Absence Of Urinary Incontinence Research Articles

Diagnosis and Management of Vesicouterine Fistula (Youssef’s Syndrome): A Case Report

Background. Vesicouterine fistula (VUF) is a rare pathological communication between the uterus or cervix and the bladder. Youssef's syndrome is an atypical presentation of a patient with a vesicouterine fistula, characterized by a triad of cyclic hematuria, amenorrhea, and absence of urinary incontinence. Because of this atypical presentation, the patient may go undiagnosed and patient management will be delayed.
 Case presentation. A 39-year-old woman complained of hematuria. The patient underwent a second caesarean section in 2008 and a few weeks after the procedure the patient complained of leakage of urine from her vagina. Six months later the patient complained hematuria on her menstrual cycle and amenorrhea, with absence of urinary incontinence. Ultrasound examination found adhesions between the uterus and vagina, and irregular bladder mucosa. Patient underwent cystoscopy with endometriosis were suspected on vesicovaginal repair scars and a bladder biopsy was also performed with the results of no endometrial stroma and glands then followed by hysteroscopy. Hysteroscopy result showed a 20 mm diameter hole with irregular margins. Subsequently, the patient was treated with hysterorrhaphy laparotomy and fistula repair.
 Conclusion. One type of vesicouterine fistula is Youssef's syndrome, which is a complication following a lower segment caesarean section with undiagnosed bladder injury. The diagnosis can be confirmed by cystoscopy, intravenous pyelography, hysterosalpingogram, sonography, and other types of imaging tests. Management of patients with VUF can be conservative, medical, or surgical.

Comparison of Retzius-sparing versus standard robot-assisted radical prostatectomy for prostate cancer

Introduction and objectivesWe aim to compare the first year oncological and functional outcomes of Retzius-sparing robot-assisted radical prostatectomy (Rs-RARP) and standard robot-assisted radical prostatectomy (RARP). Materials and methodsEighty-eight patients who underwent robotic radical prostatectomy between 2018–2019 were included. We compared the minimum one-year follow-up results of patients who underwent Rs-RARP or RARP in terms of oncological and functional outcomes. Potency was assessed with the Sexual Health Inventory for Men (SHIM) score and was defined as an erection sufficient for penetration. Continence was defined as the absence of urinary incontinence with no safety pad. Patients were evaluated in the first month of follow-up and subsequently, every three months. ResultsForty-six patients in Rs-RARP and 42 patients in the RARP group were enrolled. Catheter removal time was shorter in the Rs-RARP group (12 vs. 14 days, p = 0.001). At the 1st month visit, 41 patients (%89) were continent (no pads) in the Rs-RARP group while 25 patients (%59) were continent in the RARP group (p = 0.001). Patients who underwent Rs-RARP achieved faster recovery of urinary continence (Log-rank, p = 0.001). After one year of follow-up, 43 patients (93%) in Rs-RARP group and 38 patients (90%) in RARP group were continent (p = 0.6). Potency rates were 38.7% in Rs-RARP and 34.4% in RARP group (p = 0.28). There were no cases of biochemical recurrence in any group. ConclusionsRs-RARP is a feasible technique, providing early return of continence. However, overall continence rates were similar at the end of the one-year follow-up.

Comparación entre la prostatectomía con preservación del espacio de Retzius y la prostatectomía radical estándar asistida por robot para el cáncer de próstata

