Toileting Behaviors of Women-What is Healthy?

PURPOSE: The objective of this study was to assess toileting behaviors in community dwelling women. MATERIALS AND METHODS: Women 18 years old or older were recruited through a national registry of research volunteers. They were asked to complete validated questionnaires assessing urinary symptoms and toileting behaviors, specifically place preference for voiding, convenience voiding, delayed voiding, straining during voiding and position preference for voiding. The PPBC (patient perception of bladder condition) was administered to assess the participant impression of bladder health. Analyses were done to determine the prevalence of each toileting behavior reported to occur sometimes or more often as well as differences in toileting behaviors in women with vs without self-perceived bladder problems based on the PPBC response. RESULTS: The 6,695 women who completed the questionnaires were 18 to 89 years old (mean ± SD age 41.4 ± 15). Of the women 79.9% identified as white and 71.0% were college educated. Of the women 6,613 (98.8%) reported a place preference for voiding. The 3,552 women (53.1%) who reported a bladder problem were more likely to report convenience voiding, delayed voiding and strained voiding behaviors. While 6,657 women (99.4%) reported sitting to void at home only 5,108 (76.2%) reported sitting when using public toilets. CONCLUSIONS: Certain toileting behaviors, of which some may be considered unhealthy, were common in this sample of women and most were associated with a perception of bladder problems. Voiding positions other than sitting were frequently used when away from home. These data have important implications for defining bladder health and implementing behavior based interventions for women with lower urinary tract symptoms.

Augmentation Cystoplasty of Diseased Porcine Bladders with Bi-Layer Silk Fibroin Grafts.

IMPACT STATEMENT: The search for an ideal "off-the-shelf" biomaterial for augmentation cystoplasty remains elusive and current scaffold configurations are hampered by mechanical and biocompatibility restrictions. In addition, preclinical evaluations of potential scaffold designs for bladder repair are limited by the lack of tractable large animal models of obstructive bladder disease that can mimic clinical pathology. The results of this study describe a novel, minimally invasive, porcine model of partial bladder outlet obstruction that simulates clinically relevant phenotypes. Utilizing this model, we demonstrate that acellular, bi-layer silk fibroin grafts can support the formation of vascularized, innervated bladder tissues with functional properties.

Comparison of urologic and non-urologic presentation in interstitial cystitis/bladder pain syndrome patients with and without Hunner lesions.

AIMS: To compare severity and characteristics of urologic pain, other urinary symptoms, sexual pain, psychosocial health, and the distribution and intensity of non-urologic pain between men and women with and without Hunner lesions. METHODS: All cystoscopies were performed and documented by the same clinician to ensure uniform recognition of Hunner lesions. Intensity of urologic and sexual pain, nocturia, frequency, urgency, and bladder hypersensitivity features were assessed using validated questionnaires and numeric rating scales. The distribution and intensity of non-urologic pain was assessed using self-reported history, a body map diagram, and numeric rating scales. Somatic symptom burden, depression, and anxiety were compared. RESULTS: Among the 150 participants, 27% (n = 41) had Hunner lesions (36% of men, 25% of women). Participants with Hunner lesions were significantly older (median age 58 vs 41, P < 0.001). They reported less intense urologic pain (5 vs 7, P = 0.024) and more nocturia (ICSI nocturia symptom score: 4 vs 3, P = 0.007). They also were less likely to have a history of irritable bowel syndrome (15% vs 36%, P = 0.013) and anxiety attacks (22% vs 44%, P = 0.013). Close to half of Hunner IC patients had non-urologic pain outside the pelvis. There were no differences in bladder hypersensitivity features (eg, painful bladder filling) between the two groups. CONCLUSIONS: Hunner lesions can be identified in both men and women. There are significant overlaps in terms of their urologic and non-urologic presentation. Further investigation is needed on phenotypic and biological distinction between IC/BPS with and without Hunner lesions.

Treatment satisfaction and bothersome bladder, bowel, sexual symptoms in multiple sclerosis.

