Sample records for incontinence inpatient procedures

  1. National study of utilization of male incontinence procedures.

    PubMed

    Chughtai, Bilal; Sedrakyan, Art; Isaacs, Abby J; Mao, Jialin; Lee, Richard; Te, Alexis; Kaplan, Steven

    2016-01-01

    We explored re-interventions and short and long term adverse events associated with procedures for male incontinence among Medicare beneficiaries. All inpatient and outpatient claims for a simple random sample of Medicare beneficiaries for 2000-2011 were queried to identify patients of interest. All male patients with an International Classification of Diseases, 9th Edition (ICD-9) diagnosis code for stress incontinence or mixed incontinence were included. Artificial urinary sphincter recipients, patients who underwent a sling operation and those receiving an injection of a bulking agent were identified with Current Procedure Terminology (CPT-4) and ICD-9 Procedure Codes. The entire cohort of 1,246 patients were operated on between 2001 and 2011. 34.9% of them received an artificial urinary sphincter (AUS), 28.7% with a bulking agent, and 36.4% with a sling. There were no statistically significant differences in demographics or comorbidities between the treatment groups, except that more sling patients were obese (P = 0.006) and fewer bulk patients had diabetes (P = 0.007). There are, however, significant changes in procedures selected over time (P < 0.001). In the first year and over the entire follow-up after surgery, patients treated with bulking agents had the most subsequent interventions (40.1% and 52.9%), followed by sling (10.4% and 15.5%), and AUS (2.3% and 20%) (P < 0.001). Post-operative and 90 day complications were low. All three treatments seem to be safe among Medicare beneficiaries with multiple comorbidities. The urological, infectious, and neurological complication occurrences were low. © 2014 Wiley Periodicals, Inc.

  2. Impact of urinary incontinence on medical rehabilitation inpatients.

    PubMed

    Mallinson, Trudy; Fitzgerald, Colleen M; Neville, Cynthia E; Almagor, Orit; Manheim, Larry; Deutsch, Anne; Heinemann, Allen

    2017-01-01

    To determine the prevalence of urinary incontinence (UI) and its association with rehabilitation outcomes in patients receiving inpatient medical rehabilitation in the United States. A retrospective, cohort study of 425,547 Medicare patients discharged from inpatient rehabilitation facilities (IRFs) in 2005. We examined prevalence of UI at admission and discharge for 5 impairment groups. We examined the impact of demographics, health, and functional status on the primary outcome, change in continence status, and secondary outcomes of discharge location and 6-month mortality. Approximately one-quarter (26.6%) of men were incontinent at admission compared to 22.2% of women. In all diagnostic groups, continence status remains largely unchanged from admission to discharge. Patients who are older, have cognitive difficulties, less functional improvement, and longer lengths of stay (LOS), are more likely to remain incontinent, compared to those who improved, after controlling for patient factors and clinical variables. UI was significantly associated with discharge to another post-acute setting (PAC). For orthopedic patients, UI was associated with a 71% increase in the likelihood of discharge to an institutional setting after controlling for patient factors and clinical variables. UI was not associated with death at 6 months post-discharge. UI is highly prevalent in IRF patients and is associated with increased likelihood of discharge to institutional care, particularly for orthopedic patients. Greater attention to identifying and treating UI in IRF patients may reduce medical expenditures and improve other outcomes. Neurourol. Urodynam. 36:176-183, 2017. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.

  3. Increasing costs of urinary incontinence among female Medicare beneficiaries.

    PubMed

    Anger, Jennifer T; Saigal, Christopher S; Madison, Rodger; Joyce, Geoffrey; Litwin, Mark S

    2006-07-01

    We measured the financial burden of urinary incontinence in the United States from 1992 to 1998 among women 65 years old or older. We analyzed Medicare claims for 1992, 1995 and 1998 and estimated spending on the treatment of urinary incontinence. Total costs were stratified by type of service (inpatient, outpatient and emergency department). Costs of urinary incontinence among older women nearly doubled between 1992 and 1998 in nominal dollars, from $128 million to $234 million, primarily due to increases in physician office visits and ambulatory surgery. The cost of inpatient services increased only slightly during the period. The increase in total spending was due almost exclusively to the increase in the number of women treated for incontinence. After adjusting for inflation, per capita treatment costs decreased about 15% during the study. This shift from inpatient to outpatient care likely reflects the general shift of surgical procedures to the outpatient setting, as well as the advent of new minimally invasive incontinence procedures. In addition, increased awareness of incontinence and the marketing of new drugs for its treatment, specifically anticholinergic medication for overactive bladder symptoms, may have increased the number of office visits. While claims based Medicare expenditures are substantial, they do not include the costs of pads or medications and, therefore, underestimate the true financial burden of incontinence on the aging community.

  4. Markov chain decision model for urinary incontinence procedures.

    PubMed

    Kumar, Sameer; Ghildayal, Nidhi; Ghildayal, Neha

    2017-03-13

    Purpose Urinary incontinence (UI) is a common chronic health condition, a problem specifically among elderly women that impacts quality of life negatively. However, UI is usually viewed as likely result of old age, and as such is generally not evaluated or even managed appropriately. Many treatments are available to manage incontinence, such as bladder training and numerous surgical procedures such as Burch colposuspension and Sling for UI which have high success rates. The purpose of this paper is to analyze which of these popular surgical procedures for UI is effective. Design/methodology/approach This research employs randomized, prospective studies to obtain robust cost and utility data used in the Markov chain decision model for examining which of these surgical interventions is more effective in treating women with stress UI based on two measures: number of quality adjusted life years (QALY) and cost per QALY. Treeage Pro Healthcare software was employed in Markov decision analysis. Findings Results showed the Sling procedure is a more effective surgical intervention than the Burch. However, if a utility greater than certain utility value, for which both procedures are equally effective, is assigned to persistent incontinence, the Burch procedure is more effective than the Sling procedure. Originality/value This paper demonstrates the efficacy of a Markov chain decision modeling approach to study the comparative effectiveness analysis of available treatments for patients with UI, an important public health issue, widely prevalent among elderly women in developed and developing countries. This research also improves upon other analyses using a Markov chain decision modeling process to analyze various strategies for treating UI.

  5. Left-colon antegrade continence enema (LACE) procedure for fecal incontinence.

    PubMed

    Churchill, Bernard M; De Ugarte, Daniel A; Atkinson, James B

    2003-12-01

    Antegrade continence enemas (ACE) are an efficacious therapeutic option for patients with fecal incontinence. The authors review their institution's experience with a variation of the Monti-Malone ACE procedure using the left colon as a source of an intestinal conduit and enema reservoir. From 2000 to 2002, 18 patients with fecal incontinence or intractable constipation underwent left-colon ACE (LACE) procedure. Concomitant Mitrofanoff appendicovesicostomy was performed in 15 patients and bladder augmentation in 9. The majority of patients had neural tube defects. A segment of left colon was tubularized, tunneled into the muscular wall of the distal colon, and exteriorized through the left upper quadrant or midabdomen. Stomal catherization and enema installation were started one month postoperatively. Fifteen patients (83%) achieved fecal continence, 2 remain incontinent of stool, and 1 experienced stomal closure (mean follow-up was 24 +/- 9 months). Two patients had stomal stenosis that required revision. The mean enema volume in patient's achieving continence was 360 +/- 216 mL, and the mean transit time was 18 +/- 12 minutes. LACE is an efficacious procedure for fecal incontinence that can be performed safely at the time of major urologic reconstruction. Administration of enemas into the left colon has several physiologic advantages that result in predictable bowel evacuation.

  6. 42 CFR 405.1206 - Expedited determination procedures for inpatient hospital care.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Expedited determination procedures for inpatient... Expedited Determinations and Reconsiderations of Provider Service Terminations, and Procedures for Inpatient Hospital Discharges § 405.1206 Expedited determination procedures for inpatient hospital care. (a...

  7. Surgical correction of female urinary incontinence: comparison of colporrhaphy, sling and suspension procedures.

    PubMed

    Yumru, A E; Dinçgez Çakmak, B; Öndeş, B; Ergez, M

    2012-01-01

    To analyse clinical outcomes of three types of pelvic surgery for the correction of female mixed or stress urinary incontinence. Women who underwent surgery for urinary incontinence between January 2000 and June 2010 were included in the study (n = 268). Patients were nonrandomly assigned to undergo colporrhaphy, suspension procedure or sling procedure according to their clinical situation. Perioperative parameters were recorded. Short- (< 5 years) and long-term (5-10 years) success rates were determined for each group. The short- and long-term complete cure rates were significantly lower, and the duration of catheterization significantly longer, in patients who underwent colporrhaphy compared with both other groups, but there were no significant differences between suspension or sling procedures. Sling and suspension procedures were equally effective in this study, and both were preferable to colporrhaphy.

  8. Clinical and ultrasonographic correlations following three surgical anti-incontinence procedures (TOT, TVT and TVT-O).

    PubMed

    Chene, Gautier; Cotte, Benjamin; Tardieu, Anne-Sylvie; Savary, Denis; Mansoor, Aslam

    2008-08-01

    The aim of this study was to compare ultrasonographic findings on tape position, angulation and mobility following three surgical anti-incontinence procedures (trans-obturator tape (TOT), tension-free vaginal tape (TVT), tension-free vaginal tape obturator (TVT-O)) and to correlate these data with clinical signs of cures and failures and de novo voiding disorders. In this prospective study, vesicourethral static and dynamic analysis of 81 patients (30 TOT, 28 TVT, 23 TVT-O) were evaluated using introital ultrasonography. Width, position and appearance of the tape were similar in all three groups, i.e. like a "V" at rest, round angulation on Valsalva and closed angulation at maximum retaining. Moreover, closer angulation on Valsalva was associated with voiding disorders. Closer angulation at retaining was associated with de novo urge incontinence. Larger angulation of the tape at rest appeared to be significantly associated with recurrent stress incontinence. Ultrasonography could a be useful tool assessing anti-incontinence procedures and investigating post-operative voiding disorders.

  9. Management of recurrent stress urinary incontinence after burch and sling procedures.

    PubMed

    Zimmern, Philippe E; Gormley, E Ann; Stoddard, Anne M; Lukacz, Emily S; Sirls, Larry; Brubaker, Linda; Norton, Peggy; Oliphant, Sallie S; Wilson, Tracey

    2016-03-01

    To examine treatment options selected for recurrent stress urinary incontinence (rSUI) in follow-up after Burch, autologous fascial and synthetic midurethral sling (MUS) procedures. We performed a secondary analysis of the SISTER and ToMUS trials of participants who underwent primary stress urinary incontinence (SUI) treatment (without prior SUI surgery or concomitant procedures). Using Kaplan-Meier analysis, retreatment-free survival rates by initial surgical procedure were compared. Mean MESA (Medical Epidemiologic and Social Aspects of Aging) stress index was also compared between those retreated for rSUI compared to those not retreated. Half of the women in the SISTEr trial met inclusion criteria for this analysis (329/655, 174 Burch and 155 fascial sling), as did 444/597 (74%) of subjects in ToMUS (221 transobturator midurethral sling (TMUS), and 223 retropubic midurethral sling (RMUS). Types of surgical retreatment included autologous fascial sling (19), synthetic sling (1), and bulking agent (18). Five-year retreatment free survival rates (and standard errors) were 87% (3%), 96% (2%), 97% (1%), and 99% (0.7%) for Burch, autologous fascial sling, TMUS, and RMUS groups respectively (P < 0.0001). For all index surgery groups, the mean MESA stress index at last visit prior to retreatment for those retreated (n = 23) was significantly higher than mean MESA stress index at last visit for those not retreated (n = 645) (P < 0.0001). In these cohorts, 6% of women after standard anti-incontinence procedures were retreated within 5 years, mostly with injection therapy or autologous fascial sling. Not all women with rSUI chose surgical retreatment. © 2015 Wiley Periodicals, Inc.

  10. Management of recurrent stress urinary incontinence after Burch and sling procedures

    PubMed Central

    Zimmern, Philippe; Gormley, E. Ann; Stoddard, Anne M.; Lukacz, Emily S.; Sirls, Larry; Brubaker, Linda; Norton, Peggy; Oliphant, Sallie S.; Wilson, Tracey

    2014-01-01

    Introduction To examine treatment options selected for recurrent stress urinary incontinence (rSUI) in follow-up after Burch, autologous fascial and synthetic midurethral sling (MUS) procedures. Methods We performed a secondary analysis of the SISTER and ToMUS trials of participants who underwent primary stress urinary incontinence (SUI) treatment (without prior SUI surgery or concomitant procedures). Using Kaplan-Meier analysis, retreatment-free survival rates by initial surgical procedure were compared. Mean MESA (Medical Epidemiologic and Social Aspects of Aging) stress index was also compared between those retreated for rSUI compared to those not retreated. Results Half of the women in the SISTEr trial met inclusion criteria for this analysis (329/655, 174 Burch and 155 fascial sling), as did 444/597 (74%) of subjects in ToMUS (221 transobturator midurethral sling (TMUS), and 223 retropubic midurethral sling (RMUS). Types of surgical retreatment included autologous fascial sling (19), synthetic sling (1), and bulking agent (18). Five-year retreatment free survival rates (and standard errors) were 87% (3%), 96% (2%), 97% (1%) and 99% (0.7%) for Burch, autologous fascial sling, TMUS, and RMUS groups respectively (p <0.0001). For all index surgery groups, the mean MESA stress index at last visit prior to retreatment for those retreated (n = 23) was significantly higher than mean MESA stress index at last visit for those not retreated (n = 645) (p <0.0001). Conclusion In these cohorts, 6% of women after standard anti-incontinence procedures were retreated within 5 years, mostly with injection therapy or autologous fascial sling. Not all women with rSUI chose surgical retreatment. PMID:25598512

  11. Pubovaginal sling procedure for the management of urinary incontinence after urethral trauma in women.

    PubMed

    Woodside, J R

    1987-09-01

    Traumatic urethral injury in women occurs less frequently than in men and urinary incontinence is a serious potential complication in women. Two female patients are described in whom post-traumatic urinary incontinence resulted from either direct trauma to the urethra or from injury to the innervation of the urethra. Both patients were treated successfully with the pubovaginal sling procedure that directly compresses an incompetent proximal urethra.

  12. Simultaneous Delorme's procedure and inter-sphinteric prosthetic implant for the treatment of rectal prolapse and faecal incontinence: preliminary experience and literature review.

    PubMed

    Cavazzoni, Emanuel; Rosati, Emanuele; Zavagno, Valentina; Graziosi, Luigina; Donini, Annibale

    2015-02-01

    Rectal prolapse is a distressing condition affecting mostly elderly patients and females. Delorme's procedure is frequently performed since it offers good results and is burdened by a particularly low morbidity. Faecal Incontinence is associated with prolapse in a large percentage of patients, due to the sphincter damage caused by the prolapsed rectum through the anal canal. Prolapse resection is often ineffective in treating incontinence, and further specific procedures are frequently required. At present, no data are available on combined Delorme's procedure with the implant of Bulking Agents for the simultaneous treatment of rectal prolapse and faecal incontinence. Three patients affected by complete external rectal prolapse underwent simultaneous Delorme's procedure with application of six polyacrylonitrile prosthetic cylinders in the inter-sphinteric space (Gate Keeper™, THD, Correggio Italy). Follow up was at 3,6 and 12 months. Gate Keeper procedure required a short operative time; no morbidity or complications were experienced. Prolapse was successfully treated in all patients and the mean Vaizey's incontinence score value dropped from pre-operative 19.3 to 9.3 after 3 months. All patients experienced a reduction of incontinence episodes and an improvement in daily activities and lifestyle. Gate Keeper implant is feasible and safe when associated to surgical procedures like Delorme's prolapse resection. Preliminary results are positive even if a study with a larger numbers of patients is needed to confirm the efficacy. A simultaneous treatment of faecal incontinence should be always considered when performing surgery for rectal prolapse. The present manuscript describes a simultaneous combination of two surgical techniques to treat rectal prolapse and faecal incontinence. To date, there are no published data on a similar approach. The paper underlies the importance of treating faecal incontinence when performing surgery for rectal prolapse. Copyright

  13. Does menopausal status impact urinary continence outcomes following abdominal sacrocolpopexy without anti-incontinence procedures in continent women?

    PubMed Central

    Inan, Abdurrahman Hamdi; Toz, Emrah; Beyan, Emrah; Gurbuz, Tutku; Ozcan, Aykut; Oner, Oznur

    2016-01-01

    Objective: We investigated the impact of menopausal status on urinary continence following abdominal sacrocolpopexy (ASC) without an anti-incontinence procedure in continent women. Methods: We conducted a clinical follow-up study of 137 patients diagnosed with stage 3 or higher pelvic organ prolapse (POP) without urinary incontinence between January 2012 and December 2014. Patients were provided with detailed a priori information pertaining to the abdominal sacrocolpopexy procedure and were invited to attend follow-up visits at 1, 3, 12, and 24 months. Follow-up visits included a gynecological examination, cough test, and validated Urinary Distress Inventory-6 (UDI-6) and Incontinence Impact Questionnaire-7 (IIQ-7) questionnaires. Results: The mean follow-up time for the cohort was 16.5±3.45 months. The study group was divided according to menopausal status: premenopausal (Group-1) and postmenopausal women (Group-II). Anatomical recurrence was not detected during the follow-up period in either group, but de novo stress urinary incontinence was seen in 15 of 53 (28.3%) Group-I patients and in 6 of 84 (7.1%; p < 0.01) Group-II patients. Conclusions: The risk of de novo stress urinary incontinence in postmenopausal women after ASC is low. However, premenopausal patients have a higher incidence of de novo stress incontinence which affect quality of life. PMID:27648027

  14. Surgery for Stress Urinary Incontinence

    MedlinePlus

    ... Events Advocacy For Patients About ACOG Surgery for Stress Urinary Incontinence Home For Patients Search FAQs Surgery ... Incontinence FAQ166, July 2017 PDF Format Surgery for Stress Urinary Incontinence Special Procedures What is stress urinary ...

  15. Complications Following Common Inpatient Urological Procedures: Temporal Trend Analysis from 2000 to 2010.

    PubMed

    Meyer, Christian P; Hollis, Michael; Cole, Alexander P; Hanske, Julian; O'Leary, James; Gupta, Soham; Löppenberg, Björn; Zavaski, Mike E; Sun, Maxine; Sammon, Jesse D; Kibel, Adam S; Fisch, Margit; Chun, Felix K H; Trinh, Quoc-Dien

    2016-04-01

    Measuring procedure-specific complication-rate trends allows for benchmarking and improvement in quality of care but must be done in a standardized fashion. Using the Nationwide Inpatient Sample, we identified all instances of eight common inpatient urologic procedures performed in the United States between 2000 and 2010. This yielded 327218 cases including both oncologic and benign diseases. Complications were identified by International Classification of Diseases, Ninth Revision codes. Each complication was cross-referenced to the procedure code and graded according to the standardized Clavien system. The Mann-Whitney and chi-square were used to assess the statistical significance of medians and proportions, respectively. We assessed temporal variability in the rates of overall complications (Clavien grade 1-4), length of hospital stay, and in-hospital mortality using the estimated annual percent change (EAPC) linear regression methodology. We observed an overall reduction in length of stay (EAPC: -1.59; p<0.001), whereas mortality rates remained negligible and unchanged (EAPC: -0.32; p=0.83). Patient comorbidities increased significantly over the study period (EAPC: 2.09; p<0.001), as did the rates of complications. Procedure-specific trends showed a significant increase in complications for inpatient ureterorenoscopy (EAPC: 5.53; p<0.001), percutaneous nephrolithotomy (EAPC: 3.75; p<0.001), radical cystectomy (EAPC: 1.37; p<0.001), radical nephrectomy (EAPC: 1.35; p<0.001), and partial nephrectomy (EAPC: 1.22; p=0.006). Limitations include lack of postdischarge follow-up data, lack of pathologic characteristics, and inability to adjust for secular changes in administrative coding. In the context of urologic care in the United States, our findings suggest a shift toward more complex oncologic procedures in the inpatient setting, with same-day procedures most likely shifted to the outpatient setting. Consequently, complications have increased for the majority of

  16. Outcomes of Inpatients With and Without Sickle Cell Disease After High-Volume Surgical Procedures

    PubMed Central

    Dinan, Michaela A.; Chou, Chia-Hung; Hammill, Bradley G.; Graham, Felicia L.; Schulman, Kevin A.; Telen, Marilyn J.; Reed, Shelby D.

    2009-01-01

    In this study, we examined differences in inpatient costs, length of stay, and in-hospital mortality between hospitalizations for patients with and without sickle cell disease (SCD) undergoing high-volume surgical procedures. We used Clinical Classification Software (CCS) codes to identify discharges in the 2002–2005 Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project for patients who had undergone either cholecystectomy or hip replacement. We limited the non-SCD cohort to hospitals where patients with SCD had undergone the same procedure. We compared inpatient outcomes using summary statistics and generalized linear regression analysis to adjust for patient, hospital, and procedural characteristics. Overall, the median age of surgical patients with SCD was more than 3 decades less than the median age of patients without SCD undergoing the same procedure. In recognition of the age disparity, we limited the analyses to patients aged 18 to 64 years. Nonetheless, patients with SCD undergoing cholecystectomy or hip replacement were 12.1 and 14.4 years younger, had inpatient stays that were 73% and 82% longer, and incurred costs that were 46% and 40% higher per discharge than patients without SCD, respectively. Inpatient mortality for these procedures was low, approximately 0.6% for cholecystectomy and 0.2% for hip replacement, and did not differ significantly between patients with and without SCD. Multivariable regression analyses revealed that higher inpatient costs among patients with SCD were primarily attributable to longer hospital stays. Patients with SCD who underwent cholecystectomy or hip replacement required more health care resources than patients without SCD. PMID:19787790

  17. Transfascial vaginal tape (TFT): a simple, safe and cost-effective procedure for stress urinary incontinence. A preliminary study.

    PubMed

    Foglia, Giovanni; Mistrangelo, Emanuela; Lijoi, Davide; Alessandri, Franco; Ragni, Nicola

    2007-07-01

    To analyse prospectively the effectiveness of a new simple, minimally invasive, and cost-effective technique for the treatment of female urinary stress incontinence: the transfascial vaginal tape (TFT). In a prospective study, we enrolled 45 women undergoing TFT with or without hysterectomy and/or another pelvic reconstructive procedure between 1st December 2003 and 31st December. TFT consists of a tension-free urethrosuspension using a sling located at the mid-urethral level and placed laterally in the endopelvic fascia previously perforated. Follow-up evaluations were established at 3 and 6 months and at 1 year after the operation. During each follow-up, women underwent cough stress test and they answered to the "Incontinence quality of life questionnaire" (I-QOL), to the Patient Global Impression of Severity (PGI-S) and of Improvement (PGI-I) questions. Thirty-nine patients (88.9%) had a follow-up examination 1 year after surgery. Of these, 30 (76.9%) were defined cured, 6 (15.4%) improved and 3 (7.7%) failed. TFT procedure can be considered a simple, safe and cost-effective procedure for the treatment of stress urinary incontinence and can be an alternative to tension-free vaginal tape or transobturator route for sub-urethral tape procedures.

  18. (Can) Not talk about it - Urinary incontinence from the point of view of stroke survivors: a qualitative study.

    PubMed

    Kohler, Myrta; Mayer, Hanna; Kesselring, Jürg; Saxer, Susi

    2018-03-01

    The current study intends to gain an in-depth understanding of stroke survivors' lived experience of urinary incontinence and its treatment in an inpatient rehabilitation clinic. A qualitative approach was chosen. Semi-structured individual interviews with ten stroke survivors suffering from urinary incontinence were conducted in an inpatient rehabilitation clinic and analysed using qualitative content analysis with an inductive approach. '(Can) not talk about it' was identified as the first main category. The affected persons do not talk about urinary incontinence because they are ashamed. At the same time, no one asks them about this issue. Psychological strain is so high that patients feel the need to talk about incontinence, but from their point of view, conversations with nurses - if they indeed occur - are superficial or nurses do not listen. Therefore, patients' needs and concerns are not properly considered. 'Trying to command incontinence' was also identified as a main category. Participants reported that they try to command incontinence and to develop their own strategies in order to hide urinary incontinence and prevent shameful situations. However, this proved mostly unsuccessful and resulted in resignation to their condition. It is important to raise awareness within the treatment team of urinary incontinence in stroke survivors. Team members should be able to communicate about urinary incontinence in an open and empathic way. Obviously, there is great potential for supporting stroke survivors in dealing with incontinence. © 2017 Nordic College of Caring Science.

  19. [Comparison of the Bologna and Ingelman-Sundberg procedures for stress incontinence associated with genital prolapse: ten-year follow-up of a prospective randomized study].

    PubMed

    Debodinance, P

    2000-04-01

    Our purpose was to evaluate and compare the long-term results of the Bologna and the Ingelman-Sundberg procedures for the treatment of stress urinary incontinence in women with genital prolapse. Forty-seven women underwent surgery at the gynecologic division at Dunkirk Hospital, France between January 1989 and August 1990. All patients presented a genital prolapse with a cystocele of at least degree 2 associated with urinary stress incontinence. The subjects were randomly allocated to one of the two procedures. In the clinical incontinence group (28 patients), 12 procedures were Bologna operations and 16 were Ingelman-Sundberg operations. In the potential incontinence group (19 patients), 11 procedures were Bologna operations and 8 were Ingelman-Sundberg operations. Physical examination and urodynamic explorations were performed preoperatively, and 3 months and 1 year postoperatively. A questionnaire was sent to all participating women during the tenth year of follow-up. We obtained 46 answers. Mean follow-up was 9.7 years. The result of the 1-year postoperative evaluation has been previously published. At 1 year, complete cure was achieved in 91.7% of the patients who underwent the Bologna procedure and 93.7% in those who had the Ingelman-Sundberg procedure. At 10 years, the cure rate was 72.7% and 56.2% (p<0.05) respectively. After the first year, the decline in cure rate was twice as fast with the Ingelman-Sundberg procedure than with the Bologna operation. The longevity of the Bologna procedure is greater than that of the Ingelman-Sundberg procedure. Recovery rate declines by 20% in 9 years. All results of urinary stress incontinence surgery were good after the first year. One has to wait 5 to 10 years before reliable informative results can be obtained. This fact should be taken into consideration before accepting to use of new procedures.

  20. Ten-Year Followup after Tension-Free Vaginal Tape-Obturator Procedure for Stress Urinary Incontinence.

    PubMed

    Ulrich, Daniela; Tammaa, Ayman; Hölbfer, Susanne; Trutnovsky, Gerda; Bjelic-Radisic, Vesna; Tamussino, Karl; Aigmüller, Thomas

    2016-10-01

    Suburethral tapes are a standard surgical treatment for stress urinary incontinence. The aim of the study was to evaluate subjective and objective cure rates 10 years after a tension-free vaginal tape-obturator procedure. All 124 patients who underwent the tension-free vaginal tape-obturator procedure at a total of 2 centers in 2004 and 2005 were invited for followup. Objective cure was defined as a negative cough stress test at 300 ml. Subjects completed KHQ (King's Health Questionnaire), IOQ (Incontinence Outcome Questionnaire), FSFI (Female Sexual Function Index Questionnaire) and PGI-I (Patient Global Impression of Improvement). Overall, 55 of 112 women (49%) who were alive were available for clinical examination and 71 (63%) completed the questionnaires. The objective cure rate in the 55 women examined clinically was 69%, 22% were not cured and 9% (5) had undergone reoperation for recurrent or persistent stress urinary incontinence. Treatment was counted as having failed in these 5 women for study purposes. Subjective cure was reported by 45 of 71 women (64%). Three patients (5%) had vaginal tape extrusion at the time of clinical examination. Extrusion in all of them was small and asymptomatic, and did not require treatment for a cumulative extrusion rate of 7%. Six women (9%) had undergone reoperation for tension-free vaginal tape-obturator associated complications and 18 (26%) experienced de novo overactive bladder. Subjective and objective cure rates 10 years after the tension-free vaginal tape-obturator procedure were 69% and 64%, respectively. The vaginal extrusion rate in this study was slightly higher than in other series but major long-term complications appeared to be rare. Copyright © 2016 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  1. Results of the tension-free vaginal tape procedure for stress incontinence: patient's perspective.

    PubMed

    Manikandan, Ramaswamy; Kujawa, Magda; Pearson, Evelyn; O'Reilly, Patrick H; Brown, Stephen C W

    2004-04-01

    To evaluate the results of the tension-free vaginal tape procedure (TVT) from a patient's perspective. Between May 1999 and January 2002, 90 patients underwent a TVT for genuine stress incontinence (GSI) and mixed incontinence. Prior to the procedure, GSI was confirmed by clinical examination and urodynamic studies. Results were then audited from patient notes and the same patients were sent questionnaires to examine results from a patient perspective. Overall response rate to the questionnaire was 70 (77%). The mean age of the patients was 50.4 years (range 31-83 years). Sixty-one patients had spinal anesthesia, seven had general anesthesia and two had local anesthesia. Mean hospital stay was 3.36 days (range 2-14 days) and mean period from the operation to the time of the survey and audit was 16.34 months (range 3-28; SD 6.92). Thirty-nine (56%) of the 70 patients who answered said that the operation had cured their incontinence, 16 (23%) had an improvement in their symptoms, 7 (10%) had worsening of their symptoms and 8 (11%) felt that the operation did not make any difference. The overall success rate according to the patients' perspective was 79%, whereas our audit showed an overall success rate of 86% (77% and 82%, respectively, when we compared only the 66 patients who had both notes and replies available for analysis). Although a patient's perception regarding the success of TVT tends to differ from that of a clinician, it was not found to be statistically significant (P = 0.22, McNemar test). The TVT is a very successful operation, but realistic cure rates should be offered to patients.

  2. Practice patterns of post-radical prostatectomy incontinence surgery in Ontario

    PubMed Central

    Wallis, Christopher J.D.; Herschorn, Sender; Liu, Ying; Carr, Lesley K.; Kodama, Ronald T.; Klotz, Laurence H.; Saskin, Refik; Nam, Robert K.

    2014-01-01

    Introduction: We assess the practice patterns of artificial urinary sphincter (AUS) and urethral sling insertion after radical prostatectomy (RP) from a large population-based cohort. Methods: We examined 25 346 men in Ontario, Canada who underwent RP between 1993 and 2006. Using hospital and cancer registry data, we identified patients who subsequently underwent an incontinence procedure. We characterized the practice patterns of post-prostatectomy incontinence procedures across Ontario during the study interval. Results: A total of 703 (2.8%) men underwent subsequent insertion of an AUS and 282 (1.1%) underwent a urethral sling procedure (985 total incontinence procedures, 3.9%) over the study period. During the study period, 121 hospitals performed RP. Among them, 32 (26%) hospitals performed both RP and AUS/sling procedures, and 89 (74%) performed RP only. Four hospitals performed AUS/sling procedures but not RP. Of the 36 institutions that performed AUS/sling procedures, the median annual case volume was 0.29 (interquartile range: 0.083-0.75). Of all incontinence procedures, 56% were performed at 3 academic institutions. When examining observed rates of AUS/sling procedures compared with expected rates from the overall cohort, 15 of 32 hospitals (47%) performed significantly fewer incontinence procedures than expected given their RP case volume (p range: <0.0001–0.0390) and 5 (16%) performed significantly more (p range: <0.0001–0.038). Conclusions: A small number of academic institutions provide most of the surgical care for men with incontinence following RP in Ontario. Many centres that perform RP refer out to other centres to surgically manage their patients’ incontinence. PMID:25408805

  3. An Automated Inpatient Split-dose Bowel Preparation System Improves Colonoscopy Quality and Reduces Repeat Procedures.

    PubMed

    Yadlapati, Rena; Johnston, Elyse R; Gluskin, Adam B; Gregory, Dyanna L; Cyrus, Rachel; Werth, Lindsay; Ciolino, Jody D; Grande, David P; Keswani, Rajesh N

    2017-07-19

    Inpatient colonoscopy preparations are often inadequate, compromising patient safety and procedure quality, while resulting in greater hospital costs. The aims of this study were to: (1) design and implement an electronic inpatient split-dose bowel preparation order set; (2) assess the intervention's impact upon preparation adequacy, repeated colonoscopies, hospital days, and costs. We conducted a single center prospective pragmatic quasiexperimental study of hospitalized adults undergoing colonoscopy. The experimental intervention was designed using DMAIC (define, measure, analyze, improve, and control) methodology. Prospective data collected over 12 months were compared with data from a historical preintervention cohort. The primary outcome was bowel preparation quality and secondary outcomes included number of repeated procedures, hospital days, and costs. On the basis of a Delphi method and DMAIC process, we created an electronic inpatient bowel preparation order set inclusive of a split-dose bowel preparation algorithm, automated orders for rescue medications, and nursing bowel preparation checks. The analysis data set included 969 patients, 445 (46%) in the postintervention group. The adequacy of bowel preparation significantly increased following intervention (86% vs. 43%; P<0.01) and proportion of repeated procedures decreased (2.0% vs. 4.6%; P=0.03). Mean hospital days from bowel preparation initiation to discharge decreased from 8.0 to 6.9 days (P=0.02). The intervention resulted in an estimated 1-year cost-savings of $46,076 based on a reduction in excess hospital days associated with repeated and delayed procedures. Our interdisciplinary initiative targeting inpatient colonoscopy preparations significantly improved quality and reduced repeat procedures, and hospital days. Other institutions should consider utilizing this framework to improve inpatient colonoscopy value.

  4. Urinary Incontinence in Hospitalised Elderly Patients: Do Nurses Recognise and Manage the Problem?

    PubMed Central

    Zürcher, Sabin; Saxer, Susi; Schwendimann, René

    2011-01-01

    This study examined to what extent nurses recognize urinary incontinence (UI) in elderly hospital patients, what UI interventions nurses realize, and if elderly inpatients are willing to raise the topic during their hospital stay. A convenience sample of 78 elderly inpatients in a Swiss hospital were screened for UI and asked if they were willing to be questioned about UI during hospitalisation. Nursing records were analysed as to whether UI had been recognized, and to collect data on interventions. Forty-one patients (51%) screened positive for UI, of whom 10 (24%) were identified as such in their nursing records. The single intervention documented was the use of incontinence pads. Only 5 patients preferred not to be asked about UI at hospital. Nurses in the study hospital should systematically ask elderly patients about UI and provide them with information on interventions. PMID:21994838

  5. Trends in the surgical management of stress urinary incontinence among female Medicare beneficiaries, 2002-2007.

    PubMed

    Rogo-Gupta, Lisa; Litwin, Mark S; Saigal, Christopher S; Anger, Jennifer T

    2013-07-01

    To describe trends in the surgical management of female stress urinary incontinence (SUI) in the United States from 2002 to 2007. As part of the Urologic Diseases of America Project, we analyzed data from a 5% national random sample of female Medicare beneficiaries aged 65 and older. Data were obtained from the Centers for Medicare and Medicaid Services carrier and outpatient files from 2002 to 2007. Women who were diagnosed with urinary incontinence identified by the International Classification of Diseases, Ninth Edition (ICD-9) diagnosis codes and who underwent surgical management identified by Current Procedural Terminology, Fourth Edition (CPT-4) procedure codes were included in the analysis. Trends were analyzed over the 6-year period. Unweighted procedure counts were multiplied by 20 to estimate the rate among all female Medicare beneficiaries. The total number of surgical procedures remained stable during the study period, from 49,340 in 2002 to 49,900 in 2007. Slings were the most common procedure across all years, which increased from 25,840 procedures in 2002 to 33,880 procedures in 2007. Injectable bulking agents were the second most common procedure, which accounted for 14,100 procedures in 2002 but decreased to 11,320 in 2007. Procedures performed in ambulatory surgery centers and physician offices increased, although those performed in inpatient settings declined. Hospital outpatient procedures remained stable. The surgical management of women with SUI shifted toward a dominance of procedures performed in ambulatory surgery centers from 2002 to 2007, although the overall number of procedures remained stable. Slings remained the dominant surgical procedure, followed by injectable bulking agents, both of which are easily performed in outpatient settings. Copyright © 2013 Elsevier Inc. All rights reserved.

  6. Management of patients with faecal incontinence

    PubMed Central

    Duelund-Jakobsen, Jakob; Worsoe, Jonas; Lundby, Lilli; Christensen, Peter; Krogh, Klaus

    2016-01-01

    Faecal incontinence, defined as the involuntary loss of solid or liquid stool, is a common problem affecting 0.8–8.3% of the adult population. Individuals suffering from faecal incontinence often live a restricted life with reduced quality of life. The present paper is a clinically oriented review of the pathophysiology, evaluation and treatment of faecal incontinence. First-line therapy should be conservative and usually include dietary adjustments, fibre supplement, constipating agents or mini enemas. Biofeedback therapy to improve external anal sphincter function can be offered but the evidence for long-term effect is poor. There is good evidence that colonic irrigation can reduce symptoms and improve quality of life, especially in patients with neurogenic faecal incontinence. Surgical interventions should only be considered if conservative measures fail. Sacral nerve stimulation is a minimally invasive procedure with high rate of success. Advanced surgical procedures should be restricted to highly selected patients and only performed at specialist centres. A stoma should be considered if other treatment modalities fail. PMID:26770270

  7. Waiting time of inpatients before elective surgical procedures at a State Government Teaching Hospital in India.

    PubMed

    Ray, Shreyasi; Kirtania, Jyotirmay

    2017-01-01

    Abundant published literature exists addressing the issues of outpatient waiting lists before surgery. However, there is no published literature on inpatient waiting time before elective surgical procedures. This study aims to measure the inpatient waiting time, identify the factors that affect the inpatient waiting time, and recommend the ways of reducing the waiting time of inpatients before elective surgical procedures, at a state government teaching hospital in India. Descriptive research methods and quality control tools were used for this prospective observational study. Descriptive statistics, Shapiro-Wilk test of normality, Wilcoxon-Mann-Whitney Test, and Kruskal-Wallis test were used. Pareto charts were used to highlight the most important modifiable factors among the set of factors causing increased waiting time. We also applied the M/M/c model (Erlang - A model) of queue theory to analyze the traffic intensity and system congestion. The median waiting time of inpatients before elective surgery was 12 days (interquartile range = 11.5 days). The waiting time was influenced significantly (P < 0.05) by the patient's age, physical status, and the financial status. The surgical specialty, blood product booking and procurement, cross-specialty consultation before surgery, and Intensive Care Unit booking were the other important factors. Modifiable and nonmodifiable factors affecting the inpatient waiting time of surgical patients were identified. Control measures that can reduce the waiting time of inpatients before elective surgery were identified.

  8. Temperature-Controlled Delivery of Radiofrequency Energy in Fecal Incontinence: A Randomized Sham-Controlled Clinical Trial.

    PubMed

    Visscher, Arjan P; Lam, Tze J; Meurs-Szojda, Maria M; Felt-Bersma, Richelle J F

    2017-08-01

    Controlled delivery of radiofrequency energy has been suggested as treatment for fecal incontinence. The aim of this study was to determine whether the clinical response to the radiofrequency energy procedure is superior to sham in patients with fecal incontinence. This was a randomized sham-controlled clinical trial from 2008 to 2015. This study was conducted in an outpatient clinic. Forty patients with fecal incontinence in whom maximal conservative management had failed were randomly assigned to receiving either radiofrequency energy or sham procedure. Fecal incontinence was measured using the Vaizey incontinence score (range, 0-24). The impact of fecal incontinence on quality of life was measured by using the fecal incontinence quality-of-life score (range, 1-4). Measurements were performed at baseline and at 6 months. Anorectal function was evaluated using anal manometry and anorectal endosonography at baseline and at 3 months. At baseline, Vaizey incontinence score was 16.8 (SD 2.9). At t = 6 months, the radiofrequency energy group improved by 2.5 points on the Vaizey incontinence score compared with the sham group (13.2 (SD 3.1), 15.6 (SD 3.3), p = 0.02). The fecal incontinence quality-of-life score at t = 6 months was not statistically different. Anorectal function did not show any alteration. Patients with severe fecal incontinence were included in the study, thus making it difficult to generalize the results. Both radiofrequency energy and sham procedure improved the fecal incontinence score, the radiofrequency energy procedure more than sham. Although statistically significant, the clinical impact for most of the patients was negligible. Therefore, the radiofrequency energy procedure should not be recommended for patients with fecal incontinence until patient-related factors associated with treatment success are known. See Video Abstract at http://links.lww.com/DCR/A373.

  9. Comprehensive approach for post-prostatectomy incontinence in the era of robot-assisted radical prostatectomy

    PubMed Central

    Haga, Nobuhiro; Takinami, Ruriko; Tanji, Ryo; Onagi, Akifumi; Matsuoka, Kanako; Koguchi, Tomoyuki; Akaihata, Hidenori; Hata, Junya; Ogawa, Soichiro; Kataoka, Masao; Sato, Yuichi; Ishibashi, Kei; Aikawa, Ken; Kojima, Yoshiyuki

    2017-01-01

    Abstract Robot-assisted radical prostatectomy (RARP) has enabled steady and stable surgical procedures due to both meticulous maneuvers and magnified, clear, 3-dimensional vision. Therefore, better surgical outcomes have been expected with RARP than with other surgical modalities. However, even in the RARP era, post-prostatectomy incontinence has a relatively high incidence as a bothersome complication. To overcome post-prostatectomy incontinence, it goes without saying that meticulous surgical procedures and creative surgical procedures, i.e., “Preservation”, “Reconstruction”, and “Reinforcement” of the anatomical structures of the pelvis, are most important. In addition, medication and appropriate pad usage might sometimes be helpful for patients with post-prostatectomy incontinence. However, patients who have 1) BMI > 26 kg/m2, 2) prostate volume > 70 mL, 3) eGFR < 60 mL/min, or a 4) Charlson comorbidity index > 2 have a tendency to develop post-prostatectomy incontinence despite undergoing the same surgical procedures. It is important for patients who have a high risk for post-prostatectomy incontinence to be given information about delayed recovery of post-prostatectomy incontinence. Thus, not only the surgical procedures, but also a comprehensive approach, as mentioned above, are important for post-prostatectomy incontinence. PMID:28747618

  10. Percutaneous cecostomy in the management of organic fecal incontinence in children

    PubMed Central

    Donkol, Ragab Hani; Al-Nammi, Ahmed

    2010-01-01

    AIM: To assess the effectiveness and safety of imaging-guided percutaneous cecostomy in the management of pediatric patients with organic fecal incontinence. METHODS: Twenty three cecostomies were performed on 21 children with organic fecal incontinence (13 males, 8 females), aged from 5 to 16 years (mean 9.5 years). Thirteen patients had neurogenic fecal incontinence and 8 patients had anorectal anomalies. Procedures were performed under general anesthesia and fluoroscopic guidance. Effectiveness and complication data were obtained for at least 1 year after the procedure. RESULTS: Cecostomy was successful in 20 patients (primary technical success rate 95%). Cecostomy failed in one patient due to tube breakage (secondary technical success rate 100%). The tubes were in situ for an average of 18 mo (range 12-23 mo). Eighteen patients (87%) expressed satisfaction with the procedures. Resolution of soiling was achieved in all patients with neurogenic fecal incontinence (100%) and in 5 of 8 patients with anorectal anomalies (62.5%). Eleven patients (52%) experienced minor problems. No major complications were noted. CONCLUSION: Percutaneous cecostomy improves the quality of life in children with organic fecal incontinence. A satisfactory outcome is more prevalent in patients with neurogenic fecal incontinence than anorectal anomalies. PMID:21225001

  11. Long-term clinical outcomes with the retropubic tension-free vaginal tape (TVT) procedure compared to Burch colposuspension for correcting stress urinary incontinence (SUI).

    PubMed

    Holdø, Bjørn; Verelst, Margareta; Svenningsen, Rune; Milsom, Ian; Skjeldestad, Finn Egil

    2017-11-01

    The retropubic tension-free vaginal tape (TVT) procedure replaced Burch colposuspension as the primary surgical method for stress urinary incontinence (SUI) and mixed urinary incontinence (MUI) in women in our department in 1998. In this study we compared the short-term and long-term clinical outcomes of these surgical procedures. Using a case series design, we compared the last 5 years of the Burch procedure (n = 127, 1994-1999) with the first 5 years of the retropubic TVT procedure (n = 180, 1998-2002). Information from the medical records was transferred to a case report form comprising data on perioperative and long-term complications as well as recurrence of UI, defined as bothersome UI or UI in need of repeat surgery. Other endpoints were rates of perioperative and late complications and the rates of prolapse surgery after primary surgery. The data were analyzed with the chi-squared and t tests and survival analysis using SPSS. The cumulative recurrence rate of SUI in women with preoperative SUI was significantly higher after the Burch procedure, but no difference was observed in women with MUI. There were no significant differences in rates of perioperative and late complications. At 12 years there was a significant increase in rates of repeat surgery for incontinence and prolapse in women after the Burch procedure. The long-term efficacy of TVT surgery was superior to that of Burch colposuspension in women with SUI. In addition, the rate of late prolapse surgery was significantly higher after the Burch procedure.

  12. Therapeutic Efficacy of a New Procedure for Male Urinary Incontinence Combining a Suburethral Polypropylene Mesh and Cardiovascular Patch

    PubMed Central

    Jiang, Yuan-Hong

    2017-01-01

    Purpose Stress urinary incontinence (SUI) in men is a complication secondary to prostatectomy or resulting from neurological lesions. This study presents our experiences with male suburethral slings over the past decade. Methods In this study, we considered patients who presented with SUI and were diagnosed with an intrinsic sphincteric deficiency due to postprostatectomy incontinence (PPI) or other causes (non-PPI). Patients who underwent the suburethral sling procedure using a polypropylene mesh and a cardiovascular patch were retrospectively included. An urodynamic study was performed before and after the operation. Global response assessment (GRA) and SUI grading were used for surgical outcome. The revision rate and the infection rate were also evaluated. Results A total 31 patients were enrolled in this study; the mean patient age was 59.5±18.9 years, and the mean follow-up period was 36.9±29.4 months. Fourteen patients comprised the non-PPI group and 17 were in the PPI group. The preoperative SUI of all patients were categorized as a moderate to severe problem according to the SUI grade, with a mean score of 2.32±0.48 before the operation and 0.48±0.57 after the operation. With a mean score of 2.35±0.71, GRA showed that the patients were satisfied with the treatment. After the sling procedure, 4 patients (13%) reported a mild improvement, 12 (38.7%) a moderate improvement, while 15 (48.4%) reported an excellent improvement. Six patients (19.4%), including 5 from the non-PPI group (35.7%) and 1 (5.9%) from the PPI group (P=0.037), underwent sling removal because of infection. Conclusions The male suburethral sling procedure using a polypropylene mesh and a cardiovascular patch is a safe, efficacious, and inexpensive surgical procedure for PPI. In cases of neurological incontinence, however, the higher infection rate in non-PPI patients means that they should be carefully managed. PMID:28361511

  13. Electronic Monitoring Systems to Assess Urinary Incontinence: A Health Technology Assessment

    PubMed Central

    Nevis, Immaculate; Kabali, Conrad; Anh Tu, Hong; Ekanayake, Samanthika; Mistry, Jigna; Wells, David; Ali, Arshia; Walter, Melissa; Higgins, Caroline

    2018-01-01

    Background Urinary incontinence is involuntary leakage of urine and can affect people of all ages. Incidence rises as people age, often because of reduced mobility or conditions affecting the nervous system, such as dementia and stroke. Urinary incontinence can be a distressing condition and can harm a person's physical, financial, social, and emotional well-being. People with urinary incontinence are susceptible to skin irritation, pressure sores, and urinary tract infections. Urinary incontinence is also associated with an increased risk of falls in older adults. This health technology assessment examined the effectiveness of, budget impact of, and patient values and preferences about electronic monitoring systems to assess urinary incontinence for residents of long-term care homes or geriatric hospital inpatients with complex conditions. Methods A clinical evidence review of the published clinical literature was conducted to June 9, 2017. Critical appraisal of the clinical evidence included assessment of risk of bias and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Working Group criteria to reflect the certainty of the evidence. We calculated the funding required for an electronic urinary incontinence monitoring system in the first year of implementation (when facilities would buy the systems) and in subsequent years. We interviewed six people with urinary incontinence and two caregivers, who described ways urinary incontinence affected daily life. Results We included one observational study in the clinical review. Most of the 31 participants in the observational study were female (78%) and required high levels of care, primarily because of cognitive impairment. The quality of evidence for all outcomes was very low owing to potential risk of bias and indirectness. We are consequently uncertain about how electronic monitoring systems affect management of urinary incontinence. For patients living in long-term care homes who are

  14. Electronic Monitoring Systems to Assess Urinary Incontinence: A Health Technology Assessment.

    PubMed

    2018-01-01

    Urinary incontinence is involuntary leakage of urine and can affect people of all ages. Incidence rises as people age, often because of reduced mobility or conditions affecting the nervous system, such as dementia and stroke. Urinary incontinence can be a distressing condition and can harm a person's physical, financial, social, and emotional well-being. People with urinary incontinence are susceptible to skin irritation, pressure sores, and urinary tract infections. Urinary incontinence is also associated with an increased risk of falls in older adults.This health technology assessment examined the effectiveness of, budget impact of, and patient values and preferences about electronic monitoring systems to assess urinary incontinence for residents of long-term care homes or geriatric hospital inpatients with complex conditions. A clinical evidence review of the published clinical literature was conducted to June 9, 2017. Critical appraisal of the clinical evidence included assessment of risk of bias and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Working Group criteria to reflect the certainty of the evidence.We calculated the funding required for an electronic urinary incontinence monitoring system in the first year of implementation (when facilities would buy the systems) and in subsequent years.We interviewed six people with urinary incontinence and two caregivers, who described ways urinary incontinence affected daily life. We included one observational study in the clinical review. Most of the 31 participants in the observational study were female (78%) and required high levels of care, primarily because of cognitive impairment. The quality of evidence for all outcomes was very low owing to potential risk of bias and indirectness. We are consequently uncertain about how electronic monitoring systems affect management of urinary incontinence.For patients living in long-term care homes who are eligible for the technology, we

  15. Utilization of apical vaginal support procedures at time of inpatient hysterectomy performed for benign conditions: a national estimate.

    PubMed

    Ross, Whitney Trotter; Meister, Melanie R; Shepherd, Jonathan P; Olsen, Margaret A; Lowder, Jerry L

    2017-10-01

    Apical vaginal support is considered the keystone of pelvic organ support. Level I evidence supports reestablishment of apical support at time of hysterectomy, regardless of whether the hysterectomy is performed for prolapse. National rates of apical support procedure performance at time of inpatient hysterectomy have not been well described. We sought to estimate trends and factors associated with use of apical support procedures at time of inpatient hysterectomy for benign indications in a large national database. The National (Nationwide) Inpatient Sample was used to identify hysterectomies performed from 2004 through 2013 for benign indications. International Classification of Diseases, Ninth Revision, Clinical Modification codes were used to select both procedures and diagnoses. The primary outcome was performance of an apical support procedure at time of hysterectomy. Descriptive and multivariable analyses were performed. There were 3,509,230 inpatient hysterectomies performed for benign disease from 2004 through 2013. In both nonprolapse and prolapse groups, there was a significant decrease in total number of annual hysterectomies performed over the study period (P < .0001). There were 2,790,652 (79.5%) hysterectomies performed without a diagnosis of prolapse, and an apical support procedure was performed in only 85,879 (3.1%). There was a significant decrease in the proportion of hysterectomies with concurrent apical support procedure (high of 4.0% in 2004 to 2.5% in 2013, P < .0001). In the multivariable logistic regression model, increasing age, hospital type (urban teaching), hospital bed size (large and medium), and hysterectomy type (vaginal and laparoscopically assisted vaginal) were associated with performance of an apical support procedure. During the study period, 718,578 (20.5%) inpatient hysterectomies were performed for prolapse diagnoses and 266,743 (37.1%) included an apical support procedure. There was a significant increase in the proportion

  16. Urinary incontinence - injectable implant

    MedlinePlus

    ... injections of material into the urethra to help control urine leakage ( urinary incontinence ) caused by a weak urinary sphincter. ... choose to have implants. Women who have urine leakage and want a ... procedure to control the problem may choose to have an implant ...

  17. Stress Incontinence

    MedlinePlus

    Stress incontinence Overview Urinary incontinence is the unintentional loss of urine. Stress incontinence happens when physical movement or activity — such ... coughing, sneezing, running or heavy lifting — puts pressure (stress) on your bladder. Stress incontinence is not related ...

  18. The TVT-obturator surgical procedure for the treatment of female stress urinary incontinence: a clinical update.

    PubMed

    Waltregny, David; de Leval, Jean

    2009-03-01

    Six years ago, the inside-out transobturator tape TVT-O procedure was developed for the surgical treatment of female stress urinary incontinence (SUI) with the aim of minimizing the risk of urethra and bladder injuries and ensuring minimal tissue dissection. Initial feasibility and efficacy studies suggested that the TVT-O procedure is associated with high SUI cure rates and low morbidity at short term. A recent analysis of medium-term results indicated that the TVT-O procedure is efficient, with maintenance, after a 3-year minimum follow-up, of cure rates comparing favorably with those reported for TVT. No late complications were observed. As of July 2008, more than 35 clinical papers, including ten randomized trials and two national registries, have been published on the outcome of the TVT-O surgery. Results from these studies have confirmed that the TVT-O procedure is safe and as efficient as the TVT procedure, at least in the short/medium term.

  19. Sepsis and multiorgan failure following TVT procedure.

    PubMed

    Stec, Piotr; Connell, Rowan

    2014-04-01

    Tension-free vaginal tape (TVT), is a commonly performed, low risk procedure for treatment of stress urinary incontinence (SUI). Severe complications are rare, but can be potentially life threatening. We present a case of 66 year old patient who sustained bladder perforation at the time of TVT procedure and subsequently developed sepsis rapidly leading to multi-organ failure and triggering sequence of serious complications. During her inpatient stay she required ITU admission, emergency laparotomy, TVT mesh removal, bowel resection due to ischemic colitis and anticoagulation for pulmonary embolism. Despite of clinical picture of sepsis her microbiology tests were almost consistently negative. This case emphasise importance of awareness and quick recognition of TVT related complications. Patient ultimately survived and recovered thanks to timely and coordinated management by the multidisciplinary team of doctors.

  20. Sacral Nerve Stimulation For Urinary Urge Incontinence, Urgency-Frequency, Urinary Retention, and Fecal Incontinence

    PubMed Central

    2005-01-01

    Executive Summary Objective The aim of this review was to assess the effectiveness, safety, and cost of sacral nerve stimulation (SNS) to treat urinary urge incontinence, urgency-frequency, urinary retention, and fecal incontinence. Background: Condition and Target Population Urinary urge incontinence, urgency-frequency, urinary retention, and fecal incontinence are prevalent, yet rarely discussed, conditions. They are rarely discussed because patients may be uncomfortable disclosing their symptoms to a health professional or may be unaware that there are treatment options for these conditions. Briefly, urge incontinence is an involuntary loss of urine upon a sudden urge. Urgency-frequency is an uncontrollable urge to void, which results in frequent, small-volume voids. People with urgency-frequency may or may not also experience chronic pelvic pain. Urinary retention refers to the inability to void despite having the urge to void. It can be caused by a hypocontractile detrusor (weak or no bladder muscle contraction) or obstruction due to urethral overactivity. Fecal incontinence is a loss of voluntary bowel control. The prevalence of urge incontinence, urgency-frequency, and urinary retention in the general population is 3.3% to 8.2%, and the prevalence of fecal incontinence is 1.4% to 1.9%. About three-quarters of these people will be successfully treated by behaviour and/or drug therapy. For those who do not respond to these therapies, the options for treatment are management with diapers or pads, or surgery. The surgical procedures are generally quite invasive, permanent, and are associated with complications. Pads and/or diapers are used throughout the course of treatment as different therapies are tried. Patients who respond successfully to treatment may still require pads or diapers, but to a lesser extent. The Technology Being Reviewed: Sacral Nerve Stimulation Sacral nerve stimulation is a procedure where a small device attached to an electrode is

  1. Candida albicans colonisation, continence status and incontinence-associated dermatitis in the acute care setting: a pilot study.

    PubMed

    Campbell, Jill L; Coyer, Fiona M; Mudge, Alison M; Robertson, Ivan M; Osborne, Sonya R

    2017-06-01

    Candida albicans is the most prevalent human fungal commensal organism and is reported to be the most frequent aetiological organism responsible for infection associated with incontinence-associated dermatitis. However, it remains unclear whether incontinence predisposes a patient to increased Candida colonisation or whether incontinence acts as a trigger for Candida infection in those already colonised. The purpose of this observational cross-sectional study was to estimate colonisation rates of C. albicans in continent, compared to incontinent patients, and patients with incontinence-associated dermatitis. Data were collected on 81 inpatients of a major Australian hospital and included a pelvic skin inspection and microbiological specimens to detect C. Albicans at hospital admission. The mean age of the sample was 76 years (SD = 12.22) with 53% being male. Incontinent participants (n = 53) had a non-significant trend towards greater Candida colonisation rates at the perianal site (43% versus 28%) χ 2 (1, N = 81) = 4·453, p = ·638 and the inguinal site (24% versus 14%) χ 2 (1, N = 81) = 6·868, p = ·258 compared to continent patients (n = 28). The incontinent subgroup with incontinence-associated dermatitis (n = 22) showed no difference in colonisation rates compared to those without incontinence-associated dermatitis. Understanding the epidemiology of colonisation may have implications for the prevention of Candida infection in these patients. © 2016 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

  2. Minimally invasive surgical techniques for stress incontinence surgery.

    PubMed

    Morley, Roland; Nethercliffe, Janine

    2005-12-01

    Minimally invasive techniques for surgical correction of stress incontinence date back to the late 1950s. Since that time there have been many developments to attempt to emulate the good results achieved by open surgery with less surgical morbidity. Needle suspensions have attempted to reposition the bladder neck in the same way as a colposuspension. However, although numerous variations have been described, they do not have the long-term outcomes of colposuspension. These variations, their complications and long-term outcome are discussed. Sling surgery, especially the tension-free vaginal tape (TVT), has probably had the largest impact on incontinence surgery in recent years, offering a procedure with low morbidity and, thus far in the medium term, outcomes comparable with those of more invasive procedures. This has led the TVT procedure to become the most common procedure performed worldwide for stress incontinence. With the benefit of lessons learnt from the use of synthetic material in the genitourinary tract, some worries remain with regard to the long-term complications of TVT. Other non-synthetic material should not be forgotten, and the advantages and disadvantages of various sling materials are compared. Injectables have an established place in the treatment of sphincter deficiency, though long-term results are poor compared to those of other procedures. Various materials used and the technique for their injection are discussed.

  3. Incontinence - resources

    MedlinePlus

    Resources - incontinence ... The following organizations are good resources for information on incontinence. Fecal incontinence : The American College of Obstetricians and Gynecologists -- www.acog.org/-/media/For-Patients/faq139.pdf? ...

  4. Maintaining standards for surgery for female urinary incontinence.

    PubMed

    Riss, P; Hinterholzer, S

    2010-01-01

    MAINTAINING STANDARDS IN SURGERY FOR FEMALE URINARY INCONTINENCE: Operations for female stress urinary incontinence (SUI) are among the most common operations performed. In particular, recent advances in surgical technique and materials available for this type of surgery have made these operations more accessible, but even if an operation is characterized as "minimally invasive" surgeons must aim to maintain the highest possible standards in the interest of their patients. STANDARDS IN PATIENT SELECTION: Great care has to be taken to do a thorough workup of a patient about to undergo surgery. A detailed history and a good clinical evaluation including a clinical stress test is a prerequisite. It is highly recommended to do an urodynamic investigation prior to any surgery which affects bladder storage and micturition in order to confirm the presumptive diagnosis and to exclude patients who should not undergo surgery (e.g. with voiding disorders). STANDARDS IN SURGERY: Before taking a patient to theatre the surgeon must be clear in him or her mind about which operation to do. In other words preoperative selection of the appropriate type of operation is of the greatest importance. For this reason every surgeon has to be familiar with a certain range of incontinence procedures from which she can choose in a particular instance. There is no doubt that tension-free mid-urethral slings have become the procedures of choice in most cases of stress urinary incontinence. However, there will be cases where other procedures are called for such as traditional colposuspension or fascial slings. It is the responsibility of every surgeon not to use procedures which are outdated or not recommended. To maintain standards in incontinence surgery every surgeon has to familiarize him or herself with the procedure, to learn the procedure, to practice the procedure with the help of experienced peers, and finally to achieve the highest level of competence him or herself. So-called Industry

  5. An Evaluation of the Effects of the Transobturator Tape Procedure on Sexual Satisfaction in Women with Stress Urinary Incontinence Using the Libido Scoring System

    PubMed Central

    Narin, Raziye; Nazik, Hakan; Narin, Mehmet Ali; Aytan, Hakan; Api, Murat

    2013-01-01

    Introduction and Hypothesis. Most women experience automatic urine leakage in their lifetimes. SUI is the most common type in women. Suburethral slings have become a standard surgical procedure for the treatment of stress urinary incontinence when conservative therapy failed. The treatment of stress urinary incontinence by suburethral sling may improve body image by reducing urinary leakage and may improve sexual satisfaction. Methods. A total of 59 sexually active patients were included in the study and underwent a TOT outside-in procedure. The LSS was applied in all patients by self-completion of questionnaires preoperatively and 6 months after the operation. General pleasure with the operation was measured by visual analogue score (VAS). Pre- and postoperative scores were recorded and analyzed using SPSS 11.5. Results. Two parameters of the LSS, orgasm and who starts the sexual activity, increased at a statistically significant rate. Conclusion. Sexual satisfaction and desire have partially improved after the TOT procedure. PMID:24288621

  6. Incontinence Treatment: Newer Treatment Options

    MedlinePlus

    ... Living with Incontinence Incontinence and Relationships Incontinence and Aging Managing Incontinence Managing Incontinence: A Survey The Patient's ... Living with Incontinence Incontinence and Relationships Incontinence and Aging Managing Incontinence Managing Incontinence: A Survey The Patient's ...

  7. Incontinence Treatment: Medication

    MedlinePlus

    ... Incontinence Managing Incontinence: A Survey The Patient's Perspective Barriers on Diagnosis and Treatment Personal Stories Contact Us ... Incontinence Managing Incontinence: A Survey The Patient's Perspective Barriers on Diagnosis and Treatment Personal Stories Contact Us ...

  8. Symptoms of Incontinence

    MedlinePlus

    ... Incontinence Managing Incontinence: A Survey The Patient's Perspective Barriers on Diagnosis and Treatment Personal Stories Contact Us ... Incontinence Managing Incontinence: A Survey The Patient's Perspective Barriers on Diagnosis and Treatment Personal Stories Contact Us ...

  9. Inpatients hypospadias care: trends and outcomes from the American nationwide inpatient sample.

    PubMed

    Meyer, Christian; Sukumar, Shyam; Sood, Akshay; Hanske, Julian; Vetterlein, Malte; Elder, Jack S; Fisch, Margit; Trinh, Quoc-Dien; Friedman, Ariella A

    2015-08-01

    Hypospadias is the most common congenital penile anomaly. Information about current utilization patterns of inpatient hypospadias repair as well as complication rates remain poorly evaluated. The Nationwide Inpatient Sample was used to identify all patients undergoing inpatient hypospadias repair between 1998 and 2010. Patient and hospital characteristics were attained and outcomes of interest included intra- and immediate postoperative complications. Utilization was evaluated temporally and also according to patient and hospital characteristics. Predictors of complications and excess length of stay were evaluated by logistic regression models. A weighted 10,201 patients underwent inpatient hypospadias repair between 1998 and 2010. Half were infants (52.2%), and were operated in urban and teaching hospitals. Trend analyses demonstrated a decline in incidence of inpatient hypospadias repair (estimated annual percentage change, -6.80%; range, -0.51% to -12.69%; p=0.037). Postoperative complication rate was 4.9% and most commonly wound-related. Hospital volume was inversely related to complication rates. Specifically, higher hospital volume (>31 cases annually) was the only variable associated with decreased postoperative complications. Inpatient hypospadias repair have substantially decreased since the late 1990's. Older age groups and presumably more complex procedures constitute most of the inpatient procedures nowadays.

  10. [Study on reductive surgery for pelvic organ prolapse concomitant with anti-incontinence sling for treatment of occult stress urinary incontinence].

    PubMed

    Zhang, Xiaolong; Lu, Yongxian; Shen, Wenjie; Liu, Jingxia; Ge, Jing; Liu, Xin; Zhao, Ying; Niu, Ke; Zhang, Yinghui; Wang, Wenying; Qiu, Chengli

    2014-06-01

    between the two groups (P > 0.05). It is still difficult to make decision for concomitant anti-incontinence procedure in those patients with OSUI, who are undergoing reductive surgery because of advanced POP. Whether the patients will benefit more from anti-incontinence sling depends largely on strict preoperative evaluation for the severity of SUI. The patients with severe SUI are supposed to benefit most from anti-incontinence sling. However, a two-step approach to correct the postoperative stress urinary incontinence is also reasonable.

  11. Comparison of Efficacy and Satisfaction between the TVT-SECUR® and MONARC® Procedures for the Treatment of Female Stress Urinary Incontinence

    PubMed Central

    Jeong, Moo Youl; Kim, Su Jin; Kim, Hyo Sin; Koh, Jun Sung

    2010-01-01

    Purpose The tension-free vaginal tape SECUR® (TVT-S) is a new, minimally invasive sling procedure for treating female stress urinary incontinence (SUI). However, results of comparisons of the TVT-S with the transobturator tape (TOT) sling are lacking. Therefore, we investigated outcome and satisfaction of the TVT-S procedure compared with the TOT procedure. Materials and Methods We included 64 patients with SUI who underwent the TVT-S (n=31) or TOT (MONARC®, n=33) procedure and were followed up for more than 1 year. The preoperative evaluation included history taking, pelvic examination, consecutive 3-day voiding diary, and urodynamic study including Valsalva leak point pressure. Postoperatively, continence status and subjective patient satisfaction were evaluated. Cure was defined as the absence of any episodes of involuntary urine leakage during stressful activities and a stress cough test. Results The TVT-S group (71.0%) showed a slightly lower cure rate than did the MONARC group (84.8%); however, there was no significant difference between the 2 groups (p=0.179). Nine of the patients who underwent the TVT-S showed incontinence postoperatively. Among them, the H approach was used in 7 patients and the U approach was done in 2 patients. Following TVT-S and MONARC, the patients' reported satisfaction was 80.6% and 78.8%, respectively. Patient satisfaction did not differ significantly between the two groups (p=0.854). Conclusions Our results showed that the TVT-S and MONARC procedures may be comparable in terms of cure rate and patient satisfaction after more than 1 year of follow-up. PMID:21165197

  12. Comparison of Efficacy and Satisfaction between the TVT-SECUR® and MONARC® Procedures for the Treatment of Female Stress Urinary Incontinence.

    PubMed

    Jeong, Moo Youl; Kim, Su Jin; Kim, Hyo Sin; Koh, Jun Sung; Kim, Joon Chul

    2010-11-01

    The tension-free vaginal tape SECUR® (TVT-S) is a new, minimally invasive sling procedure for treating female stress urinary incontinence (SUI). However, results of comparisons of the TVT-S with the transobturator tape (TOT) sling are lacking. Therefore, we investigated outcome and satisfaction of the TVT-S procedure compared with the TOT procedure. We included 64 patients with SUI who underwent the TVT-S (n=31) or TOT (MONARC®, n=33) procedure and were followed up for more than 1 year. The preoperative evaluation included history taking, pelvic examination, consecutive 3-day voiding diary, and urodynamic study including Valsalva leak point pressure. Postoperatively, continence status and subjective patient satisfaction were evaluated. Cure was defined as the absence of any episodes of involuntary urine leakage during stressful activities and a stress cough test. The TVT-S group (71.0%) showed a slightly lower cure rate than did the MONARC group (84.8%); however, there was no significant difference between the 2 groups (p=0.179). Nine of the patients who underwent the TVT-S showed incontinence postoperatively. Among them, the H approach was used in 7 patients and the U approach was done in 2 patients. Following TVT-S and MONARC, the patients' reported satisfaction was 80.6% and 78.8%, respectively. Patient satisfaction did not differ significantly between the two groups (p=0.854). Our results showed that the TVT-S and MONARC procedures may be comparable in terms of cure rate and patient satisfaction after more than 1 year of follow-up.

  13. Midurethral Slings for Women with Stress Urinary Incontinence

    PubMed Central

    2006-01-01

    Executive Summary Objective The objective of the current review was to evaluate the safety, efficacy, and cost-effectiveness of midurethral slings compared with traditional surgery. Background This assessment was undertaken in order to update and expand upon the health technology & policy assessment of tension-free vaginal tape (TVT, Gynecare Worldwide, a division of Ethicon Inc, a Johnson & Johnson company, Somerville, New Jersey) sling procedure for stress urinary incontinence published by the Medical Advisory Secretariat in February 2004. Since the publication of the 2004 assessment, a number of TVT-like sling alternatives have become available which employ the same basic principles as TVT slings: minimally invasive, midurethral placement, self-fixing, and tension-free. This update will evaluate the efficacy and safety of midurethral slings. Clinical Need Normal continence is controlled by the nervous system and involves co-ordination between bladder, urethra, urethral sphincter, and pelvic floor. Incontinence occurs when the relationship among the above components is compromised, either due to physical damage or nerve dysfunction. (1) Stress urinary incontinence is the most common form of urinary incontinence in women. It is characterized by the “complaint of involuntary leakage on effort or exertion, or on sneezing or coughing” when there is increased abdominal pressure without detrusor (bladder wall) contraction. (2) There are 2 factors which define stress urinary incontinence: a weakening in the support of the proximal urethra, causing urethral hyper-mobility and deficiency in the sphincter, causing urethral leakage. Both factors are thought to coexist. (1) Accurate tests are not available to distinguish these 2 types of stress urinary incontinence. Urinary incontinence is estimated to affect about 250,000 Canadian women and 8 million American women aged 65 and over. (3;4) The prevalence of stress urinary incontinence is very difficult to measure because

  14. [Female stress urinary incontinence. Surgical repair with pubovaginal sling techniques].

    PubMed

    Escribano Patiño, Gregorio; Hernández Fernández, Carlos; Subirá Ríos, David; Castaño González, Irene; Moralejo Gárate, Mercedes; Martinez Salamanca, Juan Ignacio

    2002-11-01

    To review the treatment of female stress urinary incontinence by new systems of tension-free urethral sling TVT type (Tension free vaginal tape) or IVS (intravaginal slingplasty), and the bone anchoring trasvaginal sling procedure Infast. We describe the surgical techniques of the various procedures and perform a bibliographic review on the topic. The pubovaginal sling has become the gold standard in the treatment of female stress urinary incontinence, mainly if there is sphincter intrinsic dysfunction. The concept of tension free medium urethra support has been the most important contribution, that questions the classification of incontinence in types I, II and III, because the pubocervical tension free sling can correct all three. Tension free urethral sling techniques have demonstrated to be effective, minimally invasive with a low complication rate, easily reproducible, and with good continence results in the mid-term.

  15. 42 CFR 416.75 - Performance of listed surgical procedures on an inpatient hospital basis.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Scope of Benefits for Services Furnished Before January 1, 2008 § 416.75 Performance of listed surgical... 42 Public Health 3 2014-10-01 2014-10-01 false Performance of listed surgical procedures on an inpatient hospital basis. 416.75 Section 416.75 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES...

  16. Inpatients hypospadias care: Trends and outcomes from the American nationwide inpatient sample

    PubMed Central

    Sukumar, Shyam; Sood, Akshay; Hanske, Julian; Vetterlein, Malte; Elder, Jack S.; Fisch, Margit; Trinh, Quoc-Dien; Friedman, Ariella A.

    2015-01-01

    Purpose Hypospadias is the most common congenital penile anomaly. Information about current utilization patterns of inpatient hypospadias repair as well as complication rates remain poorly evaluated. Materials and Methods The Nationwide Inpatient Sample was used to identify all patients undergoing inpatient hypospadias repair between 1998 and 2010. Patient and hospital characteristics were attained and outcomes of interest included intra- and immediate postoperative complications. Utilization was evaluated temporally and also according to patient and hospital characteristics. Predictors of complications and excess length of stay were evaluated by logistic regression models. Results A weighted 10,201 patients underwent inpatient hypospadias repair between 1998 and 2010. Half were infants (52.2%), and were operated in urban and teaching hospitals. Trend analyses demonstrated a decline in incidence of inpatient hypospadias repair (estimated annual percentage change, -6.80%; range, -0.51% to -12.69%; p=0.037). Postoperative complication rate was 4.9% and most commonly wound-related. Hospital volume was inversely related to complication rates. Specifically, higher hospital volume (>31 cases annually) was the only variable associated with decreased postoperative complications. Conclusions Inpatient hypospadias repair have substantially decreased since the late 1990's. Older age groups and presumably more complex procedures constitute most of the inpatient procedures nowadays. PMID:26279829

  17. A Proximal Straining Mesh Location Is Associated With De Novo Stress Urinary Incontinence After Transobturator Mesh Procedures.

    PubMed

    Huang, Wen-Chen; Yang, Jenn-Ming

    2017-03-01

    The purpose of this study was to explore the association between mesh location and de novo stress urinary incontinence (SUI) after transvaginal mesh procedures. We retrospectively analyzed a database of women who had received transvaginal mesh procedures for stage III or greater cystocele according to the Pelvic Organ Prolapse Quantification system. Only data for women who neither reported SUI preoperatively nor had received concomitant anti-incontinence surgery were included for analyses. The mesh location was investigated by sonography via the percentage of the urethra covered by mesh, defined as the number calculated by dividing the portion of the urethral length covered by mesh (the distance from the bladder neck to the point of the urethra, which was indicated by an imaginary line at the level of the lower [caudal] mesh end and perpendicular to the urethra) by the total urethral length (the distance from the bladder neck to the external urethral meatus) in the sagittal plane. The resting, straining, coughing, and squeezing mesh locations of women who did (n = 29) and did not (n = 54) report SUI at the 12-month follow-up were compared. At the 12-month follow-up, women who reported SUI had a significantly smaller straining percentage of the urethra covered by mesh (mean ± SD, 28.5% ± 9.6%) compared with continent women (35.2% ± 15.8%), indicating a more proximal straining mesh location. Sonography is useful in investigating the location of the transvaginal mesh. De novo SUI after transvaginal mesh procedures is associated with a more proximal straining mesh location. © 2017 by the American Institute of Ultrasound in Medicine.

  18. Findings of universal cystoscopy at incontinence surgery and their sequelae

    PubMed Central

    Zyczynski, Halina M.; Sirls, Larry T.; Greer, W. Jerod; Rahn, David D.; Casiano, Elizabeth; Norton, Peggy; Kim, Hae-Young; Brubaker, Linda

    2014-01-01

    OBJECTIVE The purpose of this study was to report the frequency of abnormal cystoscopy at incontinence surgery and to identify risk factors and sequelae of injury. STUDY DESIGN Findings of cystoscopy were collected prospectively in 3 multicenter surgical trials. Clinical, demographic, and procedure characteristics and surgeon experience were analyzed for association with iatrogenic injury and noninjury abnormalities. Impact of abnormalities on continence outcomes and adverse events during 12 months after the procedure were assessed. RESULTS Abnormal findings in the bladder or urethra were identified in 95 of 1830 women (5.2%). Most injuries (75.8%) were iatrogenic. Lower urinary tract (LUT) injury was most common at retropubic urethropexy and retropubic midurethral sling procedures (MUS; 6.4% each), followed by autologous pubovaginal sling procedures (1.7%) and transobturator MUS (0.4%). Increasing age (56.9 vs 51.9 years; P = .04), vaginal deliveries (3.2 vs 2.6; P = .04), and blood loss (393 vs 218 mL; P=.01) were associated with LUT injury during retropubic urethropexy; however, only age (62.9 vs 51.4 years; P = .02) and smoking history (P = .04) were associated for pubovaginal sling procedures. No factors correlated with increased risk of injury at retropubic and transobturator MUS. Notably, previous incontinence surgery, concomitant procedures, anesthesia type, and trainee participation did not increase LUT injury frequency. Although discharge with an indwelling catheter was more common after trocar perforation compared with the noninjury group (55.6% vs 18.5%; P < .001), they did not differ in overall success, voiding dysfunction, recurrent urinary tract infections, or urge urinary incontinence. CONCLUSION Universal cystoscopy at incontinence surgery detects abnormalities in 1 in 20 women. Urinary trocar perforations that are addressed intraoperatively have no long-term adverse sequelae. PMID:24380742

  19. Use of Concomitant Stress Incontinence Surgery at Time of Pelvic Organ Prolapse Surgery Since Release of the 2011 Notification on Serious Complications Associated with Transvaginal Mesh.

    PubMed

    Drain, Alice; Khan, Aqsa; Ohmann, Erin L; Brucker, Benjamin M; Smilen, Scott; Rosenblum, Nirit; Nitti, Victor W

    2017-04-01

    There is controversy regarding the performance of concomitant anti-incontinence procedures at the time of pelvic organ prolapse repair. Data support improvement in stress urinary incontinence with a concomitant sling but increased adverse events. We assessed trends in preoperative stress urinary incontinence evaluation, concomitant anti-incontinence procedure at pelvic organ prolapse surgery and postoperative anti-incontinence procedures at our institution before and after the 2011 FDA (U.S. Food and Drug Administration) Public Health Notification pertaining to vaginal mesh. We retrospectively reviewed the records of patients who underwent pelvic organ prolapse surgery from 2009 to 2015. Preoperative workup included assessment of subjective stress urinary incontinence and/or evaluation for leakage with reduction of pelvic organ prolapse on physical examination, urodynamics or a pessary trial. The percentages of concomitant and postoperative anti-incontinence procedures were compared before and after the 2011 FDA notification. A total of 775 women underwent pelvic organ prolapse repair. The percentage of anti-incontinence procedures at pelvic organ prolapse repair decreased from 54.8% to 38.0% after the FDA notification (p = 0.002) while the incidence of preoperative objective stress urinary incontinence on examination, urodynamics and pessary trials remained constant. The incidence of postoperative anti-incontinence procedures within 1 year of the index surgery remained low. We found a decrease in the incidence of concomitant anti-incontinence procedures at the time of pelvic organ prolapse repair following the 2011 FDA notification despite no significant decline in subjective stress urinary incontinence or demonstrable stress urinary incontinence on preoperative evaluation. Further analysis is warranted to assess the impact of the FDA notification on treatment patterns in women with pelvic organ prolapse and stress urinary incontinence. Copyright © 2017 American

  20. Short-term effect of TVT-SECUR procedure on quality of life and sexual function in women with stress urinary incontinence.

    PubMed

    Tang, Xiang; Zhu, Lan; Zhong, Wen; Li, Bin; Lang, Jinghe

    2013-01-01

    To investigate whether patient quality of life and sexual function are improved after the tension-free vaginal tape SECUR (TVT-S) procedure (H-type). Prospective study (Canadian Task Force classification II-3). Single-center hospital. Thirty-three women with stress urinary incontinence (SUI) (high urethral mobility) and no concomitant pelvic floor prolapse underwent TVT-S between October 2009 and October 2011. TVT-S procedure. Before and after surgery(6 and 12 months), all patients completed the Chinese version of the Incontinence Quality of Life Questionnaire (I-QOL). In addition, 28 sexually active patients who underwent the TVT-S procedure completed the short-form Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ-12) before and after surgery (6 and 12 months). We used a paired t test to compare I-QOL scores before and after surgery. The Wilcoxon signed-rank test was used to compare the preoperative and postoperative PISQ scores. The objective cure rate was 78% (26 of 33 patients) at 12 months after surgery. The objective improvement rate was 12.1% (4 of 33 patients). The subjective satisfaction rate was 90%. Three operations (9.1%) were considered failures. Two patients underwent a TVT procedure after TVT-S because of recurrence. No patients reported severe pain; the mean (SD) visual analog scale pain score was 1.8 (1.2) after surgery. Only 1 patient (3%) was found to have sling erosion at 12 months postoperatively. The I-QOL score was 28.3 (14.2) before surgery and increased to 69.5 (18.9) at 12 months after the TVT-S procedure. The I-QOL score improved significantly after surgery (p <.001). The total PISQ-12 score at 6 months after surgery in all sexually active patients was 33.82 (0.87), compared with 31.57 (1.20) before surgery (p <.05). Physical domain scores on the PISQ-12 demonstrated significant improvement, increasing from 12.61 (0.75) to 14.36 (0.49) (p <.05). No significant difference was found between I-QOL and PISQ-12

  1. [TVT tape usage in the treatment of stress urinary incontinence].

    PubMed

    Włodarczyk, Bogumił; Szyłło, Krzysztof; Kamer-Bartosińska, Anna; Lewy, Jarosław

    2003-10-01

    Stress urinary incontinence is one of the most common gynecological complains. The frequency of its occurrence is from 12 to 25 and even 60%. It is most often observed in patients after menopause, but in a few percent is also found in twenty and thirty years old women. During several years of searching the effective methods of stress urinary incontinence treatment, many operative techniques have been worked out, but none of them became a perfect one. The operation with the use of TVT tape is one of the newest methods of the stress urinary incontinence treatment. The aim of our study was the attempt of the estimation the TVT operation effectiveness in the treatment of stress urinary incontinence in women treated in Surgical Gynecology Department of Polish Mother Health Centre Research Institute in years 2000-2002. Performed analysis of 60 patients at the age between 38 and 76 years revealed that stress urinary incontinence symptoms regressed after TVT operation, as evaluated 7 days after the procedure. In 51.7% of patients anterior colpoplasty or colpoperineoplasty was performed simultaneously to TVT operation. Control studies were performed a month and six months after the operation. Recurrence of the symptoms was observed in 11.7% of the patients. Revealed data let us show that the efficacy of this procedure is very high and reaches 88.3%.

  2. Utilization of penile prosthesis and male incontinence prosthetics in Saudi Arabia.

    PubMed

    Alwaal, Amjad; Al-Sayyad, Ahmad J

    2017-01-01

    Erectile dysfunction is a prevalent disease affecting over 50% of men between the ages of 40 and 70 years. Penile prosthesis represents the end of the line treatment when other less invasive therapies fail or are contraindicated. Male stress urinary incontinence can significantly diminish quality of life and lead to embarrassment and social withdrawal. Surgical therapies, such as male urethral slings and artificial urinary sphincters (AUS), are considered effective and safe treatments for male stress incontinence. No data exist on the utilization of penile prosthesis or male incontinence surgical treatment in Saudi Arabia. Generally, urological prosthetic surgery is performed either in private hospitals or in government hospitals. Our aim was to assess the trend of penile prosthesis and male incontinence device utilization in Saudi Arabia. We utilized sales' data of penile prosthetics, male slings, and AUS from the only two companies selling these devices in Saudi Arabia (AMS ® and Coloplast ® ), from January 2013 to December 2016. There were 2599 penile prosthesis implantation procedures done in the study period, with 67% of them performed in private institutions. There was a progressively increased use of penile prosthetics which nearly doubled from 2013 to 2016. The main type of prosthesis utilized was the semirigid type 70% versus 11% of the 2-piece inflatable and 17% of the 3-piece inflatable device. Only 10 slings and 31 AUS were inserted during the same study period. There is an increased utilization of penile prosthetics in Saudi Arabia. The private sector performs the majority of penile prosthesis procedures, and most of them are of the semirigid type. The governmental sector is more likely to perform inflatable penile prosthesis and male incontinence device procedures. Male incontinence prosthetics' use is very limited in Saudi Arabia.

  3. Adjustable Perineal Male Sling for the Treatment of Urinary Incontinence: Long-term Results.

    PubMed

    Altan, Mesut; Asi, Tariq; Bilen, Cenk Yucel; Ergen, Ali

    2017-08-01

    To present the long-term results in patients with urinary incontinence who were treated with adjustable perineal male sling. An adjustable male sling procedure was performed in 45 patients with a mean age of 67.6 ± 7.8 years who had urinary incontinence. The mean period between primary prostatic surgery and the sling procedure was 36.7 months. The difference between the classical sling and the adjustable one is a 10 cm tissue expander between the 2 layers of polypropylene mesh with an injection port. Adjustment of the sling was performed with saline via this port, in case of recurrence or persistence of incontinence. Mean follow-up was 48 ± 29 months. Average operative time was 101.1 ± 25.5 minutes (45-150). Median daily pad use in these patients decreased from 8(2-12) to 1(0-10) (P < .001). During long-term follow-up 37.8% used 0 pad daily, 28.9% used 1-2 pads daily, making the total success rate 66.7%. Complete dry rate was higher in patients with nonsevere incontinence compared to the others with severe incontinence (57.9% vs 23.1%, P = .029). Nevertheless, there was no significant difference in the case of total success rate (78.9% vs 57.7%, respectively; P = .135). Age was significantly greater in both complete dry group (71.1 ± 4.8 vs 65.4 ± 8.7) and total success group (70.1 ± 5.2 vs 62.4 ± 5.2) (P = .017 and P < .001, respectively). Adjustable male sling is an acceptable procedure with low complication rates especially in patients with mild and moderate incontinence. At the same time, this procedure may be offered to patients with previous incontinence surgery. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Reliability and validity of the Incontinence Quiz-Turkish version.

    PubMed

    Kara, Kerime C; Çıtak Karakaya, İlkim; Tunalı, Nur; Karakaya, Mehmet G

    2018-01-01

    The aim of this study was to investigate the reliability and validity of the Turkish version of the Incontinence Quiz, which was developed by Branch et al. (1994), to assess women's knowledge of and attitudes toward urinary incontinence. Comprehensibility of the Turkish version of the 14-item Incontinence Quiz, which was prepared following translation-back translation procedures, was tested on a pilot group of eight women, and its internal reliability, test-retest reliability and construct validity were assessed in 150 women who attended the gynecology clinics of three hospitals in İçel, Turkey. Physical and sociodemographic characteristics and presence of incontinence complaints were also recorded. Data were analyzed at the 0.05 alpha level, using SPSS version 22. The scale had good reliability and validity. The internal reliability coefficient (Cronbach α) was 0.80, test-retest correlation coefficients were 0.83-0.94; and with regard to construct validity, Kaiser-Meyer-Olkin coefficient was 0.76 and Barlett sphericity test was 562.777 (P = 0.000). Turkish version of the Incontinence Quiz had a four-factor structure, with Eigenvalues ranging from 1.17 to 4.08. The Incontinence Quiz-Turkish version is a highly comprehensible, reliable and valid scale, which may be used to assess Turkish-speaking women's knowledge of and attitudes toward urinary incontinence. © 2017 Japan Society of Obstetrics and Gynecology.

  5. Male Sling and Artificial Urethral Sphincter for Male Stress Urinary Incontinence Among Certifying American Urologists.

    PubMed

    Liu, Joceline S; Hofer, Matthias D; Milose, Jaclyn; Oberlin, Daniel T; Flury, Sarah C; Morey, Allen F; Gonzalez, Chris M

    2016-01-01

    To examine case volume characteristics among certifying urologists performing male sling and artificial urinary sphincter (AUS) procedures to evaluate practice patterns in male stress urinary incontinence (SUI). Six-month case log data of certifying urologists (2003-2013) were obtained from the American Board of Urology. Cases specifying Current Procedural Terminology code for male sling, AUS, and removal or revision of either procedure in males ≥18 years were analyzed. Among 1615 urologists (568 certifying and 1047 recertifying) logging at least 1 male incontinence procedure, 2109 (48% of all procedures) male sling and 2284 (52%) AUS cases were identified. The mean age of patients undergoing AUS was 74.9 years and the mean age of patients undergoing sling procedures was 67.3 years (P <.001). An increase in male incontinence procedures from 2003 to 2013 was demonstrated. The rate of male sling procedure increased from 32.7% of incontinence surgeries in 2004 to 45.5% in 2013 (P <.001). Academically affiliated urologists are 1.5 times more likely to perform AUS than male sling for SUI (P <.001). Median number of slings performed was 2 (range 1-40), with 32.7% placing slings exclusively. A small group of certifying urologists (3.4%) accounted for 22% of all male slings placed. This same cohort logged 10.2% of all AUS performed. Surgical management of male SUI varies widely across states (P <.001), with slings performed between 21% and 70% of the time. Overall the number of male incontinence procedures has increased over time, with a growing proportion of male slings. Most slings and AUS cases are performed by a small number of high-volume surgeons. Copyright © 2015 Elsevier Inc. All rights reserved.

  6. Incontinence Treatment: Dietary Tips

    MedlinePlus

    ... Incontinence Managing Incontinence: A Survey The Patient's Perspective Barriers on Diagnosis and Treatment Personal Stories Contact Us ... Incontinence Managing Incontinence: A Survey The Patient's Perspective Barriers on Diagnosis and Treatment Personal Stories Contact Us ...

