LOWER URINARY FUNCTION AFTER DIFFERENTSURGICAL PROCEDURES FOR TREATMENT OF HIRSCHSPRUNG S DISEASE

Size: px
Start display at page:

Download "LOWER URINARY FUNCTION AFTER DIFFERENTSURGICAL PROCEDURES FOR TREATMENT OF HIRSCHSPRUNG S DISEASE"

Transcription

1 LOWER URINARY FUNCTION AFTER DIFFERENTSURGICAL PROCEDURES FOR TREATMENT OF HIRSCHSPRUNG S DISEASE Ahmed Dorgham Pediatric Surgery, Faculty of Medicine, Al-Azhar University, Cairo SUMMARY Background: Long-term sequels in children with Hirschsprung's disease (HD) are usually related to abnormalities in defecation. However, some of these patients also suffer from voiding dysfunction. The aim of this work is to assess the effects of different definitive surgical procedures in patients with HD on lower urinary tract function by means of urodynamic studies. Patients and Methods: The study was conducted at Al-Azhar University Hospitals during the period from August 2000 to August Thirty patients with HD were subjected to Urodynamic studies before and after the different definitive surgical procedures; namely Soave`s procedure, Duhamel`s procedure and Swenson`s procedure. They were 22 male and 8 female with a mean age of 2 years. The main outcome measurements were maximum cystometric capacity, compliance, unstable detrusor contraction and residual urinary volume. Results: Bladder compliance was normal in all children After Soave `s procedure, abnormal urodynamic changes were found in 3 (23%) children. One child had abnormally large cystometric bladder capacity (C.B.C.), with significant residual post voiding urine volume. Unstable detrusor contraction, were found in 2 children, one of them with large bladder capacity. Post-void urine residual, were found in 2 children. After Duhamel`s procedure, abnormal urodynamic changes were found in 3 children (25%). Three children, had abnormally large C.B.C, (2 of them, with significant residual urinary volume.) Unstable detrusor contraction, were detected in 3 children (25%). Post-voiding residual urine was detected in 2 children (16.6%). After Swenson`s procedure (Trans anal pull-through) abnormal urodynamic changes were found in 3 (23%) children. One child, had abnormally large C.B.C. Detrusor activity, was normal in all children before and after surgery. Post voiding residual urine, was detected in only one child. Conclusions: In HD, neurovesical dysfunction may exist preoperatively and though the incidence of postoperative changes in neurovesical function may appear high. Children who present with urinary problems after surgery should be assessed urodynamically. Key Words: Urodynamic study, Hirschsprung`s Disease, Urinary dysfunction Correspondence address and reprint request to Ahmed Dorgham, MD, Pediatric Surgery Unit, Faculty of Medicine, Al-Azhar University, 11884, Cairo, Egypt. Tel: Dr.Dorgham@hotmail.com 143

2 Ahmed Dorgham INTRODUCTION Pelvic visceral surgery, may cause damage to the pelvic splanchnic nerves, the hypogastric nerves, or the pelvic nerve plexus, resulting in autonomic denervation of the lower urinary tract. Depending on which neural structures are injured, different patterns of dysfunction are seen. Injury to the pelvic splanchnic nerves (parasympathetic denervation), may cause a decentralized flaccid bladder, whereas injury to the hypogastric nerves (sympathetic denervation), may result in loss of bladder compliance and incompetence of the bladder neck and posterior urethra. Damage to the pelvic plexus, may result in mixed patterns of vesicourethral dysfunction. Long term sequelae in children with Hirschsprung's disease, are caused mainly by anorectal dysfunction, and the chief complaints are constipation, soiling, and fecal incontinence. However, some of the patients also seem to suffer from urinary incontinence because the mean percentage of postoperative "enuresis" for the different surgical techniques in Hirschsprung's disease is reported to be 9.5%, in a study by Holschneider et al The percentages for the different surgical techniques, are as follows: Rehbein, 5.4% (n = 175), Swenson, 10.4% (n = 78), Soave, 15.3% (n = 106), Duhamel, 14.3% (n = 52). With respect to these data, it is important to note that the expression enuresis at the time of the publication often was used for any form of childhood wetting, without differentiating between incontinence, and enuresis, as is done today. It is therefore likely that, at least some of the patients suffered from functional urinary incontinence, caused by acquired denervation of the lower urinary tract. PATIENTS AND METHODS This study was done on 30 children presented for definitive surgical treatment of Hirschsprung disease to the outpatient clinics of Al-Azhar University, Hospitals during the period between August, 2000 to August, They were 22 males, and 8 females. Their age ranged from 2 years old to 11 years old (mean age 6.5 years old). RESULTS After Soave endo rectal pull through, Urodynamic findings, were normal in 10 (77%) children, and abnormal in 3 (23%) children. In uroflowmetric study, no child have reduced flow, and all children void spontaneously, and clinically asymptomatic. Only, one child, developed transient retention of urine, after removal of urinary catheter. In cystometric study, one child, had postoperative C.B.C. was abnormally large in relation to the estimated capacity for age, with significant residual.. Bladder compliance, was normal in all children, after operation. Unstable detrusor contraction, were found in 2 children postoperative, one of them with large bladder capacity. Post-void urine residual, more than 20 ml were found in 2 children. After Duhamel pull-through Urodynamic studies, were normal in 9 children (75%). And abnormal in 3 children (25%). In uroflowmetric study, two children, have reduced flow, with post void residual, but still able to void spontaneously, and clinically asymptomatic. In cystometric study, 3 children, had postoperative C.B.C. were abnormally large, in relation to the estimated capacity for age, and 2 of them, 144

