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Hayashi MAL, Simon SM, Zou K, Van Wyk H, Zahid MH, Eisenberg JNS, Freeman MC. Shared sanitation facilities and risk of respiratory virus transmission in resource-poor settings: A COVID-19 modeling case study. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2024. [PMID: 39179379 DOI: 10.1111/risa.17633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 05/08/2024] [Accepted: 07/04/2024] [Indexed: 08/26/2024]
Abstract
Water supply and sanitation are essential household services frequently shared in resource-poor settings. Shared sanitation can increase the risk of enteric pathogen transmission due to suboptimal cleanliness of facilities used by large numbers of individuals. It also can potentially increase the risk of respiratory disease transmission. As sanitation is an essential need, shared sanitation facilities may act as important respiratory pathogen transmission venues even with strict control measures such as stay-at-home recommendations in place. This analysis explores how behavioral and infrastructural conditions surrounding shared sanitation may individually and interactively influence respiratory pathogen transmission. We developed an individual-based community transmission model using COVID-19 as a motivating example parameterized from empirical literature to explore how transmission in shared latrines interacts with transmission at the community level. We explored mitigation strategies, including infrastructural and behavioral interventions. Our review of empirical literature confirms that shared sanitation venues in resource-poor settings are relatively small with poor ventilation and high use patterns. In these contexts, shared sanitation facilities may act as strong drivers of respiratory disease transmission, especially in areas reliant on shared facilities. Decreasing dependence on shared latrines was most effective at attenuating sanitation-associated transmission. Improvements to latrine ventilation and handwashing behavior were also able to decrease transmission. The type and order of interventions are important in successfully attenuating disease risk, with infrastructural and engineering controls being most effective when administered first, followed by behavioral controls after successful attenuation of sufficient alternate transmission routes. Beyond COVID-19, our modeling framework can be extended to address water, sanitation, and hygiene measures targeted at a range of environmentally mediated infectious diseases.
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Affiliation(s)
- Michael A L Hayashi
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Sophia M Simon
- Department of Environmental Science and Policy, University of California, Davis, California, USA
| | - Kaiyue Zou
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Hannah Van Wyk
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Mondal Hasan Zahid
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Joseph N S Eisenberg
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Matthew C Freeman
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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Watanabe T, Sadahira T, Tominaga Y, Maruyama Y, Nagasaki N, Sekito T, Edamura K, Watanabe T, Araki M, Watanabe M. Circadian Rhythms Fluctuate the Treatment Effects of Intravesical Treatments on Rat Urinary Frequency Models. Vet Med Int 2024; 2024:6505595. [PMID: 38836165 PMCID: PMC11150046 DOI: 10.1155/2024/6505595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 04/11/2024] [Accepted: 05/16/2024] [Indexed: 06/06/2024] Open
Abstract
Objectives It is still not clear how the intravesical instillation of drugs affects rat urinary frequency. This study aimed to examine the dynamics of intravesical treatments' treatment effect on rat urinary frequency models by real-time and extended monitoring using a novel continuous urination monitoring system. Methods Nine eleven-week-old female Wistar rats were divided into three groups to receive intravesical instillation of 0.1% acetic acid (AA), 1.0% AA, or phosphate-buffered saline (PBS). Thirty minutes later, these drugs were voided, and rats were moved to a continuous urination monitoring system, UM-100. UM-100 monitored rat urination quantitatively and continuously for 24 hours. Rats were then euthanized, and histopathologic examinations using a damage score validated the severity of bladder inflammation. We used nine additional rats to determine the treatment effect of various drugs against the urinary frequency. These rats were also treated with 1.0% AA in the same way and divided into three groups (n = 3 each) to receive intravesical instillation of lidocaine, silver nitrate (AgNO3), or dimethyl sulfoxide (DMSO), respectively. Thirty minutes later, rats were catheterized again and moved to the UM-100, and their voiding was monitored for 24 hours. Results Intravesical instillation of AA increased the urinary frequency and decreased the mean voided volume (VV) in a concentration-dependent manner, with statistical significance at a concentration of 1.0% (urinary frequency; p=0.0007, mean VV; p=0.0032, respectively) compared with PBS. Histopathological analysis of these models demonstrated a significantly higher damage score of bladder mucosa in both 0.1% AA and 1.0% AA compared with PBS, with the severity in concordance with the clinical severity of urinary frequency (0.1% AA: p < 0.0001, 1.0% AA: p < 0.0001). Moreover, intravesical instillation of lidocaine, AgNO3, and DMSO decreased the urinary frequency. Continuous monitoring with UM-100 also demonstrated that the treatment effect of these intravesically instilled drugs occurred only at night. Conclusions The extended monitoring of rat urination by UM-100 revealed a significant fluctuation in the treatment effect of intravesically instilled drugs between day and night. These findings may help establish novel therapies for urinary frequency.
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Affiliation(s)
- Tomofumi Watanabe
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Shikata-cho 2-5-1, Kita-ku, Okayama 700-8558, Japan
| | - Takuya Sadahira
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Shikata-cho 2-5-1, Kita-ku, Okayama 700-8558, Japan
| | - Yusuke Tominaga
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Shikata-cho 2-5-1, Kita-ku, Okayama 700-8558, Japan
| | - Yuki Maruyama
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Shikata-cho 2-5-1, Kita-ku, Okayama 700-8558, Japan
| | - Naoya Nagasaki
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Shikata-cho 2-5-1, Kita-ku, Okayama 700-8558, Japan
| | - Takanori Sekito
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Shikata-cho 2-5-1, Kita-ku, Okayama 700-8558, Japan
| | - Kohei Edamura
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Shikata-cho 2-5-1, Kita-ku, Okayama 700-8558, Japan
| | - Toyohiko Watanabe
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Shikata-cho 2-5-1, Kita-ku, Okayama 700-8558, Japan
| | - Motoo Araki
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Shikata-cho 2-5-1, Kita-ku, Okayama 700-8558, Japan
| | - Masami Watanabe
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Shikata-cho 2-5-1, Kita-ku, Okayama 700-8558, Japan
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Cuvelier N, Avanasi R, Grunenwald M, Ramanarayanan T, Wolf DC, Bartell SM. A Novel Approach to Integrate Human Biomonitoring Data with Model Predicted Dietary Exposures: A Crop Protection Chemical Case Study Using Lambda-Cyhalothrin. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2024; 72:11663-11671. [PMID: 38718292 PMCID: PMC11117394 DOI: 10.1021/acs.jafc.3c07071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 04/10/2024] [Accepted: 04/12/2024] [Indexed: 05/23/2024]
Abstract
The appropriate use of human biomonitoring data to model population chemical exposures is challenging, especially for rapidly metabolized chemicals, such as agricultural chemicals. The objective of this study is to demonstrate a novel approach integrating model predicted dietary exposures and biomonitoring data to potentially inform regulatory risk assessments. We use lambda-cyhalothrin as a case study, and for the same representative U.S. population in the National Health and Nutrition Examination Survey (NHANES), an integrated exposure and pharmacokinetic model predicted exposures are calibrated to measurements of the urinary metabolite 3-phenoxybenzoic acid (3PBA), using an approximate Bayesian computing (ABC) methodology. We demonstrate that the correlation between modeled urinary 3PBA and the NHANES 3PBA measurements more than doubled as ABC thresholding narrowed the acceptable tolerance range for predicted versus observed urinary measurements. The median predicted urinary concentrations were closer to the median measured value using ABC than using current regulatory Monte Carlo methods.
