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PubMed2001

Inadequate repeatability of the one-hour pad test: the need for a new incontinence outcome measure.

OBJECTIVE: To assess the reproducibility of two one-hour pad tests performed within one week using serial ultrasound scanning to obtain identical bladder volumes, and to measure the effect of patient anxiety upon test reproducibility. DESIGN: Prospective observational study. SETTING: Tertiary urogynaecological unit. SAMPLE: Fifty-six incontinent women undergoing 112 pad tests. METHOD: Two one-hour pad tests were performed with natural diuresis one week apart prior to treatment. At the second test, serial ultrasound scans were performed until bladder volume reached that of the first test, followed by identical provocation. MAIN OUTCOME MEASURES: One-hour pad loss, bladder volumes (Vol1, Vol2), anxiety VAS questionnaire. RESULTS: Despite serial scanning, bladder volumes differed significantly. Median volume before second pad test was 541 mL, compared with 433 mls before first test (P < 0.001). The second pad test was also significantly larger than first (median 16g vs 4g, P = 0.017), and 13/56 (23%) women were dry on the first test but incontinent on the second. In 26 women (46%) both bladder volumes were similar, but the second pad loss was still significantly greater (median 14g vs 4g, P = 0.037). The mean difference between tests was 10g and the limits of agreement were wide (ranging from -44 to +66 g difference for the test result). Women were more anxious about leaking during the first test (Median VAS during the first test was 2.8cm, compared with 0.6cm during the second test, P = 0.008). 42.5% found the second test to be more typical. CONCLUSION: In women with similar bladder volumes, the test-retest reliability of the one-hour pad test was judged to be clinically inadequate, as the first and second pad test could differ by -44 to +66g. Lower anxiety levels at the second test may account for this finding. The one-hour pad test is a useful baseline measure of incontinence, but the poor repeatability suggests that is not an optimal measure of post-treatment change.

Anxiety↗
PubMed2003

Selection of continence products: perspectives of people who have incontinence and their carers.

PURPOSE: The needs, issues and concerns of people with incontinence and their carers were explored in order to inform the development of a comprehensive Australian consumer guide to continence products. PARTICIPANTS AND METHODS: Semi-structured interviews and focus groups were conducted with a wide range of people with incontinence and carers. Questions centred around issues and concerns regarding continence product selection, what information people need to make informed choices, and how the information should be presented. Qualitative analysis highlighted common themes and specific issues. RESULTS: Issues raised by consumers included the paucity of written information currently available, ignorance among health professionals concerning continence products and the lack of information about sources of help. Most consumers selected products by trial and error and were unaware of the range of products and services available. They wanted a consumer guide to continence products to be user-friendly and easily accessible, with information on product availability, cost, quality, comfort and design. They also wanted more general information on incontinence, sources of help, and how to select, care for and dispose of products. Participants wanted the guide to be made available in different languages, in large print and simple language. CONCLUSIONS: The findings highlight the need and provide a framework for a consumer guide and information on continence products.

Australia↗
PubMed1991

Two cases of diaper area granuloma of the adult.

Two cases of diaper area granuloma are reported. Patient 1, a 34-year-old man, had multiple reddish-purple nodules over the diaper area of the right part of the genitocrural region. Candida albicans was not detected from the lesion. Histological examination of the nodule showed acanthosis and dense infiltrates. The granulomas became smaller and flatter after the control of urination. Patient 2, a 28-year-old man, had two large decubitus lesions and multiple nodules over the diaper area of the gluteal region. The decubitus became smaller and the granulomas disappeared after the lesion was kept clean. Because these granulomas resemble granuloma gluteale infantum, but occurred in adults rather than in the aged or infants, we propose to call this condition "granuloma gluteale adultorum." We suggest that these granulomas may represent an inflammatory reaction to the irritation of urine or feces. It is, therefore, of great importance to treat and prevent this condition by controlling the flow of urine and keeping the region clean.

Adult↗
PubMed2002

Informal caregiving time and costs for urinary incontinence in older individuals in the United States.

OBJECTIVES: To obtain nationally representative estimates of the additional time, and related cost, of informal caregiving associated with urinary incontinence in older individuals. DESIGN: Multivariate regression models using data from the 1993 Asset and Health Dynamics Study, a nationally representative survey of people aged 70 and older (N = 7,443). SETTING: Community-dwelling older people. PARTICIPANTS: National population-based sample of community-dwelling older people. MEASUREMENTS: Weekly hours of informal caregiving, and imputed cost of caregiver time, for community-dwelling older people who reported (1) no unintended urine loss, (2) incontinence that did not require the use of absorbent pads, and (3) incontinence that required the use of absorbent pads. RESULTS: Thirteen percent of men and 24% of women reported incontinence. After adjusting for sociodemographics, living situation, and comorbidities, continent men received 7.4 hours per week of care, incontinent men who did not use pads received 11.3 hours, and incontinent men who used pads received 16.6 hours (P <.001). Women in these groups received 5.9, 7.6, and 10.7 hours (P <.001), respectively. The additional yearly cost of informal care associated with incontinence was $1,700 and $4,000 for incontinent men who did not and did use pads, respectively, whereas, for women in these groups, the additional yearly cost was $700 and $2,000. Overall, this represents a national annual cost of more than $6 billion for incontinence-related informal care. CONCLUSIONS: The quantity of informal caregiving for older people with incontinence and its associated economic cost are substantial. Future analyses of the costs of incontinence, and the cost-effectiveness of interventions to prevent or treat incontinence, should consider the significant informal caregiving costs associated with this condition.

Aged↗
PubMed1997

[Quantification of urine leaks: standardized one-hour pad test].

