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Uro/Gynecology

• Editor's Note
• List of Articles

List of Articles

• Pelvic Floor Muscle Rehabilitation
  Pregnancy and vaginal delivery have been considered main risk factors in the development of pelvic floor disorders and in the development of stress urinary incontinence. Urinary incontinence alone represents a $ 26 billion economic burden. There appears to be an increase in demand for care of these disorders that is disproportionate to the net growth of the population. In order to restore function of the pelvic floor muscles after childbirth, women in most industrialized countries have been encouraged to perform pelvic floor muscle exercises. Postpartum pelvic floor muscle training has been demonstrated to be effective in the prevention and treatment of stress urinary incontinence in the immediate postpartum period. Many education techniques have been described, and physiotherapists skilled in uro-gynecology frequently use pelvic floor exercises, biofeedback, and electrostimulation techniques.
  
  
• Lower Urinary Tract Infections
  Women are prone to urinary infections, especially before puberty and after the menopause. The main effect of infection on vesicourethral function is that 25% of the patients have uninhibited detrusor contractions with associated urethral relaxation. E. coli endotoxin causes these findings in many patients. In many patients urethral striated sphincteric spasm results, creating a vicious cycle of retention, obstructed voiding and repeated infection. The treatment is elimination of the infection by antimicrobial agents. Prevention of recurrent urinary tract infections is vital.
  
  
• Evaluation of Urinary Incontinence
  Urinary incontinence can be a symptom of which patients complain, a sign demonstrated on examination, or a condition that can be confirmed by definitive studies. The history and physical examination are the first and most important steps in the evaluation. A preliminary diagnosis can be made with simple office and laboratory tests, with initial therapy based on these findings. For the vast majority of women presenting with complaints of urinary incontinence who have not had prior failed anti-incontinence operations or the history of neurologic disease, the simple evaluation may be all that is needed. With a detailed history, physical examination and the neurologic examination of the lower extremities and perineum, a diagnosis can usually be established accurately in approximately 90% of patients. If complex conditions are present or if surgery is being considered, definitive specialized studies are necessary.
  
  
• Medical Management of Voiding Dysfunctions
  Recent advances in the understanding of the neurology and neuro-pharmacology of the lower urinary tract indicate that a multiplicity of different types of drugs influence the physiological activity of the bladder and urethra. Although behavior modification improves or cures most patients with detrusor instability, pharmacologic therapy remains the most popular mode of treatment. In women between the ages of 15 to 60 years, the prevalence of voiding dysfunction is about 5-25%. 12 to 38% of women are over the age of 60. 69% of women are over the age of 18 with the symptoms of urinary incontinence, and the incidence of urge incontinence among this group is about 46%. Because the cause of detrusor instability is unknown, the response to treatment is often unpredictable and the side effects are common with effective doses. In general, drugs improve detrusor instability by inhibiting the contractile activity of the bladder.
  
  

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