Disposable body-worn pads for incontinence.
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Anthropometry↗
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Urinary incontinence in prostate cancer patients treated with external beam radiotherapy.
BACKGROUND AND PURPOSE: To describe the incidence of urinary incontinence among prostate cancer patients treated with external beam radiotherapy (RT) and to investigate associated risk factors. PATIENTS AND METHODS: One thousand and hundred ninety-two patients with >or=24 months follow-up were the subjects of this series. All patients received between 50 and 72 Gy in 20-37 fractions (median 66 Gy/33#). Post-RT urinary incontinence was scored by direct patient interviewing according to the modified RTOG/SOMA scale: Grade 1--occasional use of incontinence pads, Grade 2--intermittent use of incontinence pads, Grade 3--persistent use of incontinence pads, and Grade 4--permanent catheter. Risk-factors investigated were: age, diabetes, TURP prior to RT, elapsed time from TURP to RT, clinical stage, RT dose and presence of Grade >or=2 acute GU and GI toxicity. Non-parametric, actuarial univariated (Kaplan-Meier) and multivariated tests (MVA, Cox regression) were performed. RESULTS: Median follow-up for the group is 52 months (24-109). Thirty-four patients (2.9%) had incontinence prior to RT, which was more common in TURP patients (7.8% vs 1.6% P<0.001). These are excluded from further analysis. Fifty-seven patients (4.9%) developed Grade 1 incontinence, 7 (0.6%) Grade 2, and 7 (0.6%) Grade 3. There was no Grade 4 incontinence. Actuarial rates for Grade >or=1 and >or=2 incontinence at 5 years are 7 and 1.7%, respectively. Risk factors on MVA associated with the development of Grade 1 or worse incontinence are pre-RT TURP (5-year rates 10% vs 6%, P=0.026), presence of Grade >or=2 acute GU toxicity (5-year rates 11% vs 5%, P=0.002). Age, diabetes, clinical stage, elapsed time from TURP to RT, RT dose or fraction size, acute GI toxicity were not significant. Patients who underwent post-RT TURP or dilatation for obstructive symptoms (4.3%), were more likely to develop Grade 2-3 incontinence (5-year rate 8 vs 1.5%, P=0.0015). CONCLUSIONS: Grade 2 or greater urinary incontinence is rare among patients who have been treated with external beam radiotherapy. Associated risk factors are pre-RT TURP and the presence of increased acute GU toxicity. Post-radiaton TURP increases the risk of incontinence five-fold.
Acute Disease↗
The epidemiology of pad consumption among community-dwelling incontinent women.
The aim of the study was to explore the use of incontinence pads among community-dwelling women in a well-defined area of western Norway (total female population 122,516). In Norway incontinence aids are prescribed by doctors and paid for by the national insurance. Data were collected at local insurance offices and through interviews with an age-stratified (20-89 years) random sample of incontinent women. Identified were 2,991 pad users (1-year period prevalence 2.4%). Prevalence rose sharply with advancing age, reaching a maximum of 30.1% in the 90+ age group. Median number of pads used per day was 1.8. Middle-aged women used fewer and smaller pads than the rest. When compared with the number of pads actually delivered, the incontinent women tended to overestimate their consumption.
Adult↗
No relationship between subjective assessment of urinary incontinence and pad test weight gain in a random population sample of menopausal women.
PURPOSE: We studied the association between urinary incontinence and pad weight gain during a 24-hour pad test in healthy menopausal women. MATERIALS AND METHODS: Menopausal women 45 to 58 years old were randomly sampled from the national register. Information on self-reported urinary incontinence was collected at patient interview using a structured questionnaire. A 24-hour home pad test was performed and episodes of urinary incontinence during the pad test were noted. RESULTS: A total of 144 women 45 to 57 years old (mean age 50) were included in the study. At the interview 99 subjects (69%) reported urinary continence and 45 (31%) reported incontinence. Of the continence group 78 women (80%) performed the pad test and the mean weight gain was 3.1 gm. (range 0 to 9). Of the incontinence group 38 women (84%) performed the pad test and the mean weight gain was 3.3 gm. (range 0 to 8, not significant). Of the 38 women in the incontinence group 16 reported 1 or more episodes of urinary incontinence, whereas the remaining 22 reported no incontinence during the pad test. There was no difference in pad weight gain between these 2 groups (mean gain 3.3 gm., range 0 to 8). CONCLUSIONS: The subjective assessment of urinary incontinence was frequent but it was not associated with the objective findings of the 24-hour pad test.
