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PubMed2002

Validity and reliability of an interviewer-administered questionnaire to measure the severity of lower urinary tract symptoms of storage abnormality: the Leicester Urinary Symptom Questionnaire.

OBJECTIVE: To develop a valid and reliable interviewer-administered questionnaire to measure the presence and severity of storage abnormality symptoms of incontinence, urgency, frequency and nocturia. SUBJECTS AND METHODS: Subjects were 930 men and women aged >/=40 years, taking part in a randomized controlled trial of a continence nurse practitioner (CNP) service. Criterion validity was tested by comparing questionnaire responses to 24-h pad test and 3-day urinary diary. Responsiveness was assessed by comparing questionnaire responses before and after treatment. Questions about urgency were investigated for construct validity in patients taking part in the trial who underwent urodynamic investigation (243). Test-retest and inter-rater reliability was measured at approximately 6 days in subjects recruited to an associated epidemiological study (104 and 102, respectively). RESULTS: The questionnaire responses showed significant associations with pad-test and diary measures. Questions about the severity of daytime incontinence performed better than those measuring night-time incontinence. The response categories of soaked, wet, damp and almost dry had better associations with the pad test than other measures of the severity of incontinence. Test-retest and inter-rater reliability was good for all questions, and all were responsive to change in symptoms, showing significant differences before and after treatment. CONCLUSION: There is a clear need for standardization of measurement using well-validated instruments. This interviewer-administered questionnaire is valid, reliable and sensitive to change in a wide range of severity of symptoms, and in both men and women aged >/=40 years. The questionnaire provides a useful assessment tool for primary and secondary care in research and clinical settings.

Aged↗
PubMed2003

The short-term prevalence of de novo urinary symptoms after different modes of hysterectomy.

The aim of this study was to determine the short-term prevalence of de novo urinary symptoms after hysterectomy indicated by meno/metrorrhagia or dysmenorrhea/dyspareunia. The study group consisted of 451 women who had had a hysterectomy for reasons of meno/metrorrhagia or dysmenorrhea/dyspareunia. Fifty-three (12%) had a supracervical, 151 (33%) a total abdominal and 247 (55%) a vaginal hysterectomy. As a non-gynecologic background population we enrolled 110 women who had had their gallbladder removed laparoscopically. All women received a postal questionnaire 9-45 months after their operation. Specific questions were asked about their voiding habits, comprising significant stress incontinence, bothersome stress incontinence, significant urge incontinence, bothersome urge incontinence, pollakisuria, nocturia, use of pads, and the feeling of having a hygiene problem. To evaluate de novo symptoms or de novo cure, the women assessed the symptoms before as well as after the operation. Results showed that abdominal hysterectomy lasted longer, had heavier blood loss and required longer hospitalization than did vaginal or supracervical hysterectomy. Women scheduled for a supracervical hysterectomy had preoperatively more significant and bothersome urge incontinence, and postoperatively more significant urge, urgency, and feeling of having a hygienic problem than did women having a vaginal hysterectomy, a total abdominal hysterectomy or a laparoscopic cholecystectomy. When assessing de novo symptoms, supracervical hysterectomy was associated with more urgency and the feeling of having a hygienic problem. Some women experienced de novo cure, but these were almost exclusively in the study group and rarely in the control group. It was concluded that supracervical hysterectomy is related to more urinary symptoms than vaginal or total abdominal hysterectomy. De novo symptoms as well as de novo cure are common, which is why urinary symptoms after hysterectomy must be evaluated over time.

Adult↗
PubMed2001

Long-term continence and patient satisfaction after artificial sphincter implantation for urinary incontinence after prostatectomy.

