Bladder Health Research Articles

Evaluation of a New Bladder Health Mobile Application in Pregnancy

Evaluation of a New Bladder Health Mobile Application in Pregnancy

Prevention of Lower Urinary Tract Symptoms Research Consortium Focus Group Study of Habits, Attitudes, Realities, and Experiences of Bladder Health.

The study purpose is to explore adolescent and adult women's experiences, perceptions, beliefs, knowledge and behaviors related to bladder health across the life course using a socioecological perspective. Lower urinary tract symptoms affect between 20-40% of young adult to middle-aged women, with symptoms increasing in incidence and severity with aging. There is limited evidence to address bladder health promotion and prevention of dysfunction. This first study of the Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium is designed to address gaps in existing qualitative research in this area. This focus group study will be implemented across seven geographically diverse United States research centers using a semi-structured focus group guide informed by a conceptual framework based on the socioecological model. The study was approved in July 2017. A total of 44 focus groups composed of 6-8 participants representing six different age categories (ranging from 11 to over 65 years) will be completed. We aim to recruit participants with diverse demographic and personal characteristics including race, ethnicity, education, socioeconomic status, urban/rural residence, physical/health conditions and urinary symptom experience. Up to 10 of these focus groups will be conducted in Spanish. Focus group transcripts will undergo content analysis and data interpretation to identify and classify themes and articulate emerging themes. This foundational qualitative study seeks to develop an evidence base to inform future research on bladder health promotion in adolescent and adult women. This study has the potential to provide new insights and understanding into adolescent and adult women's lived experience of bladder health, the experience of lower urinary symptoms and knowledge and beliefs across the life course. This article is protected by copyright. All rights reserved.

Urinary incontinence and cardiovascular disease: a narrative review.

Urinary incontinence (UI) has recently been associated with increased mortality. This observation deserves consideration, since UI is a frequent condition. Shared risk with cardiovascular disease and UI could offer part of the explanation. In this narrative review, we explore the association between UI and some cardiovascular risk factors: obesity, diabetes, high blood pressure, tobacco smoking, alcohol, and caffeine intake. We also review the benefit of cardiovascular risk management on bladder health. Bladder function is affected by many cardiovascular risk factors. They can be protective or detrimental. Obesity, diabetes, and, to a lesser extent, high blood pressure and cigarette smoking have been associated with UI in different settings, precede new onset UI in longitudinal studies, have a dose effect, and have a biologic mechanism linked with UI. Thus, UI could be considered a possible consequence of metabolic syndrome. Furthermore, prevention programs aimed at decreasing weight, quitting smoking, healthy diet, and increasing physical activity have resulted in a decreased incidence, prevalence, and severity of UI. Knowing the association among UI, cardiovascular risk factors, and mortality should encourage UI screening in the population as well as cardiovascular risk factor screening among patients with UI. The secondary benefit for UI could be an important motivator for increasing adherence to cardiovascular prevention programs.

Validation of Bladder Health Instrument for Evaluation in Women

Validation of Bladder Health Instrument for Evaluation in Women

Bacteriophages of the lower urinarytract.

The discovery of bacteria in the female urinary bladder has fundamentally changed current dogma regarding the urinary tract and related urinary disorders. Previous research characterized many of the bacterial components of the female urinary tract, but the viral fraction of this community is largely unknown. Viruses within the human microbiota far outnumber bacterial cells, with the most abundant viruses being those that infect bacteria (bacteriophages). Similar to observations within the microbiota of the gut and oral cavity, preliminary surveys of the urinary tract and bladder microbiota indicate a rich diversity of uncharacterized bacteriophage (phage) species. Phages are vital members of the microbiota, having critical roles in shaping bacterial metabolism and community structure. Although phages have been discovered in the urinary tract, such as phages that infect Escherichia coli, sampling them is challenging owing to low biomass, possible contamination when using non-invasive methods and the invasiveness of methods that reduce the potential for contamination. Phages could influence bladder health, but an understanding of the association between phage communities, bacterial populations and bladder health is in its infancy. However, evidence suggests that phages can defend the host against pathogenic bacteria and, therefore, modulation of the microbiome using phages has therapeutic potential for lower urinary tract symptoms. Furthermore, as natural predators of bacteria, phages have garnered renewed interest for their use as antimicrobial agents, for instance, in the treatment of urinary tract infections.