BACKGROUND: Bladder, bowel, and sexual symptoms are common among persons with multiple sclerosis (MS). We aimed to investigate the frequency and severity of bladder, bowel, and sexual symptoms, the relationships between these symptoms, satisfaction with treatment of these symptoms, and factors associated with symptom severity and treatment satisfaction. METHODS: In the fall 2010, we surveyed participants in the North American Research Committee on Multiple Sclerosis (NARCOMS) Registry regarding the severity of being bothered by bladder, bowel, and sexual symptoms, their satisfaction of health providers' inquiry and treatment with these symptoms, and whether their quality of life (QOL) had changed with the treatment. Logistic regression was used to evaluate demographic and clinical factors associated with each outcome. RESULTS: Of 9341 respondents included in the study, 7720 (77.4%) were female and their mean (SD) age was 50.3 (10.5) years. Ninety-one percent of participants were mildly, moderately or severely bothered by bladder, bowel or sexual symptoms. Severity of disability (measured using the Patient Determined Disease Steps), having a relapse in the last 6 months, and catheter use were consistently associated with being bothered (versus not bothered) by each of the three symptoms. Among respondents, 5764 (62.1%) reported that their MS health providers asked about bladder problems, 4523 (51.1%) about bowel problems, and 1890 (20.6%) about sexual problems. At most one-third of participants were completely satisfied with treatment for any of the symptoms. For those who reported how their QOL changed with treatment, 23.0% reported their QOL being better. CONCLUSION: Bladder, bowel, and sexual problems remain common among persons with MS, and treatment satisfaction is low. Health care providers should consider systematically asking about these symptoms in clinical practice. Greater efforts could be devoted to developing novel, effective therapies to manage these symptoms and thereby improve QOL.

Lesions of the central amygdala and ventromedial medulla reduce bladder hypersensitivity produced by acute but not chronic foot shock.

Both acute and chronic stress has been shown to exacerbate symptoms of chronic visceral pain conditions such as interstitial cystitis. Studies using animal models support these findings in that both acute and chronic exposure to foot shock-induced stress (FS) augment nociceptive reflex responses to urinary bladder distension (UBD). Only a few studies have examined the neural substrates mediating these phenomena and it is not clear whether acute and chronic stress engage the same or different substrates to produce bladder hypersensitivity. The present studies examined the role of two important central nervous system structures - the amygdala (AMG) and the ventromedial medulla (VMM) - in mediating/modulating hypersensitivity evoked by acute versus chronic FS using responses to graded UBD in adult, female Sprague-Dawley rats. Bladder hypersensitivity produced by acute FS was significantly reduced by either bilateral central AMG or VMM lesions using measures generated by graded UBD, but these lesions had no significant effects using the same measures on bladder hyperalgesia produced by chronic FS. Our findings provide evidence that neural substrates underlying bladder hypersensitivity produced by chronic stress differ from those produced by acute stress. These findings suggest that while the AMG and VMM participate in pain processing during periods of limited exposure to stress, prolonged stress may recruit a new set of neural substrates not initially activated by acute exposure to stress.

Urostomías: marcaje a medida versus complicaciones / No disponible

La atención integral a la persona ostomizada se inicia en el momento de la indicación quirúrgica invasiva de la extirpación completa de la vejiga que en determinadas patologías urológicas se indican: la cistitis, la litiasis vesical y en la gran mayoría de los tumores vesicales infiltrantes. Tras el primer contacto con el paciente, el objetivo de enfermería es proporcionar educación sanitaria y soporte emocional al paciente y/o cuidador durante todo el proceso, dar información individualizada para que recupere la autonomía lo antes posible

The treatment of ostomized patient is initiated when the bladder removal surgery has been performed in cases such as cystitis, vesical lithiasis and most of the bladder tumours. It is important that a professional nursing staff who has the very first contact with the patient radiate friendliness and concern, offer emotional support to the patient and/or caregiver and provides the patient with relevant information about the recovery process so the patient can restore autonomy

Qualitative Exploration of the Patient Experience of Underactive Bladder.

