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Advances in Diagnosis and Treatment of Urinary and Fecal Incontinence in Women

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Nephrology & Urology".

Deadline for manuscript submissions: closed (30 September 2020) | Viewed by 55710

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Special Issue Editors

Prof. Dr. Kurt Naber

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Guest Editor

Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
Interests: urogenital infections and inflammations; urinary tract function
Special Issues, Collections and Topics in MDPI journals

Prof. Dr. Pawel Miotla

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Guest Editor

2nd Department of Gynecology, Medical University of Lublin, 20-059 Lublin, Poland
Interests: sexual life; dyspareunia; public health; overactive bladder; stress urinary incontinence; pelvic organ prolapse; lower urinary tract symptoms; urinary tract function; urinary tract infection; antibiotic resistance

Special Issue Information

Dear Colleagues,

Urinary and fecal incontinence has a significant influence on the quality of life in patients who report such symptoms. Epidemiological studies have shown that prevalence of these troublesome symptoms is higher in women. Some field experts have reported that urine and/or bowel leakage begins in puerperium, while others have indicated that disturbances of bladder and/or bowel functioning start in peri-menopause. It should also be underlined that many female patients have also reported the collateral coexistence of urinary and fecal incontinence. Therefore, there is still a need to introduce proper prophylaxis, diagnostics, and therapy of urinary and fecal incontinence in female patients as early as possible. This Special Issue invites authors to contribute original research and review articles that will encourage progress in the efforts to understand the pathophysiological mechanisms leading to the development of urinary and/or fecal incontinence in women, the impact of these symptoms on the quality of life, and the therapeutic options available for patients.

Potential topics include but are not limited to the following:

- Epidemiology of urinary and/or fecal incontinence in women;
- Basic or clinical science studies on urinary and/or fecal incontinence in women;
- Advances in the treatment of urinary and/or fecal incontinence in women;
- Adherence to recommended therapy;
- Quality of life of women with urinary and/or fecal incontinence;
- Impact of urinary and/or fecal incontinence on sexual function and activity;
- Future directions in the diagnosis and treatment of urinary and/or fecal incontinence in women.

Prof. Dr. Kurt Naber
Dr. Pawel Miotla
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

urinary incontinence
fecal incontinence
urodynamic testing
epidemiology
diagnostic
treatment
quality of life
sexual life
new technologies

Published Papers (14 papers)

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Research

Jump to: Review

10 pages, 562 KiB

Open AccessArticle

A Randomized Clinical Trial to Evaluate the Effect of Canephron N in Comparison to Ciprofloxacin in the Prevention of Postoperative Lower Urinary Tract Infections after Midurethral Sling Surgery

by Ewa Rechberger, Tomasz Rechberger, Sara Wawrysiuk, Pawel Miotla, Beata Kulik- Rechberger, Andrzej Kuszka and Andrzej Wróbel

J. Clin. Med. 2020, 9(11), 3391; https://doi.org/10.3390/jcm9113391 - 22 Oct 2020

Cited by 8 | Viewed by 2888

Abstract

Urinary tract infections (UTIs) are one of the most common reasons for antibiotic prescriptions among women worldwide. UTIs are also associated with intra- and postoperative catheterization, which is an essential component of many gynecological surgical procedures, including midurethral sling (MUS) placement. The aim of this study was to compare the incidence of UTI subsequent to a MUS procedure. The study involved 562 female patients who underwent MUS procedures due to stress urinary incontinence (SUI). Patients were assigned in a 1:1 ratio to two study groups: patients receiving 500 mg of ciprofloxacin three times a day for 3 consecutive days after surgery or patients receiving 5 mL of Canephron taken orally three times a day for 3 weeks. After analyzing the collected data, it was found that in the group of patients receiving ciprofloxacin, 29 women (10.98%) had a UTI, whereas in the group of patients receiving Canephron, 36 women (13.64%) had a UTI within 6 months after the patient’s MUS procedure. No statistically significant difference between the two groups was noted. Postoperative prophylaxis with a phytodrug can be perceived as an attractive option in the reduction of antibiotic consumption among female patients after a MUS procedure. Full article

