1
|
Wearable and Flexible Humidity Sensor Integrated to Disposable Diapers for Wetness Monitoring and Urinary Incontinence. ELECTRONICS 2022. [DOI: 10.3390/electronics11071025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Disposable diapers are widely used by individuals with urinary incontinence. Diapers should be checked frequently for elderly, disabled, and hospital patients. Wet diapers that are not changed properly can cause health problems. The importance of electronic devices that provide warning in case of wetness is increasing in health monitoring. A disposable and wearable printed humidity sensor was designed and fabricated to detect wetness. The sensor was printed on polyamide-based taffeta label fabric by the inkjet printing method using specifically formulated PEDOT:PSS-based conductive polymer ink. The sensor sensitivity was tested under different relative humidity levels inside a controlled chamber. The resistance of the sensor decreased from 17.05 ± 0.05 MΩ to 2.09 ± 0.06 MΩ as the relative humidity increased from 35 to 100%, while the moisture value of the fabric increased from 4.8 to 23%. The response and recovery times were 42 s and 82 s. This sensor was integrated into the adult diaper to evaluate wetness. The sensor resistance change comparing to the dry state resistance (15.52 MΩ) was determined as 3.81 MΩ to 13.62 MΩ by dripping 0.1 mL to 100 mL salty water on the diaper. Due to its flexible structure and low-cost printability onto fabric, the wearable printed humidity sensor has the potential to be used as a disposable sensor for healthcare applications, particularly for urinary incontinence and capturing wetness in diapers.
Collapse
|
2
|
Shim KH, Choo SH, Park SG, Yoo HJ, Choi JB. Survey on disease insight and prevalence of urinary incontinence in women. Investig Clin Urol 2021; 62:577-583. [PMID: 34488252 PMCID: PMC8421990 DOI: 10.4111/icu.20210019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 05/12/2021] [Accepted: 06/14/2021] [Indexed: 11/26/2022] Open
Abstract
Purpose With a rapidly aging population in Korea, the number of patients with lower urinary tract symptoms is increasing. Therefore, it is important to determine the current extent of incontinence among Korean women to establish future plans. We attempted to create reference materials for organizing public relations and educational activities by investigating the effect of age on incontinence and quality of life in women. Materials and Methods The participants comprised women aged 30 years and older who visited a tertiary center for health screening from September 1 to October 31, 2016. The survey included a questionnaire consisting of 12 questions that took approximately 10 minutes to complete. We analyzed the responses and assessed the prevalence of the disease and its rate of recognition. Results A total of 509 women completed the survey. Irrespective of age, 76.8% of all respondents were aware of urinary incontinence (UI) and 57.4% of the women exhibited lower urinary tract symptoms. The most prevalent symptom was UI (45.8%), and the incidence rates of stress and urge UI were identified as 33.6% and 12.2%, respectively. Only 8.0% of the women had visited a hospital; 38.3% had awaited spontaneous symptom improvement. Many participants (61.2%) answered that a urology clinic is suitable for treating UI, while 58.9% chose a gynecology clinic. Conclusions Our study showed that more than 75% of women are aware of UI, but their perception of the disease mechanism and treatment options was low. We suggest that continuous education and publicity are necessary.
Collapse
Affiliation(s)
- Kang Hee Shim
- Department of Urology, Ajou University School of Medicine, Suwon, Korea
| | - Seol Ho Choo
- Department of Urology, Ajou University School of Medicine, Suwon, Korea
| | - Sung Gon Park
- Department of Urology, Ajou University School of Medicine, Suwon, Korea
| | - Hee Jae Yoo
- Department of Urology, Ajou University School of Medicine, Suwon, Korea
| | - Jong Bo Choi
- Department of Urology, Ajou University School of Medicine, Suwon, Korea.
| |
Collapse
|
3
|
Cho JH, Choi JY, Kim NH, Lim Y, Ohn JH, Kim ES, Ryu J, Kim J, Kim Y, Kim SW, Kim KI. A Smart Diaper System Using Bluetooth and Smartphones to Automatically Detect Urination and Volume of Voiding: Prospective Observational Pilot Study in an Acute Care Hospital. J Med Internet Res 2021; 23:e29979. [PMID: 34328427 PMCID: PMC8367151 DOI: 10.2196/29979] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 05/29/2021] [Accepted: 05/31/2021] [Indexed: 01/23/2023] Open
Abstract
Background Caregivers of patients who wear conventional diapers are required to check for voiding every hour because prolonged wearing of wet diapers causes health problems including diaper dermatitis and urinary tract infections. However, frequent checking is labor intensive and disturbs patients’ and caregivers’ sleep. Furthermore, assessing patients’ urine output with diapers in an acute care setting is difficult. Recently, a smart diaper system with wetness detection technology was developed to solve these issues. Objective We aimed to evaluate the applicability of the smart diaper system for urinary detection, its accuracy in measuring voiding volume, and its effect on incontinence-associated dermatitis (IAD) occurrence in an acute care hospital. Methods This prospective, observational, single-arm pilot study was conducted at a single tertiary hospital. We recruited 35 participants aged ≥50 years who were wearing diapers due to incontinence between August and November 2020. When the smart diaper becomes wet, the smart diaper system notifies the caregiver to change the diaper and measures voiding volume automatically. Caregivers were instructed to record the weight of wet diapers on frequency volume charts (FVCs). We determined the voiding detection rate of the smart diaper system and compared the urine volume as automatically calculated by the smart diaper system with the volume recorded on FVCs. Agreement between the two measurements was estimated using a Bland-Altman plot. We also checked for the occurrence or aggravation of IAD and bed sores. Results A total of 30 participants completed the protocol and 390 episodes of urination were recorded. There were 108 records (27.7%) on both the FVCs and the smart diaper system, 258 (66.2%) on the FVCs alone, 18 (4.6%) on the smart diaper system alone, and 6 (1.5%) on the FVCs with sensing device lost. The detection rate of the smart diaper system was 32.8% (126/384). When analyzing records concurrently listed in both the FVCs and the smart diaper system, linear regression showed a strong correlation between the two measurements (R2=0.88, P<.001). The Bland-Altman assessment showed good agreement between the two measurements, with a mean difference of –4.2 mL and 95% limits of agreement of –96.7 mL and 88.3 mL. New occurrence and aggravation of IAD and bed sores were not observed. Bed sores improved in one participant. Conclusions The smart diaper system showed acceptable accuracy for measuring urine volume and it could replace conventional FVCs in acute setting hospitals. Furthermore, the smart diaper system has the potential advantage of preventing IAD development and bed sore worsening. However, the detection rate of the smart diaper system was lower than expected. Detection rate polarization among participants was observed, and improvements in the user interface and convenience are needed for older individuals who are unfamiliar with the smart diaper system.
Collapse
Affiliation(s)
- Jae Ho Cho
- Department of Internal Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Jung-Yeon Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Nak-Hyun Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Yejee Lim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Jung Hun Ohn
- Department of Internal Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Eun Sun Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Jiwon Ryu
- Department of Internal Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Jangsun Kim
- Panoptics Corp, Gyeonggi-do, Republic of Korea
| | - Yiseob Kim
- Panoptics Corp, Gyeonggi-do, Republic of Korea
| | - Sun-Wook Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Kwang-Il Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| |
Collapse
|
4
|
Martín-Losada L, Huerta M, González N, Ortega I, Cuenca JN. Managing urinary incontinence in older people in hospital: a best practice implementation project. JBI Evid Synth 2021; 18:243-255. [PMID: 31433370 DOI: 10.11124/jbisrir-2017-003920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVES This project aimed to improve care in managing urinary incontinence in older patients admitted to a medium-to-long-stay hospital by developing and implementing strategies to improve the compliance with best practice in managing urinary incontinence and decrease its prevalence. INTRODUCTION Urinary incontinence (UI) is a major problem in hospitalized older people and is of great significance to public health. The application of evidence-based recommendations for this problem could be expected to improve the quality of care. METHODS The project used the Joanna Briggs Institute's Practical Application of Clinical Evidence System and Getting Research into Practice audit tools for promoting change in healthcare practice. Participants were evaluated at baseline and at two follow-ups at three and six months after key strategies had been implemented. The location of this implementation project was the functional rehabilitation ward of a medium-to-long-stay Spanish hospital. RESULTS In baseline audit there were four process criteria with a high level of compliance: two criteria with 35% and 44% respectively and one criterion without compliance. Action was taken to address the four barriers identified, leading to an increase in all cases except one, which was related to the characteristics of the patient. Prevalence of urinary incontinence decreased at follow-up. CONCLUSIONS The development and implementation of strategies improved quality of care. This project obtained positive results in patient health, and the implementation of the strategies used decreased the prevalence of urinary incontinence in patients.
Collapse
Affiliation(s)
- Laura Martín-Losada
- Guadarrama Hospital, Madrid, Spain.,The Spanish Centre for Evidence Based Nursing and Healthcare: a Joanna Briggs Institute Centre of Excellence
| | | | | | | | | |
Collapse
|
5
|
Agochukwu-Mmonu N, Pop-Busui R, Wessells H, Sarma AV. Autonomic neuropathy and urologic complications in diabetes. Auton Neurosci 2020; 229:102736. [PMID: 33197694 DOI: 10.1016/j.autneu.2020.102736] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/21/2020] [Accepted: 10/05/2020] [Indexed: 12/31/2022]
Abstract
Diabetic autonomic neuropathy affects the entire autonomic nervous system and can lead to dysfunction of the cardiovascular, gastrointestinal, and genitourinary organ systems. Genitourinary dysfunction associated with diabetic autonomic neuropathy includes diabetic bladder dysfunction, sexual dysfunction, and recurrent urinary tract infections. Urological complications in diabetes mellitus are very common; in fact, genitourinary complications are more common than diabetic neuropathy or nephropathy. While several studies have reported on genitourinary dysfunction in individuals with diabetes, UroEDIC, an ancillary study to the Diabetes Control and Complications Trial (DCCT) and its observational follow up, the Epidemiology of Diabetes Interventions and Complications study (EDIC), comprehensively characterized the association between urologic complications and cardiovascular autonomic neuropathy. UroEDIC demonstrated significant associations between autonomic neuropathy and urologic complications in type 1 diabetes, specifically erectile dysfunction, female sexual dysfunction, and lower urinary tract symptoms. In this narrative review, we review the current literature on urological complications in diabetes.
