Authors: Peter Emanuel Papa Petros
Publish Date: 2011/05/26
Volume: 22, Issue: 8, Pages: 919-921
Abstract
“Mixed incontinence” is defined as a combination of stress and urge symptoms Over time it has morphed into a single entity encompassing etiology and treatment My perspectives are a Stress incontinence SI and urge incontinence UI are different symptoms with often different anatomical causation and so should be treated separately b It is illogical to group urgency with SI Urgency may also be associated with frequency nocturia abnormal emptying and pelvic pain in patients with no SI “posterior fornix syndrome” and c There is growing evidence that urgency may be cured by surgical correction of a cystocele and/or apical prolapse in up to 80 of patients who do not have SI In this anatomical context sensory urgency urge incontinence and urodynamic detrusor overactivity may all be hypothesized as different manifestations of a prematurely activated micturition reflex caused by a lax vagina’s inability to support bladder base stretch receptors This statement can be tested with a simple clinical test “simulated operations” whereby digitally supporting in turn the midurethra bladder base and posterior vaginal fornix may cause a significant decrease in the urgency felt by the patientThe term “mixed incontinence” is only valid if both symptoms are caused by a lax pubourethral ligament However urgency may be caused by laxity in other parts of the vagina Regarding stress and urge as separate entities will remove the confusion resulting from this definition creating new directions for science and therapyVideo 2 explains in the most direct way how a midurethral sling can cure the urge component indeed the DO of mixed incontinence It also demonstrates that if there is sufficient support at bladder base the stretch receptors can be prevented from firing off prematurely supporting the concept of DO as a premature activation of the micturition reflex 13 by permission Dr Monteiro Portugal MPG 10349 kbVideo 3 aims to provide some insights into the mechanism of neourgency after a midurethral sling Excessive pressure applied on the vaginal membrane from below caused DO and urine loss presumably by stimulation of the bladder base stretch receptors There is a fine balance between the support of stretch receptors video 2 and stimulation thereof video 3 by permission Dr Monteiro Portugal MOV 529 kb
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