(This article belongs to the Special Issue Advances in Diagnosis and Treatment of Urinary and Fecal Incontinence in Women)

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11 pages, 3767 KiB

Open AccessArticle

Epidemiological Features of the Bladder Neck Rest Position and Mobility

by Edyta Horosz, Andrzej Pomian, Aneta Zwierzchowska, Wojciech Lisik, Wojciech Majkusiak, Paweł Tomasik, Beata Rutkowska, Joana Skalska, Małgorzata Siemion, Dominika Banasiuk and Ewa Barcz

J. Clin. Med. 2020, 9(8), 2413; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm9082413 - 28 Jul 2020

Cited by 2 | Viewed by 1868

Abstract

The data concerning epidemiological determinants of the bladder neck (BN) mobility are scarce. The aim of the study was to determine epidemiological features and identify factors influencing BN position at rest and BN mobility in patients without pelvic organ prolapse (POP). Seven hundred and ninety-six patients that attended two outpatient clinics were enrolled in the study. Position and mobility of the BN were measured with the use of pelvic floor ultrasound. Demographic and functional factors that were hypothesized to influence BN mobility were assessed. Vaginal deliveries (VDs) and age ≥65 were associated with lower BN position at rest. Higher BN mobility was observed in women with stress urinary incontinence (SUI). In obese women, higher BN position and lower BN mobility was observed compared to non-obese women, and it was correlated with longer urethras in this group of patients. VDs and their number were associated with increased BN mobility, independently of body mass index (BMI). To conclude, obesity, VDs, and age are factors associated with changes in bladder neck position at rest and its mobility. Higher BMI correlates with restricted BN mobility, and, therefore, the incidence of SUI in obese patients is probably not connected to BN hypermobility. Full article

(This article belongs to the Special Issue Advances in Diagnosis and Treatment of Urinary and Fecal Incontinence in Women)

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10 pages, 1044 KiB

Open AccessArticle

The Prognostic Value of the Surface Electromyographic Assessment of Pelvic Floor Muscles in Women with Stress Urinary Incontinence

by Kuba Ptaszkowski, Bartosz Malkiewicz, Romuald Zdrojowy, Malgorzata Paprocka-Borowicz and Lucyna Ptaszkowska

J. Clin. Med. 2020, 9(6), 1967; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm9061967 - 23 Jun 2020

Cited by 3 | Viewed by 1755

Abstract

Background: The use of surface electromyography (sEMG) measurements to evaluate the bioelectrical activity of the pelvic floor muscle (PFM) during therapeutic intervention is now well established. This study investigates the diagnostic possibilities of sEMG in women with stress urinary incontinence (SUI). The aim of this study was to carry out objective assessments of the bioelectrical activity of the PFM in women after menopause and determine the prognostic value of sEMG for assessing the PFM in patients with SUI. Methods: This was a prospective, observational study that evaluated the bioelectrical activity of the PFM in postmenopausal women with or without SUI (SUI group, n = 89 vs. non-SUI group, n = 62). The study was carried out between January 2013 and December 2018 at the Clinic of Urology (Wroclaw, Poland). The protocol for all sEMG measurements of PFM activity consisted of following elements: “baseline”, “quick flicks”, “contractions”, “static hold”, and “rest tone”; we then compared these results between groups. To determine the optimal cutoff level for sEMG activation of the PFM to detect the occurrence of SUI, we performed receiver operating characteristic (ROC) curve analysis (with Youden’s index). Results: Significantly lower results were obtained for all PFM measurements in women with SUI. The optimum diagnostic cutoff for “baseline” was 3.7 μV (area under curve (AUC), 0.63), “quick flicks” was 9.15 μV (AUC, 0.84), “contractions” was 11.33 μV (AUC, 0.80), “static hold” was 9.94 μV (AUC, 0.84), and “rest” was 3.89 μV (AUC, 0.63). Conclusions: Measuring sEMG activity in the PFM may be a useful diagnostic tool to confirm the absence of SUI. We can expect that the sEMG activity of subjects with SUI will be lower than that of healthy people. In order to determine appropriate reference values for assessing sEMG activity data in the PFM, it is now necessary to conduct multicenter studies. Full article

