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Sethia, Krishna Kumar. "The pathophysiology of detrusor instability." Thesis, University of Oxford, 1988. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.235958.
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Foster, Patricia Margaret. "Living with incontinence : a qualitative study of elderly women with urinary incontinence." Thesis, University of British Columbia, 1987. http://hdl.handle.net/2429/26131.
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Urinary incontinence has been described as a devastating symptom, an embarrassing condition, and a major geriatric problem, creating substantial personal, medical, and social difficulties. Urinary incontinence is a problem which affects men and women of all ages, but is predominantly a concern for elderly women! It is estimated that 50% to 75% of cases of incontinence are hidden or unreported.
A review of the literature on urinary incontinence reveals numerous studies describing prevalence rates and types of incontinence. Characteristics of incontinent individuals and experimental studies comparing different treatments are also available. However, qualitative studies of urinary incontinence as it is experienced by elderly women are nonexistent.
The purpose of this study is to explore and describe the impact of living with untreated urinary incontinence upon the daily lives of elderly women living in the community. The phenomenological approach to qualitative methodology was used for this study. This approach seeks to discover and describe the human experience as it is lived, and for this study, that experience was living with untreated urinary incontinence.
Incontinent women, 60 years of age and over, were contacted through seniors' community centres, seniors' newspapers, and community service agencies. Nine women served as informants and participated in intensive interviews guided by open-ended questions. Verbatim transcriptions of these interviews and field notes from contact with seniors provided the data for analyses.
Four major themes comprise the research findings: the recognition of incontinence, the avoidance of exposure, the need for information, and the redefinition of normal. The first theme describes the women's struggle to recognize the incontinence for what it was, acknowledging to themselves that it was an ongoing problem. Even after incontinence was recognized, the women emphasized the importance of keeping their symptoms hidden. This avoidance of exposure necessitated reorganization of their lives and limited opportunities to talk about problems with incontinence. Despite their hesitation in talking about incontinence, the women identified a compelling need for information. Finally, over and above these three management strategies, living with incontinence led to an attitudinal strategy of redefining what would constitute normal. For these women, this new definition of normal included incontinence.
In light of these findings, implications for nursing education and practice are identified. Suggestions for future research stemming from this study conclude the discussion.Applied Science, Faculty of
Nursing, School of
Graduate
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Saxer, Susanne. "Urinary incontinence in nursing home care." [Maastricht] : Maastricht : [Maastricht University] ; University Library, Universiteit Maastricht [host], 2008. http://arno.unimaas.nl/show.cgi?fid=13767.
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Doshani, Anjum. "Urinary incontinence in Indian women in Leicester." Thesis, University of Leicester, 2010. http://hdl.handle.net/2381/10225.
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Background: Urinary incontinence affects people of different ages, gender and ethnic backgrounds. Current review of literature shows very that very little work has been done with regards to urinary incontinence in ethnic minority groups. At Leicester there is a high ethnic minority population comprising of different ethnic groups, the largest in inner city Leicester being the Indians that migrated from the state of Gujarat in India. Observations of clinic attendees, and unpublished data from the Medical Research Council Leicester Incontinence Study, lead us to believe that significant numbers of Indian women have continence problems but do not make use of currently available services. Aims: To explore inequality in health, barriers towards accessing continence care and to further understand how best to provide continence services to this group the research program was formulated comprising of: Prevalence study, Cultural context study, Patients‘ journey through primary care study. These will address the various aspects of the influence and interaction of ethnic origin with incontinence care. Methods: This project uses a mixed method approach combining both quantitative and qualitative research methods. The quantitative arm of the study uses validated self administered questionnaires to determine the prevalence and quality of life scores in women suffering with urinary incontinence in the community. The qualitative arm of the study uses focus groups and interviews to further explore women‘s coping strategies, the effect of migration in their symptoms and help seeking behaviour, the impact incontinence has on their lives and their attitudes towards available continence care, including suggestions for improving services. Results: The South Asian named women in our research reported higher rates and severity of urinary symptoms, with a corresponding greater impact on their quality of life when compared to White British named women and Indian women in Gujarat. It highlights some of the barriers in effective continence care. None of these women were referred to secondary care immediately, unlike their White British counterparts within the same primary care setup. Management of incontinence in primary care is inadequate and doesn‘t comply with the recommendations made in the NICE guidelines. Conclusions: This research project is a unique opportunity to study the impact of ethnic origin upon urinary incontinence. The inequalities in healthcare that have been highlighted together with the suggestions of service improvement that have come from the service users has resulted in the development of a strategic framework of continence care for ethnic minority women. This will aim to ensure accessible and acceptable care for these patients.
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Pierson, Wanda Jane. "A study of the effect of stress incontinence and bladder retraining on older women's perceived self-esteem." Thesis, University of British Columbia, 1988. http://hdl.handle.net/2429/27730.
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The purpose of this descriptive study was to determine the existence of a relationship between perceptions of global self-esteem and stress incontinence episodes in a group of older women participating in a bladder retraining protocol.
A convenience sample of fifteen older women was obtained. The participants constituted a group of well older women who ranged in age from 63 years to 82 years. All participants were living in the community and experiencing urinary incontinence.
The University of British Columbia Model for Nursing was the conceptual framework which guided the focus of the study. The model views the individual as a behavioural system composed of nine interrelated and interdependent subsystems. This study focused on the interrelationship of the excretory and ego-valuative subsystems. The theory of self-efficacy, as outlined by Bandura provided the method by which this study was operationalized. Self-efficacy is the product of personal efficacy—an individual's judgement of the effectiveness of an executed course of action in achieving a desired outcome. The enactive, persuasive, and emotive modes of influence were utilized to provide efficacy information.
Data were collected on three occasions using four instruments. The first instrument involved collection of selected demographic variables and was completed during the initial interview. A continence assessment and the Rosenberg self-esteem scale were completed during the initial and final interviews. An interview guide was used during a telephone contact. The telephone contact occurred four days following the first interview; the final interview occurred fourteen days after the first.
The data were summarized, compared and described using measures of central tendency and frequency distributions. Paired t-tests were performed on selected variables to determine if there was a difference between pre and post intervention interview score. These tests demonstrated no significant differences in scores.
Study findings indicated that at the end of the two week trial 53% of the women were able to identify a change in their voiding habits. Four of the participants (26.7%) stated that they were completely continent at the completion of the two week trial and four other participants (26.7%) indicated that $ some type of positive change had occurred. Three women (20%) identified a negative change in their continence status.
