Frequency Incontinence Research Articles

Long term use of hydraulic artificial urethral sphincters in nine dogs from New Zealand with urethral sphincter mechanism incompetence

AIMS: To report on the long-term outcomes of hydraulic artificial urethral sphincter (HAUS) placement for the correction of urethral sphincter mechanism incompetence (USMI) in New Zealand dogs.METHODS: Retrospective data were obtained from cases of dogs which had a HAUS placed after failed medical and/or surgical management of USMI between August 2012 and November 2016. Owner assessment of urinary incontinence was evaluated by an online survey in May 2017 using a visual analogue scale (0 being normal, 100 being severely affected) for the frequency, volume and severity of any straining to urinate, immediately prior to the placement of the HAUS and at the time of the survey. The number of days between surgery and the completion of survey were recorded.RESULTS: Seven females and two male dogs, which were all desexed except for one female, were eligible for inclusion in the study. The period of follow-up following HAUS placement ranged from 206–1,685 days. Following HAUS placement, frequency and volume of urinary incontinence decreased for six dogs and were practically unchanged for three dogs. The median frequency score decreased from 70 to 13 and the volume score decreased from 73 to 12. There was no consistent change in the perceived degree of straining to urinate. Complications occurred in three dogs; one required repositioning of a dislodged injection port, one required management for haematuria and a hypoplastic bladder, and one required surgical removal of fibrous tissue around the HAUS cuff.CONCLUSIONS AND CLINICAL RELEVENCE: HAUS placement was an effective method for the treatment of persistent USMI in most dogs and provided good clinical results based on owner assessment. The technique was associated with few complications and allowed successful long-term control of urinary incontinence without the need for medical management.

PD48-07 BLADDER CHANGES AFTER CATHETERIZABLE CHANNEL CREATION IN ADULTS WITH CEREBRAL PALSY WHO ARE IN CHRONIC URINARY RETENTION PRE-OPERATIVELY

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Transitional Urology & GU Congenitalism1 Apr 2018PD48-07 BLADDER CHANGES AFTER CATHETERIZABLE CHANNEL CREATION IN ADULTS WITH CEREBRAL PALSY WHO ARE IN CHRONIC URINARY RETENTION PRE-OPERATIVELY Vikram Narayan, Ronak Gor, Jenna Katorski, and Sean Elliott Vikram NarayanVikram Narayan More articles by this author , Ronak GorRonak Gor More articles by this author , Jenna KatorskiJenna Katorski More articles by this author , and Sean ElliottSean Elliott More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2311AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Cerebral palsy (CP) is characterized by motor impairments as a result of injury to the brain during development. These patients are often unable to self-catheterize through their native urethra due to fine motor impairments and muscle spasticity of the limbs & pelvic floor. Chronic retention can be alleviated with catheterizable channel (CC) creation. But, we have observed that some patients with large capacity, low-pressure bladders who are in chronic urinary retention due to pseudodyssynergia pre-operatively, develop de novo neurogenic detrusor overactivity (NDO) post-operatively. We sought to better characterize this finding. METHODS We retrospectively reviewed the charts of 8 patients 17 years of age or older with a diagnosis of CP who underwent surgical creation of CC without an augmentation cystoplasty in 2011-2017. We have limited augmentation cystoplasty to those CP patients (n=11) with poor bladder compliance, refractory NDO or small bladder capacity; these are not the focus of this study. Pre-operative and post-operative UDS were reviewed, where available. Clinical data, including frequency of incontinence, use of anti-cholinergics, and need for intravesical injections of onabotulinum toxin A before and after surgery were reviewed. Descriptive summaries were tabulated. RESULTS All 8 patients had low detrusor pressures and bladder volumes of at least 250 mL (mean 528 mL) on UDS before surgery. Seven of these patients had severe CP based on the Gross Motor Function Classification System (GMFCS), with a grade of either IV or V, and one was grade III. Pre-operatively, 6 of 8 patients were in chronic retention. These patients all reported worsening incontinence post-operatively. Before surgery, 5 of 8 patients were managed with either anticholinergics or intravesical onabotulinum toxin A. Following CC creation, all patients who were previously in chronic retention required NDO management with either additional anticholinergics, intravesical onabotulinum, or mirabegron. Among those with complete UDS data (6/8 patients), 67% demonstrated lower maximum cystometric capacity post-operatively, with an average volume loss of 88.5 ±81.2 mL (SD). Median follow-up was 25 months. CONCLUSIONS Catheterizable channel creation facilitates CIC in adults with severe CP who are in chronic retention due to psuedodyssynergia. However, despite pre-operative UDS that demonstrate a large capacity, low pressure bladder, such patients often manifest diminished bladder capacities and new NDO upon initiation of CIC after surgery. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e963 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Vikram Narayan More articles by this author Ronak Gor More articles by this author Jenna Katorski More articles by this author Sean Elliott More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Onabotulinumtoxin-A improves health status and urinary symptoms in subjects with refractory overactive bladder: Real-life experience.

