Urinary Incontinence in Men

Defining and prioritizing modifiable risk factors towards the co-creation of a urinary incontinence self-management intervention for older men: A sequential multimethod study protocol

Urinary incontinence (UI), characterized by involuntary urine leakage is a chronic, embarrassing and stigmatizing condition that is under-reported and under-treated). UI is under-prioritized and under-researched, particularly in older men (defined here as men 65+), and there have been calls for more targeted research focusing on this specific group. No existing self-management interventions focus on the needs of older men and none incorporate the perspectives of older men into their development. Furthermore, health inequalities and disparities in continence services for men, and a low level of health seeking behavior in men with UI make it crucial to incorporate their perspectives into intervention development to ensure optimal outcomes. The study will identify risk factors for UI that are potentially amenable to self-management in older men, assess their self-efficacy in managing UI, and determine what modifiable risk factors older men feel are pragmatic to include as part of a self-management program. We will conduct and report a sequential multi-method design consisting of a Delphi study among healthcare experts and a survey among older men with UI, according to the Guidance on Conducting and Reporting Delphi Studies (CREDES) Checklist and the Checklist for Reporting Of Survey Studies (CROSS). A geographically dispersed, multidisciplinary group of 30 health care professionals (urologists, geriatricians, family physicians, and nurses) involved in continence care and a representative sample of at least 128 ethnically diverse older men will participate in a Delphi survey and an older men's survey respectively. The healthcare experts will evaluate an evidence-synthesized list of UI risk factors to determine those potentially amenable to self-management. Delphi rounds will be repeated until consensus threshold of 75% is reached. Thereafter, older men recruited via stratified sampling of population subgroups will rate a list of expert-identified potentially modifiable risk factors to indicate which factors they deem practicable and can prioritize. Older men's survey questionnaires will capture information on patients' characteristics (socio-demographics and UI-related items). The Geriatric Self-Efficacy Index for UI (GSE-UI Index) as well as a Likert scale to assess perceived capability and willingness to modify the expert-identified UI modifiable risk factors will be included. Data will be analyzed quantitatively and qualitatively.

[Effectiveness of early pelvic muscle training on pelvic floor strength, urinary incontinence symptoms, sexual function, and quality of life in post-radical prostatectomy patients: Systematic review of randomized clinical trials]

This study aimed to evaluate the effectiveness of early pelvic muscle training in reducing urinary incontinence symptoms, improving quality of life, sexual function, and increasing pelvic floor strength in post-radical prostatectomy patients. A search was carried out in 8 databases until October 26, 2022, the methodological quality and the risk of bias of 14 included studies (n=1236) were evaluated, moreover, the evidence and the meta-analysis were calculated. The intervention significantly reduced urinary incontinence symptoms compared to a control group (SMD=-2.80, 95% CI=-5.21 to -0.39, P=.02), with significant heterogeneity (I2=83%; P=<.0001) and moderate evidence. In addition, it presented moderate evidence to improve quality of life, and very low evidence to improve sexual function and pelvic floor strength. These results should be viewed with caution due to the significant heterogeneity of the studies analysed.

A scoping review of risk factors for urinary incontinence in older men

BACKGROUND

Most epidemiological studies have not systematically identified or categorized risk factors for urinary incontinence (UI) in older men, despite a higher prevalence than in younger men. Considering the burden of UI, an understanding of risk factors can inform cost-effective prevention/treatment programs. This scoping review aimed to identify and categorise risk factors for UI in older men, identify gaps in the evidence, and opportunities for future research.

METHODS

The Joanna Briggs Institute (JBI) method for scoping reviews guided the conduct and reporting of this review alongside the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping reviews checklist. JBI's Population, Concept, and Context approach framed the inclusion criteria (all evidence sources on UI risk factors that included older men [65 +]). We employed JBI's three-step search strategy, which included a limited initial search in Ovid MEDLINE, a detailed comprehensive database search, and a search of reference lists of included studies, Google Scholar and grey literature. There were no restrictions on language, study type, or publication date. Two independent reviewers screened, selected, and extracted eligible studies. Data were analyzed using descriptive statistics and qualitative content analysis.

