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Shaw NM, Breyer BN, Walter LC, Sudore RL, Suskind AM, Baussan C, Quanstrom K, Allen IE, Cooperberg MR, Dohan D, Hampson LA. How older men live with stress urinary incontinence: Patient experience and navigation to treatment. Neurourol Urodyn 2024; 43:11-21. [PMID: 38014566 PMCID: PMC10866353 DOI: 10.1002/nau.25325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/29/2023] [Accepted: 10/22/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVES To explore the context in which older men navigate treatment for stress urinary incontinence (SUI) following prostate surgery by characterizing lived experience of men with symptomatic SUI. SUBJECTS/PATIENTS AND METHODS Mixed method study using surveys and semistructured interviews to examine a cohort of men who underwent evaluation for treatment of postprostatectomy SUI. RESULTS Thirty-six men were interviewed after consultation for SUI and 31 had complete quantitative clinical data. Twenty-six underwent surgery and 10 chose no surgical intervention. In qualitative interviews, respondents experienced substantial decline in quality of life due to incontinence citing concerns associated with use of pads and worrying about incontinence. Most patients reported "workarounds"-efforts to mitigate or manage incontinence including Kegels, physical therapy, and garments. Participants also reported lifestyle changes including less strenuous physical activity, less sexual activity, and/or fewer social gatherings. Patients then described a "breaking point" where incontinence workarounds were no longer sufficient. After seeking evaluation, men described challenges in exploring treatment for SUI, including access to care and provider knowledge of treatment options. CONCLUSION In a novel study of patients living with SUI a predictable lived experience was observed that culminated in a desire for change or "breaking point." In all men, this led to treatment-seeking behaviors and for many it led to SUI intervention. Despite effective treatments, patients continue to meet barriers gaining access to SUI evaluation and treatment.
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Affiliation(s)
- Nathan M Shaw
- Department of Urology, School of Medicine, University of California San Francisco, San Francisco, California, USA
- Department of Urology, MedStar Georgetown, Washington, District of Columbia, USA
| | - Benjamin N Breyer
- Department of Urology, School of Medicine, University of California San Francisco, San Francisco, California, USA
- Department of Epidemiology & Biostatistics, School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Louise C Walter
- Department of Medicine, School of Medicine, University of California San Francisco, San Francisco, California, USA
- Department of Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Rebecca L Sudore
- Department of Medicine, School of Medicine, University of California San Francisco, San Francisco, California, USA
- Department of Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Anne M Suskind
- Department of Urology, School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Caitlin Baussan
- Department of Urology, School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Kathryn Quanstrom
- Department of Urology, School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Isabel E Allen
- Department of Epidemiology & Biostatistics, School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Matthew R Cooperberg
- Department of Urology, School of Medicine, University of California San Francisco, San Francisco, California, USA
- Department of Surgery, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Dan Dohan
- Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA
| | - Lindsay A Hampson
- Department of Urology, School of Medicine, University of California San Francisco, San Francisco, California, USA
- Department of Surgery, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
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Liao L, Feng H, Jiao J, Zhao Y, Ning H. Nursing assistants' knowledge, attitudes and training needs regarding urinary incontinence in nursing homes: a mixed-methods study. BMC Geriatr 2023; 23:39. [PMID: 36683023 PMCID: PMC9867858 DOI: 10.1186/s12877-023-03762-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 01/19/2023] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Urinary incontinence is an increasingly common problem, especially among older people in nursing homes. Nursing assistants are the leading workforce in nursing homes, and their knowledge and attitudes regarding urinary incontinence have garnered considerable attention in the context of aging in China. However, most previous studies on this issue have focused on registered nurses. This study aimed to explore nursing assistants' knowledge, attitudes and training needs with regard to urinary incontinence. METHODS We conducted a two-part mixed-methods study. After institutional manager approval, we surveyed the knowledge and attitudes of 509 nursing assistants regarding urinary incontinence. We carried out semi-structured interviews with 40 nursing assistants to elicit detailed information on training needs. RESULTS In general, knowledge about urinary incontinence was poor (14.00 ± 4.18), although attitudes were primarily positive (35.51 ± 3.19). Most nursing assistants were very willing to learn more about urinary incontinence (93.9%, 478/509), but time constraints and low educational background may be barriers to learning motivation. The three preferred training styles among nursing assistants were face-to-face guidance from a mentor, training combining theory with practice, and online video training. CONCLUSIONS Chinese nursing assistants had poor knowledge but positive attitudes toward urinary incontinence. Facility managers should focus on developing training and learning mechanisms regarding urinary incontinence. It is important to adopt diverse training styles according to the actual situation of nursing homes.
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Affiliation(s)
- Lulu Liao
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hui Feng
- Xiangya School of Nursing, Central South University, Changsha, China.