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Affiliation(s)
- Nicholas Cuvelier
- Department
of Environmental and Occupational Health, University of California, 856 Health Sciences Quad, Suite 3200, Irvine, California 92617, United States
- California
Department of Public Health, 1631 Alhambra Blvd., Suite 200, Sacramento, California 95816, United States
| | - Raga Avanasi
- Human
Safety, Syngenta Crop Protection, LLC, P.O. Box 18300, Greensboro, North Carolina 27409, United States
| | - Mark Grunenwald
- Human
Safety, Syngenta Crop Protection, LLC, P.O. Box 18300, Greensboro, North Carolina 27409, United States
| | - Tharacad Ramanarayanan
- Human
Safety, Syngenta Crop Protection, LLC, P.O. Box 18300, Greensboro, North Carolina 27409, United States
| | - Douglas C. Wolf
- Human
Safety, Syngenta Crop Protection, LLC, P.O. Box 18300, Greensboro, North Carolina 27409, United States
| | - Scott M. Bartell
- Department
of Environmental and Occupational Health, University of California, 856 Health Sciences Quad, Suite 3200, Irvine, California 92617, United States
- Department
of Statistics and Department of Epidemiology and Biostatistics, University of California, Anteater Instruction Research Building, Suite 2030, Irvine, California 92697, United States
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Afyouni AS, Wu YX, Balis UGJ, DeLancey J, Sadeghi Z. An Overview of the Effect of Aging on the Female Urethra. Urol Clin North Am 2024; 51:239-251. [PMID: 38609196 DOI: 10.1016/j.ucl.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
Urethral function declines by roughly 15% per decade and profoundly contributes to the pathogenesis of urinary incontinence. Individuals with poor urethral function are more likely to fail surgical management for stress incontinence that focus on improving urethral support. The reduced number of intramuscular nerves and the morphologic changes in muscle and connective tissue collectively impact urethral function as women age. Imaging technologies like MRI and ultrasound have advanced our understanding of these changes. However, substantial knowledge gaps remain. Addressing these gaps can be crucial for developing better prevention and treatment strategies, ultimately enhancing the quality of life for aging women.
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Affiliation(s)
- Andrew S Afyouni
- Division of Neurourology and Reconstructive Pelvic Surgery, Department of Urology, University of California Irvine, 3800 W. Chapman Avenue, Suite 7200, Orange, CA 92868, USA
| | - Yi Xi Wu
- Division of Neurourology and Reconstructive Pelvic Surgery, Department of Urology, University of California Irvine, 3800 W. Chapman Avenue, Suite 7200, Orange, CA 92868, USA
| | - Ulysses G J Balis
- Division of Pathology Informatics, Department of Pathology, University of Michigan Medical School, 2800 Plymouth Road, NCRC Building 35, Ann Arbor, MI 48109, USA
| | - John DeLancey
- Department of Obstetrics and Gynecology, University of Michigan Medical School, L4208 UH South, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Zhina Sadeghi
- Division of Neurourology and Reconstructive Pelvic Surgery, Department of Urology, University of California Irvine, 3800 W. Chapman Avenue, Suite 7200, Orange, CA 92868, USA.
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Wang X, Wang H, Xu P, Mao M, Feng S. Epidemiological trends and risk factors related to lower urinary tract symptoms around childbirth: a one-year prospective study. BMC Public Health 2023; 23:2134. [PMID: 37907879 PMCID: PMC10617094 DOI: 10.1186/s12889-023-17065-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 10/25/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Lower urinary tract symptoms (LUTS) are prevalent and distressing concerns for women worldwide. The prevalence of LUTS reaches the first peak during pregnancy and postnatal period. However, less attention has been paid to LUTS around childbirth and little progress has been made in the prevention of LUTS. Understanding the epidemiological characteristics of LUTS around childbirth would inform decision making for health care providers and perinatal women in the prevention of LUTS. The study aims to investigate the epidemiological trends and associated risk factors related to LUTS around childbirth. METHODS Pregnant women were consecutively enrolled during pregnancy in the obstetrical wards of a tertiary hospital and followed up at 6-8 weeks and one year postpartum through a prospective design. Urinary incontinence was assessed with the International Consultation on Incontinence Modular Questionnaire-Urinary Incontinence Short Form. Other symptoms were measured with questions based on definitions of the International Incontinence Society. Multiple logistic regression was used to examine the risk factors for LUTS including urinary incontinence, increased daytime frequency, nocturia and urgency. The report followed the STROBE statement. RESULTS A total of 1243 pregnant women participated in this study. The prevalence of at least one type of storage symptoms was 94%, 55% and 35% in late pregnancy, at 6-8 weeks and one year postpartum, respectively. The prevalence of urinary incontinence remained at 21% within one year postpartum. The majority of the participants suffered from mild to moderate urinary incontinence. Age, job, BMI before pregnancy, gestational diabetes mellitus, urinary tract infection history, previous history of LUTS, age at first birth and birth mode were predictors of LUTS one year postpartum. CONCLUSION LUTS were highly prevalent during pregnancy and postnatal period. The prevalence of urinary incontinence was more stable than that of other LUTS within one year postpartum. Women aged more than 35 years, engaging in manual work, with gestational diabetes mellitus, with a history of urinary tract infection and LUTS, with advanced age at first birth and vaginal delivery were more likely to suffer from LUTS postpartum. The findings provided a novel and deep insight into the epidemiological trends and related risk factors of LUTS around childbirth.
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Affiliation(s)
- Xiaojuan Wang
- School of Medicine, Zhejiang University, No.866 Yu Hang Tang Road, Hangzhou, Zhejiang Province, 310058, China
- Women's Hospital, School of Medicine, Zhejiang University, No.1 Xue Shi Road, Hangzhou, Zhejiang Province, 310006, China
| | - Hongyan Wang
- Women's Hospital, School of Medicine, Zhejiang University, No.1 Xue Shi Road, Hangzhou, Zhejiang Province, 310006, China
| | - Ping Xu
- School of Medicine, Zhejiang University, No.866 Yu Hang Tang Road, Hangzhou, Zhejiang Province, 310058, China
- Women's Hospital, School of Medicine, Zhejiang University, No.1 Xue Shi Road, Hangzhou, Zhejiang Province, 310006, China
| | - Minna Mao
- School of Medicine, Zhejiang University, No.866 Yu Hang Tang Road, Hangzhou, Zhejiang Province, 310058, China
- Women's Hospital, School of Medicine, Zhejiang University, No.1 Xue Shi Road, Hangzhou, Zhejiang Province, 310006, China
| | - Suwen Feng
- Women's Hospital, School of Medicine, Zhejiang University, No.1 Xue Shi Road, Hangzhou, Zhejiang Province, 310006, China.
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Sawaqed F, Kharboush I, Suoub M, Albadawi I, Alhawatmeh M, Murad A. A national survey of lower urinary tract symptoms in Jordan. Asian J Urol 2023; 10:518-525. [PMID: 38024424 PMCID: PMC10659976 DOI: 10.1016/j.ajur.2021.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 08/21/2021] [Accepted: 12/28/2021] [Indexed: 11/07/2022] Open
Abstract
Objective To determine the prevalence of lower urinary tract symptoms (LUTS) and their severity population in Jordan. Methods This cross-sectional survey was conducted using a paper-based survey between August and September in 2019. The study was carried out in the health care centers or hospitals in three different regions of Jordan: North (Irbid and Jarash), Middle (Amman, Madaba, Salt, and Zarqa), and South (Karak and Aqaba). Results To estimate the prevalence of LUTS, two definitions were used, including the first definition (presence of any LUTS regardless of the degree of severity) and the second definition (presence of any LUTS that occurs half the time or more). According to the first definition, 1038 (89.9%) reported LUTS (male: 47.3%, female: 52.7%), while 763 (66.1%) reported LUTS according to the second definition (male: 45.6%, female: 54.4%). According to the International Prostate Symptom Score characterization, 73.9% had nocturia and 62.9% reported daytime increased frequency. Conclusion LUTS are highly prevalent among the Jordanian population, and more than half of them have nocturia or daytime increased frequency as most frequently reported symptoms.