  7. Incontinence Treatment: Surgical Treatments

    MedlinePlus

    ... Incontinence Managing Incontinence: A Survey The Patient's Perspective Barriers on Diagnosis and Treatment Personal Stories Contact Us ... Incontinence Managing Incontinence: A Survey The Patient's Perspective Barriers on Diagnosis and Treatment Personal Stories Contact Us ...

  8. Management of vaginal extrusion after tension-free vaginal tape procedure for urodynamic stress incontinence.

    PubMed

    Giri, Subhasis K; Sil, Debasri; Narasimhulu, Girish; Flood, Hugh D; Skehan, Mark; Drumm, John

    2007-06-01

    To report our experience in the management of vaginal extrusion after the tension-free vaginal tape (TVT) procedure for urodynamic stress incontinence. Five patients diagnosed with vaginal extrusion after a TVT procedure performed at our institution were identified. We reviewed the patients' records retrospectively. The interval from TVT placement to diagnosis, presenting symptoms and signs, duration of symptoms, diagnostic test findings, treatment, and postoperative results were recorded. Patients were followed up for at least 12 months. From January 2001 to June 2004, a total of 166 patients underwent the TVT procedure. Of these, 5 patients (3%) were diagnosed with isolated vaginal extrusion 4 to 40 months postoperatively. No cases of urethral or bladder erosion occurred in this series. The symptoms included vaginal discharge, pain, bleeding, and dyspareunia. The eroded margin of the vaginal mucosa was trimmed, mobilized, and closed over the tape with interrupted vertical mattress sutures in a single layer using 2-0 polyglactin 910 to avoid mucosal inversion. All patients remained symptom free without any evidence of defective healing or additional extrusion at a minimal follow-up of 12 months. Primary reclosure of the vaginal mucosa over the TVT tape is an effective first-line treatment option for vaginal extrusion without compromising continence. Patients undergoing the TVT procedure should be adequately counseled about the possibility of this complication and the available treatment options.

  9. Bowel incontinence

    MedlinePlus

    Uncontrollable passage of feces; Loss of bowel control; Fecal incontinence; Incontinence - bowel ... older, women tend to have problems with bowel control more often than men. Children who have problems ...

  10. Rectal augmentation: short- and mid-term evaluation of a novel procedure for severe fecal urgency with associated incontinence.

    PubMed

    Murphy, Jamie; Chan, Christopher L H; Scott, S Mark; Vasudevan, Subash P; Lunniss, Peter J; Williams, Norman S

    2008-03-01

    Rectal augmentation (RA) with or without electrically stimulated gracilis neosphincter (ESGN) was developed to address the physiologic and anatomic abnormalities present in a subset of patients with incapacitating fecal urgency and associated urge fecal incontinence (UFI). This study evaluated the short- and medium-term clinical and physiologic results. Eleven patients with fecal urgency and UFI underwent RA, 6 with concomitant ESGN formation. Patients were evaluated preoperatively, and at a median of 12.5 and 54 months after surgery. At 4.5 years, 7/11 patients had avoided stoma construction. Symptoms recurred leading to permanent stoma formation in 1 patient, whereas one other developed evacuatory difficulty with overflow incontinence. Median ability to defer defecation improved from seconds preoperatively to 10 minutes at 1 year (P = 0.0002), and 15 minutes at 4.5 years (P = 0.002). Median Wexner incontinence scores improved from 15 preoperatively to 3 at 1 year (P = 0.002), and 4 at 4.5 years (P = 0.02). At 1 year, 2 of the rectal sensory thresholds (DDV: P = 0.008; MTV: P = 0.008) and compliance were normalized (P = 0.008), whereas at 4.5 years, all sensation thresholds improved (FCS: P = 0.002; DDV: P = 0.002; MTV: P = 0.002), but changes in compliance were not significant. RA with or without ESGN improved reported symptoms and normalized rectal sensation. Improvements were sustained in the medium term. The procedure had no associated morbidity or mortality, and should be considered in the surgical management of a select group of patients presenting with severe urgency and UFI.

  11. Female urinary incontinence and sexuality

    PubMed Central

    Mota, Renato Lains

    2017-01-01

    ABSTRACT Urinary incontinence is a common problem among women and it is estimated that between 15 and 55% of them complain of lower urinary symptoms. The most prevalent form of urinary incontinence is associated with stress, followed by mixed urinary incontinence and urge urinary incontinence. It is a symptom with several effects on quality of life of women mainly in their social, familiar and sexual domains. Female reproductive and urinary systems share anatomical structures, which promotes that urinary problems interfere with sexual function in females. This article is a review of both the concepts of female urinary incontinence and its impact on global and sexual quality of life. Nowadays, it is assumed that urinary incontinence, especially urge urinary incontinence, promotes anxiety and several self-esteem damages in women. The odour and the fear of incontinence during sexual intercourse affect female sexual function and this is related with the unpredictability and the chronicity of incontinence, namely urge urinary incontinence. Female urinary incontinence management involves conservative (pelvic floor muscle training), surgical and pharmacological treatment. Both conservative and surgical treatments have been studied about its benefit in urinary incontinence and also the impact among female sexual function. Unfortunately, there are sparse articles that evaluate the benefits of female sexual function with drug management of incontinence. PMID:28124522

  12. Disposable Versus Reusable Absorbent Underpads for Prevention of Hospital-Acquired Incontinence-Associated Dermatitis and Pressure Injuries.

    PubMed

    Francis, Kathleen; Pang, Sau Man; Cohen, Brenda; Salter, Helene; Homel, Peter

    The primary purpose of our study was to determine if there is a difference in the occurrence of hospital-acquired pressure injuries (HAPIs) and incontinence-associated dermatitis (IAD) in incontinent adults using a disposable versus reusable absorptive underpads. We also compared hospital length of stay in the 2 groups. Randomized controlled trial using cluster randomization based on inpatient care unit. Four hundred sixty-two patients admitted to 4 medical-surgical study units participated in the study; 252 used reusable underpads (control group) and 210 subjects used disposable underpads (intervention group). The study setting was a 711-bed acute care hospital located in Brooklyn, New York. Two units were randomly allocated to use disposable incontinence pads, and the remaining 2 units used standard, reusable incontinence pads. Data for PI and IAD occurrences were collected weekly by specially trained RNs (skin care champions) on the assigned units. A 2-level hierarchical linear model was used to analyze the effects of the intervention on primary and secondary outcomes separately from any effects of the unit of randomization. HAPIs were significantly lower in the disposable underpads group: 5% versus 12% (P = .02). Rates of hospital IAD were not significantly different between the groups (P = .22). Analysis of a secondary outcome, hospital length of stay, was also lower in patients who used disposable underpads (6 days vs 8 days; P = .02). Findings suggest that use of disposable incontinence pads reduces HAPI but not IAD occurrences. The effect of disposable, absorbent incontinence pads should be considered when initiating a hospital-wide skin and PI prevention and treatment plan.

  13. Urinary Incontinence

    MedlinePlus

    ... you to restrict your activities and limit your social interactions Increase the risk of falls in older adults as they rush to the toilet Causes Urinary incontinence isn't a ... and personal relationships. Prevention Urinary incontinence isn' ...

  14. Enhancing quality practice for prevention and diagnosis of urinary tract infection during inpatient spinal cord rehabilitation.

    PubMed

    Alavinia, Seyed Mohammad; Omidvar, Maryam; Farahani, Farnoosh; Bayley, Mark; Zee, Joana; Craven, Beverley Catharine

    2017-11-01

    To reduce the incidence of Urinary Tract Infection (UTI) in subacute SCI individuals admitted for tertiary inpatient rehabilitation. A quality improvement team was assembled to improve UTI prevention/diagnosis. To plan data collection, UTI-related factors were mapped in an Ishikawa (fishbone) driver diagram. Data including patient demographics, presence and frequency of signs and/or symptoms of UTI and antibiotic initiation from August to December 2015 were recorded. Sensitivity, Specificity, Positive and Negative Predictive Values (PPV, NPV), and Likelihood Ratios (LR) were calculated for each sign and symptom. Tertiary SCI Rehabilitation Results: Among 55 inpatients with subacute SCI who had signs/symptoms prompting urine culture and sensitivity (C&S), 32 (58.18%) were diagnosed with a UTI. The most frequent symptoms were foul smelling urine (41%), change in urine color (31%), and incontinence (25%), and the most common sign was fever (34%). Most UTIs (81%) occurred among individuals using Clean Intermittent Catheterization (CIC), with 46% of catheterizations performed by nurses. Foul smelling urine had the highest sensitivity (0.50, 95% CI: 0.31-0.69), and new incontinence had the highest specificity (0.88, 95% CI: 0.69-0.97) for UTI diagnosis. The highest PPV belonged to the cloudy urine (0.71, 95% CI: 0.42-0.92). The combination of cloudy and foul smelling urine increased the PPV to 78% (95% CI: (0.40-0.97). The concurrent presence of cloudy and foul smelling urine is predicted of UTI diagnosis inpatients tertiary setting. SCI inpatients are susceptible to UTI when learning CIC technique from nurses.

  15. Epidemiology of Mixed, Stress & Urgency Urinary Incontinence in Mid-Aged/Older Women: Importance of Incontinence History

    PubMed Central

    Komesu, Yuko M.; Schrader, Ronald M.; Ketai, Loren H.; Rogers, Rebecca G.; Dunivan, Gena C.

    2016-01-01

    Introduction & Hypothesis Urinary incontinence (UI) is common and the relationship between its subtypes is complex. Our objective was to describe the natural history and predictors of incontinence subtypes, Stress, Urgency and Mixed, in mid-aged and older U.S. women. We hypothesized that past UI subtype history predicted future UI subtype status and sought to determine the extent to which this occurred. Methods We analyzed longitudinal urinary incontinence data in 10,572 community-dwelling women ≥50 in the 2004–2010 Health and Retirement Study database. Mixed, Stress, Urgency incontinence prevalence (2004,2006,2008,2010) and 2-year cumulative incidence and remissions (2004–6,2006–8 2008–10) were estimated. Patient characteristics and incontinence subtype status 2004–2008 were entered into a multivariable model to determine predictors for incontinence subtype occurrence in 2010. Results Prevalence of each subtype in this population (median age 63–66) was 2.6%–8.9%. Subtype incidence equaled 2.1–3.5% and remissions for each varied between 22.3–48.7%. Incontinence subtype incidence predictors included ethnicity/race, age, body mass index, functional limitations. Compared to White women, Black women had decreased odds of incident Stress Incontinence, Hispanic women had increased odds of Stress Incontinence remission. Age 80–90 and severe obesity predicted incident Mixed Incontinence. Functional limitations predicted Mixed and Urgency Incontinence. The strongest predictor of incontinence subtypes was incontinence subtype history. Presence of the respective incontinence subtypes in 2004 and 2006 strongly predicted 2010 recurrence [Odds Ratio (OR) Stress Incontinence=30.7, Urgency OR=47.4, Mixed OR=42.1]. Conclusions Although remissions were high, prior history of incontinence subtypes predicted recurrence. Incontinence status is dynamic but tends to recur over the longer term. PMID:26670573

  16. Urinary incontinence management costs are reduced following Burch or sling surgery for stress incontinence.

    PubMed

    Subak, Leslee L; Goode, Patricia S; Brubaker, Linda; Kusek, John W; Schembri, Michael; Lukacz, Emily S; Kraus, Stephen R; Chai, Toby C; Norton, Peggy; Tennstedt, Sharon L

    2014-08-01

    The objective of the study was to estimate the effect of Burch and fascial sling surgery on out-of-pocket urinary incontinence (UI) management costs at 24 months postoperatively and identify predictors of change in cost among women enrolled in a randomized trial comparing these procedures. Resources used for UI management (supplies, laundry, dry cleaning) were self-reported by 491 women at baseline and 24 months after surgery, and total out-of-pocket costs for UI management (in 2012 US dollars) were estimated. Data from the 2 surgical groups were combined to examine the change in cost for UI management over 24 months. Univariate and bivariate changes in cost were analyzed using the Wilcoxon signed rank test. Predictors of change in cost were examined using multivariate mixed models. At baseline mean (±SD) age of participants was 53 ± 10 years, and the frequency of weekly UI episodes was 23 ± 21. Weekly UI episodes decreased by 86% at 24 months (P < .001). The mean weekly cost was $16.60 ± $27.00 (median $9.39) at baseline and $4.57 ± $15.00 (median $0.10) at 24 months (P < .001), a decrease of 72%. In multivariate analyses, cost decreased by $3.38 ± $0.77 per week for each decrease of 1 UI episode per day (P < .001) and was strongly associated with greater improvement in Urogenital Distress Inventory and Incontinence Impact Questionnaire scores (P < .001) and decreased 24-hour pad weight (P < .02). Following Burch or fascial sling surgery, the UI management cost at 24 months decreased by 72% ($625 per woman per year) and was strongly associated with decreasing UI frequency. Reduced out-of-pocket expenses may be a benefit of these established urinary incontinence procedures. Copyright © 2014. Published by Mosby, Inc.

  17. Cumulative Incidence of a Subsequent Surgery After Stress Urinary Incontinence and Pelvic Organ Prolapse Procedure.

    PubMed

    Wu, Jennifer M; Dieter, Alexis A; Pate, Virginia; Jonsson Funk, Michele

    2017-06-01

    To assess the 5-year risk and timing of repeat stress urinary incontinence (SUI) and pelvic organ prolapse (POP) procedures. We conducted a retrospective cohort study using a nationwide database, the 2007-2014 MarketScan Commercial Claims and Encounters and Medicare Supplemental Databases (Truven Health Analytics), which contain deidentified health care claims data from approximately 150 employer-based insurance plans across the United States. We included women aged 18-84 years and used Current Procedural Terminology codes to identify surgeries for SUI and POP. We identified index procedures for SUI or POP after at least 3 years of continuous enrollment without a prior procedure. We defined three groups of women based on the index procedure: 1) SUI surgery only; 2) POP surgery only; and 3) Both SUI+POP surgery. We assessed the occurrence of a subsequent SUI or POP procedure over time for women younger than 65 years and 65 years or older with a median follow-up time of 2 years (interquartile range 1-4). We identified a total of 138,003 index procedures: SUI only n=48,196, POP only n=49,120, and both SUI+POP n=40,687. The overall cumulative incidence of a subsequent SUI or POP surgery within 5 years after any index procedure was 7.8% (95% confidence interval [CI] 7.6-8.1) for women younger than 65 years and 9.9% (95% CI 9.4-10.4) for women 65 years or older. The cumulative incidence was lower if the initial surgery was SUI only and higher if an initial POP procedure was performed, whether POP only or SUI+POP. The 5-year risk of undergoing a repeat SUI or POP surgery was less than 10% with higher risks for women 65 years or older and for those who underwent an initial POP surgery.

  18. Efficacy of physiotherapy for urinary incontinence following prostate cancer surgery.

    PubMed

    Rajkowska-Labon, Elżbieta; Bakuła, Stanisław; Kucharzewski, Marek; Sliwiński, Zbigniew

    2014-01-01

    The study enrolled 81 with urinary incontinence following radical prostate-only prostatectomy for prostatic carcinoma. The patients were divided into two groups. The patients in Group I were additionally subdivided into two subgroups with respect to the physiotherapeutic method used. The patients of subgroup IA received a rehabilitation program consisting of three parts. The patients of subgroup IB rehabilitation program consist of two parts. Group II, a control group, had reported for therapy for persistent urinary incontinence following radical prostatectomy but had not entered therapy for personal reasons. For estimating the level of incontinence, a 1-hour and 24-hour urinary pad tests, the miction diary, and incontinence questionnaire were used, and for recording the measurements of pelvic floor muscles tension, the sEMG (surface electromyography) was applied. The therapy duration depended on the level of incontinence and it continued for not longer than 12 months. Superior continence outcomes were obtained in Group I versus Group II and the difference was statistically significant. The odds ratio for regaining continence was greater in the rehabilitated Group I and smaller in the group II without the rehabilitation. A comparison of continence outcomes revealed a statistically significant difference between Subgroups IA versus IB. The physiotherapeutic procedures applied on patients with urine incontinence after prostatectomy, for most of them, proved to be an effective way of acting, which is supported by the obtained results.

  19. [Urinary incontinence].

    PubMed

    Kuhn, Annette

    2010-01-01

    Incontinence is a common age-dependent and increasing problem in women that may mainly present as stress incontinence, overactive bladder, mixed incontinence or other forms. A thorough history, gynaecological and neurological examination and urinalysis as initial step will lead to the diagnosis and treatment. If midstream urine is difficult to receive, a catheter urine will be easy to obtain. Further investigations as urodynamics, cystoscopy and ultrasound may be required. As initial step, stress incontinence should be treated with physiotherapy and pelvic floor exercises, if not successful with operations as suburethral slings. Slings have good long-term success rates of approximately 85 % with a low morbidity and can even be inserted under local anaesthetic. The treatment of idiopathic overactive bladder consists of bladder training, a behavioural therapy, and mainly anticholinergics. Anticholinergics may cause side effects particularly in the elderly who are under several medications that may add anticholinergic effects as antidepressants, antibiotics or antihistaminics.

  20. Trends, Predictors, and Outcomes of Healthcare Resources Used in Patients Hospitalized with Alzheimer's Disease with at Least One Procedure: The Nationwide Inpatient Sample.

    PubMed

    Beydoun, May A; Gamaldo, Alyssa A; Beydoun, Hind A; Shaked, Danielle; Zonderman, Alan B; Eid, Shaker M

    2017-01-01

    We assessed trends, predictors and outcomes of resource utilization in hospital inpatient discharges with a principal diagnosis of Alzheimer's disease (AD) with at least one procedure. Using Nationwide Inpatient Sample data (NIS, 2002-2012), discharges primarily diagnosed with AD, aged ≥60 y and with ≥1 procedure, were selected (Weighted N = 92,300). Hospital resource utilization were assessed using ICD-9-CM codes, while hospitalization outcomes included total charges (TC, 2012$), length of stay (LOS, days), and mortality risk (MR, %). Brain and respiratory/gastrointestinal procedure utilization both dropped annually by 3-7%, while cardiovascular procedures/evaluations, blood evaluations, blood transfusion, and resuscitation ("CVD/Blood") as well as neurophysiological and psychological evaluation and treatment ("Neuro") procedures increased by 5-8%. Total charges, length of stay, and mortality risk were all markedly higher with use of respiratory/gastrointestinal procedures as opposed to being reduced with use of "Brain" procedures. Procedure count was positively associated with all three hospitalization outcomes. In sum, patterns of hospital resources that were used among AD inpatients changed over-time, and were associated with hospitalization outcomes such as total charges, length of stay, and mortality risk.

  1. Urinary incontinence in familial dysautonomia.

    PubMed

    Saini, J; Axelrod, F B; Maayan, C; Stringer, J; Smilen, S W

    2003-08-01

    The aim of this study was to determine the prevalence of urinary incontinence in women with familial dysautonomia (FD). A telephone survey was conducted on 68 known surviving female FD patients over 13 years of age registered with the Dysautonomia Centers in the USA and Israel. The mean age of the surveyed group was 27.1+/-9.8 years and 99% of the patients were nulliparous. The overall reported prevalence of urinary incontinence was 82% (n=56). Of the patients with incontinence, 59% (n=33) reported stress incontinence, 11% (n=6) reported urge incontinence, and 30% (n=17) reported symptoms of both, or mixed incontinence. In most women urinary loss was both small and infrequent, but 36% of women (n=20) with incontinence experienced a loss sufficient to necessitate the use of protection (panty liners, pads or diapers); in 7% (n=4) such loss occurred daily. Twelve per cent of all women with FD surveyed experienced primary nocturnal enuresis and 26% experienced nocturia. The prevalence of urinary incontinence is high in young female patients with familial dysautonomia. Neurophysiologic testing in this population may provide a better understanding of the role of the autonomic nervous system in urinary incontinence.

  2. Holmium:YAG Laser Ablation for the Management of Lower Urinary Tract Foreign Bodies Following Incontinence Surgery: A Case Series and Systematic Review.

    PubMed

    Chan, Garson; Mamut, Adiel; Martin, Paul; Welk, Blayne

    2016-11-01

    The objective of this study was to determine the outcomes associated with the endoscopic removal of foreign bodies (such as mesh or permanent suture) in the lower urinary tract after female stress incontinence surgery with the Holmium:YAG (Ho:YAG) laser, and to systematically review the literature on this topic. A retrospective chart review of 18 consecutive women found to have mesh or suture exposure was performed. All patients underwent Ho:YAG laser ablation. A systematic review was performed to identify literature addressing the endoscopic management of mesh/suture exposure after stress incontinence surgery. Between November 2011 and February 2016, 18 women underwent Ho:YAG laser ablation of exposed mesh or suture. Presenting symptoms included lower urinary tract symptoms, pelvic pain, incontinence, or recurrent urinary tract infections. Thirteen women had a previous synthetic midurethral sling and five had a prior retropubic suspension. The median age was 58 years (interquartile range [IQR] 50-60) and median follow-up was 2 years (IQR 1-2). Four patients (22%) had residual mesh after the first procedure, requiring a repeat endoscopic procedure. Only one patient had a small amount of asymptomatic residual mesh on cystoscopy after the final procedure. Only minor postoperative complications were observed. Eight patients had stress incontinence and four underwent operative treatment for this. In our systematic review, we identified 16 case series, which described a total of 158 patients. Women most commonly presented with voiding symptoms or incontinence. Based on the synthesis of these data, repeat procedures were necessary in 16% and vesicovaginal fistula occurred in 2%. Recurrent/persistent stress incontinence was present in 20%, and of these patients, 3/4 underwent a new stress incontinence procedure. Both our case series and the systematic review of the literature demonstrated that endoscopic treatment of lower urinary tract foreign bodies after stress

  3. Urinary incontinence in women

    PubMed Central

    Aoki, Yoshitaka; Brown, Heidi W.; Brubaker, Linda; Cornu, Jean Nicolas; Daly, J. Oliver; Cartwright, Rufus

    2018-01-01

    Urinary incontinence symptoms are highly prevalent among women, have a substantial effect on health-related quality of life and are associated with considerable personal and societal expenditure. Two main types are described: stress urinary incontinence, in which urine leaks in association with physical exertion, and urgency urinary incontinence, in which urine leaks in association with a sudden compelling desire to void. Women who experience both symptoms are considered as having mixed urinary incontinence. Research has revealed overlapping potential causes of incontinence, including dysfunction of the detrusor muscle or muscles of the pelvic floor, dysfunction of the neural controls of storage and voiding, and perturbation of the local environment within the bladder. A full diagnostic evaluation of urinary incontinence requires a medical history, physical examination, urinalysis, assessment of quality of life and, when initial treatments fail, invasive urodynamics. Interventions can include non-surgical options (such as lifestyle modifications, pelvic floor muscle training and drugs) and surgical options to support the urethra or increase bladder capacity. Future directions in research may increasingly target primary prevention through understanding of environmental and genetic risks for incontinence. PMID:28681849

  4. Discharges with surgical procedures performed less often than once per month per hospital account for two-thirds of hospital costs of inpatient surgery.

    PubMed

    O'Neill, Liam; Dexter, Franklin; Park, Sae-Hwan; Epstein, Richard H

    2017-09-01

    Most surgical discharges (54%) at the average hospital are for procedures performed no more often than once per month at that hospital. We hypothesized that such uncommon procedures would be associated with an even greater percentage of the total cost of performing all surgical procedures at that hospital. Observational study. State of Texas hospital discharge abstract data: 4th quarter of 2015 and 1st quarter of 2016. Inpatients discharged with a major therapeutic ("operative") procedure. For each of N=343 hospitals, counts of discharges, sums of lengths of stay (LOS), sums of diagnosis related group (DRG) case-mix weights, and sums of charges were obtained for each procedure or combination of procedures, classified by International Classification of Diseases version 10 Procedure Coding System (ICD-10-PCS). Each discharge was classified into 2 categories, uncommon versus not, defined as a procedure performed at most once per month versus those performed more often than once per month. Major procedures performed at most once per month per hospital accounted for an average among hospitals of 68% of the total inpatient costs associated with all major therapeutic procedures. On average, the percentage of total costs associated with uncommon procedures was 26% greater than expected based on their share of total discharges (P<0.00001). Average percentage differences were insensitive to the endpoint, with similar results for the percentage of patient days and percentage of DRG case-mix weights. Approximately 2/3rd (mean 68%) of inpatient costs among surgical patients can be attributed to procedures performed at most once per month per hospital. The finding that such uncommon procedures account for a large percentage of costs is important because methods of cost accounting by procedure are generally unsuitable for them. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Efficacy of Physiotherapy for Urinary Incontinence following Prostate Cancer Surgery

    PubMed Central

    Bakuła, Stanisław

    2014-01-01

    The study enrolled 81 with urinary incontinence following radical prostate-only prostatectomy for prostatic carcinoma. The patients were divided into two groups. The patients in Group I were additionally subdivided into two subgroups with respect to the physiotherapeutic method used. The patients of subgroup IA received a rehabilitation program consisting of three parts. The patients of subgroup IB rehabilitation program consist of two parts. Group II, a control group, had reported for therapy for persistent urinary incontinence following radical prostatectomy but had not entered therapy for personal reasons. For estimating the level of incontinence, a 1-hour and 24-hour urinary pad tests, the miction diary, and incontinence questionnaire were used, and for recording the measurements of pelvic floor muscles tension, the sEMG (surface electromyography) was applied. The therapy duration depended on the level of incontinence and it continued for not longer than 12 months. Superior continence outcomes were obtained in Group I versus Group II and the difference was statistically significant. The odds ratio for regaining continence was greater in the rehabilitated Group I and smaller in the group II without the rehabilitation. A comparison of continence outcomes revealed a statistically significant difference between Subgroups IA versus IB. The physiotherapeutic procedures applied on patients with urine incontinence after prostatectomy, for most of them, proved to be an effective way of acting, which is supported by the obtained results. PMID:24868546

  6. What is the best surgical intervention for stress urinary incontinence in the very young and very old? An International Consultation on Incontinence Research Society update.

    PubMed

    Robinson, Dudley; Castro-Diaz, David; Giarenis, Ilias; Toozs-Hobson, Philip; Anding, Ralf; Burton, Claire; Cardozo, Linda

    2015-11-01

    An increasing number of continence procedures are being performed in women of all ages. An overview of the existing literature and consensus regarding surgery for stress urinary incontinence (SUI) in the young and the old was presented and discussed at the International Consultation on Incontinence Research Society Think Tank. This manuscript reflects the Think Tank's summary and opinion. Despite the increasing number of continence procedures, there are relatively few data to guide management in the very young and the very old. When considering continence surgery in the young, long-term efficacy and safety are paramount, and the future effects of pregnancy and childbirth need to be carefully considered. Conversely, in the elderly, minimally invasive procedures with low morbidity are important, especially in the frail elderly who may have significant co-morbidities. Further research including prospective randomised trials, cohort studies and national registries, should help guide our management in these two challenging groups of patients.

  7. Changes in incontinence after hysterectomy.

    PubMed

    Kruse, Anne Raabjerg; Jensen, Trine Dalsgaard; Lauszus, Finn Friis; Kallfa, Ervin; Madsen, Mogens Rørbæk

    2017-10-01

    Information about the perioperative incontinence following hysterectomy is limited. To advance the postoperative rehabilitation further we need more information about qualitative changes in incontinence, fatigue and physical function of patients undergoing hysterectomy. 108 patients undergoing planned hysterectomy were compared pre- and postoperatively. In a sub-study of the prospective follow-up study the changes in incontinence, postoperative fatigue, quality of life, physical function, and body composition were evaluated preoperatively, 13 and 30 days postoperatively. Sample size calculation indicated that 102 women had to be included. The incontinence status was estimated by a Danish version of the ICIG questionnaire; further, visual analogue scale, dynamometer for hand grip, knee extension strength and balance were applied. Work capacity was measured ergometer cycle together with lean body mass by impedance. Quality of life was assessed using the SF-36 questionnaire. Patients were examined preoperatively and twice postoperatively. In total 41 women improved their incontinence after hysterectomy and 10 women reported deterioration. Preoperative stress incontinence correlated with BMI (r = 0.25, p < 0.01) and urge incontinence with age (r = 0.24, p < 0.02). Further, improvement after hysterectomy in stress incontinence was associated with younger age (r = 0.20, p < 0.04). Improvement in urge incontinence was positively associated with BMI (r = 0.22, p = 0.02). A slight but significant loss was seen in lean body mass 13 and 30 days postoperatively. Hysterectomy was not significantly associated with the risk of incontinence; in particular, when no further vaginal surgery is performed. Hysterectomy may even have a slightly positive effect on incontinence and de-novo cure.

  8. [Male Urinary Incontinence--a Taboo Issue].

    PubMed

    Kozomara-Hocke, Marko; Hermanns, Thomas; Poyet, Cédric

    2016-03-02

    Male urinary incontinence is an underestimated and frequently not broached issue. The urinary incontinence is divided into stress-, urge incontinence and hybrid forms as well as overflow incontinence. The fact that there are increasingly more men over 60 means that the prevalence of the urinary incontinence is up to 40%, and urinary incontinence will increasingly gain importance in daily routine practice. Many investigations and therapies can be realized by the general practitioner. Already simple therapy approaches can lead to a considerable clinical improvement of male urinary incontinence. If the initial therapy fails or pathological results (i. e. microhaematuria, recurrent urinary tract infections, raised residual urine and so on) are found, the patient should be referred to a urologist.

  9. [Drug therapy of female urinary incontinence].

    PubMed

    Hampel, C; Gillitzer, R; Pahernik, S; Melchior, S W; Thüroff, J W

    2005-03-01

    Drug treatment for female urinary incontinence requires a thorough knowledge of the differential diagnosis and pathophysiology of incontinence as well as of the pharmacological agents employed. Pharmacotherapy has to be tailored to suit the incontinence subtype and should be carefully balanced according to efficacy and side effects of the drug. Women with urge incontinence require treatment that relaxes or desensitizes the bladder (antimuscarinics, estrogens, alpha-blockers, beta-mimetics, botulinum toxin A, resiniferatoxin, vinpocetine), whereas patients with stress incontinence need stimulation and strengthening of the pelvic floor and external sphincter (alpha-mimetics, estrogens, duloxetine). Females with overflow incontinence need reduction of outflow resistance (baclofen, alpha-blockers, intrasphincteric botulinum toxin A) and/or improvement of bladder contractility (parasympathomimetics). If nocturia or nocturnal incontinence are the major complaints, control of diuresis is obtained by administration of the ADH analogue desmopressin. Future developments will help to further optimize the pharmacological therapy for female urinary incontinence.

  10. A Prospective, Descriptive, Quality Improvement Study to Decrease Incontinence-Associated Dermatitis and Hospital-Acquired Pressure Ulcers.

    PubMed

    Hall, Kimberly D; Clark, Rebecca C

    2015-07-01

    Incontinence is a common problem among hospitalized patients and has been associated with multiple health complications, including incontinence-associated dermatitis (IAD) and hospital-acquired pressure ulcers (HAPUs). A prospective, descriptive study was conducted in 2 acute care neurology units to 1) assess the prevalence of incontinence and incidence of IAD and HAPUs among incontinent patients, and 2) evaluate the effect of caregiver education and use of a 1-step cleanser, moisturizer, barrier product on the development of IAD and HAPUs among patients with incontinence. During a period of 1 month, the incontinence status of admitted patients was recorded and skin was assessed for the presence/absence of IAD and HAPUs twice per day. After the 1-month data collection, all clinicians on the study units completed a facility-based online education program about IAD, HAPUs, and skin care followed by the implementation of a 1-step cleanser/barrier product for skin care of all patients with incontinence. Data collection procedures remained the same. Data were collected using a paper/pencil instrument and entered into a spreadsheet for analysis. Descriptive statistics were calculated and prevalence and incidence rates were compared between the pre-intervention and post-intervention phase using Fisher's exact analysis. During the first phase of the study, 17 of 40 admitted patients (42.5%) were incontinent. Of those, 5 (29.4%) developed IAD and all of these patients developed HAPUs (5 of 40 admitted, 29.4%) during an average length of stay of 7.3 (range: 2-14) days. In the intervention phase of the study, 25 of 46 (54.3%) patients were incontinent and none developed IAD or a HAPU during an average length of stay of 7.4 (range: 2-14) days. The average Braden scale score was 14.14 in the pre-intervention group of patients with incontinence and 12.74 in the intervention group. The prevalence of incontinence among patients admitted to acute care neurology units and the rate

  11. The "costs" of urinary incontinence for women.

    PubMed

    Subak, Leslee L; Brown, Jeanette S; Kraus, Stephen R; Brubaker, Linda; Lin, Feng; Richter, Holly E; Bradley, Catherine S; Grady, Deborah

    2006-04-01

    To estimate costs of routine care for female urinary incontinence, health-related quality of life, and willingness to pay for incontinence improvement. In a cross-sectional study at 5 U.S. sites, 293 incontinent women quantified supplies, laundry, and dry cleaning specifically for incontinence. Costs were calculated by multiplying resources used by national resource costs and presented in 2005 United States dollars (2005). Health-related quality of life was estimated with the Health Utilities Index. Participants estimated willingness to pay for 25-100% improvement in incontinence. Potential predictors of these outcomes were examined using multivariable linear regression. Mean age was 56 +/- 11 years; participants were racially diverse and had a broad range of incontinence severity. Nearly 90% reported incontinence-related costs. Median weekly cost (25%, 75% interquartile range) increased from 0.37 dollars (0, 4 dollars) for slight to 10.98 dollars (4, 21 dollars) for very severe incontinence. Costs increased with incontinence severity (P < .001). Costs were 2.4-fold higher for African American compared with white women (P < .001) and 65% higher for women with urge compared with those having stress incontinence (P < .001). More frequent incontinence was associated with lower Health Utilities Index score (mean 0.90 +/- 0.11 for weekly and 0.81 +/- 0.21 for daily incontinence; P = .02). Women were willing to pay a mean of 70 dollars +/- 64 dollars per month for complete resolution of incontinence, and willingness to pay increased with income and greater expected benefit. Women with severe urinary incontinence pay 900 dollars annually for incontinence routine care, and incontinence is associated with a significant decrement in health-related quality of life. Effective incontinence treatment may decrease costs and improve quality of life. III.

  12. Use of Sacral Nerve Stimulation for the Treatment of Overlapping Constipation and Fecal Incontinence

    PubMed Central

    Sreepati, Gouri; James-Stevenson, Toyia

    2017-01-01

    Patient: Female, 51 Final Diagnosis: Fecal incontinence Symptoms: Constipation • fecal incontinence Medication: — Clinical Procedure: Sacral nerve stimulator Specialty: Gastroenterology and Hepatology Objective: Rare co-existance of disease or pathology Background: Fecal incontinence and constipation are common gastrointestinal complaints, but rarely occur concurrently. Management of these seemingly paradoxical processes is challenging, as treatment of one symptom may exacerbate the other. Case Report: A 51-year-old female with lifelong neurogenic bladder secondary to spina bifida occulta presented with progressive symptoms of daily urge fecal incontinence as well as hard bowel movements associated with straining and a sensation of incomplete evacuation requiring manual disimpaction. Pelvic floor testing showed poor ability to squeeze the anal sphincter, which indicated sphincter weakness as a major contributor to her fecal incontinence symptoms. Additionally, on defecography she was unable to widen her posterior anorectal angle or relax the anal sphincter during defecation consistent with dyssynergic defecation. A sacral nerve stimulator was placed for management of her fecal incontinence. Interestingly, her constipation also dramatically improved with sacral neuromodulation. Conclusions: This unique case highlights the emerging role of sacral nerve stimulation in the treatment of complex pelvic floor dysfunction with improvement in symptoms beyond fecal incontinence in a patient with dyssynergic-type constipation. PMID:28265107

  13. Randomized Comparative Study of the U- and H-Type Approaches of the TVT-Secur Procedure for the Treatment of Female Stress Urinary Incontinence: One-Year Follow-Up

    PubMed Central

    Kim, Jung Jun; Lee, Young-Suk

    2010-01-01

    Purpose We compared outcomes of the U- and H-type approaches of the tension-free vaginal tape (TVT)-Secur procedure for the treatment of female stress urinary incontinence (SUI). Materials and Methods From March 2007 to July 2008, 115 women with SUI underwent TVT-Secur by a single surgeon. Patients were randomly assigned to either the U- or the H-type approach. After 12 months, postoperative changes in the Sandvik questionnaire, incontinence quality of life questionnaire (I-QoL), Bristol female lower urinary tract symptoms-scored form (BFLUTS-SF), and postoperative patient satisfaction were evaluated. Cure was regarded as no leakage on the Sandvik questionnaire. Complications were also evaluated. Results Of 115 women, 53 were treated with the U approach, and 62 women were treated with the H approach. At 12 months, 88.7% of those treated with the U approach and 87.1% of those treated with the H approach were cured (p=0.796). The I-QoL and filling, incontinence, sexual function, and QoL sum (BFLUTS-SF) scores were improved with both approaches, and there were no significant differences in the degree of improvement between approaches. Approximately 83.7% and 82.9% of the women treated with the U and H approaches, respectively, were satisfied with the outcome (p=0.858). There were 3 cases of intra-operative vaginal wall perforation in the H-type group. Immediate postoperative retention was observed in 2 women in the U-type group and 1 woman in the H-type group. One woman in the U-type group underwent tape releasing and cutting procedures for persistent large post-void residuals. Conclusions The U- and the H-type approaches of the TVT-Secur procedure provided comparable effectiveness for the treatment of female SUI. PMID:20428427

  14. Incontinence in persons with Down Syndrome.

    PubMed

    Niemczyk, Justine; von Gontard, Alexander; Equit, Monika; Medoff, David; Wagner, Catharina; Curfs, Leopold

    2017-08-01

    To assess the rates of incontinence and associated psychological problems in children, adolescents and adults with Down Syndrome, a genetic syndrome caused by partial or complete triplication (trisomy) of chromosome 21 and characterized by typical facial features, a physical growth delay and mild or moderate intellectual disability. Three hundred and seventeen persons with Down Syndrome (4-51 years) were recruited through a German parent support group (59.6% male, mean age 19.2 years). The Parental Questionnaire: Enuresis/Urinary Incontinence, the Incontinence Questionnaire-Pediatric Lower Urinary Tract Symptoms, as well as the Developmental Behavior Checklist (DBC) for parents or for adults were filled out by parents or care-givers. 17.2% of the sample had nocturnal enuresis, 15.9% had daytime urinary incontinence, and 14.2% had fecal incontinence. Incontinence was present in 64.0% of young children (4-12 years), 10.3% of teens (13-17 years), 12.8% of young adults (18-30 years) and in 22.4% of older adults (>30 years). 13.6% of children and 8.4% of adults had a DBC score in the clinical range. 19.5% of children and 27.8% of adults with incontinence had behavioral problems. There was a significant association between nocturnal enuresis, daytime urinary incontinence and clinical DBC scores in adults. Incontinence in Down Syndrome is mainly present in young children and increases in older adults. Behavioral comorbidity is associated with incontinence only in adults with Down Syndrome. Screening and treatment of incontinence in individuals with Down Syndrome is recommended. © 2016 Wiley Periodicals, Inc.

  15. Diagnostic agreement of the 3 Incontinence Questionnaire to video-urodynamics findings in women with urinary incontinence

    PubMed Central

    Omar, Mohammad Ali; Laniado, Marc

    2017-01-01

    Introduction There are limited studies evaluating the 3 Incontinence Questionnaire (3IQ) against urodynamics based diagnosis as a reference standard. The 3IQ has been proposed to be useful to evaluate women at the level of primary care. The aim of this study was to determine correlation between 3IQ and video-urodynamics (VUDS) in diagnosing types of urinary incontinence. Material and methods Prospective data was collected on 200 consecutive female patients referred by primary care physicians for urinary incontinence. The mean age was 55 years (range 15–83 years). The patients were evaluated using the 3IQ and video-urodynamics. The 3IQ-based diagnosis of type of female urinary incontinence was compared to VUDS-based results. Sensitivity, specificity, positive likelihood ratios and positive predictive values were calculated. Results On 3IQ based self-evaluation, 28% of patients were classified as having stress urinary incontinence, 20% with urge incontinence and 40% with mixed incontinence. On video-urodynamics, urodynamic stress urinary incontinence (UDSUI) was detected in 56% of patients, detrusor overactivity (DO) in 15% and mixed urinary incontinence (MUI) in 19%. The 3IQ had a sensitivity and specificity respectively of 43% and 92% for UDSUI, 57% and 86% for DO and 58% and 64% for MUI. The corresponding positive likelihood ratios (CI, 95%) were 5.4 (CI 2.6 to 11.3) for stress urinary incontinence, 4.0 (CI 2.5 to 6.5) for DO and 1.62 (1.2 to 2.3) for MUI. The respective positive predictive values were 87% (CI 75% to 95%), 42% (CI 26% to 58%) and 28% (18% to 39%). Conclusions In our study population, stress urinary incontinence was reasonably well predicted by the 3IQ, but the questionnaire under-performed in the diagnoses of detrusor overactivity and mixed urinaryincontinence. PMID:29732212

  16. Incontinence: The Potential Budget Buster

    ERIC Educational Resources Information Center

    Gardner, Sharon

    2009-01-01

    Someone who lives with incontinence, whether bowel, bladder, or both, knows the social stigma and personal toll on his life. Incontinence is the ever-present shadowy silhouette lurking over almost every decision, sometimes requiring complex preplanning. In this article, the author describes the challenges of incontinence and discusses how she…

  17. The Efficiency and Safety of Tension-Free Vaginal Tape (TVT) Abbrevo Procedure Versus TVT Exact in the Normal Weight and Overweight Patients Affected by Stress Urinary Incontinence.

    PubMed

    Sun, Yi; Luo, Deyi; Yang, Lu; Wei, Xin; Tang, Cai; Chen, Mei; Shen, Hong; Wei, Qiang

    2017-12-01

    To compare the efficacy between 2 different slings in normal weight and overweight women. Of 426 women, 220 (119 normal weight and 101 overweight) accepted the tension-free vaginal tape Abbrevo (TVT-A) and 206 (114 normal weight and 92 overweight) accepted the TVT Exact (TVT-E) procedure. Data collected contained the subjective efficiency, objective efficiency International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), Incontinence Quality of Life Questionnaire (I-QOL), Pelvic Floor Impact Questionnaire-Short Form (PFIQ-7), Urogenital Distress Inventory-Short Form (UDI-6), and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-Short Form (PISQ)-12 at 36 months after surgery. In the normal weight patients, the subjectively and objectively cured rates were all high in both TVT-A and TVE-E (94.12% and 95.61% in objective result; 92.44% and 94.74% in subjective result). In addition, the score of I-QOL, PFIQ-7, and UDI-6 have significantly changed (P <.00001 in each one). In the overweight patients, the subjective and objective efficiency were better in TVT-E than TVT-A. Moreover, the score of I-QOL, PFIQ-7, and UDI-6 of overweight women have significantly changed only in the TVT-E (P <.00001 in each one), whereas both procedures have no effect on the score of PISQ-12 (P = .063 and P = .180 for TVT-A and TVT-E, respectively). The TVT-E might be a better choice for the overweight patient than TVT-A. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. Trans-Obturator-Tape (T.O.T.) "outside-in" approach in surgical treatment of female stress urinary incontinence.

    PubMed

    Jovanović, M; Džamić, Z; Aćimović, M; Kajmaković, B; Pejčić, T

    2014-01-01

    The aim of the study was to analyzed the efficacy and safety of a minimally invasive surgical procedure using the Trans- Obturator-Tape with "outside-in" approach for treatment female stress urinary incontinence. 171 women with stress urinary incontinence (SUI) associated with urethral hypermobility, underwent the T.O.T. procedure (March 2010 to January 2014). 27 patients were previously operated for incontinence. Mean age was 59 years (37-80). 6 patients were having mixed incontinence, and 51 had SUI with urgencies. A non-elastic, polypropylene tape was placed under the mid-urethra. The surgical placement technique utilises a trans-obturator percutaneous approach. All patients underwent post-operative clinical examination, cough-stress test (full bladder), uroflowmetry, and post-voiding residual assessment. Mean follow-up was 22 months (4-45). At 12 months follow-up 91,2% of the patients were completely cured. The overall peri-operative complication rate was 6.4% with no vascular, nerve or bowel injury. 5 patients (2.9%) had post-operative urinary retention. The present study confirms the results obtained by the instigator of the technique, E. Delorme, and allows us to consider T.O.T. as an effective and safe technique for the treatment of female stress urinary incontinence.

  19. Effects of laser procedure for female urodynamic stress incontinence on pad weight, urodynamics, and sexual function.

    PubMed

    Tien, Yi-Wen; Hsiao, Sheng-Mou; Lee, Chien-Nan; Lin, Ho-Hsiung

    2017-03-01

    The impact of the IncontiLase TM procedure on lower urinary tract symptoms (LUTS) remains unclear. Our aim was to evaluate the effects of the IncontiLase TM procedure for urodynamic stress incontinence (USI). All consecutive women with USI prospectively underwent the IncontiLase TM procedure. Urodynamic studies, pad testing, LUTS, and sexual function questionnaires were assessed before and after treatment. Thirty-five women underwent the IncontiLase TM procedure. Among the 28 women with baseline pad weights >1 g, 11 (39.3 %) were objectively cured and 11 (39.3 %) improved. Among the 18 women with mild USI (i.e., baseline pad weight 1-10 g), nine (50 %) were cured and five (27.8 %) improved. Among ten women with baseline pad weight >10 g, two (20 %) were cured and six (60 %) improved. Among the 32 women with complete questionnaire data at 6 months, seven (21.9 %) were subjectively cured, and four (12.5 %) improved. Regarding LUTS, the majority of domains on the King's Health Questionnaire and female sexual desire and function exhibited significant improvements. Forty percent (12/30) of the partners of these patients felt their sexual function had improved at 6 months. Nonetheless, urodynamic values did not differ across the timeline. The effect of the IncontiLase TM procedure for mild USI was moderate at 6-month follow-up but was not effective for pad weight >10 g. Moreover, it improved LUTS, quality of life, QoL, and sexual function of both partners. Further studies should be performed to assess long-term sustained efficacy.

  20. Surgery for stress urinary incontinence in women: A 2006 review

    PubMed Central

    Blok, Bertil F. M.; Corcos, Jacques

    2007-01-01

    The surgical treatment of female stress urinary incontinence is a rapidly changing field. This review discusses recent advances in various injectables, minimally invasive techniques and open procedures. It particularly evaluates data from long-term outcome studies and describes peri- and postoperative complications from several procedures, such as bulking agents, tension-free vaginal tape and its modifications (TOT, TVT-O) as well as open and laparoscopic colposuspension. PMID:19675792

  1. Urethral bulking agents versus other surgical procedures for the treatment of female stress urinary incontinence: a systematic review and meta-analysis.

    PubMed

    Leone Roberti Maggiore, Umberto; Bogani, Giorgio; Meschia, Michele; Sorice, Paola; Braga, Andrea; Salvatore, Stefano; Ghezzi, Fabio; Serati, Maurizio

    2015-06-01

    Bulking agents provide an alternative option in the management of women with stress urinary incontinence and they seem to have an important role in the management flow chart of SUI. However, evidence on this issue is scanty. The most important aspect is to understand whether bulking agents are comparable with the other first-line anti-incontinence surgical procedure (MUS, Burch colposuspension and pubovaginal slings). Hence, the primary aim of the current review was to assess the objective and subjective outcomes of bulking agents in comparison with the other surgical procedures for the treatment of SUI. PubMed and Medline were systematically searched and we included studies evaluating the use of bulking agents in comparison with other surgical approaches for either primary or recurrent treatment of female SUI. Three studies meeting the inclusion criteria were identified. Two of these studies were RCTs evaluating the use of bulking agents versus other surgical procedures for the treatment of primary female SUI; the remnant article was a retrospective cohort study that compared the effectiveness and safety of repeat midurethral sling with urethral bulking after failed midurethral sling. The combined results of all analyses showed that the objective recurrence rate of peri- or trans-urethral injections is significantly higher in comparison with the other surgical procedures. Similar findings were observed when considering separately the treatment for primary or recurrent SUI. Furthermore, lower subjective recurrence rate was observed among patients undergoing other surgical treatment in comparison with those undergoing bulking agents; however, this trend was not statistically significant. Moreover, patients undergoing injection of bulking agents experienced a lower rate of voiding dysfunctions in comparison to the control group. According to current evidence, bulking agents should not be proposed as first-line treatment in those women seeking permanent cure for both

  2. Urinary incontinence: the role of menopause.

    PubMed

    Trutnovsky, Gerda; Rojas, Rodrigo Guzman; Mann, Kristy Pamela; Dietz, Hans P

    2014-04-01

    This study aims to explore the effects of menopause and hormone therapy on the symptoms and signs of stress urinary incontinence and urge urinary incontinence. Records of women who attended a tertiary urogynecological unit were reviewed retrospectively. A standardized interview included evaluations of symptoms, menopause age (ie, time since last menstrual period or onset of menopausal symptoms), current or previous hormone use, and visual analogue scales for bother. Multichannel urodynamics, including urethral pressure profilometry and determination of abdominal leak point pressure, was performed. Of 382 women seen during the inclusion period, 62% were postmenopausal. Current systemic or local hormone use was reported by 7% and 6%, respectively. Two hundred eighty-eight women (76%) reported symptoms of stress urinary incontinence, with a mean bother of 5.7, and 273 women (72%) reported symptoms of urge urinary incontinence, with a mean bother of 6.4. On univariate analysis, symptoms and bother of urge incontinence were significantly related to menopause age, whereas this relationship was not found for stress incontinence. After calendar age was controlled for, length of menopause showed no significant relationship with any symptom or sign of urinary incontinence. Hormone deficiency after menopause is unlikely to play a major role in urinary incontinence.

  3. Electrical pelvic floor stimulation in the management of urinary incontinence due to neuropathic overactive bladder.

    PubMed

    Ishigooka, M; Hashimoto, T; Izumiya, K; Katoh, T; Yaguchi, H; Nakada, T; Handa, Y; Hoshimiya, N

    1993-01-01

    Electrical pelvic floor stimulation employing a portable functional electrical stimulation system with percutaneously indwelling electrodes was carried out to improve detrusor urinary incontinence. Cyclic stimulation using negative going pulse trains of 20 Hz was applied 3 to 6 times daily to the bilateral pudendal nerves distributing to the pelvic floor muscles for the purpose of strengthening these muscles, including the urethral sphincter, and simultaneously, suppressing detrusor overactivity and increasing cystometric capacity. Electrical training for 4-8 weeks resulted in an improvement of urinary incontinence in five of six patients. In two of six cases incontinence had subjectively disappeared. Urodynamic investigations demonstrated an increase in detrusor reflex threshold and less tendency for abortive detrusor contraction. No apparent complications were encountered during these periods. This procedure appears to be efficient for the management of patients with detrusor incontinence who respond poorly to conservative therapies.

  4. Fecal incontinence after minor anorectal surgery.

    PubMed

    Zbar, A P; Beer-Gabel, M; Chiappa, A C; Aslam, M

    2001-11-01

    Fecal leakage after open lateral internal anal sphincterotomy for chronic anal fissure is common, but underreported. The aim of this study was to prospectively assess the physiologic and morphologic effects of sphincterotomy, comparing continent and incontinent patients after surgery. This group was further compared with an unselected group of patients presenting with incontinence after hemorrhoidectomy. Between January 1997 and June 1999, 23 patients were prospectively followed up through internal sphincterotomy with conventional and vector volume anorectal manometry, parametric assessment of the rectoanal inhibitory reflex, and endoanal magnetic resonance imaging. Fourteen continent patients were compared with 9 incontinent postoperative cases, 9 patients referred with incontinence after hemorrhoidectomy, and 33 healthy volunteers without anorectal disease. Significant differences were noted between continent and incontinent postsphincterotomy cases for all resting conventional and vector volume parameters and for some squeeze parameters. Although there was a significant reduction in postoperative high pressure zone length at rest, there were no differences between the postoperative groups. There was an increase in sphincter asymmetry of 6.7 percent (+/- 3.5 percent) in incontinent postsphincterotomy patients and a decrease of 2.8 percent (+/- 3.2 percent) in continent cases. Significant differences were noted for resting parameters between incontinent postsphincterotomy and posthemorrhoidectomy patients, with a higher resting sphincter asymmetry in the latter group. The area under the rectoanal inhibitory curve was smaller in postsphincterotomy incontinent patients when compared with continent cohorts over the distal and intermediate sphincter zones at rest with a reduced latency of inhibition. There was no difference in the magnetic resonance images of the sphincterotomy site between incontinent and continent postsphincterotomy cases and no posthemorrhoidectomy

  5. Artificial urinary sphincter implantation: an important component of complex surgery for urinary tract reconstruction in patients with refractory urinary incontinence.

    PubMed

    Zhang, Fan; Liao, Limin

    2018-01-08

    We review our outcomes and experience of artificial urinary sphincter implantation for patients with refractory urinary incontinence from different causes. Between April 2002 and May 2017, a total of 32 patients (median age, 40.8 years) with urinary incontinence had undergone artificial urinary sphincter placement during urinary tract reconstruction. Eighteen patients (56.3%) were urethral injuries associated urinary incontinence, 9 (28.1%) had neurogenic urinary incontinence and 5 (15.6%) were post-prostatectomy incontinence. Necessary surgeries were conducted before artificial urinary sphincter placement as staged procedures, including urethral strictures incision, sphincterotomy, and augmentation cystoplasty. The mean follow-up time was 39 months. At the latest visit, 25 patients (78.1%) maintained the original artificial urinary sphincter. Four patients (12.5%) had artificial urinary sphincter revisions. Explantations were performed in three patients. Twenty-four patients were socially continent, leading to the overall success rate as 75%. The complication rate was 28.1%; including infections (n = 4), erosions (n = 4), and mechanical failure (n = 1). The impact of urinary incontinence on the quality of life measured by the visual analogue scale dropped from 7.0 ± 1.2 to 2.2 ± 1.5 (P <0.001). The primary sources for artificial urinary sphincter implantation in our center are unique, and the procedure is an effective treatment as a part of urinary tract reconstruction in complicated urinary incontinence cases with complex etiology.

  6. Mini-invasive techniques for the treatment of female stress urinary incontinence.

    PubMed

    Vianello, A; Costantini, E; Del Zingaro, M; Porena, M

    2007-12-01

    The aim of this study was to review recent literature on mini-invasive surgical technique for the treatment of female stress urinary incontinence (SUI). Surgical aspects, intraoperative and perioperative complications and objective and subjective outcomes were analyzed and compared. The PubMed databank from 2000 to February 2007 was searched for original prospective and randomized studies in English, on surgical treatment of female SUI, which avoided a laparotomic access to the female pelvis. Studies had to investigate at least 40 women with a minimum follow-up of 12 months. A total of 38 prospective studies were found: 27 of them were on mid-urethral slings; 8 assessed urethral injections; and 3 radiofrequency treatment. Fifteen studies were randomized. Follow-ups ranged from 12 to 60 months, except for sexual function which had a 6-month follow-up. Ten out of 38 studies assessed patients who did not refer pelvic organ prolapse or detrusor overactivity and had not undergone any previous anti-incontinence procedure. Mid-urethral slings showed good outcomes and are safe and brief to perform and have a relatively short learning curve. Urethral injections showed discouraging results, as they have poor outcomes and repetitive treatments are frequently necessary. Injections can be used in women with contraindications to major surgical procedures, with intrinsic sphincter deficiency as the main cause of incontinence. Radiofrequency showed worse results than mid-urethral slings and is a valuable choice in women who refuse more invasive procedures. The development of studies with longer follow-ups on mini-invasive surgical techniques are encouraged.

  7. Usage of a Trans-Obturator-Tape (T.O.T.) "outside-in" approach in surgical treatment of female stress urinary incontinence.

    PubMed

    Jovanovic, Mirko; Vuksanović, Aleksandar; Dzamić', Zoran; Aćimović, Miodrag; Radovanović, Milan; Djurasić, Ljubomir

    2011-01-01

    The aim of the study was to analyzed the efficacy and safety of a new minimally invasive surgical procedure using the Trans-Obturator-Tape with"outside-in" approach for treatment female stress urinary incontinence. 31 women with stress urinary incontinence (SUI) associated with urethral hypermobility, underwent the T.O.T. procedure (March 2010 to January 2011). 5 patients were previously operated for incontinence. Mean age was 59 years (37-80). 10 patients were having mixed incontinence. A non-elastic, polypropylene tape was placed under the mid-urethra. The surgical placement technique utilises a trans-obturator percutaneous approach. All patients underwent post-operative clinical examination, cough-stress test (full bladder), uroflowmetry, and post-voiding residual assessment. Mean follow-up was 5 months (1-9). At 6 months follow-up 96.7% of the patients were completely cured. The overall peri-operative complication rate was 6.4% with no vascular, nerve or bowel injury. One patients (3.4%) had post-operative urinary retention. The present study confirms the results obtained by the instigator of the technique, E. Delorme, and allows us to consider T.O.T. as an effective and safe technique for the treatment of female stress urinary incontinence.

  8. Data for free--can an electronic medical record provide outcome data for incontinence/prolapse repair procedures?

    PubMed

    Steidl, Matthew; Zimmern, Philippe

    2013-01-01

    We determined whether a custom computer program can improve the extraction and accuracy of key outcome measures from progress notes in an electronic medical record compared to a traditional data recording system for incontinence and prolapse repair procedures. Following institutional review board approval, progress notes were exported from the Epic electronic medical record system for outcome measure extraction by a custom computer program. The extracted data (D1) were compared against a manually maintained outcome measures database (D2). This work took place in 2 phases. During the first phase, volatile data such as questionnaires and standardized physical examination findings using the POP-Q (pelvic organ prolapse quantification) system were extracted from existing progress notes. The second phase used a progress note template incorporating key outcome measures to evaluate improvement in data accuracy and extraction rates. Phase 1 compared 6,625 individual outcome measures from 316 patients in D2 to 3,534 outcome measures extracted from progress notes in D1, resulting in an extraction rate of 53.3%. A subset of 3,763 outcome measures from D1 was created by excluding data that did not exist in the extraction, yielding an accuracy rate of 93.9%. With the use of the template in phase 2, the extraction rate improved to 91.9% (273 of 297) and the accuracy rate improved to 100% (273 of 273). In the field of incontinence and prolapse, the disciplined use of an electronic medical record template containing a preestablished set of key outcome measures can provide the ideal interface between required documentation and clinical research. Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  9. Urinary incontinence after vaginal delivery or cesarean section.

    PubMed

    Borges, João Bosco Ramos; Guarisi, Telma; Camargo, Ana Carolina Marchesini de; Gollop, Thomaz Rafael; Machado, Rogério Bonassi; Borges, Pítia Cárita de Godoy

    2010-06-01

    To assess the prevalence of stress urinary incontinence, urge incontinence and mixed urinary incontinence among women residing in the city of Jundiaí (São Paulo, Brazil), and the relation between the type of incontinence and the obstetric history of these women. A cross-sectional community-based study was conducted. A total of 332 women were interviewed; they were seen for whatever reason at the public primary healthcare units of the city of Jundiaí, from March 2005 to April 2006. A pre-tested questionnaire was administered and consisted of questions used in the EPINCONT Study (Epidemiology of Incontinence in the County of Nord-Trondelag). Statistical analysis was carried out using the χ2 test and odds ratio (95%CI). Urinary incontinence was a complaint for 23.5% of the women interviewed. Stress urinary incontinence prevailed (50%), followed by mixed urinary incontinence (35%) and urge incontinence (15%). Being in the age group of 35-64 years, having a body mass index of 30 or greater and having had only vaginal delivery or cesarean section, with uterine contraction, regardless of the number of pregnancies, were factors associated with stress urinary incontinence. However, being in the age group of 55 or older, having a body mass index of 30 or greater and having had three or more pregnancies, only with vaginal deliveries, were factors associated with mixed urinary incontinence. One third of the interviewees complained of some type of urinary incontinence, and half of them presented stress urinary incontinence. Cesarean section, only when not preceded by contractions, was not associated with stress urinary incontinence. The body mass index is only relevant when the stress factor is present.

  10. Trends in surgical management and pre-operative urodynamics in female medicare beneficiaries with mixed incontinence.

    PubMed

    Chughtai, Bilal; Hauser, Nicholas; Anger, Jennifer; Asfaw, Tirsit; Laor, Leanna; Mao, Jialin; Lee, Richard; Te, Alexis; Kaplan, Steven; Sedrakyan, Art

    2017-02-01

    We sought to examine the surgical trends and utilization of treatment for mixed urinary incontinence among female Medicare beneficiaries. Data was obtained from a 5% national random sample of outpatient and carrier claims from 2000 to 2011. Included were female patients 65 and older, diagnosed with mixed urinary incontinence, who underwent surgical treatment identified by Current Procedural Terminology, Fourth Edition (CPT-4) codes. Urodynamics (UDS) before initial and secondary procedure were also identified using CPT-4 codes. Procedural trends and utilization of UDS were analyzed. Utilization of UDS increased during the study period, from 38.4% to 74.0% prior to initial surgical intervention, and from 28.6% to 62.5% preceding re-intervention. Sling surgery (63.0%) and injectable bulking agents (28.0%) were the most common surgical treatments adopted, followed by sacral nerve stimulation (SNS) (4.8%) and Burch (4.0%) procedures. Re-intervention was performed in 4.0% of patients initially treated with sling procedures and 21.3% of patients treated with bulking agents, the majority of whom (51.7% and 76.3%, respectively) underwent injection of a bulking agent. Risk of re-intervention was not different among those who did or did not receive urodynamic tests prior to the initial procedure (8.5% vs. 9.3%) CONCLUSIONS: Sling and bulk agents are the most common treatment for MUI. Preoperative urodynamic testing was not related to risk of re-intervention following surgery for mixed urinary incontinence in this cohort. Neurourol. Urodynam. 36:422-425, 2017. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.

  11. A review of post-stroke urinary incontinence.

    PubMed

    Tuong, Nicole E; Klausner, Adam P; Hampton, Lance J

    2016-06-01

    Cerebrovascular accidents, or strokes, are a common cause of morbidity and mortality in the United States. Urinary incontinence is a prevalent morbidity experienced by post-stroke patients that is associated with long term disability and institutionalization effects on these patients. An extensive literature review was conducted using multiple academic search engines using the keywords: 'stroke,' 'CVA,' 'urinary incontinence,' 'urodynamics,' 'pharmacologic treatments,' and 'conservative treatments.' Articles were reviewed and summarized to explain incidence, assessment, and treatments of urinary incontinence in post-stroke individuals. Twenty-eight percent to seventy-nine percent of stroke survivors experience urinary incontinence with detrusor overactivity being the most common type of incontinence assessed by urodynamic studies. There continues to be insufficient data studying the effects and benefits of non-pharmacologic and pharmacologic treatments in post-stroke patients. Similarly, urinary incontinence remains an indicator of increased morbidity, disability, and institutionalization rates in the post-stroke patient. Stroke is a debilitating disease which causes urinary incontinence in many patients. As a result, patients have increased rates of hospitalization and disability compared to post-stroke patients without urinary incontinence. The history and physical exam are key in diagnosing the type of urinary incontinence with urodynamic studies being an adjunctive study. Non-pharmacologic treatment, such as behavioral therapy, and pharmacologic agents including antimuscarinics and beta adrenergic medications, are not well studied in the post-stroke patient. Urinary incontinence in stroke patients needs to be further studied to help decrease morbidity and mortality rates within this population.

  12. [Women's strategies for coping with urinary incontinence].

    PubMed

    Delarmelindo, Rita de Cássia Altino; Parada, Cristina Maria Garcia de Lima; Rodrigues, Rosalina Aparecida Partezani; Bocchi, Silvia Cristina Mangini

    2013-04-01

    This article is part of a more comprehensive qualitative study which used grounded theory and symbolic interactionism as theoretical and methodological frameworks, resulting in the theoretical model entitled, Between suffering and hope: rehabilitation of urinary incontinence as an intervenient component. In order to communicate all the knowledge produced, part of this model is presented, and it refers to the process of coping with urinary incontinence by women without perspectives of access to surgical treatment after failure of conservative procedures. When interrelating the components (categories and subcategories) of these women's experience in order to compare and analyze them to understand their interaction, moral and psychosocial vulnerability were noticed within the experience of the group, which makes them susceptible to health risks and to compromise of their quality of life, observed in the movement of the group's experience. Research is needed to further understand experiences in which there are barriers to surgical treatment due to physicians' disbelief in its effectiveness.

  13. Tension-free transobturator approach for female stress urinary incontinence.

    PubMed

    Cindolo, L; Salzano, L; Rota, G; Bellini, S; D'Afiero, A

    2004-03-01

    UraTape is a new sling for female stress urinary incontinence (SUI) inserted via a transobturator percutaneous approach. We report the safety, feasibility and short-term results of this new surgical procedure. UraTape (Porgès-Mentor) is a non-elastic polypropylene tape, with a silicone coated central part. The sling is placed tension-free under the mid-urethra and extended through the obturator foramen bypassing the posterior face of the ischiopubic ramus. From September 2002 to May 2003, 80 females affected by SUI associated with urethral hypermobility and without severe uro-genital prolapse (with cystocele 1st grade) received UraTape. Mean age was 56 (39-79) years. Sixty-two out of 80 had a positive Q tip test; 16/80 had recurrent incontinence after Burch or colpoplasty according to Kelly; 22/60 had mixed incontinence. Preoperative evaluations included: complete history and physical examination, urinalysis, urodynamic investigations, abdominal and pelvic ultrasound. Quality of life assessment was carried out pre- and postoperatively. Mean operative time was 16 (11-36) minutes. No major intraoperative complications were observed. One bladder neck laceration occurred and was treated intraoperatively. No cystoscopy was performed. Mean hospital postoperative stay time was 1.1 (1-6) days. All patients were examined periodically at 7, 30 and 90 days from intervention (mean follow-up 4 months, 1-8). There was no urethral erosion. One vaginal erosion with inguinal abscess was diagnosed and treated without removing the sling. Two de novo urge incontinence was observed. The objective and subjective cure rates were 92% and 97%; 96% expressed good quality of life (satisfied/very satisfied). This procedure is a safe, effective new technique for the treatment of female SUI. The easy technique, the short learning curve and the very high grade of satisfaction of the patients show that this approach is based upon effective anatomical and physiological criteria. Further follow

  14. One-Year Surgical Outcomes and Quality of Life after Minimally Invasive Sling Procedures for the Treatment of Female Stress Urinary Incontinence: TVT SECUR® vs. CureMesh®

    PubMed Central

    Joo, Young Min; Choe, Jin Ho

    2010-01-01

    Purpose We compared the efficacy and safety of two minimally invasive sling procedures used to treat female stress urinary incontinence (SUI), tension-free vaginal tape (TVT) SECUR® and CureMesh®, and assessed the 1-year surgical outcomes. Materials and Methods Sixty women with SUI were assigned to undergo either the TVT SECUR (n=38) or CureMesh (n=22) procedures between April 2007 and June 2008. Patients were monitored via outpatient visits at 1 month, 3 months, and 1 year after surgery. The efficacy of these procedures was evaluated by the cough test or by a urodynamic study. At these postoperative visits, the patients also completed several questionnaires, including incontinence quality of life, patient's perception of urgency severity, the scored form of the Bristol Female Lower Urinary Tract Symptoms, visual analog scale, and questions about perceived benefit, satisfaction, and willingness to undergo the same operation again. The objective cure rate was defined as no leakage during the cough test with a full bladder. The subjective cure rate was evaluated by self-assessment of goal achievement performed 1 year postoperatively. Results The two groups were similar in preoperative characteristics and urodynamic parameters. The objective cure rates were similar between TVT SECUR and CureMesh (68.4% vs. 77.3%). All respondents reported improvement after surgery. There were no intra-operative complications. Conclusions Our results showed that the TVT SECUR and CureMesh procedures are both safe and simple to perform and have no significant differences in efficacy. Comparative studies with long-term follow-up are warranted to determine the true efficacy of these procedures. PMID:20495697

  15. [Validation of questionnaires to assess quality of life related to fecal incontinence in children with anorectal malformations and Hirschsprung's disease].

    PubMed

    Mathias, Arthur Loguetti; Tannuri, Ana Cristina Aoun; Ferreira, Mariana Aparecida Elisei; Santos, Maria Mercês; Tannuri, Uenis

    2016-01-01

    Surgical treatment of anorectal malformations (ARMs) and Hirschsprung's disease (HD) leads to alterations in bowel habits and fecal incontinence, with consequent quality of life impairment. The objectives were to create and validate a Questionnaire for the Fecal Incontinence Index (FII) based on the Holschneider score, as well as a Questionnaire for the Assessment of Quality of Life Related to Fecal Incontinence in Children and Adolescents (QQVCFCA), based on the Fecal Incontinence Quality of Life. The questionnaires were applied to 71 children submitted to surgical procedure, in two stages. Validity was tested by comparing the QQVCFCA and a generic quality of life questionnaire (SF-36), and between QQVCFCA and the FII. A group of 59 normal children was used as control. At two stages, 45.0% (32/71) and 42.8% (21/49) of the patients had fecal incontinence. It was observed that the QQVCFCA showed a significant correlation with the SF-36 and FII (Pearson's correlation 0.57), showing that the quality of life is directly proportional to improvement in fecal incontinence. Quality of life in patients with fecal incontinence is still globally impaired, when compared with control subjects (p<0.05, Student's t test). There were also significant differences between the results of children with ARMs and children with HD. QQVCFCA and FII are useful tools to assess the quality of life and fecal incontinence in these groups of children. Children with ARMs submitted to surgical procedure and HD have similar quality of life impairment. Copyright © 2015 Sociedade de Pediatria de São Paulo. Publicado por Elsevier Editora Ltda. All rights reserved.

  16. The comparison of an inexpensive-modified transobturator vaginal tape versus TVT-O procedure for the surgical treatment of female stress urinary incontinence.

    PubMed

    Zhang, Yan; Jiang, Min; Tong, Xiao-Wen; Fan, Bo-Zhen; Li, Huai-Fang; Chen, Xin-Liang

    2011-09-01

    To compare the safety and efficacy of an inexpensive-modified transobturator vaginal tape procedure with the transobturator tension-free vaginal tape (TVT-O) procedure for the surgical treatment of female stress urinary incontinence (SUI). Patients with SUI were randomly allocated to either the test group receiving the inexpensive-modified transobturator vaginal tape procedure or the control group receiving the GYNECARE TVT-O procedure. Treatment outcomes and Quality-of-life scores were recorded and analyzed between two groups. A total of 156 patients were enrolled in this trial. Eighty patients underwent the modified transobturator vaginal tape procedure. Among them 75(93.8%) were cured and 5(6.2%) were improved. The rest of the 76 patients underwent the GYNECARE TVT-O procedure with a 92% (70 of 76) cure rate and an 8% (6 of 76) improvement rate. No inefficient or aggravated cases occurred in both groups. The success rates between groups had no significant statistic difference (p > 0.05). The operative time, blood loss, hospital stay, and medical cost were significantly lower in the test group (p < 0.01); the increases in Quality-of-life scores were comparable between groups. The modified transobturator vaginal tape procedure is an efficacious and economic surgical treatment for female SUI. Copyright © 2011. Published by Elsevier B.V.

  17. Effect of weight loss on urinary incontinence in women

    PubMed Central

    Whitcomb, Emily L; Subak, Leslee L

    2011-01-01

    Background The purpose of this research was review the epidemiology of the association of obesity and urinary incontinence, and to summarize the published data on the effect of weight loss on urinary incontinence. Methods A literature review of the association between urinary incontinence and overweight/obesity in women was performed. Case series and clinical trials reporting the effect of surgical, behavioral, and/or pharmacological weight loss on urinary incontinence are summarized. Results Epidemiological studies demonstrate that obesity is a strong and independent risk factor for prevalent and incident urinary incontinence. There is a clear dose-response effect of weight on urinary incontinence, with each 5-unit increase in body mass index associated with a 20%–70% increase in risk of urinary incontinence. The maximum effect of weight on urinary incontinence has an odds ratio of 4–5. The odds of incident urinary incontinence over 5–10 years increase by approximately 30%–60% for each 5-unit increase in body mass index. There appears to be a stronger association between increasing weight and prevalent and incident stress incontinence (including mixed incontinence) than for urge incontinence. Weight loss studies indicate that both surgical and nonsurgical weight loss leads to significant improvements in prevalence, frequency, and/or symptoms of urinary incontinence. Conclusion Epidemiological studies document overweight and obesity as important risk factors for urinary incontinence. Weight loss by both surgical and more conservative approaches is effective in reducing urinary incontinence symptoms and should be strongly considered as a first line treatment for overweight and obese women with urinary incontinence. PMID:24198645

  18. Urinary Incontinence: Management and Treatment Options

    ERIC Educational Resources Information Center

    Griebling, Tomas L.

    2009-01-01

    Urinary incontinence, defined as the involuntary leakage of urine, is a common health problem in both women and men. Children may also suffer from this condition. Management and treatment of urinary incontinence depends primarily on the specific type of incontinence and the underlying problem causing the leakage for a given patient. Because…

  19. A comperative study for short-term surgical outcomes of midurethral sling procedures in obese and non-obese women with stress urinary incontinence.

    PubMed

    Kokanalı, Mahmut Kuntay; Cavkaytar, Sabri; Kokanalı, Demet; Aksakal, Orhan; Doganay, Melike

    2016-11-01

    There is little data comparing the surgical outcomes of tension-free vaginal tape (TVT) and transobturator tape (TOT) procedures in obese women. Therefore, we aimed to compare the surgical outcomes of TOT and TVT procedures among obese women with a diagnosis of stress urinary incontinence (SUI). One hundred and eighty-nine women who underwent TVT or TOT procedures due to pure SUI were included. Women in whom the body mass index (BMI) was ≥30 kg/m 2 were considered as obese, while <30 kg/m 2 were non-obese. And women with BMI ≥35 kg/m 2 was defined as morbidly obese. At sixth month postoperative follow-up, neither the comparison of TVT and TOT results in obese women nor the comparison of TVT or TOT results between obese and non-obese women showed any significant differences in terms of objective and subjective cure rates, quality of life improvements, or intra/postoperative complications. TVT and TOT procedures also have similar effectiveness among morbidly obese women. We have concluded that TVT and TOT operations seem to be equally effective and safe surgical treatment procedures for female SUI regardless of BMI.

  20. Inpatient Choledocholithiasis Requiring ERCP and Cholecystectomy: Outcomes of a Combined Single Inpatient Procedure Versus Separate-Session Procedures.

    PubMed

    Passi, Monica; Inamdar, Sumant; Hersch, David; Dowling, Oonagh; Sejpal, Divyesh V; Trindade, Arvind J

    2018-03-01

    Separate-session endoscopic retrograde cholangiography (ERCP) and laparoscopic cholecystectomy (LC) is the usual method for management of inpatient choledocholithiasis. Our goal was to compare single operative-session LC and ERCP to a multi-session approach for both the same hospitalization and within 30 days after; there is limited data comparing the three groups. A retrospective review on inpatients with choledocholithiasis that underwent ERCP and LC was performed. Single operative-session ERCP + LC (SOS group) and separate hospitalization ERCP + LC (DH group) were compared against the control cohort: separate-session ERCP + LC performed during the same hospitalization (SH group). Among the 214 cases, 37 (17%) had LC + ERCP performed under a single operative session (SOS), 130 (60.7%) cases had LC + ERCP performed in separate operative sessions during the same hospitalization (SH), and 47 (22%) cases had LC + ERCP performed in different hospitalizations, within 30 days (DH). There was no statistically significant difference in efficacy or adverse events. The SOS group had a statistically significant mean shorter length of hospital stay as compared to the SH and DH groups (5.46 vs 7.15 vs 9.38; p = 0.05 and 0.02). There was a statistically significant reduction in the total cost of care in the SOS group versus the SH group ($59,221 vs $75, 808; p = 0.007). The SOS approach is safe, efficacious, and cost-efficient when compared to separate operative sessions. This approach can be considered in situations where it is preferable for the patient to undergo a single session of anesthesia, without compromising technical success and safety.

  1. Urinary incontinence - the family caregivers' perspective.

    PubMed

    Hayder, Daniela; Schnepp, Wilfried

    2008-08-01

    Urinary incontinence can be expected to present an issue in domestic care with various conditions and ways of dealing with the situation. This pilot study investigates the kinds of coping strategies developed by family caregivers of urinary incontinent persons. Therefore, it seeks to explore how family caregivers experience and shape everyday life with an incontinent family member.Based on a qualitative design, problem-centered interviews were carried out with 10 family caregivers (4 men, 6 women) and analyzed according to Grounded Theory.The results show that family caregivers place major emphasis on maintaining continence, which is conceived as an expression of concern for the care-dependent person. The data facilitated the development of four major concepts: incontinence as a cause of dependency, feelings of shame, striving for continence and coping with incontinence. These concepts indicate that family caregivers look for strategies to provide the incontinent family member with the opportunity of (self-) controlled excretion. Yet this kind of support is linked to feelings of shame on both parts.

  2. Decrease in Urinary Incontinence Management Costs in Women Enrolled in a Clinical Trial of Weight Loss to Treat Urinary Incontinence

    PubMed Central

    Subak, Leslee L.; Pinto, Angela Marinilli; Wing, Rena R.; Nakagawa, Sanae; Kusek, John W.; Herman, William H.; Kuppermann, Miriam

    2012-01-01

    Objective To estimate the effect of a decrease in urinary incontinence frequency on urinary incontinence management costs among women enrolled in a clinical trial of a weight loss intervention and to identify factors that predict change in cost. Methods This is a secondary cohort analysis of 338 obese and overweight women with ≥ 10 weekly episodes of urinary incontinence enrolled in an 18-month randomized clinical trial of a weight loss intervention compared to a structured education program to treat urinary incontinence. Quantities of resources used for incontinence management, including pads, additional laundry, and dry cleaning were reported by participants. Direct costs for urinary incontinence management (“cost”) were calculated by multiplying resources used by national resource costs (in 2006 U.S. dollars). Randomized groups were combined to examine the effects of change in incontinence frequency on cost. Possible predictors of change in cost were examined using generalized estimating equations controlling for factors associated with change in cost in univariable analyses. Results Mean (±SD) age was 53±10 years and baseline weight was 97+17 kg. Mean weekly urinary incontinence frequency was 24+18 at baseline and decreased by 37% at 6 months and 60% at 18 months follow-up (both P<0.001). At baseline, adjusted mean cost was $7.76±$14 per week, with costs increasing significantly with greater incontinence frequency. Mean cost decreased by 54% at 6 months and 81% at 18 months (both P<0.001). In multivariable analyses, cost independently decreased by 23% for each decrease of seven urinary incontinence episodes per week and 21% for each 5 kg of weight lost (P<0.001 for both). Conclusion In obese and overweight women enrolled in a clinical trial of weight loss for urinary incontinence, incontinence management cost decreased by 81% at 18 months ($327 per woman per year) and was strongly and independently associated with decreasing incontinence frequency

  3. Anticipating the impact of insurance expansion on inpatient urological surgery

    PubMed Central

    Ellimoottil, Chandy; Miller, Sarah; Wei, John T.; Miller, David C.

    2014-01-01

    PURPOSE The Affordable Care Act (ACA) is expected to provide coverage for nearly twenty-five million previously uninsured individuals. Because the potential impact of the ACA for urological care remains unknown, we estimated the impact of insurance expansion on the utilization of inpatient urological surgeries using Massachusetts (MA) healthcare reform as a natural experiment. METHODS We identified nonelderly patients who underwent inpatient urological surgery from 2003 through 2010 using inpatient databases from MA and two control states. Using July 2007 as the transition point between pre- and post-reform periods, we performed a difference-indifferences (DID) analysis to estimate the effect of insurance expansion on overall and procedure-specific rates of inpatient urological surgery. We also performed subgroup analyses according to race, income and insurance status. RESULTS We identified 1.4 million surgeries performed during the study interval. We observed no change in the overall rate of inpatient urological surgery for the MA population as a whole, but an increase in the rate of inpatient urological surgery for non-white and low income patients. Our DID analysis confirmed these results (all 1.0%, p=0.668; non-whites 9.9%, p=0.006; low income 6.6%, p=0.041). At a procedure level, insurance expansion caused increased rates of inpatient BPH procedures, but had no effect on rates of prostatectomy, cystectomy, nephrectomy, pyeloplasty or PCNL. CONCLUSIONS Insurance expansion in Massachusetts increased the overall rate of inpatient urological surgery only for non-whites and low income patients. These data inform key stakeholders about the potential impact of national insurance expansion for a large segment of urological care. PMID:25506058

  4. Female urinary incontinence: effective treatment strategies.

    PubMed

    Castro, R A; Arruda, R M; Bortolini, M A T

    2015-04-01

    Urinary incontinence is a dysfunction that tremendously affects women's quality of life, involving social, emotional and economic aspects. Although various treatments for urinary incontinence have been described, it is important to know which of them are truly effective. This review seeks to determine the current available therapies for women with stress urinary incontinence and overactive bladder syndrome, based on the best scientific evidence.

  5. Mid-urethral slings in female incontinence: Current status

    PubMed Central

    Krlin, Ryan M.; Murphy, Alana M.; Ingber, Michael S.; Vasavada, Sandip P.

    2011-01-01

    The advent of the mid-urethral sling (MUS) 15 years ago has drastically changed the surgical management of stress urinary incontinence (SUI). Both retropubic and transobturator MUS can be placed in the ambulatory setting with excellent results. The tension-free vaginal tape (TVT) sling has the most robust and long-term data, but more recent literature suggests that the transobturator tape sling may offer comparable efficacy in appropriately selected patients. Single incision sling (SIS) is the newest addition to the MUS group and was developed in an attempt to minimize morbidity and create an anti-incontinence procedure that could be performed in the office. The efficacy of SIS remains unknown as the current literature regarding SIS lacks long-term results and comparative trials. The suprapubic arc sling appears to have equally effective outcomes in at least the short-term when compared with TVT. Although evolution of the SIS has led to a less invasive procedure with decreased post-op pain and reduced recovery time, durability of efficacy could be the endpoint we are sacrificing. Until longer-term data and more quality comparison trials are available, tailoring one's choice of MUS to the individual patient and her unique clinical parameters remains the best option. PMID:22022053

  6. Management of occult stress urinary incontinence with prolapse surgery.

    PubMed

    Al-Mandeel, H; Al-Badr, A

    2013-08-01

    Pelvic organ prolapse (POP) and stress urinary incontinence (SUI), are two common health-related conditions, each affecting up to 50% women worldwide. Stress urinary incontinence only observed after the reduction of co-existent prolapse is called occult SUI (OSUI), and is found in up to 80% of women with advanced POP. Although there is no consensus on how to diagnose OSUI, there are several reported methods to better diagnose. Counseling symptomatically continent women with POP concerning the potential risk for developing SUI postoperatively cannot be overstated. Evidence suggests that positive OSUI in symptomatically continent women who are planning to have POP repair is associated with a high risk of POSUI, furthermore, adding continence procedure is found to reduce postoperative SUI. Therefore, adding continence surgery at the time of POP surgery in patients who are found to have OSUI preoperatively is advocated.

  7. Social networks lack useful content for incontinence.

    PubMed

    Sajadi, Kamran P; Goldman, Howard B

    2011-10-01

    To assess the incontinence resources readily available for patients among social networks. Social networks allow users to connect with each other and share content and are a widely popular resource on the Internet. These sites attract millions of users; however, social media are underused in the healthcare industry. A search for "incontinence" was performed on Facebook, Twitter, and YouTube in September 2010. The first 30 results were reviewed for each. The results were evaluated as useful or not useful and additionally catalogued as healthcare professionals, commercial products, or complementary and alternative medicine resources. On Facebook, 4 results (13%) were informative, 12 (40%) advertised commercial incontinence products, and 14 (47%) had no usable information. Of the live "tweets" reviewed on Twitter, 18 (60%) linked to incontinence-related healthcare information (none were from, or referred one to, healthcare professionals), 9 (30%) advertised for commercial incontinence products, 1 (3%) advertised complementary and alternative medicine resources, and 2 (7%) were humorous. Of 4 Twitter user results, 1 was comic, 1 provided incontinence-related health information, and 2 were incontinence medical supply companies. There were 14 (47%) informational YouTube videos, of which 9 came from healthcare professionals or professional organizations. Of the remainder, 12 (40%) were commercial, 1 (3%) advertised complementary and alternative medicine resources, and the remaining 3 (10%) were not useful. The results of our study show that social networks have insufficient useful incontinence content, especially from healthcare professionals and incontinence organizations. Medical professionals and societies should target these avenues to reach and educate patients. Copyright © 2011 Elsevier Inc. All rights reserved.

  8. Fecal incontinence - Challenges and solutions

    PubMed Central

    Saldana Ruiz, Nallely; Kaiser, Andreas M

    2017-01-01

    Fecal incontinence is not a diagnosis but a frequent and debilitating common final pathway symptom resulting from numerous different causes. Incontinence not only impacts the patient’s self-esteem and quality of life but may result in significant secondary morbidity, disability, and cost. Treatment is difficult without any panacea and an individualized approach should be chosen that frequently combines different modalities. Several new technologies have been developed and their specific roles will have to be defined. The scope of this review is outline the evaluation and treatment of patients with fecal incontinence. PMID:28104977

  9. Long-term durability of the distal urethral polypropylene sling for the treatment of stress urinary incontinence: minimum 11-year followup.

    PubMed

    Rogo-Gupta, Lisa; Baxter, Z Chad; Le, Ngoc-Bich; Raz, Shlomo; Rodríguez, Larissa V

    2012-11-01

    We report on the long-term outcomes of the distal urethral polypropylene sling for stress urinary incontinence in a patient cohort that was closely followed and whose outcomes were reported at 1 and 5 years after surgery. We performed a prospective study of all consecutive patients who underwent a distal urethral polypropylene sling procedure between November 1999 and April 2000. The 1 and 5-year outcomes for this particular patient cohort were previously reported. At the minimum 11-year followup, outcome was determined by patient self-assessment including validated questionnaires. A total of 69 patients were followed prospectively and followup was obtained for 30. Of those lost to followup 10 were deceased and 5 were cognitively impaired. Mean patient age at followup was 73 years (range 40 to 97). More than 11 years after surgery 48% of patients reported no stress urinary incontinence symptoms and 63% were never bothered by stress urinary incontinence. Patients reported a mean overall symptom improvement of 64% compared to 81% at 5 years. Overall 82% of patients met the criteria for treatment success by symptom scores and 80% met the criteria by bother scores. The distal urethral polypropylene sling procedure has excellent long-term durability in the treatment of stress urinary incontinence, in addition to low morbidity and low cost as previously described. Eleven years after the procedure the majority of patients report symptom improvement. Nevertheless, many older patients are unable to participate in followup. When choosing an anti-incontinence procedure, durability should be considered in light of patient age given that the theoretical advantages of long-term durability are limited by cognitive decline and mortality. Copyright © 2012 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  10. Incontinence in children with treated attention-deficit/hyperactivity disorder.

