Major depression in female urinary incontinence

The authors explored the relationship between urinary incontinence and major depression through data from the Canadian Community Health Survey. The prevalence of depression was 15.5% in women with urinary incontinence (30% in women ages 18-44) and only 9.2% in women without urinary incontinence. Women with comorbid illness reported increased physician use, subjective distress, and work absence. These conditions frequently occur together in Canadian women, and the combined impact of urinary incontinence and major depression exceeds the impact of either condition alone. Physicians need to be attentive to these findings.     

Maintaining standards for surgery for female urinary incontinence

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 It is the responsibility of every surgeon not to use procedures which are outdated or not recommended.To maintain standards in incontinence surgery every surgeon has to familiarize him or herself with the procedure, to learn the procedure, to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 sponsored “training centres” can be helpful but there are no shortcut to use all possible resources to learn and practice new surgery.Guidelines have become very important in evaluating new procedures and in categorizing the available evidence. They focus on specific recommendations which we can and should use in our daily practice. Again we still have the responsibility to follow the medical literature closely and to adapt our practice as new evidence becomes available—even before it is incorporated into guidelines.

Standards in follow-up

Last but not least we have to follow standards when following up on our patients. As far as possible in the context of the health care system where we practice we should aim to see the patient we have operated on at least once 6–12 weeks after surgery. We must also make sure that the patient has access to care in case a problem develops later. And we ourselves must be familiar with the complications and consequences of surgery for stress urinary incontinence and must be able to manage a patient who is not completely satisfied after surgery.     

Severe stress urinary incontinence: Objective analysis of risk factors

Objective

To assess differences between patients suffering from severe degree of stress urinary incontinence versus those with mild degree and to detect the risk factors of severity.

Materials and methods

118 patients suffered from pure SUI were enrolled in a prospective study. According to VLPP, patients were categorized into 2 groups: mild (VLPP > 60) and severe (VLPP < 60). Risk factors included age, parity, gravidity, menopausal status, co-morbidities and surgical history were investigated.

Results

35 patients had severe SUI; their mean VLPP ± SD was 47 ± 8 cm H2O, while in 83 patients with mild SUI, mean VLPP was 90 ± 20 cm H2O. No significant difference was detected between both groups concerning clinical parameters except for the presence of bronchial asthma in which the difference was approaching statistical significance (P = 0.07). Patients with multiple deliveries have triple risk to develop severe SUI. Obese patients with BMI > 30 and those with bronchial asthma are more prone to develop severe type (OR: 1.9, 95%CI: .07–5 and OR: 9.4, 95% CI: 0.7–25 respectively).

Conclusions

Bronchial asthma, obesity and multiple parities might be associated with low VLPP. Severe SUI is a resultant of multi-factors rather than one risk factor.     

Transdermal estrogen for female stress urinary incontinence in postmenopause

Objective: To evaluate the effect of transdermal estrogen for stress urinary incontinence in postmenopause. Study design: An open within patient, dose-finding study with transdermal 17-β-estradiol combined with cyclic medroxyprogesterone acetate was conducted over 9 months in 21 patients (mean age 57.3 years) suffering from urodynamically verified mild to moderate stress incontinence without detrusor instability. Results: Subjective improvement was noted in 16 out of 21 patients (76%). The dose level of 50 μg was better tolerated than 100 μg and sufficient enough to achieve continence. Conclusion: Transdermal estrogen therapy plays an adjuvant role in conservative therapy for mild to moderate stress urinary incontinence in postmenopausal women.     

