Urinary Incontinence
C1. Predictors of Care Seeking in Women With Urinary Incontinence
Minassian VA, Yan X, Lichtenfeld MJ, Sun H, Stewart WF. Neurourology and Urodynamics. 2012;31(4):470-474.
Article Type: Research study
Discussion/Results:
* Study explored factors leading to care seeking among women with urinary incontinence (UI) and risk factors for UI among women.
* Study found that only 398 (25%) of the 1618 women with UI had been clinically diagnosed with UI, and factors associated with care seeking included duration of symptoms and severity of urgency and bother.
* Factors associated with presence of UI in women included BMI >25 kg/m2 (70% vs 58%), parity (91% vs 87%), and college education (54% vs 46%), P < .001; factors associated with a clinical diagnosis of UI included older age (OR = 1.96), higher parity (>1 birth) (OR = 1.76), higher urgency UI (OR = 1.08), adaptive behavior (OR = 1.2), and UI bother scores.
What does this mean to me and my practice?
This study and others indicate that women with UI do not seek care until symptoms are more severe; health care providers need to be educated regarding the importance of actively screening for UI and initiating appropriate treatment or referrals.
C2. Double Incontinence in a Cohort of Nulliparous Pregnant Women
Espun~a-Pons M, Solans-Domenech M, Sa[spacing acute]nchez M. Neurourology and Urodynamics. 2012;31:1236-1241.
Article Type: Research study
Discussion/Results:
* Authors conducted a cohort study involving previously continent pregnant women who completed self-administered questionnaires regarding incontinence during pregnancy and during the postpartum period.
* In this study, the prevalence of double incontinence during pregnancy was 8.6% (95% CI: 7.0-10.3). Risk factors included age greater than 35 years and family history of urinary incontinence.
* The prevalence rate decreased to 3.5% (95% CI: 2.4-4.6) after delivery; only 6.7% of women had persistent incontinence following delivery. Instrumental vaginal deliveries carried 2.2 times more risk of double incontinence than spontaneous deliveries. Episiotomy was also associated with higher risk.
What does this mean to me and my practice?
Provides objective data that incontinence is a significant issue during pregnancy and reinforces importance of screening for incontinence during pregnancy. Also provides important information regarding modifiable risk factors related to obstetrical interventions.
C3. Can We Prevent Incontinence? ICI-RS 2011
Sievert K, Amend B, Toomey P, Robinson D, Milsom I, Koelbl H, Abrams P, et al. Neurourology and Urodynamics. 2012;31:390-399.
Article Type: Integrative review
Discussion/Results:
* Authors provide thorough review of the literature related to risk factors for urinary and fecal incontinence, and implications for prevention. (The data clearly indicate that incontinence is usually preventable.)
* Authors summarize guidelines for primary, secondary, and tertiary prevention.
What does this mean to me and my practice?
Extremely relevant article for primary care providers as well as clinicians providing incontinence care, as it provides essential information regarding risk factors for incontinence and effective preventive measures.
C4. Associations of Commonly Used Medications With Urinary Incontinence in a Community-Based Sample
Hall S, Yang M, Gates M, Steers W, Tennstedt S, McKinlay J. Journal of Urology. 2012;188(1):183-189.
Article Type: Research study
Discussion/Results:
* This study researched the association between use of common medications and prevalence of urinary incontinence (UI).
* Among women, the prevalence of UI was 28.4% among those using antihistamines, and >20% among those taking tricyclic antidepressants, beta-receptor agonists, and angiotensin II receptor blockers.
* Among men, the prevalence of UI was 22.2% among those taking angiotensin receptor blockers, 19.1% among those taking loop diuretics, and 11.6% among those taking opiates/narcotics.
What does this mean to me and my practice?
Reinforces the importance of pharmaceutical review when evaluating patients with UI. Provides important objective data regarding relationship between various medications and UI.
C5. Urinary Incontinence, Depression, and Posttraumatic Stress Disorder in Women Veterans
Bradley CS, Nygaard IE, Mengeling MA, et al. American Journal of Obstetrics & Gynecology. 2012;206:502.e1-502.e8.
Article Type: Research study
Discussion/Results:
* Study investigated relationship between urinary incontinence (UI), depression, and posttraumatic stress disorder (PTSD) in women veterans.
* In this study, urge UI/mixed UI was associated with PTSD but not with depression; stress UI was not associated with either PTSD or depression. The data also indicate that prior sexual assault is common in women with UI.
What does this mean to me and my practice?
Reinforces the importance of screening for mental health symptoms when caring for women with urge or mixed UI, and of evaluating for prior sexual assault. Valuable article for any clinician providing continence care for female veterans.
C6. The Iceberg of Health Care Utilization in Women With Urinary Incontinence
Minassian V, Yan X, Lichtenfeld M, Sun H, Stewart W. International Urogynecological Journal. 2012;23:1087-1093.
Article Type: Research study
Discussion/Results:
* Authors conducted a survey of women regarding signs and symptoms of UI and found that, among women reporting urinary incontinence, only 25% had been clinically diagnosed with UI; they also found that, among women who sought care for UI, very few were treated by a pelvic floor specialist.
What does this mean to me and my practice?
Provides further evidence that, even though UI is prevalent, preventable, and treatable, most women do not seek care and primary care providers do not screen for the condition. Continence nurses need to provide UI education to both women and primary care providers.
C7. Benefits and Harms of Pharmacologic Treatment for Urinary Incontinence in Women
Shamliyan T, Wyman J, Ramakrishnan R, Sainfort F, Kane R. Annals of Internal Medicine. 2012;156:861-874.
Article Type: Systematic review
Discussion/Results:
* This review summarizes the evidence from RCTs regarding the benefits and harms of drugs used to treat urge UI in community-dwelling women; continence and quality of life were primary outcomes.
* Pooled analyses showed that, per 1000 treated women, continence was restored in 130 with fesoterodine, 85 with tolterodine, 114 with oxybutynin, 114 with trospium, and 107 with solifenacin. Treatment discontinuation rates due to adverse effects, per 1000 treated women, were 31 treated with fesoterodine, 63 with oxybutynin, 18 with trospium, and 13 with solifenacin.
