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PubMed1996

Collagen injection therapy for type III stress urinary incontinence.

Urinary incontinence is a distressing, demoralizing, costly condition that affects 10% to 25% of women and up to 5% of men between the ages of 15 and 60 years. One common type of urinary incontinence is stress urinary incontinence (SUI), which is the involuntary loss of urine during physical activities that increase intraabdominal pressure. Many individuals with SUI have intrinsic sphincter deficiency. Until recently, treatment for intrinsic sphincter deficiency involved open surgical procedures and lengthy recovery periods. Patients now have the option of undergoing a less-invasive treatment: collagen injections into their bladder necks and proximal urethras. Perioperative nurses can enhance the success of collagen injection therapy by understanding the psychosocial needs of patients with SUI, the patient selection criteria and diagnostic tests required for this new treatment approach, and the nursing role in collagen injection procedures.

Collagen↗

PubMed1980

Urinary incontinence.

Urinary incontinence is a sign of a disorder, not a diagnosis. Careful history and physical examination often suggest the correct diagnosis. However, complete accuracy can be obtained only by the judicious use of appropriate ancillary procedures including careful neurologic assessment and urodynamic evaluation of the bladder and urethra. The fact that the varieties of urinary incontinence occur infrequently poses a significant medical and legal problem. Unless the facilities for complete urologic evaluation are available and unless the surgeon by training and experience has demonstrated success in the treatment of urinary incontinence, most if not all of these patients should be considered for referral.

Female↗

PubMed1998

Urinary incontinence and urinary tract infections in octogenarian women.

BACKGROUND: Urinary incontinence and urinary tract infection are common problems among elderly women due to age-related changes in the urogenital tract, but information regarding prevalence and presentation among the aged is limited. METHODS: A total of 97 randomly selected women aged 80-89 years, 47 living in homes for the elderly and 50 living at home, were asked about urogenital complaints in a structured interview. Medical records provided information about urinary tract infections and the use of estrogens. RESULTS: Urinary incontinence affected 46%; half of them daily. Urge incontinence was most common (43%), then mixed incontinence (28%) and stress incontinence (26%). Urge and mixed incontinence caused significantly more discomfort than stress incontinence. During the past two years 33% of the women had experienced urinary tract infection and 11% had > or = 5 infections. A total of 22 women were receiving estrogen treatment, more often in homes for the elderly (p < 0.001). Paradoxically, these women had a higher prevalence of urinary incontinence, urinary tract infection, and other complaints than women not receiving estrogens. Considerable or great discomfort from the urogenital tract was reported by 23% of the women. A third of the women had discussed urogenital complaints with a physician. CONCLUSION: In view of the prevalence of urogenital complaints, it is likely that more elderly women could benefit from early medical assessment and treatment. Indications for estrogen treatment need to be more clearly defined.

Age Factors↗

PubMed1999

Geriatric urinary incontinence.

Urinary incontinence is abnormal at any age. The prevalence of urinary incontinence increases with age due to functional impairments and concurrent medical disease. A detailed history and physical is essential in evaluating these patients. Urinary incontinence is treatable in all age groups when a logical, multifactorial and persistent approach is undertaken.

Aged↗

PubMed2000

Epidemiology and classification of urinary incontinence.

Urinary incontinence is a common symptom affecting the physical, psychological, social and economic well-being of individuals and their families. It also poses a considerable economic burden on health and social services. The literature reports widely varying prevalence rates for incontinence that are partially explained by methodological differences between studies. However, community-based studies indicate that approximately 6% of the population, particularly women and older people, will have urinary incontinence of sufficient severity to interfere with their quality of life. This represents a significant demand for health care. Although further research on prevalence is unlikely to add anything new to current knowledge on the size of the problem, more information is needed on the onset, progression and risk factors of urinary incontinence to inform methods of effective treatment and preventive strategies. In addition, there has been little investigation of the triggers to seeking professional help or of the response of health professionals to patients' demands for treatment, either for incontinence or other lower urinary tract symptoms. The aetiology of incontinence is multifactorial; incontinence is caused by pathophysiological impairments to the lower urinary tract and neurological system, as well as a range of external factors. The key to effective management, therefore, is a comprehensive assessment of the patient, including other lower urinary tract symptoms, so that appropriate intervention is tailored on a diagnosis and not on symptoms.

