深圳某社区青年女性下尿路症状的问卷调查研究

目的：分析青年女性人群下尿路症状（LUTS）的发病率和相关影响因素。方法：对广东省深圳市某社区青年女性人群进行随机抽样问卷凋查（问卷设计参考女性下尿路症状国际尿失禁标准问卷（ICIQFLUT）、国际前列腺状问卷（IPSS）布里斯托女性下尿路症状（BFLUTS）问卷及生活质量（QoL）等],根据具体情况进行调整。问卷由被调查者独立填写。结果：调查共发出问卷1500份,回收有效问卷1387份。储尿症状总患病率为91．2％,随年龄的增加,总储尿症状患病率呈增高趋势（P〈0．01）,与年龄和分娩方式有关;排尿症状总患病率为65．2％,随年龄的增加,总储尿症状患病率呈增高趋势（P〈0．01）,与生育情况、分娩方式以及文化水平有关。受调查者以刺激症状和梗阻症状的生活质量进行评分,分别为（2．87±1．32）分和（2．23±1．05）分;刺激症状和梗阻症状与生活质量评分的关联系数分别为0．51和0．23。结论：青年女性人群中的LUTS患病率很高,且不同程度影响青年女性的生活质量。     

Lower urinary tract symptoms in women and quality of life

Lower urinary tract symptoms (LUTSs) are the most common symptoms in women at all age groups worldwide, and their prevalence is increasing with age. LUTSs have a multifactorial status. The risk factors are age, race, pregnancy, birth, menopause, hysterectomy, obesity, chronic cough, depression, profession and family history. LUTSs have negative effects on women's quality of life, especially on the medical, physical, social, psychological, economical and sexual aspects. Studies report a relationship between the sexual dysfunction and urogynaecological diseases. Although the pathophysiology of high prevalence of sexual dysfunction in women with LUTS is not well known, it is estimated that the LUTS and sexual dysfunction occur due to the effects of low oestrogen levels on vagina, urethra, trigone epithelium and the atrophy of pelvic floor muscles. Especially women, who experience urinary incontinence (UI) and subgroup problems, report more common sexual dysfunctions (hypoactive sexual desire disorder, very urgent need for urination during the sexual intercourse and leakage, lack of sexual arousal, orgasm problems, sexual pain disorders). Despite the high prevalence of LUTS and its negative effects on the quality of life, the help-seeking behaviours of women for overcoming LUTS differ according to the level of disturbance. Nurses should cooperate with other health care personnel in LUTS prevention, diagnosis, treatment/follow-up, in the diagnosis of sexual dysfunction due to LUTS and its management. This article discusses the prevalence of LUTS, the risk factors of LUTS, the quality of life of women with LUTS, the negative effects of LUTS on sexual life and its nursing care.     

Distress associated with urinary incontinence, as measured by a visual analogue scale

OBJECTIVES--To estimate patients' subjective perception of having urinary incontinence by using a visual analogue scale, and to assess the scale as a preliminary diagnostical tool. DESIGN--Four groups: middle age or elderly, urge or stress symptoms. Interviews by using a symptom questionnaire, and scores by using a visual analogue scale. SUBJECTS--Thirty-six women aged 40-60 years, and fourty women aged 70 or elderly were randomly selected from a resource and information centre for incontinent people. MAIN RESULTS--Women generally experienced urinary incontinence as distressing. Women with urge symptoms had higher scores than women with stress symptoms, and the middle aged women scored higher than the elderly. The study did not support the view that a visual analogue scale can be used as a diagnostic tool.     

Bacteriuria is associated with urge urinary incontinence in older women

Objective

To investigate the association between bacteriuria and frequency and type of urinary incontinence in elderly people living in the community. Bacteriuria and urinary incontinence are common conditions and often coexisting in this population; the authors have previously reported the prevalence of bacteriuria to be 22.4% in women and 9.4% in men.

Design

Cross-sectional study.

Setting

The catchment area of a primary healthcare centre in a Swedish middle-sized town.

