Distribution by Scientific Domains
Distribution within Medical Sciences

Kinds of Continence

  • anal continence
  • faecal continence
  • urinary continence

  • Terms modified by Continence

  • continence care
  • continence rate
  • continence score
  • continence service
  • continence society
  • continence status

  • Selected Abstracts

    Management of Continence and Urinary Catheter Care

    Phyll Taylor

    Preoperative erectile function is one predictor for post prostatectomy incontinence,

    S. Wille
    Abstract Aims The precise etiology of post prostatectomy incontinence (PPI) is not fully understood and risk factors are not yet comprehensively defined. It has been reported that sparing of the neurovascular bundle during prostatectomy improves postoperative erectile function, whereas the influence on urinary control is unclear. From daily clinical experience we made the impression that patients who are in the best shape have better erections and better continence. We therefore searched our database for a possible correlation between the preoperative erectile function and the incidence of PPI. Patients and Methods Four hundred three patients who underwent radical retropubic prostatectomy between January 2000 and May 2003 were enrolled into this retrospective study. Data of 327 patients (response rate 81%) at a median follow-up of 26 months were analyzed using the validated International Index of Erectile Function (IIEF 5), the validated Urinary Distress Inventory (UDI6) and a standardized urinary symptom inventory. Continence was defined as usage of no or one pad daily. Erectile Dysfunction (ED) was defined as none/mild or moderate/severe with an IIEF 5 score of 17 or more or less than 17, respectively. Results Univariate and mulitvariate logistic regression analysis including preoperative IIEF 5 scores, age and nerve sparing prostatectomy, identified preoperative erectile function as significant predictor for PPI (P,=,0.024), whereas age (P,=,0.759) and nerve sparing prostatectomy (P,=,0.504) did not predict PPI. Conclusion Erectile function is a predictor of PPI and should be recorded preoperatively. Neurourol. Urodynam. © 2006 Wiley-Liss, Inc. [source]

    Sling distress: A subanalysis of the IVS tapes from the SUSPEND trial

    Abstract Aim:, To study the incidence of erosions and tape infections following the use of intravaginal slingplasty (IVS) treatment for stress urinary incontinence after the SUSPEND trial period of 30 months. This subanalysis was carried out because of concerns regarding high percentage of delayed sling erosions and infections during follow up of the patients who participated in the trial. Materials and methods:, The subanalysis patient group consisted of all IVS patients drawn from the SUSPEND randomised control trial that compared the safety and efficacy of three types of suburethral slings, TVT, SPARC and IVS, for the treatment of urodynamic stress incontinence. Results:, A total of 62 patients were reviewed during this study conducted from April 2002 to May 2003. Continence was achieved in 88% the patients. A total of eight (13%) sling erosions were found requiring sling removal. Forty-eight (77.4%) patients were followed up at 12 months with one case of erosion (1.7%). Twenty-nine (46.8%) of the 62 patients were followed up between 12 and 34 months, and seven cases of sling erosions were diagnosed. One patient had purulent suprapubic sinus, five patients had foul-smelling discharge, and one had recurrent urinary tract infection associated with pain and discharge. After the slings were removed the patients had no further symptoms. However, three of them had recurrent stress urinary incontinence. Discussion/conclusion:, The delayed presentation of the sling erosion from this subanalysis is a concern, and pelvic reconstructive surgeons using IVS need to be aware of the delayed presentations we found in our cohort of patients. [source]

    84 One year results of a French, multicentre, prospective clinical study of act® (adjustable continence therapy) for the treatment of female of stress urinary incontinence due to intrinsic sphincter deficiency

    Introduction:, This Prospective, multicentre clinical investigation sought to assess the feasibility and efficacy of the adjustable balloons ACT® for treatment of female Stress Urinary Incontinence SUI with ISD. Materials and Methods:, The ACT® implant consists of a two-lumen conduit of variable length with an expandable silicone balloon (0.5,8 cc) on the proximal end and a distal subcutaneous titanium port. Two balloons were placed periurethrally at the bladder neck. Continence rate (no leakage during direct visual stress test with 250 ml placed in the bladder), improvement, failures, quality of life (I-QoL) and morbidity were assessed. Results:, Sixty-seven patients (62 ± 9.8-years-old) were implanted in France during 75 procedures (8 revisions). Average follow-up was 12 months. At baseline, urethral closure pressure was 22.5 ± 10.8 cm H2Oand 39 patients (58%) had previously undergone at least one surgery for SUI. Continence increased from 0% at baseline to 57% at1 year and I-QoL improved from 39.4 ± 19 at baseline to 63.7 ± 23.3 at one year. Balloon adjustment was required in 64% of patients. Complications included erosion (11%), spontaneously resolved retention (2%) and infection (4%). Conclusion:, ACT® offers a viable alternative for the treatment of SUI in female with ISD. The implantation is a minimally invasive and efficient procedure and stable over time therapy for patients with severe SUI with ISD. Implantation can be done under local anaesthesia. The positioning of ACT® treatment versus artificial urinary sphincter still needs to be determined. [source]

    Treatment of incontinence after prostatectomy using a new minimally invasive device: adjustable continence therapy