Introduction and objectivesWe aim to compare the first year oncological and functional outcomes of Retzius-sparing robot-assisted radical prostatectomy (Rs-RARP) and standard robot-assisted radical prostatectomy (RARP). Materials and methodsEighty-eight patients who underwent robotic radical prostatectomy between 2018-2019 were included. We compared the minimum one-year follow-up results of patients who underwent Rs-RARP or RARP in terms of oncological and functional outcomes. Potency was assessed with the Sexual Health Inventory for Men (SHIM) score and was defined as an erection sufficient for penetration. Continence was defined as the absence of urinary incontinence with no safety pad. Patients were evaluated in the first month of follow-up and subsequently, every three months. ResultsForty-six patients in Rs-RARP and 42 patients in the RARP group were enrolled. Catheter removal time was shorter in the Rs-RARP group (12 vs. 14 days, P=.001). At the 1st month visit, 41 patients (%89) were continent (no pads) in the Rs-RARP group while 25 patients (%59) were continent in the RARP group (P=.001). Patients who underwent Rs-RARP achieved faster recovery of urinary continence (Log-rank, P=.001). After one year of follow-up, 43 patients (93%) in Rs-RARP group and 38 patients (90%) in RARP group were continent (P=.6). Potency rates were 38.7% in Rs-RARP and 34.4% in RARP group (P=.28). There were no cases of biochemical recurrence in any group. ConclusionsRs-RARP is a feasible technique, providing early return of continence. However, overall continence rates were similar at the end of the one-year follow-up.

Correlación del grosor de la pared vesical con síndrome de vejiga hiperactiva y hallazgos urodinámicos

Abstract Objective: To correlate the bladder wall thickness by transabdominal ultrasound in patients with overactive bladder syndrome and urodynamic findings. Materials and methods: A prospective, analytical and descriptive study was done that included 30 patients with overactive bladder syndrome diagnosis, who underwent to urodynamic study and measurement of the bladder wall thickness by transabdominal ultrasound, from the Urogynecological Unit of the Hospital Civil Fray Antonio Alcalde from January to December 2018. Descriptive statistics was done. For the quantitative variables, mean comparison tests were performed, using Student's t test. Logistic models were used to predict symptoms and ROC curves with Youden's J to determine a cut-off point for the measurement of bladder thickness in relation to symptoms. As well as correlation of variables using Pearson's test. Results: Thirty patients with overactive bladder syndrome and urodynamic diagnosis of overactive detrusor were obtained. We made two subgroups, classifying according to the presence or absence of urinary incontinence. The mean age was 58.68 ± 13.61. Compliance was found to be higher, although not significantly, in patients without incontinence. There are trends towards a higher residual volume and bladder pressure among patients with incontinence, at the same time that a moderate negative correlation is observed between incontinence and bladder thickness (R2 = -.444, p <0.05). From this, it was determined by means of the coordinates, the Youden J was obtained, which establishes the cut-off point for the increase of presenting incontinence above 2.95 mm (AUROC 0.696, SENS 53.6%, ESP 88.9%) of bladder thickness and When making the comparisons of urodynamic data, it was found that patients with more than 2.96 mm have a lower compliance (AUROC 0.760, SENS 73.3%, ESP 80%). Conclusions: The measurement of the bladder wall thickness by transabdominal ultrasound can be a useful tool for the comprehensive evaluation of patients with overactive bladder syndrome, to predict the probability of the disease as well as the prognosis for response to treatment.

The prevalence and risk factors of urinary incontinence among women with type 2 diabetes in the north West Bank: a cross-sectional study

