Reduction In Urinary Incontinence Research Articles

EFFECTIVENESS OF HYPOPRESSIVE EXERCISES ON POSTNATAL MOTHERS WITH URINARY INCONTINENCE-A PILOT STUDY.

Background: Pelvic Floor Muscle Dysfunctions can lead to Urinary Incontinence, a condition which often affects women both during pregnancy and after childbirth. As a result of this, certain exercises are recommended during and after pregnancy to prevent and treat this incontinence. Hypopressive Exercise is one of these methods used to prevent Urinary Incontinence. Objective: The purpose of the study is to find the Effectiveness of Hypopressive Exercises on Postnatal Mothers with Urinary Incontinence. Methods: 30 Mothers (between the age group of 25 – 35 years) clinically pre diagnosed with urinary incontinence with PERFECT score were included in the study. with informed consent, the protocol was explained to the subjects. Mothers were given Hypopressive Exercises for 3 sessions per week for 4 weeks. This session lasted between 30 to 40 minutes. The outcome measure of the Exercises was measured using UI – QUID and PERFECT test. Results were tabulated using statistical analysis. Result: The analysis shows that the mothers who underwent Hypopressive exercises have significant reduction in urinary incontinence (p-value) P<0.0001. Conclusion: This study concluded that the mothers underwent Hypopressive exercises have significant reduction in Urinary Incontinence and increase in Pelvic Floor Muscle Strength Implications: The Hypopressive Exercises strengthens the Deep Core Muscles which increases body awareness by training the Pelvic Floor Muscles in women and reduces Urinary Incontinence. These Exercises not only pay attention to maintaining proper body posture and Pelvic Floor Muscles activation. But also had a positive impact on the Quality of Life and reduction of incidents of urine leakage among mothers.

The Effectiveness of Modified Pilates Program with and without Kinesiotaping on Postnatal Urinary Stress Incontinence: A Randomized Clinical Trial

Introduction: Urinary Stress Incontinence is very common condition seen in postnatal woman. Without pelvic floor strengthening this condition will lead to social inhibition. The rate of urinary stress incontinence is more in normal vaginal delivery compared to C-Section. Few authors have demonstrated the effectiveness of Kegal exercise and Pilates on such woman with urinary stress incontinence. There is dirth in the literature related to effect of Kinesiotaping in reduction of urinary stress incontinence.
 Research Objective: The objective of the research was to find out the effect of Kinesiotape along with the Modified Pilates program on subjects with postnatal urinary incontinence.
 Methodology: This is an experimental study with randomised clinical trial design and the study setting was Bruhat Bangalore Mahanagar Palike, and the included 50 postnatal women who underwent vaginal delivery. The sample was divided into two groups: Group A (25) were subjected to Modified Pilates Program with Kinesiotaping and Group B (25) were subjected to Modified Pilates Program alone. The intervention was conducted for 6 weeks. The outcome measures like: PERFECT Scheme, Questionnaire for Urinary Incontinence Diagnosis and Urogenital Distress Inventory were assessed both pre and post therapy at 6th week.
 Results: Pre therapy both groups showed no statistical significance. Post therapy; Group A showed significant result with respect to all three outcome measures PERFECT (<0.0001), QUID (<0.001) and UDI (<0.001) and Group B showed significance only with respect to PERFECT Scheme (<0.05).
 Conclusion: The study concluded that Modified Pilates will no doubt strengthen the pelvic floor muscle; but Kinesiotape addition to it will improve the strength by maintaining it and thus increasing the quality of life of the patient. Thus, using kinesiotape during the pelvic floor rehabilitation of Postnatal women with stress incontinence will provide benefit to the patient.
 Summary: The current article concludes that Modified Pilates will strengthen the pelvic floor because of the abdominal cylinder involved along with Kinesiotape will add on to reduction in urinary incontinence because of the stimulation of sacral plexus.

One treatment with onabotulinumtoxinA relieves symptoms of overactive bladder in patients refractory to one or more oral medications.