RESULTS

Forty-seven articles that met the inclusion criteria identified 98 risk factors across six categories. Behavioural risk factors, reported by only two studies, were the least investigated of all the categories, whereas medical factors/diseases were the most investigated. No genetic factors were documented. The top five risk factors were increasing age/advanced age (n = 12), Benign Prostatic Hyperplasia (n = 11), Diabetes Mellitus (n = 11), Detrusor overactivity (n = 10), limitation in physical function/ADL disability (n = 10), increased Body Mass Index (BMI)/overweight/obesity (n = 8), Dementia (n = 8), and Parkinson's disease (n = 7).

CONCLUSION

There is a dearth of evidence to describe the role behavioural risk factors have in UI in older men. These factors may play a role in health promotion and disease prevention in this area.

REGISTRATION

A protocol detailing the methods was developed and published, and is registered in the Open Science Framework [Feb 07 2023; https://osf.io/xsrge/ ].

Prevalence and impacts of male urinary incontinence on quality of life, mental health, work limitation, and health care seeking in China, Taiwan, and South Korea (LUTS Asia): Results from a cross-sectional, population-based study

PURPOSE

Male urinary incontinence (UI) is a global health issue associated with bothersome symptoms which affect daily life. This study aims to evaluate the prevalence of male UI in China, Taiwan, and South Korea and to determine if UI is an independent risk factor affecting the health-related quality of life (HRQoL), mental health, work limitations, and healthcare seeking behavior.

MATERIALS AND METHODS

A post-hoc analysis was conducted on the LUTS Asia database which was collated from a cross-sectional, population-based internet survey in China, Taiwan, and South Korea. Prevalence of male UI was assessed, and the effect on HRQoL, Hospital Anxiety and Depression Scale (HADS) depression and anxiety scores, work performance, and healthcare seeking behaviors was determined using univariate and multivariate analyses.

RESULTS

A total of 4,076 male participants were surveyed. Prevalence of male UI was 17.3%. UI adversely affected the HRQoL in both physical and mental domains. Both multivariate and univariate analyses showed that male UI could be correlated with a negative effect on the HADS anxiety and depression scores. Multivariate analysis suggested that work difficulties were correlated to the presence of UI. Up to 28% of participants who reported urge UI only did not adopt any management measures.

CONCLUSIONS

UI is common in men over 40 years and adversely impacts HRQoL. It is an independent risk factor for anxiety and depression and may cause significant work limitations. Despite these negative effects, many men still do not seek any intervention.

How does the onset of incontinence affect satisfaction with life among older women and men? Findings from a nationally representative longitudinal study (German Ageing Survey)

Background

There is a large body of evidence showing that incontinence is associated with decreased health-related quality of life (HRQoL). Moreover, while a few cross-sectional studies have shown that incontinence is associated with decreased life satisfaction, there is a lack of studies regarding whether the onset of incontinence influences life satisfaction of affected individuals longitudinally. Thus, the objective of this study is: (i) to investigate the impact of incontinence on life satisfaction and (ii) whether this effect differed between women and men using a large population-based sample longitudinally.

Methods

Longitudinal data from 2008 to 2014 were retrieved from a nationally representative sample (9869 observations in regression analysis) of community-dwelling individuals aged 40 years and over (German Ageing Survey, DEAS). Physician-diagnosed incontinence was reported by respondents. Life satisfaction was quantified using the well-established Satisfaction with Life Scale. Linear fixed-effects regressions were used.

Results

After adjusting for potential confounders (e.g., self-rated health or depression), regressions revealed that the onset of incontinence was associated with a decline in life satisfaction in men (β = −.25, p < .01), but not in the total sample and in women. These differences were significant (p < .05). In a further sensitivity analysis, individuals with cancer were excluded. However, in terms of significance and effect size, the impact of incontinence on life satisfaction in men remained almost the same in both models.

Conclusions

The onset of incontinence markedly reduces life satisfaction among men aged 40 and over. Interventional strategies to postpone incontinence may assist in maintaining life satisfaction in men.

