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PubMed2004

Prevalence, impact on the quality of life and pathophysiological determinants of nocturia in urinary incontinent women.

The objective of this study was to estimate the prevalence of nocturia in incontinent women in a urogynaecologic practice and its association with the quality of life and to estimate the prevalences of the pathophysiological categories among nocturics. From 1 January 2002, all patients with complaints of urinary incontinence were analysed according to a specific protocol: multichannel urodynamic testing, a 1-h International Incontinence Society (ICS) pad test and a 3-day frequency-volume (FV) chart. From 1 June 2002, subjects had to fill in a standardised quality of life questionnaire as well. Nocturia was defined as two or more micturitions per night calculated from the FV chart. Evaluable FV charts were received from 111 patients, and 72 patients completed the questionnaires correctly. The overall prevalence of nocturia was 48.6% (confidence interval: 43.9-53.3%). Nocturia had a negative impact on several aspects of the quality of life. The maximum voided volume was significantly (p=0.005) less in nocturics. The 24-h frequency was higher in nocturics (p=0.001). Nocturics lost more urine during the pad test (p=0.039). The multivariate logistic regression analysis showed that the greater the proportion of 24-h urine excreted at night, the greater the odds of having nocturia and that the lesser the maximum voided volume, the greater the odds of having nocturia. The majority (92.7%) of the nocturics can be classified into one of the responsible pathophysiologic categories: nocturnal polyuria in 51.2%, a low functional bladder capacity in 14.6%, a combination of both in 9.8%, polyuria in 4.9% and a combination of polyuria and nocturnal polyuria in 12.2% of the cases. Nocturia is a frequent symptom among urinary incontinent patients, with a negative impact on several aspects of the quality of life. With a FV chart, nocturics can be classified into one of the responsible pathophysiologic categories in the majority (92.7%) of the cases.

Adolescent↗
PubMed1984

Long-term followup of the artificial urinary sphincter.

The artificial urinary sphincter with a pressure regulating balloon was implanted in 30 patients. All implantations were done before September 1982, for a minimum followup of 1 year and an average followup of 3.7 years. Of the patients 21 (70 per cent) have a functioning sphincter: 17 are continent and 4 are slightly incontinent, requiring 1 pad per day. Failure was owing to erosion in 6 patients and infection of the device in 3. Critical factors for successful implantation include preoperative evaluation, cuff location and pressure, primary deactivation and postoperative care. Our experience supports the further use of this device in appropriate cases.

Adult↗
PubMed2005

Adrenergic drugs for urinary incontinence in adults.

BACKGROUND: Adrenergic drugs have been used for the treatment of urinary incontinence. However, they have generally been considered to be ineffective or to have side effects which may limit their clinical use. OBJECTIVES: To determine the effectiveness of adrenergic agonists in the treatment of urinary incontinence in adults. SEARCH STRATEGY: We searched the Cochrane Incontinence Group specialised trials register (searched 9 March 2005) and the reference lists of relevant articles. SELECTION CRITERIA: Randomised or quasi-randomised controlled trials in adults with urinary incontinence which included an adrenergic agonist drug in at least one arm of the trial. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed eligibility, trial quality and extracted data. Data were processed as described in the Cochrane Reviewers' Handbook. MAIN RESULTS: Twenty-two eligible randomised trials were identified, of which 11 were crossover trials. The trials included 1099 women with 673 receiving an adrenergic drug (phenylpropanolamine in 11 trials, midodrine in two, norepinephrine in three, clenbuterol in another three, terbutaline in one, eskornade in one and Ro-115-1240 in one). No trials included men. The limited evidence suggested that an adrenergic agonist drug is better than placebo in reducing the number of pad changes and incontinence episodes, as well as improving subjective symptoms. In two small trials, the drugs also appeared to be better than pelvic floor muscle training, possibly reflecting relative acceptability of the treatments to women but perhaps due to differential withdrawal of women from the trial groups. There was not enough evidence to evaluate the use of higher compared to lower doses of adrenergic agonists nor the relative merits of an adrenergic agonist drug compared with oestrogen, whether used alone or in combination. Over a quarter of women reported adverse effects. There were similar numbers of adverse effects with adrenergics, placebo or alternative drug treatment. However, when these were due to recognised adrenergic stimulation (insomnia, restlessness and vasomotor stimulation) they were only severe enough to stop treatment in 4% of women. AUTHORS' CONCLUSIONS: There was weak evidence to suggest that use of an adrenergic agonist was better than placebo treatment. There was not enough evidence to assess the effects of adrenergic agonists when compared to or combined with other treatments. Further larger trials are needed to identify when adrenergics may be useful. Patients using adrenergic agonists may suffer from minor side effects, which sometimes cause them to stop treatment. Rare but serious side effects, such as cardiac arrhythmias and hypertension, have been reported.