BACKGROUND: Underactive bladder (UAB) is considered the symptom complex associated with the urodynamic diagnosis of detrusor underactivity. OBJECTIVE: The aim of this research was to investigate the patient reported experience of the symptoms, signs, and impact of UAB. This research is also part of the initial qualitative phase for the development of a new patient reported outcome measure for the assessment of UAB. DESIGN, SETTING, AND PARTICIPANTS: Qualitative methods were used to understand the experience of UAB from a patient perspective, in a purposive sample of male (n=29) and female (n=15) patients aged 27-88 yr (mean: 64 yr), diagnosed with a primary diagnosis of detrusor underactivity, with or without coexisting urological conditions. Semistructured interviews were conducted in Bristol, UK. RESULTS: Male and female patients reported a variety of lower urinary tract symptoms and associated impact on quality of life. Storage symptoms of nocturia, increased daytime frequency, and urgency, and the voiding symptoms of slow stream, hesitancy, and straining were reported by over half of the patients. A sensation of incomplete emptying and postmicturition dribble were also frequently described. Most had a post void residual >30ml (n=34, 77%, median: 199ml) with many reporting urinary tract infections, a history of self-catheterisation, and some experiencing occasional acute retention episodes. These symptoms and signs can have a broad impact on quality of life including having to plan their daily activities around the location of toilets, disruption to sleep, social life, and associated effect on family and friends. CONCLUSIONS: Knowledge of the lived experience of UAB obtained in the current study will be used for the development of a new patient reported outcome measure and help inform the current working definition of UAB. PATIENT SUMMARY: The symptoms, signs, and impact on quality of life of underactive bladder are described by patients with the condition.

A cross-sectional study in the USA of the epidemiology and quality of life of underactive bladder symptoms.

PURPOSE: To assess the prevalence, awareness, and quality of life (QOL) impact of symptoms suggestive of underactive bladder (UAB) in the USA. METHODS: A thirteen-item paper survey was mailed to 25,000 individuals 60 years or older living in the USA. It aimed to collect information relating to demographics, familiarity with UAB, patient urinary symptoms, and QOL concerns. RESULTS: Nine hundred and seventy-seven survey participants were stratified into four groups based on the number of UAB symptoms (straining, retention, and difficulty emptying) present: zero, one, two, and three. As the number of reported UAB symptoms increased, there was an increase prevalence in nocturia, urge, and urinary frequency (p < 0.0001). Increased UAB symptoms were associated with an increased prevalence of concerns related to urgency, urge incontinence, nocturia, and overall urinary status (p < 0.0001). Urology visits were most common in individuals who reported the most UAB symptoms (p < 0.0001); however, there was no difference among groups with regard to UAB awareness. Women were less likely to report any UAB symptoms (p < 0.0001), symptoms of urge (p = 0.001), retention (p = 0.002), difficulty emptying their bladder (p < 0.0001), a history of catheter use for retention (P = 0.002), and urology visits in the past 3 years (p < 0.0001). This study is limited in its inability to differentiate UAB from disorders that may mimic UAB clinically, based on the survey questions asked. CONCLUSIONS: Underactive bladder symptoms are common and can have a significant impact on ones QOL, although awareness is still lacking among potentially affected individuals. More must be done to allow one to better differentiate between UAB and conditions that are clinically similar.

Which factors make clean intermittent (self) catheterisation successful?

