Association of Falls and Fear of Falling with Mortality in Korean Adults: The Dong-gu Study.

This study evaluated the association between falls and the fear of falling (FOF) with the risk of all-cause mortality in Korean adults. The study enrolled 4,386 subjects aged 50 years and over who participated in the Dong-gu Study. Falls in the past year were categorized as yes or no. Injurious falls were defined as falls that resulted in fractures, head injuries, sprains or strains, bruising or bleeding, or other unspecified injuries. FOF was classified as low or high. The associations of falls and fall-related characteristics with mortality were assessed using Cox proportional hazards models. The average follow-up was 7.8 years. During this period, 255 men and 146 women died. In a fully adjusted model, falls in the past year were not associated with an increased risk of all-cause mortality (hazard ratio [HR] 1.16, 95% confidence interval [CI] 0.85-1.58), but a history of injurious falls was associated with an increased risk of mortality (HR 1.36, 95% CI 1.04-1.79). Compared with subjects without a FOF, subjects who were moderately or very afraid of falling had a higher mortality rate (HR 1.26, 95% CI 0.97-1.63). In conclusion, injurious falls and a high FOF increased the risk of all-cause mortality in Koreans. This study suggests that injurious falls and FOF can predict mortality in the general population.

Is concomitant bladder neck reconstruction necessary in neurogenic incontinent patients who undergo augmentation cystoplasty?

PURPOSE: In patients with neurogenic bladder due to spinal cord injury or disease who undergo augmentation cystoplasty (AC) for not only bladder dysfunction but also sphincteric incontinence, the need for concomitant bladder neck reconstruction at the time of AC has not yet been established. The aim of this study was to evaluate whether concomitant bladder neck reconstruction is necessary when performing AC. MATERIALS AND METHODS: We retrospectively investigated 35 patients who underwent AC from January 2006 to September 2010. Medical history, preoperative and postoperative fluoroscopic urodynamic study (FUDS) parameters, and responses to an incontinence questionnaire (ICIQ Korean version) were reviewed. RESULTS: A final analysis was performed on 17 patients (9 male, 8 female) who were diagnosed with sphincteric incontinence. Continence status, the number of pads used, and the bother score were significantly improved postoperatively in this subpopulation. Preoperatively, all patients used pads, and the average daily number was 2.2 (median; range 0 to 6). Postoperatively, the number of pads used decreased significantly to 0.9 (median; range 0 to 3) pads a day (p=0.002). Urodynamic parameters including bladder capacity, compliance, involuntary detrusor contraction, and bladder neck incompetence proven by FUDS were also significantly improved. CONCLUSIONS: Our study demonstrated that both objective urodynamic parameters and subjective incontinence symptoms improved significantly after the completion of AC as a single procedure in patients with sphincteric incompetence. This implies that anti-incontinence bladder outlet surgery does not have to be performed simultaneously and can be considered later as a staged operation.