Collapse
Affiliation(s)
| | - Rodica Pop-Busui
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States of America
| | - Hunter Wessells
- Department of Urology, University of Washington School of Medicine, Seattle, WA, United States of America
| | - Aruna V Sarma
- Department of Urology, University of Michigan, Ann Arbor, MI, United States of America
| |
Collapse
|
6
|
Nakayama N, Tsuji T, Aoyama M, Fujino T, Liu M. Quality of life and the prevalence of urinary incontinence after surgical treatment for gynecologic cancer: a questionnaire survey. BMC WOMENS HEALTH 2020; 20:148. [PMID: 32680500 PMCID: PMC7367359 DOI: 10.1186/s12905-020-01012-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 07/05/2020] [Indexed: 12/03/2022]
Abstract
Background Although there have been a number of reports on urinary voiding symptoms associated with surgical interventions for gynecologic cancer and post-voiding symptoms, there have been few reports on urinary storage symptoms such as urinary incontinence (UI) and overactive bladder (OAB). The purpose of this study was to examine the rates and impact on quality of life (QOL) of urinary storage symptoms after gynecologic cancer surgery. Methods A questionnaire survey, including Japanese-language versions of the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), Overactive Bladder Symptom Score (OABSS), and Incontinence Impact Questionnaire-7 (IIQ-7), was distributed to gynecologic cancer patients who underwent hysterectomy between 2008 and 2013. Results Of the 145 patients analyzed, 49 (33.8%) had UI pre-surgery, and 76 (52.4%) had UI post-surgery, including 34 (35.4%) first-time UI patients, with a significant difference between pre- and post-surgery. Of the 49 subjects with UI pre-surgery, 43 (87.7%) had stress incontinence, while of the 76 patients with UI post-surgery, 44 (57.1%) had stress incontinence, and 24 (31.2%) had mixed incontinence. Seven (4.8%) subjects had OAB pre-surgery, whereas 19 (13.1%) had OAB symptoms post-surgery (including 15 first-time OAB patients), with a significant difference between pre- and post-surgery. IIQ-7 scores were markedly higher for patients with mixed incontinence post-surgery than for those with stress incontinence, indicating a lower QOL. Logistic regression analysis identified the number of Cesarean sections and days of urinary bladder catheterization as risk factors for postoperative UI. Conclusions UI and OAB rates were higher after gynecologic cancer surgery than in the general female population. The mixed incontinence rate was markedly higher post-surgery; QOL was low for such patients due to the combination of urge and stress incontinence. Multiple Cesarean sections and urinary bladder catheterization post-surgery were risk factors for post-surgical UI.
Collapse
Affiliation(s)
- Noriko Nakayama
- Department of Rehabilitation, Teine Keijinkai Hospital, Sapporo, Japan
| | - Tetsuya Tsuji
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan.
| | - Makoto Aoyama
- Department of Rehabilitation, Teine Keijinkai Hospital, Sapporo, Japan
| | - Takafumi Fujino
- Department of Obstetrics & Gynecology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Meigen Liu
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| |
Collapse
|
7
|
Chen CCG, Cox JT, Yuan C, Thomaier L, Dutta S. Knowledge of pelvic floor disorders in women seeking primary care: a cross-sectional study. BMC FAMILY PRACTICE 2019; 20:70. [PMID: 31122187 PMCID: PMC6533649 DOI: 10.1186/s12875-019-0958-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 04/30/2019] [Indexed: 11/10/2022]
Abstract
Background Pelvic floor disorders including urinary incontinence (UI) and pelvic organ prolapse (POP) are common conditions; however, most women with these symptoms do not seek care. Failure to seek care may be related to misconceptions about these conditions. The aim of this study was to assess the baseline knowledge of UI and POP among adult women presenting to primary care clinics, as well as factors associated with knowledge levels. Methods A survey with questions from previously validated UI and POP knowledge questionnaires (PIKQ-UI and PIKQ-POP, respectively) was self-administered to a cross-sectional group of adult female patients presenting to three primary care clinics: geriatric, community-based, and hospital-based. Participants’ demographics and medical histories were compared using ANOVA or Kruskal-Wallis for continuous variables and Chi-square test or Fisher’s exact test for categorical variables. In order to compare various covariates with knowledge non-proficiency on PIKQ-UI and PIKQ-POP scales, unadjusted and adjusted ORs with 95% CIs were calculated using bivariate analysis and multivariate logistic regression, respectively. Results Of 346 participants, knowledge non-proficiency was similar and consistent across clinic sites and reached 72.0% for UI and 53.6% for POP. On multivariate analysis, lower educational attainment, being unaware of UI or POP as medical conditions, and having no history of care-seeking for these conditions were significantly associated with knowledge non-proficiency on UI, POP, or both. Conclusions Knowledge non-proficiency for UI and POP is common among women presenting for primary care. For UI, healthcare providers should assess patients’ actual understanding of the disease, especially among those with lower educational attainment, to eliminate any possible misconceptions. For POP, the focus should be on increasing awareness of this disease, as many women may have not previously heard of this condition. Simple strategies may increase knowledge in these areas and change care-seeking behaviors. Study registration None.
Collapse
Affiliation(s)
- Chi Chiung Grace Chen
- Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD, 21224, USA.
| | - Jacob T Cox
- Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Chloe Yuan
- John A. Burns School of Medicine, Honolulu, HI, 96813, USA
| | - Lauren Thomaier
- Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD, 21224, USA
| | - Sonia Dutta
- Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD, 21224, USA
| |
Collapse
|
8
|
Kim HJ, Moon JH, Oh YH, Kong MH, Huh JS. Association between urinary incontinence and bone health in Korean elderly women based on data from the Korea National Health and Nutrition Examination Survey. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2019. [DOI: 10.29333/ejgm/99586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
9
|
Karakaya İÇ, Yenişehir S, Karakaya MG. Nursing Home Residents' Level of Knowledge About Urinary Incontinence. Ann Geriatr Med Res 2019; 23:20-26. [PMID: 32743281 PMCID: PMC7387602 DOI: 10.4235/agmr.19.0003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 02/01/2019] [Accepted: 02/02/2019] [Indexed: 12/21/2022] Open
Abstract
Background A common problem in nursing home residents, urinary incontinence (UI) can lead to hygiene and skin problems, sleep disturbance, and decreased quality of life. This study evaluated the level of knowledge regarding UI among nursing home residents in Muğla, Turkey. Methods This study included 64 (19 females, 45 males) nursing home resident volunteers. Their physical and sociodemographic characteristics; daily living activities (Barthel Index); and the presence, frequency, severity, and type of UI as well as its impact on daily living were evaluated (International Consultation on Incontinence Questionnaire-Short Form) and history of treatment was queried. An Incontinence Quiz was used to assess the residents’ knowledge of incontinence. Results The participants were living in nursing homes for 34.48±33.16 months. Their educational level was low and most were single. The mean Barthel Index score was 89.75±13.00. Twenty-five participants had UI (18.8% urge, 4.7% stress, 15.6% mixed/other type), and the mean International Consultation on Incontinence Questionnaire-Short Form score was 8.08±4.24. Forty-four percent of the participants had no treatment and none had physiotherapy for incontinence. The mean Incontinence Quiz score was 4.88±1.96, indicating a low level of knowledge. The items with the highest ratio of incorrect responses (second and 14th) were related to the causes of incontinence and care seeking. Conclusion These findings underscore the necessity of increasing knowledge among nursing home residents about the reasons and health care options for UI. Further studies on appropriate strategies to improve UI knowledge in this population will be of great value.
Collapse
Affiliation(s)
- İlkim Çıtak Karakaya
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Muğla Sıtkı Koçman University, Muğla, Turkey
| | - Semiha Yenişehir
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Muğla Sıtkı Koçman University, Muğla, Turkey
| | - Mehmet Gürhan Karakaya
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Muğla Sıtkı Koçman University, Muğla, Turkey
| |
Collapse
|
10
|
Knowledge and practice of nursing home caregivers about urinary incontinence. Eur Geriatr Med 2018; 10:99-105. [PMID: 32720273 DOI: 10.1007/s41999-018-0129-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 11/07/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE The aim of this study was to investigate nursing home caregivers' knowledge and practice of urinary incontinence in Muğla-Turkey. METHODS Knowledge and practice of urinary incontinence of 34 nursing home caregivers were assessed by a form originated from knowledge and practice instrument and urinary incontinence knowledge scale. Incontinence quiz was also used to assess knowledge about UI. RESULTS According to the analysis of the items from the knowledge and practice instrument, 20.6% of caregivers never control the amount of urinary incontinence in residents with dementia, document the amount of urinary incontinence and set up a toilet plan for residents with no or slight mental incapacity. According to the analysis of the items from the urinary incontinence knowledge scale, majority of caregivers considered urinary incontinence as a normal result of aging. The mean incontinence quiz score of all participants was 5.5 ± 2.0, indicating poor knowledge about UI. CONCLUSION Findings indicate the need of developing strategies for improving knowledge and effective practice of urinary incontinence of nursing home caregivers.
Collapse
|
11
|
Improvement in bladder dysfunction after bladder transplantation of amniotic fluid stem cells in diabetic rats. Sci Rep 2018; 8:2105. [PMID: 29391467 PMCID: PMC5794746 DOI: 10.1038/s41598-018-20512-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 01/18/2018] [Indexed: 12/12/2022] Open
Abstract
To examine the effects of human amniotic fluid stem cells (hAFSCs) transplantation on bladder function and molecular changes in diabetic rats, 60 female Sprague-Dawley rats were used for study. Three groups were assigned including sham control rats, streptozotocin (STZ, 60 mg/kg)-induced diabetic rats and STZ-induced diabetic rats plus bladder hAFSCs transplantation. Compared to controls, diabetic rats had decreased body weight but increased bladder weight. Cystometries showed non-voiding contraction, residual volume, voided volume and intercontraction interval increased significantly in diabetic rats at week 4 and 12 after DM induction, but improved after hAFSCs transplantation. The immunoreactivities and mRNAs of nerve growth factor (NGF) decreased significantly in diabetic bladder at week 4 and 12 after DM induction, but recovered after hAFSCs transplantation. The immunoreactivities and mRNAs of M2 and M3 muscarinic receptor increased significantly in diabetic bladder at week 4 after DM induction but recovered after hAFSCs transplantation. The immunoreactivity of 8-hydroxy-20-deoxyguanosine increased significantly in diabetic bladder at week 4 and 12 after DM induction but reduced after hAFSCs transplantation. The present study showed bladder dysfunction in STZ-induced diabetic rats could be improved by hAFSCs transplantation into bladder, which may be related to the recovery of bladder NGF and muscarinic receptors.
