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Perineal dermatitis risk factors: clinical validation of a conceptual framework.
As part of a larger study previously published in December of 1994, the question was asked whether commonly used pressure ulcer assessment tools (the Braden and Medley) were applicable to a broader definition of "skin risk assessment" and altered skin integrity related to perineal dermatitis (PD), and, if so, which risk factors were actually related to PD. The three site randomized clinical trial compared the use of diapers and underpads for 166 adult patients hospitalized on medical and surgical floors who were incontinent of urine and/or feces. Variables related to skin breakdown were the number of incontinence episodes, fecal incontinence, poor skin condition, pain, poor oxygenation, fevers, and mobility problems. Results also suggest that older patients may not have the sensory perception to experience discomfort in the same intensity as younger patients. Based on the findings of this study, pressure ulcer risk assessment tools are not good risk assessment tools for PD. The previously published conceptual framework for PD was modified and validated to form a basis for preventive measures.
[Nursing and environmental protection. VI. A look across the fence: alternatives in the disposition of of refuse].
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[Nursing and environmental protection. V. The inner life of cellulose is assessed by laboratory tests].
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Always sanitary napkins: further reports and manufacturer response.
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Always sanitary napkins: further reports and manufacturer response.
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Orthotopic ileal neobladder: our experience.
We report our experience with orthotopic ileal neobladder, after radical prostatocistectomy for local advanced cancer. We performed 2 reservoirs using Camey's I-II procedure, 4 Studer, 3 Hautmann, 4 VIP and 17 performed using staplers, according to Rouxel-Coadou's technique (we underline the simplicity and speed of automatic stapling devices, very important elements for surgical staff performance in this kind of surgery). Clinical and urodynamic evaluations were performed at 3,6,12,18 months and after every year (mean follow-up 18 months). All patients referred day-time continence already 3 months and 7/10 pts (70%) night-time continence too, after 24 months; the others referred moderate incontinence (1 pad for night). The urethral sphincter was well preserved in all patients (MUCP 72,4 cm H2O). At 18 months, post-void residual volume was absent, basal cystometric pressure was 10-15 cm H2O and mean neobladder capacity was 475 ml. We report 2 cases of reservoir calculosis, 2 stenosis of neobladder-urethral anastomosis and 2 pts with I-II grade hydronephrosis (in first case it's monolateral, the second is a bilateral case) owing to a stenosis of ureteral-ileal anastomosis. In short, the use of debutularizated and bended ileum allows to achieve a low pressure with an adequate capacity and continent orthotopic reservoir.
[Prevalence of nosocomial urinary infection. Alternatives to bladder catheterization].
BACKGROUND: The detection of a high percentage of nosocomial urinary infection (NUI) associated with vesical catheterization (VC) and the frequent use of VC in patients with urinary incontinence, led us to implant a prevention programme which included the introduction of absorbent diapers as a alternative to vesical catheterization in incontinent patients. MATERIAL AND METHODS: After actualization and introduction of VC preventive measures and the introduction of absorbent diapers, regular determinations were made of the prevalence of NUI with analysis of the variations using the chi 2 test for trends. The prevalence of urinary incontinence and the efficacy of the diapers were also measured. RESULTS: The prevalence of NUI associated with VC showed a significant decrease, from 27.5% to 3% (p = 0.004). Between 6% and 11% of the patients admitted to the medical service had urinary incontinence. After introduction of the diapers as part of health care assistance programme, the use of VC in patients with urinary incontinence is rare. CONCLUSIONS: 1) The prevention programme allowed a significant reduction in the prevalence of NUI associated with VC. 2) The use of absorbent diapers to care for patients with urinary incontinence probably contributed to reducing the prevalence of NUI. It was well accepted by the nursing staff and iatrogeny associated with their use was scarce.
Diapers and diaper rashes.