BackgroundDiabetes is one of the most common chronic illnesses worldwide, and it is increasing in prevalence. Urinary incontinence is another worldwide health problem, with a reported prevalence that ranges from 9% to 67%. It decreases quality of life for men and women and has been associated with many poor outcomes, such as longer hospital stays, recurrent or persistent urinary tract infection, and a higher mortality rate. Previous studies have suggested that diabetes is an independent risk factor for urinary incontinence. In addition, the patients’ background and clinical characteristics such as age, obesity, and child-bearing history have been found to increase the risk. The aim of this study was to determine the prevalence of urinary incontinence in women with type 2 diabetes in the north West Bank and to assess the role of potential risk factors, including age, marital status, weight, and diabetes control. MethodsWomen with diabetes attending the six governmental primary health care centres in the north West Bank (Jenin, Tubas, Tulkarem, Nablus, Qalqilya, and Salfit) were interviewed using the CDC National Health and Nutrition Examination Survey (NHANES) standardised incontinence questionnaire. SPSS version 22 was used for data entry and analysis. The prevalence of urinary incontinence was estimated and differences between groups (variables of interest) were evaluated using the chi squared test. The study was approved by the Institutional Review Board of An-Najah National University, and permission to conduct the study was obtained from the Ministry of Health. Findings400 Palestinian women with diabetes were invited to participate in the study by convenience sampling, of whom 381 were recruited (a sample size that was chosen with a sample size formula, based on the population of the north West Bank). The participants were aged 30–83 years, and 44% (165 of 381; 95% CI 39–49) reported incontinence, regardless of the type. The prevalence of stress and urge incontinence were 34% (128) and 35% (133), respectively. 30% of women with urinary incontinence (49 of 165) reported that it did not affect their quality of life, and 34% (56 of 165) stated that it did not affect their daily activity. The presence or absence of urinary incontinence was studied in relation to the background and clinical variables by use of the chi squared test. The analysis showed a significant relationship between urinary incontinence status and age (p=0·0011), previous abdominal and genitourinary surgeries (p=0·0037), and caffeine consumption (p=0·041). There was no relationship between urinary incontinence and the duration, type of treatment, or complications of diabetes. InterpretationThe prevalence of urinary incontinence (regardless of the type) is high among Palestinian women with diabetes. This is similar to reported prevalence in women with diabetes in neighbouring countries, such as Jordan (44%) and Qatar (21%). The majority of participants in this study (70%) reported that urinary incontinence did not affect their quality of life. This may suggest that patients consider the problem to be ordinary, that it does not require medical advice, or that the symptoms are mild. The findings highlight the importance of educating women with diabetes about urinary incontinence. The primary health care medical teams, general practitioners, and nurses who care for patients with diabetes should focus on this neglected problem, and physicians should be alert to urinary incontinence as it may often go unreported and therefore undertreated. To understand whether non-reporting of urinary incontinence reflects mild symptoms, investigating a potential association between non-reporting and the severity or frequency of urinary incontinence may be of interest for future study. FundingNone.

Prevalence of Urinary Incontinence in Women

Objective: The objectives of the study were to find out the prevalence of urinary incontinencein women.&#x0D; Materials and Methods: A cross sectional study was conducted on five hundred one (501)women older than 18 years of age who were admitted in department of obstetrics andgynaecology of Shaheed Suhrawardi Medical College and Hospital from April to December2009, answered a questionnaire about urinary incontinence. They were grouped accordingto presence or absence of urinary incontinence (incontinent and continent) and type ofincontinence present (urge, stress and mixed).&#x0D; Results: Urinary incontinence was found in 104(20.8%) women, out of which 25 (24%)suffered from stress incontinence only, 21 (20.2%) suffered from urge incontinence and58(55.8%) suffered mixed incontinence.&#x0D; Conclusions: One in five women older than 18 years of age suffer from one or other formof urinary Incontinence.&#x0D; Bangladesh J Obstet Gynaecol, 2018; Vol. 33(1) : 59-62

EXTRAPERITONEOSCOPIC PROSTATEСTOMY: SURGICAL TECHNIQUES PRESERVING THE QUALITY OF LIFE OF THE PATIENT

Objective.Radical prostatectomy (RPE) performed without preserving the neurovascular bundles and the pubovesical complex has a great risk of developing urinary incontinence and erectile dysfunction, which significantly impairs the quality of life of patients with prostate cancer in the postoperative period. Methods. The effectiveness of surgical treatment was assessed in 22 patients (mean age 57.6 ± 6.4 years) with a diagnosis of prostate cancer, who underwent extraperitoneoscopic intrafascial nerve-saving radical prostatectomy with preservation of the pubovesical complex. The criteria for the effectiveness of this technique of surgical treatment were considered the preservation of erectile function and the absence of urinary incontinence in the early and late postoperative period. Results. In the postoperative period, all patients were continent; in 3-4 months, erectile function was restored without additional stimulation by phosphodiesterase-5 inhibitors. Conclusions.The described technique demands detailed understanding by the surgeon of the surgical anatomy of the prostate and the basic surgical principles of nerve preservation in order to significantly improve the quality of life of patients in the postoperative period.

