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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
Made available in DSpace on 2018-08-21T08:30:53Z (GMT). No. of bitstreams: 1 DiSessa_RenataGebaradeGrande_M.pdf: 1433274 bytes, checksum: 5feb9e16555674189ca32bbad41f5423 (MD5) Previous issue date: 2012
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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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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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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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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Doorbar-Baptist, Stuart. "Physiotherapy Assessment and Management of Post- Prostatectomy Urinary Incontinence." Thesis, The University of Sydney, 2015. http://hdl.handle.net/2123/15289.
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Aim: To determine the reliability of scoring real-time ultrasound (RTUS) record during an exercise protocol aimed at developing pelvic floor motor control in men with prostate cancer, and to determine predictors of acquiring control. Methods: 91 men diagnosed with prostate cancer attending physiotherapy for pelvic floor exercises. Detailed pelvic floor motor control exercises were taught by a physiotherapist to participants using trans-abdominal RTUS for biofeedback. A new protocol to measure skill attainment was developed. Three independent physiotherapists assessed skill attainment by viewing RTUS videos of the exercise. Reliability was evaluated using intraclass correlation coefficients. Logistic regression analysis was conducted to identify predictors of successful skill attainment. Acquisition of the skill was compared between pre and post-operative participants using an independent-groups t-test. Results: There was good reliability for scoring the outcome method (ICC 0.73 (95%CI 0.59 - 0.82)) for experienced therapists. Having low BMI and being seen pre- operatively predicted motor skill attainment, accounting for 46.3% of the variance. Significantly more patients trained pre-operatively acquired the skill of pelvic floor control compared with patients initially seen post-operatively (OR 11.87 95%CI 1.4 to 99.5 p = 0.02). Conclusions: A new protocol to evaluate attainment of pelvic floor control in men with prostate cancer can be scored reliably from RTUS record, and is most effective delivered pre-operatively. Future Studies: Based on the above research a proposed RCT has been
developed comparing current standard pelvic floor training protocols with a motor control led training protocol. This protocol is followed by development into a progressive resistance program that utilises progressively incremental intra- abdominal pressures as a resistance tool. Further discussion is made to evaluate optimal pelvic floor rehabilitative strategies.
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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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Al, Busaidi Kauthar Sulaiman Ahmed. "The prevalence of urinary incontinence among women in Oman." Thesis, Curtin University, 2011. http://hdl.handle.net/20.500.11937/244.
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This thesis describes an investigation of the prevalence of urinary incontinence (UI) among Omani women. First, a culturally specific questionnaire for interviews in English or Arabic was developed and tested. Next, feasibility of sampling and data collection methods were field-tested in 120 urban women. Finally, a national population-based sample of 800 women was interviewed. The prevalence of UI was 42.9%. Although UI was bothersome to 65%, care seeking was low (23.3%).
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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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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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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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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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Legendre, Guillaume. "Incidence et rémission de l’incontinence urinaire des femmes entre 45 et 60 ans." Thesis, Université Paris-Saclay (ComUE), 2016. http://www.theses.fr/2016SACLS535/document.
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Objectif : L’objectif principal de ce travail était d’évaluer les facteurs de risque d’incidence et de rémission de l’incontinence urinaire (IU) au sein d’une cohorte de femmes de la cinquantaine en prenant en compte le type d’IU (Incontinence urinaire d’effort - IUE -, Incontinence par argenture - IUU- et Incontinence urinaire mixte – IUM) et la gravité des symptômes.Matériel et Méthodes : Les données sont issues des questionnaires de l’enquête « les femmes et leur santé », des questionnaires annuels de la cohorte GAZEL et du questionnaire spécifique « les troubles urinaires » posé en 2000 et 2008. Un modèle de Cox a été utilisé entre 1990 et 2008 à partir des données de la question « Avez-vous des difficultés à retenir vos urines ? ». Des modèles de régression logistiques ont été utilisés entre 2000 et 2008 à partir de la question validée de l’IU « Au cours des 12 derniers mois, vous est-il arrivé d’avoir des fuites involontaires d’urine ? ».Résultats : Au sein de notre population, le taux annuel d’incidence de l’IU est de 5,5 % et le taux annuel de rémission est de 6,2 %, confirmant que l’IU est un phénomène dynamique avec des périodes possibles d’aggravation et d’amélioration partielle ou totale. Ces taux sont variables avec le type d’IU : entre 2000 et 2008, les taux d’incidence étaient respectivement de 14,9 % pour l’IUE, de 3,2 % pour l’IUU et de 3.1% pour l’IUM. L’IUE est le type le plus enclin à connaître une rémission de l’IU en comparaison à l’IUU et l’IUM. Les facteurs associés à l’apparition d’une IU sont des facteurs sociaux (le niveau