AIMS AND OBJECTIVES: To explore which factors determine successful intermittent catheterisation. BACKGROUND: Intermittent catheterisation is a safe, effective treatment and is associated with improved quality of life, although negative issues are reported. Factors which determine adherence are largely unknown. An additional qualitative study was conducted to gain insight into patient's experience with intermittent catheterisation in everyday life. DESIGN: A prospective multicentre study was conducted between March 2012-March 2013 with one year follow-up. METHODS: Patients with a variety of diagnoses referred to the outpatient clinic, ≥18 years, performed catheterisation at least once a day for ≥3 months were included. Data were obtained by patients' specific questionnaire Visual Analog Scale of quality of life regarding voiding problems, a questionnaire about catheterisation in daily practice, King's Health questionnaire, and a short questionnaire after one year. RESULTS: Of the 129 (72 male) patients, mean age 62 (22-86) years, seven died and 63 stopped, 32/63 (50%) due to recovered bladder function. Fifty-nine (47%) continued to perform catheterisation after one year. Forty-seven (86%) patients reported catheterisation had become part of their life or had a positive effect on their life. A weak correlation was found between increasing age and cessation of catheterisation. Visual Analogue Scale - score on quality of life improved for the total group. The King's Health questionnaire identified in the total group that the impact of the bladder problem in daily life, limitations in daily activities and negative emotions decreased over time. CONCLUSION: Adherence of successful intermittent catheterisation can be influenced negatively by increasing age. However, we think catheterisation should be considered as an option for older patients. We could not conform that if intermittent catheterisation was beneficial for the patient, it would positively influence adherence. Further prospective studies on adherence of intermittent catheterisation in larger groups need to be undertaken. RELEVANCE TO CLINICAL PRACTICE: After implementation of the national guideline in 2008, we were able to perform a multicentre study. This prospective study gives insight into patients who were undertaking intermittent catheterisation and which factors determine successful intermittent catheterisation adherence. After following the national guideline, we found no factors for additional interventions in assessment or coaching intermittent catheterisation. Post void residual volume turned out to be not a predictor for the necessity of intermittent catheterisation. A large group of patients could discontinue intermittent catheterisation during follow-up due to bladder function recovery. Although a weak correlation was found between increasing age and ceasing of catheterisation, we think the older can benefit from intermittent catheterisation. In the first period, additional support, for example given by a district nurse, may be necessary for this group to achieve better outcomes.

Interventions to decrease pain and anxiety in patients undergoing urodynamic testing: A randomized controlled trial.

AIMS: To determine if music (at 60 beats/min) or watching a pre-procedure educational video decreases pain and anxiety in women undergoing multichannel urodynamic testing compared to usual care. METHODS: Women undergoing multichannel urodynamic testing at a tertiary care center were randomized to one of three groups: usual care (UC), music (M), in which music was played throughout the urodynamic test, or video (V), in which subjects watched an informational video on the procedure prior to undergoing the test. Visual analog scales (VAS) were used to measure patient's pain and anxiety before and after the test. Demographic information was obtained and five-item Likert questionnaires were given to assess information seeking behavior, preparedness, embarrassment, and privacy. RESULTS: 98 subjects were included in this analysis. In the overall group, mean perceived pain on the pre-test VAS was significantly higher than the post-test VAS with pre-test mean (SD) 47(±30) and post-test mean (SD) 26(±23), P = 0.0001. Overall the anxiety pre-test VAS was significantly greater than post-test VAS with pre-test mean (SD) 46.9(±29) and post-test mean 17.9(±18), P = 0.0001. There were no differences in pain and anxiety scores between the two intervention groups and usual care. Patients who were randomized to usual care or the video arm felt more prepared for the test compared to patients who were randomized to the music arm, with (mean ± SD): usual care (42 ± 8), video (43 ± 9), music (37 ± 11), P = 0.002. CONCLUSIONS: Music and an educational video do not decrease pain or anxiety in subjects undergoing multichannel urodynamics compared to usual care. Neurourol. Urodynam. 35:975-979, 2016. © 2015 Wiley Periodicals, Inc.

Bladder Symptoms and Attitudes in an Ethnically Diverse Population.

OBJECTIVE: The aim of the study was to assess pelvic floor symptoms and attitudes in an ethnically diverse population. METHODS: We conducted a cross-sectional survey of women presenting to 2 community-based, ethnically diverse gynecology clinics. Before being seen by a provider, participants were asked to complete a questionnaire. RESULTS: A total of 312 women were included: 32.7% white, 50.3% African American, and 17.0% Hispanic. Other racial/ethnic groups were excluded secondary to small samples size. The median (interquartile range) age was 34.0 (27.0-44.0) years. The groups differed with respect to most demographic characteristics, such as income, education, and nation of origin. Nocturia and urinary frequency were the most commonly reported symptoms. African American respondents were more likely to report nocturia than white respondents (odds ratio, 2.4; 95% confidence interval, 1.2-4.8). Respondents' views of normal urinary function generally did not vary by race/ethnicity. However, Hispanic respondents were less likely than white respondents to agree that it is normal to leak urine after having children (odds ratio, 0.28; 95% confidence interval, 0.11-0.68). Among women who reported at least 1 symptom, 46.7% reported that at least 1 symptom bothered them, and this did not differ with respect to race/ethnicity (P ≥ 0.59). African American respondents were more likely than whites to report their urinary leakage to their doctors (P = 0.006). CONCLUSIONS: Our study demonstrates that with few exceptions, bladder symptoms and attitudes are similar among reproductive-age women of various racial/ethnic groups in a community setting.

