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Devreese AM, De Weerdt WJ, Feys HM, Dewulf M, Alaerts R, Vereecken R, Van Assche A. Functional assessment of urinary incontinence: the perineal pad test. Clin Rehabil 2016. [DOI: 10.1177/026921559601000305] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Perineal pad tests are simple, noninvasive functional tests which have been recommended for the evaluation of patients with urinary incontinence. Most are based on the one-hour pad test introduced by Sutherst and co-workers and standardized by the International Continence Society. The major problem with the one-hour pad test is its lack of sensitivity. Therefore a stringent test procedure was developed, whereby the limit of patient tolerance was reached. Mean end volumes of 568 ml (648 ml) immediately after the test (retest) confirmed that the patients had been examined with full bladders. Yet one in three of the incontinent patients remained dry during formal assessment. The use of the one-hour perineal pad test for clinical or research purposes should be seriously questioned.
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Affiliation(s)
| | | | - Hilde M Feys
- Department of Rehabilitation Science, University of Leuven
| | | | - Renilde Alaerts
- Department of Physiotherapy, University Hospital St Pieter, Leuven
| | - Raoul Vereecken
- Department of Urology, , University Hospital St Pieter, Leuven
| | - André Van Assche
- Department of Obstetrics and Gynaecology, University Hospital Gasthuisberg, Leuven, Belgium
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2
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Malik RD, Cohn JA, Bales GT. Urinary Retention in Elderly Women: Diagnosis & Management. Curr Urol Rep 2014; 15:454. [DOI: 10.1007/s11934-014-0454-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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3
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Urinary incontinence: its assessment and relationship to depression among community-dwelling multiethnic older women. ScientificWorldJournal 2014; 2014:708564. [PMID: 24982981 PMCID: PMC3984862 DOI: 10.1155/2014/708564] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 11/11/2013] [Indexed: 11/18/2022] Open
Abstract
Urinary Incontinence (UI) affects many older adults. Some of its deleterious consequences include stress, major depression, diminished quality of life, sexual dysfunction, and familial discord. Of the various mental health problems identified in the literature as being comorbid with UI, the most notable one continues to be depression. Despite a wealth of research contributions on this topic, the available literature is underrepresentative of ethnic minority older women. Culture has been shown to have a significant impact on a woman's perception of her own UI symptoms; this demonstrates the necessity for the recruitment of ethnically and culturally diverse samples when studying UI. In the present study, we determined the prevalence of UI among 140 community-dwelling, ethnically diverse older women (28.2%), discovered that our new UI screener is reliable, and did not find the UI-depression link to be significant. The clinical and research implications of our findings are discussed.
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Abstract
Until last decades, nocturia has been considered as an irritative symptom of benign prostatic hyperplasia (BPH), but the nocturia is unresponsive symptoms to various modalities of BPH treatment. More recently, it has been recognized that the prostate is not so quite important as previously believed, as nocturia is equally common in women. The understanding of nocturia has been much changed in last decade; it is a highly prevalent condition, and symptoms in men and women are really no different either quantitatively or qualitatively. The successful introduction of desmopressin (l-deamino-8-D-arginine vasopressin, DDAVP) to decrease nocturnal urine output in severe nocturia which resistant to conventional BPH treatment and in women demonstrated new perspectives in management of nocturia. We reviewed the definition and etiologies of nocturia, offering the current diagnostic procedures and standards of care.
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Affiliation(s)
- Myeong Heon Jin
- Department of Urology, Korea University College of Medicine, Seoul, Korea
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Griffiths D, Tadic SD, Schaefer W, Resnick NM. Cerebral control of the bladder in normal and urge-incontinent women. Neuroimage 2007; 37:1-7. [PMID: 17574871 PMCID: PMC2075467 DOI: 10.1016/j.neuroimage.2007.04.061] [Citation(s) in RCA: 150] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2007] [Revised: 04/12/2007] [Accepted: 04/30/2007] [Indexed: 12/30/2022] Open
Abstract
AIM To identify age-related changes in the normal brain/bladder control system, and differences between urge incontinence in younger and older women, as shown by brain responses to bladder filling; and to use age, bladder volume, urge incontinence and detrusor overactivity (DO) as probes to reveal control system function. Functional MRI was used to examine regional brain responses to bladder infusion in 21 females (26-85 years): 11 "cases" with urge incontinence and DO (proven previously) and 10 normal "controls". Responses and their age dependence were determined at small and large bladder volumes, in whole brain and in regions of interest representing right insula and anterior cingulate (ACG). In "controls", increasing bladder volume/sensation led to increasing insular responses; with increasing age, insular responses became weaker. In younger "cases", ACG responded abnormally strongly at large bladder volumes/strong sensation. Elderly "cases" showed strong ACG responses even at small bladder volume but more moderate responses at larger volumes; if DO occurred, pontine micturition center (PMC) activation did not increase. CONCLUSION Among normal "controls", increasing age leads to decreased responses in brain regions involved in bladder control, including right insula, consistent with its role in mapping normal bladder sensations. Strong ACG activation occurs in urge-incontinent "cases" and may be a sign of urgency, indicating recruitment of alternative pathways when loss of bladder control is feared. Easier ACG provocation in older "cases" reflects lack of physiological reserve or different etiology. ACG responses seem associated with PMC inhibition: reduced ACG activity accompanies failure of inhibition (DO).