d’études élevé), obstétricaux (la parité), hormonaux (la ménopause), et en rapport avec l’état de santé, physique ou mentale (la prise de poids, l’apparition de symptômes dépressifs, la dégradation de la qualité de vie - dans les dimensions tonus et isolement social du score NHP). La rémission complète est d’autant moins fréquente que les femmes vieillissent et qu’elles prennent du poids. Pour chaque type d’IU, l’influence des facteurs de risque semble différente. Ainsi, le niveau d’étude (être titulaire du baccalauréat), l’IMC (à l’inclusion, et au cours du suivi) et un syndrome dépressif à l’inclusion sont associés à l’apparition d’une IUE. Un antécédent de prise en charge chirurgicale de l’IU est associé à l’apparition d’une IUU et d’une IUM. La correction chirurgicale de l’IU pendant le suivi est, comme attendu, associée à une rémission des symptômes d’IUE, mais en revanche la rééducation périnéale et un antécédent d’accouchement par voie vaginale, sont associés à une persistance des symptômes d’IUE. L’accouchement par voie vaginale était également associé à la persistance de l’IUM. L’IUU et l’IUM sont les types d’IU les plus graves à l’inclusion. De plus, l’aggravation est plus marquée en cas d’IUU ou d’IUM que d’IUE. Hormis le type, les facteurs associés à une aggravation des symptômes sont une operation pour une IU (à l’inclusion) et l’apparition d’un syndrome dépressif. L’aggravation des symptômes est négativement associée à la consommation d’alcool à l’inclusion et une chirurgie de l’incontinence pendant la période d’étude. Le rôle des facteurs sociaux, comme l’obtention du baccalauréat par exemple, est associé à l’apparition d’un IU légère, alors que des facteurs obstétricaux comme un antécédent d’accouchement par voie basse est associé à une apparition de l’IU grave.Conclusion : L’IU est un phénomène dynamique avec des périodes possibles d’aggravation et d’amélioration partielle ou totale. L’analyse des facteurs de risque associés à l’IU doit intégrer une différentiation du type et de la gravité. Les données concernant l’épidémiologie de l’IU chez les femmes entre 45 et 60 ans sont encore trop peu nombreuses. D'autres enquêtes longitudinales incluant un nombre plus important de femmes sont essentielles afin de confirmer nos résultats et mieux conseiller les femmes en présentant les symptômesObjective: The main objective of this work was to evaluate the risk factors of incidence and remission of urinary incontinence (UI) in a cohort of women at midlife, taking into account the type of UI (Stress urinary incontinence - SUI – Urge urinary incontinence – IUU - and mixed urinary incontinence - IUM) and the severity of symptoms.Material and Methods: Data were obtained from the survey questionnaires "women and their health," the annual questionnaires cohort GAZEL and specific questionnaire "urinary problems" posed in 2000 and 2008. A Cox model was used between 1990 and 2008 from the data of the question "Have you trouble holding your urine? ". Logistic regression models were used between 2000 and 2008 from the issue validated UI "Over the last 12 months, did you have any involuntary loss of urine ? ".Results: In our population, the annual rate of incidence of UI was 5.5% and the annual rate of remission was 6.2%, confirming that the UI is a dynamic condition with possible periods of worsening and of improvement. These rates vary with the type of UI: between 2000 and 2008, incidence rates were 14.9% for SUI, 3.2% for UUI and 3.1% for the MUI. SUI is the most likely type to experience a possible remission of the UI compared to UUI and MUI. Factors associated with the occurrence of UI are social factors (high educational level), obstetrical (parity), hormonal (menopause), and factors in relation with physical or mental health status (weight gain, onset of depressive symptoms, impairment in health-related quality of life - energy dimension and social isolation dimension of NHP score). Complete remission is even less common as women gain in age and in weight. For each type of UI, the influence of risk factors seems different. Thus, educational level (baccalaureate), BMI (at baseline and during follow-up) and a depressive syndrome at baseline are associated with the onset of SUI. An antecedent of surgical procedure for UI is associated with the occurrence of UUI and MUI. Surgical correction of the UI during follow-up is, as expected, associated with remission of symptoms of SUI. By contrast, pelvic floor muscle training exercises and vaginal childbirth, are associated with persistence of symptoms of SUI. The vaginal delivery was also associated with the persistence of MUI. MUI and UUI are the more severe types of UI at baseline. Furthermore, the aggravation is more pronounced in case of UUI or MUI that for SUI. Aside from the type, the factors associated with worsening symptoms are a prior surgery for a UI (at baseline) and the onset of a depressive syndrome. A worsening of UI is negatively associated with alcohol consumption at baseline and incontinence surgery during the study period. The role of social factors, such as the baccalaureate for example, is associated with the appearance of a slight UI, while obstetric factors such as a vaginal childbirth is associated with the appearance of a severe UI.Conclusion: The UI is a dynamic condition with possible periods of worsening and of partial or total improvement. The analysis of risk factors associated with the UI must incorporate a differentiation of the type and severity. Data on the epidemiology of UI in women between 45 and 60 years are still too few. Other longitudinal studies including a larger number of women are essential to confirm our results and to better counselling women with UI symptoms
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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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Fozzatti, Maria Celina Martins. "Efeito da reeducação postural global (RPG) na incontinencia urinaria de esforço feminina." [s.n.], 2006. http://repositorio.unicamp.br/jspui/handle/REPOSIP/311597.
