Use Of Incontinence Pads Research Articles

Accuracy of a Smart Diaper System for Nursing Home Residents for Automatically Detecting Voided Volume: Instrument Validation Study.

Diapers are commonly used by older patients with urination disorders. A smart diaper system (SDS) may be able to estimate the weight of urine comparably to conventional measurements made by weighing diapers. The aim of the current research is to determine the degree of accuracy of an SDS technology specifically designed for the management of urination routines and the use of incontinence pads in older adults. From January to December 2022, 97 older patients with at least 1 chronic disease from 3 nursing homes were included. In this study, the SDS was used for 1 month per patient after obtaining their consent; all patients originally used traditional diapers in the nursing home. The index test measured the change in electrical resistance of the SDS and the reference test measured the change in actual urine weight. When measuring the actual urine weight, the degree of absorption was directly confirmed with the naked eye because the expression value varied according to pressure changes caused by the user's movement or position. The Pearson correlation was used to determine the correlation between the 2 test methods, the intraclass correlation coefficient (ICC) was used to check the degree of agreement between the evaluators, and the Bland-Altman test was used to confirm whether there was a significant difference between the 2 test methods. The average age of the 97 participants was 86.48 (SD 6.26) years, with 10 men and 87 women. There were 73 patients (75%) with hypertension, 86 patients (88%) with dementia, and 86 patients (88%) with 2 or more comorbidities, accounting for the majority. The Pearson correlation coefficient and ICC were 0.971 and 0.985 (P<.001). In the Bland-Altman figure, the difference in the mean between the 2 tests was evenly scattered without showing a specific pattern, indicating that the SDS and actual urine weight were very consistent. The difference between the mean of the 2 tests was -0.045 of the standardized mean difference, and all measurements were located within the 95% CI, so this confirms that the 2 test methods are equivalent. Our study showed a fairly high correlation coefficient and ICC for all patient groups, which reveals that the 2 tests were very consistent and that the SDS can replace traditional diapers, even in a real clinical setting. This study shows the possibility that heath care professionals could be alerted by the SDS to the need for pad replacement due to incontinence, thus avoiding the development of dermatological complications.

Absorbent incontinence pad use and the association with urinary tract infection and frailty: A retrospective cohort study

BackgroundUp to 40% of adults over 65 years are full-time users of absorbent incontinence pads due to urinary incontinence. Simultaneously, urinary tract infection is amongst the most common hospital-acquired infection in older patients. ObjectivesTo explore the association between (1) full-time use of absorbent incontinence pads and urinary tract infection at acute hospital admission, (2) state of frailty and becoming a pad user during hospitalization, and (3) becoming a pad user and acquiring a urinary tract infection during hospitalization in older patients. DesignA retrospective cohort study. SettingAdmissions in an emergency department with transfers to geriatric, cardiac, infectious, or endocrinological wards from September 7th, 2017 to February 18th, 2019. Patients1,958 patients aged 65 years or more, having daily homecare or moderate comorbidity, hospitalized due to acute illness, and living in the municipality of Aarhus. MethodsThe study was conducted by two researchers reviewing the patients' electronic health records combined with data on frailty status from a geriatric quality database. In the electronic health records, data on baseline characteristics, absorbent incontinence pad use at admission and during the hospital stay, and urinary tract infection were obtained. ResultsFull-time users of absorbent incontinence pads had a higher probability of being admitted with urinary tract infection (Odds Ratio=2.00 (95% Confidence Interval: 1.61–2.49); p<.001). Patients identified as severely frail had a higher probability of becoming pad users during hospitalization (Odds Ratio=1.57 (95% Confidence Interval: 1.45–1.71); p<.001) compared to non/mild/moderate frail patients. Patients who became pad users during hospitalization had a higher risk of a hospital-acquired urinary tract infection (Odds Ratio=4.28 (95% Confidence Interval: 1.92–9.52); p<.001). ConclusionsThere was an association between the use of absorbent incontinence pads and the development of urinary tract infections in older hospitalized patients, both in full-time users and those who were frail and became pad users during hospitalization. These findings emphasize the need for further research on preventing urinary tract infections and unnecessary pad use in older patients.

Bladder Scanners in Personal Care Homes

&#x0D; For older adults with incontinence in a personal care home setting, using a bladder scanner to assist traditional urinary incontinence care may reduce the amount of daytime urine loss and use of incontinence pads without increasing caregivers’ care burden.&#x0D; Adding a bladder scanner to urinary incontinence care may not impact patient quality of life, mental state, depression, physical function, and level of motivation.&#x0D; These findings were based on 2 studies, 1 of which lacked a control group and did not directly measure the effect of adding a bladder scanner to urinary incontinence care on patients’ urine loss. This may limit our confidence in the findings.&#x0D; We did not find any studies that reported on the effect of using bladder scanners in the personal care setting on rates of catheterization, emergency department visits, urinary tract infections, or other harms. We also did not identify any cost-effectiveness studies or evidence-based guidelines that met inclusion criteria for this report.&#x0D;

Difference in Incontinence Pad Use between Patients after Radical Prostatectomy and Cancer-Free Population with Subgroup Analysis for Open vs. Minimally Invasive Radical Prostatectomy: A Descriptive Analysis of Insurance Claims-Based Data.

