Urinary incontinence

Postprostatectomy incontinence remains a disabling condition. Sphincter injury, detrusor instability, and decreased bladder compliance have been previously reported as major factors. The aim of this study was to evaluate the urethral sphincter intrinsic component, which may provide passive continence. A urodynamic evaluation was performed in 20 patients undergoing a radical retropubic prostatectomy in the preoperative period and 3 months after surgery. Patients with disabled urinary incontinence underwent a new urodynamic evaluation 6 months later. The urethral pressure pro¢le was measured just before, then 10, 20, and 30 minutes after the injection of 0.5 mg/kg moxisylyte chlorhydrate, an alpha adrenergic blocker. Three di¡erent pressure components were de¢ned in urethral sphincter capacity: baseline, adrenergic, and voluntary. A postoperative intrinsic urethral sphincter pressure component was found in 17 patients and its value was under 6 cm H 2 O in ¢ve cases of severe incontinence. No signi¢cant di¡erence was observed for these patients on urethral pro¢le components 6 months later. In contrast, in cases of signi¢cant intrinsic component value, no incontinence was observed in most patients. Passive continence after radical prostatectomy should be a matter of concern and may also explain paradoxical incontinence, despite high voluntary urethral pressure obtained after reeducation. A follow-up evaluation of the intrinsic sphincter component is suggested, by using an alpha receptor blockage test during urodynamic studies in the management of patients with postprostatectomy incontinence.

Micturition, or urination, occurs involuntarily in infants and young children until the age of 3 to 5 years, after which it is regulated voluntarily. The neural circuitry that controls this process is complex and highly distributed: it involves pathways at many levels of the brain, the spinal cord and the peripheral nervous system and is mediated by multiple neurotransmitters. Diseases or injuries of the nervous system in adults can cause the re-emergence of involuntary or reflex micturition, leading to urinary incontinence. This is a major health problem, especially in those with neurological impairment. Here we review the neural control of micturition and how disruption of this control leads to abnormal storage and release of urine.

Autologous fascial and synthetic materials have been widely used to repair the stress form of urinary incontinence (SUI) as well as pelvic floor prolapse. The safety and long-term durability of cadaveric fascia lata in orthopedic and ophthalmologic surgery have encouraged urogynecologists to use this material for a sling material. The rationale of placement of a sling from cadaveric fascia lata

Purpose: We determined whether biofeedback enhanced pelvic floor exercises begun 6 weeks after radical prostatectomy improve the early recovery of continence. Materials and Methods: We randomized 30 patients who underwent radical retropubic prostatectomy into a group that received 5 biofeedback sessions and a control group. Results: Overall 87% of patients were pad-free at 6 months with similar results in the treatment and control groups (86% versus 88%). There was no statistically significant difference in pad test results or voiding diary records in the 2 groups. Conclusions: A treatment program of biofeedback enhanced pelvic floor exercises begun 6 weeks after radical retropubic prostatectomy did not significantly affect continence in this study.

We developed a staff management system for maintaining treatment gains achieved on a specialized continence unit located in a geriatric nursing home. Geriatric assistants learned to use a prompted voiding procedure to maintain improved dryness for 4 elderly residents. The staff management system induded self-monitoring and recording of prompted voiding activities and supervisory monitoring and feedback based on group performance of these activities. Results show that the system was effective in maintaining prompted voiding activities with corresponding maintenance of improved patient continence. However, a gradual decline in staff performance was noted 4 to 5 months after the initiation of the system. During a subsequent phase of the study, provision of individual feedback restored staff performance to previous levels. Results are discussed in relation to the practicality of prompted voiding interventions in nursing home environments and the applicability of staff management systems in this setting.

