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The following article on incontinance and the growing trend of specialty continence treatment
centers was first published in our bimonthly news fax to physicians in December 1997. We
hope you find it informative and invite you to visit the Ashley Urology Continence Centre.
Studies show that urinary incontinence (UI) affect up to 30 percent of women over 60 and 18% of men. Citing recently released clinical guidelines from the Agency for Health Care Policy and Research (AHCPR), the web site for the Spartanburg, SC-based National Association for Continence (NAFC) reports that the disorder affects more than 13 million U.S. adults. 85% of them are women.
According to the NAFC one in four, or 25% of women ages 30-59 have experienced an episode of urinary incontinence. And while children and young adults also are part of the population with the disorder, better than fifty percent of elderly persons living at home or in long-term care facilities suffer from the emotional and physical discomfort of incontinence. Economic sources estimate that urinary incontinence imposes an annual burden of $10 to $16 billion on health care.
Using both surgical and nonsurgicical techniques, approximately 80% of cases can be cured or improved. Yet of those affected, only half ever seek medical help.
SPECIALIZED CENTERS
While the numbers support the establishment of specialized centers for treating urinary incontinence, not every center is the same. Both surgical and nonsurgical procedures are available and a continence center must be able to offer a full range of diagnostic and therapeutic services to offer the patient every available treatment option.
In our July/August 1995 issue of the Physician's Fax, the Laparoscopic approach to retropubic colposuspension to urinary stress incontinence was discussed. The procedure is an effective alternative and Ashley Urology was one of the first in the Charleston area to offer this innovation as a surgical procedure.
NONINVASIVE APPROACHES
While this surgery is effective the associated risk and patient reluctance of invasive procedures often prevents treatment. Other treatment programs such as diapers, drugs and catheters often are inadequate, have side effects or do nothing to treat the problem.
However, scientific studies and recent AHCPR guidelines provide a noninvasive method for treating many patients experiencing UI. In the recently released guidelines by the AHCPR, the agency outlines recommendations for a program of noninvasive procedures and exercises. This treatment alternative is a systematic approach to treating UI using a combination of Pelvic Muscle Exercise (PME), biofeedback therapy and pelvic floor electrical stimulation. The recommendation is supported by scientific evidence.
BIOFEEDBACK DEVICE
The device is a handheld electrical stimulation unit designed to deliver electrical impulses to the pelvic floor. The resistivity of the perineal tissue determines the amount of current delivered. For patients with assorted incontinence, settings are adjusted for the dominant condition. The probe, coated with a conductive gel is inserted into the vagina and the intensity is monitored and slowly increased to the maximum current not painful to the patient. The patient should feel a contraction moving through the vagina toward the anus. At each session during a six-week therapy program the intensity is increased as tolerated.
CLINICAL STUDIES
In one study reported in the June 1990 issue of The Journal of Urology, researchers, Susset, Galea and Read treated 15 women with UI with a biofeedback device for 6 weeks. The results of the study posted a complete subjective cure in 12 patients (80%) while 2 showed from 65% to 75% subjective improvement noting that the improvement was sufficient to allow for a more productive social life. The remaining patient showed only a 25% improvement and was referred for surgery.
In another study reported in the September 1993 issue of The Journal of Reproductive Medicine, Drs. Caputo and Benson and Elizabeth McClellan R.N. of Methodist Hospital of Indiana published findings of a study conducted on 76 women. Findings reported an overall subjective improvement rate of 68% and an overall objective improvement rate of 76%.
PROBLEM RECOGNITION
Primary physicians and related specialists can play a significant
role in UI detection and guiding patients to a facility for proper
treatment or further evaluation. Partly out of embarrassment or
believing that it is a normal part of child bearing or aging, many
patients may not volunteer information.
Specific questions to ask as part of the routine medical history-taking might include: Do you have trouble with your bladder? Do you have trouble holding your urine (water)? Do you ever lose urine when you don't want to? Do you ever wear a pad or other protective device to collect your urine?
Patients exhibiting certain criteria as a
result of nontransient causes should be
referred to a specialist. Among the
criteria outlined by the AHCPR are:
Incontinence associated with recurrent symptomatic urinary tract infections.
Severe symptoms associated with difficult bladder emptying.
Prostate nodule
Abnormal post-void residual urine volume.
SUMMATION
In response to both a clinical need and to the business opportunity urinary continence centers are a natural coalescence for urologists and patients. Noninvasive therapies, while not previously unknown, can now be coupled with state of the art equipment to offer improvement for a statistically relevant number of patients. The successful center must offer a full range of surgical and nonsurgical options. Primary care and other specialties perform an invaluable patient service by including questions in patient history-taking that could expose an unreported problem.
© 1997 MarkeTech Information Services
This page last updated 2/18/98