Purpose: to quantify and compare pre- and post-surgical incontinence pad use between men treated with radical prostatectomy (RP) for prostate cancer (PCa) and cancer-free controls, using population-based Austrian insurance claims data. Methods: Men who underwent RP for treating PCa between 2013–2015 were identified. Cancer-free men ≥45 years with and without benign prostate hyperplasia (BPH) were used as controls. Longitudinal data on ICD-diagnoses, type of surgery, prescribed incontinence pads, and hospitals’ surgery volumes were aggregated between 2011–2018 to capture pre- and up to three years post-RP follow-up. Monthly rates of pad use were calculated and compared between RP types and cancer-free controls. Results: A total of 6248 RP patients, 7158 cancer-free men with BPH, and 50,257 cancer-free men without BPH were analyzed. Comparing to pre-RP (0.03, 95%CI: 0.02–0.05), RP resulted in significantly higher rates of prescribed pads (at 3 months: 12.61, 95%CI: 11.59–13.65; 12 months: 6.71, 95%CI: 6.10–7.34; 36 months: 4.91, 95%CI: 3.76–4.62). These rates were also higher than those for cancer free controls (with BPH:0.06, 95%CI: 0.04–0.09; without BPH:0.12, 95%CI: 0.10–0.14). The rate of prescribed pads after surgery continued to decline over time and remained higher among men who underwent minimally invasive RP compared to those who underwent an open procedure. Conclusion: Despite progress in surgical techniques, post-RP incontinence remains a prevalent adverse event. The rate of pad usage steadily improved over the first three years post RP. The rate of patients with incontinence needing pads was higher among those who were treated minimally invasive compared to open approach.

What are the concerns and goals of women attending a urogynaecology clinic? Content analysis of free-text data from an electronic pelvic floor assessment questionnaire (ePAQ-PF).

Understanding patients' concerns and goals is essential for providing individualised care in urogynaecology. The study objectives were to undertake a content analysis of free-text concerns and goals recorded by patients using an electronic pelvic-floor questionnaire (ePAQ-PF) and measure how these related to self-reported symptom and health-related quality-of-life (HRQOL) data also recorded using ePAQ-PF. A total of 1996 consenting patients completed ePAQ-PF. Content analysis was undertaken of free-text responses to the item: 'Considering the issues that currently concern you the most, what do you hope to achieve from any help, advice or treatment?' Key content themes were identified by the lead researcher, and three researchers read and coded all recorded responses. Student's t test was used to compare ePAQ-PF domain scores for patients reporting concerns in the relevant domain with those who did not. In total, 63% of participants who completed the questionnaire, recorded at least one free-text item. Content analysis identified 1560 individual concerns coding into the 19 ePAQ-PF domains. Symptom scores were significantly higher for patients reporting free-text concerns in 18 domains (p < 0.05). Additional concerns relating specifically to body image were recorded by 11% of patients. Key areas of importance emerging for personal goals included cure/improvement, better understanding, incontinence pad use, sexual function and surgery. Free-text reporting in ePAQ-PF is utilised by patients and facilitates self-expression and discussion of issues impacting on HRQOL. The significant relationship between recorded free-text concerns and ePAQ-PF domain scores suggests convergent validity for the instrument. Development and psychometric testing of a domain to assess body image is proposed.

Local Protocol Variations for Image Guided Radiation Therapy in the Multicenter Dutch Hypofractionation (HYPRO) Trial: Impact of Rectal Balloon and MRI Delineation on Anorectal Dose and Gastrointestinal Toxicity Levels

The phase 3 HYpofractionated irradiation for PROstate cancer (HYPRO) trial randomized patients with intermediate- to high-risk localized prostate cancer to conventionally fractionated (78Gy in 39 fractions) or hypofractionated (64.6Gy in 19 fractions) radiation therapy. Differences in techniques and treatment protocols were present between participating centers. This study aimed to compare dose parameters and patient-reported gastrointestinal symptoms between these centers. From the trial population, we selected patients (N=572) from 4 treatment centers who received image guided (IG) intensity modulated radiation therapy (IMRT). Center A (n=242) applied planning target volume (PTV) margins of 5 to 6mm and was considered the reference center. In center B (n=170, 7-mm margins), magnetic resonance imaging (MRI) was integrated in treatment planning. An endorectal balloon (ERB) was applied in center C (n=85, 7-mm margins). Center D (n=75) applied the largest PTV margins of 8mm. The study protocol provided identical anorectal dose constraints, and local protocols were applied for further treatment optimization. Anorectal dose-surface histograms were compared by applying t tests. Rectal complaints during follow-up (6months to 4years) were compared in a generalized linear model, adjusting for age, follow-up, treatment arm, and hormone therapy. Favorable anorectal dose distributions were found for center B (MRI delineation) and center C (ERB application) as compared with centers A and D. These were associated with significantly lower incidences of patient-reported complaints of rectal incontinence, use of incontinence pads, and rectal discomfort in these centers. Furthermore, lower incidences of increased stool frequency (≥4 per day) and mucous loss were observed for center C. Despite comparable IG-IMRT techniques and predefined dose constraints, pronounced differences in dose distributions and toxicity rates were observed. MRI delineation and ERB application were associated with favorable rectal dose parameters and toxicity profiles, whereas a 2- to 3-mm difference in PTV margins did not translate into observed differences. We conclude that choices for treatment optimization of IG-IMRT are important and clinically relevant for patients since these affect symptoms experienced in daily life.

