Stress Incontinence - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

STRESS INCONTINENCE A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES ...

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STRESS

INCONTINENCE A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES

J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS

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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright 2004 by ICON Group International, Inc. Copyright 2004 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Stress Incontinence: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-597-84640-5 1. Stress Incontinence-Popular works. I. Title.

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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International, Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this book.

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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on stress incontinence. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.

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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications. Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.

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About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes&Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health

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Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON STRESS INCONTINENCE............................................................................. 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Stress Incontinence ..................................................................... 11 E-Journals: PubMed Central ....................................................................................................... 19 The National Library of Medicine: PubMed ................................................................................ 19 CHAPTER 2. NUTRITION AND STRESS INCONTINENCE ................................................................... 65 Overview...................................................................................................................................... 65 Finding Nutrition Studies on Stress Incontinence...................................................................... 65 Federal Resources on Nutrition ................................................................................................... 67 Additional Web Resources ........................................................................................................... 67 CHAPTER 3. ALTERNATIVE MEDICINE AND STRESS INCONTINENCE ............................................ 69 Overview...................................................................................................................................... 69 National Center for Complementary and Alternative Medicine.................................................. 69 Additional Web Resources ........................................................................................................... 74 General References ....................................................................................................................... 74 CHAPTER 4. PATENTS ON STRESS INCONTINENCE ......................................................................... 75 Overview...................................................................................................................................... 75 Patents on Stress Incontinence .................................................................................................... 75 Patent Applications on Stress Incontinence ................................................................................ 90 Keeping Current .......................................................................................................................... 97 CHAPTER 5. BOOKS ON STRESS INCONTINENCE ............................................................................. 99 Overview...................................................................................................................................... 99 Book Summaries: Federal Agencies.............................................................................................. 99 Chapters on Stress Incontinence................................................................................................ 102 CHAPTER 6. MULTIMEDIA ON STRESS INCONTINENCE ................................................................ 107 Overview.................................................................................................................................... 107 Video Recordings ....................................................................................................................... 107 CHAPTER 7. PERIODICALS AND NEWS ON STRESS INCONTINENCE ............................................. 109 Overview.................................................................................................................................... 109 News Services and Press Releases.............................................................................................. 109 Newsletter Articles .................................................................................................................... 112 Academic Periodicals covering Stress Incontinence .................................................................. 114 APPENDIX A. PHYSICIAN RESOURCES .......................................................................................... 117 Overview.................................................................................................................................... 117 NIH Guidelines.......................................................................................................................... 117 NIH Databases........................................................................................................................... 119 Other Commercial Databases..................................................................................................... 121 APPENDIX B. PATIENT RESOURCES ............................................................................................... 123 Overview.................................................................................................................................... 123 Patient Guideline Sources.......................................................................................................... 123 Finding Associations.................................................................................................................. 126 APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 129 Overview.................................................................................................................................... 129 Preparation................................................................................................................................. 129 Finding a Local Medical Library................................................................................................ 129 Medical Libraries in the U.S. and Canada ................................................................................. 129 ONLINE GLOSSARIES................................................................................................................ 135 Online Dictionary Directories ................................................................................................... 138

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STRESS INCONTINENCE DICTIONARY .............................................................................. 139 INDEX .............................................................................................................................................. 173

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FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with stress incontinence is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about stress incontinence, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to stress incontinence, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on stress incontinence. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to stress incontinence, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on stress incontinence. The Editors

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From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.

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CHAPTER 1. STUDIES ON STRESS INCONTINENCE Overview In this chapter, we will show you how to locate peer-reviewed references and studies on stress incontinence.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and stress incontinence, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type “stress incontinence” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is what you can expect from this type of search: •

Transvaginal Electrical Stimulation in the Treatment of Genuine Stress Incontinence and Detrusor Instability Source: International Urogynecology Journal. 4(1): 9-13. February 1993. Summary: Electrical stimulation has been widely used in Europe to treat urinary incontinence, but original studies and overall use of the device has been limited in North America. This article reports on a study in which 45 patients with documented genuine stress incontinence, detrusor instability, or mixed incontinence had self-administered therapy for 15 minutes twice daily, for a duration of 6 weeks. Treatment was delivered by a new stimulation device with an attached vaginal probe. Patients recorded treatment times, leak episodes, and pad use. Objective measures included a pad test, standing stress test, standing CMG, and resting and dynamic urethral closure pressure

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profiles. The subjective success rates based on a questionnaire ranged from 52 to 71 percent, depending on the type of incontinence. Objective testing for both types of incontinence did not show significant improvement after treatment. Most patients requested to continue using the device in preference to other therapy. 1 figure. 9 tables. 25 references. (AA-M). •

Contemporary Clinical Treatment of Female Stress Incontinence Source: International Urogynecology Journal. 5(2): 112-118. April 1994. Contact: Available from Springer International. Springer-Verlag New York, Inc. 175 Fifth Avenue, New York, NY 10010. (212) 460-1500. Summary: Genuine stress incontinence is a common problem whose pathogenesis stems from an anatomical defect of the bladder neck and proximal urethra. This article reviews the contemporary clinical treatment of female stress incontinence. Topics include the pharmacological management of urinary incontinence; physiotherapy, including pelvic floor exercise programs, electrical stimulation, and biofeedback; surgical therapy, including anterior colporrhaphy, retropubic cystourethropexy, vaginally performed needle cystourethropexy, sling cystourethropexy, bladderneck/urethral reconstruction, and the artificial urinary sphincter; and periurethral injection. The authors stress that a logical approach to stress incontinence with correct clinical practice should ensure a high cure rate. 2 tables. 74 references. (AA-M).

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Nonsurgical Therapy for Stress Incontinence Source: Urologic Clinics of North America. 22(3): 613-627. August 1995. Contact: Available from W.B. Saunders Company, Periodicals Fullfillment, 6277 Sea Harbor Drive, Orlando, FL 32887. (800) 654-2452. Summary: In this article, the authors review the nonsurgical therapeutic options for stress incontinence. Topics include the anatomy of the pelvic floor muscles; pelvic-floor training; the theory of biofeedback; applied biofeedback; the principles of functional electrical stimulation; different modes of application of functional electrical stimulation; the prevalence and incidence of urinary stress incontinence and sports; and physical therapy for sportswomen. The authors conclude that the success of physiotherapy depends on a proper selection of patients to avoid unnecessary physiotherapy sessions and to identify those patients most likely to be cured and exclude those most likely to fail. The use of a prognostic scoring system, taking into account the grade of incontinence, pelvic-floor muscle grading, the hormonal state, the previous surgery, and the pelvic-floor neuropathy, is highly recommended. 5 figures. 57 references.

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Surgical Correction of Stress Incontinence in Morbidly Obese Women Source: Journal of Urology. 160(3): 754-755. September 1998. Summary: Obesity contributes to the development of stress urinary incontinence in women; it can also contribute to surgical technical factors which may make some urologists reticent to offer operative therapy. This article reports on a review of a series of morbidly obese women who underwent anti-incontinence surgery to determine if they were at higher risk for surgical failure. The authors reviewed their records of operative series of female stress urinary incontinence and 16 women were considered morbidly obese. Transvaginal bladder neck suspension was performed in 4 women and sling procedures in 12, depending on preoperative urodynamic findings. Bladder neck suspension procedures failed in two cases, and no sling procedures failed. There was no

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recurrent or new pelvic floor deficit. The operations were somewhat more difficult to perform due to the body habitus of these patients, but there were no intraoperative complications and only one minor wound infection postoperatively. The authors conclude that morbidly obese women with stress urinary incontinence can undergo operations for this disorder with a good chance of success. The authors recommend complete evaluation including urodynamics to ensure proper classification of stress incontinence. Sling operations may be the procedure of choice for stress incontinence in morbidly obese women. 18 references. (AA). •

Effect of Behavioral Training With or Without Pelvic Floor Electrical Stimulation on Stress Incontinence in Women Source: Journal of the American Medical Association. 290(3): 345-352. July 2003. Summary: Pelvic floor electrical stimulation (PFES) has been shown to be effective for stress incontinence. However, its role in a multicomponent behavioral training program has not been defined. This article reports on a study undertaken to determine if PFES increases efficacy of behavioral training for community dwelling women with stress incontinence. The patients were a volunteer sample of 200 ambulatory, nondemented community dwelling women aged 40 to 78 years with stress or mixed urinary incontinence. Patients were randomly assigned to 8 weeks (4 visits) of behavioral training, 8 weeks (4 visits) of the behavioral training plus home PFES, or 8 weeks of selfadministered behavioral treatment using a self-help booklet (control condition). Primary outcome was percentage reduction in the number of incontinent episodes as documented in bladder diaries. Results showed that incontinence was reduced a mean of 68.6 percent with behavioral training, 71.9 percent with behavioral training plus PFES, and 52.5 percent with the self-help booklet. Differences between behavioral training alone and behavioral training with PFES were not significant. 2 figures. 3 tables. 32 references.

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Injection Therapy for Stress Incontinence in Women Source: International Urogynecology Journal. 10(3): 200-206. 1999. Contact: Available from Springer-Verlag New York Inc. 175 Fifth Avenue, New York, NY 10010. (212) 460-1500. Fax (212) 473-6272. Summary: Periurethral bulking agents have been used to treat intrinsic bladder sphincter deficiency for decades. This article reviews the use of injection therapy for stress urinary incontinence in women. Currently available agents include polytetrafluoroethylene, glutaraldehyde cross linked collagen, autologous fat, and silicone microimplants. Polytetrafluoroethylene has never been approved by the U.S. Food and Drug Administration (FDA) for periurethral injection because of the risk of particle migration. Early results have reported subjective cure rates of up to 95 percent with collagen injections. However, collagen may cause allergic reactions and long term results are still awaited. Periurethral fat injection has a reported success rate ranging from 23 percent to 65 percent. It is simple and avoids the use of foreign materials, but the main disadvantage is related to the variability of resorption and connective tissue replacement. Silicone microimplants need further study to evaluate their efficacy and safety. The authors conclude that the best material has not yet been defined. Long term studies are still necessary to define the optimal injectable agent. 2 tables. 77 references.

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United States Experiences with Tension-Free Vaginal Tape Procedure for Urinary Stress Incontinence: Assessment of Safety and Tolerability Source: Techniques in Urology. 7(4): 261-265. 2001. Contact: Available from Raven Press, Ltd. 1185 Avenue of the Americas, New York, NY 10036. (800) 777-2836 or (212) 930-9500. Summary: The tension-free vaginal tape (TVT) procedure is an operation for treatment of stress urinary incontinence (SUI). A polypropylene mesh tape is placed to support the midurethra through a small vaginal incision. In this study, the authors present their preliminary results evaluating the safety, tolerability, and perioperative morbidity of this procedure. The observational study included 100 patients with SUI who underwent the TVT procedure. Patients were evaluated prospectively with history and pelvic examination, urodynamic studies, perioperative protocol, outcome and satisfaction questionnaire, and postoperative visits at 3 weeks and 2 months. The TVT procedure was performed with the patient under local anesthesia, using intravenous sedation in 97 patients and regional anesthesia in 3. Mean surgical time was 35.5 minutes. Bladder penetration occurred in 24 patients. Forty-two required overnight urethral catheterization. Mean hospital stay was 0.18 days. By 24 hours after the procedure, 95 percent were able to void. At 3 week followup, 88 percent of patients were completely continent and 9 percent significantly improved. The TVT procedure for SUI is a safe, minimally invasive operation with minimal perioperative morbidity. The authors conclude that, considering these preliminary findings and long-term European data of 1 to 3 years' experience with continence rate averaging 85 percent, the TVT procedure may prove to be the operation of choice to treat SUI for many women. 4 figures. 3 tables. 4 references.

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Symptomatic Characterization of Patients with Detrusor Instability and Those with Genuine Stress Incontinence Source: International Urogynecology Journal. 4(1): 23-26. February 1993. Summary: This article describes the symptomatology of detrusor instability and genuine stress incontinence, based on a study of the histories of 100 patients with each condition. The researchers focused particularly on certain areas which had not been reported previously, namely the severity of incontinence and its relationship to the menstrual cycle. By using a scoring system for the four most significant symptoms, as determined by logistic regression analysis, a model was constructed in an effort to more accurately predict the diagnosis from history alone. Frequency, urgency, and nocturia scored together, and urge incontinence were significantly associated with detrusor instability. The frequency of urinary leakage and the amount of protection required were significantly associated with genuine stress incontinence. The authors concluded that by scoring these four sets of symptoms alone, a correct diagnosis can be made from the history in 76 percent of cases. 1 figure. 3 tables. 8 references. (AA-M).

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Long-Term Failure of Pelvic Floor Musculature Exercises in Treatment of Genuine Stress Incontinence Source: Southern Medical Journal. 88(5): 547-549. May 1995. Summary: This article evaluates the motivation of a group of patients to continue a program of pelvic floor musculature exercises as conservative therapy for genuine stress incontinence. Fourteen women with urodynamically documented genuine stress incontinence had subjective improvement; nine of them showed objective improvement

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after 4 weeks of supervised pelvic floor musculature exercises. These patients were questioned 5 years later as to continence status, performance of pelvic floor musculature exercises, and subsequent surgery for incontinence. Ten of 14 patients responded; 4 have had anti-incontinence surgery and remain continent; 5 have not had surgery, do not perform pelvic floor musculature exercise, and continue to have stress incontinence. One patient continues to perform pelvic floor musculature exercises and has stress incontinence with a full bladder. Thus, only 1 patient out of 10 remained sufficiently motivated to perform pelvic floor musculature exercises after 5 years, even though all patients in this series had improvement after a 4-week course of supervised exercises. 16 references. (AA). •

Algorithm for the Management of Urinary Stress Incontinence Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 7(3): 221226. 1996. Contact: Available from Springer-Verlag New York, Inc. 175 Fifth Avenue, New York, NY 10010. (212) 460-1500. Fax (212) 473-6372. Summary: This article presents an algorithm for the management of urinary incontinence (UI) in the female. The authors review the performance of history, physical examination, and simple office bladder testing. Patients are categorized into a complex group which require multichannel urodynamic testing or a noncomplex group which may proceed to surgical intervention without such testing. The complex group is then subdivided into four groups: patients with significant bladder instability or a neurologic process which precludes operation; patients with no evidence of significant detrusor instability (DI) who lack urethrovesical junction rotation; patients with no evidence of significant DI who have urethrovesical junction rotation in the presence of other complex factors; and patients who have urinary retention on previous testing with or without DI demonstrated on cystogram. The authors also discuss the indications for collagen injection and for the pubovaginal sling procedure. The authors also discuss the role of patient education, noting that the vast majority of patients with incontinence benefit significantly from a 60 to 90 minute class devoted to incontinence. This offers the patient an opportunity to learn, allay fears, ask questions, and develop a greater understanding of treatment options. It also increases patient motivation, satisfaction, and compliance. 1 figure. 19 references. (AA-M).

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Conservative Treatment of Stress Incontinence with Geisha Balls Source: International Urogynecology Journal. 12(4): 223-225. 2001. Contact: Available from Springer-Verlag New York Inc. 175 Fifth Avenue, New York, NY 10010. (212) 460-1500. Fax (212) 473-6272. Summary: This article reports on a pilot study of six women with stress urinary incontinence (SUI) who were treated with Geisha balls while performing pelvic floor muscle exercises at home (half an hour a day for 12 weeks). Geisha balls consist of two hollow balls with two smaller balls inside. Geisha balls work like other wieghts or cones used in pelvic floor exercises. The feeling of losing the balls from the vagina initiates a feedback whereby retain the balls the patient uses her pelvic floor muscles to prevent this. When the patient moves around, the two inside balls click against the shell and the outer balls click against each other, giving further feedback to contraction of the pelvic floor muscles. Subjectively, four patients were cured and two had improved. Before the treatment, in 24 hour pad tests the women lsot a mean of 48 grams of urine; after the

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treatment, the mean was 10 grams. There were no adverse effects. 1 figure. 1 table. 5 references. •

Long-Term (10-15 Years) Follow-up After Burch Colposuspension for Urinary Stress Incontinence Source: International Urogynecology Journal. 12(5): 323-327. June 2001. Contact: Available from Springer-Verlag New York Inc. 175 Fifth Avenue, New York, NY 10010. (212) 460-1500. Fax (212) 473-6272. Summary: This article reports on a study of 127 patients who underwent a Burch colposuspension surgical procedure for urinary incontinence (involuntary loss of urine). All had undergone urodynamic investigation both pre and postoperatively. All patients had a mean followup of 12.4 years (range 10 to 15 years); 109 patients had an additional urodynamic investigation at least 10 years after the operation. Following surgery there was an improvement in symptoms of frequency, urgency, and urge incontinence. The cure rate was 93.7 percent. The only significant changes found on urodynamics were the measurements of the pressure transmission ratio, which were higher postoperatively and remained so after 10 years. The most frequent postoperative complications were de novo (new) detrusor (ring of muscle around the bladder) instability (16.6 percent) and anatomical defects (18.7 percent). All failed cases were found during the first postoperative year. De novo detrusor instability appeared in 12 out of 17 patients during the first year of followup. Postoperative anatomical defects were found only in 4 of 24 patients after 5 years. Ten years postoperation most of the anatomical defects had been detected (20 of 24), stressing the need for long term followup. An editorial comment is appended to the article. 6 tables. 15 references.

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Outcome Results of Transurethral Collagen Injection for Female Stress Incontinence: Assessment by Urinary Incontinence Score Source: Journal of Urology. 164(6): 2006-2009. December 2000. Contact: Available from Lippincott Williams and Wilkins. 12107 Insurance Way, Hagerstown, MD 21740. (800) 638-3030 or (301) 714-2334. Fax (301) 824-7290. Summary: This article reports on a study that assessed the results of collagen injection for female sphincteric incontinence (involuntary loss of urine due to problems with the bladder opening). The authors evaluated 63 consecutive women with sphincteric incontinence who underwent a total of 131 transurethral collagen injections. Sphincteric incontinence was confirmed by urodynamics (diagnostic testing of the mechanics of the urine tract during urination). All patients were treated with 1 to 5 transurethral collagen injections and treatment outcome was classified. The mean patient age was 67.7 years (plus or minus 12.8 years). All women had a long history of severe stress urinary incontinence, 18 (29 percent) underwent previous anti incontinence surgery, and 41 percent had combined stress and urge incontinence. Mean interval between injections was 4.4 months (plus or minus 5.7 months), mean followup was 12 months, and mean interval between the final injection and outcome assessment was 6.4 months (plus or minus 4.9 months). There was a statistically significant decrease in the total number of incontinence episodes per 24 hour voiding diary after each injection session. Although there was a clear trend toward decreased urinary loss per 24 hour pad test, statistical significance was not established. Using the strict criteria of the outcome score, overall 13 percent of procedures were classified as cure, 10 percent, 17 percent, and 42 percent were classified as good, fair, and poor, respectively, and 18 percent were classified as failure. The authors conclude that, as defined by strict subjective and objective criteria,

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there is a low short term cure rate after collagen injection in women with severe sphincteric incontinence. It remains to be determined how patients with less severe incontinence would fare using these outcome assessment instruments. 3 tables. 14 references. •

Long-Term Efficacy and Safety of a Disposable Vaginal Device (Continence Guard) in the Treatment of Female Stress Incontinence Source: International Urogynecology Journal. 8(3): 130-133. 1997. Contact: Available from Springer-Verlag New York Inc. 175 Fifth Avenue, New York, NY 10010. (212) 460-1500. Fax (212) 473-6272. Summary: This article reports on a study undertaken to evaluate the long term efficacy and safety of a new disposable vaginal device in the treatment of female stress incontinence. Out of 22 women with stress incontinence, 19 were subjectively and objectively cured or improved in a short term study and continued the treatment with the device for 1 year. The device is made of polyurethane, a foam product with well documented high tissue compatibility and approved by the FDA for use in medical devices. It is produced in three sizes and placed in the vagina with an applicator; the device can be worn from morning to night. All 19 women completed the study; 13 (68 percent) were subjectively dry, 5 (26 percent) were improved, and 1 (5 percent) reported unchanged incontinence. All but one woman had decreased leakage at the 24 hour pad test, and 67 percent had a greater than 50 percent decrease. No significant changes were found in the other urodynamic tests. The gynecologic examination showed no signs of irritation or erosion from the device, and the subjective complaints were modest and few. The authors conclude that the disposable vaginal device maintains its positive effects in alleviating the symptoms of stress incontinence in the long term, that it is safe, and that patient compliance is good. 1 figure. 3 tables. 11 references. (AA-M).

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Surgical Treatment of Recurrent Stress Incontinence Source: International Urogynecology Journal. 4(1): 31-34. February 1993. Summary: This article reports on the authors' experience with the surgical treatment of recurrent stress incontinence. They report that, between December 1982 and January 1990, 73 patients with recurrent stress incontinence were treated; 55 had successful operations and 18 had unsuccessful ones. Forty-five patients had a colposuspension and 28 had a silastic sling inserted. The authors note that success rates did not vary significantly between the two techniques. In the same study period, 117 patients had primary treatment; 94 were cured, indicating no difference in outcome between the primary and secondary groups. 24 references. (AA-M).

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Pelvic Floor Muscle Exercises in Genuine Urinary Stress Incontinence Source: International Urogynecology Journal. 8(5): 297-300. October 1997. Contact: Available from Springer-Verlag New York Inc. 175 Fifth Avenue, New York, NY 10010. (212) 460-1500. Fax (212) 473-6272. Summary: This article reports on the use of pelvic floor muscles in genuine stress urinary incontinence (SUI), a technique that has been used successfully since 1948. One may expect a significant improvement (warranting no further therapy) or cure rate of about 50 percent. These exercises have a long lasting effect. However, poorly motivated women and those with type III SUI will not benefit from physiotherapy and should be discouraged from following exercise sessions. The authors note that this is an important

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point to be ascertained when recruiting patients and should be prospectively evaluated in the future. The authors observed similar success rates immediately after exercise and 5 years later, which they speculate is because those women have learned how and when to contract the pelvic floor muscles in a timed and coordinated way. They also note that simple verbal explanation or illustrated manuals of the exercises are not sufficient for adequate teaching and implementation of the pelvic floor exercises. An active cooperation between urogynecologist, physiotherapist, and the patient is important in order to avoid undertreated and dissatisfied women. In addition, the option to choose surgery must be easily available. 4 figures. 1 table. 14 references. (AA-M). •

Female Stress Incontinence (editorial) Source: Journal of Urology. 165(5): 1612-1613. May 2001. Contact: Available from Lippincott Williams and Wilkins. 12107 Insurance Way, Hagerstown, MD 21740. (800) 638-3030 or (301) 714-2334. Fax (301) 824-7290. Summary: This brief editorial reviews recent research on the variety of surgical procedures used to treat female stress incontinence. Three different panels all concluded that retropubic suspension and sling procedure had the best long term success rates. With that conclusion fairly well established, a more recent challenge has been to minimize the morbidity of these procedures while maintaining the high success rates. One way to decrease sling morbidity is to use alternative sling materials so the patient fascia (muscles) is not harvested. The author notes that this procedure is an advancement only if the alternative material provides equal cure rates and does not introduce new complications. The risks and benefits of each alternative should be weighed carefully. In most series, synthetic materials have higher occurrences of infection and erosion than those reported for fascial slings. The author also considers the use of cadaveric fascial allograft slings; the success rate for cadaveric fascial sling varies and is dependent on sling integrity. The author advises that a surgeon not change tissue banks if he or she is currently having good results with cadaveric fascial slings. However, if cadaveric fascial slings are failing, the surgeon should consider trying a different tissue bank or using patient fascia. New materials, such as acellular dermis or acellular collagen matrix, are being evaluated and may result in the best choices in the future. 20 references.

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Urinary Stress Incontinence: Surgical Treatment (editorial) Source: International Urogynecology Journal. 9(3): 1, 2. June 1998. Contact: Available from Springer-Verlag New York Inc. 175 Fifth Avenue, New York, NY 10010. (212) 460-1500. Fax (212) 473-6272. Summary: This editorial comments on the surgical treatment options for treating urinary stress incontinence. The author notes that even though the socioeconomic costs of urinary incontinence are high, there remains no accepted best treatment for genuine anatomic stress incontinence. The author then focuses on the current movement to use a surgical technique that has been successful for Type III urinary stress incontinence in the treatment of other types of urinary incontinence. Type III urinary stress incontinence is characterized by significant intrinsic sphincteric damage, resulting in significant incontinence. Types I and II have an adequate sphincteric closure mechanism, but it is inefficient because of the excessive mobility and descent of the vesicourethral segment. The consensus has been that a sling procedure would best correct Type III. The author of this editorial reports on his experience utilizing retropubic suspension rather than a sling procedure. The author cautions against the use

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of sling procedures for Type I or Type II incontinence. Sling procedures were meant to be the answer for the failure of previous procedures, to induce increased resistance at the level of the bladder neck to stop incontinence while not interfering with free voiding. The type of patient selected for a sling procedure might not experience a complete cure but would be content with significant improvement because everything else had failed. The same degree of morbidity might not be acceptable in straightforward anatomic stress urinary incontinence. The author outlines his concerns with the surgical techniques being used and discusses anatomical outcomes, the innervation of the bladder, the different sling materials available, and the causes of failure of sling surgery.

Federally Funded Research on Stress Incontinence The U.S. Government supports a variety of research studies relating to stress incontinence. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to stress incontinence. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore stress incontinence. The following is typical of the type of information found when searching the CRISP database for stress incontinence: •

Project Title: ADIPOSE INCONTINENCE

DERIVED

STEM

CELLS

FOR

TREATMENT

OF

Principal Investigator & Institution: Rodriguez, Larissa V.; Urology; University of California Los Angeles 10920 Wilshire Blvd., Suite 1200 Los Angeles, Ca 90024 Timing: Fiscal Year 2004; Project Start 01-APR-2004; Project End 31-MAR-2009 Summary: (provided by applicant): Stress urinary incontinence (SUI) is a devastating condition affecting millions of American women. For these patients urinary incontinence is not only an embarrassing condition significantly eroding quality of life, it is also a significant cause of hospitalization. In 1995 the annual cost of incontinence in the United States was estimated to be 26.3 billion dollars. It affects women of reproductive age who are at risk after vaginal deliveries. Its incidence increases with advancing age, making it a major quality of life issue for the elderly. Developing a minimally invasive procedure with high and durable cure rates would have a significant impact on the way physicians treat incontinence and a positive financial impact on health care expenditures. More importantly, it will dramatically improve the quality of life of these patients. With aging there is atrophy of the smooth musculature of the urethra contributing to poor urethral resistance and involuntary loss of urine. 2

Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

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Bioengineering new functional tissue in order to increase urethral resistance and improve function has enormous clinical potential for the treatment of stress urinary incontinence. The long-term objective of this application is to apply tissue-engineering techniques exploiting the properties of adult stem cells derived from adipose tissue to develop an effective, minimally invasive treatment for stress incontinence. Our central hypothesis is that human adipose tissue contains a population of pluripotent stem cells capable of differentiating into functional smooth muscle. Specifically, this proposal aims at developing an injectable combination of cells, factors, and matrix to promote the development of vascularized, longlasting functional urethral musculature. The specific aims of this application are: (1) to investigate the ability of human adipose derived stem cells to form functional smooth muscle, (2) to investigate the ability of human adipose derived stem cells to be delivered, survive, and function as normal smooth musculature in the lower urinary tract, (3) to determine the ability of these cells to repair the atrophic nonfunctional urethra of stress incontinence. We will accomplish these aims by evaluating the ability of clonal populations of adipose derived stem cells to differentiate phenotypically and functionally into smooth muscle. Lastly, we will use an animal model of incontinence and decreased urethral resistance to test the hypothesis that these cells can be used to reconstruct a functional urethra as a treatment of stress incontinence. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: EACT CAROLINA UNIV. BARIATRIC SURGERY CLINICAL CENTER Principal Investigator & Institution: Pories, Walter J.; Professor; Surgery; East Carolina University 1000 E 5Th St Greenville, Nc 27858 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 31-AUG-2008 Summary: (provided by applicant): Obesity, the most prevalent, fatal, chronic disease of the 21st Century, is increasing at a rate seen before only with infectious diseases. Morbid obesity, the most severe form, afflicts 23 million Americans. These individuals are not only limited by their bulk but are sharply compromised by life-endangering comorbidities. Surgery has proven to be an effective therapy. The Greenville gastric bypass operation (GGB), developed at this institution, produces not only durable weight loss greater than 100 Ibs but also induces full remission of type 2 diabetes in 83 percent of patients, control of hypertension in over half, as well as full reversal of such comorbidities as asthma, Pickwickian syndrome, stress incontinence, and pseudotumor cerebri. The reproducible reversal of type 2 diabetes in GGB patients is a provocative finding and requires further basic research. However, the GGB, like other bariatric procedures, is associated with serious long-term nutritional deficiencies and, in vulnerable individuals, emotional disorders. Generally, there is no consensus about which of the seven common bariatric procedures should be used. There is also considerable variation in surgical outcomes across the US for the same operation due to a lack of standardization of the surgical care. Thus, bariatric surgery is ripe for a collaborative approach to answering both clinical and basic research issues. Our current center efforts include three major areas: 1. Fostering collaboration within the bariatric surgical community to promote clinical, behavioral, and basic research in morbid obesity and its co-morbidities; 2. Clinical studies of the efficacy, efficiency, and safety of two types of gastric bypass operations with an emphasis on differences in outcomes between African-American and Caucasian women. 3. Basic science studies of insulin action and sensitivity in human subjects prior to and after bariatric surgery. In addition, this application includes three proposals for inter-institutional projects: 1. Comparison of the most commonly performed bariatric operations; 2. the mechanism for increased

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insulin sensitivity after gastric bypass surgery; and 3. the ethics of the informed consent in bariatric surgery. Because East Carolina University has a productive tradition of interdisciplinary clinical, basic science, and behavioral research in morbid obesity as well as a record of national leadership, we submit this application to become one of the Bariatric Surgery Clinical Centers of the NIDDK. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: FUNCTIONAL INCONTINENCE

TISSUE

ENGINEERING

FOR

STRESS

Principal Investigator & Institution: Cannon, Tracy W.; Urology; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, Pa 15260 Timing: Fiscal Year 2003; Project Start 01-MAY-2003; Project End 30-APR-2007 Summary: (provided by applicant): Utilizing techniques developed in our laboratory, we propose to mount a systematic in vitro and in vivo physiological and biomechanical analysis of muscle stem cell based tissue engineering treatment of stress urinary incontinence (SUI). SUI is a significant medical problem affecting approximately 25 million American women 1. Despite the high prevalence of SUI, there is very little treatment-oriented research utilizing tissue engineering techniques. Using such techniques, we propose to develop a truly physiologic sling, not from synthetic or cadaveric tissue, but rather an engineered, functional stem cell muscle scaffold that can be implanted to repair a damaged urethral sphincter.Hypothesis: 1) Muscle Derived Stem Cells (MDSC) improve the mechanical properties of small intestinal submucosa (SIS) scaffold in vitro. 2) MDSC/SIS suburethral sling improves continence in an in vivo rat model of SUI.The Key Aims of this grant include: 1) Establish the mechanisms underlying the alterations in biaxial mechanical properties of MDSC-seeded SIS: a) Establish the feasibility of seeding MDSC to SIS; b) Establish the long-term persistence of MDSC on SIS; and c) Evaluate the compliance properties of SIS alone and MDSC/SIS in vitro and in vivo with comprehensive mechanical testing at different time points. 2) Evaluate the contractile properties of MDSC/SIS: a) Test muscle and neurally evoked contractile properties of MDSC/SIS based on seeding different densities of MDSC onto SIS and culturing for 7 days; b) Using the best seeding density from 2a, test muscle and neurally evoked contractility properties of MDSC/SIS, culture in vitro at different time points; and c) Using the best seeding density from 2a, test muscle and neurally evoked contractility properties of MDSC/SIS cultured in vivo and at different time points. 3) Assess the functional outcome of MDSC/SIS versus SIS suburethral sling placement following simulated birth trauma: a) Assess the effect of SIS or MDSC/SIS suburethral slings on micturition during continuous cystometry; b) Assess the effect of SIS or MDSC/SIS on leak point pressure (LPP) using the reliable and sensitive vertical tilt intravesical pressure clamp method; c) Evaluate the immunohistology of implanted SIS and MDSC/SIS suburethral slings; and d) Retest the mechanical properties as well as muscle and neurally evoked contractile properties of MDSC/SIS suburethral slings following LPP testing for correlative purposes. By reengineering the deficient urinary sphincter through functional tissue engineering, we plan to significantly improve the treatment of SUI. We want to strongly emphasize that our research is in complete compliance with the federal guidelines on embryonic stem cell research. These stem cells have not been obtained from embryos (animal or human) or cell lines of embryonic stem cells. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: FUNCTIONALLY BASED TREATMENT OF STRESS INCONTINENCE Principal Investigator & Institution: Borello-France, Diane F.; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, Pa 15260 Timing: Fiscal Year 2002 Summary: The long-term efficacy of pelvic floor exercise (PFE) as a treatment for urinary incontinence is threatened by patient compliance. To enhance compliance, PFE needs to be effective, while reducing the time burden placed on the patient. Our longterm objectives are to 1) validate a physiologically based, task-specific approach to PFE and 2) determine the exercise frequency needed to preserve muscle strength. Our specific aims are to determine: 1) the effectiveness of an individualized, physiologically based PFE regimen, 2) if a treatment progression to include exercise in upright postures is more effective than one performed in a lying position, and 3) if a low frequency exercise program is sufficient to preserve therapeutic gains over a six-month period. We will study 50 women, ages 40-70, with genuine stress incontinence. Based on symptom severity, we will randomly assign subjects to perform exercise either in upright postures or in a lying position. Subjects will attend 12 weekly physical therapy (PT) visits and perform a home exercise program (HEP) consisting of muscle strength, power, and endurance exercise. Using electromyography (an electrical recording of muscle activity), we will determine exercise progression using a protocol that individualizes exercise prescription based on muscle fatigue. At each weekly assessment, we will adjust the subject's HEP accordingly. Subjects assigned to the upright training group will perform one third of their exercises in the supine, sitting and standing positions. The other group will perform all exercises while in a lying position. At week 12, we will randomly assign subjects in each treatment group to either a low-(exercise once a week) or high-(exercises every other day) maintenance group. To determine treatment outcomes, we will compare group differences in the number of incontinent episodes, amount of urine lost during a psd test, a measure of urethral resistance (Valsalva leak point pressure), and scores on a quality of life measure. To determine the overall effectiveness of the treatment protocol, we will compare pre-to post-treatment changes in incontinent episodes to similar data reported in the literature. We will also examine the relationships between menopausal status, incontinence severity, and treatment outcomes. The results of this study may lead to a more effective exercise approach. Thus, future clients may benefit from fewer PT visits, greater pelvic muscle functions, and avoidance of surgery. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: MEMS VALVE FOR AN INTRAURETHRAL CONTINENCE PROSTHESIS Principal Investigator & Institution: Natarajan, Ananth; Ceo; Infinite Biomedical Technologies, Llc 2850 N Charles St, Ste 100 Baltimore, Md 21218 Timing: Fiscal Year 2003; Project Start 01-NOV-1999; Project End 31-JAN-2005 Summary: (provided by applicant): Urinary incontinence affects 15 - 35% of adult American women and accounts for a direct health care cost of over $26 Billion per year. It is associated with deterioration in quality of life and causes significant concern to many women. Current surgical therapies have significant morbidity associated with them. Therefore, a minimally invasive, nonsurgical treatment would be a great solution. We propose to address this challenge using microelectromechanical systems (MEMS) technology to develop a valve suitable for use in an artificial urethral sphincter. The Intraurethral Continence Prosthesis (INCOPRO) will use an innovative sphincter design

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based on biomimetic polymer technology to control urine flow. During Phase I, we successfully obtained proof-of-concept of the polypyrrole valve mechanism including testing in human urine. Further, we demonstrated micro-miniaturization using a MEMS fabrication process. In Phase II, we propose to further this work by developing a matrix of microvalves, which serves as a functional sphincter. We aim to extensively test the performance of the valve in vitro in a phantom model and further evaluate it in vivo in a porcine model. It is our long-term goal to incorporate this technology into a miniature device suitable for use in patients suffering from the debilitating problem of stress incontinence. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ORWH: SCOR ON SEX AND GENDER FACTORS AFFECTING WOMEN'S * Principal Investigator & Institution: Delancey, John Ol.; Norman F. Miller Professor; Obstetrics and Gynecology; University of Michigan at Ann Arbor 3003 South State, Room 1040 Ann Arbor, Mi 481091274 Timing: Fiscal Year 2002; Project Start 25-SEP-2002; Project End 31-JUL-2007 Summary: (provided by applicant): This proposal seeks to improve care for the women who suffer the priority health conditions of urinary incontinence and pelvic organ prolapse. These problems arise due to women's unique role in giving birth and, therefore, occur much less often in men. Each year 3 million women deliver babies and 11 % of women need surgery for incontinence and prolapse. A lack of basic understanding of the mechanisms involved in these conditions and their implications for treatment impedes progress. We propose a SCOR to unite 5 existing multidisciplinary researchers and to add 4 new investigators to expedite development of new knowledge needed to improve treatment and prevention. Project 1, "Biomechanics" will test hypotheses concerning basic mechanisms of pelvic floor structure and function. It will analyze the mechanical arrangement and properties of the components of the pelvic floor as well as how vaginal birth damages their integrity. Project 2, "Clinical Mechanisms" will test continent and stress incontinent women to detect the unique failure of component parts that, singularly and in combinations, are associated with stress incontinence. Project 3, "Treatment Selection" will identify the effects of birth induced muscle damage in women with stress incontinence and from these data, build and test a model to determine which defects will predict success or failure of pelvic muscle treatment. Core A, Administrative/Human Subjects/Biostatistics core provides project support by recruiting subjects, compiling and analyzing data and protecting subject safety. In Core A, two study groups will be formed concerning 1) Gender Impact and 2) Basic Sciences Futures to discuss expanding the issues raised by this research. Core B, Measurement & Imaging will provide technical support for the projects along with integrated image analysis for 2 and 3 dimensional spatial data gathered across projects. This research will produce needed insights to help women with pelvic floor dysfunction. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: PATHOGENESIS OF DETRUSOR OVERACTIVITY Principal Investigator & Institution: Resnick, Neil; Hebrew Rehabilitation Center for Aged 1200 Centre St, Roslindale Boston, Ma 02131 Timing: Fiscal Year 2002

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Summary: Urinary incontinence is prevalent and morbid in the elderly, and its associated costs exceed $28 billion. Yet, little is known about its most common cause, detrusor over-activity (DO), and therapy has not improved in decades. Our recent blinded and prospective geriatric studies document a perfect match between urodynamic function and detrusor ultrastructure. Every patient with DO (but none without DO) had a "complete dysjunction" pattern (CDP), in which normal muscle cell junctions were largely replaced by abundant chains of protrusion junctions and ultraclose cell abutments. These new junctions resemble gap junctions, which normally abound only in electrically-coupled smooth muscle, and suggest that cell coupling in geriatric DO changes from normal mechanical mechanism to an electrical one. Findings have been reproduced, substantiated longitudinally, corroborated by others, and seen in DO in every clinical setting (upper motor neuron [UMN] lesion, urethral obstruction, stress incontinence, and idiopathic). In addition, our preliminary data suggest that UMN-related DO can be differentiated from DO due to other causes. However, a recent study did not find the same correlation in younger subjects, raising the possibility that DO pathophysiology differs in young and old. Moreover, specific changes seen in agematched elderly controls suggest that aging itself may be associated with muscle cell dedifferentiation, thereby setting the stage for geriatric DO. Such data raise 4 important questions: 1) Do changes seen in elderly control subjects represent aging or just previously undocumented features of normal bladder? 2) Is the correlation between CDP and DO really absent in younger individuals or just an artifact of study design? 3) Are CDP junctions gap junctions? 4) Can UMN-associated DO be differentiated from other types? We will address these issues with a blinded, prospective study of adults of all ages. Using urodynamic/ultrastructural/molecular biology techniques, we will compare bladder biopsies from newly-recruited young subjects with and without DO to each other and to similar samples already acquired from aged subjects (new elderly subjects will be recruited for the molecular biology study). By further clarifying the role of CDP in DO, this study should shed valuable insights into DO's pathogenesis and yield new diagnostic and therapeutic strategies that benefit millions of older Americans afflicted with this common, morbid, and neglected condition. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PITTSBURGH INCONTINENCE COLLABORATIVE TREATMENT PROGRAM Principal Investigator & Institution: Zyczynski, Halina M.; Associate Professor; MageeWomen's Health Corporation 204 Craft Ave Pittsburgh, Pa 152133180 Timing: Fiscal Year 2002; Project Start 30-SEP-2000; Project End 30-JUN-2005 Summary: Faculty of the University of Pittsburgh School of Medicine Departments of Urology and Obstetrics and Gynecology has formed a collaborative urinary incontinence program. Our health care system with over 25 hospitals and outpatient facilities is an outstanding resource for research subject recruitment. Our proven ability to hold leadership positions in NIH sponsored multicenter surgical trials and to perform a large number of bladder suspension operations per year make us valuable contributors to the Urinary Incontinence Treatment Network (UITN). Dr. Chancellor, the principal investigator [P.I.], was funded by the NIH as PI in 1994-1998 to run a multicenter prospective randomized study between sphincterotomy and sphincter stent in spinal cord injured patients. This involved a complex surgical trial at four major spinal cord injury centers. The study was successfully finished with complete recruitment. The results were published in the Journal of Urology [Appendix 1]. In addition, Dr. Halina Zyczynski [Co-P.I.], who is the director of the Urogynecology