Drugs for the treatment of urinary disturbance with anticholinergic and smooth muscle-relaxing effects are used for the management of urinary frequency and incontinence. Oxybutynin hydrochloride, propiverine hydrochloride, terodiline hydrochloride, and flavoxate hydrochloride have been marketed in Japan as drugs for treatment of urinary disturbance, and tolterodine tartrate and solifenacin succinate were put on the market in 2006. Sales of terodiline hydrochloride, however, have been stopped because of its adverse arrhythmic effect. The average standard therapeutic doses of the remaining available drugs differ greatly. In regard to anticholinergic and smooth muscle-relaxing effects of oxybutynin, propiverine, and terodiline, it has been reported in studies using extracted rabbit bladders that in order to nearly completely inhibit contraction of the musculus detrusor urinae, each of those effects independently was insufficient and both were required. 1,2) Those results were from in vitro pharmacological experiments, while there is no known report that considered the inhibitory actions toward musculus detrusor urinae contraction using oral administration of the drugs with standard doses.

Objective: To assess the prevalence of urinary incontinence (UI) in a group of female athletes and to explore its impact on their lives. Methods: In total, 106 female athletics, basketball, and indoor football athletes were recruited. Data were collected through a questionnaire and a focus group and analyzed via Pearson's χ 2 test, 2-way analysis of variance, and thematic analysis. Results: Urinary incontinence was experienced by 41.5% of the athletes. Its prevalence across the 3 types of sport was similar and was not affected by age. However, athletes who experienced UI had a lower body weight (P = 0.011) and a lower body mass index (P = 0.035). Most (95.5%) athletes had never discussed their condition with a health professional. In the focus group, all athletes described preventive urination to avoid urine leakage. It was mentioned that UI affected their performance and made them feel uncomfortable and frustrated. Conclusion: Urinary incontinence is a prevalent condition among athletes that is not openly discussed. However, it causes regular changes in their physical performance and daily life. More research is needed to increase awareness of UI and to design interventions.

One goal of the Agency of Health Care Policy and Research (AHCPR) is to improve the quality of medical care by developing and disseminating clinical practice guidelines. An indication of the effectiveness of a clinical guideline is the relationship between the medical benefits gained and the costs of achieving those benefits when the guideline is implemented. Using outpatient and inpatient claims data, this paper reports the current practice patterns, cost variations, and cost implications of implementing a proposed clinical guideline for stress urinary incontinence. The current practice patterns reveal large practice variations for incontinence care, with many basic procedures infrequently used. If the clinical guideline for stress incontinence is implemented as designed, the authors project a total annual cost savings of roughly $36 million in 1992 dollars in the United States.

La neurosyphilis est devenue rare grâce au dépistage et au traitement dans sa phase initiale [1]. Cependant, en raison de la recrudescence de la syphilis [1], il est indispensable d'évoquer la neurosyphilis devant un tableau de myélopathie non compressive, comme nous le confirme l'observation suivante. Un homme, âgé de 41 ans, sans antécédent particulier, fut hospitalisé le 21 octobre 2004 pour une impotence fonctionnelle des deux membres inférieurs (MI) d'installation progressive avec troubles sphinctériens à type d'incontinence urinaire et anale. L'examen clinique trouvait un syndrome médullaire qui comprenait une paraplégie spastique avec un niveau sensitif D6 et une hypotonie anale. L'examen neuropsychologique Nissrine Louhab, Imane Hajjaj, Najib Kissani Service de neurologie, CHU Mohammed VI, BP 7010, Sidi Abbad, Marrakech, Maroc Correspondance : Nissrine Louhab, Service de neurologie, hôpital Ibn Tofail, BP 7010, Sidi Abbad,

The Chief Nurse National Health Service Wales initiated a national survey of acute and community hospital patients in Wales to identify the prevalence of pressure ulcers and incontinence-associated dermatitis. Teams of two nurses working independently assessed the skin of each inpatient who consented to having their skin observed. Over 28 September 2015 to 2nd October 2015, 8365 patients were assessed across 66 hospitals with 748 (8.9%) found to have pressure ulcers. Not all patients had their skin inspected with all mental health patients exempt from this part of the audit along with others who did not consent or were too ill. Of the patients with pressure ulcers, 593 (79.3%) had their skin inspected with 158 new pressure ulcers encountered that were not known to ward staff, while 152 pressure ulcers were incorrectly categorised by the ward teams. Incontinence-associated dermatitis was encountered in 360 patients (4.3%), while medical device-related pressure ulcers were rare (n=33)...

