Ionut Ciprian Iorga

Background/Objectives: Urinary incontinence (UI) is a frequent condition in postmenopausal women and is associated with a substantial negative impact on quality of life. Conservative management can include pelvic floor muscle training (PFMT) and high-intensity focused electromagnetic stimulation (HIFEM); however, data regarding the potential benefit of combining these modalities remain limited. This study aimed to evaluate whether the addition of a structured Kegel exercise program to EMSELLA-based electromagnetic stimulation is associated with enhanced clinical outcomes in postmenopausal women with urinary incontinence. Methods: This prospective comparative study included 99 postmenopausal women with stress, urgency, or mixed urinary incontinence and an International Consultation on Incontinence Questionnaire–Urinary Incontinence Short Form (ICIQ-UI SF) score ≥ 6. Participants received either EMSELLA therapy alone (Group A, n = 49) or EMSELLA combined with a standardized Kegel exercise program (Group B, n = 50) over a three-month period. Symptom severity was assessed at baseline and at three months using the ICIQ-UI SF. Between-group comparisons were performed using analysis of covariance, adjusting for baseline scores. Results: Both therapeutic approaches were associated with clinically meaningful improvement in urinary incontinence symptoms. After adjustment for baseline severity, lower follow-up ICIQ-UI SF scores, greater mean symptom reduction, and higher response rates were observed in the combined-therapy group. Across all menopausal-duration subgroups, outcomes consistently favored the association of EMSELLA therapy with Kegel exercises. No treatment-related adverse events were reported. Conclusions: The association of EMSELLA electromagnetic stimulation with a structured Kegel exercise program was associated with greater symptom improvement than electromagnetic stimulation alone, suggesting an additive therapeutic effect of voluntary pelvic floor muscle training. This combined conservative approach was well tolerated and may represent a useful management strategy for postmenopausal urinary incontinence.

Background and Clinical Significance: Retroperitoneal urinomas are uncommon complications that can arise following trauma, particularly in the context of congenital anomalies such as pyeloureteral duplication. These conditions pose significant diagnostic and therapeutic challenges, requiring a comprehensive and multidisciplinary approach to ensure optimal patient outcomes. Case Presentation: Here, we report the case of a 22-year-old male who presented to the emergency department with right lumbar and flank pain, nausea, and abrasions following a fall from a height. Initial imaging revealed a right-sided retroperitoneal urinoma and a rare congenital anomaly: complete pyeloureteral duplication with the upper pole draining into the right seminal vesicle. The patient underwent two surgical interventions, including the insertion of a ureteral stent and reimplantation of the ureter using a latero-terminal U trans U technique. Conclusions: This case highlights the complexity of managing traumatic retroperitoneal urinomas associated with congenital anomalies such as complete pyeloureteral duplication. It emphasizes the importance of timely surgical intervention to prevent complications and improve patient outcomes.

Objective: This narrative review aims to summarize current evidence on the epidemiology, risk factors, clinical patterns, and therapeutic strategies for urinary incontinence in menopausal women. Background: Urinary incontinence (UI) is a common, multifactorial condition that disproportionately affects women, with prevalence rising during pregnancy and post menopause. While stress urinary incontinence (SUI) predominates in younger and early postmenopausal women, urgency urinary incontinence (UUI) and mixed urinary incontinence (MUI) become increasingly prevalent with age and duration following menopause. Additional determinants, such as obesity, comorbidities, polypharmacy, and menopausal symptoms, burden further contribute to symptom severity and persistence. Materials and Methods: For the materials and methods, we used over 150 specialized studies and meta-analyses published in the specialized literature on this subject, of which 99 are mentioned in the bibliography of this narrative review. These materials are some of the most significant and up-to-date that address this complex topic. Content: This narrative review discusses the impact of menopause-related hormonal decline on the genitourinary tract, highlighting the role of estrogen deficiency in genitourinary syndrome of menopause (GSM). It addresses distinct patterns of UI across life stages, including pregnancy and the early and late postmenopause periods, and explores modifiable risk factors such as body mass index. Specific attention is given to nocturnal incontinence, medication-related effects, and coital incontinence, which significantly impair sexual health and quality of life. Therapeutic strategies are presented in a stepwise manner: conservative measures (pelvic floor muscle training), hormonal approaches (local vaginal estrogen), combination regimens, and surgical interventions, including midurethral slings, colposuspension, bulking agents, and neuromodulatory techniques. Future perspectives: Emerging modalities such as balneotherapy and energy-based therapies show promise but require further investigation. Conclusions: Urinary incontinence in menopausal women is best addressed through an individualized, multimodal approach that integrates conservative, hormonal, minimally invasive, and surgical options. Combination therapies demonstrate superior efficacy in addressing both continence and GSM-related symptoms. Future research should refine patient selection, optimize multimodal treatment algorithms, and prioritize long-term outcomes and quality-of-life measures in clinical decision-making.