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Background: Surgical therapy for benign prostatic obstruction is indicated after failure of medical therapy or in the presence of secondary side effects. Transurethral resection of the prostate (TURP) is the most well-established intervention. Urinary incontinence is the most distressing complication after TURP and may occur secondary to transient stress incontinence, unmasked neurogenic dysfunction, or iatrogenic injury to the external sphincter. Case Presentation: We present a 71-year-old man with total incontinence after TURP from a retained urethral Foley catheter after attempted self-extraction. Conclusion: The transected catheter was removed under general anesthesia with a larger grasper through a rigid cystoscope.

Aims An updated literature review on outcomes in men treated with currently commercially available bulking agents was performed to determine whether this is a reasonable option in selected patients. Methods The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework of systematic reviews. A comprehensive search of PubMed, Medline, and Embase was undertaken. Abstracts were independently screened by two investigators to include men with stress urinary incontinence treated with a peri-urethral injection of bulking agents currently available in the market. Results Only eight original articles met the inclusion criteria. The bulking agents used were Macroplastique in five studies (total 123 patients), Opsys, Durasphere, and Urolastic in one study each (10, 7, and 2 patients, respectively). Only one study was randomized; Macroplastique vs AUS in men with mild or total incontinence. The included populations were heterogeneous and encompassed endoscopic, perineal, abdominal and laparoscopic prostate surgery as well as spinal cord injuries and urethral sphincter insufficiency. Significant dissimilarity was evident for the duration of incontinence (9-108 months), mean volume of bulking agent used (2.3-13.5 mL), number of cushions (1-5), depth and position of the cushions. The outcomes varied significantly, with reported dry rates between 0% and 83%. Outcomes were limited by relatively short follow-up in most studies. Conclusion Following initial enthusiasm and then dismay with collagen-based compounds, sparse and heterogeneous literature data were produced on newer non-migrating and nonabsorbable bulking agents. Some studies have suggested encouraging, if short term outcomes, however, future studies are needed in this field to support recommendations for widespread use.

Typical etiologies of vesicovaginal fistula (VVF) include obstructed labor, iatrogenic surgical injury, pelvic irradiation and cancer invasion. VVF caused by cystocele are very rare. To date, there are no documented cases in Japanese literature.A 74-year-old woman presented with near total incontinence. On physical examination, she was found to have severe cystocele and pressure necrosis of anterior vaginal wall, which caused partial breakdown of vaginal mucosa and VVF. She underwent vesicovaginal fistula repair using transvaginal and transabdominal approaches. Catheter drainage was performed for 10 days and postoperative cystogram showed no sign of leakage. She is currently symptom-free at 55 months.

A total incontinence management program will benefit a community's administration, nurses, caregivers, families and most importantly, residents. An incontinence program helps reduce the risk of incidences such as agitation, urinary tract infection, falls and skin complications which assisted living and memory care communities are trying to prevent. The correct evaluation tools increase the likelihood of successful outcomes because the program has to be the right program for the resident. After evaluation of the level of incontinence, the resident can then be enrolled. This article provides a practical toolkit for assessment of a resident in assisted living general or memory care populations in addition to the different types of programs a resident can enroll into after evaluation completed.

The aim of the current study was to determine the effect of pelvic floor muscle exercises (PFME/Kegel) training administered to patients scheduled for robot-assisted radical prostatectomy on postprocedural incontinence problems. This study was a randomized controlled trial. Pelvic floor muscle exercises were applied to the procedure group three times a day for 6 months. No exercises were applied to the control group. Incontinence and quality-of-life assessments of the 60 patients in the experimental and control groups were performed on months 0 (10 days after removal of the urinary catheter), 1, 3, and 6 through face-to-face and telephone interviews. Total Incontinence Consultation on Incontinence-Short Form scores, which provide an objective criterion for the evaluation of individuals with incontinence problems, decreased over time. This decrease was statistically highly significant in the third and sixth months. Pelvic muscle floor exercises are suitable for patients experiencing incontinence after radical prostatectomy. Istanbul University Scientific Research Projects UnitIstanbul University [51730] The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was financially supported by the Istanbul University Scientific Research Projects Unit. The number of Project is 51730.