Incontinent patients are at risk for incontinence-associated dermatitis. Prolonged exposures of the skin to urine and/or stool are causal factors but the exact aetiology and pathophysiology are not fully understood. The aim of the current investigation was to identify person and health-related variables most strongly associated with incontinence-associated dermatitis development. Secondary data analysis of a multicentre-prevalence study in 2012. Hospitals, nursing homes, home care in Austria and the Netherlands. Nursing home residents, hospital patients, home care clients who completed an incontinence assessment and who were incontinent (n = 3713). Mean age 81.2 (SD 11.2) years. Demographic, functional and physiological parameters were compared between subjects with incontinence-associated dermatitis and without. A logistic regression model predicting incontinence-associated dermatitis was build. Subjects with incontinence-associated dermatitis were statistically significantly more ...

Using methods of community-based participatory research, a prospective randomized controlled trial of a violence prevention program based on Latino cultural values was implemented with elementary school children in a Mexican American community. Community members participated in intervention program selection, implementation, and data collection. High-risk students who participated in the program had greater nonviolent self-efficacy and demonstrated greater endorsement of program values than did high-risk students in the control group. This collaborative partnership was able to combine community-based participatory research with a rigorous study design and provide sustained benefit to community partners.

Objectif. -L'objectif de cette étude est de déterminer, dans une cohorte de patients candidats à une prostatectomie radicale totale (PRT), s'il existe un ou plusieurs groupes plus à un risque d'incontinence urinaire postopératoire en se basant sur un examen urodynamique préopératoire afin d'adapter au mieux la prise en charge préopératoire.

Les malformations artérioveineuses médullaires sont rares chez l'enfant et peuvent mettre en jeu le pronostic fonctionnel. Observation.-Nous rapportons l'observation d'un enfant âgé de dix ans ayant eu des troubles de la marche associés à des fuites urinaires intermittentes depuis six mois. L'examen clinique montrait une paraparésie spastique des membres inférieurs prédominante à gauche. L'imagerie par résonance magnétique et l'artériographie ont permis de porter le diagnostic d'une malformation artérioveineuse intramédullaire. Une embolisation sélective des compartiments pathologiques a permis une amélioration de la symptomatologie clinique. Conclusion.-L'intérêt de l'IRM dans l'exploration des syndromes médullaires est souligné de même que l'apport de l'embolisation dans le traitement des malformations artérioveineuses médullaires de l'enfant. © 2001 Éditions scientifiques et médicales Elsevier SAS malformation artérioveineuse médullaire / imagerie par résonance magnétique / embolisation thérapeutique Summary-Spinal arteriovenous malformations in children. Spinal arteriovenous malformations are rare lesions in children but may produce serious functional disorders and residual handicaps. Case report.-We report the case of a 10-year-old patient who had weakness in his left leg with intermittent urinary incontinence. Neurological examination showed a spastic paraparesis of both legs, more obvious in the left leg. MRI led to the diagnosis of a spinal vascular malformation, which was confirmed by angiography. The patient underwent a session of embolization, which resulted in a significant clinical improvement. Conclusion.-The importance of MRI in such a case is emphasized as is therapeutic management with embolization. © 2001 Éditions scientifiques et médicales Elsevier SAS spinal diseases / arteriovenous malformations / child

In 1942 Aldridge [1] described a sling operation for stress incontinence using an external oblique aponeurosis. Since then a wide variety of sling materials have been used, either autogenic, allogenic or inorganic. A major problem with autogenic sling material has been the size of the incision required to obtain an adequate strip of fascia. Herein we describe a technique for harvesting fascia lata with a fasciatome, using a 3-cm thigh incision. This technique is easy to learn and provides an excellent fascial strip with minimal morbidity.

