The effect of bladder training on urinary incontinence in community-dwelling older women

Six patients presented with either entrapped fourth ventricles or noncommunicating cerebrospinal fluid collections of the posterior fossa requiring drainage. These collections were treated with shunt systems whose proximal catheter was placed into the fourth ventricle via a coronal burr hole using an endoscope guided by Eleckta's ISG Viewing Wand. The technique and its advantages are described as are the complications and early outcomes.     

Quality of life of women with stress urinary incontinence with or without pollakiuria]

BACKGROUND: The optimal management of low grade Papanicolaou (Pap) smear abnormalities remains controversial. This center's experience with recommending cytologic follow-up for women with atypical cells of undetermined significance (ASCUS) or low grade squamous intraepithelial lesions (LSIL) was reviewed to determine outcome and patient/physician compliance. METHODS: The records were reviewed on women with Pap smears reported as either ASCUS (320) or LSIL (112) who did not have a history of dysplasia. The cytologic and colposcopic follow-up for a 2-year period was obtained from the laboratory data base that includes the colposcopy and cancer referrals for this region. Repeat Pap smear in 6 months was recommended. If patients subsequently demonstrated high grade SIL (HSIL) or persistent ASCUS or LSIL over three time intervals, colposcopic evaluation was recommended. RESULTS: The outcome was determined by the most significant diagnosis among the follow-up Pap smears or colposcopic biopsies. 29% of patients were lost to follow-up. Of the remaining patients, 70.5% reverted to normal or benign cellular changes, 25.3% persisted as ASCUS or LSIL, and 5.2% progressed to HSIL. The majority of patients (68%) were referred for colposcopy for persistent mildly abnormal Pap smears. The timing of referral ranged from 3-30 months. CONCLUSIONS: These results suggest that cytologic follow-up of women with low grade Pap smear abnormalities will identify a large number whose smears will regress to normal. A small but significant proportion of women showed subsequent HSIL. Most HSIL was detected within 1 year of the initial abnormal Pap smear and the majority of intervening Pap smears also were abnormal. Approximately one third of patients did not have follow-up within the study system and their outcome was uncertain. Although the recommendations are standard, patterns of follow-up and referral to colposcopy varied widely, suggesting that the guidelines need to be reinforced to both patients and physicians. [See editorial on pages 1-4, this issue.]     

Emotional distress and urinary incontinence among older women.

Objective: Examined appraisals of interference and personal tolerance in the prediction of distress among women experiencing urinary incontinence (UI). Design: Interviewed women volunteering for a behavioral treatment for UI. Women were interviewed at baseline; follow-up assessments were conducted 6 weeks and 6 months later. Measures of perceived interference, tolerance, condition-specific emotional distress, symptom severity, general intelligence, and depressive symptoms were administered. Participants: 131 women (mean age = 66.6 years, SD = 8.4; range 55-90) with reported involuntary loss of urine at least once a week prior to participation. Main Outcome Measure: Emotional distress attributed to UI. Results: Path analyses indicated that greater tolerance was associated with less interference imposed by UI. Greater tolerance was also associated with less distress. Symptom severity (frequency of UI episodes, nocturia, and objectively determined fluid loss) indirectly influenced emotional distress through perceived interference. Cognitive appraisals of interference and tolerance were stable over time. Conclusions: These data indicate that appraisals of personal ability to tolerate the condition and interference of the condition on goal-directed behavior and expected activities have greater influence on emotional distress than does severity of condition-specific symptom. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treatment of stress urinary incontinence in women

Involuntary urinary leakage due to a rise in abdominal pressure caused by stress (cough, laugh, change in position, walking, running or carrying heavy weight) is a clinical entity often experienced by women. Management can be based on physical therapy techniques, drugs or surgery but indications and results to be expected are still very largely debated. Cure of an underlying condition such as obesity, or chronic bronchitis may be sufficient in some cases and others may benefit from "preventive" physical therapy to reinforce the perineum after difficult pregnancy and delivery. Alpha-stimulating drugs have also been proposed to increase sphincter tone. Surgery gives the best results. Several procedures have been proposed, usually based on classical retropubic colposuspension and aponevrosis loops. Success rate is approximately 80 to 90% although the lack of a sufficient understanding of the underlying mechanism involved, makes it impossible to predict outcome. Results in women with recurrent incontinence are less satisfactory.     

Evaluation and management of urinary incontinence in older patients

The training of health care providers in the diagnosis and management of urinary incontinence is inadequate, and evaluation and management skills are less than optimal. Urinary incontinence volume measurement is difficult to perform accurately in elderly long-term-care inpatients. After incontinence has been noted, the physician needs to select the appropriate studies to determine the cause and choose the correct treatment. Otherwise, treatable causes such as outlet obstruction or fecal impaction may be missed. Subsequent management includes scheduled visits to the toilet, treatment of impaired mobility, use of easily identified and accessible toilet facilities, reevaluation of the need for restraints and side rails, and, if appropriate, the use of drugs to treat the incontinence. Many elderly incontinent patients who are treated in the outpatient setting can be cured or substantially improved.     

