Pure Urge Research Articles

Conservative treatment options for female incontinence

In this narrative review, we give an overview of contemporary conservative treatment concepts for urinary incontinence in female patients. Hereby, we focus on pure stress urinary incontinence, urge incontinence and mixed urinary incontinence. We emphasise the value of rationally used diagnostic methods to be able to distinguish between these subentities. Regarding conservative treatment options, we focus on life-style changes, pelvic floor muscle training and drug treatment, and we discuss the results of recent studies. In addition, we provide current expert opinions and recommendations to facilitate the integration of these findings into the daily clinical routine.

Relationship between urinary incontinence symptoms and urodynamic findings using a validated Arabic questionnaire.

BACKGROUNDUrinary incontinence is common, particularly in women. Urodynamic studies (UDS) can accurately assess the condition. Less invasive objective measuring tools correlate with urodynamic findings, but the Arabic version of the Urogenital Distress Inventory-6 (UDI-6) questionnaire has not been previously correlated with UDS in Arabian patients.OBJECTIVETo correlate the Arabic version of the UDI-6 with urodynamic findings in Arabian women with urinary incontinence.DESIGNProspective.SETTINGTertiary referral urology clinic.PATIENTS AND METHODSAll female patients presenting with urinary incontinence between July 2013 to March 2014. Patients answered the Arabic UDI-6 questionnaire and underwent a history and clinical examination, urine culture and UDS.MAIN OUTCOME MEASURESCorrelation between Arabic UDI-6 questionnaire score and urodynamic diagnosis.RESULTSEighty-seven women with a mean age of 57 (range, 22–72) years completed the UDI-6 and underwent UDS. The questionnaire revealed that 20 (23%) patients had urge incontinence, 28 (32%) had stress incontinence and 39 (45%) had mixed incontinence. As diagnosed by UDS, 26 (30%) had urge incontinence, 37 (42%) had stress incontinence, 16 (18%) had mixed incontinence and 8 (9%) had no abnormality. Eighty-six percent of patients (24/28) with pure stress urinary incontinence (SUI) symptoms had a positive UDS, and 55% (11/20) of patients with pure urge incontinence symptoms had a positive UDS. Of all patients with positive response to the question for SUI, 53/67, 79% had positive UDS diagnosis with a correlation coefficient of 0.65 (P<.01). Of all patients with positive responses for urge incontinence, 27/59, 45.8% had positive UDS diagnosis with a moderate correlation coefficient of 0.38 (P<.01).CONCLUSIONSThe validated Arabic UDI-6 correlates significantly with UDS findings in Arabian women, particularly in women with SUI.LIMITATIONSThe sample size was relatively small, which prevented sub-analyses. Patient comorbidities were not evaluated.

Restless legs syndrome: pathophysiology and treatment.

Restless legs syndrome (RLS) is a complicated sensory-motor syndrome. The pathology is increasingly understood, but a clear physiologic understanding still remains elusive. The most robust findings remain reduced central nervous system (CNS) iron and some perturbation in dopaminergic systems. Other neurotransmitter systems are also like involved, and the phenotype may result from distinct pathophysiologic processes. Treatment of RLS is often very successful, and treatment goals should be high. Dopamine agonists may most robustly improve pure urge to move and certainly periodic limb movements. They do not directly improve sleep, and long-term use is limited by augmentation. Alpha-2-delta ligand drugs such as gabapentin enacarbil and pregabalin improve RLS, presumably in a less specific manner. These drugs increase slow wave sleep and improve pain, but have less impact on leg movements. Mu specific opioids also robustly improve RLS and are probably underutilized in severe cases. Intravenous iron inconsistently but sometimes considerably improves RLS and can be considered in refractory cases.

Association of urinary incontinence and sexual function in women.

