A new external urethral occlusive device for female urinary incontinence

Urethral device in women with chronic urinary retention: an alternative to self-catheterization?

OBJECTIVE

To assess the efficacy and safety of a new urethral prosthesis in the management of chronic urinary retention in women as an alternative to intermittent or indwelling catheterization.

METHODS

Between May 1999 and July 2000, 60 women with chronic urinary retention were prospectively enrolled in the study. The prosthesis was inserted under local anaesthesia. A magnetic control unit activates the urethral device to achieve micturition. Duration of the experience, complications and compliance were evaluated.

RESULTS

Thirty patients were satisfied with the device. Discontinuation occurred in the first two weeks following implantation in 50% of cases. Bladder migration of the prosthesis occurred in two cases, urinary leakage around the device in four patients, spontaneous expulsion in two women and cystitis was diagnosed in two cases.

CONCLUSION

This intraurethral prosthesis is an attractive, simple technique for use as an alternative to catheterization. Some untoward events and technical complications explained the number of discontinuations.

External occlusive devices for management of female urinary incontinence

OBJECTIVES

Urinary incontinence affects 11 million women in the United States and is most common in older women. There are several different forms of urinary incontinence, which can be distinguished by their associated pathophysiologic conditions and signs. Genuine stress incontinence is the instantaneous leakage of urine in response to raised intraabdominal pressure associated with such activities as lifting, sneezing, and coughing. Risk factors for development of this form of incontinence include vaginal delivery, vaginal surgery, inadequate estrogen levels, and advanced age. Surgery, the most effective curative treatment for stress incontinence, is invasive and expensive and can lead to impairment of normal urinary tract functions. Other management options include pelvic floor rehabilitation by means of exercise, pharmacotherapy, intravaginal and intraurethral devices, absorbent products, and external occlusive devices.

METHODS

A review of publications on the effectiveness of available external occlusive devices is presented, with special emphasis on a new, single-use, disposable urethral cap device which offers women with stress incontinence an over-the-counter product that enables them to independently manage their incontinence according to their individual needs.

RESULTS

Non-surgical methods of managing urinary incontinence are available, with newer methods providing a greater range of choices for women.

CONCLUSIONS

External occlusive devices can be effectively used by women with urinary incontinence who will not or cannot have surgical correction of the problem.

The Incontinence Impact Questionnaire and the Urogenital Distress Inventory: a revisit of their validity in women without a urodynamic diagnosis

OBJECTIVES

We sought to assess validity of the Incontinence Impact Questionnaire (IIQ) and the Urogenital Distress Inventory (UDI) (long and short forms) in incontinent women previously urodynamically undiagnosed.

STUDY DESIGN

Post hoc analysis of responses to the IIQ and UDI questionnaires were obtained from a trial on a urethral device in community-dwelling incontinent women. Internal consistency and validity were evaluated against the 1-hour pad test.

RESULTS

Internal consistency (Cronbach's alpha) for the long forms was high for the IIQ and moderately high for the UDI, good for the IIQ-short, but poor for the UDI-short. Correlations with 1h pad test were low and non-significant for both versions. Correlation of the short with the long forms was high.

CONCLUSION

In the community-dwelling population, without a urodynamic diagnosis, neither long nor short versions of the questionnaires correlate with the severity of the urinary incontinence as shown by the pad test. The validity of the current questionnaires in women without urodynamic diagnosis is questionable.

Conservative management for urinary incontinence

Gynaecologists have become increasingly aware of the need to offer conservative therapy for genuine stress incontinence. There is good objective evidence from randomized controlled trials to support the use of supervised pelvic floor exercises. The efficacy of biofeedback therapy, vaginal cone weights and electrostimulation therapy is variable and requires further study to identify those women who will benefit the most. The mainstay of therapy for detrusor instability/sensory urgency remains bladder training, which has proven objective efficacy, but new treatments such as transcutaneous electrical nerve stimulation (TENS) offer promise. Finally, for certain groups of women with mixed stress and urge leak, a new range of vaginal and urethral devices provide useful additional options. The specific requirements for future research are discussed.