Overflow Urinary Incontinence Research Articles

Short-term effects of suprapubic catheterization on detrusor muscle contraction in a rat model of postoperative urinary dysfunction

Catheterization is commonly performed in pelvic surgery to manage postoperative urinary dysfunction. However, little is known about the effects of catheterization on bladder function, although catheterization can drain urine from the bladder. In the present study, we evaluated the short-term effects of catheterization on detrusor muscle contraction in a rat model of postoperative urinary dysfunction due to bilateral accessory nerve injury (BACNI). Ten-week-old male Wistar/ST rats were divided into sham, sham＋catheterization (sham＋C), BACNI, and BACNI＋catherterization (BACNI＋C) groups. The sham＋C and BACNI＋C groups underwent catheter placement in the bladder dome prior to sham or BACNI surgery and intermittent bladder drainage during the observation period. Four hours after surgery, the bladders were excised and subjected to isometric tension study and immunofluorescence staining. Bladder overdistension and overflow urinary incontinence were observed in the BACNI group, not the BACNI＋C group. The contractile responses of the detrusor muscle to 80 mM KCl, carbachol, and electrical field stimulation (EFS) were enhanced in the BACNI group compared to the sham group; the enhanced contractile responses to EFS were improved in the BACNI＋C group. The ratio of the detrusor muscle layer area to the total bladder area increased with increasing interstitial area ratio in the BACNI and BACNI＋C groups, while the total bladder area increased in the sham＋C and BACNI＋C groups. These results suggest that catheterization does not improve the augmentation of detrusor muscle contraction and increase in the detrusor muscle layer area ratio immediately after BACNI and that catheterization causes bladder hypertrophy.

Clinical Reasoning: A Young Woman With Rapidly Progressive Weakness and Paresthesia.

A 24-year-old Middle Eastern woman presented with a 2-month history of rapidly progressive asymmetric weakness and paresthesia that began in her left lower extremity and progressed to involve both legs and arms. It was associated with overflow urinary incontinence and significant weight loss. In addition, she complained of a constant occipital headache that worsened in the supine position and was associated with photophobia, tinnitus, nausea, vomiting, and horizontal binocular diplopia. She also had signs of meningismus, decreased left facial sensation, and right sensorineural hearing loss. Because multifocal localization suggests a wide variety of possible differential diagnoses, this study expands on the differential of a subacute multifocal process while highlighting the importance of identifying appropriate risk factors and performing a relevant yet focused diagnostic workup.

Trends and Racial Disparities in the Prevalence of Urinary Incontinence Among Men in the USA, 2001–2020

BackgroundMale urinary incontinence (UI) affects quality of life and leads to a significant burden to the health care system. However, the contemporary prevalence and recent trends in UI and its subtypes among US men remain unknown. ObjectiveWe evaluated 20-yr trends in the prevalence of UI and its subtype in US men aged ≥20 yr. Design, setting, and participantsA serial, cross-sectional analysis of the US nationally representative data from the National Health and Nutrition Examination Survey among men from 2001 to 2020. Outcome measurements and statistical analysisPrevalence of any, stress, urgency and overflow UI were derived. The frequency of UI was assessed in four categories: less than one time per month, a few times per month, a few times per week, and every day and/or night. All analyses were conducted using sample weights, stratification, and clustering of the complex sampling design. Sociodemographic and lifestyle correlates of UI over time were identified using multivariable logistic regressions. Results and limitationsData on 22994 US men (mean age, 46.6 yr [standard error, 0.20]; weighted population, 848642150) were analyzed. The prevalence of any UI increased from 2001–2002 (11.5% [95% confidence interval {CI}, 10.0–13.0]) to 2017–2020 (19.3% [95% CI, 17.2–21.3]), driven by urgency (from 9.0% [95% CI, 7.5–10.4]) to 15.2% [95% CI, 13.4–16.9]) and overflow UI (from 3.3% [95% CI, 2.7–4.0] to 5.5% [95% CI, 4.5–6.4]; all p for trend < 0.01). UI affects 38.5% US men ≥60 yr of age, with increasing trends in urgency and overflow UI and a decreasing trend in stress UI (all p for trend < 0.05). Racial/ethnic disparities were noted, with patterns differed by UI subtype. Compared with non-Hispanic White, non-Hispanic Black men were more likely to report urgency UI (odds ratio [OR], 1.94 [95% CI, 1.71–2.20]). Hispanic men were more likely to report urgency UI (OR, 1.33 [95% CI, 1.14–1.56]), but less likely to report stress (OR, 0.74 [95% CI, 0.56–0.98]) and overflow (OR, 0.75 [95% CI, 0.58–0.98]) UI. Men with higher body mass index and current smokers were more likely to report any, stress, and urgency UI than their counterparts. A higher prevalence of any UI was found in men with low family poverty ratios and chronic diseases, and those who were physically inactive. ConclusionsFrom 2001 to 2020, the overall prevalence of UI increased among US men, particularly for urgency and overflow UI. Patient summaryIn this report, we looked at the prevalence of urinary incontinence among US men in a nationally representative sample. We found that urinary incontinence increased in the past 20 yr driving by the urgency and overflow urinary incontinence.

Efficacy of filtered bone marrow stem cell lysate for overflow urinary incontinence in model rats

Efficacy of filtered bone marrow stem cell lysate for overflow urinary incontinence in model rats

Overflow Urinary Incontinence with Herniated Lumbar Disc Managed by Korean Medicine Therapy: A Case Report

Ji-Eun Koo, K.M.D., Hee-Won Lee, K.M.D., Yong-Su Kwon, K.M.D., Jae-Eun Yu, K.M.D., Jun-Hyo Bae, K.M.D., Ji-Won Park, K.M.D., Joo-Young Yoon, K.M.D., Sung-Won Choi, K.M.D., Ka-Hyun Kim, K.M.D.. J Korean Med Rehabi 2021;31:125-31. https://doi.org/10.18325/jkmr.2021.31.3.125

Impairment of accessory nerves around major pelvic ganglion leading to overflow urinary incontinence in rats.

To investigate the relationship between lower urinary tract function and the accessory nerve (ACN) arising from the major pelvic ganglion (MPG). Ten-week-old male Wistar/ST rats were randomly divided into eight groups according to the type of treatment (sham or bilateral accessory nerve injury [BACNI]) and the duration of observation (3 days, 1 week, 2 weeks, or 4 weeks: Sham-3d, Sham-1w, Sham-2w, Sham-4w, BACNI-3d, BACNI-1w, BACNI-2ws, and BACNI-4w. BACNI was induced in the following manner: the ACN was crushed for 1 min (2 mm away from the MPG) using reverse-action tweezers. The same procedure was performed on both sides. On the last day of each observation period, the bladder function was measured by awake cystometry, and histological evaluation was performed. All rats in the Sham groups micturated normally. In the BACNI-3d and BACNI-1w groups, all rats showed symptoms of overflow urinary incontinence (OUI). This OUI improved gradually over time. The bladder's size in the BACNI group was significantly larger than that in the Sham group (p < .01). In addition, fibrosis was observed in the subserosa of the bladder of rats in BACNI groups. The BACNI model rats exhibited OUI, suggesting that ACN is involved in the lower urinary tract function. It might be possible that ACN controls the function of either the bladder, the urethra, or both.

Rehabilitation treatment in patients with urinary incontinence

Urinary incontinence is the inability to control urination with spectrum of disturbances from periodical urinary leaks to complete inability to retain urine. It occurs more often in elderly and in women. Urinary incontinence has a great impact on general health and may reduce the quality of life. There are several types: stress urinary incontinence, urgent urinary incontinence, neurogenic urinary incontinence, overflow urinary incontinence. Stress urinary incontinence is the most frequent one and is due to pelvic floor muscle weakness. For assessment and treatment of these patients the individual approach is warranted. The treatment of these patients includes medications, behavioral therapy, biofeedback, pelvic floor muscle training, electrical stimulation, magnetic stimulation and surgery. Non-surgical treatment might be effective to prevent surgery. Rehabilitation treatment with pelvic floor exercises and physical modalities for patients with urinary incontinence is important for recovery of the urinary continence and improvement of quality of life in these patients.

The Impact of Urinary Incontinence on Quality of Life: A Cross-Sectional Study in the Metropolitan City of Naples.

Urinary incontinence is a hygienic and psychosocial problem that often brings people to restrict their social life and to experience depression. The main aim of this study was to evaluate the impact of urinary incontinence on quality of life among residents of the Metropolitan City of Naples, Italy, using a newly designed multidimensional questionnaire. The secondary objective was to find which variables affect the quality of life and symptom severity in these patients. To do so, a sample composed of twenty-eight patients was recruited in a multicentre cross-sectional study. Most of the participants had a mild impairment (60%) concerning social life and self-perception, especially those whose education was above the primary level (p = 0.036) and those who followed a pelvic floor rehabilitation program (p = 0.002). Overflow urinary incontinence was associated with a greater deterioration in the aspirational and occupational domain (p = 0.044). Symptom severity was worse in those who had comorbidities (p = 0.038), who had a high body mass index (p = 0.008) or who used diuretics (p = 0.007). In conclusion, our results suggest that there is a significant impairment of quality of life in patients who have only primary education and who follow a pelvic floor rehabilitation program.

Acute Transverse Myelitis Secondary to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2): A Case Report.

IntroductionRespiratory viral illnesses are associated with diverse neurological complications, including acute transverse myelitis (ATM). Among the respiratory viral pathogens, the Coronaviridae family and its genera coronaviruses have been implicated as having neurotropic and neuroinvasive capabilities in human hosts.1 Despite previous strains of coronaviruses exhibiting neurotropic and neuroinvasive capabilities, little is known about the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its involvement with the central nervous system (CNS). The current pandemic has highlighted the diverse clinical presentation of SARS-CoV-2 including a possible link to CNS manifestation with disease processes such as Guillain-Barré syndrome and cerebrovascular disease. It is critical to shed light on the varied neurological manifestation of SARS-CoV-2 to ensure clinicians do not overlook at-risk patient populations and are able to provide targeted therapies appropriately.Case ReportWhile there are currently no published reports on post-infectious ATM secondary to SARS-CoV-2, there is one report of parainfectious ATM attributed to SARS-CoV-2 in pre-print. Here, we present a case of infectious ATM attributed to SARS-CoV-2 in a 24-year-old male who presented with bilateral lower-extremity weakness and overflow urinary incontinence after confirmed SARS-CoV-2 infection. Magnetic resonance imaging revealed non-enhancing T2-weighted hyperintense signal abnormalities spanning from the seventh through the twelfth thoracic level consistent with acute myelitis.ConclusionThe patient underwent further workup and treatment with intravenous corticosteroids with improvement of symptoms and a discharge diagnosis of ATM secondary to SARS-CoV-2.

\u201cSandwich\u201d mesh reconstruction of female giant urethral diverticulum: a case report

BackgroundThere is no consensus between urologists on the diagnosis and treatment of female urethral diverticula. Once the diagnosis has been established, the most common treatment approach is surgical excision and reconstruction. Whether a staged procedure or simultaneous management is more appropriate for treating concomitant urethral diverticula and stress urinary incontinence remains controversial.Case presentationA 63-year-old woman was hospitalized for repeated frequent urination, urgent urination, odynuria, and dysuria accompanied by intermittent overflow urinary incontinence for over 10 years. She had a 5 year history of urinary stress incontinence prior to onset of these symptoms and had had four urethral caruncles resected on four separate occasions. There was visible leakage of urine when abdominal pressure was increased during physical examination and urodynamic studies. Additionally, turbid urine was discharged when the anterior vaginal wall was squeezed. Cystourethrography showed circumferential filling with contrast and multiple bladder diverticulae in the mid plane of the pubic symphysis. Urethrocystoscopy showed an orifice to a diverticulum at 7 o’clock in the proximal urethra, into which an F19.8 urethroscope could be inserted, enabling examination of most of the diverticulae. The urethral diverticulae were resected, followed by mesh reconstruction of the urethra. During a 20-month follow-up, the treatment outcomes were satisfactory.ConclusionWe here report a case of a giant circumferential urethral diverticulum combined with stress urinary incontinence that was successfully managed by an uncommon surgical reconstructive technique: a minimally invasive “Sandwich” mesh repair procedure utilizing synthetic mesh wrap in the midurethral region.

Spinal Epidural Abscess.

Spinal Epidural Abscess.

Office cystometry in a resource-constrained setting: Spectrum of diagnoses and correlation with QUID

Background: Office cystometry is an appropriate technology alternative to urodynamics, especially in resource-poor settings. The combination of a validated screening tool such as the Questionnaire for Urinary Incontinence Diagnosis (QUID) and office cystometry stands as the gold standard in the evaluation of urinary incontinence, where urodynamics is not available. Objectives: This study aimed to determine the spectrum of urinary incontinence diagnoses using a combination of urogynecological examination and office cystometry among women in a resource-constrained sub-Saharan African setting and to correlate this with their QUID diagnoses. Methods: Sixty consenting women who had urinary incontinence diagnosed with QUID were recruited from a related study. The cough stress test was performed to elicit stress incontinence. Standard digital and speculum examinations were performed. Postvoid residual urine volume was determined by catheterization. Simple cystometry was performed to detect detrusor overactivity. Using urogynecological examination and simple cystometry as the gold standard, sensitivity, specificity, positive, and negative predictive values were calculated for QUID. Results: The spectrum of diagnoses made using urogynecological examination and office cystometry included no incontinence 13 (21.7%), urge incontinence 23 (38.3%), stress incontinence 18 (30.0%), mixed incontinence 5 (8.3%), and overflow incontinence in 1 (1.7%) woman, respectively. Using this as the gold standard, QUID demonstrated sensitivity of 87.0%, 55.6%, and 60.0% for urge, stress, and mixed incontinence, respectively, with corresponding specificity of 73.0%, 81.0%, and 83.6%, respectively. Conclusion: Urogynecological examination and office cystometry identified stress, urge, mixed, and overflow urinary incontinence in the study population. Overall, good correlation existed between the QUID and office cystometric diagnoses.

Treatment strategy for flail foot with sensory disorder of spina bifida sequela in adult

To summarize the main methods and comprehensive effects of limited surgery combined with external fixation for the treatment of flail foot with sensory disorder of spina bifida sequela in adult. The clinical data of 22 cases (30 feet) of the adult spina bifida sequela who suffered from flail foot with sensory disorder and treated by limited surgery combined with external fixation were retrospectively analysed between January 2005 and December 2015. There were 14 males and 8 females with an age of 8-38 years (mean, 21.5 years). All 30 feet were distal ankle sensory loss, including 2 cases (2 feet) on the left side, 2 cases (2 feet) on the right side, and 18 cases (26 feet) on both sides. There was 1 foot accompanied by ulcerative plantar ulcers, and 3 feet lost their toes due to foot osteomyelitis in the weight-bearing area. Combined with 3 cases of hip dislocation, 3 cases of scoliosis, 4 cases of knee deformity, and 3 cases of ptosis. There were 5 cases of normal control of urine and stool, 10 cases of partial control of urine and stool, 6 cases of overflow urinary incontinence, and 1 case of cystostomy. According to X-ray film, the lesion of spina bifida was evaluated, the laminar insufficiency was located at L 3-L 5 in 8 cases, L 5, S 1 in 9 cases, and L 3-S 3 in 5 cases. In the patients, 12 feet were performed ankle joint arthrodesis, 10 feet subtalar arthrodesis, and 8 feet tibia-talus-calcaneus arthrodesis. Ilizarov external fixator was used in 18 feet, Hybrid fixator in 8 feet, Hybrid fixator and cannulate screws in 3 feet, and Ilizarov fixator and cannulate screws in 1 foot. All 22 patients were followed up 10-80 months (mean, 48.5 months). All ankle deformities were corrected effectively after operation, the middle and hind feet were stable, the plantar foot was restored, the whole foot was loaded, and the ulcer healed without recurrence. There were 2 cannulate screws ruptured in the subtalar arthrodesis, bone healed after screws break; no complication such as surgical infection, neurovascular injury, and so on happened. At last follow-up, based on the evaluation criteria of QIN Sihe lower limb deformity correction, the results were excellent in 15 feet, good in 9 feet, and fair in 6 feet, with an excellent and good rate of 80.0%. The treatment of flail foot with sensory disorder of spina bifida sequela is more demanding. The limited surgeries combined with external fixation play an important role for recovering the stability of foot and ankle, better clinical results, and less complications.

Two cases of plasmacytoid variant of bladder cancer

Introduction: Plasmacytoid urothelial carcinoma (PUC) is a rare and aggressive variant of bladder cancer. Since PUC is infrequently encountered, its management continues to be a formidable challenge.&#x0D; Case 1: A 74-year-old gentleman was admitted with a 1-month history of gross hematuria and urinary overflow incontinence. Cystoscopy revealed an abnormal growth at the bladder base and biopsies were taken. This patient had high grade PUC sparing the muscularis propria (MP). He underwent nephrostomy tube insertion and subsequent conversion to internal stents 8 weeks later. Repeat resection showed muscle-invasive PUC. Repeat CT showed subcentimeter bilateral inguinal and external iliac lymphadenopathy. The surgeon discovered a dense infiltrative reaction within the retroperitoneum and colonic obstruction during radical cystoprostatectomy and palliative colostomy, confirming metastatic PUC.&#x0D; Case 2: A 72-year-old gentleman presented with gross hematuria, bleeding from an established end ileostomy, and bowel obstruction symptoms. Cystoscopy identified an anterior bladder tumour and CT staging confirmed a small bowel obstruction (SBO). Transurethral resection showed PUC with invasion of the MP and lymphovascular space. Obvious positive margins were identified during radical cystoprostatectomy, as the tumour clearly invaded bone and the rectal stump. Ileostomy output ceased post-operatively on day 4, and bowel contents began leaking through his urethra the following day. Reassessment of goals of care resulted in cessation of significant interventions. Unfortunately, he passed away 2 weeks post-operatively due to sepsis.&#x0D; Discussion: These cases illustrate the aggressiveness of PUC bladder tumours and how imaging frequently under-stages these patients. Neoadjuvant chemotherapy prior to attempting surgical control may be beneficial.

Nursing diagnoses of urinary incontinence in patients with stroke

Identifying the prevalence of Stress urinary incontinence (SUI), Urge urinary incontinence (UUI), Functional urinary incontinence (FUI), Overflow urinary incontinence (OUI) and Reflex urinary incontinence (RUI) nursing diagnoses and their defining characteristics in stroke patients. A cross-sectional study with 156 patients treated in a neurological clinic. Data were collected through interviews and forwarded to nurses for diagnostic inference. 92.3% of the patients had at least one of the studied diagnoses; OUI showed the highest prevalence (72.4%), followed by FUI (53.2%), RUI (50.0%), UUI (41.0%) and SUI (37.8%). Overdistended bladder and reports of inability to reach the toilet in time to avoid urine loss were the most prevalent defining characteristics. A statistically significant association of the defining characteristics with the studied diagnosis was verified. The five incontinence diagnoses were identified in the evaluated patients, with different prevalence.

Bladder Buzz: The Effect of a 6-Week Evidence-Based Staff Education Program on Knowledge and Attitudes Regarding Urinary Incontinence in a Nursing Home

Research shows that there is a basic gap in the knowledge of nursing home staff about urinary incontinence and the previous societal belief that urinary incontinence is a normal part of aging. This study examines the knowledge of nursing home staff about the types and treatment of urinary incontinence as well as attitudes toward urinary incontinence. A quasi-experimental, within-subject, longitudinal pretest/posttest design was used. Nursing home staff members received a 6-week educational intervention on the types and treatment of urinary incontinence and attitudes toward urinary incontinence. Changes in knowledge about the types of urinary incontinence showed statistical significance for stress (p < .001), functional (p < .003), and overflow (p < .00) urinary incontinence. Changes in attitudes toward urinary incontinence showed statistical significance (p < .000). Changes in staff knowledge of the assessment and treatment of urinary incontinence did not reach statistical significance. This study showed that creative, evidence-based educational programming can improve staff knowledge about urinary incontinence and change staff attitudes toward urinary incontinence. Further research is needed on staff knowledge about the assessment and treatment of urinary incontinence.

Overflow urinary incontinence due to bladder stones

Overflow urinary incontinence is rare in women. We report a case of overflow incontinence due to bladder stones in a 40-year-old widow (para 2) who presented with a 5-month history of involuntary loss of urine aggravated by postural change, and associated with recurrent painful ineffectual urge to urinate. Her intravenous urogram revealed multiple bladder stones, for which she underwent cystolithotomy. However, following catheter removal on the fifth postoperative day, she developed urge incontinence due to urinary tract infection. She responded well to the choice of antibiotics dictated by the sensitivity result of her postoperative urinary culture, and she was discharged home on the ninth postoperative day. This case highlights the uncommon occurrence of bladder stones as a cause of urinary incontinence, as well as the potential value of intravenous urography in incontinence evaluation.

Pyogranulomatous lesion causing neurological signs localised to the sacral region in a horse

This case report describes neurological signs associated with a pyogranulomatous lesion within the sacral vertebral canal of a horse. The clinical findings included urinary overflow incontinence and reduced anal, perianal and tail tone. The horse failed to respond to medical management and a guarded prognosis for return to athletic performance initiated the decision for euthanasia.

Associations of Commonly Used Medications with Urinary Incontinence in a Community Based Sample

We examined the association between the use of medications and the prevalence of urinary incontinence in gender specific analyses of a community based, representative sample. A population based epidemiological study was conducted of 5,503 men and women 30 to 79 years old residing in Boston, Massachusetts (baseline data collected from 2002 to 2005). Urological symptoms were ascertained in a 2-hour, in person interview. Urinary incontinence was defined as urine leakage occurring weekly or more often during the last year. Medications used in the last month were considered current use. Associations of 20+ medications and prevalent urinary incontinence were examined using multivariate logistic regression (ORs and 95% CIs) with adjustments for known urinary incontinence risk factors. The prevalence of urinary incontinence in the analysis sample was 9.0% in women and 4.6% in men. For women the prevalence was highest among users of certain antihistamines (28.4%) and angiotensin II receptor blockers (22.9%). For men the prevalence was highest among angiotensin II receptor blocker (22.2%) and loop diuretic (19.1%) users. After final multivariate adjustment there were significant positive associations for certain antihistamines, beta receptor agonists, angiotensin II receptor blockers and estrogens with urinary incontinence in women (all ORs greater than 1.7), and a borderline significant association for anticonvulsants (OR 1.75; 95% CI 1.00, 3.07). Among men only anticonvulsants were associated with urinary incontinence after final adjustments (OR 2.50; 95% CI 1.24, 5.03), although angiotensin II receptor blockers showed an adjusted association of borderline significance (OR 2.21; 95% CI 0.96, 5.10). Although a cross-sectional analysis cannot determine causality, our analysis suggests certain medications should be further examined in longitudinal analyses of risk to determine their influence on urological symptoms.

Cauda equina syndrome in extruded lumbar disk herniation

Cauda equina syndrome (CES) is a rare consequence of lumbar disc prolapse. The reported incidence of CES due to an herniated lumbar disc varies from 1 to 6%. It is defined as a complex of symptoms that include lower back pain, unilateral or more typically bilateral sciatica, saddle sensory disturbances, and variable lower extremity motor and sensory loss, along with bladder, bowel, and erectile dysfunction. The motor loss varies from weakness to flaccid paralysis over time, with no upper motor neuron signs. Similarly, sensory symptoms include saddle anesthesia and a variable sensory loss in lower extremities. Low back pain can be divided into local and radicular pain: local pain is generally a deep aching pain resulting from soft-tissue and vertebral body irritation; radicular pain is generally a sharp, stabbing pain resulting from compression of the dorsal nerve roots and projects in dermatomal distributions. Urinary manifestations of cauda equina syndrome include retention, difficulty initiating micturition, decreased urethral sensation. Typically, urinary manifestations begin with urinary retention and are later followed by an overflow urinary incontinence. Bowel disturbances may include incontinence and/or constipation, and loss of anal tone and sensation.