Onabotulinumtoxin-A has been approved for wet overactive bladder refractory to anticholinergics in randomised controlled trials; however, data from real-life practice are scarce. This study was designed to assess the efficacy of intravesical onabotulinumtoxin-A injections, focusing on health status, urinary symptoms and subjective satisfaction. Data from consecutive patients with overactive bladder-refractory to anticholinergics treated with onabotulinumtoxin-A were prospectively collected and analysed. Standard doses (100-150 U) were used, followed by repeat sessions when clinical benefits diminished. Efficacy and safety of repeat onabotulinumtoxin-A administrations were assessed at 12-week post-injection. Clinical parameters evaluated were: change in the magnitude and frequency of incontinence, urgency and nocturia episodes, change in the number of pads used and procedural complications. Quality of life was evaluated using the 36-Item Short-Form Health Survey, Overactive Bladder Screener and Treatment Benefit Scale questionnaires. Consecutive overactive bladder-refractory to anticholinergics patients ( n = 22) (median duration of oral therapy: 10 months) were enrolled. No intraoperative complications occurred, but two urinary retention cases were recorded. Forty-five percent of patients (10/22) were re-treated (median duration of perceived benefits: 18 months, range: 8-55 months). The number of urinary incontinence, frequency and nocturia episodes, and pads used went from 3.6, 11.3, 2.7 and 2.4 preoperatively to 1.0, 5.8, 0.7 and 0.7 postoperatively ( p < 0.005). Quality of life (36-Item Short-Form Health Survey) was significantly improved and symptom scores (Overactive Bladder Screener) were reduced, from 34.5 to 17.1 at week 12 ( p < 0.05). Eighty-seven percent of patients indicated improvement/great improvement in their condition (Treatment Benefit Scale). Intradetrusor injections of onabotulinumtoxin-A in patients with overactive bladder-refractory to anticholinergics significantly improved health status and urinary symptoms, with high subjective satisfaction.

Beta oscillations and urinary voiding in Parkinson disease.

To investigate the role of beta oscillations in urinary voiding and their association with lower urinary tract symptoms in Parkinson disease (PD). We used surgically implanted deep brain stimulation electrodes to record local field potential signals from the subthalamic nucleus (STN) and globus pallidus interna (GPi) of patients with PD during urinary voiding. Five patients with STN electrodes and 5 patients with GPi electrodes were tested. We also explored correlations between beta oscillatory power and urinary symptoms assessed by the International Consultation on Incontinence Lower Urinary Tract Symptoms questionnaire. Beta suppression occurred during urinary voiding in the GPi (p < 0.05) but not the STN. Furthermore, the beta signal in the GPi during voiding correlated significantly with severity of incontinence and urinary frequency (p < 0.05). In this study, we have demonstrated that local field potentials can provide information about the neural control of the bladder. Our findings suggest that the GPi is implicated in the process of urinary voiding and that its mechanism of action is linked to signals in the beta frequency band. Moreover, our correlational analyses show that beta oscillations may be implicated more generally in the pathophysiology of lower urinary tract symptoms in PD.

Sleep Quality and Daytime Sleepiness Among Women With Urgency Predominant Urinary Incontinence.

