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You must have JavaScript enabled in your browser to utilize the functionality of this website. An external, fully adjustable clamp, designed to gently apply pressure to the urethra and top of the penis to help control bladder leakage.
Incontinence in men is commonly linked to prostate surgery whereby the sphincter muscle or valve is damaged which can leave it too weak to function. The Dribblestop™ Male Urinary Incontinence Clamp is a small and comfortable external clamp, designed to gently apply pressure to the urethra and top of the penis to help control bladder leakage. The Dribblestop™ can be worn while sleeping, but it is advised the clamp is worn one size looser than normal day wearing. This service is brought to you by Incontinence Advisors working in association with the Age UK Group. Medi-Line and the CHU of Liege launch an innovative medical device to treat male urinary incontinence. MEDI-LINE and the CHU of Liege have recently launched the Tom-Sling®, a new medical device that allows treating male urinary incontinence that occurs after radical prostatectomy for prostate cancer. Urinary incontinence is a common symptom after prostate surgery, and particularly after complete removal of the prostate gland for cancer. The innovation of this sling with respect to the competitors is the good results of the device in the treatment of severe incontinence. This product is recommended for patients after radical prostatectomy and failure of conservative treatments. Thanks to the very good results even for severe incontinence, MEDI-LINE hopes to have 30% or 40% of European Market when the product will be in its maturity phase.
The department of Urology at the University Hospital of Liege is largely renowned for its expertise in the field of the development of new surgical devices and techniques for the treatment of female stress urinary incontinence, including the TVT-Obturator, TVT-Exact, and TVT-ABBREVO devices. Founded in 1994 by three individuals, the MEDI-LINE company now employs more than 50 workers in the Liege Science Park of Sart-Tilman. The Attends Faecal pad is a new product especially designed for cost effective protection and containment of faecal incontinence. Science, Technology and Medicine open access publisher.Publish, read and share novel research. Biofeedback with Pelvic Floor Electromyography as Complementary Treatment in Chronic Disorders of the Inferior Urinary TractB.
S Arlandis-guzman, and E Martinez-agullo, 2002Alternativas terapeuticas para la disfuncion miccional cronica. Men who suffer from Incontinence may find this a troubling issue and find it impacts on their active lifestyles, meaning pads may not be an ideal option. Only slight pressure is applied, so blood circulation is not affected, meaning the clamp can be worn comfortably day and night. If the natrual urge to pass urine is decreased, the clamp should be released every two to three hours to avoid the bladder overfilling. The surgical procedure, safe and effective, and the medical device are the result of a close collaboration between experienced urologists, Professors Jean de Leval and David Waltregny, and the MEDI-LINE know-how in the medical devices field.
If after six months, the majority of patients who have undergone radical prostatectomy regain acceptable continence. In Belgium, it is estimated that the target population that could benefit from this product is between 300 and 450 patients per year. For the past 10 years, MEDI-LINE, has engineered and manufactured the plastic tubes used for these devices.
We are glad to offer a novel alternative to the implantation of an artificial urinary sphincter in patients who suffer from incontinence, even when incontinence is severe”, underlines Professor de Leval, Professor Emeritus of Urology at the University Hospital of Liege. From the beginning, its activities have been devoted 100% in the surgical and pharmaceutical sectors.
The pad is available in one size and is designed to manage only faecal incontinence with improved leakage protection and containment versus traditional rectangular pads.
The pad has leakage barriers to provide improved containment, leakage protection and safety for the patient.
To keep the catheter from slipping out, it has a balloon on the end that is inflated with sterile water once the end is inside the bladder.An indwelling urinary catheter is a flexible plastic tube that is inserted through the opening that carries urine from the bladder to outside of the body (urethra), into the bladder, to drain urine. This may occur because of medical conditions, such as prostate enlargement and incontinence, or after surgery for prostate cancer. Neuromodulacion: Una nueva alternativa terapeutica para los tratornos del tracto urinario inferior. The Dribblestop™ Male Urinary Incontinence Clamp is an ideal solution to help men who suffer from incontinence return to their active lives without worry.
