Efficacy of urinary guidelines in the management of post-stroke incontinence

Urinary incontinence (UI) is common occurrence among stroke survivors and impacts their recovery. This mixed method study examined the effects of implementation of evidence-based urinary guidelines by the Interdisciplinary (ID) team in the management of post-stroke UI in stroke survivors in an acute rehabilitation hospital in Southern California. Essential elements of the guidelines included assessment of the bladder pattern, the urinary WBC's, the implementation of a scheduled toileting program, pelvic floor exercises, and the administration of Vitamin C 500 mg. by mouth. Functional Independent Measure (FIM) scores and urinary white blood cells (WBC's) were used to evaluate the efficacy the guidelines. Post guideline implementation FIM scores and urinary WBC's demonstrated improvement over the pre-scores. These results indicate that positive stroke outcomes were achieved following implementation. In addition, the ID team, comprised of nurses, physical therapists, speech pathologists, and occupational therapists, was queried as to the member's knowledge and perceptions of their roles in the implementation of the guidelines. Highlighted themes from the ID focus groups were communication and structure, relating that the guidelines were useful in promoting collaborative practice among the ID team members.     

男性尿失禁患者留置导尿与使用保鲜袋接尿效果比较

目的：探讨男性尿失禁患者留置导尿与使用保鲜袋接尿并发症发生率对比,研究更适合男性尿失禁患者接尿方法。方法回顾我院综合病房2012年5月1日~2013年9月30日就诊男性尿失禁患100例,按入院时间分为观察组与对照组50例,观察组应用保鲜袋接尿法,对照组应用留置导尿。结果通过1个月观察期间,两组并发症对比,观察组尿道感染与阴茎糜烂、管道脱落、漏尿、4 w总费用、患者满意度有显著差异,差异有统计学意义(<0.05)。结论男性尿失禁患者使用保鲜袋接尿方法避免了有创留置导尿,并减少了导管相关性尿路感染的发生率,减轻患者痛苦与经济负担,同时减少了漏尿与皮肤损伤的问题,提高了患者舒适度,方便可行,是与家庭护理紧密衔接的方法,值得在长期卧床尿失禁患者中普遍采用。     

3M液体敷料在治疗癌症晚期患者失禁性皮炎中的应用

目的 探讨3M Cavilon液体敷料在治疗癌症晚期患者大小便失禁所致失禁性皮炎的应用效果.方法 将84例大小便失禁的癌症晚期患者随机分成观察组42例和对照组42例.对照组采用常规皮肤护理,观察组在常规护理的基础上使用3M液体敷料进行皮肤护理,观察二组皮肤护理的效果.结果 使用3M液体敷料治疗组疗效明显优于常规护理组,二组比较差异有统计学意义(P＜0.05),失禁性皮炎的愈合时间短于对照组,二组比较差异有统计学意义(P＜0.05).结论 3M液体敷料的应用可有效的隔离排泄物对皮肤的刺激,尽早使用可以使大小便失禁患者保持皮肤完整性,减少了晚期癌症患者由于失禁性皮炎导致的疼痛和不适.     

Pelvic Floor Imaging

The purpose of this paper is to describe the current modalities of pelvic floor imaging: pelvic floor and endoanal ultrasonography, cystourethrography, evacuation proctography, dynamic colpocystoproctography, magnetic resonance imaging and endoanal magnetic resonance imaging.As there are no set standards for prescribing imaging tests in pelvic floor disorders, we drew up a table of tests to be performed according to the anatomical abnormality observed on physical examination or functional sign reported by the patient.     

