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Inhibition of moisture penetration to the skin by a novel incontinence barrier product.

OBJECTIVE: To measure the ability of a multiple-barrier product to inhibit the passage of a highly water-soluble tracer into the skin when compared with products currently available on the market (Peri-Care; Sween Corp., and Double-Guard; C. R. Bard, Inc.) DESIGN: Dye extraction from the skin was measured at specified intervals and a spectrophotometric measurement of the amount of dye was obtained. SETTING AND SUBJECTS: Two groups of light-skinned volunteers, 6 young adults subjects, aged 22 to 31 years, and 6 older subjects, aged 61 to 73 years, were studied in a controlled laboratory setting. INSTRUMENTS: Spectronic 601 spectrophotometer. METHODS: Rectangles (1 inch x 4 inch), inscribed on the ventral forearm skin, were divided into 4 1 inch x 1-inch squares, onto which 50 microL of different barrier products were spread. Band-Aids (Johnson & Johnson), saturated with 70 microL of an FD&C red dye No. 40 solution, were placed over the treated squares and left in place for specified intervals up to 8 hours. Similarly treated Band-Aids placed onto untreated skin comprised the controls. MAIN OUTCOME MEASURE: Amount of dye extracted from the skin as reflected by absorbance spectrophotometry. RESULTS: This multiple-barrier product inhibited the passage of the tracer into the skin significantly better than the other 2 products at all time points, except for 1 point in the elderly group. CONCLUSION: Noninvasive preclinical methods show that this prototype barrier cream inhibits the absorption onto the skin of a solution simulating the density and ionic strength of urine. The advantages and limitations of the methods are clarified and directions for clinical research are suggested.

Adult↗

Breaking the silence: women living with multiple sclerosis and urinary incontinence.

This study examined women's understandings of living with multiple sclerosis (MS) and urinary incontinence and the challenges they have encountered in their day-to-day lives. As health-care professionals, we aimed to understand how people living with MS manage urinary incontinence. This paper reports the findings from a Participatory Action Research (PAR) group with four women, the researcher and two Continence Nurse Advisors (CNAs). The group met on five occasions between March and June 1999. The women's stories held personal and gendered meanings about living with MS and urinary incontinence. Four themes were derived from the transcripts: maintaining control; seeking understanding; avoiding shame; and good and bad days. The women and the CNAs benefited from an exchange of knowledge about living with MS and incontinence. The CNAs became sensitive to the women's experience and have been able to incorporate these understandings into their practice. By sharing our research we hope the findings may be more widely incorporated into sensitive health practice.

Adaptation, Psychological↗

Long-term results of high-power holmium laser vaporization (ablation) of the prostate.

OBJECTIVE: To present the 7-year follow-up data from the initial series of patients treated by holmium laser ablation of the prostate (HoLAP) for symptoms of benign prostatic hyperplasia at our institution. PATIENTS AND METHODS: In all, 79 patients underwent HoLAP in the initial series between September 1994 and May 1995. All patients were contacted by telephone and mail; those available for follow-up had their peak urinary flow rate, American Urological Association (AUA) symptom score, single-question quality-of-life (QoL) score and adverse events assessed. Patients were also assessed using the International Continence Society 'male short-form' (ICSmaleSF) questionnaire on lower urinary tract symptoms (LUTS). RESULTS: At a median follow-up of 89 months (7.4 years), 17 patients had died (21%), 28 could not be contacted or refused follow-up (35%), leaving 34 patients (43%) available for assessment. The mean (range) AUA score of the remainder was 10.0 (0-26), the maximum urinary flow rate 16.8 (5-35) mL/s and QoL score 2.1 (0-5). The mean ICSmaleSF voiding score was 5.8 and the mean incontinence score 3.2. The impact score of their current LUTS (QoL) was 0.68, implying a minimal effect. No patient required pads for incontinence. The reoperation rate was 15%, with one patient each undergoing transurethral resection or bladder neck incision, two undergoing holmium laser enucleation of the prostate and one having a bladder stone removed endoscopically. CONCLUSIONS: The long-term results of HoLAP were satisfactory in those patients who were available for the follow-up.

Adult↗

Quality by selection and purchasing of urinary incontinence aids-- perceptions of nurses and administrators.

In a qualitative-quantitative study, differences in the perceptions of nurses and administrators (admin's) dealing with the purchasing of urinary incontinence (UI) aids were studied by means of interviews with a cognitive and emotional approach. Various aspects of purchasing were concentrated on: cooperation, strategy, competence, costs, measures, and decisions, as well as quality in the selection of aids in order to improve quality of care and achieve better economy. The findings show a continued need for centrally coordinated purchasing (CCP), not least related to the European Community, and also problems of integration. Due to the decentralization process, the nurses perceived a need for more education in overall business strategies in order to underline more constructively their caring and patient-oriented opinions. The admin's experienced uncertainty in their purchasing activities caused by the absence of purchasing policies and lack of knowledge of new demands and routines.

Administrative Personnel↗

[Management of voiding dysfunction in elderly patients: prognosis 1 year after discharge from hospital].

