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We investigated the difficulties involved in assessing post prostatectomy voiding according to 20 nurses working in urology and dermatology wards. Problems they encountered included completing a urination (frequency/volume) chart and performing an assessment. We constructed a hourly urination chart for basic nursing education in urinary incontinence. This was used for a 76-year-old male patient with hypertension and diabetes mellitus who underwent a prostatectomy. Urination was recorded for 17 consecutive days after catheter removal. Detailed pathological findings were more distinct in the hourly rather than daily recordings of voluntary micturition. Voluntary micturition appeared 12 h after catheter removal, but it was very scanty. After the onset of urination, frequency and amount of daily voluntary micturition was inversely related to incontinence during the 17 days after catheter removal. We drafted a set of urination recovery stages to enable the analysis of a patient's urination status. Nurses understood its importance and were able to reach a consensus on how to manage patients with postoperative incontinence. We have constructed a practical system for use by specialist urology nurses.
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PMID:Urination assessment after the removal of bladder catheter using a novel urination chart. 1287 20

Vascular parkinsonism has not been well defined and the clinical correlation of vascular parkinsonism is still not clear. The aim of the study was to estimate prevalence of occurrence of vascular parkinsonism, analysis of risk factors leading to its development and to identify clinical features that suggest a vascular origin. 214 patients with Parkinson's disease were examined. Their ages ranged from 37 to 88 years (median 66.4 years). Evidence of vascular parkinsonism was assessed using a vascular rating scale previously described by Winikates and Jankovic. Statistical analysis was performed with Mann-Whitney U test, chi 2 Pearson test, chi 2 Yates test, Spearman rank correlation and Student's t test. Out of 214 patients 8 were proved to have developed Parkinson's disease due to vascular disease, what gave 3.74%. Out of risk factors for stroke 5 patients had hypertension, 3 had diabetes mellitus, 2 suffered from heart disease, 2 had infarctus myocardii, 1 had hyperlipidemia, 1 had atrial fibrillation. Additionally, those patients had neuroimaging (CT or MRI) evidence of vascular disease in one or more vascular territories. Patients with vascular parkinsonism were older, had shorter duration of disease, were more likely to present rigidity rather than tremor. Dementia and incontinence were more common in vascular group than in Parkinson's disease group. Patients with vascular parkinsonism were also significantly more likely to have corticospinal findings. Proving that Parkinson's disease had vascular etiology is extremely difficult. The test results are inconclusive.
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PMID:[Clinical correlation of vascular parkinsonism]. 1509 42

Overactive bladder is associated with symptoms of urgency, with or without urge incontinence, usually with daytime frequency and nocturia in the absence of local pathological factors. Muscarinic receptor antagonists (antimuscarinics) are the first-line pharmacotherapy. Tolterodine, a competitive, nonselective antimuscarinic specifically developed for the treatment of overactive bladder, demonstrated tissue selectivity for the bladder over the parotid gland in an animal model. As of March 5, 2003, the immediate-release (IR) formulation had been approved in 72 countries and the extended-release (ER) formulation had been approved in 28 countries, and tolterodine had been administered to 5 million patients. This review evaluates the benefit-risk profile of tolterodine in the treatment of adults with overactive bladder, summarising clinical trial and postmarketing surveillance data. Tolterodine has been found to significantly reduce micturition frequency, urgency perception and the number of episodes of urge incontinence and increase the volume voided per micturition. Dry mouth, an antimuscarinic class effect, is the most commonly reported adverse effect but is mostly mild to moderate in severity. Serious adverse effects are reported infrequently. Based on summary and review of postmarketing surveillance and clinical trial safety data received by the market authorization holder and contained in the Periodic Safety Update Reports for tolterodine, several monitored serious events of the gastrointestinal tract (e.g. ileus or haemorrhage), nervous system (e.g. syncope, convulsions and memory disorders) and cardiovascular system (e.g. ventricular arrhythmia, atrial fibrillation, palpitations, bradycardia, transient ischaemic attacks and hypertension) were not considered related to tolterodine. QT or corrected QT (QTc) prolongation was not observed in any of the five cases of verified ventricular arrhythmia in patients administered tolterodine; there is insufficient evidence to indicate that tolterodine causes ventricular arrhythmia or extrasystoles or any specific type of cardiac rhythm abnormality. The safety profile of tolterodine is similar in patients aged > or =65 years and in younger adults. Clinically relevant drug interactions are limited to cytochrome P450 3A4 inhibitors, such as ketoconazole, and co-administration with such agents warrants a tolterodine dosage decrease. In addition, tolterodine IR 2mg twice daily is similar in efficacy to oxybutynin IR 5mg three times daily, and tolterodine ER 4 mg once daily is similar in efficacy to oxybutynin ER 10mg once daily. Dry mouth occurred less frequently with tolterodine than oxybutynin, and moderate to severe dry mouth occurred more than three times less frequently. Based on the low frequency of adverse events, the absence of unexpected adverse events and the very low frequency of serious adverse events, we conclude that tolterodine is a well tolerated treatment for overactive bladder in adults, in whom it should be considered as first-line therapy.
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PMID:Benefit-risk assessment of tolterodine in the treatment of overactive bladder in adults. 1547 9

