sodium-ethylxanthate and Urinary-Incontinence

This Report puts forward a plan for the management of physical disability. It recognises that the subject is administratively complex and that many different organisations, including Social Services, are involved. The Report concentrates upon the role of the NHS in general, and upon the position of physicians in particular. The Report starts by reviewing some of the evidence that services for the physically disabled are in many respects deficient. The evidence includes accounts given by disabled people themselves, the fact that many patients are 'follow-up' by inexperienced junior hospital staff, and the lack of agreed standards of provision in many areas (see Section 3) such as pressure sores, incontinence, wheelchairs, and the care of head injured patients. Disabled people between the ages of 15 and 65 are identified as requiring particular attention (Paediatric and Geriatric Services probably cater reasonably well for the young and the old). The 'size' of the problem of physical disability is examined. For instance, the average Health District (of 250,000 persons) will contain 25,000 physically disabled people, of whom 6,250 will be severely, or very severely disabled; and 1,800 will have a wheelchair; 40 per cent of disabled people are under the age of 65. The Working Party on Rehabilitation Medicine of the Royal College of Physicians (1978) was of the opinion that rehabilitation is an integral part of total patient care, and is therefore the concern of all clinicians. The implication of this view is that Medical Disability Services should be developed without a major specialty of Rehabilitation or its equivalent, such as exists in most western countries. The Report explores the practical implications of this principle in the light of evidence discussed above.

Topics: Adolescent; Adult; Aged; Automobile Driving; Child; Communication Aids for Disabled; Craniocerebral Trauma; Delivery of Health Care; Disabled Persons; England; Female; Hearing Disorders; Humans; Male; Middle Aged; Orthotic Devices; Pressure Ulcer; Prostheses and Implants; Quality of Health Care; Regional Medical Programs; Rehabilitation; Research; Sex; Urinary Incontinence; Vision Disorders; Wales; Wheelchairs

Topics: Accidents, Home; Activities of Daily Living; Aged; Aging; Cardiovascular Physiological Phenomena; Dementia; Depressive Disorder; Drug Therapy; Endocrine Glands; Female; Humans; Immune System; Kidney; Lung; Male; Neoplasms; Nutritional Physiological Phenomena; Osteoporosis; Physical Examination; Postoperative Complications; Sex; Socioeconomic Factors; Urinary Incontinence

Compromised urinary bladder syndrome (CUBS), a combination of frequency and incontinence, causes multiple discomforts for community-dwelling adults. A holistic intervention--audiotaped cognitive strategies--was designed to augment the effects of an educational program designed to treat CUBS. CUBS was operationalized with a voiding diary, and comfort related to bladder health was operationalized in a questionnaire. In this quasi-experimental design the outcomes were measured at four time points. Repeated measures multivariate analyses of variance and nonparametric analyses were conducted to assess differences between the two groups. Results indicated that the treatment group had more comfort and improved CUBS compared with the control group.

Topics: Adult; Age Factors; Aged; Aged, 80 and over; Cognitive Behavioral Therapy; Holistic Nursing; Humans; Middle Aged; Outcome and Process Assessment, Health Care; Patient Satisfaction; Sex; Treatment Outcome; Urinary Incontinence

The aim of this study was to evaluate the effect of perineal massage performed during pregnancy on perineal symptoms 3 months after delivery.. Pregnant women from 5 hospitals in the province of Quebec, Canada, participated in this single-blind, randomized, controlled trial. All participants received oral and written information on the prevention of perineal trauma. Women in the experimental group were taught the perineal massage technique and were asked to perform a 10-minute perineal massage daily from the 34th through 35th weeks of pregnancy until delivery. Participants completed a self-administered questionnaire on perineal pain, dyspareunia, sexual satisfaction, and incontinence of urine, flatus, and stool at the time of enrollment and 3 months after delivery.. Among participants without a previous vaginal birth there were no differences between the massage (n = 283) and the control (n = 289) groups with respect to perineal pain, dyspareunia, sexual satisfaction, and incontinence of urine, gas, or stool 3 months post partum. Among women with a previous vaginal birth more women in the massage group (n = 187) than in the control group (n = 190) were free of perineal pain (93.6% vs 85.8%; P =.01) but the frequencies of dyspareunia and incontinence of urine, gas, or stool were similar in the 2 groups.. Perineal massage during pregnancy neither impairs nor substantially protects perineal function at 3 months post partum.