Collapse
|
12
|
Hester AG, Kretschmer A, Badlani G. Male Incontinence: The Etiology or Basis of Treatment. Eur Urol Focus 2017; 3:377-384. [PMID: 29249687 DOI: 10.1016/j.euf.2017.12.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 11/24/2017] [Accepted: 12/02/2017] [Indexed: 11/18/2022]
Abstract
CONTEXT Elderly men are an increasing proportion of the aging population in the 21st century. Urinary incontinence reduces the quality of life and increases the burden of care for the aging population. OBJECTIVE The primary objective of this review is to explore the etiopathology of common causes of incontinence in aging male patients. The focus is on the algorithm of the initial evaluation of these patients from both a primary care and a urologic standpoint. EVIDENCE ACQUISITION A nonsystematic review of the literature was performed in September 2017. The data and evidence of this paper have been obtained by a PubMed search, and through official statements and recommendations from the International Consultation on Incontinence. Our search incorporated terms such as elderly, urinary incontinence, male, urodynamics, bladder outlet obstruction, BPH, neurologic, urethral stricture, spinal shock, and urethral sphincter injury. EVIDENCE SYNTHESIS A total of 7204 papers were identified; 6838 were excluded for female populations and populations <65 yr. A broad differential diagnosis exists for urinary incontinence in aging male patients, and many patients will be found to have multifactorial incontinence, compounding the issue. Neurologic etiologies common in this population include cerebrovascular accidents, Parkinson's disease, and dementia. Spinal cord injuries and multiple sclerosis are less common. In this analysis, non-neurologic etiologies leading to incontinence are broadly grouped under bladder outlet obstruction, sphincter injury, overactive bladder, underactive bladder, polypharmacy, and urinary tract infections. CONCLUSIONS We provide a review of the differential diagnosis of incontinence in an elderly male patient. There is a need for understanding etiopathology and recognizing that many patients may have a combination of the above. The assessment algorithm, modified from the International Continence Society, provides a pathway for the provider in evaluating and treating elderly patients. PATIENT SUMMARY In this review, we have identified the sources of urinary incontinence in elderly male patients by neurologic and non-neurologic causes. We also discuss the basic evaluation and workup of an incontinent patient.
Collapse
Affiliation(s)
- Austin G Hester
- Department of Urology, Wake Forest University, Winston-Salem, NC, USA.
| | - Alexander Kretschmer
- Urologische Klinik und Poliklinik, Campus Großhadern, Ludwig-Maximilians-Universität, Munich, Germany
| | - Gopal Badlani
- Department of Urology, Wake Forest University, Winston-Salem, NC, USA
| |
Collapse
|
13
|
No Association of Caffeinated Beverage or Caffeine Intake with Prevalence of Urinary Incontinence Among Middle-Aged Japanese Women: A Multicenter Cross-Sectional Study. J Womens Health (Larchmt) 2017. [DOI: 10.1089/jwh.2016.6094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
14
|
Nonbiologic factors that impact management in women with urinary incontinence: review of the literature and findings from a National Institute of Diabetes and Digestive and Kidney Diseases workshop. Int Urogynecol J 2017; 28:1295-1307. [PMID: 28674734 DOI: 10.1007/s00192-017-3400-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 06/12/2017] [Indexed: 12/15/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Urinary incontinence (UI)-defined as a complaint of involuntary loss of urine-is common in women, with major public health, financial, and quality of life (QoL) implications. Despite the high toll of UI and the availability of effective conservative treatments, many women with UI do not seek care. Those who do often continue to experience symptoms. Improving UI treatment may require a comprehensive approach to urology research, including a broad set of potentially influential factors beyond biologic. METHODS To explore the effects of nonbiologic factors (NBF) on UI management and treatment response, the National Institute of Diabetes and Digestive and Kidney Diseases convened a workshop for clinical and psychosocial researchers. Participants proposed a UI treatment pathway: recognizing the problem, willingness to seek treatment, access to care, receiving quality treatment, engaging in self-management, and adhering to chosen treatments; discussed potential NBFs that may affect the pathway; and identified areas for future research. After the meeting, a rapid literature review was conducted to assess the current state of research on NBFs in women with UI. RESULTS Participants identified several patient-level NBFs that may influence the UI management pathway, including QoL and perceived bother; stigma, shame, and embarrassment; knowledge and perceptions; social determinants of health; cultural and language characteristics; personal characteristics and skills; and physical abilities. Additionally, participants acknowledged that provider- and system-level factors also play a role and likely interact with patient-level factors. CONCLUSIONS NBFs that potentially affect the UI management pathway are not well understood, and a comprehensive, interdisciplinary approach to research is needed to understand and appropriately support effective UI treatment.
Collapse
|
15
|
Ahmadi M, Rajamani R, Timm G, Sezen S. Instrumented Urethral Catheter and Its Ex Vivo Validation in a Sheep Urethra. MEASUREMENT SCIENCE & TECHNOLOGY 2017; 28:035702. [PMID: 28959090 PMCID: PMC5611866 DOI: 10.1088/1361-6501/aa5434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This paper designs and fabricates an instrumented catheter for instantaneous measurement of distributed urethral pressure profiles. Since the catheter enables a new type of urological measurement, a process for accurate ex-vivo validation of the catheter is developed. A flexible sensor strip is first fabricated with nine pressure sensors and integrated electronic pads for an associated sensor IC chip. The flexible sensor strip and associated IC chip are assembled on a 7 Fr Foley catheter. A sheep bladder and urethra are extracted and used in an ex-vivo set up for verification of the developed instrumented catheter. The bladder-urethra are suspended in a test rig and pressure cuffs placed to apply known static and dynamic pressures around the urethra. A significant challenge in the performance of the sensor system is the presence of parasitics that introduce large bias and drift errors in the capacitive sensor signals. An algorithm based on use of reference parasitic transducers is used to compensate for the parasitics. Extensive experimental results verify that the developed compensation method works effectively. Results on pressure variation profiles circumferentially around the urethra and longitudinally along the urethra are presented. The developed instrumented catheter will be useful in improved urodynamics to more accurately diagnose the source of urinary incontinence in patients.
Collapse
Affiliation(s)
- Mahdi Ahmadi
- Department of Mechanical Engineering, University of Minnesota - Twin Cities, 111 Church Street SE, Minneapolis, MN 55455, USA
| | - Rajesh Rajamani
- Department of Mechanical Engineering, University of Minnesota - Twin Cities, 111 Church Street SE, Minneapolis, MN 55455, USA
| | - Gerald Timm
- Department of Mechanical Engineering, University of Minnesota - Twin Cities, 111 Church Street SE, Minneapolis, MN 55455, USA
| | - Serdar Sezen
- Department of Mechanical Engineering, University of Minnesota - Twin Cities, 111 Church Street SE, Minneapolis, MN 55455, USA
| |
Collapse
|
16
|
Lu S, Zhang HL, Zhang YJ, Shao QC. Prevalence and risk factors of urinary incontinence among perimenopausal women in Wuhan. ACTA ACUST UNITED AC 2016; 36:723-726. [PMID: 27752911 DOI: 10.1007/s11596-016-1651-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 08/22/2016] [Indexed: 10/20/2022]
Abstract
This study investigated the prevalence and risk factors of urinary incontinence (UI) among perimenopausal women in Wuhan. A cross-sectional survey was performed on 1067 women aged 40-65 years sampled in Wuhan urban area from April to October 2014. Information about demographic characteristics, menstruation, parity and UI symptoms was collected using a questionnaire. The data were evaluated by Chi-square test and multiple Logistic regression analysis. The prevalence rate of UI was 37.2%, with stress UI (32.2%) being more prevalent than urgency UI (21.6%) and mixed UI (16.6%). 31.2% women with UI stated that UI had negative impact on their life. Risk factors for UI included menstrual disorder, menopause, overweight, perineal laceration, atrophic vaginitis, constipation and pelvic organ prolapse. Appropriate investigation apropos the factors associated with UI should be performed to diminish its impact on women's life.
Collapse
Affiliation(s)
- Shi Lu
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
| | - Hong-Ling Zhang
- Community Health Service Station of Changqing Garden, Wuhan Polytechnic University, Wuhan, 430024, China
| | - Ya-Jun Zhang
- Department of Obstetrics and Gynecology, Xiangyang Central Hospital, Xiangyang, 441021, China
| | - Qing-Chun Shao
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| |
Collapse
|
17
|
Wu L, Zhang X, Xiao N, Huang Y, Kavran M, Elrashidy RA, Wang M, Daneshgari F, Liu G. Functional and morphological alterations of the urinary bladder in type 2 diabetic FVB(db/db) mice. J Diabetes Complications 2016; 30:778-85. [PMID: 27037041 PMCID: PMC4912852 DOI: 10.1016/j.jdiacomp.2016.03.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Revised: 03/04/2016] [Accepted: 03/05/2016] [Indexed: 10/22/2022]
Abstract
AIMS Diabetic bladder dysfunction (DBD) has been extensively studied in animal models of type 1 diabetes. We aimed to examine the functional and morphological alterations of the urinary bladder in a type 2 diabetes model, FVB(db/db) mice. METHODS FVB(db/db) mice and age-matched FVB/NJ control mice were tested at either 12, 24 or 52weeks of age. Body weight, blood glucose and glycated hemoglobin (HbA1c) levels were measured. Bladder function was assessed by measurement of 24-h urination behavior and conscious cystometry. Bladder was harvested for Masson's Trichrome staining and morphometric analysis. RESULTS The body weights of FVB(db/db) mice were twice as those of FVB/NJ control mice. The blood glucose and HbA1c levels were higher in FVB(db/db) mice at 12 and 24weeks, but not at 52weeks. A significant increase in the mean volume per void, but decrease in the voiding frequency, in FVB(db/db) mice was observed. Cystometry evaluation showed increased bladder capacity, voided volume, and peak micturition pressure in FVB(db/db) mice compared with FVB/NJ mice. Morphometric analysis revealed a significant increase in the areas of detrusor muscle and urothelium in FVB(db/db) mice. In addition, some FVB(db/db) mice, especially males at 12 and 24weeks, showed small-volume voiding during 24-h urination behavior measurement, and detrusor overactivity in the cystometry measurement. CONCLUSIONS The FVB(db/db) mouse, displaying DBD characterized by not only increased bladder capacity, void volume, and micturition pressure, but also bladder overactivity, is a useful model to further investigate the mechanisms of type 2 diabetes-related bladder dysfunction.
