Treatment of patients with urge or stress urinary incontinence

This article outlines the nursing assessment of urinary incontinence, and describes both conservative management of individuals with incontinence and common pharmacological treatment options. The article focuses on therapeutic options for patients with urge or stress incontinence.     

Treatments for stress urinary incontinence

Stress urinary incontinence (SUI) is a common problem among women, particularly after childbearing. While it is not in itself life-threatening, it inevitably impairs quality of life, causing embarrassment and even social isolation--this is often both the reason that people with SUI seek medical help and the method of measuring the success of treatment. A range of treatment and management options is available for dealing with this distressing condition.     

Treatment options for women with stress urinary incontinence

About one-quarter million surgical procedures are performed each year in the United States for stress urinary incontinence. After outlining the presentation and diagnostic evaluation of stress urinary incontinence, this review concentrates specifically on the numerous conservative management strategies and minimally invasive surgical options for women with this common complaint. In the evaluation of nursing home residents with incontinence, the Minimum Data Set and Resident Assessment Protocol facilitate nonspecialist evaluation and management. In healthy adults, the therapeutic implications of the physical examination of the pelvic floor, assessing for the presence and strength of the voluntary contraction of the pelvic floor muscles, are detailed as the basis for all conservative management strategies. Reports on the effectiveness of pelvic floor muscle reeducation and pelvic floor electrical stimulation vary substantially, as do long-term results of surgical interventions. Surgical management is highly effective in the appropriate candidate. The current theory and practice of surgical treatment of stress urinary incontinence are outlined, with certain caveats regarding the lack of long-term follow-up for newer less invasive techniques.     

Home treatment for women with stress urinary incontinence

Urinary incontinence is an unpleasant, unwanted and distressing problem that is common among women in the UK. A recent study (Hunskarr et al, 2004) estimated that 10 million women in the UK suffer with urinary incontinence. Stress urinary incontinence (SUI) is the most common form, affecting four million women. The International Continence Society defines SUI as 'the complaint of involuntary leakage [of urine] on effort or exertion, or on sneezing or coughing' (Abrams et al, 2002).     

无张力阴道吊带手术治疗女性压力性尿失禁的循证护理

目的探讨女性压力性尿失禁(SUI)患者行无张力阴道吊带手术(TVT)的循证护理。方法针对20例行TVT手术的女性SUI患者的需求,提出问题,并进行文献检索。结果将TVT手术的Cochrane证据和随机对照实验(RCT)结果以及扩展检索到的相关证据应用于临床护理中,增加了健康宣教、心理护理、专科护理和护理科研的证据支持。结论循证护理提高了护理实践的科学性,有利于持续质量改进和密切医护患关系,推动了护理科研的开展。     

Understanding stress urinary incontinence

Underreported and undertreated, stress urinary incontinence leads to decreased quality of life in sufferers and financial burdens for both the patient and the healthcare industry. Nurse practitioners should understand their role in identifying, diagnosing, and treating the condition.     

认知行为干预对女性压力性尿失禁患者盆底肌训练依从性和治疗效果的影响

目的:探讨认知行为干预对轻中度女性压力性尿失禁患者盆底肌训练依从性和治疗效果的影响。方法:选择88例轻中度压力性尿失禁患者,按照抽签方法随机分为观察组45例和对照组43例,分别对两组患者入组前及入组后2周,1,2,3个月进行1 h尿垫试验和采用国际尿失禁咨询委员会尿失禁问卷表简表评估尿失禁次数和量,采用尿失禁生活质量问卷(QOL)评估对生活质量的影响。结果:入组1,2,3个月干预组患者依从性明显较对照组提高,疗效明显比对照组好,差异具有统计学意义(P0.05)。结论:对轻中度尿失禁患者进行认知行为干预能保证患者的依从性,且临床疗效明显。     

Treatment of stress urinary incontinence

This review presents reported cure and improvement rates of stress urinary incontinence in women obtained by different treatment modalities. Apart from the urodynamic findings, histological and histochemical changes of the pelvic floor may be clinically relevant to treatment in the future. Long-term cure and improvement rates achieved by non-surgical treatment (physiotherapy, biofeedback, bladder training, electrostimulation) are commented on. These rates range from 40-60% for physiotherapy and electrostimulation but are considerably less after biofeedback and bladder training. Pharmacotherapy is unlikely to offer more than a placebo effect. Studies of a single surgical procedure usually report high cure rates. In making the appropriate choice of operation the best guidelines are the cure rates from comparative or prospective randomized reports. From such studies an abdominal retropubic suspension operation (cure rates after five years 57-78 %) is more likely to help the patient than an anterior colporrhaphy (cure rates 31-70 %) or a transvaginal needle bladder neck suspension (cure rates 39-61 %). In selected patients sling procedures or the use of artificial sphincters may produce excellent results (70-80 %). To estimate the results of different treatments urine loss should be assessed objectively and physical restrictions and hygienic and social implications taken into account. A method of pre- and post-treatment "performance scores" should be developed.     

盆底肌系列训练法对压力性尿失禁患者的干预效果评价

目的 探讨盆底肌系列行为训练法对压力性尿失禁(SUI)的治疗效果.方法随机抽取41例压力性尿失禁患者,对他们开展为期6个月的泌尿系统和盆底肌相关解剖、生理知识讲座,视觉错误图引导式盆底肌训练法,循序渐进式间断排尿训练和尿急训练等.并对训练效果进行评价.结果训练后患者的主观评价有所改善,1 h尿垫试验、3 d漏尿、初始尿意膀胱容量、最大膀胱容量等指标训练前后比较均有显著差异.结论盆底肌系列训练法简便易行,可减轻SUI患者的身心痛苦.     