Global self-esteem scores, as measured by the Rosenberg self-esteem scale, remained relatively stable during the two week trial period. Scores appeared to be unaffected by a change in continence status. This may be due to the many successful normalizing strategies subjects had developed to hide the evidence of the symptom of urinary incontinence.Applied Science, Faculty of
Nursing, School of
Graduate
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Di, Sessa Renata Gebara de Grande 1981. "Estudo da associação entre o escore do International Consultation on Incontinence Questionnaire - Urinary Incontinence / Short Form e a avaliação urodinâmica em mulheres com incontinência urinária = Correlation of the International Consultation on Incontinence Questionnaire - Urinary Incontinence / Short Form to urodynamic diagnosis in women with urinary incontinence." [s.n.], 2012. http://repositorio.unicamp.br/jspui/handle/REPOSIP/312267.
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Orientador: Viviane Herrmann RodriguesDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: Introdução: A Incontinência Urinária (IU) tem impacto na qualidade de vida da mulher, física, psicológica e socialmente. A Avaliação Urodinâmica (AU) pode ser considerada o padrão ouro no diagnóstico da etiologia da IU. Entretanto, trata-se de exame invasivo, que provoca desconforto e constrangimento à paciente e cujo resultado nem sempre reproduz a sintomatologia clínica. Objetivo: Avaliar a associação entre o "International Consultation on Incontinence Questionnaire - Urinary Incontinence/Short Form" (ICIQ-UI/SF) e a Avaliação Urodinâmica, em mulheres com incontinência urinária. Métodos: Foi realizada análise retrospectiva dos dados clínicos e AU de 358 mulheres com IU atendidas em clínica privada. Utilizou-se a curva ROC com os valores de sensibilidade e especificidade dos escores do ICIQ-UI/SF apresentados pelas pacientes, a fim de estabelecer o escore capaz de discriminar o diagnóstico urodinâmico nos grupos estudados. Para o cálculo do p valor foi utilizado o teste de qui-quadrado ou exato de Fisher. O teste de Spearman avaliou a correlação entre o ICIQ-UI/SF e os parâmetros urodinâmicos. O nível de significância foi de 5% e o software utilizado para a análise foi o SAS versão 9.2. Resultados: A média de idade entre as pacientes foi de 51,1 anos, a raça predominante foi branca e 86,5% das pacientes tiveram ao menos duas gestações. As pacientes com Incontinência Urinária de Esforço segundo a AU (grupo 1) representaram 67.3% das pacientes estudadas. As pacientes com IUE na AU e Hiperatividade Detrusora (HD) - grupo 2 - representaram 16,2% da amostra e as pacientes com HD isolada (grupo 3) representaram 7,3% do total. Em 9.2% a Avaliação Urodinâmica foi considerada normal. Pacientes dos grupos 1 e 2 apresentaram escore ? 14 no ICIQ-UI/SF, sendo esta associação significativa (p=0,01 e p=0,001, respectivamente). Foi observada significativa associação entre a PPE ? 90 cmH2O e escore ICIQ-UI/SF ? 15 (p=0,0037). O teste de Spearman mostrou significativa correlação inversa entre o escore do ICIQ-UI/SF e a PPE, porém não mostrou correlação entre este escore e a Capacidade Cistométrica Máxima (CCM) ou com o volume vesical no primeiro desejo miccional (PDM). Conclusão: Mulheres com PPE ? 90 cmH2O apresentaram escores mais altos ao ICIQ-UI/SF, porém não há correlação com a CCM ou o PDM. Foi observada associação significativa entre a IUE e a PPE ? 90 cmH2O e escores mais altos no ICIQ-UI/SF
Abstract: Introduction: Urinary incontinence (UI) compromises women's quality of life, either in physical, psychological or sexual aspects. Urodynamics is considered the gold standard in the diagnosis of urinary symptoms. However it is invasive, expensive, provokes constraints to patients and is not always related to clinical complains. Objective: To evaluate the association between the "International Consultation on Incontinence Questionnaire - Urinary Incontinence/Short Form" (ICIQ-UI/SF) and urodynamics in women with urinary incontinence. Methods: It was a retrospective analysis of the data of 358 women with urinary incontinence attending a private clinic. A ROC curve was applied for sensitivity and specificity of ICIQ-UI/SF, to identify the score that would discriminate urodynamic diagnosis for the groups considered. P-value was obtained by Q-square and Fishers Exact Test. Spearman's test was used to correlate the ICIQ-UI/SF score to urodinamic parameters. Significance was 5% and the software SAS version 9.2. Results: Mean age was 51.1 years-old, the majority was white and 86.5% has been pregnant at least twice. Two hundred forty one patients (67.3%) presented stress urinary incontinence (SUI) on urodynamics (group 1), 16.2% presented SUI and Detrusor Overactivity (DO) (group 2) and 7.3% only DO. In 9.2% of the cases, urodynamics was considered normal. Women in groups 1 and 2 presented a significant association with ICIQ-UI/SF scores ? 14 (p=0.01 and p=0.001, respectively). A significant association was observed between Leak-point Pressure (LPP) ? 90 cmH2O and an ICIQ-UI/SF ? 15 (p=0.0037). Spearman's test showed a significant inverse correlation between ICIQ-UI/SF and LPP, but not to Maximum Cistometric Capacity (MCC) or First Desire to Void (FDV). Conclusions: Women with LPP ? 90cmH2O presented higher ICIQ-UI/SF scores, but no correlation was observed with MCC or FDV. Higher scores of the ICIQ-UI/SF were significantly associated with SUI and LPP ? 90cmH2O
Mestrado
Fisiopatologia Ginecológica
Mestra em Ciências da Saúde
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Wong, Chi-Kuan Ada. "Effect of behavioral therapy on urinary incontinence among community-dwelling older women." Click to view the E-thesis via HKUTO, 2008. http://sunzi.lib.hku.hk/hkuto/record/B40721541.
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Mummery, Christine C. "Efficacy of physiotherapy treatment for female urinary incontinence." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape9/PQDD_0020/MQ47075.pdf.
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Cartwright, James Rufus Patrick. "The genetic basis of urinary incontinence in women." Thesis, Imperial College London, 2015. http://hdl.handle.net/10044/1/51094.
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Background: Both urgency and stress urinary incontinence are heritable, with genetic factors contributing approximately half of total susceptibility. Aims: The overall aim of this project is to identify known and novel genetic polymorphisms associated with urgency and stress incontinence in women. Design: We systematically reviewed prior genetic association studies of incontinence, and other pelvic floor disorders. We then conducted a two stage GWAS, using women enrolled in NFBC1966, UK Twins, and ALSPAC for discovery, and women in six separate cohorts for replication. To prioritise likely susceptibility genes we measured gene expression in bladder biopsies, using whole genome microarrays, and PCR using custom microfluidic plates. Results: From prior studies of incontinence, and the related condition of prolapse among women, we conducted 13 meta-analyses for different polymorphisms, finding a single moderately credible association for a common variant in the ADRB3 gene associated with overactive bladder. From prior studies of lower urinary tract symptoms in men, we conducted 35 meta-analyses for different polymorphisms, finding a single moderately credible association for a common variant in the VDR gene associated with a composite of symptoms. For the GWAS discovery phase 8,997 women provided both incontinence phenotypes and genome wide genotypes. In meta-analysis, five loci included at least one genome-wide significant variant (p < 5x10⁻⁸). Twelve loci were taken forward for replication, with two demonstrating robust replication. In bladder biopsies we identified 1,115 significantly differentially expressed genes between stress and urgency incontinence. In the context of the previous literature, these results suggested EN1 and EDN1 as the most likely causal genes within the two replicated GWAS significant loci. Conclusions: This work highlights many of the challenges of identification of risk variants for complex conditions such as incontinence. The discovery of two novel risk loci for incontinence represents a significant advance in understanding the pathophysiology of these conditions.