Aged↗
[Update of the morbidity of radical retropubic prostatectomy: retrospective analysis of 100 consecutive operations during the period 1996-1997].
OBJECTIVE: To retrospectively evaluate the morbidity of radical prostatectomy, with the exception of sexual complications, based on a recent single-centre series. MATERIAL AND METHOD: From January 1996 to January 1998, the morbidity of 100 consecutive patients undergoing radical retropubic prostatectomy was compared to the morbidity of the first 150 patients operated by the same technique in our department for the period 1983-1993. The perioperative morbidity was studied retrospectively on case files, while continence was evaluated in the last 50 patients by a self-administered questionnaire. Sexual complications could not be evaluated objectively for methodological reasons and were not addressed in this study. RESULTS: The single operative complication was a rectal injury (1%). The transfusion rate was 31%. The early complication rate was 23% with a major complication rate of 5% (four thromboembolic complications and one gastrointestinal haemorrhage). The most frequent minor complications (18%) were wound abscess (5%). The reoperation rate was 3%. The mean duration of vesical catheterization was 7 days (range: 4-30) and the mean hospital stay was 8 days (range: 5-30). With a mean follow-up of 14 months, 73% of patients are perfectly continent, with no incontinence pads, while 15% of the patients required incontinence pads "as a precaution". Incontinence required implantation of an artificial sphincter in 2 patients (2%). Only one patient developed stenosis of the anastomosis requiring internal urethrotomy. The reduction of morbidity in these 100 recently operated patients compared to the first 150 operated patients concerned the transfusion rate (31% versus 65%), the reoperation rate (3% versus 8%) and the minor complication rate (18% versus 32%). The reduction of operative morbidity partly explains the reduction of mean duration of vesical catheterization (7 days versus 15 days), and hospital stay (8 days versus 18 days); the anastomotic stenosis rate was also decreased from 17.3% to 1%. CONCLUSION: This study confirms the reduction of overall morbidity of retropubic radical prostatectomy. This improvement is probably multifactorial: increased operative experience and better postoperative management. These retrospective data must be taken into account in the diagnostic and therapeutic decisions concerning localized prostate cancer.
Aged↗
A hospital study of a new absorbent bed pad for incontinent patients.
The benefits of a unique washable and reusable absorbent bed pad (Kylie) present significant advantages over drawsheets. In a crossover study on incontinent geriatric patients, those on the new bed pads required less than half the bed changes needed by patients who were lying on drawsheets. The patients benefited by having longer periods when their skin was dry, so that the incidence of erythema was reduced. The new bed pads also demonstrated other advantages, such as less wrinkling and creasing and a reduction in the level of odour, which resulted in patients being more restful. The subsequent need for less linen meant a reduced workload for nurses and cost savings to hospitals and laundries. This bed pad represents a significant advance in the management of incontinent patients.
Absorption↗
Health related quality of life significance of single pad urinary incontinence following radical prostatectomy.