PURPOSE: We assess long-term continence and patient satisfaction after implantation of the AMS Sphincter 800 (American Medical Systems, Minnetonka, Minnesota) in men who were incontinent after total and subtotal prostatectomy. MATERIALS AND METHODS: Patients who had an artificial urinary sphincter implanted for urinary incontinence after prostatectomy and a minimum of 20 months of followup were identified from a patient database. The medical records of these 209 patients were reviewed, and a questionnaire was mailed. Telephone contact was attempted with patients who did not respond to the questionnaire. Of the 209 patients 11 (5%) had undergone device removal, 34 (16%) were deceased and an additional 51 (24%) could not be contacted for followup. Our study group consisted of the 113 patients with artificial urinary sphincters who could be contacted for followup. Mean followup was 73 months (range 20 to 170). RESULTS: There were 4 (4%) patients who were dry and continent and 68 (60%) were incontinent using 0 to 1 pad daily. An additional 35 (31%) patients required 2 to 3 pads daily and 5 (4%) used more than 3 daily. There were 14 (12%) patients who had undergone surgical revision of the device. Of the 113 patients 31 (28%) were very satisfied, 50 (45%) satisfied, 20 (18%) neutral, 7 (6%) dissatisfied and 4 (4%) very dissatisfied. One patient was not using his device to control continence. CONCLUSIONS: Artificial urinary sphincter implantation offers men who are incontinent after prostatectomy a reasonable chance for obtaining long-term satisfactory urinary control, although complete continence is unusual.

Follow-Up Studies↗
PubMed1997

Pelvic pain following radical retropubic prostatectomy: a prospective study.

OBJECTIVES: To evaluate subacute and chronic pelvic pain after radical retropubic prostatectomy (RRP) performed for clinically localized prostate cancer. METHODS: Twenty-four consecutive patients undergoing RRP completed pain, quality-of-life, and incontinence questionnaires. They also wore pads for 24 hours to measure urine loss objectively before and after surgery. RESULTS: Three patients had pelvic pain preoperatively. Thirteen, 7, and 5 patients had pelvic pain at 1, 3, and 6 months, respectively, after RRP. At 6 months, none of the 5 patients with pelvic pain required analgesic medication. There was a strong relationship between pain and cancer worry, as well as between pain and incontinence. CONCLUSIONS: Many patients have subacute pelvic pain after RRP but improve over time. Severe chronic pain is unlikely after RRP.

Acute Disease↗
PubMed1999

Urinary incontinence after non-nerve-sparing radical prostatectomy with neoadjuvant androgen deprivation.

OBJECTIVES: The impact of non-nerve-sparing retropubic radical prostatectomy (RRP) for prostate cancer combined with neoadjuvant androgen deprivation on urinary control is not well documented. We examined the incidence and severity of urinary incontinence after such therapy and determined the etiologic factors causing this complication. METHODS: We examined the postoperative continence status of 104 consecutive patients admitted to the National Cancer Center Hospital who underwent RRP with wide resection of the pelvic nerves after neoadjuvant androgen deprivation. Incontinence was scored according to the number of pads used daily by the patient for urinary leakage. The severity of incontinence was analyzed according to patient age, weight of resected specimen, status of cancer stage, duration of neoadjuvant androgen blockade therapy, preoperative length of membranous urethra, and duration of urethral catheterization after surgery. We also measured the configuration and diameter of the reconstructed bladder neck by retrograde cystourethrography. RESULTS: In 104 patients examined, the percentage of patients who became dry postoperatively was 22% at 1 month, 47% at 3 months, 69% at 6 months, and 78% at 1 year. Of 81 patients who became dry postoperatively at any interval, 22 (27%) became continent within 1 month of RRP, 49 (61 %) were continent within 3 months, 71 (88%) became continent by 6 months, and another 10 (12%) became continent between 6 and 12 months postoperatively. Of 48 patients who were followed up for more than 1 year and for whom continence status at 1 month after surgery was available, all patients who used 1 to 2 pads per day (13 of 13) at 1 month after surgery regained continence by 1 year after surgery. However, only 62% of patients (16 of 26) who required more than 3 pads per day at 1 month after surgery became dry by 1 year after surgery. Only age (older than 70 years) and large prostate size (weight of surgical specimen more than 40 g) temporarily influenced the recovery of urinary continence after surgery. Dilation of the bladder neck evaluated by retrograde cystourethrography was prominent in severely incontinent patients in the immediate postoperative period. CONCLUSIONS: Our experience in patients who undergo non-nerve-sparing RRP after neoadjuvant androgen deprivation closely matches published surveys of patient-reported complications. Postoperative incontinence is not a major contraindication for non-nerve-sparing RRP after neoadjuvant endocrine therapy. Dilation of the bladder neck affected the recovery from incontinence, highlighting the importance of adequate reconstruction of the bladder neck.

