女性压力性尿失禁患者盆底三维超声显像初步研究

目的:通过三维超声对正常未孕妇女及产后压力性尿失禁(SUI)患者的盆底结构显像,研究SUI患者的膀胱颈尿道活动度及肛提肌变化,评估三维超声显像对女性盆底病变的诊断价值.方法:分别对研究组和对照组行盆底结构三维超声检查,测量膀胱尿道连接部的直接移动度(UVJ-M)、张力期膀胱尿道后角、静息期及张力期耻骨直肠肌厚度、耻骨直肠肌夹角,观察肛提肌形态.结果:SUI研究组UVJ-M 15.93± 2.07mm,较对照组7.64± 1.37mm增大(P＜0.01),研究组张力期膀胱尿道后角145.90±22.03°,较对照组106.49±14.32°增大(P＜0.01),研究组静息期耻骨直肠肌厚度6.39±0.48小于对照组6.71±0.69(P＜0.05),研究组张力期耻骨直肠肌厚度6.13±0.49小于对照组6.64± 0.61(P＜0.05),静息期研究组耻骨直肠肌夹角70.08±3.15大于对照组69.45±2.19°,但无统计学意义(P＞0.05),张力期75.49±3.92大于对照组70.35±1.51° (P＜0.01).结论:三雏超声显像能直观有效地观察女性尿道、肛提肌等盆底结构,对诊断压力性尿失禁是一个有意义的辅助手段.     

护理干预对成年女性压力性尿失禁患者的影响

目的：探讨护理干预对成年女性压力性尿失禁患者的影响。方法：在患者自愿参与的情况下,随机抽取浏阳市市区80名有压力性尿失禁症状的成年女性,对她们进行护理干预,并对干预效果进行评价。结果：护理干预后,患者压力性尿失禁发作次数显著减少,盆底肌肉张力显著提高,漏尿量显著减少。结论：护理干预可减轻成年女性压力性尿失禁症状,减轻患者的身心痛苦,提高压力性尿失禁患者的生活质量。     

成年女性压力性尿失禁患者心理健康状况调查分析

目的:探讨成年女性压力性尿失禁患者的心理健康状况,提出护理干预方法。方法:采用SCL-90及自编一般资料,对浏阳市市区80名有压力性尿失禁症状的成年女性进行心理健康自评调查,另80名无压力性尿失禁症状的成年女性为对照。结果:有压力性尿失禁症状的成年女性SCL-90总分、阳性项目数、阳性项目均分及躯体化、人际关系、抑郁、焦虑、敌对、恐怖和精神病性等因子评分均明显高于对照组及常模组(P<0.05)。结论:成年女性压力性尿失禁患者心理健康状况不容乐观,应引起重视,并对其进行护理干预,加强对她们的心理疏通,可以提高疾病的防治效果。     

经闭孔无张力尿道中段悬吊术治疗女性压力性尿失禁3 年随访分析

目的:探讨经闭孔无张力尿道中段悬吊术(TVT-O术)治疗女性压力性尿失禁的中期疗效。方法:选择2007年5月-2011年5月于我院行TVT-O术治疗压力性尿失禁女性患者172例,应用压力性实验评估术前及术后短期疗效,持续3年的随访,分析中期疗效、尿流动力学参数、术后生活质量等重要数据。结果:术后1年,患者主观治愈率为93.0%,客观治愈率为94.8%,术后3年主观治愈率为91.3%,客观治愈率为93.0%,术后1年与术后3年比较均无统计学意义(均P>0.05);术后1、3年自我感觉模糊数字评分、I-QOL评分、最大流速及残余尿量较术前均有改善,差异均有统计学意义(均P<0.05);而术后1年与术后3年比较差异均无统计学意义(均P>0.05);随访期间主要并发症为腹股沟疼痛及排尿困难,均可控,未严重影响预后。结论:TVT-O治疗女性压力性尿失禁的中期疗效良好,并发症低,安全可靠,具备推广价值。     