Patients with overactive bladder (OAB) often undergo prolonged treatment with one or more oral OAB medications. OnabotulinumtoxinA (onabotA), a type A botulinum toxin, may provide an appropriate alternative to oral treatments in patients intolerant of or refractory to one or more oral OAB medications. The GRACE study demonstrated real-world benefits of onabotA treatment for OAB in patients refractory to oral medications. This exploratory post hoc analysis of data from the GRACE study aims to determine if treatment history impacts benefit from treatment with onabotA. This is a subanalysis of the GRACE study, a prospective observational study (NCT02161159) that enrolled patients with symptomatic OAB inadequately managed by at least one oral OAB medication. Patients had a treatment history of one or more anticholinergics (AC) and/or β-3 adrenoreceptor agonists (β-3) for relief of OAB; results were stratified according to treatment history. Patients in this analysis elected to discontinue oral medications upon treatment with onabotA. Safety was followed for 12 months in all patients that received at least 1 dose of onabotA; efficacy was determined over a 12-week period. Compared to baseline levels, significant reductions in urinary incontinence(UI), urgency, micturition, and nocturia were noted as early as 1week and were sustained at 12 weeks, regardless of the type and number of oral medications taken before treatment with onabotA. At 12 weeks post-onabotA, the mean change from baseline UI episodes/day for those with a treatment history of only one AC was -2.4 (n = 43, p ≤ 0.001); more than one AC, -2.4 (n = 52, p ≤ 0.001); one β-3, -3.3 (n = 12, p < 0.05); at least one AC and at least one β-3, -3.2 (n = 56, p ≤ 0.001). Pad and liner use was significantly decreased at 12 weeks post-onabotA across all treatment history groups. Reductions in diaper pant use varied, with less of a reduction in patients with a treatment history of more than one AC compared to patients with a history of at least one AC and one β-3 (p < 0.05) or those with a history of only one AC (p < 0.05). Overall, a total of 253/288 of patients (88%) reported improvements on the treatment benefit scale 12 weeks after treatment with onabotA, regardless of type and number of prior oral medications. In the population of patients that received at least one dose of onabotA (N = 504), 57 adverse events were reported in 38 patients (7.5%); 9 were serious (1.8%). Urinary retention was reported in 5 patients (1.0%); 1 was severe (0.2%). Symptomatic urinary tract infection was reported in 2 patients (0.4%). In this exploratory post hoc analysis of real-world data from the GRACE study, there were few significant differences in outcomes based on the type and number of prior oral medications. Thus, patients who are refractory to one or more oral OAB medications may benefit from earlier treatment with onabotA.

Efficacy and Safety of AbobotulinumtoxinA in Patients with Neurogenic Detrusor Overactivity Incontinence Performing Regular Clean Intermittent Catheterization: Pooled Results from Two Phase 3 Randomized Studies (CONTENT1 and CONTENT2)

BackgroundFor patients with neurogenic detrusor overactivity incontinence (NDOI), treatment with oral medications is often unsatisfactory. ObjectiveTo assess the efficacy and safety of abobotulinumtoxinA (aboBoNT-A) for NDOI. Design, setting, and participantsTwo randomized, double-blind phase 3 studies (CONTENT1, NCT02660138; CONTENT2, NCT02660359) enrolled patients with NDOI who were regularly performing clean intermittent catheterization (CIC) and were inadequately managed with oral therapy. Pooled results from the first placebo-controlled treatment cycle are reported. InterventionPatients received injections of aboBoNT-A 600 U (n = 162) or 800 U (n = 161) or placebo (n = 162) into the detrusor muscle. Outcome measurements and statistical analysisThe primary endpoint was the mean change from baseline in NDOI episodes per week at week 6. Secondary endpoints reported are the proportion of patients with no NDOI episodes, the volume per void, urodynamic parameters, and quality of life (QoL). Safety was also assessed. Statistical analyses were conducted for the pooled study populations (each aboBoNT-A dose vs placebo). Results and limitationsAt week 6, NDOI episodes per week were significantly reduced in each aboBoNT-A group versus placebo (both p < 0.001) and the volume per void had significantly increased. Approximately one-third of patients in each aboBoNT-A dose group reported no NDOI episodes versus 3% of patients in the placebo group. Reductions in urinary incontinence (UI) were reflected in significantly greater improvements in UI-related QoL in the aboBoNT-A groups versus placebo. Urodynamic parameters (bladder capacity and detrusor pressure) were significantly improved with each aboBoNT-A dose versus placebo. Each aboBoNT-A dose was well tolerated. Symptomatic urinary tract infection was the most frequent treatment-emergent adverse event, with incidence comparable across the aboBoNT-A and placebo groups. The studies were terminated prematurely owing to slow recruitment and were not designed for statistical comparison between the two aboBoNT-A doses. ConclusionsIntradetrusor aboBoNT-A is an effective treatment and alternative option for patients with NDOI who have an inadequate response to oral anticholinergics and are already performing CIC. Patient summaryIn patients with bladder muscle overactivity caused by neurological conditions (multiple sclerosis or spinal cord injury) and resulting in urinary incontinence, abobotulinumtoxinA injections improved their symptoms and bladder function, with no unexpected effects.

Satisfaction with Detrusor OnabotulinumtoxinA Injections and Conversion to Other Bladder Management in Patients with Chronic Spinal Cord Injury.