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Affiliation(s)
- Fadi Sawaqed
- Section of Urology, Department of Special Surgery, Faculty of Medicine, Mu'tah University, Karak, Jordan
| | - Ibrahim Kharboush
- Department of Public Health, Faculty of Medicine Mu'tah University, Karak, Jordan
- High Institute of Public Health, Alexandria University, Egypt
| | - Mohammed Suoub
- Section of Urology, Department of Special Surgery, Faculty of Medicine, Mu'tah University, Karak, Jordan
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Faustino M, Silva S, Costa EM, Pereira AM, Pereira JO, Oliveira AS, Ferreira CMH, Pereira CF, Durão J, Pintado ME, Carvalho AP. Effect of Mannan Oligosaccharides Extracts in Uropathogenic Escherichia coli Adhesion in Human Bladder Cells. Pathogens 2023; 12:885. [PMID: 37513732 PMCID: PMC10384913 DOI: 10.3390/pathogens12070885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 06/16/2023] [Accepted: 06/27/2023] [Indexed: 07/30/2023] Open
Abstract
Urinary tract infections (UTIs) are a common public health problem, mainly caused by uropathogenic Escherichia coli (UPEC). Patients with chronic UTIs are usually treated with long-acting prophylactic antibiotics, which promotes the development of antibiotic-resistant UPEC strains and may complicate their long-term management. D-mannose and extracts rich in D-mannose such as mannan oligosaccharides (MOS; D-mannose oligomers) are promising alternatives to antibiotic prophylaxis due to their ability to inhibit bacterial adhesion to urothelial cells and, therefore, infection. This highlights the therapeutic potential and commercial value of using them as health supplements. Studies on the effect of MOS in UTIs are, however, scarce. Aiming to evaluate the potential benefits of using MOS extracts in UTIs prophylaxis, their ability to inhibit the adhesion of UPEC to urothelial cells and its mechanism of action were assessed. Additionally, the expression levels of the pro-inflammatory marker interleukin 6 (IL-6) were also evaluated. After characterizing their cytotoxic profiles, the preliminary results indicated that MOS extracts have potential to be used for the handling of UTIs and demonstrated that the mechanism through which they inhibit bacterial adhesion is through the competitive inhibition of FimH adhesins through the action of mannose, validated by a bacterial growth impact assessment.
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Affiliation(s)
- Margarida Faustino
- CBQF-Centro de Biotecnologia e Química Fina-Laboratório Associado, Universidade Católica Portuguesa, Escola Superior de Biotecnologia, Rua Diogo Botelho 1327, 4169-005 Porto, Portugal
| | - Sara Silva
- CBQF-Centro de Biotecnologia e Química Fina-Laboratório Associado, Universidade Católica Portuguesa, Escola Superior de Biotecnologia, Rua Diogo Botelho 1327, 4169-005 Porto, Portugal
| | - Eduardo M Costa
- CBQF-Centro de Biotecnologia e Química Fina-Laboratório Associado, Universidade Católica Portuguesa, Escola Superior de Biotecnologia, Rua Diogo Botelho 1327, 4169-005 Porto, Portugal
| | - Ana Margarida Pereira
- CBQF-Centro de Biotecnologia e Química Fina-Laboratório Associado, Universidade Católica Portuguesa, Escola Superior de Biotecnologia, Rua Diogo Botelho 1327, 4169-005 Porto, Portugal
- Amyris Bio Products Portugal, Unipessoal Lda, Rua Diogo Botelho, 1327, 4169-005 Porto, Portugal
| | - Joana Odila Pereira
- CBQF-Centro de Biotecnologia e Química Fina-Laboratório Associado, Universidade Católica Portuguesa, Escola Superior de Biotecnologia, Rua Diogo Botelho 1327, 4169-005 Porto, Portugal
- Amyris Bio Products Portugal, Unipessoal Lda, Rua Diogo Botelho, 1327, 4169-005 Porto, Portugal
| | - Ana Sofia Oliveira
- CBQF-Centro de Biotecnologia e Química Fina-Laboratório Associado, Universidade Católica Portuguesa, Escola Superior de Biotecnologia, Rua Diogo Botelho 1327, 4169-005 Porto, Portugal
| | - Carlos M H Ferreira
- CBQF-Centro de Biotecnologia e Química Fina-Laboratório Associado, Universidade Católica Portuguesa, Escola Superior de Biotecnologia, Rua Diogo Botelho 1327, 4169-005 Porto, Portugal
- Amyris Bio Products Portugal, Unipessoal Lda, Rua Diogo Botelho, 1327, 4169-005 Porto, Portugal
| | - Carla F Pereira
- CBQF-Centro de Biotecnologia e Química Fina-Laboratório Associado, Universidade Católica Portuguesa, Escola Superior de Biotecnologia, Rua Diogo Botelho 1327, 4169-005 Porto, Portugal
| | - Joana Durão
- CBQF-Centro de Biotecnologia e Química Fina-Laboratório Associado, Universidade Católica Portuguesa, Escola Superior de Biotecnologia, Rua Diogo Botelho 1327, 4169-005 Porto, Portugal
- Amyris Bio Products Portugal, Unipessoal Lda, Rua Diogo Botelho, 1327, 4169-005 Porto, Portugal
| | - Manuela E Pintado
- CBQF-Centro de Biotecnologia e Química Fina-Laboratório Associado, Universidade Católica Portuguesa, Escola Superior de Biotecnologia, Rua Diogo Botelho 1327, 4169-005 Porto, Portugal
| | - Ana P Carvalho
- CBQF-Centro de Biotecnologia e Química Fina-Laboratório Associado, Universidade Católica Portuguesa, Escola Superior de Biotecnologia, Rua Diogo Botelho 1327, 4169-005 Porto, Portugal
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Constantine ML, Rockwood TH, Rickey LM, Bavendam T, Low LK, Lowder JL, Markland AD, McGwin G, Mueller ER, Newman DK, Putnam S, Rudser K, Smith AL, Stapleton AE, Miller JM, Lukacz ES. Validation of bladder health scales and function indices for women's research. Am J Obstet Gynecol 2023; 228:566.e1-566.e14. [PMID: 36596439 PMCID: PMC10425263 DOI: 10.1016/j.ajog.2022.12.319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 12/15/2022] [Accepted: 12/21/2022] [Indexed: 01/02/2023]
Abstract
BACKGROUND Existing bladder-specific measures lack the ability to assess the full range of bladder health, from poor to optimal health. OBJECTIVE This study aimed to report evidence of validity of the self-administered, multidimensional bladder health scales and function indices for research in adult women. STUDY DESIGN A cross-sectional population-based validation study with random assignment to paper or electronic administration was conducted using national address-based probability sampling supplemented by purposive sampling of women with lower urinary tract symptoms in 7 clinical research centers. Construct validity of the bladder health scales and function indices was guided by a multitrait-multimethod approach using health and condition-specific questionnaires, bladder diaries, expert ratings of bladder health, and noninvasive bladder function testing. Internal dimensional validity was evaluated using factor analysis; internal reliability was assessed using paired t-tests and 2-way mixed-effects intraclass correlation coefficient models. Chi-square, Fisher exact, or t-tests were used for mode comparisons. Convergent validity was evaluated using Pearson correlations with the external construct measures, and known-group validity was established with comparison of women known and unknown to be symptomatic of urinary conditions. RESULTS The sample included 1072 participants. Factor analysis identified 10 scales, with Cronbach's alpha ranging from 0.74 to 0.94. Intraclass correlation coefficients of scales ranged from 0.55 to 0.94. Convergent validity of the 10 scales and 6 indices ranged from 0.52 to 0.83. Known-group validity was confirmed for all scales and indices. Item distribution was similar by mode of administration. CONCLUSION The paper and electronic forms of the bladder health scales and function indices are reliable and valid measures of bladder health for use in women's health research.
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Affiliation(s)
- Melissa L Constantine
- Division of Biostatistics, University of Minnesota, Minneapolis, MN; Patient Centered Research, Evidera, Bethesda, MD.
| | - Todd H Rockwood
- Department of Health Policy, University of Minnesota, Minneapolis, MN
| | - Leslie M Rickey
- Departments of Urology and Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT
| | - Tamara Bavendam
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
| | - Lisa Kane Low
- School of Nursing, University of Michigan, Ann Arbor, MI
| | - Jerry L Lowder
- Department of Obstetrics and Gynecology, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO
| | - Alayne D Markland
- Division of Gerontology, Geriatrics and Palliative Care, Department of Medicine, The University of Alabama at Birmingham, Birmingham, AL
| | - Gerald McGwin
- School of Public Health, The University of Alabama at Birmingham, Birmingham, AL
| | - Elizabeth R Mueller
- Departments of Urology and Obstetrics and Gynecology, Loyola University Medical Center, Loyola University Chicago, Chicago, IL
| | - Diane K Newman
- Division of Urology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Sara Putnam
- Division of Biostatistics, University of Minnesota, Minneapolis, MN
| | - Kyle Rudser
- Division of Biostatistics, University of Minnesota, Minneapolis, MN
| | - Ariana L Smith
- Division of Urology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Ann E Stapleton
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA
| | - Janis M Miller
- School of Nursing, University of Michigan, Ann Arbor, MI
| | - Emily S Lukacz
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Diego, La Jolla, CA.
