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PubMed2002

Prevalence of urinary incontinence and associated risk factors in a cohort of nuns.

OBJECTIVE: To estimate the prevalence of urinary incontinence among a group of nulliparous nuns and to assess risk factors for developing incontinence. METHODS: Information on symptoms of urinary incontinence, as well as medical history and demographic data were obtained from 149 nuns. The prevalence of urinary incontinence was determined, and a logistic regression model was used to estimate the impact of demographic and medical risk factors on the likelihood of incontinence. RESULTS: The mean (+/- standard deviation) age of our sample of nuns was 68 (+/-11.7). All but one were white, 96% were postmenopausal, and 25% were taking hormone replacement therapy (HRT). Their mean body mass index (BMI) was 27.3 +/- 5.6. According to their self-reported symptoms, half the nuns had urinary incontinence. Of these, 22 nuns (30%) had stress incontinence, 18 (24%) had urge incontinence, 26 (35%) had mixed incontinence, and 8 (11%) had urine loss unrelated to stress and urge. More than half the incontinent nuns used sanitary pads for protection. From univariate analyses, statistically significant risk factors for urinary incontinence included BMI, current HRT use, multiple urinary tract infections, hypertension, arthritis, depression, hysterectomy, and previous spinal surgery. From multivariate logistic regression, only BMI, multiple urinary tract infections, and depression remained statistically significant after adjusting for the other variables. CONCLUSION: The prevalence of incontinence in nulliparous, predominantly postmenopausal nuns is similar to rates reported in parous, postmenopausal women. Even in the absence of pelvic floor trauma from childbirth, urine loss is associated with symptoms of stress incontinence more often than with symptoms of urge incontinence.

Adult↗
PubMed1990

The prevalence of urinary incontinence and use of incontinence aids in 85-year-old men and women.

The prevalence of urinary incontinence and the use of incontinence aids was investigated in 85-year-old men and women resident in the city of Göteborg. The overall prevalence of urinary incontinence was 37.2%. Urinary incontinence was more prevalent (p less than 0.001) in women (43.2%) than men (24.0%), and in residents of a nursing home or hospital (83.9%) than in men and women living at home (29.4%). Urinary incontinence was more commonly encountered in men with neurological (p less than 0.001) and respiratory (p less than 0.05) illnesses, and in women suffering from cardiovascular (p less than 0.05), neurological (p less than 0.001) and urogenital (p less than 0.01) illnesses. Incontinence aids were used more often (p less than 0.001) by incontinent women (67.9%) then 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 and women lived in the community or in an institution. Indwelling urinary catheters were used by only 2% of the 85-year-old men and women.

Aged↗
PubMed2001

[Retropubic radical prostatectomy with the use of ultrasonic cutting and coagulating system (AutoSonix System)].

We report our experience of using the ultrasonic coagulating and cutting device, AutoSonix System, which began in January 2000 to reduce the amount of bleeding in radical retropubic prostatectomy. The mean age of the 24 prostate cancer patients operated on was 68.2 years old. The operation results were excellent; the mean operation time was 227 +/- 29 minutes (mean +/- standard deviation), and the mean amount of blood loss during the operation was 215 +/- 114 ml. There were no major complications. After three months or more of follow-up, no patients needed any pads for urinary incontinence. Only one case showed a stricture at cystourethral anastomosis. AutoSonix System was useful to reduce the blood loss from the venous plexus in the pelvic cavity. We believe that radical prostatectomy would be safer if this device would be used by the urologist.

Aged↗
PubMed2006

[Our results with radical retropubic prostatectomy in the first hundred patients].