This study investigated the satisfaction with continued detrusor Botox injections for urinary incontinence and conversion to other surgical procedures and bladder management procedures for neurogenic detrusor overactivity (NDO) in patients with chronic spinal cord injury (SCI). A total of 223 patients with chronic SCI underwent detrusor Botox 200U for urodynamically confirmed NDO and urinary incontinence. After initial detrusor Botox injections, patients opted to either continue detrusor Botox injections every six to nine months and on clean intermittent catheterization (CIC), switch to other bladder management procedures, or receive surgical procedures to improve their urinary incontinence, correct emergent complications, or have better voiding conditions without CIC. Urinary incontinence improvement rates and satisfaction with bladder management were assessed and compared between different subgroups, urodynamic parameters, and bladder management procedures. Finally, a total of 154 male and 69 female patients were included, among whom 56 (25.1%), 81 (36.3%), 51 (22.9%), and 35 (15.7%) showed a marked, moderate, mild, and no reduction in urinary incontinence, respectively. However, only 48.4% of the patients continued detrusor Botox injections over the mean follow-up period of seven years. Patients with cervical or thoracic SCI had fair incontinence improvement rates. The presence of high detrusor pressure and higher-grade bladder outlet resistance also predicted a decrease in incontinence. Although more than 50% of the patients switched to other bladder management procedures or received surgical treatment, 69.1% expressed satisfaction with their current status. This large cohort of patients with chronic SCI who received initial detrusor Botox injections revealed that only 48.4% continued with Botox injections. Those who received surgical procedures due to urological complications or demanded change in bladder management could achieve high satisfaction rates.

Painless, Drainless Lipoabdominoplasty: A Retrospective Study of Pain Following Lipoabdominoplasty Utilizing Liposomal Bupivacaine and a Modified Enhanced Recovery After Surgery Protocol.

BackgroundThere are many functional and aesthetic benefits to lipoabdominoplasty (combination of liposuction with abdominoplasty), including increase in core strength, reduction in urinary incontinence, and improvement in lower back pain. However, patients are still hesitant to undergo surgery due to the perceived fears of postsurgical drains, and postoperative pain.ObjectivesTo propose a standardized multimodal pain protocol for patients undergoing lipoabdominoplasty procedures that aims to improve postoperative pain control.MethodsA total of 80 patients operated on between July 2020 and December 2021 were evaluated in this study. Patients all underwent lipoabdominoplasty and were administered a standardized preoperative, intraoperative, and postoperative pain regimen. Pain scores were measured across all patients in the immediate postoperative period, and postoperative days (PODs) 1, 7, 28, and 90.ResultsMean pain scores in the postanesthesia recovery unit were 0.46/10 (+/− 0.18). Subsequent reassessment in the postop recovery suite yielded mean pain scores of 0.34 (+/− 0.15). Mean pain scores on POD1 were 1.23 (+/− 0.15) and consistent through to POD7 at 1.24 (+/− 0.11) with patients taking an average of 6.65 total Percocet 5 mg (Endo Pharmaceuticals Inc., Malvern, PA) during the week. After POD7, 95% (76/80) of patients were only taking nonsteroidal anti-inflammatory drugs. A total of 75/80 patients (93.75%) reported zero pain at 4 to 6 weeks after surgery (mean pain score 0.10 +/− 0.08).ConclusionsThe multimodal analgesia protocol consisting of preoperative or immediate induction intravenous Tylenol (Johnson & Johnson, New Brunswick, NJ), precut local analgesia with Marcaine (Pfizer Inc., New York, NY) and lidocaine, and intraoperative use of liposomal bupivacaine can improve perioperative pain control in patients undergoing lipoabdominoplasty. Level of Evidence: 4

OnabotulinumtoxinA for the treatment of neurogenic detrusor overactivity in children.

AimsThis study evaluated whether one (or more) of three doses of onabotulinumtoxinA were safe and effective to treat neurogenic detrusor overactivity (NDO) in children.MethodsThis was a 48‐week prospective, multicenter, randomized, double‐blind study in children (aged 5–17 years) with NDO and urinary incontinence (UI) receiving one onabotulinumtoxinA treatment (50, 100, or 200 U; not to exceed 6 U/kg). Primary endpoint: change from baseline in daytime UI episodes. Secondary endpoints: change from baseline in urine volume at first morning catheterization, urodynamic measures, and positive response on the treatment benefit scale. Safety was also assessed.ResultsThere was a similar reduction in urinary incontinence from baseline to Week 6 for all doses (−1.3 episodes/day). Most patients reported positive responses on the treatment benefit scale (75.0%−80.5%). From baseline to Week 6, increases were observed in urine volume at first morning clean intermittent catheterization (50 U, 21.9 ml; 100 U, 34.9 ml; 200 U, 87.5 ml; p = 0.0055, 200 U vs. 50 U) and in maximum cystometric capacity (range 48.6−63.6 ml) and decreases in maximum detrusor pressure during the storage phase (50 U, −12.9; 100 U, −20.1; 200 U, −27.3 cmH2O; p = 0.0157, 200 U vs. 50 U). The proportion of patients experiencing involuntary detrusor contractions dropped from baseline (50 U, 94.4%; 100 U, 88.1%; 200 U, 92.6%) to Week 6 (50 U, 61.8%; 100 U, 44.7%; 200 U, 46.4%). Safety was similar across doses; urinary tract infection was most frequent.ConclusionsOnabotulinumtoxinA was well tolerated and effective for the treatment of NDO in children; 200 U showed greater efficacy in reducing bladder pressure and increasing bladder capacity.

