12/41; P = 0.0268). CONCLUSIONS Based on both subjective and objective measures, pessaries are an effective conservative treatment option for SUI. This supports pessary use, though larger studies with longer-term follow-up are warranted.
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The Role of Pessaries in the Treatment of Women With Stress Urinary Incontinence: A Systematic Review and Meta-Analysis. Female Pelvic Med Reconstr Surg 2022; 28:e171-e178. [PMID: 35420550 DOI: 10.1097/spv.0000000000001180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
IMPORTANCE Pessaries are an important conservative therapy for stress urinary incontinence (SUI), but few studies have comprehensively evaluated their utility. OBJECTIVE The objective of this study is to evaluate the existing evidence on the efficacy and safety of pessaries for the treatment of SUI. STUDY DESIGN We searched for the terms "stress urinary incontinence" and "pessar/y/ies/ium" in PubMed, Embase, and Cinhal on June 10, 2020. Studies that characterized subjective and/or objective data were included. Studies performed in pediatric populations, pregnancy, and use of pessaries not for SUI were excluded. Two reviewers independently screened and assessed data quality and risk of bias according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS Ten studies, including 376 patients, were included. In terms of subjective outcomes, 76% of 72 patients reported feeling continent after pessary treatment compared with 0% of 86 patients surveyed before pessary use (P < 0.0001). Both Urinary Distress Inventory and Incontinence Impact Questionnaire scores decreased significantly by 46.7% (n = 155 baseline, n = 139 follow-up; P < 0.0001) and 67.8% (n = 139 baseline, n = 107 follow-up; P < 0.0001), respectively. Significant objective measures associated with pessary use included increased urethral closure pressure (n = 122; g = 0.56; 95% confidence interval [CI], -0.66 to 1.77; P < 0.049) and decreased pad weight (n = 129 baseline; n = 118 follow-up; g = -0.89; 95% CI, -1.986 to 0.19; P = 0.009). Adverse events significantly decreased at greater than 6 months follow-up compared with less than 6 months follow-up, including pain (31.5%, n = 29/92 vs 14.3%, n = 5/35; P = 0.0513) and discomfort (50%, n = 46/92 vs 29.3%, n = 12/41; P = 0.0268). CONCLUSIONS Based on both subjective and objective measures, pessaries are an effective conservative treatment option for SUI. This supports pessary use, though larger studies with longer-term follow-up are warranted.
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A Vaginal Inlay for Reduction of Stress Urinary Incontinence: Outcome of a Randomized Clinical Trial and Four User Acceptance Studies. Adv Urol 2021; 2021:8822186. [PMID: 33628229 PMCID: PMC7899758 DOI: 10.1155/2021/8822186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 12/16/2020] [Accepted: 01/22/2021] [Indexed: 11/17/2022] Open
Abstract
A multicenter, randomized, controlled clinical trial and four postmarket user acceptance investigations were carried out to document the safety, performance, and user acceptance of Efemia Bladder Support, a novel vaginal inlay for the temporary reduction of stress urinary incontinence (SUI). The clinical investigation enrolled 97 women diagnosed with SUI, randomized 3 : 1 to either treatment or standard care (control). The primary endpoint was reduction of urine leakage, measured as change in pad weight baseline week compared with treatment week. Secondary endpoints were treatment success, calculated as the percentage of subjects with >70% reduction in pad weight, reduction in incontinence episodes, and quality of life (QoL). 75 women (77%) completed the clinical investigation. No serious adverse events occurred. The treatment group reached a 55% (p < 0.001) mean reduction of total leakage compared to the control arm. A subanalysis, involving only leakage during provocation testing (coughing and jumping), showed a 67% (p < 0.001) mean reduction of leakage. No significant effect on QoL could be observed. 51% of the women answered “yes” to the question if they would use the device to reduce SUI. The user acceptance of the device was further investigated in four postmarket studies, using an improved device design with a slimmer centerpiece and a thinner handle, while keeping the effect achieving parts of the device unchanged. An average of 74% of the 102 participants in the postmarket studies reported that they were likely to continue using Efemia. The highest user satisfaction was seen in the two studies evaluating the use of Efemia during exercise, where 83% and 88% of the women were likely to continue using Efemia. It can be concluded that Efemia is a safe, well-tolerated, and effective alternative for reducing SUI, both in everyday life and during physical exercise.