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Orientadores: Paulo Cesar Rodrigues Palma, Miriam DambrosDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: A Incontinência urinária de esforço (IUE) feminina, condição com alta prevalência, é definida como um sinal e sintoma ligado a distúrbios funcionais da uretra (esfíncteres) e/ou bexiga e não caracteriza uma doença. Trata-se então de uma disfunção mecânica em que alterações na biomecânica da bacia pélvica podem estar associadas à modificação deste mecanismo. Atualmente tem-se valorizado e vem-se aplicando o tratamento fisioterapêutico nesta afecção, como o treinamento dos músculos do assoalho pélvico, obtendo-se bons resultados a curto e médio prazos. Além disso, técnicas baseadas na abordagem global da paciente, que consideram aspectos da estrutura postural, estão ainda em fase de investigação. O trabalho aqui descrito constou da aplicação do tratamento da Reeducação Postural Global (RPG), trabalhando-se a reestruturação postural por meio do reequilíbrio do Sistema músculo esquelético (SME), alongamento das cadeias musculares e reequilíbrio dos eixos ósseos, num enfoque global. Objetivo: Avaliar os efeitos da RPG nas queixas de IUE e qualidade de vida em um grupo de mulheres incontinentes. Casuística e Método: Para o estudo, foram selecionadas 26 mulheres portadoras de queixa clínica de IUE, que foram submetidas ao tratamento da RPG. O tratamento constou de sessões semanais de 50 minutos num período de três meses e posteriormente de sessões quinzenais por mais três meses. O grupo foi acompanhado por seis meses após final do tratamento, sendo reavaliado no término do tratamento, no terceiro e sexto meses. A avaliação foi feita usando Questionário de Qualidade de Vida, diário miccional de três dias, Pad Use e Avaliação funcional do assoalho pélvico (AFA). No término do tratamento e no seguimento de seis meses, as pacientes também foram avaliadas por meio de escala analógica de satisfação. Resultados: Das 26 pacientes que iniciaram o programa, 25 concluíram o tratamento. No final deste quatro pacientes (16%) estavam curadas, 18 (72%) apresentaram melhora significativa e três (12%) não apresentaram melhora. No seguimento de seis meses, seis (24%) pacientes estavam curadas, 16 (64%) apresentaram melhora e três (12%) não apresentaram melhora. Diferenças significativas foram notadas no número de perdas (p<0.001), Pad Use (p<0.001) e AFA (p<0.001). Além disso, foi percebida melhora em todos os domínios do Questionário de Qualidade de Vida, especialmente em Percepção geral da saúde (p<0.005) e Impacto da incontinência (p<0.001) em todos os seguimentos da avaliação. Conclusão: A RPG induziu à melhora significativa dos sintomas de IUE e qualidade de vida no grupo de mulheres incontinentes estudado
Abstract: Stress Urinary Incontinence (SUI), is defined as a signal and/or a symptom connected to functional disorders of the urethra (sphincter) and/or blader and do not characterize a disease. It is, indeed a dysfunction where alterations in the pelvis biomechanics can be associated to a modification of this mechanism. Lately, physiotherapeutic treatments, as the training of the pelvic floor muscles, have been used and good results have been obtained in short and medium terms. Besides, techniques based on a global approach of the patient, which consider also aspects of the postural structure, are still under investigation. The work hereby described consisted of the application of the Global Postural Reeducation (GPR) treatment, in which the postural restructuring is worked through the reestablishment of the balance of the skeletal muscle system, stretching of the muscle chains and rebalance of the bone axis, in a global approach. Objective: Evaluate the effects of the GPR on Stress Urinary Incontinence and Life Quality in a group of incontinent women. Material and Methods: For this study, 26 women with SUI were selected, who underwent a GPR treatment. All patients were treated for six months using GPR, 50 minutes weekly sessions during three months and three more months of sessions every other week. The patients were evaluated before and after the treatment, and also at three and six months follow-up. Outcome measures were made using King's Health Questionnaire, three days voiding diary, Pad Use and Functional Evaluation of Pelvic Floor (FEPF). In the end of the treatment and after six months, the patient satisfaction was evaluated trough a standardized analogical visual scale. Results: Twenty-five patients were available for follow-up. At the end of the treatment there were four (16%) patients completely dry, 18 (72%) pesented significant improvement and three (12%) did not presented improvement. At six months follow-up there were six (24%) patients completely dry, 16 (64%) improved and three (12%) failures. Significant differences were noted in the number of leak episodes (p<0.001), Pad Use (p<0.001) and FEPF (p<0.001). Regarding the King's Health Questionnaire, improvement in all domains were observed, especially in General Perception of Health (p<0.005), leakage impact (p<0.001) in all the moments of evaluation. Conclusion: GPR significantly improved the symptoms and Quality of Life in women with SUI
Mestrado
Pesquisa Experimental
Mestre em Cirurgia
37
Silveira, Arlon Breno Figueiredo da. "Uso de sling sintetico pre-publico para tratamento da incontinencia urinaria de esforço : eficacia, segurança e qualidade de vida." [s.n.], 2008. http://repositorio.unicamp.br/jspui/handle/REPOSIP/308657.