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Creech, Linda Sue. "Urinary Incontinence and Sexual Intimacy: Older Women's Perceptions." Diss., Virginia Tech, 2002. http://hdl.handle.net/10919/27449.
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The purpose of this study was to examine factors that influence the experience of urinary incontinence (UI) as it relates to sexual intimacy for older women. Additionally, I wanted to identify perceived areas of intervention that might positively influence the experience of UI as it relates to sexual intimacy for participants. The sample consisted of 10 women who ranged in age from 65 to 81.
The theoretical framework guiding this study was a systemic perspective in which how participants make meaning is given prominence. Symbolic interactionism, social constructionism, and systems perspective are interwoven to provide the foundation for this study. Data were collected utilizing in-depth interviews. Self-portraits were introduced to enrich conversation during the second interview.
Three conclusions were drawn from this study. First, feelings of secrecy that permeated this project were manifested in the lack of willing participants as well as brevity of responses during interactions with participants. Second, participants indicated a tendency to minimize their incontinence and to manage their symptoms without formal medical intervention. Third, participants offered perceived potential interventions that might positively influence the experience of UI. These included the provision information related to UI in a way that does not require individuals to request the information, such as brochures at physicians' offices, post-surgical follow-up, and individuals from whom participants would be most comfortable receiving such information.Ph. D.
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Spirka, Thomas A. "Finite Element Modeling of Stress Urinary Incontinence Mechanics." Cleveland State University / OhioLINK, 2010. http://rave.ohiolink.edu/etdc/view?acc_num=csu1291495865.
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Hägglund, Doris. "Att leva med urinläckage : en longitudinell populationsstudie om livskvalitet hos kvinnor och hur de hanterar sitt urinläckage /." Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2002. http://publications.uu.se/uu/fulltext/nbn_se_uu_diva-2542.pdf.
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黃智君 and Chi-Kuan Ada Wong. "Effect of behavioral therapy on urinary incontinence among community-dwelling older women." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2008. http://hub.hku.hk/bib/B40721541.
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Månsson-Lindström, Ann. "Urinary incontinence in the elderly aspects of knowledge and quality of aids /." Lund : Dept. of Community Health Sciences, Lund University, 1994. http://catalog.hathitrust.org/api/volumes/oclc/39693825.html.
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Gotoh, Momokazu. "Quality of Life Assessment for Patients with Urinary Incontinence." Nagoya University School of Medicine, 2007. http://hdl.handle.net/2237/9186.
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Berglund, Anna-Lena. "A holistic view of urinary stress incontinence in women." Doctoral thesis, Umeå universitet, Obstetrik och gynekologi, 1995. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-96892.
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The present study group consists of 45 women with genuine stress incontinence who were selected for surgical treatment and randomized either to retropubic urethrocystopexy (n=30) or pubococcygeal repair (n=15). The preoperative assessment included medical history, gynecological examination, urine analysis and culture, residual urine, pad test, frequency-continence charts, water urethrocystoscopy, continence test and cystometry with analysis of micturition. Moreover, five semistructured interviews were performed with the women and two with their partner. The following questionnaires were used measuring a) personality characteristics: Karolinska Scales of Personality (KSP), Eysenck Personality Inventory (EPI), b) depression: Beck Depression Inventory (BDI) and c) social support: Interview Schedule for Social Interaction (ISSI). The results have shown that there was no difference in the subjective cure rate between the two surgical methods (73% vs. 80 % respectively). The bladder volume had increased in both groups and the intravesical pressure of the bladder filled to maximum had increased in the pubococcygeal repair group. Other urodynamic variables were unchanged by the operation. Pad tests have demonstrated that 67 % of the women in the urethrocystopexy group and 47 % in the pubococcygeal repair group ceased to leak urine. Postoperatively, 63 % of the women in the urethrocystopexy group needed high doses of analgesics compared with only 33 % in the pubococcygeal repair group. Among the women experiencing severe to very severe pain dysphoric subjects were overrepresented. Postoperative residual urine was a minor nursing problem in both groups. Women with SUI of long duration scored significantly higher than controls on the KSP scales of somatic anxiety, psychic anxiety, psychasthenia, suspicion and on the EPI lie-scale. There was no significant difference in sexual activity before and after surgery. One or two sexual dysfunctions within the desire, excitement, orgasmic and resolution phase were reported by the majority of women both before and after surgical intervention. The cured women reported a higher level of overall activities before surgery than the improved (i.e. not cured) women, whereas post surgery both the cured and the improved women obtained about the same level of activities. Regarding social support, no differences between the cured or improved women occured as concerns attachment. The cured women showed a higher degree of adequacy of social integration compared with the improved women. In order to delineate predictive factors for the surgical outcome the following variables were investigated: age of patient, duration of urine leakage, parity, personality, psychological and social factors. The following predictors of the outcome of surgical treatment emerged: duration of stress incontinence, neuroticism and age of patient. The results of the present study indicate the ecessity of a multidisciplinary approach to the treatment and nursing of women with SUI.Diss. (sammanfattning) Umeå : Umeå universitet, 1995
digitalisering@umu
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Cheater, Francine M. "Urinary incontinence in hospital in-patients : a nursing perspective." Thesis, University of Nottingham, 1990. http://eprints.nottingham.ac.uk/13306/.
