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T J Wells

Publications and source records attributed to T J Wells.

At least 19 recordsLinked to original sources
PubMed1994

Correlations between dynamic urethral profilometry and perivaginal pelvic muscle activity.

Of 208 ambulatory female subjects evaluated for complaints of urinary incontinence, complete history, physical findings, and urodynamic data were available on 163 patients allowing correlation of measures of perivaginal muscle activity to urethral profilometry measurement of sphincter strength. Perivaginal measures include pelvic digital exam score as well as vaginal electromyography with a modified perinometer. Urethral profilometry was performed at rest and during pelvic muscle contractions in both supine and standing positions. There was a moderate and significant correlation (r = 0.19 to 0.32) between profilometry measures of voluntary sphincter contractions and perivaginal EMG parameters of endurance peak and area, as well as to the digital test parameters of pressure and displacement. The correlation values between the vaginal EMG and the Digital Test scale of perivaginal strength were higher (r = 0.28 to 0.74). When the patients with pure stress incontinence were stratified by degrees of incontinence (mild, moderate, severe), urethral prolfilometry measures were a more accurate indicator of severity of incontinence than measures of perivaginal strength or the degree of bladder neck mobility as measured by the Q-tip test.

Adult↗
PubMed1991

Pelvic muscle exercise for stress urinary incontinence in elderly women.

PURPOSE: To compare pelvic muscle exercise to pharmacologic treatment of stress urinary incontinence, the most common cause of urine leakage reported by community-living elderly women. SUBJECTS: Convenience sample of 157 community-living women, aged 55 to 90 years, after completion of a comprehensive diagnostic evaluation. METHODS: Eighty-two subjects were randomly assigned to the exercise protocol (with a 34% attrition rate). Pelvic muscle exercises were taught and monitored for 6 months. Phenylpropanolamine hydrochloride was given to the other group in a dose of 50 mg a day, increasing to 50 mg twice a day. MAIN RESULTS: Treatment outcomes (subjective improvement, self recorded frequency of wetting) were equally satisfactory in both groups. The response to exercises was as good in 5 months as in 6. It was also as good when the minimum recommended number of exercises per day was 80 as when it was 125. CONCLUSIONS: Among those completing the protocol, pelvic exercises were beneficial in reducing stress incontinence, and the benefit was comparable to that produced by phenylpropanolamine.

Aged↗
PubMed1990

Urinary incontinence in nursing home residents with dementia: the mobility-cognition paradigm.

The purpose of the study was to evaluate patient factors associated with urinary incontinence in nursing homes to identify the relative importance of these factors in predicting urinary incontinence. Cognitive ability and patient mobility were measured for 61 patients residing in a nursing home. Twenty-nine of the patients were incontinent and 32 continent. Cognitive ability and mobility were found to differ significantly between continent and incontinent patients. When the variables were examined together, mobility emerged as the best predictor of the patient's urine control, followed by cognitive impairment. The findings highlight the importance of addressing patient mobility issues when dealing with urinary incontinence in nursing homes.

Activities of Daily Living↗
PubMed1988

Relationship between drug use and urinary incontinence in elderly women.

Two hundred older women with urinary incontinence were studied to observe the influence of their prescription and nonprescription drug use on symptoms of incontinence. Ninety percent of women reported using medication, with an average use of four drugs. Medications statistically associated with urinary incontinence symptomatology were prostaglandin inhibitors, diuretics, and estrogen therapy. Further studies are needed to clarify the relationship between medication usage and the presence and severity of urinary incontinence.

Aged↗
PubMed1988

Nursing assessments in the inpatient geriatric population.

