THE 2002 OFFICIAL PATIENT’S SOURCEBOOK
on
URINARY
INCONTINENCE
J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS
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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright Ó2002 by ICON Group International, Inc. Copyright Ó2002 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1
Publisher, Health Care: Tiffany LaRochelle Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher’s note: The ideas, procedures, and suggestions contained in this book are not intended as a substitute for consultation with your physician. All matters regarding your health require medical supervision. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation, in close consultation with a qualified physician. The reader is advised to always check product information (package inserts) for changes and new information regarding dose and contraindications before taking any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960The 2002 Official Patient’s Sourcebook on Urinary Incontinence: A Revised and Updated Directory for the Internet Age/James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary and index. ISBN: 0-597-83253-6 1. Urinary Incontinence-Popular works. I. Title.
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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem or as a substitute for consultation with licensed medical professionals. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors or authors. ICON Group International, Inc., the editors, or the authors are not responsible for the content of any Web pages nor publications referenced in this publication.
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Dedication To the healthcare professionals dedicating their time and efforts to the study of urinary incontinence.
Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this sourcebook which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which directly or indirectly are dedicated to urinary incontinence. All of the Official Patient’s Sourcebooks draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this sourcebook. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany LaRochelle for her excellent editorial support.
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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for the Official Patient’s Sourcebook series published by ICON Health Publications.
Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for the Official Patient’s Sourcebook series published by ICON Health Publications.
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About ICON Health Publications In addition to urinary incontinence, Official Patient’s Sourcebooks are available for the following related topics: ·
The Official Patient's Sourcebook on Cystocele
·
The Official Patient's Sourcebook on Glomerular Disease
·
The Official Patient's Sourcebook on Goodpasture Syndrome
·
The Official Patient's Sourcebook on Hematuria
·
The Official Patient's Sourcebook on Hemochromatosis
·
The Official Patient's Sourcebook on Immune Thrombocytopenic Purpura
·
The Official Patient's Sourcebook on Impotence
·
The Official Patient's Sourcebook on Interstitial Cystitis
·
The Official Patient's Sourcebook on Kidney Failure
·
The Official Patient's Sourcebook on Kidney Stones
·
The Official Patient's Sourcebook on Lupus Nephritis
·
The Official Patient's Sourcebook on Nephrotic Syndrome
·
The Official Patient's Sourcebook on Peyronie
·
The Official Patient's Sourcebook on Polycystic Kidney Disease
·
The Official Patient's Sourcebook on Prostate Enlargement
·
The Official Patient's Sourcebook on Prostatitis
·
The Official Patient's Sourcebook on Proteinuria
·
The Official Patient's Sourcebook on Pyelonephritis
·
The Official Patient's Sourcebook on Renal Osteodystrophy
·
The Official Patient's Sourcebook on Renal Tubular Acidosis
·
The Official Patient's Sourcebook on Simple Kidney Cysts
·
The Official Patient's Sourcebook on Urinary Incontinence for Women
·
The Official Patient's Sourcebook on Urinary Incontinence with Children
·
The Official Patient's Sourcebook on Urinary Tract Infection in Children
·
The Official Patient's Sourcebook on Urinary Tract Infections in Adults
·
The Official Patient's Sourcebook on Vasectomy
·
The Official Patient's Sourcebook on Vesicoureteral Reflux
To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes & Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health
Contents vii
Table of Contents INTRODUCTION ................................................................................................................................. 1 Overview ....................................................................................................................................... 1 Organization ................................................................................................................................. 3 Scope.............................................................................................................................................. 3 Moving Forward............................................................................................................................ 4 PART I: THE ESSENTIALS ............................................................................................................. 7 CHAPTER 1. THE ESSENTIALS ON URINARY INCONTINENCE: GUIDELINES .................................... 9 Overview ....................................................................................................................................... 9 NIH Consensus Statement on Urinary Incontinence in Adults................................................. 11 What Is Urinary Incontinence in Adults? .................................................................................. 11 Occurrence and Risk of Urinary Incontinence............................................................................ 13 Clinical, Psychological, and Social Impact .................................................................................. 14 Pathophysiological and Functional Factors................................................................................. 15 Subtypes of Urinary Incontinence............................................................................................... 16 Evaluation and Therapy .............................................................................................................. 17 General Principles of Treatment.................................................................................................. 19 Pharmacologic Treatment............................................................................................................ 19 Behavioral Techniques ................................................................................................................. 22 Management Techniques............................................................................................................. 24 Improving Public and Professional Knowledge........................................................................... 25 Need for Future Research Related to Urinary Incontinence ....................................................... 26 Directions for Future Research.................................................................................................... 27 Conclusions ................................................................................................................................. 27 More Guideline Sources .............................................................................................................. 28 Vocabulary Builder...................................................................................................................... 43 CHAPTER 2. SEEKING GUIDANCE ................................................................................................... 49 Overview ..................................................................................................................................... 49 Associations and Urinary Incontinence ...................................................................................... 49 Finding More Associations ......................................................................................................... 52 Finding Doctors........................................................................................................................... 54 Finding a Urologist ..................................................................................................................... 55 Selecting Your Doctor ................................................................................................................. 55 Working with Your Doctor ......................................................................................................... 56 Broader Health-Related Resources .............................................................................................. 57 Vocabulary Builder...................................................................................................................... 58 CHAPTER 3. CLINICAL TRIALS AND URINARY INCONTINENCE .................................................... 59 Overview ..................................................................................................................................... 59 Recent Trials on Urinary Incontinence....................................................................................... 62 Benefits and Risks........................................................................................................................ 63 Keeping Current on Clinical Trials ............................................................................................. 66 General References....................................................................................................................... 67 PART II: ADDITIONAL RESOURCES AND ADVANCED MATERIAL ........................... 69 CHAPTER 4. STUDIES ON URINARY INCONTINENCE ...................................................................... 71 Overview ..................................................................................................................................... 71 The Combined Health Information Database .............................................................................. 71 Federally-Funded Research on Urinary Incontinence................................................................. 78 E-Journals: PubMed Central ....................................................................................................... 91 The National Library of Medicine: PubMed................................................................................ 92 Vocabulary Builder.................................................................................................................... 101
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CHAPTER 5. PATENTS ON URINARY INCONTINENCE................................................................... 103 Overview ................................................................................................................................... 103 Patents on Urinary Incontinence .............................................................................................. 104 Patent Applications on Urinary Incontinence .......................................................................... 117 Keeping Current ........................................................................................................................ 125 Vocabulary Builder.................................................................................................................... 125 CHAPTER 6. BOOKS ON URINARY INCONTINENCE ...................................................................... 129 Overview ................................................................................................................................... 129 Book Summaries: Federal Agencies ........................................................................................... 129 Book Summaries: Online Booksellers ........................................................................................ 131 The National Library of Medicine Book Index........................................................................... 136 Chapters on Urinary Incontinence............................................................................................ 140 Directories ................................................................................................................................. 148 General Home References .......................................................................................................... 150 Vocabulary Builder.................................................................................................................... 150 CHAPTER 7. MULTIMEDIA ON URINARY INCONTINENCE ........................................................... 153 Overview ................................................................................................................................... 153 Video Recordings....................................................................................................................... 153 Audio Recordings ...................................................................................................................... 157 Bibliography: Multimedia on Urinary Incontinence................................................................. 159 Vocabulary Builder.................................................................................................................... 162 CHAPTER 8. PERIODICALS AND NEWS ON URINARY INCONTINENCE ........................................ 163 Overview ................................................................................................................................... 163 News Services & Press Releases ................................................................................................ 163 Newsletters on Urinary Incontinence ....................................................................................... 175 Newsletter Articles .................................................................................................................... 176 Academic Periodicals covering Urinary Incontinence .............................................................. 182 Vocabulary Builder.................................................................................................................... 184 CHAPTER 9. PHYSICIAN GUIDELINES AND DATABASES .............................................................. 185 Overview ................................................................................................................................... 185 NIH Guidelines ......................................................................................................................... 185 NIH Databases .......................................................................................................................... 186 Other Commercial Databases .................................................................................................... 198 The Genome Project and Urinary Incontinence ........................................................................ 199 Specialized References ............................................................................................................... 203 Vocabulary Builder.................................................................................................................... 204 CHAPTER 10. DISSERTATIONS ON URINARY INCONTINENCE ...................................................... 207 Overview ................................................................................................................................... 207 Dissertations on Urinary Incontinence..................................................................................... 207 Keeping Current ........................................................................................................................ 208 PART III. APPENDICES .............................................................................................................. 209 APPENDIX A. RESEARCHING YOUR MEDICATIONS ..................................................................... 211 Overview ................................................................................................................................... 211 Your Medications: The Basics ................................................................................................... 212 Learning More about Your Medications ................................................................................... 214 Commercial Databases............................................................................................................... 216 Contraindications and Interactions (Hidden Dangers)............................................................. 219 A Final Warning ....................................................................................................................... 219 General References..................................................................................................................... 220 Vocabulary Builder.................................................................................................................... 221 APPENDIX B. RESEARCHING ALTERNATIVE MEDICINE ............................................................... 223 Overview ................................................................................................................................... 223 What Is CAM? .......................................................................................................................... 223
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What Are the Domains of Alternative Medicine? ..................................................................... 224 Can Alternatives Affect My Treatment?................................................................................... 227 Finding CAM References on Urinary Incontinence ................................................................. 228 Additional Web Resources......................................................................................................... 240 General References..................................................................................................................... 243 APPENDIX C. RESEARCHING NUTRITION..................................................................................... 245 Overview ................................................................................................................................... 245 Food and Nutrition: General Principles .................................................................................... 246 Finding Studies on Urinary Incontinence ................................................................................ 250 Federal Resources on Nutrition................................................................................................. 254 Additional Web Resources......................................................................................................... 255 Vocabulary Builder.................................................................................................................... 255 APPENDIX D. FINDING MEDICAL LIBRARIES ............................................................................... 257 Overview ................................................................................................................................... 257 Preparation ................................................................................................................................ 257 Finding a Local Medical Library ............................................................................................... 258 Medical Libraries Open to the Public ........................................................................................ 258 APPENDIX E. YOUR RIGHTS AND INSURANCE ............................................................................. 265 Overview ................................................................................................................................... 265 Your Rights as a Patient............................................................................................................ 265 Patient Responsibilities ............................................................................................................. 269 Choosing an Insurance Plan...................................................................................................... 270 Medicare and Medicaid ............................................................................................................. 272 NORD’s Medication Assistance Programs............................................................................... 275 Additional Resources................................................................................................................. 276 Vocabulary Builder.................................................................................................................... 277 ONLINE GLOSSARIES ............................................................................................................... 279 Online Dictionary Directories................................................................................................... 286 URINARY INCONTINENCE GLOSSARY .............................................................................. 287 General Dictionaries and Glossaries ......................................................................................... 301 INDEX.............................................................................................................................................. 303
Introduction
1
INTRODUCTION Overview Dr. C. Everett Koop, former U.S. Surgeon General, once said, “The best prescription is knowledge.”1 The Agency for Healthcare Research and Quality (AHRQ) of the National Institutes of Health (NIH) echoes this view and recommends that every patient incorporate education into the treatment process. According to the AHRQ: Finding out more about your condition is a good place to start. By contacting groups that support your condition, visiting your local library, and searching on the Internet, you can find good information to help guide your treatment decisions. Some information may be hard to find—especially if you don’t know where to look.2 As the AHRQ mentions, finding the right information is not an obvious task. Though many physicians and public officials had thought that the emergence of the Internet would do much to assist patients in obtaining reliable information, in March 2001 the National Institutes of Health issued the following warning: The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading.3
Quotation from http://www.drkoop.com. The Agency for Healthcare Research and Quality (AHRQ): http://www.ahcpr.gov/consumer/diaginfo.htm. 3 From the NIH, National Cancer Institute (NCI): http://cancertrials.nci.nih.gov/beyond/evaluating.html. 1 2
2
Urinary Incontinence
Since the late 1990s, physicians have seen a general increase in patient Internet usage rates. Patients frequently enter their doctor’s offices with printed Web pages of home remedies in the guise of latest medical research. This scenario is so common that doctors often spend more time dispelling misleading information than guiding patients through sound therapies. The 2002 Official Patient’s Sourcebook on Urinary Incontinence has been created for patients who have decided to make education and research an integral part of the treatment process. The pages that follow will tell you where and how to look for information covering virtually all topics related to urinary incontinence, from the essentials to the most advanced areas of research. The title of this book includes the word “official.” This reflects the fact that the sourcebook draws from public, academic, government, and peerreviewed research. Selected readings from various agencies are reproduced to give you some of the latest official information available to date on urinary incontinence. Given patients’ increasing sophistication in using the Internet, abundant references to reliable Internet-based resources are provided throughout this sourcebook. Where possible, guidance is provided on how to obtain free-ofcharge, primary research results as well as more detailed information via the Internet. E-book and electronic versions of this sourcebook are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). Hard copy users of this sourcebook can type cited Web addresses directly into their browsers to obtain access to the corresponding sites. Since we are working with ICON Health Publications, hard copy Sourcebooks are frequently updated and printed on demand to ensure that the information provided is current. In addition to extensive references accessible via the Internet, every chapter presents a “Vocabulary Builder.” Many health guides offer glossaries of technical or uncommon terms in an appendix. In editing this sourcebook, we have decided to place a smaller glossary within each chapter that covers terms used in that chapter. Given the technical nature of some chapters, you may need to revisit many sections. Building one’s vocabulary of medical terms in such a gradual manner has been shown to improve the learning process. We must emphasize that no sourcebook on urinary incontinence should affirm that a specific diagnostic procedure or treatment discussed in a research study, patent, or doctoral dissertation is “correct” or your best option. This sourcebook is no exception. Each patient is unique. Deciding on
Introduction
3
appropriate options is always up to the patient in consultation with their physician and healthcare providers.
Organization This sourcebook is organized into three parts. Part I explores basic techniques to researching urinary incontinence (e.g. finding guidelines on diagnosis, treatments, and prognosis), followed by a number of topics, including information on how to get in touch with organizations, associations, or other patient networks dedicated to urinary incontinence. It also gives you sources of information that can help you find a doctor in your local area specializing in treating urinary incontinence. Collectively, the material presented in Part I is a complete primer on basic research topics for patients with urinary incontinence. Part II moves on to advanced research dedicated to urinary incontinence. Part II is intended for those willing to invest many hours of hard work and study. It is here that we direct you to the latest scientific and applied research on urinary incontinence. When possible, contact names, links via the Internet, and summaries are provided. It is in Part II where the vocabulary process becomes important as authors publishing advanced research frequently use highly specialized language. In general, every attempt is made to recommend “free-to-use” options. Part III provides appendices of useful background reading for all patients with urinary incontinence or related disorders. The appendices are dedicated to more pragmatic issues faced by many patients with urinary incontinence. Accessing materials via medical libraries may be the only option for some readers, so a guide is provided for finding local medical libraries which are open to the public. Part III, therefore, focuses on advice that goes beyond the biological and scientific issues facing patients with urinary incontinence.
Scope While this sourcebook covers urinary incontinence, your doctor, research publications, and specialists may refer to your condition using a variety of terms. Therefore, you should understand that urinary incontinence is often considered a synonym or a condition closely related to the following: ·
Bed Wetting
·
Bed-wetting
4
Urinary Incontinence
·
Fallen Bladder
·
Loss of Pelvic Support
·
Overflow Incontinence
·
Primary Nocturnal Enuresis
·
Self-wetting
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Stress Incontinence
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Transient Incontinence
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Urge Incontinence
·
Urinary Incontinence
In addition to synonyms and related conditions, physicians may refer to urinary incontinence using certain coding systems. The International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) is the most commonly used system of classification for the world’s illnesses. Your physician may use this coding system as an administrative or tracking tool. The following classification is commonly used for urinary incontinence:4 ·
307.6 enuresis
·
788.3 incontinence of urine
·
788.30 urinary incontinence, unspecified (enuresis)
For the purposes of this sourcebook, we have attempted to be as inclusive as possible, looking for official information for all of the synonyms relevant to urinary incontinence. You may find it useful to refer to synonyms when accessing databases or interacting with healthcare professionals and medical librarians.
Moving Forward Since the 1980s, the world has seen a proliferation of healthcare guides covering most illnesses. Some are written by patients or their family members. These generally take a layperson’s approach to understanding and 4 This list is based on the official version of the World Health Organization’s 9th Revision, International Classification of Diseases (ICD-9). According to the National Technical Information Service, “ICD-9CM extensions, interpretations, modifications, addenda, or errata other than those approved by the U.S. Public Health Service and the Health Care Financing Administration are not to be considered official and should not be utilized. Continuous maintenance of the ICD-9-CM is the responsibility of the federal government.”
Introduction
5
coping with an illness or disorder. They can be uplifting, encouraging, and highly supportive. Other guides are authored by physicians or other healthcare providers who have a more clinical outlook. Each of these two styles of guide has its purpose and can be quite useful. As editors, we have chosen a third route. We have chosen to expose you to as many sources of official and peer-reviewed information as practical, for the purpose of educating you about basic and advanced knowledge as recognized by medical science today. You can think of this sourcebook as your personal Internet age reference librarian. Why “Internet age”? All too often, patients diagnosed with urinary incontinence will log on to the Internet, type words into a search engine, and receive several Web site listings which are mostly irrelevant or redundant. These patients are left to wonder where the relevant information is, and how to obtain it. Since only the smallest fraction of information dealing with urinary incontinence is even indexed in search engines, a non-systematic approach often leads to frustration and disappointment. With this sourcebook, we hope to direct you to the information you need that you would not likely find using popular Web directories. Beyond Web listings, in many cases we will reproduce brief summaries or abstracts of available reference materials. These abstracts often contain distilled information on topics of discussion. While we focus on the more scientific aspects of urinary incontinence, there is, of course, the emotional side to consider. Later in the sourcebook, we provide a chapter dedicated to helping you find peer groups and associations that can provide additional support beyond research produced by medical science. We hope that the choices we have made give you the most options available in moving forward. In this way, we wish you the best in your efforts to incorporate this educational approach into your treatment plan. The Editors
7
PART I: THE ESSENTIALS
ABOUT PART I Part I has been edited to give you access to what we feel are “the essentials” on urinary incontinence. The essentials of a disease typically include the definition or description of the disease, a discussion of who it affects, the signs or symptoms associated with the disease, tests or diagnostic procedures that might be specific to the disease, and treatments for the disease. Your doctor or healthcare provider may have already explained the essentials of urinary incontinence to you or even given you a pamphlet or brochure describing urinary incontinence. Now you are searching for more in-depth information. As editors, we have decided, nevertheless, to include a discussion on where to find essential information that can complement what your doctor has already told you. In this section we recommend a process, not a particular Web site or reference book. The process ensures that, as you search the Web, you gain background information in such a way as to maximize your understanding.
Guidelines
CHAPTER 1. THE ESSENTIALS INCONTINENCE: GUIDELINES
ON
9
URINARY
Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines on urinary incontinence. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. The great advantage of guidelines over other sources is that they are often written with the patient in mind. Since new guidelines on urinary incontinence can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.
The National Institutes of Health (NIH)5 The National Institutes of Health (NIH) is the first place to search for relatively current patient guidelines and fact sheets on urinary incontinence. Originally founded in 1887, the NIH is one of the world’s foremost medical research centers and the federal focal point for medical research in the United States. At any given time, the NIH supports some 35,000 research grants at universities, medical schools, and other research and training institutions, both nationally and internationally. The rosters of those who have conducted research or who have received NIH support over the years include the world’s most illustrious scientists and physicians. Among them are 97 scientists who have won the Nobel Prize for achievement in medicine.
5
Adapted from the NIH: http://www.nih.gov/about/NIHoverview.html.
10 Urinary Incontinence
There is no guarantee that any one Institute will have a guideline on a specific disease, though the National Institutes of Health collectively publish over 600 guidelines for both common and rare diseases. The best way to access NIH guidelines is via the Internet. Although the NIH is organized into many different Institutes and Offices, the following is a list of key Web sites where you are most likely to find NIH clinical guidelines and publications dealing with urinary incontinence and associated conditions: ·
Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm
·
National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines available at http://www.nlm.nih.gov/medlineplus/healthtopics.html
·
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm
Among these, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) is particularly noteworthy. The NIDDK’s mission is to conduct and support research on many of the most serious diseases affecting public health.6 The Institute supports much of the clinical research on the diseases of internal medicine and related subspecialty fields as well as many basic science disciplines. The NIDDK’s Division of Intramural Research encompasses the broad spectrum of metabolic diseases such as diabetes, inborn errors of metabolism, endocrine disorders, mineral metabolism, digestive diseases, nutrition, urology and renal disease, and hematology. Basic research studies include biochemistry, nutrition, pathology, histochemistry, chemistry, physical, chemical, and molecular biology, pharmacology, and toxicology. NIDDK extramural research is organized into divisions of program areas: ·
Division of Diabetes, Endocrinology, and Metabolic Diseases
·
Division of Digestive Diseases and Nutrition
·
Division of Kidney, Urologic, and Hematologic Diseases
The Division of Extramural Activities provides administrative support and overall coordination. A fifth division, the Division of Nutrition Research Coordination, coordinates government nutrition research efforts. The Institute supports basic and clinical research through investigator-initiated This paragraph has been adapted from the NIDDK: http://www.niddk.nih.gov/welcome/mission.htm. “Adapted” signifies that a passage is reproduced exactly or slightly edited for this book. 6
Guidelines 11
grants, program project and center grants, and career development and training awards. The Institute also supports research and development projects and large-scale clinical trials through contracts. The following patient guideline was recently published by the NIDDK on urinary incontinence.
NIH Consensus Statement on Urinary Incontinence in Adults NIH Consensus Development Conferences are convened to evaluate available scientific information and resolve safety and efficacy issues related to biomedical technology. The resultant NIH Consensus Statements are intended to advance understanding of the technology or issue in question and to be useful to health professionals and the public.7 Each NIH consensus statement is the product of an independent, non-Federal panel of experts and is based on the panel’s assessment of medical knowledge available at the time the statement was written. Therefore, a consensus statement provides a “snapshot in time” of the state of knowledge of the conference topic. The NIH makes the following caveat: “When reading or downloading NIH consensus statements, keep in mind that new knowledge is inevitably accumulating through medical research. Nevertheless, each NIH consensus statement is retained on this website in its original form as a record of the NIH Consensus Development Program.”8 The following concensus statement was posted on the NIH site and not indicated as “out of date” in March 2002. It was originally published, however, in October, 1988.9
What Is Urinary Incontinence in Adults? Urinary incontinence, the involuntary loss of urine so severe as to have social and/or hygienic consequences, is a major clinical problem and a significant cause of disability and dependency. Urinary incontinence affects all age groups and is particularly common in the elderly. At least 10 million adult Americans suffer from urinary incontinence, including approximately 15 to 30 percent of community-dwelling older people and at least one-half of all nursing home residents. The monetary costs of managing urinary
This paragraph is adapted from the NIH: http://odp.od.nih.gov/consensus/cons/cons.htm. Adapted from the NIH: http://odp.od.nih.gov/consensus/cons/consdate.htm. 9 Urinary Incontinence in Adults. NIH Consens Statement Online 1988 Oct 3-5 [cited 2002 February 20];7(5):1-32. http://consensus.nih.gov/cons/071/071_statement.htm. 7 8
12 Urinary Incontinence
incontinence are conservatively estimated at $10.3 billion annually, and the psychosocial burden of urinary incontinence is great. Urinary incontinence is a symptom rather than a disease. It appears in a limited number of clinical patterns, each having several possible causes. In some cases, the disorder is transient, secondary to an easily reversed cause such as a medication or an acute illness like urinary tract infection. Many cases are chronic, however, lasting indefinitely unless properly diagnosed and treated. There is a persistent myth that urinary incontinence is a normal consequence of aging. While normal aging is not a cause of urinary incontinence, agerelated changes in lower urinary tract function predispose the older person to urinary incontinence in the face of additional anatomic or physiologic insults to the lower urinary tract or by systemic disturbances such as illnesses common in older people. Even frail nursing home residents or persons being cared for by family caregivers often have urinary incontinence that can be significantly improved or cured. Persons with urinary incontinence should be alerted to the importance of reporting their symptoms to a health care professional and of asserting their right to proper assessment, diagnosis, and treatment. The first steps to treatment are acknowledgment of the problem and appropriate assessment and diagnosis. Knowledge of the occurrence, causes, consequences, and treatment of the specific forms of urinary incontinence has increased. While new diagnostic tests have been developed, well-defined guidelines are needed for their application. Similarly, despite numerous new potential therapies, opinions differ widely concerning the best approach to many specific forms of the disorder. The most common treatments include pelvic muscle exercises and other behavioral treatments, local and systemic drug therapies, and a variety of surgical approaches. The number of patients with urinary incontinence who are not successfully treated remains surprisingly high. This is due to several factors, including underreporting by patients; underrecognition as a significant clinical problem by health providers; lack of education of health providers regarding new research findings; inadequate staffing in the long-term care setting; and the persistent major gaps in our understanding of the natural history, pathophysiology, and most effective treatments of the common forms of urinary incontinence. The amount of basic research as well as research focusing on prevention is meager.
Guidelines 13
To resolve issues regarding the incidence, causes, and consequences of urinary incontinence in adults, the National Institute on Aging and the Office of Medical Applications of Research of the National Institutes of Health, in conjunction with the National Institute of Diabetes and Digestive and Kidney Diseases, the National Center for Nursing Research, the National Institute of Neurological and Communicative Disorders and Stroke, and the Veterans Administration, convened a Consensus Development Conference on Urinary Incontinence in Adults on October 3-5, 1988. After a day and a half of presentations by experts in the relevant fields involved with urinary incontinence, a consensus panel consisting of representatives from geriatrics, urology, gynecology, psychology, nursing, epidemiology, basic sciences, and the public considered the evidence and developed answers to the following central questions: ·
What is the prevalence and clinical, psychological, and social impact of urinary incontinence among persons living at home and in institutions?
·
What are the pathophysiological and functional factors leading to urinary incontinence?
·
What diagnostic information should be obtained in assessment of the incontinent patient? What criteria should be employed to determine which tests are indicated for a particular patient?
·
What are the efficacies and limitations of behavioral, pharmacological, surgical, and other treatments for urinary incontinence? What sequences and/or combination of these interventions are appropriate? What management techniques are appropriate when treatment is not effective or indicated?
·
What strategies are effective in improving public and professional knowledge about urinary incontinence?
·
What are the needs for future research related to urinary incontinence?
Occurrence and Risk of Urinary Incontinence Estimates of the occurrence of urinary incontinence depend on the nature of the study population and definition of the disorder. Prevalence rates range from 8 to 51 percent; an estimate of 15 to 30 percent for community-dwelling older persons seems reasonable, and of these, 20 to 25 percent may be classified as severe. Prevalence rates are twice as high in women as in men, and are higher in older than in younger adults. Though these community rates are alarmingly high, rates in nursing homes are even higher. Half or
14 Urinary Incontinence
more of the 1.5 million Americans in nursing homes suffer from urinary incontinence. Little is known about the natural history of urinary incontinence, including age at onset, incidence rates, progression, and spontaneous remission. Limited data exist on associated morbidity and functional impairment. To date, most studies have been conducted in whites, and data are needed on the occurrence in nonwhite ethnic groups. Though urinary incontinence is a symptom of many conditions, defining risk factors would be extremely useful for identifying high-risk persons and remediable environmental causes. While age, gender, and parity are established risk factors, many other factors have been suggested but not rigorously proven. These include urinary infection, menopause, genitourinary surgery, lack of postpartum exercise, chronic illnesses, and various medications. Risk factor identification is essential for a concerted effort at prevention.
Clinical, Psychological, and Social Impact In the Community Because only about half of the people with incontinence in the community have consulted a doctor about the problem, the true extent and clinical impact of urinary incontinence is not known. Rashes, pressure sores, skin and urinary tract infections, and restriction of activity are some of the problems that could be prevented or treated if the underlying incontinence were brought to medical attention. Many people with incontinence turn prematurely to the use of absorbent materials without having their difficulty properly diagnosed and treated. The psychosocial impact of incontinence in the community falls on individuals and their care providers. Studies of women show that the condition is associated with depressive symptoms and leads to embarrassment about appearance and odor, although such reactions may be related more to illness than to incontinence. Excursions outside the home, social interactions with friends and family, and sexual activity may be restricted or avoided entirely in the presence of incontinence. Spouses and other intimates also may share the burden of this condition. A highly conservative estimate of the direct costs of caring for persons with incontinence of all ages in the community is $7 billion annually in the United States.
Guidelines 15
In Nursing Homes Many physicians fail to recognize the clinical impact of urinary incontinence in nursing homes, and very few nursing home residents with incontinence have had any type of diagnostic evaluation. In this setting, fecal incontinence, physical and mental impairment, pressure sores, and urinary tract infections are commonly associated with urinary incontinence, but cause-and-effect relationships are not clear. Many nursing home residents who are incontinent are managed with indwelling catheters, which carry an increased risk of significant urinary tract infection, and the use of such devices varies widely. The odor of urine that permeates many nursing homes can be repellent to residents, staff, and potential visitors. Managing those with incontinence presents a major problem to insufficient and often untrained staff. The annual direct cost of caring for incontinence among nursing home patients is approximately $3.3 billion.
Pathophysiological and Functional Factors Continence requires a compliant bladder and active sphincteric mechanisms, such that maximum urethral pressure always exceeds intravesical pressure. Normal voiding requires sustained and coordinated relaxation of the sphincters and contraction of the urinary bladder. These functions are regulated by the central nervous system through autonomic and somatic nerves. The system requires the integration of visceral and somatic muscle function and involves control by voluntary mechanisms originating in the cerebral cortex. These voluntary mechanisms are learned and culturally prescribed (i.e., toilet training). Incontinence can be produced by any pathologic, anatomic, or physiologic factor that causes intravesical pressure to exceed maximum urethral pressure. Intravesical pressure can be raised by involuntary detrusor contractions (unstable bladder or detrusor hyperreflexia), by acute or chronic bladder overdistension (urinary retention with overflow), or by an increase in intra-abdominal pressure. Similarly, a decrease in urethral pressure may occur as a result of uninhibited sphincter relaxation (unstable urethra), loss of pelvic floor support (genuine stress incontinence), and urethral wall defects from trauma, surgery, or neurologic disease.
16 Urinary Incontinence
Subtypes of Urinary Incontinence The most commonly encountered clinical forms of urinary incontinence in adults are stress incontinence, urge incontinence, overflow incontinence, and a mixed form. In stress incontinence, dysfunction of the bladder outlet leads to leakage of urine as intra-abdominal pressure is raised above urethral resistance while coughing, bending, or lifting heavy objects. Volume of urine leakage is generally modest at each occurrence and, in uncomplicated cases, postvoid residual volume is low. Stress incontinence has many causes, including direct anatomic damage to the urethral sphincter (sphincteric incontinence), which may lead to severe, continuous leakage, and weakening of bladder neck supports, as is often associated with parity. Urge incontinence occurs when patients sense the urge to void (urgency) but are unable to inhibit leakage long enough to reach the toilet. In most, but not all, cases, uninhibited bladder contractions contribute to the incontinence. Urine loss is moderate in volume, occurs at several hour intervals, and postvoid residual volume is low at several hour intervals. Among the causes of urge incontinence are central nervous system lesions such as stroke or demyelinating disease, which impair inhibition of bladder contraction, and local irritating factors such as urinary infection or bladder tumors. In many cases of urge incontinence, no specific etiology can be identified despite detailed clinical and laboratory evaluation. An important variant of urge incontinence is reflex incontinence, in which urine is lost due to uninhibited bladder contractions in the absence of the symptoms of urgency. In addition, many persons suffer from very frequent symptoms of urgency and are only able to remain continent by conducting their activities in the proximity of restrooms. Overflow incontinence occurs when the bladder cannot empty normally and becomes overdistended, leading to frequent, sometimes nearly constant, urine loss. Causes include neurologic abnormalities that impair detrusor contractile capacity, including spinal cord lesions, and any factor that obstructs outflow, including medications, tumors, benign strictures, and prostatic hypertrophy. Many cases of urinary incontinence fall into the mixed category, displaying some aspects of more than one of the major subtypes, both clinically and on extensive laboratory evaluation.
Guidelines 17
The term “functional” incontinence is applied to those cases in which the function of the lower urinary tract is intact, but other factors such as immobility or severe cognitive impairment result in urinary incontinence. It should be clear that urinary incontinence can be caused by multiple and often interacting conditions. Of particular importance are the transient or reversible factors such as infection, delirium, and drugs. These causes, which may be common in the elderly patient, should be carefully considered in the pathophysiology of urinary incontinence. There are age-related changes in the lower urinary tract that increase its vulnerability to both chronic and transient factors. Increases in uninhibited contractions, nocturnal fluid excretion, and prostate size, accompanied by decreases in bladder capacity and flow rate, all lead to greater susceptibility to urinary incontinence in the face of stresses associated with disease, functional impairment, or environmental factors. In older persons, cognitive decline, musculoskeletal impairments, and restricted access to toilets may all convert the marginally continent system to incontinence.
Evaluation and Therapy Evaluation and therapy must be tailored to the individual, taking into account clinical, cognitive, functional, and residential status in addition to the potential for correcting the problem. Just as a child is not simply a young adult, octogenarians differ from persons in their forties. Patients with stress urinary incontinence are quite dissimilar from those with uninhibited contractions and unstable bladders. Proper diagnosis and active case finding are imperative. History The evaluation of all patients with incontinence requires a thorough history, including medical, urologic, gynecologic, and neurologic assessment, with particular attention to those factors that influence bladder function. The duration, frequency, volume, and type of incontinence should be described and validated by a voiding diary. Other important information includes associated illnesses, previous operations, and current medications.
18 Urinary Incontinence
Physical Examination Physical examination is required, with emphasis on mental status; mobility and dexterity; and neurologic, abdominal, rectal, and pelvic findings. A provoked full-bladder stress test is recommended. Since prostate enlargement is often asymmetric, the size of the prostate as estimated on rectal exam may be misleading when evaluating the possible contribution of prostatic hypertrophy to urinary obstruction. In addition to the history and physical examination, core measurements to be obtained in all patients are urinalysis, serum creatinine or blood urea nitrogen, and postvoid residual urine volume. Other tests such as urine culture, blood glucose, and urinary cytology may be useful. Based on the findings from the core evaluation, a decision for treatment or more definitive evaluation is made, taking into consideration the type and degree of incontinence. Specialized Studies The tests currently available for specialized study include: ·
Cystometrogram--to be used as the basic study in cases requiring more than core evaluation, should be accompanied by measurement or estimation of abdominal pressure.
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Electrophysiologic sphincter testing (EMG).
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Ultrasound of the bladder or kidneys may detect residual urine or hydronephrosis.
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Cystourethroscopy with or without cytology is indicated in patients with hematuria or the recent onset of urgency or urge incontinence who are at increased risk for carcinoma.
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Uroflowmetry has wide application in the evaluation of obstructive disease in men but a limited role in the evaluation of women.
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Videourodynamic evaluation requires special expertise. Its role is limited to the more elusive incontinence problems.
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Urethral pressure profilometry is a controversial test. Its predictive value has been questioned, and it requires further validation before it can be recommended for widespread use.
Guidelines 19
These numerous noninvasive and invasive tests must be used selectively. Examples of patients rarely requiring further diagnostic testing after the core examination include the young woman with classic stress incontinence or the 80-year-old woman with a recent stroke and the new onset of urge incontinence. Patients with stress incontinence and a significant urge component or those in whom previous operations have failed may require combined cystography and fluoroscopy with a complete urodynamic evaluation. Some patients with urge or mixed incontinence, or those who are not helped by empiric therapy or operation, also will require more complete urodynamic testing. Some patients may not be candidates for sophisticated studies due to inability to cooperate or a poor prognosis for correction. Armed with this information, the investigating physician should be able to reach an accurate diagnosis leading to appropriate therapy.
General Principles of Treatment ·
All persons with incontinence should be considered for evaluation and treatment.
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Treatment decisions should be based on a diagnosis made after a reasonable evaluation of anatomy and function of urine storage and emptying.
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Treatment for incontinence is given to a specific individual, whose personality, environment, expectations, and clinical status are important determinants of treatment modalities to be used and the order of their application.
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The patient requires sufficient information and explanation to be able to make a choice among therapeutic options.
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Environmental constraints in the community or in an institution that may impede treatment are common, and strategies to circumvent impediments are a part of the therapy.
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In particular, availability of adequate numbers of properly constructed public toilets is an important adjunct to incontinence management.
Pharmacologic Treatment Most drugs currently used in managing the varied causes of urinary incontinence have not been studied in well-designed clinical trials. Nevertheless, it has been suggested that many agents are beneficial, especially for urge incontinence due to uninhibited detrusor contractions.
20 Urinary Incontinence
For these patients, drugs that increase bladder capacity can be helpful. One attendant risk is the precipitation of retention. Accordingly, outlet obstruction or a weak detrusor should be looked for as possible contraindications to these agents.
Bladder Relaxants These agents are generally used for urge incontinence.
Anticholinergics Anticholinergic agents inhibit detrusor contraction, and may produce increased bladder capacity and delay and reduction in amplitude of involuntary contractions. Propantheline is frequently effective, although high doses may produce unacceptable side effects such as dry mouth, dry eyes, constipation, confusion, or precipitation of glaucoma.
Direct Smooth Muscle Relaxants These antispasmodics work directly on bladder muscle, but they have a mild anticholinergic effect as well. A randomized, double-blind, placebocontrolled study has shown benefit with oxybutynin in patients with detrusor instability, some but not all of whom were incontinent. Favorable reports also exist about flavoxate and dicyclomine, the other two agents in this class.
Calcium Channel Blockers These agents, used clinically for cardiovascular indications, have a depressant effect on the bladder as well, but they have not been studied rigorously for the treatment of urge incontinence in comparison with other agents. In the patient being considered for treatment for heart disease, the bladder effects of calcium antagonists must be kept in mind for both their potential benefit as well as risk of retention.
Guidelines 21
Imipramine This tricyclic antidepressant has anticholinergic and direct relaxant effects on the detrusor and an alpha adrenergic enhancing (contracting) effect on the bladder outlet, all of which enhance continence. Although imipramine is commonly used, potential side effects of postural hypotension and sedation as well as all peripheral anticholinergic effects make caution imperative when considering this agent in older persons.
Bladder Outlet Stimulants Alpha adrenergic agonists, used in treatment of stress incontinence, produce smooth muscle contraction at the bladder outlet and may improve continence. Pseudoephedrine and ephedrine both are active, but phenylpropanolamine has been used most often, and objective benefit by urodynamic study has been shown.
Estrogens Because urinary incontinence increases in women with increasing age, and because menopause results in estrogen deficiency, estrogen replacement has been thought to be helpful for urinary incontinence. Several studies have shown no improvement in stress incontinence, but women with postmenopausal urge incontinence, urgency, and frequency have shown improvement. Long-term use should be considered in view of other risks and benefits.
Surgery Surgery is particularly effective in treatment of pure stress incontinence associated with urethrocoele. A variety of surgical techniques for the transvaginal or transabdominal suspension of the bladder neck yield a success rate between 80 and 95 percent in appropriately selected patients with stress incontinence at 1-year followup. Long-term results require study. When incontinence in men is secondary to outflow obstruction and chronic retention is secondary to prostatic enlargement, it is best treated with prostatectomy. In addition, there are several specialized and more extensive surgical procedures. When incontinence is due to intrinsic sphincter dysfunction,
22 Urinary Incontinence
which may occur after the surgical trauma of radical prostatectomy or sphincter denervation, the compressive action of the sphincter is lost. An implantable prosthetic sphincter can restore this compression. Continence is restored in 70 to 90 percent of patients in various series. A complication rate greater than 20 percent includes erosion of the urethra, infection, and mechanical failure. Reoperations are frequently required. Urethral sling procedures pass a ribbon of fascia or artificial material beneath the urethra. The sling, fixed to the anterior body wall, serves to elevate and compress the urethra, restoring continence in 80 percent of patients. Bladder augmentation with isolated bowel segments will increase bladder capacity and vent excessive bladder pressure. This procedure is limited to certain specific bladder problems such as the contracted bladder of neurologic disease or tuberculosis. Bladder replacement with continent diversion can also be offered to the cystectomy patient. There are no simple procedures to control bladder instability or sensory urgency. When incontinence is due to a mixture of stress and urge, pharmacologic or behavioral treatment may be employed in conjunction with surgery, but results are not as good as when stress incontinence exists alone. Selection of patients for surgical procedures depends upon the diagnosis and upon the condition of the patient. The frailty of the patient, the condition of tissues, and the state of nutrition bear on the ability to heal. The severity of symptoms must be considered in relation to the risk the patients must undertake for their surgical correction. Finally, such factors as the durability of the treatment and the incidence of complications must also be considered in choosing a treatment option.
Behavioral Techniques Behavioral techniques increase the patient’s awareness of the lower urinary tract and environment and can enhance control of detrusor and pelvic muscular function. Such techniques are participatory, relatively noninvasive, and generally free of side effects, and they do not limit future options. They do require time, effort, and continued practice. Some patients become dry, while a larger number experience important reduction of wetness, and others receive no benefit. Those who appear to benefit most are highly motivated individuals without cognitive deficits. Men and women with stress and urge incontinence have benefited, whereas patients with severe
Guidelines 23
sphincter damage (such as in postradical prostatectomy with constant leakage) generally do not benefit. Behavioral techniques should be offered as a choice to patients who are motivated to put in the time and effort and wish to avoid a more invasive procedure. Commonly employed techniques include:
Pelvic Muscle Exercises Pelvic muscle exercises strengthen the voluntary periurethral and pelvic floor muscles, the contraction of which exerts a closing force on the urethra. These techniques have been emphasized for women with stress incontinence but appear to be useful in men as well. Benefit has been reported in 30 to 90 percent of women, but criteria for improvement differ among studies. Patients with mild symptoms may improve most. Continued exercise is required for continued benefit. Biofeedback Biofeedback is a learning technique to exert better voluntary control over urine storage. Biofeedback uses visual or auditory instrumentation to give patients moment-to-moment information on how well they are controlling the sphincter, detrusor, and abdominal muscles. After such training, successful patients typically learn to perform the correct responses relatively automatically. Patients with urinary incontinence are trained to relax the detrusor and abdominal muscles and/or contract the sphincter, depending upon the form of incontinence. When used in patients with stress and/or urge incontinence, biofeedback has been shown to result in complete control of incontinence in approximately 20-25 percent of patients and to provide important improvement in another 30 percent. There are two caveats: the degree of improvement is variable, and long-term followup data are not available. It is important to recognize that biofeedback requires sophisticated equipment and training. The benefit of adding biofeedback to pelvic muscle exercise regimens has not been adequately evaluated.
Bladder Training Bladder training instructs patients to void at regular short intervals, usually hourly during the day, and then at progressively longer intervals of up to 3 hours over a training period of a few to a dozen weeks. Bladder training
24 Urinary Incontinence
appears to be effective in reducing the frequency of stress and urge incontinence. Studies have indicated cure rates of 10-15 percent and improvement in the majority of patients. Behavioral Techniques in the Nursing Home For institutionalized elderly, almost any consistent attention to the problem, including bladder training and frequent scheduled checks for dryness appears to reduce incontinence in at least some patients. Another technique applicable in the nursing home is prompted voiding, in which frequent (1 to 2 hourly) checks for dryness are made, reminding the patient to void and praising success. Staging of Treatment As a general rule, the least invasive or dangerous procedures should be tried first. For many forms of incontinence, behavioral techniques meet this criterion. When behavioral techniques do not achieve the desired result, pharmacologic treatment can be initiated. Clear indications for surgical intervention must be respected, however, and surgical treatment should not be withheld inappropriately. Overflow incontinence due to prostatism and urge incontinence due to carcinoma of the bladder or prostate must be recognized and treated promptly. After having been informed of surgical and nonoperative options, the patient who is a surgical candidate and wants prompt treatment (e.g., as in the case of stress incontinence) should be operated on. In patients with mixed incontinence, a combination of surgery, behavioral techniques, and pharmacotherapy may be helpful.
Management Techniques For patients who have not been successfully treated, management plans must be developed to maximize their well-being. Even when permanent improvement is not expected, techniques such as frequent toileting and reminders may be useful in reducing the impact of the patient’s incontinence. Careful evaluation of the timing and pattern of incontinence may suggest helpful changes such as bedtime fluid restriction, provision of easier access to toilet facilities, and temporary or permanent arrangements for protection of the patients, their clothing, and environment.
Guidelines 25
Currently available modes of protection include absorbent pads or garments, indwelling catheters, and external collection devices such as condom catheters. Absorbent pads or garments provide comfort and convenience when used temporarily in conjunction with therapy; no method is entirely satisfactory for long-term use. For long-term use with incapacitated patients, absorbent materials are expensive, require personnel time, and can be associated with pressure sores when circumstances prevent meticulous attention to prompt changes. For men, external collection devices are less expensive and less timeconsuming for patient and caregiver, but they are associated with increased incidence of urinary tract infection and other complications. Practical external collection devices for women are not generally available. Indwelling urethral or suprapubic catheters may be necessary for selected patients, but almost invariably lead to bacteriuria within a few weeks and have been associated with sepsis.
Improving Public and Professional Knowledge There have been limited efforts to inform the public and professionals about urinary incontinence. The effectiveness of these strategies has not been evaluated. Incontinence education, therefore, must rely on methods that have been used in other areas of health education. Effective strategies to improve public and professional awareness need to be developed, implemented, and evaluated. Negative societal attitudes about urinary incontinence have been a barrier to increasing public and professional knowledge. The scientific study of incontinence and the dissemination of research findings will help professionals and laypersons realize that loss of continence need not be a condition that is inevitable or shameful.
Strategies for Improving Public Knowledge Providing accurate information on the management of incontinence to persons with this problem and their families is a challenging and important task. Studies suggest that only half of the people with incontinence report their condition to a physician. Strategies that will reach the largest number of people will be effective in encouraging them to seek professional help. These
26 Urinary Incontinence
include informative newspaper and magazine articles, radio and television programs, and special educational programs in senior centers. One innovative suggestion that deserves consideration is the mandatory labeling of all absorbent products, informing the public that persistent urinary incontinence should be evaluated and that effective treatments are available. Strategies for Improving Professional Knowledge There is an urgent need to educate professionals and paraprofessionals about urinary incontinence. First and foremost, information on urinary incontinence should be included in the core curricula of undergraduate and graduate professional schools. Schools of nursing should consider the feasibility of educating specialists on incontinence care, who can serve as expert advisers to health care professionals. To increase practitioners’ knowledge of this important condition, continuing education courses focusing on the types of incontinence and appropriate diagnostic measures and treatment should be offered. Professionals most likely to provide care to people with incontinence should be encouraged to attend these courses. Education on the topic of urinary incontinence should also be a part of the training programs for paraprofessional students such as licensed vocational nurses, nurses aides, and auxiliary workers in the community. Because urinary incontinence is a problem of great magnitude in long-term care settings, special emphasis should be placed on educating nurses aides. Last, coordinated care for people with incontinence will be facilitated by encouraging alliances among all professionals responsible for caring for people with incontinence.
Need for Future Research Related to Urinary Incontinence The Consensus Development Conference on Urinary Incontinence in Adults has provided an overview of current knowledge on the etiology, pathophysiology, sequelae, and management of this prevalent clinical problem. Although information on incontinence is increasing, this field has
Guidelines 27
long been neglected, and numerous gaps exist in our knowledge. While many controversies were addressed, numerous questions were identified that await answers and thus serve as the focus for future research directions. These issues will require the collaborative input of investigators from the spectrum of relevant disciplines and the rigorous application of appropriate research principles.
Directions for Future Research ·
Basic research on the mechanisms underlying the etiology, exacerbation, and response to treatment of specific forms of urinary incontinence and urgency.
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Epidemiologic studies with emphasis on elucidation of risk factors for development of urinary incontinence, its occurrence in specific populations (particularly males and nonwhites), and the natural history of the various clinical and physiologic subtypes.
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Studies of strategies to prevent urinary incontinence.
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Randomized clinical trials, including longitudinal studies in wellspecified populations, of algorithms for the systematic assessment of patients with incontinence and of specific behavioral, pharmacologic, and surgical treatment, either alone or in combination.
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Development of new therapies, including pharmacologic agents with greater specificity for the urinary tract and new behavioral and surgical strategies and other innovative techniques, including electrical stimulation.
Conclusions ·
Urinary incontinence is very common among older Americans and is epidemic in nursing homes.
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Urinary incontinence costs Americans more than $10 billion each year.
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Urinary incontinence is not part of normal aging, but age-related changes predispose to its occurrence.
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Urinary incontinence leads to stigmatization and social isolation.
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Of the 10 million Americans with urinary incontinence, more than half have had no evaluation or treatment.
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Contrary to public opinion, most cases of urinary incontinence can be cured or improved.
28 Urinary Incontinence
·
Every person with urinary incontinence is entitled to evaluation and consideration for treatment.
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Most health care professionals ignore urinary incontinence and do not provide adequate diagnosis and treatment.
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Inadequate nursing home staffing prohibits proper treatment and contributes to the neglect of nursing home residents.
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Medical and nursing education neglect urinary incontinence. Curriculum development is urgent.
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A major research initiative is required to improve assessment and treatment for Americans with urinary incontinence.
More Guideline Sources The guideline above on urinary incontinence is only one example of the kind of material that you can find online and free of charge. The remainder of this chapter will direct you to other sources which either publish or can help you find additional guidelines on topics related to urinary incontinence. Many of the guidelines listed below address topics that may be of particular relevance to your specific situation or of special interest to only some patients with urinary incontinence. Due to space limitations these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly.
Topic Pages: MEDLINEplus For patients wishing to go beyond guidelines published by specific Institutes of the NIH, the National Library of Medicine has created a vast and patientoriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages.” You can think of a health topic page as a guide to patient guides. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. If you do not find topics of interest when browsing health topic pages, then you can choose to use the advanced search utility of MEDLINEplus at http://www.nlm.nih.gov/medlineplus/advancedsearch.html. This utility is similar to the NIH Search Utility, with the exception that it only includes
Guidelines 29
material linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search.
The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on urinary incontinence and related conditions. One of the advantages of CHID over other sources is that it offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: ·
Special Care Problems: Urinary Incontinence Source: Minneapolis, MN: Department of Veterans Affairs, Geriatric Research, Education and Clinical Center, Office of Geriatrics, Veterans Health Services and Research Administration. August 1989. 14 p. Contact: Available from Department of Veterans Affairs. Publications Office, 6307 Gravel Road, Alexandria, VA 22310. Price: Single copies free. Summary: This pamphlet is part of a series prepared by the Department of Veterans Affairs Medical Center's Geriatric Research, Education, and Clinical Center. It is designed to serve as a guide for families and primary caregivers caring for persons with dementia-related diseases, provides basic information and guidance concerning how to recognize and handle the special care problems posed by urinary incontinence that may be exhibited by such patients. Particular attention is given to: the particular types of problems raised by these actions, and how to look for signs of these particular problems: how such special problem areas can be treated (or, if not, how it can be managed); and practical tips to help in communicating with a patient having these types of special problems. The increased difficulty for a caregiver in caring for such patients is discussed, and the importance of the caregiver taking proper care of their own health is emphasized. Included is a list of further recommended readings.
30 Urinary Incontinence
·
Understanding Urinary Incontinence in Women: A Common and Treatable Condition Source: San Bruno, CA: StayWell Company. 2000. 15 p. Contact: Available from Staywell Company. Order Department, 1100 Grundy Lane, San Bruno, CA 94066-9821. (800) 333-3032. Fax (650) 2444512. Price: $1.35 per copy; plus shipping and handling. Order number 11230. Summary: This patient education booklet reviews the diagnosis and therapy of urinary incontinence (UI) in women. The booklet begins with a description of the different types of UI: stress incontinence, in which urine leaks out when stress (pressure) is put on the bladder; urge incontinence, characterized by a strong, uncontrollable need to urinate; overflow incontinence, in which the bladder does not empty normally; and mixed incontinence. The booklet lists the symptoms of each type of incontinence. The booklet reviews the normal urinary system, how urine is normally kept in the bladder, and how urination normally occurs. Tests that may be used to diagnose UI include the pelvic examination, urinalysis and culture (to test for infection), cystoscopy, cystogram, and urodynamics (tests that show how well the bladder is working). Treatment options can include Kegel exercises, special therapies, medication (drug therapy), timed voiding, bladder retraining, collagen injections, self catheterization, and surgery. The booklet describes how to perform Kegel (pelvic floor) exercises and explains how adjunctive therapies such as biofeedback and electrical stimulation can be utilized. A final section offers an overview of pelvic floor surgery, including preoperative care, the surgery itself, risks and complications, and postoperative recovery. The booklet includes a series of checklists and a bladder diary for readers to complete and bring to their physician, to help in the diagnosis of UI. The booklet concludes with the toll free telephone numbers of three related resource organizations. The booklet is illustrated with full color line drawings. 26 figures. 1 table.