The diaper-wearing population has expanded from infants and children to include adults, especially the elderly. Nurses caring for patients over a wide age range are commonly asked for advice about diapering choices, and for guidance in evaluation, prophylaxis, and treatment of diaper rashes. Two different diaper types, disposables and reusables, and the advantages and disadvantages of each are discussed. A systematic approach is presented for the nursing evaluation of common diaper rashes and their differentiation from rarer skin eruptions of the groin and perineum in diaper-wearing persons.
Care of the patient with perineal skin injury.
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Significance of pad test loss for the evaluation of women with urinary incontinence.
AIMS: The aim of this study was to determine whether the objective incontinence severity, as measured by the pad test, correlated with urethral parameters, and if the objective incontinence severity was differentiated by the incontinence types and also, if it influenced the patient's clinical outcome. METHODS: Two hundred seventy-four female patients who had undergone a tension-free vaginal tape procedure between March 1999 and May 2003 were retrospectively reviewed. The 1 hr pad test was carried out as recommended by the International Continence Society, with some modification. The mean patient age was 55.1 years (range: 28-80). Two hundred-one women (73.3%) that complained of stress urinary incontinence and another 73 women (26.7%) that had additional symptoms of urge incontinence were enrolled as study subjects. A cure for incontinence, after the tension-free vaginal tape procedure, was defined as the absence of a subjective complaint of leakage and the absence of objective leakage on stress testing, and all other cases were considered failures. RESULTS: In linear regression analysis, the Valsalva leak point pressure (VLPP) was the only explanatory variable influencing the objective incontinence severity. The urine leakage was significant higher in the mixed urinary incontinence group than in the stress urinary incontinence group (39.7 +/- 7.5 g vs. 30.3 +/- 2.8 g, P < 0.05). For the total patients, the failure group had a more severe preoperative objective severity than the cure group (53.2 +/- 16.6 vs. 32.0 +/- 3.0, P < 0.05). Upon a subgroup analysis, a similar result was found in the stress urinary incontinence group (87.1 +/- 8.2 vs. 29.8 +/- 2.8, P < 0.05) but not in the mixed urinary incontinence group. CONCLUSIONS: Our findings suggest that the amount of urine leakage as measured during the pad test may be associated with the clinical outcome, after the anti-incontinence surgery.
A simple patient-administered test for objective quantitation of the symptom of urinary incontinence.
A pad-weighing test for the quantitation of urinary loss, performed by the patient during 48 hours of daily activities, was evaluated. All patients (n = 46, age 21-73 years) were able to perform the test. The precision of their weighing was good and the reproducibility of the results equal or better than that of previously published tests. There was no correlation between the results of the 48-hour test and a standardized one-hour test, indicating that these two tests measure different aspects of incontinence. Of the two tests the 48-hour test likely gives a more valid measure of the symptom of urinary incontinence. Other advantages over the standardized short term tests are that no hospital staff is involved in the testing and that the test is independent of the physical capacity of the patient.
The treatment of male stress urinary incontinence with polydimethylsiloxane in compliant bladders following spinal cord injury.
STUDY DESIGN: Retrospective analysis. OBJECTIVES: To evaluate the safety and efficacy of polydimethylsiloxane (PDS, Macroplastique) submucosal injections, in the treatment of male genuine stress urinary incontinence secondary to spinal cord injury (SCI). SETTING: London Spinal Injuries Unit, Stanmore, UK and Institute of Urology and Nephrology, London, UK. PATIENTS AND METHODS: A retrospective analysis identified 14 patients treated with PDS for stress urinary incontinence secondary to SCI between 1997 and 2001. A single surgeon at a specialist spinal injuries unit managed all patients. A total of 13 patients had suffered a traumatic SCI (T11:n=2; T12:n=5; L1:n=5; L2:n=1), while one developed stress incontinence after spinal surgery. The mean age was 41 years (range 26-69 years) and the mean duration of injury was 9.6 years (range 1.5-48 years). The preoperative investigations included video cystometrogram (VCMG) confirming the presence of urodynamically proven stress incontinence without evidence of urge incontinence. Complete cure was defined as a cessation of pad usage with no evidence of leakage on VCMG. Incomplete cure with improvement was defined as a >50% reduction in the number of pads used, with incontinence present on VCMG. RESULTS: The follow-up ranged from 12 to 58 months (mean 34.7 months). Five patients (36%) reported complete success, confirmed by VCMG. Three patients (21%) reported improvement with >50% reduction in the use of pads. The procedure failed completely in six patients (43%). No immediate or late complications were noted with the procedure. CONCLUSIONS: The use of PDS is a safe and minimally invasive treatment for genuine stress urinary incontinence in males following SCI with a stable compliant bladder. We achieved complete cure in 36% of our patients with confirmation on VCMG. A further 21% reported greater than 50% reduction in usage of pads; however, on VCMG stress incontinence was demonstrated in these patients. We suggest that PDS can be used as the first line of treatment in this difficult group of patients with complex problems.
