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 24,445 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Urinary incontinence (UI) is a relatively common condition in middle-aged and older women. Traditional measures of symptoms do not adequately capture the impact that UI has on individuals' lives. Further, severe morbidity and mortality are not associated with this condition. Rather, UI's impact is primarily on the health status and health-related quality of life (HRQOL) of women. Generic measures of HRQOL inadequately address the impact of the condition on the day-to-day lives of women with UI. The current paper presents data on two new condition-specific instruments designed to assess the HRQOL of UI in women: the Urogenital Distress Inventory (UDI) and the Incontinence Impact Questionnaire (IIQ). Used in conjunction with one another, these two measures provide detailed information on how UI affects the lives of women. The measures provide data on the more traditional view of HRQOL by assessing the impact of UI on various activities, roles and emotional states (IIQ), as well as data on the less traditional but critical issue of the degree to which symptoms associated with UI are troubling to women (UDI). Data on the reliability, validity and sensitivity to change of these measures demonstrate that they are psychometrically strong. Further, they have been developed for simple, self-administration.
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PMID:Health-related quality of life measures for women with urinary incontinence: the Incontinence Impact Questionnaire and the Urogenital Distress Inventory. Continence Program in Women (CPW) Research Group. 784 63

The purpose of this study was to investigate the effectiveness of two hourly toileting regimes for the management of urinary incontinence in elderly nursing home residents. A comparison of two hourly regimes with four hourly toileting was undertaken over two eight-week periods to establish the most effective form of continence promotion. No significant difference in the levels of incontinence was noted and the severity of incontinence did not significantly differ between regimes. The author concludes that two hourly regimes are a waste of nurses' time and cause unnecessary discomfort to patients.
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PMID:Elderly toileting: is two hourly too often? 839 49

We evaluated the significance of urodynamic parameters versus transrectal ultrasound with regard to postoperative outcome-control after operation for procedentia and urinary stress incontinence. We studied 30 continent women and 84 women with purely stress induced urinary incontinence. All had a pre- and postoperative urodynamic testing including urethral profilometry and cystometry, paralleled by a transrectal ultrasound examination. From the urodynamic parameters only the transmission ratio is suitable to judge the surgical outcome, although it is less correlative to the patient's complaints (p = 0.033) than the bladder neck mobility (p < 0.0001, Tab. 5). Within the rather short time of follow-up, each of the operation-techniques was able to improve the bladder neck mobility significantly. Nevertheless, anterior colporrhaphia is not suitable for incontinence-surgery (Fig. 2/Tab. 5). Concerning operative results, transrectal endosonography was found to be an adequate or even superior method as compared to urodynamic studies, because it can likewise demonstrate the function of the bladder neck, but furthermore can show the morphologic aspects of bladder, urethra and pelvic floor. As a result, for the first time, this minimal invasive method offers quality control for the individual surgeon as well as for long-term follow-up studies after operation for procedentia and stress induced urinary incontinence without using much time or causing great discomfort to the patient.
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PMID:[Success and quality control in prolapse and stress incontinence operations--comparative use of urodynamics and transrectal endosonography]. 846 27

Appendicovesicostomy is a useful adjunct to continent reconstruction of the bladder. During the last 3 years we have used this procedure in 14 children with difficult incontinence due to spina bifida (7), exstrophy/epispadias (5), imperforate anus (1) and urethral agenesis (1). In 4 patients in whom previous operations had failed to achieve continence the bladder neck was closed. In the remaining 10 children, all of whom had difficulty or discomfort catheterizing the native urethra, the bladder neck/urethra was preserved or reconstructed to serve as a vent for elevated bladder pressures. Continence was achieved in all 14 children with no complications related to the appendix. All children in whom the bladder neck/urethra was salvaged preferentially empty via the appendix and remain dry, except when the bladder is overly full.
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PMID:Appendicovesicostomy: a useful adjunct to continent reconstruction of the bladder. 848 19