Does trunk muscle training with an oscillating rod improve urinary incontinence after radical prostatectomy? A prospective randomized controlled trial

Objective: To investigate the effect of a new therapeutic approach, using an oscillating rod to strength the pelvic floor and deep abdominal musculature and to speed up recovery of continence after radical prostatectomy. Design: Prospective randomized controlled clinical trial. Setting: Inpatient uro-oncology rehabilitation clinic. Subjects: Ninety-three (intervention group (IG)) and ninety-one patients (control group (CG)) with urinary incontinence after prostatectomy were examined. Intervention: All patients were randomly allocated to either standard pelvic floor muscle exercises and oscillating rod therapy (IG) or standard pelvic floor muscle exercises and relaxation therapy (CG). Main outcome measures: Urinary incontinence (1- and 24-hour pad test) was assessed, and health-related quality of life (HRQL; Functional Assessment of Cancer Therapy-Prostate (FACT-P) questionnaire) was measured for all patients before and after three weeks of treatment. Results: One hundred and eighty-four patients (mean (SD) age: 64.1 (6.94) years) completed the study. The IG showed a significant reduction in urinary incontinence (1-hour pad test: P = 0.008, 24-hour pad test: P = 0.012) and a significant improvement of HRQL (P = 0.017) compared with CG. Continence was significantly improved in both groups (1-hour pad test: 22.6–8.5 g (IG) vs. 23.0–18.1 g (CG)/24-hour pad test: 242.9–126.7 g (IG) vs. 237.6–180.9 g (CG)). Conclusion: The study demonstrated that a combination of conventional continence exercises and the new oscillation rod training increased abdominal and pelvic floor musculature and speeded up recovery of continence after radical prostatectomy.

The effect of childbirth on urinary incontinence: a matched cohort study in women aged 40–64 years

The relative impact of age, pregnancy and vaginal delivery on urinary incontinence is still an unresolved issue that involves the controversial question about the protective effect of cesarean delivery. The purpose of this study was to estimate and compare the effect size of 1 pregnancy, 1 vaginal delivery, and the derived protective effect of cesarean delivery for different aspects of urinary incontinence in women 40-64 years old, all 20 years after birth. This Swedish nationwide matched cohort study involved 14,335 women. Data from 3 restricted, randomly selected, source cohorts of (1) nulliparous women who were unexposed to childbirth (n=9136), (2) primiparous women who had experienced cesarean delivery and who had been exposed to 1 pregnancy (n=1412), and (3) primiparous women who had been exposed to 1 pregnancy followed by vaginal delivery (n=3787) were retrieved from The Swedish Medical Birth Register and Statistics Sweden and surveyed in 2008 and 2014, respectively. Parous women were all assessed 20 years postnatally. One-to-one matching with an interval for pairing of 3 years and 3 body mass index units was used in women 40-64 years old with information about body mass index (kilograms/square meters) and urinary incontinence. The procedure succeeded in 2630 of 2635 women (99.8%) and resulted in an adequate distribution of age and body mass index between groups. The surveys used a postal- and an internet-based questionnaire with validated questions for various aspects of urinary incontinence. Fisher's exact test and the Mann-Whitney U test were used for comparisons between matched groups; trend was analyzed with Mantel-Haenszel statistics. Predicted, age-related values of different aspects of urinary incontinence were obtained by logistic regression analysis. Pregnancy increased the prevalence of urinary incontinence from 20.1-30.1% (odds ratio, 1.71; 95% confidence interval, 1.43-2.05; P<.0001]. Urinary incontinence increased further after vaginal delivery to 43.0% (odds ratio, 1.75; 95% confidence interval, 1.49-2.05; P<.0001); "moderate" and "severe" urinary incontinence increased from 12.7-19.5% (odds ratio, 1.67; 95% confidence interval, 1.35-2.07; P <.0001). There was a parallel increase in urinary incontinence from 40-65 years of age in nulliparous and vaginally and cesarean delivered women. Cesarean delivery, compared with vaginal delivery, was associated with a 30.0% reduction of urinary incontinence (P<.0001) and a 35-52% reduction of more severe grades of urinary incontinence (P<.0001) and was unaffected by age. Both pregnancy and vaginal delivery incurred an increased risk of urinary incontinence in the long term. The age-related gap for urinary incontinence between nulliparous and primiparous women who were delivered by vaginal delivery or cesarean delivery was constant between parallel trajectories that spanned ages from 40-64 years. The calculated protective effect of cesarean delivery was unaltered and significant during the same age interval.