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17

Program at Magee-Womens Hospital, has developed a large pelvic floor dysfunction treatment program. Together, Urogynecology and Urology performed 357 stress incontinence operations this past year. We propose a protocol that prospectively compares non-invasive history exam with urodynamic evaluation. The patients will then be randomized to either the pubovaginal sling or the Burch procedure. Coexisting detrusor instability (DI) will not be treated preoperatively to determine its outcome after surgery. Persistent or denovo DI at 12 weeks will be randomized to pharmaceutical or behavioral intervention. Urodynamics studies will be performed 12 months postoperative. We are committed to adhering to the final protocol of UITN upon the activation of this grant. In conclusion we are enthusiastic about this RFA. All five investigators are experienced surgeons with similar techniques for both incontinence operations. We believe we have the unique resources and talent to become successful contributing members of the UITN. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: TREATMENT INCONTINENCE

OF

PERSISTENT

POSTPROSTATECTOMY

Principal Investigator & Institution: Goode, Patricia S.; Medicine; University of Alabama at Birmingham Uab Station Birmingham, Al 35294 Timing: Fiscal Year 2003; Project Start 01-AUG-2003; Project End 31-JUL-2007 Summary: (provided by applicant): Post-prostatectomy incontinence (PPI) has significant medical, psychological and social consequences. Although severe incontinence is temporary for most men after prostatectomy, persistent stress incontinence and detrusor instability are not uncommon. Conservative treatments for PPI include behavioral training (pelvic floor muscle exercises, self-monitoring with bladder diaries, regular office visits, fluid management, and bladder control techniques to control urgency and stress-induced leakage) with and without biofeedback (BF) and pelvic muscle electrical stimulation (ES). These treatments have demonstrated efficacy in small clinical series; however, randomized, controlled trials of behavioral treatments for PPI are lacking. Also the role of technologies (BF and ES) in behavioral training for PPI remains to be discerned. Specific Aim 1 is to test the effectiveness of behavioral treatment with and without the use of BF and ES technology. This project is a prospective, randomized, controlled, 3-arm trial in which 204 men, at least one year post-prostatectomy, will be stratified by type and severity of incontinence. Subjects will be randomized to 8 weeks of (1) behavioral training with BF and ES, (2) behavioral training without technologies, or (3) no treatment. Bladder diaries, 24-hour pad tests, and quality of life (QoL) instruments completed by subjects prior to randomization and following the last treatment session will be used to calculate reduction of the frequency and volume of incontinence and impact on QoL. Because long-term outcome data for conservative treatments of PPI are absent from the literature, outcome data will also be obtained at 6 and 12 months. Specific Aim 2 is to examine the cost-effectiveness of both conservative treatments using the most widely adopted method for the economic evaluation of health interventions, cost-effectiveness analysis (CEA). Cost data are essential to assist third party payors and clinicians in selection of appropriate, costeffective therapy for PPI. Specific Aim 3 is to characterize subjects on pre-treatment variables with potential predictive value to explore useful selection criteria for behavioral treatments with and without technology, data essential for development of clinical pathways. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: UAB CONTINENCE TREATMENT CENTER Principal Investigator & Institution: Richter, Holly E.; Obstetrics and Gynecology; University of Alabama at Birmingham Uab Station Birmingham, Al 35294 Timing: Fiscal Year 2002; Project Start 01-SEP-2001; Project End 30-JUN-2005 Summary: Urinary incontinence is a major problem with significant medical, psychological, social and financial consequences. Currently, there is a lack of prospectively evaluated, unbiased short- and long-term data regarding the most appropriate means of evaluation, therapeutic, intervention and measurement of treatment outcomes with respect to the surgical management of stress incontinence. The establishment of a Urinary Incontinence Treatment Network (UITN) with up to 7 Continence Treatment Centers (CTC) would help to recruit a significant cohort of female patients in which to vigorously address these important issues regarding the surgical treatment of incontinence. The primary purpose of this proposal is to outline our ability to participate as a Continence Treatment Center in the Urinary Incontinence Network and to participate in a four-year prospective cohort study of women who have undergone different surgical procedures for urinary incontinence. The Division of Medical Surgical Gynecology, Urology and Geriatric Medicine at the University of Alabama at Birmingham (UAB) have a unique liaison in the evaluation and treatment of women with urinary incontinence working together at the UAB Genitourinary Disorder Center (GDC). The Center will easily facilitate participation in and contribute greatly to the success of this important trial. We have extensive experience in performing incontinence clinical trials, including multicenter trials and a strong supporting research infrastructure. Existing facilities, equipment, recruitment resources and trained personnel will be utilized in the service of the UITN protocols and projects. Our investigators have over 20 years experience in incontinence research and have contributed greatly to the literature in that regard. Expanded details of our capability will be provided in this application. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: URINARY INCONTINENCE: MOLECULAR MECHANISM&MATRIXBASED T Principal Investigator & Institution: Lue, Tom F.; Professor of Urology; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 941222747 Timing: Fiscal Year 2002; Project Start 01-SEP-2002; Project End 31-AUG-2007 Summary: It is estimated that 100 million men and women are affected by urinary incontinence (UI). The prevalence of UI is generally higher in women than in men, women being between two (older age groups) and four times (younger and middleaged) more likely to be incontinent than men. In the past 3 years, supported by an NIH grant, we have studied the effect of pregnancy, delivery, birth trauma, ovariectomy and aging on the ultrastructure and function of the continence mechanism. We have learned that the final common pathway of stress urinary incontinence in the rat model is the alteration of nervous, vascular, and muscular components of the continence mechanism. We therefore propose to further study the molecular mechanism involved in the pathogenesis of female stress urinary incontinence. We hypothesize that pregnancy/delivery, birth trauma, and hormonal deficiency (menopause) alter the gene and protein expression of many factors. We propose to use the state-of-the-art technique such as gene microarray, realtime PCR, multiple PCR etc to identify genes that are associated with female stress urinary incontinence and to further study the molecular mechanism. Further more, we have obtained encouraging results from using organ

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specific acellular matrix as a scaffold for the repair of bladder and ureteral defects in our lab. We propose to study whether the acellular matrix with or without growth factors can be used for the treatment of stress urinary incontinence. The hypotheses will be tested by completing the following specific aims. Specific aim 1: To identify gene that are associated with stress incontinence and to elucidate the molecular mechanism of stress urinary incontinence associated with pregnancy/delivery, birth trauma, and ovariectomy. Specific aim 2: To identify the best growth factor combinations that can enhance angiogenesis, neural growth and urethral smooth/striated muscle proliferation in a novel in vitro assay system. Specific aim 3: To apply acellular matrix with or without growth factors identified from specific aim 2 to animals with stress urinary incontinence. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

E-Journals: PubMed Central3 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).4 Access to this growing archive of e-journals is free and unrestricted.5 To search, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Pmc, and type “stress incontinence” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for stress incontinence in the PubMed Central database: •

Prospective multicentre randomised trial of tension-free vaginal tape and colposuspension as primary treatment for stress incontinence. by Ward K, Hilton P.; 2002 Jul 13; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=117136

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Single blind, randomised controlled trial of pelvic floor exercises, electrical stimulation, vaginal cones, and no treatment in management of genuine stress incontinence in women. by Bo K, Talseth T, Holme I.; 1999 Feb 20; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=27740

The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.6 The advantage of PubMed over previously mentioned sources is that it covers a greater 3 4

Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html.

With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 5 The value of PubMed Central, in addition to its role as an archive, lies in the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print. 6 PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.

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number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with stress incontinence, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “stress incontinence” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for stress incontinence (hyperlinks lead to article summaries): •

A comparison of the objective and subjective outcomes of colposuspension for stress incontinence in women. Author(s): Bidmead J, Cardozo L, McLellan A, Khullar V, Kelleher C. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2001 April; 108(4): 408-13. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11305549

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A comparison of urethral pressure profilometry using microtip and double-lumen perfusion catheters in women with genuine stress incontinence. Author(s): Wang AC, Chen MC. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2002 March; 109(3): 322-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11950188

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A cost-utility analysis of tension-free vaginal tape versus colposuspension for primary urodynamic stress incontinence. Author(s): Manca A, Sculpher MJ, Ward K, Hilton P. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2003 March; 110(3): 255-62. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12628263

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A multicentre evaluation of a new surgical technique for urethral bulking in the treatment of genuine stress incontinence. Author(s): Henalla SM, Hall V, Duckett JR, Link C, Usman F, Tromans PM, van Veggel L. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2000 August; 107(8): 1035-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10955438

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A new intravaginal device for stress incontinence in women. Author(s): Thyssen H, Bidmead J, Lose G, Moller Bek K, Dwyer P, Cardozo L. Source: Bju International. 2001 December; 88(9): 889-92. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11851609

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A new, simple, safe, effective and cost-effective procedure for genuine stress incontinence: midurethral polypropylene sling. Author(s): Demirci F, Ozdemir I, Yucel O, Alhan A. Source: The Australian & New Zealand Journal of Obstetrics & Gynaecology. 2003 February; 43(1): 58-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12755350

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A prospective multicenter randomized trial of tension-free vaginal tape and colposuspension for primary urodynamic stress incontinence: two-year follow-up. Author(s): Ward KL, Hilton P; UK and Ireland TVT Trial Group. Source: American Journal of Obstetrics and Gynecology. 2004 February; 190(2): 324-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14981369

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A prospective multisite study of radiofrequency bipolar energy for treatment of genuine stress incontinence. Author(s): Ross JW, Galen DI, Abbott K, Albala D, Presthus J, Su-Ou C, Turk T. Source: The Journal of the American Association of Gynecologic Laparoscopists. 2002 November; 9(4): 493-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12386362

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A prospective placebo controlled double blind randomised study to investigate the use of indoramin to prevent post-operative voiding disorders after surgical treatment for genuine stress incontinence. Author(s): Watson AJ, Currie I, Jarvis GJ. Source: British Journal of Obstetrics and Gynaecology. 1999 March; 106(3): 270-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10426648

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A retrospective comparison of abdominal sacrocolpopexy with Burch colposuspension versus sacrospinous fixation with transvaginal needle suspension for the management of vaginal vault prolapse and coexisting stress incontinence. Author(s): Sze EH, Kohli N, Miklos JR, Roat T, Karram MM. Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 1999; 10(6): 390-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10614976

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A simplified surgical procedure for the correction of stress incontinence in women. 1959. Author(s): Pereyra AJ. Source: The Journal of Urology. 2002 February; 167(2 Pt 2): 1116-8; Discussion 1119. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11905884

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Abdominal versus vaginal approach for the management of genital prolapse and coexisting stress incontinence. Author(s): Roovers JP, van der Bom JG, van der Vaart CH, Schagen van Leeuwen JH, Heintz AP. Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 2002; 13(4): 224-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12189427

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An algorithm for the management of urinary stress incontinence. Author(s): Cornella JL, Magrina JF. Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 1996; 7(4): 221-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10895808

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An evaluation of a new pattern of electrical stimulation as a treatment for urinary stress incontinence: a randomized, double-blind, controlled trial. Author(s): Jeyaseelan SM, Haslam EJ, Winstanley J, Roe BH, Oldham JA. Source: Clinical Rehabilitation. 2000 December; 14(6): 631-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11128739

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Anterior urethropexy according to lapides: how effective is it in the treatment of genuine female stress incontinence? Author(s): Ilker Y, Tarcan T, Ozveren B, Yildirim A. Source: Arch Esp Urol. 2003 January-February; 56(1): 95-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12701489

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Are midurethral slings the gold standard surgical treatment for primary genuine stress incontinence? Author(s): Paraiso MF, Muir TW, Sokol AI. Source: The Journal of the American Association of Gynecologic Laparoscopists. 2002 November; 9(4): 405-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12386347

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Are slings now the gold standard treatment for the management of female urinary stress incontinence and if so which technique? Author(s): Bemelmans BL, Chapple CR. Source: Current Opinion in Urology. 2003 July; 13(4): 301-7. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12811294

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Assessment of a new bone anchor system for the treatment of female genuine stress incontinence. Author(s): El-Toukhy TA, Tolba MA, Davies AE. Source: Bju International. 1999 November; 84(7): 780-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10532971

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Assessment of stress incontinence--1. Author(s): Addison R. Source: Nurs Times. 1999 November 10-17; 95(45): Suppl 1-2. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11000785

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Assessment of stress incontinence--2. Author(s): Addison R. Source: Nurs Times. 1999 November 17-23; 95(46): Suppl 1-2. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11096865

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Bead chain urethrocystography in the investigation of postoperative urinary stress incontinence. Author(s): Kauppila A, Pietila K, Sjostedt JE, Korkonen M, Vahala J. Source: Acta Obstetricia Et Gynecologica Scandinavica. 1972; 51(3): 223-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4672369

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Beginning research: stress incontinence. Author(s): Hunter B. Source: Nurs Times. 1977 October 20; 73(42): 1636-9. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=928104

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Beta adrenoceptor blockade in the treatment of female urinary stress incontinence. Author(s): Kaisary AV. Source: J Urol (Paris). 1984; 90(5): 351-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6501913

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beta(2)-adrenergic agonists and pelvic floor exercises for female stress incontinence. Author(s): Ishiko O, Ushiroyama T, Saji F, Mitsuhashi Y, Tamura T, Yamamoto K, Kawamura Y, Ogita S. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 2000 October; 71(1): 39-44. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11044540

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Bilateral S3 nerve stimulation, a minimally invasive alternative treatment for postoperative stress incontinence after implantation of an anterior root stimulator with posterior rhizotomy: a preliminary observation. Author(s): Everaert K, Derie A, Van Laere M, Vandekerckhove T. Source: Spinal Cord : the Official Journal of the International Medical Society of Paraplegia. 2000 April; 38(4): 262-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10822398

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Biofeedback and pelvic floor exercises for the rehabilitation of urinary stress incontinence. Author(s): Aksac B, Aki S, Karan A, Yalcin O, Isikoglu M, Eskiyurt N. Source: Gynecologic and Obstetric Investigation. 2003; 56(1): 23-7. Epub 2003 July 14. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12867764

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Biofeedback or pelvic floor muscle exercises for female genuine stress incontinence: a meta-analysis of trials identified in a systematic review. Author(s): Weatherall M. Source: Bju International. 1999 June; 83(9): 1015-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10368247

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Biomechanics of urinary stress incontinence surgery--theory of the non-permanently acting suburethral supportive structure. Author(s): Lazarevski MB. Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 2000 December; 11(6): 377-85. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11147746

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Bionursing: assessment of stress incontinence. Author(s): Torrance C, Jordan S. Source: Nursing Standard : Official Newspaper of the Royal College of Nursing. 1995 October 18-24; 10(4): 29-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7492498

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Bladder function after surgery for stress incontinence. Author(s): Hutchins CJ. Source: Br J Clin Pract. 1980 March; 34(3): 67-71. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7378265

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Bladder leiomyoma: a rare cause of urinary stress incontinence. Author(s): Ilbey O, Apaydin E, Gursan A, Cikili N. Source: Arch Ital Urol Androl. 2000 June; 72(2): 85-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10953395

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Bladder neck circulation by Doppler ultrasonography in postmenopausal women with urinary stress incontinence. Author(s): Tsai E, Yang C, Chen H, Wu C, Lee J. Source: Obstetrics and Gynecology. 2001 July; 98(1): 52-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11430956

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Bladder neck mobility and urethral closure pressure as predictors of genuine stress incontinence. Author(s): Dietz HP, Clarke B, Herbison P. Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 2002; 13(5): 289-93. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12355287

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Bladder neck suspension for stress incontinence as an outpatient procedure. Author(s): Heaton JP, Morales A, VanCott GF, Grennell HJ. Source: The Urologic Clinics of North America. 1987 February; 14(1): 209-15. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3811054

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Bladder neck suspension for stress incontinence: long-term evaluation. Author(s): Mazeman E, Wemeau L, Biserte J, Riquet D. Source: European Urology. 1978; 4(2): 123-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=631154

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Bladder neck suspension using bone anchors for the treatment of female stress incontinence. Author(s): Nativ O, Moskovitz B, Issaq E, Condrea A, Kastin A, Halachmi S, Burbara J, Madjar S, Beyar M. Source: Asaio Journal (American Society for Artificial Internal Organs : 1992). 1997 MayJune; 43(3): 204-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9152492

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Bowel dysfunction: a pathogenic factor in uterovaginal prolapse and urinary stress incontinence. Author(s): Spence-Jones C, Kamm MA, Henry MM, Hudson CN. Source: British Journal of Obstetrics and Gynaecology. 1994 February; 101(2): 147-52. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8305390

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Burch colposuspension or sling for stress incontinence? A prospective study using transrectal ultrasound. Author(s): Richmond DH, Sutherst JR. Source: British Journal of Urology. 1989 December; 64(6): 600-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2697451

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Changes in the quantity of collagen type I in women with genuine stress incontinence. Author(s): Liapis A, Bakas P, Pafiti A, Hassiakos D, Frangos-Plemenos M, Creatsas G. Source: Urological Research. 2000 October; 28(5): 323-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11127711

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Changes of collagen type III in female patients with genuine stress incontinence and pelvic floor prolapse. Author(s): Liapis A, Bakas P, Pafiti A, Frangos-Plemenos M, Arnoyannaki N, Creatsas G. Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2001 July; 97(1): 76-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11435014

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Clinical outcome of fascial slings for female stress incontinence. Author(s): de Rossi P. Source: Medscape Women's Health [electronic Resource]. 2002 May-June; 7(3): 1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12142854

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Collagen injections for urinary stress incontinence in a small urban urology practice: time to failure analysis of 99 cases. Author(s): Tschopp PJ, Wesley-James T, Spekkens A, Lohfeld L. Source: The Journal of Urology. 1999 September; 162(3 Pt 1): 779-82; Discussion 782-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10458366

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Colposuspension or sling for low urethral pressure stress incontinence? Author(s): Maher CF, Dwyer PL, Carey MP, Moran PA. Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 1999; 10(6): 384-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10614975

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Combined stent and artificial urinary sphincter for management of severe recurrent bladder neck contracture and stress incontinence after prostatectomy: a long-term evaluation. Author(s): Elliott DS, Boone TB. Source: The Journal of Urology. 2001 February; 165(2): 413-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11176385

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Comparative analysis of biofeedback and physical therapy for treatment of urinary stress incontinence in women. Author(s): Pages IH, Jahr S, Schaufele MK, Conradi E. Source: American Journal of Physical Medicine & Rehabilitation / Association of Academic Physiatrists. 2001 July; 80(7): 494-502. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11421517

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Comparison of anterior colporrhaphy versus Bologna procedure in women with genuine stress incontinence. Author(s): de Tayrac R, Salet-Lizee D, Villet R. Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 2002; 13(1): 36-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11999203

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Comparison of pubovaginal sling and burch colposuspension procedures in type I/II genuine stress incontinence. Author(s): Demirci F, Yucel O. Source: Archives of Gynecology and Obstetrics. 2001 November; 265(4): 190-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11789743

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Comparison of treatment outcomes for imipramine for female genuine stress incontinence. Author(s): Lin HH, Sheu BC, Lo MC, Huang SC. Source: British Journal of Obstetrics and Gynaecology. 1999 October; 106(10): 1089-92. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10519437

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Comparison the efficiency of different surgical procedures for urinary stress incontinence. Author(s): Lan Z, Jinghe L, Zhufeng L, Rongli H. Source: Chinese Medical Sciences Journal = Chung-Kuo I Hsueh K'o Hsueh Tsa Chih / Chinese Academy of Medical Sciences. 2000 June; 15(2): 107-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12901635

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Compliance with a pelvic muscle exercise program as a causal predictor of urinary stress incontinence amongst Chinese women. Author(s): Siu LS, Chang AM, Yip SK, Chang AM. Source: Neurourology and Urodynamics. 2003; 22(7): 659-63. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14595610

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Complications of surgery for genuine stress incontinence. Author(s): Chaliha C, Stanton SL. Source: British Journal of Obstetrics and Gynaecology. 1999 December; 106(12): 1238-45. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10609716

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Computer-assisted virtual urethral pressure profile in the assessment of female genuine stress incontinence. Author(s): Wolters M, Methfessel HD, Goepel C, Koelbl H. Source: Obstetrics and Gynecology. 2002 January; 99(1): 69-74. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11777513

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Conservative management of genuine stress incontinence in women. Study's flaws may be misleading. Author(s): Khullar V, Salvatore S, Bidmead J, Anders K, Cardozo L. Source: Bmj (Clinical Research Ed.). 1999 July 17; 319(7203): 190-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10406774

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Conservative treatment of stress incontinence with Geisha balls. Author(s): Glavind K. Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 2001; 12(4): 223-4; Discussion 224-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11569648

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Cooper's ligament urethrovesical suspension for stress incontinence. Nine years' experience -- results, complications, techniques. 1968. Author(s): Burch JC. Source: American Journal of Obstetrics and Gynecology. 2002 August; 187(2): 512, Discussion 513. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12193951

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Correlation among maximal urethral closure pressure, retrograde leak point pressure, and abdominal leak point pressure in men with postprostatectomy stress incontinence. Author(s): Comiter CV, Sullivan MP, Yalla SV. Source: Urology. 2003 July; 62(1): 75-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12837426

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Cortical magnetic stimulation in patients with genuine stress incontinence: correlation with results of pelvic floor exercises. Author(s): Gunnarsson M, Ahlmann S, Lindstrom S, Rosen I, Mattiasson A. Source: Neurourology and Urodynamics. 1999; 18(5): 437-44; Discussion 444-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10494114

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Cough-induced leak-point pressure--a valid measure for assessing treatment in women with stress incontinence. Author(s): Siltberg H, Larsson G, Victor A. Source: Acta Obstetricia Et Gynecologica Scandinavica. 1998 November; 77(10): 1000-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9849845

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Denervation and re-innervation of the urethral sphincter in the aetiology of genuine stress incontinence and a comparison of bioelectrical and mechanical activity of the female urethra. Author(s): Hosker GL, Mallet VT. Source: British Journal of Obstetrics and Gynaecology. 1994 June; 101(6): 559-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8018655

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Denervation and re-innervation of the urethral sphincter in the aetiology of genuine stress incontinence: an electromyographic study. Author(s): Barnick CG, Cardozo LD. Source: British Journal of Obstetrics and Gynaecology. 1993 August; 100(8): 750-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8399014

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Detrusor activity and outflow resistance in stress incontinence. Author(s): Palmtag H, Schneider P. Source: Urologia Internationalis. 1976; 31(1-2): 100-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=944477

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Detrusor instability following colposuspension for urinary stress incontinence. Author(s): Langer R, Ron-el R, Newman M, Herman A, Caspi E. Source: British Journal of Obstetrics and Gynaecology. 1988 June; 95(6): 607-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3390403

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Detrusor instability following surgery for genuine stress incontinence. Author(s): Cardozo LD, Stanton SL, Williams JE. Source: British Journal of Urology. 1979 June; 51(3): 204-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=465987

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Development of a symptom severity index and a symptom impact index for stress incontinence in women. Author(s): Black N, Griffiths J, Pope C. Source: Neurourology and Urodynamics. 1996; 15(6): 630-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8916115

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Development of postoperative urinary stress incontinence in clinically continent patients undergoing prophylactic Kelly plication during genitourinary prolapse repair. Author(s): Gordon D, Groutz A, Wolman I, Lessing JB, David MP. Source: Neurourology and Urodynamics. 1999; 18(3): 193-7; Discussion 197-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10338439

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Device to promote pelvic floor muscle training for stress incontinence. Author(s): Sugaya K, Owan T, Hatano T, Nishijima S, Miyazato M, Mukouyama H, Shiroma K, Soejima K, Masaki Z, Ogawa Y. Source: International Journal of Urology : Official Journal of the Japanese Urological Association. 2003 August; 10(8): 416-22. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12887362

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Dimensions of urine loss among older women with genuine stress incontinence. Author(s): Nochajski TH, Burns PA, Pranikoff K, Dittmar SS. Source: Neurourology and Urodynamics. 1993; 12(3): 223-33. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8330045

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Disappointing effect of endoscopic Teflon injection for female stress incontinence. Author(s): Kiilholma P, Makinen J. Source: European Urology. 1991; 20(3): 197-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1823042

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Discriminant analysis of urethral pressure profilometry data for the diagnosis of genuine stress incontinence. Author(s): Versi E. Source: British Journal of Obstetrics and Gynaecology. 1990 March; 97(3): 251-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2334653

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Distigmine bromide and stress incontinence in women. Author(s): Shah PJ, Abrams PH. Source: Prog Clin Biol Res. 1981; 78: 329-34. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6121333

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Do fertile women remember the onset of stress incontinence? Recall bias 5 years after 1st delivery. Author(s): Viktrup L, Lose G. Source: Acta Obstetricia Et Gynecologica Scandinavica. 2001 October; 80(10): 952-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11580741

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Does medical therapy cure female stress incontinence? Author(s): Lose G, Diernaes E, Rix P. Source: Urologia Internationalis. 1989; 44(1): 25-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2568711

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Dynamic cystoproctography and physiological testing in women with urinary stress incontinence and urogenital prolapse. Author(s): Halligan S, Spence-Jones C, Kamm MA, Bartram CI. Source: Clinical Radiology. 1996 November; 51(11): 785-90. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8937321

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Effect of a vaginal device on quality of life with urinary stress incontinence. Author(s): Sander P, Thyssen H, Lose G, Andersen JT. Source: Obstetrics and Gynecology. 1999 March; 93(3): 407-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10074989

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Effect of adding biofeedback to pelvic floor muscle training to treat urodynamic stress incontinence. Author(s): Schiotz H. Source: Obstetrics and Gynecology. 2003 May; 101(5 Pt 1): 1024; Reply 1024-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12738173

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Effect of adding biofeedback to pelvic floor muscle training to treat urodynamic stress incontinence. Author(s): Morkved S, Bo K, Fjortoft T. Source: Obstetrics and Gynecology. 2002 October; 100(4): 730-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12383542

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Effect of behavioral training with or without pelvic floor electrical stimulation on stress incontinence in women: a randomized controlled trial. Author(s): Goode PS, Burgio KL, Locher JL, Roth DL, Umlauf MG, Richter HE, Varner RE, Lloyd LK. Source: Jama : the Journal of the American Medical Association. 2003 July 16; 290(3): 345-52. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12865375

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Effect of methoxamine on maximum urethral pressure in women with genuine stress incontinence: a placebo-controlled, double-blind crossover study. Author(s): Radley SC, Chapple CR, Bryan NP, Clarke DE, Craig DA. Source: Neurourology and Urodynamics. 2001; 20(1): 43-52. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11135381

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Effectiveness of the conveen continence guard (a disposable vaginal device) in the treatment of complicated female stress incontinence. Author(s): Nilsson CG. Source: Acta Obstetricia Et Gynecologica Scandinavica. 2000 December; 79(12): 1052-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11130086

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Effectiveness of two conservative modes of physical therapy in women with urinary stress incontinence. Author(s): Arvonen T, Fianu-Jonasson A, Tyni-Lenne R. Source: Neurourology and Urodynamics. 2001; 20(5): 591-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11574936

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Efficacy of biofeedback in the treatment of urinary stress incontinence. Author(s): Glavind K, Laursen B, Jaquet A. Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 1998; 9(3): 151-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9745974

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Efficacy of functional electrical stimulation in treating genuine stress incontinence: a randomized clinical trial. Author(s): Luber KM, Wolde-Tsadik G. Source: Neurourology and Urodynamics. 1997; 16(6): 543-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9353803

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Efficacy of pelvic floor rehabilitation for treatment of genuine stress incontinence. Author(s): Chen HY, Chang WC, Lin WC, Yeh LS, Hsu TY, Tsai HD, Yang KY. Source: J Formos Med Assoc. 1999 April; 98(4): 271-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10389372

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Electrical stimulation as a treatment for stress incontinence. Author(s): Jeyaseelan SM, Oldham JA. Source: British Journal of Nursing (Mark Allen Publishing). 2000 August 10-September 13; 9(15): 1001-7. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11276637

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Electrical stimulation for stress incontinence. Author(s): Yamanishi T, Yasuda K. Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 1998; 9(5): 281-90. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9849761

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Electromyographic study of the striated urethral sphincter in type 3 stress incontinence: evidence of myogenic-dominant damages. Author(s): Takahashi S, Homma Y, Fujishiro T, Hosaka Y, Kitamura T, Kawabe K. Source: Urology. 2000 December 20; 56(6): 946-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11113738

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Endoscopic correction of intractable stress incontinence with silicone micro-implants. Author(s): Sheriff MK, Foley S, Mcfarlane J, Nauth-Misir R, Shah PJ. Source: European Urology. 1997; 32(3): 284-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9358214

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Endoscopic injection of collagen for the treatment of female urinary stress incontinence. Author(s): Ang LP, Tay KP, Lim PH, Chng HC. Source: International Journal of Urology : Official Journal of the Japanese Urological Association. 1997 May; 4(3): 254-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9255662

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Evaluation of pressure transmission ratios in women with genuine stress incontinence and low urethral pressure: a comparative study. Author(s): Summitt RL Jr, Sipes DR 2nd, Bent AE, Ostergard DR. Source: Obstetrics and Gynecology. 1994 June; 83(6): 984-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8190446

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Evaluation of urethrovesical angle by ultrasound in women with and without urinary stress incontinence. Author(s): Alper T, Cetinkaya M, Okutgen S, Kokcu A, Malatyalioglu E. Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 2001; 12(5): 308-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11715996

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Expanded indications for the pubovaginal sling: treatment of type 2 or 3 stress incontinence. Author(s): Zaragoza MR. Source: The Journal of Urology. 1996 November; 156(5): 1620-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8863552

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Experience of tension-free vaginal tape for the treatment of stress incontinence in females with neuropathic bladders. Author(s): Hamid R, Khastgir J, Arya M, Patel HR, Shah PJ. Source: Spinal Cord : the Official Journal of the International Medical Society of Paraplegia. 2003 February; 41(2): 118-21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12595875

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Extraperitoneal laparoscopic colposuspension for genuine urinary stress incontinence. Author(s): Saidi MH, Sadler RK, Saidi JA. Source: The Journal of the American Association of Gynecologic Laparoscopists. 1998 August; 5(3): 247-52. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9668145

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Failure to predict and attempts to explain urinary stress incontinence following vaginal repair in continent women by using a modified lateral urethrocystography. Author(s): Borstad E, Skrede M, Rud T. Source: Acta Obstetricia Et Gynecologica Scandinavica. 1991; 70(6): 501-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1842676

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Favorable outcome of pubovaginal slings for geriatric women with stress incontinence. Author(s): Carr LK, Walsh PJ, Abraham VE, Webster GD. Source: The Journal of Urology. 1997 January; 157(1): 125-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8976232

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Feasibility of and interest in laparoscopic assessment in recurrent urinary stress incontinence after Burch procedure performed by laparotomy. Author(s): von Theobald P, Barjot P, Levy G. Source: Surgical Endoscopy. 1997 May; 11(5): 468-71. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9153177

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Female genuine stress incontinence. A study with single cough urethrocystometry using a six-microtransducer catheter. Author(s): Penttinen J. Source: Acta Obstetricia Et Gynecologica Scandinavica. 1990; 69(7-8): 673. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2094158

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Female stress incontinence in the 1990s--changing concepts. Author(s): Klutke CG. Source: The Journal of Urology. 1996 November; 156(5): 1626-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8863554

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Female stress incontinence. Author(s): Erickson DR. Source: The Journal of Urology. 2001 May; 165(5): 1612-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11342928

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Female stress incontinence. A review of fifty cases. Author(s): Millard OH, Gosse CL. Source: N S Med Bull. 1968 April; 47(3): 87-9. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5239981

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Female stress incontinence. Treatment options and indications. Author(s): Stanton SL. Source: Der Urologe. Ausg. A. 1991 July; 30(4): 239-43. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1926669

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Female urinary genuine stress incontinence: anatomic considerations at MR imaging of the paravaginal fascia and urethra initial observations. Author(s): deSouza NM, Daniels OJ, Williams AD, Gilderdale DJ, Abel PD. Source: Radiology. 2002 November; 225(2): 433-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12409577

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Female urinary stress incontinence in terms of connective tissue biochemistry. Author(s): Rechberger T, Donica H, Baranowski W, Jakowicki J. Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology. 1993 May; 49(3): 187-91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8405633

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Female urinary stress incontinence treated with Teflon injections. Author(s): Osther PJ, Rohl H. Source: Acta Obstetricia Et Gynecologica Scandinavica. 1987; 66(4): 333-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3425230

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Female urinary stress incontinence--does it have familial prevalence? Author(s): Mushkat Y, Bukovsky I, Langer R. Source: American Journal of Obstetrics and Gynecology. 1996 February; 174(2): 617-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8623794

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FES-biofeedback versus intensive pelvic floor muscle exercise for the prevention and treatment of genuine stress incontinence. Author(s): Sung MS, Hong JY, Choi YH, Baik SH, Yoon H. Source: Journal of Korean Medical Science. 2000 June; 15(3): 303-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10895973

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Foley catheter urethrography in stress incontinence. Author(s): Frewen WK. Source: J Obstet Gynaecol Br Commonw. 1971 July; 78(7): 660-3. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5105191

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Follow-up results with the Stamey operation for stress incontinence of urine. Author(s): Ashken MH. Source: British Journal of Urology. 1990 February; 65(2): 168-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2317650

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Functional and tonometrical investigation of bladder and urethra in patients with stress incontinence. Author(s): Radej M, Hitrec V, Krivec O, Kovacic M, Parazajder J, Pavletic M. Source: The Journal of Urology. 1976 May; 115(5): 551-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=944791

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Genuine stress incontinence and detrusor instability--a review of 200 patients. Author(s): Cardozo LD, Stanton SL. Source: British Journal of Obstetrics and Gynaecology. 1980 March; 87(3): 184-90. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7387918

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Genuine stress incontinence induced by prazosin. Author(s): Srinivasan V, Blackford HN. Source: British Journal of Urology. 1993 October; 72(4): 510. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8261310

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Genuine stress incontinence theories of etiology and surgical correction. Author(s): Plzak L 3rd, Staskin D. Source: The Urologic Clinics of North America. 2002 August; 29(3): 527-35. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12476517

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Genuine stress incontinence: colpocystourethropexy versus sling procedures. Author(s): Bidmead J, Cardozo L. Source: Current Opinion in Obstetrics & Gynecology. 2000 October; 12(5): 421-6. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11111886

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Genuine stress incontinence: pathophysiology and rationale for its medical management. Author(s): Fantl JA. Source: Obstetrics and Gynecology Clinics of North America. 1989 December; 16(4): 82740. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2697817

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Genuine stress incontinence: prospective randomized comparison of two operative methods. Author(s): Liapis A, Pyrgiotis E, Kontoravdis A, Louridas C, Zourlas PA. Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology. 1996 January; 64(1): 69-72. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8801153

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Gracilis urethromyoplasty--an autologous urinary sphincter for neurologically impaired patients with stress incontinence. Author(s): Chancellor MB, Hong RD, Rivas DA, Watanabe T, Crewalk JA, Bourgeois I. Source: Spinal Cord : the Official Journal of the International Medical Society of Paraplegia. 1997 August; 35(8): 546-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9267922

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Histologic analysis of needle biopsy of urethral sphincter from women with normal and stress incontinence with comparison of electromyographic findings. Author(s): Hale DS, Benson JT, Brubaker L, Heidkamp MC, Russell B. Source: American Journal of Obstetrics and Gynecology. 1999 February; 180(2 Pt 1): 3428. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9988798

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Hormone replacement therapy plus pelvic floor muscle exercise for postmenopausal stress incontinence. A randomized, controlled trial. Author(s): Ishiko O, Hirai K, Sumi T, Tatsuta I, Ogita S. Source: J Reprod Med. 2001 March; 46(3): 213-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11304861

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Horn's operation in the treatment of stress incontinence. Author(s): McGuinness EP. Source: Ir J Med Sci. 1985 April; 154(4): 156-7. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4040127

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Ilioinguinal nerve entrapment during needle suspension for stress incontinence. Author(s): Miyazaki F, Shook G. Source: Obstetrics and Gynecology. 1992 August; 80(2): 246-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1635738

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Impact of surgery for stress incontinence on morbidity. Colposuspension has highest cure rates. Author(s): Duckett JR. Source: Bmj (Clinical Research Ed.). 1998 July 11; 317(7151): 144. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9696612

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Impact of surgery for stress incontinence on morbidity. Effects of confounding variables on outcomes of incontinence surgery must be considered. Author(s): Khullar V, Cardozo L, Boos K, Bidmead J, Kelleher C. Source: Bmj (Clinical Research Ed.). 1998 July 11; 317(7151): 143; Disscussion 144. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9657800

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Impact of surgery for stress incontinence on morbidity. Patients should be told hospital results and allowed to choose where they want surgery. Author(s): James M, Abrams P, Gujral S. Source: Bmj (Clinical Research Ed.). 1998 July 11; 317(7151): 143; Author Reply 144. Erratum In: Bmj 1998 August 8; 317(7155): 417. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9696610

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Impact of surgery for stress incontinence on morbidity. Pragmatic randomised trial is required. Author(s): Lose G, Walter S. Source: Bmj (Clinical Research Ed.). 1998 July 11; 317(7151): 144. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9696613

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Impact of surgery for stress incontinence on morbidity. Treatment needs to be based on objective assessment rather than on symptoms. Author(s): O'Connor RA. Source: Bmj (Clinical Research Ed.). 1998 July 11; 317(7151): 143-4; Author Reply 144. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9696611

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Impact of surgery for stress incontinence on morbidity: cohort study. Author(s): Black N, Griffiths J, Pope C, Bowling A, Abel P. Source: Bmj (Clinical Research Ed.). 1997 December 6; 315(7121): 1493-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9420489

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Impact of surgery for stress incontinence on the social lives of women. Author(s): Black NA, Bowling A, Griffiths JM, Pope C, Abel PD. Source: British Journal of Obstetrics and Gynaecology. 1998 June; 105(6): 605-12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9647150

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Impact of surgery for stress incontinence on the social lives of women. Author(s): Khullar V, Cardozo L, McLellan A, Bidmead J, Kelleher C. Source: British Journal of Obstetrics and Gynaecology. 1999 March; 106(3): 290-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10426658

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Impact of surgery for stress incontinence on the social lives of women. Author(s): O'Connor RA. Source: British Journal of Obstetrics and Gynaecology. 1999 June; 106(6): 613-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10426630

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Improving the diagnosis of genuine stress incontinence in symptomatic women with negative cough stress test: the Distal Urethral Electrical Conductance test (DUEC) revisited. Author(s): Adekanmi OA, Freeman RM, Reed H, Bombieri L. Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 2003 February; 14(1): 9-12; Discussion 12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12601509

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Incidence and cause of postpartum urinary stress incontinence. Author(s): Dimpfl T, Hesse U, Schussler B. Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology. 1992 January 9; 43(1): 29-33. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1737605

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Incisionless per vaginal bone anchor cystourethropexy for the treatment of female stress incontinence: experience with the first 50 patients. Author(s): Nativ O, Levine S, Madjar S, Issaq E, Moskovitz B, Beyar M. Source: The Journal of Urology. 1997 November; 158(5): 1742-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9334591

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Influence of catheterisation on the results of sonographic urethrocystography in patients with genuine stress incontinence. Author(s): Hanzal E, Joura EM, Haeusler G, Koelbl H. Source: Archives of Gynecology and Obstetrics. 1994; 255(4): 189-93. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7695365