Adrenergic Agonists↗
PubMed2000

[Use of devices for urinary incontinence among the elderly of the basic health area of Cabra (Córdoba)].

AIMS: To study the proportion and characteristics of elderly people who use aids for urinary incontinence, and the economic cost of pads. DESIGN: Cross-sectional study. INTERVENTIONS: A specific questionnaire on urinary incontinence and Barthel and Lawton indexes; and economic analysis of the number of pads used. LOCATION: Basic Health Zone of Cabra (Córdoba). PATIENTS: 827, among a total of 5139 > or = 65 years-old subjects, by means of a random sampling, classified in age groups. MEASUREMENTS: Two sources of data were used: a home health interview gathering information about the use of aids; the register which controls the prescription of pads in the Basic Health Zone of Cabra. MAIN RESULTS: Urinary incontinence was detected in 36% of elderly people. Sixty-three percent of the incontinent people used some sort of aid, 8.1% used pads and 2.9% used an urethral catheter. The use of aids was related to advanced age, female gender and functional dependence. In 1996, the cost of the pads was 19,416,298 pesetas and 51,659 pesetas per incontinent person. CONCLUSIONS: The overall prevalence of the use of aids was greater than or similar to that of other studies whereas the use of pads was less. During 1996 the average cost of the pads per elderly person amounted to 49% of the theoretical maximum cost permitted by the health authority.

Aged↗
PubMed2000

Early experience with small volume periurethral polytetrafluoroethylene for female stress urinary incontinence.

PURPOSE: Injectable polytetrafluoroethylene paste has been used to treat female stress urinary incontinence. Since the substance is antigenically nonreactive we postulated that the reported morbidity may be due in part to the relatively large volumes injected. Therefore, we assessed the outcome of injecting small volumes of polytetrafluoroethylene with attention to the durability of success and morbidity. MATERIALS AND METHODS: A total of 46 women with a median age of 73.8 years (range 26 to 88) with stress urinary incontinence were treated. The procedure was done on an outpatient basis using topical urethral lidocaine and periurethral lidocaine as anesthesia. A 20Fr urethroscope was used to inject polytetrafluoroethylene through an 18 gauge needle periurethrally. Patients were reinjected 1 to 3 months after initial injection if not cured (no incontinence or no pads). Continence was assessed by questionnaire from an interviewer not known to the patient. Subsequent top-up injections were given if required. Morbidity was monitored with clinical examination and imaging as required. RESULTS: Of the patients 14 (30.4%) were dry, 19 (41.3%) were improved and 13 (28.3%) had treatment failure at a mean of 17.9, 15. 9 and 9.1 months, respectively, after last injection. For cured and improved patients (71.7%) an average of 2 treatments were needed, for a total mean volume of 5.4 cc polytetrafluoroethylene. Using a Kaplan-Meier survival curve the probability of the 14 patients remaining dry without additional polytetrafluoroethylene was 90% at 1 and 60% at 2 years. Outcome was not affected by radiological type of incontinence (that is with or without hypermobility), age, pretreatment bladder instability or previous interventions. CONCLUSIONS: Periurethral injection of small volumes of polytetrafluoroethylene is effective and safe for treatment of female stress urinary incontinence. Early analysis shows that success is durable with minimal morbidity.

Adult↗
PubMed1997

Retrograde leak point pressure for evaluating postradical prostatectomy incontinence.