Topics: Delivery, Obstetric; Dyspareunia; Feces; Female; Flatulence; Gestational Age; Humans; Massage; Pain; Perineum; Postpartum Period; Pregnancy; Quebec; Sex; Urinary Incontinence

We retrospectively evaluated the outcome of Hautmann neobladder reconstruction in terms of complications, lower urinary tract symptoms, and sexual function in a large group of patients who underwent radical cystectomy.. We reviewed the medical records of 118 patients (105 men and 13 women) who underwent radical cystectomy and Hautmann neobladder construction at the Gifu University Hospital or one of its affiliate hospitals between Jan 1993 and Dec 1999. The 118 patients were asked to complete a questionnaire regarding lower urinary tract symptoms and sexual activity, and the data was compiled.. The mean follow-up period was 50.4 months (range, 6.8-88.2). Early complications comprised wound infection (in 17.8% of patients) and ileus (in 10.1% of patients). Late complications comprised ileus, pyelonephritis, stone, and stricture of the pouch-urethral anastomosis, each of which occurred in 3.4% of patients. Eighty-one (73 men and 8 women, 72.9%) of 90 surviving patients replied to the questionnaire. Seventy-seven (95.1%) of these patients reported spontaneous micturition, whereas 4 (4.9%) patients required intermittent self-catheterization. The mean total I-PSS was 11.6 points. Twenty-five percent of patients experienced interrupted voiding almost always; 38% of patients did not experience this at all. Approximately 26% of patients experienced weak urinary streams; 36% did not. Daytime continence was achieved in 97.3% of patients; nighttime incontinence was present in 61.3%. Preoperatively, 79.7% of the men were capable of sexual intercourse. Postoperatively, 63.6% of men who underwent radical cystectomy with the nerve-sparing procedure were capable of sexual intercourse, whereas only 14.8% of men who underwent radical cystectomy without the nerve-sparing procedure were.. Morbidity rates were acceptable and functional outcome was excellent in this rather large group of patients who underwent Hautmann neobladder construction. Some problems have not been fully overcome, however, i.e., nocturnal incontinence and sexual dysfunction.

Topics: Adult; Aged; Aged, 80 and over; Cystectomy; Female; Follow-Up Studies; Humans; Male; Middle Aged; Postoperative Complications; Retrospective Studies; Sex; Surveys and Questionnaires; Treatment Outcome; Urinary Bladder Neoplasms; Urinary Diversion; Urinary Incontinence; Urination

Patients with prostate cancer and their physicians need knowledge of treatment options and their potential complications, but limited data on complications are available in unselected population-based cohorts of patients.. To measure changes in urinary and sexual function in men who have undergone radical prostatectomy for clinically localized prostate cancer.. The Prostate Cancer Outcomes Study, a population-based longitudinal cohort study with up to 24 months of follow-up.. Population-based cancer registries in 6 geographic regions of the United States.. A total of 1291 black, white, and Hispanic men aged 39 to 79 years who were diagnosed as having primary prostate cancer between October 1, 1994, and October 31, 1995, and who underwent radical prostatectomy within 6 months of diagnosis for clinically localized disease.. Distribution of and change in urinary and sexual function measures reported by patients at baseline and 6, 12, and 24 months after diagnosis.. At 18 or more months following radical prostatectomy, 8.4% of men were incontinent and 59.9% were impotent. Among men who were potent before surgery, the proportion of men reporting impotence at 18 or more months after surgery varied according to whether the procedure was nerve sparing (65.6% of non-nerve-sparing, 58.6% of unilateral, and 56.0% of bilateral nerve-sparing). At 18 or more months after surgery, 41.9% reported that their sexual performance was a moderate-to-large problem. Both sexual and urinary function varied by age (39.0% of men aged <60 years vs 15.3 %-21.7% of older men were potent at > or =18 months [P<.001]; 13.8% of men aged 75-79 years vs 0.7%-3.6% of younger men experienced the highest level of incontinence at > or =18 months [P = .03]), and sexual function also varied by race (38.4% of black men reported firm erections at > or =18 months vs 25.9% of Hispanic and 21.3% of white men; P = .001).. Our study suggests that radical prostatectomy is associated with significant erectile dysfunction and some decline in urinary function. These results may be particularly helpful to community-based physicians and their patients with prostate cancer who face difficult treatment decisions.