The increasing incidence and prevalence of female multiple sclerosis--a critical analysis of potential environmental factors

Multiple sclerosis (MS) is the most common acquired inflammatory demyelinating disorder of the central nervous system (CNS). Not unlike many inflammatory diseases with a presumed autoimmune pathogenesis, it has been established that there is a female preponderance in prevalence. While in the past it was shown that there are two women for every man with a diagnosis of MS, recent serial cross-sectional assessments provide compelling evidence for an increase of the female to male sex ratio in patients with relapsing-remitting MS over the last decades. An understanding of this phenomenon might provide key insights into the pathogenesis of the disease but also may have implications for health-care strategies and further research efforts. We review possible etiologies for the gender disparity in MS, and we discuss possible underlying causes. We determined that the biologically most plausible explanations for a disproportional increase of MS among women in some population may be the role of vitamin D in MS pathogenesis. Decreased sun exposure may be a critical factor in diminished vitamin D levels in many recent cohort studies. Vitamin D insufficiency or deficiency has been shown to affect T cell differentiation and regulation, which may affect cellular immune responses against autoantigens and pathogens that have been associated with the etiology of MS. Vitamin D also appears to impact B cell activation and differentiation, another cell type that has been implicated in the inflammatory cascade underlying CNS autoimmune disease.     

Predictors of female urinary incontinence at midlife and beyond

Urinary incontinence (UI) is an important middle age health issue and approximately 20% of women over 40 years of age have problems with continence. Urinary incontinence poses a significant negative impact on social functioning and quality of life to many individuals. It is estimated that around three million people are regularly incontinent in the UK with a prevalence of about 40 per 1000 adults. There are various factors which can cause incontinence such as pregnancy, childbirth, obesity, menopause, or just inherent connective-tissue weakness. All of these factors can cause pathophysiology changes in the muscular and fascial structures of the pelvic floor and lead to pelvic support defects and possibly pelvic floor dysfunction. We aim with this review article to highlight predictors or predisposing factors of incontinence; in order to help clinicians during their decisions and put in place a policy of a preventive strategy to decrease the incontinence rate in the general population.     

Occurrence, nature and treatment of urinary incontinence in a 70-year-old female population

An intervention trial using oral oestriol to treat urinary incontinence was performed in a number of patients taken from a representative sample of 562 women aged 75 yr. The clinical series consisted of 34 patients who took part in a double-blind crossover study of the possible effects of oestriol, given in a single daily dose of 3 mg, and of a placebo over a period of 3 mth. The clinical examinations included bacteriological cultures and an assessment of the degree of atrophy of the surface membranes in the vagina. In most patients, oestriol was effective in reversing the atrophy. The clinical effect was excellent in urgency and mixed incontinence, but not in stress incontinence.     

Diagnosis and management of female urinary incontinence in general practice.

In response to an invitation sent to women who had complained previously of regular incontinence, 65 women with regular incontinence were seen by their general practitioner. A diagnosis was made using a personally administered questionnaire and appropriate examination. Patients were placed in one of three diagnostic/management categories--stress, urge or stress/urge incontinence--and were given an appropriate treatment programme. Fifty six women were recruited as matched controls from non-responders while attending the surgery for other reasons. They underwent identical entry procedures but were not offered a treatment programme. All the patients were reassessed after 12 weeks at which time significant improvement in incontinence was reported by the treated women in the stress and urge categories compared with the controls. There was no significant difference in reported efficacy of treatment between age groups and treatment was shown to be effective irrespective of the duration of incontinence. This study shows that for the majority of women reporting incontinence the condition can be diagnosed by a general practitioner and significantly improved by appropriate intervention.     

Age-specific prevalence of,and factors associated with,different types of urinary incontinence in community-dwelling Australian women assessed with a validated questionnaire

Objective

The aim of this study was to document the age-specific prevalence of different types of urinary incontinence (UI) in women and to identify the risk factors associated with each type of UI.

Design

A detailed self-administered questionnaire was mailed to 542 community-dwelling women, aged 24–80 years. The questionnaire included a validated instrument, the Questionnaire for Urinary Incontinence Diagnosis (QUID), for the assessment of stress, urge and mixed UI.

Results

Five hundred and six of the 542 women provided data (93.4%). The overall prevalence of any UI was 41.7% [95% confidence interval (CI): 37.2–45.8%]. Of the 210 women reporting UI, 16% [95% CI: 12.9–19.3%] reported stress only; 7.5% [95% CI: 5.2–9.8%] reported urge only and 18% [95% CI: 14.7–21.5%] reported a mixed pattern. Stress incontinence was most common amongst middle-aged women (25.3% of women aged 35–44 years), while urge incontinence was most common in women over the age of 75 years (24.2%). In logistic regression analyses, obesity (p < 0.001) and being parous (p = 0.019) were found to be significantly associated with stress incontinence, increasing age (p = 0.002) with urge incontinence, and being overweight (p = 0.035) or obese (p < 0.001) and having had a hysterectomy (p = 0.021) with mixed incontinence.

