Urinary incontinence after radical retropubic prostatectomy is not related to patient body mass index.

To determine if a relationship exists between patient body habitus and urinary incontinence after radical retropubic prostatectomy (RRP) for clinically localized prostate cancer. A questionnaire developed by combining parts of lower urinary tract symptom questionnaires concerning voiding symptoms after RRP was mailed to 268 consecutive patients who underwent RRP over a 2-year period. The interval between surgery and questionnaire administration was greater than 24 months for each patient. No interval was greater than 54 months. The questionnaire attempted to overcome the subjectivity of patient documented urinary incontinence by probing different aspects of each patient's voiding symptoms. Body mass index (BMI), obtained from preoperative anesthesia records, was used as the measurement for body habitus. Pearson correlations were used to determine relationships between BMI and responses and the independent t-test was used to determine differences between grouped responses and BMI. One hundred and eighty-two of 268 (68%) questionnaires were returned. No relationship was detected between BMI and patient estimates of urinary control, QOL relating to urinary symptoms, severity of stress incontinence, or use of protection (pad use). As well, no statistically significant relationship was found between BMI and a patient's willingness to undergo RRP again, based on his voiding symptoms, if given the choice. In conclusion, although patient body habitus may be related to other clinical outcomes following RRP, there does not appear to be a relationship of BMI to post-RRP urinary incontinence.

Sexual function in the elderly.

Little is known about sexual behavior among the elderly living in the community. Questions about sexual activity and its correlates were included in a clinic examination whose participants were identified by a household survey of a probability of Washtenaw County, Michigan, elderly, aged 60 years and over, on the medical, epidemiological, and social aspects of aging. Estimates of proportions based on responses at the clinic examination were also projected to the demographics of the household survey. The estimated proportions of individuals who are sexually active are 73.8% for married men and 55.8% for married women; among unmarried men and women the proportions are 31.1% and 5.3%, respectively. The levels decrease significantly with age in both genders. The estimated proportion of married men with erectile impotence is 35.3%. Significant associations were observed between having problems with mobility and the lack of sexual activity in both genders. The prevalence of impotency was significantly associated with a history of heart attack, urinary incontinence, and the use of sedatives. The consumption of at least one cup of coffee per day was significantly associated with a higher prevalence of sexual activity in women and with a higher potency rate in men.

Urinary incontinence in elderly women: clinical findings.

Two-hundred women self-described as having urinary incontinence, aged 55 to 90 years and living in the community completed a comprehensive history and physical examination. Initial presentation of urine loss was most commonly stress incontinence symptoms (35%). Scoring of peak response to volume lost and frequency revealed urine loss necessitating a clothing change for 78% and daily loss experienced by 73%. Over half had experienced a urine loss problem for more than five years. Most (65%) had sought treatment, but a minority reported current (11%) or previous (36%) treatment. Thirty-six percent were found to have severe atrophic vaginitis with severe urethocele (10%), cystocele (13%), rectocele (12%) less common. Pelvic floor strength by clinical scoring was weak (mean, 1.05 on a 5-point scale). The vaginal electromyograph first contraction peak mean was 5.94 microvolts sustained at 50% or better for 3.92 seconds. Clinical criteria established that 66% had stress, 27% a mixture of stress and urge, only 4% pure urge incontinence, and 4% other.

Urinary incontinence in elderly women: urodynamic evaluation.

The objective of this study is to characterize urinary incontinence observed in elderly women and to assess the importance of various parameters used to evaluate urinary incontinence. Two hundred consecutive, ambulatory, outpatient, incontinent women 55 years of age and over who were seen at the Continence Program Clinic and completed a medical and urodynamic protocol are included in this paper. After a thorough medical history and a complete physical examination, urodynamic tests were performed. The urodynamic results showed that 77% of incontinent women had an incompetent urethra. Twenty-five percent had a hyperactive bladder, 8% had "other" types, and 7% had a normal study. Comparison of the clinical diagnosis with the actual urodynamic diagnosis for stress incontinence revealed a 78% accuracy and only a 6% false negative. In contrast, a similar comparison for urge incontinence found only 44% accurate and 45% false negative. Analysis of the urodynamic tests revealed that the simple provocative full-bladder stress test was as effective as the radiographic or electronic pressure measurement in detecting incompetent urethra producing stress urinary incontinence. Provocative upright cystometry was helpful in uncovering 33% of hyperactive bladders not provoked in the supine position. Complex urodynamic tests should be reserved for unexplained incontinence or when symptomatology is complex.