To investigate the association between urinary incontinence and female sexual function in a non-clinical population. A self-administered questionnaire was distributed to 2159 female employees of two hospitals. Of the 883 sexually active participants, pure stress urinary incontinence was reported in 18.3%, pure urge urinary incontinence in 6.8%, mixed urinary incontinence in 15.1% and no urinary incontinence in 59.8%. The prevalence of female sexual difficulty, defined by the Female Sexual Function Index total score ≤ 26.55, was 52.0%, 56.1%, 54.3% and 42.2%, respectively (P < 0.05). After adjustment of age, menstrual status, length of marriage, having children and relationship with the partner, all types of urinary incontinence showed a significant association with female sexual difficulty with an odds ratio of 1.6-1.8. Taking into consideration the individual domains, pure urge urinary incontinence was a risk factor for decreased sexual lubrication and more sexual pain, and mixed urinary incontinence was a risk factor for less sexual satisfaction, whereas pure stress urinary incontinence was not related to a difficulty in individual domains. Stress urinary incontinence and urge urinary incontinence are associated with general impairment of female sexual function to a mild degree. Only urge urinary incontinence is related to sexual difficulty in specific domains including sexual lubrication and sexual pain.

Minimum important difference for validated instruments in women with urge incontinence

Minimum important difference (MID) estimates the minimum degree of change in an instrument's score that correlates with subjective sense of improvement. The aim of this study was to estimate the MID for the Urogenital Distress Inventory (UDI), Incontinence Impact Questionnaire (IIQ) and Overactive Bladder Questionnaire (OAB-q) using anchor and distribution-based approaches in patients with urge-predominant incontinence and whether MID changes over time. This was a sub-analysis of a multi-center trial of 307 women with pure urge (11) or urge-predominant (296) incontinence who completed condition-specific instruments 10 weeks and 8 months after randomization to anticholinergic medication with or without behavioral therapy. We applied anchor-based methods only when the Kendall's rank correlations between the anchors (Global Perception of Improvement (GPI), Patient Satisfaction Questionnaire (PSQ), and incontinence episodes) and the incontinence instruments (UDI, UDI irritative subscale, IIQ, and OAB-q subscales) were ≥ 0.3. We applied three distribution-based methods to all instruments: effect sizes of ± 0.2 SD (small) and ± 0.5 SD (medium), and standard error of measurement of ± 1. Analyses were performed at both time points. Anchor-based MIDs for the UDI ranged from -35 to -45 and -15 to -25 for the irritative subscale distribution-based methods MIDs for UDI and IIQ ranged between -10 to -25 and -19 to -49, respectively, reflective of a reduction in bother and symptom severity (SS). OAB-q subscale MIDs ranged from +5 to +12, denoting improved quality of life (HRQL) and -13 to -25, consistent with a reduction in SS. The MID in women with urge-predominant UI for the UDI and UDI irritative are -35 and -15. Our findings are consistent with previously reported MIDs for the OAB-q subscales. Distribution-based method MIDs are lower values than anchor-based values. The MID did not typically change over the time.