PURPOSE: Continence outcomes after radical prostatectomy are frequently reported as the proportion of men using 1 urinary pad or less daily. We postulated that under appreciated health related quality of life (HRQOL) differences may exist between patients requiring 1 pad daily and those who do not require pads. MATERIALS AND METHODS: A total of 168 patients who underwent radical prostatectomy performed by a single surgeon in a 2-year period were surveyed at a mean of 75 +/- 30 weeks postoperatively using the urinary function and bother scales of the University of California-Los Angeles Prostate Cancer Index (PCI), the American Urological Association symptom index and a question assessing satisfaction. To establish patient groups the levels of the PCI question assessing pad use were redefined to 0, 1, or 2 or greater pads daily. The remaining 4 urinary function questions were used to calculate the summary function score. RESULTS: Of the patients 146 (86.9%) reported no pad use and 20 (11.9%) used 1 pad daily. The mean function score +/-SD was 81.7 +/- 19.5 and 51.5 +/- 26.5 for the no and 1 pad groups, respectively (p <0.0001). The mean bother score was 86.8 +/- 18.8 and 54.2 +/- 30.0 (p <0.0001). There were sharp differences between the 2 groups for each of the individual PCI questions and for the satisfaction question but no differences in American Urological Association symptom index scores. CONCLUSIONS: We noted significant differences in urinary HRQOL between patients who do not require urinary pads after surgery and those who use a single pad daily across several domains of urinary function and bother. We believe that these findings underscore the need for more comprehensive HRQOL assessment in urinary outcome assessment after prostatectomy.
Humans↗
A system for logging incontinence events using a simple disposable sensor.
Many elderly people entering residential or nursing care are already incontinent to some degree, relying on incontinence pads to deal with the consequences. A proportion of these people have been shown to exhibit a regular pattern in their incontinence, which opens up the possibility of mitigating the problem by instituting an individual toileting regime for the person. This can reduce their reliance on incontinence pads, both improving their quality of life, and reducing the cost of care. This paper covers the development and evaluation of a sensor for detecting incontinence events, suitable for use in this setting, and describes the design of an associated electronic logger. The devices form part of an assessment system intended to identify a pattern in incontinence where it exists, and to help with the design of the toilet regime for an individual. The requirement is that the system must reliably record incontinence events, and present the information describing them in a manner appropriate to the users of the devices, who are likely to be non-technical and non-specialist.
Analog-Digital Conversion↗
Significance of fibrosis around and/or at external urinary sphincter on pelvic magnetic resonance imaging in patients with postprostatectomy incontinence.
OBJECTIVES: To determine the clinical importance of fibrosis on pelvic magnetic resonance imaging in patients with postprostatectomy incontinence (PPI) due to sphincteric incompetence. METHODS: Urethral and periurethral fibrosis was determined by pelvic magnetic resonance imaging in patients who did (n = 22) or did not (n = 14) have urinary incontinence after transurethral resection, transvesical prostatectomy, or radical retropubic prostatectomy. The relation between fibrosis and the duration of incontinence, pad weight, symptom score, cystoscopy findings, and urodynamic findings was examined. RESULTS: Fibrosis was seen in all patients (22 of 22) in the study group and in 4 of 14 patients in the control group (P <0.001). All the patients with severe fibrosis had undergone radical retropubic prostatectomy (P <0.001). Similar to the etiology for incontinence, no relation was found between the severity of fibrosis and the duration of incontinence, pad weight, symptom score, cystoscopy findings, or urodynamic findings. However, the duration of incontinence was shorter in patients with mild fibrosis, clinically. CONCLUSIONS: The results of our study have shown that the incidence of fibrosis is much greater in patients with PPI than in patients without PPI. Consequently, we believe that fibrosis plays an important role in the development of PPI because it may have a negative effect on external urethral sphincter function.
Aged↗
An open-label pilot study of cannabis-based extracts for bladder dysfunction in advanced multiple sclerosis.
The majority of patients with multiple sclerosis (MS) develop troublesome lower urinary tract symptoms (LUTS). Anecdotal reports suggest that cannabis may alleviate LUTS, and cannabinoid receptors in the bladder and nervous system are potential pharmacological targets. In an open trial we evaluated the safety, tolerability, dose range, and efficacy of two whole-plant extracts of Cannabis sativa in patients with advanced MS and refractory LUTS. Patients took extracts containing delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD; 2.5 mg of each per spray) for eight weeks followed by THC-only (2.5 mg THC per spray) for a further eight weeks, and then into a long-term extension. Assessments included urinary frequency and volume charts, incontinence pad weights, cystometry and visual analogue scales for secondary troublesome symptoms. Twenty-one patients were recruited and data from 15 were evaluated. Urinary urgency, the number and volume of incontinence episodes, frequency and nocturia all decreased significantly following treatment (P <0.05, Wilcoxon's signed rank test). However, daily total voided, catheterized and urinary incontinence pad weights also decreased significantly on both extracts. Patient self-assessment of pain, spasticity and quality of sleep improved significantly (P <0.05, Wilcoxon's signed rank test) with pain improvement continuing up to median of 35 weeks. There were few troublesome side effects, suggesting that cannabis-based medicinal extracts are a safe and effective treatment for urinary and other problems in patients with advanced MS.
