1/8. Bladder leiomyoma: a rare cause of urinary stress incontinence.Lejomyoma of the bladder is an uncommon lesion and usually present as small intramural or submucosal lesions. Preoperative evaluation based on careful physical and radiologic examinations must rule out malignant and other lesions. It is readily and successfully treated in most cases with transurethral or open resection. The prognosis of this tumor is excellent and no malignant degeneration has been reported. The most common presentations are obstructive voiding symptoms, irritative symptoms, and hematuria. Occasionally, it may be a cause of urinary stress incontinence. Although this condition is rare, it should be considered in the causes of urinary stress incontinence.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/8. Management of intrinsic sphincter deficiency in adolescent females with normal bladder emptying function.PURPOSE: Intrinsic sphincter deficiency is rare in adolescent females with normal bladder emptying function. Information regarding the long-term outcome of therapy in this group of patients is sparse. We report our long-term experience with 3 adolescent females with intrinsic sphincter deficiency and normal bladder function who were treated with an artificial urinary sphincter. We critically reviewed the literature regarding experience with anti-incontinence surgery in adolescent females, not only regarding the outcome of the surgical technique, but also issues not usually considered in older adults, including the impact of physical development and future childbearing. MATERIALS AND methods: The charts of 3 adolescent females with intrinsic sphincter deficiency were reviewed. In addition, relevant peer reviewed articles were selected by a medline search. The results of the artificial urinary sphincter, pubovaginal sling and periurethral injection of bulking agents were reviewed. Long-term efficacy, the complication rate, impact of pregnancy and physical development were assessed. RESULTS: The 3 patients had an excellent long-term outcome with the artificial urinary sphincter, including 1 with 2 pregnancies that ended in a normal vaginal delivery. The literature showed that a good long-term outcome was consistently achieved with the artificial urinary sphincter. An equally good outcome was achieved with the pubovaginal sling but long-term data are lacking. While periurethral injection of a bulking agent provides good initial results, they do not appear to be durable. In addition, the artificial urinary sphincter does not appear to impact pregnancy or physical development negatively. CONCLUSION: Data support the artificial urinary sphincter and pubovaginal sling as effective therapies in adolescent females with intrinsic sphincter deficiency. However, long-term data on the pubovaginal sling are not available. When considering the impact on future childbearing and physical development, the artificial urinary sphincter is a favorable option.- - - - - - - - - - ranking = 4keywords = physical (Clic here for more details about this article) |
3/8. 8-ply small intestinal submucosa tension-free sling: spectrum of postoperative inflammation.PURPOSE: We report a series of postoperative inflammatory reactions of a tension-free pubourethral sling procedure using an 8-ply small intestinal submucosa (SIS) and review the literature regarding inflammatory reactions with this material in genitourinary reconstruction. MATERIALS AND methods: Between August 2002 and June 2003, 6 of 10 patients treated for stress urinary incontinence with 8-ply SIS had postoperative inflammatory reactions. patients underwent a thorough evaluation, including history, physical examination and urodynamic studies, before surgical intervention. RESULTS: All patients presented with induration and erythema at the abdominal incision site(s) and pain 10 to 39 days postoperatively. Pelvic examinations were negative. In 3 patients the inflammatory reaction resolved with minimal or no intervention. Incision and drainage of a sterile abscess were required in 1 patient. Despite 7 days of prophylactic postoperative antibiotics and anti-inflammatory drugs, 2 patients had delayed inflammatory reactions. One patient had resolution with conservative treatment, while the other had an abscess that spontaneously drained. With short-term followup (mean 7 months, range 4 to 10), 8 patients are dry, 1 is improved and 1 is incontinent. CONCLUSIONS: While the results with the 8-ply SIS tension-free sling in the short term are encouraging, the additional morbidity is alarming and caution is warranted. It is essential that patients be made aware of potential risks and possible delayed presentation of morbidity with the use of this material. The human to 8-ply SIS interaction needs further investigation to ensure that long-term safety and efficacy will not be jeopardized. Until then we will continue to use other sling materials.