Overactive bladder (OAB) affects millions of people in the United States and is associated with poor health, impaired quality of life, social isolation, and depressive symptoms. Despite the high prevalence of this syndrome, studies show that it is not adequately addressed by the busy primary care physician, who may be preoccupied with management of other chronic diseases perceived as more serious such as heart disease, diabetes mellitus, and hypertension. Pharmacologic flexible-dosing studies with anticholinergic agents offer a relatively simple strategy for optimal management of OAB: physician-initiated, patient-managed dose adjustment. Recent flexible-dosing studies with extended-release oxybutynin, darifenacin, and solifenacin suggest that urge urinary and total incontinence episodes may be reduced significantly with a flexible-dosing strategy. Dose adjustment may improve the therapeutic outcome, facilitating a balance between efficacy and anticholinergic side effects such as dry mouth. Flexible-dosing studies indicate that dry mouth, the adverse effect most frequently seen with the use of anticholinergic agents, seldom leads to study withdrawal. Patient-initiated control of OAB symptoms may be achieved in 1 month by following established protocols.
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PMID:Pharmacologic management of overactive bladder: practical options for the primary care physician. 1648 65

This study correlated Doppler resistive indices (RIs) with maximum urethral closure pressures (MUCPs) in women with stress urinary incontinence. We hypothesized that urethral blood flow would be inversely correlated to urethral closure pressures. Fifty-three women underwent spectral Doppler waveform analyses of periurethral vasculature to calculate RI. Urethral morphology including pubovesicular length (PVL) with and without cough was measured. MUCPs were obtained according to International Continence Society guidelines. Physical exam and history were also obtained. Correlation coefficients were calculated for comparisons of Doppler measurements and closure pressures. Fifty patients were required to detect a difference between no correlation and a modest correlation of 0.38 with 80% power and alpha of 0.05. Significance is set at p<0.05. Measurements were reproducible between Doppler waveforms and MUCP measurements (all p=NS). RI was not correlated with age, parity, MUCP, Incontinence Impact Questionnaire-7 scores, urethral length, or urethral width (all p=NS). RI and MUCP were likewise not associated with history of diabetes, hypertension, or anterior vaginal prolapse to or beyond the hymen (all p=NS). MUCP was negatively correlated with age (r=-0.33, p=0.01) even when controlled for hormonal status (ANCOVA, p=0.003) and positively correlated with urethral/bladder neck diameter (r=27, p=0.05), PVL (r=0.30, p=0.03), and PVL with cough (r=0.36, p=0.009).
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PMID:A comparison of periurethral blood flow resistive indices and urethral closure pressure of incontinent women. 1652 Aug 91

The typical symptoms and signs of neuroleptic malignant syndrome (NMS) consist of fever muscle rigidity (stiffness, myoclonus, rod-like), alterations of consciousness (confusion, agitation, aggression, or catatonia), autonomic nervous system disturbances (i.e., hypertension, tachycardia, tachypnea, profuse sweating, and urine incontinence), abnormal blood tests such as low serum electrolytes, elevated serum creatinine phosphokinase (CPK) level, and leukocytosis. Muscle rigidity is often associated with myonecrosis, myoglobinuria, and elevated serum CPK. The mortality among NMS cases is in the 10 to 70% range depending on the severity of the symptoms and time of therapeutic approach. Mandatory therapy should include removal of causative agents, correction of body fluid and electrolytes, administration of benzodiazepine, clonazepam and bromocriptine (dopamine agonist), proved life-saving medications. The authors reported herein six cases with unusual clinical features of NMS. Four of them had been on antipsychotic for a year before becoming anorexic, dehydrated, agitated, and violent with paranoid delusion. One instance with underlying delirium tremens developed NMS after receiving haloperidol (30 mg IV) in addition to diazepam (200 mg IV) within 24 hours. Another patient was found to suffer from severe NMS after receiving bupropion (Dopamine inhibitor antidepressant) 300 mg/day. All patients displayed cardinal signs and symptoms of NMS in addition to dehydration and pallor. They were treated in the psychiatric ward and recovered rapidly from NMS after receiving clonazepam and bromocriptine and removal of the offending agents.
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PMID:Neuroleptic malignant syndrome: a review and report of six cases. 1721 72