Development of an ICF-based questionnaire for urinary and/or fecal incontinence (ICF-IAF): The male patients' perspective using focus groups

AIMS

This study seeks to explore barriers faced by and resources available to male patients with urinary (UI) and/or fecal incontinence (FI) based on the ICF framework. As a result, this study contributes to the development of the ICF-Incontinence Assessment Form (ICF-IAF), which is designed to be a standardized planning and evaluation tool for interventions in a multidisciplinary setting.

METHODS

A mixed-method sequential design that places emphasis on the quantitative approach was considered appropriate for this study. Focus group interviews (FG) were chosen to collect data. Data were analysed with deductive content analysis and themes identified during FG were linked to the most corresponding ICF categories by two raters. Cohen's κ was calculated to determine interrater reliability.

RESULTS

Four FG were conducted with a total of 13 male participants. The mean age of the participants was 74.7 years. A total of 73 barriers and resources on the second ICF level (body functions 26, body structures five, activities and participation 26 and environmental factors 16), whereby four categories were not sufficiently covered by the ICF, could be identified. The κ score for the two raters was 0.82.

CONCLUSIONS

While barriers are fundamental factors affecting patients, this study found that resources are as important and should not be overlooked in the conventional treatment in both UI and FI-specific assessments.

Urinary incontinence in the Netherlands: Prevalence and associated risk factors in adults

AIMS

To determine the prevalence and risk factors associated with urinary incontinence (UI) among adults in the Netherlands.

METHODS

In this cross-sectional study, we included 1257 respondents aged ≥ 18 years, who completed the validated Groningen Defecation and Fecal Continence Checklist. UI was defined as any involuntary leakage of urine during the past 6 months.

RESULTS

The prevalence of UI in the total group was 36.8%. Women experienced UI significantly more often than men (49.0% versus 22.6%, respectively, P < 0.001). We found that in both men and women, the prevalence of UI increased with aging (P = 0.003 and P < 0.001, respectively). Remarkably, multivariate analysis revealed that age did not influence UI in men. Men and women aged 18-39 also experienced UI (17.0% and 36.1%, respectively). We established that diabetes mellitus, fecal incontinence, and constipation were risk factors for UI. In women, obesity, vaginal hysterectomies, and vaginal parturition were also risk factors for UI, as was prostate surgery in men.

CONCLUSIONS

The prevalence of UI in the Netherlands is high. Medical practitioners should therefore not underestimate this problem, especially among young people. Because the multivariate analysis revealed that in men age did not correlate significantly with UI, we believe that the risk of experiencing UI increases with age because of diseases that are known to lead to UI and not because of aging as a single factor itself. Finally, this study can be used as a reference for patients living in Western-Europe.

Barriers experienced by patients with multiple sclerosis in seeking care for lower urinary tract symptoms

AIM

The Actionable Bladder Symptom and Screening Tool (ABSST) is used to identify multiple sclerosis (MS) patients in possible need of evaluation for urinary symptoms. The primary objective of this study was to identify barriers experienced by MS patients in seeking evaluation for urinary symptoms. We also assessed the utility of ABSST tool in identifying patients that will follow up with urologic evaluation.

METHODS

This was a prospective observational study where 100 patients with MS were enrolled from an MS center. Patients completed demographic information, questions to assess barriers to care, a short form of the ABSST, and incontinence questionnaires. An ABSST score >3 met criteria for referral and evaluation. One year after enrollment, follow up calls assessed whether patients had seen a urinary specialist.

RESULTS

The most common barriers to seeking care included "Doctor never referred" (16%) and "Doctor never asked" (13%). Thirty-eight percent (n = 8/21) of men stated "Doctor never referred" compared to 10% (n = 8/79) of women (P = 0.002). Twenty-seven patients had an ABSST Score ≥3 and were more interested in seeing a specialist compared to those scoring <3 (88.9%, n = 24/27 vs. 26%, n = 19/73; P = <0.001). After 1 year, 70 patients were reached for follow up. A total of 57.9% (n = 11/19) patients who followed up for evaluation screened positive on the ABSST.