Aged↗
PubMed1996

Post-prostatectomy incontinence: urodynamic findings and treatment outcomes.

PURPOSE: We examined urodynamic findings and treatment outcomes in a large population of men with post-prostatectomy incontinence. MATERIALS AND METHODS: A total of 215 men was referred for evaluation and treatment of significant post-prostatectomy incontinence. Urodynamic evaluation consisted of provocation multichannel medium fill cystometry with vigorous attempts to demonstrate incontinence. Treatment was directed by the results of the urodynamic study. A pad scoring system was used to gauge the severity of incontinence before and after treatment. RESULTS: Based on the results of urodynamic studies 40% of the men had genuine stress incontinence alone and approximately 60% had a major component of bladder dysfunction contributing to incontinence. Treatment results of 135 men demonstrated a significant decrease in pad score (p<0.001) for those treated with anticholinergics, those undergoing artificial sphincter insertion and those treated pharmacologically before sphincter placement. CONCLUSIONS: In our large series most men with prostatectomy incontinence did not have genuine stress incontinence alone. Thus, urodynamic studies are critical, not only to define cause of incontinence but to direct effective therapy.

Aged↗
PubMed1976

Detection of urine loss using the Exeter recording nappy and other similar devices.

A technical evaluation of the Exeter recording nappy has been carried out with particular reference to (a) linearity, (b) reproducibility of calibration, (c) the effect of variation in the position of moistened zones produced by consecutive leakages and (d) the effect of variation in the electrical conductivity of the liquid detected. The clinical use of the nappy is also discussed. A miniature alarm coupled to a similar pad arrangement has been developed as a training system for the geriatric incontinent patient and patients with neurogenic bladders. A 'pad and pant' version of an enuresis alarm has also been designed which had advantages over the conventional under-sheet type.

Adult↗
PubMed2000

Urinary incontinence in women seen in the obstetrics and gynecology clinic.

The aim of this study was to present the prevalence of urinary incontinence (UI) in women seen in the obstetrics and gynecology clinic and to describe their behavioral characteristics. A UI-specific questionnaire was administered to 1222 randomly selected women who came to the obstetrics and gynecology clinic of our institution and 15 affiliated hospitals, all located in the island of Kyushu, Japan, for reasons other than incontinence. The prevalence of UI was 31%. Body mass index, parity and menopause significantly influenced the prevalence of UI. The majority of these women (78%) suffered from the stress type of incontinence. A direct relationship was found between the patient's assessment of the severity of her incontinence and the degree of effect on daily activities. The duration, frequency of incontinence and the number of pads used influenced their consultation attitude. Only 25% of these women consulted a physician, often a gynecologist.

Activities of Daily Living↗
PubMed1996

Stress urinary incontinence due to a low-pressure urethra: a socially invalidizing disease.

To compare the quality of life and clinical findings of patients with low-pressure urethra (LPU: < or = 20 cm H2O) with those of stress urinary incontinent (SUI) patients without LPU, and to compare the quality of urethral sphincter (US) muscle innervation parameters in LPU patients with those in control continent patients. Historical, clinical, urodynamic, and US muscle innervation parameters were compared in 38 LPU (group 1), 241 SUI (group 2), and 7 control patients (group 3). In comparison with group 2, the incidence of previous surgery and daily incontinence episodes, SUI severity, and pad test values were significantly higher in group 1, whereas the incidence of previous traumatic deliveries was the same in both groups. The mobility of the bladder neck assessed by the Q-Tip test was significantly reduced in group 1. In comparison with group 3, US motor unit potential (MUP) duration and pudendal motor latencies to the urethral sphincter (PMLUS) were increased in LPU group 1 patients, whereas there was no difference in these parameters between LPU patients with or without previous incontinence surgery. Fifty-three percent of our LPU patients had normal PMLUS, but showed signs of abnormal reinnervation on quantitative electromyography. Three nullipara LPU patients had normal MUP durations and PMLUS values, but a decreased area in response to pudendal nerve stimulation. Apart from a rare form of LPU in nullipara patients, probably due to a dysgenesis of their US muscle, LPU patients suffer from neuro-muscular damage responsible for a severe urinary invalidity. Previous incontinence surgery, as well as previous vaginal deliveries, may be responsible for such US damage.