MP54-03 BENEFITS AND COMPLICATIONS DURING INPATIENT FOLLOW-UP TREATMENT AFTER RADICAL CYSTECTOMY FOR BLADDER CANCER

You have accessJournal of UrologyBladder Cancer: Invasive IV1 Apr 2017MP54-03 BENEFITS AND COMPLICATIONS DURING INPATIENT FOLLOW-UP TREATMENT AFTER RADICAL CYSTECTOMY FOR BLADDER CANCER Gerald Schulz, Tobias Grimm, Alexander Buchner, Friedrich Jokisch, Markus Grabbert, Birte-Swantje Schneevoigt, Alexander Kretschmer, Christian Stief, and Alexander Karl Gerald SchulzGerald Schulz More articles by this author , Tobias GrimmTobias Grimm More articles by this author , Alexander BuchnerAlexander Buchner More articles by this author , Friedrich JokischFriedrich Jokisch More articles by this author , Markus GrabbertMarkus Grabbert More articles by this author , Birte-Swantje SchneevoigtBirte-Swantje Schneevoigt More articles by this author , Alexander KretschmerAlexander Kretschmer More articles by this author , Christian StiefChristian Stief More articles by this author , and Alexander KarlAlexander Karl More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1675AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES A three-week inpatient follow-up treatment (FT) in government-approved rehabilitation clinics is offered after radical cystectomy (RC) for bladder cancer (BC) for all patients in Germany. We investigated both the physical condition and expectations of the patients at the beginning of the FT as well as complications during the 3-week period and results thereafter. METHODS 81 patients from different urological departments who underwent RC for BC and an orthotopic neobladder reconstruction were included. Time from hospital discharge until beginning of FT, BMI, initial blood count, Karnovsky scale, antibiotics, antithrombotics and use of incontinence pads were assessed. Furthermore patients were asked for main complaints as well as expectations towards the three-week FT. Complications like metabolic acidosis and urinary tract infections during FT as well as medication, incontinence pad use and patients' complaints after FT were monitored. RESULTS Median time between RC and discharge from the primary hospital to FT was 35 days (interquartile range [IQR] 25-41 days) and 13 days ([IQR] 4-16 days) respectively. The medical condition at the beginning of FT was good: mean Karnovsky 72% ([IQR] 70-88%), mean BMI 23.1 ([IQR] 20.9-27.7), mean hemoglobin, creatinine and leukocytes in the normal range. The five most common complaints mentioned are general weakness (79%), incontinence (77%), pain (31%), fatigue (30%), and mental distress (43%). The three most important expectations towards FT were improvement of the general physical capacity (86%), followed by improvement of incontinence (81%) and reduction of mental distress (31%). During FT 25.9% of patients had a urinary tract infection requiring antibiotics and 8.6% had a symptomatic metabolic acidosis. Only 18.1% were under antithrombotic medication at the beginning of FT. Antibiotic use decreased from 19.8% to 17.3%. Incontinence pad use increased from 2.14 to 2.55 pads per day on average. At the end of FT, patients indicated improvement of incontinence, physical capacity and mental distress in 60.5%, 74.1% and 30.86%. CONCLUSIONS Compared to the pre- and perioperative management of BC, there is a scarcity of studies investigating FT of BC. A multitude of significantly different FT models have been implemented in different countries. Both from the economic as well as medical point of view high-quality FT must be strived for. Our study gives insights into the current state of FT in Germany and shows both benefits as well as unsolved challenges. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e722-e723 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Gerald Schulz More articles by this author Tobias Grimm More articles by this author Alexander Buchner More articles by this author Friedrich Jokisch More articles by this author Markus Grabbert More articles by this author Birte-Swantje Schneevoigt More articles by this author Alexander Kretschmer More articles by this author Christian Stief More articles by this author Alexander Karl More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Incontinence pad absorption and skin barrier creams: a non-patient study.