Topics: Adult; Aged; Data Collection; Erectile Dysfunction; Follow-Up Studies; Humans; Longitudinal Studies; Male; Middle Aged; Outcome Assessment, Health Care; Prostatectomy; Prostatic Neoplasms; Regression Analysis; Sex; Urinary Incontinence; Urinary Tract

The aim of this study was to determine the prevalence of urinary incontinence in both sexes in Austria and to assess its impact on quality of life and sexual function. Voluntary health examinations free of charge are regularly organized in the area of Vienna. From May 1998 to April 1999 we have included in this health examination an incontinence questionnaire containing 37 items, which was largely based on the Bristol female lower urinary tract symptoms (LUTS) questionnaire. This questionnaire asks in detail for various aspects of urinary incontinence/voiding problems, including the impact of urinary incontinence on quality of life and sexual function. In this questionnaire, urinary incontinence was defined as any involuntary loss of urine within the past 4 weeks. The data of 2,498 participants (1,262 women [f]: mean age: 49.7+/-13.6 years and 1,236 men [m]: 48.6+/-13.0 years; age range: 20-96 years) were analyzed. Overall, 26.3% of women and 5.0% of men reported on episodes of urinary incontinence during the past 4 weeks. Prevalence rates increased constantly with age in both sexes: 20-29 years: 4.1% (f), 1.7% (m); 30-39 years: 10.8% (f), 2.7% (m); 40-49 years: 22.9% (f); 3.9% (m); 50-59 years: 34.9% (f), 3.7% (m); 60-69 years: 36.9% (f), 7.6% (m); 70 years or older: 36.0%% (f), 11.5% (m). Overall, 65.7% of women and 58.3% of men stated that quality of life was affected by their incontinence status. A moderate or severe impairment was reported by 18.3% of women and 16.6% of men. Impairment of quality of life was related as statistically significant (P < 0.05) to frequency and degree of incontinence (irrespective of the type of incontinence), the impact on sexual function and need for pads or other incontinence devices. Patient gender, age, and the duration of incontinence had no effect (P > 0.05) on quality of life. An impairment of sexual life by urinary incontinence was stated by 25. 1% of women and 30.5% of women, respectively. Although only 65.7% of women and 58.3% men with urinary incontinence reported on an impairment of quality of life, these data underline the high prevalence and socioeconomic implications of this disorder. The impact of urinary incontinence on quality of life is significantly higher than on sexual function.

Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Prevalence; Quality of Life; Sex; Surveys and Questionnaires; Urinary Incontinence

To define the prevalence of pelvic floor disorders in a non-institutionalised community and to determine the relationship to gender, age, parity and mode of delivery.. A representative population survey using the 1998 South Australian Health Omnibus Survey.. Random selection of 4400 households; 3010 interviews were conducted in the respondents' homes by trained female interviewers. This cross sectional survey included men and women aged 15-97 years.. The prevalence of all types of self-reported urinary incontinence in men was 4.4% and in women was 35.3% (P<0.001). Urinary incontinence was more commonly reported in nulliparous women than men and increased after pregnancy according to parity and age. The highest prevalence (51.9%) was reported in women aged 70-74 years. The prevalence of flatus and faecal incontinence was 6.8% and 2.3% in men and 10.9% and 3.5% in women, respectively. Pregnancy (> 20 weeks), regardless of the mode of delivery, greatly increased the prevalence of major pelvic floor dysfunction, defined as any type of incontinence, symptoms of prolapse or previous pelvic floor surgery. Multivariate logistic regression showed that, compared with nulliparity, pelvic floor dysfunction was significantly associated with caesarean section (OR 2.5, 95% CI 1.5-4.3), spontaneous vaginal delivery (OR 3.4, 95% CI 2.4-4.9) and at least one instrumental delivery (OR 4.3, 95% CI 2.8-6.6). The difference between caesarean and instrumental delivery was significant (P<0.03) but was not for caesarean and spontaneous delivery. Other associations with pelvic floor morbidity were age, body mass index, coughing, osteoporosis, arthritis and reduced quality of life scores. Symptoms of haemorrhoids also increased with age and parity and were reported in 19.9% of men and 30.2% of women.. Pelvic floor disorders are very common and are strongly associated with female gender, ageing, pregnancy, parity and instrumental delivery. Caesarean delivery is not associated with a significant reduction in long term pelvic floor morbidity compared with spontaneous vaginal delivery.

Topics: Adolescent; Adult; Age Distribution; Aged; Aged, 80 and over; Cross-Sectional Studies; Delivery, Obstetric; Fecal Incontinence; Female; Humans; Male; Middle Aged; Obstetric Labor Complications; Parity; Pelvic Floor; Pregnancy; Sex; Urinary Incontinence; Uterine Prolapse

The objective was to investigate how prostate cancer and its treatment affects sexual, urinary and bowel functions and to what extent eventual complications cause distress. A questionnaire was sent to 431 men aged 50-80 years with prostate cancer diagnosed in 1992 in the Stockholm area (Sweden) and 435 randomly selected men with a similar age distribution. Sexual function, as compared with their youth, was diminished in a majority of all men. The prostate cancer patients were, however, more likely to report low frequency and/or intensity in all aspects of sexual function. A majority of the men were distressed by a waning sexual capacity. The proportion of men with prostate cancer who were severely distressed owing to a decline in sexual function was larger than in the reference group. The willingness to trade off an intact sexual function for long-term survival varied considerably among the men in the reference group. Urinary and bowel symptoms were less common than a waning sexual function in both groups, and few appeared to be severely distressed by urinary or bowel symptoms. A decline in sexual functions was the most common cause of disease-specific distress in men with prostate cancer.

