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PubMed2003

Clinical pharmacokinetics of drugs used to treat urge incontinence.

Urge incontinence (also known as overactive bladder) is a common form of urinary incontinence, occurring alone or as a component of mixed urinary incontinence, frequently together with stress incontinence. Because of the pathophysiology of urge incontinence, anticholinergic/antispasmodic agents form the cornerstone of therapy. Unfortunately, the pharmacological activity of these agents is not limited to the urinary tract, leading to systemic adverse effects that often promote nonadherence. Although the pharmacokinetics of flavoxate, propantheline, scopolamine, imipramine/desipramine, trospium chloride and propiverine are also reviewed here, only for oxybutynin and tolterodine are there adequate efficacy/tolerability data to support their use in urge incontinence. Oxybutynin is poorly absorbed orally (2-11% for the immediate-release tablet formulation). Controlled-release oral formulations significantly prolong the time to peak plasma concentration and reduce the degree of fluctuation around the average concentration. Significant absorption occurs after intravesical (bladder) and transdermal administration, although concentrations of the active N-desethyl metabolite are lower after transdermal compared with oral administration, possibly improving tolerability. Food has been found to significantly affect the absorption of one of the controlled-release formulations of oxybutynin, enhancing the rate of drug release. Oxybutynin is extensively metabolised, principally via N-demethylation mediated by the cytochrome P450 (CYP) 3A isozyme. The pharmacokinetics of tolterodine are dependent in large part on the pharmacogenomics of the CYP2D6 and 3A4 isozymes. In an unselected population, oral bioavailability of tolterodine ranges from 10% to 74% (mean 33%) whereas in CYP2D6 extensive metabolisers and poor metabolisers mean bioavailabilities are 26% and 91%, respectively. Tolterodine is metabolised via CYP2D6 to the active metabolite 5-hydroxymethyl-tolterodine and via CYP3A to N-dealkylated metabolites. Urinary excretion of parent compound plays a minor role in drug disposition. Drug effect is based upon the unbound concentration of the so-called 'active moiety' (sum of tolterodine + 5-hydroxymethyl-tolterodine). Terminal disposition half-lives of tolterodine and 5-hydroxymethyl-tolterodine (in CYP2D6 extensive metabolisers) are 2-3 and 3-4 hours, respectively. Coadministration of antacid essentially converts the extended-release formulation into an immediate-release formulation. Knowledge of the pharmacokinetics of these agents may improve the treatment of urge incontinence by allowing the identification of individuals at high risk for toxicity with 'usual' dosages. In addition, the use of alternative formulations (controlled-release oral, transdermal) may also facilitate adherence, not only by reducing the frequency of drug administration but also by enhancing tolerability by altering the proportions of parent compound and active metabolite in the blood.

Aging↗
PubMed2006

The clinical pharmacokinetics of darifenacin.

Darifenacin hydrobromide is a selective muscarinic M(3) receptor antagonist that is indicated for use in treatment of overactive bladder disorder. Darifenacin was found to have a short terminal elimination half-life after intravenous and immediate-release oral dosage forms (3-4 hours) but this increased with a prolonged-release (PR) formulation (14-16 hours). The absolute bioavailability of darifenacin from 7.5 and 15 mg PR tablets was estimated to be 15.4% and 18.6%, respectively. With repeated once-daily oral administration of the PR formulation, peak plasma concentrations of darifenacin are achieved approximately 7 hours post-dose. After oral administration, darifenacin is well absorbed from the gastrointestinal tract and very little unchanged drug (<2%) is recovered in the faeces. Steady state is achieved after 6 days of once-daily administration of the PR formulation. As expected, values of peak plasma concentration (C(max)) and area under the plasma concentration-time curve are dose dependent, although the increase in plasma concentrations is proportionally greater than the increase in dose owing to saturation of presystemic metabolism. From intravenous administration, it has been established that darifenacin possesses a moderate-to-high hepatic extraction ratio, with high plasma clearance (36-52 L/h) and a volume of distribution (165-276L) that exceeds total body water. It is highly protein bound (98%), primarily to alpha(1)-acid glycoprotein. Darifenacin is subject to extensive hepatic metabolism, with 3% of unchanged drug excreted in urine and faeces. Metabolism is mediated by hepatic cytochrome P450 2D6 and 3A4, the main metabolic routes being monohydroxylation in the dihydrobenzfuran ring, dihydrobenzfuran ring opening, and N-dealkylation of the pyrrolidine nitrogen. Several possibly important drug-drug interactions have been identified with darifenacin, including ketoconazole, erythromycin and fluconazole, each of which increases darifenacin mean C(max) by 9.52-, 2.28- and 1.88-fold, respectively. When given with imipramine, darifenacin causes 1.6-fold higher plasma concentrations of the antidepressant and its major metabolite. Moderate hepatic impairment, but not renal insufficiency, has been shown to increase plasma concentrations of the drug. The pharmacokinetic profile of darifenacin is not affected by food.

