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[Urinary tract infection--diapers control us. Interview by Kirsten Bjørnsson].
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[Urinary incontinence in the elderly].
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Definition of mild, moderate and severe incontinence on the 24-hour pad test.
The values for 'mild', 'moderate' and 'severe' urinary incontinence have not been determined for the 24-hour pad test. To define these values, a prospective observational study was performed on 110 women with the primary symptom of urinary incontinence. Consenting women performed two 1-hour pad tests one week apart, and seven 24-hour pad tests for seven consecutive days. The 1-hour pad test definitions for mild, moderate and severe were translated to centiles, and used to categorise the 24-hour test values. This revealed that the range for 'mild incontinence' was between 1.3 and 20 g, 'moderate incontinence' ranged from 21 to 74 g, and 'severe incontinence' was defined as 75 g or more in 24 hours. Severity of leakage was analysed in relation to urodynamic diagnosis, age, parity and pelvic floor muscle strength. Increasing severity was associated with increasing age and parity. Women with detrusor overactivity were most likely to have severe leakage. In conclusion, this study defines the three grades of severity for the 24-hour pad test, which may help to guide patients' choice between conservative and surgical treatment and is useful for stratified randomisation of controlled trial participants.
Concurrent validity, internal consistency and responsiveness of the Portuguese version of the King's Health Questionnaire (KHQ) in women after stress urinary incontinence surgery.
OBJECTIVE: To evaluate the concurrent validity, internal consistency and responsiveness of King's Health Questionnaire (KHQ) in patients who underwent sling procedures for the treatment of stress urinary incontinence. MATERIALS AND METHODS: We performed a prospective open label multicenter study in 4 tertiary referral centers. Sixty-eight female patients were enrolled with urodynamically diagnosed urinary stress incontinence. Patients were treated using surgical procedures, mostly (73%) with the synthetic sling procedure, which has been considered one of the gold standard methods for the treatment of urinary incontinence. The patients were assessed before and after one month of postoperative follow up, using the KHQ in its validated Portuguese version. Patients also underwent preoperative urodynamic test, Stamey incontinence grading, pad usage and the assessment of number of pads used per day. After surgery, patients underwent stress test, Stamey incontinence grading pad usage and the assessment of number of pads used per day. RESULTS: The concurrent validity showed good correlations in some domains of KHQ to clinical parameters. The internal consistency was higher after treatment compared to preoperative values. Objective parameters, such as pad usage and the assessment of number of pads used per day, had significant correlation with changes in post-treatment scores on KHQ. The responsiveness expressed in terms of standardized effect size (SES) and standardized response mean (SRM) was large. CONCLUSION: The results showed moderate concurrent validity, strong internal consistency and high responsiveness for KHQ, indicating that it is suitable for measuring outcomes in clinical trials among female patients with stress urinary incontinence.
Diuretic response to fluid load in women with urinary incontinence: optimum duration of pad test.
The pattern of bladder filling in response to a 1-litre fluid load was assessed in 20 women with urinary incontinence. The period between 60 and 120 min after the fluid load was identified as best for pad testing because of consistently high bladder volumes and filling rates. A 2-h pad test is recommended as achieving effective and reproducible test conditions for the quantification of urine loss.
A multicenter comparative evaluation: disposable pads for women with light incontinence.
OBJECTIVE: The purpose of this study was to evaluate the current range of disposable pads for women with light incontinence available in the United Kingdom. SETTING AND SUBJECTS: Sixty community-based women aged 50 years or older were recruited to the study from several locations throughout the United Kingdom. METHODS: A multiple crossover design was used, which enabled all subjects to test all of the 12 products that were available on the UK market at the time of the evaluation. Two tools were used to evaluate the products: a product performance questionnaire and a pad leakage diary. This incorporated both subjective and objective outcome measures. RESULTS: Statistically significant differences were found between the products in 13 of the 17 performance aspects, eg, ability to hold urine without leaking and the fit of the pad. CONCLUSIONS: As a group, all of the products tested performed well in terms of their ability to hold urine without leakage. However, two products performed particularly well and scored highly on most aspects of performance and represented successful "all-round" products; these were the Tena Lady Extra and the Prevail Extra Plus.
[Questionnaire and pad-test in assessment of incontinence after radical retro-pubic prostatectomy].
