Practical Aspects of Urinary Incontinence

Urinary incontinence is becoming an increasingly dominant condition in daily urological and gynaecological practice, although the total number of patients suffering from the different forms ofincontinence remains unclear. An estimated figure for The Netherlands, with a population of 14 500000, has been given as between 500000 and 600000 patients, showing that approximately 4 % of the total population suffer from this condition, the majority being female. The impact ofthis number is tremendous, not only regarding health care costs, but even more with regard to the psycho-social consequences. It is obvious that continuing efforts must be made to under­ stand more fully the different forms of urinary incontinence. An exact diagnosis is the first step necessary for adequate therapy. We all know how disastrous it can be to institute inappropriate treatment as a consequence of misunderstanding the proper aetiology in each individual case. What has happened in the past 15 years? During that time we have developed sophisticated machinery to diagnose in more detail the exact ori­ gin of each type of urinary incontinence, and on entering a urodynamic laboratory, one is struck by the complexity of measuring equipment. But how reliable are all these measurements and how can they be translated into an effective therapy? This still remains one ofthe major problems, although continuing progress has been made and will be made by the research work of many experts in the field of urinary incontinence.

Inhalt

Introduction: Problems in the management of urinary incontinence.- One: Investigations for Urinary Incontinence.- I.1. Practical equipment for office urodynamics.- I.2. The role of radiology in urodynamics.- I.3. The value of the urethral pressure profile.- I.4. The role of telemetry in the evaluation of incontinence.- I.5. New developments in urodynamic investigations.- Two: Genuine Urinary Stress Incontinence.- II.1. The female sphincter mechanisms and their relation to incontinence surgery.- II.2. The rational approach for the surgical treatment of urinary stress incontinence.- II.3. A simplified technique of bladder neck suspension with tissue glue.- II.4. Transurethral teflon injection for stress incontinence in women. A critical evaluation after three years.- II.5. Burch colposuspension: method of choice?.- II.6. Turner-Warwick vagino-obturator shelf urethral-repositioning procedure.- II.7. Vaginal plasty operation for stress incontinence using fascia lata substitute.- Three: Recurrent Urinary Stress Incontinence.- III.1. Recurrent urinary stress incontinence: evaluation and therapy.- III.2. The treatment of recurrent urinary stress incontinence: a urologie view.- III.3. The treatment of recurrent urinary stress incontinence: a gynaecological view.- III.4. Recurrent urinary stress incontinence treated fascia sling plasty: technical considerations and results.- III.5. Practical aspects of vaginal sling plasty in the management of recurrent urinary stress incontinence.- III.6. Critical analysis of the role of surgery in the management of recurrent urinary stress incontinence.- Four: Incontinence and Resolutions of Vaginal Prolapse.- IV.1. Anterior vaginal repair for urinary incontinence associated with vaginal prolapse.- IV.2. Anterior colporrhaphy for urinary incontinence associated with vaginal prolapse: a gynaecological view.- IV.3. The surgical possibilities and limitations of the vaginal approach.- IV.4. Essentials of the technical aspects of anterior colporrhaphy and colpoperineal plastic repair: a gynaecologic procedure.- IV.5. Criterial review of the surgical techniques in the management of vaginal prolapse and urinary incontinence.- Five: Vesico-Vaginal Fistulae.- V.1. Female incontinence due to urethro- and vesico-vaginal fistulae.- V.2. The omental repair of complex vesico-vaginal fistulae.- V.3. Technical considerations in the vaginal approach of vesicovaginal fistulae.- Six: Male Incontinence.- VI.1. The sphincter mechanisms of the male and the prevention of postprostatectomy incontinence.- VI.2. Postprostatectomy incontinence.- VI.3. The mechanisms of continence and incontinence after prostatectomy.- VI.4. Incontinence operation for postprostatectomy incontinence.- VI.5. Critical analysis of the surgical procedures in the management of postprostatectomy incontinence.- Seven: Artificial Sphincters in the Management of Urinary Incontinence.- VII.1. The bladder neck artificial sphincter.- VII.2. Bulbar artificial sphincter.- VII.3. The implantable artificial urinary sphincter in children: a 6-year experience.- VII.4. The penoscrotal sphincter to treat male sphincter insufficiency.- Eight: Past and Future of Urinary Incontinence.- VIII.1. A review of 35 years experience in the management of urinary incontinence.- VIII.2. Future aspects in the management of urinary incontinence.