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Inguinovaginal sling procedure for female stress incontinence: introduction of a minimally invasive technique. Author(s): Leissner J, Allhoff EP, Naumann G, Pretzsch G, Hockel M, Black P, Hohenfellner R. Source: Tech Urol. 2001 June; 7(2): 105-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11383987

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Injectable collagen for type 3 female stress incontinence: the first 50 Australian patients. Author(s): Stricker P, Haylen B. Source: The Medical Journal of Australia. 1993 January 18; 158(2): 89-91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8419782

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Injection therapy for stress incontinence in women. Author(s): Su TH, Hsu CY, Chen JC. Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 1999; 10(3): 200-6. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10430015

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Intrasubject variability of the pressure-transmission ratio in patients with genuine stress incontinence. Author(s): Swift SE, Rust PF, Ostergard DR. Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 1996; 7(6): 312-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9203478

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Is antenatal bladder neck mobility a risk factor for postpartum stress incontinence? Author(s): King JK, Freeman RM. Source: British Journal of Obstetrics and Gynaecology. 1998 December; 105(12): 1300-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9883922

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Is modified in situ vaginal wall sling operation the treatment of choice for recurrent genuine stress incontinence? Author(s): Su TH, Huang JP, Wang YL, Yang JM, Wei HJ, Huang CL. Source: The Journal of Urology. 1999 December; 162(6): 2073-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10569573

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JAMA patient page. Stress incontinence. Author(s): Parmet S, Lynm C, Glass RM. Source: Jama : the Journal of the American Medical Association. 2003 July 16; 290(3): 426. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12865384

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Kegel's exercises with biofeedback therapy for treatment of stress incontinence. Author(s): Burns PA, Marecki MA, Dittmar SS, Bullough B. Source: The Nurse Practitioner. 1985 February; 10(2): 28, 33-4, 46. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3974953

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Laparoscopic bladder suspension for the treatment of stress incontinence. Author(s): Albala DM, Schuessler WW, Vancaillie TG. Source: Semin Urol. 1992 November; 10(4): 222-6. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1485064

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Laparoscopic bladder-neck suspension for urinary stress incontinence in women: our first twenty patients. Author(s): Tay KP, Lim PH, Ravintharan T. Source: International Journal of Urology : Official Journal of the Japanese Urological Association. 1996 July; 3(4): 278-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8844283

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Laparoscopic Burch colposuspension--a new approach for stress incontinence. Author(s): Seman E, O'Shea RT. Source: The Medical Journal of Australia. 1994 January 3; 160(1): 42. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8018148

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Laparoscopic needle colposuspension for genuine stress incontinence. Author(s): Harewood LM. Source: Journal of Endourology / Endourological Society. 1993 August; 7(4): 319-22. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8252027

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Laparoscopic procedures for stress incontinence and prolapse. Author(s): Wattiez A, Boughizane S, Alexandre F, Canis M, Mage G, Pouly JL, Bruhat MA. Source: Current Opinion in Obstetrics & Gynecology. 1995 August; 7(4): 317-21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7578974

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Laparoscopic Retzio-plasty. A new surgical approach to stress incontinence. Author(s): Manhes H. Source: Int Surg. 1996 October-December; 81(4): 371-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9127797

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Laparoscopic surgery for genuine stress incontinence. Author(s): Kovac SR. Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 2000 December; 11(6): 395. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11147750

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Laparoscopic surgery for genuine stress incontinence. Author(s): Paraiso MF, Falcone T, Walters MD. Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 1999; 10(4): 237-47. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10450823

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Laparoscopic surgery for stress incontinence. Author(s): Lam AM, Hyslop R. Source: The Medical Journal of Australia. 1994 May 2; 160(9): 590-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8164568

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Leak point pressures in women with urinary stress incontinence: correlation with patient history. Author(s): Cummings JM, Boullier JA, Parra RO, Wozniak-Petrofsky J. Source: The Journal of Urology. 1997 March; 157(3): 818-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9072575

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Levator ani muscle morphology and recurrent genuine stress incontinence. Author(s): Hanzal E, Berger E, Koelbl H. Source: Obstetrics and Gynecology. 1993 March; 81(3): 426-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8437799

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Long term follow up of the cruciate fascial sling for women with genuine stress incontinence. Author(s): Hawkins E, Taylor D, Hughes-Nurse J. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2002 March; 109(3): 327-38. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11950189

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Long-Term (10-15 years) follow-up after Burch colposuspension for urinary stress incontinence. Author(s): Langer R, Lipshitz Y, Halperin R, Pansky M, Bukovsky I, Sherman D. Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 2001; 12(5): 323-6; Discussion 326-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11715999

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Long-term assessment of the incontinence ring pessary for the treatment of stress incontinence. Author(s): Robert M, Mainprize TC. Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 2002; 13(5): 326-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12355294

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Long-term clinical and urodynamic evaluation of the polytetrafluoroethylene suburethral sling for treatment of genuine stress incontinence. Author(s): Weinberger MW, Ostergard DR. Source: Obstetrics and Gynecology. 1995 July; 86(1): 92-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7784030

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Long-term efficacy and safety of a disposable vaginal device (continence guard) in the treatment of female stress incontinence. Author(s): Thyssen HH, Lose G. Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 1997; 8(3): 130-2; Discussion 133. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9449583

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Long-term evaluation of the Gittes procedure for urinary stress incontinence. Author(s): Elkabir JJ, Mee AD. Source: The Journal of Urology. 1998 April; 159(4): 1203-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9507834

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Long-term follow-up of women treated with perurethral Teflon injections for stress incontinence. Author(s): Beckingham IJ, Wemyss-Holden G, Lawrence WT. Source: British Journal of Urology. 1992 June; 69(6): 580-3. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1638342

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Long-term results of colposuspension operation for genuine stress incontinence. Author(s): Abu-Heija AT. Source: Asia Oceania J Obstet Gynaecol. 1994 June; 20(2): 179-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8092964

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Long-term results of transvaginal colposuspension for the treatment of genuine stress incontinence combined with vaginal hysterectomy. Author(s): Athanasopoulos A, Barlas P, Perimenis P, Dimitrakopoulos S, Markou S, Gianitsas K, Gyftopoulos K, Hatzipapas J, Barbalias G. Source: Urologia Internationalis. 2003; 71(1): 41-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12845259

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Magnetic resonance imaging for stress incontinence: evaluation of patients before and after surgical correction. Author(s): Perk H, Oral B, Yesildag A, Serel TA, Ozsoy M, Turgut T. Source: European Journal of Radiology. 2002 October; 44(1): 44-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12350411

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Magnetic stimulation of the sacral roots for the treatment of stress incontinence: an investigational study and placebo controlled trial. Author(s): Fujishiro T, Enomoto H, Ugawa Y, Takahashi S, Ueno S, Kitamura T. Source: The Journal of Urology. 2000 October; 164(4): 1277-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10992380

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Male stress incontinence. Diagnostic work-up and therapteutic considerations. Author(s): Thuroff JW, Petri E, Jonas U. Source: Urologia Internationalis. 1980; 35(5): 356-62. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7423680

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Management of recurrent urinary stress incontinence by the Marshall-MarchettiKrantz vesicourethropexy. Author(s): Parnell JP 2nd, Marshall VF, Vaughan ED Jr. Source: The Journal of Urology. 1984 November; 132(5): 912-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6541711

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Marlex gauze hammock sling operation with Cooper's ligament attachment in the management of recurrent urinary stress incontinence. Author(s): Bryans FE. Source: American Journal of Obstetrics and Gynecology. 1979 February 1; 133(3): 292-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=433990

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Measurement of the transmission factor and stress factor at four points in the urethra in patients with stress incontinence. Author(s): von Fischer B, Dreher E, Adam PJ, Maurer HP. Source: Arch Gynecol. 1980 January; 229(1): 67-75. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7189108

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Measurement of total urethral compliance in females with stress incontinence. Author(s): Walter JS, Wheeler JS, Morgan C, Zaszczurynski P, Plishka M. Source: Neurourology and Urodynamics. 1993; 12(3): 273-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8330050

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Medical technology assessment and surgery for stress incontinence. Author(s): Lose G, Ostergard DR. Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 1999; 10(6): 351-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10614967

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Menstrual phase-dependent gene expression differences in periurethral vaginal tissue from women with stress incontinence. Author(s): Chen B, Wen Y, Zhang Z, Wang H, Warrington JA, Polan ML. Source: American Journal of Obstetrics and Gynecology. 2003 July; 189(1): 89-97. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12861144

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Mental factors influencing recurrence of stress incontinence. Author(s): Obrink A, Fedor-Freybergh P, Hjelmkvist M, Bunne G. Source: Acta Obstetricia Et Gynecologica Scandinavica. 1979; 58(1): 91-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=419964

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Minimally invasive pervaginam procedures for the treatment of female stress incontinence using a new pubic bone anchoring system. Author(s): Madjar S, Wald M, Halachmi S, Issaq E, Moskovitz B, Beyar M, Nativ O. Source: Artificial Organs. 1998 October; 22(10): 879-85. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9790087

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Modifications of the urethral rest and stress profiles after different types of surgery for urinary stress incontinence. Author(s): Weil A, Reyes H, Bischoff P, Rottenberg RD, Krauer F. Source: British Journal of Obstetrics and Gynaecology. 1984 January; 91(1): 46-55. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6537885

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Modified bladder neck suspension for female stress incontinence. Author(s): Raz S. Source: Urology. 1981 January; 17(1): 82-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7456206

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Modified four corner bladder neck suspension in anatomical stress incontinence with moderate cystocele. Author(s): Atahan O, Kayigil O, Metin A. Source: International Urology and Nephrology. 1998; 30(4): 439-44. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9821046

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Modified Gittes's needle colposuspension method complemented with the laparoscopic ventrosuspension of the uterus for the treatment of stress incontinence associated with stage III or IV pelvic organ prolapse. Author(s): Bodis J, Domany B, Torok A, Buzogany I, Gotz F. Source: American Journal of Obstetrics and Gynecology. 1997 June; 176(6): 1394-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9215206

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Modified insitu vaginal wall sling in stress incontinence. Author(s): Metin A, Kayigil O, Ahmed SI. Source: International Urology and Nephrology. 2001; 32(4): 641-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11989556

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Modified Marshall-Marchetti-Krantz method by Joseph A. Riggs in urinary stress incontinence (our experience--a preliminary report). Author(s): Poryazov K. Source: Folia Med (Plovdiv). 1990; 32(3): 26-9. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2132613

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Modified Pereyra procedure for female stress incontinence. Author(s): Makinen J, Kiilholma P, Hamalainen R, Erkkola R, Hirvonen T. Source: Ann Chir Gynaecol Suppl. 1987; 202: 57-61. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3477988

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Modified Pereyra procedure for stress incontinence. Author(s): Roberts JA, Angel JR, Thomas R, McClung T, Lewis RW. Source: The Journal of Urology. 1981 June; 125(6): 787-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7017168

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Morphologic and functional aspects of pelvic floor muscles in patients with pelvic relaxation and genuine stress incontinence. Author(s): Koelbl H, Strassegger H, Riss PA, Gruber H. Source: Obstetrics and Gynecology. 1989 November; 74(5): 789-95. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2682414

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Needle bladder neck suspension for female stress incontinence. Author(s): Boyd SD, Raz S. Source: The Urologic Clinics of North America. 1984 May; 11(2): 357-66. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6375070

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Needle suspension procedures for urinary stress incontinence: a review and historical perspective. Author(s): Cornella JL, Ostergard DR. Source: Obstetrical & Gynecological Survey. 1990 December; 45(12): 805-16. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2270155

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Neurophysiological measurements in patients with genuine stress incontinence of urine and the relation of neurogenic defects to the presence of spina bifida occulta. Author(s): Fidas A, MacDonald HL, Elton RA, McInnes A, Brown A, Chisholm GD. Source: British Journal of Urology. 1988 July; 62(1): 46-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3044478

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New and simplified vaginal approach for correction of urinary stress incontinence in women. Author(s): Falconer C, Larsson B. Source: Neurourology and Urodynamics. 1995; 14(4): 365-70. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7581473

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New approaches for managing stress incontinence in women. Author(s): Newman DK, Burns PA. Source: Lippincott's Primary Care Practice. 1997 September-October; 1(4): 382-7. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9313531

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New disposable vaginal device (continence guard) in the treatment of female stress incontinence. Design, efficacy and short term safety. Author(s): Thyssen H, Lose G. Source: Acta Obstetricia Et Gynecologica Scandinavica. 1996 February; 75(2): 170-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8604606

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New treatment options for stress incontinence. Author(s): Sasso KC. Source: Rn. 1998 September; 61(9): 36-9. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9783004

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Newer approaches to the correction of urinary stress incontinence in female patients. Author(s): Shortliffe LM, Stamey TA. Source: The Surgical Clinics of North America. 1982 December; 62(6): 1035-45. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6217566

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No-incision pubovaginal suspension for stress incontinence. Author(s): Gittes RF, Loughlin KR. Source: The Journal of Urology. 1987 September; 138(3): 568-70. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3305991

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Non-operative treatment of recurrent stress incontinence in female subjects: preliminary report of a new device. Author(s): Habib HN. Source: The Journal of Urology. 1969 June; 101(6): 854-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5771256

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Nonsurgical therapy for stress incontinence. Author(s): Bourcier AP, Juras JC. Source: The Urologic Clinics of North America. 1995 August; 22(3): 613-27. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7645160

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Norfenefrine in the treatment of female stress incontinence. A double-blind controlled trial. Author(s): Lose G, Rix P, Diernaes E, Alexander N. Source: Urologia Internationalis. 1988; 43(1): 11-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3287737

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Norfenefrine in the treatment of female urinary stress incontinence assessed by onehour pad weighing test. Author(s): Diernaes E, Rix P, Sorensen T, Alexander N. Source: Urologia Internationalis. 1989; 44(1): 28-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2568712

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Office based criteria for predicting type II stress incontinence without further evaluation studies. Author(s): Diokno AC, Dimaculangan RR, Lim EU, Steinert BW. Source: The Journal of Urology. 1999 April; 161(4): 1263-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10081882

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On the physiology of continence and pathophysiology of stress incontinence in the female. Author(s): Asmussen M, Ulmsten U. Source: Contrib Gynecol Obstet. 1983; 10: 32-50. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6685604

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Once more on G. Marion's operation in the treatment of urinary stress incontinence (in memoriam--70 years after its introduction). Author(s): Poryazov K. Source: Folia Med (Plovdiv). 1990; 32(4): 20-2. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2133560

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One month maximal electrostimulation for genuine stress incontinence in women. Author(s): Schiotz HA. Source: Neurourology and Urodynamics. 1994; 13(1): 43-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8156074

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One-year urodynamic outcome and quality of life in patients with concomitant tension-free vaginal tape during pelvic floor reconstruction surgery for genitourinary prolapse and urodynamic stress incontinence. Author(s): Pang MW, Chan LW, Yip SK. Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 2003 October; 14(4): 256-60; Discussion 259-60. Epub 2003 August 23. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14530838

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Operative treatment of women with prolapse and genuine primary stress incontinence. Author(s): Iosif CS. Source: Urologia Internationalis. 1983; 38(4): 199-202. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6683889

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Oral and intravaginal estrogens alone and in combination with alpha-adrenergic stimulation in genuine stress incontinence. Author(s): Wein AJ. Source: The Journal of Urology. 1991 December; 146(6): 1670-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1942363

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Outcome results of transurethral collagen injection for female stress incontinence: assessment by urinary incontinence score. Author(s): Groutz A, Blaivas JG, Kesler SS, Weiss JP, Chaikin DC. Source: The Journal of Urology. 2000 December; 164(6): 2006-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11061903

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Pathophysiology of genuine stress incontinence: what do we really know? Author(s): Karram MM. Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 2003 June; 14(2): 77. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12938691

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Patient characteristics that are associated with urodynamically diagnosed detrusor instability and genuine stress incontinence. Author(s): Klingele CJ, Carley ME, Hill RF. Source: American Journal of Obstetrics and Gynecology. 2002 May; 186(5): 866-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12015497

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Pelvic floor electrical stimulation for genuine stress incontinence: who will benefit and when? Author(s): Miller K, Richardson DA, Siegel SW, Karram MM, Blackwood NB, Sand PK. Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 1998; 9(5): 265-70. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9849758

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Pelvic floor reeducation for stress incontinence: comparing three methods. Author(s): Laycock J, Brown J, Cusack C, Green S, Jerwood D, Mann K, McLachlan Z, Schofield A. Source: British Journal of Community Nursing. 2001 May; 6(5): 230-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11893948

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Periurethral collagen injection for stress incontinence with and without urethral hypermobility. Author(s): Waetjen LE, Jackson R. Source: Obstetrics and Gynecology. 2000 July; 96(1): 153. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10928905

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Periurethral connective tissue status of postmenopausal women with genital prolapse with and without stress incontinence. Author(s): Goepel C, Hefler L, Methfessel HD, Koelbl H. Source: Acta Obstetricia Et Gynecologica Scandinavica. 2003 July; 82(7): 659-64. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12790849

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Periurethral injection of autologous fat for the treatment of post-fistula repair stress incontinence: a preliminary report. Author(s): Hilton P, Ward A, Molloy M, Umana O. Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 1998; 9(2): 118-21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9694142

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Persistence of delayed hypersensitivity following transurethral collagen injection for recurrent urinary stress incontinence. Author(s): Echols KT, Chesson RR, Breaux EF, Shobeiri SA. Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 2002; 13(1): 52-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11999209

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Point of Technique. A training model for transurethral injection therapy for stress incontinence. Author(s): Radley SC, Chapple CR, Martin SW, Boaler D. Source: Bju International. 1999 April; 83(6): 711-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10233585

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Predictive value of urethral mobility before suburethral tape procedure for urinary stress incontinence in women. Author(s): Fritel X, Zabak K, Pigne A, Demaria F, Benifla JL. Source: The Journal of Urology. 2002 December; 168(6): 2472-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12441943

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Pre-pubic TVT: an alternative to classic TVT in selected patients with urinary stress incontinence. Author(s): Daher N, Boulanger JC, Ulmsten U. Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2003 April 25; 107(2): 205-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12648870

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Prevalence of stress incontinence in nulliparous elite trampolinists. Author(s): Eliasson K, Larsson T, Mattsson E. Source: Scandinavian Journal of Medicine & Science in Sports. 2002 April; 12(2): 106-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12121428

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Prevention of postpartum stress incontinence in primigravidae with increased bladder neck mobility: a randomised controlled trial of antenatal pelvic floor exercises. Author(s): Reilly ET, Freeman RM, Waterfield MR, Waterfield AE, Steggles P, Pedlar F. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2002 January; 109(1): 68-76. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11845813

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Primary slings for everyone with genuine stress incontinence? The argument against. Int Urogynecol J 1997,8:321-322. Author(s): Rovner ES. Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 1998; 9(6): 419. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9891966

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Primary slings for everyone with genuine stress incontinence? The argument for. Author(s): Appell RA. Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 1998; 9(5): 249-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9849755

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Proposal for a novel and inexpensive surgical instrument to perform the tension-free vaginal tape procedure in women with genuine stress incontinence. Author(s): Larciprete F, Larciprete G, Valensise H. Source: Clin Exp Obstet Gynecol. 2001; 28(4): 232. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11838746

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Prospective multicentre randomised trial of tension-free vaginal tape and colposuspension as primary treatment for stress incontinence. Author(s): Ward K, Hilton P; United Kingdom and Ireland Tension-free Vaginal Tape Trial Group. Source: Bmj (Clinical Research Ed.). 2002 July 13; 325(7355): 67. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12114234

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Pubic bone anchoring devices for the surgical treatment of urinary stress incontinence in patients with severe genital prolapse. Author(s): Iglesias X, Espuna M, Puig M, Davi E, Ribas C, Palau MJ. Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 2002; 13(5): 314-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12355292

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Pubovaginal sling procedure for stress incontinence. 1978. Author(s): McGuire EJ, Lytton B. Source: The Journal of Urology. 2002 February; 167(2 Pt 2): 1120-3; Discussion 1124. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11905885

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Pudendal nerve terminal motor latency in women with genuine stress incontinence and prolapse. Author(s): Bakas P, Liapis A, Karandreas A, Creatsas G. Source: Gynecologic and Obstetric Investigation. 2001; 51(3): 187-90. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11306907

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Q-tip test and tension-free vaginal tape in the management of female patients with genuine stress incontinence. Author(s): Bakas P, Liapis A, Creatsas G. Source: Gynecologic and Obstetric Investigation. 2002; 53(3): 170-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12053102

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Randomized prospective comparison of needle colposuspension versus endopelvic fascia plication for potential stress incontinence prophylaxis in women undergoing vaginal reconstruction for stage III or IV pelvic organ prolapse. The Continence Program for Women Research Group. Author(s): Bump RC, Hurt WG, Theofrastous JP, Addison WA, Fantl JA, Wyman JF, McClish DK. Source: American Journal of Obstetrics and Gynecology. 1996 August; 175(2): 326-33; Discussion 333-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8765249

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Randomized trial of porcine dermal sling (Pelvicol implant) vs. tension-free vaginal tape (TVT) in the surgical treatment of stress incontinence: a questionnaire-based study. Author(s): Arunkalaivanan AS, Barrington JW. Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 2003 February; 14(1): 17-23; Discussion 21-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12601511

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Re: Combined stent and artificial urinary sphincter for management of severe recurrent bladder neck contracture and stress incontinence after prostatectomy: a long-term evaluation. Author(s): Theodorou Ch. Source: The Journal of Urology. 2002 March; 167(3): 1407-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11832755

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Re: Editorial comment: should Stamey colposuspension be our primary surgery for stress incontinence? Author(s): Stamey TA. Source: The Journal of Urology. 1997 February; 157(2): 627-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8996379

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Re: Long-term follow-up of women treated with perurethral teflon injections for stress incontinence. Author(s): Dewan PA, Byard RW. Source: British Journal of Urology. 1993 January; 71(1): 112. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8435726

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Re: The endoscopic fascial sling for treatment of female urinary stress incontinence. Author(s): Zimmern PE, Hadley R. Source: The Journal of Urology. 1997 January; 157(1): 268. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8976273

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Re: The sign of stress incontinence--should we believe what we see? Author(s): Browne DS. Source: The Australian & New Zealand Journal of Obstetrics & Gynaecology. 1999 February; 39(1): 139-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10099775

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Re: The sign of stress incontinence--should we believe what we see? Author(s): Farnsworth B. Source: The Australian & New Zealand Journal of Obstetrics & Gynaecology. 1999 February; 39(1): 139. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10099774

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Re: The sign of stress incontinence--should we believe what we see? Author(s): Petros PP. Source: The Australian & New Zealand Journal of Obstetrics & Gynaecology. 1998 August; 38(3): 352-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9761174

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Re: Transurethral Polytef injection for post-prostatectomy urinary incontinence and Long-term follow-up of women treated with periurethral Teflon injections for stress incontinence. Author(s): Dewan PA, Byard RW. Source: British Journal of Urology. 1993 January; 71(1): 112. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8435727

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Re: Treatment results using pubovaginal slings in patients with large cystoceles and stress incontinence. Author(s): Zimmern PE. Source: The Journal of Urology. 1998 July; 160(1): 132-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9628629

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Recurrence of stress incontinence after vault suspension: can it be prevented? Author(s): Bombieri L, Freeman RM. Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 1998; 9(1): 58-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9657181

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Reliability of the urethral closure pressure profile during stress in the diagnosis of genuine stress incontinence. Author(s): Hanzal E, Berger E, Koelbl H. Source: British Journal of Urology. 1991 October; 68(4): 369-71. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1933156

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Results in 32 women operated for genuine stress incontinence with the pubovaginal sling procedure ad modum Ed McGuire. Author(s): Borup K, Nielsen JB. Source: Scandinavian Journal of Urology and Nephrology. 2002; 36(2): 128-33. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12028686

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Results of pubovaginal sling for stress incontinence: a prospective comparison of 4 instruments for outcome analysis. Author(s): Chaikin DC, Blaivas JG, Rosenthal JE, Weiss JP. Source: The Journal of Urology. 1999 November; 162(5): 1670-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10524894

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Retroperitoneal laparoscopic surgery for stress incontinence. Author(s): Taylor JD, Tsokos N. Source: Lancet. 1993 December 18-25; 342(8886-8887): 1564-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7902947

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Risk factors and their effect on the results of Burch colposuspension for urinary stress incontinence. Author(s): Gillon G, Engelstein D, Servadio C. Source: Isr J Med Sci. 1992 June; 28(6): 354-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1607271

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Risk of recurrent stress incontinence in women undergoing the combined modified pereyra procedure and transvaginal sacrospinous ligament vault suspension. Author(s): Nguyen JK, Bhatia NN. Source: Urology. 2001 December; 58(6): 947-52. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11744465

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Role of the artificial urinary sphincter in the treatment of stress incontinence in women. Author(s): Duncan HJ, Nurse DE, Mundy AR. Source: British Journal of Urology. 1992 February; 69(2): 141-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1537024

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Role of the four-corner bladder neck suspension to correct stress incontinence with a mild to moderate cystocele. Author(s): Dmochowski RR, Zimmern PE, Ganabathi K, Sirls L, Leach GE. Source: Urology. 1997 January; 49(1): 35-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9000182

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Selection of treatment for patients with stress incontinence. Author(s): Bent AE. Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 1999; 10(4): 213-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10450818

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Sertoli tumour presenting with stress incontinence in a patient with testicular feminization. Author(s): Hawkyard S, Poon P, Morgan DR. Source: Bju International. 1999 August; 84(3): 382-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10468749

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Sexual function after using tension-free vaginal tape for the surgical treatment of genuine stress incontinence. Author(s): Maaita M, Bhaumik J, Davies AE. Source: Bju International. 2002 October; 90(6): 540-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12230613

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Sexual function after vaginal surgery for stress incontinence: results of a mailed questionnaire. Author(s): Lemack GE, Zimmern PE. Source: Urology. 2000 August 1; 56(2): 223-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10925082

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Single blind, randomised controlled trial of pelvic floor exercises, electrical stimulation, vaginal cones, and no treatment in management of genuine stress incontinence in women. Author(s): Bo K, Talseth T, Holme I. Source: Bmj (Clinical Research Ed.). 1999 February 20; 318(7182): 487-93. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10024253

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Stress incontinence and pelvic floor neurophysiology 15 years after the first delivery. Author(s): Dolan LM, Hosker GL, Mallett VT, Allen RE, Smith AR. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2003 December; 110(12): 1107-14. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14664882

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Stress incontinence diagnosed without multichannel urodynamic studies. Author(s): Videla FL, Wall LL. Source: Obstetrics and Gynecology. 1998 June; 91(6): 965-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9611005

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Stress incontinence in women under 50: does urodynamics improve surgical outcome? Author(s): Thompson PK, Duff DS, Thayer PS. Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 2000; 11(5): 285-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11052563

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Stress incontinence in younger women: prevention and treatment. Author(s): Simpson L. Source: Nursing Standard : Official Newspaper of the Royal College of Nursing. 2000 May 24-30; 14(36): 49-54; Quiz 56, 58. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11974266

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Stress incontinence observed with real time sonography and dynamic fastscan magnetic resonance imaging--insights into pathophysiology. Author(s): Mostwin JL, Genadry R, Saunders R, Yang A. Source: Scand J Urol Nephrol Suppl. 2001; (207): 94-9; Discussion 106-25. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11409622

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Stress incontinence surgery for patients presenting with mixed incontinence and a normal cystometrogram. Author(s): Osman T. Source: Bju International. 2003 December; 92(9): 964-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14632856

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Stress incontinence. Author(s): Cooper J. Source: Clin Evid. 2002 June; (7): 1772-83. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12230788

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Suprapubic sling adjustment: minimally invasive method of curing recurrent stress incontinence after sling surgery. Author(s): Choe JM. Source: The Journal of Urology. 2002 November; 168(5): 2059-62. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12394708

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Surgery for stress incontinence: a non-randomised trial of colposuspension, needle suspension and anterior colporrhaphy. Author(s): Hutchings A, Black NA. Source: European Urology. 2001 April; 39(4): 375-82. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11306874

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Surgery for stress incontinence: factors associated with a successful outcome. Author(s): Hutchings A, Griffiths J, Black NA. Source: British Journal of Urology. 1998 November; 82(5): 634-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9839576

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Surgical correction of genuine stress incontinence in an achondroplastic woman. Author(s): Tamilselvi A, Duckett JR. Source: Journal of Obstetrics and Gynaecology : the Journal of the Institute of Obstetrics and Gynaecology. 2002 November; 22(6): 704. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12554286

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Surgical correction of stress incontinence in morbidly obese women. Author(s): Cummings JM, Boullier JA, Parra RO. Source: The Journal of Urology. 1998 September; 160(3 Pt 1): 754-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9720539

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Surgical treatment of urinary stress incontinence using a method for postoperative adjustment of sling tension (Remeex System). Author(s): Iglesias X, Espuna M. Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 2003 November; 14(5): 326-30; Discussion 330. Epub 2003 September 06. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14618309

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Suture injury to the urinary tract in urethral suspension procedures for stress incontinence. Author(s): Dwyer PL, Carey MP, Rosamilia A. Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 1999; 10(1): 15-21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10207762

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Systematic review of the clinical effectiveness and cost-effectiveness of tension-free vaginal tape for treatment of urinary stress incontinence. Author(s): Cody J, Wyness L, Wallace S, Glazener C, Kilonzo M, Stearns S, McCormack K, Vale L, Grant A. Source: Health Technology Assessment (Winchester, England). 2003; 7(21): Iii, 1-189. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=13678548

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Tension-free vaginal tape (TVT) in the treatment of urinary stress incontinence: 3 years experience involving 256 operations. Author(s): Debodinance P, Delporte P, Engrand JB, Boulogne M. Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2002 October 10; 105(1): 49-58. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12270565

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The association of diet and other lifestyle factors with overactive bladder and stress incontinence: a longitudinal study in women. Author(s): Dallosso HM, McGrother CW, Matthews RJ, Donaldson MM; Leicestershire MRC Incontinence Study Group. Source: Bju International. 2003 July; 92(1): 69-77. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12823386

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The correction of stress incontinence by simple vesicourethral suspension. 1949. Author(s): Marshall VF, Marchetti AA, Krantz KE. Source: The Journal of Urology. 2002 October; 168(4 Pt 1): 1326-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12352385

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The development of a questionnaire to measure the severity of symptoms and the quality of life before and after surgery for stress incontinence. Author(s): Kulseng-Hanssen S, Borstad E. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2003 November; 110(11): 983-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14592582

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The evaluation of stress incontinence prior to primary surgery. Author(s): Farrell SA, Epp A, Flood C, Lajoie F, MacMillan B, Mainprize T, Robert M; Urogynaecology Committtee; Executive and Council of the Society of Obstetricians and Gynaecologists of Canada. Source: J Obstet Gynaecol Can. 2003 April; 25(4): 313-24. English, French. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12679823

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The impact of urodynamic stress incontinence and detrusor overactivity on marital relationship and sexual function. Author(s): Yip SK, Chan A, Pang S, Leung P, Tang C, Shek D, Chung T. Source: American Journal of Obstetrics and Gynecology. 2003 May; 188(5): 1244-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12748492

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The influence of pad test loss on management of women with urodynamic stress incontinence. Author(s): Thomson AJ, Tincello DG. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2003 August; 110(8): 771-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12892690

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The tension free vaginal tape procedure is successful in the majority of women with indications for surgical treatment of urinary stress incontinence. Author(s): Navaneetham N, Doshani A. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2003 January; 110(1): 89-90. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12504957

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Transabdominal vesical sonography of urethral syndrome and stress incontinence. Author(s): Sugaya K, Nishijima S, Oda M, Owan T, Ashitomi K, Miyazato M, Morozumi M, Hatano T, Ogawa Y. Source: International Journal of Urology : Official Journal of the Japanese Urological Association. 2003 January; 10(1): 36-42. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12534925

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Treatment of urinary stress incontinence by intravaginal electrical stimulation and pelvic floor physiotherapy. Author(s): Amaro JL, Oliveira Gameiro MO, Padovani CR. Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 2003 August; 14(3): 204-8; Discussion 208. Epub 2003 April 23. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12955344

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Trials of surgery for stress incontinence--thoughts on the 'Humpty Dumpty principle'. Author(s): Hilton P. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2002 October; 109(10): 1081-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12387459

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Ultrasound imaging of paravaginal defects in women with stress incontinence before and after paravaginal defect repair. Author(s): Martan A, Masata J, Halaska M, Otcenasek M, Svabik K. Source: Ultrasound in Obstetrics & Gynecology : the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology. 2002 May; 19(5): 496-500. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11982985

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United States experience with tension-free vaginal tape procedure for urinary stress incontinence: assessment of safety and tolerability. Author(s): Niemczyk P, Klutke JJ, Carlin BI, Klutke CG. Source: Tech Urol. 2001 December; 7(4): 261-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11763484

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Urethral barriers for stress incontinence. Author(s): Supanich B. Source: The Journal of Family Practice. 1999 September; 48(9): 662-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10498066

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Urethral collagen morphologic characteristics among women with genuine stress incontinence. Author(s): Fitzgerald MP, Mollenhauer J, Hale DS, Benson JT, Brubaker L. Source: American Journal of Obstetrics and Gynecology. 2000 June; 182(6): 1565-74. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10871479

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Urinary stress incontinence in obese women: tension-free vaginal tape is the answer. Author(s): Mukherjee K, Constantine G. Source: Bju International. 2001 December; 88(9): 881-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11851607

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Urinary stress incontinence. Author(s): Maddern GJ, Middleton PF, Grant AM. Source: Bmj (Clinical Research Ed.). 2002 October 12; 325(7368): 789-90. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12376426

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Urinary stress incontinence. A urodynamic and quantitative electromyographic study of the perineal muscles. Author(s): Aanestad O, Flink R. Source: Acta Obstetricia Et Gynecologica Scandinavica. 1999 March; 78(3): 245-53. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10078588

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Urodynamic investigation of women operated on for genuine stress incontinence. Author(s): Matanyi S, Acs N, Fontanyi Z, Paulin F. Source: Gynecologic and Obstetric Investigation. 1999; 48(4): 263-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10592430

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Urodynamic outcome after surgery for severe prolapse and potential stress incontinence. Author(s): Klutke JJ, Ramos S. Source: American Journal of Obstetrics and Gynecology. 2000 June; 182(6): 1378-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10871452

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Use of intravenous anesthesia for tension-free vaginal tape therapy in elderly women with genuine stress incontinence. Author(s): Lo TS, Huang HJ, Chang CL, Wong SY, Horng SG, Liang CC. Source: Urology. 2002 March; 59(3): 349-53. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11880068

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Vaginal cones: a conservative method of treating genuine stress incontinence. Author(s): Versi E, Mantle J. Source: British Journal of Obstetrics and Gynaecology. 1989 June; 96(6): 752-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2804004

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Vaginal hysterectomy allied with Kelly-Kennedy surgery and perineal repair for the treatment of patients with a prolapsed uterus and urinary stress incontinence. Author(s): Kayano CE, Sartori MG, Baracat EC, de Lima GR, Girao MJ. Source: Clin Exp Obstet Gynecol. 2002; 29(1): 27-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12013087

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Vaginal retropubic urethropexy with intraoperative cystometry for treating urinary stress incontinence. Author(s): Clark AD, Salloum MS. Source: Bju International. 2001 July; 88(1): 49-52. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11446845

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Validation of cough-induced leak point pressure measurement in the evaluation of pharmacological treatment of stress incontinence. Author(s): Siltberg H, Larsson G, Hallen B, Johansson C, Ulmsten U. Source: Neurourology and Urodynamics. 1999; 18(6): 591-602. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10529707

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Value of the cough pressure profile in the evaluation of patients with stress incontinence. Author(s): Richardson DA. Source: American Journal of Obstetrics and Gynecology. 1986 October; 155(4): 808-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3766634

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Vesicosuspension for female stress incontinence and cystocele using pubic bone anchors. Author(s): Visser AJ, Heyns CF, Visser Jun AJ. Source: S Afr J Surg. 2001 November; 39(4): 129-32. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11820144

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Videourodynamic diagnosis of occult genuine stress incontinence in patients with anterior vaginal wall relaxation. Author(s): Versi E, Lyell DJ, Griffiths DJ. Source: Journal of the Society for Gynecologic Investigation. 1998 November-December; 5(6): 327-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9824814

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Voiding cystourethrography in female stress incontinence. Author(s): Kelvin FM, Maglinte DD, Hale D, Benson JT. Source: Ajr. American Journal of Roentgenology. 1996 October; 167(4): 1065-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8819416

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Voiding cystourethrography in female stress incontinence. Author(s): Pelsang RE, Bonney WW. Source: Ajr. American Journal of Roentgenology. 1996 March; 166(3): 561-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8623628

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Voiding function after Burch colposuspension for stress incontinence. Author(s): Wall LL, Hewitt JK. Source: J Reprod Med. 1996 March; 41(3): 161-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8778413

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What determines the choice of procedure in stress incontinence surgery? The use of multilevel modeling. Author(s): Griffiths JM, Black NA, Pope C, Stanley J, Bowling A, Abel PD. Source: International Journal of Technology Assessment in Health Care. 1998 Summer; 14(3): 431-45. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9780530

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What is the optimal anti-incontinence procedure in women with advanced prolapse and 'potential' stress incontinence? Author(s): Karram MM. Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 1999; 10(1): 1-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10207758

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What is the right operation for stress incontinence? A gynaecological view. Author(s): Stanton SL. Source: British Journal of Urology. 1997 July; 80 Suppl 1: 84-7. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9240232

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What is the right operation for stress incontinence? A urologist's view. Author(s): Evans C. Source: British Journal of Urology. 1997 July; 80 Suppl 1: 88-90. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9240233

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Which is the most appropriate operation for genuine stress incontinence (GSI)? Author(s): Ng KW. Source: Singapore Med J. 1995 December; 36(6): 590-6. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8781627

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Which women with stress incontinence require urodynamic evaluation? Author(s): Weidner AC, Myers ER, Visco AG, Cundiff GW, Bump RC. Source: American Journal of Obstetrics and Gynecology. 2001 January; 184(2): 20-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11174474

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CHAPTER 2. NUTRITION AND STRESS INCONTINENCE Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and stress incontinence.

Finding Nutrition Studies on Stress Incontinence The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements; National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: 301-435-2920, Fax: 301-480-1845, E-mail: [email protected]). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.7 The IBIDS includes references and citations to both human and animal research studies. As a service of the ODS, access to the IBIDS database is available free of charge at the following Web address: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. Now that you have selected a database, click on the “Advanced” tab. An advanced search allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “stress incontinence” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.

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Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.