- Xiangya-Oceanwide Health Management Research Institute, Central South University, Changsha, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China.
| | - Jingjing Jiao
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Yinan Zhao
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Hongting Ning
- Xiangya School of Nursing, Central South University, Changsha, China
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Kilpatrick KA, Paton P, Subbarayan S, Stewart C, Abraha I, Cruz-Jentoft AJ, O'Mahony D, Cherubini A, Soiza RL. Non-pharmacological, non-surgical interventions for urinary incontinence in older persons: A systematic review of systematic reviews. The SENATOR project ONTOP series. Maturitas 2020; 133:42-48. [PMID: 32005422 DOI: 10.1016/j.maturitas.2019.12.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 11/04/2019] [Accepted: 12/18/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND Urinary incontinence is especially common in older age. Non-pharmacological therapies are particularly desirable in this group. OBJECTIVE To define optimal evidence-based non-pharmacological, non-surgical therapies for urinary incontinence in older persons. METHODS A Delphi process determined critical outcome measures of interest. Studies of any non-pharmacological intervention reporting critical outcomes were identified through database searches for relevant systematic reviews in Medline, Embase, CINAHL, PsycInfo and Cochrane up to June 2018. Primary trials with a population mean age ≥65years were identified, from which data were extracted and risk of bias was assessed. Qualitative analysis and meta-analysis, when possible, were undertaken, followed by grading of the evidence using GradePro software. Finally, bullet-point recommendations were formulated for the indications and contraindications for non-pharmacological interventions for urinary incontinence in older persons. RESULTS Frequency of incontinence was identified as a critically important outcome. In total, 33 systematic reviews were identified with 27 primary trials meeting inclusion criteria. Evaluated therapies included exercise therapy, habit retraining, behavioural therapy, electrical stimulation, transcutaneous tibial nerve stimulation, magnetic stimulation, caffeine reduction and acupuncture. From meta-analysis, group exercise therapy and behavioural therapy in women were beneficial in reducing episodes of incontinence (mean reduction of 1.07 (95 %CI 0.69-1.45) and 0.74 (95 %CI 0.42-1.06) episodes per day respectively, evidence grade 'moderate'). Evidence for other interventions was limited and of insufficient quality. CONCLUSIONS There is sufficient evidence to warrant recommendation of group exercise therapy for stress incontinence and behavioural therapy for urgency, stress or mixed urinary incontinence in older women. Evidence was insufficient to recommend any other non-drug therapy.
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Affiliation(s)
- Kirsty A Kilpatrick
- Ageing Clinical & Experimental Research Group, School of Medicine & Dentistry, University of Aberdeen, United Kingdom
| | - Pamela Paton
- Ageing Clinical & Experimental Research Group, School of Medicine & Dentistry, University of Aberdeen, United Kingdom; Dept of Geriatric Medicine, NHS Grampian, Aberdeen, United Kingdom
| | - Selvarani Subbarayan
- Ageing Clinical & Experimental Research Group, School of Medicine & Dentistry, University of Aberdeen, United Kingdom
| | - Carrie Stewart
- Ageing Clinical & Experimental Research Group, School of Medicine & Dentistry, University of Aberdeen, United Kingdom
| | - Iosief Abraha
- Geriatria, Accettazione Geriatrica e Centro di ricerca per l'invecchiamento, IRCCS INRCA, Ancona, Italy
| | | | | | - Antonio Cherubini
- Geriatria, Accettazione Geriatrica e Centro di ricerca per l'invecchiamento, IRCCS INRCA, Ancona, Italy
| | - Roy L Soiza
- Ageing Clinical & Experimental Research Group, School of Medicine & Dentistry, University of Aberdeen, United Kingdom; Dept of Geriatric Medicine, NHS Grampian, Aberdeen, United Kingdom.
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Abstract
This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Results of focus groups, conducted as part of the AARP Public Policy Institute's No Longer Home Alone video project, supported evidence that family caregivers aren't given the information they need to manage the complex care regimens of family members. This series of articles and accompanying videos aim to help nurses provide caregivers with the tools they need to manage their family member's health care at home.The articles in this new installment of the series provide simple and useful instructions that nurses should reinforce with family caregivers. This article is the first of two that provide an update on urinary incontinence and its management in older adults. The second article will contain an informational tear sheet-Information for Family Caregivers-that contains links to the instructional videos. To use this series, nurses should read the articles first, so they understand how best to help family caregivers, and then encourage caregivers to watch the videos and ask questions. In this article, the videos can be found in Resources for Nurses.