The increasing importance of a continence nurse specialist to improve outcomes and save costs of urinary incontinence care: an analysis of future policy scenarios

BackgroundIn an ageing population, it is inevitable to improve the management of care for community-dwelling elderly with incontinence. A previous study showed that implementation of the Optimum Continence Service Specification (OCSS) for urinary incontinence in community-dwelling elderly with four or more chronic diseases results in a reduction of urinary incontinence, an improved quality of life, and lower healthcare and lower societal costs. The aim of this study was to explore future consequences of the OCSS strategy of various healthcare policy scenarios in an ageing population.MethodsWe adapted a previously developed decision analytical model in which the OCSS new care strategy was operationalised as the appointment of a continence nurse specialist located within the general practice in The Netherlands. We used a societal perspective including healthcare costs (healthcare providers, treatment costs, insured containment products, insured home care), and societal costs (informal caregiving, containment products paid out-of-pocket, travelling expenses, home care paid out-of-pocket). All outcomes were computed over a three-year time period using two different base years (2014 and 2030). Settings for future policy scenarios were based on desk-research and expert opinion.ResultsOur results show that implementation of the OSCC new care strategy for urinary incontinence would yield large health gains in community dwelling elderly (2030: 2592–2618 QALYs gained) and large cost-savings in The Netherlands (2030: health care perspective: €32.4 Million - €72.5 Million; societal perspective: €182.0 Million - €250.6 Million). Savings can be generated in different categories which depends on healthcare policy. The uncertainty analyses and extreme case scenarios showed the robustness of the results.ConclusionsImplementation of the OCSS new care strategy for urinary incontinence results in an improvement in the quality of life of community-dwelling elderly, a reduction of the costs for payers and affected elderly, and a reduction in time invested by carers. Various realistic policy scenarios even forecast larger health gains and cost-savings in the future. More importantly, the longer the implementation is postponed the larger the savings foregone. The future organisation of healthcare affects the category in which the greatest savings will be generated.

Plan quality and dosimetric association of patient-reported rectal and urinary toxicities for prostate stereotactic body radiotherapy

Background and purposeTo study the association between dosimetric parameters with patient-reported quality-of-life (QOL) in urinary irritative/incontinency and bowel functions for prostate stereotactic body radiotherapy (SBRT). Material and methodsThe patient-reported QOL was evaluated using the Expanded Prostate Cancer Index Composite (EPIC-26). According to the progression in QOL score over 12months, patients were assigned to one of three subgroups: score decrement, no change, or increment. The dosimetric parameters were cross-compared among subgroups in urinary and bowel domains using univariate Analysis of Variance (ANOVA). The evaluated dosimetric metrics included target volume, V100 (volume receiving 100% prescription dose); rectal volume/dose–volume endpoints, maximum/mean doses; bladder volume/dose–volume endpoints, and maximum/mean doses. ResultsPatients with consistent QOL reduction in urinary irritation function were significantly associated with greater mean bladder dose, greater V85/V90/V95/V100 and D2cc/D10cc. Patients with QOL reduction in urinary incontinence were marginally associated with greater mean bladder dose (p=0.06). None of the evaluated dosimetric parameters showed a significant correlation with QOL score change in bowel function. ConclusionsPatients with large prostate size were more susceptible to QOL decrements for urinary irritative and incontinency functions. Large bladder V85/V90/V95/V100 was associated with QOL decrements in the urinary irritative domain at 1-year after prostate SBRT.