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The following information is typical of that found when using the “Full IBIDS Database” to search for “stress incontinence” (or a synonym): •

An analysis of rapid pad testing and the history for the diagnosis of stress incontinence. Author(s): Department of Gynecology, Royal Perth Hospital, Western Australia. Source: Papa Petros, P E Ulmsten, U Acta-Obstet-Gynecol-Scand. 1992 October; 71(7): 529-36 0001-6349

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Estrogen effects on the urethra: beneficial effects in women with genuine stress incontinence. Author(s): Department of Obstetrics and Gynecology, University of Southern California School of Medicine, Women's Hospital, Los Angeles 90033. Source: Elia, G Bergman, A Obstet-Gynecol-Survolume 1993 July; 48(7): 509-17 00297828

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Intravesical prostaglandin F2 for promoting bladder emptying after surgery for female stress incontinence. Source: Tammela, T Kontturi, M Kaar, K Lukkarinen, O Br-J-Urol. 1987 July; 60(1): 43-6 0007-1331

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Intravesically instilled prostaglandin F2-alpha for the promotion of bladder emptying after surgery for female stress incontinence. Author(s): Department of Surgery, Oulu University, Central Hospital, Finland. Source: Tammela, T Kontturi, M Scand-J-Urol-Nephrol-Suppl. 1988; 110231-4 0300-8886

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Prostaglandins for enhancing detrusor function after surgery for stress incontinence in women. Author(s): Department of Obstetrics and Gynecology, University of Southern California, Los Angeles. Source: Koonings, P P Bergman, A Ballard, C A J-Reprod-Med. 1990 January; 35(1): 1-5 0024-7758

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The effect of oestradiol on vaginal collagen metabolism in postmenopausal women with genuine stress incontinence. Author(s): Department of Gynaecology, John Radcliffe Hospital, Oxford, UK. Source: Jackson, Simon James, Mark Abrams, Paul BJOG. 2002 Mar; 109(3): 339-44 14700328

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The effect of oestrogen supplementation on post-menopausal urinary stress incontinence: a double-blind placebo-controlled trial. Author(s): Department of Obstetrics and Gynaecology, Southmead Hospital, Bristol, UK. Source: Jackson, S Shepherd, A Brookes, S Abrams, P Br-J-Obstet-Gynaecol. 1999 July; 106(7): 711-8 0306-5456

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The therapeutic effect of treatment of urinary stress incontinence with estriol. Source: Poryazov, K Folia-Med-(Plovdiv). 1990; 32(4): 16-9 0204-8043

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Transurethral endoscopic treatment of urinary stress incontinence in women. Materials and results in former and present agents. Author(s): Department of Obstetrics and Gynaecology, University Hospital, Uppsala, Sweden. Source: Stenberg, A Larsson, G Heimer, G Johnson, P Ulmsten, U Acta-Obstet-GynecolScand-Suppl. 1998; 16844-6 0300-8835

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Transvaginal incisionless bladder neck suspension. A simplified technique for female genuine stress incontinence. Author(s): Department of Urology, Polycliniki Hospital, Athens, Greece. Source: Theodorou, Ch Floratos, D Katsifotis, Ch Moutzouris, G Mertziotis, N Thermogianni, H Int-Urol-Nephrol. 1998; 30(3): 273-8 0301-1623

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Treatment with oral piperazine oestrone sulphate for genuine stress incontinence in postmenopausal women. Source: Wilson, P D Faragher, B Butler, B Bu'Lock, D Robinson, E L Brown, A D Br-JObstet-Gynaecol. 1987 June; 94(6): 568-74 0306-5456

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Urethral afferent nerve activity affects the micturition reflex; implication for the relationship between stress incontinence and detrusor instability. Author(s): Department of Pharmacology, University of Pittsburgh School of Medicine, Pennsylvania, USA. Source: Jung, S Y Fraser, M O Ozawa, H Yokoyama, O Yoshiyama, M De Groat, W C Chancellor, M B J-Urol. 1999 July; 162(1): 204-12 0022-5347

Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: •

healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0

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The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov

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The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov

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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/

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The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/

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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/

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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/

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Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/

Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats

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Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html

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Google: http://directory.google.com/Top/Health/Nutrition/

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Healthnotes: http://www.healthnotes.com/

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Open Directory Project: http://dmoz.org/Health/Nutrition/

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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/

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WebMDHealth: http://my.webmd.com/nutrition

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

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CHAPTER 3. ALTERNATIVE MEDICINE AND STRESS INCONTINENCE Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to stress incontinence. At the conclusion of this chapter, we will provide additional sources.

National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov/) has created a link to the National Library of Medicine’s databases to facilitate research for articles that specifically relate to stress incontinence and complementary medicine. To search the database, go to the following Web site: http://www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “stress incontinence” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine that are related to stress incontinence: •

A comparison of effectiveness of biofeedback and pelvic muscle exercise treatment of stress incontinence in older community-dwelling women. Author(s): Burns PA, Pranikoff K, Nochajski TH, Hadley EC, Levy KJ, Ory MG. Source: J Gerontol. 1993 July; 48(4): M167-74. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8315230

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Age as a variable in an exercise program for the treatment of simple urinary stress incontinence. Author(s): Henderson JS, Taylor KH. Source: Journal of Obstetric, Gynecologic, and Neonatal Nursing : Jognn / Naacog. 1987 July-August; 16(4): 266-72. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3650327

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Ambulatory bio-feedback for stress incontinence exercise regimes: a novel development of the perineometer. Author(s): Jones KR. Source: Journal of Advanced Nursing. 1994 March; 19(3): 509-12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8014312

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Biofeedback and pelvic floor exercises for the rehabilitation of urinary stress incontinence. Author(s): Aksac B, Aki S, Karan A, Yalcin O, Isikoglu M, Eskiyurt N. Source: Gynecologic and Obstetric Investigation. 2003; 56(1): 23-7. Epub 2003 July 14. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12867764

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Biofeedback or pelvic floor muscle exercises for female genuine stress incontinence: a meta-analysis of trials identified in a systematic review. Author(s): Weatherall M. Source: Bju International. 1999 June; 83(9): 1015-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10368247

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Comparative analysis of biofeedback and physical therapy for treatment of urinary stress incontinence in women. Author(s): Pages IH, Jahr S, Schaufele MK, Conradi E. Source: American Journal of Physical Medicine & Rehabilitation / Association of Academic Physiatrists. 2001 July; 80(7): 494-502. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11421517

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Conservative treatment of stress incontinence with Geisha balls. Author(s): Glavind K. Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 2001; 12(4): 223-4; Discussion 224-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11569648

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Effect of adding biofeedback to pelvic floor muscle training to treat urodynamic stress incontinence. Author(s): Schiotz H. Source: Obstetrics and Gynecology. 2003 May; 101(5 Pt 1): 1024; Reply 1024-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12738173

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Effect of adding biofeedback to pelvic floor muscle training to treat urodynamic stress incontinence. Author(s): Morkved S, Bo K, Fjortoft T. Source: Obstetrics and Gynecology. 2002 October; 100(4): 730-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12383542

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Effect of behavioral training with or without pelvic floor electrical stimulation on stress incontinence in women: a randomized controlled trial. Author(s): Goode PS, Burgio KL, Locher JL, Roth DL, Umlauf MG, Richter HE, Varner RE, Lloyd LK. Source: Jama : the Journal of the American Medical Association. 2003 July 16; 290(3): 345-52. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12865375

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Effects of biofeedback and urinary stress incontinence in older women. Author(s): Taylor K, Henderson J. Source: Journal of Gerontological Nursing. 1986 September; 12(9): 25-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3639106

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Efficacy of biofeedback in the treatment of urinary stress incontinence. Author(s): Glavind K, Laursen B, Jaquet A. Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 1998; 9(3): 151-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9745974

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Efficacy of biofeedback, when included with pelvic floor muscle exercise treatment, for genuine stress incontinence. Author(s): Berghmans LC, Frederiks CM, de Bie RA, Weil EH, Smeets LW, van Waalwijk van Doorn ES, Janknegt RA. Source: Neurourology and Urodynamics. 1996; 15(1): 37-52. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8696355

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Electrical stimulation in the treatment of intractable stress incontinence; a preliminary report. Author(s): HUFFMAN JW, OSBORNE SL, SOKOL JK. Source: Archives of Physical Medicine and Rehabilitation. 1952 November; 33(11): 674-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12997298

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Electrotherapy and exercises for stress incontinence and urinary frequency. Author(s): McQuire WA. Source: Physiotherapy. 1975 October; 61(10): 305-7. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1081697

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FES-biofeedback versus intensive pelvic floor muscle exercise for the prevention and treatment of genuine stress incontinence. Author(s): Sung MS, Hong JY, Choi YH, Baik SH, Yoon H. Source: Journal of Korean Medical Science. 2000 June; 15(3): 303-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10895973

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Genuine stress incontinence: pathophysiology and rationale for its medical management. Author(s): Fantl JA. Source: Obstetrics and Gynecology Clinics of North America. 1989 December; 16(4): 82740. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2697817

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Kegel's exercises with biofeedback therapy for treatment of stress incontinence. Author(s): Burns PA, Marecki MA, Dittmar SS, Bullough B. Source: The Nurse Practitioner. 1985 February; 10(2): 28, 33-4, 46. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3974953

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Long-term electrostimulation of the pelvic floor: primary therapy in female stress incontinence? Author(s): Eriksen BC, Eik-Nes SH. Source: Urologia Internationalis. 1989; 44(2): 90-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2786271

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Magnetic stimulation of the sacral roots for the treatment of stress incontinence: an investigational study and placebo controlled trial. Author(s): Fujishiro T, Enomoto H, Ugawa Y, Takahashi S, Ueno S, Kitamura T. Source: The Journal of Urology. 2000 October; 164(4): 1277-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10992380

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Nonsurgical therapy for stress incontinence. Author(s): Bourcier AP, Juras JC. Source: The Urologic Clinics of North America. 1995 August; 22(3): 613-27. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7645160

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One month maximal electrostimulation for genuine stress incontinence in women. Author(s): Schiotz HA. Source: Neurourology and Urodynamics. 1994; 13(1): 43-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8156074

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Pelvic floor reeducation for stress incontinence: comparing three methods. Author(s): Laycock J, Brown J, Cusack C, Green S, Jerwood D, Mann K, McLachlan Z, Schofield A. Source: British Journal of Community Nursing. 2001 May; 6(5): 230-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11893948

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Pelvic-floor rehabilitation, Part 2: Pelvic-floor reeducation with interferential currents and exercise in the treatment of genuine stress incontinence in postpartum women--a

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cohort study. Author(s): Dumoulin C, Seaborne DE, Quirion-DeGirardi C, Sullivan SJ. Source: Physical Therapy. 1995 December; 75(12): 1075-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7501710 •

Predictive factors of the outcome of primary surgical treatment of stress incontinence in women. Author(s): Berglund AL, Eisemann M, Lalos A, Lalos O. Source: Scandinavian Journal of Urology and Nephrology. 1997 February; 31(1): 49-55. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9060084

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Stress incontinence: new alternatives. Author(s): McGuire EJ. Source: Int J Fertil Menopausal Stud. 1996 March-April; 41(2): 142-7. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8829693

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The effect of pelvic floor muscle exercises on genuine stress incontinence among Korean women--focusing on its effects on the quality of life. Author(s): Sung MS, Choi YH, Back SH, Hong JY, Yoon H. Source: Yonsei Medical Journal. 2000 April; 41(2): 237-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10817026

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Transcutaneous electrical nerve stimulator for stress incontinence. Author(s): Krauss DJ, Lilien OM. Source: The Journal of Urology. 1981 June; 125(6): 790-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6972453

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Treatment of stress incontinence with pelvic floor exercises and biofeedback. Author(s): Burns PA, Pranikoff K, Nochajski T, Desotelle P, Harwood MK. Source: Journal of the American Geriatrics Society. 1990 March; 38(3): 341-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2179379

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Vaginal electrostimulation for the treatment of genuine stress incontinence. Author(s): Wilson PD, George M, Imrie JJ. Source: The Australian & New Zealand Journal of Obstetrics & Gynaecology. 1997 November; 37(4): 446-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9429711

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Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: •

Alternative Medicine Foundation, Inc.: http://www.herbmed.org/

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AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats

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Chinese Medicine: http://www.newcenturynutrition.com/

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drkoop.com: http://www.drkoop.com/InteractiveMedicine/IndexC.html

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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm

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Google: http://directory.google.com/Top/Health/Alternative/

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Healthnotes: http://www.healthnotes.com/

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MedWebPlus: http://medwebplus.com/subject/Alternative_and_Complementary_Medicine

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Open Directory Project: http://dmoz.org/Health/Alternative/

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HealthGate: http://www.tnp.com/

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WebMDHealth: http://my.webmd.com/drugs_and_herbs

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/

The following is a specific Web list relating to stress incontinence; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

General Overview Obesity Source: Integrative Medicine Communications; www.drkoop.com Urinary Incontinence Source: Integrative Medicine Communications; www.drkoop.com

General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at http://www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources.

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CHAPTER 4. PATENTS ON STRESS INCONTINENCE Overview Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.8 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical patents that use the generic term “stress incontinence” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on stress incontinence, we have not necessarily excluded non-medical patents in this bibliography.

Patents on Stress Incontinence By performing a patent search focusing on stress incontinence, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. 8Adapted

from the United States Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.

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The following is an example of the type of information that you can expect to obtain from a patent search on stress incontinence: •

Apparatus and method for applying and adjusting an anchoring device Inventor(s): Castro; Salvatore (Seymour, CT), Green; David T. (Westport, CT), Manzo; Scott E. (Shelton, CT), Ratcliff; Keith (Sandy Hook, CT), Sienkiewicz; Henry R. (Stamford, CT) Assignee(s): United States Surgical Corporation (norwalk, Ct) Patent Number: 5,507,754 Date filed: August 20, 1993 Abstract: A method and apparatus for elevating, approximating and/or restraining internal organs or structures, and more particularly for treating female urinary stress incontinence is provided. The invention includes an anchoring device having an elongated suture with an anchor at each end thereof and a cinching member therebetween for adjusting the length of the suture, an apparatus for applying the anchoring device, and an apparatus for drawing the suture relative to the cinching member after it has been emplaced. The method involves securing a first anchor to a first structure, such as the vaginal wall, securing a second anchor to a second structure, such as Cooper's ligament, and drawing the suture relative to the cinching member to approximate the first and second anchors, and thereby move the first structure and the second structure into juxtaposition so as to approximate them. Excerpt(s): The present invention relates to an apparatus and method for applying and adjusting a sutured anchoring device. More particularly, this invention relates to an apparatus and a method of elevating the urethrovesical junction relative to the bladder to correct female urinary stress incontinence. In females, incontinence, or the inability to control the outflow of urine, can have a variety of causes in the urinary system including congenital defects and defects from trauma or disease. The most common cause of female incontinence is known as stress incontinence and results from weakness or relaxation of the urethral sphincter. Many procedures, several involving urethrovesical elevation, have been devised over the years, to cure urinary stress incontinence. One early procedure involved fixation of the urethrovesical junction to the symphysis pubis by placing sutures through part of the urethral wall, but caused urethral distortion. A modified version of the procedure involved suturing the urethral lumen directly to the symphysis pubis, and placing additional sutures through the bladder. This technique however, often led to urine loss and/or the formation of bladder stones. Web site: http://www.delphion.com/details?pn=US05507754__

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Apparatus for the measurement of urethral angle change and vesical pressure Inventor(s): Sohn; Ze'ev (D.N. Mod'in, IL), Zimet; Nahman (Tel Aviv, IL) Assignee(s): Influence Medical Technologies Limited (il) Patent Number: 6,056,699 Date filed: May 2, 1997 Abstract: Apparatus for diagnosing urinary stress incontinence of a subject, including a substantially rigid, disposable probe insertable into the urethra of the subject, generally along a longitudinal axis of the urethra. A reusable sensor unit, is removably coupled to

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the probe, for sensing physiological parameters of the subject. The apparatus preferably includes a fluid pressure sensor, contained in the sensor unit, in pressure communication with a distal end of the probe. The probe includes a flexible diaphragm in fluid communication with the distal end. The diaphragm provides the pressure communication between the pressure sensor and the distal end while substantially preventing fluid communication between the distal end and the pressure sensor. Excerpt(s): The present invention relates to urinary apparatus generally and particularly to apparatus for the measurement of urethral angle change and vesical pressure. Female urinary stress incontinence is a pathology affecting more than ten percent of the female population over age 60. The pathology results from either one or both of the following anatomical conditions: 1) abdominal straining causing urethral hypermobility; 2) urethral intrinsic sphincter deficiency (ISD), which is the inability of urethral musculature to completely close the urethra or keep it closed during stress. The surgical procedures to correct these pathologies are dependent on whether urethral hypermobility or ISD is the predominant pathology. In the case of urethral hypermobility, incontinence is corrected by prevention of urethral descent during stress and/or abdominal straining. In the case of ISD, correction is accomplished by increasing the passive pressure applied on the urethra so as to increase its passive resistance to urine passage. Failure to determine the correct type of incontinence results in the performance of an inappropriate surgical procedure with subsequent unsatisfactory surgical success and subsequent complications. To properly establish the type of urinary incontinence, two factors must be determined: 1) urethral descent during straining, which may be determined by measurement of the spatial angular change of the urethral axis (herein called the urethral angle change) during straining and 2) leak point pressure, the minimal vesical pressure at which urine leaks through the urethra. Low leak point pressure characterizes ISD. A common method in the art to evaluate urethral angle change is by installing a "rod" into the urethra with the physician estimating the rod axis angle change by visual examination. Leak point pressure is generally established during urodynamic evaluation by the placement of a pressure measuring catheter in the bladder with the physician recording the pressure at which urine leakage through the meatus is visually detected. Both these testing methods lack objectivity and accuracy in obtaining results. There is therefore a need for an invention which provides a more objective and accurate measurement of urethral angle change and leak point pressure concomitantly. Web site: http://www.delphion.com/details?pn=US06056699__ •

Devices and methods for treating e.g. urinary stress incontinence Inventor(s): Abrams; Jerome H. (St. Paul, MN), Hovland; Claire T. (Andover, MN), Robinson; Paul J. (Mahtomedi, MN) Assignee(s): Surgical Connections, Inc. (bloomington, Mn) Patent Number: 6,517,566 Date filed: July 14, 2000 Abstract: Embodiments of the invention provide a permanent implanted support for e.g. the urethral neck of the bladder, generally preventing urinary leakage caused by transmission of intra-abdominal pressure pulse waves. The support is implanted in a straightforward manner without the significant complexity and invasiveness associated with known surgical techniques. Pelvic trauma is dramatically reduced. Embodiments

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of the invention can be used in treatment of stress incontinence, and other types of incontinence, in both males and females. Excerpt(s): The invention relates to devices and methods for treating urinary incontinence. More specifically, the invention relates to surgical devices and methods for eliminating or reducing urinary stress incontinence, particularly (though not exclusively) in minimally invasive surgical settings. Urinary incontinence involves the involuntary passage of urine. A wide range of disorders and conditions can cause urinary incontinence, including injuries to the pelvic region, pregnancy/childbirth, infection, and degenerative changes associated with aging. In a healthy patient, on the other hand, urine remains in the bladder until the patient voluntarily causes it to flow through the urethra and out of the body. Currently, an estimated 13 million Americans suffer some form of incontinence. As many as 85% of them are women, and indeed it is believed that as many as one in four women aged 30-59 has experienced at least one episode of urinary incontinence. Naturally, incontinence causes not only physical discomfort and inconvenience but also has emotional and psychological consequences as well. Web site: http://www.delphion.com/details?pn=US06517566__ •

Disposable waterproof encasement and panty for sanitary pad Inventor(s): Brier; Michael I. (Philadelphia, PA) Assignee(s): Hygienics Industries, Inc. (philadelphia, Pa) Patent Number: 4,664,663 Date filed: February 5, 1985 Abstract: A disposable waterproof encasement for an absorbent sanitary pad may be releasably secured to an undergarment to convert an everyday undergarment into a sanitary panty or stress incontinence garment. Preferably, the encasement is secured to the panty with the Velcro-type fasteners. The encasement includes a waterproof back and a waterproof marginal front portion secured to the marginal portion of the back to form a water-tight fold. The marginal front portion forms an opening to expose the absorbent pad. The encasement may include an elongated strap bridging the central portion of the opening for retaining the absorbent pad within the encasement. One end portion of the strap may be releasably secured to the front marginal portion to facilitate insertion and removal of the absorbent pad. To ease removing the absorbent pad, the encasement may include an elasticized rubber pad. Excerpt(s): The present invention relates to a waterproof encasement for sanitary pads, and, more particularly, to a disposable encasement for temporarily converting the regular undergarment into a sanitary panty or stress incontinence garment. The invention further relates to such an encasement which is designed for the easy insertion and removal of the absorbent pad while securely retaining the pad within the encasement. As used in this disclosure, sanitary pads and sanitary garments include absorbent pads and garments for use by men and women suffering from urinary incontinence and women during postpartum menstruation as well as women during monthly menstruation. Numerous designs for waterproof encasements have been proposed such as disclosed in U.S. Pat. Nos. 4,352,356 to Tong, 4,044,769 to Papajohn, 2,977,957 to Clyne, and 2,985,170 to Title. However, one feature which all these prior art references have in common is that the encasement is formed as part of the sanitary garment. Therefore, women in particular, must have either two sets of undergarments,

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one for use during menstruation and one set to be used during other times, or must wear a regular set of undergarments over a sanitary napkin holder such as shown in Clyne, U.S. Pat. No. 2,977,957. Web site: http://www.delphion.com/details?pn=US04664663__ •

Female incontinence control device actuated by abdominal pressure Inventor(s): Karram; Mickey M. (8000 Indian Hill Rd., Cincinnati, OH 45243), Knodel; Bryan D. (6100 N. Country Club, Flagstaff, AZ 86004) Assignee(s): None Reported Patent Number: 6,095,969 Date filed: March 3, 1998 Abstract: A surgeon-implantable, fluid-filled, flexible device for automatically controlling stress incontinence in female patients employs a flexible diaphragm element positioned in the patient's abdominal space to compress in response to increases in intraabdominal pressure. Upon such compression of the diaphragm, pressurized fluid flows therefrom via a flexible tubing, optionally via a flow control element, to an inflatable urethra-constricting element in fluid communication therewith and positioned over the patient's urethra close to her bladder neck. Thus, when the patient experiences an increase in intraabdominal pressure, e.g., when she coughs, fluid from the diaphragm flows rapidly to the urethra-constricting element which presses against and forcibly constricts the urethra adjacent thereto. Upon abatement of the intraabdominal pressure, the flow control element releases fluid from the urethra-constricting element which then ceases to press on the urethra. Excerpt(s): This invention relates to apparatus and a method for controlling female stress-induced incontinence. More particularly, it relates to apparatus provided within a female user to respond automatically to constrict the user's urethra in response to an increase in abdominal pressure. Incontinence, i.e., uncontrolled release of urine from the bladder, has been noticed as a condition affecting a growing segment of the female population in the United States. It is believed that, in the U.S., approximately 40% of community-dwelling females over 60 years of age suffer from urinary incontinence that is felt to be socially disabling. See J. Urol., vol. 136, p. 1022, 1986. This also has a huge economic impact on society. A recent estimate of the annual direct costs of caring for persons of all ages with incontinence is about $11.2 billion in the community and about $5.2 billion in nursing homes (based on 1994 dollars). See Geriatric Nephrol. Urol., v. 4, pp.85-91, 1994. The problems of incontinence in females can be broadly grouped into one of two categories. The first category is one where the incontinence is due to involuntary contraction of the bladder (or detrusor) muscle. Such a condition is sometimes termed "an unstable bladder." The second category is the more common one and comprises stress-induced incontinence, which is best understood as involuntary loss of urine occurring in correspondence with an increase in the female's abdominal pressure, e.g., during a sudden bout of coughing. Web site: http://www.delphion.com/details?pn=US06095969__

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Instrument and method for measuring urethral defects in patients with urinary stress incontinence Inventor(s): Apuzzio; Joseph J. (1005 Fanny St., Elizabeth, NJ 07201), Pelosi; Marco Antonio (182 Springfield Ave., Berkeley Heights, NJ 07922) Assignee(s): None Reported Patent Number: 4,072,144 Date filed: January 21, 1976 Abstract: The present method involves the use of a urethral probe, having one tapered end with a silk thread anchored near said tapered end, at about four centimeters from the apex of the taper. The probe is inserted into the urethra while the free end of the thread is held firmly in the examiner's hand. Once the probe has been inserted into the urethra to the point where the attachment of the string is exactly at the external meatus, the examiner holds only the thread, exerting a slight tension on it. (The thread represents a continuation of the unstrained urethral axis.) The patient is then asked to strain. If there is any weakness of urethral support, the instrument is deflected upward. This upward deflection causes the stationary thread to create an angle which is then read directly from a scale, wherein the degree of deflection can be interpretively read in order to determine the degree of deformity of the urethrovesical angle from its normal anatomic position. Excerpt(s): During the past 25 years, a number of important innovations have been made in the diagnosis of urinary stress incontinence. Whereas, in the past, the emphasis was upon surgical approaches to problems in this area, such thinking has, with advances in the field, undergone substantial change. It is now important to evaluate the patient preoperatively, with an objective investigation, to determine the degree of anatomic abnormality present so that an appropriate choice of surgical approach can be made at the outset. The introduction of the chain cystourethrogram has proved to be an important diagnostic aid in the evaluation of patients with urinary stress incontinence. With this technique, the posterior urethrovesical angle and the urethral axis can be investigated easily, and a rational method of operative repair selected for each patient. Web site: http://www.delphion.com/details?pn=US04072144__

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Intravaginal set, a method of treatment of prolaps of urogenital organ and urinary stress incontinence in women and an application of a intravaginal set Inventor(s): Adamkiewicz; Marian (Warsaw, PL) Assignee(s): Adamed, Sp. Z.o.o. (czosnow, Pl) Patent Number: 6,530,879 Date filed: May 3, 1999 Abstract: An intravaginal set and a method of treatment of prolaps of urogenital organs and urinary stress incontinence or in the period of intervals in women when the intravaginal therapeutic insert for treatment of static disorders of the urogenital organs and urinary stress incontinence is not currently inserted, said method being realised by means of an intravaginal set of inserts, characterized by selecting the appropriate size of corrective insert from a subset of intravaginal corrective inserts, consisting of at least two balls with step increase in diameter, ranging between the minimal and maximal woman vaginal diameter, each ball being preferably hollow, each ball has the loosely

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hanging string and each ball is made preferably of medical material, such as polycarbonate or methyl methacrylate, said selecting being realised by means of an intravaginal measuring subset comprising at least two metal or plastic balls having graduated diameters corresponding to graduated diameters of the balls from the subset of the intravaginal corrective inserts, which balls instead of the loosely hanging string have a rigidly mounted linearly scaled slat for measurement of optimal diameter and depth of localization of the corrective insert in the vagina, depending on actual and individual anatomical conditions of urogenital organ of the woman being treated, by the selection of appropriate optimal diameter and depth of localization of the corrective insert in vagina by approximations with using the balls from the measuring subset, so that contraction of the levator ani muscle will cause the elevation of the insert and the elevation of the insert will cause the elevation of the uterus and/or correction of the cysto-urethral angle, and during the progress of said treatment the sizes of successive applied corrective inserts are adjusted by analogic selection of appropriate optimal diameter and depth of localization of the measuring ball in the vagina, and advantageously by carrying out the exercises of the pelvic floor muscles of treated woman lying in prone or genucubital position in the intervals between successive replacements of the corrective inserts. Excerpt(s): The present invention relates to an intravaginal set, used in the case of prolapse of the urogenital organs and urinary stress incontinence, or during the period when a therapeutic intravaginal insert for treatment of static disorders of the urogenital organs and urinary stress incontinence is not currently inserted and the method of the treatment with usage of this intravaginal set, and application thereof. Aging and past parturitions result in weakening and elongation of the perineum muscles leading to the prolapse of urogenital organs and other anatomical disorders. Once extended, muscles become weaker and weaker which subsequently results in progress of prolapse up to transvaginal eversion of the uterus. As the vaginal canal is the "locus minoris resistentiae" in the pelvic floor, walls of the vagina may become the ring of hernia (cystocele, uretrocele and rectocele). In the course of progressive prolapse of urogenital organs, discomfort in lower abdominal part intensifies, from a feeling of "heaviness" to one of pain, and urinary stress incontinence becomes apparent. Web site: http://www.delphion.com/details?pn=US06530879__ •

Mesh pubovaginal sling Inventor(s): Trabucco; Arnaldo F. (85 Clapham, Manhasset, NY 11030) Assignee(s): None Reported Patent Number: 6,306,079 Date filed: December 7, 1999 Abstract: A mesh pubovaginal sling comprises two mesh pieces, each having a first mesh portion of polypropylene and a second mesh portion comprising an absorbable material such as poly-dioxanone underlying the first mesh portion. One piece is inserted at the endopelvic fascia and the other at the suprapubic region. The two pieces are then connected via sutures to support prolapsed organs so as to relieve urinary stress incontinence in patients. Excerpt(s): The invention relates to a surgical implant for treating urinary incontinence. The implant comprises two band-aid-like mesh pieces comprised of absorbable and nonabsorbable material. The absorbable material is preferably a monofilament absorbable

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material that is weaved in a mesh or polyfilament. One suitable material is absorbable poly dioxanone (PDS). The non-absorbable material is preferably polypropylene. Each mesh piece has absorbable material in the middle and non-absorbable material on the ends. One mesh piece is placed in the suprapubic region and the second is placed in the vaginal vault. The two pieces are then tied together via sutures to support the prolapsed organs. The absorbable material dissolves over time. Nearly 15 to 30 percent of elderly individuals, who are aging continuously, are afflicted with urinary incontinence. Recent estimates show that urinary incontinence affects over 13 million American patients. Approximately 15-20% of women between the ages of 20 and 64 experience urinary incontinence. In many women, urinary incontinence is related to problems of poor pelvic muscle support in the bladder. Urinary incontinence is defined by the American Urological Association as uncontrolled leakage of urine. Web site: http://www.delphion.com/details?pn=US06306079__ •

Metallic surgical suture Inventor(s): Wendorff; Erwin R. (1303 Garden Lane, Reading, PA 19602) Assignee(s): None Reported Patent Number: 4,037,603 Date filed: May 13, 1975 Abstract: A suture of a type particularly adaptable for employment for operations such as that referred to as "urethrovaginal fixation to Cooper's ligament in the treatment of stress incontinence." The suture is employed in the form of a loop with its end portions in interlocking engagement. The suture comprises an elongated, flexible, plastic-coated, thin steel band penetrated by longitudinal series of rectangular apertures with their greater dimensions extending longitudinally of the band. Both ends of the band have projecting shouldered tongues normally lying in the plane of the band. When the suture is formed into a loop with the end portions thereof in overlapping relationship, as occurs during the final stages of an operation such as that referred to above, the tongue at the end of the overlapping portion is twisted from its planar position and inserted in a selected aperture of the underlapping portion. Similarly, the tongue at the end of the underlapping portion is twisted and inserted in an aperture of the overlapping portion. In each case, after the insertion of the tongue, it is restored to its planar position with its shoulders contacting the face of the band. Excerpt(s): The invention concerns improved sutures particularly adapted for employment in operations such as that entitled "urethrovaginal fixation to Cooper's ligament for correction of recurrent stress incontinence". It will be understood, however, that use of the suture is not limited to such operations. Heretofore in operations such as referred to above and as described in an article entitled "Urethrovaginal Fixation to Cooper's Ligament (Burch) in the Treatment of Incontinence" by Erfurth Nielsen and Finn Lundval of Copenhagen, Denmark, the article having been published in Acta Scand. Suppl. 433: 118- 120, 1973, and copies of the article being available in medical libraries, have involved the use of three or more sutures of catgut on each side of Cooper's ligament which are passed through the perivaginal fascia on each side of the urethra after dissection of the space of Retzius and adequate exposure of the bladder and urethra. Each suture is then passed through the most easily reached point of Cooper's ligament and tied. The above procedure has presented serious problems as, for example, the procedure is very time-consuming for the surgeon and the patient is exposed for an excessive period of trauma. Also, the sutures do not necessarily

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uniformly distribute the stress as in many instances some will be tighter than others. In addition, it has been found that in a number of instances the sutures break if the patient should have a coughing spell or be subject to other spasms. Web site: http://www.delphion.com/details?pn=US04037603__ •

Method and means for treating female urinary incontinence Inventor(s): Blake, III; Joseph W. (77 Locust Ave., New Canaan, CT 06840), Spitz; Robert M (58 Gallup La., Waterford, CT 06385) Assignee(s): None Reported Patent Number: 5,647,836 Date filed: September 28, 1995 Abstract: A female urinary stress incontinence remedy in which endopelvic fascia attached to either side of the urethra is elevated and held in place by means of a pair of anchors comprised of upper and lower stays interconnected by suture and surgically positioned on either side of the urethra with the upper stay positioned above the rectus fascia and the lower anchor stay engaging the endopelvic fascia, exposed by aligned insisions in the vaginal wall. Excerpt(s): The present invention relates to female urinary stress incontinence and provides a method and means for treatment. The prior art reveals a variety of methods and devices for treating female urinary incontinence including surgical procedures for implanting corrective devices. Lemay U.S. Pat. No. 5,013,192 discloses a surgical technique using local anesthesia for burying a pair of implants to the left and right of a median line at the superior border of the symphsis pubis, threading suture from the vagina through each implant and back through the vagina to provide two ends of each suture protruding from the vagina, and tying the first and second ends of the left and right sutures, respectively, to support and constrict the urethra. Lemay discloses a reinforcing element such as a small strip of biologically acceptable cloth (e.g., Dacron) under the tied ends of the sutures. Lemay also discloses the use of a supporting saddle for holding the neck of the urethra in case incontinence reoccurs after a first procedure. A problem with Lemay is that the lower implant platform may, in time, damage the urethra causing other problems. Web site: http://www.delphion.com/details?pn=US05647836__

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Method for diagnosis of stress incontinence in women Inventor(s): Robertson; Jack R. (1451 Refugio Rd., Santa Ynez, CA 93460) Assignee(s): None Reported Patent Number: 4,612,939 Date filed: October 15, 1984 Abstract: A tube is passed through the urethra into the bladder (indicated by liquid flow from the bladder to the distal end of the tube) and then withdrawn slightly so that its proximal end is within the urethra (indicated by flow cessation). The tube is anchored in that position by sliding a hygroscopic bougie up the outside of the tube and just inside the urethral meatus, and then spraying the bougie with water to expand it against the urethral wall. A proximal enlargement in the tube also aids anchoring.A conical sheath

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is used to expand the meatus, to aid in inserting the tube and bougie. The patient holds a handle on the sheath to facilitate access to the meatus.With the tube anchored, the patient undergoes stress of the type which produces the incontinence to be diagnosed, and the diagnostician observes the timing of liquid discharge from the urethra through the tube, relative to stress incidence. From this relative timing the type of incontinence is inferred. A second tube may be added for simultaneous measurement of bladder pressure. Excerpt(s): This invention relates generally to diagnostic apparatus and methods in gynecology, and more particularly to clinical diagnosis of stress incontinence. (a) Causes of Incontinence--Inability to deter the flow of urine from the bladder is a common phenomenon in women, particularly older women. Such inability to contain urine is termed "incontinence." Roughly half of elderly women are incontinent. An incontinent women usually has an adequate reservoir (the bladder) for urine, but the biological "valve" is for one or another reason inadequate to prevent discharge of urine. The "valve" that normally performs this function is the urethra--the duct through which the bladder is normally emptied during urination--in conjunction with the muscle or sphincter that surrounds the urethra. Web site: http://www.delphion.com/details?pn=US04612939__ •

Refined suspension incontinence

procedure

with

implement

for

treating

female

stress

Inventor(s): Robertson; Jack R. (1430 E. Main St., Suite 202, Santa Maria, CA 93454) Assignee(s): None Reported Patent Number: 5,019,032 Date filed: April 3, 1990 Abstract: The incision-free pubovaginal suspension due to Gittes and Loughlin is improved by simultaneous gas obturation and visual monitoring using a suprapubic endoscope, inserted with the aid of a urethral trocar. It is further improved by simultaneous manipulation of the urethra, bladder and other tissues by the trocar, to optimize alignment for the Gittes procedures. The trocar, and procedure for its use, are refinements of the present inventor's earlier apparatuses and procedures for suprapubic cystostomy with endoscopy, and for gas obturation. Excerpt(s): This invention relates generally to medical procedures and apparatus; and more particularly to refinement of such procedures and apparatus for treating stress incontinence in women by pubovaginal suspension without surgery. "A special long mattress-type needle is needed. A small puncture is made. into the suprapubic fat pad. The long needle is popped through the rectus fascia and the anteriorly deflected tip is advanced carefully down the posterior aspect of the pubic bone. At the same time, the operator's second hand elevates the anterior vaginal wall lateral to the Foley balloon, thus, just lateral to the bladder neck. Wiggling the needle from above and directing it toward the fingertip by rocking forward the suprapubic portion of the needle shaft avoids a false passage into the bladder or past the lateral vaginal wall. While controlling the tip of the needle with the tip of the finger, the operator examines the tented-up vaginal wall to make sure it is not too medial or lateral, and then the tip is popped through the wall and then forward through the introitus." Id. at 568. Although Gittes and Loughlin go on to recommend using a suprapubic "puncture" later for placement of

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a "suprapubic tube of the trocar variety"--for postprocedure drainage--they clearly do not use that puncture for placement of a viewing device for the monitoring step. Web site: http://www.delphion.com/details?pn=US05019032__ •

Single needle apparatus and method for performing retropublic urethropexy Inventor(s): McKay; Hunter A. (18 Meadow La., Mercer Island, WA 98040) Assignee(s): None Reported Patent Number: 5,474,543 Date filed: May 17, 1993 Abstract: A suturing needle asssembly used for the retropubic surgical correction of anatomical stress incontinence due to pelvic relaxation, the suturing needle assembly having an array of four needles inside a protective sheath. The sheath protects fragile tissues from inadvertent penetration by the four needles, each of which has an eyelet for capture of a surgical suture. The spacing of the four needles within the sheath allows for the precise positioning of two sutures (previously woven through a polypropylene "bolster") underneath the endopelvic fascia at the junction of the bladder neck and urethra. According to a method of the present invention, the suturing needle assembly is positioned retropubically at the right side of the bladder neck and the needle points extruded from within the sheath, thus penetrating through the endopelvic fascia. Through a small vaginotomy, a previously fashioned flat bolster is positioned beneath the endopelvic fascia and the four needle points used to capture the two monofilament sutures passing through the bolster. Cephalad withdrawal of the instrument positions the four suture ends into the retropubic region for securing to Cooper's ligament. An identical procedure is done on the left side. As a result, anterior pelvic relaxation and stress urinary incontinence are corrected with a high degree of success. Excerpt(s): The invention relates generally to an apparatus and method for performing a retropubic urethropexy procedure to correct female stress incontinence, and more specifically to a single needle assembly apparatus and method for manipulating a plurality of sutures, preferably suspending a surgical bolster, to facilitate the surgical procedure and improve morbidity. Relaxation of muscles and tissues supporting the bladder neck can produce stress incontinence in the human female. Surgical correction of this condition can be effective when the bladder neck can be elevated and supported from above with heavy, non-absorbable sutures. Surgical procedures for this purpose have evolved from purely retropubic operations such as the Marshall-Marchetti procedure described in journal article "The Correction of Stress Incontinence by Simple Vesicourethral Suspension", Marshall, V. F., Marchetti, A. A., Krantz, K. E., Surgery Gynecology and Obstetrics, 88:590, 1949, and its variants such as described in the journal article "Urethrovaginal Fixation to Cooper's Ligament for Correction of Stress Incontinence, Cystocele, and Prolapse:, Burch, J. C., American Journal of Obstetrics and Gynecology, 81:281, 1961, to combined retropubic and vaginal operations. Such procedures are, for example, described in journal articles: "Combined Urethrovesical Suspension and Vaginourethroplasty for Correction of Urinary Stress Incontinence", Peyrera, A. J., and Lebherz, T. B., Obstetrics and Gynecology, 30:537, 1967; "Endoscopic Suspension of the Vesical Neck for Urinary Incontinence", Stamey, T. A., Surgery Gynecology and Obstetrics, 136:547, 1973; and "Modified Bladder Neck Suspension for Female Stress Incontinence", Raz, S., Suspension for Female Stress Incontinence", Raz, S., Urology, 17:82, 1981. This group of surgical operations, commonly and collectively referred to as needle suspensions, requires precise positioning of various needles for the

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placement of the heavy, non-absorbable sutures. Endoscopic confirmation of needle and suture placement has proven a valuable aspect of these operations. However, technical difficulties with placement of the various needles in patients who have undergone prior incontinence surgery may result in repeated entries into the bladder, and/or less than optimal positioning of the sutures at other than the precise bladder neck. The relatively small cross-section of the sutures can produce physical stresses on the supported tissues that eventually cause the sutures to bear into the supported tissues, reversing the effect of the surgery. Web site: http://www.delphion.com/details?pn=US05474543__ •

Spiral needle for endoscopic surgery Inventor(s): McJames, II; William C. (Belle Mead, NJ), Miller; Donald G. (Three Bridges, NJ), Nering; Robert (Sergeantsville, NJ), Nering; Thomas (Milford, NJ), Rollero; Joseph (Whitehouse Station, NJ), Schaible; Lester E. (Somerville, NJ) Assignee(s): Ethicon, Inc. (somerville, Nj) Patent Number: 5,935,138 Date filed: September 24, 1997 Abstract: A needle for endoscopic surgery is curved into an arc of more than 180.degree. and twisted, so that it forms a part of a spiral, with a lateral offset between the needle point and barrel. The needle is sized to fit through a 10 mm trocar and is also blackened, to improve its visibility in a bloody field. The needle curvature is preferably not constant over its entire length, so that different sections have different radii of curvature. The needle is particularly well adapted for performing laporascopically a procedure (Burch Colposuspension) that is used to treat female stress incontinence. Excerpt(s): This invention relates to a needle for endoscopic surgery, more particularly, a horseshoe-shaped needle that is twisted out of a single plane. Surgical needles come in a variety of shapes, from straight to curved. Among curved needles, the needle may be "planar", with the entire needle in a single plane, or "aplanar", in which the point and barrel of the needle may be said to be offset from one another. Aplanar needles have been known for many years. U.S. Pat. No. 1,377,359, issued May 10, 1921, to D. Littlejohn discloses a surgical needle with semicircular bends at each end, the two semicircular regions being in planes that are at right angles to each other. Thus, when the needle is laid upon a flat surface, it always presents an upstanding grasping surface. Web site: http://www.delphion.com/details?pn=US05935138__