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Affiliation(s)
- Derek Griffiths
- Division of Geriatric Medicine and Institute on Aging, University of Pittsburgh, Pittsburgh, PA 15213, USA.
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7
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Ostaszkiewicz J. Incomplete bladder emptying in frail older adults: a clinical conundrum. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2007. [DOI: 10.1111/j.1749-771x.2007.00019.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Pfisterer MHD, Griffiths DJ, Schaefer W, Resnick NM. The Effect of Age on Lower Urinary Tract Function: A Study in Women. J Am Geriatr Soc 2006; 54:405-12. [PMID: 16551306 DOI: 10.1111/j.1532-5415.2005.00613.x] [Citation(s) in RCA: 178] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To identify age-associated changes in female lower urinary tract function across a wide age spectrum, controlling for detrusor overactivity (DO). DESIGN Secondary analysis of a cross-sectional study of DO and aging. Eligible volunteers were stratified by age group and presence of DO. SETTING Community-based volunteers, evaluated in research laboratory. PARTICIPANTS Eighty-five ambulatory, nondemented, community-dwelling female volunteers, with and without bladder symptoms suggestive of DO, recruited by advertising, mean age 54 (range 22-90); 75% Caucasian, 21% African American. MEASUREMENTS Comprehensive assessment included bladder diary, uroflowmetry, and detailed videourodynamics. Predefined urodynamic and diary variables were examined for association with age and DO. Mean values of these variables were calculated for subgroups aged 20 to 39, 40 to 59, and 60 and older (14 subjects > or =70). RESULTS Maximum urethral closure pressure, detrusor contraction strength, and urine flow rate declined significantly with age (P<.001, P<.001, P=.006, respectively), regardless of whether DO was present. Most elderly individuals continued to empty their bladder almost completely, with normal voiding frequency. Mean number of nocturnal voids was less than one in all age groups. Bladder capacity did not decrease with age (mean 522 mL in oldest group) but was smaller in subjects with DO. Bladder sensation diminished significantly with age (P<.001) but was stronger in subjects with DO. CONCLUSION Female bladder and urethral function appear to deteriorate throughout adult life, whether DO is present or not. Specifically, detrusor contractility, bladder sensation, and urethral pressure decline. The common belief that bladder capacity shrinks with age may be related to DO rather than to aging itself.
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Affiliation(s)
- Mathias H-D Pfisterer
- Bethanien-Krankenhaus, Geriatric Center of the University of Heidelberg, Heidelberg, Germany.
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9
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Rosenberg LJ, Griffiths DJ, Resnick NM. FACTORS THAT DISTINGUISH CONTINENT FROM INCONTINENT OLDER ADULTS WITH DETRUSOR OVERACTIVITY. J Urol 2005; 174:1868-72. [PMID: 16217326 DOI: 10.1097/01.ju.0000176794.22042.eb] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE In older adults detrusor overactivity (DO) is almost as common in continent individuals as in those with urge incontinence (UUI). Thus, UUI likely reflects the contribution of additional factors. We postulated that of functionally independent individuals in whom transient causes were excluded those in whom DO was accompanied by UUI would be more likely to have smaller functional bladder capacity, less warning and less ability to avert urine loss in the face of DO. MATERIALS AND METHODS While blinded to continence status, we reviewed the records of all 52 cognitively intact and nonobstructed volunteers older than 65 years who had DO associated with urgency during urodynamic testing and had been asked to try to prevent leakage for 2 minutes. Of these individuals 31 were continent at home. RESULTS In patients with UI mean functional bladder capacity +/- SD was smaller (313 +/- 153 vs 390 +/- 178 ml, p = 0.06) and warning was briefer (87 +/- 81 vs 120 +/- 116 ml), although the association with warning was less impressive (p = 0.14). The ability to forestall leakage for at least 2 minutes correlated strongly with being continent at home (p < 0.002). For continence detrusor suppression at the onset of DO was more important than sphincter contraction. CONCLUSIONS Urge incontinence in older adults involves more than simply the presence of DO. Physical function, cognitive function and medications are already known to be important for continence. Our data suggest that functional bladder capacity and the ability to suppress involuntary contraction (and possibly warning) are also potentially important covariates. These factors may represent additional potential targets for behavioral and pharmacological therapy.
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Affiliation(s)
- Lisa J Rosenberg
- Division of Geriatric Medicine and Gerontology, University of Pittsburgh and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
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10
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Abstract
Nocturia is a common condition in the elderly that profoundly influences general health and quality of life. It appears to predict a higher risk of death. One consequence of nocturia is sleep deterioration, with increased daytime sleepiness and loss of energy and activity. Accidents, e.g. falls, are increased both at night and during the day in elderly persons with nocturia. Nocturia is caused by nocturnal polyuria, reduced voided volumes, or a combination of the two. Nocturnal polyuria can be caused by numerous diseases, e.g. diabetes insipidus, diabetes mellitus, congestive heart failure, and sleep apnoea. A disorder of the vasopressin system, with very low or undetectable vasopressin levels at night, is manifested as an increased nocturnal urine output, which in the most extreme cases reaches 85% of the 24-h diuresis: the prevalence of low or undetectable vasopressin levels at night has been estimated to be 3-4% in those aged >or= 65 years. Treatment of nocturia may include avoiding excessive fluid intake and use of diuretic medication in the afternoon rather than the morning, oral desmopressin at bedtime in cases of nocturnal polyuria, and antimuscarinic agents in the case of overactive bladder or impaired storage capacity of the bladder.
