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Query: UMLS:C0042024 (incontinence)
 13,409 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Incontinence isn't itself a disease but the feature of possible urinary tract alterations or outside of it. Incontinence is frequent above all in the elderly but it can be on charge of both sexes at every age. In Italy, according to recent evaluations, people affected with this disease would be more than 4 millions. Incontinence is therefore an important failure for its health aspects but also for economic and social ones. The problem is to evaluate if incontinence can't be prevented and as consequence needs only an assistance management, or it can be considered a preventable disease able to be cured, as we deeply believe, suggested also by the positive results of new therapeutical procedures, in association with traditional surgery and rehabilitation such as injectables or mini-invasive quick operations such as colpocleisis or percutaneous vaginal colposuspension (PVC), matters of this presentation and always performed according to correct diagnosis and indication. Bovine dermal collagen highly purified, poorly viscous and easily injectable, despite traditional rehabilitation and surgery, is a further procedure, endoscopic and minimally invasive to treat stress incontinence. Collagen is employed to perform a bladder neck plasty, increasing urethrosphincterial competence, to obtain continence without the creation of an obstruction. Genital prolapse, that is hysterocolpocele or simple vaginal vault prolapse, has course in high proportion (37%) in elderly (after 80 years). Surgical management of severe failures of continence and often also of the voiding function, such as: hyscuria with vesicoureteral reflux, obstinate constipation related to severe genital prolapse with allied rectocele is often hardly performed in elderly owing to the age and general health conditions: colpoclesis is a vaginal surgical approach that can be easily performed by the urologist too, it is an effective alternative to permanent catheterization or maxipad to be offered to the patient to improve her quality of life. In between the above maintained procedures takes place the percutaneous vaginal colposuspension (PVC). It is an original technique made up in our Institute to treat incontinence by the bladder neck resuspension to Cooper ligament according to a complete miniinvasive retropubic tension free transvaginal colposuspension, in local anaesthesia and complementary light narcosis in Day Surgery. Urinary incontinence is today a disturbance easy to be cured thanks to injectables and to miniinvasive surgical procedures as reported in this presentation concerning the most advanced approaches to its management.
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PMID:[Male and female urinary incontinence: treatment in day surgery]. 973 19

Genital prolapse is a common problem in women. The wide variety of surgical techniques used to treat this problem demonstrate how difficult it is to manage. Laparoscopic surgery offers a new approach. It allows a good view of the anterior and posterior compartments so that a global approach for the prolapse is possible by the same surgical route. Traditional promontofixation can be combined with a new approach to the posterior compartment. Laparoscopic promontofixation through installation of an intervesicouterine prosthesis for the treatment of hysterocele and cystocele is associated with paravaginal repair of lateral defects and a Burch anterior colposuspension for urinary stress incontinence. When combined with laparoscopic treatment of rectocele by myorrhaphy and reinforcement of the fascia by means of a prosthesis, it provides a complete range of treatment for all types of feminine prolapse. After 20 years of experience through laparotomy, promontofixation using a triangle has been carried out by laparoscopy at the authors' center since 1991 in an attempt to eliminate the cystocele by solidly anchoring the uterus and bladder floor to the promontory. This laparoscopic technique follows the usual steps for pelvic prolapse repair: 1. Total or subtotal hysterectomy or suspension of the uterus is performed in such a way that it returns to normal physiologic position, and a solid subvesical floor is created. 2. The physiologic axis of the vagina is restored by creating a strong, low posterior point of support and by performing culdoplasty. 3. Evident or latent stress incontinence is treated. It would be pointless to treat the hysterocele on its own because, once the prolapse has been cured, the subvesical mass will disappear and allow urinary incontinence to appear. 4. Reconstruction of the posterior rectovaginal support structures seems to be mandatory and is carried out in almost all cases. The first phase of the laparoscopic approach to pelvic prolapse allowed the authors to explore the technical aspects. Several approaches are possible by laparoscopy. Herein, the authors report 8 years of technical research and assessment. This experience confirms the tremendous potential of laparoscopic surgery for the treatment of all aspects of this pathology by the same route. Stress incontinence, cystocele, hysterocele, rectocele, or enterocele can be treated. The operative time is longer than with the open route, and the surgeon must be highly experienced. Based on their experience, the authors are discovering new concepts. More data are required before a conclusion can be drawn concerning this promising new approach.
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PMID:Promontofixation for the treatment of prolapse. 1127 60

Urinary incontinence is the complaint of any involuntary leakage of urine. Among women in the general population, the most common types are stress urinary incontinence, urge urinary incontinence and mixed urinary incontinence (EL4). Urinary incontinence is common and affects 25% to 45% of the women in the general population. The prevalence of incontinence increases with age up to the age of 65 (EL2). Many risk factors have been proposed for urinary incontinence. However, those for which the definitive evidence for a causal link and an effective risk reduction intervention are available are only a few. The best studied factor is overweight, clearly associated with incontinence and which reduction decreases by approximately 50% urinary incontinence episodes. Genital prolapse is associated with urinary incontinence and prolapse surgery reduces incontinence. Data concerning several classical risk factors for incontinence such as hypoestrogenism and vaginal delivery are contradictory (EL1). Urinary incontinence affects health with consequences such as dermatologic complications (skin maceration and ulcers) and falls. Urinary incontinence reduces the quality of life and generates high costs for affected individuals and in terms of public health (EL1).
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PMID:[Epidemiology and definition of female urinary incontinence]. 2014 13

Genital prolapse frequently coexists with lower urinary tract symptoms. The first difficulty is to detect occult incontinence masked by the prolapsed organs. Rates of detection are not the same with the different clinical maneuvers (manual, pessary, cotton swab, speculum, etc.). The second difficulty is to choose a management strategy. Through a recent analysis of the literature, this paper suggests recommendations.
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PMID:[Genital prolapse and urinary incontinence: a review]. 2426 Aug 42