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Stress incontinence diagnostic and treatment device Inventor(s): Manetta; Alberto (2729 Eighth Ave., Altoona, PA 16602) Assignee(s): None Reported Patent Number: 4,290,420 Date filed: June 9, 1980 Abstract: An apparatus for diagnosing and treating stress urinary incontinence includes a belt surrounding the patient's trunk, a support plate on the belt, parallel tubes on the plate, and a generally U-shaped, downwardly opening pressure member having bent portions at the ends of the legs with enlarged tips. The bent portions enter the vagina

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and apply pressure against the anterior wall thereof to modify the urethrovesical angle, relieving the condition. The pressure member is wire coated with a physiologically inert polymer. Excerpt(s): This invention relates to an apparatus for assisting in the diagnosis of a medical condition commonly referred to as stress urinary incontinence and for nonsurgical treatment of that condition. Stress urinary incontinence is a well recognized female physical problem which manifests itself by uncontrolled urinary discharge during strenuous exercise or activity such as lifting, coughing or sneezing. The cause of the condition is anatomical and has been traced to a characteristic of the angle between the bladder and the urethra, known as the urethrovesical angle. Discussions of the condition and some devices for dealing with it appear in the following patents. U.S. Pat. No. 4,139,006 Corey. Web site: http://www.delphion.com/details?pn=US04290420__ •

Surgical correction of female urinary stress incontinence and kit therefor Inventor(s): Lemay; Claude (Ste. Croix, CA) Assignee(s): R. Laborie Medical Corporation (quebec, Ca) Patent Number: 5,013,292 Date filed: February 24, 1989 Abstract: A surgical kit is provided, for a urethropexy procedure, comprising at least one needle (comprising a cannula and a trocar), a pair of implants and a tray for supporting and packaging the needle(s) and implants. The kit is sterilizable. A procedure for urethropexy is disclosed which may be carried out under local anesthesia. Excerpt(s): The present invention is directed to a method for the surgical correction of female urinary stress incontinence and a kit therefor. More particularly, the present invention is directed to a surgical technique for urethropexy and a kit containing materials to effectuate the technique. Female urinary stress incontinence is treated urgically by tying the urethro-vesical junction to the back of the symphysis pubis. Kelly 1913, Marshall 1949, Pereyra 1959, Burch 1961, Stamey 1973, Stamey 1975, Cobb et al. 1978 and Pereyra et al. 1967 have all helped to refine the technique and to improve the results. However, these prior techniques have required the utilization of general anesthesia and have not been conducive to repeat performances, even though such reoperation may be dictated in numerous cases. It is an object of the invention to provide a surgical technique for urethropexy which may be performed under local anesthesia. Web site: http://www.delphion.com/details?pn=US05013292__

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Urethral probe for diagnosing stress incontinence Inventor(s): Vaughan; Ward P. (115 Old Forest Cir., Winchester, VA 22602) Assignee(s): None Reported Patent Number: 5,864,961 Date filed: September 4, 1996 Abstract: An urethral probe comprised of a generally inflexible rod having a length of about 14 to 20 centimeters, extremely smooth surfaces and including a bulbous tip

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approximately one centimeter in length, an enlarged central portion of approximately 0.5 centimeters in diameter and a rounded terminal end portion. The probe is preferably of molded plastic, packaged in a sterile individual wrapper and disposed of after a single use. Calibrations in hypoallergenic ink assist the doctor or technician in the performance of a "Q-tip test" for measuring the urethral length, for evaluating the tone of the patient's sphincter, i.e., the trigone of the bladder, and for detecting the amount of change in the urethral vesicle angle incident to the diagnosis and evaluation of urinary stress incontinence. Excerpt(s): It has been more than 25 years since gynecologists first performed a "Q-tip test" utilizing a cotton-tipped device as an urethral probe for measuring the urethral length and change in the vesicle angle while making a diagnosis and/or evaluation of urinary stress incontinence. This procedure is described in considerable detail in U.S. Pat. No. 4,072,144 granted in 1978 and in U.S. Pat. No. 4,612,939 granted in 1986. A clinician uses an urethral probe for examining the urethra of a female patient as an aid in determining the extent of relaxation or change in position of the supporting tissues around the neck of the bladder, sphincter (trigone) and urethra. The probe in the hands of a skilled physician is used to measure the change in the urethral vesicle angle when the patient performs one or more straining maneuvers, and also is used to determine the length of the urethra and the tone of the sphincter, i.e., the trigone of the bladder. Web site: http://www.delphion.com/details?pn=US05864961__ •

Vibratory device for treating voiding dysfunction Inventor(s): Borodulin; German (583-46th Ave., San Francisco, CA 94121), Persidsky; Maxim (35 Temescal, San Francisco, CA 94118), Shkolnik; Alexander (485 Dartmouth Ave., San Carlos, CA 94070) Assignee(s): None Reported Patent Number: 5,921,944 Date filed: January 16, 1998 Abstract: A vibratory device (20) for treating female voiding dysfunctions, such as urinary stress incontinence, by inserting it into a patient's urinary tract and imparting vibrations to the urethral walls and the bladder neck. The device is made in the form of a urological bougie (23) which has a distal end and a proximal end and consists of two resilient rods (26 and 28). The rods are removably interconnected at their distal ends by means of two short extensions (52a and 52b) which are inserted into a cup-shaped cavity (68). This cavity is formed at the end of a cam (66). The cam has an elliptical or oval shape and is driven into rotation from a rotary drive unit (24) through a cam shaft (64) which passes through the hole formed by grooves (54) on the mating surface of the rods. Due to the elliptical configuration of the cam, its rotation causes expansion of the rods (26 and 28). The rods, however, cannot be disconnected during the operation, as their projections (52a and 52b) are confined within the cup-shaped cavity. The probe is covered by a rubber condom-like shell (30) which protects the mucosa of the patient's urethra from pinching. At the same time the outer shell prevents leaking of the urine from the patient's bladder during the treatment procedure. With the shell the vibratory treatment can be carried out with the bladder being filled. In this case vibration can be transmitted to the detrusor muscles, i.e., to the bladder walls. As a result, the vibratory treatment can be more efficiently used.

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Excerpt(s): This invention is a modification of the expandable urethral bougie disclosed in U.S. Pat. No. 4,773,400, issued on Sep. 27, 1988. The present invention relates to medical instruments, particularly to a vibratory device for treating female voiding dysfunctions associated with functional and organic changes in the urethra and bladder neck. Most often met form of voiding dysfunctions is urinary incontinence. According to data from the January 1991 issue of "Lovett Underwood Neuhause & Webb", over 10 million Americans, i.e. 4 percent of the U.S. adult population alone suffer from some form of urinary incontinence. The economic impact of urinary incontinence is enormous and is likely to rise as the number of elderly in the population increases. In accordance with data from the Journal of Urology, April 1988, urinary incontinence in the elderly is a major social problem. The annual cost of incontinence care in the U.S. alone currently exceeds $10 billion. Web site: http://www.delphion.com/details?pn=US05921944__ •

Visually-directed surgical instrument and method for treating female urinary incontinence Inventor(s): Miller; Gary H. (Milpitas, CA) Assignee(s): Ethicon, Inc. (somerville, Nj) Patent Number: 6,475,139 Date filed: May 18, 2000 Abstract: Described is a surgical instrument and method for treating female urinary stress incontinence. The instrument includes a curved needle-like element defining in part a curved shaft having a distal end and a proximal end. A tape attaches to the needle for implanting into the lower abdomen of a female to provide support to the urethra. The needle defines an inner lumen for passage of optical devices and/or fluids. A surgical optical system may interface directly with the needle, or alternatively, the needle hand piece or handle may be modified to accept the optical system. The tip of the needle is also modified to contain a window or viewing port that allows for the transmission of light from the ambient target tissue into the imaging lens of the optical system. The optical system allows the surgeon to maintain continuous anatomic visualization during introduction and navigation of the needle within the lower abdomen. Excerpt(s): The present invention relates generally to a surgical instrument and a method for treating female urinary incontinence and in particular to a needle adapted to provide visualization of the tissue during the procedure. Women account for more than 11 million of incontinence cases. Moreover, a majority of women with incontinence suffer from stress urinary incontinence (SUI). Women with SUI involuntarily lose urine during normal daily activities and movements, such as laughing, coughing, sneezing and regular exercise. Normally, the urethra, when properly supported by strong pelvic floor muscles and healthy connective tissue, maintains a tight seal to prevent involuntary loss of urine. When a woman suffers from the most common form of SUI, however, weakened muscle and pelvic tissues are unable to adequately support the urethra in its correct position. As a result, during normal movements when pressure is exerted on the bladder from the diaphragm, the urethra cannot retain its seal, permitting urine to escape. Because SUI is both embarrassing and unpredictable, many women with SUI avoid an active lifestyle, shying away from social situations. Web site: http://www.delphion.com/details?pn=US06475139__

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Patent Applications on Stress Incontinence As of December 2000, U.S. patent applications are open to public viewing.9 Applications are patent requests which have yet to be granted. (The process to achieve a patent can take several years.) The following patent applications have been filed since December 2000 relating to stress incontinence: •

Apparatus and method for treating urinary stress incontinence Inventor(s): Franco, Nicholas; (New Orleans, LA) Correspondence: Thomas S. Keaty; Keaty Professional Law CORP.; 2140 World Trade Center; NO. 2 Canal Street; New Orleans; LA; 70130; US Patent Application Number: 20030028180 Date filed: August 1, 2001 Abstract: An apparatus and method for treating female stress-induced incontinence and other similar diseases associated with weakening of the pelvic floor muscles. A guiding catheter with temperature sensor(s) is positioned in patient's urethra. An inflatable balloon carried by a forward end of the catheter is inflated to sit in a neck of a bladder. Measuring indicia on the exterior of the catheter is indicative of a distance between the bladder neck and external meatus. A vagina probe member provided with a laser output in a forward portion thereof is then positioned in place such that the laser output is at about a level of the bladder neck, as facilitated by the guiding catheter. The laser output is operationally connected to a medical laser generating and monitoring device that delivers a laser beam to selected areas in the pelvic floor to cause denaturing and recoiling of the tissue collagen in the area surrounding the urethra. A cooling medium is circulated through the probe member to cool the immediately adjacent tissue. If temperature inside the urethra reaches a dangerous level, supply of the laser energy through the probe is terminated. Excerpt(s): The present invention relates to the field of surgery, and more particularly to an apparatus and method for surgical treatment of female urinary stress incontinence. Stress-induced urinary incontinence (SUI) may be caused by a variety of activities, such as coughing, laughing, sneezing, exercising, lifting of heavy objects and other everyday activities. Sudden change of pressure in the intra-abdominal cavity causes the urethra to incompletely shut and leakage occurs. Such phenomenon usually takes place when there is an insufficient support of the urethra from the pelvic floor muscles and the structures within the muscles. A number of factors cause this effect: aging, vaginal deliveries of babies, changes in hormonal level, and others. The present invention takes into consideration the fact that women suffering from the SUI show deficient levels of collagen in the matrix of the tissue that supports the urethra and the base of the bladder, the bladder neck. The supporting tissue resembles a trampoline that stretches underneath the bladder; when the support is weakened or sagging, the entire pelvic floor experiences changes that may lead to SUI, vaginal prolapse and other diseases. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

9

This has been a common practice outside the United States prior to December 2000.

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Devices for interstitial delivery of thermal energy into tissue and methods of use thereof Inventor(s): Loeb, Marvin P.; (Huntington Beach, CA) Correspondence: Olson & Hierl, LTD.; 36th Floor; 20 North Wacker Drive; Chicago; IL; 60606; US Patent Application Number: 20020193781 Date filed: June 14, 2001 Abstract: A device is provided for interstitial delivery of thermal energy and/or a biologically compatible bulking material into tissues in a confined space. The device include means for delivering laser, radio-frequency, electrical, microwave, ultrasound or other thermal energy, as well as a port and channel for concomitant or subsequent injection of a bulking agent. The method of use of the device in the treatment of female stress incontinence (FSI), gastro-esophageal reflex disease (GERD), benign prostate hyperplasia (BPH) and other conditions is described. Excerpt(s): The invention relates to catheter devices. More particularly, the invention relates to catheter devices capable of interstitially delivering thermal energy to selected body tissues. It is common to apply localized heating to tissue within patient's bodies to cauterize lesions and stop bleeding. Localized heating is also used to coagulate or vaporize tissues in a variety of medical procedures, for example, in the treatment of bleeding ulcers. RF energy is frequently utilized for thermally coagulating tissues to stop bleeding. Other examples of the use of radio frequently (RF) heating devices can be found in cauterization of the endometrium of the uterus to treat excessive bleeding and the lobes of the prostate to treat benign prostate hyperplasia (BPH). Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Diagnosis of lower urinary tract dysregulation Inventor(s): Schmidt, Richard A.; (Lane Arvada, CO) Correspondence: Dorsey & Whitney, Llp; Intellectual Property Department; 370 Seventeenth Street; Suite 4700; Denver; CO; 80202-5647; US Patent Application Number: 20040015100 Date filed: March 7, 2003 Abstract: The invention disclosed herein provides a system and method for diagnosing lower urinary system conditions by receiving urodynamic data and subjective symptomatic impressions concerning a patient. The system and method then assigns weighted point values to the urodynamic data, for example, urethal pressure profiles due to sphincter contraction conditions such as urgency (2) and stress incontinence (4), and the subjective symptomatic impressions, quantifies norms for lower urinary system function, as a whole or in part, and quantifies recognized pathologies of lower urinary system conditions as degrees of departure from the norms. The system and method then determines a lower urinary system condition diagnosis of the patient, as a function of the degrees of departure from the norms, by invoking a set of rules to compare the weighted point values assigned and the quantified norms. The invention then reports the lower urinary system condition diagnosis, treatment recommendation, or further diagnostic suggestions.

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Excerpt(s): This application claims priority to U.S. provisional application No. 60/232,280 entitled "Method for Diagnosis of Lower Urinary Tract Dysregulation and Related Conditions," filed Sep. 13, 2000 (the '280 application). The '280 application is herby incorporated by reference as though fully set forth herein. The present invention relates to a diagnostic system for lower urinary tract dysregulation and related conditions. The invention specifically concerns the provision of diagnoses and recommended treatments of lower urinary tract dysregulation and related disorders through the computerized comparison and interpretation of urethral pressure profiles and other lower urinary tract data. Over the past decade, the urethral pressure profile (UPP) has become less popular as a diagnostic tool for urinary incontinence. There are several publications that have noted very poor correlation between the diagnosis of incontinence and peak urethral pressures. Some of these papers are, for example, G. Lose, Urethral Pressure Measurement, 166 Acta. Obstet. Gynecol. Scand. Suppl. 39 (1997); S. Meyer, et al., Urodynamic Parameters in Patients with Slight and Severe Genuine Stress Incontinence: Is the Stress Profile Useful?, 13(1) Neurourol. Urodyn. 21 (1994); E. Versi, Discriminant Analysis of Urethral Pressure Profilometry Data for the Diagnosis of Genuine Stress Incontinence, 97(3) Br. J. Obstet. Gynaecol. 251 (1990); M. C. de Jong, et al., The Static Urethral Pressure Profile in Female Incontinence: A Comparison Between Sphincter and Detrusor Incontinence, 78 Prog. Clin. Biol. Res. 231 (1981). The conclusion of these authors has been that measurements obtained through a UPP add little value to the work-up of an incontinent patient. On the other hand, many published articles reference and document the phenomenon of urethral instability. The role of urethral instability, unlike detrusor instability, however, has remained undefined both in terms of its contribution to symptoms and defining an approach to treatment. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Incontinence treatment device Inventor(s): Cohen, Ehud; (Ganei Tikva, IL), Gross, Yossi; (Moshav Mazor, IL), Lifschitz, David; (Zurich, CH), Nissenkorn, Israel; (Tel Aviv, IL) Correspondence: Wolf Greenfield & Sacks, PC; Federal Reserve Plaza; 600 Atlantic Avenue; Boston; MA; 02210-2211; US Patent Application Number: 20020062060 Date filed: January 15, 2002 Abstract: A device and method for treatment of urinary stress incontinence. At least one electrode is implanted in a pelvic muscle of a patient. A control unit receives signals indicative of abdominal stress in the patient and responsive thereto applies an electrical waveform to the electrode which stimulates the muscle to contract, so as to inhibit involuntary urine flow through the patient's urethra due to the stress. Excerpt(s): This application is a continuation-in-part of U.S. patent application No. 09/167,244, which is incorporated herein by reference. The present invention relates generally to medical electronic devices, and specifically to implantable electrical muscle stimulators. Urinary stress incontinence affects millions of people, causing discomfort and embarrassment, sometimes to the point of social isolation. Stress incontinence results from weakness or inability of pelvic muscles to hold back urinary flow from the bladder when abdominal pressure increases due to everyday events such as coughing, laughing or mild physical exertion. Muscles involved in controlling the urinary flow include primarily the urethral sphincter and the levator ani, with the cooperation of fibromuscular extensions along the urethra and other muscles in the general region of

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the pelvic diaphragm. In the United States, it is estimated that 10-13 million patients seek medical care for incontinence each year, of whom about 35% suffer from stress-type incontinence. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Medical sling procedures and anchor insertion methods and devices Inventor(s): Beyar, Mordechay; (Caesarea, IL) Correspondence: Oppenheimer Wolff & Donnelly Llp; 840 Newport Center Drive; Suite 700; Newport Beach; CA; 92660; US Patent Application Number: 20020050277 Date filed: November 26, 2001 Abstract: A procedure for treating urinary stress incontinence by using bone anchors, whether screw or staple type, with or without suture, inserted pervaginally for use with a sling material for supporting the bladder neck and/or proximal urethra. Excerpt(s): The present application claims the priority of U.S. patent application Ser. No. 08/733,798, filed Oct. 18, 1996 (pending); the priority of U.S. patent application Ser. No. 08/622,598 filed Mar. 26, 1996 (patented, and issued as U.S. Pat. No. 5,807,403 on Sep. 15, 1998); the priority of U.S. patent application Ser. No. 08/150,517 filed on Nov. 10, 1993 (patented, and issued as U.S. Pat. No. 5,520,700 on May 28, 1996); the priority of Israeli Patent Application No. 103737, filed Nov. 13, 1992; the priority of U.S. Provisional Application No. 60/012,205, filed Feb. 23, 1996; and the priority of U.S. Provisional Patent Application No. 60/005,348, filed Oct. 18, 1995; and the priority of Israeli Patent Application No. 127978, filed Jan. 8, 1999. The present application claims all domestic and foreign priority benefits of these prior applications, all of which are fully incorporated herein by reference. The present invention relates to pervaginal sling procedures using bone anchors. Urinary stress incontinence, i.e., the inability to control urination from the bladder, is a distressing problem for more than ten percent of elderly women as well as for many young women. Different theories exist to explain the pathology. In a normally anatomically positioned bladder, the proximal urethra and the bladder are in pressure continuity with the abdominal cavity, so that an increase in abdominal pressure is transmitted both to the bladder and to the proximal urethra, resulting in normal continence. However, particularly among elderly women, the bladder and the proximal urethra tend to descend from their normal or original anatomic positions such that the bladder neck and proximal urethra move away from the posterior wall of the pubic bone. When this occurs, the proximal urethra is no longer in pressure continuity with the abdominal cavity; therefore, an unintended increase in intra-abdominal pressure (e.g. by laughing or coughing) results in an increase in intravesical pressure, but no change in the urethral closing pressure, thereby producing so-called stress incontinence. It also appears that as the bladder descends, the urethra becomes shorter and curved, so that its radial tonic muscle contraction is reduced, contributing to incontinence. Another pathology may arise from urethral sphincteric damage (type III incontinence). Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Pelvic disorder treatment device Inventor(s): Cohen, Ehud; (Ganei Tikva, IL), Gross, Yossi; (Moshav Mazor, IL), Nissenkorn, Israel; (Ramat Aviv, IL) Correspondence: Ladas & Parry; 26 West 61st Street; New York; NY; 10023; US Patent Application Number: 20030100930 Date filed: November 29, 2001 Abstract: A device for treating a medical condition is provided, and a surgical procedure for implanting the device is disclosed. The device includes a sensor, which is adapted to generate a signal responsive to a state of a patient, and at least one electrode, which is adapted to be coupled to a pelvic site of the patient. A control unit is adapted to receive the signal, to analyze the signal so as to distinguish between an imminent stress incontinence event and an imminent urge event, and, responsive to analyzing the signal, to apply an electrical waveform to the at least one electrode. In various configurations, the device may be used alternatively or additionally to treat fecal incontinence, interstitial cystitis, chronic pelvic pain, or urine retention. Excerpt(s): The present invention relates generally to electronic medical devices, and specifically to devices to relieve problems associated with urinary incontinence and other pelvic disorders. Urinary incontinence affects millions of people, causing discomfort and embarrassment, sometimes to the point of social isolation. In the United States, recent studies have shown that as many as 25 million persons, of whom approximately 85% are women, are affected by bladder control problems. Incontinence occurs in children and young adults, but the largest number affected are the elderly. Urethral hypermobility--Weakness of or injury to pelvic floor muscles causes the bladder to descend during abdominal straining or pressure, allowing urine to leak out of the bladder. This is the more common source of stress incontinence. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Percutaneous device and method for treating urinary stress incontinence in women using a sub-urethral tape Inventor(s): Scetbon, Victor; (Paris, FR) Correspondence: Oliff & Berridge, Plc; P.O. Box 19928; Alexanderia; VA; 22320; US Patent Application Number: 20010018549 Date filed: January 22, 2001 Abstract: A device for treating urinary stress incontinence in women includes a flexible and elongate mechanism including a tape for supporting a urethra and a flat protective sheath enveloping the tape; and a puncturing needle with an active distal end and a proximal end connected to a first end of the flexible and elongate mechanism, wherein the proximal end of the puncturing needle is connected to a first end of the flexible and elongate mechanism by an intermediate traction element, a second end of the flexible and elongate mechanism being free. A method for treating urinary stress incontinence in a woman suffering from urinary stress incontinence is also provided including (a) forming an opening in an anterior vaginal wall; (b) creating, from two small suprapubic incisions formed in the abdominal wall, a right track and a left track from the abdominal skin to the opening formed in the anterior vaginal wall; (c) using a needle and an intermediate traction element to follow one of the tracks and following the other track

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with at least a needle; (d) verifying by cystoscopy that the paths of the tracks are outside the bladder and the urethra; (e) using a support tape surrounded by a plastic sheath to follow the tracks by passage under an inferior surface of the urethra; (f) adjusting a loop formed by the sheathed tape under the inferior surface of the urethra; (g) removing the sheath by pulling the sheath toward the outside of the woman's body through the small suprapubic incisions; and (h) leaving the tape implanted from the first to the second incision and around the urethra to support the urethra. Excerpt(s): The present invention relates to the problems of urinary incontinence in women and more specifically to the problems of urinary stress incontinence. The invention relates more particularly to a percutaneous device for treating urinary stress incontinence in women using a sub-urethral tape. These problems are currently treated during surgical interventions under local, regional or general anesthetic and consist in implanting a tape in such a way as to support the urethra without tension. Thanks to the regional or local anesthesia, the surgeon can immediately check that continence has been restored, with the participation of the patient. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Suburethral support assembly in treatment of female urinary stress incontinence Inventor(s): Therin, Michel; (Lyon, FR) Correspondence: Oliff & Berridge, Plc; P.O. Box 19928; Alexandria; VA; 22320; US Patent Application Number: 20030004395 Date filed: May 22, 2002 Abstract: This assembly includes a suburethral supporting strip and a needle or similar sharp part designed to pass through the skin.According to the invention:a) the assembly includes a composite band comprised of at least the suburethral supporting strip and a flat protective sheath, said strip being disposed for example freely inside this sheath;b) the flat sheath includes, in its lengthwise direction, two parts disposed on either side of a central separation area;c) at each of its two ends the composite band has a single part of a lockable and unlockable connecting means, while the percutaneous needle has at least one other part of a connecting means, the connecting means of the composite band and each connecting means of the needle enabling the needle to be connected releasably to at least one of the ends of said composite band. Excerpt(s): The present invention relates to surgical treatment of female urinary stress incontinence. In particular, the invention relates to a surgical assembly which, at the end of the procedure or operation, supports the urethra by a suburethral strip both of whose ends are attached to an appropriate part of the body of the patient, for example to the abdominal wall thereof. For this purpose, in general, the surgical assembly according to the present invention comprises a suburethral supporting strip and a needle or similar sharp part passed through the skin, said needle engaging and pulling the suburethral supporting strip. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Surgical instrument and method for treating female urinary incontinence Inventor(s): Chen, Chao-Chen; (Edison, NJ), Lehe, Jorn; (Hamburg, DE), Luscombe, Brian H.; (Warren, NJ) Correspondence: Audley A. Ciamporcero JR.; Johnson & Johnson; One Johnson & Johnson Plaza; New Brunswick; NJ; 08933-7003; US Patent Application Number: 20010049467 Date filed: June 18, 2001 Abstract: Described is a surgical instrument and method for treating female urinary stress incontinence. The instrument includes a curved needle-like element defining in part a curved shaft having a distal end and a proximal end. The diameter of the needle decreases from the proximal end to the distal end, and the needle terminates in a blunt tip. A tape attaches to the needle for implanting into the lower abdomen of a female to provide support to the urethra. The tape may be made from synthetic and natural materials. The needle and tape may also be modified to allow the surgeon to attach and detach the tape during the surgical operation. Excerpt(s): The present invention claims the benefit of earlier-filed U.S. provisional patent application Ser. No. 60/138,231, filed on Jun. 9, 1999, which is hereby incorporated by reference in its entirety herein. The present invention relates generally to a surgical instrument and a method for treating female urinary incontinence and in particular to a conical needle for facilitating the perforation of different layers of tissue, with each tissue layer having a different resistance against perforation. Women account for more than 11 million of incontinence cases. Moreover, a majority of women with incontinence suffer from stress urinary incontinence (SUI). Women with SUI involuntarily lose urine during normal daily activities and movements, such as laughing, coughing, sneezing and regular exercise. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Topical composition and method for treating urinary stress incontinence Inventor(s): Wyllie, Michael G.; (Kent, GB) Correspondence: Drinker Biddle & Reath; One Logan Square; 18th And Cherry Streets; Philadelphia; PA; 19103-6996; US Patent Application Number: 20040044082 Date filed: September 29, 2003 Abstract: There is provided a method and composition for treating urinary stress incontinence based upon the topical administration of an alpha-adrenoceptor agonist, such as phenylephrine. A daily dosage of 20 mg to 2000 mg is suitable, and the composition may conveniently be applied as a cream or gel to the vaginal or periurethral area. Excerpt(s): The present invention relates to a pharmaceutical composition for treating urinary stress incontinence. Urinary incontinence is the involuntary loss of urine which is objectively demonstrable, and the condition presents both a social or hygienic problem to those affected. "Stress incontinence" is the term used to describe the condition when the involuntary loss of urine occurs during physical exertion. Stress incontinence will affect up to 10% of the adult female population. The incidence increases substantially after child-birth. Conventionally, treatment of urinary stress

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incontinence has included either lifestyle modification or surgery. The former treatment includes weight reduction, reduction or elimination of smoking and reduction of food, and particularly fluid, intake. Various surgical procedures are also possible, should the symptoms be sufficiently severe. The use of drugs is not widespread, and sufferers often have to resort to the use of incontinence pads and adult nappies. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

Keeping Current In order to stay informed about patents and patent applications dealing with stress incontinence, you can access the U.S. Patent Office archive via the Internet at the following Web address: http://www.uspto.gov/patft/index.html. You will see two broad options: (1) Issued Patent, and (2) Published Applications. To see a list of issued patents, perform the following steps: Under “Issued Patents,” click “Quick Search.” Then, type “stress incontinence” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on stress incontinence. You can also use this procedure to view pending patent applications concerning stress incontinence. Simply go back to http://www.uspto.gov/patft/index.html. Select “Quick Search” under “Published Applications.” Then proceed with the steps listed above.

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CHAPTER 5. BOOKS ON STRESS INCONTINENCE Overview This chapter provides bibliographic book references relating to stress incontinence. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on stress incontinence include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.

Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “stress incontinence” (or synonyms) into the “For these words:” box. You should check back periodically with this database which is updated every three months. The following is a typical result when searching for books on stress incontinence: •

Patient's Guide to Urology: Plumbing Problems in Layman's Terms Source: Toledo, OH: High Oaks Publishing Company. 1995. 258 p. Contact: Available from bookstores and libraries and, at the wholesale level, from Baker and Taylor, (908) 722-8000. Also available in orders of 10 or more copies from High Oaks Publishing Company, Center Urology of Toledo, Inc. 3425 Executive Parkway, Suite 214, Toledo, OH 43606. (419) 531-1700. PRICE: $21.95 (cloth); $12.95 (paperback). ISBN: 0964577305 (cloth); 0964577313 (paper). Summary: In this book, the author presents a clear and concise discussion of the functioning of the normal genital and urinary tracts, the common malfunctions resulting from disease, and the principles of treatment. Twenty-eight chapters cover topics including impotence; circumcision; hypospadias; Peyronie's disease; benign prostatic hyperplasia; prostatic cancer; the bladder and urinary incontinence; stress incontinence;

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urethral stenosis; interstitial cystitis; bedwetting; blood in the urine and bladder cancer; toilet training; kidney cysts and cancer; kidney stones; dialysis and kidney transplantation; scrotal problems; testicular cancer and the role of male selfexamination; vasectomy; male fertility problems; infections of the urinary tract; prostatitis; sexually transmitted diseases; and AIDS. A detailed glossary and brief subject index conclude the book. •

Practical Urogynecology Source: Baltimore, MD: Williams and Wilkins. 1993. 399 p. Contact: Available from Williams and Wilkins. 428 East Preston Street, Baltimore, MD 21202. (800) 638-0672. PRICE: $70 plus $4 UPS shipping and handling. ISBN 0683086456. Summary: Oriented to the general clinician and resident-in-training, this volume discusses the lower urinary tract problems of the adult female. Eighteen chapters cover topics including the psychosocial issues of urinary incontinence; pelvic anatomy and the physiology of the lower urinary tract; evaluating symptoms; practical urodynamics; stress incontinence, including conservative and surgical management; urge incontinence and the unstable bladder; mixed incontinence; atypical causes of incontinence; urinary tract infection; sensory disorders of the bladder and urethra; bladder emptying problems; prolapse and the lower urinary tract; special considerations in the elderly; urinary tract injury in gynecologic surgery; absorbent products and catheters; and case studies. Each chapter includes numerous references and the volume concludes with two appendices: useful organizations and publications; and an index to the case studies in the last chapter. A subject index is also included.

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Instructions for Patients. 5th ed Source: Philadelphia, PA: W.B. Saunders Company. 1994. 598 p. Contact: Available from W.B. Saunders Company. Book Order Fulfillment, 6277 Sea Harbor Drive, Orlando, FL 32887-4430. (800) 545-2522. Fax (800) 874-6418. PRICE: $49.95. ISBN: 0721649300 (English); 0721669972 (Spanish). Summary: This book is a compilation of instructions for patients, published in paperback format. Each fact sheet provides information in three sections: basic information, including a description of the condition, frequent signs and symptoms, causes, risk factors, preventive measures, expected outcome, and possible complications; treatment, including general measures, medication, activity guidelines, and diet; and when to contact one's health care provider. Fact sheets are available on kidney and urologic topics including: enuresis; cystitis in women; cystitis in men; bladder or urethra injury; bladder tumor; glomerulonephritis; male impotence; urinary incontinence; stress incontinence; urge incontinence; acute pyelonephritis; chronic kidney infection; polycystic kidney; kidney stones; the nephrotic syndrome; priapism; benign prostatic hyperplasia; prostatitis; acute renal failure; chronic kidney failure; testicular torsion; urethritis; and Kegel exercises. The fact sheets can be photocopied and distributed to patients as a reinforcement of oral instructions and as a teaching tool. The book is available in English or Spanish.

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Conquering Bladder and Prostate Problems: The Authoritative Guide for Men and Women Source: New York, NY: Plenum Publishing Corporation. 1998. 340 p.

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Contact: Available from Kluwer Academic-Plenum Publishing Corporation. 233 Spring Street, New York, NY 10013-1578. (800) 221-9369 or (212) 620-8035. Fax (212) 647-1898. Website: www.plenum.com. PRICE: $26.95. ISBN: 0306458640. Summary: This book is for people who have urinary bladder and prostate problems: people who urinate too often, who plan their daily activities around the availability of a bathroom, men with prostate problems, women with incontinence, and people with bladder pain. The first three chapters review the anatomy and physiology of the urinary system, how urine is created and why, and bladder symptoms. The next 17 chapters cover how to determine the cause of bladder symptoms; urinary frequency, urgency, and urge incontinence; nocturia (urinating at night); bedwetting (enuresis); stress incontinence in women; pregnancy and the bladder; urinary tract infection (UTI); interstitial cystitis and other painful bladder syndromes; difficulty urinating and urinary retention; benign prostate problems; cancer of the prostate; bladder cancer; sphincter incontinence in men; neurogenic bladder; aging and the bladder; fistula (hole) in the bladder; urinary reconstruction and diversion; and the use of absorbent pads, appliances, and other products for controlling incontinence. The author concludes that bladder and prostate problems are symptoms that, in the majority of people, are diagnosable and treatable, and for most, even curable, provided that the patient is treated by a competent physician. The book is written in a clear, nontechnical, humorous style that makes the material more accessible to the lay reader. The book includes an epilogue, glossary of terms, and three appendices: commonly prescribed medications, professional and patient advocacy organizations, and other reading material. A subject index concludes the text, which is illustrated with line drawings, figures, and tables. •

Urinary Incontinence in the Elderly: Pharmacotherapy Treatment Source: Binghamton, NY: Pharmaceutical Products Press. 1997. 72 p. Contact: Available from Haworth Press, Inc. 10 Alice Street, Binghamton, NY 139041580. (800) 429-6784. Fax (800) 895-0582. E-mail: [email protected]. PRICE: $24.95. ISBN: 0789003279. Summary: This reference text covers how to educate health care providers and the public about urinary incontinence (UI) and how physicians, directors of nursing, and other health care providers can begin and maintain a comprehensive, science-based approach to diagnosing and treating UI. The volume begins with the AHCPR guidelines on UI for clinicians. Subsequent chapters are extensions of the AHCPR panel efforts directed at the consumer, caregivers, and directors of nursing. Topics include teaching women about gestational and postpartum pelvic muscle exercises; proper bladder emptying techniques; behavioral, pharmacologic, and surgical treatment of UI; risk factors associated with UI; stress incontinence; and how the body makes, stores, and releases urine (physiology). The text features tables and charts to help readers diagnose the patient's condition, identify the causes for UI, and select appropriate treatment methods. The book also provides a list of helpful questions to assist in the identification and assessment of UI and sample bladder records with which patients can keep track of voluntary and involuntary urine voidings. The book concludes with an annotated bibliography of selected pharmacotherapy studies of the treatment of UI compiled by the editor. 15 references. (AA-M).

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Urogynecology and Urodynamics: Theory and Practice. 4th ed Source: Baltimore, MD: Williams and Wilkins. 1996. 726 p.

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Contact: Available from Williams and Wilkins. 351 West Camden Street, Baltimore, MD 21201-2436. (800) 638-0672 or (410) 528-4223. Fax (800) 447-8438 or (410) 528-8550. E-mail: [email protected]. PRICE: $112.00. ISBN: 068306648X. Summary: This textbook on urogynecology and urodynamics is designed to promote a more active role for the obstetrician, gynecologist, urologist, and other physicians in the evaluation of the female lower urinary tract. The textbook offers information concerning gross and functional neurophysiology, maturation of micturition (urination), new techniques for the evaluation of the lower urinary tract, urodynamics, endoscopy, and imaging. The contributors to the text include experts in neurology, urology, gynecology, geriatrics, psychiatry, and nursing. The text offers 49 chapters covering the normal urinary tract, the epidemiology of incontinence, evaluation of the lower urinary tract and pelvic floor, the pathology and treatment of lower urinary tract abnormalities, detrusor instability, and genuine stress incontinence. Specific topics include embryology, differential diagnosis of urinary incontinence (UI), the effects of drugs on the lower urinary tract, congenital urological abnormalities, urethral diverticula, vesicovaginal fistula, geriatric urogynecology, behavioral and surgical therapy for detrusor instability, the evaluation of different surgical procedures, the prevention of complications about continence surgery, and the use of periurethral bulking agents. The text includes numerous charts, figures, black-and-white photographs, and references; a subject index concludes the volume. •

Urinary Incontinence in Primary Care Source: Oxford, England: Isis Medical Media, Ltd. 2000. 136 p. Contact: Available from Isis Medical Media Ltd. 59 St Aldates, Oxford, OX1 1ST United Kingdom. 01865202939. Fax: 01865202940. Website: www.isismedical.com. PRICE: $25.00 plus shipping and handling. ISBN: 1901865681. Summary: Urinary incontinence (UI) regularly disrupts the lives of about 5 percent of home dwelling adults and is a common problem at all ages. Inadequate training remains a major obstacle to the improved management of UI in primary care: few family practitioners have received postgraduate education or have any specialist knowledge on the subject. This handy sized practical reference guide helps the family care practitioner manage UI in the primary care setting. After an introductory chapter that offers an overview from the primary care perspective, the book includes 11 chapters on anatomy and physiology, the development of urinary incontinence, patient history and examination, investigations (diagnostic tests), coping strategies, treatment of genuine stress incontinence, treatment of detrusor instability, treatment of voiding disorders, other causes of incontinence, practical management, and misconceptions and frequently asked questions. The book includes full color illustrations, flowcharts and algorithms, and a special chapter on case studies to illustrate the practical applications of the concepts presented. A subject index concludes the handbook. 55 figures. 21 tables. 13 references.

Chapters on Stress Incontinence In order to find chapters that specifically relate to stress incontinence, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and stress incontinence using the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the

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drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” Type “stress incontinence” (or synonyms) into the “For these words:” box. The following is a typical result when searching for book chapters on stress incontinence: •

Intravaginal and Intraurethral Devices for Stress Incontinence Source: in Corcos, J.; Schick, E., eds. Urinary Sphincter. New York, NY: Marcel Dekker, Inc. 2001. p. 535-540. Contact: Available from Marcel Dekker, Inc. Cimarron Road, P.O. Box 5005, Monticello, NY 12701. (800) 228-1160 or (845) 796-1919. Fax (845) 796-1772. E-mail: [email protected]. International E-mail: [email protected]. Website: www.dekker.com. PRICE: $225.00 plus shipping and handling. ISBN: 0824704770. Summary: Recent technological advances and the adaptation of products that have traditionally been employed for other purposes have provided interesting options for the nonsurgical management of urinary loss in female patients. These devices include those that are placed externally to the urethral meatus (outside the urinary opening), and accomplish urinary collection; intravaginally beneath the bladder neck, and give anatomical support; or outside or within the urethra, and occlude the exit of urine either at the external meatus or within the urethra. This chapter on intravaginal and intraurethral devices for stress incontinence (involuntary loss of urine in conjunction with a stress such as coughing, sneezing, or laughing) is from a textbook that presents a detailed and systematic account of the current knowledge on the anatomy, physiology, functional relationships, and range of dysfunctions that affect the urinary sphincter. The authors report that many devices currently in use have not been investigated objectively, especially those employed traditionally for other purposes. The most common external collection devices are diapers, pads, and incontinence pads. Several occlusive devices are currently marketed, but their success and presence in the peer reviewed literature are limited. Support of the bladder neck to improve stress urinary incontinence has been achieved, with varying degrees of success, with tampons, pessaries, contraceptive diaphragms, and intravaginal devices not specifically designed for such support. Again, the research data to support the use of these devices is limited and of varying quality. Intraurethral inserts have demonstrated their effectiveness in the control of urinary incontinence. However, the morbidity (complications, problems) associated with their use varies with the design. The authors conclude by calling for more long term outcome research to identify which device or devices provide optimal convenience and effectiveness and the lowest morbidity in the nonsurgical correction of genuine stress incontinence. 26 references.