Benzofurans↗
PubMed2005

Facilitating adherence to highly active antiretroviral therapy in children with HIV infection: what are the issues and what can be done?

Treatment of HIV infection with highly active antiretroviral therapy (HAART) requires sustained adherence to treatment to maintain efficacy. In pediatric patients, adherence to HAART represents a significant challenge for treated children and for their caregivers and healthcare providers. Many factors can affect adherence to HAART including: (i) factors related to the patient and his/her family; (ii) factors related to the drug/medication; and (iii) factors related to the healthcare system. Different strategies can be employed to tackle the specific obstacles identified in these three groups, and thus to facilitate adherence. Among the key interventions centered on the patient and his/her family are the tailoring of the HAART regimen to the daily activities of the child and his/her family, and the implementation of an intensive education program on adherence for the child and the caregiver, prior to starting the treatment. Specific medication-related problems (depending on drug pharmacokinetic and pharmacodynamic properties, taste and palatability, food interactions, etc.) exist; such problems can not be solved solely by clinicians or by families. Greater commitment of the pharmaceutical industry is needed, and innovative solutions have to be identified by clinicians in partnership with drug manufacturers. Furthermore, the development of an 'adherence strategy/program' can be recommended to all institutions working in pediatric HIV infection. Most of the necessary interventions to be included in such programs can be easily implemented, but they require trained and committed staff (and institutions), and time to be spent with patients and their caregivers.

Antiretroviral Therapy, Highly Active↗
PubMed2006

[Questionnaire survey on lower urinary tract symptoms (LUTS) for patients attending general practice clinics].

OBJECTIVES: We investigated the incidence of lower urinary tract symptoms (LUTS) in people consulting a general practice (GP) clinics. MATERIALS AND METHODS: The questionnaire included 7 questions regarding LUTS and 1 question regarding QOL (QOL index) based on the International Prostate Symptom Score (I-PSS), 3 questions on the Overactive Bladder Symptom Score (OABSS) and 4 questions on the International Conference of Incontinence Questionnaire Short-form (ICIQ-SF) and the survey was conducted among 1,120 people aged 50 or older who consulted a GP clinic. RESULTS: Questionnaires were collected from 958 persons (86%) and the data from 822 (73%) who completed all the above questions were analyzed. There were 364 men (mean age: 67 year-old) and 458 women (68 year-old). Moderate or severe grades on I-PSS and OABSS were indicated in 99 (27%) and 43 (12%), respectively, for men, and 55 (12%) and 40 (9%) for women. Moderately or severely impaired QOL was indicated in 206 (57%) men and 193 (42%) women. Fifty-five (15%) men and 185 (40%) women indicated that they had some type of urinary incontinence. There were 138 (38%) men and 165 (36%) women showing both moderate or severe I-PSS and moderate or severe impairment of QOL, and/or with an ICIQ-SF score greater than 1. CONCLUSION: When I-PSS and QOL score were used for LUTS screening, 38% of men and 36% of women aged over 50, consulting a GP clinic, had some LUTS which should be assessed to determine whether they need treatment.

Age Factors↗
PubMed2003

Pharmacokinetics, metabolism, and saliva output during transdermal and extended-release oral oxybutynin administration in healthy subjects.