    PubMed

    Niemczyk, J; Equit, M; Hoffmann, L; von Gontard, A

    2015-06-01

    Attention-deficit/hyperactivity disorder (ADHD) and incontinence (nocturnal enuresis, daytime urinary incontinence and fecal incontinence) are common disorders in childhood. Both disorders are strongly associated with each other. ADHD can affect compliance to incontinence therapy in a negative way; it can also affect outcome. The aim of the present study was to assess the prevalence of incontinence, age of bladder and bowel control, and psychological symptoms in children having treatment for ADHD compared to a control group. Forty children having treatment for ADHD (75% boys, mean age 11.4 years) and 43 matched controls (60.5% boys, mean age 10.7 years) were assessed. Their parents filled out questionnaires to assess: child psychopathology (Child Behavior Checklist), incontinence (Parental Questionnaire: Enuresis/Urinary Incontinence; Encopresis Questionnaire - Screening Version) and symptoms of the lower urinary tract (International-Consultation-on-Incontinence-Questionnaire - Pediatric Lower Urinary Tract Symptoms). The ICD-10 diagnoses and children's IQ were measured by standardized instruments (Kinder-DIPS, Coloured Progressive Matrices/Standard Progressive Matrices). Rates of incontinence in the ADHD group (5% nocturnal enuresis, 5% daytime urinary incontinence, 2.5% fecal incontinence) did not differ significantly from incontinence rates in the control group (4.7% daytime urinary incontinence). More children in the ADHD group had Child Behavior Checklist scores in the clinical range. Further ICD-10 disorders were present in eight children with ADHD and in one control child. More children with ADHD had delayed daytime and nighttime bladder control, as well as delayed bowel control, than the controls. The present study showed that if children are treated for their ADHD, according to standard practice guidelines, incontinence rates are similar to those without ADHD. More children with ADHD reached continence at a later age than the controls, which could be an

  11. Inpatient versus outpatient cleft lip repair and alveolar bone grafting: a cost analysis.

    PubMed

    Albert, Mark Graham; Babchenko, Oksana Olegovna; Lalikos, Janice Fay; Rothkopf, Douglas Miller

    2014-12-01

    The lifetime cost of a child with an orofacial cleft is estimated at $101,000, which amounts to $697 million total for those born each year with orofacial clefts. There has been a trend toward outpatient procedures for cleft lip repair (CLR) and alveolar bone grafting (ABG), and studies have shown no disparities in safety or outcome between inpatient and ambulatory treatment. The financial implications of outpatient versus inpatient procedures have not been compared. Financial data were collected for outpatient (n = 33) and inpatient (n = 2) CLR, as well as outpatient (n = 7) and inpatient (n = 5) ABG during a 5-year period at our institution. We examined hospital charges and reimbursement for these procedures by private insurance plans and Medicaid Managed Care (MMC) plans. The average total reimbursements for inpatient and outpatient CLR were similar at $6848 and $5557, respectively. Average facility reimbursement for CLR was greater for inpatient ($5344) than outpatient ($4291) procedures. Average professional reimbursement was similar between inpatient ($1504) and outpatient ($1266) CLR.For ABG, the average total inpatient reimbursement was $14,573, whereas outpatient was $8877. Average facility reimbursements were greater for inpatient ($12,398) than outpatient ($7183) ABG. Average professional reimbursement was similar between inpatient ($2175) and outpatient ($1693) ABG, with 35% and 31% of charges reimbursed, respectively.A substantial difference existed between reimbursements based on insurance types for both outpatient CLR and outpatient ABG. On average for CLR, commercial payers reimbursed 52% ($7344) of overall charges, whereas Medicaid and MMC reimbursed 9% ($1447). For ABG, commercial payers reimbursed an average of 78% ($11,950) of overall charges, whereas Medicaid and MMC reimbursed 10% ($1192). Fewer patients' insurance companies are reimbursing for inpatient stays; in many cases, even patients who remain hospitalized up to 48 hours are treated as

  12. New treatments for incontinence.

    PubMed

    MacLachlan, Lara S; Rovner, Eric S

    2015-07-01

    Urinary incontinence (UI) is a common, yet underdetected and under-reported, health problem that can significantly affect quality of life. UI may also have serious medical and economic ramifications for untreated or undertreated patients, including perineal dermatitis, worsening of pressure ulcers, urinary tract infections, and falls. To prevent incontinence, the urethral sphincter must maintain adequate closure to resist the flow of urine from the bladder at all times until voluntary voiding is initiated and the bladder must accommodate increasing volumes of urine at a low pressure. UI can be categorized as a result of urethral underactivity (stress UI), bladder overactivity (urge UI), a combination of the 2 (mixed incontinence), or urethral overactivity/bladder underactivity (overflow incontinence). The main goal of therapy for the management of UI is to reduce the number of UI episodes, prevent complications, and, if possible, restore continence. This review highlights the existing treatment of stress, urge, mixed, and overflow UI in adult men and women and discusses many of the novel treatments including potential future or emerging therapies. Copyright © 2015 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  13. Urinary incontinence in patients with cystic fibrosis.

    PubMed

    Reichman, Gina; De Boe, Veerle; Braeckman, Johan; Michielsen, Dirk

    2016-01-01

    Owing to evolution in treatment, the average life expectancy of patients with cystic fibrosis (CF) has increased. This has been followed by an increase in urological complications such as urinary incontinence. As stress incontinence occurs during exercise, it may have a negative effect on the implementation of respiratory physiotherapy. The purpose of this study is to determine the prevalence of urinary incontinence and its effect on the quality of life and physiotherapy in a population with CF. Questionnaires were used to determine the prevalence of incontinence in patients of the Cystic Fibrosis Clinic of the University Hospital in Brussels. Two different surveys were used, depending on the age of the patients (< 12 or ≥ 12 years). The different characteristics of incontinence were emphasized. Questionnaires were completed by 122 participants aged 6-59 years, showing an overall prevalence of 27% for urinary incontinence. Mainly adults reported urinary incontinence, with a prevalence of 11% in men and 68% in women aged 12 and above. The amount of urinary leakage was usually only a few drops and it was mainly triggered by coughing. Many of the participants had never mentioned this symptom to anyone. Doctors' and physical therapists' attention should be drawn to the fact that urinary incontinence is part of the complication spectrum of CF. A quarter of the study population refrained from coughing up phlegm and from physiotherapy. It is important to actively question and inform about this problem, to enable its detection and treatment.

  14. Internal Delorme's Procedure for Treating ODS Associated With Impaired Anal Continence.

    PubMed

    Liu, Weicheng; Sturiale, Alessandro; Fabiani, Bernardina; Giani, Iacopo; Menconi, Claudia; Naldini, Gabriele

    2017-12-01

    The aim of this study was to evaluate the medium-term outcomes of internal Delorme's procedure for treating obstructed defecation syndrome (ODS) patients with impaired anal continence. In a retrospective study, 41 ODS patients who underwent internal Delorme's procedure between 2011 and 2015 were divided into 3 subgroups according to their associated symptoms of impaired continence, as urgency, passive fecal incontinence and both, before study. Then the patients' preoperative statuses, perioperative complications, and postoperative outcomes were investigated and collected from standardized questionnaires, including Altomare ODS score, Fecal Incontinence Severity Index (FISI), Patient Assessment of Constipation-Quality of Life Questionnaire (PAC-QoL), and Fecal Incontinence Quality of Life Scale (FIQLS). All results with a 2-tailed P < .05 were considered statistically significant. At an average 2.8 years of follow-up, there were significant improvements ( P < .01) in Altomare ODS score, FISI, PAC-QoL, and FIQLS in all patients when comparing scores from before the operation with those at the final follow-up. Similar results were also observed in both the urgency subgroup and passive fecal incontinence subgroup, but there were no statistically significant improvements ( P > .05) in Altomare ODS score, FISI, PAC-QoL, or FIQLS in the urgency and passive fecal incontinence subgroups. Anorectal manometry showed the mean value of anal resting pressure increased 20%. Additionally, no major complications occurred. Internal Delorme's procedure is effective without major morbidity for treating ODS associated with urgency or passive fecal incontinence, but it may be less effective for treating ODS associated with both urgency and passive fecal incontinence.

  15. The management of mixed urinary incontinence in women.

    PubMed

    Welk, Blayne; Baverstock, Richard J

    2017-06-01

    Mixed urinary incontinence is a common diagnosis among women with urinary leakage and is often present in women who are unable to characterize their incontinence. Research and optimized clinical treatment of these patients is limited by the challenges in objectively defining and stratifying this population. The evaluation of these patients should follow the same general principles as any assessment of any women with incontinence; however, it is essential to define whether urge or stress incontinence is the predominant symptom. Urodynamics (UDS) may be helpful in this regard and may help predict surgical outcomes. Behavioural therapy, weight loss, and pelvic floor muscle therapy are usually appropriate initial management strategies. In postmenopausal women, vaginal estrogen can be considered, and in women with equal parts stress and urge incontinence or urge-predominant mixed incontinence, a trial of anticholinergics or beta-3 agonists is appropriate. In women with stress-predominant or equal parts stress and urge incontinence, stress incontinence surgery can be considered, with the caveat that outcomes are generally worse among women with more severe levels of urgency, success rates may not be as durable, and a significant proportion of women may need additional medical therapy.

  16. Inpatient burden of childhood functional GI disorders in the USA: an analysis of national trends in the USA from 1997 to 2009.

    PubMed

    Park, R; Mikami, S; LeClair, J; Bollom, A; Lembo, C; Sethi, S; Lembo, A; Jones, M; Cheng, V; Friedlander, E; Nurko, S

    2015-05-01

    Functional gastrointestinal disorders (FGIDs) are among the most common outpatient diagnoses in pediatric primary care and gastroenterology. There is limited data on the inpatient burden of childhood FGIDs in the USA. The aim of this study was to evaluate the inpatient admission rate, length of stay (LoS), and associated costs related to FGIDs from 1997 to 2009. We analyzed the Kids' Inpatient Sample Database (KID) for all subjects in which constipation (ICD-9 codes: 564.0-564.09), abdominal pain (ICD-9 codes: 789.0-789.09), irritable bowel syndrome (IBS) (ICD-9 code: 564.1), abdominal migraine (ICD-9 code: 346.80 and 346.81) dyspepsia (ICD-9 code: 536.8), or fecal incontinence (ICD-codes: 787.6-787.63) was the primary discharge diagnosis from 1997 to 2009. The KID is the largest publicly available all-payer inpatient database in the USA, containing data from 2 to 3 million pediatric hospital stays yearly. From 1997 to 2009, the number of discharges with a FGID primary diagnosis increased slightly from 6,348,537 to 6,393,803. The total mean cost per discharge increased significantly from $6115 to $18,058 despite the LoS remaining relatively stable. Constipation and abdominal pain were the most common FGID discharge diagnoses. Abdominal pain and abdominal migraine discharges were most frequent in the 10-14 year age group. Constipation and fecal incontinence discharges were most frequent in the 5-9 year age group. IBS discharge was most common for the 15-17 year age group. Hospitalizations and associated costs in childhood FGIDs have increased in number and cost in the USA from 1997 to 2009. Further studies to determine optimal methods to avoid unnecessary hospitalizations and potentially harmful diagnostic testing are indicated. © 2015 John Wiley & Sons Ltd.

  17. Surgery for stress incontinence: factors associated with a successful outcome.

    PubMed

    Hutchings, A; Griffiths, J; Black, N A

    1998-11-01

    To investigate which patient and health-service factors are predictive of outcome after surgery for stress incontinence. In all, 232 women were assessed before and 3, 6 and 12 months after surgery for stress incontinence. Twelve patient characteristics and seven health-service factors were considered. Successful outcome was assessed in four ways: avoidance of complications after discharge, reduction in symptom severity. reduction in the social impact of stress incontinence, and improvement in activities of daily living (ADL). Relationships between possible predictors and outcome were explored using logistic regression models. Complications were less likely (r2=0.11) in women over 50 years of age, with no comorbidity and no urgency/urge incontinence, operated on by a gynaecologist. Reduction in symptom severity was more likely (r2=0.21) in younger women (< or = 50 years) with little limitation in their ADL, who suffered from severe or very severe stress incontinence symptoms but no urgency or urge incontinence, and who underwent preoperative urodynamic tests. A reduction in symptom impact was more likely (r2 = 0.15) in women in whom symptoms were having a moderate or severe impact, who were not grossly overweight, and who underwent a colposuspension or needle suspension performed by a gynaecologist. The only factor associated with improvement in ADL was the preoperative ADL score, i.e. the more limited a woman, the greater the likelihood of improvement (r2=0.15). The study provided evidence to support several of the widely held views about surgical success. Good outcomes were more likely if there is no urge incontinence, there is no or only mild comorbidity, no or only slight obesity, urodynamic investigations are conducted, and the surgeon is a gynaecologist. In contrast, there was no evidence that outcomes are worse if patients have undergone previous surgery for incontinence. Outcomes were also not related to grade of surgeon, surgeon's workload, or teaching

  18. Urinary incontinence

    MedlinePlus

    Loss of bladder control; Uncontrollable urination; Urination - uncontrollable; Incontinence - urinary ... have diabetes, keep your blood sugar under good control. For urine leaks, wear absorbent pads or undergarments. ...

  19. FREQUENCY OF POST-OPERATIVE FAECAL INCONTINENCE IN PATIENTS WITH CLOSED AND OPEN INTERNAL ANAL SPHINCTEROTOMY.

    PubMed

    Ghayas, Nighat; Younus, Syed Muneeb; Mirani, Abdul Jabbar; Ghayasuddin, Mohammed; Qazi, Aamna; Suchdev, Sunil Dutt; Bakshi, Saqib Kamran

    2015-01-01

    Fissure in ano is one of the commonest benign and painful proctologic diseases causing considerable morbidity and reduction in quality of life. There are medical as well as surgical treatment options for anal fissure. The study was conducted to compare the frequency of postoperative faecal incontinence in patients with closed lateral internal anal sphincterotomy with von-greaves knife versus standard Park's operation (open method) for chronic anal fissure. This was a randomized controlled trial (RCT) was conducted at the Department of Surgery, KVSS, S.I.T.E. Hospital, Karachi, for a period of six months from 13th February to 12th August 2011. Ninety four consecutive patients having chronic anal fissure were assigned through blocked randomization to groups A & B, with 47 patients in each group. Closed lateral internal anal sphincterotomy (CLIAS) via von-greaves knife was carried out in patients of group-A whereas patients of group-B were subjected to open internal anal sphincterotomy (OIAS) also known as Parks' procedure. Faecal incontinence was noted on the 5th post-operative day. Data was analysed using SPSS 16. There were 81 (86.2%) males and 13 (13.8%) females with male to female ratio being 6:1. Mean age was 38.38 mp ± 14.56 years. Post-operative faecal incontinence in patients undergoing CLIAS was 4.3% while it was 21.3% in those undergoing OIAS with a p-value of 0.027. CLIAS with von-greaves knife is effective in reducing faecal incontinence on 5th postoperative day as compared to standard OIAS. CLIAS with von-greaves knife is effective in reducing faecal incontinence on 5th postoperative day as compared to OIAS (Park's procedure). Therefore, this technique may be used in future regularly to treat chronic anal fissure for prevention of this morbidity.

  20. Double incontinence in a cohort of nulliparous pregnant women.

    PubMed

    Espuña-Pons, Montserrat; Solans-Domènech, Maite; Sánchez, Emília

    2012-11-01

    To estimate the frequency of double incontinence, and to identify associated risk factors during pregnancy and postpartum in previously continent nulliparous women. A cohort study in healthy, nulliparous, continent pregnant women, attending the public healthcare system of Catalonia (Spain) was designed. The field work was conducted during the control visits of pregnancy, at the time of delivery, and in the postpartum. Double incontinence was defined as a situation in which participants reported simultaneously urinary incontinence (UI) and anal incontinence with the help of a self-administered questionnaire. Prevalence rates, and their corresponding confidence intervals (95% CI), were calculated, as well as the impact on daily life. Multivariable logistic regressions in pregnancy and postpartum were estimated to assess the association of potential risk factors. The prevalence rate of double incontinence during pregnancy was 8.6% (95% CI: 7.0-10.3). Age over 35 years, and family history of UI were associated to a higher risk of double incontinence. After delivery, the prevalence rate decreased to 3.5% (95% CI: 2.4-4.6); only 6.7% of women with double incontinence in pregnancy had a persistency of their symptoms in early postpartum. Instrumental vaginal deliveries carried 2.2 times more risk of double incontinence than spontaneous ones. Episiotomy implied a higher risk for double incontinence. Symptoms of double incontinence are prevalent during first pregnancy; age and other intrinsic factors may favor the occurrence of double incontinence throughout gestation, while instrumental delivery and episiotomy increase the risk of double incontinence in the postpartum period. Copyright © 2012 Wiley Periodicals, Inc.

  1. Quality of life in women with urinary incontinence.

    PubMed

    Mladenović Segedi, Ljiljana; Segedi, Dimitrije; Parezanović Ilić, Katarina

    2011-08-01

    To determine the characteristics of urinary incontinence and its impact on the quality of life in adult women with urinary incontinence who presented to a tertiary care clinic of Vojvodina from September 2008 to May 2009 for treatment We used a prospective case-control study. Cases were defined as patients (47) with urinary incontinence symptoms. Controls (50) were defined as patients without urinary incontinence who presented to a tertiary care gynecology clinic for other reasons. Both, cases and controls, completed two questionnaires recommended for the evaluation of symptoms, The Urinary Distress Inventory, and quality of life impact The Urinary Impact Questionnaire. There was a significant correlation between aging (r=0.614; p<0.01), body mass index (r=0.357; p<0.01) and menopause (r= -0.572; p<0.01) and urinary incontinence. All patients had symptoms of stress incontinence, 61.7% had urge incontinence symptoms, 21.3% voiding difficulty and 85.1% dysuria. Ninety-four patients believed that urinary incontinence impaired their quality of life: 50% of patients reported an impaired ability to do household activities, 59.1% avoided social activities, 70.4% reported an impaired ability to travel more than 30 minutes by car or bus, 88.6% avoided leisure activities, 45.5% of patients had impaired emotional health and 34% felt frustrated. The dominant type of urinary incontinence in more than half of the respondents was a mixed type, with moderate to very severe problems. Symptoms of urinary incontinence interfere with the performance of everyday household and social activities, causing the appearance of anxiety, depression and frustration, and in more than 50% of women leads to reduced quality of life.

  2. Faecal soiling: pathophysiology of postdefaecatory incontinence.

    PubMed

    Pucciani, F

    2013-08-01

    Passive postdefaecatory incontinence is poorly understood and yet is an important clinical problem. The aim of this study was to characterize the pathophysiology of postdefaecatory incontinence in patients affected by faecal soiling. Seventy-two patients (30 women, age range 49-79 years; 42 men, age range, 53-75 years) affected by faecal passive incontinence with faecal soiling were included in the study. Two patient groups were identified: Group 1 comprised 42 patients with postdefaecatory incontinence and Group 2 had 30 patients without incontinence after bowel movements. After a preliminary clinical evaluation, including the Faecal Incontinence Severity Index (FISI) score and the obstructed defaecation syndrome (ODS) score, all patients of Groups 1 and 2 were studied by means of endoanal ultrasound and anorectal manometry. The results were compared with those from 20 healthy control subjects. A significantly higher ODS score was found in Group 1 (P < 0.001). Endoanal ultrasound revealed a significantly diffuse thinning of the internal anal sphincter (IAS) in Group 2 (P < 0.02) with a linear relationship between signs of IAS atrophy and the FISI score (ρs 0.78; P < 0.03). Anal resting pressure (Pmax and Pm ) was significantly lower in Group 2 (P < 0.04). The straining test was considered positive in 30 (71.4%) patients in Group 1, significantly greater than in Group 2 (P < 0.01). A significantly higher conscious rectal sensitivity threshold (CRST) was found in Group 1 patients (P < 0.01). The ODS score, a positive straining test and high CRST values suggest that postdefaecatory incontinence is secondary to impaired defaecation. Colorectal Disease © 2013 The Association of Coloproctology of Great Britain and Ireland.

  3. [Analysis of obstetrical and gynaecological history of women with urinary stress incontinence].

    PubMed

    Sobański, Andrzej; Pozowski, Janusz; Poreba, Ryszard; Piwowarczyk, Magdalena; Pasierbek, Aneta

    2004-01-01

    Urinary leakage is a hygienic and social problem, that concerns women both in reproductive and perimenopausal age. It leads to a life deterioration, depression, and social isolation. Urinary stress incontinence (USI) is one of the most common-type of urine leakage. Characteristic symptom of this disorder there is involuntary leakage of urine during increased intra-abdominal pressure (cough, laugh, sneezing or physical work). There are many various predictive factors of urinary stress incontinence in a large number of publications. One of them, the most important, seems to be a gravidity and labor. 40-82% pregnant women complain of urinary leakage. The main aim of investigation was to determine obstetrical and gynaecological predictive factors of urinary stress incontinence. 53 women with diagnosed USI and qualified to TVT procedure have to fill in questionnaire with row questions about their obstetrical and gynaecological history. Our investigation revealed that significant influence on appearance of USI exert number of spontaneous labors, birth weight >3500 g, lack of substitute hormonal therapy during menopause and hard physical work in the past.

  4. Characterizing hospital inpatients: the importance of demographics and attitudes.

    PubMed

    Danko, W D; Janakiramanan, B; Stanley, T J

    1988-01-01

    To compete effectively, hospital administrators must understand inpatients who are involved in hospital-choice decisions more clearly. To this end, a methodology is presented to measure and assess the importance of inpatients' personal attributes in predicting hospital selection. Empirical results show that demographic characteristics are poor--but attitudes are useful--segmentation variables that delineate differences between two particular hospitals' inpatients. More generally, the survey method and statistical procedures outlined are applicable (with slight modification) to markets with a greater number of competitors.

  5. Urinary Incontinence

    MedlinePlus

    Urinary incontinence (UI) is loss of bladder control. Symptoms can range from mild leaking to uncontrollable wetting. It can happen to anyone, but it becomes more common with age. Women experience ...

  6. Functional and morphological differences following Monarc and TVT-O procedures.

    PubMed

    Huang, W-C; Yang, S-H; Yang, J-M; Tzeng, C-R

    2012-12-01

    To explore function of the lower urinary tract and morphology of tape and urethra following Monarc or TVT-O suburethral tape placement for urodynamic stress incontinence (USI). We recruited prospectively women undergoing either Monarc or TVT-O placement for USI. Before and 3 months after the procedure, participants were evaluated by a question-directed interview, the measures of Sandvik Incontinence Severity Index (SISI), Incontinence Bother Scale (IBS), Ingelman-Sundberg Score (ISS) and short forms of Urogenital Distress Inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ-7), physical examination, a cough stress test and 4D ultrasound investigation. The primary outcome was participants' responses to clinical assessments and the secondary outcome was ultrasound findings. A total of 67 women with Monarc procedures and 60 women with TVT-O procedures completed the survey both preoperatively and 3 months postoperatively. There were significant improvements in scores of SISI, IBS, ISS, UDI-6 and IIQ-7 after both Monarc and TVT-O procedures. At the 3-month follow-up, both procedures had similar success rates, SISI scores, IBS scores, ISS scores, UDI-6 scores and IIQ-7 scores, and similar incidences of postoperative voiding difficulty and overactive bladder symptoms. After Bonferroni correction, all ultrasound parameters representing tape location, tape tension and urethral mobility were similar between the two procedures. At short-term follow-up, Monarc and TVT-O procedures are comparable in both functional outcome of the lower urinary tract and morphology on ultrasound as assessed by parameters representing tape location, tape tension and urethral mobility. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.

  7. Inventing urine incontinence devices for women.

    PubMed

    Pieper, B; Cleland, V; Johnson, D E; O'Reilly, J L

    1989-01-01

    Nurses have long been aware of the devastating effects of urinary incontinence on women. Although women may find diapers, pads and protective clothing valuable protection, there are few options for a continuous wear, external urine incontinence device (EUID). Inventors have attempted to develop an EUID since ancient times; the first United States patent for an EUID was awarded in 1949. The purpose of this paper is to review technological considerations for development of an external urinary incontinence device for women. Patents and products illustrate the considerations.

  8. Urinary incontinence in working women: a comparison study.

    PubMed

    Palmer, Mary H; Fitzgerald, Sheila

    2002-12-01

    To compare the findings of two surveys concerning the nature of urinary incontinence and management strategies used by full-time employed working women. The first study was conducted in an urban academic setting with a survey distributed to 2000 women. The second study was conducted with 500 women in a rural pottery manufacturing facility. Twenty-one percent of the women working in an academic setting (group A) and 29% (p = 0.002) of the women working in a manufacturing setting (group B) reported being incontinent of urine at least monthly. More women in group B reported antecedents mixed incontinence (i.e., antecedent to both stress and urge incontinence). More women in group B also used panty liners to manage urine loss (p = 0.003), whereas more women in group A used voiding schedules (p = 0.008) and pelvic muscle exercises (p = 0.04). More women in group A reported that they did not know if their incontinence could improve (40% vs. 1%, p = 0.00). The majority in both groups said that getting treatment was of no or little importance, yet, overwhelmingly, most women (group A 81%; group B 86%) wanted more information about incontinence. Incontinence is a prevalent condition in working women. Discrepancies exist in the nature of the urine loss and strategies used to manage incontinence. Treatment also differs for those women who report urine loss to healthcare providers. Most women want to learn more about incontinence. Secondary prevention strategies need to be tailored and tested to meet symptoms and concerns for women in different work settings.

  9. Continent or incontinent? That is the question.

    PubMed

    Taunton, Roma Lee; Swagerty, Daniel L; Lasseter, Joyce A; Lee, Robert H

    2005-09-01

    A qualitative, emergent, case study design guided the description of care provided to nursing home residents with urinary incontinence in three Midwestern nursing facilities. Participants included 17 residents and 16 family members or friends of the respective residents. Staff and managers involved in the planning and delivery of care to the participating residents also were included. The three facilities represented variation in size, location, ownership, and Medicare certification. Data were collected via observation, resident record audit, and semi-structured interview. Definitions of incontinence varied among staff. A collectively held expectation that residents would be toileted every 2 hours was not met. Maintaining skin integrity was the primary motivation for keeping residents clean and dry. Medical directors viewed incontinence as a nursing problem. Staff described situations in which incontinence was improved for specific residents, but there was little evidence of formal programs to maintain continence or improve incontinence.

  10. Urinary incontinence in Belgium: a population-based epidemiological survey.

    PubMed

    Schulman, C; Claes, H; Matthijs, J

    1997-01-01

    To investigate the prevalence, typology, and experience of urinary incontinence, as well as the available therapeutic modalities and information sources among people living at home in Belgium. A representative population sample of 5,269 adults completed a questionnaire in their own homes. There were 2,499 men and 2,770 women aged 30 years and over. 130 men (5.2%) and 442 women (16.30%) had urinary incontinence at the time of the survey. Of 1,426 women aged over 50 years, 300 (21.0%) had urinary incontinence. 17.4% of the incontinent people experience several episodes daily. In women, incontinence increases with parity. Stress incontinence is by far the most common form of the disease (42%); 53% of incontinent women (9.9% of the female population) experience this kind of disorder. Overall, 95% of stress incontinent people are women. The relative frequency of urge incontinence is similar in both sexes (males 45%; females 55%). Urinary incontinence is considered as bothersome by about 30% of the affected subjects; 7 of 10 subjects with daily incontinence episodes consider the disorder as more or less bothersome. 29.9% of affected people report that they discuss the problem with their general practitioner, 11.4% with a specialist, 25.3% with their spouse or partner, and 17.4% with a family member. Of course, people who consider the disease as bothersome score higher on these items. On the other hand, 32.1% do not reveal the problem. Although 72.5% of incontinent people are aware of protection systems, the main therapeutic modalities are not very well known (drugs 33.9%; surgery 24.7%). Most people with incontinence (70-75%) take no specific measures, 20% use pads, panty liners or nappies, and only 9% look for a curative measure. The preferred information source is the family physician for 50%, the specialist physician for 11%, and the pharmacist for 9%. The role of the mass media is equivalent to that of specialist physicians and pharmacists. Incontinence has a

  11. Urinary incontinence self-report questions: reproducibility and agreement with bladder diary.

    PubMed

    Bradley, Catherine S; Brown, Jeanette S; Van Den Eeden, Stephen K; Schembri, Michael; Ragins, Arona; Thom, David H

    2011-12-01

    This study aims to measure self-report urinary incontinence questions' reproducibility and agreement with bladder diary. Data were analyzed from the Reproductive Risk of Incontinence Study at Kaiser. Participating women reporting at least weekly incontinence completed self-report incontinence questions and a 7-day bladder diary. Self-report question reproducibility was assessed and agreement between self-reported and diary-recorded voiding and incontinence frequency was measured. Test characteristics and area under the curve were calculated for self-reported incontinence types using diary as the gold standard. Five hundred ninety-one women were included and 425 completed a diary. The self-report questions had moderate reproducibility and self-reported and diary-recorded incontinence and voiding frequencies had moderate to good agreement. Self-reported incontinence types identified stress and urgency incontinence more accurately than mixed incontinence. Self-report incontinence questions have moderate reproducibility and agreement with diary, and considering their minimal burden, are acceptable research tools in epidemiologic studies.

  12. Preliminary results of sacral transcutaneous electrical nerve stimulation for fecal incontinence.

    PubMed

    Leung, Edmund; Francombe, James

    2013-03-01

    Fecal incontinence is a common debilitating condition. The aim of this study is to investigate the feasibility of sacral transcutaneous electrical nerve stimulation as an alternative treatment modality for fecal incontinence. All consecutive patients who presented with fecal incontinence to the senior author's clinic were prospectively recruited between June 2009 and September 2010. The severity of their fecal incontinence was assessed by the Wexner and Vaizey scores and anal physiology. Any improvement following a period of sacral transcutaneous electrical nerve stimulation treatment was determined by repeating the scores. In addition, patient satisfaction with the procedure was assessed by using a patient impression score. Twenty female patients with a median age of 57.5 years (range, 30-86) were evaluated. The median follow-up was 10 months (range, 5-12 months). Two patients did not record a change in their Vaizey score. The overall mean Wexner score was 7.9 ± 4.2 before in comparison with 4.0 ± 3.1 after sacral transcutaneous electrical nerve stimulation treatment (p < 0.0001, CI = 2.2-5.7, SE = 0.832). The overall mean Vaizey score was 12.7 ± 5.7 before in comparison with 5.8 ± 5.6 after sacral transcutaneous electrical nerve stimulation treatment (p < 0.0001, CI = 4.5-9.4, SE = 1.162). The pretreatment patient impression score was set at a mean of 1 ± 0 in comparison with 2.8 ± 1.1 after sacral transcutaneous electrical nerve stimulation treatment (p < 0.0001, CI = 1.2-2.3, SE = 0.25). The preliminary results suggest sacral transcutaneous electrical nerve stimulation is a promising noninvasive alternative to existing modalities in the treatment of idiopathic fecal incontinence.

  13. [Characteristic Features of Urinary Incontinence--Diagnostic Investigation in Geriatric Patients].

    PubMed

    Kirschner-Hermanns, R; Anding, R

    2016-02-01

    Urinary incontinence is a common medical and social problem in elderly people. It leads to a massive reduction in the quality of life of affected persons and their dependants and causes an enormous socio-economic burden, which will increase significantly within the next years and decades as the age structure of the German population changes. Successful treatment of urinary incontinence in the elderly requires a good pathophysiological understanding of the underlying problem as well as individually tailored diagnostic procedures, which must be oriented at the patient's wishes, the social environment and the resulting therapeutic consequences. This especially applies to persons with symptoms of dementia. Comorbidities such as diabetes mellitus, reduced mobility and a medication-induced decrease in cognitive function play a major role in the severity of urgency and urinary incontinence in the elderly. Also the frequently described concomitant diagnosis of urinary tract infection must be exactly evaluated. Before antibiotic treatment is given, it should be clarified if the patient suffers from "harmless" bacteriuria or a urinary tract infection requiring treatment. Patients with an age-associated decrease in brain power must be diagnosed quite carefully, because these patients may potentially be harmed by pharmacological treatment for overactive bladder syndrome. © Georg Thieme Verlag KG Stuttgart · New York.

  14. COEXISTENCE OF CONSTIPATION AND INCONTINENCE IN CHILDREN AND ADULTS

    PubMed Central

    Nurko, S; Scott, SM

    2011-01-01

    The coexistence of constipation and fecal incontinence has long been recognized in pediatric and geriatric populations, but is grossly underappreciated in the rest of the adult population. In children, functional fecal incontinence is usually associated with constipation, stool retention and incomplete evacuation, and is frequently allied to urinary incontinence. Pathophysiology of the incontinence is incompletely understood, although both in children and adults, it is thought to be secondary to overflow, while in adults it may also be related to pelvic floor dysfunction and denervation. Incontinence has an important impact on quality of life and daily functioning, and in children may be associated with behavior problems. The treatment of underlying constipation usually results in improvement in incontinence. This review broadly addresses the epidemiology and pathophysiology of coexistent constipation and incontinence in both children and adults, and also reviews clinical presentation and treatment response in pediatrics. PMID:21382577

  15. Prevalence of Urinary Incontinence During Pregnancy and Associated Risk Factors.

    PubMed

    Dinç, Ayten

    2017-07-04

    To investigate the prevalence of urinary incontinence during pregnancy and associated risk factors. The study is a cross-sectional and descriptive study. A questionnaire was conducted with a total of 750 pregnant women about their urinary incontinence complaints between April and December 2013. The prevalence of urinary incontinence during pregnancy was 300 in 750 (40%). Stress urinary incontinence was the most common type of incontinence during pregnancy. 41.7% of nulliparous women, 38% of primipara women, and 20.3% of multipara women experienced urinary incontinence. Among women reporting UI, 29.3% experienced leakage a few times a day and the amount of leakage was generally (59.7%) moderate. Factors significantly associated with urinary incontinence included age group, gestational age, parity, previous urinary incontinence, constipation, mode of delivery at last childbirth, previous urinary tract infection, body mass index during pregnancy. But on multivariable analysis, the risk factors for urinary incontinence during pregnancy were previous urinary tract infection (OR = 3.8, 95%CI 1.5-9.3), constipation (OR 3.1, 95%CI 1.7-5.6) and gestational age (OR 0.5, 95%CI 0.3-0.9). As a result of this study, urinary incontinence is a common condition during pregnancy. Results would help the design of more intensive training programs to prevent incontinence during pregnancy by increasing the awareness about urinary incontinence of healthcare staff engaging in the care of pregnant women. © 2017 John Wiley & Sons Australia, Ltd.

  16. Inpatient Burden of Childhood Functional GI Disorders in the United States: An Analysis of National Trends in the U.S. from 1997 to 2009

    PubMed Central

    Park, Richard; Mikami, Sage; LeClair, Jack; Bollom, Andrea; Lembo, Cara; Sethi, Saurabh; Lembo, Anthony; Jones, Mike; Cheng, Vivian; Friedlander, Elizabeth; Nurko, Samuel

    2017-01-01

    BACKGROUND Functional Gastrointestinal Disorders (FGIDs) are among the most common outpatient diagnoses in pediatric primary care and gastroenterology. There is limited data on the inpatient burden of childhood FGIDs in the U.S. The aim of this study was to evaluate the inpatient admission rate, length of stay, and associated costs related to FGIDs from 1997–2009. METHODS We analyzed the Kids’ Inpatient Sample Database (KID) for all subjects in which constipation (ICD-9 codes: 564.0–564.09), abdominal pain (ICD-9 codes: 789.0–789.09), irritable bowel syndrome (IBS) (ICD-9 code: 564.1), abdominal migraine (ICD-9 code:346.80 and 346.81)dyspepsia (ICD-9 code: 536.8) or fecal incontinence (ICD-codes: 787.6–787.63) was the primary discharge diagnosis from 1997–2009. The KID is the largest publicly available all-payer inpatient database in the U.S., containing data from 2–3 million pediatric hospital stays yearly. KEY RESULTS From 1997–2009, the number of discharges with a FGID primary diagnosis increased slightly from 6,348,537 to 6,393,803. The total mean cost per discharge increased significantly from $6115 to $18,058 despite the length of stay remaining relatively stable. Constipation and abdominal pain were the most common FGID discharge diagnoses. Abdominal pain and abdominal migraine discharges were most frequent in the 10–14 year age group. Constipation and fecal incontinence discharges were most frequent in the 5–9 year age group. IBS discharge was most common for the 15–17 year age group. CONCLUSIONS AND INFERENCES Hospitalizations and associated costs in childhood FGIDs have increased in number and cost in the U.S. from 1997–2009. Further studies to determine optimal methods to avoid unnecessary hospitalizations and potentially harmful diagnostic testing are indicated. PMID:25809794

  17. Impact of urinary incontinence types on women's quality of life.

    PubMed

    Saboia, Dayana Maia; Firmiano, Mariana Luisa Veras; Bezerra, Karine de Castro; Vasconcelos, José Ananias; Oriá, Mônica Oliveira Batista; Vasconcelos, Camila Teixeira Moreira

    2017-12-21

    To identify the most frequent type of urinary incontinence in women assisted in two outpatient clinics of urogynecology, and to compare general and specific quality of life among the different types of incontinence measured through validated questionnaires. Cross-sectional study conducted at the urogynecology outpatient clinic. The following questionnaires were used for quality of life assessment: Medical Outcomes Study 36-item Short-Form Health Survey (SF-36), International Consultation Incontinence Questionnaire Short-Form (ICIQ-SF), King's Health Questionnaire (KHQ), and Pelvic Organ Prolapse Incontinence Sexual Questionnaire (PISQ-12). The study included 556 women. Mixed Urinary Incontinence was the most frequent type (n=348/62.6%), followed by Stress Urinary Incontinence (n=173/31.1%) and Urge Urinary Incontinence (n=35/6.3%). Women with mixed urinary incontinence had greater impact on the general (SF-36) and specific quality of life (KHQ and ICIQ-SF) compared to the others (p<0.05). In the evaluation of sexual function (PISQ-12), there was no difference between groups (p=0.28). All types of urinary incontinence interfere both in the general and specific quality of life, but women with mixed urinary incontinence are the most affected.

  18. A new questionnaire for urinary incontinence diagnosis in women: development and testing.

    PubMed

    Bradley, Catherine S; Rovner, Eric S; Morgan, Mark A; Berlin, Michelle; Novi, Joseph M; Shea, Judy A; Arya, Lily A

    2005-01-01

    The purpose of this study was to develop a questionnaire for urinary incontinence diagnosis in women and to test its reliability and validity, with incontinence specialists' clinical evaluations as the gold standard. One hundred seventeen urogynecology outpatients with urinary incontinence symptoms completed the Questionnaire for Urinary Incontinence Diagnosis at enrollment and 1 week and 9 months later. Baseline clinical diagnoses were compared with Questionnaire for Urinary Incontinence Diagnosis diagnoses (criterion validity). Nine-month Questionnaire for Urinary Incontinence Diagnosis change scores were compared across treatment groups (responsiveness). Clinical diagnoses included stress (n = 15), urge (n = 26), and mixed urinary incontinence (n = 72). Internal consistency and test-retest reliability estimates were good. Sensitivity and specificity were 85% (95% CI, 75%, 91%) and 71% (95% CI, 51%, 87%), respectively, for stress urinary incontinence and 79% (95% CI, 69%, 86%) and 79% (95% CI, 54%, 94%), respectively, for urge urinary incontinence. The Questionnaire for Urinary Incontinence Diagnosis correctly diagnosed urinary incontinence type in 80% of subjects. Questionnaire for Urinary Incontinence Diagnosis Stress and Urge scores decreased significantly in treated subjects. The Questionnaire for Urinary Incontinence Diagnosis, a new 6-item questionnaire for female urinary incontinence type diagnosis, is reliable and able to diagnose stress urinary incontinence and urge urinary incontinence in a referral urogynecology patient population with accuracy.

  19. Evaluation and treatment of urinary incontinence in long term care.

    PubMed

    Pannill, F C; Williams, T F; Davis, R

    1988-10-01

    All elderly patients with established urinary incontinence residing in an intermediate care facility during one year were evaluated for medical and urological conditions contributing to the incontinence; treatment was initiated for all diagnosed problems if possible. Unstable detrusor function (65%), sphincter weakness (13%), and overflow incontinence (10%) were all frequent urological causes, although several patients required extensive testing in addition to cystometrics to establish a complete diagnosis. Frequent nonurological causes of incontinence included behavioral problems (53%), immobility (45%), medication problems (24%), diabetes (18%), and local pathology (47%). Thirty-seven percent had three or more conditions identified. Treatment aimed at nonurological causes was more successful in ameliorating incontinence than urological medication; side effects were significant limitations to urological treatment success. Of the 22 patients who completed evaluation, treatment, and follow-up, five patients (23%) were cured, three (14%) showed at least a 65% decrease in incontinence, four (18%) showed at least a 30% decrease in incontinence, and 10 (45%) showed no change or worsened. We conclude that nonurological problems frequently contribute to urinary incontinence in long term care facilities; incontinence in some of these patients can be improved without urological therapy. Nonurological problems need careful definition and treatment; patients whose incontinence persists require comprehensive urological evaluation and therapy. A complete solution to incontinence in this setting may require safer drugs and better understanding of urinary pathophysiology.

  20. Fecal Incontinence

    MedlinePlus

    ... Infants and Toddlers Kids and Teens Pregnancy and Childbirth Women Men Seniors Your Health Resources Healthcare Management ... incontinence. In women, this damage commonly occurs during childbirth. It’s especially likely to happen in a difficult ...

  1. Factors Related to Urinary Incontinence among the Malaysian Elderly.

    PubMed

    Eshkoor, S A; Hamid, T A; Shahar, S; Mun, C Y

    2017-01-01

    Urinary incontinence is a prevalent condition in the elderly that is the spontaneous leakage of urine. It is an age-related problem and increases especially in people aged above 65 years. It can cause many psychological, behavioral, biological, economic and social effects. The treatment of urinary incontinence can reduce morbidity and mortality. Thus, this study aimed to determine the effects of variables including age, ethnicity, gender, education, marital status, body weight, blood elements and nutritional parameters on urinary incontinence among the Malaysian elderly. The study was on 2322 non-institutionalized Malaysian elderly. The hierarchy logistic regression analysis was applied to estimate the risk of independent variables for urinary incontinence among respondents. The findings indicated that approximately 3.80% of subjects had urinary incontinence. In addition, constipation was found a significant factor that increased the risk of urinary incontinence in samples (p=0.006; OR=3.77). The increase in dietary monounsaturated fat (p=0.038; OR=0.59) and plasma triglyceride levels (p=0.029; OR=0.56) significantly reduced the risk of incontinence in subjects. Many of suspected variables including socio-demographic factors, diseases, nutritional minerals, blood components and body weight were non-relevant factors to urinary incontinence in respondents. Constipation increased the risk of urinary incontinence in subjects, and increase in dietary monounsaturated fat and plasma triglyceride levels decreased the risk.

  2. Urinary incontinence - vaginal sling procedures

    MedlinePlus

    ... you are numb and feel no pain. A catheter (tube) is placed in your bladder to drain urine from your bladder. The doctor ... to urinate more often More difficulty emptying your bladder, and the need to use a catheter Worsening of urine leakage Before the Procedure Tell ...

  3. Does body mass index influence the outcome of midurethral sling procedures for stress urinary incontinence?

    PubMed

    Xia, Ziyuan; Qian, Jialei; Chen, Yuntian; Liao, Banghua; Luo, Deyi

    2017-06-01

    Whether midurethral sling (MUS) procedures are as effective in obese women as they are in women of normal weight is still a matter of controversy. The objective of this study was to determine if body mass index (BMI) influences the outcome of MUS procedures for stress urinary incontinence (SUI). We searched electronic databases including EMBASE, MEDLINE, Web of Science and Ovid evidence-based medicine reviews to identify studies that explored the association between BMI and outcomes of MUS procedures. The studies were rated using the Newcastle-Ottawa scale; the meta-analysis was performed using Review Manager 5.3 software. This review included 11 studies, 6 prospective cohort studies and 5 retrospective studies, with a total of 2,846 patients. The objective success rates of MUS in patients with BMI >25 kg/m 2 (overweight and obese) were lower than in patients with BMI 18.5 - <25 kg/m 2 (normal weight; RR = 0.93, 95 % CI 0.89 - 0.97; P = 0.002). The objective success rates were not significantly different between the overweight group (BMI 25 - <30 kg/m 2 ) and the obese group (BMI ≥30 kg/m 2 ; RR = 0.95, 95 % CI 0.89 - 1.01; P = 0.08). There were no significant differences in subjective outcomes among the different BMI groups: BMI ≥25 kg/m 2 versus 18.5 - <25 kg/m 2 (RR = 1.03, 95 % CI 0.97 - 1.10; P = 0.29), and BMI ≥30 kg/m 2 versus 25 - <30 kg/m 2 (RR = 0.98, 95 % CI 0.92 - 1.04; P = 0.55). The objective success rates of MUS were lower in overweight and obese patients; however, the subjective outcomes of MUS were not significantly different among normal weight, overweight and obese patients. The MUS procedure is as effective in obese women as in women of normal weight, and therefore surgeons should not consider BMI >25 kg/m 2 as a risk factor when discussing the suitability of the MUS procedure in a patient with SUI.

  4. TVT-O for the treatment of pure urodynamic stress incontinence: efficacy, adverse effects, and prognostic factors at 5-year follow-up.

    PubMed

    Serati, Maurizio; Bauer, Ricarda; Cornu, Jean Nicolas; Cattoni, Elena; Braga, Andrea; Siesto, Gabriele; Lizée, Daphné; Haab, François; Torella, Marco; Salvatore, Stefano

    2013-05-01

    Inside-out tension-free vaginal transobturator tape (TVT-O) is currently one of the most effective and popular procedures for the surgical treatment of female stress urinary incontinence (SUI), but data reporting long-term outcomes are scarce. To evaluate the efficacy and safety of TVT-O 5-yr implantation for management of pure SUI in women. A prospective observational study was conducted in four tertiary reference centers. Consecutive women presenting with urodynamically proven, pure SUI treated by TVT-O were included. Patients with mixed incontinence and/or anatomic evidence of pelvic organ prolapse were excluded. TVT-O implantation without any associated procedure. Data regarding subjective outcomes (International Consultation on Incontinence-Short Form [ICIQ-SF], Patient Global Impression of Improvement, patient satisfaction scores), objective cure (stress test) rates, and adverse events were collected during follow-up. Multivariable analyses were performed to investigate outcomes. Of the 191 women included, 21 (11.0%) had previously undergone a failed anti-incontinence surgical procedure. Six (3.1%) patients were lost to follow-up. The 5-yr subjective and objective cure rates were 90.3% and 90.8%, respectively. De novo overactive bladder (OAB) was reported by 24.3% of patients at 5-yr follow-up. Median ICIQ-SF score significantly improved from 17 (interquartile range [IQR]:16-17) preoperatively to 0 (IQR: 0-2) (p<0.0001). Failure of a previous anti-incontinence procedure was the only independent predictor of subjective recurrence of SUI (hazard ratio [HR]: 4.4; p = 0.009) or objective (HR: 3.7; p = 0.02). No predictive factor of de novo OAB was identified. TVT-O implantation is a highly effective option for the treatment of women with pure SUI, showing a very high cure rate and a low incidence of complications after 5-yr follow-up. Copyright © 2012 European Association of Urology. Published by Elsevier B.V. All rights reserved.

  5. Comparison between three mini-sling surgical procedures and the traditional transobturator vaginal tape technique for female stress urinary incontinence

    PubMed Central

    LEANZA, V.; INTAGLIATA, E.; LEANZA, A.; FERLA, F.; LEANZA, G.; VECCHIO, R.

    2014-01-01

    Objectives To compare mini-sling and traditional tension-free operations for female stress urinary incontinence. Study design A systematic review of articles in the Literature published between 2002 and 2012, was conducted. A Pubmed search was performed. Primary outcomes were subjective and objective cure rates at 12 months comparing the three single-incision mini-slings techniques (TVT-Secur, MiniArc and Monarc systems) with the standard mid-urethral sling procedure TOT (Transobturator Vaginal Tape). Secondary outcomes included peri-operative (vaginal and/or bladder perforation, urine retention, urinary tract infection, bleeding, pain) and post-operative (mesh exposure, de novo urgency, and dyspareunia) complications. Results In term of objective cure rate at 12 month after surgery, it is evident that TOT at first, and MiniArc are the most effective procedures. The incidence of post-operative urgency and UTI was lower in TOT technique, while vaginal perforation was described in equal frequency both in TOT and in MiniArc procedures. The advantages of the three above described mini-invasive techniques seem to consist into lower cases of urinary retention, pain and bleeding. Furthermore, bladder perforation and bleeding are not described in the Literature for TVT-Secur and Monarc systems. Conclusions Some single-incision slings look promising and as effective as conventional sub-urethral slings at short term evaluation. However, at this moment a clear statement in favor of the widespread use of single-incision slings cannot be made. More studies must define the efficacy of these techniques. PMID:24841685

  6. Urinary incontinence among female soldiers.

    PubMed

    Davis, G; Sherman, R; Wong, M F; McClure, G; Perez, R; Hibbert, M

    1999-03-01

    A self-administered questionnaire was developed to assess the prevalence of urinary incontinence among active duty female soldiers. The questionnaire also addressed basic demographic information, including height, age, weight, and the subjects' present and past military activities. Adaptive measures that the soldiers commonly used to continue exercising and perform their duties were also explored. Seven hundred thirteen questionnaires were handed out to female soldiers at Fort Lewis (Washington), Fort Benning (Georgia), and Fitzsimons Army Medical Center (Colorado) during preparation for physical fitness tests. Of the 563 soldiers (79%) who returned completed questionnaires, 31% indicated that they commonly experienced urinary incontinence during duty and/or training to the extent that it interfered with job performance, hygiene, or was socially embarrassing. Thus, urinary incontinence is a pervasive problem among female soldiers.

  7. Effects of bariatric surgery on urinary incontinence

    PubMed Central

    Bulbuller, Nurullah; Habibi, Mani; Yuksel, Mustafa; Ozener, Onur; Oruc, Mehmet Tahir; Oner, Osman Zekai; Kazak, Mehmet Altug

    2017-01-01

    Introduction Obesity is an important modifiable etiological factor associated with several diseases. There is strong evidence that urinary incontinence (UI) is positively correlated with body mass index (BMI). Aim One of the many benefits experienced by obese patients after bariatric surgery is decrease in UI. To investigate this correlation, we aimed to examine the effects of weight loss on UI in female patients who had undergone laparoscopic sleeve gastrectomy (LSG). Materials and methods Obese female patients (n=120), ≥18 years of age, and planning to undergo LSG were included in this prospective study. We administered the International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form (ICIQ-UI-SF) and Incontinence Impact Questionnaire (IIQ-7) to the patients prior to surgery and 6 months after the surgery. Using the collected data, we determined the incidence of UI and examined the relationship between the preoperative and postoperative BMI and UI values. Results The mean age of the patients was 39.19 (standard deviation [SD] =9.94) years and the mean preoperative BMI was 46.17 (SD =5.35). Of the 120 patients, 72 (60%) complained of UI preoperatively. Among these 72 patients, 23 (31.95%) described urge incontinence, 18 (25%) stress incontinence, and 31 (43.05%) mixed-type incontinence. At 6 months postoperatively, the percentage of excess weight loss was 70.33% (SD =14.84%). For all three UI subtypes, the 6-month postoperative ICIQ-UI-SF and IIQ-7 scores decreased significantly compared to the preoperative scores (P<0.05). Conclusion LSG results in a clinically significant improvement in most common types of UI, regardless of patient reproductive history, existence of comorbid conditions, and smoking status. PMID:28176911

  8. [Surgical treatment of prolapse by abdominal route and effort-related urinary incontinence].

    PubMed

    Wagner, L; Fatton, B; Delmas, V; Haab, F; Costa, P

    2009-12-01

    Stress urinary incontinence is often associated with prolapse. The suburethral tapes have modified the indication for a preventive treatment of incontinence. The tapes are necessary in case of patent or masked incontinence, discussed in case of potential incontinence. The diagnosis of incontinence is done on questions to the patient, clinical exam, more than in urodynamic study. There is no absolute sign allowing to predict postoperative incontinence after surgery for prolapse. A continent woman can be incontinent postoperatively. If a potential incontinence is treated in the same as the prolapse, the patient must be informed of risk of obstruction and/or urgency.

  9. Experiences Related to Urinary Incontinence of Stroke Patients: A Qualitative Descriptive Study.

    PubMed

    Arkan, Gulcihan; Beser, Ayse; Ozturk, Vesile

    2018-02-01

    Poststroke urinary incontinence is a common problem, with a prevalence ranging from 32% to 79%. Urinary incontinence after stroke has negative physiological, psychological, and economic effects, which lead to lifestyle changes for both patients and caregivers. Nurses play an important role in preventing and improving incontinence, understanding the experiences of individuals experiencing incontinence, providing healthcare for them, and implementing behavioral therapy methods. The aim of this study was to determine the experience related to urinary incontinence of stroke patients. In this qualitative descriptive study, using semistructured interviews, 15 participants with urinary incontinence after stroke selected through purposeful sampling were interviewed. Data were collected with a semistructured interview form prepared within the framework of the Health Belief Model. All data were analyzed using content analysis. Three main themes were identified: "perception of urinary incontinence," "effects of urinary incontinence," and "management of urinary incontinence." The respondents explained that urinary incontinence also adversely affected their caregivers. They experienced many daily life and psychological problems because of urinary incontinence. In addition, they made several changes to management urinary incontinence such as limiting fluid intake, changing underwear frequently, using waterproof mattress protectors, applying traditional practice, and taking medicine. This study revealed that stroke patients needed help and support for urinary incontinence management. Nurses should provide information about management and urinary incontinence after stroke.

  10. Conservative Management of Urinary Incontinence in Women

    PubMed Central

    Faiena, Izak; Patel, Neal; Parihar, Jaspreet S; Calabrese, Marc; Tunuguntla, Hari

    2015-01-01

    Urinary incontinence in women has a high prevalence and causes significant morbidity. Given that urinary incontinence is not generally a progressive disease, conservative therapies play an integral part in the management of these patients. We conducted a nonsystematic review of the literature to identify high-quality studies that evaluated the different components of conservative management of stress urinary incontinence, including behavioral therapy, bladder training, pelvic floor muscle training, lifestyle changes, mechanical devices, vaginal cones, and electrical stimulation. Urinary incontinence can have a severe impact on our healthcare system and patients’ quality of life. There are currently a wide variety of treatment options for these patients, ranging from conservative treatment to surgical treatment. Although further research is required in the area of conservative therapies, nonsurgical treatments are effective and are preferred by some patients. PMID:26543427

  11. Urodynamic study in women with pure stress urinary incontinence.

    PubMed

    Valdevenito, J P; Águila, F; Naser, M; Manríquez, V; Wenzel, C; Díaz, J P

    2015-03-01

    To describe the results of urodynamic study in women with pure stress urinary incontinence symptoms, including the characteristics of the overactive detrusor. No other clinical assessments were taken into account. A retrospective study in women with urinary incontinence consecutively evaluated by urodynamic study. From a total of 710 women, only 108 (15%) with pure stress urinary incontinence symptoms were selected. Women with prior urinary incontinence surgery, pelvic organ prolapse (stage ≥iii), pelvic radiotherapy, using medication active on the lower urinary tract and neurological diseases were excluded. Infusion rate was 70 ml/min. Detrusor overactivity was induced only by cough. A standardized cough stress test with progressive cough intensity was carried out. Reference urodynamic values for stress incontinent women are described. Urodynamic stress incontinence was observed in 79 women (73.1%), detrusor overactivity in 4 (3.7%) and mixed urodynamic diagnosis in 15 (13.8%). Test was inconclusive in 10 patients (9.2%). Two women had detrusor overactivity incontinence (1.9%). One patient had detrusor overactivity induced by cough without urodynamic stress incontinence (0.9%). There was an association between detrusor overactivity and nocturia ≥2 (P=.002; odds ratio: 3.74; 95% confidence interval: 1.22-11.39). One woman had a bladder outlet obstruction (0.9%). In women with pure stress urinary incontinence, without knowing the outcome of other clinical assessments, urodynamic study can provide useful information to define the proper therapy. Copyright © 2014 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  12. Anal incontinence after childbirth

    PubMed Central

    Eason, Erica; Labrecque, Michel; Marcoux, Sylvie; Mondor, Myrto

    2002-01-01

    Background Incontinence of stool and flatus are frequent complications of childbirth. We examined the prevalence and possible causes of these adverse outcomes in a large cohort of women. Methods We studied 949 pregnant women who gave birth in 5 hospitals in 1995/96 in the province of Quebec. These women, participants in a randomized controlled trial of prenatal perineal massage, completed a self-administered questionnaire 3 months after giving birth. Results Three months after delivery 29 women (3.1%) reported incontinence of stool, and 242 (25.5%) had involuntary escape of flatus. Incontinence of stool was more frequent among women who delivered vaginally and had third- or fourth-degree perineal tears than among those who delivered vaginally and had no anal sphincter tears (7.8% v. 2.9%). Forceps delivery (adjusted risk ratio [RR] 1.45, 95% confidence interval [CI] 1.01–2.08) and anal sphincter tears (adjusted RR 2.09, 95% CI 1.40–3.13) were independent risk factors for incontinence of flatus or stool or both. Anal sphincter injury was strongly and independently associated with first vaginal birth (RR 39.2, 95% CI 5.4–282.5), median episiotomy (adjusted RR 9.6, 95% CI 3.2–28.5), forceps delivery (adjusted RR 12.3, 95% CI 3.0–50.4) and vacuum-assisted delivery (adjusted RR 7.4, 95% CI 1.9–28.5) but not with birth weight (adjusted RR for birth weight 4000 g or more: 1.4, 95% CI 0.6–3.0) or length of the second stage of labour (adjusted RR for second stage 1.5 hours or longer compared with less than 0.5 hours: 1.2, 95% CI 0.5–2.7). Interpretation Anal incontinence is associated with forceps delivery and anal sphincter laceration. Anal sphincter laceration is strongly predicted by first vaginal birth, median episiotomy, and forceps or vacuum delivery but not by birth weight or length of the second stage of labour. PMID:11868640

  13. Anal incontinence after childbirth.

    PubMed

    Eason, Erica; Labrecque, Michel; Marcoux, Sylvie; Mondor, Myrto

    2002-02-05

    Incontinence of stool and flatus are frequent complications of childbirth. We examined the prevalence and possible causes of these adverse outcomes in a large cohort of women. We studied 949 pregnant women who gave birth in 5 hospitals in 1995/96 in the province of Quebec. These women, participants in a randomized controlled trial of prenatal perineal massage, completed a self-administered questionnaire 3 months after giving birth. Three months after delivery 29 women (3.1%) reported incontinence of stool, and 242 (25.5%) had involuntary escape of flatus. Incontinence of stool was more frequent among women who delivered vaginally and had third- or fourth-degree perineal tears than among those who delivered vaginally and had no anal sphincter tears (7.8% v. 2.9%). Forceps delivery (adjusted risk ratio [RR] 1.45, 95% confidence interval [CI] 1.01-2.08) and anal sphincter tears (adjusted RR 2.09, 95% CI 1.40-3.13) were independent risk factors for incontinence of flatus or stool or both. Anal sphincter injury was strongly and independently associated with first vaginal birth (RR 39.2, 95% CI 5.4-282.5), median episiotomy (adjusted RR 9.6, 95% CI 3.2-28.5), forceps delivery (adjusted RR 12.3, 95% CI 3.0-50.4) and vacuum-assisted delivery (adjusted RR 7.4, 95% CI 1.9-28.5) but not with birth weight (adjusted RR for nirth weight 4000 g or more: 1.4, 95% CI 0.6-3.0) or length of the second stage of labour (adjusted RR for second stage 1.5 hours or longer compared with less than 0.5 hours: 1.2, 95% CI 0.5-2.7). Anal incontinence is associated with forceps delivery and anal sphincter laceration. Anal sphincter laceration is strongly predicted by first vaginal birth, median episiotomy, and forceps or vacuum delivery but not by birth weight or length of the second stage of labour.

  14. Urinary Incontinence

    MedlinePlus

    ... stress incontinence. The sling is either a narrow piece of synthetic (man-made) mesh or a piece of tissue from your own body that your ... the United States. World Journal of Urology; 20(6): 327–336. American College of Obstetricians and Gynecologists. ( ...

  15. The inpatient economic and mortality impact of hepatocellular carcinoma from 2005 to 2009: analysis of the US nationwide inpatient sample.

    PubMed

    Mishra, Alita; Otgonsuren, Munkhzul; Venkatesan, Chapy; Afendy, Mariam; Erario, Madeline; Younossi, Zobair M

    2013-09-01

    Hepatocellular carcinoma (HCC) is an important complication of cirrhosis. Our aim was to assess the inpatient economic and mortality of HCC in the USA METHODS: Five cycles of Nationwide Inpatient Sample (NIS) conducted from 2005 to 2009 were used. Demographics, inpatient mortality, severity of illness, payer type, length of stay (LoS) and charges were available. Changes and associated factors related to inpatient HCC were assessed using simple linear regression. Odds ratios and 95% CIs for hospital mortality were analysed using log-linked regression model. To estimate the sampling variances for complex survey data, we used Taylor series approach. SAS(®) v.9.3 was used for statistical analysis. From 2005 to 2009, 32,697,993 inpatient cases were reported to NIS. During these 5 years, primary diagnosis of HCC increased from 4401 (2005), 4170 (2006), 5065 (2007), 6540 (2008) to 6364 (2009). HCC as any diagnosis increased from 68 per 100,000 discharges (2005) to 99 per 100,000 (2009). However, inpatient mortality associated with HCC decreased from 12% (2005) to 10% (2009) (P < 0.046) and LoS remained stable. However, median inflation-adjusted charges at the time of discharge increased from $29,466 per case (2005) to $31,656 per case (2009). Total national HCC charges rose from $1.0 billion (2005) to $2.0 billion (2009). In multivariate analysis, hospital characteristic was independently associated with decreasing in-hospital mortality (all P < 0.05). Liver transplantation for HCC was the main contributor to high inpatient charges. Longer LoS and other procedures also contributed to higher inpatient charges. There is an increase in the number of inpatient cases of HCC. Although inpatient mortality is decreasing and the LoS is stable, the inpatient charges associated with HCC continue to increase. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  16. National audit of pressure ulcers and incontinence-associated dermatitis in hospitals across Wales: a cross-sectional study

    PubMed Central

    Clark, Michael; Semple, Martin J; Ivins, Nicola; Mahoney, Kirsten; Harding, Keith

    2017-01-01

    Objective The Chief Nurse National Health Service Wales initiated a national survey of acute and community hospital patients in Wales to identify the prevalence of pressure ulcers and incontinence-associated dermatitis. Methods Teams of two nurses working independently assessed the skin of each inpatient who consented to having their skin observed. Results Over 28 September 2015 to 2nd October 2015, 8365 patients were assessed across 66 hospitals with 748 (8.9%) found to have pressure ulcers. Not all patients had their skin inspected with all mental health patients exempt from this part of the audit along with others who did not consent or were too ill. Of the patients with pressure ulcers, 593 (79.3%) had their skin inspected with 158 new pressure ulcers encountered that were not known to ward staff, while 152 pressure ulcers were incorrectly categorised by the ward teams. Incontinence-associated dermatitis was encountered in 360 patients (4.3%), while medical device-related pressure ulcers were rare (n=33). The support surfaces used while patients were in bed were also recorded to provide a baseline against which future changes in equipment procurement could be assessed. The presence of other wounds was also recorded with 2537 (30.3%) of all hospital patients having one or more skin wounds. Conclusions This survey has demonstrated that although complex, it is feasible to undertake national surveys of pressure ulcers, incontinence-associated dermatitis and other wounds providing comprehensive and accurate data to help plan improvements in wound care across Wales. PMID:28827240

  17. Military exposure and urinary incontinence among American men.

    PubMed

    Vaughan, Camille P; Johnson, Theodore M; Goode, Patricia S; Redden, David T; Burgio, Kathryn L; Markland, Alayne D

    2014-01-01

    We examined the association between military exposure and urinary incontinence in American men. Data from the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2008 were merged to include 5,297 men 20 years old or older. The question, "Did you ever serve in the Armed Forces of the United States?" (yes/no) was used to assess military exposure. Urinary incontinence was categorized as any or moderate/severe urinary incontinence vs none. Because the impact of military exposure varied by age, multivariate logistic regression models were used to estimate the OR and 95% CI stratified by 3 age groups, including 55 or less, 56 to 69 and 70 years or greater. Analysis was adjusted for race/ethnicity, education, body mass index, self-reported health status, number of chronic conditions, depression and prostate conditions, the latter in men 40 years old or older. Overall 23% of male respondents reported military exposure. Men with military exposure were more likely to report any urinary incontinence (18.6% vs 10.4%) and moderate/severe urinary incontinence (9.0% vs 3.1%, each p <0.001) than men without military exposure. After multivariate adjustment in men 55 years old or younger those with military exposure had 3 times greater odds of urinary incontinence (OR 3.28, 95% CI 1.38-7.77). Military exposure did not increase the odds of urinary incontinence in men 56 to 69 years old (OR 0.97, 95% CI 0.44-2.18), or 70 years old or older (OR 0.91, 95% CI 0.55-1.50). Prior military exposure was associated with moderate/severe urinary incontinence in American men 55 years old or younger even after controlling for known risk factors. Case finding is warranted for urinary incontinence in younger men with a history of military service. Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  18. Patency and Incontinence Rates After Robotic Bladder Neck Reconstruction for Vesicourethral Anastomotic Stenosis and Recalcitrant Bladder Neck Contractures: The Trauma and Urologic Reconstructive Network of Surgeons Experience.

    PubMed

    Kirshenbaum, Eric J; Zhao, Lee C; Myers, Jeremy B; Elliott, Sean P; Vanni, Alex J; Baradaran, Nima; Erickson, Bradley A; Buckley, Jill C; Voelzke, Bryan B; Granieri, Michael A; Summers, Stephen J; Breyer, Benjamin N; Dash, Atreya; Weinberg, Aaron; Alsikafi, Nejd F

    2018-05-16

    To review a robotic approach to recalcitrant bladder neck obstruction and to assess success and incontinence rates. Patients with a recalcitrant bladder neck contracture or vesicourethral anastomotic stenosis who underwent robotic bladder neck reconstruction (RBNR) were identified. We reviewed patient demographics, medical history, etiology, previous endoscopic management, cystoscopic and symptomatic outcomes, urinary continence, and complications. Stricture success was anatomic and functional based upon atraumatic passage of a 17 Fr flexible cystoscope or uroflowmetry rate >15 ml/s. Incontinence was defined as the use of >1 pad per day or procedures for incontinence. Between 2015 and 2017, 12 patients were identified who met study criteria and underwent RBNR. Etiology of obstruction was endoscopic prostate procedure in 7 and radical prostatectomy in 5. The mean operative time was 216 minutes (range 120-390 minutes), with a mean estimated blood loss of 85 cc (range 5-200 cc). Median length of stay was 1 day (range 1-5 days). Three of 12 patients had recurrence of obstruction for a 75% success rate. Additionally, 82% of patients without preoperative incontinence were continent with a median follow-up of 13.5 months (range 5-30 months). There was 1 Clavien IIIb complication of osteitis pubis and pubovesical fistula that required vesicopubic fistula repair with pubic bone debridement. RBNR is a viable surgical option with high patency rates and favorable continence outcomes. This is in contrast to perineal reconstruction, which has high incontinence rates. If future incontinence procedures are needed, outcomes may be improved given lack of previous perineal dissection. Copyright © 2018 Elsevier Inc. All rights reserved.

  19. Cost savings of outpatient versus standard inpatient total knee arthroplasty

    PubMed Central

    Huang, Adrian; Ryu, Jae-Jin; Dervin, Geoffrey

    2017-01-01

    Background With diminishing reimbursement rates and strained public payer budgets, a high-volume inpatient procedure, such as total knee arthroplasty (TKA), is a common target for improving cost efficiencies. Methods This prospective case–control study compared the cost-minimization of same day discharge (SDD) versus inpatient TKA. We examined if and where cost savings can be realized and the magnitude of savings that can be achieved without compromising quality of care. Outcome variables, including detailed case costs, return to hospital rates and complications, were documented and compared between the first 20 SDD cases and 20 matched inpatient controls. Results In every case–control match, the SDD TKA was less costly than the inpatient procedure and yielded a median cost savings of approximately 30%. The savings came primarily from costs associated with the inpatient encounter, such as surgical ward, pharmacy and patient meal costs. At 1 year, there were no major complications and no return to hospital or readmission encounters for either group. Conclusion Our results are consistent with previously published data on the cost savings associated with short stay or outpatient TKA. We have gone further by documenting where those savings were in a matched cohort design. Furthermore, we determined where cost savings could be realized during the patient encounter and to what degree. In carefully selected patients, outpatient TKA is a feasible alternative to traditional inpatient TKA and is significantly less costly. Furthermore, it was deemed to be safe in the perioperative period. PMID:28234591

  20. Urinary incontinence at orgasm: relation to detrusor overactivity and treatment efficacy.

    PubMed

    Serati, Maurizio; Salvatore, Stefano; Uccella, Stefano; Cromi, Antonella; Khullar, Vik; Cardozo, Linda; Bolis, Pierfrancesco

    2008-10-01

    To understand the pathophysiological mechanism of incontinence during orgasm and to compare women affected by symptomatic detrusor overactivity (DO) with and without incontinence at orgasm in terms of efficacy of antimuscarinic treatment. All consecutive sexually active women with incontinence during intercourse were prospectively included and divided into two groups: women with coital incontinence at orgasm or at penetration. The two forms of coital incontinence were correlated to the urodynamic finding of DO. Women complaining of overactive bladder (OAB) symptoms, with urinary incontinence at orgasm and urodynamically proven DO (cases), were prescribed tolterodine 4 mg extended release for at least 12 wk. The cases were compared in terms of efficacy of treatment on OAB symptoms to consecutive patients with symptomatic DO without coital incontinence (control group). Among the 1133 women who underwent urodynamic testings during the study period, 132 patients were eligible for final analysis. A significant difference in DO was observed in women with incontinence at orgasm (34 of 49; 69.4%) compared with women with incontinence during penetration (24 of 83; 28.9%) (p<0.0001). The 34 women with incontinence at orgasm associated with DO were given antimuscarinics treatment and were compared with 53 controls. Fourteen of 34 (41.2%) and 9 of 53 (17%) women did not respond to antimuscarinics in the cases and in the control group, respectively (p=0.023). Incontinence at orgasm is associated with DO in the majority of cases. This is the first study showing an inferior efficacy of antimuscarinic treatment in women with DO complaining of incontinence at orgasm.

  1. Lower Urinary Tract Symptoms and Urinary Incontinence During Pregnancy.

    PubMed

    Balik, Gülşah; Güven, Emine Seda G; Tekin, Yeşim B; Şentürk, Şenol; Kağitci, Mehmet; Üstüner, Işık; Mete Ural, Ülkü; Şahin, Figen K

    2016-05-01

    Lower urinary tract symptoms (LUTS) can frequently be seen in pregnant women. Pregnancy and delivery have been considered as risk factors in the occurrence of pelvic floor dysfunction and determinants of LUTS. The main associated risk factor is parity. In the present study, we aim to determine the frequency of LUTS and urinary incontinence (UI) during pregnancy and the associated risk factors. This prospective study was carried out in a total of 250 women during their 28- and 40-gestational week checks. The Urinary Distress Inventory-6, the Incontinence Impact Questionnaire-7, and International Consultation on Incontinence Questionnaire-Short Form were used to determine LUTS and its effect on quality of life. The mean age and gestational age of the participants were 29.41 ± 5.70 year (range 18-44) and 35.45 ± 2.98 weeks (range 28-40), respectively. The prevalence of LUTS was 81.6%. The prevalence of UI during pregnancy was 37.2%. Stress urinary incontinence, urge urinary incontinence and mixed urinary incontinence were diagnosed as 15.6, 4.8 and 16.8%, respectively. We found that advanced age, smoking and multiparity were risk factors associated with incontinence. Incontinence reduced pregnant women's quality of life. Lower urinary tract symptoms are commonly seen among pregnant women and these symptoms negatively affect the quality of life of pregnant women. Advanced age, smoking and multiparity were risk factors associated with urinary incontinence and LUTS. Obstetricians should be on the lookout for individual urological problems in pregnancy. Resolving any urological issues and cessation of smoking for the affected individuals will help alleviate the problem. © 2014 Wiley Publishing Asia Pty Ltd.

  2. Risk factors for urinary tract infection following incontinence surgery.

    PubMed

    Nygaard, Ingrid; Brubaker, Linda; Chai, Toby C; Markland, Alayne D; Menefee, Shawn A; Sirls, Larry; Sutkin, Gary; Zimmern, Phillipe; Arisco, Amy; Huang, Liyuan; Tennstedt, Sharon; Stoddard, Anne

    2011-10-01

    The purpose of this study is to describe risk factors for post-operative urinary tract infection (UTI) the first year after stress urinary incontinence surgery. Multivariable logistic regression analyses were performed on data from 1,252 women randomized in two surgical trials, Stress Incontinence Surgical Treatment Efficacy trial (SISTEr) and Trial Of Mid-Urethral Slings (TOMUS). Baseline recurrent UTI (rUTI; ≥3 in 12 months) increased the risk of UTI in the first 6 weeks in both study populations, as did sling procedure and self-catheterization in SISTEr, and bladder perforation in TOMUS. Baseline rUTI, UTI in the first 6 weeks, and PVR > 100 cc at 12 months were independent risk factors for UTI between 6 weeks and 12 months in the SISTEr population. Few (2.3-2.4%) had post-operative rUTI, precluding multivariable analysis. In women with pre-operative rUTI, successful surgery (negative cough stress test) at 1 year did not appear to decrease the risk of persistent rUTI. Pre-operative rUTI is the strongest risk factor for post-operative UTI.

  3. Nursing students' knowledge and attitudes toward urinary incontinence: A cross-sectional survey.

    PubMed

    Luo, Yan; Parry, Monica; Huang, Yan-Jin; Wang, Xiu-Hua; He, Guo-Ping

    2016-05-01

    Nurses must have adequate knowledge to manage the complexities of urinary incontinence. Nursing students are the nurses of the future, yet little is known about urinary incontinence education in undergraduate nursing programs. The aim of this study was (a) to assess the knowledge and attitudes of urinary incontinence held by undergraduate nursing students in China and (b) to explore the relationship between knowledge, attitudes and socio-demographic characteristics. A cross-sectional survey using cluster random sampling. Undergraduate departments of Nursing within the Faculty of Health Sciences at six Universities, located in different areas of China. A random selection of 6 faculties with a total of 1313 full time undergraduate nursing students completed the survey. Self-reported data were collected using two validated questionnaires, the Urinary Incontinence Knowledge Scale and the Urinary Incontinence Attitude Scale, to access students' knowledge and attitudes toward urinary incontinence. Overall urinary incontinence knowledge was poor (49.9%, 15.0/30) and attitudes about urinary incontinence were generally positive (71.7%, 43.0/60). A high level of interest in learning more about urinary incontinence was found. There was a weak correlation between urinary incontinence knowledge and attitudes (r=0.135, p<0.01). There was also a significant positive correlation between urinary incontinence knowledge and attitudes and nursing students' year of study, urinary incontinence education and training, and formal clinical practicum experience in urology (p<0.05). Chinese nursing students showed poor urinary incontinence knowledge but generally positive attitudes toward urinary incontinence. This study suggests there is a need to examine urinary incontinence content throughout undergraduate nursing curricula in China. Copyright © 2016 Elsevier Ltd. All rights reserved.

  4. Pressure Ulcer Risk in the Incontinent Patient: Analysis of Incontinence and Hospital-Acquired Pressure Ulcers From the International Pressure Ulcer Prevalence™ Survey.

    PubMed

    Lachenbruch, Charlie; Ribble, David; Emmons, Kirsten; VanGilder, Catherine

    2016-01-01

    To measure the prevalence of incontinence in the 2013-2014 International Pressure Ulcer Prevalence (IPUP) surveys and determine the relative risk of developing a facility-acquired pressure ulcers (FAPUs) by stage and by Braden Scale score groupings. The IPUP survey is an observational, cross-sectional cohort database designed to determine the frequency and severity of pressure ulcers in various populations. The survey includes acute care (91.4%), long-term acute care (1.7%), rehabilitation patients (1.7%) and long-term care residents (5.2%). Geographic distribution included 182,832 patients in the United States, 22,282 patients in Canada, and the rest of the world, primarily in Europe and the Middle East. We analyzed data from the 2013 and 2014 IPUP surveys to better understand the relationship between incontinence and the frequency and severity of FAPUs. The IPUP survey is an annual voluntary survey of patients who are hospitalized or who reside in long-term care facilities. Data were collected over a 24-hour period within each participating facility. Data collection included limited demographics, presence and stage of pressure ulcers, and pressure ulcer risk assessment score (Braden Scale for Pressure Sore Risk, Braden Q, Norton, Waterlow, and others). In addition, data were collected on pertinent pressure ulcer risk factors including the number of linen layers, use of a pressure redistributing surface, adherence to repositioning schedule, and whether moisture management was provided in the last 24 hours. We aggregated data by urinary, urinary catheter, fecal, fecal management system, double (urinary and fecal), and ostomy incontinence category. If patients were managed by indwelling urinary catheter or fecal management systems, they were considered incontinent in this analysis. In order to analyze ulcers likely to be affected by incontinence, we defined a subset of ulcers as Relevant Pressure Ulcers, which are ulcers that are facility-acquired, non

  5. Obesity, overweight, and eating problems in children with incontinence.

    PubMed

    Wagner, Catharina; Equit, Monika; Niemczyk, Justine; von Gontard, Alexander

    2015-08-01

    The aim was to analyze the prevalence of eating problems and specific associations between overweight, obesity, and eating behavior in children with incontinence. Forty-three consecutively presented children with incontinence, diagnosed to International Children's Continence Society standards, and 44 matched continent controls were examined prospectively. All children received a physical examination, sonography, and a one-dimensional intelligence test. Child psychopathology was measured with the Child Behavior Checklist (CBCL/4-18). Eating problems were assessed with the German version of the Dutch Eating Behaviour Questionnaire for Children (DEBQ-C) and a 40-item-parental questionnaire referring to atypical eating problems. Of the 43 children with incontinence, 23.3% had nocturnal enuresis (NE) only, 37.2% had any form of daytime urinary incontinence (DUI) (isolated or combined with NE) and 39.5% had fecal incontinence (FI) (isolated or combined with NE and/or DUI). Incontinent children showed significantly more CBCL externalizing symptoms (35.7% vs. 6.8%) and total problems (46.3% vs. 6.8%) in the clinical range (>90th percentile), as well as significantly lower mean IQ (105.5 vs. 120.6) than continent controls. Of the children with incontinence, 16.9% were affected by obesity (≥95th body mass index [BMI] percentile) compared with none of the continent controls. Especially in children with FI, the rate of obesity was significantly increased (23.5%). In addition, 46.5% of incontinent children, but none of the controls, had constipation. Again, children with FI (82.4%) had the highest rate of constipation (>DUI: 25% > NE only: 20%). "Food refusal" (FR) and "intense fear of gaining weight" (GW), but not other eating problems, were significantly more common among incontinent children (FR mean score 7.3; GW mean score 1.4) than in controls (FR mean score 5.6; GW mean score 0.7). After controlling for BMI percentiles, FR still was significantly higher in

  6. Diabetes, glycemic control, and urinary incontinence in women

    PubMed Central

    Wang, Rui; Lefevre, Roger; Hacker, Michele R.; Golen, Toni H.

    2015-01-01

    OBJECTIVES To estimate the association between urinary incontinence and glycemic control in women ages 20 to 85. METHODS We included 7,270 women from the 2005–2010 National Health and Nutrition Examination Survey, stratified into three groups of glycemic control defined by hemoglobin A1c (HbA1c): i) those below the diagnostic threshold (HbA1c<6.5%), ii) those with relatively controlled diabetes (HbA1c 6.5–8.5%), and iii) those with poorly controlled diabetes (HbA1c>8.5%) to allow for a different relationship between glycemic control and urinary incontinence within each group. The primary outcomes were the presence of any, only stress, only urgency, and mixed urinary incontinence. We calculated adjusted risk ratios using Poisson regressions with robust variance estimates. RESULTS The survey-weighted prevalence was 52.9% for any, 27.2% for only stress, 9.9% for only urgency, and 15.8% for mixed urinary incontinence. Among women with relatively controlled diabetes, each one-unit increase in HbA1c was associated with a 13% (95% CI: 1.03–1.25) increase for any urinary incontinence and a 34% (95% CI 1.06–1.69) increase in risk for only stress incontinence but was not significantly associated with only urgency and mixed incontinence. Other risk factors included body mass index, hormone replacement therapy, smoking, and physical activity. CONCLUSIONS Worsening glycemic control is associated with an increased risk for stress incontinence for women with relatively controlled diabetes. For those either below the diagnostic threshold or with poorly controlled diabetes, the risk may be driven by other factors. Further prospective investigation of HbA1c as a modifiable risk factor may motivate measures to improve continence in women with diabetes. PMID:26313496

  7. Future Directions of Research and Care for Urinary Incontinence: Findings from the National Institute of Diabetes and Digestive and Kidney Diseases Summit on Urinary Incontinence Clinical Research in Women.

    PubMed

    Chai, Toby C; Asfaw, Tirsit S; Baker, Jan E; Clarkson, Becky; Coleman, Pamela; Hoffstetter, Susan; Konkel, Kimberly; Lavender, Missy; Nair, Shailaja; Norton, Jenna; Subak, Leslee; Visco, Anthony; Star, Robert A; Bavendam, Tamara

    2017-07-01

    Female urinary incontinence is prevalent, costly and morbid. Participants in a NIDDK (National Institute of Diabetes and Digestive and Kidney Diseases) sponsored summit reviewed findings from NIH (National Institutes of Health) funded clinical research on urinary incontinence in women and discussed the future of urinary incontinence research. The NIDDK convened the Summit on Urinary Incontinence Clinical Research in Women on March 14, 2014. Participants representing a broad range of clinical expertise reviewed completed NIH sponsored urinary incontinence related studies, including results from community based epidemiological studies such as the BACH (Boston Area Community Health) Survey and from randomized clinical trials such as PRIDE (Program to Reduce Incontinence by Diet and Exercise), and studies conducted by the Pelvic Floor Disorders Network and the Urinary Incontinence Treatment Network. BACH Survey results improved our understanding of precursors, incidence, prevalence and natural history of urinary incontinence in a diverse group of women. The Pelvic Floor Disorders Network study found that anticholinergic medications and onabotulinumtoxinA are efficacious for treating urge urinary incontinence, and Burch colposuspension and retropubic mid urethral polypropylene slings are efficacious for decreasing stress urinary incontinence following pelvic organ prolapse surgery in women with potential stress urinary incontinence. The Urinary Incontinence Treatment Network study found that fascial slings were better than colposuspension, and that retropubic and transobturator mid urethral polypropylene slings were equivalent for stress urinary incontinence. In patients with stress urinary incontinence a preoperative urodynamic study was noninferior to basic office examinations for surgical outcome. The addition of behavioral intervention did not allow female patients to discontinue antimuscarinics for urge urinary incontinence. PRIDE showed that modest weight

  8. Cell Therapy for Stress Urinary Incontinence.

    PubMed

    Hart, Melanie L; Izeta, Ander; Herrera-Imbroda, Bernardo; Amend, Bastian; Brinchmann, Jan E

    2015-08-01

    Urinary incontinence (UI) is the involuntary loss of urine and is a common condition in middle-aged and elderly women and men. Stress urinary incontinence (SUI) is caused by leakage of urine when coughing, sneezing, laughing, lifting, and exercise, even standing leads to increased intra-abdominal pressure. Other types of UI also exist such as urge incontinence (also called overactive bladder), which is a strong and unexpected sudden urge to urinate, mixed forms of UI that result in symptoms of both urge and stress incontinence, and functional incontinence caused by reduced mobility, cognitive impairment, or neuromuscular limitations that impair mobility or dexterity. However, for many SUI patients, there is significant loss of urethral sphincter muscle due to degeneration of tissue, the strain and trauma of pregnancy and childbirth, or injury acquired during surgery. Hence, for individuals with SUI, a cell-based therapeutic approach to regenerate the sphincter muscle offers the advantage of treating the cause rather than the symptoms. We discuss current clinically relevant cell therapy approaches for regeneration of the external urethral sphincter (striated muscle), internal urethral sphincter (smooth muscle), the neuromuscular synapse, and blood supply. The use of mesenchymal stromal/stem cells is a major step in the right direction, but they may not be enough for regeneration of all components of the urethral sphincter. Inclusion of other cell types or biomaterials may also be necessary to enhance integration and survival of the transplanted cells.

  9. To evaluate the safety and efficacy of the TVT-Secur procedure in the treatment of stress urinary incontinence in women.

    PubMed

    Sandhu, J S; Karan, S C; Maiti, G D; Dudeja, Puja

    2017-01-01

    The prevalence of stress urinary incontinence (SUI) in the middle-aged Indian women is around 16%. The use of transvaginal tapes (TVTs) has revolutionised the surgical management of SUI. Patients who undergo placement of the tape via the transobturator route often complain of persistent thigh pain at the site of trocar insertion. The use of minimally invasive tapes with a single suburethral incision reduces surgical trauma by eliminating thigh incisions, while maintaining the cure achieved by conventional TVTs. The study was conducted to test the efficacy and safety of minimally invasive TVT-Secur tape placement for treatment of SUI in women. 20 women with stress incontinence were implanted with TVT-Secur tapes and followed up for a year. The objective cure rate of SUI was 85% at the end of a year. The improvement in the patient satisfaction and Incontinence-specific QOL scores, of both Urogenital Distress Inventory (UDI-6) and Incontinence Impact Questionnaire-7 (IIQ-7), was statistically significant at 95% and 99% confidence levels. There were no complaints of thigh pain; however, there were intraoperative complications in the form of bladder perforation in 5% ( n  = 1), urethral injury in 5% ( n  = 1) and urethral tape exposure in 10% ( n  = 2), at 3 months requiring tape sectioning. These cure rates and complications are comparable to the standard TVT implantations at the end of a year, without thigh pain; however, a greater number of patients and a longer follow-up is required to see whether the long-term cure is maintained or not, before recommending the same as a standard of treatment.

  10. The effects of expanding outpatient and inpatient evaluation and management services in a pediatric interventional radiology practice.

    PubMed

    Edalat, Faramarz; Lindquester, Will S; Gill, Anne E; Simoneaux, Stephen F; Gaines, Jennifer; Hawkins, C Matthew

    2017-03-01

    Despite a continuing emphasis on evaluation and management clinical services in adult interventional radiology (IR) practice, the peer-reviewed literature addressing these services - and their potential economic benefits - is lacking in pediatric IR practice. To measure the effects of expanding evaluation and management (E&M) services through the establishment of a dedicated pediatric interventional radiology outpatient clinic and inpatient E&M reporting system. We collected and analyzed E&M current procedural terminology (CPT) codes from all patients seen in a pediatric interventional radiology outpatient clinic between November 2014 and August 2015. We also calculated the number of new patients seen in the clinic who had a subsequent procedure (procedural conversion rate). For comparison, we used historical data comprising pediatric patients seen in a general interventional radiology (IR) clinic for the 2 years immediately prior. An inpatient E&M reporting system was implemented and all inpatient E&M (and subsequent procedural) services between July 2015 and September 2015 were collected and analyzed. We estimated revenue for both outpatient and inpatient services using the Medicare Physician Fee Schedule global non-facility price as a surrogate. Following inception of a pediatric IR clinic, the number of new outpatients (5.5/month; +112%), procedural conversion rate (74.5%; +19%), estimated E&M revenue (+158%), and estimated procedural revenue from new outpatients (+228%) all increased. Following implementation of an inpatient clinic reporting system, there were 8.3 consults and 7.3 subsequent hospital encounters per month, with a procedural conversion rate of 88%. Growth was observed in all meaningful metrics following expansion of outpatient and inpatient pediatric IR E&M services.

  11. Bone-anchored sling using the Mini Quick Anchor Plus and polypropylene mesh to treat post-radical prostatectomy incontinence: early experience.

    PubMed

    Suzuki, Yasutomo; Saito, Yuka; Ogushi, Satoko; Kimura, Go; Kondo, Yukihiro

    2012-10-01

    Herein we describe our experience with a bone-anchored sling using a suture anchor and polypropylene mesh for the treatment of post-radical prostatectomy urinary incontinence. Eight patients with urinary incontinence as a result of intrinsic sphincter deficiency after radical prostatectomy were included in the analysis. The procedure involved piercing the pubic bone with a bone drill, inserting the suture anchor and fixing a soft or rigid polypropylene mesh to press firmly on the bulbar urethra. Urinary incontinence was significantly improved according to changes in the daily number of pads used at 1, 3 and 6 months postoperatively in comparison with preoperatively. However, no meaningful improvement at 6 months postoperatively was seen with the soft mesh. Complications included perineal pain in four cases, but pain control was achieved using non-steroidal anti-inflammatory drugs. The bone-anchored sling with a suture anchor and polypropylene mesh appears to be safe and effective for the treatment of post-radical prostatectomy urinary incontinence. Soft mesh appears inappropriate as material for the bone-anchored sling because of the progressive likelihood of worsened urinary incontinence. © 2012 The Japanese Urological Association.

  12. Management of urinary incontinence in residential care.

    PubMed

    Lim, David S

    2016-07-01

    Urinary incontinence is prevalent in residential care and rates are expected to increase with the ageing population in Australia. It contributes to poor quality of life (QoL), functional impairments in activities of daily living, and deterioration of mental and sexual health. Management depends on the type of incontinence, its aetiology, the severity of symptoms, the effects on QoL, and patient factors. Treatment options include active treatment and passive containment. However, not all active treatment options are feasible in residential care. There is little evidence to advise on standard best practice. The aims of this article are to review treatment options for urinary incontinence in residential care, feasibility of service delivery and challenges associated with this. A greater understanding of the issues surrounding the management of urinary incontinence in residential care is required to deliver satisfactory patient-centred care on a consistent basis.