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Overcoming Stress Incontinence: Simple Surgery to Restore Your Lifestyle Source: Minnetonka, MN: American Medical Systems. 2000. [4 p.]. Contact: Available from American Medical Systems. 10700 Bren Road West, Minnetonka, MN 55343. (800) 328-3881 or (952) 930-6157. Fax (952) 930-6157. Website: www.visitAMS.com. Price: Single copy free. Summary: Millions of women suffer the inconvenient and often embarrassing problem of urine leakage when they sneeze, laugh, cough, or otherwise strain. Known as stress urinary incontinence (SUI), this is by
Guidelines 31
far the most common type of urinary incontinence among women. This brochure notes that there are many alternative treatment options available to treat SUI; the brochure focuses on a minimally invasive procedure undertaken to correct SUI surgically. By restoring proper support to the anatomical structures responsible for normal bladder control, the symptoms of stress incontinence are greatly reduced, if not eliminated altogether. The brochure reviews the causes of SUI, basic urinary anatomy, how stress incontinence occurs, and the procedure used for sling surgery. The objective of sling surgery is to reinforce support to the bladder neck and urethra while supplementing urethral closure. Traditional sling surgery is rather involved, requiring an abdominal incision and extended recovery time. However, a minimally invasive technique has been developed that can be performed entirely through the vagina with no abdominal incision (or scar) involved. A specially designed surgical device is placed in the vagina and positioned against the back of the pubic bone, above the roof of the vagina. Two miniature screws are then fully embedded in the bone on either side of the urethra. Sutures attached to the screws are used to tie up the ends of a small graft taken from the patient's own body, obtained from a tissue band, or made of synthetic material. The sling bridges the distance between the two screws and forms a hammock just beneath the urethra. The procedure is usually completed in less than an hour with regional or general anesthesia; a hospital stay is not usually required. 2 figures. ·
Urinary Incontinence: A Guide for Men Source: Minnetonka, MN: American Medical Systems. 1999. 10 p. Contact: Available from American Medical Systems. 10700 Bren Road West, Minnetonka, MN 55343. (800) 328-3881 or (612) 933-4666. Fax (612) 930-6592. Website: www.VisitAMS.com. Price: Single copy free. Order number 21600011D. Summary: This brochure provides information about urinary incontinence in men. Urinary incontinence (UI) is defined as the involuntary loss of urine which causes a social or hygienic problem. In a healthy person, the urinary sphincter muscle controls bladder storage; in men, it is located below the prostate. There are many things that can prevent the urinary sphincter muscle and bladder muscles from doing their jobs, including multiple sclerosis, strokes, postoperative complications, posttrauma complications, and spinal cord injuries. Approximately one in five older men will experience UI in their lifetime. The brochure defines four basic types of incontinence: stress (loss of urine during physical activity), urge (overwhelming need to urinate and the inability to hold it long enough to reach a toilet), mixed (combination of
32 Urinary Incontinence
urge and stress incontinence), and overflow (frequent leakage from a full bladder than never completely empties). The brochure reviews the diagnostic tests used to confirm and classify UI, including urinalysis, stress test, postvoid residual (PVR) measurement, and urodynamic testing. Treatment options are then outlined, including external devices, condom catheters, indwelling catheters, behavioral therapy, injectable materials, and surgery. The brochure then describes the use of the artificial urinary sphincter (AUS) prosthesis, a small, implantable device used for UI. The brochure concludes by encouraging readers to work with their family doctor and urologist to diagnose and treat problems with UI. 3 figures. ·
Urinary Incontinence: A Guide for Women Source: Minnetonka, MN: American Medical Systems. 1999. 11 p. Contact: Available from American Medical Systems. 10700 Bren Road West, Minnetonka, MN 55343. (800) 328-3881 or (612) 933-4666. Fax (612) 930-6592. Website: www.VisitAMS.com. Price: Single copy free. Order number 21600016D. Summary: This brochure provides information about urinary incontinence in women. Urinary incontinence (UI) is defined as the involuntary loss of urine which causes a social or hygienic problem. In a healthy person, the urinary sphincter muscle controls bladder storage; in women, it is located below the bladder. There are many things that can prevent the urinary sphincter muscle and bladder muscles from doing their jobs, including childbirth, multiple pregnancies, aging, multiple sclerosis, strokes, and spinal cord injuries. Approximately half of all older women will experience UI in their lifetime. The brochure defines four basic types of incontinence: stress (loss of urine during physical activity), urge (overwhelming need to urinate and the inability to hold it long enough to reach a toilet), mixed (combination of urge and stress incontinence), and overflow (frequent leakage from a full bladder than never completely empties). The brochure reviews the diagnostic tests used to confirm and classify UI, including urinalysis, stress test, postvoid residual (PVR) measurement, and urodynamic testing. Treatment options are then outlined, including behavioral therapy (bladder retraining), pelvic floor muscle exercises (Kegel exercises), biofeedback, electrical stimulation, injectable materials, and surgery. The brochure then describes the use of the artificial urinary sphincter (AUS) prosthesis, a small, implantable device used for UI. The brochure concludes by encouraging readers to work with their family doctor and urologist to diagnose and treat problems with UI. 5 figures.
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·
Five Facts About Urinary Incontinence: Plus Ten Things You Can Do About Urinary Incontinence Source: Rockville, MD: Urology Wellness Center. 1998. [2 p.]. Contact: Available from Urology Wellness Center. 14820 Physicians Lane, Suite 241, Rockville, MD 20850. (301) 424-5661. Fax (301) 424-3734. Price: Single copy free. Summary: This straightforward brochure first lists 5 facts about urinary incontinence (the involuntary leakage of urine), then offers 10 strategies for preventing or managing urinary incontinence (UI). The facts are: UI is not an inevitable part of aging; UI is a symptom, not a disease; UI can be helped without surgery in 70 percent of people with the problem; the absorbent products that many people with UI use instead of seeking treatment can be very expensive; and UI causes increased admission to nursing homes, urinary tract infections (UTIs), skin diseases, and falls. The strategies offered to manage UI include maintaining a record of urinary activity, evaluating the diary (with or without a health care provider's input), urinating every 3 hours, eliminating bladder irritants from the diet (caffeine, aspartame, alcohol, and orange juice), not restricting water and other fluids, learning how to do Kegel exercises (pelvic floor exercises), doing Kegel exercises regularly, and managing urge incontinence. The back section of the brochure lists four types of UI and their causes: stress UI, urge UI, overflow UI, and functional UI. The brochure concludes with the telephone numbers of three organizations through which readers can get additional information.
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Surgery for Stress Urinary Incontinence Source: San Bruno, CA: StayWell Company. 1998. 15 p. Contact: Available from Staywell Company. Order Department, 1100 Grundy Lane, San Bruno, CA 94066-9821. (800) 333-3032. Fax (650) 2444512. Price: $1.35 per copy; plus shipping and handling. Order number 11121. Summary: This patient education booklet reviews the surgical treatment for stress urinary incontinence (SUI). SUI is the problem of leaking urine when there is physical stress (pressure) put on the bladder; this can happen when the patient lifts something heavy, exercises, coughs, sneezes, or laughs, or gets up from a bed or chair. The booklet reviews the anatomy of the pelvis, then discusses preoperative care and preparation, the abdominal surgical procedure, the vaginal surgical procedures, the sling surgical procedure, other problems that may need repair, postoperative recovery in the hospital, and continued recovery at home. The booklet describes in clear, nontechnical language what the
34 Urinary Incontinence
patient can expect to happen at each stage of the surgery, including before and after the actual procedure. The booklet lists the risks and possible complications of surgery for SUI, which can include infection; bleeding; the risks of anesthesia; damage to nerves, muscles, or nearby pelvic structures; and blood clots. The booklet reviews other problems that may need repair, including cystocele, uterine prolapse, rectocele, and vaginal vault prolapse. Each surgical procedure is illustrated with simple line drawings. One sidebar lists the postoperative problems that would require a call to the physician. The booklet is illustrated with full color line drawings. 30 figures. ·
Urinary Incontinence in Women: A Guide for Women Source: San Ramon, CA: Health Information Network, Inc. 1997. 32 p. Contact: Available from HIN, Inc. 231 Market Place, Number 331, San Ramon, CA 94583. (800) HIN-1121. Fax (925) 358-4377. Website: www.hinbooks.com. Price: $2.95 suggested list price; professional discount price $1.35 with bulk discounts available. Order number 303. ISBN: 1885274416. Summary: This booklet familiarizes readers with urinary incontinence in women. Urinary incontinence (UI) is defined as uncontrolled leakage of urine from the bladder. The author stresses that many treatment choices exist for UI, even when a complete cure may not be possible. UI can be caused by infection, injury, hormonal changes, pregnancy, childbirth, use of certain medications, and illness. The booklet describes how the urinary system works, the types of UI, treating UI, what to expect at the doctor's office, the role of support groups, behavioral techniques used to treat UI, biofeedback, the use of absorbent products, medications (drug therapy), and surgical options used to treat the problem. The booklet teaches readers how to perform pelvic floor exercises (Kegel exercises) as one option for treatment. Other treatment options described in detail are bladder exercises and intermittent self-catheterization. One sidebar emphasizes the importance of adequate skin care, especially for those persons using absorbent products on a regular basis. The booklet concludes with a glossary of related terms and a list of resource organizations through which readers can get more information. 14 references. 1 table.
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Injection Therapy: For Urinary Incontinence Source: Spartanburg, SC: National Association for Continence. 1997. 2 p.
Guidelines 35
Contact: Available from National Association for Continence. P.O. Box 8310, Spartanburg, SC 29305-8310. (800) 252-3337 or (864) 579-7900. Fax (864) 579-7902. Price: $1.00 for members, $1.50 for nonmembers. Summary: This brochure explains the use of injection therapy for urinary incontinence, particularly that caused by intrinsic sphincteric deficiency (ISD), defined as poor function of the sphincter mechanism at the neck of the bladder. This can be a result of a neurologic injury, surgical trauma, or congenital problems like spina bifida. One technique of treating this type of incontinence is with the injection of bulking material into the tissues around the urethra. This bulk protects against incontinence by increasing the resistance to the outflow of urine. After many years of research, the use of collagen (Contigen implant) has been established as a safe and effective treatment for sphincter malfunction. The brochure outlines patient selection, treatment technique, postinjection patient care, and expected results. Since therapy with contigen implant can usually be performed with local anesthesia alone, a significant number of patients who are not candidates for surgical procedures may benefit from this treatment. Eighty percent of women are dry or improved after three treatments; 77 percent will remain dry once this has been attained. Unfortunately, results in men are not as favorable, since only 40 percent attain dryness. The brochure lists related publications available through the National Association for Continence. 3 figures. ·
Urinary Incontinence in Men: Regaining Control Source: San Bruno, CA: Krames Communications. 1996. 2 p. Contact: Available from Krames Communications. Order Department, 1100 Grundy Lane, San Bruno, CA 94066. (800) 333-3032. Fax (415) 2444512. Price: $0.40 each (as of 1996); bulk prices available. Summary: This brochure provides information about urinary incontinence in men. Topics include the types of incontinence, i.e., stress, urge, and overflow; treatment options, including medications, catheters, behavioral changes, and surgery; and the anatomy of the male lower urinary tract. The brochure notes that short-term causes of all types of incontinence include medication side effects, infection, surgery, or mobility problems. Incontinence due to nerve or muscle damage may be longer term. The brochure encourages readers to seek treatment for any urinary incontinence problems.
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Urinary Incontinence: Treating Loss of Urine Control Source: New York, NY: National Kidney Foundation. 1996. 7 p.
36 Urinary Incontinence
Contact: National Kidney Foundation. 30 East 33rd Street, New York, NY 10016. (800) 622-9010. Website: www.kidney.org. Price: Single copy free; bulk copies available. Summary: This brief brochure from the National Kidney Foundation reviews the treatment options for urinary incontinence. Written in an easy to read, question and answer format, the brochure discusses the possible causes of urinary incontinence, including aging, pregnancy, and diseases (diabetes, stroke, and nerve disease); how to define urinary incontinence; treatment methods including drugs, behavior therapy, exercise, biofeedback, electrical stimulation, and surgery; the use of absorbent protective pads and catheterization; and the impact of urinary incontinence on sexual activity. The brochure stresses that incontinence can be treated and often can be cured. ·
Women and Stress Incontinence: Restore Your Active Lifestyle Source: Covington, GA: Bard Urological Division, C.R. Bard, Inc. 1995. 7 p. Contact: Available from Bard Urological Division. (800) 526-2687. Price: Single copy free. Summary: This brochure provides basic information about the causes, diagnosis, and treatment of female stress incontinence (urinary). Topics include the incidence of stress incontinence, the treatment options for stress incontinence, and the use of the Contigen Bard collagen implant to treat stress incontinence. The brochure encourages readers with urinary incontinence to seek medical advice, as treatment options are often successful. The brochure concludes with a list of resource organizations through which readers can obtain more information. 1 figure. 1 table.
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Six Myths of Stress Incontinence Source: Covington, GA: Bard Urological Division, C.R. Bard, Inc. 1995. 5 p.
Contact: Available from Bard Urological Division. (800) 526-2687. Price: Single copy free. Summary: This brochure provides basic information about the causes, diagnosis, and treatment of male and female urinary incontinence. The 'six myths' about urinary incontinence are discussed and dispelled. Those myths are: I'm not really incontinent; I can't discuss incontinence with my doctor; incontinence is a natural part of growing older; I'm too old to receive medical attention for incontinence; incontinence is a natural part of bearing children; and my case is hopeless. The brochure encourages readers not to believe these myths, but instead to have any problems with incontinence evaluated and treated by a health care provider. The
Guidelines 37
brochure is excerpted from a book entitled 'Keeping Dry: A Practical Guide to Bladder Control' by Burgio, Pearce, and Lucco. 1 table. ·
Simple Facts About Male Urinary Incontinence Source: Neenah, WI: Kimberly-Clark Corporation. 1995. 10 p. Contact: Available from Kimberly-Clark Corporation. 2001 Marathon Avenue, Neenah, WI 54956. (800) 558-6423. Price: Single copy free. Summary: This brochure provides basic information about the causes, diagnosis, and treatment of male urinary incontinence. Topics include incontinence following prostate surgery, the use of pelvic muscle exercises, variations in the severity of urinary incontinence, male incontinence not related to prostate surgery, the role of diet and general health in managing urinary incontinence, and absorbent products available. The brochure concludes with a list of suggested reading, as well as a description of a few resource organizations and self-help groups through which readers can obtain more information. This brochure is also available, in slightly different form, in Spanish ('La Realidad Sobre La Incontinencia Urinaria'). 2 figures.
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Incontinence: You Are Not Alone Source: Baltimore, MD: American Urological Association, Inc. 1998. (campaign kit). Contact: Available from American Urological Association. 1120 North Charles Street, Baltimore, MD 21201-5559. (410) 223-4367. Fax (410) 2234375. Website: www.auanet.org. Price: $40.00 plus shipping and handling; available to AUA members only. Summary: This public service campaign, from the American Urological Association (AUA), includes a variety of materials designed to encourage women with urinary incontinence (UI) to seek care from a urologist. The campaign emphasizes that embarrassment should not keep women from seeking care and benefiting from new treatment options. The materials include three table-top posters, each with a black and white photograph of a woman, noting that half of all women experience incontinence at some point in their lives and encouraging women to talk with a urologist or call a toll free information line. The kit also reproduces the public service announcements (PSA) created for the campaign, one aimed at younger women and one aimed at older women. The kit includes a 10 slide presentation that describes the public service campaign, outlines the major symptoms of incontinence, describes the causes of UI, explains the anatomy of the female urinary tract, and discusses the common treatments for urinary incontinence, including behavior modification,
38 Urinary Incontinence
drug therapy, devices, injection therapy, and surgery. The kit also includes numerous copies of a brochure that describes the treatments for urinary incontinence. The brochure reviews conditions that may contribute to female UI, how UI is diagnosed, the anatomy of the female urological organs, the types of UI, and treatment options (as listed above). The brochure encourages readers to call the toll free number (877DRYLIFE or 877-379-5433) to find a urologist in their own local area. All of the materials, except the slides, are in black and white. The AUA hopes that focusing attention on this condition through national and local media will pave the way for a healthy and more open public attitude toward this problem and help women of all ages lead lives free of incontinence. ·
[Bladder Control for Women: Professional Kit] Source: Bethesda, MD: National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). 1997. [100 p]. Contact: Available from National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). Attention: BCW. 3 Information Way, Bethesda, MD 20892-3580. (800) 891-5390 or (301) 654-4415. Fax (301) 907-8906. E-mail:
[email protected]. World Wide Web: http://www.niddk.nih.gov/. Price: 1-5 kits free; additional copies $5.00 each. Summary: This professional education kit, part of a public health awareness campaign on bladder control for women, lists patient and professional education materials on urinary incontinence. Included are fact sheets, booklets, brochures, books, program and education kits, charts and posters, audiovisual materials, and resource guides. Readers are referred to the appropriate organization to obtain each of the resources listed. The source, title, and pricing information for each item are noted. A title index is included. The kit also includes a fact sheet for professionals on working with female patients with urinary incontinence, as well as copies of patient education brochures on bladder control problems.
·
[Bladder Control for Women: Patient Kit] Source: Bethesda, MD: National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). 1997. [75 p]. Contact: Available from National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). Attention: BCW. 3 Information Way, Bethesda, MD 20892-3580. (800) 891-5390 or (301) 654-4415. Fax (301) 907-8906. E-mail:
[email protected]. World Wide Web:
Guidelines 39
http://www.niddk.nih.gov/. Price: 1-25 kits free; additional copies $5.00 each. Summary: This patient education kit, part of a public health awareness campaign on bladder control for women, provides four educational brochures on urinary incontinence. Also included is a daily bladder diary, with which patients can record their bladder functions in preparation for consultation with a health care provider. Brochure titles are Bladder Control for Women, Exercising Your Pelvic Muscles, Talking to Your Health Care Team About Bladder Control, and Your Body's Design for Bladder Control. All of the materials emphasize the potential for successful treatment of bladder control problems and the importance of working in tandem with health care providers to determine the cause of incontinence and to establish the best treatment option. The brochures are written in nontechnical, clear language, with medical terms defined for the reader. ·
[Bladder Control for Women: Professional Photocopy Master Set] Source: Bethesda, MD: National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). 1997. [50 p]. Contact: Available from National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). Attention: BCW. 3 Information Way, Bethesda, MD 20892-3580. (800) 891-5390 or (301) 654-4415. Fax (301) 907-8906. E-mail:
[email protected]. World Wide Web: http://www.niddk.nih.gov/. Price: $3.00 per set. Summary: This photocopy master kit, part of a public health awareness campaign on bladder control for women, provides master copies of six educational brochures on urinary incontinence. Also included is a master of a daily bladder diary, with which patients can record their bladder functions in preparation for consultation with a health care provider. Professionals can photocopy these materials and distribute them to their patients. Brochure titles are Exercising Your Pelvic Muscles; Talking to Your Health Care Team About Bladder Control; Your Body's Design for Bladder Control; Menopause and Bladder Control; Pregnancy, Childbirth, and Bladder Control; and Your Medicines and Bladder Control. All of the materials emphasize the potential for successful treatment of bladder control problems and the importance of working in tandem with health care providers to determine the cause of incontinence and to establish the best treatment option. The brochures are written in nontechnical, clear language, with medical terms defined for the reader.
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Clinical Bulletin: Treating Patients With Urinary Incontinence Source: Washington, DC: Alliance for Aging Research. National Institute on Aging. 1992. 44 p. Contact: Available from National Institute on Aging (NIA) Information Center. P.O. Box 8057, Gaithersburg, MD 20898-8057. (800) 222-2225 or (301) 495-3450. Fax (301) 589-3014. TTY (800) 222-4225. E-mail:
[email protected]. Also available from Alliance for Aging Research. 2021 K Street NW., Suite 305, Washington, DC 20006. (202) 2932856. Price: Single copy free; bulk copies available. Summary: This information packet keeps primary care providers informed of the latest treatment information for their patients with urinary incontinence (UI). Included in the packet is a summary of findings from the clinical trial of bladder training supported by the National Institutes of Health (NIH); a reprint from the Journal of the American Medical Association describing the trial; a vocabulary of UI terms; and the Statement of the NIH Consensus Development Conference on UI in Adults. Patient information materials include a pad of fact sheets on controlling urinary incontinence through bladder training; a brochure on incontinence; and an Age Page about urinary incontinence. The packet also includes request cards to obtain additional copies of the patient education brochure, as well as a copy of the UI treatment guideline available from the Agency for Health Care Policy and Research (AHCPR). The materials are gathered in a folder. The National Guideline Clearinghouse™
The National Guideline Clearinghouse™ offers hundreds of evidence-based clinical practice guidelines published in the United States and other countries. You can search their site located at http://www.guideline.gov by using the keyword “urinary incontinence” or synonyms. The following was recently posted: ·
Prompted voiding for persons with urinary incontinence. Source: University of Iowa Gerontological Nursing Interventions Research Center, Research Dissemination Core.; 1999; 47 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 0950&sSearch_string=urinary+incontinence
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·
The surgical management of female stress urinary incontinence. Source: American Urological Association, Inc..; 1997 June; 72 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 0777&sSearch_string=urinary+incontinence
·
Urinary incontinence. Source: American Medical Directors Association.; 1996 (reviewed January 2001); 16 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 1038&sSearch_string=urinary+incontinence
Healthfinder™ Healthfinder™ is an additional source sponsored by the U.S. Department of Health and Human Services which offers links to hundreds of other sites that contain healthcare information. This Web site is located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database: ·
Age Page - Urinary Incontinence Summary: Incontinence does not happen because of aging. It may be caused by changes in your body due to disease. For example, incontinence may be the first and only symptom of a urinary tract infection. Source: National Institute on Aging, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=808
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Incontinence Can Be Controlled Summary: This consumer health information article discusses how proper treatment and control of urinary incontinence can improve the quality of life for millions of people. Source: Office of Consumer Affairs, U.S. Food and Drug Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=3583
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·
Urinary Incontinence in Children Summary: Although it affects many young people, it usually disappears naturally over time, which suggests that incontinence, for some people, may be a normal part of growing up. Source: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=832
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Urinary Incontinence in Women Summary: Overview of the types of urinary incontinence in women and its diagnosis and treatment. Source: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=6544
The NIH Search Utility After browsing the references listed at the beginning of this chapter, you may want to explore the NIH Search Utility. This allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEBSPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to urinary incontinence. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html.
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Additional Web Sources A number of Web sites that often link to government sites are available to the public. These can also point you in the direction of essential information. The following is a representative sample: ·
AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats
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drkoop.comÒ: http://www.drkoop.com/conditions/ency/index.html
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Family Village: http://www.familyvillage.wisc.edu/specific.htm
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Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/
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Med Help International: http://www.medhelp.org/HealthTopics/A.html
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Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/
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Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/
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WebMDÒHealth: http://my.webmd.com/health_topics
Vocabulary Builder The material in this chapter may have contained a number of unfamiliar words. The following Vocabulary Builder introduces you to terms used in this chapter that have not been covered in the previous chapter: Adrenergic: Activated by, characteristic of, or secreting epinephrine or substances with similar activity; the term is applied to those nerve fibres that liberate norepinephrine at a synapse when a nerve impulse passes, i.e., the sympathetic fibres. [EU] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH]
Anticholinergic: An agent that blocks the parasympathetic nerves. Called also parasympatholytic. [EU] Antidepressant: An agent that stimulates the mood of a depressed patient, including tricyclic antidepressants and monoamine oxidase inhibitors. [EU]
44 Urinary Incontinence
Antispasmodic: An agent that relieves spasm. [EU] Aspartame: Flavoring agent sweeter than sugar, metabolized as phenylalanine and aspartic acid. [NIH] Auditory: Pertaining to the sense of hearing. [EU] Autonomic: Self-controlling; functionally independent. [EU] Bacteriuria: The presence of bacteria in the urine with or without consequent urinary tract infection. Since bacteriuria is a clinical entity, the term does not preclude the use of urine/microbiology for technical discussions on the isolation and segregation of bacteria in the urine. [NIH] Benign: Not malignant; not recurrent; favourable for recovery. [EU] Carcinoma: A malignant new growth made up of epithelial cells tending to infiltrate the surrounding tissues and give rise to metastases. [EU] Cardiovascular: Pertaining to the heart and blood vessels. [EU] Catheter: A tubular, flexible, surgical instrument for withdrawing fluids from (or introducing fluids into) a cavity of the body, especially one for introduction into the bladder through the urethra for the withdraw of urine. [EU]
Catheterization: The employment or passage of a catheter. [EU] Chronic: Persisting over a long period of time. [EU] Collagen: The protein substance of the white fibres (collagenous fibres) of skin, tendon, bone, cartilage, and all other connective tissue; composed of molecules of tropocollagen (q.v.), it is converted into gelatin by boiling. collagenous pertaining to collagen; forming or producing collagen. [EU] Confusion: Disturbed orientation in regard to time, place, or person, sometimes accompanied by disordered consciousness. [EU] Constipation: Infrequent or difficult evacuation of the faeces. [EU] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Criterion: A standard by which something may be judged. [EU] Cystectomy: Used for excision of the urinary bladder. [NIH] Cystoscopy: Direct visual examination of the urinary tract with a cystoscope. [EU] Dementia: An acquired organic mental disorder with loss of intellectual abilities of sufficient severity to interfere with social or occupational functioning. The dysfunction is multifaceted and involves memory, behavior, personality, judgment, attention, spatial relations, language, abstract thought, and other executive functions. The intellectual decline is usually progressive, and initially spares the level of consciousness. [NIH]
Guidelines 45
Dicyclomine: A muscarinic antagonist used as an antispasmodic and in urinary incontinence. It has little effect on glandular secretion or the cardiovascular system. It does have some local anesthetic properties and is used in gastrointestinal, biliary, and urinary tract spasms. [NIH] Empiric: Empirical; depending upon experience or observation alone, without using scientific method or theory. [EU] Endocrinology: A subspecialty of internal medicine concerned with the metabolism, physiology, and disorders of the endocrine system. [NIH] Epidemic: Occurring suddenly in numbers clearly in excess of normal expectancy; said especially of infectious diseases but applied also to any disease, injury, or other health-related event occurring in such outbreaks. [EU] Estrogens: A class of sex hormones associated with the development and maintenance of secondary female sex characteristics and control of the cyclical changes in the reproductive cycle. They are also required for pregnancy maintenance and have an anabolic effect on protein metabolism and water retention. [NIH] Flavoxate: A drug that has been used in various urinary syndromes and as an antispasmodic. Its therapeutic usefulness and its mechanism of action are not clear. It may have local anesthetic activity and direct relaxing effects on smooth muscle as well as some activity as a muscarinic antagonist. [NIH] Fluoroscopy: screen. [NIH]
Production of an image when x-rays strike a fluorescent
Genitourinary: Pertaining to the genital and urinary organs; urogenital; urinosexual. [EU] Glucose: D-glucose, a monosaccharide (hexose), C6H12O6, also known as dextrose (q.v.), found in certain foodstuffs, especially fruits, and in the normal blood of all animals. It is the end product of carbohydrate metabolism and is the chief source of energy for living organisms, its utilization being controlled by insulin. Excess glucose is converted to glycogen and stored in the liver and muscles for use as needed and, beyond that, is converted to fat and stored as adipose tissue. Glucose appears in the urine in diabetes mellitus. [EU] Gynecology: A medical-surgical specialty concerned with the physiology and disorders primarily of the female genital tract, as well as female endocrinology and reproductive physiology. [NIH] Hematology: A subspecialty of internal medicine concerned with morphology, physiology, and pathology of the blood and blood-forming tissues. [NIH] Hematuria: Presence of blood in the urine. [NIH] Hormonal: Pertaining to or of the nature of a hormone. [EU]
46 Urinary Incontinence
Hygienic: Pertaining to hygiene, or conducive to health. [EU] Hyperreflexia: Exaggeration of reflexes. [EU] Hypertrophy: Nutrition) the enlargement or overgrowth of an organ or part due to an increase in size of its constituent cells. [EU] Hypotension: Abnormally low blood pressure; seen in shock but not necessarily indicative of it. [EU] Imipramine: The prototypical tricyclic antidepressant. It has been used in major depression, dysthymia, bipolar depression, attention-deficit disorders, agoraphobia, and panic disorders. It has less sedative effect than some other members of this therapeutic group. [NIH] Incision: 1. cleft, cut, gash. 2. an act or action of incising. [EU] Incontinence: Inability to control excretory functions, as defecation (faecal i.) or urination (urinary i.). [EU] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Intrinsic: Situated entirely within or pertaining exclusively to a part. [EU] Irritants: Drugs that act locally on cutaneous or mucosal surfaces to produce inflammation; those that cause redness due to hyperemia are rubefacients; those that raise blisters are vesicants and those that penetrate sebaceous glands and cause abscesses are pustulants; tear gases and mustard gases are also irritants. [NIH] Lesion: Any pathological or traumatic discontinuity of tissue or loss of function of a part. [EU] Menopause: Cessation of menstruation in the human female, occurring usually around the age of 50. [EU] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Parity: The number of offspring a female has borne. It is contrasted with gravidity, which refers to the number of pregnancies, regardless of outcome. [NIH]
Pathologic: 1. indicative of or caused by a morbid condition. 2. pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Phenylpropanolamine: A sympathomimetic that acts mainly by causing
Guidelines 47
release of norepinephrine but also has direct agonist activity at some adrenergic receptors. It is most commonly used as a nasal vasoconstrictor and an appetite depressant. [NIH] Physiologic: Normal; not pathologic; characteristic of or conforming to the normal functioning or state of the body or a tissue or organ; physiological. [EU]
Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from INCIDENCE, which refers to the number of new cases in the population at a given time. [NIH] Prolapse: 1. the falling down, or sinking, of a part or viscus; procidentia. 2. to undergo such displacement. [EU] Propantheline: A muscarinic antagonist used as an antispasmodic, in rhinitis, in urinary incontinence, and in the treatment of ulcers. At high doses it has nicotinic effects resulting in neuromuscular blocking. [NIH] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Prostatism: A symptom complex resulting from compression or obstruction of the urethra, due most commonly to hyperplasia of the prostate; symptoms include diminution in the calibre and force of the urinary stream, hesitancy in initiating voiding, inability to terminate micturition abruptly (with postvoiding dribbling), a sensation of incomplete bladder emptying, and, occasionally, urinary retention. [EU] Prosthesis: An artificial substitute for a missing body part, such as an arm or leg, eye or tooth, used for functional or cosmetic reasons, or both. [EU] Psychology: The science dealing with the study of mental processes and behavior in man and animals. [NIH] Rectal: Pertaining to the rectum (= distal portion of the large intestine). [EU] Relaxant: 1. lessening or reducing tension. 2. an agent that lessens tension. [EU]
Remission: A diminution or abatement of the symptoms of a disease; also the period during which such diminution occurs. [EU] Reoperation: A repeat operation for the same condition in the same patient. It includes reoperation for reexamination, reoperation for disease progression or recurrence, or reoperation following operative failure. [NIH] Sclerosis: A induration, or hardening; especially hardening of a part from inflammation and in diseases of the interstitial substance. The term is used chiefly for such a hardening of the nervous system due to hyperplasia of the connective tissue or to designate hardening of the blood vessels. [EU]
48 Urinary Incontinence
Serum: The clear portion of any body fluid; the clear fluid moistening serous membranes. 2. blood serum; the clear liquid that separates from blood on clotting. 3. immune serum; blood serum from an immunized animal used for passive immunization; an antiserum; antitoxin, or antivenin. [EU] Somatic: 1. pertaining to or characteristic of the soma or body. 2. pertaining to the body wall in contrast to the viscera. [EU] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Stimulant: 1. producing stimulation; especially producing stimulation by causing tension on muscle fibre through the nervous tissue. 2. an agent or remedy that produces stimulation. [EU] Surgical: Of, pertaining to, or correctable by surgery. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Tricyclic: Containing three fused rings or closed chains in the molecular structure. [EU] Tuberculosis: Any of the infectious diseases of man and other animals caused by species of mycobacterium. [NIH] Urinalysis: Examination of urine by chemical, physical, or microscopic means. Routine urinalysis usually includes performing chemical screening tests, determining specific gravity, observing any unusual color or odor, screening for bacteriuria, and examining the sediment microscopically. [NIH] Urinary: Pertaining to the urine; containing or secreting urine. [EU] Urodynamics: The mechanical laws of fluid dynamics as they apply to urine transport. [NIH] Urology: A surgical specialty concerned with the study, diagnosis, and treatment of diseases of the urinary tract in both sexes and the genital tract in the male. It includes the specialty of andrology which addresses both male genital diseases and male infertility. [NIH]
Seeking Guidance 49
CHAPTER 2. SEEKING GUIDANCE Overview Some patients are comforted by the knowledge that a number of organizations dedicate their resources to helping people with urinary incontinence. These associations can become invaluable sources of information and advice. Many associations offer aftercare support, financial assistance, and other important services. Furthermore, healthcare research has shown that support groups often help people to better cope with their conditions.10 In addition to support groups, your physician can be a valuable source of guidance and support. Therefore, finding a physician that can work with your unique situation is a very important aspect of your care. In this chapter, we direct you to resources that can help you find patient organizations and medical specialists. We begin by describing how to find associations and peer groups that can help you better understand and cope with urinary incontinence. The chapter ends with a discussion on how to find a doctor that is right for you.
Associations and Urinary Incontinence As mentioned by the Agency for Healthcare Research and Quality, sometimes the emotional side of an illness can be as taxing as the physical side.11 You may have fears or feel overwhelmed by your situation. Everyone has different ways of dealing with disease or physical injury. Your attitude, your expectations, and how well you cope with your condition can all Churches, synagogues, and other houses of worship might also have groups that can offer you the social support you need. 11 This section has been adapted from http://www.ahcpr.gov/consumer/diaginf5.htm. 10
50 Urinary Incontinence
influence your well-being. This is true for both minor conditions and serious illnesses. For example, a study on female breast cancer survivors revealed that women who participated in support groups lived longer and experienced better quality of life when compared with women who did not participate. In the support group, women learned coping skills and had the opportunity to share their feelings with other women in the same situation. In addition to associations or groups that your doctor might recommend, we suggest that you consider the following list (if there is a fee for an association, you may want to check with your insurance provider to find out if the cost will be covered): ·
American Foundation for Urologic Disease Address: American Foundation for Urologic Disease 1128 North Charles Street, Baltimore, MD 21201 Telephone: (410) 468-1800 Toll-free: (800) 242-2383 Fax: (410) 468-1808 Email:
[email protected] Web Site: http://www.afud.or Background: The American Foundation for Urologic Disease (AFUD) is a national not-for-profit health organization dedicated to the prevention and cure of urologic diseases through the expansion of medical research and the education of health care professionals and the public. Such urologic diseases include bladder cancer, urinary incontinence, urinary tract disorders, interstitial cystitis, kidney stones, benign prostatic hyperplasia, prostate cancer, prostatitis, and sexual dysfunction. Established in 1987, the Foundation sponsors a Research Scholars Program to encourage physicians to conduct research into urologic diseases, provides appropriate referrals, engages in patient advocacy, and offers networking services. AFUD also offers a variety of educational materials including brochures, pamphlets, and a quarterly magazine entitled 'Family Urology.' In addition, the Foundation has a web site on the Internet at http://www.afud.org. Relevant area(s) of interest: Impotence, Interstitial Cystitis, Kidney Stones, Prostatitis
·
Continence Foundation (UK) Address: Continence Foundation (UK) 307 Hatton Square, 16 Baldwins Gardens, London, EC1N 7RJ, United Kingdom Telephone: 0171 404 6875 Toll-free: (800) 242-2383 Fax: 0171 404 6876
Seeking Guidance 51
Email:
[email protected] Web Site: http://www.vois.org.uk/cf Background: The Continence Foundation is a not-for-profit organization in the United Kingdom dedicated to offering information and support to individuals affected by an inability to control urination (urinary incontinence) or defecation (fecal incontinence). The Foundation is also committed to providing educational publications to health care professionals, engaging in advocacy efforts, and increasing public awareness of bladder and bowel problems that may be associated with incontinence. The Foundation provides a variety of services including offering a telephone helpline for affected individuals and family members, maintaining a web site on the Internet, and providing a range of educational materials for patients and health care professionals including leaflets, booklets, fact sheets, reports, directories, and reading lists. In addition, a support group for affected individuals and their caregivers was established in 1989 in affiliation with the Continence Foundation. Known as 'Incontact,' the group functions as a national charity that works with and for people with bladder and bowel disorders associated with urinary or fecal incontinence. Incontact is dedicated to providing information and support to affected individuals and family members and lobbying for improved patient services. The group also offers a pen pals program, enabling members to exchange mutual support, information, and resources; works to raise awareness to increase public understanding and encourage people with bladder and bowel problems to seek help; and produces a quarterly newsletter. ·
National Association for Continence Address: National Association Spartanburg, SC 29305
for
Continence
P.O.
Box
8310,
Telephone: (864) 579-7900 Fax: (864) 579-7902 TollEmail: None Web Site: http://www.nafc.or Background: National Association for Continence (NAFC), originally known as Help for Incontinent People, is a not-for-profit self-help organization dedicated to improving the quality of life for people with urinary incontinence. Incontinence is a condition in which one loses bladder control. Established in 1982, the organization is a leading source of education, advocacy, and support to the public and to health care professionals regarding the causes, prevention, diagnosis, treatment, and
52 Urinary Incontinence
management alternatives for incontinence. NAFC's purpose is to be the leading source of education, advocacy and support to the public and to the health professional about the causes, prevention, diagnosis, treatments, and management alternatives for incontinence. The NAFC's objectives are to destigmatize incontinence; to provide consumer information; and to provide advocacy and service for those who are affected by this problem. To achieve its objectives, NAFC offers a wide variety of publications and services, such as 'Quality Care,' a quarterly newsletter that provides moral support and practical information to over 100,000 subscribers; 'The Resource Guide - Products and Services for Incontinence,' which assists people in finding the most helpful product for their type of incontinence; pamphlets; audio visuals aids; and books designed to educate the general public and health care professionals.
Finding More Associations There are a number of directories that list additional medical associations that you may find useful. While not all of these directories will provide different information than what is listed above, by consulting all of them, you will have nearly exhausted all sources for patient associations.
The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about urinary incontinence. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797.
DIRLINE A comprehensive source of information on associations is the DIRLINE database maintained by the National Library of Medicine. The database comprises some 10,000 records of organizations, research centers, and government institutes and associations which primarily focus on health and biomedicine. DIRLINE is available via the Internet at the following Web site: http://dirline.nlm.nih.gov/. Simply type in “urinary incontinence” (or a synonym) or the name of a topic, and the site will list information contained in the database on all relevant organizations.
Seeking Guidance 53
The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “urinary incontinence”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” By making these selections and typing in “urinary incontinence” (or synonyms) into the “For these words:” box, you will only receive results on organizations dealing with urinary incontinence. You should check back periodically with this database since it is updated every 3 months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by specific diseases. You can access this database at the following Web site: http://www.rarediseases.org/cgi-bin/nord/searchpage. Select the option called “Organizational Database (ODB)” and type “urinary incontinence” (or a synonym) in the search box.
Online Support Groups In addition to support groups, commercial Internet service providers offer forums and chat rooms for people with different illnesses and conditions. WebMDÒ, for example, offers such a service at their Web site: http://boards.webmd.com/roundtable. These online self-help communities can help you connect with a network of people whose concerns are similar to yours. Online support groups are places where people can talk informally. If you read about a novel approach, consult with your doctor or other healthcare providers, as the treatments or discoveries you hear about may not be scientifically proven to be safe and effective. ·
Depends.com http://www.depend.com/incont_educ_center
·
Tri State Incontinnce Support Group http://tis-group.org/
54 Urinary Incontinence
Finding Doctors One of the most important aspects of your treatment will be the relationship between you and your doctor or specialist. All patients with urinary incontinence must go through the process of selecting a physician. While this process will vary from person to person, the Agency for Healthcare Research and Quality makes a number of suggestions, including the following:12 ·
If you are in a managed care plan, check the plan’s list of doctors first.
·
Ask doctors or other health professionals who work with doctors, such as hospital nurses, for referrals.
·
Call a hospital’s doctor referral service, but keep in mind that these services usually refer you to doctors on staff at that particular hospital. The services do not have information on the quality of care that these doctors provide.
·
Some local medical societies offer lists of member doctors. Again, these lists do not have information on the quality of care that these doctors provide.
Additional steps you can take to locate doctors include the following: ·
Check with the associations listed earlier in this chapter.
·
Information on doctors in some states is available on the Internet at http://www.docboard.org. This Web site is run by “Administrators in Medicine,” a group of state medical board directors.
·
The American Board of Medical Specialties can tell you if your doctor is board certified. “Certified” means that the doctor has completed a training program in a specialty and has passed an exam, or “board,” to assess his or her knowledge, skills, and experience to provide quality patient care in that specialty. Primary care doctors may also be certified as specialists. The AMBS Web site is located at http://www.abms.org/newsearch.asp.13 You can also contact the ABMS by phone at 1-866-ASK-ABMS.
·
You can call the American Medical Association (AMA) at 800-665-2882 for information on training, specialties, and board certification for many licensed doctors in the United States. This information also can be found in “Physician Select” at the AMA’s Web site: http://www.amaassn.org/aps/amahg.htm.
This section is adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm. While board certification is a good measure of a doctor’s knowledge, it is possible to receive quality care from doctors who are not board certified. 12 13
Seeking Guidance 55
Finding a Urologist The American Urological Association (AUA) provides the public with a freeto-use “Find A Urologist” service to help patients find member urologists in their area. The database can be searched by physician name, city, U.S. State, or country and is available via the AUA’s Web site located at http://www.auanet.org/patient_info/find_urologist/index.cfm. According to the AUA: “The American Urological Association is the professional association for urologists. As the premier professional association for the advancement of urologic patient care, the AUA is pleased to provide Find A Urologist, an on-line referral service for patients to use when looking for a urologist. All of our active members are certified by the American Board of Urology, which is an important distinction of the urologist’s commitment to continuing education and superior patient care.”14 If the previous sources did not meet your needs, you may want to log on to the Web site of the National Organization for Rare Disorders (NORD) at http://www.rarediseases.org/. NORD maintains a database of doctors with expertise in various rare diseases. The Metabolic Information Network (MIN), 800-945-2188, also maintains a database of physicians with expertise in various metabolic diseases.
Selecting Your Doctor15 When you have compiled a list of prospective doctors, call each of their offices. First, ask if the doctor accepts your health insurance plan and if he or she is taking new patients. If the doctor is not covered by your plan, ask yourself if you are prepared to pay the extra costs. The next step is to schedule a visit with your chosen physician. During the first visit you will have the opportunity to evaluate your doctor and to find out if you feel comfortable with him or her. Ask yourself, did the doctor: ·
Give me a chance to ask questions about urinary incontinence?
·
Really listen to my questions?
·
Answer in terms I understood?
·
Show respect for me?
·
Ask me questions?
Quotation taken from the AACE’s Web site: http://www.aace.com/memsearch.php. section has been adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm. 14
15 This
56 Urinary Incontinence
·
Make me feel comfortable?
·
Address the health problem(s) I came with?
·
Ask me my preferences about different kinds of treatments for urinary incontinence?
·
Spend enough time with me?
Trust your instincts when deciding if the doctor is right for you. But remember, it might take time for the relationship to develop. It takes more than one visit for you and your doctor to get to know each other.
Working with Your Doctor16 Research has shown that patients who have good relationships with their doctors tend to be more satisfied with their care and have better results. Here are some tips to help you and your doctor become partners: ·
You know important things about your symptoms and your health history. Tell your doctor what you think he or she needs to know.
·
It is important to tell your doctor personal information, even if it makes you feel embarrassed or uncomfortable.
·
Bring a “health history” list with you (and keep it up to date).
·
Always bring any medications you are currently taking with you to the appointment, or you can bring a list of your medications including dosage and frequency information. Talk about any allergies or reactions you have had to your medications.
·
Tell your doctor about any natural or alternative medicines you are taking.
·
Bring other medical information, such as x-ray films, test results, and medical records.
·
Ask questions. If you don’t, your doctor will assume that you understood everything that was said.
·
Write down your questions before your visit. List the most important ones first to make sure that they are addressed.
This section has been adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm.
16
Seeking Guidance 57
·
Consider bringing a friend with you to the appointment to help you ask questions. This person can also help you understand and/or remember the answers.
·
Ask your doctor to draw pictures if you think that this would help you understand.
·
Take notes. Some doctors do not mind if you bring a tape recorder to help you remember things, but always ask first.
·
Let your doctor know if you need more time. If there is not time that day, perhaps you can speak to a nurse or physician assistant on staff or schedule a telephone appointment.
·
Take information home. Ask for written instructions. Your doctor may also have brochures and audio and videotapes that can help you.
·
After leaving the doctor’s office, take responsibility for your care. If you have questions, call. If your symptoms get worse or if you have problems with your medication, call. If you had tests and do not hear from your doctor, call for your test results. If your doctor recommended that you have certain tests, schedule an appointment to get them done. If your doctor said you should see an additional specialist, make an appointment.
By following these steps, you will enhance the relationship you will have with your physician.
Broader Health-Related Resources In addition to the references above, the NIH has set up guidance Web sites that can help patients find healthcare professionals. These include:17 ·
Caregivers: http://www.nlm.nih.gov/medlineplus/caregivers.html
·
Choosing a Doctor or Healthcare Service: http://www.nlm.nih.gov/medlineplus/choosingadoctororhealthcareserv ice.html
·
Hospitals and Health Facilities: http://www.nlm.nih.gov/medlineplus/healthfacilities.html
You can access this information at: http://www.nlm.nih.gov/medlineplus/healthsystem.html.
17
58 Urinary Incontinence
Vocabulary Builder The following vocabulary builder provides definitions of words used in this chapter that have not been defined in previous chapters: Cystitis: Inflammation of the urinary bladder. [EU] Defecation: The normal process of elimination of fecal material from the rectum. [NIH] Hyperplasia: The abnormal multiplication or increase in the number of normal cells in normal arrangement in a tissue. [EU] Impotence: The inability to perform sexual intercourse. [NIH] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU]
Clinical Trials 59
CHAPTER 3. INCONTINENCE
CLINICAL
TRIALS
AND
URINARY
Overview Very few medical conditions have a single treatment. The basic treatment guidelines that your physician has discussed with you, or those that you have found using the techniques discussed in Chapter 1, may provide you with all that you will require. For some patients, current treatments can be enhanced with new or innovative techniques currently under investigation. In this chapter, we will describe how clinical trials work and show you how to keep informed of trials concerning urinary incontinence.
What Is a Clinical Trial?18 Clinical trials involve the participation of people in medical research. Most medical research begins with studies in test tubes and on animals. Treatments that show promise in these early studies may then be tried with people. The only sure way to find out whether a new treatment is safe, effective, and better than other treatments for urinary incontinence is to try it on patients in a clinical trial.
The discussion in this chapter has been adapted from the NIH and the NEI: www.nei.nih.gov/netrials/ctivr.htm.
18
60 Urinary Incontinence
What Kinds of Clinical Trials Are There? Clinical trials are carried out in three phases: ·
Phase I. Researchers first conduct Phase I trials with small numbers of patients and healthy volunteers. If the new treatment is a medication, researchers also try to determine how much of it can be given safely.
·
Phase II. Researchers conduct Phase II trials in small numbers of patients to find out the effect of a new treatment on urinary incontinence.
·
Phase III. Finally, researchers conduct Phase III trials to find out how new treatments for urinary incontinence compare with standard treatments already being used. Phase III trials also help to determine if new treatments have any side effects. These trials--which may involve hundreds, perhaps thousands, of people--can also compare new treatments with no treatment. How Is a Clinical Trial Conducted?
Various organizations support clinical trials at medical centers, hospitals, universities, and doctors’ offices across the United States. The “principal investigator” is the researcher in charge of the study at each facility participating in the clinical trial. Most clinical trial researchers are medical doctors, academic researchers, and specialists. The “clinic coordinator” knows all about how the study works and makes all the arrangements for your visits. All doctors and researchers who take part in the study on urinary incontinence carefully follow a detailed treatment plan called a protocol. This plan fully explains how the doctors will treat you in the study. The “protocol” ensures that all patients are treated in the same way, no matter where they receive care. Clinical trials are controlled. This means that researchers compare the effects of the new treatment with those of the standard treatment. In some cases, when no standard treatment exists, the new treatment is compared with no treatment. Patients who receive the new treatment are in the treatment group. Patients who receive a standard treatment or no treatment are in the “control” group. In some clinical trials, patients in the treatment group get a new medication while those in the control group get a placebo. A placebo is a harmless substance, a “dummy” pill, that has no effect on urinary incontinence. In other clinical trials, where a new surgery or device (not a medicine) is being tested, patients in the control group may receive a “sham
Clinical Trials 61
treatment.” This treatment, like a placebo, has no effect on urinary incontinence and does not harm patients. Researchers assign patients “randomly” to the treatment or control group. This is like flipping a coin to decide which patients are in each group. If you choose to participate in a clinical trial, you will not know which group you will be appointed to. The chance of any patient getting the new treatment is about 50 percent. You cannot request to receive the new treatment instead of the placebo or sham treatment. Often, you will not know until the study is over whether you have been in the treatment group or the control group. This is called a “masked” study. In some trials, neither doctors nor patients know who is getting which treatment. This is called a “double masked” study. These types of trials help to ensure that the perceptions of the patients or doctors will not affect the study results. Natural History Studies Unlike clinical trials in which patient volunteers may receive new treatments, natural history studies provide important information to researchers on how urinary incontinence develops over time. A natural history study follows patient volunteers to see how factors such as age, sex, race, or family history might make some people more or less at risk for urinary incontinence. A natural history study may also tell researchers if diet, lifestyle, or occupation affects how a disease or disorder develops and progresses. Results from these studies provide information that helps answer questions such as: How fast will a disease or disorder usually progress? How bad will the condition become? Will treatment be needed? What Is Expected of Patients in a Clinical Trial? Not everyone can take part in a clinical trial for a specific disease or disorder. Each study enrolls patients with certain features or eligibility criteria. These criteria may include the type and stage of disease or disorder, as well as, the age and previous treatment history of the patient. You or your doctor can contact the sponsoring organization to find out more about specific clinical trials and their eligibility criteria. If you are interested in joining a clinical trial, your doctor must contact one of the trial’s investigators and provide details about your diagnosis and medical history. If you participate in a clinical trial, you may be required to have a number of medical tests. You may also need to take medications and/or undergo
62 Urinary Incontinence
surgery. Depending upon the treatment and the examination procedure, you may be required to receive inpatient hospital care. Or, you may have to return to the medical facility for follow-up examinations. These exams help find out how well the treatment is working. Follow-up studies can take months or years. However, the success of the clinical trial often depends on learning what happens to patients over a long period of time. Only patients who continue to return for follow-up examinations can provide this important long-term information.
Recent Trials on Urinary Incontinence The National Institutes of Health and other organizations sponsor trials on various diseases and disorders. Because funding for research goes to the medical areas that show promising research opportunities, it is not possible for the NIH or others to sponsor clinical trials for every disease and disorder at all times. The following lists recent trials dedicated to urinary incontinence.19 If the trial listed by the NIH is still recruiting, you may be eligible. If it is no longer recruiting or has been completed, then you can contact the sponsors to learn more about the study and, if published, the results. Further information on the trial is available at the Web site indicated. Please note that some trials may no longer be recruiting patients or are otherwise closed. Before contacting sponsors of a clinical trial, consult with your physician who can help you determine if you might benefit from participation. ·
A Casefinding and Referral System for Older Veterans within Primary Care Condition(s): Depression; Urinary Incontinence; Geriatrics Study Status: This study is currently recruiting patients. Sponsor(s): Department of Veterans Affairs; Department of Veterans Affairs Health Services Research and Development Service Purpose - Excerpt: Underdiagnosis and undertreatment of elderly persons remains a widespread problem. While many innovative geriatric care programs exist within VHA, we still lack a systematic process for identifying at-risk elders from the larger VA population who are likely to benefit from specialized geriatric services. Our goal is to improve care for at-risk older veterans through a comprehensive system of casefinding, assessment, referral and follow-up within the primary care setting. We hypothesize that subjects receiving this intervention will have more complete evaluation and treatment for selected geriatric conditions (i.e.,
19
These are listed at www.ClinicalTrials.gov.
Clinical Trials 63
falls, urinary incontinence, functional status impairments, depression, and cognitive deficits), better continuity of care, less decline in functional status, and better general health than subjects receiving usual care. This randomized controlled trial is being performed at the Sepulveda VA Outpatient Clinic. The study sample is composed of community-dwelling veterans aged 65 and older who are not receiving VA geriatric services. Veterans are mailed a health screening survey to identify those at risk for decline based on criteria established in pilot work. At-risk respondents who are in the intervention group receive a structured telephone assessment (casefinding) and referral to appropriate geriatric services, including a geriatric assessment and teaching clinic integrated with primary care, and telephone case management. Subjects in the control group receive usual care. Major outcome measures collected by telephone interview at baseline, 12, 24, and 36 months include functional status, self-rated health, satisfaction, and health care utilization. Medical records are reviewed for evidence of evaluation and treatment of the target conditions. Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00012740
Benefits and Risks20 What Are the Benefits of Participating in a Clinical Trial? If you are interested in a clinical trial, it is important to realize that your participation can bring many benefits to you and society at large: ·
A new treatment could be more effective than the current treatment for urinary incontinence. Although only half of the participants in a clinical trial receive the experimental treatment, if the new treatment is proved to be more effective and safer than the current treatment, then those patients who did not receive the new treatment during the clinical trial may be among the first to benefit from it when the study is over.
·
If the treatment is effective, then it may improve health or prevent diseases or disorders.
This section has been adapted from ClinicalTrials.gov, a service of the National Institutes of Health: http://www.clinicaltrials.gov/ct/gui/c/a1r/info/whatis?JServSessionIdzone_ct=9jmun6f291. 20
64 Urinary Incontinence
·
Clinical trial patients receive the highest quality of medical care. Experts watch them closely during the study and may continue to follow them after the study is over.
·
People who take part in trials contribute to scientific discoveries that may help other people with urinary incontinence. In cases where certain diseases or disorders run in families, your participation may lead to better care or prevention for your family members. The Informed Consent
Once you agree to take part in a clinical trial, you will be asked to sign an “informed consent.” This document explains a clinical trial’s risks and benefits, the researcher’s expectations of you, and your rights as a patient. What Are the Risks? Clinical trials may involve risks as well as benefits. Whether or not a new treatment will work cannot be known ahead of time. There is always a chance that a new treatment may not work better than a standard treatment. There is also the possibility that it may be harmful. The treatment you receive may cause side effects that are serious enough to require medical attention. How Is Patient Safety Protected? Clinical trials can raise fears of the unknown. Understanding the safeguards that protect patients can ease some of these fears. Before a clinical trial begins, researchers must get approval from their hospital’s Institutional Review Board (IRB), an advisory group that makes sure a clinical trial is designed to protect patient safety. During a clinical trial, doctors will closely watch you to see if the treatment is working and if you are experiencing any side effects. All the results are carefully recorded and reviewed. In many cases, experts from the Data and Safety Monitoring Committee carefully monitor each clinical trial and can recommend that a study be stopped at any time. You will only be asked to take part in a clinical trial as a volunteer giving informed consent.
Clinical Trials 65
What Are a Patient’s Rights in a Clinical Trial? If you are eligible for a clinical trial, you will be given information to help you decide whether or not you want to participate. As a patient, you have the right to: ·
Information on all known risks and benefits of the treatments in the study.