1867 LOWER URINARY TRACT SYMPTOMS AND PELVIC PAIN IN YOUNG WOMEN AND THE EFFECTS OF PEDIATRIC VOIDING DYSFUNCTION

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Female Urology1 Apr 20111867 LOWER URINARY TRACT SYMPTOMS AND PELVIC PAIN IN YOUNG WOMEN AND THE EFFECTS OF PEDIATRIC VOIDING DYSFUNCTION W. Stuart Reynolds, Roger Dmochowski, and Harriette Scarpero W. Stuart ReynoldsW. Stuart Reynolds Nashville, TN More articles by this author , Roger DmochowskiRoger Dmochowski Nashville, TN More articles by this author , and Harriette ScarperoHarriette Scarpero Nashville, TN More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1949AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Little is known about pelvic floor symptoms in young nulliparous women, particularly related to etiology and associated conditions. We performed an email-based survey at our institution collecting information on lower urinary tract (LUTS) and pelvic symptoms specifically in young women ascertaining the prevalence of pelvic symptoms (specifically frequency-urgency, urinary incontinence and pelvic pain or painful urination) and associated conditions. We hypothesized that women with pelvic floor symptoms would have an increased rate of childhood voiding and elimination disorders. METHODS Women older than 18 were anonymously recruited to complete an online questionnaire circulated by email to faculty, staff and students at our university medical center. Information regarding demographic information, medical and gynecologic history, voiding and pelvic symptoms and quality of life was obtained. RESULTS 811 respondents, aged 18–40, were analyzed for this study. Overall, 474 (58%) have symptoms either “frequently” or “all the time” and were considered to have pelvic floor dysfunction (PFD): 59 (7%) experience frequency/urgency; 334 (41%) experience urinary incontinence; and 81 (10%) experience pelvic pain. Of those with incontinence, 23% reported pure stress incontinence, 11% pure urge incontinence, and 14% mixed incontinence. Overall, 299 (37%) women reported a history of pediatric voiding or elimination dysfunction, either bedwetting (8%), frequency/incontinence (3%), urinary tract infections (17%), or constipation/encopresis (9%). 208 (44%) of patients with PFD had a history of pediatric dysfunction while only 91 (27%) with no PFD had a similar history (p<0.001). Patients with PFD vs. without PFD more frequently reported childhood bedwetting (9% vs. 7%), frequency/incontinence (4% vs. 1%), UTI (20% vs.12%), and constipation (11% vs.7%) [p<0.001]. A history of any pediatric dysfunction was associated with an increased prevalence of PFD (adjusted OR 1.94, 95% CI [1.42, 2.63]), when corrected for overall health, mode of delivery, exercise and endometriosis on multivariate regression analysis. CONCLUSIONS Pelvic symptoms (LUTS and pelvic pain) are common in women aged 18–40 years and appear to be associated with a history of childhood voiding and elimination disorders. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e749 Peer Review Report Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information W. Stuart Reynolds Nashville, TN More articles by this author Roger Dmochowski Nashville, TN More articles by this author Harriette Scarpero Nashville, TN More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Once-Daily Trospium Chloride 60 mg Extended Release in Subjects with Overactive Bladder Syndrome Who Use Multiple Concomitant Medications

Overactive bladder syndrome (OAB) is associated with various co-morbidities; treatment of these frequently results in multiple medication use (MMU) and the potential for drug-drug interactions, which may lead to adverse events and altered efficacy. With the aging population, the prevalence of MMU is likely to increase in the overall population, an increase due in part to treatment of co-morbidities that are more common in the elderly. To assess safety and efficacy outcomes with once-daily trospium chloride 60 mg extended release (XR) in subjects with OAB who were taking multiple concomitant medications. Post hoc analysis of pooled data from two 12-week randomized, placebo-controlled studies. Urology, urogynaecology, and primary care offices/clinics. Subjects aged ≥18 years with OAB for ≥6 months who had baseline urinary frequency of ≥30 toilet voids/3 days; ≥1 'severe' urgency severity rating/3 days (on the Indevus Urgency Severity Scale); and pure urge urinary incontinence (UUI) or mixed incontinence with predominant UUI, with ≥3 UUI episodes/3 days. This analysis utilized data from subjects taking concomitant medications, focusing on those taking seven or more. Once-daily trospium chloride 60 mg XR or placebo. Predictors of treatment-emergent adverse events (TEAEs) identified by multivariate logistic regression analysis. Concomitant medications were being taken by 1135 subjects (placebo, n = 576; trospium chloride XR, n = 559); 427 were taking seven or more (placebo, n = 199; trospium XR, n = 228). Among subjects taking seven or more concomitant medications, there was no significant difference between trospium chloride XR and placebo in the proportion of subjects experiencing one or more TEAEs (64.5% vs 58.3%). Logistic regression analysis indicated that the odds of experiencing a TEAE were influenced by concomitant medication use, but not by randomization assignment to trospium chloride XR or to placebo, suggesting that concomitant drugs contribute more to TEAEs than trospium chloride XR. Compared with subjects taking one to two concomitant medications, the adjusted odds ratio (OR) for experiencing any TEAE was 3.39 (95% CI 2.39, 4.80; p < 0.0001) for subjects taking seven or more concomitant medications. The adjusted OR for experiencing any TEAE for subjects randomized to active treatment compared with placebo was 1.19 (95% CI 0.85, 1.67; p = 0.31). Efficacy in subjects taking seven or more concomitant medications was similar to that in the overall pooled study population. Trospium chloride XR does not increase the likelihood of a TEAE compared with placebo. The probability of experiencing a TEAE was significantly influenced by use of multiple concomitant medications. Trospium chloride XR was as effective in subjects with OAB taking seven or more concomitant medications as in the overall pooled study population. The data support the conclusion that trospium chloride XR is safe and effective in patients with OAB taking multiple concomitant medications.

