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PubMed1992

Which pad is for you?

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Clinical Nursing Research↗
PubMed2004

Assessing outcome after a modified vaginal wall sling for stress incontinence with intrinsic sphincter deficiency.

Forty women with stress incontinence, intrinsic sphincter deficiency (ISD), associated or not with urethral hypermobility, a Valsalva leak point pressure (VLLP)<60 cmH(2)0 and a maximum urethral closure pressure<30 cmH(2)0 underwent in situ vaginal wall sling. The main modification to the technique was the use of two small Marlex meshes placed at the lateral edges of the sling. Outcome was assessed by pad use, surgical results and patients' satisfaction. Data of 39/40 patients were analyzed after a minimum follow-up of 1 year. After surgery 30/39 patients were completely dry (no pads), stress incontinence disappeared in 22/39, and 30/39 patients were satisfied with outcome. Reasons for dissatisfaction included recurrence of stress incontinence in three, infections in one and urge incontinence in five. Overall results are good given this category of patients. The vaginal wall sling can be recommended for patients with ISD because the results are promising, it corrects urethral hypermobility and, in our experience, it does not cause obstruction if correctly performed.

Adult↗
PubMed2006

Preoperative biofeedback assisted behavioral training to decrease post-prostatectomy incontinence: a randomized, controlled trial.

PURPOSE: We tested the effectiveness of preoperative biofeedback assisted behavioral training for decreasing the duration and severity of incontinence, and improving quality of life in the 6 months following radical prostatectomy. MATERIALS AND METHODS: We performed a prospective, randomized, controlled trial comparing preoperative behavioral training to usual care. The volunteer sample included 125 men 53 to 68 years old who elected radical prostatectomy for prostate cancer. Patients were stratified according to age and tumor differentiation, and randomized to 1 preoperative session of biofeedback assisted behavioral training plus daily home exercise or a usual care control condition, consisting of simple postoperative instructions to interrupt the urinary stream. The main outcome measurements were duration of incontinence (time to continence), as derived from bladder diaries, incontinence severity (the proportion with severe/continual leakage), pad use, Incontinence Impact Questionnaire, psychological distress (Hopkins Symptom Checklist) and health related quality of life (Medical Outcomes Study Short Form Health Survey). RESULTS: Preoperative behavioral training significantly decreased time to continence (p = 0.03) and the proportion of patients with severe/continual leakage at the 6-month end point (5.9% vs 19.6%, p = 0.04). There were also significant differences between the groups for self-reported urine loss with coughing (22.0% vs 51.1%, p = 0.003), sneezing (26.0% vs 48.9%, p = 0.02) and getting up from lying down (14.0% vs 31.9%, p = 0.04). No differences were found on return to work and usual activities or quality of life measures. CONCLUSIONS: Preoperative behavioral training can hasten the recovery of urine control and decrease the severity of incontinence following radical prostatectomy.

Aged↗
PubMed1986

Analysis of the pattern of urine loss in women with incontinence as measured by weighing perineal pads.

Three hundred and thirty-five women with urinary incontinence underwent a pad-weighing test for quantifying urine loss. Each one wore a series of pre-weighed sanitary towels for a total of 1 h. The pads were weighed again after use. The test results gave information about the severity of the incontinence which was not easy to obtain either from patient interview or from clinical examination. The type of activity was the main factor determining urine loss, although patients with detrusor instability lost more on average than the others. Voiding during the test period did not appear to influence the overall test results. Reproducibility of the test has been studied in 50 patients.

Adult↗
PubMed1982

Pads and pants for urinary incontinence.

Fifty-one female patients, incontinent of urine, were asked to compared two different combinations of pants and pads used in the ambulatory management of their incontinence. They were offered the Kanga pant with a Kanga pad and the Sandra pant with a Bambi pad. Each patient tried both pants and pads and thus comparisons could be made on a within-patient basis. Both systems kept a similar proportion of patients dry during the day and night. In terms of comfort, however, the Kanga pant was quite clearly preferred to the Sandra. The Bambi pad was rated more highly than the Kanga pad, although the difference between the two pads was not so pronounced as that between pants.

Adult↗
PubMed1990

The Pyridium pad test for diagnosing urinary incontinence. A comparative study of asymptomatic and incontinent women.