(This article belongs to the Special Issue Advances in Diagnosis and Treatment of Urinary and Fecal Incontinence in Women)

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27 pages, 3734 KiB

Open AccessArticle

The Influence of Vaginal Native Tissue Repair (VNTR) on Various Aspects of Quality of Life in Women with Symptomatic Pelvic Organ Prolapse—A Prospective Cohort Study

by Ewa Rechberger, Katarzyna Skorupska, Tomasz Rechberger, Aleksandra Kołodyńska, Paweł Miotła, Beata Kulik-Rechberger and Andrzej Wróbel

J. Clin. Med. 2020, 9(6), 1634; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm9061634 - 28 May 2020

Cited by 1 | Viewed by 1856

Abstract

Pelvic organ prolapse (POP) and the associated functional disorders are a major epidemiological problem that compromises the quality of life (QoL). The aim of this study was to assess the impact of lower urinary tract symptoms (LUTS) related to POP and vaginal native tissue repair (VNTR) on QoL. Two hundred patients with symptomatic POP were stratified into four groups according to the dominant storage phase function disorders: Urgency; stress urinary incontinence (SUI); mixed urinary incontinence (MUI), and without clinically significant symptoms from lower urinary tract (LUT). They underwent VNTR from January 2018 to February 2019. After 12 months, the QoL was assessed by the Prolapse Quality of Life (P-QoL) and visual analogue scale (VAS) questionnaires. The data were analyzed with Statistica package version 12.0 (StatSoft, Krakow, Poland), using the Kalmogorow–Smirnoff, Shapiro–Wilk W and the one-way analysis of variance with post hoc Tukey tests. The results of P-QoL showed significant improvement (p < 0.05) in all the study groups in most domains assessed before surgery and 12 months after surgery. Significant improvements in all the symptoms assessed by the VAS scale results were found in groups Urgency and MUI. The LUTS questionnaire revealed significant improvement in all voiding and post voiding symptoms in these groups. VNTR effectively eliminated LUTS and significantly improved the patients’ QoL associated with POP. Full article

(This article belongs to the Special Issue Advances in Diagnosis and Treatment of Urinary and Fecal Incontinence in Women)

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8 pages, 224 KiB

Open AccessArticle

Impact of Midurethral Sling Implantation on Sexual Function in Women with Stress Urinary Incontinence

by Edyta Horosz, Aneta Zwierzchowska, Andrzej Pomian, Wojciech Majkusiak, Paweł Tomasik and Ewa Barcz

J. Clin. Med. 2020, 9(5), 1538; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm9051538 - 20 May 2020

Cited by 4 | Viewed by 2587

Abstract

Stress urinary incontinence (SUI) negatively influences sexual functions. However, the available data on sexual activity of patients who underwent midurethral sling (MUS) implantation are inconsistent. Our aim was to evaluate the impact of MUS implantation on sexual functions of women with SUI. We enrolled 171 patients undergoing the MUS procedure. Preoperative examination included the cough test, 1 h pad test and the Prolapse/Urinary Incontinence Sexual Questionnaire, IUGA Revised (PISQ-IR). All patients had the retropubic sling implanted. Follow-up visits were performed 6–12 months after surgery. Objective cure rate was obtained in 90.98% of patients. Coital incontinence was reported by 56% of women before the surgery, and 8.6% afterwards. Among women who gained continence, significant improvement in sexual function was observed in the majority of the domains. In women who were not objectively cured (9.02%), we did not observe improvement in sexual life. All these patients indicated fear of leaking urine during sexual activity as the main cause of avoiding sex, similarly as before operation. To conclude, successful treatment of SUI with MUS significantly improves the quality of sexual life. On the other hand, persistent incontinence appears to be the most probable cause of lack of improvement in the quality of sexual life. Full article

(This article belongs to the Special Issue Advances in Diagnosis and Treatment of Urinary and Fecal Incontinence in Women)

7 pages, 502 KiB

Open AccessArticle

Urine Proteomic Study in OAB Patients—Preliminary Report

by Konrad Futyma, Łukasz Nowakowski, Alicja Ziętek-Strobl, Aleksandra Kamińska, Nadia Taoussi and Tomasz Rechberger