The Dribblestop™ is a custom fit clamp, supplied with different sized links to suit the users needs. If the user is involved in activities such as lifiting and straining, it is recommended that an additonal pad is worn to avoid accidental leakage. But Quite reliable in use once one has learned safe & comfortable positioning but I also use additional pad protection when in public.
For patients with severe incontinence, the solution relies primarily on the implantation of an Artificial Urinary Sphincter. Thanks to a privileged partnership, Professors de Leval and Waltregny and MEDI-LINE have been able to finalize the development of the TOM-Sling® in a short time interval. Specialist in plastic devices, MEDI-LINE is manufacturer and supplier to the major player companies such as Johnson & Johnson and GE Healthcare.
The tube is kept in place by a small balloon that is inflated once the tube is securely in the bladder. Each kit also contains two clamps, designed to wear on alternate days, allowing the foam to maintain its shape and size, so optimum protection can be provided. With the TOM-Sling®, there is a new alternative, which is less expensive and does not need any manipulation by the patient. Since early May 2014, MEDI-LINE launched, for the first time, a new and innovative medical device in its own name becoming manufacturer and distributor. C, et al1986The role of biofeedback in Kegel exercise training for stress urinary incontinence." Am J Obstet Gynecol.
The closed cell foam padding does not absorb water, making the clamp simple and easy to clean with soap and water.
Check the area around the urethra for inflammation or signs of infection, such as irritated, swollen, red or tender skin at the insertion site or drainage around the catheter. The quality plastic and soft foam ensure the clamp is a comfortable solution to Male Urinary Incontinence, discreet and lightweight, the user won't even know its there.
Caring for your catheterIf your health professional has given you specific instructions on caring for your urinary catheter, be sure to follow them. Always wash your hands before and after caring for your catheter.Clean the area around the drainage tube twice each day. Do not tug or pull on the drainage tube Unless you have been instructed otherwise, you may take a shower wearing your urinary catheter. Lorenzo-Gomez1, 4[1] Department of Urology, Universitary Hospital of Salamanca, Spain[2] Family and Community Medicine, Department of Surgery.
You may wrap a small piece of gauze around the area where the cather comes out of your body. University of Salamanca, Spain[3] Department of Rehabilitation, Universitary Hospital of Salamanca, Spain[4] Department of Surgery, University of Salamanca, Spain[5] Department of Preventive Medicine and Public Health, University of Salamanca, Spain1.
IntroductionChronic inflammatory disorders of the female urinary tract are common and often impact negatively on the quality of life of the affected individual. The management of these disorders, which encompass infectious and non-infectious conditions presenting with pain, is evolving as a result of current research. Pelvic floor biofeedback with electromyography is used as a primary or adjuvant treatment for these disorders. In this chapter we present the experience gathered in our unit with this treatment modality. Most adults should drink between 8 and 10 glasses of water, noncaffeinated beverages, or fruit juice each day. Precise instruments measure physiological activity such as brainwaves, heart function, breathing, muscle activity, and skin temperature.


The presentation of this information —often in conjunction with changes in thinking, emotions, and behavior— supports desired physiological changes. Over time, these changes can endure without continued use of an instrument.Also, biofeedback techniques have been defined as the use of instrumentation to help a person to instantly and better perceive the information of a specific physiological process which is under the control of the nervous system control but that is not correctly perceived (Miller 1974). Many physiological responses which are purely anatomical can be modified under voluntary control.
Draining the urine collection bagThe bag that collects urine may be strapped to your thigh. You will need to empty the bag at regular intervals, whenever it is half-full, and at bedtime. Be sure to wash your hands before and after emptying urine from your collection bag.Wash your hands with soap and water. Electronic instrumentation allows the translation of normal or abnormal physiological processes (often unconscious) to visual or auditory signals. If you are emptying another person's collection bag you may wish to wear disposable gloves.