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Orientadores: Cassio Luis Zanettini Riccetto, Paulo Cesar Rodrigues PalmaDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias
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Resumo: Objetivos: Com o objetivo de avaliar os resultados cirúrgicos e de modificação na qualidade de vida de mulheres submetidas ao tratamento de incontinência urinária de esforço com sling sintético de polipropileno com abordagem pré-púbica. Métodos: Foi desenvolvido estudo prospectivo, de intervenção, com seguimento por seis meses, envolvendo 20 pacientes, com idade mínima de 21 anos e com diagnóstico de incontinência urinária de esforço realizado no Serviço de Uroginecologia do Hospital das Clínicas da Universidade Estadual de Campinas, Campinas, São Paulo, com base em dados clínicos, urodinâmicos e de Pad-test compatíveis, as quais expressaram a vontade de se submeter à implantação de sling para correção cirúrgica; não gestantes; sem doença ou qualquer condição que pudesse comprometer o resultado da cirurgia, tal como: distúrbio de coagulação sanguínea, obstrução do trato urinário superior, insuficiência renal, comprometimento do sistema imune, infecção urinária ou vaginal; não submetidas a procedimento de sling sintético prévio; que concordaram em participar do estudo, por meio da assinatura do Termo de Consentimento Livre Esclarecido e em responder os questionários King's Health Questionnaire (KHQ) e International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) antes da cirurgia e decorridos seis meses do procedimento. Para o tratamento de incontinência urinária de esforço, empregou-se tela manufaturada em fibras de polipropileno, classe I, monofilamentar com 42 µm de diâmetro e macroporos maiores que 75 mm, por abordagem pré-púbica. As variáveis estudadas incluíram: idade, avaliação urodinâmica, Pad-test e resultados dos questionários King's Health Questionnaire (KHQ) e International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) . Os dados foram organizados por meio do programa Epi-INfo versão 6.04d e analisados com o programa Statistical Package for Social Sciences (SPSS), versão 13.0. As variáveis nominais e ordinais foram expressas em distribuição de freqüências absolutas e relativas e as quantitativas, pelos parâmetros da Estatística Descritiva. Para comparação dos parâmetros objetivos uroginecológicos e de qualidade de vida aferida pelos questionários International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) e King's Health Questionnaire (KHQ), do período pré-operatório e decorridos seis meses do procedimento cirúrgico, empregou-se teste de diferença de médias, em nível de significância de 0,05, determinando-se o intervalo de confiança em nível de confiança de 95%. Resultados: Comparando a avaliação pré-operatória àquela decorridos seis meses do procedimento cirúrgico, verificou-se redução significante da perda de urina mensurada através do Pad-test (p<0,001). A pressão de perda sob esforço foi negativa em 90% das pacientes decorridos seis meses da cirurgia. Os demais parâmetros urodinâmicos da cistometria não foram alterados significativamente comparando antes e depois da cirurgia. O fluxo máximo miccional despida de significância estatística (p = 0,034). Houve melhora de todos os parâmetros subjetivos avaliados pelo International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF), com significância estatística da freqüência de perda de urina (0,009) e menor interferência na vida da pacientes (p= 0,001), assim como de todos os domínios do King's Health Questionnaire (KHQ). Houve 6 (30%) casos de complicações, que consistiram em extrusão vaginal do sling, instituindo-se tratamento cirúrgico por retirada do segmento da tela exposta e síntese da mucosa vaginal. Conclusão: Embora tenha havido a necessidade de interromper este estudo devido ao alto índice de complicações, confirmou-se o fato de ser a incontinência urinária um evento que compromete a qualidade de vida das pacientes exercendo tal impacto que, mesmo diante do insucesso do procedimento terapêutico, a avaliação subjetiva foi favorável, decorridos seis meses da cirurgia
Abstract: Objectives: A prospective study of intervention was developed aiming to evaluate the surgical results and impact in the quality of life of women submitted to stress urinary incontinence treatment with polypropylene synthetic sling with prepubic approach. Methods: Twenty patients were included in this study. Diagnosis of stress urinary incontinence were based on clinical data, urodynamics and Pad-test. Inclusion criteria included: minimum age of 21 years; non pregnant; without illness or any condition that could compromise surgery's result (sanguineous coagulation disorders, superior urinary tract obstruction, renal insufficiency, immune system disorder, urinary or vaginal infection); abcense of previous synthetic sling procedure; agreement to participate of the study, by means of Free Consent Term signature and to answer to the questionnaires King's Health Questionnaire (KHQ) e International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) before the surgery and after six months of the procedure. Its