HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by KADAR, N. Articles by NELSON, J. H. Search for Related Content PubMed PubMed Citation Articles by KADAR, N. Articles by NELSON, J. H., Jr

Treatment of Urinary Incontinence After Radical Hysterectomy

From the Department of Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.

Abstract

The results of therapy of eight previously untreated women without urinary fistulas who had been severely incontinent for three to eight years after radical hysterectomy are presented and the principles of management discussed. Radio-logic and urodynamic studies are required to assess the bladder pressure response to filling, proximal urethral pressures, bladder neck closure at rest, and mobility of the bladder neck, to determine the mechanism responsible for the urine loss and to select appropriate therapy. Augmentation of proximal urethral pressures by medical or surgical means is required if the bladder neck is open at rest. All such patients improved dramatically on ephedrine, but tachyphylaxis developed in cases of total sphincter failure. Retropubic urethropexy did not relieve the incontinence in these cases, whereas a sling operation restored complete continence. If an incremental bladder pressure response to filling is present, operations to increase bladder outlet resistance are contraindicated. Treatment with anticholinergic medications was unsuccessful in these cases.