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Urinary incontinence is a common health problem with not only physical, but also far-reaching psychological and social implications for the sufferer, her family and carers. Assisting patients with meeting their eliminatory needs is a fundamental part of nursing care. Incontinence is encountered in almost every sphere of clinical practice and is a problem with which nurses are often directly concerned. Nurses, in association with other members of the health care team, have considerable potential to help patients regain continence, or when this is not possible, to ensure that the individuals concerned, and their relatives or carers, can cope effectively with the problem, both physically and psychologically. This is an area of nursing care, however, which to date has attracted little research. The studies undertaken in this thesis sought to examine the nursing assessment and management of the care of patients with urinary incontinence in acute medical and care of the elderly wards. The research comprises of a sequence of studies which examined the problem from a number of perspectives. Methods of data collection included nurse and patient self-, reports, the examination of nursing and medical documentation, direct observation and self-completed questionnaires. Findings indicated that urinary incontinence was common in acute medical and care of the elderly wards, and that a considerable proportion of patients had indwelling catheters to manage the problem. Nurses were not always aware of patients' incontinence problems and their assessments concerning important aspects of the symptom were frequently unreliable. Further inadequacies in nurses' assessments, as well as in the management of the care of patients with incontinence, were identified from an examination of the nursing and medical records, and observations of verbal hand-over reports. Qualified nurses and learners appeared ill-informed about the causes of incontinence, and the majority had little knowledge of the range of factors which need to be considered to ensure that a systematic assessment of the problem is carried out. Despite considerable scope for the provision of rehabilitative care for incontinence sufferers, many nurses appeared to have a limited appreciation of their potential for initiating such care. Evidence collected from the nursing and medical records, the verbal hand-over reports and nurses' questionnaires, suggested that the management of patients with incontinence still focuses predominantly on measures which aim to contain the problem with little attention being given to rehabilitative interventions. A considerable proportion of the charge nurses, and the majority of the other qualified nursing staff, stated they had not received any continuing in-service education relevant to the promotion of continence or management of incontinence since their basic training. Nurses exhibited positive attitudes, overall, towards the management of incontinence but their responses indicated that a number of common misconceptions surrounding the problem persist. The enrolled nurses demonstrated significantly less positive attitudes towards the management of patients with incontinence than other grades of nurses. Similarly, the nursing staff who worked in the slow-stream rehabilitation care of the elderly wards showed significantly less positive attitudes towards incontinence than the nurses working in other types of wards. The implications of the findings of these studies for nursing practice, education and further research are discussed.
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Robinson, Timothy Dudley. "Anti-diuresis in the management of daytime urinary incontinence." Thesis, King's College London (University of London), 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.429408.
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AL, Hasni Alya Ali Abdullah. "URINARY INCONTINENCE AND WOMEN’S QUALITY OF LIFE IN OMAN." OpenSIUC, 2017. https://opensiuc.lib.siu.edu/dissertations/1481.
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Urinary incontinence (UI) is a common public health concern among women worldwide, with adverse effects on their quality of life (QoL). This study aims to explore the prevalence of UI among Omani women aged 18-49 years old, and to explore the impact of UI on women's daily prayers, physical activities, social life, mental health, and general QoL. The study is of quantitative comparative design, and the researcher used the World Health Organization’s (WHOs) International Classification of Functioning, Disability and Health (ICF), as a conceptual framework. The researcher randomly chose four-hundred and one participants from ten primary health care centres in Muscat. The researcher assessed their UI status and impact on different domains of their life using UDI-6 and IIQ-7 respectively, which are validated self-reported questionnaires. From the results, the researcher highlighted the high prevalence (85%) of UI among young Omani women. Additionally, UI did have a statistically significant impact on Omani women’s ability to perform their daily prayers, physical activities, social life, mental health, as well as, their general QoL. The use of ICF framework allows policymakers and public health officials to see the big picture of UI as public health concern in Oman. It forms the basis for implementing cost-effective health education programs at the Primary Health Care (PHC) institutions in Oman, for the goal of improving women’s health and community health.
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Khullar, Vikram. "Ultrasound imaging of the female lower urinary tract." Thesis, King's College London (University of London), 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.391595.
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Quinn, Martin. "Vaginal ultrasound of the lower urinary tract." Thesis, University of Bristol, 1994. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.240026.
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Cutner, Alfred. "The lower urinary tract in pregnancy." Thesis, Imperial College London, 1993. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.338240.
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Cutone, Benjamin. "Female urinary incontinence and treatment rates among a Medicare population." Thesis, Boston University, 2012. https://hdl.handle.net/2144/12340.
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Thesis (M.S.)--Boston University
PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you.Introduction and Hypothesis: The objective ofthis study was to determine the treatment rates of urinary incontinence (UI) in women 65 years old and older by education, poverty, and socioeconomic status (SES). Additionally, it was investigated ifhaving a discussion with a health care provider about UI had any effect on treatment rates. Methods: The publicly available 2007-2009 Medicare Health Outcome Survey data was examined in regards to four items that query about UI. All women 65 years old and older who provided data on UI and level of education were included in the analysis. United States Census Bureau data were used to establish poverty and SES variables. Results: In total, 87,805 women met inclusion criteria and 43.2% reported experiencing some UI in the past 6-months with only 28.6% receiving any treatment for UI. Women with a college education who self-reported either a "small" or "big" UI problem were more likely to receive treatment for their UI (OR = 0.84 (95% CI 0.79, 0.89)) and (OR= 0.77 (95% CI 0.69, 0.86). Women with a college education and any magnitude ofUI were also more likely to discuss their UI problem with a health care provider (OR = 0.93 (95% CI 0.88, 0.97)) and (OR= 0.80 (95% CI 0.72, 0.89)). For women with a small UI problem, a discussion with a provider was most impactful in regards to treatment for women without a college education. For women with a big UI problem, a discussion was most beneficial to treatment for women with a college education. Conclusion: UI is a prevalent condition among women 65 years old and older. Women without a college education are disadvantaged in regards to receiving any treatment for UI. Treatment rates may be improved among less educated women if providers initiate discussions regarding UI during the clinical encounter.
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Balog, Brian Michael. "Brain-Derived Neurotrophic Factor Mediates Recovery from Stress Urinary Incontinence." University of Akron / OhioLINK, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=akron1602113592326106.
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Macaulay, Andrew John. "Psychological factors in the aetiology and treatment of urinary symptoms in women." Thesis, Imperial College London, 1988. http://hdl.handle.net/10044/1/47163.
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Dass, Narinder. "Studies of the anatomy and autonomic innervation of the vesicourethral junction and urethra." Thesis, University of Oxford, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.363675.
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Hasan, Tahseen. "Transcutaneous electrical nerve stimulation (TENS) and temporary S3 nerve root stimulation in idiopathic detrusor instability and characterization of the human detrusor smooth muscle contraction." Thesis, University of Newcastle Upon Tyne, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.310132.
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McNally, Donal Stewart. "Pressure measurement in the investigation and treatment of urinary stress incontinence." Thesis, University of Exeter, 1990. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.253561.
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Jha, Swati. "Urinary incontinence & impact of management on sexual function in women." Thesis, University of Sheffield, 2017. http://etheses.whiterose.ac.uk/18525/.