Conclusions

UI is a highly prevalent condition in women living in the community. Stress, urge and mixed incontinence have different age distributions and risk factors. These data are important in understanding the etiology, management and possible prevention of these conditions.     

盆底磁刺激治疗女性压力性尿失禁近期疗效初探

目的探讨盆底磁刺激治疗女性压力性尿失禁的短期临床效果。方法20例压力性尿失禁患者，平均年龄为（52．5±11．0）岁．平均产次（1．4±0．6）次：11例（56％）处于绝经期。接受Neocontrol 盆底磁刺激治疗8周，根据治疗前后患者主观和客观临床参数评分进行疗效评价，并进行治疗前后生活质量评分和膀胱充盈试验，治疗结束后随访3个月,随诊率100％。结果治疗结束后75％患者不再漏尿，15％患者症状得到改善。1h尿垫试验结果平均溢尿量减少7．6g,3d溢尿次数平均减少5．1次。16例患者治疗前后行膀胱灌注试验,治疗后初始排尿欲膀胱容量和最大膀胱容量较治疗前增大,差异有统计学意义（P〈0．05）。所有患者生活质量评分显著提高（P〈0．05）。治疗中未见任何副作用。治疗后随诊3个月，治愈患者中60％症状复发。结论盆底磁刺激是治疗压力性尿失禁的安全、有效、简便、无痛的方法，但疗效持续时间较短。     

Mixed infection with Beijing and non-Beijing strains in pulmonary tuberculosis in Taiwan: prevalence,risk factors,and dominant strain

Patients with pulmonary tuberculosis (TB) can be simultaneously infected with different strains of Mycobacterium tuberculosis (mixed infection). We investigated the prevalence and risk factors of mixed infection by Beijing and non-Beijing strains in pulmonary TB patients in Taiwan. We developed a quantitative PCR method to simultaneously detect the presence of Beijing and non-Beijing strains. A total of 868 pre-treatment samples (from 868 patients), including 563 sputum samples smear-positive for acid-fast bacilli and 305 liquid medium samples culture-positive for mycobacteria, were tested. Medical records of patients with culture-confirmed pulmonary TB were reviewed. The detection limit of our quantitative PCR method was five copies of target sequences. With mycobacterial culture result as the reference standard, the sensitivity and specificity of our quantitative PCR method were 95% and 98%, respectively. M. tuberculosis strains were isolated in 466 samples, of which 231 (49.6%) were infected with a Beijing strain. Another 14 patients (3.0%) had mixed infection, with the Beijing strain being the dominant strain in 13 (93%). Age <25 years with pulmonary cavities was associated with mixed infection. In patients infected with non-Beijing strains, the bacterial load of non-Beijing strains was lower among those with mixed infection than among those without. Our quantitative PCR method was accurate in detecting Beijing and non-Beijing strains in smear-positive sputum and culture-positive liquid medium samples. Mixed infection was present in pulmonary TB patients (3.0%), especially in those aged <25 years with pulmonary cavities. Beijing strains seem to be more dominant than non-Beijing strains in patients with mixed infection.     

尿道悬吊术吊带材料的研究进展

目前临床侵入性治疗压力性尿失禁存在多种手术方式,文献对无张力阴道吊带术及其繁多的植入材料报道甚多。文章就目前流行的控尿机制、吊带术历史和临床使用吊带材料的最新进展做系统综述。     

Dynamic graciloplasty for urinary incontinence: the potential for sequential closed-loop stimulation