The method involves the manipulation of unconscious or involuntary events modifying these signals.
Thus the technique is at the same time behavioural therapy and a learning process which aims at creating awareness of an unconscious function that is incorrectly performed, and to correct it. Biofeedback has allowed going from subjectivity to objectivity.Individuals know little about their perineal region, and therefore control its functions (bladder, anorectal and sexual functions) poorly. Biofeedback permits a progressive and active awareness of these functions, creating a “ring” or “communication cycle” between patient and computer. The instructor serves as a guide in this Learning process.Biofeedback with electromyography (BFB-EMG) was approved by the Food and Drug Administration in the USA in 1991. It has been effectively used since 1992 without secondary effects or complications (Perry 1994).For biofeedback to be successful, it is important to have a single instructor conducting the sessions with a given patient. Avoid touching the tubing or drainage cap on the toilet, the collection container, or the floor. If your health professional has instructed you to measure the amount of urine, do so before you have emptied the urine into the toilet. Replace the drainage cap, close the clamp, and refasten the collection tube to the drainage bag. Existing protocols for perineal electromyographyMany protocols have been used to treat pelvic floor dysfunction.
We favour a personalized approach or “therapist guided method” in which one therapist carries out the entire treatment (Lorenzo Gomez, Silva Abuin et al.
When to call a health professionalIf your health professional has given you instructions about when to notify him or her, be sure to follow those instructions. Call your health professional if:No urine or very little urine is flowing into the collection bag for 4 or more hours.
For example: Three 20-minutes sessions per week over a seven-week period (Amaro, Gameiro et al. No urine or very little urine is flowing into the collection bag and you feel like your bladder is full. 2006); stimulator is activated on demand only by a sudden increase in intra-abdominal pressure (Nissenkorn, Shalev et al.
Your urine has changed color, is very cloudy, looks bloody, or has large blood clots in it.
The insertion site becomes very irritated, swollen, red, or tender, or you have pus draining from the catheter insertion site.
Scientific evidence supporting the use of biofeedback with electromyography (BFB-EMG)The main component of the pelvic floor musculature is the levator ani. The contraction of the levator compresses the urethra and helps continence (DeLancey 1990). The aim of pelvic floor re-education is to improve muscle function, which can significantly reduce stress incontinence. Success rates vary between 21 and 84%, but the subjective improvement is always greater than the objective results.Several studies have demonstrated the efficacy of BFB-EMG for the treatment of pelvic floor dysfunction in women with stress urinary incontinence (Burgio, C et al. 2002).In the elderly, pelvic exercises with biofeedback in the office is more effective than pelvic floor exercises alone (Burns, Pranikoff et al. The first study using rehabilitation assisted with pelvic floor muscles EMG for the treatment of vulvovaginal pain was published in 1995 by Glazer et al. These authors reported a cure rate greater than 50% with an average subjective improvement of 83%. These findings confirmed that the efficacy of the treatment depended on muscle stabilization (Glazer, Rodke et al.
Recurrent urinary tract infectionsUrinary tract infections (UTIs) are the second most common infections in humans (Foxman 2002). A UTI is the presence of microorganisms in the urine (not due to contamination) which can invade the urinary tract or adjacent structures. It is well established the route of infection is ascending in most cases of infections with enteric bacteria which explains why UTIs are more common in females.
The development of a UTI is determined by the balance between bacterial virulence, size of the inoculum, local defence mechanisms and anatomical or functional alterations of the urinary tract (Andreu, Cacho et al. Eighteen out 10000 of these women will develop pyelonephritis and 7% will require hospitalization (Andreu, Cacho et al.
