Research Priorities (Indicates
what is known about preventing incontinence)
- Prospective
study of the effect of hysterectomy on bladder functions.
- Long-term
effects of childbirth, including obstetric practices and age of
childbearing.
- Study
further the role of collagen.
- Investigate
the effect of menopause and hormone replacement therapy on the
urinary tract.
- Study
the effects of prolapse and its repair, other pelvic surgery, and
continence.
- Long-term
sequelae of untreated obstruction or its medical management in men.
- Radical
prostatectomy is associated with urinary incontinence.
- Specialized
centers should be developed for the treatment of prostate cancer
(performing more than 20 operations per year), and men need improved
information about incontinence risks to enable an informed choice on
intervention. Pre-operative detrusor dysfunction may make urinary
incontinence more likely after transurethral resection of the
prostate (TURP).
- Post-micturition
dribbling can often be prevented by simple education. In men with
symptoms suggestive of prostatic hyperplasia and co-existing
Parkinsonism, particular care should be taken not to misdiagnose
Multiple System Atrophy (MSA) as Parkinson's disease. Removal of the
prostate is inadvisable in men with MSA.
Clinical Evidence (not
in order of priority)
- Radiotherapy
for pelvic malignancies is associated with increased urinary
incontinence.
- For
women the link with vaginal delivery becomes less clear than in
younger women.
- The
role of estrogen and menopause is likewise unclear. It is not known
if hormone replacement therapy (HRT) helps to prevent the
development of urinary incontinence.
- Urinary
incontinence is clearly linked to obesity in women.
- The
role of smoking is less clear, as is the role of hysterectomy and of
straining due to chronic constipation.
- Sometimes
repair of a vaginal prolapse can unmask a tendency to urinary
incontinence.
- Incidence
of incontinence in women tends to level off with advancing years;
stress incontinence may even decrease with age. Only when dementia,
immobility or general frailty develop does the prevalence increase
with age.
- Men
continue to be a low risk group, until the age where the prostate
becomes troublesome for some and may need intervention.
- Prospective
study of pre-operative risk factors and continence after
prostatectomy.
- Development
of a standardized outcome questionnaire, including continence
status, to be used with patients undergoing radical prostatectomy.
Comparison of continence results from different surgeons and
centers.
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