    BJU INTERNATIONAL, Issue 4 2005
    Wilhelm A. Hübner
    OBJECTIVE To evaluate the safety and efficacy of a new minimally invasive urological implant for incontinence after prostatectomy. PATIENTS AND METHODS The adjustable continence therapy device (ProACTTM, Uromedica, Plymouth, MN, USA) consists of two balloons placed via a perineal approach bilaterally at the bladder neck in patients after prostatectomy. Titanium ports, attached via discrete tubing to each balloon, are placed in the scrotum, allowing for separate volume adjustments of the balloons at any time during and after surgery. Changes in a quality-of-life questionnaire (I-QoL), pad usage and a subjective continence grading score were assessed in 117 consecutive men after implanting the Pro-ACT, at baseline and at 1, 3, 6, 12 and 24 months. RESULTS After a mean (range) follow-up of 13 (3,54) months and with a mean of 3 (0,15) adjustments, 67% of men were dry, using at most one ,security' pad daily; 92% were significantly improved, and 8% showed no improvement. The I-QoL score improved from a median of 34.7 to 66.3 after 2 years (42 men; P <,0.001), the daily pad count decreased from a mean of 6 (1,24)/day to 1 (0,6)/day at 2 years (P < 0.001). Continence achieved at ,,6 months after implantation through incremental adjustment remained durable at ,,2 years in most patients. There were complications during and after surgery in 54 patients, mostly minor and decreasing with increasing expertise, primarily reflecting the development and refinement of the new surgical technique and its instrumentation. Re-implantation for complications was required in 32 patients, with a 75% success rate. CONCLUSIONS The ProACT peri-urethral prosthesis produces durable outcomes equivalent or better than other minimally invasive treatments for incontinence after prostatectomy. Its unique design allows for easy adjustment after surgery to achieve the desired urethral resistance, with no further surgical intervention, thus allowing for an optimum balance between voiding pressures and continence. The promising results reported here suggest that this may be an appropriate, effective and durable first-line treatment to offer men with stress urinary incontinence after prostatectomy. [source]

    Combined external urethral bulking and artificial urinary sphincter for urethral atrophy and stress urinary incontinence

    BJU INTERNATIONAL, Issue 6 2005
    Nadeem U. Rahman
    OBJECTIVE To describe a technique of externally bulking the urethra with a soft-tissue graft before placing another artificial urinary sphincter (AUS), as when placing another AUS for recurrent male stress urinary incontinence (SUI) other manoeuvres, e.g. placing a tandem cuff or transcorporal cuff, must be used to obtain urinary continence in an atrophic urethra, and each is associated with morbidity. PATIENTS AND METHODS From January 2003 to July 2004, five patients (mean age 74 years, range 62,84) treated by radical prostatectomy were referred for recurrent SUI after placing an AUS (four, including one with urethral erosion) or a male sling (one, with a resulting atrophic urethra). Each patient was treated with an external urethral bulking agent (Surgisis® ES, Cook Urological, Spencer, Indiana) and had an AUS placed. RESULTS In each patient the greatest urethral circumference was <4 cm. To place a functional 4 cm cuff, the diameter of the urethra was enhanced by wrapping it with Surgisis ES. Continence was significantly improved in all patients except one 84-year-old man who had the replanted artificial sphincter removed because of erosion 14 months after surgery. CONCLUSION In cases of severe recurrent SUI from urethral atrophy after placing an AUS, externally bulking the urethra with Surgisis ES before placing another AUS is well tolerated, and gives satisfactory results. [source]

    The technique of apical dissection of the prostate and urethrovesical anastomosis in robotic radical prostatectomy

    BJU INTERNATIONAL, Issue 6 2004
    M. Menon
    Much of the current interest in robotic surgery in urology has been caused by the results of the work from the Vattikuti Urology Institute in Detroit, and these authors describe their extensive experience in the technique of radical prostatectomy; specifically their modified single running suture urethrovesical anastomosis. They ascribe their ability to remove the urethral catheter at 4 days, and to have an excellent continence rate, to this technique, and to their apical dissection. The European Randomised Study for Screening of Prostate Cancer will generate much interesting information over the nest few years and will in itself become one of the landmark urological studies. The authors from Amsterdam evaluated (-7-5)proPSA and hK2 in a subset of patients from this study for detecting and grading prostate cancer, and found that their impact in these areas remains limited. Screening for prostate cancer is a controversial but very interesting topic for those involved in urological oncology. Although many countries have not advocated a national screening programme, and indeed some have advised against screening of any kind for this condition, "backdoor" screening does in fact take place. The authors from Belfast have reviewed PSA testing in Northern Ireland from 1990 to 1999, finding that many men have an elevated PSA level, with a resulting requirement for further evaluation. OBJECTIVE To describe the technique of dissecting the apex of the prostate and a modified single running-suture urethrovesical anastomosis in patients undergoing robot-assisted radical prostatectomy for organ-confined prostate cancer. PATIENTS AND METHODS Over 550 robot-assisted radical prostatectomies have been undertaken using Vattikuti Institute Prostatectomy (VIP) technique in patients with localized carcinoma of the prostate. We present a critical analysis of the first 120 procedures by one surgeon (M.M.) at our institution using this newly developed technique of urethrovesical anastomosis preceded by dissecting the apex of the prostate. RESULTS The mean time for the urethrovesical anastomosis was 13 min. All but 24 patients had their catheter removed 4 days after surgery, as indicated by a cystogram. The catheter was removed successfully at 7 days in the remaining 24 patients who had a mild leak on cystography. Two patients had urinary retention within a week of removing the catheter and had to be re-catheterized. Continence was evaluated using standardized criteria before and after the procedure. The patients also replied to a mailed validated questionnaire survey; 96% were continent at 3 months and the remaining 4% used a thin pad for security. CONCLUSIONS We report a technique of dissecting the apex of the prostate and prostatovesical junction for dividing the bladder neck, and a modified single running-suture urethrovesical anastomosis, in patients undergoing robot-assisted radical prostatectomy for organ-confined cancer of the prostate. The same principles can also be applied for the anastomosis during pure laparoscopic procedures and for urethro-neovesical anastomosis in patients undergoing robotic radical cystoprostatectomy for carcinoma of the bladder. [source]

    Urinary incontinence after radical retropubic prostatectomy: the outcome of a surgical technique