  13. Interventions for preventing and treating incontinence-associated dermatitis in adults.

    PubMed

    Beeckman, Dimitri; Van Damme, Nele; Schoonhoven, Lisette; Van Lancker, Aurélie; Kottner, Jan; Beele, Hilde; Gray, Mikel; Woodward, Sue; Fader, Mandy; Van den Bussche, Karen; Van Hecke, Ann; De Meyer, Dorien; Verhaeghe, Sofie

    2016-11-10

    Incontinence-associated dermatitis (IAD) is one of the most common skin problems in adults who are incontinent for urine, stool, or both. In practice, products and procedures are the same for both prevention and treatment of IAD. The objective of this review was to assess the effectiveness of various products and procedures to preventand treat incontinence-associated dermatitis in adults. We searched the Cochrane Incontinence Group Specialised Trials Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE In-Process, MEDLINE Epub Ahead of Print, CINAHL, ClinicalTrials.gov, WHO ICTRP and handsearching of journals and conference proceedings (searched 28 September 2016). Additionally we searched other electronic databases: CENTRAL(2015, Issue 4), MEDLINE (January 1946 to May Week 3 2015), MEDLINE In-Process (inception to 26 May 2015), CINAHL(December 1981 to 28 May 2015), Web of Science (WoS; inception to 28 May 2015) and handsearched conference proceedings (to June 2015) and the reference lists of relevant articles, and contacted authors and experts in the field. We selected randomised controlled trials (RCTs) and quasi-RCTs, performed in any healthcare setting, with included participants over 18 years of age, with or without IAD. We included trials comparing the (cost) effectiveness of topical skin care products such as skin cleansers, moisturisers, and skin protectants of different compositions and skin care procedures aiming to prevent and treat IAD. Two review authors independently screened titles, abstracts and full-texts, extracted data, and assessed the risk of bias of the included trials. We included 13 trials with 1295 participants in a qualitative synthesis. Participants were incontinent for urine, stool, or both, and were residents in a nursing home or were hospitalised.Eleven trials had a small sample size and short follow-up periods. .The overall risk of bias in the included studies

  14. Audiovisual distraction for pain relief in paediatric inpatients: A crossover study.

    PubMed

    Oliveira, N C A C; Santos, J L F; Linhares, M B M

    2017-01-01

    Pain is a stressful experience that can have a negative impact on child development. The aim of this crossover study was to examine the efficacy of audiovisual distraction for acute pain relief in paediatric inpatients. The sample comprised 40 inpatients (6-11 years) who underwent painful puncture procedures. The participants were randomized into two groups, and all children received the intervention and served as their own controls. Stress and pain-catastrophizing assessments were initially performed using the Child Stress Scale and Pain Catastrophizing Scale for Children, with the aim of controlling these variables. The pain assessment was performed using a Visual Analog Scale and the Faces Pain Scale-Revised after the painful procedures. Group 1 received audiovisual distraction before and during the puncture procedure, which was performed again without intervention on another day. The procedure was reversed in Group 2. Audiovisual distraction used animated short films. A 2 × 2 × 2 analysis of variance for 2 × 2 crossover study was performed, with a 5% level of statistical significance. The two groups had similar baseline measures of stress and pain catastrophizing. A significant difference was found between periods with and without distraction in both groups, in which scores on both pain scales were lower during distraction compared with no intervention. The sequence of exposure to the distraction intervention in both groups and first versus second painful procedure during which the distraction was performed also significantly influenced the efficacy of the distraction intervention. Audiovisual distraction effectively reduced the intensity of pain perception in paediatric inpatients. The crossover study design provides a better understanding of the power effects of distraction for acute pain management. Audiovisual distraction was a powerful and effective non-pharmacological intervention for pain relief in paediatric inpatients. The effects were

  15. [Functional dyspepsia, constipation and faecal incontinence].

    PubMed

    Wiesel, Paul; Frei, Alain

    2007-01-24

    Regarding functional dyspepsia, constipation, fecal incontinence, the main therapeutic acquisitions of the period are the following: for functional dyspepsia, remember that alarm signs are not absolute signs of seriousness; for constipation, encourage and repeat advises such as physical exercise; for fecal incontinence the transcutaneous neuro-modulation and the TENS (Transcutaneous Electrical Nerve Stimulation) are potential alternatives to sacral neuro-modulation.

  16. [Sacral nerve stimulation in fecal incontinence].

    PubMed

    Rasmussen, Ole Ø; Christiansen, John

    2002-08-12

    Sacral nerve stimulation for the treatment of faecal incontinence has gained increasing use in Europe over the last two years. Experience with the first patients treated in Denmark is described here. Fourteen patients with severe faecal incontinence were given sacral nerve stimulation. The first treatment was temporary, and if this was successful they had a device for permanent stimulation implanted. The result of the test stimulation was good in ten of the 14 patients and a permanent system was implanted. After a median of 4.5 months' stimulation, nine of the ten patients continued to respond to respond well. Sacral nerve stimulation in the treatment of faecal incontinence shows promising results. Compared to other more advanced forms of treatment, this method is minimally invasive.

  17. Increased pediatric sub-specialization is associated with decreased surgical complication rates for inpatient pediatric urology procedures

    PubMed Central

    Tejwani, R.; Wang, H-H. S.; Young, B. J.; Greene, N. H.; Wolf, S.; Wiener, J. S.; Routh, J. C.

    2016-01-01

    Summary Introduction Increased case volumes and training are associated with better surgical outcomes. However, the impact of pediatric urology sub-specialization on perioperative complication rates is unknown. Objectives To determine the presence and magnitude of difference in rates of common postoperative complications for elective pediatric urology procedures between specialization levels of urologic surgeons. The Nationwide Inpatient Sample (NIS), a nationally representative administrative database, was used. Study Design The NIS (1998–2009) was retrospectively reviewed for pediatric (≤18 years) admissions, using ICD-9-CM codes to identify urologic surgeries and National Surgical Quality Improvement Program (NSQIP) inpatient postoperative complications. Degree of pediatric sub-specialization was calculated using a Pediatric Proportion Index (PPI), defined as the ratio of children to total patients operated on by each provider. The providers were grouped into PPI quartiles: Q1, 0–25% specialization; Q2, 25–50%; Q3, 50–75%; Q4, 75–100%. Weighted multivariate analysis was performed to test for associations between PPI and surgical complications. Results A total of 71,479 weighted inpatient admissions were identified. Patient age decreased with increasing specialization: Q1, 7.9 vs Q2, 4.8 vs Q3, 4.8 vs Q4, 4.6 years, P<0.01). Specialization was not associated with race (P>0.20), gender (P>0.50), or comorbidity scores (P=0.10). Mortality (1.5% vs 0.2% vs 0.3% vs 0.4%, P<0.01) and complication rates (15.5% vs 11.7% vs 9.6% vs 10.9%, P<0.0001) both decreased with increasing specialization. Patients treated by more highly specialized surgeons incurred slightly higher costs (Q2, +4%; Q3, +1%; Q4 + 2%) but experienced shorter length of hospital stay (Q2, –5%; Q3, –10%; Q4, –3%) compared with the least specialized providers. A greater proportion of patients treated by Q1 and Q3 specialized urologists had CCS ≥2 than those seen by Q2 or Q4 urologists

  18. Increased pediatric sub-specialization is associated with decreased surgical complication rates for inpatient pediatric urology procedures.

    PubMed

    Tejwani, R; Wang, H-H S; Young, B J; Greene, N H; Wolf, S; Wiener, J S; Routh, J C

    2016-12-01

    Increased case volumes and training are associated with better surgical outcomes. However, the impact of pediatric urology sub-specialization on perioperative complication rates is unknown. To determine the presence and magnitude of difference in rates of common postoperative complications for elective pediatric urology procedures between specialization levels of urologic surgeons. The Nationwide Inpatient Sample (NIS), a nationally representative administrative database, was used. The NIS (1998-2009) was retrospectively reviewed for pediatric (≤18 years) admissions, using ICD-9-CM codes to identify urologic surgeries and National Surgical Quality Improvement Program (NSQIP) inpatient postoperative complications. Degree of pediatric sub-specialization was calculated using a Pediatric Proportion Index (PPI), defined as the ratio of children to total patients operated on by each provider. The providers were grouped into PPI quartiles: Q1, 0-25% specialization; Q2, 25-50%; Q3, 50-75%; Q4, 75-100%. Weighted multivariate analysis was performed to test for associations between PPI and surgical complications. A total of 71,479 weighted inpatient admissions were identified. Patient age decreased with increasing specialization: Q1, 7.9 vs Q2, 4.8 vs Q3, 4.8 vs Q4, 4.6 years, P < 0.01). Specialization was not associated with race (P > 0.20), gender (P > 0.50), or comorbidity scores (P = 0.10). Mortality (1.5% vs 0.2% vs 0.3% vs 0.4%, P < 0.01) and complication rates (15.5% vs 11.7% vs 9.6% vs 10.9%, P < 0.0001) both decreased with increasing specialization. Patients treated by more highly specialized surgeons incurred slightly higher costs (Q2, +4%; Q3, +1%; Q4 + 2%) but experienced shorter length of hospital stay (Q2, -5%; Q3, -10%; Q4, -3%) compared with the least specialized providers. A greater proportion of patients treated by Q1 and Q3 specialized urologists had CCS ≥2 than those seen by Q2 or Q4 urologists (12.5% and 12.2%, respectively vs 8.4% and

  19. Parturition Events and Risk of Urinary Incontinence in Later Life

    PubMed Central

    Thom, David H.; Brown, Jeanette S.; Schembri, Michael; Ragins, Arona I.; Creasman, Jennifer M.; Van Den Eeden, Stephen K.

    2011-01-01

    Aims To examine the association between specific events during vaginal deliveries and urinary incontinence later in life. Methods A retrospective cohort study of 1521 middle-aged and older women with at least 1 vaginal delivery who were long-term members of an integrated health delivery system. Age, race/ethnicity, current incontinence status, medical, surgical history, pregnancy and parturition history, menopausal status, hormone replacement, health habits, and general health were obtained by questionnaire. Labor and delivery records, archived since 1948, were abstracted by professional medical record abstractors to obtain parturition events including induction, length of labor stages, type of anesthesia, episiotomy, instrumental delivery, and birth weight. The primary dependent variable was current weekly urinary incontinence (once per week or more often) vs urinary incontinence less than monthly (including no incontinence) in past 12 months. Associations of parturition events and later incontinence were assessed in multivariate analysis with logistic regression. Results The mean age of participants was 56 years. After adjustment for multiple risk factors, weekly urinary incontinence significantly associated with age at first birth (p=.036), greatest birth weight (p=.005), and ever having been induced for labor (OR=1.51; 95% CI=1.06–2.16, p=.02). Risk of incontinence increased from OR=1.35 (95% CI=0.92–1.97, p=0.12) for women with one induction to OR=2.67 (95% CI= 1.25–5.71, p=.01) for women with 2 or more inductions (p=0.01 for trend). No other parturition factors were associated with incontinence. Conclusions Younger age at first birth, greatest birth weight, and induction of labor were associated with an increased risk of incontinence in later life. PMID:21780171

  20. Parturition events and risk of urinary incontinence in later life.

    PubMed

    Thom, David H; Brown, Jeanette S; Schembri, Michael; Ragins, Arona I; Creasman, Jennifer M; Van Den Eeden, Stephen K

    2011-11-01

    To examine the association between specific events during vaginal deliveries and urinary incontinence later in life. A retrospective cohort study of 1,521 middle-aged and older women with at least one vaginal delivery who were long-term members of an integrated health delivery system. Age, race/ethnicity, current incontinence status, medical, surgical history, pregnancy and parturition history, menopausal status, hormone replacement, health habits, and general health were obtained by questionnaire. Labor and delivery records, archived since 1948, were abstracted by professional medical record abstractors to obtain parturition events including induction, length of labor stages, type of anesthesia, episiotomy, instrumental delivery, and birth weight. The primary dependent variable was current weekly urinary incontinence (once per week or more often) versus urinary incontinence less than monthly (including no incontinence) in past 12 months. Associations of parturition events and later incontinence were assessed in multivariate analysis with logistic regression. The mean age of participants was 56 years. After adjustment for multiple risk factors, weekly urinary incontinence significantly associated with age at first birth (P = 0.036), greatest birth weight (P = 0.005), and ever having been induced for labor (OR = 1.51; 95%CI = 1.06-2.16, P = 0.02). Risk of incontinence increased from OR = 1.35 (95%CI = 0.92-1.97, P = 0.12) for women with one induction to OR = 2.67 (95%CI = 1.25-5.71, P = 0.01) for women with two or more inductions (P = 0.01 for trend). No other parturition factors were associated with incontinence. Younger age at first birth, greatest birth weight, and induction of labor were associated with an increased risk of incontinence in later life. Copyright © 2011 Wiley Periodicals, Inc.

  1. Nursing management of patients with faecal incontinence.

    PubMed

    Barrie, Mariama

    2018-05-02

    Faecal incontinence is a condition that can develop as a result of age, injury or long-term conditions, and may be associated with significant stigma for those affected. Symptoms of faecal incontinence include leakage of flatus and faeces, and the condition can affect people of any age, although it is most prevalent in older people. Faecal incontinence is a subject that might not be openly discussed by patients and healthcare professionals; therefore, it is important for nurses to be aware of its signs, symptoms, causes and risk factors, so that they can identify patients at high risk. This article provides an overview of faecal incontinence, exploring its causes, psychological effects for patients, and conservative and specialised management measures, as well as the nurse's role in providing treatment and support. © 2018 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.

  2. TVT and TVT-Obturator: comparison of two operative procedures.

    PubMed

    Neuman, Menahem

    2007-03-01

    To compare two anti-incontinence operations: the tension-free vaginal tape (TVT) and the TVT-Obturator for the first two 75-patient groups. One surgeon operated on two patient groups with urodynamically proven urinary stress incontinence. The first 75-patient group in 1998 included the first TVT procedures performed according to Ulmsten [Ulmsten U, Henriksson L, Johnson P, Varhos G. An ambulatory surgical procedure under local anesthesia for treatment of female urinary incontinence. Int Urogynecol J 1996;7:81-6]. Follow-up lasted for 5-6 years. The second 75-patient group in 2004 included the first TVT-Obturator operations performed according to [De Leval J. Novel surgical technique for the treatment of female stress urinary incontinence: transobturator vaginal tape inside-out. Eur. Urol. 2003;44:724-30]. Follow-up lasted for 6-13 months. The two patient groups were similar from the demographic and therapeutic points of view. The TVT-Obturator procedure required neither bladder catheterization nor intra-operative diagnostic cystoscopy. TVT-related bladder penetration (8.0%), post-operative voiding difficulties (5.0%), intra-operative bleeding (4.0%), post-operative field infection (2.7%), and post-operative pelvic floor relaxation (1.3%) were not noted with the TVT-Obturator. The early therapeutic failure rates were 2.7% for the TVT and 1.3% for the TVT-Obturator, and neither bowel nor urethral injuries were recorded. The surgeons' learning curves of these two minimally invasive surgical procedures for the treatment of female urinary stress incontinence are comparable. The safety and cost-effectiveness of the TVT are well-established. The TVT-Obturator, a novel mid-urethral sling, was designed to overcome some of the TVT-related operative complications. The TVT-Obturator patients seem to have less intra-operative and post-operative surgical complications than the TVT patients. However, long-term comparative data collection is required prior to drawing solid

  3. Patient reported outcome measures in male incontinence surgery.

    PubMed

    Tran, M G B; Yip, J; Uveili, K; Biers, S M; Thiruchelvam, N

    2014-10-01

    Patient reported outcome measures (PROMs) were used to evaluate outcomes of the artificial urinary sphincter (AUS) and the AdVance™ (American Medical Systems, Minnetonka, MN, US) male sling system (AVMS) for the symptomatic management of male stress urinary incontinence. All male patients with stress urinary incontinence referred to our specialist clinic over a two-year period completed the ICIQ-UI SF (International Consultation on Incontinence Questionnaire on Urinary Incontinence Short Form) and the ICIQ-MLUTS LF (International Consultation on Incontinence Questionnaire on Male Lower Urinary Tract Symptoms Long Form) at consultation as well as at subsequent follow-up appointments. The Wilcoxon signed-rank test for non-parametric paired data was used for pre and postoperative comparisons. The chi-squared test was used for categorical variables. Thirty-seven patients (forty surgical cases) completed a preoperative and at least one follow-up questionnaire. There was a statistically significant improvement in PROMs postoperatively, regardless of mode of surgery (p<0.01). Analysis of the ICIQ-MLUTS LF showed that patients with higher preoperative scores (>25) had greater improvement with an AUS than with the AVMS (p<0.01). This prospective study shows that completion and collection of PROMs as part of routine clinical practice is achievable and useful in the assessment of male stress incontinence surgery. PROMs are important instruments to assess effectiveness of healthcare intervention and they are useful adjuncts in surgical studies.

  4. Lifestyle Intervention Is Associated With Lower Prevalence of Urinary Incontinence

    PubMed Central

    Brown, Jeanette S.; Wing, Rena; Barrett-Connor, Elizabeth; Nyberg, Leroy M.; Kusek, John W.; Orchard, Trevor J.; Ma, Yong; Vittinghoff, Eric; Kanaya, Alka M.

    2006-01-01

    OBJECTIVE Diabetes is associated with increased urinary incontinence risk. Weight loss improves incontinence, but exercise may worsen this condition. We examined whether an intensive lifestyle intervention or metformin therapy among overweight pre-diabetic women was associated with a lower prevalence of incontinence. RESEARCH DESIGN AND METHODS We analyzed data from the Diabetes Prevention Program, a randomized controlled trial in 27 U.S. centers. Of the 1,957 women included in this analysis, 660(34%) were randomized to intensive lifestyle therapy, 636(32%) to metformin, and 661 (34%) to placebo with standard lifestyle advice. The main outcome measure was incontinence symptoms by frequency and type by a validated questionnaire completed at the end-of-trial visit (mean 2.9 years). RESULTS The prevalence of total (stress or urge) weekly incontinence was lower among women in the intensive lifestyle group (38.3%) than those randomized to metformin (48.1%) or placebo (45.7%). This difference was most apparent among women with stress incontinence (31.3% for intensive lifestyle group vs. 39.7% for metformin vs. 36.7% for placebo, P = 0.006). Changes in weight accounted for most of the protective effect of the intensive lifestyle intervention on stress incontinence. CONCLUSIONS Less-frequent urinary incontinence may be a powerful motivator for women to choose lifestyle modification to prevent diabetes. PMID:16443892

  5. Time to and predictors of dual incontinence in older nursing home admissions.

    PubMed

    Bliss, Donna Z; Gurvich, Olga V; Eberly, Lynn E; Harms, Susan

    2018-01-01

    There are few studies of nursing home residents that have investigated the development of dual incontinence, perhaps the most severe type of incontinence as both urinary and fecal incontinence occur. To determine the time to and predictors of dual incontinence in older nursing home residents. Using a cohort design, records of older nursing home admissions who were continent or had only urinary or only fecal incontinence (n = 39,181) were followed forward for report of dual incontinence. Four national US datasets containing potential predictors at multiple levels describing characteristics of nursing home residents, nursing homes (n = 445), and socioeconomic and sociodemographic status of the community surrounding nursing homes were analyzed. A Cox proportional hazard regression with nursing home-specific random effect was used. At 6 months after admission, 28% of nursing home residents developed dual incontinence, at 1 year 42% did so, and at 2 years, 61% had dual incontinence. Significant predictors for time to developing dual incontinence were having urinary incontinence, greater functional or cognitive deficits, more comorbidities, older age, and lesser quality of nursing home care. The development of dual incontinence is a major problem among nursing home residents. Predictors in this study offer guidance in developing interventions to prevent and reduce the time to developing this problem which may improve the quality of life of nursing residents. © 2017 Wiley Periodicals, Inc.

  6. [Stress urinary incontinence after radical cystectomy: neobladder construction and placement of the functional retrourethral sling].

    PubMed

    Mayer, M; Bauer, R M; Walther, S; Becker, A J; Stief, C G; Bastian, P J; Gozzi, C

    2009-06-01

    Stress urinary incontinence (SUI) following radical cystectomy and orthotopic ileal neobladder construction represents a challenging problem. The incidence of incontinence following this surgery is reported to be 30-60% and is - despite a better understanding of the male (and female) pelvic anatomy - still regarded as an adverse outcome of this surgery.Therapeutic options have been limited up until now and include pharmacological agents, surgical treatment and pelvic floor training with only moderate amelioration of the symptoms and often unacceptable side effects. Nevertheless, urinary continence is probably the most important key to patient satisfaction. Here we introduce the perineal approach of the functional retrourethral mesh as a new and innovative sling suspension based on a non-obstructive procedure in a patient with urinary stress incontinence after ileal neobladder. The sling adjusts the changed anatomy after radical cystectomy returning it to the former preoperative position and thus continence can be achieved again. The approach of the sling in a patient with ileal neobladder is safe and the good result concerning continence is promising.

  7. Incontinence Treatment: Biofeedback

    MedlinePlus

    ... 2nd Consensus Conference Report 1st Consensus Conference Report Stories of Hope "For a person who is incontinent, ... Norton, Founder and President of IFFGD Read Personal stories A personal account from the Founder of IFFGD ...

  8. Quantitative anal sphincter electromyography in primiparous women with anal incontinence

    PubMed Central

    Gregory, W. Thomas; Lou, Jau-Shin; Simmons, Kimberly; Clark, Amanda L.

    2010-01-01

    OBJECTIVE The purpose of this study was to determine whether evidence of denervation/reinnervation of the external anal sphincter is associated with anal incontinence symptoms immediately after delivery. STUDY DESIGN After a first vaginal delivery, 42 women completed an anal incontinence questionnaire. They also underwent concentric needle electromyography of the external anal sphincter. For each subject, motor unit action potential and interference pattern parameters were determined. RESULTS For the motor unit action potential, no difference was observed between patients with and without anal incontinence symptoms (t-test). For the interference pattern, the amplitude/turn was greater in subjects with fecal urgency (318 ± 48 [SD] μV) and fecal incontinence (332 ± 48 μV), compared with those without fecal urgency (282 ± 38 μV) and fecal incontinence (286 ± 41 μV; P = .02, t-test). CONCLUSION In this group of postpartum women with mild anal incontinence symptoms, interference pattern analysis shows evidence of denervation and subsequent reinnervation. PMID:18455531

  9. Variations in data collection methods between national databases affect study results: a comparison of the nationwide inpatient sample and national surgical quality improvement program databases for lumbar spine fusion procedures.

    PubMed

    Bohl, Daniel D; Russo, Glenn S; Basques, Bryce A; Golinvaux, Nicholas S; Fu, Michael C; Long, William D; Grauer, Jonathan N

    2014-12-03

    There has been an increasing use of national databases to conduct orthopaedic research. Questions regarding the validity and consistency of these studies have not been fully addressed. The purpose of this study was to test for similarity in reported measures between two national databases commonly used for orthopaedic research. A retrospective cohort study of patients undergoing lumbar spinal fusion procedures during 2009 to 2011 was performed in two national databases: the Nationwide Inpatient Sample and the National Surgical Quality Improvement Program. Demographic characteristics, comorbidities, and inpatient adverse events were directly compared between databases. The total numbers of patients included were 144,098 from the Nationwide Inpatient Sample and 8434 from the National Surgical Quality Improvement Program. There were only small differences in demographic characteristics between the two databases. There were large differences between databases in the rates at which specific comorbidities were documented. Non-morbid obesity was documented at rates of 9.33% in the Nationwide Inpatient Sample and 36.93% in the National Surgical Quality Improvement Program (relative risk, 0.25; p < 0.05). Peripheral vascular disease was documented at rates of 2.35% in the Nationwide Inpatient Sample and 0.60% in the National Surgical Quality Improvement Program (relative risk, 3.89; p < 0.05). Similarly, there were large differences between databases in the rates at which specific inpatient adverse events were documented. Sepsis was documented at rates of 0.38% in the Nationwide Inpatient Sample and 0.81% in the National Surgical Quality Improvement Program (relative risk, 0.47; p < 0.05). Acute kidney injury was documented at rates of 1.79% in the Nationwide Inpatient Sample and 0.21% in the National Surgical Quality Improvement Program (relative risk, 8.54; p < 0.05). As database studies become more prevalent in orthopaedic surgery, authors, reviewers, and readers should

  10. Surgical treatment of female stress urinary incontinence with a trans-obturator-tape (T.O.T.) Uratape: short term results of a prospective multicentric study.

    PubMed

    Costa, P; Grise, P; Droupy, S; Monneins, F; Assenmacher, C; Ballanger, P; Hermieu, J F; Delmas, V; Boccon-Gibod, L; Ortuno, C

    2004-07-01

    The aim of the study was to assess the efficacy and safety of a new minimally invasive surgical procedure using the Trans-Obturator-Tape Uratape to treat female stress urinary incontinence. 183 women with stress urinary incontinence (SUI) associated with urethral hypermobility, underwent the T.O.T. procedure (October 2001 to March 2003). 26 patients were previously operated for incontinence. 26 patients were operated at the same time for their genital prolapse. Mean age was 56 years (29-87). 50/183 patients were having mixed incontinence. A non-elastic, polypropylene tape (UraTape, Mentor-Porgès) with a silicon coated central part was placed under the mid-urethra. The surgical placement technique utilises a trans-obturator percutaneous approach. All patients underwent post-operative clinical examination, cough-stress test (full bladder), uroflowmetry, and post-voiding residual assessment. Mean follow-up was 7 months (1-21). At 1 year follow-up 80.5% of the patients were completely cured and 7.5% were improved. The overall peri-operative complication rate was 2.2% with no vascular, nerve or bowel injury. 6 patients (3.3%) had post-operative urinary retention. The present multicentric study confirms the results obtained by the instigator of the technique, E. Delorme, and allows us to consider T.O.T. as an effective and safe technique for the treatment of female stress urinary incontinence, alone or in combination with prolapse repair. Copyright 2004 Elsevier B.V.

  11. National audit of pressure ulcers and incontinence-associated dermatitis in hospitals across Wales: a cross-sectional study.

    PubMed

    Clark, Michael; Semple, Martin J; Ivins, Nicola; Mahoney, Kirsten; Harding, Keith

    2017-08-21

    The Chief Nurse National Health Service Wales initiated a national survey of acute and community hospital patients in Wales to identify the prevalence of pressure ulcers and incontinence-associated dermatitis. Teams of two nurses working independently assessed the skin of each inpatient who consented to having their skin observed. Over 28 September 2015 to 2nd October 2015, 8365 patients were assessed across 66 hospitals with 748 (8.9%) found to have pressure ulcers. Not all patients had their skin inspected with all mental health patients exempt from this part of the audit along with others who did not consent or were too ill. Of the patients with pressure ulcers, 593 (79.3%) had their skin inspected with 158 new pressure ulcers encountered that were not known to ward staff, while 152 pressure ulcers were incorrectly categorised by the ward teams. Incontinence-associated dermatitis was encountered in 360 patients (4.3%), while medical device-related pressure ulcers were rare (n=33). The support surfaces used while patients were in bed were also recorded to provide a baseline against which future changes in equipment procurement could be assessed. The presence of other wounds was also recorded with 2537 (30.3%) of all hospital patients having one or more skin wounds. This survey has demonstrated that although complex, it is feasible to undertake national surveys of pressure ulcers, incontinence-associated dermatitis and other wounds providing comprehensive and accurate data to help plan improvements in wound care across Wales. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  12. Urinary Incontinence: Causes and Methods of Evaluation

    ERIC Educational Resources Information Center

    Griebling, Tomas L.

    2008-01-01

    This article presents the third of a multi-part series offering the most timely educational information, innovative approaches, products and technology solutions as well as coping and stigma-fighting approaches available on the subject of incontinence. Here, the author introduces the types and physiology of urinary incontinence. The author also…

  13. New concept for treating female stress urinary incontinence with radiofrequency.

    PubMed

    Lordelo, Patrícia; Vilas Boas, Andrea; Sodré, Danielle; Lemos, Amanda; Tozetto, Sibele; Brasil, Cristina

    2017-01-01

    To evaluate the clinical response and adverse effects of radiofrequency on the urethral meatus in the treatment of stress urinary incontinence in women. This phase one study included ten women with Stress Urinary Incontinence (SUI). The evaluation consisted of 1 hour Pad tests to quantify urine loss and to assess the degree of procedure satisfaction by using the Likert scale. To evaluate safety, we observed the number of referred side effects. Average age was 53.10 years±7.08 years. In assessing the final Pad Test, 70% showed a reduction and 30% a worsening of urinary loss. Using the Pad Test one month later, there was a reduction in all patients (p=0.028). The degree of satisfaction was 90% and no side effects have been observed. One patient reported burning sensation. The treatment of SUI with radiofrequency on the urethral meatus has no adverse effects, being a low risk method that reduces urinary loss in women. However, to increase the validity of the study, larger clinical trials are warranted. Copyright® by the International Brazilian Journal of Urology.

  14. New concept for treating female stress urinary incontinence with radiofrequency

    PubMed Central

    Lordelo, Patrícia; Boas, Andrea Vilas; Sodré, Danielle; Lemos, Amanda; Tozetto, Sibele; Brasil, Cristina

    2017-01-01

    ABSTRACT Purpose: To evaluate the clinical response and adverse effects of radiofrequency on the urethral meatus in the treatment of stress urinary incontinence in women. Materials and Methods: This phase one study included ten women with Stress Urinary Incontinence (SUI). The evaluation consisted of 1 hour Pad tests to quantify urine loss and to assess the degree of procedure satisfaction by using the Likert scale. To evaluate safety, we observed the number of referred side effects. Results: Average age was 53.10 years±7.08 years. In assessing the final Pad Test, 70% showed a reduction and 30% a worsening of urinary loss. Using the Pad Test one month later, there was a reduction in all patients (p=0.028). The degree of satisfaction was 90% and no side effects have been observed. One patient reported burning sensation. Conclusion: The treatment of SUI with radiofrequency on the urethral meatus has no adverse effects, being a low risk method that reduces urinary loss in women. However, to increase the validity of the study, larger clinical trials are warranted. PMID:28727373

  15. Bladder neck competency at rest in women with incontinence.

    PubMed

    English, S F; Amundsen, C L; McGuire, E J

    1999-02-01

    We determine the presence of an open bladder neck during video urodynamic studies and relate that finding to the presence of stress urinary incontinence. Patients presenting with urinary incontinence, voiding dysfunction or pelvic floor prolapse underwent video urodynamics. With the patient upright and after 200 ml. contrast material had been instilled into the bladder the bladder neck was viewed to determine if it was open or closed. At that point the abdominal leak point pressure was measured. Of 102 women, average age 56.5 years (range 31 to 82), 13% had an open bladder neck and demonstrable stress incontinence on video urodynamics with an average abdominal leak point pressure of 45 cm. water (range 26 to 90). Of those with stress incontinence on urodynamics 23% had an open bladder neck. No continent patient had an open bladder neck. The presence of an open bladder neck with the bladder filled to 200 ml. correlates strongly with the presence of stress incontinence.

  16. Urinary and fecal incontinence in a community-residing older population in Japan.

    PubMed

    Nakanishi, N; Tatara, K; Naramura, H; Fujiwara, H; Takashima, Y; Fukuda, H

    1997-02-01

    To estimate the prevalence and risk factors of urinary and fecal incontinence among a community-residing older population in Japan. Population-based cross-sectional study. A randomly selected sample of 1473 people aged 65 years and older living in the City of Settsu, Osaka, in 1992. Data collected via in-home visits were used to estimate the prevalence of urinary and fecal incontinence and to provide information regarding potential risk factors of urinary and fecal incontinence. Data were obtained from 1405 older adults, a response rate of 95.4%. The prevalence of any degree of urinary incontinence was 98/1000 in both sexes, and 87/ 1000 men and 66/1000 women admitted to some degree of fecal incontinence. Daily, 34/1000 and 20/1000 of the population were incontinent of urine and feces, respectively. There was an increasing prevalence of urinary and fecal incontinence with age in both sexes, but the expected greater prevalence in women was not found. By univariate analyses, age older than 75 years, poor general health as measured by Activities of Daily Living, stroke, dementia, no participation in social activities, and lack of life worth living (Ikigai) were associated significantly with both urinary and fecal incontinence. In the multivariate analyses using logistic regression, age older than 75 years, poor general health, and stroke were independent risk factors for any type of incontinence. Diabetes was an independent risk factor for isolated fecal incontinence, and dementia and no participation in social activities were independent risk factors for double incontinence. Incontinence of urine and feces is a prevalent condition among very old people living in the community in Japan and is associated highly with health and psychosocial conditions.

  17. Introital ultrasonography: a comparison of women with stress incontinence due to urethral hypermobility and continent women.

    PubMed

    Cassadó, Jordi; Pessarrodona, Antoni; Tulleuda, Raquel; Cabero, Lluís; Valls, Marta; Quintana, Salvador; Rodríguez-Carballeira, Mónica

    2006-10-01

    To determine if there is a variable on introital ultrasonography (IUS) that can be used to distinguish between women with stress urinary incontinence (SUI) due to urethral hypermobility (UH) and continent women. This single-centre, prospective, blind, cohort, observational study comprised 383 women (245 continent and 138 incontinent) who were all appropriately informed volunteers selected according to the inclusion criteria. IUS with a convex probe was performed on all women; the measurement plane was standardized and coordinates were obtained at rest and on straining. Several distances were measured to determine if any provided an objective distinction between continent and incontinent women. Among all the IUS variables assessed, sliding (calculated as the difference between the distance urethra-bladder neck, U-BN, at rest and under stress) was the best for distinguishing continent and incontinent women. The receiver operating characteristic curves showed that with a threshold of 8 mm, sliding had a sensitivity of 92% and a specificity of 79.6% for detecting SUI due to UH. The distances symphysis-urethra (S-U) and U-BN at rest could also discriminate, but with lower significance. IUS is an important tool for diagnosing SUI; there are three independent variables, one dynamic (sliding) and two static (distances S-U and U-BN), that can be used to distinguish between continent women and those with SUI due to UH. Sliding is the most reliable, as it has the highest sensitivity and specificity. We think that the simplicity, low financial cost and reliability of IUS could allow it to be a routine procedure for physicians working in incontinence units.

  18. Incontinence in children, adolescents and adults with Williams syndrome.

    PubMed

    von Gontard, Alexander; Niemczyk, Justine; Borggrefe-Moussavian, Sorina; Wagner, Catharina; Curfs, Leopold; Equit, Monika

    2016-11-01

    Williams Syndrome (WS) is a microdeletion syndrome (chromosome 7q11.23) characterized by typical facial features, cardiovascular disease, behavioural symptoms, and mild intellectual disability (ID). The aim of this study was to assess the rates of incontinence and psychological problems in persons with WS. 231 individuals with WS were recruited through the German parent support group (52.0% male, mean age 19.4 years). Faecal incontinence (FI) was diagnosed from the age of 4 years and nocturnal enuresis (NE) and daytime urinary incontinence (DUI) of 5 years onwards. The Parental Questionnaire: Enuresis/Urinary Incontinence, the International-Consultation-on-Incontinence-Questionnaire-Pediatric LUTS (ICIQ-CLUTS), as well as the Developmental Behavior Checklist for parents (DBC-P) or for adults (DBC-A) were filled out by parents or caregivers. 17.8% of the sample had NE, 5.9% DUI and 7.6% FI. NE was present in 44.9% of children (4-12 years), 13.5% of teens (13-17y), 3.3% of young adults (18-30y) and in 3.6% of adults (> 30y). DUI (and FI) decreased from 17.9% (21.4%) in children to 0% in adults. 3.5% of the sample had an ICIQ-CLUTS score in the clinical range. 30.5% of children and 22.1% of adults had a clinical DBC score. Children and teens with clinically relevant DBC-P-scores had significantly higher DUI rates. Children with WS have high rates of incontinence and LUTS, which decrease with age. Most adults are continent. NE is the most common subtype. Except for DUI in children, incontinence is not associated with behavioural problems. Screening, assessment and treatment of incontinence in individuals with WS is recommended. Neurourol. Urodynam. 35:1000-1005, 2016. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.

  19. Pelvic floor muscle training for urinary incontinence postpartum.

    PubMed

    Hall, Bethany; Woodward, Sue

    The offering of pelvic floor muscle exercises to all women during their first pregnancy is recommended by National Institute for Health and Care Excellence (NICE) guidelines. Pelvic floor muscles suffer significant trauma throughout pregnancy and childbirth, which may sometimes lead to urinary incontinence postpartum. However, it is uncertain how effective pelvic floor muscle exercises are in treating this incontinence. Several trials have been analysed to try to understand this question. Issues such as when the exercises were undertaken, how often they were performed and in what circumstances they were carried out, have all been considered. While it is still uncertain whether they are effective in reducing urinary incontinence postpartum, as they are non-invasive and fairly simple to carry out, they are still the first-line management for urinary incontinence postpartum with other treatments being considered if this is ineffective.

  20. An evidence-based strategy for the conservative management of the male patient with incontinence.

    PubMed

    Newman, Diane K; Guzzo, Thomas; Lee, David; Jayadevappa, Ravishankar

    2014-11-01

    Incontinence is not an isolated symptom in men, but rather a component of a multifactorial problem that may include other lower urinary tract symptoms (LUTS). Male urinary incontinence is often seen following prostate surgery and procedures, particularly prostate cancer surgery. Men with enlarged prostates experience overactive bladder symptoms of urgency and frequency. Despite these bothersome lower urinary tract problems in men, conservative treatment remains poorly investigated. This review will provide the current evidence-based strategies for the use of conservative management in men with urinary incontinence and other LUTS. Conservative treatment for urinary incontinence is an effective intervention and has been recommended by the evidence-based guidelines as the first-line intervention for LUTS. Despite this prevalence, the only population of men who continue to receive systematic consideration with respect to conservative management are those with postprostatectomy urinary symptoms. Although continence status gradually improves in the ensuing weeks and months, evidence-based research has shown that preoperative and early postoperative pelvic floor muscle training can speed the recovery of continence in the short and long term. Recent research has also shown that behavioral therapy combined with medication can improve the male symptom of nocturia. Lifestyle changes of weight loss in obese men with diabetes and LUTS and dietary modification has also been shown to be effective. Although sparse, there are data to support conservative interventions as the first-line treatment in men with LUTS. There is a strong recommendation for implementing a pelvic floor muscle training (PFMT) program before and after prostatectomy. Positive lifestyle changes such as weight loss in obese men and dietary modification can lessen urgency, nocturia, and incontinence. Despite this growing evidence on effectiveness, urologists rarely recommend conservative treatment to patients.

  1. Outcome of the use of tension-free vaginal tape in women with mixed urinary incontinence, previous failed surgery, or low valsalva pressure.

    PubMed

    Abdel-Hady, El-Said; Constantine, Glyn

    2005-02-01

    To assess the safety and efficacy of the use of tension-free vaginal tape (TVT) for the treatment of stress urinary incontinence (SUI) in women with mixed incontinence, previous failed incontinence surgery or low valsalva leak point pressure (VLPP). Six hundred and fifty-eight women with SUI underwent the TVT procedure. These included women with mixed stress and urge incontinence (n=128), previous surgery for SUI (n=118), low VLPP (n=80), and those over 70 years old (n=68). The procedure was carried out under spinal anesthetic and operative and immediate postoperative data was collected for all women. Six-month follow-up data was available on 454 women, with the first 300 women completing a quality of life (QOL) questionnaire before and after surgery. The overall subjective cure rate at 6 months was 91%, with 8% of women reporting significant (>50%) improvement in their symptoms. Subgroups with a body mass index > 30, age > 70 years, coexisting instability, previous failed surgery, and low VLPP showed cure rates of 81-89%. QOL improvements for all groups were highly significant. Significant complications included voiding difficulties in 29 women (4.4%), retropubic hematomas in four (0.6%), and thromboembolic episodes in three (0.5%). The simplicity and high efficacy of the TVT makes it the first choice for the treatment of women with SUI, including those with more complex problems or coexisting risk factors.

  2. The urethral pressure profiles in continent and stress-incontinent women.

    PubMed

    Henriksson, L; Andersson, K E; Ulmsten, U

    1979-01-01

    Simultaneous urethrocystometry, including recording of the urethral pressure profile, was performed in 127 women aged 30 to 69 years; 42 of the women were free from urologic disorders and 85 had stress incontinence of urine. Both groups were subgrouped according to age. The results in the continent and the incontinent women were analyzed separately, in order to disclose any age-related changes. The data within each decade of age were also comparatively analyzed. In the bladder pressure at rest no age-related changes were found, and the readings were similar in the continent and the incontinent women. The maximum urethral pressure fell significantly with rising age in both groups and was significantly reduced in stress incontinence. The urethral closure pressure showed variations similar to those in the maximum urethral pressure. No lower limit of urethral closure pressure that definitely predisposed to stress incontinence could be established. The functional length of the urethra diminished significantly with rising age in the continent, but not in the incontinent women. The absolute length of the urethra did not show such diminution. Both the functional and the absolute urethral length were significantly less in the incontinent than in the continent women in the age groups between 30 and 49 years.

  3. Incontinence Briefs Containing Spiral-Shaped Fiber Acidify Skin pH of Older Nursing Home Residents at Risk for Incontinence-Associated Dermatitis.

    PubMed

    Bliss, Donna Z; Bland, Peggy; Wiltzen, Kjerstie; Gannon, Alexandra; Wilhems, Anna; Mathiason, Michelle A; Turnbaugh, Robert

    The study's purpose was to assess the pH of the skin of older (aged ≥75 years) incontinent nursing home residents after exposure to an incontinence brief containing spiral-shaped fiber wet with an alkaline solution mimicking urine or fecal pH and compared to skin pH after exposure to an industry standard brief wet with the same solution and various controls. The design was experimental, as conditions were applied to skin and skin pH was measured in random order, and subjects served as their own controls. The setting was a Midwestern nonprofit nursing home. The sample was 26 nursing home residents; their mean age was 87 years (SD = 6 years); 77% were female. Most (69%) had urinary incontinence alone, and 31% had dual urinary and fecal incontinence. Skin pH was measured in duplicate on 6 areas of the inner thighs and 6 areas of the volar surface of the forearms. Each area was exposed to 1 of 6 conditions applied in random order: an incontinence brief containing spiral-shaped fiber wet with an alkaline solution and one that was dry; a standard incontinence brief (without spiral-shaped fiber) wet with the same alkaline solution and one that was dry; the alkaline solution alone; and normal skin. On both the thighs and the forearms, skin pH was significantly lower (more acidic) after exposure to the incontinence brief containing spiral-shaped fiber wet with an alkaline solution compared to the wet standard brief and all other control conditions (P < .001). On thighs, the mean skin pH was 5.7 (SD = 0.5) after exposure to the wet brief with spiral-shaped fiber versus 6.4 (SD = 0.5) after exposure to the wet standard brief. On forearms, the mean skin pH was 5.3 (SD = 0.4) after exposure to the wet brief with spiral-shaped fiber versus 6.0 (SD = 0.4) after exposure to the wet standard brief. Incontinence briefs containing a spiral-shaped fiber significantly acidify the pH of the skin exposed to an alkaline solution, while industry standard briefs do not. Since alkaline

  4. Self-injury and incontinence in psychogenic seizures.

    PubMed

    Peguero, E; Abou-Khalil, B; Fakhoury, T; Mathews, G

    1995-06-01

    Two patients who incurred significant injuries during psychogenic seizures prompted us to do a telephone survey of self-injury and incontinence in 102 consecutive patients diagnosed with psychogenic seizures by EEG-closed-circuit TV (EEG-CCTV) monitoring. Seventy-three patients (or a close family member or friend) were reached by telephone and responded to our survey. During typical attacks of psychogenic seizures, 40% reported injuries, 44% reporting tongue biting, and 44% reported urinary incontinence. Suicide attempts were reported by 32% and were more common in those with self-injury and urinary incontinence. We compared the results of patients with psychogenic seizures with those of 30 patients with refractory epilepsy documented by ictal recordings, using a similar telephone survey. Injuries of all types were more commonly reported by epilepsy patients. Burn injuries were reported only by patients with epilepsy. Suicide attempts were more commonly reported by the psychogenic seizure group. Self-injury and incontinence are commonly reported by psychogenic seizure patients. In view of their significant association with suicide attempts, they may indicate an underlying depression.

  5. Rectal intussusception and unexplained faecal incontinence: findings of a proctographic study.

    PubMed

    Collinson, R; Cunningham, C; D'Costa, H; Lindsey, I

    2009-01-01

    The aetiology of faecal incontinence is multifactorial, yet there remains an approach to assessment and treatment that focusses on the sphincter. Rectal intussusception (RI) is underdiagnosed and manifests primarily as obstructed defecation. Yet greater than 50% of these patients admit to faecal incontinence on closer questioning. We aimed to evaluate the incidence of RI at evacuation proctography selectively undertaken in the evaluation of patients with faecal incontinence. Patients with faecal incontinence seen in a pelvic floor clinic were evaluated with anorectal physiology and ultrasound. Where the faecal incontinence was not fully explained by physiology and ultrasound, evacuation proctography was undertaken. Studies were classified as 'normal', 'low-grade RI' (recto-rectal), 'high-grade RI' (recto-anal) or 'anismus'. Forty patients underwent evacuation proctography (33 women, 83%). Median age was 63 years (range 34-77 years). Seven patients (17%) had a normal proctogram. Three (8%) had recto-rectal RI. Twenty-five (63%) demonstrated recto-anal RI. Five patients (12%) had anismus. Recto-anal intussusception is common in patients undergoing selective evacuation proctography for investigation of faecal incontinence. The role of recto-anal intussusception in the multifactorial aetiology of faecal incontinence has been largely overlooked. Evacuation proctography should be considered as part of routine work-up of patients with faecal incontinence.

  6. Validation of use of the International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form (ICIQ-UI-SF) for impairment rating: a transversal retrospective study of 120 patients.

    PubMed

    Timmermans, Luc; Falez, Freddy; Mélot, Christian; Wespes, Eric

    2013-09-01

    A urinary incontinence impairment rating must be a highly accurate, non-invasive exploration of the condition using International Classification of Functioning (ICF)-based assessment tools. The objective of this study was to identify the best evaluation test and to determine an impairment rating model of urinary incontinence. In performing a cross-sectional study comparing successive urodynamic tests using both the International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form (ICIQ-UI-SF) and the 1-hr pad-weighing test in 120 patients, we performed statistical likelihood ratio analysis and used logistic regression to calculate the probability of urodynamic incontinence using the most significant independent predictors. Subsequently, we created a template that was based on the significant predictors and the probability of urodynamic incontinence. The mean ICIQ-UI-SF score was 13.5 ± 4.6, and the median pad test value was 8 g. The discrimination statistic (receiver operating characteristic) described how well the urodynamic observations matched the ICIQ-UI-SF scores (under curve area (UDA):0.689) and the pad test data (UDA: 0.693). Using logistic regression analysis, we demonstrated that the best independent predictors of urodynamic incontinence were the patient's age and the ICIQ-UI-SF score. The logistic regression model permitted us to construct an equation to determine the probability of urodynamic incontinence. Using these tools, we created a template to generate a probability index of urodynamic urinary incontinence. Using this probability index, relative to the patient and to the maximum impairment of the whole person (MIWP) relative to urinary incontinence, we were able to calculate a patient's permanent impairment. Copyright © 2012 Wiley Periodicals, Inc.

  7. Effect of Preoperative Low Maximal Flow Rate on Postoperative Voiding Trials after the Midurethral Sling Procedure in Women with Stress Urinary Incontinence.

    PubMed

    Chae, Ji Y; Bae, Jae H; Lee, Jeong G; Park, Hong S; Moon, Du G; Oh, Mi M

    2017-06-02

    To evaluate the effects of preoperative low maximal flow rate (Qmax) on voiding trials after the midurethral sling (MUS) procedure in women with stress urinary incontinence (SUI). One hundred and sixty-eight women who underwent MUS procedure were enrolled. Preoperative free uroflowmetry was performed and patients were divided by Qmax. Low Qmax was defined as a Qmax under 15 mL/sec with voided volume at least 150 mL. Surgical results, failure of voiding trial, and postoperative uroflowmetry parameters were compared between the groups. Failure of voiding trial was defined by a PVR more than 100 mL on postoperative uroflowmetry. At the discharge day, there were 42 cases showing failure of voiding trial and 33 cases requiring CIC, but only one patient showed failure of voiding trial at 12 months postoperatively. Overall, 48 patients had preoperative low Qmax. Low Qmax group showed lower Qmax in all of postoperative uroflowmetry, but there were no significant differences in the rate of postoperative voiding trial failure or CIC. The low Qmax group was then divided into two groups according to the preoperative detrusor pressure at Qmax over and under 20 cmH 2 O in pressure flow study. Comparing the two groups, no significant differences were observed in the cure rate, voiding trial failure or CIC. Our results suggest that women with preoperative low Qmax experienced no definite unfavorable voiding problem from the MUS procedure compared to those with normal voiding function. MUS procedure may be regarded as a safe and successful procedure in SUI women with low Qmax. © 2017 John Wiley & Sons Australia, Ltd.

  8. Fecal incontinence in men: Causes and clinical and manometric features

    PubMed Central

    Muñoz-Yagüe, Teresa; Solís-Muñoz, Pablo; Ciriza de los Ríos, Constanza; Muñoz-Garrido, Francisco; Vara, Jesús; Solís-Herruzo, José Antonio

    2014-01-01

    AIM: To determine the causes and characteristics of fecal incontinence in men and to compare these features with those presented by a group of women with the same problem. METHODS: We analyzed the medical history, clinical and manometric data from 119 men with fecal incontinence studied in our unit and compared these data with those obtained from 645 women studied for the same problem. Response to treatment was evaluated after 6 mo of follow-up. RESULTS: Fifteen percent of patients studied in our unit for fecal incontinence were male. Men took longer than women before asking for medical help. Ano-rectal surgery was the most common risk factor for men related to fecal incontinence. Chronic diarrhea was present in more than 40% of patients in both groups. Decreased resting and external anal sphincter pressures were more frequent in women. No significant differences existed between the sexes regarding rectal sensitivity and recto-anal inhibitory reflex. In 17.8% of men, all presenting soiling, manometric findings did not justify fecal incontinence. Response to treatment was good in both groups, as 80.4% of patients improved and fecal incontinence disappeared in 13.2% of them. CONCLUSION: In our series, it was common that men waited longer in seeking medical help for fecal incontinence. Ano-rectal surgery was the major cause of this problem. Chronic diarrhea was a predisposing factor in both sexes. Manometric differences between groups were limited to an increased frequency of hypotony of the external anal sphincter in women. Fecal incontinence was controllable in most patients. PMID:24976729

  9. Risperidone-associated urinary incontinence in patients with autistic disorder with mental retardation.

    PubMed

    Kumazaki, Hirokazu; Watanabe, Koichiro; Imasaka, Yasushi; Iwata, Kazuhiko; Tomoda, Akemi; Mimura, Masaru

    2014-10-01

    We report several cases in which patients with autistic disorder with mental retardation who received risperidone experienced urinary incontinence. We retrospectively investigated the medical records of patients housed in facilities for patients with autistic disorder with mental retardation. Those who had undergone a medical examination at a hospital in Tokyo from April 1999 to March 2009 were included in the study.Retrospective data were gathered including age, sex, IQ, birth weight, dosage of risperidone, urinary density, as well as existence of urinary and fecal incontinence. We divided the participants into those who did and did not experience urinary incontinence after taking risperidone and compared the 2 groups. Risperidone had been prescribed to 35 patients. In spite of the fact that no patient had a history of urinary incontinence, 14 patients experienced urinary incontinence after receiving risperidone. Moreover, 4 of these 14 patients also had fecal incontinence. Among the variables we examined, the only significant difference between groups was in sex, with significantly more women experiencing incontinence compared with men. When the dose of risperidone was reduced or the patients switched to other drugs, urinary incontinence of the patients improved.Hence, risperidone may have a casual relationship with urinary incontinence. Further research is needed to understand the pathophysiology of possible effect.

  10. Systematic review of the management of incontinence and promotion of continence in older people in care homes: descriptive studies with urinary incontinence as primary focus

    PubMed Central

    Roe, Brenda; Flanagan, Lisa; Jack, Barbara; Barrett, James; Chung, Alan; Shaw, Christine; Williams, Kate

    2011-01-01

    Aim This is a review of descriptive studies with incontinence as the primary focus in older people in care homes. Background Incontinence is prevalent among residents of care home populations. Data sources MEDLINE and CINAHL were searched from 1996 to 2007 using the highly sensitive search strings of the Cochrane Incontinence Review Group for urinary and faecal incontinence including all research designs. Search strings were modified to enhance selectiveness for care homes and older people and exclude studies involving surgical or pharmacological interventions. Searching of reference sections from identified studies was also used to supplement electronic searches. The Cochrane Library was searched for relevant systematic reviews to locate relevant studies from those included or excluded from reviews. The search was limited to English-language publications. Methods A systematic review of studies on the management of incontinence, promotion of continence or maintenance of continence in care homes was conducted in 2007–2009. This is a report of descriptive studies. Results Ten studies were identified that reported on prevalence and incidence of incontinence (urinary with or without faecal), policies, assessment, documentation, management or economic evaluation of its management. Use of incontinence pads and toileting programmes comprised the most common management approaches used. No studies were identified that attempted to maintain continence of residents in care homes. Conclusions Studies on maintaining continence and identifying components of toileting programmes that are successful in managing or preventing incontinence and promoting continence in residents of care home populations along with their economic evaluation are warranted. PMID:21105895

  11. Systematic review of the management of incontinence and promotion of continence in older people in care homes: descriptive studies with urinary incontinence as primary focus.

    PubMed

    Roe, Brenda; Flanagan, Lisa; Jack, Barbara; Barrett, James; Chung, Alan; Shaw, Christine; Williams, Kate

    2011-02-01

    This is a review of descriptive studies with incontinence as the primary focus in older people in care homes. Incontinence is prevalent among residents of care home populations. MEDLINE and CINAHL were searched from 1996 to 2007 using the highly sensitive search strings of the Cochrane Incontinence Review Group for urinary and faecal incontinence including all research designs. Search strings were modified to enhance selectiveness for care homes and older people and exclude studies involving surgical or pharmacological interventions. Searching of reference sections from identified studies was also used to supplement electronic searches. The Cochrane Library was searched for relevant systematic reviews to locate relevant studies from those included or excluded from reviews. The search was limited to English-language publications. A systematic review of studies on the management of incontinence, promotion of continence or maintenance of continence in care homes was conducted in 2007-2009. This is a report of descriptive studies. Results. Ten studies were identified that reported on prevalence and incidence of incontinence (urinary with or without faecal), policies, assessment, documentation, management or economic evaluation of its management. Use of incontinence pads and toileting programmes comprised the most common management approaches used. No studies were identified that attempted to maintain continence of residents in care homes. Studies on maintaining continence and identifying components of toileting programmes that are successful in managing or preventing incontinence and promoting continence in residents of care home populations along with their economic evaluation are warranted. © 2010 The Authors. Journal of Advanced Nursing © 2010 Blackwell Publishing Ltd.

  12. [Prevalence and associated factors of female urinary incontinence in Hebei province].

    PubMed

    Jiang, Y; Yan, L; Du, F D; Zheng, P T; Zhang, L; Jiang, L; Huang, X H

    2016-12-25

    Objective: To estimate the prevalence and associated factors of adult female urinary incontinence in Hebei province. Methods: Stratified and multistage sampling method was used, between January 2016 to May 2016, to investigate the target population in Hebei province. While, logistic regression was used to analyse datas. Results: A population-based survey was conducted in 2 450 women in Hebei province, there were 2 408 effective questionnaires after deleting 48 invalid questionnaires. According to the results, the average age of subjects was (56±15) years old, and the urinary incontinence prevalence of adult female in Hebei province was 27.70% (667/2 408). Stress urinary incontinence, urge urinary incontinence and mixed urinary incontinence were diagnosed as 23.13% (557/2 408), 1.58% (38/2 408) and 2.99% (72/2 408), respectively. There were only 2.85% (19/667) urinary incontinence patients seeking medical help. The results of logistic regression analysis showed that age, daily water intake, pulmonary diseases, urinary tract infection, hypertension, chronic low back pain, dysmenorrhea, vaginitis, abortion, mode of delivery, postpartum infection were statistically significant (all P ≤0.05). Among these factors, cesarean section was the protective factor for urinary incontinence ( OR= 0.365, 95 % CI: 0.195-0.685, P <0.01). Conclusions: The prevalence of urinary incontinence in adult female in Hebei province is high, and there are few patients seeking medical help. It is a common disorder in women and is associated with many factors; among these factors, cesarean section is the protective factor for urinary incontinence.

  13. Fecal Incontinence in Children

    MedlinePlus

    ... in children and teens. You will find many articles to help you understand digestive disorders in children and teens in our Learning Center . FAQs Prevalence Causes of Incontinence Childbirth and ...

  14. Fecal incontinence decreases sexual quality of life, but does not prevent sexual activity in women.

    PubMed

    Imhoff, Laurel R; Brown, Jeanette S; Creasman, Jennifer M; Subak, Leslee L; Van den Eeden, Stephen K; Thom, David H; Varma, Madhulika G; Huang, Alison J

    2012-10-01

    The impact of anal incontinence on women's sexual function is poorly understood. The aim of this study was to investigate the relationship between anal incontinence and sexual activity and functioning in women. This is a cross-sectional study. This investigation was conducted in a community-based integrated health care delivery system. Included were 2269 ethnically diverse women aged 40 to 80 years. Self-administered questionnaires assessed accidental leakage of gas (flatal incontinence) and fluid/mucus/stool (fecal incontinence) in the past 3 months. Additional questionnaires assessed sexual activity, desire and satisfaction, as well as specific sexual problems (difficulty with arousal, lubrication, orgasm, or pain). Multivariable logistic regression models compared sexual function in women with 1) isolated flatal incontinence, 2) fecal incontinence (with or without flatal incontinence), and 3) no fecal/flatal incontinence, controlling for potential confounders. Twenty-four percent of women reported fecal incontinence and 43% reported isolated flatal incontinence in the previous 3 months. The majority were sexually active (62% of women without fecal/flatal incontinence, 66% with isolated flatal incontinence, and 60% with fecal incontinence; p = 0.06). In comparison with women without fecal/flatal incontinence, women with fecal incontinence were more likely to report low sexual desire (OR: 1.41 (CI: 1.10-1.82)), low sexual satisfaction (OR: 1.56 (CI: 1.14-2.12)), and limitation of sexual activity by physical health (OR: 1.65 (CI: 1.19-2.28)) after adjustment for confounders. Among sexually active women, women with fecal incontinence were more likely than women without fecal/flatal incontinence to report difficulties with lubrication (OR: 2.66 (CI: 1.76-4.00)), pain (OR: 2.44 (CI: 1.52-3.91)), and orgasm (OR: 1.68 (CI: 1.12-2.51)). Women with isolated flatal incontinence reported sexual functioning similar to women without fecal/flatal incontinence. The cross

  15. The greatest taboo: urinary incontinence as a source of shame and embarrassment.

    PubMed

    Elenskaia, Ksenia; Haidvogel, Karin; Heidinger, Christine; Doerfler, Daniela; Umek, Wolfgang; Hanzal, Engelbert

    2011-10-01

    While urinary incontinence is often labeled as a taboo in the literature, we found no scientific data addressing this issue exclusively. The aim of our study was to measure the perception of urinary incontinence as a taboo and how this compares to other medical conditions that may be embarrassing. 150 test persons completed a self-administered 13-item questionnaire about perception and knowledge of urinary incontinence. Data were analysed with the SPSS 10.0.5 software package using the U-test, Chi-square-test, Yates-correction, Fisher's exact test and Kolmogorov-Smirnov test. Eighty-six (60.6%) of 142 respondents thought that urinary incontinence constituted a taboo in Austria. To be incontinent was considered significantly more embarrassing than depression or cancer, respectively (p = 0.001). Despite its high prevalence, urinary incontinence is still considered a taboo in up to 60% of our Austrian test persons. The level of shame and embarrassment of urinary incontinence is significantly higher than that of depression and cancer.

  16. Objective and subjective cure rates after trans-obturator tape (OBTAPE) treatment of female urinary incontinence.

    PubMed

    Deval, Bruno; Ferchaux, Jérome; Berry, Richard; Gambino, Sandro; Ciofu, Calin; Rafii, Arash; Haab, François

    2006-02-01

    To evaluate the safety and efficacy of a thermally bonded nonwoven polypropylene mesh in a transobturator suburethral tape procedure (OBTAPE), Mentor-Porges, Le Plessis Robinson, France) for women with stress urinary incontinence. Between January 2003 and January 2005, 129 consecutive women (mean age 57.2 years) underwent OBTAPE) in two academic centers. All the patients had stress urinary incontinence preoperatively. Detrusor instability was ruled out by cystometry. The women were evaluated 1, 6 and 12 months postoperatively. The objective cure rate was evaluated by clinical examination and the subjective cure rate was assessed using the KHQ and BFLUTS questionnaire. Mean follow-up was 17.2+/-4.7 months (range 4 to 28 months). The objective and subjective cure rates were respectively 89.9% and 77.5%. Most of the patients received general anesthesia (85.3%). Urinary retention was observed in two women (1.5%), necessitating tape adjustment. Voiding difficulties were observed in 7 cases (5.4%) necessitating intermittent self-catheterization for 4.2+/-2.4 days (range 1 to 7 days). Seven patients developed vaginal erosion (one with vaginal extrusion, and two with an obturator abscess). Complete mesh removal was necessary in 6 patients, four of whom had recurrent stress urinary incontinence. Our results suggest that the OBTAPE) is an effective treatment for women with stress urinary incontinence. However, vaginal mesh erosion occurred in 6.2% of women, and this implies the need for careful follow-up.

  17. The assessment of bladder neck position and mobility in continent nullipara, mulitpara, forceps-delivered and incontinent women using perineal ultrasound: a future office procedure?

    PubMed

    Meyer, S; De Grandi, P; Schreyer, A; Caccia, G

    1996-01-01

    The purpose of this study was to assess the effects of spontaneous and instrumented deliveries, the baby's birthweight, the presence of stress incontinence and the woman's age and weight on bladder neck (BN) position and mobility using perineosonography, a simple non-invasive method, and to compare these results with those from continent nulliparous controls. Two hundred and fourteen women, including 74 nullipara, 29 para-1, 64 para-2 and 3, 16 with previous forceps deliveries and 32 with stress incontinence, underwent perineosonography with measurements of BN position and backwards/downwards displacement of BN using a two-axis calculation system. Results showed that bladder neck position undergoes a significantly backwards and downwards displacement on assuming an upright position. When compared with nulliparous controls, the bladder neck position at rest was the same in all groups of parous women in the supine/standing positions, but lower in patients having undergone forceps delivery (standing position) and in stress incontinent patients (both supine and standing); the bladder neck position during Valsalva was significantly lower in all groups of patients in the standing position, but the only significant difference in the supine position was seen in stress incontinent patients; the extent of bladder neck displacement was not significantly different between the groups, except in stress incontinent patients. A strong correlation (r = 0.66) was found between the relative importance of backwards and downwards displacement, but no correlation was found between bladder neck displacement and baby's birth-weight or patient's weight. It was concluded that compared to nulliparous continent patients, normal and instrumented delivery induces no modifications of BN position at rest, but is responsible for a lower bladder neck position during Valsalva in the standing position only. The extent of BN displacement is virtually the same in all groups of patients in both

  18. Effects of stigma on Chinese women's attitudes towards seeking treatment for urinary incontinence.

    PubMed

    Wang, Cuili; Li, Jingjing; Wan, Xiaojuan; Wang, Xiaojuan; Kane, Robert L; Wang, Kefang

    2015-04-01

    To examine whether and how stigma influences attitudes towards seeking treatment for urinary incontinence, and whether its effect varies by symptom severity. Urinary incontinence is prevalent among women, but few seek treatment. Negative attitudes towards urinary incontinence treatment inhibit from seeking care. Urinary incontinence is a stigmatised attribute. However, the relationship between stigma and attitudes towards seeking treatment for urinary incontinence has not been well understood. This was a cross-sectional community-based study. We enrolled a sample of 305 women aged 40-65 years with stress urinary incontinence from three communities in a Chinese city between May-October in 2011. Data were collected on socio-demographic characteristics, urinary incontinence symptoms, stigma and attitudes towards seeking treatment for urinary incontinence using a self-reported questionnaire. Effects of stigma were analysed using path analysis. Attitudes towards seeking treatment for urinary incontinence were generally negative. For the total sample, all the stigma domains of social rejection, social isolation and internalised shame had direct negative effects on treatment-seeking attitudes. The public stigma domain of social rejection also indirectly affected treatment-seeking attitudes through increasing social isolation, as well as through increasing social isolation and then internalised shame. The final model accounted for 28% of the variance of treatment-seeking attitudes. Symptom severity influenced the strength of paths: the effect of internalised shame was higher in women with more severe urinary incontinence. Stigma enhances the formation of negative attitudes towards seeking treatment for urinary incontinence; public stigma affects treatment-seeking attitudes through internalisation of social messages. Stigma reduction may help incontinent women to form positive treatment-seeking attitudes and engage them in treatment. Interventions should specifically target

  19. Quality of life in neurologically healthy children with urinary incontinence.

    PubMed

    Gladh, Gunilla; Eldh, Monica; Mattsson, Sven

    2006-12-01

    To bring forward the arguments for active treatment of urine incontinence in otherwise healthy children, a quality-of-life (QoL) study was performed. A self-rating QoL questionnaire, child-adjusted and validated, was completed by 120 neurologically healthy children, aged 6-16 y, with urinary incontinence. Another 239 age-matched children made up a control group. The two groups were compared both totally and in age-related subgroups (6-8, 9-12, >12 y) concerning the index for all questions, for universal parts (without questions dealing with incontinence) as well as for specific key domains. The patient group had a significantly lower index than the control group both with and without items related to incontinence (p<0.0001). Social situation, self-esteem and self-confidence were most influenced, particularly in the youngest children. Thirty-one children (13%) of the control group reported incontinence and did not score their QoL as good as their continent peers but better than the study patients. From the quality-of-life aspects, the study supports active treatment of urinary incontinence in children already at younger ages.

  20. The older persons' assessment and liaison team 'OPAL': evaluation of comprehensive geriatric assessment in acute medical inpatients.

    PubMed

    Harari, D; Martin, F C; Buttery, A; O'Neill, S; Hopper, A

    2007-11-01

    Reducing hospital length of stay (LOS) in older acute medical inpatients is a key productivity measure. Evidence-based predictors of greater LOS may be targeted through Comprehensive Geriatric Assessment (CGA). Evaluate a novel service model for CGA screening of older acute medical inpatients linked to geriatric intervention. Urban teaching hospital. Acute medical inpatients aged 70+ years. Multidisciplinary CGA screening of all acute medical admissions aged 70+ years leading to (a) rapid transfer to geriatric wards or (b) case-management on general medical wards by Older Persons Assessment and Liaison team (OPAL). Prospective pre-post comparison with statistical adjustment for baseline factors, and use of national benchmarking LOS data. Pre-OPAL (n = 46) and post-OPAL (n = 49) cohorts were similarly identified as high-risk by the CGA screening tool, but only post-OPAL patients received the intervention. Pre-OPAL, 0% fallers versus 92% post-OPAL were specifically assessed and/or referred to a falls service post-discharge. Management of delirium, chronic pain, constipation, and urinary incontinence similarly improved. Over twice as many patients were transferred to geriatric wards, with mean days from admission to transfer falling from 10 to 3. Mean LOS fell by 4 days post-OPAL. Only the OPAL intervention was associated with LOS (P = 0.023) in multiple linear regression including case-mix variables (e.g. age, function, 'geriatric giants'). Benchmarking data showed the LOS reduction to be greater than comparable hospitals. CGA screening of acute medical inpatients leading to early geriatric intervention (ward-based case management, appropriate transfer to geriatric wards), improved clinical effectiveness and general hospital performance.

  1. Diagnosis and management of urinary incontinence and functional fecal incontinence (encopresis) in children.

    PubMed

    Nijman, Rien J M

    2008-09-01

    The ability to maintain normal continence for urine and stools is not achievable in all children by a certain age. Gaining control of urinary and fecal continence is a complex process, and not all steps and factors involved are fully understood. While normal development of anatomy and physiology are prerequisites to becoming fully continent, anatomic abnormalities, such as bladder exstrophy, epispadias, ectopic ureters, and neurogenic disturbances that can usually be recognized at birth and cause incontinence, will require specialist treatment, not only to restore continence but also to preserve renal function. Most forms of urinary incontinence are not caused by an anatomic or physiologic abnormality and, hence, are more difficult to diagnose and their management requires a sound knowledge of bladder and bowel function.

  2. [Prevalence and risk factors of urinary incontinence in female workers of hotels].

    PubMed

    Fontana, L; Falconi, G; Di Martino, T; Iavicoli, I

    2007-01-01

    The International Continence Society defines urinary incontinence (UI) as "a condition in which involuntary loss of urine is a social or hygienic problem and is objectively demonstrable". There are three different jorms of UI. stress urinary incontinence, urge urinary incontinence and mixed incontinence. The aim of this study was to investigate the prevalence of UI in a group of female workers in the hotel sector. The International Consultation on Incontinence Questionnaire Urinary Incontinence short form (ICIQ-UI Short Form) was administered to all female workers and data were collected about age, body mass index, number of vaginal and Caesarean delivery. Results showed a prevalence of UI widely bigger in the plans waitress than in video display terminal workers and suggest the hypothesis that manual handling of loads representing a possible occupational risk for UI.

  3. [Comparative study of the LIFT and the TVT procedure in the surgical treatment of female stress urinary incontinence].

    PubMed

    Boukerrou, M; Just, S Bresson; Girard, J-M; Nayama, M; Cosson, M

    2008-02-01

    The purpose of the study was to compare a polyester mesh coated with silicone (LIFT, Cousin) to a polypropylene mesh (TVT, Gynecare), in terms of results, and short and middle term complications. We have performed a retrospective study concerning 140 patients between 2000 and 2002 (71 LIFT and 69 TVT operated for stress incontinence with or without vaginal surgery (prolapse surgery or hysterectomy). We noticed per- and postoperative complications. The patients were contacted by phone to evaluate the middle and long-term results. The mean age of the patients were of 58.8+/-11.3 years in LIFT group and 57.2+/-7.5 years in TVT group. More intraoperative complications arose in the TVT group (six bladder injuries and three haemorrhages versus two in LIFT group, p<0.05). There was no difference for the postoperative time. The mean follow-up was 16.6+/-5.7 months for the LIFT and 32.2+/-11.3 months for the TVT. 80% of the patients were dry in the LIFT and 75.8% in the TVT group. There was no significant difference concerning the rate of de novo urge incontinence (18.3 versus 17.7%) and voiding difficulties (10 versus 16%). On the other hand, 6.7% of the patients of the group LIFT presented bad healing with prosthesis exposure, in every case a partial resection of the mesh was performed. We did not observe any case of exposure in the TVT group. The LIFT seems as effective as the TVT with a rate of de novo urge incontinence and voiding difficulties similar to the TVT and to the literature's data. However the rate of 6.7% of exposure leads us to prefer polypropylene meshes.

  4. Bony Pelvis Dimensions in Women With and Without Stress Urinary Incontinence

    PubMed Central

    Berger, Mitchell B.; Doumouchtsis, Stergios K.; DeLancey, John O.

    2012-01-01

    AIMS To test the null hypothesis that bony pelvis dimensions are similar in women with and without stress urinary incontinence, both in the postpartum and midlife periods. METHODS Secondary analyses were performed of two case-control studies comparing women with stress urinary incontinence to asymptomatic controls. One study examined primiparas in the first 9–12 months postpartum; the other study involved middle-aged women. Stress urinary incontinence was confirmed by full-bladder stress test. All subjects underwent pelvic magnetic resonance imaging. The interspinous and intertuberous diameters, subpubic angle and sacrococcygeal joint-to-the inferior pubic point distance were measured from the images independently by two authors. RESULTS In the young cohorts, we compared primiparas with de novo postpartum stress urinary incontinence to both continent primiparas and nulliparas. Postpartum stress urinary incontinence is associated with a wider subpubic angle. There is also a trend towards wider interspinous and intertuberous diameters in the stress-incontinent primiparas as compared to the continent cohorts, although this did not reach statistical significance with our sample sizes. By contrast, no significant differences in bony pelvis dimensions were identified when comparing middle-aged women with stress urinary incontinence and their continent controls. CONCLUSIONS Bony pelvis dimensions are different in women with stress urinary incontinence than in matched continent controls. However, these differences are only identified in young primiparas in the postpartum period, not in middle-aged women. PMID:22674676

  5. Inpatient Complexity in Radiology-a Practical Application of the Case Mix Index Metric.

    PubMed

    Mabotuwana, Thusitha; Hall, Christopher S; Flacke, Sebastian; Thomas, Shiby; Wald, Christoph

    2017-06-01

    With ongoing healthcare payment reforms in the USA, radiology is moving from its current state of a revenue generating department to a new reality of a cost-center. Under bundled payment methods, radiology does not get reimbursed for each and every inpatient procedure, but rather, the hospital gets reimbursed for the entire hospital stay under an applicable diagnosis-related group code. The hospital case mix index (CMI) metric, as defined by the Centers for Medicare and Medicaid Services, has a significant impact on how much hospitals get reimbursed for an inpatient stay. Oftentimes, patients with the highest disease acuity are treated in tertiary care radiology departments. Therefore, the average hospital CMI based on the entire inpatient population may not be adequate to determine department-level resource utilization, such as the number of technologists and nurses, as case length and staffing intensity gets quite high for sicker patients. In this study, we determine CMI for the overall radiology department in a tertiary care setting based on inpatients undergoing radiology procedures. Between April and September 2015, CMI for radiology was 1.93. With an average of 2.81, interventional neuroradiology had the highest CMI out of the ten radiology sections. CMI was consistently higher across seven of the radiology sections than the average hospital CMI of 1.81. Our results suggest that inpatients undergoing radiology procedures were on average more complex in this hospital setting during the time period considered. This finding is relevant for accurate calculation of labor analytics and other predictive resource utilization tools.

  6. Skin care and incontinence

    MedlinePlus

    ... skin problems such as redness, peeling, irritation, and yeast infections likely. Bedsores ( pressure sores ) may also develop ... drying the skin. Incontinence problems can cause a yeast infection on the skin. This is an itchy, ...

  7. Urinary incontinence in persons with Prader-Willi Syndrome.

    PubMed

    Von Gontard, Alexander; Didden, Robert; Sinnema, Margje; Curfs, Leopold

    2010-12-01

    To assess and identify the frequency and type of urinary incontinence (UI), as well as associated symptoms in persons with Prader-Willi syndrome (PWS). PWS is characterized by mental retardation, short stature, obesity and hypogonadism. The behavioural phenotype includes eating problems, temper outbursts, affective disorders, stereotypies and speech abnormalities. UI is common in children with mental retardation in general, but has not been reported systematically in children with PWS so far. The Dutch version of the 'Parental Questionnaire: Enuresis/Urinary Incontinence' was completed by 118 parents of children with PWS. This questionnaire includes items referring to day- and night-time wetting, toilet habits, observable voiding behaviours and reactions, urinary tract infections, stool habits and behavioural symptoms. The rate of nocturnal enuresis in persons with PWS was 13.6% (16) at a mean age of 15.1 years. 3.8% (5) had additional daytime urinary incontinence, and 3.3% (4) had faecal incontinence. Lower urinary tract symptoms were commonly indicative of overactive bladder, dysfunctional voiding and postponement. Also, the rate of internalizing and externalizing behavioural problems was high. Urinary incontinence is more common in persons with PWS than in typically developing children, adolescents and adults. As lower urinary tract symptoms are common, detailed assessment and specific treatment of UI should be part of the care of all persons with PWS. © 2010 THE AUTHORS. JOURNAL COMPILATION © 2010 BJU INTERNATIONAL.

  8. Molecular Mechanisms Related to Parturition-Induced Stress Urinary Incontinence

    PubMed Central

    Lin, Guiting; Shindel, Alan W.; Banie, Lia; Deng, Donna; Wang, Guifang; Hayashi, Narihiko; Lin, Ching-Shwun; Lue, Tom F.

    2010-01-01

    Background The molecular mechanisms underlying stress urinary incontinence (SUI) at the tissue level are poorly understood. Objective To study genetic and molecular alterations in the urethra of animals with experimentally induced SUI. Design/Setting/Participants Cohort analysis of primiparous 2-month-old female Sprague-Dawley rats with experimentally induced SUI versus those who did not develop SUI in a university research laboratory setting Intervention Within 24 h of parturition, rats underwent intravaginal balloon dilation and bilateral ovariectomy. Transvesical cystometry was performed 12 wk after parturition. Rats were classified as continent (C) or incontinent (I) according to the results of cystometry. Measurements The expression of over 22,000 genes in urethral tissue from the two groups was assessed with the use of an oligo microarray. The expression of relevant genes was confirmed by real-time polymerase chain reaction. Protein expression of small mothers against decapentaplegic 2 (Smad2), one of the differentially expressed genes, was extensively studied by immunohistochemistry and Western blot analysis. Regulation of Smad2 activity by transforming growth factor-β (Tgf-β) was assessed in cultured urethral smooth muscle cells (USMCs). Results & Limitations After intervention, 14 (58.3%) rats remained continent and 10 (41.7%) became incontinent. There were significant differences in the expression of 42 urethral genes between continent and incontinent rats. The expression of genes involved in the TGF cellular signaling pathway (Smad2), collagen breakdown (matrix metalloproteinase 13 [Mmp13]), and smooth muscle inhibition (regulator of G-protein signaling 2 [Rgs2]) was significantly increased in the incontinent group. Smad2 protein expression was significantly upregulated in the incontinent rats. In cultured USMCs, Smad2 phosphorylation and nuclear translocation increased after Tgf-β treatment. Conclusions Genes important in inflammation, collagen

  9. Incontinence and sexuality in later life.

    PubMed

    Garrett, Dawne; Tomlin, Karen

    2015-07-01

    This article explores the interrelated aspects of incontinence and sexuality in older age. It describes the physiological changes that may have an effect on sexual function and the genitourinary system as people age. The enduring importance of sexual intimacy is discussed. Treatments for incontinence and to improve sexual function are explored. The authors conclude that nurses, particularly those involved in continence management, have a role in ensuring sensitive assessment and access to treatment, which can support many older people to maintain fulfilling sexual activity.

  10. [Our experience with mini tapes (TVT Secur and MiniArc) in the surgery for stress urinary incontinence].

    PubMed

    Jiménez Calvo, J; Hualde Alfaro, A; Raigoso Ortega, O; Cebrian Lostal, J L; Alvarez Bandres, S; Jiménez Parra, J; Montesino Semper, M; Santiago Gonzalez de Garibay, A

    2008-01-01

    The purpose of this publication is to describe the surgical technique, assess complications and short-term results of TVT secur and MiniArc tapes. From October 2006 to August 2007 it was carried out the surgical correction with TVT Secur,Women's Health & Urology, Ethicon, Johnson & Johnson, placing the tape as a hammock, to 51 patients, 38 of them with pure stress incontinence and 13 with mixed incontinence and with an average age of 57 years. From September 2007 to February 2008 41 patients, 33 of them with pure stress incontinence and 8 with mixed incontinence, with an average of age of 58 years were operated with AMS Miniarc swing system tape, posted on hammock. All procedures were performed with sedoanalgesia and Ambulatory Surgery regime. Patients were monitored in outpatient visits one month, 3 months and one year after surgical procedure. Medical history and questionnaire and ICIQ-SF, to which we added a question to quantify the degree of satisfaction, as well as physical examination, were done. We compared the results of both technical procedures and statistical survey was conducted by Student test. [Analysis with SPSS software (V14.0)]. The median follow-up in TVT secur group was 328 days (range 163-522 days) and 101 days (range 41-209 days) inthe MiniArc group. We only had one (TVT secur group) surgical complication in all the series (92 patients) being a bladder perforation. Taking into account that we read a negative test effort as an objective cure in the TVT secur group, 80.4% patients are cured and 90.2% inthe MiniArc group without significant difference between both groups (p 0095). To assess the subjective healing we utilized the ICIQ-SF test and the satisfaction extra-question and we noted that there is no significant difference between the first and third month controls. (90% of patients satisfied). 80% of patients were completely satisfied in the first year control that was only performed to TVT secur group. These new tapes show fewer

  11. The Effect of Ultralow-Dose Transdermal Estradiol on Urinary Incontinence in Postmenopausal Women

    PubMed Central

    Waetjen, L. Elaine; Brown, Jeanette S.; Vittinghoff, Eric; Ensrud, Kristine E.; Pinkerton, JoAnn; Wallace, Robert; Macer, Judith L.; Grady, Deborah

    2006-01-01

    OBJECTIVE To estimate the effect of 2 years of treatment with ultralow-dose transdermal estradiol (E2) on incontinence in postmenopausal women. METHODS Ultra Low Dose Transdermal estRogen Assessment (ULTRA) was a multicenter, randomized, double-blinded, placebo-controlled trial of unopposed ultralow-dose (0.014 mg/d) transdermal E2 for prevention of osteoporosis in 417 postmenopausal women aged 60 to 80 years. Frequency of incontinence episodes was assessed at baseline and after 4 months and 2 years of treatment using a self-reported questionnaire. We used an intention-to-treat analysis to compare change in incontinence frequency, improved (decreased 2 or more episodes per week), unchanged (increased or decreased no more than 1 episode per week), or worsened (increased 2 or more episodes per week) between the E2 and placebo groups among women with and without at least weekly incontinence at baseline. RESULTS At baseline, the prevalence of at least weekly incontinence was similar between E2 and placebo groups (43%). After 2 years, there was no difference between groups in the proportions of women with incontinence at baseline whose incontinence improved, worsened, or was unchanged. The odds ratio for worsening incontinence in the E2 compared with placebo group was 1.35 (95% confidence interval 0.75–2.42. In women without incontinence at baseline, the odds of developing at least weekly incontinence after 2 years in the E2 compared with placebo group was not significant (odds ratio 1.2, 95% confidence interval 0.7–2.2). CONCLUSION Two years of treatment with unopposed ultralow-dose transdermal E2 did not substantially change the frequency of incontinence symptoms or alter the risk of developing at least weekly incontinence. PMID:16260511

  12. The mediating effect of 'bothersome' urinary incontinence on help-seeking intentions among community-dwelling women.

    PubMed

    Xu, Dongjuan; Wang, Xiaojuan; Li, Jingjing; Wang, Kefang

    2015-02-01

    To explore the mediating effect of bother of urinary incontinence between urinary incontinence severity and help-seeking intentions and detect whether the International Consultation on Incontinence Questionnaire-UI Short Form could be a valid measure to delineate bothersome urinary incontinence. Urinary incontinence is a common condition among women, which has a profound adverse effect on quality of life. However, many of them experiencing significant clinical symptoms do not seek medical help. A cross-sectional survey design. Women with urinary incontinence (N = 620) from three randomized selected community health service centres from May-October 2011 participated in the study. Data were collected using a pencil-and-paper questionnaire. Multivariate regression models were used to test the role of bother as a mediator in the relation between urinary incontinence severity and help-seeking intentions. Receiver operating characteristic analysis was used to find the best cut-off International Consultation on Incontinence Questionnaire-UI Short Form score (range: 0-21) to delineate the bother of urinary incontinence. Bothersome urinary incontinence mediated the relationship between urinary incontinence severity and help-seeking intentions. Age and duration of urine leakage had a negative association on help-seeking intentions, while educational level and previous help-seeking behaviours had a positive association. Bother was a mediator in the relation between urinary incontinence severity and help-seeking intentions. The International Consultation on Incontinence Questionnaire-UI Short Form was a discriminative measure to delineate the bothersome urinary incontinence. © 2014 John Wiley & Sons Ltd.

  13. Prevalence of Bowel Incontinence

    MedlinePlus

    ... Urinary Incontinence in Adults. December 12, 2007. Drossman DA, Li Z, Andruzzi E, et al. U.S. Householder ... Rectum Vol. 41, No. 10 October 1998. Drossman DA, Sandler RS, Broom CM, et al. Urgency and ...

  14. Utilization and outcomes of inpatient surgical care at critical access hospitals in the United States.

    PubMed

    Gadzinski, Adam J; Dimick, Justin B; Ye, Zaojun; Miller, David C

    2013-07-01

    There is a growing interest in the quality and cost of care provided at Critical Access Hospitals (CAHs), a predominant source of care for many rural populations in the United States. To evaluate utilization, outcomes, and costs of inpatient surgery performed at CAHs. A retrospective cohort study of patients undergoing inpatient surgery from 2005 through 2009 at CAHs or non-CAHs was performed using data from the Nationwide Inpatient Sample and American Hospital Association. The CAH status of the admitting hospital. In-hospital mortality, prolonged length of stay, and total hospital costs. Among the 1283 CAHs and 3612 non-CAHs reporting to the American Hospital Association, 34.8% and 36.4%, respectively, had at least 1 year of data in the Nationwide Inpatient Sample. General surgical, gynecologic, and orthopedic procedures composed 95.8% of inpatient cases at CAHs vs 77.3% at non-CAHs (P < .001). For 8 common procedures examined (appendectomy, cholecystectomy, colorectal cancer resection, cesarean delivery, hysterectomy, knee replacement, hip replacement, and hip fracture repair), mortality was equivalent between CAHs and non-CAHs (P > .05 for all), with the exception that Medicare beneficiaries undergoing hip fracture repair in CAHs had a higher risk of in-hospital death (adjusted odds ratio = 1.37; 95% CI, 1.01-1.87). However, despite shorter hospital stays (P ≤ .001 for 4 procedures), costs at CAHs were 9.9% to 30.1% higher (P < .001 for all 8 procedures). In-hospital mortality for common low-risk procedures is indistinguishable between CAHs and non-CAHs. Although our findings suggest the potential for cost savings, changes in payment policy for CAHs could diminish access to essential surgical care for rural populations.

  15. Risk of urinary incontinence following prostatectomy: the role of physical activity and obesity.

    PubMed

    Wolin, Kathleen Y; Luly, Jason; Sutcliffe, Siobhan; Andriole, Gerald L; Kibel, Adam S

    2010-02-01

    Urinary incontinence is one of the most commonly reported and distressing side effects of radical prostatectomy for prostate carcinoma. Several studies have suggested that symptoms may be worse in obese men but to our knowledge no research has addressed the joint effects of obesity and a sedentary lifestyle. We evaluated the association of obesity and lack of physical activity with urinary incontinence in a sample of men who had undergone radical prostatectomy. Height and weight were abstracted from charts, and obesity was defined as body mass index 30 kg/m(2) or greater. Men completed a questionnaire before surgery that included self-report of vigorous physical activity. Men who reported 1 hour or more per week of vigorous activities were considered physically active. Men reported their incontinence to the surgeon at their urology visits. Information on incontinence was abstracted from charts at 6 and 58 weeks after surgery. At 6 weeks after surgery 59% (405) of men were incontinent, defined as any pad use. At 58 weeks after surgery 22% (165) of men were incontinent. At 58 weeks incontinence was more prevalent in men who were obese and physically inactive (59% incontinent). Physical activity may offset some of the negative consequences of being obese because the prevalence of incontinence at 58 weeks was similar in the obese and active (25% incontinent), and nonbese and inactive (24% incontinent) men. The best outcomes were in men who were nonobese and physically active (16% incontinent). Men who were not obese and were active were 26% less likely to be incontinent than men who were obese and inactive (RR 0.74, 95% CI 0.52-1.06). Pre-prostatectomy physical activity and obesity may be important factors in post-prostatectomy continence levels. Interventions aimed at increasing physical activity and decreasing weight in patients with prostate cancer may improve quality of life by offsetting the negative side effects of treatment. Copyright 2010 American Urological

  16. Identification of Key Odorants in Used Disposable Absorbent Incontinence Products

    PubMed Central

    Hall, Gunnar; Forsgren-Brusk, Ulla

    2017-01-01

    PURPOSE: The purpose of this study was to identify key odorants in used disposable absorbent incontinence products. DESIGN: Descriptive in vitro study SUBJECTS AND SETTING: Samples of used incontinence products were collected from 8 residents with urinary incontinence living in geriatric nursing homes in the Gothenburg area of Sweden. Products were chosen from a larger set of products that had previously been characterized by descriptive odor analysis. METHODS: Pieces of the used incontinence products were cut from the wet area, placed in glass bottles, and kept frozen until dynamic headspace sampling of volatile compounds was completed. Gas chromatography–olfactometry was used to identify which compounds contributed most to the odors in the samples. Compounds were identified by gas chromatography–mass spectrometry. RESULTS: Twenty-eight volatiles were found to be key odorants in the used incontinence products. Twenty-six were successfully identified. They belonged to the following classes of chemical compounds: aldehydes (6); amines (1); aromatics (3); isothiocyanates (1); heterocyclics (2); ketones (6); sulfur compounds (6); and terpenes (1). CONCLUSION: Nine of the 28 key odorants were considered to be of particular importance to the odor of the used incontinence products: 3-methylbutanal, trimethylamine, cresol, guaiacol, 4,5-dimethylthiazole-S-oxide, diacetyl, dimethyl trisulfide, 5-methylthio-4-penten-2-ol, and an unidentified compound. PMID:28328644

  17. The effect of major adverse renal cardiovascular event (MARCE) incidence, procedure volume, and unit cost on the hospital savings resulting from contrast media use in inpatient angioplasty.