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Hip and Pelvic Floor Muscle Strength in Women with and without Urgency and Frequency Predominant Lower Urinary Tract Symptoms. ACTA ACUST UNITED AC 2021; 45:126-134. [PMID: 34366727 DOI: 10.1097/jwh.0000000000000209] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Urgency and frequency are common lower urinary tract symptoms (UF-LUTS) in women. There is limited evidence to guide physical therapist-led treatment. Objectives To compare hip and pelvic floor muscle strength between women with and without UF-LUTS. We hypothesized women with UF-LUTS would demonstrate 1) diminished hip external rotator and abductor strength and 2) equivalent pelvic floor strength and diminished endurance compared to controls. Study Design A matched case-control study. Methods Women with UF-LUTS (cases) and controls were matched on age, body mass index (BMI), vaginal parity. Examiner measured participants' 1) hip external rotator and abductor strength via dynamometry (maximum voluntary effort against fixed resistance) and 2) pelvic floor muscle strength (peak squeeze pressure) and endurance (squeeze pressure over a 10 second hold) via vaginal manometry. Values compared between cases and controls with paired-sample t-tests (hip) or Wilcoxon signed rank tests (pelvic floor). Results 21 pairs (42 women): Hip external rotation (67.0 ± 19.0 N vs 83.6 ± 21.5 N; P=0.005) and hip abduction strength (163.1 ± 48.1 N vs 190.1 ± 53.1 N; P=0.04) were significantly lower in cases than controls. There was no significant difference in pelvic floor strength (36.8 ± 19.9 cmH20 vs 41.8 ± 21.0 cmH20; P=0.40) or endurance (234.0 ± 149.6 cmH20*seconds vs 273.4 ± 149.1 cmH20*seconds; P=0.24). Conclusion Women with UF-LUTS had weaker hip external rotator and abductor muscles, but similar pelvic floor strength and endurance compared to controls. Hip strength may be important to assess in patients with UF-LUTS, further research is needed.
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10
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Wu C, Newman D, Schwartz TA, Zou B, Miller J, Palmer MH. Effects of unsupervised behavioral and pelvic floor muscle training programs on nocturia, urinary urgency, and urinary frequency in postmenopausal women: Secondary analysis of a randomized, two-arm, parallel design, superiority trial (TULIP study). Maturitas 2021; 146:42-48. [PMID: 33722363 DOI: 10.1016/j.maturitas.2021.01.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/22/2021] [Accepted: 01/28/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine and compare the effects of an unsupervised behavioral and pelvic floor muscle training (B-PFMT) program delivered in two formats on nocturia, urinary urgency, and urinary frequency in postmenopausal women. STUDY DESIGN A secondary analysis used data collected from women enrolled in the TULIP study. Women aged 55 years or more with no urinary incontinence were provided the B-PFMT program. Each woman was randomly assigned to a face-to-face class that took about 2 h (2-hrClass) or to a DVD showing essentially the same information as a 20-minute video (20-minVideo). All women were instructed to independently continue the program following their education session. Three urinary outcomes were assessed at baseline, 3, 12, and 24 months. MAIN OUTCOME MEASURES Nocturia and urinary urgency were examined with one item each from the questionnaire-based voiding diary, and urinary frequency was assessed with patients' self-documenting 3-day bladder diary. RESULTS Women in the 2-hrClass group experienced significantly fewer nocturia episodes and longer average inter-void interval at each follow-up and fewer urinary urgency episodes at 12 months. Women in the 20-minVideo group experienced significantly fewer episodes of nocturia and urinary urgency and longer average inter-void interval at each follow-up time point. No significant between-group differences were found for any outcome, except for nocturia at 24 months, when effectiveness favored women in the 20-minVideo group. CONCLUSIONS Unsupervised B-PFMT programs are effective for improving postmenopausal women's urinary outcomes regardless of the format. The optimal format to deliver B-PFMT programs in terms of effectiveness should be explored in future studies.
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Affiliation(s)
- Chen Wu
- University of North Carolina at Chapel Hill, School of Nursing, Chapel Hill, NC, United States
| | - Diane Newman
- University of Pennsylvania, Perelman School of Medicine, Division of Urology, Department of Surgery, Philadelphia, PA, United States
| | - Todd A Schwartz
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Biostatistics, School of Nursing, Chapel Hill, NC, United States
| | - Baiming Zou
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Biostatistics, School of Nursing, Chapel Hill, NC, United States
| | - Janis Miller
- University of Michigan, School of Nursing, Ann Arbor, MI, United States
| | - Mary H Palmer
- Helen W. & Thomas L. Umphlet Distinguished Professor in Aging, University of North Carolina at Chapel Hill, School of Nursing, CB 7460, Chapel Hill, NC 27599-7460, United States.
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11
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Burgio KL, James AS, LaCoursiere DY, Mueller ER, Newman DK, Low LK, Weinfurt KP, Wyman JF, Cunningham SD, Vargo K, Connett J, Williams BR. Views of Normal Bladder Function Among Women Experiencing Lower Urinary Tract Symptoms. Urology 2020; 150:103-109. [PMID: 32841655 DOI: 10.1016/j.urology.2020.08.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/28/2020] [Accepted: 08/10/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To explore the perspectives of normal bladder function among women with lower urinary tract symptoms. METHODS This was a secondary analysis of qualitative data from structured interviews with 50 adult women with lower urinary tract symptoms. A directed content analysis of the transcripts explored women's perspectives on normal bladder function. RESULTS Participants' descriptions of "normal" took many forms and were based on several aspects of bladder function. A prominent feature of normal was that voiding occurred as a seamless process, beginning with an urge sensation, followed by voiding with ease and to completion, and then "being done." Descriptions of normal were based largely on concepts of voiding regularity, including voiding frequency, intervals, and patterns during the day and night. Another aspect of normal bladder function was the notion of having control in terms of not leaking urine, as well as the ability to hold urine and defer urination. Views of normal bladder function extended to the absence of symptoms and the impact of being symptom-free on day-to-day life, including not having to think about or worry about the bladder or limit daily activities. CONCLUSION Women's perspectives on normal bladder function are multifaceted, reflecting attributes most salient to each individual and likely informed by their personal experience with symptoms and their influence on daily life. This work has implications for how clinicians might engage women in discussing bladder symptoms and can inform future research and public health messaging about normal bladder function.
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Affiliation(s)
- Kathryn L Burgio
- University of Alabama at Birmingham School of Medicine, Birmingham, AL; Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham, AL.
| | - Aimee S James
- Washington University School of Medicine, St. Louis, MO
| | | | | | - Diane K Newman
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| | - Lisa Kane Low
- University of Michigan School of Nursing, Ann Arbor, MI
| | | | - Jean F Wyman
- University of Minnesota, School of Nursing, Minneapolis, MN
| | | | - Keith Vargo
- University of Minnesota School of Public Health, Minneapolis, MN
| | - John Connett
- University of Minnesota School of Public Health, Minneapolis, MN
| | - Beverly Rosa Williams
- University of Alabama at Birmingham School of Medicine, Birmingham, AL; Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham, AL
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- National Institutes of Health (NIH), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), Bethesda, MD
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12
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Kowalik CG, Daily A, Goodridge SD, Hartigan SM, Kaufman MR, Fowke JH, Dmochowski RR, Reynolds WS. Factors associated with urinary incontinence in a community sample of young nulligravid women. Neurourol Urodyn 2020; 39:1430-1436. [PMID: 32324941 DOI: 10.1002/nau.24368] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 01/30/2020] [Accepted: 04/13/2020] [Indexed: 12/17/2022]
Abstract
AIMS The aim of this study is to identify factors associated with urinary incontinence (UI) in a community sample of young nulligravid women. METHODS This was a secondary analysis from a cross-sectional survey-based study of cisgender women aged 18 to 25 years recruited through a national registry of research volunteers. Participants completed validated questionnaires assessing toileting behaviors, lower urinary tract symptoms (LUTS), and bowel symptoms. Women were excluded from analysis if currently pregnant, any prior pregnancy, cystectomy, or any neurologic disease including spinal cord injury, stroke, or multiple sclerosis. Analyses determined the prevalence of symptoms and evaluated candidate risk factors for UI. RESULTS Final analyses included 964 women (mean age, 22.6 ± 2.0). Monthly UI was identified in 295 (30.6%) subjects, with mixed UI being the most common (56.9%; n = 168). Seventy-two women (7.4%) reported fecal incontinence (FI) and 24 (3.5%) women reported both UI and FI. After multivariable regression modeling, UI was associated with an intermittent urine stream and the delayed voiding toileting behavior subscale. CONCLUSIONS UI in this cohort of young nulliparous women was highly prevalent and warrants further study as to the cause. Therapeutic guidelines to prevent UI and LUTS may need to be adjusted by targeting populations earlier than traditionally considered.