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Affiliation(s)
- Ragnar Asplund
- Department of Family Medicine, Karolinska Institute, Stockholm, Sweden.
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11
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Alivizatos G, Skolarikos A, Albanis S, Ferakis N, Mitropoulos D. Unreliable residual volume measurement after increased water load diuresis. Int J Urol 2005; 11:1078-81. [PMID: 15663678 DOI: 10.1111/j.1442-2042.2004.00951.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The aim of the present study was to examine whether increased water load intake prior to ultrasound examination of the lower urinary tract, affects the measurement of postvoid residual urine volume. PATIENTS AND METHODS Ninety four male patients with postvoid residual volumes after increased water load diuresis of more than 100 mL (PVR1) were included in the present study. All patients underwent a second PVR measurement by an urologist with a portable transabdominal bladder ultrasound scan without having received an increased water load (PVR2). A comparison of the measurements was performed and the PVR values were also correlated with other parameters, such as age, International Prostate Symptom Score, prostate volume and serum prostate-specific antigen (PSA) values. RESULTS Postvoid residual urine volume after increased water load diuresis (PVR1) differed from that recorded after normal bladder filling and voiding at first desire (PVR2), with the former being larger than the later in every patient (P < 0.001). The PVR values, PVR1 and PVR2, were independent to patient age, symptom score prostate volume and PSA value. CONCLUSIONS Measurement of postvoid residual volume in a relaxed patient, who voids at first desire, represents everyday life and should be the correct method of testing.
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Affiliation(s)
- Gerasimos Alivizatos
- Second Department of Urology, Athens Medical School, Sismanoglio Hospital, Athens, Greece.
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12
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Abstract
The physiology of incontinence is related to the normal physiologic mechanisms of aging and to abnormal pathologic changes that recently have become better understood. Further research is needed to develop new methods of pharmacologic treatment.
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Affiliation(s)
- Rafi Kevorkian
- Division of Geriatric Medicine, Saint Louis University, 1402 South Grand Boulevard, Suite M238, St. Louis, MO 63104, USA.
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13
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Abstract
Nocturia is a common symptom in the elderly, which profoundly influences general health and quality of life. One consequence of nocturia is sleep deterioration, with increased daytime sleepiness and loss of energy and activity. Accidents, e.g., fall injuries, are increased both at night and in the daytime in elderly persons with nocturia. Nocturia is caused by nocturnal polyuria, a reduced bladder capacity, or a combination of the two. Nocturnal polyuria can be caused by numerous diseases, such as diabetes insipidus, diabetes mellitus, congestive heart failure, and sleep apnoea. In the nocturnal polyuria syndrome (NPS), the 24-h diuresis is normal or only slightly increased, while there is a shift in diuresis from daytime to night. NPS is caused by a disturbance of the vasopressin system, with a lack of nocturnal increase in plasma vasopressin or, in some cases, no detectable levels of the hormone at any time of the 24-h period. The calculated prevalence of NPS is about 3% in an elderly population, with no gender difference. In NPS, there are serious sleep disturbances, partly due to the need to get up for micturition, but there is also increased difficulty in falling asleep after nocturnal awakenings and increased sleepiness in the morning. The treatment of NPS may include avoidance of excessive fluid intake, use of diuretics medication in the afternoon rather than the morning, and desmopressin orally at bedtime.
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Affiliation(s)
- R Asplund
- Family Medicine Stockholm, Karolinska Institute, SE-141 83 Huddinge, Sweden.
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14
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Gomes CM, Arap S, Trigo-Rocha FE. Voiding dysfunction and urodynamic abnormalities in elderly patients. ACTA ACUST UNITED AC 2004; 59:206-15. [PMID: 15361987 DOI: 10.1590/s0041-87812004000400010] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Lower urinary tract dysfunction is a major cause of morbidity and decreased quality of life in elderly men and women. With the progressive aging of the population, it is important to understand common micturitional disorders that may occur in this population. Most urinary problems in the elderly are multifactorial in origin, demanding a comprehensive assessment of the lower urinary tract organs, functional impairments, and concurrent medical diseases. Urodynamics is a highly valuable tool in the investigation of elderly patients with lower urinary tract symptoms. Urodynamic tests are not always necessary, being indicated after excluding potentially reversible conditions outside the urinary tract that may be causing or contributing to the symptoms. Although urodynamic tests may reveal common diagnoses such as bladder outlet obstruction and stress urinary incontinence in the elderly population, findings such as detrusor overactivity and impaired detrusor contractility are common and have important prognostic and therapeutic implications. The purpose of this article is to describe common urologic problems in the elderly and review the indications for and clinical aspects of urodynamic studies in these conditions.
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Affiliation(s)
- Cristiano M Gomes
- Division of Urology, Department of Surgery, Hospital das Clínicas, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil.