OBJECTIVE: To confirm urinary incontinence after radical retro-pubic prostatectomy by questionnaire and pad-test, observe the influence of radical prostatectomy on the patient's quality of life (QOL), and study the effect of urethral sphincter preservation and the patient's age on incontinence. METHODS: Questionnaire and pad-test were conducted in 165 consecutive prostate cancer patients who underwent radical prostatectomies. The mean follow-up time was 13 months (12-14 months). Each patient was kept in contact with our incontinence advisor by telephone or direct interview. At 12 months after operation, the patients were asked to the clinic to fill in the questionnaire and underwent the pad-test. In accordance to different operative techniques, the patients were divided into a sphincter repairing group (19 cases) and a sphincter preservation group (146 cases). RESULTS: All the 165 patients were kept in contact with us, underwent the pad-test and filled in the questionnaire. Of the 7 patients diagnosed as incontinence for admitting using pads, only 1 had urinary leakage, and the other 6, who did not use pads very often, showed slight change of QOL. In the pad-test, 5 patients were considered to be incontinent since the pad weight gained > 1 grams. Between the questionnaire and the pad-test there was a high concordant rate (98.8%). Within 3 months after operation, younger patients seemed to return to continence sooner. The continence rate at 12 months after operation was 99.3% in the sphincter preservation group and 94.7% in the sphincter-repairing group. The incontinence rates at the removal of the urinary catheter after operation were 60% and 82% in patients aged 51-60 and 61-70, respectively. At 3 months after operation, the incontinence rates were similar in both groups. CONCLUSION: Both the questionnaire and the pad-test are recommendable in the assessment of post-operative incontinence since it can accurately document patients' incontinent status. Preservation of the urethral sphincter and its possible innervations can improve the incontinence rate. Younger patients seem to return to continence sooner than the elders.
[A successful nursing concept for patients with fecal incontinence. Personal attention instead of padding].
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Comparison of long-term indwelling catheters and bed-pads in the treatment of urinary incontinence in elderly patients.
Bed-pads and long-term indwelling catheters were compared in the treatment of urinary incontinence in two groups of eight elderly bedridden women. The same silicone catheter could be left in situ on average for 2 months. A detailed description of the changes of urinary bacterial flora in patients of both experimental groups is given. At the end of the 6 months' study all of the patients in both groups had significant bacteriuria (greater than or equal to 10(8) CFU/1), Proteus species being the most common pathogen in catheterised patients. The development of multiple resistance was observed in both groups, but it was more pronounced in the catheterised group. The indwelling catheter was more economical (P less than 0.001), but carried a higher risk of infection.
Two-stage management of severe postprostatectomy bladder neck contracture associated with stress incontinence.
OBJECTIVES: To report our experience using a two-stage, rather than a synchronous, approach in the management of bladder neck contracture (BNC). Anastomotic BNC associated with urinary incontinence is a major complication after radical prostatectomy. Patients may present with a decreased force of stream, urinary retention, or stress, urge, or overflow urinary incontinence. METHODS: The pertinent data of 15 patients (age range 52 to 78 years, mean 62) with postradical prostatectomy BNC associated with stress urinary incontinence (mean pad use 3 per day) were retrospectively reviewed. Video-urodynamic evaluation in 10 of 15 patients revealed a Valsalva leak point pressure of less than 80 cm H2O in all 10 patients. Bladder outlet obstruction was noted in 4 of 10 patients. Of the 15 patients, 2 declined an artificial urinary sphincter (AUS), the other 13 proceeded with our two-stage management. Step one consisted of deep transurethral incision of the BNC (TUIBNC) with Collin's knife electrocautery. Step two consisted of implantation of an AUS (AMS-800) 6 to 8 weeks after TUIBNC once bladder neck patency had been demonstrated cystoscopically. RESULTS: During a mean follow-up of 15 months, 3 patients developed early recurrence of BNC: 2 at the 5-week cystoscopy, 1 at 8 weeks discovered at the scheduled AUS placement. All 3 patients underwent repeat TUIBNC and remained clinically patent at a mean follow-up of 9 months. The remaining 10 patients were clinically patent after a single TUIBNC, with good subjective flow and postvoid residual volume of less than 30 mL at a mean follow-up of 11 months. Of the 13 patients who underwent AUS placement, 12 were socially continent (wearing 0 to 1 thin pad daily). The thirteenth patient remained incontinent after AUS placement. One of the 12 continent patients developed an infection at the device 8 months postoperatively and required explantation. CONCLUSIONS: We recommend a two-stage approach (TUIBNC followed by AUS insertion) rather than synchronous management for postprostatectomy BNC associated with stress urinary incontinence. Such an approach allows identification of BNC recurrence and its safe management before AUS implantation.