Adult↗
[Limited efficacy of permanent injectable agents in the treatment of stress urinary incontinence after radical prostatectomy].
OBJECTIVES: There is not enough evidence about efficacy in the treatment of stress urinary incontinence (SUI) after radical prostatectomy (RP). The objective of this paper is to describe our experience with the injection of pyrolytic carbon microspheres (Durasphere) in the treatment of SUI after RP METHODS: Between January and October 2003 8 patients with the diagnosis of SUI after RP underwent treatment. Analyzed variables included age, time from RP to treatment, number of incontinence pads per day, operative report, subjective and objective response to treatment, and clinical-surgical outcomes. RESULTS: Mean age was 63.2 years (50-71). Median time from radical prostatectomy to injection was 25 months (14-134). No patient suffered urinary incontinence before radical prostatectomy. Median number of incontinence pads required before treatment with Durasphere injection was 2 per day (1-6). Mean Durasphere volume injected was 23.8 ml (15-30 ml). No patient achieved subjective or objective cure after treatment. After a median follow-up of 5 months (9.9-12.5) 5 patients (62.5%) chose to undergo a second more invasive treatment to solve their incontinence. CONCLUSIONS: The use of Durasphere as a permanent injectable agent did not result effective in the treatment of mild to moderate SUI after RP in our patients.
Adenocarcinoma↗
Pad tests in children with incontinence.
Different pad tests were compared in 50 incontinent children. In a 2-hour ward test with standardized activities and fluid provocation 70% were positive. In a simple 12-hour home test with 30 children 68% were positive; when a fluid provocation period was included in the home test with 20 children the frequency increased to 80%. Pad tests are easy to perform with children in the home and are valuable as screening instruments. Further, the simultaneous registration of events gives a more complete picture of the incontinence pattern.
Adolescent↗
Urinary tract infections. Does the smell really tell?
Asymptomatic bacteriuria is considered a transient and benign condition in the geriatric population. Before a diagnosis of a urinary tract infection (UTI) can be made, symptoms and significant bacteriuria must be present. One of these symptoms is malodorous urine. Other symptoms of a UTI, typical in the younger population, have been found to be absent or misleading in the older adult population. Though early detection of UTIs improves outcomes, unnecessary laboratory tests are costly and time-consuming, and may encourage inappropriate antibiotic therapy. The purpose of this study was to determine if urine odor is an accurate predictor of a UTI in the older adult incontinent nursing home population. Ninety-seven recently wet incontinence pads of residents in six Midwestern nursing homes were evaluated for odor within 1 hour of voiding. These results were compared to microscopy and culture results of clean-catch urine samples from these individuals. Defining a UTI as either bacteriuria or bacteriuria and pyuria, using urine odor to identify a UTI resulted in error in one third of cases. Results of this study indicate smell of urine in incontinence pads may be an absent or misleading symptom for UTIs in elderly nursing home residents.
Aged↗
Importance of the appropriate selection and use of continence pads.
Urinary incontinence is becoming an increasingly common problem for older men and women living in the community. It can have a deleterious effect on quality of life and, although advances have been made in treatments and therapies for this condition, there is still confusion over selection of continence products. This article will explore the problems associated with product selection and discuss alternative advice.
Aged↗
A statistical comparison of pad numbers versus pad weights in the quantification of urinary incontinence.