Pelvic muscle exercise for stress urinary incontinence in elderly women.

PURPOSE: To compare pelvic muscle exercise to pharmacologic treatment of stress urinary incontinence, the most common cause of urine leakage reported by community-living elderly women. SUBJECTS: Convenience sample of 157 community-living women, aged 55 to 90 years, after completion of a comprehensive diagnostic evaluation. METHODS: Eighty-two subjects were randomly assigned to the exercise protocol (with a 34% attrition rate). Pelvic muscle exercises were taught and monitored for 6 months. Phenylpropanolamine hydrochloride was given to the other group in a dose of 50 mg a day, increasing to 50 mg twice a day. MAIN RESULTS: Treatment outcomes (subjective improvement, self recorded frequency of wetting) were equally satisfactory in both groups. The response to exercises was as good in 5 months as in 6. It was also as good when the minimum recommended number of exercises per day was 80 as when it was 125. CONCLUSIONS: Among those completing the protocol, pelvic exercises were beneficial in reducing stress incontinence, and the benefit was comparable to that produced by phenylpropanolamine.

Urinary incontinence as a risk factor for mortality.

OBJECTIVE: To determine whether mortality is independently associated with urinary incontinence. DESIGN: 6-year prospective study that started in 1983/84. SETTING: A Midwestern County. PARTICIPANTS: Probability sample of 1956 community-residing persons 60 years of age and older in 1983/84. MEASUREMENTS: The independent variables of urinary incontinence, its types and severity, were measured by survey self-report, which was validated with clinical exams. The control variables of age, education, and health status were also self-reported. The dependent variable of death was established during follow-up interviews from reports of previously designated contact persons. RESULTS: Neither incontinence status nor its severity level or types were found to be positively associated with 6-year mortality in logistic regression analyses that adjusted for age, education, and health status. CONCLUSION: Whereas urinary incontinence can be an embarrassing and socially debilitating condition, it does not itself predict or contribute to mortality.

Methods used to manage urinary incontinence by older adults in the community.

This paper addresses the ways that noninstitutionalized older adults deal with involuntary urine loss. The data come from a 1983-1984 sample survey of Washtenaw County, Michigan residents aged 60 and over. Five hundred twelve self-reported incontinent respondents are included in the analyses. About a quarter of the incontinent respondents had discussed their condition with a doctor in the previous year, while 66% used one or more methods to control urine loss. Respondents preferred using absorbent products (47% of those who used some method) and locating a toilet upon reaching a destination (42%). Fewer respondents manipulated their voiding patterns (29%) or diet and fluid intake (17%), or did pelvic muscle exercises (10%). Only 7% were taking medication for their incontinence. Logistic regression analyses were performed to identify factors associated with the choice of actions. Predictors were taken from theoretical models of health service utilization and health behavior, and included predisposing characteristics, health beliefs, enabling factors, and illness variables. Illness variables, particularly severity and type of incontinence, were the best predictors of consultation with a doctor and use of any urine control method. The predictors were less useful for understanding the choice of a specific method.

Prevalence and severity of urinary incontinence in older African American and Caucasian women.