Collapse
Affiliation(s)
- Liyang Wu
- Department of Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA; Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, PRC
| | - Xiaodong Zhang
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, PRC
| | - Nan Xiao
- Department of Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA; Department of Urology, Lanzhou University Second Hospital, Lanzhou, PRC
| | - Yexiang Huang
- Department of Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA; Department of Urology, The First Affiliated Hospital, China Medical University, Shenyang, PRC
| | - Michael Kavran
- Department of Urology, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Rania A Elrashidy
- Department of Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA; Department of Biochemistry, Faculty of Pharmacy, Zagazig University, Zagazig, Egypt
| | - Mingshuai Wang
- Department of Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA; Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, PRC
| | - Firouz Daneshgari
- Department of Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Guiming Liu
- Department of Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA.
| |
Collapse
|
18
|
Overview of the Epidemiology of Lower Urinary Tract Dysfunction in South Korea. Int Neurourol J 2016; 20:91-100. [PMID: 27377940 PMCID: PMC4932641 DOI: 10.5213/inj.1630502.251] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 03/21/2016] [Indexed: 12/25/2022] Open
Abstract
This review assessed the epidemiology of voiding dysfunctions in South Korea. Comprehensive understanding of this epidemiology is crucial because the senior population and the social burden are increasing because of voiding dysfunctions is growing. We searched the medical records using several terms related to voiding dysfunction: benign prostatic hyperplasia, urinary incontinence, lower urinary tract symptoms, overactive bladder, and nocturia. We then estimated the prevalence of voiding dysfunctions in South Korea; our data were comparable with those from other countries, with slight differences. The ranges of incidences varied widely between studies, mostly because investigators defined disorders differently. Voiding dysfunction greatly affects healthcare costs and individual quality of life; therefore, more proper and valuable epidemiologic data are needed. In addition, efforts to unify the definitions of various voiding dysfunctions and progress in investigational methodologies using multimedia are warranted.
Collapse
|
19
|
Ahmadi M, Rajamani R, Timm G, Sezen A. Flexible Distributed Pressure Sensing Strip for a Urethral Catheter. JOURNAL OF MICROELECTROMECHANICAL SYSTEMS : A JOINT IEEE AND ASME PUBLICATION ON MICROSTRUCTURES, MICROACTUATORS, MICROSENSORS, AND MICROSYSTEMS 2015; 24:1840-1847. [PMID: 27065719 PMCID: PMC4824413 DOI: 10.1109/jmems.2015.2444992] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
A multi-sensor flexible strip is developed for a urethral catheter to measure distributed pressure in a human urethra. The developed sensor strip has important clinical applications in urodynamic testing for analyzing the causes of urinary incontinence in patients. There are two major challenges in the development of the sensor. First, a highly sensitive sensor strip that is flexible enough for urethral insertion into a human body is required and second, the sensor has to work reliably in a liquid in-vivo environment in the human body. Capacitive force sensors are designed and micro-fabricated using polyimide/PDMS substrates and copper electrodes. To remove the parasitic influence of urethral tissues which create fringe capacitance that can lead to significant errors, a reference fringe capacitance measurement sensor is incorporated on the strip. The sensing strip is embedded on a catheter and experimental in-vitro evaluation is presented using a bench-top pressure chamber. The sensors on the strip are able to provide the required sensitivity and range. Preliminary experimental results also show promise that by using measurements from the reference parasitic sensor on the strip, the influence of parasitics from human tissue on the pressure measurements can be removed.
Collapse
Affiliation(s)
- Mahdi Ahmadi
- Department of Mechanical Engineering, University of Minnesota, Twin Cities, MN 55455
| | - Rajesh Rajamani
- Department of Mechanical Engineering, University of Minnesota, Twin Cities, MN 55455
- Corresponding author: , tel: (612) 626-7961
| | - Gerald Timm
- Department of Urology, University of Minnesota, Twin Cities, MN 55455
| | - A.S. Sezen
- Department of Mechanical Engineering, University of Minnesota, Twin Cities, MN 55455
| |
Collapse
|
20
|
Fujimori I, Yukawa T, Kamei T, Nakada Y, Sakauchi N, Yamada M, Ohba Y, Takiguchi M, Kuno M, Kamo I, Nakagawa H, Hamada T, Igari T, Okuda T, Yamamoto S, Tsukamoto T, Ishichi Y, Ueno H. Design, synthesis and biological evaluation of a novel series of peripheral-selective noradrenaline reuptake inhibitor. Bioorg Med Chem 2015; 23:5000-5014. [DOI: 10.1016/j.bmc.2015.05.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Revised: 05/06/2015] [Accepted: 05/08/2015] [Indexed: 11/29/2022]
|
21
|
Cho AJ, Kim SJ, Lee YK, Song YR, Oh J, Kim SG, Seo JW, Yoon JW, Koo JR, Kim HJ, Noh JW. Effect of post-voiding urine volume on progression of renal function decline in patients with type 2 diabetes. Diabetes Res Clin Pract 2015; 109:164-9. [PMID: 25979274 DOI: 10.1016/j.diabres.2015.04.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 02/03/2015] [Accepted: 04/12/2015] [Indexed: 11/29/2022]
Abstract
Diabetic bladder dysfunction (DBD) is a common complication of type 2 diabetes mellitus (T2DM). The association between DBD and progression of diabetic nephropathy has not been clarified. In this study, we investigated the relationship between post-voiding residual urine (PVR) with decline in renal function in patients with type 2 diabetes. This retrospective study included 164 patients at a single center. We collected medical histories and laboratory findings of patients undergoing uroflowmetry from January 1, 2008 to October 30, 2013. Renal function was assessed by calculating the estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease (MDRD) study equation. We evaluated whether greater PVR was a risk factor for faster decline of GFR during a 1-year follow-up. The subjects' mean age was 65±12 years, duration of diabetes 12.8±8.8 years, baseline serum creatinine level 106.1±53.0 μmol/L, and eGFR was 64.6±25.2 mL/min/1.73 m(2). Mean PVR was 69.8±96.3 mL and in 17.7% of subjects, PVR>100 mL. In linear regression analysis, PVR was independently associated with GFR decrease (standardized β coefficient=0.2, P=0.009). Multiple logistic analysis showed that subjects with PVR>100 mL had a 2.8-fold higher risk of an eGFR change during 1 year higher than the median value of all subjects (95% confidence interval, 1.1-6.8; P=0.03). Increased PVR was independently associated with a more rapid decline in renal function in patients with type 2 diabetes.
Collapse
Affiliation(s)
- A Jin Cho
- Department of Internal Medicine, Hallym Kidney Research Institute, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Soo Jin Kim
- Department of Internal Medicine, Hallym Kidney Research Institute, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Young-Ki Lee
- Department of Internal Medicine, Hallym Kidney Research Institute, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Young Rim Song
- Department of Internal Medicine, Hallym Kidney Research Institute, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Jieun Oh
- Department of Internal Medicine, Hallym Kidney Research Institute, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Sung Gyun Kim
- Department of Internal Medicine, Hallym Kidney Research Institute, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Jang Won Seo
- Department of Internal Medicine, Hallym Kidney Research Institute, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Jong-Woo Yoon
- Department of Internal Medicine, Hallym Kidney Research Institute, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Ja-Ryong Koo
- Department of Internal Medicine, Hallym Kidney Research Institute, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Hyung Jik Kim
- Department of Internal Medicine, Hallym Kidney Research Institute, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Jung Woo Noh
- Department of Internal Medicine, Hallym Kidney Research Institute, Hallym University College of Medicine, Seoul, Republic of Korea.
| |
Collapse
|
22
|
Lee KS, Choo MS, Seo JT, Oh SJ, Kim HG, Ng K, Lee KJ, Tan JT, Kim JC. Impact of overactive bladder on quality of life and resource use: results from Korean Burden of Incontinence Study (KOBIS). Health Qual Life Outcomes 2015; 13:89. [PMID: 26113125 PMCID: PMC4480453 DOI: 10.1186/s12955-015-0274-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 05/25/2015] [Indexed: 01/22/2023] Open
Abstract
Background To evaluate the impact of overactive bladder (OAB) on quality of life (QOL), resource use and productivity loss in patients recruited from six hospitals in Korea. Methods This cross-sectional survey recruited 625 OAB patients between July to December 2013. Patients were categorised into four groups based on the average number of urinary incontinence (UI) episodes over the past three days (0, 1, 2–3 and ≥4 UI/day). QOL was measured using the Incontinence-Specific Quality of Life Instrument (I-QOL), the Overactive Bladder Questionnaire (OAB-q), and a generic health-related utility instrument (EQ-5D). Information on hospital and clinic visit frequency, and continence pads use were also collected. Work productivity was assessed using the Work Productivity and Activity Impairment (WPAI) questionnaire. Between group differences were assessed using ANOVA. Multivariable regression analyses were performed to examine the independent effects of OAB symptoms on QOL. Results Severity of UI showed a significant linear relationship with QOL, with clinically meaningful differences between each UI severity category. Compared to the dry category, patients in the most severe category (≥4 UI/day) had significantly lower I-QOL scores (69.8 vs 42.6; p < 0.0001), greater symptom bother on the OAB-q (30.4 vs 64.6; p < 0.0001), and poorer EQ-5D utility (0.848 vs 0.742; p < 0.001). Multivariable analyses showed that UI severity, frequency, urgency, and nocturia are independently associated with poorer QOL. Incontinence severity is also significantly associated with cost of incontinence pads (p < 0.0001), and a greater interference with work and regular activities (p = 0.001), however, no significant difference in hospital and clinic visits were observed. Conclusion Severity of UI is a key contributor to the disease burden of OAB in Korean patients, even after taking into account the impact of other symptoms associated with OAB. Electronic supplementary material The online version of this article (doi:10.1186/s12955-015-0274-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Kyu Sung Lee
- Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, South Korea.
| | - Myung Soo Choo
- Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro, 43-Gil, Songpa-Gu, Seoul, South Korea.
| | - Ju Tae Seo
- Cheil General Hospital, Dankoo University College of Medicine, 1-19 Mukjeong-Dong, Jung-Gu, Seoul, South Korea.
| | - Seung June Oh
- Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, South Korea.
| | - Hyeong Gon Kim
- Konkuk University School of Medicine, Konkuk University Medical Center, Gwangjin-Gu, Seoul, South Korea.
| | - Kwong Ng
- Allergan APAC, Pasir Panjang Road, MBC, West Building #09-25, Singapore, 117439, Singapore.