    BJU INTERNATIONAL, Issue 4 2003
    A. Moinzadeh
    It is a reflection of the many manuscripts submitted on urological oncology in general, and prostate cancer in particular, that I am publishing 10 papers in this section this month. Seven of these relate to the latter subject. The authors from the Lahey Clinic describe their technique of radial prostatectomy and include a novel method of posterior bladder plication. They report an early return to continence and conclude that the technique is important in achieving their excellent results. In another study the group from Stockport show that patients often make decisions about types of treatment for prostate cancer having been strongly influenced by their partner, who in turn may have had pre-existing conceptions about this. They recommend early involvement of the partner to help in this very important decision-making. The two papers on bladder cancer describe possible prognostic factors, both clinical and laboratory-based, from a large experience in Hamburg and Mansoura. OBJECTIVE To analyse the incidence of incontinence after radical retropubic prostatectomy (RRP) and the time to return of continence, using an RRP technique including a novel posterior bladder plication PATIENTS AND METHODS We retrospectively reviewed the medical records of 200 consecutive patients who underwent RRP between September 1995 and February 1997, by one surgeon, at our institution. Patient characteristics including age, preoperative prostate-specific antigen (PSA) level and Gleason grade, were assessed. Continence was assessed before and after RRP by either a third-party patient interview or a prospective validated questionnaire. Continence was defined as not requiring the use of any sanitary pads or diapers. The continence rate was determined immediately after catheter removal, and at 3, 6, 12 and 15 months after RRP. RESULTS The mean age of the patients was 59.4 years, the preoperative PSA level 8.5 ng/mL and the Gleason grade 6.1. The time to continence and percentage of continent patients was 63.5% immediately, 82% at 3 months, 91% at 6 months, and 98.5% at 12 months after RRP. At 15 months, 199 of 200 consecutive patients were continent (99.5%). CONCLUSION With our technique there was an early return to continence and only a minor incontinence rate at 15 months. The cumulative effect of sequential technical manoeuvres in our RRP technique, including posterior bladder plication, is critical for continence after RRP. [source]

    The urethral Kock pouch: long-term functional and oncological results in men

    BJU INTERNATIONAL, Issue 4 2003
    A.A. Shaaban
    The Department of Urology in Mansoura has a well-known experience in, among many things, urinary tract reconstruction in patients with bladder cancer. They review their results in 338 male patients who had a radical cystectomy and Kock pouch. They found good functional and oncological outcomes in properly selected patients. However, they also drew attention to several valve-related complications. OBJECTIVE To evaluate our experience with men who underwent radical cystectomy and urethral Kock pouch construction between January 1986 and January 1996. PATIENTS AND METHODS Complications were classified as early (within the first 3 months after surgery) or late. Continence was assessed by interviewing the patient; they were considered continent if they were completely dry with no need of protection by pads, condom catheter or medication. The patients were followed oncologically and Kaplan-Meier survival curves constructed. Urodynamic studies were used to define the possible causes of enuresis. RESULTS Three patients died after surgery from pulmonary embolism. There were 67 early complications in 63 patients. The mean (sd) follow-up was 87.8 (49.1) months. There were 111 treatment failures from cancer; of these, four men only had an isolated local recurrence in the urethra. Late complications included 72 pouch stones in 55 patients, and 36 deteriorated renal units caused by reflux (17), uretero-ileal stricture (11), nipple valve eversion (four) or stenosis (four). Interestingly, 65 renal units that were dilated before surgery improved significantly afterward. Ileo-urethral strictures occurred in seven men and anterior urethral strictures in six. Nine patients were totally incontinent and two had chronic urinary retention. Daytime continence was complete in 94% of men, with nocturnal enuresis in 55; the latter had significantly more residual urine, and a higher amplitude and duration of phasic contractions. CONCLUSIONS Orthotopic bladder substitution after cystectomy for cancer is feasible, with good functional and oncological outcomes in properly selected patients. Nevertheless, the use of a hemi-Kock pouch is associated with many valve-related complications. [source]

    Continence and some properties of the urethral striated muscle of male greyhounds

    BJU INTERNATIONAL, Issue 3 2000
    B.A. Van Der Werf
    Objective To determine the properties of the striated muscle of the greyhound (dog) urethra and to consider its role in maintaining continence. Materials and methods The thickness of the muscle layers and the muscle types were determined by examining sections stained with haematoxylin and eosin or Masson's trichrome. These factors were correlated with the mechanical and electrical responses of muscle strips to nerve stimulation, and compared with muscle from other breeds of dog and other parts of the animal. Results The striated muscle formed ,70% of the membranous urethra and was predominantly (68%) type IIa muscle (i.e. fast but fatigue-resistant). The mean resting membrane potential was ,74 mV; nerve stimulation produced an action potential with a mean amplitude of 97 mV and contraction lasting about 200 ms. All responses were abolished by d -tubocurarine. The contractions were well maintained with continuous or intermittent stimulation. The properties were intermediate between those of the anconeus (slow) and the extensor carpi radialis (fast) muscles. Conclusions The distribution, fibre type and contractile characteristics would enable the striated urethral muscle to maintain tension for continence at rest and provide additional continence during sprints. [source]

    Ascertaining the prevalence of childhood disability

    T. Hutchison
    Abstract Objectives, To reapply 1985 Office of Population Census and Surveys (OPCS) disability survey methods, modified as necessary, to a sample of children to ascertain presence of disability. To compare OPCS-based prevalence with prevalence based on carer's views and medical records. Design, Analytical study. Setting, Community Child Health Department in UK. Participants, Principal carers of 100 children aged 5,15, selected from a district special needs register. Main outcome measures, Comparable information about disability from three sources and diagnosis from carers and medical records. Results, Medical records of 46% contained a diagnosis. Carers were always aware of this, although a single question did not always elicit their knowledge. OPCS-derived threshold disability criteria in categories of Hand function, Personal care, Consciousness and Continence gave prevalence results similar to medical records and carers. OPCS criteria yielded higher prevalence of disability in the areas of Locomotion (8%), Communication (14%) and Hearing (18%). Carers, OPCS and medical records disagreed markedly about prevalence of disabilities of Vision, probably because of the use of differing definitions. OPCS learning criteria were judged unsuitable and standard attainment targets (SATs) were substituted. These provided similar prevalence figures to carers and medical records. OPCS behaviour criteria were also unsuitable and were replaced by the General Health and Behaviour Questionnaire (GHBQ). This found an increased prevalence of problems compared with carers and doctors. Conclusions, Diagnostic labels have limited use when collecting data about disabled children. Doubt is cast on the validity of some of the 1985 OPCS threshold criteria, and reassessment is suggested before their future use. Further work is needed on the use of SATs and GHBQ in the benchmarking of disability. To collect population data it would be easier and at least equally effective (with caution in the case of Vision) to ask carers directly rather than applying descriptive thresholds and external judgements. Similar information could be obtained from medical records, however, they are likely to be out of date. [source]