This is despite the fact that most young women with UTI have normal urinary tracts (Hooton 2001). The development of infection is determined by the balance between bacterial virulence, size of the inoculum, local defence mechanisms and anatomical or functional alterations of the urinary tract.Recurrent UTIs are defined as 3 or more culture-documented infections in 1 year or 2 or more in 6 months in women without structural or functional abnormalities. Risk factors that predispose to UTIs abnormalities of the urinary tract (such as urinary incontinence or obstruction), sexual behaviour, use of contraceptives, postmenopausal hormonal deficiency, asymptomatic bacteriuria and past urinary tract surgery (Grabe, Bjerklund-Johansen et al.
Risk factors for recurrent UTIs in postmenopausal institutionalised women include atrophic vaginitis, incontinence, cystocele and post-voiding residual urine and a history of UTI before menopause (Nicolle 1997).
Collagen diseases represent another extra-urogenital risk factor.Systemic diseases, mainly diabetes mellitus and chronic renal failure are also important risk factors (Sharifi, Geckler et al.
Risk factors for renal damage in women with type 2 diabetes mellitus and recurrent UTIs include old age, proteinuria and low body mass index (Geerlings, Stolk et al.
In addition, autonomic neuropathy may cause bladder dysfunction(Korzeniowski 1991).In the presence of risk factors, bacterial strains of low virulence can cause UTIs. 2011).Antibiotic prophylaxis should only be used after counselling and behaviour modification has been attempted (Grabe, Bjerklund-Johansen et al.
Other measures to prevent recurrences include immune active prophylaxis (Lorenzo-Gomez, MF et al. Non-infectious chronic cystitis — Painful bladder syndromeOver the years much of the focus for chronic pelvic pain has been on peripheral-end-organ mechanisms, such as inflammatory or infective conditions (Engeler, Baranowski et al. 2012).A peripheral stimulus such as infection may initiate the beginning of chronic pelvic pain, and the illness may become self-perpetuating as a result of modulation of the central nervous system, independent of the original cause (Engeler, Baranowski et al. Nevertheless in most cases, inflammation or infection is not present (van de Merwe, Nordling et al.
However, conditions that produce recurrent trauma, infection or inflammation may result in chronic pelvic pain in a small proportion of cases (van de Merwe, Nordling et al. Central sensitisation is responsible for a decrease in threshold and increase in response duration and magnitude of dorsal horn neurons. For instance, with central sensitisation, stimuli that are normally below the threshold may result in a sensation of fullness and a need to void (Nazif, Teichman et al. 2007) and other non-painful stimuli may be interpreted as pain and noxious stimuli may be magnified with an increased perception of pain.
Also, somatic tissue hyperaesthesia is associated with recurrent bladder infection.The increased perception of stimuli in the viscera is known as visceral hyperalgesia, and the underlying mechanisms are thought to be responsible, among, others for bladder pain syndrome and dysmenorrhoea. Chronic bladder pain may be associated with the presence of Hunner’s ulcers and glomerulation on cystoscopy, whereas other bladder pain conditions may have normal cystoscopic findings.
The European Urological Association (EUA), the International Society for the study of BPS (ESSIC), the International Association for the Study of Pain (IASP) and several other groups now prefer the term bladder pain syndrome (BPS).
Chronic pelvic pain may be subdivided into conditions with well-defined classical pathology, such as infection, and those with no obvious pathology.


There may be specific types of inflammation as a feature in subsets of patients (Engeler, Baranowski et al. 2012).Pelvic floor muscle pain syndrome is the occurrence of persistent or recurrent episodic pelvic floor pain. It is often associated with symptoms suggestive of lower urinary tract dysfunction (Engeler, Baranowski et al.
Of interest however is the fact that UTI and urgency are significantly more frequent during childhood and adolescence in patients who later develop BPS in adulthood (Peters, Killinger et al.