Adult↗
PubMed1995

Exercise pad testing in continent exercisers: reproducibility and correlation with voided volume, pyridium staining, and type of exercise.

This study was undertaken to determine normal values for a modified pad test to be used for testing outcomes of studies addressing therapy for exercise incontinence. Fourteen asymptomatic volunteers who were continent by history completed three similar exercise sessions wearing pre-weighed pads after ingesting phenazopyridine hydrochloride (Pyridium, Parke-Davis, Sandy, UT). The mean pad weight gain for all exercise sessions combined was 3.19 +/- 3.16 g (range 0.1-12.4). The mean area of pyridium staining was 2.66 +/- 3.14 mm. Mean volume voided after the exercise sessions was 193 +/- 108 cc (range 10-625). The Kendall coefficient of concordance used to test the interest reliability was 0.96 for pad weight gain, 0.76 for area of stain, and 0.60 for volume voided. All but one of the subjects had at least one spot of pyridium stain on at least one of the three pads. The increase in pad weight attributable to sweat and vaginal moisture is reproducible in a given individual performing the same exercise routine, but due to the large variation between subjects, we were unable to establish a cut-off value separating continence from incontinence. Adding pyridium did not improve the specificity of the test, despite instructing subjects to milk the urethra and blot before applying the pad.

Adult↗
PubMed1997

Adverse prognostic features of collagen injection therapy for urinary incontinence following radical retropubic prostatectomy.

PURPOSE: We identified and characterized predictive factors associated with an unfavorable outcome of collagen injection therapy in post-radical prostatectomy incontinence. MATERIALS AND METHODS: A total of 46 patients, 49 to 85 years old (mean age 67) and incontinent after radical retropubic prostatectomy, underwent a mean of 2.8 transurethral injections of collagen (mean cumulative volume injected 31 ml.). Preoperatively, all patients underwent fluoroscopic multichannel video urodynamics including determination of Valsalva's leak point pressure. Stress urinary incontinence was subjectively graded as 1 (0 to 1 pad per day), 2 (2 to 3 pads per day) and 3 (greater than 3 pads per day). Patient age, duration and severity of pretreatment incontinence, presence of detrusor instability and anastomotic strictures, number of injections, total volume of collagen delivered and the impact of a nerve sparing procedure plus adjuvant radiation therapy were assessed and correlated with treatment outcome. RESULTS: Of the patients 11 (24%) became completely dry (9 after 3 or fewer treatments), 21 (41%) improved (17 after 3 or fewer treatments) and 14 (30%) showed no benefit (after more than 3 treatments). Of the 14 patients in whom treatment failed 6 had undergone adjuvant radiation treatment, pretreatment urinary incontinence was grade 3 in all, and concomitant detrusor instability was present in 11 (79%). All patients had received more than 3 treatments (mean total volume injected 37 ml.). CONCLUSIONS: Notwithstanding the need for multiple treatments, the prospect for cure by collagen injection of the post-radical prostatectomy incontinent patient is significantly affected by the severity of pretreatment incontinence, concomitant detrusor overactivity and exposure to radiation therapy. Age, duration of incontinence, presence of mild to moderate anastomotic strictures and a nerve sparing technique did not seem to influence treatment outcome.

Aged↗
PubMed1999

Efficacy and user acceptability of the urethral occlusive device in women with urinary incontinence.