    Standardized health check data from community-dwelling elderly people: the potential for comparing populations and estimating need

    Peter Bath PhD
    Abstract The main aim of this study was to compare EASY-Care data obtained during nurse-administered annual health checks in two populations of older people. A secondary aim was to determine whether a standardized assessment system administered as part of routine practice by a trained nurse during the over-75 health check could generate useful information for comparing population health and functional status of community-dwelling-older people. One hundred and seventy-nine elderly people (aged 75 years and over) from the Woodstock ward, Belfast, having relatively high deprivation; and 238 elderly people from south Hampshire, ranging from affluent wards in New Forest to inner city wards, were assessed using the EASY-Care assessment system as part of their annual health check. There was a high response rate to the standardized assessment in both populations (75% and 79%). Compared to people in south Hampshire, the people in Belfast had higher relative risk of having fair/poor self-rated health, and lower relative risk of having good/sufficient accommodation and of having difficulty chewing. People in Belfast had a higher relative risk of being dependent for six of the seven IADL items and for continence of urine, bathing, grooming, use of the stairs and dressing among the ADL items. The results demonstrate the ability of data generated by assessment system to discriminate between populations of older people when used as part of routine practice. Differences in health and functional status may be associated with deprivation. Data collected during the annual health check about the health and functional status of older people could provide a useful adjunct to census and survey data to measure population needs and to support locality planning. [source]

    Mode of delivery and risk of fecal incontinence in women with or without inflammatory bowel disease: Questionnaire survey,

    J.P.L. Ong MRCP
    Abstract Background: Elective cesarean section (CS) may be recommended for patients with Crohn's disease and perineal involvement. Little is known about CS rates in parous women with inflammatory bowel disease (IBD), nor the possible long-term impact of vaginal delivery and episiotomy on continence in women with IBD. Methods: Questionnaires were sent to all 777 regional members of a Colitis and Crohn's Disease patient association. Male members were asked to request their unaffected female spouse/partner to complete the forms in order to give a "control" group for comparison. Results: Forms were returned by 491 members (response rate 63%). CS had been undertaken for 37 of the 229 parous women with IBD (16%) versus 15 of the 116 without IBD (13%) (,2 = 0.62, P = NS). Only 2 women had undergone CS due to IBD. Of the parous women with IBD, 75 (33%) had persisting problems with fecal incontinence, of whom 21 (28%) dated this back to the time of vaginal delivery. By contrast, only 2 (2%) of the parous control group had suffered persisting fecal incontinence following vaginal delivery (,2 = 8.27, P < 0.01). Conclusions: Persisting fecal incontinence is reported by a significant minority of parous women with IBD, of whom over one-quarter date this back to vaginal delivery. CS is rarely recommended due to IBD alone. If our findings are confirmed in prospective studies, the threshold for recommending CS may need to be lowered for patients with IBD. (Inflamm Bowel Dis 2007) [source]

    How work-place conditions, environmental toxicants and lifestyle affect male reproductive function,

    Jens Peter Bonde
    Summary Major temporal and geographical shifts in male reproductive function is presently an issue worldwide. The hormonal disruption hypothesis has achieved considerable attention but epidemiological evidence in support of the theory is lacking. Several occupational hazards to male reproductive function are known but exposure prevalences are hardly sufficient to play a role for reduced sperm count in the general male population. Sedentary work may be an exception. Perhaps prolonged time in the sedentary position exhausts the testicular heat regulation. But so far studies addressing implications of the heat hypothesis in the general population are few. Neither change of sexual behaviour nor reduced period of sexual continence seems to be a likely explanation. Tobacco smoking and consumption of caffeine and alcoholic beverages in adulthood have a rather marginal impact on spermatogenesis and can hardly explain major shifts or regional differences in male reproductive health. However, prenatal effects following smoking during pregnancy might play a role because we have witnessed a smoking epidemic among fertile women in some countries during the second half of the twentieth century. Moreover, if genetic factors play more than a marginal role for testicular function and sperm count, pregnancy planning resulting in reduced family size during the past 100 years could possibly explain a decline in semen quality because the most fertile part of the population reproduce less while the subfertile probably continue to get a limited number of children. [source]

    Current use of the artificial urinary sphincter and its long-term durability: A nationwide survey in Japan

    Yoichi Arai
    Objectives: Although the artificial urinary sphincter (AUS) is one of the most effective surgical treatments for severe urinary incontinence, little is known about its use in Japan. A nationwide survey was done to determine contemporary trends in AUS use and its long-term durability. Methods: Data on AUS units sold in Japan were provided directly by Takai Hospital Supply Co., Ltd., Tokyo, Japan, and a survey form was sent to all 44 institutes where AUS implantation had been carried out. The survey included various demographic and preoperative variables, surgical variables, and postoperative outcomes. Results: Between 1994 and 2007, a total of 100 AUS devices had been provided in Japan. Of the 44 institutes, 24 responded to the survey, and a total of 64 patients were enrolled in the study. Post-urological surgery incontinence accounted for 81.3% of the indications. During the mean follow-up of 50 months, mechanical failure occurred in four (6.2%), and the device was removed in 13 (20.3%) due to infection (14.0%), erosion (4.7%), or urination difficulty (1.5%). Of the 58 patients evaluated, 91.4% reported social continence. Five- and 10-year failure-free rates were 74.8% and 70.1%, respectively. On multivariate analysis, operative time was an independent predictor of treatment failure (P = 0.0334). Conclusions: Considering recent trends in prostate surgery, the AUS may be significantly underused in Japan. Although excellent long-term durability has been achieved, a learning effect appears to be evident. The Japanese urological community needs to provide appropriate patients with this treatment option. [source]