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Affiliation(s)
- Casey G Kowalik
- Department of Urology, University of Kansas Health System, Kansas City, Kansas
| | - Adam Daily
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sophia D Goodridge
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Siobhan M Hartigan
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Melissa R Kaufman
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jay H Fowke
- Department of Preventative Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Roger R Dmochowski
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - William S Reynolds
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
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13
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Abstract
Urinary incontinence (UI) is common among women and contributes to decreased quality of life. Several effective treatment options are available for the most common types of UI (stress, urge, and mixed), including lifestyle and behavioral therapy, drug therapy, and minimally invasive procedures. Most women improve with treatment, and UI is not an inevitable part of aging. To maximize the opportunity for successful treatment, it is critical to align the treatment approach with patient goals and expectations for care, including an assessment of patient-driven priorities regarding potential adverse effects, costs, and expected benefit of different treatment approaches.
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Affiliation(s)
- Camille P Vaughan
- Birmingham/Atlanta VA Geriatric Research Education and Clinical Center and Emory University, Atlanta, Georgia (C.P.V.)
| | - Alayne D Markland
- Birmingham/Atlanta VA Geriatric Research Education and Clinical Center and University of Alabama at Birmingham, Birmingham, Alabama (A.D.M.)
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14
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Hardacker CT, Baccellieri A, Mueller ER, Brubaker L, Hutchins G, Zhang JLY, Hebert-Beirne J. Bladder Health Experiences, Perceptions and Knowledge of Sexual and Gender Minorities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16173170. [PMID: 31480302 PMCID: PMC6747507 DOI: 10.3390/ijerph16173170] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 08/27/2019] [Accepted: 08/29/2019] [Indexed: 12/23/2022]
Abstract
While recent efforts have been made to understand the bladder health experiences, perceptions, and knowledge of cisgender adolescent females and women, virtually nothing is known about the bladder health experiences of people who identify as sexual and gender minorities (SGMs). A community-based participatory research approach using a focus group methodology to engage 36 adult participants who identify as SGM, including individuals who identify as gender non-conforming, queer, transgender (trans) men, or lesbian, in one of six focus group discussions on bladder health. Using directed content qualitative data analysis from the six unique focus groups, three interrelated themes were revealed: gender socialization of voiding behavior and toilet environment culture producing identity threats, and risks to gender affirmation; consequences of hetero-cis normative bathroom infrastructure necessitating adaptive voiding behaviors; and, physical and psychosocial consequences of chronic anxiety and fear are associated with voiding experiences. Insight on how SGMs navigate voiding behaviors, toilet experiences, and health care seeking is needed to assure that bladder health promotion activities are inclusive of this population's needs.
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Affiliation(s)
- Cecilia T Hardacker
- Howard Brown Health, Chicago, IL 60613, USA
- Rush University College of Nursing, Chicago, IL 60612, USA
| | - Anna Baccellieri
- Community Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Elizabeth R Mueller
- Departments of Obstetrics and Gynecology, Loyola University Stritch School of Medicine, Maywood, IL 60153, USA
- Departments of Urology, Loyola University Stritch School of Medicine, Maywood, IL 60153, USA
| | - Linda Brubaker
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, La Jolla, CA 92093, USA
| | - Georgia Hutchins
- Community Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago, IL 60612, USA
| | | | - Jeni Hebert-Beirne
- Community Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago, IL 60612, USA.
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15
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Abstract
Pelvic floor disorders commonly affect women and may cause distress and difficulty with daily functions and self-image. Urinary incontinence may present as stress incontinence, urgency incontinence, or in some combination (mixed incontinence). Symptomatic pelvic organ prolapse (POP) occurs when the patient is bothered by the sensation of a herniation of the pelvic organs through the vagina. Although POP is often distressing and embarrassing, it is not considered life-threatening unless the patient cannot urinate or defecate. There are numerous ways to treat these conditions, including conservative (including observation), medical, and surgical management.
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Affiliation(s)
- Meadow Maze Good
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine & Reconstructive Surgery, University of Florida College of Medicine Jacksonville, Jacksonville, FL, USA.
| | - Ellen R Solomon
- Obstetrics and Gynecology, Division of Female Pelvic Surgery, University of Massachusetts-Baystate Medical Center, 759 Chestnut Street, Springfield, MA 01199, USA
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16
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Oluwole OSA. Circatidal rhythm of void volume in young healthy adults. BIOL RHYTHM RES 2019. [DOI: 10.1080/09291016.2018.1474570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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17
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Kowalik CG, Daily A, Delpe S, Kaufman MR, Fowke J, Dmochowski RR, Reynolds WS. Toileting Behaviors of Women-What is Healthy? J Urol 2019; 201:129-134. [PMID: 30053511 PMCID: PMC6309941 DOI: 10.1016/j.juro.2018.07.044] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE The objective of this study was to assess toileting behaviors in community dwelling women. MATERIALS AND METHODS Women 18 years old or older were recruited through a national registry of research volunteers. They were asked to complete validated questionnaires assessing urinary symptoms and toileting behaviors, specifically place preference for voiding, convenience voiding, delayed voiding, straining during voiding and position preference for voiding. The PPBC (patient perception of bladder condition) was administered to assess the participant impression of bladder health. Analyses were done to determine the prevalence of each toileting behavior reported to occur sometimes or more often as well as differences in toileting behaviors in women with vs without self-perceived bladder problems based on the PPBC response. RESULTS The 6,695 women who completed the questionnaires were 18 to 89 years old (mean ± SD age 41.4 ± 15). Of the women 79.9% identified as white and 71.0% were college educated. Of the women 6,613 (98.8%) reported a place preference for voiding. The 3,552 women (53.1%) who reported a bladder problem were more likely to report convenience voiding, delayed voiding and strained voiding behaviors. While 6,657 women (99.4%) reported sitting to void at home only 5,108 (76.2%) reported sitting when using public toilets. CONCLUSIONS Certain toileting behaviors, of which some may be considered unhealthy, were common in this sample of women and most were associated with a perception of bladder problems. Voiding positions other than sitting were frequently used when away from home. These data have important implications for defining bladder health and implementing behavior based interventions for women with lower urinary tract symptoms.
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Affiliation(s)
- Casey G. Kowalik
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Adam Daily
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sophia Delpe
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Melissa R. Kaufman
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jay Fowke
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Roger R. Dmochowski
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - W. Stuart Reynolds
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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18
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Liu NY, Cay-Durgun P, Lai T, Sprowls M, Thomas L, Lind ML, Forzani E. A Handheld, Colorimetric Optoelectronic Dynamics Analyzer for Measuring Total Ammonia of Biological Samples. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE-JTEHM 2018; 6:2800610. [PMID: 30112251 PMCID: PMC6092083 DOI: 10.1109/jtehm.2018.2840678] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 05/11/2018] [Accepted: 05/20/2018] [Indexed: 12/30/2022]
Abstract
This paper introduces a wireless, solid-state, portable, and automated device capable of measuring the total ammonia [ammonia (NH3) and ammonium (NH4+)] levels of fluids, including biological samples. This device reliably measures the total ammonia of biological samples (e.g., urine) faster than the current ammonia quantification techniques. Medical professionals typically estimate NH4+ levels using error-prone indirect measurement techniques (i.e., urine anion gap), which are time-consuming and are seldom suitable for periodic measurements. Several instantaneous measurements of total ammonia levels in a patient urine could be utilized as an early warning for both acid-base and/or potassium disturbances. Given the device’s operation mechanism, it is able to quantify the total ammonia concentration within a biological sample in only 5 s and can simultaneously transmit data to other devices via Bluetooth. The analytical operation demonstrated high sensitivity, high specificity, fast reversibility, rapid response time, and has enabled the accurate determination of total ammonia concentration in urine samples produced by subjects who had consumed diets of variable protein compositions.