INTRODUCTION: The most used treatment of localised prostate cancer is: retropubic radical prostatectomy. OBJECTIVE: The authors present their own results, on the basis of detailed discussions of 100 cases and compare them with international ones. METHODOLOGY: The authors analyse the data of 100 radically operated patients suffering of localised prostate cancer. The indication of the operations was based on the results of rectal digital examinations, serum PSA concentration levels and ultrasound guided, rectally performed, prostate biopsies. The average preoperative PSA level was 13.6 ng/ml; the mean age of the patients was 61.1 years. They analyse the early and late complications. They follow up the patients on a regular basis assessing the PSA level, continence and potency. RESULTS: The operation time, blood loss, amount of blood transfusion all decreased linearly during operations performed between 1998 and 2005. The longest period of follow up lasted for 70 months; the shortest lasted for 5 months. None of the patients died in the course of an operation or in 30 days following it; they lost one patient 18 months after the operation because of progression. From the late complications: in 22% of all cases they noticed anastomotic stricture constrictions which were resolved by urethrotomy. From all patients: 86% are fully continent; the rest mostly have grade 1 incontinence (requiring 1 pad per day). Altogether 18% of all patients have retained their potency without the use of drugs or appliances. CONCLUSIONS: The results are comparable to international data and are in harmony with them. Therefore early recognition and radical surgery of prostate tumors would be advisable.

Aged↗
PubMed2004

High rate of vaginal extrusion of silicone-coated polyester sling.

OBJECTIVES: To report the results of a pilot study evaluating the suitability of silicone-coated polyester as a suburethral sling material for female stress incontinence surgery. METHODS: Ten women with stress or mixed urinary incontinence were prospectively evaluated with history and physical examination, pad test, urodynamic studies, and the Incontinence-Quality of Life questionnaire. The 2 x 7-cm sling was secured with transvaginal bone anchors placed through an anterior vaginal wall incision. Patients were evaluated at 1, 6, and 12 months by history and physical examination, pad test, and the Incontinence-Quality of Life and Success Rate and Overall Patient Satisfaction questionnaires. RESULTS: Ten patients (mean age 62.3 years) underwent successful placement of the suburethral sling. The Incontinence-Quality of Life scores improved from a mean total score of 43.3 +/- 14.6 preoperatively to 97.7 +/- 14.4 at 1 year postoperatively (P <0.001). The Success Rate and Overall Patient Satisfaction questionnaires completed at 1 year demonstrated a mean satisfaction rating of 8.9 +/- 1.7 (scale 1 to 10), and the mean reported improvement in incontinence was 90% +/- 16.3%. The mean pad weight decreased from 103.1 +/- 33.2 g preoperatively to 1.6 +/- 1.01 g at 1 year (P <0.007). Two patients (20%) developed vaginal extrusion of the suburethral sling at 6 and 10 months. The slings were removed surgically. Both women healed without incident and reported continued continence at 1 year without additional surgical intervention. CONCLUSIONS: Placement of a suburethral sling using transvaginal bone anchors and silicone-coated polyester is an effective surgical treatment for stress urinary incontinence at 1 year. The high rate of vaginal extrusion in our series limits its utility.

Coated Materials, Biocompatible↗
PubMed1996

Detection of urinary incontinence during ambulatory monitoring of bladder function by a temperature-sensitive device.

OBJECTIVES: To determine whether the difference between urinary and perineal temperatures is sufficient to allow registration of incontinent episodes by detection of temperature change alone. To design and assess the use of a diode-based temperature-sensitive device in the detection of episodes of urinary incontinence in long-term ambulatory monitoring (LTAM) studies. SUBJECTS AND METHODS: Perineal temperature recordings were made in 46 women during various activities. A temperature-sensitive device consisting of six IN4148 diodes, spanning 5 cm, and a nearby reference negative diode, was placed in a light perineal pad and attached to a portable amplifier/digitizer and recorder. The performance of the device was determined by comparison with increases in pad weight in 51 incontinent and 23 continent control subjects. RESULTS: A sufficient temperature differential existed between perineal and urinary temperature during all activities except being seated with crossed legs. Incontinence was reliably detected by the temperature-sensitive device. The device had a sensitivity of 95.2% and a specificity of 90.6% compared to a pad test. CONCLUSIONS: This temperature-sensitive device offers a new method for detecting urinary incontinence during LTAM studies. It can be fitted in an unobtrusive perineal pad and has a higher sensitivity and specificity for the detection of incontinence when compared to a pad test. It may also be used as a marker of voiding in ambulatory studies not employing an integrated voiding channel.

Female↗
PubMed2004

Comparison of the ICIQ-SF and 24-hour pad test with other measures for evaluating the severity of urodynamic stress incontinence.