J. Clin. Med. 2020, 9(5), 1389; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm9051389 - 08 May 2020

Cited by 3 | Viewed by 2130

Abstract

Overactive bladder (OAB) is defined by International Urogynecological Association (IUGA)/ International Continence Society (ICS) as urinary urgency, usually accompanied by frequency and nocturia, with or without urgency urinary incontinence, in the absence of urinary tract infection (UTI) or other obvious pathology. The pathophysiology of OAB is not well understood, however a number of different proteins and cytokines including vascular cell adhesion molecule-1 (VCAM-1) were found to be important in regulating structural integrity of the bladder wall. Proteome analysis may thus provide significant information with regard to OAB and may help in discovering novel diagnostic disease biomarkers. Sixteen Caucasian women aged 32–78 were included in the study. Patients were placed within 2 groups: OAB group (n = 8) and control group (n = 8). Urine samples were collected, immediately preserved in a protease inhibitor mixture, and frozen at −80 ℃. All samples were then further processed according to the isobaric tags for relative and absolute quantification (iTRAQ) manual. Proteins were labeled and analyzed in the mass spectrometer conjugated with liquid chromatograph (data are available via ProteomeXchange with the identifier PXD017799). There were no statistically significant differences in demographic data between control and OAB groups. VCAM-1 was the only protein that reached statistical significance as a differentiating protein in both of our experiments assessing the proteomic constitution in OAB patients. Studies involving a larger group of patients may provide further information on urinary bladder proteomics. Full article

(This article belongs to the Special Issue Advances in Diagnosis and Treatment of Urinary and Fecal Incontinence in Women)

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9 pages, 240 KiB

Open AccessArticle

Circadian Patterns in Postvoid Residual and Voided Percentage among Older Women with Urinary Incontinence

by Veerle Decalf, Thomas F. Monaghan, Marie-Astrid Denys, Mirko Petrovic, Ronny Pieters, Jeffrey P. Weiss and Karel Everaert

J. Clin. Med. 2020, 9(4), 922; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm9040922 - 27 Mar 2020

Cited by 1 | Viewed by 1900

Abstract

Background: Women with urinary incontinence incur an increased risk of elevated postvoid residual (PVR) volume and impaired voiding efficiency (i.e., voided percentage (Void%)), but the clinical significance of these parameters remains poorly described. Further characterization of PVR and voiding efficiency may thus be useful in refining the evaluation and management of urinary incontinence. This study aims to explore possible circadian variations in PVR and Void% in older women with stress (SUI), urge (UUI) and mixed urinary incontinence (MUI). Methods: A single center prospective study which enrolled a convenience sample of 90 older women who consulted a tertiary referral hospital for urinary incontinence. Participants underwent an extensive medical interview and were hospitalized to complete a 24-h frequency-volume chart (FVC) with PVR measurement after each void (FVC_PVR). Results: FVC_PVR analysis demonstrated no differences in mean PVR and Void% between patients with SUI, UUI and MUI. Likewise, no daytime or nighttime differences were observed in mean PVR or Void% within or between groups. Conclusions: No evidence of circadian variation in PVR or Void% was observed in older women with SUI, UUI or MUI. Full article

(This article belongs to the Special Issue Advances in Diagnosis and Treatment of Urinary and Fecal Incontinence in Women)

10 pages, 622 KiB

Open AccessArticle

Assessment of the Short-Term Effects after High-Inductive Electromagnetic Stimulation of Pelvic Floor Muscles: A Randomized, Sham-Controlled Study

by Kuba Ptaszkowski, Bartosz Malkiewicz, Romuald Zdrojowy, Lucyna Ptaszkowska and Malgorzata Paprocka-Borowicz