OBJECTIVE: To assess the feasibility and diagnostic performance of the one hour pad test proposed by ICS. PATIENTS AND METHODS: The pad test was performed in 20 women referred for incontinence. Five were included in a surgical protocol and 15 had inconsistent medical history. Their mean age was 52.5 years, the mean time of incontinence was 3.4 years and they used a mean of 3.5 pads/day. Six showed leakage on physical examination (PE) and 2 during previous cystometry. RESULTS: The test is well tolerated and lasts one hour and 15 minutes. The test was positive in 17 (mean leakage = 168 g). Leakage was not related to duration of incontinence, number of pads or cystometric capacity. A weak negative correlation (r = -0.52) was found between leakage and voided volume on uroflowmetry performed after the test. All patients who leaked on PE had a positive test and a significantly higher leakage compared to patients who didn't leak on PE. CONCLUSION: The pad test is a feasible outpatient procedure in the context of a Urodynamics Unit, providing objective information on leakage in most patients.

Adult↗
PubMed2002

Perineal pad test in evaluating outcome of treatments for female incontinence: a systematic review.

Our objective was to systematically review clinical studies of incontinence treatments for women that used pad tests to assess outcome, to determine how closely the ICS guidelines had been followed. Our review (Medline 1988-2000, plus referenced studies) identified 75 relevant papers, carrying out pad tests in clinics ( n = 53) or patients' homes ( n = 28). Clinic pad tests lasted between 60 seconds and 2 hours, with inconsistent starting bladder volumes, activities carried out, other test details and presentation of results. Home pad tests lasted between 1.5 and 48 hours: the conduct and reporting of these tests were also variable. Only 25 studies used pad tests that were apparently consistent with ICS guidelines. Pad tests are important in identifying urine loss in clinical evaluations; however, we found wide variations in their conduct and reporting. We recommend that the ICS should review the guidelines, and that further research should develop clinically valid pad tests. Authors and journal editors should ensure that pad test details are fully reported.

Female↗
PubMed2001

Postanal sphincter repair for anterior resection anal sphincter injuries: report of three cases.

Treatment options are limited for intractable excessive stool frequency and incontinence after low anterior resection for rectal cancer. Fortunately, this is quite rare, but three such patients were reported. The patients did not respond to two years of expectant treatment, including medications and anorectal biofeedback. Anorectal physiologic tests and endoanal ultrasound findings were consistent with internal anal sphincter injuries, which are known to occur with transanal insertion of stapling instruments. After postanal sphincter repair, stool frequency was reduced from 5.7 (standard error of the mean, 1.3) to 1.7 (0.3) stools per day. Fecal incontinence requiring pads in all patients was reduced to full continence in two patients and gas incontinence in one. Continence score improved from 13.7 (2.2) to 1.3 (0.3). Mean follow-up was 3.2 (0.5) years. Postanal sphincter repair could be considered when persistent bowel dysfunction after anterior resection is caused by internal sphincter injury.

Adenocarcinoma↗
PubMed2001

The CPE network: creating an evidence base for continence product selection.

Selecting continence products for an individual patient or hospital contract is often a daunting task. This article describes the evaluation process developed for a program of government-funded multicenter evaluations of continence products established in the United Kingdom to provide an evidence base for product selection. The essential requirements of an evaluation are discussed, together with the methodologic and statistical issues that such evaluations present. The strengths and limitations of multicenter trials are examined and suggestions are made regarding other areas of nursing in which this approach could be usefully adopted.

Catheterization↗
PubMedDate not supplied

A survey regarding the use of the dipstick/pad method with elderly, incontinent patients.

OBJECTIVE: To determine if nurses and physicians would use the dipstick/pad method to test urine in elderly, incontinent patients with suspected urinary tract infection. DESIGN: A cross-sectional survey was sent to 1900 physicians and nurses. SETTING AND SUBJECTS: A convenience sample of nurses and geriatricians, family practice, and internal medicine physicians was obtained from lists on the Internet, a geriatric care conference, and a geriatric nursing journal mailing list. INSTRUMENTS: A 3-part questionnaire queried: (1) whether respondents would use the dipstick/pad method; (2) would they use results to initiate or monitor nonantibiotic interventions, antibiotic interventions, or determine further laboratory analysis; (3) would a particular combination of nitrite and leukocyte esterase results determine the need for further laboratory testing. Nurses were also asked if they had used results of dipstick urinalysis in their management of urinary tract infections. METHODS: The questionnaire was mailed to 300 geriatric physicians, 1000 internal medicine and family practice physicians, and 600 nurses. RESULTS: A total of 373 individuals (20%) responded to the survey. Sixty-five percent of the nurses responding had not used dipstick results; 90% of these nurses would consider using dipstick/pad results. Ninety-five percent of both the physician groups and the nurses who had previously used dipstick results indicated that they would consider using the dipstick/pad method. Determining the need for further laboratory analyses was the most accepted application by all groups. No combination of nitrite and leukocyte esterase dipstick results elicited greater than a 76% agreement by either physician group with regard to outcomes for further analyses. CONCLUSIONS: Although the response rate was low, the results of this survey suggest that healthcare workers would consider using the dipstick/pad method with incontinent elderly patients in the assessment of a urinary tract infection, primarily to determine further laboratory tests.

Aged↗
PubMed1995

Self-care behaviors of older women with urinary incontinence.

1. Despite the availability of effective treatments for urinary incontinence, many women self-manage incontinence and never have it evaluated or treated. 2. The vast majority of women in this study used one or more self-care behaviors to manage their incontinence; the most frequently used behaviors were locating or staying near bathrooms when out, voiding more frequently, and wearing some type of protective garment. 3. Most women reported that incontinence was not at all or only a little difficult to manage and were satisfied with the self-care behaviors they used to manage this problem despite the fact that most of these behaviors had little or no potential to reduce or eliminate their incontinence.

Aged↗