The Spectrum of Bladder Health: The Relationship Between Lower Urinary Tract Symptoms and Interference with Activities.

Background: Little research to date has focused on lower urinary tract symptom (LUTS) prevention and bladder health promotion in women. To address this gap, the Prevention of LUTS Research Consortium developed the following working bladder health definition: "A complete state of physical, mental, and social well-being related to bladder function [that] permits daily activities [and] allows optimal well-being." To begin to inform and quantify this definition, we used data from the Boston Area Community Health Survey, drawing upon its rare collection of information on LUTS and LUTS-specific interference with activities. Methods: At baseline, participants reported their frequency of 15 LUTS and interference with 7 activities. Prevalence ratios (PRs) were calculated by generalized linear models with robust variance estimation, adjusting for LUTS risk factors and individual LUTS. Results: Of the 3169 eligible participants, 17.5% reported no LUTS or interference, whereas the remaining 82.5% reported some frequency of LUTS/interference: 15.1% rarely; 21.7% a few times; 22.6% fairly often/usually; and 22.9% almost always. LUTS independently associated with interference were urgency incontinence, any incontinence, urgency, nocturia, perceived frequency, and urinating again after <2 hours (PRs = 1.2-1.5, all p < 0.05). Conclusions: Our findings suggest that bladder health exists on a continuum, with approximately one in five women considered to have optimal bladder health (no LUTS/interference), the majority to have intermediate health (LUTS/interference rarely to usually), and a further one in five to have worse or poor health (LUTS/interference almost always). These findings underscore the need for LUTS prevention and bladder health promotion.

Incontinence Care Needs in a US rural border region:: Perspectives of promotoras

Purpose: The purpose of this study was to explore the incontinence care needs of rural, primarily Hispanic, community dwelling adults living along the U.S.-Mexico border of southern New Mexico from the perspective of the community health workers, or promotoras, who serve this community.Sample: Community health workers (promotoras) attending a regional meeting were invited to participate in a focus group format to discuss their experiences with urinary incontinence; 25 promotoras provided verbal and/or written feedback.Method: A participatory action framework guided this focus group session, which followed an outreach presentation on basic concepts of urinary incontinence. Participant feedback and discussion solicited following the presentation was used to assess perceived community needs for incontinence care and bladder health promotion. Participants’ verbal feedback and written responses to open-ended questions were analyzed by methods of qualitative content analysis for themes depicting perceived needs of their community for bladder health education and behavioral strategies to alleviate incontinence.Findings: The following themes were identified: predisposing conditions, treatments tried, home remedies, psychosocial effects, and training requested. Promotoras’ comments revealed the lack of information regarding the causes and associated factors of urinary incontinence, the lack of understanding of available behavioral treatment options and how to perform behavioral strategies to promote continence. Promotoras identified the negative effects of urinary incontinence on psychosocial health and asked for strategies to help rural adults cope with this condition.Conclusion: Themes identified will guide the content development of future train-the-trainer sessions for community health workers or promotoras in urinary incontinence self-care strategies. Train-the-trainer sessions were identified through methods of participatory action to be the preferred strategy for bladder health promotion outreach to rural adults living in areas with limited access to medical services. Keywords: incontinence, rural, promotoras, Hispanic, qualitative, needs assessment, participatory action, community health worker DOI: http://dx.doi.org/10.14574/ojrnhc.v19i1.546

Terminology for bladder health research in women and girls: Prevention of Lower Urinary Tract Symptoms transdisciplinary consortium definitions.