    Long-term functional outcomes in patients with various types of orthotopic intestinal neobladder

    Hideaki Miyake
    Objectives: To evaluate the long-term functional outcomes of various types of orthotopic neobladder (NB). Methods: Eighty-nine patients who underwent orthotopic NB reconstruction after radical cystectomy and were followed for at least 60 months after surgery were included in this retrospective study. The types of NB in this series were: modified Studer type, Hautmann type, Mainz type, Goldwasser type and modified Reddy type in 36, 9, 15, 10 and 19 patients, respectively. Results: Sixty-seven (75.3%) patients could void spontaneously, 15 (16.8%) voided with clean intermittent catheterization (CIC) assistance and seven (7.9%) with CIC alone. After excluding the seven voiding with CIC alone, daytime and night-time continence was achieved in 63 and 50 of the remaining 82 patients, respectively. In addition, the proportion of daytime continence in the modified Studer group was significantly greater than that in the Mainz group, whereas there was no significant difference in the proportion of night-time continence among these groups. Uroflow examination indicated that despite the lack of significant differences in the maximal flow rates and the voided volumes, the post-void residual in the modified Reddy group was significantly smaller than that in the modified Studer group. Blood gas analysis in the 82 patients showed that there were no significant differences in the pH, bicarbonate, chloride and base excess among these groups. Conclusions: Orthotopic NB created with intestinal segments generally has acceptable functional outcomes on long term follow up. These outcomes differ according to the type of NB. To define the optimal procedure for NB reconstruction, it is necessary to understand the long-term functional prospects, on which the subjective success of NB creation is based. [source]

    Treatment of adult female epispadias without exstrophy in the presence of rhabdosphincter function

    Abstract, Female epispadias without exstrophy is a very rare entity. Symptoms of female epispadias are primary urinary incontinence and anatomical abnormal features. A 24-year-old married women with two children presented with primary urinary incontinence. Due to previous failure of correct diagnosis and ineffective medical treatment, the patient developed psychological problems (anxiety and depression). In the presence of minimal rhabdosphincter function we could achieve socially acceptable urinary continence by bladder neck plication and a Burch colposuspension. The patient did not consent to a major reconstruction. [source]

    Postoperative morbidity, functional results and quality of life of patients following orthotopic neobladder reconstruction

    Tatsuaki Yoneda
    Abstract Aim: To evaluate postoperative morbidity, functional results and health-related quality of life of patients with an orthotopic neobladder. Methods: A total of 37 patients with orthotopic neobladder (modified Studer method: 35 cases; Hautmann method: one case; sigmoid neobladder: one case) were included in the present study. Postoperative morbidity and neobladder function were analyzed. To determine quality of life, the Sickness Impact Profile questionnaire was used. The quality of life of patients who underwent orthotopic neobladder was compared with that of patients who underwent ileal conduit. Results: In 37 consecutive patients with neobladder reconstruction, early complications included 10 cases of pyelonephritis (27.0%) and one of stenosis of ureterointestinal anastomosis (2.7%). Two patients died of ARDS and sepsis following peritonitis and pneumonia in the perioperative period. Late complications included pyelonephritis in three patients (8.6%). In 32 cases, except for an early postoperative case and those that died, complete daytime and night-time continence was achieved in 31 patients (96.9%) and 16 patients (50.0%), respectively. Concerning health-related quality of life, the mean sum scores per category of the Sickness Impact Profile were calculated for 32 patients with orthotopic neobladder and 30 patients with ileal conduit. There were no significant differences in overall satisfaction, however, the scores for patients with orthotopic neobladder reconstruction were significantly higher than those for patients with ileal conduit in the three categories of emotions, feelings and sensation, social interaction and recreation. Conclusion: Orthotopic neobladder reconstruction exhibited good functional results with acceptable complications. Patients who underwent neobladder reconstruction were satisfied with their voiding. Assessment of quality of life using the Sickness Impact Profile questionnaire demonstrated that orthotopic neobladder improved their quality of life better than ileal conduit, especially with regard to mental, physical and social functioning in daily life. [source]

    Functional Incidental Training: A Randomized, Controlled, Crossover Trial in Veterans Affairs Nursing Homes

    Joseph G. Ouslander MD
    Objectives: To test the effects of a rehabilitative intervention directed at continence, mobility, endurance, and strength (Functional Incidental Training (FIT)) in older patients in Department of Veterans Affairs (VA) nursing homes. Design: Randomized, controlled, crossover trial. Setting: Four VA nursing homes. Participants: All 528 patients in the nursing homes were screened; 178 were eligible, and 107 were randomized to an immediate intervention group (Group 1; n=52) and a delayed intervention group (Group 2; n=55). Intervention: Trained research staff provided the FIT intervention, which included prompted voiding combined with individualized, functionally oriented endurance and strength-training exercises offered four times per day, 5 days per week, for 8 weeks. Group 1 received the intervention while Group 2 served as a control group; then Group 2 received the intervention while Group 1 crossed over to no intervention. A total of 64 subjects completed the intervention phase of the trial. Measurements: Timed measures of walking or wheeling a wheelchair (mobility), sit-to-stand exercises, independence in locomotion and toileting as assessed using the Functional Independence Measure (FIM), one-repetition maximum weight for several measures of upper and lower body strength, frequency of urine and stool incontinence, and appropriate toileting ratios. Results: There was a significant effect of the FIT intervention on virtually all measures of endurance, strength, and urinary incontinence but not on the FIM for locomotion or toileting. The effects of FIT were observed when Group 1 received the intervention and was compared with the control group and when Group 2 crossed over to the intervention. Group 1 deteriorated in all measures during the 8-week crossover period. Within-person comparisons also demonstrated significant effects on all measures in the 64 participants who completed the intervention; 43 (67%) of these participants were "responders" based on maintenance or improvement in at least one measure of endurance, strength, and urinary incontinence. No adverse events related to FIT occurred during the study period. Conclusion: FIT improves endurance, strength, and urinary incontinence in older patients residing in VA nursing homes. Translating these positive benefits achieved under research conditions into practice will be challenging because of the implications of the intervention for staff workload and thereby the costs of care. [source]