CONCLUSIONS

The ABSST is a valuable tool to identify MS patients with urinary symptoms who will likely follow up for genitourinary evaluation. However, other barriers beyond awareness exist and prevent patients from being evaluated.

Clinical characteristics of patients with cancer referred for outpatient physical therapy

BACKGROUND

Cancer rehabilitation is a developing area, with an increasing number of survivors of cancer in the United States. The increase in survivorship occurs alongside impairments arising directly from cancer or from treatment-related side effects.

OBJECTIVE

This study described clinical characteristics of patients with cancer referred for outpatient physical therapy and explored patterns in frequency of impairments between type of cancer and mode of cancer treatment.

DESIGN

This was a retrospective chart review of patients with cancer referred to a tertiary care physical therapy clinic over a 2-year period.

METHODS

Characteristics such as age, sex, cancer type, mode of treatment, and neuromusculoskeletal impairments were identified. Impairment frequencies were computed based on cancer type and mode of treatment.

RESULTS

Data from 418 patients (mean age=57.9 years, SD=14.3; 41.1% female) were examined. Genitourinary cancer (n=169) and breast cancer (n=90) were the most prevalent types of cancer reported in this sample. Impairments in strength (83.6%) and soft tissue (71.3%) were the most common examination findings. Lymphedema was most common in patients with breast cancer, and incontinence was most common in patients with genitourinary cancer.

LIMITATIONS

The types of cancer identified in this study may be reflective of this tertiary center and may not generalize to other facilities. Impairment identification during the initial physical therapist evaluation was not performed systematically.

CONCLUSION

These data reinforce that physical therapists should screen for lymphedema in patients with breast cancer and incontinence in urogenital cancers. Strength and soft tissue integrity should be evaluated in most patients with cancer. Assessing pain and fatigue levels is recommended for patients who have had radiation therapy.

Barriers and enablers to the provision and receipt of preoperative pelvic floor muscle training for men having radical prostatectomy: a qualitative study

Background

Strong evidence exists to support preoperative pelvic floor muscle training (PFMT) to reduce the severity and duration of urinary incontinence after radical prostatectomy. Receipt of preoperative PFMT amongst men having radical prostatectomy in Western Sydney, however, is suboptimal. This study was undertaken to investigate barriers and enablers to provision/receipt of preoperative PFMT from the perspectives of potential referrers to and providers of PFMT, and of men having radical prostatectomy.

Methods

A qualitative research design was used. Semi-structured, one-to-one interviews were conducted with participants from three groups: (i) current and potential referrers to PFMT, including urological cancer surgeons, urological cancer nurses and general practitioners (n = 11); (ii) current and potential providers of PFMT across public and private sector hospital and outpatient settings, including physiotherapists and continence nurses (n = 14); and (iii) men having had radical prostatectomy at a specific public and co-located private hospital in Western Sydney (n = 13). Interview schedules were developed using Michie’s theoretical domains for investigating the implementation of evidence-based practice, and allowed participants to identify potential and actual barriers and enablers to preoperative PFMT. Transcribed interview data were analysed using a framework approach, and key themes were identified.

Results

Participant groups concurred that a recommendation for PFMT from the urological cancer surgeon, accompanied with a referral to a specific provider, was a key enabler of preoperative PFMT. Perceived barriers varied between participant groups and across public and private healthcare settings. Perceptions of financial cost of private sector PFMT, limited knowledge amongst referrers of public sector providers of PFMT, and limited awareness amongst patients of the benefits of PFMT were all posited to contribute to suboptimal PFMT provision and receipt.

Conclusions

This study has provided valuable data on barriers and enablers to preoperative PFMT, with implications for the planning of a behaviour change intervention to improve provision and receipt of preoperative PFMT in Western Sydney.