Behavioral vs drug treatment for urge urinary incontinence in older women: a randomized controlled trial

CONTEXT: Urinary incontinence is a common condition caused by many factors with several treatment options. OBJECTIVE: To compare the effectiveness of biofeedback-assisted behavioral treatment with drug treatment and a placebo control condition for the treatment of urge and mixed urinary incontinence in older community-dwelling women. DESIGN: Randomized placebo-controlled trial conducted from 1989 to 1995. SETTING: University-based outpatient geriatric medicine clinic. PATIENTS: A volunteer sample of 197 women aged 55 to 92 years with urge urinary incontinence or mixed incontinence with urge as the predominant pattern. Subjects had to have urodynamic evidence of bladder dysfunction, be ambulatory, and not have dementia. INTERVENTION: Subjects were randomized to 4 sessions (8 weeks) of biofeedback-assisted behavioral treatment, drug treatment (with oxybutynin chloride, possible range of doses, 2.5 mg daily to 5.0 mg 3 times daily), or a placebo control condition. MAIN OUTCOME MEASURES: Reduction in the frequency of incontinent episodes as determined by bladder diaries, and patients' perceptions of improvement and their comfort and satisfaction with treatment. RESULTS: For all 3 treatment groups, reduction of incontinence was most pronounced early in treatment and progressed more gradually thereafter. Behavioral treatment, which yielded a mean 80.7% reduction of incontinence episodes, was significantly more effective than drug treatment (mean 68.5% reduction; P=.04) and both were more effective than the placebo control condition (mean 39.4% reduction; P<.001 and P=.009, respectively). Patient-perceived improvement was greatest for behavioral treatment (74.1% "much better" vs 50.9% and 26.9% for drug treatment and placebo, respectively). Only 14.0% of patients receiving behavioral treatment wanted to change to another treatment vs 75.5% in each of the other groups. CONCLUSION: Behavioral treatment is a safe and effective conservative intervention that should be made more readily available to patients as a first-line treatment for urge and mixed incontinence.     

Endoscopic treatment for urinary incontinence in children with a congenital neuropathic bladder

A new method for more timely monitoring of cancer patient survival was employed to assess progress in 5-year survival of breast cancer patients in Saarland, Germany, between 1980-84 and 1990-94. Five-year relative survival gradually increased from 68.8% to 73.5%. Improvements were most pronounced among age groups 50-59 and 60-69. The latter had the highest 5-year relative survival (77.1%) in 1990-94.     

Stamey-Lorenz operation for treatment of stress urinary incontinence in women

The Stamey-Lorenz operation was presented as a new method for treatment of stress urinary incontinence in women. During operation the urethra is suspended by using special needles and under cystoscopic control, thus proper vesico-urethral angle is restored. 10 incontinent women were cured using this method, 8 with good results. In two cases we failed.     

Response to urinary incontinence by older persons living in the community

PURPOSE: To investigate the responses to urinary incontinence (UI) of older persons living in the community. DESIGN: Detailed interviews were completed on a sample of 42 independent, community-dwelling persons who were at least 60 years of age. Nineteen participants reported UI, and their experiences are reported in detail. SETTING AND SUBJECTS: Subjects were recruited from 3 sources: volunteers who acknowledged having UI, those with known UI who were invited by their doctors to participate, and those who selected "Loss of bladder control" in a 20-card sort of common ailments. All interviews were conducted in a private setting at a seniors center or at participants' church or home. INSTRUMENTS: Twenty cards with a common ailment printed in large type and an interview schedule with questions relating to the ailment selected as having the most impact were used; demographic data were collected on a standardized form. METHODS: Interviews were recorded on audiotape and lasted from 20 to 60 minutes. These recordings were analyzed for themes with use of Ethnography software. MAIN OUTCOME MEASURES: Demographic and other data from the interview schedule were tabulated. The communication style of the 19 subjects with UI was analyzed to determine how freely they spoke about problems with bladder control to family and friends and their sources of information for managing urinary leakage. Analysis was done both by the researcher and a faculty member; an interrater reliability of 1.00 was achieved. RESULTS: There was little difference in the self-rating of health for those with or without UI. Subjects recruited by letters sent to doctors' patients ranked the impact of loss of bladder control higher than other subjects did. Of the 19 subjects with UI, 10 spoke freely to family and friends, but 9 seldom discussed the subject--and then only to a family member. Four of the 9 with a closed communication style reported no current source of information about UI or its management. CONCLUSION: Though UI had a major effect on the lives of these subjects, they were more willing to admit having "loss of bladder control" than "urinary incontinence." Communication style is related to prior sources of information about UI, but not its perceived impact on health. This relationship helps to determine the teaching methods that are most likely to influence elderly persons with UI who have either on open or closed communication style.     