Durable Efficacy and Safety of Long-Term OnabotulinumtoxinA Treatment in Patients with Overactive Bladder Syndrome: Final Results of a 3.5-Year Study

These are the final results of the prospective, multicenter, long-term (3.5-year) study of the efficacy/safety of onabotulinumtoxinA for overactive bladder syndrome. Patients who completed either of 2, 24-week phase 3 trials could enter a 3-year extension and continue treatment with onabotulinumtoxinA 100 U as needed to control overactive bladder symptoms. Data were analyzed by the treatment(s) received (up to 6) and in discrete subgroups that received 1, 2, 3, 4, 5 or 6 treatments (to evaluate the consistency of the response after repeat treatments in the same patient groups). Assessments included the change from baseline in the number of urinary incontinence episodes per day and the proportion of patients who reported improvement/great improvement in urinary symptoms on the TBS (Treatment Benefit Scale) at week 12 as co-primary end points. Other end points were the change from baseline in I-QOL (Incontinence Quality of Life), the number of urgency and micturition episodes per day; duration of effect; the number of adverse events; and the initiation of intermittent catheterization. Consistent mean reductions in urinary incontinence were observed following continued onabotulinumtoxinA treatment, ranging from -3.1 to -3.8 in the overall population and -2.9 to -4.5 in the discrete subgroups. Durable improvements were seen in overactive bladder symptoms and quality of life. A high proportion of patients rated their condition as improved/greatly improved. The median duration of effect was 7.6 months. The most common adverse event was urinary tract infection. The rate of de novo catheterization after the first treatment was 4.0% and it ranged from 0.6% to 1.7% after subsequent treatments. Long-term onabotulinumtoxinA treatment consistently decreased overactive bladder symptoms and improved quality of life with no new safety signals.

Bariatric Surgery and Urinary Incontinence.

About one-quarter of adults in the United States are obese.1 Among itsmyriadadverseeffectsonhealth, obesity affects the support and function of the pelvic floor. As obesity increases, the pelvic floor disorders of urinary incontinence, anal incontinence, and (forwomen) pelvic organ prolapse become more prevalent. More than half of the women who are morbidly obese have pelvic floor disorders.2 Obesity may cause or aggravate pelvic floor disorders throughmechanisms such as chronic strain on ligaments and nerves, leading to excessive stretch and increased abdominal pressure. Using an indwelling urinary catheter in 63morbidly obese patients about to undergo bariatric surgery, Varela and colleagues3 demonstrated elevated intra-abdominal pressure in 48 patients (77.0%). Increased intra-abdominal pressure has also been found in obese women with stress urinary incontinence, which is involuntary leakage on effort or exertion, sneezing, or coughing, and in urge urinary incontinence, which is involuntary leakage accompanied by or immediately preceded by urgency.4 Epidemiological investigationshave shown that obesity is a strong independent risk factor for urinary incontinence.5 Obesewomen undergoing surgery for stress incontinence report more incontinence episodes, greater symptom distress, andworsequalityof lifecomparedwithnormal-weightwomen. Formen andwomen, the probability of having urinary incontinence increases with increasing weight.5 Although urinary incontinence ismore common in severely obesewomen than men, it occurs frequently in both sexes. Thewide rangeof treatments forurinary incontinenceand other pelvic floor disorders include pelvic muscle exercises, vaginal devices knownas continence rings or dishes, anticholinergicandbeta-agonistmedications, andbehavioral changes. Weight loss is one of the best-studied behavioral treatments. In the 2009 PRIDE (Program to Reduce Incontinence by Diet and Exercise) study,6 a total of 338 overweight and obese womenwith urinary incontinencewere randomized to an intensive intervention to lose weight or to a control intervention. The intensive weight loss program met in groups of 10 to 15personsweekly for 6months for 1-hour sessions. The sessions were led by experts in nutrition and exercise. The control interventionwasa structurededucationprogram inwhich groups met monthly for 4 months. All participants received self-help information on pelvic muscle exercises and methods for improving bladder control. The intensive group had a greater reduction in the mean weekly number of urinary incontinence episodes than the control group. The effects of bariatric surgery on pelvic floor disorders have also been studied, but typically with small cohorts or in single-site studies.Outcomeshavebeenassessedwithin 1year after surgery and are assessed with a proxy measure of urinary incontinence such as International Classification of Diseases, Ninth Revision, codes.7 In this issue of JAMA Internal Medicine, Subak et al8 report a large multicenter observational cohort study of urinary incontinencebefore andafter bariatric surgerywithmultiple direct assessments of incontinence symptoms and longtermfollow-up.Amongwomenandmen,bariatric surgerywas associated with substantial reductions in urinary incontinence over 3 years. For both sexes, the largest improvements occurred in the first year after surgery. Men and women had reductions in any typeof urinary incontinence, aswell as urge urinary incontinence. Forwomen, the study founda trend toRelated article page 1378 Urinary Incontinence Before and After Bariatric Surgery Original Investigation Research