3 with significant residuals. However, all children, had normal detrusor contractility, and able to void spontaneously, and clinically asymptomatic. Bladder compliance, was normal in all children, before and after surgery. Unstable detrusor contraction, were detected in 3 children (25%), after operation. Post-voiding residual, more than 20 ml were detected in 2 children (16.6%), after operation. After Trans anal pullthrough Urodynamic studies, were normal in 4 children (80%). And abnormal in 1 child (20%). In uroflowmetric study, The parameter of maximum, average Flow rate, and flow time are difficult to calculated due to younger age of children. However, all children able to void spontaneously, and clinically asymptomatic. In cystometric study, 1 child, had postoperative C.B.C. was abnormally large, in relation to the estimated capacity for age. Bladder compliance, was normal in all children before and after surgery. Detrusor activity, was normal in all children before and after surgery. Post void urine residual, was detected in only one child, which was less than 20ml. DISCUSSION In this study, an increased bladder capacity, with high residuals, usually implies weakening of the detrusor muscle. However, motor innervation to the detrusor muscle was not affected substantially, because all children, were able to void spontaneously, except one patient, undergoes Soave pull-through develops transient retention of urine after removal of catheter in early postoperative period, and improved with massage of bladder, and warm packs on the lower abdomen, and was able to void spontaneously on follow up. Boemers et al 2001, explains the findings of increased bladder capacity, with high residuals, in his patients after pull-through operations as it may suggest, that at least in part, sensory denervation with partial loss of bladder sensation (exteroception), and loss of filling perception (proprioception) may occur, a finding also reported in adults after pelvic surgery. But he can not assess bladder sensation, and filling perception because the children were too young. In this study, the assessment of bladder sensation, and filling perception, also was difficult, especially in young children, so accurate determination, and differentiation between the first desire to void, normal desire to void, strong desire to void and urgency was not possible. In this respect, it is also important to consider the fact that, many adults undergoing pelvic visceral surgery have preexisting urologic problems, in particular, outflow obstruction caused by prostate hypertrophy in men, and pelvic floor conditions after childbirth in women. Superimposed iatrogenic partial detrusor denervation, will then aggravate the problems. Another point, is that surgery in these patients is mostly performed for malignant disease, which requires more radical excision of the perirectal structures than in benign conditions, therefore, more severe damage to pelvic nerve structures is likely. In the study done by Boemers et al 2001, no signs of somatic denervation, caused by pudendal nerve injury, were seen in his patients. Only one child, had a low bladder compliance, postoperatively, and this finding has been described after sympathetic detrusor denervation in adults, and he explains this, as in this patient, 145

4 Ahmed Dorgham interpretation was difficult, because clinically he did not suffer from bladder neck incompetence, or consecutive urinary incontinence, a phenomenon often described in adults. Also, this child did not have any urinary problems at follow up. Unfortunately, he was not able to perform any follow-up urodynamics, for ethical reasons, because all children were clinically asymptomatic. In this study, bladder compliance, was normal in all children after Soave pull-through. Also after Duhamel pull-through, and Trans anal pull-through, bladder compliance, was normal in all children after surgery. Also, no child in any group, suffer from urinary incontinence, or had any urinary problems at follow up study, and all children were clinically asymptomatic at follow up study. In the study done by Ates et al 2007, 7 children, in dilated ganglionic segment group, showed post voiding residual, but the volume of the post voiding urine was less than 20 ml, which the International Children's Continence Society had defined as "borderline zone" in all of his patients. In this study, post void residual more than 20 ml detected in 2 patients (15.3 %) after Soave pull-through. After Duhamel pull-through post-voiding residual were detected in 2 patients (16.6%), the amount are more than 20 ml. After Transanal pull-through, post void urine residual was detected in only one child, which was less than 20ml. In study done by Jindal et al 2007, because there is preoperative urodynamic changes, this make the interpretation of the finding in the postoperative urodynamic studies, whether this changes directly related to surgery, or not was difficult. He explained, some changes in the postoperative study by fact that, the bladder might have been compressed by the retained fecal matter in the colon, or a distended retrovesical sigmoid loop or rectum. In the study done by Ates et al 2007, unfortunately, because he did not perform preoperative urodynamic studies, he could not compare the pre- and postoperative results. However, he considered that, because all the patients had normal postoperative urodynamic study results, the question of whether these patients had urodynamic problems before the operation, had lost its importance. In this study, all children, had normal preoperative urodynamic studies, and any child, with abnormal urodymaic studies are excluded from this study. So any postoperative finding, in the urodynamics studies, are directly related to surgery. In study done by Jindal et al 2007, he reported that, one child was clinically symptomatic with intermittent stream. In the study done by Boemers et al 2001, all children, were clinically asymptomatic. In the study done by Ates et al 2007, all children, were clinically asymptomatic. In this study, after Soave pull-through, no child had interrupted stream, only one child, develops transient retention of urine after removal of catheter, in early postoperative period. Also, after Duhamel pull-through, although two children, have reduced flow with post void residual, but still able to void spontaneously, and clinically asymptomatic. After Transanal pull-through, no child had interrupted stream, or retention of urine, or urinary tract infections. However, all children in all groups were clinically asymptomatic, and able to void spontaneously at follow up study. Boemers et al 2001, reported that, the main portion of the pelvic nerve plexus, lies in close relationship to the rectovesical pouch in the boy, and 146

5 rectouterine pouch in the girl. To reduce the risk of neural injury, it is important to stay close to the rectal wall, and perform sharp instead of blunt dissection of the retrorectal space, because blunt dissection may tear the visceral fascia, and cause damage to the splanchnic nerves ensheated by it. Especially in its anterolateral aspect, the connective tissue adjacent to the rectum, which often is tented away during mobilization, should be spared because it contains most of the parasympathetic nerve fibers that innervate the bladder. Traction injury (neuropraxia), alone is not likely to be responsible for partial denervation as it is reported to resolve within 3 to 5 months. Ates et al 2007, reported that, One-stage transanal endorectal pull through for Hirschsprung's disease, may possess preoperative problems, such as inability to reduce the caliber of the ganglionic segment, despite vigorous colonic irrigations, especially in infants older than 3 months or older patients without previous colostomy. Narrowing the dilated distal ganglionic segment, by a "V" shape excision has been suggested to solve this problem. However, this procedure carries risks of anastomotic stricture, leakage, and formation of cuff abscess. Also, during transanal endorectal pull through, if dissection was performed inside the rectal muscular cuff, this decreases the risk of direct nerve damage. Cutting the muscular cuff posteriorly, may carry the risk for direct nerve damage. However, Ates et al, reported that, urodynamic findings, are normal even after the division of muscular cuff posteriorly. In this study, to prevent pelvic nerve damage during Duhamal pull-through, retrorectal dissection, was done as close as possible to the rectal wall, and nerves adjacent or near the rectum were not seen or identified in any of the patients. During Transanal pull-through, the rectal muscular cuff, was ceased posteriorly in all patients, and the rectoanal anastomosis was started with 4 initial 4- quadrant stay sutures, and completed with complementary sutures, that were placed in between the previous ones, that are at a distance equal from previous stay sutures in 4 quadrants, to avoid folding and dog ear formation. from this study, it appear that, Soave or endorectal pull-through, and Trans-anal endo rectal pull-through, are associated with least postoperative urological disturbance, from the urodynamic point of view. This results are parallel to the result of study done by Ates et al 2007, on one stage Trans anal endo rectal pull-through, and the Marty et al's 1995, on long term follow up in 135 patients, undergoing Soave endorectal pull-through. And, study of Jasonni 2008, on two groups of patients, with Hirschsprung's disease, treated using Soave s procedure. But this results, against the study reported by Holschneider et al. 1980, as he reported percentage of postoperative "enuresis" after soave more than other techniques. Conclusion: Urological complications should be considered after pull-through operation for treatment of HD in children although all patients remains asymptomatic and had no urological problems after surgery. But if there is little urological disturbance before surgery, this may be aggravated by surgery, and the child may become clinically symptomatic, and this may be considered by the parents as a complication 147

