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Query: UMLS:C0042024 (incontinence)
 13,409 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

One hundred and thirty-nine patients undergoing urodynamic investigation were studied. Urine samples taken at the time of the test and at 72 hours afterwards were cultured and data on symptoms following the test were collected. The overall infection rate was 15.8%. Men and women aged over 70 years were no more likely than younger subjects to become infected. A high residual urine volume was not associated with an increased risk of infection. The only clinical feature associated with infection following the test was an increase in incontinence. These findings were all in contradiction to previous studies on smaller numbers of patients.
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PMID:An age-related investigation of urinary tract symptoms and infection following urodynamic studies. 782 93

Much controversy surrounds the appropriateness of screening for prostate cancer. The individual benefit from screening is unproven. Screening may result in many men being unnecessarily treated for prostate cancer with the associated risks of developing treatment related side effects, including impotence and incontinence. Men requesting screening need to be informed of these issues before they decide whether to proceed. This article reviews the current position in relation to screening, critically appraising current thinking in order to clarify the issues.
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PMID:Prostate cancer screening: what general practitioners and patients need to know. 885 14

Hip fractures can adversely affect an older adult's functional well-being. Little is known about the changes in continence status after hip-fracture repair. To investigate postoperative complications, the authors reviewed a convenience sample of 100 medical records of adults ages 55 years and over who were admitted to two metropolitan Baltimore hospitals for surgical repair of a fractured hip. There were data regarding postoperative incontinence for 95 individuals. Prevalence of urinary incontinence significantly increased from the preoperative rate of 20% to 43% postoperatively. That is, 19 individuals were incontinent preoperatively, and 41 individuals were incontinent postoperatively. Two individuals who had been incontinent preoperatively became continent postoperatively. Men were more likely to become incontinent than women, as were cognitively impaired individuals compared to cognitively intact individuals.
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PMID:Urinary continence changes after hip-fracture repair. 928 32

Forty-seven males referred due to postprostatectomy urinary incontinence (34 after transurethral resection of prostatic adenoma and 13 after open suprapubic adenomectomy) were retrospectively studied. Urodynamic evaluation identified 19 (40.4%) men with incontinence due solely to sphincter incompetence, and 19 (40.4%) men, in addition to sphincter incompetence, had urinary bladder dysfunction (unstable detrusor and/or reduced bladder compliance). Seven (14.8%) men had pure bladder dysfunction as the only cause of urinary incontinence. Two patients had normal urodynamic findings (N = 2; 4.2%). Men with urinary incontinence due only to sphincter incompetence were treated by insertion of artificial sphincter devices or condom catheter drainage (lack of artificial sphincters), while others were treated pharmacologically (imipramine, propantheline, oxybutynin or their combinations ... N = 25), or by augmentation cystoplasty using ileum after unsuccessful pharmacological treatment (N = 3). Out of 25 patients with pharmacological treatment, 21 were available for the final assessment of the treatment efficacy. Eleven (52.3%) patients were "socially continent" after the treatment. It is concluded that in the assessment of the cause of postprostatectomy urinary incontinence urodynamic evaluation is mandatory, and that the treatment should be based on the results of such studies. The role of bladder dysfunction as a cause of postsurgical urinary incontinence is again strongly emphasized.
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PMID:[Urinary bladder incontinence after prostatectomy. Urodynamic evaluation and results of therapy]. 947 79