·
Know how the researchers plan to carry out the study, for how long, and where.
·
Know what is expected of you.
·
Know any costs involved for you or your insurance provider.
·
Know before any of your medical or personal information is shared with other researchers involved in the clinical trial.
·
Talk openly with doctors and ask any questions.
After you join a clinical trial, you have the right to: ·
Leave the study at any time. Participation is strictly voluntary. However, you should not enroll if you do not plan to complete the study.
·
Receive any new information about the new treatment.
·
Continue to ask questions and get answers.
·
Maintain your privacy. Your name will not appear in any reports based on the study.
·
Know whether you participated in the treatment group or the control group (once the study has been completed).
What about Costs? In some clinical trials, the research facility pays for treatment costs and other associated expenses. You or your insurance provider may have to pay for costs that are considered standard care. These things may include inpatient hospital care, laboratory and other tests, and medical procedures. You also may need to pay for travel between your home and the clinic. You should find out about costs before committing to participation in the trial. If you have health insurance, find out exactly what it will cover. If you don’t have health insurance, or if your insurance company will not cover your costs, talk to the clinic staff about other options for covering the cost of your care.
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What Should You Ask before Deciding to Join a Clinical Trial? Questions you should ask when thinking about joining a clinical trial include the following: ·
What is the purpose of the clinical trial?
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What are the standard treatments for urinary incontinence? Why do researchers think the new treatment may be better? What is likely to happen to me with or without the new treatment?
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What tests and treatments will I need? Will I need surgery? Medication? Hospitalization?
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How long will the treatment last? How often will I have to come back for follow-up exams?
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What are the treatment’s possible benefits to my condition? What are the short- and long-term risks? What are the possible side effects?
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Will the treatment be uncomfortable? Will it make me feel sick? If so, for how long?
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How will my health be monitored?
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Where will I need to go for the clinical trial? How will I get there?
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How much will it cost to be in the study? What costs are covered by the study? How much will my health insurance cover?
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Will I be able to see my own doctor? Who will be in charge of my care?
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Will taking part in the study affect my daily life? Do I have time to participate?
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How do I feel about taking part in a clinical trial? Are there family members or friends who may benefit from my contributions to new medical knowledge?
Keeping Current on Clinical Trials Various government agencies maintain databases on trials. The U.S. National Institutes of Health, through the National Library of Medicine, has developed ClinicalTrials.gov to provide patients, family members, and physicians with current information about clinical research across the broadest number of diseases and conditions. The site was launched in February 2000 and currently contains approximately 5,700 clinical studies in over 59,000 locations worldwide, with
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most studies being conducted in the United States. ClinicalTrials.gov receives about 2 million hits per month and hosts approximately 5,400 visitors daily. To access this database, simply go to their Web site (www.clinicaltrials.gov) and search by “urinary incontinence” (or synonyms). While ClinicalTrials.gov is the most comprehensive listing of NIH-supported clinical trials available, not all trials are in the database. The database is updated regularly, so clinical trials are continually being added. The following is a list of specialty databases affiliated with the National Institutes of Health that offer additional information on trials: ·
For clinical studies at the Warren Grant Magnuson Clinical Center located in Bethesda, Maryland, visit their Web site: http://clinicalstudies.info.nih.gov/
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For clinical studies conducted at the Bayview Campus in Baltimore, Maryland, visit their Web site: http://www.jhbmc.jhu.edu/studies/index.html
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For trials on diseases of the digestive system and kidneys, and diabetes, visit the National Institute of Diabetes and Digestive and Kidney Diseases: http://www.niddk.nih.gov/patient/patient.htm
General References The following references describe clinical trials and experimental medical research. They have been selected to ensure that they are likely to be available from your local or online bookseller or university medical library. These references are usually written for healthcare professionals, so you may consider consulting with a librarian or bookseller who might recommend a particular reference. The following includes some of the most readily available references (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): ·
A Guide to Patient Recruitment : Today’s Best Practices & Proven Strategies by Diana L. Anderson; Paperback - 350 pages (2001), CenterWatch, Inc.; ISBN: 1930624115; http://www.amazon.com/exec/obidos/ASIN/1930624115/icongroupinterna
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A Step-By-Step Guide to Clinical Trials by Marilyn Mulay, R.N., M.S., OCN; Spiral-bound - 143 pages Spiral edition (2001), Jones & Bartlett Pub; ISBN: 0763715697; http://www.amazon.com/exec/obidos/ASIN/0763715697/icongroupinterna
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The CenterWatch Directory of Drugs in Clinical Trials by CenterWatch; Paperback - 656 pages (2000), CenterWatch, Inc.; ISBN: 0967302935; http://www.amazon.com/exec/obidos/ASIN/0967302935/icongroupinterna
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The Complete Guide to Informed Consent in Clinical Trials by Terry Hartnett (Editor); Paperback - 164 pages (2000), PharmSource Information Services, Inc.; ISBN: 0970153309; http://www.amazon.com/exec/obidos/ASIN/0970153309/icongroupinterna
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Dictionary for Clinical Trials by Simon Day; Paperback - 228 pages (1999), John Wiley & Sons; ISBN: 0471985961; http://www.amazon.com/exec/obidos/ASIN/0471985961/icongroupinterna
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Extending Medicare Reimbursement in Clinical Trials by Institute of Medicine Staff (Editor), et al; Paperback 1st edition (2000), National Academy Press; ISBN: 0309068886; http://www.amazon.com/exec/obidos/ASIN/0309068886/icongroupinterna
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Handbook of Clinical Trials by Marcus Flather (Editor); Paperback (2001), Remedica Pub Ltd; ISBN: 1901346293; http://www.amazon.com/exec/obidos/ASIN/1901346293/icongroupinterna
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PART II: ADDITIONAL RESOURCES AND ADVANCED MATERIAL
ABOUT PART II In Part II, we introduce you to additional resources and advanced research on urinary incontinence. All too often, patients who conduct their own research are overwhelmed by the difficulty in finding and organizing information. The purpose of the following chapters is to provide you an organized and structured format to help you find additional information resources on urinary incontinence. In Part II, as in Part I, our objective is not to interpret the latest advances on urinary incontinence or render an opinion. Rather, our goal is to give you access to original research and to increase your awareness of sources you may not have already considered. In this way, you will come across the advanced materials often referred to in pamphlets, books, or other general works. Once again, some of this material is technical in nature, so consultation with a professional familiar with urinary incontinence is suggested.
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CHAPTER 4. STUDIES ON URINARY INCONTINENCE Overview Every year, academic studies are published on urinary incontinence or related conditions. Broadly speaking, there are two types of studies. The first are peer reviewed. Generally, the content of these studies has been reviewed by scientists or physicians. Peer-reviewed studies are typically published in scientific journals and are usually available at medical libraries. The second type of studies is non-peer reviewed. These works include summary articles that do not use or report scientific results. These often appear in the popular press, newsletters, or similar periodicals. In this chapter, we will show you how to locate peer-reviewed references and studies on urinary incontinence. We will begin by discussing research that has been summarized and is free to view by the public via the Internet. We then show you how to generate a bibliography on urinary incontinence and teach you how to keep current on new studies as they are published or undertaken by the scientific community.
The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and urinary incontinence, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the
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format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type in “urinary incontinence” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is a sample of what you can expect from this type of search: ·
Urinary Incontinence and Dementia: The Perils of Guilt by Association Source: Journal of the American Geriatrics Society. 43(3): 310-311. March 1995. Summary: This paper discusses the flaws in an argument that dementia causes incontinence. Research suggests that overactivity of the muscles of the bladder wall was the most common type of lower urinary tract dysfunction in nursing home residents regardless of cognitive function. Realization that the etiology of incontinence in people with dementia is multifactorial and often complex is changing the approach to incontinence in the nursing home. According to the authors, the prevalence, morbidity, and cost of incontinence demand that certain questions be addressed thoughtfully and expediently; these questions are listed. 13 references.
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Urinary Incontinence Associated With Dementia Source: Journal of the American Geriatrics Society. 43(3): 286-294. March 1995. Summary: This paper critically reviews the literature on urinary incontinence associated with Alzheimer's disease and vascular (multiinfarct) dementia, with particular reference to its prevalence, etiology, assessment, and management. Urinary incontinence is common in patients with dementia and is more prevalent in people with dementia than in older people without dementia. It occurs with equal or greater frequency in males than in females. Research on the management of urinary incontinence in patients with dementia has focused almost exclusively on toileting programs and drug treatments for detrusor hyperactivity. To date, anticholinergic and antispasmodic medications have not been shown to be effective in treating incontinence in people with dementia. Few studies have been undertaken involving patients who are severely mentally and physically deteriorating, and these medications may have greater efficacy in less impaired people. Prompted voiding regimens have been shown to reduce incontinence by an average of 32 percent and appear to be a useful approach in managing
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incontinence in some of these patients. However, according to the authors, unless staff management systems are used, staff compliance with these programs diminishes with time and the labor costs involved may limit their applicability in nursing homes. Patients who are the most severely cognitively impaired, least mobile, and have the greatest frequency of incontinence derive the least benefit from toileting programs, and palliative measures may be more appropriate in these cases. 2 tables, 96 references. ·
Effects of Patterned Urge-Response Toileting (PURT) on Urinary Incontinence Among Nursing Home Residents Source: Journal of the American Geriatrics Society. 40(2): 135-141. February 1992. Summary: This journal article describes a 37-week study designed to test, over time, an individualized form of habit training for urinary incontinence (UI) among long stay cognitively and/or physically impaired elderly residents of four nonprofit nursing homes. The study involved 113 elderly persons, randomized by nursing home unit into experimental and control groups. Eighty-eight persons completed the study. All were physically and/or mentally impaired, averaged age 85, and had either urge or urge/stress urinary incontinence. Baseline wet checks were done hourly for one 24-hour period at 3-week intervals over 12 weeks followed by 72 hours of continuous electronic monitoring to establish precise voiding patterns for each individual. The 12-week intervention period was administered by regular staff after they attended a 4-hour urinary incontinence educational program. The residents were followed an additional 12 weeks to determine the extent of maintenance of the intervention among staff and study patients. Urinary incontinence was significantly decreased during the 3-month period in the experimental group. Eighty-six percent showed improvement over baseline while one third improved 25 percent or more over their baseline rate. During the same period of time, the control group's urinary incontinence increased. The authors conclude that the training program was effective in reducing urinary incontinence, although compliance among nursing staff averaged only 70 percent of the prescribed toileting times. They note that this individualized approach supports the recent regulatory thrust to individualize care to promote and maintain functional abilities and autonomy. 26 references. (AA-M).
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Copy Task Performance and Urinary Incontinence in Alzheimer's Disease Source: Journal of the American Geriatrics Society. 39(5): 467-471. May 1991. Summary: The relationship between behavioral symptoms and cognitive impairment in Alzheimer's disease is only poorly understood. The aim of this study was to examine cognitive correlates of urinary incontinence in Alzheimer's disease. Although incontinence is generally accepted as an accompaniment of Alzheimer's disease, it is the authors' clinical impression that it correlated poorly with global measures of cognitive impairment. A retrospective pilot study of 17 incontinent demented patients and 17 continent patients, matched for age, sex, and total score on the Folstein Mini-Mental Status Exam (MMSE), revealed a striking association between an inability to do a copy task and urinary incontinence. A prospective study confirmed this finding in a sample of 45 patients meeting DSMIII-R diagnostic criteria for dementia, probably Alzheimer's disease. The 17 incontinent patients did not differ from the 28 continent patients in age, sex distribution, or total score on the MMSE. However, the incontinent subjects scored significantly lower on a cube copying task. Qualitative analysis revealed that the drawings by incontinent patients showed features comparable with those observed in the drawings by patients with right-sided parietal lesions, in particular, poor representation of perspective and spatial orientation. Further investigation of the relationship between copying performance and incontinence may have implications for understanding the cortical mechanisms of urinary incontinence. The present results also underscore the limitations of the MMSE as a measure of dementia severity and suggest there are areas of cognitive ability which are inadequately assessed by MMSE but which may be of major importance in understanding the loss of functional skills in the patient with dementia. 18 references. (AA).
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Urinary Incontinence in Nursing Home Residents With Dementia: The Mobility-Cognition Paradigm Source: Applied Nursing Research. 3(3): 112-117. August 1990. Summary: This journal article describes a study that evaluated various patient factors associated with urinary incontinence in nursing homes. The goal of the study was to identify the importance of these factors in predicting urinary incontinence in patients with cognitive impairment. The sample consisted of 61 elderly residents of a rural skilled nursing facility who had some type of chronic degenerative brain disease. Of the 61 patients, 29 were incontinent and 32 were continent. The residents'
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cognitive ability and patient mobility were measured using direct interviews, a mental status questionnaire, a visual counting test, and the set test. The cognitive ability and mobility differed significantly between the incontinent and continent patients. Mobility was determined to be the best predictor of a patient's urine control, with cognitive impairment being the next best predictor. The authors assert that these findings demonstrate the importance of examining patient mobility issues when dealing with urinary incontinence in nursing home residents. 21 references. ·
Managing Urinary Incontinence in Persons With Alzheimer's Disease Source: American Journal of Alzheimer's Care and Related Disorders and Research. 2(5): 13-19. September-October 1987. Contact: Available from Prime National Publishing Corp. 470 Boston Post Road, Weston, MA 02193. (617) 899-2702. PRICE: Single issue $8.00. Call for information. Summary: This article offers advice on the management of incontinence in patients with Alzheimer's disease. It reviews the effects of normal aging on urinary continence, the causes of urinary incontinence in the elderly, and the differences in appropriate management of incontinence in normal aging and in Alzheimer's disease. Practical advice is given for each stage of Alzheimer's, from clothing modification for easy removal, to fluid intake monitoring, to clean intermittent catheterization. The article also considers the implications for future research.
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Keeping Dry: Help for Urinary Incontinence Source: Diabetes Self-Management. 13(1): 46-50, 52. January-February 1996. Contact: Available from R.A. Rapaport Publishing, Inc. 150 West 22nd Street, New York, NY 10011. (800) 234-0923. Summary: This article updates readers on treatment options for female urinary incontinence. Topics include the incidence of urinary incontinence in women with diabetes; the types of incontinence and the symptoms of each; the causes of incontinence; diagnosis of a urinary incontinence problem; and treatment options, including Kegel exercises, bladder neck support prostheses, clean intermittent catheterization, and surgery. The article includes the addresses for two organizations through which readers can obtain more information. 3 references.
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Urinary Incontinence Source: Diabetes Forecast. 43(1): 39-41. January 1990.
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Summary: This article discusses the causes, symptoms, and treatments of urinary incontinence, with a special emphasis on incontinence related to diabetes mellitus. The author notes that identifying risk factors is essential for prevention and treatment of urinary incontinence. Diabetes, in addition to altering glucose levels, can lead to frequent infections, restricted mobility, and constipation. These, as well as certain medications, can play a part in bringing on repeated occurrences of urinary incontinence. The author stresses that urinary incontinence is a symptom, not a disease, that appears in a limited number of illnesses, each having several possible causes. It is often preventable and usually treatable, especially if detected early. The author concludes by encouraging people with diabetes to participate actively with an appropriate health care provider in developing a plan that prevents urinary incontinence from occurring or that corrects the condition when it already exists. ·
Male Sling for Stress Urinary Incontinence: A Prospective Study Source: Journal of Urology. 167(2 Part 1): 597-601. February 2002. Contact: Available from Lippincott Williams and Wilkins. 12107 Insurance Way, Hagerstown, MD 21740. (800) 638-3030 or (301) 714-2334. Fax (301) 824-7290. Summary: This article reports on a prospective study of the male sling surgical technique used for treating stress urinary incontinence (SUI). A total of 21 men underwent sling surgery. There were 2 titanium screws loaded with polypropylene suture placed in each descending pubic ramus through a 3.5 centimeter perineal incision at the level of the bulbar urethra. A polypropylene mesh was placed over the urethra and tied to the bone anchors, adjusting sling tension to a compression of 60 centimeters water. Followup was done with the incontinence section of the University of California, Los Angeles RAND Prostate Cancer Index. Mean followup was 12 months (range 5 to 21 months). Overall, incontinence was cured in 16 patients (76 percent), substantially improved (SUI very small or small problem, 1 pad daily) in 3 patients (14 percent), somewhat improved in 1 patient (5 percent), and no improvement in 1 patient (5 percent). The patients with SUI after undergoing transurethral prostatectomy (TURP) were cured, as was the individual with myelomeningocele. Of the 18 patients with SUI after radical prostatectomy, 13 were cured, including 1 of 2 who underwent previous artificial urinary sphincter placement and 2 of adjuvant radiation. There was significant improvement in each survey question, and the total score improved. The author concludes that this minimally invasive sling surgery has not been associated with any significant
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complication, and early results compare favorably with artificial urinary sphincter. Prior radiation or artificial urinary sphincter does not appear to be a contraindication to sling surgery. An editorial comment is appended to the article. 4 figures. 30 references. ·
Urinary Incontinence in Nursing Homes Source: Journal of WOCN. Journal of Wound, Ostomy and Continence Nurses. 29(1): 4-5. January 2002. Contact: Mosby, Inc. Periodicals Department, 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452. Summary: Nurses profess belief in behavioral interventions in nursing homes, but despite the evidence of their effectiveness that has accumulated over the years, it appears that little continence restoration or incontinence prevention occurs in nursing homes. In this editorial, the author considers regulatory tag 315 (urinary incontinence: catheterization) and regulatory tag 316 (urinary incontinence: prevent infection). The author reports on a panel of clinicians, researchers, and surveyors that was assembled in May 2001 to assist in an ongoing process to develop severity levels for deficiency behaviors under these regulatory tags. With use of specific protocols, a 4 level severity scale was developed. Revised interpretative guidance for surveyors was also developed. The guidance includes terminology, definitions, types of incontinence, and standard assessment techniques. During a facility's survey, surveyors will be looking for assurances that a facility uses an indwelling catheter for only medically valid reasons; the catheter is removed as soon as clinically warranted; efforts are applied to restore or improve bladder function as much as possible; and while the catheter is inserted efforts are made to prevent infection. Nursing behavior, then, will be shaped by these changes in the regulatory survey process. The author encourages nurses to also consider some of the issues regarding incontinence care in nursing homes, including strategies to increase the use of prompted voiding techniques rather than absorbent products to manage incontinence. 7 references.
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National Coverage Decision for Reimbursement for Biofeedback and Pelvic Floor Electrical Stimulation for Treatment of Urinary Incontinence Source: Journal of WOCN. Journal of Wound, Ostomy and Continence Nurses. 29(1): 11-19. January 2002. Contact: Mosby, Inc. Periodicals Department, 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452.
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Summary: On October 6, 2000, the Centers for Medicare and Medicaid Services (CMS, formerly the Health Care Financing Administration or HCFA) issued a national coverage decision for the use of biofeedback and pelvic floor electrical stimulation in the treatment of urinary incontinence (involuntary loss of urine). This decision was the first major health care coverage decision made using CMS's new 'open' process. The new process included the use of a panel of physicians to evaluate adequacy of evidence to support the utilization of the modalities. This article discusses this national coverage decision. From the very beginning, there were indications that CMS was not favorably disposed toward the use of these modalities, and there was a real threat that coverage could be withdrawn or that no decision would be made. The organized and cohesive response of the health care community influenced CMS to make a positive coverage decision; CMS announced its decision to support reimbursement for biofeedback and pelvic floor electrical stimulation therapy. The author concludes that through the diligent and tenacious work of a group of nurses called the SUNA WOCN Continent Coalition, professional organizations and prominent individuals were brought together to approach CMS with one message and one voice. 4 tables. 18 references.
Federally-Funded Research on Urinary Incontinence The U.S. Government supports a variety of research studies relating to urinary incontinence and associated conditions. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.21 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally-funded biomedical research projects conducted at universities, hospitals, and other institutions. Visit the CRISP Web site at http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket. You can perform targeted searches by various criteria including geography, date, as well as topics related to urinary incontinence and related conditions. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally-funded studies use animals or simulated models to explore Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).
21
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urinary incontinence and related conditions. In some cases, therefore, it may be difficult to understand how some basic or fundamental research could eventually translate into medical practice. The following sample is typical of the type of information found when searching the CRISP database for urinary incontinence: ·
Project Title: Advanced Device to Treat Female Urinary Incontinence Principal Investigator & Institution: Kotzar, Geoffrey M.; Research Scientist; Biomec, Inc. 1771 E 30Th St Cleveland, Oh 44114 Timing: Fiscal Year 2000; Project Start 5-SEP-2000; Project End 0-JUN2001 Summary: Stress urinary incontinence afflicts 20% of women. The lifetime risk of undergoing a single surgery for either prolapse or incontinence by age 80 is reported to be greater than 11%. For many women, however, surgery is not a viable option. The use of vaginal inserts, known as pessaries, to help control incontinence is an effective option, relieving the symptoms in 80% of users. These devices are not without drawbacks. For many women, the devices are uncomfortable or difficult to deal with resulting in as many as 50% of the users abandoning the devices within the first year of use. We are proposing to examine the use of some advanced materials to improve the interface and vaginal canal filling properties of these devices. The use of these new materials will improve the fit to the female anatomy and ease insertion of the devices. The goodness of fit of the devices will be assessed qualitatively by a series of cadaveric experiments using MR and CT images and qualitatively by two skilled clinicians. The quantitative and qualitative scores will be correlated and those designs which meet our standards will be used in Phase II to determine their clinical efficacy. PROPOSED COMMERCIAL APPLICATIONS: In the United States, over $16 billion are spent annually on incontinence related care. An additional $1.1 billion are spent on disposable absorbent products. If the consequences due to incontinence are included, the total annual expenditures related to urinary incontinence approached $28 billion in the United States alone. The market for intra- vaginal devices is expected to exceed $320 million dollars by the end of 2001. We project that the market share for the new devices we develop will fall within the 2-5% range or $6.4 to $16 million dollars annually. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
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Project Title: Biofeedback and Urinary Incontinence in Older Women Principal Investigator & Institution: Dugan, Elizabeth; ; Tanglewood Research, Inc. 7017 Albert Pick Rd, Ste D Greensboro, Nc 27409
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Timing: Fiscal Year 2000; Project Start 1-JUL-2000; Project End 1-DEC2001 Summary: The broad, long-term aims of our research team are to determine the effectiveness of behavioral and pharmacological interventions in the treatment of urinary incontinence in older women. Poor bladder control is a serious health problem that can have severe consequences on the independence and quality of life of older women. The aims of the 1 year pilot study are to collect critical pilot data and experience prior to a larger, more complex clinical trial. This pilot study aims to: Assess our ability to recruit participants to participate in a randomized clinical trial of the efficacy of biofeedback in treating urinary incontinence; provide experience with intervention materials, data collection procedures, and participant management related to the proposed clinical trial; provide confidence in the hypothesis that our regimens of biofeedback are associated with clinically meaningful treatment effects. Thirty women aged 50-65 will be randomized to one of three conditions: 6 treatments of biofeedback-assisted behavioral therapy, 3 treatments of biofeedback-assisted behavioral therapy, and control (pelvic floor exercise, self-monitoring, and urge strategy instruction). Subjective self-report data and objective incontinence severity measures will be used. In addition, data will be collected on: generic and incontinence-specific quality of life, adherence to pelvic floor exercises, adherence to biofeedback, patient satisfaction and treatment preferences. Descriptive statistics, such as counts, frequencies, and means will be calculated for all variables. Analyses will be conducted primarily using SAS software. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Incontinence
Computerized
Guidelines-Managing
Urinary
Principal Investigator & Institution: Hofmann, Roger H.; ; West Portal Software Corporation 332 Pine St, Ste 610 San Francisco, Ca 94104 Timing: Fiscal Year 2001; Project Start 0-SEP-2001; Project End 8-FEB-2002 Summary: A large proportion (15-35%) of women suffer from urinary incontinence (UI), which can cause or exacerbate other physical health problems and significantly reduce individuals' quality of life. Though appropriate outpatient management can reduce the morbidity and cost of UI, it remains a vastly under-diagnosed and under-treated problem in primary care settings. The need to reduce variations in practice, control health care costs, and improve patient care outcomes has spurred the development of clinical practice guidelines. These guidelines, often cumbersome and difficult to navigate, have little impact on practice and
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outcomes. To successfully implement guidelines, providers must be able to quickly access and analyze key information and provide patientspecific advice at the time of consultation. Innovative, point-of-care tools can help physicians effectively navigate and incorporate clinical guidelines into patient care visits. We aim to develop point-of-care decision support software to help primary care physicians implement practice guidelines for the management of urinary incontinence in women. Phase I goals include translating text-based guidelines into algorithmic statements, developing prototype of decision support software deliverable on hand held computer, and collecting and analyzing observational, survey, and interview data to evaluate the prototype's feasibility and acceptability in a sample of primary care physicians. Proposed Commercial Applications: If proven effective in improving guideline compliance, the proposed decision support software would be significantly attractive to managed care organizations, individual practice associations, and insurance companies. Another potentially strong market would be medical schools, whose students and residents routinely use hand-held computers as point-of-care resources. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Incontinence
Molecular
Mechanism
Female
Stress
Urinary
Principal Investigator & Institution: Lue, Tom F.; Professor of Urology; Urology; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 94122 Timing: Fiscal Year 2000; Project Start 1-DEC-1996; Project End 0-NOV2002 Summary: (Adapted from the Applicant's Abstract): In the past 1 and 1/2 years, supported by grant 1 R55DK51374, we have modified and tested the feasibility of developing a reproducible rat model to study female stress urinary incontinence. We have studied the effect of pregnancy and delivery on the ultrastructure and function of the continence mechanism. We also modified our model by using pregnant rats and placed a intravaginal balloon under traction to direct the force to the levators and perineum to simulate the human situation. The information we have gained strongly support our opinion that the continence mechanism in the rats is similar to that of humans. We therefore propose to study the molecular mechanism involved in the pathogenesis of female stress urinary incontinence. We hypothesize that birth trauma, hormonal deficiency (menopause) and old age affect the gene and protein expression of several growth factors (IGF system, FGF, NGF, TGF, PDGF) and receptors (adrenergic, muscarinic and estrogen) which in turn
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change the structure and function of the continence mechanism. The hypothesis will be tested by completing the following specific aims: 1. To study and compare the functional, ultrastructural, cellular and molecular changes of the continence mechanism a). during pregnancy and after spontaneous delivery, b) after oxytocin-induced delivery and c) after delivery by cesarean section. 2. To examine the functional, ultrastructural, cellular and molecular changes of the continence mechanism after repeated birth trauma. 3. To examine the functional, ultrastructural, cellular and molecular changes of the continence mechanism after simulated birth trauma and bilateral ovariectomy. 4. To determine the functional, ultrastructural, cellular and molecular changes of the continence mechanism after combined simulated birth trauma, ovariectomy and aging. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Urinary Incontinence Treatment Network Principal Investigator & Institution: Zimmern, Philippe E.; Professor; Urology; University of Texas Sw Med Ctr/Dallas Southwestern Medical Ctr/Dallas Dallas, Tx 75390 Timing: Fiscal Year 2001; Project Start 1-SEP-2001; Project End 1-AUG2005 Summary: (Provided by Applicant) This application emphasizes the ability of UT Southwestern group of investigators from the Departments of Urology and Urogynecology and their sub-contractor at North Texas Center for Urinary Control in Ft. Worth, TX to prospectively recruit a large cohort of women candidates, including ethnic minority women, for urinary incontinence surgery and follow them prospectively postsurgery. The five sites selected for participation in the Urinary Incontinence Treatment Network represent the most active, productive, and respected treatment centers for urinary incontinence in the current Dallas/Ft. Worth "market." In addition to this unique grouping of talents and resources, the strengths of this application stem from: 1) broad clinical and surgical experience of the investigators with established reputations in female urology and urogynecology; 2) specialized and fully-dedicated patient care facilities with state-of-the-art urodynamic equipment and adjunctive modalities such as biofeedback; 3) well organized, efficient, and experienced clinical trial offices with documented on-going leadership in recruitment and retention of subjects through highly qualified, technical and administrative staff; 4) full institutional and multi-departmental support for the proposed program; 5) established collaborative relationship between the investigators in each sub-specialty; 6) recognized experience of the Principal investigator (PI)
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and most co-investigators in multi-centric cooperative projects; 7) close proximity and easy access to computerized database to ensure complete and timely transmission and management of all study data; and finally 8) a balanced budget encouraging the full participation of all five sites. This unique compilation of skill, experience, and facilities should contribute to a large enrollment of ethnically diverse women with urinary incontinence suitable for this trial. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Urinary Incontinence--Prevalence, Incidence, And Risks Principal Investigator & Institution: Brown, Jeanette S.; Professor; Ob, Gyn and Reproductive Scis; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 94122 Timing: Fiscal Year 2000; Project Start 1-MAY-1997; Project End 0-APR2001 Summary: The proposed research is designed to determine the prevalence and incidence of urinary incontinence by type (urge, stress and mixed), frequency and severity; to determine risk factors for urinary incontinence; to test the effectiveness of hormone therapy to decrease risk for developing urinary incontinence; and to improve the severity of urinary incontinence in elderly women. The research aims will be achieved b analyzing data from an established study of osteoporotic fractures (SOF) and from an established heart and estrogen-progestin replacement study (HERS). The former (SOF) is a prospective cohort study of risk factors for osteoporotic fractures among 9704 women 65 years of age or older, while the latter (HERS) is a randomized trial of hormone therapy to prevent recurrent heart disease events in 2763 postmenopausal women with heart disease. Both provide measures of incontinence that will allow calculation of prevalence and information on a large number of potential risk factors including age, reproductive history, obesity, medical illnesses, medications, social habits, and physical performance. Identifications of risk factors will guide the development of randomized trials of the efficacy of preventable or modifiable factors. Ancillary measurements appended to these studies will provide data on incidence of incontinence. As a large randomized trial, HERS will provide definitive data on the efficacy of hormone therapy to prevent the development or urinary incontinence and as treatment for incontinence. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
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Project Title: A Knowledge Based System for Continence Principal Investigator & Institution: Boyington, Alice R.; None; University of North Carolina Chapel Hill Box 2688, 910 Raleigh Rd Chapel Hill, Nc 27515 Timing: Fiscal Year 2000; Project Start 1-JUN-1999; Project End 1-MAY2002 Summary: Urinary continence problems are a health concern for older women and the prevalence rate of urinary incontinence in this group is estimated at 38 percent. The study of urinary incontinence has resulted in behavioral management strategies that can reduce urinary incontinence symptoms significantly. Information about urinary incontinence and behavioral management strategies has not been communicated effectively to older women. Thus, there is a need to communicate what is known about urinary incontinence and to promote risk-free behavioral management strategies for women with continence problems. A promising new approach is computer- based health promotion in the form of a knowledge-based system, which can provide individualized information in a convenient manner. This study proposes to develop and test the effectiveness of a knowledge-based system in communicating information on continence health promotion to women with symptoms of involuntary urine loss, urinary frequency, urinary urgency, or nocturia. To accomplish this, the candidate will pursue a career development program consisting of training in the design, development, construction, and evaluation of knowledge-based systems. The training will be applied to research in three study phases: Phase 1; Knowledge-Based System Design and Development will construct a knowledge-based system to provide continence promotion information and advice tailored to individual women's needs and risks. Phase 2; Knowledge-Based System Construction, Pilot Study and Revision will complete usability and validity testing, and conduct a pilot study to test procedures and instruments with 24 older ambulatory women. Revisions will be made based on pilot study findings. Phase 3: Test of the Knowledge-Based System for Continence Health Promotion in Older, Ambulatory Women will test the effectiveness of the continence knowledge-based system comparing ambulatory women (n=165), aged 55 years or older, randomized to a treatment group or to a wait-list control group. The groups will be compared on symptom distress, frequency of voiding, number of episodes of urgency, voiding episodes per night, and episodes of involuntary urine loss, and in improving quality of life. Repeated measures ANCOVA will be conducted for all outcome variables and exploratory descriptive analysis will be performed on the process
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variables to determine whether or not the women actually carried out the recommended strategies. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Collagenolysis as Function of MMPS in Incontinent Women Principal Investigator & Institution: Polan, Mary L.; Professor and Chairman; Gynecology and Obstetrics; Stanford University Stanford, Ca 94305 Timing: Fiscal Year 2000; Project Start 5-MAR-2000; Project End 9-FEB2004 Summary: (Adapted from the Applicant's Abstract): Urinary incontinence is a major public health problem in the United States, resulting in an 11% lifetime risk of surgery for women with incontinence and/or prolapse. The basic molecular pathophysiology of urinary incontinence is poorly understood and, therefore, the development of medical prophylaxis or therapy for this growing area of disability for older women has lagged. The investigators hypothesize that stress urinary incontinence (SUI) results from abnormal pelvic collagen metabolism as a function of differential expression of the matrix metalloproteinases (MMPs) known to degrade extracellular matrix collagen and the tissue inhibitors of metalloproteinases (TIMPs) which specifically inhibit MMP proteolytic activity. Thus, variations in the expression of MMPs and TIMPs govern the amount and type of collagen in the supporting pelvic structures by controlling proteolysis. They propose to investigate MMP and TIMP expression in vaginal cuff tissue isolated from women with SUI and continent women before and after menopause to delineate differences in proteolytic activity and pelvic collagen content by, first, measuring mRNA and protein expression of MMP-1, MMP-2, MMP-9, TIMP-1, TIMP-2, and TIMP-3 by quantitative, competitive reverse transcription polymerase chain reaction, Western blot analysis, and zymography. Second, they will culture tissue fibroblasts from vaginal cuff samples from control and incontinent women and determine the in vitro mRNA and protein expression of MMPs and TIMPs in response to gonadal steroid, cytokine, and growth factor modulation. Third, to confirm differences in collagenolysis between control and incontinent women, they will measure and compare total collagen content, ratio of type I/type III collagen, amount of the carboxy-terminal epitope, COL23/4Cshort, generated by the initial collagen cleavage, and level of pyridinoline crosslinks from both in vivo isolated vaginal cuff tissue and in vitro cultured fibroblasts from control and incontinent patients. Twothirds of the burden of urinary incontinence is borne by women with
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prevalence rates of 14 to 41%. The investigators do not believe that any medical therapy for SUI is available. Their fourth goal is to determine the ability of a clinically relevant MMP inhibitor (RS113,456; Roche Bioscience, Inc.) to ablate in vivo MMP proteolysis in fibroblast cultures from women with SUI and control women. Such MMP inhibitors may offer a therapeutic intervention to reverse the pathophysiologc degradation of collagen in women as they age, which results in incontinence. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Muscle Cells Mediated Gene Therapy for Incontinence Principal Investigator & Institution: Chancellor, Michael B.; Associate Professor; Surgery; University of Pittsburgh at Pittsburgh 4200 5Th Ave Pittsburgh, Pa 15260 Timing: Fiscal Year 2000; Project Start 0-SEP-1998; Project End 1-AUG2002 Summary: Urinary incontinence is a major health care problem in the United States. The NIDDK has recently convened a workshop to bring attention and foster research in this underserved area. This grant will explore and develop a novel and promising treatment of urinary incontinence. The investigators will explore in depth the role of cellular tissue engineering using myoblast and muscle derived cells as a treatment of stress urinary incontinence when injected into the urethra. In addition, myoblast injection may improve detrusor contractility when injected into the bladder wall. They will also develop cell mediated gene therapy for the lower urinary tract using autologous muscle derived cells. The investigators hypothesize that: 1. Myoblast injection can improve bladder and urethral smooth muscle function. 2. Autologous myoblast can be harvested and injected to achieve long-term success. 3. Cell mediated gene therapy using myoblasts transduced with trophic factors can further repair urinary tract muscle damage. 4. Myoblast engineered with adenovirus carrying the expression for nitric oxide synthase gene can increase NO release and improve inflammatory cystitis and reduce bladder outlet obstruction. This grant explores the frontier of tissue engineering and gene therapy for the treatment of urinary tract dysfunction. The investigators believe that this project has direct clinical utility in the near future. Based on their anticipated results, they propose to harvest autologous muscle derived stem cells by aspirating a very small amount of skeletal muscle from a patient's arm. Grow the muscle derived cells in culture and engineered these myoblasts with viruses carrying the expression of growth and trophic factors or nitric oxide synthase [sic]. The engineered myoblasts are then injected into the
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impaired urethra or bladder of that patient during a simple outpatient cystoscopic procedure. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Proposal for UCSD Incontinence Treatment Center Principal Investigator & Institution: Albo, Michael; Surgery; University of California San Diego 9500 Gilman Dr San Diego, Ca 92093 Timing: Fiscal Year 2001; Project Start 1-SEP-2001; Project End 1-AUG2005 Summary: The goal of this proposal is to establish the University of California, San Diego (UCSD) as one of the Continence Treatment Centers (CTC) in the Urinary Incontinence Treatment Network (UITN). As a member of the UITN, UCSD will collaborate with the other centers in the Network to assess the short and long-term outcomes of the multiple therapeutic modalities utilized in the treatment of women with stress and mixed urinary incontinence and participate in the enrollment of patients and data into any databases which may be developed. The treatment of women with stress and mixed urinary incontinence includes observation, behavioral, medical and surgical therapies. The indications for which of these therapies should be used for which type of patients varies greatly both regionally and between physicians in different specialties. There are few scientifically rigorous studies that evaluate the outcomes of these therapies, their morbidity and the effects they have on quality of life and other pelvic floor functions. In fact, each year more therapeutic options are offered without comparing them to any set standard. The UITN will have as a secondary goal the establishment of standardized definitions, evaluation and quality of life measurements. Vital to the success of this endeavor is the recruitment of a sufficient number of patients, establishment of a standardized protocol for evaluation and follow-up. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
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Project Title: Race Differences in Female UI: Epidemiology and Biology Principal Investigator & Institution: Delancey, John O.; Associate Professor; Obstetrics and Gynecology; University of Michigan at Ann Arbor Ann Arbor, Mi 48109 Timing: Fiscal Year 2001; Project Start 9-SEP-2001; Project End 1-AUG2006 Summary: (provided by applicant): The prevalence of urinary incontinence is often reported to be lower in black women than in white
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women. Whether or not this is true has not been confirmed in population based studies of younger women. In addition, the reasons for this prevalence difference are also unknown. This proposed population based, cross-sectional study will test the null hypothesis that no difference exists in the overall prevalence of urinary incontinence in black and white women. A telephone survey concerning occurrence of urinary incontinence (UT) and factors possible associated with UT will be administered to a regional sample of 1000 white women and 1500 black women age 30-60 years. A sub-sample of 130 black and white stress urinary incontinent, 100 black and white urge incontinent and 100 black and white continent women will undergo clinical testing in the form of pelvic floor testing to quantify bladder and urethra function. This survey will achieve the following aims: Aim lA: Define the prevalence of urinary incontinence in black and white women. Aim 1B: Determine the prevalence of stress and urge incontinence in black and white women. Aim 2: Identify demographic and personal factors that might explain the prevalence differences between the races. The clinical testing will accomplish the following aim. Aim 3: Compare the urethral and pelvic floor function of black and white women and continent and incontinent women. The survey and clinical components combined will achieve the final aim. Aim 4: Identify both epidemiologic and clinical factors associated with urinary incontinence. This research will confirm the reported race differences in the prevalence of urinary incontinence. It will also identify which epidemiologic and clinical factors contribute to this difference. Knowledge of these factors can then provide the basis for risk factor identification and the development of preventive strategies appropriate to different racial groups. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: UAB Continence Treatment Center Principal Investigator & Institution: Richter, Holly E.; Obstetrics and Gynecology; University of Alabama at Birmingham Uab Station Birmingham, Al 35294 Timing: Fiscal Year 2001; Project Start 1-SEP-2001; Project End 1-AUG2005 Summary: Urinary incontinence is a major problem with significant medical, psychological, social and financial consequences. Currently, there is a lack of prospectively evaluated, unbiased short- and long-term data regarding the most appropriate means of evaluation, therapeutic, intervention and measurement of treatment outcomes with respect to the surgical management of stress incontinence. The establishment of a Urinary Incontinence Treatment Network (UITN) with up to 7
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Continence Treatment Centers (CTC) would help to recruit a significant cohort of female patients in which to vigorously address these important issues regarding the surgical treatment of incontinence. The primary purpose of this proposal is to outline our ability to participate as a Continence Treatment Center in the Urinary Incontinence Network and to participate in a four-year prospective cohort study of women who have undergone different surgical procedures for urinary incontinence. The Division of Medical Surgical Gynecology, Urology and Geriatric Medicine at the University of Alabama at Birmingham (UAB) have a unique liaison in the evaluation and treatment of women with urinary incontinence working together at the UAB Genitourinary Disorder Center (GDC). The Center will easily facilitate participation in and contribute greatly to the success of this important trial. We have extensive experience in performing incontinence clinical trials, including multicenter trials and a strong supporting research infrastructure. Existing facilities, equipment, recruitment resources and trained personnel will be utilized in the service of the UITN protocols and projects. Our investigators have over 20 years experience in incontinence research and have contributed greatly to the literature in that regard. Expanded details of our capability will be provided in this application. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Urine Loss and Prolapse in Nuns and Their Parous Sisters Principal Investigator & Institution: Buchsbaum, Gunhilde M.; Assistant Professor; Obstetrics and Gynecology; University of Rochester Rochester, Ny 14627 Timing: Fiscal Year 2001; Project Start 9-SEP-2001; Project End 1-AUG2004 Summary: (provided by applicant): This proposal is submitted in response to RFA: HD-O0-012 entitled "Epidemiologic Research on Female Pelvic Floor Disorders." Urinary incontinence (UT) and pelvic organ prolapse (POP) are common health problems in older women, for which the etiologies are poorly understood. Injuries to the pelvic floor at the time of vaginal delivery and genetic predisposition have been implicated as factors associated with UT and POP. However, the epidemiological evidence for these relationships is scant and controversial. Our data from a survey study of 149 nulliparous nuns found the same prevalence of stress urinary incontinence (S UT) as was reported for parous women. The major objective of our proposed study is to determine whether vaginal delivery and familiality are associated with the development of urinary incontinence and pelvic organ prolapse by comparing the prevalence of objectively confirmed incontinence and prolapse in nuns
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(nulliparous women) with the corresponding rates in their biological sisters who have had at least one vaginal delivery. To achieve this objective, we will: recruit the nuns' biological sisters who have had at least one vaginal delivery; collect data from nuns and their sisters about the presence of any symptoms of UT and POP, and on any risk factors for these conditions; and examined nuns and sisters for objective evidence of UT and POP. The examiner will be blinded to the subjects' identity as to nun or sister, and to the presence or absence of symptoms. Women with signs or symptoms of UT and POP will undergo further urodynamic testing. Finally, the data collected will be tested in a matched pair analysis. We will determine whether nulliparous nuns differ from their biological sisters with regard to UT and POP. A matched pair logistic regression will be performed to obtain an adjusted estimate of the impact of familiality and vaginal delivery in UT and POP, taking into account other risk factors. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Utah Continence Treatment Center (CTC) Principal Investigator & Institution: Norton, Peggy A.; Associate Professor; Obstetrics-Gynecology; University of Utah 200 S University St Salt Lake City, Ut 84112 Timing: Fiscal Year 2001; Project Start 1-SEP-2001; Project End 1-AUG2005 Summary: Urinary incontinence constitutes a common and significant public health challenge in the United States, a challenge that is continuously compounded by the "graying" of America and by the ever improving life expectancy for women. Outcomes following surgery for urinary incontinence have not been ,adequately evaluated. As a result, objective, rigorously-obtained data, required to fully inform patients and on which to base important policy decisions, are unavailable. The longterm objective of the Urinary Incontinence Treatment Network (UITN) is to systematically evaluate the long-term outcomes of commonly utilized therapeutic approaches for urinary incontinence. This proposal describes the strengths that the University of Utah Continence Center would bring if it were to become a member Continence Treatment Center (CTC) of the UITN. Specifically, we will demonstrate the extensive expertise of the Utah Continence Center in the evaluation and treatment of urinary incontinence, including non-surgical and surgical approaches. We will further document that the Utah Continence Center has the- necessary ability to participate in or lead multicenter clinical trials, and that the Department of Obstetrics and Gynecology at the University of Utah Health Sciences Center, 14th'in the nation in NIH awards, has a proven
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track record in participating and managing NIH-driven multicenter network studies. Finally, we propose to carry out a prospective, randomized clinical trial for the two proposed surgical procedures (Bunch colposuspension versus pubovaginal sling) rather than a prospective cohort study, since the three investigators-surgeons for the Utah CTC can perform both procedures with equal expertise. Thus, inclusion of the proposed Utah CTC will increase the likelihood that the UITN will be in a position to complete a randomized controlled trial as the final outcome. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
E-Journals: PubMed Central22 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).23 Access to this growing archive of e-journals is free and unrestricted.24 To search, go to http://www.pubmedcentral.nih.gov/index.html#search, and type “urinary incontinence” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for urinary incontinence in the PubMed Central database: ·
Health information and interaction on the internet: a survey of female urinary incontinence by Hogne Sandvik; 1999 July 3 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=28152
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Interventions led by nurse continence advisers in the management of urinary incontinence: a randomized controlled trial by Michael J. Borrie, Mary Bawden, Mark Speechley, and Marita Kloseck; 2002 May 14 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=111077
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Questionnaire survey of urinary incontinence in women with cystic fibrosis by A Orr, R J McVean, A K Webb, and M E Dodd; 2001 June 23 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=33391
Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html. 23 With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 24 The value of PubMed Central, in addition to its role as an archive, lies the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print. 22
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Single blind, randomised controlled trial of pelvic floor exercises, electrical stimulation, vaginal cones, and no treatment in management of genuine stress incontinence in women by Kari Bo, Trygve Talseth, and Ingar Holme; 1999 February 20 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=27740
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Validity study of the severity index, a simple measure of urinary incontinence in women by Janet Hanley, Ann Capewell, and Suzanne Hagen; 2001 May 5 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=31262
The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine. The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to the public.25 If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with urinary incontinence, simply go to the PubMed Web site at www.ncbi.nlm.nih.gov/pubmed. Type “urinary incontinence” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for “urinary incontinence” (hyperlinks lead to article summaries): ·
Electromagnetic pelvic floor stimulation for urinary incontinence and bladder disease. Author(s): Goldberg RP, Sand PK. Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 2001; 12(6): 401-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11795645&dopt=Abstract
PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.
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Electrostimulation of the pelvic floor in female urinary incontinence. Author(s): Eriksen BC. Source: Acta Obstetricia Et Gynecologica Scandinavica. 1990; 69(4): 35960. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2244472&dopt=Abstract
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Endovesical electrotherapy in treatment of urinary incontinence in spina-bifida patients. Author(s): Nicholas JL, Eckstein HB. Source: Lancet. 1975 December 27; 2(7948): 1276-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=54798&dopt=Abstract
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Ethical and practice considerations for biofeedback therapists in the treatment of urinary incontinence. Author(s): Paul P, Cassisi JE, Larson P. Source: Biofeedback Self Regul. 1996 September; 21(3): 229-40. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8894056&dopt=Abstract
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Extracorporeal magnetic innervation therapy for stress urinary incontinence. Author(s): Galloway NT, El-Galley RE, Sand PK, Appell RA, Russell HW, Carlan SJ. Source: Urology. 1999 June; 53(6): 1108-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10367836&dopt=Abstract
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Female urinary incontinence. Management in primary care. Author(s): O'Connell HE, MacGregor RJ, Russell JM. Source: Med J Aust. 1992 October 19; 157(8): 537-44. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1479975&dopt=Abstract
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Female urinary incontinence--consultation behaviour and patient experiences: an epidemiological survey in a Norwegian community. Author(s): Seim A, Sandvik H, Hermstad R, Hunskaar S.
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Source: Family Practice. 1995 March; 12(1): 18-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7665034&dopt=Abstract ·
Followup of ureterosigmoidostomy diversion for bladder exstrophy-behavioral biofeedback as an alternative treatment for fecal-urinary incontinence: a case report. Author(s): Purcell MH, Duckro PN, Schultz K, Gregory JG. Source: The Journal of Urology. 1987 May; 137(5): 945-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3573191&dopt=Abstract
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Geriatric urinary incontinence. Author(s): Ouslander JG. Source: Dis Mon. 1992 February; 38(2): 65-149. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1732088&dopt=Abstract
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Help seeking behaviour and health and social services utilisation by people suffering from urinary incontinence. Author(s): Roe B, Doll H, Wilson K. Source: International Journal of Nursing Studies. 1999 June; 36(3): 245-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10404294&dopt=Abstract
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Historical aspects of the treatment of urinary incontinence. Author(s): Schultheiss D, Hofner K, Oelke M, Grunewald V, Jonas U. Source: European Urology. 2000 September; 38(3): 352-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10940713&dopt=Abstract
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Home-based management of urinary incontinence: a pilot study with both frail and independent elders. Author(s): Bear M, Dwyer JW, Benveneste D, Jett K, Dougherty M. Source: Journal of Wound, Ostomy, and Continence Nursing : Official Publication of the Wound, Ostomy and Continence Nurses Society / Wocn. 1997 May; 24(3): 163-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9224024&dopt=Abstract
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Identifying strategies for managing urinary incontinence with women who have multiple sclerosis. Author(s): Koch T, Kelly S. Source: Journal of Clinical Nursing. 1999 September; 8(5): 550-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10786527&dopt=Abstract
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Improving treatment of urinary incontinence. Author(s): Resnick NM. Source: Jama : the Journal of the American Medical Association. 1998 December 16; 280(23): 2034-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9863856&dopt=Abstract
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In-home management of urinary incontinence. Author(s): Plymat KR, Turner SL. Source: Home Healthcare Nurse. 1988 July-August; 6(4): 30-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3204031&dopt=Abstract
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Innovative technologies for the treatment of urinary incontinence. Author(s): Godsey SG. Source: Ostomy Wound Manage. 1992 January-February; 38(1): 22-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1605825&dopt=Abstract
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Intravaginal surface EMG probe design test for urinary incontinence patients. Author(s): Pauliina A, Jorma P, Paula I, Olavi A. Source: Acupunct Electrother Res. 2002; 27(1): 37-44. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12044019&dopt=Abstract
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Management of urinary incontinence in adult ambulatory care populations. Author(s): Wyman JF. Source: Annu Rev Nurs Res. 2000; 18: 171-94. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10918936&dopt=Abstract
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Managing urinary incontinence in community-residing elderly persons. Author(s): Baigis-Smith J, Smith DA, Rose M, Newman DK. Source: The Gerontologist. 1989 April; 29(2): 229-33. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2753383&dopt=Abstract
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Managing urinary incontinence with bladder training: a case study. Author(s): Wyman JF. Source: J Et Nurs. 1993 May-June; 20(3): 121-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8394146&dopt=Abstract
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Managing urinary incontinence--a common geriatric problem. Author(s): Burton JR. Source: Geriatrics. 1984 October; 39(10): 46-51, 54, 59 Passim. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=6479599&dopt=Abstract
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Non-invasive feedback of external pubococcegii muscle activity as a treatment for urinary incontinence. Author(s): Van Zak DB. Source: Int J Psychosom. 1993; 40(1-4): 56-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8070987&dopt=Abstract
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Nonpharmacologic treatment of urinary incontinence. Author(s): Weiss BD. Source: American Family Physician. 1991 August; 44(2): 579-86. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1858614&dopt=Abstract
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Nonsurgical therapies for urinary incontinence. Author(s): Amuzu BJ. Source: Clinical Obstetrics and Gynecology. 1998 September; 41(3): 70211. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9742366&dopt=Abstract
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Nursing interventions for urinary incontinence in home health. Author(s): Hiser V.
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Source: Journal of Wound, Ostomy, and Continence Nursing : Official Publication of the Wound, Ostomy and Continence Nurses Society / Wocn. 1999 May; 26(3): 142-60. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10711124&dopt=Abstract ·
Outcomes of a small group educational intervention for urinary incontinence: health-related quality of life. Author(s): McFall SL, Yerkes AM, Cowan LD. Source: Journal of Aging and Health. 2000 August; 12(3): 301-17. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11067699&dopt=Abstract
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Pelvic floor muscle training for urinary incontinence in women. Author(s): Hay-Smith EJ, Bo Berghmans LC, Hendriks HJ, de Bie RA, van Waalwijk van Doorn ES. Source: Cochrane Database Syst Rev. 2001; (1): Cd001407. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11279716&dopt=Abstract
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Pelvic floor rehabilitation in the female according to the integral theory of female urinary incontinence. First report. Author(s): Petros PP, Skilling PM. Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2001 February; 94(2): 264-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11165737&dopt=Abstract
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Pelvic muscle exercise/biofeedback for urinary incontinence after prostatectomy: an education program. Author(s): Mathewson-Chapman M. Source: J Cancer Educ. 1997 Winter; 12(4): 218-23. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9440013&dopt=Abstract
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Perineal biofeedback versus pelvic floor training in the treatment of urinary incontinence. Author(s): Ceresoli A, Zanetti G, Seveso M, Bustros J, Montanari E, Guarneri A, Tzoumas S.
