Pad-weighing Test Research Articles

The Effectiveness of Pelvic Floor Muscle Training in Men after Radical Prostatectomy Measured with the Insert Test.

A commonly used physiotherapeutic method for the treatment of urinary incontinence (UI) after radical prostatectomy (RP) is pelvic floor muscle training (PFMT). The aim of this study was to evaluate the effectiveness of PFMT by enhanced biofeedback using the 1h pad-weighing test. The following factors were taken into consideration in the analysis of PFMT effectiveness: the relevance of the patients’ age, time from RP, BMI, mental health, functional state, and depression. A total of 60 post-RP patients who underwent 10-week PFMT were studied. They were divided into groups: A (n = 20) and B (n = 20) (random division, time from RP: 2–6 weeks) and group C (time from RP > 6 weeks). Group B had enhanced training using EMG biofeedback. UI improved in all groups: A, p = 0.0000; B, p = 0.0000; and C, p = 0.0001. After the completion of PFMT, complete control over miction was achieved by 60% of the patients in group A, 85% in group B, and 45% in group C. There was no correlation between the results of PFMT efficacy and patients’ age, BMI, time from RP, mental health, functional state, and depression. PFMT is highly effective in UI treatment. The enhancement of PFMT by EMG biofeedback seems to increase the effectiveness of the therapy.

Effect of radical prostatectomy on involuntary pelvic floor muscle contraction.

Radical prostatectomy may cause stress urinary incontinence (SUI). We compared continent and incontinent men after radical prostatectomy, in regard to the change of the temporal pattern of pelvic floor activation during cough. Twenty-two patients were included in this prospective, multicentric study. All patients gave their informed consent. Simultaneous recordings of electromyographic activity of external anal sphincter (EAS EMG) and external intercostal muscle (EIC EMG) during cough were performed with a pair of pregelled surface electrodes. Cough effort caused an involuntary pelvic contraction. Intercostal muscles recording was chosen because they are one of the muscular components of cough initiation with diaphragm muscle. Twenty-four-hour pad-weighing test was used to quantify urinary incontinence. The primary endpoint was the latency between the onset of EIC EMG and EAS EMG (RT3), during a cough effort. We also measured the contraction time, the maximum EAS EMG activity, and the area under the curve. All the patients were analyzed: 12 continent and 10 with SUI. The median age was 66 years old. Both groups were similar except in term of follow-up. Median latency was increased by -1.7 ms (-47.9; +34.2) to 55.8 ms (+47.5; +80) in patients with SUI (P = 0.0033; Table 2). The duration of the contraction, the maximum EAS EMG activity and the area under the curve were not different. The latency between the onset of EIC EMG and EAS EMG is increased in patients with SUI after radical prostatectomy. It may be one of the reasons for SUI in these patients.

Long-term functional outcomes after radical cystectomy with ileal bladder substitute: does the definition of continence matter?

Objective: Functional outcomes after ileal bladder substitution reflect the expectations of future patients at a particular centre. The aim of this study was to use validated questionnaires and a pad-weighing test to investigate functional outcomes after neobladder reconstruction at long-term follow-up in patients at a single centre.Materials and methods: During 2005 − 2015, 75 patients received a Studer ileal bladder substitute at the Department of Urology, Malmö. Forty-six of these patients were alive for follow-up and were evaluated using the pad-weighing test and the International Consultation on Incontinence Questionnaire–Urinary Incontinence Short Form (ICIQ-UI-SF), the Female Sexual Function Index (FSFI) and the International Index of Erectile Function (IIEF).Results: Five of 37 evaluable patients (14%) were considered fully continent, reporting a pad-weighing test result of 0 g and an ICIQ-UI-SF score of 0. The median ICIQ-UI-SF score was 8 [interquartile range (IQR) 3–11], and seven patients (17%) were continent according to the ICIQ-UI-SF score only. In the pad-weighing test, 28 out of 37 patients (76%) reported 0 g day-time leakage whereas only 12 out of 37 patients (32%) reported 0 g night-time leakage. At follow-up, nine out of 39 (23%) of evaluable male patients were potent. The median ICIQ-UI-SF score was significantly lower during the second half of the study period [4 (IQR 0–8) vs 10 (IQR 6–14); p = .003]. The inverse applied to the median IIEF score [5 (IQR 3–12) vs 2 (IQR 1–4); p = .02].Conclusions: Functional outcomes at long-term follow-up after radical cystectomy and Studer ileal bladder substitute were at best modest in this series. Better outcomes during the second half of the study period might be explained by improved patient selection and a refined surgical technique, but possibly also by longer follow-up of patients during the first half of the period resulting in a more pronounced time-dependent decline in functional outcomes.

Acupuncture for urinary incontinence after stroke: a protocol for systematic review

IntroductionThe aim of this study, which will include randomised controlled trials (RCTs), is to assess the efficacy and safety of acupuncture for patients with stroke and urinary incontinence.Methods and analysisRCTs...

The impact of tension-free vaginal tape on the urethral closure function: mechanism of action.

To investigate if the tension-free vaginal tape (TVT) works by increasing the abdominal to urethral pressure impact ratio (APIR). Twenty one women with urodynamically proven stress urinary incontinence (SUI) were assessed by ICIQ-SF, pad-weighing test, incontinence diary and Urethral Pressure Reflectometry (UPR) before and after TVT. UPR was conducted during resting and increased intra-abdominal pressure (P(Abd)) by straining. Related values of P(Abd) and urethral opening pressure (P(o)) were plotted into an abdomino-urethral pressuregram. Linear regression of the values was conducted, and the slope of the line was found. The slope expresses the ratio of pressure increase in the urethra compared to the pressure increase in the abdomen and was called APIR. The urethral opening pressure at rest (P(o-rest)) was unchanged after TVT, while APIR increased in all women (from 0.7 to 1.4, P < 0.0001). The TVT seems to strengthen the urethral closure function by increasing the APIR while P(o-rest) is unchanged regardless of the type of pre-operative dysfunction. This confirms the theory of TVT's mechanism of action being mid-urethral support.

Urethral pressure reflectometry during intra‐abdominal pressure increase—an improved technique to characterize the urethral closure function in continent and stress urinary incontinent women

to assess the urethral closure function by urethral pressure reflectometry (UPR) during intra-abdominal pressure-increase in SUI and continent women. Twenty-five urodynamically proven SUI women and eight continent volunteer women were assessed by ICIQ-SF, pad-weighing test, incontinence diary, and UPR. UPR was conducted during resting and increased intra-abdominal pressure (P(Abd)) by straining. Related values of P(Abd) and urethral opening pressure (P(o)) were plotted into an abdomino-urethral pressuregram. Linear regression of the values was conducted, and the slope of the line ("APIR") and the intercept with the y-axis found. By the equation of the line, Po was calculated for various values of P(Abd), for example, 50 cm H2O (P(o-Abd 50)). The resting P(o) (P(o-rest)) and APIR, respectively, significantly differed in SUI and continent women but could not separate the two groups. The urethral closure equation (UCE) based on P(o-rest) and APIR provided a more detailed characterization of a woman's closure function based on the permanent closure forces (primarily generated by the urethral sphincteric unit) and the adjunctive closure forces (primarily generated by the support system). P(o-Abd 50) and UCE, respectively, which express the combined permanent and adjunctive closure forces and estimate the efficiency of the closure function, separated SUI and continent women and were highly significantly negatively correlated with ICIQ-SF, pad test, and the number of incontinence episodes. New parameters for characterization of the urethral closure function and possible dysfunctions and its efficiency were provided. P(o-Abd 50) and UCE may be used as diagnostic tests and severity measures.

Validation of use of the International Consultation on Incontinence Questionnaire‐Urinary Incontinence‐Short Form (ICIQ‐UI‐SF) for impairment rating: A transversal retrospective study of 120 patients

A urinary incontinence impairment rating must be a highly accurate, non-invasive exploration of the condition using International Classification of Functioning (ICF)-based assessment tools. The objective of this study was to identify the best evaluation test and to determine an impairment rating model of urinary incontinence. In performing a cross-sectional study comparing successive urodynamic tests using both the International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form (ICIQ-UI-SF) and the 1-hr pad-weighing test in 120 patients, we performed statistical likelihood ratio analysis and used logistic regression to calculate the probability of urodynamic incontinence using the most significant independent predictors. Subsequently, we created a template that was based on the significant predictors and the probability of urodynamic incontinence. The mean ICIQ-UI-SF score was 13.5 ± 4.6, and the median pad test value was 8 g. The discrimination statistic (receiver operating characteristic) described how well the urodynamic observations matched the ICIQ-UI-SF scores (under curve area (UDA):0.689) and the pad test data (UDA: 0.693). Using logistic regression analysis, we demonstrated that the best independent predictors of urodynamic incontinence were the patient's age and the ICIQ-UI-SF score. The logistic regression model permitted us to construct an equation to determine the probability of urodynamic incontinence. Using these tools, we created a template to generate a probability index of urodynamic urinary incontinence. Using this probability index, relative to the patient and to the maximum impairment of the whole person (MIWP) relative to urinary incontinence, we were able to calculate a patient's permanent impairment.

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.

Effect of physical training on urinary incontinence: a randomized parallel group trial in nursing homes

BackgroundResidents in nursing homes (NHs) are often frail older persons who have impaired physical activity. Urinary incontinence (UI) is a common complaint for residents in NHs. Reduced functional ability and residence in NHs are documented to be risk factors for UI.ObjectiveTo investigate if an individualized training program designed to improve activity of daily living (ADL) and physical capacity among residents in nursing homes has any impact on UI.Materials and methodsThis randomized controlled trial was a substudy of a Nordic multicenter study. Participants had to be >65 years, have stayed in the NH for more than 3 months and in need of assistance in at least one ADL. A total of 98 residents were randomly allocated to either a training group (n = 48) or a control group (n = 50) after baseline registrations. The training program lasted for 3 months and included accommodated physical activity and ADL training. Personal treatment goals were elicited for each subject. The control group received their usual care. The main outcome measure was UI as measured by a 24-hour pad-weighing test. There was no statistically significant difference between the groups on this measure at baseline (P = 0.15). Changes were calculated from baseline to 3 months after the end of the intervention.ResultsAltogether, 68 participants were included in the analysis, 35 in the intervention group and 33 in the control group. The average age was 84.3 years. The 3 months’ postintervention adjusted mean difference between groups according to amount of leakage was 191 g (P = 0.03). This result was statistically significant after adjusting for baseline level, age, sex, and functional status. The leakage increased in residents not receiving the experimental intervention, while UI in the training group showed improvement.ConclusionThe intervention group had significant better results compared with the control group after an individualized training program designed to improve ADL and physical capacity. Further studies are needed to evaluate the effect of a goal-oriented physical training program toward NH residents UI complaints.

Prevalence of Urinary Incontinence in Men: Results From the National Health and Nutrition Examination Survey

We estimated the prevalence of urinary incontinence in the United States adult male population and identified associated factors. Data were analyzed for 5,297 men 20 years old or older who participated in the 2005 to 2006 and 2007 to 2008 cycles of the National Health and Nutrition Examination Survey, a cross-sectional, nationally representative survey of the United States noninstitutionalized population. Urinary incontinence (score of 3 or greater on a validated incontinence severity index, indicating moderate to severe leakage) was assessed. Potential associated factors included age, race/ethnicity, education, self-reported health status, prior diagnosis of prostate cancer and/or enlarged prostate (men 40 years old or older), chronic diseases and depression status. Prevalence ORs were estimated from a multivariable logistic regression analysis using appropriate sampling weights. The prevalence of moderate/severe urinary incontinence was 4.5% (95% CI 3.8, 5.4). Prevalence increased with age from 0.7% (95% CI 0.4, 1.6) in men 20 to 34 years old, to 16.0% (95% CI 13.0, 19.4) in men 75 years old or older (p <0.001). We found no difference in prevalence by racial/ethnic group (p = 0.38). Factors significantly associated (p <0.05) with urinary incontinence were age (per 10-year increase, OR 1.8; 95% CI 1.6, 2.0), major depression (OR 2.7; 95% CI 1.6, 4.0) and hypertension (OR 1.3; 95% CI 1.1, 1.5). Age and race adjusted prevalence estimates for urinary incontinence in men are consistent with other estimates using a similar definition. To our knowledge this is the first study that identifies factors associated with moderate to severe urinary incontinence in men.

Long-term efficacy of the tension-free vaginal tape procedure for the treatment of urinary incontinence

The aim was to evaluate the long-term cure rates and the late complications of the tension-free vaginal tape (TVT). One hundred and forty-seven women with stress incontinence underwent surgery at our clinic between 1994 and 1997. At the time of follow-up, 128 were alive, 104 attended an objective evaluation at the clinic, while 20 women were contacted by telephone for an extensive interview. Eighty-four percent were assessed in a retrospective study 10-13 (11.5) years post-operatively. The evaluation included a stress test and, if this test was positive, also a 24-h pad-weighing test, the same questionnaire about urinary symptoms as that used pre-operatively and a visual analogue scale. The objective cure rate was 84%. The subjective cure rate was 77%, while 18% had improved. Ninety-four percent of the patients were satisfied with the surgical result. No late adverse effects of the operation were found. The TVT procedure is effective and safe for more than 10 years.