OBJECTIVES: To evaluate a technique of measuring the retrograde leak point pressure (RLPP) for assessing men with postradical prostatectomy stress urinary incontinence (SUI). METHODS: We measured RLPP in adult men by retrograde infusion of the distal urethra while simultaneously recording intraurethral pressure. The reproducibility of this test, and its dependence on urethral infusion rate, bladder volume, and anterior urethral catheter position, were evaluated. RLPP and abdominal leak point pressure (ALPP) measurements were performed in postradical prostatectomy patients. RLPP was compared with ALPP and with severity of incontinence determined by pad usage. RESULTS: Repeated RLPP measurements were not significantly different and did not change with bladder volume up to half capacity or with the location of the catheter in the anterior urethra. The differences between RLPP measurements with infusion rates of 2, 4, and 8 mL/min were also not significant. Twenty-seven men were evaluated 6 to 108 months after surgery. Of these, 22 (81%) demonstrated SUI. Mean RLPP in men without SUI (79.2 +/- 14 cm H2O) was significantly higher than in men with SUI (51.9 +/- 13 cm H2O, P < 0.01). In men with SUI, ALPP and RLPP were significantly correlated, and ALPP (49.8 +/- 24 cm H2O) was not significantly different from RLPP (51.9 +/- 13 cm H2O) Pad use and RLPP were also significantly related. CONCLUSIONS: RLPP measurements are reproducible and simple to perform. The pressure at which leakage occurs is easily identifiable as the plateau pressure. RLPP correlates significantly with the lowest of multiple ALPP measurements in men with SUI. This technique represents a reliable urodynamic alternative for evaluating men with postradical prostatectomy SUI.

Aged↗
PubMed1997

Long-term followup and evaluation of primary realignment of posterior urethral disruptions.

PURPOSE: We analyzed the long-term results of treatment of posterior urethral disruptions with immediate primary realignment. MATERIALS AND METHODS: A total of 57 patients with posterior urethral disruptions (56 complete and 1 partial) underwent primary urethral realignment within 6 hours after injury. Pelvic fractures were present in 52 patients. In all cases the actual operating time for realignment was 1.25 hours or less. All patients were evaluated postoperatively for incontinence, impotence and strictures. Mean followup was 10.5 years (range up to 40 years) after injury and 53 patients were available for long-term followup. RESULTS: Erections-42 of 53 patients (79%) reported no erectile dysfunction, 7 (13%) reported decreased quality of erection but required no treatment and 4 (7.5%) had erectile dysfunction requiring treatment. Incontinence-2 of 53 patients (3.7%) reported mild post-realignment stress incontinence. Both patients did not need treatment for incontinence or protective padding. Strictures-18 of 53 patients (34%) had evidence of post-realignment strictures and required no further urethral dilation or surgical intervention. Mean followup for these 18 patients was 12 years 2 months. A total of 36 patients (68%) had post-realignment strictures; however, 23 (43.4%) were considered to have mild strictures that were observed or easily managed with in-office dilation. Mean followup for these patients was 8.5 years. Of the 53 patients 13 (24.5%) had more significant strictures that required a repeat procedure using general anesthesia. A total of 20 procedures was required to treat the 13 patients. Of the 20 procedures done using general anesthesia 16 (80%) were completed on an outpatient basis. The remaining 4 patients required urethroplasty. Mean followup of the 13 patients was 11 years 9 months. CONCLUSIONS: Immediate primary realignment resulted in negligible intraoperative morbidity, and acceptably low incidences of impotence, incontinence and symptomatic strictures.

Adolescent↗
PubMed2002

Reliability of pelvic floor muscle strength measurement in elderly incontinent women.