Rate of recurrent stress urinary incontinence after retropubic urethrolysis.
PURPOSE: We determined the rate of recurrent female stress urinary incontinence after retropubic urethrolysis without a concomitant anti-incontinence procedure. MATERIALS AND METHODS: We reviewed the charts of all women who underwent urethrolysis at our institution for urethral obstruction due to an anti-incontinence procedure. The study was limited to patients who underwent retropubic urethrolysis without a synchronous anti-incontinence operation or interposition flap inlay for obstruction associated with a suburethral sling. Variables reviewed included the history of urethrolysis, success of retropubic urethrolysis and incidence of urinary incontinence after the operation. RESULTS: A total of 12 patients met our study criteria, of whom 1 had stress urinary incontinence before retropubic urethrolysis. Of the 12 patients 10 achieved a successful result after urethrolysis and 2 achieved improvement but not success secondary to urinary urge incontinence. Protective padding was needed postoperatively for urinary incontinence in 5 of the 12 cases, including 3 (25%) and 2 (17%) due to stress and urgency incontinence, respectively. New onset stress urinary incontinence developed postoperatively in 2 of the 11 patients (18%) who did not have stress urinary incontinence before retropubic urethrolysis. A history of failed urethrolysis did not significantly increase the urinary incontinence rate postoperatively. CONCLUSIONS: Although retropubic urethrolysis has a high potential success rate for resolving urethral obstruction, it may cause a higher incidence of recurrent stress urinary incontinence than transvaginal approaches. There is no clear need for a synchronous anti-incontinence procedure at the time of retropubic urethrolysis.
Recent advances in absorbent products for the incontinent patient with burns.
The purpose of this study is to describe the physical configuration of disposable and reusable absorbent products and relate composition and construction to efficacy in the management of urinary incontinence in patients with burn injuries. The basic structure of a wearable absorbent product consists of three layers: a fluid-impermeable backing sheet, a fluid-pervious coverstock on the body-contacting surface, and an interposed absorbent core. The biomechanical performance of these absorbent products was determined by measuring the total absorbent capacity, defined as the maximum amount of liquid held by the product as a whole. On the basis of the results of this study, absorbent products are recommended for the incontinent patient with burns.
Homemade male incontinence pouch.
It is estimated that more than 13 million Americans experience incontinence or loss of bladder control. As a registered nurse specializing in urology, the author created a male drip collector, made from a female sanitary napkin (ALWAYS with Wings). This homemade male incontinence pouch is cost effective, comfortable to use, easy to make, can absorb 20 cc to 70 cc of urine, and is available in any store.
[A fact-finding inquiry on urinary management of the elderly in home care].
A fact-finding inquiry was made on elderly people in home care, in order to investigate urinary management. A questionnaire survey was performed on 2,322 elderly people (1,023 male and 1,299 female) cared at home by 40 home nursing stations in Aichi prefecture. The survey focused on the urinary management and the practical problems at home. The number of the elderly managed by an indwelling catheter was 225 (9.7%) and 1,301 (56.0%) of the elderly wore diapers. The rates of the people managed by an indwelling catheter or diapers widely varied among the home nursing stations. In 25.3% of the people managed by an indwelling catheter, the catheter was used because of urinary incontinence, which should not normally be indicated. Diapers were unnecessarily used in 23.9% of people mainly for a protective purpose. The majority of the people whose voiding dysfunction was managed either by an indwelling Foley catheter or diapers had had this treatment started before discharge from hospital. Only 5.8% of the elderly wearing diapers received consultation from medical specialists. Intermittent catheterization was performed in 36 people (1.6%), and in 23 (63.9%) the catheterization was carried out by the care givers. We conclude that the urinary management in the elderly cared at home is insufficient and that standardization of the urinary management and creation of a network of care givers, nurses, general physicians, medical specialists and government representatives should be urgently needed to improve the quality in urinary management in the elderly.
"Wet Sundays"; their pharmacology, chemistry and cure.
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Know your product: it's vital for care.
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