Thorough assessment is essential in caring for the institutionalized elderly who have difficulty with urine control. The assessment should include a physical examination, a functional assessment, and an evaluation of the environment. The physical examination should be completed in a timely fashion after incontinence develops in order to rule out treatable causes of urine loss. The examination includes a health history and physical examination, with special attention being given to the genitourinary system. A urine specimen should be obtained during the examination to rule out bladder infection. The functional assessment of the patient is one of the most important aspects of the patient assessment. This is particularly true for elderly inpatients because much of the incontinence found in nursing homes is attributable to functional deficits. The functional assessment should address the history of the patient's incontinence, the patient's cognitive abilities and potential for participating in continence care, the patient's mobility, and the patient's abilities related to activities of daily living. Deficits in any of these areas may contribute to or cause urinary incontinence. In addition to the physical examination and functional assessment of the patient, the environment should be evaluated. The visibility, location, and structure of the toileting facilities can serve to either promote or impair urine control. In addition to the physical facilities provided, the overall nursing care approach may foster or hinder the patient's ability to maintain urinary continence. Nursing assessment that addresses these three areas will provide information that is needed to develop a nursing care plan that will maximize the patient's potential for urine control.

Aged↗
PubMed1987

Comparison of self-reported voided volume with cystometric bladder capacity.

We determined the validity of cystometric bladder capacity compared to self-reported voided urine volumes measured by the patient at home. The subjects included 200 ambulatory incontinent women 55 or more years old who were evaluated with a prospective protocol of home diaries, history, physical examination and urodynamic studies. The mean smallest and largest daily voided volumes, and the daily mean of all voided volumes were determined from the diary. Comparison of the cystometric bladder capacity with the daily voided volumes showed a significant positive correlation between cystometric bladder capacity and the largest voided volume (r equals 0.4938, p less than 0.01). Comparison of the mean daily and mean largest daily void, and the cystometric capacity with the different urodynamic diagnoses using analysis of variance revealed a statistical significance among the groups (p less than 0.01). We established the validity of cystometric bladder capacity in the measurement of functional bladder volume and that a home diary may be useful in clinical practice.

Aged↗
PubMed1987

Urinary incontinence in elderly women: clinical findings.

Two-hundred women self-described as having urinary incontinence, aged 55 to 90 years and living in the community completed a comprehensive history and physical examination. Initial presentation of urine loss was most commonly stress incontinence symptoms (35%). Scoring of peak response to volume lost and frequency revealed urine loss necessitating a clothing change for 78% and daily loss experienced by 73%. Over half had experienced a urine loss problem for more than five years. Most (65%) had sought treatment, but a minority reported current (11%) or previous (36%) treatment. Thirty-six percent were found to have severe atrophic vaginitis with severe urethocele (10%), cystocele (13%), rectocele (12%) less common. Pelvic floor strength by clinical scoring was weak (mean, 1.05 on a 5-point scale). The vaginal electromyograph first contraction peak mean was 5.94 microvolts sustained at 50% or better for 3.92 seconds. Clinical criteria established that 66% had stress, 27% a mixture of stress and urge, only 4% pure urge incontinence, and 4% other.

Aged↗
PubMed1987

Urinary incontinence in elderly women: urodynamic evaluation.

The objective of this study is to characterize urinary incontinence observed in elderly women and to assess the importance of various parameters used to evaluate urinary incontinence. Two hundred consecutive, ambulatory, outpatient, incontinent women 55 years of age and over who were seen at the Continence Program Clinic and completed a medical and urodynamic protocol are included in this paper. After a thorough medical history and a complete physical examination, urodynamic tests were performed. The urodynamic results showed that 77% of incontinent women had an incompetent urethra. Twenty-five percent had a hyperactive bladder, 8% had "other" types, and 7% had a normal study. Comparison of the clinical diagnosis with the actual urodynamic diagnosis for stress incontinence revealed a 78% accuracy and only a 6% false negative. In contrast, a similar comparison for urge incontinence found only 44% accurate and 45% false negative. Analysis of the urodynamic tests revealed that the simple provocative full-bladder stress test was as effective as the radiographic or electronic pressure measurement in detecting incompetent urethra producing stress urinary incontinence. Provocative upright cystometry was helpful in uncovering 33% of hyperactive bladders not provoked in the supine position. Complex urodynamic tests should be reserved for unexplained incontinence or when symptomatology is complex.

Aged↗