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Contribution au traitement de l'incontinence urinaire chez la chienne par soutènement urétral prothétique trans-obturateur/Contribution to the treatment of urinary incontinence in the bitch by trans-obturator prosthetic urethral slingClaeys, Stéphanie 24 October 2009 (has links)
Lincompétence du sphincter urétral (ISU) est la cause la plus fréquente dincontinence urinaire chez la chienne adulte. Elle affecte typiquement les chiennes stérilisées, dâge moyen et de grande race. Son traitement est initialement médical. La phénylpropanolamine (PPA) est le traitement médical de choix et son taux de succès varie de 85 à 97 % de continence. Des études expérimentales antérieures ont démontré lavantage urodynamique dune administration de PPA une fois par jour par rapport à ladministration 3 fois par jour recommandée habituellement. Aucune étude clinique na cependant été réalisée jusquà présent pour confirmer lefficacité de ce protocole de traitement chez la chienne incontinente.
Un traitement chirurgical est recommandé en cas de non réponse ou de réponse partielle au traitement médical, si la chienne devient réfractaire au traitement ou développe des effets secondaires, ou si les propriétaires ne souhaitent pas administrer un médicament à long terme. De nombreuses techniques chirurgicales ont été décrites pour traiter lISU chez la chienne mais aucune à lheure actuelle ne permet de garantir un taux de continence complète élevé et ce, à long terme et avec un faible taux de complications.
Le traitement de lincontinence urinaire deffort chez la femme est principalement chirurgical et implique le placement dune bandelette sous-urétrale par voie vaginale. Parmi les techniques décrites, la TVT-O offre un très bon taux de succès et présente très peu de complications postopératoires.
Les objectifs de ce travail étaient donc dévaluer lefficacité clinique dun dosage quotidien unique de PPA et dadapter la technique TVT-O à la chienne en passant par une étude préliminaire sur cadavres et chiennes Beagles saines pour ensuite lutiliser chez des chiennes incontinentes atteintes dISU, afin den évaluer les effets cliniques, urodynamiques et morphologiques.
Dans la première étude, lefficacité clinique de la PPA administrée une seule fois par jour à un dosage de 1.5 mg/kg a été démontrée. En effet, le suivi à long terme (23.9 mois en moyenne) montre que 8 chiennes sur 9 étaient continentes après traitement. Une chienne na pas répondu à la PPA et a été traitée chirurgicalement. Aucun effet secondaire na été observé chez les animaux traités. Dun point de vue urodynamique, ladministration de PPA augmente significativement les valeurs de pression urétrale maximale de fermeture (MUCP). Ladministration de PPA 2 à 3 fois par jour, telle que recommandée habituellement, nest donc pas utile puisquune administration quotidienne unique, plus pratique et moins coûteuse pour les propriétaires, suffit à maintenir la continence chez 89 % des chiennes traitées.
La faisabilité de la technique TVT-O a ensuite été évaluée chez la chienne. La dissection de 12 cadavres de chiennes après mise en place de la bandelette montre que la TVT-O est faisable chez la chienne moyennant certaines adaptations. Une épisiotomie est notamment nécessaire chez la chienne contrairement à la femme. Les résultats montrent que la bandelette est située à une distance raisonnable des structures neuro-vasculaires importantes, y compris les vaisseaux fémoraux et le nerf obturateur, minimisant le risque de les léser. Elle est également localisée de manière constante en arrière du muscle élévateur de lanus, en région périnéale, rendant ainsi le risque de lésion vésicale quasi inexistant. La technique apparaît donc peu risquée et reproductible chez la chienne.
Lapplication de la TVT-O chez 2 chiennes Beagles continentes nous a ensuite permis dobserver labsence de complications intra- et postopératoires. Dun point de vue urodynamique, la pression intégrée (aire sous la courbe dUPP représentant la résistance urétrale) est augmentée jusquà 4 mois après lintervention. Les vagino-urétrographies postopératoires montrent un déplacement ventral et un rétrécissement de lurètre distal juste en avant du méat urinaire. Dun point de vue histologique, les tissus entourant la bandelette montrent une réaction fibroblastique modérée accompagnée dune réaction inflammatoire lympho-plasmocytaire légère à modérée. La bandelette semble donc relativement inerte et bien tolérée chez le chien. La tolérance de la bandelette est dune importance majeure puisquune réaction inflammatoire excessive peut induire une érosion vaginale ou urétrale pouvant entraîner une infection.