Female↗

PubMed2003

Identifying and treating reversible causes of urinary incontinence.

Urinary incontinence can be a symptom of a variety of reversible conditions. Common and reversible causes of urinary incontinence include polyuria, exposure to irritants (including concentrated urine), infection, urinary retention, use of pharmaceuticals, stool impaction or constipation, atrophic urethritis or vaginitis, restricted mobility or dexterity, psychological conditions, and delirium or acute confused state. Healthcare professionals can use existing assessment strategies, tools, and parameters to guide decisions and treatment options to manage these conditions. First-line assessment tools are reviewed, including the use of a voiding and bowel diary, simple dipstick urinalysis, catheterization for post-void residual, the Folstein Mini Mental Status evaluation, and the Geriatric Depression Scale. Guidelines for estimating normal ranges of urine output, the influence of irritants, the risk of incontinence caused by stool impaction, and urinary retention are discussed. Primary care providers are well positioned to rule out or treat many of the reversible causes of urinary incontinence using simple assessment tools and pragmatic guidelines.

Causality↗

PubMed2004

Pharmacologic management of urinary incontinence.

Urinary incontinence is a highly prevalent and difficult to treat medical condition. For those who are affected, urinary incontinence produces profound modifications in lifestyle and perceived quality of life. Pharmacologic therapy clearly is beneficial for most types of urinary incontinence. The low therapeutic success of current treatments and obnoxious side effects, however, limit patient satisfaction and compliance. There is a considerable need for improved therapeutic options to treat this devastating condition.

Adrenergic Antagonists↗

PubMedDate not supplied

Behavioral therapy for urinary incontinence.

Urinary incontinence is a serious and costly problem that affects many patients, especially the elderly. Because this population is growing, many methods of treatment for urinary incontinence have been developed. However, even though the behavioral techniques have been available for years, only recently has the use of formal behavioral methods become more popular as a less invasive alternative for the treatment of incontinence. These methods have proven effective in several series. This article reviews the treatment of types of urinary incontinence with behavioral therapeutic techniques.

Behavior Therapy↗

PubMed2005

[Place of duloxetine in the treatment of stress urinary incontinence].

Urinary incontinence is a public health problem, as more than three million women in France are concerned by this problem. The prevalence of stress urinary incontinence is about 40% among these women. Duloxetine is a molecule developed for the oral treatment of stress urinary incontinence. It is a serotonin and norepinephrine reuptake inhibitor, which acts by increasing urethral sphincter tone. In several phase III trials, duloxetine administered orally at a high dose of 80 mg per day, significantly reduced episodes of incontinence. Total scores on the Incontinence Quality of Life questionnaire (I-QOL) were more markedly improved by duloxetine than by placebo. Nausea was an adverse effect observed in more than 25% of cases and required discontinuation of treatment in some patients. However, the encouraging preliminary results of duloxetine in this indication must be confirmed during phase IV post-marketing clinical trials.

Clinical Trials as Topic↗

PubMedDate not supplied

Alaska nursing home takes national role in addressing urinary incontinence.

Urinary incontinence affects over half of all residents in the nation's 25,000 nursing homes. While incontinence assessment, treatment and management techniques have been validated under "laboratory" conditions, the practicality of maintaining the systems pose difficulties for most nursing homes. An evaluation of a new automated system for managing urinary incontinence indicates that a nursing home in Anchorage, Alaska, has successfully implemented and maintained the new system for over ten (10) months. Researchers found that The Mary Conrad Center quickly reduced wetness rates in the target group from 25 percent prior to implementation of the program, to about eight percent and have been able to reduce wetness rates to even lower levels in subsequent months. The evaluation provides critical evidence that nursing homes can implement and maintain the comprehensive system. If further testing in other facilities result in similar findings, the system stands to impact the quality of care for over one million nursing home residents affected by urinary incontinence.

