Female Urinary Incontinence

Description

This book provides a comprehensive review of the etiology, anatomy, diagnosis, treatments, and future directions of care for female incontinence. It includes a historical review of past treatments many women have undergone and resultant altered anatomy. This book discusses conservative treatments such as patient and provider handouts on behavioral modification and how to perform pelvic floor exercises. It also covers medical therapy from minimally invasive treatments to radical surgical approaches and management of treatment failures. Addressing the treatment of stress incontinence with chapters progressing from least invasive to most invasive therapies, it also describes mesh complications and treatment failures. The book illuminates the intersection of prolapse with female incontinence, incontinence diagnosis and management after major reconstructions such as neobladder or penile inversion, vaginoplasty, and incontinence due to rarer conditions such as fistulas. Further chapters explore female urinary incontinence in special populations including pediatric patients, the elderly, and women with neurogenic lower urinary tract dysfunction, as well as poorly understood populations such as older children, women post-reconstruction, and trans-women. It also addresses research needs and the ever-expanding horizon of new developments in the field of incontinence in women. Female Urinary Incontinence provides a comprehensive text directed towards urologists, gynecologists, and those trained in female pelvic medicine and reconstructive surgery (FPMRS). Given the topic of incontinence specifically in women and the burgeoning rise of women in the field of FPMRS, the book features an all-female author list comprised of an international group of female urologists and urogynecologists selected to author chapters on their particular expertise. Contents Summary Contributors Part I: Diagnosis and Etiology of Incontinence in Women Chapter 1: Epidemiology, Definitions, and Cost of Incontinence in Women Introduction Definitions of Urinary Incontinence in Women Rates of Urinary Incontinence Rates of Urinary Incontinence by Age Rates of Urinary Incontinence by Race or Ethnicity Risk Factors for Urinary Incontinence Age Parity and Mode of Delivery Family History Physical Activity Smoking Pelvic Surgery Comorbid Conditions Obesity Constipation Pelvic Pain Chronic Respiratory Disease Diabetes Mellitus (DM) The Cost of Urinary Incontinence Any Urinary Incontinence Stress Incontinence Urgency Incontinence Social Disparities in Female Pelvic Floor Disorders Conclusion References Chapter 2: Anatomy and Physiology of Female Urinary Incontinence Introduction Definitions Physiology of Voiding Bony Pelvis and Pelvic Ligaments The Pelvic Bones Pelvic Ligaments Figs. 2.1 and 2.4 Pelvic Foramina Pelvic Side Walls The Muscles of the Pelvic Side Wall (Table 2.1) The Pelvic Floor The Pelvic Diaphragm Muscles (Figs. 2.2 and 2.4) Uterine Support (Figs. 2.1 and 2.3) The Perineum The Deep Perineal Pouch, the Perineal Membrane, and the Perineal Body (Figs. 2.2 and 2.4) Superficial Perineal Pouch (Figs. 2.2, 2.4, and 2.5) Features of Female External Genitalia (Fig. 2.4) The Ischioanal Fossae (Fig. 2.4) Female Pelvic Organs Reproductive Organs Uterus and Cervix Fallopian Tubes Ovaries Lower Urinary Tract Organs Urinary Bladder Urethra (Figs. 2.2, 2.4, 2.6, and 2.7) Ureters (Figs. 2.3 and 2.5) Other Pelvic Organs Rectum and Anus (Figs. 2.1, 2.2, 2.4, and 2.5) Pelvic Blood Supply Arteries Internal Iliac Artery Arterial Blood Supply to Specific Structures and Organs in the Pelvis and Perineum Ovary Vagina Urethra Rectum and Anus Veins Pelvic Plexuses and the Nerve Supply of the Pelvis and Perineum Sacral Plexus, Coccygeal Plexus, and Somatic Nerves Innervation of the Lower Urinary Tract: Visceral Plexuses Other Important Nerves Pudendal Nerve (Figs. 2.4 and 2.9) Obturator Nerve Sensory Nerves Lymphatics of the Female Pelvis Urinary Tract Reproductive Organs Rectum and Anus Conclusions Take-Home Message References Chapter 3: Diagnosis of Urinary Incontinence in Women Introduction Differential Diagnosis History and Physical Exam Noninvasive Testing Advanced Testing Conclusions References Chapter 4: Urodynamic Testing of Female Incontinence Principles