Male incontinence: a critical review of the literature

The aim was to identify and analyze studies on the quality of life and life experiences of men with urinary incontinence. Through critical review of the literature, data were analyzed using content analysis technique based on psychodynamic references. The results were grouped into two themes: Psychosocial lived experience aspects of men with urinary incontinence; Men's lived experience in the management of urinary incontinence. Men with urinary incontinence experienced a low self-image along with a sense of social stigma associated to the image of a deteriorated body. Seeking treatment when the incontinence is mild and making use of psychological and social mechanisms to adapt to the urinary incontinence. The study shows that incontinent men to have low expectation regarding treatment due to the lack of knowledge about existing therapies and strategies to urinary loss control.

The effects of urinary incontinence on sexuality: seeking an intimate partnership

PURPOSE

The purpose of this study was to investigate the impact of urinary incontinence (UI) on sexuality and intimate relationships.

SUBJECTS AND SETTING

Thirty-two problem-centered interviews were conducted with 22 community-dwelling women and 10 men between 38 and 83 years of age. Their mean age was 54.8 years; their age range was 38 to 83 years. Interviews were primarily conducted in participants' homes across Germany.

METHODS

A qualitative design, based on the Grounded Theory method, was used for data collection.

RESULTS

Urinary incontinence influenced 4 important areas: (1) sexuality, (2) existing partnerships, (3) new partnerships, and (4) the search for professional help. Participants reported that a part of their male or female identity was lost. In some cases, UI led to separation, which was experienced as very hurtful for participants and had negative impact on the search for a new partnership. While some persons developed strategies to enjoy a fulfilling sexual life despite incontinence, others gave up hope of finding sexual intimacy. The participants in this study rarely felt understood or supported by health care professionals.

CONCLUSIONS

Participants reported that UI resulted in changes in their sex life that affected both them and their partners. Some participants reported that part of their male or female identity had been lost because of restrictions in sexual activities imposed by urine loss.

Genitourinary dysfunction in male rats after bilateral neurectomy of the motor branch of the sacral plexus

AIMS

To determine the contribution of the striated musculature anatomically related to the urethra on urinary continence in conscious male rats. We tested whether the bilateral neurectomy of the motor branch of the sacral plexus (MBSP), a nerve that innervates the bulbospongiosus, ischiocavernosus, and external urethral sphincter, is a reliable procedure to induce changes in voiding pattern that can be used as indicators of urinary incontinence in unanesthetized male rats.

METHODS

Micturition behavior was videotaped and urinary parameters measured 24 h before and at day 2 and 10 after surgery.

RESULTS

Intact animals have a stereotyped behavior of micturition consisting in urination in the corner of the cage. Neurectomized animals lost place preference for voiding demonstrated by leakage of urine throughout the cage while eating, walking, or sleeping. Voiding frequency was double and voiding duration was triple the amount before surgery. Urine flow rate and voiding volume were also significantly decreased. Necropsy showed that 10 days post-denervation semen material was accumulated in the urethra and in the bladder.

CONCLUSION

In male rats the perineal striated muscles are crucial to maintaining normal urinary continence, preventing retrograde ejaculation, and to expelling urine and seminal secretions. Bilateral neurectomy of the MBSP may not be appropriate for long term survival urinary studies because effects on urinary parameters can be contaminated and/or masked by impaired seminal fluid expulsion, as a consequence of impairment of striated urethral muscle function.

Effectiveness of educational interventions to raise men's awareness of bladder and bowel health

BACKGROUND

Urinary incontinence is a common health problem with significant medical, psychological and economic burdens. Health education is capable of improving perceptions about and attitudes towards incontinence in turn encouraging them to seek help.

AIM

The aim of the present study was to determine the effectiveness of educational interventions at raising men's awareness of bladder and bowel health.