PURPOSE: We determine the efficacy and user acceptability of the urethral occlusive device (FemAssist) for incontinence for 1 month and identify factors that may predict successful use of the device. MATERIALS AND METHODS: Baseline and posttreatment outcome measures included a 1-hour pad test, frequency volume chart (leakage, voiding and number of pads per 24 hour), visual analog scale for incontinence impact and quality of life (Urogenital Distress Inventory). The last 36 consecutive women also completed a linear analog scale about attitudes toward touching the genitalia. RESULTS: The device was offered to 100 consecutive incontinent women of whom 3 did not enroll in the study and 57 (57%) completed the 1-month trial. Age, incontinence type or severity and attitudes about touching the genitalia were not significantly different between dropouts and participants. Only 13% of recruits were disinclined to place the device on the urethra. Significant reduction of incontinence was observed for all outcome measures with the device in situ. Pad testing revealed that 47% of the patients became continent and 33% had more than 50% benefit, while 9% had worse leakage. Those with severe baseline leakage were equally likely to respond as those with mild or moderate pad test loss. Women with stress, urge or mixed incontinence appeared to respond equally well. CONCLUSIONS: The urethral occlusive device provides a further nonsurgical treatment option which is useful for a range of incontinence types.

Aged↗
PubMed2004

Mini-incisional Burch urethropexy: a less invasive method to accomplish a time-tested procedure for treatment of genuine stress incontinence.

The purpose of this study was to evaluate the feasibility, safety and efficacy of performing the Burch urethropexy (BU) and the abdominal paravaginal repair (APR) through a 1.5-2.5 in suprapubic incision. A prospective clinical study was undertaken by four urogynecologists. Seventy-three patients, each with a urodynamic and clinical diagnosis of genuine stress incontinence, underwent a BU procedure, with 33 of the 73 having concomitant APR through the same incision. The duration of surgery and any complications were recorded. Postoperative outcome tests included subjective incontinence questionnaire, cough stress testing, pad testing, measurement of residual volumes, and analgesia requirements. The BU procedure was accomplished in 72 of 73 patients, with 1 requiring conversion to a 5 in incision. The mean operative time was 64.6 +/-21.9 (SD) min. Intraoperatively, 1 patient was noted to have a suture in the bladder. All patient having only a BU (40) went home on the day of surgery or the first postoperative day, and all patients with BU and APR went home within 2 days. All but 1 patient met the criteria for catheter removal within 7 days, with 1 patient suffering obstructive voiding. At a mean follow-up of 9 months, cough stress test and questionnaire demonstrated complete cure in 70 of 72 patients tested. Pad testing confirmed cure in all of the 46 patients who consented to the test. We conclude that the standard Burch procedure and paravaginal repair can be accomplished safely and with excellent short-term efficacy through a 1.5-2.5 in incision.

Female↗
PubMed1992

Urge incontinence history is an accurate predictor of urge incontinence.

The reliability of urge symptoms associated with actual observed urine loss was tested using subtracted cystometry, and a hand-washing pad test in a total of 169 patients with urinary incontinence, 70 of whom had a prior history of urge incontinence. Our results showed: 1. that urodynamic or pad tests performed at a single point in time cannot retrospectively confirm a patient's past history of urge incontinence with any reliability; 2. a patient's history of urge incontinence is likely to be accurate.

Adult↗
PubMed1999

Questionnaire based results of the bulbourethral sling procedure.

PURPOSE: The success rate of the bulbourethral sling procedure to treat post-radical prostatectomy incontinence has been reported in a previous chart review analysis. We present further evaluation of the procedure using postoperative mailed questionnaires. MATERIALS AND METHODS: Between October 1994 and October 1997, 66 men underwent the bulbourethral sling procedure at our hospital. Postoperatively all patients with indwelling bolsters were mailed questionnaires to assess continence status, discomfort and voiding patterns. RESULTS: Of the 66 patients 4 required bolster removal for infection (2), erosion (1) or pain (1), and 1 died. These patients were not assessed further. Questionnaire data were obtained from the remaining 61 patients. At a median followup of 9.6 months (mean 11.9, range 3 to 30) 25 patients (41%) reported complete cure of incontinence, 32 (53%) required no pad for protection and 52 (85%) required 2 pads or less. Persistent perineal numbness or discomfort was present in 32 patients (52%). Of 12 patients who received adjuvant radiation therapy only 1 (8%) was cured. CONCLUSIONS: The short-term success rate following the bulbourethral sling procedure is high but persistent perineal discomfort is common. Adjuvant radiation predisposes to treatment failure.