was used a sling made of staple fibres of polypropylene, type I, monofilamentar (42 µm diameter) and macropores. All the procedures were performed under spinal anesthesia. The sling was placed and adjusted in midurethral area with minimal periurethral dissection. The proper tension and fixation was achieved by passing the sling arms through the prepubic subcutaneous fat tissue. The variables studied included: age; urodynamic evaluation; Pad-test; King's Health Questionnaire; and International Consultation on Incontinence Questionnaire. Data were recorded using Epi-INfo version 6.04d software and analyzed with Statistical Package for Social Sciences (SPSS), version 13.0. The nominal and ordinal variables were express in absolute and relative frequency distribution and the quantitative ones by parameters of descriptive statistics. Difference of means test was used (significance level of 0,05, 95% confidence interval) for comparison of the urogynecologic objective parameters and quality of life surveyed by ICIQ and KHQ questionnaires, of pre-operative and six months post-operative evaluation. Results: Comparing pre-surgical evaluations with those after six months of the surgical procedure, there were significant reduction of urine loss assessed by the pad-test (p<0,001). Comparing urodynamics evaluations before and after surgical procedure 90% patients no there were of urine loss. Other urodynamics parameters no there were significant alterations. The max flow there was significant reduction (p=0,034). There was an improvement of all subjective parameters evaluated by ICIQ-SF, with significance for frequency of urine loss (0,009) and minor interference in life (p= 0.001), as well as of all KHQ domains. Six patients (20%) presented complications which consisted of vaginal exposition of the sling. All of them were corrected surgically by excision of the mesh and suture of the vaginal wall. The study was interrupted after six months of follow up due to the high frequency of adverse effects. Conclusion: Although the decision of interrupting the study due to the high index of complication, it allowed to confirm that stress urinary incontinence compromises the quality of life of the patients significantly, and the treatmet could promote an improvement in the quality of life, even when objective results were unfavourable
Mestrado
Cirurgia
Mestre em Cirurgia
38
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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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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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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Zaitsev, V. I., O. S. Fedoruk, and I. I. Iliuk. "Chronic urinary infection (CUI) and bladder function in female incontinence (FI) patients." Thesis, БДМУ, 2017. http://dspace.bsmu.edu.ua:8080/xmlui/handle/123456789/16919.
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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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Zaitsev, V. I. "Influence of chronic urinary infection on the muscles activities of bladder and perineum in the patients with urinary incontinence." Thesis, БДМУ, 2022. http://dspace.bsmu.edu.ua:8080/xmlui/handle/123456789/19689.
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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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Fozzatti, Maria Celina Martins. "Tratamento da incontinência urinária de esforço feminina pela Reeducação Postural Global (RPG) : estudo comparativo longitudinal." [s.n.], 2010. http://repositorio.unicamp.br/jspui/handle/REPOSIP/312270.
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Orientadores: Viviane Herrmann, Paulo César Rodrigues PalmaTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
Made available in DSpace on 2018-08-17T02:53:51Z (GMT). No. of bitstreams: 1 Fozzatti_MariaCelinaMartins_D.pdf: 4656341 bytes, checksum: eb6677485cb09dbe79185403e87167c4 (MD5) Previous issue date: 2010
Resumo: A incontinência urinária de esforço é uma das queixas clínicas mais comuns de mulheres em consultório médico e o desequilíbrio postural tem sido considerado como possível causa deste sintoma. Estudos demonstram que disfunções posturais como a hiperlordose, a anteversão da bacia pélvica, dores lombares e fraqueza dos músculos abdominais estão associados às disfunções dos músculos do assoalho pélvico. Objetivo: Comparar o efeito da Reeducação Postural Global com o treinamento dos músculos do assoalho pélvico no tratamento da incontinência urinária de esforço feminina a curto e a longo prazo. Metodologia: Cinquenta e duas mulheres com queixa clínica de incontinência urinária de esforço foram divididas em dois grupos: o Grupo 1 (G1) recebeu tratamento pela Reeducação Postural Global em 1 sessão semanal de 50 minutos por três meses e o Grupo 2 (G2) recebeu treinamento dos músculos do assoalho pélvico quatro vezes por semana, uma vez supervisionada em sessão individual de 50 minutos e três não supervisionadas, por três meses. Ao final do tratamento, após 6 meses, e em dois anos, foi realizada