Comparison of a 20-Min Pad Test with the 1-Hour Pad Test of the International Continence Society to Evaluate Post-Prostatectomy Incontinence

Objectives: Urinary incontinence is a hygienic and socially distressing problem for affected people and causes high healthcare costs. Objective standardized noninvasive quantification of urinary incontinence is highly important and, in addition, enables control of therapeutic efficacy. The aim of this prospective study was to evaluate the feasibility, accuracy and reproducibility of a standardized 20-min pad test to measure urinary incontinence after radical prostatectomy in comparison to the 1-hour pad-weighing test recommended by the International Continence Society (ICS). Methods: We applied a standardized questionnaire, the ICS 1-hour pad test and a simplified 20-min pad test to evaluate subjective and objective post-prostatectomy urinary incontinence in 56 men. Results: The technical feasibility of the 20-min pad test was excellent; the results correlated significantly with both the self-assessment via questionnaire (r = 0.63; p < 0.001) and the 1-hour pad test (ICS; r = 0.66; p < 0.001). Moreover, it was highly reliable (r = 0.74; p < 0.0005) with excellent patient acceptance. Conclusions: The 20-min pad test qualified as a reliable, cost-effective and noninvasive tool which can easily be applied in urologic or physiotherapeutic practice to assess post-prostatectomy urinary incontinence and to evaluate the success of therapeutic approaches.

Validity of the incontinence severity index: comparison with pad-weighing tests

The incontinence severity index (ISI) consists of two questions, regarding frequency and amount of leakage. It categorizes urinary incontinence (UI) into slight, moderate, severe, and very severe. The purpose of this study was to test its validity. The index was compared with the results of pad-weighing tests performed by 200 incontinent women referred to a hospital clinic and 103 at a primary care incontinence clinic. Inconvenience was scored by a six-level Likert scale. Mean pad-weighing results (grams per 24 hours, 95% confidence intervals) were 7 (4-10) for slight, 39 (26-51) for moderate, 102 (75-128) for severe, and 200 (131-268) for very severe UI. Spearman's correlation coefficient for pad-weighing results and severity index was 0.58 (p<0.01), and inconvenience increased significantly with increasing severity. The ISI demonstrated good criterion validity against 24-h pad tests. Good construct validity was indicated by a clear link between ISI and inconvenience.

Effectiveness of the conveen continence guard (a disposable vaginal device) in the treatment of complicated female stress incontinence

Treatment alternatives for women with stress urinary incontinence, complicated by prior unsuccessful surgery or concomitant diseases that prevent surgical intervention are limited. The aim of this study was to investigate the usefulness and effectiveness of a disposable vaginal device, the Conveen Continence Guard, in cases where surgery was not recommended for treatment of stress urinary incontinence. Twenty-eight women, with a urodynamically proven stress urinary incontinence, were offered the use of a vaginal device during a prospective three-week treatment period. Objective and subjective prevention of urinary leakage was assessed by a 24-h pad-weighing test, by a visual analog scale and a quality of life questionnaire. At the end of the treatment period the women answered a questionnaire on the ease and comfort of use of the device. Of the nineteen women who completed the study, 89.5% were cured or improved according to subjective assessments, the respective figure being 84.2% according to objective assessment. The Conveen Continence Guard seems to be a promising treatment alternative for women for whom other treatment methods have failed. The device was well tolerated by the women and was regarded easy to use.

Pad testing in incontinent women: a review.

This article reviews the literature on pad-weighing tests used for objectifying and quantifying incontinence in urinary incontinent women. The patients wear pads weighed before and after the test period. A weight gain is taken as a measure of the amount of urine loss. The tests are in principle of two different types: short-term office tests and long-term home tests, and measure different aspects of urinary control and dysfunction. Both have an inherent large intra- and interindividual variability. Pad weight gains obtained from patients referred for incontinence and those from self-reported continent controls overlap to a certain degree, and it is not possible to identify distinct numerical cut-off values separating continence from incontinence. This suggests that incontinence is a complex condition in which the amount of leakage, other sources of weight gain, and differences in the individual patients' personal characteristics influence the identification and quantification of the problem. In spite of the shortcomings the pad tests remain a valuable tool for both the clinician and the researcher. The home pad tests are superior to the office tests in terms of authenticity, and should be performed with a concomitant systematic registration of the participant's voidings, fluid intake and episodes of incontinence.

Efficacy of biofeedback in the treatment of urinary stress incontinence.

Thirty-seven women with stress incontinence were given biofeedback instruction on how to perform pelvic floor exercises correctly. After 3 months with home exercises 31 patients performed a new standardized pad-weighing test: 39% were objectively cured and 42% improved. After a mean of 2 years 15 patients were evaluated with another pad-weighing test: 27% were now objectively cured and 47% improved. A questionnaire showed that 78% had an exact knowledge about the location of the pelvic floor muscles and 47% were satisfied with their present situation, but only 58% performed daily exercises.