Stress Incontinence During the Learning Curve of Holmium Laser Enucleation of the Prostate

Holmium laser enucleation of the prostate (HoLEP) is an excellent surgical treatment for patients with benign prostatic hyperplasia, but surgical complications are not well described. We set out to determine the predictors of stress incontinence (SUI) after HoLEP during the learning curve. A retrospective review of our institution's HoLEP database was performed. Patients were divided into two groups: No pads at 3 months (group 1); SUI and/or mixed incontinence necessitating ≥ one pad at 3 months (group 2). Seventy-seven patients underwent HoLEP at our institution. Nine (12%) were excluded for pure urge symptoms and two (3%) were lost to follow-up, leaving 66 total patients. No differences were noted as regards age (P = 0.54), operating room time (P = 0.18), prostate size (P = 0.85), prostate-specific antigen level (P = 0.96), or International Prostate Symptom Score (P = 0.11). The number of days between cases, however, was higher in group 2 (44.5 vs 18.1, P = 0.02) and was associated with SUI in simple logistic regression models (odds ratio [OR] 1.25; 95% confidence interval [CI]: 1.04-1.51; P = 0.019). As the interval time between cases increased from 1, 3, and 5 weeks, the strength of the association increased (1 week: OR 2.75; 95% CI: 0.78-9.66; P = 0.12; 3 weeks: OR 2.86; 95% CI: 0.92-8.91; P = 0.07; 5 weeks: OR 4.69; 95% CI: 1.21-18.26; P = 0.026). SUI resolved in all but two patients by 1 year. The major associated risk for SUI, a complication presumably related to surgical technique, was prolonged duration between cases. During the learning curve, surgeons should schedule patients frequently to enhance learning and decrease time to mastery of the technique, thereby reducing SUI.

THE ADVANCE MALE SLING: PREDICTORS OF SUCCESS

A distal cuff location is often required in patients undergoing artificial urinary sphincter reimplantation after previous erosion or in those requiring revision because of urethral atrophy at the original cuff site. Dissecting the urethra at a more distal site increases the risk of urethral injury and erosion, and often the urethral circumference is so small that a 4 cm. cuff is too large. We present a novel technique for distal cuff placement using transcorporal dissection that leaves corporal tunica albuginea on the dorsal surface of the urethra, allowing for its safer mobilization and adding to its bulk.We reviewed the charts of 31 men who underwent this technique and contacted 26 by telephone. The indications for distal transcorporal cuff placement varied. In 7 men with inadequate urethral coaptation with a 4 cm. proximal cuff at initial implantation a primary transcorporal tandem cuff was implanted distal. In 8 men persistent or recurrent incontinence despite a 4 cm. proximal cuff led to secondary distal reimplantation. Previous artificial urinary sphincter erosion and/or infection in 10 cases, previous urethral surgery at the optimal cuff site in 5 and radiation changes at the optimal cuff site in 1 led to selection of the more distal site and technique. Of the transcorporally placed cuffs 18 were 4 cm. and 13 were 4.5 cm. Preoperatively 5.2 pads were used daily. Of the 31 patients 27 were impotent preoperatively, 1 had normal erections, 1 had partial erections with the MUSE drug delivery system (Vivus, Inc., Menlo Park, California) and 2 had a previously placed penile prosthesis.At a mean followup of 17 months 26 of the 31 patients (84%) had occasional or no stress incontinence requiring 0 to 1 pad daily, 2 with pure urge incontinence used 1 to 2 pads daily and 3 had mixed incontinence requiring 0 to 3 pads daily. Of the 26 men surveyed 25 were very satisfied with the postoperative level of incontinence. Postoperatively erectile function deteriorated in 1 patient and was unchanged in the remainder. There was no erosion or infection of the transcorporally placed cuffs, although 3 were replaced for malfunction.This technique offers significant advantages in cases of revision. The technique protects the urethra from intraoperative dissection injury and decreases the risk of erosion because the urethra is buttressed at its vulnerable location. In addition, bulk is added to the urethra, allowing for better cuff sizing, which is usually a problem at this location where the urethra is small, thereby, improving continence in revised cases. Our success has recently led us to abandon tandem cuff placement altogether. There is a potential for deteriorating erectile function in potent men who undergo implantation in this fashion.