| | - Kyung Jin Lee
- Allergan Korea, GT Tower 14F, 1317-23, Seocho-dong, Seocho-gu, Seoul.
| | - Jonathan T Tan
- Allergan APAC, Pasir Panjang Road, MBC, West Building #09-25, Singapore, 117439, Singapore.
| | - Joon Chul Kim
- Bucheon St.Mary's Hospital, 2 Sosa-Dong, Wonmi-Gu, Gyeonggido, South Korea.
| |
Collapse
|
23
|
Population-based survey on disease insight, quality of life, and health-seeking behavior associated with female urinary incontinence. Int Neurourol J 2015; 19:39-46. [PMID: 25833480 PMCID: PMC4386485 DOI: 10.5213/inj.2015.19.1.39] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 03/23/2015] [Indexed: 02/01/2023] Open
Abstract
Purpose: To evaluate disease insight, personal distress, and healthcare-seeking behavior of women with urinary incontinence (UI) to improve women’s health in Korea. Methods: In October 2012, 500 Korean women residing around Seoul, Incheon, and Gyeonggi-do were selected by random sampling for a population-based cross-sectional survey conducted by computer-aided telephone interview. Sixteen questions, which included information on demographic characteristics, information sources, disease insights, and general health-seeking behavior, were used for data collection. Results: Among the responders, 23.8% experienced UI, the prevalence of which increased with increasing age; 83.3% knew about UI through the mass media out of 98.2% apprehended people. Regarding general awareness of UI, 77.2% understood that UI is caused by aging. A total of 48.7% of subjects experienced societal restrictions because of UI. Most women in their 30s (25.6%) acquired UI information from the Internet, while those in their 50s and 60s (50–59 years, 51.1%; 60–64 years, 42.4%) learned about UI through friends. Among subjects who did not have UI, 89.37% intended to see a doctor or consult a professional if they developed UI (83.2%). Among those with UI, however, only 59.0% had talked about UI; 79.7% had talked with friends or associates, whereas only 23.2% had consulted a professional. Conclusions: Most respondents tended to obtain information on UI through the mass media. Subjects who did not have UI expressed their intention to consult a professional if they developed UI, while the percentage of subjects with UI who had consulted a professional was very low. Many women are ashamed of UI in Korea, which may be changed by providing efficient advertising with the right information and establishing a new perception of UI.
Collapse
|
24
|
Thompson AM, Linnebur SA, Vande Griend JP, Saseen JJ. Glycemic targets and medication limitations for type 2 diabetes mellitus in the older adult. ACTA ACUST UNITED AC 2014; 29:110-23. [PMID: 24513421 DOI: 10.4140/tcp.n.2014.110] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To review the optimal management of type 2 diabetes mellitus (T2DM) in the older adult. DATA SOURCES A PubMed search was completed to identify publications in the English language from 1947 to 2013 using combinations of the search terms: geriatrics, aged, diabetes mellitus, and type 2 diabetes mellitus. References of articles were also reviewed for inclusion if not identified in the PubMed search. STUDY SELECTION AND DATA EXTRACTION Original studies, clinical reviews, and guidelines were identified and evaluated for clinical relevance. DATA SYNTHESIS Although the number of older adults with T2DM is growing, evidence for the treatment of T2DM in this population is lacking. Barriers such as polypharmacy, comorbid conditions, economic limitations, cognitive impairment, and increased risk of hypoglycemia may limit optimal glycemic control in older adults. Several organizations provide recommendations for glycemic targets and recommend using standard glycemic goals in most healthy older adults. However, less stringent goals are necessary in certain older populations such as those patients with limited life expectancy and severe hypoglycemia. In general, glycemic goals should be individualized in older patients. Age-related pharmacokinetic and pharmacodynamic changes, comorbid conditions, adverse drug reactions, ease of medication administration, and cost of medications necessitate the need to individualize pharmacologic therapy. CONCLUSION Glycemic targets and medication use for T2DM should be individualized in older adults.
Collapse
Affiliation(s)
| | - Sunny A Linnebur
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colorado
| | - Joseph P Vande Griend
- Departments of Clinical Pharmacy and Family Medicine, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences
| | - Joseph J Saseen
- Departments of Clinical Pharmacy and Family Medicine, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences
| |
Collapse
|
25
|
Ignjatovic I, Potic M, Basic D, Dinic L, Medojevic N, Laketic D, Skakic A, Mihajlovic M. Self-created transobturator tape treatment of stress urinary incontinence without prior urodynamic investigation. Eur J Obstet Gynecol Reprod Biol 2014; 182:76-80. [PMID: 25262290 DOI: 10.1016/j.ejogrb.2014.08.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 07/31/2014] [Accepted: 08/21/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate and compare the results of tension free self-created transobturator tape (SCTOT) with the standard industrially created transobturator tape (ICTOT) in the treatment of stress urinary incontinence (SUI). STUDY DESIGN A prospective study of the treatment of SUI with SCTOT (67 patients) and ICTOT (47 patients) was performed. SCTOT was created from polypropylene mesh and monofilament sutures. The symptoms were evaluated before and after the surgery with the following: the Incontinence Impact questionnaire (IIC-7), the urogenital distress inventory (UDI-6), and the International Continence impact questionnaire short form (ICIQ5-SF). The overactive bladder symptom score (OABSS) was used to classify patients in the SUI or the mixed urinary incontinence (MUI) group. The follow up period was 18 months. Cure was defined as a negative stress test and no need for additional surgery. RESULTS Objective cure was achieved in 56/67 (83.5%) participants in the SCTOT group and in 40/47 (85.1%) participants in the ICTOT group (p>0.05). There was a significant improvement in IIC-7, UDI-6, ICIQ5-SF and OABSS in both groups. Improvement was better in the group with pure SUI than in patients with MUI, but this difference was not significant. Postoperative infection occurred in 5/67 (7.4%) participants and in 5/47 (10.6%) patients in the SCTOT and the ICTOT group, respectively. De novo overactive bladder symptoms occurred in 4/67 (5.9%) of the participants in the SCTOT group and in 3/47 (6.3%) of the patients in the ICTOT group. Operating time was longer in patients with SCTOT compared to those with ICTOT. CONCLUSION The results of the treatment with SCTOT are not inferior to the results of the treatment with ICTOT and other results reported in the literature.
Collapse
Affiliation(s)
- Ivan Ignjatovic
- Clinic of Urology, Clinical Center Nis and Faculty of Medicine Nis, Serbia.
| | - Milan Potic
- Clinic of Urology, Clinical Center Nis and Faculty of Medicine Nis, Serbia
| | - Dragoslav Basic
- Clinic of Urology, Clinical Center Nis and Faculty of Medicine Nis, Serbia
| | - Ljubomir Dinic
- Clinic of Urology, Clinical Center Nis and Faculty of Medicine Nis, Serbia
| | - Nina Medojevic
- Clinic of Urology, Clinical Center Nis and Faculty of Medicine Nis, Serbia
| | | | - Aleksandar Skakic
- Clinic of Urology, Clinical Center Nis and Faculty of Medicine Nis, Serbia
| | - Marija Mihajlovic
- Clinic of Urology, Clinical Center Nis and Faculty of Medicine Nis, Serbia
| |
Collapse
|
26
|
Prevalence, Risk Factors, Quality of Life, and Health-Care Seeking Behaviors of Female Urinary Incontinence: Results From the 4th Korean National Health and Nutrition Examination Survey VI (2007-2009). Int Neurourol J 2014; 18:31-6. [PMID: 24729925 PMCID: PMC3983507 DOI: 10.5213/inj.2014.18.1.31] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 03/03/2014] [Indexed: 11/17/2022] Open
Abstract
Purpose There is a lack of information on female urinary incontinence (UI) in South Korea. We investigated the prevalence, risk factors, quality of life (QoL), and healthcare-seeking behaviors of women with UI. Methods We included 9,873 women over the age of 20 years who had participated in the Korea National Health and Nutrition Examination Survey IV. The condition of UI was defined as answering "yes" to the question "Do you have UI?" Additionally, health care seeking behavior for UI was defined as answering "yes" to "Have you ever been treated for UI?' The EuroQoL-5 Dimension (EQ-5D) descriptive system was used to evaluate QoL. Results The mean age of our sample was 49.7 years. The overall prevalence of UI was 7.9%. The prevalence of UI significantly increased with age. The rate of healthcare-seeking behavior for UI also significantly increased with age. However, the rate of healthcare seeking for UI was significantly lower when compared to the prevalence of UI. In our multivariate analysis, age, body mass index, and marriage were significantly and independently associated with UI. As the severity of all the subscales of EQ-5D increased, the unadjusted odds ratio for UI also increased. After adjusting for potential confounders, the subscales of mobility, usual activities, pain/discomfort, and anxiety/depression from the EQ-5D were significantly associated with UI. Conclusions UI is a common disease and is significantly associated with QoL. Our results suggest the need for developing preventive measures and treatment policies for UI.
Collapse
|
27
|
Mandimika CL, Murk W, Mühlhäuser McPencow A, Lake A, Wedderburn T, Collier CH, Connell KA, Guess MK. Knowledge of pelvic floor disorders in a population of community-dwelling women. Am J Obstet Gynecol 2014; 210:165.e1-9. [PMID: 24126299 DOI: 10.1016/j.ajog.2013.10.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Revised: 09/24/2013] [Accepted: 10/10/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The objective of the study was to investigate baseline knowledge and demographic factors associated with a lack of knowledge about urinary incontinence (UI) and pelvic organ prolapse (POP). STUDY DESIGN This study was a community-based, cross-sectional survey of 431 racially and socioeconomically diverse women aged 19-98 years. The Prolapse and Incontinence Knowledge Questionnaire was used to assess participants' knowledge. Primary endpoints were the total number of correct responses on the UI and POP scales, respectively. Percentages of individuals answering each item or group of items correctly were explored as secondary outcomes. RESULTS All women lacked knowledge proficiency about UI and POP, although knowledge about UI was slightly greater than knowledge about POP. Overall, 71.2% of subjects lacked UI proficiency (<80% correct), whereas 48.1% lacked proficiency in POP knowledge (<50% correct). Black women demonstrated significantly less knowledge about UI and POP than white women, both before and after adjustment for age, education, and household income. When combined into 1 group, Asian, Hispanic, and other women also showed significantly less UI and POP knowledge than white women. Most women who reported symptoms of UI had not received treatment for their problems. CONCLUSION There is a global lack of knowledge about UI and POP among community-dwelling women, with more pronounced knowledge gaps among nonwhite women. UI and POP are chronic medical conditions that should be included in routine screening questions for well-woman care. Further studies are needed to explore how best to educate and improve women's awareness of these prevalent pelvic floor disorders.