Aged↗
PubMed1992

Obesity and lower urinary tract function in women: effect of surgically induced weight loss.

OBJECTIVE: The subjective and objective effects of massive weight loss on lower urinary tract function in morbidly obese women were examined. STUDY DESIGN: Thirteen subjects underwent a comprehensive evaluation of lower urinary tract function before and 1 year after surgically induced weight loss. RESULTS: We demonstrated significant improvements in lower urinary tract function after weight loss. Of 12 subjects who complained of incontinence before surgery only three complained of incontinence (p = 0.004) and only one requested treatment after weight loss. Objective and subjective resolution of both stress and urge incontinence was documented. Statistically significant changes were seen in measures of vesical pressure, the magnitude of bladder pressure increases with coughing, bladder-to-urethra pressure transmission with cough, urethral axial mobility, number of incontinence episodes, and the need to use absorptive pads. CONCLUSION: Weight reduction is desirable for obese women complaining of urinary incontinence and may obviate the need for further incontinence therapy.

Adult↗
PubMed1992

Reusables get high marks in adult incontinence care market.

The adult incontinence care market is coming of age. As environmental concerns gradually erode the popularity of disposables, nursing homes and hospitals are looking at reusables in a new light. In addition, the aging of the U.S. population is expected to increase the demand for incontinence care products. A recent study found that the sales of reusable cloth diapers and pads accounted for $385 million annually. All of these factors add up to a lucrative market for textile rental companies that can supply these products.

Conservation of Natural Resources↗
PubMed2001

Transcutaneous electrical nerve stimulation in the treatment of neurological patients with urinary symptoms.

OBJECTIVE: To determine whether transcutaneous electrical nerve stimulation (TENS) benefits patients with urinary symptoms caused by neurological diseases. PATIENTS AND METHODS: Patients with urinary symptoms from any kind of neurological disease were prospectively recruited between October 1996 and July 1998. Before attending the first assessment patients were asked to complete a week's diary recording the frequency of micturition, incontinence episodes, and frequency of pad and clothes changing. At the first assessment the patients completed the Frimodt-Moller urinary symptom questionnaire, and quality-of-life scales including the Nottingham Health Profile and Short-Form 36. Demographic and disability data (Barthel Index and Frenchay Aphasia Screening Test) were recorded, and patients underwent a neurological examination and urodynamic studies. The placing of electrode pads on the sacral dermatomes 2.5 cm either side of and 2.5 cm above the natal cleft was demonstrated, and the patient instructed to use TENS for 90 min twice a day. The current strength applied was set to that which the patient could tolerate, at a square-wave of 20 Hz and 200-micros duration. Six weeks later the patients were further assessed, where the diary exercise, questionnaires and urodynamics were repeated. In all, 44 patients (13 men and 33 women, mean age 50.8 years) were recruited. RESULTS: The commonest disease was multiple sclerosis and the commonest impairments para/tetraplegia or hemiplegia. There was no change in the neurological status of the 34 patients completing the study. Irritative voiding symptoms were significantly decreased (0.68-0.61, P = 0.003) and diaries also showed significant improvements in the 24 h frequency of micturition (P = 0.01), incontinence episodes (P = 0.04) and clothes changes (P = 0.02). Urodynamics showed detrusor hyper-reflexia in most patients. The only significant changes after TENS were an increased postvoid residual volume (from a mean of 134 mL to 160 mL, P = 0.03) and an increase in the volume leaked during the urodynamic study with TENS on (from a mean of 4.7 mL to 12 mL, P = 0.003). There were no significant changes in the quality-of-life scores. Of the 34 patients completing the study, half still reported a benefit from TENS at 1 year, although some patients found it took 3-4 weeks to work. CONCLUSION: TENS applied to the sacral dermatomes of neurological patients with urinary symptoms had a minimal effect on urodynamic data but significantly improved irritative urinary symptoms, 24-h urinary frequency, incontinence and clothes changing. The lack of effect on quality-of-life measures probably reflects the lack of sensitivity in the tools used in this group of patients. We therefore recommend using TENS in this often problematical group of patients.

Adolescent↗