Incidence and Remission of Lower Urinary Tract Symptoms During 12 Years After the First Delivery: A Cohort Study

We estimated the incidence and remission of lower urinary tract symptoms during the 12 years following the first pregnancy and delivery. In a cohort study 242 primiparae were questioned about lower urinary tract symptoms 3 months, 5 years and 12 years after the first delivery. From 3 months to 5 years after first delivery the incidence of stress urinary incontinence, urge urinary incontinence, urgency, diurnal frequency and nocturia was 56 of 213 cases (26.3%), 33 of 219 (15.1%), 33 of 206 (16.0%), 49 of 219 (22.4%) and 6 of 225 (2.7%), respectively. Remission of stress urinary incontinence, urge urinary incontinence, urgency, diurnal frequency and nocturia during the same period occurred in 1 of 11 cases (9.1%), 2 of 5 (40%), 2 of 5 (40%), 4 of 7 (57.1%) and 1 of 1 (100%), respectively. From 5 to 12 years after the first delivery the incidence of stress urinary incontinence, urge urinary incontinence, urgency, diurnal frequency and nocturia was 40 of 158 cases (25.3%), 25 of 188 (13.3%), 24 of 175 (13.7%), 40 of 174 (23.0%) and 13 of 220 (5.9%), respectively. Remission of stress urinary incontinence, urge urinary incontinence, urgency, diurnal frequency and nocturia during the same period occurred in 14 of 66 cases (21.2%), 13 of 36 (36.1%), 22 of 36 (61.1%), 14 of 52 (26.9%) and 4 of 6 (66.7%), respectively. Of 62 women with pure stress urinary incontinence during the first pregnancy and puerperium 20 (32.2%) had pure stress urinary incontinence, 3 (4.8%) had pure urge urinary incontinence and 15 (24.2%) had mixed urinary incontinence 12 years later. Of 13 women with pure urge urinary incontinence during the first pregnancy and puerperium 3 (23.1%) had pure urge urinary incontinence, 2 (15.4%) had pure stress urinary incontinence and 3 (23.1%) had mixed urinary incontinence 12 years later. The overall prevalence of lower urinary tract symptoms 12 years after the first delivery increased significantly. The incidence and remission of lower urinary tract symptoms after the first pregnancy and delivery fluctuate and the types of urinary incontinence may interchange, while the overall prevalence of lower urinary tract symptoms increases in the long term.

Mixed incontinence is more bothersome than pure incontinence subtypes

The purpose of the study was to compare incontinence bother in women with mixed incontinence versus pure incontinence subtypes. This is an institutional review board-approved study comparing physical exam findings and responses to the Medical Epidemiologic and Social Aspects of Aging (MESA) questionnaire and the Urinary Distress Inventory (UDI-6). The MESA responses were used to classify women as mixed, pure stress, or pure urge incontinence. This analysis includes 551 women with a mean age of 56 +/- 16 years. Most women were Caucasian (86%) with 7% African American and 5% Hispanic. UDI scores were significantly higher in women with mixed incontinence (61 +/- 23) than those with pure stress incontinence (40 +/- 26) or pure urge incontinence (40 +/- 25; p < 0.0001). Women with mixed incontinence report greater incontinence bother than women with either pure stress or urge incontinence.

Establishing the Prevalence of Incontinence Study: Racial Differences in Women’s Patterns of Urinary Incontinence

We examine racial differences in urinary incontinence prevalence, frequency, quantity, type, and risk factors in a population based sample of community dwelling black and white women. Women 35 to 64 years old were sampled from telephone records from 3 southeast Michigan counties. Women self-identifying as black or white race completed a telephone interview that assessed demographics, health history, lifestyle factors and urinary incontinence experience. Statistical analysis included descriptive statistics, factor analysis and multivariable logistic regression to determine adjusted odds of urinary incontinence. Estimates were weighted to reflect probability and nonresponse characteristics of the sample, and to increase generalizability of the findings. Interviews were completed by 1,922 black and 892 white women (response rate = 69%). The overall prevalence of urinary incontinence was 26.5%. By race, urinary incontinence prevalence was 14.6% for black women and 33.1% for white women (p <0.001). Among incontinent women there was no difference by race in the frequency of urinary incontinence. However, black women reported more urine loss per episode (p <0.05). A larger proportion of white women with incontinence (39.2%) reported symptoms of pure stress incontinence compared to black women (25.0%), whereas a larger proportion of black women (23.8%) reported symptoms of pure urge incontinence compared to white women (11.0%). Risk factors for urinary incontinence were generally similar for white and black women. In this population based study we observed racial differences in prevalence, quantity and type of urinary incontinence. Frequency of and risk factors for urinary incontinence were generally similar for white and black women.