Subjects

Residents, except for those in nursing homes, aged 80 and over. Participation rate: 80.3% (431/537).

Main outcome measures

Urinary cultures and questionnaire data on urinary incontinence.

Results

In women the OR for having bacteriuria increased with increasing frequency of urinary incontinence; the OR was 2.83 (95% CI 1.35–5.94) for women who were incontinent daily as compared with continent women. Reporting urge urinary incontinence increased the risk of having bacteriuria: 3.36 (95% CI 1.49–7.58) in comparison with continent women while there was no significant association between stress urinary incontinence and bacteriuria. The prevalence of bacteriuria among men was too low to make any meaningful calculations about the association between bacteriuria and frequency and type of incontinence.

Conclusion

Bacteriuria is associated with more frequent leakage and predominantly with urge urinary incontinence. The causes of this association and their clinical implications remain unclear. There might be some individuals who would benefit from antibiotic treatment, but further studies are warranted.     

Influence of poststroke urinary incontinence on disability: the nursing home setting

OBJECTIVE: To characterize the association of poststroke urinary incontinence with disability progression in nursing home residents. DESIGN: In this prospective cohort study, the Minimum Data Set from the State of New York between 1994 and 1997 was utilized. From a pool of over 240,000 potential subjects, 500 met inclusion/exclusion criteria. Previously continent, first-time stroke survivors were classified as being continent or incontinent immediately after their stroke and were followed for changes in activities of daily living status (disability) at quarterly intervals for a 1 yr. In addition, a post hoc analysis was performed examining changes in activities of daily living status from the prestroke condition and exploring the relationship between poststroke impairments in continence and limitations in mobility. RESULTS: An almost 2-fold difference in level of disability was noted poststroke among those who were incontinent those who were continent (P < 0.001). This difference in disability level remained unchanged for 1 yr. Through the post hoc analysis, it was determined that, although the onset of stroke produced significant elevations in disability for both continent and incontinent stroke survivors (P < 0.001), the presence of an impairment in urinary continence was associated with a significantly greater increase (94% 13%) in disability (P < 0.001). In addition, incontinence occurred more frequently among those who had a loss in mobility function. CONCLUSION: Incontinence is a clinical factor after stroke that is associated with greater disability among nursing home residents. These findings have clinical implications for physiatrists and nursing home clinicians and provide a context in which future disability research can be conducted.     

Outlook after an acute stroke: urinary incontinence and loss of consciousness compared in 532 patients

Data from a sample of 532 patients seen within seven days of an acute stroke has been analysed to compare the prognostic importance of urinary incontinence with that of a history of any depression of consciousness. Urinary incontinence was more specific and had a higher predictive value. Considering conscious patients with moderate or severe initial disability, after six months 53 per cent of incontinent patients had died and 57 per cent of the survivors were still moderately or severely disabled whereas only 19 per cent of continent patients had died and 80 per cent of survivors made a good recovery. We conclude that early urinary incontinence is an important indicator of poor prognosis, identifying patients who may need extra attention.     

Changes in urinary incontinence and quality of life after four years. A population-based study of women aged 22-50 years

OBJECTIVES: To investigate (a) the incidence and remission rates of female urinary incontinence (UI), (b) changes in type of UI and quality of life (QoL), and (c) whether professional help had been consulted regarding UI. DESIGN: A 4-year follow-up population-based cohort study. SETTING: Surahammar, Sweden, a community of 10,500 inhabitants. SUBJECTS: All 118 incontinent and 130 continent women aged between 22 and 50 years. MAIN OUTCOME MEASURES: Changes in type of UI were measured using the Detrusor Instability Score (DIS), which was used to distinguish between the stress incontinent and the urge incontinent women. Changes in QoL were measured using the SF-36 Health Survey. RESULTS: The mean annual incidence and remission rates of UI were the same (4%). The majority of women (83%) reported unchanged UI after 4 years and 77% of these women had stress incontinence. At follow-up, the changes in QoL scores were significantly greater in five out of eight dimensions in the persistently incontinent group compared with the persistently continent group. QoL scores did not change significantly from baseline to the 4-year follow-up within the incidence and remission groups. Three of four women with UI had not sought professional help. CONCLUSIONS: At 4-year follow-up the type of UI is fairly stable in women below 50 years of age. The QoL decreases in five dimensions, but the clinical relevance of this might be questioned. Most women with UI had not sought professional help.     