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Regaining Control with Stress Incontinence Source: in King, B.D. and Harke, J. Coping with Bowel and Bladder Problems. San Diego, CA: Singular Publishing. 1994. p. 45-67. Contact: Available from Singular Publishing Group, Inc. 401 West A Street, Suite 325, San Diego, CA 92101-7904. (800) 521-8545 or (619) 238-6777. Fax (800) 774-8398 or (619) 238-6789. PRICE: $18.95. ISBN: 1565930681. Summary: This chapter is from a book in the Coping with Aging Series on managing bowel and bladder problems. The chapter provides a discussion of the strategies used to regain control of stress incontinence. Topics covered include the role of weight loss; estrogen replacement, including estrogen tablets and vaginal estrogen cream; perineal exercises (Kegel exercises) and identifying the pubococcygeal muscle; a perineal muscle

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exercise program; medications; the use of biofeedback; electrical stimulation used to increase perineal muscle tone; surgical procedures available for women with stress incontinence; considerations for women post-hysterectomy; stress incontinence in men after surgery of the prostate gland; the placement of an artificial sphincter; periurethral injections; and the use of the penile clamp. The authors recommend that patients with stress incontinence begin with the noninvasive methods outlined, before exploring other management options. 11 figures. •

Stress Incontinence in Women Source: in Blaivas, J.G. Conquering Bladder and Prostate Problems: The Authoritative Guide for Men and Women. New York, NY: Plenum Publishing Corporation. 1998. p. 85-106. Contact: Available from Kluwer Academic-Plenum Publishing Corporation. 233 Spring Street, New York, NY 10013-1578. (800) 221-9369 or (212) 620-8035. Fax (212) 647-1898. Website: www.plenum.com. PRICE: $26.95. ISBN: 0306458640. Summary: This chapter on stress incontinence in women is from a book for people who have urinary bladder and prostate problems: people who urinate too often, who plan their daily activities around the availability of a bathroom, men with prostate problems, women with incontinence, and people with bladder pain. The book is written in a clear, nontechnical, humorous style that makes the material more accessible to the lay reader. The author uses the story of one woman's experiences with stress incontinence to describe how the condition can develop and what can be done about it. Topics covered include prolapse (the sagging of the bladder and urethra), the indications for treatment, the surgical treatment of stress incontinence, and the nonsurgical treatments for stress urinary incontinence, including medications, biofeedback, electrical stimulation, pelvic floor exercises, bladder neck prosthesis, and absorbent pads. The six categories of surgery for stress incontinence are based on the same common principle: to restore the support of the bladder and urethra so that they don't fall down again, and to provide a kind of backboard against which the urethra is compressed during stress. The six categories are vaginal suspensions, needle suspensions, retropubic suspensions, pubovaginal sling operations, prosthetic sphincters, and periurethral injections. The author focuses on the components of decision making for stress incontinence surgery, including the patient's needs, overall health (including presence of obesity), and the cause of the incontinence. Each type of surgery is illustrated with a line drawing. 8 figures.

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Genuine Stress Incontinence: An Overview Source: in Ostergard, D.R. and Bent, A.E., eds. Urogynecology and Urodynamics: Theory and Practice. Baltimore, MD: Williams and Wilkins. 1996. p. 493-504. Contact: Available from Williams and Wilkins. 351 West Camden Street, Baltimore, MD 21201-2436. (800) 638-0672 or (410) 528-4223. Fax (800) 447-8438 or (410) 528-8550. E-mail: [email protected]. PRICE: $112.00. ISBN: 068306648X. Summary: Urinary incontinence, whether present in the elderly or young woman, can have devastating effects on self-esteem, psychological well being, and overall physical health. This chapter on genuine stress incontinence is from a textbook on urogynecology and urodynamics that is designed to promote a more active role for the obstetrician, gynecologist, urologist, and other physicians in the evaluation of the female lower urinary tract. This chapter provides an overview of genuine stress incontinence, defined as a symptom, a sign, and a condition. The symptom is the patient's complaint

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of involuntary urine loss with physical exercise. The sign is the observation of urine loss from the urethra immediately upon increasing intra-abdominal pressure (e.g., coughing). The condition genuine stress incontinence is the involuntary loss of urine that occurs when intravesical pressure exceeds maximal urethral pressure in the absence of detrusor activity. The authors provide a historical background, then discuss the mechanism of continence, the urodynamic assessment of stress incontinence, the mechanism of stress incontinence, the scope of the problem, the diagnosis of stress incontinence, and management indications. The primary components that prevent urinary stress incontinence in the female include an internal urethral sphincteric mechanism, an external urethral sphincter, and proper anatomic support of the urethra and urethrovesical junction. Genuine stress incontinence is a consequence primarily from a defect in pelvic support of the urethrovesical junction. Individualized therapies directed toward these defects can correct or improve urodynamically measured parameters that correlate with stress incontinence. 2 figures. 2 tables. 50 references. (AA-M).

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CHAPTER 6. MULTIMEDIA ON STRESS INCONTINENCE Overview In this chapter, we show you how to keep current on multimedia sources of information on stress incontinence. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine.

Video Recordings An excellent source of multimedia information on stress incontinence is the Combined Health Information Database. You will need to limit your search to “Videorecording” and “stress incontinence” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Videorecording (videotape, videocassette, etc.).” Type “stress incontinence” (or synonyms) into the “For these words:” box. The following is a typical result when searching for video recordings on stress incontinence: •

Burch Colposuspension for Genuine Stress Incontinence Source: Atlanta, GA: Emory University Office of Medical Television. 1993. (videocassette). Contact: Available from Robert W. Woodruff Health Sciences Center, Emory University. Office of Medical Television, 1364 Clifton Road, Box M-16, Atlanta, GA 30322. (404) 7279797. Fax (404) 727-9798. PRICE: $75.00 (as of 1996). Also available for rental; contact producer for current fee. Item Number 93-12. Summary: This videocassette familiarizes gynecologists with the Burch colposuspension for genuine stress incontinence. The narrator, Dr. Anne Wiskind, first defines genuine stress incontinence and discusses nonsurgical treatment modalities (including pelvic floor exercises, vaginal cones, biofeedback, and electrical stimulation of the pelvic floor). The Burch colposuspension is then reviewed in detail, including the indications for the procedure, the preoperative evaluation of candidates, the technical details of the

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procedure, how it works to correct urinary incontinence, postoperative care, and postoperative complications and their management. In conclusion, Dr. Wiskind discusses cure rates and the treatment of postoperative voiding dysfunction. (AA-M). •

Management of Female Stress Incontinence Source: Bellaire, TX: American Urological Association (AUA) Office of Education. 1992. (videocassette). Contact: Available from Karol Media. 350 North Pennsylvania Avenue, P.O. Box 7600, Wilkes-Barre, PA 18773-7600. (800) 608-0096. Fax (717) 822-8226. PRICE: $20.00. Item number 919-2065. Summary: This videocassette program, one of a series from the American Urological Association, presents seven surgical techniques for the management of female urinary stress incontinence. Included are bone fixation technique for transvaginal needle suspension; four-corner bladder suspension in the treatment of moderate cystocele; treatment of female diverticulum complicated by stress urinary incontinence; periurethral injection of cross-linked collagen; transvaginal placement of artificial urinary sphincter; and sling procedures in women. The video also features interviews with four of the urologists, who describe patient indications, details of the procedures they performed, and potential complications.

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CHAPTER 7. PERIODICALS AND NEWS ON STRESS INCONTINENCE Overview In this chapter, we suggest a number of news sources and present various periodicals that cover stress incontinence.

News Services and Press Releases One of the simplest ways of tracking press releases on stress incontinence is to search the news wires. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing. PR Newswire To access the PR Newswire archive, simply go to http://www.prnewswire.com/. Select your country. Type “stress incontinence” (or synonyms) into the search box. You will automatically receive information on relevant news releases posted within the last 30 days. The search results are shown by order of relevance. Reuters Health The Reuters’ Medical News and Health eLine databases can be very useful in exploring news archives relating to stress incontinence. While some of the listed articles are free to view, others are available for purchase for a nominal fee. To access this archive, go to http://www.reutershealth.com/en/index.html and search by “stress incontinence” (or synonyms). The following was recently listed in this archive for stress incontinence: •

Phase III trial shows duloxetine safe and effective for stress incontinence Source: Reuters Industry Breifing Date: October 29, 2003

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Electrical stimulation does not improve behavior training for stress incontinence Source: Reuters Medical News Date: July 16, 2003

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More women in US undergoing surgery for stress incontinence Source: Reuters Medical News Date: April 02, 2003

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UK watchdog backs tension-free vaginal tape for stress incontinence Source: Reuters Industry Breifing Date: January 17, 2003

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UK agency backs tension-free vaginal tape for stress incontinence Source: Reuters Medical News Date: January 17, 2003

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Duloxetine reduces frequency of stress incontinence episodes Source: Reuters Industry Breifing Date: July 29, 2002

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Mentor acquires stress incontinence implant from ProSurg Source: Reuters Industry Breifing Date: March 11, 2002

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New intravaginal device supports bladder neck, controls stress incontinence Source: Reuters Industry Breifing Date: December 25, 2001

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Vaginal tape effective for urinary stress incontinence in obese women Source: Reuters Medical News Date: December 18, 2001

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Collagen implant an alternative to surgery for stress incontinence Source: Reuters Industry Breifing Date: October 16, 2001

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Estriol, pelvic floor muscle exercises may combat postmenopausal stress incontinence Source: Reuters Industry Breifing Date: April 20, 2001

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"Sandwich" surgical technique promising for urinary stress incontinence Source: Reuters Medical News Date: February 14, 2001

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Magnetic stimulation shows promise as stress incontinence therapy Source: Reuters Industry Breifing Date: October 24, 2000

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New device eases placement of urethral bulking agent for stress incontinence Source: Reuters Medical News Date: August 30, 2000

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Sexual dysfunction not uncommon following surgery for stress incontinence Source: Reuters Medical News Date: August 21, 2000

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Tension-free vaginal tape promising for primary genuine stress incontinence Source: Reuters Industry Breifing Date: July 31, 2000

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Modified Gore-Tex sling improves outcomes for women with stress incontinence Source: Reuters Medical News Date: April 10, 2000

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Ear collagen used to treat stress incontinence linked to intrinsic sphincter deficiency Source: Reuters Medical News Date: October 25, 1999

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Extracorporeal magnetic innervation therapy effective for stress incontinence Source: Reuters Medical News Date: June 09, 1999

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UroMed Patch For Stress Incontinence Cleared For OTC Sale To Women Source: Reuters Medical News Date: April 01, 1998

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New Treatment Guidelines Issued For Female Stress Incontinence Source: Reuters Medical News Date: June 26, 1997

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Electrical Stimulation Effective In Treatment Of Stress Incontinence Source: Reuters Medical News Date: May 02, 1997

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Cough Test : Poor Screening Tool For Urinary Stress Incontinence Source: Reuters Medical News Date: June 24, 1996

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Causes Of Genuine Stress Incontinence Evaluated Source: Reuters Medical News Date: May 17, 1996

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Female Stress Incontinence May Have A Genetic Basis Source: Reuters Medical News Date: February 28, 1996

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Burch Urethropexy Superior To Other Surgical Procedures For Treatment Of Stress Incontinence In Women Source: Reuters Medical News Date: August 08, 1995 The NIH

Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine. Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name.

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Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to Market Wire’s home page at http://www.marketwire.com/mw/home, type “stress incontinence” (or synonyms) into the search box, and click on “Search News.” As this service is technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests. Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “stress incontinence” (or synonyms). If you know the name of a company that is relevant to stress incontinence, you can go to any stock trading Web site (such as http://www.etrade.com/) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. Google offers a similar service at http://news.google.com/. BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “stress incontinence” (or synonyms).

Newsletter Articles Use the Combined Health Information Database, and limit your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” Type “stress incontinence” (or synonyms) into the “For these words:” box. You should check back periodically with this database as it is updated every three months. The following is a typical result when searching for newsletter articles on stress incontinence: •

New Approaches to Stress Incontinence Source: Harvard Women's Health Watch. 4(2): 7. October 1996. Contact: Available from Harvard Women's Health Watch. P.O. Box 420234, Palm Coast, FL 32142-0234. (800) 829-5921. Summary: This brief newsletter article reports on two recently approved devices for managing stress incontinence. Stress incontinence is the leakage of urine caused by

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increased pressure on the bladder from laughing, coughing, or exertion. Both devices are expected to be available by prescription within the next few months. The Miniguard, which received FDA clearance in May 1996, is a contoured adhesive-backed foam patch about the size of a postage stamp that fits over the opening of the urethra. The Reliance Urinary Control Insert, which was approved by the FDA in August 1996, is designed for women who have moderate to severe incontinence. It is a balloon-tipped plug about one-fifth the diameter of a tampon that is inserted into the urethra with an applicator. The force of insertion inflates the balloon so that it obstructs the neck of the bladder. The device should be removed and discarded before intercourse or urination by pulling the string. •

Surgery for Stress Incontinence Source: AUA News. 2(1): 16-17. January-February 1997. Contact: Available from AUA News. Williams and Wilkins, 351 West Camden Street, Baltimore, MD 21201-2436. Summary: This newsletter article reports on surgery for stress urinary incontinence (UI). All surgical approaches for stress incontinence have the common goal of restoring normal anatomic relationships; that is, to replace the bladder neck and proximal urethra into their appropriate position above the level of the pelvic floor muscle group. This positioning can be accomplished transvaginally or transabdominally; the approach is based on surgeon experience and preference, as well as on patient indications. The author reports on the surgical strategy to treat intrinsic sphincteric deficiency (ISD) or type III stress urinary incontinence. Generally, it is stated that there is an 85 percent cure rate of stress UI regardless of which procedure is performed. The author contends that the literature does not support this conclusion. The author also stresses that surgery only corrects one of the factors important for normal urinary control. Recurrence of UI with good anatomic support is not to be considered a surgical failure. The author concludes that more important than the choice of therapy is the identification of the proper patient for treatment. Correction of an anatomic abnormality by one of the many resuspension procedures will be inadequate for correction in those patients with ISD. Current urodynamic, radiographic, and endoscopic techniques must be used to select properly those patients who require augmentation of outlet function rather than an outlet stabilization (suspension) procedure. 1 figure. 3 references. (AA-M).

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Surgical Success in Female Stress Incontinence Source: Quality Care. 14(4): 1-2. Fall 1996. Contact: Available from National Association for Continence. P.O. Box 8310, Spartanburg, SC 29305-8310. (800) BLADDER or (864) 579-7900. Fax (864) 579-7902. Web site: http://www.nafc.org. Summary: This newsletter article reviews the surgical techniques used to treat female stress incontinence. Stress incontinence is urinary leakage that occurs with activity such as coughing or sneezing; leakage occurs during activity because the pressures in the abdomen and bladder go up during these times and the urethra may not stay closed all the way. All surgical approaches for correcting stress urinary incontinence (UI) have the same goal: to put the bladder neck and urethra back into the correct position above the pelvic floor muscles and to provide support for the urethra. The surgical approach (either vaginal or abdominal) is generally selected by the surgeon based on his or her experience and on the needs of the individual patient. The author describes surgical suspensions used for stress UI and surgical therapy for intrinsic sphincteric deficiency

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(ISD), including slings, the artificial urinary sphincter, and peri-urethral injections. The author notes that recurrent UI should not automatically be considered a surgical failure. Surgery only corrects one of the factors important for normal urinary control. References are available on request from the publisher. 2 figures. (AA-M).

Academic Periodicals covering Stress Incontinence Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to stress incontinence. In addition to these sources, you can search for articles covering stress incontinence that have been published by any of the periodicals listed in previous chapters. To find the latest studies published, go to http://www.ncbi.nlm.nih.gov/pubmed, type the name of the periodical into the search box, and click “Go.” If you want complete details about the historical contents of a journal, you can also visit the following Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/, you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”

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APPENDICES

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APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.

NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute10: •

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

•

National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/

•

National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html

•

National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25

•

National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm

•

National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm

•

National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375

•

National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/

10

These publications are typically written by one or more of the various NIH Institutes.

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•

National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm

•

National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/

•

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm

•

National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm

•

National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/

•

National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/

•

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm

•

National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html

•

National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm

•

National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm

•

National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm

•

National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html

•

National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm

•

Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp

•

National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/

•

National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp

•

Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html

•

Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm

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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.11 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:12 •

Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html

•

HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html

•

NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html

•

Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/

•

Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html

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Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html

•

Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/

•

Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html

•

Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html

•

Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html

•

MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html

11

Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 12 See http://www.nlm.nih.gov/databases/databases.html.

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Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html

•

Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html

The NLM Gateway13 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.14 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “stress incontinence” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total

Items Found 5866 92 939 1 6 6904

HSTAT15 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.16 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.17 Simply search by “stress incontinence” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

13

Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.

14

The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 15 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 16 17

The HSTAT URL is http://hstat.nlm.nih.gov/.

Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations.

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Coffee Break: Tutorials for Biologists18 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.19 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.20 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.

Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: •

CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.

•

Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.

18 Adapted 19

from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html.

The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 20 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.

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APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on stress incontinence can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internetbased services that post them.

Patient Guideline Sources The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to stress incontinence. Due to space limitations, these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. The National Institutes of Health The NIH gateway to patients is located at http://health.nih.gov/. From this site, you can search across various sources and institutes, a number of which are summarized below. Topic Pages: MEDLINEplus The National Library of Medicine has created a vast and patient-oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages” which list links to available materials relevant to stress incontinence. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following when searched for “stress incontinence”:

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Other guides Bladder Cancer http://www.nlm.nih.gov/medlineplus/bladdercancer.html Bladder Diseases http://www.nlm.nih.gov/medlineplus/bladderdiseases.html Interstitial Cystitis http://www.nlm.nih.gov/medlineplus/interstitialcystitis.html Pelvic Support Problems http://www.nlm.nih.gov/medlineplus/pelvicsupportproblems.html Prostate Cancer http://www.nlm.nih.gov/medlineplus/prostatecancer.html Toilet Training and Bedwetting http://www.nlm.nih.gov/medlineplus/toilettrainingandbedwetting.html Urinary Tract Infections http://www.nlm.nih.gov/medlineplus/urinarytractinfections.html

You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on stress incontinence. CHID offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: •

Women and Stress Incontinence: Restore Your Active Lifestyle Source: Covington, GA: Bard Urological Division, C.R. Bard, Inc. 1995. 7 p. Contact: Available from Bard Urological Division. (800) 526-2687. PRICE: Single copy free. Summary: This brochure provides basic information about the causes, diagnosis, and treatment of female stress incontinence (urinary). Topics include the incidence of stress incontinence, the treatment options for stress incontinence, and the use of the Contigen Bard collagen implant to treat stress incontinence. The brochure encourages readers with urinary incontinence to seek medical advice, as treatment options are often successful. The brochure concludes with a list of resource organizations through which readers can obtain more information. 1 figure. 1 table.

Patient Resources

•

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Stress Incontinence Source: in Sodeman, W.A., Jr. Instructions for Geriatric Patients. Philadelphia, PA: W.B. Saunders Company. 1995. p. 82-83. Contact: Available from W.B. Saunders Company. Order Fulfillment, 6277 Sea Harbor Drive, Orlando, FL 32887. (800) 545-2522. Fax (800) 874-6418 or (407) 352-3445. PRICE: $38.95. ISBN: 0721643353. Summary: This chapter, from a handbook of instructions for older people and their caregivers, provides an overview of stress urinary incontinence (UI). Stress incontinence is often a problem in older women. In these women, small amounts of urine are lost when they sneeze, cough, or suddenly strain. This occurs because of increased pressure within the abdomen and the inability of the muscles to support the bladder. The weakened muscles are a normal part of the aging process, but normally they do not weaken to the point of causing stress incontinence. The chapter mentions treatment options, including physical therapy using pelvic floor muscle exercises (Kegel exercises), weight loss, intra-vaginal support devices, and surgery. Strategies for performing Kegel exercises are outlined. The author emphasizes the need for careful patient evaluation before incontinence is treated. The section concludes with a description of the symptoms which should prompt a call to the health care provider's office. These include evidence of urinary tract infection and return of an earlier problem with stress incontinence. The chapter appears in large print text to promote ease of reading. (AA-M).

•

Continence Facts: Injectable Implants: A Treatment For Stress Incontinence Source: Quebec, Canada: Simon Foundation for Continence. 1996. 2 p. Contact: Available from Simon Foundation for Continence Canada. P.O. Box 66524, Cavendish Mall P.O., Cote St. Luc, Quebec, Canada H4W3J6. (514) 923-6060. Fax: (514) 923-6060. Website: www.simonfoundation.org. PRICE: contact organization for print copies. Summary: Urinary incontinence (UI) is the loss of bladder control; stress incontinence refers to leakage of urine when coughing, sneezing, laughing, lifting, jogging, or doing anything that causes the abdominal pressure to override the bladder's closure mechanism. This fact sheet outlines the use of injectable implants as a treatment option for stress incontinence. Topics include patient selection for the procedure, what to expect during and after the procedure, the different types of implants used for stress incontinence (collagen, PTFE paste or Teflon, and autologous fat), and side effects or risks associated with injectable implants. Readers are encouraged to work closely with their health care providers to find solutions for their UI problems. The fact sheet includes the contact information for the Simon Foundation for Continence Canada (800265-9575). 3 figures. The NIH Search Utility

The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to stress incontinence. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide

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useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats

•

Family Village: http://www.familyvillage.wisc.edu/specific.htm

•

Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/

•

Med Help International: http://www.medhelp.org/HealthTopics/A.html

•

Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/

•

Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/

•

WebMDHealth: http://my.webmd.com/health_topics

Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to stress incontinence. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with stress incontinence. The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about stress incontinence. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “stress incontinence” (or a synonym), and you will receive information on all relevant organizations listed in the database.

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Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “stress incontinence”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “stress incontinence” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “stress incontinence” (or a synonym) into the search box, and click “Submit Query.”

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APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.

Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.21

Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.

Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of

21

Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.

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libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)22: •

Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/

•

Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)

•

Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm

•

California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html

•

California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html

•

California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html

•

California: Gateway Health Library (Sutter Gould Medical Foundation)

•

California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/

•

California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp

•

California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html

•

California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/

•

California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/

•

California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/

•

California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html

•

California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/

•

Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/

•

Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/

•

Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/

22

Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.

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•

Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml

•

Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm

•

Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html

•

Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm

•

Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp

•

Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/

•

Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm

•

Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html

•

Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/

•

Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm

•

Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/

•

Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/

•

Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/

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Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm

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Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html

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Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm

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Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/

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Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/

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Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10

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Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/

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Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html

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Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp

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Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp

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Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/

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Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html

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Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm

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Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp

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Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/

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Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html

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Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/

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Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm

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Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/

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Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html

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Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm

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Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330

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Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)

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National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html

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National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/

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National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/

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Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm

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New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/

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New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm

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New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm

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New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/

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New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html

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New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/

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New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html

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New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/

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Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm

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Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp

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Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/

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Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/

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Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml

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Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html

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Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html

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Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml

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Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp

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Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm

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Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/

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South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp

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Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/

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Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/

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Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72

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ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •

ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html

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MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp

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Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/

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Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html

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On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/

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Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp

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Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm

Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a). The NIH suggests the following Web sites in the ADAM Medical Encyclopedia when searching for information on stress incontinence: •

Basic Guidelines for Stress Incontinence Stress incontinence Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000891.htm

•

Signs & Symptoms for Stress Incontinence Constipation Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003125.htm Cough Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003072.htm Coughing Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003072.htm Discomfort during intercourse Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003157.htm

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Incontinence Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003142.htm Increased urinary frequency or urgency Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003140.htm Muscle Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003193.htm Obesity Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003101.htm Pain during intercourse Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003157.htm Sneezing Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003060.htm Stress Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003211.htm Vaginal discharge Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003158.htm Weakness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003174.htm •

Diagnostics and Tests for Stress Incontinence Abdominal ultrasound Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003777.htm Cystoscopy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003903.htm EMG Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003929.htm Erosion Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003225.htm Myogram Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003929.htm Stress test Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003878.htm Ultrasound Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003336.htm Urinalysis Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003579.htm

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Urine culture Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003751.htm •

Surgery and Procedures for Stress Incontinence Episiotomy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002920.htm MMK Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002992.htm

•

Background Topics for Stress Incontinence Allergic reaction Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000005.htm ANTERIOR Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002232.htm Biofeedback Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002241.htm Chronic Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002312.htm Exercise Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001941.htm Fistula Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002365.htm Inspection Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002388.htm Kegel exercises Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003975.htm Mucosa Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002264.htm Physical activity Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001941.htm Physical examination Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002274.htm Scrotum Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002296.htm Systemic Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002294.htm

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Vagina Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002342.htm Wound Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000043.htm

Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •

Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical

•

MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html

•

Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/

•

Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine

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STRESS INCONTINENCE DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Abortion: 1. The premature expulsion from the uterus of the products of conception - of the embryo, or of a nonviable fetus. The four classic symptoms, usually present in each type of abortion, are uterine contractions, uterine haemorrhage, softening and dilatation of the cervix, and presentation or expulsion of all or part of the products of conception. 2. Premature stoppage of a natural or a pathological process. [EU] Acrylonitrile: A highly poisonous compound used widely in the manufacture of plastics, adhesives and synthetic rubber. [NIH] Actin: Essential component of the cell skeleton. [NIH] Acute renal: A condition in which the kidneys suddenly stop working. In most cases, kidneys can recover from almost complete loss of function. [NIH] Adaptation: 1. The adjustment of an organism to its environment, or the process by which it enhances such fitness. 2. The normal ability of the eye to adjust itself to variations in the intensity of light; the adjustment to such variations. 3. The decline in the frequency of firing of a neuron, particularly of a receptor, under conditions of constant stimulation. 4. In dentistry, (a) the proper fitting of a denture, (b) the degree of proximity and interlocking of restorative material to a tooth preparation, (c) the exact adjustment of bands to teeth. 5. In microbiology, the adjustment of bacterial physiology to a new environment. [EU] Adipose Tissue: Connective tissue composed of fat cells lodged in the meshes of areolar tissue. [NIH] Adjustment: The dynamic process wherein the thoughts, feelings, behavior, and biophysiological mechanisms of the individual continually change to adjust to the environment. [NIH] Adrenal Cortex: The outer layer of the adrenal gland. It secretes mineralocorticoids, androgens, and glucocorticoids. [NIH] Adrenergic: Activated by, characteristic of, or secreting epinephrine or substances with similar activity; the term is applied to those nerve fibres that liberate norepinephrine at a synapse when a nerve impulse passes, i.e., the sympathetic fibres. [EU] Adrenergic Agonists: Drugs that bind to and activate adrenergic receptors. [NIH] Adverse Effect: An unwanted side effect of treatment. [NIH] Aeroembolism: Joint pains, respiratory distress, and central nervous system symptoms which may follow decompression after exposure to air or other gas mixture at a pressure greater than the normal atmospheric pressure. [NIH] Aerosol: A solution of a drug which can be atomized into a fine mist for inhalation therapy. [EU]

Aetiology: Study of the causes of disease. [EU]

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Afferent: Concerned with the transmission of neural impulse toward the central part of the nervous system. [NIH] Affinity: 1. Inherent likeness or relationship. 2. A special attraction for a specific element, organ, or structure. 3. Chemical affinity; the force that binds atoms in molecules; the tendency of substances to combine by chemical reaction. 4. The strength of noncovalent chemical binding between two substances as measured by the dissociation constant of the complex. 5. In immunology, a thermodynamic expression of the strength of interaction between a single antigen-binding site and a single antigenic determinant (and thus of the stereochemical compatibility between them), most accurately applied to interactions among simple, uniform antigenic determinants such as haptens. Expressed as the association constant (K litres mole -1), which, owing to the heterogeneity of affinities in a population of antibody molecules of a given specificity, actually represents an average value (mean intrinsic association constant). 6. The reciprocal of the dissociation constant. [EU] Age Groups: Persons classified by age from birth (infant, newborn) to octogenarians and older (aged, 80 and over). [NIH] Age of Onset: The age or period of life at which a disease or the initial symptoms or manifestations of a disease appear in an individual. [NIH] Aged, 80 and Over: A person 80 years of age and older. [NIH] Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Agoraphobia: Obsessive, persistent, intense fear of open places. [NIH] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Allograft: An organ or tissue transplant between two humans. [NIH] Alpha-1: A protein with the property of inactivating proteolytic enzymes such as leucocyte collagenase and elastase. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Alveolar Process: The thickest and spongiest part of the maxilla and mandible hollowed out into deep cavities for the teeth. [NIH] Ampulla: A sac-like enlargement of a canal or duct. [NIH] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Anastomosis: A procedure to connect healthy sections of tubular structures in the body after the diseased portion has been surgically removed. [NIH] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Androgens: A class of sex hormones associated with the development and maintenance of the secondary male sex characteristics, sperm induction, and sexual differentiation. In addition to increasing virility and libido, they also increase nitrogen and water retention and stimulate skeletal growth. [NIH] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH]

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Angiogenesis: Blood vessel formation. Tumor angiogenesis is the growth of blood vessels from surrounding tissue to a solid tumor. This is caused by the release of chemicals by the tumor. [NIH] Animal model: An animal with a disease either the same as or like a disease in humans. Animal models are used to study the development and progression of diseases and to test new treatments before they are given to humans. Animals with transplanted human cancers or other tissues are called xenograft models. [NIH] Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Antidepressant: A drug used to treat depression. [NIH] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Anuria: Inability to form or excrete urine. [NIH] Anus: The opening of the rectum to the outside of the body. [NIH] Aperture: A natural hole of perforation, especially one in a bone. [NIH] Approximate: Approximal [EU] Aqueous: Having to do with water. [NIH] Arachidonic Acid: An unsaturated, essential fatty acid. It is found in animal and human fat as well as in the liver, brain, and glandular organs, and is a constituent of animal phosphatides. It is formed by the synthesis from dietary linoleic acid and is a precursor in the biosynthesis of prostaglandins, thromboxanes, and leukotrienes. [NIH] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Artery: Vessel-carrying blood from the heart to various parts of the body. [NIH] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Atrophy: Decrease in the size of a cell, tissue, organ, or multiple organs, associated with a variety of pathological conditions such as abnormal cellular changes, ischemia, malnutrition, or hormonal changes. [NIH] Atypical: Irregular; not conformable to the type; in microbiology, applied specifically to strains of unusual type. [EU] Auditory: Pertaining to the sense of hearing. [EU] Auditory nerve: The eight cranial nerve; also called vestibulocochlear nerve or acoustic nerve. [NIH] Autologous: Taken from an individual's own tissues, cells, or DNA. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or

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bacillary, and spiral or spirochetal. [NIH] Bacterial Physiology: Physiological processes and activities of bacteria. [NIH] Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Basilar Artery: The artery formed by the union of the right and left vertebral arteries; it runs from the lower to the upper border of the pons, where it bifurcates into the two posterior cerebral arteries. [NIH] Bends: The form of aeroembolism that is marked by intense pain in muscles and joints due to formation of gas bubbles in the tissues. [NIH] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]

Benign prostatic hyperplasia: A benign (noncancerous) condition in which an overgrowth of prostate tissue pushes against the urethra and the bladder, blocking the flow of urine. Also called benign prostatic hypertrophy or BPH. [NIH] Bifida: A defect in development of the vertebral column in which there is a central deficiency of the vertebral lamina. [NIH] Biological therapy: Treatment to stimulate or restore the ability of the immune system to fight infection and disease. Also used to lessen side effects that may be caused by some cancer treatments. Also known as immunotherapy, biotherapy, or biological response modifier (BRM) therapy. [NIH] Biopsy: Removal and pathologic examination of specimens in the form of small pieces of tissue from the living body. [NIH] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Bladder: The organ that stores urine. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Body Fluids: Liquid components of living organisms. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Bowel Movement: Body wastes passed through the rectum and anus. [NIH] Branch: Most commonly used for branches of nerves, but applied also to other structures. [NIH]

Breakdown: A physical, metal, or nervous collapse. [NIH] Breast Self-Examination: The inspection of one's breasts, usually for signs of disease, especially neoplastic disease. [NIH]

Dictionary 143

Bulking Agents: Laxatives that make bowel movements soft and easy to pass. [NIH] Bypass: A surgical procedure in which the doctor creates a new pathway for the flow of body fluids. [NIH] Cannula: A tube for insertion into a duct or cavity; during insertion its lumen is usually occupied by a trocar. [EU] Carbon Dioxide: A colorless, odorless gas that can be formed by the body and is necessary for the respiration cycle of plants and animals. [NIH] Cardiac: Having to do with the heart. [NIH] Cardiotonic: 1. Having a tonic effect on the heart. 2. An agent that has a tonic effect on the heart. [EU] Case series: A group or series of case reports involving patients who were given similar treatment. Reports of case series usually contain detailed information about the individual patients. This includes demographic information (for example, age, gender, ethnic origin) and information on diagnosis, treatment, response to treatment, and follow-up after treatment. [NIH] Catecholamine: A group of chemical substances manufactured by the adrenal medulla and secreted during physiological stress. [NIH] Catgut: Sterile collagen strands obtained from healthy mammals. They are used as absorbable surgical ligatures and are frequently impregnated with chromium or silver for increased strength. They tend to cause tissue reaction. [NIH] Catheter: A flexible tube used to deliver fluids into or withdraw fluids from the body. [NIH] Catheterization: Use or insertion of a tubular device into a duct, blood vessel, hollow organ, or body cavity for injecting or withdrawing fluids for diagnostic or therapeutic purposes. It differs from intubation in that the tube here is used to restore or maintain patency in obstructions. [NIH] Caudal: Denoting a position more toward the cauda, or tail, than some specified point of reference; same as inferior, in human anatomy. [EU] Causal: Pertaining to a cause; directed against a cause. [EU] Caustic: An escharotic or corrosive agent. Called also cauterant. [EU] Cauterization: The destruction of tissue with a hot instrument, an electrical current, or a caustic substance. [NIH] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell Division: The fission of a cell. [NIH] Cell membrane: Cell membrane = plasma membrane. The structure enveloping a cell, enclosing the cytoplasm, and forming a selective permeability barrier; it consists of lipids, proteins, and some carbohydrates, the lipids thought to form a bilayer in which integral proteins are embedded to varying degrees. [EU] Cell Survival: The span of viability of a cell characterized by the capacity to perform certain functions such as metabolism, growth, reproduction, some form of responsiveness, and adaptability. [NIH] Character: In current usage, approximately equivalent to personality. The sum of the relatively fixed personality traits and habitual modes of response of an individual. [NIH] Chromium: A trace element that plays a role in glucose metabolism. It has the atomic symbol Cr, atomic number 24, and atomic weight 52. According to the Fourth Annual

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Report on Carcinogens (NTP85-002,1985), chromium and some of its compounds have been listed as known carcinogens. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Chronic Disease: Disease or ailment of long duration. [NIH] Chronic renal: Slow and progressive loss of kidney function over several years, often resulting in end-stage renal disease. People with end-stage renal disease need dialysis or transplantation to replace the work of the kidneys. [NIH] Circumcision: Excision of the prepuce or part of it. [NIH] Clamp: A u-shaped steel rod used with a pin or wire for skeletal traction in the treatment of certain fractures. [NIH] Clinical series: A case series in which the patients receive treatment in a clinic or other medical facility. [NIH] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Collagen: A polypeptide substance comprising about one third of the total protein in mammalian organisms. It is the main constituent of skin, connective tissue, and the organic substance of bones and teeth. Different forms of collagen are produced in the body but all consist of three alpha-polypeptide chains arranged in a triple helix. Collagen is differentiated from other fibrous proteins, such as elastin, by the content of proline, hydroxyproline, and hydroxylysine; by the absence of tryptophan; and particularly by the high content of polar groups which are responsible for its swelling properties. [NIH] Colloidal: Of the nature of a colloid. [EU] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU]

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Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complete remission: The disappearance of all signs of cancer. Also called a complete response. [NIH] Compliance: Distensibility measure of a chamber such as the lungs (lung compliance) or bladder. Compliance is expressed as a change in volume per unit change in pressure. [NIH] Compress: A plug used to occludate an orifice in the control of bleeding, or to mop up secretions; an absorbent pad. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Concomitant: Accompanying; accessory; joined with another. [EU] Cones: One type of specialized light-sensitive cells (photoreceptors) in the retina that provide sharp central vision and color vision. [NIH] Confounding: Extraneous variables resulting in outcome effects that obscure or exaggerate the "true" effect of an intervention. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue Cells: A group of cells that includes fibroblasts, cartilage cells, adipocytes, smooth muscle cells, and bone cells. [NIH] Connexins: A group of homologous proteins which form the intermembrane channels of gap junctions. The connexins are the products of an identified gene family which has both highly conserved and highly divergent regions. The variety contributes to the wide range of functional properties of gap junctions. [NIH] Constrict: Tighten; narrow. [NIH] Constriction: The act of constricting. [NIH] Continence: The ability to hold in a bowel movement or urine. [NIH] Contractility: Capacity for becoming short in response to a suitable stimulus. [EU] Contracture: A condition of fixed high resistance to passive stretch of a muscle, resulting from fibrosis of the tissues supporting the muscles or the joints, or from disorders of the muscle fibres. [EU] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments,

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etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Cyclic: Pertaining to or occurring in a cycle or cycles; the term is applied to chemical compounds that contain a ring of atoms in the nucleus. [EU] Cystitis: Inflammation of the urinary bladder. [EU] Cystocele: Fallen bladder. When the bladder falls or sags from its normal position down to the pelvic floor, it can cause either urinary leakage or urinary retention. [NIH] Cystometrogram: A line graph that records urinary bladder pressure at various volumes. [NIH]

Cystoscopy: Endoscopic examination, therapy or surgery of the urinary bladder. [NIH] Cystostomy: Surgical creation of an opening (stoma) for drainage of the urinary bladder. [NIH]

De novo: In cancer, the first occurrence of cancer in the body. [NIH] Decision Making: The process of making a selective intellectual judgment when presented with several complex alternatives consisting of several variables, and usually defining a course of action or an idea. [NIH] Decongestant: An agent that reduces congestion or swelling. [EU] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Density: The logarithm to the base 10 of the opacity of an exposed and processed film. [NIH] Dermal: Pertaining to or coming from the skin. [NIH] Dermis: A layer of vascular connective tissue underneath the epidermis. The surface of the dermis contains sensitive papillae. Embedded in or beneath the dermis are sweat glands, hair follicles, and sebaceous glands. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Diaphragm: The musculofibrous partition that separates the thoracic cavity from the abdominal cavity. Contraction of the diaphragm increases the volume of the thoracic cavity aiding inspiration. [NIH] Diastolic: Of or pertaining to the diastole. [EU] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Dilatation: The act of dilating. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Dissection: Cutting up of an organism for study. [NIH] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Diverticula: Plural form of diverticulum. [NIH] Diverticulum: A pathological condition manifested as a pouch or sac opening from a tubular or sacular organ. [NIH] Dorsal: 1. Pertaining to the back or to any dorsum. 2. Denoting a position more toward the back surface than some other object of reference; same as posterior in human anatomy;

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superior in the anatomy of quadrupeds. [EU] Double-blind: Pertaining to a clinical trial or other experiment in which neither the subject nor the person administering treatment knows which treatment any particular subject is receiving. [EU] Drive: A state of internal activity of an organism that is a necessary condition before a given stimulus will elicit a class of responses; e.g., a certain level of hunger (drive) must be present before food will elicit an eating response. [NIH] Drug Evaluation: Any process by which toxicity, metabolism, absorption, elimination, preferred route of administration, safe dosage range, etc., for a drug or group of drugs is determined through clinical assessment in humans or veterinary animals. [NIH] Drug Evaluation, Preclinical: Preclinical testing of drugs in experimental animals or in vitro for their biological and toxic effects and potential clinical applications. [NIH] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Duct: A tube through which body fluids pass. [NIH] Duodenum: The first part of the small intestine. [NIH] Edema: Excessive amount of watery fluid accumulated in the intercellular spaces, most commonly present in subcutaneous tissue. [NIH] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Elastin: The protein that gives flexibility to tissues. [NIH] Electrode: Component of the pacing system which is at the distal end of the lead. It is the interface with living cardiac tissue across which the stimulus is transmitted. [NIH] Electrolytes: Substances that break up into ions (electrically charged particles) when they are dissolved in body fluids or water. Some examples are sodium, potassium, chloride, and calcium. Electrolytes are primarily responsible for the movement of nutrients into cells, and the movement of wastes out of cells. [NIH] Electromyography: Recording of the changes in electric potential of muscle by means of surface or needle electrodes. [NIH] Embryo: The prenatal stage of mammalian development characterized by rapid morphological changes and the differentiation of basic structures. [NIH] Embryology: The study of the development of an organism during the embryonic and fetal stages of life. [NIH] Emulsion: A preparation of one liquid distributed in small globules throughout the body of a second liquid. The dispersed liquid is the discontinuous phase, and the dispersion medium is the continuous phase. When oil is the dispersed liquid and an aqueous solution is the continuous phase, it is known as an oil-in-water emulsion, whereas when water or aqueous solution is the dispersed phase and oil or oleaginous substance is the continuous phase, it is known as a water-in-oil emulsion. Pharmaceutical emulsions for which official standards have been promulgated include cod liver oil emulsion, cod liver oil emulsion with malt, liquid petrolatum emulsion, and phenolphthalein in liquid petrolatum emulsion. [EU] Endocrinology: A subspecialty of internal medicine concerned with the metabolism, physiology, and disorders of the endocrine system. [NIH] Endometrium: The layer of tissue that lines the uterus. [NIH] Endoscope: A thin, lighted tube used to look at tissues inside the body. [NIH]