Exposure of the skin to excessive moisture, such as in cases of incontinence, can damage its natural barrier function and lead to tissue damage and breakdown. Common methods for managing incontinence and preventing related skin damage include the use of incontinence pads and the application of skin barrier creams to reduce exposure to moisture and irritants. Previous reports have indicated that barrier creams can transfer onto incontinence pads from the skin and reduce their absorbency, and thus the efficacy of both products. This study, using non-patient volunteers, investigated the effect on incontinence pad absorbency of Medi Derma-S and Medi Derma-Pro; two products from the Medi Skin Protection range, in comparison with other market-leading products. Results indicated that, while there was a small degree of product transfer onto the incontinence pads, this did not have a major impact on the absorption of synthetic urine. Medi Derma-S and Medi Derma-Pro performed consistently with other similar market-leading products.

Clinical Use of Expanded Prostate Cancer Index Composite for Clinical Practice to Assess Patient Reported Prostate Cancer Quality of Life Following Robot-Assisted Radical Prostatectomy

EPIC-CP (Expanded Prostate Cancer Index Composite for Clinical Practice) is a short questionnaire that comprehensively measures patient reported health related quality of life at the point of care. We evaluated the feasibility of using EPIC-CP in the routine clinical care of patients with prostate cancer without research infrastructure. We compared longitudinal patient and practitioner reported prostate cancer outcomes. We reviewed health related quality of life outcomes in 482 patients who underwent radical prostatectomy at our institution from 2010 to 2014. EPIC-CP was administered and interpreted in routine clinical practice without research personnel. We compared practitioner documented rates of incontinence pad use and functional erections to patient reported rates using EPIC-CP. A total of 708 EPIC-CP questionnaires were completed. Mean urinary incontinence domain scores were significantly higher (worse) than baseline (mean ± SD 0.6 ± 0.2) 3 and 6 months after treatment (mean 3.1 ± 2.3 and 2.2 ± 2.1, respectively, each p <0.05) but they returned to baseline at 12 months (mean 1.6 ± 1.7, p >0.05). Mean sexual domain scores were significantly worse than baseline (mean 2.4 ± 2.8) at all posttreatment time points (each p <0.05). Practitioners significantly overestimated incontinence pad-free rates at 3 months (48% vs 39%) and functional erection rates at 3 months (18% vs 12%), 6 months (38% vs 23%) and 12 months (45% vs 23%, each p <0.05). EPIC-CP is feasible to use in the routine clinical care of patients with prostate cancer without requiring a research infrastructure. Using EPIC-CP in clinical practice may help practitioners objectively assess and appropriately manage posttreatment side effects in patients with prostate cancer.

Selecting appropriate absorbent products to treat urinary incontinence.

Urinary incontinence can have a significant negative effect on a person's life, especially if left unmanaged and untreated. Continence assessment, often carried out by community nurses, is an important element in the management of a person's urinary incontinence, and so is the selection of appropriate absorbent incontinence pads. This article reviews: the causes and effects of urinary incontinence; how to derive the most appropriate information from a continence assessment; strategies for selecting incontinence pads for a person, on the basis of the results of the continence assessment; and some of the problems and risks associated with the use of incontinence pads.

Cost-Effectiveness of Mirabegron Compared with Antimuscarinic Agents for the Treatment of Adults with Overactive Bladder in the United Kingdom

BackgroundMirabegron, a first-in-class selective oral β3-adrenoceptor agonist, has similar efficacy to most antimuscarinic agents and a lower incidence of dry mouth in patients with overactive bladder (OAB). ObjectivesTo evaluate the cost-effectiveness of mirabegron 50 mg compared with oral antimuscarinic agents in adults with OAB from a UK National Health Service perspective. MethodsA Markov model including health states for symptom severity, treatment status, and adverse events was developed. Cycle length was 1 month, and the time horizon was 5 years. Antimuscarinic comparators were tolterodine extended release, solifenacin, fesoterodine, oxybutynin extended release and immediate release (IR), darifenacin, and trospium chloride modified release. Transition probabilities for symptom severity levels and adverse events were estimated from a mirabegron trial and a mixed treatment comparison. Estimates for other inputs were obtained from published literature or expert opinion. Quality-adjusted life-years (QALYs) and total health care costs, including costs of drug acquisition, physician visits, incontinence pad use, and botox injections, were modeled. Deterministic and probabilistic sensitivity analyses were performed. ResultsBase-case incremental cost-effectiveness ratios ranged from £367 (vs. solifenacin 10 mg) to £15,593 (vs. oxybutynin IR 10 mg) per QALY gained. Probabilistic sensitivity analyses showed that at a willingness-to-pay threshold of £20,000/QALY gained, the probability of mirabegron 50 mg being cost-effective ranged from 70.2% versus oxybutynin IR 10 mg to 97.8% versus darifenacin 15 mg. A limitation of our analysis is the uncertainty due to the lack of direct comparisons of mirabegron with other agents; a mixed treatment comparison using rigorous methodology provided the data for the analysis, but the studies involved showed heterogeneity. ConclusionsMirabegron 50 mg appears to be cost-effective compared with standard oral antimuscarinic agents for the treatment of adults with OAB from a UK National Health Service perspective.