Ultrasonic evaluation of urethrovesical junction in women with stress urinary incontinence

An ultrasonic evaluation of the bladder base and urethrovesical junction, at rest and during stress, using a transrectal probe, was performed on 24 continent and 67 incontinent patients. Forty-four of the incontinent patients had clinical and urodynamic diagnoses of stress urinary incontinence and 23 patients had detrusor instability incontinence. Thirty-eight of the 44 patients (86%) with urodynamically and urethroscopically proven genuine stress urinary incontinence and a weak urethral sphincter had a urethrovesical junction (UVJ) drop during stress of greater than or equal to 1 cm (mean 1.3 cm +/- 0.6 cm), as demonstrated on transrectal ultrasonic evaluation. All 23 patients with detrusor instability and 22 of the 24 continent (control) patients had UVJ drop on straining of less than 1 cm (mean 0.48 cm +/- 0.23 cm and 0.54 cm +/- 0.29 cm, respectively, p less than 0.05). The sensitivity of ultrasonic evaluation of women with stress urinary incontinence (when 1-cm drop of UVJ is considered as the upper boundary of normal) was 86% and the specificity was 91%. This ultrasound technique is quick, simple, and appears to be accurate. We believe this technique should be considered in the preoperative evaluation of women with stress urinary incontinence.     

Ferrans and Powers' Quality of life index applied in urinary incontinence research--a pilot study

Scand J Caring Sci; 2011; 25; 410–416
Ferrans and Powers’ Quality of life index applied in urinary incontinence research – a pilot study Background: The aim of this study was to explore the usefulness of applying a global, evaluation‐based quality of life (QoL) questionnaire in assessing the impact of urinary incontinence (UI) on women’s lives. Methods: The study population comprised long‐term gynaecological cancer survivors (n = 160) and controls from the general population (n = 493). The presence of UI was assessed by the question ‘Do you leak urine?’ while UI perceived as a problem was assessed on a five‐point scale from ‘No problem’ to ‘A very large problem’. QoL was measured by Ferrans & Powers’ QoL index (QLI), generic version II. Results: UI was distributed equally among women with a history of gynaecological cancer and among women from the general population (34%). UI has a negative impact on overall QLI as well as a wide range of items. Approximately 20% of the incontinent women defined UI as no problem, with QLI scores similar to continent women. Only 5% experienced UI as a large/very large problem; with exceptionally low QLI scores. The psychometric testing of QLI (acceptability, internal consistency reliability and known‐group validity) supports the use of QLI in UI‐studies. Conclusions: The Ferrans & Powers’ QLI is considered an acceptable tool for UI research, but further psychometric testing is required.     

Longitudinal comparison study of pelvic floor function between women with and without stress urinary incontinence after vaginal delivery

Purpose

To compare the pelvic floor function between women with and without stress urinary incontinence after vaginal delivery.

Methods

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.

Results

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).

Conclusion

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.     

Urinary incontinence among older women. Measurement of the effect on health-related quality of life

For women, urinary incontinence and other related lower urinary tract symptoms (e.g., nocturia, urinary urgency, frequency) are common, often increasing as women age. Urinary incontinence, however, is more than just a physiologic loss of urine. Emotional distress is also a significant issue for incontinent individuals. Researchers and clinicians are increasingly aware of the importance of identifying urinary incontinence and, in particular, urinary incontinence that causes distress or adversely effects health-related quality of life. This article addresses the effect of urinary incontinence on health-related quality of life among elderly women. Selected methods for evaluating health-related quality of life are highlighted and discussed. Suggestions are included for gerontological nurses interested in evaluating the effect of urinary incontinence on older women.     