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Affiliation(s)
- Nicole J Davis
- Nicole J. Davis is an assistant professor at the Clemson University School of Nursing in Greenville, SC; Jean F. Wyman is a professor at the University of Minnesota School of Nursing, Minneapolis; Suzanne Gubitosa is an NP in palliative and provider services at Patriot Healthcare in Easley, SC; and LaTonya Pretty is an NP in geriatric medicine at Prisma Health Upstate in Greenville, SC. Contact author: Nicole J. Davis, . The authors have disclosed no potential conflicts of interest, financial or otherwise
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Sex Differences in Lower Urinary Tract Symptoms in Older Korean Adults Living in Rural Areas: Prevalence, Quality of Life, and Associated Factors. Int Neurourol J 2018; 22:212-219. [PMID: 30286585 PMCID: PMC6177734 DOI: 10.5213/inj.1836100.050] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 06/29/2018] [Indexed: 12/03/2022] Open
Abstract
Purpose Urinary incontinence (UI) is associated with nursing home admission, functional decline, and risk of death among community-dwelling older adults. Little information, however, is available on sex differences in lower urinary tract symptoms (LUTS) in older Korean adults exclusively living in rural areas. This study examined sex-related differences in LUTS, factors associated with UI in older adults living in rural areas, and health-related quality of life (HRQoL) in incontinent older adults. Methods This was a cross-sectional study in which face-to-face interviews were conducted at 15 rural community-health centres. A total of 323 older adults aged ≥65 years from rural areas of Korea participated. LUTS prevalence was evaluated and HRQoL was measured using the King’s Health Questionnaire. The chi-square test and t -test were used to examine sex differences in characteristics, LUTS, and HRQoL. Multivariable logistic regression was used to identify risk factors associated with UI. Results Nocturia was the most prevalent symptom, affecting 87% of men and 86% of women. Women (53%) had significantly more UI of any kind than did men (35%) (P=0.007). Urgency UI was the most frequent type of UI in men, whereas stress UI was the most frequent in women. Regarding HRQoL, men had significantly higher scores in the domains of sleep/energy disturbances (P=0.032) than did women, and women reported greater effects from the severity of incontinence (P=0.001) than did men. Arthritis was the only factor associated with UI in men (odds ratio [OR], 6.88; 95% confidence interval [CI], 1.46–32.36). However, women with diabetes mellitus were less likely to have UI than those without (OR, 0.43; 95% CI, 0.23–0.82). Conclusions LUTS were found to be highly prevalent in community-dwelling older Korean adults in rural areas. Interventions to improve sleep and to reduce UI severity are needed for incontinent men and women, respectively.
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Hall LM, Aljuraifani R, Hodges PW. Design of programs to train pelvic floor muscles in men with urinary dysfunction: Systematic review. Neurourol Urodyn 2018; 37:2053-2087. [PMID: 29687914 DOI: 10.1002/nau.23593] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 03/23/2018] [Indexed: 01/01/2023]
Abstract
AIMS Pelvic floor muscle training (PFMT) is a first line conservative treatment for men with urinary dysfunction, but reports of its efficacy are variable. This study aimed to systematically review the content of PFMT programs used for urinary dysfunction in men. METHODS Electronic databases (PubMed, CINAHL, EMBASE, Cochrane, PEDro) were searched for studies that used PFMT in the treatment of adult men with urinary dysfunction. Details of PFMT treatment sessions and home exercise protocols were extracted. Criteria specific to PFMT were developed, based on the Consensus on Exercise Reporting Template, and applied to all studies to measure the comprehensiveness of the PFMT description in the manuscript. RESULTS Results from the 108 included studies indicate substantial heterogeneity in both the content of PFMT and the quality of reporting of the components of the exercise regimes. There was notable disparity in the muscles targeted by the interventions (and few focused on urethral control despite the use in management of urinary conditions) and the intensity of the programs (eg, 18-240 contractions per day). Most studies were missing key details of description of the PFMT programs (eg, the position in which the pelvic floor muscle [PFM] contraction was taught and how it was assessed, methods used to ensure exercise adherence). CONCLUSIONS Variation in content of PFMT programs is likely to contribute to variation in the reported efficacy for management of urinary dysfunction in men, and unclear description of the details of the evaluated programs makes it difficult to identify the effective/ineffective components. PROSPERO registration number CRD42017071038.
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Affiliation(s)
- Leanne M Hall
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Rafeef Aljuraifani
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Paul W Hodges
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
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Burge A, Lee A, Kein C, Button B, Sherburn M, Miller B, Holland A. Prevalence and impact of urinary incontinence in men with chronic obstructive pulmonary disease: a questionnaire survey. Physiotherapy 2017; 103:53-58. [DOI: 10.1016/j.physio.2015.11.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 11/16/2015] [Indexed: 01/23/2023]
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Hälleberg Nyman M, Forsman H, Ostaszkiewicz J, Hommel A, Eldh AC. Urinary incontinence and its management in patients aged 65 and older in orthopaedic care - what nursing and rehabilitation staff know and do. J Clin Nurs 2017; 26:3345-3353. [PMID: 27982485 DOI: 10.1111/jocn.13686] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2016] [Indexed: 12/01/2022]
Abstract
AIMS AND OBJECTIVES To describe what nursing and rehabilitation staff know and do with regard to urinary incontinence and risk of urinary incontinence in patients 65 years or older undergoing hip surgery. BACKGROUND Urinary incontinence is a common but often neglected issue for older people. Despite the existence of evidence-based guidelines on how to assess, manage and prevent urinary incontinence, there are indications that these guidelines are not applied in hospital care. DESIGN A qualitative study with descriptive design was conducted in two orthopaedic units. METHODS Forty-six interviews and 36 observations of care were conducted from January-October 2014 and analysed with qualitative content analysis. RESULTS Enrolled nurses performed most of the care related to bladder function, with focus on urinary catheterisation and preventing urinary tract infection and urinary retention. Registered nurses' role in urinary matters mainly comprised documentation, while the rehabilitation staff focused on making it possible for the patient to be independent in toileting. The nursing staff considered urinary incontinence a common condition for older people and that it was convenient for the patients to have an indwelling catheter or incontinence pad/pant, although they acknowledged some of the risks associated with these procedures. CONCLUSIONS Urinary incontinence is not a priority in orthopaedic care, and urinary incontinence guidelines are not applied. Further, attitudes and actions are mainly characterised by a lack of urinary incontinence knowledge and the nursing and rehabilitation staff do not take a team approach to preventing and managing urinary incontinence. RELEVANCE TO CLINICAL PRACTICE An increased focus on knowledge on urinary incontinence and evidence-based guidelines is needed. To secure evidence-based practice, the team of nursing and rehabilitation staff and managers must be aligned and work actively together, also including the patient in the team.