INCLUSION CRITERIA

Types of participants. Adult and adolescent men (age 12 years and over) and it was anticipated that some interventions/promotions may be directed at family members or carers of, and health professionals caring for, adult men and therefore these would also be considered for inclusion. Types of intervention. Any intervention, program or action that provided information, or attempted to raise awareness of men's bladder and bowel health. Type of outcome. Any measure defined by included studies such as: bladder and bowel management and treatment, increased knowledge of bladder and bowel health and number of attendees at promotion. Type of studies. Concurrent controls, such as: systematic reviews of concurrently controlled trials, meta-analysis, randomised controlled trials, controlled clinical trials, interrupted time series and controlled before after designs and observational design (cohort, case-control). Search strategy. A search for published and unpublished studies in the English language was undertaken restricted by a publication date of 10 years prior, with the exception of a review of seminal papers before this time.

METHODOLOGICAL QUALITY

Each study was appraised independently by two reviewers using the standard Joanna Briggs Institute instruments.

DATA COLLECTION AND ANALYSIS

Information was extracted from studies meeting quality criteria using the standard Joanna Briggs Institute tools. For two studies with similar population types, interventions and outcomes quantitative results were combined into a meta-analysis using Revman 5.0 software. However, the majority of studies were heterogenous and results are presented in a narrative form.

RESULTS

With the exception of instruction for pelvic floor muscle exercises for men after prostatectomy, little quantitative research has been performed that establishes the effectiveness of interventions on men's awareness of bladder and bowel health. While numerous interventions have been trialled on mixed gender populations, and these trials suggest that the interventions would be effective, their effectiveness on the male component cannot be definitively established.

CONCLUSION

There is little quantitative evidence for the effectiveness of interventions to improve men's awareness of bladder and bowel health therefore few recommendations can be made. Well-designed controlled trials using male sample populations only are needed.

Effectiveness of educational interventions to raise men's awareness of bladder and bowel health

EXECUTIVE SUMMARY

Urinary incontinence (UI) has been defined as a condition in which the involuntary loss of urine is a social or hygienic problem and is objectively demonstrable. Urinary incontinence is a common health problem that carries with it significant medical, psychosocial and economic burdens. Fecal incontinence has been defined as the involuntary or inappropriate passing of liquid or solid stool and can also include the incontinence of flatus. Studies suggest that twice as many men suffer from fecal incontinence compared to urinary incontinence whilst more than three times as many women suffer from urinary incontinence compared to fecal incontinence. The general consensus in the literature is that barriers exist for seeking help for those with incontinence. REVIEW QUESTION: 'How effective are educational interventions at raising men's awareness of bladder and bowel health?'

TYPES OF PARTICIPANTS

Adult and adolescent males (age 12 years and over).

TYPES OF INTERVENTIONS

Any intervention, program or action that provided information, or attempted to raise awareness of men's bladder and bowel health.

TYPES OF OUTCOME MEASURES

The primary outcomes of interest included any measure defined by included studies such as: TYPES OF STUDIES: As this review attempted to evaluate the effectiveness of an intervention or interventions, reviewers considered studies using concurrent controls.

SEARCH STRATEGY

The search strategy was designed to identify both published and unpublished material and was restricted to English language publications with a publication date of 10 years prior to the search with the exception of a review of seminal papers before this time.

ASSESSMENT OF METHODOLOGICAL QUALITY

The quality of included studies was assessed by two reviewers using the Joanna Briggs Institute Checklists for experimental and observational studies.

DATA EXTRACTION

For each included paper the type of information that was extracted and tabulated in a database followed the JBI Data Extraction Form for Experimental and Observational Studies.

DATA SYNTHESIS

Where possible relative risk (RR), odds ratios (OR), Mean differences and associated 95% confidence intervals (95% CI) were calculated from individual studies. For homogeneous studies quantitative results were combined into a meta-analysis for evaluation of the overall effect of an intervention. Where heterogeneity existed between studies the results were presented in a narrative summary.