Fecal incontinence is a serious problem especially for the elderly. The epidemiology of incontinence is not well described in the literature although it is often used as an endpoint for treatment evaluation in clinical trials. Complete continence is often assumed to be the "normal" standard. The goals of this study were to establish detailed prevalence rates for fecal incontinence in a standard population and to identify differences due to age and sex. A questionnaire about fecal incontinence and its consequences with predefined answers was filled out anonymously by 500 volunteers. The study population was selected to meet the respective age and sex distribution of the German adult population. The data indicated that 4.8% of the persons were unable to control solid stools, while 19.6% had problems at least with one type of incontinence (solid, pasty, or lipid stools, winds). Problems with pasty or liquid stools are more frequent in women. The ability to control wind is decreased in elderly persons. The time needed to reach a toilet is shorter for women, and generally decreases in the elderly. Men more often describe soiling the underwear. Persons with signs of incontinence show decreased levels of social activities. A global incontinence rate of 5% fits well with some previously published results. Soiling of the underwear is not well suited for defining incontinence. The increased rate in women may in part be explained by morphological differences. The reduced time to hold stools especially in the elderly in combination with a reduced mobility may result in a higher rate of incontinence, which is correlated with reduced social activities.
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PMID:Prevalence of fecal incontinence: what can be expected? 963 91

The recurrence of prostate cancer after potentially curative local therapy is becoming a significant urologic problem. There are few prospective randomized trials, and the optimal diagnostic and treatment strategies for men who fail potentially curative therapy are not known. The experience to date seems to suggest the following as a reasonable approach. A detectable serum PSA level (> or = 0.4 ng/mL) after radical prostatectomy is evidence of residual or recurrent prostate cancer. Men with low- or moderate-grade cancers (Gleason score < 7), with capsular penetration, or with positive surgical margins in whom disease recurs more than 2 years after radical prostatectomy with a PSA doubling time greater than 12 months seem likely to harbor a local recurrence and are the only good candidates for salvage therapy. Unless there is a palpable recurrence, transrectal ultrasound and biopsy are generally not recommended, and CT scanning and bone scintigraphy usually do not provide helpful information. The role of monoclonal antibody scanning is currently investigational. Men with high-grade tumors (Gleason score > or = 7) or with seminal vesicle or lymph node involvement in whom disease recurs within 2 years of radical prostatectomy are most appropriately observed or treated with early hormonal therapy. Men who do not achieve a PSA nadir of 0.5 ng/mL or less within 2 years of radiotherapy are very likely to harbor residual disease. For young healthy men who are willing to accept a substantial risk of impotency, urinary incontinence, and bladder neck contractures, salvage radical prostatectomy is a reasonable option if the preradiation tumor characteristics are acceptable (PSA < 10 ng/mL, Gleason score < or = 6) and if the current PSA is less than 10 ng/mL. Salvage cryotherapy may result in substantial morbidity and should only be offered on an investigational basis. Other men failing radiation may be observed or treated with hormonal therapy. There is seldom a role for repeat biopsy. Because the optimal time to begin hormone therapy is still not known, early or delayed treatment are both reasonable options. Testicular androgen ablation by orchiectomy or LHRH agonists is considered standard therapy. Combined therapy with an antiandrogen does not seem to be beneficial for all patients and should not be routinely used. Sexually active men in whom preservation of potency is important can be offered an investigational regimen such as a 5-alpha-reductase inhibitor combined with an oral antiandrogen or intermittent LHRH agonist therapy. It is hoped that the results of ongoing randomized trials and future research will establish efficient and effective practice guidelines to evaluate and treat men who have failed potentially curative therapy for localized prostate cancer. This remains a very important and controversial topic that will challenge many practicing urologists.
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PMID:Evaluation and management of the man who has failed primary curative therapy for prostate cancer. 1002 68

