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The Top Article on incontinence treatment

Urinary incontinence is a condition characterized by unintentionally releasing urine. It affects about 12 million Americans and is more common in women than men. It can be a problem at any age, but is especially prevalent in older individuals, with at least 1 in 10 people age 65 or older complaining of this problem. Although associated with aging, age itself does not cause incontinence. It can occur for several different reasons and can last for a short time or indefinitely. Unfortunately, out of embarrassment, many people with bladder control issues don't seek medical advice, despite there being a number of effective treatments available.


Guidelines on choice of surgery for SUI from the Society of Obstetricians and Gynaecologists of Canada (Robert et al, 2005) concluded that there is insufficient evidence to support the use of the TOT procedure for stress urinary incontinence. Guidelines on UI from the National Collaborating Centre for Women's and Children's Health concluded that the TOT procedure is recommended as alternative treatment option for SUI if conservative management has failed, "provided women are made aware of the lack of long-term outcome data." This was a "D" recommendation, based on consensus or low quality evidence.
Urinary incontinence associated with neurologic conditions can be difficult to manage," said George Benson, MD, deputy director of the FDA's Division of Reproductive and Urologic Products. "Botox offers another treatment option for these patients." A statement from the FDA notes that uninhibited urinary bladder contractions in patients with certain neurological conditions can lead to an inability to store urine. Current treatment for this condition includes drugs known as anticholinergics or use of a catheter. Allergan, the manufacturer of Botox, notes that the approval is for patients who have an inadequate response to anticholinergic therapy or in whom such therapy was not tolerated.

The ABC trial (Anticholinergic therapy vs onabotulinum toxinA for urgency incontinence) shed some light on the utility of 100 units of onabotulinum toxinA in the setting of overactive bladder. The data have shown comparable efficacy of 100 units of onabotulinum toxinA to anticholinergic medications with reduced systemic side effects in the onabotulinum toxinA-injected group, yet higher rates of retention and urinary tract infections. Patients receiving onabotulinum toxinA were more likely to be dry however. Patients who received anticholinergic drugs were more likely to suffer from dry mouth and other systemic side effects. 71 Intravesical pharmacotherapy
An UpToDate review on _Treatment of urinary incontinence_ (DuBeau, 2012) does not mention the use of collagen porcine dermis mesh as a therapeutic option. Furthermore, an UpToDate review on _Overview of transvaginal placement of reconstructive materials (surgical mesh or biografts) for treatment of pelvic organ prolapse or stress urinary incontinence_ (Trabuco and Gebhart, 2012) states that _Midurethral slings, using macroporous polypropylene mesh, are the most common procedures for treatment of SUI 11. A sling made of microporous material (ObTape) for midurethral slings was associated with high complication rates and was removed from the market_. It does not mention the use of collagen porcine dermis.
Bladder control training can help you to more efficiently control your bladder. It can improve the bladder's weaknesses and enable it to hold more urine. You are requested to urinate only when scheduled, at a progressively increasing intervals. You are taught to postpone urination according to a fixed schedule and might be asked to keep a bladder diary to record fluid intake, trips to the bathroom, episodes of urine leakage and an estimate of the amount of leakage. A bladder diary should be kept as an aid to a treatment as well as a motivating factor.



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