2009).Cystoscopic and biopsy findings in both ulcer and non-ulcer BPS are consistent with defects in the urothelial glycosaminoglycan (GAG) layer. Urinary uronate, and sulphated GAG levels are increased in patients with severe BPS (Lokeshwar, Selzer et al. 2005).The physiopathologic relationship between interstitial cystitis and rheumatic, autoimmune, and chronic inflammatory diseases has been investigated. Cimetidine, prostaglandins, L-Arginine, anticholinergic drugs have also been used (Engeler, Baranowski et al. Intravesical therapy: Local anaesthetic (lidocaine), Pentosan polysulphate sodium, intravesical heparin, hyaluronic acid (hyaluronan, chondroitin sulphate, dimethyl sulphoxide (DMSO), bacillus Calmette Guerin (BCG) and vanilloids which disrupt sensory neurons such as Resiniferatoxin (Engeler, Baranowski et al.
Urethral pain syndromeUrethral pain syndrome is the occurrence of chronic or recurrent episodic pain perceived in the urethra, in the absence of proven infection or other obvious local pathology (Parsons 2011). There pathogenesis of urethral pain syndrome is unknown but it may part of the spectrum of BPS.
Some have postulated that neuropathic hypersensitivity can develop following urinary a UTI (Kaur and Arunkalaivanan 2007). Other causes of chronic pelvic painPelvic organ prolapse is often an asymptomatic condition, unless it is so marked that it causes back strain, vaginal pain and skin excoriation (Roovers, van der Vaart et al. 2004).In the past few years, non-absorbable mesh has been used in the pelvic organ prolapse surgery. Although they may have a role in supporting the vagina, they are also associated with several complications including bladder, bowel and vaginal trauma (Niro, Philippe et al.
2010).A subset of these patients may develop chronic pain because mesh insertion causes nerve and muscle irritation (Daniels, Gray et al.
Most patients can be treated by surgical removal of the mesh (Margulies, Lewicky-Gaupp et al. Chronic perineal pain at 12 months after surgery was reported by 21 trials and meta-analysis of these data showed strong evidence of a higher rate in women undergoing transobturator insertion (7%) compared to retropubic insertion (3%)(Barber, Kleeman et al.
2013).Vulvovaginal pain can developed after bacterial vaginal infections or bacterial vaginosis.
Oestrogen deficiency in peri- and post-menopausal women can also lead to vulvar tissue atrophy and a subsequent irritation.
Contact with irritanting agents such as soaps, detergents and topical preparations as well as vulvar trauma associated with accidents or surgery can lead to vulvar irritation and the development of vulvovaginal pain (White, Jantos et al. It causes a great deal of distress and embarrassment, as well as significant costs, to both individuals and societies (Lucas, Bosch et al. The standardization committee of the International Continence Society (ICS) has defined the female urinary incontinence as the involuntary urine loss, objectively demonstrable, which represents a social or hygienic problem (Abrahams, Blaivas et al. 1988).At least one out of four women in Europe suffers from a disorder associate with incontinence which often has been present for several years before consultation (Thomas, Plymat et al. In geriatric hospitals, the incidence of urinary incontinence I in women is 43% and as high as n 91% in psychogeriatric patients. Patients with ‘complicated incontinence’ are those with co-morbidities, a history of previous pelvic surgery, past surgery for incontinence, radiotherapy and associated genitourinary prolapse (Lucas, Bosch et al.
Urinary incontinence is more common in women with UTIs and is also more likely in the first few days following an acute infection (Moore, Jackson et al. In women with incontinence, diagnosis of a UTI by positive leucocytes or nitrites using urine test strips had low sensitivity but high specificity (Semeniuk and Church 1999; Buchsbaum, Albushies et al.
Incontinent women with symptoms of lower urinary tract or pelvic floor dysfunction and pelvic organ prolapse have a higher risk of of incomplete bladder emptying (elevated post void residual urine volume) compared to asymptomatic patients. Therefore it is suggested that the presence of post void residual should be ruled out in this patients (Fowler, Panicker et al. 2009).In the elderly incontinence can be caused or worsened by underlying diseases including diabetes (Lee, Cigolle et al. A higher prevalence of incontinence was associated with higher age and body mass index (Sarma, Kanaya et al. A recent meta-analysis showed that systemic oestrogen therapy for post-menopausal women was associated with the development and worsening of urinary incontience (Cody, Richardson et al. Physical therapies for the urinary incontinenceThe treatment of lower urinary tract’s disorders with pelvic floor exercises with or without biofeedback represents a risk-free option which can be applied in a great number of women.