Pelvic floor rehabilitation in women affected with stress urinary incontinence. Authors' experience

BACKGROUND: This study evaluated pelvic floor rehabilitation as a possible treatment for urinary stress incontinence: a challenge to tradition. METHODS: In this study 20 female subjects with urinary stress incontinence had rehabilitation therapy, at first in the outpatients clinic with motivated physiotherapists and afterwards by home exercises. RESULTS: At the end of 3 months of training, stress incontinence had disappeared in 7 patients (35%), while an improvement was recorded in 13 (65%). CONCLUSIONS: In summary, pelvic floor rehabilitation program can be an effective alternative to surgical approach in reducing the frequency of urinary leakage. Further studies are needed to identify factors predicting success and to improve the techniques of pelvic floor rehabilitation.     

Transrectal sonographic investigation of urethral and paraurethral structures in women with stress urinary incontinence

Transrectal sonography of the urethra was used in 14 asymptomatic volunteers, 37 women with frequency-urgency syndrome, 42 patients with mild stress urinary incontinence, and 18 with severe stress urinary incontinence. Transverse scanning over the midurethra was performed and cross-sectional images of the urethral and paraurethral structures were compared among the four groups, with P < 0.05 being considered statistically significant. The total cross-sectional area of the midurethra was significantly smaller in patients with stress urinary incontinence than in those without this disorder (86.7+/-29.9 versus 104+/-35.6 mm2, P = 0.005); this difference resulted from a significantly smaller peripheral striated muscle component in patients with stress urinary incontinence (42.8+/-20.7 versus 58.3+/-27.3 mm2, P = 0.001). The thickness of the urethropelvic ligaments was significantly thinner in patients with stress urinary incontinence than in those without (5.9+/-1.7 versus 8.9+/-2.1 mm, P < 0.001). The distribution of the peripheral striated muscle around the urethra was variable: complete surrounding the urethra was noted in 35.7% of the control women and in 48.6% of frequency-urgency patients, but only in 16.7% of patients with mild stress urinary incontinence and 5.3% of patients with severe disease. Bladder neck incompetence was seen in 42 patients with stress urinary incontinence but in none of the control women. The length of the pubourethral ligaments was similar in the four groups. Our finding showed that stress urinary patients had a smaller striated muscle component in the midurethra and thinner urethropelvic ligaments. These defects in the continence mechanisms might have great implications in the pathophysiology of stress urinary incontinence. Transrectal sonography of the urethra is a valuable investigative tool in assessing urethral and paraurethral conditions in patients with stress urinary incontinence before deciding treatment modality.     

Treatment of urinary incontinence in women in general practice: observational study

OBJECTIVE: To examine what is attainable when treating urinary incontinence in women in general practice. DESIGN: Observational study with 12 months' follow up. Interview and clinical examination before, during, and after treatment of women seeking help for urinary incontinence in general practice. SETTING: General practice in the rural district of Rissa, Norway. SUBJECTS: 105 women aged 20 or more with urinary incontinence. INTERVENTIONS: Treatment with pelvic floor exercises, electrostimulation, oestrogen, anticholinergic drugs, bladder training, and protective pads. MAIN OUTCOME MEASURES: Subjective and objective measures of urinary incontinence; number of patients referred to a specialist. RESULTS: After 12 months' follow up 70% (69/99) of the women were cured or much better; the mean score on a 100 mm visual analogue scale decreased from 37 to 20 mm; and the proportion of women who were greatly bothered by their incontinence decreased by 62%. 20% (20/98) of women became continent, and the percentage of women with severe incontinence decreased from 64% (63/99) to 28% (27/98). Mean leakage per 24 hours measured by a pad test decreased from 28 g at the start of treatment to 13 g after 12 months. The number of light weight pads or sanitary towels decreased from 1.6 to 0.6 a day. In all, 17/105 (16%) patients were referred to a specialist. CONCLUSIONS: Urinary incontinence in women can be effectively managed in general practice with fairly simple treatment. Most women will be satisfied with the results.     

Urethrocystometry as a routine method for the objective evaluation of women with urinary incontinence

Over a 2-year period, 401 patients with urinary incontinence were examined at the Women's Clinics in Lund and Malm? and then investigated by urethral pressure profile measurement and simultaneous urethrocystometry. After full investigation the patients could be classified as follows: 214 (53.4%) had genuine stress incontinence, 48 (12.0%) had genuine urge incontinence, 41 (10.2%) had mixed incontinence, 20 (5.0%) had urgency-frequency, 6 (1.5%) had neurogenic incontinence, 9 (2.2%) had incontinence of uncertain aetiology, and 63 (15.7%) of the patients were apparently continent with normal urethral pressure profiles and urethrocystometrograms.