Neural Network Analysis of Anal Sphincter Repair

PURPOSE: Prediction of success after anterior sphincter repair for incontinence is difficult. Standard multivariate analysis techniques have only 75 to 80 percent accuracy. Artificial intelligence, including artificial neural networks, has been used in the analysis of complex clinical data and has proved to be successful in predicting the outcome of other surgical procedures. Using a neural network algorithm, we have assessed the probability of success after anterior sphincter repair. METHODS: Prospective anorectal physiology data of 72 patients undergoing anterior sphincter repair was collected between 1995 and 1999. Complete data sets of 75 percent of the series were used to train an artificial neural network; the remaining 25 percent were used for data validation. The output was continence grading, ranging from 0 to 4 (worse to continent). RESULTS: The outcome at 3, 6, and 12 months postoperatively was obtained and assessed. The best correlation between actual data value and artificial neural network value was found at 12 months (r = 0.931; P = 0.0001). Clear correlations also were found at three months (r = 0.898; P = 0.0001) and six months (r = 0.742; P = 0.002). Results of applying a net to details excluding pudendal nerve latency were poor. CONCLUSIONS: Artificial neural networks are more accurate (93 percent correlation) than standard statistics (75 percent) when applied to the prediction of outcome after anterior sphincter repair. This assessment also confirms the usefulness of pudendal latency in the prediction of anterior sphincter repair outcome. The results obtained highlight the obvious usefulness of artificial neural networks, which could now be used in a prospective evaluation for application of the technique.     

预防ICU患者大便失禁性皮炎的循证实践

目的 总结预防ICU患者大便失禁性皮炎的循证证据,并评价其临床应用效果。 方法 应用循证护理的方法系统检索2010年1月—2019年9月国内外相关临床实践指南、专家共识和系统评价。评价并汇总最佳证据,制订审查条目进行基线审查,并基于审查结果分析促进与障碍因素。于2020年5月—9月将证据应用于临床,比较循证实践前后ICU患者失禁性皮炎发生率、护士对失禁性皮炎相关知识的认知水平以及对审查条目的执行率。 结果 最终纳入8篇文献,包括临床实践指南3篇、专家共识2篇、系统评价3篇,在风险评估和预防策略2方面总结了11条最佳证据。循证实践后,ICU患者失禁性皮炎发生率为19.10%,低于循证实践前（40.48%）,差异具有统计学意义（P<0.05）;护士对失禁性皮炎相关知识问卷的得分为（42.35±5.77）分,高于循证实践前（35.65±5.07）分,差异具有统计学意义（P<0.001）。护士对审查条目2、4、5、6的执行率由循证实践前的0、0、66.67%、22.62%上升至100%、84.27%、97.75%、76.40%,差异具有统计学意义（P<0.001）。结论 将预防ICU患者大便失禁性皮炎的最佳证据应用于临床,可降低失禁性皮炎发生率,提高护士对失禁性皮炎相关知识的认知水平以及执行依从性。     

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

Purpose

To report our intermediate experience in treating patients with severe incontinence using an adjustable perineal male sling with a tissue expander.

Materials and Methods

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.

Results

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.

Conclusions

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.     

Incontinence after lateral internal sphincterotomy

PURPOSE: This study was designed to evaluate the anatomic and functional consequences of lateral internal sphincterotomy in patients who developed anal incontinence and in matched controls. METHODS: The study includes 13 patients with anal incontinence after lateral internal sphincterotomy and 13 controls who underwent the same operation and were continent and satisfied with the results of the procedure. Patients underwent clinical evaluation, anorectal manometry, pudendal nerve terminal motor latency testing, and endoanal ultrasonography. RESULTS: Sphincterotomies were longer in incontinent patients (75vs. 57 percent), but the resting pressure and length of the high-pressure zone were not different between groups. Surprisingly, maximum voluntary contraction was higher in incontinent patients than in continent controls (136vs. 100 mmHg). Rectal sensation and pudendal nerve terminal motor latency were similar in both groups. The defect in the internal sphincter was wider in incontinent patients than in continent controls (17.3vs. 14.4 mm), but these differences were not statistically significant. The thickness of the internal sphincter measured by endoanal ultrasound was identical in both groups, but the external sphincter was thinner in incontinent patients both at the site of the sphincterotomy (6.8vs. 8.1 mm) and in the posterior midline (7.1vs. 8.6 mm). CONCLUSIONS: Anal incontinence after lateral internal sphincterotomy is directly related to the length of the sphincterotomy. Whether secondary to preoperative sphincter abnormality or the result of lateral internal sphincterotomy, the external sphincter is thinner in incontinent patients than in continent controls.Read at the meeting of The American Society of Colon and Rectal Surgeons, Montreal, Quebec, Canada, May 7 to 12, 1995.