of Urodynamics Urodynamics Testing Alternatives Urodynamics Testing and Interpretation Antibiotics and Patient Preparation for UDS Systematic Interpretation of a UDS Study Urodynamic Diagnoses Stress Urinary Incontinence Detrusor Overactivity Detrusor Underactivity or Atonic Bladder Bladder Outflow Obstruction NGB Safety or Poor Compliance Anatomic Diagnoses Seen on Fluoroscopy Conclusion References Chapter 5: Historical Treatment of SUI and UUI in Women Introduction Native Tissue Plication Autologous Tissue Retropubic Slings Cystourethropexy Needle Suspension Procedures Urethral Bulking Bladder Denervation Detrusor Myectomy Conclusion References Part II: Conservative Treatment Chapter 6: Behavioral Therapy and Lifestyle Modifications for the Management of Urinary Incontinence in Women Introduction Diet Fluid and Caffeine Management Alcohol and Tobacco Timed Voiding Bladder Training Bowel Management Exercise Weight Loss Absorbent Products and Skin Protection Conclusion References Chapter 7: Physical Therapy and Continence Inserts Introduction Primary Prevention of Incontinence Prevention of UI in Older Women UI Prevention During Pregnancy and Postpartum Vaginal and Urethral Devices Pelvic Floor Muscle Therapy Assessment of Pelvic Floor Contraction Education on Pelvic Floor Muscle Contraction Outcomes Counterbracing and Urge Suppression Creating Individualized Programs Conclusion References Part III: Medical and Surgical Treatment of UUI Chapter 8: Medical Therapy with Antimuscarinics and ß3-Agonists Introduction Medication Pharmacology Antimuscarinic Effectiveness Comparative Effectiveness Transdermal Use of Antimuscarinics ß3-Agonist Effectiveness Mirabegron Vibegron Efficacy of ß3-Agonist Compared to Antimuscarinic Monotherapy Combination Therapy OAB Treatment and Cognitive Impairment Summary References Chapter 9: Posterior Tibial Nerve Stimulation for Female Urge Urinary Incontinence Mechanism of Action Techniques Evidence for Effectiveness Percutaneous Posterior Tibial Nerve Stimulation Transcutaneous Posterior Tibial Nerve Stimulation Side Effects/Complications Failed PTNS Pathophysiology and Treatment New Technology in Posterior Tibial Nerve Stimulation Conclusion References Chapter 10: Sacral and Pudendal Neuromodulation (SNM) Introduction Mechanism of Action of Sacral and Pudendal Neuromodulation Operative Techniques for Sacral and Pudendal Neuromodulation Sacral Neuromodulation Pudendal Neuromodulation Recent Technological Advances Outcomes of SNM Outcomes of PNM Failed SNM Adverse Events/Complications Conclusions References Chapter 11: Botulinum Toxin for Overactive Bladder Introduction Botulinum Toxin Mechanism of Action Neurotoxins Available Worldwide Dysport, Abobotulinum Toxin A (Ipsen Biopharm Ltd., Slough, UK) Xeomin, Incobotulinum Toxin A (Merz Pharmaceutics, Frankfurt Germany) Botox Injection Techniques Other Delivery Techniques Under Investigation Efficacy Injection Complications and Other Considerations Immunogenicity: Timing of Other BTXA Injections Distant Spread Contraindications Conclusion References Chapter 12: Augmentation Cystoplasty in the Non-neurogenic Bladder Patient Overactive Bladder Interstitial Cystitis/Bladder Pain Syndrome Following Partial Cystectomy Decreased Bladder Capacity Surgical Approach Augmentation Cystoplasty Techniques AC with/without Catheterizable Channel-Open Technique AC Laparoscopic/Robotic Technique Follow-Up Pregnancy after Bladder Augmentation Summary References Chapter 13: Advanced Options for Treatment of Refractory Urgency Urinary Incontinence Suprapubic Catheter: Indications and Methods Percutaneous Placement of SP Catheter Endoscopic Placement of SP Catheter Surgical Placement of SP Catheter Bladder Neck Closure Indications and Methods Transvaginal Approach Transurethral Approach Transabdominal Approach Urinary Diversion: Indications and Methods Simple Cystectomy with Conduit Conclusion References Part IV: Surgical Treatment for SUI Chapter 14: Urethral Bulking Agents Introduction Method of Action Patient Selection and Indications Procedural Aspects and Injection Techniques Transurethral Injection Periurethral Injection Device-Guided Injection Postoperative Recommendations and Findings Comparison of Injection Methods Summary of Urethral Bulking Agents in Women: Safety and Efficacy