* Authors note that inconsistent definitions of UI reduction and quality of life limited data synthesis.
* The authors provide the following summary: drugs provided better clinical outcomes than placebo in terms of continence restoration, but adverse effects result in discontinuation in significant numbers of patients.
What does this mean to me and my practice?
Provides essential data regarding clinical benefits and adverse effects associated with medications used for urge UI; would be relevant to any continence nurse working with these patients and providing monitoring and education regarding adverse effects.
C8. Caffeine Intake and Risk of Urinary Incontinence Progression Among Women
Townsend M, Resnick N, Grodstein F. Obstetrical Gynecology. 2012;119(5):950-957.
Article Type: Research study
Discussion/Results:
* Authors studied long-term caffeine intake and progression of UI progression over a 2-year period among 21,564 enrolled in the Nurses' Health Study (NHS and NHSII).
* In this study, coffee was not associated with any increase in moderate UI over 2 years.
What does this mean to me and my practice?
Provides limited evidence that caffeine is not a risk factor for progression of moderately severe UI; further study is needed in order to inform practice and patient education regarding caffeine restriction.
C9. Effect of Urinary Incontinence and Its Subtypes on Quality of Life of Women in Eastern Turkey
Firdolas F, Onur R, Deveci S, Rahman S, Sevindik F, Acik F. Urology. 2012;80:1221-1226.
Article Type: Research study
Discussion/Results:
* Authors studied health-seeking behavior and quality of life (QOL) among women with UI in Turkey.
* Most women (>98%) in the study did not seek treatment for UI even though they were informed about health care centers. The possible explanations include embarrassment, low expectations, restrictions by religious beliefs, low socioeconomic status, and assuming that after surgical treatment UI will recur.
* The worst QOL scores were among women with mixed UI and severe UI; domains least affected were entertainment activities, and the domains with greatest impact were emotional health and feelings of frustration. The subjects who experienced significant negative effects on QOL were older and unemployed women, housewives, women living in urban areas, multiparous women, women with history of difficult labor, and women with increased weight.
What does this mean to me and my practice?
Provides additional evidence that women frequently do not seek treatment for UI and reinforces critical need for education of women and primary care providers. Emotional health issues related to UI could be incorporated into community education.
C10. Urinary Incontinence: Prevalence, Risk Factors, and Impact on Health-Related Quality of Life in Saudi Women
Altaweeland W, Alharbi M. Neurourology and Urodynamics. 2012;31:642-645.
Article Type: Research study
Discussion/Results:
* Authors studied UI in Saudi women; they found an overall prevalence of 29%, though only 9% sought treatment. Prevalence according to type was 50% stress UI, 28% urge UI, and 22% mixed UI.
* Primary risk factors included age, obesity, large baby birth weight, high parity, cesarean delivery, vaginal delivery, and diabetes.
* Less than 10% of the women in this study reported a significant effect of urinary incontinence on their individual health-related quality of life.
What does this mean to me and my practice?
Provides additional data regarding prevalence of UI among women, low incidence of health-seeking behavior, and risk factors; reinforces need for community and caregiver education. Also provides helpful information regarding risk factors, which can be used to provide preventive care and education.
C11. Nurses' Interventions in the Management of Urinary Incontinence in the Elderly: An Integrative Review
Abreu da Silva V, D'Elboux M. Revista daEscola Enfermagem U S P. 2012;46(5):1218-1223.
Article Type: Integrative review
Discussion/Results:
* Purpose of this review was to identify nursing strategies used to manage urinary incontinence (UI) in the elderly.
* Measures addressed include fluid intake, measures to eliminate constipation, reduced intake of bladder irritants, weight loss, increased activity, and bladder training for management urgency.
What does this mean to me and my practice?
Provides a helpful summary of strategies currently being used to manage UI in the elderly.
C12. Competence to Provide Urinary Incontinence Care in Taiwan's Nursing Homes: Perceptions of Nurses and Nurse Assistants
Lin S, Wang R, Lin C, Chiang H. Journal of Wound, Ostomy and Continence Nursing. 2012;39(2):187-193.
Article Type: Research study
Discussion/Results:
* In this study, authors found that nurses had significantly higher UI-related knowledge than nurse assistants (NAs); however, no significant differences were found between nurses and NAs in terms of clinical practice behaviors related to UI care.
* Both nurses and NAs showed positive attitudes toward residents with UI, though nurses' attitudes were slightly worse than those of NAs.
* In terms of management, NAs were most likely to select diaper or urinary condom as initial intervention, whereas nurses were most likely to collect a urine sample to evaluate for urinary tract infection.
What does this mean to me and my practice?
Reinforces importance of education re: UI management for all care providers; also provides helpful insights into "usual approach" to management of UI in nursing home residents, and the need for organizational culture change.
C13. Lower Urinary Tract Symptoms and Urinary Incontinence in a Geriatric Cohort-A Population-Based Analysis
Wehrberger C, Madersbacher C, Jungwirth S, Fischer P, Tragl K. BJU: An International Journal of Obstetrics and Gynaecology. 2012;110:1516-1521.
Article Type: Research study
Discussion/Results:
* Authors evaluated a selective sample of octogenarians who were relatively fit and scored high on MMSE (minimum score of 28) to determine prevalence of lower urinary tract symptoms (LUTS) and UI.
* Male cohort reported UI (26%), OAB (50%), nocturia 2x or more (69%), and urgency (54%). Female cohort reported UI (36%), OAB (55%), nocturia 2x or more (49%), and urgency (54%).
* The impact on quality of life was moderate for lower urinary tract dysfunction. Both sexes indicated nocturia to be the most bothersome symptom.
What does this mean to me and my practice?
As the population ages with increased octogenarians, it is helpful to realize that LUTS is prevalent in this age group. Surprisingly, nocturia was noted by the participants to be the most bothersome. Treatment of nocturia should be considered a high priority for this age group. This article has a helpful questionnaire for use with the elderly population.