MP83-19 REAL-WORLD USE OF EPIC FOR CLINICAL PRACTICE (EPIC-CP) TO ASSESS PATIENT-REPORTED PROSTATE CANCER QUALITY-OF-LIFE IN THE CLINICAL SETTING

You have accessJournal of UrologyProstate Cancer: Localized IX1 Apr 2015MP83-19 REAL-WORLD USE OF EPIC FOR CLINICAL PRACTICE (EPIC-CP) TO ASSESS PATIENT-REPORTED PROSTATE CANCER QUALITY-OF-LIFE IN THE CLINICAL SETTING Peter Chang, Arie Carneiro, Ostap Dovirak, Kimberly Taylor, Catrina Crociani, Kyle McAnally, Andrew Percy, Martin G. Sanda, and Andrew A. Wagner Peter ChangPeter Chang More articles by this author , Arie CarneiroArie Carneiro More articles by this author , Ostap DovirakOstap Dovirak More articles by this author , Kimberly TaylorKimberly Taylor More articles by this author , Catrina CrocianiCatrina Crociani More articles by this author , Kyle McAnallyKyle McAnally More articles by this author , Andrew PercyAndrew Percy More articles by this author , Martin G. SandaMartin G. Sanda More articles by this author , and Andrew A. WagnerAndrew A. Wagner More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1894AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Prostate cancer practitioners tend to underestimate the severity of patients' treatment-related side effects. We developed the Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP) to facilitate patient-reported health-related quality of life (HRQOL) assessment at the point-of-care (Chang P et al, J Urol Sep 2011). In this study, we sought to demonstrate the feasibility of EPIC-CP use in the routine clinical care of prostate cancer patients, and to compare longitudinal patient-reported and practitioner-reported prostate cancer outcomes. METHODS We reviewed practitioner- and patient-reported HRQOL outcomes in 482 patients who underwent radical prostatectomy at our institution from 2010 to 2014. All EPIC-CP questionnaires were administered and interpreted in routine clinical practice flow without research personnel. To assess practitioner-reported outcomes, we reviewed practitioners' documentation of patients' incontinence pad use (yes/no) and erections sufficient for intercourse (yes/no). We used the paired t-test and Wilcoxon signed-rank test to compare pre- and post-treatment EPIC-CP domain scores, and Fisher's exact test to compare patient-reported and practitioner-reported outcomes. We considered p-values < 0.05 statistically significant. RESULTS A total of 708 EPIC-CP questionnaires were completed. Mean urinary incontinence domain scores were significantly higher (worse) than baseline (0.6±0.2) at 3 months (3.1±2.3; p < 0.05) and 6 months (2.2±2.1; p < 0.05) post-treatment, and statistically returned to baseline at 12 months (1.6±1.7; p > 0.05). Patient-reported incontinence pad-free rates using EPIC-CP at 3, 6, and 12 months were 39%, 70%, and 76%, respectively, which were consistent with our practitioner-reported rates. Mean sexual domain scores were significantly worse than baseline (2.4±2.8) at 3 months (7.0±3.5), 6 months (5.7±3.1), and 12 months (5.9±3.3; p < 0.05 for all). Practitioners significantly overestimated the rate of functional erections compared to patients' EPIC-CP-reported rates at 3 months (18% vs 12%, p < 0.05) and 12 months (45% vs 23%, p < 0.05). Bowel and vitality/hormonal scores were unchanged, and urinary irritation/obstruction scores significantly improved after surgery. CONCLUSIONS EPIC-CP is feasible to use in the routine clinical care of prostate cancer patients without requiring research infrastructure. Using EPIC-CP in clinical practice may help practitioners objectively assess the severity of patients' post-treatment side effects. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e1057 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Peter Chang More articles by this author Arie Carneiro More articles by this author Ostap Dovirak More articles by this author Kimberly Taylor More articles by this author Catrina Crociani More articles by this author Kyle McAnally More articles by this author Andrew Percy More articles by this author Martin G. Sanda More articles by this author Andrew A. Wagner More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Systematic review of systematic reviews for the management of urinary incontinence and promotion of continence using conservative behavioural approaches in older people in care homes.