Collapse
|
28
|
PARK HK, CHANG S, PALMER MH, KIM I, CHOI H. Assessment of the Impact of Male Urinary Incontinence on Health-Related Quality of Life: A Population Based Study. Low Urin Tract Symptoms 2013; 7:22-6. [DOI: 10.1111/luts.12043] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 09/03/2013] [Accepted: 09/17/2013] [Indexed: 12/18/2022]
Affiliation(s)
- Hyoung Keun PARK
- Department of Urology; School of Medicine, Konkuk University; Seoul Korea
| | - Sounghoon CHANG
- Department of Preventive Medicine; School of Medicine, Konkuk University; Seoul Korea
| | - Mary H. PALMER
- School of Nursing, The University of North Carolina; Chapel Hill North Carolina USA
| | - Inja KIM
- Department of Nursing; Daejeon University; Daejeon Korea
| | - Heejung CHOI
- Department of Nursing; Konkuk University; Seoul Korea
| |
Collapse
|
29
|
CHANG S, KIM H, PARK HK, KIM HG, PALMER MH, CHOI H. Prevalence and Risk Factors of Male Urinary Incontinence: Results of a Korean Population-Based Study. Low Urin Tract Symptoms 2013; 5:150-3. [DOI: 10.1111/luts.12009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
30
|
Palmer MH, Athanasopoulos A, Lee KS, Takeda M, Wyndaele JJ. Sociocultural and environmental influences on bladder health. Int J Clin Pract 2012; 66:1132-8. [PMID: 23163494 DOI: 10.1111/ijcp.12029] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- M H Palmer
- Institute on Aging, University of North Carolina, Chapel Hill, NC, USA.
| | | | | | | | | |
Collapse
|
31
|
McKenzie S, St John W, Wallis M, Griffiths S. Men's management of urinary incontinence in daily living: implications for practice. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2012. [DOI: 10.1111/j.1749-771x.2012.01167.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
32
|
Multimorbidity and associated factors in Brazilian women aged 40 to 65 years: a population-based study. Menopause 2012; 19:569-75. [PMID: 22415564 DOI: 10.1097/gme.0b013e3182455963] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the presence of multimorbidity and associated factors in Brazilian women aged 40 to 65 years with 11 or more years of school education. METHODS A secondary analysis of a cross-sectional population-based study was conducted using an anonymous self-report questionnaire completed by 377 women. The number of reported morbid conditions was evaluated (depression, hypertension, diabetes mellitus, urinary incontinence, and insomnia) and classified as none or one and two or more morbid conditions. The sociodemographic, behavioral, clinical, and reproductive factors associated with these conditions were also assessed. The χ test and multiple logistic regression analysis with stepwise selection criteria were used to select the major factors associated with morbid conditions, with a significance level set at 5%. RESULTS Insomnia was reported by 38.5%, depression by 31%, hypertension by 28.4%, urinary incontinence by 23.2%, and diabetes by 6.3% of the participants. In this sample, 28.9% did not report any morbid conditions, 31.8% reported one morbid condition, and 39.3% reported two or more morbid conditions. On logistic regression analysis, the increased likelihood of having two or more morbid conditions was associated with bad/fair self-perception of health (increased 5.1 times; 95% CI, 1.85-14.1), nonperformance of physical activity (increased by 2.7 times; 95% CI, 1.08-6.81), obesity (increased by 30.3 times; 95% CI, 3.17-250), postmenopause (increased by 4.4 times; 95% CI, 1.57-12.11), and nervousness (increased by 3.8 times; 95% CI, 1.45-9.8). CONCLUSIONS A worse self-perception of health, sedentariness, obesity, nervousness, and being postmenopausal were associated with multimorbidity.
Collapse
|
33
|
Jo JK, Lee S, Kim YT, Choi HY, Kim SA, Choi BY, Moon HS. Analysis of the risk factors for overactive bladder on the basis of a survey in the community. Korean J Urol 2012; 53:541-6. [PMID: 22949998 PMCID: PMC3427838 DOI: 10.4111/kju.2012.53.8.541] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2012] [Accepted: 05/18/2012] [Indexed: 11/18/2022] Open
Abstract
Purpose To evaluate the risk factors for overactive bladder (OAB) in a population aged 40 years and over in the community. Materials and Methods We conducted a community-based survey of OAB in a population aged 40 years and over in Guri City and Yangpyeong County, South Korea, by use of the overactive bladder symptom score (OABSS) questionnaire. A total of 926 subjects were included in the final analysis. The definition of OAB was more than 2 points for the urgency score and 3 points for the sum of scores. In addition, the subjects were asked about age, dwelling place, marital status, educational status, behavioral factors (smoking, drinking, etc), and medical history. Categorical variables were analyzed by using the logistic regression model and were adjusted for age by using the logistic regression model. Results Overall OAB prevalence was 14.1% (130/926), made up of 49/403 males (12.2%) and 81/523 females (15.5%). OAB prevalence increased with age (p<0.0001). Risk factors for OAB were educational status (age-adjusted p=0.0487), stroke (p=0.0414), osteoporosis (p=0.0208), asthma (p=0.0091), rhinitis (p=0.0008), and cataract. Other factors (dwelling place, marital status, smoking, drinking, hypertension, diabetes, hyperlipidemia, myocardial infarction, angina, tuberculosis, atopic dermatitis, hepatitis B, and depression) were not associated with OAB. Conclusions The prevalence of OAB in our study was about 14.1% and the risk factors for OAB were educational status, stroke, osteoporosis, asthma, rhinitis, and cataract. Knowledge of these risk factors may help in the diagnosis and treatment of OAB.
Collapse
Affiliation(s)
- Jung Ki Jo
- Department of Urology, Hanyang University College of Medicine, Seoul, Korea
| | | | | | | | | | | | | |
Collapse
|
34
|
Yoshimura N, Miyazato M. Neurophysiology and therapeutic receptor targets for stress urinary incontinence. Int J Urol 2012; 19:524-37. [PMID: 22404481 DOI: 10.1111/j.1442-2042.2012.02976.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Stress urinary incontinence is the most common type of urinary incontinence in women. Stress urinary incontinence involves involuntary leakage of urine in response to abdominal pressure caused by activities, such as sneezing and coughing. The condition affects millions of women worldwide, causing physical discomfort as well as social distress and even social isolation. This type of incontinence is often seen in women after middle age and it can be caused by impaired closure mechanisms of the urethra as a result of a weak pelvic floor or poorly supported urethral sphincter (urethral hypermobility) and/or a damaged urethral sphincter system (intrinsic sphincter deficiency). Until recently, stress urinary incontinence has been approached by clinicians as a purely anatomic problem as a result of urethral hypermobility requiring behavioral or surgical therapy. However, intrinsic sphincter deficiency has been reported to be more significantly associated with stress urinary incontinence than urethral hypermobility. Extensive basic and clinical research has enhanced our understanding of the complex neural circuitry regulating normal function of the lower urinary tract, as well as the pathophysiological mechanisms that might underlie the development of stress urinary incontinence and lead to the development of potential novel strategies for pharmacotherapy of stress urinary incontinence. Therapeutic targets include adrenergic and serotonergic receptors in the spinal cord, and adrenergic receptors at the urethral sphincter, which can enhance urethral reflex activity during stress conditions and increase baseline urethral pressure, respectively. This article therefore reviews the recent advances in stress urinary incontinence research and discusses the neurophysiology of urethral continence reflexes, the etiology of stress urinary incontinence and potential targets for pharmacotherapy of stress urinary incontinence.