OBJECTIVE: To compare the pharmacokinetics and adverse effect dynamics of 2 modified-release oxybutynin treatments. SUBJECTS AND METHODS: Between October 15 and November 6, 2001, 13 healthy subjects (7 men and 6 women) participated in a randomized, 2-way crossover study of transdermal (Oxytrol, 3.9 mg/d) and extended-release oral (Ditropan XL, 10 mg) oxybutynin. Multiple blood and saliva samples were collected. Pharmacokinetic parameters and total salivary output were assessed. Statistical analyses included 95% confidence intervals, paired t test, analysis of variance, and linear regression. RESULTS: Steady-state plasma concentrations were achieved after the first transdermal application and after the second extended-release oral dose. Mean +/- SD 24-hour oxybutynin areas under the concentration-time curve were comparable during transdermal and oral extended-release treatments, 10.8 +/- 24 vs 9.2 +/- 33 ng x h(-1) x mL(-1), respectively. However, the ratio of area under the curve (N-desethyloxybutynin/oxybutynin) after transdermal administration (1.2 +/- 03) was significantly lower (P < .001) than after extended-release oral administration (4.1 +/- 0.9). Mean plasma concentrations were less variable during transdermal compared with extended-release oral administration. Mean +/- SD saliva output was greater during transdermal than extended-release oral treatment (15.7 +/- 93 vs 12.2 +/- 6.8 g, respectively; P = .02). Lower N-desethyloxybutynin during transdermal application was associated with greater saliva output (r = -059, P = .04). No clinically important treatment-related adverse effects were observed. CONCLUSIONS: Transdermal oxybutynin administration results in greater systemic availability and minimizes metabolism to N-desethyloxybutynin compared with extended-release oral administration. Lower N-desethyloxybutynin plasma concentration and greater saliva output during transdermal treatment correspond to the reported low incidence of dry mouth in patients with overactive bladder.

Administration, Cutaneous↗
PubMed2004

Absorption pattern of trospium chloride along the human gastrointestinal tract assessed using local enteral administration.

BACKGROUND AND OBJECTIVES: The antimuscarinic drug trospium chloride is hydrophilic and therefore does not enter the CNS when used for the treatment of overactive bladder disturbances. However, the same property is the main reason for low and variable oral bioavailability. The present study was performed to assess the influence of intestinal site on absorption of the drug as the basis for the development of modified release preparations. METHODS: In a change-over pilot study, 8 healthy male volunteers received single 20 mg doses oftrospium chloride orally as a tablet (reference), as Eudragit-coated tablets dissolving at pH 6.0 (local administration into the small intestine), and rectally via a mini enema (corresponding to local administration into the large intestine). Plasma concentrations of trospium chloride were determined up to 36 hours after administration using GC/MS. RESULTS: Extent and rate of trospium chloride absorption declined rapidly upon administration into more distal regions of the gastrointestinal tract. C(max) (median: 6.42 ng/ml) and AUC(0.tlast) (42.28 ng/ml x h) were highest and t(max) (3.5 h) was shortest after administration of the reference tablet. AUC(0-tlast) reached 78% (90% CI 43 - 139%) after small intestine administration and 2% (90% CI 1 - 9%) following rectal administration, respectively, relative to the values for the oral tablet. CONCLUSION: Trospium chloride is absorbed primarily in the upper gastrointestinal tract. Development of modified release preparations must balance prolonged apparent absorption rates of the drug against a decrease in bioavailability.

Administration, Oral↗
PubMed1992

[Urinary disturbance due to HTLV-1 associated myelopathy].

Patients with human T-cell lymphotropic virus type 1 associated myelopathy (HAM) have complaints of urinary disturbance frequently. Symptoms and urodynamic examinations were evaluated in untreated twenty-one patients with HAM. Although two cases (11%) had no urinary symptom, nineteen cases (89%) suffered from dysuria, pollakisuria, incontinence or urgency. The combination of irritative and obstructive urinary disturbance was a characteristic symptom in the HAM patients. In three cases the urinary symptoms preceded the gait disturbance which is a main symptom of HAM. In urodynamic study overactive bladder was found in fourteen cases (66%), although three cases (15%) showed underactive or acontractile bladder with disturbance of urinary sensation. There was no abnormal finding by urethral pressure profile (UPP), but detrusor sphincter dyssynergia (DSD) was revealed frequently by EMG. This typical dysfunction of the HAM patients was thought to be caused by destruction of the lateral column of the spinal cord.