Male Urinary Incontinence: Prevalence,Risk Factors,and Preventive Interventions

Urinary incontinence (UI) in community-dwelling men affects quality of life and increases the risk of institutionalization. Observational studies and randomized, controlled trials published in English from 1990 to November 2007 on the epidemiology and prevention of UI were identified in several databases to abstract rates and adjusted odds ratios (OR) of incontinence, calculate absolute risk difference (ARD) after clinical interventions, and synthesize evidence with random-effects models. Of 1083 articles identified, 126 were eligible for analysis. Pooled prevalence of UI increased with age to 21% to 32% in elderly men. Poor general health, comorbidities, severe physical limitations, cognitive impairment, stroke (pooled OR 1.54; 95% confidence interval [CI], 1.14–2.1), urinary tract infections (pooled OR 3.49; 95% CI, 2.33–5.23), prostate diseases, and diabetes (pooled OR 1.36; 95% CI, 1.14–1.61) were associated with UI. Treatment with tolterodine alone (ARD 0.17; 95% CI, 0.02–0.32) or combined with tamsulosin (ARD 0.17; 95% CI, 0.08–0.25) resulted in greater self-reported benefit compared with placebo. Radical prostatectomy or radiotherapy for prostate cancer compared with watchful waiting increased UI. Short-term prevention of UI with pelvic floor muscle rehabilitation after prostatectomy was not consistently seen across randomized, controlled trials. The prevalence of incontinence increased with age and functional dependency. Stroke, diabetes, poor general health, radiation, and surgery for prostate cancer were associated with UI in community-dwelling men. Men reported overall benefit from drug treatments. Limited evidence of preventive effects of pelvic floor rehabilitation requires future investigation.Key words: Urinary incontinence, Risk factors, Rehabilitation, Drug therapyUrinary incontinence (UI) affects substantial proportions of men¹; the estimated prevalence of UI varied from 11% among those aged 60 to 64 years to 31% in older men, and from 16% among white men to 21% among African American men.² Daily UI was reported by 30% to 47% and weekly UI by 15% to 37% of community-dwelling men.² A small proportion (22%) of men with weekly UI episodes ever sought medical care for this problem, whereas 40% of treated men reported moderate to great frustration with continued urine leakage.³Baseline mechanisms of UI include overactive bladder that may result in urge UI and poor urethral sphincter function that can result in primary urethral incompetence and stress UI.^4,5 Baseline mechanisms of incontinence lead to variable definitions, risk factors, and effective interventions to prevent and treat UI.⁵This review was commissioned as background material for a National Institutes of Health Office of Medical Applications of Research State of the Science Conference on Incontinence. We aimed to synthesize evidence of the effectiveness of different clinical interventions to prevent the occurrence and progression of UI in community-dwelling men.     