avaliação subjetiva (cura, melhora, inalterada e piora), diário miccional, avaliação funcional do assoalho pélvico (AFA) e questionário de qualidade de vida. Resultados: Concluíram o tratamento 25 pacientes do G1 e 17 do G2. A avaliação subjetiva do G1 ao final do tratamento apresentou 16% cura e após seis meses, 24%. No G2, no final do tratamento, nenhuma paciente considerava-se curada, 69% referiram melhora e 31% encontravam-se inalteradas. Após seis meses, 19% referiram cura, 37,5% melhoram, 31% inalteradas e 12,5% que haviam referido melhora ao final do tratamento, apresentaram piora dos sintomas. O número de episódios de perda e o número de troca de absorventes diminuiram significativamente nos dois grupos (p<0,001), sendo significativamente menor no G1. A Avaliação Funcional do Assoalho Pélvico (AFA) melhorou significativamente nos dois grupos (p<0,001), sem diferença entre eles. A avaliação da Qualidade de Vida demonstrou melhora significativa nos dois grupos, em todos os domínios. Após dois anos foram reavaliadas 21 pacientes no G1 e 12 no G2. O G1 apresentou 47,6% de cura e o G2, 16,7%, sendo que neste grupo, 33,3% das pacientes referiram piora com relação ao final do tratamento. O número de perdas e o número de absorventes diminuíram significativamente nos dois grupos (p=0,0001), sem diferença significativa entre eles (p=0,0787 e p=0,0579, respectivamente). A AFA melhorou significativamente no G1, porém no G2, apresentou melhora significativa ao final do tratamento e mante-se inalterada no seguimento de dois anos (p=0,045). Conclusão: A RPG mostrou-se uma alternativa eficaz no tratamento da Incontinência Urinária de Esforço Feminina, com resultados comparáveis ao treinamento dos músculos do assoalho pélvico, a curto e a longo prazo
Abstract: Stress urinary incontinence (SUI) is one of the most common complains of women and postural unbalances have been considered as a possible cause. Studies have shown that postural disequilibrium such as hiperlordose, pelvis anteversion, lumbar pain and weakness of the abdominal muscles are associated to pelvic floor muscles dysfunctions. Objective: To compare the effect of Global Postural Re-education (GPR) and Pelvic Floor Muscle Training (PFMP) for the treatment of female stress urinary incontinence at short and long term. Methodology: Fifty-two women with SUI complain were distributed into two groups: Group 1 (G1) was submitted to 50 minutes weekly sessions of GPR for three months and Group 2 (G2) performed PFMT four times a week for three months, being one time in individual session under professional supervision and the other three times at home, for three months. Patients were evaluated at the end of the treatment and after six months and two years on subjective evaluation (cure, improvement, no change and recurrence), voiding diary, functional evaluation of pelvic floor (FEPF) and through a questionnaire of quality of life. Results: The number of patients completing the treatments was 25 in G1 and 17 in G2. The subjective evaluation of G1 showed cure in 16% women at the end of the treatment and 24% after six months. In G2 no women reported cure at the end of the treatment, 69% indicated improvement and 31% reported no change. After six months, the reports of cure, improvement and no change in G2 were, respectively, 19%, 37.5% and 31%. Additionally, 12.5% of the women in this group, who had referred to improvement at the end of the treatment, reported symptom recurrence after six months. The urine leakage episodes reduced significantly in both groups (p<0.001), being significantly lower in G1. PAD use reduced significantly in both groups (p<0.001) and was significantly lower in G1. FEPF improved significantly in both groups (p<0.001), with no difference between them. The evaluation of Quality of Life had shown significantly improvement in both groups, in all domains. Two years after the end of the treatment, 21 patients of G1and 12 of G2 were reevaluated. The amount of women reporting cure in G1 and G2 were, respectively, 47.6% and 16.7%. In G2, 33.3% of the patients referred to symptoms recurrence in comparison with the end of the treatment. Episodes of urine leakage and PAD use reduced significantly in both groups (p=0.0001), without significant difference between groups (p=0.0787 and p=0.0579, respectively). FEPF had shown improvement in G1 in the evaluation at six months and two years; however, in G2 it had shown improvement at the end of the treatment but it did not change in the evaluation at two years. This shows that the behavior of the groups was different throughout the time (p=0.045). Conclusion: GPR has proven to be an efficient alternative to treat SUI in women when compared to PFMT, either on short term or long term follow-up
Doutorado
Fisiopatologia Cirúrgica
Doutor em Ciências
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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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Thiel, Marcelo. "Analise quantitativa da fibrose e semiquantitativa da reação inflamatoria de quatro diferentes slings sinteticos." [s.n.], 2006. http://repositorio.unicamp.br/jspui/handle/REPOSIP/308661.