La TVT-O a ensuite été réalisée sur 8 chiennes incontinentes atteintes dISU. Après un suivi de 2 semaines à 12 mois (moyenne, 7.3 mois), 7 des 8 chiennes sont continentes. Une chienne a récidivé 2 mois après la chirurgie et a été traitée à la PPA. Dun point de vue urodynamique, MUCP et la pression intégrée sont augmentées significativement après lintervention. Laugmentation de pression se situe principalement au niveau de lurètre moyen. Il apparaît donc que la localisation du pic de pression urétrale postopératoire ne correspond pas à la localisation anatomique de la bandelette. Les vagino-urétrographies, pour la plupart non remarquables, montrent que la bandelette ne modifie pas la position du col vésical puisque les vessies en position pelvienne en préopératoire le restent en postopératoire. Une complication intra-opératoire sest produite chez une chienne chez qui une lésion urétrale caudale a été créée pendant lintervention. Aucune complication postopératoire na été observée. Les résultats cliniques à court et moyen terme de lutilisation de la TVT-O dans le traitement de lISU chez la chienne sont donc très favorables. Lhypothèse dun rétablissement dun support urétral déficient, entraînant une restauration de la fonction urétrale, reste à démontrer.
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Yngre kvinnors upplevelse av hur urinläckage påverkar livssituationenWahlström, Gunilla, Jonsson, Kerstin January 2009 (has links)
Background: Among young women vary the presence of urinary leakage between 28-80% depending on the study and the sport practiced. Poor support in the upper part of the urethra and urinary bladder base is considered the common cause of stress urinary incontinence. Supports are given by the pelvic floor muscles and the key muscles to prevent incontinence. Urinary leakage occurs more frequent in women who engaged in sports that provide a high abdominal pressure. Pelvic floor training is considered to be an effective and safe method to treat stress urinary incontinence and is recommended in the literature as the first treatment action. Aim: To examine young active women's experience of urinary incontinence affects their lives. Method: A qualitative design with tape-recorded interviews and semi-structured open questions were used as data collection method. A strategic selection was made. Six young active elite sportswomen interviewed. A qualitative content analysis was conducted. Results: Four categories were identified: manageable, social limitations, emotional and communication. Main findings shows that young women do not talk about urinary leakage as a problem, they have different ways to cope. Women experience a fear of urinary leakage shall be affected without prior notice and to lose control. The risk of urinary leakage gives concentration difficulties in training. The study shows a great lack of information. Weighted understanding: Among young women, there may be a risk that they are more affected by urinary leakage than middle-aged and older women, in terms of their experience of urinary leakage and leak impact on their lives. This in view of the ideals which today makes high demands and is difficult to live up to. Women get often their first information on the basin floor exercise to prevent urinary leakage at childbirth. This information should take place earlier. / Bakgrund: Hos unga elitidrottare varierar förekomsten av urinläckage mellan 28-80 % beroende på studie och vilken sport som utövas. Dåligt stöd i övre delen av urinröret och urinblåsans botten anses vara den valigaste orsaken till ansträngningsinkontinens. Stödet ges av bäckenbottenmuskulaturen och dess viktiga muskler för att förhindra inkontinens. Urinläckage förekommer oftare hos kvinnor som utövar sporter som ger ett högt buktryck. Bäckenbottenträning anses vara en effektiv och säker metod för att behandla ansträngningsinkontinens och rekommenderas i litteraturen som första behandlingsåtgärd. Syfte: Att undersöka yngre aktiva idrottande kvinnors upplevelse av om urininkontinens påverkar deras livssituation. Metod: En kvalitativ metod med bandade intervjuer och halvstrukturerade öppna frågor användes som datainsamlingsmetod. Ett strategiskt urval gjordes. Sex yngre kvinnliga aktiva elitidrottare intervjuades. En kvalitativ innehålls analys utfördes. Resultat: Fyra kategorier identifierades: Hanterbarhet, sociala begränsningar, Emotionellt och kommunikation. Huvudesultatet visar att yngre kvinnor inte pratar om urinläckage som ett problem, de hade olika sätt att hantera situationen. Kvinnorna upplevde en rädsla för att urinläckage skulle ske utan förvarning och för att tappa kontrollen. Risk för urinläckage gav koncentrationssvårigheter vid träning. Studien visar en stor informationsbrist. Sammanvägd förståelse: Hos yngre kvinnor kan det finnas en risk för att de påverkas mer av urinläckage än medelålders och äldre kvinnor, när det gäller upplevelsen av urinläckage och läckagets påverkan på livssituationen. Detta med tanke på de ideal som idag ställer stora krav och är svåra att leva upp till. Kvinnor får oftast sin första information om bäcken botten träning för att förebygga urinläckage vid barnafödande. Denna information bör ske tidigare.