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Endoscopic: A technique where a lateral-view endoscope is passed orally to the duodenum for visualization of the ampulla of Vater. [NIH] Endoscopy: Endoscopic examination, therapy or surgery performed on interior parts of the body. [NIH] End-stage renal: Total chronic kidney failure. When the kidneys fail, the body retains fluid and harmful wastes build up. A person with ESRD needs treatment to replace the work of the failed kidneys. [NIH] Enuresis: Involuntary discharge of urine after the age at which urinary control should have been achieved; often used alone with specific reference to involuntary discharge of urine occurring during sleep at night (bed-wetting, nocturnal enuresis). [EU] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]

Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Epidermis: Nonvascular layer of the skin. It is made up, from within outward, of five layers: 1) basal layer (stratum basale epidermidis); 2) spinous layer (stratum spinosum epidermidis); 3) granular layer (stratum granulosum epidermidis); 4) clear layer (stratum lucidum epidermidis); and 5) horny layer (stratum corneum epidermidis). [NIH] Epinephrine: The active sympathomimetic hormone from the adrenal medulla in most species. It stimulates both the alpha- and beta- adrenergic systems, causes systemic vasoconstriction and gastrointestinal relaxation, stimulates the heart, and dilates bronchi and cerebral vessels. It is used in asthma and cardiac failure and to delay absorption of local anesthetics. [NIH] Erection: The condition of being made rigid and elevated; as erectile tissue when filled with blood. [EU] Esophageal: Having to do with the esophagus, the muscular tube through which food passes from the throat to the stomach. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]

Estradiol: The most potent mammalian estrogenic hormone. It is produced in the ovary, placenta, testis, and possibly the adrenal cortex. [NIH] Estriol: (16 alpha,17 beta)-Estra-1,3,5(10)-triene-3,16,17-triol. A metabolite of estradiol and usually the predominant estrogenic metabolite in urine. During pregnancy, large amounts of estriol are produced by the placenta. It has also been obtained from plant sources. The 16 beta-isomer has also been isolated from the urine of pregnant women. [NIH] Estrogen: One of the two female sex hormones. [NIH] Evaluation Studies: Studies determining the effectiveness or value of processes, personnel, and equipment, or the material on conducting such studies. For drugs and devices, clinical trials, drug evaluation, and drug evaluation, preclinical are available. [NIH] Excrete: To get rid of waste from the body. [NIH] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Extracellular: Outside a cell or cells. [EU] Extracellular Matrix: A meshwork-like substance found within the extracellular space and in association with the basement membrane of the cell surface. It promotes cellular proliferation and provides a supporting structure to which cells or cell lysates in culture dishes adhere. [NIH]

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Facial: Of or pertaining to the face. [EU] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Fat: Total lipids including phospholipids. [NIH] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH]

Fatty acids: A major component of fats that are used by the body for energy and tissue development. [NIH] Fecal Incontinence: Failure of voluntary control of the anal sphincters, with involuntary passage of feces and flatus. [NIH] Feces: The excrement discharged from the intestines, consisting of bacteria, cells exfoliated from the intestines, secretions, chiefly of the liver, and a small amount of food residue. [EU] Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [NIH] Fibroid: A benign smooth muscle tumor, usually in the uterus or gastrointestinal tract. Also called leiomyoma. [NIH] Fibrosis: Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. [NIH] Fine-needle aspiration: The removal of tissue or fluid with a needle for examination under a microscope. Also called needle biopsy. [NIH] Fistula: Abnormal communication most commonly seen between two internal organs, or between an internal organ and the surface of the body. [NIH] Fixation: 1. The act or operation of holding, suturing, or fastening in a fixed position. 2. The condition of being held in a fixed position. 3. In psychiatry, a term with two related but distinct meanings : (1) arrest of development at a particular stage, which like regression (return to an earlier stage), if temporary is a normal reaction to setbacks and difficulties but if protracted or frequent is a cause of developmental failures and emotional problems, and (2) a close and suffocating attachment to another person, especially a childhood figure, such as one's mother or father. Both meanings are derived from psychoanalytic theory and refer to 'fixation' of libidinal energy either in a specific erogenous zone, hence fixation at the oral, anal, or phallic stage, or in a specific object, hence mother or father fixation. 4. The use of a fixative (q.v.) to preserve histological or cytological specimens. 5. In chemistry, the process whereby a substance is removed from the gaseous or solution phase and localized, as in carbon dioxide fixation or nitrogen fixation. 6. In ophthalmology, direction of the gaze so that the visual image of the object falls on the fovea centralis. 7. In film processing, the chemical removal of all undeveloped salts of the film emulsion, leaving only the developed silver to form a permanent image. [EU] Flatus: Gas passed through the rectum. [NIH] Foetoplacental: Pertaining to the fetus and placenta. [EU] Fold: A plication or doubling of various parts of the body. [NIH] Foramen: A natural hole of perforation, especially one in a bone. [NIH] Fovea: The central part of the macula that provides the sharpest vision. [NIH] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Gap Junctions: Connections between cells which allow passage of small molecules and electric current. Gap junctions were first described anatomically as regions of close

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apposition between cells with a narrow (1-2 nm) gap between cell membranes. The variety in the properties of gap junctions is reflected in the number of connexins, the family of proteins which form the junctions. [NIH] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gastric: Having to do with the stomach. [NIH] Gastric Bypass: Surgical procedure in which the stomach is transected high on the body. The resulting proximal remnant is joined to a loop of the jejunum in an end-to-side anastomosis. This procedure is used frequently in the treatment of morbid obesity. [NIH] Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastrointestinal tract: The stomach and intestines. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]

Gene Expression: The phenotypic manifestation of a gene or genes by the processes of gene action. [NIH] Genital: Pertaining to the genitalia. [EU] Genitourinary: Pertaining to the genital and urinary organs; urogenital; urinosexual. [EU] Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Gestational: Psychosis attributable to or occurring during pregnancy. [NIH] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Glomerular: Pertaining to or of the nature of a glomerulus, especially a renal glomerulus. [EU]

Glomeruli: Plural of glomerulus. [NIH] Glomerulonephritis: Glomerular disease characterized by an inflammatory reaction, with leukocyte infiltration and cellular proliferation of the glomeruli, or that appears to be the result of immune glomerular injury. [NIH] Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. [NIH] Glycogen: A sugar stored in the liver and muscles. It releases glucose into the blood when cells need it for energy. Glycogen is the chief source of stored fuel in the body. [NIH] Gonads: The gamete-producing glands, ovary or testis. [NIH] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Grade: The grade of a tumor depends on how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. Grading systems are different for each type of cancer. [NIH] Grading: A system for classifying cancer cells in terms of how abnormal they appear when examined under a microscope. The objective of a grading system is to provide information about the probable growth rate of the tumor and its tendency to spread. The systems used to grade tumors vary with each type of cancer. Grading plays a role in treatment decisions. [NIH]

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Grafting: The operation of transfer of tissue from one site to another. [NIH] Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH] Growth factors: Substances made by the body that function to regulate cell division and cell survival. Some growth factors are also produced in the laboratory and used in biological therapy. [NIH] Gynaecological: Pertaining to gynaecology. [EU] Gynecology: A medical-surgical specialty concerned with the physiology and disorders primarily of the female genital tract, as well as female endocrinology and reproductive physiology. [NIH] Hair follicles: Shafts or openings on the surface of the skin through which hair grows. [NIH] Heart failure: Loss of pumping ability by the heart, often accompanied by fatigue, breathlessness, and excess fluid accumulation in body tissues. [NIH] Hemodialysis: The use of a machine to clean wastes from the blood after the kidneys have failed. The blood travels through tubes to a dialyzer, which removes wastes and extra fluid. The cleaned blood then flows through another set of tubes back into the body. [NIH] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Hernia: Protrusion of a loop or knuckle of an organ or tissue through an abnormal opening. [NIH]

Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Hydrogel: A network of cross-linked hydrophilic macromolecules used in biomedical applications. [NIH] Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hydroxylysine: A hydroxylated derivative of the amino acid lysine that is present in certain collagens. [NIH] Hydroxyproline: A hydroxylated form of the imino acid proline. A deficiency in ascorbic acid can result in impaired hydroxyproline formation. [NIH] Hygienic: Pertaining to hygiene, or conducive to health. [EU] Hyperplasia: An increase in the number of cells in a tissue or organ, not due to tumor formation. It differs from hypertrophy, which is an increase in bulk without an increase in the number of cells. [NIH] Hypersensitivity: Altered reactivity to an antigen, which can result in pathologic reactions upon subsequent exposure to that particular antigen. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hypertrophy: General increase in bulk of a part or organ, not due to tumor formation, nor to an increase in the number of cells. [NIH]

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Hypospadias: A developmental anomaly in the male in which the urethra opens on the underside of the penis or on the perineum. [NIH] Hypotensive: Characterized by or causing diminished tension or pressure, as abnormally low blood pressure. [EU] Hysterectomy: Excision of the uterus. [NIH] Id: The part of the personality structure which harbors the unconscious instinctive desires and strivings of the individual. [NIH] Idiopathic: Describes a disease of unknown cause. [NIH] Imipramine: The prototypical tricyclic antidepressant. It has been used in major depression, dysthymia, bipolar depression, attention-deficit disorders, agoraphobia, and panic disorders. It has less sedative effect than some other members of this therapeutic group. [NIH]

Implantation: The insertion or grafting into the body of biological, living, inert, or radioactive material. [EU] Impotence: The inability to perform sexual intercourse. [NIH] In situ: In the natural or normal place; confined to the site of origin without invasion of neighbouring tissues. [EU] In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] Incision: A cut made in the body during surgery. [NIH] Incontinence: Inability to control the flow of urine from the bladder (urinary incontinence) or the escape of stool from the rectum (fecal incontinence). [NIH] Incontinence Pads: Absorbent pads made of various materials used for personal hygiene usually in urinary incontinence and usually in the elderly. They may be worn as underpants or as pants liners. They are made of absorbent materials such as fluff wood pulp and hydrogel absorbent with viscose rayon, polyester, polypropylene, or polyethylene coverstock. [NIH] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Indoramin: A hypotensive agent with some anti-arrhythmic effects. [NIH] Infant, Newborn: An infant during the first month after birth. [NIH] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]

Infertility: The diminished or absent ability to conceive or produce an offspring while sterility is the complete inability to conceive or produce an offspring. [NIH] Infiltration: The diffusion or accumulation in a tissue or cells of substances not normal to it or in amounts of the normal. Also, the material so accumulated. [EU]

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Informed Consent: Voluntary authorization, given to the physician by the patient, with full comprehension of the risks involved, for diagnostic or investigative procedures and medical and surgical treatment. [NIH] Innervation: 1. The distribution or supply of nerves to a part. 2. The supply of nervous energy or of nerve stimulus sent to a part. [EU] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulin-dependent diabetes mellitus. [NIH] Insulin-dependent diabetes mellitus: A disease characterized by high levels of blood glucose resulting from defects in insulin secretion, insulin action, or both. Autoimmune, genetic, and environmental factors are involved in the development of type I diabetes. [NIH] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU] Intestinal: Having to do with the intestines. [NIH] Intestine: A long, tube-shaped organ in the abdomen that completes the process of digestion. There is both a large intestine and a small intestine. Also called the bowel. [NIH] Intoxication: Poisoning, the state of being poisoned. [EU] Intracellular: Inside a cell. [NIH] Intracranial Pressure: Pressure within the cranial cavity. It is influenced by brain mass, the circulatory system, CSF dynamics, and skull rigidity. [NIH] Intraoperative Complications: Complications that affect patients during surgery. They may or may not be associated with the disease for which the surgery is done, or within the same surgical procedure. [NIH] Intravenous: IV. Into a vein. [NIH] Intravesical: Within the bladder. [NIH] Intrinsic: Situated entirely within or pertaining exclusively to a part. [EU] Intubation: Introduction of a tube into a hollow organ to restore or maintain patency if obstructed. It is differentiated from catheterization in that the insertion of a catheter is usually performed for the introducing or withdrawing of fluids from the body. [NIH] Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU]

Involuntary: Reaction occurring without intention or volition. [NIH] Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Jejunum: That portion of the small intestine which extends from the duodenum to the ileum; called also intestinum jejunum. [EU] Joint: The point of contact between elements of an animal skeleton with the parts that surround and support it. [NIH] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Kidney Failure: The inability of a kidney to excrete metabolites at normal plasma levels

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under conditions of normal loading, or the inability to retain electrolytes under conditions of normal intake. In the acute form (kidney failure, acute), it is marked by uremia and usually by oliguria or anuria, with hyperkalemia and pulmonary edema. The chronic form (kidney failure, chronic) is irreversible and requires hemodialysis. [NIH] Kidney Failure, Acute: A clinical syndrome characterized by a sudden decrease in glomerular filtration rate, often to values of less than 1 to 2 ml per minute. It is usually associated with oliguria (urine volumes of less than 400 ml per day) and is always associated with biochemical consequences of the reduction in glomerular filtration rate such as a rise in blood urea nitrogen (BUN) and serum creatinine concentrations. [NIH] Kidney Failure, Chronic: An irreversible and usually progressive reduction in renal function in which both kidneys have been damaged by a variety of diseases to the extent that they are unable to adequately remove the metabolic products from the blood and regulate the body's electrolyte composition and acid-base balance. Chronic kidney failure requires hemodialysis or surgery, usually kidney transplantation. [NIH] Kidney stone: A stone that develops from crystals that form in urine and build up on the inner surfaces of the kidney, in the renal pelvis, or in the ureters. [NIH] Kidney Transplantation: The transference of a kidney from one human or animal to another. [NIH] Lactation: The period of the secretion of milk. [EU] Laparotomy: A surgical incision made in the wall of the abdomen. [NIH] Latency: The period of apparent inactivity between the time when a stimulus is presented and the moment a response occurs. [NIH] Least-Squares Analysis: A principle of estimation in which the estimates of a set of parameters in a statistical model are those quantities minimizing the sum of squared differences between the observed values of a dependent variable and the values predicted by the model. [NIH] Leiomyoma: A benign tumor derived from smooth muscle tissue, also known as a fibroid tumor. They rarely occur outside of the uterus and the gastrointestinal tract but can occur in the skin and subcutaneous tissues, probably arising from the smooth muscle of small blood vessels in these tissues. [NIH] Lens: The transparent, double convex (outward curve on both sides) structure suspended between the aqueous and vitreous; helps to focus light on the retina. [NIH] Library Services: Services offered to the library user. They include reference and circulation. [NIH]

Ligament: A band of fibrous tissue that connects bones or cartilages, serving to support and strengthen joints. [EU] Likelihood Functions: Functions constructed from a statistical model and a set of observed data which give the probability of that data for various values of the unknown model parameters. Those parameter values that maximize the probability are the maximum likelihood estimates of the parameters. [NIH] Linear Models: Statistical models in which the value of a parameter for a given value of a factor is assumed to be equal to a + bx, where a and b are constants. The models predict a linear regression. [NIH] Lipid: Fat. [NIH] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH]

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Localization: The process of determining or marking the location or site of a lesion or disease. May also refer to the process of keeping a lesion or disease in a specific location or site. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Logistic Models: Statistical models which describe the relationship between a qualitative dependent variable (that is, one which can take only certain discrete values, such as the presence or absence of a disease) and an independent variable. A common application is in epidemiology for estimating an individual's risk (probability of a disease) as a function of a given risk factor. [NIH] Longitudinal study: Also referred to as a "cohort study" or "prospective study"; the analytic method of epidemiologic study in which subsets of a defined population can be identified who are, have been, or in the future may be exposed or not exposed, or exposed in different degrees, to a factor or factors hypothesized to influence the probability of occurrence of a given disease or other outcome. The main feature of this type of study is to observe large numbers of subjects over an extended time, with comparisons of incidence rates in groups that differ in exposure levels. [NIH] Loop: A wire usually of platinum bent at one end into a small loop (usually 4 mm inside diameter) and used in transferring microorganisms. [NIH] Lumen: The cavity or channel within a tube or tubular organ. [EU] Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] Magnetic Resonance Imaging: Non-invasive method of demonstrating internal anatomy based on the principle that atomic nuclei in a strong magnetic field absorb pulses of radiofrequency energy and emit them as radiowaves which can be reconstructed into computerized images. The concept includes proton spin tomographic techniques. [NIH] Malnutrition: A condition caused by not eating enough food or not eating a balanced diet. [NIH]

Mandible: The largest and strongest bone of the face constituting the lower jaw. It supports the lower teeth. [NIH] Meatus: A canal running from the internal auditory foramen through the petrous portion of the temporal bone. It gives passage to the facial and auditory nerves together with the auditory branch of the basilar artery and the internal auditory veins. [NIH] Medial: Lying near the midsaggital plane of the body; opposed to lateral. [NIH] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Menopause: Permanent cessation of menstruation. [NIH] Menstrual Cycle: The period of the regularly recurring physiologic changes in the endometrium occurring during the reproductive period in human females and some primates and culminating in partial sloughing of the endometrium (menstruation). [NIH] Menstruation: The normal physiologic discharge through the vagina of blood and mucosal tissues from the nonpregnant uterus. [NIH] Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to the chin. [EU] Mental Disorders: Psychiatric illness or diseases manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function. [NIH]

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Meta-Analysis: A quantitative method of combining the results of independent studies (usually drawn from the published literature) and synthesizing summaries and conclusions which may be used to evaluate therapeutic effectiveness, plan new studies, etc., with application chiefly in the areas of research and medicine. [NIH] Metabolite: Any substance produced by metabolism or by a metabolic process. [EU] Methoxamine: An alpha-adrenergic agonist that causes prolonged peripheral vasoconstriction. It has little if any direct effect on the central nervous system. [NIH] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Microorganism: An organism that can be seen only through a microscope. Microorganisms include bacteria, protozoa, algae, and fungi. Although viruses are not considered living organisms, they are sometimes classified as microorganisms. [NIH] Micturition: The passage of urine; urination. [EU] Migration: The systematic movement of genes between populations of the same species, geographic race, or variety. [NIH] Mobility: Capability of movement, of being moved, or of flowing freely. [EU] Modeling: A treatment procedure whereby the therapist presents the target behavior which the learner is to imitate and make part of his repertoire. [NIH] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Morphology: The science of the form and structure of organisms (plants, animals, and other forms of life). [NIH] Mucosa: A mucous membrane, or tunica mucosa. [EU] Muscle Contraction: A process leading to shortening and/or development of tension in muscle tissue. Muscle contraction occurs by a sliding filament mechanism whereby actin filaments slide inward among the myosin filaments. [NIH] Muscle Fatigue: A state arrived at through prolonged and strong contraction of a muscle. Studies in athletes during prolonged submaximal exercise have shown that muscle fatigue increases in almost direct proportion to the rate of muscle glycogen depletion. Muscle fatigue in short-term maximal exercise is associated with oxygen lack and an increased level of blood and muscle lactic acid, and an accompanying increase in hydrogen-ion concentration in the exercised muscle. [NIH] Musculature: The muscular apparatus of the body, or of any part of it. [EU] Mydriatic: 1. Dilating the pupil. 2. Any drug that dilates the pupil. [EU] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Myosin: Chief protein in muscle and the main constituent of the thick filaments of muscle

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fibers. In conjunction with actin, it is responsible for the contraction and relaxation of muscles. [NIH] Nausea: An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. [NIH] Need: A state of tension or dissatisfaction felt by an individual that impels him to action toward a goal he believes will satisfy the impulse. [NIH] Needle biopsy: The removal of tissue or fluid with a needle for examination under a microscope. Also called fine-needle aspiration. [NIH] Neoplasm: A new growth of benign or malignant tissue. [NIH] Nephrosis: Descriptive histopathologic term for renal disease without an inflammatory component. [NIH] Nephrotic: Pertaining to, resembling, or caused by nephrosis. [EU] Nephrotic Syndrome: Clinical association of heavy proteinuria, hypoalbuminemia, and generalized edema. [NIH] Nerve: A cordlike structure of nervous tissue that connects parts of the nervous system with other tissues of the body and conveys nervous impulses to, or away from, these tissues. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Neural: 1. Pertaining to a nerve or to the nerves. 2. Situated in the region of the spinal axis, as the neutral arch. [EU] Neurogenic: Loss of bladder control caused by damage to the nerves controlling the bladder. [NIH] Neurologic: Having to do with nerves or the nervous system. [NIH] Neurology: A medical specialty concerned with the study of the structures, functions, and diseases of the nervous system. [NIH] Neuropathy: A problem in any part of the nervous system except the brain and spinal cord. Neuropathies can be caused by infection, toxic substances, or disease. [NIH] Neurophysiology: The scientific discipline concerned with the physiology of the nervous system. [NIH] Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Nocturia: Excessive urination at night. [EU] Norepinephrine: Precursor of epinephrine that is secreted by the adrenal medulla and is a widespread central and autonomic neurotransmitter. Norepinephrine is the principal transmitter of most postganglionic sympathetic fibers and of the diffuse projection system in the brain arising from the locus ceruleus. It is also found in plants and is used pharmacologically as a sympathomimetic. [NIH] Nuclei: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nulliparous: Having never given birth to a viable infant. [EU] Observational study: An epidemiologic study that does not involve any intervention, experimental or otherwise. Such a study may be one in which nature is allowed to take its course, with changes in one characteristic being studied in relation to changes in other

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characteristics. Analytical epidemiologic methods, such as case-control and cohort study designs, are properly called observational epidemiology because the investigator is observing without intervention other than to record, classify, count, and statistically analyze results. [NIH] Occult: Obscure; concealed from observation, difficult to understand. [EU] Oestradiol: Growth hormone. [NIH] Oestrogen: A generic term for oestrus-producing steroid compounds; the female sex hormones. In humans, oestrogen is formed in the ovary, possibly the adrenal cortex, the testis, and the foetoplacental unit; it has various functions in both sexes. It is responsible for the development of the female secondary sex characteristics, and during the menstrual cycle it acts on the female genitalia to produce an environment suitable for the fertilization, implantation, and nutrition of the early embryo. Oestrogen is used in oral contraceptives and as a palliative in cancer of the breast after menopause and cancer of the prostate; other uses include the relief of the discomforts of menopause, inhibition of lactation, and treatment of osteoporosis, threatened abortion, and various functional ovarian disorders. [EU]

Office Visits: Visits made by patients to health service providers' offices for diagnosis, treatment, and follow-up. [NIH] Oliguria: Clinical manifestation of the urinary system consisting of a decrease in the amount of urine secreted. [NIH] Opacity: Degree of density (area most dense taken for reading). [NIH] Ophthalmology: A surgical specialty concerned with the structure and function of the eye and the medical and surgical treatment of its defects and diseases. [NIH] Optic Nerve: The 2nd cranial nerve. The optic nerve conveys visual information from the retina to the brain. The nerve carries the axons of the retinal ganglion cells which sort at the optic chiasm and continue via the optic tracts to the brain. The largest projection is to the lateral geniculate nuclei; other important targets include the superior colliculi and the suprachiasmatic nuclei. Though known as the second cranial nerve, it is considered part of the central nervous system. [NIH] Optic Nerve Diseases: Conditions which produce injury or dysfunction of the second cranial or optic nerve, which is generally considered a component of the central nervous system. Damage to optic nerve fibers may occur at or near their origin in the retina, at the optic disk, or in the nerve, optic chiasm, optic tract, or lateral geniculate nuclei. Clinical manifestations may include decreased visual acuity and contrast sensitivity, impaired color vision, and an afferent pupillary defect. [NIH] Osteoporosis: Reduction of bone mass without alteration in the composition of bone, leading to fractures. Primary osteoporosis can be of two major types: postmenopausal osteoporosis and age-related (or senile) osteoporosis. [NIH] Outpatient: A patient who is not an inmate of a hospital but receives diagnosis or treatment in a clinic or dispensary connected with the hospital. [NIH] Ovariectomy: The surgical removal of one or both ovaries. [NIH] Ovaries: The pair of female reproductive glands in which the ova, or eggs, are formed. The ovaries are located in the pelvis, one on each side of the uterus. [NIH] Ovary: Either of the paired glands in the female that produce the female germ cells and secrete some of the female sex hormones. [NIH] Overactive bladder: A condition in which the patient experiences two or all three of the following conditions: [NIH]

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Painful bladder syndrome: Another name for interstitial cystitis. [NIH] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Panic: A state of extreme acute, intense anxiety and unreasoning fear accompanied by disorganization of personality function. [NIH] Panic Disorder: A type of anxiety disorder characterized by unexpected panic attacks that last minutes or, rarely, hours. Panic attacks begin with intense apprehension, fear or terror and, often, a feeling of impending doom. Symptoms experienced during a panic attack include dyspnea or sensations of being smothered; dizziness, loss of balance or faintness; choking sensations; palpitations or accelerated heart rate; shakiness; sweating; nausea or other form of abdominal distress; depersonalization or derealization; paresthesias; hot flashes or chills; chest discomfort or pain; fear of dying and fear of not being in control of oneself or going crazy. Agoraphobia may also develop. Similar to other anxiety disorders, it may be inherited as an autosomal dominant trait. [NIH] Papilledema: Swelling around the optic disk. [NIH] Partial remission: The shrinking, but not complete disappearance, of a tumor in response to therapy. Also called partial response. [NIH] Passive resistance: Airflow resistance + tissue resistance. [NIH] Patch: A piece of material used to cover or protect a wound, an injured part, etc.: a patch over the eye. [NIH] Pathogenesis: The cellular events and reactions that occur in the development of disease. [NIH]

Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Pathologies: The study of abnormality, especially the study of diseases. [NIH] Pathophysiology: Altered functions in an individual or an organ due to disease. [NIH] Patient Advocacy: Promotion and protection of the rights of patients, frequently through a legal process. [NIH] Patient Compliance: Voluntary cooperation of the patient in following a prescribed regimen. [NIH] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]

Patient Selection: Criteria and standards used for the determination of the appropriateness of the inclusion of patients with specific conditions in proposed treatment plans and the criteria used for the inclusion of subjects in various clinical trials and other research protocols. [NIH] Pelvic: Pertaining to the pelvis. [EU] Pelvis: The lower part of the abdomen, located between the hip bones. [NIH] Penis: The external reproductive organ of males. It is composed of a mass of erectile tissue enclosed in three cylindrical fibrous compartments. Two of the three compartments, the corpus cavernosa, are placed side-by-side along the upper part of the organ. The third compartment below, the corpus spongiosum, houses the urethra. [NIH]

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Percutaneous: Performed through the skin, as injection of radiopacque material in radiological examination, or the removal of tissue for biopsy accomplished by a needle. [EU] Perforation: 1. The act of boring or piercing through a part. 2. A hole made through a part or substance. [EU] Perfusion: Bathing an organ or tissue with a fluid. In regional perfusion, a specific area of the body (usually an arm or a leg) receives high doses of anticancer drugs through a blood vessel. Such a procedure is performed to treat cancer that has not spread. [NIH] Perineal: Pertaining to the perineum. [EU] Perineum: The area between the anus and the sex organs. [NIH] Perioperative: Around the time of surgery; usually lasts from the time of going into the hospital or doctor's office for surgery until the time the patient goes home. [NIH] Pessary: 1. An instrument placed in the vagina to support the uterus or rectum or as a contraceptive device. 2. A medicated vaginal suppository. [EU] Phallic: Pertaining to the phallus, or penis. [EU] Phantom: Used to absorb and/or scatter radiation equivalently to a patient, and hence to estimate radiation doses and test imaging systems without actually exposing a patient. It may be an anthropomorphic or a physical test object. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Pharmacotherapy: A regimen of using appetite suppressant medications to manage obesity by decreasing appetite or increasing the feeling of satiety. These medications decrease appetite by increasing serotonin or catecholamine—two brain chemicals that affect mood and appetite. [NIH] Phenylephrine: An alpha-adrenergic agonist used as a mydriatic, nasal decongestant, and cardiotonic agent. [NIH] Phospholipids: Lipids containing one or more phosphate groups, particularly those derived from either glycerol (phosphoglycerides; glycerophospholipids) or sphingosine (sphingolipids). They are polar lipids that are of great importance for the structure and function of cell membranes and are the most abundant of membrane lipids, although not stored in large amounts in the system. [NIH] Photoreceptors: Cells specialized to detect and transduce light. [NIH] Physical Examination: Systematic and thorough inspection of the patient for physical signs of disease or abnormality. [NIH] Physical Therapy: The restoration of function and the prevention of disability following disease or injury with the use of light, heat, cold, water, electricity, ultrasound, and exercise. [NIH]

Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]

Physiology: The science that deals with the life processes and functions of organismus, their cells, tissues, and organs. [NIH] Pilot study: The initial study examining a new method or treatment. [NIH] Placenta: A highly vascular fetal organ through which the fetus absorbs oxygen and other nutrients and excretes carbon dioxide and other wastes. It begins to form about the eighth day of gestation when the blastocyst adheres to the decidua. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized

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regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Platinum: Platinum. A heavy, soft, whitish metal, resembling tin, atomic number 78, atomic weight 195.09, symbol Pt. (From Dorland, 28th ed) It is used in manufacturing equipment for laboratory and industrial use. It occurs as a black powder (platinum black) and as a spongy substance (spongy platinum) and may have been known in Pliny's time as "alutiae". [NIH]

Pneumonia: Inflammation of the lungs. [NIH] Polycystic: An inherited disorder characterized by many grape-like clusters of fluid-filled cysts that make both kidneys larger over time. These cysts take over and destroy working kidney tissue. PKD may cause chronic renal failure and end-stage renal disease. [NIH] Polyethylene: A vinyl polymer made from ethylene. It can be branched or linear. Branched or low-density polyethylene is tough and pliable but not to the same degree as linear polyethylene. Linear or high-density polyethylene has a greater hardness and tensile strength. Polyethylene is used in a variety of products, including implants and prostheses. [NIH]

Polytetrafluoroethylene: Homopolymer of tetrafluoroethylene. Nonflammable, tough, inert plastic tubing or sheeting; used to line vessels, insulate, protect or lubricate apparatus; also as filter, coating for surgical implants or as prosthetic material. Synonyms: Fluoroflex; Fluoroplast; Ftoroplast; Halon; Polyfene; PTFE; Tetron. [NIH] Port: An implanted device through which blood may be withdrawn and drugs may be infused without repeated needle sticks. Also called a port-a-cath. [NIH] Port-a-cath: An implanted device through which blood may be withdrawn and drugs may be infused without repeated needle sticks. Also called a port. [NIH] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Postmenopausal: Refers to the time after menopause. Menopause is the time in a woman's life when menstrual periods stop permanently; also called "change of life." [NIH] Postnatal: Occurring after birth, with reference to the newborn. [EU] Postoperative: After surgery. [NIH] Postoperative Complications: Pathologic processes that affect patients after a surgical procedure. They may or may not be related to the disease for which the surgery was done, and they may or may not be direct results of the surgery. [NIH] Practicability: A non-standard characteristic of an analytical procedure. It is dependent on the scope of the method and is determined by requirements such as sample throughout and costs. [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Prazosin: A selective adrenergic alpha-1 antagonist used in the treatment of heart failure, hypertension, pheochromocytoma, Raynaud's syndrome, prostatic hypertrophy, and

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urinary retention. [NIH] Preoperative: Preceding an operation. [EU] Prepuce: A covering fold of skin; often used alone to designate the preputium penis. [EU] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Priapism: Persistent abnormal erection of the penis, usually without sexual desire, and accompanied by pain and tenderness. It is seen in diseases and injuries of the spinal cord, and may be caused by vesical calculus and certain injuries to the penis. [EU] Probe: An instrument used in exploring cavities, or in the detection and dilatation of strictures, or in demonstrating the potency of channels; an elongated instrument for exploring or sounding body cavities. [NIH] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Prolapse: The protrusion of an organ or part of an organ into a natural or artificial orifice. [NIH]

Proline: A non-essential amino acid that is synthesized from glutamic acid. It is an essential component of collagen and is important for proper functioning of joints and tendons. [NIH] Prone: Having the front portion of the body downwards. [NIH] Prophylaxis: An attempt to prevent disease. [NIH] Prospective study: An epidemiologic study in which a group of individuals (a cohort), all free of a particular disease and varying in their exposure to a possible risk factor, is followed over a specific amount of time to determine the incidence rates of the disease in the exposed and unexposed groups. [NIH] Prostaglandin: Any of a group of components derived from unsaturated 20-carbon fatty acids, primarily arachidonic acid, via the cyclooxygenase pathway that are extremely potent mediators of a diverse group of physiologic processes. The abbreviation for prostaglandin is PG; specific compounds are designated by adding one of the letters A through I to indicate the type of substituents found on the hydrocarbon skeleton and a subscript (1, 2 or 3) to indicate the number of double bonds in the hydrocarbon skeleton e.g., PGE2. The predominant naturally occurring prostaglandins all have two double bonds and are synthesized from arachidonic acid (5,8,11,14-eicosatetraenoic acid) by the pathway shown in the illustration. The 1 series and 3 series are produced by the same pathway with fatty acids having one fewer double bond (8,11,14-eicosatrienoic acid or one more double bond (5,8,11,14,17-eicosapentaenoic acid) than arachidonic acid. The subscript a or ß indicates the configuration at C-9 (a denotes a substituent below the plane of the ring, ß, above the plane). The naturally occurring PGF's have the a configuration, e.g., PGF2a. All of the prostaglandins act by binding to specific cell-surface receptors causing an increase in the level of the intracellular second messenger cyclic AMP (and in some cases cyclic GMP also). The effect produced by the cyclic AMP increase depends on the specific cell type. In some cases there is also a positive feedback effect. Increased cyclic AMP increases prostaglandin synthesis leading to further increases in cyclic AMP. [EU] Prostaglandins A: (13E,15S)-15-Hydroxy-9-oxoprosta-10,13-dien-1-oic acid (PGA(1)); (5Z,13E,15S)-15-hydroxy-9-oxoprosta-5,10,13-trien-1-oic acid (PGA(2)); (5Z,13E,15S,17Z)-15hydroxy-9-oxoprosta-5,10,13,17-tetraen-1-oic acid (PGA(3)). A group of naturally occurring secondary prostaglandins derived from PGE. PGA(1) and PGA(2) as well as their 19-

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hydroxy derivatives are found in many organs and tissues. [NIH] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Prostate gland: A gland in the male reproductive system just below the bladder. It surrounds part of the urethra, the canal that empties the bladder, and produces a fluid that forms part of semen. [NIH] Prostatectomy: Complete or partial surgical removal of the prostate. Three primary approaches are commonly employed: suprapubic - removal through an incision above the pubis and through the urinary bladder; retropubic - as for suprapubic but without entering the urinary bladder; and transurethral (transurethral resection of prostate). [NIH] Prostatic Hyperplasia: Enlargement or overgrowth of the prostate gland as a result of an increase in the number of its constituent cells. [NIH] Prostatitis: Inflammation of the prostate. [EU] Prosthesis: An artificial replacement of a part of the body. [NIH] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Proteinuria: The presence of protein in the urine, indicating that the kidneys are not working properly. [NIH] Protocol: The detailed plan for a clinical trial that states the trial's rationale, purpose, drug or vaccine dosages, length of study, routes of administration, who may participate, and other aspects of trial design. [NIH] Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Pseudotumor Cerebri: A condition marked by raised intracranial pressure and characterized clinically by headaches; nausea; papilledema, peripheral constriction of the visual fields, transient visual obscurations, and pulsatile tinnitus. Obesity is frequently associated with this condition, which primarily affects women between 20 and 44 years of age. Chronic papilledema may lead to optic nerve injury (optic nerve diseases) and visual loss (blindness). [NIH] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Psychoactive: Those drugs which alter sensation, mood, consciousness or other psychological or behavioral functions. [NIH] Psychogenic: Produced or caused by psychic or mental factors rather than organic factors. [EU]

Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Pulmonary: Relating to the lungs. [NIH] Pulmonary Edema: An accumulation of an excessive amount of watery fluid in the lungs, may be caused by acute exposure to dangerous concentrations of irritant gasses. [NIH] Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts.