C14. Long-term Experience With Surgical Treatment of Selected Patients With Bladder Pain Syndrome/Interstitial Cystitis
Andersen A, Granlund P, Schultz A, Talseth T, Hedlund H, Frich L. Scandinavian Journal of Urology and Nephrology. 2012;46:284-289.
Article Type: Research study
Discussion/Results:
* In this study, surgical procedures performed for bladder pain syndrome/interstitial cystitis included cystectomy (n = 5), subtotal cystectomy and bladder augmentation (n = 16), and supravesical urinary diversion with intact bladder (n = 20). Thirteen patients later underwent cystectomy due to persistent pain 12 (6-146) months following the primary procedure.
* A total of 28 patients (74%) reported being free of pain, and 26 patients (68%) reported satisfactory results. Persistent pain following surgical intervention was correlated with prolonged duration of symptoms preoperatively.
What does this mean to me and my practice?
Provides support for presentation of surgery as a treatment option with good symptom relief in patients with disabling bladder pain syndrome/interstitial cystitis who have failed conservative treatment. Helpful resource for any clinician caring for these patients.
C15. Systematic Screening for Urinary Incontinence in Older Women: Who Could Benefit From It?
Visser K, DeBock G, Kollen B, Meijerink M, Berger M, Dekker J. Scandinavian Journal of Primary Health Care. 2012;Early Online:1-8.
Article Type: Research study
Discussion/Results:
* In this study, 64% of the women with UI did not seek care.
* Younger women did not feel that their problem was severe enough to warrant care; older women who sought care reported greater bother and distress from their UI.
What does this mean to me and my practice?
Provides additional evidence that women do not seek care for UI until their symptoms become more severe and bothersome; reinforces need for systematic screening for UI among women during routine health care visits and examinations.
Overactive Bladder
C16. Self-report Function and Disability: A Comparison Between Women With and Without Urgency Urinary Incontinence
Kafri R, Shames J, Golomb J, Melzer I. Disability & Rehabilitation. 2012;34(20):1699-1705.
Article Type: Research study
Discussion/Results:
* In this study, women with urge urinary incontinence reported lower Late Life Function and Disability Instrument scores in overall function, and basic and advanced lower limb function than age-matched continent women.
* Authors note that disability is a multifactorial combination of behavioral, psychological, and environmental factors; authors also noted a negative correlation between body mass index and function scores.
What does this mean to me and my practice?
Provides evidence that urge UI contributes to disability, and suggests that weight loss and physical therapy to improve lower limb function may be effective interventions for patients with urge UI.
C17. Sexually Transmitted Infection and Long-term Risk of Lower Urinary Tract Symptoms
Glass A, Kovshilovskaya B, Breyer B. European Urological Review. 2012;7(2):133-136.
Article Type: Systematic review
Discussion/Results:
* The literature suggests that inflammation resulting from sexually transmitted infection (STI) may play an important role in later urinary tract symptoms (LUTS)/morbidity.
* Data suggest that the risk of later LUTS should be included in education and counseling regarding STI prevention and treatment. For patients presenting with LUTS, the assessment should include STI screening and inquiries regarding past STIs.
What does this mean to me and my practice?
Would be helpful for any clinician providing care for patients with STIs or LUTS.
C18. Incidence and Epidemiology of Storage Lower Urinary Tract Symptoms
Abrams P, Manson J, Kirby M. European Urological Review. 2012;7(1):50-54.
Article Type: Integrative review
Discussion/Results:
* Studies indicate an association between age and an increase in the prevalence of LUTS; OAB with UI is more prevalent among women, and OAB without UI is more prevalent in men.
* Epidemiologic studies show that OAB is more common among African American and Hispanic men than among white men, while race was not predictive of OAB in women. Obesity is a risk factor for OAB in women, and metabolic syndrome is a predictor for OAB and LUTS in men.
* Studies reflect significant costs associated with LUTS and OAB ($65.9 billion per year in the United States), as well as reduced work productivity and increased absenteeism.
What does this mean to me and my practice?
Provides important data regarding prevalence and impact of OAB and LUTS, and reinforces importance of educating primary care providers regarding assessment and management of this condition.
C19. Pharmacologic Treatment for Urgency-Predominant Urinary Incontinence in Women Diagnosed Using a Simplified Algorithm: A Randomized Trial
Huang A, Hess R, Arya L, Richter H, Subak L, Bradley C, Rogers R, et al. American Journal of Obstetrics and Gynecology. 2012;206(5):444.1-444.11.
Article Type: Research study
Discussion/Results:
* Study tested a streamlined diagnosis and treatment plan including pharmacological therapy with patients assigned randomly to fesoterodine therapy (4-8 mg daily) or placebo. Urgency diagnosis was made with 3-item questionnaire. Urinary incontinence was assessed with the use of voiding diaries; postvoid residual volume was measured after treatment.
* Women assigned randomly to fesoterodine therapy noted 0.9 fewer urgency and 1.0 fewer total incontinence episodes/day, compared with placebo (P <= .001). Four serious adverse events (none related to treatment) occurred in each group. Postvoid residual volumes were <=250 mL after treatment.
What does this mean to me and my practice?
The tested algorithm of 3-item questionnaire and pharmacologic therapy resulted in a moderate decrease in incontinence frequency without causing either significant urinary retention or serious adverse events, which provides support for use of a streamlined algorithm for diagnosis and treatment of female urgency.
Stress Incontinence
C20. Adjustable Continence Balloons: Clinical Results of a New Minimally Invasive Treatment for Male Urinary Incontinence
Kjaer L, Fode M, Norgaard N, Sonksen J, Nordling J. Scandinavian Journal of Urology and Nephrology. 2012;46:196-200.
Article Type: Research study
Discussion/Results:
* Adjustable continence balloons (ProAct) were surgically implanted in 114 incontinent men with SUI.
* Results included a decrease in 24-hour urinary leakage (352.5 vs 11 mL; P < .001) and in the number of pads used per day (4.75 vs 2.25; P = .001). A total of 72 patients (80%) reported >50% reduction in leakage, and 58 patients (61%) reported being dry or markedly improved. Fifty patients (53%) reported being very satisfied or predominantly satisfied. Sixty patients (63%) reported no discomfort.