To report research terminology and definitions for describing healthy bladder function among women and girls. The Prevention of Lower Urinary tract Symptoms (PLUS) Consortium developed research terminology and definitions for elements of healthy bladder function based on existing understanding of storage and emptying functions of the bladder and accepted definitions of lower urinary tract symptoms (LUTS). The novel concept of a bladder "bioregulatory" function was also proposed. Elements of bladder function corresponding to bladder health (BH) and LUTS were developed and refined using an iterative process. A comprehensive reference table structured by bladder function (Storage, Emptying, and Bioregulatory) and elements of each function was created to document proposed research terminology and definitions. The BH research definitions for each bladder function are: (1) Storage: the ability to hold urine for a reasonable duration of time and sense bladder fullness without fear of or concern about urgency, discomfort or leakage; (2) Emptying: the ability to empty the bladder completely in a timely, efficient, effortless, comfortable manner; and (3) Bioregulatory: the bladder barrier protects the individual/host from pathogens, chemicals, and malignancy. Research definitions for seven Storage, seven Emptying, and three Bioregulatory elements of function are presented. Novel LUTS research definitions were developed when gaps in existing definitions were identified or nonclinical language was desired. PLUS BH definitions reflect a transdisciplinary approach to standardizing research definitions for elements of bladder function from a perspective of health rather than dysfunction and provide a framework for studying BH in clinical practice, public health promotion, and LUTS prevention.

\u201cA secret club\u201d: focus groups about women\u2019s toileting behaviors

BackgroundUnderstanding reasons for and impact of women’s toileting behaviors on bladder health is important to prevent and manage urinary incontinence (UI) and overactive bladder (OAB).MethodsWomen, regardless of urinary incontinence (UI) and overactive bladder (OAB) status, were recruited in Pennsylvania and North Carolina. Focus groups were conducted by trained female moderators and sessions were audiotaped. Participants completed an anonymous questionnaire containing validated items to determine the presence of UI and OAB. Audiotapes were transcribed and content was analyzed by two investigators to identify themes.ResultsTwenty-four women participated (mean age 68 ± 13.4 years); most had UI (75%) or OAB (87.5%). Many women had difficulty in describing bladder health, and talked about bladder function, diseases or conditions, and control over the bladder. Four themes about toileting emerged: 1) cues/triggers/alerts women used to find and use toilets, 2) toilet cleanliness away from and at home, 3) toileting as a nuisance, and 4) situational awareness. Women described internal (e.g., sensation of heaviness) and external cues/triggers/alerts (e.g., walking by restrooms), and the trade-off between their concerns about public toilet cleanliness and the need to urinate. Some women expressed being irritated or annoyed about having to stop activities to urinate. Most women reported sitting on their home toilets, whereas, many hovered or stood over the toilet in public places.ConclusionsThe information gained from this study will facilitate the development of relevant public health messaging and interventions to raise public awareness about UI, OAB, and bladder health with the aim to encourage women to seek help when symptoms are present.

Culture, teams, and organizations: A qualitative exploration of female nurses' and midwives' experiences of urinary symptoms at work.

To explore nurses' and midwives' experiences of urinary symptoms at work. Lower urinary tract symptoms are common in female nurses and midwives. There is limited understanding of the relationship between urinary symptoms, bladder health practices, and work. Qualitative design providing in-depth exploration of nurses' and midwives' experiences of urinary symptoms at work through focus group discussions. Twelve focus groups were held July-September 2016 with 96 Registered Nurses and midwives working at two tertiary-referral hospitals in urban New South Wales, Australia. A semi-structured question schedule was used. An inductive process guided thematic analysis of data using a socioecological framework of health behaviours. Nurses' and midwives' experiences of urinary symptoms at work primarily relate to delaying voiding. This practice is explained by a work culture of "patient-first" care at expense of self-care, relationships in the nursing team, demands of the nursing role, and inadequacy of workplace amenities. The first two themes reflect cultural and social caring dilemmas central to nursing. The second two themes identify issues with workforce management and physical workplace environments. Nurses' and midwives' urinary symptoms and behaviours in response to sensory cues for bladder emptying are dependent on several socioecological influences. Occupational health initiatives in the workforce are required to break cultural norms that deter self-care and to promote work environments that support healthy bladder practices. Workforce management and physical workplace environments are key influences on nurses' timely and dignified access to amenities.