6 Ahmed Dorgham of surgery. So it is very important that any child with HD, should be assessed carefully, for any urological disturbance before surgery. Also parents should be informed of possible urologic problems related to surgery. REFERENCES 1) Holschneider AM, Borner W, Buurman 0, et al(1980): Clinical and electomanometrical investigations of postoperative continence in Hirschsprung's disease, An international workshop. Z Kinderchir 29: ) Boemers TM, Bax NM, van Gool JD.(2001) The effect of rectosigmoidectomy and Duhamel-type pull-through procedure on lower urinary tract function in children with Hirschsprung's disease. J Pediatr Surg. Mar;36(3): ) Ateş O, Hakgüder G, Kart Y, et al (2007) The effect of dilated ganglionic segment on anorectal and urinary functions during 1-stage Transanal endorectal 4) 4- Jindal B, Grover V.P, Bhatnagar (2007) Assessment of lower urinary tract function in children before and after swenson's pull-through for Hirschsprung's disease. J. Indian Assoc Pediatr Surg. Apr-Jun. Vol 12, Issue 2. pull through for Hirschsprung's disease. J Pediatr Surg. Jul;42(7): ) Jasonni V, Pini Prato A, Martucciello G (2008): Soave s Extramucosal Endorectal Pull-Through Procedure. In Hirschsprung s Disease and Allied Disorders, Chapter 25, p , Third edition, published by Springer-Verlag Berlin Heidelberg. 6) Marty TL, Seo T, Sullivan JJ, et al.(1995) Rectal irrigations for the prevention of postoperative enterocolitis in Hirschsprung's disease. J Pediat Surg. May;30(5);

7 الملخص العربى هناك مشاكل بعيدة المدى تحدث فى الا طفال الذين يعانون من مرض هيرش اسبرنج لهاعلاقة بعملية الا خ ارج الشرجى ومع ذلك بعض هؤلاء المرضى يعانون ايضا من عيوب فى عملية الا خ ارج البولى. ان الهدف من هذة الد ارسة هو تقييم تا ثر هؤلاء المرضى الذين يعانون من مرض هيرش اسبرنج بعد اج ارء العمليات الج ارحية الازمة لهم على وظيفة المثانة وذلك باستخدام ديناميكية التبول. المرضى والطرق : 2000 اجريت هذة الد ارسة على 30 مريضا بكلية الطب جامعة الازهر فى الفترة من اغسطس وحتى اغسطس 2008 وذلك بعمل د ارسة لديناميكية التبول قبل وبعد اج ارء التدخل الج ارحى 22 ( ( لهؤلاءالمرضى و خاصة عملية (دوهاميل )و (اسوافى و(اسونسن وكان عدد المرضى من الذكور و 8 من الاناث ومتوسط اعمارهم سنتين وكانت وحدات القياس الا ساسية هى قياس السعة الكلية للمثاتة والانقباض الغير مستقر للمثانة وقياس حجم البول المتبقى بها. النتاي ج : لوحظ ان وظيفة المثانة كانت طبيعية فى الا طفال بعد عملية اسوافى.كما لوحظ وجود تغي ارت فى ديناميكية التبول فى ثلاثة اطفال واحد منهم كان لدية اتساع فى المثانة مع وجود كمية من البول بعد عملية الا خ ارج البولى.الانقباض الغير مستقر فى المثانة لوحظ ايضا فى عدد اثنين من الا طفال واحد منهم لدية اتساع بالمثانة اما عملية الاخ ارج البولى كانت طبيعية فيهم. اما بعد عملية دوهاميل لوحظ وجود تغي ارت فى ديناميكية التبول فى ثلاثة اطفال الثلاثة لديهم اتساع بالمثانة (اثنين منهم لديهم ت اركم بولى ملحوظ بالمثانة).اما الانقباض الغير مستقر فى المثانة لوحظ ايضا فى عدد ثلاثة اطفال( الت اركم البولى بالمثانة لوحظ فى اثنين منهم). اما بعد عملية سحب القولون عن طريق فتحة الش رج لوحظ وجود تغي ارت فى ديناميكية التبول فى ثلاثة اطفال واحد منهم لديه اتساع بالمثانة.اما الانقباض الغير مستقر فى المثانة كان طبيعى فى كل الاطفال قبل وبعد الج ارحة.الت اركم البولى بالمثانة لوحظ فى واحد منهم فقط. 149

Urinary Continence. Second edition FAST FACTS. by Julian Shah and Gary Leach. Anatomy and physiology 7. Investigations and diagnosis 11

Urinary Continence. Second edition FAST FACTS. by Julian Shah and Gary Leach. Anatomy and physiology 7. Investigations and diagnosis 11 FAST FACTS Urinary Continence Second edition Indispensable Guides to by Julian Shah and Gary Leach Clinical Practice Anatomy and physiology 7 Investigations and diagnosis 11 Detrusor instability 28 Primary

More information

1 ST JAMAICAN PAEDIATRIC NEPHROLOGY CONFERENCE

1 ST JAMAICAN PAEDIATRIC NEPHROLOGY CONFERENCE in association with 1 ST JAMAICAN PAEDIATRIC NEPHROLOGY CONFERENCE Jamaica Conference Centre Kingston, Jamaica October 4 th 2014 VOIDING DISORDERS IN CHILDREN Dr. Colin Abel Paediatric Urologist Bustamante

More information

symptoms of Incontinence

symptoms of Incontinence Types, causes and symptoms of Urinary Incontinence Aims and Objectives Aim: To have an understanding of the types and causes of urinary incontinence. Objectives: To be aware of the incidence and prevalence

More information

Adult Urodynamics: American Urological Association (AUA)/Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU) Guideline

Adult Urodynamics: American Urological Association (AUA)/Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU) Guideline Adult Urodynamics: American Urological Association (AUA)/Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU) Guideline RECOMMENDATIONS 1 Conditional: Clinicians who are making

More information

Basics on Bladder and Bowel

Basics on Bladder and Bowel Basics on Bladder and Bowel A quick journey through some of our recent new insights on the nervous system, the lower urinary tract and gastrointestinal tract Basics on Bladder and Bowel Basics on bladder

More information

Topic review: Clinical presentation and diagnosis of urinary incontinence in the elderly. Prapa Pattrapornpisut 7 June 2012

Topic review: Clinical presentation and diagnosis of urinary incontinence in the elderly. Prapa Pattrapornpisut 7 June 2012 1 Topic review: Clinical presentation and diagnosis of urinary incontinence in the elderly Prapa Pattrapornpisut 7 June 2012 2 Urinary incontinence Definition the complaint of any involuntary leakage of

More information

Incontinence. What is incontinence?

