1/5. Sacral neuromodulation and pregnancy.PURPOSE: Sacral neuromodulation is effective for lower urinary tract dysfunction. However, despite its increasing use and a preponderance of female patients treated to our knowledge its effect in pregnant women and developing fetuses remains unknown. Therefore, we obtained information on patients on sacral neuromodulation who then achieved pregnancy. MATERIALS AND methods: Data were obtained using a standard questionnaire from 4 physicians with a total of 6 eligible patients. We recorded patient urological history, indication for neuromodulation, pregnancy course, the mode of delivery and neonatal health. We also noted the timing of implant deactivation and reactivation. RESULTS: In 5 patients the stimulator was deactivated between weeks 3 and 9 of gestation, after which 2 with a history of urinary retention had urinary tract infection. In another case, stimulation was discontinued 2 weeks before conception. The only noted complication developed in a pregnancy in which birth was premature at 34 weeks. Three patients underwent normal vaginal delivery, including 1 in whom subsequent implant reactivation did not resolve voiding dysfunction. In 3 cases elective cesarean section was performed. All neonates were healthy. CONCLUSIONS: When a patient on neuromodulation achieves pregnancy, the stimulation should be deactivated. If implant deactivation leads to urinary related complications that threaten the pregnancy, reactivation should be considered. Elective cesarean section should be discussed since it is possible for sacral lead damage or displacement to occur during vaginal delivery.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/5. Approach to urinary incontinence in women. diagnosis and management by family physicians.OBJECTIVE; To outline an approach to diagnosis and management of the types of urinary incontinence seen by family physicians. SOURCES OF INFORMATION: Recommendations for diagnosis are based on consensus guidelines. Treatment recommendations are based on level I and II evidence. Guidelines for referral are based on the authors' opinions and experience. MAIN MESSAGE: Diagnoses of stress, urge, or mixed urinary incontinence are easily established in family physicians' offices by history and gynecologic examination and sometimes a urinary stress test. There is little need for formal diagnostic testing. Management by family physicians (without need for specialist referral) includes lifestyle modification, pelvic floor muscle strengthening, bladder retraining, and pharmacotherapy with muscarinic receptor antagonists. patients with pelvic organ prolapse might require specialist referral for consideration of pessaries or surgery, but family physicians can provide follow-up care. Women with more complex problems, such as severe prolapse or failed continence surgery, require referral. CONCLUSION: urinary incontinence is a common condition in women. In most cases, it can be diagnosed and managed effectively by family physicians.- - - - - - - - - - ranking = 9keywords = physician (Clic here for more details about this article) |
3/5. Management of urinary incontinence in women: clinical applications.urinary incontinence, defined as involuntary loss of urine, is a common health problem among women. The prevalence rate is between 12% and 55% for having ever experienced urinary incontinence. It is associated with poor self-rated health, impaired quality of life, social isolation, and depressive symptoms. However, physicians are usually not the ones to initiate discussion about incontinence with their patients. We present clinical cases to illustrate common scenarios in which a physician may be able to help a female patient manage her urinary incontinence by specifically addressing associated factors and offering treatments to improve or possibly even cure her symptoms. Several evidence-based effective nonpharmacological, pharmacological, and surgical treatment options are outlined.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
4/5. Psychogenic aspects of urinary incontinence in women.Gynecologists and other primary care physicians have long recognized the occurrence of psychogenic factors in some patients with urinary incontinence, usually of the urgency or detrusor dyssynergia types. However, to the best of our knowledge this is the first report of psychiatric study of these patients. Eighteen patients were referred following complete gynecologic urology work-up including electronic urethrocystometry and chain cystography. Most of these patients were 40 to 60 years of age, were multiparous, and had had hysterectomies. Major psychiatric findings were a) severe situational problems in all 18 patients, b) chronic depression in 17, and c) hysterical personality traits in 10. patients whose psychiatric treatment provided some relief of their situational and emotional distress also, concomitantly, had relief of urinary incontinence.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/5. Treating urinary incontinence in the elderly population: accepting the challenge.health care professionals who choose to treat the elderly have a responsibility to be knowledgeable about incontinence. The elderly present challenging and complex problems that may require a collaborative approach from a dedicated team, to include family members, home health nurses, continence nurses, physical therapists, as well as primary care physicians, geriatricians, urologists, and gynecologists. The elderly patient should be reminded that they are a member of that team and their commitment and participation will facilitate successful outcomes.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |