Urinary incontinence volume measurementin elderly male inpatients

Urinary incontinence is a debilitating disease in the elderly and is a leading cause of nursing home placement for aged patients in our society. Accurate measurement of urinary incontinence in elderly inpatients is necessary to determine the severity of the disease and to evaluate the efficacy of any treatment methods being investigated. The technique required for evaluation of elderly chronic care inpatients is different from methods that can be used in patients who do not have the ambulatory and cortical impairment that is common among chronic care inpatients. Since chronic care nursing staff involvement is necessary for accurate measurement and recording of incontinence episodes, a procedure for measurement must be well defined and clearly outlined in a sequence that can be followed easily. This study provides a method of incontinence volume assessment for elderly inpatients that can be performed by inpatient nursing staff to provide accurate incontinence volume measurements. Quantitative urinary incontinence volume measurements were done over ten days in 42 elderly men. Urinary incontinence presented as a significant problem in these patients over a wide range of both frequency and volume of urinary incontinence episodes. The volume measurement technique described allowed the nursing staff to identify, measure, and record incontinence severity over a wide range of frequency and volume while monitoring multiple patients simultaneously.     

Bothersome urinary symptoms and disease-specific quality of life in patients with benign prostatic obstruction

OBJECTIVES: Firstly, to describe self-reported urinary symptoms and bothersomeness, including disease-specific quality of life (QOL), in patients with symptomatic benign prostatic obstruction (BPO) before and 6 months after intervention. Secondly, to identify factors which predict disease-specific QOL. Thirdly, to develop and test the reliability of an instrument to evaluate incontinence, the Link?ping Incontinence Questionnaire (LIQ). Finally, to translate and test the reliability of Swedish versions of the International Prostate Symptom Score, including the bother question, the American Urological Association Symptom Problem Index (SPI) and the Benign Prostatic Hyperplasia Impact Index. MATERIAL AND METHODS: Disease-specific QOL was studied in 572/720 consecutively treated patients using structured questionnaires. The reliability of the instruments was tested in 122 patients with lower urinary tract symptoms (LUTS) or BPO. RESULTS: The frequency and weak stream items of the SPI were among those that best explained the patients' disease-specific QOL both before and after intervention. Before and after intervention the prevalence of urinary incontinence, assessed using the LIQ instrument, was 46% and 16%, respectively. Symptoms and disease-specific QOL improved most in the surgery group, intermediately in the transurethral incision of the prostate/transurethral microwave thermotherapy group and least in the drug therapy group. CONCLUSIONS: The frequency and weak stream items of the SPI were the factors that best explained disease-specific QOL. The prevalence of incontinence before and after intervention was higher than that previously reported.     

Suture Injury to the Urinary Tract in Urethral Suspension Procedures for Stress Incontinence

The case histories of women attending the Urogynecology Department at the Royal Women’s Hospital and Mercy Hospital for Women were reviewed between 1986 and 1998 to determine the incidence and postoperative morbidity caused by suture injury to the urinary tract following urethral suspension surgery for stress incontinence. In our department 1103 Burch colposuspensions and 61 Stamey urethral suspensions have been performed. Intraoperative cystourethroscopy was performed routinely for the early detection and treatment of urinary tract injury. Intravesical sutures were found by routine intraoperative cystoscopy in 1 Stamey suspension, 1 open Burch colposuspension and 3 laparoscopic Burch colposuspensions. Ureteric suture ligation was diagnosed in 2 women intraoperatively and 1 woman postoperatively after laparoscopic Burch colposuspension. Two women presented with late complications from intravesical sutures following open Burch colposuspension. A further 7 women referred with urinary symptoms were found to have intravesical sutures, 2 following Burch colposuspension, 4 following Stamey urethral suspension and 1 following the Marshall–Marchetti–Kranz procedure. Seven of the 9 women diagnosed with intravesical sutures presented with bladder or pelvic pain, frequency or urinary tract infection. Two women had recurrent stress incontinence and were found to have a intravesical suture on routine cystoscopy at the time of stress incontinence surgery. Suture removal, with any accompanying calculus, was achieved cystoscopically with almost immediate resolution of symptoms without loss of urinary control in all cases. Non-absorbable intravesical sutures occurring as a result of suture misplacement or erosion is an infrequent but important complication of stress incontinence surgery, but should be suspected if pain and irritative bladder symptoms or recurrent urinary infection occur postoperatively. Cystourethroscopy performed intraoperatively or postoperatively is essential for early diagnosis and treatment.     

Value of the patient's case history in diagnosing urinary incontinence in general practice

What is the value of the case history in diagnosing urinary incontinence in general practice? A total of 103 women with urinary incontinence presented to their general practitioner (GP) and underwent a standard history-taking, physical examination and urodynamic testing. The urodynamic diagnoses were analysed against symptoms and symptom complexes. Symptoms of stress incontinence in the absence of symptoms of urge incontinence had a sensitivity of 78%, specificity of 84% and predictive value of 87%. Symptoms of urge incontinence in the absence of symptoms of stress incontinence excluded genuine stress incontinence. Information on age, parity, enuresis, nocturia, frequency, urgency, cystocele, prolapse and hysterectomy did not contribute to a correct diagnosis. It was concluded that urodynamics are unnecessary in most women presenting with urinary incontinence in general practice.     

Overactive bladder symptoms in patients with multiple sclerosis: Frequency,severity, diagnosis and treatment

Objective: To determine the frequency and severity as well as the diagnosis and treatment of overactive bladder problems in patients with multiple sclerosis (MS) followed up at five centers in Turkey.

Design: Survey study.

Setting: Outpatient tertiary clinics of physical medicine and rehabilitation and neurology.

Participants: Consecutive MS patients scheduled for outpatient follow-up (n?=?309).

Intervention: MS patients were asked to complete a questionnaire regarding the frequency and severity, as well as the diagnosis and treatment of their overactive bladder problems.

Results: The mean age?±?SD was 39.3?±?10.6 years. Urinary urgency was the most common urinary symptom (62%), followed by frequency (50.4%), urge incontinence (44.7%) and nocturia (33%). Residual urine volume was measured using a portable ultrasound instrument in 13.3% of the patients and by catheterization in 16.2% of them. Urodynamic investigations and urinary tract ultrasound were performed on 26.5% and 35.3% of the patients, respectively. Anticholinergic medications were prescribed for 27.5% of the patients. Intermittent catheterization and indwelling catheterization were used on 8.1% and 1.9% of the patients, respectively. The overactive bladder symptom score (OABSS) was significantly higher in patients who had had residual urine measurement (P?<?0.001), upper urinary tract assessment by ultrasound (P?<?0.001), urodynamic assessment (P?<?0.001), admitted to a doctor for urinary symptoms (P?<?0.001), and current or past catheter use (P?=?0.002).

Conclusion: Urgency was the most common urinary symptom followed by frequency, urge incontinence and nocturia in MS patients. The patients with lower OABSS had detailed urological assessments less frequently than the patients with higher OABSS.     

Depression and incontinence

 The urologic literature suggests that there is an association between a variety of psychiatric disorders and incontinence. Most notably, depression is found in a significant percentage of patients with urinary incontinence. Depression also occurs in other conditions associated with urinary urge incontinence, such as aging and dementia, and in neurologic disorders such as normal pressure hydrocephalus. Correction of some neurologic disorders eliminates both depression and urge incontinence. Although chronic medical disorders such as urge incontinence may lead to depression, an alternative hypothesis is that these two conditions share a common neurochemical pathogenesis. Lowering monoamines such as serotonin and noradrenaline in the central nervous system (CNS) leads to depression and urinary frequency and a hyperactive bladder in experimental animals. Thus, depression may not only be the result of persistent urinary incontinence, but individuals with altered CNS monoamines could manifest both depression and an overactive bladder. The latter condition may lead to urge incontinence, urinary frequency, urgency, or enuresis. Uncovering further evidence for such a linkage could serve as the basis for the development of genetic markers and novel therapeutic interventions for these two conditions.     