Urinary incontinence in patients with neurological disease is a major health problem. A modified rectus fascial sling has been assessed in incontinent male patients. Fourteen adult male patients with total incontinence due to neurogenic or post-traumatic and etiology were included in this study. A rectangular rectus sheath flap was harvested and defatted.The flap was placed around the bulbar urethra and sutures were passed both in front of and behindthe pubic bone. Both sutures on each side were tied to each other over the pubic bone. Of the 14 patients, 9 (64.3%) were completely dry, 3 (21.4%) reported improved continence, while 2 (14.3 %) were a failure. In total, 71.4% of the patients showed significant improvement using the Incontinence Quality of Life (IQoL) questionnaire. A significant decrease in the number of pads used per day of 61.3 % (p

Objective: We evaluated the effect of verumontanum resection after transurethral resection of the prostate on postoperative urination and incontinence symptoms in patients. Materials and Methods: A total of 68 patients who had undergone transurethral resection of the prostate during the period between January 2006 and January 2009 were included in the study. The patients were separated into two groups. After transurethral resection of the prostate, a verumontanum resection was carried out in the first group of patients, but no additional operation was carried out in the second group. At the end of the third and sixth months, all patients were assessed in terms of the International Prostate Symptom Score, maximum urinary flow rate, quality of life and urinary incontinence. Results: At the end of the sixth month, the obstructive International Prostate Symptom Score of the group in which verumontanum resection was carried out was found to be significantly better, but in terms of other parameters, no significant differences were detected between the two groups. The results achieved at the end of the sixth month were significantly better then the third month's results in both groups. In one patient who had a verumontanum resection, total incontinence developed and, consequently, an artificial urinary sphincter was placed. Conclusion: Although verumontanum resection causes no serious urination changes in patients, it was shown that the verumontanum and its circumference can be safely resected without affecting the patient's continence status.

ObjectiveThe objective of the study was to determine the longer-term efficacy and safety of initiating treatment for urgency-predominant urinary incontinence (UUI) in women diagnosed using a simple questionnaire rather than an extensive evaluation.Study designWomen completing a 12 week randomized controlled trial of fesoterodine therapy for UUI diagnosed by questionnaire were invited to participate in a 9 month, open-label continuation study. UUI and voiding episodes were collected using voiding diaries. Participant satisfaction was measured by questionnaire. Safety was assessed by the measurement of postvoid residual volume and adverse event monitoring; if necessary, women underwent a specialist evaluation. The longitudinal changes in UUI and voiding episodes were evaluated using linear mixed models adjusting for baseline.ResultsOf the 567 women completing the randomized trial, 498 (87.8%) took at least 1 dose of medication during this open-label study. Compared with the baseline visit in the randomized trial, fesoterodine was associated with a reduction in total incontinence episodes per day and urgency incontinence episodes per day at the end of the open-label study (adjusted mean [SE], 4.6 [0.12] to 1.2 [0.13] and 3.9 [0.11] to 0.9 [0.11], respectively, P < .0001 for both). Most women were satisfied with treatment (89%, 92%, and 93% at 3, 6, and 9 months, respectively). Twenty-six women experienced 28 serious adverse events, 1 of which was considered possibly treatment related. Twenty-two women had a specialist evaluation: 5 women's incontinence was misclassified by the 3 Incontinence Questions; none experienced harm because of misclassification.ConclusionUsing a simple validated questionnaire to diagnose and initiate treatment for UUI in community-dwelling women is safe and effective, allowing timely treatment by primary care practitioners.

Temporary sacral nerve stimulation for faecal incontinence caused by pelvic radiation injuries was successful in 7 of 13 patients (54%). The improvement of total incontinence episodes during the temporary stimulation period was a median of 83% (range 25-93%). This may be a viable treatment option for radiation-induced faecal incontinence.

Female genital mutilation (FGM) is a horrible procedure which may have detrimental physical and pyschological effects on women and mostly performed in the Middle East and African regions. FGM has four different types described in various regions. Total urinary incontinence due to type 3 FGM is described in a 21-year-old female in the present article.

Epispadias surgery has mainly two components: bladder and genitourethral reconstruction. Herein, a novel vulvoplasty method, an alternative for the latter component, carried out in a rare case of female epispadias was presented. In a 6-year-old girl admitted with complaint of total incontinence, epispadias without evident extrophy associated with adequate bladder capacity was determined. Firstly the vulvoplasty in which a circumferencial skin flap around the urethral meatus was rolled backwards, and secondly bladder neck reconstruction was performed. The vulvoplasty resulted in sufficient cosmetic outcome and continence up to half an hour, and after cervicoplasty total day and night continence at rest or on exertion were obtained. It was concluded that this vulvoplasty with sufficient cosmetic outcome could be considered as a first stage operation in female epispadias, because it could facilitate bladder neck reconstruction by increasing urethral resistance, and contribute to continence.