BACKGROUND: Few studies have investigated the prevalence and severity of urinary incontinence in older African American women. Comparisons of findings with those for older Caucasian women could provide important clues to the etiology of urinary incontinence and be used in planning screening programs and treatment services. METHODS: Data are from the first wave of the Asset and Health Dynamics Among the Oldest Old (AHEAD) study. A nationally representative sample of noninstitutionalized adults 70 years of age and older was interviewed. African Americans were oversampled to ensure that there would be enough minority respondents to compare findings across racial groups. RESULTS: A statistically significant relationship was found between race and urinary incontinence in the previous year: 23.02% of the Caucasian women reported incontinence, compared with 16.17% of the African American women. Other factors that appear to increase the likelihood of incontinence include education, age, functional impairment, sensory impairment, stroke, body mass, and reporting by a proxy. Race was not related to the severity (as measured by frequency) of urine loss among incontinent older women. CONCLUSION: This study identifies or confirms important risk factors for self-reported urinary incontinence in a national context, and suggests factors leading to protection from incontinence. Race is found to relate to incontinence, with older African American women reporting a lower prevalence.

Review of neurogenic bladder in multiple sclerosis.

Neurologic involvement of the urinary bladder and urethral sphincter in multiple sclerosis has been known for some time. Thirty-one patients with a proved diagnosis of multiple sclerosis were evaluated urologically for symptoms of urinary incontinence, retention, or urinary tract infection. On initial presentation, 27 (74 per cent) were found to have neurogenic bladders of which 23 (85 per cent) were of the uninhibited type. Electromyography of the periurethral striated muscle revealed vesicosphincter incoordination in 9 of the 19 patients studied. Approximately one-half of the patients with uninhibited bladders had uncoordinated sphincters. Modalities of treatment are discussed.

Action of oral and parenteral bethanechol on decompensated bladder.

A double blind balanced Latin-square study was conducted on 20 adult patients with decompensated bladders to determine the relative effectiveness of oral and parenteral bethanechol chloride (Urecholine) on the stretch response of bladder muscle. Detrusor reaction was measured by modified cystometry. Five mg. of subcutaneous bethanechol chloride produced a significant increase in intravesical pressure which was more rapid in onset, of larger magnitude, and of shorter duration than oral doses of 100 and 200 mg.

Uninhibited neurogenic bladder in adults.

The uninhibited neurogenic bladder is a common entity. It is characterized by urge incontinence, frequency, enuresis, and recurrent urinary tract infections. The diagnosis can only be made by a thorough urologic investigation, including cystometrography. A sound treatment program involves the use of anticholinergic medication to abolish uninhibited contractions, frequent voiding to keep intravesical pressure low, and antibiotic treatment when indicated for concurrent infection.

Bethanechol chloride in neurogenic bladder dysfunction.

Representative case summaries of patients with different types of neurogenic bladder diagnosed by combined cystometric-perineal electromyography and treated with bethanechol (Urecholine) are presented. Determination of the activity of the periurethral striated muscle in relation to bladder dysfunction is extremely important in the selection of patients for bethanechol therapy. In the absence of structural obstruction, bethanechol can be used in patients with (1) the early phase of coordinated reflex neurogenic bladder and sphincter when there is incomplete bladder emptying due to feeble or unsustained detrusor contractions, (2) recovery phase of spinal shock when the periurethral striated muscle has recovered and is under voluntary control, (3) incomplete motor paralytic bladder with coordinated sphincter, and (4) sensory paralytic bladder with decompensation. The bethanechol regimen will vary in accordance with the type of bladder being treated.

Carbon dioxide urethral pressure profiles in males.

Carbon dioxide urethral pressure profiles were obtained in a group of continent and incontinent male patients. Cystometry, needle electromyography of the striated urinary sphincter, and cystourethroscopy were also performed in most patients. A characteristic reproducible urethral pressure profile can be obtained in the continent, obstructed, and incontinent groups. The results also showed that the urethral pressure profile is influenced by the activity of the periurethral striated muscle. The urethral profile when performed with other established urodynamic procedures is a useful test in delineating normal and abnormal urinary sphincter function.

Ephedrine in treatment of urinary incontinence.

Patients with urinary incontinence caused by various urologic disorders were evaluated and treated with oral ephedrine sulfate. The drug was found to improve continence in those patients with mild degrees of wetting due to urethral dysfunction regardless of cause. The failures occurred in severely damaged posterior urethras or denervated bladders and urogenital diaphragms.