Incontinence. What is incontinence? Incontinence What is incontinence? Broadly speaking, the medical term incontinence refers to any involuntary release of bodily fluids, but many people associate it strongly with the inability to control

More information

Fecal incontinence (Encopresis) It is the fecal incontinence condition observed in children with chronic constipation over 1-2 years.

Fecal incontinence (Encopresis) It is the fecal incontinence condition observed in children with chronic constipation over 1-2 years. WHAT IS DYSFUNCTIONAL URINATION (URINATION FUNCTION DISORDER)? It stands for the urination phase disorders, which appear due to wrongly acquired urination habits during the toilet training of some neurologically

More information

Overactive Bladder (OAB)

Overactive Bladder (OAB) Overactive Bladder (OAB) Overactive bladder is a problem with bladder storage function that causes a sudden urge to urinate. The urge may be difficult to suppress, and overactive bladder can lead to the

More information

Urinary Incontinence in Women. Susan Hingle, M.D. Department of Medicine

Urinary Incontinence in Women. Susan Hingle, M.D. Department of Medicine Urinary Incontinence in Women Susan Hingle, M.D. Department of Medicine Background Estimated 13 million Americans with urinary incontinence Women are affected twice as frequently as men Only 25% will seek

More information

Learning Resource Guide. Understanding Incontinence. 2000 Prism Innovations, Inc. All Rights Reserved

Learning Resource Guide. Understanding Incontinence. 2000 Prism Innovations, Inc. All Rights Reserved Learning Resource Guide Understanding Incontinence 2000 Prism Innovations, Inc. All Rights Reserved ElderCare Online s Learning Resource Guide Understanding Incontinence Table of Contents Introduction

More information

Normal bladder function requires a coordinated effort between the brain, spinal cord, and the bladder.

Normal bladder function requires a coordinated effort between the brain, spinal cord, and the bladder. .. Urinary Incontinence Urinary incontinence is not an inevitable part of aging, and it is not a disease. The loss of bladder control - called urinary incontinence - affects between 13 and 17 million adult

More information

Urodynamics in Neuro-Urology

Urodynamics in Neuro-Urology Urodynamics in Neuro-Urology R Hamid MD (Res), FRCS (Urol) Consultant Urologist London Spinal Injuries Unit, Stanmore & University College London Hospitals Micturition Micturition can be visualized as

More information

Urinary incontinence during sexual intercourse: a common, but rarely volunteered, symptom

Urinary incontinence during sexual intercourse: a common, but rarely volunteered, symptom British Journal of Obstetrics and Gynaecology April 1988, Vol. 95, pp. 77-81 Urinary incontinence during sexual intercourse: a common, but rarely volunteered, symptom PAUL HILTON Summary. A total of 4

More information

LOSS OF BLADDER CONTROL IS TREATABLE TAKE CONTROL AND RESTORE YOUR LIFESTYLE

LOSS OF BLADDER CONTROL IS TREATABLE TAKE CONTROL AND RESTORE YOUR LIFESTYLE LOSS OF BLADDER CONTROL IS TREATABLE TAKE CONTROL AND RESTORE YOUR LIFESTYLE TALKING ABOUT STRESS INCONTINENCE (SUI) Millions of women suffer from stress incontinence (SUI). This condition results in accidental

More information

Urinary Incontinence. Anatomy and Terminology Overview. Moeen Abu-Sitta, MD, FACOG, FACS

Urinary Incontinence. Anatomy and Terminology Overview. Moeen Abu-Sitta, MD, FACOG, FACS Urinary Incontinence Anatomy and Terminology Overview Moeen Abu-Sitta, MD, FACOG, FACS Purpose Locate and describe the anatomy of the Female Urinary System Define terminology related to Incontinence Describe

More information

PREPARING FOR YOUR STOMA REVERSAL

PREPARING FOR YOUR STOMA REVERSAL PREPARING FOR YOUR STOMA REVERSAL Information Leaflet Your Health. Our Priority. Page 2 of 6 Introduction- What you need to know As part of your bowel operation you may have had a temporary stoma formed.

More information

URINARY INCONTINENCE CASE PRESENTATION #1. Urinary Incontinence - History 2014/10/07. Structure of the Female Lower Urinary Tract

URINARY INCONTINENCE CASE PRESENTATION #1. Urinary Incontinence - History 2014/10/07. Structure of the Female Lower Urinary Tract Bladder pressure 2014/10/07 Structure of the Female Lower Urinary Tract Ureter URINARY INCONTINENCE Clinical Clerkship Lecture Series Outer peritoneal coat Detrusor smooth muscle Mucosa Trigone Proximal

More information

Urinary Incontinence (Involuntary Loss of Urine) A Patient Guide

Urinary Incontinence (Involuntary Loss of Urine) A Patient Guide Urinary Incontinence (Involuntary Loss of Urine) A Patient Guide Urinary Incontinence (Urine Loss) This booklet is intended to give you some facts on urinary incontinence - what it is, and is not, and

More information

Bladder Health Promotion

Bladder Health Promotion Bladder Health Promotion Community Awareness Presentation endorsed by the Society of Urologic Nurses (SUNA) National Association for Continence( NAFC) Simon Foundation for Continence This presentation

More information

Bladder Health Promotion

Bladder Health Promotion Bladder Health Promotion Community Awareness Presentation Content contributions provided by the Society of Urologic Nurses (SUNA) National Association for Continence (NAFC) Simon Foundation for Continence

More information

Refer to Coaptite Injectable Implant Instructions for Use provided with product for complete instructions for use.

Refer to Coaptite Injectable Implant Instructions for Use provided with product for complete instructions for use. Questions for my Doctor Refer to Coaptite Injectable Implant Instructions for Use provided with product for complete instructions for use. INDICATIONS: Coaptite Injectable Implant is indicated for soft

More information

Management of Urinary Incontinence. Sheri J. Ross, BSc, DVM, PhD, Dipl. ACVIM (Internal Medicine)

Management of Urinary Incontinence. Sheri J. Ross, BSc, DVM, PhD, Dipl. ACVIM (Internal Medicine) Management of Urinary Incontinence Sheri J. Ross, BSc, DVM, PhD, Dipl. ACVIM (Internal Medicine) Managing Urinary Incontinence Urinary incontinence is very prevalent among older animals. In this group

More information

Overactive bladder is a common condition thought to. women, and is a serious condition that can lead to. significant lifestyle changes.