[Early versus delayed physiotherapy in the treatment of post-prostatectomy male urinary incontinence].
OBJECTIVES: To analyze the importance of the starting time for pelvic floor physiotherapy in patients with post radical prostatectomy urinary incontinence. METHODS: Between May 2003 and February 2004 18 patients with the diagnosis of post radical prostatectomy urinary incontinence underwent physiotherapy of the pelvic floor. Each patient received 12 sessions using kinesotherapy and electric stimulation on a weekly basis. Patients were divided into two groups: Group 1 included eight patients that started therapy within the first six months after surgery; Group 2 included 10 patients starting therapy after the sixth post operative month. All patients were evaluated by the pad test and number of incontinence pads per day. RESULTS: Evaluating pad tests before and after treatment, six patients in group 1 had a reduction of the amount of urine leak in comparison to seven patients in group 2. The statistical analysis showed significant differences before and after treatment for both groups (group 1: p = 0.028; group 2: p = 0.018). The evaluation of the number of pads showed: Group 1: all eight patients using pods had a reduction in the number of pads. Group 2: 5 of the eight patients using pads had a reduction and the other three continued using the same number. Statistical analysis comparing the number of pads per day before and after treatment showed a significant difference in group 1 (p = 0.004). There was no statistically significant difference in the number of pads per day before and after physiotherapy in group 2, although half of the patients showed a diminishment in the number of pads required after treatment. CONCLUSIONS: Results demonstrate that early indication of physiotherapy for the treatment of post radical prostatectomy urinary incontinence is better than delayed treatment. New works may be developed in the future to confirm our results.
A randomized controlled trial of duloxetine alone, pelvic floor muscle training alone, combined treatment and no active treatment in women with stress urinary incontinence.
PURPOSE: We primarily compared the effectiveness of combined pelvic floor muscle training (PFMT) and duloxetine with imitation PFMT and placebo for 12 weeks in women with stress urinary incontinence (SUI). In addition, we compared the effectiveness of combined treatment with single treatments, single treatments with each other and single treatments with no treatment. MATERIALS AND METHODS: This blinded, doubly controlled, randomized trial enrolled 201 women 18 to 75 years old with SUI at 17 incontinence centers in the Netherlands, United Kingdom and United States. Women averaged 2 or more incontinence episodes daily and were randomized to 1 of 4 combinations of 80 mg duloxetine daily, placebo, PFMT and imitation PFMT, including combined treatment (in 52), no active treatment (in 47), PFMT only (in 50) and duloxetine only (in 52). The primary efficacy measure was incontinence episode frequency. Other efficacy variables included the number of continence pads used and the Incontinence Quality of Life questionnaire score. RESULTS: The intent to treat population incontinence episode frequency analysis demonstrated the superiority of duloxetine with or without PFMT compared with no treatment or with PFMT alone. However, pad and Incontinence Quality of Life analyses suggested greater improvement with combined treatment than single treatment. A completer population analysis demonstrated the efficacy of duloxetine with or without PFMT and suggested combined treatment was more effective than either treatment alone. CONCLUSIONS: The data support significant efficacy of combined PFMT and duloxetine in the treatment of women with SUI. We hypothesize that complementary modes of action of duloxetine and PFMT may result in an additive effect of combined treatment.