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Affiliation(s)
| | - Henrietta Forsman
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Joan Ostaszkiewicz
- School of Nursing and Midwifery, Deakin University, Melbourne, Vic., Australia
| | - Ami Hommel
- Faculty of Health and Society, Department of Care Science, Malmö University, Malmö, Sweden.,Department of Orthopaedics, Skaane University Hospital, Lund, Sweden
| | - Ann Catrine Eldh
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.,Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
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Held F, Le Couteur DG, Blyth FM, Hirani V, Naganathan V, Waite LM, Seibel MJ, Handelsman DJ, Cumming RG, Allore HG, Gnjidic D. Polypharmacy in older adults: Association Rule and Frequent-Set Analysis to evaluate concomitant medication use. Pharmacol Res 2016; 116:39-44. [PMID: 27988385 DOI: 10.1016/j.phrs.2016.12.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 12/13/2016] [Indexed: 12/01/2022]
Abstract
The aim of this study was to apply Association Rule and Frequent-Set analysis, and novel means of data visualisation to ascertain patterns of medication use and medication combinations contributing to medication group clusters according to geriatric syndrome status in older adults. Participants were community-dwelling men (aged ≥70 years, n=1686), Sydney, Australia. Medication exposure was categorised at medication class level and data were analysed according to geriatric syndrome status (presence of at least one syndrome including frailty, falls, cognitive impairment and urinary incontinence). Association Rule and Frequent-Set analysis were performed to identify "interesting" patterns of medication combinations that occur together. This analysis involves advanced computer algorithms that investigated all possible combinations of medications in the dataset in order to identify those which are observed more or much less frequently than expected. Frequent-Set Analysis demonstrated one unexpected medication combination, antiulcer and antidiabetic medications (3.5% of participants) in the overall population (n=1687). Frequency of medication combinations was similar in participants with (n=666) and without (n=1020) geriatric syndromes. Among participants with geriatric syndromes, the most frequent combinations included antigout with lipid-lowering agents (5.7%) followed by angiotensin II and diuretics combination (22%). This novel methodology can be used to detect common medication combinations overall by data visualisation, and against specific adverse drug reactions such as geriatric syndromes. This methodology may be a valuable pharmacovigilance approach to monitor large databases for the safety of medications.
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Affiliation(s)
- Fabian Held
- Charles Perkins Centre, University of Sydney, Sydney NSW, Australia
| | - David G Le Couteur
- Charles Perkins Centre, University of Sydney, Sydney NSW, Australia; Centre for Education and Research on Ageing, the Ageing and Alzheimers Institute, Concord Hospital and University of Sydney, Sydney NSW, Australia; ANZAC Research Institute, University of Sydney, New South Wales, Australia
| | - Fiona M Blyth
- Centre for Education and Research on Ageing, the Ageing and Alzheimers Institute, Concord Hospital and University of Sydney, Sydney NSW, Australia; School of Public Health, University of Sydney, Sydney NSW, Australia
| | - Vasant Hirani
- Centre for Education and Research on Ageing, the Ageing and Alzheimers Institute, Concord Hospital and University of Sydney, Sydney NSW, Australia
| | - Vasi Naganathan
- Centre for Education and Research on Ageing, the Ageing and Alzheimers Institute, Concord Hospital and University of Sydney, Sydney NSW, Australia
| | - Louise M Waite
- Centre for Education and Research on Ageing, the Ageing and Alzheimers Institute, Concord Hospital and University of Sydney, Sydney NSW, Australia
| | - Markus J Seibel
- ANZAC Research Institute, University of Sydney, New South Wales, Australia
| | - David J Handelsman
- ANZAC Research Institute, University of Sydney, New South Wales, Australia
| | - Robert G Cumming
- Centre for Education and Research on Ageing, the Ageing and Alzheimers Institute, Concord Hospital and University of Sydney, Sydney NSW, Australia; School of Public Health, University of Sydney, Sydney NSW, Australia
| | - Heather G Allore
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Danijela Gnjidic
- Charles Perkins Centre, University of Sydney, Sydney NSW, Australia; Faculty of Pharmacy, University of Sydney, Sydney NSW, Australia.