* Complications were reported by 23 patients, all of which were successfully treated in the outpatient setting with a replacement device implanted.
What does this mean to me and my practice?
The adjustable continence balloons (ProAct) were found in this study to be a viable treatment option for men with stress urinary incontinence.
C21. Pelvic Floor Muscle Strength Predicts Stress Urinary Incontinence in Primiparous Women After Vaginal Delivery
Baracho S, da Silva L, Baracho E, da Silva Filho A, Sampaio R, de Figueiredo E. International Urogynecology Journal. 2012;23:899-906.
Article Type: Research study
Discussion/Results:
* Authors studied 192 primiparous women for 5 to 7 months postpartum to determine predictors of SUI and found that pelvic floor muscle (PFM) strength was the strongest single predictor of SUI.
* Authors also found that a model using combination of predictors (PFM strength <=35.5 cmH2O, newborn weight >2.988 g) and a new onset of SUI during pregnancy predicted postpartum SUI with 84% accuracy (P = 0.00).
What does this mean to me and my practice?
Study data indicate that SUI can be predicted reliability in primiparous women, and that PFM strengthening prior to pregnancy may prevent or reduce SUI.
C22. Do Urodynamic Parameters Predict Persistent Postoperative Stress Incontinence After Midurethral Sling? A Systematic Review
Kawasaki A, Wu J, Amundsen C, Weidner A, Judd J, Balk E, Siddiqui N. International Urogynecology Journal. 2012;23:813-822.
Article Type: Systematic review
Discussion/Results:
* Data indicate that high maximum urethral closure pressure preoperatively is a predictor of success following retropubic or transobturator sling.
* Data also indicate that high preoperative Valsalva Leak Point Pressure is predictive of cure following retropubic sling but is not a statistically significant predictor of cure with transobturator sling.
What does this mean to me and my practice?
Provides very helpful information regarding urodynamic results that can predict positive outcomes for various surgical procedures designed to cure stress UI; these results can guide the clinician in determining best surgical options for an individual patient.
C23. Treatment Options for Male Stress Urinary Incontinence
Elterman D, Chughtai B, Sandhu J. European Urological Review. 2012;7(2):127-131.
Article Type: Integrative review
Discussion/Results:
* Review addresses diagnostic and treatment options for male stress urinary incontinence, including evaluation of a treatment algorithm for postprostatectomy incontinence.
* Prior to implementing interventions, a patient evaluation should be performed to include history; physical examination; urinalysis; Post Void Residual; symptoms and quality-of-life questionnaires; and voiding diary.
* Conservative treatment including pelvic floor muscle training and lifestyle modifications should be implemented; surgical options should be explored for patients who do not show significant improvement after 6 to 12 months. Some authors recommend cystourethroscopy and urodynamics prior to any surgicaltreatment.
What does this mean to me and my practice?
This article provides an excellent overview of evaluation and treatment for male SUI and especially postprostatectomy incontinence.
C24. Early Results of a European Multicentre Experience With a New Self-anchoring Adjustable Transobturator System for Treatment of Stress Urinary Incontinence in Men
Hoda M, Primus G, Fischereder K, Von Heyden B, Mohammed N, Schmid N, Moll V, et al. BJU International. 2012;111:296-303.
Article Type: Research study
Discussion/Results:
* Study involved an adjustable transobturator system (ATOMS; AMI, Vienna, Austria) for treatment of SUI in men. The mean number of adjustments required to reach the desired outcome of dryness, improvement in incontinence, and/or patient satisfaction was 3.8.
* The overall success rate at mean follow-up time of 17.8 months was 92%; mean pad use decreased from 7.1 to 1.3 pads/24 hours (P = .001). 63% of patients were dry and 29% were improved.
* Complications included temporary urinary retention in 2 patients and transient perineal/scrotal dysesthesia or pain in 68 patients, which resolved after 3 to 4 weeks of nonopioid analgesics. Wound infections at the titanium port occurred in 4 cases.
What does this mean to me and my practice?
Provides objective data that self-anchoring adjustable transobturator male system can be effectively used to treat males with stress urinary incontinence.
C25. Comparisons of Approaches to Pelvic Floor Muscle Training for Urinary Incontinence in Women: An Abridged Cochrane Systematic Review
Hay-Smith J, Herdeschee R, Dumoulin C, Herbison P. European Journal of Physical and Rehabilitation Medicine. 2012;48:689-705.
Article Type: Systematic review
Discussion/Results:
* The search produced 574 studies; 21 studies were included. Findings reveal that PFMT involving weekly visits with health care providers was the most effective method.
What does this mean to me and my practice?
Provides objective data to guide patient instruction in pelvic muscle exercises and supports regular weekly visits as the most beneficial method.
C26. Reproducibility of a Cough and Jump Stress Test for the Evaluation of Urinary Incontinence
Horndalsveen Berild G, Kulseng-Hanssen S. International Urogynecology Journal. 2012;23:1449-1453.
Article Type: Research study
Discussion/Results:
* This study of 108 incontinent women measured volume of leakage with 2 stress tests (cough and jump), and demonstrated significant variation in the volume of leakage produced by the 2 maneuvers, with much greater leakage occurring with the jump test (P < .02).
* Study showed poor correlation between stress tests and 24-hour pad test, and between stress tests and Stress Incontinence Index.
What does this mean to me and my practice?
The stress tests (cough and jump) are reliable at detecting leakage with stress incontinence and provide a noninvasive test for SUI; beneficial for any clinician evaluating women with symptoms of stress UI.
C27. Stress Urinary Incontinence and Quality of Life: A Reliability Study of a Condition-Specific Instrument in Paper- and Web-Based Versions
Sjostrom M, Stenlund H, Johansson S, Umefjord G, Samuelsson E. Neurourology and Urodynamics. 2012;31:1242-1246.
Article Type: Research study
Discussion/Results:
* Authors evaluated reliability of the Swedish questionnaire (International Consultation on Incontinence Modular Questionnaire-Lower Urinary Tract Symptoms Quality of Life (ICIQ-LUTSqol) in paper- and Web-based formats for women with stress urinary incontinence.
