Cath Lab Digest

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  Problems associated with diagnosing and treating bladder and bowel control symptoms and related pelvic floor disorders continue to receive increasing attention globally by healthcare providers. In October 2008, the 38th Annual Meeting of the International Continence Society (ICS) was held in Cairo, Egypt, where 128 abstracts were formally presented. As a member of the ICS, the NAFC actively participates in the workshops of its annual scientific meetings and its Continence Promotion Committee. Given the fact that incontinence was referenced as a medical condition in some of the earliest written records of human history, it was fitting for the ICS to meet on the soil of ancient civilization. Ostomy Wound Management is pleased to provide highlights from the meeting.

  Mesh. Numerous papers presented findings from randomized controlled trials comparing one mesh material to another or to autologous tissue for the surgical treatment of stress urinary incontinence or prolapse in women. Although some materials and mesh “kits” have been shown to be inferior to others, research is still lacking. Proper selection of patients for appropriate use of mesh in prolapse repair is needed to minimize recurrent symptoms, subsequent surgery, and adverse outcomes. Controversy in the scientific community on this topic is growing.

  Patient adherence. In consideration of the number of prescription drugs that address symptoms of overactive bladder (OAB), enlarged prostate or benign prostatic enlargement (BPH), and other problems associated with voiding dysfunction, several papers were presented on the subject of patient compliance. (Note: The more politically acceptable, more patient-centered term used today in the US is “patient adherence.” It encompasses cultural values, social needs, the presence of a multidisciplinary care team, and self-directed, behavioral intervention by the patient.) Research continues to determine optimal means of engaging patients, framing expectations, and maintaining motivation.

  Male incontinence. Attention to problems men face regarding stress incontinence following prostate surgery, OAB, and retention is growing. A paper presented from Turkey recommended that a bulking agent injection is preferred for patients with incontinence after transurethral resection of the prostate (TURP); whereas, an artificial urinary sphincter (AUS) implantation is the choice for patients experiencing incontinence after radical prostatectomies.

  Pelvic floor assessment. A paper from the UK shared a new technique that provides dynamic, functional assessment of pelvic floor musculature, considered useful to individualizing patient treatment strategies. Researchers found that patients with obstructed defecation and significant prolapse have irregular, asymmetric pelvic floors, which may indicate altered contractility and function.

  Managing prolapse with pessaries. A paper and an enlightening workshop addressed management of pelvic organ prolapse with vaginal pessaries. Prolapse symptoms were shown to improve, becoming less bothersome after 1 year of pessary use, indicating pessary use is an acceptable alternative to surgery. More nurse specialists in particular should encourage pessary use as a viable alternative to surgery, especially given the many questions about reconstructive surgery, its reoccurrence rate, questions surrounding synthetic materials, and widespread variation in surgical training and techniques around the globe.

  Fittingly, the ICS ended beneath a veil of spotlights shining on the pyramids in Cairo.