Eighteen women with urodynamically proven genuine stress incontinence awaiting surgery and 23 normal, asymptomatic, continent female volunteers took part in a study to compare the accuracy of a qualitative pad test with a quantitative pad-weighing test in detecting urine loss. Each woman took 600 mg of phenazopyridine hydrochloride (Pyridium, Parke-Davis) in three equally divided doses over 18-24 hours and then underwent a standardized, one-hour pad test as described by the International Continence Society. The Pyridium pad test was regarded as positive if there was any orange staining on the pad. The quantitative pad-weighing test was considered positive if there was a weight gain of 1.0 g or more at the end of the one-hour test period. All 18 patients with genuine stress incontinence had positive Pyridium pad tests, and all had pad weight gains of greater than or equal to 1.0 g (mean, 16.5). The maximum pad weight gain in the asymptomatic, continent volunteers was 0.7 g (mean, 0.1), and none was aware of any urinary leakage during the test; however, 12 (52%) had positive Pyridium pad tests. The Pyridium pad test appears 100% sensitive in detecting urine loss in symptomatic women with genuine stress incontinence, but it has a high false-positive rate in healthy, asymptomatic, continent women. If pad-weighing tests are done, the addition of Pyridium generally will not be useful, and if Pyridium is used by itself, the results may be misleading.

Aminopyridines↗
PubMed2000

Sacral nerve neuromodulation in the treatment of patients with refractory motor urge incontinence: long-term results of a prospective longitudinal study.

PURPOSE: Conservative treatment rarely results in a durable cure of patients with urge incontinence and bladder overactivity. Instrumental and surgical procedures often have significant side effects and less than optimal results. We developed a technique of sacral nerve neuromodulation using chronic unilateral electrical stimulation of the S3 sacral nerve to inhibit the micturition reflex to provide effective nondestructive alternative therapy for patients whose condition is refractory to conservative treatment. MATERIALS AND METHODS: Of 85 patients 45 who responded to a test with a temporary electrode underwent implantation of a permanent S3 sacral nerve electrode coupled to a pulse generator. Treatment results were evaluated by urodynamic studies and voiding/incontinence diaries documenting pad use, incontinence episodes, voiding frequency and voided volume. Partial success and cure were defined as 50% to 90% and more than 90% improvement, respectively, in pad use and/or incontinence episodes. RESULTS: Of 45 patients 18 (40%) were cured at an average followup of 47.1 months and 9 (20%) achieved partial success. Median number of pads used and median number of incontinence episodes daily had decreased from 5.4 to 1.2 (p = 0.0001) and 7.1 to 1.3 (p = 0.0001), respectively, 6 months after implantation. Subsequently these results remained almost constant for 5 years. Bladder overactivity disappeared in 19 of the 44 patients (43%). The repeat intervention rate was 37.7% and there was no permanent injury or nerve damage. CONCLUSIONS: Sacral nerve neuromodulation is safe, effective and durable in patients with urge incontinence refractory to conservative treatment.

Adolescent↗
PubMed2002

Systematic review of the effectiveness of urinary continence products.

Urinary incontinence is common, and considerable advances have been made in treatments and therapies for this distressing and socially unacceptable condition. Most people with incontinence use continence products to conceal their loss in the short term or long term. A huge range of products is available, including absorbent products, collection devices, catheters, and accessories. However, little guidance is available to aid consumers and health professionals in product selection. Therefore, a systematic review of research literature from 1982 to 2000 concerning the effectiveness of continence products was conducted. More than 350 articles were retrieved, of which 75 met the selection criteria for this review. It is apparent that there is a lack of high-quality research into the effectiveness of continence products. A recurrent theme in the literature is the importance of individual assessment to find products to suit the particular needs of each consumer. This review indicates that the absence of research information about the effectiveness of continence aids and appliances makes selection difficult.

Equipment Design↗
PubMedDate not supplied

Skin care in the frail, elderly, dependent, incontinent patient.

Despite a plethora of recommendations, protocols and dictums in the nursing literature, no research studies have defined the basic elements of preventive skin care for incontinent patients, and the prevalence of skin problems associated with incontinence is unknown. Yet the importance of skin care for incontinent elderly or immobilized patients has long been acknowledged. This literature review sought to determine current practices and principles for skin care of frail, elderly, dependent, incontinent patients. Protocols vary widely. And although there is mounting evidence that incontinence, particularly fecal incontinence, is a primary risk factor for pressure ulcer development, most preventive efforts focus on pressure relief, repositioning, and nutrition, rather than incontinence care. More clinical trials are needed in this area. The design and analysis of these trials should take into account the frequency and manner in which skin is cleansed, products used for skin care, risks and benefits of absorbent products and devices, the presence of infection, and patients' concomitant medical conditions and degree of immobility.

Activities of Daily Living↗