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/8. When the sling is too proximal: a specific mechanism of persistent stress incontinence after pubovaginal sling placement.OBJECTIVES: To review a series of patients with persistent stress urinary incontinence (SUI) after pubovaginal sling (PVS) placement because of an excessively proximal position of the graft on the bladder neck. methods: Four women, who had previously undergone PVS placement for SUI, presented for evaluation of persistent SUI. All underwent investigations, including history, symptom questionnaire, quality-of-life assessment, physical examination, voiding cystourethrography, and multichannel urodynamic studies. Subsequently, takedown of the primary PVS and placement of an autologous fascial PVS were performed on all patients. A detailed case review of one of the patients is presented. RESULTS: All patients had persistent severe SUI confirmed by a positive supine stress test and Valsalva leak point pressure determination. Malposition of the graft was diagnosed preoperatively on the basis of severe distortion of the bladder base and a wide-open bladder neck at rest on the lateral standing voiding cystourethrography images. The diagnosis was confirmed on operative exploration. All patients were continent after takedown of the prior PVS and placement of an autologous fascial sling. CONCLUSIONS: Persistent SUI after PVS placement may occur secondary to positioning of the graft excessively proximally on the bladder neck. True lateral voiding cystourethrography views are essential for the precise diagnosis. In our experience, optimal management involves takedown of the primary PVS and placement of an autologous fascial PVS.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/8. Obturator abscess after transobturator tape for stress urinary incontinence.BACKGROUND: A transobturator tape is a nonwoven, thermally bonded polypropylene tape recently approved in europe for minimally invasive treatment of stress urinary incontinence. CASE: Three cases of obturator abscess after transobturator tape procedures are reported. patients presented with groin pain and vaginal discharge, and physical examination showed vaginal erosions. magnetic resonance imaging confirmed the obturator abscess. All patients had complete sling removal and were treated with antibiotics. The organism responsible for the obturator abscess was bacteroides fragilis in all three cases, suggesting that the infection occurred through a vaginal erosion. CONCLUSION: Persistent painful or irritating symptoms after suburethral tape procedures may be due to a vaginal erosion that can be associated with an obturator abscess. Appropriate evaluation and treatment result in marked symptomatic improvement, although stress incontinence may recur.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/8. Managing a patient's constipation with physical therapy.BACKGROUND AND PURPOSE: constipation is a prevalent condition in the united states, with typical treatment consisting of diet modification, stool softeners, and laxatives. These interventions, however, are not always effective. The purpose of this case report is to describe the use of abdominal massage in physical therapist management for a patient with constipation. CASE DESCRIPTION: An 85-year-old woman with constipation was referred for physical therapy following unsuccessful treatment with stool softeners. The patient was instructed in bowel management as well as a daily, 10-minute home abdominal massage program. OUTCOMES: Upon re-examination, the patient reported a return of normal bowel frequency and function without the need to strain or use digital evacuation. DISCUSSION: Physical therapy incorporating abdominal massage appeared to be helpful in resolving this patient's constipation. Unlike medical management of constipation, no known side effects have been identified with abdominal massage.- - - - - - - - - - ranking = 6keywords = physical (Clic here for more details about this article) |
7/8. collagen injection therapy for type III stress urinary incontinence.urinary incontinence is a distressing, demoralizing, costly condition that affects 10% to 25% of women and up to 5% of men between the ages of 15 and 60 years. One common type of urinary incontinence is stress urinary incontinence (SUI), which is the involuntary loss of urine during physical activities that increase intraabdominal pressure. Many individuals with SUI have intrinsic sphincter deficiency. Until recently, treatment for intrinsic sphincter deficiency involved open surgical procedures and lengthy recovery periods. patients now have the option of undergoing a less-invasive treatment: collagen injections into their bladder necks and proximal urethras. Perioperative nurses can enhance the success of collagen injection therapy by understanding the psychosocial needs of patients with SUI, the patient selection criteria and diagnostic tests required for this new treatment approach, and the nursing role in collagen injection procedures.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
8/8. Delayed hypersensitivity and systemic arthralgia following transurethral collagen injection for stress urinary incontinence.PURPOSE: During a prospective cohort study to determine the effectiveness of and adverse effects associated with transurethral collagen injection for treatment of stress urinary incontinence in women, we observed 3 cases of delayed allergic reaction at the skin test site associated with arthralgia. MATERIALS AND methods: A total of 337 women with at least a 1-year history, physical findings and urodynamic abnormalities consistent with stress urinary incontinence, who required pads or protective clothing and who had no or only grade 1 cystocele were enrolled in this prospective cohort study. Adverse effects were documented by a third party at each followup. RESULTS: Delayed reaction at the skin test site occurred in 3 patients (0.9%), and was associated with arthralgias in 2. CONCLUSIONS: The incidence and systemic nature of this type of reaction suggest that gluteraldehyde cross-linked collagen injection is not as innocuous as previously believed. patients should be counseled regarding the unknown long-term outcome of this complication. Before treatment clinicians should consider double skin testing.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |