Innovation for Pelvic Health

When most clinicians first see the term near infrared spectroscopy (NIRS), they do not recognize that this is an application of physics to medicine that they do in fact have some experience using. Transillumination of a scrotal mass employs the basic physics of light transmission through tissue, and oximetry is able to provide measurement of oxygen saturation (SaO2) because of application of spectroscopic principles. Oximeters use wavelengths that optimize light penetration into tissue and allow measurement of changes in the concentration of hemoglobin because light absorption by this molecule varies depending on the wavelengths used and whether or not it is carrying oxygen. The net result, derived with the aid of signal averaging and software algorithms, is a value of such importance that it is now widely regarded as “the fifth vital sign.”

The International Continence Society (ICS) defines urinary incontinence as the complaint of any involuntary leakage.1 The prevalence of urinary incontinence in community-dwelling women ranges from 10% to 40%; wider ranges can be found in elderly women.2 In studies that differentiate any urinary incontinence from severe or daily disease, the prevalence was 29% (range 11%–72%) and 7% (3%–17%), respectively.3 About a quarter of urinary incontinence is regarded as severe.4 Prevalence has always been higher in institutionalized subjects. Several recent studies from around the world suggest a prevalence of ≥ 50%.2 Approximately half of all incontinent women are classified as stress incontinent, making this group the largest among urge, mixed, and stress types.3

Physicians and their patients have been well served by the recent innovations that have revolutionized the treatment of urinary incontinence and pelvic surgery; however, few developments have dramatically improved post-operative (post-op) urinary management since the introduction of the Foley catheter in 1935.1 There is scarcely better support for this position than the prevalence of cases in which the patients’ predominant concerns are directed toward post-op care rather than the comparative risks inherent to surgical intervention.

Ironically, apprehension regarding postsurgical catheters and urine bags typically overshadows what would logically be far more serious mortality and morbidity concerns associated with general anesthesia, significant blood loss, or other surgical complications.2,3

To many involved with the routine assessment of voiding and storage dysfunction, urodynamics involves the measurement of long-established parameters of bladder pressures and uroflow rates. Initially, voiding assessment was simply “eyeball” urodynamics. From those simple observations to the use of the hydrostatic water column, urodynamics moved from qualitative measurements to something more quantitative.