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Aims and Objectives: It was hypothesized that urinary incontinence has an impact on sexual function in women though the exact impact and its mechanism remains unproven. This thesis aimed to analyze the association between urinary incontinence and sexual function in women. The impact of different treatment modalities for urinary incontinence and their effect on sexual function was measured. This was through a series of separate experiments. Methods: It is widely accepted that urinary incontinence impacts on sexual function but the pathophysiology of sexual dysfunction remains unclear. A review of female sexual dysfunction (Paper 1) and the impact of pelvic floor problems on sexual function (Paper 2) was undertaken. As studies analyzing sexual function in women with pelvic floor disorders tend to cluster women with prolapse and incontinence it has been difficult to identify which of these has a greater impact on sexual function. A study was undertaken to compare sexual function in these 2 main disorders of the pelvic floor, prolapse and incontinence (Paper 3). The incidence of sexual dysfunction and comparison of symptoms in both groups were done using Mann-Whitney U test. The two most common causes for urinary incontinence are sphincter weakness and involuntary detrusor contractions, which usually manifest clinically as stress incontinence and overactive bladder. Traditional teaching has been that both are responsible for coital incontinence but there remains considerable controversy on the exact impact different types of urinary incontinence has. This was further explored in another study (Paper4). Data were collected as part of routine clinical care using an electronic pelvic floor questionnaire (ePAQ) and correlated with urodynamic findings. By correlating the different types of incontinence based on urodynamic diagnosis to sexual function, the exact incidence of coital incontinence, penetration and orgasm incontinence were estimated. Various treatment modalities for both types of urinary incontinence were assessed and the impact these treatments have on sexual function studied. The main treatments for Stress incontinence are Pelvic Floor Muscle Training (PFMT) and surgical treatment. To assess the former a prospective cohort randomized controlled trial was conducted looking at the impact of electrical stimulation compared to standard PFMT alone in women with urinary incontinence and the impact this has on sexual function (Paper 7). This was a single centre two arm parallel group randomised controlled trial. The interventions compared were electric stimulation versus standard pelvic floor muscle training. Outcome measures included Prolapse and Incontinence Sexual function Questionnaire (PISQ) physical function dimension at post-treatment (primary); other dimensions of PISQ, SF-36; EQ-5D, EPAQ, resource use, adverse events and cost-effectiveness (secondary outcomes). The impact of all continence surgery including the Tension free vaginal tape (TVT) on sexual function was evaluated by conducting a systematic review and meta-analysis (Paper 5). Observational studies and randomised controlled trials investigating the impact of surgical correction of stress urinary incontinence on sexual function were included. Surgical interventions included TVT, TVT-O, TOT, Burch and AFS. Studies which included patients undergoing concurrent prolapse surgery were excluded from the analysis. Coital incontinence was analyzed separately and OR with 95% CI calculated. The data were analysed in Review Manager 5 software. In addition to analyzing various treatment options we also compared the different types of midurethral tapes and their overall impact on sexual function. The mainstay of treatment for women with overactive bladder symptoms (OAB) is anticholinergics and this was assessed in a separate study. Women identified to have OAB and sexual dysfunction being commenced on anticholinergics were followed up to observe the impact of medical treatment on their sexual function (Paper 6). The ePAQ PF, PISQ 12 and PGI-I were used for the assessment of Overactive bladder and Sexual function. Sexually active women with overactive bladder were included in the study and assessed using the ePAQ-PF, PISQ 12 and PGI-I for Overactive bladder and Sexual function. Prolapse and voiding dysfunction were exclusion criteria for the study. All women were treatment naïve and followed up for 6 months. Sexual function before and after treatment was compared. The data were analysed using SPSS (version 20). Results: The individual impact of pelvic organ prolapse (POP) and urinary incontinence on sexual function was found to be similar. Patient and partner avoidance in women with POP was greater than those with stress urinary incontinence (Paper 3). Worsening urinary incontinence has a deleterious effect on sexual function. However the type of urinary incontinence as established on Urodynamic diagnosis does not correlate with the nature of underlying sexual problems, orgasm or penetration incontinence (Paper 4). PFMT improved sexual function, but there was no difference in the outcomes when comparing standard PFMT to electrical stimulation (Paper 7). Surgical correction of SUI significantly reduced coital incontinence . An analysis of overall impact on sexual function with all surgical continence procedures demonstrated an improvement, no change and deterioration in 31.9%, 55.5% and 13.1% respectively. These were similar when analyzing overall sexual function following mid urethral tapes in isolation (Paper 5). Anticholinergics and cure of overactive bladder did not however correlate to an improvement in sexual function (Paper 6). Conclusions: Sexual dysfunction is complex and multifactorial. The prevalence of sexual dysfunction is greater in women with pelvic floor disorders and the interventions for urinary incontinence have a variable impact.
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Eliasson, Kerstin. "Urinary leakage and physical activity in young women /." Stockholm : Karolinska institutet, 2005. http://diss.kib.ki.se/2005/91-7140-530-5/.
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Murray, A. "A critical study of the application of the fluid bridge test before, during and after surgery for stress incontinence in women." Thesis, University of Liverpool, 1988. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.384350.
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Morison, Moya Joy. "Family perspectives on bed wetting in young people." Thesis, Open University, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.295009.
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Abdel-Fattah, Mohamed. "Evaluation of transobturator tension free vaginal tapes in management of female urodynamic stress incontinence." Thesis, University of Aberdeen, 2015. http://digitool.abdn.ac.uk:80/webclient/DeliveryManager?pid=230504.
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Mostafa, Alyaa. "Evaluation of single incision mini-slings in surgical management of female stress urinary incontinence." Thesis, University of Aberdeen, 2014. http://digitool.abdn.ac.uk:80/webclient/DeliveryManager?pid=217882.
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Objectives: To compare single incision mini-slings (SIMS) versus standard mid-urethral sling (SMUS) in the surgical management of female stress urinary incontinence (SUI) with regards; efficacy, safety and cost-effectiveness. Methods: A multicentre randomised controlled trial (RCT) comparing SIMS-Ajust® with SMUS-TVT-OTM (1-year follow-up) was performed. In addition, a systematic review and meta-analysis of RCTs comparing SIMS versus SMUS (1-3 years follow-up) was performed, incorporating the results of the RCT. Both studies assessed post-operative pain, time to return to normal activities and work, patient-reported and objective cure rates, peri-operative complications and impact on pre-operative urgency, women's quality of life (QoL), sexual function and cost effectiveness. Results: For the RCT, 137 women were randomised (SIMS-Ajust® [n=69] vs. TVT-OTM [n=68]). The SIMS Ajust® group had significantly lower post-operative pain-profile within the first four weeks (p <0.001). There were no significant differences in patient-reported success rate (p >0.999), objective success rate (p >0.999) or re-operation rates (p= 0.721) at 1-year follow-up. For the systematic review, 670 articles were identified, and 26 RCTs (n=3308 women) were included. After excluding RCTs evaluating TVT-SecurTM (recently withdrawn from clinical practice), there were no significant differences between SIMS and SMUS in patient-reported cure rates (RR 0.94, 95% CI 0.88, 1.00) and objective cure rates (RR 0.98, 95% CI 0.94, 1.01) at a mean follow-up of 18.6 months. SIMS had significantly lower post- 1 operative pain scores (WMD -2.94; 95% CI -4.16, -1.73), and earlier return to normal activities and work (WMD -5.08; 95% CI -9.59, -0.56; and WMD -7.20; 95% CI -12.43, -1.98, respectively). Conclusion: Adjustable anchored SIMS-Ajust® appears to have more favourable recovery, pain and cost effectiveness outcomes than SMUS-TVT-OTM, whilst having similar effectiveness outcomes, at 1-year follow-up. Generally, SIMS appear to have equivalent outcomes compared with SMUS at a mean follow-up of 18-months, in terms of patient-reported cure, objective cure and impact on women's QoL and sexual function. Consequently, SIMS represent a promising group of procedures in the treatment of women with SUI, and merits further research especially in terms of longer term outcomes.