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Source: Arch Ital Urol Androl. 1993 October; 65(5): 559-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8252086&dopt=Abstract ·
Physical therapy as an effective change agent in the treatment of patients with urinary incontinence. Author(s): McCandless S, Mason G. Source: J Miss State Med Assoc. 1995 September; 36(9): 271-4. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7473700&dopt=Abstract
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Preliminary results of muscle cuff cervicoplasty in the ewe for the treatment of urinary incontinence. Author(s): Pfister C, Vallancien G, Bougaran-Andre J, Grise P. Source: European Urology. 1997; 32(4): 448-54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9412804&dopt=Abstract
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Prompted voiding therapy for urinary incontinence in aged female nursing home residents. Author(s): Creason NS, Grybowski JA, Burgener S, Whippo C, Yeo S, Richardson B. Source: Journal of Advanced Nursing. 1989 February; 14(2): 120-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2703597&dopt=Abstract
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Rehabilitative treatment of non-neurogenic female urinary incontinence. Clinical and urodynamic evaluation. Author(s): Vecchioli Scaldazza C. Source: Minerva Urol Nefrol. 1997 March; 49(1): 5-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9099056&dopt=Abstract
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Relationship between health promotion lifestyle profiles and patient outcomes of biofeedback therapy for urinary incontinence. Author(s): Shinopulos NM, Jacobson J. Source: Urologic Nursing : Official Journal of the American Urological Association Allied. 1999 December; 19(4): 249-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10889768&dopt=Abstract
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Stress urinary incontinence after radical prostatectomy. Author(s): Rayome RG, Johnson V, Gray M. Source: Journal of Wound, Ostomy, and Continence Nursing : Official Publication of the Wound, Ostomy and Continence Nurses Society / Wocn. 1994 November; 21(6): 264-9. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7704135&dopt=Abstract
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Subjective and objective effects of intravaginal electrical myostimulation and biofeedback in patients with genuine stress urinary incontinence. Author(s): Meyer S, Dhenin T, Schmidt N, De Grandi P. Source: Br J Urol. 1992 June; 69(6): 584-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1638343&dopt=Abstract
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Terodiline. A review of its pharmacological properties, and therapeutic use in the treatment of urinary incontinence. Author(s): Langtry HD, McTavish D. Source: Drugs. 1990 November; 40(5): 748-61. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2292235&dopt=Abstract
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The influence of obesity, constitution and physical work on the phenomenon of urinary incontinence in women. Author(s): Sustersic O, Kralj B. Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 1998; 9(3): 140-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9745972&dopt=Abstract
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The national coverage decision for reimbursement for biofeedback and pelvic floor electrical stimulation for treatment of urinary incontinence. Author(s): Thompson DL. Source: Journal of Wound, Ostomy, and Continence Nursing : Official Publication of the Wound, Ostomy and Continence Nurses Society / Wocn. 2002 January; 29(1): 11-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11810068&dopt=Abstract
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The role of biofeedback in Kegel exercise training for stress urinary incontinence. Author(s): Burgio KL, Robinson JC, Engel BT. Source: American Journal of Obstetrics and Gynecology. 1986 January; 154(1): 58-64. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3946505&dopt=Abstract
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The role of muscular re-education by physical therapy in the treatment of genuine stress urinary incontinence. Author(s): Wall LL, Davidson TG. Source: Obstetrical & Gynecological Survey. 1992 May; 47(5): 322-31. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1570126&dopt=Abstract
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Treatment of female urinary incontinence with EMG-controlled biofeedback home training. Author(s): Hirsch A, Weirauch G, Steimer B, Bihler K, Peschers U, Bergauer F, Leib B, Dimpfl T. Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 1999; 10(1): 7-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10207760&dopt=Abstract
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Treatment of postprostatectomy urinary incontinence with behavioral methods. Author(s): Harris JL. Source: Clinical Nurse Specialist Cns. 1997 July; 11(4): 159-66. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9274154&dopt=Abstract
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Treatment of stress urinary incontinence. Author(s): Fischer-Rasmussen W. Source: Annals of Medicine. 1990 December; 22(6): 455-65. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2076279&dopt=Abstract
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Treatment of urinary incontinence in homebound older adults: interface between research and practice. Author(s): Engberg S, McDowell BJ, Donovan N, Brodak I, Weber E.
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Source: Ostomy Wound Manage. 1997 November-December; 43(10): 1822, 24-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9460431&dopt=Abstract ·
Treatment of urinary incontinence in women in general practice: observational study. Author(s): Seim A, Sivertsen B, Eriksen BC, Hunskaar S. Source: Bmj (Clinical Research Ed.). 1996 June 8; 312(7044): 1459-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8664627&dopt=Abstract
Vocabulary Builder Adjuvant: A substance which aids another, such as an auxiliary remedy; in immunology, nonspecific stimulator (e.g., BCG vaccine) of the immune response. [EU] Bulbar: Pertaining to a bulb; pertaining to or involving the medulla oblongata, as bulbar paralysis. [EU] Contractility: stimulus. [EU]
Capacity for becoming short in response to a suitable
Cortical: Pertaining to or of the nature of a cortex or bark. [EU] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Epidemiological: Relating to, or involving epidemiology. [EU] Extracellular: Outside a cell or cells. [EU] Fibroblasts: Connective tissue cells which secrete an extracellular matrix rich in collagen and other macromolecules. [NIH] Gonadal: Pertaining to a gonad. [EU] Hypertension: Persistently high arterial blood pressure. Various criteria for its threshold have been suggested, ranging from 140 mm. Hg systolic and 90 mm. Hg diastolic to as high as 200 mm. Hg systolic and 110 mm. Hg diastolic. Hypertension may have no known cause (essential or idiopathic h.) or be associated with other primary diseases (secondary h.). [EU] Innervation: 1. the distribution or supply of nerves to a part. 2. the supply of nervous energy or of nerve stimulus sent to a part. [EU]
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Nocturia: Excessive urination at night. [EU] Nulliparous: Having never given birth to a viable infant. [EU] Obstetrics: A medical-surgical specialty concerned with management and care of women during pregnancy, parturition, and the puerperium. [NIH] Outpatients: Persons who receive ambulatory care at an outpatient department or clinic without room and board being provided. [NIH] Ovariectomy: The surgical removal of one or both ovaries. [NIH] Oxytocin: A nonapeptide posterior pituitary hormone that causes uterine contractions and stimulates lactation. [NIH] Palliative: 1. affording relief, but not cure. 2. an alleviating medicine. [EU] Paraplegia: Paralysis of the legs and lower part of the body. [EU] Parietal: 1. of or pertaining to the walls of a cavity. 2. pertaining to or located near the parietal bone, as the parietal lobe. [EU] Percutaneous: Performed through the skin, as injection of radiopacque material in radiological examination, or the removal of tissue for biopsy accomplished by a needle. [EU] Perineal: Pertaining to the perineum. [EU] Predisposition: A latent susceptibility to disease which may be activated under certain conditions, as by stress. [EU] Prophylaxis: The prevention of disease; preventive treatment. [EU] Proteolytic: 1. pertaining to, characterized by, or promoting proteolysis. 2. an enzyme that promotes proteolysis (= the splitting of proteins by hydrolysis of the peptide bonds with formation of smaller polypeptides). [EU] Receptor: 1. a molecular structure within a cell or on the surface characterized by (1) selective binding of a specific substance and (2) a specific physiologic effect that accompanies the binding, e.g., cell-surface receptors for peptide hormones, neurotransmitters, antigens, complement fragments, and immunoglobulins and cytoplasmic receptors for steroid hormones. 2. a sensory nerve terminal that responds to stimuli of various kinds. [EU] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Viruses: Minute infectious agents whose genomes are composed of DNA or RNA, but not both. They are characterized by a lack of independent metabolism and the inability to replicate outside living host cells. [NIH]
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CHAPTER 5. PATENTS ON URINARY INCONTINENCE Overview You can learn about innovations relating to urinary incontinence by reading recent patents and patent applications. Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.26 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available to patients with urinary incontinence within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available to patients with urinary incontinence. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information.
26Adapted
from The U. S. Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.
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Patents on Urinary Incontinence By performing a patent search focusing on urinary incontinence, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. The following is an example of the type of information that you can expect to obtain from a patent search on urinary incontinence: ·
Vaginal stimulator and device for the treatment of female urinary incontinence Inventor(s): Marty; Jean-Claude (16-21 Bay Rd., #908, Miami Beach, FL 33139) Assignee(s): none reported Patent Number: 6,402,683 Date filed: February 17, 2000 Abstract: A vaginal applicator-stimulator system includes a body having a first set of conductors for transmitting electrical pulses to the vagina. A battery power supply is located inside the stimulator body and a microcontroller is located in the stimulator body for controlling the application of pulsating signals to the first set of conductors in accordance with programmed instructions corresponding to a particular type of urinary incontinence to be treated. A case is included for enclosing the cylindrical stimulator body during non-use of the stimulator body, the case havingcontacts correspondingly aligned with the conductors of the stimulator body. An apparatus is located in the case for entering instructions regarding current to be applied by the first set of conductors of the stimulator body that stimulate according to the type of urinary incontinence to be treated. The micro-controller in the stimulator body stores the entered instructions. Excerpt(s): The present invention relates to a vaginal stimulator and a device for the treatment of female urinary incontinence by the way of electrical stimulation applied to the pelvic floor musculature and surrounding structures. ... Female urinary incontinence is a condition with severe economic and psychosocial impact. There are several types of
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urinary incontinence but all are characterized by an inability to restrain urinary voiding. The three most frequent types of urinary incontinence are the stress incontinence, characterized by the involuntary loss of urine from the urethra during physical exertion, the urge incontinence or involuntary loss of urine associated with an abrupt and strong desire to void, and the mixed urinary incontinence which results from both urge incontinence and stress incontinence. ... With the first electrical stimulation methods used to treat female urinary incontinence, women had to go in a medical setting to undergo electrical stimulation session of their pelvic floor muscle. Later electrical stimulators for home treatment appeared. These devices are usually in two parts: an inside vagina part which is a vaginal plug with electrodes intended to be in contact with the vagina wall and an outside vagina part which can be the pulse generator and a power supply or a power supply only if the pulse generator is inside the vaginal plug. Such devices are not convenient because of the cable(s) between the inside vagina part and the outside vagina part. Moreover, hygiene problems are encountered when the vaginal plug has not been completely cleaned before its insertion in the vagina. Web site: http://www.delphion.com/details?pn=US06402683__ ·
Treatment of urinary incontinence by administration of .alpha.1Ladrenoceptor agonists Inventor(s): Esser; Franz (Ingelheim am Rhein, DE), Staehle; Helmut (Ingelheim am Rhein, DE), Luettke; Sven (Ockenheim, DE), Muramatsu; Ikunobu (Yoshida-gun, JP), Kitagawa; Hisato (Osaka Prefecture, JP), Uchida; Shuji (Toyonaka, JP) Assignee(s): Boehringer Ingelheim KG (Ingelheim, DE) Patent Number: 6,268,389 Date filed: January 11, 1999 Abstract: The present invention relates to the use of .alpha..sub.lL agonists for treating urinary incontinence. Excerpt(s): The present invention relates to the use of .alpha..sub.1L agonists for treating urinary incontinence, particularly stress incontinence. ... have surprising pharmacological properties and are particularly suitable for treating urinary incontinence. ... Compared with phenylephrine the compound of Example 2 according to the invention exhibits a potency which is higher by a factor of 2.73 with regard to the contraction of the urethra and with a duration of effect which is longer by a factor of 4.3. By comparison, the increase in blood pressure with the compound according to the invention is only 1.39 times that of the
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comparison compound phenylephrine. It is notable that the increase in blood pressure is prolonged only to an insignificant degree (by a factor of 1.17) compared with phenylephrine. These experiments show that the compounds according to the invention have a -selective effect on the urethra. Being selective .alpha..sub.1L -adrenoreceptor agonists, the compounds according to the invention are suitable for treating problems of urinary incontinence, particularly for treating stress incontinence. Web site: http://www.delphion.com/details?pn=US06268389__ ·
Male urinary incontinence device having expandable flutes Inventor(s): Dwork; Paul (1127 Garrido Dr., Camarillo, CA 93010), Elson; Edward E. (Anaheim, CA) Assignee(s): Dwork; Paul (Camarillo, CA) Patent Number: 6,248,096 Date filed: December 8, 1999 Abstract: An apparatus for forming a fluid tight seal around a penis of a user comprising for controlling male urinary incontinence, the apparatus having a substantially fluid impermeable sheath having a proximal end and a distal end, an inner surface and an outer surface, wherein, in use, at least a portion of the inner surface contacts the skin of the penis. The sheath has a first longitudinally compliant portion and a second radially compliant portion positioned between the proximal and distal ends. The longitudinally compliant portion can take the form of bellows, and the radially compliant portion can take the form of flutes. A retention arrangement, such as a strap for retaining the radially compliant portion about the circumference of the penis of a user can also be provided. The sheath is, in use, attached at the proximal end to a retention ring attached to a user. Excerpt(s): The present invention relates to urinary incontinence in general, and more specifically to a male urinary incontinence device using a wrap for enveloping the penis. ... Urinary Incontinence (UI) is a very common problem in the United States estimated to afflict more than 13 million people. Of those afflicted, about one third are men. The total annual cost of providing care for persons with UI is estimated to be $16 billion. The market for adult absorbent devices or diapers alone in 1994 was $1.5 billion projected to be growing about 25% per year. As the demographics in the United States shift to a more aged population, and as society in general becomes increasingly mobile, the increasing number of persons suffering from, and demanding solutions for UI will simultaneously increase. ... Overflow incontinence accounts for 10-15% of
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urinary incontinence. Overflow UI is usually the result of an obstruction. (e.g., enlarged prostate, urethral stricture) of the bladder outlet or an atonic bladder as the result of neurologic injury (e.g., spinal chord trauma, stroke), diabetic neuropathic bladder, or drug-induced atonia. The obstruction leads to bladder overfilling, resulting in a compulsive detrusor contraction. In this form of UI chronic "dribbling" is common. Drug induced atonia can be caused by anticholinergics, narcotics, antidepressants, and smooth muscle relaxants. Web site: http://www.delphion.com/details?pn=US06248096__ ·
Urinary incontinence treatment instrument Inventor(s): Ishikawa; Norio (Tokyo, JP), Suda; Shin (Tokyo, JP), Sasaki; Tadashi (Tokyo, JP), Hosaka; Hidehiro (Tokyo, JP) Assignee(s): Nihon Kohden Corporation (Tokyo, JP) Patent Number: 6,223,750 Date filed: May 27, 1999 Abstract: A seat face part 20 of a chair 1 is provided with a stimulating coil 3. A projection 10 is made on the top of the stimulating coil 3. When a treated patient sits in the chair 1, the anus of the treated patient is placed on the top of the projection 10, whereby the treated patient can be made to sit at the optimum position for urinary incontinence treatment relative to the stimulating coil 3. Excerpt(s): This invention relates to a urinary incontinence treatment instrument for applying a magnetic line of force to a treated patient for urinary incontinence treatment. ... A urinary incontinence treatment apparatus with a magnetic stimulating coil buried in a chair is shown, for example, in JP-A-9-276418. According to such an apparatus, urinary incontinence treatment is conducted in the same state as a patient sits in a normal chair, so that easy treatment can be conducted without burdening the treated patient or the operator with the treatment. ... In magnetic stimulating intended for urinary incontinence treatment, an eddy current is produced in a living body by a fluctuating magnetic field for stimulating the pelvic floor muscle or pudendal nerve from urethral opening to the anus or perineum neighborhood. At this time, to suppress power consumption, it is necessary to efficiently give an effective stimulus to the parts. Web site: http://www.delphion.com/details?pn=US06223750__
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Pubo-urethral support harness apparatus for percutaneous treatment of female stress urinary incontinence with urethal hypemobility Inventor(s): Bruckner; Norman I. (3432 Brookshire Dr., Plano, TX 75075), Davila; Guillermo H. (2580 SE. 8th St., Pompano Beach, FL 33062) Assignee(s): none reported Patent Number: 6,221,005 Date filed: September 7, 1999 Abstract: An apparatus for treatment of female stress urinary incontinence with urethral hypermobility with a support harness adapted to fit over the superior edge of the pubic bone of a patient, left or right of the pubis symphysis, a sling adapted to rest against the anterior vaginal wall or submucosally at the level just below the urethrovesical junction, and vaginal shaft connecting the sling to the support harness and adapted to position the sling causing stabilization and support of the urethrovesical junction. Excerpt(s): This invention relates to medical devices as alternatives for surgical correction of anatomic female stress urinary incontinence with urethral hypermobility (referred to as SUI) and more particularly to a Pubo-Urethral Support Harness Apparatus (referred to as a "PUSH apparatus") for Percutaneous Treatment of Female Stress Urinary Incontinence with Urethral Hypermobility. ... The present invention relates to SUI and provides an apparatus and method for treatment. More specifically, this invention relates to an apparatus and method of stabilizing and supporting the urethrovesical junction without use of sutures, staples or bone anchors to correct female stress urinary incontinence with urethral hypermobility. ... The primary object of the invention is to provide effective, long-lasting, therapy for Stress Urinary Incontinence with urethral hypermobility (referred to as SUI) that has minimal impact on life style activities. Web site: http://www.delphion.com/details?pn=US06221005__
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Methods and compositions for treating urinary incontinence using enantiomerically enriched (R,R)-glycopyrrolate Inventor(s): Fabiano; Vincent L. (Princeton, NJ), McCullough; John R. (Hudson, MA) Assignee(s): Sepracor Inc. (Marlborough, MA) Patent Number: 6,204,285 Date filed: December 29, 1998
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Abstract: A method for treating urinary incontinence, such as incontinence resulting from bladder detrusor muscle instability, using enantiomerically enriched (R, R)-glycopyrrolate. The method comprises administering a therapeutically effective amount of enantiomerically enriched (R, R)-glycopyrrolate, or a pharmaceutically acceptable salt thereof, substantially free of the (S, S)-glycopyrrolate enantiomer. Pharmaceutical compositions for the treament of urinary incontinence comprising enantiomerically enriched (R, R)-glycopyrrolate, or a pharmaceutically acceptable salt thereof, and an acceptable carrier are also disclosed. Excerpt(s): The present invention relates to methods for treating urinary incontinence, such as incontinence caused by bladder detrusor muscle instability, and to pharmaceutical compositions for such treatment. ... Urinary incontinence is a prevalent problem that affects people of all ages and levels of physical health, both in healthcare settings and in the community at large. At present, urinary incontinence afflicts 15-30% of elderly people living at home, one-third of those living in acute-care settings, and at least one-half of those in long-term care institutions (R. M. Resnick, Lancet 346:94 (1995)). Medically, it predisposes persons to urinary tract infections, pressure ulcers, perineal rashes, and urosepsis. Psychosocially, urinary incontinence is associated with embarrassment, social stigmatization, depression, and with the risk of institutionalization (Herzo et al., Annu. Rev. Gerontol. Geriatr., 9:74 (1989)). Economically, the costs are great; in the United States alone, over $10 billion is spent per annum managing incontinence. ... The present invention provides methods and compositions for treatment of urinary incontinence, including, e.g., bladder detrusor muscle instability incontinence, stress incontinence, urge incontinence, overflow incontinence, enuresis, and post-prostectomy incontinence, with (R,R)-glycopyrrolate. The methods of the present invention provide for treatment of incontinence with fewer adverse effects than occur upon administration of racemic glycopyrrolate. Web site: http://www.delphion.com/details?pn=US06204285__ ·
Vaginal electrode for urinary incontinence treatment Inventor(s): Mo; Seung Kee (#107-703 Kangbyun Apt., Manyun-dong Seoh-ku, Taejon 302-150, KR), Lee; Soo Yeol (#101-1406 Samil Apt., Childeum-dong Choongjoo-shi, Choongheongbook-do 380-220, KR) Assignee(s): none reported Patent Number: 6,185,465 Date filed: February 17, 1999
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Abstract: An electrode for insertion into a body cavity during medical treatment, for example, urinary incontinence treatment, may be inserted into a body cavity and used in contact with a muscular surface, and through which at least one electrical signal is applied to the muscular surface under a control of a controller and at least one EMG signal is detected from the muscular surface. The electrode includes: a rod-shaped main body composed of non-conductive material; a plurality of ringshape conductive bands each of which is disposed apart from one another along a longitudinal axis of the rod-shaped main body; a plurality of ring-shaped metal bands each of which is buried within one of the plurality of ring-shape conductive bands, respectively; and a plurality of electrical lines each of which has one end connected to a corresponding one of the plurality of ring-shaped metal bands and buried within the rod-shaped main body and the other end extended through a rear side of the rod-shaped main body to be electrically coupled to the controller. The main body and the ring-shaped conductive bands are made of non-conductive silicon and conductive silicon, respectively. Also, the main body is formed in a unit by molding process so that there is no hollow space within it. The ring-shaped conductive bands can be formed on the inner and the outer surfaces of the ringshaped metal bands by a molding process using conductive silicon. This electrode feeds excellent when inserted into a body cavity, is waterproof, durable and easy to manufacture. Moreover, the cost of manufacturing according to the present invention can be remarkably reduced. Excerpt(s): The present invention relates to an electrode for insertion into a body cavity, and in particular, to an electrode for insertion into a vagina for urinary incontinence treatment. ... Urinary incontinence is a common problem throughout the world and is particularly prevalent in the female population and in the aged. A large number of women suffer from urinary incontinence due to childbirth or general deterioration of body structures as an aging process and so on. It is known that about 20-30% of women over 50 years old suffers from urinary incontinence. Resulting from urinary incontinence is embarrassment, discomfort and distress, loss of sleep and the necessity for large monetary disbursements by the patients for absorbent pads, diapers, rubber sheeting and for cleaning of soiled clothing. ... These days the treatment for urinary incontinence includes surgery, physical rehabilitation and drug therapy. Web site: http://www.delphion.com/details?pn=US06185465__
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Magnetic stimulus type urinary incontinence treatment apparatus Inventor(s): Ishikawa; Norio (Kawasaki, JP), Suda; Shin (Tokyo, JP), Sasaki; Tadashi (Iruma, JP), Hosaka; Hidehiro (Sayama, JP) Assignee(s): Nihon Kohden Corporation (Tokyo, JP) Patent Number: 6,179,769 Date filed: December 23, 1997 Abstract: A magnetic stimulus type urinary incontinence treatment coil apparatus for generating flux for generating eddy current in a physiological body by providing a coil having an upper surface curved in a concave manner at least in a longitudinal direction such that the coil is fitted to at least part of an area from a front face region of a urethra opening to a rear face region of an anus, the coil wound around the area; and a support for supporting the coil at a position at which the coil is fitted to a patient. Excerpt(s): The present invention relates to a magnetic stimulus type urinary incontinence treatment apparatus for magnetically treating a patient for urinary incontinence by supplying pulse current and thereby generating flux for generating eddy current in a physiological body. ... As a urinary incontinence treatment, an electrical stimulus treatment for stress incontinence, urge incontinence and the like by fitting a stimulus electrode to a physiological body and supplying electrical pulses thereto has been well known in addition to a medical treatment and the like. In case of the electrical stimulus treatment, a plug-shaped electrode having a diameter of 2 cm and a length of 4 cm for a vagina or double enveloping electrode having the same dimensions for an anus connected to a pulse wave generator is inserted into the vagina or anus, and pulse current of a repeated frequency of several Hz to several tens Hz, a peak current of 1 to 100 mA and a pulse width of 100 .mu.s to 1 ms is applied directly from the body surface. By so doing, pelvic floor muscle is stimulated and trained by the pulse current applied from the body surface and the weaken muscle is reinforced to thereby strengthen the force for tightening a urethra. Thus, it is effective in the treatment for stress incontinence. ... As for urge incontinence caused by the involuntary contraction of a urinary bladder, pudendal nerves or their branches formed from the second to fourth sacral nerves of lunbosacral plexus are stimulated to thereby reflexively prevent the involuntary contraction of the urinary bladder, whereby urinary incontinence can be prevented. Web site: http://www.delphion.com/details?pn=US06179769__
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Device for treatment of male and female urinary incontinence Inventor(s): Engel; Konrad (Gaissach, DE), Engel; Kilian (Gaissach, DE) Assignee(s): Medi-Globe Vertriebs GmbH (Prien, DE) Patent Number: 6,167,886 Date filed: August 27, 1999 Abstract: A device for treatment of human urinary incontinence in the form of a catheter which can be inserted into the urethra and carries a balloon arrangement which can be filled with fluid to close off the urinary bladder, where the balloon arrangement holds the catheter in the lumen of the bladder. The fluid can be admitted to and discharged from the balloon arrangement via at least one channel running along the catheter wall which is closed off at the distal end of the distal part of the catheter. A self-closing valve is formed at a proximal end of the proximal part of the catheter. A hydraulic actuating mechanism is also located in the lumen of the urinary bladder. The hydraulic actuating mechanism can be hydraulically actuated by mechanical pressure exerted on a compressible balloon located at the distal end of the catheter. The compressible balloon is filled with fluid and is connected to the actuating mechanism via a connecting channel. Excerpt(s): The invention relates to a device for the treatment of male and female urinary incontinence according to the preamble of claim 1. ... Urinary incontinence is understood as meaning the involuntary loss of urine from the urinary bladder and urethra. The causes are either direct damage to the occlusive mechanism (sphincter muscle) of the urinary bladder, generally as a result of an operation on the prostate gland or by infiltration of a prostate gland carcinoma in men or a sphincter muscle injury as a result of childbirth in the case of women. Further causes of urinary incontinence are nerve damage resulting form metabolic diseases such as e.g. diabetes mellitus or as a result of traumas to the nerves to the urinary bladder and its occlusive mechanism such as stroke, tumor operations in the pelvic region or injuries to the spinal cord. ... A wide range of different methods are already known for treating and overcoming the urinary incontinence, depending on the cause of the incontinence and the sex of the patient; in serious cases, however, these are generally not sufficiently effective or require an operation with or without implantation and is not free from disadvantages in all cases. Web site: http://www.delphion.com/details?pn=US06167886__
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·
Urinary incontinence device and a method of making the same Inventor(s): Zunker; MaryAnn (Oshkosh, WI), Fell; David Arthur (Neenah, WI) Assignee(s): Kimberly-Clark Worldwide, Inc. (Neenah, WI) Patent Number: 6,142,928 Date filed: December 21, 1998 Abstract: A urinary incontinence device is disclosed along with a method of making the device. The device includes a resilient member and a nonabsorbent which at least partially encloses the resilient member. The nonabsorbent and the resilient member are formed into an elongated softwind having a first end and a second end. The softwind is folded upon itself such that the first and second ends are aligned adjacent to one another and the softwind contains at least two folds therebetween. The resilient member extends between at least two of the folds. The softwind is then compressed into an elongated pledget having an insertion end and a trailing end with the resilient member located at least in the insertion end. The resilient member is capable of expanding at least a portion of the pledget to provide a supportive backdrop for a woman's urethra when inserted into a woman's vagina. The method includes the steps of enclosing the resilient member by the non-absorbent, folding the two materials to form a softwind, folding the softwind into a generally M-shape configuration and then compressing the softwind into an elongated pledget. Excerpt(s): This invention relates to a urinary incontinence device and a method of making the device. More specifically, this invention relates to a non-absorbent urinary incontinence device which is designed to be placed in a woman's vagina for providing support to a woman's urethra to prevent the involuntary urine loss commonly associated with stress urinary incontinence. ... Some women, especially women who have given birth to one or more children, and older women, can experience incidences of involuntary urine loss due to stress urinary incontinence or combined stress and urge incontinence. A sneeze or cough can increase the intra-abdominal pressure impinging on a persons bladder and cause the involuntary release of urine. The frequency and severity of such urine loss can increase as the muscles and tissues near the urethro-vaginal myofascial area grow weaker. It has also been recognized that the urinary sphincter muscle, which is located at the upper end of the urethra adjacent to the bladder, works well at sealing off the passing of urine from the bladder to the urethra when it has a round or circular crosssectional configuration. However, when this passageway becomes distorted into a cross-sectional configuration having more of an elliptical
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or oval appearance, the sphincter muscle can not close properly, therefore, the tendency for involuntary urine loss increases. ... As the world's female population ages, there is an ever increasing need for a non-surgical procedure to reduce the involuntary urine loss commonly associated with "stress urinary incontinence." Today, there are a number of products available for this purpose. Essentially all of these products can only be purchased with a prescription and they need to be physically inserted and/or adjusted by a medical doctor or a nurse practitioner in order to perform correctly. Currently, no products are commercially available, without a prescription, to prevent involuntary urine loss from stress urinary incontinence. Web site: http://www.delphion.com/details?pn=US06142928__ ·
S-procyclidine for treating urinary incontinence Inventor(s): Fabiano; Vincent L. (Princeton, NJ), McCullough; John R. (Hudson, MA) Assignee(s): Sepracor Inc. (Marlborough, MA) Patent Number: 6,130,242 Date filed: December 29, 1998 Abstract: A method for treating urinary incontinence, such as incontinence resulting from bladder detrusor muscle instability, using enantiomerically enriched (S)-procyclidine. The method comprises administering a therapeutically effective amount of enantiomerically enriched (S)-procyclidine, or a pharmaceutically acceptable salt thereof, substantially free of the (R)-procyclidine enantiomer. Pharmaceutical compositions for the treatment of urinary incontinence comprising enantiomerically enriched (S)-procyclidine, or a pharmaceutically acceptable salt thereof, and an acceptable carrier are also disclosed. Excerpt(s): The present invention relates to methods for treating urinary incontinence, such as incontinence caused by bladder detrusor muscle instability, and to pharmaceutical compositions for such treatment. ... Urinary incontinence is a prevalent problem that affects people of all ages and levels of physical health, both in healthcare settings and in the community at large. At present, urinary incontinence afflicts 15-30% of elderly people living at home, one-third of those living in acute-care settings, and at least one-half of those in long-term care institutions (R. M. Resnick, Lancet 346:94 (1995)). Medically, it predisposes persons to urinary tract infections, pressure ulcers, perineal rashes, and urosepsis. Psychosocially, urinary incontinence is associated with depression, embarrassment, social stigmatization and with the risk of
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institutionalization (Herzo et al., Annu. Rev. Gerontol. Geriatr., 9:74 (1989)). Economically, the costs are great; in the United States alone, over $10 billion is spent per annum managing incontinence. ... The present invention provides methods and compositions for treatment of urinary incontinence, including, e.g., bladder detrusor muscle instability incontinence, stress incontinence, urge incontinence, overflow incontinence, enuresis, and post-prostectomy incontinence, with (S)procyclidine. The methods of the present invention provide for treatment of incontinence with fewer adverse effects than occur upon administration of racemic procyclidine. Web site: http://www.delphion.com/details?pn=US06130242__ ·
Treating urinary incontinence with (R)-desethyloxybutynin and (R)oxybutynin Inventor(s): Aberg; A. K. Gunnar (Sarasota, FL) Assignee(s): Bridge Pharma, Inc. (Sarasota, FL) Patent Number: 6,123,961 Date filed: September 23, 1997 Abstract: A method for treating or preventing urinary incontinence and other motility disorders involving the urethrogenital tract, by administering to a mammal an effective amount of the R-isomers of 4diethylamino-2-butynyl cyclohexylphenylglycolate and 4-ethylamino-2butynyl cyclohexylphenylglycolate and pharmaceutically acceptable salts thereof. Excerpt(s): Racemic oxybutynin (OXY) is used therapeutically in the treatment of urinary incontinence due to detrusor muscle instability. OXY exerts a spasmolytic effect by inhibiting the receptors for acetylcholine on smooth muscle. OXY is selective for muscarinic acetylcholine receptors over nicotinic receptors and as a result, no blocking effects are observed at skeletal neuromuscular junctions. ... The magnitude of a prophylactic or therapeutic dose of the compounds of this invention in the acute or chronic management of disease will vary with the severity and nature of the condition to be treated and the route of administration. The dose and the frequency of the dosing will also vary according to the age, body weight and response of the individual patient. In general, the total daily dose range for the compounds of this invention for the conditions described herein is from about 1 mg to about 100 mg in single or divided doses, preferably in divided doses. In managing the patient, the therapy should be initiated at a lower dose, perhaps at about 0.5 mg to about 25 mg, and may be increased up to about 200 mg
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depending on the patient's global response. It is further recommended that patients over 65 years and those with impaired renal or hepatic function initially receive low doses and that they be titrated based on individual response(s) and plasma drug level(s). It may be necessary to use dosages outside these ranges, as will be apparent to those skilled in the art. Further, it is noted that the clinician or treating physician will know how and when to interrupt, adjust, or terminate therapy in conjunction with individual patient response. The terms "a therapeutically effective amount" and "an amount sufficient to treat urinary incontinence but insufficient to cause adverse effects" are encompassed by the above-described dosage amounts and dose frequency schedule. Web site: http://www.delphion.com/details?pn=US06123961__ ·
Device for the treatment of male and female urinary incontinence Inventor(s): Engel; Konrad (Gaissach, DE), Engel; Kilian (Gaissach, DE) Assignee(s): Medi-Globe Vertriebs-GmbH (DE) Patent Number: 6,119,697 Date filed: May 28, 1997 Abstract: A device for the treatment of human urinary incontinence with a catheter which can be inserted into the urethra and carries a balloon arrangement which can be filled with fluid to close off the urinary bladder and to hold the catheter in the lumen of the urethra. The fluid can be admitted to and discharged from this balloon arrangement via at least one closed channel running along the catheter wall which is closed off at the distal end of the catheter, and via a valve mounted at one proximal end section of the catheter in inserted condition. The length of the catheter is dimensioned such that its distal end in inserted condition lies within the urethra. A hydraulic actuating mechanism, also located in the lumen of the urinary bladder, is assigned to the self-closing valve. This hydraulic actuating mechanism can be hydraulically actuated by mechanical pressure exerted on an actuating balloon located at the distal end of the catheter which is filled with fluid and linked to the actuating mechanism via a connecting channel (FIG. 1). Excerpt(s): The invention relates to a device for the treatment of male and female urinary incontinence according to the preamble of claim 1. ... Urinary incontinence is understood as meaning the involuntary loss of urine from the urinary bladder and urethra. The causes are either direct damage to the occlusive mechanism (sphincter muscle) of the urinary bladder, generally as a result of an operation on the prostate gland or by
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infiltration of a prostate gland carcinoma in men or a sphincter muscle injury as a result of childbirth in the case of women. Further causes of urinary incontinence are nerve damage resulting form metabolic diseases such as e.g. Diabetes mellitus or as a result of traumas to the nerves to the urinary bladder and its occlusive mechanism such as stroke, tumor operations in the pelvic region or injuries to the spinal cord. ... A wide range of different methods are already known for treating and overcoming the urinary incontinence, depending on the cause of the incontinence and the sex of the patient; in serious cases, however, these are generally not sufficiently effective or require an operation with or without implantation and is not free from disadvantages in all cases. Web site: http://www.delphion.com/details?pn=US06119697__
Patent Applications on Urinary Incontinence As of December 2000, U.S. patent applications are open to public viewing.27 Applications are patent requests which have yet to be granted (the process to achieve a patent can take several years). The following patent applications have been filed since December 2000 relating to urinary incontinence: ·
Implantable particles for tissue bulking and the treatment of gastroesophageal reflux disease, urinary incontinence, and skin wrinkles Inventor(s): Vogel, Jean Marie ; (Boxborough, MA), Thomas, Richard ; (Belmont, MA), Boschetti, Egisto ; (Croissy sur Seine, FR) Correspondence: Pennie & Edmonds Llp; 1667 K Street Nw; Suite 1000; Washington; DC; 20006 Patent Application Number: 20020068089 Date filed: December 28, 2001 Abstract: The invention encompasses the treatment of urinary incontinence, gastroesophageal reflux disease and the amelioration of skin wrinkles using biocompatible hydrophilic cationic microparticles and a cell adhesion promoter. Excerpt(s): The present invention relates to tissue bulking, the treatment gastroesophageal reflux disease, urinary incontinence and the amelioration of skin wrinkles. ... Urinary incontinence is a prevalent problem that affects people of all ages and levels of physical health, both in the community at large and in healthcare settings. Medically, urinary
27
This has been a common practice outside the United States prior to December 2000.
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incontinence predisposes a patient to urinary tract infections, pressure ulcers, perineal rashes, and urosepsis. Socially and psychologically, urinary incontinence is associated with embarrassment, social stigmatization, depression, and especially for the elderly, an increased risk of institutionalization (Herzo et al., Ann. Rev. Gerontol. Geriatrics, 9: 74 (1989)). Economically, the costs are astounding; in the United States alone, over ten billion dollars per year is spent managing incontinence. ... One approach for treatment of urinary incontinence involves administration of drugs with bladder relaxant properties, with anticholinergic medications representing the mainstay of such drugs. For example, anticholinergics such as propantheline bromide, and combination smooth muscle relaxant/anticholinergics such as racemic oxybutynin and dicyclomin, have been used to treat urge incontinence. (See, e.g., A. J. Wein, Urol. Clin. N. Am., 22:557 (1995)). Often, however, such drug therapies do not achieve complete success with all classes of incontinent patients, and often results in the patient experiencing significant side effects. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Treating urinary incontinence Inventor(s): Gellman, Barry N. ; (North Easton, MA) Correspondence: Testa, Hurwitz & Thibeault, Llp; High Street Tower; 125 High Street; Boston; MA; 02110; US Patent Application Number: 20020058959 Date filed: November 14, 2001 Abstract: A surgical device for use in a minimally invasive procedure to treat urinary incontinue can include a dilator coupled to a curved needle at one end and a sling at the opposite end. Urinary incontinence can be treated minimally invasively. One treatment includes positioning the sling on an anterior portion of the urethra to provide proper coaption to the urethra. Excerpt(s): The present invention relates to devices and methods for treating urinary incontinence, such as urinary incontinence in women resulting from intrinsic sphincter deficiency. ... Urinary incontinence is a widespread problem throughout the world. Urinary incontinence affects people of all ages and can severely impact a patient both physiologically and psychologically. ... One form of urinary incontinence suffered by women is intrinsic sphincter deficiency (ISD), a condition in which the valve of the urethral sphincter does not function properly, thus preventing proper coaptation of the urethra. Without proper coaptation,
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a person is unable to control urinary leakage. ISD can arise from loss of urethral vasculature, thinning of urethral mucosa, loss of the urethral connective tissue elements, neurologic compromise of the sympathetic smooth muscle, or compromise of the external striated sphincter. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Male urinary incontinence control device Inventor(s): Single, Charles H. ; (Ann Arbor, MI), Cochrane, John D. III ; (Ann Arbor, MI) Correspondence: Eric J. Sosenko; Brinks Hofer Gilson & Lione; P.O. Box 10395; Chicago; IL; 60610; US Patent Application Number: 20020017303 Date filed: October 9, 2001 Abstract: A male urinary incontinence control device including a first element for applying preferential pressure to the penis shaft between the lateral superficial veins and the central dorsal vascular group, and a second element for applying pressure ventrally to the penis shaft at the urethra and the corpus spongiosum thereby substantially or completely closing the urethra and preventing or limiting the flow of urine through the urethra. Excerpt(s): This invention generally relates to medical appliances and, more particularly, to a device used to control urinary incontinence of a male patient. ... Male urinary incontinence is a long-recognized medical condition which can pose an embarrassment to men whose natural urethral valve or sphincter is no longer capable of controlling the flow of urine from the bladder. Urinary incontinence can arise from a variety of causes, including disease, surgery, neurological dysfunction, malformation of urethral valve, physical deterioration accompanying advancing age, and other causes. Externally applied absorbent pads and internal catheters connected to collection bags are currently used as solutions to the problem of incontinence. Each of these solutions ultimately entails the external collection of the urine which escapes the bladder. Unfortunately, collection devices such as these can often be uncomfortable, inconvenient, unsanitary, offensive, unreliable and even inadequate during use. ... A variety of other devices are known for more actively regulating or controlling male urinary incontinence, rather than merely externally capturing or collecting urine. Some of these other
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devices include clamps or valves which are surgically implanted, positioned around and compressing the urethra. The clamp or valve is actuated in one way or another to permit the flow of urine through the urethra. These invasive devices have several drawbacks. The most significant of these drawbacks is the risk and cost associated with performing the implant surgery. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Surgical Treatment of Stress Urinary Incontinence Inventor(s): Benderev, Theodore V. ; (Laguna Hills, Ca), Naves, Neil H. ; (Mission Viejo, Ca), Legome, Mark J. ; (Mission Viejo, CA) Correspondence: Testa, Hurwitz & Thibeault, Llp; High Street Tower; 125 High Street; Boston; MA; 02110; US Patent Application Number: 20020005204 Date filed: March 14, 1997 Abstract: The surgical treatment of stress urinary incontinence is disclosed. The disclosed methods include: 1) a technique of probe passage to avoid injuring the bladder and to provide a more accurate and reproducible capture of the pubocervical fascia lateral to the bladder neck and urethra, 2) anchor fixation of the suspending sutures to the pubic bone to decrease the risk of suture pull through from above and to decrease post-operative pain and 3) a simple and reproducible technique to set a limited tension of the suspending sutures. A description of these methods and results of procedures with some of these methods are disclosed. Novel drill guides, suture passers, suture tensioners, and various related tools and devices for use in the surgical method are also disclosed. Excerpt(s): The present invention relates to the treatment of stress urinary incontinence "SUI," and, in particular, to improved methods and surgical devices for the surgical treatment of SUI in females. The devices disclosed herein are additionally useful in a wide variety of other surgical procedures. ... Lapides and associates have stressed the importance of urethral length in the maintenance of continence in the female. However, although it certainly interacts with other factors to contribute to continence, a short urethra alone will not produce incontinence. Urethral length varies considerably in normal women, and women with proven genuine stress urinary incontinence do not invariably have urethral shortening. ... In accordance with a further aspect of the present invention, there is provided a surgical bladder neck suspension procedure, for the treatment of stress urinary incontinence. In accordance
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with the method, a technique of creating a suspension web comprising a plurality of lengths of suture is constructed extending between the pubocervical fascia and the pubic bone, on each of the right and left sides of the midline. Sutures are carried through tissue utilizing the suture passer disclosed herein, and sutures are tied down to the pubic bone utilizing a bone anchor positioned on each of the right and left sides of the midline by a drill guide as disclosed herein. Prior to tying, sutures are appropriately tensioned by advancing the suture around the suture tensioner disclosed herein and tying in a conventional manner. Thereafter, the suture tensioner is removed and the surgical site prepared and closed in a conventional manner. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Methods and devices for the treatment of urinary incontinence Inventor(s): Rioux, Robert F. ; (Ashland, MA) Correspondence: Testa, Hurwitz & Thibeault, Llp; High Street Tower; 125 High Street; Boston; MA; 02110; US Patent Application Number: 20010053916 Date filed: June 5, 2001 Abstract: Methods and devices for treating female stress urinary incontinence are disclosed. The methods include transvaginally accessing the pelvic cavity and introducing a suburethral sling into the retropubic space. In some embodiments the ends of the sling are attached to an anatomical support structure. In other embodiments, the ends of the suburethral sling are not attached to an anatomical support structure. The devices include a surgical instrument for blunt dissection of the pelvic cavity which includes a curved shaft and a blunt distal end. A hook deployment device may optionally be attached to the surgical instrument. Excerpt(s): This invention relates to methods and devices for the treatment of female urinary incontinence. ... Stress urinary incontinence in women may be caused by urethral hypermobility. Hypermobility is a condition in which the pelvic floor fails to properly support an area between the bladder neck and mid-urethra, thus permitting the urethra to descend from its normal anatomic position in response to increases in intra-abdominal pressure, resulting in urinary incontinence. ... Methods and instruments for treating female urinary incontinence that obviate the need for "blind" dissection with sharp instruments and/or the use of bone anchors, and thus, avoiding the ensuing complications, are disclosed.
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Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Urinary incontinence diagnostic system Inventor(s): Mosel, Brian ; (Dublin, CA), Roy, Loren ; (San Jose, CA), Ingle, Frank ; (Palo Alto, CA), Levy, Stanley ; (Saratoga, CA) Correspondence: Townsend and Townsend and Crew; Two Embarcadero Center; Eighth Floor; San Francisco; CA; 94111-3834; US Patent Application Number: 20010020162 Date filed: May 8, 2001 Abstract: Devices, systems, and methods for diagnosing and/or treating urinary incontinence can accurately and reliably monitor both a vesicle pressure and a maximum urethral pressure of a patient during an abdominal pressure pulse so as to determine relationships between these pressures. Alignment between the location of maximum urethral pressure and a pressure sensor of a catheter can be maintained using an anchoring structure having a surface which engages a tissue surface along the bladder neck, urethra, or external meatus, which move with the urethra during abdominal pressure pulses. A pressuregram is generated graphically showing an increase in urethral pressure relative to an increase in vesicle pressure, and is often displayed in real time to a system operator adjacent the patient. Quantitative and/or qualitative diagnostic output allow selective remodeling of the patient's support structure so that the incontinence is inhibited. Excerpt(s): The present invention generally relates to devices, system, and methods for diagnosing and/or treating urinary incontinence. In an exemplary embodiment, the invention provides catheter-based pressure sensing systems for diagnosing female urinary incontinence, and in particular, provides systems for determining the relationship between urethral pressure and vesicle pressure in response to changes in abdominal pressure. Preferred aspects of the present invention relate to urethral catheter holder mechanisms. ... Urinary incontinence arises in both men and women with varying degrees of severity, and from different causes. In men, the condition most frequently occurs as a result of prostatectomies which result in mechanical damage to the urethral sphincter. In women, the condition typically arises after pregnancy when musculoskeletal damage has occurred as a result of inelastic stretching of the structures which support the genitourinary tract. Specifically, pregnancy can result in inelastic stretching of the pelvic floor, the external sphincter, and the tissue structures which support the bladder and bladder neck region. In each of these cases, urinary leakage typically
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occurs when a patient's abdominal pressure increases as a result of stress, e.g., coughing, sneezing, laughing, exercise, or the like. ... Treatment of urinary incontinence can take a variety of forms. Most simply, the patient can wear absorptive devices or clothing, which is often sufficient for minor leakage events. Alternatively or additionally, patients may undertake exercises intended to strengthen the muscles in the pelvic region, or may attempt a behavior modification intended to reduce the incidence of urinary leakage. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Coil apparatus for urinary incontinence treatment Inventor(s): Ishikawa, Norio ; (Tokyo, JP), Suda, Shin ; (Tokyo, JP) Correspondence: Sughrue, Mion, Zinn; Macpeak & Seas, PLLC; 2100 Pennsylvania Avenue, N.W.; Washington; DC; 20037; US Patent Application Number: 20010011152 Date filed: January 29, 2001 Abstract: A core 5 is composed of a J-shaped front core portion 1, a Jshaped rear core portion 2, a U-shaped left core portion 3, and a Ushaped right core portion 4. These core portions 1 to 4 have one-side end portions which are substantially directed in one and the same direction and which are fixed to one another to thereby form a center portion 6. A coil 7 is wound on the center portion 6. The core 5 is attached to a core support member attached closely to a patient. In use, the coil apparatus is made close or near to the patient. When the coil 7 is supplied with a pulse current, pulse-like magnetic flux is generated in the purdendal nerve and pelvic floor muscle group of the patient so that an eddy current is induced. The patient in the region where magnetic flux is generated and an eddy current is generated, is stimulated sufficiently, so that urinary incontinence treatment is performed. Excerpt(s): The present invention relates to a coil apparatus for medically treating an urinary incontinence patient by generating magnetic flux to thereby induce an eddy current in the body of the patient when a coil apparatus is supplied with a pulse current. ... 2. Related Art There is proposed an apparatus for medically treating an urinary incontinence patient by stimulating the pelvic floor muscle group, the purdendal nerve, or the like, of the patient with an eddy current induced by magnetic flux generated from a coil and given to the patient (JP-A-9276418, JP-A-10-234870), in place of a well-known electric stimulation apparatus for medically treating an urinary incontinence patient by attaching stimulation electrodes and giving an electric pulse to the
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patient. ... The proposed apparatus has made it possible to medically treat an urinary incontinence noninvasively patient with his or her clothes on without pain and shock of the patient. Moreover, the proposed apparatus has made it possible to reduce electric power consumption. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Electrical stimulation adjunct (add-on) therapy for urinary incontinence and urological disorders using an external stimulator Inventor(s): Boveja, Birinder R. ; (Highlands Ranch, CO) Correspondence: Angely Widhany; NAC Technologies Inc.; 8879 South Chestnut Hill way; Highlands Ranch; CO; 80130; US Patent Application Number: 20010002441 Date filed: December 29, 2000 Abstract: An apparatus and method for neuromodulation therapy for urinary incontinence and urological disorders comprises an implantable lead-receiver, and an external stimulator having a power source, controlling circuitry, and predetermined programs. The stimulator further includes a primary coil which inductively transfers electrical signals to the lead-receiver, which is also in electric contact with the sacral nerves. The external stimulator emits electrical pulses to stimulate the sacral plexus according to a predetermined program. In a second mode of operation, an operator may manually override the predetermined sequence of stimulation. Excerpt(s): The present invention relates to electrical neuromodulation therapy for medical disorders, more specifically neuromodulation therapy for urinary incontinence and urological disorders utilizing an implanted lead-receiver and external stimulator containing predetermined programs. ... Biological and human clinical research has shown utility of electrical nerve stimulation for urinary incontinence and a broad group of urological disorders. This invention is directed to the adjunct therapy for these disorders utilizing an implanted lead-receiver and an external stimulator with predetermined stimulation programs. ... A neurophysiological explanation for the effectiveness of this treatment modality in detrusor instability is based on animal experiments and electrophysiological studies in humans. Electrical stimulation for the treatment of urinary incontinence has evolved over the past 40 years. The mechanism of action of electrical stimulation was investigated initially in animal models. Over 100 years ago, Griffiths demonstrated relaxation of a contracted detrusor during stimulation of the proximal pudendal nerve in the cat model and further work clarified the role of pudendal afferents
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in relation of the detrusor. Spinal inhibitory systems capable of interrupting a detrusor contraction can be activated by electrical stimulation of afferent anorectal branhes of the pelvic nerve, afferent sensory fibers in the pudendal nerve and muscle afferents from the limbs. The effectiveness of neuromodulation in humans has been objectively demonstrated by urodynamic improvement, especially in light of the fact that such effects have not been noted in drug trials. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
Keeping Current In order to stay informed about patents and patent applications dealing with urinary incontinence, you can access the U.S. Patent Office archive via the Internet at no cost to you. This archive is available at the following Web address: http://www.uspto.gov/main/patents.htm. Under “Services,” click on “Search Patents.” You will see two broad options: (1) Patent Grants, and (2) Patent Applications. To see a list of granted patents, perform the following steps: Under “Patent Grants,” click “Quick Search.” Then, type “urinary incontinence” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on urinary incontinence. You can also use this procedure to view pending patent applications concerning urinary incontinence. Simply go back to http://www.uspto.gov/main/patents.htm. Under “Services,” click on “Search Patents.” Select “Quick Search” under “Patent Applications.” Then proceed with the steps listed above.
Vocabulary Builder Acetylcholine: A neurotransmitter. Acetylcholine in vertebrates is the major transmitter at neuromuscular junctions, autonomic ganglia, parasympathetic effector junctions, a subset of sympathetic effector junctions, and at many sites in the central nervous system. It is generally not used as an administered drug because it is broken down very rapidly by cholinesterases, but it is useful in some ophthalmological applications. [NIH] Anorectal: Pertaining to the anus and rectum or to the junction region between the two. [EU] Anus: The distal or terminal orifice of the alimentary canal. [EU] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the
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median line of the jaw. [EU] Dorsal: 1. pertaining to the back or to any dorsum. 2. denoting a position more toward the back surface than some other object of reference; same as posterior in human anatomy; superior in the anatomy of quadrupeds. [EU] Electrophysiological: Pertaining to electrophysiology, that is a branch of physiology that is concerned with the electric phenomena associated with living bodies and involved in their functional activity. [EU] Enuresis: Involuntary discharge of urine after the age at which urinary control should have been achieved; often used alone with specific reference to involuntary discharge of urine occurring during sleep at night (bedwetting, nocturnal enuresis). [EU] Glycopyrrolate: A muscarinic antagonist used as an antispasmodic, in some disorders of the gastrointestinal tract, and to reduce salivation with some anesthetics. [NIH] Hepatic: Pertaining to the liver. [EU] Hydrophilic: Readily absorbing moisture; hygroscopic; having strongly polar groups that readily interact with water. [EU] Implantation: The insertion or grafting into the body of biological, living, inert, or radioactive material. [EU] Infiltration: The diffusion or accumulation in a tissue or cells of substances not normal to it or in amounts of the normal. Also, the material so accumulated. [EU] Institutionalization: The caring for individuals in institutions and their adaptation to routines characteristic of the institutional environment, and/or their loss of adaptation to life outside the institution. [NIH] Lumen: The cavity or channel within a tube or tubular organ. [EU] Malformation: A morphologic defect resulting from an intrinsically abnormal developmental process. [EU] Motility: The ability to move spontaneously. [EU] Musculature: The muscular apparatus of the body, or of any part of it. [EU] Narcotic: 1. pertaining to or producing narcosis. 2. an agent that produces insensibility or stupor, applied especially to the opioids, i.e. to any natural or synthetic drug that has morphine-like actions. [EU] Neuromuscular: Pertaining to muscles and nerves. [EU] Particle: A tiny mass of material. [EU] Penis: The male organ of copulation and of urinary excretion, comprising a root, body, and extremity, or glans penis. The root is attached to the descending portions of the pubic bone by the crura, the latter being the
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extremities of the corpora cavernosa, and beneath them the corpus spongiosum, through which the urethra passes. The glans is covered with mucous membrane and ensheathed by the prepuce, or foreskin. The penis is homologous with the clitoris in the female. [EU] Phenylephrine: An alpha-adrenergic agonist used as a mydriatic, nasal decongestant, and cardiotonic agent. [NIH] Plexus: A network or tangle; a general term for a network of lymphatic vessels, nerves, or veins. [EU] Procyclidine: A muscarinic antagonist that crosses the blood-brain barrier and is used in the treatment of drug-induced extrapyramidal disorders and in parkinsonism. [NIH] Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH] Reflux: A backward or return flow. [EU] Silicon: Silicon. A trace element that constitutes about 27.6% of the earth's crust in the form of silicon dioxide. It does not occur free in nature. Silicon has the atomic symbol Si, atomic number 14, and atomic weight 28.09. [NIH] Sneezing: Sudden, forceful, involuntary expulsion of air from the nose and mouth caused by irritation to the mucous membranes of the upper respiratory tract. [NIH] Sympathetic: 1. pertaining to, caused by, or exhibiting sympathy. 2. a sympathetic nerve or the sympathetic nervous system. [EU] Trihexyphenidyl: A centrally acting muscarinic antagonist used in the treatment of parkinsonism and drug-induced extrapyramidal movement disorders and as an antispasmodic. [NIH] Ulcer: A local defect, or excavation, of the surface of an organ or tissue; which is produced by the sloughing of inflammatory necrotic tissue. [EU] Veins: The vessels carrying blood toward the heart. [NIH]
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CHAPTER 6. BOOKS ON URINARY INCONTINENCE Overview This chapter provides bibliographic book references relating to urinary incontinence. You have many options to locate books on urinary incontinence. The simplest method is to go to your local bookseller and inquire about titles that they have in stock or can special order for you. Some patients, however, feel uncomfortable approaching their local booksellers and prefer online sources (e.g. www.amazon.com and www.bn.com). In addition to online booksellers, excellent sources for book titles on urinary incontinence include the Combined Health Information Database and the National Library of Medicine. Once you have found a title that interests you, visit your local public or medical library to see if it is available for loan.
Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go to http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “urinary incontinence” (or synonyms) into the “For these words:” box. You will only receive results on books. You should check back periodically with this database which is updated every 3 months. The following is a typical result when searching for books on urinary incontinence:
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·
Urinary Incontinence in Primary Care Source: Oxford, England: Isis Medical Media, Ltd. 2000. 136 p. Contact: Available from Isis Medical Media Ltd. 59 St Aldates, Oxford, OX1 1ST United Kingdom. 01865202939. Fax: 01865202940. Website: www.isismedical.com. Price: $25.00 plus shipping and handling. ISBN: 1901865681. Summary: Urinary incontinence (UI) regularly disrupts the lives of about 5 percent of home dwelling adults and is a common problem at all ages. Inadequate training remains a major obstacle to the improved management of UI in primary care: few family practitioners have received postgraduate education or have any specialist knowledge on the subject. This handy sized practical reference guide helps the family care practitioner manage UI in the primary care setting. After an introductory chapter that offers an overview from the primary care perspective, the book includes 11 chapters on anatomy and physiology, the development of urinary incontinence, patient history and examination, investigations (diagnostic tests), coping strategies, treatment of genuine stress incontinence, treatment of detrusor instability, treatment of voiding disorders, other causes of incontinence, practical management, and misconceptions and frequently asked questions. The book includes full color illustrations, flowcharts and algorithms, and a special chapter on case studies to illustrate the practical applications of the concepts presented. A subject index concludes the handbook. 55 figures. 21 tables. 13 references.
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Urinary Incontinence in the Elderly: Pharmacotherapy Treatment Source: Binghamton, NY: Pharmaceutical Products Press. 1997. 72 p. Contact: Available from Haworth Press, Inc. 10 Alice Street, Binghamton, NY 13904-1580. (800) 429-6784. Fax (800) 895-0582. E-mail:
[email protected]. Price: $24.95. ISBN: 0789003279. Summary: This reference text covers how to educate health care providers and the public about urinary incontinence (UI) and how physicians, directors of nursing, and other health care providers can begin and maintain a comprehensive, science-based approach to diagnosing and treating UI. The volume begins with the AHCPR guidelines on UI for clinicians. Subsequent chapters are extensions of the AHCPR panel efforts directed at the consumer, caregivers, and directors of nursing. Topics include teaching women about gestational and postpartum pelvic muscle exercises; proper bladder emptying techniques; behavioral, pharmacologic, and surgical treatment of UI; risk factors associated with UI; stress incontinence; and how the body makes,
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stores, and releases urine (physiology). The text features tables and charts to help readers diagnose the patient's condition, identify the causes for UI, and select appropriate treatment methods. The book also provides a list of helpful questions to assist in the identification and assessment of UI and sample bladder records with which patients can keep track of voluntary and involuntary urine voidings. The book concludes with an annotated bibliography of selected pharmacotherapy studies of the treatment of UI compiled by the editor. 15 references. (AA-M). ·
Urinary Incontinence in Adults: Acute and Chronic Management. Clinical Practice Guideline Update Source: Rockville, MD: Agency for Health Care Policy and Research (AHCPR). March 1996. 154 p. Contact: Available from Agency for Health Care Policy and Research (AHCPR) Publications Clearinghouse. P.O. Box 8547, Silver Spring, MD 20907-8547. (800) 358-9295. Price: $6.00. AHCPR publication number 960682. Summary: This clinical practice guideline was developed by an expert panel of health care professionals sponsored by the Agency for Health Care Policy and Research, and represents the 1996 update of guidelines originally released in 1992. The authors address major evaluative, diagnostic, treatment, and management issues of urinary incontinence (UI) in adults. Topics addressed include the methodology for updating the guideline; incidence and prevalence of UI; quality of life; risk factors and prevention; costs; identification and evaluation of types UI; principles of diagnostic evaluation; treatment of UI, including behavioral techniques, pharmacologic treatment, surgical treatment, and other measures and supportive devices; long-term management of chronic intractable UI; and public and professional education about UI. The volume includes a glossary, biographical information about the guideline panel, and a subject index.
Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes & Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in PrintÒ). The following have been recently listed with online booksellers as relating to urinary incontinence (sorted
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alphabetically by title; follow the hyperlink to view more details at Amazon.com): ·
A Practical Guide to Bowel and Bladder Retraining of the Elderly Client (Briggs Guidebook Series) by Helyn S. Agee (1988); ISBN: 094135301X; http://www.amazon.com/exec/obidos/ASIN/094135301X/icongroupi nterna
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Basic Urogynecology (Oxford Medical Publications) by Linda Cardozo, et al (1993); ISBN: 0192623591; http://www.amazon.com/exec/obidos/ASIN/0192623591/icongroupin terna
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Clinical Urogynecology by Mark D. Walters, Mickey M. Karram (1993); ISBN: 0801656737; http://www.amazon.com/exec/obidos/ASIN/0801656737/icongroupin terna
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Continence Promotion in General Practice (Practical Guides for General Practice 13 Oxford Medical Publications) by Nigel Smith, et al (1995); ISBN: 0192620436; http://www.amazon.com/exec/obidos/ASIN/0192620436/icongroupin terna
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Coping With Bowel and Bladder Problems (Coping With Aging Series) by Barbara Doherty King, Judy Harke (1994); ISBN: 1565930681; http://www.amazon.com/exec/obidos/ASIN/1565930681/icongroupin terna
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Disorders of the Female Urethra and Urinary Incontinence (1982); ISBN: 0683077465; http://www.amazon.com/exec/obidos/ASIN/0683077465/icongroupin terna
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Female Urinary Incontinence: Diagnostics and Treatment by Attila Tanko (1994); ISBN: 9630565307; http://www.amazon.com/exec/obidos/ASIN/9630565307/icongroupin terna
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Female Urology by Elroy D. Kursh, Edward J. McGuire (Editor) (1994); ISBN: 039751154X; http://www.amazon.com/exec/obidos/ASIN/039751154X/icongroupi nterna
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Genito-Urinary Problems in Childhood (Progress in Pediatric Surgery:, V. 17) by Peter Paul Rickham (1983); ISBN: 0806715170; http://www.amazon.com/exec/obidos/ASIN/0806715170/icongroupin terna
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Incontinence (Patient Handbook 18) by R.C.L. Feneley (1984); ISBN: 0443028559; http://www.amazon.com/exec/obidos/ASIN/0443028559/icongroupin terna
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Incontinence and Its Management (1986); ISBN: 0709935803; http://www.amazon.com/exec/obidos/ASIN/0709935803/icongroupin terna
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Incontinence and Its Management by Dorothy Mandelstam (Editor) (1986); ISBN: 0412340402; http://www.amazon.com/exec/obidos/ASIN/0412340402/icongroupin terna
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Key Aspects of Elder Care: Managing Falls, Incontinence, and Cognitive Impairment by Sandra G. Funk (Editor), et al (1992); ISBN: 0826177204; http://www.amazon.com/exec/obidos/ASIN/0826177204/icongroupin terna
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Managing Incontinence (1985); ISBN: 0898031435; http://www.amazon.com/exec/obidos/ASIN/0898031435/icongroupin terna
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Managing Incontinence by Cheryle B. Gartley (Editor) (1985); ISBN: 091546313X; http://www.amazon.com/exec/obidos/ASIN/091546313X/icongroupi nterna
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Managing Urinary Incontinence in the Elderly by John F. Schnelle (1991); ISBN: 0826173608; http://www.amazon.com/exec/obidos/ASIN/0826173608/icongroupin terna
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Micturition by J.O. Drife, et al (1990); ISBN: 0387196145; http://www.amazon.com/exec/obidos/ASIN/0387196145/icongroupin terna
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Nursing for Continence by Katherine F. Jeter, et al (1990); ISBN: 0721628923; http://www.amazon.com/exec/obidos/ASIN/0721628923/icongroupin terna
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Overcoming Bladder Disorders (1990); ISBN: 0890431965; http://www.amazon.com/exec/obidos/ASIN/0890431965/icongroupin terna
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Overcoming Bladder Disorders: Compassionate Authoritative Medical and Self-Help Solutions for Incontinence, Cystitis, Interstitial Cystitis,
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prostate by Rebecca Chalker, Kristene E. Whitmore (1990); ISBN: 0060162775; http://www.amazon.com/exec/obidos/ASIN/0060162775/icongroupin terna ·
Overcoming Urinary Incontinence: A Simple Self-Help Guide by Richard J., Dr. Millard (1989); ISBN: 0722516924; http://www.amazon.com/exec/obidos/ASIN/0722516924/icongroupin terna
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Pelvic Floor Re-Education: Principles and Practice by B. Schussler (1994); ISBN: 0387198601; http://www.amazon.com/exec/obidos/ASIN/0387198601/icongroupin terna
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Practical Aspects of Urinary Incontinence (Developments in Surgery, Vol 7) by F.M.J. Debruyne, E.V.A. Van Kerrebroeck (Editor) (1986); ISBN: 0898387523; http://www.amazon.com/exec/obidos/ASIN/0898387523/icongroupin terna
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Sexocize: A Female Genitourinary Program by Janan Clark (1989); ISBN: 0929593014; http://www.amazon.com/exec/obidos/ASIN/0929593014/icongroupin terna
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Staying Dry: A Practical Guide to Bladder Control by Kathryn L. Burgio, et al (1990); ISBN: 0801839092; http://www.amazon.com/exec/obidos/ASIN/0801839092/icongroupin terna
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Surgery of Female Incontinence by Stuart L. Stanton, Emil A. Tanagho (Editor) (1986); ISBN: 0387158219; http://www.amazon.com/exec/obidos/ASIN/0387158219/icongroupin terna
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Surgical Repair of Vaginal Defects by Wayne F. Baden (1992); ISBN: 0397511779; http://www.amazon.com/exec/obidos/ASIN/0397511779/icongroupin terna
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The Promotion of Continence in Adult Nursing by David Colburn, D. Colborn (1994); ISBN: 0412494604; http://www.amazon.com/exec/obidos/ASIN/0412494604/icongroupin terna
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The Unstable Bladder by Robert M. Freeman, John Malvern (Editor) (1989); ISBN: 0723614393;
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http://www.amazon.com/exec/obidos/ASIN/0723614393/icongroupin terna ·
Urinary and Fecal Incontinence (1991); ISBN: 9991851968; http://www.amazon.com/exec/obidos/ASIN/9991851968/icongroupin terna
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Urinary Incontinence by Mary H. Palmer (1985); ISBN: 0943432227; http://www.amazon.com/exec/obidos/ASIN/0943432227/icongroupin terna
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Urinary Incontinence in Adults Clinical Practice Guide for Clinicians/Ahcpr 92 0038/Sold in Packages of 10 Only (1993); ISBN: 9995523477; http://www.amazon.com/exec/obidos/ASIN/9995523477/icongroupin terna
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Urinary Incontinence in Adults, Quick Reference Guide for Clinicians/Sold in Packages of 25 (1993); ISBN: 0160417627; http://www.amazon.com/exec/obidos/ASIN/0160417627/icongroupin terna
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Urinary Incontinence in Adults: A Patient's Guide/Ahcpr 92 0040/Sold in Packages of 50 (1995); ISBN: 0160417635; http://www.amazon.com/exec/obidos/ASIN/0160417635/icongroupin terna
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Urinary Incontinence in Women (Clinical Symposia, Vol 47, No 3) (1995); ISBN: 9996114953; http://www.amazon.com/exec/obidos/ASIN/9996114953/icongroupin terna
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Urodynamics and the Evaluation of Female Incontinence: A Practical Guide by D.R. Ostergard, Peter K. Sand (1995); ISBN: 0387199047; http://www.amazon.com/exec/obidos/ASIN/0387199047/icongroupin terna
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Urogynecologic Surgery (Principles and Techniques of Gynecologic Surgery Series) by W. Glenn, M.D. Hurt (Editor) (1992); ISBN: 0834203391; http://www.amazon.com/exec/obidos/ASIN/0834203391/icongroupin terna
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Urogynecology and Urodynamics (1991); ISBN: 0683066463; http://www.amazon.com/exec/obidos/ASIN/0683066463/icongroupin terna
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Urogynecology and Urodynamics: Theory and Practice by Donald R. Ostergard, Alfred E. Bent (Editor) (1991); ISBN: 0683066471;
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http://www.amazon.com/exec/obidos/ASIN/0683066471/icongroupin terna ·
What You Can Do About Bladder Control (The Dell Medical Library) by Nancy Bruning (1992); ISBN: 0440210771; http://www.amazon.com/exec/obidos/ASIN/0440210771/icongroupin terna
The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “urinary incontinence” (or synonyms) into the search box, and select “books only.” From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:28 ·
Clinical protocol series for care managers in community based longterm care. Incontinence [microform]. Author: [written by Barbara Schneider and Emily Amerman]; Year: 1997; Philadelphia, PA (642 North Broad St., Philadelphia 19130-3409): Philadelphia Corporation for Aging, c1995
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Collagen implant therapy for the treatment of stress incontinence. Author: M. M. Johnson; Year: 1991; Vancouver, British Columbia, Canada: BCOHTA CHSPR, 1991
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Collagen implant therapy for the treatment of stress incontinence. Author: M. M. Johnson, K. D. Friesen; Year: 1993; Vancouver, British Columbia, Canada: BCOHTA CHSPR, 1993
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Conquering bladder and prostate problems: the authoritative guide for men and women. Author: Jerry G. Blaivas; Year: 1998; New York: Plenum Trade, c1998; ISBN: 0306458640
In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is adapting biomedical books for the Web. The books may be accessed in two ways: (1) by searching directly using any search term or phrase (in the same way as the bibliographic database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a “Books” button that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and PubMed. In the future, more links will be created between the books and other types of information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.
28
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http://www.amazon.com/exec/obidos/ASIN/0306458640/icongroupin terna ·
Continence: promotion and management by the primary health care team: consensus guidelines. Author: Denise Button... [et al.]; Year: 1998; London: Whurr Publishers, 1998; ISBN: 1861560788 http://www.amazon.com/exec/obidos/ASIN/1861560788/icongroupin terna
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Correlates of incontinence: an analysis of nursing home data from the Medicare and Medicaid Automated Certification System (revised). Final rept [microform]. Author: P. O'Brien, D. Klingman; Year: 1990; Washington, DC: SysteMetrics, Inc., 1990
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Efficacy of prostatectomy in treatment of benign prostatic hyperplasia. Author: L. R. Levy, J. I. Williams; Year: 1993; Ontario: Institute for Clinical Evaluative Sciences in Ontario, 1993
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Female urinary incontinence. Author: edited by Nils-Otto Sjöberg, Tore H. Holmdahl, Kristina Crafoord; with a foreword by Linda Cardozo; [translated by Tore H. Holmahl.]; Year: 2000; New York: Parthenon Pub. Group, c2000; ISBN: 1850704937 http://www.amazon.com/exec/obidos/ASIN/1850704937/icongroupin terna
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Helping people with incontinence [microform]: caregiver guide. ; Year: 1996; Rockville, MD: U.S. Dept. of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research, 1996
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Hysterectomy. Ratings of appropriateness. Author: K. Hagenfeldt, B. Brorsson, S. J. Serstein; Year: 1995; Stockholm: Swedish Council on Technology Assessment in Health Care, 1995; ISBN: 9187890283
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Implantable sacral nerve stimulation for the treatment of idiopathic urinary dysfunction. Author: ECRI; Year: 2000; Plymouth Meeting, PA: ECRI, c2000
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Implanted and injected materials in urology. Author: edited by Jean Marie Buzelin; Year: 1995; Oxford: Isis Medical Media, 1995; ISBN: 1899066152 http://www.amazon.com/exec/obidos/ASIN/1899066152/icongroupin terna
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Incontinence. Author: edited by Malcolm Lucas, Simon Emery, John Beynon; Year: 1999; Oxford; Malden, MA.: Blackwell Science, 1999; ISBN: 0632050039 http://www.amazon.com/exec/obidos/ASIN/0632050039/icongroupin terna
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Management of acute and chronic urinary incontinence in adults. Author: Urinary Incontinence in Adults Guideline Update Panel; J.
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andrew Fantl (co-chair) ... [et al.]; Year: 1996; Rockville, Md.: U.S. Dept. of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research, [1996] ·
Pelvic floor dysfunction: investigations & conservative treatment. Author: editors, R.A. Appell, A.P. Bourcier, F. La Torre; Year: 1999; Rome: Casa Editrice Scientifica Internazionale, c1999; ISBN: 8886062435
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Penile sheaths: a comparative evaluation. Author: R. C. Feneley, A. M. Cottenden; Year: 1995; London: Department of Health, 1995
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Report on the surgical management of female stress urinary incontinence. Author: American Urological Association, Female Stress Urinary Incontinence Clinical Guidelines Panel; Year: 1997; Baltimore, Md.: The Association, c1997; ISBN: 0964970236 http://www.amazon.com/exec/obidos/ASIN/0964970236/icongroupin terna
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Science of life [microform]: a pamphlet addressed to all members of the universities of Oxford and Cambridge: and to all who are or will be teachers, clergymen, fathers. Author: Newman, Diane Kaschak; Year: 1877; London: J. Burns, 1877
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Skin care triad: continence management, wound care, and therapeutic positioning. Author: edited by Jack L. Rook, Lyn D. Weiss, Deborah D. Hagler; Year: 2000; Boston: Butterworth-Heinemann, c2000; ISBN: 0750670355 (alk. paper) http://www.amazon.com/exec/obidos/ASIN/0750670355/icongroupin terna
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Urinary and fecal incontinence: nursing management. Author: [edited by] Dorothy B. Doughty; Year: 2000; St. Louis: Mosby, c2000; ISBN: 0815129122 http://www.amazon.com/exec/obidos/ASIN/0815129122/icongroupin terna
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Urinary incontinence in primary care. Author: Linda Cardozo, David Staskin, Michael Kirby; with a contribution from Angela Billington; Year: 2000; Oxford: Isis Medical Media, 2000; ISBN: 1901865681 http://www.amazon.com/exec/obidos/ASIN/1901865681/icongroupin terna
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Urinary incontinence in the elderly: pharmacotherapy treatment. Author: James W. Cooper, editor; Year: 1997; New York: Pharmaceutical Products Press, c1997; ISBN: 0789003279 (alk. paper) http://www.amazon.com/exec/obidos/ASIN/0789003279/icongroupin terna
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Urinary incontinence sourcebook. Author: by Diane Kaschak Newman; with Mary K. Dzurinko; foreword by Ananias C. Diokno; Year: 1999; Los
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Angeles, CA: Lowell House; Chicago: NTC/Contemporary Books, c1999; ISBN: 0737302615 http://www.amazon.com/exec/obidos/ASIN/0737302615/icongroupin terna ·
Urinary incontinence sourcebook. Author: by Diane Kaschak Newman with Mary K. Dzurinko; foreword by AnaniasC. Diokno; Year: 1997; Los Angeles: Lowell House; Chicago: Contemporary Books, c1997; ISBN: 1565656482 http://www.amazon.com/exec/obidos/ASIN/1565656482/icongroupin terna
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Urinary incontinence. Author: edited by Adolphe Steg; Year: 1992; Edinburgh; New York: Churchill Livingstone, 1992; ISBN: 0443046433 http://www.amazon.com/exec/obidos/ASIN/0443046433/icongroupin terna
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Urinary incontinence. Author: [edited by] Pat D. O'Donnell; Year: 1997; St. Louis: Mosby, c1997; ISBN: 081516517X http://www.amazon.com/exec/obidos/ASIN/081516517X/icongroupi nterna
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Urogynecologic surgery. Author: edited by W. Glenn Hurt; Year: 2000; Philadelphia: Lippincott Williams & Wilkins, c2000; ISBN: 0781719631 http://www.amazon.com/exec/obidos/ASIN/0781719631/icongroupin terna
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Urogynecology and reconstructive pelvic surgery. Author: edited by Mark D. Walters, Mickey M. Karram; Year: 1999; St. Louis: Mosby, c1999; ISBN: 0815136714 http://www.amazon.com/exec/obidos/ASIN/0815136714/icongroupin terna
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Urogynecology and reconstuctive pelvic surgery. Author: volume editor, J. Thomas Benson; with 14 contributors; Year: 2000; Philadelphia: Current Medicine; New York: McGraw-Hill, Health Professions Division, c2000; ISBN: 0838503209 http://www.amazon.com/exec/obidos/ASIN/0838503209/icongroupin terna
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Urogynecology. Author: edited by Gretchen M. Lentz; Year: 2000; London: Arnold; New York: Co-published in the USA by Oxford University Press, 2000; ISBN: 0340742305 (hb) http://www.amazon.com/exec/obidos/ASIN/0340742305/icongroupin terna
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Chapters on Urinary Incontinence Frequently, urinary incontinence will be discussed within a book, perhaps within a specific chapter. In order to find chapters that are specifically dealing with urinary incontinence, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and urinary incontinence using the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” By making these selections and typing in “urinary incontinence” (or synonyms) into the “For these words:” box, you will only receive results on chapters in books. The following is a typical result when searching for book chapters on urinary incontinence: ·
Urinary Frequency, Urgency, and Urge Incontinence Source: in Blaivas, J.G. Conquering Bladder and Prostate Problems: The Authoritative Guide for Men and Women. New York, NY: Plenum Publishing Corporation. 1998. p. 45-60. Contact: Available from Kluwer Academic-Plenum Publishing Corporation. 233 Spring Street, New York, NY 10013-1578. (800) 221-9369 or (212) 620-8035. Fax (212) 647-1898. Website: www.plenum.com. Price: $26.95. ISBN: 0306458640. Summary: Urinary frequency, urgency, and urge incontinence are a group of symptoms each of which may occur alone or, more commonly, in combination with one another. This chapter on urinary frequency, urgency, and urge incontinence is from a book for people who have urinary bladder and prostate problems: people who urinate too often, who plan their daily activities around the availability of a bathroom, men with prostate problems, women with incontinence, and people with bladder pain. The book is written in a clear, nontechnical, humorous style that makes the material more accessible to the lay reader. Urinary frequency (voiding too often) is probably the most common of all lower urinary tract symptoms. It may be caused by nothing more serious than drinking too much fluid, or it may be the only initial sign of diabetes or a urinary tract infection (UTI). Urinary urgency is the sudden feeling that one must urinate. Urge incontinence is the loss of urinary control because the urgency is so intense that one cannot hold back the urine. Urgency and urge incontinence are usually caused by involuntary contractions of the bladder. The most common cause is probably cystitis (bladder infection), but many other conditions can be responsible. After UTI, the
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most common causes include an enlarged prostate in men and sphincteric incontinence in women. The author discusses treatment options, including behavior modification, drug therapy, biofeedback, electrical stimulation, absorbent pads, and surgery. 1 table. ·
Injectable Agents for Urinary Incontinence Source: in Carson, C.C., III. Urologic Prostheses: The Complete Practical Guide to Devices, Their Implantation, and Patient Follow up. Totowa, NJ: The Humana Press, Inc. 2002. p. 29-42. Contact: Humana Press, Inc. 999 Riverview Dr., Suite 208 Totowa, NJ 07512. (973) 256-1699. Fax (973) 256-8341. E-mail:
[email protected] Price: $125.00, plus shipping and handling. ISBN: 0896038947. Summary: Injectable materials have been sporadically used for the treatment of urinary incontinence for many years. This chapter on injectable agents for urinary incontinence is from a text that was compiled to provide a broad view of prosthetic devices used in urologic surgery. The author discusses incontinence subdivided by a specific type of urethral dysfunction; data on the use of collagen; antegrade injection; results in children; the use of other agents; carbon steel particles; and technical details, including patient selection and injection methods for men and women, collagen techniques, and durasphere techniques. 4 figures. 52 references.
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Artificial Urinary Sphincter for Treatment of Male Urinary Incontinence Source: in Carson, C.C., III. Urologic Prostheses: The Complete Practical Guide to Devices, Their Implantation, and Patient Follow up. Totowa, NJ: The Humana Press, Inc. 2002. p. 263-284. Contact: Humana Press, Inc. 999 Riverview Dr., Suite 208 Totowa, NJ 07512. (973) 256-1699. Fax (973) 256-8341. E-mail:
[email protected] Price: $125.00, plus shipping and handling. ISBN: 0896038947. Summary: This chapter on the use of the artificial urinary sphincter (AUS) for treatment of male urinary incontinence (involuntary loss of urine) is from a text that was compiled to provide a broad view of prosthetic devices used in urologic surgery. The authors note that insertion of the AUS in the male is presently still the most effective treatment for stress incontinence secondary to sphincter dysfunction. The authors discuss indications and patient selection for artificial urinary sphincter implantation, surgical techniques, postoperative followup,
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potential problems, and results with the AMS800 artificial urinary sphincter. The authors conclude that the AMS800 has proved successful and effective in the short and long term. Meticulous care in the patient workup preoperatively and during insertion is necessary, however, if maximum success is to be met. And, to meet with continued success after insertion, the patients must be monitored closely as long as the device is in place. Patients and physicians should be aware of signs of potential problems, changes in voiding habits, or signs of voiding dysfunction or infection. 10 figures. 18 references. ·
Lifestyle Interventions in the Treatment of Urinary Incontinence Source: in Corcos, J.; Schick, E., eds. Urinary Sphincter. New York, NY: Marcel Dekker, Inc. 2001. p. 437-442. Contact: Available from Marcel Dekker, Inc. Cimarron Road, P.O. Box 5005, Monticello, NY 12701. (800) 228-1160 or (845) 796-1919. Fax (845) 796-1772. E-mail:
[email protected]. International E-mail:
[email protected]. Website: www.dekker.com. Price: $225.00 plus shipping and handling. ISBN: 0824704770. Summary: The urinary sphincter is the key to understanding both normal and abnormal function of the lower urinary tract. Its relationships with the bladder, the pelvic floor, and the bony structures of the pelvis are complex and incompletely understood. This chapter on lifestyle interventions in the treatment of urinary incontinence (UI) is from a textbook that presents a detailed and systematic account of the current knowledge on the anatomy, physiology, functional relationships, and range of dysfunctions that affect the urinary sphincter. Interventions often recommended by physicians include weight loss, changing activity, smoking cessation, and decreasing or changing fluid intake. In this chapter, the published evidence for recommending these and other lifestyle interventions are addressed. Although the data do strongly suggest that weight loss reduces incontinence in morbidly obese women, no studies have evaluated this intervention in the more commonly seen, moderately obese woman. Given current evidence, maintaining normal weight through adulthood may be an important factor in the prevention of incontinence. There is no strong evidence in the literature that associates smoking and incontinence in humans and no data have been reported concerning the effects of smoking cessation on incontinence. In addition, no randomized trials have assessed the effectiveness of caffeine restriction, fluid management, or dietary changes in the treatment of incontinence. Given that decreasing fluid intake may lead to urinary tract infections, constipation, or dehydration, this intervention should be reserved for patients with abnormally high fluid intakes. The author
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notes that further research is needed to delineate the role of straining with constipation and the pathogenesis (development) of incontinence. 32 references. ·
Urethral Injection Treatment for Stress Urinary Incontinence Source: in Corcos, J.; Schick, E., eds. Urinary Sphincter. New York, NY: Marcel Dekker, Inc. 2001. p. 497-515. Contact: Available from Marcel Dekker, Inc. Cimarron Road, P.O. Box 5005, Monticello, NY 12701. (800) 228-1160 or (845) 796-1919. Fax (845) 796-1772. E-mail:
[email protected]. International E-mail:
[email protected]. Website: www.dekker.com. Price: $225.00 plus shipping and handling. ISBN: 0824704770. Summary: Urethral injectable agents (drugs injected directly into the urethra, the opening from the bladder to outside the body) have been used to treat urinary incontinence (involuntary loss of urine) resulting from intrinsic sphincteric deficiency (ISD). This chapter on ISD is from a textbook that presents a detailed and systematic account of the current knowledge on the anatomy, physiology, functional relationships, and range of dysfunctions that affect the urinary sphincter. The injection of bulking agents into the urethra is a minimally invasive procedure that can be done in the physician's office, as compared to the surgical procedures that have been used to treat ISD. The authors discuss the proposed mechanism of action of urethral injectable agents, the selection of the appropriate patient, various types of bulking agents, nuances of injection technique, and the outcomes in different patient groups. The two most commonly used urethral injectable agents are collagen and autologous (from the patient) fat. Contraindications to urethral injection include untreated urinary tract infection (UTI), unmanaged detrusor instability, or known hypersensitivity to bovine (cow) collagen. The technique is best suited for patients who have ISD associated with minimal urethral hypermobility, an adequate bladder capacity, and a stable detrusor muscle. The procedure is well tolerated by patients and is associated with minimal morbidity, which is usually transient. The authors conclude that this minimally invasive procedure can offer hope for those patients who are elderly or are poor surgical candidates, and will not preclude a surgical procedure for those who desire a more aggressive treatment for their urinary incontinence in the future. 2 figures. 5 tables. 71 references.
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Intravaginal and Intraurethral Devices for Stress Incontinence Source: in Corcos, J.; Schick, E., eds. Urinary Sphincter. New York, NY: Marcel Dekker, Inc. 2001. p. 535-540.
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Contact: Available from Marcel Dekker, Inc. Cimarron Road, P.O. Box 5005, Monticello, NY 12701. (800) 228-1160 or (845) 796-1919. Fax (845) 796-1772. E-mail:
[email protected]. International E-mail:
[email protected]. Website: www.dekker.com. Price: $225.00 plus shipping and handling. ISBN: 0824704770. Summary: Recent technological advances and the adaptation of products that have traditionally been employed for other purposes have provided interesting options for the nonsurgical management of urinary loss in female patients. These devices include those that are placed externally to the urethral meatus (outside the urinary opening), and accomplish urinary collection; intravaginally beneath the bladder neck, and give anatomical support; or outside or within the urethra, and occlude the exit of urine either at the external meatus or within the urethra. This chapter on intravaginal and intraurethral devices for stress incontinence (involuntary loss of urine in conjunction with a stress such as coughing, sneezing, or laughing) is from a textbook that presents a detailed and systematic account of the current knowledge on the anatomy, physiology, functional relationships, and range of dysfunctions that affect the urinary sphincter. The authors report that many devices currently in use have not been investigated objectively, especially those employed traditionally for other purposes. The most common external collection devices are diapers, pads, and incontinence pads. Several occlusive devices are currently marketed, but their success and presence in the peer reviewed literature are limited. Support of the bladder neck to improve stress urinary incontinence has been achieved, with varying degrees of success, with tampons, pessaries, contraceptive diaphragms, and intravaginal devices not specifically designed for such support. Again, the research data to support the use of these devices is limited and of varying quality. Intraurethral inserts have demonstrated their effectiveness in the control of urinary incontinence. However, the morbidity (complications, problems) associated with their use varies with the design. The authors conclude by calling for more long term outcome research to identify which device or devices provide optimal convenience and effectiveness and the lowest morbidity in the nonsurgical correction of genuine stress incontinence. 26 references. ·
Urinary Incontinence Source: in Landau, L.; Kogan, B.A. 20 Common Problems in Urology. New York, NY: McGraw-Hill, Inc. 2001. p. 95-118. Contact: Available from McGraw-Hill, Inc. 1221 Avenue of the Americas, New York, NY 10020. (612) 832-7869. Website: www.bookstore.mcgrawhill.com. Price: $45.00;plus shipping and handling. ISBN: 0070634130.
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Summary: Urinary incontinence (involuntary loss of urine) has been estimated to affect approximately 13 million people in the United States, with an annual cost of more than 16 billion dollars. The prevalence of incontinence is higher in females and the elderly, but incontinence should not be considered normal in females nor considered a normal feature of aging. This chapter on urinary incontinence (UI) is from a text on common problems in urology (written for the primary care provider). The authors emphasize that UI not only affects the patient physically but psychologically as well; self-induced behavioral modifications can reduce social activities and degrade the patient's quality of life. The authors note that knowledgeable primary care providers can perform the initial evaluation and implement nonsurgical treatments with referral of more complicated patients or those who fail initial intervention. Topics include the definition of incontinence and classifications, including transient, stress, urge, mixed, continuous, and overflow incontinence, and nocturnal enuresis (bedwetting); evaluation of the patient with incontinence, including the history (key questions, the use of a voiding log, bowel patterns, and underlying medical problems), physical examination (abdominal exam, pelvic exam, Q tip test, stress maneuvers, and examination in men), diagnostic tests (uroflowmetry, urodynamics, and cystourethroscopy); treatment options for incontinence, including nonsurgical (behavioral and pharmacologic or drug therapy) and surgical treatment options including periurethral bulking and bladder suspension surgery. 12 figures. 7 tables. 15 references. ·
Interstitial Cystitis Source: in Dierich, M. and Froe, F. Overcoming Incontinence: A Straightforward Guide to Your Options. Somerset, NJ: John Wiley and Sons, Inc. 2000. p. 105-109. Contact: Available from John Wiley and Sons, Inc. Distribution Center, 1 Wiley Drive, Somerset, NJ 08875-1272. (800) 225-5945 or (732) 469-4400. Fax (732) 302-2300. E-mail:
[email protected]. Website: www.wiley.com. Price: $14.95 plus shipping and handling. ISBN: 0471347957. Summary: This chapter on interstitial cystitis (IC) is from a practical guide that dispels the many myths associated with urinary incontinence, offering readers information about the latest options for treatment, from simple lifestyle changes and exercises to devices, medications, and surgery. The authors emphasize that incontinence can be prevented, is almost always treatable, and is often curable. In this chapter, the authors describe IC, a painful, often debilitating, disease of the bladder. The symptoms are severe frequency, urgency, and pain in the lower abdomen or perineum that are relieved with urination. The authors cover
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diagnosis, theories about the cause of IC, and treatments. With the finding that the lining of the bladder is damaged in IC comes a drug that is marketed specifically for this disease: Elmiron (pentosan polysulfate). This drug helps bladder surface defense mechanisms to detoxify agents in the urine. Dimethylsulfoxide (DMSO) is also used to treat IC; this medication is placed into the bladder on a weekly basis, usually for 6 to 8 weeks, through a temporary catheter inserted in the bladder at the doctor's office. The other medications that are frequently used are heparin, steroids, and lidocaine. Infrequently, surgery is performed to treat IC. The authors encourage patients with IC to learn as much as they can about their disease and to be patient as they try different treatments to cope with this chronic problem. ·
Stress Incontinence in Women Source: in Blaivas, J.G. Conquering Bladder and Prostate Problems: The Authoritative Guide for Men and Women. New York, NY: Plenum Publishing Corporation. 1998. p. 85-106. Contact: Available from Kluwer Academic-Plenum Publishing Corporation. 233 Spring Street, New York, NY 10013-1578. (800) 221-9369 or (212) 620-8035. Fax (212) 647-1898. Website: www.plenum.com. Price: $26.95. ISBN: 0306458640. Summary: This chapter on stress incontinence in women is from a book for people who have urinary bladder and prostate problems: people who urinate too often, who plan their daily activities around the availability of a bathroom, men with prostate problems, women with incontinence, and people with bladder pain. The book is written in a clear, nontechnical, humorous style that makes the material more accessible to the lay reader. The author uses the story of one woman's experiences with stress incontinence to describe how the condition can develop and what can be done about it. Topics covered include prolapse (the sagging of the bladder and urethra), the indications for treatment, the surgical treatment of stress incontinence, and the nonsurgical treatments for stress urinary incontinence, including medications, biofeedback, electrical stimulation, pelvic floor exercises, bladder neck prosthesis, and absorbent pads. The six categories of surgery for stress incontinence are based on the same common principle: to restore the support of the bladder and urethra so that they don't fall down again, and to provide a kind of backboard against which the urethra is compressed during stress. The six categories are vaginal suspensions, needle suspensions, retropubic suspensions, pubovaginal sling operations, prosthetic sphincters, and periurethral injections. The author focuses on the components of decision making for stress incontinence surgery, including the patient's needs, overall health
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(including presence of obesity), and the cause of the incontinence. Each type of surgery is illustrated with a line drawing. 8 figures. ·
Rectus Muscle Sling Procedure for Severe Stress Urinary Incontinence Source: in Graham, S.D., Jr., et al., eds. Glenn's Urologic Surgery. 5th ed. Philadelphia, PA: Lippincott Williams and Wilkins. 1998. p. 357-360. Contact: Available from Lippincott Williams and Wilkins. P.O. Box 1600, Hagerstown, MD 21741. (800) 638-3030 or (301) 714-2300. Fax (301) 8247390. Website: lww.com. Price: $199.00 plus shipping and handling. ISBN: 0397587376. Summary: Type III stress urinary incontinence results from intrinsic dysfunction of the urethra and bladder neck incompetence. Effective surgical repair must restore closure of the deficient urethra. This chapter on the rectus muscle sling procedure used for severe stress urinary incontinence (SUI) is from an exhaustive textbook on urologic surgery. Current surgical techniques include the use of fascial slings, vaginal island slings, artificial urinary sphincter, or periurethral injections. Traditional indications would reserve sling procedures for those who have failed a primary surgical repair. In contemporary practice, the sling is also used as a primary procedure for patients with severe SUI. Clinical features would include leakage with a flood that occurs instantly with the first cough in a supine position, that occurs with a comfortably full bladder, or that occurs while standing without provocation. The authors detail the surgical technique using a combined abdominal and vaginal approach. Complications from this operation are few, but can include superficial wound infection and pelvic abscess. The authors note that voiding is quite normal for many of these patients after rectus muscle sling, and there are few complaints of irritative symptoms. 3 figures. 1 reference.
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Cystocele Source: in Graham, S.D., Jr., et al., eds. Glenn's Urologic Surgery. 5th ed. Philadelphia, PA: Lippincott Williams and Wilkins. 1998. p. 361-371. Contact: Available from Lippincott Williams and Wilkins. P.O. Box 1600, Hagerstown, MD 21741. (800) 638-3030 or (301) 714-2300. Fax (301) 8247390. Website: lww.com. Price: $199.00 plus shipping and handling. ISBN: 0397587376. Summary: A cystoscele is herniation of the urinary bladder through the weakened supportive fascia of the anterior vaginal compartment. Cystocele is one of the manifestations of pelvic floor relaxation and prolapse. This chapter on cystocele and its surgical correction is from an
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exhaustive textbook on urologic surgery. The authors stress it is important to ascertain the level of sphincteric competence preoperatively in any patient undergoing cystocele repair. The repair of cystocele is based on several factors: the presence or absence of urinary incontinence, the grade of the cystocele, the inherent pathophysiological fascial weakness (central or lateral), the bladder's emptying ability, and the associated vaginal or abdominal pathology to be repaired. The authors describe the surgical techniques used, including combined repair of lateral and central defects with mesh and vaginal wall sling, repair of lateral defect (six corner bladder suspension), and repair of a central defect. Complications associated with cystocele repair can be avoided by careful attention to detail during dissection of the cystocele and passage of the ligature carrier. Careful cystoscopic evaluation intraoperatively should alert the surgeon to many other potential complications. Postoperative bladder instability is a well documented complication of cystocele repair. Other potential complications are persistent pain, infection, bleeding, recurrent incontinence, vaginal stenosis or shortening, vesicovaginal fistula, ureterovaginal fistula, and dyspareunia (pain during sexual intercourse). 5 figures. 8 references.
Directories In addition to the references and resources discussed earlier in this chapter, a number of directories relating to urinary incontinence have been published that consolidate information across various sources. These too might be useful in gaining access to additional guidance on urinary incontinence. The Combined Health Information Database lists the following, which you may wish to consult in your local medical library:29 ·
Continence Specialists Registry: A Guide to Professional Continence Providers Source: Philadelphia, PA: Access to Continence Care and Treatment, Inc. (ACCT). 1996. 250 p.
You will need to limit your search to “Directories” and urinary incontinence using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find directories, use the drop boxes at the bottom of the search page where “You may refine your search by”. For publication date, select “All Years”, select language and the format option “Directory”. By making these selections and typing in “urinary incontinence” (or synonyms) into the “For these words:” box, you will only receive results on directories dealing with urinary incontinence. You should check back periodically with this database as it is updated every three months.
29
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Contact: Available from Access to Continence Care and Treatment, Inc. (ACCT). Ben Franklin House, 834 Chestnut Street, Suite T-171, Philadelphia, PA 19107. (215) 923-1492. Fax (215) 923-9024. Price: $100.00 plus $1.75 shipping and handling. Summary: This directory lists over 300 health care professionals who provide direct patient services in the area of urinary incontinence (UI). Registry listings include doctors, nurses, nurse practitioners, clinical nurse specialists, and physical and occupational therapists. The publication is designed to meet the need for referral and networking resources by UI practitioners and insurers, as well as to serve as a reference tool for the health profession in general. The main listing includes a list of programs (ranging from private practice to large urban hospital clinics), the contact information, staff titles, continence services provided, specialties, the site of practice, affiliations, and comments. Extensive indexes are also provided: personal names of providers, location, provider specialties, and services provided. Programs and individuals included were referred to the Registry or submitted their own entries; professional readers are invited to participate in future editions of the directory. ·
Who? What? Where?: Resources for women's health and aging Source: Bethesda, MD: National Institute on Aging, U.S. Department of Health and Human Services. 1992. 82 pp. Contact: Available from National Institute on Aging Information Center, P.O. Box 8057, Gaithersburg, MD 20898-8057. Telephone: (301) 587-2528 or (800) 222-2225 or (800) 222-4225 TDD / fax: (301) 589-3014 / e-mail:
[email protected] / Web site: http://www.nih.gov/nia. Available at no charge. Summary: This directory lists resources available to women which can help them cope with the processes of aging. The first section provides resources for health promotion and prevention. Topics included here are skin care, nutrition and exercise, and menopause. The second section concentrates on common disorders associated with age such as osteoporosis, urinary incontinence, cancer, and heart disease. The third section focuses on other aspects of women's lives such as widowhood, finances, and caregiving. The final sections provided information on women's health research and other organizations and readings.
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General Home References In addition to references for urinary incontinence, you may want a general home medical guide that spans all aspects of home healthcare. The following list is a recent sample of such guides (sorted alphabetically by title; hyperlinks provide rankings, information, and reviews at Amazon.com): · Urodynamics Made Easy by Christopher R. Chapple, Scott A. MacDiarmid; Paperback -- 2nd edition (April 15, 2000), Churchill Livingstone; ISBN: 0443054630; http://www.amazon.com/exec/obidos/ASIN/0443054630/icongroupinterna
Vocabulary Builder Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Abscess: A localized collection of pus caused by suppuration buried in tissues, organs, or confined spaces. [EU] Contraceptive: conception. [EU]
An agent that diminishes the likelihood of or prevents
Dehydration: The condition that results from excessive loss of body water. Called also anhydration, deaquation and hypohydration. [EU] Diaphragm: The musculofibrous partition that separates the thoracic cavity from the abdominal cavity. Contraction of the diaphragm increases the volume of the thoracic cavity aiding inspiration. [NIH] Dyspareunia: Difficult or painful coitus. [EU] Fathers: Male parents, human or animal. [NIH] Fistula: An abnormal passage or communication, usually between two internal organs, or leading from an internal organ to the surface of the body; frequently designated according to the organs or parts with which it communicates, as anovaginal, brochocutaneous, hepatopleural, pulmonoperitoneal, rectovaginal, urethrovaginal, and the like. Such passages are frequently created experimentally for the purpose of obtaining body secretions for physiologic study. [EU] Heparin: Heparinic acid. A highly acidic mucopolysaccharide formed of equal parts of sulfated D-glucosamine and D-glucuronic acid with sulfaminic bridges. The molecular weight ranges from six to twenty thousand. Heparin occurs in and is obtained from liver, lung, mast cells, etc., of vertebrates. Its function is unknown, but it is used to prevent blood
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clotting in vivo and vitro, in the form of many different salts. [NIH] Hypersensitivity: A state of altered reactivity in which the body reacts with an exaggerated immune response to a foreign substance. Hypersensitivity reactions are classified as immediate or delayed, types I and IV, respectively, in the Gell and Coombs classification (q.v.) of immune responses. [EU] Idiopathic: Of the nature of an idiopathy; self-originated; of unknown causation. [EU] Incompetence: Physical or mental inadequacy or insufficiency. [EU] Lidocaine: A local anesthetic and cardiac depressant used as an antiarrhythmia agent. Its actions are more intense and its effects more prolonged than those of procaine but its duration of action is shorter than that of bupivacaine or prilocaine. [NIH] Micturition: The passage of urine; urination. [EU] Osteoporosis: Reduction in the amount of bone mass, leading to fractures after minimal trauma. [EU] Stenosis: Narrowing or stricture of a duct or canal. [EU]
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CHAPTER 7. MULTIMEDIA ON URINARY INCONTINENCE Overview Information on urinary incontinence can come in a variety of formats. Among multimedia sources, video productions, slides, audiotapes, and computer databases are often available. In this chapter, we show you how to keep current on multimedia sources of information on urinary incontinence. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine. If you see an interesting item, visit your local medical library to check on the availability of the title.
Video Recordings Most diseases do not have a video dedicated to them. If they do, they are often rather technical in nature. An excellent source of multimedia information on urinary incontinence is the Combined Health Information Database. You will need to limit your search to “video recording” and “urinary incontinence” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Videorecording (videotape, videocassette, etc.).” By making these selections and typing “urinary incontinence” (or synonyms) into the “For these words:” box, you will only receive results on video productions. The following is a typical result when searching for video recordings on urinary incontinence:
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Management of Urinary Incontinence in Long-Term Care Source: Baltimore, MD: University of Maryland at Baltimore School of Medicine. 1996. (videocassette). Contact: Available from Video Press, University of Maryland at Baltimore School of Medicine. Suite 133, 100 Penn Street, Baltimore, MD 21201-1082. (800) 328-7450 or (410) 706-5497. Fax (410) 706-8471. Price: $100.00 for 2-week rental; $300.00 for purchase. Summary: Greater than 75 percent of long-term care residents are affected by incontinence. The impact of this problem profoundly affects residents as well as staff. In this videotape, the Johns Hopkins team presents specific management programs that can minimize incontinence. Team roles of the physician, nurse, and nursing assistant are examined, with emphasis on the essential contributions of the nursing assistant. Topics include evaluation of residents to identify potential causes, documentation, behavioral interventions, and other management programs. Support print materials include bladder record sample, short assessment form, and behavioral instructions. (AA-M).
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Bladder Leakage (Urinary Incontinence): Don't Suffer in Silence! Source: Royal Palm Beach, FL: Hepworth International, Inc. 1996. (videocassette). Contact: Available from SRS Medical Systems, Inc. 14950 NE 95th Street, Redmond, WA 98052. (800) 345-5642 or (425) 882-1101. Price: $19.95 each. Item number 4632B. Summary: This videotape program educates the public about treatments for bladder leakage. The program features experts in the field of urinary incontinence (UI) explaining the various treatment options. Topics covered include the types and causes of bladder leakage, prevention strategies (particularly before and after surgery, including childbirth), a structured program of pelvic muscle exercises (Kegels), foods and beverages that cause frequent urination, how to control the urge to urinate, treatment options including surgery and drug therapy, and where to find additional help and information. The program emphasizes that education and knowledge are the first steps toward successful treatment. The video comes with a self-test that helps viewers determine if they are a candidate for medical treatment for bladder leakage (UI). This viewer insert also lists beverages and foods to avoid if UI is a problem. (AA-M).
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Surgery for Urinary Incontinence in Women Source: Timonium, MD: Milner-Fenwick, Inc. 1995. Contact: Available from Milner-Fenwick, Inc. 2125 Greenspring Drive, Timonium, MD 21093. (800) 432-8433. Fax (410) 252-6316. Price: $175 (as of 1995). Order Number OB-135. Summary: This patient education videotape is for female patients with stress incontinence who are being recommended for surgery. The program describes the various operations that may be performed and their associated length of recovery in hospital or at home. Techniques include the open abdominal, laparoscopic, and vaginal approaches to bladder surgery. The program also provides general information on the risks involved with bladder surgery, including infection, bleeding, reaction to anesthesia, injury to the bladder or urethra, and difficulty urinating. The videotape depicts a patient discussing these options with her physician. This video is also available with closed captioning. (AAM).
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Treating Urinary Incontinence: A Guide to Behavioral Methods for Patients and Caregivers Source: Charlottesville, VA: Family Health Media. 1994. Contact: Available from Family Health Media. P.O. Box 1842, Charlottesville, VA 22903. (800) 366-3641. Fax (804) 296-2289. Price: $99 plus $5 shipping and handling (as of 1995); free preview available. ISBN: 1885279019. Summary: This patient education videotape presents an overview of the behavioral methods used to treat urinary incontinence. Topics covered include the anatomy and physiology of the urinary system; urge versus stress incontinence; pelvic muscle exercises; bladder training; and dietary recommendations. The accompanying teacher's guide is designed to help in the preparation of in-service programs. It contains program objectives, an outline of the video content, pre-and post-tests, a glossary of terms used in the video, and a bibliography. Also included is a fact sheet based on the content of the video. The fact sheet illustrates and summarizes pelvic muscle exercises, and summarizes bladder training and dietary factors. There is room on the fact sheet for the educator to enter comments or instructions specific to each patient's needs.
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Burch Colposuspension for Genuine Stress Incontinence Source: Atlanta, GA: Emory University Office of Medical Television. 1993. (videocassette).
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Contact: Available from Robert W. Woodruff Health Sciences Center, Emory University. Office of Medical Television, 1364 Clifton Road, Box M-16, Atlanta, GA 30322. (404) 727-9797. Fax (404) 727-9798. Price: $75.00 (as of 1996). Also available for rental; contact producer for current fee. Item Number 93-12. Summary: This videocassette familiarizes gynecologists with the Burch colposuspension for genuine stress incontinence. The narrator, Dr. Anne Wiskind, first defines genuine stress incontinence and discusses nonsurgical treatment modalities (including pelvic floor exercises, vaginal cones, biofeedback, and electrical stimulation of the pelvic floor). The Burch colposuspension is then reviewed in detail, including the indications for the procedure, the preoperative evaluation of candidates, the technical details of the procedure, how it works to correct urinary incontinence, postoperative care, and postoperative complications and their management. In conclusion, Dr. Wiskind discusses cure rates and the treatment of postoperative voiding dysfunction. (AA-M). ·
Urinary Incontinence in Elderly Women Source: Chapel Hill, NC: Health Sciences Consortium. 1992. Contact: Available from Health Sciences Consortium. Distribution Department, 201 Silver Cedar Court, Chapel Hill, NC 27514-1517. (919) 942-8731. Fax (919) 942-3689. Price: $276.50 for HSC members, $395 for nonmembers (as of 1996). Item Number C920-VI-049. Rentals: $55 (HSC members); $80 (nonmembers). Summary: Urinary incontinence is a problem for many elderly people, especially women. This videotape program describes ways to help people manage their urinary incontinence, critiques incontinence supplies, and reviews issues of concern for health professionals. The program also covers the types of incontinence and treatment options for each. (AA-M).
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Leg Bags for Managing Urinary Incontinence Source: Libertyville, IL: Hollister Incorporated. 1992. (videocassette). Contact: Available from Hollister Incorporated. 2000 Hollister Drive, Libertyville, IL 60048. (800) 323-4060. Price: Single copy free. Summary: This videotape program familiarizes nurses with the use of urinary leg bags for people with urinary incontinence (UI). The program covers the incidence of UI, etiologic considerations, and the three primary types of UI; for each type, the etiology and treatment are covered. The program then notes the various products available from the Hollister company, focusing on the urinary leg bag. The features of the two types
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of urinary leg bag (vented and nonvented) are outlined. The program also includes a brief discussion of clinical applications for the leg bag in addition to male UI. ·
Management of Female Stress Incontinence Source: Bellaire, TX: American Urological Association (AUA) Office of Education. 1992. (videocassette). Contact: Available from Karol Media. 350 North Pennsylvania Avenue, P.O. Box 7600, Wilkes-Barre, PA 18773-7600. (800) 608-0096. Fax (717) 8228226. Price: $20.00. Item number 919-2065. Summary: This videocassette program, one of a series from the American Urological Association, presents seven surgical techniques for the management of female urinary stress incontinence. Included are bone fixation technique for transvaginal needle suspension; four-corner bladder suspension in the treatment of moderate cystocele; treatment of female diverticulum complicated by stress urinary incontinence; periurethral injection of cross-linked collagen; transvaginal placement of artificial urinary sphincter; and sling procedures in women. The video also features interviews with four of the urologists, who describe patient indications, details of the procedures they performed, and potential complications.
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Periurethral Injection of Cross-Linked Collagen for Urinary Incontinence: An Investigational Device Source: Purchase, NY: P.C. Communication, Inc. 1990. Contact: Available from VideoUrology Times Inc. 270 Madison Avenue, New York, NY 10016. (800) 342-8244. (One of six video presentations comprising a videocassette program representing Program 1 of Volume 3 of VideoUrology. Price: $59.95 for 6-title set; $150 for 24-title set. Summary: This program, from a video journal on urology, demonstrates the technique of periurethral injection of collagen for increasing urethral resistance to the flow of urine in patients with incontinence. (AA-M).