Pelvic floor muscles (PFM) play an important role in maintaining urinary continence with increasing age. Therefore, their contractile properties need to be evaluated. The aim of the study was to examine the reliability and correlation of simple techniques to measure PFM strength in elderly women with urinary incontinence. An interview was used to evaluate the ability to stop the urinary stream during micturition and to calculate the incontinence index. A pad test was applied to objectively evaluate the severity of the disease. Functional testing included a digital examination to measure the force and duration of one contraction, a perineometer measurement (Peritron) to assess maximal contraction force and contraction force of 5 s, and a cone-retention test (Femcon) while walking for 1 min and during Valsalva's manoeuvre. This procedure was performed on three separate occasions within one week. The 37 participating women with a mean age of 62+/-8 (mean+/-SD) years had a severity index of 4.4+/-2.6 and a urine loss of 9.5+/-13.6 mg during the pad test. Sixteen women were able to completely stop the urinary stream during micturition. The digital examination showed no intratester variability. The perineometer measurement showed that the absolute difference in maximal contraction force and mean contraction force within 5 s was less than 5.3 mm Hg and 4.5 mm Hg, respectively, with a probability of 0.95. While walking and during Valsalva's manoeuvre, 19 and 20 women, respectively, held the same cone in place on all three occasions. The maximal contraction force and mean force during the 5-s contraction correlated well with the ability to stop the urinary stream and the digital examination but only weakly with the cone-retention tests. The reliability of PFM strength measurement is highest in the digital examination, followed by perineometer measurements, and then by vaginal cone tests. As PFM function is easy to assess, it should be routinely done in the assessment of urinary incontinence in elderly women.

Aged↗
PubMed1998

Delayed hypersensitivity and systemic arthralgia following transurethral collagen injection for stress urinary incontinence.

PURPOSE: During a prospective cohort study to determine the effectiveness of and adverse effects associated with transurethral collagen injection for treatment of stress urinary incontinence in women, we observed 3 cases of delayed allergic reaction at the skin test site associated with arthralgia. MATERIALS AND METHODS: A total of 337 women with at least a 1-year history, physical findings and urodynamic abnormalities consistent with stress urinary incontinence, who required pads or protective clothing and who had no or only grade 1 cystocele were enrolled in this prospective cohort study. Adverse effects were documented by a third party at each followup. RESULTS: Delayed reaction at the skin test site occurred in 3 patients (0.9%), and was associated with arthralgias in 2. CONCLUSIONS: The incidence and systemic nature of this type of reaction suggest that gluteraldehyde cross-linked collagen injection is not as innocuous as previously believed. Patients should be counseled regarding the unknown long-term outcome of this complication. Before treatment clinicians should consider double skin testing.

Adult↗
PubMed1989

Continence following nerve-sparing radical prostatectomy.

Urinary incontinence after radical prostatectomy is a difficult postoperative problem and often is a major consideration in the selection of therapy for clinically localized disease. The occurrence of incontinence is unpredictable and the relationship of incontinence to operative technique is unclear. We compared urinary continence in 68 consecutive patients undergoing radical prostatectomy. In 34 patients nonnerve-sparing radical prostatectomy was performed and in 34 subsequent patients a nerve-sparing operation was done. Patient age, Gleason score and stage of the tumor, and operative time were not significantly different between the groups. In the nonnerve-sparing operated group there were 4 patients (12%) with total and 6 (18%) with stress incontinence requiring absorbent pads, compared to 0 and 2 (6%), respectively, in the nerve-sparing group. The postoperative functional urethral length in the nonnerve-sparing group was 1.9 +/- 0.6 cm. (standard deviation) and in the nerve-sparing group it was 2.3 +/- 0.5 cm., which was significantly different (p less than 0.05). The peak resting urethral pressure of the nonnerve-sparing group was 35.4 +/- 14.2 cm. water and in the nerve-sparing group it was 46.5 +/- 12.3 cm. water, which also was significantly different (p less than 0.05). The study indicates that preservation of the pelvic nerves during radical prostatectomy has a major role in the functional preservation of urinary continence.

Humans↗
PubMed1998

[The Studer orthotopic ileal neobladder: patient compliance].

