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.
Author(s): Anne P. Cameron
Publisher: Springer
Year: 2022
Language: English
Pages: 544
City: Cham
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