Propiverine hydrochloride improved correlatively subjective QOL and objective findings in Japanese patients with urinary frequency and/or incontinence

To investigate how urinary frequency and incontinence affect the patient's subjective quality of life (QOL) and whether an improvement in objective findings by medical treatment affects his/her subjective QOL, a voiding diary using the King's Health Questionnaire (KHQ) and International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) was delivered to patients with urinary frequency and/or incontinence before and after treatment with propiverine hydrochloride for 8 weeks. Sixty-eight patients completed the diary and the questionnaires. Objective symptoms decreased significantly with respect to the mean frequency of urination and to the mean incidence of urinary incontinence. The KHQ and ICIQ-SF scores improved significantly with respect to all domains except personal relationships in the KHQ. In the KHQ, furthermore, a significant correlation was found between decreased incidence of urinary incontinence and improvement in role limitations and between decreased incidence of urinary incontinence and improvement in emotional problems. In the ICIQ-SF, a significant correlation was found between decreased incidence of urinary frequency and subjective improvement in quantity of leakage, between decreased incidence of urinary frequency and improvement in subjective QOL scores, between decreased incidence of urinary frequency and improvement in the total ICIQ-SF score, and between decreased incidence of urinary incontinence and improvement in subjective QOL scores. Thirty-two episodes of adverse reactions were observed. None of them were serious. These results suggest that an improvement in objective symptoms with propiverine hydrochloride favorably improves subjective QOL of the patient, and provide further evidence about the safety and efficacy of propiverine hydrochloride.     

Urinary incontinence volume patterns in elderly inpatient men

Urinary incontinence is a costly and debilitating disease of the aged. Although the most common clinical finding is detrusor hyperreflexia on filling cystometry, the role of this urodynamic abnormality in the etiology of incontinence is uncertain. The purpose of this study was to evaluate elderly patients who have cystometric detrusor hyperreflexia and to determine the incontinence volume characteristics of these patients during regular daily activities. Ten patients with detrusor hyperreflexia during filling cystometry and an incontinence volume level above 1 L per day were evaluated according to the volume of urine loss per incontinence episode during a ten-day measurement period. All patients studied were found to have an irregular urinary incontinence volume distribution with a wide range of involuntary urine loss per incontinence episode. An irregular pattern of incontinence volume was found in each patient which suggests that detrusor hyperreflexia is manifest as an irregular involuntary loss of urine during daily activities of elderly inpatients. This unstable bladder activity relative to the volume of urine loss appears to be an important factor in the pathophysiology of urinary incontinence in aged inpatients.     

Mixed urinary incontinence: international urogynecological association research and development committee opinion

Background and aim

The definition as well as the treatment of women with mixed urinary incontinence (MUI) is controversial. Since women with MUI are a heterogeneous group, the treatment of MUI requires an individual assessment of the symptom components: stress urinary incontinence, urinary urgency, urgency urinary incontinence, urinary frequency, and nocturia. The purpose of this paper is to summarize the current literature and give an evidence-based review of the assessment and treatment of MUI.

Methods

A working subcommittee from the International Urogynecological Association (IUGA) Research and Development (R&D) Committee was formed. An initial document addressing the diagnosis and management of MUI was drafted based on a literature review. After evaluation by the entire IUGA R&D Committee, revisions were made, and the final document represents the IUGA R&D Committee Opinion on MUI.

Results

This R&D Committee Opinion reviews the literature on MUI and summarizes the assessment and treatment with evidence-based recommendations.

Conclusions

The diagnosis of MUI encompasses a very heterogeneous group of women. The evaluation and treatment requires an individualized approach. The use of validated questionnaires is recommended to assess urinary incontinence symptoms and effect on quality of life. Conservative therapy is suggested as a first-line approach; if surgery is contemplated, urodynamic investigation is recommended. Women undergoing surgical treatment for MUI need to be counselled about the possibility of persistence of urinary urgency, frequency and urge incontinence even if stress urinary incontinence is cured.     

Incontinence management scale for elderly inpatient men

For many elderly inpatients, urinary incontinence cannot be successfully treated and the management objective is identifying a suitable method for containment of urine loss. In elderly inpatient men, an external catheter is utilized in many cases for incontinence management. The role of the severity of incontinence and the use of an external catheter was investigated in 66 elderly inpatient men. Quantitative incontinence measurements showed incontinent patients having an external catheter had approximately 6.3 (SD = 2.5) episodes per day compared with 3.2 (SD = 2.0) episodes per day in the noncatheter incontinent patients. The clinical management method used in these patients was associated with the measured severity of incontinence.     

Pathophysiology of urinary incontinence

Urinary incontinence, or the complaint of involuntary loss of urine, is a debilitating condition of the lower urinary tract with a potentially significant impact on a patient's physical and mental wellbeing and on their functioning and place in society. Due to the high prevalence of this disorder, the economic burden on healthcare systems worldwide is enormous. Urinary incontinence has a high prevalence in women, but men can be affected as well after a radical prostatectomy or when suffering from chronic urinary retention. Stress, urgency and mixed urinary incontinence are the most common types of urinary incontinence, but other types exist as well. The pathophysiological mechanisms behind these different types of urinary incontinence have been studied extensively. New insights allow for the development of improved diagnostic and therapeutic strategies and ultimately in the reduction of the potentially devastating impact of urinary incontinence on an individual patients' quality of life. In this review, we explore the current theories on the mechanisms behind urinary incontinence.     

Reproducibility of a new method to determine cough-induced leak-point pressure in women with stress urinary incontinence

The aim of the study was to test the reproducibility of a new method of determining cough-induced leak-point pressure (CILPP). A cough-induced increase in intra-abdominal pressure was recorded vaginally in 26 women with stress incontinence and urinary leakage was detected electronically. CILPP determinations and short-term pad tests were carried out on two different occasions. Reproducibility is expressed by a coefficient of repeatability as limits of agreement. These indicate that, for 95% of the cases, a repeat measurement of CILPP will be between 0.72 and 1.28 times the first measurement. The coefficient of variation was 11.2%. There was a moderate inverse correlation between padtest data and CILPP. It was concluded that the new method allows for an accurate determination of CILPP, which represents a quantitative and dynamic assessment of urethral function. The reproducibility of the method appears to be better than that of pad tests and standard urodynamic parameters. The correlation with pad-test data gives support to the validity of the method.Editorial Comment: As healthcare providers for women with urinary incontinence, we are constantly seeking new and better ways to evaluate patients and optimize the outcome of their care. Leak-point pressure measurement has recently been presented as a less cumbersome, less costly and less invasive technique. Its proponents claim it is more physiologic and incremental, thus allowing us to assess improvement with therapy as well as to diagnose incontinence. However, detractors rightfully claim that its use is not supported by any outcome-based data, and that there is little known about many confounding variables, including position, fluid density, loss detection, number and size of catheters, abdominal versus vesical pressure etc. The reproducibility of the technique also needs to be addressed. The leak-point pressure may prove to be a useful addition to the armamentarium of the urodynamic unit. Work like this is a welcome addition to our knowledge base but represents a fraction of what is necessary before leak-point pressure can be widely embraced as a clinical tool.     

The frequency/volume chart in genuine stress incontinent women

Urinary incontinence is a major health problem. Simple methods of investigation are thus of great interest. For example, the frequency/volume chart is in common use, but the efficiency of this instrument in characterizing different conditions of incontinence does not seem to have been scrutinized. In this study the frequency/volume charts of 81 genuine stress incontinent women are compared to those of 151 women without complaints from the lower urinary tract. The total voided volume, the frequency of micturition, the largest single voided volume, and the variability of voided volumes are all shown to be statistically different in the genuine stress incontinent material from that of the normal material. If this is of importance from a differential diagnostic viewpoint is uncertain, as the overlap between the materials for all parameters is great.     

Age at surgery, educational level and long-term urinary incontinence after radical prostatectomy

Study Type – Harm (case series) Level of Evidence 4 What’s known on the subject? and What does the study add? Several factors, including age, body mass index (BMI), prostate size and previous transurethral resection of the prostate, have been suggested to play a part in determining the risk of urinary incontinence after radical prostatectomy. Results relating to the importance of each factor have been conflicting, so we need more data to be able to identify the relevant factors. In this consecutive series, with information from 1179 patients who had undergone radical prostatectomy, age at the time of surgery, educational level, respiratory disease and salvage radiation therapy predicted the occurrence of long‐term urinary incontinence. Increasing age predicted the risk in an exponential manner, and the data indicate a correlation across all educational levels. There was no certain association between previous transurethral resection of the prostate, increased BMI or prostate size and urinary incontinence.

OBJECTIVE

? To identify predictors for long‐term urinary leakage after radical prostatectomy.

PATIENTS AND METHODS

? A consecutive series of 1411 patients who underwent radical prostatectomy (open surgery or robot‐assisted laparoscopic surgery) at Karolinska University Hospital between 2002 and 2006 were invited to complete a study‐specific questionnaire. ? Urinary leakage was defined as use of two or more pads per day.

RESULTS

? Questionnaires were received from 1288 (91%) patients with a median follow‐up of 2.2 years. Age at surgery predicts in an exponential manner long‐term urinary incontinence at follow‐up with an estimated relative increase of 6% per year. ? Among the oldest patients, 19% had urinary incontinence compared with 6% in the youngest age group, translating to a prevalence ratio of 2.4 (95% confidence interval [CI], 1.5–8.1). ? Low educational level, as compared with high, yielded an increased age‐adjusted prevalence ratio of 2.5 (95% CI, 1.7–3.9). ? Patients who had undergone salvage radiation therapy had an increased prevalence of urinary incontinence (2.5; 95% CI, 1.6–3.8), as did those with respiratory disease (2.4; 95% CI, 1.3–4.4). ? Body mass index, prostate weight, presence of diabetes or previous transurethral resection did not appear to influence the prevalence of urinary incontinence.

CONCLUSIONS

? In this series, a patient’s age at radical prostatectomy influenced, in an exponential manner, his risk of long‐term urinary incontinence. ? Other predictors are low educational level, salvage radiation therapy and respiratory disease. ? Intervention studies are needed to understand if these data are relevant to the prevalence of urinary leakage if a radical prostatectomy is postponed in an active monitoring programme.     

Comorbidities affect the impact of urinary incontinence as measured by disease-specific quality of life instruments

The aim of this study was to determine if the impact of urinary incontinence on activities of daily living, as measured by a disease-specific quality of life instrument, is dependent on comorbid conditions. Incontinent kidney transplant recipients participated in a survey to determine the impact of urinary incontinence on activities of daily living using the Incontinence Impact Questionnaire (IIQ-7). Similar information was collected from the charts of nontransplant incontinent women. Participants were matched for age, incontinence severity, pads per day, and leaks per day noted in a 3-day 24-h bladder diary. IIQ-7 scores from participants were compared using Mann-Whitney U tests. Nontransplant incontinent women reported a 200% greater affect of incontinence on activities of daily living than incontinent renal transplant recipients (35.5±26.5 vs 12.9±15.4, p<0.0001) despite similarities in incontinence severity measures. Urinary incontinence has less of an impact on activities of daily living for renal transplant recipients than nontransplant incontinent women with similar incontinence severity measures because the disease-specific quality of life instrument used in this study was sensitive to their comorbid condition (transplant status).Editorial Comment: This paper evaluates incontinence impact using an established questionnaire. The control group of women reported a 200% greater impact of incontinence on activities of daily living compared to transplant recipients. Transplant status explained 22% of the variance in IIQ-7 scores. The authors postulate several reasons for the difference between renal transplant patients and controls, but these are speculative. Perhaps urinary leakage is a minor inconvenience compared to the medical challenges these patients faced previously.     

Pathophysiology of urinary incontinence

Urinary incontinence, or the complaint of involuntary loss of urine, is a debilitating condition of the lower urinary tract with a potentially significant impact on a patient’s physical and mental wellbeing and on their functioning and place in society. Due to the high prevalence of this disorder, the economic burden on healthcare systems worldwide is enormous. Urinary incontinence has a high prevalence in women, but men can be affected as well after a radical prostatectomy or when suffering from chronic urinary retention. Stress, urgency and mixed urinary incontinence are the most common types of urinary incontinence, but other types exist as well. The pathophysiological mechanisms behind these different types of urinary incontinence have been studied extensively. New insights allow for the development of improved diagnostic and therapeutic strategies and ultimately in the reduction of the potentially devastating impact of urinary incontinence on an individual patients’ quality of life. In this review, we explore the current theories on the mechanisms behind urinary incontinence.     