* This highly recommended quality-of-life questionnaire was found to be reliable in either the paper- or Web-based format.
What does this mean to me and my practice?
Provides objective data regarding reliability of ICIQ-LUTSqol when used to assess women with stress urinary incontinence and supports its use in clinical practice.
C28. Long-term Impact of Surgical Repair for Stress Urinary Incontinence on Female Sexual Functions, Distress, and Behaviors
Witek A, Drosdzol-Cop A, Nowosielski K, Solecka A, Mikus K. Journal of Clinical Nursing. 2012;22:1591-1598.
Article Type: Research study
Discussion/Results:
* Study evaluated outcomes among women with stress SUI undergoing surgical intervention; all women reported significant reduction in UI symptoms postoperatively.
* The comparison of sexual function pre- and postsurgery showed positive significant differences in reports of desire, arousal, and frequency of orgasm; women also reported improvement in feelings of sexual attractiveness, quality of sex life, and relationship with partner.
What does this mean to me and my practice?
Provides evidence that surgical correction of SUI improves female sexual function and reduces sexual distress; findings would be beneficial when counseling women considering surgical repair for SUI.
C29. Women With Pure Stress Urinary Incontinence Symptoms Assessed by the Initial Standard Evaluation Including Measurement of Postvoid Residual Volume and a Stress Test: Are Urodynamic Studies Still Needed?
Jeong S, Kim H, Lee B, Rha W, Oh J, Jeong C, Kim J, et al. Neurourology and Urodynamics. 2012;31:508-512.
Article Type: Research study
Discussion/Results:
* Authors evaluated accuracy of diagnosis of SUI based only on symptoms as compared to urodynamic diagnosis; of 211 women classified as having pure SUI by clinical presentation only 167 (79.1%) had pure urodynamic stress urinary incontinence (USUI), while 33 (15.7%) had detrusor overactivity and 8 (3.8%) had detrusor underactivity/bladder outlet obstruction.
* In this study, the sensitivity and specificity of pure SUI symptoms for pure USUI were 28.6% and 89.9%, respectively. Adding PVR and a stress test resulted in only a 3.6% increase in predictive accuracy.
* Authors emphasize that 20% of women with pure SUI symptoms exhibit pathophysiologies that could affect surgical outcomes.
What does this mean to me and my practice?
Provides objective data that surgical intervention for SUI should not be based only on clinical presentation; urodynamic evaluation is necessary presurgical repair for SUI.
Pediatric Incontinence
C30. Prevalence of Enuresis and Daytime Urinary Incontinence in Children and Adolescents With Sickle Cell Disease
Portocarrero ML, Portocarrero ML, Sobral M, Lyra I, Lordelo P, Barroso P. The Journal of Urology. 2012;187:1037-1040.
Article Type: Research study
Discussion/Results:
* Study evaluated prevalence of enuresis and daytime UI in children and adolescents with sickle cell disease; enuresis was present in 50 patients (32.3%) in the sickle cell disease group versus 5 (5%) in the control group (P = .000), and daytime UI was reported in 36 individuals (23.2%) of the sickle cell group versus 11 (11.0%) without sickle cell disease (P = .014).
* Complaints of urgency were found in a total of 52 patients with sickle cell disease (33.5%) compared to 10 in the control group (10%; P = .000), and frequency was noted in a total of 49 patients with sickle cell disease (31.6%) compared to 6 control group members (6%; P = .000).
What does this mean to me and my practice?
Screening for enuresis and daytime urinary incontinence should occur with children and adolescents with sickle cell disease to facilitate treatment.
C31. Unexpected Results of a Nationwide, Treatment-Independent Assessment of Fecal Incontinence in Patients With Anorectal Anomalies
Schmiedeke E, Zwink N, Schwarzer N, Bartels E, Schmidt D, Grasshoff-Derr S, et al. Pediatric Surgery International. 2012;28(8):825-830.
Article Type: Research study
Discussion/Results:
* This study revealed complete continence in 27%, grade 1 soiling in 42%, and grade 2/3 soiling in 31% (Krickenbeck Grade Classification) of patients with anorectal anomalies.
* Bowel management was practiced by 49% of the incontinent patients, with continence achieved in 19%.
* Overall anorectal malformations (ARM) patients showed a high rate of fecal incontinence and insufficiently treated constipation.
What does this mean to me and my practice?
Provides important data indicating insufficient treatment of children with anorectal anomalies, and the need for intensifiedconservative treatment with routine follow-up for constipation and fecal incontinence. Education of parents of children with ARM should include stool assessment and indicators of constipation and fecal incontinence.
C32. Use of Validated Bladder/Bowel Dysfunction Questionnaire in the Clinical Pediatric Urology Setting
Drzewiecki B, Thomas J, Pope J, Adams M, Brock J, Tanaka S. The Journal of Urology. 2012;188(4S):1578-1583.
Article Type: Research study
Discussion/Results:
* Authors evaluated the use of bladder/bowel dysfunction questionnaire in a busy clinical practice; among 267 patients, 134 had bladder/bowel dysfunction with related diagnoses and 133 had bladder/bowel dysfunction with unrelated diagnoses.
* Higher score on questionnaire correlated with bladder/bowel dysfunction-related diagnoses: urinary incontinence, dysuria, and nocturnal enuresis (P < .001).
* The ICD-9 diagnosis of constipation did not correlate with higher scores for constipation-related items.
What does this mean to me and my practice?
The bladder/bowel dysfunction questionnaire is a valid questionnaire for bladder dysfunction but does not provide valid information related to constipation. Beneficial article for any clinician managing bowel and bladder dysfunction in the pediatric setting.
Fecal Incontinence
C33. Economic Cost of Fecal Incontinence
Xu X, Menees S, Zochowski M, Fenner D. Diseases of the Colon & Rectum. 2012;55(5):586-598.
Article Type: Research study
Discussion/Results:
* Study participants included 332 adult patients with fecal incontinence for >1 year with at least monthly leakage of solid, liquid, or mucous stool.