Traitement focal par HIFU versus prostatectomie radicale robot-assistée pour cancer de la prostate localisé : résultats carcinologiques et fonctionnels à 1 an

To analyse the functional and oncologic outcomes at one year of focal therapy with HIFU compared with total prostatectomy in patients with localised prostate cancer (PCa). Retrospective and monocentric study from 2008 to 2014 comparing 2 cohorts of patients with localised PCa (T1/T2 clinical stage, Gleason score≤3+4=7 and PSA<15ng/mL), one treated by focal therapy (HIFU-F group), one by robot-assisted total prostatectomy (RATP group). Primary outcome was a trifecta defined as: absence of urinary incontinence, erectile function with sexual relations without treatment, negative PSA with negative surgical margins (RATP group) or negative biopsy cores (HIFU-F group). The 53 patients included in the "HIFU-F" group and the 66 patients in the "RATP" group were similar in terms of preoperative PSA, D'Amico risk group, erectile function but were different in terms of age, prostatic volume, length of cancer, Gleason score. Complication rate was not different. In multivariate analyse with propensity score, "HIFU-F" group achieved a better trifecta score than "RATP" group (OR=8,3, p=0,005). In case of low or intermediate risk localised PCa, "HIFU-F" group had better functional outcomes than initial learning curse "RATP" group, at one year. A long-term evaluation by a common endpoint is necessary to judge the oncological equivalence of both techniques. 3.

Mental Health, Sleep and Physical Function in Treatment Seeking Women with Urinary Incontinence

We examined how mental health measures, sleep and physical function are associated with the presence and type of urinary incontinence and severity in women seeking treatment for lower urinary tract symptoms. This baseline cross-sectional analysis was performed in treatment seeking women with lower urinary tract symptoms. All participants completed the LUTS (Lower Urinary Tract Symptoms) Tool (Pfizer, New York, New York), which was used to classify women based on urinary incontinence symptoms and measure severity. The PROMIS (Patient-Reported Outcomes Measurement Information System) questionnaire for depression, anxiety, sleep disturbance and physical function, the PSS (Perceived Stress Scale) and the IPAQ-SF (International Physical Activity Questionnaire Short Form) were administered. Multivariable regression modeling was done to assess associations with urinary symptom presence, type and severity. We studied 510 women with a mean ± SD age of 56 ± 14 years. Of the women 82% were Caucasian, 47% were obese and 14% reported diabetes. Urinary incontinence was reported by 420 women (82.4%), including stress urinary incontinence in 70, urgency urinary incontinence in 85, mixed urinary incontinence in 240 and other urinary incontinence in 25. On adjusted analyses there was no difference in any mental health, sleep or physical function measure based on the presence vs the absence of urinary incontinence. Among women with urinary incontinence PROMIS anxiety and sleep disturbance scores were higher in those with mixed urinary incontinence than stress urinary incontinence. Increasing urinary incontinence severity was associated with higher PROMIS depression and anxiety scores, and higher PSS scores. However, higher urinary incontinence severity was not associated with a difference in sleep or physical function. Among treatment seeking women with lower urinary tract symptoms, increasing urinary incontinence severity rather than the presence or type of urinary incontinence was associated with increased depression, anxiety and stress.

Quality of Life Assessment With Orthotopic Ileal Neobladder Reconstruction After Radical Cystectomy: Results From a Prospective Italian Multicenter Observational Study

To assess health-related quality of life (HRQoL) parameters in patients who received radical cystectomy (RC) with ileal orthotopic neobladder (IONB) reconstruction and to identify clinic-pathologic predictors of HRQoL. From January 2010 to December 2013, a multicenter, retrospective on 174 RC-IONB patients was carried out. All patients completed the following questionnaires: the European Organization for Research and Treatment of Cancer (EORTC) generic (QLQ-C30) and bladder cancer-specific instruments (QLQ-BLM30) and the IONB-Patient Reported Outcome (IONB-PRO). Univariate and multivariate analyses were computed to identify clinic-pathologic predictors of HRQoL. Median age was 66 years (range, 31-83), and 91.4% of patients were men. Median follow-up period was 37 months (range, 3-247). The EORTC QLQ-C30 revealed that age >65 years, absence of urinary incontinence, and absence of peripheral vascular disease were independent predictors of deteriorated body image. A follow-up > 36 months and the presence of urinary incontinence were independent predictors of worsened urinary symptoms, whereas the absence of urinary incontinence was an independent predictor of a worsened body image according to EORTC QLQ-BLM30 results. A follow-up >36 months and the absence of urinary incontinence were independent predictors of better functioning in terms of relational life, emotional life, and fatigue as revealed by the IONB-PRO. Age, presence of urinary incontinence, length of follow-up, and comorbidity status may influence postoperative HRQoL and should all be taken into account when counseling RC-IONB patients.