A 46-year-old white female underwent a left hemipelvectomy for chondrosarcoma. She presented with total incontinence and a bulging vaginal mass. Exam confirmed complete transurethral bladder eversion that was addressed with transvaginal multilayer bladder neck closure and suprapubic tube placement. Eventually she underwent abdominal hysterectomy, mesh sacral colpopexy, and catheterizable stoma creation. Patient is continent of urine 3 months postoperatively. We present the first reported case of bladder eversion after hemipelvectomy and propose possible pathophysiologic mechanisms.

Urinary incontinence is a stent-related complication; however, total incontinence is not often seen in emergency departments. We report a patient who presented with a sudden, painless, and total urinary incontinence after extracorporeal shock wave lithotripsy. This is the first case of total incontinence due to migrated ureteral double J stent through the external urethral sphincter into the urethra following extracorporeal shock wave lithotripsy.

Objectives To examine the test-retest reliability and the validity of a voiding diary designed to assess the symptoms of frequency, urgency, and urge urinary incontinence (UI).Voiding diaries serve as the primary tool to assess symptoms of overactive bladder in clinical settings and in clinical trials of treatment for overactive bladder. Despite the widespread use of these instruments, few studies have documented their measurement properties or investigated the number of days required to assess symptoms accurately. Methods Study participants included 21 men and 133 women at least 20 years of age recruited from urogynecology and urology clinics. All had a history of urge incontinence or mixed incontinence with urge as the primary component. Participants completed a 7-day voiding diary on two occasions, separated by at least 1 week. Results Men and women reported a daily average of approximately 10 micturitions, 7 occurrences of strong urge, and 2 episodes of urge urinary incontinence. The diary exhibited good to excellent reliability, with estimated intraclass correlation coefficients (ICCs) ranging from 0.81 to 0.86 for the symptoms of strong urge, diurnal and nocturnal micturitions, total incontinence, and urge incontinence episodes. Estimates did not differ appreciably between men and women. Moderate correlations with global questions on micturition frequency and UI episodes supported the validity of the diary. Diaries completed for 3 and 4 days were similar, with only slightly lower estimates of reliability (ICC 0.79 to 0.84). Conclusions The voiding diary completed for 7 days, following detailed instruction, is reliable and appears to be valid for documenting the change in symptoms of overactive bladder in men and women with predominantly urge incontinence. Because of comparable reliability and reduced patient burden, diaries of shorter duration may also be acceptable to assess the symptoms of overactive bladder, depending on the degree of precision required.

Clam ileocystoplasty was performed in 18 patients with urge incontinence, total incontinence or enuresis with instable detrusor. Although the persistence of detrusor instability was observed in 33.33% of the patients, complete clinical cure was found in 72.23 and symptomatic improvement was 22.22%.

Objectives To analyse demographics and outcome of radical prostatectomy (RPE) in Austria in a nationwide series. Methods All patients ( n =16,524) who underwent RPE in public hospitals (covering 95% of all surgical procedures) in Austria between 1992 and 2003 were analysed. Patient demographics, interventions for anastomotic strictures/urinary incontinence/inguinal hernias, perioperative mortality, and overall survival (OS) were determined. Data were provided by the Austrian Health Institute (OBIG). For decades Austria has had a public and equal access health system with compulsory insurance coverage. Results The annual number of RPEs increased from 396 in 1992 to 2640 (+666%) in 2003; the mean age at surgery declined from 64±6.3 yr (1992) to 62.0±6.7yr (2003). An endourologic intervention for anastomotic strictures was performed in 8.5% (45–49 yr: 5.8%; 70–74 yr: 10.8%). An artificial urinary sphincter was implanted in 1.6% with a 5-fold increase from the youngest (0.5%; 45–49 yr) to 2.5% in those aged 70–74 yr. Overall, 6.4% of men underwent an inguinal herniotomy after RPE. The 30-d mortality rate was 0.12%. The 5-yr OS declined from 95% in those aged 50–59 yr to 89.8% in those aged 60–69 yr to 82% in the oldest age group (70–79 yr). Conclusions This nationwide analysis describes the current standard of RPE in Austria. The perioperative mortality was low, the risk of total incontinence acceptable, and the OS indistinguishable to the life expectancy of the age-matched male population in Austria.