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Wu YM, Welk B. Revisiting current treatment options for stress urinary incontinence and pelvic organ prolapse: a contemporary literature review. Res Rep Urol 2019; 11:179-188. [PMID: 31355157 PMCID: PMC6590839 DOI: 10.2147/rru.s191555] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 05/20/2019] [Indexed: 02/02/2023] Open
Abstract
Stress urinary incontinence (SUI) and pelvic organ prolapse (POP) affect many women in their lifetime. In this review, we describe and evaluate the latest treatment options for SUI and POP, including the controversy around transvaginal mesh (TVM) use. Growing evidence supports the utilization of pelvic floor muscle training as first-line treatment for both SUI and POP. Vaginal pessaries continue to be an effective and reversible option to manage SUI and POP symptoms. The midurethral sling remains the gold standard for surgical treatment of SUI, although patients and clinicians should acknowledge the potentially serious complications of TVM. Burch urethropexy and pubovaginal sling offer good SUI cure and may be preferred in women wishing to avoid mesh implants; however, their operative morbidities and more challenging surgical approach may limit their use. Site-specific cystocele or rectocele repairs may be indicated for isolated anterior or posterior vaginal compartment prolapse; however, in women with more severe POP, evidence supports using a vaginal native-tissue repair involving apical suspension as the primary surgical technique. Although abdominal and laparoscopic sacrocolpopexies are both effective in treating POP, their failure and mesh complication rates increase with time. There is insufficient evidence to support the widespread use of uterine-preserving surgical POP repairs at present due to the lack of long-term data. Routine TVM use is not recommended in POP surgeries and should only be considered on a case-by-case basis by trained surgeons, primarily in women with multiple risk factors for POP recurrence. In general, clinicians should individualize SUI and POP treatment options for women based on their symptoms, comorbidities, and risk factors for mesh-related complications.
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Affiliation(s)
- You Maria Wu
- Department of Obstetrics and Gynecology, London Health Sciences Centre, London, Ontario, Canada
| | - Blayne Welk
- Department of Surgery and Epidemiology & Biostatistics, Western University, London, Ontario, Canada
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Management of stress urinary incontinence using vaginal incontinence pessaries in rural Kilimanjaro, Tanzania. Int Urogynecol J 2019; 31:1091-1097. [DOI: 10.1007/s00192-019-03980-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 05/10/2019] [Indexed: 10/26/2022]
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A Cost-Utility Analysis of Nonsurgical Treatments for Stress Urinary Incontinence in Women. Female Pelvic Med Reconstr Surg 2019; 25:49-55. [DOI: 10.1097/spv.0000000000000502] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Al-Shaikh G, Syed S, Osman S, Bogis A, Al-Badr A. Pessary use in stress urinary incontinence: a review of advantages, complications, patient satisfaction, and quality of life. Int J Womens Health 2018; 10:195-201. [PMID: 29713205 PMCID: PMC5909791 DOI: 10.2147/ijwh.s152616] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Stress urinary incontinnce (SUI) is a common condition among women. The usual approach to treatment of SUI is a stepwise plan from conservative to surgical procedures. A vaginal pessary is one of the commonly used conservative treatments that offer symptomatic improvement for women with incontinence. This review provides a critical analysis of the benefits and shortcomings offered by vaginal pessaries to patients affected by SUI, with a particular focus on indications, advantages, quality of life, patient satisfaction, and potential complications. To obtain the required information, an extensive search of PubMed and Cochrane databases was performed, covering the time frame from January 2000 to December 2016. We also surveyed the published guidelines of American Urological Association, Canadian Urological Association, American Urogynecological Society, National Institutes of Health (USA), and National Institute for Health and Care Excellence (UK). A total of 192 original research papers, review articles, and clinical trials were identified. The analysis of retrieved data provides evidence that vaginal pessaries constitute an effective nonsurgical option for SUI. The satisfaction rate with pessary use is high and only minor complications, if any, occur, vaginal discharge being the most common. The reviewed studies document that vaginal pessaries provide an adequate control of SUI if they are fit properly and managed by frequent replacements and regular checkups. They should be considered among the first line of treatment for SUI associated with exercise and increased intra-abdominal pressure.