Adult↗
PubMed1999

Normality in urodynamics studied in healthy adults.

PURPOSE: Urodynamic data were evaluated prospectively in symptom-free adults. MATERIALS AND METHODS: A total of 28 men and 10 women with no history, symptoms or signs of urological disease and a mean age of 24 years were included in the study. Free flow, cystometry and pressure flow studies were performed using standard techniques. RESULTS: A wide variation was found in all urodynamic parameters. Different and changing flow patterns, low maximum flow rate, large bladder capacity, bladder overactivity and residual urine, which are all usually considered signs of pathological conditions, were seen. Data from free flow and pressure flow studies correlated significantly but maximum flow rate was significantly lower, and voiding time and flow time were significantly longer in pressure flow studies. CONCLUSIONS: Technical urodynamics in their actual form are not physiological but they are the best tests available. Since normality in urodynamics may include so many different features the interpretation of technical urodynamic investigations should be made with caution.

Adult↗
PubMedDate not supplied

[Urinary incontinence].

After defining U.I. as a symptom, sign and condition, the author claims, through epidemiological studies, that this reflects a major medical, social and economic problem. On the other hand the physiopathology of U.I. can be explained in a context of balance between the retention and emptying forces during the filling phase. Therefore the author explains U.I. as an urgency due to overactive bladder as well as hypermobility of the bladder neck and/or injury of the intrinsic sphincter. The diagnosis and severity of the different types of U.I. are based on clinical history, the pad test, the diurnal fictional record and the Q tip test. The abnormal continence factors are measured by the following tests: plain XR of the urinary system, urinoculture, urodynamic studies, transvaginal ultrasound. The treatment of U.I. can be explained by the physiopathology and exemplified with clinical cases in a systematic way.

Female↗
PubMed1999

Differential effects of sex hormones and phytoestrogens on peak and steady state contractions in isolated rabbit detrusor.