    PubMed

    Keuffel, Eric; McCullough, Peter A; Todoran, Thomas M; Brilakis, Emmanouil S; Palli, Swetha R; Ryan, Michael P; Gunnarsson, Candace

    2018-04-01

    To determine the net economic impact of switching from low-osmolar contrast media (LOCM) to iso-osmolar contrast media (IOCM; iodixanol) in patients undergoing inpatient coronary or peripheral angioplasty in the United States (US). A budget impact model (BIM) was developed from a hospital perspective. Nationally representative procedural and contrast media prevalence rates, along with MARCE (major adverse renal cardiovascular event) incidence and episode-related cost data were derived from Premier Hospital Data (October 2014 to September 2015). A previously estimated relative risk reduction in MARCE associated with IOCM usage (9.3%) was applied. The higher cost of IOCM was included when calculating the net impact estimates at the aggregate, hospital type, and per hospital levels. One-way (±25%) and probabilistic sensitivity analyses identified the model's most important inputs. Based on weighted analysis, 513,882 US inpatient angioplasties and 35,610 MARCE cases were estimated annually. Switching to an "IOCM only" strategy from a "LOCM only" strategy increases contrast media cost, but prevents 2,900 MARCE events. The annual budget impact was an estimated saving of $30.71 million, aggregated across all US hospitals, $6,316 per hospital, or $60 per procedure. Net savings were maintained across all univariate sensitivity analyses. While MARCE/event-free cost differential was the most important factor driving total net savings for hospitals in the Northeast and West, procedural volume was important in the Midwest and rural locations. Switching to an "IOCM only" strategy from a "LOCM only" approach yields substantial net global savings to hospitals, both at the national level and within hospital sub-groups. Hospital administrators should maintain awareness of the factors that are likely to be more influential for their hospital and recognize that purchasing on the basis of lower contrast media cost may result in higher overall costs for patients undergoing inpatient

  18. Anal incontinence after two vaginal deliveries without obstetric anal sphincter rupture.

    PubMed

    Persson, Lisa K G; Sakse, Abelone; Langhoff-Roos, Jens; Jangö, Hanna

    2017-06-01

    To evaluate prevalence and risk factors for long-term anal incontinence in women with two prior vaginal deliveries without obstetric anal sphincter injury (OASIS) and to assess the impact of anal incontinence-related symptoms on quality of life. This is a nation-wide cross-sectional survey study. One thousand women who had a first vaginal delivery and a subsequent delivery, both without OASIS, between 1997 and 2008 in Denmark were identified in the Danish Medical Birth Registry. Women with more than two deliveries in total till 2012 were excluded at this stage. Of the 1000 women randomly identified, 763 were eligible and received a questionnaire. Maternal and obstetric data were retrieved from the national registry. The response rate was 58.3%. In total, 394 women were included for analysis after reviewing responses according to previously defined exclusion criteria. Median follow-up time was 9.8 years after the first delivery and 6.4 years after the second. The prevalence of flatal incontinence, fecal incontinence and fecal urgency were 11.7, 4.1, and 12.3%, respectively. Overall, 20.1% had any degree of anal incontinence and/or fecal urgency. In 6.3% these symptoms affected their quality of life. No maternal or obstetric factors including episiotomy and vacuum extraction were consistently associated with altered risk of anal incontinence in the multivariable analyses. Anal incontinence and fecal urgency is reported by one fifth of women with two vaginal deliveries without OASIS at long-term follow-up. Episiotomy or vacuum extraction did not alter the risk of long-term anal incontinence.

  19. Assessment and management of urinary incontinence in women.

    PubMed

    Stewart, Ellie

    2018-05-02

    Urinary incontinence is a common and usually hidden issue that can affect women of all ages. It is often ignored by the patient because of their misconception that incontinence is an inevitable consequence of ageing and their low expectations of successful treatment. There are various types of incontinence, with symptoms that can significantly affect patients' quality of life. This article aims to enhance nurses' understanding of the types of urinary incontinence affecting women, associated risk factors and continence assessment, as well as the initial investigations and conservative treatments that can be instigated by general nurses. It also discusses some of the advanced treatments offered by specialist services. The article emphasises the importance of undertaking a holistic continence assessment to ensure appropriate continence care is provided, and how tailoring this care to the individual can improve adherence to treatment plans. © 2018 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.

  20. Prospective regenerative medicine therapies for obstetric trauma-induced fecal incontinence.

    PubMed

    Parmar, Nina; Kumar, Lalit; Emmanuel, Anton; Day, Richard M

    2014-01-01

    Fecal incontinence is a major public health issue that has yet to be adequately addressed. Obstetric trauma and injury to the anal sphincter muscles are the most common cause of fecal incontinence. New therapies are emerging aimed at repair or regeneration of sphincter muscle and restoration of continence. While regenerative medicine offers an attractive option for fecal incontinence there are currently no validated techniques using this approach. Although many challenges are yet to be resolved, the advent of regenerative medicine is likely to offer disruptive technologies to treat and possibly prevent the onset of this devastating condition. This article provides a review on regenerative medicine approaches for treating fecal incontinence and a critique of the current landscape in this area.

  1. Adjustable perineal male sling using tissue expander as an effective treatment of post-prostatectomy urinary incontinence.

    PubMed

    Balci, Melih; Tuncel, Altug; Bilgin, Ovunc; Aslan, Yilmaz; Atan, Ali

    2015-01-01

    To report our intermediate experience in treating patients with severe incontinence using an adjustable perineal male sling with a tissue expander. An adjustable male sling procedure was performed on 21 patients with severe incontinence. The underlying etiology of urinary incontinence was radical prostatectomy in 13 patients, open prostatectomy in 5 patients and transurethral prostate resection in 3 patients. The difference between the classical and the adjustable sling is that in the latter there is a 25 mL tissue expander between the two layers of polypropylene mesh with an injection port. Adjustment of the sling was performed with saline via an inflation port, in case of recurrence or persistence of incontinence. The mean age of the patients was 66.2 ± 7.3 (50-79) years and mean pad usage was 6.4 ± 0.6 per day. The mean follow-up time was 40.1 ± 23.2 (6-74) months. The balloon was postoperatively inflated on average with 11.6 ± 5.7 (5-25) mL. After the mean 40.1 months of follow-up, 16 of the 21 patients (76.2%) were dry (11 patients, 0 pads; 5 patients using safety pads), 3 patients (14%) had mild and 2 (9.8%) had moderate degree post-prostatectomy urinary incontinence (PPI). The average maximum urine flow rate of the patients was 15.6 ± 4.7 (10-31) mL/s. No residual urine was found. In 2 patients, all parts of the device were removed due to infection and discomfort, and in 3 patients only the inflation component was removed due to local scrotal infection. Our results show that using an adjustable perineal male sling with a tissue expander seems to be an efficient, and safe surgical treatment option in patients with PPI.

  2. Relation of Bowel Habits to Fecal Incontinence in Women

    PubMed Central

    Bharucha, Adil E.; Seide, Barbara M.; Zinsmeister, Alan R.; Melton, L. Joseph

    2008-01-01

    BACKGROUND Though most women with fecal incontinence (FI) have anorectal dysfunctions, a majority have intermittent symptoms. Variations in bowel habits and daily routine may partly explain this. AIM To compare bowel habits and daily routine between controls and FI, and between continent and incontinent stools among women with FI. METHOD Using a mailed questionnaire, we identified 507 women with FI among 5,300 women in Olmsted County, MN. Bowel habits were compared among 127 randomly selected controls and 154 women with self-reported FI, who did (“active” FI, N = 106) or did not (“inactive” FI, N = 48) have an incontinent episode during a 2-wk bowel diary period. RESULTS Independent risk factors for FI were: rectal urgency (odds ratio [OR] for inactive FI vs controls 5.6, 95% confidence interval [CI] 2.3–13.3; and OR for active FI vs inactive FI 2.0, 95% CI 0.9–4.3) and a sense of incomplete evacuation (OR for inactive FI vs controls 3.5, 95% CI 1.4–8.8; and OR for active FI vs inactive FI 2.2, 95% CI 1.1–4.9). Similar results were found for stool frequency and form. Among incontinent women, incontinent stools (versus continent stools) were less formed, more likely to occur at work, and to be preceded by rectal urgency. CONCLUSIONS Bowel patterns, rectal urgency, and daily routine influence the occurrence of FI. Stool characteristics explained 46% of the likelihood for incontinence episodes, emphasizing that anorectal sensorimotor dysfunctions must also contribute to FI in women. PMID:18510612

  3. [Caesarean section and anal incontinence].

    PubMed

    Kalis, V; Stipán, J; Chaloupka, P; Karbanová, J; Rokyta, Z

    2008-04-01

    Summary of the impact of Caesarean section on anal incontinence. Review. Department of Gynaecology and Obstetrics, Charles University and University Hospital Plzen. Review of the current international literature. Currently, Caesarean section is not considered to reduce symptoms of anal incontinence. If there is any reduction of symptoms, that remains only for a short term (40% in 3 months after the delivery in the largest trial). In a long term, virtually in no trial has been observed any difference, and others, non-obstetrical factors (particularly aging) prevail. Current knowledge does not allow to assess sufficiently pros and cons of Caesarean compared to vaginal delivery. High risk groups, that would profit from elective Ceasarean, have not been clearly identified yet.

  4. Integrating yoga therapy in the management of urinary incontinence: a case report.

    PubMed

    Vinchurkar, Suhas Ashok; Arankalle, Dhananjay Vijay

    2015-04-01

    A 63-year-old overweight female prediagnosed of stress urinary incontinence presented with exacerbated events of urine leakage. She was advised a residential lifestyle and behavioral program, primarily consisting of a monitored yoga therapy module, apart from her ongoing anticholinergic medicine, for 21 days. Assessments were based on a frequency volume chart, a bladder diary for the entire duration of treatment, and the International Consultation on Incontinence Modular Questionnaire-Urinary Incontinence Short Form questionnaire on the days of admission and discharge. A total of 1.9 kg of weight loss was observed during her stay. Usage of pad, as reported in her diary, reduced from 3 to 1 per day. Her International Consultation on Incontinence Modular Questionnaire-Urinary Incontinence Short Form score reduced from 16 to 9, indicating better continence. She expressed subjective well-being and confidence in her social interactions. This is probably the first case report demonstrating feasibility of integration of yoga therapy in the management of urinary incontinence. © The Author(s) 2014.

  5. Obstetrical anal sphincter laceration and anal incontinence 5-10 years after childbirth

    PubMed Central

    EVERS, Emily C.; BLOMQUIST, Joan L.; MCDERMOTT, Kelly C.; HANDA, Victoria L.

    2012-01-01

    Objective To investigate the long-term impact of anal sphincter laceration on anal incontinence. Study Design Five to ten years after first delivery, anal incontinence and other bowel symptoms were measured using the Epidemiology of Prolapse and Incontinence Questionnaire and the short form of the Colorectal-Anal Impact Questionnaire. Obstetrical exposures were assessed with review of hospital records. Symptoms and quality of life impact were compared between 90 women with at least one anal sphincter laceration, 320 who delivered vaginally without sphincter laceration and 527 who delivered by cesarean. Results Women who sustained an anal sphincter laceration were most likely to report anal incontinence (odds ratio 2.32; 95% confidence interval 1.27, 4.26) and reported the greatest negative impact on quality of life. Anal incontinence and quality of life scores were similar between women who delivered by cesarean and those who delivered vaginally without sphincter laceration. Conclusion(s) Anal sphincter laceration is associated with anal incontinence 5-10 years after delivery. PMID:22831810

  6. A chief of service rotation as an alternative approach to pediatric otolaryngology inpatient care.

    PubMed

    Adil, Eelam; Xiao, Roy; McGill, Trevor; Rahbar, Reza; Cunningham, Michael

    2014-09-01

    Maintaining an outpatient practice and providing high-quality inpatient care pose significant challenges to the traditional call team approach. To introduce a unique rotating hospitalist inpatient program and assess its clinical, educational, and financial impact. The chief of service (COS) program requires 1 attending physician to rotate weekly as chief of the inpatient service with no conflicting elective duties. This was a retrospective internal billing data review performed at a tertiary pediatric hospital. A total of 1241 patients were evaluated by the COS from October 2012 through October 2013. All patients were treated by the inpatient service under the supervision of the COS. A retrospective analysis of patient encounters and procedures, including International Classification of Diseases, Ninth Revision (ICD-9) and Current Procedural Terminology (CPT) codes, locations of service, clinicians, service dates, and average weekly relative value units (RVUs). Over the study period, the COS was involved in the care of 1241 patients, generating 2786 billable patient encounters. The COS averaged 11.2 patient encounters per day. The most common reasons for consultation were respiratory distress, dysphagia, and stridor. Of patient encounters, 63.0% resulted in a procedure; 82.8% of those procedures were performed in the operating room with the most common being lower airway endoscopy (340 [19.4%]). The average weekly RVUs for the COS (232) were comparable with those of the average weekly outpatient clinic and procedural RVUs of the other otolaryngology faculty in the group (240). The COS program was created to meet the clinical, educational, and organizational demands of a high-volume and high-acuity inpatient service. It is a financially sustainable model with unique advantages, particularly for the staff who maintain their outpatient practices without disruption and for the trainees who have the opportunity to work closely with the entire faculty. Patients are

  7. Anti-diuresis in the management of daytime urinary incontinence

    PubMed Central

    Robinson, D.; Cardozo, L.

    2009-01-01

    Urinary incontinence and lower urinary tract dysfunction, whilst not life threatening conditions, remain an important cause of morbidity in women and are responsible for significant impairment of quality of life. Drug therapy is often used to treat women who complain of urgency and urge incontinence and has an emerging role in the management of stress urinary incontinence. However, bothersome side effects are known to affect compliance and therefore compromise efficacy, making longterm drug therapy unpopular. The principle aim of this thesis is to assess the role of antidiuresis in women complaining of daytime urinary incontinence and also to examine its role as a ‘designer therapy’ which women can choose to use as, or when, required. In addition both the patients’ and clinicians’ attitudes towards treatment have been studied to clarify the meaning of ‘cure’, and to determine treatment acceptability, overall outcome and patient satisfaction. In the first study the patients’ concept of cure is explored as well as their expectations regarding treatment and outcome. The second study examines cure from the clinician’s perspective in addition to reviewing outcome measures in the clinical and research settings. Finally in the third study the use of desmopressin in women complaining of daytime urinary incontinence is reported. PMID:25478070

  8. Long-term follow-up of bulking agents for stress urinary incontinence in older patients.

    PubMed

    Plotti, Francesco; Montera, Roberto; Terranova, Corrado; Luvero, Daniela; Marrocco, Francesca; Miranda, Andrea; Gatti, Alessandra; De Cicco Nardone, Carlo; Angioli, Roberto; Scaletta, Giuseppe

    2018-06-01

    Implantation of bulking agents represents a noninvasive procedure for the treatment of stress urinary incontinence (SUI) in all patients where a more invasive procedure may increase perioperative risks. The primary aim of this retrospective study was to evaluate the efficacy over time of bulking agent implantation. As secondary aims, we evaluated long-term (patients' subjective) satisfaction rate, rate of de novo urinary symptoms, and the impact of urinary incontinence on the quality of life. All patients who underwent implantation of bulking agents between 1999 and 2013 at Campus Bio-Medico of Rome were retrospectively considered eligible for this study. Patients were interviewed using two standardized questionnaires: International Consultation on Incontinence Questionnaire Short Form and Patient Global Impression of Improvement. Cure rate, improvement rate, failure rate, and the onset of new symptoms were also investigated through specific questions. The original group of patients was then divided into two subgroups according to follow-up time (group A: shorter than median follow-up; group B: longer than median follow-up). Sixty-three patients were enrolled. Mean follow-up was 8.3 ± 3.5 years with a range of 3.5 to 18 years. Fifteen (24%) cured patients (cure rate), 12 (19%) improved patients (improvement rate), 36 (57%) failed treatment (failure rate). We reported an overall success rate of 43%. No differences were reported among groups in terms of overall success rate (42% vs 44% for group A and group B, respectively). Bulking agent implantation is an effective treatment for people with intrinsic sphincter deficiency (type III SUI) and it is a valid alternative to more invasive surgeries in older patients. Moreover, it shows an overall success rate (43%) that remains high even after many years.

  9. Pelvic floor muscle training for female urinary incontinence: Does it work?

    PubMed

    Singh, Nilanjana; Rashid, Mumtaz; Bayliss, Lorna; Graham, Penny

    2016-06-01

    Supervised pelvic floor muscle training in patients of stress and mixed urinary incontinence has been recommended. Our aim was to assess the utilisation and effectiveness of our supervised pelvic floor muscle training service and assess the impact of incontinence scores before physiotherapy on the subsequent results of physiotherapy. All 271 patients referred to physiotherapy for symptoms of incontinence filled out the International Consultation on Incontinence Modular Questionnaire-Female Lower Urinary Tract Symptoms before starting treatment. Depending on pelvic floor muscle assessment, plans for exercises and follow up were made. If the strength of pelvic floor muscles was poor, electrical stimulation was offered. If awareness of the pelvic floor muscle contraction was poor, bio feedback was offered. Group sessions and vaginal cones were also used. Depending on the response to the treatment; patients were either discharged, referred to Urogynaecology clinic or continued physiotherapy. All patients who were discharged or referred for surgery were given a post treatment questionnaire to fill out. 79 (56 %) of 132 women with stress, 49 (51 %) of 98 with mixed and 27 (66 %) of 41 with urge incontinence reported successful control of symptoms (overall success 54 %). However, 65 % of women with incontinence scores of 0-5 before physiotherapy, 64 % with 6-10, 42 % with 11-15 and mere 28 % with 16-20 achieved success with physiotherapy. 27 (10 %) were lost to follow up. 1 in 2 women referred to physiotherapy for incontinence, achieved successful control of symptoms without the need for invasive investigations or surgery. However, poor incontinence scores before the start of physiotherapy is a poor prognostic indicator for success. 90 % women utilised the service.

  10. Geropsychiatric inpatient care: what is state of the art?

    PubMed

    Smith, Marianne; Specht, Janet; Buckwalter, Kathleen C

    2005-01-01

    Although dedicated geropsychiatric units have been available for many years, little information is available about them as a group. This article describes a survey that was developed to learn what type of resources, policies, or procedures geropsychiatric inpatient units employed to promote best nursing care practices. Physical changes to the unit and enhanced staff training were components of the current units and were consistently identified as needing enhancement to move to the next level of excellence. An unanticipated outcome was survey respondents' interest in becoming a part of a network of individuals who provide inpatient geropsychiatric care.

  11. Stress incontinence and pelvic floor exercises in pregnancy.

    PubMed

    Sahakian, Josine

    This literature review is a critique of the research looking at the impact of pelvic floor exercises during pregnancy on urinary stress incontinence in postnatal women. Seven studies were selected for review following a database search on the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, Medline and the British Nursing Index (BNI). The research produced mixed findings. Four of the seven studies demonstrated a significant improvement in urinary stress incontinence in postnatal women following pelvic floor muscle exercise during pregnancy. However, the studies that spanned a longer time period found no long-term effectiveness. More research is needed for a more conclusive picture as to whether antenatal pelvic floor exercises can improve stress incontinence in the postpartum period.

  12. [The artificial sphincter: therapy for faecal incontinence].

    PubMed

    Baumgartner, U

    2012-08-01

    Faecal incontinence (FI) challenges a patient's professional, social and sexual life. Often the patient becomes depressive and socially isolated. If able to break open for therapy the patient should receive as first line a conservative treatment (like dietary measures, pelvic re-education, biofeedback, bulking agents, irrigation). When is the time to implant an artificial anal sphincter? If conservative therapy fails as well as surgical options (like a sphincteroplasty - if indicated a reconstruction of the pelvic floor if insufficient, or a sacral nerve stimulation) an ultimo surgical procedure should be offered to appropriate and compliant patients: an artificial anal sphincter. Worldwide, there are two established devices on the market: the artificial bowel sphincter® (ABS) from A. M. S. (Minnetonka, MN, USA) and the soft anal band® from A. M. I. (Feldkirch, Austria). How to implant the artificial anal sphincter? Both devices consist of a silicon cuff which can be filled with fluid. Under absolute aseptic conditions this cuff is placed in the lithotomy position by perianal incisions around the anal canal below the pelvic floor. A silicon tube connects the anal cuff with a reservoir (containing fluid) which is placed either behind the pubis bone in front of the bladder (ABS) or below the costal arch (anal band). With a pump placed in the scrotum/labia (ABS) or by pressing the balloon (anal band) in both types operated by the patient the fluid is shifted forth and back between the anal cuff and the reservoir closing or opening the anal canal. Both systems are placed completely subcutaneously. Both devices improve significantly the anal continence. Both systems have a high rate of reoperations. However, the causes for the redos are different. The ABS is associated with high infection and anal penetration rates of the cuff leading to an explantation rate to up to 60 % of the implants. This kind of complication seems to be much lower with the anal band. The major

  13. A prospective study of the natural history of urinary incontinence in women.

    PubMed

    Hagan, Kaitlin A; Erekson, Elisabeth; Austin, Andrea; Minassian, Vatche A; Townsend, Mary K; Bynum, Julie P W; Grodstein, Francine

    2018-05-01

    Symptoms of urinary incontinence are commonly perceived to vary over time; yet, there is limited quantitative evidence regarding the natural history of urinary incontinence, especially over the long term. We sought to delineate the course of urinary incontinence symptoms over time, using 2 large cohorts of middle-aged and older women, with data collected over 10 years. We studied 9376 women from the Nurses' Health Study, age 56-81 years at baseline, and 7491 women from the Nurses' Health Study II, age 39-56 years, with incident urinary incontinence in 2002 through 2003. Urinary incontinence severity was measured by the Sandvik severity index. We tracked persistence, progression, remission, and improvement of symptoms over 10 years. We also examined risk factors for urinary incontinence progression using logistic regression models. Among women age 39-56 years, 39% had slight, 45% had moderate, and 17% had severe urinary incontinence at onset. Among women age 56-81 years, 34% had slight, 45% had moderate, and 21% had severe urinary incontinence at onset. Across ages, most women reported persistence or progression of symptoms over follow-up; few (3-11%) reported remission. However, younger women and women with less severe urinary incontinence at onset were more likely to report remission or improvement of symptoms. We found that increasing age was associated with higher odds of progression only among older women (age 75-81 vs 56-60 years; odds ratio, 1.84; 95% confidence interval, 1.51-2.25). Among all women, higher body mass index was strongly associated with progression (younger women: odds ratio, 2.37; 95% confidence interval, 2.00-2.81; body mass index ≥30 vs <25 kg/m 2 ; older women: odds ratio, 1.93; 95% confidence interval, 1.62-2.22). Additionally, greater physical activity was associated with lower odds of progression to severe urinary incontinence (younger women: odds ratio, 0.86; 95% confidence interval, 0.71-1.03; highest vs lowest quartile of activity

  14. Urinary Incontinence and Levels of Regular Physical Exercise in Young Women.

    PubMed

    Da Roza, T; Brandão, S; Mascarenhas, T; Jorge, R N; Duarte, J A

    2015-08-01

    The purpose of this study was to determine the influence of different levels of regular physical exercise on the frequency of urinary incontinence in young nulliparous women from the northern region of Portugal. Participants (n=386) self-reported demographic variables, frequency, and time spent practicing organized exercise per week, as well as completed the International Consultation on Incontinence Questionnaire-Short Form. The level of exercise was calculated based on the time (in minutes) usually spent per week in organized exercise. 19.9% of Portuguese nulliparous women reported incontinence symptoms. Considering the distribution of urinary incontinence among the different quartiles of organized exercise, women from the 4(th)quartile (those who train for competitive purposes) demonstrated highest relative frequency (p=0.000) and a 2.53 greater relative risk to develop (95% CIs,1.3-2.7) incontinence compared to women from the 1(st) quartile (inactive). Women who practice exercise for recreational purposes (2(nd) and 3(rd) quartiles) did not show significant differences in the urinary incontinence prevalence and relative risk of developing it compared to women from the 1(st) quartile. The results showed that women participating in organized exercise involving high volume training for competition are potentially at risk of developing urinary incontinence, although organized exercise undertaken without the intent to compete seems to be safe for maintaining urinary continence. © Georg Thieme Verlag KG Stuttgart · New York.

  15. Urinary Incontinence in Physically Active Young Women: Prevalence and Related Factors.

    PubMed

    Alves, Jessica Oliveira; Luz, Soraia Tonon Da; Brandão, Sofia; Da Luz, Clarissa Medeiros; Jorge, Renato Natal; Da Roza, Thuane

    2017-11-01

    This cross-sectional survey aims to (1) verify the prevalence of urinary incontinence and its impact on the quality of life among nulliparous fit women, and to (2) analyze whether urinary incontinence is influenced by the intensity of the sport (high- vs. low-impact) or by the volume of physical activity (minutes per week) performed. Two hundred forty-five nulliparous women (18-40 years) completed the International Consultation on Incontinence Questionnaire-Short Form, the Kings Health Questionnaire and a questionnaire regarding demographic and training variables. Overall 22.9% of the participants self-reported urinary incontinence, and among them, 60.7% had stress urinary incontinence. Incontinent women demonstrated worse quality of life than continent females (p=0.000). Women practicing high-impact sports presented higher frequency in loss of urine than those practicing low-impact sports (p=0.004). Regardless the intensity of the sport, the volume of exercise showed positive association with the frequency of loss of urine (p=0.005, r=0.475). In conclusion, almost one fourth of the women enrolled in this study reported symptoms of urinary incontinence and worse quality of life than those who were continent. Women who practice high-impact sports or who have higher volume of training should be aware of the symptoms associated with pelvic floor dysfunction, since they seem to predispose to urine leakage. © Georg Thieme Verlag KG Stuttgart · New York.

  16. Lower Urinary Tract Symptoms and Incontinence in Children with Pompe Disease.

    PubMed

    Ajay, Divya; McNamara, Erin R; Austin, Stephanie; Wiener, John S; Kishnani, Priya

    2016-01-01

    Pompe disease (PD) is a disorder of lysosomal glycogen storage. The introduction of enzyme replacement therapy (ERT) has shifted the focus of care from survival to quality of life. The presence of lower urinary tract symptoms (LUTS) and incontinence has not been previously described in children with PD. Children with PD followed in the Duke Lysosomal Storage Disease Clinic completed a validated bladder control symptom score (BCSS) and additional questions regarding urinary tract infections (UTIs), giggle, and stress incontinence. Descriptive statistics were used to discriminate urinary symptoms between gender, age, and different types of PD. Sixteen of 23 children (aged 4-14 years) seen in our clinic participated. Seven were girls; ten had classic infantile PD, two atypical infantile PD, and four childhood presentation late-onset PD (LOPD). When stratified by PD subtype, median BCSS was worst for the classic PD subtype followed by atypical PD and LOPD. Daytime urinary incontinence accompanied by constipation was noted in six. Eight reported urinary incontinence with laughing: giggle incontinence in six and stress incontinence in two. Four girls reported a history of UTI. Longitudinal follow-up in 11 patients showed stable BCSS in six, improvement in three, and worsening in two. Worsening corresponded with changes in bowel function and improvement with increase in ERT dose or treatment of constipation. LUTS and incontinence are common in children with PD with greater symptoms noted with infantile-type PD. Improved bowel function and increase in ERT dose may lead to improvements in BCSS.

  17. The Management of Urinary Incontinence by Community-Living Elderly.

    ERIC Educational Resources Information Center

    Mitteness, Linda S.

    1987-01-01

    Explored ways elderly people (N=30) manage urinary incontinence. Subjects tended to dismiss their urinary incontinence as a normal part of aging and used various behavioral and psychological strategies to maintain their independence, usually without any assistance from the health professions. Management strategies commonly involved some degree of…

  18. Programmed Instruction, Self-Control, and In-Patient Psychiatry.

    ERIC Educational Resources Information Center

    Layng, Terrence; And Others

    The extension of the instructional programming process, as outlined by Markle and Tiemann (1967), to the treatment of psychiatric in-patients is described. Three case studies are presented as examples of the application of the programming procedures as derived from the Constructional Model of Dr. Israel Goldiamond. The emphasis throughout all…

  19. Women with urinary incontinence: self-perceived worries and general practitioners' knowledge of problem.

    PubMed Central

    Lagro-Janssen, T L; Smits, A J; Van Weel, C

    1990-01-01

    In the context of a large scale survey of health problems in women aged 50 to 65 years, a study was undertaken on the effects of incontinence on daily life. For this purpose 1442 women randomly selected from the practice files of 75 general practitioners in the eastern part of the Netherlands were interviewed at home (response rate 60%). In cases of moderate or severe incontinence the general practitioner of the woman concerned was asked whether this problem had been diagnosed in general practice. Incontinence was reported in 22.5% of the women. Overall, 77.8% of the women did not feel worried about it and 75.4% did not feel restricted in their activities; even for women with severe incontinence (daily frequency and needing protective pads) only 15.6% experienced much worry and 15.7% much restriction. About a third of the women with incontinence (32.0%) had been identified by their general practitioner. The greater the worries and restrictions owing to incontinence, the greater the chance that the incontinence was known to the general practitioner concerned. Only a small minority of the women who felt severely restricted were not identified by their general practitioner. There was a positive relation between recognized incontinence and a history of hysterectomy. This study contradicts the image of the incontinent woman as isolated and helpless; most women in this study seemed able to cope. PMID:2121179

  20. Anal incontinence among first time mothers - what happens in pregnancy and the first year after delivery?

    PubMed

    Johannessen, Hege Hølmo; Wibe, Arne; Stordahl, Arvid; Sandvik, Leiv; Mørkved, Siv

    2015-09-01

    Pregnancy- and delivery-related factors affect postpartum anal incontinence. We aimed to explore changes in continence status among primiparas from late pregnancy through the first year postpartum. In this prospective cohort study set in two Norwegian hospitals, 862 healthy primiparas completed questionnaires about the main outcome measure anal incontinence, including flatus incontinence and urgency, at three time points; late pregnancy, 6 and 12 months postpartum. Socioeconomic and delivery-related data were obtained from hospital records. Logistic regression analyses were applied to determine the association between continence status at 12 months postpartum, and continence status in late pregnancy, 6 months postpartum, demographic and delivery-related characteristics. Among the 189 (22%) primiparas reporting anal incontinence in late pregnancy, 34 (18%) had persistent anal incontinence 1 year later. Forty-eight (43%) of the 113 women incontinent at 6 months postpartum experienced persistent anal incontinence at 12 months. Eight percent of previously continent women reported new onset anal incontinence at 6 and 12 months after delivery. Occipitoposterior presentation was the only delivery-related factor increasing the risk of postpartum anal incontinence [odds ratio (OR) 1.8, 95% confidence interval (CI) 1.0-3.4]. Young age increased the risk of anal incontinence at 1 year after delivery, whereas incontinence in late pregnancy increased the risk of anal incontinence persisting through 6 and 12 months postpartum. In most first-time mothers with postpartum anal incontinence, the onset of anal incontinence was before delivery. Except for occipitoposterior presentation, no delivery-related factors increased the risk of postpartum anal incontinence. This may indicate that hormonal, mechanical or neuromuscular changes in pregnancy affect long-term anal incontinence more than vaginal delivery. © 2015 Nordic Federation of Societies of Obstetrics and Gynecology.

  1. Influence of Obesity on Short-term Surgical Outcome of the Transobturator Tape Procedure in Patients with Stress Urinary Incontinence.

    PubMed

    Tchey, Dong-Un; Kim, Won-Tae; Kim, Yong-June; Yun, Seok-Joong; Lee, Sang-Cheol; Kim, Wun-Jae

    2010-04-01

    The purpose of our study was to evaluate the influence of obesity on clinical characteristics, quality of life (QoL), and outcomes in patients with stress urinary incontinence (SUI) who underwent the transobturator tape (TOT) surgery. The medical records of SUI patients who underwent the TOT operation from January 2007 to February 2009 were retrospectively reviewed. Patients with any neurologic diseases that affect the voiding pattern were excluded, and 107 patients were enrolled. The patients were divided into nonobese (BMI<25) and obese (BMI≥25) groups. The preoperative evaluation consisted of history taking, physical examination, cystometrography, 3-day frequency-volume chart, King's Health Questionnaire (KHQ), and symptom perception scale questionnaires. The nonobese group consisted of 55 (51.4%) patients and the obese group of 52 (48.6%). The median age was 49.0 (range, 30.8-73.5) years in the nonobese group and 52.7 (range, 35.5-73.5) years in the obese group (p>0.05). The obese group showed a higher SUI symptom grade, urethral hypermobility, urgency, and urge incontinence scale than did the nonobese group (each p<0.05). Neither the domains of the KHQ nor the items on the 3-day frequency-volume chart differed between the two groups (each p>0.05). After the operation, the symptom scales and parameters in the 3-day frequency-volume chart of the obese group were similar to those of the nonobese group (each p>0.05). The objective success, recurrence, and complication rates at 1year were similar in the two groups (each p>0.05). Obese SUI patients had worse SUI symptom grade, urgency, and urge incontinence symptoms than did nonobese patients. However, surgical correction by the TOT operation could restore the symptoms and voiding parameters as effectively in obese patients as in nonobese patients.

  2. Long-term durability of sacral nerve stimulation therapy for chronic fecal incontinence.

    PubMed

    Hull, Tracy; Giese, Chad; Wexner, Steven D; Mellgren, Anders; Devroede, Ghislain; Madoff, Robert D; Stromberg, Katherine; Coller, John A

    2013-02-01

    Limited data have been published regarding the long-term results of sacral nerve stimulation, or sacral neuromodulation, for severe fecal incontinence. The aim was to assess the outcome of sacral nerve stimulation with the use of precise tools and data collection, focusing on the long-term durability of the therapy. Five-year data were analyzed. Patients entered in a multicenter, prospective study for fecal incontinence were followed at 3, 6, and 12 months and annually after device implantation. Patients with chronic fecal incontinence in whom conservative treatments had failed or who were not candidates for more conservative treatments were selected. Patients with ≥ 50% improvement over baseline in fecal incontinence episodes per week during a 14-day test stimulation period received sacral nerve stimulation therapy. Patients were assessed with a 14-day bowel diary and Fecal Incontinence Quality of Life and Fecal Incontinence Severity Index questionnaires. Therapeutic success was defined as ≥ 50% improvement over baseline in fecal incontinence episodes per week. All adverse events were collected. A total of 120 patients (110 women; mean age, 60.5 years) underwent implantation. Seventy-six of these patients (63%) were followed a minimum of 5 years (maximum, longer than 8 years) and are the basis for this report. Fecal incontinence episodes per week decreased from a mean of 9.1 at baseline to 1.7 at 5 years, with 89% (n = 64/72) having ≥ 50% improvement (p < 0.0001) and 36% (n = 26/72) having complete continence. Fecal Incontinence Quality of Life scores also significantly improved for all 4 scales between baseline and 5 years (n = 70; p < 0.0001). Twenty-seven of the 76 (35.5%) patients required a device revision, replacement, or explant. The therapeutic effect and improved quality of life for fecal incontinence is maintained 5 years after sacral nerve stimulation implantation and beyond. Device revision, replacement, or explant rate was acceptable, but future

  3. No. 127-The Evaluation of Stress Incontinence Prior to Primary Surgery.

    PubMed

    Farrell, Scott A

    2018-02-01

    To provide clinical guidelines for the evaluation of women with stress urinary incontinence prior to primary anti-incontinence surgery. The modalities of evaluation range from basic pelvic examination through to the use of adjuncts including ultrasound and urodynamic testing. These guidelines provide a comprehensive approach to the preoperative evaluation of urinary incontinence to ensure that excessive evaluation is avoided without sacrificing diagnostic accuracy. Published opinions of experts, supplemented by evidence from clinical trials, where appropriate. The quality of the evidence is rated using the criteria described by the Canadian Task Force on the Periodic Health Examination. Comprehensive evaluation of women considering surgery to treat urinary incontinence is essential to rule out causes of incontinence that may not be amenable to surgical treatment. Simplifying the evaluation minimizes the discomfort and embarrassment potentially experienced by women. VALIDATION: These guidelines have been approved by the Urogynaecology Committee and the Executive and Council of The Society of Obstetricians and Gynaecologists of Canada. Copyright © 2018. Published by Elsevier Inc.

  4. Behavioural treatment of urinary incontinence in geriatric patients.

    PubMed Central

    Sogbein, S. K.; Awad, S. A.

    1982-01-01

    Urinary incontinence and a program to treat it were studied in a geriatric hospital. Of 161 men, 58 (36%) were incontinent. The most common probable causes were cerebrovascular accident and organic brain syndrome. Evaluation by cystometry (after treatment of infections) in 30 patients showed 24 (80%) to have detrusor hyperreflexia. Twenty patients with hyperreflexia completed a timed-voiding routine, which benefited 17 of them (85%). PMID:7139506

  5. Experiences of incontinence and pelvic floor muscle training after gynaecologic cancer treatment.

    PubMed

    Lindgren, Anna; Dunberger, G; Enblom, A

    2017-01-01

    The purpose of the present study is to describe how gynaecological cancer survivors (GCS) experience incontinence in relation to quality of life, their possibilities for physical activity and exercise and their perceptions and experiences of pelvic floor muscle training. This qualitative interview content analysis study included 13 women (48-82 age) with urinary (n = 10) or faecal (n = 3) incontinence after radiation therapy (n = 2), surgery (n = 5) and surgery and radiation therapy (n = 6) for gynaecological cancer, 0.5-21 years ago. Symptoms related to incontinence and restrictions in daily activities reduced physical quality of life. Emotions related to incontinence reduced psychological quality of life and social and existential quality of life, due to restrictions in activity and feelings of exclusion. Practical and mental strategies for maintaining quality of life were described, such as always bringing a change of clothes and accepting the situation. Possibilities for sexual and physical activity as well as exercise were also restricted by incontinence. The women had little or no experience of pelvic floor muscle training but have a positive attitude towards trying it. They also described a lack of information about the risk of incontinence. The women were willing to spend both money and time on an effective treatment for their incontinence. Nine out of 10 were willing to spend at least 7 h a week. GCS experienced that incontinence reduced quality of life and limited possibilities for sexual and physical activity as well as exercise. Coping strategies, both practical and emotional, facilitated living with incontinence. The women had a positive attitude towards pelvic floor muscle training. Lack of information had a negative impact on their way of dealing with the situation.

  6. Effects of physiotherapy treatment for urinary incontinence in patient with multiple sclerosis.

    PubMed

    Pereira, Carla Maria de Abreu; Castiglione, Mariane; Kasawara, Karina Tamy

    2017-07-01

    [Purpose] The aim of the study was to evaluate the benefits of physical therapy for urinary incontinence in patients with multiple sclerosis and to verify the impact of urinary incontinence on the patient's quality of life. [Subject and Methods] A case study of a 55-year-old female patient diagnosed with multiple sclerosis and mixed urinary incontinence was conducted. Physical therapy sessions were conducted once a week, in total 15 sessions, making use of targeted functional electrical vaginal stimulation, along with active exercises for the pelvic floor muscles and electrical stimulation of the posterior tibial nerve, behavioral rehabilitation and exercise at home. [Results] After 15 physical therapy sessions, a patient diagnosed with multiple sclerosis and mixed urinary incontinence showed continued satisfactory results after five months. She showed better quality of life, higher strength of pelvic floor muscle and reduced urinary frequency without nocturia and enuresis. [Conclusion] The physical therapy protocol in this patient with multiple sclerosis and mixed urinary incontinence showed satisfactory results reducing urinary incontinence symptomatology and improving the patient's quality of life.

  7. [Quality of life in patients with urinary incontinence].

    PubMed

    Córcoles, Martínez B; Sánchez, Salinas A S; Bachs, Giménez J M; Moreno, Donate M J; Navarro, Pastor H; Rodríguez, Virseda J A

    2008-02-01

    To assess the quality of life of female patients with urinary stress incontinence (USI) who were attended at the urology department of the University Hospital at Albacete. Between November 2001 and December 2005, 126 patients with USI were surveyed in our hospital using the King's Health Questionnaire (KHQ), which is a specific instrument to measure the quality of life among female patients with urinary incontinence (UI). The mean age of patients was 57.09 años (SD: 9.57) and the mean BMI was 28.14 Kg/m2 (SD: 4.66). The mean evolution of UI was 114.48 months, with a median of 96 months. During the last week of the study period, a total of 73 women (57.94%) had more than 10 urine leaks a day. As regards the number of sanitary towels used a day, 82.5% (104 cases) stated they used less than 6. The urodynamic diagnosis was described as normal in 8 cases (6.3%), 16 cases (12.7%) were diagnosed as mixed urinary incontinence and, finally, 102 cases (81%) suffered genuine USI. The best scores were presented in the Personal Relationships scale with a mean score of 26.8, whereas the worse scores were noted in that of Impact of Urinary Incontinence, whose mean score was 82.96. Generally, the lowest scores (better quality of life) were obtained in the youngest age groups. Scores in the scales of General Health, Impact on daily activities, Impact on physical activity, Impact on social activity and Emotions, were significantly higher in patients who had undergone a histerectomy. Patients whose evolution of urinary incontinence was longer presented lower scores in the Personal Relationships scale (r=0.179; p=0.045). The quality of life of female patients with U.I. is affected, which limits both their physical activity and image. Their quality of life worsens with age, a greater extent of incontinence, greater urinary symptomatology and when episodes of urinary infection are associated.

  8. Prevalence and predictors of urinary/anal incontinence after vaginal delivery: prospective study of Nigerian women.

    PubMed

    Obioha, Kingsley Chukwu; Ugwu, Emmanuel Onyebuchi; Obi, Samuel Nnamdi; Dim, Cyril Chukwudi; Oguanuo, Theophilus Chimezie

    2015-09-01

    Urinary and anal incontinence are major public health problems impacting on the quality of life of affected women, with resultant loss of self-esteem. Despite the anticipated magnitude of this public health problem in sub-Saharan Africa, there is paucity of data on the prevalence of urinary and/or anal incontinence after childbirth in the region. This study determined the prevalence and predictors of urinary and anal incontinence after vaginal delivery among women in Enugu, southeastern Nigeria. This was a longitudinal study of 230 consecutive parturients at the University of Nigeria Teaching Hospital, Enugu, Nigeria. Eligible women were followed up immediately, 6 weeks, and 3 months postpartum to assess the development of urinary and/or anal incontinence using validated questionnaires. Overall, 28 women had urinary incontinence, giving a cumulative prevalence rate of 12.2 %. The cumulative prevalence rate was 13.5 % for anal incontinence and 3 % for combined urinary and anal incontinence. Age, social class, parity, prolonged second stage of labor, and neonatal birth weight were significantly associated with postpartum urinary incontinence (P < 0.05). On the other hand, age, parity, prolonged second stage of labor, episiotomy, and instrumental vaginal delivery were significantly associated with postpartum anal incontinence (P < 0.05). Urinary and anal incontinence are common after vaginal delivery in Enugu, Nigeria. Modification of obstetric care and discouraging preventable predisposing factors for incontinence, such as prolonged second stage of labor and vaginal delivery of macrosomic babies, are measures that may reduce the prevalence of postpartum incontinence in our population.

  9. Urinary incontinence in women in relation to occupational status.

    PubMed

    Kim, Yoonjung; Kwak, Yeunhee

    2017-01-01

    Through this cross-sectional study the authors explore urinary incontinence in women in relation to occupational status and environment. Data from the fourth Korea National Health and Nutrition Examination Survey (2008-2009) were used (n = 5,928) excluding those aged under 19 or over 65 years, male, with renal disease, and with missing data. Urinary incontinence was prevalent in working women. Compared to unemployed women, the adjusted odds ratio (95% confidence intervals) for women working in services/sales was 1.62 (1.21-2.19); for paid workers was 1.81 (1.20-2.73); and for self-employed workers was 1.46 (1.05-2.03). Compared to unemployed women, the adjusted odds ratio for working women with a daytime work schedule was 2.14 (1.18-3.87), while for those with evening work schedules, it was 1.35 (1.05-1.74). Urinary incontinence was significantly associated with various occupational environments: an unclean and uncomfortable workplace, dangerous job and probability of accidents, feeling pressed for time, awkward position for long periods, and carrying heavy weights. These findings suggest that urinary incontinence was prevalent in working women and was associated with occupational status and working environment. Therefore, improving occupational status and environment for working women-such as modifying the working schedule, posture, and workplace atmosphere-are needed to prevent urinary incontinence.

  10. Correlates Among Nocturnal Agitation, Sleep, and Urinary Incontinence in Dementia

    PubMed Central

    Rose, Karen; Specht, Janet; Forch, Windy

    2016-01-01

    Family caregivers of elders with dementia often face the challenging behaviors of nighttime agitation, sleep disturbances, and urinary incontinence. To date, no study has examined the interrelationships of these behaviors in community-dwelling persons. This single group, descriptive study employs wireless body sensors to objectively collect data on nighttime agitation, sleep, and urinary incontinence in patients with dementia in their homes over a 5- to 7-day period. The aims are to (1) examine the feasibility and acceptability of the use of body sensors in community-dwelling persons with dementia; (2) describe patterns of nocturnal agitation, sleep continuity and duration, and nighttime urinary incontinence; and (3) examine the relationships among nocturnal agitation, sleep continuity and duration, and nighttime urinary incontinence. Data collection is in early stages and is still in progress. Challenges and advantages from preliminary data collection are reported. PMID:24670931

  11. Clinical anatomy of fecal incontinence in women.

    PubMed

    Kadam-Halani, Priyanka K; Arya, Lily A; Andy, Uduak U

    2017-10-01

    Fecal incontinence is a devastating condition that has a severe impact on quality of life. This condition disproportionately affects women and its incidence is increasing with the aging United States population. Fecal continence is maintained by coordination of a functioning anal sphincter complex, intact sensation of the anorectum, rectal compliance, and the ability to consciously control defecation. Particularly important are the puborectalis sling of the levator ani muscle complex and intact innervation of the central and peripheral nervous systems. An understanding of the intricate anatomy required to maintain continence and regulate defecation will help clinicians to provide appropriate medical and surgical management and diminish the negative impact of fecal incontinence. In this article, we describe the anatomic and neural basis of fecal continence and normal defecation as well as changes that occur with fecal incontinence in women. Clin. Anat. 30:901-911, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  12. Faecal incontinence in rural and regional northern Queensland community-dwelling adults.

    PubMed

    Bartlett, Lynne M; Nowak, Madeleine J; Ho, Yikhong

    2013-01-01

    In Australia, faecal incontinence, the involuntary loss of liquid or solid stool with or without a person's awareness, has been reported in 8% of the South Australian and 11% of the urban New South Wales community-dwelling populations. Studies conducted in 2004 and 2005 reported faecal incontinence in more than 20% of colorectal and urogynaecological clinic patients at Townsville Hospital (a referral centre serving rural North Queensland). This prompted concern regarding the level of faecal incontinence in the community. The aim of this study was to investigate the prevalence of faecal incontinence in the North and Far North Queensland urban and rural communities. The sample size was based on the New South Wales postal surveys (11% prevalence). Higher rates were expected in North/Far North Queensland, so prevalence there was estimated at 12.1% (confidence interval ± 2%, ie the true level to be between 10.1% and 14.1%). The sample for each of the Townsville, Cairns (in Far North Queensland) and rural/remote settings was calculated at 1022. The database for the present study was compiled using a systematic randomised process selecting two private names from each column on each page of the Cairns and Townsville White Pages® (Cairns: 1112 urban, 481 rural, 226 remote; Townsville: 1049 urban, 432 rural, 320 remote). The questionnaire covered personal demographics, health/risk factors, bowel habits, nutrition (fibre and fluid intake) and physical activity. Faecal incontinence was defined as accidental leakage of solid or liquid stool in the past 12 months that was not caused by a virus, medication or contaminated food. To improve the response rate a participation incentive of a chance to win a $250 voucher or one of ten $50 vouchers was offered in the initial mail-out. The initial survey was mailed out in July 2007; two follow-up surveys were mailed out to non-responders in September 2007 and January 2008. One hundred randomly selected non-responders were telephoned in

  13. Evaluation of the urinary microbiota of women with uncomplicated stress urinary incontinence.

    PubMed

    Thomas-White, Krystal J; Kliethermes, Stephanie; Rickey, Leslie; Lukacz, Emily S; Richter, Holly E; Moalli, Pamela; Zimmern, Philippe; Norton, Peggy; Kusek, John W; Wolfe, Alan J; Brubaker, Linda

    2017-01-01

    Female urinary microbiota are associated with urgency urinary incontinence and response to medication. The urinary microbiota of women with stress urinary incontinence has not been described. We sought to study the cross-sectional relationships between urinary microbiota features and demographic and clinical characteristics of women undergoing stress urinary incontinence surgery. Preoperative urine specimens were collected from women without urinary tract infection and were available from 197 women (174 voided, 23 catheterized) enrolled in a multicenter prospective randomized trial, the Value of Urodynamic Evaluation study. Demographic and clinical variables were obtained including stress and urgency urinary incontinence symptoms, menopausal status, and hormone use. The bacterial composition of the urine was qualitatively assessed by sequencing the bacterial 16S ribosomal RNA gene. Phylogenetic relatedness and microbial alpha diversity were compared to demographics and symptoms using generalized estimating equation models. The majority of 197 urine samples (86%) had detectable bacterial DNA. Bacterial diversity was significantly associated with higher body mass index (P = .02); increased Medical, Epidemiologic, and Social Aspects of Aging urge index score (P = .04); and hormonal status (P < .001). No associations were detected with stress urinary incontinence symptoms. Increased diversity was also associated with a concomitant lower frequency of Lactobacillus in hormone-negative women. Women undergoing stress urinary incontinence surgery have detectable urinary microbiota. This cross-sectional analysis revealed that increased diversity of the microbiota was associated with urgency urinary incontinence symptoms, hormonal status, and body mass index. In contrast, the female urinary microbiota were not associated with stress urinary incontinence symptoms. Published by Elsevier Inc.

  14. [Minimally invasive bone anchor in therapy of female stress incontinence. A good concept?].

    PubMed

    Schostak, M; Heicappell, R; Müller, M; Sauter, T; Steiner, U; Miller, K

    2001-03-01

    Transvaginal pubic bone anchoring represents a minimally invasive technique for cystourethropexy or urethral sling suspension. This study assesses the results of this procedure. Cystourethropexy was performed in 4 and a sling procedure in 13 of 17 patients. The stress incontinence showed a median improvement from grade 2 to 1.35 (p = 0.01). Nine patients had impaired vaginal wound healing with urge symptoms. Revision was necessary in eight of them. An unfavorable outcome could not be significantly correlated with the surgical technique, the surgeon, the patient's age or the number of previous operations. The technique of minimally invasive bone anchoring must be regarded as unsuitable in view of the largely poor wound healing associated with irritation symptoms.

  15. Influence of Race on Inpatient Treatment Intensity at the End of Life

    PubMed Central

    Chang, Chung-Chou H.; Saynina, Olga; Garber, Alan M.

    2007-01-01

    OBJECTIVE To examine inpatient intensive care unit (ICU) and intensive procedure use by race among Medicare decedents, using utilization among survivors for comparison. DESIGN Retrospective observational analysis of inpatient claims using multivariable hierarchical logistic regression. SETTING United States, 1989–1999. PARTICIPANTS Hospitalized Medicare fee-for-service decedents (n = 976,220) and survivors (n = 845,306) aged 65 years or older. MEASUREMENTS AND MAIN RESULTS Admission to the ICU and use of one or more intensive procedures over 12 months, and, for inpatient decedents, during the terminal admission. Black decedents with one or more hospitalization in the last 12 months of life were slightly more likely than nonblacks to be admitted to the ICU during the last 12 months (49.3% vs. 47.4%, p <.0001) and the terminal hospitalization (41.9% vs. 40.6%, p < 0.0001), but these differences disappeared or attenuated in multivariable hierarchical logistic regressions (last 12 months adjusted odds ratio (AOR) 1.0 [0.99–1.03], p = .36; terminal hospitalization AOR 1.03 [1.0–1.06], p = .01). Black decedents were more likely to undergo an intensive procedure during the last 12 months (49.6% vs. 42.8%, p < .0001) and the terminal hospitalization (37.7% vs, 31.1%, p < .0001), a difference that persisted with adjustment (last 12 months AOR 1.1 [1.08–1.14], p < .0001; terminal hospitalization AOR 1.23 [1.20–1.26], p < .0001). Patterns of differences in inpatient treatment intensity by race were reversed among survivors: blacks had lower rates of ICU admission (31.2% vs. 32.4%, p < .0001; AOR 0.93 [0.91–0.95], p < .0001) and intensive procedure use (36.6% vs. 44.2%; AOR 0.72 [0.70–0.73], p <.0001). These differences were driven by greater use by blacks of life-sustaining treatments that predominate among decedents but lesser use of cardiovascular and orthopedic procedures that predominate among survivors

  16. Procedural volume, cost, and reimbursement of outpatient incisional hernia repair: implications for payers and providers.

    PubMed

    Song, Chao; Liu, Emelline; Tackett, Scott; Shi, Lizheng; Marcus, Daniel

    2017-06-01

    This analysis aimed to evaluate trends in volumes and costs of primary elective incisional ventral hernia repairs (IVHRs) and investigated potential cost implications of moving procedures from inpatient to outpatient settings. A time series study was conducted using the Premier Hospital Perspective ® Database (Premier database) for elective IVHR identified by International Classification of Diseases, Ninth revision, Clinical Modification codes. IVHR procedure volumes and costs were determined for inpatient, outpatient, minimally invasive surgery (MIS), and open procedures from January 2008-June 2015. Initial visit costs were inflation-adjusted to 2015 US dollars. Median costs were used to analyze variation by site of care and payer. Quantile regression on median costs was conducted in covariate-adjusted models. Cost impact of potential outpatient migration was estimated from a Medicare perspective. During the study period, the trend for outpatient procedures in obese and non-obese populations increased. Inpatient and outpatient MIS procedures experienced a steady growth in adoption over their open counterparts. Overall median costs increased over time, and inpatient costs were often double outpatient costs. An economic model demonstrated that a 5% shift of inpatient procedures to outpatient MIS procedures can have a cost surplus of ∼ US $1.8 million for provider or a cost-saving impact of US $1.7 million from the Centers for Medicare & Medicaid Services perspective. The study was limited by information in the Premier database. No data were available for IVHR cases performed in free-standing ambulatory surgery centers or federal healthcare facilities. Volumes and costs of outpatient IVHRs and MIS procedures increased from January 2008-June 2015. Median costs were significantly higher for inpatients than outpatients, and the difference was particularly evident for obese patients. A substantial cost difference between inpatient and outpatient MIS cases

  17. [Sport and urinary incontinence in women].

    PubMed

    Lousquy, R; Jean-Baptiste, J; Barranger, E; Hermieux, J-F

    2014-09-01

    Women are more attentive to their physical appearance and a quarter of French women use to practice a regular physical activity. Benefits of sport on general health are recognized. However, sport may be the cause of various diseases when it is poorly chosen or improperly performed. In literature, intensive exercise is a risk factor for urinary incontinence, defined as "the complaint of any involuntary leakage of urine". It is essentially stress urinary incontinence, occurring because of the phenomenon of intrabdominal hyperpressure, inherent with certain activities, and excess capacity of sphincters. Some sports are more risky than others, and high-level sportswomen are the most exposed. Health professionals must invest in information, screening, prevention, counseling and treatment track athletes So, the general practitioner and the doctor of sports play a vital role in informing, screening, prevention, therapeutic and monitoring of sportswomen. Better information is needed because according to the severity of incontinence and its impact, there are simple, effective, more or less invasive treatment options. The aim of this study was to establish an inventory of scientific knowledge and to improve the management of these patients. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  18. Predicting who will undergo surgery after physiotherapy for female stress urinary incontinence.

    PubMed

    Labrie, J; Lagro-Janssen, A L M; Fischer, K; Berghmans, L C M; van der Vaart, C H

    2015-03-01

    To predict who will undergo midurethral sling surgery (surgery) after initial pelvic floor muscle training (physiotherapy) for stress urinary incontinence in women. This was a cohort study including women with moderate to severe stress incontinence who were allocated to the physiotherapy arm from a previously reported multicentre trial comparing initial surgery or initial physiotherapy in treating stress urinary incontinence. Crossover to surgery was allowed. Data from 198/230 women who were randomized to physiotherapy was available for analysis, of whom 97/198 (49 %) crossed over to surgery. Prognostic factors for undergoing surgery after physiotherapy were age <55 years at baseline (OR 2.87; 95 % CI 1.30-6.32), higher educational level (OR 3.28; 95 % CI 0.80-13.47), severe incontinence at baseline according to the Sandvik index (OR 1.77; 95 % CI 0.95-3.29) and Urogenital Distress Inventory; incontinence domain score (OR 1.03; per point; 95 % CI 1.01-1.65). Furthermore, there was interaction between age <55 years and higher educational level (OR 0.09; 95 % CI 0.02-0.46). Using these variables we constructed a prediction rule to estimate the risk of surgery after initial physiotherapy. In women with moderate to severe stress incontinence, individual prediction for surgery after initial physiotherapy is possible, thus enabling shared decision making for the choice between initial conservative or invasive management of stress urinary incontinence.

  19. Long-term efficacy and safety of sacral nerve stimulation for fecal incontinence.

    PubMed

    Mellgren, Anders; Wexner, Steven D; Coller, John A; Devroede, Ghislain; Lerew, Darin R; Madoff, Robert D; Hull, Tracy

    2011-09-01

    Sacral nerve stimulation is effective in the treatment of urinary incontinence and is currently under Food and Drug Administration review in the United States for fecal incontinence. Previous reports have focused primarily on short-term results of sacral nerve stimulation for fecal incontinence. The present study reports the long-term effectiveness and safety of sacral nerve stimulation for fecal incontinence in a large prospective multicenter study. Patients with fecal incontinent episodes more than twice per week were offered participation in this multicentered prospective trial. Patients showing ≥ 50% improvement during test stimulation were offered chronic implantation of the InterStim Therapy system (Medtronic; Minneapolis, MN). The aims of the current report were to provide 3-year follow-up data on patients from that study who underwent sacral nerve stimulation and were monitored under the rigors of an Food and Drug Administration-approved investigational protocol. One hundred thirty-three patients underwent test stimulation with a 90% success rate, of whom 120 (110 females) with a mean age of 60.5 years and a mean duration of fecal incontinence of 7 years received chronic implantation. Mean length of follow-up was 3.1 (range, 0.2-6.1) years, with 83 patients completing all or part of the 3-year follow-up assessment. At 3 years follow-up, 86% of patients (P < .0001) reported ≥ 50% reduction in the number of incontinent episodes per week compared with baseline and the number of incontinent episodes per week decreased from a mean of 9.4 at baseline to 1.7. Perfect continence was achieved in 40% of subjects. The therapy also improved the fecal incontinence severity index. Sacral nerve stimulation had a positive impact on the quality of life, as evidenced by significant improvements in all 4 scales of the Fecal Incontinence Quality of Life instrument at 12, 24, and 36 months of follow-up. The most common device- or therapy-related adverse events through the

  20. Orgasm-associated urinary incontinence and sexual life after radical prostatectomy.

    PubMed

    Nilsson, Andreas E; Carlsson, Stefan; Johansson, Eva; Jonsson, Martin N; Adding, Christofer; Nyberg, Tommy; Steineck, Gunnar; Wiklund, N Peter

    2011-09-01

    Involuntary release of urine during sexual climax, orgasm-associated urinary incontinence, occurs frequently after radical prostatectomy. We know little about its prevalence and its effect on sexual satisfaction. To determine the prevalence of orgasm-associated incontinence after radical prostatectomy and its effect on sexual satisfaction. Consecutive series, follow-up at one point in calendar time of men having undergone radical prostatectomy (open surgery or robot-assisted laparoscopic surgery) at Karolinska University Hospital, Stockholm, Sweden, 2002-2006. Of the 1,411 eligible men, 1,288 (91%) men completed a study-specific questionnaire. Prevalence rate of orgasm-associated incontinence. Of the 1,288 men providing information, 691 were sexually active. Altogether, 268 men reported orgasm-associated urinary incontinence, of whom 230 (86%) were otherwise continent. When comparing them with the 422 not reporting the symptom but being sexually active, we found a prevalence ratio (with 95% confidence interval) of 1.5 (1.2-1.8) for not being able to satisfy the partner, 2.1 (1.1-3.5) for avoiding sexual activity because of fear of failing, 1.5 (1.1-2.1) for low orgasmic satisfaction, and 1.4 (1.2-1.7) for having sexual intercourse infrequently. Prevalence ratios increase in prostate-cancer survivors with a higher frequency of orgasm-associated urinary incontinence. We found orgasm-associated urinary incontinence to occur among a fifth of prostate cancer survivors having undergone radical prostatectomy, most of whom are continent when not engaged in sexual activity. The symptom was associated with several aspects of sexual life. © 2011 International Society for Sexual Medicine.

  1. Transanal submucosal polyacrylamide gel injection treatment of anal incontinence: a randomized controlled trial.

    PubMed

    Altman, Daniel; Hjern, Fredrik; Zetterström, Jan

    2016-05-01

    The efficacious and safe use of transurethral injections of polyacrylamide hydrogel (Bulkamid(®)) in women with stress urinary incontinence suggests that it may be suitable also for treatment of anal incontinence. We aimed to determine the effectiveness and safety of polyacrylamide hydrogel when used as a transanal submucosal bulking agent in women with anal incontinence. Thirty women with a diagnosis of anal incontinence and a Cleveland Clinic Incontinence Score (CCIS) >10 were randomized to three different techniques of transanal submucosal injections using polyacrylamide hydrogel. Follow up was performed at 2, 6 and 12 months using CCIS and the Fecal Incontinence Quality of Life scale (FIQL). In all, 29 of the 30 women completed the follow up. Approximately half of the women requested a re-injection at the 6-month visit. The overall CCIS improved significantly from baseline (14.7. SD 2.5) to 1 year (12.4. SD 3.1) (p = 0.003). There was a significant improvement with regard to the occurrence of loose fecal incontinence (p = 0.014) but not for solid fecal incontinence (p = 0.28). At 1 year the FIQL domains of coping-behavior, depression, and embarrassment showed significant improvements (p = 0.012, p = 0.007 and p = 0.007, respectively). We recorded no adverse events related either to the injection technique or the biomaterial. There were no significant differences between the treatment groups in either CCIS or FIQL scores. Transanal submucosal injection of polyacrylamide hydrogel resulted in a modest although significant overall improvement in anal incontinence symptom scores with corresponding improvements in several domains of quality of life, regardless of injection volume. © 2016 Nordic Federation of Societies of Obstetrics and Gynecology.

  2. Urinary incontinence surgery - female - discharge

    MedlinePlus

    ... activities, such as golfing, playing tennis, bowling, running, biking, weight lifting, gardening or mowing, and vacuuming for ... A.D.A.M. Editorial team. Related MedlinePlus Health Topics Urinary Incontinence Browse the Encyclopedia A.D. ...

  3. Sacral nerve root neuromodulation: an effective treatment for refractory urge incontinence.

    PubMed

    Shaker, H S; Hassouna, M

    1998-05-01

    Sacral foramina implants have been recognized recently as a method for treatment of refractory urinary urge incontinence. We study the outcome of the procedure with in-depth analysis of the results of 18 implanted cases. Patients with urinary urge incontinence were subjected to percutaneous nerve evaluation of the S3 roots as a temporary screening test to determine response to neuromodulation. Satisfactory responders were implanted with permanent sacral root neuroprosthesis. The study design included comprehensive voiding diaries for 4 consecutive days twice as a baseline, 1 with percutaneous nerve evaluation screening, 1 after the percutaneous nerve evaluation, 1 at the 1, 3 and 6 post-implantation visits, and every 6 months thereafter. Uroflowmetry and quality of life questionnaires were performed at the same intervals. Urodynamic study was done as a baseline and 6 months after implantation of the neuroprosthesis. All 18 patients (16 women and 2 men) with refractory urge incontinence received a sacral foramina neuroprosthesis after demonstrating a good response to the percutaneous nerve evaluation. Average patient age at presentation was 42.3+/-3.3 years (range 22 to 67) and duration of urinary symptoms was 6.6+/-1.3 years (range 1.2 to 18.8). Average followup was 18.8 months (range 3 to 83). Neuromodulation in these patients showed a marked reduction in leakage episodes from 6.49 to 1.98 times per 24 hours and in the leakage severity score. Eight patients became completely dry and 4 had average leakage episodes of 1 or less daily. Patients showed as well a decrease in urinary frequency with an increase in functional bladder capacity. Associated pelvic pain improved substantially. Cystometrograms demonstrated increased volume at first sensation by 50% and increased cystometric capacity by 15% with the disappearance of uninhibited contractions in 1 of the 4 patients who presented with it preoperatively. There was also noticeable improvement in the quality of life

  4. Diagnosis, Evaluation, and Treatment of Mixed Urinary Incontinence in Women.

    PubMed

    Chughtai, Bilal; Laor, Leanna; Dunphy, Claire; Lee, Richard; Te, Alexis; Kaplan, Steven

    2015-01-01

    Mixed urinary incontinence (MUI) is a common clinical problem in the community and hospital setting. The broad definition of the term makes it difficult to diagnose, as well as determine effective treatment strategies. There are no current guidelines recommended for physicians. The estimated prevalence of this condition is approximately 30% in all women with incontinence. It has also been suggested that patients with MUI report more bothersome symptoms than either stress or urge incontinence; approximately 32% of 40- to 64-year-olds with MUI report symptoms of depression. The authors examine the diagnosis, evaluation, and treatment of patients with MUI.

  5. Endoanal ultrasonography in fecal incontinence: Current and future perspectives.

    PubMed

    Albuquerque, Andreia

    2015-06-10

    Fecal incontinence has a profound impact in a patient's life, impairing quality of life and carrying a substantial economic burden due to health costs. It is an underdiagnosed condition because many affected patients are reluctant to report it and also clinicians are usually not alert to it. Patient evaluation with a detailed clinical history and examination is very important to indicate the type of injury that is present. Endoanal ultrasonography is currently the gold standard for sphincter evaluation in fecal incontinence and is a simple, well-tolerated and non-expensive technique. Most studies revealed 100% sensitivity in identifying sphincter defect. It is better than endoanal magnetic resonance imaging for internal anal sphincter defects, equivalent for the diagnosis of external anal sphincter defects, but with a lower capacity for assessment of atrophy of this sphincter. The most common cause of fecal incontinence is anal sphincter injury related to obstetric trauma. Only a small percentage of women are diagnosed with sphincter tears immediately after vaginal delivery, but endoanal ultrasonography shows that one third of these women have occult sphincter defects. Furthermore, in patients submitted to primary repair of these tears, ultrasound revealed a high frequency of persistent sphincter defects after surgery. Three-dimensional endoanal ultrasonography is currently largely used and accepted for sphincter evaluation in fecal incontinence, improving diagnostic accuracy and our knowledge of physiologic and pathological sphincters alterations. Conversely, there is currently no evidence to support the use of elastography in fecal incontinence evaluation.

  6. [Inpatient psychotherapy].

    PubMed

    Spitzer, C; Rullkötter, N; Dally, A

    2016-01-01

    In German-speaking countries inpatient psychotherapy plays a major role in the mental healthcare system. Due to its characteristic features, i. e. multiprofessionalism, multimodality and method integration, the inpatient approach represents a unique and independent type of psychotherapy. In order to be helpful, the manifold verbal and non-verbal methods need to be embedded into an overall treatment plan. Additionally, the therapeutic milieu of the hospital represents an important effective factor and its organization requires a more active construction. The indications for inpatient psychotherapy are not only based on the mental disorder but also on illness, setting and healthcare system-related criteria. In integrative concepts, the multiprofessional team is a key component with many functions. The effectiveness of psychotherapeutic hospital treatment has been proven by meta-analysis studies; however, 20-30% of patients do not benefit from inpatient psychotherapy and almost 13% drop-out prematurely.

  7. Efficacy and safety of TVT-O and TVT-Secur in the treatment of female stress urinary incontinence: 1-year follow-up.

    PubMed

    Tommaselli, Giovanni A; Di Carlo, Costantino; Gargano, Virginia; Formisano, Carmen; Scala, Mariamaddalena; Nappi, Carmine

    2010-10-01

    To reduce complications of transobturator tension-free vaginal tape, single-incision devices were introduced in the last years. We here report a comparison between the tension-free vaginal tape-obturator (TVT-O) and the TVT-Secur techniques in terms of efficacy and safety. Eighty-four patients with stress urinary incontinence (SUI) were scheduled to undergo TVT-O or TVT-Secur. Duration of the procedure, subjective estimate of blood loss, intraoperative and postoperative complications, postoperative postvoidal residue (PVR), time to first voiding, and pain level were recorded. Urodynamic tests, PVR, Incontinence Questionnaire Short Form (ICIQ-SF), King's Health Questionnaire, and a urinary diary were performed before and 12 months after procedure. No differences in terms of cure rate were observed between the two groups (81.6% vs. 83.8%). Complication rate in the TVT-Secur group was lower (8.1%) than in the TVT-O group (15.8%), but not significant. Both techniques seem to be effective and safe, with a low incidence of complications in both groups.

  8. The demographics and costs of inpatient vesicoureteral reflux management in the USA.

    PubMed

    Spencer, John David; Schwaderer, Andrew; McHugh, Kirk; Vanderbrink, Brian; Becknell, Brian; Hains, David S

    2011-11-01

    This study evaluates the impact of vesicoureteral reflux (VUR) on the economy and inpatient healthcare utilization in the USA. A retrospective analysis was performed on children ≤ 18 years of age, hospitalized with the principal discharge diagnosis of VUR between 2000 and 2006, using the Healthcare Cost and Utilization Project Kids' Inpatient Database. The results are stratified as follows. First, by hospitalizations: between 2000 and 2006, 6,655  ±  720 (standard error) children/year were hospitalized with VUR. Since 2003, both the length of each hospitalization and the number of hospitalizations have decreased. Second, by related procedures/diagnoses: ureteral reimplantation was the most common procedure, accounting for 89% of hospitalizations. Congenital genitourinary anomalies, disorders of the kidney/ureter/bladder, and urinary tract infections (UTI) were the most common related diagnoses. Thirdly, by hospital economics: since 2000, hospital charges for VUR increased despite decreased lengths of hospitalization. By 2006, hospital charges rose to $18,798/hospitalization, and aggregate national charges exceeded $100 million. Our results indicate that fewer children with VUR are requiring inpatient management. Children with VUR are often hospitalized for ureteral reimplantation or the management of related diagnoses. Since 2000, hospital charges for inpatient VUR management have increased. More efforts are needed to evaluate cost-effective strategies for the evaluation and management of VUR.

  9. A Behavioral Weight Loss Program and Nonurinary Incontinence Lower Urinary Tract Symptoms in Overweight and Obese Women with Urinary Incontinence: A Secondary Data Analysis of PRIDE.

    PubMed

    Breyer, Benjamin N; Creasman, Jennifer M; Richter, Holly E; Myers, Deborah; Burgio, Kathryn L; Wing, Rena R; West, Delia Smith; Kusek, John W; Subak, Leslee L

    2018-01-01

    We sought to determine whether a behavioral weight reduction intervention would improve nonurinary incontinence lower urinary tract storage symptoms at 6 months, including urinary frequency, nocturia and urgency, compared to a structured education program serving as the control group among overweight and obese women with urinary incontinence. PRIDE (Program to Reduce Incontinence by Diet and Exercise) was a randomized clinical trial performed in 338 overweight or obese women with urinary incontinence. Participants were randomized, including 226 to 6-month behavioral weight loss intervention and 112 to the control group. All participants received a self-help behavioral treatment booklet to improve bladder control. On this secondary data analysis we examined changes in nonurinary incontinence lower urinary tract storage symptoms from baseline to 6 months and the impact of treatment allocation (intervention vs control), weight loss and physical activity. Nonurinary incontinence lower urinary tract storage symptoms were common at baseline, varying from 48% to 62%. In the 2 groups combined women experienced significant improvement in nocturia, urgency and International Prostate Symptom Score at 6 months (all p <0.001). However, lower urinary tract storage symptom outcomes at 6 months did not differ between the intervention and control groups. Similarly no difference was observed in the amount of weight lost (5% or greater vs less than 5%) or physical activity (1,500 kcal or greater expenditure per week compared to less than 1,500 kcal). Lower urinary tract storage symptoms were common among overweight and obese women with urinary incontinence. The prevalence decreased significantly after 6 months independent of treatment group assignment, amount of weight lost or physical activity. These improvements may have been due to self-help behavioral educational materials, trial participation or repeat assessment of symptoms. Copyright © 2018 American Urological Association

  10. Urinary incontinence following transurethral prostatectomy presenting as self inflicted penile gangrene

    PubMed Central

    Mukherjee, Subhabrata; Sinha, Rajan Kumar; Ghosh, Nabankur; Karmakar, Dilip

    2015-01-01

    An elderly diabetic man with a 67 g prostate developed a moderate degree of stress urinary incontinence along with urge urinary incontinence after transurethral resection of the prostate. Initially, he did not perform the recommended pelvic floor exercise and wrapped a rubber band around his penis to control the problem. He presented with late development of penile gangrene requiring partial amputation of his penis. The stress urinary incontinence subsided on subsequent follow-up. The patient is now doing well. PMID:26055582

  11. Teaching strategies for assessing and managing urinary incontinence in older adults.

    PubMed

    Bradway, Christine; Cacchione, Pamela

    2010-07-01

    Urinary incontinence is common and affects many aspects of older adults' lives; therefore, it is essential that nursing faculty include this content in classroom and clinical teaching situations. This article describes innovative strategies for teaching upper-level nursing students (e.g., junior and senior undergraduates) about urinary incontinence in older adults, specifically, the relevant anatomy and physiology of continence and associated pathophysiology of urinary incontinence, risk factors and consequences, definitions and types, and effective nursing assessment and management strategies. Copyright 2010, SLACK Incorporated.

  12. Racial disparities in primary prevention of incontinence among older adults at nursing home admission.

    PubMed

    Bliss, Donna Z; Gurvich, Olga V; Eberly, Lynn E; Savik, Kay; Harms, Susan; Wyman, Jean F; Mueller, Christine; Virnig, Beth; Wiltzen, Kjerstie

    2017-04-01

    Maintaining continence of nursing home (NH) residents promotes dignity and well-being and may reduce morbidity and healthcare treatment costs. To determine the prevalence of older continent adults who received primary prevention of incontinence at NH admission, assess whether there were racial or ethnic disparities in incontinence prevention, and describe factors associated with any disparities. The design was an observational cross-sectional study of a nation-wide cohort of older adults free of incontinence at NH admission (n = 42,693). Four US datasets describing NH and NH resident characteristics, practitioner orders for NH treatment/care, and socioeconomic and sociodemographic status of the community surrounding the NHs were analyzed. Disparities were analyzed for four minority groups identified on the minimum data set using the Peters-Belson method and covariates at multiple levels. Twelve percent of NH admissions received incontinence prevention. There was a significant disparity (2%) in incontinence prevention for Blacks (P < 0.05): Fewer Black admissions (8.6%) were observed to receive incontinence prevention than was expected had they been part of the White group (10.6%). The percentage of White admissions receiving incontinence prevention was 10.6%. Significant factors associated with disparity in receiving incontinence prevention were having greater deficits in ADL function and cognition and more comorbidities. No disparity disadvantaging the other minority groups was found. Greater efforts for instituting incontinence prevention at the time of NH admission are needed. Eliminating racial disparities in incontinence prevention seems an attainable goal. Appropriate staff training, organizational commitment, and monitoring progress toward equitable outcomes can help achieve this goal. Neurourol. Urodynam. 36:1124-1130, 2017. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  13. Effect of pelvic floor muscle exercise programme on stress urinary incontinence among pregnant women.

    PubMed

    Sangsawang, Bussara; Serisathien, Yaowalak

    2012-09-01

    This article is a report of a study of the effects of a pelvic floor muscle exercise programme on the severity of stress urinary incontinence in pregnant women. Pregnancy is main risk factor for the development of stress urinary incontinence. Stress urinary incontinence can be cured by pelvic floor muscle exercise which is a safe inexpensive treatment with no complications and does not require the use of instruments. A quasi-experimental study, pre-post test with control group design was used at the antenatal care unit in a tertiary care hospital between June and October of 2006. The participants were 66 pregnant women who had stress urinary incontinence with gestational ages of 20-30 weeks. The main outcome measure was severity of stress urinary incontinence which comprised frequency and amount of urine leakage and perceived severity of stress urinary incontinence. After the experimental group's participation in the pelvic floor muscle exercise programme, the frequency and amount of urine leakage and the score of perceived stress urinary incontinence severity were significantly lower than the same scores before participation in the programme. In addition, women in the experimental group had frequency and volume of urine leakage, and score of perceived stress urinary incontinence severity after participation significantly lower than those in the control group. The 6-week pelvic floor muscle exercise programme was able to decrease the severity of symptoms in pregnant women with stress urinary incontinence. © 2011 Blackwell Publishing Ltd.

  14. Urinary incontinence in frail elderly persons: Report from the 5th International Consultation on Incontinence.

    PubMed

    Wagg, Adrian; Gibson, William; Ostaszkiewicz, Joan; Johnson, Theodore; Markland, Alayne; Palmer, Mary H; Kuchel, George; Szonyi, George; Kirschner-Hermanns, Ruth

    2015-06-01

    Evidence based guidelines for the management of frail older persons with urinary incontinence are rare. Those produced by the International Consultation on Incontinence represent an authoritative set of recommendations spanning all aspects of management. To update the recommendations of the 4th ICI. A series of systematic reviews and evidence updates were performed by members of the working group in order to update the 2009 recommendations. The resulting guidelines were presented at the 2012 meeting of the European Associatioon of Urology. Along with the revision of the treatment algorithm and accompanying text. There have been significant advances in several areas including pharmacological treatment of overactive bladder. The committee continue to notes the relative paucity of data concerning frail older persons and draw attention to knowledge gaps in this area. © 2014 Wiley Periodicals, Inc.

  15. Resource utilization and charges of patients with and without diagnosed venous thromboembolism during primary hospitalization and after elective inpatient surgery: a retrospective study.

    PubMed

    Sepassi, Aryana; Chingcuanco, Francine; Gordon, Ronald; Meier, Angela; Divino, Victoria; DeKoven, Mitch; Ben-Joseph, Rami

    2018-06-01

    To assess incremental charges of patients experiencing venous thromboembolisms (VTE) across various types of elective inpatient surgical procedures with administration of general anesthesia in the US. The authors performed a retrospective study utilizing data from a nationwide hospital operational records database from July 2014 through June 2015 to compare a group of inpatients experiencing a VTE event post-operatively to a propensity score matched group of inpatients who did not experience a VTE. Patients included in the analysis had a hospital admission for an elective inpatient surgical procedure with the use of general anesthesia. Procedures of the heart, brain, lungs, and obstetrical procedures were excluded, as these procedures often require a scheduled ICU stay post-operatively. Outcomes examined included VTE events during hospitalization, length of stay, unscheduled ICU transfers, number of days spent in the ICU if transferred, 3- and 30-day re-admissions, and total hospital charges incurred. The study included 17,727 patients undergoing elective inpatient surgical procedures. Of these, 36 patients who experienced a VTE event were matched to 108 patients who did not. VTE events occurred in 0.2% of the study population, with most events occurring for patients undergoing total knee replacement. VTE patients had a mean total hospital charge of $60,814 vs $48,325 for non-VTE patients, resulting in a mean incremental charge of $11,979 (p < .05). Compared to non-VTE patients, VTE patients had longer length of stay (5.9 days vs 3.7 days, p < .001), experienced a higher rate of 3-day re-admissions (3 vs 0 patients) and 30-day re-admissions (7 vs 2 patients). Patients undergoing elective inpatient surgical procedures with general anesthesia who had a VTE event during their primary hospitalization had a significantly longer length of stay and significantly higher total hospital charges than comparable patients without a VTE event.

  16. School Experiences of an Adolescent with Medical Complexities Involving Incontinence

    ERIC Educational Resources Information Center

    Filce, Hollie Gabler; Bishop, John B.

    2014-01-01

    The educational implications of chronic illnesses which involve incontinence are not well represented in the literature. The experiences of an adolescent with multiple complex illnesses, including incontinence, were explored via an intrinsic case study. Data were gathered from the adolescent, her mother, and teachers through interviews, email…

  17. TVT-Secur mini-sling for stress urinary incontinence: a review of outcomes at 12 months.

    PubMed

    Walsh, Colin A

    2011-09-01

    • Synthetic mid-urethral slings (MUSs) are considered the first choice surgical procedure for stress urinary incontinence. Recent publications have raised concerns about the efficacy of third generation single-incision mini-slings. The present paper is a systematic review of studies reporting 12-month outcomes after the TVT-Secur (TVT-S) procedure. • Pubmed/Medline online databases, abstracts from recent International Continence Society and International Urogynecological Association annual scientific meetings and the Clinicaltrials.gov and Controlled-trials.com online trial registries were searched for English-language articles containing the terms 'TVT-Secur', 'TVT Secur' or 'mini-sling'. The primary outcomes were objective and subjective cure rates at 12 months. Secondary outcomes included peri-operative (vaginal perforation, urinary retention, urinary tract infection [UTI]) and postoperative (mesh exposure, de novo overactive bladder (OAB), dyspareunia and return to theatre) complication rates. • Among 1178 women undergoing the TVT-S procedure, from 10 studies, both objective and subjective cure rate at 12 months was 76%, with objective cure significantly higher in women undergoing the 'U-type' approach. Vaginal perforation was a complication in 1.5% of cases, with a 2.4% incidence of mesh exposure in the first year. The incidence of de novo OAB symptoms was 10%. Rates of urinary retention (2.3%), UTI (4.4%), dyspareunia (1%) and return to theatre for complications (0.8%) were low. In the first year after a TVT-S procedure 5% of women required repeat continence surgery. • Longer-term studies and randomized comparisons with more established MUSs are required before TVT-S should be routinely used in the surgical treatment of stress urinary incontinence. © 2011 THE AUTHOR. BJU INTERNATIONAL © 2011 BJU INTERNATIONAL.

  18. Early incontinence after radical prostatectomy: a community based retrospective analysis in 911 men and implications for preoperative counseling.

    PubMed

    Khoder, Wael Y; Trottmann, Matthias; Stuber, Andrea; Stief, Christian G; Becker, Armin J

    2013-10-01

    Radical prostatectomy (RP) is curative for localized prostatic cancer. Incontinence after RP (P-RP-I) varies widely (2% to <60%) according to the definition and quantification of incontinence, timing of evaluation, and who evaluates (physician or patient). Conservative treatments, including pelvic floor muscle training (PFMT), anal electrical stimulation (AES), lifestyle adjustment, or combination are usually recommended at first for P-RP-I. Between January 2002 and December 2004, a total of 911 patients, median age 63 years (46-78), with different grades of P-RP-I have been retrospectively examined for perioperative risk factors and effect of rehabilitation procedures. These consecutive patients were from 67 clinics with median postoperative interval of 26 days. Incontinence was graded by Stamey classification, number of used pads and pads' consistency (dry, lightly wet, and wet). Therapeutic measures were done by team of specialists in rehabilitation, psycho-oncology, physiotherapy, internal medicine, and urology. Ninety-six percent of patients suffered different grades of incontinence at beginning of hospitalization. This was reported as Stamey first grade (49.4%), second grade (36.4%), and third grade (10.3%). Analysis included patients' age, body mass index (BMI), prostate volume, surgical approach, nerve sparing, pelvic lymphadenectomy, previous therapy, and catheterization time. Analysis showed age, nerve sparing, and BMI as significant risk factors for P-RP-I. Conservative therapy, including PFMT, AES, or combinations has been performed on all patients. Grade of P-RP-I showed significant improvement after 3 weeks rehabilitation period. Preoperative counseling of patients should provide them with realistic expectations for P-RP-I and motivate them to conservative therapy, as it reduces the duration and degree of urinary incontinence. Copyright © 2013 Elsevier Inc. All rights reserved.

  19. Efficacy and safety of the TVT-SECUR® and impact on quality of life in women with stress urinary incontinence: a 2-year follow-up.

    PubMed

    Shin, Yu Seob; Cha, Jai Seong; Cheon, Min Woo; Kim, Young Gon; Kim, Myung Ki

    2011-05-01

    As recently reported, the short-term results of the tension-free vaginal tape SECUR® (TVT-S) procedure seem to be similar to those of the conventional transobturator tape (TOT) procedure. However, results of efficacy and satisfaction with TVT-S are insufficient in patients with more than 1 year of follow-up. Therefore, we evaluated the results of the TVT-S procedure in women with stress urinary incontinence (SUI) during 2 years. We evaluated 51 patients with clinical and urodynamic diagnoses of SUI who underwent the TVT-S procedure from March 2008 to February 2009. Preoperative evaluation included a history, cough stress test with full bladder, urodynamic study, and incontinence quality of life (I-QoL) questionnaire. Following the postoperative period, urinary incontinence status was examined through a physical examination and the I-QoL questionnaire was completed in an outpatient setting or by telephone. Data from 2 years of follow-up were available for 46 of 51 patients. The cure rate was 80.4% at 1 month after TVT-S and 76.0% at 2 years after TVT-S. The cure or improvement rate was 93.5% at 1 month after TVT-S and 86.8% at 2 years after TVT-S. The mean total I-QoL score increased by 42 points at 1 month after TVT-S (p<0.026) and by 32 points at 2 years after TVT-S (p<0.013). Most patients reported significant improvements in quality of life. At the 2-year follow-up, there were no significant complications related to TVT-S. The results of this study suggest that TVT-S is an efficient and safe procedure for the improvement of both the quality of life of the patients and the SUI itself.

  20. Efficacy and Safety of the TVT-SECUR® and Impact on Quality of Life in Women with Stress Urinary Incontinence: A 2-Year Follow-Up

    PubMed Central

    Shin, Yu Seob; Cha, Jai Seong; Cheon, Min Woo; Kim, Young Gon

    2011-01-01

    Purpose As recently reported, the short-term results of the tension-free vaginal tape SECUR® (TVT-S) procedure seem to be similar to those of the conventional transobturator tape (TOT) procedure. However, results of efficacy and satisfaction with TVT-S are insufficient in patients with more than 1 year of follow-up. Therefore, we evaluated the results of the TVT-S procedure in women with stress urinary incontinence (SUI) during 2 years. Materials and Methods We evaluated 51 patients with clinical and urodynamic diagnoses of SUI who underwent the TVT-S procedure from March 2008 to February 2009. Preoperative evaluation included a history, cough stress test with full bladder, urodynamic study, and incontinence quality of life (I-QoL) questionnaire. Following the postoperative period, urinary incontinence status was examined through a physical examination and the I-QoL questionnaire was completed in an outpatient setting or by telephone. Results Data from 2 years of follow-up were available for 46 of 51 patients. The cure rate was 80.4% at 1 month after TVT-S and 76.0% at 2 years after TVT-S. The cure or improvement rate was 93.5% at 1 month after TVT-S and 86.8% at 2 years after TVT-S. The mean total I-QoL score increased by 42 points at 1 month after TVT-S (p<0.026) and by 32 points at 2 years after TVT-S (p<0.013). Most patients reported significant improvements in quality of life. At the 2-year follow-up, there were no significant complications related to TVT-S. Conclusions The results of this study suggest that TVT-S is an efficient and safe procedure for the improvement of both the quality of life of the patients and the SUI itself. PMID:21687393

  1. Effects of urinary incontinence subtypes on women's quality of life (including sexual life) and psychosocial state.

    PubMed

    Asoglu, Mehmet Resit; Selcuk, Selcuk; Cam, Cetin; Cogendez, Ebru; Karateke, Ates

    2014-05-01

    Our aim was to investigate the effects of urinary incontinence subtypes on women's quality of life (including sexual life) and psychosocial state. The patients, who applied to our clinic from March 2011 to August 2011, were identified and stratified into three groups: those with stress incontinence proved urodynamically (USI), those with urge incontinence (UI), and those with mixed incontinence urge incontinence (UI) proved by urodynamic and clinic evaluation. Scores on the Beck anxiety inventory (BAI), pelvic organ prolapse/urinary incontinence sexual questionnaire (PISQ-12), urogenital distress inventory (UDI-6), and incontinence impact questionnaire (IIQ-7) were compared between the urinary incontinence subtypes. According to urodynamic and clinical examination of 111 women with urinary incontinence, 59 (53%) had USI, 35 (32%) had UI, and 17 (15%) had MI. BAI-scores significantly differed between the USI and UI groups (p=0.030) and between the USI and MI groups (p=0.011) not between the UI and MI groups (p=0.597). UDI-6 scores did not significantly differ between the three groups (p=0.845). IIQ-7 scores significantly differed between the USI and MI groups (p=0.003) and between the UI and MI groups (p=0.006) but not between the USI and UI groups. Patients with USI had significantly lower PISQ-12 scores than those with UI (p=0.015). These differences in the effects of incontinence subtypes should be kept in mind in the evaluation of patients with urinary incontinence. Psychiatric assessment may improve the management of incontinence in women, especially UI and MI. Published by Elsevier Ireland Ltd.

