URINARY INCONTINENCE Edited by Ammar Alhasso and Ashani Fernando Urinary Incontinence Edited by Ammar Alhasso and Ashani Fernando Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2012 InTech All chapters are Open Access distributed under the Creative Commons Attribution 3.0 license, which allows users to download, copy and build upon published articles even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. As for readers, this license allows users to download, copy and build upon published chapters even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. Notice Statements and opinions expressed in the chapters are these of the individual contributors and not necessarily those of the editors or publisher. No responsibility is accepted for the accuracy of information contained in the published chapters. The publisher assumes no responsibility for any damage or injury to persons or property arising out of the use of any materials, instructions, methods or ideas contained in the book. Publishing Process Manager Danijela Duric Technical Editor Teodora Smiljanic Cover Designer InTech Design Team First published April, 2012 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechopen.com Urinary Incontinence, Edited by Ammar Alhasso and Ashani Fernando p. cm. ISBN 978-953-51-0484-1 Contents Preface IX Part 1 The Basics 1 Chapter 1 The Role of Altered Connective Tissue in the Causation of Pelvic Floor Symptoms 3 B. Liedl, O. Markovsky, F. Wagenlehner and A. Gunnemann Chapter 2 Epidemiology of Urinary Incontinence in Pregnancy and Postpartum 17 Stian Langeland Wesnes, Steinar Hunskaar and Guri Rortveit Chapter 3 A Multi-Disciplinary Perspective on the Diagnosis and Treatment of Urinary Incontinence in Young Women 41 Mariola Bidzan, Jerzy Smutek, Krystyna Garstka-Namysł, Jan Namysł and Leszek Bidzan Chapter 4 Effects of Pelvic Floor Muscle Training with Biofeedback in Women with Stress Urinary Incontinence 59 Nazete dos Santos Araujo, Érica Feio Carneiro Nunes, Ediléa Monteiro de Oliveira, Cibele Câmara Rodrigues and Lila Teixeira de Araújo Janahú Chapter 5 Incontinence: Physical Activity as a Supporting Preventive Approach 69 Aletha Caetano Chapter 6 Elderly Women and Urinary Incontinence in Long-Term Care 89 Catherine MacDonald Chapter 7 Geriatric Urinary Incontinence – Special Concerns on the Frail Elderly 113 Verdejo-Bravo Carlos VI Contents Chapter 8 A Model of the Psychological Factors Conditioning Health Related Quality of Life in Urodynamic Stress Incontinence Patients After TVT 131 Mariola Bidzan, Leszek Bidzan and Jerzy Smutek Chapter 9 The Concept and Pathophysiology of Urinary Incontinence 145 Abdel Karim M. El Hemaly, Laila A. Mousa and Ibrahim M. Kandil Part 2 The Overactive Bladder 161 Chapter 10 Diagnosis and Treatment of Overactive Bladder 163 Howard A. Shaw and Julia A. Shaw Chapter 11 Biomarkers in the Overactive Bladder Syndrome 189 Célia Duarte Cruz, Tiago Antunes Lopes, Carlos Silva and Francisco Cruz Part 3 Surgical Options 205 Chapter 12 Preoperative Factors as Predictors of Outcome of Midurethral Sling in Women with Mixed Urinary Incontinence 207 Jin Wook Kim, Mi Mi Oh and Jeong Gu Lee Chapter 13 Suburethral Slingplasty Using a Self-Fashioned Mesh for Treating Urinary Incontinence and Anterior Vaginal Wall Prolapse 219 Chi-Feng Su, Soo-Cheen Ng, Horng-Jyh Tsai and Gin-Den Chen Chapter 14 Refractory Stress Urinary Incontinence 233 Sara M. Lenherr and Arthur P. Mourtzinos Chapter 15 Surgical Complications with Synthetic Materials 241 Verónica Ma. De J. Ortega-Castillo and Eduardo S. Neri-Ruz Chapter 16 Treatment of Post-Prostatic Surgery Stress Urinary Incontinence 263 José Anacleto Dutra de Resende Júnior, João Luiz Schiavini, Danilo Souza Lima da Costa Cruz, Renata Teles Buere, Ericka Kirsthine Valentin, Gisele Silva Ribeiro and Ronaldo Damião Chapter 17 Continent Urinary Diversions in Non Oncologic Situations: Alternatives and Complications 279 Ricardo Miyaoka and Tiago Aguiar Contents VII Chapter 18 Futuristic Concept in Management of Female SUI: Permanent Repair Without Permanent Material 291 Yasser Farahat and Ali Abdel Raheem Preface Urinary incontinence is a condition that affects a significant proportion of the population. The prevalence increases with age and there is a female preponderance. With the advent of more aggressive management strategies for prostate cancer, there is an increase in the proportion of men struggling with incontinence as well. Incontinence has social, physical, psychological and economic implications for the individual as well as society as a whole. This book attempts to look at the aetiology, investigation and current management of urinary incontinence along with setting it within the framework of clinical practice. Management strategies are framed within a multidisciplinary team structure and as such a range of specialists ranging from psychologists, specialist nurses, gynaecologists and urologists author the chapters. There are some novel methods outlined by the authors with their clinical application and utility described in detail, along with exhaustive research on epidemiology, which is particularly relevant in planning for the future. We would like to acknowledge all the authors for all the hard work and dedication to excellence in completing this book. Mr Ammar Alhasso Consultant Urological Surgeon and Honorary Clinical Senior Lecturer at University of Edinburgh, UK Ms Ashani Fernando Fellow in Urologic Reconstructive Surgery Western General Hospital, Edinburgh, UK [...]