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Affiliation(s)
- Ghadeer Al-Shaikh
- Department of Obstetrics and Gynecology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Sadiqa Syed
- Department of Basic Sciences, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Somaia Osman
- Department of Urogynecology & Pelvic Reconstructive Surgery, Women's Specialized Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Abdulrahman Bogis
- Department of Obstetrics and Gynecology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ahmed Al-Badr
- Department of Urogynecology & Pelvic Reconstructive Surgery, Women's Specialized Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
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[Urinary incontinence in women]. MMW Fortschr Med 2017; 159:49-52. [PMID: 29124583 DOI: 10.1007/s15006-017-0277-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Lovatsis D, Best C, Diamond P. Short-term Uresta efficacy (SURE) study: a randomized controlled trial of the Uresta continence device. Int Urogynecol J 2017; 28:147-150. [PMID: 27438055 DOI: 10.1007/s00192-016-3090-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 06/22/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND HYPOTHESIS An intravaginal device (Uresta) is currently available for the treatment of stress urinary incontinence (SUI). Case-series data on its effectiveness exist; however, controlled data are lacking. The objective of this study is to determine the short-term efficacy of the Uresta device using a randomized placebo controlled trial. The hypothesis is that the Uresta device might significantly reduce urinary loss. METHODS A single blind randomized controlled trial was conducted among women with urodynamic SUI recruited from a single urogynecology unit. Participants were randomized to receive the Uresta device or a placebo vaginal silastic ring placed high in the vagina for the duration of a pad test. Pad tests were performed before and after device placement. The primary outcome was the achievement of a 50 % or greater reduction in pad weight after device placement, in a comparison of the two groups. Sample size calculation showed a need for 18 subjects per group. Fisher's exact test was used to analyze the primary outcome. Research Ethics Board approval was obtained. RESULTS Eighteen subjects per group completed the study protocol. The percentage of patients who achieved the primary outcome was 66.7 % in the Uresta group and 22.2 % in the placebo group (p = 0.01). The baseline demographic data were similar in the two groups. There were no adverse events during the test period. CONCLUSIONS The Uresta intravaginal continence device significantly reduces the short-term objective measures of urine loss due to SUI. Further study to assess subjective outcomes and long-term patient satisfaction is required.
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Affiliation(s)
- Danny Lovatsis
- Division of Urogynaecology and Reconstructive Pelvic Surgery, Mount Sinai Hospital and University of Toronto, 700 University Avenue, Room 8-814, Toronto, ON, Canada, M5G 1Z5.