Lack of care? Women's experiences of maternity bladder management

Background A healthy urinary system is vital to every woman's life, and the relationship between childbirth and bladder dysfunction has been well documented in the medical literature. Aims To explore women's bladder care experiences during the antepartum, intrapartum, and postpartum periods. Methods An exploratory, descriptive research study with nine in-depth semi-structured interviews. Findings Thematic analysis showed three themes: ‘muddling through to earn “a badge of honour”’, ‘caring for a baby, but who cares for me?’ and ‘do you speak bladder language?’ with an overarching theme of ‘lack of bladder care’. Women's experiences reflected a lack of understanding, information, and promotion regarding bladder care, aggravated by the use of ambiguous language when professionals communicated with women about bladder health. Conclusions Bladder care was very limited for women during the antepartum, intrapartum and postpartum period although reports of urinary incontinence were frequent. Bladder care could therefore be characterised as ‘lack of bladder care’. Clinicians should become more proactive in delivering information and promoting bladder health during these periods but that attention needs to be paid to communication methods.

Bladder health in patients treated with BCG instillations for T1G2-G3 bladder cancer – a follow-up five years after the start of treatment

Objective: Investigate symptoms and how they affect daily life in patients with Non-Muscle Invasive Bladder Cancer (NMIBC) treated with Bacillus Calmette-Guérin (BCG) instillations.Materials and methods: Patients treated with BCG were included. After an initial transurethral resection (TURB) followed by a second-look resection, the patients were given an induction course with BCG for 6 weeks followed by maintenance therapy for 2 years. The patients answered a questionnaire before, during and after the treatment. The questionnaire contained questions about specific symptoms combined with bother questions on how each symptom affected patients’ life.Results: In total, 113 of 116 patients responded to the first questionnaire. Thirty per cent of all patients were bothered by disease-specific symptoms before the start of BCG. Few patients reported fever, haematuria, illness or urinary tract symptoms. No difference in symptoms was found between patients with or without concomitant CIS (carcinoma in situ). Patients younger than 65 years of age reported a greater worry about the symptom burden in the future than those who were older. Patients younger than 65 years reported a decreased level of mental well-being.Conclusion: Patients with bladder cancer T1G2–G3 had disease-specific symptoms present already before the start of the BCG. The burden of symptoms was reduced over time and showed that the bladder might recover. BCG instillations had side-effects that negatively affected the patient’s well-being. It is important to record the patients’ baseline bladder and voiding status before as well as during the BCG-instillation period in order to understand symptoms caused by the treatment.

Effect of Group-Administered Behavioral Treatment on Urinary Incontinence in Older Women