Muscle tissue transplantation applied to regain or dynamically assist contractile functions is known as 'dynamic myoplasty'. Success rates of clinical applications are unpredictable, because of lack of endurance, ischemic lesions, abundant scar formation and inadequate performance of tasks due to lack of refined control. Electrical stimulation is used to control dynamic myoplasties and should be improved to reduce some of these drawbacks. Sequential segmental neuromuscular stimulation improves the endurance and closed-loop control offers refinement in rate of contraction of the muscle, while function-controlling stimulator algorithms present the possibility of performing more complex tasks. An acute feasibility study was performed in anaesthetised dogs combining these techniques. Electrically stimulated gracilis-based neo-sphincters were compared to native sphincters with regard to their ability to maintain continence. Measurements were made during fast bladder pressure changes, static high bladder pressure and slow filling of the bladder, mimicking among others posture changes, lifting heavy objects and diuresis. In general, neo-sphincter and native sphincter performance showed no significant difference during these measurements. However, during high bladder pressures reaching 40 cm H(2)O the neo-sphincters maintained positive pressure gradients, whereas most native sphincters relaxed. During slow filling of the bladder the neo-sphincters maintained a controlled positive pressure gradient for a prolonged time without any form of training. Furthermore, the accuracy of these maintained pressure gradients proved to be within the limits set up by the native sphincters. Refinements using more complicated self-learning function-controlling algorithms proved to be effective also and are briefly discussed. In conclusion, a combination of sequential stimulation, closed-loop control and function-controlling algorithms proved feasible in this dynamic graciloplasty-model. Neo-sphincters were created, which would probably provide an acceptable performance, when the stimulation system could be implanted and further tested. Sizing this technique down to implantable proportions seems to be justified and will enable exploration of the possible benefits.     

TVT术治疗女性压力性尿失禁临床分析

目的评价无张力阴道吊带术T(VT)治疗女性压力性尿失禁疗效。方法经临床检查确诊为女性压力性尿失禁患者28例,采用聚丙烯网状吊带,手术自阴道前壁切口经耻骨后向下腹部穿刺,将无张力吊带置于尿道中段下方,利用吊带的倒刺结构提起、固定于穿刺经过的耻骨后和各层腹壁组织上,术中膀胱镜监视。结果手术时间平均(30±15)min;术中出血量平均(20±10)ml;术后平均留置导尿管2d;术后平均住院3d。随访1～39个月,平均21个月,尿失禁症状完全消失25例,明显改善3例,无手术失败病例。结论TVT手术治愈率高,操作简便,损伤小,恢复快,并发症发生率低,是一种治疗女性压力性尿失禁的有效方法。     

Hepatitis B prevalence and risk factors in Morocco

Aim

The aim of this study was to determine the prevalence of hepatitis B and the risk factors in Morocco.

Study design

A total number of 16,634 individuals were screened for HBsAg using the Murex HBsAg Version 3 assay and were interviewed using a structured standard questionnaire to collect information about risk factor.

Results

Two hundred seventy-six subjects were positive for HBsAg, the prevalence of HBV infection was 1.66%. Using a structured standard questionnaire we reported that sexual behaviours (43.84%) are among the main risk factors for HBV transmission.

Conclusion

This study indicates that the prevalence of HBsAg in Morocco is currently estimated at 1.66% in the active population. The risk factors for HBV infection identified here indicate that prevention is the most cost-effective method for successfully controlling HBV infection, so vaccination remains the best way to control this infection and its related complications.     

Risk factors for the development of fecal and urinary incontinence in Wisconsin nursing home residents

PURPOSE: To determine factors associated with the development of urinary and fecal incontinence in nursing homes. DESIGN AND METHODS: Residents of Wisconsin skilled nursing facilities reported in the Wisconsin annual nursing home survey continent to both urine and stool in 1992 were re-assessed 1 year later for the development of urinary and/or fecal incontinence. Independent variables were elements of the HCFA minimum data set found to be significantly associated with incontinence in cross-sectional surveys of Wisconsin nursing home residents. RESULTS: Dementia and advancing age were consistently associated with the development of incontinence, but the strongest associations were impairment of activities of daily living and the use of patient restraints. IMPLICATION: Adjusting for the major reasons to apply patient restraint: dementia, blindness, arthritis and stroke, along with other risk factors for incontinence, the use of patient restraints is the most significant cause for the development of incontinence in nursing homes.