PURPOSE: Recent evidence suggests that sex steroids may produce rapid inhibition of voltage operated Ca2+ channels (VOCCs). Detrusor smooth muscle is highly dependent upon Ca2+ influx for receptor-activated contractions. Thus, we examined the relative effectiveness of a select group of sex steroids and dietary phytoestrogens to relax detrusor contracted with the muscarinic receptor agonist, bethanechol (BE) and the purinergic P2X receptor agonist, alpha,beta-methylene ATP (alpha,beta-MeATP). MATERIALS AND METHODS: Isolated strips of rabbit detrusor were secured to isometric force transducers in a tissue bath and length-adjusted until maximum contractions were achieved. Peak (P) contractile responses were recorded for alpha,beta-MeATP (P(ATP)) and BE (P(BE)) and steady-state (SS) responses were recorded for BE (SS(BE)) in the presence and absence of selected sex steroids and phytoestrogens (10 microM, unless indicated). RESULTS: The L-type VOCC inhibitor, nifedipine (1 to 10 microM), completely inhibited P(ATP) but reduced SS(BE) by approximately 50%, whereas the VOCC and non-VOCC inhibitor, SKF 96365, inhibited SS(BE) by approximately 95%, suggesting that P(ATP) was entirely dependent on L-type VOCCs, but (BE)-induced contractions depended also on activation of non-VOCCs. 17Beta-estradiol (estradiol) and progesterone inhibited P(ATP) by approximately 60% and 20%, respectively, and 32 microM estradiol and ethinyl estradiol inhibited SS(BE) by approximately 80 and 95%, respectively. Inhibition by estradiol was potentiated, rather than blocked, by the nuclear estrogen receptor antagonist, tamoxifen. Moreover, tamoxifen alone nearly completely relaxed SS(BE). The inactive metabolite of estradiol, 17alpha-estradiol, inhibited both P(ATP) and P(BE) by approximately 40%. Testosterone had no effect on P(ATP) and P(BE). The phytoestrogen and tyrosine kinase inhibitor, genistein, inhibited SS(BE) by 44%, whereas daidzein, a phytoestrogen without tyrosine kinase inhibitory activity, produced only a 7% inhibition. None of the phytoestrogens examined inhibited P(BE), whereas all inhibited P(ATP) by approximately 20 to 35%. A comparison of inhibition of (BE) and alpha,beta-MeATP-induced contractions by selected estrogen isomers showed some distinct differences. For example, estrone did not inhibit P(BE) or SS(BE), but inhibited P(ATP) by approximately 20%, whereas DES inhibited SS(BE) by nearly 90%, but P(ATP) by a lesser degree (approximately 70%). CONCLUSIONS: Our data support the hypothesis that 17beta-estradiol, ethinyl estradiol, DES, tamoxifen and genistein may relax detrusor contractions by inhibition of both VOCCs and non-VOCCs. Moreover, our data show that genistein, a dietary phytoestrogen with tyrosine kinase inhibitory activity, selectively reduced alpha,beta-MeATP-induced peak and BE-induced steady-state contractions, sparing the maximum response to BE. Lastly, the inactive isomer, 17alpha-estradiol, inhibited both BE- and alpha,beta-MeATP-induced contractions. These data suggest that certain dietary phytoestrogens (for example, genistein) or sex steroids, especially those with weak activity at the nuclear steroid site (for example, 17alpha-estradiol), or tamoxifen may prove therapeutically useful in treating overactive bladder caused by elevated muscarinic and purinergic receptor activation.

Animals↗
PubMed2000

Pubovaginal sling technique utilizing a unique bone anchor instrumentation system.

INTRODUCTION: In the past, the pubovaginal sling (PVS) technique was originally delegated for the treatment of intrinsic sphincter deficiency syndrome (ISD). Today, it has not only undergone a revitalization, but is being recommended for the treatment of all forms of stress urinary incontinence (SUI) as well as the ISD syndrome. In an attempt to combine the best features of the traditional approach plus add the benefits of simplicity, reduction of costs, morbidity, and rapid return to patient normality, a new variation of the PVS has been developed. The technique utilizes pre-threaded bone anchors to which either a natural fascia or pre-prepared cadaveric fascia can be anchored. MATERIAL AND METHODS: This study consists of 78 female patients treated between September 1997 and December 1998 with our PVS procedure. The patient population spans the spectrum of pure stress incontinence, with or without associated pelvic relaxation defects, pure ISD group and lastly, those individuals who suffered from both anatomical incontinence and overactive bladder syndrome. In our 72 evaluable patients, the results as of this publication are: an overall cure rate of 86% with an additional 11% improved and 3% failure. The following text describes in detail the patient population, the surgical technique, the final results, complications, and patient satisfaction scores. Also included is a short review of the literature documenting several other techniques utilizing bone anchoring fixation devices. CONCLUSION: A simplification of the true-and-tried PVS is described which provides the surgeon with a new and exciting methodology for the treatment of all forms of hypermobility, i.e. stress incontinence, as well as the intrinsic sphincter deficiency syndrome. At the same time the surgical learning curve, patient morbidity, and hospital stay are decreased; without compromising total surgical outcome.

Adult↗
PubMed2001

Use of tolterodine in children with dysfunctional voiding: an initial report.

