Use this URL to cite or link to this record in EThOS: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.440139
Title: Non-invasive and minimally invasive techniques for urodynamic stress incontinence of urine in women
Author: Ismail, Sharif Ibrahim Muhammad Farag
ISNI:       0000 0001 3587 4566
Awarding Body: University of Hull
Current Institution: University of Hull
Date of Award: 2006
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Abstract:
1. Extra-corporeal magnetic energy stimulation of pelvic floor muscles for urodynamic stress incontinence; Objective: To assess the efficacy and practicalities of extra-corporeal magnetic energy stimulation of pelvic floor muscles as a non-invasive technique for urodynamic stress incontinence of urine in women. Design: Prospective non-controlled study. Setting: 2 district general hospitals. Population: Female patients with urodynamic stress incontinence of urine. Main outcome measures: Pad test, continence diary, quality of life assessment using the King's health and EuroQol questionnaires as well as side effects and drop out. Method; 18, twice weekly sessions. Assessment was made on recruitment, at the end of treatment and at 3 months follow up. Results: 48 patients were recruited, 31 completed treatment sessions and 27 attended for follow up at 3 months. There was no significant change in outcome measures at the end of treatment as well as at 3 months follow up. Side effects were encountered by 52.1 % of patients and the drop out rate was 35.4%. Relevant side effects were significantly more common in those who dropped out. Conclusions; Extra-corporeal magnetic energy stimulation of pelvic floor muscles seems unlikely to improve urodynamic stress incontinence of urine. This appears to be due to the passive nature of the contractions evoked. Side effects are prominent and appear to contribute to the drop out rate. 2. Transvaginal radiofreguency remodelling of the endopelvic fascia for urodynamic stress incontinence due to urethral hypermobility: Objective: To assess the efficacy and safety of transvaginal radiofrequency remodelling of the endopelvic fascia as a minimally invasive technique for urodynamic stress incontinence of urine due to urethral hypermobility in women. Design: Prospective non-controlled study. Setting: 3 district general hospitals and 1 university hospital. Population: Female patients with urodynamic stress incontinence of urine due to urethral hypermobility. Main outcome measures: Pad test, urodynamic assessment, continence diary, pain scores and operative as well as post-operative complications. Method: Transvaginal radiofrequency of the endopelvic fascia. Assessment was made on recruitment, during hospital admission and at 3,6 and 12 months follow up. Results: 24 patients were available for analysis. A rising failure rate was noted as early as 3 months, leading to a cumulative cure rate of 36% at 12 months follow up. No major complications were encountered and pain scores were mild. Conclusions: The effectiveness of transvaginal radiofrequency remodelling of the endopelvic fascia for urodynamic stress incontinence of urine due to urethral hypermobility appears to be low. Inherent weakness of the endopelvic fascia appears to be the main reason. The technique has a low complication and pain profile. 3. Comparison between the tension·free vaginal tape (TVT), pelvicol as well as short autologous slings for urodynamic stress incontinence: Objective: To compare the efficacy and morbidity of the tension·free vaginal tape (TVT), pelvicol as well as short autologous slings, as minimally invasive technique for urodynamic stress incontinence of urine in women. Design: Muticentre randomised controlled single blind study. Setting: 4 district general hospitals and 2 teaching university hospitals. Population: Female patients with urodynamic stress incontinence of urine. Main outcome measures: Quality of life and symptom assessment using Bristol Female Lower Urinary Tract Symptoms as well as EuroQol questionnaires, pad test, continence diary, operating time, stay in hospital, operative as well as post-operative complications. Method: Tension-free vaginal tape (TVT) , pelvicol or short autologous sling insertion. Assessment was made on recruitment, during hospital stay and at 6 weeks as well as 6 and 12 months follow up. Results: A total of 181 patients were recruited. An interim analysis of re-operation rate showed a significantly higher rate with pelvicol, necessitating closure of this arm. All pelvicol failures appeared after 6 months, raising the possibility of a delayed reaction. No significant difference was observed between the tension-free vaginal tape (TVT) and short autologous slings in terms of operative as well as post-operative complications, pad test and continence diary. Operating time and post-operative stay in hospital were significantly shorter following the tension-free vaginal tape (TVT) sling than after the short autologous one. This reduces the higher capital cost of the tension free vaginal tape (TVT) sling. There was also a short term advantage in quality of life assessment. Conclusions: Pelvicol slings are associated with a delayed failure, and should not therefore be used for continence surgery. Although both the tension-free vaginal tape (TVT) and short autologous slings are equally effective and have a comparable complications profile, the tension-free vaginal tape (TVT) sling is quicker to insert and is followed by a shorter stay in hospital; 2 features that reduce its higher cost. It is also associated with a better quality of life change in the short term.
Supervisor: Killick, Stephen Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID: uk.bl.ethos.440139  DOI: Not available
Keywords: Medicine
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