The impact of urinary incontinence on female sexual function

Although urinary incontinence is not a life-threatening disorder, it has been shown to have detrimental effects on quality of life in terms of psychological, social, and sexual problems. In this study, investigators explored the effects of different types of urinary incontinence on female sexual function with a reliable and validated questionnaire, the Female Sexual Function Index (FSFI). One hundred fifty-three women with complaints of incontinence were enrolled in the study. An age-matched group of 89 women who had no incontinence or lower urinary tract disorders were enrolled as a control group; all completed the FSFI. Incontinence was classified as urge, stress, and mixed type. Pelvic organ prolapse (POP), if present, was also recorded. FSFI scores were compared between the incontinent and control groups. A multivariate linear regression analysis model was used to explore the effects of patient characteristics on total FSFI domain score. All domain scores of FSFI except lubrication and pain were statistically significant in the incontinence group (for total domain score, P=.005). For FSFI, in terms of types of incontinence, the difference was significant when the group with mixed urinary incontinence was compared with the control group. In multivariate linear regression analysis, age, presence of POP, and mode of delivery were predictors of female sexual function. Mixed urinary incontinence, when compared with other types, had a significant impact on sexual function. When POP was also present, no negative effects were noted in incontinent women.     

Self-reported urinary incontinence in the postpartum period: clinical characteristics

The objective of this cross-sectional study was to characterize the manifestations of self-reported urinary incontinence in the postpartum period. We interviewed 288 women who were clients of a teaching health center in S?o Paulo, between the months of January and August of 2009. The data showed that among the 71 incontinent women (24.6%), 44 (62%) reported stress urinary incontinence, 65 (91.5%) were aware of urine leakage, 33 women (46.5%) experienced urine loss more than once a week, and 24 (33.8%) reported persistent urinary incontinence at the time of interview. The severity classified as moderate urinary incontinence was identified in 53 women (74.7%). The findings highlight the importance of studies on urinary incontinence in the postpartum period, as well as approaching this issue in education and health care interventions with women in the reproductive stage.     

瑜伽训练在产后早期尿失禁治疗中的应用研究

目的:探讨瑜伽训练在产后尿失禁治疗中的应用价值。方法:选取2018年10~12月产后6周常规复查时明确诊断为产后尿失禁的90例产妇作为研究对象,随机分为Kegel组和Kegel+Yoga组,每组45例。Kegel组接受Kegel盆底肌训练,Kegel+Yoga组接受Kegel盆底肌训练联合瑜伽训练。参照Oxford盆底肌力评估法阴道指诊检测两组产妇干预前后盆底肌力变化情况,通过Bristol女性下尿路症状问卷调查两组产妇干预前后泌尿症状评分和生活质量2个维度评分的变化情况,并评估两组1个疗程后的临床疗效。结果:干预前,两组产妇的盆底肌力、Bristol下尿路症状问卷中泌尿症状评分和生活质量评分相比较,差异均无统计学意义,P>0.05;干预后,两组产妇的盆底肌力、Bristol下尿路症状问卷中泌尿症状评分和生活质量评分均较同组干预前显著改善,差异均有统计学意义,P<0.05;Kegel+Yoga组的上述指标和临床疗效均优于Kegel组,差异均有统计学意义,P<0.05。结论:产后早期瑜伽训练可以增强产妇盆底肌力,改善其尿失禁症状,提高生活质量。     

社区老年女性尿失禁生活质量及影响因素的调查分析

目的调查乌鲁木齐社区老年女性尿失禁患者的生活质量与其影响因素。方法采用整群分层抽样法,选取2011年1月—2012年12月乌鲁木齐30个社区的老年女性尿失禁患者1340例,运用尿失禁问卷简表中文版和尿失禁生活质量量表进行问卷调查。结果1340例患者的生活质量平均得分为（78．5±15．6）分,其中逃避和限制性行为（26．1±5．3）分;心理社会影响（34．1±8．6）分;社交活动受限（15．4±4．9）分。影响患者生活质量的因素共有9个,最终进入回归方程的有4个,分别是民族、文化程度（初中、高中、大专及以上）、混合性尿失禁和中重度尿失禁。结论乌鲁木齐社区老年女性尿失禁患者的生活质量水平整体较好,影响因素较多,应依据影响因素的不同进行针对性的护理干预。     