Overactive bladder is a common condition thought to. women, and is a serious condition that can lead to. significant lifestyle changes. Overactive bladder is a common condition thought to FADE UP TO WIDE SHOT OF FEMALE MODEL WITH TRANSPARENT SKIN. URINARY BLADDER VISIBLE IN PELVIC REGION affect over 16 percent of adults. It affects men

More information

Urinary Incontinence FAQ Sheet

Urinary Incontinence FAQ Sheet Urinary Incontinence FAQ Sheet Are you reluctant to talk to your doctor about your bladder control problem? Don t be. There is help. Loss of bladder control is called urinary incontinence. It can happen

More information

Consumer summary Minimally invasive techniques for the relief of stress urinary incontinence

Consumer summary Minimally invasive techniques for the relief of stress urinary incontinence ASERNIP S Australian Safety and Efficacy Register of New Interventional Procedures Surgical Consumer summary Minimally invasive techniques for the relief of stress urinary incontinence (Adapted from the

More information

An illustrated guide to the management of incontinence.

An illustrated guide to the management of incontinence. An illustrated guide to the management of incontinence. 1 The problem of incontinence The ACA describes incontinence as an involuntary loss of urine and/or bowel motion. The amount can vary from slight

More information

Canine Urinary Incontinence

Canine Urinary Incontinence Urinary Incontinence in the Bitch Laurie Edge-Hughes, BScPT, MAnimSt, CAFCI, CCRT Urinary Incontinence = Involuntary leakage of urine during storage Micturation disorders (non-neurologic): 61% = Urethral

More information

Postoperative. Voiding Dysfunction

Postoperative. Voiding Dysfunction Postoperative Voiding Trial Voiding Dysfunction Stephanie Pickett, MD Fellow Female Pelvic Medicine and Reconstructive Surgery Objectives Define postoperative voiding dysfunction Describe how to evaluate

More information

Bowel and Bladder Dysfunction in MS. Tracy Walker, WOCN, MSCN, FNP C Nurse Practitioner MS Institute at Shepherd Center. Bladder Dysfunction

Bowel and Bladder Dysfunction in MS. Tracy Walker, WOCN, MSCN, FNP C Nurse Practitioner MS Institute at Shepherd Center. Bladder Dysfunction Bowel and Bladder Dysfunction in MS Tracy Walker, WOCN, MSCN, FNP C Nurse Practitioner MS Institute at Shepherd Center Bladder Dysfunction Approximately 75% of people with MS experience bladder problems

More information

FEMALE INCONTINENCE REVIEW

FEMALE INCONTINENCE REVIEW 200 S. Wenona Suite 298 Steven L. Jensen, M.D. 5400 Mackinaw, Suite 4302 Bay City, MI 48706 Frank H. Kim, M.D. Saginaw, MI 48604 Telephone (989) 895-2634 Adult & Pediatric Urologists (989) 791-4020 Fax

More information

Case Based Urology Learning Program

Case Based Urology Learning Program Case Based Urology Learning Program Resident s Corner: UROLOGY Case Number 21 CBULP 2011 068 Case Based Urology Learning Program Editor: Associate Editors: Manager: Case Contributors: Steven C. Campbell,

More information

Urinary Incontinence. Types

Urinary Incontinence. Types Urinary Incontinence Leakage of urine is called urinary incontinence. It is a common problem in women. Some women occasionally leak small amounts of urine. At other times, leakage of urine is frequent

More information

surg urin Surgery: Urinary System 1

surg urin Surgery: Urinary System 1 Surgery: Urinary System 1 This section contains information to assist providers in billing for surgical procedures related to the urinary system. Extracorporeal Shock Wave Lithotripsy Medi-Cal covers Extracorporeal

More information

Role of the Wound Ostomy Continence Nurse or Continence Care Nurse in Continence Care

Role of the Wound Ostomy Continence Nurse or Continence Care Nurse in Continence Care Role of the Wound Ostomy Continence Nurse or Continence Care Nurse in Continence Care Background Incontinence (i.e., loss of bladder and/or bowel control) is a significant health care problem, which affects

More information

Female Urinary Disorders and Pelvic Organ Prolapse

Female Urinary Disorders and Pelvic Organ Prolapse Female Urinary Disorders and Pelvic Organ Prolapse Richard S. Bercik, M.D. Director, Division of Urogynecology & Reconstruction Pelvic Surgery Department of Obstetrics, Gynecology & Reproductive Sciences

More information

Regain Control of Your Active Life Treatment Options for Incontinence and Pelvic Organ Prolapse

Regain Control of Your Active Life Treatment Options for Incontinence and Pelvic Organ Prolapse Regain Control of Your Active Life Treatment Options for Incontinence and Pelvic Organ Prolapse Nearly one quarter of all women in the United States have some sort of pelvic floor disorder such as urinary

More information

Bowel Control Problems

Bowel Control Problems Bowel Control Problems WOMENCARE A Healthy Woman is a Powerful Woman (407) 898-1500 Bowel control problems affect at least 1 million people in the United States. Loss of normal control of the bowels is

More information

Navigating Anorectal Anatomy: Terms, Planes, Spaces, Structures

Navigating Anorectal Anatomy: Terms, Planes, Spaces, Structures Navigating Anorectal Anatomy: Terms, Planes, Spaces, Structures Lawrence M. Witmer, PhD Lawrence M. Witmer, PhD Department of Biomedical Sciences College of Osteopathic Medicine Ohio University Athens,

More information

1 in 3 women experience Stress Urinary Incontinence.

1 in 3 women experience Stress Urinary Incontinence. A PATIENT S GUIDE 1 in 3 women experience Stress Urinary Incontinence. It s time to talk about SUI Get the facts. This Patient s Guide is intended as a public resource on the issue of Stress Urinary Incontinence

More information

Urinary Diversion: Ileovesicostomy/Ileal Loop/Colon Loop

Urinary Diversion: Ileovesicostomy/Ileal Loop/Colon Loop Urinary Diversion: Ileovesicostomy/Ileal Loop/Colon Loop Why do I need this surgery? A urinary diversion is a surgical procedure that is performed to allow urine to safely pass from the kidneys into a

More information

Urinary Tract Infections in Children

Urinary Tract Infections in Children Urinary Tract Infections in Children National Kidney and Urologic Diseases Information Clearinghouse National Institute of Diabetes and Digestive and Kidney Diseases NATIONAL INSTITUTES OF HEALTH Urinary

More information

Lower Urinary Tract Symptoms (LUTS) in Middle-Aged and Elderly Men

Lower Urinary Tract Symptoms (LUTS) in Middle-Aged and Elderly Men Prostatic Diseases Lower Urinary Tract Symptoms (LUTS) in Middle-Aged and Elderly Men JMAJ 47(12): 543 548, 2004 Tomonori YAMANISHI Associate Professor, Department of Urology, Dokkyo University School

More information

THE MANAGEMENT OF URINARY INCONTINENCE WITHIN A STROKE UNIT POPULATION REENA DHAMI STROKE CNS EPSOM & ST.HELIER UNIVERSITY HOSPITALS

THE MANAGEMENT OF URINARY INCONTINENCE WITHIN A STROKE UNIT POPULATION REENA DHAMI STROKE CNS EPSOM & ST.HELIER UNIVERSITY HOSPITALS THE MANAGEMENT OF URINARY INCONTINENCE WITHIN A STROKE UNIT POPULATION REENA DHAMI STROKE CNS EPSOM & ST.HELIER UNIVERSITY HOSPITALS Definition Urinary Incontinence is AN INABILITY TO HOLD URINE until

More information

Urinary Incontinence. Causes of Incontinence. What s Happening?