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Orientadores: Cassio Luis Zanettini Riccetto, Paulo Cesar Rodrigues PalmaTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas
Made available in DSpace on 2018-08-06T21:41:51Z (GMT). No. of bitstreams: 1 Thiel_Marcelo_D.pdf: 2563508 bytes, checksum: cb0427728a1aecf6795c3443f2f0cea9 (MD5) Previous issue date: 2006
Resumo: OBJETIVOS: Analisar quantitativamente, com método estereológico, a densidade de fibras colágenas formadas após implante de quatro diferentes tipos de sling;verificar por análise histopatológica a reação inflamatória. MATERIAS E MÉTODOS: Realizou-se o estudo em 70 ratas da raça Wistar, divididas em 3 grupos (A,B,C): No grupo A (30 ratas) implantou-se uma faixa de silicone e outra de submucosa intestinal suína, de 8x 4 mm, no tecido subcutâneo da parede abdominal. No grupo B (30 ratas), implantou-se, da mesma maneira, uma faixa de copolímeros de poligalactina com ácido poliglicólico e outra de polipropileno monofilamentar, de 8x 4 mm. Sutura com fio de nylon 5/0, fixou as faixas e, no grupo C (10 ratas), denominado controle, realizou-se dissecção do subcutâneo e aplicação do mesmo fio, sem implante de material. A coloração de Picro-Sirius, empregada apenas no 90° dia de pós-operatório, permitiu análise das fibras colágenas e a de Hematoxilia-eosina, o estudo histopatológico da reação inflamatória. Nos dias 7, 30 e 90 de pós-operatório, sacrificaram-se 10 ratas de cada grupo. RESULTADOS: No 7° dia, todos os materiais induziram moderada reação inflamatória, sem diferença com o controle. No 30° dia, os copolímeros de poligalactina com ácido poliglicólico apresentaram a menor reação inflamatória, sem diferença com o controle. Neste período, polipropileno monofilamentar e silicone produziram inflamação moderada, enquanto que na submucosa intestinal suína, a intensidade foi severa. No 90° dia, a reação inflamatória, nos copolímeros de poligalactina com ácido poliglicólico, foi maior que antes, porém menor do que a do polipropileno monofilamentar e silicone, que permaneceram semelhantes entre si. Novamente, o grau de inflamação na submucosa intestinal suína continuou o maior de todos. Na análise estereológica, a densidade. de fibras colágenas dos copolímeros de poligalactina com ácido poliglicólico e polipropileno monofilamentar foi significativamente menor (61 % e 65% respectivamente) do que o silicone (85%) e submucosa intestinal suína (86%). CONCLUSÕES: Polipropileno monofilamentar foi o melhor material inabsorvível, pois induziu menos reação inflamatória que os outros materiais testados. Como a submucosa intestinal suína foi completamente removida, a intensa reação fibrótica que produz, toma-se útil, e responsável pelo suporte suburetral após a cirurgia
Abstract: OBJECTIVES: To analyse quantitatively, using stereological methods, the density of the collagen fibres induced by four types of sling materials, and verify by a histopathological analysis the corresponding inflammatory reaction, as fibrosis secondary to sling implantation is considered responsible for restoring urethral support and re-establishing continence in women with stress urinary incontinence, and new synthetic materials that promote adequate fibrosis with the least intensity and duration have been proposed to substitute the aponeurotic sling. MATERIALS AND METHODS: The study comprised 70 isogenic white Wistar rats divided into three groups: group A (30 rats) had 8 x 4 mm strips of silicone and porcine small intestine submucosa (SIS) implanted in the abdominal subcutaneous tissues; group B (30 rats) had 8 x 4 mm strips of polycaprolactone and polylactic acid copolymers and monofilament polypropylene (PLP) implanted the abdominal subcutaneous layer; while a control group of 10 rats had dissection and suturing with 5/0 Nylon in the abdominal subcutaneous layer, as used to fix the strips in the other rats. Picro-Sirius staining was used to assess collagen fibres, and haematoxylin-eosin for the histopathological study. At 7, 30 and 90 days after surgery, 10 rats from each group were killed and assessed. RESULTS: Afier 7 days all the materials induced a moderate inflammatory reaction that did not differ from that in the control group. At 30 days there was no difference between the control and polycaprolactone and polylactic acid copolymers, having the least inflammatory reaction. PLP and silicone produced a moderate inflammatory reaction, while the porcine SIS induced a more intense reaction. At 90 days there was a more intense inflammatory reaction in polycaprolactone and polylactic acid copolymers than before but it was less than with PLP and silicone, which again were no different. During this period the inflammatory reaction induced by SIS was greater. The stereological analysis indicated that collagen fibres induced by polycaprolactone and polylactic acid copolymers and PLP were less dense (61% and 65%, respectively), and significant1y less than with silicone (85%) and SIS (86%). CONCLUSION: PLP was the best nonabsorbable material as it induced a less intense inflammatory reaction than the other tested materials. As porcine SIS was completely absorbed the intense fibrosis induced is useful, as it is exclusively responsible for the urethral support later after surgery
Doutorado
Cirurgia
Mestre em Cirurgia
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Bedretdinova, Dina. "Vers une modélisation de l'incontinence urinaire des femmes." Thesis, Université Paris-Saclay (ComUE), 2015. http://www.theses.fr/2015SACLS157/document.