Transvaginal prolapse repair with or without the addition of a midurethral sling in women with genital prolapse and stress urinary incontinence: a randomised trial.

To compare transvaginal prolapse repair combined with midurethral sling (MUS) versus prolapse repair only. Multi-centre randomised trial. Fourteen teaching hospitals in the Netherlands. Women with symptomatic stage two or greater pelvic organ prolapse (POP), and subjective or objective stress urinary incontinence (SUI) without prolapse reduction. Women were randomly assigned to undergo vaginal prolapse repair with or without MUS. Analysis was according to intention to treat. The primary outcome at 12 months' follow-up was the absence of urinary incontinence (UI) assessed with the Urogenital Distress Inventory and treatment for SUI or overactive bladder. Secondary outcomes included complications. One hundred and thirty-four women were analysed at 12 months' follow-up (63 in MUS and 71 in control group). More women in the MUS group reported the absence of UI and SUI; respectively 62% versus 30% UI (relative risk [RR] 2.09; 95% confidence interval [CI] 1.39-3.15) and 78% versus 39% SUI (RR 1.97; 95% CI 1.44-2.71). Fewer women underwent treatment for postoperative SUI in the MUS group (10% versus 37%; RR 0.26; 95% CI 0.11-0.59). In the control group, 12 women (17%) underwent MUS after prolapse surgery versus none in the MUS group. Severe complications were more common in the MUS group, but the difference was not statistically significant (16% versus 6%; RR 2.82; 95% CI 0.93-8.54). Women with prolapse and co-existing SUI are less likely to have SUI after transvaginal prolapse repair with MUS compared with prolapse repair only. However, only 17% of the women undergoing POP surgery needed additional MUS. A well-informed decision balancing risks and benefits of both strategies should be tailored to individual women.

Effect of Age, Educational Status, Parity and BMI on Development of Urinary Incontinence - a Cross Sectional Study in Saudi Population.

Background:The research article looks at the background of women with urinary incontinence and exposed to different demographic factors. Women who had urinary incontinence and women without urinary incontinence were compared with regards to their demographic features and risk of development of urinary problems. These risk factors can either cause short term or temporary urinary incontinence or they can cause long term or permanent urinary incontinence. This article explores the association of age, educational status, body mass index (BMI) and parity on the development of urinary incontinence.Aim of Study:This study aimed at conducting an analysis into the risk factors that are related to urinary incontinence.Results and Analysis:Z-tests were conducted for every demographic factor and the results are then discussed comprehensively citing various studies that have been conducted before. Analysis shows that age and BMI increase chances of urinary infection and consequently urinary incontinence. Women of lower educational levels record more cases of urinary incontinence due to lack of general information about the condition. Women with higher parity levels also record more cases of urinary infections and subsequently urinary incontinence.Conclusion:From the analysis above, it can be seen that these factors usually play great roles in the existence and absence of urinary incontinence especially in women in Saudi Arabia. Most important is that, its prevention is mostly by use of the risk factors mentioned here in the research. This will usually involve observing a given risk factor to a state that makes it unfavorable for urinary incontinence to occur.

Is urinary incontinence the hidden secret complications after total hip arthroplasty?