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Bedretdinova D, Fritel X, Zins M, Ringa V. The Effect of Urinary Incontinence on Health-related Quality of Life: Is It Similar in Men and Women? Urology 2016; 91:83-9. [PMID: 26827846 DOI: 10.1016/j.urology.2015.12.034] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 11/23/2015] [Accepted: 12/03/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare the association between self-reported urinary incontinence (UI) and health-related quality of life (HRQoL) in men and women while taking chronic comorbidities into account, on the hypothesis that UI might negatively affect HRQoL differently in each sex. METHODS In 2006, a total of 10,723 men (aged 57-67 years) and 3777 women (aged 52-67 years) participating in the GAZEL cohort (www.gazel.inserm.fr) completed a self-administered questionnaire including the Nottingham Health Profile to assess HRQoL. UI was defined as self-reported involuntary loss of urine in the past 12 months. Adjusted logistic regression models were fitted to estimate the association between impaired HRQoL and UI, taking age, chronic conditions, and other confounders into account. For each QoL dimension, we compared the strength of the associations between UI and HRQoL between the sexes by tests of interaction. RESULTS Women were more likely than men to report both UI (13.9% vs 2.7%) and impaired HRQoL. UI was associated with impaired HRQoL in both sexes, mainly in the dimensions of energy (OR = 3.17 in men [95% CI 2.49-4.04] and 2.11 in women [1.75-2.54]), social isolation (OR = 2.29 in men [1.74-3.02] and 1.75 in women [1.44-2.12]), and physical mobility (OR = 2.05 in men [1.62-2.60] and 2.27 in women [1.88-2.74]). There were no significant interactions between the sexes after adjustment. CONCLUSION UI was associated negatively with HRQoL in both sexes, mostly in the dimensions of energy, social isolation, and physical mobility. The association was similar in men and women after we took age, sociodemographic characteristics, and chronic diseases into account. The cross-sectional design of the analysis prevents any conclusion that UI induced an impairment of HRQoL, and no causal relation can be inferred.
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Affiliation(s)
- Dina Bedretdinova
- Paris-Saclay, Paris-Sud, and Versailles-Saint-Quentin Universities, Center for Research in Epidemiology and Population Health, French National Institute of Health and Medical Research, Le Kremlin-Bicêtre, France; Doctoral School of Public Health, UMRS 1018, F-94276 Le Kremlin-Bicêtre, France; French School of Public Health (EHESP), Rennes, France; The French Institute for Demographic Studies, Paris, France.
| | - Xavier Fritel
- Paris-Saclay, Paris-Sud, and Versailles-Saint-Quentin Universities, Center for Research in Epidemiology and Population Health, French National Institute of Health and Medical Research, Le Kremlin-Bicêtre, France; The French Institute for Demographic Studies, Paris, France; Obstetrics-Gynecology and Reproductive Medicine, Poitiers University, Clinical Investigation Center 1402, Poitiers University Hospital, Poitiers, France
| | - Marie Zins
- Paris-Saclay, Paris-Sud, and Versailles-Saint-Quentin Universities, Center for Research in Epidemiology and Population Health, French National Institute of Health and Medical Research, Villejuif, France
| | - Virginie Ringa
- Paris-Saclay, Paris-Sud, and Versailles-Saint-Quentin Universities, Center for Research in Epidemiology and Population Health, French National Institute of Health and Medical Research, Le Kremlin-Bicêtre, France; The French Institute for Demographic Studies, Paris, France; Obstetrics-Gynecology and Reproductive Medicine, Poitiers University, Clinical Investigation Center 1402, Poitiers University Hospital, Poitiers, France
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Ischemic heart disease, prescription of optimal medical therapy and geriatric syndromes in community-dwelling older men: A population-based study. Int J Cardiol 2015; 192:49-55. [DOI: 10.1016/j.ijcard.2015.05.045] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 03/24/2015] [Accepted: 05/07/2015] [Indexed: 10/23/2022]
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Transitions in Symptom Cluster Subgroups Among Men Undergoing Prostate Cancer Radiation Therapy. Cancer Nurs 2015; 39:3-11. [PMID: 25730597 DOI: 10.1097/ncc.0000000000000236] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Prostate cancer is a common type of cancer worldwide and in the United States. However, little information has been reported on the symptoms of men over time who receive radiation therapy. OBJECTIVE The objectives of this study were to identify subgroups of men at pre- and post-radiation therapy on general and treatment-related symptoms and to determine transitions in subgroup membership over time. METHODS Men (n = 84) receiving radiation therapy completed questionnaires on fatigue, insomnia, pain, depression, anxiety, and sexual, urinary, and bowel problems at pretreatment and posttreatment. Latent class analysis identified subgroups. One-way analyses of variance determined subgroups differed on symptoms, participant characteristics, and quality of life. Latent transition analysis examined subgroup transitions over time. RESULTS At pretreatment, 4 subgroups were identified: resilient group, with little to no symptom reporting; adjusted group, with moderately high treatment-related symptoms, low insomnia, depression, and anxiety; distressed group, consistently high on most symptoms; and emerging group, with moderately high fatigue, depression, and anxiety with few treatment-related symptoms. At posttreatment, similar results were seen in groups to those at pretreatment: resilient, adjusted. and distressed groups with an impacted group having high pain, insomnia, depression, and urinary and bowel symptoms. Quality of life and participant characteristics further distinguished groups at pretreatment and posttreatment. Income level predicted a transition in group membership. CONCLUSIONS Men can be classified into distinctly different subgroups over time. IMPLICATIONS FOR PRACTICE Assessment and intervention with men in subgroups such as distressed and emerging before and during treatment may lessen potential for remaining distressed or moving into impacted group where symptom severity is high at posttreatment. Interventions to reduce multiple symptoms are vitally needed.