女性压力性尿失禁患者健康信念量表的编制

目的编制用于评价女性压力性尿失禁患者的健康信念量表,并检验其信效度。方法以健康信念模式为理论框架,通过文献回顾和专家咨询设计初始量表。经专家内容效度评定、预调查和统计学分析等过程对量表条目进行修订和筛选,形成正式量表,然后对量表的信度和效度进行评价。结果正式量表包括4个维度:罹患性认知(3个条目)、严重性认知(12个条目)、障碍性认知(8个条目)和利益性认知(7个条目),共30个条目。量表中每个条目均具有较好的鉴别度,量表的内部一致性信度Cronbach'sα系数为0.97,重测信度为0.95。量表的内容效度为0.97,其4个维度用主成分分析均抽取了特征值大于1的公因子1个,每个公因子的贡献率均大于50%,每个条目在各自公因子上的载荷值均大于0.4。结论编制的女性压力性尿失禁患者健康信念量表具有良好的信度和效度,可用于评价女性压力性尿失禁患者的健康信念水平。     

医院-社区-家庭失禁护理平台在压力性尿失禁患者管理中的应用研究

目的 探讨医院-社区-家庭失禁护理平台（以下简称失禁护理平台）在压力性尿失禁患者中的应用效果。方法 开发了包含压力性尿失禁患者电子档案、网页操作及失禁移动护理应用程序在内的失禁护理平台,客户端分为居民端、基层医疗机构端与医院端。将压力性尿失禁患者随机分为试验组51例和对照组54例,两组均给予常规的门诊失禁评估和教育, 指导试验组使用失禁护理平台,为其提供在线的健康教育及功能锻炼提醒和监测;对照组给 予定期门诊随访。 随访并调查两组的盆底肌力、一小时尿垫试验漏尿量,并进行干预前后尿 失禁问卷表简表、盆底肌肉锻炼自我效能的对比。 结果 干预后 6 个月,试验组的尿失禁症状明显改善,自我效能得分高于对照组,尿失禁问卷简表得分低于于对照组,两组差异均有统计学意义（均P＜0.05）。结论 与门诊常规复诊教育相比,失禁护理平台能更有效地提高患者盆底肌锻炼的依从性,提高患者的盆底肌力,降低失禁程度,提高生活质量。     

胶原蛋白与压力性尿失禁

压力性尿失禁(Stress Urinary Incontinence,SUI)在中、老年妇女中较高的患病率,影响了她们的生活质量.SUI的发病机制比较复杂,其中整体理论详细阐述了盆底结缔组织对维持正常控尿的重要作用.胶原蛋白是盆底结缔组织的重要组成部分,其合成与降解影响盆底结缔组织的形态和功能.SUI患者可能由于胶原蛋白合成减少和(或)降解增加,使盆底结缔组织的弹性和韧性受到影响,从而引发尿失禁.     

女性压力性尿失禁患者围手术期的护理干预

目的:探讨女性压力性尿失禁围手术期的护理方法。方法:选择2009年7月~2012年7月在我院手术治疗的女性压力性尿失禁患者68例,采取精心细致的全程护理干预措施。结果:68例患者中治愈65例,好转3例,手术成功率100%。结论:专科护士充分的术前准备是手术成功的保证,做好切口观察、保留尿管的护理、盆底肌功能锻炼等术后护理是手术成功的关键。     

Functional imaging of stress urinary incontinence

Stress urinary incontinence (SUI) is defined as an involuntary loss of urine during increases in intraabdominal pressure such as coughing or laughing. It is often a consequence of weakness of the pelvic floor. Treatment of SUI consists of pelvic floor muscle training with EMG-biofeedback (PFMT) or contraction-exercises, with voluntary pelvic contractions in order to strengthen the pelvic floor. We investigated neuroplastic changes comparing PFMT with EMG-biofeedback before and after training in ten female patients with SUI using event-related functional Magnetic Resonance Imaging (fMRI). After a 12-week training a more focused activation in the primary motor and somatosensory cortical representation sites of the lower urogenital tract was found. In addition, reductions in brain activation in the insula, right frontal operculum and the anterior cingulate cortex suggest changes in emotional arousal in micturition after treatment. These changes are related to clinical improvement documented by decreased number of incontinence episodes and increased EMG-activity of the pelvic floor muscles after training. The changes in EMG-activity were correlated with heightened BOLD responses in the primary motor and primary sensory cortical representation sites of the lower urogenital tract.     

女性压力性尿失禁病人报告结局评估工具的研究进展

介绍了女性压力性尿失禁病人症状严重程度、疾病困扰程度和生活质量方面病人报告结局评估工具的研究情况,旨在为女性压力性尿失禁研究提供更有效的评估工具。     

压力性尿失禁诊疗135例临床分析(英文)

Objective The purpose of this study is to evaluate and compare the two different treatments by researching 135 cases with stress urinary incontinence.Methods From June 2006 to June 2010,135 patients with stress urinary incontinence were treated in Department of Gynecology and Obstetrics of Peking University Shenzhen Hospital.91 cases of them were treated with low frequency electric stimulation and biofeedback therapy (Group A),and the other 44 cases were treated by improved transobturaor tension-free vagina...