女性尿失禁患者生活质量的评价及干预

目的 探讨尿失禁对女性生活质量的影响及改善其生活质量积极有效的措施。方法 分析患有尿失禁女性的生活质量评价及干预的研究现状。结果 尿失禁在生理、心理、日常生活、性生活等方面不同程度地影响了患者的生活质量,通过规律的盆底肌肉锻炼能够预防及控制尿失禁症状,改善患者的生活质量。结论 应当在社区开展一些宣传活动,积极宣传尿失禁是可以治疗的,采取积极有效的措施来预防和管理尿失禁,改善患者的生活质量。     

Translabial ultrasonography in the assessment of urethral diameter and intrinsic urethral sphincter deficiency.

OBJECTIVE: The purpose of this study was to determine the role of translabial ultrasonography in the investigation of intrinsic urethral sphincter deficiency (ISD), assessing bladder neck hypermobility and urethral diameter in continent and incontinent patients. METHODS: A case-control study evaluated 94 women with the diagnosis of urinary incontinence and 96 continent women. Both groups underwent translabial ultrasonography to assess bladder neck hypermobility by means of the x-y coordinate system and urethral diameter. The study was performed at Hospital de Clínicas de Porto Alegre. RESULTS: Women with urinary stress incontinence showed significantly greater bladder neck descent than continent women and women with urge and mixed incontinence (P = .05). Women with ISD showed significantly larger urethral diameters than control subjects and incontinent women without ISD (P = .05). Of women with urinary incontinence, 78.7% had descent of greater than 10 mm, and 91.7% of the women with ISD had urethral diameters of greater than 6 mm. A urethral diameter of greater than 6 mm showed sensitivity of 91.7% and specificity of 75.6% for ISD. CONCLUSIONS: Translabial ultra-sonography has an important role in the assessment of women with urinary stress incontinence and intrinsic urethral sphincter deficiency.     

Help seeking behaviour and health and social services utilisation by people suffering from urinary incontinence.

It is estimated that urinary incontinence can effect up to 23% of the population at some time during their adult years, with 9% currently experiencing symptoms. This study found that the majority of sufferers had spoken to or had contacted their GP about their incontinence, and that people currently suffering from incontinence were significantly more likely to have seen their GP within the last month than those who were continent. Help seeking behaviour was also influenced by the severity of incontinence, with people suffering from severe incontinence significantly more likely to have sought help than those with light to moderate incontinence. Two thirds of sufferers who did not seek help were too embarrassed to do so. Significantly more people who were incontinent that did not seek help in a health authority without an established continence service did not know that health services were available, compared with those in a health authority having an established continence service. It is important for health care providers to ensure that the public knows what services are on offer and how to access them. Significantly more incontinence sufferers in the health authority with an established continence service chose not to seek help from a health professional compared with those in the health authority without service, which could indicate there was an element of informed choice in not accessing the services available. Significantly more people who were incontinent than continent required help with their activities of daily living and personal self care. They were also significantly more likely than those who were continent to require formal and informal contacts provided by health services, local authority, the church or voluntary sector. It is important that people suffering from incontinence have their health and social needs assessed so that services can be effectively targeted.     

Urinary incontinence in nursing home residents with dementia: the mobility-cognition paradigm

The purpose of the study was to evaluate patient factors associated with urinary incontinence in nursing homes to identify the relative importance of these factors in predicting urinary incontinence. Cognitive ability and patient mobility were measured for 61 patients residing in a nursing home. Twenty-nine of the patients were incontinent and 32 continent. Cognitive ability and mobility were found to differ significantly between continent and incontinent patients. When the variables were examined together, mobility emerged as the best predictor of the patient's urine control, followed by cognitive impairment. The findings highlight the importance of addressing patient mobility issues when dealing with urinary incontinence in nursing homes.