Abdominal spiral computed tomography (CT) pneumocolon is performed after cleansing the colon, using a smooth muscle relaxant and rectal air insufflation. Rapid dynamic scanning is undertaken with intravenous contrast to give optimal hepatic and vascular enhancement, and 5-10 mm contiguous slices. The area of interest in the colon is reconstructed every 2.5 mm. This technique was performed in four patients with colorectal cancer and the CT findings were compared with the barium enema and pathology following surgical resection. Spiral CT pneumocolon clearly showed the primary tumour in all cases as an enhancing soft tissue mass, and was able to detect local extension and lymphadenopathy as well as assess the liver, peritoneum and remaining abdomen. CT depicted the morphology of the primary tumour more clearly than barium enema, and in one case also detected a 1 cm polyp which was not seen on the barium study because the patient was incontinent of barium and views were limited. There was good correlation between the CT and pathological findings. Compared to a barium enema, spiral CT pneumocolon is quick, with minimal patient discomfort, no risk of barium incontinence, and there is good assessment of the local and distant abdominal disease. Multiplanar formatting is possible and 3-D reconstruction gives intra- and extra-luminal views.
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PMID:Technical report: spiral CT pneumocolon for suspected colonic neoplasms. 881 Jul 4

As part of a larger study previously published in December of 1994, the question was asked whether commonly used pressure ulcer assessment tools (the Braden and Medley) were applicable to a broader definition of "skin risk assessment" and altered skin integrity related to perineal dermatitis (PD), and, if so, which risk factors were actually related to PD. The three site randomized clinical trial compared the use of diapers and underpads for 166 adult patients hospitalized on medical and surgical floors who were incontinent of urine and/or feces. Variables related to skin breakdown were the number of incontinence episodes, fecal incontinence, poor skin condition, pain, poor oxygenation, fevers, and mobility problems. Results also suggest that older patients may not have the sensory perception to experience discomfort in the same intensity as younger patients. Based on the findings of this study, pressure ulcer risk assessment tools are not good risk assessment tools for PD. The previously published conceptual framework for PD was modified and validated to form a basis for preventive measures.
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PMID:Perineal dermatitis risk factors: clinical validation of a conceptual framework. 867 50

We report a 46-year-old man with right side dominant parkinsonism who died suddenly two years after the onset. The patient was well until the age of 42 years in January of 1993, when he noted an onset of difficulty in using his right hand and then the right leg. Soon after he noted nocturnal urinary incontinence. In January of 1994, a local doctor prescribed 200 mg of levodopa with benserazide and 5 mg of bromocriptine. The patient noted some improvement. Cystometry revealed 300 ml of residual urine. He visited our clinic on 24th of December, 1996. He was alert and oriented. BP was 106/60. He showed masked face and small voice. He walked in stopped posture dragging his feet; retropulsion was noted. He showed moderate bradykinesia and rigidity more on the right side. No resting tremor or cerebellar ataxia was noted. Ankle jerks were somewhat exaggerated but no Babinski sign was noted. He continued to show residual urine, but orthostatic hypotension was absent. Routine laboratory examination was unremarkable, however, his cranial MRI showed atrophy of the left putamen and a T2-linear high signal intensity lesion along the lateral border of the left putamen. On January 15, 1997, he ate certain amount of rice cake and drank alcohol. After coming back home and while changing his clothes, he suddenly complained of chest discomfort and lost consciousness. He was pronounced dead in the afternoon. The patient was discussed in a neurological CPC. Opinions were divided between Parkinson's disease and striatonigral degeneration. The chief discussed arrived at a conclusion that the patient had Parkinson's disease, because he responded to levodopa to some extent and except for nocturnal incontinence he did not have wide spread autonomic failure. Postmortem examination revealed marked loss of neurons and extensive gliosis in the left putamen. The right putamen did not show such changes. The substantia nigra showed gliosis in the lateral part on both side, however, neuronal loss was not apparent. The locus coeruleus was well retained. No Lewy bodies were found. The pontine nucleus and the cerebellum were intact. However, glial cytoplasmic inclusions were seen in oligodendrocytes of the cerebral white matter and the pontine base. The heart and lungs were intact and the cause of the sudden death could not be determined. The pathologic diagnosis is striatonigral degeneration. Such a marked asymmetry of the pathologic change is quite unusual. Probably, the death in the early stage of the disease is the reason for this asymmetry.
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PMID:[A 46-year-old man with right-side dominant parkinsonism, who suffered a sudden death]. 895