Collapse
Affiliation(s)
- Naoki Yoshimura
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
| | | |
Collapse
|
35
|
Madhuvrata P, Cody JD, Ellis G, Herbison GP, Hay-Smith EJC. Which anticholinergic drug for overactive bladder symptoms in adults. Cochrane Database Syst Rev 2012; 1:CD005429. [PMID: 22258963 DOI: 10.1002/14651858.cd005429.pub2] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Around 16% to 45% of adults have overactive bladder symptoms (urgency with frequency and/or urge incontinence - 'overactive bladder syndrome'). Anticholinergic drugs are common treatments. OBJECTIVES To compare the effects of different anticholinergic drugs for overactive bladder symptoms. SEARCH METHODS We searched the Cochrane Incontinence Group Specialised Trials Register (searched 8 March 2011) and reference lists of relevant articles. SELECTION CRITERIA Randomised trials in adults with overactive bladder symptoms or detrusor overactivity that compared one anticholinergic drug with another, or two doses of the same drug. DATA COLLECTION AND ANALYSIS Two authors independently assessed eligibility, trial quality and extracted data. Data were processed as described in the Cochrane Reviewers' Handbook. MAIN RESULTS Eighty six trials, 70 parallel and 16 cross-over designs were included (31,249 adults). Most trials were described as double-blind, but were variable in other aspects of quality. Crossover studies did not present data in a way that could be included in the meta-analyses. Twenty nine collected quality of life data (the primary outcome measure) using validated measures, but only fifteen reported useable data.Tolterodine versus oxybutynin: There were no statistically significant differences for quality of life, patient reported cure or improvement, leakage episodes or voids in 24 hours, but fewer withdrawals due to adverse events with tolterodine (Risk Ratio (RR) 0.52, 95% confidence interval (CI) 0.40 to 0.66, data from eight trials), and less risk of dry mouth (RR 0.65, 95% CI 0.60 to 0.71, data from ten trials).Solifenacin versus tolterodine: There were statistically significant differences for quality of life (standardised mean difference (SMD) -0.12, 95% CI -0.23 to -0.01, data from three trials), patient reported cure/improvement (RR 1.25, 95% CI 1.13 to 1.39, data from two trials), leakage episodes in 24 hours (weighted mean difference (WMD) -0.30, 95% CI -0.53 to -0.08, data from four studies) and urgency episodes in 24 hours (WMD -0.43, 95% CI -0.74 to -0.13, data from four trials), all favouring solifenacin. There was no difference in withdrawals due to adverse events and dry mouth, but after sensitivity analysis the dry mouth (RR 0.69, 95% CI 0.51 to 0.94) was statistically significantly lower with solifenacin when compared to Immediate Release (IR) tolterodine.Fesoterodine versus extended release tolterodine: Three trials contributed to the meta analyses. There were statistically significant differences for quality of life (SMD -0.20, 95% CI -0.27 to -0.14), patient reported cure/improvement (RR 1.11, 95% CI 1.06 to 1.16), leakage episodes (WMD -0.19, 95% CI -0.30 to -0.09), frequency (WMD -0.27, 95% CI -0.47 to -0.06) and urgency episodes (WMD -0.44, 95% CI -0.72 to -0.16) in 24 hours, all favouring fesoterodine, but those taking fesoterodine had higher risk of withdrawal due to adverse events (RR 1.45, 95% CI 1.07 to 1.98) and higher risk of dry mouth (RR 1.80, 95% CI 1.58 to 2.05) at 12 weeks.Different doses of tolterodine: The standard recommended starting dose (2 mg twice daily) was compared with two lower (0.5 mg and 1 mg twice daily), and one higher dose (4 mg twice daily). The effects of 1 mg, 2 mg and 4 mg doses were similar for leakage episodes and micturitions in 24 hours, with greater risk of dry mouth with 2 and 4 mg doses at two to 12 weeks.Different doses of solifenacin: The standard recommended starting dose of 5 mg once daily was compared to 10 mg: while frequency and urgency were less (better) with 10 mg compared to 5 mg, there was a higher risk of dry mouth with 10 mg solifenacin at four to 12 weeks.Different doses of fesoterodine:The recommended starting dose of 4mg once daily was compared to 8 and 12 mg. The clinical efficacy (patient reported cure, leakage episodes, micturition per 24 hours) of 8 mg was better than 4 mg fesoterodine but with a higher risk of dry mouth with 8 mg.There was no statistically significant difference between 4 and 12 mg in the efficacy but the dry mouth was significantly higher with 12 mg at eight to 12 weeks.Extended versus immediate release preparations of oxybutynin and/or tolterodine: There were no statistically significant differences for cure/improvement, leakage episodes or micturitions in 24 hours, or withdrawals due to adverse events, but there were few data. Overall, extended release preparations had less risk of dry mouth at two to 12 weeks.One extended release preparation versus another: There was less risk of dry mouth with oral extended release tolterodine than oxybutynin (RR 0.75, 95% CI 0.59 to 0.95), but no difference between transdermal oxybutynin and oral extended release tolterodine although some people withdrew due to skin reaction at the transdermal patch site at 12 weeks. AUTHORS' CONCLUSIONS Where the prescribing choice is between oral immediate release oxybutynin or tolterodine, tolterodine might be preferred for reduced risk of dry mouth. With tolterodine, 2 mg twice daily is the usual starting dose, but a 1 mg twice daily dose might be equally effective, with less risk of dry mouth. If extended release preparations of oxybutynin or tolterodine are available, these might be preferred to immediate release preparations because there is less risk of dry mouth.Between solifenacin and immediate release tolterodine, solifenacin might be preferred for better efficacy and less risk of dry mouth. Solifenacin 5 mg once daily is the usual starting dose, this could be increased to 10 mg once daily for better efficacy but with increased risk of dry mouth.Between fesoterodine and extended release tolterodine, fesoterodine might be preferred for superior efficacy but has higher risk of withdrawal due to adverse events and higher risk of dry mouth.There is little or no evidence available about quality of life, costs, or long-term outcome in these studies. There were insufficient data from trials of other anticholinergic drugs to draw any conclusions.
Collapse
Affiliation(s)
- Priya Madhuvrata
- Obstetrics & Gynaecology, Sheffield Teaching Hospital NHS Foundation Trust, Sheffield,
| | | | | | | | | |
Collapse
|
36
|
Tomehata S. [Urinary bladder function in young and elderly women]. Nihon Ronen Igakkai Zasshi 2012; 49:767-774. [PMID: 23883642 DOI: 10.3143/geriatrics.49.767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
AIM To identify the effect of aging on urinary bladder function, the maximal volume, post-voiding residual of the urinary bladder, mean urine flow rate, and urine volume were examined during micturition after drinking water (500-700 ml). METHODS Bladder volume, post-voiding residual, mean urine flow rate, and urine volume during micturition were measured in young (22±3 yr, n=12) and elderly women (64±3 yr, n=6). RESULTS The maximal urinary bladder volume was not significantly different (P>0.05) between young and elderly women (576±158 vs. 505±119 ml). In contrast, post-voiding residual volume was greater (88±52 ml, P<0.05) in elderly than in 34±40 ml in young women. Accordingly, urine volume was decreased to 418±155 ml in elderly compared to the volume in young women (556±141 ml). Although mean urine flow rate of 16 ml/s was equivalent between young and elderly women, the time period necessary for voiding was 27±6 s in elderly women, shorter (p<0.05) than the period for 43±24 s in young women. CONCLUSION It is suggested that contraction of the urinary bladder in elderly women is not so sustained as in young women, causing a greater post-voiding residual volume of the urinary bladder.
Collapse
Affiliation(s)
- Sumie Tomehata
- Department of Physiology, Graduate School of Health Sciences, Hiroshima University
| |
Collapse
|
37
|
Geriatric conditions develop in middle-aged adults with diabetes. J Gen Intern Med 2011; 26:272-9. [PMID: 20878496 PMCID: PMC3043187 DOI: 10.1007/s11606-010-1510-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2009] [Revised: 02/02/2010] [Accepted: 08/12/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Geriatric conditions, collections of symptoms common in older adults and not necessarily associated with a specific disease, increase in prevalence with advancing age. These conditions are important contributors to the complex health status of older adults. Diabetes mellitus is known to co-occur with geriatric conditions in older adults and has been implicated in the pathogenesis of some conditions. OBJECTIVE To investigate the prevalence and incidence of geriatric conditions in middle-aged and older-aged adults with diabetes. DESIGN Secondary analysis of nationally-representative, longitudinal health interview survey data (Health and Retirement Study waves 2004 and 2006). PARTICIPANTS Respondents 51 years and older in 2004 (n=18,908). MAIN MEASURES Diabetes mellitus. Eight geriatric conditions: cognitive impairment, falls, incontinence, low body mass index, dizziness, vision impairment, hearing impairment, pain. KEY RESULTS Adults with diabetes, compared to those without, had increased prevalence and increased incidence of geriatric conditions across the age spectrum (p< 0.01 for each age group from 51-54 years old to 75-79 years old). Differences between adults with and without diabetes were most marked in middle-age. Diabetes was associated with the two-year cumulative incidence of acquiring new geriatric conditions (odds ratio, 95% confidence interval: 1.8, 1.6-2.0). A diabetes-age interaction was discovered: as age increased, the association of diabetes with new geriatric conditions decreased. CONCLUSIONS Middle-aged, as well as older-aged, adults with diabetes are at increased risk for the development of geriatric conditions, which contribute substantially to their morbidity and functional impairment. Our findings suggest that adults with diabetes should be monitored for the development of these conditions beginning at a younger age than previously thought.
Collapse
|
38
|
McKown S, Abraham L, Coyne K, Gawlicki M, Piault E, Vats V. Linguistic validation of the N-QOL (ICIQ), OAB-q (ICIQ), PPBC, OAB-S and ICIQ-MLUTSsex questionnaires in 16 languages. Int J Clin Pract 2010; 64:1643-52. [PMID: 20722767 DOI: 10.1111/j.1742-1241.2010.02489.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Overactive bladder (OAB) is a highly prevalent condition with a negative impact on both health-related quality of life and sexual functioning. We aimed to create and validate conceptually equivalent tools to assess OAB for use in diverse cultural and linguistic settings. RESEARCH DESIGN AND METHODS To evaluate the linguistic validity of harmonised translations of the Nocturia Quality of Life (N-QOL) questionnaire, Overactive Bladder Questionnaire (OAB-q) family, Patient Perception of Bladder Condition (PPBC) questionnaire, Overactive Bladder Satisfaction Questionnaire (OAB-S) and International Consultation on Incontinence Questionnaire (ICIQ) Male Sexual Matters associated with Lower Urinary Tract Symptoms Questionnaire (ICIQ-MLUTSsex), bilingual (target language and English) interviewers cognitively debriefed subjects to assess their ability to paraphrase and understand the instructions, questions and responses within each questionnaire. RESULTS Overall item comprehension rates were 96% for the N-QOL, 98.9% for the OAB-q, 92% for the PPBC, 98.5% for the OAB-S and 94.3% for the ICIQ-MLUTSsex. DISCUSSION We found that the translations were well-understood by subjects, although a number of minor changes were made to the N-QOL, OAB-q, OAB-S and ICIQ-MLUTSsex translations in an effort to improve clarity and cultural appropriateness. In a few instances, the majority of subjects in a language were unable to paraphrase a specific term or phrase prior to the revisions. In several cases, problems arose from the wording of the question in the source language. CONCLUSIONS The translated instruments in this study demonstrated a high level of overall linguistic validity.
Collapse
Affiliation(s)
- S McKown
- Corporate Translations, Inc, Linguistic Validation, Chicago, IL 60647, USA.
| | | | | | | | | | | |
Collapse
|
39
|
Masue T, Wada K, Nagata C, Deguchi T, Hayashi M, Takeda N, Yasuda K. Lifestyle and health factors associated with stress urinary incontinence in Japanese women. Maturitas 2010; 66:305-9. [DOI: 10.1016/j.maturitas.2010.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Revised: 03/24/2010] [Accepted: 04/02/2010] [Indexed: 10/19/2022]
|
40
|
Eriksson I, Gustafson Y, Fagerström L, Olofsson B. Prevalence and factors associated with urinary tract infections (UTIs) in very old women. Arch Gerontol Geriatr 2010; 50:132-5. [DOI: 10.1016/j.archger.2009.02.013] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2008] [Revised: 02/23/2009] [Accepted: 02/25/2009] [Indexed: 10/20/2022]
|
41
|
Daneshgari F, Liu G, Birder L, Hanna-Mitchell AT, Chacko S. Diabetic bladder dysfunction: current translational knowledge. J Urol 2010; 182:S18-26. [PMID: 19846137 DOI: 10.1016/j.juro.2009.08.070] [Citation(s) in RCA: 152] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2009] [Indexed: 02/06/2023]
Abstract
PURPOSE Diabetes mellitus, a metabolic disorder caused by an absolute or relative deficiency of insulin, is a debilitating and costly disease with multiple serious complications. Lower urinary tract complications are among the most common complications of diabetes mellitus. The most common, bothersome lower urinary tract complication of diabetes mellitus is diabetic cystopathy or diabetic bladder dysfunction. We reviewed the current translational knowledge of diabetic bladder dysfunction. MATERIALS AND METHODS We performed a search of the English literature through PubMed. The key words used were diabetes and bladder dysfunction or cystopathy. Our data and perspective are provided for consideration of the future direction of research. RESULTS Despite traditional recognition of diabetic bladder dysfunction as a voiding problem characterized by poor emptying and overflow incontinence, recent clinical and experimental evidence indicate storage problems such as urgency and urge incontinence in diabetes mellitus cases. Recent experimental evidence from studies of diabetic bladder dysfunction in small animal models of diabetes mellitus show a temporal effect on diabetic bladder dysfunction. Early phase diabetes mellitus causes compensated bladder function and the late phase causes decompensated bladder function. The temporal theory could plausibly provide the scientific road map to correlate clinical and experimental findings, and identify the role of mechanisms such as polyuria, hyperglycemia, oxidative stress, autonomic neuropathy and decompensation of the bladder contractile apparatus in the creation of clinical and experimental manifestations of diabetic bladder dysfunction. CONCLUSIONS Diabetic bladder dysfunction includes time dependent manifestations of storage and emptying problems. Identifying mechanistic pathways would lead to the identification of therapeutic intervention.