  2. An Overview of Bowel Incontinence: What Can Go Wrong?

    ERIC Educational Resources Information Center

    Norton, William F.

    2008-01-01

    Bowel incontinence, also called fecal incontinence, is the loss of control over liquid or solid stools. It can occur at any age--as a child, teenager, or adult. Severity can range from infrequent leakage of a small amount of stool to total loss of bowel control. Some persons might feel the urge to have a bowel movement but be unable to control it…

  3. Recovery orientation in mental health inpatient settings: Inpatient experiences?

    PubMed

    Waldemar, Anna Kristine; Esbensen, Bente Appel; Korsbek, Lisa; Petersen, Lone; Arnfred, Sidse

    2018-06-01

    Offering mental health treatment in line with a recovery-oriented practice has become an objective in the mental health services in many countries. However, applying recovery-oriented practice in inpatient settings seems challenged by unclear and diverging definitions of the concept in and the organization of these settings. In Denmark, educational and organizational efforts have been made to organize inpatient services with a recovery-oriented approach. Hence, we aimed to explore whether and how these efforts are reflected in the inpatients' experiences of their care and treatment. Semi-structured interviews were conducted with 14 inpatients from two mental health inpatient wards using an interview guide based on factors from the Recovery Self-Assessment. Qualitative content analysis was applied in the analysis. Six themes covering the participants' experiences were identified. The participants felt accepted and protected in the ward and found comfort in being around other people but missed talking and engaging with health professionals. They described limited choice and influence on the course of their treatment, and low information levels regarding their treatment, which they considered to consist predominantly of medication. Furthermore, they described feeling continuously observed and assessed from a distance by health professionals. Like the sparse previous research among inpatients, the results highlight ambivalent experiences of health professionals' support and ward structure as well as the medical treatment hegemony. As such, the educational and organizational efforts of introducing recovery-oriented practices in the wards seemed not very well reflected in the participants' experiences of their stay. © 2018 Australian College of Mental Health Nurses Inc.

  4. Vaginal birth and de novo stress incontinence: Relative contributions of urethral dysfunction and mobility

    PubMed Central

    DeLancey, John O. L.; Miller, Janis M.; Kearney, Rohna; Howard, Denise; Reddy, Pranathi; Umek, Wolfgang; Guire, Kenneth E.; Margulies, Rebecca U.; Ashton-Miller, James A.

    2009-01-01

    Background Vaginal birth increases the chance a woman will develop stress incontinence. This study evaluates the relative contributions of urethral mobility and urethral function to stress incontinence. Methods This is a case-control study with group matching. Eighty primiparous women with self-reported new stress incontinence 9–12 months postpartum were compared to 80 primiparous continent controls to identify impairments specific to stress incontinence. Eighty nulliparous continent controls were evaluated as a comparison group to allow us to determine birth-related changes not associated with stress incontinence. Urethral function was measured with urethral profilometry, and vesical neck mobility was assessed with ultrasound and Q-tip test. Urethral sphincter anatomy and mobility were evaluated using MRI. The association between urethral closure pressure, vesical neck movement, and incontinence were explored using logistic regression. Results Urethral closure pressure in primiparous incontinent women (62.9 +/− 25.2 s.d. cm H20) was lower than in primiparous continent women (83.0 +/− 21.0, p<0.001; effect size d= 0.91) who were similar to nulliparous women (90.3 +/− 25.0, p=0.09). Vesical neck movement measured during cough with ultrasound was the mobility parameter most associated with stress incontinence; 15.6 +/− 6.2 mm in incontinent women versus 10.9 +/− 6.2 in primiparous continent women (p < 0.0001, d = 0.75) or nulliparas (9.9 +/− 5.0, p=0.33). Logistic regression disclosed the two-variable model (max-rescaled R2 =0.37, p < 0.0001) was more strongly associated with stress incontinence than either single variable models, urethral closure pressure (R2 = 0.25, p <0.0001) or vesical neck movement (R2 = 0.16 p < 0.0001). Conclusions Lower maximal urethral closure pressure is the parameter most associated with de novo stress incontinence after first vaginal birth followed by vesical neck mobility. PMID:17666611

  5. Sensory Characterization of Odors in Used Disposable Absorbent Incontinence Products

    PubMed Central

    Widén, Heléne; Forsgren-Brusk, Ulla; Hall, Gunnar

    2017-01-01

    PURPOSE: The objectives of this study were to characterize the odors of used incontinence products by descriptive analysis and to define attributes to be used in the analysis. A further objective was to investigate to what extent the odor profiles of used incontinence products differed from each other and, if possible, to group these profiles into classes. SUBJECTS AND SETTING: Used incontinence products were collected from 14 residents with urinary incontinence living in geriatric nursing homes in the Gothenburg area, Sweden. METHODS: Pieces were cut from the wet area of used incontinence products. They were placed in glass bottles and kept frozen until odor analysis was completed. A trained panel consisting of 8 judges experienced in this area of investigation defined terminology for odor attributes. The intensities of these attributes in the used products were determined by descriptive odor analysis. Data were analyzed both by analysis of variance (ANOVA) followed by the Tukey post hoc test and by principal component analysis and cluster analysis. RESULTS: An odor wheel, with 10 descriptive attributes, was developed. The total odor intensity, and the intensities of the attributes, varied considerably between different, used incontinence products. The typical odors varied from “sweetish” to “urinal,” “ammonia,” and “smoked.” Cluster analysis showed that the used products, based on the quantitative odor data, could be divided into 5 odor classes with different profiles. CONCLUSIONS: The used products varied considerably in odor character and intensity. Findings suggest that odors in used absorptive products are caused by different types of compounds that may vary in concentration. PMID:28328646

  6. The female urinary microbiome in urgency urinary incontinence.

    PubMed

    Pearce, Meghan M; Zilliox, Michael J; Rosenfeld, Amy B; Thomas-White, Krystal J; Richter, Holly E; Nager, Charles W; Visco, Anthony G; Nygaard, Ingrid E; Barber, Matthew D; Schaffer, Joseph; Moalli, Pamela; Sung, Vivian W; Smith, Ariana L; Rogers, Rebecca; Nolen, Tracy L; Wallace, Dennis; Meikle, Susan F; Gai, Xiaowu; Wolfe, Alan J; Brubaker, Linda

    2015-09-01

    The purpose of this study was to characterize the urinary microbiota in women who are planning treatment for urgency urinary incontinence and to describe clinical associations with urinary symptoms, urinary tract infection, and treatment outcomes. Catheterized urine samples were collected from multisite randomized trial participants who had no clinical evidence of urinary tract infection; 16S ribosomal RNA gene sequencing was used to dichotomize participants as either DNA sequence-positive or sequence-negative. Associations with demographics, urinary symptoms, urinary tract infection risk, and treatment outcomes were determined. In sequence-positive samples, microbiotas were characterized on the basis of their dominant microorganisms. More than one-half (51.1%; 93/182) of the participants' urine samples were sequence-positive. Sequence-positive participants were younger (55.8 vs 61.3 years old; P = .0007), had a higher body mass index (33.7 vs 30.1 kg/m(2); P = .0009), had a higher mean baseline daily urgency urinary incontinence episodes (5.7 vs 4.2 episodes; P < .0001), responded better to treatment (decrease in urgency urinary incontinence episodes, -4.4 vs -3.3; P = .0013), and were less likely to experience urinary tract infection (9% vs 27%; P = .0011). In sequence-positive samples, 8 major bacterial clusters were identified; 7 clusters were dominated not only by a single genus, most commonly Lactobacillus (45%) or Gardnerella (17%), but also by other taxa (25%). The remaining cluster had no dominant genus (13%). DNA sequencing confirmed urinary bacterial DNA in many women with urgency urinary incontinence who had no signs of infection. Sequence status was associated with baseline urgency urinary incontinence episodes, treatment response, and posttreatment urinary tract infection risk. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. Incontinence--an aggressive approach to treatment: a case series.

    PubMed

    Dornan, P R

    2005-12-01

    Recent evidence suggests that, for some, leaking urine may be a barrier to physical activity. Although important from a lifestyle point of view, bladder problems and incontinence also affect both men and women socially, psychologically and economically. For example, it can be particularly distressing when incontinence occurs post-prostate surgery, especially if these patients were continent before surgery. This case series outlines an aggressive, innovative, exercise-based approach to the management of stress incontinence post-prostatectomy. The program attempts to enhance neuromuscular and vascular systems associated with continence, with emphasis placed on the abdominal and pelvic floor muscles. The program was undertaken by 14 incontinent post-prostatectomy patients (mean age 63.5 y, using a mean of 3.5 sanitary pads per day). The program was initiated a mean of two months post-op and had a mean duration of six months. Upon completion of the program. 10 patients were found to be completely dry with three retaining a small leakage (a few drops). The 14th could not comply with the program because of illness. The results of this study appear promising in this patient population. There are indications for further research.

  8. Physical Therapy for Fecal Incontinence in Children with Pelvic Floor Dyssynergia.

    PubMed

    Muddasani, Swathi; Moe, Amanda; Semmelrock, Caitlin; Gilbert, Caroyl Luan; Enemuo, Valentine; Chiou, Eric Howard; Chumpitazi, Bruno Pedro

    2017-11-01

    To determine the efficacy of physical therapy (PT) for fecal incontinence in children with pelvic floor dyssynergia (PFD). Retrospective chart review of children with PFD completing >1 PT session for fecal incontinence at a quaternary children's hospital. The frequency of fecal incontinence (primary outcome), constipation-related medication use, number of bowel movements (in those with <3 per week at baseline) and pelvic floor muscle (PFM) function were captured at baseline and at the final PT visit. Outcomes were categorized as excellent (complete continence), good (>50% decrease in fecal incontinence frequency), fair (not worsening but <50% fecal incontinence frequency decrease), and poor (more frequent fecal incontinence). Compliance with PT was determined by the percentage of attended PT appointments. Children included met the following primary outcomes: 27 (42.2%) excellent, 24 (37.5%) good, 11 (17.1%) fair, and 2 (3.1%) poor. Factors associated with an excellent or good outcome included improved PFM functioning and good (≥70% PT attendance) compliance. Children with a history of surgically corrected tethered spinal cord were more likely to have a fair outcome (P = .015). Use of constipation-related medications decreased (1.9 ± 0.7 vs 1.5 ± 0.9, P = .005). Weekly bowel movement frequency increased (1.6 ± 0.6 vs 6.4 ± 4.8, P < .001) in those with infrequent bowel movements (n = 26) at baseline. Pelvic floor PT is effective in the majority of children with fecal incontinence related to PFD. Factors associated with PT efficacy include improved PFM functioning, good compliance with PT, and history of tethered cord. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Nonabsorbable urethral bulking agent - clinical effectiveness and late complications rates in the treatment of recurrent stress urinary incontinence after 2 years of follow-up.

    PubMed

    Futyma, Konrad; Nowakowski, Łukasz; Gałczyński, Krzysztof; Miotła, Paweł; Rechberger, Tomasz

    2016-12-01

    Those patients who failed to achieve continence after a procedure aimed to correct it, require a special attitude and precise management due to the sophisticated anatomical and functional field of interest. The purpose of the present study was to assess long-term clinical efficacy and evaluate the frequency and severity of any complications related to recurrent stress urinary incontinence treatment with a non-absorbable bulking agent periurethral injections. Between February 2012-September 2013, 66 patients with recurrent stress urinary incontinence were treated with Urolastic in the tertiary referral gynecologic department. The efficacy of the procedure was assessed objectively at each follow-up visit, scheduled at two, six weeks and 3, 6, 12 and 24 months after primary procedure. Material was injected under local anesthesia according to the manufacturer's instructions, at 10, 2, 4 and 8 o'clock positions with 0.5-1.25ccm per spot. Statistical analyses were performed with Statistica package version 8.0 (StatSoft Inc., Tulsa, OK, USA). A p value <0.05 was considered statistically significant. Objective success rate at 24 months was found in 32.7% of patients, including 22.4% patients who were completely dry. The efficacy of Urolastic, when considering the intention to treat, is 24.2% and 16.7%, respectively. In 4.5% patients an oval shaped material was found inside the bladder. Overall, complications were observed in 17 (25.8%) patients. Although only 30% of patients will benefit from Urolastic injection on the long-term basis it seems to be a safe procedure in the treatment of recurrent stress urinary incontinence. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  10. Health-related quality of life and mental health in older women with urinary incontinence.

    PubMed

    Kwak, YeunHee; Kwon, HaeJin; Kim, YoonJung

    2016-07-01

    The purpose of this cross-sectional study was to compare health-related quality of life (QOL) and mental health between older women with and without urinary incontinence. This study is a secondary data analysis using raw data from 1874 women aged 65 years or older who participated in the Korea National Health and Nutrition Examination Survey (KNHANES) IV (2008-2009), a nationally representative sample. In the pain/discomfort dimension of the EuroQol-5, 25.4% of the participants experienced urinary incontinence and 14.7% did not (p = .001). In the anxiety/depression dimension, urinary incontinence was present in 8.3% of the participants and absent in 3.6% (p = 0.012). In addition, the results of an ANCOVA showed that scores in both the EuroQol visual analogue scale and the EQ-5D index were significantly lower in participants with urinary incontinence relative to those without. The risk of stress and depression in older women with urinary incontinence was approximately 2 and 1.5 times higher, respectively, than that of participants without urinary incontinence. Health-related QOL in older women with urinary incontinence was relatively low, while levels of stress and depression were high. Therefore, in order to improve QOL and mental health in older women, the understanding and management of urinary incontinence interventions is required.

  11. Psychosocial problems of women with stress urinary incontinence.

    PubMed

    Stadnicka, Grażyna; Łepecka-Klusek, Celina; Pilewska-Kozak, Anna; Jakiel, Grzegorz

    2015-01-01

    The aim of the study was evaluation of the influence of stress urinary incontinence on women's quality of life. The study covered 275 women between 30-65 years of age. The study was conducted using the following tools: Gaudenz Questionnaire, King's Health Questionnaire (KHQ), Female Sexual Function Index (FIFI) Questionnaire, and a questionnaire devised by the authors of the study. The study shows that the disease has a negative effect on evaluation of the quality of thee women's lives. The symptoms of stress urinary incontinence had a significant influence on the feeling of emotional comfort, social and professional activity of the surveyed women - respectively p= 0.000; p=0.000; p=0.000. Nearly every third woman (28.7%) felt great mental discomfort related to the disease symptoms, 31.7% a considerable discomfort, 33.1% a moderate, and very few women (6.5 %) claimed that the disease had a minimal effect on their emotional state. About two-thirds of the surveyed women (68.7%) were sexually active, and the remaining 31.3% declared the lack of sexual intercourse. The occurrence of stress urinary incontinence symptoms affects the quality of life of women, especially their mental state and interpersonal contacts. Most women with the symptoms of stress urinary incontinence fulfill their sexual needs; however, many of them do not feel complete satisfaction with their sex life.

  12. Urinary incontinence in Emirati women with diabetes mellitus type 2: prevalence, risk factors and impact on life.

    PubMed

    Bani-issa, Wegdan; Fakhry, Randa; Al Momani, Fida

    2013-11-01

    To evaluate prevalence, risk factors for urinary incontinence and its impact on lives of Emirati women with diabetes mellitus type 2 (DM2). Risk factors examined were age, parity, history of urinary tract infections, body mass index (BMI) and DM2 duration. Incontinence is a known complication of DM2 with impact on women's lives. Less is known about incontinence problem among Emirati women with DM2. A cross-sectional survey design using probability sampling approach was employed to assess urinary incontinence in Emirati women with DM2. A total of 300 women with DM2, aged 20-65 years, were recruited from six healthcare centres. Data were collected over an 18-month period. A standardised incontinence questionnaire was used to assess type and frequency of incontinence within the past 12 months. Presence of weekly incontinence was the main outcome. Of the 300 women, 188 (63%) reported any incontinence, of which 48% had at least weekly episode. Both stress (n = 154, 51·3%) and urge (n = 181, 60·3%) were reported by participants, with 48 (31·1%) reporting at least weekly stress and 85 (46·9%) expressing at least weekly urge incontinence. Diabetes duration was a significant risk factor for any, stress and urge incontinence followed by age for only any and stress incontinence. BMI was a risk factor for urge incontinence. Women perceived incontinence as bothersome, disturbing their social activities and daily prayers. The prevalence of incontinence in Emirati women with DM2 is higher than that reported by women in other cultures. Risk factors identified were DM2 duration, age and obesity. Emirati women found incontinence to be a bothersome problem influencing their daily lives and prayers. Nurses in general practice should be alert to the incontinence problem by considering it as part of the routine diabetes evaluation of women, especially of those with longer duration of diabetes, obese and older. Cultural knowledge, sensitivity and individualised treatment plans need

  13. Management of geriatric incontinence in nursing homes.

    PubMed Central

    Schnelle, J F; Traughber, B; Morgan, D B; Embry, J E; Binion, A F; Coleman, A

    1983-01-01

    A behavioral management system designed to reduce urinary incontinence was evaluated in two nursing homes with a pretest-posttest control group design with repeated measures. The primary components of the system were prompting and contingent social approval/disapproval which required approximately 2.5 minutes per patient per hour to administer. The frequency of correct toileting for experimental subjects increased by approximately 45%. The experimental groups were significantly different from the control groups on both incontinence and correct toileting measures. The results are discussed in view of the management issues inherent in nursing home settings. PMID:6885672

  14. Causes and risk factors of urinary incontinence: Avicenna's point of view vs. contemporary findings.

    PubMed

    Nojavan, Fatemeh; Sharifi, Hossein; Ghanbari, Zinat; Kamalinejad, Mohammad; Mokaberinejad, Roshanak; Emami, Maryam

    2015-02-22

    To extract the causes and risk factors of urinary incontinence from an old medical text by Avicenna entitled "Canon of Medicine" and comparing it with contemporary studies. In this study, etiology and risk factors of urinary incontinence were extracted from Avicenna's "Canon of Medicine". Commentaries written on this book and other old reliable medical texts about bladder and its diseases were also studied. Then the achieved information was compared with contemporary findings of published articles. Urinary incontinence results from bladder dysfunction in reservoir phase. Bladder's involuntary muscles and voluntary external sphincter are two main components which are involved in this process. Urinary incontinence can exist without obvious structural and neuronal etiologies. According to Avicenna, distemperment of muscular tissue of bladder and external sphincter is the cause for urinary incontinence in such cases. Distemperment is the result of bothering qualities in tissue, i.e.: "wet" and "cold". They are the two bothering qualities which are caused by extracorporeal and intracorporeal factors. Interestingly, the positive associations of some of these factors with urinary incontinence have been shown in recent researches. "Cold" and "wet" distemperment of bladder and external sphincter can be independent etiologies of urinary incontinence which should be investigated. 

  15. [Comparison of the efficacy and safety between TVT-O and TVT-O with biofeedback pelvic floor electrical stimulation on female stress urinary incontinence].

    PubMed

    Min, Ling; Zhao, Xia

    2015-01-01

    To compare the efficacy and safety between tension-free vaginal tape obturator technique (TVT-O) and TVT-O with biofeedback pelvic floor electrical stimulation on the therapy of female stress urinary incontinence. In this prospective study, 120 female patients of female stress urinary incontinence were enrolled from January 2012 to December 2013. The patients were randomly assigned to two groups, 60 in group A received TVT-O alone, while 60 in group B not only received TVT-O but also received biofeedback pelvic floor electrical stimulation. All the patients were followed up for 12 months to assess the efficacy and safety of the two procedures. Subjective indices [total volume of urine (TV), the total frequency of urination (TOV), the total leakage of urine events (TL), urinary incontinence related quality of life questionnaire (I-QOL), International Advisory Committee on urinary incontinence urinary incontinence questionnaire short form scale (ICI-Q-SF)] and objective indices [Valsalva leak point pressure (VLPP), maximum flow rate (MFR), residual urine volume (RUV),pad test] were analyzed. Overall, the cure rate was 75% at 1 year follow-up for group A and 88.33% for group B (P<0.05). The effective rate was 16.67% for group A and 10% for group B (P<0.05). The ineffective rate was 8.33% for group A and 1.67% for group B (P<0.05). TV, I-QOL, ICI-Q-SF, VLPP and pad test in group B were superior to group A (P<0.05). Pelvic floor electrical stimulation biofeedback therapy could improve the curative effects of TVT-O on the treatment of female stress urinary incontinence.

  16. Female stress urinary incontinence: standard techniques revisited and critical evaluation of innovative techniques

    NASA Astrophysics Data System (ADS)

    de Riese, Cornelia; de Riese, Werner T. W.

    2003-06-01

    Objectives: The treatment of female urinary incontinence (UI) is a growing health care concern in our aging society. Publications of recent innovations and modifications are creating expectations. This brief review provides some insight and structure regarding indications and expected outcomes for the different approaches. Materials: Data extraction is part of a Medline data base search, which was performed for "female stress incontinence" from 1960 until 2000. Additional literature search was performed to cover 2001 and 2002. Outcome data were extracted. Results: (1) INJECTION OF BULKING AGENTS (collagen, synthetic agents): The indication for mucosal coaptation was more clearly defined and in the majority of articles limited to ISD. (2) OPEN COLPOSUSPENSION (Burch, MMK): Best long-term results of all operative procedures, to date considered the gold standard. (3) LAPAROSCOPIC COLPOSUSPENSION (different modifications): Long-term success rates appear dependent on operator skills. There are few long-term data. (4) NEEDLE SUSPENSION: (Stamey, Pareyra and modifications): Initial results were equal to Burch with less morbidity, but long-term success rates are worse. (5) SLING PROCEDURES (autologous, synthetic, allogenic graft materials, different modes of support and anchoring, free tapes): The suburethral sling has traditionally been considered a procedure for those in whom suspension had failed and for those with severe ISD. The most current trend shows its use as a primary procedure for SUI. Long-term data beyond 5 years are insufficient. (6) EXTERNAL OCCLUSIVE DEVICES (vaginal sponges and pessaries, urethral insert): Both vaginal and urethral insert devices can be effective in selected patients. (7) IMPLANTABLE ARTEFICIAL URETHRAL SPHINCTERS: Modifications and improvements of the devices resulted in improved clinical results regarding durability and efficacy. CONCLUSION: (1) The Burch colposuspension is still considered the gold standard in the treatment of female

  17. [Suburethral bands in women urinary stress incontinence: a review of the various techniques].

    PubMed

    Hermieu, J F

    2005-01-01

    With more than 1,000,000 procedures in the world and the good results that have been published (85% recovery rate, low morbidity), Tension free Vaginal Tape (TVT) is now considered the gold standard for the treatment of female urinary stress incontinence. Currently, advances are noticed concerning the material used (monofilament, multifilament or extruded cross-linked polypropylene), the surgical access (ascending or descending retropubic, transobturator approach), and the ancillary instruments. The surgeon's vigilance is essential in selecting the most adapted material and access to obtain good results and the lower morbidity rate.

  18. Urethral injection therapy for urinary incontinence in women.

    PubMed

    Kirchin, Vivienne; Page, Tobias; Keegan, Phil E; Atiemo, Kofi Om; Cody, June D; McClinton, Samuel; Aluko, Patricia

    2017-07-25

    Urinary incontinence imposes a significant health and economic burden to society. Periurethral or transurethral injection of bulking agents is a minimally invasive surgical procedure used as one the surgical treatments of stress urinary incontinence (SUI) in adult women. To assess the effects of periurethral or transurethral injection therapy on the cure or improvement of urinary incontinence in women. We searched the Cochrane Incontinence Group Specialised Trials Register (searched 8 November 2010) and the reference lists of relevant articles. All randomised or quasi-randomised controlled trials of treatment for urinary incontinence in which at least one management arm involved periurethral or transurethral injection therapy. Two review authors independently assessed methodological quality of each study using explicit criteria. Data extraction was undertaken independently and clarification concerning possible unreported data sought directly from the investigators. Excluding duplicate reports, we identified 14 trials (excluding one that was subsequently withdrawn from publication and not included in this analysis) including 2004 women that met the inclusion criteria. The limited data available were not suitable for meta-analysis because they all came from separate trials. Trials were small and generally of moderate quality.One trial of 45 women that compared injection therapy with conservative treatment showed early benefit for the injectable therapy with respect to continence grade (risk ratio (RR) 0.70, 95% confidence interval (CI) 0.52 to 0.94) and quality of life (mean difference (MD) 0.54, 95% CI 0.16 to 0.92). Another trial, comparing Injection of autologous fat with placebo, terminated early because of safety concerns. Two trials that compared injection with surgical management found significantly better objective cure in the surgical group (RR 4.77, 95% CI 1.96 to 11.64; and RR 1.69, 95% CI 1.02 to 2.79), although the latter trial data did not reach

  19. Prevalence of faecal incontinence in community-dwelling older people in Bali, Indonesia.

    PubMed

    Suyasa, I Gede Putu Darma; Xiao, Lily Dongxia; Lynn, Penelope Ann; Skuza, Pawel Piotr; Paterson, Jan

    2015-06-01

    To explore the prevalence rate of faecal incontinence in community-dwelling older people, associated factors, impact on quality of life and practices in managing faecal incontinence. Using a cross-sectional design, 600 older people aged 60+ were randomly selected from a population of 2916 in Bali, Indonesia using a simple random sampling technique. Three hundred and three participants were interviewed (response rate 51%). The prevalence of faecal incontinence was 22.4% (95% confidence interval (CI) 18.0-26.8). Self-reported constipation (odds ratio (OR) 3.68, 95% CI 1.87-7.24) and loose stools (OR 2.66, 95% CI 1.47-4.78) were significantly associated with faecal incontinence. There was a strong positive correlation between total bowel control score and total quality-of-life score (P < 0.001, rs = 0.61) indicating significant alterations in quality of life. The current management practices varied from changing diet, visiting health-care professionals, and using modern and traditional medicines. Faecal incontinence is common among community-dwelling older people in Bali. © 2014 ACOTA.

  20. Living with faecal incontinence: trying to control the daily life that is out of control.

    PubMed

    Olsson, Frida; Berterö, Carina

    2015-01-01

    To identify and describe the lived experience of persons living with faecal incontinence and show how it affects daily life. Faecal incontinence is a relatively common condition, with a prevalence ranging from 3-24%, not differing between men and women. There is an under-reporting due to patients' reluctance to talk about their symptoms and consult healthcare professionals about their problems, which means that problems related to faecal incontinence are often underestimated. Living with faecal incontinence affects the quality of life negatively and has a negative impact on family situations, social interaction, etc. A qualitative interpretative study based on interviews. In-depth interviews were conducted with five informants, all women, living with faecal incontinence. The interviews were transcribed verbatim and analysed using interpretive phenomenological analysis. The analysis identified four themes: self-affirmation, guilt and shame, limitations in life and personal approach. The themes differ from each other, but are related and have similarities. The results show different aspects of living with faecal incontinence and how they affected daily life. Living with faecal incontinence is a complex problem affecting everyday life in a number of different ways. It is a highly distressing and socially incapacitating problem. Living with faecal incontinence is about trying to control the daily life which is out of control. Living with faecal incontinence cannot be generalised as individuals experience the situation in unique ways. By gaining insight into the experience of living with faecal incontinence, healthcare professionals can deepen their understanding of this complex problem and thereby better address it and provide more individually based care. © 2014 John Wiley & Sons Ltd.

  1. The influence of incontinence on the characteristic properties of the skin in bedridden elderly subjects.

    PubMed

    Fujimura, Tsutomu; Makino, Mayumi; Takagi, Miyuki; Maki, Kumiko; Murakami, Emiko; Tasaka, Yoshiko; Sato, Noriko; Akiba, Shunichi; Hotta, Mitsuyuki; Kitahara, Takashi; Ando, Kikue

    2016-05-01

    The mechanisms of skin breakdown induced by incontinence have been proposed from a variety of experimental studies. However, studies on the influence of skin properties caused by incontinence of bedridden subjects are very limited. This work was conducted to reveal how incontinence influences skin properties by comparing bedridden incontinent elderly subjects with age-matched healthy continent elderly and middle-aged subjects. Bedridden incontinent elderly subjects (n = 35, 83.5 ± 9.7 years, mean age ± SD), healthy continent elderly (n = 41, 75.9 ± 5.6 years), and middle-aged (n = 20, 41.3 ± 2.8 years) were recruited for this study. Skin surface pH, capacitance/hydration, transepidermal water loss, and bacteria on forearm and buttock skin were measured. Hydration and transepidermal water loss values between healthy elderly subjects and incontinent elderly subjects were significantly different on buttock skin. Significant differences between those two groups were also observed regarding pH and total bacteria levels on buttock skin. The forearm skin showed no significant difference in these parameters. No significant influence was observed between with and without urination at the measurement time except for the pH of buttock skin. No significant correlation was observed except between pH and bacteria levels on buttock skin of incontinent elderly subjects. In this study, we clarified the characteristic features of skin induced by incontinence. Our results indicate that these parameters are adequate not only to evaluate the characteristic skin features of bedridden incontinent subjects but also to develop new diapers to avoid the diaper dermatitis caused by incontinence. © 2015 The International Society of Dermatology.

  2. [Urinary incontinence as a risk factor for pressure sores does not withstand a critical examination].

    PubMed

    Krause, Tom; Anders, Jennifer; von Renteln-Kruse, Wolfgang

    2005-10-01

    The association between urinary incontinence and pressure sores is put down to various causes. Most frequently urinary wet and following maceration of the skin are mentioned. However, it is possible that urinary incontinence is only an indicator for other risk factors or a measure of the need for care without any causal relation to pressure sores. There are hardly any controlled or randomised studies; this lack of scientific evidence is problematic. Based on a case-control-study including data of 200 patients as well as on the existing models of explanation, the following study tries to examine critically the connections between pressure sores and urinary incontinence. Out of the patients in our study population 97.5 percent were incontinent. Different categories of the risk factor urinary incontinence and different dichotomisations have led to different statistical results. Statements concerning the connection between urinary incontinence and pressure sores have to be interpreted critically. The dependence of urinary incontinence on other risk factors such as patients' need for care or compliance suggests that the causal connection to pressure sores be not reduced to the influence of wetness. We advise to research connections between urinary incontinence and pressure sores in a methodologically appropriate setting.

  3. Does pelvic floor muscle training abolish symptoms of urinary incontinence? A randomized controlled trial.

    PubMed

    Celiker Tosun, O; Kaya Mutlu, E; Ergenoglu, A M; Yeniel, A O; Tosun, G; Malkoc, M; Askar, N; Itil, I M

    2015-06-01

    To determine whether symptoms of urinary incontinence is reduced by pelvic floor muscle training, to determine whether urinary incontinence can be totally eliminated by strengthening the pelvic floor muscle to grade 5 on the Oxford scale. Prospective randomized controlled clinical trial. Outpatient urogynecology department. One hundred thirty cases with stress and mixed urinary incontinence. All participants were randomly allocated to the pelvic floor muscle training group or control group. A 12-week home based exercise program, prescribed individually, was performed by the pelvic floor muscle training group. Urinary incontinence symptoms (Incontinence Impact Questionnaire-7, Urogenital Distress Inventory-6, bladder diary, stop test and pad test) were assessed, and the pelvic floor muscle strength was measured for (PERFECT testing, perineometric and ultrasound) all participants before and after 12 weeks of treatment. The pelvic floor muscle training group had significant improvement in their symptoms of urinary incontinence (P=0.001) and an increase in pelvic floor muscle strength (P=0.001, by the dependent t test) compared with the control group. All the symptoms of urinary incontinence were significantly decreased in the patients that had reached pelvic floor muscle strength of grade 5 and continued the pelvic floor muscle training (P<0.05). The study demonstrated that pelvic floor muscle training is effective in reducing the symptoms of stress and mixed urinary incontinence and in increasing pelvic floor muscle strength. © The Author(s) 2014.

  4. 42 CFR 412.405 - Preadmission services as inpatient operating costs under the inpatient psychiatric facility...

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 2 2011-10-01 2011-10-01 false Preadmission services as inpatient operating costs under the inpatient psychiatric facility prospective payment system. 412.405 Section 412.405 Public... PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Inpatient Hospital...

  5. 42 CFR 412.405 - Preadmission services as inpatient operating costs under the inpatient psychiatric facility...

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 2 2013-10-01 2013-10-01 false Preadmission services as inpatient operating costs under the inpatient psychiatric facility prospective payment system. 412.405 Section 412.405 Public... PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Inpatient Hospital...

  6. 42 CFR 412.405 - Preadmission services as inpatient operating costs under the inpatient psychiatric facility...

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Preadmission services as inpatient operating costs under the inpatient psychiatric facility prospective payment system. 412.405 Section 412.405 Public... PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Inpatient Hospital...

  7. 42 CFR 412.405 - Preadmission services as inpatient operating costs under the inpatient psychiatric facility...

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 2 2014-10-01 2014-10-01 false Preadmission services as inpatient operating costs under the inpatient psychiatric facility prospective payment system. 412.405 Section 412.405 Public... PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Inpatient Hospital...

  8. 42 CFR 412.405 - Preadmission services as inpatient operating costs under the inpatient psychiatric facility...

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 2 2012-10-01 2012-10-01 false Preadmission services as inpatient operating costs under the inpatient psychiatric facility prospective payment system. 412.405 Section 412.405 Public... PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Inpatient Hospital...

  9. Bladder control, urgency, and urge incontinence: evidence from functional brain imaging.

    PubMed

    Griffiths, Derek; Tadic, Stasa D

    2008-01-01

    To review brain imaging studies of bladder control in subjects with normal control and urge incontinence; to define a simple model of supraspinal bladder control; and to propose a neural correlate of urgency and possible origins of urge incontinence. Review of published reports of brain imaging relevant to urine storage, and secondary analyses of our own recent observations. In a simple model of normal urine storage, bladder and urethral afferents received in the periaqueductal gray (PAG) are mapped in the insula, forming the basis of sensation; the anterior cingulate gyrus (ACG) provides monitoring and control; the prefrontal cortex makes voiding decisions. The net result, as the bladder fills, is inhibition of the pontine micturition center (PMC) and of voiding, together with gradual increase in insular response, corresponding to increasing desire to void. In urge-incontinent subjects, brain responses differ. At large bladder volumes and strong sensation, but without detrusor overactivity (DO), most cortical responses become exaggerated, especially in ACG. This may be both a learned reaction to previous incontinence episodes and the neural correlate of urgency. The neural signature of DO itself seems to be prefrontal deactivation. Possible causes of urge incontinence include dysfunction of prefrontal cortex or limbic system, suggested by weak responses and/or deactivation, as well as abnormal afferent signals or re-emergence of infantile reflexes. Bladder control depends on an extensive network of brain regions. Dysfunction in various parts may contribute to urge incontinence, suggesting that there are different phenotypes requiring different treatments. (c) 2007 Wiley-Liss, Inc.

  10. Prevalence and Characteristics of Urinary Incontinence in a Treatment Seeking Male Prospective Cohort: Results from the LURN Study.

    PubMed

    Helfand, Brian T; Smith, Abigail R; Lai, H Henry; Yang, Claire C; Gore, John L; Erickson, Brad A; Kreder, Karl J; Cameron, Anne P; Weinfurt, Kevin P; Griffith, James W; Lentz, Aaron; Talaty, Pooja; Andreev, Victor P; Kirkali, Ziya

    2018-03-01

    Male urinary incontinence is thought to be infrequent. We sought to describe the prevalence of urinary incontinence in a male treatment seeking cohort enrolled in the LURN (Symptoms of Lower Urinary Tract Dysfunction Research Network). Study inclusion and exclusion criteria, including men with prostate cancer or neurogenic bladder, were previously reported. LURN participants prospectively completed questionnaires regarding lower urinary tract symptoms and other clinical variables. Men were grouped based on incontinence type, including 1) no urinary incontinence, 2) post-void dribbling only and 3) urinary incontinence. Comparisons were made using ANOVA and multivariable regression. Of the 477 men 24% reported no urinary incontinence, 44% reported post-void dribbling only and 32% reported urinary incontinence. African American men and those with sleep apnea were more likely to be in the urinary incontinence group than in the no urinary incontinence group (OR 3.2, p = 0.02 and OR 2.73, p = 0.003, respectively). Urinary incontinence was associated with significantly higher bother compared to men without leakage (p <0.001). Compared to men without urinary incontinence and men with only post-void dribbling those with urinary incontinence were significantly more likely to report higher scores (more severe symptoms) on the PROMIS (Patient-Reported Outcomes Measurement Information System) questionnaire regarding bowel issues, depression and anxiety than men without urinary incontinence (p <0.01). Urinary incontinence is common among treatment seeking men. This is concerning because the guideline recommended questionnaires to assess male lower urinary tract symptoms do not query for urinary incontinence. Thus, clinicians may be missing an opportunity to intervene and improve patient care. This provides a substantial rationale for a new or updated symptom questionnaire which provides a more comprehensive symptom assessment. Copyright © 2018 American Urological Association

  11. Factors associated with fecal incontinence in women with lower urinary tract symptoms.

    PubMed

    Chang, Ting-Chen; Chang, Shiow-Ru; Hsiao, Sheng-Mou; Hsiao, Chin-Fen; Chen, Chi-Hau; Lin, Ho-Hsiung

    2013-01-01

    The aim of this study was to identify the factors associated with fecal incontinence in female patients with lower urinary tract symptoms.   Data regarding clinical and urodynamic parameters and history of fecal incontinence of 1334 women with lower urinary tract symptoms who had previously undergone urodynamic evaluation were collected and subjected to univariate, multivariate, and receiver-operator characteristic curve analysis to identify significant associations between these parameters and fecal incontinence.   Multivariate analysis identified age (odds ratio [OR]=1.03, 95% confidence interval [CI]=1.01-1.05, P=0.005), presence of diabetes (OR=2.10, 95%CI=1.22-3.61, P=0.007), presence of urodynamic stress incontinence (OR=1.90, 95%CI=1.24-2.91, P=0.003), pad weight (OR=1.01, 95%CI=1.00-1.01, P=0.04), and detrusor pressure at maximum flow (OR=1.02, 95%CI=1.01-1.03, P=0.003) as independent risk factors for fecal incontinence. Receiver-operator characteristic curve analysis identified age≥55years, detrusor pressure at maximum flow≥35 cmH(2) O, and pad weight≥15g as having positive predictive values of 11.4%, 11.5%, and 12.4%, respectively, thus indicating that they are the most predictive values in concomitant fecal incontinence.   Detrusor pressure at maximum flow and pad weight may be associated with fecal incontinence in female patients with lower urinary tract symptoms, but require confirmation as indicators by further study before their use as screening tools. © 2012 The Authors. Journal of Obstetrics and Gynaecology Research © 2012 Japan Society of Obstetrics and Gynecology.

  12. [Assessment of the state of knowledge of women with urinary incontinence--a social problem].

    PubMed

    Stadnicka, Grazyna; Iwanowicz-Palus, Grazyna; Bień, Agnieszka

    2002-01-01

    Urinary incontinence is also one of the commonest problems of the Polish society. It is estimated that every sixth woman in Poland suffers from this disease, which can be prevented by using adequate prophylactic measures. This study aimed at the assessment of the state of knowledge of women on the prophylaxis of strain urinary incontinence. Investigations were carried out from May to September 2001 among 194 patients hospitalised on the ward of operative gynaecology of one of the teaching hospitals in Lublin. The criterion of selection of women for the study was lack of symptoms of strain urinary incontinence. The analysis of results allowed to draw the following conclusions: though the knowledge of the term urinary incontinence was declared by nearly half of the respondents (42.8%), about two thirds of them (65.4%) assessed their state of knowledge in this sphere as unsatisfactory; women show great interest (85.7%) in information on urinary incontinence. The favourite forms of information in this sphere are educational materials--brochures, leaflets (58.2%), individual talks with a doctor, midwife (34.8%), demonstration of exercises of the floor of the pelvis (29.9%). The above conclusions enabled to state that the educational success and even doing away with strain urinary incontinence depends on the program of urinary incontinence prophylaxis.

  13. Parameters of two-dimensional perineal ultrasonography for evaluation of urinary incontinence after Radical Prostatectomy.

    PubMed

    Costa Cruz, Danilo Souza Lima da; D'Ancona, Carlos Arturo Levi; Baracat, Jamal; Alves, Marco Antonio Dionisio; Cartapatti, Marcelo; Damião, Ronaldo

    2014-01-01

    Urinary incontinence remains a major concern for patients undergoing radical prostatectomy. Its prevalence can reach 20% in the late postoperative period. This clinical study investigated the differences of a dynamic evaluation of the urethra and pelvic floor contraction using perineal ultrasound in men without prostate surgery and in men submitted to radical prostatectomy with and without stress urinary incontinence. Ninety two male patients were included, which 70% of them underwent radical prostatectomy (RP) for more than one year. Thirty one men with clinically post prostatectomy incontinence were compared by two-dimensional (2D) perineal ultrasound to 34 patients without post prostatectomy incontinence and to 27 men without surgery in two centers in Brazil. Our results showed that the continent group presented the urethral angle at rest significantly lower than the prostate group (p = 0.0002). We also observed that the incontinent group showed the displacement of the anterior bladder neck during contraction significantly lower than the continent group (p = 0.008). We found that the continent group presented the urethral angle at rest significantly lower than the prostate group. The incontinent group also showed the anterior bladder neck displacement during contraction significantly lower than the continent group. It was more evident when the severe incontinent group and the continent group were compared.

  14. Effectiveness of midurethral slings in intrinsic sphincteric-related stress urinary incontinence.

    PubMed

    Lim, Yik N; Dwyer, Peter L

    2009-10-01

    Previous literature has shown that urodynamic evidence of intrinsic sphincter deficiency (ISD) decreases the surgical success of traditional antistress incontinence surgeries. The aim of this review is to assess recent evidence on the effectiveness of the increasingly popular midurethral slings (MUS) in women with ISD and stress urinary incontinence. Using the ISD definition of maximum urethral closure pressure of 20 cm H2O or less and/or abdominal/valsalva leak point pressure of 60 cm H2O or less, current literature would suggest that the effectiveness of retropubic MUS is reduced but remained acceptable in women with stress urinary incontinence and ISD. There are conflicting data on whether coexisting poor urethral mobility could further compromise surgical success. Of note, there is now emerging evidence to suggest that transobturator tapes are associated with much higher failure rates in this setting and retropubic MUS should be used instead. Currently, there is too little data on the new single-incision mini-slings for any recommendation of use in women with stress incontinence with good or poor intrinsic urethral function. MUS is an effective treatment for stress urinary incontinence. However, when urodynamic evidence of ISD is present, the retropubic approach may be preferable to the transobturator approach.

  15. Randomized controlled study of MONARC® vs. tension-free vaginal tape obturator (TVT-O®) in the treatment of female urinary incontinence: comparison of 3-year cure rates.

    PubMed

    Park, Yoo Jun; Kim, Duk Yoon

    2012-04-01

    Transobturator approaches to midurethral sling surgery are one of the most commonly performed operations for female stress urinary incontinence throughout the world. However, very few results of randomized clinical trials of transobturator midurethral sling surgery (MONARC vs. TVT-O) for the treatment of female urinary incontinence have been reported. In this study, we compared the 3-year follow-up cure rates of these two procedures. From July 2006 to June 2008, 74 patients who had undergone MONARC (35 patients) or TVT-O (39 patients) were included in the study and were analyzed prospectively. The mean follow-up duration of both groups was 39.2 months. Preoperative and postoperative evaluations included physical examination, uroflowmetry and postvoid residual measurement, involuntary urine loss with physical activity, and urinary symptoms. Cure of female urinary incontinence was defined as patient report of no loss of urine upon physical activity. The patients' satisfaction after treatment was rated as very satisfied, satisfied, equivocal, and unsatisfied. Very satisfied and satisfied were considered as the satisfied rate. There were no significant differences in preoperative patient characteristics, postoperative complications, or success rate between the two groups. The cure rate of the MONARC and TVT-O groups was 85.7% and 84.6%, respectively. The patient satisfaction (very satisfied, satisfied) rate of the MONARC and TVT-O groups was 82.8% and 82.1%, respectively. The MONARC and TVT-O procedures were equally efficient for the treatment of female urinary incontinence, with maintenance of high cure rates for 3 years. Longer follow-up is needed to confirm these results.

  16. Variations in inpatient pediatric anesthesia in California from 2000 to 2009: a caseload and geographic analysis.

    PubMed

    Mudumbai, Seshadri C; Honkanen, Anita; Chan, Jia; Schmitt, Susan; Saynina, Olga; Hackel, Alvin; Gregory, George; Phibbs, Ciaran S; Wise, Paul H

    2014-12-01

    Regional referral systems are considered important for children hospitalized for surgery, but there is little information on existing systems. To examine geographic variations in anesthetic caseloads in California for surgical inpatients ≤6 years and to evaluate the feasibility of regionalizing anesthetic care. We reviewed California's unmasked patient discharge database between 2000 and 2009 to determine surgical procedures, dates, and inpatient anesthetic caseloads. Hospitals were classified as urban or rural and were further stratified as low, intermediate, high, and very high volume. We reviewed 257,541 anesthetic cases from 402 hospitals. Seventeen California Children's Services (CCS) hospitals conducted about two-thirds of all inpatient anesthetics; 385 non-CCS hospitals accounted for the rest. Urban hospitals comprised 82% of low- and intermediate-volume centers (n = 297) and 100% of the high- and very high-volume centers (n = 41). Ninety percent (n = 361) of hospitals performed <100 cases annually. Although potentially lower risk procedures such as appendectomies were the most frequent in urban low- and intermediate-volume hospitals, fairly complex neurosurgical and general surgeries were also performed. The median distance from urban lower-volume hospitals to the nearest high- or very high-volume center was 12 miles. Up to 98% (n = 40,316) of inpatient anesthetics at low- or intermediate-volume centers could have been transferred to higher-volume centers within 25 miles of smaller centers. Many urban California hospitals maintained low annual inpatient anesthetic caseloads for children ≤6 years while conducting potentially more complex procedures. Further efforts are necessary to define the scope of pediatric anesthetic care at urban low- and intermediate-volume hospitals in California. © 2014 John Wiley & Sons Ltd.

  17. Adaptation to Spanish language and validation of the fecal incontinence quality of life scale.

    PubMed

    Minguez, Miguel; Garrigues, Vicente; Soria, Maria Jose; Andreu, Montserrat; Mearin, Fermin; Clave, Pere

    2006-04-01

    The aim of this study was to perform a psychometric evaluation of the Fecal Incontinence Quality of Life Scale in the Spanish language. Eleven hospitals in Spain participated in the study, which included 118 patients with active fecal incontinence. All the patients filled out a questionnaire on the severity of their incontinence, a general questionnaire of health (Medical Outcomes Survey Short Form), and a Spanish translation of the Fecal Incontinence Quality of Life Scale (Cuestionario de Calidad de Vida de Incontinencia Anal), which consists of 29 items in four domains: lifestyle, behavior, depression, and embarrassment. On a second visit, patients repeated the Fecal Incontinence Quality of Life Scale. For each domain, an evaluation was made of temporal reliability, internal reliability, the convergent validity with the generic questionnaire of health, and the discriminant validity correlating the domains of Cuestionario de Calidad de Vida de Incontinencia Anal with the severity of fecal incontinence. For cultural adaptation, the answer alternatives for 14 items were modified. A total of 111 patients (94 percent) completed the study adequately. Temporal reliability (test-retest) was good for all domains except for embarrassment, which showed significant differences (P < 0.02). Internal reliability was good/excellent for all domains (Cronbach alpha >0.80, between 0.84 and 0.96). The four domains of Cuestionario de Calidad de Vida de Incontinencia Anal significantly correlated with the domains of the generic questionnaire on health (P < 0.01) and with the scale of severity of fecal incontinence (P < 0.001). All domains of Cuestionario de Calidad de Vida de Incontinencia Anal correlated negatively with the need to wear pads (P < 0.01) and with the presence of complete fecal incontinence. The Cuestionario de Calidad de Vida de Incontinencia Anal incorporates sufficient requirements of reliability and validity to be applied to patients with fecal incontinence.

  18. A conceptual model of the risk of elder abuse posed by incontinence and care dependence.

    PubMed

    Ostaszkiewicz, Joan

    2017-12-08

    To describe and critically analyse the thinking that led to the concept of an association between incontinence, care dependence and elder abuse. Coercive or abusive continence care practices include chastising a person for their incontinence and overriding their attempts to resist continence care. Neglect in continence care is characterised by withholding or delaying responding to requests for help to maintain continence or to manage incontinence, and restricting a person's access to toileting assistance, incontinence aids or hygiene care. Contemporary biomedical understandings about incontinence and influencing concepts from the fields of sociology, psychology and nursing were analysed to inform the design of a conceptual model that elucidates possible associations between incontinence, care dependence and elder abuse. Ideas generated from an analysis of the concepts led to the development of a model termed the "Model of Attributes to Abuse of Dependent Elders in Continence Care" (MADE-CC). The MADE-CC theorises factors that cause and contribute to abuse in continence care. Carer factors include physical and emotional exhaustion, frustration related to the inability to control or predict incontinence, resentment associated with constraints imposed by care dependence, disgust associated with physical contact with urine/faeces, limited knowledge and skills about incontinence and ethical conflicts concerning care. Care recipient factors include frequent and severe incontinence, cognitive impairment and a history of physical or psychological trauma. Social factors that are theorised include the stigmatised nature of incontinence, social taboos and cultural norms and the private nature of continence care. The MADE-CC illuminates the potential risk of elder abuse posed by incontinence and care dependence. It should be used to improve ethical care of older people and stimulate debate about everyday ethics in the care of older people who are care dependent and to optimise

  19. Orgasm associated incontinence (climacturia) following radical pelvic surgery: rates of occurrence and predictors.

    PubMed

    Choi, Judy M; Nelson, Christian J; Stasi, Jason; Mulhall, John P

    2007-06-01

    Orgasm associated incontinence, that is the inadvertent leakage of urine at orgasm, has received little attention in the literature. We evaluated the rate of occurrence of orgasm associated incontinence following radical pelvic surgery as well as its associated factors and predictors. From January 2005 to March 2006, 696 patients were evaluated for post-radical pelvic surgery sexual dysfunction. A database was created, and descriptive statistics, chi-square analysis and logistic regression analysis were used to evaluate associated factors and predictors. Of 475 patients 96 (20%) reported orgasm associated incontinence following radical pelvic surgery. The incidence was significantly less in the cystoprostatectomy group than in the open and laparoscopic radical prostatectomy groups (p <0.05). Orgasm associated incontinence was more commonly found within 12 months following surgery vs greater than 12 months (RR 0.81, 95% CI 0.72-0.92, p <0.01) and in patients with orgasm associated pain (RR 1.09, 95% CI 1.01-1.16, p <0.01) and penile length loss (RR 1.32, 95% CI 1.09-1.59, p <0.01). On multivariate analysis all factors associated on univariate analyses remained predictive. Orgasm associated incontinence was not associated with patient age, the degree of nerve sparing, surgical margin status, seminal vesicle or lymph node involvement, preoperative erectile function, nocturnal erections, libido level or daytime continence. Orgasm associated incontinence occurs in a fifth of men (96 of 475) following radical pelvic surgery. The incidence of orgasm associated incontinence is greater with radical prostatectomy than with radical cystectomy and it is unrelated to the type of prostatectomy performed (open vs laparoscopic). Orgasm associated incontinence is more likely to be reported within year 1 following surgery and in men who complain of orgasmic pain and/or penile shortening.

  20. Effects of carrying a pregnancy and of method of delivery on urinary incontinence: a prospective cohort study.

    PubMed

    Eason, Erica; Labrecque, Michel; Marcoux, Sylvie; Mondor, Myrto

    2004-02-19

    BACKGROUND: This study was carried out to identify risk factors associated with urinary incontinence in women three months after giving birth. METHODS: Urinary incontinence before and during pregnancy was assessed at study enrolment early in the third trimester. Incontinence was re-assessed three months postpartum. Logistic regression analysis was used to assess the role of maternal and obstetric factors in causing postpartum urinary incontinence. This prospective cohort study in 949 pregnant women in Quebec, Canada was nested within a randomised controlled trial of prenatal perineal massage. RESULTS: Postpartum urinary incontinence was increased with prepregnancy incontinence (adjusted odds ratio [adj0R] 6.44, 95% CI 4.15, 9.98), incontinence beginning during pregnancy (adjOR 1.93, 95% CI 1.32, 2.83), and higher prepregnancy body mass index (adjOR 1.07/unit of BMI, 95% CI 1.03,1.11). Caesarean section was highly protective (adjOR 0.27, 95% CI 0.14, 0.50). While there was a trend towards increasing incontinence with forceps delivery (adjOR 1.73, 95% CI 0.96, 3.13) this was not statistically significant. The weight of the baby, episiotomy, the length of the second stage of labour, and epidural analgesia were not predictive of urinary incontinence. Nor was prenatal perineal massage, the randomised controlled trial intervention. When the analysis was limited to women having their first vaginal birth, the same risk factors were important, with similar adjusted odds ratios. CONCLUSIONS: Urinary incontinence during pregnancy is extremely common, affecting over half of pregnant women. Urinary incontinence beginning during pregnancy roughly doubles the likelihood of urinary incontinence at 3 months postpartum, regardless whether delivery is vaginal or by Caesarean section.

  1. Incidence and Predictors of Incontinence Associated Skin Damage in Nursing Home Residents with New Onset Incontinence

    PubMed Central

    Bliss, Donna Z.; Mathiason, Michelle A.; Gurvich, Olga; Savik, Kay; Eberly, Lynn E.; Fisher, Jessica; Wiltzen, Kjerstie R.; Akermark, Haley; Hildebrandt, Amanda; Jacobson, Megan; Funk, Taylor; Beckman, Amanda; Larson, Reed

    2016-01-01

    Purpose The purpose of this study was to determine the incidence and predictors of incontinence associated dermatitis (IAD) in nursing home residents. Methods Records of a cohort of 10,713 elderly (aged 65+) newly incontinent nursing home residents in 448 nursing homes in 28 states free of IAD were followed for IAD development. Potential multi-level predictors of IAD were identified in four national datasets containing information about the characteristics of individual nursing home residents, nursing home care environment, and communities in which the nursing homes were located. A unique set of health practitioner orders provided information about IAD and the predictors of IAD prevention and pressure injuries in the extended perineal area. Analysis was based on hierarchical logistical regression. Results The incidence of IAD was 5.5%. Significant predictors of IAD were not receiving preventive interventions for IAD, presence of a perineal pressure injury, having greater functional limitations in activities of daily living, more perfusion problems, and lesser cognitive deficits. Conclusion Findings highlight the importance of prevention of IAD and treatment/prevention of pressure injuries. A Wound Ostomy and Continence (WOC) nurse offers expertise in these interventions and can educate staff about IAD predictors which can improve resident outcomes. Other recommendations include implementing plans of care to improve functional status, treat perfusion problems, and provide assistance with incontinence and skin care to residents with milder as well as greater cognitive deficits. PMID:28267124

  2. Standardized pelvic floor exercises improve stress urinary incontinence in women with intrinsic sphincter deficiency.

    PubMed

    Lehmann, Corinne; Zipponi, Ingrid; Baumann, Marc U; Radlinger, Lorenz; Mueller, Michael D; Kuhn, Annette

    2016-08-01

    Pelvic floor rehabilitation is the conservative therapy of choice for women with stress urinary incontinence (SUI). The success rate of surgical procedures in SUI patients with intrinsic sphincter deficiency (ISD) is low. The aim of this study was to analyse the effect of a standardized physiotherapy on patients with SUI and normotonic urethra and ISD. In this study, 64 patients with ISD and 69 patients with normotonic urethra were enrolled. Maximum urethral pressure (MUCP) >20 cm H2 O was considered as normotonic urethral pressure. Before and after physiotherapy MUCP was measured and cough testing was performed. Additionally, patient reported outcome was assessed using the King's Health Questionnaire (KHQ). For statistical analyses Excel 2010 (Microsoft Inc; Redmond, Washington) and SPSS 20 (SPSS Inc; Chicago, Illinois) for Windows were used. Power calculation was based on the primary endpoint incontinence impact and general health. For power calculation, GraphPad Statmate version 2.00 for Windows was used. Sixty-four patients with ISD and 69 patients with normotonic urethra were included in the study. In SUI patients with normotonic and hypotonic urethra KHQ-scores regarding the primary endpoins "general health" and "incontinence impact" significantly improved following standardized physiotherapy. In both groups MUCP increased after physiotherapy. In SUI patients with ISD standardized physiotherapy resulted in a decreased incidence of a positive cough test. Standardized physiotherapy should be offered to patients with SUI and ISD. Long-term results are subject to future studies. Neurourol. Urodynam. 35:711-716, 2016. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.

  3. Hospital organization and importance of an interventional radiology inpatient admitting service: Italian single-center 3-year experience.

    PubMed

    Simonetti, Giovanni; Bollero, Enrico; Ciarrapico, Anna Micaela; Gandini, Roberto; Konda, Daniel; Bartolucci, Alberto; Di Primio, Massimiliano; Mammucari, Matteo; Chiocchi, Marcello; D'Alba, Fabrizio; Masala, Salvatore

    2009-03-01

    In June 2005 a Complex Operating Unit of Interventional Radiology (COUIR), consisting of an outpatient visit service, an inpatient admitting service with four beds, and a day-hospital service with four beds was installed at our department. Between June 2005 and May 2008, 1772 and 861 well-screened elective patients were admitted to the inpatient ward of the COUIR and to the Internal Medicine Unit (IMU) or Surgery Unit (SU) of our hospital, respectively, and treated with IR procedures. For elective patients admitted to the COUIR's inpatient ward, hospital stays were significantly shorter and differences between reimbursements and costs were significantly higher for almost all IR procedures compared to those for patients admitted to the IMU and SU (Student's t-test for unpaired data, p < 0.05). The results of the 3-year activity show that the activation of a COUIR with an inpatient admitting service, and the better organization of the patient pathway that came with it, evidenced more efficient use of resources, with the possibility for the hospital to save money and obtain positive margins (differences between reimbursements and costs). During 3 years of activity, the inpatient admitting service of our COUIR yielded a positive difference between reimbursements and effective costs of 1,009,095.35 euros. The creation of an inpatient IR service and the admission of well-screened elective patients allowed short hospitalization times, reduction of waiting lists, and a positive economic outcome.

  4. Hospital Organization and Importance of an Interventional Radiology Inpatient Admitting Service: Italian Single-Center 3-Year Experience

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Simonetti, Giovanni; Bollero, Enrico; Ciarrapico, Anna Micaela

    2009-03-15

    In June 2005 a Complex Operating Unit of Interventional Radiology (COUIR), consisting of an outpatient visit service, an inpatient admitting service with four beds, and a day-hospital service with four beds was installed at our department. Between June 2005 and May 2008, 1772 and 861 well-screened elective patients were admitted to the inpatient ward of the COUIR and to the Internal Medicine Unit (IMU) or Surgery Unit (SU) of our hospital, respectively, and treated with IR procedures. For elective patients admitted to the COUIR's inpatient ward, hospital stays were significantly shorter and differences between reimbursements and costs were significantly highermore » for almost all IR procedures compared to those for patients admitted to the IMU and SU (Student's t-test for unpaired data, p < 0.05). The results of the 3-year activity show that the activation of a COUIR with an inpatient admitting service, and the better organization of the patient pathway that came with it, evidenced more efficient use of resources, with the possibility for the hospital to save money and obtain positive margins (differences between reimbursements and costs). During 3 years of activity, the inpatient admitting service of our COUIR yielded a positive difference between reimbursements and effective costs of Euro 1,009,095.35. The creation of an inpatient IR service and the admission of well-screened elective patients allowed short hospitalization times, reduction of waiting lists, and a positive economic outcome.« less

  5. Pelvic Floor Morphometric Differences in Elderly Women with or without Urinary Incontinence.

    PubMed

    Fradet, Sarah; Morin, Mélanie; Kruger, Jennifer; Dumoulin, Chantale

    2018-01-01

    Purpose: Urinary incontinence (UI) affects as many as 50% of women aged 60 years and older, but UI pathophysiology, specifically in elderly women, remains unclear. A better understanding of morphometric differences between continent and urinary incontinent elderly women is needed to improve the effectiveness of conservative treatment approaches. We hypothesized that morphometric differences in the pelvic floor muscles (PFM) among elderly women with and without UI could be observed using three- and four-dimensional (3D/4D) transperineal ultrasound (TPU) imaging. Method: A total of 40 elderly women (20 women with and 20 women without UI), with a mean age of 67.10 (SD 4.94) years, participated in the study. This was a case-control study in which TPU images were taken under three conditions: rest, maximal voluntary contraction (MVC), and Valsalva. Independent t -tests were conducted to compare measurements between the groups. Results: The study revealed statistically significant differences between the groups. At rest, the levator hiatal area and transverse diameter were bigger, and the PFM position was lower in the incontinent group. During MVC, all axial plane parameters were bigger in the incontinent group. In the sagittal plane, PFM position was again lower in the incontinent group. During Valsalva, the anorectal angle was wider in the women with incontinence. Conclusion: PFM morphometric differences were present and were observed using 3D/4D TPU imaging in elderly women with and without UI.

  6. The cost of obesity for nonbariatric inpatient operative procedures in the United States: national cost estimates obese versus nonobese patients.

    PubMed

    Mason, Rodney J; Moroney, Jolene R; Berne, Thomas V

    2013-10-01

    To evaluate the economic impact of obesity on hospital costs associated with the commonest nonbariatric, nonobstetrical surgical procedures. Health care costs and obesity are both rising. Nonsurgical costs associated with obesity are well documented but surgical costs are not. National cost estimates were calculated from the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) database, 2005-2009, for the highest volume nonbariatric nonobstetric procedures. Obesity was identified from the HCUP-NIS severity data file comorbidity index. Costs for obese patients were compared with those for nonobese patients. To control for medical complexity, each obese patient was matched one-to-one with a nonobese patient using age, sex, race, and 28 comorbid defined elements. Of 2,309,699 procedures, 439,8129 (19%) were successfully matched into 2 medically equal groups (obese vs nonobese). Adjusted total hospital costs incurred by obese patients were 3.7% higher with a significantly (P < 0.0001) higher per capita cost of $648 (95% confidence interval [CI]: $556-$736) compared with nonobese patients. Of the 2 major components of hospital costs, length of stay was significantly increased in obese patients (mean difference = 0.0253 days, 95% CI: 0.0225-0.0282) and resource utilization determined by costs per day were greater in obese patients due to an increased number of diagnostic and therapeutic procedures needed postoperatively (odds ratio [OR] = 0.94, 95% CI: 0.93-0.96). Postoperative complications were equivalent in both groups (OR = 0.97, 95% CI: 0.93-1.02). Annual national hospital expenditures for the largest volume surgical procedures is an estimated $160 million higher in obese than in a comparative group of nonobese patients.

  7. Combined pelvic muscle exercise and yoga program for urinary incontinence in middle-aged women.

    PubMed

    Kim, Gwang Suk; Kim, Eun Gyeong; Shin, Ki Young; Choo, Hee Jung; Kim, Mi Ja

    2015-10-01

    Urinary incontinence is a major health problem among middle-aged women. Pelvic muscle exercise is one of the primary interventions, but difficulty performing this exercise has led researchers to seek alternative or conjunctive exercise. This study aimed to examine the effect of a combined pelvic muscle exercise and yoga intervention program on urinary incontinence. A single group pre-/post-test design was used. Subjects were recruited from a community health center in Seoul, Korea, and a questionnaire survey was conducted. Fifty-five women participated in the first day of the program, 34 of whom completed the 8 week, twice weekly intervention program. Urinary incontinence was measured by five domains of urinary tract symptoms: filling factor, voiding factor, incontinence factor, sexual function, and quality of life. Also measured were attitude toward pelvic muscle exercise and pelvic muscle strength. Significant improvements were found in attitude toward pelvic muscle exercise, pelvic muscle strength, and incontinence factor. Daily performance of pelvic muscle exercise was positively correlated with improved incontinence factor and with quality of life related to urinary tract symptoms. A combined pelvic muscle exercise and yoga program was effective for improving overall urinary incontinence in community health center attendees in Korea. Further study is needed with a control group, different populations, and a longer intervention period. © 2015 The Authors. Japan Journal of Nursing Science © 2015 Japan Academy of Nursing Science.

  8. Female ejaculation orgasm vs. coital incontinence: a systematic review.

    PubMed

    Pastor, Zlatko

    2013-07-01

    Women may expel various kinds of fluids during sexual arousal and at orgasm. Their origins, quantity, compositions, and expulsion mechanisms depend on anatomical and pathophysiological dispositions and the degree of sexual arousal. These are natural sexual responses but may also represent symptoms of urinary incontinence. The study aims to clarify the etiology of fluid leakage at orgasm, distinguish between associated physiological sexual responses, and differentiate these phenomena from symptoms of illness. A systematic literature review was performed. EMBASE (OvidSP) and Web of Science databases were searched for the articles on various phenomena of fluid expulsions in women during sexual arousal and at orgasm. Articles included focused on female ejaculation and its variations, coital incontinence (CI), and vaginal lubrication. Female ejaculation orgasm manifests as either a female ejaculation (FE) of a smaller quantity of whitish secretions from the female prostate or a squirting of a larger amount of diluted and changed urine. Both phenomena may occur simultaneously. The prevalence of FE is 10-54%. CI is divided into penetration and orgasmic forms. The prevalence of CI is 0.2-66%. Penetration incontinence occurs more frequently and is usually caused by stress urinary incontinence (SUI). Urodynamic diagnoses of detrusor overactivity (DOA) and SUI are observed in orgasmic incontinence. Fluid expulsions are not typically a part of female orgasm. FE and squirting are two different physiological components of female sexuality. FE was objectively evidenced only in tens of cases but its reported high prevalence is based mostly on subjective questionnaire research. Pathophysiology of squirting is rarely documented. CI is a pathological sign caused by urethral disorder, DOA, or a combination of both, and requires treatment. An in-depth appreciation of these similar but pathophysiologically distinct phenomena is essential for distinguishing normal, physiological sexual

  9. Odors and incontinence: What does the nose know?

    PubMed

    Dalton, Pamela; Maute, Christopher

    2018-06-01

    The fear of producing malodors that can be detected by others is a daily cause of anxiety for millions of people with incontinence. For many, the risk-whether real or imagined-that leaked waste products will be detectable by odor is sufficiently concerning to result in limitations on many types of activities. However, worry about personal odors can sensitize our olfactory system and cause us to be more aware of odors that may otherwise not be perceptible. In addition, heightened olfactory attention can often lead to odor misattributions, such as when we erroneously identify our body as the source of an odor that may simply be present in the environment. Odors produced by our bodies (endogenous odors) do enjoy a greater access to emotional brain centers and are processed faster than general odors. Here we provide examples from both everyday life and laboratory studies to explain how and why the olfactory system is unique among our sensory systems and how this knowledge can provide insights to our concerns about smell and incontinence and inform the development of products and solutions for incontinence.

  10. Do we manage incontinence in children and adults with special needs adequately? ICI-RS 2014.

    PubMed

    von Gontard, Alexander; de Jong, Tom P V M; Rantell, Angie; Nieuwhof-Leppink, Anka; Badawi, Jasmin Katrin; Cardozo, Linda

    2016-02-01

    To review studies on the associations of incontinence and special needs in children and adults and to outline future directions in research and clinical care. A review of literature was conducted. Open questions and future directions were discussed during the ICI-RS meeting in 2014. Special needs comprise a wide variety of conditions and disabilities. Individuals with special needs carry a greater risk for all types of incontinence. There is a high tendency for incontinence to persist from childhood into adulthood. Many people do not receive adequate medical care for their incontinence. More detailed research is needed, especially in the adult population with special needs. Assessment and treatment of incontinence should be offered routinely to all those with special needs. © 2016 Wiley Periodicals, Inc.

  11. Spontaneous pushing to prevent postpartum urinary incontinence: a randomized, controlled trial.

    PubMed

    Low, Lisa Kane; Miller, Janis M; Guo, Ying; Ashton-Miller, James A; DeLancey, John O L; Sampselle, Carolyn M

    2013-03-01

    The risk for urinary incontinence can be 2.6-fold greater in women after pregnancy and childbirth compared with their never-pregnant counterparts, with the incidence increasing with parity. We tested the hypothesis that the incidence of de novo postpartum urinary incontinence in primiparous women is reduced with the use of spontaneous pushing alone or in combination with perineal massage compared with women who experienced traditional directed pushing for second-stage management. This was a prospective clinical trial enrolling and randomizing 249 women into a four-group design: (1) routine care with coached or directed pushing, (2) spontaneous self-directed pushing, (3) prenatal perineal massage initiated in the third trimester, and (4) the combination of spontaneous pushing plus perineal massage. Self-report of incontinence was assessed using analysis of variance (ANOVA) and covariance (ANCOVA) models in 145 remaining women at 12 months postpartum using the Leakage Index, which is sensitive to minor leakage. No statistical difference in the incidence of de novo postpartum incontinence was found based on method of pushing (spontaneous/directed) (P value = 0.57) or in combination with prenatal perineal massage (P value = 0.57). Fidelity to pushing treatment of type was assessed and between-groups crossover detected. Spontaneous pushing did not reduce the incidence of postpartum incontinence experienced by women 1 year after their first birth due to high cross-over between randomization groups.

  12. Prospective trial of pelvic floor retraining in patients with fecal incontinence.

    PubMed

    Rieger, N A; Wattchow, D A; Sarre, R G; Cooper, S J; Rich, C A; Saccone, G T; Schloithe, A C; Toouli, J; McCall, J L

    1997-07-01

    Our aim was to prospectively evaluate pelvic floor retraining (PFR) in improving symptomatic fecal incontinence. PFR was used to treat 30 patients with fecal incontinence (28 women; age range, 29-85 (median, 68) years). PFR was performed by a physiotherapist in the outpatient department according to a strict protocol and included biofeedback using an anal plug electromyometer. Manometry (24 patients), pudendal nerve terminal motor latency (PNTML, 16 patients), and anal ultrasound (14 patients) were done before commencing therapy. Independent assessment of symptoms was done at the commencement of therapy, at 6 weeks, and at 6 and 12 months posttherapy. Twenty patients (67 percent) had improved incontinence scores, with eight patients (27 percent) being completely or nearly free of symptoms. Of 28 patients followed up longer than six months, 14 achieved a 25 percent or greater improvement at six weeks, which was sustained in all cases. Fourteen had an initial improvement of less than 25 percent, with only four (29 percent) showing later improvement (P < 0.0001). There was no relationship between results of the therapy and patient age, initial severity of symptoms, etiology of incontinence, and results of anal manometry, PNTML, and anal ultrasound. PFR is a physical therapy that should be considered as the initial treatment in patients with fecal incontinence. An improvement can be expected in up to 67 percent of patients. Initial good results can predict overall outcome.

  13. Long-term anal incontinence after obstetric anal sphincter injury-does grade of tear matter?

    PubMed

    Jangö, Hanna; Langhoff-Roos, Jens; Rosthøj, Susanne; Saske, Abelone

    2018-02-01

    Anal incontinence is a major concern following delivery with obstetric anal sphincter injury (OASIS), and has been related to the degree of sphincter tear. The aims of this study were (1) to evaluate whether women with a fourth-degree OASIS in the first delivery have an increased risk of long-term anal and fecal incontinence after a second delivery, and (2) to assess the impact of mode of second delivery on anal incontinence and related symptoms in these patients. We performed secondary analyses of a national questionnaire study in all Danish women with an OASIS in their first delivery and 1 subsequent delivery, both deliveries in 1997 to 2005. The questionnaires were sent a minimum of 5 years since the second delivery. In Denmark, women with anal incontinence after a delivery with OASIS are recommended elective cesarean deliveries in subsequent pregnancies. We performed uni- and multivariable logistic regression analyses to evaluate the outcomes. In total, 2008 patients had an OASIS, of whom 12.2% (n = 245) had a fourth-degree tear in the first delivery. The median follow-up time since the first delivery with OASIS was 11.6 years (IQR, 10.2-13.2 years) and since the second delivery 8.5 years (IQR, 7.1-10.1 years). Women with a fourth-degree sphincter injury in the first delivery were at higher risk for anal incontinence (58.8%, n = 144) as well as fecal incontinence (30.6%, n = 75) than patients with a third-degree injury in the first delivery (41.0%, n = 723, and 14.6%, n = 258, respectively). The differences between groups persisted after adjustment for important maternal, fetal, and obstetric characteristics (adjusted odds ratio [aOR], 2.14; 95% confidence interval [CI], 1.52-3.02; P < 0.001 for anal incontinence; and aOR, 2.49; 95% CI, 1.73-3.56; P < 0.001 for fecal incontinence). In subgroup analyses of patients with fourth-degree anal sphincter injury in the first delivery, the mode of second delivery was not associated with the risk of anal

  14. Urethral obstruction after anti-incontinence surgery in women: evaluation, methodology, and surgical results.

    PubMed

    Austin, P; Spyropoulos, E; Lotenfoe, R; Helal, M; Hoffman, M; Lockhart, J L

    1996-06-01

    To evaluate a group of women with voiding dysfunction and a low maximum flow rate (MFR) (less than or equal to 12 mL/s) after surgery for stress urinary incontinence (SUI); to establish diagnostic parameters indicating obstruction in an attempt to determine treatment selection; and to evaluate preliminary surgical results. Eighteen women who underwent anti-incontinence surgery for SUI were diagnosed as having infravesical obstruction (IO). Thirteen women (group A [72%]) presented with clinically predominant symptoms of urgency, frequency, intermittency, and a variable vesical residual volume (RV), and five (group B [28%]) had as their most significant symptoms a high vesical RV and urinary tract infection that had been managed with intermittent catheterization (IC). The diagnosis of IO, suspected after clinical history, was established after physical examination and cystoscopic, cystographic and urodynamic investigations. Bladder instability was demonstrated in 6 group A patients (46%) and 1 group B patient (20%) (P = NS). Mean MFRs were 8.07 and 7.2 mL/s, respectively, in both groups (P = NS). Mean maximal voiding pressures (MVPs) were 20.23 and 5 cm H20, and mean RVs were 57.46 and 174 mL, respectively; both differences were statistically very significant (P <0.01 and P <0.001, respectively). High to normal MVPs occurred in 2 patients overall (11%). Bladder neck overcorrection, midurethral distortion, and postsurgical cystocele were demonstrated in both groups in 11 (85%), 0, and 2 (15%) patients in group A and 3 (60%), 2 (40%), and 3 (60%) patients in group B, respectively (P = NS). Patients in group A were treated surgically with cystourethrolysis and a repeated, less obstructive anti-incontinence operation. In group B 2 women (40%) had a similar surgical procedure; 1 (20%) underwent isolated urethrolysis; and 2 (40%) are currently maintained with IC. Among these 18 patients with voiding dysfunction after anti-incontinence surgery, a primary diagnosis of IO was

  15. NIH state-of-the-science conference statement on prevention of fecal and urinary incontinence in adults.

    PubMed

    To provide health care providers, patients, and the general public with a responsible assessment of currently available data on prevention of fecal and urinary incontinence in adults. A non-DHHS, nonadvocate 15-member panel representing the fields of geriatrics, nursing, gastroenterology, obstetrics and gynecology, internal medicine, urology, general surgery, oncology, neurosurgery, epidemiology, biostatistics, psychiatry, rehabilitation medicine, environmental health sciences, and healthcare financing. In addition, 21 experts from pertinent fields presented data to the panel and conference audience. Presentations by experts and a systematic review of the literature prepared by the Minnesota Evidence-based Practice Center, through the Agency for Healthcare Research and Quality. Scientific evidence was given precedence over anecdotal experience. The panel drafted its statement based on scientific evidence presented in open forum and on published scientific literature. The draft statement was presented on the final day of the conference and circulated to the audience for comment. The panel released a revised statement later that day at http://consensus.nih.gov. This statement is an independent report of the panel and is not a policy statement of the NIH or the Federal Government. (1) Fecal incontinence and urinary incontinence will affect more than one fourth of all U.S. adults during their lives. The natural history of fecal incontinence is unknown, and the natural history of urinary incontinence over several years is not well described. (2) Fecal incontinence and urinary incontinence often have serious effects on the lives of the many individuals who suffer physical discomfort, embarrassment, stigma, and social isolation, and on family members, caregivers, and society. Financial costs are substantial and may be underestimated because of underreporting. (3) Routine episiotomy is the most easily preventable risk factor for fecal incontinence. Risk factors for both

  16. [Effect of pelvic floor exercise during pregnancy and puerperium on prevention of urinary stress incontinence].

    PubMed

    Gorbea Chávez, Viridiana; Velázquez Sánchez, María del Pilar; Kunhardt Rasch, Jorge R

    2004-12-01

    The main factor for the appearance of urinary stress incontinence in almost all women is pregnancy and vaginal childbirth. The pelvic floor exercises have been described for the treatment of urinary stress incontinence. To determine with a randomized controlled trial if the pelvic floor exercises during pregnancy and late puerperium diminish the prevalence of urinary stress incontinence at 28 and 35 gestational week and at 6 weeks after childbirth. The study was made with nulliparous, pregnant women who realized pelvic floor exercises during pregnancy and after birth. 72 women were studied, 52.7% realized pelvic floor exercises and 47.2% did not. The urinary stress incontinence frequency at the 28 gestational week in the no exercises group was 17.2%, and at the 35 gestational week of 47% and at 6 weeks after childbirth was of 47%, while in the exercises group was 0, 0 and 15%, respectively. Moreover there were statistically significant differences between both groups regarding the presence of urinary stress incontinence, that is, the group that realized exercises presented less incontinence at the 28 and 35 gestational weeks and at 6 weeks after childbirth. The results of this study concluded that the pelvic floor exercises during pregnancy and after childbirth prevent the urinary stress incontinence at this time.

  17. Effectiveness of pelvic floor muscle training in treating urinary incontinence in women: A current review.

    PubMed

    García-Sánchez, E; Rubio-Arias, J A; Ávila-Gandía, V; Ramos-Campo, D J; López-Román, J

    2016-06-01

    To analyse the content of various published studies related to physical exercise and its effects on urinary incontinence and to determine the effectiveness of pelvic floor training programmes. We conducted a search in the databases of PubMed, CINAHL, the Cochrane Plus Library, The Cochrane Library, WOS and SPORTDiscus and a manual search in the Google Scholar metasearcher using the search descriptors for documents published in the last 10 years in Spanish or English. The documents needed to have an abstract or complete text on the treatment of urinary incontinence in female athletes and in women in general. We selected 3 full-text articles on treating urinary incontinence in female athletes and 6 full-text articles and 1 abstract on treating urinary incontinence in women in general. The 9 studies included in the review achieved positive results, i.e., there was improvement in the disease in all of the studies. Physical exercise, specifically pelvic floor muscle training programmes, has positive effects on urinary incontinence. This type of training has been shown to be an effective programme for treating urinary incontinence, especially stress urinary incontinence. Copyright © 2015 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  18. [Prevalence of urinary and anal incontinence in women from metropolitan area of Guadalajara].

    PubMed

    Martínez Espinoza, Claudia Josefina; Flores Carreras, Oscar; García de Alba García, Javier E; Velázquez Castellanos, Patricia Inés; González Ruiz, María Isabel; Márquez Allegre, René

    2006-06-01

    Female urinary and anal incontinence are common entities in pelvic floor dysfunction. The most frequently age affected range from 45 to 69 years. Previous studies performed in the United States report a prevalence of 24-62% for urinary incontinence and 3-60% for anal incontinence. To determine the prevalence of these disorders in the Guadalajara metropolitan area because we do not know it. A transversal and various stage study was performed recollecting blocks first, then houses, finally interviewing women and applying a structured questionnaire with somatometric and social-demographic data and also clinical-pathological antecedents. The data obtained was registered and processed first manually then using Excel and Epi-Info software. The group of women interviewed (n = 352) were between 15-85 years. The majority were married, housewives, 33% with grammar school, 23% finished high school, 25% professionists and 19% did not finish school; with an average of three pregnancies and with a body mass index (BMI) positive for overweight and obesity. The prevalence for urinary incontinence was 27.8% and anal incontinence of 3.4%. These are results compatible with those reported in the United States. Women living in Guadalajara have the same behavior that European and American women about prevalence of urinary incontinence. We recommend the performance of this type of studies in other states of this country in order to enrich the present information.

  19. Sonographic evaluation of the bladder neck in continent and stress-incontinent women.

    PubMed

    Schaer, G N; Perucchini, D; Munz, E; Peschers, U; Koechli, O R; Delancey, J O

    1999-03-01

    To evaluate a new sonographic method to measure depth and width of proximal urethral dilation during coughing and Valsalva maneuver and to report its use in a group of stress-incontinent and continent women. Fifty-eight women were evaluated, 30 with and 28 without stress incontinence proven urodynamically, with a bladder volume of 300 mL and the subjects upright. Urethral pressure profiles at rest were performed with a 10 French microtip pressure catheter. Bladder neck dilation and descent were assessed by perineal ultrasound (5 MHz curved linear array transducer) with the help of ultrasound contrast medium (galactose suspension-Echovist-300), whereas abdominal pressure was assessed with an intrarectal balloon catheter. Statistical analysis used the nonparametric Mann-Whitney test. The depth and diameter of urethral dilation could be measured in all women. During Valsalva, all 30 incontinent women exhibited urethral dilation. One incontinent woman showed dilation only while performing a Valsalva maneuver, not during coughing. In the continent group, 12 women presented dilation during Valsalva and six during coughing. In continent women, dilation was visible only in those who were parous. Nulliparous women did not have dilation during Valsalva or coughing. Bladder neck descent was visible in continent and incontinent women. This method permits quantification of depth and diameter of bladder neck dilation, showing that both incontinent and continent women might have bladder neck dilation and that urinary continence can be established at different locations along the urethra in different women. Parity seems to be a main prerequisite for a proximal urethral defect with bladder neck dilation.

  20. Blog text about female incontinence: presentation of self, disclosure, and social risk assessment.

    PubMed

    Saiki, Lori S; Cloyes, Kristin G

    2014-01-01

    Female urinary incontinence is a significant health concern that often remains undisclosed to healthcare providers, often because of embarrassment and fear of a negative response. The purpose of this study was to explore communication patterns found in blog text regarding self-presentation by women living with incontinence for clues to facilitate disclosure. This is a descriptive, empirical study of publically archived blog text (years inclusive 2006-2011; N = 16,629 words from 19 bloggers) by women communicating about urinary incontinence, utilizing methods of content analysis. Valence and word concordance analysis showed that words indicative of facilitating social connections were used more often in proximity with close contacts (Z = -2.68, p = .004) and words indicative of blocking social connections were used more often in proximity with community contacts (Z = -2.97, p = .002). Differences between descriptions of facilitative and blocking reactions from healthcare providers were not significant (Z = -0.28, p = .39). Cluster analysis indicated a decreasing level of negatively charged descriptors of incontinence-related communications as the context moved from the hidden self to close contacts and then to the public sphere. Word frequency analysis identified a pattern in the blog text about urinary incontinence of self-presenting as otherwise fit, healthy, and competent. Study results suggest that any report of incontinence concerns, including joking or casual references, should be addressed because women may not disclose the degree to which symptoms affect their psychosocial health. Further research is needed to explore whether providers might facilitate disclosure of urinary incontinence by first acknowledging the woman's strengths, thereby creating a sense of safety and acceptance.

  1. Urinary Incontinence and Psychosocial Factors Associated With Intimate Relationship Satisfaction Among Midlife Women.

    PubMed

    Saiki, Lori; Meize-Grochowski, Robin

    To explore associations among symptoms of urinary incontinence, severity of symptoms, and measures of psychosocial health that may be assessed during a well-woman screening examination and the possible contribution of these variables to the relationship satisfaction of partnered midlife women living with urinary incontinence. Exploratory correlational design using self-report questionnaires. Community recruitment by posted fliers, advertisements, and social media. Partnered women, ages 45 to 65 years, with urinary incontinence (N = 57). Self-report measures of severity of incontinence symptoms, relationship satisfaction, self-concept/emotional health (self-esteem, body image, depression, anxiety), and relationship factors (sexual quality of life, incontinence-related communication). Data were analyzed using Spearman rho correlation with an exploration of the contribution of study factors to relationship satisfaction through standard multiple regression. The severity of urinary incontinence symptoms had no significant correlation with scores on relationship satisfaction or psychosocial health. Measures of self-concept/emotional health and relationship factors were significantly correlated with each other (r s  = .40-.75, p < .01) and with relationship satisfaction (r s  = .35-.71, p < .05). Preliminary exploration of the contribution of study factors to relationship satisfaction through exploratory regression analysis showed unique contributions from sexual quality of life (18.7%, p < .001) and depression (8.7%, p = .004). Midlife women with urinary incontinence, regardless of symptom severity, might benefit from screening for poorer sexual quality of life and mild depression symptoms because these two study factors significantly contributed to poorer intimate relationship satisfaction among this study's participants. Copyright © 2017 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.

  2. Associations between individual characteristics and incontinence-associated dermatitis: a secondary data analysis of a multi-centre prevalence study.

    PubMed

    Kottner, Jan; Blume-Peytavi, Ulrike; Lohrmann, Christa; Halfens, Ruud

    2014-10-01

    Incontinent patients are at risk for incontinence-associated dermatitis. Prolonged exposures of the skin to urine and/or stool are causal factors but the exact aetiology and pathophysiology are not fully understood. The aim of the current investigation was to identify person and health-related variables most strongly associated with incontinence-associated dermatitis development. Secondary data analysis of a multicentre-prevalence study in 2012. Hospitals, nursing homes, home care in Austria and the Netherlands. Nursing home residents, hospital patients, home care clients who completed an incontinence assessment and who were incontinent (n = 3713). Mean age 81.2 (SD 11.2) years. Demographic, functional and physiological parameters were compared between subjects with incontinence-associated dermatitis and without. A logistic regression model predicting incontinence-associated dermatitis was build. Subjects with incontinence-associated dermatitis were statistically significantly more often male, had more often diabetes mellitus, had a higher BMI, were less often affected by urinary but more often by faecal incontinence and showed higher degrees of functional and psychical impairments. Being faecal incontinent (OR 1.70; 95% CI 1.14-2.55), having diabetes mellitus (OR 1.46; 95% CI 1.03-2.06) and having "friction and shear" problems (OR 0.65; 95% CI 0.51-0.81) according to the Braden scale item were the strongest covariates for the presence of incontinence-associated dermatitis. It is recommended to target special preventive skin care interventions especially to persons who are faecal incontinent and who have moist perineal skin, who have higher BMIs, who are diabetics, and who need increased assistance in moving. Copyright © 2014 Elsevier Ltd. All rights reserved.

  3. Rare complication of needleless mini-sling procedure: Case report.

    PubMed

    Karalar, Mustafa; Keles, Ibrahim; Unlu, Serdar; Sarici, Hasmet; Kose, Mesut; Ay, Cemil

    2017-01-01

    The mini-sling procedure is a widely used, minimally invasive treatment for stress urinary incontinence. While bladder perforation and stone formation over the mesh is not an expected complication of the mini-sling procedure, in this case, we report on the management of bladder calculi formed over the mesh, which was passed through the bladder while applying the mini-sling procedure, and was eventually removed using holmium laser. Performing cystoscopy in patients with irritative and obstructive symptoms after the sling procedure will help confirm bladder perforation, and an endoscopic approach using holmium laser is an effective treatment.