Alaska↗

PubMed1992

Understanding and evaluating chronic urinary incontinence.

Urinary incontinence is a geriatric syndrome of large proportions financially and psychosocially. It may be one of the most neglected ailments. An understanding of the anatomy and pathophysiology of the problem is necessary to creatively assess and treat individual cases. The physician should have in mind an orderly and reasonably complete classification of urinary incontinence and be familiar with the terms traditionally used to describe various mechanisms and phenomena related to the condition. Evaluation of patients involves a discriminating selection of studies and, at times, trials of therapy. A "bedside cystometrogram" may yield much information.

Aged↗

PubMed1985

Etiology and method of radiologic assessment of male urinary incontinence.

Urinary incontinence presenting after iatrogenic or other trauma to the urethral sphincters is a distressing symptom for the patient and often a troublesome problem for a surgeon. Dynamic retrograde urethrography and voiding cystourethrography can greatly assist the urologist in determining the extent of the damage to the sphincters and thence selecting the appropriate treatment. We outline a method of urethrography for the assessment of male urinary incontinence, not previously described in the radiologic literature, to be used as a radiologic adjunct to clinical and urodynamic assessment.

Contrast Media↗

PubMed1989

Female urinary incontinence.

Urinary incontinence is a common problem that can affect women of all ages. Urinary leakage twice or more each month is estimated to occur in 8.5 per cent of women aged 15 to 64, increasing to 11.6 per cent in women over 65 years and to be present in more than one half of all nursing home residents. Of these only one sufferer in four is receiving any treatment.

Female↗

PubMedDate not supplied

An introduction to urinary incontinence.

Urinary incontinence is most frequently associated with the elderly, particularly women, and is often thought of as inevitable. However, orthopaedic nurses encounter incontinence as a response to alterations in orthopaedic health. This article reviews the types of urinary incontinence, with emphasis on those which may most directly result from orthopaedic problems. It will also help the nurse differentiate between types of incontinence in a way that will clarify appropriate interventions.

Aged↗

PubMed1997

The 'costs' of urinary incontinence.

Urinary incontinence is a prevalent and costly health condition. This paper discusses the 'costs' of untreated urinary incontinence. Costs are broadly conceptualised within a framework which includes physical, psychosocial, and economical components. Limited data is available documenting the different costs of incontinence. Further research is needed to better quantify these costs to aid clinicians, payers, and public policy-makers in decision-making related to incontinence management.

Cost of Illness↗

PubMed1990

Basic evaluation of female urinary incontinence.

Urinary incontinence is a common disorder that is frequently underreported because of its social implications. Although several types of urinary incontinence are recognized, they can be generally classified as failure of the bladder to store or failure of the urethral mechanism. A systematic approach for the evaluation of incontinence that includes history, physical examination, basic laboratory tests, and often urodynamic evaluation, offers the most comprehensive assessment of the etiology of incontinence.

Aged↗

PubMed2005

Pharmacotherapy of female urinary incontinence.

Urinary incontinence is a major clinical problem and a significant cause of disability and dependency in older adults. Overall, the prevalence of urinary incontinence approaches 55% among women aged over 55 years. The past few years have seen significant advances in the pharmacotherapy of overactive bladder and stress incontinence. The review examines the evidence regarding their benefits and side-effects.

Adrenergic Agonists↗

PubMed1998

Diagnosis and management of female urinary incontinence.

Urinary incontinence affects an estimated 13 million Americans of which 85% are women. It is an embarrassing and lifestyle limiting condition for which effective treatment is available. Health care providers should be alert to the signs and symptoms of UI and pursue its etiology. Those patients who fail medical therapy, in whom the etiology for the incontinence is unclear, or those patients with concomitant cystocele, enterocele, or rectocele, should be referred to an incontinence specialist.

Adolescent↗