Historical Agents Sclerosing Agents Polytetrafluoroethylene (Teflon™) Autologous Fat Glutaraldehyde Cross-Linked (GAX) Collagen (Contigen™) Ethylene Vinyl Alcohol (Uryx™, Tegress™) Dextranomer with Hyaluronic Acid (Zuidex™, Deflux™) Contemporary UBAs Porcine Collagen (Permacol™) Calcium Hydroxylapatite (Coaptite™) Carbon-Coated Zirconium (Durasphere™) Cross-Linked Polydimethylsiloxane (Macroplastique™) Polyacrylamide Hydrogel (Bulkamid™, Aquamid ™) Polydimethylsiloxane (Urolastic™) The Use of UBAs Compared with Other Anti-Incontinence Procedures UBAs as a Salvage Procedure After Failed MUS Conclusion References Chapter 15: Burch Colposuspension Introduction Mechanism of Action Surgical Technique Anatomy Surgical Steps Surgical Outcomes Complications and Adverse Events Conclusion References Chapter 16: The Innovation of Midurethral Slings: Where We’ve Been and Where We Are Today Introduction Stress Urinary Incontinence: Historical Pearls Integral Theory Evolution of the Mid-Urethral Sling Contemporary Comparative Data for SUI Surgical Treatments Comparable Efficacy: Burch, Pubovaginal Slings, Mid-Urethral Sling Comparable Efficacy: Mid-urethral Slings (Retropubic, Transobturator, Single-Incision Slings) Mesh Complications What About Urethral Bulking Agents? Current Guidelines for SUI and the Worldwide Standard Conclusion References Chapter 17: Autologous Fascial Sling Historical Perspective Indications Urethral Mechanics Preoperative Evaluation Operative Technique Patient Positioning Rectus Fascia Graft Harvest Vaginal Dissection Sling Placement and Fixation Fascia Lata Considerations Postoperative Care Outcomes and Complications Cure/Improvement Rates Voiding Dysfunction/Urgency/Retention Erosion and Extrusion Other Complications Autologous Fascial Sling after Synthetic Mesh Sling Rectus Fascia Versus Fascia Lata Autologous Graft Compared to Allograft Materials Autologous Fascia Use for Transobturator Slings References Chapter 18: Managing Complications After Surgical Treatment of Stress Urinary Incontinence Introduction Evaluation and Diagnosis Bladder Outlet Obstruction Chronic Irritative Symptoms Infection Pain Vaginal Mesh Exposure and Extrusion Urinary Tract Erosion Sexual Dysfunction Conclusions References Chapter 19: Failure of Treatment of Stress Urinary Incontinence Failed Sling Pathophysiology and Treatment Definition of Failure Pathophysiology of Failure Management of Failure De Novo OAB The Treatment of the Failed Sling with Recurrent SUI Conservative and Medical Therapy Surgical Management of Recurrent SUI Autologous Fascial Sling (AFS) Bulking Agents Repeat Mid-urethral Synthetic Sling Including Using an Adjustable Sling Colposuspension: Laparoscopic or Open Sling Plication and Manipulation Bladder Neck Suspension Techniques Spiral or Obstructing Slings Adjustable Continence (ACTs) Stem Cell Therapy Artificial Urinary Sphincter (Indications and Methods) Introduction Indications for AUS in Women Outcomes Surgical Technique Pre-operative Considerations Robot-Assisted AMS 800 Bladder Neck Implantation Bladder Neck Dissection AMS-800 Placement Conclusion References Part V: Other Contributors and Causes of Incontinence Chapter 20: Prolapse as a Contributing Factor to Stress and Urgency Urinary Incontinence Epidemiology of Prolapse Definition Prevalence Risk Factors How Could Prolapse Cause Urinary Incontinence? Common Risk Factors Prolapse and Stress Urinary Incontinence Prolapse and Urgency Incontinence How Does Treating Prolapse Improve SUI and UUI? Pessary Use Surgery When Should an Incontinence Procedure Be Offered with Pelvic Organ Prolapse Repair? When Should a Concomitant Incontinence Procedure Be Offered with Prolapse Surgery? Demonstrable SUI Occult SUI Prophylactic Incontinence Procedure in Continent Women Presence of Risk Factors and Patient-Centered Outcomes Risk Calculator for De Novo SUI Staged Procedure Conclusion References Chapter 21: Incontinence After Complex Urinary Reconstruction: Orthotopic Neobladder and Gender-Affirming Surgery Introduction Urinary Incontinence in Women After Orthotopic Urinary Diversion Principles of Continent Orthotopic Urinary Diversion Continence Mechanism Incontinence After Orthotopic Urinary Diversion Evaluation and Workup Treatment Physical Therapy Medications Transurethral Bulking