Diagnosis,Evaluation, and Treatment of Mixed Urinary Incontinence in Women

Mixed urinary incontinence (MUI) is a common clinical problem in the community and hospital setting. The broad definition of the term makes it difficult to diagnose, as well as determine effective treatment strategies. There are no current guidelines recommended for physicians. The estimated prevalence of this condition is approximately 30% in all women with incontinence. It has also been suggested that patients with MUI report more bothersome symptoms than either stress or urge incontinence; approximately 32% of 40- to 64-year-olds with MUI report symptoms of depression. The authors examine the diagnosis, evaluation, and treatment of patients with MUI.Key words: Mixed urinary incontinence, Detrusor overactivity, Stress incontinence, Urge incontinence, Urodynamic stress incontinence, Pelvic organ prolapse, Transvaginal tapeMixed urinary incontinence (MUI) is the leading cause of incontinence in the community and hospital setting.¹ The term refers to a combination of symptoms, with the patient exhibiting features of both stress urinary incontinence (SUI) and urge urinary incontinence (UUI); it may also refer to a combination of features of urodynamic SUI and detrusor hyperactivity.¹ The current International Continence Society guidelines define MUI as a complaint of the involuntary loss of urine during exertion, sneezing, or coughing, as well as leakage associated with urgency.²The term MUI is extremely broad because it may refer to equal stress and urge symptoms, stress-predominant symptoms, urge-predominant symptoms, urodynamic SUI (USUI) with detrusor overactivity (DO), or USUI with clinical urge symptoms but no DO.³ The challenge of this broad definition is that it leads to inconsistencies when evaluating treatment options and outcomes. In an attempt to validate diagnostic questions that could later be used in an epidemiological survey, Sandvik and colleagues⁴ defined MUI based on subjective answers to a structured questionnaire designed for their study.⁴ SUI was presumed if a positive answer was given to the question: “Do you lose urine during sudden physical exertion, lifting, coughing, or sneezing?” If the patient responded positively to the question: “Do you experience such a strong and sudden urge to void that you leak before reaching the toilet?” then a diagnosis of UUI was presumed. MUI was considered if a positive answer was given to both questions. In contrast, Brubaker and colleagues⁵ reported that strict definitions based on self-reported symptoms do not properly categorize patients as having MUI. Their group believed that patients should be broken down into MUI subgroups of SUI and UUI rather than describing it as a single entity. However, without a precise definition or understanding of the role of these stress and urge subcomponents, the assessment of an intervention for SUI or UUI is challenging.⁶The prevalence rates of MUI vary widely in the literature. In a secondary analysis of the Stress Incontinence Surgical Treatment Efficacy Trial (SISTEr), Brubaker and colleagues⁵ evaluated 655 women for the presence of incontinence and their response to treatment. They found that 50% to 93% of women fell into the category of MUI based on patient-reported answers to the Medical Epidemiologic and Social Aspects of Aging (MESA) and Urinary Distress Inventory (UDI) questionnaires. However, when objective criteria such as urodynamic findings were used, only 8% of women were categorized with MUI. Dooley and associates⁷ compared physical examination findings and responses to the MESA and UDI questionnaires in 551 women with a mean age of 56 ± 16 years. They estimated a prevalence rate of 30% of MUI in all women with urinary incontinence.According to Dooley and associates,⁷ in their cohort, MUI was more bothersome to patients than either pure SUI or UUI. In a cross-sectional population-based study across 6 European countries that included over 300 patients, the effects of overactive bladder (OAB) symptoms on employment, social interactions, and emotional well-being were evaluated by direct interview or a telephone-conducted interview. Irwin and associates⁸ found 32% of patients aged 40 to 64 years reported being depressed. In addition, they determined that symptoms of OAB have a statistically significant negative impact on emotional well-being both at home and at work.We sought to examine the existing literature on MUI and better understand the role urodynamic testing (UDS) plays in its diagnosis. In addition, we sought to examine treatment methods so that better treatment outcomes may be achieved.     

Pelvic Floor Muscle Biofeedback in the Treatment of Urinary Incontinence: A Literature Review

Biofeedback is efficacious in the training of the pelvic floor musculature in order to enhance continence. This article reviews the anatomy and physiology of micturition as the underlying rationale for pelvic floor muscle biofeedback in the treatment of urinary incontinence. It critically reviews 28 studies published in peer reviewed journals from 1975 to 2005 that were prospective, randomized studies with parametric statistical analyses, operationally defined patient selection criteria, treatment protocols and outcome measures. The overall mean treatment improvement for patients undergoing biofeedback for urinary incontinence was 72.61%. In 21 of 35 (60%) paired comparisons, biofeedback demonstrated superior symptomatic outcome to control or alternate treatment groups. Larger studies and a standardization of technology and methodology are required for more conclusive determinations.     