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Affiliation(s)
- Nai-Yuan Liu
- School for Engineering of Matter, Transport, and EnergyArizona State UniversityTempeAZ85287USA.,Center for Bioelectronics and BiosensorsThe Biodesign Institute, Arizona State UniversityTempeAZ85287USA
| | - Pinar Cay-Durgun
- School for Engineering of Matter, Transport, and EnergyArizona State UniversityTempeAZ85287USA
| | - Tianmiao Lai
- School for Engineering of Matter, Transport, and EnergyArizona State UniversityTempeAZ85287USA.,Center for Bioelectronics and BiosensorsThe Biodesign Institute, Arizona State UniversityTempeAZ85287USA
| | - Mark Sprowls
- School for Engineering of Matter, Transport, and EnergyArizona State UniversityTempeAZ85287USA.,Center for Bioelectronics and BiosensorsThe Biodesign Institute, Arizona State UniversityTempeAZ85287USA
| | - Leslie Thomas
- School for Engineering of Matter, Transport, and EnergyArizona State UniversityTempeAZ85287USA.,Mayo Clinic in Arizona Division of NephrologyScottsdaleAZ85259USA
| | - Mary Laura Lind
- School for Engineering of Matter, Transport, and EnergyArizona State UniversityTempeAZ85287USA.,Center for Bioelectronics and BiosensorsThe Biodesign Institute, Arizona State UniversityTempeAZ85287USA.,Mayo Clinic in Arizona Division of NephrologyScottsdaleAZ85259USA
| | - Erica Forzani
- School for Engineering of Matter, Transport, and EnergyArizona State UniversityTempeAZ85287USA.,Center for Bioelectronics and BiosensorsThe Biodesign Institute, Arizona State UniversityTempeAZ85287USA.,Mayo Clinic in Arizona Division of NephrologyScottsdaleAZ85259USA
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19
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Fung CH, Vaughan CP, Markland AD, Huang AJ, Mitchell MN, Bliwise DL, Ancoli-Israel S, Redline S, Alessi CA, Stone K. Nocturia is Associated with Poor Sleep Quality Among Older Women in the Study of Osteoporotic Fractures. J Am Geriatr Soc 2017; 65:2502-2509. [PMID: 28914959 DOI: 10.1111/jgs.15027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES (1) To examine relationships between frequency of nocturia and self-reported sleep quality and objective sleep measures in older women, and (2) to estimate the amount of variation in sleep measures that is specifically attributable to frequency of nocturia. DESIGN AND SETTING Secondary, cross sectional analysis of the multicenter prospective cohort Study of Osteoporotic Fractures (SOF). PARTICIPANTS Community-dwelling women aged ≥80 years. MEASUREMENTS Frequency of nocturia in the previous 12 months, Pittsburgh Sleep Quality Index sleep quality subscale, and actigraphy-measured wake after sleep onset (WASO) and total sleep time (TST). RESULTS Of 1,520 participants, 25% (n = 392) reported their nocturia frequency was 3-4 times/night and an additional 60% (n = 917) reported their nocturia frequency was 1-2 times/night. More frequent nocturia was associated with poor sleep quality (3-4/night: 26.8% reported fairly bad or very bad sleep quality; 1-2/night: 14.7%; 0/night: 7.7%; P < .001) and longer WASO (3-4/night: 89.8 minutes; 1-2/night: 70.6; 0/night: 55.5; P < .001). In nested regression models, a nocturia frequency of 3-4/night quadrupled the odds of poor sleep quality (odds ratio: 4.26 [95% CI 1.65, 11.01]; P = .003) and was associated with a 37-minute worsening in WASO (95% CI 26.0, 49.0; P < .001). Frequency of nocturia explained an additional 6% variation in WASO, above and beyond demographic, medical/psychiatric conditions, and medication factors (∆R2 = 0.06). CONCLUSIONS Nocturia is common among octogenarian and nonagenarian women and is independently associated with poor sleep quality and longer wake time at night. Interventions that improve nocturia may be useful in improving sleep quality and wake time at night.
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Affiliation(s)
- Constance H Fung
- Department of Veterans Affairs Greater, Los Angeles Geriatric Research, Education, and Clinical Center, Los Angeles, California.,Department of Medicine, University of California Los Angeles, Los Angeles, California
| | - Camille P Vaughan
- Department of Veterans Affairs Birmingham, Atlanta Geriatric Research, Education, and Clinical Center, Birmingham, Alabama.,Department of Medicine, Division of General Medicine and Geriatrics, Emory University, Atlanta, Georgia
| | - Alayne D Markland
- Department of Veterans Affairs Birmingham, Atlanta Geriatric Research, Education, and Clinical Center, Birmingham, Alabama.,Department of Medicine, Division of Geriatrics, Gerontology and Palliative Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Alison J Huang
- Department of Medicine, University of California San Francisco, San Francisco, California
| | - Michael N Mitchell
- Department of Veterans Affairs Greater, Los Angeles Geriatric Research, Education, and Clinical Center, Los Angeles, California
| | - Donald L Bliwise
- Sleep Program, Emory University School of Medicine, Atlanta, Georgia
| | - Sonia Ancoli-Israel
- Departments of Psychiatry and Medicine, University of California, San Diego, La Jolla, California
| | - Susan Redline
- Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Cathy A Alessi
- Department of Veterans Affairs Greater, Los Angeles Geriatric Research, Education, and Clinical Center, Los Angeles, California.,Department of Medicine, University of California Los Angeles, Los Angeles, California
| | - Katie Stone
- California Pacific Medical Center, San Francisco, California
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20
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Microablative fractional CO 2 laser for the genitourinary syndrome of menopause: power of 30 or 40 W? Lasers Med Sci 2017; 32:1865-1872. [PMID: 28770400 DOI: 10.1007/s10103-017-2293-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 07/21/2017] [Indexed: 02/08/2023]
Abstract
This retrospective case-control study aimed to compare 30 versus 40 W power of CO2 laser for the therapy of genitourinary syndrome of menopause (GSM). Postmenopausal women with severe intensity of dyspareunia and dryness were eligible to be included in this study. Primary outcomes were dyspareunia and dryness. Secondary outcomes were itching/burning, dysuria, frequency and urgency, Female Sexual Function Index (FSFI), vaginal maturation value (VMV), and Vaginal Health Index Score (VHIS). One laser therapy was applied every month for 3 months. Outcomes were evaluated at baseline and 1 month following the 3rd therapy. Fifty (25 per group) women were included in this study. In the 30-W group, mean improvement of dyspareunia, dryness, itching/burning, FSFI, VMV, and VHIS was 6.1 ± 1.7, 6.0 ± 1.9, 5.9 ± 2.0, 16.6 ± 6.7, 29.9 ± 13.0, and 11.0 ± 2.9, respectively (within group comparisons all p < 0.001). In the 40-W group, mean improvement of dyspareunia, dryness, itching/burning, FSFI, VMV, and VHIS was 6.1 ± 1.7, 6.5 ± 2.0, 5.2 ± 2.5, 14.8 ± 7.1, 25.0 ± 13.4, and 10.5 ± 4.1, respectively (within-group comparisons, all p ≤ 0.001). Comparison between 30 and 40 W revealed that mean improvement or presence of all GSM symptoms and clinical signs was not statistically significant different. CO2 laser therapy may improve GSM symptoms and clinical signs. This improvement did not seem to associate to power of 30 or 40 W.