Radical cystectomy represents the gold standard for locally advanced bladder cancer. Orthotopic neobladder is considered the surgical option which may offer the least modification of body image and the best life condition to the unfortunate patient requiring radical cystectomy. Objective of this study was to investigate long term clinical outcome of orthotopic ileal bladder substitute with special reference to late complications and patient compliance. Twenty male patients 48 to 71 years old (mean age 59.8 + 7.4 years) underwent radical cystectomy and Studer orthotopic ileal neobladder for invasive carcinoma of the bladder. Before surgery all patients filled in a phycometric test for evaluating their knowledge capacity; after surgery they underwent a course of biofeedback and instructed to avoid overfilling of the neobladder with timed micturitions and a regular regimen of fluid intake. Pressure flow study was included in the routine follow-up carried out at six months and then yearly. Seventeen patients (85%), with a good knowledge capacity, reported a good compliance to the modified life style imposed by the bladder substitute, they all were dry during the day with 3 to 5.5 hour interval between micturitions; fourteen of these patients were continent at night with timed micturitions every 3-4 hours (mean: 3.2); an average cystometric capacity of 450 ml was found in these patients with no residual urine; three patients (18%) had incontinence episodes once or twice a week during the night; no decompensation of the neobladder, significant ureteral reflux or dilatation were reported; elongation of the afferent loop was found in one patient following small bowel resection for ileal volvulus. Three patients (15%), with a reduced knowledge capacity, who did not follow the suggested life style: fluid intake was irregular, micturitions were not timed during both day and night time, had residual urine larger than 400 ml. and incontinence episodes requiring pads; nevertheless no dilation of the upper urinary tract was found. Our experience suggests that careful compliance of patients to the new life style imposed by the orthotopic neobladder is of importance to avoid its decompensation. The possible causative role of gastrointestinal hormones such as enteroglucagon (EG) and peptide tyrosine-tyrosine (PYY) in the elongation of the afferent limb of the Studer neobladder is proposed. In conclusion, we believe that orthotopic ileal neobladder is an ideal surgical option on in the young, educated and cooperative patients.

Aged↗
PubMed1997

Results of hospital cancer registry surveys by the American College of Surgeons: outcomes of prostate cancer treatment by radical prostatectomy.

BACKGROUND: The number of prostate cancer patients treated by radical prostatectomy has increased. Different data sources have yielded various estimates of the outcomes of this treatment and the need for additional therapy. To provide additional perspective on these issues, the American College of Surgeons conducted surveys of cancer registries and reviewed related data. METHODS: In 1993, in the first phase of the study, hospital cancer registries and programs were sent survey forms and instructions requesting data on up to 5 patients treated by radical prostatectomy at their institutions in 1990. In 1996, in the second phase of the study, additional data were requested on treatment administered to the 1990 patients up to 5 years after surgery, and hospitals were also invited to submit new data on patients diagnosed in 1993. Responses were received from 482 hospitals concerning 2122 patients for 1990, and 265 hospitals provided data on 1304 patients diagnosed in 1993. Follow-up data on 1076 of the 1990 patients were provided by 258 hospitals. Kaplan-Meier survival curves were calculated to determine the probability of additional treatment after radical prostatectomy. RESULTS: Similar surgical pathology outcomes were reported for the 1990 and 1993 patients. For 1990 and 1993, respectively, it was reported that 27.5% and 29.7% of patients maintained erectile function adequate for intercourse after surgery. For 1990 and 1993, respectively, complete control or only occasional urinary incontinence requiring no pads was reported for 81.3% and 79.8% of patients. The surgical mortality rates were less than 1% for both the 1990 and the 1993 patients. The 5-year cumulative probability of any additional treatment after radical prostatectomy was 10.5%. Seminal vesicle involvement, positive surgical margins, lymph node involvement, capsular penetration, high Gleason score, and high prostate specific antigen were significantly associated with greater probability of additional treatment. CONCLUSIONS: Hospital cancer registries are valuable sources of data on patterns of care and outcome for prostate cancer patients. Continuing evaluation of the outcomes of prostate cancer treatments is needed to reconcile the differences in outcomes reported from different data sources.

Erectile Dysfunction↗
PubMed2003

Prospective randomised controlled trial comparing laparoscopic and open colposuspension.

OBJECTIVE: To compare the efficacy, safety, complications, and short-term outcome of laparoscopic and open colposuspension in women with genuine stress incontinence. DESIGN: Randomised controlled trial. SETTING: Urogynaecology unit in a public hospital, Hong Kong. SUBJECTS AND METHODS: Ninety patients with urodynamically proven genuine stress incontinence. Forty-three patients were randomly allocated to receive open colposuspension and 47 to undergo laparoscopy. All patients had reassessment within 1 year of the operation. MAIN OUTCOME MEASURES: Objective and subjective measures and complication rates. RESULTS: There was no significant difference in the duration of stress incontinence, mean preoperative pad test results, or proportion with pre-existing detrusor instability. Among patients in the laparoscopic group, the mean operating time was significantly longer (42.0 minutes versus 29.3 minutes; P<0.0001), while the mean blood loss was significantly less (124.7 mL versus 326.9 mL; P=0.001). Subjective and objective success rates within 1 year were similar for patients in the open and laparoscopic groups (86.0% versus 80.9%; P=0.58, and 86.0% versus 85.1%; P=1.00, respectively). There was no significant difference in the rate of complications, including de novo detrusor instability and an obstructive voiding pattern, enterocele, or dyspareunia. CONCLUSION: Laparoscopic colposuspension is a feasible alternative to the open approach. The operating time is longer but the short-term cure rate is comparable with that of the open approach.