Normal pressure hydrocephalus (NPH) is one of the few reversible causes of dementia in older adults and accounts for approximately 6% of all dementias. The cardinal sign of NPH is a hypokinetic gait disorder in which the older adult's feet look as though they are glued to the floor. The gait also has been described as magnetic. People with NPH also may have mild dementia and bladder and bowel incontinence. A 78-year-old man exhibited symptoms of NPH for at least 4 years before being diagnosed. A neurological assessment of the patient revealed gait, posture, and balance abnormalities; mild dementia; and urinary urgency, frequency, nocturia, and incontinence at least once a day. His risk factors for NPH included diabetes and hypertension. A computed tomography (CT) scan revealed dilated lateral ventricles in the brain. A lumbar puncture was used to remove 50 ml of cerebrospinal fluid, which resulted in a transient improvement in his gait for approximately 18 hours. A ventriculoperitoneal shunt was then inserted in the patient, and during a 1-year period his symptoms gradually improved. He recovered without any complications and was eventually able to resume his usual activities. When the gait associated with NPH is observed in an older adult, he or she should be referred to a neurologist or multidisciplinary team for a comprehensive evaluation. If an individual receives treatment for NPH, he or she may have an improved quality of life and the opportunity to reduce functional limitations and disability. Families may also experience positive outcomes, such as having a loved one who is cognitively improved and requires less care.
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PMID:Gait disorder is the cardinal sign of normal pressure hydrocephalus: a case study. 1759 8

Diuretic use and overactive bladder syndrome are common in older adults. However, the relationship between the two has not been well studied. Data were collected by self-administered questionnaires including the Urge Urinary Distress Inventory (Urge-UDI) and the Urge Incontinence Impact Questionnaire (Urge-IIQ), and by outpatient chart abstraction. Patients (n=172) had a mean age of 79+/-7.5 (+/-S.D.), 76% were women, and 48% were African Americans; 76% had hypertension, 32% had heart failure, and 66% were receiving diuretics (57% loop diuretics). Overall, 72%, 68%, and 73% of patients, respectively, reported urinary frequency, urgency and urge incontinence. Diuretic use was associated with increased frequency (81% versus 55% non-diuretic; odds ratio (OR)=3.48; 95% confidence interval (CI)=1.73-7.03) and urgency (74% versus 57% non-diuretic; OR=2.17; 95% CI=1.11-4.24) but not with incontinence (OR=1.74; 95% CI=0.87-3.50). When adjusted for propensity scores, diuretic use had independent associations with frequency (adjusted OR=3.09; 95% CI=1.20-7.97) and urgency (adjusted OR=2.50; 95% CI=1.00-6.27). In addition to frequency and urgency, loop diuretic use was also associated with incontinence (OR=2.54; 95% CI=1.09-5.91), which lost significance after propensity adjustment (adjusted OR=1.88; 95% CI=0.57-6.17). Overall summary mean Urge-IIQ score was 1.83+/-0.85 with 1.75+/-0.86, 1.68+/-0.76, and 2.03+/-0.88, respectively, for no diuretic, non-loop, and loop-diuretic patients (one-way analysis of variance (ANOVA) p=0.063). Overactive bladder symptoms were common among ambulatory older adults and were associated with diuretic use, and had stronger associations with loop diuretic use.
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PMID:Association of diuretic use and overactive bladder syndrome in older adults: a propensity score analysis. 1875 58

The population of older Americans is expected to represent 20 percent of the total U.S. population in the next 50 years, and older women will comprise the majority of that group. Thus, the health care needs of older women are and will be an increasing concern. A subcommittee of the Public Health Service Task Force on Women's Health, which studied the health issues related to older women, observed that many factors relate to the health care of this group. Several factors, such as the homogeneity of the population over 65 years, the distinction between normal aging and disease, and the impact of socioeconomic concerns on physical and mental health, are important for developing preventive and treatment strategies.Older women die of the same disorders that affect men-heart disease, cancer, cardiovascular disease, and accidental injuries-but are more likely to be afflicted with one or more chronic conditions that can cause limitations in their lifestyles (for example, diabetes, hypertension, arthritis).The subcommittee also highlighted disorders with special implications for older women such as incontinence, osteoporosis, prescription drug misuse, and depression, and recommended that health messages for older women be targeted at both young and old cohorts to encourage health promotion and good health practices at all ages.
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PMID:Health concerns of older women. 1931 90

Several recent population-based studies have provided insight into the clinical importance and impact of overactive bladder (OAB). Although OAB can affect anyone at any age, the prevalence tends to increase with advancing age. Diuretic use is also common among older adults, as the prevalence of clinical conditions such as hypertension and heart failure requiring its use increases markedly with age. By causing increased formation of urine by the kidneys, diuretics increase urinary frequency and may cause urinary urgency and incontinence. This review provides a summary of available data, focusing on the association between OAB and diuretic use in the elderly. Although there is very little research work in this area, available studies have provided insight into the possible contribution of diuretic use to OAB in the elderly. Based on a recent report, OAB symptoms are common among older adults using diuretics, particularly the loop-type, and are associated with poor quality of life. More studies are required to fully understand the association between diuretic use and OAB, particularly its impact on health-related quality of life.
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PMID:The association between overactive bladder and diuretic use in the elderly. 1986 54


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