This study explored the extent to which a new skin care protocol comprising a skin cleanser, barrier cream and barrier film could be implemented in nursing homes, and its effects on patients' skin condition, staff time and associated costs. A pre-and post-intervention study design was used. Data were collected on current skin condition and skin care procedures, before and after the introduction of a new skin care protocol. Nurses and carers were observed as they undertook skin care following episodes of incontinence. The time taken, products and amounts used were recorded. The presence and severity of incontinence dermatitis was recorded, together with the presence and severity of pressure ulceration. A supportive education programme was delivered to staff. All patients with incontinence and all staff working in six nursing homes were included in this study. Two nursing homes were randomly selected to participate in detailed skin assessments, documentation of skin care procedures and product usage. A total of 164 patients were included in detailed assessments, 79 pre-intervention, 85 post intervention; 49 were male (29.9%) and 115 were female (70.1%). Their mean age was 83.44 years (standard deviation = 8.38). Only 3% of patients were under 70 years of age, with 72% over 80 years of age. Pre-intervention 29.1% were incontinent of urine only, 64.6% were doubly incontinent and 6.3% were catheterised. Post-intervention 29.4% had urinary incontinence, 65.9% were doubly incontinent, and 4.7% were catheterised. Skin condition was maintained or improved using the new skin care protocol. The presence of grade 1 pressure ulcers was found to significantly decrease over time (,0=0.042). The presence of incontinence dermatitis was found to be significantly lower after introducing the skin care protocol (,0=0.021). There was significant reduction in time taken to deliver skin care post·intervention (p<0.001) with a mean time saving of 4 minutes and 2 seconds, per patient per procedure. On average this procedure was carried out 8.5 times per day, giving a time saving of 34 minutes and 17 seconds per patient per day using the new skin care protocol. This was associated with an average saving per patient per day of £8.83 for qualified staff and £3.43 for unqualified staff. Staff adherence to the new skin care protocol was good, with only one observed episode when the protocol was not followed, suggesting a high degree of success in its implementation. This study demonstrated that the introduction of a new skin care protocol, supported by an educational programme, maintained or improved patients' skin condition, and significantly reduced the resources used in delivering nursing care.

The scientific literature was silent about a relationship of pelvic floor, urinary, and fecal incontinence and sexual issues with mode of birth until 1993, when Sultan et al's impressive rectal ultrasound studies were published. They showed that perirectal fibers were damaged in many vaginal births, but not as a result of a cesarean section. These findings helped to pioneer a new area of research, ultimately leading to increasing support among health professionals and the public that maternal choice of cesarean delivery could be justified-even that maternal choice and autonomous decision-making trump other considerations, including evidence. A growing number of birth practitioners are choosing cesarean section for themselves-usually on the basis of concerns over pelvic floor, urinary incontinence, and sexual issues. Behind this choice is a training experience that focuses on the abnormal, interprets the literature through a pathological lens, and lacks sufficient opportunity to see normal childbirth. Cesarean section on maternal request is a complex issue based on fear and misinformation that is a symptom of a system needing reform, that is, a major change in community and professional education, governmental policy making, and creation of environments emphasizing the normal. Systemic change will require the training of obstetricians mainly as consultants and the education of a much larger cadre of midwives and family physicians who will provide care for most pregnant women in settings designed to facilitate the normal. Tinkering with the system will not work-it requires a complete refit.

Objective To propose the inclusion of a gynecological investigation during the evaluation of athletes before competitions, using a specific instrument called the Pre-participation Gynecological Examination (PPGE). Methods The study assessed 148 athletes, mean age of 15.4±2.0 years, who engaged in eight different sports modalities, and who responded to a questionnaire named Pre-Participation Gynecological Examination (PPGE), to the International Consultation on Incontinence Questionnaire - Short Form (for urinary loss), and to the Eating Attitudes Test (for eating disorders). Results Fifty percent of the participants reported irregular menstrual intervals, 23.0% did not know about sexually transmitted diseases, and 72.4% denied having, at least, an annual gynecological appointment. The study identified 18.2% who had urinary loss, and 15% presented with an increased risk of eating disorders. Moreover, 89.9% were not familiar with the occurrence of urinary incontinence in athletes and ...