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[NIH]

Pyelonephritis: Inflammation of the kidney and its pelvis, beginning in the interstitium and rapidly extending to involve the tubules, glomeruli, and blood vessels; due to bacterial infection. [EU] Quality of Life: A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral and social environment. [NIH] Race: A population within a species which exhibits general similarities within itself, but is both discontinuous and distinct from other populations of that species, though not sufficiently so as to achieve the status of a taxon. [NIH] Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH] Radioactive: Giving off radiation. [NIH] Radiological: Pertaining to radiodiagnostic and radiotherapeutic procedures, and interventional radiology or other planning and guiding medical radiology. [NIH] Random Allocation: A process involving chance used in therapeutic trials or other research endeavor for allocating experimental subjects, human or animal, between treatment and control groups, or among treatment groups. It may also apply to experiments on inanimate objects. [NIH] Randomization: Also called random allocation. Is allocation of individuals to groups, e.g., for experimental and control regimens, by chance. Within the limits of chance variation, random allocation should make the control and experimental groups similar at the start of an investigation and ensure that personal judgment and prejudices of the investigator do not influence allocation. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Randomized clinical trial: A study in which the participants are assigned by chance to separate groups that compare different treatments; neither the researchers nor the participants can choose which group. Using chance to assign people to groups means that the groups will be similar and that the treatments they receive can be compared objectively. At the time of the trial, it is not known which treatment is best. It is the patient's choice to be in a randomized trial. [NIH] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Reflex: An involuntary movement or exercise of function in a part, excited in response to a stimulus applied to the periphery and transmitted to the brain or spinal cord. [NIH] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Regression Analysis: Procedures for finding the mathematical function which best describes the relationship between a dependent variable and one or more independent variables. In linear regression (see linear models) the relationship is constrained to be a straight line and least-squares analysis is used to determine the best fit. In logistic regression (see logistic models) the dependent variable is qualitative rather than continuously variable

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and likelihood functions are used to find the best relationship. In multiple regression the dependent variable is considered to depend on more than a single independent variable. [NIH]

Remission: A decrease in or disappearance of signs and symptoms of cancer. In partial remission, some, but not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although there still may be cancer in the body. [NIH] Renal pelvis: The area at the center of the kidney. Urine collects here and is funneled into the ureter, the tube that connects the kidney to the bladder. [NIH] Reproductive system: In women, this system includes the ovaries, the fallopian tubes, the uterus (womb), the cervix, and the vagina (birth canal). The reproductive system in men includes the prostate, the testes, and the penis. [NIH] Resorption: The loss of substance through physiologic or pathologic means, such as loss of dentin and cementum of a tooth, or of the alveolar process of the mandible or maxilla. [EU] Restoration: Broad term applied to any inlay, crown, bridge or complete denture which restores or replaces loss of teeth or oral tissues. [NIH] Retina: The ten-layered nervous tissue membrane of the eye. It is continuous with the optic nerve and receives images of external objects and transmits visual impulses to the brain. Its outer surface is in contact with the choroid and the inner surface with the vitreous body. The outer-most layer is pigmented, whereas the inner nine layers are transparent. [NIH] Retrograde: 1. Moving backward or against the usual direction of flow. 2. Degenerating, deteriorating, or catabolic. [EU] Retropubic: A potential space between the urinary bladder and the symphisis and body of the pubis. [NIH] Retrospective: Looking back at events that have already taken place. [NIH] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Rod: A reception for vision, located in the retina. [NIH] Rubber: A high-molecular-weight polymeric elastomer derived from the milk juice (latex) of Hevea brasiliensis and other trees. It is a substance that can be stretched at room temperature to atleast twice its original length and after releasing the stress, retractrapidly, and recover its original dimensions fully. Synthetic rubber is made from many different chemicals, including styrene, acrylonitrile, ethylene, propylene, and isoprene. [NIH] Sanitary: Relating or belonging to health and hygiene; conductive to the restoration or maintenance of health. [NIH] Scatter: The extent to which relative success and failure are divergently manifested in qualitatively different tests. [NIH] Schizoid: Having qualities resembling those found in greater degree in schizophrenics; a person of schizoid personality. [NIH] Schizophrenia: A mental disorder characterized by a special type of disintegration of the personality. [NIH] Schizotypal Personality Disorder: A personality disorder in which there are oddities of thought (magical thinking, paranoid ideation, suspiciousness), perception (illusions, depersonalization), speech (digressive, vague, overelaborate), and behavior (inappropriate affect in social interactions, frequently social isolation) that are not severe enough to characterize schizophrenia. [NIH]

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Screening: Checking for disease when there are no symptoms. [NIH] Sebaceous: Gland that secretes sebum. [NIH] Sebaceous gland: Gland that secretes sebum. [NIH] Sedative: 1. Allaying activity and excitement. 2. An agent that allays excitement. [EU] Self-Examination: The inspection of one's own body, usually for signs of disease (e.g., breast self-examination, testicular self-examination). [NIH] Semen: The thick, yellowish-white, viscid fluid secretion of male reproductive organs discharged upon ejaculation. In addition to reproductive organ secretions, it contains spermatozoa and their nutrient plasma. [NIH] Sensor: A device designed to respond to physical stimuli such as temperature, light, magnetism or movement and transmit resulting impulses for interpretation, recording, movement, or operating control. [NIH] Serotonin: A biochemical messenger and regulator, synthesized from the essential amino acid L-tryptophan. In humans it is found primarily in the central nervous system, gastrointestinal tract, and blood platelets. Serotonin mediates several important physiological functions including neurotransmission, gastrointestinal motility, hemostasis, and cardiovascular integrity. Multiple receptor families (receptors, serotonin) explain the broad physiological actions and distribution of this biochemical mediator. [NIH] Sex Characteristics: Those characteristics that distinguish one sex from the other. The primary sex characteristics are the ovaries and testes and their related hormones. Secondary sex characteristics are those which are masculine or feminine but not directly related to reproduction. [NIH] Sexually Transmitted Diseases: Diseases due to or propagated by sexual contact. [NIH] Shock: The general bodily disturbance following a severe injury; an emotional or moral upset occasioned by some disturbing or unexpected experience; disruption of the circulation, which can upset all body functions: sometimes referred to as circulatory shock. [NIH]

Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Signs and Symptoms: Clinical manifestations that can be either objective when observed by a physician, or subjective when perceived by the patient. [NIH] Skeletal: Having to do with the skeleton (boney part of the body). [NIH] Skeleton: The framework that supports the soft tissues of vertebrate animals and protects many of their internal organs. The skeletons of vertebrates are made of bone and/or cartilage. [NIH] Smooth muscle: Muscle that performs automatic tasks, such as constricting blood vessels. [NIH]

Sneezing: Sudden, forceful, involuntary expulsion of air from the nose and mouth caused by irritation to the mucous membranes of the upper respiratory tract. [NIH] Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH] Social Isolation: The separation of individuals or groups resulting in the lack of or minimizing of social contact and/or communication. This separation may be accomplished by physical separation, by social barriers and by psychological mechanisms. In the latter, there may be interaction but no real communication. [NIH]

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Solid tumor: Cancer of body tissues other than blood, bone marrow, or the lymphatic system. [NIH] Sonogram: A computer picture of areas inside the body created by bouncing sound waves off organs and other tissues. Also called ultrasonogram or ultrasound. [NIH] Sound wave: An alteration of properties of an elastic medium, such as pressure, particle displacement, or density, that propagates through the medium, or a superposition of such alterations. [NIH] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Sperm: The fecundating fluid of the male. [NIH] Sphincter: A ringlike band of muscle fibres that constricts a passage or closes a natural orifice; called also musculus sphincter. [EU] Spina bifida: A defect in development of the vertebral column in which there is a central deficiency of the vertebral lamina. [NIH] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Stabilization: The creation of a stable state. [EU] Statistically significant: Describes a mathematical measure of difference between groups. The difference is said to be statistically significant if it is greater than what might be expected to happen by chance alone. [NIH] Steel: A tough, malleable, iron-based alloy containing up to, but no more than, two percent carbon and often other metals. It is used in medicine and dentistry in implants and instrumentation. [NIH] Stem Cells: Relatively undifferentiated cells of the same lineage (family type) that retain the ability to divide and cycle throughout postnatal life to provide cells that can become specialized and take the place of those that die or are lost. [NIH] Stenosis: Narrowing or stricture of a duct or canal. [EU] Stent: A device placed in a body structure (such as a blood vessel or the gastrointestinal tract) to provide support and keep the structure open. [NIH] Sterile: Unable to produce children. [NIH] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH] Stoma: A surgically created opening from an area inside the body to the outside. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stool: The waste matter discharged in a bowel movement; feces. [NIH]

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Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stress incontinence: An involuntary loss of urine that occurs at the same time that internal abdominal pressure is increased, such as with laughing, sneezing, coughing, or physical activity. [NIH] Stress urinary: Leakage of urine caused by actions--such as coughing, laughing, sneezing, running, or lifting--that place pressure on the bladder from inside the body. Stress urinary incontinence can result from either a fallen bladder or weak sphincter muscles. [NIH] Stricture: The abnormal narrowing of a body opening. Also called stenosis. [NIH] Styrene: A colorless, toxic liquid with a strong aromatic odor. It is used to make rubbers, polymers and copolymers, and polystyrene plastics. [NIH] Subacute: Somewhat acute; between acute and chronic. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Subcutaneous: Beneath the skin. [NIH] Supine: Having the front portion of the body upwards. [NIH] Supplementation: Adding nutrients to the diet. [NIH] Suppository: A medicated mass adapted for introduction into the rectal, vaginal, or urethral orifice of the body, suppository bases are solid at room temperature but melt or dissolve at body temperature. Commonly used bases are cocoa butter, glycerinated gelatin, hydrogenated vegetable oils, polyethylene glycols of various molecular weights, and fatty acid esters of polyethylene glycol. [EU] Suspensions: Colloids with liquid continuous phase and solid dispersed phase; the term is used loosely also for solid-in-gas (aerosol) and other colloidal systems; water-insoluble drugs may be given as suspensions. [NIH] Sweat: The fluid excreted by the sweat glands. It consists of water containing sodium chloride, phosphate, urea, ammonia, and other waste products. [NIH] Sweat Glands: Sweat-producing structures that are embedded in the dermis. Each gland consists of a single tube, a coiled body, and a superficial duct. [NIH] Symphysis: A secondary cartilaginous joint. [NIH] Symptomatic: Having to do with symptoms, which are signs of a condition or disease. [NIH] Symptomatology: 1. That branch of medicine with treats of symptoms; the systematic discussion of symptoms. 2. The combined symptoms of a disease. [EU] Synapse: The region where the processes of two neurons come into close contiguity, and the nervous impulse passes from one to the other; the fibers of the two are intermeshed, but, according to the general view, there is no direct contiguity. [NIH] Systemic: Affecting the entire body. [NIH] Systolic: Indicating the maximum arterial pressure during contraction of the left ventricle of the heart. [EU] Temporal: One of the two irregular bones forming part of the lateral surfaces and base of the skull, and containing the organs of hearing. [NIH] Testicles: The two egg-shaped glands found inside the scrotum. They produce sperm and male hormones. Also called testes. [NIH]

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Testicular: Pertaining to a testis. [EU] Testicular Feminization: A type of male pseudohermaphroditism in which the individual is phenotypically female, but with XY genotype. Fallopian tubes and a uterus may be present, but the gonads are usually testes. Androgens and estrogens are formed, but tissues are unresponsive to the androgens. [NIH] Testis: Either of the paired male reproductive glands that produce the male germ cells and the male hormones. [NIH] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Thermal: Pertaining to or characterized by heat. [EU] Thoracic: Having to do with the chest. [NIH] Thorax: A part of the trunk between the neck and the abdomen; the chest. [NIH] Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Tinnitus: Sounds that are perceived in the absence of any external noise source which may take the form of buzzing, ringing, clicking, pulsations, and other noises. Objective tinnitus refers to noises generated from within the ear or adjacent structures that can be heard by other individuals. The term subjective tinnitus is used when the sound is audible only to the affected individual. Tinnitus may occur as a manifestation of cochlear diseases; vestibulocochlear nerve diseases; intracranial hypertension; craniocerebral trauma; and other conditions. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tissue Banks: Centers for acquiring, characterizing, and storing organs or tissue for future use. [NIH] Toilet Training: Conditioning to defecate and urinate in culturally acceptable places. [NIH] Tone: 1. The normal degree of vigour and tension; in muscle, the resistance to passive elongation or stretch; tonus. 2. A particular quality of sound or of voice. 3. To make permanent, or to change, the colour of silver stain by chemical treatment, usually with a heavy metal. [EU] Tonic: 1. Producing and restoring the normal tone. 2. Characterized by continuous tension. 3. A term formerly used for a class of medicinal preparations believed to have the power of restoring normal tone to tissue. [EU] Tonus: A state of slight tension usually present in muscles even when they are not undergoing active contraction. [NIH] Tooth Preparation: Procedures carried out with regard to the teeth or tooth structures preparatory to specified dental therapeutic and surgical measures. [NIH] Topical: On the surface of the body. [NIH] Torsion: A twisting or rotation of a bodily part or member on its axis. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicology: The science concerned with the detection, chemical composition, and

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pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxins: Specific, characterizable, poisonous chemicals, often proteins, with specific biological properties, including immunogenicity, produced by microbes, higher plants, or animals. [NIH] Traction: The act of pulling. [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Transrectal ultrasound: A procedure used to examine the prostate. An instrument is inserted into the rectum, and sound waves bounce off the prostate. These sound waves create echoes, which a computer uses to create a picture called a sonogram. [NIH] Transurethral: Performed through the urethra. [EU] Transurethral resection: Surgery performed with a special instrument inserted through the urethra. Also called TUR. [NIH] Transurethral Resection of Prostate: Resection of the prostate using a cystoscope passed through the urethra. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Treatment Outcome: Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, practicability, etc., of these interventions in individual cases or series. [NIH]

Trees: Woody, usually tall, perennial higher plants (Angiosperms, Gymnosperms, and some Pterophyta) having usually a main stem and numerous branches. [NIH] Tricyclic: Containing three fused rings or closed chains in the molecular structure. [EU] Tryptophan: An essential amino acid that is necessary for normal growth in infants and for nitrogen balance in adults. It is a precursor serotonin and niacin. [NIH] Tumour: 1. Swelling, one of the cardinal signs of inflammations; morbid enlargement. 2. A new growth of tissue in which the multiplication of cells is uncontrolled and progressive; called also neoplasm. [EU] Tunica: A rather vague term to denote the lining coat of hollow organs, tubes, or cavities. [NIH]

Type 2 diabetes: Usually characterized by a gradual onset with minimal or no symptoms of metabolic disturbance and no requirement for exogenous insulin. The peak age of onset is 50 to 60 years. Obesity and possibly a genetic factor are usually present. [NIH] Ultrasonography: The visualization of deep structures of the body by recording the reflections of echoes of pulses of ultrasonic waves directed into the tissues. Use of ultrasound for imaging or diagnostic purposes employs frequencies ranging from 1.6 to 10 megahertz. [NIH] Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [NIH] Uremia: The illness associated with the buildup of urea in the blood because the kidneys are not working effectively. Symptoms include nausea, vomiting, loss of appetite, weakness, and mental confusion. [NIH] Ureters: Tubes that carry urine from the kidneys to the bladder. [NIH] Urethra: The tube through which urine leaves the body. It empties urine from the bladder.

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[NIH]

Urethral Obstruction: Obstruction anywhere along the urethra. [NIH] Urethritis: Inflammation of the urethra. [EU] Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urinary Retention: Inability to urinate. The etiology of this disorder includes obstructive, neurogenic, pharmacologic, and psychogenic causes. [NIH] Urinary tract: The organs of the body that produce and discharge urine. These include the kidneys, ureters, bladder, and urethra. [NIH] Urinary tract infection: An illness caused by harmful bacteria growing in the urinary tract. [NIH]

Urinate: To release urine from the bladder to the outside. [NIH] Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Urodynamic: Measures of the bladder's ability to hold and release urine. [NIH] Urogenital: Pertaining to the urinary and genital apparatus; genitourinary. [EU] Urologist: A doctor who specializes in diseases of the urinary organs in females and the urinary and sex organs in males. [NIH] Urology: A surgical specialty concerned with the study, diagnosis, and treatment of diseases of the urinary tract in both sexes and the genital tract in the male. It includes the specialty of andrology which addresses both male genital diseases and male infertility. [NIH] Uterus: The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a fetus develops. Also called the womb. [NIH] Vaccine: A substance or group of substances meant to cause the immune system to respond to a tumor or to microorganisms, such as bacteria or viruses. [NIH] Vagina: The muscular canal extending from the uterus to the exterior of the body. Also called the birth canal. [NIH] Vaginal: Of or having to do with the vagina, the birth canal. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vasectomy: An operation to cut or tie off the two tubes that carry sperm out of the testicles. [NIH]

Vasoconstriction: Narrowing of the blood vessels without anatomic change, for which constriction, pathologic is used. [NIH] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Ventricle: One of the two pumping chambers of the heart. The right ventricle receives oxygen-poor blood from the right atrium and pumps it to the lungs through the pulmonary artery. The left ventricle receives oxygen-rich blood from the left atrium and pumps it to the body through the aorta. [NIH] Vertebrae: A bony unit of the segmented spinal column. [NIH] Vertebral: Of or pertaining to a vertebra. [EU] Vesicovaginal Fistula: An abnormal communication between the bladder and the vagina. [NIH]

Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH]

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Visual field: The entire area that can be seen when the eye is forward, including peripheral vision. [NIH] Vitreous: Glasslike or hyaline; often used alone to designate the vitreous body of the eye (corpus vitreum). [EU] Vitro: Descriptive of an event or enzyme reaction under experimental investigation occurring outside a living organism. Parts of an organism or microorganism are used together with artificial substrates and/or conditions. [NIH] Vivo: Outside of or removed from the body of a living organism. [NIH] Void: To urinate, empty the bladder. [NIH] Volition: Voluntary activity without external compulsion. [NIH] Withdrawal: 1. A pathological retreat from interpersonal contact and social involvement, as may occur in schizophrenia, depression, or schizoid avoidant and schizotypal personality disorders. 2. (DSM III-R) A substance-specific organic brain syndrome that follows the cessation of use or reduction in intake of a psychoactive substance that had been regularly used to induce a state of intoxication. [EU] Womb: A hollow, thick-walled, muscular organ in which the impregnated ovum is developed into a child. [NIH] Wound Infection: Invasion of the site of trauma by pathogenic microorganisms. [NIH] Xenograft: The cells of one species transplanted to another species. [NIH]

173

INDEX A Abdomen, 89, 96, 113, 125, 139, 142, 153, 154, 159, 167, 169 Abdominal, 21, 22, 28, 77, 79, 81, 90, 92, 93, 94, 95, 105, 113, 125, 136, 139, 146, 159, 168 Abortion, 139, 158 Acrylonitrile, 139, 165 Actin, 139, 156, 157 Acute renal, 100, 139 Adaptation, 103, 139 Adipose Tissue, 12, 139 Adjustment, 57, 58, 139 Adrenal Cortex, 139, 148, 158 Adrenergic, 23, 49, 139, 148, 156, 160, 161 Adrenergic Agonists, 23, 139 Adverse Effect, 8, 139, 166 Aeroembolism, 139, 142 Aerosol, 139, 168 Aetiology, 29, 139 Afferent, 67, 140, 158 Affinity, 140 Age Groups, 18, 140 Age of Onset, 140, 170 Aged, 80 and Over, 140 Agonist, 96, 140, 156, 160 Agoraphobia, 140, 152, 159 Algorithms, 102, 140, 142 Allograft, 10, 140 Alpha-1, 140, 161 Alternative medicine, 112, 140 Alveolar Process, 140, 165 Ampulla, 140, 148 Anal, 140, 149, 155 Anastomosis, 140, 150 Anatomical, 4, 8, 11, 45, 77, 81, 85, 87, 103, 140 Androgens, 139, 140, 169 Anesthesia, 6, 61, 83, 87, 95, 140 Angiogenesis, 19, 141 Animal model, 12, 141 Antibody, 140, 141, 144, 152 Antidepressant, 141, 152 Antigen, 140, 141, 144, 151, 152 Anuria, 141, 154 Anus, 140, 141, 142, 160 Aperture, 82, 141 Approximate, 76, 141

Aqueous, 141, 142, 147, 154 Arachidonic Acid, 141, 162 Arterial, 141, 151, 163, 168 Arteries, 141, 142, 146, 156 Artery, 141, 142, 146, 163, 171 Assay, 19, 141 Atrophy, 11, 141 Atypical, 100, 141 Auditory, 141, 155 Auditory nerve, 141, 155 Autologous, 5, 37, 50, 125, 141 B Bacteria, 141, 142, 149, 156, 171 Bacterial Physiology, 139, 142 Base, 90, 142, 146, 153, 154, 168 Basilar Artery, 142, 155 Bends, 86, 142 Benign, 91, 99, 100, 101, 142, 149, 154, 157 Benign prostatic hyperplasia, 99, 100, 142 Bifida, 142 Biological therapy, 142, 151 Biopsy, 142, 160 Biotechnology, 19, 112, 119, 142 Blood pressure, 142, 151, 152 Blood vessel, 141, 142, 143, 153, 154, 160, 164, 166, 167, 171 Body Fluids, 142, 143, 147 Bowel, 25, 103, 140, 142, 143, 145, 153, 167 Bowel Movement, 142, 143, 145, 167 Branch, 133, 142, 155, 159, 167, 168, 169 Breakdown, 142, 146, 150 Breast Self-Examination, 142, 166 Bulking Agents, 5, 102, 143 Bypass, 12, 143 C Cannula, 87, 143 Carbon Dioxide, 143, 149, 160 Cardiac, 143, 147, 148, 156, 167 Cardiotonic, 143, 160 Case series, 143, 144 Catecholamine, 143, 160 Catgut, 82, 143 Catheter, 34, 35, 77, 90, 91, 143, 153 Catheterization, 6, 143, 153 Caudal, 143, 161 Causal, 27, 143 Caustic, 143 Cauterization, 91, 143

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Cell, 13, 16, 139, 140, 141, 142, 143, 144, 148, 150, 151, 153, 160, 161, 162, 164 Cell Division, 141, 143, 151, 161 Cell membrane, 143, 150, 160 Cell Survival, 143, 151 Character, 143, 146 Chromium, 143 Chronic, 12, 94, 100, 137, 144, 148, 152, 154, 161, 163, 168 Chronic Disease, 12, 144 Chronic renal, 144, 161 Circumcision, 99, 144 Clamp, 13, 104, 144 Clinical series, 17, 144 Clinical trial, 11, 18, 119, 144, 147, 148, 159, 163, 164 Cloning, 142, 144 Collagen, 5, 7, 8, 10, 26, 33, 39, 49, 50, 60, 66, 90, 108, 110, 111, 124, 125, 143, 144, 162 Colloidal, 144, 168 Complement, 144, 145 Complementary and alternative medicine, 69, 74, 145 Complementary medicine, 69, 145 Complete remission, 145, 165 Compliance, 7, 13, 14, 27, 44, 145 Compress, 79, 145 Computational Biology, 119, 145 Concomitant, 48, 91, 145 Cones, 7, 19, 56, 61, 107, 145 Confounding, 38, 145 Connective Tissue, 5, 35, 50, 89, 144, 145, 146, 149 Connective Tissue Cells, 145 Connexins, 145, 150 Constrict, 79, 83, 145 Constriction, 145, 153, 163, 171 Continence, 6, 7, 9, 13, 14, 18, 32, 43, 47, 48, 52, 93, 95, 102, 105, 113, 125, 145 Contractility, 13, 145 Contracture, 26, 53, 145 Contraindications, ii, 145 Coronary, 145, 146, 156 Coronary Thrombosis, 146, 156 Curative, 146, 169 Cyclic, 146, 162 Cystitis, 94, 100, 101, 124, 146, 159 Cystocele, 45, 55, 62, 81, 85, 108, 146 Cystometrogram, 57, 146 Cystoscopy, 95, 136, 146 Cystostomy, 84, 146

D De novo, 8, 146 Decision Making, 104, 146 Decongestant, 146, 160 Degenerative, 78, 146 Density, 13, 146, 158, 161, 167 Dermal, 53, 146 Dermis, 10, 146, 168 Diagnostic procedure, 75, 112, 146 Diaphragm, 77, 79, 89, 93, 146 Diastolic, 146, 151 Digestion, 142, 146, 153, 154, 167 Dilatation, 139, 146, 162 Direct, iii, 14, 79, 146, 156, 161, 164, 168 Dissection, 82, 146 Distal, 39, 77, 83, 88, 89, 94, 96, 146, 147, 163 Diverticula, 102, 146 Diverticulum, 108, 146 Dorsal, 146, 161 Double-blind, 22, 31, 48, 66, 147 Drive, ii, vi, 4, 65, 88, 100, 125, 147 Drug Evaluation, 147, 148 Drug Evaluation, Preclinical, 147, 148 Drug Interactions, 147 Duct, 84, 140, 143, 147, 167, 168 Duodenum, 147, 148, 153, 167 E Edema, 147, 157 Efficacy, 5, 9, 12, 14, 17, 32, 43, 47, 71, 147, 170 Elastin, 144, 147 Electrode, 92, 94, 147 Electrolytes, 147, 154 Electromyography, 14, 147 Embryo, 139, 147, 158 Embryology, 102, 147 Emulsion, 147, 149 Endocrinology, 147, 151 Endometrium, 91, 147, 155 Endoscope, 84, 147, 148 Endoscopic, 30, 33, 53, 66, 85, 86, 113, 146, 148 Endoscopy, 34, 84, 102, 148 End-stage renal, 144, 148, 161 Enuresis, 100, 101, 148 Environmental Health, 118, 120, 148 Enzyme, 148, 172 Epidermis, 146, 148 Epinephrine, 139, 148, 157 Erection, 148, 162 Esophageal, 91, 148

Index

Esophagus, 148, 167 Estradiol, 148 Estriol, 66, 110, 148 Estrogen, 66, 103, 148 Evaluation Studies, 48, 148 Excrete, 141, 148, 153 Exogenous, 148, 170 Extracellular, 145, 148 Extracellular Matrix, 145, 148 F Facial, 149, 155 Family Planning, 119, 149 Fat, 5, 50, 84, 125, 139, 141, 149, 154 Fatigue, 149, 151, 156 Fatty acids, 149, 162 Fecal Incontinence, 94, 149, 152 Feces, 149, 167 Fetus, 139, 149, 160, 171 Fibroid, 149, 154 Fibrosis, 145, 149 Fine-needle aspiration, 149, 157 Fistula, 50, 101, 137, 149 Fixation, 21, 76, 82, 85, 108, 149 Flatus, 149, 150 Foetoplacental, 149, 158 Fold, 78, 149, 162 Foramen, 149, 155 Fovea, 149 G Gallbladder, 139, 149 Gap Junctions, 16, 145, 149 Gas, 84, 139, 142, 143, 149, 150, 151, 157, 168 Gastric, 12, 150 Gastric Bypass, 12, 150 Gastrointestinal, 148, 149, 150, 154, 166, 167 Gastrointestinal tract, 149, 150, 154, 166, 167 Gene, 18, 44, 142, 145, 150 Gene Expression, 44, 150 Genital, 22, 50, 52, 99, 150, 151, 171 Genitourinary, 18, 30, 48, 150, 171 Genotype, 150, 169 Gestational, 101, 150 Gland, 139, 150, 159, 163, 166, 167, 168 Glomerular, 150, 154 Glomeruli, 150, 164 Glomerulonephritis, 100, 150 Glucose, 143, 150, 153 Glycogen, 150, 156 Gonads, 150, 169

175

Governing Board, 150, 161 Grade, 4, 150 Grading, 4, 150 Grafting, 151, 152 Growth, 19, 140, 141, 143, 150, 151, 157, 158, 160, 170 Growth factors, 19, 151 Gynaecological, 63, 151 H Hair follicles, 146, 151 Heart failure, 151, 161 Hemodialysis, 151, 154 Heredity, 150, 151 Hernia, 81, 151 Hormonal, 4, 18, 90, 141, 151 Hormone, 37, 148, 151, 153, 158 Hydrogel, 151, 152 Hydrogen, 142, 151, 156 Hydroxylysine, 144, 151 Hydroxyproline, 144, 151 Hygienic, 96, 151 Hyperplasia, 91, 151 Hypersensitivity, 50, 151 Hypertension, 12, 151, 161, 169 Hypertrophy, 142, 151, 161 Hypospadias, 99, 152 Hypotensive, 152 Hysterectomy, 43, 62, 104, 152 I Id, 67, 74, 84, 126, 132, 134, 152 Idiopathic, 16, 152 Imipramine, 27, 152 Implantation, 24, 152, 158 Impotence, 99, 100, 152 In situ, 40, 152 In vitro, 13, 15, 19, 147, 152 In vivo, 13, 15, 152 Incision, 6, 47, 84, 95, 152, 153, 154, 163 Incontinence Pads, 97, 103, 152 Indicative, 90, 92, 152, 159, 171 Indoramin, 21, 152 Infant, Newborn, 140, 152 Infarction, 146, 152, 156 Infection, 10, 78, 100, 142, 152, 155, 157, 164, 168 Infertility, 152, 171 Infiltration, 150, 152 Informed Consent, 13, 153 Innervation, 11, 29, 111, 153 Insulin, 12, 153, 170 Insulin-dependent diabetes mellitus, 153 Interstitial, 91, 94, 100, 101, 124, 153, 159

176

Stress Incontinence

Intestinal, 13, 153 Intestine, 142, 147, 151, 153, 164 Intoxication, 153, 172 Intracellular, 152, 153, 162 Intracranial Pressure, 153, 163 Intraoperative Complications, 5, 153 Intravenous, 6, 61, 153 Intravesical, 13, 66, 93, 105, 153 Intrinsic, 5, 10, 77, 111, 113, 140, 153 Intubation, 143, 153 Invasive, 6, 11, 14, 17, 24, 39, 45, 57, 78, 153, 155 Involuntary, 8, 11, 78, 79, 89, 92, 96, 101, 103, 105, 148, 149, 153, 156, 164, 166, 168 Ions, 142, 147, 151, 153 Ischemia, 141, 153 J Jejunum, 150, 153 Joint, 139, 153, 168 K Kb, 118, 153 Kidney Failure, 100, 148, 153, 154 Kidney Failure, Acute, 154 Kidney Failure, Chronic, 154 Kidney stone, 100, 154 Kidney Transplantation, 100, 154 L Lactation, 154, 158 Laparotomy, 34, 154 Latency, 52, 154 Least-Squares Analysis, 154, 164 Leiomyoma, 24, 149, 154 Lens, 89, 154 Library Services, 132, 154 Ligament, 28, 44, 55, 76, 82, 85, 154, 163 Likelihood Functions, 154, 165 Linear Models, 154, 164 Lipid, 153, 154 Liver, 139, 141, 147, 149, 150, 154 Localization, 81, 155 Localized, 91, 149, 152, 155, 160 Logistic Models, 155, 164 Longitudinal study, 58, 155 Loop, 82, 95, 150, 151, 155 Lumen, 20, 76, 89, 143, 155 Lymphatic, 152, 155, 167 M Magnetic Resonance Imaging, 57, 155 Malnutrition, 141, 155 Mandible, 140, 155, 165 Meatus, 77, 80, 83, 90, 103, 155 Medial, 84, 155

MEDLINE, 119, 155 Membrane, 143, 144, 148, 155, 156, 160, 165 Menopause, 18, 155, 158, 161 Menstrual Cycle, 6, 155, 158 Menstruation, 78, 155 Mental, iv, 11, 45, 118, 120, 149, 155, 163, 165, 170 Mental Disorders, 155, 163 Meta-Analysis, 24, 70, 156 Metabolite, 148, 156 Methoxamine, 31, 156 MI, 138, 156 Microbiology, 139, 141, 156 Microorganism, 156, 172 Micturition, 13, 67, 102, 156 Migration, 5, 156 Mobility, 10, 25, 40, 50, 51, 156 Modeling, 63, 156 Modification, 89, 97, 156, 164 Molecular, 16, 18, 119, 121, 142, 145, 156, 165, 168, 170 Molecule, 141, 142, 144, 156, 164 Morphology, 42, 156 Mucosa, 88, 137, 156 Muscle Contraction, 93, 156 Muscle Fatigue, 14, 156 Musculature, 6, 11, 77, 156 Mydriatic, 156, 160 Myocardium, 156 Myosin, 156 N Nausea, 157, 159, 163, 170 Need, 3, 5, 8, 15, 77, 99, 102, 107, 112, 125, 127, 144, 150, 157 Needle biopsy, 37, 149, 157 Neoplasm, 157, 170 Nephrosis, 157 Nephrotic, 100, 157 Nephrotic Syndrome, 100, 157 Nerve, 24, 37, 52, 67, 73, 139, 140, 141, 153, 157, 158, 167, 169 Nervous System, 139, 140, 156, 157, 158, 166 Neural, 19, 140, 157 Neurogenic, 46, 101, 157, 171 Neurologic, 7, 157 Neurology, 102, 157 Neuropathy, 4, 157 Neurophysiology, 56, 102, 157 Nitrogen, 140, 149, 154, 157, 170 Nocturia, 6, 101, 157

Index

Norepinephrine, 139, 157 Nuclei, 155, 157, 158 Nulliparous, 51, 157 O Observational study, 6, 157 Occult, 62, 158 Oestradiol, 66, 158 Oestrogen, 66, 158 Office Visits, 17, 158 Oliguria, 154, 158 Opacity, 146, 158 Ophthalmology, 149, 158 Optic Nerve, 158, 163, 165 Optic Nerve Diseases, 158, 163 Osteoporosis, 158 Outpatient, 16, 25, 158 Ovariectomy, 18, 158 Ovaries, 158, 165, 166 Ovary, 148, 150, 158 Overactive bladder, 58, 158 P Painful bladder syndrome, 101, 159 Palliative, 158, 159, 169 Pancreas, 139, 153, 159 Panic, 152, 159 Panic Disorder, 152, 159 Papilledema, 159, 163 Partial remission, 159, 165 Passive resistance, 77, 159 Patch, 111, 113, 159 Pathogenesis, 4, 16, 18, 159 Pathologic, 142, 146, 151, 159, 161, 165, 171 Pathologies, 77, 91, 159 Pathophysiology, 16, 36, 48, 49, 57, 72, 159 Patient Advocacy, 101, 159 Patient Compliance, 9, 14, 159 Patient Education, 7, 124, 130, 132, 138, 159 Patient Selection, 125, 159 Pelvis, 139, 158, 159, 164, 171 Penis, 152, 159, 160, 162, 165 Percutaneous, 94, 95, 160 Perforation, 96, 141, 149, 160 Perfusion, 20, 160 Perineal, 61, 62, 103, 160 Perineum, 81, 152, 160 Perioperative, 6, 160 Pessary, 42, 160 Phallic, 149, 160 Phantom, 15, 160 Pharmacologic, 101, 140, 160, 170, 171 Pharmacotherapy, 101, 160

177

Phenylephrine, 96, 160 Phospholipids, 149, 160 Photoreceptors, 145, 160 Physical Examination, 7, 160 Physical Therapy, 4, 14, 27, 32, 70, 73, 125, 160 Physiologic, 13, 140, 155, 160, 162, 164, 165 Physiology, 48, 100, 101, 102, 103, 147, 151, 157, 160 Pilot study, 7, 160 Placenta, 148, 149, 160 Plants, 143, 150, 156, 157, 160, 170 Plasma, 143, 153, 161, 166 Platinum, 155, 161 Pneumonia, 145, 161 Polycystic, 100, 161 Polyethylene, 152, 161, 168 Polytetrafluoroethylene, 5, 42, 161 Port, 89, 91, 161 Port-a-cath, 161 Posterior, 24, 80, 84, 93, 140, 142, 146, 159, 161 Postmenopausal, 25, 37, 50, 66, 67, 110, 158, 161 Postnatal, 161, 167 Postoperative, 6, 8, 17, 23, 24, 30, 58, 108, 161 Postoperative Complications, 8, 108, 161 Practicability, 161, 170 Practice Guidelines, 120, 161 Prazosin, 36, 161 Preoperative, 4, 107, 162 Prepuce, 144, 162 Prevalence, 4, 13, 18, 35, 51, 162 Priapism, 100, 162 Probe, 3, 76, 80, 87, 88, 90, 162 Progression, 14, 141, 162 Progressive, 81, 144, 151, 154, 162, 170 Prolapse, 15, 21, 22, 25, 26, 30, 31, 41, 45, 48, 49, 50, 52, 61, 63, 81, 85, 90, 100, 104, 162 Proline, 144, 151, 162 Prone, 81, 162 Prophylaxis, 52, 162 Prospective study, 16, 25, 155, 162 Prostaglandin, 66, 162 Prostaglandins A, 162 Prostate, 91, 100, 101, 104, 124, 142, 158, 163, 165, 170 Prostate gland, 104, 163 Prostatectomy, 17, 26, 53, 54, 163 Prostatic Hyperplasia, 163

178

Stress Incontinence

Prostatitis, 100, 163 Prosthesis, 14, 104, 163 Protein S, 142, 163 Proteins, 141, 143, 144, 145, 150, 156, 157, 161, 163, 170 Proteinuria, 157, 163 Protocol, 6, 14, 17, 163 Proximal, 4, 83, 88, 89, 93, 94, 96, 113, 146, 150, 163 Pseudotumor Cerebri, 12, 163 Psychiatry, 102, 149, 163 Psychoactive, 163, 172 Psychogenic, 163, 171 Public Policy, 119, 163 Pulmonary, 142, 154, 163, 171 Pulmonary Edema, 154, 163 Pulse, 77, 163 Pyelonephritis, 100, 164 Q Quality of Life, 11, 14, 17, 31, 48, 59, 73, 164 R Race, 156, 164 Radiation, 160, 164 Radioactive, 151, 152, 164 Radiological, 160, 164 Random Allocation, 164 Randomization, 17, 164 Randomized, 16, 17, 21, 22, 31, 32, 37, 52, 53, 71, 147, 164 Randomized clinical trial, 32, 164 Receptor, 139, 141, 164, 166 Rectum, 141, 142, 149, 150, 152, 160, 163, 164, 170 Recurrence, 45, 54, 113, 164 Refer, 1, 144, 149, 155, 164 Reflex, 67, 91, 164 Regimen, 14, 147, 159, 160, 164 Regression Analysis, 6, 164 Remission, 12, 164, 165 Renal pelvis, 154, 165 Reproductive system, 163, 165 Resorption, 5, 165 Restoration, 160, 165 Retina, 145, 154, 158, 165 Retrograde, 28, 165 Retropubic, 4, 10, 62, 85, 104, 163, 165 Retrospective, 21, 165 Risk factor, 40, 55, 100, 101, 155, 162, 165 Rod, 77, 87, 144, 165 Rubber, 78, 88, 139, 165

S Sanitary, 78, 165 Scatter, 160, 165 Schizoid, 165, 172 Schizophrenia, 165, 172 Schizotypal Personality Disorder, 165, 172 Screening, 111, 144, 166 Sebaceous, 146, 166 Sebaceous gland, 146, 166 Sedative, 152, 166 Self-Examination, 100, 166 Semen, 163, 166 Sensor, 76, 90, 94, 166 Serotonin, 160, 166, 170 Sex Characteristics, 140, 158, 166 Sexually Transmitted Diseases, 100, 166 Shock, 166, 170 Side effect, 125, 139, 142, 166, 169 Signs and Symptoms, 100, 165, 166 Skeletal, 140, 144, 166 Skeleton, 139, 153, 162, 166 Smooth muscle, 12, 16, 145, 149, 154, 166 Sneezing, 87, 89, 90, 96, 103, 113, 125, 136, 166, 168 Social Environment, 164, 166 Social Isolation, 92, 94, 165, 166 Solid tumor, 141, 167 Sonogram, 167, 170 Sound wave, 167, 170 Specialist, 102, 126, 167 Species, 148, 156, 164, 167, 172 Sperm, 140, 167, 168, 171 Spina bifida, 46, 167 Spinal cord, 16, 157, 162, 164, 167 Stabilization, 113, 167 Statistically significant, 8, 167 Steel, 82, 144, 167 Stem Cells, 12, 13, 167 Stenosis, 100, 167, 168 Stent, 16, 26, 53, 167 Sterile, 88, 143, 167 Steroid, 158, 167 Stimulus, 145, 147, 153, 154, 164, 167, 169 Stoma, 146, 167 Stomach, 139, 148, 150, 151, 157, 167 Stool, 152, 167 Stress urinary, 4, 5, 6, 7, 8, 9, 11, 13, 18, 85, 86, 87, 89, 96, 103, 104, 108, 113, 125, 168 Stricture, 167, 168 Styrene, 165, 168 Subacute, 152, 168 Subclinical, 152, 168

Index

Subcutaneous, 147, 154, 168 Supine, 14, 168 Supplementation, 66, 168 Suppository, 160, 168 Suspensions, 85, 104, 113, 168 Sweat, 146, 168 Sweat Glands, 146, 168 Symphysis, 76, 87, 163, 168 Symptomatic, 6, 39, 91, 168 Symptomatology, 6, 168 Synapse, 139, 168 Systemic, 137, 142, 148, 152, 168 Systolic, 151, 168 T Temporal, 155, 168 Testicles, 168, 171 Testicular, 55, 100, 166, 169 Testicular Feminization, 55, 169 Testis, 148, 150, 158, 169 Therapeutics, 169 Thermal, 91, 169 Thoracic, 146, 169 Thorax, 139, 169 Threshold, 151, 169 Tinnitus, 163, 169 Tissue Banks, 10, 169 Toilet Training, 100, 124, 169 Tone, 88, 104, 169 Tonic, 93, 143, 169 Tonus, 169 Tooth Preparation, 139, 169 Topical, 96, 169 Torsion, 100, 152, 169 Toxic, iv, 147, 157, 168, 169, 170 Toxicity, 147, 169 Toxicology, 120, 169 Toxins, 141, 152, 170 Traction, 94, 144, 170 Transfection, 142, 170 Transrectal ultrasound, 25, 170 Transurethral, 8, 49, 50, 54, 66, 163, 170 Transurethral resection, 163, 170 Transurethral Resection of Prostate, 163, 170 Trauma, 13, 18, 76, 77, 82, 169, 170, 172 Treatment Outcome, 8, 14, 18, 27, 170 Trees, 165, 170 Tricyclic, 152, 170 Tryptophan, 144, 166, 170 Tumour, 55, 170 Tunica, 156, 170

179

Type 2 diabetes, 12, 170 U Ultrasonography, 25, 170 Unconscious, 152, 170 Uremia, 154, 170 Ureters, 154, 170, 171 Urethral Obstruction, 16, 171 Urethritis, 100, 171 Urinary Retention, 7, 101, 146, 162, 171 Urinary tract, 12, 58, 88, 91, 92, 99, 100, 101, 102, 104, 125, 171 Urinary tract infection, 100, 101, 125, 171 Urinate, 101, 104, 169, 171, 172 Urodynamic, 4, 6, 7, 8, 9, 16, 17, 20, 21, 31, 42, 48, 56, 59, 61, 64, 70, 77, 91, 92, 105, 113, 171 Urogenital, 31, 80, 81, 150, 171 Urologist, 63, 102, 104, 171 Uterus, 45, 62, 81, 91, 139, 147, 149, 152, 154, 155, 158, 160, 165, 169, 171 V Vaccine, 163, 171 Vagina, 7, 9, 81, 83, 86, 90, 138, 155, 160, 165, 171 Vaginal, 3, 6, 9, 11, 15, 19, 20, 21, 22, 31, 32, 33, 34, 39, 40, 43, 44, 45, 47, 48, 51, 52, 53, 56, 58, 59, 60, 61, 62, 66, 73, 76, 80, 81, 82, 83, 84, 85, 90, 94, 96, 103, 104, 107, 110, 113, 125, 136, 160, 168, 171 Vascular, 18, 146, 152, 160, 171 Vasectomy, 100, 171 Vasoconstriction, 148, 156, 171 Vein, 153, 171 Ventricle, 163, 168, 171 Vertebrae, 167, 171 Vertebral, 142, 167, 171 Vesicovaginal Fistula, 102, 171 Veterinary Medicine, 119, 171 Visual field, 163, 172 Vitreous, 154, 165, 172 Vitro, 13, 172 Vivo, 13, 172 Void, 6, 172 Volition, 153, 172 W Withdrawal, 85, 172 Womb, 165, 171, 172 Wound Infection, 5, 172 X Xenograft, 141, 172

180

Stress Incontinence

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