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Gosch M, Talasz H, Nicholas JA, Kammerlander C, Lechleitner M. Urinary incontinence and poor functional status in fragility fracture patients: an underrecognized and underappreciated association. Arch Orthop Trauma Surg 2015; 135:59-67. [PMID: 25399238 DOI: 10.1007/s00402-014-2113-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Indexed: 12/25/2022]
Abstract
PURPOSE/INTRODUCTION Urinary incontinence (UI) affects some 20 % of community-dwelling older people and 30-60 % of people in institutional care. UI is known as an independent predictor of falls, and likely impacts fracture rates. The aim of the study was to measure the prevalence of UI in a typical fragility fracture population, to evaluate the relationship of UI with functional disability in the post-acute setting. METHODS Our study is a retrospective cross-sectional study of patients admitted to rehabilitation setting after inpatient hospital management for a fragility fracture. We included all consecutively admitted fragility fracture patients aged over 65. All patients underwent standard clinical examination and Geriatric Assessment. We assessed UI using a two-stage process with a six-item UI screening questionnaire followed by an interview. RESULTS 1,857 (80.7 % female) patients were available for analysis, mean age was 81.7 years. UI was identified in 59.2 % of all fragility fracture patients, and was more prevalent in females. Patients suffering from UI differed significantly in almost all measured functional and cognitive tests, with increased dependency/lower ADL scores, increased rates of immobility, and higher rates of cognitive dysfunction and depression. CONCLUSION This study confirms the high prevalence of UI in older fragility fracture patients, and the association between UI and functional impairments. The diagnostic work-up and treatment of patients should be focused on the special needs of these older patients. More efforts are needed to increase awareness about prevalence and consequences of UI among older fragility fracture patients.
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Affiliation(s)
- M Gosch
- Department of Internal Medicine 2, Geriatric Medicine, Klinikum Nürnberg, Paracelsus Private Medical University, Prof. Ernst-Nathan Strasse 1, 90419, Nuremberg, Germany,
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Sahin-Onat S, Unsal-Delialioğlu S, Güzel O, Uçar D. Relationship between urinary incontinence and quality of life/depression in elderly patients. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.jcgg.2014.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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White AJ, Reeve BB, Chen RC, Stover AM, Irwin DE. Coexistence of urinary incontinence and major depressive disorder with health-related quality of life in older Americans with and without cancer. J Cancer Surviv 2014; 8:497-507. [PMID: 24770937 PMCID: PMC4127347 DOI: 10.1007/s11764-014-0360-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Accepted: 03/31/2014] [Indexed: 01/01/2023]
Abstract
PURPOSE This study evaluates the prevalence and factors associated with major depressive disorder (MDD) in a population of cancer survivors and the impact of co-occurring MDD and urinary incontinence (UI) on health-related quality of life (HRQOL). METHODS The prevalence of MDD risk among cancer survivors (breast, prostate, bladder, colorectal, lung, and endometrial/uterine cancers) and those without cancer was estimated using the Surveillance, Epidemiology and End Results Program-Medicare Health Outcomes Survey (SEER-MHOS) linked database (n = 9,282 with cancer/n = 289,744 without cancer). Risk for MDD was measured using three items from the Diagnostic Interview Schedule, and HRQOL was measured by the SF-36. UI was defined as self-reported leakage of urine causing a problem in previous 6 months. Factors associated with MDD were investigated using logistic regression, and the impact of co-occurring MDD and UI on HRQOL scores was determined using linear regression. RESULTS The prevalence of MDD risk ranged from 19.2 % for prostate to 34.1 % for lung. Lung cancer diagnosis was associated with risk of MDD. Being ≥5 years from diagnosis was associated with decreased risk of MDD (prevalence odds ratio (POR) = 0.82, 95 % confidence interval (95 % CI) 0.71, 0.95). The coexistence of both UI and MDD was associated with a decrease across HRQOL subscales; including 40 points on role-emotional (RE) score. CONCLUSIONS Cancer survivors reporting co-occurrence of UI and MDD experienced significant decrements in HRQOL. IMPLICATIONS OF CANCER SURVIVORS Understanding the combined effect of UI and MDD may help clinicians to better recognize and alleviate their effects on cancer survivors' HRQOL.