Prior research suggests that overactive bladder (OAB) is common and adversely affects sexuality in both men and women. However, more data are needed from population-based studies to evaluate the impact OAB on sexual health. Aim. To describe sexual health outcomes in men and women with continent and incontinent OAB (C-OAB, I-OAB) compared to those with no/minimal urinary symptoms (NMS) and to evaluate correlates of decreased sexual activity and enjoyment in men and women, and correlates of erectile dysfunction (ED), ejaculatory dysfunction (EjD), and premature ejaculation (PE) in men.

Patients with mixed urinary incontinence (MUI) are frequently treated with antimuscarinic therapy, despite little data being previously published for this patient group. We present a subgroup analysis of patients with overactive bladder syndrome, assessing the efficacy of once-daily solifenacin succinate in patients with MUI (n=1041) or urge urinary incontinence (UUI; n=1648) only. A greater proportion of patients receiving solifenacin achieved resolution of incontinence in both the MUI and UUI groups (MUI: 5 mg=43%, 10 mg=49%; UUI: 5 mg=55%, 10 mg= 54%) compared with patients receiving placebo (MUI 33%, UUI 35%). Baseline to endpoint improvements in all other symptoms were statistically significant vs placebo for both solifenacin doses in both cohorts. The incidence of adverse events was comparable between the MUI and UUI cohorts. This analysis shows that once-daily solifenacin was as effective and well tolerated in patients with MUI as in patients with UUI.

Incontinence urinaire de la femme ; Pays au sud du Sahara Résumé L'objectif de ce travail était de dresser le profil épidémiologique de l'incontinence urinaire de la femme africaine dans trois pays au sud du Sahara. Matériel et méthodes. -Il s'agissait d'une étude multicentrique qui résumait trois enquêtes épidémiologiques effectuées par questionnaire à Nouakchott, à Dakar et à Ndjamena. Les études étaient effectuées à partir d'un questionnaire anonyme qui a permis de recueillir : l'état civil, les antécédents médicaux, chirurgicaux, gynéco-obstétricaux, la fuite urinaire et ses caractéristiques.

We tested the hypothesis that estrogen promotes improvement in urethral function and nerve regeneration following bilateral pudendal nerve crush in ovariectomized female rats. Materials and Methods: A total of 52 female rats underwent ovariectomy 6 days before bilateral pudendal nerve crush. Estrogen and sham capsules were subcutaneously implanted at the time of nerve crush in 16 and 14 of these rats, respectively, while 22 served as unoperated controls. Seven days following nerve crush urethral LPP testing was performed using urethane anesthesia. Spinal cord sections containing motoneurons of Onufrowicz's nucleus were subjected to in situ hybridization to detect the expression of ␤ II tubulin mRNA, a marker of the neuroregenerative response. Results: Mean LPP Ϯ SEM was significantly decreased after pudendal nerve crush in sham treated animals compared to unoperated controls (32.1 Ϯ 6.8 vs 54.4 Ϯ 11.6 cm H 2 O). Rats with an estrogen implant had an LPP of 42.5 Ϯ 16.8 cm H 2 O, which was significantly greater than rats given sham implants and significantly less than unoperated controls. Rats that received an estrogen implant had increased ␤ II tubulin mRNA expression compared to those that received a sham implant.