ANÁLISE DO COMPORTAMENTO E O ESTUDO DO ENVELHECIMENTO HUMANO: REVISÃO DOS ESTUDOS DE APLICAÇÃO

O ensino de habilidades e o uso de procedimentos comportamentais têm demonstrado efetividade no cuidado de idosos dependentes, aumentando e/ou mantendo habilidades funcionais e evitando a institucionalização. O presente artigo objetivou levantar dados na literatura da área que deem suporte para o uso de procedimentos e técnicas em análise do comportamento, que possam ser eficazes no tratamento de disfunções comportamentais em população idosa. Realizou-se um levantamento bibliográfico em diversos periódicos da área de análise do comportamento, destacando-se os artigos que tinham como alvo populações idosas, seus cuidadores e instituições que prestam serviços a essa clientela. Foram analisados 16 artigos. Esses artigos apresentam estudos sobre memória, comportamento de vaguear, redução da incontinência urinária e fala desconexa. Os resultados sugerem eficácia no uso de intervenções comportamentais com idosos e a necessidade de estudos adicionais utilizando delineamentos experimentais mais rigorosos e medidas de validade social. Na atenção ao idoso, deve-se considerar que a manutenção, aquisição ou recuperação de uma habilidade traz benefícios pessoais, como autonomia, aumento da autoestima e melhor domínio de seu ambiente físico e social. Palavras-chave: gerontologia, análise do comportamento, habilidades funcionais, independência do indivíduo idoso.

Weight Loss to Treat Urinary Incontinence in Overweight and Obese Women

Obesity is a strong risk factor for urinary incontinence. Although marked weight loss after bariatric surgery in morbidly obese women was associated in previous studies with a reduction in urinary incontinence, the overall evidence for a benefit of weight loss in obese women is inconclusive. In this randomized clinical trial, the Program to Reduce Incontinence by Diet and Exercise, the potential benefits of a behavioral weight-reduction intervention were compared with a structured educational program in 338 overweight and obese women with at least 10 urinary incontinence episodes per week. The study subjects were randomized to receive either an intensive 6-month weight-loss program that included diet, exercise, and behavior modification (intervention group, n = 226) or a structured education program consisting of general information about healthy eating, physical activity, and weight loss (control group, n = 112). The mean (±SD) age of the study subjects was 53 ± 11 years. Body-mass index (BMI) was calculated as the weight in kilograms divided by the square of the height in meters. The primary study outcome was the change in the total number of self-reported incontinence episodes of any type (including stress and urge incontinence) recorded in a 7-day voiding diary at 6 months after randomization. At baseline, the mean BMI and the total number of incontinence episodes per week were the same in the intervention and control groups (BMI, 36 ± 6 vs. 36 ± 5, respectively; incontinence episodes, 24 ± 18 vs. 24 ± 16, respectively). At 6 months, the mean weight loss among women in the intervention group was 8.0% (7.8 kg), whereas the mean weight loss among women in the control group was 1.6% (1.5 kg) (P <.001). There was a greater decrease in total number of incontinence episodes per week in the intervention group at 6 months compared with the control group (intervention: 47.4% vs. control: 28.1%, P = 0.01). The frequency of stress incontinence episodes was reduced more in the intervention group (57.6%) than the control group (32.7%, P = 0.02). The frequency of episodes of urge incontinence was also decreased more in the intervention group (42.4% vs. 26.0%), but the difference was not statistically significant (P = 0.14). In comparison with the control group, a higher proportion of women in the intervention group reported a clinically meaningful reduction of at least 70% in the total weekly number of episodes of any type of incontinence (P < 0.001), stress-incontinence (P = 0.009), and urge-incontinence (P = 0.04). The investigators conclude from these findings that weight loss should be considered as a first-line treatment in overweight and obese women with incontinence.

Effectiveness of prompted voiding in treating urinary incontinence in cognitively impaired homebound older adults

Objective: The objective of this study was to examine the short-term effectiveness of prompted voiding (PV) in cognitively impaired homebound older adults. Design: This was a prospective, controlled exploratory study with a cross-over design where usual care controls crossed-over to the intervention following an 8-week observation period. Setting: Adults aged 60 years and older with urinary incontinence and who met Center for Medicare and Medicaid Services criteria for being homebound were referred to the study by home care nurses from 2 large Medicare-approved home health agencies in a large metropolitan county in southwestern Pennsylvania. Nineteen cognitively impaired older adults were randomly assigned to either the PV intervention or a usual care attention control group. Measures: Measures used included structured continence and medical histories, Older American Research and Service Physical and Instrumental Activities of Daily Living scales, Folstein Mini Mental State Examination, Clock Drawing Test, Geriatric Depression Scale, Performance-Based Toileting Assessment, bladder diaries, and physical examination. Results: Nineteen subjects were randomly assigned to a PV (n = 9) or delayed attention-control group (n = 10). Treatment subjects with complete pretreatment and posttreatment data (n = 6) experienced a mean 60% reduction in daytime incontinent episodes compared with a mean 37% reduction among control subjects (n = 10). Following the control phase, subjects crossed over to the treatment protocol. A total of 15 subjects completed the PV protocol. Among all subjects completing the treatment protocol, there was a 22% reduction in daytime incontinent episodes compared with true baseline (immediately following the control phase for those crossing over from the control group). Conclusions: The PV intervention resulted in clinically significant reductions in urinary incontinence for many of the participants, which may be achievable for many cognitively impaired homebound older adults. (J WOCN 2002;29:252-65.)