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Dragomir, Anca Dana Schroeder Jane C. "Uterine location of leiomyomata risk factors and relation to stress urinary incontinence /." Chapel Hill, N.C. : University of North Carolina at Chapel Hill, 2007. http://dc.lib.unc.edu/u?/etd,1223.
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Thesis (Ph. D.)--University of North Carolina at Chapel Hill, 2007.Title from electronic title page (viewed Mar. 26, 2008). "... in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Department of Epidemiology." Discipline: Epidemiology; Department/School: Public Health.
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Kelleher, Cornelius John. "The impact of urinary incontinence on the quality of life of women." Thesis, King's College London (University of London), 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.309418.
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Pagorek, Stacey. "PREVALENCE OF SPORTS-RELATED STRESS URINARY INCONTINENCE IN THE FEMALE COLLEGIATE ATHLETE." UKnowledge, 2019. https://uknowledge.uky.edu/rehabsci_etds/57.
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Urinary incontinence is a health condition that is associated with involuntary leakage of urine. Stress urinary incontinence (SUI) describes involuntary leakage of urine on effort or exertion and can impact one’s ability to participate in activities and affect quality of life. Furthermore, clinical management of this health condition is challenging as individuals who experience urinary incontinence often do not report this concern to a health care provider.
Stress urinary incontinence is not typically a health concern associated with young, healthy athletes. However, researchers have begun to examine the presence of this health condition amongst both a younger population and in athletes. Therefore, the purpose of this study is to assess the prevalence of stress urinary incontinence in collegiate female athletes.
This study involved the development of an electronic survey tool to assess the prevalence of SUI in the female collegiate athlete. Female collegiate athletes from six different NCAA Division I schools were asked to complete the survey. The overall response rate for the survey was 32.6% (333/1020). Results indicate that SUI does in fact occur in NCAA Division I collegiate female athletes. Overall, 68.5% of female collegiate athletes surveyed reported ever experiencing SUI. During daily life activities (cough, sneeze, laugh), 54.2% of female collegiate athletes reported experiencing SUI. During participation in their sport, 40.0% of female collegiate athletes reported experiencing SUI, referred to as sports-related SUI. When reporting SUI experienced during either sport participation or during other exercise-based activities, 58.2% of female collegiate athletes reported SUI.
The proportion of female athletes reporting sports-related SUI varied by sport. The highest prevalence of leakage in sport was reported by gymnasts (80%) and the lowest prevalence was reported by those who participated in rifle (0%). Over half (52.3%) of female athletes who reported sports-related SUI said their symptoms first began in high school. While majority of female collegiate athletes stated they did not avoid their sport because of SUI, one-fifth (20.5%) of athletes with sports-related SUI reported they alter how they move in their sport out of concern for leakage. The impact of sports-related SUI on other aspects of life (family, social, or school life) were reported to be minimal.
Athletes who experience sports-related SUI are most likely to tell either a teammate (49%) or no one (36%). Very few female athletes have told someone in healthcare about this concern: doctor (3%), athletic trainer (4%); physical therapist (1%). Furthermore, only 3% of female collegiate athlete with sports-related SUI reported ever seeking treatment and only 25.8% reported they would find value in seeing a healthcare provider to discuss SUI. Most (76.7%) female collegiate athletes, whether they reported SUI or not, stated they had never been instructed on exercises to strengthen the pelvic floor muscles and 60.6% reported they would find educational programs involving exercises to decrease or prevent SUI beneficial.
In conclusion, SUI does occur in the female collegiate athlete and is often not reported to healthcare providers. Based on this information, the general practice of screening athletes for relevant health conditions during pre-participation physicals may need to include additional questions for SUI. Further investigation needs to explore how to best engage and educate female collegiate athletes on the subject of SUI and how to successfully communicate with and address those with the condition.
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Garley, Ailyn. "A case series to pilot cognitive behaviour therapy for female urinary incontinence." Thesis, Lancaster University, 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.422963.
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Tegerstedt, Gunilla. "Clinical and epidemiological aspects of pelvic floor dysfunction /." Stockholm, 2004. http://diss.kib.ki.se/2004/91-7140-065-6/.
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Kang, Youngmi. "Predictors of Help-Seeking Among Community-Dwelling Korean American Women With Urinary Incontinence." Diss., The University of Arizona, 2007. http://hdl.handle.net/10150/193616.
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The purpose of this study is to develop a better understanding how the social and cultural constructions of UI influences aging Korean American women's help-seeking behavior (HSB). Specific aims are to test the psychometric properties of newly translated Korean versions of instruments and test a conceptual framework derived from a systemic perspective.This study uses a cross-sectional correlation descriptive design to understand relationships among predisposing (culture, health beliefs, and social structure), enabling (family and community resources), and need factors (perceived need) within the framework of socio-structural and cultural context. A sample of 149 Korean American women with UI was recruited from local religious organizations in Arizona. Data analysis includes descriptive statistics and multiple regression to test the conceptual framework.The results of research question one showed that reliabilities of the four newly translated measures and a validity of the Social Support Scale were appropriate to measure HSB among Korean target population. Results of research question two indicated that 35.8% of explained variance in HSB was explained by the conceptual framework. Significant predictors of HSB were severity of UI, Incontinence-quality of life (QOL) and social support. The results of research question four showed that there are moderator effects of enabling factors (health care support and social support) on perceived need (severity of UI and Incontinence-QOL) to facilitate seeking help.It is noteworthy that the notion of UI among Korean American women was influenced by social and cultural construction. Particularly, collectivism of social construction and ageism, and fatalism of cultural construction of UI has permeated to Korean women's beliefs about incontinence.
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Ng, Sau-loi, and 吳秀來. "A randomised controlled trial study of the efficacy of intensive pre-operative pelvic floor muscle training to decrease post-prostatectomy urinary incontinence." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2013. http://hdl.handle.net/10722/198846.