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A causal model : factors influencing pelvic muscle exercise adherence among Taiwanese women with urinary incontinence /Chen, Shu-Yueh. January 2001 (has links)
Thesis (Ph. D.)--University of Washington, 2001. / Vita. Includes bibliographical references (leaves 144-158).
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An evidence-based pelvic floor muscle training program to prevent urinary incontinence for patients following radical prostatectomyChan, Fun-yee., 陳芬怡. January 2011 (has links)
published_or_final_version / Nursing Studies / Master / Master of Nursing
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Prevalence of appropriate evaluation and management of urinary incontinence in Texas long-term care facilitiesMonroe, Deirdre Marie 05 May 2011 (has links)
Not available / text
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Development of a pad test to assess stress urinary incontinence in young healthy women: a pilot study2014 April 1900 (has links)
Purpose: Current literature reports that between 7 and 14% of young, healthy women have stress urinary incontinence (SUI). No gold standard exists for quantifying urine leakage, although pad tests have been used in older, parous populations. The aim of this study was to determine the reliability and accuracy of a new pad test for young, healthy women with SUI. Methods: The pad test consisted of measuring quantity of leakage after the following activities: stair running, standing up from sitting, curl-ups, running on the spot, jumping jacks, jumping on a mini-trampoline and coughing vigorously. Bladder volume was standardised by having the volunteers drink one litre of water one hour prior to the testing. The volunteers performed the pad test on two consecutive days. Results: Sixteen nulliparous women between the ages of 18 and 30 years (7 controls and 9 with SUI) participated in this study. The mean increase in pad weight was 0.64 g (± 0.50) in the continent group and 11.89 g (± 20.32) in the group with SUI. There was no significant difference in pad weight between the testing sessions (p=0.228), however the test was not able to elicit measureable urine loss in 3 participants with SUI. Pad weights between the two groups of women were significantly different (p=0.023). The test re-test ICC for the continent group was 0.845 (95% CI: 0.139–0.973) and 0.782 (95% CI: -0.040–0.952) for the group with SUI. Significance: The results of this study support the use of this pad test in healthy young women with SUI; it appears to be reliable and challenging enough to cause measureable urine loss in the majority, and it may be useful for diagnosing and quantifying SUI without urodynamic studies.
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Jag läcker! Kvinnors upplevelser av att leva med urininkontinens / I'm leaking! Women's experiences of living with urinary incontinenceMalm, Helena, Gunnarsson, Sandra January 2014 (has links)
Urininkontinens är ett globalt problem som förekommer hos mer än 50 miljoner av världens befolkning och är tre gånger vanligare bland kvinnor än hos män. Urininkontinens medför en försämrad livskvalitet genom att bland annat påverka kvinnors fysiska, psykiska, sexuella och sociala välbefinnande. Sjuksköterskan kommer i kontakt med kvinnor som har urininkontinens och för att kunna ge god vård och främja hälsa behövs kunskap om hur kvinnor upplever urininkontinens. Syftet med litteraturstudien var att beskriva kvinnors upplevelser av att leva med urininkontinens. Metoden var en litteraturstudie som bestod av 13 vetenskapliga artiklar. Resultatet visade att kvinnors upplevelser av urininkontinens var besvärande men att vissa kvinnor använde sig av strategier för att hantera vardagen. Fyra kategorier var framträdande: upplevelsen av förlorad kontroll, upplevelsen av urininkontinens som tabubelagt ämne, upplevelsen av begränsningar i vardagen och upplevelsen av att hantera vardagen. Trots att urininkontinens är vanligt förekommande finns fortfarande brister i vårdens omhändertagande av urininkontinenta kvinnor. Sjuksköterskor bör bli bättre på att identifiera och informera kvinnor som lever med urininkontinens. Mer kunskap om urininkontinens inom sjuksköterskeutbildning och bland vårdpersonal behövs. / Urinary incontinence is a global problem that affects more than 50 million people and is three times more common among women than in men. Urinary incontinence means reduced quality of life by affecting women physically, psychologically, sexually and socially. Nurses encounter women with urinary incontinence and in order to provide high quality care and promote health, knowledge is needed on how women experience urinary incontinence. The purpose of this study was to describe women's experiences of living with urinary incontinence. The method was a literature review consisting of 13 articles. The result showed that women's experiences of urinary incontinence were bothersome but that some women used strategies to cope with everyday life. Four categories were prominent: the experience of loss of control, the experience of urinary incontinence as a taboo subject, the experience of limitations in everyday life, the experience of dealing with everyday life. Although urinary incontinence is common, there are still deficiencies in the health care of urinary incontinent women. There is a need for nurses to become better at identifying and informing women living with urinary incontinence. More knowledge about urinary incontinence is needed in nursing education and among health professionals.