Urinary Incontinence. Causes of Incontinence. What s Happening? National Institute on Aging AgePage Urinary Incontinence Sarah loves to spend time with her friends talking about her grandchildren and going to exercise classes with neighbors. But she s started to have

More information

AMS Sphincter 800 Urinary Prosthesis

AMS Sphincter 800 Urinary Prosthesis AMS Sphincter 800 Urinary Prosthesis AMS Sphincter 800 AMS Sphincter 800 AMS Sphincter 800 The device is implanted in the body and cannot be seen. The cuff can be placed at the bulbous urethra or at the

More information

Get the Facts, Be Informed, Make YOUR Best Decision. Pelvic Organ Prolapse

Get the Facts, Be Informed, Make YOUR Best Decision. Pelvic Organ Prolapse Pelvic Organ Prolapse ETHICON Women s Health & Urology, a division of ETHICON, INC., a Johnson & Johnson company, is dedicated to providing innovative solutions for common women s health problems and to

More information

Fecal Incontinence. What is fecal incontinence?

Fecal Incontinence. What is fecal incontinence? Scan for mobile link. Fecal Incontinence Fecal incontinence is the inability to control the passage of waste material from the body. It may be associated with constipation or diarrhea and typically occurs

More information

Transobturator tape sling Female sling system

Transobturator tape sling Female sling system Transobturator tape sling Female sling system Delivering the best in care UHB is a no smoking Trust To see all of our current patient information leaflets please visit www.uhb.nhs.uk/patient-information-leaflets.htm

More information

URINARY INCONTINENCE

URINARY INCONTINENCE URINARY INCONTINENCE What is urinary incontinence? Urinary incontinence is the uncontrollable loss of urine. The amount of urine leaked can vary from only a few drops when you cough or sneeze to entirely

More information

Effects of Pregnancy & Delivery on Pelvic Floor

Effects of Pregnancy & Delivery on Pelvic Floor Effects of Pregnancy & Delivery on Pelvic Floor 吳 銘 斌 M.D., Ph.D. 財 團 法 人 奇 美 醫 院 婦 產 部 婦 女 泌 尿 暨 骨 盆 醫 學 科 ; 台 北 醫 學 大 學 醫 學 院 婦 產 學 科 ; 古 都 府 城 台 南 Introduction Pelvic floor disorders (PFDs) include

More information

PROCEDURE FOR THE ASSESSMENT OF ADULTS AND CHILDREN WITH BLADDER OR BOWEL DYSFUNCTION

PROCEDURE FOR THE ASSESSMENT OF ADULTS AND CHILDREN WITH BLADDER OR BOWEL DYSFUNCTION PROCEDURE FOR THE ASSESSMENT OF ADULTS AND CHILDREN WITH BLADDER OR BOWEL DYSFUNCTION First Issued Issue Version One Purpose of Issue/Description of Change Planned Review Date Procedure for the effective

More information

Urinary tract and perineum

Urinary tract and perineum 9 Urinary tract and perineum Key Points 9.1 9.1 THE URINARY BLADDER URINARY RETENTION Acute retention of urine is an indication for emergency drainage of the bladder The common causes of acute retention

More information

MANAGEMENT OF PROSTATE ENLARGEMENT/BPH

MANAGEMENT OF PROSTATE ENLARGEMENT/BPH MANAGEMENT OF PROSTATE ENLARGEMENT/BPH J E S S I C A E. P A O N E S S A, M. D. A S S I S T A N T P R O F E S S O R D E P A R T M E N T O F U R O L O G Y S U N Y U P S T A T E M E D I C A L U N I V E R

More information

MANAGEMENT OF SLING COMPLICATIONS IN FEMALES. Jorge L. Lockhart M.D. Program Director Division of Urology University of South Florida

MANAGEMENT OF SLING COMPLICATIONS IN FEMALES. Jorge L. Lockhart M.D. Program Director Division of Urology University of South Florida MANAGEMENT OF SLING COMPLICATIONS IN FEMALES Jorge L. Lockhart M.D. Program Director Division of Urology University of South Florida INTRODUCTION The traditional gold standard treatments for stress urinary

More information

GENUINE STRESS AND URGE INCONTINENCE PROTOCOL

GENUINE STRESS AND URGE INCONTINENCE PROTOCOL GENUINE STRESS AND URGE INCONTINENCE PROTOCOL Using the NeuroTrac ETSTM in combination of electrostimulation and EMG Biofeedback in the treatment of female urinary incontinence. Anna Pawlaczyk Specialist

More information

Female Urinary Incontinence

Female Urinary Incontinence Female Urinary Incontinence Molly Heublein, MD Assistant Professor Clinical Medicine UCSF Women s Health Primary Care Disclosures I have nothing to disclose. 1 Objectives Review the problem Feel confident

More information

URINARY INCONTINENCE IN WOMEN

URINARY INCONTINENCE IN WOMEN URINARY INCONTINENCE IN WOMEN Definition Urinary incontinence (UI) is defined as involuntary loss of urine that is a social or hygienic problem (International Continence Society, 1973) Magnitude of the

More information

International Journal of Case Reports in Medicine

International Journal of Case Reports in Medicine International Journal of Case Reports in Medicine Vol. 2013 (2013), Article ID 340925, 18 minipages. DOI:10.5171/2013.340925 www.ibimapublishing.com Copyright 2013. Massinde Anthony. Distributed under

More information

Therapies for Prostate Cancer and Treatment Selection

Therapies for Prostate Cancer and Treatment Selection Prostatic Diseases Therapies for Prostate Cancer and Treatment Selection JMAJ 47(12): 555 560, 2004 Yoichi ARAI Professor and Chairman, Department of Urology, Tohoku University Graduate School of Medicine

More information

Information for men considering a male sling procedure

Information for men considering a male sling procedure Information for men considering a male sling procedure Delivering the best in care UHB is a no smoking Trust To see all of our current patient information leaflets please visit www.uhb.nhs.uk/patient-information-leaflets.htm

More information

Urodynamic Studies. Urinary flow rate Cystometry (CMG) Urethral pressure profile (UPP)