To synthesize evidence from systematic reviews on the management of urinary incontinence and promotion of continence using conservative/behavioural approaches in older people in care homes to inform clinical practice, guidelines and research. Incontinence is highly prevalent in older people in care home populations. Systematic review of systematic reviews with narrative synthesis. Electronic searches of published systematic reviews in English using MEDLINE and CINAHL with no date restrictions up to September 2013. Searches supplemented by hand searching and electronic searching of Cochrane Library and PROSPERO. PRISMA statement was followed, as were established methods for systematic review of systematic reviews. Five systematic reviews of high quality were included, three specific to intervention studies and two reviewed descriptive studies. Urinary incontinence was the primary outcome in three reviews with factors associated with the management of urinary incontinence the primary outcome for the other reviews. Toileting programmes, in particular prompted voiding, with use of incontinence pads are the main conservative behavioural approach for the management of incontinence and promotion of continence in this population with evidence of effectiveness in the short term. Evidence from associated factors; exercise, mobility, comorbidities, hydration, skin care, staff perspectives, policies and older people's experiences and preference are limited. The majority of evidence of effectiveness are from studies from one country which may or may not be transferable to other care home populations. Future international studies are warranted of complex combined interventions using mixed methods to provide evidence of effectiveness, context of implementation and economic evaluation.

MP78-18 THE ECONOMIC IMPACT OF ROBOTIC AND OPEN RADICAL PROSTATECTOMY ON PATIENTS AND THEIR FAMILIES

You have accessJournal of UrologyProstate Cancer: Epidemiology & Natural History III1 Apr 2014MP78-18 THE ECONOMIC IMPACT OF ROBOTIC AND OPEN RADICAL PROSTATECTOMY ON PATIENTS AND THEIR FAMILIES Will Lowrance, Coral Swartz, James Eastham, and Elena Elkin Will LowranceWill Lowrance More articles by this author , Coral SwartzCoral Swartz More articles by this author , James EasthamJames Eastham More articles by this author , and Elena ElkinElena Elkin More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2501AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Robotic-assisted laparoscopic prostatectomy (RALP) and open radical prostatectomy (ORP) have similar clinical and functional outcomes. RALP is more expensive than ORP, but it is not clear whether subsequent postoperative costs vary. We assessed the economic impact of RALP and ORP on patients and their families in the year following surgery. METHODS We recruited ORP and RALP patients planning surgery for stage T1-T2 prostate cancer at an academic cancer center. Economic impact questionnaires were completed at 3, 6, and 12 months after surgery. The self-administered survey included items regarding the use and cost of health services and supplies, health insurance coverage and employment, and changes in the patient’s and his family’s finances since prostate cancer surgery. RESULTS Between June 2010 and September 2013, 441 of 584 eligible patients consented (76% response rate), and 205 completed a 12-month assessment, of whom 39% had ORP and 61% had RALP. All patients had health insurance. Of 179 men (87%) who reported any new prescription medications since surgery, 12% said insurance did not cover any of the cost of those medications. Of 173 men (84%) who reported new use of incontinence pads, 75% had no insurance coverage for those costs and 23% were uncertain. Of 159 men who were working full- or part-time before surgery, 6% did not return to work after prostatectomy, 36% missed more than 4 weeks of work and 19% had no paid sick days. Approximately 22% of men said their monthly income was lower and 45% said their monthly expenses were greater than before surgery. Almost 88% of men said that since surgery they spent money on hospital, physician or other provider bills, medications, supplies or alternative therapies. About 37% said that since surgery they or their families had to downscale their lifestyle, not pay bills or pay them late, or use money from savings. Nearly 21% of men reported visiting an emergency department at least once in the 12 months following prostatectomy. Comparing men who had RALP vs. ORP, there were no statistically significant differences in their reports of new prescriptions, pad use, return to work, use of sick days, or other postoperative expenses or health care utilization. CONCLUSIONS Both RALP and ORP are associated with an economic burden on patients and their families, and many postoperative costs are not covered by health insurance. Neither approach appears to have an economic advantage from the patient perspective. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e927-e928 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Will Lowrance More articles by this author Coral Swartz More articles by this author James Eastham More articles by this author Elena Elkin More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Evaluation of the EmbaGYN™ Pelvic Floor Muscle Stimulator in Addition to Kegel Exercises for the Treatment of Female Stress Urinary Incontinence: A Prospective, Open-Label, Multicenter, Single-Arm Study

To assess the efficacy and safety of the EmbaGYN™ Pelvic Floor Exerciser, a battery-powered neuromuscular stimulation device with a vaginal, two-electrode stimulation probe in women with stress urinary incontinence. In this prospective, open-label, multicenter, single-arm study, patients with stress urinary incontinence (n = 83) underwent 12 weeks of treatment with EmbaGYN with Kegel exercises. At week 12, the mean number of incontinence episodes/day (primary end point) fell 56.2% (p = 0.152). A ≥50% decrease from baseline in incontinence episodes was seen in 65.3% of subjects (p = 0.006). The mean number of incontinence pads/day fell 57.1% (p = 0.001). Mean 24- and 1-h in-office urine loss declined 59.0% (p < 0.001) and 67% (p = 0.019), respectively. There was one nonserious device-related adverse event. EmbaGYN with Kegel exercises resulted in significant reductions in urine loss, incontinence pad use and improved incontinence-related quality of life, but did not have a significant effect on incontinence episodes/day.