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Background: Radical prostatectomy is the gold-standard treatment for clinically organ-confined cancer of the prostate. However, urinary incontinence and erectile dysfunction are major clinical problems, despite advances in surgical techniques. Pelvic floor muscle training is still the first-line treatment used to restore pelvic floor or bladder function after radical prostatectomy although its role is still inconclusive.
Objectives: To determine the benefit of starting pelvic floor muscle training three weeks before radical prostatectomy in order to find by the end of three months after surgery: (1) any degree of continence regained in the intervention group, measured by 24-hour and one-hour pad tests; (2) any positive improvement in the quality of life in that group.
Methods: Sixty-six eligible participants were randomised into either the intervention or the control group before radical prostatectomy. The former received three weeks’ pre-operative pelvic floor muscle training from an advanced practice nurse, while the latter received only standard care. Urine loss by 24-hour pad test was compared in the two groups as the primary outcome, and the questionnaires on incontinence impact, functional assessment on prostate cancer and potency satisfaction at one, two, three and six months after surgery were compared as secondary outcomes.
Results: The intervention group regained continence significantly (p=0.002) earlier than the control group at the end of three months after surgery, as measured by the 24-hour pad test. The intervention group also reported a significantly better quality of life in the questionnaire on ‘incontinence impact’ than the control group. Interestingly, the Functional Assessment of Cancer Therapy-Prostate questionnaire showed no statistical significant difference between the groups, despite significantly less urine loss in the intervention group, which also had a higher potency satisfaction score on the International Index of Erectile Function (p=0.005) by the end of three months after surgery.
Discussion: The present study found that three weeks’ pre-operative pelvic floor muscle training decreased the duration and severity of incontinence after radical prostatectomy, as measured by the 24-hour pad test of urine loss (in grams). Some other studies counted the number of pads used as the comparative data between the groups; however, there might be divergent findings in different studies. In one previous study of pelvic floor muscle training initiated two to four weeks before surgery but showing no benefit, it was found that patients received only one training session before surgery without further monitoring. A limitation of present study is that participants were followed-up for six months after surgery. It is possible that a longer period, perhaps one or two years, of post-prostatectomy follow-up might provide further important information.
Conclusions: This is the first comprehensive study in Hong Kong to examine the efficacy of three weeks’ pre-operative pelvic floor muscle training in reducing post-prostatectomy urinary incontinence, and to evaluate the continence-related quality of life and potency satisfaction of intervention and control groups. The results demonstrated that such training not only significantly hastens the recovery of urinary continence after surgery but also leads to a better continence-related quality of life and potency satisfaction in the intervention group.published_or_final_version
Nursing Studies
Doctoral
Doctor of Nursing
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Foote, Andrew UNSW. "The treatment of urinary incontinence : cost utility analysis and quality of life benefits." Awarded by:University of New South Wales, 2003. http://handle.unsw.edu.au/1959.4/20855.
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Aims: The aim of this thesis was to identify the most cost effective urogynaecological treatment from a range of five standard therapies of 217 female patients, and to test the hypothesis that the conservative treatment of urinary incontinence was more cost effective than surgical or pharmacological interventions, using the cost per Quality Adjusted Life Year (QALY) as a common assessment. Methods: The first step in this process was to determine whether a generic cost effectiveness instrument, the York Quality of Life Questionnaire was sufficiently sensitive to allow its use in the field of urogynaecology. The York Questionnaire was compared with several other quality of life questionnaires and outcome measures that have been previously utilised in urinary incontinence, and was found to be equally sensitive in detecting change in quality of life as a result of treatment. The next step was to measure the costs required to produce this change in quality of life and to calculate the QALY's for five urogynaecological treatments in three prospective trials comprising of: a randomised trial of Nurse Continence Advisor versus Urogynaecologist conservative treatment of urinary incontinence (n=143), a prospective trial of laparoscopic versus open colposuspension (n=62), and the pharmacological treatment of detrusor instability (n=12). Costs assessed included consultation fees, investigations, theatre costs, hospital stay, patient time off work & travel expenses, and reduction in protective pad costs. Results: The cost/QALY for 5 years as a result of each of the five treatments varied from $28,009 for the Nurse Continence Advisor conservative treatment to $134,069 for the open colposuspension treatment. Conclusions: This finding suggests that the conservative treatment of urinary incontinence is the most cost effective, and should be utilised as the first form of treatment. As a consequence, financial resources would be more efficiently utilised in the conservative treatment of urinary incontinence, such as increasing the availability of services offered by Nurse Continence Advisors and physiotherapists.
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Moore, Katherine N. "The effect of urinary incontinence on the quality of life following radical prostatectomy." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1997. http://www.collectionscanada.ca/obj/s4/f2/dsk3/ftp04/nq23039.pdf.
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Tindall, Mary. "Urinary incontinence, self esteem and social participation among women 60 years and older." Thesis, The University of Arizona, 1988. http://hdl.handle.net/10150/276884.
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The purpose of this study was to explore the relationship between urinary incontinence and self-esteem and also social participation. A convenience sample of 25 women 60 years of age and older participated. Forty-eight percent of the women had urinary incontinence at the time of the study. No significant differences were found in the level of self-esteem between those women with urinary incontinence and those women without urinary incontinence. Two subjects with urinary incontinence reported refusing social participation due to urinary incontinence. However, no difference in the overall level of social participation was found when comparing those with to those without urinary incontinence. A nonsignificant correlation was found between self-esteem and the overall level of social participation. In addition, the relationship between self-esteem and the level of social participation for women with urinary incontinence was nonsignificant. Only two of the 12 subjects with urinary incontinence reported receiving treatment.
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Miao, Yongqing, and 苗永青. "Association between urinary incontinence and self-rated health in HongKong Chinese elderly people." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2007. http://hub.hku.hk/bib/B39724529.
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Avery, Kerry Natasha Louise. "Development and evaluation of a new questionnarie for urinary incontinence : the ICIQ-SF." Thesis, University of Bristol, 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.399961.
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Jackson, Simon. "Oestrogen supplementation in postmenopausal urinary stress incontinence : effect secondary to altered collagen pathophysiology?" Thesis, University of Bristol, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.390374.
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Anderson, Margaret Joan. "Case studies in the nursing management of urinary incontinence in confused, elderly patients." Thesis, University of Edinburgh, 1991. http://hdl.handle.net/1842/19693.