* The average annual cost associated with fecal incontinence was $4110 per person ($2353 direct medical costs, $209 nonmedical costs, $1549 indirect cost of lost productivity). Data analysis suggests that severity of incontinence is directly correlated with the cost of care.
What does this mean to me and my practice?
Provides objective data regarding cost of fecal incontinence and importance of effective prevention and management to reduce cost.
C34. A Review of Posterior Tibial Nerve Stimulation for Faecal Incontinence
Thomas G, Dudding T, Rahbour G, Nicholls R, Vaizey C. Colorectal Disease. 2012;15:519-526.
Article Type: Systematic review
Discussion/Results:
* Thirteen posterior tibial nerve stimulation studies were identified and all studies demonstrated reduction in fecal incontinence.
* 63% to 82% of patients reported >50% improvement in fecal incontinence episodes; improvement was reported in urgency (1-5 minutes), and in Cleveland Clinic fecal incontinence scores. Urge and mixed incontinence appeared to improve more than passive incontinence.
What does this mean to me and my practice?
Provides evidence that PTNS provides effective management of fecal incontinence. Further study is recommended by the authors of this systematic review.
C35. Prevalence, Management, and Clinical Challenges Associated With Acute Faecal Incontinence in the ICU and Critical Care Settings: The FIRST(TM) Cross-sectional Descriptive Survey
Garciaa C, Binks R, De Lucac E, Dierkes C, Franci A, Gallart E, Niederalt G, Wyncoll D. Intensive and Critical Care Nursing. 2012;28:242-250.
Article Type: Research study
Discussion/Results:
* A total of 962 questionnaires were completed by nurses (60%), physicians (29%), and pharmacists or purchasing personnel (11%).
* The prevalence of acute fecal incontinence with diarrhea (AFId) among ICU patients on the day of the survey ranged from 9% to 37%. Clinical challenges associated with AFId included perineal dermatitis, moisture lesions, and sacral pressure ulcers; clinical challenges rated as most important included reducing the risk of cross-infection and maintaining skin integrity. 49% of respondents stated that there was no hospital protocol or guideline for AFId management.
* The amount of nursing time spent managing AFId was estimated as 10 to 20 minutes for managing one AFId episode by 2 to 3 health care staff.
What does this mean to me and my practice?
Provides valuable data regarding prevalence of AFId in ICU patients and the related clinical challenges. Reinforces need for management protocols and staff education, both of which fall within the scope of practice for WOC nurses.
C36. Sacral Nerve Stimulation in Faecal Incontinence Associated With an Anal Sphincter Lesion: A Systematic Review
Ratto C, Litta F, Parello A, Donisi L, De Simone V, Zaccone G. Colorectal Disease. 2012;14:e297-e304.
Article Type: Systematic review
Discussion/Results:
* Review included 10 studies including 119 patients, all of whom had a lesion involving the external and/or internal anal sphincter documented on endoanal ultrasound.
* Of the 119 patients who underwent a peripheral nerve evaluation test, 106 (89%) had a definitive implant performed. Incontinence episodes per week decreased from 12.1 to 2.3, and the average Cleveland Clinic Score decreased from 16.5 to 3.8. The ability to delay defecation improved significantly, as did quality of life.
What does this mean to me and my practice?
Provides evidence supporting the use of sacral nerve stimulation for patients with fecal incontinence due to an anal sphincter lesion. Education regarding management options for these patients should include information regarding sacral nerve stimulation.
C37. Faecal Incontinence Persisting After Childbirth: A 12-Year Longitudinal Study
MacArthur C, Wilson D, Herbison P, Lancashire RJ, Hagen S, Toozs-Hobson P, Dean N, Glazener C. BJOG: An International Journal of Obstetrics and Gynaecology. 2013;120(2):169-179. Published Online 27 November 2012.
Article Type: Research study
Discussion/Results:
* Persistent fecal incontinence was studied in relation to delivery history and quality of life 12 years following delivery; the prevalence of persistent fecal incontinence was 6.0% (227/3763).
* 43% of participants with FI at 3 months also reported persistent FI at 12 years; risk factors included 1 or more forceps deliveries and obesity.
* Persistent FI correlated with lower quality-of-life scores.
What does this mean to me and my practice?
Provides objective data regarding risk factors for persistent fecal incontinence. Obesity is a modifiable factor that is associated with persistent FI and should be included with modifiable lifestyle changes in the management of persistent FI.
C38. Bowel Habits and Fecal Incontinence in Patients With Obesity Undergoing Evaluation for Weight Loss: The Importance of Stool Consistency
Pares D, Vallverdu H, Monroy G, Amigo P, Romagosa C, Toral M, Hermoso J, Saenz-de-Navarrete G. Diseases of the Colon & Rectum. 2012;55(5):599-604.
Article Type: Research study
Discussion/Results:
* Study involved 52 patients with a mean BMI of 39.6 kg/m2 undergoing weight loss management. Seventeen patients (32.7%) reported FI: flatus in 9 of 17 (52.9%), liquid stool in 6 of 17 (35.2%), and solid stool in 2 of 17 (11.7%). There was a significant relationship between nonformed stools and FI (P = .004).
* Health-related quality of life was lower in patients with fecal incontinence in the dimensions of physical role (P = .03) and social functioning (P = .04).
What does this mean to me and my practice?
Provides evidence that modifying stool consistency may reduce fecal incontinence in obese patients during weight loss management.
Infectious Diarrhea
C39. A Gastroenterologist's Guide to Probiotics
Ciorba M. Clinical Gastroenterology and Hepatology. 2012;10:960-968.
Article Type: Integrative review
Discussion/Results:
* This article provides an overview of probiotics and their role in treatment of infectious diarrhea, antibiotic-associated diarrhea, irritable bowel syndrome, inflammatory bowel disease, and pouchitis along with study results.
* A summary chart of probiotics is included in the article.
* Probiotic safety is discussed in the article with evidence that probiotics have few side effects and complications.
What does this mean to me and my practice?
Provides summary review of current evidence regarding probiotics and their role in treatment of various gastrointestinal disorders.