Radical prostatectomy is a procedure performed with increasing frequency in patients with localized prostate cancer. Although, the operative morbidity is considerably low, urinary incontinence and erectile dysfunction remain an important and persistent problem. Since several years the impact of radical prostatectomy on the quality of life (HRQOL) is investigated. However, there are only few prospective studies dealing with rather small groups of patients. These studies indicate that urinary and sexual function have major impact on HRQOL. Although, there is a steady improvement in urinary function and decrease in urinary bother only about 65% of the patients reach the baseline at the end of the first year. In spite of this almost 90% of patients reach baseline in all other HRQOL domains such as general health perception, physical and social function after a mean period of 5 months. The importance of sexual desire and erectile capacity decreases with age; being important in 75 and 84% of men at the 5th decenium and 48 and 59% at the 6th decenium. After standard radical prostatectomy almost all of the patients are impotent. Applying so-called nerve sparing techniques erectile function may be preserved in careful selected patients. It is the common theme that preservation of the 'neurovascular bundles' equals a high rate, but still age depended postoperative potency; however difficulties in regaining urinary control may embarrass the patient to such an extent to withdraw from sexual activity. Furthermore, the change of sexual ability and quality may have impact on the partner who do not want to initiate sexual activity because of the possible failure. This may cause an increased level of emotional distance, which again is deleterious for sexual activities. Patients who are sexually active prior to surgery report major distress in case of postoperative erectile impotence, but even in case of maintained erectile capacity some patients are bothered by the sexual dysfunction. Sexual counselling and providing the optimal erectile aid is therefore very important. Psychlogical distress of spouses may be significantly greater than that of the patients; general cancer distress, treatment related worries, concerns on physical limitations and pain are the main reasons. However, it may well be that women are willing to Contents : S 1 0 4 0 -8 4 2 8 ( 0 2 ) 0 0 0 2 6 -4 report their problems more often than their partners who may have a grin-and-bear-it attitude. In spite of this caveate, it is important to include the patient's spouse into the discussions on therapy and associated morbidity early on. Since radical prostatectomy for localized prostate cancer is only one of the possible treatment options, the patient has to be informed about the incidence and various types of morbidity which is associated with treatment and their possible impact on HRQOL. Appropriate and honest counselling will have significant influence on the well being of the patient after completing therapy. #

Designing for women's healthcare remains an underexplored area of HCI, particularly outside informational systems for maternal health. Drawing on a case study of a body disruption-urinary incontinence in women-we illustrate the experience of women's health both from the perspective of the patient and the therapist. We show how knowledge, esteem and agency play crucial roles in remedial women's care practices, as well as preventative. In describing these challenges we deliberate on possible futures of women's health that take advantage of the many advances in design and technology from across the spectrum of HCI research. We show how with some care and courage HCI has the potential to transform women's experience within this setting.

the UPS and patient voiding diary variables and other patient assessments, including: perception of bladder condition; perception of treatment benefit; the Medical Outcomes Study Short-Form 36 health survey; the King's Health Questionnaire; the OAB Questionnaire; and the Overall Treatment Effect scale.

Aims. To evaluate two quality of life measures for urinary incontinence (UI) in Scottish females. Methods. Three groups with UI from two regions in Scotland were studied. Two groups were receiving treatment for incontinence; the third was not. Women completed the UDI and IIQ twice to allow assessment of test-retest reliability and validity. Treatment groups completed the questionnaires again, postintervention, to assess ability of the measures to detect change. Other measures used to assess validity were the SF-36, HADS, weight of urine leaked, and number of incontinence episodes. By design, the three subject groups di¡ered signi¢cantly in their characteristics, ensuring a diverse sample of women. Results. Analysis of reliability showed a clinically trivial but statistically signi¢cant decrease in total UDI (mean, À6.1; 95% CI, À11.0 to À1.5) and IIQ (mean, À9.7; 95% CI, À15.5 to À3.9) scores between test and retest assessments, possibly due to a research e¡ect. Most items of the UDI (18 of 19) and IIQ (28 of 30) performed very well on test-retest. The UDI and IIQ were valid in that higher scores (indicating more bothersomeness of symptoms/impact on daily living) were associated with greater severity of UI. Additionally the IIQ showed the expected associations with measures of anxiety and health status. Conclusions. Both the UDI and IIQ detected changes in women's conditions due to intervention. The measures had good psychometric properties, including test-retest reliability, across subject groups.

Effects of ovariectomy and estrogen replacement on attractivity and receptivity in the red-sided garter snake (Thamnophis sirtalis parietalis) Abstract Activation of courtship behavior in male redsided garter snakes, Thamnophis sirtalis parietalis, is independent of the presence of sex steroids. The only consistent treatment that stimulates courtship behavior in males is prolonged exposure to low temperature followed by subsequent warming, mimicking the emergence from hibernation. We investigated whether attractivity and receptivity in female red-sided garter snakes is similarly steroid independent.