Audio Recordings The Combined Health Information Database contains abstracts on audio productions. To search CHID, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find audio productions, use the drop boxes at the bottom of the search page where “You may refine your
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search by.” Select the dates and language you prefer, and the format option “Sound Recordings.” By making these selections and typing “urinary incontinence” (or synonyms) into the “For these words:” box, you will only receive results on sound recordings (again, most diseases do not have results, so do not expect to find many). The following is a typical result when searching for sound recordings on urinary incontinence: ·
Urinary Incontinence: The Scope of the Problem-The Solutions on the Horizon Source: Dumont, NJ: Center for Bio-Medical Communication, Inc. 1997. (audiocassette). Contact: Available from Center for Bio-Medical Communication, Inc. 80 West Madison Avenue, Dumont, NJ 07628. (201) 385-8080. Price: Single copy free. Summary: This audiotape and accompanying monograph present highlights of a roundtable convened to identify and evaluate current and future therapies for urinary incontinence (UI), particularly UI due to the overactive bladder. Current concepts related to epidemiology, pathophysiology, diagnosis, monitoring, and treatment are presented. The pros and cons of current treatment options are weighted, and special considerations in the elderly, community-dwelling individuals, and institutionalized individuals are addressed. Among the therapies discussed are behavioral modification, pharmacologic treatments, electrical stimulation, and surgery. UI affects approximately 13 million Americans, or 6 percent of the population, and costs the US economy $16 billion per year. The prevalence of the disorder increases progressively with age. At present, no validated, reproducible, well accepted efficacy instruments are available for the assessment of treatment outcomes in patients with UI. Primary outcome measures include the patient's own assessment of success, the number of incontinent episodes, volume of urine loss, and type of incontinence. UI is common in the elderly population, and the disorder tends to be more complex than in younger individuals. Electrical stimulation has been used to manage both bladder and urethral dysfunction in individuals with UI. When conservative management of detrusor instability (DI) is unsuccessful, surgical intervention may be indicated to control chronic, intractable symptoms or to circumvent the effects of a contracted bladder. Behavioral therapy for UI assumes that some individuals with incontinence can relearn continence control. In patients who are institutionalized, behavioral therapy may not control UI, but these techniques can be expected to reduce the severity of UI and improve the quality of life for the patient. Pharmacologic therapy for improving urine storage may be directed
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toward inhibiting bladder contractility, reducing sensory input, or increasing bladder capacity. The program requires a total of 150 minutes of study time and is approved for 2.5 CME credits. (AA-M). ·
Pelvic Muscle Exercises: Audio Cassette Tape and Manual Source: Spartanburg, SC: National Association for Continence (NAFC). 199x. (audiocassette and manual). Contact: Available from National Association for Continence (NAFC). P.O. Box 8310, Spartanburg, SC 29305-8310. (800) BLADDER or (864) 5797900. Fax (864) 579-7902. Price: $6.00 plus $2.00 shipping and handling (as of 1996). Item number 316. Summary: This booklet and audiocassette package presents an overview of pelvic muscle training for urinary incontinence. Topics include the types of urinary incontinence, the causes of urinary incontinence, the anatomy of the male and female pelvic floor muscles, the use of pelvic muscle training in preventing and treating incontinence, how to know when the appropriate muscles are being exercised, when and how frequently the exercises should be done, and the types of results to expect. Specific exercises, separated into easy and difficult exercises, are described and illustrated in the booklet. The program concludes with some helpful hints for lifting and for rising from a reclining position without straining the stomach muscles. The package is designed to be most useful to women with mild to moderate stress and urge incontinence.
Bibliography: Multimedia on Urinary Incontinence The National Library of Medicine is a rich source of information on healthcare-related multimedia productions including slides, computer software, and databases. To access the multimedia database, go to the following Web site: http://locatorplus.gov/. Select “Search LOCATORplus.” Once in the search area, simply type in urinary incontinence (or synonyms). Then, in the option box provided below the search box, select “Audiovisuals and Computer Files.” From there, you can choose to sort results by publication date, author, or relevance. The following multimedia has been indexed on urinary incontinence. For more information, follow the hyperlink indicated: ·
Abdominal colposacropexy and vaginal sacrospinus suspension. Source: [presented by] Glaxo; produced by Ciné-Med; Year: 1994; Format: Videorecording; Research Triangle Park, NC: Glaxo, c1994
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Adult anal atresia with perineal fistula. Source: from the Film Library and the Clinical Congress of ACS; Year: 1998; Format: Videorecording; [Woodbury, Conn.]: Ciné-Med, [1998]
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Anatomy and the Marshall-Marchetti-Krantz. Source: the University of Texas Medical School at Houston; produced by UT-TV Houston; Year: 1992; Format: Videorecording; [Houston, Tex.]: The School, c1992
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Appendico-vesicostomy : Mitrofanoff continence mechanism. Source: American College of Surgeons; produced by Ciné-Med; Year: 1994; Format: Videorecording; [United States]: American Cyanamid Corp., c1994
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Burch colposuspension for genuine stress incontinence. Source: [presented by] the Emory Medical Television Network, Emory University School of Medicine of the Robert W. Woodruff Health Sciences Center; Year: 1993; Format: Videorecording; Atlanta, Ga.: The University, c1993
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Compendium of surgical procedures for female stress incontinence. Source: Brigham and Women's Hospital [and] Medical Video Services; Year: 1992; Format: Videorecording; Washington, DC: American College of Obstetricians & Gynecologists, [1992]
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Fascia lata and rectus fascial sling procedures for type III stress incontinence. Source: Kaiser Permanente, Southern California Permanente Medical Group; Year: 1991; Format: Videorecording; [Los Angeles, Calif.: s.n., 1991]
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Female incontinence. Source: a co-production of the Regional Audio Visual Center and Physician Education & Development; Year: 1996; Format: Videorecording; [Oakland, Calif.]: Kaiser Foundation Health Plan, c1996
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Four corner bladder neck suspension for urinary stress incontinence associated with a moderate cystocele. Source: Kaiser Permanente, Southern California Permanente Medical Group; Wexler Films; Year: 1993; Format: Videorecording; Los Angeles: Kaiser Permanente Medical Center, c1993
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Laparoscopic Burch and paravaginal defect repair. Source: [presented by] the American College of Obstetricians and Gynecologists; the Cleveland Clinic Foundation; Year: 1998; Format: Videorecording; [Cleveland, Ohio]: The Foundation, c1998
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Laparoscopic paravaginal repair & Burch colposuspension. Source: the American College of Obstetricians and Gynecologists, Giro Studio; Year: 2000; Format: Videorecording; Washington, DC: The College, [2000]
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Living with incontinence. Source: a presentation of Films for the Humanities & Sciences; Information Television Network; Year: 2000;
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Format: Videorecording; Princeton, N.J.: Films for the Humanities and Sciences, c2000 ·
Management of urinary incontinence in long-term care. Source: a Whiteford-Cohen production; produced and distributed by Video Press, University of Maryland, School of Medicine; Year: 1996; Format: Videorecording; Baltimore, Md.: Video Press, c1996
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Management strategies for the incontinent ambulatory elderly. Source: a Whiteford-Cohen production; produced and distributed by Video Press, the University of Maryland, School of Medicine; Year: 1996; Format: Videorecording; Baltimore, Md.: Video Press, c1996
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Medical and surgical management of urinary incontinence. Source: [presented by] the American College of Obstetricians and Gynecologists; produced by Ciné-Med; Year: 1993; Format: Videorecording; Woodbury, Conn.: Ciné-Med, c1993
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Modified transvaginal fascia lata sling for stress incontinence. Source: American College of Obstetricians & Gynecologists, SGS, the Society of Gynecologic Surgeons, Inc.; produced by Ciné-Med; Year: 1996; Format: Videorecording; Washington, DC: The College, c1996
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Operative procedure for total urinary incontinence. Source: [presented by] the United States Army; Year: 1951; Format: Motion picture; United States: The Army, 1951
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Paravaginal repair of cystourethrocele. Source: American College of Obstetricians and Gynecologists; produced by Davis + Geck, American Cyanamid Company; Year: 1981; Format: Videorecording; Danbury, Conn.: The Company, c1981
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Stress incontinence treated by the tension-free vaginal tape method. Source: the American College of Obstetricians and Gynecologists; Year: 1999; Format: Videorecording; Washington, DC: The College, [1999]
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Suburethral sling using pubic bone fixation. Source: the American College of Obstetricians and Gynecologists; Year: 2000; Format: Videorecording; Washington, DC: The College, [2000]
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Surgical correction of urethral kinking and funneling accompanying hypermotile urethra in massive vaginal eversion. Source: an educational service provided by DG, Davis+Geck; produced by CinéMed; Year: 1994; Format: Videorecording; [Wayne, N.J.]: American Cynamid Co., c1994
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Thelma Wells, Ph. D., University of Rochester School of Nursing : the treatment of urinary incontinence in women. Source: Mosby Year Book, Samuel Merritt College, Studio Three Productions; [presented by] Sigma Theta Tau International; Year: 1993; Format: Videorecording; St. Louis, Mo.: Mosby-Year Book, c1993
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Transvaginal repair of urinary stress incontinence associated with a large cystocele. Source: Kaiser Permanente, Southern California Permanente Medical Group; Wexler Films; Year: 1992; Format: Videorecording; Los Angeles: Kaiser Permanente Medical Center, c1992
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Treating urinary incontinence : a guide to behavioral methods. Source: Family Health Media; Year: 1994; Format: Videorecording; Charlottesville, VA: Family Health Media, c1994
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Urinary incontinence in adults. Source: [presented by] Medcom; Year: 1996; Format: Videorecording; Cypress, CA: Medcom, c1996
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Vaginal suburethral sling procedure. Source: DG, Davis+Geck; produced by Cine´-Med; Year: 1993; Format: Videorecording; Woodbury, Conn.: American Cyanamid Co., c1993
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Video assisted extraperitoneal laparoscopic bladder neck suspension (VELBNS). Source: an educational service provided by DG Davis+Geck; produced by Ciné Med; Year: 1994; Format: Videorecording; [United States]: American Cyanamid Co., c1994
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What's new in diagnosis and treatment of urinary stress incontinence. Source: American College of Surgeons; Year: 1991; Format: Sound recording; [Chicago, Ill.]: The College, [1991]
Vocabulary Builder Diverticulum: A pathological condition manifested as a pouch or sac opening from a tubular or sacular organ. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH]
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CHAPTER 8. PERIODICALS AND NEWS ON URINARY INCONTINENCE Overview Keeping up on the news relating to urinary incontinence can be challenging. Subscribing to targeted periodicals can be an effective way to stay abreast of recent developments on urinary incontinence. Periodicals include newsletters, magazines, and academic journals. In this chapter, we suggest a number of news sources and present various periodicals that cover urinary incontinence beyond and including those which are published by patient associations mentioned earlier. We will first focus on news services, and then on periodicals. News services, press releases, and newsletters generally use more accessible language, so if you do chose to subscribe to one of the more technical periodicals, make sure that it uses language you can easily follow.
News Services & Press Releases Well before articles show up in newsletters or the popular press, they may appear in the form of a press release or a public relations announcement. One of the simplest ways of tracking press releases on urinary incontinence is to search the news wires. News wires are used by professional journalists, and have existed since the invention of the telegraph. Today, there are several major “wires” that are used by companies, universities, and other organizations to announce new medical breakthroughs. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing.
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PR Newswire Perhaps the broadest of the wires is PR Newswire Association, Inc. To access this archive, simply go to http://www.prnewswire.com. Below the search box, select the option “The last 30 days.” In the search box, type “urinary incontinence” or synonyms. The search results are shown by order of relevance. When reading these press releases, do not forget that the sponsor of the release may be a company or organization that is trying to sell a particular product or therapy. Their views, therefore, may be biased. The following is typical of press releases that can be found on PR Newswire: ·
Stress Urinary Incontinence: Millions of Women Suffer In Silence Summary: Spartanburg, S.C., May 30 /PRNewswire/ -- A recent survey of more than 1,000 American women conducted by HarrisInteractive for the National Association For Continence (NAFC) found significant misconceptions and low awareness about stress urinary incontinence. The number of sufferers of stress incontinence -- the involuntary leakage of urine brought on by abdominal "stress" or pressure as a result of laughing, coughing, sneezing and physical activity -- is difficult to quantify because most women do not seek treatment. This week, medical professionals gathered at the American Urological Association's annual meeting in Orlando to discuss stress urinary incontinence and other urological disorders. The NAFC national survey showed that the problem affects nearly one third of American women over the age of 18. The NAFC survey examined current attitudes and awareness of stress incontinence among sufferers as well as women in general. NAFC found that very few women recognize stress incontinence as a legitimate medical condition. Eight out of 10 women mistakenly thought that the symptoms were a normal part of aging. "Involuntary urine leakage can strike women in the prime of their lives. Whether a woman is 30 or 60, she needs to be made aware of the fact that urine leakage is not normal. Urine leakage at any age is not acceptable," said Nancy Muller, executive director of the National Association For Continence. "Unfortunately, because the onset of symptoms is often gradual, many women learn to adjust and only wait until their symptoms become truly unbearable before seeking any help."
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Prevalence of Stress Incontinence Stress urinary incontinence is the most common form of urinary incontinence. It is a condition that primarily affects women. One quarter of the women surveyed, age 18 and older, reported experiencing leakage symptoms in the past month. Previous research suggested that the prevalence might be as high as one third of American women over the age of eighteen. Other key findings are: * Women mistakenly indicated that having too much sex and drinking too much water puts them at risk for developing these symptoms * Over half believe that stress incontinence symptoms affect only women over 50 * 40% of women with the condition reported that they began experiencing symptoms before age 40 * One in three women are not aware that the primary cause of stress incontinence is childbirth Pregnancy and childbirth are the leading causes of stress urinary incontinence. Other causes of stress incontinence include nerve and muscle damage, pelvic and abdominal surgery, and general loss of pelvic muscle tone. Additionally, obesity, smoking, constipation, menopause and lung disease can contribute to or put a woman at risk for the onset of stress incontinence.
Doctor-Patient Communications NAFC found that many women affected by the condition have never talked with a physician about the problem or have waited more than a year before consulting a doctor. Further, many of these women are not even talking to their family and friends. The majority of women simply learn to tolerate their symptoms because they think this is something that is supposed to happen to them. "Doctors need to know that embarrassment is a major issue for women with stress urinary incontinence," said Dr. Nicolette Horbach, Associate Clinical Professor of Obstetrics and Gynecology at George Washington University Medical Center and a practicing physician. "I personally suffered from stress incontinence following the birth of my son, which made it difficult for me to get down on the floor and run and play with
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him. I tell my patients, embarrassment shouldn't stop you from living your life." Coping Mechanisms "We receive calls from women every day whose lives have been totally disrupted by stress incontinence -- it affects careers, relationships and a woman's overall sense of herself," said Muller. "Sufferers tend to isolate themselves because they're afraid of going out and having an accident in public. Many cope with the symptoms by always wearing sanitary pads and avoiding favorite activities, like exercising, gardening or picking up a child. Women should not have to live this way." "Stress urinary incontinence disrupts your life in little and big ways -from having to wear dark clothes all the time to affecting intimacy," said Carolann Zuchowski, who suffered from SUI for five years before seeking help. "I remember one time I was dancing and, all of a sudden, my pants were soaked. At that point I figured my life had changed forever, and my dancing days were numbered." Knowledge About Options Research demonstrates that the large majority of women can be helped if they are properly diagnosed and seek treatment. Ignorance about options lies at the heart of so many millions avoiding corrective action. New insights into how the central nervous system functions are leading to discoveries -- both in medical devices and pharmaceuticals for the treatment of stress urinary incontinence. The most important thing a woman can do is take initiative to get educated, seek preventive steps and explore new advances in treatment as they are proven clinically and become commercially available. For more information about stress urinary incontinence, women can call 1-800-BLADDER (1-800-252-3337) or visit the National Association For Continence web site at http://www.nafc.org . The survey results are based on telephone interviews with a sample of 1,039 women age 18 or older. The survey was conducted by HarrisInteractive for NAFC under an unrestricted educational grant from Eli Lilly and Company.
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Reuters The Reuters’ Medical News database can be very useful in exploring news archives relating to urinary incontinence. While some of the listed articles are free to view, others can be purchased for a nominal fee. To access this archive, go to http://www.reutershealth.com/frame2/arch.html and search by “urinary incontinence” (or synonyms). The following was recently listed in this archive for urinary incontinence: ·
Medical Technology & Innovations gets FDA okay for urinary incontinence device Source: Reuters Industry Breifing Date: May 23, 2002 http://www.reuters.gov/archive/2002/05/23/business/links/20020523 rglt005.html
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Hysterectomy associated with urge incontinence Source: Reuters Medical News Date: March 29, 2002 http://www.reuters.gov/archive/2002/03/29/professional/links/20020 329clin015.html
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Mentor acquires stress incontinence implant from ProSurg Source: Reuters Industry Breifing Date: March 11, 2002 http://www.reuters.gov/archive/2002/03/11/business/links/20020311 inds007.html
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Sling surgery shows promise as treatment for male urinary incontinence Source: Reuters Medical News Date: February 20, 2002 http://www.reuters.gov/archive/2002/02/20/professional/links/20020 220clin008.html
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NicOx to begin US testing of urinary incontinence drug Source: Reuters Industry Breifing Date: January 07, 2002 http://www.reuters.gov/archive/2002/01/07/business/links/20020107 rglt003.html
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Tutogen, Mentor in new distribution deal for urinary incontinence graft Source: Reuters Industry Breifing Date: November 15, 2001 http://www.reuters.gov/archive/2001/11/15/business/links/20011115 inds006.html
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Collagen implant an alternative to surgery for stress incontinence Source: Reuters Industry Breifing Date: October 16, 2001 http://www.reuters.gov/archive/2001/10/16/business/links/20011016 clin009.html
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Estrogen replacement linked to urinary incontinence following hysterectomy Source: Reuters Medical News Date: October 08, 2001 http://www.reuters.gov/archive/2001/10/08/professional/links/20011 008epid004.html
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Natural menopause not a significant risk factor for urinary incontinence Source: Reuters Medical News Date: October 01, 2001 http://www.reuters.gov/archive/2001/10/01/professional/links/20011 001epid001.html
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Disagreement continues over best treatment for urge incontinence Source: Reuters Industry Breifing Date: August 17, 2001 http://www.reuters.gov/archive/2001/08/17/business/links/20010817 clin008.html
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Transdermal oxybutynin treats urge urinary incontinence with less side effects Source: Reuters Industry Breifing Date: July 13, 2001 http://www.reuters.gov/archive/2001/07/13/business/links/20010713 clin008.html
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Medicare to cover sacral nerve stimulation for urinary incontinence Source: Reuters Medical News Date: June 29, 2001 http://www.reuters.gov/archive/2001/06/29/professional/links/20010 629rglt010.html
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Medicare to cover novel treatment for urinary incontinence Source: Reuters Industry Breifing Date: June 29, 2001 http://www.reuters.gov/archive/2001/06/29/business/links/20010629 rglt009.html
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Anterior urethral stitch reduces urinary incontinence after radical prostatectomy Source: Reuters Medical News Date: May 15, 2001 http://www.reuters.gov/archive/2001/05/15/professional/links/20010 515clin002.html
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Protein Polymer partner to begin human trials of urinary incontinence drug in UK Source: Reuters Industry Breifing Date: May 01, 2001 http://www.reuters.gov/archive/2001/05/01/business/links/20010501 rglt004.html
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Estriol, pelvic floor muscle exercises may combat postmenopausal stress incontinence Source: Reuters Industry Breifing Date: April 20, 2001 http://www.reuters.gov/archive/2001/04/20/business/links/20010420 clin021.html
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"Sandwich" surgical technique promising for urinary stress incontinence Source: Reuters Medical News Date: February 14, 2001 http://www.reuters.gov/archive/2001/02/14/professional/links/20010 214clin014.html
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Urinary incontinence commonly follows hysterectomy Source: Reuters Medical News Date: August 14, 2000 http://www.reuters.gov/archive/2000/08/14/professional/links/20000 814clin007.html
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Urge incontinence increases risk of falls, fractures in elderly women Source: Reuters Medical News Date: July 18, 2000 http://www.reuters.gov/archive/2000/07/18/professional/links/20000 718epid010.html
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Successful phase II results for Sepracor's urinary incontinence therapy Source: Reuters Industry Breifing Date: June 20, 2000 http://www.reuters.gov/archive/2000/06/20/business/links/20000620 drgd001.html
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Urinary incontinence common, but underreported, among male veterans Source: Reuters Medical News Date: April 24, 2000 http://www.reuters.gov/archive/2000/04/24/professional/links/20000 424epid004.html
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Continuous magnetic stimulator effective in treatment of urinary incontinence Source: Reuters Medical News Date: February 01, 2000 http://www.reuters.gov/archive/2000/02/01/professional/links/20000 201drgd002.html
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Rochester Medical receives FDA approval for female urinary incontinence device Source: Reuters Medical News Date: October 04, 1999 http://www.reuters.gov/archive/1999/10/04/professional/links/19991 004rglt001.html
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Advanced UroScience gets FDA approval for urinary incontinence agent Source: Reuters Medical News Date: September 21, 1999 http://www.reuters.gov/archive/1999/09/21/professional/links/19990 921rglt002.html
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Age-related loss of striated muscle cells a cause of elderly urinary incontinence Source: Reuters Medical News Date: September 16, 1999 http://www.reuters.gov/archive/1999/09/16/professional/links/19990 916clin009.html
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Adult urinary incontinence linked to childhood enuresis Source: Reuters Medical News Date: August 03, 1999 http://www.reuters.gov/archive/1999/08/03/professional/links/19990 803epid002.html
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Female urinary incontinence device gets EU marketing approval Source: Reuters Medical News Date: July 23, 1999 http://www.reuters.gov/archive/1999/07/23/professional/links/19990 723rglt005.html
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Extracorporeal magnetic innervation therapy effective for stress incontinence Source: Reuters Medical News Date: June 09, 1999 http://www.reuters.gov/archive/1999/06/09/professional/links/19990 609drgd003.html
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Behavioral therapy should be first-line treatment for urge urinary incontinence Source: Reuters Medical News Date: December 16, 1998 http://www.reuters.gov/archive/1998/12/16/professional/links/19981 216clin004.html
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Alza acquires rights to urinary incontinence drug from SmithKline Source: Reuters Medical News Date: November 05, 1998 http://www.reuters.gov/archive/1998/11/05/professional/links/19981 105inds003.html
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Depression after stroke associated with urinary incontinence Source: Reuters Medical News Date: October 12, 1998 http://www.reuters.gov/archive/1998/10/12/professional/links/19981 012clin005.html
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Johnson & Johnson to distribute urinary incontinence product in Japan Source: Reuters Medical News Date: July 23, 1998 http://www.reuters.gov/archive/1998/07/23/professional/links/19980 723inds004.html
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Global guidelines for urinary incontinence Source: Reuters Health eLine Date: July 08, 1998 http://www.reuters.gov/archive/1998/07/08/eline/links/19980708elin 004.html
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WHO releases new guidelines for management of urinary incontinence Source: Reuters Medical News Date: July 07, 1998 http://www.reuters.gov/archive/1998/07/07/professional/links/19980 707plcy001.html
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Noninvasive stress urinary incontinence device effective Source: Reuters Medical News Date: June 11, 1998 http://www.reuters.gov/archive/1998/06/11/professional/links/19980 611drgd001.html
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New oxybutynin improves on current formulation for urge incontinence Source: Reuters Medical News Date: June 08, 1998 http://www.reuters.gov/archive/1998/06/08/professional/links/19980 608clin014.html
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Urinary incontinence linked to poor health and quality of life Source: Reuters Medical News Date: June 03, 1998 http://www.reuters.gov/archive/1998/06/03/professional/links/19980 603epid004.html
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Urinary incontinence affects psyche Source: Reuters Health eLine Date: June 02, 1998 http://www.reuters.gov/archive/1998/06/02/eline/links/19980602elin 011.html
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New Stress Urinary Incontinence Test Provides Rapid, Reliable Results Source: Reuters Medical News Date: May 05, 1998 http://www.reuters.gov/archive/1998/05/05/professional/links/19980 505clin009.html
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UroMed Patch For Stress Incontinence Cleared For OTC Sale To Women Source: Reuters Medical News Date: April 01, 1998 http://www.reuters.gov/archive/1998/04/01/professional/links/19980 401rglt002.html
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Subjective Assessment Of Urinary Incontinence Often Inaccurate Source: Reuters Medical News Date: March 27, 1998 http://www.reuters.gov/archive/1998/03/27/professional/links/19980 327clin011.html
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Pelvic Exercises Reduce Pregnancy-Related Urinary Incontinence Source: Reuters Medical News Date: March 02, 1998 http://www.reuters.gov/archive/1998/03/02/professional/links/19980 302clin007.html
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Postprostatectomy Radiation Does Not Cause Urinary Incontinence Source: Reuters Medical News Date: January 15, 1998 http://www.reuters.gov/archive/1998/01/15/professional/links/19980 115clin006.html
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Transurethral Collagen Injection Effective For Urinary Incontinence Source: Reuters Medical News Date: January 09, 1998 http://www.reuters.gov/archive/1998/01/09/professional/links/19980 109clin003.html
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New Treatment Guidelines Issued For Female Stress Incontinence Source: Reuters Medical News Date: June 26, 1997 http://www.reuters.gov/archive/1997/06/26/professional/links/19970 626plcy003.html
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Snoring Linked to Bed Wetting Source: Reuters Health eLine Date: May 30, 1997 http://www.reuters.gov/archive/1997/05/30/eline/links/19970530elin 004.html
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Urinary Incontinence Plus Pelvic Organ Prolapse Associated With Fecal Incontinence Source: Reuters Medical News Date: March 04, 1997 http://www.reuters.gov/archive/1997/03/04/professional/links/19970 304epid001.html
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Prevalence Of Remediable Urinary Incontinence High In Frail Elderly Source: Reuters Medical News Date: February 10, 1997 http://www.reuters.gov/archive/1997/02/10/professional/links/19970 210epid001.html
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Urinary Incontinence Treatment Guide Available Source: Reuters Medical News Date: September 19, 1996 http://www.reuters.gov/archive/1996/09/19/professional/links/19960 919prof006.html
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Electrical Stimulation "Promising" For MS-Associated Urinary Incontinence Source: Reuters Medical News Date: September 17, 1996 http://www.reuters.gov/archive/1996/09/17/professional/links/19960 917clin007.html
The NIH Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within their search engine.
Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com. You can scan the news by industry category or company name.
Internet Wire Internet Wire is more focused on technology than the other wires. To access this site, go to http://www.internetwire.com and use the “Search Archive” option. Type in “urinary incontinence” (or synonyms). As this service is oriented to technology, you may wish to search for press releases covering diagnostic procedures or tests that you may have read about.
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Search Engines Free-to-view news can also be found in the news section of your favorite search engines (see the health news page at Yahoo: http://dir.yahoo.com/Health/News_and_Media/, or use this Web site’s general news search page http://news.yahoo.com/. Type in “urinary incontinence” (or synonyms). If you know the name of a company that is relevant to urinary incontinence, you can go to any stock trading Web site (such as www.etrade.com) and search for the company name there. News items across various news sources are reported on indicated hyperlinks.
BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “urinary incontinence” (or synonyms).
Newsletters on Urinary Incontinence Given their focus on current and relevant developments, newsletters are often more useful to patients than academic articles. You can find newsletters using the Combined Health Information Database (CHID). You will need to use the “Detailed Search” option. To access CHID, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. Your investigation must limit the search to “Newsletter” and “urinary incontinence.” Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter.” By making these selections and typing in “urinary incontinence” or synonyms into the “For these words:” box, you will only receive results on newsletters. The following list was generated using the options described above: ·
Fat Injection Offers Another Alternative for Incontinence Tx Source: Urology Times. 22(3): 1, 24. March 1994. Contact: Available from Advanstar Communications, Inc. Corporate and Editorial Offices, 7500 Old Oak Boulevard, Cleveland, OH 44130. (216) 243-8100. Summary: This newsletter article report that 1-year results are making autologous fat injection look like a good alternative to surgery for stress urinary incontinence, possibly as good as collagen injection, but at lower
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cost and with less risk. Topics include results of a study in which 25 women have undergone the treatment; the need for second injections; complications encountered; the potential advantages of autologous fat over bovine collagen; the procedure itself; and patient selection issues. The researchers conclude that this promising procedure deserves further development and longer-term follow-up for analysis.
Newsletter Articles If you choose not to subscribe to a newsletter, you can nevertheless find references to newsletter articles. We recommend that you use the Combined Health Information Database, while limiting your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” By making these selections, and typing in “urinary incontinence” (or synonyms) into the “For these words:” box, you will only receive results on newsletter articles. You should check back periodically with this database as it is updated every 3 months. The following is a typical result when searching for newsletter articles on urinary incontinence: ·
New Approaches to Stress Incontinence Source: Harvard Women's Health Watch. 4(2): 7. October 1996. Contact: Available from Harvard Women's Health Watch. P.O. Box 420234, Palm Coast, FL 32142-0234. (800) 829-5921. Summary: This brief newsletter article reports on two recently approved devices for managing stress incontinence. Stress incontinence is the leakage of urine caused by increased pressure on the bladder from laughing, coughing, or exertion. Both devices are expected to be available by prescription within the next few months. The Miniguard, which received FDA clearance in May 1996, is a contoured adhesive-backed foam patch about the size of a postage stamp that fits over the opening of the urethra. The Reliance Urinary Control Insert, which was approved by the FDA in August 1996, is designed for women who have moderate to severe incontinence. It is a balloon-tipped plug about one-fifth the diameter of a tampon that is inserted into the urethra with an applicator. The force of insertion inflates the balloon so that it obstructs the neck of
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the bladder. The device should be removed and discarded before intercourse or urination by pulling the string. ·
New Therapy for Relief of Urinary Urge Incontinence Source: Quality Care. 16(1): 7. Winter 1998. Contact: Available from National Association for Continence. P.O. Box 8310, Spartanburg, SC 29305-8310. (800) 252-3337 or (864) 579-7900. Fax (864) 579-7902. Summary: People with urinary urge incontinence, 80 percent of whom are women, accidentally pass urine as soon as the urge is felt and often cannot control their bladder long enough to find a bathroom. This patient education newsletter article reviews a new type of therapy for urinary urge incontinence. A variety of treatments have been used for urge incontinence, including diet changes, pelvic muscle exercises, biofeedback, medications, and surgery. The new treatment is a long term therapy provided by a small electrical device called a stimulator, placed completely under the skin in the lower abdomen. The stimulator is connected to an electronic lead placed near the nerves in the sacrum (tailbone). The InterStim (Medtronic, Inc) system delivers mild electric pulses to the nerves that influence urinary function, helping to restore more normal urinary control. A urologist can perform a test stimulation period to help determine if a patient experiencing urge incontinence may benefit from this device. In this test, a temporary lead is placed in the sacrum, and an external test stimulator is connected to the temporary lead (this is done on an outpatient basis). Patients then return home for 5 to 7 days and keep a daily record of their urinary symptoms; if those symptoms are reduced or eliminated, then long term use of the InterStim is considered. Though not a cure for incontinence, InterStim has been shown to significantly reduce or eliminate symptoms for many people with urinary urge incontinence. 2 figures.
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Sexual Function and Urinary Incontinence Source: Quality Care. 19(4): 1,5. Fall 2001. Contact: Available from National Association for Continence. P.O. Box 8310, Spartanburg, SC 29305-8310. (800) 252-3337 or (864) 579-7900. Fax (864) 579-7902. Summary: This newsletter article helps women with urinary incontinence (UI) understand the impact of UI on sexual function. Some women experience loss of urine during sexual activity. Causes of leakage can include pelvic floor muscle weakness, overactive bladder contractions, or incomplete bladder emptying. With minimal arousal, the pelvic muscles
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can relax and allow drops of leakage. With penetration (intercourse) a woman may experience bladder contractions, or with orgasm, involuntary relaxation may cause a flood. When this happens, women may avoid sexual activity altogether. In addition, constant wetness from UI may lead to irritation in the vulvar area, and this can cause discomfort with sexual activity. This author offers strategies to prevent these problems, focusing on the surgical options. Surgery is an effective treatment option for some women with UI, particularly the stress type of incontinence (leaking provoked by physical stress such as coughing, sneezing, running, or jumping). Stress incontinence can occur in combination with pelvic organ prolapse (when the vagina, uterus, or bladder have lost support and dropped down). The author briefly describes the surgical techniques that are usually used for UI. The article concludes with four suggestions to help manage UI during sexual activity. ·
Acupuncture as a Treatment for Urinary Incontinence Source: Quality Care. 18(3): 3. Summer 2000. Contact: Available from National Association for Continence. P.O. Box 8310, Spartanburg, SC 29305-8310. (800) 252-3337 or (864) 579-7900. Fax (864) 579-7902. Summary: This brief article considers the role of acupuncture in the treatment of patients with urinary incontinence (involuntary loss of urine). There are two versions of acupuncture: traditional and modern. Traditional acupuncture believes that one part of the body cannot be treated alone; it must be considered and balanced. Treatment for urinary incontinence (UI) would be guided by conducting a patient history and performing two basic diagnostic tests: the examination of the tongue and the character of the pulse at the wrist. In traditional acupuncture, specific trigger points along the energy paths (meridians) are stimulated by inserting very small needles through the skin. Modern acupuncture differs from traditional in many ways. Instead of examining the pulse and the tongue, the practitioner performs the customary examination of the body with a more detailed physical exam, paying close attention to the trigger points. The practitioner may then use fewer needles for a shorter period of time. The article concludes with a brief discussion of what patients can expect after a sessions of acupuncture. An acute condition may respond in only one session. A chronic condition, like urinary incontinence, may take 6 to 12 sessions, each lasting about 30 to 60 minutes. The author concludes that the effect of acupuncture differs for each person and accumulates with time.
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Urinary Incontinence: Putting an End to the Embarrassment Source: Harvard Health Letter. 24(7): 6-7. May 1999. Contact: Available from Harvard Medical School Health Publications Group. Harvard Health Letter, P.O. Box 420300, Palm Coast, FL 321420300. (800) 829-9045. E-mail:
[email protected]. Summary: This newsletter article encourages readers to learn about urinary incontinence (UI) and seek health care for managing any UI problems. Although UI affects both women and men, it is more common in women, and it is not a problem just in older people. The author stresses that incontinence is not considered normal at any age, and it should not be seen as an inevitable part of growing older. However, many people are too embarrassed to discuss the problem with a doctor, so they resign themselves to wearing adult diapers or pads. Fortunately, incontinence can be treated or even cured in most people by strengthening the pelvic muscles, taking medication, or both. The article briefly reviews the anatomy of the urinary tract, then defines three types of incontinence: stress, urge, and overflow. Individuals may be asked to keep a diary during the week prior to the doctor's visit to keep track of how much and how often they urinated or leaked urine. Tests performed in the office may include a pelvic or rectal exam, a urinalysis to test for infection, and a noninvasive imaging scan to check for residual urine in the bladder. Strengthening pelvic floor muscles with Kegel exercises has been shown to reduce urine leakage in 50 to 75 percent of women and cure it in 20 percent with stress incontinence. Other treatment options covered include bladder retraining, biofeedback, drug therapy, dietary changes (cutting back on alcohol and caffeine), and surgery. The author concludes that surgery is generally considered a last resort and is mainly used to strengthen pelvic muscles or lift the bladder to alleviate stress incontinence. 1 figure.
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Urinary Incontinence and Sexuality Source: Quality Care. 16(3): 5. Summer 1998. Contact: Available from National Association for Continence. P.O. Box 8310, Spartanburg, SC 29305-8310. (800) 252-3337 or (864) 579-7900. Fax (864) 579-7902. Summary: This brief newsletter article reviews the problem of urinary incontinence and its impact on the patient's sexuality. The impact of incontinence may upset an established love life or create particular difficulties with a new relationship. Intimacy is about being close, and incontinence or the fear of leakage might be an obstacle, both mentally and physically. Problems may be greatest for those who have known
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continence but have lost it as a result of a difficult childbirth or surgery. This surgery can include hysterectomy or prolapse surgeries for women and prostatectomy for men. Loss of orgasm can also occur after surgery. There is often embarrassment, anger, and frustration with these adverse outcomes. Some causes for leakage include pelvic floor muscle weakness, overactive bladder contractions, or incomplete bladder emptying. The author notes that incontinence episodes with sex can sometimes be cured, often improved, but always managed by optimal care. The author briefly summarizes the principles of successful management: make sure the bladder and bowel are empty before sexual activity, use warmed lubricating gel, avoid a position that may provoke leakage, and share concerns with the sexual partner. The author encourages readers to work with their health care providers to manage urinary incontinence problems. ·
Surgery for Stress Incontinence Source: AUA News. 2(1): 16-17. January-February 1997. Contact: Available from AUA News. Williams and Wilkins, 351 West Camden Street, Baltimore, MD 21201-2436. Summary: This newsletter article reports on surgery for stress urinary incontinence (UI). All surgical approaches for stress incontinence have the common goal of restoring normal anatomic relationships; that is, to replace the bladder neck and proximal urethra into their appropriate position above the level of the pelvic floor muscle group. This positioning can be accomplished transvaginally or transabdominally; the approach is based on surgeon experience and preference, as well as on patient indications. The author reports on the surgical strategy to treat intrinsic sphincteric deficiency (ISD) or type III stress urinary incontinence. Generally, it is stated that there is an 85 percent cure rate of stress UI regardless of which procedure is performed. The author contends that the literature does not support this conclusion. The author also stresses that surgery only corrects one of the factors important for normal urinary control. Recurrence of UI with good anatomic support is not to be considered a surgical failure. The author concludes that more important than the choice of therapy is the identification of the proper patient for treatment. Correction of an anatomic abnormality by one of the many resuspension procedures will be inadequate for correction in those patients with ISD. Current urodynamic, radiographic, and endoscopic techniques must be used to select properly those patients who require augmentation of outlet function rather than an outlet stabilization (suspension) procedure. 1 figure. 3 references. (AA-M).
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Surgical Success in Female Stress Incontinence Source: Quality Care. 14(4): 1-2. Fall 1996. Contact: Available from National Association for Continence. P.O. Box 8310, Spartanburg, SC 29305-8310. (800) BLADDER or (864) 579-7900. Fax (864) 579-7902. Web site: http://www.nafc.org. Summary: This newsletter article reviews the surgical techniques used to treat female stress incontinence. Stress incontinence is urinary leakage that occurs with activity such as coughing or sneezing; leakage occurs during activity because the pressures in the abdomen and bladder go up during these times and the urethra may not stay closed all the way. All surgical approaches for correcting stress urinary incontinence (UI) have the same goal: to put the bladder neck and urethra back into the correct position above the pelvic floor muscles and to provide support for the urethra. The surgical approach (either vaginal or abdominal) is generally selected by the surgeon based on his or her experience and on the needs of the individual patient. The author describes surgical suspensions used for stress UI and surgical therapy for intrinsic sphincteric deficiency (ISD), including slings, the artificial urinary sphincter, and peri-urethral injections. The author notes that recurrent UI should not automatically be considered a surgical failure. Surgery only corrects one of the factors important for normal urinary control. References are available on request from the publisher. 2 figures. (AA-M).
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Urinary Incontinence and Alzheimer's Disease Source: HIP Report. Help for Incontinent People Report. 12(3): 1. Summer 1994. Contact: Available from National Association for Continence (NAFC). (formerly Help For Incontinent People). P.O. Box 8310, Spartanburg, SC 29305-8310. (800) BLADDER or (864) 579-7900. Fax (864) 579-7902. Summary: This newsletter article discusses urinary incontinence (UI) and Alzheimer's disease. The author notes that UI is rarely seen in early or middle stages of Alzheimer's disease, because changes in the brain that affect urinary control do not occur until quite late in the course of the disease. Topics include the causes of UI, including urinary tract infection; difficulties with locating the bathroom; difficulties with clothing; suggestions for environmental adaptations to help patients use the toilet; and the timing of fluid intake and voiding intervals. The article concludes with the address and telephone number of the Alzheimer's Association, through which readers can obtain more information.
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Needle Bladder Suspension for the Treatment of Stress Urinary Incontinence in Women Source: HIP Report. Help for Incontinent People Report. 11(2): 4. Spring 1993. Contact: Available from National Association for Continence (NAFC) (formerly Help for Incontinent People, or HIP). P.O. Box 8310, Spartanburg, SC 29305-8310. (800) BLADDER or (864) 579-7900. Fax (864) 579-7902. Summary: The transvaginal needle suspension of the bladder neck is a safe and effective operation used to restore urinary control to women with stress incontinence due to weak urethral support. This article explains the technique of needle bladder suspension and how it works. A brief prefatory section discusses the different types of urinary incontinence. Other topics include postoperative care, temporary urinary diversion after surgery, intermittent catheterization after surgery, and the use of pelvic muscle exercises to either avoid the need for surgery or to help with bladder control after surgery.
Academic Periodicals covering Urinary Incontinence Academic periodicals can be a highly technical yet valuable source of information on urinary incontinence. We have compiled the following list of periodicals known to publish articles relating to urinary incontinence and which are currently indexed within the National Library of Medicine’s PubMed database (follow hyperlinks to view more information, summaries, etc., for each). In addition to these sources, to keep current on articles written on urinary incontinence published by any of the periodicals listed below, you can simply follow the hyperlink indicated or go to the following Web site: www.ncbi.nlm.nih.gov/pubmed. Type the periodical’s name into the search box to find the latest studies published. If you want complete details about the historical contents of a periodical, you can also visit http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/ you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.” The following is a sample of periodicals which publish articles on urinary incontinence:
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Acta Obstetricia Et Gynecologica Scandinavica. (Acta Obstet Gynecol Scand) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Ac ta+Obstetricia+Et+Gynecologica+Scandinavica&dispmax=20&dispstart= 0
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American Family Physician. (Am Fam Physician) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=A merican+Family+Physician&dispmax=20&dispstart=0
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Annals of Medicine. (Ann Med) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=An nals+of+Medicine&dispmax=20&dispstart=0
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Bailliere's Best Practice & Research. Clinical Obstetrics & Gynaecology. (Baillieres Best Pract Res Clin Obstet Gynaecol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Ba illiere's+Best+Practice+&+Research.+Clinical+Obstetrics+&+Gynaecolog y&dispmax=20&dispstart=0
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Bmj (Clinical Research Ed. . (BMJ) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=B mj+(Clinical+Research+Ed.+&dispmax=20&dispstart=0
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Family Practice. (Fam Pract) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Fa mily+Practice&dispmax=20&dispstart=0
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Home Healthcare Nurse. (Home Healthc Nurse) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=H ome+Healthcare+Nurse&dispmax=20&dispstart=0
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Journal of Advanced Nursing. (J Adv Nurs) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Jo urnal+of+Advanced+Nursing&dispmax=20&dispstart=0
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Obstetrical & Gynecological Survey. (Obstet Gynecol Surv) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Ob stetrical+&+Gynecological+Survey&dispmax=20&dispstart=0
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Postgraduate Medicine. (Postgrad Med) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Po stgraduate+Medicine&dispmax=20&dispstart=0
Vocabulary Builder Orgasm: The apex and culmination of sexual excitement. [EU] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Uterus: The hollow muscular organ in female mammals in which the fertilized ovum normally becomes embedded and in which the developing embryo and fetus is nourished. In the nongravid human, it is a pear-shaped structure; about 3 inches in length, consisting of a body, fundus, isthmus, and cervix. Its cavity opens into the vagina below, and into the uterine tube on either side at the cornu. It is supported by direct attachment to the vagina and by indirect attachment to various other nearby pelvic structures. Called also metra. [EU]
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CHAPTER 9. PHYSICIAN GUIDELINES AND DATABASES Overview Doctors and medical researchers rely on a number of information sources to help patients with their conditions. Many will subscribe to journals or newsletters published by their professional associations or refer to specialized textbooks or clinical guides published for the medical profession. In this chapter, we focus on databases and Internet-based guidelines created or written for this professional audience.
NIH Guidelines For the more common diseases, The National Institutes of Health publish guidelines that are frequently consulted by physicians. Publications are typically written by one or more of the various NIH Institutes. For physician guidelines, commonly referred to as “clinical” or “professional” guidelines, you can visit the following Institutes: ·
Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm
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National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/
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National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html
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National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm
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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.30 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:31 ·
Bioethics: Access to published literature on the ethical, legal and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html
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HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html
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NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html
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Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/
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Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html
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Cancer Information: Access to caner-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html
Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 31 See http://www.nlm.nih.gov/databases/databases.html. 30
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Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/
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Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html
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Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html
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Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html
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MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html
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Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html
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Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html
While all of the above references may be of interest to physicians who study and treat urinary incontinence, the following are particularly noteworthy.
The Combined Health Information Database A comprehensive source of information on clinical guidelines written for professionals is the Combined Health Information Database. You will need to limit your search to “Brochure/Pamphlet,” “Fact Sheet,” or “Information Package” and urinary incontinence using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For the publication date, select “All Years,” select your preferred language, and the format option “Fact Sheet.” By making these selections and typing “urinary incontinence” (or synonyms) into the “For these words:” box above, you will only receive results on fact sheets dealing with urinary incontinence. The following is a sample result:
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Pharmocotherapy of Urge Incontinence Reviewed Source: in InConText. Management of the Incontinent Patient. Philadelphia, PA: CoMed Communications. 1990. p. 1, 3. Contact: Available from CoMed Communications. 210 West Washington Square, Philadelphia, PA 19106. (215) 592-1363. Price: Free. Summary: This report developed from a presentation at the symposium, 'Pharmacotherapy for Urge Incontinence,' held March 17, 1990 in Miami, Florida, reviews the drugs used to treat storage failure secondary to either bladder hyperactivity or bladder hypersensitivity. The following classes of drugs are discussed: the anticholinergics; antispasmodics or musculotropic relaxants; calcium antagonists; and tricyclic antidepressants. In addition, specific drugs including oxybutynin, propantheline, dicyclomine, terodiline, and phenazopyridine, are mentioned. The article concludes that sphincter incontinence is best treated pharmacologically with alpha-adrenergic agonists. Finally, estrogen is noted as a useful adjunct therapy for post-menopausal women.
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Report on the Surgical Management of Female Stress Urinary Incontinence: Clinical Practice Guidelines Source: Baltimore, MD: American Urological Association, Inc. 1997. 72 p. Contact: Available from American Urological Association, Inc. Health Policy Department, 1120 N. Charles Street, Baltimore, MD 21201. (410) 223-4367. Web site: http://www.auanet.org. Price: $49.00 (members); $69.00 (nonmembers). ISBN: 0964970236. Summary: This report outlines recommendations for the surgical management of female stress urinary incontinence (SUI). The report provides a descriptive discussion of incontinence diagnostic procedures; descriptions of surgical procedures for treating SUI; a summary discussion of the methodology employed by the panel in developing recommendations for choosing a surgical procedure; displays of evidence extracted from published outcomes data; and recommendations of practice policies for surgical management of SUI. Also included in the report are discussion of limitations in the literature hindering the development of evidence-based recommendations, detailed suggestions for minimal standards to be used in clinical trials for assessing the efficacy of urinary incontinence therapies, and recommendations for future research. The preoperative evaluation of women with symptoms of SUI should comprise patient history, including impact of symptoms on lifestyle; physical examination including an objective demonstration of stress incontinence; urinalysis; and other diagnostic studies designed to
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assess symptom causes, frequency and severity of incontinent episodes, and patient's expectations from treatment. There are four major types of procedures for SUI: retropubic suspensions, transvaginal suspensions, anterior repairs, and sling procedures. A subject index concludes the report. 3 appendices. 3 figures. 2 tables. 478 references. (AA-M). ·
Surgical Management of Female Stress Urinary Incontinence: A Doctor's Guide for Patients Source: Baltimore, MD: American Urological Association, Inc. 1997. 11 p. Contact: Available from American Urological Association, Inc. Health Policy Department, 1120 N. Charles Street, Baltimore, MD 21201. (410) 223-4367. Web site: http://www.auanet.org. Price: $19.00 (members); $29.00 (nonmembers) for set of 25. Summary: This brochure is designed to provide information for women with urinary incontinence who have chosen surgery as their treatment of choice. The brochure shows how the urinary system works and discusses causes of unwanted urine leakage and how they are diagnosed. The author then discusses the major types of surgery used to correct these problems, including the success rates of each type and the possible complications that may occur. Three types of surgery are covered: retropubic suspensions, transvaginal suspensions, and sling procedures. The author also briefly mentions collagen injections as a treatment option for intrinsic sphincteric deficiency (ISD). The brochure emphasizes that these surgical procedures that treat stress urinary incontinence can correct only what is causing the stress incontinence. If another type of incontinence is present as well, such as urge incontinence, the patient may still have urgency symptoms even if the surgery is successful in curing the stress incontinence. The brochure concludes with a list of information resources, a list of questions to ask the physician, and a glossary of related terms. The brochure is illustrated with line drawings of the urinary tract and of each of the procedures described. 7 figures. (AA-M).
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Female Stress Urinary Incontinence Clinical Guidelines Panel Summary Report on Surgical Management of Female Stress Urinary Incontinence Source: Journal of Urology. 158(3): 875-880. September 1997. Summary: This article reports on the results of a literature review regarding surgical procedures for treating stress urinary incontinence in the otherwise healthy female subject and to make practice recommendations based on the treatment outcomes data. The American
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Urological Association convened a Female Stress Urinary Incontinence Clinical Guidelines Panel to undertake this literature analysis. The panel searched the MEDLINE database for all articles through 1993 on surgical treatment of female stress urinary incontinence. Outcomes data were extracted from articles accepted after panel review. The data were then meta-analyzed to produce outcome estimates for alternative surgical procedures. The data indicate that after 48 months, retropubic suspensions and slings appear to be more efficacious than transvaginal suspensions, and also more efficacious than anterior repairs. The literature suggests higher complication rates when synthetic materials are used for slings. The evidence supports surgery as initial therapy and as a secondary form of therapy after failure of other treatments for stress urinary incontinence. 2 tables. 8 references. (AA-M). ·
Urinary Incontinence in Adults Source: New York, NY: Nidus Information Services, Inc. 1996. 8 p. Contact: Available from Nidus Information Services, Inc. 175 Fifth Avenue, Suite 2338, New York, NY 10010. (800) 334-9355 or (212) 2604268. Fax (212) 529-2349. E-mail:
[email protected]. Price: $5.95; bulk discounts available. Summary: This report, updated in 1996, provides information about urinary incontinence in adults. Written in a question and answer format, the report covers topics including a definition of urinary incontinence; the four types of incontinence, including stress, urge, overflow, and functional; the incidence and prevalence of incontinence; the causes of each of the types of incontinence; the diagnostic tests and methods used to confirm urinary incontinence, including catheterization, ultrasound, cystometrography, urinary flow rate (uroflowmetry), cystoscopy or cystourethroscopy, intravenous pyelograms and other radiographic studies, and urodynamics; the effects of urinary incontinence, including complications and psychosocial effects; and treatment options, including behavioral techniques, medications, and surgery. One final section discusses the management of chronic incontinence, including the use of absorbent products, external collection devices, and catheterization. The report concludes with a list of four resource organizations through which readers can obtain more information.
·
Urinary Incontinence Source: Washington, DC: American College of Obstetricians and Gynecologists (ACOG). 1995. 12 p.
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Contact: Available from Resource Center, American College of Obstetricians and Gynecologists (ACOG). 409 12th Street SW., Washington, DC 20024-2188. (202) 638-5577. Price: Single copy free. Summary: This professional education bulletin focuses on urinary incontinence (UI), defined as the involuntary loss of urine that is objectively demonstrable and a social or hygienic problem. After an introduction briefly discussing the epidemiology of UI, the bulletin covers etiologic factors of stress incontinence, urge incontinence, and extraurethral causes of incontinence; diagnostic considerations, including patient history, voiding diary, physical examination, urine culture, stress test, pad test, cystometry, and cystourethroscopy; treatment options, including palliative measures, behavioral therapy, pelvic muscle exercises, biofeedback, devices, pharmacotherapy, and surgery; and patient education and counseling issues. The bulletin includes the addresses and telephone numbers of two patient information and support organizations, Help for Incontinent People (now the National Association For Continence) and the Simon Foundation. 32 references. ·
Barriers to Rehabilitation of Persons with End-Stage Renal Disease or Chronic Urinary Incontinence: Workshop Summary Report Source: Bethesda, MD: National Kidney and Urologic Diseases Advisory Board. 1994. [100 p.]. Contact: Available from Cygnus Corporation. 5640 Nicholson Lane, Suite 300, Rockville, MD 20852. (301) 231-0551. Fax (301) 984-8527. Price: Single copy free. Summary: This summary report is the end product of the National Workshop on Barriers to Rehabilitation of Persons with End-Stage Renal Disease (ESRD) or Chronic Urinary Incontinence, held in March 1994 in Bethesda, MD. The report is organized in three major sections: rehabilitation issues for adults with ESRD, rehabilitation issues for children with ESRD, and rehabilitation issues for persons with urinary incontinence. Each section covers a series of key rehabilitation issues for the relevant group and then presents a series of charts summarizing the barriers, recommended solutions, and potential target organizations for each issue. References are included as is a reference list of acronyms that are used throughout the document. The report's appendices include the workshop agenda, a list of workshop planning committee members, and abstracts submitted by workshop speakers. 2 figures. 11 tables. 39 references. (AA-M).
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Standards of Care: Patient With Urinary Incontinence Source: Costa Mesa, CA: Wound Ostomy and Continence Nurses Society. 1992. 69 p. Contact: Available from Wound Ostomy and Continence Nurses Society. 2755 Bristol Street, Suite 110, Costa Mesa, CA 92626. (714) 476-0268. Price: $10 (members); $15 (non-members). Summary: This document provides the standards of nursing care for urinary incontinence, as recommended by the Standards Committee of the Wound Ostomy and Continence Nurses Society. These standards were developed to assist the enterostomal therapy (ET) nurse and other health care professionals to define and evaluate individual practice. Outcome standards and process standards for nursing assessment and intervention are provided for a collaborative diagnosis of potential complications related to bladder/sphincter dysfunction due to urinary tract infection, urinary calculi, or urinary tract damage; and for nursing diagnoses of the following: altered patterns of urinary elimination; stress incontinence; urge incontinence; reflex incontinence; functional incontinence; total incontinence; impairment in skin integriety, potential or actual; potential disturbance in self-concept related to changes in selfesteem, body image, role performance, or personal identiy; potential social isolation related to odor and embarrassment; knowledge deficit related to urinary tract function, normal voiding process, and altered voiding patterns; and knowledge deficit related to individual management program. An appendix lists information groups and resource publications. A glossary and bibliography are also appended. 66 references.