We hypothesized that posterior approach (PA) dissecting the short external rotators and anterior approach (AA) not dissecting these have different influences on the pelvic floor muscles and subsequently affect urinary incontinence. The objective of this study was to investigate whether AA advantageously influences symptoms of urinary incontinence. The subjects were 76 female patients who underwent their primary total hip arthroplasty. The presence or absence of urinary incontinence before and after surgery was surveyed by a direct interview at the time of outpatient examination within a period from 1.5 year after surgery using the international consultation on incontinence questionnaire-short form. Urinary incontinence improved after surgery in eight patients (22.2%), slightly improved in one (2.8%), remained unchanged in 26 (72.2%), slightly aggravated in one (2.8%) in the AA group. In the PA group, urinary incontinence improved after surgery in one (2.5%), remained unchanged in 30 (75%), slightly aggravated in four (10%), and aggravated in five (12.5%). Symptoms of urinary incontinence were significantly improved in the AA group and aggravated in the PA group (Mann-Whitney U test, P = 0.0057). As the anatomical characteristic of the short external rotators, the root of the internal obturator muscle is connected to the levator ani muscle. Among the pelvic floor muscles, this levator ani muscle is closely involved in supporting the pelvic organs. Since the short external rotators may have been atrophied due to hip joint dysfunction before surgery, if the strength of this muscle group recovers, support of the pelvic organs and urinary incontinence may be improved. It was assumed that surgery through AA improved external rotation contracture of the hip joint and leg length, which increased tension of the internal obturator muscle, with which tension of the pelvic floor muscle also increased and improved urinary incontinence.

A Case of Vesicouterine Fistula: Unwanted Medical Anomaly but Consequentiality of Most-Wanted Medical Intervention ‘Caesarean Section’

Vesicouterine fistula is a rare entity, with unique presentation of cyclical haematuria, amenorrhoea, absence of urinary incontinence (Youssef syndrome). A 35 year old female patient, P2L2 with 2 previous LSCS presented with cyclical haematuria, amenorrhoea, repeated UTI, dating from 11th day of last LSCS. Transabdominal sonography revealed communication between bladder & uterus, confirmed by cystoscopy. At laparotomy fistulous tract delineated and bladder separated from uterus. Hysterectomy and closure of bladder done. Continuous bladder drainage with suprapubic and perurethral foleys catheters maintained. Postoperative period was uneventful. Cystoscopy during followup revealed healthy scar. Vesicouterine fistula is an avoidable complication of LSCS which can be prevented by sound surgical technique.

Evaluation of the prevalence of urinary incontinence in spayed female dogs: 566 cases (2003–2008)

To determine the prevalence of urinary incontinence in spayed female dogs and categorize affected dogs by age at time of ovariohysterectomy, number of litters prior to ovariohysterectomy, body weight, treatment of affected dogs, and severity of incontinence and to determine associations among these variables. Retrospective case series. 566 ovariohysterectomized dogs. An attempt was made to contact owners of 912 dogs ovariohysterectomized between January 2003 and January 2008 to discuss presence or absence of urinary incontinence. The actual number of responders was 566. Those owners with incontinent pets received a questionnaire further assessing degree of incontinence, diagnostic testing, treatment, and history. The prevalence of acquired urinary incontinence was determined to be 5.12% (29/566 dogs) on the basis of results of phone surveys and questionnaires. There was no significant difference in the age at time of ovariohysterectomy between incontinent and continent groups. A significant association was found between body weight and incontinence, with incontinence rates higher among larger (≥ 15 kg [33.1 lb]) dogs. Larger dogs were approximately 7 times as likely (OR, 7.2 [95% confidence interval, 2.5 to 21.1]) to develop acquired urinary incontinence, compared with small dogs (< 15 kg). Although acquired urinary incontinence in female dogs is known to be associated with ovariohysterectomy, the prevalence in this study was low.