... try to help the reader understand why estimates differ Hopefully this will give a better 22 Urinary Incontinence understanding of incidence and prevalence estimates of urinary incontinence in association with pregnancy 2 Urinary incontinence in pregnancy 2.1 Incidence of urinary incontinence in pregnancy Urinary incontinence (UI) is common also among women who have not given birth (nulliparous women)... cross sectional study, Ex = examination, Quest = questionnaire, Interv = interview, PP = postpartum, (s) = stress UI Table 2 Prevalence of urinary incontinence in pregnancy by parity 26 Urinary Incontinence 3 Urinary incontinence postpartum 3.1 Incidence of urinary incontinence postpartum Prevalence of UI postpartum is a so called “mixed bag” of incident UI before pregnancy, incident UI in pregnancy... 49 % cross-s = cross sectional study, Quest = Questionnaire, Interv = interview, Ex = examination, PP = postpartum, (s) = stress UI Table 1 Incidence of urinary incontinence in pregnancy by parity 24 Urinary Incontinence 2.2 Prevalence of urinary incontinence in pregnancy Data from a large number of cross-sectional studies and cohort studies indicate that UI in women is highly prevalent in pregnancy... An Integral Theory of female incontinence Acta Obstetrica et Gynecologica Scandinavia, Supplement 153, Vol 69: 1-79 Petros PE, Ulmsten U (1993) An Integral Theory and its Method for the Diagnosis and Management of Female Urinary Incontinence Part II The biomechanics of vaginal tissue, and supporting ligaments with special relevance to the pathogenesis of female urinary incontinence Scand J Urol Nephrol... pregnancy has been published The International consultation on incontinence published in 2009 their latest report “Epidemiology of Urinary (UI) and Faecal (FI) Incontinence and Pelvic Organ Prolapse (POP)” (Milsom et al., 2009) It describes period prevalence of any UI in pregnancy of 32 – 64% among all women 25 Epidemiology of Urinary Incontinence in Pregnancy and Postpartum Author, year (Burgio et... descensus/prolapse of the vaginal wall Many symptoms are associated with these different forms of descensus/prolapse: stress urinary incontinence, abnormal emptying of the bladder, urgency and frequency, nocturia, faecal incontinence, obstructed defecation and pelvic pain 14 Urinary Incontinence Fig 7 Pelvic pain caused by loose uterosacral ligaments (USL) Especially in the standing position, the uterus... Female Urinary Incontinence Part I Theory, morphology, radiographic correlations and clinical perspective Scand J Urol Nephrol Supp 153: 5-28 Petros P, Ulmsten U (1993) Bladder instability in women: A premature activation of the micturition reflex Neurourol Urodynam 12:235-239 Petros PE, Ulmsten U (1995) Urethral and bladder neck closure mechanisms Am J Obstet Gynecol 173: 346-347 20 Urinary Incontinence. .. Wesnes, Steinar Hunskaar and Guri Rortveit Department of Public Health and Primary Health Care, University of Bergen, Norway 1 Introduction Urinary incontinence is a common condition in pregnancy and postpartum There are published more than a thousand articles on urinary incontinence (UI) in pregnancy Incidence and prevalence figures of UI in association with pregnancy vary substantially Not many reviews... LANCET 1984 2 546-550 Swash M, Henry MM, Snooks SJ Unifying concept of pelvic floor disorders and incontinence Journal of the Royal Society of Medicine, (1985),78: 906-911 Ulmsten U, Henriksson L, Johnson P, and Varhos G An ambulatory surgical procedure under local anesthesia for treatment of female urinary incontinence, Int Urogynecol J (1996); 7: 81-86 Uitto J, Bernstein EF (1998) Molecular Mechanisms... Wachter S (2008) The sensory bladder (1): an update on the different sensations described in the lower urinary tract and the physiological mechanisms behind them Neurourol Urodyn 27: 274-278 Zacharin RF (1963) A suspensory mechanism of the female urethra Journal of Anatomy 97:423-427 2 Epidemiology of Urinary Incontinence in Pregnancy and Postpartum Stian Langeland Wesnes, Steinar Hunskaar and Guri Rortveit . URINARY INCONTINENCE Edited by Ammar Alhasso and Ashani Fernando Urinary Incontinence Edited by Ammar Alhasso and Ashani. Approach 69 Aletha Caetano Chapter 6 Elderly Women and Urinary Incontinence in Long-Term Care 89 Catherine MacDonald Chapter 7 Geriatric Urinary Incontinence – Special Concerns on the Frail Elderly. in Women with Mixed Urinary Incontinence 207 Jin Wook Kim, Mi Mi Oh and Jeong Gu Lee Chapter 13 Suburethral Slingplasty Using a Self-Fashioned Mesh for Treating Urinary Incontinence and Anterior