We investigated how 293 elderly patients who had been successfully treated to be free of catheters or diapers managed to urinate one year after their discharge from our hospital. Of 192 patients who returned to their own home 154 (80%) had good activities in daily life (ADL), and of 101 who moved to a nursing home or other hospital only 7 (7%) had good ADL. Among the 192 in their own home, 151 (79%) remained free of catheters or diapers thanks to the home care services provided by trained nurses belonging to our hospital. However, among the 101 at other facilities 21 (21%) could avoid these appliances. Furthermore, those who stayed in their own home with poor ADL had a significantly higher rate of being independent of catheters or diapers (34%) compared to those who lived in facilities other than their home with poor ADL (13%). These findings indicate that the elderly patients who reside in their own home or have good ADL possess a better chance of avoiding catheters or diapers compared to those who live in other than their residence or have poor ADL, and that continued urological care coupled with the home-visiting services is effective and important in attaining these aims.

Activities of Daily Living↗

Weigh the evidence.

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Evidence-Based Medicine↗

[Treatment of postoperative male urinary incontinence by INVANCE prosthesis: preliminary results].

PURPOSE: To evaluate the preliminary results of treatment of postoperative male stress urinary incontinence (SUI) by the INVANCE (AMS) suburethral sling. MATERIAL AND METHODS: From June 2003 to May 2004, 22 patients with stress urinary incontinence secondary to prostatic surgery (13 radical prostatectomies, 7 Ablatherm, 2 transurethral resections of the prostate) were treated by INVANCE sling. The patients presented either grade 1 incontinence (1 to 2 pads per day), or grade 2 incontinence (3 to 4 pads per day), or grade 3 incontinence (5 or more pads per day). The INVANCE process uses a rectangular polyester sling positioned under the bulbar urethra via a perineal incision. It is attached to the 2 ischiopubic rami by 3 titanium screws using a disposable electric screwdriver. Patients were reviewed every 3 months to evaluate the results (continence, Qmax, post-voiding residual volume, IPSS score, quality of life) RESULTS: The mean duration of the procedure was 79 minutes (range: 60-120). No intraoperative incidents were observed. The bladder catheter was removed on D1 (n=20) or D2 (n=2). The mean length of stay was 3.3 days (range: 2-8). Complications consisted of perineal haematoma (n=1), acute urinary retention after catheter removal (n=4), sling infection requiring removal (n=1), and prolonged perineal pain (n=5). No de novo irritative or obstructive urinary tract disorders were observed. With a median follow-up of 12 weeks (range: 3-44), 11 patients were completely continent (50%), 5 patients were significantly improved (22.7%) and 6 patients were considered to be failures (27.3%), 3 of whom had previously received external beam radiotherapy. CONCLUSION: The INVANCE process appears to be a simple and effective option for the treatment of grade 1 and 2 postoperative male stress urinary incontinence.

Aged↗

The male perineal sling: comparison of sling materials.

PURPOSE: Urinary incontinence continues to be a significant problem for patients after radical prostatectomy. The male perineal sling is emerging as a safe and effective treatment option for postprostatectomy stress urinary incontinence. We compare the efficacy of porcine dermal collagen and silicone mesh as the sling material. MATERIALS AND METHODS: Of 36 patients with postprostatectomy stress urinary incontinence a porcine dermal collagen sling was placed in 20 and a silicone mesh sling was placed in 16. The sling was placed at the bulbar urethra and secured to 3 titanium bone screws anchored into the medial aspect of bilateral inferior pubic rami. RESULTS: Results at 12 months were compared. In the dermis group 9 (56%) patients were cured of incontinence (no pads daily), 5 (31%) had significant improvement (decrease of 50% or more in pads daily) and 2 (13%) had no change in symptoms. In the silicone mesh group 14 (87%) patients were cured of incontinence and 2 (13%) were significantly improved. Results showed that a previously placed artificial urinary sphincter led to poorer outcomes but a history of radiation therapy did not affect results. The most common complication was temporary urinary retention observed in 1 (5%) patient in the dermis group and 2 (12%) in the silicone mesh group. CONCLUSIONS: Early results demonstrate that the male sling is a safe and efficacious treatment option for postprostatectomy urinary incontinence. This study demonstrates superior outcomes with the synthetic silicone mesh sling compared to the porcine dermal collagen.

Aged↗

Pad weighing test--a simple method to quantitate urinary incontinence.

This paper reviews the litterature on pad weighing tests designed to measure urinary incontinence. These can be divided into short-term (one to two hours), as suggested by the International Continence Society, or long-term (12 to 48 hours). Apart from practical disadvantages the short-term tests have a low sensitivity and require retrograde filling of the bladder to reach acceptable reproducibility. The long-term tests have practical advantages, better sensitivity and acceptable reproducibility. The validity of the long-term test as a measure of the symptom of incontinence is evident, whereas it is unclear what the short term test measures. An evaluation of the value of pad-weighing tests in different kinds of incontinence is lacking.

Clothing↗

Engineered structures for use in disposable incontinence products.

The background and evolution of absorbent disposable hygiene products is discussed. The current technology used to produce disposable hygiene products such as baby diapers, feminine hygiene products and adult incontinence management products is shown to have a number of manufacturing and in-use problems. Alternative technologies, such as multilayer composite webs offer the opportunity to achieve better product weight control, and therefore better control over the other related properties, reduced raw material waste and improved functional characteristics. There are still problems to be resolved when using such composite materials, but the potential of these new technologies has now been established.

Disposable Equipment↗

Catheter care.

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Aged↗