生物反馈盆底肌肉训练治疗男性获得性尿失禁的体会

目的 探讨生物反馈盆底肌肉训练治疗男性获得性尿失禁效果.方法 61例尿失禁的患者,按照各人意愿将其分为对照组(30例)和实验组(31例).对照组行单纯盆底肌肉训练,实验组接受生物反馈盆底肌肉训练.治疗前后分别计量患者每日自觉尿失禁次数、24h尿垫重量、膀胱残余尿、盆底肌表面肌电信号值.结果 治疗前各项指标差异无统计学意义(P＞0.05).治疗后,实验组与对照组比较,盆腔外伤术后以及神经源性尿失禁次数差异无统计学意义(P＞0.05).余统计量均有差异(P＜0.05).实验组治疗前后比较,神经源性的盆底肌表面肌电信号值为0.076,无差异,余统计量均有差异(P＜0.05).对照组治疗前后比较,神经源性的尿失禁次数以及膀胱残余尿量P分别为0.09、0.05,差异无统计学意义,余统计量均有差异(P＜0.05).结论 生物反馈系统盆底肌肉训练治疗男性获得性尿失禁是一种有效的、治愈率较高的治疗手段.     

Pathophysiology of urinary incontinence

Urinary incontinence, or the complaint of involuntary loss of urine, is a debilitating condition of the lower urinary tract with a potentially significant impact on a patient's physical and mental wellbeing and on their functioning and place in society. Due to the high prevalence of this disorder, the economic burden on healthcare systems worldwide is enormous. Urinary incontinence has a high prevalence in women, but men can be affected as well after a radical prostatectomy or when suffering from chronic urinary retention. Stress, urgency and mixed urinary in-continence are the most common types of urinary incontinence, but other types exist as well. The pathophysiological mechanisms behind these different types of urinary incontinence have been studied extensively. New insights allow for the development of improved diagnostic and therapeutic strategies and ultimately in the reduction of the potentially devastating impact of urinary incontinence on an individual patient's quality of life. In this review, we explore the current theories on the mechanisms behind urinary incontinence.     

Detection of urinary incontinence during ambulatory monitoring of bladder function by a temperature-sensitive device

Objectives To determine whether the difference between urinary and perineal temperatures is sufficient to allow registration of incontinent episodes by detection of temperature change alone. To design and assess the use of a diode-based temperature-sensitive device in the detection of episodes of urinary incontinence in long-term ambulatory monitoring (LTAM) studies. Subjects and methods Perineal temperature recordings were made in 46 women during various activities. A temperature-sensitive device consisting of six IN4148 diodes, spanning 5 cm, and a nearby reference negative diode, was placed in a light perineal pad and attached to a portable amplifier/digitizer and recorder. The performance of the device was determined by comparison with increases in pad weight in 51 incontinent and 23 continent control subjects. Results A sufficient temperature differential existed between perineal and urinary temperature during all activities except being seated with crossed legs. Incontinence was reliably detected by the temperature-sensitive device. The device had a sensitivity of 95.2% and a specificity of 90.6% compared to a pad test. Conclusions This temperature-sensitive device offers a new method for detecting urinary incontinence during LTAM studies. It can be fitted in an unobtrusive perineal pad and has a higher sensitivity and specificity for the detection of incontinence when compared to a pad test. It may also be used as a marker of voiding in ambulatory studies not employing an integrated voiding channel.     

Does Weight Loss Improve Incontinence in Moderately Obese Women?

The aim of this study was to evaluate the effect of weight reduction on urinary incontinence in moderately obese women. This prospective cohort study enrolled moderately obese women experiencing four or more incontinence episodes per week. BMI and a 7-day urinary diary were collected at baseline and on the completion of weight reduction. The study included 10 women with a mean (tSD) baseline BMI of 38.3 (t10.1) kg/m² and 13 (t10) incontinent episodes per week. Participants had a mean BMI reduction of 5.3 (t6.2) kg/m² (P<0.03). Among women achieving a weight loss of ≥5%, 6/6 had ≥50% reduction in incontinence frequency compared to 1 in 4 women with <5% weight loss (P<0.03). Incontinence episodes decreased to 8 (t10) per week following weight reduction (P<0.07). The study demonstrated an association between weight reduction and improved urinary incontinence. Weight reduction should be considered for moderately obese women as part of non-surgical therapy for incontinence.