Effectiveness of Prompted Voiding in Treating Urinary Incontinence in Cognitively Impaired Homebound Older Adults

Objective The objective of this study was to examine the short-term effectiveness of prompted voiding (PV) in cognitively impaired homebound older adults. Design This was a prospective, controlled exploratory study with a cross-over design where usual care controls crossed-over to the intervention following an 8-week observation period. Setting Adults aged 60 years and older with urinary incontinence and who met Center for Medicare and Medicaid Services criteria for being homebound were referred to the study by home care nurses from 2 large Medicare-approved home health agencies in a large metropolitan county in southwestern Pennsylvania. Nineteen cognitively impaired older adults were randomly assigned to either the PV intervention or a usual care attention control group. Measures Measures used included structured continence and medical histories, Older American Research and Service Physical and Instrumental Activities of Daily Living scales, Folstein Mini Mental State Examination, Clock Drawing Test, Geriatric Depression Scale, Performance-Based Toileting Assessment, bladder diaries, and physical examination. Results Nineteen subjects were randomly assigned to a PV (n = 9) or delayed attention-control group (n = 10). Treatment subjects with complete pretreatment and posttreatment data (n = 6) experienced a mean 60% reduction in daytime incontinent episodes compared with a mean 37% reduction among control subjects (n = 10). Following the control phase, subjects crossed over to the treatment protocol. A total of 15 subjects completed the PV protocol. Among all subjects completing the treatment protocol, there was a 22% reduction in daytime incontinent episodes compared with true baseline (immediately following the control phase for those crossing over from the control group). Conclusions The PV intervention resulted in clinically significant reductions in urinary incontinence for many of the participants, which may be achievable for many cognitively impaired homebound older adults.

Current perspectives on the benefits of HRT in menopausal women

Aims: Women in the West can now expect to live one third of their life in a postmenopausal state, and consequently in a state of estrogen deficiency. This can have a number of consequences, and many women suffer vasomotor symptoms during the climacteric. Estrogen deficiency can also result in changes to the skin, hair, urogenital, cardiovascular and skeletal systems. This article reviews some of the main actions of replacement estrogen in postmenopausal women, and discusses the major benefits of estrogen replacement therapy (ERT) and hormone replacement therapy (HRT). Review: HRT is well documented to reduce vasomotor symptoms in women suffering from estrogen deficiency, and can have beneficial effects on the skin and the prevention of skin aging. HRT has beneficial effects on urogenitary function including reductions in urinary incontinence and vaginal atrophy. HRT is used as a first-line treatment to prevent or reverse the development of postmenopausal osteoporosis and can reduce the risk of fractures if taken for 5–10 years from the menopause. In epidemiological studies, ERT was associated with a reduction in the risk of coronary heart disease. Estrogens seem to affect the cardiovascular system directly and indirectly such as reducing some of the coronary risk factors. In recent years, estrogen has been linked to beneficial effects in the CNS including an association with a reduction in the risk of developing Alzheimer’s Disease. Despite these benefits, HRT compliance remains low, and physicians need to address this if patients are to gain the benefits.

Reduction of urinary incontinence in nursing homes: does it reduce or increase costs?

Labor and supply costs associated with the care of urinary incontinent patients in three nursing homes were measured. First, normal nursing home changing patterns and their associated costs were measured. Second, the costs were documented when patients were checked by research staff and changed on an hourly basis as needed. Nursing home staff changed patients significantly less frequently than patient voiding as detected by the hourly checking system. Thus, cost of incontinence during the hourly checking condition ($3.35) per 12-hour patient-day was significantly higher than the cost normally incurred in nursing homes ($1.52) per 12-hour patient-day. The cost of an incontinence rehabilitation program, which significantly reduced incontinence episodes, was contrasted to the cost of incontinence as measured under both of the previous conditions. The rehabilitation program produced significant labor and supply savings only when compared with the hourly checking and changing system. Maintaining patients in a more continent condition costs significantly more than the direct incontinence cost normally incurred by the nursing home. Quality of life and other second-order benefits must be considered if continence rehabilitation is to be judged cost-effective.