Collapse
Affiliation(s)
- Firouz Daneshgari
- Department of Urology, Case Western Reserve University, Cleveland, Ohio, USA.
| | | | | | | | | |
Collapse
|
42
|
Abstract
PURPOSE Diabetes mellitus is a group of debilitating and costly diseases with multiple serious complications. Lower urinary tract complications or diabetic uropathy are among the most common complications of diabetes mellitus, surpassing widely recognized complications such as neuropathy and nephropathy. Diabetic uropathy develops in individuals with types 1 and 2 diabetes, and little is known about the natural history of these common and troublesome complications. Animal models have the potential to reveal mechanisms and aid in the development of treatment strategies. MATERIALS AND METHODS We present a review of available animal models of diabetes mellitus relative to their use in the study of diabetic uropathy. RESULTS Large and small animal models of diabetes mellitus are available. While large animals such as dogs and swine may closely mirror the human disease in size and phenotype, the time between diabetic complication onset and development, and associated husbandry expenditures can make acquiring data on statistically valid sample sizes prohibitively expensive. In contrast, small animal models (rats and mice) have much lower expenditures for a larger number of animals and compressed observation time due to a shorter life span. Also, mice are readily manipulated genetically to facilitate the isolation of the effect of single genes (transgenic and knockout mice). Type 1 diabetes mellitus can be induced chemically with streptozotocin, which is selectively toxic to pancreatic beta cells. Type 2 diabetes mellitus models have been developed by selective breeding for hyperglycemia with or without associated obesity. Diabetic uropathy has been noted in several well characterized, predictable animal models of diabetes mellitus. CONCLUSIONS Diabetic uropathy, including diabetic bladder dysfunction, has been more frequently studied in small animals with type I diabetes. The recent availability of transgenic models provides a new opportunity for further studies of diabetic uropathy in mouse models of types I and II diabetes mellitus.
Collapse
Affiliation(s)
- Firouz Daneshgari
- Department of Urology and Female Pelvic Surgery, State University of New York, Upstate Medical University, Syracuse, New York, USA.
| | | | | | | |
Collapse
|
43
|
Su TH, Huang WC, Lee MY, Lin TY, Chang HC, Chen CP. Tension-free vaginal tape-obturator procedure for treatment of severe urodynamic stress incontinence: Subjective and objective outcomes during 2âyears of follow-up. J Obstet Gynaecol Res 2009; 35:1077-82. [DOI: 10.1111/j.1447-0756.2009.01065.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
44
|
Grise P, Caremel R. L’incontinence urinaire d’effort chez l’homme : place des alternatives au sphincter artificiel urinaire. Prog Urol 2009; 19:897-901. [DOI: 10.1016/j.purol.2009.09.030] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2009] [Accepted: 09/30/2009] [Indexed: 11/26/2022]
|
45
|
Liapis A, Bakas P, Liapi S, Sioutis D, Creatsas G. Epidemiology of female urinary incontinence in the Greek population: EURIG study. Int Urogynecol J 2009; 21:217-22. [PMID: 19936999 DOI: 10.1007/s00192-009-1019-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2009] [Accepted: 09/17/2009] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We estimated the current prevalence of urinary incontinence (UI) in the female Greek population, estimated the prevalence of the subtypes of UI, and assessed its impact on patients' quality of life. METHODS The study was performed by personal interview based on structured questionnaires, and 2,000 Greek women (from the whole of Greece) aged between 20 and 80 years old participated in the study. RESULTS The prevalence of UI in a female Greek population comprising women aged between 20 and 80 years was 27%. The impact was proportional to the frequency and severity of the UI. UI had no effect or only a mild effect on patients' quality of life. CONCLUSION Significant improvement is required in patient information about the nature of UI and its effects on life, and about available treatments (conservative and surgical), and their efficacy and complications.
Collapse
Affiliation(s)
- Angelos Liapis
- 2nd Department of Obstetrics and Gynecology, Aretaieio Hospital, University of Athens, Athens, Greece.
| | | | | | | | | |
Collapse
|
46
|
Ham E, Choi H, Seo JT, Kim HG, Palmer MH, Kim I. Risk Factors for Female Urinary Incontinence among Middle-Aged Korean Women. J Womens Health (Larchmt) 2009; 18:1801-6. [DOI: 10.1089/jwh.2008.1039] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Eunmi Ham
- Department of Nursing, Konkuk University, Korea.
| | | | | | | | | | | |
Collapse
|
47
|
The epidemiological study of women with urinary incontinence and risk factors for stress urinary incontinence in China. Menopause 2009; 16:831-6. [PMID: 19240656 DOI: 10.1097/gme.0b013e3181967b5d] [Citation(s) in RCA: 133] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the prevalence and associated risk factors of urinary incontinence (UI) in Chinese women. METHODS In the cross-sectional survey, 20,000 Chinese women 20 years or older were randomly selected and interviewed with modified Bristol Female Lower Urinary Tract Symptoms questionnaires to estimate population prevalence rates and identify potential risk factors. RESULTS A total of 19,024 women were included in the analysis and 976 excluded; qualified rate is 95% (19,024/20,000). Of the Chinese women aged from 20 to 99 years (mean +/- SD, 45 +/- 16 y), the overall prevalence rate of UI was 30.9%. Estimates of stress urinary incontinence (SUI), urge urinary incontinence, and mixed urinary incontinence prevalence were 18.9%, 2.6%, and 9.4%, with a corresponding proportional distribution of 61%, 8%, and 31%, respectively. The prevalence of mixed urinary incontinence increased with aging, whereas the prevalence of SUI peaked in the group of women aged 50 years and that of urge urinary incontinence in the group of women aged 70 years. Only 25% of women have consulted doctors on this issue. Through multivariable logistic regression analysis, we identified age, vaginal delivery, multiparity, alcohol consumption, central obesity (women's waist circumference, >/=80 cm), constipation, chronic pelvic pain, history of respiratory disease, gynecological events, pelvic surgery, and perimenopause and postmenopause status as potential risk factors for SUI, among which age, vaginal delivery, and multiparity are three major risk factors. CONCLUSIONS Our findings suggest that the prevalence of UI is high in China, with SUI as the most common subtype. Age, vaginal delivery, and others are risk factors for SUI.
Collapse
|
48
|
A 2-year prospective follow-up study of lower urinary tract symptoms in patients treated with clozapine. J Clin Psychopharmacol 2008; 28:618-24. [PMID: 19011429 DOI: 10.1097/jcp.0b013e31818a6cfd] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Urinary incontinence and enuresis are well-known side effects of clozapine. However, clinical experience has shown that patients also suffer from diverse lower urinary tract symptoms (LUTS). The natural course of clozapine-related LUTS is unclear. Thus, a longitudinal follow-up study is needed. A total of 101 subjects who were taking clozapine initially participated. Their LUTS were evaluated using the International Prostate Symptom Score (IPSS), other questionnaires, and a medical records review. After 2 years, 87 of the original subjects could be contacted, and the status of their LUTS was re-evaluated. The average IPSS total was 7.4 +/- 5.9 at the initial evaluation. Although only 11 subjects (10.9%) reported actual incontinence, 42 subjects (41.6%) were found to have clinically significant LUTS (IPSS total score > or =8). No influencing factors could be found among the demographic and clinical variables. At the follow-up, the average IPSS total (7.9 +/- 6.0) and the percentage of subjects with clinically significant LUTS (43.7%) had both increased, although the change was not statistically significant. The prevalence of LUTS in clozapine-medicated patients was higher than in the general population of the same age. However, the prevalence of incontinence was only a quarter of that of LUTS. If clinicians focus only on incontinence, distress from LUTS will not receive appropriate attention. Furthermore, contrary to literature observations, clozapine-related LUTS did not remit easily but rather persisted even into the long-term maintenance phase. More concern should be directed at these troublesome and often neglected side effects.
Collapse
|
49
|
Differences between older Chinese men and women from Hong Kong in the impact of urinary incontinence on their lives. J Cross Cult Gerontol 2008; 24:307-17. [PMID: 18787935 DOI: 10.1007/s10823-008-9079-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study reports the epidemiology of urinary incontinence (UI) and its impact on the social lives of older Chinese people in Hong Kong, a modern city in China. It also examines the relationship between sex and this impact, as well as the extent of UI in a convenience sample of 101 sufferers aged 60 or older. This study was cross-sectional and used face-to-face interviews with a structured questionnaire. A number of findings concur with studies conducted in Western countries. Prevalence of UI increased with adult age, and it affected women more than men. UI had a negative impact on 86.1% of the incontinent respondents. There were no significant differences between men and women in the duration of UI, the level of UI, or health status. Out of the nine impacts on social lives, only one showed a significant difference between older men and women: "restriction on opportunities to participate in social activities." Statistically, men tended to report more negative impacts than women. More than 80% of the respondents were affected by their UI. The impact of UI on social lives was basically the same for men and women, though men reported significantly more social impacts than did women. However, this study does not support the claim that the social life of those who reported more social impacts was worse than that of those who reported fewer.
Collapse
|
50
|
Azuma R, Murakami K, Iwamoto M, Tanaka M, Saita N, Abe Y. Prevalence and risk factors of urinary incontinence and its influence on the quality of life of Japanese women. Nurs Health Sci 2008; 10:151-8. [DOI: 10.1111/j.1442-2018.2008.00390.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|