Cost-Effectiveness of Including a Nurse Specialist in the Treatment of Urinary Incontinence in Primary Care in the Netherlands

Objective

Incontinence is an important health problem. Effectively treating incontinence could lead to important health gains in patients and caregivers. Management of incontinence is currently suboptimal, especially in elderly patients. To optimise the provision of incontinence care a global optimum continence service specification (OCSS) was developed. The current study evaluates the costs and effects of implementing this OCSS for community-dwelling patients older than 65 years with four or more chronic diseases in the Netherlands.

Method

A decision analytic model was developed comparing the current care pathway for urinary incontinence in the Netherlands with the pathway as described in the OCSS. The new care strategy was operationalised as the appointment of a continence nurse specialist (NS) located with the general practitioner (GP). This was assumed to increase case detection and to include initial assessment and treatment by the NS. The analysis used a societal perspective, including medical costs, containment products (out-of-pocket and paid by insurer), home care, informal care, and implementation costs.

Results

With the new care strategy a QALY gain of 0.005 per patient is achieved while saving €402 per patient over a 3 year period from a societal perspective. In interpreting these findings it is important to realise that many patients are undetected, even in the new care situation (36%), or receive care for containment only. In both of these groups no health gains were achieved.

Conclusion

Implementing the OCSS in the Netherlands by locating a NS in the GP practice is likely to reduce incontinence, improve quality of life, and reduce costs. Furthermore, the study also highlighted that various areas of the continence care process lack data, which would be valuable to collect through the introduction of the NS in a study setting.     

"Being Alive Well": Health and the Politics of Cree Well-Being.

"Being Alive Well": Health and the Politics of Cree Well-Being. Naomi Adelson. Toronto: University of Toronto Press, 2000. ix. 141 pp.     

Panopticonics: The Control and Surveillance of Black Female Athletes in a Collegiate Athletic Program

This article analyzes black female student athletes' participation in an elite collegiate athletic program and shows how the program maximizes black female participants' athletic and academic potential through surveillance, control, and discipline. The program instills in black female athletes a model of womanhood whereby they come to expect and achieve academic and athletic success, but does so at the expense of their autonomy and freedom from surveillance. Ultimately, this analysis shows the promise and peril of panopticonics as educational technology.     

Urinary Retention,Incontinence, and Dysregulation of Muscarinic Receptors in Male Mice Lacking Mras

Here we show that male, but not female mice lacking expression of the GTPase M-Ras developed urinary retention with distention of the bladder that exacerbated with age but occurred in the absence of obvious anatomical outlet obstruction. There were changes in detrusor morphology in Mras ^-/- males: Smooth muscle tissue, which exhibited a compact organization in WT mice, appeared disorganized and became increasingly ‘layered’ with age in Mras ^-/- males, but was not fibrotic. Bladder tissue near the apex of bladders of Mras ^-/- males exhibited hypercontractility in response to the cholinergic agonist carbachol in in vitro, while responses in Mras ^-/- females were normal. In addition, spontaneous phasic contractions of detrusors from Mras ^-/- males were increased, and Mras ^-/- males exhibited urinary incontinence. We found that expression of the muscarinic M2 and M3 receptors that mediate the cholinergic contractile stimuli of the detrusor muscle was dysregulated in both Mras ^-/- males and females, although only males exhibited a urinary phenotype. Elevated expression of M2R in young males lacking M-Ras and failure to upregulate M3R with age resulted in significantly lower ratios of M3R/M2R expression that correlated with the bladder abnormalities. Our data suggests that M-Ras and M3R are functionally linked and that M-Ras is an important regulator of male bladder control in mice. Our observations also support the notion that bladder control is sexually dimorphic and is regulated through mechanisms that are largely independent of acetylcholine signaling in female mice.     