Urodynamic Studies. Urinary flow rate Cystometry (CMG) Urethral pressure profile (UPP) Paediatric Urodynamics 小 兒 尿 動 力 學 Frances Sit NS Dept. of Surgery, PWH Urodynamic Studies Urodynamic investigations study the pressure, volume & flow relationships in the lower urinary tract 3 investigations

More information

Patient. Frequently Asked Questions. Transvaginal Surgical Mesh for Pelvic Organ Prolapse

Patient. Frequently Asked Questions. Transvaginal Surgical Mesh for Pelvic Organ Prolapse Patient Frequently Asked Questions Transvaginal Surgical Mesh for Pelvic Organ Prolapse Frequently Asked Questions WHAT IS PELVIC ORGAN PROLAPSE AND HOW IS IT TREATED? Q: What is pelvic organ prolapse

More information

in 1996 by the Agency for Health Care Policy and Research, 13 million Americans are

in 1996 by the Agency for Health Care Policy and Research, 13 million Americans are Seeking Treatment: What? When? Why? Who? How? & Where? In recent membership surveys, the National Association For Continence (NAFC) was distressed to learn that on average people were waiting years before

More information

Male Continence Training. AMS 800 Artificial Urinary Sphincter

Male Continence Training. AMS 800 Artificial Urinary Sphincter Male Continence Training AMS 800 Artificial Urinary Sphincter The AMS Sphincter 800 is the Gold Standard, time-tested surgical solution for control of moderate to severe stress urinary incontinence. Patient

More information

Stress incontinence. Supported by an unrestricted grant from

Stress incontinence. Supported by an unrestricted grant from Stress incontinence As a health care provider you can make a significant difference to the quality of life of patients like these by addressing urinary incontinence, introducing conservative therapies

More information

GLOSSARY of research terms

GLOSSARY of research terms GLOSSARY of research terms JLA Urinary Incontinence Working Partnership Workshop to set research priorities in Urinary Incontinence November 2008 Terms in bold are commonly used clinical/research terms.

More information

Medical Tests for Prostate Problems

Medical Tests for Prostate Problems Medical Tests for Prostate Problems National Kidney and Urologic Diseases Information Clearinghouse U.S. Department of Health and Human Services NATIONAL INSTITUTES OF HEALTH What is the prostate? The

More information

Urinary Incontinence in Men National Kidney and Urologic Diseases Information Clearinghouse

Urinary Incontinence in Men National Kidney and Urologic Diseases Information Clearinghouse Urinary Incontinence in Men National Kidney and Urologic Diseases Information Clearinghouse National Institute of Diabetes and Digestive and Kidney Diseases NATIONAL INSTITUTES OF HEALTH Urinary incontinence

More information

Urinary Incontinence Dr. Leffler

Urinary Incontinence Dr. Leffler Urinary Incontinence Dr. Leffler The involuntary loss of urine at socially unacceptable times occurs in both women and men, but more commonly in women. It has multiple, far-reaching effects on daily activities,

More information

Male urinary incontinence (leakage of urine) you are not alone

Male urinary incontinence (leakage of urine) you are not alone Male urinary incontinence (leakage of urine) you are not alone Delivering the best in care UHB is a no smoking Trust To see all of our current patient information leaflets please visit www.uhb.nhs.uk/patient-information-leaflets.htm

More information

Beverly E Hashimoto, M.D. Virginia Mason Medical Center, Seattle, WA

Beverly E Hashimoto, M.D. Virginia Mason Medical Center, Seattle, WA Pelvic Floor Relaxation Beverly E Hashimoto, M.D. Virginia Mason Medical Center, Seattle, WA Disclosures Beverly Hashimoto: GE Medical Systems: research support and consultant (all fees given to Virginia

More information

Urinary Incontinence

Urinary Incontinence Urinary Incontinence (Involuntary Passage of Urine) Basics OVERVIEW Loss of voluntary control of urination, usually observed as involuntary urine leakage while resting SIGNALMENT/DESCRIPTION OF PET Species

More information

To decrease and/or prevent the incidence of catheter associated infections and other complications associated with IUC.

To decrease and/or prevent the incidence of catheter associated infections and other complications associated with IUC. Patient Care Manual Standardized Procedure Number: PC-SP.115 Latest Revision Date: 01/27/2015 Effective Date: 10/10/2011 Standardized Procedure: Urethral Catheter (IUC), Adult, Discontinuance of FUNCTION

More information

FEMALE ANATOMY. the Functions of the Female Organs

FEMALE ANATOMY. the Functions of the Female Organs FEMALE ANATOMY the Functions of the Female Organs An educational video for every woman who is told she needs pelvic surgery, including exploratory surgery or removal of the uterus, fallopian tubes, or

More information

Urinary Incontinence 9/17/2015. Conflict of Interest. Objectives. None

Urinary Incontinence 9/17/2015. Conflict of Interest. Objectives. None Urinary Incontinence Karla Reinhart DNP, FNP-C, ARNP October, 2015 Conflict of Interest None Objectives Acquire knowledge of A & P of micturition, as well as pertinent pathologies for male and female incontinence

More information

Overactive bladder and urgency incontinence

Overactive bladder and urgency incontinence Overactive bladder and urgency incontinence As a health care provider you can make a significant difference to the quality of life of patients like these by addressing urinary incontinence, introducing

More information

Stress Urinary Incontinence: Treatment Manisha Patel, MD April 10, 2006

Stress Urinary Incontinence: Treatment Manisha Patel, MD April 10, 2006 Stress Urinary Incontinence: Treatment Manisha Patel, MD April 10, 2006 What treatment options are available for a woman with stress urinary incontinence (SUI)? Behavioral therapy, medication, pessary,

More information

Registered Charity No. 5365

Registered Charity No. 5365 THE MULTIPLE SCLEROSIS SOCIETY OF IRELAND Dartmouth House, Grand Parade, Dublin 6. Telephone: (01) 269 4599. Fax: (01) 269 3746 MS Helpline: 1850 233 233 E-mail: mscontact@ms-society.ie www.ms-society.ie

More information

Las Vegas Urogynecology

Las Vegas Urogynecology Las Vegas Urogynecology 7500 Smoke Ranch Road - #200 Las Vegas, NV 89128 Telephone: (702) 233-0727 Fax: (702) 233-4799 Urinary Incontinence in Women Urinary incontinence is an inability to hold your urine

More information

Childhood Urinary Tract Infections

Childhood Urinary Tract Infections Childhood Urinary Tract Infections What is a UTI? Urinary tract infection (UTI) is one of the most common infections in childhood. It can cause distress to the child, concerns to the parents, and may

More information

Prevention and Recognition of Obstetric Fistula Training Package. Module 8: Pre-repair Care and Referral for Women with Obstetric Fistula