Topics: Aged; Attitude to Health; Constipation; Defecation; Ejaculation; Fecal Incontinence; Humans; Libido; Male; Middle Aged; Orgasm; Penile Erection; Prostatic Neoplasms; Radiography; Reference Values; Sex; Surveys and Questionnaires; Urinary Incontinence; Urination

Urinary incontinence can have a profound negative impact on female sexuality. Not only feelings of shame and loss of libido are important; complaints of urine loss during sexual activity can also exist. The prevalence of this phenomenon was examined in a study of 245 patients complaining of urinary incontinence. We also analysed the evoking moments and the impact of the complaint on the sexual relation. 20% of the patients had no partner. 66 (34%) of the remaining women reported losing urine during sexual activity. It was often experienced during pressure on the abdomen and deep vaginal penetration. Non-mechanical factors played an important part as well. Neither the history nor the urodynamic diagnosis had a clear relationship with evoking moments during intercourse. Incontinence was frequently (also) experienced during orgasm and sexual excitement. We found a strong negative effect of this complaint on the sexual lives of many women and their partners. Adequate relief of stress incontinence by colpo-suspension will also stop urine loss during intercourse.

Topics: Adult; Aged; Coitus; Female; Humans; Libido; Male; Middle Aged; Sex; Sexual Behavior; Urinary Incontinence; Urinary Incontinence, Stress

Between 1980-1989 a total of 349 patients underwent one-stage radical cystoprostatectomy and an orthotopic bladder substitution. 278 patients underwent the Camey I bladder replacement and in 71 patients a detubularized ileal loop was utilized (Camey II). 75 patients underwent a potency-sparing cystectomy (32 patients of the Camey I and 43 patients of the Camey II groups). All patients were followed at least one year and had continence and potency assessment. Among the patients who underwent the Camey I procedure, 66% achieved daytime continence and 21% night-time continence 6 months after surgery. One year after surgery 86% of patients had normal continence during the day and 47% was continent during the night. 14% of patients had episodes of day-time incontinence one year after surgery. Among the patients who underwent the Camey II bladder replacement 86% achieved day-time continence and 59% night-time continence 6 months after surgery. At one year after surgery 91% was continent during the day, 72% was dry during the night and only 9% had episodes of diurnal incontinence. Potency was achieved in 24 of 32 patients (75%) with the Camey I bladder substitution, and in 34 of the 43 patients (79%) with the Camey II bladder substitution. Our data demonstrate that excellent rates of continence and potency are achievable in the post-cystectomy population. Patients with the Camey II bladder replacement achieve continence earlier than patients with the Camey I bladder substitution. Diurnal continence is slightly better after the Camey II procedure, one year after surgery, but the difference is not statistically significant. Nocturnal continence is significantly better with the Camey II bladder substitution.

Topics: Adult; Aged; Aged, 80 and over; Cystectomy; Humans; Male; Middle Aged; Prostatectomy; Sex; Urinary Bladder Neoplasms; Urinary Incontinence; Urinary Reservoirs, Continent; Urination

Topics: Aged; Aged, 80 and over; Female; Health Services for the Aged; Humans; Male; Quality of Life; Sex; Urinary Incontinence; Urologic Diseases

Topics: Adolescent; Child; Child, Preschool; Humans; Infant; Infant, Newborn; Meningomyelocele; Patient Education as Topic; Sex; Urinary Incontinence; Urinary Tract; Urinary Tract Infections; Urologic Diseases

Topics: Adaptation, Psychological; Adult; Female; Humans; Life Style; Sex; Urinary Incontinence

Topics: Aged; Female; Humans; Male; Sex; Urinary Incontinence

Topics: Bradycardia; Coitus; Cordotomy; Divorce; Ejaculation; Female; Fertility; Humans; Labor, Obstetric; Male; Marriage; Nervous System Diseases; Paraplegia; Pregnancy; Sex; Spinal Cord Diseases; Spinal Cord Injuries; Subarachnoid Hemorrhage; Urinary Incontinence