Urinary incontinence (UI) guidelines recommend behavioral interventions as first-line treatment using individualized approaches. A one-time, group-administered behavioral treatment (GBT) could enhance access to behavioral treatment. To compare the effectiveness, cost, and cost-effectiveness of GBT with no treatment for UI in older women. Multisite randomized clinical trial (the Group Learning Achieves Decreased Incidents of Lower Urinary Symptoms [GLADIOLUS] study), conducted from July 7, 2014, to December 31, 2016. The setting was outpatient practices at 3 academic medical centers. Community-dwelling women 55 years or older with UI were recruited by mail and screened for eligibility, including a score of 3 or higher on the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), symptoms of at least 3 months' duration, and absence of medical conditions or treatments that could affect continence status. Of 2171 mail respondents, 1125 were invited for clinical screening; 463 were eligible and randomized; 398 completed the 12-month study. The GBT group received a one-time 2-hour bladder health class, supported by written materials and an audio CD. Outcomes were measured at in-person visits (at 3 and 12 months) and by mail or telephone (at 6 and 9 months). The primary outcome was the change in the ICIQ-SF score. Secondary outcome measures assessed UI severity, quality of life, perceptions of improvement, pelvic floor muscle strength, and costs. Evaluators were masked to group assignment. Participants (232 in the GBT group and 231 in the control group) were aged 55 to 91 years (mean [SD] age, 64 [7] years), and 46.2% (214 of 463) were African American. In intent-to-treat analyses, the ICIQ-SF scores for GBT were consistently lower than control across all time points but did not achieve the projected 3-point difference. At 3 months, the difference in differences was 0.96 points (95% CI, -1.51 to -0.41 points), which was statistically significant but clinically modest. The mean (SE) treatment effects at 6, 9, and 12 months were 1.36 (0.32), 2.13 (0.33), and 1.77 (0.31), respectively. Significant group differences were found at all time points in favor of GBT on all secondary outcomes except pelvic floor muscle strength. The incremental cost to achieve a treatment success was $723 at 3 months; GBT dominated at 12 months. The GLADIOLUS study shows that a novel one-time GBT program is modestly effective and cost-effective for reducing UI frequency, severity, and bother and improving quality of life. Group-administered behavioral treatment is a promising first-line approach to enhancing access to noninvasive behavioral treatment for older women with UI. ClinicalTrials.gov identifier: NCT02001714.

The Prevention of Lower Urinary Tract Symptoms (PLUS) in girls and women: Developing a conceptual framework for a prevention research agenda

The Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium was established by the National Institutes of Health in 2015 to expand research beyond the detection and treatment of lower urinary tract symptoms (LUTS) to the promotion and preservation of bladder health and prevention of LUTS in girls and women. While many multi-disciplinary scientific networks focus on pelvic floor dysfunction and LUTS, the PLUS Consortium stands alone in its focus on prevention. This article describes the PLUS approach to developing a conceptual framework to guide the Consortium's initial prevention research agenda. The conceptual framework was informed by traditional social ecological models of public health, biopsychosocial models of health, Glass and McAtee's Society-Behavior-Biology Nexus, and the World Health Organization's conceptual framework for action on the social determinants of health. The PLUS conceptual framework provides a foundation for developing prevention interventions that have the greatest likelihood of promoting and preserving bladder health among diverse populations. PLUS Consortium work is premised on the notion that programs, practices, and policies designed to promote health will have optimal impact if the conceptual foundation upon which efforts are based is comprehensive and informed by multiple disciplines. The PLUS conceptual framework is broadly applicable to domains of health that have historically focused on the treatment of illness and symptoms rather than the promotion of health. It is also applicable to domains of health that have been examined from a predominantly biological or social ecological perspective, without integration of both perspectives.

Cancer survivorship issues with radiation and hemorrhagic cystitis in gynecological malignancies.

Given that more cancers are being diagnosed earlier and that treatment of cancer is improving, health issues of cancer survivors are becoming more common and apparent. Pelvic radiation therapy for the treatment of gynecological cancers can lead to long-term collateral damage to the bladder, a condition termed radiation cystitis (RC). Late sequelae may take many years to develop and include incontinence and pain as well as hematuria. RC is a rare but potentially life-threatening condition for which there are few management and treatment options. There are limited data in the literature regarding the effects of radiation on the bladder after gynecological cancer therapy and we hereby review the literature on cancer survivorship issues of pelvic radiation for gynecology literature. Treatment options are available for patients with radiation-induced hemorrhagic cystitis. However, most treatments are risky or only effective for a short timeframe and no therapy is currently available to reverse the disease progress. Furthermore, no standardized guidelines exist describing preferred management options. Common therapies include hyperbaric oxygen therapy, clot evacuation, fulguration, intravesical instillation of astringent agents, and surgery. Novel developing strategies include Botulinum Toxin injections and liposomal-tacrolimus instillations. These treatments and strategies are discussed. In this review, we will present current and advanced therapeutic strategies for RC to help cancer survivors deal with long-term bladder health issues.