J. Clin. Med. 2020, 9(3), 874; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm9030874 - 23 Mar 2020

Cited by 2 | Viewed by 4915

Abstract

Background: Physiotherapy should be performed by patients with stress or mixed urinary incontinence (SUI and MUI) to increase the strength and endurance of the pelvic floor muscles (PFMs). A method that can positively affect the pelvic floor is stimulation with high-inductive electromagnetic stimulation (HIES). The aim of the study was to evaluate the PFMs after the application of HIES in women with SUI and MUI by using surface electromyography (sEMG). Methods: This was a prospective, randomized, single-blind study with a sham intervention group. The participants were randomly assigned to the HIES group or sham group. The outcomes were features of the bioelectrical PFM activity assessed using sEMG and endovaginal probes. A single-session intervention in the HIES group included 20 min of HIES with an electromagnetic induction intensity of 2.5 T. Results: In the HIES group, there was a statistically significant difference in the PFM sEMG activity during “contractions” (p < 0.001) and “quick flicks” (p = 0.005). In the intergroup comparison, higher PFM sEMG activity after the intervention (“contraction”) was observed in the HIES group than in the sham group (after: p = 0.047; 1 h after: p = 0.017). Conclusions: The assessed HIES method seems effective for SUI and MUI patients in the short term and shows an advantage over the sham intervention in the assessment of PFM contractions. Full article

(This article belongs to the Special Issue Advances in Diagnosis and Treatment of Urinary and Fecal Incontinence in Women)

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11 pages, 258 KiB

Open AccessArticle

The Influence of Vaginal Native Tissues Pelvic Floor Reconstructive Surgery in Patients with Symptomatic Pelvic Organ Prolapse on Preexisting Storage Lower Urinary Tract Symptoms (LUTS)

by Ewa Rechberger, Katarzyna Skorupska, Tomasz Rechberger, Małgorzata Wojtaś, Paweł Miotła, Beata Kulik-Rechberger and Andrzej Wróbel

J. Clin. Med. 2020, 9(3), 829; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm9030829 - 18 Mar 2020

Cited by 6 | Viewed by 1890

Abstract

The aim of this study was to assess the effectiveness of vaginal native tissue repair (VNTR) on preexisting Lower Urinary Tract Symptoms (LUTS) in women with symptomatic pelvic organ prolapse (POP). Two hundred patients who underwent VNTR for symptomatic POP from January 2018 to February 2019 were followed up for 6 months. All patients underwent VNTR, but in the posterior compartment, the rectovaginal fascia was reconnected to the uterosacral ligaments and additionally sutured to the iliococcygeus fascia and muscle. To assess the severity and change in storage phase LUTS before and after surgery, all participants were asked to complete 3 questionnaires: the International Consultation on Incontinence Questionnaire- Short Form (ICIQ-SF), Urogenital Distress Inventory-6 (UDI-6), and Incontinence Impact Questionnaire-7 (IIQ-7). The data were assessed with Statistica package version 12.0, using Kalmogorow–Smirnoff, W Shapiro–Wilk tests. Furthermore, one-way analysis of variance was applied with post-hoc Tukey test. The study results indicate that the majority of patients with advanced POP suffered from various LUTS. Among storage symptoms, the occurrence of urinary incontinence (UI) and urgency decreased significantly after surgery. Moreover, ICIQ-SF, UDI-6, and IIQ-7 results showed statistically significant improvement in the impact of UI on the quality of life (QoL) in the vast majority of patients after surgery. VNTR is an effective way to treat not only anatomical, but also functional problems in such patients. Full article

(This article belongs to the Special Issue Advances in Diagnosis and Treatment of Urinary and Fecal Incontinence in Women)

9 pages, 210 KiB

Open AccessArticle

Does Previous Pelvic Organ Prolapse Surgery Influence the Effectiveness of the Sub-Urethral Sling Procedure

by Edyta Horosz, Andrzej Pomian, Aneta Zwierzchowska, Wojciech Majkusiak, Paweł Tomasik and Ewa Barcz