Incontinence Pad Usage in Medical Welfare Facilities in Korea

PurposeThe prevalence of urinary incontinence and the usage of incontinence pads by elderly residents in Korean medical welfare facilities were investigated.MethodsFrom a total of 1,832 facilities, 33 medical welfare facilities in the capital area were randomly selected; all nursing homes were excluded. All data were collected by questionnaires to investigate the residents' age and sex, the presence or absence of urinary incontinence, incontinence pad usage per month, and management methods for urinary incontinence. Surveys were also conducted from January 2010 to August 2010.ResultsA total number of residents in medical welfare facilities were 2,783, and all of them were selected for this study. Approximately, 65.3% of residents (1,816 individuals) had incontinence. The mean usage was 75 incontinence pads per month. Only 15.6% of residents received proper management for urinary incontinence, while the remaining 84.4% of residents did not have any experience in evaluating or managing their urinary symptoms.ConclusionsThe prevalence of urinary incontinence in medical welfare facilities in Korea was about 65.3%. However, the management of urinary incontinence was insufficient. Urologists should make further efforts for the proper management of urinary incontinence in elders in these facilities.

Síndrome de Youssef y fístulas vesicouterinas

Youssef's syndrome is a rare complication commonly secondary to lower segment caesarean section. It consists of a vesicouterine fistula situated above the isthmus of the uterus. Its symptomatology is analysed, which includes the classical triad of caesarean section, amenorrhoea and cyclic haematuria or menurias in the absence of urinary incontinence, together with its diagnosis and treatment, usually surgical, with excision of its fistulous tract and interposition of an omental pedicle.

Prevalence of Urinary Incontinence in Women With Osteoporosis

ObjectiveTo investigate the prevalence and frequency of urinary incontinence in women presenting to a specialist osteoporosis clinic. MethodsParticipants included 412 female patients aged 22 to 94 years (mean 62 years) presenting to a hospital-based specialist multidisciplinary osteoporosis clinic over one year. The presence or absence of urinary incontinence, urgency without leakage, type of symptoms (stress, urge, mixed) and frequency of urinary incontinence were recorded. ResultsSixty-seven percent of patients (277/412) reported some symptoms of urinary incontinence, 23% reported no symptoms and 10% reported urgency without any leakage. Of those who reported some urinary incontinence, 51% reported symptoms of stress incontinence, urgency, and urge incontinence. Almost 40% of all patients (163/412) and 59% of those with any urinary incontinence (163/277) reported leakage at least once per week. ConclusionThe prevalence of at least weekly urinary incontinence in this population is much higher than that reported in studies of other older adult female populations. There is also a high prevalence of incontinence accompanied by urgency in women with osteoporosis. Based on these results and because urinary incontinence can limit a woman’s ability to be physically active and increase the risk of falls and fractures, screening for incontinence should be a routine part of osteoporosis management. Clinicians seeing patients for osteoporosis should consider the presence of incontinence when prescribing exercise for bone health and fall prevention.

Les fistules vésico-utérines : une expérience de 17 ans

To discuss the diagnostic and the prognostic problems of vesicouterine fistulas (VUF) emphasizing on the therapeutic characteristics that lead to successful treatment. The authors retrieve retrospective series of 16 cases, collected between 1989 and June 2006, and they analyze the clinical, diagnostic and therapeutic aspects. The patients were young (29-40 years) with an average having three children. Cesarean was the most frequent etiology. The presentation symptoms were hematuria (in five cases), a urinary incontinence through the vagina (in eight cases) and both of them (in three cases). The diagnosis was suspected from the history and confirmed by the additional analyses. The treatment was surgical (excision of the fistulas) in 15 cases with an average follow-up of 2.5 years, the results on the functional aspect were satisfactory hence they were marked by the absence of urinary incontinence as well as the hematuria. On the obstetric aspect, the occurrence of pregnancy was noted in a patient at four years post-VUF repair. Vesicouterine fistulas are not very frequent and most often secondary to a cesarean or to consequences of difficult delivery. The treatment is essentially preventive by improving the obstetrical techniques through avoiding the bladder injuries during the cesareans.

Single-Case Evaluation of a Negative Reinforcement Toilet Training Intervention

ABSTRACT A negative reinforcement intervention was used to toilet train a child with multiple disabilities. The child appeared to actively withhold urinating in the toilet and was unresponsive to two positive reinforcement training programs. Negative reinforcement required that the child remain in the bathroom during toileting opportunities until he urinated properly. In-toilet urinating was achieved on the first day of intervention and the duration of training sessions decreased steadily. Appropriate toileting and an absence of urinary incontinence were documented post-intervention.