Toileting behaviors of adult women: What is healthy?

PurposeThe objective of this study was to assess toileting behaviors in community-dwelling adult women. Materials and MethodsWomen age 18 years or older were recruited through a national registry of research volunteers, and asked to complete validated questionnaires assessing urinary symptoms and toileting behaviors, specifically place preference for voiding, convenience voiding, delayed voiding, straining during voiding, and position preference for voiding. The patient perception of bladder condition (PPBC) assessed the participant’s impression of their bladder health. Analyses determined the prevalence of each toileting behavior (reported to occur “sometimes” or more often), and differences in toileting behaviors between women with and without self-perceived bladder problems based on their PPBC response. ResultsThe 6695 women completing the questionnaires ranged in age from 18-89 (mean 41.4 ±15 years), with 79.9% identifying as white and 71.0% college-educated. Almost all women (98.8%, n=6613) reported place preference for voiding. Women reporting a bladder problem (n=3552, 53.1%) were more likely to report convenience voiding, delayed voiding, and strained voiding behaviors. While 99.4% (n=6657) of women reported sitting to void at home, only 76.2% (n=5108) of women reported sitting when using public toilets. ConclusionsCertain toileting behaviors, some of which may be considered unhealthy, were common in this sample of adult women, and most were associated with a perception of bladder problems. Voiding positions other than sitting were frequently used when away from home. These data have important implications for defining bladder health and for implementing behavior-based interventions for women with lower urinary tract symptoms.

Effects of an education program on toileting behaviors and bladder symptoms in overactive bladder patients with type 2 diabetes: A randomized clinical trial

BackgroundOveractive bladder is more common in patients with type 2 diabetes than in those without diabetes. Many patients with diabetes adopt unhealthy toileting behaviors to empty their bladder that may contribute to the onset or worsening of overactive bladder. ObjectiveTo investigate whether an education program targeting toileting behaviors is effective for helping overactive bladder patients with type 2 diabetes in terms of adopting healthy toileting behaviors, improving bladder symptoms, and enhancing quality of life. DesignThe study was a parallel, pragmatic, open-label randomized trial. SettingsThe trial was conducted in a hospital-based endocrinology outpatient department in Jinan, China. ParticipantsA total of 104 patients were randomly assigned to a 6-week education program or a control group. MethodsPrimary outcomes included toileting behaviors and bladder symptoms, including dry/wet overactive bladder and severity of urgency. Secondary outcomes were overactive bladder-specific and general quality of life. The patients were reassessed on the outcome variables at the end of the intervention and at 3 months and 6 months following the intervention. The analysis followed the intent-to-treat principle. To account for the longitudinal data with repeated measures, group comparisons for continuous outcomes were evaluated using linear mixed models. Group differences in binary outcomes were examined using mixed-effects logit models. ResultsCompared with the control group, the education program group showed significant changes in three unhealthy toileting behaviors: premature voiding (−0.7, p < 0.001), place preference for voiding (−0.5, p = 0.007), and delayed voiding (−0.2, p = 0.011). The program significantly relieved the bladder symptoms (−2.2, p < 0.001) and decreased the probability of having wet overactive bladder (−0.3, p < 0.001) and the severity of urgency (−0.4, p < 0.001). It also significantly improved the overactive bladder-specific quality of life by 10.8 points (p = 0.001). Regarding patients’ general quality of life, the physical aspect was enhanced by 3.0 points (p = 0.049); however, no effect on the mental well-being aspect was observed. ConclusionsAmong overactive bladder patients with type 2 diabetes, the 6-week education program targeting toileting behaviors resulted in the adoption of healthy toileting behaviors, relief of bladder symptoms and improvement in quality of life in the 6 months following the intervention compared with routine care alone. The education program was highly successful and may represent an effective, acceptable, feasible, and safe intervention for improving bladder health and quality of life during diabetes care, given that the toileting behavioral changes were maintained during the 6-month follow-up period.