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15
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Hershkovitz A, Manevitz D, Beloosesky Y, Gillon G, Brill S. Medical treatment for urinary retention in rehabilitating elderly women: is it necessary? Aging Clin Exp Res 2003; 15:19-24. [PMID: 12841414 DOI: 10.1007/bf03324475] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND AIMS It is unclear whether medical treatment of elderly women with acute urinary retention in geriatric rehabilitation centers affects the recovery rate. The aims of the present study were to assess the rate of spontaneous recovery from urinary retention in elderly women in rehabilitation centers and to determine whether medical treatment with a adrenergic receptor blockers (a blockers) is effective in resumption of urination in this population. METHODS We surveyed 84 elderly women with urinary retention, admitted to a geriatric rehabilitation center between September 1998 and March 2000. Most had undergone orthopedic surgeries. Post-voiding urine residual (PVR) was measured 3 days after an acute episode of urinary retention. PVR of 250 mL and below was the desirable outcome. Patients with PVR over 250 mL were randomly assigned to two groups, placebo vs Doxazosin. Medication doses in both groups were increased every 3 days and catheterization was used until a desirable outcome was achieved. RESULTS Seventy-eight out of the 84 patients entered the study, of whom 48 (62%) recovered spontaneously prior to initiation of medical treatment. Of the remaining 30, 7 patients dropped out and 23 began medical treatment. Twelve women recovered (a similar rate occurred in the placebo and Doxazosin groups), and 11 did not. The study was terminated due to the high rate of spontaneous recovery and because it became clear from the initial results that Doxazosin had no beneficial effect over placebo in the treatment of urinary retention. Diabetes and poor functional status were found to be prognostic factors for recovery failure. CONCLUSIONS Most elderly women with urinary retention in geriatric rehabilitation centers will probably recover spontaneously. Alpha blockers appear to have no beneficial effect in this population.
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Affiliation(s)
- Avital Hershkovitz
- Beit Rivka' Geriatric Rehabilitation Center Day Hospital, Petach Tikva, Israel.
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Weiss JP, Blaivas JG. Nocturia. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2003; 539:751-72. [PMID: 15202485 DOI: 10.1007/978-1-4419-8889-8_47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
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Griffiths DJ, McCracken PN, Harrison GM, Gormley EA, Moore KN. Urge incontinence and impaired detrusor contractility in the elderly. Neurourol Urodyn 2002; 21:126-31. [PMID: 11857665 DOI: 10.1002/nau.10042] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Among the elderly, both urge incontinence and elevated residual urine are common. When they occur together, they present a challenging clinical problem, called detrusor hyperactivity with impaired contractile function (DHIC). Impaired detrusor contractility has two aspects: elevated post-void residual urine volume and reduced detrusor contraction strength. Geriatric urge incontinence, especially in combination with reduced bladder sensation, is associated with specific cortical abnormalities: frontal and global cortical underperfusion and cognitive impairment. We have investigated, in 73 elderly incontinent patients, whether either aspect of impaired contractility is associated with urge incontinence, reduced sensation or these cortical abnormalities. For post-void residual urine, there are no significant associations. Detrusor contraction strength, however, is significantly increased (not impaired) if there is urge incontinence, reduced bladder sensation, or cortical underperfusion. Thus, DHIC appears to be a coincidental occurrence of two common conditions with different etiological factors.
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Affiliation(s)
- Derek J Griffiths
- Urodynamics Unit, Edmonton General Hospital, Edmonton, Alberta, Canada.
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Miller KL, DuBeau CE, Bergmann M, Griffiths DJ, Resnick NM. Quest for a detrusor overactivity index. J Urol 2002; 167:578-84; discussion 584-5. [PMID: 11792922 DOI: 10.1097/00005392-200202000-00028] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Urge incontinence, which is the predominant type of geriatric incontinence, is generally attributed to detrusor overactivity. However, detrusor overactivity is present in up to half of continent elderly individuals. We postulated that detrusor overactivity associated with urge incontinence would be more severe but there are no established criteria for judging severity. Using urge incontinence frequency as a yardstick and controlling for nonurodynamic contributing factors we sought intrinsic lower urinary tract parameters that reflect detrusor overactivity severity. We postulated that parameters in 1 or more of 5 domains would be important, namely characteristics of uninhibited contraction, bladder capacity, bladder proprioception, detrusor contractility and sphincter adequacy. MATERIALS AND METHODS We analyzed data on 79 community dwelling incontinent individuals older than 60 years old. All subjects had urge incontinence on a 4-day voiding record and underwent multichannel videourodynamics. We examined the associations of urge incontinence frequency with the postulated key factors. RESULTS Multivariable analysis revealed that 24-hour urine output and functional bladder capacity consistently predicted urge incontinence frequency. Bladder proprioception was significant in some models. Uninhibited contraction pressure was another predictor. Surprisingly higher uninhibited contraction pressure was associated with lower urge incontinence frequency. This negative correlation was more pronounced in a subgroup with a less adequate sphincter but absent in those with good sphincter function, implying that low uninhibited contraction pressure does not necessarily indicate less severe detrusor overactivity but rather reflects sphincter inadequacy in many patients. Age was not independently associated with urge incontinence frequency. CONCLUSIONS We identified functional bladder capacity as a measure of detrusor overactivity severity. The measure commonly used, namely uninhibited contraction pressure, is inappropriate because it is severely confounded by sphincter function, especially in older individuals. Furthermore, we confirmed that urine output, and possibly bladder sensation and sphincter strength modify the clinical manifestation of detrusor overactivity.