The aim of our study was to determine the urodynamic basis for the observation that aging women report comparable benign prostatic hyperplasia (BPH) symptom scores as age-matched men. Sixty-seven women (mean age, 60.4 +/- 1.5 years; mean +/- standard error of the mean) and 70 age-matched men (mean age, 63.7 +/- 0.9 years; P > 0.05) entered this prospective study. Men were referred for the diagnostic workup of lower urinary tract symptoms (LUTS) due to BPH and women predominantly for urinary incontinence. All patients completed the International Prostate Symptom score (IPSS) with quality-of-life assessment and underwent a detailed clinical and urodynamic evaluation including a multichannel pressure-flow study. Results of the IPSS, quality-of-life assessment, and irritative and obstructive component of the IPSS were correlated with urodynamic findings and the respective data were compared in both sexes. The mean IPSS was 15.7 for men and 13.0 for women (P = 0.02), quality-of-life score was higher in women (4.2 vs. 3.4; P = 0.0008). The irritative score was significantly higher in women (8.7 vs. 6.8; P = 0.003). Incidence of detrusor instability (DI), however, was higher in men (women, 38.1%; men, 48.6%; P = 0.015) and bladder capacity was higher in women (425 vs. 333 ml; P = 0.0001). There was no correlation between incidence and degree of DI with the irritative score in both sexes. The obstructive score was significantly higher in men (8.8 vs. 4.4; P = 0.0001). Ninety-one percent (64/70) of men had urodynamically documented bladder outlet obstruction (BOO), whereas this was the case in only 9% (6/67) of women. In parallel to the irritative score, we could not identify a correlation between the degree of urodynamically proven BOO and the obstructive score in both sexes. This urodynamics-based comparison fails to give an explanation for the observation that aging women report similar BPH scores as men. These data suggest that other mechanisms, such as changes in diurnal urine production, structural alterations of the aging detrusor, endocrine disturbances affecting lower urinary tract function, and subtle urodynamic changes are responsible.
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PMID:The International Prostate Symptom score in both sexes: a urodynamics-based comparison. 1033 37

Prostate cancer early detection choices and treatment options are fraught with controversy. To update the consultation-liaison psychiatrist who works with at-risk men, the authors reviewed all pertinent citations in the medicine database from 1966 to 1998 and in other relevant publications. Though watchful waiting for early-stage prostate cancer has no side effects, men must cope psychologically with issues of long-term cancer survivorship. Men can choose between different treatment options (e.g., radiation vs. radical prostatectomy) with early detection. Urinary incontinence, sexual dysfunction, and fatigue are major emotional and physical stressors for this population. Consultation-liaison psychiatrists and physicians need to be aware of the psychosocial sequelae of both prostate cancer and treatment-related side effects.
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PMID:Biopsychosocial aspects of prostate cancer. 1074 45

Male lower urinary tract symptoms include frequency, nocturia, urgency, urge incontinence, stress incontinence, post-micturition dribble and post-prostatectomy incontinence. All of these symptoms can be treated conservatively. In this article, the first of two parts, a detailed subjective and objective assessment is provided based on a Delphi study undertaken by the author. The objective assessment includes a digital rectal examination to assess the pelvic floor muscle strength in order to provide a patient-specific exercise programme. The diagnosis of stress incontinence, urge incontinence, post-prostatectomy incontinence, post-micturition dribble and functional incontinence is made from the assessment. Men with lower urinary tract symptoms need a detailed subjective and objective assessment before a diagnosis is made and individual treatment is planned.
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PMID:Male patients with lower urinary tract symptoms. 1: Assessment. 1114 72

There are more women than men at any elderly age group. Depression and osteoporosis are the commonest problems in elderly subjects. Some problems specific to males are hypogonadism, erectile dysfunction and enlargement of prostrate and to females are post-menopausal disturbances, urinary incontinence and breast and lung cancer. However, problems of special concern in both male and female elderly are malnutrition, falls and cognitive dysfunction. Men and women in general suffer from the same sorts of health problems but the frequency of these problems as well as the speed of the onset of death distinguishes them. Infact cultural and social forces act to separate the sexes in their personal health ethos and their sick propensity. The impact of old age on women is different from that of men because of differences in their status and role in society. This is specially so because proportion of widows in 60+ age group is considerably higher than that of widowers. Sexuality is often overlooked as a health status particularly in elderly women. Clinicians should recognise the importance of sexual functions to the overall health of older persons particularly women. Religious participation and involvement are associated with positive mental and physical health. Family life is the key to the health of elders specially older men. Lack of social support increases the risk of mortality and supportive relationships are associated with lower illness rates, faster recovery rates and higher levels of health care behavior.
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PMID:Gender, aging, health and society. 1184 8


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