This study compared the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) and the 24-h pad test with other measures that assess severity of urinary loss in women with urodynamic stress incontinence (USI). Ninety-five women with primary or recurrent (secondary) USI were recruited. Assessment of the severity of urinary loss was made using the ICIQ-SF, a 24-h pad test, continence questionnaire, Stamey grade, and 3-day frequency volume diary. The relationship between these measures of incontinence severity was analysed. The mean age was 54 years (SD+/-12) and median parity 2 (IQR 1-3). In the primary USI group there was a strong correlation between the ICIQ-SF and the 24-h pad test (r=0.458, P =0.000). Both the ICIQ-SF (Kendall's' tau b=0.331, p =0.003) and 24-h pad test (Kendall's tau b=0.399, p =0.002) also correlated with the mean frequency of urinary loss on diary but not with the Stamey grade. No subjective or objective tests correlated with each other in women with secondary USI. These results demonstrate a good correlation between the 24-h pad test diary loss, and ICIQ-SF in women with primary USI. Because it also includes a measure of quality of life impact in a short user-friendly format, we suggest that the ICIQ-SF should have widespread applicability as an outcome measure in patients with stress incontinence.

Adult↗
PubMed1999

The external urethral barrier for stress incontinence: a multicenter trial of safety and efficacy. Miniguard Investigators Group.

OBJECTIVE: To assess the efficacy and safety of an external urethral barrier for the management of mild to moderate stress urinary incontinence in adult women. METHODS: Four hundred eleven women with the symptom of stress urinary incontinence in 12 United States centers participated. Additional inclusion and exclusion criteria were applied before protocol device use, and ultimately 390 subjects began device use. Outcome measures for efficacy and safety were assessed. Efficacy was evaluated by the number of leakage episodes using a voiding diary, subjective urinary leakage severity, incontinence impact scores, and pad testing. Safety was evaluated by symptom assessment, urinalysis, urine culture, measurement of postvoid residual urine volume, vulvar cytology, vaginal culture, and (n = 81) cystometric testing. RESULTS: Efficacy was indicated by statistically significant reductions in the number of leakage episodes, subjective leakage severity scores, incontinence impact scores, and pad-test loss during device use. The data also indicated that the device was safe, as evidenced by the lack of statistically significant changes in the percentage of subjects with urinary tract infections during device use or in postvoid residual urine volume and cystometric indices. Symptoms of vulvar irritation or lower urinary tract discomfort occurred in a small percentage of subjects but were generally transient, and only three women discontinued using the device. CONCLUSION: The external urethral barrier appears to be a safe nonsurgical alternative to absorbent products for the management of mild to moderate stress urinary incontinence in adult women.

Adolescent↗
PubMed2004

Reliability, validity, and gender differences in the quality of life index of the SEAPI-QMM incontinence classification system.

PURPOSE: To evaluate reliability and validity of the SEAPI-QMM 15-item quality of life index and assess differences between male and female patients with urinary incontinence. MATERIALS AND METHODS: Twice pre- and once post-treatment, 315 patients (102 men, 213 women) with incontinence and 35 without incontinence completed the self-directed SEAPI-QMM quality of life index. A voiding diary reported frequency of incontinence episodes with number of pads or type of protection used daily for incontinence. In 30%, the Nottingham Health Profile (NHP) was administered to further validate the measure. RESULTS: Cronbach's alpha coefficient for the index was 0.91. Domain-specific alpha coefficients ranged from 0.88 to 0.73. Test-retest reliability scores at 5 days gave a reliability coefficient of 0.93. Split half reliability was 0.89. Correlation of the index with the NHP was 0.78 for women, 0.72 for men. Mean scores before and after treatment with medical or surgical management were significantly different in both genders and were sensitive to the presence or absence of use of protection and the type of protection chosen in men. Men with incontinence (61%) reported a high level of impact in the sexuality domain compared to 7% of women. CONCLUSIONS: The SEAPI quality of life index has a high degree of reliability relating to stability and internal consistency across a wide age range in both genders. There are differences between men and women in life domains most frequently affected by urinary incontinence.

Adult↗
PubMed2004

Is physical activity influenced by urinary incontinence?