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21
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Tibaek S, Gard G, Dehlendorff C, Iversen HK, Biering-Soerensen F, Jensen R. Is Pelvic Floor Muscle Training Effective for Men With Poststroke Lower Urinary Tract Symptoms? A Single-Blinded Randomized, Controlled Trial. Am J Mens Health 2015; 11:1460-1471. [PMID: 26483291 DOI: 10.1177/1557988315610816] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The aim of the current study was to evaluate the effect of pelvic floor muscle training in men with poststroke lower urinary tract symptoms. Thirty-one poststroke men, median age 68 years, were included in this single-blinded randomized controlled trial. Thirty participants, 15 in each group, completed the study. The intervention consisted of 3 months (12 weekly sessions) of pelvic floor muscle training in groups and home exercises. The effect was evaluated by the DAN-PSS-1 (Danish Prostate Symptom Score) questionnaire, a voiding diary, and digital anal palpation of the pelvic floor muscle. The DAN-PSS-1, symptom score indicated a statistical significant improvement ( p < .01) in the treatment group from pretest to posttest, but not in the control group. The DAN-PSS-1, total score improved statistically significantly in both groups from pretest to posttest (treatment group: p < .01; control group: p = .03). The median voiding frequency per 24 hours decreased from 11 at pretest to 7 (36%; p = .04) at posttest and to 8 (27%; p = .02) at follow-up in treatment group, although not statistical significantly more than the control group. The treatment group but not the control group improved statistically significantly in pelvic floor muscle function ( p < .01) and strength ( p < .01) from pretest to posttest and from pretest to follow-up ( p = .03; p < .01). Compared with the control group the pretest to posttest was significantly better in the treatment group ( p = .03). The results indicate that pelvic floor muscle training has an effect for lower urinary tract symptoms, although statistical significance was only seen for pelvic floor muscle.
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22
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Abstract
OBJECTIVE To examine the prevalence, predictors, and effects of nocturia in women and evaluate overlaps with established urinary tract disorders. METHODS This was a cross-sectional analysis of 2,016 women, aged 40 years and older, recruited from Kaiser Permanente Northern California from 2008 to 2012. Nocturia and other urinary symptoms were assessed using structured interviewer-administered questionnaires. Nocturia was defined as patient-reported nocturnal voiding of two or more times per night over a typical week. RESULTS Thirty-four percent (n=692) reported nocturia, and 40% of women with nocturia reported no other urinary tract symptom. Women with nocturia were older (mean age 58 compared with 55 years) (odds ratio [OR] per 5-year increase 1.21, 95% confidence interval [CI] 1.12-1.31), more likely black (45%) (OR 1.75, 95% CI 1.30-2.35) or Latina (37%) (OR 1.36, 95% CI 1.02-1.83) compared with non-Latina white (30%), have worse depression (mean Hospital Anxiety and Depression Scale score 3.8 compared with 2.8) (OR per 1-point increase in Hospital Anxiety and Depression Scale score 1.08, 95% CI 1.04-1.12), and worse mobility (mean Timed Up-and-Go 11.3 compared with 10 seconds) (OR per 5-second increase in Timed Up-and-Go 1.29, 95% CI 1.05-1.58). Nocturia occurred more among women with hysterectomy (53% compared with 33%) (OR 1.78, 95% CI 1.08-2.94), hot flushes (38% compared with 32%) (OR 1.49, 95% CI 1.19-1.87), and vaginal estrogen use (42% compared with 34%) (OR 1.50, 95% CI 1.04-2.18). CONCLUSION Nocturia is common in women and not necessarily attributable to other urinary tract disorders. Factors not linked to bladder function may contribute to nocturia risk, underlining the need for multiorgan prevention and treatment strategies. LEVEL OF EVIDENCE II.
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Excessive daytime sleepiness and nocturia in women. Sleep Med 2014; 15:677-80. [DOI: 10.1016/j.sleep.2014.01.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Revised: 12/20/2013] [Accepted: 01/03/2014] [Indexed: 11/19/2022]
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Noël S, Massart L, Hamaide A. Urodynamic investigation by telemetry in Beagle dogs: validation and effects of oral administration of current urological drugs: a pilot study. BMC Vet Res 2013; 9:197. [PMID: 24099564 PMCID: PMC3852831 DOI: 10.1186/1746-6148-9-197] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Accepted: 10/02/2013] [Indexed: 11/10/2022] Open
Abstract
Background Vesico-urethral function may be evaluated in humans and dogs by conventional urodynamic testing (cystometry and urethral pressure profilometry) or by electromyography. These techniques are performed under general anaesthesia in dogs. However, anaesthesia can depress bladder and urethral pressures and inhibit the micturition reflex. The primary objective of this pilot study was to evaluate the use of telemetry for urodynamic investigation in dogs. We also aimed to determine the applicability of telemetry to toxicologic studies by assessing the repeatability of telemetric recordings. Results Conventional diuresis cystometry was performed in six continent adult female Beagle dogs prior to surgical implantation of telemetric and electromyographic devices. In the first phase of the telemetric study, continuous recordings were performed over 8 days and nights. Abdominal, intravesical and detrusor threshold pressures (Pdet th), voided volume (Vv), urethral smooth muscle electrical activity and involuntary detrusor contractions (IDC) were measured during the bladder filling phase and during micturition episodes. Vv recorded during telemetry was significantly lower than bladder volume obtained by diuresis cystometry. Repeatability of telemetric measurements was greater for observations recorded at night. IDC frequency and Pdet th were both lower and Vv was higher at night compared to values recorded during daytime. In the second phase of the telemetric study, phenylpropanolamine, oestriol, bethanechol, oxybutynin or duloxetine were administered orally for 15 days. For each drug, continuous recordings were performed overnight for 12 hours on days 0, 1, 8 and 15. Electromyographic urethral activity was significantly increased 8 days after oestriol or duloxetine administration. No significant changes in bladder function were observed at any time point. Conclusions In dogs, the high repeatability of nocturnal telemetric recordings indicates that this technique could provide more informative results for urologic research. Urethral smooth muscle electrical activity appears to be modified by administration of drugs with urethral tropism. In this pilot telemetric study, bladder function was not affected by oral administration of urological drugs at their recommended clinical dosages. Experimental studies, (pharmacokinetic and pharmacodynamic) and clinical studies are warranted to further define the effects of these drugs on vesico-urethral function in dogs.
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Affiliation(s)
- Stéphanie Noël
- Department of Companion Animal Clinical Sciences, College of Veterinary Medicine, University of Liège, 4000 Liège, Belgium.
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25
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Park HK, Kim HG. Current evaluation and treatment of nocturia. Korean J Urol 2013; 54:492-8. [PMID: 23956822 PMCID: PMC3742899 DOI: 10.4111/kju.2013.54.8.492] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 06/05/2013] [Indexed: 01/16/2023] Open
Abstract
Nocturia is usually considered to be just one of the symptoms included with lower urinary tract symptoms (LUTS) and is treated with therapy based on LUTS. Recent research suggests, however, that nocturia is not merely a simple symptom of LUTS but is a multifactorial condition with many contributing etiological factors. The causes of nocturia can be classified into bladder storage problems, increased urine output, sleep disturbance problems, and other potential diseases. The frequency-volume chart (FVC) is very important in evaluating and diagnosing nocturia. Patients usually record the volume and timing of voids for a period of 1 to 3 days on the FVC. The FVC data can provide information on voiding patterns and clues about the etiology and treatment of nocturia. It is doubtful that alpha-blockers will have clinical significance for treatment because the difference in nocturia episodes between treatment with alpha-blockers and placebo is too small. Antimuscarinics also exert no effect on nocturnal polyuria, and the evidence supporting the efficacy of antimuscarinics for the treatment of nocturia is limited. However, several randomized placebo-controlled trials have shown the efficacy of oral desmopressin in the treatment of adults with nocturia. Short-acting hypnotics may be helpful for patients with sleep disturbances. Although surgical or interventional therapy is not indicated for nocturia, transurethral resection of the prostate appears to confer a greater improvement in benign prostatic hyperplasia symptoms including nocturia. The management of nocturia may require a team approach by making optimal use of multidisciplinary expertise.