We report a case of total urinary incontinence secondary to sphincter destruction after prostate cryotherapy for recurrent prostatic carcinoma in a 64-year-old man. Periurethral collagen injection was impossible due to inadequate penetration of the injection needle, because of severe scarring and fibrotic changes of the urethra after cryotherapy.

Aim:To evaluate the bowel symptoms of patients who underwent local excision of rectal adenomas and carcinomas. Methods: This was a patient questionnaire study sent to patients with at least 12 months of follow up. Modified Kamm symptom scoring system was used. Score 0 was perfect continence and score 20 was total incontinence. Information on alteration in life style was not collected. Results: 68 out of 83 patients responded.( response rate 83%) 4 questionnaires were void leaving 64 questionnaires for analysis from 30 men and 34 women.23 female patients had vaginal delivaries in the past and 12/23 and 3/23 underwent episiotomy and forceps delivary respectively. Only 58% of female patients compared to 90% of men had Kamm scores of 0 to 5. Conclusion: As only 15% and 30% of female and male patients respectively had perfect continence (score 0) detailed symptom scoring is essential prior to local excision.

Although incontinence has been reported after radical vulvectomy, its relationship to operative technique, anatomy, and treatment has not been defined. Twenty-one patients having vulvectomies for vulvar cancer were prospectively evaluated preoperatively and postoperatively with urodynamic function studies. A portion of the urethra was removed in four patients undergoing radical vulvectomy, and 14 had a vulvectomy excision that came within 1 cm of the distal urethra. Six patients (28%) developed a change of continence, with three developing total incontinence, two stress incontinence, and one urge incontinence. All four patients who had a portion of the urethra excised developed stress or total incontinence. The other two patients with incontinence (one total, one urge) had the vulvectomy excision that came close to the urethra. No patient had a change in continence when surgery did not involve or come close to the urethra. When the four patients with a distal urethral resection were compared with patients in whom the urethra was not excised, there was a significant decrease postoperatively in functional urethral length (P less than .0001), anatomical urethral length (P less than .0001), and distal urethral pressure transmission ratios in Q3 (P = .004), Q4 (P = .02), and Q5 (P = .005); but no difference in urethral support (Q-tip test), flow rates, residual urine, bladder capacity, maximal urethral pressure, resting closure pressure, or squeeze pressure. Histologic examination of urethral specimens demonstrated that a portion of the compressor urethrae muscle was often excised. Radical vulvectomy by itself does not cause incontinence, but it would appear that removal of a portion of the urethra increases the chance of incontinence.(ABSTRACT TRUNCATED AT 250 WORDS)

The solid-sphere test was used to measure the strength of the anal sphincter. A plastic sphere 2 cm in diameter was inserted into the rectum. The plastic sphere was stepwise loaded. The patient was asked to contract his sphincter and try to keep the sphere inside the rectum. The maximal strength was defined as the force needed to draw the sphere through the anus. In continent persons the force needed was above 7 N, in persons with partial incontinence between 5 and 7 N, and in persons with total incontinence below 5 N. A clear difference between continent and totally incontinent persons was found. The solid-sphere test is simple, cheap, and of great value in examination of faecal incontinence.

Radical prostatectomy in patients who have had prior transurethral resection of the prostate has been reported to result in significant morbidity. From 1974 to 1982, 30 patients who had had previous transurethral resection of the prostate underwent radical perineal prostatectomy for localized prostatic cancer. Operative time and blood loss were similar to a group of patients who had not had prior transurethral resection of the prostate. Over-all, 3 patients (10 per cent) had total incontinence and 3 (10 per cent) had stress incontinence requiring a pad or device. No patient undergoing radical prostatectomy less than 4 weeks or more than 4 months after transurethral resection of the prostate had postoperative incontinence. When radical perineal prostatectomy was performed between 4 weeks and 4 months after transurethral resection of the prostate the incidence of incontinence was 50 per cent. Five patients experienced prolonged perineal urinary drainage, all but 1 of whom healed spontaneously. Of the 6 patients with incontinence 3 had prolonged drainage. No patient had a rectal injury and there was no operative mortality. Two patients died without cancer and 1 has evidence of disease recurrence. We conclude that radical prostatectomy may be performed safely with acceptable morbidity following transurethral resection of the prostate and that if 4 weeks has elapsed since resection it might be advantageous to wait 4 months before performing radical surgery to lessen the risk of incontinence.