The objective of this study was to examine the strength and direction of the association between urinary symptoms and both poor quality sleep and daytime sleepiness among women with urgency urinary incontinence. A planned secondary analysis of baseline characteristics of participants in a multicenter, double-blinded, 12-week randomized controlled trial of pharmacologic therapy for urgency-predominant urinary incontinence in ambulatory women self-diagnosed by the 3 Incontinence Questions was performed. Urinary symptoms were assessed by 3-day voiding diaries. Quality of sleep was assessed using the Pittsburgh Sleep Quality Index (PSQI) and daytime sleepiness using the Epworth Sleepiness Scale. Of the 640 participants, mean (SD) age was 56 (±14) years and 68% were white. Participants reported an average of 3.9 (±3.0) urgency incontinence episodes per day and 1.3 (±1.3) episodes of nocturia per night. At baseline, 57% had poor sleep quality (PSQI score, >5) and 17% reported daytime sleepiness (Epworth Sleepiness Scale score, >10). Most women (69%) did not use sleeping medication during the prior month, whereas 13% reported use of sleeping medication 3 or more times per week. An increase in total daily incontinence episodes, total daily urgency incontinence episodes, total daily micturitions, and moderate to severe urge sensations were all associated with higher self-report of poor sleep quality according to the PSQI (all P ≤ 0.01). Higher scores on the Bother Scale and the Health-Related Quality of Life for overactive bladder on the Overactive Bladder Questionnaire were similarly associated with higher rates of poor sleep quality (both P ≤ 0.01). In subgroup analysis of those who took sleeping medications less than twice a week, there was still a significant relationship between incontinence measures and quality of sleep as measured by the PSQI. In multivariable analyses, greater frequency of nighttime urgency incontinence was associated with poor sleep quality (P = 0.03). Among ambulatory women with urgency urinary incontinence, poor sleep quality is common and greater frequency of incontinence is associated with a greater degree of sleep dysfunction. Women seeking urgency urinary incontinence treatment should be queried about their sleeping habits so that they can be offered appropriate interventions.

Urinary incontinence among adolescent female athletes

A collection of studies have demonstrated that approximately one-third of female nulliparous athletes experience urinary incontinence during their athletic activities. Contributing factors of incontinence that have thus far been the focus of study include type of sport, duration and intensity of athletic activity, use of hormonal contraception, and weight. There has, as yet, been a notable underemphasis on several other factors which influence incontinence, including bowel pattern, urinary habits, and menstrual status. The purpose of this pilot study was to describe the urinary habits and frequency of incontinence among adolescent female athletes. A secondary purpose was to identify factors associated with incontinence. To investigate these factors, a questionnaire was completed by 44 female high school athletes. Descriptive statistics were used, including means and percentages to answer the first purpose of our study. Chi-square tests and effect sizes were employed to determine the magnitude and statistical significance of the differences. The second research purpose was tested using correlations and logistic regression. Approval was obtained for this study from the Dartmouth Hitchcock Medical Center Committee for the Protection of Human Subjects. There is an even higher rate of athletic incontinence (34.15%) among high school female athletes surveyed in this study than in previous studies of college age athletes. The more seasons athletes are engaged in vigorous exercise, the higher the rate of incontinence in athletics as well as during laughter and activities of daily living (ADLs). A habit of voiding more than six times per day was associated with incontinence. Athletic incontinence is common among adolescent female athletes. Athletes who compete four seasons of the year have higher rates of all types of incontinence (athletic, laughter, and during ADLs) than athletes who compete during fewer seasons of the year. Avid participation in vigorous exercise may be a risk factor not only for athletic incontinence but also incontinence during laughter and ADLs. Several areas of findings warrant further research, including the impact of hot weather on incontinence and increased incontinence with particular body positions or athletic maneuvers.

Improvements in bladder, bowel and sexual outcomes following task-specific locomotor training in human spinal cord injury.

ObjectiveLocomotor training (LT) as a therapeutic intervention following spinal cord injury (SCI) is an effective rehabilitation strategy for improving motor outcomes, but its impact on non-locomotor functions is unknown. Given recent results of our labs’ pre-clinical animal SCI LT studies and existing overlap of lumbosacral spinal circuitries controlling pelvic-visceral and locomotor functions, we addressed whether LT can improve bladder, bowel and sexual function in humans at chronic SCI time-points (> two years post-injury).Study designProspective cohort study; pilot trial with small sample size.MethodsEight SCI research participants who were undergoing 80 daily one-hour sessions of LT on a treadmill using body-weight support, or one-hour of LT and stand training on alternate days, as part of another research study conducted at the Kentucky Spinal Cord Injury Research Center, University of Louisville, were enrolled in this pilot trial. Urodynamic assessments were performed and International Data Set questionnaire forms completed for bladder, bowel and sexual functions at pre-and post-training time points. Four usual care (non-trained; regular at-home routine) research participants were also enrolled in this study and had the same assessments collected twice, at least 3 months apart.ResultsFilling cystometry documented significant increases in bladder capacity, voiding efficiency and detrusor contraction time as well as significant decreases in voiding pressure post-training relative to baseline. Questionnaires revealed a decrease in the frequency of nocturia and urinary incontinence for several research participants as well as a significant decrease in time required for defecation and a significant increase in sexual desire post-training. No significant differences were found for usual care research participants.ConclusionsThese results suggest that an appropriate level of sensory information provided to the spinal cord, generated through task-specific stepping and/or loading, can positively benefit the neural circuitries controlling urogenital and bowel functions.Trial registrationClinicalTrials.gov NCT03036527

Effects of continuous nursing care on postoperative urinary incontinence in patients with prostate cancer

Objective To explore the effects of continuous nursing on postoperative urinary incontinence in patients with prostate cancer, so as to provide clinical evidence to improve the quality of postoperative and extended nursing care. Methods A total of 120 patients with prostate cancer underwent radical prostatectomy in the First Affiliated Hospital of Wenzhou Medical University from January 2016 to January 2017, who met the inclusion criteria were recruited in the research. The patients were randomly divided into experimental group and control group by sortition randomization method, with 60 cases in each. The patients in control group were given routine discharge health education, and the experimental group received continuous nursing on the basis of routine discharge nursing. Three months after discharge, the incidence, duration, frequency and quantity of urinary incontinence in the two groups were recorded by the International Consultation on Incontinence Questionnaire Short Form (ICI-Q-SF) . A self-designed prostate cancer postoperative-related knowledge questionnaire, which evaluated the patients understanding prostate cancer care, was completed by the patients of the two groups. A self-designed satisfaction questionnaire was used to evaluate and compare the satisfaction of the two groups of patients to the quality of nursing. Results The incidence rate and the duration of postoperative urinary continence in the experimental group [16.7%, (4.1±2.8) d] were significantly lower than those in the control group (χ2=9.076, t=-2.630; P<0.05) . After 3 months of discharge, the score of related knowledge and the satisfaction of nursing work in the experimental group were both higher than those of the control group, and the differences were statistically significant (P<0.05) . Conclusions Continuous nursing care for discharged patients after prostatectomy can enhance patients' knowledge of disease, effectively reduce the incidence of postoperative incontinence, reduce urinary incontinence duration, and improve patients' satisfaction with nursing quality. Key words: Prostatic neoplasms; Urinary incontinence; Postoperative complications; Health education; Continuous nursing care

Genetic and clinical evidence of mitochondrial dysfunction in autism spectrum disorder and intellectual disability.

Clinical conditions commonly associated with mitochondrial disorders (CAMDs) are often present in autism spectrum disorders (ASD) and intellectual disability (ID). Therefore, the mitochondrial dysfunction hypothesis has been proposed as a transversal mechanism that may function in both disorders. Here, we investigated the presence of conditions associated with mitochondrial disorders and mitochondrial DNA (mtDNA) alterations in 122 subjects who presented ASD with ID (ASD group), 115 subjects who presented ID but not ASD (ID group) and 112 healthy controls (HC group). We assessed in the three study groups the presence of the clinical conditions through a questionnaire and the mtDNA content of two mitochondrial genes, MT-ND1 and MT-ND4, by qPCR. The mtDNA sequences of 98 ASD and 95 ID subjects were obtained by mtDNA-targeted next generation sequencing and analysed through the MToolBox pipeline to identify mtDNA mutations. Subjects with ASD and ID showed higher frequencies of constipation, edema, seizures, vision alterations, strabismus and sphincter incontinence than HCs subjects. ASD and ID subjects showed significantly lower mtDNA content than HCs in both MT-ND1 and MT-ND4 genes. In addition, we identified 49 putative pathogenic variants with a heteroplasmy level higher than 60%: 8 missense, 29 rRNA and 12 tRNA variants. A total of 28.6% of ASD and 30.5% of ID subjects carried at least one putative pathogenic mtDNA mutation. The high frequency of CAMDs, the low mtDNA content and the presence of putative pathogenic mtDNA mutations observed in both ASD and ID subjects are evidence of mitochondrial dysfunction in ASD and ID.

Evaluation of urinary incontinence and quality of life in married women aged between 20 and 49 years (Sakarya, Turkey)

Background/aim: This study aimed to determine the prevalence of urinary incontinence and to evaluate the relationship between urinary incontinence and quality of life in married women. Materials and methods: This is a cross-sectional study conducted among married women aged 20-49 years living in the vicinity of the Çökekler Community Clinic (Family Health Center) in Sakarya, Turkey, from 1 November 2011 to 15 April 2012. The study group consisted of 1161 women. Results: The frequency of urinary incontinence was 71.5% (n = 830). Out of a total of 830 patients with symptoms of urinary incontinence, mixed was the most frequently determined type (60.4%), followed by urge (33.9%) and then stress urinary incontinence (5.8%). The mean scores obtained by women with urinary incontinence from the general health perceptions and social functioning domains of the SF-36 survey were lower (P < 0.05 for each domain). Conclusion: Urinary incontinence was found to be a common problem among women, and it affects quality of life adversely. Recurrent urinary tract infection and advancing age were the key risk factors in the development of urinary incontinence.

Development and validation of a patient-reported questionnaire assessing systemic therapy induced diarrhea in oncology patients

BackgroundSystemic therapy-induced diarrhea (STID) is a common side effect experienced by more than half of cancer patients. Despite STID-associated complications and poorer quality of life (QoL), no validated assessment tools exist to accurately assess STID occurrence and severity to guide clinical management. Therefore, we developed and validated a patient-reported questionnaire (STIDAT).MethodsThe STIDAT was developed using the FDA iterative process for patient-reported outcomes. A literature search uncovered potential items and questions for questionnaire construction used by oncology clinicians to develop questions for the preliminary instrument. The instrument was evaluated on its face validity and content validity by patient interviews. Repetitive, similar and different themes uncovered from patient interviews were implemented to revise the instrument to the version used for validation. Patients starting high-risk STID treatments were monitored using the STIDAT, bowel diaries and EORTC QLQ-C30. The STIDAT was evaluated for construct validity using exploratory factor analysis (EFA) using minimal residual method with Promax rotation, reliability and consistency. A weighted scoring system was developed and a receiver-operating characteristic (ROC) curve evaluated the tool’s ability to detect STID occurrence. Median scores and variability were analysed to determine how well it differentiates between diarrhea severities. A post-hoc analysis determined how diarrhea severity impacted QoL of cancer patients.ResultsPatients defined diarrhea based on presence of watery stool. The STIDAT assessed patient’s perception of having diarrhea, daily number of bowel movements, daily number of diarrhea episodes, antidiarrheal medication use, the presence of urgency, abdominal pain, abdominal spasms or fecal incontinence, patient’s perception of diarrhea severity, and QoL. These dimensions were sorted into four clusters using EFA – patient’s perception of diarrhea, frequency of diarrhea, fecal incontinence and abdominal symptoms. Cronbach’s alpha was 0.78; kappa ranged from 0.934–0.952, except for abdominal spasms (κ = 0.0455). The positive predictive value was 96.4%, with the minimum score of 1.35 predicting a positive STID occurrence. Patients with moderate or severe diarrhea experience significant decreases in QoL compared to those with no diarrhea.ConclusionsThis is the first patient-reported questionnaire that accurately predicts the occurrence and severity of diarrhea in oncology patients via assessing several bowel habit dimensions.

Percutaneous Tibial Nerve Stimulation in the Office Setting: Real-world Experience of Over 100 Patients

To examine the outcomes and compliance with percutaneous tibial nerve stimulation (PTNS) for overactive bladder (OAB) symptoms. Adults who had PTNS from June 30, 2011, to October 8, 2015, were retrospectively reviewed for demographics, copay, travel distance, employment status, history, symptoms, and treatments used before, during, and after PTNS. Pearson chi-square test, Fisher exact test, Wilcoxon rank and paired t test were performed. Of 113 patients (mean age 75 ± 12 years), most were women (65.5%), married (78.1%), and retired or unemployed (80.2%). The median distance to the clinic was 8.1 mi, and the median copay was $0. The most common indication for PTNS was nocturia (92.9%) followed by OAB with urgency urinary incontinence (75.2%) and urinary urgency and/or frequency (24.8%). Prior treatments included anticholinergics (75.2%), mirabegron (36.6%), behavioral modification (29.2%), pelvic floor physical therapy (18.6%), and others (19.5%). Patients completed a mean of 10.5 ± 3 of 12 planned weekly PTNS treatments. Of 105 patients, 40 (38.1%) used concomitant treatments (most commonly anticholinergics). Of 87 patients, 62 (71.3%) had decreased symptoms at 6 weeks, and of 85 patients, 60 (70.6%) had decreased symptoms at 12 weeks. The majority (82; 75.6%) completed all 12 weekly treatments and 45 (54.9%) completed 3 (median) monthly maintenance treatments. The most common reason for noncompliance was lack of efficacy. Visit copay, employment status, and distance to the clinic were not associated with failure to complete weekly treatments or progression to monthly maintenance. Although most patients' symptoms decreased after weekly PTNS, nonadherence to maintenance and lack of efficacy may limit long-term feasibility. Copay and distance traveled were not associated with noncompliance.

Stimulators and activators of soluble guanylate cyclase for urogenital disorders.

Lower urinary tract symptoms (LUTS), comprising storage (such as urinary incontinence and urinary frequency), voiding, and postmicturition symptoms, are highly prevalent conditions that affect millions of people worldwide. LUTS have a profound effect on quality of life and are a considerable cost to health care systems. In men specifically, BPH commonly leads to LUTS. Clinical studies also show an association of LUTS with erectile dysfunction (ED). Nitric oxide (NO) has long been recognized as an important nonadrenergic, noncholinergic (NANC) transmitter in bladder, urethra, prostate, and corpus cavernosum smooth muscle. Data from clinical and basic research show that oxidation and degradation of soluble guanylate cyclase (sGC; also known as GCS) and reduced cyclic GMP (cGMP) levels are involved in the physiopathology of genitourinary diseases. The NO-sGC-cGMP signalling pathway has a role in disease pathophysiology of the bladder, urethra, prostate, and corpus cavernosum in animal models and humans. Advances in targeting sGC directly to enhance cGMP production independently of endogenous NO have been made using NO-independent stimulators and activators of sGC. These molecules are potential therapeutics in the treatment of LUTS and ED.

Falls and hip fractures associated with urinary incontinence among older men and women with complex needs: A national population study.

To determine if urinary incontinence (UI) was an independent risk factor for falls and hip fractures in community-dwelling older men and women with complex needs, after controlling for confounders. Since 2012, all community care recipients in New Zealand have undergone standardized needs assessments using the Home Care International Residential Assessment Instrument (interRAI-HC). The interRAI-HC elicits information over multiple domains, including UI frequency and falls. Those aged 65+ years with assessment between July 1, 2012 and May 31, 2014 without collection devices or indwelling catheters were matched to hospital, mortality, and pharmaceutical databases, and apposite regression models applied. Overall, 25 257 (37.5%) men and 42 032 (62.5%) women were eligible, with average age of 82.7 years (range: 65, 106 years). Incontinence was reported by 34.3% of men and 42.6% of women, falls within 90 days by 42.7% of men and 39.1% of women; and fractures recorded for 2.5% of men and 3.7% of women. In multivariable analysis, UI was significantly associated with falls (P < 0.001), and differentially related by sex (P < 0.001). Compared to continent participants, the odds of increasing falls risk was 1.69 (95% CI: 1.57, 1.82) for men with frequent incontinence and 1.53 (95% CI: 1.43, 1.64) for men with occasional continence; higher than the 1.39 (95% CI: 1.32, 1.46) and 1.33 (95% CI: 1.26, 1.39), respectively, for women. UI was not associated with hip fractures. UI is a common independent risk factor for falls but not hip fractures. Patterns are different between men and women with complex needs.

Incontinence in autism spectrum disorder: a systematic review.

Autism spectrum disorders (ASD) are defined by persistent deficits in reciprocal social interaction, communication, and language, as well as stereotyped and repetitive behavior. Functional incontinence, as well as ASD are common disorders in childhood. The aim of this systematic review was to give an overview of the co-occurrence of nocturnal enuresis (NE), daytime urinary incontinence (DUI), and fecal incontinence (FI) in ASD, and vice versa, of ASD in children with incontinence. A systematic literature search of the terms "incontinence", "enuresis", and "encopresis" in combination with "autism" or "Asperger" in four databases (Scopus, PubMed, PsycInfo and Web of science) was conducted. All studies that examined incontinence frequencies in samples with ASD, and studies that measured frequencies of ASD diagnoses or symptoms in samples with incontinence were included. Risk of bias and limitations of each study were described. After eligibility assessment, 33 publications were included in the review. The published literature implies a higher prevalence of incontinence in children with ASD compared to typically developing children. Limitations and biases as inappropriate diagnostic criteria for ASD and incontinence, selected samples, or lack of control groups are reported. Associations of incontinence in ASD with psychopathological symptoms were found. Vice versa, ASD symptoms are found in incontinent children, but no study included a non-ASD control sample. Incontinence symptoms are also reported as an adverse effect of medication in ASD. Due to methodological problems and definitional discrepancies in some publications, results have to be interpreted cautiously. Research in ASD and incontinence is scarce. More systematic research including state-of-the-art assessments is needed.