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Clinical Outcomes involving the Use of Extracorporeal Magnetic Innervation in the Treatment of Urinary IncontinenceDavis, Kathy 18 December 2014 (has links)
ABSTRACT
CLINICAL OUTCOMES INVOLVING THE USE OF EXTRACORPOREAL MAGNETIC INNERVATION IN THE TREATMENT OF URINARY INCONTINENCE
by
KATHY E. DAVIS
Urinary incontinence affects approximately 25 million Americans, significantly diminishing their function and quality of life. It is estimated that 50% of all women will experience some form of urinary incontinence in their lifetime. Although women are disproportionately affected by urinary incontinence, 69% of men who have undergone prostatectomy also report post-surgical incontinence.
Extracorporeal Magnetic Innervation (ExMI) is a novel conservative approach to the treatment of urinary incontinence. As a patient sits fully clothed on a chair, an electromagnet delivers a timed magnetic field that penetrates the pelvic floor, inducing a nerve impulse that prompts contractions of the muscles of the pelvic floor. When the magnet is switched off, the muscles relax. This forced, passive exercise of the pelvic floor muscles serves to build endurance and strengthen the muscles supporting the bladder during times of physical stress such as coughing, laughing or running.
This study is a descriptive, retrospective analysis of data collected from a specialty continence center within a major Atlanta metropolitan outpatient facility. The records for all patients who received ExMI from 2000 to 2012 were reviewed. Of the 43 patients who had received ExMI, 35 met study inclusion criteria. Eight patients were eliminated from the study. Four of these patients experienced ExMI benefits for conditions unrelated to urinary incontinence and are discussed. Data were analyzed using descriptive and inferential statistics. .
The majority of the patients were women (n=26, 74%); most patients had stress urinary incontinence (n=16, 46%) or mixed urinary incontinence (n=12, 34%). The patient outcome was determined by comparing the pad usage before treatment and at the end of treatment (16 weeks). The average number of pads used daily was significantly reduced to 1.6 3 + 0.94 (p<.0001). Treatment with ExMI for urinary incontinence was briefly popular in the United States shortly after it was introduced. Although ExMI is used extensively across Europe and Asia, very few studies on the efficacy of ExMI appear in the literature. These results will add to this body of knowledge.
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The effects of changes in family interpersonal relationships on the behavior of enuretic children and their parentsKnight, Nancy Allen January 1974 (has links)
Typescript. / Thesis (Ph. D.)--University of Hawaii at Manoa, 1974. / Bibliography: leaves 157-169. / ix, 169 leaves ill
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Prevalence and impact of urinary incontinence on quality of life among adult Kigali women.Gashugi, Phophina Muhimpundu January 2004 (has links)
Urinary incontinence has already been identified worldwide for years as a health problem affecting essentially women, which can interfere with their overall quality of life. However in Rwanda, this problem has yet not been addressed adequately either because of lack of expertise, or because of cultural traditions associated with taboos among women. Social conditions of women facing this problem hinder them from seeking possibly adequate medical assistance. It is important that this problem be addressed because it may lead to disability, social seclusion, psychological stress and economic burdens. This study was a pioneer one, intended to diagnose the extent of the problem through determining the prevalence of urinary incontinence as well as its impact on the quality of life among women. The study will hopefully be followed by the promotion of physiotherapy to tackle the problem and therefore reduce the number of people suffering from urinary incontinence.
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