    Comparison of the contractile properties, oxidative capacities and fibre type profiles of the voluntary sphincters of continence in the rat

    JOURNAL OF ANATOMY, Issue 3 2010
    Maria Buffini
    Abstract The external urethral sphincter (EUS) and external anal sphincter (EAS) are the principal voluntary striated muscles that sustain continence of urine and faeces. In light of their common embryological origin, shared tonic sphincteric action and synchronized electrical activity in vivo, it was expected that they would exhibit similar physiological and structural properties. However, the findings of this study using paired observations of both sphincters isolated from the rat show clearly that this is not the case. The anal sphincter is much more fatigable than the urethral sphincter. On completion of a fatigue protocol, the amplitude of the last twitch of the EAS had declined to 42 ± 3% of the first twitch, whereas the last twitch of the EUS was almost identical to that of the first (95 ± 3%). Immunocytochemical detection of myosin heavy-chain isoforms showed that this difference was not due to the presence of more slow-twitch oxidative type 1 fibres in the EUS compared with the EAS (areal densities 4 ± 1% and 5 ± 1%, respectively; P = 0.35). In addition, the fatigue difference was not explained by a greater contribution to force production by fast oxidative type 2A fibres in the urethral sphincter. In fact, the anal sphincter contained a higher areal density of type 2A fibres (56 ± 5% vs. 37 ± 4% in the EUS, P = 0.017). The higher oxidative capacity of the EUS, measured histochemically, explained its fatigue resistance. These results were surprising because the fatigue-resistant urethral muscle exhibited faster single-twitch contraction times compared with the anal sphincter (56 ± 0.87 ms vs. 72.5 ± 1.16 ms, P < 0.001). Neither sphincter expressed the type 2X myosin isoform but the fast-twitch isoform type 2B was found exclusively in the EUS (areal density 16 ± 2%). The type 2B fibres of the EUS were small (diameter 19.5 ± 0.4 ,m) in comparison to typical type 2B fibres of other muscles. As a whole the EUS is a more oxidative than glycolytic muscle. In conclusion, analysis of the twitch mechanics and fatigue of two sphincters showed that the EUS contained more fatigue-resistant muscle fibres compared with the EAS. [source]

    Managing the self: living with an indwelling urinary catheter

    Debbie Kralik MN
    Aims., This paper reports the findings of a study that aimed to understand the perspectives of community dwelling adults' who lived with a permanently indwelling urinary catheter. The objectives of the research were to: reveal the participants' perspective of living in the community with a permanent indwelling urinary catheter, raise awareness of the experiences of catheterized men and women and to inform community nursing practice. Background., Catheter care is a common nursing intervention. Clinical Nurse Consultants (CNCs) with a focus on continence drove this inquiry because it was believed that Community Nurses may underestimate the impact that a permanently indwelling catheter may have on peoples' lives. Design., Structured interviews were undertaken with twelve men and nine women (n = 21), aged between 24 and 82 years and who had a permanently indwelling catheter (either urethral or supra pubic) for longer than six months. Analysis of the interview transcripts was a collaboration between the researchers and clinicians. Results., The most significant finding was that participants wanted to learn urinary catheter self-care as this allowed them to take control and gave relevance to their daily life. Data revealed a learning pattern consisting of seven interrelated themes as people have learned to self-manage: (i) resisting the intrusion of a catheter, (ii) reckoning with the need for a catheter, (iii) being vigilant for signs of problems, (iv) reconciling between the needs of self and others, (v) reclaiming life, (vi) managing self-care, and (vii) taking control. Conclusions., We do not suggest that people undergo a straightforward path toward catheter self-care, rather, that the seven interactive themes we have identified may be useful for observation in nursing practice whilst sensitizing nurses to clients' experiences of living with a catheter. Relevance to clinical practice., Promoting self-care of a catheter is not simply about educating clients about their condition or giving them relevant information. It is intrinsically a learning process, observing responses to every day events, such as the identification of the different sounds and sensations that may alert the individual to a full catheter bag, urine that has stopped flowing or signs of impending infection. [source]

    Long-term continence after surgery for Hirschsprung's disease

    Anthony G Catto-Smith
    Abstract Aim:, Our aim was to examine the long-term bowel dysfunction that followed surgery for Hirschsprung's disease. Methods:, Of 414 patients diagnosed with Hirschsprung's disease between 1974 and 2002, 98 were interviewed using a structured questionnaire to provide an assessment of bowel function, medication, diet, physical and social limitations. Forty-two completed a prospective 4-week toileting diary and 16 underwent anorectal manometry. Results:, Four of the 98 patients had permanent stomas and 10 had Down's syndrome. Of the remaining 84 patients (mean age 12 ± 8 years, range 1.9,41.9 years), 13% (11/84) had heavy soiling by day and 17% (14/84) by night. Fifty percent reported episodic urgency, but 36% also reported episodic constipation. Stool consistency was looser in patients with a history of long segment disease. Some aspects of bowel function improved with age. Enuresis was much more frequent than expected. Sixty-four percent reported adverse reactions to foods, particularly to fruit, vegetables, fats and diary products, and 15% limited their social activities because of fecal incontinence. There were no significant differences in manometric parameters between those patients who soiled and those who did not. Conclusions:, Fecal incontinence is common after surgery for Hirschsprung's disease and has a significant impact on social activities. Some aspects of bowel function did improve with age. Adverse reactions to food were unexpectedly frequent and need to be further studied. [source]