The effect of Kegel Exercise toward urinary in continence on the elderlies

&lt;p&gt;&lt;em&gt;Because of the increasing age, it causes the changes of anatomy and function of the urinary organs caused by weakening of the pelvic muscles. About 12 million people, 34% occurred in men and 60% in women. Indonesia 32.2% in the Elderlies suffers urinary incontinence. The aims of this study was to determine the effect of Kegel Exercise toward urinary in continence on the elderlies.The design of this study is Quasy experiment with design of one group pretest-posttest. This research was conducted in January-August 2015. The population in this research was 110 Elderlies, based on inclusion criteria were 12 people taken by total sampling techniques. The Data was collected by using questionaire and checklist sheets. Data were analyzed by using univariate and bivariate statistical dependent T-test with Shapiro Wilk normality test. The result showed that the frequency of urinary incontinence in the elderlies before doing Kegel exercises had the average about 10.58 with deviation 2,065. Freqency of urinary incontinence in the elderlies after doing Kegel exercises had the average about 8.00 with standard deviation 2,796. After doing the statistical, there is the effect of urinary incontinence before and after doing Kegel exercises in the elderlies. Kegel exercises can reduce urinary incontinence. It can be applied as the daily activities at social institution every day. &lt;/em&gt;&lt;/p&gt;

Treating Overactive Bladder in Older Patients with a Combination of Mirabegron and Solifenacin: A Prespecified Analysis from the BESIDE Study

BackgroundThe BESIDE study demonstrated that combination therapy (mirabegron and solifenacin 5mg) improved overactive bladder symptoms versus solifenacin 5mg or 10mg, and was well tolerated. ObjectiveTo ensure efficacy and safety is maintained in older patients (>65 yr), who usually experience greater symptom severity and comorbidities, a prespecified subanalysis stratified by age group was conducted. Design, setting, and participantsPatients remaining incontinent (≥1 episode during 3-d diary) following 4-wk single-blind daily solifenacin 5mg were randomized 1:1:1 to a daily double-blind combination (solifenacin 5mg and mirabegron 25mg, increased to 50mg at wk 4), solifenacin 5mg or 10mg for 12 wk. Four cohorts stratified by age (<65 yr, ≥65 yr and < 75 yr, ≥75 yr) were investigated. Outcome measurements and statistical analysisEfficacy assessments: change from baseline to end of treatment in average daily incontinence (primary) and micturition frequency (key secondary), number of incontinence episodes during the 3-d diary (key secondary), and change from baseline in average daily urgency and urgency incontinence episodes. Safety included treatment-emergent adverse events and vital signs. Results and limitationsFull analysis set included 2110 patients: 30.9% aged ≥65 yr and 8.9% aged ≥75 yr. At the end of treatment, daily, and 3-d incontinence daily micturitions, urgency, and urgency incontinence, were improved in each treatment group and age group; the largest reductions were observed with combination in each age cohort. There were no notable differences in vital signs or the incidence of treatment-emergent adverse events between treatment and age groups, with the exception of dry mouth, which was highest with solifenacin 10mg. ConclusionsEfficacy and safety in the overall population is maintained in older (≥65 yr) and elderly (≥75 yr) patients treated with a combination of solifenacin and mirabegron, or solifenacin monotherapy; irrespective of age, combination was associated with the greatest improvement in overactive bladder symptoms. Patient summaryThis study investigated the effectiveness and safety of a combination of two different treatments (mirabegron 50mg and solifenacin 5mg) or solifenacin (5mg or 10mg) alone in patients aged <65 yr or ≥65 yr, and <75 yr or ≥75 yr with overactive bladder. Symptoms of overactive bladder, such as the urgent need to visit the toilet, incontinence, and frequent urination, were improved with all treatments regardless of the patient’s age, but combination treatment demonstrated the greatest benefit, and was well tolerated.

Frequency of urinary incontinence among Turkish women, effective factors and its effect on quality of life

ABSTRACTWhat is the frequency of urinary incontinence in Turkish women and how does it affect their quality of life? The aim of this study is to determine the frequency of urinary incontinence among Turkish women, effective factors and its effect on quality of life. Urinary incontinence, a health problem that is commonly seen among women, leads to primarily social and hygienic problems, and affects the physiological, psychological and economic aspects of individuals who are effected. This cross‐sectional study was conducted in the gynaecological outpatient clinics of a Turkish hospital, between 01 August 2014 and 26 December 2014. The population of the study consisted of 155 women aged 19 and over who applied to the gynaecology outpatient clinics for reasons other than pregnancy. The entire population was included in the study without selecting a sample. The data were collected by using a 16‐question questionnaire and King's Health Questionnaire (KHQ). A total of 67·7% of the women were found to suffer from urinary incontinence problem. A significant correlation was found between the age groups and incontinence problems. While pollakiuria was observed more in the age group of 20–29 years (37·3%), urge incontinence (35·6%), stress incontinence (36·2%), and enuresis nocturna (31·6%) were observed more in the age group of 30–39 years. Quality of life of women with bladder problems was significantly impaired. When the women with stress incontinence were compared with women who suffered from other incontinence problems, all sub‐scale mean scores obtained by the women with stress incontinence from KHQ were higher and the quality of life of these women was seriously impaired.

Physical Therapy for Fecal Incontinence in Children with Pelvic Floor Dyssynergia

To determine the efficacy of physical therapy (PT) for fecal incontinence in children with pelvic floor dyssynergia (PFD). Retrospective chart review of children with PFD completing >1 PT session for fecal incontinence at a quaternary children's hospital. The frequency of fecal incontinence (primary outcome), constipation-related medication use, number of bowel movements (in those with <3 per week at baseline) and pelvic floor muscle (PFM) function were captured at baseline and at the final PT visit. Outcomes were categorized as excellent (complete continence), good (>50% decrease in fecal incontinence frequency), fair (not worsening but <50% fecal incontinence frequency decrease), and poor (more frequent fecal incontinence). Compliance with PT was determined by the percentage of attended PT appointments. Children included met the following primary outcomes: 27 (42.2%) excellent, 24 (37.5%) good, 11 (17.1%) fair, and 2 (3.1%) poor. Factors associated with an excellent or good outcome included improved PFM functioning and good (≥70% PT attendance) compliance. Children with a history of surgically corrected tethered spinal cord were more likely to have a fair outcome (P = .015). Use of constipation-related medications decreased (1.9 ± 0.7 vs 1.5 ± 0.9, P = .005). Weekly bowel movement frequency increased (1.6 ± 0.6 vs 6.4 ± 4.8, P < .001) in those with infrequent bowel movements (n = 26) at baseline. Pelvic floor PT is effective in the majority of children with fecal incontinence related to PFD. Factors associated with PT efficacy include improved PFM functioning, good compliance with PT, and history of tethered cord.

Fecal Incontinence Is Associated With Mortality Among Older Adults With Complex Needs: An Observational Cohort Study.

Fecal incontinence (FI) is a problem in growing older populations. Validating a suspected association between FI and mortality in community dwelling older adults could lead to improved planning for and management of the increasing complex older population. In a large cohort of New Zealand older adults, we assessed the prevalence of FI, urinary incontinence (UI), combined FI and UI, and their associations with mortality. This study consisted of a retrospective analysis of international standardized geriatric assessment-home care (InterRAI-HC) data from community-dwelling adults aged 65 years or older, who met the criteria required for the InterRAI-HC, having complex needs and being under consideration for residential care. The prevalence of UI and FI was analyzed. Data were adjusted for demography and 25 confounding factors. Mortality was the primary outcome measure. The total cohort consisted of 41,932 older adults. Both UI and FI were associated with mortality (P<0.001), and risk of mortality increased with increased frequency of incontinence. In the adjusted model, FI remained significantly related to survival (P<0.001), whereas UI did not (P=0.31). Increased frequency of FI was associated with an increased likelihood of death (hazard ratio 1.28). This large national study is the first study to prove a statistically significant relationship between FI and mortality in a large, old and functionally impaired community. These findings will help improve the management of increasingly complex older populations.