Agents Slings Neobladder Vaginal Fistula Hypercontinence Incontinence After Gender-Affirming Surgery Feminizing Surgery Masculinizing Surgery Conclusion References Chapter 22: Rare Conditions Causing Incontinence and Their Treatment Vesicovaginal Fistula Etiology Impact Diagnosis Treatment Ureterovaginal Fistula Etiology Diagnosis Treatment Urethrovaginal Fistula Etiology Diagnosis Treatment Vesicouterine Fistula Etiology Diagnosis Treatment Radiation Cystitis and Radiation Fistula Etiology Diagnosis Treatment Urethral Diverticulum Etiology Diagnosis Treatment Postoperative Care Recurrence/Retreatment Ongoing Symptoms Management Conclusion References Part VI: Incontinence in Special Populations Chapter 23: Incontinence in Older Girls and Adolescents Introduction Background and Epidemiology Prevalence of UI in Older Girls and Adolescents Stress Urinary Incontinence in the Adolescent Females Obesity High-Intensity Athletic Training Disordered Eating Pulmonary Disease Urgency Urinary Incontinence in Female Adolescents Link Between Childhood and Adult Urinary Incontinence Giggle Incontinence Congenital Causes of Urinary Incontinence Evaluation of the Adolescent with Incontinence History Physical Examination Adjunct Testing Treatment Behavioral Modification and Urotherapy Medical Therapy More Intensive Therapies Transcutaneous Neuromodulation Surgical Treatments Conclusion References Chapter 24: Female Neurogenic Incontinence Introduction Etiology of Neurogenic Urinary Incontinence Different Clinical Presentations Urodynamic Investigation Storage Issues Emptying Issues Timing of Urodynamics Safety Workup Treatment of the Bladder Treatment of the Outlet Salvage Treatment with Urinary Diversion Conclusion References Chapter 25: Urinary Incontinence in the Elderly Introduction Conditions Contributing to Urinary Incontinence in Elderly Women General Treatment Considerations in Elderly Women Treatment of Urge Urinary Incontinence First-Line Treatments: Behavioral Modifications Second-Line Treatments: Pharmacologic Treatment Third-Line Treatments: Intradetrusor Onabotulinum Toxin A and Neuromodulation Treatment of Stress Urinary Incontinence Nonsurgical Treatment Options Surgical Treatment Options Conclusion References Chapter 26: Maximizing Intraoperative Performance and Safety During Incontinence Surgery Patient Safety in the Operating Room Safe Patient Positioning Supine Positioning Trendelenburg Positioning Lithotomy Positioning Positioning in Challenging Situations Obese Patients Patients with Contractures or Amputations Safe Use of Intraoperative Radiation Patient Protection Staff Protection Surgeon Safety and Occupational Health Strategies to Maximize Intraoperative Ergonomics and Prevent Injury Strategies to Optimize the Physical Environment Surgeon-Specific Strategies to Improve Ergonomics and Decrease Pain Intraoperative Breaks/Stretches Prevention Strategies Beyond the Operating Room Workstation Optimization Exercise, Physical Therapy, Massage Ergonomic Education Maximizing Intraoperative Surgeon and Team Performance Strategies to Optimize Individual Surgeon Performance Surgical Coaching or Didactic Training Encourage Psychological Safety Mental Practice Stress, Emotion, Conflict Management Optimize Physiology Strategies to Optimize Surgical Team Performance Team Training Crisis Preparation Institutional Culture and Policies References Chapter 27: Experimental Therapies and Research Needs for Urinary Incontinence in Women Introduction Novel Medical Therapies for Urgency Urinary Incontinence Vibegron Gene Therapy Technological Advancements in Neuromodulation Implantable Tibial Nerve Stimulation Sacral Neuromodulation Targeted Therapy for Urgency Urinary Incontinence Microbiome Nonsurgical Options for Stress Urinary Incontinence Pulsed Magnetic Stimulation Electrical Stimulation Slings for Stress Urinary Incontinence Nonpermanent Sling Materials Drug-Eluting and Coated Mesh Adjustable Slings Regenerative Treatments for Stress Urinary Incontinence Stem Cell Therapy Low-Intensity Extracorporeal Shockwave Therapy Other Technological Advancements for Stress Urinary Incontinence Radiofrequency Laser Therapies Vesair® Intravesical Balloon Current Limitations to Research for Urinary Incontinence Strategies for Future Research Conclusion References Index