Effects of bladder training and/or tolterodine in female patients with overactive bladder syndrome: a prospective, randomized study

We compared the effects of bladder training and/or tolterodine as first line treatment in female patients with overactive bladder (OAB). One hundred and thirty-nine female patients with OAB were randomized to treatment with bladder training (BT), tolterodine (To, 2 mg twice daily) or both (Co) for 12 weeks. Treatment efficacy was measured by micturition diary, urgency scores and patients' subjective assessment of their bladder condition. Mean frequency and nocturia significantly decreased in all treatment groups, declining 25.9% and 56.1%, respectively, in the BT group; 30.2% and 65.4%, respectively, in the To group; and 33.5% and 66.3%, respectively in the Co group (p<0.05 for each). The decrease in frequency was significantly greater in the Co group than in the BT group (p<0.05). Mean urgency score decreased by 44.8%, 62.2% and 60.2% in the BT, To, and Co groups, respectively, and the improvement was significantly greater in the To and Co groups than in the BT group (p<0.05 for each). Although BT, To and their combination were all effective in controlling OAB symptoms, combination therapy was more effective than either method alone. Tolterodine alone may be instituted as a first-line therapy, but may be more effective when combined with bladder training.     

The Utility of Pudendal Nerve Terminal Motor Latencies in Idiopathic Incontinence

Purpose Pudendal nerve terminal motor latency testing has been used to test for pudendal neuropathy, but its value remains controversial. We sought to clarify the relationship of pudendal nerve terminal motor latency to sphincter pressure and level of continence in a cohort of patients with intact anal sphincters and normal pelvic floor anatomy. Methods We reviewed 1,404 consecutive patients who were evaluated at our pelvic floor laboratory for fecal incontinence. From this group, 83 patients had intact anal sphincters on ultrasound and did not have internal or external rectal prolapse during defecography. These patients were evaluated by pudendal nerve terminal motor latency testing, a standardized questionnaire, and anorectal manometry, which measured resting and squeeze anal pressures. Incontinence scores were calculated by using the American Medical Systems Fecal Incontinence Score. Values were compared by using the Fisher’s exact test and Wilcoxon’s rank-sum test; and significance was assigned at the P < 0.05 level. Results 1) Using a 2.2-ms threshold, 28 percent of patients had prolonged pudendal nerve terminal motor latency unilaterally and 12 percent bilaterally. 2) At a 2.4-ms threshold, 18 percent of patients had prolonged pudendal nerve terminal motor latency unilaterally and 8 percent bilaterally. 3) Bilaterally prolonged pudendal nerve terminal motor latency was significantly associated with decreased maximum mean resting pressure and increased Fecal Incontinence Score, but not decreased maximum mean squeeze pressure, at both 2.2-ms and 2.4-ms thresholds. 4) Unilaterally prolonged pudendal nerve terminal motor latency was not associated with maximum mean resting pressure, maximum mean squeeze pressure, or fecal incontinence score at either threshold. Conclusions The majority of incontinent patients with intact sphincters have normal pudendal nerve terminal motor latency. Bilaterally but not unilaterally prolonged pudendal nerve terminal motor latency is associated with poorer function and physiology in the incontinent patient with an intact sphincter. Presented at the meeting of The American Society of Colon and Rectal Surgeons, Dallas, Texas, May 8 to 13, 2004. Reprints are not available.     

皮肤保护膜联合造口粉治疗重症患者失禁性皮炎的疗效观察

目的：探讨3M皮肤保护膜联合康乐保造口粉对重症患者失禁性皮炎的治疗效果.方法：将53例失禁性皮炎的重症患者随机分为对照组26例和观察组27例,对照组常规使用氧化锌软膏保护肛周皮肤,观察组使用3M皮肤保护膜联合康乐保造口粉进行处理,对两组疗效及皮炎愈合时间进行对比.结果：观察组治愈16例,有效9例;对照组治愈10例,有效6例,两组比较有统计学差异（P＜0.05）.观察组愈合时间短于对照组,差异有统计学意义（P＜0.05）.结论：皮肤保护膜联合造口粉,能有效治疗失禁性皮炎,缩短愈合时间,减轻患者痛苦,同时减轻护士工作量,值得在临床推广应用.     

产后盆底训练对预防女性早期盆底功能障碍的价值研究

目的：了解产后盆底训练对预防女性早期盆底障碍的临床价值。方法：住院分娩的产妇240名分成研究组（118例）和观察组（122例）。研究组产后42d采用法国PHENIX盆底肌肉康复系统进行盆底肌肉训练,对照组进行一般产后随访,两组分别以产后42d及产后3、6个月进行随访,项目包括测定盆底肌肉张力及问卷调查尿失禁的发生情况,并进行POP～Q分度评估。结果：研究组产后3、6个月阴道静息压、阴道收缩压及阴道收缩持续时问均高于对照组,差异有高度统计学意义（P〈0．01）;研究组产后3、6个月尿失禁的发生率低于对照组,两组比较差异均有统计学意义（均P〈0．05）。两组产后3、6个月随访期间无脏器Ⅲ度脱垂情况发生。结论：产后早期盆底训练可减少尿失禁的发生,改善盆腔脏器脱垂,值得临床推广应用。     

BPH患者术后发生尿失禁的影响因素分析

目的探讨前列腺增生（benign prostatic hyperplasia,BPH）术后患者发生尿失禁的情况及其具体的影响因素。方法对来我院进行治疗的215例前列腺增生患者尿失禁发生情况进行调查,采用尿失禁影响因素调查表及其尿失禁问卷表简表进行,所有患者均术后随访1个月。结果调查的前列腺增生患者中有32．1％（69／215）的患者术后出现尿失禁现象,但是程度轻重不同。与无尿失禁组比较,尿失禁组的患者年龄、不同的IPSS评分、膀胱功能是否失代偿、术前是否存在尿失禁、术后膀胱有无痉挛等因素比较有显著性差异（P〈0．05）;多因素分析结果发现,影响术后尿失禁的独立危险因素为患者的年龄、膀胱功能、术前存在尿失禁。结论影响BPH患者术后尿失禁发生的高危因素为年龄较大、术前膀胱功能失代偿及其术前存在尿失禁。对于高危BPH患者手术时机的准确把握及其在治疗过程中给予正确、有效的预防及其治疗措施对于降低术后尿失禁发生率具有非常重要的意义。     

Changes in reciprocal support provision and need-based support from partners of patients undergoing radical prostatectomy

We examined need-related and reciprocal provision of support in couples facing radical prostatectomy and its sequelae, including patients’ urinary incontinence. Partners’ reciprocal support provision to patients was assumed to drop from prior to until after patients’ surgeries and increase again in the following months, while need-related indicators were assumed to remain unique correlates throughout. In this study of German prostatectomy patients and their partners, N = 141 couples provided data on 4 measurement occasions from presurgery to 1-year postsurgery. Need-based predictors of partners’ support provision were patients’ mobilized support, such as efforts to obtain advice or comfort, and degree of postsurgery incontinence. Strength of association between partner-received and provided supports served as an indicator of reciprocal support provision. Data suggested that partners’ reciprocal support provision dropped significantly postsurgery and then increased again in the following months. This was true for emotional as well as instrumental reciprocal support provision. Findings also indicated that one need-based predictor of partners’ support provision, patients’ mobilization of support from their partners, remained a unique correlate of partners’ support provision to patients. Reciprocal support provision in couples may vary during the adaptation to illness-related functional impairment and coexist with need-oriented support provision.