Female↗
PubMed1997

[Suburethral sling urethropexy: a vaginal approach].

Considering the poor long term results with the bladder neck suspensions, the poor results with the retropubic approach in obese or intrinsic sphincter deficiency and the complexity of the classical retropubic sling procedure, a simple vaginal sling urethropexy approach was developed. The vaginal mucosa is opened at 12 o'clock under the urethra. Dissection of the endopelvic fascia is undertaken. Polypropylene sutures are placed at the 4 corners of a free 2 x 4 cm rectus abdominis muscle flap which is suspended under the bladder neck transvaginally. Polypropylene sutures are tied at the rectus muscle through a 3 cm suprapubic incision. 25 patients were operated by one single surgeon. 7 had previous uretropexies. Previous hysterectomies: 8. Average age: 57. Average weight: 67.6. Severe stress incontinence was demonstrated in 23 patients. 9 patients had mixed incontinence. Average protective pads per day pre-op: 4.1. OR time: 93.8 min. Blood loss was minimal. 10 patients had transient post op retention (24 days average). 1 bladder perforation. 2 incisional hernias. 6 suprapubic wound infections. Average hospital stay: 5.95 days. The average follow up was 22 months. All patients were either cured (76%) or improved. 73% were satisfied (questionnaire). Despite a longer OR time, and the incidence of transient post op retention, this vaginal sling urethropexy approach is a simple and efficient procedure. It can be useful in previously operated or obese patients. It is easier to perform than the more conventional retropubic or combined (retropubic and vaginal) sling urethropexy.

Dissection↗
PubMed2004

A randomized crossover study to evaluate Ro 115-1240, a selective alpha1A/1L-adrenoceptor partial agonist in women with stress urinary incontinence.

OBJECTIVES: To investigate the potential therapeutic benefits of the selective alpha1A/1l-adrenoceptor partial agonist Ro 115-1240 in women with mild-to-moderate stress urinary incontinence (SUI). PATIENTS AND METHODS: Thirty-seven women with mild-to-moderate SUI were enrolled in a randomized, placebo-controlled crossover study. Patients received 1.5 mg Ro 115-1240 twice daily or matching placebo for 2 or 4 weeks. Voiding diaries were used to record the number of SUI episodes, urge incontinence episodes and pads used. Sitting blood pressures and heart rate were recorded at each visit. RESULTS: Ro 115-1240 was associated with a significantly lower mean weekly number of SUI episodes than placebo (8.4 vs 6.0; P= 0.0079), a 28% relative improvement over placebo. There was also a significantly lower mean number of pads used and wet pads changed/week with Ro 115-1240 than with placebo (P = 0.0055 and 0.0066, respectively). The most frequently reported treatment-emergent adverse events were scalp tingling, headache, chills, piloerection, and pruritus. Generally these events were transient and mild to moderate. There was a slightly lower mean sitting heart rate with Ro 115-1240 than with placebo, but no difference in mean systolic or diastolic blood pressure between treatments. CONCLUSIONS: This study suggests that selective alpha1A/1l-adrenoceptor partial agonists have the potential to improve the symptoms of SUI with little or no cardiovascular effect. These results are encouraging and a randomized controlled trial of Ro 115-1240 in a larger population with SUI is warranted to substantiate these findings.

Adolescent↗
PubMed2002

Fecal incontinence severity index after fistulotomy: a predictor of quality of life.

