Pessaries have long been used to treat stress urinary incontinence. Standard-shaped pessaries, or those that have been modified with a ball or a protuberance, may successfully treat incontinence. These pessaries stabilize the bladder neck and increase urethral resistance.
Vierhout and Lose2 found a 63% subjective cure or improvement rate with pessary use in their review of the literature. A 36% to 66% rate of complete continence has been reported when pessaries were used to treat exercise-induced stress incontinence.3,4 However, a long-term assessment of the incontinence ring pessary demonstrated only a 16% success rate for the treatment of mixed and stress incontinence.5 Complications from pessary use are uncommon and include vaginal abrasions, ulcerations, urinary tract infections, and vaginal infection. These problems are rare if the pessary is cared for properly, removed and cleaned at least every 3 months, and if the patients concomitantly use estrogen locally in the vagina. We have not found any particular type of pessary to be superior in treating stress urinary incontinence. If the Smith-Hodge remains in place, it has theoretical advantages in providing bladder neck support.
Other vaginal devices that have been used to treat stress incontinence include the contraceptive diaphragm, tampons, and the bladder neck support prothesis (Introl; UroMed, Needham, MA). Contraceptive diaphragms have a reported success rate of 46% to 83%.2 Tampons have been successful in treating incontinence. In fact, standard super tampons were shown to be more efficacious than pessaries in treating exercise-induced incontinence.4 Special types of tampons have been developed to specifically treat incontinence. The Conveen Continence Guard (Coloplast a/s, Humlebaek, Denmark) is a hydrophilic polyurethane tampon that has two wings to support the bladder neck. It must be soaked in water, and then attached to an applicator before insertion. It has a 53% to 73% success rate.2 A newer device, the Contrelle Continence Tampon (Coloplast a/s) is made of hydrophobic polyurethane and has its own applicator that inserts similarly to a standard tampon. In a study comparing these two devices, both devices were found to reduce the amount of leakage significantly, but the Contrelle reduced urine loss significantly more than the Conveen.6 These tampons can be left in the vagina for up to 16 hours, and do not need to be removed in order to void. They should, however, be replaced monthly.
The Introl prosthesis (UroMed) is a vaginal device with two prongs that sit against the anterior vaginal wall at the level of the bladder neck. It has been suggested that the device may mimic the results of a retropubic urethropexy. Success rates are reported between 50% and 94%.2
Table 6-1.1. Devices for the treatment of stress urinary incontinence Vaginal Devices Standard pessaries
• Ring with support
• Hodge Anti-incontinence pessaries
• Incontinence ring
• Incontinence dish
• Incontinence dish with support Contraceptive diaphragm Tampon
• Standard tampon
• Contrelle Continence Tampon
• Conveen Continence Guard Bladder neck support prothesis (Introl) Urethral Devices
Urethral cap (FemAssist) Urethral patch Urethral insert
• Reliance Urinary Control Insert
• Viva urethral plug
Figure 6-1.1. Devices for stress urinary incontinence include intravaginal pessaries, intravaginal disposable devices, urethral meatal barriers, and intraurethral plugs.
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