Aim.  The aim of this paper is to explore whether nurses working in elderly medicine and in acute medical settings promote urinary continence in older people or in reality use containment strategies.Background.  Untreated urinary incontinence in older adults can result in prolonged hospital admission and increased risk of admission to long-term care. Urinary incontinence can also have severe psychosocial effects on older people. Most studies relating to this topic have relied on quantitative approaches to data collection with a seeming lack of qualitative investigation into how nursing staff promote urinary continence in hospitalized older people.Method.  Focus groups and one-to-one semi-structured interviews were carried out in two NHS regions in Scotland. Registered and non-Registered Nurses were invited to participate. Five focus groups (n = 17) and four single interviews (n = 4) were conducted. Data generated were analysed thematically using QSR N-VIVO 2.Findings.  Some nurses believe that older people accept urinary incontinence as a consequence of ageing. Lack of assessment results in older people being labelled as incontinent of urine. Assessment strategies in medicine for the elderly tend to focus on product identification and management of incontinence. Although nurses from all clinical areas identify the importance of promoting continence, the problem continues to be contained rather than treated. Conflicting clinical priorities, varying staff approaches to urinary continence and deficits in education are cited among the barriers to promoting continence.Conclusions.  The results suggest that nurses continue to contain urinary incontinence rather than promoting continence in older people.Relevance to clinical practice.  Nursing staff need to be aware of the impact of untreated urinary incontinence on older people. Practitioners should promote continence rather than employing containment strategies. A validated assessment tool for older people needs to be developed. Views of older people should be sought regarding their attitudes towards urinary incontinence.

E U R O P E A N U R O L O G Y 5 7 ( 2 0 1 0 ) 1 0 3 9 -1 0 4 4 a v a i l a b l e a t w w w . s c i e n c e d i r e c t . c o m j o u r n a l h o m e p a g e : w w w . e u r o p e a n u r o l o g y . c o m Abstract Background: Despite improvements in surgical techniques, urinary incontinence (UI) is not uncommon after radical prostatectomy (RP), and it may dramatically worsen quality of life (QoL). Objective: To determine the benefit of starting pelvic floor muscle exercise (PFME) 30 d before RP and of continuing PFME postoperatively for early recovery of continence. Design, setting, and participants: A randomised, prospective study was designed. Men with localised prostate cancer (PCa) who underwent an open radical retropubic prostatectomy (RRP) at our department of urology were included. Intervention: Patients were randomised to start PFME preoperatively and continue postoperatively (active group: A) or to start PFME postoperatively alone (control group: B). Measurements: The primary outcome measure was self-reported continence after surgery. Secondary outcome measures were assessed by degree of UI based on a 24-h pad test and QoL instruments (International Continence Society [ICS] male short form [SF]). Results and limitations: Of 143 men evaluated for the study, 118 were randomised either to start PFME preoperatively and continue postoperatively (group A; n = 59) or to start postoperative PFME (group B; n = 59). After 1 mo, 44.1% (26 of 59) of patients were continent in group A, while 20.3% (12 of 59) were continent in group B ( p = 0.018). At 3mo, 59.3% (35 of 59) and 37.3% (22 of 59) patients were continent in group A and group B, respectively ( p = 0.028). The ICS male SF mean score showed better results in group A than in group B patients at both 1 mo (14.6 vs 18.3) and 3 mo (8.1 vs 12.2) after RP ( p = 0.002). In age-adjusted logistic regression analyses, patients who performed preoperative PFME had a 0.41-fold lower risk of being incontinent 1 mo after RP and a 0.38-fold lower risk of being incontinent 3 mo after RP ( p 0.001). Conclusions: Preoperative PFME may improve early continence and QoL outcomes after RP. Further studies are needed to corroborate our results.

This cross-sectional study aimed to study the religious and cultural practices of ethnic minorities that might affect the experience and ideas that sufferers of incontinence have. Subjects were multiparous women from the local community who suffered from incontinence. Structured and unstructured interviews were conducted to assess the effect of incontinence and menstruation on home life, sexual life, personal and communal prayer, rules and customs associated with menstruation, and the ability to discuss problems with their doctor and partners. Individual women differed in how they rated their daily activities, and this was not related to religious or ethnicity. Higher restrictions on activity were perceived for fecal than for urinary incontinence. Sexual relationships were restricted for Jewish and Muslim women during menses. Incontinence led to religious restriction, which was most marked for Jewish and Muslim women, and this was related to the need for cleanliness for prayer. Less then 50% of patients sought help, and this was not related to duration and severity of symptoms. Only Muslim women had a strong preference for female doctors, and this was for cultural reasons.