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VERS UNE MODELISATION DE L’INCONTINENCE URINAIRE DES FEMMES Introduction : L’objectif principal était de mieux comprendre l’histoire naturelle de l’incontinence urinaire (IU) féminine grâce à une modélisation de sa prévalence sur ses facteurs de risque, en tenant compte de sa gravité et de ses types. Un objectif secondaire était de travailler sur la classification des circonstances des fuites urinaires.Matériel et méthodes : Nous avons utilisé les données de deux sondages téléphoniques sur une population représentative, Le Baromètre Santé 2010 (3089) et Fecond (5017) ; de deux enquêtes postales au sein de la cohorte GAZEL (3098), l’une générale et l’autre centrée sur les problèmes urinaires ; et enfin d’un sondage internet de volontaires adultes, NutriNet-Santé (85037). L’IU a été définie à partir d'un questionnaire validé, l’ICIQ-UI-SF et à partir d’une liste de problèmes de santé. Nous avons utilisé des modèles binomiaux et multinomiaux de régression logistique, des analyses de correspondances multiples et de classification ascendante hiérarchique.Résultats : La prévalence de l’IU tout venant (quel que soit son type ou sa gravité) variait de 1,5 % à 38,8 % selon les enquêtes et était égale à 17,3 % dans les 2 échantillons représentatifs. La conception de l’enquête, c’est-à-dire la nature de l’échantillon (représentatif ou non), son objectif (centré sur la santé générale ou l’IU), le mode de recueil des données et la mode de définition de l’IU (à partir d’un questionnaire spécifique validé ou basée sur une liste de maladies) étaient susceptibles de modifier à la hausse ou à la baisse les estimations de la prévalence de l’IU.Les fuites les plus fréquentes étaient les fuites à la toux, les fuites avant d’arriver aux toilettes et les fuites lors de l’exercice physique. Les femmes décrivant des circonstances attribuées aux principaux types d’IU, effort, par urgenturie et mixte, formaient un groupe distinct de celles déclarant des circonstances attribuées au type IU autre. De même, les femmes déclarant des circonstances attribuables à une IU d’effort se démarquaient de celles déclarant des circonstances attribuables à une IU par urgenturie. Les circonstances les plus discriminantes pour classer les femmes incontinentes étaient : fuites tout le temps, à la toux, pendant le sommeil et après la miction. Dans toutes les enquêtes nous avons identifié des associations significatives entre presque tous les facteurs de risque disponibles et l’incontinence ; mais certains facteurs étaient liés avec toutes les formes d’IU et d’autres seulement avec certaines formes. De plus nombreuses associations ont été observées avec l’IU grave, c’est-à-dire quotidienne, qu’avec l’IU hebdomadaire. Nous avons observé plus d’associations significatives avec l’IU mixte et l’IU autre qu’avec l’IU d’effort et l’IU par urgenturie. Les plus fortes associations ont été observées pour la dépression et l’obésité, liées avec presque toutes les formes d’IU. Les variables obstétricales étaient souvent liées à l’IU mixte. Conclusion : Le questionnaire ICIQ-UI-SF est approprié pour estimer la prévalence de l’incontinence urinaire dans des échantillons représentatifs mais il apparaît insuffisant pour définir tous les types d’IU. Nos résultats ont objectivé qu’il est possible d’utiliser les circonstances des fuites d’urine pour identifier des groupes spécifiques de femmes incontinentes, et que certaines circonstances peu utilisées en cliniques sont pourtant très discriminantes. Il y a probablement des travaux à faire et à poursuivre pour explorer dans quelle mesure les circonstances des fuites ont une valeur pronostique ou prédictive de réponse au traitement. Grâce à la modélisation, où nous avons pris en compte le type et la gravité de l’IU, nous avons pu constater quelles modalités de l’IU sont liées à certains facteurs de risque et quelles modalités ne le sont pasTOWARDS A MODELLING OF FEMALE URINARY INCONTINENCE Introduction: The main objective was to better understand the natural history of the female urinary incontinence (UI) through modelling of its prevalence by risk factors, while taking into account its severity and its type. A secondary objective was to work on the classification of the circumstances of urinary leakage.Methods: Data came from two telephone surveys of a representative population, The Health Barometer 2010 and Fecond; two mail surveys within the cohort GAZEL, one general and the other centred on urinary problems; and an Internet survey of adult volunteers, NutriNet-Health. We defined UI from a validated questionnaire, the ICIQ-UI-SF, and from a list of diseases. We used binomial and multinomial logistic regression models, multiple correspondence analysis and hierarchical clustering.Results: The prevalence of any UI ranged from 1.5% to 38.8%. In both representative samples it was 17.3%. The design of the survey, i.e. the sampling (representative or not), its objective (centred on general health or UI-centred), the data collection mode and UI definition (symptom-based or perception-based) were likely to change either upwards or downwards the estimates of the prevalence of UI.The most frequent circumstances were leaks during coughing, leakage before getting to the toilet and leaks during physical exercise. Women describing circumstances attributable to stress, urge or mixed types of incontinence formed a separate group from those reporting leakage circumstances attributable to other UI. Similarly, women declaring circumstances attributable to stress UI stood out from those declaring circumstances attributable to urge UI. The most discriminating circumstances to classify incontinent women were: leaks all the time, leaks during coughing, leaks during sleep and leaks after urination.In all the surveys included in our work we have identified significant associations between almost all available risk factors and incontinence, but some factors were associated with all forms of incontinence and others only with few forms. In addition, more associations were observed with severe UI (i.e. daily UI), than with weekly UI. Among UI types, we observed more significant associations with mixed UI and other UI than with stress and urge UI. The strongest associations were found for depression and obesity with almost all forms of UI. Obstetric variables were often associated with mixed UI.Conclusion: Precise estimates of UI prevalence should be based on non–UI-focused surveys among representative samples and using a validated standardised symptom-based questionnaire, as ICIQ-UI-SF, but it appears to be insufficient to define all types of UI. We found that it is possible to use the circumstances of urine leaks for identifying specific groups of incontinent women. But we need to explore to what extent the circumstances of urinary leakage have prognostic or predictive value for response to treatment. With modelling, as we took into account UI type and severity, we identified which UI modalities are related to certain risk factors and which are not
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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.