The correct function of the female pelvic floor depends on the position and mobility of the urethra and the urethrovesical junction.
Pelvic floor muscle training increases urethral closure pressure and stabilises the urethra, preventing downward movement during moments of increased physical activity. There is evidence that increasing pelvic floor strength may help to inhibit bladder contraction in patients with an overactive bladder.
This training may be augmented with biofeedback (Bidmead 2002).The evidence published in the guidelines regarding urinary incontinence suggests that UTI treatment does not correct the UI.
Valid methods to evaluate the morphologic and electromyographic abnormalities of the levator ani muscle are necessary in order to better select women or the treatment with pelvic floor training and biofeedback (Bo, Larsen et al. 2010), therefore pelvic floor physiotherapy must always be the first line of treatment for stress incontinence and overactive bladder. RTUI after surgical correction of UI or pelvic organs prolapsesIn 1995 the tension-free transvaginal tape (TVT) was introduced to treat UI (Ulmsten and Petros 1995). In 2001 another technique, the suburethral transobturator tape (TOT), was introduced (Delorme 2001). The main advantages were that the tape lays at a more anatomic position than in TVT, the needle does not cross the retropubic space, no abdominal incisions are made, there is a lower risk of vesical or intestinal injury and no cystoscopy is required (Sola Dalenz, Pardo Schanz et al. The simplicity of these techniques and their reproducibility has dramatically increased their use, by both Urologists and Gynaecologists (Castineiras-Fernandez 2005).When surgical treatment is indicated, the TOT procedure is the procedure of choice, absent contraindications. This recommendation is supported by the establishment of TVT as a worldwide validated and proven procedure for the surgical correction of urinary stress incontinence.2. Our experience with the treatment of bladder pain syndromeIn the following sections we describe the experience with biofeedback and electromyography obtained at our academic unit.
Method and tools usedWe conducted a retrospective study of 548 women diagnosed with inflammatory, infectious and non-infectious disorders of the lower urinary tract treated between March 2003 and May 2012.Patients were divided into 2 groups according to whether or not they had UTIs.
Each group received conventional treatment and were further divided into 2 subgroups, one receiving biofeedback with electromyography and the other not. Age, secondary diagnoses, concomitant treatments, medical and surgical background, response to treatment, answers to the King’s Health Questionnaire (Kelleher, Cardozo et al.
The interpretation of results of the questionaires was as follows:for of Kings Health questionnaire the range varied between 25 points (normal status, healthy) to 97 points (critical illness perception). For the SF-36 questionnaire the range varied from 149 points (normal status, healthy) to 36 points (critical illness perception).For subgroups A2 and B2, the program of biofeedback with electromyography (BFB-EMG) consisted of 20 sessions of therapy.
Two surface electrodes were placed on the perineum over the pelvic floor musculature and a neutral or ground electrode was placed on the inner aspect of the thigh. The weekly session lasted 20 minutes.Sessions took place at the urodynamics office with Medicina y MercadoTM equipment.
The patient lay supine, with light flexion of the hips and protection of the lumbar lordosis in order to avoid fatigue (figure 2).
In this position the patient could see the screen of the biofeedback equipment (figures 3 and 4). After explaining the anatomy and physiology of the pelvic floor, the patient was instructed to contract the perineal musculature during 3-5 seconds and relaxing to relax it during 6-8 seconds. Descriptive and inferential studies included analysis of cross tabulation, Fisher exact test, Chi-square, Student’s t-test, Pearson correlation test.



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