Bladder and bowel dysfunction affect quality of life. A cross sectional study of 60 patients with aquaporin-4 antibody positive Neuromyelitis Optica spectrum disorder.

BACKGROUND: Transverse myelitis (TM) associated with Neuromyelitis Optica (NMO) can be severe and is well known to reduce mobility early in the disease. However the burden of bladder and bowel dysfunction is unknown and overlooked. We studied the frequency of bladder and bowel dysfunction and their impact on quality of life. METHODS: A cross-sectional study of 60 patients who had AQP4-IgG positive NMO associated TM was performed using the Bladder Control Scale, Lower Urinary Tract Quality of Life, Bowel Control Scale and Neurogenic Bowel Score, Short-Form-36 Health Survey and EDSS. The relationships between the variables were analysed with multiple linear regression. RESULTS: Fifty women and 10 men participated. 78% (47/60) patients reported bladder symptoms and a similar number reported bowel problems. 87% (52/60) patients reported either bladder or bowel dysfunction. 65% (39/60) developed residual symptoms after the first episode of myelitis and the remaining by the second episode. Both bladder and bowel dysfunction reduced quality of life and required modification of lifestyle in 83% (39/47) and 70% (33/47) respectively. CONCLUSION: Bladder and bowel dysfunction is very common in NMO associated myelitis developing early in the disease and significantly affects quality of life.

Does visualisation during urethrocystoscopy provide pain relief? Results of an observational study.

BACKGROUND: To measure the effects of real-time visualisation during urethrocystoscopy on pain in patients who underwent ambulatory urethrocystoscopy. METHODS: An observational study was designed. From June 2012 to June 2013 patients who had ambulatory urethrocystoscopy participated in the study. In order to measure pain perception we used a numeric rating scale (NRS) 0 to 10. Additional data was collected including gender, reason for intervention, use of a rigid or a flexible instrument and whether the patient had had urethrocystoscopy before. RESULTS: 185 patients were evaluated. 125 patients preferred to watch their urethrocystoscopy on a real-time video screen, 60 patients did not. There was no statistically relevant difference in pain perception between those patients who watched their urethrocystoscopy on a real-time video screen and those who did not (p = 0.063). However, men who were allowed to watch their flexible urethrocystoscopy experienced significantly less pain, than those who did not (p = 0.007). No such effects could be measured for rigid urethrocystoscopy (p = 0.317). Furthermore, women experienced significantly higher levels of pain during the urethrocystoscopy than men (p = 0.032). CONCLUSIONS: Visualisation during urethrocystoscopy procedures in general does not significantly decrease pain in patients. Nevertheless, men who undergo flexible urethrocystoscopy should be offered to watch their procedure in real-time on a video screen. To make urethrocystoscopy less painful for both genders, especially for women, should be subject to further research.

Protective effect of preserved bladder-filling sensation on upper urinary tract in patients with spinal cord injury.