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Affiliation(s)
- Alexandra J White
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, 27599-7435, USA,
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16
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Kalisch Ellett LM, Pratt NL, Barratt JD, Rowett D, Roughead EE. Risk of Medication-Associated Initiation of Oxybutynin in Elderly Men and Women. J Am Geriatr Soc 2014; 62:690-5. [DOI: 10.1111/jgs.12741] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Lisa M. Kalisch Ellett
- Quality Use of Medicines and Pharmacy Research Centre; School of Pharmacy and Medical Sciences; University of South Australia; Adelaide South Australia Australia
| | - Nicole L. Pratt
- Quality Use of Medicines and Pharmacy Research Centre; School of Pharmacy and Medical Sciences; University of South Australia; Adelaide South Australia Australia
| | - John D. Barratt
- Quality Use of Medicines and Pharmacy Research Centre; School of Pharmacy and Medical Sciences; University of South Australia; Adelaide South Australia Australia
| | - Debra Rowett
- Quality Use of Medicines and Pharmacy Research Centre; School of Pharmacy and Medical Sciences; University of South Australia; Adelaide South Australia Australia
- Drug and Therapeutics Information Service; Repatriation General Hospital; Adelaide South Australia Australia
| | - Elizabeth E. Roughead
- Quality Use of Medicines and Pharmacy Research Centre; School of Pharmacy and Medical Sciences; University of South Australia; Adelaide South Australia Australia
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Jerez-Roig J, Souza DLBD, Lima KC. Incontinência urinária em idosos institucionalizados no Brasil: uma revisão integrativa. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2013. [DOI: 10.1590/s1809-98232013000400020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Este estudo teve como objetivo abordar os principais aspectos relacionados à incontinência urinária (IU) em idosos institucionalizados no Brasil, por meio de revisão integrativa de literatura. Em agosto de 2013, foram pesquisadas as bases de dados PubMed, Scopus, LILACS, SciELO, PAHO, MedCarib, CAPES e Google Acadêmico, utilizando combinações dos termos "incontinência urinária", "idosos", "institucionalizados" e "Brasil". Após aplicação dos critérios de elegibilidade, selecionaram-se 11 trabalhos: nove artigos científicos e duas dissertações de mestrado. A maior parte dos estudos foi do tipo seccional, realizado na Região Sul ou Sudeste, e com amostra menor que 100 indivíduos. A frequência da IU variou entre 22 e 100%, ultrapassando 50% na maior parte das pesquisas, com acometimento maior no sexo feminino. A forma clínica mais comum foi a IU de esforço, seguida pela IU de urgência, e o volume das perdas urinárias referido pelos residentes variou entre pequena e grande quantidade, sem predominância de nenhuma das categorias. O impacto da condição na qualidade de vida do indivíduo é diverso, entre leve e elevado, mas parece ser menor que em idosos não institucionalizados. Com base neste trabalho, conclui-se que a IU é um problema de saúde frequente no âmbito asilar, que pode afetar a qualidade de vida do residente e se associar ao declínio da mobilidade e à função cognitiva. As pesquisas no Brasil, contudo, são escassas e com amostra reduzida e, portanto, são necessários estudos com maior rigor metodológico que facilitem o planejamento de medidas adequadas de prevenção e tratamento, que visem reduzir os gastos sanitários, a sobrecarga dos cuidadores e profissionais de saúde e que permitam diminuir o impacto desta condição na saúde dos idosos institucionalizados.
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Affiliation(s)
- Javier Jerez-Roig
- Universidade Federal do Rio Grande do Norte, Brasil; Hospital Can Misses, Espanha
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Fan WJ, Li YT, Chen JJJ, Chen SC, Lin YS, Kou YR, Peng CW. Sexually dimorphic urethral activity in response to pharmacological activation of 5-HT1A receptors in the rat. Am J Physiol Renal Physiol 2013; 305:F1332-42. [PMID: 24049146 DOI: 10.1152/ajprenal.00261.2013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In this study, we examined the possibility that 5-HT1A receptors may underlie sexually dimorphic mechanisms affecting the regulation of urethral functions in anesthetized rats. Simultaneous recordings of intravesical pressure under isovolumetric conditions, external urethral sphincter-electromyography, and urethral perfusion pressure were used to examine the effects of a 5-HT1A receptor agonist [8-hydroxy-2-(di-n-propylamino)tetralin (8-OH-DPAT)] and antagonist (WAY-100635) on bladder and urethral functions. This research also evaluated the effects of 8-OH-DPAT and α-bungarotoxin (a neuromuscular blockade agent) on urethral continence using leak point pressure testing, and the distribution of 5-HT1A receptors in the lower urinary tract was assessed by immunohistochemistry. The serotonergic mechanism that controls the urinary bladder and external urethral sphincter-electromyography activity showed no significant sexual differences, but urethral activity in urethral perfusion pressure and leak point pressure values exhibited some sexual differences. 8-OH-DPAT enhanced urethral pressure during continence in rats of both sexes, but the drug elevated the pressure during voiding in male rats and reduced it in female rats. The distribution of 5-HT1A receptors in the spinal cord also showed some sexual differences. The present study contributes to our understanding of the role of 5-HT1A receptors in physiological and immunohistochemical properties of urethral smooth muscle in rats of different sexes. These findings may be a basis for the future development of pharmacotherapies for stress urinary incontinence in men.