| | - Carolyn Best
- Division of Urogynaecology and Reconstructive Pelvic Surgery, Mount Sinai Hospital and University of Toronto, 700 University Avenue, Room 8-814, Toronto, ON, Canada, M5G 1Z5
| | - Phaedra Diamond
- Division of Urogynaecology and Reconstructive Pelvic Surgery, Mount Sinai Hospital and University of Toronto, 700 University Avenue, Room 8-814, Toronto, ON, Canada, M5G 1Z5
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Robert M, Schulz JA, Harvey MA. Mise à jour technique sur l'utilisation des pessaires. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2016; 38:S264-S276. [DOI: 10.1016/j.jogc.2016.09.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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García-Sánchez E, Rubio-Arias J, Ávila-Gandía V, Ramos-Campo D, López-Román J. Effectiveness of pelvic floor muscle training in treating urinary incontinence in women: A current review. Actas Urol Esp 2016; 40:271-8. [PMID: 26614435 DOI: 10.1016/j.acuro.2015.09.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 09/03/2015] [Accepted: 09/03/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To analyse the content of various published studies related to physical exercise and its effects on urinary incontinence and to determine the effectiveness of pelvic floor training programmes. METHOD We conducted a search in the databases of PubMed, CINAHL, the Cochrane Plus Library, The Cochrane Library, WOS and SPORTDiscus and a manual search in the Google Scholar metasearcher using the search descriptors for documents published in the last 10 years in Spanish or English. The documents needed to have an abstract or complete text on the treatment of urinary incontinence in female athletes and in women in general. RESULTS We selected 3 full-text articles on treating urinary incontinence in female athletes and 6 full-text articles and 1 abstract on treating urinary incontinence in women in general. The 9 studies included in the review achieved positive results, i.e., there was improvement in the disease in all of the studies. CONCLUSIONS Physical exercise, specifically pelvic floor muscle training programmes, has positive effects on urinary incontinence. This type of training has been shown to be an effective programme for treating urinary incontinence, especially stress urinary incontinence.
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Abstract
Urinary incontinence is a prevalent condition in elderly women with significant associated morbidity. Incontinence can by grouped into several types: stress incontinence, urgency incontinence, overflow incontinence, functional incontinence, and mixed urinary incontinence. Careful evaluation, including history and physical examination, is critical to making the correct diagnosis and guiding therapy. A variety of nonsurgical treatments, including behavioral therapies, pelvic floor muscle exercise, medications, and other treatments, are available; can be successful for many older women; and may preclude the need for surgery. Working closely with the patient, understanding her goals of care, and targeting treatments accordingly are essential for success.
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Affiliation(s)
- William P Parker
- Department of Urology, The Landon Center on Aging, School of Medicine, The University of Kansas, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA
| | - Tomas Lindor Griebling
- Department of Urology, The Landon Center on Aging, School of Medicine, The University of Kansas, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
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The Non-surgical Options for SUI—Is Any One Optimal? CURRENT BLADDER DYSFUNCTION REPORTS 2016. [DOI: 10.1007/s11884-016-0349-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Jundt K, Peschers U, Kentenich H. The investigation and treatment of female pelvic floor dysfunction. DEUTSCHES ARZTEBLATT INTERNATIONAL 2015; 112:564-74. [PMID: 26356560 PMCID: PMC4570968 DOI: 10.3238/arztebl.2015.0564] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 07/09/2015] [Accepted: 07/09/2015] [Indexed: 01/12/2023]
Abstract
BACKGROUND 25% of all women report involuntary loss of urine, and 7% may require treatment. METHODS This review is based on a selection of pertinent literature, including guidelines and Cochrane reviews. RESULTS The assessment of pelvic floor dysfunction in women begins with a basic evaluation that is followed by special diagnostic tests if indicated. The physician taking the clinical history should inquire about the patient's behavior, personality, social and other stressors, and eating and drinking habits, as well as any mental disorders that may be present, including anxiety disorders, depression, somatization disorders, and disorders of adaptation. Conservative treatment consists mainly of lifestyle changes, physiotherapy, and medication. Stress incontinence is most commonly treated with pelvic floor exercises, with a documented success rate of 56.1% vs. 6% without such treatment (relative risk 8.38, 95% confidence interval 3.67-19.07). If incontinence persists, surgery may be indicated ( implantation of suburethral tension-free slings, or colposuspension). Feedback and biofeedback training can be used to treat an overactive bladder. If these techniques and drug therapy are unsuccessful, botulinum toxin injections can be considered. CONCLUSION Well-validated treatments for pelvic floor dysfunction are available. Psychosomatic factors must be taken into account and can have a major effect on treatment outcomes.