PURPOSE: Tolterodine was recently approved for the treatment of incontinence and overactive bladder in adults, and has fewer side effects than oxybutynin. We evaluated the safety and efficacy of tolterodine in children with dysfunctional voiding. MATERIALS AND METHODS: We retrospectively reviewed our experience with 30 pediatric patients treated with tolterodine for a primary diagnosis of dysfunctional voiding. Patients were treated with adult doses of tolterodine and behavioral modifications. Standard definitions determined by the International Children's Continence Society were adapted to designate final treatment outcomes on medication as cured-greater than 90% reduction in wetting episodes, improved-greater than 50% reduction or failed-less than 50% reduction. RESULTS: The children were 4 to 17 years old (mean age 8.7) and were treated with tolterodine for an average of 5.2 months. The final dose was 1 mg. twice daily in 1, 2 mg. twice daily in 27 and 4 mg. twice daily in 2 patients. Wetting episodes were cured in 10 (33%), improved in 12 (40%), and failed to show improvement in 8 (27%) cases. Four patients (13.3%) reported side effects and only 1 discontinued the medication due to diarrhea. There were no reports of hyperpyrexia, flushing or intolerance to sunshine and outdoor temperature. CONCLUSIONS: Our results demonstrate that tolterodine at adult doses without titration can be used safely to decrease wetting episodes in children with dysfunctional voiding. Controlled clinical trials should be completed to evaluate further efficacy and safety in children.

Adolescent↗
PubMed2001

[Urinary incontinence: frequency and diagnostic and therapeutic approach in general practice in Italy].

OBJECTIVE: A large observational study was conducted to assess the frequency of urinary incontinence (UI) and overactive bladder (OAB) and to describe the diagnostic and therapeutic approach in General Medical Practice in Italy. MATERIALS AND METHODS: Subjects eligible for the study were men aged > 50 years and women aged > 40 years, observed consecutively by their own General Practitioner (GP) for a check-up or medical prescription examination during the recruitment period, who agreed to participate in the study. All the subjects included in the study were interviewed by their GP using a common questionnaire that included information about their general characteristics and a specific medical history. The subject was also asked: "Have you had involuntary loss of urine during the last 3 months?"; "Do you urinate more than 8 times a day on average and/or Do you have to get up more than once a night?"; "Have you urgency problems?". If the subject answered yes to the first question or to both the second and third, a urinary problem was diagnosed, in particular UI if the anser was yes to the first and OAB if to the second and third. In these subjects the interview was continued in order to define the type of UI, using the diagnostic flow chart proposed by Wean. RESULTS: On the whole, 9613 men (average age 64.8, range 50-98) and 13,365 women (average age 60.3 years, range 40-98) were interviewed by 774 GPs. A diagnosis of urinary problems was made in 1084 men (11.3%) and 1507 women (11.3%). Among the men the GP was already aware of the condition in 603 cases (55.6%) and a new diagnosis was made in 481 cases (44.4%). The corresponding figures for women were 560 (37.2%) and 947 (62.8%). The proportion of new diagnosis out of all the subjects with micturition problems tended to be greater in the younger age (chi square for trend p < 0.05). The presence of OAB without UI was found in 3.0% [95% Confidence Interval (CI) 1.7-3.5] of the men and 1.1% (95% CI 0.9-1.3) of the women. Over all, 8.3% (95% CI 7.7-8.9) of the men and 10.2% (95% CI 9.6-10.8) of the women reported UI. The frequency of OAB and UI conditions increased with age in both men and women. On the whole, a urine test was requested in 71.9% of the subjects with a new diagnosis of UI or OAB and the frequency of haematuria was equal to 15.7% of the cases, without marked differences by type of diagnosis of micturition problem. A urine culture was done in 60.7% of the cases and was positive in 17.7%. Further diagnostic investigations were prescribed in the majority of cases, 76.6%. This was observed in particular among the men (86.2% of the cases compared to 71.7% of the women) but with no substantial differences between the different diagnoses of UI. Pharmacological treatment was suggested to 68% of the men and 44.9% of the women. The condition for which pharmacological treatment was less often prescribed was stress UI, where it was suggested in 54.5% of the men and 27.3% of the women. For men, alpha-lytics were the drugs most often prescribed for all urinary problems, regardless of the type. For women, anticholinergics were the most commonly advised type of drug, followed by anti-infectives.

Adult↗
PubMedDate not supplied

The unspeakable illness: the work-up of female urinary incontinence.

