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- Title
UPDATES ON THE MANAGEMENT OF URINARY INCONTINENCE.
- Authors
Ng, Peter
- Abstract
Urinary incontinence continues to present a growing worldwide health problem. In the area of physical therapies there has been little movement. Prompted voiding for the cognitively impaired, Bladder training,pelvic floor muscle training have been proven effective but magnetic stimulation has not been proven useful. Electrical stimulation with surface electrodes to the skin, anus or vagina are no longer recommended. Pelvic floor exercises have been proven useful for regaining continence in men post prostatectomy and its reducing the rate of urinary incontinence in late pregnancy and up to 6 months post partum. Most significant is the recent development of the Beta 3 agonist in particular Mirabegron which has been extensively trialed and shown to be efficacious and safe providing an alternative to the use of antimuscarinics for the treatment of the overactive bladde r. This is timely as there have been recent evidence of incident dementia and mood disorders in patients with long term use of antimuscarinics. There is evidence of it's efficacy in patients unsuitable for or refractory to antimuscarinic therapy. Adherence to and persistence with Mirabegron is greater than with antimuscarinics as well. Mirabegron has also been trialled in combination with Solifenacin as an add on treatment with promising results. In the field of paediatrics, although it is only Oxybutinin that has been FDA approved for use with the overactive bladder, recent trials have shown good results with Solifenacin and Tolteridine. Propeverine has also been many other countries. Posterior tibial nerve stimulation has been shown to be as effective as tolteridine in women. For patients with refractory overactive bladders, the use of Botulinum toxin A (BoNT-A) has had medium to long term experience with proven efficacy without significant incidence of bladder fibrosis but with risks of urinary tract infections and the need for clean intermittent self catheterisation. Duloxetine has been the only drug proven useful for stress urinary incontinence but all studies show a high withdrawal rate due to nausea and has a risk of suicide which has limited its use. Intravaginal use of estrogens has been shown to be useful for post menopausal women with stress incontinence as well as symptoms of vulval-vaginal atrophy. The surgical treatment of stress urinary incontinence has established the mid urethral sling as the most widely studied and effective procedure. The transvaginal tape insertion is more effective than the transobturator tape insertion but at the cost of more complications as well as lower tract symptoms. Periurethral bulking injections have not been proven effective over the long run. For post prostatectomy incontinence the use of the male slings has been gaining ground and there is now an adjustable male sling which is being trialed extensively.
- Subjects
URINARY incontinence treatment; ADRENERGIC beta agonists; BOTULINUM toxin; ELECTRIC stimulation; ARTIFICIAL implants; URINARY incontinence; TREATMENT of urinary stress incontinence; DULOXETINE; MUSCARINIC antagonists; KEGEL exercises
- Publication
World Council of Enterostomal Therapists Journal, 2018, Vol 38, Issue 2, p44
- ISSN
0819-4610
- Publication type
Article