Stress Urinary Incontinence – Pen is mightier than Knife

Kushtagi, Pralhad (2015) Stress Urinary Incontinence – Pen is mightier than Knife. In: 58th All India Congress of Obstetrics and Gynaecology, January 23-25, Chennai.

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Abstract

Stress Urinary Incontinence (SUI) is the most common type of urinary incontinence in women. In most cases, the history and physical examination can identify patients with a significant stress component without the need for urodynamic testing. The treatment for SUI includes various types of behavioral interventions, mechanical devices, and surgery, however,pharmacologic treatment options are being investigated and becoming more widely available. Management should begin with pelvic floormuscle exercises that help to rehabilitate and strengthen the pelvic floor muscles and promote urine storage. Compliance is often poor, but results have been favorable for motivated patients who receive proper clinicaltraining and assessment and who repeat contractions several times a day. Nonsurgical mechanical treatments include pessaries to elevate the vesico-urethral angle, urethral occlusive devices, and use of weighted vaginal cones to provide sensory feedback during pelvic floor muscle exercise. Although these devices have demonstrated efficacy and tolerability in clinical studies, patient acceptance has not been sufficient for commercial success. Defects that result in SUI can be repaired surgically with techniques such as retropubiccolposuspension, or pubovaginal sling or via minimally invasive radiofrequency bladder neck suspension. Although all the procedures had some measure of success, failure, and complications, no single procedure or intervention is optimal for all patients. Anticholinergics and alpha-adrenergics have been suggested for off-label treatment of SUI. An anticholinergic effect on the smooth muscle of the urethra has not been documented, however. In addition, alpha-adrenergic agents such as pseudoephedrine and tricyclic agents such as imipramine do not constitute effective treatment for most SUI patients. An understanding of the physiology of bladder filling, emptying, and control under stress suggests that unlike anticholinergics, selective inhibition of serotonin and norepinephrine reuptake can help control SUI. Pudendalmotor neurons located in Onuf’snucleus regulate the urethral striated muscle sphincter, and Onuf’s nucleus has a high density of norepinephrine and serotonin receptors. Norephinephrine and serotonin stimulate these neurons, causing an increase in the strength of urethral sphincter contractions.Duloxetine, a selective serotonin and norepinephrine reuptake inhibitor, blocks the reuptake of norepinephrine and serotonin, increasing pudendal nerve activity and sphincter muscle tone. The trials have shown that there is significantdecrease in the median incontinence episode frequency, greater benefit from symptoms in those with more severe group. It must be remembered that be it for writing a prescription (for alpha-adrenergics/ anticholinergics/ serotonin uptake inhibitors), giving a co-prescription (for estrgens), involving the patient in the management exercise to record voiding diary, or for making markings on the skin before placement of sling/ tapes, pen is inevitable. Even the various contraptions suggested like cones and pessaries are also shaped like a pen!

Item Type: Conference or Workshop Item (Paper)
Uncontrolled Keywords: Stress urinary incontinence; nonsurgical management; surgical management; evidence based debate
Subjects: Medicine > KMC Mangalore > Obstetrics & Gynaecology
Depositing User: KMCMLR User
Date Deposited: 31 Mar 2015 05:08
Last Modified: 31 Mar 2015 05:08
URI: http://eprints.manipal.edu/id/eprint/142294

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