**7. References**


Understanding the complexity involving the patients who need a urinary derivation is the cornerstone of treatment success. This includes knowing when and which urinary derivation is more suitable for each situation and assuring an appropriate preparation pre operatively. Proper patient education will facilitate patient's adherence to self catheterization and elevate chances to meet his expectations towards the treatment. It cannot be forgotten that although continent urinary conduits offer a very high rate of success, revisions are expected and may occur throughout patient's entire lifetime. Therefore, regular

[1] Adams MC, Joseph DB. Urinary Tract Reconstruction in Children. In Campbell-Walsh

[2] Metcalfe PD, Cain MP. Incontinent and Continent Urinary Diversion. Pediatric Urology

[3] Farrugia MK, Malone PS. Educational article: The Mitrofanoff procedure. J Ped Urol

[4] Westney OL. The Neurogenic Bladder and Incontinent Urinary Diversion Urol Clin N

[5] Lapides J, Diokno C, Silber SJ, et al. Clean, intermittent self- catheterization in the

[6] McGuire EJ, Woodside JR, Borden TA, et al. Prognostic value of urodynamic testing in

[7] Stöhrer M, Murtz G, Kramer G, et al. Propiverine compared to oxybutynin in neurogenic

[8] Goessl C, Knispel HH, Fiedler U, et al. Urodynamic effects of oral oxybutynin chloride in

[9] Lee CT. Quality of life following incontinent cutaneous and orthotopic urinary

[10] Moore KN, Fader M, Getliffe K. Long-term bladder management by intermittent

[11] Newman DK, Willson MM. Review of intermittent catheterization and current best

[12] Mitrofanoff P. Cystostomie continent trans-appendiculaire dans le traitement des

treatment of urinary tract disease. Trans Amer Assoc Genitourin Surg 1971; 63:92-

detrusor: results of a randomized, double-blind, multicenter clinical study. Eur

children with myelomeningocele and detrusor hyperreflexia. Urology 1998; 51:94-

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myelodysplastic patients. J Urol 1981; 126:205- 209.

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vessies neurologiques. Chir Pediatr 1980; 21:297- 305.

2nd Ed. 2010, Chapter 56, p. 737-747.

**5. Final considerations** 

and thorough follow up is warranted.

CIC – Clean intermittent catheterization

**6. List of abbreviations** 

UTI – Urinary tract infection

2010; 6: 330-337.

Am 2010; 37: 581–592.

Urol 2007; 51:235-242.

practices. Urol Nurs. 2011; 31:12-28.

QoL – Quality of life

96.

98.

CD006008.

**7. References** 


**1. Introduction** 

elements of both disorders (Table 1).

management strategies include:

constipation …. etc).

2. Pelvic floor muscle training ± biofeedback. 3. Vaginal cones and electrical stimulation.

**18** 

*Egypt* 

**Futuristic Concept in Management** 

Stress urinary incontinence (SUI) is defined as the complaint of involuntary leakage of urine on exertion or on sneezing or coughing **(Abrams et al, 2002)**. Female SUI is a common distressing health problem, affecting large number of women worldwide, with prevalence rates ranging from 12.8% to 46.0% **(Botlero et al, 2008)**. SUI is considered the most common type of urinary incontinence among women and presents about 50 % of these populations, while mixed urinary incontinence presents 36 % and only 14 % are due to urge urinary incontinence **(Hannestad et al, 2000)**. SUI has a negative impact on women quality of life

specially their social, physical, occupational, psychological, and sexual aspects of life.

SUI arises when the bladder pressure exceeds the urethral pressure, in the setting of sudden increases of intra-abdominal pressure (coughing, sneezing …etc). Most researchers now identify two main etiologic mechanisms for the development of SUI: urethral hypermobility due to loss of urethral support - the hammock-like supportive layer described by DeLancey **(DeLancey, 1994 )**, and intrinsic sphincter deficiency (ISD), with most patients having

There are several options for treatment of female SUI. Conservative treatment (pelvic floor muscle exercise) is usually advocated as a 1st line therapy since it carries minimal risks and studies have shown up to 70% improvement in symptoms of SUI following appropriately performed pelvic floor exercise **(Price, Dawood and Jackson, 2010)**. Conservative

1. Life style changes (weight reduction, smoking cessation, ↓ fluid intake, treatment of

Regarding pharmacotherapy, no drug till now has been approved to be used by the Food and Drug Administration (FDA) for the treatment of female SUI. Duloxetine is a serotonin– norepinephrine reuptake inhibitor (SNRI) has been investigated, it can significantly improve the quality of life of patients with SUI, but it is unclear whether or not benefits are

sustainable in addition it has a common side-effects **(Mariappan et al, 2007)**.

**of Female SUI: Permanent Repair** 

**Without Permanent Material** 

Yasser Farahat and Ali Abdel Raheem

*Tanta University Hospital* 