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

We determined racial differences in urinary incontinence prevalence using the 2001-2004 National Health and Nutrition Examination Survey. The National Health and Nutrition Examination Survey is a continuous survey of a representative sample of the noninstitutionalized United States population. Demographic, self-reported racial/ethnic data and responses to the urinary portion of the survey were available for 4,229 women older than 20 years. We classified women by urinary incontinence subtype, that is pure stress incontinence, pure urge incontinence or mixed incontinence. Logistic regression models were fitted to investigate racial differences by type of urinary incontinence. The sample was racially and ethnically diverse with 58% white nonHispanic, 22% Mexican-American and 20% black nonHispanic. Women were divided into 3 age ranges of 20 to 39 years old (36.3%), 40 to 59 (28%), and 60 years old or older (35.7%). Of the 4,229 women in the analytical sample 49.6% (2,098) reported urinary incontinence symptoms. Of those reporting incontinence symptoms 49.8% reported pure stress incontinence, 34.3% mixed incontinence and 15.9% pure urge incontinence. The odds of pure stress incontinence in white and Mexican-American women were approximately 2.5 times higher than in black women (OR 2.79, CI 2.1-3.8 and OR 2.5, CI 1.9-3.4) after adjusting for age, parity, body mass index and activity level. In contrast, black and Mexican-American women were more likely to report pure urge incontinence compared to white women (OR 0.6, CI 0.43-0.8). The prevalence of mixed incontinence was not significantly different among race/ethnicity groups. Race/ethnicity differences exist in self-reported urinary incontinence. While self-reported urinary incontinence is prevalent in United States community dwelling women regardless of racial background, the odds of pure stress incontinence are at least 2.5-fold higher in white and Mexican-American women than in black women.

Prevalence of Urinary Incontinence and Lower Urinary Tract Symptoms for Community-Dwelling Elderly 85 Years of Age and Older

We sought to identify the prevalence of urinary incontinence (UI) and lower urinary tract symptoms (LUTS) and to evaluate the risk factors of community-dwelling South Korean elders for developing UI. We undertook a cross-sectional study based on interviews using a structured questionnaire. One hundred thirty-five community-dwelling elders, aged 85 years and older residing in 9 villages of Jeju Island, South Korea, were interviewed. Of 218 persons registered by the provincial government, interviews with 135 (62%) persons were completed. Between April 5, 2004 and May 31, 2004, a researcher or 1 of 3 research assistants visited each subject's home. The interview took approximately 40 minutes to complete. Data were recorded by a research assistant and interviews were performed by the primary investigator or research assistant. LUTS severity was assessed by the Korean version of the International Prostate Symptom Score (IPSS) (7 items), and 3 additional items that specifically queried Urinary Incontinence (UI). Cognitive function and depression were assessed using the Korean version of the Mini Mental State Examination (MMSE-K) (13 items) and Geriatric Depression Scale Short Form Korean Version (GDSSF-K) (15 items). Forty-seven elderly (34.8%) reported UI more than once a week during the prior 12 months. Mixed UI symptoms were reported by 29 subjects (61.7%), pure urge UI symptoms by 16 (34.0%), and pure stress UI symptoms by 2 respondents (4.3%). The mean IPSS score of the subjects was 6.0 +/- 6.3 (range: 0-35). Risk factors for developing UI were moderate (odds ratio (OR) 17.6; 95% confidence interval (CI) 6.87-45.30) and severe LUTS (OR 36.5; 95% CI 3.86-345.07) measured by the IPSS. UI was found to affect 34.8% (47) of the community-dwelling elders 85 years or older in this study and mixed UI symptoms were predominant. LUTS was associated with an increased risk of UI.

Do sleep problems or urinary incontinence predict falls in elderly women?