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Confronting Urinary Incontinence: A Guidebook for the Aging Network Source: Tampa, FL: University of South Florida. 1994. 30 p. Contact: Available from National Eldercare Institute on Long Term Care and Alzheimer's Disease at the Suncoast Gerontology Center, University of South Florida. 12901 Bruce B. Downs Boulevard, Tampa, FL 336124799. (813) 974-4355; FAX (813) 974-4251. Price: $5.00. Summary: This booklet is designed to help service providers in the aging network deal with urinary incontinence (UI) in service settings and provides material for nonclinical staff training. It includes information about UI in people with Alzheimer's disease (AD). Part I discusses the problems caused by UI, different types of UI, and treatments for UI, and offers guidelines for the assessment and management of UI in service settings such as adult day-care centers. It includes two UI questionnaires,
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one for general use and one for use in adult day-care settings. The section on UI and AD explains how impaired thinking, disorientation, and loss of fine motor skills can cause functional incontinence and suggests interventions to compensate for these cognitive and motor deficits. Part II provides summary sheets which can be used as training materials for staff. These sheets include information about UI facts, the urinary tract, causes and types of UI, pelvic muscle exercises, and intervention approaches. ·
Before, During, and After Your Radical Prostatectomy Source: Baltimore, MD: American Foundation for Urologic Disease, Inc. 2001. 17 p. Contact: Available from American Foundation for Urologic Disease, Inc. 1128 North Charles Street, Baltimore, MD 21201. (800) 242-2383. Website: www.afud.org. Price: Single copy free. Summary: This brochure explains the procedure of radical prostatectomy (removal of the prostate gland) as it is used to treat prostate cancer. Radical prostatectomy refers to complete removal of the prostate gland, seminal vesicles, and possibly some lymph nodes. This technique is often chosen when tests suggest that the prostate cancer is localized to the prostate, has not spread outside the prostate, and has a good chance of being cured. The brochure provides information to help the patient know what to expect before, during, and after the prostatectomy. Before the surgery, patients will undergo tests to evaluate their cancer and their overall health, including the prostate specific antigen (PSA) test, bone scan, CT (computed tomography) or MRI (magnetic resonance imaging), and autologous (self) blood donation. No special changes in diet or activity are required until the days immediately preceding the surgery, however all aspirin and aspirin like substances should be stopped, and patients should quit smoking if at all possible. Most patients check into the hospital on the day of their surgery; the presurgery preparation will include various monitoring devices and the insertion of an intravenous line. After the surgery, there are several tubes in the patient, including a Foley catheter (for urine drainage), suction drains (to collect and remove blood and fluids from the operation site), and intravenous line, for nutrition and liquids. Two basic types of surgery are described: radical retropubic prostatectomy and radical perineal prostatectomy. There are good methods for managing pain after surgery, including patient controlled anesthesia and an epidural catheter, as well as oral medications. Most patients go home 2 to 4 days after surgery; home care instructions are outlined. The brochure also describes possible complications and their treatments, including erectile dysfunction,
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urinary incontinence, and rectal injury. The brochure stresses that support groups of men who presently have or have had prosate cancer are organized in most areas; patients are strongly encouraged to participate in support groups to address their concerns. The brochure includes a pretest to quiz the reader's knowledge, a glossary of related terms, and line drawings of the anatomy involved. 2 figures. ·
Continence Referral Service Source: Spartanburg, SC: National Association for Continence (NAFC). 1996. 5 p. Contact: Available from National Association for Continence (NAFC). P.O. Box 8310, Spartanburg, SC 29305-8310. (800) 252-3337. Fax (864) 5797902. Price: Single copy free. Summary: This brochure describes the Continence Referral Service (CRS) operated by the National Association for Continence (NAFC). CRS was initiated to help Americans and Canadians link up with local health care providers who provide treatment for urinary incontinence. The brochure lists the eligibility requirements for physicians who wish to be included in CRS. An application form for joining CRS is included. In addition, information is requested of applicants regarding the types of diagnostic, surgical, behavioral, and other treatment or management techniques that they use. The brochure also includes a brief statement about NAFC and their activities.
·
Helping People With Incontinence: Caregiver Guide; Clinical Practice Guideline Source: Rockville, MD: Agency for Health Care Policy and Research (AHCPR). 1996. 9 p. Contact: Available from Agency for Health Care Policy and Research (AHCPR) Publications Clearinghouse. P.O. Box 8547, Silver Spring, MD 20907-8547. (800) 358-9295. Price: Single copy free. AHCPR Publication number 96-0683. Summary: This booklet, designed primarily for caregivers in long-term care settings, reviews urinary incontinence and its management. Topics include a definition of the types of urinary incontinence (UI); the important role of the caregiver in managing the problem; the causes of UI; recordkeeping strategies; treatment options, including behavioral treatments, medicine, surgery, and exercises; and other suggestions for helping residents with UI, including environmental changes. The booklet includes a list of resource organizations and a blank bladder record form (incontinence diary) and is illustrated with simple line drawings.
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Managing Bladder and Bowel Problems: Practical Ways of Helping You Better Care for a Person with Memory Loss and Confusion Source: Santa Cruz, CA: Journeyworks Publishing. 1996. 2 p. Contact: Available from Journeyworks Publishing. P.O. Box 8466, Santa Cruz, CA 95061. (800) 775-1998 or (408) 423-1400. Fax (408) 423-8102. Price: Single copy free; bulk copies available. ISBN: 1568850085. Summary: This brochure presents practical suggestions for caregivers who are managing bladder and bowel problems in people with memory loss and confusion. Ten strategies are presented and discussed. They include the following: use the toilet regularly, watch for signals, use simple clothing, try protective garments, give clear instructions, make using the bathroom easy and comfortable, use fluids and foods to prevent problems, plan for accidents, talk with a doctor, and help the person relax. Each strategy is illustrated with a line drawing and includes a bulleted list of ideas to try. The diet therapy section reminds readers that plenty of liquids can help prevent bladder infections that can lead to urinary incontinence.
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Working With The Incontinent: A Community Education Kit for Health Care Professionals Source: Neenah, WI: Kimberly-Clark Corporation. 1991. (instructional package). Contact: Available from Kimberly-Clark Corporation. 2001 Marathon Avenue, Neenah, WI 54957-9002. (414) 721-2000 or (800) 558-6423. Price: Single copy free to health professionals. Summary: This kit is designed to help the health care provider educate the public about urinary incontinence. The kit includes an introduction and guide to using the materials; a Presentation Outline to be used in addressing community groups and organizations; thirteen 35mm color slides that support key points; a flip chart presenting the slide information in print form for use where a slide projector is unavailable or inappropriate; multiple copies of a brochure presenting basic facts about bladder control problems, treatment, and management; and a pad of patient education handouts describing and illustrating Kegel exercises. A listing of community education resources is also provided.
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Urinary Incontinence and the AMS Sphincter 800 Source: Minneapolis, MN: American Medical Systems. 6 p. Contact: American Medical Systems, Consumer Information, Department 800, P.O. Box 9, Minneapolis, MN 55440. (800) 843-4315. Price: Free.
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Summary: This brochure contains a picture of the artificial sphincter and describes the use of the device in selected patients with urinary incontinence. The surgical procedure is discussed. A source for information on the device is listed. A list of the terminology used and an anatomical diagram are included.
The NLM Gateway32 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing “one-stop searching” for many of NLM’s information resources or databases.33 One target audience for the Gateway is the Internet user who is new to NLM’s online resources and does not know what information is available or how best to search for it. This audience may include physicians and other healthcare providers, researchers, librarians, students, and, increasingly, patients, their families, and the public.34 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “urinary incontinence” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category.
Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x. The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 34 Other users may find the Gateway useful for an overall search of NLM’s information resources. Some searchers may locate what they need immediately, while others will utilize the Gateway as an adjunct tool to other NLM search services such as PubMed® and MEDLINEplus®. The Gateway connects users with multiple NLM retrieval systems while also providing a search interface for its own collections. These collections include various types of information that do not logically belong in PubMed, LOCATORplus, or other established NLM retrieval systems (e.g., meeting announcements and pre-1966 journal citations). The Gateway will provide access to the information found in an increasing number of NLM retrieval systems in several phases. 32 33
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Results Summary Category Items Found Journal Articles 16321 Books / Periodicals / Audio Visual 370 Consumer Health 83 Meeting Abstracts 17 Other Collections 20 Total 16811
HSTAT35 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.36 HSTAT’s audience includes healthcare providers, health service researchers, policy makers, insurance companies, consumers, and the information professionals who serve these groups. HSTAT provides access to a wide variety of publications, including clinical practice guidelines, quick-reference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.37 Simply search by “urinary incontinence” (or synonyms) at the following Web site: http://text.nlm.nih.gov.
Coffee Break: Tutorials for Biologists38 Some patients may wish to have access to a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. The HSTAT URL is http://hstat.nlm.nih.gov/. 37 Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration’s Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force’s Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations. 38 Adapted from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html. 35 36
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may one day assist physicians in developing treatments. To this end, we recommend “Coffee Break,” a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.39 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.40 This site has new articles every few weeks, so it can be considered an online magazine of sorts, and intended for general background information. You can access the Coffee Break Web site at http://www.ncbi.nlm.nih.gov/Coffeebreak/.
Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are a few examples that may interest you: ·
CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.
·
Image Engine: Multimedia electronic medical record system that integrates a wide range of digitized clinical images with textual data stored in the University of Pittsburgh Medical Center’s MARS electronic medical record system; see the following Web site: http://www.cml.upmc.edu/cml/imageengine/imageEngine.html.
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Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.
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MedWeaver: Prototype system that allows users to search differential diagnoses for any list of signs and symptoms, to search medical literature, and to explore relevant Web sites; see http://www.med.virginia.edu/~wmd4n/medweaver.html.
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Metaphrase: Middleware component intended for use by both caregivers and medical records personnel. It converts the informal language
The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 40 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process. 39
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generally used by caregivers into terms from formal, controlled vocabularies; see http://www.lexical.com/Metaphrase.html.
The Genome Project and Urinary Incontinence With all the discussion in the press about the Human Genome Project, it is only natural that physicians, researchers, and patients want to know about how human genes relate to urinary incontinence. In the following section, we will discuss databases and references used by physicians and scientists who work in this area.
Online Mendelian Inheritance in Man (OMIM) The Online Mendelian Inheritance in Man (OMIM) database is a catalog of human genes and genetic disorders authored and edited by Dr. Victor A. McKusick and his colleagues at Johns Hopkins and elsewhere. OMIM was developed for the World Wide Web by the National Center for Biotechnology Information (NCBI).41 The database contains textual information, pictures, and reference information. It also contains copious links to NCBI’s Entrez database of MEDLINE articles and sequence information. Go to http://www.ncbi.nlm.nih.gov/Omim/searchomim.html to search the database. Type “urinary incontinence” (or synonyms) in the search box, and click “Submit Search.” If too many results appear, you can narrow the search by adding the word “clinical.” Each report will have additional links to related research and databases. By following these links, especially the link titled “Database Links,” you will be exposed to numerous specialized databases that are largely used by the scientific community. These databases are overly technical and seldom used by the general public, but offer an abundance of information. The following is an example of the results you can obtain from the OMIM for urinary incontinence: ·
Apnea, Central Sleep Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?207720
Adapted from http://www.ncbi.nlm.nih.gov/. Established in 1988 as a national resource for molecular biology information, NCBI creates public databases, conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information--all for the better understanding of molecular processes affecting human health and disease.
41
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·
Camptobrachydactyly Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?114150
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Cerebrovascular Disease with Thin Skin, Alopecia, and Disk Disease Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?600142
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Chloride Diarrhea, Familial Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?214700
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Cockayne Syndrome, Type I Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?216400
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Gangliosidosis, Generalized Gm1, Type I Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?230500
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Glycogen Storage Disease Ii Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?232300
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Hand-foot-uterus Syndrome Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?140000
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Hexosaminidase B; Hexb Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?606873
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Hydrocephalus, Normal-pressure Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?236690
Genes and Disease (NCBI - Map) The Genes and Disease database is produced by the National Center for Biotechnology Information of the National Library of Medicine at the National Institutes of Health. This Web site categorizes each disorder by the system of the body associated with it. Go to http://www.ncbi.nlm.nih.gov/disease/, and browse the system pages to have a full view of important conditions linked to human genes. Since this site is regularly updated, you may wish to re-visit it from time to time. The following systems and associated disorders are addressed:
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Immune System: Fights invaders. Examples: Asthma, autoimmune polyglandular syndrome, Crohn’s disease, DiGeorge syndrome, familial Mediterranean fever, immunodeficiency with Hyper-IgM, severe combined immunodeficiency. Web site: http://www.ncbi.nlm.nih.gov/disease/Immune.html
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Muscle and Bone: Movement and growth. Examples: Duchenne muscular dystrophy, Ellis-van Creveld syndrome, Marfan syndrome, myotonic dystrophy, spinal muscular atrophy. Web site: http://www.ncbi.nlm.nih.gov/disease/Muscle.html
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Signals: Cellular messages. Examples: Ataxia telangiectasia, Baldness, Cockayne syndrome, Glaucoma, SRY: sex determination, Tuberous sclerosis, Waardenburg syndrome, Werner syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Signals.html
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Transporters: Pumps and channels. Examples: Cystic Fibrosis, deafness, diastrophic dysplasia, Hemophilia A, long-QT syndrome, Menkes syndrome, Pendred syndrome, polycystic kidney disease, sickle cell anemia, Wilson’s disease, Zellweger syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Transporters.html
Entrez Entrez is a search and retrieval system that integrates several linked databases at the National Center for Biotechnology Information (NCBI). These databases include nucleotide sequences, protein sequences, macromolecular structures, whole genomes, and MEDLINE through PubMed. Entrez provides access to the following databases: ·
PubMed: Biomedical literature (PubMed), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed
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Nucleotide Sequence Database (Genbank): Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Nucleotide
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Protein Sequence Database: Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Protein
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Structure: Three-dimensional macromolecular structures, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Structure
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Genome: Complete genome assemblies, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Genome
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·
PopSet: Population study data sets, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Popset
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OMIM: Online Mendelian Inheritance in Man, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=OMIM
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Taxonomy: Organisms in GenBank, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Taxonomy
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Books: Online books, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=books
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ProbeSet: Gene Expression Omnibus (GEO), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo
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3D Domains: Domains from Entrez Structure, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo
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NCBI’s Protein Sequence Information Survey Results: Web site: http://www.ncbi.nlm.nih.gov/About/proteinsurvey/
To access the Entrez system at the National Center for Biotechnology Information, go to http://www.ncbi.nlm.nih.gov/entrez/, and then select the database that you would like to search. The databases available are listed in the drop box next to “Search.” In the box next to “for,” enter “urinary incontinence” (or synonyms) and click “Go.”
Jablonski’s Multiple Congenital Anomaly/Mental Retardation (MCA/MR) Syndromes Database42 This online resource can be quite useful. It has been developed to facilitate the identification and differentiation of syndromic entities. Special attention is given to the type of information that is usually limited or completely omitted in existing reference sources due to space limitations of the printed form. At http://www.nlm.nih.gov/mesh/jablonski/syndrome_toc/toc_a.html you can also search across syndromes using an alphabetical index. You can also search at http://www.nlm.nih.gov/mesh/jablonski/syndrome_db.html.
Adapted from the National Library of Medicine: http://www.nlm.nih.gov/mesh/jablonski/about_syndrome.html.
42
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The Genome Database43 Established at Johns Hopkins University in Baltimore, Maryland in 1990, the Genome Database (GDB) is the official central repository for genomic mapping data resulting from the Human Genome Initiative. In the spring of 1999, the Bioinformatics Supercomputing Centre (BiSC) at the Hospital for Sick Children in Toronto, Ontario assumed the management of GDB. The Human Genome Initiative is a worldwide research effort focusing on structural analysis of human DNA to determine the location and sequence of the estimated 100,000 human genes. In support of this project, GDB stores and curates data generated by researchers worldwide who are engaged in the mapping effort of the Human Genome Project (HGP). GDB’s mission is to provide scientists with an encyclopedia of the human genome which is continually revised and updated to reflect the current state of scientific knowledge. Although GDB has historically focused on gene mapping, its focus will broaden as the Genome Project moves from mapping to sequence, and finally, to functional analysis. To access the GDB, simply go to the following hyperlink: http://www.gdb.org/. Search “All Biological Data” by “Keyword.” Type “urinary incontinence” (or synonyms) into the search box, and review the results. If more than one word is used in the search box, then separate each one with the word “and” or “or” (using “or” might be useful when using synonyms). This database is extremely technical as it was created for specialists. The articles are the results which are the most accessible to nonprofessionals and often listed under the heading “Citations.” The contact names are also accessible to non-professionals.
Specialized References The following books are specialized references written for professionals interested in urinary incontinence (sorted alphabetically by title, hyperlinks provide rankings, information, and reviews at Amazon.com): · Adult and Pediatric Urology (3-Volume Set) (Includes a Card to Return to Receive the Free CD-ROM) by Jay Y. Gillenwater, M.D. (Editor), et al; Hardcover - 2828 pages, 4th edition (January 15, 2002), Lippincott, Williams & Wilkins Publishers; ISBN: 0781732204; http://www.amazon.com/exec/obidos/ASIN/0781732204/icongroupinterna
Adapted from the Genome Database: http://gdbwww.gdb.org/gdb/aboutGDB.html#mission.
43
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· Campbell’s Urology (4-Volume Set) by Meredith F. Campbell (Editor), et al; Hardcover, 8th edition (May 15, 2002), W B Saunders Co; ISBN: 0721690580; http://www.amazon.com/exec/obidos/ASIN/0721690580/icongroupinterna · Clinical Manual of Urology by Philip M. Hanno, M.D. (Editor), et al; Paperback - 924 pages, 3rd edition (May 2, 2001), McGraw-Hill Professional Publishing; ISBN: 0071362010; http://www.amazon.com/exec/obidos/ASIN/0071362010/icongroupinterna · Comprehensive Urology by George Weiss O’Reilly; Hardcover - 724 pages, 1st edition (January 15, 2001), Elsevier Science, Health Science Division; ISBN: 0723429499; http://www.amazon.com/exec/obidos/ASIN/0723429499/icongroupinterna · Manual of Urology: Diagnosis & Therapy by Mike B. Siroky (Editor), et al; Spiral-bound - 362 pages, 2nd spiral edition (October 15, 1999), Lippincott, Williams & Wilkins Publishers; ISBN: 078171785X; http://www.amazon.com/exec/obidos/ASIN/078171785X/icongroupinterna · The Scientific Basis of Urology by A.R. Mundy (Editor), et al; 531 pages 1st edition (March 15, 1999), Isis Medical Media; ISBN: 1899066217; http://www.amazon.com/exec/obidos/ASIN/1899066217/icongroupinterna · Smith’s General Urology by Emil A. Tanagho (Editor), et al; Paperback 888 pages, 15th edition (January 21, 2000), McGraw-Hill Professional Publishing; ISBN: 0838586074; http://www.amazon.com/exec/obidos/ASIN/0838586074/icongroupinterna · Urology (House Officer Series) by Michael T. MacFarlane, M.D.; Paperback - 3rd edition (January 2001), Lippincott, Williams & Wilkins Publishers; ISBN: 0781731461; http://www.amazon.com/exec/obidos/ASIN/0781731461/icongroupinterna · Urology for Primary Care Physicians by Unyime O. Nseyo (Editor), et al; Hardcover - 399 pages, 1st edition (July 15, 1999), W B Saunders Co; ISBN: 0721671489; http://www.amazon.com/exec/obidos/ASIN/0721671489/icongroupinterna
Vocabulary Builder Alopecia: Baldness; absence of the hair from skin areas where it normally is present. [EU] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of
Physician Guidelines and Databases 205
that response, that is, with specific antibody or specifically sensitized Tlymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Apnea: A transient absence of spontaneous respiration. [NIH] Calculi: An abnormal concretion occurring mostly in the urinary and biliary tracts, usually composed of mineral salts. Also called stones. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Disorientation: The loss of proper bearings, or a state of mental confusion as to time, place, or identity. [EU] Epidural: Situated upon or outside the dura mater. [EU] Hydrocephalus: A condition marked by dilatation of the cerebral ventricles, most often occurring secondarily to obstruction of the cerebrospinal fluid pathways, and accompanied by an accumulation of cerebrospinal fluid within the skull; the fluid is usually under increased pressure, but occasionally may be normal or nearly so. It is typically characterized by enlargement of the head, prominence of the forehead, brain atrophy, mental deterioration, and convulsions; may be congenital or acquired; and may be of sudden onset (acute h.) or be slowly progressive (chronic or primary b.). [EU]
Suction: The removal of secretions, gas or fluid from hollow or tubular organs or cavities by means of a tube and a device that acts on negative pressure. [NIH] Tomography: The recording of internal body images at a predetermined plane by means of the tomograph; called also body section roentgenography. [EU]
Dissertations 207
CHAPTER 10. INCONTINENCE
DISSERTATIONS
ON
URINARY
Overview University researchers are active in studying almost all known diseases. The result of research is often published in the form of Doctoral or Master’s dissertations. You should understand, therefore, that applied diagnostic procedures and/or therapies can take many years to develop after the thesis that proposed the new technique or approach was written. In this chapter, we will give you a bibliography on recent dissertations relating to urinary incontinence. You can read about these in more detail using the Internet or your local medical library. We will also provide you with information on how to use the Internet to stay current on dissertations.
Dissertations on Urinary Incontinence ProQuest Digital Dissertations is the largest archive of academic dissertations available. From this archive, we have compiled the following list covering dissertations devoted to urinary incontinence. You will see that the information provided includes the dissertation’s title, its author, and the author’s institution. To read more about the following, simply use the Internet address indicated. The following covers recent dissertations dealing with urinary incontinence:
208 Urinary Incontinence
·
A Causal Model: Factors Influencing Pelvic Muscle Exercise Adherence among Taiwanese Women with Urinary Incontinence by Chen, Shu-yueh; Phd from University of Washington, 2001, 212 pages http://wwwlib.umi.com/dissertations/fullcit/3013944
·
A Minor Complaint with Major Consequences: a Survey of Urinary Incontinence in Japan by Tsuchiya, Noriko; Drph from University of Hawaii, 2000, 124 pages http://wwwlib.umi.com/dissertations/fullcit/9977578
·
Examining the Effect of Patient Guidelines on Consumer Perceptions and Behavior: an Extended Utilization of the Health Belief Model (Urinary Incontinence) by Olson, Lisa K., Phd from The George Washington University, 1994, 167 pages http://wwwlib.umi.com/dissertations/fullcit/9426793
·
Non-surgical Treatment of Urinary Incontinence and Outcomes in a Nursing Practice by Wiggin, Barbara Mclean; Phd from Brandeis U., the F. Heller Grad. Sch. for Adv. Stud. in Soc. Wel., 2002, 106 pages http://wwwlib.umi.com/dissertations/fullcit/3035632
·
Quality of Life: the Impact of Age, Severity of Urinary Incontinence and Adaptation by Toughill, Eileen Helbig; Phd from New York University, 2001, 142 pages http://wwwlib.umi.com/dissertations/fullcit/9992365
·
Stress Urinary Incontinence: Parous Versus Nulliparous Women Ages 18--35 by Stoner, Lisa Marie; Way, Michelle Marie; Mpas from Grand Valley State University, 2000, 69 pages http://wwwlib.umi.com/dissertations/fullcit/1398317
Keeping Current As previously mentioned, an effective way to stay current on dissertations dedicated to urinary incontinence is to use the database called ProQuest Digital Dissertations via the Internet, located at the following Web address: http://wwwlib.umi.com/dissertations. The site allows you to freely access the last two years of citations and abstracts. Ask your medical librarian if the library has full and unlimited access to this database. From the library, you should be able to do more complete searches than with the limited 2-year access available to the general public.
209
PART III. APPENDICES
ABOUT PART III Part III is a collection of appendices on general medical topics which may be of interest to patients with urinary incontinence and related conditions.
Researching Your Medications 211
APPENDIX A. RESEARCHING YOUR MEDICATIONS Overview There are a number of sources available on new or existing medications which could be prescribed to patients with urinary incontinence. While a number of hard copy or CD-Rom resources are available to patients and physicians for research purposes, a more flexible method is to use Internetbased databases. In this chapter, we will begin with a general overview of medications. We will then proceed to outline official recommendations on how you should view your medications. You may also want to research medications that you are currently taking for other conditions as they may interact with medications for urinary incontinence. Research can give you information on the side effects, interactions, and limitations of prescription drugs used in the treatment of urinary incontinence. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.
212 Urinary Incontinence
Your Medications: The Basics44 The Agency for Health Care Research and Quality has published extremely useful guidelines on how you can best participate in the medication aspects of urinary incontinence. Taking medicines is not always as simple as swallowing a pill. It can involve many steps and decisions each day. The AHCRQ recommends that patients with urinary incontinence take part in treatment decisions. Do not be afraid to ask questions and talk about your concerns. By taking a moment to ask questions early, you may avoid problems later. Here are some points to cover each time a new medicine is prescribed: ·
Ask about all parts of your treatment, including diet changes, exercise, and medicines.
·
Ask about the risks and benefits of each medicine or other treatment you might receive.
·
Ask how often you or your doctor will check for side effects from a given medication.
Do not hesitate to ask what is important to you about your medicines. You may want a medicine with the fewest side effects, or the fewest doses to take each day. You may care most about cost, or how the medicine might affect how you live or work. Or, you may want the medicine your doctor believes will work the best. Telling your doctor will help him or her select the best treatment for you. Do not be afraid to “bother” your doctor with your concerns and questions about medications for urinary incontinence. You can also talk to a nurse or a pharmacist. They can help you better understand your treatment plan. Feel free to bring a friend or family member with you when you visit your doctor. Talking over your options with someone you trust can help you make better choices, especially if you are not feeling well. Specifically, ask your doctor the following: ·
The name of the medicine and what it is supposed to do.
·
How and when to take the medicine, how much to take, and for how long.
·
What food, drinks, other medicines, or activities you should avoid while taking the medicine.
·
What side effects the medicine may have, and what to do if they occur.
44
This section is adapted from AHCRQ: http://www.ahcpr.gov/consumer/ncpiebro.htm.
Researching Your Medications 213
·
If you can get a refill, and how often.
·
About any terms or directions you do not understand.
·
What to do if you miss a dose.
·
If there is written information you can take home (most pharmacies have information sheets on your prescription medicines; some even offer large-print or Spanish versions).
Do not forget to tell your doctor about all the medicines you are currently taking (not just those for urinary incontinence). This includes prescription medicines and the medicines that you buy over the counter. Then your doctor can avoid giving you a new medicine that may not work well with the medications you take now. When talking to your doctor, you may wish to prepare a list of medicines you currently take, the reason you take them, and how you take them. Be sure to include the following information for each: ·
Name of medicine
·
Reason taken
·
Dosage
·
Time(s) of day
Also include any over-the-counter medicines, such as: ·
Laxatives
·
Diet pills
·
Vitamins
·
Cold medicine
·
Aspirin or other pain, headache, or fever medicine
·
Cough medicine
·
Allergy relief medicine
·
Antacids
·
Sleeping pills
·
Others (include names)
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Learning More about Your Medications Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications your doctor has recommended for urinary incontinence. One such source is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the “U.S. Pharmacopeia (USP).” Today, the USP is a non-profit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at www.usp.org. The USP currently provides standards for over 3,700 medications. The resulting USP DIÒ Advice for the PatientÒ can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database.45 While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopoeia. It is important to read the disclaimer by the United States Pharmacopoeia (http://www.nlm.nih.gov/medlineplus/drugdisclaimer.html) before using the information provided. Of course, we as editors cannot be certain as to what medications you are taking. Therefore, we have compiled a list of medications associated with the treatment of urinary incontinence. Once again, due to space limitations, we only list a sample of medications and provide hyperlinks to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.). The following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to urinary incontinence:
Though cumbersome, the FDA database can be freely browsed at the following site: www.fda.gov/cder/da/da.htm.
45
Researching Your Medications 215
Antidepressants, Tricyclic ·
Systemic - U.S. Brands: Anafranil; Asendin; Aventyl; Elavil; Endep; Norfranil; Norpramin; Pamelor; Sinequan; Surmontil; Tipramine; Tofranil; Tofranil-PM; Vivactil http://www.nlm.nih.gov/medlineplus/druginfo/antidepressantst ricyclicsystem202055.html
Caffeine ·
Systemic - U.S. Brands: Cafcit; Caffedrine Caplets; Dexitac Stay Alert Stimulant; Enerjets; Keep Alert; Maximum Strength SnapBack Stimulant Powders; NoDoz Maximum Strength Caplets; Pep-Back; Quick Pep; Ultra Pep-Back; Vivarin http://www.nlm.nih.gov/medlineplus/druginfo/caffeinesystemic 202105.html Estrogens ·
Systemic - U.S. Brands: Alora; Aquest; Climara; Clinagen LA 40; Delestrogen; depGynogen; Depo-Estradiol; Depogen; Dioval 40; Dioval XX; Dura-Estrin; Duragen-20; E-Cypionate; Estinyl; Estrace; Estraderm; Estragyn 5; Estragyn LA 5; Estra-L 40; Estratab; Estro-A; Estro-Cyp; Estro http://www.nlm.nih.gov/medlineplus/druginfo/estrogenssystem ic202226.html
·
Vaginal - U.S. Brands: Estrace; Estring; Ogen; Ortho Dienestrol; Premarin http://www.nlm.nih.gov/medlineplus/druginfo/estrogensvagina l202227.html
Phenylpropanolamine ·
Systemic - U.S. Brands: Note:; Propagest; Thinz-Span http://www.nlm.nih.gov/medlineplus/druginfo/phenylpropanol aminesystemic202462.html
Tolterodine ·
Systemic - U.S. Brands: Detrol http://www.nlm.nih.gov/medlineplus/druginfo/tolterodinesyste mic203475.html
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Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. You may be able to access these sources from your local medical library or your doctor’s office.
Reuters Health Drug Database The Reuters Health Drug Database can be searched by keyword at the hyperlink: http://www.reutershealth.com/frame2/drug.html. The following medications are listed in the Reuters’ database as associated with urinary incontinence (including those with contraindications):46 ·
Cetirizine http://www.reutershealth.com/atoz/html/Cetirizine.htm
·
Cidofovir http://www.reutershealth.com/atoz/html/Cidofovir.htm
·
Dantrolene Sodium http://www.reutershealth.com/atoz/html/Dantrolene_Sodium.htm
·
Donepezil http://www.reutershealth.com/atoz/html/Donepezil.htm
·
Doxapram HCl http://www.reutershealth.com/atoz/html/Doxapram_HCl.htm
·
Estradiol http://www.reutershealth.com/atoz/html/Estradiol.htm
·
Estrogens Conjugated http://www.reutershealth.com/atoz/html/Estrogens_Conjugated.htm
·
Estropipate http://www.reutershealth.com/atoz/html/Estropipate.htm
·
Estropipate (Piperazine Estrone Sulfate) http://www.reutershealth.com/atoz/html/Estropipate_(Piperazine_Est rone_Sulfate).htm
·
Felbamate http://www.reutershealth.com/atoz/html/Felbamate.htm
46
Adapted from A to Z Drug Facts by Facts and Comparisons.
Researching Your Medications 217
·
Flurazepam HCl http://www.reutershealth.com/atoz/html/Flurazepam_HCl.htm
·
Galantamine Hydrobromide http://www.reutershealth.com/atoz/html/Galantamine_Hydrobromid e.htm
·
Guanethidine Monosulfate http://www.reutershealth.com/atoz/html/Guanethidine_Monosulfate. htm
·
Guanfacine HCl http://www.reutershealth.com/atoz/html/Guanfacine_HCl.htm
·
Leuprolide Acetate http://www.reutershealth.com/atoz/html/Leuprolide_Acetate.htm
·
Levodopa http://www.reutershealth.com/atoz/html/Levodopa.htm
·
Levodopa Carbidopa http://www.reutershealth.com/atoz/html/Levodopa_Carbidopa.htm
·
Midodrine HCl http://www.reutershealth.com/atoz/html/Midodrine_HCl.htm
·
Mycophenolate Mofetil http://www.reutershealth.com/atoz/html/Mycophenolate_Mofetil.htm
·
Olanzapine http://www.reutershealth.com/atoz/html/Olanzapine.htm
·
Oxybutynin Chloride http://www.reutershealth.com/atoz/html/Oxybutynin_Chloride.htm
·
Pramipexole Dihydrochloride http://www.reutershealth.com/atoz/html/Pramipexole_Dihydrochlori de.htm
·
Rivastigmine Tartrate http://www.reutershealth.com/atoz/html/Rivastigmine_Tartrate.htm
·
Ropinirole Hydrochloride http://www.reutershealth.com/atoz/html/Ropinirole_Hydrochloride.h tm
·
Sildenafil http://www.reutershealth.com/atoz/html/Sildenafil.htm
·
Sirolimus http://www.reutershealth.com/atoz/html/Sirolimus.htm
218 Urinary Incontinence
·
Tacrine HCl http://www.reutershealth.com/atoz/html/Tacrine_HCl.htm
·
Topiramate http://www.reutershealth.com/atoz/html/Topiramate.htm
·
Travoprost http://www.reutershealth.com/atoz/html/Travoprost.htm
·
Valproic Acid and Derivatives http://www.reutershealth.com/atoz/html/Valproic_Acid_and_Derivati ves.htm
Mosby’s GenRx Mosby’s GenRx database (also available on CD-Rom and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Information in Mosby’s GenRx database can be obtained at the following hyperlink: http://www.genrx.com/Mosby/PhyGenRx/group.html.
Physicians Desk Reference The Physicians Desk Reference database (also available in CD-Rom and book format) is a full-text drug database. The database is searchable by brand name, generic name or by indication. It features multiple drug interactions reports. Information can be obtained at the following hyperlink: http://physician.pdr.net/physician/templates/en/acl/psuser_t.htm. Other Web Sites A number of additional Web sites discuss drug information. As an example, you may like to look at www.drugs.com which reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. which allows users to download articles on various drugs and therapeutics for a nominal fee: http://www.medletter.com/.
Researching Your Medications 219
Contraindications and Interactions (Hidden Dangers) Some of the medications mentioned in the previous discussions can be problematic for patients with urinary incontinence--not because they are used in the treatment process, but because of contraindications, or side effects. Medications with contraindications are those that could react with drugs used to treat urinary incontinence or potentially create deleterious side effects in patients with urinary incontinence. You should ask your physician about any contraindications, especially as these might apply to other medications that you may be taking for common ailments. Drug-drug interactions occur when two or more drugs react with each other. This drug-drug interaction may cause you to experience an unexpected side effect. Drug interactions may make your medications less effective, cause unexpected side effects, or increase the action of a particular drug. Some drug interactions can even be harmful to you. Be sure to read the label every time you use a nonprescription or prescription drug, and take the time to learn about drug interactions. These precautions may be critical to your health. You can reduce the risk of potentially harmful drug interactions and side effects with a little bit of knowledge and common sense. Drug labels contain important information about ingredients, uses, warnings, and directions which you should take the time to read and understand. Labels also include warnings about possible drug interactions. Further, drug labels may change as new information becomes available. This is why it’s especially important to read the label every time you use a medication. When your doctor prescribes a new drug, discuss all over-thecounter and prescription medications, dietary supplements, vitamins, botanicals, minerals and herbals you take as well as the foods you eat. Ask your pharmacist for the package insert for each prescription drug you take. The package insert provides more information about potential drug interactions.
A Final Warning At some point, you may hear of alternative medications from friends, relatives, or in the news media. Advertisements may suggest that certain alternative drugs can produce positive results for patients with urinary incontinence. Exercise caution--some of these drugs may have fraudulent
220 Urinary Incontinence
claims, and others may actually hurt you. The Food and Drug Administration (FDA) is the official U.S. agency charged with discovering which medications are likely to improve the health of patients with urinary incontinence. The FDA warns patients to watch out for47: ·
Secret formulas (real scientists share what they know)
·
Amazing breakthroughs or miracle cures (real breakthroughs don’t happen very often; when they do, real scientists do not call them amazing or miracles)
·
Quick, painless, or guaranteed cures
·
If it sounds too good to be true, it probably isn’t true.
If you have any questions about any kind of medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.
General References In addition to the resources provided earlier in this chapter, the following general references describe medications (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): ·
Complete Guide to Prescription and Nonprescription Drugs 2001 (Complete Guide to Prescription and Nonprescription Drugs, 2001) by H. Winter Griffith, Paperback 16th edition (2001), Medical Surveillance; ISBN: 0942447417; http://www.amazon.com/exec/obidos/ASIN/039952634X/icongroupinterna
·
The Essential Guide to Prescription Drugs, 2001 by James J. Rybacki, James W. Long; Paperback - 1274 pages (2001), Harper Resource; ISBN: 0060958162; http://www.amazon.com/exec/obidos/ASIN/0060958162/icongroupinterna
·
Handbook of Commonly Prescribed Drugs by G. John Digregorio, Edward J. Barbieri; Paperback 16th edition (2001), Medical Surveillance; ISBN: 0942447417; http://www.amazon.com/exec/obidos/ASIN/0942447417/icongroupinterna
·
Johns Hopkins Complete Home Encyclopedia of Drugs 2nd ed. by Simeon Margolis (Ed.), Johns Hopkins; Hardcover - 835 pages (2000),
47
This section has been adapted from http://www.fda.gov/opacom/lowlit/medfraud.html.
Researching Your Medications 221
Rebus; ISBN: 0929661583; http://www.amazon.com/exec/obidos/ASIN/0929661583/icongroupinterna ·
Medical Pocket Reference: Drugs 2002 by Springhouse Paperback 1st edition (2001), Lippincott Williams & Wilkins Publishers; ISBN: 1582550964; http://www.amazon.com/exec/obidos/ASIN/1582550964/icongroupinterna
·
PDR by Medical Economics Staff, Medical Economics Staff Hardcover 3506 pages 55th edition (2000), Medical Economics Company; ISBN: 1563633752; http://www.amazon.com/exec/obidos/ASIN/1563633752/icongroupinterna
·
Pharmacy Simplified: A Glossary of Terms by James Grogan; Paperback 432 pages, 1st edition (2001), Delmar Publishers; ISBN: 0766828581; http://www.amazon.com/exec/obidos/ASIN/0766828581/icongroupinterna
·
Physician Federal Desk Reference by Christine B. Fraizer; Paperback 2nd edition (2001), Medicode Inc; ISBN: 1563373971; http://www.amazon.com/exec/obidos/ASIN/1563373971/icongroupinterna
·
Physician’s Desk Reference Supplements Paperback - 300 pages, 53 edition (1999), ISBN: 1563632950; http://www.amazon.com/exec/obidos/ASIN/1563632950/icongroupinterna
Vocabulary Builder The following vocabulary builder gives definitions of words used in this chapter that have not been defined in previous chapters: Cetirizine: A potent second-generation histamine H1 antagonist that is effective in the treatment of allergic rhinitis, chronic urticaria, and polleninduced asthma. Unlike many traditional antihistamines, it does not cause drowsiness or anticholinergic side effects. [NIH] Dienestrol: A synthetic, non-steroidal estrogen structurally related to stilbestrol. It is used, usually as the cream, in the treatment of menopausal and postmenopausal symptoms. [NIH] Estradiol: The most potent mammalian estrogenic hormone. It is produced in the ovary, placenta, testis, and possibly the adrenal cortex. [NIH] Levodopa: The naturally occurring form of dopa and the immediate precursor of dopamine. Unlike dopamine itself, it can be taken orally and crosses the blood-brain barrier. It is rapidly taken up by dopaminergic neurons and converted to dopamine. It is used for the treatment of parkinsonism and is usually given with agents that inhibit its conversion to
222 Urinary Incontinence
dopamine outside of the central nervous system. [NIH] Sirolimus: A macrolide compound obtained from Streptomyces hygroscopicus that acts by selectively blocking the transcriptional activation of cytokines thereby inhibiting cytokine production. It is bioactive only when bound to immunophilins. Sirolimus is a potent immunosuppressant and possesses both antifungal and antineoplastic properties. [NIH]
Researching Alternative Medicine 223
APPENDIX B. RESEARCHING ALTERNATIVE MEDICINE Overview Complementary and alternative medicine (CAM) is one of the most contentious aspects of modern medical practice. You may have heard of these treatments on the radio or on television. Maybe you have seen articles written about these treatments in magazines, newspapers, or books. Perhaps your friends or doctor have mentioned alternatives. In this chapter, we will begin by giving you a broad perspective on complementary and alternative therapies. Next, we will introduce you to official information sources on CAM relating to urinary incontinence. Finally, at the conclusion of this chapter, we will provide a list of readings on urinary incontinence from various authors. We will begin, however, with the National Center for Complementary and Alternative Medicine’s (NCCAM) overview of complementary and alternative medicine.
What Is CAM?48 Complementary and alternative medicine (CAM) covers a broad range of healing philosophies, approaches, and therapies. Generally, it is defined as those treatments and healthcare practices which are not taught in medical schools, used in hospitals, or reimbursed by medical insurance companies. Many CAM therapies are termed “holistic,” which generally means that the healthcare practitioner considers the whole person, including physical, mental, emotional, and spiritual health. Some of these therapies are also known as “preventive,” which means that the practitioner educates and 48
Adapted from the NCCAM: http://nccam.nih.gov/nccam/fcp/faq/index.html#what-is.
224 Urinary Incontinence
treats the person to prevent health problems from arising, rather than treating symptoms after problems have occurred. People use CAM treatments and therapies in a variety of ways. Therapies are used alone (often referred to as alternative), in combination with other alternative therapies, or in addition to conventional treatment (sometimes referred to as complementary). Complementary and alternative medicine, or “integrative medicine,” includes a broad range of healing philosophies, approaches, and therapies. Some approaches are consistent with physiological principles of Western medicine, while others constitute healing systems with non-Western origins. While some therapies are far outside the realm of accepted Western medical theory and practice, others are becoming established in mainstream medicine. Complementary and alternative therapies are used in an effort to prevent illness, reduce stress, prevent or reduce side effects and symptoms, or control or cure disease. Some commonly used methods of complementary or alternative therapy include mind/body control interventions such as visualization and relaxation, manual healing including acupressure and massage, homeopathy, vitamins or herbal products, and acupuncture.
What Are the Domains of Alternative Medicine?49 The list of CAM practices changes continually. The reason being is that these new practices and therapies are often proved to be safe and effective, and therefore become generally accepted as “mainstream” healthcare practices. Today, CAM practices may be grouped within five major domains: (1) alternative medical systems, (2) mind-body interventions, (3) biologicallybased treatments, (4) manipulative and body-based methods, and (5) energy therapies. The individual systems and treatments comprising these categories are too numerous to list in this sourcebook. Thus, only limited examples are provided within each. Alternative Medical Systems Alternative medical systems involve complete systems of theory and practice that have evolved independent of, and often prior to, conventional biomedical approaches. Many are traditional systems of medicine that are
49
Adapted from the NCCAM: http://nccam.nih.gov/nccam/fcp/classify/index.html.
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practiced by individual cultures throughout the world, including a number of venerable Asian approaches. Traditional oriental medicine emphasizes the balance or disturbances of qi (pronounced chi) or vital energy in health and disease, respectively. Traditional oriental medicine consists of a group of techniques and methods including acupuncture, herbal medicine, oriental massage, and qi gong (a form of energy therapy). Acupuncture involves stimulating specific anatomic points in the body for therapeutic purposes, usually by puncturing the skin with a thin needle. Ayurveda is India’s traditional system of medicine. Ayurvedic medicine (meaning “science of life”) is a comprehensive system of medicine that places equal emphasis on body, mind, and spirit. Ayurveda strives to restore the innate harmony of the individual. Some of the primary Ayurvedic treatments include diet, exercise, meditation, herbs, massage, exposure to sunlight, and controlled breathing. Other traditional healing systems have been developed by the world’s indigenous populations. These populations include Native American, Aboriginal, African, Middle Eastern, Tibetan, and Central and South American cultures. Homeopathy and naturopathy are also examples of complete alternative medicine systems. Homeopathic medicine is an unconventional Western system that is based on the principle that “like cures like,” i.e., that the same substance that in large doses produces the symptoms of an illness, in very minute doses cures it. Homeopathic health practitioners believe that the more dilute the remedy, the greater its potency. Therefore, they use small doses of specially prepared plant extracts and minerals to stimulate the body’s defense mechanisms and healing processes in order to treat illness. Naturopathic medicine is based on the theory that disease is a manifestation of alterations in the processes by which the body naturally heals itself and emphasizes health restoration rather than disease treatment. Naturopathic physicians employ an array of healing practices, including the following: diet and clinical nutrition, homeopathy, acupuncture, herbal medicine, hydrotherapy (the use of water in a range of temperatures and methods of applications), spinal and soft-tissue manipulation, physical therapies (such as those involving electrical currents, ultrasound, and light), therapeutic counseling, and pharmacology.
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Mind-Body Interventions Mind-body interventions employ a variety of techniques designed to facilitate the mind’s capacity to affect bodily function and symptoms. Only a select group of mind-body interventions having well-documented theoretical foundations are considered CAM. For example, patient education and cognitive-behavioral approaches are now considered “mainstream.” On the other hand, complementary and alternative medicine includes meditation, certain uses of hypnosis, dance, music, and art therapy, as well as prayer and mental healing.
Biological-Based Therapies This category of CAM includes natural and biological-based practices, interventions, and products, many of which overlap with conventional medicine’s use of dietary supplements. This category includes herbal, special dietary, orthomolecular, and individual biological therapies. Herbal therapy employs an individual herb or a mixture of herbs for healing purposes. An herb is a plant or plant part that produces and contains chemical substances that act upon the body. Special diet therapies, such as those proposed by Drs. Atkins, Ornish, Pritikin, and Weil, are believed to prevent and/or control illness as well as promote health. Orthomolecular therapies aim to treat disease with varying concentrations of chemicals such as magnesium, melatonin, and mega-doses of vitamins. Biological therapies include, for example, the use of laetrile and shark cartilage to treat cancer and the use of bee pollen to treat autoimmune and inflammatory diseases.
Manipulative and Body-Based Methods This category includes methods that are based on manipulation and/or movement of the body. For example, chiropractors focus on the relationship between structure and function, primarily pertaining to the spine, and how that relationship affects the preservation and restoration of health. Chiropractors use manipulative therapy as an integral treatment tool. In contrast, osteopaths place particular emphasis on the musculoskeletal system and practice osteopathic manipulation. Osteopaths believe that all of the body’s systems work together and that disturbances in one system may have an impact upon function elsewhere in the body. Massage therapists manipulate the soft tissues of the body to normalize those tissues.
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Energy Therapies Energy therapies focus on energy fields originating within the body (biofields) or those from other sources (electromagnetic fields). Biofield therapies are intended to affect energy fields (the existence of which is not yet experimentally proven) that surround and penetrate the human body. Some forms of energy therapy manipulate biofields by applying pressure and/or manipulating the body by placing the hands in or through these fields. Examples include Qi gong, Reiki and Therapeutic Touch. Qi gong is a component of traditional oriental medicine that combines movement, meditation, and regulation of breathing to enhance the flow of vital energy (qi) in the body, improve blood circulation, and enhance immune function. Reiki, the Japanese word representing Universal Life Energy, is based on the belief that, by channeling spiritual energy through the practitioner, the spirit is healed and, in turn, heals the physical body. Therapeutic Touch is derived from the ancient technique of “laying-on of hands.” It is based on the premises that the therapist’s healing force affects the patient’s recovery and that healing is promoted when the body’s energies are in balance. By passing their hands over the patient, these healers identify energy imbalances. Bioelectromagnetic-based therapies involve the unconventional use of electromagnetic fields to treat illnesses or manage pain. These therapies are often used to treat asthma, cancer, and migraine headaches. Types of electromagnetic fields which are manipulated in these therapies include pulsed fields, magnetic fields, and alternating current or direct current fields.
Can Alternatives Affect My Treatment? A critical issue in pursuing complementary alternatives mentioned thus far is the risk that these might have undesirable interactions with your medical treatment. It becomes all the more important to speak with your doctor who can offer advice on the use of alternatives. Official sources confirm this view. Though written for women, we find that the National Women’s Health Information Center’s advice on pursuing alternative medicine is appropriate for patients of both genders and all ages.50
50
Adapted from http://www.4woman.gov/faq/alternative.htm.
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Is It Okay to Want Both Traditional and Alternative Medicine? Should you wish to explore non-traditional types of treatment, be sure to discuss all issues concerning treatments and therapies with your healthcare provider, whether a physician or practitioner of complementary and alternative medicine. Competent healthcare management requires knowledge of both conventional and alternative therapies you are taking for the practitioner to have a complete picture of your treatment plan. The decision to use complementary and alternative treatments is an important one. Consider before selecting an alternative therapy, the safety and effectiveness of the therapy or treatment, the expertise and qualifications of the healthcare practitioner, and the quality of delivery. These topics should be considered when selecting any practitioner or therapy.
Finding CAM References on Urinary Incontinence Having read the previous discussion, you may be wondering which complementary or alternative treatments might be appropriate for urinary incontinence. For the remainder of this chapter, we will direct you to a number of official sources which can assist you in researching studies and publications. Some of these articles are rather technical, so some patience may be required. The Combined Health Information Database For a targeted search, The Combined Health Information Database is a bibliographic database produced by health-related agencies of the Federal Government (mostly from the National Institutes of Health). This database is updated four times a year at the end of January, April, July, and October. Check the titles, summaries, and availability of CAM-related information by using the “Simple Search” option at the following Web site: http://chid.nih.gov/simple/simple.html. In the drop box at the top, select “Complementary and Alternative Medicine.” Then type “urinary incontinence” (or synonyms) in the second search box. We recommend that you select 100 “documents per page” and to check the “whole records” options. The following was extracted using this technique: ·
Biofeedback in the Treatment of Urinary Incontinence in Adults Source: Tecnologica MAP Supplement. 65(5): 3-5. April 2000.
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Summary: This journal article evaluates the use of biofeedback as an adjunct to pelvic floor muscle exercises (PME) for the treatment of urinary incontinence in adults. The purpose is to determine whether biofeedback for urinary incontinence meets the Blue Cross and Blue Shield Association Technology Evaluation Center (TEC) criteria. The evaluating panel reviewed eight controlled trials (n=383) that concurrently compared patients treated with PME plus biofeedback with patients treated with PME alone. These trials studied patients with stress incontinence (n=6 trials), urge incontinence (n=1 trial), and postprostatectomy incontinence (n=1 trial). The panel concludes that the evidence is not sufficient to demonstrate an additional benefit for biofeedback above that obtained with PME alone. Therefore, biofeedback for the treatment of urinary incontinence does not meet the TEC criteria. ·
Behavioral vs Drug Treatment for Urge Urinary Incontinence in Older Women: A Randomized Controlled Trial Source: JAMA. Journal of the American Medical Association. 280(23): 1995-2000. December 16, 1998. Summary: This journal article describes a study comparing the effectiveness of behavioral and drug treatments for urge urinary incontinence in 197 older women (aged 55 to 92 years) recruited from the community. All had urge urinary incontinence or mixed incontinence with urge as the predominant pattern. They were randomly assigned to four sessions of biofeedback-assisted behavioral treatment, drug treatment with oxybutynin chloride at doses of 2.5 mg/day to 5.0 mg three times a day, or a placebo control condition for 8 weeks. The main outcome measures were reduction of incontinent episodes as recorded in bladder diaries, and patient perceptions of improvement, comfort, and satisfaction with treatment. In all three groups, reduction of incontinence was most pronounced early in treatment and progressed more gradually thereafter. Behavioral treatment was significantly more effective than drug treatment (80.7 percent versus 68.5 percent reduction of incontinent episodes), and both were more effective than the placebo control condition (39.4 percent reduction). All measures of patient-perceived improvement, satisfaction, and comfort also were highest in the behavioral treatment group. The authors conclude that behavioral treatment appears to be a safe and effective conservative intervention that should be made available as a first-line treatment for urge and mixed incontinence. The article has 4 figures, 5 tables, and 30 references. (See AMJA01511 for a related editorial).
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Improving Treatment of Urinary Incontinence. (editorial) Source: JAMA. Journal of the American Medical Association. 280(23): 2034-2035. December 16, 1998. Summary: This editorial discusses the use of behavioral interventions for urinary incontinence in older patients. First, it reviews the reasons why pharmacological therapy is used more frequently than behavioral techniques as a treatment for urinary incontinence, and outlines some of the drawbacks to these agents. Then, it highlights a 1998 study by K. L. Burgio and colleagues, which found that a biofeedback-assisted behavioral intervention was superior to both oxybutynin and placebo in the treatment of urge and mixed urinary in older women (see AMJA01510). This editorial explores some of the lessons from that earlier study for clinicians, and suggests directions for future research. Potential areas of inquiry include the relative efficacy of bladder training and biofeedback, the benefits of adding biofeedback to pharmacotherapy, and the efficacy of biofeedback for patients with more severe forms of incontinence. The article has 10 references.
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Urinary Incontinence: Alternative Therapies That Are Standard Treatment Source: Alternative and Complementary Therapies. 3(4): 261-268. August 1997. Summary: This journal article describes the alternative therapies used for urinary incontinence including Kegal exercises (an exercise that strengthens the levator ani muscles), biofeedback, electrostimulation, vaginal cones, traditional Chinese medicine, use of herbals, lifestyle changes, and homeopathic treatments. Each method is defined, and examples are given. There are tables giving instruction on evaluating urinary incontinence and performing Kegal exercises. Also provided are a sample bladder diary, a sample informed consent form for biofeedback, a recommended reading list, and a list of resources for further information. This journal article contains 20 references.
National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov) has created a link to the National Library of Medicine’s databases to allow patients to search for articles that specifically relate to urinary incontinence and complementary medicine. To search the database, go to the following Web site: www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on
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PubMed.” Enter “urinary incontinence” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine (CAM) that are related to urinary incontinence: ·
A behavioral approach to the treatment of urinary incontinence in a disabled population. Author(s): Fried GW, Goetz G, Potts-Nulty S, Cioschi HM, Staas WE Jr. Source: Archives of Physical Medicine and Rehabilitation. 1995 December; 76(12): 1120-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8540787&dopt=Abstract
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A conservative approach for a patient with traumatically induced urinary incontinence. Author(s): Stude DE, Bergmann TF, Finer BA. Source: Journal of Manipulative and Physiological Therapeutics. 1998 June; 21(5): 363-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9627868&dopt=Abstract
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A long-term study of patient outcomes with pelvic muscle re-education for urinary incontinence. Author(s): Dattilo J. Source: Journal of Wound, Ostomy, and Continence Nursing : Official Publication of the Wound, Ostomy and Continence Nurses Society / Wocn. 2001 July; 28(4): 199-205. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11452256&dopt=Abstract
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A new technique for sacral nerve stimulation: a percutaneous method for urinary incontinence caused by spinal cord injury. Author(s): Ishigooka M, Suzuki Y, Hashimoto T, Sasagawa I, Nakada T, Handa Y. Source: Br J Urol. 1998 February; 81(2): 315-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9488079&dopt=Abstract
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A pilot study to determine predictors of behavioral treatment completion for urinary incontinence. Author(s): Kincade JE, Peckous BK, Busby-Whitehead J.