REVIEW RESULTS

The review identified 12 RCT and 2 controlled trials. Ten studies evaluated the effectiveness of interventions on the incidence of urinary incontinence symptoms in men after prostatectomy Only two trials examined interventions to manage post-micturition dribble, one evaluated the effectiveness of lifestyle and behavioural modifications to manage lower urinary tract symptoms and one evaluated the use of a consensus guideline for the management of continence by primary health care teams in an urban general practice.No controlled trials evaluated interventions to improve men's knowledge or management of bowel health, or to improve men's attendance at promotional events.Few of the RCT described the method of randomisation and no trials reported using blinding either to assessment or to treatment.Two studies did not provide the measures of dispersion (no standard deviation), one study provided graphical data only and one presented no data whatsoever.Pelvic floor muscle exercises with or without additional interventions are effective at reducing the incidence of urinary incontinence in men >65 years who have had a prostatectomy.Education on lifestyle and behavioural modifications may be more effective in reducing lower urinary tract symptoms than doing nothing.Pelvic floor muscle exercisesmay be effective in treating post-micturition dribble in men with or without erectile dysfunction.Providing verbal feedback to participants to support pelvic floor muscle exercises technique appears to be as effective as biofeedback for improvement of urinary incontinence symptoms in this group.No evidence for the effectiveness of education interventions on faecal incontinence orNo evidence for the effectiveness of education interventions to improve men's attendance at promotional events.

DISCUSSION

The results of this review have highlighted that with the exception of pelvic floor muscle exercises (PME) after prostatectomy, few controlled trials have examined the effectiveness of any interventions at raising awareness of bladder and bowel health in males aged 12 years and over.The majority of trials that evaluated interventions to manage bladder and bowel health presented data for both male and female in a combined form making it impossible to estimate the effect of the intervention(s) on male participants only. In some cases, where the male data were presented separately, the population was too small to provide adequate power, and therefore most comparisons between treatment groups were found to have statistically insignificant differences in effectiveness.

CONCLUSIONS

There is little quantitative evidence for the effectiveness of interventions to improve men's awareness of bladder and bowel health. Therefore few recommendations can be made. Pelvic floor muscle exercises with or without additional interventions such as biofeedback could be used to reduce the incidence of urinary incontinence in men who have had a prostatectomy.Education on lifestyle and behavioural modifications may be more effective in reducing lower urinary tract symptoms than doing nothing.Pelvic floor muscle exercises may be effective in treating post-micturition dribble in men with or without erectile dysfunction.With the exception of instruction of pelvic floor muscle exercises for men after prostatectomy, little quantitative research has been performed that establishes the effectiveness of interventions on men's awareness of bladder and bowel health. While numerous interventions have been trialed on mixed gender populations, and these trials suggest that the interventions would be effective, their effectiveness on the male component cannot be definitively established. Therefore, well designed controlled trials using male sample populations only are needed to confirm these suppositions.

Older people, continence care and catheters: dilemmas and resolutions

Urinary incontinence (UI) is a common problem and has a profound impact on quality of life among older people. There are various nursing interventions and treatments which can improve UI for the majority of people. Catheterization should be considered for specific clinical indications only when other options have been ruled out. Many complications are associated with catheterization, including catheter-associated urinary tract infections (CAUTIs), which are the most common cause of hospital-acquired infections. It is important for nurses and other healthcare professionals to appreciate how catheters produce infection so that appropriate catheter care is used. The best way to avoid CAUTI is to avoid catheterization, whenever possible, and to remove indwelling catheters when they are no longer required. There is a need to raise public awareness about UI and the interventions and treatments available so that more older people seek help. The challenge for nurses is to avoid using catheters and develop alternative approaches to the care of older people with incontinence.

Effects of Combined Pelvic Floor Muscle Exercise and a Support Group on Urinary Incontinence and Quality of Life of Postprostatectomy Patients

PURPOSE/OBJECTIVES

To examine the effect of combined pelvic floor muscle exercise (PFME) and a support group on postprostatectomy urinary incontinence and quality of life.

DESIGN

Pilot study of a randomized, controlled clinical trial.

SETTING

Two metropolitan hospitals in northeastern Ohio.

SAMPLE

29 men with postprostatectomy urinary incontinence.

METHODS

The participants learned PFME through biofeedback and were randomized to the control group (n = 15) or the support group (n = 14). The control group practiced PFME at home, whereas the support group attended six biweekly group meetings facilitated by a health psychologist. Assessment of urinary incontinence and quality of life was conducted at baseline and three months.