OBJECTIVE: To evaluate physical activity among urinary incontinent women seeking treatment and to assess the change of physical activity after treatment. DESIGN: Part of a prospective observational intervention study to examine the factors influencing the severity of urinary incontinence. SETTING: Tampere University Hospital-referral unit. POPULATION: Eighty-two urinary incontinent women were evaluated in the baseline and 69 (84%) one year (mean 13 months, range 6-21) after treatment. METHODS: Physical activity was measured by self-report questionnaire and electronic motion sensor: Caltrac accelerometer worn by women for one week. The diagnosis and severity of urinary incontinence was estimated on the basis of urodynamics, pad test, diary and incontinence-specific quality of life measures. Treatment outcome was assessed according to objective parameters and patients satisfaction. MAIN OUTCOME MEASURES: Physical activity at work, leisure and sport expressed in MET (metabolic unit) and kilocalories, change in physical activity after treatment. RESULTS: Twenty-one (25.6%) of all women reported exercise of more than three times per week. Incontinent women with the highest leisure time activity > or =6 MET (n= 23, above 75th centile) were younger; they had less body mass index and greater urine leakage than others. One year after treatment, there was no change in any parameters of physical activities. Also exercise habits among women who were completely dry (n= 37) after treatment were not changed. CONCLUSION: Urinary incontinent women who seek treatment are as physically active as the normal population. Even after successful incontinence treatment, exercise habits do not change.

Adult↗
PubMed1999

[Evaluation of new intraurethral occlusive depot (ORIS FEMININO) in the management of female stress urinary incontinence].

OBJECTIVE: To determine the utility and safety of an intraurethral device (Oris Femenino) in the management of female stress urinary incontinence. METHODS: A prospective clinical study was conducted on 54 female patients, mean age 46.4 years, with stress urinary incontinence. The degree and severity of the incontinence was determined before and one month after treatment with the intraurethral device. The reasons for the dropouts were analyzed and the rehabilitative effects two months after treatment had been completed were evaluated in 22 patients. RESULTS: 83% of the patients who completed the study referred positive results. A significant improvement was demonstrated for the degree of incontinence as well as the number of absorbent pads used. Age and severity of incontinence inversely correlated with positive results. A correlation between the absence of a previous urethropexy and positive results was also found. The dropout rate was 44% (24 patients) and was chiefly due to symptomatic bacteriuria in 14 cases and the difficulty in fixation and degree of incontinence. A statistically significant reduction was found in the number of pads used in the group of patients evaluated two months after treatment had been completed. CONCLUSIONS: The intraurethral device analyzed in this study significantly reduced urinary incontinence. This method appears to be more effective in younger women who are not severely incontinent and have not previously undergone urethropexy. The intraurethral device appears to have some rehabilitative effect on the perineal muscle. Symptomatic bacteriuria was found to be the main disadvantage.

Female↗
PubMed1999

Correlation of persistent stress urinary incontinence with quality of life after suspension procedures: is continence the only decisive postoperative criterion of success?

OBJECTIVES: To determine objective continence rates and to include in the evaluation subjective assessment of continence and quality of life by the affected patients and correlate these with the objective continence rates in a retrospective study. METHODS: One hundred thirty-three female patients in our clinic underwent suspension procedures for stress urinary incontinence, 68 undergoing a Burch colposuspension and 65 a Raz bladder neck suspension. The continence rate was evaluated by questionnaire and compared with patients' postoperative self-assessment of continence and pre- and postoperative quality of life assessments. RESULTS: For the 105 women returning evaluable questionnaires (57 Burch and 48 Raz procedure), the continence rate was 69.5% (75.4% in the Burch group, 60.4% in the Raz group). Mild incontinence requiring 1 to 2 sanitary pads daily was found in 19.3% of the Burch group and 31.3% of the Raz group. Moderate incontinence requiring 3 to 5 pads daily was found in 5.3% of the Burch and 8.3% of the Raz group. No patients had severe incontinence (more than 5 pads daily). Both groups showed statistically significant improvement in postoperative quality of life. Despite persistent incontinence, the satisfaction rate was comparable to that of continent patients. CONCLUSIONS: The results show that in addition to objective parameters, subjective assessment of quality of life is a factor that should be included in the postoperative evaluation of surgical results.

Adult↗
PubMed1997

Prospective assessment of incontinence after radical retropubic prostatectomy: objective and subjective analysis.