    Long-term continence in patients with Hirschsprung's disease and Down syndrome

    Background and Aim:, Hirschsprung's disease is more common in children with Down syndrome, but the outcome for continence in this group is unclear. The aim of the present study was to determine the natural history of bowel function in children with Down syndrome and Hirschsprung's disease. Methods:, We undertook a retrospective study of all patients with both Down syndrome and Hirschsprung's disease diagnosed at the Royal Children's Hospital, Melbourne, between 1974 and 2001 using a structured questionnaire. Results:, Ten of the 20 eligible patients were interviewed. Fecal incontinence was common (87%), as were episodes of diarrhea and perianal excoriation (40%). Persistent constipation was relatively unusual (20%). Adverse reactions to food, especially vegetables and fruit, were very common (90%). There was evidence that bowel dysfunction improved with age, particularly sensation of impending stool (P < 0.05), ability to discriminate stool consistency (P = 0.05), constipation (P < 0.05), episodes of diarrhea (P = 0.08) and excoriation (P < 0.05). Conclusion:, Persistent bowel dysfunction is common in children with Down syndrome and Hirschsprung's disease, but there is evidence of improvement with age. There was an unexpectedly high prevalence of food-related adverse reactions. [source]

    Elimination disorders in people with intellectual disability

    E. Van Laecke
    Incontinence in children with intellectual and physical disabilities is an underestimated problem in paediatric urology. Literature is scarce, often limited to the incidence and urodynamics, and seldom focused on treatment and prevention. Lack of interest and knowledge of this population are the major reasons why urologists know so little. Very often continence difficulties are accepted and even expected in children with intellectual disabilities. The published prevalence of urinary incontinence in children with intellectual and physical disabilities varies between 23% and 86%. In our experience the prevalence ranges from 60% to 65%. The vast majority of these children have bladder dysfunction, showing overactive detrusor and sphincter dyssynergia on video-urodynamic examination. The uroflow pattern is disturbed in over 65% of these children but is not correlated with the degree of urinary incontinence. Over 70% of the children have reduced bladder capacity. This is due to low bladder compliance and restricted fluid intake which effects urinary incontinence and is an important cause of constipation. Constipation is a common problem in intellectual and physical disabled children and there is a correlation between constipation and urinary incontinence. Children with intellectual disability, particularly those with a greater degree of disability need more time to become continent than typically developing children. Children with mild intellectual disability do not differ significantly from typically developing children with regard to nocturnal enuresis and faecal continence but they are more prone to urinary incontinence during the day. Greater mobility is associated with a higher incidence of continence. Some factors that influence continence, such as intellectual and motor capacity cannot easily be influenced but others, such as bladder capacity, detrusor overactivity and fluid intake, are treatable. It is importance that children with intellectual and physical disabilities suffering urinary incontinence are referred for assessment and treatment to increase their quality of life. [source]

    Retropubic versus perineal radical prostatectomy in early prostate cancer: Eight-year experience

    Gianni Martis MD
    Abstract Background Prostate cancer is the most common malignancy in men and the second leading cause of cancer death. A randomized study was performed on patients with localized prostate cancer and treated with radical prostatectomy using the perineal or the retropubic approach comparing oncological outcomes, cancer control, and functional results. Study Design Between 1997 and 2004, in a randomized study 200 patients underwent a radical prostatectomy performed by retropubic (100 patients) or perineal (100 patients) approach. Results Differences between hospital stay, duration of catheter drainage, intraoperative blood loss, and transfusion requirements were statistically significant in favor of perineal prostatectomy. Differences between positive surgical margins and urinary continence in the two groups were not statistically significant at 6 and 24 months. Differences between erectile function at 24 months were statistically significant in favor of retropubic prostatectomy. Conclusions Radical perineal prostatectomy is an excellent alternative approach for radical surgery in the treatment of early prostate cancer. J. Surg. Oncol. 2007; 95: 513,518. © 2007 Wiley-Liss, Inc. [source]

    Recent trends in diagnosis and treatment of faecal incontinence

    A. K. Tuteja
    Summary The inability to control bowel discharge is not only common but extremely distressing. It has a negative impact on a patient's lifestyle, leads to a loss of self-esteem, social isolation and a diminished quality of life. Faecal incontinence is often due to multiple pathogenic mechanisms and rarely due to a single factor. Normal continence to stool is maintained by the structural and functional integrity of the anorectal unit. Consequently, disruption of the normal anatomy or physiology of the anorectal unit leads to faecal incontinence. Currently, several diagnostic tests are available that can provide an insight regarding the pathophysiology of faecal incontinence and thereby guide management. The treatment of faecal incontinence includes medical, surgical or behavioural approaches. Today, by using logical approach to management, it is possible to improve symptoms and bowel function in many of these patients. [source]

    The pathophysiology of faecal spotting in obese subjects during treatment with orlistat

    M. Fox
    Summary Background :,The intermittent loss of oil or liquid faeces (,spotting') is an adverse effect that occurs in obese patients during treatment with the lipase inhibitor orlistat; the pathophysiology is unknown. Aim :,To investigate the effects of orlistat on anorectal sensorimotor function and continence. Methods :,Obese subjects susceptible to spotting were identified by an unblind trial of orlistat. Obese spotters (n = 15) and non-spotters (n = 16) completed a randomized, double-blind, cross-over trial of orlistat and placebo. Anorectal function was assessed by rectal barostat and anal manometry, together with a novel stool substitute retention test, a quantitative measurement of faecal continence. Results :,Orlistat increased stool volume and raised faecal fat and water. Treatment had no effect on anorectal motor function, but rectal sensation was reduced; on retention testing, the volume retained was increased. Subjects susceptible to spotting had lower rectal compliance, heightened rectal sensitivity and weaker resting sphincter pressure than non-spotters. On retention testing, gross continence was maintained; however, spotters lost small volumes of rectal contents during rectal filling. Conclusion :,Treatment with orlistat has no direct adverse effects on anorectal function or continence. Spotting occurs during treatment with orlistat when patients with sub-clinical anorectal dysfunction are exposed to increased stool volume and altered stool composition. [source]