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Affiliation(s)
- Hyoung Keun Park
- Department of Urology, Konkuk University School of Medicine, Seoul, Korea
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26
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Ellsworth P, Marschall-Kehrel D, King S, Lukacz E. Bladder health across the life course. Int J Clin Pract 2013; 67:397-406. [PMID: 23574100 DOI: 10.1111/ijcp.12127] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 01/07/2013] [Indexed: 12/22/2022] Open
Abstract
Influences on bladder health begin during infancy and continue throughout the lifespan. Bladder anatomy and physiology change as individuals age, and the risk and propensity for bladder conditions, including lower urinary tract symptoms, throughout life are related to factors specific to age, sex, and life events. Bladder habits and dysfunctions at one stage of life may affect bladder health in subsequent stages. However, bladder problems are neither a normal part of aging nor inevitable at any stage of life. Many of the factors that negatively impact bladder health at all ages may be modifiable, and healthy bladder habits may prevent or reverse bladder dysfunctions that can occur naturally or in response to life events. There are opportunities to further define and promote healthy bladder habits through focused research and heightened public awareness of the importance of bladder health, which may lead to improvements in overall health and quality of life. It is our hope that this paper will inform and encourage public health initiatives and research programs aimed at this goal.
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Affiliation(s)
- P Ellsworth
- University Urological Associates Inc., Brown University, Providence, RI 02905, USA.
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27
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Abstract
PURPOSE Nocturia is a troubling condition with implications for daytime functioning. However, it often goes unreported. Many prevalence studies exist but differences in populations and definitions of nocturia render assimilation of the data difficult. This review provides an overview of the nocturia prevalence literature. MATERIALS AND METHODS A PubMed® search was performed to identify articles published in English from 1990 to February 2009 reporting nocturia prevalence in community based populations. Rates reported as overall data, and by age and by gender, were plotted for comparison. RESULTS A total of 43 relevant articles were identified. Prevalence rates in younger men (20 to 40 years) were 1 or more voids in 11% to 35.2% and 2 or more voids in 2% to 16.6%. Prevalence rates in younger women were 1 or more voids in 20.4% to 43.9% and 2 or more voids in 4.4% to 18%. In older men (older than 70 years) rates were 1 or more void in 68.9% to 93% and 2 or more voids in 29% to 59.3%. In older women rates were 1 or more void in 74.1% to 77.1% and 2 or more voids in 28.3% to 61.5%. Therefore, in practice up to 1 in 5 or 6 younger people consistently wake to void at least twice each night. In some studies younger women appeared more likely to be affected than men. Up to 60% of older people void 2 or more times nightly. CONCLUSIONS Nocturia is common across populations. It is most prevalent in older people but it also affects a significant proportion of younger individuals. Clinicians should be alert to the possibility that nocturia may impact the sleep, quality of life and overall health of their patients. Since the condition is highly multifactorial, frequency-volume charts are invaluable tools for the diagnosis of underlying factors and for treatment selection.
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28
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Abstract
A panel of experts in urology, urogynecology, nursing, and behavioral therapy convened in 2010 to discuss the importance of a healthy bladder on overall health. They determined that a consensus statement was necessary to raise awareness among the general public, healthcare providers, payors, and policymakers, with the goals of minimizing the impact of poor bladder health and stimulating primary prevention of bladder conditions. In this statement, 'healthy' bladder function is described, as well as internal and external factors that influence bladder health. It is suggested that primary prevention strategies should be aimed at providing education regarding normal lower urinary tract structures and functioning to the public, including patients and healthcare providers. This education may promote the achievement of optimal bladder health by increasing healthy bladder habits and behaviors, awareness of risk factors, healthcare seeking, and clinician engagement and reducing stigma and other barriers to treatment. Promoting optimal bladder health may reduce the personal, societal and economic impact of bladder conditions, including anxiety and depression and costs associated with conditions or diseases and their treatment. While adopting healthy bladder habits and behaviors and behaviors may improve or maintain bladder health, it is important to recognize that certain symptoms may indicate the presence of conditions that require medical attention; many bladder conditions are treatable with a range of options for most bladder conditions. Lastly, the authors propose clinical directives based on persuasive and convergent research to improve and maintain bladder health. The authors hope that this statement will lead to promotion and achievement of optimal bladder health, which may improve overall health and help minimize the effects of bladder conditions on the public, healthcare professionals, educators, employers, and payors. The advisors are in consensus regarding the recommendations for improving and maintaining bladder health presented herein.
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Affiliation(s)
- E S Lukacz
- University of California, San Diego, San Diego, CA 92037, USA.
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29
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Abstract
BACKGROUND Data that incorporate the full complexity of healthy beverage intake and voiding frequency do not exist; therefore, clinicians reviewing bladder habits or voiding diaries for continence care must rely on expert opinion recommendations. OBJECTIVE The aims of this study were to use data-driven cluster analyses to reduce complex voiding diary variables into discrete patterns or data cluster profiles, descriptively name the clusters, and perform validity testing. METHODS Participants were 352 community women who filled out a 3-day voiding diary. Six variables (void frequency during daytime hours, void frequency during nighttime hours, modal output, total output, total intake, and body mass index) were entered into cluster analyses. The clusters were analyzed for differences by continence status, age, race (Black women, n= 196; White women, n = 156), and, for those who were incontinent, by leakage episode severity. RESULTS Three clusters emerged, labeled descriptively as "conventional," "benchmark," and "superplus." The conventional cluster (68% of the sample) demonstrated a mean daily intake of 1320 ± 375 ml, a mean daily output of 1069 ± 434 ml, mean daily voids of 5 ± 2 times, mean modal daytime output of 290 ± 144 ml, and mean nighttime voids of 1 ± 1 times. The superplus cluster (7% of the sample) showed double or triple these values across the five variables, and the benchmark cluster (25%) showed values consistent with current popular recommendations on intake and output (e.g., meeting or exceeding the 8 × 8 fluid intake rule of thumb). The clusters differed significantly (p < .05) by age, race, amount of bladder irritant beverages consumed, and incontinence. DISCUSSION Identification of three discrete clusters provides for a potential parsimonious but data-driven means of classifying individuals for additional epidemiological or clinical study. The clinical utility rests with potential for intervening to move an individual from a high-risk to low-risk cluster with regard to incontinence.
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Affiliation(s)
- Janis M Miller
- School of Nursing, University of Michigan, Ann Arbor, MI 48109-5482, USA.
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30
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Abstract
PURPOSE Nocturia is a troubling condition with implications for daytime functioning. However, it often goes unreported. Many prevalence studies exist but differences in populations and definitions of nocturia render assimilation of the data difficult. This review provides an overview of the nocturia prevalence literature. MATERIALS AND METHODS A PubMed search was performed to identify articles published in English from 1990 to February 2009 reporting nocturia prevalence in community based populations. Rates reported as overall data, and by age and by gender, were plotted for comparison. RESULTS A total of 43 relevant articles were identified. Prevalence rates in younger men (20 to 40 years) were 1 or more voids in 11% to 35.2% and 2 or more voids in 2% to 16.6%. Prevalence rates in younger women were 1 or more voids in 20.4% to 43.9% and 2 or more voids in 4.4% to 18%. In older men (older than 70 years) rates were 1 or more void in 68.9% to 93% and 2 or more voids in 29% to 59.3%. In older women rates were 1 or more void in 74.1% to 77.1% and 2 or more voids in 28.3% to 61.5%. Therefore, in practice up to 1 in 5 or 6 younger people consistently wake to void at least twice each night. In some studies younger women appeared more likely to be affected than men. Up to 60% of older people void 2 or more times nightly. CONCLUSIONS Nocturia is common across populations. It is most prevalent in older people but it also affects a significant proportion of younger individuals. Clinicians should be alert to the possibility that nocturia may impact the sleep, quality of life and overall health of their patients. Since the condition is highly multifactorial, frequency-volume charts are invaluable tools for the diagnosis of underlying factors and for treatment selection.
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Affiliation(s)
- J L H Ruud Bosch
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands.
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Wang K, Palmer MH. Women’s toileting behaviour related to urinary elimination: concept analysis. J Adv Nurs 2010; 66:1874-84. [DOI: 10.1111/j.1365-2648.2010.05341.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Van Kerrebroeck PE, Dmochowski R, FitzGerald MP, Hashim H, Norgaard JP, Robinson D, Weiss JP. Nocturia research: Current status and future perspectives. Neurourol Urodyn 2010; 29:623-8. [DOI: 10.1002/nau.20913] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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