The objectives of this cross-sectional study were: (1) To determine if night-time sleep disturbance, daytime sleepiness, or urinary incontinence were associated with an increased risk of falling in older Australian women and (2) to explore the interrelationships between daytime sleepiness, night-time sleep problems, and urge incontinence. Participants were 782 ambulatory, community-dwelling women aged 75 to 86 recruited from within the existing Calcium Intake Fracture Outcome Study, in which women above 70 years were selected at random from the electoral roll. Daytime sleepiness, night-time sleep problems, urinary incontinence and falls data were collected via self-complete questionnaires. Thirty-five per cent of participants had fallen at least once in the past 12 months and 37.7% reported at least one night-time sleep problem. However, only 8.1% of the study sample experienced abnormal daytime sleepiness (Epworth Sleepiness Scale score > 10). Pure stress, pure urge, and mixed incontinence occurred in 36.8%, 3.7%, and 32.6% of participants respectively. In forward stepwise multiple logistic regression analysis, urge incontinence (OR 1.76; 95% CI 1.29 to 2.41) and abnormal daytime sleepiness (OR 2.05; 95% CI 1.21 to 3.49) were significant independent risk factors for falling after controlling for other falls risk factors (age, central nervous system drugs, cardiovascular drugs). As urge incontinence and abnormal daytime sleepiness were independently associated with an increased falls risk, effective management of these problems may reduce the risk of falling in older women.

1310: Minimal Invasive Cough Leak Point Pressure (CLPP) Measurements Differentiates Between Patients with Pure Stress, Pure Urge or Mixed Incontinence

You have accessJournal of UrologyModerated Poster, Tuesday, May 24, 2005, 1:00 - 3:00 pm1 Apr 20051310: Minimal Invasive Cough Leak Point Pressure (CLPP) Measurements Differentiates Between Patients with Pure Stress, Pure Urge or Mixed Incontinence Sebastian Wille, Rolf von Knobloch, and Rainer Hofmann Sebastian WilleSebastian Wille More articles by this author , Rolf von KnoblochRolf von Knobloch More articles by this author , and Rainer HofmannRainer Hofmann More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)35455-7AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "1310: Minimal Invasive Cough Leak Point Pressure (CLPP) Measurements Differentiates Between Patients with Pure Stress, Pure Urge or Mixed Incontinence." The Journal of Urology, 173(4S), p. 356 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 173Issue 4SApril 2005Page: 356 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Sebastian Wille More articles by this author Rolf von Knobloch More articles by this author Rainer Hofmann More articles by this author Expand All Advertisement PDF downloadLoading ...

365Minimal invasive cough leak point pressure (CLPP) measurements differentiates between patients with pure stress, pure urge or mixed incontinence

365Minimal invasive cough leak point pressure (CLPP) measurements differentiates between patients with pure stress, pure urge or mixed incontinence

Transcorporal Artificial Urinary Sphincter Cuff Placement in Cases Requiring Revision for Erosion and Urethral Atrophy

A distal cuff location is often required in patients undergoing artificial urinary sphincter reimplantation after previous erosion or in those requiring revision because of urethral atrophy at the original cuff site. Dissecting the urethra at a more distal site increases the risk of urethral injury and erosion, and often the urethral circumference is so small that a 4 cm. cuff is too large. We present a novel technique for distal cuff placement using transcorporal dissection that leaves corporal tunica albuginea on the dorsal surface of the urethra, allowing for its safer mobilization and adding to its bulk. We reviewed the charts of 31 men who underwent this technique and contacted 26 by telephone. The indications for distal transcorporal cuff placement varied. In 7 men with inadequate urethral coaptation with a 4 cm. proximal cuff at initial implantation a primary transcorporal tandem cuff was implanted distal. In 8 men persistent or recurrent incontinence despite a 4 cm. proximal cuff led to secondary distal reimplantation. Previous artificial urinary sphincter erosion and/or infection in 10 cases, previous urethral surgery at the optimal cuff site in 5 and radiation changes at the optimal cuff site in 1 led to selection of the more distal site and technique. Of the transcorporally placed cuffs 18 were 4 cm. and 13 were 4.5 cm. Preoperatively 5.2 pads were used daily. Of the 31 patients 27 were impotent preoperatively, 1 had normal erections, 1 had partial erections with the MUSE drug delivery system (Vivus, Inc., Menlo Park, California) and 2 had a previously placed penile prosthesis. At a mean followup of 17 months 26 of the 31 patients (84%) had occasional or no stress incontinence requiring 0 to 1 pad daily, 2 with pure urge incontinence used 1 to 2 pads daily and 3 had mixed incontinence requiring 0 to 3 pads daily. Of the 26 men surveyed 25 were very satisfied with the postoperative level of incontinence. Postoperatively erectile function deteriorated in 1 patient and was unchanged in the remainder. There was no erosion or infection of the transcorporally placed cuffs, although 3 were replaced for malfunction. This technique offers significant advantages in cases of revision. The technique protects the urethra from intraoperative dissection injury and decreases the risk of erosion because the urethra is buttressed at its vulnerable location. In addition, bulk is added to the urethra, allowing for better cuff sizing, which is usually a problem at this location where the urethra is small, thereby, improving continence in revised cases. Our success has recently led us to abandon tandem cuff placement altogether. There is a potential for deteriorating erectile function in potent men who undergo implantation in this fashion.