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Affiliation(s)
- Wen-Jia Fan
- Dept. of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical Univ., No. 250, Wuxing St., Taipei 11031, Taiwan.
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Aguilar-Navarro S, Navarrete-Reyes AP, Grados-Chavarría BH, García-Lara JMA, Amieva H, Avila-Funes JA. The severity of urinary incontinence decreases health-related quality of life among community-dwelling elderly. J Gerontol A Biol Sci Med Sci 2012; 67:1266-71. [PMID: 22879454 DOI: 10.1093/gerona/gls152] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Urinary incontinence (UI) is an important geriatric syndrome that has been associated with a wide range of health-related outcomes. However, UI severity has rarely been examined in the context of a comprehensive geriatric assessment. Therefore, the aim of this study is to examine the association between UI severity and health-related quality of life (QoL) when frequent geriatric issues are taken into account. METHODS We performed a cross-sectional study of 1,124 participants aged 70 y and older. UI was diagnosed when difficulty with urinary continence was reported, and its severity was assessed through a modified version of the Sandvik Index. Health-related QoL was measured using the SF-36, including its physical and mental component summaries. Multivariate linear regression was performed to determine the association between UI severity and health-related QoL. RESULTS Prevalence of UI was 18%, and it was severe in 29.3% of cases. Severely incontinent subjects were older and had worse self-perceived health status, greater disability, and more depressive symptoms in comparison with continent participants or with those affected to a lesser degree. Multivariate regression analysis showed a significant inverse association between the physical component summaries and moderate (B = -4.54) as well as severe UI (B = -6.72). The mental component summaries showed similar results (B = -1.44 and -4.43, respectively). CONCLUSIONS UI severity is associated with lower QoL scores in both its components. This association appears to be more important as severity increases. UI severity must be evaluated thoroughly in the elderly because of its potential adverse effects on physical and mental health.
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Affiliation(s)
- Sara Aguilar-Navarro
- Department of Geriatrics Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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Hrisanfow E, Hägglund D. Impact of cough and urinary incontinence on quality of life in women and men with chronic obstructive pulmonary disease. J Clin Nurs 2012; 22:97-105. [PMID: 22805299 DOI: 10.1111/j.1365-2702.2012.04143.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES The aim of this study was to investigate the impact of cough and urinary incontinence on quality of life in women and men with chronic obstructive pulmonary disease in primary health care. BACKGROUND Existing information on the impact of cough and urinary incontinence on quality of life in patients with chronic obstructive pulmonary disease is scant. DESIGN A questionnaire survey. METHOD The study included 391 women and 337 men, aged 50-75 years, with chronic obstructive pulmonary disease. A self-administered questionnaire consisted of CCQ and SF-12 questionnaires. A response rate of 66% was obtained. Most patients had been diagnosed with moderate (Stage II) chronic obstructive pulmonary disease. RESULTS Women and men with urinary incontinence showed a significantly higher presence of symptomatic cough and phlegm production than did women and men without incontinence. Women with incontinence had a significantly higher burden of CCQ symptoms, functional and mental state than did women without incontinence. Concerning quality-of-life scores, women with incontinence had lower physical state scores (37·6 ± 10·4 vs. 41·4 ± 9·9; p < 0·001) and mental state scores (44·3 ± 10·2 vs. 47·1 ± 10·5; p < 0·007) than did women without incontinence. Men with incontinence had a significantly higher burden of CCQ symptoms and mental state than did men without incontinence. When examining the quality-of-life scores, men with incontinence had lower mental state scores than did men without incontinence (46·0 ± 9·7 vs. 49·8 ± 9·7; p < 0·001). CONCLUSION The present results indicate that cough and urinary incontinence lead to poor quality of life in women and men with chronic obstructive pulmonary disease. RELEVANCE TO CLINICAL PRACTICE In the context of primary health care, appropriate questions concerning urinary incontinence and quality of life should be included in care plans for women and men living with chronic obstructive pulmonary disease.
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Affiliation(s)
- Elisabet Hrisanfow
- Clinical Nurse, Family Medicine Research Centre, Örebro University, Örebro, Sweden
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Staskin D, Tubaro A, Norton PA, Ashton-Miller JA. Mechanisms of continence and surgical cure in female and male SUI: surgical research initiatives. Neurourol Urodyn 2011; 30:704-7. [PMID: 21661017 DOI: 10.1002/nau.21139] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
AIMS To report the conclusions of the Think Tank on mechanisms of incontinence and surgical cure in female and male SUI: surgical research initiatives during the ICI-RS meeting in 2010. METHODS The sub-group considered five areas for future research in stress urinary incontinence (SUI); (i) epidemiology and public health efforts in SUI, (ii) the basic sciences examining the physiology and pathophysiology of the continence mechanism, (iii) diagnostic techniques and clinical assessment of SUI, (iv) the future of treatment and surgical cure, and (v) the separate issue of male SUI. RESULTS Roadblocks to progress were identified for each of the five directions. CONCLUSIONS Future research directions are suggested for each of these areas.
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Affiliation(s)
- David Staskin
- Division of Urology, St. Tufts University School of Medicine, Boston, MA, USA
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