Age and gender stratified normative values for the International Prostate Symptom Score for adults aged 60 years and over.

To identify age and gender stratified normative values for the International Prostate Symptom Score (IPSS) for older community-living adults. Secondary analysis of data from a large cohort study produced norms presented as means, standard deviations, medians, ranges, and percentile scores. Non-parametric analyses were conducted to investigate the effect that demographic variables, smoking status and comorbidity had on the severity of Lower Urinary Tract Symptoms (LUTS) as measured by the IPSS. Data from a total of 1103 survey respondents of community-living men and women aged between 60 and 99 years in the UK were analyzed. Normal ranges for the IPSS (as indicated by the median and 25th to 75th percentiles) were within the mild and low moderate LUTS categories of the IPSS, irrespective of age or gender. Age, gender, co-habitant status, and comorbidity had an effect on LUTS severity with comorbidity being the best predictor of IPSS scores. This study has provided IPSS normative values for an older UK adult population aged 60-99 years. These normative values can be used by researchers and practitioners for peer comparison making the individual's IPSS score more meaningful. Presenting the normative values suggests that some mild symptoms may be described as "normal." It may also help to combat the perception that poor bladder health is an inevitable part of aging, as all norms in the current study fell into either mild or low moderate symptom categories.

Optimal Bladder Management Following Spinal Cord Injury: Evidence, Practice and a Cooperative Approach Driving Future Directions in Australia

We examined spinal cord injury (SCI) catheterization practices in Australia to understand practice patterns and consistency with research evidence. A national facilitated discussion forum was held during the annual Australian and New Zealand Spinal Cord Society conference attended by 66 conference delegates. Initially, presentations were given on the latest laboratory research examining bladder changes following SCI; an overview of evidence-based recommendations indicating that intermittent catheterization is best practice; and results of a single-center practice audit that demonstrated substantial delay in transition between acute SCI and intermittent catheterization. The ensuing discussion covered current catheterization practices in both inpatient SCI units and the community and highlighted gaps between evidence and practice, with considerable variation in practice between centers and settings. Reported challenges to implementing best practice included social, economic, and resource factors. A disconnect between hospital and community practice was also identified as an important barrier to long-term uptake of intermittent catheterization following acute SCI. The discussion identified 3 proposed activities: (1) explore current practice and bladder health following SCI in greater depth across SCI units and in local communities through audits and standardized biochemical analysis; (2) determine the behavioral drivers of current practice; and (3) develop a knowledge translation strategy to better align practice with current clinical practice guidelines.

A Novel Research Definition of Bladder Health in Women and Girls: Implications for Research and Public Health Promotion.

Bladder health in women and girls is poorly understood, in part, due to absence of a definition for clinical or research purposes. This article describes the process used by a National Institutes of Health funded transdisciplinary research team (The Prevention of Lower Urinary Tract Symptoms [PLUS] Consortium) to develop a definition of bladder health. The PLUS Consortium identified currently accepted lower urinary tract symptoms (LUTS) and outlined elements of storage and emptying functions of the bladder. Consistent with the World Health Organization's definition of health, PLUS concluded that absence of LUTS was insufficient and emphasizes the bladder's ability to adapt to short-term physical, psychosocial, and environmental challenges for the final definition. Definitions for subjective experiences and objective measures of bladder dysfunction and health were drafted. An additional bioregulatory function to protect against infection, neoplasia, chemical, or biologic threats was proposed. PLUS proposes that bladder health be defined as: "A complete state of physical, mental, and social well-being related to bladder function and not merely the absence of LUTS. Healthy bladder function permits daily activities, adapts to short-term physical or environmental stressors, and allows optimal well-being (e.g., travel, exercise, social, occupational, or other activities)." Definitions for each element of bladder function are reported with suggested subjective and objective measures. PLUS used a comprehensive transdisciplinary process to develop a bladder health definition. This will inform instrument development for evaluation of bladder health promotion and prevention of LUTS in research and public health initiatives.