MAIN RESEARCH VARIABLES

Urinary incontinence and disease-specific quality of life.

FINDINGS

Eighty-six percent of the support group participants versus 46% of the control group participants practiced PFME four to seven days per week. The support group had a lower rating of urinary incontinence based on a 0- to 10-point visual analog rating scale than the control group (X = 3.2 versus 4.7), and fewer support group participants used pads (50%) than control group participants (85%) at three months. The support group also scored significantly lower on the severity of incontinence problems than the control group at three months, especially in relationship with spouse and social outing, despite no group difference in these areas at baseline.

CONCLUSIONS

The study provided promising evidence regarding the effect of the proposed intervention on adherence to PFME, urinary incontinence, and quality of life.

IMPLICATIONS FOR NURSING

Reports regarding nursing practice are lacking with respect to PFME. This study suggests that practicing PFME in a group with patients with incontinence who have undergone prostatectomy can be a useful nursing intervention.

Differences in Resident Characteristics and Prevalence of Urinary Incontinence in Nursing Homes in the Southeastern United States

BACKGROUND

Relatively little is known about differences in the prevalence of urinary incontinence (UI) by race and region in the United States.

OBJECTIVES

To use the 1999-2002 Centers for Medicare and Medicaid Services (CMS) Minimum Data Set (MDS), Atlanta Region, to investigate the prevalence of UI among African American and Caucasian residents of nursing homes (NH) in the southeastern United States.

METHODS

A repeated-measures, two time-period design was employed. Data for 95,911 residents in 7,640 NH were extracted using the study's inclusion and exclusion criteria. Residents' admission and annual assessment records were accessed; UI presence and relevant indicators were captured; and admission and postadmission UI prevalence rates were determined by region, state, race, and gender. Logistic regression, adjusting for residents' demographics, morbidity status, bed mobility, and cognitive and functional statuses, was conducted also.

RESULTS

The majority of residents were Caucasian (82.4%) and women (76.5%) with mean (+/-SD) age of 82.7 +/- 7.58 years. Regional UI prevalence was 65.4% at admission and 74.3% postadmission. Postadmission, 73.5% of Caucasian and 78.1% of African Americans were incontinent. Similarly, 72.2% of men and 75% of women were incontinent. For African Americans postadmission, adjusted odds of UI were OR = 1.07 (95% CI: 1.01, 1.14).

DISCUSSION

Prevalence of UI was high in this region and the odds of UI was significantly higher among African Americans in two of eight states, suggesting racial disparity in this condition in these states. Factors contributing to this disparity should be explored to increase quality care to vulnerable populations.

The prevalence of urinary incontinence among community dwelling men: results from the National Health and Nutrition Examination survey

PURPOSE

To measure the prevalence of urinary incontinence in community dwelling men in the United States, we analyzed data from respondents to the National Health and Nutrition Examination Survey.

MATERIALS AND METHODS

From 1999 to 2000 the National Health and Nutrition Examination Survey asked a national sample of community dwelling men, "In the past 12 months, have you had difficulty controlling your bladder, including leaking small amounts of urine when you cough or sneeze?" Questionnaire results were recorded and analyzed with respect to demographic data, and compared to the National Health and Nutrition Examination Survey data in women.

RESULTS

The overall prevalence of urinary incontinence in men was 17%. Prevalence increased with age from 11% in men 60 to 64 years old to 31% in men 85 years old or older. Of the men reporting any incontinence 42% reported daily incontinence and 24% reported it weekly. Black men had the highest prevalence of male incontinence (21%) and black women had the lowest prevalence of female incontinence (20%). While the prevalence of incontinence in black women was virtually the same as that in black men, the prevalence of incontinence in white and Mexican-American women was at least 2.5 times that of men of the same ethnicity.

CONCLUSIONS

The National Health and Nutrition Examination Survey draws a nationally representative sample of subjects from the community and, thus, provides prevalence data for urinary incontinence for all men in the United States. Ethnicity appears to be a contributing risk factor for incontinence, although racial patterns clearly differ between men and women.