J. Clin. Med. 2020, 9(3), 653; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm9030653 - 28 Feb 2020

Cited by 1 | Viewed by 2216

Abstract

Pelvic organ prolapse (POP) often co-occurs with stress urinary incontinence. There is no consensus on whether prolapse repair and anti-incontinence surgery should be performed concomitantly or separately, in a two-step manner. The present study evaluated the effects of the tension-free vaginal tape (TVT) procedure in patients who had previously undergone pelvic floor repair (study group), compared to women who underwent TVT insertion only (control group). The study group comprised 84 patients who underwent the TVT procedure but had previously also undergone surgical POP repair. The control group consisted of 250 women in whom the TVT was inserted. The primary objective was to compare the objective cure rate and the secondary objective was to compare the subjective cure rate in both groups. Negative pad test was achieved in over 91% in both groups. Objective and subjective cure rates were compared, as well as complication rates. Significant improvement was observed in the postoperative 1-h pad test in all patients. In all patients, we observed significant improvement in the quality of life, with no differences between the groups. No differences were found in the occurrence of postoperative urinary retention, urgency and frequency of daytime micturition, or vaginal erosion between the groups. The current results demonstrate that the two-step approach to pelvic reconstruction and anti-incontinence surgery is as safe and effective as primary TVT implantation. Full article

(This article belongs to the Special Issue Advances in Diagnosis and Treatment of Urinary and Fecal Incontinence in Women)

9 pages, 639 KiB

Open AccessArticle

Identification of the Pelvic Organ Prolapse/Incontinence Sexual Questionnaire—IUGA Revised (PISQ-IR) Cutoff Scores for Impaired Sexual Function in Women with Pelvic Floor Disorders

by Magdalena Emilia Grzybowska, Konrad Futyma and Dariusz Wydra

J. Clin. Med. 2020, 9(1), 13; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm9010013 - 19 Dec 2019

Cited by 9 | Viewed by 2972

Abstract

The aim of this cross-sectional study was to determine the cutoff scores for sexual dysfunction in disease-specific Pelvic Organ Prolapse/Incontinence Sexual Questionnaire—IUGA Revised (PISQ-IR) for women with pelvic floor disorders (PFD). Medical history and urogynecological data of 521 women with PFD were collected. The subjects provided information about their sexual activity and completed Female Sexual Function Index (FSFI) and PISQ-IR questionnaires. Sexually active (SA) women were further analyzed and categorized using their FSFI scores: <26.55—sexual dysfunction, >26.55—no sexual dysfunction. Receiver operating characteristics (ROC) curve tested how well PISQ-IR allowed to discriminate between patients with and without sexual disorders. Area under curve (AUC) was calculated to measure the PISQ-IR Summary Score efficiency in the prediction. The cutoff values which minimalize (1-specifity) and maximize sensitivity were selected. In the analyzed cohort, 250 (48%) women were SA and a total of 226 SA were recruited for the study: 143 (63.3%) with <26.55 FSFI and 83 (36.7%) with >26.55 FSFI (response rate: 90.4%). Using ROC curve analysis, PISQ-IR Summary Score of 2.68 was determined to be the optimal cutoff for distinguishing between dysfunctional and nondysfunctional women (AUC = 0.85), allowing to diagnose sexual dysfunction in SA women with PFD, with 90% sensitivity and 71% specificity. Full article

(This article belongs to the Special Issue Advances in Diagnosis and Treatment of Urinary and Fecal Incontinence in Women)

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8 pages, 1013 KiB

Open AccessArticle

Platelet-Rich Plasma as Adjuvant Therapy for Recurrent Vesicovaginal Fistula: A Prospective Case Series

by Dominika Streit-Ciećkiewicz, Konrad Futyma, Paweł Miotła, Magdalena Emilia Grzybowska and Tomasz Rechberger

J. Clin. Med. 2019, 8(12), 2122; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm8122122 - 02 Dec 2019

Cited by 20 | Viewed by 5937

Abstract

Vesicovaginal fistula (VVF) is the nonphysiological communication between the bladder and vagina, and surgical closure is the gold treatment standard. Despite that successful closure occurs in around 85% of patients after the first repair, recurrence remains a highly distressing complication for patients and surgeons. The aim of our study was to evaluate the efficacy of a platelet-rich plasma (PRP) injection as a supportive treatment in the surgical repair of recurrent VVF. Between January 2018 and July 2019, 16 patients with recurrent VVF were injected with PRP in a tertiary gynecological department. Subsequently, a surgical Latzko procedure for VVF closure was scheduled 6–8 weeks after the PRP injection allowing proper neovascularization and remodeling of surrounding tissues. Patients were considered cured if no leakage was observed after surgery and negative dye test results were indicated at follow-up. All patients who were examined therein remained dry. To the best of our knowledge, this is the first study aiming to assess PRP injections as a supporting treatment prior to surgical procedure for recurrent VVF. Preliminary results are encouraging, and we incorporated this method in our clinical practice. Further reports on a larger group will follow. Full article