Prevention and Recognition of Obstetric Fistula Training Package. Module 8: Pre-repair Care and Referral for Women with Obstetric Fistula Prevention and Recognition of Obstetric Fistula Training Package Module 8: Pre-repair Care and Referral for Women with Obstetric Fistula Early detection and treatment If a woman has recently survived a

More information

MEDICAL POLICY No. 91502-R1 INCONTINENCE SUPPLIES FOR MEDICAID MEMBERS

MEDICAL POLICY No. 91502-R1 INCONTINENCE SUPPLIES FOR MEDICAID MEMBERS INCONTINENCE SUPPLIES FOR MEDICAID MEMBERS Effective Date: December 23, 2013 Review Dates: 1/05, 12/05, 12/06, 12/07, 12/08, 12/09, 12/10, 12/11, 12/12, 12/13, 2/15 Date Of Origin: January 19, 2005 Status:

More information

Electroneuromyographic studies

Electroneuromyographic studies Electroneuromyographic studies in the diagnosis of Pudendal Entrapment Syndrome BY NAGLAA ALI GADALLAH PROFESSOR OF PHYSICAL MEDICINE, RHEUMATOLOGY& REHABILITATION AIN SHAMS UNIVERSITY Pudendal neuralgia

More information

Bladder and Bowel Control

Bladder and Bowel Control Bladder and Bowel Control Dr Sue Woodward Lecturer, Florence Nightingale School of Nursing and Midwifery 2 Why do we need to understand anatomy? Normal physiology Normal adult bladder capacity = 450-500mls

More information

150640_Brochure_B 4/12/07 2:58 PM Page 2. Patient Information. Freedom From an Enlarged Prostate

150640_Brochure_B 4/12/07 2:58 PM Page 2. Patient Information. Freedom From an Enlarged Prostate 150640_Brochure_B 4/12/07 2:58 PM Page 2 Patient Information Freedom From an Enlarged Prostate 150640_Brochure_B 4/12/07 2:58 PM Page 3 GreenLight Laser Therapy 1 150640_Brochure_B 4/12/07 2:58 PM Page

More information

male sexual dysfunction

male sexual dysfunction male sexual dysfunction lack of desire Both men and women often lose interest in sex during cancer treatment, at least for a time. At first, concern for survival is so overwhelming that sex is far down

More information

Urinary Incontinence

Urinary Incontinence Urinary Incontinence Q: What is urinary Urinary (YOOR-in-air-ee) incontinence (in-kahn-tih-nens) is when urine leaks out before you can get to a bathroom. If you have urinary incontinence, you re not alone.

More information

CARE PROCESS STEP EXPECTATIONS RATIONALE

CARE PROCESS STEP EXPECTATIONS RATIONALE URINARY INCONTINENCE CARE PROCESS STEP EXPECTATIONS RATIONALE ASSESSMENT/PROBLEM RECOGNITION 1. Did the staff and physician seek and document risk factors for urinary incontinence and any history of urinary

More information

Bard: Continence Therapy. Stress Urinary Incontinence. Regaining Control. Restoring Your Lifestyle.

Bard: Continence Therapy. Stress Urinary Incontinence. Regaining Control. Restoring Your Lifestyle. Bard: Continence Therapy Stress Urinary Incontinence Regaining Control. Restoring Your Lifestyle. Stress Urinary Incontinence Becoming knowledgeable about urinary incontinence Uterus Normal Pelvic Anatomy

More information

Laparoscopic Surgery of the Colon and Rectum (Large Intestine) A Simple Guide to Help Answer Your Questions

Laparoscopic Surgery of the Colon and Rectum (Large Intestine) A Simple Guide to Help Answer Your Questions Laparoscopic Surgery of the Colon and Rectum (Large Intestine) A Simple Guide to Help Answer Your Questions What are the Colon and Rectum? The colon and rectum together make up the large intestine. After

More information

Name of Policy: Urodynamic Testing to Evaluate Urinary Incontinence

Name of Policy: Urodynamic Testing to Evaluate Urinary Incontinence Name of Policy: Urodynamic Testing to Evaluate Urinary Incontinence Policy #: 315 Latest Review Date: September 2011 Category: Medical Policy Grade: Active Policy but no longer scheduled for regular literature

More information

How do I know if I need to have surgery?

How do I know if I need to have surgery? How do I know if I need to have surgery? Deciding whether or not to have surgery for your bladder, bowel and/or prolapse problems is an individual decision. The success or failure of someone else's operation

More information

The Work Up of Pelvic Floor Dyssynergia and Fecal Incontinence. Gina R. Sam, MD/MPH Director, Mount Sinai Gastrointestinal Motility Center

The Work Up of Pelvic Floor Dyssynergia and Fecal Incontinence. Gina R. Sam, MD/MPH Director, Mount Sinai Gastrointestinal Motility Center The Work Up of Pelvic Floor Dyssynergia and Fecal Incontinence Gina R. Sam, MD/MPH Director, Mount Sinai Gastrointestinal Motility Center Constipation Overview Constipation Normal Transit Constipation

More information

How to Improve Bladder After Bowler Cancer

How to Improve Bladder After Bowler Cancer Bladder changes after bowel cancer treatment This information is from the booklet Managing the late effects of bowel cancer treatment. You may find the full booklet helpful. We can send you a free copy

More information

Diabetes and the bladder

Diabetes and the bladder encathopedia Volume 5 Diabetes and the bladder Important to manage Know the warning signs CIC can help Diabetes (diabetes mellitus, DM) Diabetes mellitus is a group of metabolic diseases in which a person

More information

COMPLICATIONS OF FISTULA REPAIR SURGERY. Sherif Mourad

COMPLICATIONS OF FISTULA REPAIR SURGERY. Sherif Mourad COMPLICATIONS OF FISTULA REPAIR SURGERY Sherif Mourad In the developing world, the true incidence of obstetric fistulas is unknown, as many patients with this condition suffer in silence and isolation.

More information

Women suffer in silence

Women suffer in silence Women suffer in silence Stress urinary incontinence is the involuntary loss of urine resulting from increased intra-abdominal pressure. In people who suffer with this condition, forms of exertion such

More information

Information for patients. Sex and Incontinence. Royal Hallamshire Hospital

Information for patients. Sex and Incontinence. Royal Hallamshire Hospital Information for patients Sex and Incontinence Royal Hallamshire Hospital Why is sex important? We may choose to be sexual, regardless of our age, physical status or stage of life. Those with health problems

More information

CMScript. Member of a medical scheme? Know your guaranteed benefits! Issue 7 of 2014

CMScript. Member of a medical scheme? Know your guaranteed benefits! Issue 7 of 2014 Background CMScript Member of a medical scheme? Know your guaranteed benefits! Issue 7 of 2014 Prostate cancer is second only to lung cancer as the leading cause of cancer-related deaths in men. It is

More information