Evaluation of pelvic-floor muscle (PFM) function and strength is necessary (1) to be able to teach and give feedback regarding a woman's ability to contract the PFM and (2) to document changes in PFM function and strength throughout intervention. The aims of this article are to give an overview of methods to assess PFM function and strength and to discuss the responsiveness, reliability, and validity of data obtained with the methods available for clinical practice and research today. Palpation, visual observation, electromyography, ultrasound, and magnetic resonance imaging (MRI) measure different aspects of PFM function. Vaginal palpation is standard when assessing the ability to contract the PFM. However, ultrasound and MRI seem to be more objective measurements of the lifting aspect of the PFM. Dynamometers can measure force directly and may yield more valid measurements of PFM strength than pressure transducers. Further research is needed to establish reliability and validity scores for imaging techniques. Imaging techniques may become important clinical tools in future physical therapist practice and research to measure both pathophysiology and impairment of PFM dysfunction. [Bø K, Sherburn M. Evaluation of female pelvic-floor muscle function and strength. Phys Ther. 2005;85:269 -282.] Perspective ⅷ ўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўў ўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўўў Inferior view of the pelvic-floor muscles, showing the pelvic diaphragm (levator ani muscles) and urogenital diaphragm (perineal muscles).

. Second, a self-reported UI prevalence was calculated by asking respondents if they ever had urine loss. To conform to the International Continence Society standard definition, spouses were also asked to complete a general (Short Form-12) and lower urinary tract disease-specific quality-of-life questionnaire, and were asked about their need to seek help.

Clean intermittent self-catheterisation (CISC) is often a treatment option for women with urinary incontinence, particularly those with neurogenic bladder dysfunction. When used for appropriate patients it has been shown to promote continence and improve quality of life. There are a range of different products available on prescription for patients and many have been designed specifically with women in mind. Curan Lady is a new catheter that has recently been added to the UK NHS Drug Tariff. Patients suffering from limited/restricted mobility in their hands, found the Curan Lady easy to open and use. CISC can promote privacy and dignity for women with urinary incontinence and patient choice regarding product selection is important. Nurses need to keep up to date with new product availability for patients in order to offer choice to women performing CISC.

Aim: The aim of this study was to evaluate urodynamic changes after percutaneous tibial nerve stimulation (PTNS) for the treatment of complaints related to overactive bladder syndrome and to search for urodynamic-based predictive factors. Methods: Ninety consecutive patients with symptoms related to overactive bladder syndrome were enrolled in this study. Patients underwent 12 PTNS sessions. For evaluating objective success, the primary outcome measure was a reduction in number of urinary leakage episodes of 50% or more per 24 hours. Patients' request for continuation of therapy was considered subjective success. This study focussed on urodynamic features at baseline and on changes found after 12 PTNS treatments. Results: The objective success rate was 56% (leakages/24 hours). Subjective success rate was 64%. Frequency/volume chart data and quality of life scores improved signi¢cantly (P < 0.01). Pre-and posturodynamic data were available from 46 participants. Detrusor instabilities (DI) could be abolished in a few cases only. Increments in cystometric bladder capacity and in volume at DI were signi¢cant (P ¼ 0.043 and 0.012, respectively). Subjects without detrusor instabilities at baseline were 1.7 times more prone to respond to PTNS (odds ratio, 1.75; 95% con¢dence interval [CI], 0.67^4.6). The more the bladder overactivity was pronounced, the less these patients were found to respond to PTNS, the area under the receiver operating curve was 0.644 (95% CI, 0.48^0.804). Conclusion: PTNS could not abolish DI. PTNS increased cystometric capacity and delayed the onset of DI. Cystometry seemed useful to select good candidates: patients without DI or with late DI onset proved to be the best candidates for PTNS. Neurourol. Urodynam. 22:227^232,