(This article belongs to the Special Issue Advances in Diagnosis and Treatment of Urinary and Fecal Incontinence in Women)

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Review

Jump to: Research

22 pages, 753 KiB

Open AccessReview

Physiotherapy for Prevention and Treatment of Fecal Incontinence in Women—Systematic Review of Methods

by Agnieszka Irena Mazur-Bialy, Daria Kołomańska-Bogucka, Marcin Opławski and Sabina Tim

J. Clin. Med. 2020, 9(10), 3255; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm9103255 - 12 Oct 2020

Cited by 17 | Viewed by 7166

Abstract

Fecal incontinence (FI) affects approximately 0.25–6% of the population, both men and women. The most common causes of FI are damage to/weakness of the anal sphincter muscle and/or pelvic floor muscles, as well as neurological changes in the central or peripheral nervous system. The purpose of this study is to report the results of a systematic review of the possibilities and effectiveness of physiotherapy techniques for the prevention and treatment of FI in women. For this purpose, the PubMed, Embase, and Web of Science databases were searched for 2000–2020. A total of 22 publications qualified for detailed analysis. The studies showed that biofeedback (BF), anal sphincter muscle exercises, pelvic floor muscle training (PFMT), and electrostimulation (ES) are effective in relieving FI symptoms, as reflected in the International Continence Society recommendations (BF: level A; PFMT and ES: level B). Research has confirmed that physiotherapy, by improving muscle strength, endurance, and anal sensation, is beneficial in the prevention of FI, both as an independent method of conservative treatment or in pre/post-surgery treatment. Moreover, it can significantly improve the quality of life of patients. In conclusion, physiotherapy (in particular, BF, PFMT, or ES, as effective methods) should be one of the key elements in the comprehensive therapy of patients with FI. Full article

(This article belongs to the Special Issue Advances in Diagnosis and Treatment of Urinary and Fecal Incontinence in Women)

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32 pages, 521 KiB

Open AccessReview

Urinary Incontinence in Women: Modern Methods of Physiotherapy as a Support for Surgical Treatment or Independent Therapy

by Agnieszka Irena Mazur-Bialy, Daria Kołomańska-Bogucka, Caroline Nowakowski and Sabina Tim

J. Clin. Med. 2020, 9(4), 1211; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm9041211 - 23 Apr 2020

Cited by 22 | Viewed by 14837

Abstract

Urinary incontinence (UI) is a common health problem affecting quality of life of nearly 420 million people, both women and men. Pelvic floor muscle (PFM) training and other physiotherapy techniques play an important role in non-surgical UI treatment, but their therapeutic effectiveness is limited to slight or moderate severity of UI. Higher UI severity requires surgical procedures with pre- and post-operative physiotherapy. Given that nearly 30%–40% of women without dysfunction and about 70% with pelvic floor dysfunction are unable to perform a correct PFM contraction, therefore, it is particularly important to implement physiotherapeutic techniques aimed at early activation of PFM. Presently, UI physiotherapy focuses primarily on PFM therapy and its proper cooperation with synergistic muscles, the respiratory diaphragm, and correction of improper everyday habits for better pelvic organ support and continence. The purpose of this work is a systematic review showing the possibilities of using physiotherapeutic techniques in the treatment of UI in women with attention to the techniques of PFM activation. Evidence of the effectiveness of well-known (e.g., PFM training, biofeedback, and electrostimulation) and less-known (e.g., magnetostimulation, vibration training) techniques will be presented here regarding the treatment of symptoms of urinary incontinence in women. Full article

(This article belongs to the Special Issue Advances in Diagnosis and Treatment of Urinary and Fecal Incontinence in Women)

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