In this study the possible preventive effect of bladder-filling sensation (BFS) on upper urinary tract deterioration (UUTD) in spinal cord injury (SCI) patients was investigated. Eighty-four (60 males, 24 females) patients with SCI who underwent neurourological assessment and urodynamic examinations because of neurogenic lower urinary tract dysfunction and were prescribed appropriate bladder management and were under follow-up and whose disease duration was at least 3 years were included in the study. Bladder-filling sensation was categorised as "absent", "partially preserved" or "preserved", and as "normal" (preserved) and "abnormal" (partially preserved, absent). Presence of hydronephrosis, renal stones, and chronic pyelonephritis in any renal USG or IVP performed during the follow-up period were accepted as criteria of UUTD. The frequencies of UUTD for BFS subgroups were determined and compared. Mean age and mean disease duration were 38.4 ± 13.0 years and 72.2 ± 36.2 months. The frequency of UUTD was 31/84 (36.9 %) in the study population. The frequencies of UUTD were 0/8 (0 %), 22/53 (41.5 %) and 9/23 (39.1 %) for "preserved" "partially preserved" and "absent" BFS subgroups, respectively (p = 0.074). There was a statistically significant difference between normal BFS [0/8 (0 %)] and abnormal BFS [31/76 (40.8 %)] subgroups (p = 0.024). According to the results of our study preserved (normal) bladder-filling sensation has protective effect on upper urinary tract in patients with SCI.

Health-related quality of life in multiple sclerosis patients with bladder, bowel and sexual dysfunction.

PURPOSE: Bladder, bowel and sexual dysfunction are often overlooked symptoms in patients with multiple sclerosis (MS) and can be associated with lower health-related quality of life (HRQoL). The aim is to explore the association of bladder, bowel and sexual dysfunction with HRQoL in MS patients stratified by disease duration (≤5 and >5 years) and controlled for clinical and sociodemographic variables. METHODS: The study comprised 223 MS patients (mean age 38.9 ± 10.8 years, 67% female, mean EDSS 3.0 ± 1.5) who filled out the Short-Form-36 Health Survey, the Bladder Control Scale, the Bowel Control Scale and the Incapacity Status Scale. The relationships between the variables were analyzed with multiple linear regression using the SF36's Physical Component Summary (PCS) and Mental Component Summary (MCS) as dependent variables. RESULTS: More severe bladder dysfunction was associated with lower PCS in both disease duration groups (ß = -0.35, p ≤ 0.001 versus ß = -0.43, p ≤ 0.001), whereas more severe sexual dysfunction was associated with lower MCS in the group with shorter disease duration (ß = -0.23, p ≤ 0.05). CONCLUSION: Bladder and sexual dysfunction are associated with a poorer HRQoL in MS patients even if they have had MS for a relatively short time. Recognition and proper treatment is needed to prevent the development of more severe dysfunction; this may also lead to a better HRQoL. IMPLICATIONS FOR REHABILITATION: Bladder and sexual dysfunction are associated with a poor health-related quality of life in MS patients. Sexual dysfunction may explain mental health issues among individuals with a short disease duration. Recognition and treatment may prevent the development of more severe sexual and bladder dysfunction and increase physical health-related quality of life.

Bladder and bowel dysfunction: evidence for multidisciplinary care.

PURPOSE: We examined the symptoms of bladder-bowel dysfunction (ie severity of voiding dysfunction and stool consistency) and psychosocial difficulties in children presenting to the pediatric urology clinic for voiding dysfunction and to the pediatric gastroenterology clinic for functional constipation. MATERIALS AND METHODS: Parents of children seen at the gastroenterology clinic were recruited during the outpatient clinic appointment, and parents of children seen at the urology clinic were randomly selected from the research database and matched to the gastroenterology sample based on age and gender of the child. All parents completed the Dysfunctional Voiding Scoring System, Bristol Stool Form Scale, Pediatric Symptom Checklist and Parenting Stress Index™-Short Form, which assessed severity of voiding dysfunction, stool consistency, level of psychosocial difficulties and level of parenting stress, respectively. RESULTS: Children seen at the urology and gastroenterology clinics did not differ significantly on any of the measures, indicating that the severity of their bladder-bowel dysfunction is similar. However, they had significantly more severe voiding dysfunction, more constipated stool and more psychosocial difficulties than historical healthy controls. Additionally, level of parenting stress was significantly correlated with patient level of psychosocial difficulties and severity of voiding dysfunction. CONCLUSIONS: Patients with bladder and bowel dysfunction represent a homogeneous group that would potentially benefit from a multidisciplinary treatment approach involving urology, gastroenterology and psychology professionals.