Management of bladder dysfunction and satisfaction of life after spinal cord injury in Norway

BackgroundThere is limited knowledge about bladder dysfunction and bladder management in persons with spinal cord injury (SCI) after discharge from the hospital in Norway. The impact of bladder dysfunction on satisfaction of life has been rarely explored.SettingCommunity-based survey from Norway.MethodsAn anonymous cross-sectional postal survey. A questionnaire was sent to the registered members of the Norwegian Spinal Cord Injuries Association. A total of 400 participants, with traumatic or non-traumatic SCI, received the questionnaire.ResultsA total of 248 subjects (62%), 180 men and 68 women, answered the questionnaire. Mean age was 54 years and mean time since injury 13.4 years. A total of 164 participants (66.1%) used intermittent catheterization for bladder emptying (48.5% women versus 72.8% men); more paraplegics than tetraplegics (77.2% versus 55.7%). Recommendations given at the Spinal Cord Units were thoroughly followed by persons who had used catheters more than 5 years. Use of incontinence pads were associated with reduced satisfaction of life.ConclusionsThe most common method of management of bladder dysfunction is clean intermittent catheterization in Norway. Recommendations were followed more thoroughly by persons who have used intermittent catheterization for more than 5 years. Spinal Cord Units are important source for information and guidance.

PUK22 - Cost-Effectiveness of Mirabegron Compared with Antimuscarinics for the Treatment of Patients with Overactive Bladder in the United Kingdom

Mirabegron is a first-in-class beta-3 adrenoceptor agonist for the treatment of overactive bladder (OAB) that demonstrated superior efficacy compared to placebo by reducing OAB symptoms and improving HRQoL. We sought to assess the cost-effectiveness of mirabegron 50 mg in comparison with current antimuscarinics for the treatment of patients with OAB in the UK. A Markov model was developed to simulate the therapeutic management, the changes in symptoms (micturitions and incontinence), and complications in hypothetical cohorts of OAB patients. The model was used to predict costs and QALYs over 5 years in cohorts initially treated with antimuscarinics or mirabegron 50mg. Effectiveness and safety data were based on the results from a mixed treatment comparison (MTC). A calibration approach was used to derive transition probabilities from mean changes in frequency of micturitions and incontinence episodes. Other input data were obtained from several sources, including scientific literature and expert opinions. Costs were evaluated from the UK National Health Service (NHS) perspective and included costs of drug acquisition, GP visits, specialist visit, incontinence pad use and botox injections. Utilities were obtained from equations predicting EQ-5D index scores according to symptom severity, estimated from a clinical trial of Mirabegron. The Mirabegron strategy was slightly more expensive and associated with a greater number of QALYs, as a result of improved persistence, related to a lower risk of adverse event compared to each antimuscarinic. Mirabegron 50mg was found to be cost-effective compared to each antimuscarinic, with an ICER of £340 vs. solifenacin 10mg, £3,607 versus fesoterodine 4mg, £3,715 vs. tolterodine ER 4mg, £3,878 vs. oxybutynin ER 10mg, £8,881 versus trospium chloride MR 60 mg, £12,493 versus solifenacin 5mg, and £14,234 oxybutynin IR 10mg. Treatment with mirabegron appears to be a cost-effective strategy compared with antimuscarinics from a UK NHS perspective.

Männer mit Typ-2-Diabetes und Erektiler Dysfunktion sind eine besondere Risikogruppe für LUTS - Ergebnisse der Wittener Diabetes-Erhebung

According to our data on 4 071 patients with type 2 diabetes, 65.5% of the men and 70.4% of the women complain of lower urinary tract symptoms (LUTS). That is twice as much as the normal population for the same age group. The most common symptom was overactive bladder (OAB). In patients with a diabetes-related complication such as retinopathy or nephropathy, the incidence for LUTS was about 20% higher than that in patients without complications, whereas in men with diabetes mellitus type 2 and erectile dysfunction (ED) the incidence for LUTS was 31.9% higher than without ED. We wanted to compare the incidence of LUTS in patients with type 2 diabetes and ED against patients without ED as well as women with type 2 diabetes. Men with ED had a statistically significant longer history of diabetes, a higher HbA1c and increased serum creatinine compared to men without ED (p value <0.0001). The length of diabetes history was not statistically relevant compared to women with type 2 diabetes. However the HbA1c and serum creatinine were higher than those of the women from the data bank (p value <0.0001). Diabetic men with ED complained more often of urinary incontinence, urge incontinence and made more often use of incontinence pads (p value <0.0001). As for pollakisuria and nocturia the difference was not significant. 42.3% of type 2 diabetic patients with ED were diagnosed with OAB by their urologist or GP. That was significantly more than type 2 diabetic patients without ED and type 2 diabetic women (see graph). The same was true of stress incontinence, overflow incontinence and non-classified incontinence with the exception of faecal incontinence. Patients with type 2 diabetes and ED had to take drugs more often than type 2 diabetic men without ED and women with diabetes. Amongst patients with type 2 diabetes, ED increases the risk of developing lower urinary tract disorders. Moreover it is connected with a higher HbA1c and a higher risk for LUTS, especially for OAB. The regular use of incontinence pads in every fourth patient with type 2 diabetes and erectile dysfunction demonstrates a high number of under-treated patients. Patients with type 2 diabetes and especially patients with type 2 diabetes AND erectile dysfunction represent a risk group that needs special attention and a special management plan from urologists and GPs.