Female "dispersal" in hamadryas baboons: transfer among social units in a multilevel society

Unlike most cercopithecines, hamadryas baboons (Papio hamadryas hamadryas) are characterized by female-biased dispersal. To clarify this pattern within the context of their hierarchical social system (comprising one-male units, clans, bands, and troops), we report here 7 years of data on female transfers among social units in wild hamadryas baboons in Ethiopia. Female tenure in one-male units (OMUs) ranged from 1 to 2,556 days (N = 208) and survival analysis revealed a median tenure length of 1,217 days (40 months). Changes in OMU membership consisted almost exclusively of takeovers by males, not voluntary transfer. Of 130 takeovers, 67% occurred within the band and 33% across bands, and, of the 22 takeovers for which we have clan membership data, 77% occurred within, not between, clans. These results reinforce the notion that hamadryas female dispersal is not analogous to sex-biased dispersal in other taxa, because (1) at least in Ethiopian populations, females do not disperse voluntarily but are transferred, often forcibly, by males; (2) only dispersal between bands will promote gene flow, whereas females are most often rearranged within bands; (3) hamadryas females undergo social dispersal but not usually locational dispersal; and (4) while male hamadryas are far more philopatric than females, they have been observed to disperse. It thus appears that the ancestral baboon pattern of female philopatry and male dispersal has evolved into a system in which neither sex is motivated to disperse, but females are forcibly transferred by males, leading to female-mediated gene flow, and males more rarely disperse to find females.     

The Long-Term Influence of Body Mass Index on the Success Rate of Mid-Urethral Sling Surgery among Women with Stress Urinary Incontinence or Stress-Predominant Mixed Incontinence: Comparisons between Retropubic and Transobturator Approaches

Objectives

Mid-urethral sling (MUS) surgery for the treatment of urinary incontinence has been widespread since the introduction of tension-free vaginal tape in the mid-1990s. The majority of studies with short-term follow-up <2 years found no differences in the surgical outcomes according to body mass index (BMI). However, considering the chronic influence of obesity on pelvic floor musculature, it is cautiously speculated that higher BMI could increase stress on pelvic floor and sub-urethral tape, possibly decreasing the long-term success rate in the obese population. We aimed to compare the long-term effects of BMI on the outcomes of MUS between women with retropubic and transobturator approaches.

Methods

We performed a retrospective analysis on 243 consecutive women who received MUS and were followed up for ≥36 months. The influence of BMI on the success rates was separately estimated and the factors for treatment failure were examined using logistic regression in either approach.

Results

The mean follow-up was 58.4 months, and 30.5% were normal weight, 51.0% overweight, and 18.5% obese. Patients received either the retropubic (30.5%) or transobturator (69.5%) approach. The success rates (%) under the transobturator approach differed according to the BMI groups (94.3, 88.6, and 78.6, respectively; P = 0.037) while those under the retropubic approach were not different according to the BMI groups. However, in multivariate models, only the presence of preoperative mixed urinary incontinence (MUI) was proven to be the risk factor for treatment failure in the transobturator approach (OR 6.39, P = 0.003). The percent of subjects with MUI was higher in obese women than in non-obese women with the transobturator approach.

Conclusions

BMI was not independently associated with failures in either approach. Higher success rates in women with lower BMI in the transobturator approach were attributed to the lower percent of preoperative MUI in those with lower BMI.     

Language Learning and the Politics of Belonging: Sudanese Women Refugees Becoming and Being"American"

In this article, I explore the complicated relationship between ideologies of language and language learning, discourses of immigration and belonging, and the actual lived experiences of individual language learners. The analysis demonstrates how questions of educational access, economic stability, and social membership are all influenced by a range of social, political, and historical factors, particularly for recently arrived immigrants and refugees from war-torn African contexts.     

"In the Clique": Popular Culture, Constructions of Place, and the Everyday Lives of Urban Youth

This study focuses on two teens, Tony and Rufus, and how they used key popular texts to construct a sense of place in the small city where this research was conducted. These two teens mobilized these popular texts in very specific ways, both finding specific thematic links between and across them and also using them to index their relationships with biological and extended family in this city and "down South." This study highlights the complex, emergent, and messy relationships many young people have with popular culture.