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Affiliation(s)
- Katharina Jundt
- Private practice for gynecology at Pasinger Bahnhof, München
- PD Dr. Jundt and Prof. Dr. Kentenich have equally contributed to the article
| | - Ursula Peschers
- Pelvic Floor Center München, Surgical Hospital München-Bogenhausen
- PD Dr. Jundt and Prof. Dr. Kentenich have equally contributed to the article
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Robert M, Schulz JA, Harvey MA, Lovatsis D, Walter JE, Chou Q, Easton WA, Epp A, Farrell SA, Geoffrion R, Girouard L, Gupta CK, Harvey MA, Larochelle A, Maslow KD, Neustaeder G, Pascali D, Pierce M, Robert M, Ross S, Schachter J, Schulz JA, Senikas V, Wilkie DH. Technical Update on Pessary Use. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2013; 35:664-674. [DOI: 10.1016/s1701-2163(15)30888-4] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Cornu JN, Mouly S, Amarenco G, Jacquetin B, Ciofu C, Haab F. 75NC007 device for noninvasive stress urinary incontinence management in women: a randomized controlled trial. Int Urogynecol J 2012; 23:1727-34. [PMID: 22588140 DOI: 10.1007/s00192-012-1814-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Accepted: 04/22/2012] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Management of stress urinary incontinence (SUI) with intravaginal devices is an alternative to surgical management, but data of a high level of evidence remain scarce. Our goal was to assess efficacy, tolerance, and acceptability of the 75NC007 intravaginal device for SUI management. METHODS A phase III, multicenter randomized controlled trial was conducted. After an initial washout period with no treatment, allowing baseline evaluation, women with SUI were randomly assigned to a treatment or control group (no treatment). The primary endpoint was the reduction of incontinence episode frequency (IEF), according to bladder diaries, as compared to baseline. Secondary endpoints were variation of the Urinary Symptom Profile (USP) score, of 24-h pad test, and of CONTILIFE questionnaire scores as compared to baseline. Intent-to-treat and per-protocol analyses were conducted. RESULTS Fifty-five patients were enrolled and analyzed (26 controls and 29 treated). The mean relative variations of IEF, SUI USP subscore, and overactive bladder (OAB) USP subscore were more significant in the treatment group than in the control group (-31.7 ± 65.1 % vs -7.6 ± 24.5 %, p = 0.002, -2.4 ± 2.6 vs 0.2 ± 2.2, p = 0.004, and -1.5 ± 2.8 vs 0.2 ± 1.8, p = 0.016, respectively). The dysuria USP subscore was slightly decreased in the treatment group. CONTILIFE scores were slightly improved in the treatment group. Pad test variations were not different between groups. No serious adverse event was noted throughout the entire study. CONCLUSIONS The 75NC007 intravaginal device is a safe and effective noninvasive treatment of SUI in women.
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Affiliation(s)
- Jean-Nicolas Cornu
- Department of Urology, Tenon Hospital, Assistance Publique-Hôpitaux de Paris, University Pierre-et-Marie-Curie Paris 6, 4 rue de chine, 75020 Paris, France.