OBJECTIVES: To assess prospectively-using pad test and questionnaire-the rate and degree of incontinence after radical retropubic prostatectomy, to analyze factors that may predispose individuals to postoperative incontinence, and to assess the impact of incontinence on patient lifestyle. METHODS: Fifty-one consecutive patients were assessed at 3-month intervals for 1 year after radical retropubic prostatectomy. Patients were objectively assessed using a 1-hour pad test and subjectively assessed by questionnaire. Incontinence was graded objectively according to the change in weight of the pad at 1 hour and subjectively by the number of pads used per day. Lifestyle modifications were assessed by questionnaire at 12 months. A number of variable factors were studied to assess risk factors for postoperative incontinence. RESULTS: Continence continued to improve up to 12 months. At 12 months, pad testing revealed 84% of patients were dry, 6% were mildly incontinent. 6% were moderately incontinent, and 4% were severely incontinent. Questionnaire assessment revealed 80% wore no pad, 14% had mild incontinence, 4% had moderate incontinence, and 2% had severe incontinence. Pad testing was not as sensitive as the questionnaire for the detection of minimal incontinence but was more reliable for moderate and severe levels. Patients made lifestyle changes proportional to the level of incontinence. No predisposing factor was identified for the development of incontinence after radical retropubic prostatectomy. CONCLUSIONS: Significant incontinence after radical prostatectomy occurs in as many as 10% of patients. Pad testing provides an inexpensive and simple form of objective assessment in patients with bothersome incontinence and allows documentation of improvement over time.

Aged↗
PubMed2000

The development and evaluation of an incontinence screening questionnaire for female primary care.

Although there is a high prevalence of leaking urine among Australian women, there are currently no standardized procedures for screening patients for incontinence in the primary care setting (known in Australia as general practice). In response to this, an incontinence screening questionnaire (ISQ) was developed and evaluated for use in general practice. Eighty-nine women completed an original compilation of 33 items that asked about situations associated with leaking urine, avoidance of leakage, and concern about leakage. Each item was assessed according to its acceptability for the population of female general practice patients, discriminative value, and test-retest reliability. These patients also underwent an objective test of incontinence, the 48-hour pad test, so that the screening items could be validated against an objective classification of incontinence. The study included women who had bladder control problems and those who did not. Eight items on the ISQ were shown to be acceptable to patients, discriminative, reliable, and valid indicators of objective incontinence. Five items were capable of predicting almost 70% of patients who showed objective leakage of urine and misclassified fewer than 15% of these patients. Those five items were selected for inclusion in the (refined) ISQ.

Adaptation, Psychological↗
PubMed1999

[Satisfactory long-term results with a sphincter prosthesis in patients with urinary incontinence due to an intrinsic urinary sphincter deficiency: evaluation of 86 patients].

OBJECTIVE: Evaluation of the results of treatment with an artificial urinary sphincter in 86 patients with urinary incontinence due to intrinsic sphincter deficiency. DESIGN: Retrospective. METHODS: In the period 1982-1997 an artificial urinary sphincter (American Medical Systems, Minnetonka, Minnesota, USA) was inserted in the Academic Hospital Rotterdam-Dijkzigt, Department of Urology, the Netherlands, in 86 patients (15 women and 71 men) aged 8-84 years. All patients suffered from urinary incontinence due to intrinsic sphincter deficiency. A 'good' result was defined as being completely dry or using a maximum of one pad per day. During follow-up visits, the pad counts were registered and the pumping characteristics of the prosthesis were checked. In case of deterioration of the continence status a re-evaluation was started using imaging modalities and urodynamic studies. RESULTS: After an average follow-up of 41 months 76% of the patients were either completely dry or used a maximum of one incontinence pad per day. Urinary continence had markedly improved in another 7% of the patients. One or more reoperations due to mechanical or non-mechanical problems with the prosthesis had to be performed in 37 patients (43%). CONCLUSION: The artificial urinary sphincter can give excellent results as far as urinary continence is concerned, if the price of a relatively large number of revisions is accepted, in a population of patients to whom, in most cases, no other treatment options apply.

Adolescent↗
PubMed2000

Percutaneous needle bladder neck suspension for the treatment of stress urinary incontinence in women: long-term results.