PURPOSE: The purpose of this study was to use the Fecal Incontinence Severity Index to assess fecal incontinence after fistulotomy and to correlate the Fecal Incontinence Severity Index score with quality-of-life measures. METHODS: A retrospective chart review was performed on consecutive patients undergoing fistulotomy by a single colon and rectal surgeon at a university hospital from 1991 to 1999. Demographics, fistula anatomy, surgical technique, and length of follow-up were recorded. Mailed questionnaires and telephone interviews were conducted to determine the Fecal Incontinence Severity Index score, pad usage, lifestyle restriction, and psychosocial factors. A linear regression model was used to determine the relationship of clinical factors with Fecal Incontinence Severity Index. One-way ANOVA was used to correlate Fecal Incontinence Severity Index with quality-of-life measures. RESULTS: Of 110 patients who underwent fistulotomy, 96 (88 percent) had complete follow-up. Mean age was 48 (range, 17-84) years, and 68 percent were male. Follow-up was less than two years in 26 percent, two to five years in 39 percent, and more than five years in 35 percent. Of these patients, 41 percent had intersphincteric fistulas, whereas 59 percent had transsphincteric fistulas. Median Fecal Incontinence Severity Index score was 6, with a mean of 13 (maximum Fecal Incontinence Severity Index = 61); 36 percent had a Fecal Incontinence Severity Index score of zero. Linear regression revealed that only the amount of external sphincter divided correlated with Fecal Incontinence Severity Index score (P = 0.05). Quality-of-life measures strongly correlated with Fecal Incontinence Severity Index by analysis of variance (P < 0.01 for pad usage, lifestyle restriction, depression, and embarrassment), with substantial quality-of-life drop-off documented with Fecal Incontinence Severity Index >30. CONCLUSION: The Fecal Incontinence Severity Index is an excellent tool to gauge quality of life after fistulotomy. Fecal Incontinence Severity Index scores >30 predict a detrimental effect on quality of life.

Adolescent↗
PubMedDate not supplied

An evaluation of the acceptability of incontinence aids used by 85-year-old men and women.

An evaluation of the acceptability of incontinence aids was performed in incontinent 85-year-old men and women (n = 355) resident in the city of Göteborg. Incontinence aids were used more often (P < 0.001) by incontinent women (67.9%) than men (42.9%) living in the community, and were used by 86.4% of the incontinent men and 91.5% of the incontinent women living in an institution. Pads were the commonest form of incontinence aid used, irrespective of whether the men (26.6%) and women (67.9%) lived in the community or in an institution (men, 59.1% and women, 86.2%). Urinary leakage and odour as a result of urinary incontinence limited daily life for many men (22.4% and 30.6%, respectively) and women (14.7% and 27.4%, respectively), and meant that 24% of the men and 18% of the women were dependent on another person. At the primary assessment 38.8% of the men and 26.8% of the women living at home were dissatisfied with their present form of incontinence aid. An individual assessment of the patients' requirements regarding incontinence aids was then performed by a urotherapist. Following intervention there was an increase in the number of men (61.2%, P < 0.01) and women (75.3%, P < 0.05) using incontinence aids. There was also an increase (P < 0.01) in the acceptability of the incontinence aids used as judged by the men (dissatisfied: before, 38.8%; after, 14.3%) and women (dissatisfied: before, 26.8%; after, 6.8%) living at home who were already using some form of incontinence aid at the primary assessment.

Journal Article↗
PubMed1984

Catheter-free geriatric care. Routines and consequences for clinical infection, care and economy.

In a geriatric hospital the routines of one ward were modified with the intention of removing indwelling catheters from all patients admitted to the ward. A continence training programme had been designed during the preceding 6 months. A total of 124 patients were admitted with indwelling catheters during a period of 18 months. It was possible to remove the catheters in 117 of these. Patients and their relatives reacted favourably to catheter-free care. The attitude of ward staff also was positive. The overall nursing requirements did not increase. Antibiotic prescription was 90 per cent less than in the control wards. This difference was accounted for not only by a reduction in drugs used against urinary tract infections, but also by a lower consumption of agents mainly used in the treatment of septicaemia, bronchopneumonia and wound infection. The cost of laundry and of hygiene and storage articles, including catheters, absorbing pads and other incontinence aids was 46 per cent of that in the control wards. Four years later, 65 per cent and 72 per cent of the patients from the test and control wards respectively, had died. Of the surviving patients from the test ward 78 per cent were still catheter-free.

Aged↗