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Affiliation(s)
- K L Miller
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah, USA
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19
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Hershkovitz A, Beloosesky Y, Pomp N, Brill S. Is routine screening for urinary tract infection in rehabilitation day-hospital elderly patients necessary? Arch Gerontol Geriatr 2002; 34:29-36. [PMID: 14764308 DOI: 10.1016/s0167-4943(01)00193-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2001] [Revised: 07/02/2001] [Accepted: 07/11/2001] [Indexed: 11/19/2022]
Abstract
It is not known whether all rehabilitation day-hospital patients need to be assessed for urinary tract infection (UTI). The aims of this study were to identify patients at high risk to develop UTI and to determine whether there was an association between the amount of post-void residual urine (PVR) and UTI. We surveyed 211 consecutive patients admitted to the day-hospital unit of a geriatric rehabilitation center between June 1998 and February 1999. The main diagnoses were stroke, orthopedic surgeries and deconditioning. Urine samples for general analysis and bacteriology were collected from each patient upon admission. PVR was measured using portable ultrasound. Telephone interviews were conducted with 141 patients, 3-11 months after the initial screening. The prevalence of UTI at admission was higher in women (P=0.007), and patients with decreased functional level (P=0.001). The incidence rate correlated with the functional level but not with gender or main diagnosis. The relative risk of dependent patients to develop UTI was 7.5 times higher than in independent patients. Significant amounts of PVR were equal in males and females. The relative risk of individuals with significant amounts of PVR to develop UTI was 1.63 times greater then those with negligible and moderate amounts of PVR. Gender, degree of functional level and main diagnosis had no effect on the relationship between PVR and UTI. We conclude that low functional level and significant amounts of PVR are risk factors for prevalence and incidence of UTI in elderly patients in a rehabilitation day-hospital. There is no need for routine urine analysis in every elderly patient admitted to rehabilitation day-hospitals, however, PVR measurements by portable ultrasound are valuable.
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Affiliation(s)
- Avital Hershkovitz
- Day-Hospital, Beth Rivka Geriatric Rehabilitation, Petach Tikva, Israel.
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20
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Shimanouchi S, Kamei T, Hayashi M. Home care for the frail elderly based on urinary incontinence level. Public Health Nurs 2000; 17:468-73. [PMID: 11115145 DOI: 10.1046/j.1525-1446.2000.00468.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Incontinence is a common problem in the frail elderly. We conducted interviews focusing on urinary incontinence with 249 elderly clients in the home care setting, and studied differences of the needs among three (mild, moderate, and catheter) groups based on incontinence level. The mild group had the highest number of professional care needs, although their problems were not as serious as the other two groups. The moderate group required the highest amount of daily care by caregiver. A similar need pattern was shown in the moderate and catheter groups, while more diversified needs were required in the mild group. Portable toilet, rehabilitation, and short-stay services were frequently used in the mild group. The use of telephone consultation was the highest in the moderate group, and the use of doctor visit and bathing service were higher in the catheter group. The most important challenge was significantly different in each group: preventive efforts to maintain activities of daily living (ADL) in the mild group, interpersonal relationships in the moderate group, and infection control in the catheter group. Education was necessary for caregivers in all three groups. These findings help to project realistic care needs for each client based on his or her incontinence level.
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Affiliation(s)
- S Shimanouchi
- Department of Nursing Science, School of Allied Health Sciences, Tokyo Medical and Dental University, Japan.
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21
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Abstract
Nocturia is one of the most bothersome of all urologic symptoms, yet even a rudimentary classification does not exist. We herein propose a classification system of nocturia based on a retrospective study. The records of 200 consecutive patients with nocturia were reviewed. Evaluation included history, micturition diary (including day, night, and 24-hr voided volume), postvoid residual urine (PVR), and videourodynamic study (VUDS). Functional bladder capacity (FBC) was determined to be the largest voided volume in a 24-hr period. The etiology of nocturia was thus classified into one of three groups: nocturnal polyuria ([NP] in which voided urine volume during the hours of sleep exceeds 35% of the 24-hr output), nocturnal detrusor overactivity ([NDO] defined as nocturia attributable to diminished bladder capacity during the hours of sleep), and mixed (NP+NDO); polyuria (24-hr urine output >2,500 cc) was classified separately. There were 129 women and 65 men ranging in age from 17 to 94 years (x=59). Overall 13 (7%) had NP, 111 (57%) NDO, and 70 (36%) had a mixed etiology of their nocturia (both NP and NDO). Forty-five (23%) also had polyuria. These data confirm that the etiology of nocturia is multifactorial and in many instances unrelated to the underlying urologic condition. Nocturnal overproduction of urine is a significant component of nocturia in 43% of patients, most of whom will also have NDO. We believe that treatment should be directed at both conditions.
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Affiliation(s)
- J P Weiss
- New York Hospital/Cornell Medical Center, New York, USA.