AIMS: Pad per day (PPD) usage is a frequently utilized measure of urinary incontinence. The 24-hour pad weight test (24PWT) is a reproducible test for quantifying incontinence volumes. We investigated whether PPD validly reports the magnitude of urinary incontinence. METHODS: This was a retrospective review of patients undergoing stress incontinence surgery from July 2002 to 2005. Inclusion criteria were a documented 24PWT and patient-reported PPD usage. Grams of urine loss per pad (GPP) provided a third measure of incontinence. Descriptive statistics and correlations between all variables and significance were noted. Factor analysis was performed on the three measures of leakage and age for all patients over age 50. RESULTS: One hundred forty-five male and 116 female patients met inclusion criteria. Correlated against 24PWT, GPP has the strongest association with a correlation of 0.80 for males and 0.88 for females. PPD has a weaker correlation of 0.64 for males and 0.61 for females (R2 = 0.38 overall). Factor analysis identified two components associated with incontinence. A "leakage" component correlated best with 24PWT and GPP. Additionally, an "age" component implies that despite stable 24PWT values, older patients increase GPP while PPD decreases. CONCLUSIONS: Self-reported PPD is an unreliable measure of incontinence as this variable only measures 38% of the variation of urinary incontinence volume. Patients at a given PPD level present with a wide range of 24PWT values. Older patients have higher per-pad leakage. Future incontinence studies should report 24PWT to ensure the most reliable and uniform data.
Age Distribution↗
Evaluation of the home pad test for quantifying incontinence.
The home pad test to quantify urinary incontinence is described. Patients conduct the test in their homes and bring the pad, in a self-sealing plastic bag, for weighing at their next clinic visit. The validity of the procedure was assessed by measuring evaporation loss from the pads and comparing the home with the standard hospital test. Evaporation loss was shown to be acceptable if the test was carried out within 72 h of weighing. There were no significant differences between home and hospital tests and 95% of home results were within 32% below to 16% above hospital results. This was at least as consistent as the "gold standard" hospital test as 95% of the hospital results were within 28% below to 44% above repeated test results. The principal advantages in performing the pad test at home are simplicity, cost effectiveness and the relaxed environment, which reproduces more accurately the conditions leading to incontinence when compared with the relatively unfamiliar hospital setting.
Female↗
[Do the incontinent patients improve their equality of life using a humidity detector device?].
BACKGROUND: To evaluate the effect of a humidity detector device on the quality of life of patients with urinary incontinence IU. METHOD: Quasi-experimental study: a series of ten cases followed for a month. The devices were placed and the questionnaires filled in before and after using it for at least ten hours a day during a month. Health related quality of life was assessed through the questionnaires for IU convalidated and adapted to our specific environment: Urogenital Inventory Distress (UDI) and Incontinence Impact Questionary (IIQ). An improvement of 58 points by a four option Likert scale was considered a positive impact in the quality of life (IIQ). The scores obtained in UDI and IIQ are described before and after use the device and paried T test and Wilcoxon sign test were carried out to compare the scores obtained in each instance. The capacity to detect a difference of 58 points on the UDI scale was calculated (minimum relevant difference). A binomial test was undertaken to ascertain a probability of achieving an increase in the above mentioned index which would exceed the clinical relevance threshold. RESULTS: Average increase in IIQ improvement: x = 5.48 (Std Error = 20.43) 95% CI = -34.56 to 45.56. Average increase in UDI improvement: x = -11.87 (Std Error = 20.70) 95% IC = -52.45 to 28.70. The power of the analysis to detect as relevant a difference of a 588 point increase in IIQ 71.1% and probability of obtaining a relevant improvement in the questionnaire IIQ 10% (IC 95%) 0% to 39.4%. CONCLUSIONS: A negative impact in the Quality of Life due to frequent changes of incontinence pads.
Humans↗
A newly designed deodorant pad for urinary incontinence.
The authors designed a new pad for urinary incontinence. It is composed of a cloth of acrylonitrile copper sulfide and another cloth of iron-phthalocyanine. In vitro experiments showed that acrylonitrile copper sulfide cloth inhibited the growth of most bacteria causing urinary tract infection, and that iron-phthalocyanine cloth effectively eliminated bad-smelling gases. The use of this pad relieved diaper-dermatitis and diminished offensive smells from feces and urine. This pad was well received by nurses and helpers taking care of incontinent elderly people.
Acrylonitrile↗