Gore-Tex patch sling: 7 years later

Objectives. To assess the long-term results of a transvaginal endoscopic Gore-Tex patch sling in women with genuine stress urinary incontinence due to urethral hypermobility and/or intrinsic sphincter deficiency, with or without coexistent urge incontinence. Methods. Between December 1989 and June 1994, we performed a Gore-Tex patch sling procedure in 141 consecutive women. All patients had documented stress urinary incontinence on preoperative videourodynamic testing. We conducted outcomes analysis using the information from postoperative office visits, detailed chart reviews, patient questionnaires, and telephone surveys. Results. A complete follow-up was available in 90 patients. The mean follow-up was 51 months (range 27 to 84). Their mean age was 54.2 years (range 32 to 86). Stress incontinence was completely cured in 80 (88.9%) of 90 patients. Pure stress incontinence persisted in 4 (4.4%) of 90 patients. Mixed incontinence occurred in 6 (6.7%) of 90 patients. Pure urge incontinence was experienced by 16 (17.8%) of 90 patients. Six patients required incision of the Gore-Tex patch for obstruction or retention; 3 remain continent. Five patients developed vaginal granulation tissue requiring Gore-Tex patch removal; 1 remains continent. There was no bladder or urethral erosion. Conclusions. The transvaginal Gore-Tex patch sling has provided durable efficacy with minimal morbidity for the treatment of stress urinary incontinence due to anatomic urethral hypermobility and/or intrinsic sphincter deficiency.

Characteristics of Urinary Incontinence in Homebound Older Adults

To describe the characteristics of urinary incontinence and related factors in incontinent homebound older adults. A descriptive study of 90 cognitively intact incontinent homebound older persons referred to a clinical trial to examine the effectiveness of behavioral therapies in the treatment of urinary incontinence (UI) in homebound patients. Incontinent patients more than 60 years of age who met the Health Care Financing Administration's definition of homebound were referred to a clinical trial by home care nurses from a Medicare-approved home care agency in a large metropolitan country in Pennsylvania. Structured continence and medical history, basic and instrumental activities of daily living, Folstein MMSE, Geriatric Depression Scale, mobility-toileting skills, bladder diaries, and physical examination. Four hundred eighty-four persons were referred to the clinical trial, and 90 cognitively intact persons were found eligible to participate in this study (80 women and 10 men). Subjects had a mean age of 75.8 years, reported a mean of 8.4 medical problems, and most, 80%, had functional limitations in ambulation. Subjects recorded a mean of 3.8 urinary accidents/day-1.4 large and 2.4 small accidents/ day-in baseline bladder diaries. The majority, 73.3%, had more than 10 accidents per week, and most patients reported mixed urge, stress (57.1%), or pure urge (37.7%) UI. Half (54.4%) reported that UI further restricted their activities, and 52.2% reported that this problem was extremely disturbing. However, 90.5% believed that UI could be treated. Urinary incontinence tends to be severe among cognitively intact homebound older adults in both frequency and volume of accidents. Although subjects were homebound with many health and functional disabilities, they perceived UI as a very disturbing problem that further restricted their activities. Participants in this study were optimistic about the potential benefits of treatment.