A case of total incontinence that developed after radical vulvectomy and subtotal urethrectomy is presented. Complete relief of the incontinence was obtained after an Aldridge sling operation. The rationale for selecting this operation is discussed.

A new surgical technique for post-prostatectomy incontinence is described. A simple surgical procedure was developed using a tube from a bladder flap and was applied successfully to 4 patients. Of the 4 patients 3 with total incontinence as a result of different surgical procedures on the prostate were cured and 1 was improved.

A review of 159 patients treated by radical retropubic prostatovesiculectomy from 1951 through 1970 has reinforced our belief that this is a satisfactory method of treatment for prostatic cancer confined to the prostate. A 10-year survival of 55 per cent and a 15-year survival of 45 per cent compare well to the results reported for perineal prostatectomy. The postoperative mortality rate was 2.5 per cent and total incontinence was 12.5 per cent after radical retropubic prostatectomy. Completely normal voiding occurred in 108 of the 159 patients. Stress incontinence but no need for an incontinence device occurred in 31 patients. Improved methods for preoperative staging of the disease give promise for even higher cure rates in the future.

The Goebell-Stoeckel fascia lata strap operation for stress incontinence of urine has been used for 30 years. This is a review of eight cases from our practice using this operation for problems of total urinary incontinence secondary to congenital defects and complications of vaginal surgery. The Goebell-Fragenheim-Stoeckel 1–3 operation was first described in 1917. In the original operation, strips of fascia lata were not used for the strap. In later modifications of the procedure, a strip of fascia lata and a small transverse suprapubic incision were employed. The basic principle of the operation is having a supporting structure beneath the urethrovesicle junction that slightly elevates the urethra in this area upon downward or caudad movement of the bladder. Such movement occurs in all Valsalva maneuvers such as coughing, sneezing, laughing, lifting heavy objects, and many body movements. During these movements, the intravesical pressure is raised. If the intraurethral pressure is lower than the intravesical pressure, at that particular moment, urine in the bladder moves to the lower pressure area in the urethra and drains to the outside. The strap procedure, by supporting the suburethral tissue and the urethral vesical angle, probably increases the intraurethral pressure to a level greater than the intravesical pressure preventing urinary incontinence associated with Valsalva maneuvers but the pressure is not elevated to such a level as to retard urinary drainage during detrusor muscle contraction for voluntary voiding. If the above physiologic explanation is true for stress incontinence, how can the Goebell-Stoeckel strap procedure be explained for total incontinence, particularly secondary to congenital defects such as total bladder exstrophy and epispadias? A physiologic explanation of the success of the strap operation in congenital defects cannot be given. This physiologic explanation remains to be answered. However, the clinical results achieved in these eight cases deserve further study. Consideration of this operation may be warranted in these severe cases of incontinence.

Between 1946 and 1980, 54 patients with epispadias and total urinary incontinence were evaluated at our institution. Factors critical to the achievement of complete continence include deferral of surgery until at least 3 yr of age, the patient having a well-developed bladder with adequate capacity and musculature, and maturation of the prostate at puberty in males. Complete continence was obtained in 9 of 11 female patients (82%). Fourteen of 35 male patients obtained complete urinary continence in the initial postoperative period. Complete urinary control was delayed until puberty in 11 additional patients, for an overall success rate of 25 of 35 males (71%). The significant increase in continence with the onset of puberty in males demonstrates the importance of expectant management of the child's progress in relation to the potential contribution of prostatic maturation in the development of urinary control.

A case of congenital absence of the urethra in a women suffering from total incontinence was cured by constructing a sphincteric tube from the lateral and posterior (trigone) walls of the bladder.

Various operations for the treatment of total urinary incontinence are outlined and reviewed. A new application for transvaginal plication of the bladder neck is described, in which layer upon layer of silk mattress sutures are placed until the bladder neck or internal sphincter can be seen to close as the urethrascope is withdrawn. A Vest-straight ahead view lens system is best for observing this sphincter activity. When adequate plication was achieved, three or four girls so treated became continent. Where adequate plication could not be attained, this simple transvaginal procedure did not prejudice the results of subsequent open reconstruction of the bladder outlet. The role of the Berry procedure, Young-Dees, and Leadbetter operations in the treatment of total incontinence is briefly discussed. Twelve patients underwent 18 operations for the correction of total incontinence. Six subsequently developed urinary control, and two more were objectively improved.