Clean intermittent self-catheterization in the elderly.

There has been some doubt as to whether or not the elderly patient can successfully master and comply with clean intermittent self-catheterization in the treatment of their bladder dysfunctions. We recently reviewed our experience with intermittent self-catheterization in patients sixty years of age and older to determine whether or not this was an acceptable alternative to other methods of urinary drainage. Our retrospective analysis of 65 patients between the ages of sixty and eighty years revealed that the elderly patient had little difficulty mastering the technique of intermittent self-catheterization. Complications were minimal and in general correctable. The catheterization program was successful in 94 per cent of the patients in our series.

Predicting lower urinary tract dysfunctions in patients with spinal cord injury.

The results of combined cystometry and perineal electromyography were reviewed retrospectively in 75 consecutive, traumatic spinal cord-injured patients to predict lower urinary tract dysfunctions. In patients with vertebral spinal injuries at vertebral level T7 or above a reflex neurogenic bladder eventually developed. In those with vertebral level injuries T11 or below a lower motor neuron bladder dysfunction developed. Injuries at the vertebral levels T8, T9, and T10 represent a gray zone; and, depending on adjacent soft tissue injury, in these patients an upper or lower motor neuron bladder dysfunction developed. In transition from spinal shock (areflexia) to reflex neurogenic (hyperreflexia) bladder occurred at different times in different patients and could not be correlated to level of injury or its severity. The periurethral striated muscle was generally denervated if a lower motor neuron bladder dysfunction existed, however, rarely, dissociation may occur. When a reflex neurogenic bladder existed, sphincter dyssynergia was present 68 per cent of the time. This also could not be correlated with time after injury, level of injury, or severity of injury.

Cystometric and perineal electromyography in spinal cord-injured patients.

The results of combined cystometry and perineal electromyography were reviewed retrospectively in 50 consecutive, traumatic spinal cord-injured patients. Early and frequent urodynamic evaluation was found necessary in order to tailor treatment to the changing cystometric and electromyographic states in these patients.

Success with penile prosthesis from patient's viewpoint.

This study is designed to explore the patient's point of view on success with penile prosthesis. Detailed questionnaires were sent to 57 penile prosthesis recipients, 38 of whom responded. Overall, 89 per cent claimed improved sexual satisfaction, and 76 per cent noted improved self-image with their prostheses. Seventy-six per cent claimed their partners approved of the prosthetic device. Prosthetic appearance was satisfactory to 87 per cent. Five patients, knowing what they now know, would not have had the prosthetic implantation. A significant factor in 4 of the 5 patients was lack of partner approval. We conclude penile prosthesis implantation is successful in returning satisfactory sexual intercourse to impotent men and their partners. Partners of those desiring penile prosthesis should be included in the preoperative evaluation process.

Significance of urinary extravasation during renal colic.

To establish the clinical significance of renal colic associated with extravasation of contrast material, the authors reviewed 158 consecutive patients who presented with renal colic-like symptoms at the William Beaumont Hospital Emergency Center over a four-month period. Forty-three patients were eliminated either because excretory urography was not performed or IVU did not show obstruction. Of the remaining 115 patients with "obstructive" IVUs, 21 (18 men, 3 women) or 18.3 per cent, were associated with contrast media extravasation of varying degrees. Patients with extravasation were compared with patients without extravasation by cross matching as to age, gender, and time of presentation. Extravasation patients demonstrated significantly less hydronephrosis, had smaller stones (1-5 mm) usually located at the ureterovesical junction, tended to pass their stones spontaneously, and required less hospitalization and one-third the number of manipulative procedures. There was no incidence of sepsis. The significance and future research implications of these findings are presented.

Testicular tumor in male pseudohermaphrodite with X/XY chromosomal mosaicism.

A case of testicular tumor in an intersex patient is presented. Knowledge of the potential of gonadal malignancy is important in the management of disorders of sexual differentiation. These patients, in whom the fields of oncology, embryology, endocrinology, and genetics intersect, provide a fruitful ground for clinical investigation.