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Fonda D, Resnick NM, Colling J, Burgio K, Ouslander JG, Norton C, Ekelund P, Versi E, Mattiasson A. Outcome measures for research of lower urinary tract dysfunction in frail older people. Neurourol Urodyn 2000; 17:273-81. [PMID: 9590479 DOI: 10.1002/(sici)1520-6777(1998)17:3<273::aid-nau12>3.0.co;2-l] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- D Fonda
- Aged Care Services, Caulfield General Medical Centre, Australia
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Affiliation(s)
- JEFFREY P. WEISS
- From the New York Hospital/Cornell Medical Center, New York, New York
| | - JERRY G. BLAIVAS
- From the New York Hospital/Cornell Medical Center, New York, New York
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Weiss JP, Blaivas JG, Stember DS, Chaikin DC. Evaluation of the etiology of nocturia in men: the nocturia and nocturnal bladder capacity indices. Neurourol Urodyn 1999; 18:559-65. [PMID: 10529704 DOI: 10.1002/(sici)1520-6777(1999)18:6<559::aid-nau6>3.0.co;2-d] [Citation(s) in RCA: 95] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
To determine and quantify the cause of nocturia in men, we describe and evaluate the relative contribution of two complementary indices of nocturia: the nocturia index (Ni), a measure of nocturnal urine overproduction, and the nocturnal bladder capacity index (NBCi), reflective of nocturnal bladder capacity. The records of 100 consecutive men with lower urinary tract symptoms (LUTS), having undergone video-urodynamic studies (VUDS), were prospectively studied. Evaluation included American Urological Association symptom score (AUASS), micturition diary (day, night, and 24-hr voided volume), and VUDS. Voiding diary analysis was carried out as previously described by us, determining the Ni, NBCi, and nocturnal polyuria index (NPi) (nocturnal urine volume/24-hr urine volume). In the case of AUASS question #7 (degree of nocturia), the odds of having a severe AUA question #7 response was found to be 4.09 times higher for patients with NBCi > 2.0 compared with patients whose NBCi was </= 2.0 using logistic regression analysis. In comparing patients with severe nocturia and low NBCi with those having mild nocturia and low NBCi, Ni performed in a fashion superior to NPi in identifying relative nocturnal urine overproduction as the suspected explanation for their nocturia (Ni = 3.42 vs. 1.42, P = 0.0002 cf. Npi = 0.44 vs. 0.27, P = 0.018, Mann-Whitney test, respectively). We suggest a discriminating threshold of NBCi > 2 as highly significant in defining diminished NBC as a factor in the etiology of nocturia. In addition, we propose Ni of 1.5 as a threshold greater than which nocturia may be attributed to nocturnal urine overproduction in excess of maximum bladder capacity. Together, these indices describe in quantitative fashion the relative contributions of nocturnal urine overproduction and diminished NBC in identifying the etiology of nocturia in male patients. Neurourol. Urodynam. 18:559-565, 1999.
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Affiliation(s)
- J P Weiss
- Weill Medical College of Cornell University, The New York Presbyterian Hospital, New York, New York, USA.
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Asplund R, Sundberg B, Bengtsson P. Desmopressin for the treatment of nocturnal polyuria in the elderly: a dose titration study. BRITISH JOURNAL OF UROLOGY 1998; 82:642-6. [PMID: 9839577 DOI: 10.1046/j.1464-410x.1998.00849.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the decrease in nocturnal polyuria and the tolerability of three different doses of oral desmopressin in elderly subjects. SUBJECTS AND METHODS Subjects were included in the study if they; (i) were healthy and free from medication with possible influence on their diuresis or voiding pattern: (ii) had an increased nocturnal frequency (> or = 2 nocturnal voids, as reported in the pre-screening period); and (iii) had a nocturnal urinary output of > or = 0.9 mL/min. Seventeen men and six women (mean age 68.1, SD 4.7 years) met these criteria and were treated with 0.1, 0.2 and 0.4 mg oral desmopressin given at bedtime, each dose taken for one week on three consecutive weeks. RESULTS The mean (SD) nocturnal diuresis before treatment was 1.6 (0.7) mL/min, which decreased significantly to 1.1 (0.4) mL/min when 0.1 mg desmopressin was given. A dose of 0.2 mg desmopressin resulted in a further small decrease in the nocturnal diuresis to 0.9 (0.4) mL/min, whereas the 0.4 mg dose produced no additional effect. The reduction in nocturnal diuresis occurred almost exclusively in the group with a nocturnal urinary output of > or =1.3 mL/min. After treatment, diuresis returned to pretreatment levels. There was no change in body weight or in ankle circumference during desmopressin treatment and no serious adverse effects were observed. CONCLUSION Desmopressin reduces nocturnal diuresis in polyuric elderly subjects and this reduction, occurring with doses of 0.1 mg given at bedtime, does not increase in a dose-dependent way.
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Affiliation(s)
- R Asplund
- Department of Clinical Neuroscience and Family Medicine, Karolinska Institute, Huddinge, Sweden
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Griffiths D. Clinical studies of cerebral and urinary tract function in elderly people with urinary incontinence. Behav Brain Res 1998; 92:151-5. [PMID: 9638957 DOI: 10.1016/s0166-4328(97)00187-3] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Brain and urinary tract function have been studied in a group of 128 geriatric patients with established urinary incontinence. Median age was 79 years. About half suffered from dementia. A group of 27 continent patients of similar age and cognitive status was used in some comparisons. It was expected that impaired voluntary control of voiding (urge incontinence) would be associated with particular aspects of cognitive impairment and dysfunction of specific regions of the brain. Comprehensive investigations, including 24 h monitoring of incontinence, videourodynamic testing, cognitive testing and SPECT brain scanning, demonstrated that genuine urge incontinence could be proven in half of the patients and was frequently accompanied by reduced sensation of bladder filling, especially in males. Genuine urge incontinence with reduced bladder filling sensation led to greater urine loss than other types of incontinence. Overall, cognitive function was slightly more impaired in patients with genuine urge incontinence, but the strongest and most specific association was with impaired temporal orientation. Genuine urge incontinence with reduced bladder filling sensation was associated with global underperfusion of the cerebral cortex and more specifically, with underperfusion of the frontal areas of the brain, especially on the right. These results are consistent with PET scan observations of Blok et al. (Brain 1997;20:112-121), which show that areas in the right anterior cingulate gyrus and right inferior frontal gyrus are involved in voluntary voiding of normal males.