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The nursing care of the confused, elderly patient suffering from urinary incontinence (UI) is poorly understood. The objectives of a study to examine the complex relationships between patient characteristics, the social and physical environment and the organisation of nursing care were to: (i) explore the ways in which nursing staff approached the problem of UI in the confused, elderly patient; (ii) examine the effect of the organisation of care on the management of UI; and (iii) examine the application of principles derived from behavioural psychology to nursing practice. As the issues are complex, an extensive review of literature in four fields was undertaken. Biomedical explanations of UI and the nature of the dementing illnesses were examined and it was concluded that evidence of an environmental component in UI was probable. Models derived from behavioural psychology were found to be inadequate to understand behavioural problems associated with a dementing illness. A contextual-dialectic framework was proposed which provided also the rationale for the study design and research methods. A combination of action-science research using case studies and single case experimental studies provided the best means of exploring the issues and was consistent with evolving thinking in nursing in which the role of the nurse is to facilitate the interaction between person and environment. Two main propositions stated that (i) under the conditions of a routine geriatric model of nursing care, the level of UI in a ward would be high and (ii) under the conditions of an intervention model in which the nurse sought to manage the interaction between person and environment, levels of UI would be reduced. Comparisons from preliminary studies in two psychogeriatric wards and one residential home provided insights that were applied in two main studies. By using the concept of accident to categorise UI as fundamental, predisposing and precipitating factors, two frames of reference, the biological and the social, were linked. Staff were encouraged to reframe the problem of UI through this perspective and to assist in the development and testing of nursing interventions. In a residential home, the legibility of the environment was improved by the use of signposts as recommended by the Department of Health, on the assumption that this would reduce episodes of UI by making toilets easier to locate. Rapid and marked improvement was shown in one of four cases over a period of four weeks following a programme of guided orientation. In a psychogeriatric ward, systematic and sustained interactions between nurse and patient was improved when the organisation of nursing was altered to limit the number of nurses caring for a small group of elderly, incontinent men. Systematic and sustained interaction was improved by alterations in the arrangement of furniture and facilitated prompted voiding. The findings showed a reduction in UI of one third of the baseline figure and an increased appropriate use of the toilet. It was concluded that, to be effective, an intervention like prompted voiding requires a shift from a routine, geriatric model of care to an interventionist model inherent in a process of systematic nursing organised in an integrated code of primary nursing practice. Although nurses are exhorted to adopt a patient-centred and individualised approach to patient care, in practice a powerful conflict exists in caring for an individual in a collective and congregate setting that can be countered only by overt strategies. It was concluded that, while alterations in the environment were necessary, these were insufficient alone to affect UI in the confused, elderly patient and that the active presence of a nurse was required. Recommendations for nursing management, education, practice and research are made.
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Djokic, Jasmina. "Development and characterisation of polycaprolactone as a biodegradable material for use in urinary tract devices." Thesis, Queen's University Belfast, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.301738.
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Coit, Victoria Ann. "Studies into the effects of gonadectomy on the canine urinary bladder with reference to acquired urinary incontinence in the bitch." Thesis, University of Glasgow, 2009. http://theses.gla.ac.uk/855/.
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Acquired urinary incontinence in the canine is a distressing and debilitating condition affecting up to 20% of neutered bitches, whilst less than 1% of entire bitches and males suffer from this condition. Although a number of medical and surgical therapies exist for treatment of acquired urinary incontinence, none are able to cure the condition and many animals become refractory to treatment over time. It has long been thought that a decrease in resting tone within the urethra of a bitch following neutering is responsible for the development of acquired urinary incontinence; however, recent studies show that low urethral tone does not always lead to urinary incontinence, suggesting further factors must be involved. Although the exact aetiology and pathophysiology of the condition in the neutered bitch is unknown, it is thought to have many similarities to that of post menopausal urinary incontinence in women. In this condition, urinary incontinence is known to be mediated primarily by changes in the structure and function of the urinary bladder post menopause. The present study looks at the structure and function of the canine urinary bladder in vitro to determine if changes occur post neutering that could lead a bitch to develop acquired urinary incontinence and which may provide novel therapeutic targets for treatment of this disease. Contractility in response to carbachol (muscarinic) and electrical field stimulation was assessed in isolated strips of detrusor muscle from male and female, intact and gonadectomised canines. The potential role of non-adrenergic, non-cholinergic mediated contraction of the detrusor muscle was also examined and this system does not appear to be significantly altered by gonadectomy. Maximal contractile responses were, however, decreased in detrusor strips from neutered compared to entire canines regardless of gender, with detrusor strips from incontinent bitches having some of the weakest responses. Sensitivity to carbachol was also decreased in detrusor strips from neutered compared to entire canines. This suggests a decrease in contractile function of the urinary bladder in neutered canines and is similar to that seen in the bladders of women suffering from urinary incontinence post-menopause due to impaired contractility of the bladder and idiopathic detrusor instability. This suggests that changes in the function of the bladder post neutering may be partly responsible for the development of acquired urinary incontinence in the bitch. Post-menopausal urinary incontinence in women is hypothesised to be a linked to an increase in the collagen to smooth muscle ratio within the wall of the urinary bladder which is thought to impair bladder contractility and lead to the development of detrusor instability. Morphometric analysis of the urinary bladder wall of canines showed that the percentage of collagen within this organ was significantly increased in neutered compared to entire bitches, with incontinent bitches having some of the highest percentage collagen. The percentage of collagen was unchanged in neutered compared to entire males which were similar to entire bitches. These results support the long postulated theory that a decrease in oestrogen following gonadectomy / menopause is involved in the increase of collagen within the bladder. Results describing the pharmacological characterisation of muscarinic receptors (Schild analysis of pKB values) in strips of canine detrusor muscle suggest that the M3 receptor is the primary receptor responsible for bladder contraction in entire canines in vitro but that the M2 receptor predominates in neutered canines. This previously unreported finding could be significant in providing a novel therapeutic target to treat this debilitating disease. Studies that looked at mRNA expression for the muscarinic as well as the LH and GnRH receptors in canine bladder wall showed that there was an increase in expression of all receptors in tissue from neutered compared to entire canines and that tissue from females had higher expression levels than that from their male counterparts. It is known that gonadotrophin levels in the blood increase post neutering, and that decreasing these levels can provide continence in a number of animals. It is therefore possible, that an up-regulation of mRNA expression for these receptors is involved in the changes at the level of the detrusor that could lead to development of acquired urinary incontinence. It is also acknowledged that the muscarinic pathway is the primary pathway responsible for bladder contraction and emptying, therefore, a change in the expression of muscarinic receptors has the potential to alter bladder contractility as demonstrated previously. In conclusion these studies have shown that the structure and function of the urinary bladder of a neutered canine is altered compared to that of an entire canine, and that these changes have the potential to be involved in the development of acquired urinary incontinence in the bitch. Many of these changes mimic those seen in the bladders of post menopausal women suffering from urinary incontinence, thus suggesting that there may be commonality of disease process between the two species which may allow the use of the canine as a model of human urinary incontinence. This data, the first to include male animals in the study of bladder function and structure, suggest that the loss of oestrogen in the female and the concurrent increase in percentage collagen within the urinary bladder are not significant factors in the development of decreased detrusor contractility per se. On the contrary these results suggest that the muscarinic receptor effector pathway may play a crucial role in the development of altered bladder contractility and acquired urinary incontinence, and may provide a therapeutic target for effective treatment of this disease.