  4. Urinary Incontinence of Women in a Nationwide Study in Sri Lanka: Prevalence and Risk Factors.

    PubMed

    Pathiraja, Ramya; Prathapan, Shamini; Goonawardena, Sampatha

    2017-05-23

    Urinary incontinence, be stress incontinence or urge incontinence or a mixed type incontinence affects women of all ages. The aim of this study was to describe the prevalence and risk factors of urinary incontinence in Sri Lanka. A community based cross-sectional study was performed in Sri Lanka. The age group of the women in Sri Lanka was categorized into 3 age groups: Less than or equal to 35 years, 36 to 50 years of age and more than or equal to 51 years of age. A sample size of 675 women was obtained from each age category obtaining a total sample of 2025 from Sri Lanka. An interviewer-administered questionnaire consisting of two parts; Socio demographic factors, Medical and Obstetric History, and the King's Health Questionnaire (KHQ), was used for data collection. Stepwise logistic regression analysis was performed. The Prevalence of women with only stress incontinence was 10%, with urge incontinence was 15.6% and with stress and urge incontinence was 29.9%. Stepwise logistic regression analysis showed that the age groups of 36 - 50 years (OR = 2.03; 95% CI = 1.56 - 2.63) and 51 years and above (OR = 2.61; 95% CI= 1.95 - 3.48), Living in one of the districts in Sri Lanka (OR = 4.58; 95% CI = 3.35 - 6.27) and having given birth to multiple children (OR = 1.1; 95% CI = 1.02 - 1.21), diabetes mellitus (OR = 1.97; 95% CI = 1.19 - 3.23), and respiratory diseases (OR = 2.17; 95% CI = 1.48 - 3.19 ) showed a significant risk in the regression analysis. The risk factor, mostly modifiable, if prevented early, could help to reduce the symptoms of urinary incontinence.

  5. Randomized Controlled Study of MONARC® vs. Tension-free Vaginal Tape Obturator (TVT-O®) in the Treatment of Female Urinary Incontinence: Comparison of 3-Year Cure Rates

    PubMed Central

    Park, Yoo Jun

    2012-01-01

    Purpose Transobturator approaches to midurethral sling surgery are one of the most commonly performed operations for female stress urinary incontinence throughout the world. However, very few results of randomized clinical trials of transobturator midurethral sling surgery (MONARC vs. TVT-O) for the treatment of female urinary incontinence have been reported. In this study, we compared the 3-year follow-up cure rates of these two procedures. Materials and Methods From July 2006 to June 2008, 74 patients who had undergone MONARC (35 patients) or TVT-O (39 patients) were included in the study and were analyzed prospectively. The mean follow-up duration of both groups was 39.2 months. Preoperative and postoperative evaluations included physical examination, uroflowmetry and postvoid residual measurement, involuntary urine loss with physical activity, and urinary symptoms. Cure of female urinary incontinence was defined as patient report of no loss of urine upon physical activity. The patients' satisfaction after treatment was rated as very satisfied, satisfied, equivocal, and unsatisfied. Very satisfied and satisfied were considered as the satisfied rate. Results There were no significant differences in preoperative patient characteristics, postoperative complications, or success rate between the two groups. The cure rate of the MONARC and TVT-O groups was 85.7% and 84.6%, respectively. The patient satisfaction (very satisfied, satisfied) rate of the MONARC and TVT-O groups was 82.8% and 82.1%, respectively. Conclusions The MONARC and TVT-O procedures were equally efficient for the treatment of female urinary incontinence, with maintenance of high cure rates for 3 years. Longer follow-up is needed to confirm these results. PMID:22536469

  6. Comparative urodynamic studies of continent and stress incontinent women in pregnancy and in the puerperium.

    PubMed

    Iosif, S; Ulmsten, U

    1981-07-15

    Twelve pregnant women were examined by urethral pressure profile measurement and simultaneous urethrocystometry early in pregnancy (weeks 12 to 16), in the thirty-eighth week, and 5 to 7 days after delivery. All patients reported symptoms of stress incontinence starting at an early 5 to 7 days after delivery. All patients reported symptoms of stress incontinence starting at an early gestational age, it was found that that the stress incontinent women, compared to 14 continent, healthy women from whom measurements were obtained earlier, had shorter urethral lengths. Furthermore, no increase in urethral length during pregnancy was registered among the stress incontinent women, whereas such an increase did occur in the continent women. In contrast to the continent women, the incontinent patients had a low urethral closure pressure at rest and this pressure did not appear to increase sufficiently to compensate for the progressive increase in bladder pressure during pregnancy. As a result the urethral closure pressure in the stress incontinent women, therefore, decreased more and more during stress situations as pregnancy progressed, resulting in an increased leakage of urine.

  7. Knowledge and attitudes about urinary incontinence among community-dwelling Korean American women.

    PubMed

    Kang, Youngmi

    2009-01-01

    The purpose of this study was to explore knowledge and attitudes about urinary incontinence (UI) among Korean American women with incontinence and provide initial information needed to design education programs and culture-specific interventions. One hundred eighty-two community-dwelling Korean American women who were 30 years and older and self-identified as having UI were invited to participate in the study. Data collection was conducted in 12 Korean religious organizations. This study uses a cross-sectional descriptive design by means of interviews. The Incontinence Quiz was used to measure knowledge and attitudes about UI. Higher scores indicate greater knowledge and more positive attitudes. The mean Incontinence Quiz was 4.85 (SD = 2.75) out of 14, which was much lower than the midpoint of 7.0, indicating that respondents tended to have limited knowledge and negative attitudes toward UI. The number of correct responses to the items on the Incontinence Quiz in this sample was lower than that reported in other studies that sampled the general population. Interventions to improve Korean women's knowledge of, and attitudes toward, UI are needed. WOC and continence nurses should take an active role in educating women about the prevention and treatment of UI.

  8. The influence of obesity, constitution and physical work on the phenomenon of urinary incontinence in women.

    PubMed

    Sustersic, O; Kralj, B

    1998-01-01

    Urinary incontinence in women is a common and complex problem which can be defined and classified as stress, urge and mixed incontinence. Three of the eight most common risk factors are obesity, constitution and physical work, in addition to age, length of menstrual cycle, number of pregnancies, education and level of health awareness. Women with the diagnosis of urinary incontinence were invited to respond to questionnaires on a voluntary basis. The three factors found to be associated with urinary incontinence are increased body weight, strong osteomuscular structure and hard physical work. These indicate that the work of a health team must take a holistic approach to women even before the phenomenon of urinary incontinence occurs.

  9. Day care versus in-patient surgery for age-related cataract.

    PubMed

    Fedorowicz, Zbys; Lawrence, David; Gutierrez, Peter; van Zuuren, Esther J

    2011-07-06

    Age-related cataract accounts for more than 40% of cases of blindness in the world with the majority of people who are blind from cataract found in the developing world. With the increased number of people with cataract there is an urgent need for cataract surgery to be made available as a day care procedure. To provide reliable evidence for the safety, feasibility, effectiveness and cost-effectiveness of cataract extraction performed as day care versus in-patient procedure. We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2011, Issue 5), MEDLINE (January 1950 to May 2011), EMBASE (January 1980 to May 2011), Latin American and Caribbean Health Sciences Literature Database (LILACS) (January 1982 to May 2011), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com) and ClinicalTrials.gov (www.clinicaltrials.gov). There were no date or language restrictions in the electronic searches for trials. The electronic databases were last searched on 23 May 2011. We included randomised controlled trials comparing day care and in-patient surgery for age-related cataract. The primary outcome was the achievement of a satisfactory visual acuity six weeks after the operation. Two authors independently assessed trial quality and extracted data. We contacted study authors for additional information. Adverse effects information was collected from the trials. We included two trials (conducted in Spain and USA), involving 1284 people. One trial reported statistically significant differences in early postoperative complication rates in the day care group, with an increased risk of increased intraocular pressure, which had no clinical relevance to visual outcomes four months postoperatively. The mean change in visual acuity (Snellen lines) of the operated eye four months postoperatively was 4.1 (standard deviation (SD) 2.3) for the day care group and 4.1 (SD 2.2) for the in-patient group and not statistically

  10. Spontaneous pushing to prevent postpartum urinary incontinence: a randomized, controlled trial

    PubMed Central

    Miller, Janis M.; Guo, Ying; Ashton-Miller, James A.; DeLancey, John O. L.; Sampselle, Carolyn M.

    2014-01-01

    Introduction and hypothesis The risk for urinary incontinence can be 2.6-fold greater in women after pregnancy and childbirth compared with their never-pregnant counterparts, with the incidence increasing with parity. We tested the hypothesis that the incidence of de novo postpartum urinary incontinence in primiparous women is reduced with the use of spontaneous pushing alone or in combination with perineal massage compared with women who experienced traditional directed pushing for second-stage management. Methods This was a prospective clinical trial enrolling and randomizing 249 women into a four-group design: (1) routine care with coached or directed pushing, (2) spontaneous self-directed pushing, (3) prenatal perineal massage initiated in the third trimester, and (4) the combination of spontaneous pushing plus perineal massage. Self-report of incontinence was assessed using analysis of variance (ANOVA) and covariance (ANCOVA) models in 145 remaining women at 12 months postpartum using the Leakage Index, which is sensitive to minor leakage. Results No statistical difference in the incidence of de novo postpartum incontinence was found based on method of pushing (spontaneous/directed) (P value=0.57) or in combination with prenatal perineal massage (P value=0.57). Fidelity to pushing treatment of type was assessed and between-groups crossover detected. Conclusions Spontaneous pushing did not reduce the incidence of postpartum incontinence experienced by women 1 year after their first birth due to high cross-over between randomization groups. PMID:22829349

  11. Prospective analyses of female urinary incontinence symptoms following total hip arthroplasty.

    PubMed

    Okumura, Keiko; Yamaguchi, Kumiko; Tamaki, Tatsuya; Oinuma, Kazuhiro; Tomoe, Hikaru; Akita, Keiichi

    2017-04-01

    Some patients with hip osteoarthritis report that urinary incontinence (UI) is improved following total hip arthroplasty (THA). However, the type and severity of UI remain unclear. In this study, we hypothesize that both stress urinary incontinence (SUI) and urge urinary incontinence (UUI) are improved after THA. We assess the characteristics of UI and discuss the anatomical factors related to UI and THA for improved treatment outcome. Fifty patients with UI who underwent direct anterior-approach THA were evaluated. Type of UI was assessed using four questionnaires: Core Lower Urinary Tract Symptom Score (CLSS), Urogenital Distress Inventory Short Form (UDI-6), International Prostate Symptom Score (IPSS), and Overactive Bladder Symptom Score (OABSS). Uroflowmetry and postvoid residual urine were measured using ultrasound technology. Hip-joint function was evaluated using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and range of motion (ROM). Of the 50 patients, 21 had SUI, 16 had mixed urinary incontinence (MUI), and eight had urgency urinary incontinence (UUI). In total, 36 patients were better than improved (72 %). The rate of cured and improved was 76 % for SUI, 100 % MUI, and 50 % UUI. The improvement of ROM was more significant in cured or improved patients than in stable or worse patients. Improvement in mild UI may be an added benefit for those undergoing THA for hip-joint disorders. These data suggest that for patients with hip-joint disorder, hip-joint treatment could prove to also be a useful treatment for UI.

  12. Uncommon combinations of ICD10-PCS or ICD-9-CM operative procedure codes account for most inpatient surgery at half of Texas hospitals.

    PubMed

    O'Neill, Liam; Dexter, Franklin; Park, Sae-Hwan; Epstein, Richard H

    2017-09-01

    Recently, there has been interest in activity-based cost accounting for inpatient surgical procedures to facilitate "value based" analyses. Research 10-20years ago, performed using data from 3 large teaching hospitals, found that activity-based cost accounting was practical and useful for modeling surgeons and subspecialties, but inaccurate for individual procedures. We hypothesized that these older results would apply to hundreds of hospitals, currently evaluable using administrative databases. Observational study. State of Texas hospital discharge abstract data for 1st quarter of 2016, 4th quarter of 2015, 1st quarter of 2015, and 4th quarter of 2014. Discharged from an acute care hospital in Texas with at least 1 major therapeutic ("operative") procedure. Counts of discharges for each procedure or combination of procedures, classified by ICD-10-PCS or ICD-9-CM. At the average hospital, most surgical discharges were for procedures performed at most once a month at the hospital (54%, 95% confidence interval [CI] 51% to 55%). At the average hospital, approximately 90% of procedures were performed at most once a month at the hospital (93%, CI 93% to 94%). The percentages were insensitive to the quarter of the year. The percentages were 3% to 6% greater with ICD-10-PCS than for the superseded ICD 9 CM. There are many different procedure codes, and many different combinations of codes, relative to the number of different hospital discharges. Since most procedures at most hospitals are performed no more than once a month, activity-based cost accounting with a sample size sufficient to be useful is impractical for the vast majority of procedures, in contrast to analysis by surgeon and/or subspecialty. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Female Sexual Function Following Surgical Treatment of Stress Urinary Incontinence: Systematic Review and Meta-Analysis.

    PubMed

    Bicudo-Fürst, Maria Cláudia; Borba Leite, Pedro Henrique; Araújo Glina, Felipe Placco; Baccaglini, Willy; de Carvalho Fürst, Rafael Vilhena; Bezerra, Carlos Alberto; Glina, Sidney

    2018-04-01

    The impact of surgery for stress urinary incontinence (SUI) on female sexual function has received attention in the medical literature, but not in a structured manner. To assess the most recent evidence on the impact of surgical management for female SUI on female sexual function. The review and meta-analysis of available articles published in Medline, Cochrane, LILACS, SCOPUS, Web of Science, CINHAL, and EMBASE included prospective randomized and non-randomized studies that assessed patients who underwent surgical treatment for UI through 2 validated questionnaires: the Pelvic Organ Prolapse Urinary Incontinence Sexual Questionnaire (PISQ-12) and the Female Sexual Function Index (FSFI). The following terms were searched: (urinary incontinence OR female OR woman OR women) AND (suburethral slings OR transobturator tape* OR transobturator suburethral tape OR trans-obturator tape* OR urethral sling* OR midurethral sling* OR mid-urethral sling* OR "standard midurethral slings" OR tensionless vaginal tape* OR mini sling* OR Burch* OR "Burch colposuspension" OR "urologic surgical procedures" OR "tension-free vaginal tape" OR pubovaginal sling) AND (sexual behavior OR "Female Sexual Function Index" OR FSFI OR sexual function OR "Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire" OR PISQ-12). 1,043 articles were retrieved; 9 studies were included for qualitative analysis and 4 were included for meta-analysis. 25 articles were excluded because they used questionnaires other than the FSFI and PISQ-12. Meta-analysis of 2 studies composed of 411 women who underwent to retropubic and transobturator sling intervention and completed the PISQ-12 questionnaire showed an increase in sexual function of 2.40 points after transobturator compared with retropubic sling intervention (95% CI = -2.48 to -2.32; I 2  = 35%, P < .00001). However, 2 other studies composed of 183 women comparing the same techniques, but using the FSFI, did not show a statistically significant

  14. Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women.

    PubMed

    Woodley, Stephanie J; Boyle, Rhianon; Cody, June D; Mørkved, Siv; Hay-Smith, E Jean C

    2017-12-22

    About one-third of women have urinary incontinence and up to one-tenth have faecal incontinence after childbirth. Pelvic floor muscle training (PFMT) is commonly recommended during pregnancy and after birth for both prevention and treatment of incontinence.This is an update of a review previously published in 2012. To determine the effectiveness of pelvic floor muscle training (PFMT) in the prevention or treatment of urinary and faecal incontinence in pregnant or postnatal women. We searched the Cochrane Incontinence Specialised Register (16 February 2017) and reference lists of retrieved studies. Randomised or quasi-randomised trials in pregnant or postnatal women. One arm of the trial included PFMT. Another arm was no PFMT, usual antenatal or postnatal care, another control condition, or an alternative PFMT intervention. Review authors independently assessed trials for inclusion and risk of bias. We extracted data and checked them for accuracy. Populations included: women who were continent (PFMT for prevention), women who were incontinent (PFMT for treatment) at randomisation and a mixed population of women who were one or the other (PFMT for prevention or treatment). We assessed quality of evidence using the GRADE approach. The review included 38 trials (17 of which were new for this update) involving 9892 women from 20 countries. Overall, trials were small to moderate sized, and the PFMT programmes and control conditions varied considerably and were often poorly described. Many trials were at moderate to high risk of bias. Other than two reports of pelvic floor pain, trials reported no harmful effects of PFMT.Prevention of urinary incontinence: compared with usual care, continent pregnant women performing antenatal PFMT may have had a lower risk of reporting urinary incontinence in late pregnancy (62% less; risk ratio (RR) for incontinence 0.38, 95% confidence interval (CI) 0.20 to 0.72; 6 trials, 624 women; low-quality evidence). Similarly, antenatal PFMT

  15. Incontinence and trauma: sexual violence, female genital cutting and proxy measures of gynecological fistula.

    PubMed

    Peterman, Amber; Johnson, Kiersten

    2009-03-01

    Obstetric fistula, characterized by urinary or fecal incontinence via the vagina, has begun to receive attention on the international public health agenda, however less attention has been given to traumatic fistula. Field reports indicate that trauma contributes to the burden of vaginal fistula, especially in regions wrought by civil unrest, however evidence is largely anecdotal or facility-based. This paper specifically examines the co-occurrence of incontinence and two potential sources of trauma: sexual violence and female genital cutting using the most recent Demographic and Health Surveys in Malawi, Rwanda, Uganda and Ethiopia. Multivariate selection models are used to control for sampling differences by country. Results indicate that sexual violence is a significant determinant of incontinence in Rwanda and Malawi, however not in Uganda. Simulations predict that elimination of sexual violence would result in from a 7 to a 40% reduction of the total burden of incontinence. In contrast, no evidence is found that female genital cutting contributes to incontinence and this finding is robust for types of cutting and high risk samples. Results point to the importance of reinforcing prevention programs which seek to address prevention of sexual violence and for the integration of services to better serve women experiencing both sexual violence and incontinence.

  16. Urinary incontinence in multiple sclerosis: prevalence, severity and impact on patients' quality of life.

    PubMed

    Zecca, C; Riccitelli, G C; Disanto, G; Singh, A; Digesu, G A; Panicari, L; Puccini, F; Mattioli, M; Tubaro, A; Gobbi, C

    2016-07-01

    Lower urinary tract symptoms (LUTS) including frequent urination, nocturia and urge urinary incontinence negatively impact quality of life. This project aimed at characterizing the prevalence and severity of urinary incontinence in multiple sclerosis (MS) patients and its association with demographic and clinical features. In all, 403 consecutive clinically stable MS patients answered the International Consultation on Incontinence Questionnaire (ICIQ) and the Patient Perception of Bladder Condition (PPBC) questionnaire. Demographic and clinical parameters including the Expanded Disability Status Scale (EDSS) were collected. Statistical analyses were performed using univariate and multivariate linear regression models. Females represented 72%, relapsing-remitting patients 82%. The mean (SD) disease duration and EDSS were 11.8 (8.6) years and 3.1 (1.9) respectively. Approximately 35% of patients reported urine incontinence. ICIQ scores were positively associated with EDSS, female gender, presence of LUTS therapies and absence of disease modifying treatments (P < 0.001). PPBC scores were positively associated with EDSS and the presence of LUTS therapies (P < 0.001). Urinary incontinence is frequent in MS, prevailing in more disabled and female patients. Currently available LUTS therapies appear insufficient in the treatment of this symptom. The negative impact of urinary incontinence on quality of life is high and requires more attention in clinical management and research. © 2016 EAN.

  17. A Graduate Nursing Curriculum for the Evaluation and Management of Urinary Incontinence

    ERIC Educational Resources Information Center

    Rogalski, Nicole

    2005-01-01

    Geriatric nurse practitioners should be educated in the evaluation and treatment of common geriatric syndromes like urinary incontinence. However, many advanced-practice nursing programs do not place an educational emphasis on urinary incontinence management. The purpose of this project is to provide information that supports the need for…

  18. Identifying Patients With Vesicovaginal Fistula at High Risk of Urinary Incontinence After Surgery

    PubMed Central

    Bengtson, Angela M.; Kopp, Dawn; Tang, Jennifer H.; Chipungu, Ennet; Moyo, Margaret; Wilkinson, Jeffrey

    2016-01-01

    Objective To develop a risk score to identify women with vesicovaginal fistula at high risk of residual urinary incontinence after surgical repair. Methods We conducted a prospective cohort study among 401 women undergoing their first vesicovaginal fistula repair at a referral fistula repair center in Lilongwe, Malawi, between September 2011 and December 2014, who returned for follow-up within 120 days of surgery. We used logistic regression to develop a risk score to identify women with high likelihood of residual urinary incontinence, defined as incontinence grade 2-5 within 120 days of vesicovaginal fistula repair, based on preoperative clinical and demographic characteristics (age, number of years with fistula, HIV status, body mass index, previous repair surgery at an outside facility, revised Goh Classification, Goh vesicovaginal fistula size, circumferential fistula, vaginal scaring, bladder size, and urethral length). The sensitivity, specificity, positive and negative predictive values of the risk score at each cut-point were assessed. Results Overall, 11 (3%) women had unsuccessful fistula closure. Of those with successful fistula closure (n=372), 85 (23%) experienced residual incontinence. A risk score cut-point of 20 had sensitivity 82% (95% CI 72%, 89%) and specificity 63% (95% CI 57%, 69%) to potentially identify women with residual incontinence. In our population, the positive predictive value for a risk score cut-point of _20 or higher was 43% (95% CI 36%, 51%) and the negative predictive value was 91% (95% CI 86%, 94%). Forty-eight percent of our study population had a risk score ≥20 and therefore, would have been identified for further intervention. Conclusions A risk score 20 or higher was associated with an increased likelihood of residual incontinence, with satisfactory sensitivity and specificity. If validated in alternative settings, the risk score could be used to refer women with high likelihood of postoperative incontinence to more

  19. [Physical medicine in hospital. Minimum standards in a physical medical department in acute inpatient areas in rheumatology].

    PubMed

    Reißhauer, A; Liebl, M E

    2012-07-01

    Standards for what should be available in terms of equipment and services in a department of physical medicine caring for acute inpatients do not exist in Germany. The profile of a department determines the therapeutic services it focuses on and hence the technical facilities required. The German catalogue of operations and procedures defines minimum thresholds for treatment. In the opinion of the authors a department caring for inpatients with acute rheumatic diseases must, as a minimum, have the facilities and equipment necessary for offering thermotherapeutic treatment. Staff trained in physical therapeutic procedures and occupational therapy is also crucial. Moreover, it is desirable that the staff should be trained in manual therapy.

  20. Do women of reproductive age presenting with pelvic floor dysfunction have undisclosed anal incontinence: A retrospective cohort study.

    PubMed

    Tucker, Julie; Grzeskowiak, Luke; Murphy, Elizabeth Mary Ann; Wilson, Anne; Clifton, Vicki L

    2017-02-01

    Indirect and direct trauma following vaginal birth can negatively impact on the pelvic floor function increasing the risk of anal incontinence. It is often difficult for women to openly disclose that they have anal incontinence and there are limited data collection tools available for the identification of these women in a clinical setting. This study aims to describe the prevalence of undisclosed anal incontinence in antenatal and postnatal women with pelvic floor dysfunction. Retrospective cohort study of 230 antenatal and postnatal women referred to a Continence Nursing Service in a large tertiary hospital in South Australia, Australia, with pelvic floor dysfunction. A criteria list was utilised to access the primary reason for referral, anal incontinence assessments and attendance to an appointment. Anal incontinence was identified in 26% of women (n=59). Anal incontinence was the primary reason for referral amongst 8 women, with the remaining 51 women identified as having anal incontinence following clinical screening via phone consultation. Eighty six percent of women stated they had not previously disclosed anal incontinence to health professionals. Overall, 71% of symptomatic women (n=28 antenatal and n=14 postnatal women) attended appointments to a service specialising in pelvic floor dysfunction. Women presenting with urinary incontinence or other markers of pelvic floor dysfunction should be actively screened for anal incontinence as the prevalence of this condition is high amongst childbearing women. Copyright © 2016 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  1. Pregnancy and postpartum bowel changes: constipation and fecal incontinence.

    PubMed

    Shin, Grace Hewon; Toto, Erin Lucinda; Schey, Ron

    2015-04-01

    Pregnancy and the postpartum period are often associated with many gastrointestinal complaints, including nausea, vomiting, and heartburn; however, the most troublesome complaints in some women are defecatory disorders such as constipation and fecal incontinence, especially postpartum. These disorders are often multifactorial in etiology, and many studies have looked to see what risk factors lead to these complications. This review discusses the current knowledge of pelvic floor and anorectal physiology, especially during pregnancy, and reviews the current literature on causes and treatments of postpartum bowel symptoms of constipation and fecal incontinence.

  2. Trans-obturator vaginal tape (TOT) for female stress incontinence: one year follow-up in 120 patients.

    PubMed

    Roumeguère, Thierry; Quackels, Th; Bollens, R; de Groote, A; Zlotta, A; Bossche, M Vanden; Schulman, C

    2005-11-01

    The aim of this study was to evaluate the effectiveness of a new minimally invasive surgical procedure, the Trans-obturator Vaginal Tape (TOT) in the treatment of female urodynamic stress incontinence (USI) and to analyse functional results and quality of life after one year of follow up. 120 consecutive women with stress urinary incontinence underwent the procedure since February 2002 under general or loco-regional anesthesia. Minimum follow up was one year (range 12-30 months). Mean age was 58 years (range 31-86). 70% of the patients had pure USI. 5 patients were previously operated for USI. In 10 cases, concomitant repair of pelvic floor defects was mandatory. Collection of the data included operative time, pre- and post-operative complications. Patients were post-operatively assessed at one week, one month and one year. A validated urinary incontinence-specific measure of Quality of Life (QoL) questionnaire (Contilife) was sent and completed 12 months after surgery. The mean operative time was 12 min (range 6-30) with a catheterisation time of 0,9 day (range 0-2). No severe bleeding was observed. There were 13 minor lateral tears of the vagina without any sequelae. Three perforations of the urethra and one of the bladder occurred during the learning phase. In two cases a re-intervention was necessary for tape removal when the injury was not recognised during the procedure. Two transient urinary retention needed a supra pubic catheter and tape release. Eleven women presented transient voiding outflow obstruction. After one month, 93% patients were cured with no pad and a negative cough test with a full bladder. Uroflowmetry did not show any significant changes between pre- and post-operative time in all the population. De novo urgency occurred only in 2.5% and persistent dysuria (Qmax <10 ml/s and/or post-void residual volume >120 cc) in 4%. 80% of patients were completely dry after one year and 12% were greatly improved. According to the pre-operative maximal

  3. Current Developments and Perspectives on the Diagnosis and Treatment of Urinary Incontinence and Genital Prolapse in Women

    PubMed Central

    Naumann, G.; Kölbl, H.

    2012-01-01

    As a key area of gynaecology, urogynaecology has undergone impressive changes in the past few years. Together with the high prevalence of functional pelvic floor disorders, modern anaesthesia procedures and the introduction of new, innovative minimally invasive operation techniques have led to a dramatic increase in the number of operations for incontinence and prolapses. The increasingly subtle diagnostic options, such as, e. g., 2D and 3D sonography of the pelvic floor provide unambiguous findings and facilitate decision making. Tension-free vaginal slings in retro-pubic, trans-obturator or single-incision techniques show a high success rate with few complications and have almost completely replaced the more invasive abdominal surgical techniques for the operative management of stress incontinence. Especially for recurrent prolapse the use of alloplastic nets leads to a markedly improved anatomic and functional outcome. In spite of the euphoria about modern operation techniques and novel net materials, in-depth knowledge of pelvic floor anatomy, sufficient surgical experience and unequivocal guideline-conform indications are mandatory for satisfactory treatment outcomes. The afflicted women must be informed in detail about alternative procedures and more emphasis should be placed on conservative therapy. Novel surgical techniques should be monitored by registers or clinical trials. The professional society is called upon to improve the training curricula for pelvic floor surgery. PMID:25308980

  4. Association between urinary incontinence and depressive symptoms in overweight and obese women.

    PubMed

    Sung, Vivian W; West, Delia S; Hernandez, Alexandra L; Wheeler, Thomas L; Myers, Deborah L; Subak, Leslee L

    2009-05-01

    The objective of the study was to determine the association between urinary incontinence (UI) and depressive symptoms. The study was a cross-sectional study of 338 incontinent and overweight women at baseline in the Program to Reduce Incontinence by Diet and Exercise trial. Depressive symptoms were defined as a Beck Depression Inventory score of 10 or greater. UI frequency was determined by a 7-day voiding diary. Symptom bother and quality of life were determined using the Urogenital Distress Inventory (UDI) and the Incontinence Impact Questionnaire (IIQ). Multivariable regression was used to estimate the association between UI and depressive symptoms. Women with depressive symptoms (n = 101) reported a higher mean number of UI episodes per week (28 vs 23; P = .005) and higher (worse) mean scores on the UDI (176 vs 162; P = .02) and IIQ (136 vs 97; P < .001) compared with women without depressive symptoms. The risk of having depressive symptoms increased with each 7-episode increase in UI per week (adjusted odds ratio [AOR], 1.10; 95% confidence interval [CI], 1.01-1.21), each 50-point increase in UDI (AOR, 1.27; 95% CI, 1.01-1.60), and each 50-point increase in IIQ (AOR, 1.44; 95% CI, 1.22-1.71). Urinary incontinence frequency, symptom bother, and quality of life are independently associated with depressive symptoms in overweight and obese women.

  5. Effect of Age, Educational Status, Parity and BMI on Development of Urinary Incontinence - a Cross Sectional Study in Saudi Population.

    PubMed

    Saadia, Zaheera

    2015-08-01

    The research article looks at the background of women with urinary incontinence and exposed to different demographic factors. Women who had urinary incontinence and women without urinary incontinence were compared with regards to their demographic features and risk of development of urinary problems. These risk factors can either cause short term or temporary urinary incontinence or they can cause long term or permanent urinary incontinence. This article explores the association of age, educational status, body mass index (BMI) and parity on the development of urinary incontinence. This study aimed at conducting an analysis into the risk factors that are related to urinary incontinence. Z-tests were conducted for every demographic factor and the results are then discussed comprehensively citing various studies that have been conducted before. Analysis shows that age and BMI increase chances of urinary infection and consequently urinary incontinence. Women of lower educational levels record more cases of urinary incontinence due to lack of general information about the condition. Women with higher parity levels also record more cases of urinary infections and subsequently urinary incontinence. From the analysis above, it can be seen that these factors usually play great roles in the existence and absence of urinary incontinence especially in women in Saudi Arabia. Most important is that, its prevention is mostly by use of the risk factors mentioned here in the research. This will usually involve observing a given risk factor to a state that makes it unfavorable for urinary incontinence to occur.

  6. Correlation between urodynamic tests, history and clinical findings in treatment of women with urinary incontinence.

    PubMed

    Borges, João Bosco Ramos; Guarisi, Telma; Camargo, Ana Carolina Marchesini de; Borges, Pítia Cárita de Godoy

    2010-12-01

    The aim of this study was to evaluate the role of urodynamic test in diagnosis of urinary incontinence, comparing detailed data of history and physical examination, and some easy- to-apply clinical tests. A cross-sectional retrospective study was carried out by reviewing the medical charts of 55 patients with complaint of loss of urine, seen at the Urogynecology Service of Women's Health Outpatient Clinic of Hospital Universitário de Jundiaí, between October 2006 and March 2007. The patients answered a specific questionnaire involving the epidemiological and physical examination variables considered in this study. They were submitted to physical examination and urodynamic tests. The complaint of loss of urine upon exertion, either isolated or associated with urge incontinence, was confirmed by urodynamic tests in most women, and only 4 of 49 symptomatic women had negative results. The clinical sign was present in 35 patients (63.6%), and 46 patients (83.6%) had the exertion component in the urodynamic test. The exertion component was observed in 10 (18%) out of 15 patients without symptoms (30%). The positive and negative predictive values of the clinical sign for diagnosis of any type of urinary incontinence in this studied group were 97.1 and 26.7%, respectively. As for the clinical complaint of urinary loss upon exertion, the positive and negative predictive values for any type of urinary incontinence were 92 and 40%, respectively. For the clinical complaint of urge incontinence, the positive and negative predictive values of 92.5 and 23.1%, respectively. It was concluded that the urodynamic evaluation is an important instrument to evaluate the severity of incontinence, although it was not necessary to diagnose loss of urine. The finding of urinary loss during physical examination had low sensitivity and specificity in diagnosis of the type of loss of urine. Urodynamic tests had better performance in demonstrating urinary incontinence in patients with

  7. Urinary incontinence, fecal incontinence and pelvic organ prolapse in a population-based, racially diverse cohort. Prevalence and risk factors

    PubMed Central

    RORTVEIT, Guri; SUBAK, Leslee L.; THOM, David H.; CREASMAN, Jennifer M.; VITTINGHOFF, Eric; VAN DEN EEDEN, Stephen K.; BROWN, Jeanette S.

    2016-01-01

    Objectives We investigated the prevalence of and risk factors for combinations of urinary incontinence (UI), fecal incontinence (FI) and pelvic organ prolapse (POP) in racially diverse women over age 40. Methods The Reproductive Risks for Incontinence Study at Kaiser (RRISK) is a population-based study with data from 2106 women > 40 years. Pelvic floor conditions were determined by self-report. Risk factors were assessed by self-report, interview and record review. Independent risk factors were identified by multinomial logistic regression analysis. Results At least one pelvic floor condition was reported by 714 (34%) women. Of these, 494 (69%) had UI only, 60 (8%) POP only, and 46 (6%) had FI only. Both UI and FI were reported by 64 (9%), both UI and POP by 51 (7%). Among women with FI, 60% reported more than one condition. Corresponding figures for POP and UI were 49% and 18%. Estrogen use and constipation were shared risk factors for UI, FI and POP. BMI was a unique risk factor for UI only, diabetes for FI only and parity for POP only. No clear pattern could be found to support the hypothesis that risk factors for single conditions are more strongly associated with combined conditions. Conclusions Patients with FI or POP often have concomitant UI. These diseases both share and have unique risk factors in a complex pattern. PMID:22453506

  8. Symptom outcomes important to women with anal incontinence: a conceptual framework.

    PubMed

    Sung, Vivian W; Rogers, Rebecca G; Bann, Carla M; Arya, Lily; Barber, Matthew D; Lowder, Jerry; Lukacz, Emily S; Markland, Alayne; Siddiqui, Nazema; Wilmot, Amanda; Meikle, Susan F

    2014-05-01

    To develop a framework that describes the most important symptom outcomes for anal incontinence treatment from the patient perspective. A conceptual framework was developed by the Pelvic Floor Disorders Network based on four semistructured focus groups and confirmed in two sets of 10 cognitive interviews including women with anal incontinence. We explored: 1) patient-preferred terminology for describing anal incontinence symptoms; 2) patient definitions of treatment "success"; 3) importance of symptoms and outcomes in the framework; and 4) conceptual gaps (defined as outcomes not previously identified as important). Sessions were conducted according to grounded theory transcribed, coded, and qualitatively and quantitatively analyzed to identify relevant themes. Content and face validity of the framework were further assessed using cognitive interviews. Thirty-four women participated in focus groups and 20 in cognitive interviews. Overall, 29 (54%) were aged 60 years or older, 42 (78%) were white, and 10 (19%) had a high school degree or less. Two overarching outcome themes were identified: "primary bowel leakage symptoms" and "ancillary bowel symptoms." Subdomains important in primary bowel leakage symptoms included leakage characteristics (symptom frequency, amount of leakage, symptom bother) and conditions when bowel leakage occurs (predictability, awareness, urgency). Subdomains important under ancillary bowel symptoms included emptying disorders (constipation, obstructed defecation, and wiping issues) and discomfort (pain, burning). New outcomes identified included predictability, awareness, wiping issues, and discomfort. Women with anal incontinence desire a wide range of symptom outcomes after treatment. These are captured in our conceptual framework, which can aid clinicians and researchers in assessing anal incontinence. LEVEL OF EVIEDENCE: II.

  9. Longitudinal comparison study of pelvic floor function between women with and without stress urinary incontinence after vaginal delivery.

    PubMed

    Yoshida, Mikako; Murayama, Ryoko; Haruna, Megumi; Matsuzaki, Masayo; Yoshimura, Kenichi; Murashima, Sachiyo; Kozuma, Shiro

    2013-04-01

    To compare the pelvic floor function between women with and without stress urinary incontinence after vaginal delivery. Seventeen women (age 35.5 ± 3.5) were prospectively studied at about 6 weeks, 3 months, and 6 months after vaginal delivery. Urinary incontinence was assessed by the International Consultation on Incontinence Questionnaire - Short Form. Pelvic floor function was assessed by antero-posterior diameter of the levator hiatus using transperineal ultrasound. Five of 17 women experienced postpartum stress urinary incontinence. The antero-posterior diameter of the levator hiatus at rest was significantly longer in stress urinary incontinent women than in continent women until 3 months after delivery (p < 0.01), though shortening of the antero-posterior diameter of the levator hiatus was not significantly different between continent women and stress urinary incontinent women. Regardless of urinary incontinence, the antero-posterior diameter of the levator hiatus at rest shortened at 6 months postpartum, compared to 6 weeks postpartum (p < 0.001). The antero-posterior diameter of the levator hiatus during contraction had shortened only in continent women by 6 months postpartum (p = 0.02). The extended pelvic floor may be a cause of stress urinary incontinence in the postpartum period. Therefore, treatment to improve the extended pelvic floor should be developed for the prevention of stress urinary incontinence.

  10. Characteristics Associated With Treatment Response in Women Undergoing OnabotulinumtoxinA and Sacral Neuromodulation for Refractory Urgency Urinary Incontinence

    PubMed Central

    Richter, HE; Amundsen, CL; Erickson, SW; Jelovsek, JE; Komesu, Y; Chermansky, C; Harvie, H; Albo, M; Myers, D; Gregory, WT; Wallace, D

    2017-01-01

    Purpose To identify clinical and demographic characteristics associated with onabotulinumtoxinA and sacral neuromodulation treatment response in women with refractory urgency urinary incontinence. Material and Methods Data were analyzed from the Refractory Overactive Bladder: Sacral Neuromodulation vs Botulinum Toxin Assessment trial. Baseline participant characteristics and clinical variables associated with two definitions of treatment response: 1) reduction in mean daily urgency incontinence episodes over 6 months 2) ≥50% decrease in urgency incontinence episodes across 6 months were identified. Linear and logistic regression models were fit to estimate mean reductions in incontinence episodes and adjusted odds ratios for incidence of ≥50% decrease with 95% confidence intervals, respectively. Results For both treatments, a greater reduction in mean daily urgency incontinence episodes was associated with higher Health Utility Index scores (P=0.002) and higher baseline incontinence episodes (P<0.001). Increased age was associated with less reduction in incontinence episodes (P<0.001). Increasing body mass index (aOR 0.82 per 5 points, 95% CI 0.70, 0.96) was associated with reduced achievement of ≥50% decrease in incontinence episodes after both treatments. Greater age (aOR 0.44 per 10 years, 95% CI 0.30, 0.65) and higher functional comorbidity index (aOR 0.84 per point, 95% CI 0.71, 0.99) were associated with reduced achievement of ≥50% decrease in urgency incontinence episodes in the onabotulinuntoxinA group only (P=0.016; P=0.031, respectively). Conclusion Increasing age, body mass index, and functional comorbidity are negatively associated with treatment response while greater incontinence frequency and health utility is associated with a greater response to third line treatments for refractory urgency incontinence. PMID:28501541

  11. Involuntary reflexive pelvic floor muscle training in addition to standard training versus standard training alone for women with stress urinary incontinence: study protocol for a randomized controlled trial.

    PubMed

    Luginbuehl, Helena; Lehmann, Corinne; Baeyens, Jean-Pierre; Kuhn, Annette; Radlinger, Lorenz

    2015-11-17

    Pelvic floor muscle training is effective and recommended as first-line therapy for female patients with stress urinary incontinence. However, standard pelvic floor physiotherapy concentrates on voluntary contractions even though the situations provoking stress urinary incontinence (for example, sneezing, coughing, running) require involuntary fast reflexive pelvic floor muscle contractions. Training procedures for involuntary reflexive muscle contractions are widely implemented in rehabilitation and sports but not yet in pelvic floor rehabilitation. Therefore, the research group developed a training protocol including standard physiotherapy and in addition focused on involuntary reflexive pelvic floor muscle contractions. The aim of the planned study is to compare this newly developed physiotherapy program (experimental group) and the standard physiotherapy program (control group) regarding their effect on stress urinary incontinence. The working hypothesis is that the experimental group focusing on involuntary reflexive muscle contractions will have a higher improvement of continence measured by the International Consultation on Incontinence Modular Questionnaire Urinary Incontinence (short form), and - regarding secondary and tertiary outcomes - higher pelvic floor muscle activity during stress urinary incontinence provoking activities, better pad-test results, higher quality of life scores (International Consultation on Incontinence Modular Questionnaire) and higher intravaginal muscle strength (digitally tested) from before to after the intervention phase. This study is designed as a prospective, triple-blinded (participant, investigator, outcome assessor), randomized controlled trial with two physiotherapy intervention groups with a 6-month follow-up including 48 stress urinary incontinent women per group. For both groups the intervention will last 16 weeks and will include 9 personal physiotherapy consultations and 78 short home training sessions (weeks 1

  12. Occurrence rates and predictors of lower urinary tract symptoms and incontinence in female athletes.

    PubMed

    Simeone, C; Moroni, A; Pettenò, A; Antonelli, A; Zani, D; Orizio, C; Cosciani Cunico, S

    2010-01-01

    To assess the prevalence of lower urinary tract symptoms (LUTS) and incontinence in female athletes and to determine the etiological factors. An anonymous self-questionnaire was collected from 623 casual female athletes aged 18 to 56 years, who were involved in 12 different sports. The surveys were distributed by hand to the athletes, during their sports fitness tests, in a sports center. We investigated the relationship between urinary disorders and factors such as age, body mass index (BMI), parity, duration of physical exercise, and type of sport. The prevalence of LUTS was 54.7%, and 30% for urinary incontinence. Changes in urinary frequency were detected in 91 (14.6%) women. Prevalence of dysuria was 13.3%, urinary straining was present in 173 (27.8%) athletes, whereas urinary urgency had an estimated prevalence of 37.2% with 232 athletes suffering from this disorder. Urgency was very common in volleyball players, as was dysuria among hockey and basketball players, whereas straining mainly affected aerobic participants and cyclists. Long training hours and competitive practices were correlated with the onset of LUTS. High-impact sports were more frequently associated with incontinence, while low-impact sports with LUTS. The sport with the main number of incontinent people was football. Urge incontinence affected a lot of athletes, mainly cyclists and football players. Stress incontinence was more frequent in hockey and volleyball players. LUTS and incontinence are prevalent in female athletes. In many cases, the disorders were present only during sports activities. In this sample, the presence of urinary disorders did not seem to be a barrier during sports or exercise.

  13. Inpatient Applications of Cognitive-Behavioral Therapy

    PubMed Central

    STUART, SCOTT; THASE, MICHAEL E.

    1994-01-01

    The authors review empirical research of the past decade on cognitive-behavioral therapy (CBT) in the treatment of depressed inpatients and offer suggestions for future investigations. CBT appears to offer additive benefits in combination with pharmacotherapy, particularly after the transition from inpatient to outpatient treatment. CBT also holds promise as a primary treatment for inpatients but has not been clearly shown to be as effective as antidepressants. There is as yet no evidence that inpatient CBT is superior to other psychotherapies of comparable intensity or that short-term inpatient CBT has enduring value if not followed by outpatient therapy. Further research is needed to clarify the specific effects of CBT for inpatients and to establish its cost-effectiveness. PMID:22700196

  14. Evaluation of day care versus inpatient cataract surgery performed at a Jiangsu public Tertiary A hospital.

    PubMed

    Zhuang, Min; Cao, Juan; Cui, Minglan; Yuan, Songtao; Liu, Qinghuai; Fan, Wen

    2018-06-05

    High cataract incidence and low cataract surgical rate are serious public health problems in China, despite the fact that efficient day care cataract surgery has been implemented in some public Tertiary A hospitals in China. In this study, we compared not only clinical outcomes, hospitalization time and total costs but also payment manners between day care and inpatient procedures for cataract surgery in a Jiangsu public Tertiary A hospital to put forward several instructional suggestions for the improvement of government medical policies. In total, 4151 day care cases and 2509 inpatient cases underwent the same cataract surgery in the day care ward and ordinary ward respectively, and were defined as two groups. General information, complications, postoperative best corrected visual acuity (BCVA), hospitalization time, total costs and especially payment method were analyzed to compare day care versus inpatient. The general data display no significant differences (P > 0.05), and no significant difference between complications and postoperative BCVA were observed between the two groups (P > 0.05). The period of stay in hospital was significantly different (P < 0.001). The total costs were lower for day care than for inpatients (P < 0.001). To avoid sampling error, we analyzed the data of payment manner for each patient among this period. Day care patients tended to pay for the procedure using the Urban Employees Basic Medical Insurance (UEBMI) method, while inpatients tended to use the Out-of-Pocket Medical Treatment (OMT) payment method (P < 0.001). Day surgery of cataract is more cost-effective and efficient than inpatient surgery with equivalent clinical outcomes. As an efficient therapeutic regimen, day care surgery should be further promoted and supported by the government policies.

  15. Prevalence of stress urinary incontinence in elite female endurance athletes.

    PubMed

    Poświata, Anna; Socha, Teresa; Opara, Józef

    2014-12-09

    The goal of the study was to assess the prevalence of stress urinary incontinence in a group of elite female endurance athletes, as professional sport is one of the risk factors for stress urinary incontinence. SUI rates in the groups of female cross-country skiers and runners were compared to determine whether the training weather conditions like temperature and humidity influenced the prevalence of urinary incontinence. An anonymous questionnaire was distributed among 112 elite female athletes ie., 57 cross-country skiers and 55 runners. We used a short form of the Urogenital Distress Inventory (UDI-6) to assess the presence of SUI symptoms and the level of urogenital distress. Only women who had been practicing sport professionally for at least 3 years, on an international and national level, were included in the research. The study group consisted of 76% nulliparous and 24% parous women. 45.54% of all participants reported leakage of urine associated with sneezing or coughing which indicates stress urinary incontinence. 29.46% were not bothered by the urogenital distress symptoms. 42.86% of the participants were slightly bothered by the symptoms, 18.75% were moderately bothered, 8.04% were significantly bothered and 0.89% were heavily bothered. The absence of statistically significant differences between both groups seems to indicate that training weather conditions did not influence the prevalence of SUI in elite female endurance athletes.

  16. Prevalence of Stress Urinary Incontinence in Elite Female Endurance Athletes

    PubMed Central

    Poświata, Anna; Socha, Teresa; Opara, Józef

    2014-01-01

    The goal of the study was to assess the prevalence of stress urinary incontinence in a group of elite female endurance athletes, as professional sport is one of the risk factors for stress urinary incontinence. SUI rates in the groups of female cross-country skiers and runners were compared to determine whether the training weather conditions like temperature and humidity influenced the prevalence of urinary incontinence. An anonymous questionnaire was distributed among 112 elite female athletes ie., 57 cross-country skiers and 55 runners. We used a short form of the Urogenital Distress Inventory (UDI-6) to assess the presence of SUI symptoms and the level of urogenital distress. Only women who had been practicing sport professionally for at least 3 years, on an international and national level, were included in the research. The study group consisted of 76% nulliparous and 24% parous women. 45.54% of all participants reported leakage of urine associated with sneezing or coughing which indicates stress urinary incontinence. 29.46% were not bothered by the urogenital distress symptoms. 42.86% of the participants were slightly bothered by the symptoms, 18.75% were moderately bothered, 8.04% were significantly bothered and 0.89% were heavily bothered. The absence of statistically significant differences between both groups seems to indicate that training weather conditions did not influence the prevalence of SUI in elite female endurance athletes. PMID:25713669

  17. [Treatment of stress urinary incontinence with perineal biofeedback by using superficial electrodes].

    PubMed

    Lorenzo Gómez, M F; Silva Abuín, J M; García Criado, F J; Geanini Yagüez, A; Urrutia Avisrror, M

    2008-06-01

    We analyze the pelvic floor muscles treatment outcomes by using biofeedback (BFB) with electromyography with superficial electrodes in women diagnosed as having stress urinary incontinence (SUI). Besides, we compare this treatment with pelvic floor muscle exercises (PFME) plus vaginal electrostimulation. 85 women with stress urinary incontinence, aged 42 - 74 years. We divided the patients in two groups: Group 1 (N = 50): This patients carry out a perineal biofeedback with superficial electrodes without electrostimulation, and Group 2 (N = 35): This patients were treated with pelvis floor muscle exercices and vaginal electrostimulation. All patients carry out two session per week (of 30 minutes each one) during ten weeks. We assess the outcomes through international urinary incontinence questionnaires (IU-5 and ICIQ-SF) and urinary incontinence related quality of life test (King's questionnaire). Student t-test and Fisher Exact test were used, p < 0.05 was considered statistically significant. No difference was found in the age average of both groups. 84% of patients of group 1 and 80% of patients of group 2 were cured with the treatment. We assumed they were cured when incontinence episodes not happened or they do not need to use absorbent materials. In the Group 1, 50% of patients in the fourth week and 84% in the tenth week were cured. In the Group 2, 71.42% of patients in the fourth week and 80% in the tenth week were cured. In the Group 2, eight patients (22.85%) complained side effects. Both groups improved the quality of life similarly. Grade 1 and grade 2 stress urinary incontinence treatment by using perineal biofeedback with superficial electrodes electromyography is better or similar to more invasive treatments. Also pelvic floor muscle exercices plus vaginal electrostimulation have good outcomes although some patients complain side effects. Both conservative treatments are effective and feasible.

  18. 42 CFR 424.14 - Requirements for inpatient services of inpatient psychiatric facilities.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... psychiatric facilities. 424.14 Section 424.14 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... Certification and Plan Requirements § 424.14 Requirements for inpatient services of inpatient psychiatric... requirements differ from those for other hospitals because the care furnished in psychiatric hospitals is often...

  19. Anorectal function investigations in incontinent and continent patients. Differences and discriminatory value.

    PubMed

    Felt-Bersma, R J; Klinkenberg-Knol, E C; Meuwissen, S G

    1990-06-01

    Anal manometry, rectal capacity measurement, and the saline-infusion test were performed in 350 patients, 178 of whom had fecal incontinence and 172 of whom were continent. Anal manometry was also performed in 80 control subjects, whose results were compared with the patients. Women and older patients exhibited lower pressures. Compared with continent patients, incontinent patients had lower anal sphincter pressures at rest and during squeeze, a smaller rectal capacity, and leaked earlier and more with the saline infusion test. Differentiation between incontinent and continent patients was not possible with a single test because there was complete overlap. The maximum squeeze pressure showed the best discrimination. Combining the three tests did not show better discrimination than any individual test. Anal pressure and rectal capacity below the normal range only were found in very few incontinent patients. The authors' study demonstrates that no prediction can be made about continence with anorectal function tests. Therefore, in the individual patient, an abnormal result in one test must be interpreted with caution and only in relationship with other tests, especially when therapeutic surgery is considered.

  20. Controlling inpatient psychiatric utilization through managed care.

    PubMed

    Wickizer, T M; Lessler, D; Travis, K M

    1996-03-01

    There is little current understanding of how managed care strategies affect hospital inpatient psychiatric care for mentally ill patients. This study examined one prominent form of managed care, utilization management, which reviews requests for psychiatric care and authorizes provision of care deemed appropriate and clinically necessary. The authors analyzed data on 2,265 utilization management reviews conducted during 1989-1992 for patients insured by a single large commercial insurance company. Three utilization management procedures were examined: preadmission review, continued-stay review, and case management. The performance indicators analyzed included percent of admission requests granted, number of days requested and approved, and number of treatment extensions granted. Utilization management initially approved inpatient psychiatric treatment for nearly all (98.8%) of the patients but authorized, on average, only one-third of the days requested (6.9 versus 19.0). On average, 23.5 (total) days of care were requested and 16.8 days were approved. Care for patients with alcohol or drug dependence diagnoses was more restricted than was care for other patients. These data suggest that managed care does restrict inpatient psychiatric care, primarily by managing length of stay. The fact that almost all patients were approved for the same initial length of stay implies adherence to strict treatment protocols that do not distinguish among different clinical or patient factors. There is a need for careful study of the effects of managed care on outcomes and quality of psychiatric care.

  1. Pelvic-floor strength in women with incontinence as assessed by the brink scale.

    PubMed

    FitzGerald, Mary P; Burgio, Kathryn L; Borello-France, Diane F; Menefee, Shawn A; Schaffer, Joseph; Kraus, Stephen; Mallett, Veronica T; Xu, Yan

    2007-10-01

    The purpose of this study was to describe how clinical pelvic-floor muscle (PFM) strength (force-generating capacity) is related to patient characteristics, lower urinary tract symptoms, and fecal incontinence symptoms. Data were obtained from 643 women who were participating in a randomized surgical trial for treatment of stress urinary incontinence. Patient demographic variables, baseline urinary and fecal incontinence symptom questionnaires, urodynamic data and urinary diary data, pad test results, and standardized assessment of pelvic organ support were compared with PFM strength as described by the Brink scoring system. Bivariate analysis of factors associated with the Brink scale score was done using analysis of variance and linear regression. Multivariate analysis included patient variables that were significant on bivariate analysis. The mean Brink scale score was 9 (SD=2) and did not vary widely in this large, but highly select, patient sample. We found a weak, but statistically strong, relationship between age and Brink score. Brink scores were not related to diary and pad test measures of incontinence severity. Overall, PFM strength was good in this sample of women with stress incontinence. Scores tended to be similar, and it is possible that the Brink scale does not reflect real clinical differences in PFM strength.

  2. Recurrent obstetric anal sphincter injury and the risk of long-term anal incontinence.

    PubMed

    Jangö, Hanna; Langhoff-Roos, Jens; Rosthøj, Susanne; Sakse, Abelone

    2017-06-01

    Women with an obstetric anal sphincter injury are concerned about the risk of recurrent obstetric anal sphincter injury in their second pregnancy. Existing studies have failed to clarify whether the recurrence of obstetric anal sphincter injury affects the risk of anal and fecal incontinence at long-term follow-up. The objective of the study was to evaluate whether recurrent obstetric anal sphincter injury influenced the risk of anal and fecal incontinence more than 5 years after the second vaginal delivery. We performed a secondary analysis of data from a postal questionnaire study in women with obstetric anal sphincter injury in the first delivery and 1 subsequent vaginal delivery. The questionnaire was sent to all Danish women who fulfilled inclusion criteria and had 2 vaginal deliveries 1997-2005. We performed uni- and multivariable analyses to assess how recurrent obstetric anal sphincter injury affects the risk of anal incontinence. In 1490 women with a second vaginal delivery after a first delivery with obstetric anal sphincter injury, 106 had a recurrent obstetric anal sphincter injury. Of these, 50.0% (n = 53) reported anal incontinence compared with 37.9% (n = 525) of women without recurrent obstetric anal sphincter injury. Fecal incontinence was present in 23.6% (n = 25) of women with recurrent obstetric anal sphincter injury and in 13.2% (n = 182) of women without recurrent obstetric anal sphincter injury. After adjustment for third- or fourth-degree obstetric anal sphincter injury in the first delivery, maternal age at answering the questionnaire, birthweight of the first and second child, years since first and second delivery, and whether anal incontinence was present before the second pregnancy, the risk of flatal and fecal incontinence was still increased in patients with recurrent obstetric anal sphincter injury (adjusted odds ratio, 1.68 [95% confidence interval, 1.05-2.70), P = .03, and adjusted odds ratio, 1.98 [95% confidence interval, 1

  3. A retrospective review of fall risk factors in the bone marrow transplant inpatient service.

    PubMed

    Vela, Cory M; Grate, Lisa M; McBride, Ali; Devine, Steven; Andritsos, Leslie A

    2018-06-01

    Purpose The purpose of this study was to compare medications and potential risk factors between patients who experienced a fall during hospitalization compared to those who did not fall while admitted to the Blood and Marrow Transplant inpatient setting at The James Cancer Hospital. Secondary objectives included evaluation of transplant-related disease states and medications in the post-transplant setting that may lead to an increased risk of falls, post-fall variables, and number of tests ordered after a fall. Methods This retrospective, case-control study matched patients in a 2:1 ratio of nonfallers to fallers. Data from The Ohio State University Wexner Medical Center (OSUWMC) reported fall events and patient electronic medical records were utilized. A total of 168 adult Blood and Marrow Transplant inpatients with a hematological malignancy diagnosis were evaluated from 1 January 2010 to 30 September 2012. Results Univariable and multivariable conditional logistic regression models were used to assess the relationship between potential predictor variables of interest and falls. Variables that were found to be significant predictors of falls from the univariable models include age group, incontinence, benzodiazepines, corticosteroids, anticonvulsants and antidepressants, and number of days status-post transplant. When considered for a multivariable model age group, corticosteroids, and a cancer diagnosis of leukemia were significant in the final model. Conclusion Recent medication utilization such as benzodiazepines, anticonvulsants, corticosteroids, and antidepressants placed patients at a higher risk of experiencing a fall. Other significant factors identified from a multivariable analysis found were patients older than age 65, patients with recent corticosteroid administration and a cancer diagnosis of leukemia.

  4. [Recommendations for the urodynamic examination in the investigation of non-neurological female urinary incontinence].

    PubMed

    Hermieu, Jean François

    2007-11-01

    INDICATIONS FOR URODYNAMIC ASSESSMENT IN WOMEN: Urodynamic assessment is not useful for the diagnosis of female urinary incontinence which remains a clinical diagnosis. Before any form of surgery for pure stress urinary incontinence, evaluation of bladder emptying by determination of maximum flow rate and residual urine is recommended. In the presence of pure stress urinary incontinence with no other associated clinical symptoms, a complete urodynamic assessment is not mandatory, but can be helpful to define the prognosis and inform the patient about her vesicosphincteric function. On the other hand, a complete urodynamic assessment is recommended to investigate complex or complicated urinary incontinence, mainly in the case of: history of surgery for urinary incontinence. urgency with or without urine leakage, severe urinary incontinence, voiding abnormalities, negative cough test, decreased bladder capacity, suspected obstruction or decreased bladder contractility, failure of first-line treatment. PATIENT PREPARATION: The patient should be thoroughly informed about the examination procedure and its possible consequences. The patient should be advised to attend the examination with a normal desire to urinate. Urodynamic assessment must not be performed in the presence of untreated urinary tract infection. Antibiotic prophylaxis is not recommended. UROFLOWMETRY: The flowmeter must be regularly calibrated and must be installed in a quiet room. Whenever possible, uroflowmetry should be performed before cystometry with a normal desire to urinate. The patient should be advised to urinate normally without straining and by staying as relaxed as possible. During voiding, all of the stream must enter the flowmeter. The main parameters recorded are Qmax (expressed in ml/s), the voided volume (expressed in ml), and the appearance of the curve. The examination must be interpreted manually without taking into account the automated interpretation. GUIDELINES CONCERNING

  5. Static postural stability in women with stress urinary incontinence: Effects of vision and bladder filling.

    PubMed

    Chmielewska, Daria; Stania, Magdalena; Słomka, Kajetan; Błaszczak, Edward; Taradaj, Jakub; Dolibog, Patrycja; Juras, Grzegorz

    2017-11-01

    This case-control study was designed to compare static postural stability between women with stress urinary incontinence and continent women and it was hypothesized that women with incontinence aged around 50 years also have balance disorders. Eighteen women with incontinence and twelve women without incontinence aged 50-55 years participated in two 60-s trials of each of four different testing conditions: eyes open/full bladder, eyes open/empty bladder, eyes closed/full bladder, eyes closed/empty bladder. The center of foot pressure (COP): sway range, root mean square, velocity (in the antero-posterior and medio-lateral directions), and COP area were recorded. The stabilograms were decomposed into rambling and trembling components. The groups of women with and without incontinence differed during the full bladder condition in antero-posterior COP sway range, COP area, and rambling trajectory (range in the antero-posterior and medio-lateral directions, root mean square in the antero-posterior and medio-lateral directions and velocity in the antero-posterior direction). The women with incontinence had more difficulty controlling their postural balance than continent women while standing with a full bladder. Therefore, developing therapeutic management focused on strengthening the women's core muscles and improving their postural balance seems advisable. © 2017 Wiley Periodicals, Inc.

  6. Macrovascular Complications and Prevalence of Urgency Incontinence in Japanese Patients with Type 2 Diabetes Mellitus: The Dogo Study.

    PubMed

    Furukawa, Shinya; Sakai, Takenori; Niiya, Tetsuji; Miyaoka, Hiroaki; Miyake, Teruki; Yamamoto, Shin; Kanzaki, Sayaka; Maruyama, Koutatsu; Tanaka, Keiko; Ueda, Teruhisa; Senba, Hidenori; Torisu, Masamoto; Minami, Hisaka; Onji, Morikazu; Tanigawa, Takeshi; Matsuura, Bunzo; Hiasa, Yoichi; Miyake, Yoshihiro

    2017-01-01

    Objective Macrovascular diseases and urgency incontinence are common among Japanese patients with type 2 diabetes mellitus. However, little evidence exists regarding the association between stroke and urgency incontinence among patients with type 2 diabetes mellitus. We examined the associations between macrovascular complications and urgency incontinence among Japanese patients with type 2 diabetes mellitus. Methods The study subjects were 818 Japanese patients with type 2 diabetes mellitus. Urgency incontinence was defined as present when a subject answered "once a week or more" to the question: "Within one week, how often do you leak urine because you cannot defer the sudden desire to urinate?" We adjusted our analyses for sex, age, body mass index, duration of type 2 diabetes, current smoking, current drinking, hypertension, dyslipidemia, glycated hemoglobin, diabetic nephropathy, diabetic retinopathy, and diabetic peripheral neuropathy. Results The prevalence of urgency incontinence was 9.2%. Stroke was independently positively associated with urgency incontinence, with an adjusted odds ratio of 2.34 (95% confidence interval: 1.03-4.95). The associations between ischemic heart disease or peripheral artery disease and the prevalence of urgency incontinence were not significant. Conclusion In Japanese patients with type 2 diabetes mellitus, stroke, but not ischemic heart diseases or peripheral artery disease, was independently positively associated with urgency incontinence.

  7. [Robot assisted Frykman-Goldberg procedure. Case report].

    PubMed

    Zubieta-O'Farrill, Gregorio; Ramírez-Ramírez, Moisés; Villanueva-Sáenz, Eduardo

    2017-12-01

    Rectal prolapse is defined as the protrusion of the rectal wall through the anal canal; with a prevalence of less than 0.5%. The most frequent symptoms include pain, incomplete defecation sensation with blood and mucus, fecal incontinence and/or constipation. The surgical approach can be perineal or abdominal with the tendency for minimal invasion. Robot-assisted procedures are a novel option that offer technique advantages over open or laparoscopic approaches. 67 year-old female, who presented with rectal prolapse, posterior to an episode of constipation, that required manual reduction, associated with transanal hemorrhage during defecation and occasional fecal incontinence. A RMI defecography was performed that reported complete rectal and uterine prolapse, and cystocele. A robotic assisted Frykman-Goldberg procedure wass performed. There are more than 100 surgical procedures for rectal prolapse treatment. We report the first robot assisted procedure in Mexico. Robotic assisted surgery has the same safety rate as laparoscopic surgery, with the advantages of better instrument mobility, no human hand tremor, better vision, and access to complicated and narrow areas. Robotic surgery as the surgical treatment is a feasible, safe and effective option, there is no difference in recurrence and function compared with laparoscopy. It facilitates the technique, improves nerve preservation and bleeding. Further clinical, prospective and randomized studies to compare the different minimal invasive approaches, their functional and long term results for this pathology are needed. Copyright © 2016 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

  8. [Raz's technics in the surgical treatment of stress urinary incontinence in women].

    PubMed

    Gutiérrez Baños, J L; de Diego Rodríguez, E; Portillo Martín, J A; Martín García, B; Hernández Rodríguez, R; Correas Gómez, M A; del Valle Schaan, J I; Roca Edreira, A; Rado Velázquez, M A

    1999-05-01

    To analyze our results in the surgery of the stress urinary incontinence in women with the Raz's techniques, to assess the association among continence and factors like surgical technique, grade of incontinence and urethral pressure profile. We do a retrospective study of 88 operations in 81 patients between the first of January 1990 and the thirty-one of December 1998. We describe the patients, previous treatments, grade of incontinence ans urodynamics data. We analyze the pre and post-operative complications. The outcome is evaluated by the Kaplan-Meier method, and the results are compared by the log rank test. 11 patients had a previous surgery and 7 had done physiotherapy; the grade of incontinence was 1 in 7 patients, 2 in 56 and 3 in 18. There were neither significative difference between UPP and abdominal leak point pressure and grade of incontinence nor between those parameters and continence. We did the Raz 1 technique in 67 patients, Raz 2 in 3, Raz 3 in 18. There were no significant difference among them. There are a progressive loose in the continence rate along the two first years; after that the continence rates are stabilized about 75%. The complications rate was scarce, except for the postoperative urinary retention, that reached the 20.45%. Our results are similar to those cited in the bibliography, mainly in the Spanish one. The highest rate of failure is in the two first years.

  9. Brain Mechanisms Underlying Urge Incontinence and its Response to Pelvic Floor Muscle Training.

    PubMed

    Griffiths, Derek; Clarkson, Becky; Tadic, Stasa D; Resnick, Neil M

    2015-09-01

    Urge urinary incontinence is a major problem, especially in the elderly, and to our knowledge the underlying mechanisms of disease and therapy are unknown. We used biofeedback assisted pelvic floor muscle training and functional brain imaging (functional magnetic resonance imaging) to investigate cerebral mechanisms, aiming to improve the understanding of brain-bladder control and therapy. Before receiving biofeedback assisted pelvic floor muscle training functionally intact, older community dwelling women with urge urinary incontinence as well as normal controls underwent comprehensive clinical and bladder diary evaluation, urodynamic testing and brain functional magnetic resonance imaging. Evaluation was repeated after pelvic floor muscle training in those with urge urinary incontinence. Functional magnetic resonance imaging was done to determine the brain reaction to rapid bladder filling with urgency. Of 65 subjects with urge urinary incontinence 28 responded to biofeedback assisted pelvic floor muscle training with 50% or greater improvement of urge urinary incontinence frequency on diary. However, responders and nonresponders displayed 2 patterns of brain reaction. In pattern 1 in responders before pelvic floor muscle training the dorsal anterior cingulate cortex and the adjacent supplementary motor area were activated as well as the insula. After the training dorsal anterior cingulate cortex/supplementary motor area activation diminished and there was a trend toward medial prefrontal cortex deactivation. In pattern 2 in nonresponders before pelvic floor muscle training the medial prefrontal cortex was deactivated, which changed little after the training. In older women with urge urinary incontinence there appears to be 2 patterns of brain reaction to bladder filling and they seem to predict the response and nonresponse to biofeedback assisted pelvic floor muscle training. Moreover, decreased cingulate activation appears to be a consequence of the improvement

  10. Procedure for prolapse and hemorrhoids vs traditional surgery for outlet obstructive constipation.

    PubMed

    Lu, Ming; Yang, Bo; Liu, Yang; Liu, Qing; Wen, Hao

    2015-07-14

    To compare the clinical efficacies of two surgical procedures for hemorrhoid rectal prolapse with outlet obstruction-induced constipation. One hundred eight inpatients who underwent surgery for outlet obstructive constipation caused by internal rectal prolapse and circumferential hemorrhoids at the First Affiliated Hospital of Xinjiang Medical University from June 2012 to June 2013 were prospectively included in the study. The patients with rectal prolapse hemorrhoids with outlet obstruction-induced constipation were randomly divided into two groups to undergo either a procedure for prolapse and hemorrhoids (PPH) (n = 54) or conventional surgery (n = 54; control group). Short-term (operative time, postoperative hospital stay, postoperative urinary retention, postoperative perianal edema, and postoperative pain) and long-term (postoperative anal stenosis, postoperative sensory anal incontinence, postoperative recurrence, and postoperative difficulty in defecation) clinical effects were compared between the two groups. The short- and long-term efficacies of the two procedures were determined. In terms of short-term clinical effects, operative time and postoperative hospital stay were significantly shorter in the PPH group than in the control group (24.36 ± 5.16 min vs 44.27 ± 6.57 min, 2.1 ± 1.4 d vs 3.6 ± 2.3 d, both P < 0.01). The incidence of postoperative urinary retention was higher in the PPH group than in the control group, but the difference was not statistically significant (48.15% vs 37.04%). The incidence of perianal edema was significantly lower in the PPH group (11.11% vs 42.60%, P < 0.05). The visual analogue scale scores at 24 h after surgery, first defecation, and one week after surgery were significantly lower in the PPH group (2.9 ± 0.9 vs 8.3 ± 1.1, 2.0 ± 0.5 vs 6.5 ± 0.8, and 1.7 ± 0.5 vs 5.0 ± 0.7, respectively, all P < 0.01). With regard to long-term clinical effects, the incidence of anal stenosis was lower in the PPH group than in

  11. Procedure for prolapse and hemorrhoids vs traditional surgery for outlet obstructive constipation

    PubMed Central

    Lu, Ming; Yang, Bo; Liu, Yang; Liu, Qing; Wen, Hao

    2015-01-01

    AIM: To compare the clinical efficacies of two surgical procedures for hemorrhoid rectal prolapse with outlet obstruction-induced constipation. METHODS: One hundred eight inpatients who underwent surgery for outlet obstructive constipation caused by internal rectal prolapse and circumferential hemorrhoids at the First Affiliated Hospital of Xinjiang Medical University from June 2012 to June 2013 were prospectively included in the study. The patients with rectal prolapse hemorrhoids with outlet obstruction-induced constipation were randomly divided into two groups to undergo either a procedure for prolapse and hemorrhoids (PPH) (n = 54) or conventional surgery (n = 54; control group). Short-term (operative time, postoperative hospital stay, postoperative urinary retention, postoperative perianal edema, and postoperative pain) and long-term (postoperative anal stenosis, postoperative sensory anal incontinence, postoperative recurrence, and postoperative difficulty in defecation) clinical effects were compared between the two groups. The short- and long-term efficacies of the two procedures were determined. RESULTS: In terms of short-term clinical effects, operative time and postoperative hospital stay were significantly shorter in the PPH group than in the control group (24.36 ± 5.16 min vs 44.27 ± 6.57 min, 2.1 ± 1.4 d vs 3.6 ± 2.3 d, both P < 0.01). The incidence of postoperative urinary retention was higher in the PPH group than in the control group, but the difference was not statistically significant (48.15% vs 37.04%). The incidence of perianal edema was significantly lower in the PPH group (11.11% vs 42.60%, P < 0.05). The visual analogue scale scores at 24 h after surgery, first defecation, and one week after surgery were significantly lower in the PPH group (2.9 ± 0.9 vs 8.3 ± 1.1, 2.0 ± 0.5 vs 6.5 ± 0.8, and 1.7 ± 0.5 vs 5.0 ± 0.7, respectively, all P < 0.01). With regard to long-term clinical effects, the incidence of anal stenosis was lower in

  12. CONSIDER - Core Outcome Set in IAD Research: study protocol for establishing a core set of outcomes and measurements in incontinence-associated dermatitis research.

    PubMed

    Van den Bussche, Karen; De Meyer, Dorien; Van Damme, Nele; Kottner, Jan; Beeckman, Dimitri

    2017-10-01

    This study protocol describes the methodology for the development of a core set of outcomes and a core set of measurements for incontinence-associated dermatitis. Incontinence is a widespread disorder with an important impact on quality of life. One of the most common complications is incontinence-associated dermatitis, resulting from chemical and physical irritation of the skin barrier, triggering inflammation and skin damage. Managing incontinence-associated dermatitis is an important challenge for nurses. Several interventions have been assessed in clinical trials, but heterogeneity in study outcomes complicates the comparability and standardization. To overcome this challenge, the development of a core outcome set, a minimum set of outcomes and measurements to be assessed in clinical research, is needed. A project team, International Steering Committee and panelists will be involved to guide the development of the core outcome set. The framework of the Harmonizing Outcomes Measures for Eczema roadmap endorsed by Cochrane Skin Group Core Outcomes Set Initiative, is used to inform the project design. A systematic literature review, interviews to integrate the patients' perspective and a consensus study with healthcare researchers and providers using the Delphi procedure will be performed. The project was approved by the Ethics review Committee (April 2016). This is the first project that will identify a core outcome set of outcomes and measurements for incontinence-associated dermatitis research. A core outcome set will reduce possible reporting bias, allow results comparisons and statistical pooling across trials and strengthen evidence-based practice and decision-making. This project has been registered in the Core Outcome Measures in Effectiveness Trials (COMET) database and is part of the Cochrane Skin Group Core Outcomes Set Initiative (CSG-COUSIN). © 2016 John Wiley & Sons Ltd.

  13. [A comparative study on treating femal stress urinary incontinence with TVT-Abbrevo and TVT-Obturator].

    PubMed

    Li, W L; Lu, Z W; Li, F P; Yu, H Y

    2016-07-26

    To compare the effectiveness and complications of TVT-Abbrevo (tension-free vaginal tape-Abbrevo) and TVT-Obturator (tension-free vaginal tape-obturator) for the treatment of female stress urinary incontinence (SUI). From Nov.2012 to Nov.2013, 117 patients suffering from SUI were treated with TVT-Abbrebo (n=79) or TVT-Obturator (n=38) procedure, the clinical efficacy and operation-correlated complications were observed. A total of 117 cases, 107 cases of urinary incontinence symptoms disappeared completely, 10 cases were improved. 72 cases (91.1%) were cured and 7 cases (8.9%) were improved in TVT-Abbrevo group; 35 cases (92.1%) were cured and 3 cases (7.9%) were improved in TVT-Obturator group. No significant differences could be found for the curing rates between two groups (P>0.05). Compared with the TVT-Obturator group, the TVT-Abbrevo group had less patients complaining of inner thigh pain at 24 h and 1 w after surgery (P<0.05). No significant differences were observed for the incidence of inner thigh pain at 1m and 1y after surgery between TVT-Abbrevo and TVT-Obturator group (P>0.05). No intraoperative complications such as blood vessel, nerve, bladder damage were recorded and no postoperative retropubic hematoma, tape adjustment and other complications occurred in two goups. No recurrence after 1 year follow-up. The study shows that TVT-Abbrevo procedure is safe and efficacy in treatment of SUI, and associated with low incidence of recent postoperative inner thigh pain.

  14. Do Intra-anal Bowel Management Devices Reduce Incontinence-Associated Dermatitis and/or Pressure Injuries?

    PubMed

    Beeson, Terrie; Eifrid, Bethany; Pike, Caitlin A; Pittman, Joyce

    The purpose of this article was to examine the evidence and provide recommendations related to the effectiveness of intra-anal bowel management systems including intra-anal bowel catheters and rectal trumpets in reducing incontinence-associated dermatitis and pressure injuries. Does the use of an intra-anal bowel management system (intra-anal bowel catheter or rectal trumpet) reduce incontinence-associated skin damage and/or hospital-acquired pressure injuries in the acute care adult patient population? A search of the literature was performed by a trained university librarian, which resulted in 133 articles that examined intra-anal bowel management systems (intra-anal bowel catheter and rectal trumpet), incontinence-associated dermatitis, and pressure injuries. A systematic approach was used to review titles, abstracts, and text yielding 6 studies that met inclusion criteria. Strength of the evidence was rated using rating methodology from Essential Evidence Plus: Levels of evidence and Oxford Center for Evidence-based Medicine, adapted by Gray and colleagues. Five of the 6 studies reported positive results concerning the effectiveness of intra-anal bowel management systems to reduce incontinence-associated dermatitis and/or pressure injuries. One randomized control trial found no improvement in incontinence-associated dermatitis in the intra-anal bowel management system (intra-anal bowel catheter or rectal trumpet) groups or pressure injuries as compared to usual care. The strength of the evidence for the identified studies was moderate (2 level A, 3 level B, and 1 level C). An important finding in 2 of the studies was the safety of the intra-anal bowel management systems-both intra-anal bowel catheter and rectal trumpet. Evidence indicates intra-anal bowel management system (intra-anal bowel catheters and rectal trumpet) provides a viable option for fecal incontinence management and these devices reduce incontinence-associated dermatitis and/or pressure injuries.

  15. Low-Dose Intravaginal Estriol and Pelvic Floor Rehabilitation in Post-Menopausal Stress Urinary Incontinence.

    PubMed

    Castellani, Daniele; Saldutto, Pietro; Galica, Vikiela; Pace, Gianna; Biferi, Daniela; Paradiso Galatioto, Giuseppe; Vicentini, Carlo

    2015-01-01

    Pelvic floor muscle training (PFMT) and electrical stimulation (ES) are conservative models of therapy for treating female stress urinary incontinence (SUI). The presence of estradiol receptors in the lower urinary tract advances the case for estradiol therapy in SUI. The aim of our study was to investigate the effects of the combination of pelvic floor rehabilitation and intravaginal estriol (IE) on SUI treatment in postmenopausal women. Sixty-two women with SUI were randomized to PFMT, ES and biofeedback (Group 1) or the same treatment plus 1 mg IE (Group 2) for 6 months. Patients were evaluated with medical history, pelvic examination, urodynamics, 24-hour pad test. Urinary incontinence was evaluated using the International Consultation on Incontinence questionnaire on urinary incontinence short form and quality of life using the Incontinence Impact Questionnaire-Short Form. Two patients were lost at follow-up and one discontinued the study. Mean urine leakage at the 24-hour pad test dropped from 42.3 ± 20.2 g/die to 31.5 ± 14.2 g/die in Group 1 and from 48.3 ± 19.8 g/die to 22.3 ± 10.1 g/die in Group 2. Symptoms scores and incontinence status were statistically significant better in Group 2 when compared to Group 1. IE added to PFMT, ES and BF is a safe and efficacious first-line therapy in postmenopausal women with SUI. © 2015 S. Karger AG, Basel.

  16. Pad per day usage, urinary incontinence and urinary tract infections in nursing home residents.

    PubMed

    Omli, Ragnhild; Skotnes, Liv Heidi; Romild, Ulla; Bakke, August; Mykletun, Arnstein; Kuhry, Esther

    2010-09-01

    many elderly suffer from urinary incontinence and use absorbent pads. Pad use per day (PPD) is a frequently used measure of urinary incontinence. Nursing home residents are often dependent on help from nursing staff to change pads. This study was performed in order to determine whether PPD is a reliable method to quantify urinary incontinence in nursing home residents. Furthermore, the association between urinary tract infections (UTIs), PPD and fluid intake was studied. data were retrieved from a multicentre, prospective surveillance among nursing home residents. Data on the use of absorbent pads, fluid intake and incontinence volumes were collected during 48 h. During a 1-year follow-up period, data on UTIs were collected. in this study, 153 residents were included, of whom 118 (77%) used absorbent pads. Residents who used absorbent pads were at increased risk of developing UTIs compared to residents who did not use pads (41 vs 11%; P = 0.001). Daily fluid intake was not associated with UTIs (P = 0.46). The number of pad changes showed no correlation with the risk of developing UTIs (P = 0.62). Patients with a given PPD presented a wide range of incontinence volumes. the use of absorbent pads is associated with an increased risk of developing UTIs. PPD and daily fluid intake are not correlated with the risk of developing UTIs. PPD is an unreliable measure of urinary incontinence in nursing home residents.

  17. Late Fecal Incontinence After High-Dose Radiotherapy for Prostate Cancer: Better Prediction Using Longitudinal Definitions

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Fiorino, Claudio, E-mail: fiorino.claudio@hsr.it; Rancati, Tiziana; Fellin, Gianni

    2012-05-01

    Purpose: To model late fecal incontinence after high-dose prostate cancer radiotherapy (RT) in patients accrued in the AIROPROS (prostate working group of the Italian Association of Radiation Oncology) 0102 trial using different endpoint definitions. Methods and Materials: The self-reported questionnaires (before RT, 1 month after RT, and every 6 months for {<=}3 years after RT) of 586 patients were available. The peak incontinence (P{sub I}NC) and two longitudinal definitions (chronic incontinence [C{sub I}NC], defined as the persistence of Grade 1 or greater incontinence after any Grade 2-3 event; and mean incontinence score [M{sub I}NC], defined as the average score duringmore » the 3-year period after RT) were considered. The correlation between the clinical/dosimetric parameters (including rectal dose-volume histograms) and P{sub I}NC (Grade 2 or greater), C{sub I}NC, and M{sub I}NC of {>=}1 were investigated using multivariate logistic analyses. Receiver operating characteristic curves and the area under the curve were used to assess the predictive value of the different multivariate models. Results: Of the 586 patients, 36 with a Grade 1 or greater incontinence score before RT were not included in the present analysis. Of the 550 included patients, 197 (35.8%) had at least one control with a Grade 1 or greater incontinence score (M{sub I}NC >0). Of these 197 patients, 37 (6.7%), 22 (4.0%), and 17 (3.1%) were scored as having P{sub I}NC, M{sub I}NC {>=}1, and C{sub I}NC, respectively. On multivariate analysis, Grade 2 or greater acute incontinence was the only predictor of P{sub I}NC (odds ratio [OR], 5.9; p = .0009). Grade 3 acute incontinence was predictive of C{sub I}NC (OR, 9.4; p = .02), and percentage of the rectal volume receiving >40 Gy of {>=}80% was predictive of a M{sub I}NC of {>=}1 (OR, 3.8; p = .008) and of C{sub I}NC (OR, 3.6; p = .03). Previous bowel disease, previous abdominal/pelvic surgery, and the use of antihypertensive (protective

  18. Anal endosonography and bowel function in patients undergoing different types of endorectal pull-through procedures for Hirschsprung disease.

    PubMed

    Stensrud, Kjetil J; Emblem, Ragnhild; Bjørnland, Kristin

    2015-08-01

    The reasons for fecal incontinence after surgery for Hirschsprung disease (HD) remain unclear. The aim of this study was to examine the anal sphincters by anal endosonography and manometry after transanal endorectal pull-through, with or without laparotomy or laparoscopy, in HD patients. Furthermore, we aimed to correlate these findings to bowel function. Fifty-two HD patients were followed after endorectal pull-through. Anal endosonography and manometry were performed without sedation at the age of 3 to 16 years. Endosonographic internal anal sphincter (IAS) defects were found in 24/50 patients, more frequently after transanal than transabdominal procedures (69 vs. 19%, p=0.001). In a multiple variable logistic regression model, operative approach was the only significant predictor for IAS defects. Anal resting pressure (median 40mm Hg, range 15-120) was not correlated to presence of IAS defects. Daily fecal incontinence occurred more often in patients with IAS defects (54 vs. 25%, p=0.03). Postoperative IAS defects were frequently detected and were associated with daily fecal incontinence. IAS defects occurred more often after solely transanal procedures. We propose that these surgical approaches are compared in a randomized controlled trial before solely transanal endorectal pull-through is performed as a routine procedure. Copyright © 2015 Elsevier Inc. All rights reserved.

  19. High pressure vaginography to diagnose vaginal ureteral ectopia in patients with continuous urinary incontinence.

    PubMed

    Zuckerman, Jack M; Shekarriz, Bijan; Upadhyay, Jyoti

    2013-02-01

    Continuous urinary incontinence in female patients can be a diagnostic dilemma if traditional imaging fails to identify a source. Vaginography has been used to diagnose vaginal ectopic ureters in the past with mixed results. Institutional review board approval was obtained for a retrospective review. Five teenage females with continuous incontinence and prior negative imaging work ups underwent high pressure vaginography. Their findings and treatment outcomes are reviewed. A vaginal ectopic ureter was diagnosed in each of the five patients at a mean age 15.8 years. Each had undergone prior magnetic resonance urography that was non-diagnostic. Four of the five were managed surgically with resolution of their incontinence. One was lost to follow up. High pressure vaginogram should be considered during the work up of female patients with continuous urinary incontinence, especially when other imaging modalities fail to identify an etiology.

  20. [Central Patients Admission (CPA) unit--connecting inpatient and outpatient care].

    PubMed

    Fleck, Martin; Zeuner, Martin; Schölmerich, Jürgen

    2009-12-15

    Due to the novel reimbursement policies, hospitals face substantial conflicts regarding best patient care and optimal utilization of resources. In order to optimize patient treatment, a central patients admission (CPA) unit has been established. All patients electively referred to the hospital were primarily treated by a medical specialist at the CPA unit. According to an appropriateness evaluation protocol established with the medical service of the health insurances of Bavaria ("MDK-Bayern"), patients were treated as inpatients or outpatients. The impact of this novel admission procedure was assessed for a period of 30 months. Within 30 months following establishment of the CPA unit, 10% of the patients were treated as outpatients, whereas 90% of referred patients were admitted as inpatients. Nonetheless, numbers of inpatients increased by 20.7% after 24 months compared to 12 months following establishment of the CPA unit with a substantial increase of patients referred by external medical specialists. In addition, there were no cases of inappropriate admission. The CPA unit is an ideal instrument for treating patients cross-sectorally as well as more effectively and economically advocating reorganization. Establishment of a CPA unit leads to greater satisfaction among patients, referring physicians, and medical staff.

  1. Evaluation of urinary incontinence and quality of life in married women aged between 20 and 49 years (Sakarya, Turkey)

    PubMed

    Özdemir, Kevser; Şahin, Sevil; Özerdoğan, Nebahat; Ünsal, Alaattin

    2018-02-23

    Background/aim: This study aimed to determine the prevalence of urinary incontinence and to evaluate the relationship between urinary incontinence and quality of life in married women. Materials and methods: This is a cross-sectional study conducted among married women aged 20-49 years living in the vicinity of the Çökekler Community Clinic (Family Health Center) in Sakarya, Turkey, from 1 November 2011 to 15 April 2012. The study group consisted of 1161 women. Results: The frequency of urinary incontinence was 71.5% (n = 830). Out of a total of 830 patients with symptoms of urinary incontinence, mixed was the most frequently determined type (60.4%), followed by urge (33.9%) and then stress urinary incontinence (5.8%). The mean scores obtained by women with urinary incontinence from the general health perceptions and social functioning domains of the SF-36 survey were lower (P < 0.05 for each domain). Conclusion: Urinary incontinence was found to be a common problem among women, and it affects quality of life adversely. Recurrent urinary tract infection and advancing age were the key risk factors in the development of urinary incontinence.

  2. Long-term prevalence and predictors of urinary incontinence among women in the Diabetes Prevention Program Outcomes Study.

    PubMed

    Phelan, Suzanne; Kanaya, Alka M; Ma, Yong; Vittinghoff, Eric; Barrett-Connor, Elizabeth; Wing, Rena; Kusek, John W; Orchard, Trevor J; Crandall, Jill P; Montez, Maria G; Brown, Jeanette S

    2015-02-01

    To examine the long-term prevalence and predictors of weekly urinary incontinence in the Diabetes Prevention Program Outcomes Study, a follow-up study of the Diabetes Prevention Program randomized clinical trial of overweight adults with impaired glucose tolerance. This analysis included 1778 female participants of the Diabetes Prevention Program Outcomes Study who had been randomly assigned during the Diabetes Prevention Program to intensive lifestyle intervention (n = 582), metformin (n = 589) or placebo (n = 607). The study participants completed semi-annual assessments after the final Diabetes Prevention Program visit and for 6 years until October 2008. At the study entry, the prevalence of weekly urinary incontinence was lower in the intensive lifestyle intervention group compared with the metformin and placebo groups (44.2% vs 51.8%, 48.0% urinary incontinence/week, P = 0.04); during the 6-year follow-up period, these lower rates in intensive lifestyle intervention were maintained (46.7%, 53.1%, 49.9% urinary incontinence/week; P = 0.03). Statistically adjusting for urinary incontinence prevalence at the end of the Diabetes Prevention Program, the treatment arm no longer had a significant impact on urinary incontinence during the Diabetes Prevention Program Outcomes Study. Independent predictors of lower urinary incontinence during the Diabetes Prevention Program Outcomes Study included lower body mass index (odds ratio 0.988, 95% confidence interval 0.982-0.994) and greater physical activity (odds ratio 0.999, 95% confidence interval 0.998-1.000) at the Diabetes Prevention Program Outcomes Study entry, and greater reductions in body mass index (odds ratio 0.75, 95% confidence interval 0.60-0.94) and waist circumference (odds ratio 0.998, 95% confidence interval 0.996-1.0) during the Diabetes Prevention Program Outcomes Study. Diabetes was not significantly related to urinary incontinence. Intensive lifestyle intervention has a modest

  3. Predicting help-seeking intention of women with urinary incontinence in Jinan, China: a theory of planned behaviour model.