    Microsurgical lip replantation: Evaluation of functional and aesthetic results of three cases

    MICROSURGERY, Issue 4 2004
    F. Duroure M.D.
    Lip amputations are rare, and microsurgical replantation must be systematically tried to restore form and function in one step. The authors present a series of three cases. Revascularization of the amputated segment was obtained by arterial anastomosis with the corresponding labial coronary artery. No venous anastomosis was carried out, because no vein could be identified. Venous drainage was obtained by inducing bleeding and by postoperative application of leeches for 6 days. Anticoagulant therapy and antibiotherapy were used for 10 days. With this approach, two lip amputations were completely saved, and a third amputation only suffered partial necrosis. Aesthetic and functional results were evaluated as being good, with reestablishment of labial continence and recovery of protective sensitivity. © 2004 Wiley-Liss, Inc. [source]

    Sacral nerve stimulation for fecal incontinence and constipation in adults: A short version cochrane review,,

    G. Mowatt
    Background Fecal incontinence and constipation are disabling conditions that reduce quality of life. If conservative treatment fails, one option is sacral nerve stimulation (SNS), a minimally invasive technique allowing modulation of the nerves and muscles of the pelvic floor and hindgut. Objectives To assess the effects of SNS for fecal incontinence and constipation in adults. Search strategy We searched the Cochrane Incontinence Group Specialized Trials Register (searched 24 April 2007) and the reference lists of relevant articles. Selection criteria All randomized or quasi-randomized trials assessing the effects of SNS for fecal incontinence or constipation in adults. Data collection and analysis Two review authors independently screened the search results, assessed the methodological quality of the included studies, and undertook data extraction. Main results Three crossover studies were included. Two, enrolling 34 (Leroi) and two participants (Vaizey), assessed the effects of SNS for fecal incontinence, and one (Kenefick), enrolling two participants, assessed SNS for constipation. In the study by Leroi, following the crossover period, participants, while still blinded, chose the period of stimulation they had preferred. Outcomes at different time points were reported separately for 19 participants who preferred the "on" and five who preferred the "off" period. For the group of 19, the median (range) episodes of fecal incontinence per week fell from 1.7 (0,9) during the "off" period to 0.7 (0,5) during the "on" period; for the group of five, however, the median (range) rose from 1.7 (0,11) during the "off" period compared with 3.7 (0,11) during the "on" period. Vaizey reported an average of six, and one, episodes of fecal incontinence per week during the "off" and "on" periods, respectively. Leroi reported that four of 27 participants experienced an adverse event resulting in removal of the stimulator; Vaizey did not report adverse events. For SNS for constipation, during the "off" crossover period the participants experienced an average of two bowel movements per week, compared with five during the "on" period. Abdominal pain and bloating occurred 79% of the time during the "off" period compared with 33% during the "on" period. No adverse events occurred. Authors' conclusions The very limited evidence from the included studies suggests that SNS can improve continence in selected people with fecal incontinence, and reduce symptoms in selected people with constipation. However, temporary, percutaneous stimulation for a 2,3-week period does not always successfully identify those for whom a permanent implant will be beneficial. Larger, good quality randomized crossover trials are needed to allow the effects of SNS for these conditions to be assessed with more certainty. Neurourol. Urodynam. 27:155,161, 2008. © 2008 Wiley-Liss, Inc. [source]

    Ileovesicostomy for adults with neurogenic bladders: Complications and potential risk factors for adverse outcomes,,

    Hung-Jui Tan
    Abstract Aims Risk factors for complications following ileovesicostomy have not been well defined. This study's purpose was to examine outcomes following ileovesicostomy in adults and identify possible risk factors that may contribute to post-operative complications. Methods Retrospective database review identified ileovesicostomy procedures from August 1999 to September 2003. Demographic, pre-operative, and post-operative data were extracted. Statistical analysis determined whether risk factors influenced outcomes of urethral continence, re-operation, and post-operative complications. Factors included age, tobacco use, diabetes, neurogenic bladder etiology, body mass index, pre-operative indwelling catheterization, or simultaneous procedures including pubovaginal sling/urethral closure. Results 50 adults status-post ileovesicostomy were identified. At last follow-up, 36 patients (72%) were continent per urethra. The incidence of complications decreased significantly from 3.38 per patient to 1.16 post-operatively (P,<,0.0001). Twenty-seven averaged 1.52 inflammatory or infectious post-operative complications per patient, 19 averaged 1.47 stomal complications, and 11 averaged 2.09 ileovesicostomy mechanical obstructions. Overall, 27 required 2.85 re-operations or additional procedures following ileovesicostomy. Sub-group analysis identified BMI (P,=,0.0569) as a possible risk factor. Differences in outcomes based on age, tobacco use, diabetes, neurogenic bladder etiology, pre-operative indwelling catheterization, or urethral closure were not significant. Conclusions Ileovesicostomy is a valuable management option for adults with neurogenic bladder unable to perform intermittent catheterization. The incidence of urinary tract comorbid events significantly decreased following ileovesicostomy though the onset of other complications should be considered. The morbidity associated with ileovesicostomy requires careful patient selection, close long-term follow-up, and potential subsequent interventions to address post-operative complications. Neurourol. Urodynam. 27:238,243, 2008. © 2007 Wiley-Liss, Inc. [source]