The implantation of a Wallstent prosthesis is a minimally invasive alternative to conventional TUR-P for the treatment of infravesical obstruction owing to benign prostatic hyperplasia. We report on the long-term follow-up of 37 patients with a high-risk status for TUR-P who have been implanted since May 1990. The ASA status was: ASA I: 0, ASA II: 2, ASA III: 17 and ASA IV: 18 patients. The median follow-up is now 38.5 months. Directly after implantation, a medium increase in the maximum flow-rate from 7.5 ml/s to 16.9 ml/s was documented. Residual urine was reduced from 120 to 24.2 ml on average. After 12, 18, 24 and 36 months, average maximum flow rates of 16.1, 16.7, 12.0 and 11.6 ml/s were evaluated. The corresponding residual urine was 50.3, 121.1, 56.8 and 65 ml, respectively. Also, micturition frequency decreased from 12.4 preoperatively to 8.3, 7.6, 8.0, and 8.4 per day on average. Nearly all patients reported perineal discomfort in the 1st weeks after implantation. For this reason, the stent had to be removed in 1 patient on the 45th postoperative day. In addition, a dislocated stent had to be replaced in 2 patients. Six of 15 retention patients presented with persisting detrusor dysfunction after implantation and were therefore discharged with a suprapubic tube. Endoscopic controls showed complete urothelial coverage in 78% of our patients after 6 months. After 18 months all stents were completely covered. Long-term follow-up showed reobstruction in 6 of 37 patients (16.7%) and signs of incontinence in 4 of 37 (10.8%). The late complication rate is therefore calculated at 27.5%. Stent-related deaths could not be found. We conclude that Wallstent implantation into the prostatic urethra is an alternative to TUR-P for patients at high risk from surgery. The good postoperative results also remain stable during long-term follow-up.
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PMID:[Long-term results of wall stent implantation in benign prostatic hyperplasia and high risk status]. 919 43

The purpose of this research was to describe the relationship between symptoms of urinary incontinence and their impact on daily activities, and the degree of incontinence-related distress perceived by 25- to 45-year-old women. A second purpose was to identify differences, if any, in impact on daily life and degree of incontinence-related distress perceived among women with stress, urge, and mixed incontinence. Guided by Lazarus and Folkman's (1984) Stress, Appraisal and Coping Theory, a descriptive correlational prospective study (N = 35) was conducted using the Urogenital Distress Inventory and the Incontinence Impact Questionnaire. A significant moderate (r = 0.5701, p = 0.000) correlation was found between urinary incontinence symptoms and their impact on travel, social, physical, and emotional activities. No significant differences were found among women with stress, urge, and mixed urinary incontinence and the impact of incontinence symptoms on their daily activities or with their perceived degree of incontinence-related distress.
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PMID:The psychosocial impact of urinary incontinence on women aged 25 to 45 years. 934 44

To assess the prevalence and characteristics of enuresis nocturna in adults, the treatment they received and the perceived impact, a random sample of 13081 non-institutionalized adults (18-64 years old) were asked to participate in the study in January-March 1996. The response rate was 87%. A personal computer questionnaire included 23 questions on frequency of bedwetting, daytime wetting, treatment and perceived impact. Any respondent reporting bedwetting at least once during the previous 4 weeks was considered to have enuresis nocturna. The overall prevalence of enuresis nocturna was 0.5%. Differences between age groups and sexes were not significant. Fifty percent of men and 19% of women reporting enuresis nocturna had primary enuresis nocturna, of those with enuresis nocturna, 12% of men and 29% of women had always daytime incontinence. Fifty percent of the men and 35% of the women had never consulted a care provider for their bedwetting and 38% of the men and 26% of the women had done nothing to become dry. Only 30% believed that bedwetting was treatable. Bedwetting was associated with several psychosocial problems. Enuresis nocturna in adults is common and may lead to embarrassment and discomfort. It may affect careers, social life and personal relationships. Adults should be more aware that bedwetting is a treatable problem. More information should be given on this issue.
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PMID:Enuresis nocturna in adults. 945 10


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