C40. Association Between Proton Pump Inhibitor Therapy and Clostridium difficile Infection in a Meta-analysis
Deshpande A, Pant C, Pasupuleti V, Rolston D, Jain A, Deshpande N, Thota P, et al. Clinical Gastroenterology and Hepatology. 2012;10:225-233.
Article Type: Research study (meta-analysis)
Discussion/Results:
* Thirty studies met the inclusion criteria (n = 202,965). Results indicate that protein pump inhibitor (PPI) therapy increased the risk for Clostridium difficile infection (CDI) (odds ratio, 2.15, 95% confidence interval, 1.81-2.55).
* Authors point out the need for caution with generalization of results as there was significant heterogeneity among studies(P = .0001).
What does this mean to me and my practice?
While further study is recommended, there is significant evidence that protein pump inhibitors may increase the risk of Clostridium difficile infection.
C41. Chronic Gastrointestinal Consequences of Acute Infectious Diarrhea: Evolving Concepts in Epidemiology and Pathogenesis
Verdu E, Riddle M. American Journal of Gastroenterology. 2012;107:981-989.
Article Type: Integrative Review
Discussion/Results:
* This review summarizes epidemiologic and pathological evidence related to acute infectious diarrhea and related complications.
* Gaps in research and knowledge are identified, and public policy related to acute infectious diarrhea is discussed.
What does this mean to me and my practice?
Acute infectious diarrhea is encountered frequently by WOC nurses in clinical practice. This literature review provides an excellent foundation for the understanding of acute infectious diarrhea.
Urinary Tract Infections
C42. Lactobacilli vs Antibiotics to Prevent Urinary Tract Infections: A Randomized, Double-Blind Noninferiority Trial in Postmenopausal Women
Beerepoot M, ter Riet G, Nys S, van der Wal W, de Borgie C, de Reijke T, Prins J, et al. Archives of Internal Medicine. 2012;172(9):704-712.
Article Type: Research study
Discussion/Results:
* A total of 252 postmenopausal women with recurrent urinary tract infections (UTIs) were randomly assigned to 1 of 2 treatment arms for prevention of UTIs: 12 months of prophylaxis with trimethoprim sulfamethoxazole 480 mg once daily, or oral capsules containing 109 colony-forming units of Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 twice daily.
* The mean number of symptomatic UTIs after 12 months of prophylaxis were 2.9 in the trimethoprim sulfamethoxazole group and 3.3 in the lactobacilli group. The between-treatment difference of 0.4 UTIs per year (95% CI, -0.4 to 1.5) indicated no statistical difference between the 2 prophylaxis arms. Resistance developed after 1 month of trimethoprim sulfamethoxazole while no resistance occurred in the lactobacilli prophylaxis group.
What does this mean to me and my practice?
Lactobacilli prophylaxis may be a viable option with less resistance than trimethoprim sulfamethoxazole in postmenopausal women with recurrent UTIs.
C43. Urinary Tract Infections in Hospitalized Inflammatory Bowel Disease Patients: A 10-Year Experience
Peyrin-Biroulet L, Pillot C, Oussalah A, Billioud V, Aissa N, Balde M, Williet N, et al. Inflammatory Bowel Diseases. 2012;18:697-702.
Article Type: Research study
Discussion/Results:
* Study reviewed risk factors for urinary tract infection (UTI) in patients with inflammatory bowel disease (IBD). Data indicated prevalence of UTI in IBD patients was 4% versus 3.3% in non-IBD patients (P = .1). Prevalence of UTI was 4.5% in ulcerative colitis (UC) patients and 2.1% in Crohn's disease (CD) patients (P = .6).
* Risk factors for UTI in CD patients were perianal disease and colonic disease; in UC patients, risk factors were age over40 years, and disease duration over 11 months. Male gender was negatively associated with UTI.
What does this mean to me and my practice?
Cystitis is the most common genitourinary complication in CD, and the study suggests that IBD patients should be educated regarding risk factors and signs and symptoms of UTI (especially female patients.)
C44. The Impact of Obesity on Urinary Tract Infection Risk
Semins M, Shore A, Makary M, Weiner J, Matlaga B. Urology. 2012;79:266-269.
Article Type: Research study
Discussion/Results:
* In this study, women were 4.2 times more likely than men to be diagnosed with a UTI (19.3% vs 4.6%) and 3.6 times more likely to be diagnosed with pyelonephritis (1.22% vs 0.34%).
* Obesity was a significant risk factor for both UTI and pyelonephritis.
What does this mean to me and my practice?
Obesity appears to be associated with an increased risk for UTI and pyelonephritis. Obesity appears to be a modifiable risk factor and weight loss can be a viable option for reduction of UTI and pyelonephritis.
C45. Cranberry-Containing Products for Prevention of Urinary Tract Infections in Susceptible Populations: A Systematic Review and Meta-analysis of Randomized Controlled Trials
Wang C, Fang C, Chen N, Liu S, Yu P, Wu T, Chen W, et al. Archives of Internal Medicine. 2012;172(13):988-996.
Article Type: Research study (meta-analysis)
Discussion/Results:
* In this study, cranberry-containing products seemed to be more effective in women with recurrent UTIs (RR, 0.53; 95% CI, 0.33-0.83) (I2 = 0%), female populations (RR, 0.49; 95% CI, 0.34-0.73) (I2 = 34%), children (RR, 0.33; 95% CI, 0.16-0.69)(I2 = 0%), cranberry juice drinkers (RR, 0.47; 95% CI, 0.30-0.72) (I2 = 2%), and subjects consuming cranberry-containing products more than twice daily (RR, 0.58; 95% CI, 0.40-0.84)(I2 = 18%).
What does this mean to me and my practice?
This systematic review and meta-analysis support the consumption of cranberry-containing products for protection against UTIs in certain populations; however, this conclusion should be interpreted cautiously due to variation across the different trials.
Catheter-Associated Urinary Tract Infections
C46. Guidelines to Prevent Catheter-Associated Urinary Tract Infection: 1980 to 2010
Conway L, Larson E. Heart and Lung. 2012;41(3):271-283.