    PubMed

    Wu, Chen; Wang, Kefang; Sun, Tao; Xu, Dongjuan; Palmer, Mary H

    2015-02-01

    To develop and test a predictive model of women's help-seeking intention for urinary incontinence that was developed using the theory of planned behaviour and to identify factors that influenced women's help-seeking intention. Urinary incontinence is a chronic progressive condition if left untreated, but few women seek help from healthcare providers. Reasons for not seeking help have been studied in Western countries while relatively little information is available from mainland China. Questionnaire-based cross-sectional survey was performed in this study. From May-October 2011, a cross-sectional survey was conducted with a representative sample of 346 incontinent women from three communities in Jinan using strict inclusion and exclusion criteria. Data were collected via a self-administered pencil-and-paper survey that consisted of a multi-item questionnaire. Predictive model estimation was performed using structural equation model. The resultant model demonstrated that incontinent women's help-seeking intention could be predicted by their perceived self-efficacy and perceived social impact from urine loss. Perceived self-efficacy was the negative predictor, while the perceived social impact was the positive one. Overall, the predictive model explained 36% of the variance for incontinent women's help-seeking intention. The theory of planned behaviour can be used to predict help-seeking intention in women who have urinary incontinence. Community nurses should increase patients' help-seeking intention by addressing perceived social impact and perceived self-efficacy in managing incontinent symptoms. Our findings suggest that high perceived self-efficacy in dealing with incontinent symptoms could hinder incontinent women from seeking help from healthcare providers. The strong social impact women perceived, however, facilitates intention to seek help. Nurses should understand and address these factors through education and evidence-based practices to increase help

  4. Transvaginal radio frequency treatment of the endopelvic fascia: a prospective evaluation for the treatment of genuine stress urinary incontinence.

    PubMed

    Dmochowski, Roger R; Avon, Mark; Ross, James; Cooper, Jay M; Kaplan, Richard; Love, Beverly; Kohli, NeeraJ; Albala, David; Shingleton, Bruce

    2003-03-01

    We evaluate the safety and efficacy of a new treatment modality for genuine stress urinary incontinence which was a transvaginal radio frequency applicator to deliver radio frequency energy to the endopelvic fascia. The purported mechanism of effect for this therapy is shrinkage of the collagenated tissue which composes the endopelvic fascia that supports the bladder neck and proximal urethra, thus stabilizing the proximal urethra and bladder neck. In prior animal trials and early pilot studies this therapy was shown to cause a reproducible thermal effect manifested by fascial shrinkage. Preliminary human trials indicated a therapeutic benefit of this therapy for women with genuine stress urinary incontinence. To our knowledge this is the first multicenter study of a transvaginal approach for radio frequency of the endopelvic fascia for treatment of genuine stress incontinence. Between June 1999 and June 2000, 120 consecutive women (mean age 49.9 years) at 10 sites underwent transvaginal radio frequency treatment in a prospective trial to evaluate the overall efficacy and safety profile of this therapy. All patients had preoperative urethral hypermobility (average cotton swab change 38 degrees). Detrusor instability was excluded by cystometry. In all procedures precisely controlled radio frequency energy was applied to the endopelvic fascia to heat and shrink the tissue. The patients were evaluated postoperatively at 1 week and at 1, 3, 6 and 12 months using objective and subjective measures. Primary end points consisted of physician assessment of continence, patient reported pad use and the number of patient reported episodes. Safety was determined for acute (immediate postoperative) and chronic time frames. Of the 120 patients 96 completed 1-year evaluation. Average operative time was less than 30 minutes, and all patients were treated as outpatients. Preoperatively 101 patients (84%) averaged 1 or more episodes of urinary incontinence per day. At 3, 6 and 12

  5. Urodynamic characterization of obese women with urinary incontinence undergoing a weight loss program: the Program to Reduce Incontinence by Diet and Exercise (PRIDE) trial.

    PubMed

    Richter, Holly E; Creasman, Jennifer M; Myers, Deborah L; Wheeler, Thomas L; Burgio, Kathryn L; Subak, Leslee L

    2008-12-01

    The purpose of this study was to describe urodynamic characteristics of overweight or obese women with urinary incontinence and explore the relationship between urodynamic parameters, body mass index (BMI), and abdominal circumference (AC). One hundred ten women underwent a standardized cough stress test and urodynamic study. Eighty-six percent of women had urodynamic stress incontinence and 15% detrusor overactivity. Intra-abdominal pressure (Pabd) at maximum cystometric capacity (MCC) increased 0.4 cm H(2)O per kg/m(2) unit of BMI (95% confidence interval [CI] = 0.0,0.7, p = 0.04) and 0.4 cm H(2)O per 2 cm increase in AC (CI = 0.2, 0.7, p < 0.01). Intravesical pressure (Pves) at MCC increased 0.4 cm H(2)O per 2 cm increase in AC (CI = 0.0, 0.8, p = 0.05) but was not associated with BMI (p = 0.18). BMI and AC had a stronger association with Pabd than with Pves, suggesting a possible mechanism for the association between obesity and urinary incontinence.

  6. Central control of micturition in women: Brain-bladder pathways in continence and urgency urinary incontinence.

    PubMed

    Arya, Nisha G; Weissbart, Steven J

    2017-04-01

    Urinary incontinence disproportionately affects women. Anatomical textbooks typically describe continence mechanisms in women in the context of the pelvic floor support of the urinary bladder and the urethral sphincters. However, the urinary bladder and urethral sphincters are under the central control of the brain through a complex network of neurons that allow storage of urine followed by voiding when socially appropriate. Recent studies suggest that the most common type of urinary incontinence in women, urgency urinary incontinence, involves significant dysfunction of the central control of micturition. In this paper, we review the anatomy and functional connectivity of the nervous system structures involved in the control of micturition. Clinical application of this anatomy in the context of urgency urinary incontinence is also discussed. Understanding the anatomy of the neural structures that control continence will allow clinicians to better understand the underlying pathology of urge incontinence and consider new ways of treating this distressing condition. Clin. Anat. 30:373-384, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  7. Management of functional nonretentive fecal incontinence in children: Recommendations from the International Children's Continence Society.

    PubMed

    Koppen, I J N; von Gontard, A; Chase, J; Cooper, C S; Rittig, C S; Bauer, S B; Homsy, Y; Yang, S S; Benninga, M A

    2016-02-01

    Fecal incontinence (FI) in children is frequently encountered in pediatric practice, and often occurs in combination with urinary incontinence. In most cases, FI is constipation-associated, but in 20% of children presenting with FI, no constipation or other underlying cause can be found - these children suffer from functional nonretentive fecal incontinence (FNRFI). To summarize the evidence-based recommendations of the International Children's Continence Society for the evaluation and management of children with FNRFI. Functional nonretentive fecal incontinence is a clinical diagnosis based on medical history and physical examination. Except for determining colonic transit time, additional investigations are seldom indicated in the workup of FNRFI. Treatment should consist of education, a nonaccusatory approach, and a toileting program encompassing a daily bowel diary and a reward system. Special attention should be paid to psychosocial or behavioral problems, since these frequently occur in affected children. Functional nonretentive fecal incontinence is often difficult to treat, requiring prolonged therapies with incremental improvement on treatment and frequent relapses. Copyright © 2015 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

  8. Three-dimensional translabial ultrasound assessment of urethral supports and the urethral sphincter complex in stress urinary incontinence.

    PubMed

    Cassadó Garriga, Jordi; Pessarrodona Isern, Antoni; Rodríguez Carballeira, Monica; Pallarols Badia, Mar; Moya Del Corral, Manuela; Valls Esteve, Marta; Huguet Galofré, Eva

    2017-09-01

    The pathophysiological mechanism of incontinence is multifactorial. We evaluated the role of 3D-4D ultrasound in the assessment of the fascial supports of the urethra and the urethral sphincter complex (USC) for diagnosing stress urinary incontinence. Observational case-control study in women with and without stress urinary incontinence attending a urogynecology service and a general gynecology service. All women were interviewed, examined, and classified according to the Pelvic Organ Prolapse Quantification (POP-Q) and underwent a 3D-4D translabial ultrasound. Fascial supports of the urethra were assessed by tomographic ultrasound and were considered to be intact or absent if it was possible to identify them at eight levels on each side, urethral mobility was assessed on maximal Valsalva in sagittal section and the length and volume of the USC at rest and on maximal Valsalva were determined using the Virtual Organ Computer-aided Analysis (VOCAL) program. Variables were compared between continent and incontinent women. A total of 173 women were examined, 78 continent and 95 incontinent. There was a significant difference in urethral mobility between continent and incontinent women (12.82 mm vs. 21.85 mm, P < 0.001), but there was no significant difference in the percentage of supports affected (43.27% vs. 35.94%, P < 0.070). The length of the USC at rest was significantly shorter (P < 0.001) ​​in incontinent patients. Ultrasound evaluation of urethral supports does not discriminate between continent and incontinent women. However, the length of the USC at rest was shorter and urethral mobility was higher in incontinent women. Neurourol. Urodynam. 9999:XX-XX, 2016. © 2016 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  9. Cost-effectiveness of botulinum toxin a versus anticholinergic medications for idiopathic urge incontinence.

    PubMed

    Wu, Jennifer M; Siddiqui, Nazema Y; Amundsen, Cindy L; Myers, Evan R; Havrilesky, Laura J; Visco, Anthony G

    2009-05-01

    We assessed the cost-effectiveness of botulinum toxin A injection compared to anticholinergic medications for the treatment of idiopathic urge incontinence. A Markov decision analysis model was developed to compare the costs in 2008 U. S. dollars and effectiveness in quality adjusted life-years of botulinum toxin A injection and anticholinergic medications. The analysis was conducted from a societal perspective with a 2-year time frame using 3-month cycles. The primary outcome was the incremental cost-effectiveness ratio, defined as the difference in cost (botulinum toxin A cost--anticholinergic cost) divided by the difference in effectiveness (botulinum toxin A quality adjusted life-years--anticholinergic quality adjusted life-years). While the botulinum strategy was more expensive ($4,392 vs $2,563) it was also more effective (1.63 vs 1.50 quality adjusted life-years) compared to the anticholinergic regimen. The calculated incremental cost-effectiveness ratio was $14,377 per quality adjusted life-year, meaning that botulinum toxin A cost $14,377 per quality adjusted life-year gained. A strategy is often considered cost-effective when the incremental cost-effectiveness ratio is less than $50,000 per quality adjusted life-year. Given this definition botulinum toxin A is cost-effective compared to anticholinergics. To determine if there are situations in which anticholinergics would become cost-effective we performed sensitivity analyses. Anticholinergics become cost-effective if compliance exceeds 75% (33% in the base case) and if the botulinum toxin A procedure cost exceeds $3,875 ($1,690 in the base case). For the remainder of the sensitivity analyses botulinum toxin A remained cost-effective. Botulinum toxin A injection was cost-effective compared to anticholinergic medications for the treatment of refractory urge incontinence. Anticholinergics become cost-effective if patients are highly compliant with medications or if the botulinum procedure costs increase

  10. Lifestyle interventions for the treatment of urinary incontinence in adults.

    PubMed

    Imamura, Mari; Williams, Kate; Wells, Mandy; McGrother, Catherine

    2015-12-02

    Low cost, non-invasive alterations in lifestyle are frequently recommended by healthcare professionals or those presenting with incontinence. However, such recommendations are rarely based on good evidence. The objective of the review was to determine the effectiveness of specific lifestyle interventions (i.e. weight loss; dietary changes; fluid intake; reduction in caffeinated, carbonated and alcoholic drinks; avoidance of constipation; stopping smoking; and physical activity) in the management of adult urinary incontinence. We searched the Cochrane Incontinence Group Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and MEDLINE in process, and handsearching of journals and conference proceedings (searched 3 July 2013), and the reference lists of relevant articles. We incorporated the results of these searches fully in the review. We undertook an updated search of the Specialised Register, which now includes searches of ClinicalTrials.gov and WHO ICTRP, on 27 October 2014; potentially eligible studies from this search are currently awaiting classification. Randomised and quasi-randomised studies of community-based lifestyle interventions compared with no treatment, other conservative therapies, or pharmacological interventions for the treatment of urinary incontinence in adults. Two authors independently assessed study quality and extracted data. We collected information on adverse effects from the trials. Data were combined in a meta-analysis when appropriate. We assessed the quality of the evidence using the GRADE approach. We included 11 trials in the review, involving a total of 5974 participants.Four trials involving 4701 women compared weight loss programmes with a control intervention. Low quality evidence from one trial suggested that more women following weight loss programmes reported improvement in symptoms of incontinence at six months (163/214 (76%) versus 49/90 (54

  11. Detection of intracellular bacteria in exfoliated urothelial cells from women with urge incontinence.

    PubMed

    Cheng, Ying; Chen, Zhuoran; Gawthorne, Jayde A; Mukerjee, Chinmoy; Varettas, Kerry; Mansfield, Kylie J; Schembri, Mark A; Moore, Kate H

    2016-10-01

    The role of subclinical infection in patients with urge incontinence has been largely ignored. The aim of this study was to test for the presence of intracellular bacteria in exfoliated urothelial cells obtained from the urine of patients with detrusor overactivity or mixed incontinence +/- a history of UTI, and compare this to a control group of patients with stress incontinence and no history of infection. Bacterial cystitis was assessed by routine microbiology and compared to microscopic analysis of urine by Wright staining. Subsequent analysis of urothelial cells by confocal microscopy was performed to determine the existence of intracellular bacteria. Bacterial cystitis was seen in 13% of patients based on routine microbiology. Wright staining of concentrated urothelial cells demonstrated the presence of bacteria in 72% of samples. Filamentous bacterial cells were observed in 51% of patients and were significantly more common in patients with detrusor overactivity. Intracellular Escherichia coli were observed by confocal microscopy. This study supports the possibility that a subset of patients with urge incontinence may have unrecognised chronic bacterial colonisation, maintained via an intracellular reservoir. In patients with negative routine microbiology, application of the techniques used in this study revealed evidence of infection, providing further insights into the aetiology of urge incontinence. © FEMS 2016. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  12. Inpatient Violence.

    PubMed

    Fisher, Kayla

    2016-12-01

    Inpatient violence constitutes a major concern for staff, patients, and administrators. Violence can cause physical injury and psychological trauma. Although violence presents a challenge to inpatient clinicians, it should not be viewed as inevitable. By looking at history of violence, in addition to clinical and other historical factors, clinicians can identify which patients present the most risk of exhibiting violent behavior and whether the violence would most likely flow from psychosis, impulsivity, or predatory characteristics. With that information, clinicians can provide environmental and treatment modifications to lessen the likelihood of violence. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Electrical stimulation with non-implanted devices for stress urinary incontinence in women.

    PubMed

    Stewart, Fiona; Berghmans, Bary; Bø, Kari; Glazener, Cathryn Ma

    2017-12-22

    Several treatment options are available for stress urinary incontinence (SUI), including pelvic floor muscle training (PFMT), drug therapy and surgery. Problems exist such as adherence to PFMT regimens, side effects linked to drug therapy and the risks associated with surgery. We have evaluated an alternative treatment, electrical stimulation (ES) with non-implanted devices, which aims to improve pelvic floor muscle function to reduce involuntary urine loss. To assess the effects of electrical stimulation with non-implanted devices, alone or in combination with other treatment, for managing stress urinary incontinence or stress-predominant mixed urinary incontinence in women. Among the outcomes examined were costs and cost-effectiveness. We searched the Cochrane Incontinence Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE In-Process, MEDLINE Epub Ahead of Print, CINAHL, ClinicalTrials.gov, WHO ICTRP and handsearches of journals and conference proceedings (searched 27 February 2017). We also searched the reference lists of relevant articles and undertook separate searches to identify studies examining economic data. We included randomised or quasi-randomised controlled trials of ES with non-implanted devices compared with any other treatment for SUI in women. Eligible trials included adult women with SUI or stress-predominant mixed urinary incontinence (MUI). We excluded studies of women with urgency-predominant MUI, urgency urinary incontinence only, or incontinence associated with a neurologic condition. We would have included economic evaluations had they been conducted alongside eligible trials. Two review authors independently screened search results, extracted data from eligible trials and assessed risk of bias, using the Cochrane 'Risk of bias' tool. We would have performed economic evaluations using the approach recommended by Cochrane Economic Methods. We identified

  14. [Treatment of Urinary incontinence associated with genital prolapse: Clinical practrice guidelines].

    PubMed

    Cortesse, A; Cardot, V; Basset, V; Le Normand, L; Donon, L

    2016-07-01

    Prolapse and urinary incontinence are frequently associated. Patente (or proven) stress urinary incontinence (SUI) is defined by a leakage of urine that occurs with coughing or Valsalva, in the absence of any prolapse reduction manipulation. Masked urinary incontinence results in leakage of urine occurring during reduction of prolapse during the clinical examination in a patient who does not describe incontinence symptoms at baseline. The purpose of this chapter is to consider on the issue of systematic support or not of urinary incontinence, patent or hidden, during the cure of pelvic organs prolapse by abdominal or vaginal approach. This work is based on an systematic review of the literature (PubMed, Medline, Cochrane Library, Cochrane database of systematic reviews, EMBASE) for meta-analyzes, randomized trials, registries, literature reviews, controlled studies and major not controlled studies, published on the subject. Its implementation has followed the methodology of the HAS on the recommendations for clinical practice, with a scientific argument (with the level of evidence, NP) and a recommendation grade (A, B, C, and professional agreement). In case of patent IUE, concomitant treatment of prolapse and SUI reduces the risk of postoperative SUI. However, the isolated treatment of prolapse can treat up to 30% of preoperative SUI. Concomitant treatment of SUI exposed to a specific overactive bladder and dysuria morbidity. The presence of a hidden IUE represents a risk of postoperative SUI, but there is no clinical or urodynamic test to predict individually the risk of postoperative SUI. Moreover, the isolated treatment of prolapse can treat up to 60% of the masked SUI. Concomitant treatment of the hidden IUE therefore exposes again to overtreatment and a specific overactive bladder and dysuria morbidity. In case of overt or hidden urinary incontinence, concomitant treatment of SUI and prolapse reduces the risk of postoperative SUI but exposes to a specific

  15. The "1-3-5 cough test": comparing the severity of urodynamic stress incontinence with severity measures of subjective perception of stress urinary incontinence.

    PubMed

    Grigoriadis, Themos; Giannoulis, George; Zacharakis, Dimitris; Protopapas, Athanasios; Cardozo, Linda; Athanasiou, Stavros

    2016-03-01

    The purpose of the study was to examine whether a test performed during urodynamics, the "1-3-5 cough test", could determine the severity of urodynamic stress incontinence (USI). We included women referred for urodynamics who were diagnosed with USI. The "1-3-5 cough test" was performed to grade the severity of USI at the completion of filling cystometry. A diagnosis of "severe", "moderate" or "mild" USI was given if urine leakage was observed after one, three or five consecutive coughs respectively. We examined the associations between grades of USI severity and measures of subjective perception of stress urinary incontinence (SUI): International Consultation of Incontinence Modular Questionnaire-Female Lower Urinary Tract Symptom (ICIQ-FLUTS), King's Health Questionnaire (KHQ), Urinary Distress Inventory-6 (UDI-6), Urinary Impact Questionnaire-7 (UIQ-7). A total of 1,181 patients completed the ICIQ-FLUTS and KHQ and 612 completed the UDI-6 and UIQ-7 questionnaires. There was a statistically significant association of higher grades of USI severity with higher scores of the incontinence domain of the ICIQ-FLUTS. The scores of the UDI-6, UIQ-7 and of all KHQ domains (with the exception of general health perception and personal relationships) had statistically significant larger mean values for higher USI severity grade. Groups of higher USI severity had statistically significant associations with higher scores of most of the subjective measures of SUI. Severity of USI, as defined by the "1-3-5 cough test", was associated with the severity of subjective measures of SUI. This test may be a useful tool for the objective interpretation of patients with SUI who undergo urodynamics.

  16. Randomized clinical trial comparing TVT Secur system and trans vaginal obturator tape for the surgical management of stress urinary incontinence.

    PubMed

    Maslow, Ken; Gupta, Chander; Klippenstein, Peter; Girouard, Lise

    2014-07-01

    This prospective randomized study aimed to compare the safety and efficacy of the TVT-Secur (TVT-S) with the trans vaginal obturator tape (TVT-O) for the treatment of stress urinary incontinence. We set out to enroll 136 patients in our study. 106 patients with stress urinary incontinence were randomized to either the TVT-S (n = 56) or TVT-O (n = 50) procedure. Patients were evaluated postoperatively at 2 months and 1 year. Our primary outcome was objective cure measured by the cough test. Secondary outcomes of subjective symptoms, questionnaires, pain scores, complications, and urodynamic studies were also included. Statistical analysis was by Chi-squared, Kruskal-Wallis, Wilcoxon, and Fisher's exact tests as appropriate. P values of <0.05 were considered significant. Objective cure rates were better for TVT-O compared with TVT-S at 1 year (86 % and 63 % respectively, p = 0.01). Subjective cure rates were 88 % for TVT-O and 63 % for TVT-S. Quality of life scores through questionnaires improved in both groups and were not statistically different. Initial post-operative groin pain was more prevalent in the TVT-O group; however, this resolved quickly with time. TVT-O was superior to TVT-S in the objective cure of stress urinary incontinence at 1-year follow-up.

  17. Are older women more likely to receive surgical treatment for stress urinary incontinence since the introduction of the mid-urethral sling? An examination of Hospital Episode Statistics data.

    PubMed

    Gibson, W; Wagg, A

    2016-07-01

    To examine the trends in surgical treatment of stress urinary incontinence (SUI) in older women since the introduction of the mid-urethral sling. Analysis of data from Hospital Episode Statistics (HES) between 2000 and 2012. All surgical procedures for SUI in the National Health Service (NHS) in England. Retrospective cohort analysis of Hospital Episode Statistics for England from 2000 to 2012. Number of invasive, less invasive, and urethral bulking procedures performed in women in three age groups. There was a 90% fall in the number of invasive surgical treatments for SUI and a four-fold increase in the number of mid-urethral slings over this time. The total number of surgical procedures for SUI increased from 8458 to 13 219. However, the rise in the number of procedures in women aged over 75 was more modest-a three-fold increase from a low start of 187-and these women now make up a smaller proportion of all women receiving a mid-urethral sling (MUS). Despite the development and wide availability of a less invasive, safe and effective operation for stress urinary incontinence in older women, they do not appear to have benefitted. The reasons for this require prospective investigation. © 2015 Royal College of Obstetricians and Gynaecologists.

  18. Prevalence of urinary incontinence among women and analysis of potential risk factors in Germany and Denmark.

    PubMed

    Schreiber Pedersen, Louise; Lose, Gunnar; Høybye, Mette Terp; Elsner, Susanne; Waldmann, Annika; Rudnicki, Martin

    2017-08-01

    Urinary incontinence (UI) is a prevalent condition that interferes with women's health-related quality of life. Prevalence rates from earlier studies are wide-ranging, due to heterogeneity in methodology, definition of UI and the populations included. We aimed to determine the prevalence of UI and associated risk factors in Germany and Denmark using the same methodology, definition and population. A postal survey was conducted in two regions in Germany and Denmark, including 8000 women aged 18+ years. UI was defined as any complaint of involuntary loss of urine. The questionnaire contained socio-demographic questions and the International Consultation on Incontinence Modular Questionnaire Urinary Incontinence Short Form (ICIQ-UI SF). The response rate in Germany and Denmark was 46.2 and 66.6% (p < 0.001) and the prevalence rate of UI was 48.3 and 46.4% (p = 0.188), respectively. Stress urinary incontinence dominated among younger women, and urgency urinary incontinence and mixed urinary incontinence among women 80+ years in Germany and Denmark, respectively. The subgroup of women with body mass index (BMI) ≥35 had the highest prevalence of UI (67.3%). The subgroup of women with BMI <35 were more likely to have stress urinary incontinence, and the subgroup of women with BMI ≥35 were more likely to have mixed urinary incontinence. UI was significantly associated with age as with BMI, vaginal delivery, chronic obstructive pulmonary disease, and having at least one co-morbidity. Prevalence rates in the two regions in Germany and Denmark were similar, despite significantly different response rates. This difference may reflect various attitudes towards answering a questionnaire, but the response rate on questions concerning UI seemed consistent. © 2017 Nordic Federation of Societies of Obstetrics and Gynecology.

  19. A practice-based intervention to improve primary care for falls, urinary incontinence, and dementia.

    PubMed

    Wenger, Neil S; Roth, Carol P; Shekelle, Paul G; Young, Roy T; Solomon, David H; Kamberg, Caren J; Chang, John T; Louie, Rachel; Higashi, Takahiro; MacLean, Catherine H; Adams, John; Min, Lillian C; Ransohoff, Kurt; Hoffing, Marc; Reuben, David B

    2009-03-01

    To determine whether a practice-based intervention can improve care for falls, urinary incontinence, and cognitive impairment. Controlled trial. Two community medical groups. Community-dwelling patients (357 at intervention sites and 287 at control sites) aged 75 and older identified as having difficulty with falls, incontinence, or cognitive impairment. Intervention and control practices received condition case-finding, but only intervention practices received a multicomponent practice-change intervention. Percentage of quality indicators satisfied measured using a 13-month medical record abstraction. Before the intervention, the quality of care was the same in intervention and control groups. Screening tripled the number of patients identified as needing care for falls, incontinence, or cognitive impairment. During the intervention, overall care for the three conditions was better in the intervention than the control group (41%, 95% confidence interval (CI)=35-46% vs 25%, 95% CI=20-30%, P<.001). Intervention group patients received better care for falls (44% vs 23%, P<.001) and incontinence (37% vs 22%, P<.001) but not for cognitive impairment (44% vs 41%, P=.67) than control group patients. The intervention was more effective for conditions identified by screening than for conditions identified through usual care. A practice-based intervention integrated into usual clinical care can improve primary care for falls and urinary incontinence, although even with the intervention, less than half of the recommended care for these conditions was provided. More-intensive interventions, such as embedding intervention components into an electronic medical record, will be needed to adequately improve care for falls and incontinence.

  20. Factors Associated With Ineligibility for PCI Differ Between Inpatient and Outpatient ST-Elevation Myocardial Infarction.

    PubMed

    Jaski, Brian E; Grigoriadis, Christopher E; Dai, Xuming; Meredith, Richard D; Ortiz, Bryan C; Stouffer, George A; Thomas, Lorie; Smith, Sidney C

    2016-08-01

    Without early revascularization, both inpatient and outpatient STEMIs have poor outcomes. Reasons for denying PCI for STEMI, however, remain uncertain. This single-center retrospective cohort study compares factors and outcomes associated with ineligibility for PCI between inpatients and outpatients following ST-elevation myocardial infarction (STEMI). A total of 1,759 STEMI patients between June 2009 and January 2015 were assessed. Individual medical records were reviewed to obtain reasons for PCI ineligibility for STEMI patients who did not receive reperfusion therapy. Compared to outpatients with STEMI (n = 1,688), inpatients (n = 71) were less likely to receive coronary angiography (60.6% vs 95.9%; P < 0.001) or PCI (50.7% vs 80.9%; P < 0.001), with longer ECG/door to first device activation times (97 [78, 131] vs 63 [49, 78] minutes; P < 0.001). When coronary angiography was performed, however, similar rates of PCI and procedural success were seen in both groups. Principal contraindication for PCI was risk of bleeding within the inpatient population and complex coronary artery disease within the outpatient population. Total in-hospital mortality was higher in inpatient STEMIs compared to outpatients (42.2% vs 10.0%; P < 0.001), but lower for patients eligible for PCI in both groups. Reasons for PCI ineligibility differ between inpatient and outpatient STEMIs. Inpatients have increased risks of bleeding, lower coronary angiography and PCI use, and higher in-hospital mortality. Especially for inpatients, specific PCI STEMI protocols that anticipate and overcome types of ineligibility and delay for cardiac catheterization may improve outcomes. © 2016, Wiley Periodicals, Inc.

  1. Longitudinal trends with improvement in quality of life after TVT, TVT O and Burch colposuspension procedures.

    PubMed

    Drahoradova, Petra; Martan, Alois; Svabik, Kamil; Zvara, Karel; Otava, Martin; Masata, Jaromir

    2011-02-01

    Comparison of the quality of life (QoL) trends after TVT, TVT O and Burch colposuspension (BCS) procedures and comparison of long-term subjective and objective outcomes. The study included 215 women who underwent a TVT, TVT O or BCS procedure. We monitored QoL after each procedure and the effect of complications on the QoL as assessed by the IQOL questionnaire over a 3-year period. The study was completed by 74.5% of women after TVT, 74.5% after TVT O, and 65.2% after BCS procedure. In the long-term, the QoL improved from 46.9 to 88.7 and remained stable after BCS; after TVT and TVT O, it declined, but only after TVT O was the decline statistically significant compared to BCS. The IQOL for women with post-operative complications has a clear descending tendency. The effect of the complications is highly significant (p<0.001). Only the OAB complication had a statistically significant effect on QoL p<0.001. Preexistent OAB does not negatively affect postoperative results of anti-incontinence surgery. There was a statistically significant decline with the longitudinal values of IQOL with TVT O, but not with TVT or BCS. Anti-incontinence operations significantly improve quality of life for women with MI, but compared to the SI group, the quality of life is worse when measured at a longer time interval after the operation. Anti-incontinence operations significantly improve quality of life, and the difference in preoperative status in the long-term follow-up is demonstrable.

  2. Comparison of the clinical and quality-of-life outcomes after the inside-out TVT-O procedure with or without concomitant transvaginal gynaecological surgery.

    PubMed

    Cho, M K; Kim, C H; Kang, W D; Kim, J W; Kim, S M; Kim, Y H

    2012-04-01

    The study was undertaken to compare the clinical and quality-of-life (QoL) outcomes of the inside-out transobturator vaginal tape (TVT-O)-only procedures and TVT-O procedures with concomitant transvaginal gynaecological surgery for the treatment of stress urinary incontinence (SUI). A review of charts from January 2006 to March 2010 identified 305 patients with urodynamic stress incontinence for whom we performed the TVT-O. Of the initial 305 patients, 272 (89.2%) were re-examined for complications 1 month, 4 months, 1 year and 2-4 years postoperatively (122 TVT-O only; 150 TVT-O + other transvaginal gynaecological surgery). They were also evaluated with the Urogenital Distress Inventory Questionnaire (UDI-6) and the Incontinence Impact Questionnaire (IIQ-7) 1-4 years after the procedure. The median follow-up was 37.3 months. The success rate was 89.3% in the TVT-O-only group vs 93.3% in the TVT-O with concomitant gynaecological surgery group (p =0.729). The QoL score was quite good for 91.8% of the TVT-O-only patients and for 96.7% of the TVT-O with concomitant gynaecologic surgery patients (p =0.405). In conclusion, gynaecological operations performed concomitantly with the TVT-O procedure do not affect the clinical and QoL outcomes of the TVT-O procedure.

  3. A randomized, controlled clinical trial of an intravesical pressure-attenuation balloon system for the treatment of stress urinary incontinence in females.

    PubMed

    Wyndaele, Jean-Jacques; De Wachter, Stefan; Tommaselli, Giovanni A; Angioli, Roberto; de Wildt, Michel J; Everaert, Karel C M; Michielsen, Dirk P J; Van Koeveringe, Gommert A

    2016-02-01

    Evaluate the efficacy, safety, and tolerability of a novel pressure-attenuation balloon for the treatment of female stress urinary incontinence (SUI) using a prospective, randomized, single-blind, multi-center design, evaluated at 3 months. Sixty-three females with SUI were randomized 2:1 to treatment with a balloon (N = 41) or sham procedure (N = 22). The sham (control) entailed the same procedure without the deployment of a balloon. Endpoints were evaluated at 3 months and included a composite endpoint that required both ≥10 point increase in the 22-item Incontinence Quality of Life Survey (I-QOL) and ≥50% decrease in provocative pad weight. Additional endpoints included incontinence episode frequency, and PGII assessment. In an ITT analysis, 63% of women in the treatment group achieved the composite endpoint, compared to 31% in the Control Group (P = 0.0200). In a per protocol analysis, 81% of women in the treatment arm had a 50% decrease in pad weight test vs. 45% in the Control Group (P = 0.0143); 41.6% of the treatment patients were dry on pad weight test (≤1gram) vs. 0% in the Control Group (P < 0.001), and 58% of treated patients reported improvement on a PGII assessment versus 25% of women in the Control Group (P = 0.025). Adverse events in the treatment group included dysuria (14.6%), gross hematuria (9.8%), and UTI (7.3%). This minimally invasive treatment for female SUI with an intravesical pressure-attenuation balloon was safe and effective. The concept of pressure attenuation as a therapy for SUI is valid and feasible for those patients that can tolerate the balloon. © 2015 The Authors. Neurourology and Urodynamics published by Wiley Periodicals, Inc.

  4. Quality of life after periurethral injection with polyacrylamide hydrogel for stress urinary incontinence.

    PubMed

    Trutnovsky, Gerda; Tamussino, Karl; Greimel, Elfriede; Bjelic-Radisic, Vesna

    2011-03-01

    The purpose of this observational study was to examine the effect of periurethral injections with polyacrylamide hydrogel (PAHG) on quality of life (QoL) in selected patients with stress urinary incontinence (SUI). Fifty-four women with comorbidities or other reasons precluding other surgery received PAHG for SUI. Patient-reported outcomes were assessed with the "Incontinence Outcome Questionnaire" (IOQ) 9 months postoperatively. The IOQ is a 27-item, condition-specific instrument that assesses patient-reported outcomes after incontinence surgery. Forty-two women (78%) completed the questionnaire. Responses ranged from considerable (40%) and slight improvement (21%) to no change (29%) and worsening of symptoms (10%). Periurethral injections with PAHG are likely to provide relief of symptoms and improvement in QoL.

  5. Prospective assessment of interobserver agreement for defecography in fecal incontinence.

    PubMed

    Dobben, Annette C; Wiersma, Tjeerd G; Janssen, Lucas W M; de Vos, Rien; Terra, Maaike P; Baeten, Cor G; Stoker, Jaap

    2005-11-01

    The primary aim of our study was to determine the interobserver agreement of defecography in diagnosing enterocele, anterior rectocele, intussusception, and anismus in fecal-incontinent patients. The subsidiary aim was to evaluate the influence of level of experience on interpreting defecography. Defecography was performed in 105 consecutive fecal-incontinent patients. Observers were classified by level of experience and their findings were compared with the findings of an expert radiologist. The quality of the expert radiologist's findings was evaluated by an intraobserver agreement procedure. Intraobserver agreement was good to very good except for anismus: incomplete evacuation after 30 sec (kappa, 0.55) and puborectalis impression (kappa, 0.54). Interobserver agreement for enterocele and rectocele was good (kappa, 0.66 for both) and for intussusception, fair (kappa, 0.29). Interobserver agreement for anismus: incomplete evacuation after 30 sec was moderate (kappa, 0.47), and for anismus: puborectalis impression was fair (kappa, 0.24). Agreement in grading of enterocele and rectocele was good (kappa, 0.64 and 0.72, respectively) and for intussusception, fair (kappa, 0.39). Agreement separated by experience level was very good for rectocele (kappa, 0.83) and grading of rectoceles (kappa, 0.83) and moderate for intussusception (kappa, 0.44) at the most experienced level. For enterocele and grading, experience level did not influence the reproducibility. Reproducibility for enterocele, anterior rectocele, and severity grading is good, but for intussusception is fair to moderate. For anismus, the diagnosis of incomplete evacuation after 30 sec is more reproducible than puborectalis impression. The level of experience seems to play a role in diagnosing anterior rectocele and its grading and in diagnosing intussusception.

  6. OnabotulinumtoxinA in urinary incontinence: Prospective Study of a Case Series.

    PubMed

    Martín-Martínez, A; Fernández-Mederos, A; García-Hernández, J Á

    2017-09-01

    To assess the safety and efficacy of a single intravesical injection of onabotulinumtoxinA (OnaBTA) for treating urge urinary incontinence (UUI) in women. We performed a prospective case-series study of consecutive patients with refractory UUI treated with an intravesical injection of OnaBTA. The patients were administered 100 units of OnaBTA injected into the bladder wall following 4 weeks of flushing with anticholinergic agents or beta 3 agonists. The urodynamic and clinical endpoints were evaluated before and 6 months after the injection of OnaBTA. The primary study endpoint was the number of episodes of urinary leakage. A total of 204 of the 210 selected patients conducted a valid visit 6 months after the therapeutic application. At 6 months of treatment with OnaBTA, 110 (53.9%) patients remained continent and were considered a success. However, 57 (27.9%) patients experienced one episode of urinary leakage per day, and 37 (18.2%) had 2 or more. In terms of the urodynamic parameters, we observed the following changes: increase in maximum bladder capacity (P<.0001) and reduced maximum pressure of the detrusor (P<.0001). In terms of the safety profile, 8 (3.9%) patients had self-limiting haematuria during the procedure, which resolved spontaneously, and 9 (4.4%) patients had acute urinary retention that required intermittent catheterisation. This study supports the use of OnabotulinumtoxinA in patients with urge urinary incontinence that does not respond to medical treatment. Copyright © 2017 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  7. Consumer Perception of Inpatient Medical Services

    PubMed Central

    Takase, Kozo

    2016-01-01

    Although it is currently popular to reflect consumers’ perspectives to medical service management, insufficient attempts have been made to understand detailed perception of the consumer side of medical services to promote medical services’ evaluation from the consumer viewpoint. The aim of this study was to descriptively reveal how consumers perceive medical services that they receive, focusing on inpatient medical services. We conducted semi-structured interviews with 10 adults who experienced hospitalization of five or more days. Constant comparative analysis was performed on the obtained descriptive data. We identified 1) medical procedures, 2) explanations from medical professionals, 3) behavior of medical service providers, 4) somatic sensations, and 5) self-perceived physical conditions as target factors that medical service consumers perceived during hospitalization. The response to the perceived target factors, “compared with the expectation that the consumer had before the hospitalization,” suggests that it is an important medical service consumer reaction to check if the service met their expectations for perceived factors. The response to the medical services perception targets suggested that medical service consumers are involved in medical services and interested in various perception targets. The expectations that medical service consumers have prior to hospitalization can largely influence inpatient medical services evaluation. PMID:27832165

  8. Consumer Perception of Inpatient Medical Services.

    PubMed

    Izugami, Satoko; Takase, Kozo

    2016-01-01

    Although it is currently popular to reflect consumers' perspectives to medical service management, insufficient attempts have been made to understand detailed perception of the consumer side of medical services to promote medical services' evaluation from the consumer viewpoint. The aim of this study was to descriptively reveal how consumers perceive medical services that they receive, focusing on inpatient medical services. We conducted semi-structured interviews with 10 adults who experienced hospitalization of five or more days. Constant comparative analysis was performed on the obtained descriptive data. We identified 1) medical procedures, 2) explanations from medical professionals, 3) behavior of medical service providers, 4) somatic sensations, and 5) self-perceived physical conditions as target factors that medical service consumers perceived during hospitalization. The response to the perceived target factors, "compared with the expectation that the consumer had before the hospitalization," suggests that it is an important medical service consumer reaction to check if the service met their expectations for perceived factors. The response to the medical services perception targets suggested that medical service consumers are involved in medical services and interested in various perception targets. The expectations that medical service consumers have prior to hospitalization can largely influence inpatient medical services evaluation.

  9. TVT compared with TVT-O and TOT: results from the Norwegian National Incontinence Registry.

    PubMed

    Dyrkorn, Ole A; Kulseng-Hanssen, Sigurd; Sandvik, Leiv

    2010-11-01

    The aim of this study is to compare the outcome and complication rates of the tension-free vaginal tape (TVT) operations with the transobturator vaginal tape (TVT-O and TOT) operations in the treatment of urinary stress incontinence. This is a multicenter, prospective cohort study. Preoperative and postoperative assessments included a validated Stress and Urge Incontinence Questionnaire, a 24-h pad test, and a standardized stress test. The study included 5,942 women--4,281 women had a TVT operation and 731 and 373 women had TVT-O and TOT operations, respectively. Median follow-up time was 8 months. Women in the TVT group had less leakage during stress test and fewer subjective stress incontinence symptoms, and were more satisfied with the operation compared with the women in TVT-O and TOT groups, but more complications were reported after TVT operation. The TVT operation is more efficient than TVT-O and TOT operations in treating stress incontinent women.

  10. Treatment of a child with daytime urinary incontinence.

    PubMed

    Reilly, Margaret; Homsy, Yves

    2008-01-01

    This case report describes physical therapy management of a child with daytime urinary incontinence, taking into account the patient's age as well as her emotional and cognitive development. An 8-year-old girl was referred for physical therapy with a diagnosis of pelvic floor muscle hypertonus and dysfunctional voiding. Functional deficits included daytime urinary incontinence (4-8 leaks/d, 7 d/wk) and increased voiding frequency (8-10 times/d). Intervention included age appropriate education, biofeedback, behavioral modification and performance of "roll for control" exercises. Normal levels of voiding frequency occurred by the third therapy session, and complete recovery of normal function, including daytime continence, occurred by the eleventh therapy session. The outcome demonstrates the successful achievement of urinary continence in an 8-year-old child following physical therapy intervention of lower urinary tract rehabilitation.

  11. Risk Factors for Urinary Incontinence Among Women with Type 1 Diabetes: Findings from the Epidemiology of Diabetes Interventions and Complications Study

    PubMed Central

    Sarma, Aruna V.; Kanaya, Alka; Nyberg, Leroy M.; Kusek, John W.; Vittinghoff, Eric; Rutledge, Brandy; Cleary, Patricia A.; Gatcomb, Patricia; Brown, Jeanette S.

    2009-01-01

    Objectives To determine risk factors for and long-term effects of glycemic control on urinary incontinence among women with type 1 diabetes enrolled in the Epidemiology of Diabetes Interventions and Complications (EDIC) study. Methods The Diabetes Control and Complications Trial (1982 to 1993) cohort follow-up, EDIC, began in 1994. In 2004, women participants (N=550), completed a self-administered questionnaire on incontinence. Our primary outcome was ≥ weekly incontinence, overall and by type. Multivariable regression models were used to determine independent predictors of weekly UI, both overall and by type. Results Overall, 38% of women reported any incontinence and 17% reported ≥ weekly incontinence. Increasing body mass index (Odds Ratio (OR) 1.1 per kg/m2, 95% Confidence Interval (CI) 1.1−1.2) was significantly associated with weekly incontinence, overall and by type. Advancing age and two or more urinary tract infections in the prior year were associated with weekly urge incontinence (OR 1.4, 95% CI 1.0−2.0 per 5 years; OR 4.9, 95% CI 1.8−13.5, respectively). There was weaker evidence for increased risk with age for overall weekly incontinence (22% per 5 years, p=0.06) and stress incontinence (21 % per 5 years, p=0.08) Conclusions Urinary incontinence is common among women with type 1 diabetes and risk factors including advancing age, increased weight, and prior urinary tract infection are important. Weight reduction and treatment of urinary tract infections may have the additional benefit of preventing incontinence or reducing its severity. PMID:19362350

  12. Functional asymmetry of pelvic floor innervation and its role in the pathogenesis of fecal incontinence.

    PubMed

    Enck, Paul; Hinninghofen, Heidemarie; Wietek, Beate; Becker, Horst D

    2004-01-01

    While the regular and symmetric innervation of the pelvic floor has been regarded as "established" for many years, recent data indicate that asymmetry of innervation of the sphincters may exists and may contribute to the occurrence and severity of incontinence symptoms in case of pelvic floor trauma. A systematic review of published papers on asymmetry of sphincter innervation was performed including studies in healthy volunteers and patients with incontinence. 234 consecutive patients with fecal incontinence were investigated by means of side-separated mass surface EMG from the left and right side anal canal, these data were correlated to clinical and anamnestic findings. The literature survey indicates that asymmetry of sphincter innervation exists in a subgroup of healthy male and female volunteers, and may be a risk factor to become incontinent in case of trauma. Patients with incontinence in whom asymmetry of sphincter innervation could be shown more frequently reported a history of pelvic floor trauma during childbirth. Childbirth per se but not the number of deliveries predicted sphincter asymmetry. Asymmetrically innervated sphincters show a compromised sphincter function in routine anorectal manometry. Assessment of sphincter innervation asymmetry may be of value in clinical routine testing of patients with incontinence. However, a new technology is needed to replace mass surface EMG by multi-electrode arrays on a sphincter probe. This is one of the goals of the EU-sponsored research project OASIS. Copyright 2004 S. Karger AG, Basel

  13. 42 CFR 405.1202 - Expedited determination procedures.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Reconsiderations of Provider Service Terminations, and Procedures for Inpatient Hospital Discharges § 405.1202... exercise the right to an expedited determination must submit a request for a determination to the QIO in...

  14. Weight loss prevents urinary incontinence in women with type 2 diabetes: results from the Look AHEAD trial.

    PubMed

    Phelan, Suzanne; Kanaya, Alka M; Subak, Leslee L; Hogan, Patricia E; Espeland, Mark A; Wing, Rena R; Burgio, Kathryn L; DiLillo, Vicki; Gorin, Amy A; West, Delia S; Brown, Jeanette S

    2012-03-01

    We determined the effect of weight loss on the prevalence, incidence and resolution of weekly or more frequent urinary incontinence in overweight/obese women with type 2 diabetes after 1 year of intervention in the Look AHEAD (Action for Health in Diabetes) trial. Women in this substudy (2,739, mean ± SD age 57.9 ± 6.8 years, body mass index 36.5 ± 6.1 kg/m(2)) were randomized into an intensive lifestyle weight loss intervention or a diabetes support and education control condition. At baseline 27% of participants reported urinary incontinence on a validated questionnaire (no significant difference by intensive lifestyle intervention vs diabetes support and education). After 1 year of intervention the intensive lifestyle intervention group in this substudy lost 7.7 ± 7.0 vs 0.7 ± 5.0 kg in the diabetes support and education group. At 1 year fewer women in the intensive lifestyle intervention group reported urinary incontinence (25.3% vs 28.6% in the diabetes support and education group, p = 0.05). Among participants without urinary incontinence at baseline 10.5% of intensive lifestyle intervention and 14.0% of diabetes support and education participants experienced urinary incontinence after 1 year (p = 0.02). There were no significant group differences in the resolution of urinary incontinence (p >0.17). Each kg of weight lost was associated with a 3% reduction in the odds of urinary incontinence developing (p = 0.01), and weight losses of 5% to 10% reduced these odds by 47% (p = 0.002). Moderate weight loss reduced the incidence but did not improve the resolution rates of urinary incontinence at 1 year among overweight/obese women with type 2 diabetes. Weight loss interventions should be considered for the prevention of urinary incontinence in overweight/obese women with diabetes. Copyright © 2012 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  15. The Determinants of the Technical Efficiency of Acute Inpatient Care in Canada.

    PubMed

    Wang, Li; Grignon, Michel; Perry, Sheril; Chen, Xi-Kuan; Ytsma, Alison; Allin, Sara; Gapanenko, Katerina

    2018-04-17

    To evaluate the technical efficiency of acute inpatient care at the pan-Canadian level and to explore the factors associated with inefficiency-why hospitals are not on their production frontier. Canadian Management Information System (MIS) database (CMDB) and Discharge Abstract Database (DAD) for the fiscal year of 2012-2013. We use a nonparametric approach (data envelopment analysis) applied to three peer groups (teaching, large, and medium hospitals, focusing on their acute inpatient care only). The double bootstrap procedure (Simar and Wilson 2007) is adopted in the regression. Information on inpatient episodes of care (number and quality of outcomes) was extracted from the DAD. The cost of the inpatient care was extracted from the CMDB. On average, acute hospitals in Canada are operating at about 75 percent efficiency, and this could thus potentially increase their level of outcomes (quantity and quality) by addressing inefficiencies. In some cases, such as for teaching hospitals, the factors significantly correlated with efficiency scores were not related to management but to the social composition of the caseload. In contrast, for large and medium nonteaching hospitals, efficiency related more to the ability to discharge patients to postacute care facilities. The efficiency of medium hospitals is also positively related to treating more clinically noncomplex patients. The main drivers of efficiency of acute inpatient care vary by hospital peer groups. Thus, the results provide different policy and managerial implications for teaching, large, and medium hospitals to achieve efficiency gains. © Health Research and Educational Trust.

  16. Preventing Suicide Among Inpatients

    PubMed Central

    Sakinofsky, Isaac

    2014-01-01

    Objective Inpatient suicide comprises a proportionately small but clinically important fraction of suicide. This study is intended as a qualitative analysis of the comprehensive English literature, highlighting what is known and what can be done to prevent inpatient suicide. Method: A systematic search was conducted on the Cochrane Library, PubMed, Embase, Web of Knowledge, and a personal database for articles on cohort series, preferably controlled, of inpatient suicide (not deliberate self-harm or attempted suicide, unless they also dealt specifically with suicide data). Results: A qualitative discussion is presented, based on the findings of the literature searched. Conclusions: The bulk of inpatient suicides actually occur not on the ward but off premises, when the patient was on leave or had absconded. Peaks occur shortly after admission and discharge. It is possible to reduce suicide risk on the ward by having a safe environment, optimizing patient visibility, supervising patients appropriately, careful assessment, awareness of and respect for suicide risk, good teamwork and communication, and adequate clinical treatment. PMID:24881161

  17. An economic evaluation of outpatient versus inpatient polyp treatment for abnormal uterine bleeding.

    PubMed

    Diwakar, L; Roberts, T E; Cooper, N A M; Middleton, L; Jowett, S; Daniels, J; Smith, P; Clark, T J

    2016-03-01

    To undertake a cost-effectiveness analysis of outpatient uterine polypectomy compared with standard inpatient treatment under general anaesthesia. Economic evaluation carried out alongside the multi-centre, pragmatic, non-inferiority, randomised controlled Outpatient Polyp Treatment (OPT) trial. The UK National Health Service (NHS) perspective was used in the estimation of costs and the interpretation of results. Thirty-one secondary care UK NHS hospitals between April 2008 and July 2011. Five hundred and seven women with abnormal uterine bleeding and hysteroscopically diagnosed endometrial polyps. Outpatient uterine polypectomy versus standard inpatient treatment. Clinicians were free to choose the technique for polypectomy within the allocated setting. Patient-reported effectiveness of the procedure determined by the women's self-assessment of bleeding at 6 months, and QALY gains at 6 and 12 months. Inpatient treatment was slightly more effective but more expensive than outpatient treatment, resulting in relatively high incremental cost-effectiveness ratios. Intention-to-treat analysis of the base case at 6 months revealed that it cost an additional £9421 per successfully treated patient in the inpatient group and £ 1,099,167 per additional QALY gained, when compared with outpatient treatment. At 12 months, these costs were £22,293 per additional effectively treated patient and £445,867 per additional QALY gained, respectively. Outpatient treatment of uterine polyps associated with abnormal uterine bleeding appears to be more cost-effective than inpatient treatment at willingness-to-pay thresholds acceptable to the NHS. HTA-funded OPT trial concluded that outpatient uterine polypectomy is cost-effective compared with inpatient polypectomy. © 2015 Royal College of Obstetricians and Gynaecologists.

  18. Factors affecting staff morale on inpatient mental health wards in England: a qualitative investigation

    PubMed Central

    2011-01-01

    Background Good morale among staff on inpatient psychiatric wards is an important requirement for the maintenance of strong therapeutic alliances and positive patient experiences, and for the successful implementation of initiatives to improve care. More understanding is needed of mechanisms underlying good and poor morale. Method We conducted individual and group interviews with staff of a full range of disciplines and levels of seniority on seven NHS in-patient wards of varying types in England. Results Inpatient staff feel sustained in their potentially stressful roles by mutual loyalty and trust within cohesive ward teams. Clear roles, supportive ward managers and well designed organisational procedures and structures maintain good morale. Perceived threats to good morale include staffing levels that are insufficient for staff to feel safe and able to spend time with patients, the high risk of violence, and lack of voice in the wider organisation. Conclusions Increasing employee voice, designing jobs so as to maximise autonomy within clear and well-structured operational protocols, promoting greater staff-patient contact and improving responses to violence may contribute more to inpatient staff morale than formal support mechanisms. PMID:21510852

  19. Efficacy of antibiotherapy for treating flatus incontinence associated with small intestinal bacterial overgrowth: A pilot randomized trial.

    PubMed

    Melchior, Chloé; Gourcerol, Guillaume; Bridoux, Valérie; Ducrotté, Philippe; Quinton, Jean-François; Leroi, Anne-Marie

    2017-01-01

    An increase in intestinal gas production due to small intestinal bowel overgrowth (SIBO) is a contributing factor for flatus incontinence. The aims of our study were to assess the efficacy of metronidazole in a select population of patients with flatus incontinence associated with SIBO and to compare its efficacy with that of a combination of simethicone and activated charcoal (SC; Carbosylane) in randomized experimental arms. Adult patients suffering from flatus incontinence associated with SIBO diagnosed by a glucose breath test were enrolled in the study. They were given metronidazole or Carbosylane (SC) for 10 days. The reduction in the mean daily number of gas leakages reported in a 3-day diary before and at the end of the treatment was used as the primary endpoint. Of 52 consecutive subjects with flatus incontinence, 23 (44%) had SIBO, 16 (33%) of whom were included in and completed the study. The relative reduction in flatus incontinence episodes was significantly higher in the metronidazole than in the SC group (66.8±34.8% vs. 25±50%, P = 0.03), decreasing by more than 50% in 7 (87.5%) of the subjects in the metronidazole group compared with only 1 (12.5%) in the SC group (odds ratio 1.9, 95% confidence interval 0.9-56.9, P = 0.06). Our results show a promising trend indicating that metronidazole might significantly improve flatus incontinence associated with SIBO and might be more successful in treating flatus incontinence than gas absorbents.

  20. Perspectives on Procedure Importance: Residents, Faculty, and Community Practitioners.

    PubMed

    Ludden-Schlatter, Alicia; Wells, Jack; Kruse, Robin L

    2018-06-01

    Procedural training is integral to family medicine residencies. Although accreditation bodies require that family medicine residency programs train residents in procedures relevant to their practices, there are no standards defining the scope of family medicine. We compared the perceived importance of 31 procedures by faculty, residents, and recent graduates of one institution. An online survey was sent to current residents and faculty of a large academic family medicine residency, as well as community practitioners who had graduated from that residency within the past 5 years. The survey asked participants to rate how important 31 procedures are for family medicine practices. The overall response rate was 37%. Most respondents provided outpatient care, and few provided or intended to provide obstetric care. Dermatologic and musculoskeletal procedures were rated as having high importance by all groups, whereas obstetric and inpatient procedures received lower ratings. Residents ascribed higher importance than faculty or recent graduates for nearly all procedures. Most residents, faculty, and community practitioners provided outpatient care and rated dermatologic and musculoskeletal procedures as important. Inpatient and obstetric care are less common career paths, and related procedures were rated as less important. Resident physicians ascribed greater importance than community practitioners for many procedures, which may be due misperceptions of their future practice needs or imposed requirements for graduation.

  1. Urinary incontinence in Moroccan and Turkish women: a qualitative study on impact and preferences for treatment

    PubMed Central

    van den Muijsenbergh, Maria ETC; Lagro-Janssen, Toine ALM

    2006-01-01

    Aim To gain insight into the impact of urinary incontinence on the daily lives of Moroccan and Turkish women and their preferences for treatment. Design of study A qualitative analysis of data from semi-structured in depth interviews with 30 Moroccan and Turkish migrant women with urinary incontinence. Setting Six general practices with large numbers of immigrant families in four cities in the Netherlands. Method Semi-structured in depth interviews were conducted with Moroccan and Turkish migrant women, who presented with complaints of urinary incontinence in six general practices with large numbers of immigrant families on the practice list in four different cities in the Netherlands. Results All the women adhered closely to bodily cleanliness and considered incontinence to be dirty. As Muslims, they were obliged to perform ritual prayers preceded by ablution five times per day and the urinary incontinence breached their status of ritual purity. Therefore, they had to wash more often and experienced this as a heavy burden. In a number of the women, shame formed a reason why they could not talk to anybody about the incontinence, not even with the doctor. One-third of the women felt that their GP had not taken them seriously. Knowledge about anatomy, physiology and available treatments was mostly lacking. In addition, the women did not understand the aim of the exercises from the physiotherapist. The majority of women gave preference to help from a female doctor. Conclusion Urinary incontinence in Moroccan and Turkish migrant women formed a considerable problem in their daily following of the Islam faith. Shame on the part of the patient and miscommunication at the doctor's surgery led to inadequate care. PMID:17132383

  2. Prevalence of urinary incontinence and lower urinary tract symptoms in school-age children.

    PubMed

    Akil, Ipek Ozunan; Ozmen, Dilek; Cetinkaya, Aynur Cakmakci

    2014-07-08

    To investigate the prevalence of lower urinary tract symptoms (LUTS) and urinary incontinence (UI) in elementary school aged children in Manisa. Dysfunctional Voiding and Incontinence Scoring System (DVIS) which was developed in Turkey is used. A total of 416 children, 216 (51.9%) male and 200 (48.1%) female were recruited in this study. Mean age of children was 10.35 ± 2.44 years (median10 years). Daytime UI frequency was 6.7% (28 child), nocturnal incontinence 16.6% (69 child) and combined daytime and nocturnal incontinence 4.1% (17 child). There was no statistically significant difference in the prevalence of nocturnal and or daytime UI between male and female gender. Mean DVIS score was 2.65 ± 3.95 and gender did not affect total DVIS points. The mean ages of achieving daytime bowel and bladder control were all significantly correlated with DVIS points. DVIS points were positively correlated with the history of UI of the family. Total points were increased when the father was unemployed. UI negatively influences health related quality of life of the family and child, so it is important that awareness of the UI and symptoms of lower urinary tract dysfunction.

  3. Urinary incontinence and quality of life of women living in nursing homes in the Mediterranean region of Turkey.

    PubMed

    Göral Türkcü, Sinem; Kukulu, Kamile

    2017-11-01

    This study was conducted to determine the effect of urinary incontinence (UI) on the quality of life of women living in nursing homes in the Mediterranean region of Turkey. The study was conducted on 95 women living in nursing homes in the Mediterranean region. Data were collected from a questionnaire on sociodemographic characteristics, the Urinary Incontinence Quality of Life Scale, the Index of Activities of Daily Living, and the International Consultation on Incontinence Questionnaire Short Form. The quality of life of women who did not consider UI a health problem was significantly higher than that of those who considered otherwise. Mixed UI was the most common UI type among the women living in nursing homes, with a rate of 31.7%. According to the overall mean scores on the Urinary Incontinence Quality of Life Scale, quality of life was the most affected among women who had nocturnal incontinence. Quality of life was affected from most to least by the mixed type, stress type, and urge type of incontinence. Early diagnosis and treatment of UI could be improved if health professionals, who have a unique role in changing the perception of society, offered training to women experiencing incontinence. Identifying this problem and determining and preventing the risk factors are important for enhancing women's quality of life. © 2017 Japanese Psychogeriatric Society.

  4. Comparison of Predictive Factors for Postoperative Incontinence of Holmium Laser Enucleation of the Prostate by the Surgeons' Experience During Learning Curve.

    PubMed

    Shigemura, Katsumi; Tanaka, Kazushi; Yamamichi, Fukashi; Chiba, Koji; Fujisawa, Masato

    2016-03-01

    To detect predictive factors for postoperative incontinence following holmium laser enucleation of the prostate (HoLEP) according to surgeon experience (beginner or experienced) and preoperative clinical data. Of 224 patients, a total of 203 with available data on incontinence were investigated. The potential predictive factors for post-HoLEP incontinence included clinical factors, such as patient age, and preoperative urodynamic study results, including detrusor overactivity (DO). We also classified the surgeons performing the procedure according to their HoLEP experience: beginner (<21 cases) and experienced (≥21 cases). Our statistical data showed DO was a significant predictive factor at the super-short period (the next day of catheter removal: odds ratio [OR], 3.375; P=0.000). Additionally, patient age, surgeon mentorship (inverse correlation), and prostate volume were significant predictive factors at the 1-month interval after HoLEP (OR, 1.072; P=0.004; OR, 0.251; P=0.002; and OR, 1.008; P=0.049, respectively). With regards to surgeon experience, DO and preoperative International Prostate Symptom Score (inverse) at the super-short period, and patient age and mentorship (inverse correlation) at the 1-month interval after HoLEP (OR, 3.952; P=0.002; OR, 1.084; P=0.015; and OR,1.084; P=0.015; OR, 0.358; P=0.003, respectively) were significant predictive factors for beginners, and first desire to void (FDV) at 1 month after HoLEP (OR, 1.009; P=0.012) was a significant predictive factor for experienced surgeons in multivariate analysis. Preoperative DO, IPSS, patient age, and surgeon mentorship were significant predictive factors of postoperative patient incontinence for beginner surgeons, while FDV was a significant predictive factors for experienced surgeons. These findings should be taken into account by surgeons performing HoLEP to maximize the patient's quality of life with regards to urinary continence.

  5. A randomised controlled trial of Outpatient versus inpatient Polyp Treatment (OPT) for abnormal uterine bleeding.

    PubMed

    Clark, T Justin; Middleton, Lee J; Cooper, Natalie Am; Diwakar, Lavanya; Denny, Elaine; Smith, Paul; Gennard, Laura; Stobert, Lynda; Roberts, Tracy E; Cheed, Versha; Bingham, Tracey; Jowett, Sue; Brettell, Elizabeth; Connor, Mary; Jones, Sian E; Daniels, Jane P

    2015-07-01

    Uterine polyps cause abnormal bleeding in women and conventional practice is to remove them in hospital under general anaesthetic. Advances in technology make it possible to perform polypectomy in an outpatient setting, yet evidence of effectiveness is limited. To test the hypothesis that in women with abnormal uterine bleeding (AUB) associated with benign uterine polyp(s), outpatient polyp treatment achieved as good, or no more than 25% worse, alleviation of bleeding symptoms at 6 months compared with standard inpatient treatment. The hypothesis that response to uterine polyp treatment differed according to the pattern of AUB, menopausal status and longer-term follow-up was tested. The cost-effectiveness and acceptability of outpatient polypectomy was examined. A multicentre, non-inferiority, randomised controlled trial, incorporating a cost-effectiveness analysis and supplemented by a parallel patient preference study. Patient acceptability was evaluated by interview in a qualitative study. Outpatient hysteroscopy clinics and inpatient gynaecology departments within UK NHS hospitals. Women with AUB - defined as heavy menstrual bleeding (formerly known as menorrhagia) (HMB), intermenstrual bleeding or postmenopausal bleeding - and hysteroscopically diagnosed uterine polyps. We randomly assigned 507 women, using a minimisation algorithm, to outpatient polypectomy compared with conventional inpatient polypectomy as a day case in hospital under general anaesthesia. The primary outcome was successful treatment at 6 months, determined by the woman's assessment of her bleeding. Secondary outcomes included quality of life, procedure feasibility, acceptability and cost per quality-adjusted life-year (QALY) gained. At 6 months, 73% (166/228) of women who underwent outpatient polypectomy were successfully treated compared with 80% (168/211) following inpatient polypectomy [relative risk (RR) 0.91, 95% confidence interval (CI) 0.82 to 1.02]. The lower end of the CIs showed

  6. Pad stress tests with increasing load for the diagnosis of stress urinary incontinence.

    PubMed

    Rimstad, Liv; Larsen, Elsa Skjønhaug; Schiøtz, Hjalmar A; Kulseng-Hanssen, Sigurd

    2014-09-01

    The aim of the study was to test the ability of pad stress tests with increasing load (supine, jumping on the floor, and jumping on a trampoline) to document stress incontinence in subjectively stress incontinent women. In this prospective study 147 subjectively stress and mixed incontinent women performed consecutively the three pad stress tests with a bladder volume of 300 ml. Nineteen women performed a second trampoline pad stress test to test repeatability of the test. Nine continent women performed a trampoline pad stress test in order to determine if subjectively continent women would leak during the test. Seventy-two women (49%) leaked during the supine, 136 (93%) leaked during the jumping, and 146 (99%) leaked during the trampoline pad stress test. The differences between pad stress tests were significant with P < 0.005. Correlation between the two trampoline pad stress tests was high at 0.8. None of the nine continent women leaked during the trampoline pad stress test. The supine pad stress test has low sensitivity and is therefore often falsely negative. The jumping pad stress test is a simple test to perform and is satisfactory for everyday use. Subjectively stress incontinent women who do not leak during the jumping pad stress test may perform a trampoline pad stress test to document stress incontinence. The trampoline pad stress test is also simple to perform and detected leakage in 91% of the women who did not leak during the jumping pad stress test. © 2013 Wiley Periodicals, Inc.

  7. Relationships between perioperative physical activity and urinary incontinence after radical prostatectomy: an observational study

    PubMed Central

    2013-01-01

    Background Higher physical activity levels are continence-protective in non-prostate cancer populations. Primary aims of this study were to investigate changes in physical activity levels over the perioperative period in patients having radical prostatectomy, and relationships between perioperative physical activity levels and post-prostatectomy urinary incontinence. Methods A prospective analysis of patients having radical prostatectomy and receiving perioperative physiotherapy including pelvic floor muscle training and physical activity prescription (n = 33). Physical activity levels were measured using the International Physical Activity Questionnaire and/or the SenseWear Pro3 Armband at four timepoints: before preoperative physiotherapy, the week before surgery, and 3 and 6 weeks postoperatively. Urinary incontinence was measured at 3 and 6 weeks postoperatively using a 24-hour pad test and the International Consultation on Incontinence Questionnaire – Urinary Incontinence Short Form (ICIQ). Results Physical activity levels changed significantly over the perioperative period (p < 0.001). At 6 weeks postoperatively, physical activity levels did not differ significantly from baseline (p = 0.181), but remained significantly lower than the week before surgery (p = 0.002). There was no significant interaction effect between preoperative physical activity category and time on the 24-hour pad test (p = 0.726) or ICIQ (p = 0.608). Nor were there any significant correlations between physical activity levels and the 24-hour pad test and ICIQ at 3 or 6 weeks postoperatively. Conclusions This study provides novel data on perioperative physical activity levels for patients having radical prostatectomy. There was no relationship between perioperative physical activity levels and post-prostatectomy urinary incontinence, although participants had high overall preoperative physical activity levels and low overall urinary incontinence. PMID:24289104

  8. Longitudinal trends with Improvement in Quality of Life after TVT, TVT O and Burch Colposuspension Procedures

    PubMed Central

    Drahoradova, Petra; Martan, Alois; Svabik, Kamil; Zvara, Karel; Otava, Martin; Masata, Jaromir

    2011-01-01

    Summary Background Comparison of the quality of life (QoL) trends after TVT, TVT O and Burch colposuspension (BCS) procedures and comparison of long-term subjective and objective outcomes. Material/Methods The study included 215 women who underwent a TVT, TVT O or BCS procedure. We monitored QoL after each procedure and the effect of complications on the QoL as assessed by the IQOL questionnaire over a 3-year period. Results The study was completed by 74.5% of women after TVT, 74.5% after TVT O, and 65.2% after BCS procedure. In the long-term, the QoL improved from 46.9 to 88.7 and remained stable after BCS; after TVT and TVT O, it declined, but only after TVT O was the decline statistically significant compared to BCS. The IQOL for women with post-operative complications has a clear descending tendency. The effect of the complications is highly significant (p<0.001). Only the OAB complication had a statistically significant effect on QoL p<0.001. Preexistent OAB does not negatively affect postoperative results of anti-incontinence surgery. Conclusions There was a statistically significant decline with the longitudinal values of IQOL with TVT O, but not with TVT or BCS. Anti-incontinence operations significantly improve quality of life for women with MI, but compared to the SI group, the quality of life is worse when measured at a longer time interval after the operation. Anti-incontinence operations significantly improve quality of life, and the difference in preoperative status in the long-term follow-up is demonstrable. PMID:21278690

  9. Efficacy of antibiotherapy for treating flatus incontinence associated with small intestinal bacterial overgrowth: A pilot randomized trial

    PubMed Central

    Melchior, Chloé; Gourcerol, Guillaume; Bridoux, Valérie; Ducrotté, Philippe; Quinton, Jean-François; Leroi, Anne-Marie

    2017-01-01

    Aim An increase in intestinal gas production due to small intestinal bowel overgrowth (SIBO) is a contributing factor for flatus incontinence. The aims of our study were to assess the efficacy of metronidazole in a select population of patients with flatus incontinence associated with SIBO and to compare its efficacy with that of a combination of simethicone and activated charcoal (SC; Carbosylane) in randomized experimental arms. Methods Adult patients suffering from flatus incontinence associated with SIBO diagnosed by a glucose breath test were enrolled in the study. They were given metronidazole or Carbosylane (SC) for 10 days. The reduction in the mean daily number of gas leakages reported in a 3-day diary before and at the end of the treatment was used as the primary endpoint. Results Of 52 consecutive subjects with flatus incontinence, 23 (44%) had SIBO, 16 (33%) of whom were included in and completed the study. The relative reduction in flatus incontinence episodes was significantly higher in the metronidazole than in the SC group (66.8±34.8% vs. 25±50%, P = 0.03), decreasing by more than 50% in 7 (87.5%) of the subjects in the metronidazole group compared with only 1 (12.5%) in the SC group (odds ratio 1.9, 95% confidence interval 0.9–56.9, P = 0.06). Conclusion Our results show a promising trend indicating that metronidazole might significantly improve flatus incontinence associated with SIBO and might be more successful in treating flatus incontinence than gas absorbents. PMID:28763464

  10. Update on extracorporeal magnetic innervation (EXMI) therapy for stress urinary incontinence.

    PubMed

    Galloway, N T; El-Galley, R E; Sand, P K; Appell, R A; Russell, H W; Carlin, S J

    2000-12-04

    Pulsed magnetic technology has been developed for pelvic floor muscle strengthening for the treatment of urinary incontinence. This report includes an update of the prospective multicenter study of extracorporeal magnetic innervation (ExMI) therapy for stress incontinence and a discussion of the possible mechanisms of action. Issues of patient selection for ExMI therapy will also be discussed. One hundred and eleven women with demonstrable stress urinary incontinence were studied. The mean age was 55 +/- 13 years, and the mean duration of symptoms was 11 years. Ninety-seven completed ExMI therapy and analysis. Evaluation before treatment included bladder diaries, dynamic pad weight test, urodynamics, and a quality-of-life survey. For treatment the patients were seated fully clothed in a Neocontrol chair with a magnetic field therapy head in the seat. Treatment sessions were for 20 minutes, twice a week, for 6 weeks. After ExMI therapy, all of the measures were repeated at 8 weeks, including the dynamic pad weight testing and quality-of-life survey. At 6 months, further data were added, including repeat bladder diary, pad use, and quality-of-life survey. Forty-seven women completed 6 months of follow-up; of the 47, 13 patients were completely dry (28%) and 25 used no pad or less than 1 pad per day (53%). Pad use was reduced in 33 patients (70%). The median number of pads was reduced from 2.16 to 1 per day (Wilcoxon signed rank test, P <0.005). The frequency of leak episodes was reduced from 3.0 to 1.7 at 6 months (Wilcoxon signed rank test, P = 0.004). Detrusor instability was demonstrated in 10 before and 6 after ExMI (P <0.05). ExMI offers an alternative approach for the treatment of urinary incontinence. ExMI therapy is effective for both stress and urge incontinence. The best results are achieved in those patients who use no more than 3 pads a day and have had no prior continence surgery.

  11. Assessment of symptoms of urinary incontinence in women with polycystic ovary syndrome.

    PubMed

    Montezuma, Thais; Antônio, Flávia Ignácio; Rosa e Silva, Ana Carolina Japur de Sá; Sá, Marcos Felipe Silva de; Ferriani, Rui Alberto; Ferreira, Cristine Homsi Jorge

    2011-01-01

    The pelvic floor muscles are sensitive to androgens, and due to hyperandrogenism, women with polycystic ovary syndrome can have increased mass in these muscles compared to controls. The aim of this study is to compare reports of urine leakage and quality of life between women with and without polycystic ovary syndrome. One hundred thirteen 18-to 40-year-old nulliparous women with polycystic ovary syndrome or without the disease (controls) were recruited at the University Hospital of School Medicine of São Paulo University at Ribeirão Preto City, Brazil. The subjects were not taking any hormonal medication, had not undergone previous pelvic surgery and did not exercise their pelvic floor muscles. The women were divided into the following four groups: I-polycystic ovary syndrome with normal body mass index (n = 18), II-polycystic ovary syndrome with body mass index >25 (n = 32), III-controls with normal body mass index (n = 29), and IV-controls with Body Mass Index >25 (n = 34). Quality of life was evaluated using the SF-36 questionnaire, and the subjects with urinary complaints also completed the International Consultation on Incontinence Questionnaire Short Form to evaluate the severity of their urinary incontinence. The replies to the International Consultation on Incontinence Questionnaire Short Form revealed a significant difference in urinary function between groups, with 24% of the subjects in group IV reporting urinary incontinence. The mean scores for the SF-36 questionnaire revealed that group II had the lowest quality of life. The control obese group (IV) reported a higher prevalence of urinary incontinence. There was no difference in the reported frequency of urine loss between the polycystic ovary syndrome and control groups with normal body mass index or between the polycystic ovary syndrome and control groups with body mass index >25.

  12. Global prevalence and economic burden of urgency urinary incontinence: a systematic review.

    PubMed

    Milsom, Ian; Coyne, Karin S; Nicholson, Sean; Kvasz, Marion; Chen, Chieh-I; Wein, Alan J

    2014-01-01

    The prevalence and economic burden of urgency urinary incontinence (UUI) are difficult to ascertain because of overlap with data on overactive bladder and other types of incontinence. To summarize the evidence on the global prevalence and economic burden of UUI. A PubMed search was performed used the following terms: (urgency urinary incontinence OR urge incontinence OR mixed incontinence OR overactive bladder) AND (burden OR cost OR economic OR prevalence). A similar search was conducted using Embase. English-language articles published from 1991 through 2013 on non-neurogenic UUI were retained. We retained 54 articles (50 studies); 22 large-scale, population-based surveys indicated varying UUI prevalence estimates with ranges of 1.8-30.5% in European populations, 1.7-36.4% in US populations, and 1.5-15.2% in Asian populations, with prevalence dependent on age and gender. Nineteen smaller-scale studies supported these findings. Despite varying methods, 11 studies estimating the costs of UUI worldwide consistently concluded that the economic burden is substantial and will increase markedly as the population ages. In a 2005 multinational study, the annual cost-of-illness estimate for UUI in Canada, Germany, Italy, Spain, Sweden, and the United Kingdom was €7 billion. A US cost-of-illness study reported a total cost of $66 billion in 2007 US dollars. The costs of routine care and nursing home admissions for UUI were major contributors to the cost. UUI affects millions of men and women worldwide. Current evidence demonstrates the substantial economic burden of UUI to patients and society. Worldwide public health and clinical management programs are needed to improve UUI awareness and highlight the need for early diagnosis and management. Copyright © 2013 European Association of Urology. Published by Elsevier B.V. All rights reserved.

  13. Electrophysiological Basis of Fecal Incontinence and Its Implications for Treatment

    PubMed Central

    2017-01-01

    The majority of patients with neuropathic incontinence and other pelvic floor conditions associated with straining at stool have damage to the pudendal nerves distal to the ischial spine. Sacral nerve stimulation appears to be a promising innovation and has been widely adopted and currently considered the standard of care for adults with moderate to severe fecal incontinence and following failed sphincter repair. From a decision-to-treat perspective, the short-term efficacy is good (70%–80%), but the long-term efficacy of sacral nerve stimulation is around 50%. Newer electrophysiological tests and improved anal endosonography would more effectively guide clinical decision making. PMID:29159162

  14. Regional Correlates of Psychiatric Inpatient Treatment.

    PubMed

    Ala-Nikkola, Taina; Pirkola, Sami; Kaila, Minna; Saarni, Samuli I; Joffe, Grigori; Kontio, Raija; Oranta, Olli; Sadeniemi, Minna; Wahlbeck, Kristian

    2016-12-05

    Current reforms of mental health and substance abuse services (MHS) emphasize community-based care and the downsizing of psychiatric hospitals. Reductions in acute and semi-acute hospital beds are achieved through shortened stays or by avoiding hospitalization. Understanding the factors that drive the current inpatient treatment provision is essential. We investigated how the MHS service structure (diversity of services and balance of personnel resources) and indicators of service need (mental health index, education, single household, and alcohol sales) correlated with acute and semi-acute inpatient treatment provision. The European Service Mapping Schedule-Revised (ESMS-R) tool was used to classify the adult MHS structure in southern Finland (population 1.8 million, 18+ years). The diversity of MHS in terms of range of outpatient and day care services or the overall personnel resourcing in inpatient or outpatient services was not associated with the inpatient treatment provision. In the univariate analyses, sold alcohol was associated with the inpatient treatment provision, while in the multivariate modeling, only a general index for mental health needs was associated with greater hospitalization. In the dehospitalization process, direct resource re-allocation and substituting of inpatient treatment with outpatient care per se is likely insufficient, since inpatient treatment is linked to contextual factors in the population and the health care system. Mental health services reforms require both strategic planning of service system as a whole and detailed understanding of effects of societal components.

  15. Are procedures codes in claims data a reliable indicator of intraoperative splenic injury compared with clinical registry data?

    PubMed

    Stey, Anne M; Ko, Clifford Y; Hall, Bruce Lee; Louie, Rachel; Lawson, Elise H; Gibbons, Melinda M; Zingmond, David S; Russell, Marcia M

    2014-08-01

    Identifying iatrogenic injuries using existing data sources is important for improved transparency in the occurrence of intraoperative events. There is evidence that procedure codes are reliably recorded in claims data. The objective of this study was to assess whether concurrent splenic procedure codes in patients undergoing colectomy procedures are reliably coded in claims data as compared with clinical registry data. Patients who underwent colectomy procedures in the absence of neoplastic diagnosis codes were identified from American College of Surgeons (ACS) NSQIP data linked with Medicare inpatient claims data file (2005 to 2008). A κ statistic was used to assess coding concordance between ACS NSQIP and Medicare inpatient claims, with ACS NSQIP serving as the reference standard. A total of 11,367 colectomy patients were identified from 212 hospitals. There were 114 patients (1%) who had a concurrent splenic procedure code recorded in either ACS NSQIP or Medicare inpatient claims. There were 7 patients who had a splenic injury diagnosis code recorded in either data source. Agreement of splenic procedure codes between the data sources was substantial (κ statistic 0.72; 95% CI, 0.64-0.79). Medicare inpatient claims identified 81% of the splenic procedure codes recorded in ACS NSQIP, and 99% of the patients without a splenic procedure code. It is feasible to use Medicare claims data to identify splenic injuries occurring during colectomy procedures, as claims data have moderate sensitivity and excellent specificity for capturing concurrent splenic procedure codes compared with ACS NSQIP. Copyright © 2014 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  16. Investigation on the frailty status of the elderly inpatients in Shanghai using the FRAIL (fatigue, resistance, ambulation, illness, and loss) questionnaire.

    PubMed

    Wei, Yin; Cao, Yanpei; Yang, Xiaoli; Xu, Yan

    2018-05-01

    This study was to investigate the frailty status of inpatients older than 65 years old in Shanghai.A 6-month cross-sectional survey was conducted using FRAIL (fatigue, resistance, ambulation, illness, and loss) questionnaire. Totally 587 patients were included. The data, including demographic characteristics, constipation, urinary retention, urinary incontinence, grip strength, and muscle strength, were collected. The data of serum prealbumin, serum albumin, serum total protein, and hemoglobin were obtained from laboratory blood tests.The incidence of nonfrailty, prefrailty, and frailty was 0.249, 0.417, and 0.334, respectively. The high incidence age of frailty was 86 to 90 years old (0.342), and the high incidence age of prefrailty was 65 to 70 years old (0.282). There was significant difference in the grip strength among different degrees of frailty (P < .01). The influencing factors related to prefrailty included prealbumin, grip strength, urinary retention, constipation and education level of illiterate (P < .05). The populations with high prealbumin level, high grip strength and illiteracy population were not easy to enter the prefrailty period, while those with constipation (OR (odds ratio) = 1.867, 95% CI (confidence interval): 1.046-3.330) and urinary retention (OR = 7.007, 95% CI: 1.137-2.757) were more likely to enter the prefrailty period. Factors associated with frailty included age, prealbumin, grip strength, muscle strength, urinary incontinence, urinary retention, and constipation (P < .05). The populations with high prealbumin level, high grip strength, and high muscle strength were not easy to enter frailty period, while those with older age (OR = 1.141, 95% CI: 1.085-1.200), urinary incontinence (OR = 10.314, 95% CI: 1.950-54.548), urinary retention (OR = 3.058, 95% CI: 1.571-5.952), and constipation (OR = 3.004, 95% CI: 1.540-5.857) were easy to enter frailty period.The high incidence ages of frailty and

  17. Refractory urgency urinary incontinence treatment in women: impact of age on outcomes and complications.

    PubMed

    Komesu, Yuko M; Amundsen, Cindy L; Richter, Holly E; Erickson, Stephen W; Ackenbom, Mary F; Andy, Uduak U; Sung, Vivian W; Albo, Michael; Gregory, W Thomas; Paraiso, Marie Fidela; Wallace, Dennis

    2018-01-01

    Women with refractory urgency urinary incontinence (ie, unresponsive to behavioral and pharmacological interventions) are treated with onabotulinumtoxinA or sacral neuromodulation. The objective of the study was to compare treatment efficacy and adverse events in women <65 and ≥65 years old treated with onabotulinumtoxinA or sacral neuromodulation. This study was a planned secondary analysis of a multicenter, randomized trial that enrolled community-dwelling women with refractory urgency urinary incontinence to onabotulinumtoxinA or sacral neuromodulation treatments. The primary outcome was a change in mean daily urgency urinary incontinence episodes on a bladder diary over 6 months. Secondary outcomes included ≥75% urgency urinary incontinence episode reduction, change in symptom severity/quality of life, treatment satisfaction, and treatment-related adverse events. Both age groups experienced improvement in mean urgency urinary incontinence episodes per day following each treatment. There was no evidence that mean daily urgency urinary incontinence episode reduction differed between age groups for onabotulinumtoxinA (adjusted coefficient, -0.127, 95% confidence interval, -1.233 to 0.979; P = .821) or sacral neuromodulation (adjusted coefficient, -0.698, 95% confidence interval, -1.832 to 0.437; P = .227). Among those treated with onabotulinumtoxinA, women <65 years had 3.3-fold greater odds of ≥75% resolution than women ≥65 years (95% confidence interval, 1.56 -7.02). Women <65 years had a greater reduction in Overactive Bladder Questionnaire Short Form symptom bother scores compared with women ≥65 years by 7.49 points (95% confidence interval, -3.23 to -11.74), regardless of treatment group. There was no difference between quality of life improvement by age. Women ≥65 years had more urinary tract infections following onabotulinumtoxinA and sacral neuromodulation (odds ratio, 1.9, 95% confidence interval, 1.2-3.3). There was no evidence of age

  18. In vitro methods for evaluating skin hydration under diapers and incontinence products.

    PubMed

    Tate, M L; Wright, A S

    2017-11-01

    Excessive skin hydration from wearing wet undergarments, such as infant diapers and adult incontinence products, has been historically problematic. Skin damage occurs from wetness (urine) and limited product breathability. Evaporative water loss has been measured on adult arms (armband method) or infant torsos (on-baby method), after wearing a saline-insulted diaper product. The current study developed a reliable in vitro method of evaluating diaper and incontinence products for improvements in skin dryness. A simulated skin substrate was applied to a heated mechanical arm or baby torso. A disposable diaper or incontinence product was wrapped around the arm or baby torso, and loaded with saline. Hydration of the simulated skin was measured by evaporimetry and compared with clinical data from adult armband evaluations. The heated mechanical arm and baby torso accurately distinguished products for skin dryness. Eight diaper products were evaluated and compared to human test results. The torso in vitro and mechanical arm evaluations demonstrated strong correlations to human epidermal water loss evaluations, with repeatable results. Additionally, the bench test has been used for adult incontinence products, and it proved to differentiate those products as well as infant products. A rapid and reliable means of evaluation has been developed, and it is predictive of human subject testing. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  19. Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women.

    PubMed

    Hay-Smith, Jean; Mørkved, Siv; Fairbrother, Kate A; Herbison, G Peter

    2008-10-08

    About a third of women have urinary incontinence and up to a tenth have faecal incontinence after childbirth. Pelvic floor muscle training is commonly recommended during pregnancy and after birth both for prevention and treatment of incontinence. To determine the effect of pelvic floor muscle training compared to usual antenatal and postnatal care on incontinence. We searched the Cochrane Incontinence Group Specialised Register (searched 24 April 2008) and the references of relevant articles. Randomised or quasi-randomised trials in pregnant or postnatal women. One arm of the trials needed to include pelvic floor muscle training (PFMT). Another arm was either no pelvic floor muscle training or usual antenatal or postnatal care. The pelvic floor muscle training programmes were divided into either: intensive; or unspecified if training elements were lacking or information was not provided. Reasons for classifying as intensive included one to one instruction, checking for correct contraction, continued supervision of training, or choice of an exercise programme with sufficient exercise dose to strengthen muscle. Trials were independently assessed for eligibility and methodological quality. Data were extracted then cross checked. Disagreements were resolved by discussion. Data were processed as described in the Cochrane Handbook. Three different populations of women were considered separately: women dry at randomisation (prevention); women wet at randomisation (treatment); and a population-based approach in women who might be one or the other (prevention or treatment). Trials were further divided into: those which started during pregnancy (antenatal); and after delivery (postnatal). Sixteen trials met the inclusion criteria. Fifteen studies involving 6181 women (3040 PFMT, 3141 controls) contributed to the analysis. Based on the trial reports, four trials appeared to be at low risk of bias, two at low to moderate risk, and the remainder at moderate risk of bias

  20. The effect of urodynamic testing on clinical diagnosis, treatment plan and outcomes in women undergoing stress urinary incontinence surgery.

    PubMed

    Sirls, Larry T; Richter, Holly E; Litman, Heather J; Kenton, Kimberly; Lemack, Gary E; Lukacz, Emily S; Kraus, Stephen R; Goldman, Howard B; Weidner, Alison; Rickey, Leslie; Norton, Peggy; Zyczynski, Halina M; Kusek, John W

    2013-01-01

    We evaluated the influence of preoperative urodynamic studies on diagnoses, global treatment plans and outcomes in women treated with surgery for uncomplicated stress predominant urinary incontinence. We performed a secondary analysis from a multicenter, randomized trial of the value of preoperative urodynamic studies. Physicians provided diagnoses before and after urodynamic studies and global treatment plans, defined as proceeding with surgery, surgery type, surgical modification and nonoperative therapy. Treatment plan changes and surgical outcomes between office evaluation and office evaluation plus urodynamic studies were compared by the McNemar test. Of 315 subjects randomized to urodynamic studies after office evaluation 294 had evaluable data. Urodynamic studies changed the office evaluation diagnoses in 167 women (56.8%), decreasing the diagnoses of overactive bladder-wet (41.6% to 25.2%, p <0.001), overactive bladder-dry (31.4% to 20.8%, p = 0.002) and intrinsic sphincter deficiency (19.4% to 12.6%, p = 0.003) but increasing the diagnosis of voiding dysfunction (2.2% to 11.9%, p <0.001). After urodynamic studies physicians canceled surgery in 4 of 294 women (1.4%), changed the incontinence procedure in 13 (4.4%) and planned to modify mid urethral sling tension (more or less obstructive) in 20 women (6.8%). Nonoperative treatment plans changed in 40 of 294 women (14%). Urodynamic study driven treatment plan changes were not associated with treatment success (OR 0.96, 95% CI 0.41, 2.25, p = 0.92) but they were associated with increased postoperative treatment for urge urinary incontinence (OR 3.23, 95% CI 1.46, 7.14, p = 0.004). Urodynamic studies significantly changed clinical diagnoses but infrequently changed the global treatment plan or influenced surgeon decision to cancel, change or modify surgical plans. Global treatment plan changes were associated with increased treatment for postoperative urgency urinary incontinence. Copyright © 2013 American