An effective day case treatment combination for refractory neuropathic mixed incontinence.
نویسندگان
چکیده
OBJECTIVE Women with drug refractory neurogenic mixed incontinence (NMI) have limited minimally invasive treatment options and require reconstructive surgery. We examined efficacy of a combination of day case intradetrusor (ID) botulinum toxin (BTX-A) bladder injections and transobturator (TOT) or tension free vaginal tape (TVT). MATERIALS AND METHODS Eleven women who are pharmacotherapy intolerant or who have drug refractory NMI were treated. Two opted for open surgery and the remaining 9 received 1000 units of Dysport diluted in 30 mL saline cystoscopically at 30 ID sites followed by TOT in 6 or TVT in 3 as a day case combination treatment. Patient demographics, pre and post treatment videocystometrogram (VCMG), pad test and International Committee on Incontinence Questionnaire (ICIQ) scores were recorded. At 6 weeks (repeat ICIQ, pad test and patient satisfaction), at 3 and 12 months (VCMG) and 'current' (ICIQ and patient satisfaction) was recorded. RESULTS The mean age was 56.7 years (range 41 to 78) with a mean follow up of 19.1 months (range 7 to 33). All women were continent at 3 and 12 months. Quality of life (ICIQ scores) improved at 6 weeks (p > 0.001) and remained stable up to the last follow up (p > 0.001). Eight women have stopped using pads. At 3 months, there was significant improvement in MDP (p > 0.014) and MCC (p = 0.002). Anticholinergics were discontinued in 7 with global high satisfaction with the treatment BTX-A injections were repeated in 4 (mean 13.5 months). CONCLUSION Anticholinergic refractory women with NMI can be effectively treated as a day case with combination of ID BTX-A injections and TVT or TOT.
منابع مشابه
Treatment of chronic intractable neuropathic pain with dronabinol: case report of two adolescents.
OBJECTIVE To evaluate the effectiveness of dronabinol for the treatment of neuropathic pain refractory to previous treatment. METHODS We studied the response (reduction of pain intensity and functional improvement) to dronabinol (5 mg/day to 25 mg/day) in two adolescents with neuropathic pain and depression refractory to previous treatments over two and five years, respectively. RESULTS Red...
متن کاملIntrathecal Ziconotide and Morphine for Pain Relief: A Case Series of Eight Patients with Refractory Cancer Pain, Including Five Cases of Neuropathic Pain.
INTRODUCTION Studies have shown that, at low doses and with careful titration, combination therapy with intrathecal ziconotide and morphine results in rapid control of opioid-refractory cancer pain. However, there is a lack of published data regarding the efficacy and safety of intrathecal ziconotide specifically for the treatment of neuropathic cancer pain. CASE SERIES Case reports of zicono...
متن کاملتاثیر استفاده از مخروط های مهبلی بر بی اختیاری استرسی ادرار
Background: Stress incontinence is the most common types of urinary incontinence in women and the second factor for permanent incontinence in old women, which effects on their health and quality of life. Basic treatment for this problem is pelvic floor exercises. Usage of vaginal cones is an effective intervention for prevention and treatment of urinary stress incontinence. Objective: To determ...
متن کاملEffectiveness of pamidronate for treating intractable chronic neuropathic pain: case report of two adolescents.
The objective of this study is to evaluate the effectiveness of pamidronate for the treatment of chronic neuropathic pain refractory to previous management. Intravenous pamidronate (60 mg/day for 3 days) was administered to 2 adolescents with neuropathic pain refractory to previous multidisciplinary treatments. Pain intensity, functional improvement, and adverse effects were evaluated. There we...
متن کاملEffects of combined chronic progesterone administration and forced exercise on behavioral pain responses in the neuropathic pain model of chronic constriction injury in rats
Introduction: Neuropathic pain is a chronic pain that results from damage to the central and peripheral nerves. According to the previous studies, physical activity or progesterone can be an effective treatment for alleviating sensory neuropathic pain individually. In this way, the combined effect of chronic progesterone and forced exercise on behavioral pain responses in the neuropathic pain m...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید
ثبت ناماگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید
ورودعنوان ژورنال:
- International braz j urol : official journal of the Brazilian Society of Urology
دوره 34 1 شماره
صفحات -
تاریخ انتشار 2008