Individually tailored ultrasound-assisted prompted voiding for institutionalized older adults with urinary incontinence.

OBJECTIVES: To assess individually tailored ultrasound-assisted prompted voiding as a means of managing urinary incontinence in hospitalized elderly patients. METHODS: A total of 88 incontinent elderly individuals who were inpatients in general hospitals were included. Each individual's mean bladder volume before starting to void (voided urine volume plus residual urine volume) was regarded as the optimal bladder volume. Bladder volume was regularly monitored with an ultrasound device, and when the urine volume had reached the individual's optimal bladder volume, the subject was prompted to void. The outcomes were evaluated on the basis of scores on a four-grade scale for items in six domains: urine volume, voiding function, urinary control, physical and cognitive function for toileting, and caregivers' burden in regard to continence care. The score for use of a pad/diaper, an item of urinary control domain, was used as the primary outcome measure. RESULTS: A total of 80 participants were included for analysis. After ultrasound-assisted prompted voiding care for a 4-week period, the score for use of a pad/diaper in 50 out of 80 participants (62.5%) had decreased, and 21 out of 80 participants (26.3%) no longer required the use of a pad/diaper at all. The scores of the other 30 out of 80 participants (37.5%) were unchanged. The improvement was not significantly affected by patients' backgrounds at baseline. The mean scores in the domains of urinary control, physical function, cognitive function and caregivers' burden improved significantly. CONCLUSION: The present preliminary study suggests that individually tailored ultrasound-assisted prompted voiding can improved urinary incontinence of institutionalized elderly patients. Further studies are worth carrying out.

[Diaper cystitis as recurrent cause of urinary infections in geriatric community hospital].

AIM: Chronic cystitis in diaper-dependent elderly patients can be a causative pathology for recurrent urinary tract infections (UTIs) in community hospitals. METHODS: We analyzed hospital infections to determine causative organisms from January 2007 to December 2009 in patients in a long-term care hospital. The reading causes of hospital infections were UTIs (30.4%), aspiration pneumonia (CAP; 26%) and hospital-acquired pneumonia (HAP; 17.2%). Of a total of 3,097 hospital infections over the investigation period, UTIs were the most common (n=940, 30.4%) followed by CAP (n=809, 26%) and HAP (n=533, 17.2%). Of 278 UTIs in 2007, the causative strains were Escherichia coli (n=106, 38%), Enterococcus faecalis (n=44, 16%), Proteus mirabilis (n=31, 11%), α-hemolytic streptococcus (n=22, 8%), and ß-hemolytic streptococcus (n=14, 5%). Extended spectrum ß-lactamase (n=14, 13%) strains were noted in 106 patients with Escherichia coli. We then retrospectively examined the records of 110 diaper dependent elderly patients, (medical words, n=52, mix-care wards, n=68) for UTIs over the same study period. Of these 16 (14.5%) had no UTIs at any time, 12 (11%) were infected 50% of the time, 17 (15.5%) were infected 51% to 99% of the time and 65 (59%) were infected 100% of the time. The UTI rate was not correlated with bladder function or between the 2 wards. We treated bacterial cystitis with antibiotics for 3-5 days but these were unsuccessful. Antiseptics worked temporarily, but recurrence or re-infection always occurred. It remains unknown if diapers are a potential cause of chronic cystitis in dependent elderly patients. The clinical dilemma of whether recurrent diaper cystitis should be treated and prohibit the growth and spread of drug-resistant strains, remains challenging.

[Long-term usefulness and safety of the contemporary balloon catheter].

OBJECTIVE: To evaluate usefulness and safety of an indwelling contemporary balloon catheter, we compared complication rates among five methods of urinary tract management. PATIENTS AND METHODS: History of febrile episode, bladder stones, pyuria and the miscellaneous urinary tract problems of 114 patients were retrospectively reviewed. The rates of complications were compared among five types of urinary tract management as clean intermittent catheterization dry (not incontinent) (CIC-dry: n = 33), clean intermittent catheterization with incontinence (CIC-wet: n = 16), clean intermittent catheterization with a contemporary balloon catheter indwelling at night (Contemporary catheter: n = 20), a suprapubic cystostomy catheter indwelling (Cystostomy: n = 22) and permanent urethral balloon catheter indwelling (Urethral catheter: n = 24). The contemporary balloon catheter used consisted of a reusable balloon catheter and a reservoir to inflate the balloon. The patients in the Contemporary catheter group self-inserted the catheter every night before sleeping, and then removed it in the next morning. After use, the catheter was washed with tap water, and stored in a special purpose case filled with disinfectant. RESULTS: The mean follow up period was 41 months. The incidence of febrile episode in CIC-wet was 3.36 times/100 months, Urethral catheter was 2.96, Cystostomy was 1.26, Contemporary catheter was 0.57, and CIC-dry was 0.42. The incidence of febrile episode in CIC-wet and Urethral catheter were significantly higher than in CIC-dry (p<0.05). The incidence of bladder stone in Urethral catheter was 1.11 times/100 months, Cystostomy was 1.05, Contemporary catheter was 0.96, CIC-wet was 0.61, and CIC-dry was 0.21. The Urethral catheter group had significantly higher incidence of bladder stone than CIC-dry (p<0.05). CONCLUSIONS: The indwelling contemporary balloon catheter is recommended for long-term use in CIC-wet group.