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Affiliation(s)
- D Griffiths
- Urodynamics Unit 1SE-133, Misericordia Community Hospital and Health Centre, University of Alberta, Edmonton, Canada.
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Abstract
Aging often disturbs the normal circadian rhythm of urine production. The nocturia commonly seen with aging may result from the loss of nighttime vasopressin production or release that develops by childhood. Restoring the nocturnal increase in vasopressin can have a dramatic clinical response: improved quality of life and less risk of nighttime falls in carefully selected and accurately diagnosed patients.
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Affiliation(s)
- J L Donahue
- Department of Medicine, Pharmacology, and Exercise Science, University of Florida, Gainesville, USA
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DuBeau CE. Interpreting the effect of common medical conditions on voiding dysfunction in the elderly. Urol Clin North Am 1996; 23:11-8. [PMID: 8677529 DOI: 10.1016/s0094-0143(05)70289-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Medical conditions often have an important causal role in urinary incontinence in the elderly. Aside from causing functional impairments, such diseases directly may involve the genitourinary system--particularly its neurologic control--resulting in specific lower urinary tract pathophysiology. Knowledge of the specific effects that medical conditions may have on the genitourinary system and continence can assist the urologic specialist in determining the often complex cause(s) of UI in older persons.
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Affiliation(s)
- C E DuBeau
- Gerontology Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Griffiths DJ, Harrison G, Moore K, McCracken P. Variability of post-void residual urine volume in the elderly. UROLOGICAL RESEARCH 1996; 24:23-6. [PMID: 8966837 DOI: 10.1007/bf00296729] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Residual urine volume, though clinically important as a diagnostic tool, is reported to be variable and unreliable. Variability was examined among 14 geriatric patients, mean age 77 years. Residual urine was measured by ultrasound at three different times of day on each of two visits separated by 2-4 weeks. Results were examined by analysis of variance. Mean residual urine was 154 ml. Between-patient variability was large [standard deviation (SD) 246 ml]. There was no significant difference between values in men and women, nor between visits. Within-patient variability was large because of a large systematic variation with time of day (SD 128 ml), with greatest volumes in the early morning. The inherent, random variability of the measurement was much smaller than this (SD 44 ml). If the physiological factors causing the temporal variation could be controlled, more reproducible measurements would be possible.
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Affiliation(s)
- D J Griffiths
- Urodynamics Unit, Misericordia Community Health Centre, Edmonton, Alberta, Canada
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Griffiths DJ, McCracken PN, Harrison GM, Moore KN. Urge incontinence in elderly people: factors predicting the severity of urine loss before and after pharmacological treatment. Neurourol Urodyn 1996; 15:53-7. [PMID: 8696356 DOI: 10.1002/(sici)1520-6777(1996)15:1<53::aid-nau5>3.0.co;2-e] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Geriatric patients with urge incontinence lose different amounts of urine and respond differently to treatment. Identification of factors predicting the amount of urine loss before or after treatment might help to select therapy. We have sought such factors in 41 elderly patients (23 women and 18 men), mean age 79 years with established urge incontinence that was urodynamically proven to be associated with detrusor hyperreflexia, who were treated with oxybutynin chloride. Urine loss was measured by 24-hour monitoring (mean 378 g/24 hour). Demographic, psychosocial, behavioral, cortical, circulatory, urodynamic, and urological factors were studied before and after treatment. Multiple regression analysis showed that, before intervention, factors predicting the amount of urine loss were fluid intake, voiding frequency, and impaired orientation on cognitive testing. After intervention, urine loss was significantly smaller (mean 259 g/24 hour). Different factors predicted the amount of this persistent incontinence: underperfusion of the cerebral cortex, reduced bladder sensation, and (again) impaired orientation. The analysis confirms that the severity of geriatric urge incontinence associated with detrusor hyperreflexia, particularly incontinence that is resistant to anticholinergic therapy, depends on cortical factors, that bladder sensation plays an important role, and that therapeutic manipulation of fluid intake and voiding frequency may offer a modest reduction in urine loss (e.g., about 40 g/day).
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Affiliation(s)
- D J Griffiths
- Urodynamics Unit, Edmonton General Hospital, University of Alberta, Canada
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Cucchi A. Detrusor contractility in hyperreflexic bladders (from intracerebral neuropathies) versus unstable and stable unobstructed ones. Neurourol Urodyn 1996; 15:109-15; discussion 115-7. [PMID: 8713557 DOI: 10.1002/(sici)1520-6777(1996)15:2<109::aid-nau1>3.0.co;2-j] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Three male patient groups of 20 subjects each have been assessed urodynamically by pressure flow study, namely, patients with detrusor hyperreflexia (DH) due to intracerebral neuropathies were compared with subjects bearing a condition of idiopathic detrusor instability, as well as with a control group of males showing normal urodynamic findings. Detrusor contractility proved greater in the unstable patients, but did not differ significantly between those with DH and the controls. Such results may suggest that intracerebral neuropathies leading to DH have no influence on, whilst the factors responsible for detrusor instability are strongly related to, the degree of activation of bladder muscle mechanical capability.