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Friedman B. Conservative treatment for female stress urinary incontinence: simple, reasonable and safe. Can Urol Assoc J 2012; 6:61-3. [PMID: 22396373 DOI: 10.5489/cuaj.12021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Boris Friedman
- Department of Urologic Sciences, Bladder Care Center, University of British Columbia, Vancouver, BC
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Haddad JM, Ribeiro RM, Bernardo WM, Abrão MS, Baracat EC. Vaginal cone use in passive and active phases in patients with stress urinary incontinence. Clinics (Sao Paulo) 2011; 66:785-91. [PMID: 21789381 PMCID: PMC3109376 DOI: 10.1590/s1807-59322011000500013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Revised: 01/03/2011] [Accepted: 01/11/2011] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate vaginal cone therapy in two phases, passive and active, in women with stress urinary incontinence. METHODS A prospective study was conducted at the Department of Obstetrics and Gynecology, São Paulo University, Brazil. Twenty-four women with a clinical and urodynamic diagnosis of stress urinary incontinence were treated with vaginal cones in a passive phase (without voluntary contractions of the pelvic floor) and an active phase (with voluntary contractions), each of which lasted three months. Clinical complaints, a functional evaluation of the pelvic floor, a pad test, and bladder neck mobility were analyzed before and after each phase. RESULTS Twenty-one patients completed the treatment. The reduction in absolute risk with the pad test was 0.38 (p<0.034) at the end of the passive phase and 0.67 (p<0.0001) at the end of the active phase. The reduction in absolute risk with the pelvic floor evaluation was 0.62 (p<0.0001) at the end of the passive phase and 0.77 (p<0.0001) at the end of the active phase. The reduction in absolute risk of bladder neck mobility was 0.38 (p<0.0089) at the end of the passive phase and 0.52 (p<0.0005) at the end of the active phase. Complete reversal of symptomatology was observed in 12 (57.1%) patients, and satisfaction was expressed by 19 (90.4%). CONCLUSION Using vaginal cones in the passive phase, as other researchers did, was effective. Inclusion of the active phase led to additional improvement in all of the study parameters evaluated in women with stress urinary incontinence. Randomized studies are needed, however, to confirm these results.
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Affiliation(s)
- Jorge Milhem Haddad
- Divisão de Clínica Ginecológica, Ginecologia Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
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Continence pessary compared with behavioral therapy or combined therapy for stress incontinence: a randomized controlled trial. Obstet Gynecol 2010; 115:609-617. [PMID: 20177294 DOI: 10.1097/aog.0b013e3181d055d4] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To compare the effectiveness of a continence pessary to evidence-based behavioral therapy for stress incontinence and to assess whether combined pessary and behavioral therapy is superior to single-modality therapy. METHODS This was a multisite, randomized clinical trial (Ambulatory Treatments for Leakage Associated with Stress Incontinence [ATLAS]) that randomly assigned 446 women with stress incontinence to pessary, behavioral therapy, or combined treatment. Primary outcome measures, at 3 months, were Patient Global Impression of Improvement and the stress incontinence subscale of the Pelvic Floor Distress Inventory. A priori, to be considered clinically superior, combination therapy had to be better than both single-modality therapies. Outcome measures were repeated at 6 and 12 months. Primary analyses used an intention-to-treat approach. RESULTS At 3 months, scores from 40% of the pessary group and 49% of the behavioral group were "much better" or "very much better" on the Patient Global Impression of Improvement (P=.10). Compared with the pessary group, more women in the behavioral group reported having no bothersome incontinence symptoms (49% compared with 33%, P=.006) and treatment satisfaction (75% compared with 63%, P=.02). Combination therapy was significantly better than pessary as shown on the Patient Global Impression of Improvement (53%, P=.02) and Pelvic Floor Distress Inventory (44%, P=.05) but not better than behavioral therapy; it was therefore not superior to single-modality therapy. Group differences were not sustained to 12 months on any measure, and patient satisfaction remained above 50% for all treatment groups. CONCLUSION Behavioral therapy resulted in greater patient satisfaction and fewer bothersome incontinence symptoms than pessary at 3 months, but differences did not persist to 12 months. Combination therapy was not superior to single-modality therapy. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, www.clinicaltrials.gov, NCT00270998.
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Ziv E, Stanton SL, Abarbanel J. Significant improvement in the quality of life in women treated with a novel disposable intravaginal device for stress urinary incontinence. Int Urogynecol J 2009; 20:651-8. [DOI: 10.1007/s00192-009-0824-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2008] [Accepted: 01/27/2009] [Indexed: 11/28/2022]
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