The work-up for female urinary incontinence--i.e., diagnosis and, perhaps, initial therapy-is a rational, multi-step procedure, complicated by the reticence of patients concerning their problem (except when the chief complaint is interference with sexual relations). The chief causes of incontinence are (genuine) stress incontinence and overactive bladder (OABR, although there is a continuum between them. Diagnosis begins with a review of symptoms and thorough history-taking, followed by testing: a urination diary and in-office neurologic and gynecologic tests, preceded by a thorough physical examination including all relevant gynecologic and neurologic aspects, the latter centered around S2-4--the so-called Q-tip test. If tests are inconclusive, or if medical history is suggestive, the patient is referred to a urodynamic laboratory for multi-channel urodynamic testing and other tests requiring sophisticated urodynamic equipment. Treatment plans include pharmacologic therapy of OAB and surgery, but are often less drastic.

Attitude to Health↗
PubMedDate not supplied

Behavioral and functional abnormalities linked with recurrent urinary tract infections in girls.

BACKGROUND: Most girls with recurrent urinary tract infections do not have major urinary tract abnormalities. Recent studies focus on predisposing behavioral and functional abnormalities: infrequent voiding, inadequate fluid intake, stool retention, poor genital hygiene and voiding dysfunction. METHODS: Complete history, bladder and bowel questionnaire, physical examination, voiding-drinking diary, sonography and uroflowmetry were used to assess infrequent voiding, functional stool retention, poor fluid intake, inadequate hygiene, or voiding dysfunction in girls referred for evaluation of three or more symptomatic urinary tract infections (with a first infection at the age of more than 36 months). RESULTS: A total of 141 girls aged 3.9 to 18 years were evaluated between 1996 and 1999; 212 abnormalities were noted in 120 patients: infrequent voiding (isolated, 16; combined with other abnormalities, 47), poor fluid intake (isolated, 10; combined, 50), functional stool retention (isolated, 5; combined, 25), inadequate hygiene or toilet habits (isolated, 3; combined, 24), dysfunctional voiding (isolated, 15; combined, 10), bladder overactivity (isolated, 5; combined, 2). CONCLUSIONS: Most girls referred for evaluation of three or more urinary tract infections have host-mediated predisposing abnormalities: infrequent voiding, poor fluid intake, functional stool retention or voiding dysfunction. Poor genital hygiene and toilet habits were almost always combined with other abnormalities, suggesting that infections are not necessarily related to poor genital hygiene or toilet habits. Two or more indications of predisposing behavior often concur in the same patient.

Adolescent↗
PubMedDate not supplied

[Urinary incontinence: new pharmacologic therapies].

Several classes of drugs have been investigated for their efficacy in treating overactive bladder syndrome (OAB) and stress urinary incontinence (SUI). Surgery and behavioral therapies are currently the mainstay of treating SUI. However, results are also being made available about a new oral medication, Duloxetine, which appears to be clinically safe and effective for the treatment of SUI. On the other hand, a new muscarinic receptor antagonist, Solifenacin, has been shown in clinical trials to be clinically effective, safe and well tolerated for treating OAB.

Duloxetine Hydrochloride↗
PubMed2005

Use of a continence nurse specialist in an extended care facility.

PURPOSE: The aim of this study was to determine if the number of incontinence episodes for an elderly female population could be decreased through an individualized continence program in a Connecticut long-term care center. METHODS: Forty-two female residents who in a long-term care facility who were incontinent or had urgency related to overactive bladder were included in the incontinence program. Total numbers of incontinent episodes for each participant were recorded 1 week prior to the study. An individualized plan of care for each patient was developed by the continence specialist and the plan of care implemented for at least 1 year. FINDINGS: After the continence specialist recommended a program of treatment and the program of treatment was implemented for 1 year, the number of UTIs (31 preintervention year; 6 postintervention year) and pressure ulcers (15 preintervention year; 2 postintervention year) were substantially decreased and the number of falls cut by more than 50% (18 preintervention; 7 postintervention). CONCLUSION: A nurse continence specialist can be used to help long-term care facilities plan a program that will direct individualized nursing interventions that will improve patient outcomes related to UTI, pressure sore and fall rates, and reduce the costs of care.

Accidental Falls↗