Article Type: Guideline review
Discussion/Results:
* Authors reviewed 8 CAUTI (catheter-associated urinary tract infection) guidelines and identified 3 consistent recommendations: (1) catheterize only when necessary and only for as long as necessary, (2) insert catheters using aseptic technique and sterile equipment, and (3) maintain a closed, sterile drainage system. Advice regarding meatal cleansing was contradictory.
* Appropriate use and indications for urinary catheterization include (1) acute urinary retention or obstruction, (2) perioperative use in select procedures, and (3) accurate measurement of urine output in critically ill patients.
* Additional recommendations included the use of sample port and aseptic technique to obtain small volume urine samples; keeping drainage bag below the bladder level; avoidance of routine irrigation and catheter changes; avoidance of routine use of antibiotics/antiseptics for asymptomatic bacteriuria.
What does this mean to me and my practice?
This review of CAUTI prevention guidelines offers insight into the review of 8 guidelines and provides applicable prevention options.
C47. Complications of Foley Catheters-Is Infection the Greatest Risk?
Leuck A, Wright D, Ellingson L, Kraemer L, Kuskowski M, Johnson J. The Journal of Urology. 2012;187:1662-1666.
Article Type: Research study
Discussion/Results:
* Urinalysis and urine culture were obtained on 407/6513 (6.3%) surveyed Foley catheter days. A total of 116 possible urinary tract infections (UTIs) were identified with only 21 (18%) exhibiting clinical manifestations. Thirty-nine (70%) of 56 antimicrobial-treated suspected UTIs were asymptomatic bacteriuria.
* Catheter-associated genitourinary trauma occurred in 100 instances (1.5% of Foley catheter days); 32 (32%) led to interventions such as prolonged catheterization or cystoscopy.
What does this mean to me and my practice?
Avoidance of indwelling catheters reduces unnecessary antimicrobial use and also reduces catheter-associated genitourinary trauma. Unnecessary indwelling catheters should be avoided.
C48. Catheter-Associated Urinary Tract Infection
Tambyah P, Oon J. Current Opinion in Infectious Diseases. 2012;25:365-370.
Article Type: Guideline review
Discussion/Results:
* Review of 5 guidelines including the Infectious Diseases Society of America (IDSA); provides a summary table of guideline recommendations included in this review.
* Across the guidelines the most effective and consistent recommendation identified is avoidance of catheter use or removal. Reminder systems can be helpful (eg, automatic stop orders that prompt removal of indwelling catheters within 3 days of insertion).
* Alternatives to indwelling catheter use include condom and suprapubic catheters, and intermittent self-catheterization.
* Catheter care guidelines include maintenance of a closed drainage system and minimal duration of catheterization.
* Catheter selection guidelines are also summarized (silver or antibiotic-coated catheters, hydrophilic catheters, and trefoil catheters).
What does this mean to me and my practice?
This review provides current recommendations regarding prevention of CAUTI and a succinct summary table that provides applicable clinical information. Catheter selection and bladder bundling concepts are discussed.
Incontinence-Associated Dermatitis
C49. Incontinence-Associated Dermatitis Consensus Statements, Evidence-Based Guidelines for Prevention and Treatment, and Current Challenges
Doughty D, Junkin J, Kurz P, Selekof J, Gray M, Fader M, Bliss D, et al. Journal of Wound, Ostomy and Continence Nursing. 2012;39(3):303-315.
Article Type: Integrative review and consensus
Discussion/Results:
* This review addresses clinical challenges associated with IAD: lack of consensus among clinicians regarding differential classification of pressure ulcers and moisture lesions such as IAD; product selection and application for prevention and management of IAD; the need for consistent labeling and for listing of product features and benefits along with education of bedside nursing staff; and education regarding the prevention, assessment, and management of IAD.
* Instruments that facilitate appropriate management are included in the article.
What does this mean to me and my practice?
Summarizes current guidelines regarding differential assessment IAD versus ITD versus pressure ulcers, and current guidelines for prevention and management of IAD. Currently available tools to assist with differential assessment and management are discussed and highlighted. Valuable reference for any clinician caring for these patients.
C50: Incontinence-Associated Dermatitis: A Comprehensive Review and Update
Gray M, Beeckman D, Bliss D, Fader M, Logan S, Junkin J, Selekof J, Doughty D. Journal of Wound, Ostomy and Continence Nursing. 2012;39(1):1-14.
Article Type: Integrative review
Discussion/Results:
* Literature review found lack of common nomenclature for moisture-related skin damage in the perineal area. The term incontinence-associated dermatitis (IAD) was an acceptable term to the panel.
* IAD studies are few but increasing in number. Prevalence rates and time to onset differ among care settings.
* Etiological and pathogenesis studies are lacking and most recommendations for prevention and management are based primarily on clinical consensus.
* Differentiation of IAD from pressure ulcers remains problematic presenting challenges and lack of interrater reliability for pressure ulcer prevalence and incidence studies.
What does this mean to me and my practice?
IAD is a common clinical problem that requires further research and refinement. This article reviews the available research and is a valuable reference for any nurse providing skin care for incontinent patients.
C51: Incontinence-Associated Dermatitis in a Long-term Acute Care Facility
Long M, Reed L, Dunning K, Ying J. Journal of Wound, Ostomy and Continence Nursing. 2012;39(3):318-327.
Article Type: Research study
Discussion/Results:
* Authors studied prevalence and incidence of IAD in a long-term acute care facility (LTAC).
* IAD was present on admission in 39 out of 171 patients (prevalence of 22.8%); 10 out of 132 patients developed IAD following admission (7.6% incidence).
* Sixty of 171 patients had a pressure ulcer (PU) noted on admission (prevalence rate of 35.1%); 4/111 patients developed pressure ulcers following admission (3.6% incidence).
* Authors discuss factors associated with IAD and PU prevalence and incidence.
What does this mean to me and my practice?
This study identifies factors associated with prevalence and incidence of IAD and PU prevalence and incidence and provides comparative basis for prevalence and incidence rates for IAD and PU.