[Training of patients with urinary incontinence]. / Paedagogiske behandlingsprincipper ved urin-inkontinens.

The different types of urinary incontinence are defined and the possible educational treatment modalities are described. Stress incontinence may be treated by pelvic floor exercise and bio-feed-back. The object is training in muscle awareness with the purpose of teaching the patients to squeeze without activating the abdominal muscles. Significant improvement can be obtained in 22-63% of the patients. Urge incontinence can be treated by bladder drill and bio-feed-back. Voluntary control over the detrusor reflex is re-educated and the patients are instructed to adhere to a fixed voiding schedule every three hours. In women, 80% may be improved. In reflex incontinence, prophylactic bladder emptying may be initiated by stimulation of specific trigger points. Overflow incontinence may be reduced by optimal voiding technique and clean intermittent self-catheterization. Postmicturition dribble can be relieved by manual emptying of the urethra. No treatment is known for giggle incontinence. In nocturnal enuresis, conditioning treatment is recommended. Immediate waking is essential. Environmental incontinence is treated by securing easy access to voiding facilities and by training in toileting skills. Half of the patients are curable.

[Training of patients with residual urine and/or recurrent urinary tract infections]. / Paedagogiske behandlingsprincipper ved residualurin og ved recidiverende urinvejsinfektion.

The principles for voiding instructions to patients with symptoms due to residual urine and to patients with recurrent urinary tract infection are reviewed and motivated. Residual urine may be reduced by triple voiding at one-minute intervals, fixed voiding intervals of three hours and by treatment of constipation. Additional abdominal straining and manual suprapubic expression may be necessary. To improve the voiding technique, pelvic floor training or bio-feed-back are advocated with the purpose of teaching the patients to strain without squeezing the pelvic floor muscles. In cases without symptomatic relief, clean intermittent self-catheterization is advocated. The frequency of recurrent, uncomplicated, symptomatic, bacterial urinary tract infections may be halved by copious fluid intake (at least 2 litres per day), voiding every three hours in the daytime regardless of desire to void, triple voiding until the bladder is empty and regular bowel emptying. Women are advised to void after sexual intercourse.

[Treatment of phimosis with a steroid creme in boys]. / Behandling af phimosis hos drenge med steroidcreme.

UNLABELLED: The current treatment of phimosis in Denmark is surgical. Reports of success rates of 70-80% with topical steroids have prompted us to carry out the present study. METHODS: Parents of boys, who were referred because of phimosis, volunteered to participate in an open trial of topical clobetasol 0.05%, along with gentle mobilisation of the foreskin once daily for 4-6 weeks. Fifty-five boys completed the treatment. The results were recorded at clinical follow-up four and six weeks later, and a long-term follow-up was done by questionnaire sent after 9-11 months. RESULTS: At six weeks of treatment, 42 had a fully retractable foreskin, 11 a partially retractable foreskin, and two had unchanged phimosis. Ten patients had a circumcision or plasty. At long-term follow-up, 12 had a symptomatic recurrence. Four of these were given surgical treatment and eight had a repeat topical treatment, which was effective in six. The overall effect was independent of the degree of phimosis. Four patients with obvious sacrified foreskin failed. Twelve patients had agglutinations, which became apparent after the treatment for phimosis. We recorded no systemic and very few local side effects. The patients and parents found the treatment convenient and satisfactory. CONCLUSION: Topical clobetasol 0.05% once a day for 4-6 weeks can be recommended as primary treatment in phimosis in boys without scarification of the foreskin. The treatment may be repeated as necessary.

[The prostate coil. A new form of treatment of urinary retention in men. Clinical experiences during a 6-month observation period]. / Prostataspiral. En ny behandling af urinretention hos maend. Kliniske erfaringer med 6 månders observationstid.

A prostate spiral developed in Denmark may be introduced with a special catheter under local anaesthesia under the guidance of transabdominal ultrasonic scanning. Forty-four consecutive patients with retention of urine were treated with the prostate spiral. Ultrasonic-guided introduction was successful in 33 patients (73%). Cystoscopy proved necessary for introduction of the spiral in six patients and, in two cases, it was introduced over a ureteric catheter. In four patients the spiral could not be introduced on account of pronounced curving of the prostatic urethra. On follow-up examination after six months, eight patients had died with spirals which functioned well. The spiral had been removed in 12 patients and, in six of these, the problems could be attributed to the spiral. Nineteen out of 21 patients with the spiral in situ had subjectively satisfactory miction. The median maximal flow was 9.4 ml/s (range 1.0-21.3 ml/s). Ultrasonically-guided introduction of the prostate spiral under local anaesthesia is an easy and rapid procedure. The spiral is a good alternative to urethral indwelling catheter, also during the waiting time before prostatectomy.