PURPOSE: We evaluated the long-term results of percutaneous needle suspension using bone anchor devices for treating stress urinary incontinence in women. MATERIALS AND METHODS: We retrospectively evaluated the long-term results of percutaneous bladder neck needle suspension performed at our institution. None of the women had undergone any anti-incontinence surgery before percutaneous needle suspension. A telephone survey was done for all available patients. Subjective cure was defined as no evidence of incontinence, significant improvement as 0 to 1 protective pad soaked daily and patient satisfaction with incontinence level, and failure as more than 1 pad used daily, lack of patient satisfaction or a secondary procedure required to treat stress urinary incontinence. In cases considered failures a detailed video urodynamic study was performed when possible before any secondary procedure. RESULTS: In 1996 and 1997, 49 patients underwent percutaneous needle bladder neck suspension with bone anchors, of whom 42 (86%) were available for telephone interview. Mean patient age was 57 years (range 31 to 77) and mean followup was 29 months (range 16 to 52). As defined, subjective outcome in the 42 women was cure in 2 (5%), significant improvement in 5 (12%) and failure in 35 (83%). Of the 35 patients with treatment failure who did not undergo a secondary procedure 25 were asked to present for video urodynamics and 18 were evaluated. Urodynamics revealed demonstrable urinary incontinence, urethral hypermobility in 16 (88%), intrinsic sphincter deficiency in 1 (6%) and detrusor instability in 1 (6%). In 2 cases x-ray revealed that a bone anchor had dislodged and migrated into the pelvis. Serious osteomyelitis at the bone anchor site in 1 case required surgical débridement and 6 weeks of intravenous antibiotics. CONCLUSIONS: Percutaneous needle suspension is associated with poor long-term results in women with stress urinary incontinence. Other procedures should be considered.

Adult↗
PubMed1999

A bladder-neck support prosthesis for women with stress and mixed incontinence.

OBJECTIVE: To evaluate the safety and efficacy of a bladder-neck support prosthesis, a vaginal device designed to support the bladder neck, in women with genuine stress and mixed incontinence. METHODS: For enrollment, incontinent women underwent a history, physical examination including cotton-swab test, urinalysis, postvoid residual urine, and multichannel urodynamic testing. Those with genuine stress incontinence or mixed incontinence and urethral hypermobility completed 7-day bladder diaries, the Incontinence Impact Questionnaire, and underwent standardized pad tests. They were fitted with a prosthesis and seen weekly to optimize fit and efficacy. At week 5, they underwent repeat evaluations with the best-fitting prosthesis in place. RESULTS: Seventy women were enrolled and 53 completed the 1-month study (29 genuine stress incontinence, 24 mixed incontinence). The mean ages were 50.4 years for genuine stress incontinence (range 24-76) and 55.7 years for mixed incontinence (range 30-88). A statistically significant reduction in incontinence was noted on pad testing (genuine stress incontinence, mean 46.6-16.6 g; mixed incontinence, mean 31.9-6.8 g) and in the bladder diary (genuine stress incontinence, mean 28.6-7.8 losses per week; mixed incontinence, mean 30.2-15 losses per week). Quality-of-life scores improved in both groups. With the device in place, urodynamic testing indicated normalization of urethral function without evidence of outflow obstruction. Subjects found the device comfortable, easy to use, and convenient. Side effects included five urinary tract infections and 23 cases of vaginal mucosal soreness or mild irritation. CONCLUSION: The bladder-neck support prosthesis significantly reduced involuntary urine loss in women with stress and mixed incontinence.

Adult↗
PubMed2004

The repeatability of the 24-hour pad test.

A prospective observational study was conducted in a tertiary urogynaecology unit in women with the primary symptom of urinary incontinence to assess the repeatability of the 24-hour pad test. One hundred and eight women undertook seven 24-hour pad tests over 7 consecutive days together with 7 simultaneous fluid and activity charts. The results were analysed collectively and according to urodynamic subsets. Repeatability was assessed by repeated measures analysis of variance and univariate analysis of variance for each urodynamic diagnosis group (USI, mixed and no USI). Variation between pad test weights over the 7 days was low, supporting good repeatability. The number of days of pad testing required to approximate the 7-day average was 3 days. However, a single 24-hour pad test correlated highly with the 7-day average (r=0.881) and was considered sufficient to gauge leakage severity.

Aged↗