PND29 - Estimating the cost-effectiveness of onabotulinumtoxinA for neurogenic detrusor overactivity in the United States

Abstract Background Urinary incontinence (UI) secondary to a neurogenic pathology, including spinal cord injury and multiple sclerosis, is termed neurogenic detrusor overactivity (NDO). Patients with NDO experience decreased quality of life and are at risk for upper urinary tract damage. Two recent trials demonstrated that onabotulinumtoxinA significantly reduced UI, improved urodynamic parameters, and improved quality of life relative to placebo. However, the economic impact of onabotulinumtoxinA treatment for UI due to NDO in the United States remains unknown. Objective The objective of this analysis was to evaluate whether the benefit observed in NDO patients receiving onabotulinumtoxinA provides good value for money. Methods We developed a Markov state transition model to estimate population outcomes and costs for anticholinergic-refractory NDO patients who received either onabotulinumtoxinA or best supportive care (use of incontinence pads with either an anticholinergic drug, clean intermittent self-catheterization, or both). Nonresponding patients ( Results In the base case, onabotulinumtoxinA increased QALYs by 0.059 and costs by $1466 compared with best supportive care, which resulted in an estimated ICER of $24,720/QALY. OnabotulinumtoxinA also decreased mean UI episodes per person-year by 398, resulting in a cost of $4 per UI episode avoided. Model results were most sensitive to the probability of treatment response. The probabilistic sensitivity analysis indicated that at a willingness to pay of $50,000/QALY, onabotulinumtoxinA has a 97% probability of being cost-effective. In subgroup analyses of each etiology, onabotulinumtoxinA yielded an ICER of $32,268/QALY in multiple sclerosis and $2182 in spinal cord injury. Conclusion OnabotulinumtoxinA seems to be a cost-effective intervention for UI due to NDO compared with best supportive care.

Estimating the Cost-Effectiveness of OnabotulinumtoxinA for Neurogenic Detrusor Overactivity in the United States

BackgroundUrinary incontinence (UI) secondary to a neurogenic pathology, including spinal cord injury and multiple sclerosis, is termed neurogenic detrusor overactivity (NDO). Patients with NDO experience decreased quality of life and are at risk for upper urinary tract damage. Two recent trials demonstrated that onabotulinumtoxinA significantly reduced UI, improved urodynamic parameters, and improved quality of life relative to placebo. However, the economic impact of onabotulinumtoxinA treatment for UI due to NDO in the United States remains unknown. ObjectiveThe objective of this analysis was to evaluate whether the benefit observed in NDO patients receiving onabotulinumtoxinA provides good value for money. MethodsWe developed a Markov state transition model to estimate population outcomes and costs for anticholinergic-refractory NDO patients who received either onabotulinumtoxinA or best supportive care (use of incontinence pads with either an anticholinergic drug, clean intermittent self-catheterization, or both). Nonresponding patients (<50% reduction in UI episodes at 6 weeks) were eligible to receive invasive procedures, including augmentation cystoplasty or sacral neuromodulation. Patients could transition through 6 health states, 3 defined based on response to initial treatment, 2 capturing patients who underwent invasive procedures, and death. Time in each health state was adjusted for patient quality of life and summed to estimate quality-adjusted life-years (QALYs). The model included direct medical costs related to initial and subsequent drug and invasive treatments, physician visits, and catheterization. Outcomes and costs were summed and compared across intervention groups by using the incremental cost-effectiveness ratio (ICER; cost per QALY). The time horizon of the model was 3 years, and results were discounted at 3%. Scenario, 1-way, and probabilistic sensitivity analyses were performed to test the robustness of the model results. ResultsIn the base case, onabotulinumtoxinA increased QALYs by 0.059 and costs by $1466 compared with best supportive care, which resulted in an estimated ICER of $24,720/QALY. OnabotulinumtoxinA also decreased mean UI episodes per person-year by 398, resulting in a cost of $4 per UI episode avoided. Model results were most sensitive to the probability of treatment response. The probabilistic sensitivity analysis indicated that at a willingness to pay of $50,000/QALY, onabotulinumtoxinA has a 97% probability of being cost-effective. In subgroup analyses of each etiology, onabotulinumtoxinA yielded an ICER of $32,268/QALY in multiple sclerosis and $2182 in spinal cord injury. ConclusionOnabotulinumtoxinA seems to be a cost-effective intervention for UI due to NDO compared with best supportive care.