The objective assessment of urinary incontinence in children.

To assess urinary incontinence objectively in children. Thirty-three children (mean age 8.2 years, range 5-12) were examined, of whom 23 suffered from incontinence and 10 did not. The first method of assessing incontinence was the 1-h pad-weighing test proposed by the International Continence Society in 1983 and the second was a test in which the pad was weighed between one urination and the next. At the end of the tests the volume of normally voided urine was measured and the total voided volume during the test calculated. The volume of urine lost during incontinence and the ratio [incontinence volume/(incontinence volume + voided volume)] were evaluated; the ratio was used because the bladder capacity in children differed with age. In both tests, no wetting occurred in any of the 10 patients not complaining of incontinence. In the 1-h pad-weighing test, no wetting occurred in 14 of the 23 patients complaining of incontinence but did in the nine remaining patients, the loss being 1-30 g, and the incontinence ratio 0.5-14.8%. In the second test, no wetting occurred in 12 of the 23 patients complaining of incontinence but did so in the 11 remaining patients, with losses of 2-50 g and incontinence ratios of 1.5-80.6%. There was no significant difference between the tests in the incidence of incontinence. However, the second method seemed to be more closely related to the clinical symptoms than was the 1-h pad-weighing test and may be useful in the assessment of incontinence in children.

Treatment with ?2-agonist for severe bladder dysfunction due to high-dose irradiation after radical hysterectomy

A case of severe bladder dysfunction due to a high-dose irradiation of 180 Gy after radical hysterectomy for cervical cancer is presented. The patient had suffered from urinary disturbances for 11 years after operation and radiation therapy. The results of urodynamic studies were low capacity, low compliance and low urethral pressure. The β2-agonist mabuterol was administered for 3 years. Bladder capacity, compliance and urethral closure pressure improved significantly after the treatment. The voided volume increased significantly to twice the pretreatment state. Frequency, incontinence and urine loss by the 60-minute padweighing test decreased significantly to one-third to one-fifth of the pretreatment state. The patient is doing well without any side effects 3 years after initiation of the treatment.

Pelvic floor reeducation and body posture correction for treatment of female urinary incontinence: Results of comprehensive pre‐ and post‐treatment urodynamic testing

AbstractOf the conservative treatment modalities for stress urinary incontinence in females, the effectiveness of electric pelvic floor stimulation and exercise programs for reeducation of pelvic floor muscles are generally accepted and recognized. This prospective study reports on the analysis of subjective and objective pre‐ and post‐treatment parameters in 12 selected female patients with stress incontinence who were enrolled in a physiotherapeutical training program consisting of acute intrarectal electrostimulation, pelvic floor exercises, and body posture correction (Mensendieck). Patients' symptom scores, performance status of pelvic floor muscles, body posture alterations as well as standard urodynamic parameters (maximal urethral closing pressure, functional urethral length, and maximum cystometric capacity), and telemetric ambulatory urodynamic parameters (pad‐weighing test, urethral relaxations) were analyzed. This study shows the advantageous effect of pelvic floor reeducation and body posture correction for the treatment of female low‐urethral‐resistance urinary incontinence. A remarkable finding was the coalescence of genuine stress incontinence, proven on standard urodynamic investigation, and urethral instability on telemetric ambulatory urodynamic investigation in 10 of 12 patients (83%). This was very well treated by the training program. Pathophysiology of low‐urethral‐resistance urinary incontinence and the mode of action of the training program are discussed. © 1992 Wiley‐Liss, Inc.

Pad-weighing tests in the diagnosis and quantification of incontinence

Pad tests for assessing urinary incontinence have existed for over 20 years, but have recently been subject to scientific scrutiny. Essentially there are two types of tests, those carried out in the laboratory or office and those done at home. The principal issues are those of accuracy and validity, the latter usually being a question of reproducibility. The laboratory tests last for 1 or 2 hours, have precisely defined exercise regimens and documented normal loss rates of less than 2 g/h. For the tests where bladder volume is regulated, reproducibility is better but the tests are more invasive. These office tests have a high predictive value positive but do suffer from an excessive false negative rate. Home pad tests, on the other hand are less regulated, last for 24 or 48 hours and have normal loss rates of less than 8 g/24 h. They have a better predictive value negative and an equivalent predictive value positive and so are probably superior in terms of their reproducibility. Pad tests have their limitations but should be regarded as a valuable component of the urodynamic armamentarium.