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Affiliation(s)
- A Cucchi
- Divisione di Urologia, Policlinico S. Matteo, Pavia, Italy
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Abstract
1. The nocturnal polyuria syndrome (NPS) is characterized by an increased nocturnal urine output. The diurnal rhythm in the antidiuretic hormone (ADH) system is absent, and often there is no detectable ADH in the plasma at all during the night. The 24-hr urine output is normal or only moderately increased. Men without nocturnal micturition, normally have a substantial increase in their nocturnal plasma ADH, while those with a need to micturate during the night have the same ADH level at night as in the daytime. Women have lower ADH levels than men, and no nocturnal increase in ADH irrespective of nocturnal voiding. Subjects with an increased nocturnal voiding frequency due to increased nocturnal urine output have an increased thirst, most markedly at night. They often avoid drinking in the evening, but they are unable to resist the impulse to drink during the night. People with polyuria at night wake up often because of the need to void, and accordingly are often tired during the day. 2. An increased nocturnal urine output can be reduced by administration of desmopressin at night. In a short-term study of elderly sufferers from NPS, treated with 20 micrograms desmopressin as nose drops in the evening the nocturnal urine output was reduced from 65 +/- 8% of the 24-hr urine output before treatment to 50 +/- 15% during treatment. In another study elderly with NPS were treated with 40 micrograms desmopressin as an intranasal aerosol in the evening.(ABSTRACT TRUNCATED AT 250 WORDS)
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Månsson-Linström A, Dehlin O, Isacsson A. Urinary incontinence in primary health care. 1. Perceived knowledge and training among various categories of nursing personnel and care units. Scand J Prim Health Care 1994; 12:169-74. [PMID: 7997694 DOI: 10.3109/02813439409003694] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES To investigate perceived knowledge, skills and education of urinary incontinence (UI), focusing on UI facts, product assessment, and quality of care. DESIGN A quantitative-qualitative questionnaire study. SETTING Three different care units; a health care centre, a nursing home, and a geriatric clinic in Sweden. SUBJECTS 254 nurses, nursing assistants, and auxiliary nurses. MAIN OUTCOME MEASURES Responses to questionnaire. RESULTS The study shows fragmentary knowledge about UI facts, aid products, and costs, and a lack of holistic view. The differences in knowledge between the groups were small but registered nurses generally showed better results, probably due to their longer vocational training. The health care centre had the best total knowledge as regards facts about UI. CONCLUSION All categories of nursing personnel wanted more knowledge about UI care and aids, which indicates that improvements in quality of care could be achieved by increasing product awareness.
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Griffiths D, Harrison G, Moore K, McCracken P. Long-term changes in urodynamic studies of voiding in the elderly. UROLOGICAL RESEARCH 1994; 22:235-8. [PMID: 7871636 DOI: 10.1007/bf00541899] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Urodynamic studies were conducted in 80 incontinent elderly patients (27 men and 53 women; mean age, 77 years) and repeated 2-4 weeks later after patients had been subject to interventions. Interpretable voiding studies were performed in 84% of sessions. Interpretable initial and repeat studies were performed in 74% of patients. For detrusor pressure at maximum flow the intra-individual, between-sessions variability was +/- 11.7 cm H2O (SD) and the initial-repeat correlation coefficient was 0.61. For maximum flow rate the corresponding figures were +/- 4.7 ml/s and 0.44. Mean residual urine volume was 195 ml, with a between-sessions variability of +/- 113 ml (SD). These results suggest that there is substantial long-term variability in voiding function, including urethral resistance. Of the mean, 5% showed a change in obstruction classification (unobstructed/obstructed) between sessions. This variability and the modest proportion of interpretable studies should be taken into account when assessing urethral obstruction and designing clinical trials.
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Affiliation(s)
- D Griffiths
- Urodynamics Unit, Edmonton General Hospital, Alberta, Canada
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Gormley EA, Griffiths DJ, McCracken PN, Harrison GM, McPhee MS. Effect of transurethral resection of the prostate on detrusor instability and urge incontinence in elderly males. Neurourol Urodyn 1993; 12:445-53. [PMID: 7504554 DOI: 10.1002/nau.1930120502] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Detrusor instability is common in men with evidence of outflow obstruction due to benign prostatic hypertrophy and typically reverses in about two thirds of patients after transurethral resection of the prostate (TURP). It is also common among the elderly without outflow obstruction and may lead to urge incontinence. To determine whether TURP has an effect on detrusor instability and urge incontinence in elderly men, or whether these abnormalities are due to other age-associated changes, 12 males (mean age 80 years) with urge incontinence or frequency and urgency of micturition, and symptomatic benign prostatic hypertrophy, were studied by 24-hour monitoring of incontinence and videourodynamic examination, before and after TURP; 7/12 patients were significantly cognitively impaired. Preoperatively, all patients showed detrusor instability, which reversed postoperatively in only one patient, a significantly smaller proportion than that consistently reported in younger patients. Preoperatively, 11/12 patients were incontinent. After TURP, 8/11 patients had an improvement in the amount of incontinence, by up to 458 g in 24 hours. Those who improved had been urodynamically more severely obstructed preoperatively. Those with the most improvement were also cognitively impaired. We conclude that, in the geriatric population, detrusor instability and urge incontinence may be the result of age-associated changes and not secondary to obstruction. Detrusor instability is likely to persist following TURP. Preoperative urodynamic assessment of obstruction in the incontinent male with benign prostatic hypertrophy may be useful since the severity of incontinence responds well to TURP if there is marked obstruction. Cognitive impairment should not be a deterrent to operation.
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