Quantification of urinary incontinence in elderly women with the 48-hour pad test.
The ability of 34 elderly women (79 +/- 6 years, range 71-95 years) with urinary incontinence to perform the 48-h perineal pad test in their home environment was investigated. The mean involuntary urinary loss during the 48-h observation period was 80 +/- 88 g (range (2-411 g). Thirty patients successfully compared the two perineal pad systems commercially available in Sweden (LIC and Mölnlycke). Twelve women considered the systems to be equivalent. Thirteen women preferred the Mölnlycke system while five women preferred the LIC system. There was a good correlation between the patients own weighing of the pads and control weighings at the clinic, performed on a precision weight scale (LIC: n = 15, r = 0.99; Mölnlycke: n = 15, r = 0.99). The 48-h perineal pad test performed in the patients home environment should have a given place in the investigation of urinary incontinence amongst elderly women.
Urinary incontinence in both sexes: prevalence rates and impact on quality of life and sexual life.
The aim of this study was to determine the prevalence of urinary incontinence in both sexes in Austria and to assess its impact on quality of life and sexual function. Voluntary health examinations free of charge are regularly organized in the area of Vienna. From May 1998 to April 1999 we have included in this health examination an incontinence questionnaire containing 37 items, which was largely based on the Bristol female lower urinary tract symptoms (LUTS) questionnaire. This questionnaire asks in detail for various aspects of urinary incontinence/voiding problems, including the impact of urinary incontinence on quality of life and sexual function. In this questionnaire, urinary incontinence was defined as any involuntary loss of urine within the past 4 weeks. The data of 2,498 participants (1,262 women [f]: mean age: 49.7+/-13.6 years and 1,236 men [m]: 48.6+/-13.0 years; age range: 20-96 years) were analyzed. Overall, 26.3% of women and 5.0% of men reported on episodes of urinary incontinence during the past 4 weeks. Prevalence rates increased constantly with age in both sexes: 20-29 years: 4.1% (f), 1.7% (m); 30-39 years: 10.8% (f), 2.7% (m); 40-49 years: 22.9% (f); 3.9% (m); 50-59 years: 34.9% (f), 3.7% (m); 60-69 years: 36.9% (f), 7.6% (m); 70 years or older: 36.0%% (f), 11.5% (m). Overall, 65.7% of women and 58.3% of men stated that quality of life was affected by their incontinence status. A moderate or severe impairment was reported by 18.3% of women and 16.6% of men. Impairment of quality of life was related as statistically significant (P < 0.05) to frequency and degree of incontinence (irrespective of the type of incontinence), the impact on sexual function and need for pads or other incontinence devices. Patient gender, age, and the duration of incontinence had no effect (P > 0.05) on quality of life. An impairment of sexual life by urinary incontinence was stated by 25. 1% of women and 30.5% of women, respectively. Although only 65.7% of women and 58.3% men with urinary incontinence reported on an impairment of quality of life, these data underline the high prevalence and socioeconomic implications of this disorder. The impact of urinary incontinence on quality of life is significantly higher than on sexual function.
The continence control pad--a new external urethral occlusion device in the management of stress incontinence.
OBJECTIVE: To assess the use of an external urethral occlusion pad (the continence control pad, CCP) in the management of stress incontinence. PATIENTS AND METHODS: Nineteen women (median age 47 years, range 36-72) complaining of stress incontinence were taught to use the CCP. The patients were assessed during the week before, and again after using the CCPs for 2 weeks, by urinary diaries, pad-tests and a review of their symptoms. RESULTS: Use of the CCP was associated with a cure or improvement in 17 women, as assessed by the number of incontinent episodes per week. There was a significant decrease in both the number of incontinent episodes (P < 0.001) and pad-test leakage (P = 0.002) when using the CCP. Minor difficulties in placement and removal were described in a minority of women. CONCLUSION: The CCP offers a simple, non-invasive treatment for women complaining of stress incontinence. The short-term success rate was better than that with other conservative methods of treatment, is independent of the general practitioner and safe. It is a promising home-based method of managing stress incontinence.