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Source: Urologic Nursing : Official Journal of the American Urological Association Allied. 2001 February; 21(1): 39-44. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11998114&dopt=Abstract ·
A population based, randomized, controlled trial of conservative treatment for urinary incontinence in women. Author(s): Holtedahl K, Verelst M, Schiefloe A. Source: Acta Obstetricia Et Gynecologica Scandinavica. 1998 July; 77(6): 671-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9688247&dopt=Abstract
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A tangible means of assessing progress. Biofeedback in the management of urinary incontinence. Author(s): Wells M. Source: Prof Nurse. 1991 April; 6(7): 396-7, 399. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2020682&dopt=Abstract
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Addressing Medicare coverage for biofeedback in the treatment of urinary incontinence. Author(s): Jewell KE. Source: Ostomy Wound Manage. 1998 December; 44(12): 54-60, 62-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10026549&dopt=Abstract
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An interdisciplinary approach to the assessment and behavioral treatment of urinary incontinence in geriatric outpatients. Author(s): McDowell BJ, Burgio KL, Dombrowski M, Locher JL, Rodriguez E. Source: Journal of the American Geriatrics Society. 1992 April; 40(4): 370-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1556364&dopt=Abstract
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An overview of urinary incontinence in adults: assessments and behavioral interventions. Author(s): Beckman NJ.
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Source: Clinical Nurse Specialist Cns. 1995 September; 9(5): 241-7, 274. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8697354&dopt=Abstract ·
Anal electrostimulation in urinary incontinence. Technical description of a new device. Author(s): Bergmann S, Eriksen BC. Source: Urologia Internationalis. 1986; 41(6): 411-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3824696&dopt=Abstract
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Assessment and management of urinary incontinence among homebound older adults: a clinical trial protocol. Author(s): Engberg S, McDowell BJ, Weber E, Brodak I, Donovan N, Engberg R. Source: Adv Pract Nurs Q. 1997 Fall; 3(2): 48-56. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9432453&dopt=Abstract
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Assessment for biofeedback and behavioral therapy for urinary incontinence. Author(s): Coxe J. Source: Urologic Nursing : Official Journal of the American Urological Association Allied. 1994 September; 14(3): 82-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7732422&dopt=Abstract
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Behavior therapies for urinary incontinence in the elderly. Author(s): Burgio KL, Burgio LD. Source: Clinics in Geriatric Medicine. 1986 November; 2(4): 809-27. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3536064&dopt=Abstract
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Behavioral therapy for urinary incontinence. Author(s): Wheeler JS Jr, Walter JS, Niecestro RM, Scalzo AJ. Source: J Et Nurs. 1992 March-April; 19(2): 59-65. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1558862&dopt=Abstract
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Behavioral therapy: practical approach to urinary incontinence. Author(s): Burgio KL. Source: Contemp Urol. 1994 February; 6(2): 24, 29-36, 41. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10146675&dopt=Abstract
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Behavioral training for post-prostatectomy urinary incontinence. Author(s): Burgio KL, Stutzman RE, Engel BT. Source: The Journal of Urology. 1989 February; 141(2): 303-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2913349&dopt=Abstract
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Behavioral training for urinary incontinence in elderly ambulatory patients. Author(s): Burton JR, Pearce KL, Burgio KL, Engel BT, Whitehead WE. Source: Journal of the American Geriatrics Society. 1988 August; 36(8): 693-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3403874&dopt=Abstract
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Behavioral treatment of exercise-induced urinary incontinence among female soldiers. Author(s): Sherman RA, Davis GD, Wong MF. Source: Mil Med. 1997 October; 162(10): 690-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9339085&dopt=Abstract
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Behavioral vs drug treatment for urge urinary incontinence in older women: a randomized controlled trial. Author(s): Burgio KL, Locher JL, Goode PS, Hardin JM, McDowell BJ, Dombrowski M, Candib D. Source: Jama : the Journal of the American Medical Association. 1998 December 16; 280(23): 1995-2000. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9863850&dopt=Abstract
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Biofeedback and electrical stimulation therapy for treating urinary incontinence and voiding dysfunction: one center's experience. Author(s): Abdelghany S, Hughes J, Lammers J, Wellbrock B, Buffington PJ, Shank RA 3rd.
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Source: Urologic Nursing : Official Journal of the American Urological Association Allied. 2001 December; 21(6): 401-5, 410. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11998506&dopt=Abstract ·
Biofeedback and physiotherapy versus physiotherapy alone in the treatment of genuine stress urinary incontinence. Author(s): Glavind K, Nohr SB, Walter S. Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 1996; 7(6): 339-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9203484&dopt=Abstract
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Biofeedback for community-dwelling individuals with urinary incontinence. Author(s): Payne CK. Source: Urology. 1998 February; 51(2A Suppl): 35-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9495734&dopt=Abstract
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Biofeedback in treatment of urinary incontinence in stroke patients. Author(s): Middaugh SJ, Whitehead WE, Burgio KL, Engel BT. Source: Biofeedback Self Regul. 1989 March; 14(1): 3-19. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2752058&dopt=Abstract
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Biofeedback in urinary incontinence: past, present and future. Author(s): Weatherall M. Source: Current Opinion in Obstetrics & Gynecology. 2000 October; 12(5): 411-3. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11111884&dopt=Abstract
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Biofeedback therapy technique for treatment of urinary incontinence. Author(s): O'Donnell PD, Doyle R. Source: Urology. 1991 May; 37(5): 432-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2024391&dopt=Abstract
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Biofeedback vs verbal feedback as learning tools for pelvic muscle exercises in the early management of urinary incontinence after radical prostatectomy.
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Author(s): Floratos DL, Sonke GS, Rapidou CA, Alivizatos GJ, Deliveliotis C, Constantinides CA, Theodorou C. Source: Bju International. 2002 May; 89(7): 714-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11966630&dopt=Abstract ·
Bladder training and related therapies for urinary incontinence in older people. Author(s): Hadley EC. Source: Jama : the Journal of the American Medical Association. 1986 July 18; 256(3): 372-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3723724&dopt=Abstract
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Changes in urodynamic measurements after successful anal electrostimulation in female urinary incontinence. Author(s): Eriksen BC, Mjolnerod OK. Source: Br J Urol. 1987 January; 59(1): 45-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3493825&dopt=Abstract
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Clinical application of Pavlov conditioning reflexes in treatment of urinary incontinence. Author(s): Godec CJ. Source: Urology. 1983 October; 22(4): 397-400. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=6636396&dopt=Abstract
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Comparative efficacy of behavioral interventions in the management of female urinary incontinence. Continence Program for Women Research Group. Author(s): Wyman JF, Fantl JA, McClish DK, Bump RC. Source: American Journal of Obstetrics and Gynecology. 1998 October; 179(4): 999-1007. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9790388&dopt=Abstract
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Comparison of behavior therapy methods for urinary incontinence following prostate surgery: a pilot study. Author(s): Joseph AC, Chang MK.
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Source: Urologic Nursing : Official Journal of the American Urological Association Allied. 2000 June; 20(3): 203-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11998139&dopt=Abstract ·
Conservative care of urinary incontinence in the elderly. Author(s): Keating JC Jr, Schulte EA, Miller E. Source: Journal of Manipulative and Physiological Therapeutics. 1988 August; 11(4): 300-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3049892&dopt=Abstract
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Conservative management for post prostatectomy urinary incontinence. Author(s): Moore KN, Cody DJ, Glazener CM. Source: Cochrane Database Syst Rev. 2001; (2): Cd001843. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11406013&dopt=Abstract
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Conservative management for urinary incontinence. Author(s): Moore KH. Source: Bailliere's Best Practice & Research. Clinical Obstetrics & Gynaecology. 2000 April; 14(2): 251-89. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10897322&dopt=Abstract
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Conservative treatment of stress urinary incontinence in women: a systematic review of randomized clinical trials. Author(s): Berghmans LC, Hendriks HJ, Bo K, Hay-Smith EJ, de Bie RA, van Waalwijk van Doorn ES. Source: Br J Urol. 1998 August; 82(2): 181-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9722751&dopt=Abstract
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Conservative treatment of stress urinary incontinence in women: who will benefit? Author(s): Truijen G, Wyndaele JJ, Weyler J. Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 2001; 12(6): 386-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11795642&dopt=Abstract
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Conservative treatment of urge urinary incontinence in women: a systematic review of randomized clinical trials. Author(s): Berghmans LC, Hendriks HJ, De Bie RA, van Waalwijk van Doorn ES, Bo K, van Kerrebroeck PE. Source: Bju International. 2000 February; 85(3): 254-63. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10671878&dopt=Abstract
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Coping with urinary incontinence: a conceptualization of the process. Author(s): Talbot LA. Source: Ostomy Wound Manage. 1994 March; 40(2): 28-30, 32, 34 Passim. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8043177&dopt=Abstract
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Cues to action: pelvic floor muscle exercise compliance in women with stress urinary incontinence. Author(s): Gallo ML, Staskin DR. Source: Neurourology and Urodynamics. 1997; 16(3): 167-77. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9136139&dopt=Abstract
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Development of a non-invasive treatment system for urinary incontinence using a functional continuous magnetic stimulator (FCMS). Author(s): Ishikawa N, Suda S, Sasaki T, Yamanishi T, Hosaka H, Yasuda K, Ito H. Source: Med Biol Eng Comput. 1998 November; 36(6): 704-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10367460&dopt=Abstract
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Does electrostimulation cure urinary incontinence? Author(s): Fall M. Source: The Journal of Urology. 1984 April; 131(4): 664-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=6608590&dopt=Abstract
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Effect of anal electrostimulation with the 'Incontan' device in women with urinary incontinence. Author(s): Eriksen BC, Bergmann S, Mjolnerod OK.
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Source: Br J Obstet Gynaecol. 1987 February; 94(2): 147-56. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3493802&dopt=Abstract ·
Effect of functional continuous magnetic stimulation for urinary incontinence. Author(s): Yamanishi T, Yasuda K, Suda S, Ishikawa N, Sakakibara R, Hattori T. Source: The Journal of Urology. 2000 February; 163(2): 456-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10647653&dopt=Abstract
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Electric stimulation and urinary incontinence: research and alternatives. Author(s): Moore KN, Gray M, Rayome R. Source: Urologic Nursing : Official Journal of the American Urological Association Allied. 1995 September; 15(3): 94-6. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7481893&dopt=Abstract
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Electric stimulation: does nursing have a role in the treatment of adult urinary incontinence? Author(s): Davis VM. Source: Urologic Nursing : Official Journal of the American Urological Association Allied. 1995 June; 15(2): 56-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7597450&dopt=Abstract
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Electrical pelvic floor stimulation: a possible alternative treatment for reflex urinary incontinence in patients with spinal cord injury. Author(s): Ishigooka M, Hashimoto T, Hayami S, Suzuki Y, Nakada T, Handa Y. Source: Spinal Cord : the Official Journal of the International Medical Society of Paraplegia. 1996 July; 34(7): 411-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8963996&dopt=Abstract
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Electrical stimulation for the treatment of urinary incontinence. Author(s): Appell RA.
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Source: Urology. 1998 February; 51(2A Suppl): 24-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9495731&dopt=Abstract ·
Electrical stimulation for the treatment of urinary incontinence: do we know enough to accept it as part of our practice? Author(s): Moore KN. Source: Journal of Advanced Nursing. 1994 December; 20(6): 1018-22. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7860846&dopt=Abstract
Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: ·
Alternative Medicine Foundation, Inc.: http://www.herbmed.org/
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AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats
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Chinese Medicine: http://www.newcenturynutrition.com/
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drkoop.comÒ: http://www.drkoop.com/InteractiveMedicine/IndexC.html
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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm
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Google: http://directory.google.com/Top/Health/Alternative/
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Healthnotes: http://www.thedacare.org/healthnotes/
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Open Directory Project: http://dmoz.org/Health/Alternative/
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TPN.com: http://www.tnp.com/
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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/
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WebMDÒHealth: http://my.webmd.com/drugs_and_herbs
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WellNet: http://www.wellnet.ca/herbsa-c.htm
·
WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,,00.html
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The following is a specific Web list relating to urinary incontinence; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: ·
General Overview Urinary Incontinence Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Urinar yIncontinencecc.html
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Alternative Therapy Biofeedback Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsModalities/Biofeed backcm.html
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Herbs and Supplements Caffeine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Urinar yIncontinencecc.html Estrogen Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Urinar yIncontinencecc.html Herbal Medicine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Urinar yIncontinencecc.html Horsetail
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Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Hyperlink: http://www.wellnet.ca/herbsg-i.htm Marshmallow Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Urinar yIncontinencecc.html Pollen Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Pollen.htm Royal Jelly Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Royal_Jelly.htm Thyme Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Hyperlink: http://www.wellnet.ca/herbss-v.htm ·
Related Conditions Cancer, Prostate Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Cancer Prostatecc.html Incontinence, Urinary Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Urinar yIncontinencecc.html Multiple Sclerosis Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Multiple_Sclerosis.htm
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Prostate Cancer Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Cancer Prostatecc.html
General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at: www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources. The following additional references describe, in broad terms, alternative and complementary medicine (sorted alphabetically by title; hyperlinks provide rankings, information, and reviews at Amazon.com): · Alternative Medicine for Dummies by James Dillard (Author); Audio Cassette, Abridged edition (1998), Harper Audio; ISBN: 0694520659; http://www.amazon.com/exec/obidos/ASIN/0694520659/icongroupinterna ·
Complementary and Alternative Medicine Secrets by W. Kohatsu (Editor); Hardcover (2001), Hanley & Belfus; ISBN: 1560534400; http://www.amazon.com/exec/obidos/ASIN/1560534400/icongroupinterna
·
Dictionary of Alternative Medicine by J. C. Segen; Paperback-2nd edition (2001), Appleton & Lange; ISBN: 0838516211; http://www.amazon.com/exec/obidos/ASIN/0838516211/icongroupinterna
·
Eat, Drink, and Be Healthy: The Harvard Medical School Guide to Healthy Eating by Walter C. Willett, MD, et al; Hardcover - 352 pages (2001), Simon & Schuster; ISBN: 0684863375; http://www.amazon.com/exec/obidos/ASIN/0684863375/icongroupinterna
· Encyclopedia of Natural Medicine, Revised 2nd Edition by Michael T. Murray, Joseph E. Pizzorno; Paperback - 960 pages, 2nd Rev edition (1997), Prima Publishing; ISBN: 0761511571; http://www.amazon.com/exec/obidos/ASIN/0761511571/icongroupinterna ·
Herbs for the Urinary Tract: Herbal Relief for Kidney Stones, Bladder Infections and Other Problems of the Urinary Tract by Michael Moore; Paperback - 96 pages (June 1998), McGraw Hill - NTC; ISBN: 0879838159; http://www.amazon.com/exec/obidos/ASIN/0879838159/icongroupinterna
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·
Integrative Medicine: An Introduction to the Art & Science of Healing by Andrew Weil (Author); Audio Cassette, Unabridged edition (2001), Sounds True; ISBN: 1564558541; http://www.amazon.com/exec/obidos/ASIN/1564558541/icongroupinterna
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New Encyclopedia of Herbs & Their Uses by Deni Bown; Hardcover - 448 pages, Revised edition (2001), DK Publishing; ISBN: 078948031X; http://www.amazon.com/exec/obidos/ASIN/078948031X/icongroupinterna
· Textbook of Complementary and Alternative Medicine by Wayne B. Jonas; Hardcover (2003), Lippincott, Williams & Wilkins; ISBN: 0683044370; http://www.amazon.com/exec/obidos/ASIN/0683044370/icongroupinterna For additional information on complementary and alternative medicine, ask your doctor or write to: National Institutes of Health National Center for Complementary and Alternative Medicine Clearinghouse P. O. Box 8218 Silver Spring, MD 20907-8218
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APPENDIX C. RESEARCHING NUTRITION Overview Since the time of Hippocrates, doctors have understood the importance of diet and nutrition to patients’ health and well-being. Since then, they have accumulated an impressive archive of studies and knowledge dedicated to this subject. Based on their experience, doctors and healthcare providers may recommend particular dietary supplements to patients with urinary incontinence. Any dietary recommendation is based on a patient’s age, body mass, gender, lifestyle, eating habits, food preferences, and health condition. It is therefore likely that different patients with urinary incontinence may be given different recommendations. Some recommendations may be directly related to urinary incontinence, while others may be more related to the patient’s general health. These recommendations, themselves, may differ from what official sources recommend for the average person. In this chapter we will begin by briefly reviewing the essentials of diet and nutrition that will broadly frame more detailed discussions of urinary incontinence. We will then show you how to find studies dedicated specifically to nutrition and urinary incontinence.
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Food and Nutrition: General Principles What Are Essential Foods? Food is generally viewed by official sources as consisting of six basic elements: (1) fluids, (2) carbohydrates, (3) protein, (4) fats, (5) vitamins, and (6) minerals. Consuming a combination of these elements is considered to be a healthy diet: ·
Fluids are essential to human life as 80-percent of the body is composed of water. Water is lost via urination, sweating, diarrhea, vomiting, diuretics (drugs that increase urination), caffeine, and physical exertion.
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Carbohydrates are the main source for human energy (thermoregulation) and the bulk of typical diets. They are mostly classified as being either simple or complex. Simple carbohydrates include sugars which are often consumed in the form of cookies, candies, or cakes. Complex carbohydrates consist of starches and dietary fibers. Starches are consumed in the form of pastas, breads, potatoes, rice, and other foods. Soluble fibers can be eaten in the form of certain vegetables, fruits, oats, and legumes. Insoluble fibers include brown rice, whole grains, certain fruits, wheat bran and legumes.
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Proteins are eaten to build and repair human tissues. Some foods that are high in protein are also high in fat and calories. Food sources for protein include nuts, meat, fish, cheese, and other dairy products.
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Fats are consumed for both energy and the absorption of certain vitamins. There are many types of fats, with many general publications recommending the intake of unsaturated fats or those low in cholesterol.
Vitamins and minerals are fundamental to human health, growth, and, in some cases, disease prevention. Most are consumed in your diet (exceptions being vitamins K and D which are produced by intestinal bacteria and sunlight on the skin, respectively). Each vitamin and mineral plays a different role in health. The following outlines essential vitamins: ·
Vitamin A is important to the health of your eyes, hair, bones, and skin; sources of vitamin A include foods such as eggs, carrots, and cantaloupe.
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Vitamin B1, also known as thiamine, is important for your nervous system and energy production; food sources for thiamine include meat, peas, fortified cereals, bread, and whole grains.
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Vitamin B2, also known as riboflavin, is important for your nervous system and muscles, but is also involved in the release of proteins from
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nutrients; food sources for riboflavin include dairy products, leafy vegetables, meat, and eggs. ·
Vitamin B3, also known as niacin, is important for healthy skin and helps the body use energy; food sources for niacin include peas, peanuts, fish, and whole grains
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Vitamin B6, also known as pyridoxine, is important for the regulation of cells in the nervous system and is vital for blood formation; food sources for pyridoxine include bananas, whole grains, meat, and fish.
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Vitamin B12 is vital for a healthy nervous system and for the growth of red blood cells in bone marrow; food sources for vitamin B12 include yeast, milk, fish, eggs, and meat.
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Vitamin C allows the body’s immune system to fight various diseases, strengthens body tissue, and improves the body’s use of iron; food sources for vitamin C include a wide variety of fruits and vegetables.
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Vitamin D helps the body absorb calcium which strengthens bones and teeth; food sources for vitamin D include oily fish and dairy products.
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Vitamin E can help protect certain organs and tissues from various degenerative diseases; food sources for vitamin E include margarine, vegetables, eggs, and fish.
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Vitamin K is essential for bone formation and blood clotting; common food sources for vitamin K include leafy green vegetables.
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Folic Acid maintains healthy cells and blood and, when taken by a pregnant woman, can prevent her fetus from developing neural tube defects; food sources for folic acid include nuts, fortified breads, leafy green vegetables, and whole grains.
It should be noted that one can overdose on certain vitamins which become toxic if consumed in excess (e.g. vitamin A, D, E and K). Like vitamins, minerals are chemicals that are required by the body to remain in good health. Because the human body does not manufacture these chemicals internally, we obtain them from food and other dietary sources. The more important minerals include: ·
Calcium is needed for healthy bones, teeth, and muscles, but also helps the nervous system function; food sources for calcium include dry beans, peas, eggs, and dairy products.
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Chromium is helpful in regulating sugar levels in blood; food sources for chromium include egg yolks, raw sugar, cheese, nuts, beets, whole grains, and meat.
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·
Fluoride is used by the body to help prevent tooth decay and to reinforce bone strength; sources of fluoride include drinking water and certain brands of toothpaste.
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Iodine helps regulate the body’s use of energy by synthesizing into the hormone thyroxine; food sources include leafy green vegetables, nuts, egg yolks, and red meat.
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Iron helps maintain muscles and the formation of red blood cells and certain proteins; food sources for iron include meat, dairy products, eggs, and leafy green vegetables.
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Magnesium is important for the production of DNA, as well as for healthy teeth, bones, muscles, and nerves; food sources for magnesium include dried fruit, dark green vegetables, nuts, and seafood.
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Phosphorous is used by the body to work with calcium to form bones and teeth; food sources for phosphorous include eggs, meat, cereals, and dairy products.
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Selenium primarily helps maintain normal heart and liver functions; food sources for selenium include wholegrain cereals, fish, meat, and dairy products.
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Zinc helps wounds heal, the formation of sperm, and encourage rapid growth and energy; food sources include dried beans, shellfish, eggs, and nuts.
The United States government periodically publishes recommended diets and consumption levels of the various elements of food. Again, your doctor may encourage deviations from the average official recommendation based on your specific condition. To learn more about basic dietary guidelines, visit the Web site: http://www.health.gov/dietaryguidelines/. Based on these guidelines, many foods are required to list the nutrition levels on the food’s packaging. Labeling Requirements are listed at the following site maintained by the Food and Drug Administration: http://www.cfsan.fda.gov/~dms/labcons.html. When interpreting these requirements, the government recommends that consumers become familiar with the following abbreviations before reading FDA literature:51 ·
DVs (Daily Values): A new dietary reference term that will appear on the food label. It is made up of two sets of references, DRVs and RDIs.
·
DRVs (Daily Reference Values): A set of dietary references that applies to fat, saturated fat, cholesterol, carbohydrate, protein, fiber, sodium, and potassium.
51
Adapted from the FDA: http://www.fda.gov/fdac/special/foodlabel/dvs.html.
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·
RDIs (Reference Daily Intakes): A set of dietary references based on the Recommended Dietary Allowances for essential vitamins and minerals and, in selected groups, protein. The name “RDI” replaces the term “U.S. RDA.”
·
RDAs (Recommended Dietary Allowances): A set of estimated nutrient allowances established by the National Academy of Sciences. It is updated periodically to reflect current scientific knowledge. What Are Dietary Supplements?52
Dietary supplements are widely available through many commercial sources, including health food stores, grocery stores, pharmacies, and by mail. Dietary supplements are provided in many forms including tablets, capsules, powders, gel-tabs, extracts, and liquids. Historically in the United States, the most prevalent type of dietary supplement was a multivitamin/mineral tablet or capsule that was available in pharmacies, either by prescription or “over the counter.” Supplements containing strictly herbal preparations were less widely available. Currently in the United States, a wide array of supplement products are available, including vitamin, mineral, other nutrients, and botanical supplements as well as ingredients and extracts of animal and plant origin. The Office of Dietary Supplements (ODS) of the National Institutes of Health is the official agency of the United States which has the expressed goal of acquiring “new knowledge to help prevent, detect, diagnose, and treat disease and disability, from the rarest genetic disorder to the common cold.”53 According to the ODS, dietary supplements can have an important impact on the prevention and management of disease and on the maintenance of health.54 The ODS notes that considerable research on the effects of dietary supplements has been conducted in Asia and Europe where the use of plant products, in particular, has a long tradition. However, the This discussion has been adapted from the NIH: http://ods.od.nih.gov/whatare/whatare.html. 53 Contact: The Office of Dietary Supplements, National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: (301) 435-2920, Fax: (301) 480-1845, E-mail:
[email protected]. 54 Adapted from http://ods.od.nih.gov/about/about.html. The Dietary Supplement Health and Education Act defines dietary supplements as “a product (other than tobacco) intended to supplement the diet that bears or contains one or more of the following dietary ingredients: a vitamin, mineral, amino acid, herb or other botanical; or a dietary substance for use to supplement the diet by increasing the total dietary intake; or a concentrate, metabolite, constituent, extract, or combination of any ingredient described above; and intended for ingestion in the form of a capsule, powder, softgel, or gelcap, and not represented as a conventional food or as a sole item of a meal or the diet.” 52
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overwhelming majority of supplements have not been studied scientifically. To explore the role of dietary supplements in the improvement of health care, the ODS plans, organizes, and supports conferences, workshops, and symposia on scientific topics related to dietary supplements. The ODS often works in conjunction with other NIH Institutes and Centers, other government agencies, professional organizations, and public advocacy groups. To learn more about official information on dietary supplements, visit the ODS site at http://ods.od.nih.gov/whatare/whatare.html. Or contact: The Office of Dietary Supplements National Institutes of Health Building 31, Room 1B29 31 Center Drive, MSC 2086 Bethesda, Maryland 20892-2086 Tel: (301) 435-2920 Fax: (301) 480-1845 E-mail:
[email protected]
Finding Studies on Urinary Incontinence The NIH maintains an office dedicated to patient nutrition and diet. The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.55 IBIDS is available to the public free of charge through the ODS Internet page: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. We recommend that you start with the Consumer Database. While you may not find references for the topics that are of most interest to you, check back periodically as this database is frequently updated. More studies can be Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.
55
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found by searching the Full IBIDS Database. Healthcare professionals and researchers generally use the third option, which lists peer-reviewed citations. In all cases, we suggest that you take advantage of the “Advanced Search” option that allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “urinary incontinence” (or synonyms) into the search box. To narrow the search, you can also select the “Title” field. The following information is typical of that found when using the “Full IBIDS Database” when searching using “urinary incontinence” (or a synonym): ·
A new injectable bulking agent for treatment of stress urinary incontinence: results of a multicenter, randomized, controlled, doubleblind study of Durasphere. Author(s): Mayo Clinic, Rochester, Minnesota, USA Source: Lightner, D Calvosa, C Andersen, R Klimberg, I Brito, C G Snyder, J Gleason, D Killion, D Macdonald, J Khan, A U Diokno, A Sirls, L T Saltzstein, D Urology. 2001 July; 58(1): 12-5 1527-9995
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A prospective, randomized controlled trial of inpatient versus outpatient continence programs in the treatment of urinary incontinence in the female. Author(s): Department of Gynaecology, Southern General Hospital, Glasgow, Scotland. Source: Ramsay, I N Ali, H M Hunter, M Stark, D McKenzie, S Donaldson, K Major, K Int-Urogynecol-J-Pelvic-Floor-Dysfunct. 1996; 7(5): 260-3
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Alternatives for the pharmacologic management of urge and stress urinary incontinence in the elderly. Author(s): Department of Urology, Tulane University School of Medicine, New Orleans 70112, USA. Source: Ghoniem, G M Hassouna, M J-Wound-Ostomy-Continence-Nurs. 1997 November; 24(6): 311-8 1071-5754
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Behavioral treatment of urinary incontinence: a complementary approach. Author(s): West Coast Continence Clinic, Cumberland, British Columbia, Canada. Source: Foster, P Ostomy-Wound-Manage. 1998 June; 44(6): 62-6, 68, 70 0889-5899
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Beta(3)-adrenoceptor agonists for the treatment of frequent urination and urinary incontinence: 2-[4-(2-[[(1S,2R)-2-hydroxy-2-(4-
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hydroxyphenyl)-1-methylethyl]amino]ethyl)phenoxy]-2methylpropionic acid. Author(s): Central Research Laboratory, Kissei Pharmaceutical Company Ltd., 4365-1, Hotaka, Nagano, 399-8304, Japan.
[email protected] Source: Tanaka, N Tamai, T Mukaiyama, H Hirabayashi, A Muranaka, H Ishikawa, T Akahane, S Akahane, M Bioorg-Med-Chem. 2001 December; 9(12): 3265-71 0968-0896 ·
Clinical and radiographic findings compared with urodynamic findings in neutered female dogs with refractory urinary incontinence. Source: Nickel, R.F. Vink Noteboom, M. Brom, W.E. van den. Vet-rec. London : The British Veterinary Association. July 3, 1999. volume 145 (1) page 11-15. 0042-4900
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Dietary caffeine, fluid intake and urinary incontinence in older rural women. Author(s): School of Nursing, Hawaii Pacific University, Honolulu 96813, USA. Source: Tomlinson, B U Dougherty, M C Pendergast, J F Boyington, A R Coffman, M A Pickens, S M Int-Urogynecol-J-Pelvic-Floor-Dysfunct. 1999; 10(1): 22-8
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Estrogens and phenylpropanolamine in combination for stress urinary incontinence in postmenopausal women. Author(s): Department of Urology, Karolinska Hospital, Stockholm, Sweden. Source: Kinn, A C Lindskog, M Urology. 1988 September; 32(3): 273-80 0090-4295
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Evaluation of a simple, non-surgical concept for management of urinary incontinence (minimal care) in an open-access, interdisciplinary incontinence clinic. Author(s): Department of Urology, Hvidovre Hospital, University of Copenhagen, Denmark. Source: Sander, P Mouritsen, L Andersen, J T Fischer Rasmussen, W Neurourol-Urodyn. 2000; 19(1): 9-17 0733-2467
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Five-year incidence and remission rates of female urinary incontinence in a Swedish population less than 65 years old. Author(s): Family Medicine Section, Department of Public Health and Caring Sciences, University Hospital, Uppsala University, Uppsala, Sweden. Source: Samuelsson, E C Victor, F T Svardsudd, K F Am-J-ObstetGynecol. 2000 September; 183(3): 568-74 0002-9378
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·
Group learning behavior modification and exercise for women with urinary incontinence. Source: Gerard, L Urol-Nurs. 1997 March; 17(1): 17-22 1053-816X
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Long-term efficacy of nonsurgical urinary incontinence treatment in elderly women. Author(s): Department of Obstetrics and Gynecology, University of Wisconsin-Madison, USA.
[email protected] Source: Weinberger, M W Goodman, B M Carnes, M J-Gerontol-A-BiolSci-Med-Sci. 1999 March; 54(3): M117-21 1079-5006
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Low-dose desmopressin in the treatment of nocturnal urinary incontinence in the exstrophy-epispadias complex. Author(s): Division of Paediatric Urology, 'Bambino Gesu' Children's Hospital, Rome, Italy. Source: Caione, P Nappo, S De Castro, R Prestipino, M Capozza, N BJUInt. 1999 August; 84(3): 329-34 1464-4096
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Medical therapy of urinary incontinence in ovariectomised bitches: a comparison of the effectiveness of diethylstilboestrol and pseudoephedrine. Source: Nendick, P A Clark, W T Aust-Vet-J. 1987 April; 64(4): 117-8 00050423
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Nonsurgical treatment of urinary incontinence. Author(s): Case Western Reserve University, Division of Urogynecology, University MacDonald Womens Hospital, Cleveland, OH 44106. Source: Walters, M D Realini, J P Dougherty, M Curr-Opin-ObstetGynecol. 1992 August; 4(4): 554-8 1040-872X
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Patient history in the diagnosis of urinary incontinence and determining the quality of life. Author(s): Department of Obstetrics and Gynaecology, Tampere University Hospital, Finland. Source: Kujansuu, E Acta-Obstet-Gynecol-Scand-Suppl. 1997; 16615-8 0300-8835
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Postmenopausal urinary incontinence. Source: Zhao, C X J-Tradit-Chin-Med. 1987 December; 7(4): 305-6 02546272
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Self-esteem before and after treatment in children with nocturnal enuresis and urinary incontinence. Author(s): Department of Child and Adolescent Psychiatry, University Hospital of Umea, Sweden. Source: Hagglof, B Andren, O Bergstrom, E Marklund, L Wendelius, M Scand-J-Urol-Nephrol-Suppl. 1997; 18379-82 0300-8886
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·
Sexual function in women with urinary incontinence and pelvic organ prolapse. Author(s): Department of Obstetrics and Gynecology, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
[email protected] Source: Barber, Matthew D Visco, Anthony G Wyman, Jean F Fantl, J Andrew Bump, Richard C Obstet-Gynecol. 2002 February; 99(2): 281-9 0029-7844
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The pharmacological treatment of urinary incontinence. Author(s): The Department of Clinical Pharmacology, Lund University Hospital, Lund, Sweden.
[email protected] Source: Andersson, K E Appell, R Cardozo, L D Chapple, C Drutz, H P Finkbeiner, A E Haab, F Vela Navarrete, R BJU-Int. 1999 December; 84(9): 923-47 1464-4096
Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: ·
healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0
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The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov
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The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov
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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/
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The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/
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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/
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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/
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·
Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/
Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: ·
AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats
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Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html
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Google: http://directory.google.com/Top/Health/Nutrition/
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Healthnotes: http://www.thedacare.org/healthnotes/
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Open Directory Project: http://dmoz.org/Health/Nutrition/
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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/
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WebMDÒHealth: http://my.webmd.com/nutrition
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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,,00.html
Vocabulary Builder The following vocabulary builder defines words used in the references in this chapter that have not been defined in previous chapters: Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, poly- and heterosaccharides. [EU] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Epispadias: Congenital absence of the upper wall of the urethra. [NIH]
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Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH]
Neural: 1. pertaining to a nerve or to the nerves. 2. situated in the region of the spinal axis, as the neutral arch. [EU] Niacin: Water-soluble vitamin of the B complex occurring in various animal and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic properties. [NIH] Nickel: Nickel. A trace element with the atomic symbol Ni, atomic number 28, and atomic weight 58.69. It is a cofactor of the enzyme urease. [NIH] Overdose: 1. to administer an excessive dose. 2. an excessive dose. [EU] Paediatric: Of or relating to the care and medical treatment of children; belonging to or concerned with paediatrics. [EU] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Refractory: Not readily yielding to treatment. [EU] Riboflavin: Nutritional factor found in milk, eggs, malted barley, liver, kidney, heart, and leafy vegetables. The richest natural source is yeast. It occurs in the free form only in the retina of the eye, in whey, and in urine; its principal forms in tissues and cells are as FMN and FAD. [NIH] Selenium: An element with the atomic symbol Se, atomic number 34, and atomic weight 78.96. It is an essential micronutrient for mammals and other animals but is toxic in large amounts. Selenium protects intracellular structures against oxidative damage. It is an essential component of glutathione peroxidase. [NIH] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH]
Finding Medical Libraries 257
APPENDIX D. FINDING MEDICAL LIBRARIES Overview At a medical library you can find medical texts and reference books, consumer health publications, specialty newspapers and magazines, as well as medical journals. In this Appendix, we show you how to quickly find a medical library in your area.
Preparation Before going to the library, highlight the references mentioned in this sourcebook that you find interesting. Focus on those items that are not available via the Internet, and ask the reference librarian for help with your search. He or she may know of additional resources that could be helpful to you. Most importantly, your local public library and medical libraries have Interlibrary Loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. NLM’s interlibrary loan services are only available to libraries. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.56
56
Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.
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Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.
Medical Libraries Open to the Public In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries that are generally open to the public and have reference facilities. The following is the NLM’s list plus hyperlinks to each library Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located):57 ·
Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/
·
Alabama: Richard M. Scrushy Library (American Sports Medicine Institute), http://www.asmi.org/LIBRARY.HTM
·
Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm
·
California: Kris Kelly Health Information Center (St. Joseph Health System), http://www.humboldt1.com/~kkhic/index.html
·
California: Community Health Library of Los Gatos (Community Health Library of Los Gatos), http://www.healthlib.org/orgresources.html
·
California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html
·
California: Gateway Health Library (Sutter Gould Medical Foundation)
·
California: Health Library (Stanford University Medical Center), http://www-med.stanford.edu/healthlibrary/
57
Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.
Finding Medical Libraries 259
·
California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp
·
California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html
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California: San José PlaneTree Health Library, http://planetreesanjose.org/
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California: Sutter Resource Library (Sutter Hospitals Foundation), http://go.sutterhealth.org/comm/resc-library/sac-resources.html
·
California: University of California, Davis. Health Sciences Libraries
·
California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System), http://www.valleycare.com/library.html
·
California: Washington Community Health Resource Library (Washington Community Health Resource Library), http://www.healthlibrary.org/
·
Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.exempla.org/conslib.htm
·
Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/
·
Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/
·
Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital), http://www.waterburyhospital.com/library/consumer.shtml
·
Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute), http://www.christianacare.org/health_guide/health_guide_pmri_health _info.cfm
·
Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine), http://www.delamed.org/chls.html
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Georgia: Family Resource Library (Medical College of Georgia), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm
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Georgia: Health Resource Center (Medical Center of Central Georgia), http://www.mccg.org/hrc/hrchome.asp
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Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library), http://hml.org/CHIS/
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·
Idaho: DeArmond Consumer Health Library (Kootenai Medical Center), http://www.nicon.org/DeArmond/index.htm
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Illinois: Health Learning Center of Northwestern Memorial Hospital (Northwestern Memorial Hospital, Health Learning Center), http://www.nmh.org/health_info/hlc.html
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Illinois: Medical Library (OSF Saint Francis Medical Center), http://www.osfsaintfrancis.org/general/library/
·
Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital), http://www.centralbap.com/education/community/library.htm
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Kentucky: University of Kentucky - Health Information Library (University of Kentucky, Chandler Medical Center, Health Information Library), http://www.mc.uky.edu/PatientEd/
·
Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation), http://www.ochsner.org/library/
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Louisiana: Louisiana State University Health Sciences Center Medical Library-Shreveport, http://lib-sh.lsuhsc.edu/
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Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital), http://www.fchn.org/fmh/lib.htm
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Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center), http://www.cmmc.org/library/library.html
·
Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare), http://www.emh.org/hll/hpl/guide.htm
·
Maine: Maine Medical Center Library (Maine Medical Center), http://www.mmc.org/library/
·
Maine: Parkview Hospital, http://www.parkviewhospital.org/communit.htm#Library
·
Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center), http://www.smmc.org/services/service.php3?choice=10
·
Maine: Stephens Memorial Hospital Health Information Library (Western Maine Health), http://www.wmhcc.com/hil_frame.html
·
Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html
·
Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre), http://www.deerlodge.mb.ca/library/libraryservices.shtml
Finding Medical Libraries 261
·
Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Md., Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp
·
Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/
·
Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://medlibwww.bu.edu/library/lib.html
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Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm
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Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital), http://www.nebh.org/health_lib.asp
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Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital), http://www.southcoast.org/library/
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Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html
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Massachusetts: UMass HealthNet (University of Massachusetts Medical School), http://healthnet.umassmed.edu/
·
Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm
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Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/
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Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html
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Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center), http://www.cancer.med.umich.edu/learn/leares.htm
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Michigan: Sladen Library & Center for Health Information Resources Consumer Health Information, http://www.sladen.hfhs.org/library/consumer/index.html
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Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center), http://www.saintpatrick.org/chi/librarydetail.php3?ID=41
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·
National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html
·
National: National Network of Libraries of Medicine (National Library of Medicine) - provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/
·
National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/
·
Nevada: Health Science Library, West Charleston Library (Las Vegas Clark County Library District), http://www.lvccld.org/special_collections/medical/index.htm
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New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/
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New Jersey: Consumer Health Library (Rahway Hospital), http://www.rahwayhospital.com/library.htm
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New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center), http://www.englewoodhospital.com/links/index.htm
·
New Jersey: Meland Foundation (Englewood Hospital and Medical Center), http://www.geocities.com/ResearchTriangle/9360/
·
New York: Choices in Health Information (New York Public Library) NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html
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New York: Health Information Center (Upstate Medical University, State University of New York), http://www.upstate.edu/library/hic/
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New York: Health Sciences Library (Long Island Jewish Medical Center), http://www.lij.edu/library/library.html
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New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/
·
Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm
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Oklahoma: Saint Francis Health System Patient/Family Resource Center (Saint Francis Health System), http://www.sfhtulsa.com/patientfamilycenter/default.asp
Finding Medical Libraries 263
·
Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center), http://www.mcmc.net/phrc/
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Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center), http://www.hmc.psu.edu/commhealth/
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Pennsylvania: Community Health Resource Library (Geisinger Medical Center), http://www.geisinger.edu/education/commlib.shtml
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Pennsylvania: HealthInfo Library (Moses Taylor Hospital), http://www.mth.org/healthwellness.html
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Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System), http://www.hsls.pitt.edu/chi/hhrcinfo.html
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Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml
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Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System), http://www.shscares.org/services/lrc/index.asp
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Pennsylvania: Medical Library (UPMC Health System), http://www.upmc.edu/passavant/library.htm
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Quebec, Canada: Medical Library (Montreal General Hospital), http://ww2.mcgill.ca/mghlib/
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South Dakota: Rapid City Regional Hospital - Health Information Center (Rapid City Regional Hospital, Health Information Center), http://www.rcrh.org/education/LibraryResourcesConsumers.htm
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Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/
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Texas: Matustik Family Resource Center (Cook Children’s Health Care System), http://www.cookchildrens.com/Matustik_Library.html
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Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/
·
Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center), http://www.swmedctr.com/Home/
Your Rights and Insurance 265
APPENDIX E. YOUR RIGHTS AND INSURANCE Overview Any patient with urinary incontinence faces a series of issues related more to the healthcare industry than to the medical condition itself. This appendix covers two important topics in this regard: your rights and responsibilities as a patient, and how to get the most out of your medical insurance plan.
Your Rights as a Patient The President’s Advisory Commission on Consumer Protection and Quality in the Healthcare Industry has created the following summary of your rights as a patient.58 Information Disclosure Consumers have the right to receive accurate, easily understood information. Some consumers require assistance in making informed decisions about health plans, health professionals, and healthcare facilities. Such information includes: ·
Health plans. Covered benefits, cost-sharing, and procedures for resolving complaints, licensure, certification, and accreditation status, comparable measures of quality and consumer satisfaction, provider network composition, the procedures that govern access to specialists and emergency services, and care management information.
58Adapted
from Consumer Bill of Rights and Responsibilities: http://www.hcqualitycommission.gov/press/cbor.html#head1.
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·
Health professionals. Education, board certification, and recertification, years of practice, experience performing certain procedures, and comparable measures of quality and consumer satisfaction.
·
Healthcare facilities. Experience in performing certain procedures and services, accreditation status, comparable measures of quality, worker, and consumer satisfaction, and procedures for resolving complaints.
·
Consumer assistance programs. Programs must be carefully structured to promote consumer confidence and to work cooperatively with health plans, providers, payers, and regulators. Desirable characteristics of such programs are sponsorship that ensures accountability to the interests of consumers and stable, adequate funding.
Choice of Providers and Plans Consumers have the right to a choice of healthcare providers that is sufficient to ensure access to appropriate high-quality healthcare. To ensure such choice, the Commission recommends the following: ·
Provider network adequacy. All health plan networks should provide access to sufficient numbers and types of providers to assure that all covered services will be accessible without unreasonable delay -including access to emergency services 24 hours a day and 7 days a week. If a health plan has an insufficient number or type of providers to provide a covered benefit with the appropriate degree of specialization, the plan should ensure that the consumer obtains the benefit outside the network at no greater cost than if the benefit were obtained from participating providers.
·
Women’s health services. Women should be able to choose a qualified provider offered by a plan -- such as gynecologists, certified nurse midwives, and other qualified healthcare providers -- for the provision of covered care necessary to provide routine and preventative women’s healthcare services.
·
Access to specialists. Consumers with complex or serious medical conditions who require frequent specialty care should have direct access to a qualified specialist of their choice within a plan’s network of providers. Authorizations, when required, should be for an adequate number of direct access visits under an approved treatment plan.
·
Transitional care. Consumers who are undergoing a course of treatment for a chronic or disabling condition (or who are in the second or third trimester of a pregnancy) at the time they involuntarily change health
Your Rights and Insurance 267
plans or at a time when a provider is terminated by a plan for other than cause should be able to continue seeing their current specialty providers for up to 90 days (or through completion of postpartum care) to allow for transition of care. ·
Choice of health plans. Public and private group purchasers should, wherever feasible, offer consumers a choice of high-quality health insurance plans.
Access to Emergency Services Consumers have the right to access emergency healthcare services when and where the need arises. Health plans should provide payment when a consumer presents to an emergency department with acute symptoms of sufficient severity--including severe pain--such that a “prudent layperson” could reasonably expect the absence of medical attention to result in placing that consumer’s health in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part.
Participation in Treatment Decisions Consumers have the right and responsibility to fully participate in all decisions related to their healthcare. Consumers who are unable to fully participate in treatment decisions have the right to be represented by parents, guardians, family members, or other conservators. Physicians and other health professionals should: ·
Provide patients with sufficient information and opportunity to decide among treatment options consistent with the informed consent process.
·
Discuss all treatment options with a patient in a culturally competent manner, including the option of no treatment at all.
·
Ensure that persons with disabilities have effective communications with members of the health system in making such decisions.
·
Discuss all current treatments a consumer may be undergoing.
·
Discuss all risks, nontreatment.
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Give patients the opportunity to refuse treatment and to express preferences about future treatment decisions.
benefits,
and
consequences
to
treatment
or
268 Urinary Incontinence
·
Discuss the use of advance directives -- both living wills and durable powers of attorney for healthcare -- with patients and their designated family members.
·
Abide by the decisions made by their patients and/or their designated representatives consistent with the informed consent process.
Health plans, health providers, and healthcare facilities should: ·
Disclose to consumers factors -- such as methods of compensation, ownership of or interest in healthcare facilities, or matters of conscience -that could influence advice or treatment decisions.
·
Assure that provider contracts do not contain any so-called “gag clauses” or other contractual mechanisms that restrict healthcare providers’ ability to communicate with and advise patients about medically necessary treatment options.
·
Be prohibited from penalizing or seeking retribution against healthcare professionals or other health workers for advocating on behalf of their patients.
Respect and Nondiscrimination Consumers have the right to considerate, respectful care from all members of the healthcare industry at all times and under all circumstances. An environment of mutual respect is essential to maintain a quality healthcare system. To assure that right, the Commission recommends the following: ·
Consumers must not be discriminated against in the delivery of healthcare services consistent with the benefits covered in their policy, or as required by law, based on race, ethnicity, national origin, religion, sex, age, mental or physical disability, sexual orientation, genetic information, or source of payment.
·
Consumers eligible for coverage under the terms and conditions of a health plan or program, or as required by law, must not be discriminated against in marketing and enrollment practices based on race, ethnicity, national origin, religion, sex, age, mental or physical disability, sexual orientation, genetic information, or source of payment. Confidentiality of Health Information
Consumers have the right to communicate with healthcare providers in confidence and to have the confidentiality of their individually identifiable
Your Rights and Insurance 269
healthcare information protected. Consumers also have the right to review and copy their own medical records and request amendments to their records. Complaints and Appeals Consumers have the right to a fair and efficient process for resolving differences with their health plans, healthcare providers, and the institutions that serve them, including a rigorous system of internal review and an independent system of external review. A free copy of the Patient’s Bill of Rights is available from the American Hospital Association.59
Patient Responsibilities Treatment is a two-way street between you and your healthcare providers. To underscore the importance of finance in modern healthcare as well as your responsibility for the financial aspects of your care, the President’s Advisory Commission on Consumer Protection and Quality in the Healthcare Industry has proposed that patients understand the following “Consumer Responsibilities.”60 In a healthcare system that protects consumers’ rights, it is reasonable to expect and encourage consumers to assume certain responsibilities. Greater individual involvement by the consumer in his or her care increases the likelihood of achieving the best outcome and helps support a quality-oriented, cost-conscious environment. Such responsibilities include: ·
Take responsibility for maximizing healthy habits such as exercising, not smoking, and eating a healthy diet.
·
Work collaboratively with healthcare providers in developing and carrying out agreed-upon treatment plans.
·
Disclose relevant information and clearly communicate wants and needs.
·
Use your health insurance plan’s internal complaint and appeal processes to address your concerns.
·
Avoid knowingly spreading disease.
To order your free copy of the Patient’s Bill of Rights, telephone 312-422-3000 or visit the American Hospital Association’s Web site: http://www.aha.org. Click on “Resource Center,” go to “Search” at bottom of page, and then type in “Patient’s Bill of Rights.” The Patient’s Bill of Rights is also available from Fax on Demand, at 312-422-2020, document number 471124. 60 Adapted from http://www.hcqualitycommission.gov/press/cbor.html#head1. 59
270 Urinary Incontinence
·
Recognize the reality of risks, the limits of the medical science, and the human fallibility of the healthcare professional.
·
Be aware of a healthcare provider’s obligation to be reasonably efficient and equitable in providing care to other patients and the community.
·
Become knowledgeable about your health plan’s coverage and options (when available) including all covered benefits, limitations, and exclusions, rules regarding use of network providers, coverage and referral rules, appropriate processes to secure additional information, and the process to appeal coverage decisions.
·
Show respect for other patients and health workers.
·
Make a good-faith effort to meet financial obligations.
·
Abide by administrative and operational procedures of health plans, healthcare providers, and Government health benefit programs.
Choosing an Insurance Plan There are a number of official government agencies that help consumers understand their healthcare insurance choices.61 The U.S. Department of Labor, in particular, recommends ten ways to make your health benefits choices work best for you.62 1. Your options are important. There are many different types of health benefit plans. Find out which one your employer offers, then check out the plan, or plans, offered. Your employer’s human resource office, the health plan administrator, or your union can provide information to help you match your needs and preferences with the available plans. The more information you have, the better your healthcare decisions will be. 2. Reviewing the benefits available. Do the plans offered cover preventive care, well-baby care, vision or dental care? Are there deductibles? Answers to these questions can help determine the out-of-pocket expenses you may face. Matching your needs and those of your family members will result in the best possible benefits. Cheapest may not always be best. Your goal is high quality health benefits.
More information about quality across programs is provided at the following AHRQ Web site: http://www.ahrq.gov/consumer/qntascii/qnthplan.htm. 62 Adapted from the Department of Labor: http://www.dol.gov/dol/pwba/public/pubs/health/top10-text.html. 61
Your Rights and Insurance 271
3. Look for quality. The quality of healthcare services varies, but quality can be measured. You should consider the quality of healthcare in deciding among the healthcare plans or options available to you. Not all health plans, doctors, hospitals and other providers give the highest quality care. Fortunately, there is quality information you can use right now to help you compare your healthcare choices. Find out how you can measure quality. Consult the U.S. Department of Health and Human Services publication “Your Guide to Choosing Quality Health Care” on the Internet at www.ahcpr.gov/consumer. 4. Your plan’s summary plan description (SPD) provides a wealth of information. Your health plan administrator can provide you with a copy of your plan’s SPD. It outlines your benefits and your legal rights under the Employee Retirement Income Security Act (ERISA), the federal law that protects your health benefits. It should contain information about the coverage of dependents, what services will require a co-pay, and the circumstances under which your employer can change or terminate a health benefits plan. Save the SPD and all other health plan brochures and documents, along with memos or correspondence from your employer relating to health benefits. 5. Assess your benefit coverage as your family status changes. Marriage, divorce, childbirth or adoption, and the death of a spouse are all life events that may signal a need to change your health benefits. You, your spouse and dependent children may be eligible for a special enrollment period under provisions of the Health Insurance Portability and Accountability Act (HIPAA). Even without life-changing events, the information provided by your employer should tell you how you can change benefits or switch plans, if more than one plan is offered. If your spouse’s employer also offers a health benefits package, consider coordinating both plans for maximum coverage. 6. Changing jobs and other life events can affect your health benefits. Under the Consolidated Omnibus Budget Reconciliation Act (COBRA), you, your covered spouse, and your dependent children may be eligible to purchase extended health coverage under your employer’s plan if you lose your job, change employers, get divorced, or upon occurrence of certain other events. Coverage can range from 18 to 36 months depending on your situation. COBRA applies to most employers with 20 or more workers and requires your plan to notify you of your rights. Most plans require eligible individuals to make their COBRA election within 60 days of the plan’s notice. Be sure to follow up with your plan sponsor if you don’t receive notice, and make sure you respond within the allotted time.
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7. HIPAA can also help if you are changing jobs, particularly if you have a medical condition. HIPAA generally limits pre-existing condition exclusions to a maximum of 12 months (18 months for late enrollees). HIPAA also requires this maximum period to be reduced by the length of time you had prior “creditable coverage.” You should receive a certificate documenting your prior creditable coverage from your old plan when coverage ends. 8. Plan for retirement. Before you retire, find out what health benefits, if any, extend to you and your spouse during your retirement years. Consult with your employer’s human resources office, your union, the plan administrator, and check your SPD. Make sure there is no conflicting information among these sources about the benefits you will receive or the circumstances under which they can change or be eliminated. With this information in hand, you can make other important choices, like finding out if you are eligible for Medicare and Medigap insurance coverage. 9. Know how to file an appeal if your health benefits claim is denied. Understand how your plan handles grievances and where to make appeals of the plan’s decisions. Keep records and copies of correspondence. Check your health benefits package and your SPD to determine who is responsible for handling problems with benefit claims. Contact PWBA for customer service assistance if you are unable to obtain a response to your complaint. 10. You can take steps to improve the quality of the healthcare and the health benefits you receive. Look for and use things like Quality Reports and Accreditation Reports whenever you can. Quality reports may contain consumer ratings -- how satisfied consumers are with the doctors in their plan, for instance-- and clinical performance measures -- how well a healthcare organization prevents and treats illness. Accreditation reports provide information on how accredited organizations meet national standards, and often include clinical performance measures. Look for these quality measures whenever possible. Consult “Your Guide to Choosing Quality Health Care” on the Internet at www.ahcpr.gov/consumer.
Medicare and Medicaid Illness strikes both rich and poor families. For low-income families, Medicaid is available to defer the costs of treatment. The Health Care Financing Administration (HCFA) administers Medicare, the nation’s largest health insurance program, which covers 39 million Americans. In the following pages, you will learn the basics about Medicare insurance as well as useful
Your Rights and Insurance 273
contact information on how to find more in-depth information about Medicaid.63
Who is Eligible for Medicare? Generally, you are eligible for Medicare if you or your spouse worked for at least 10 years in Medicare-covered employment and you are 65 years old and a citizen or permanent resident of the United States. You might also qualify for coverage if you are under age 65 but have a disability or EndStage Renal disease (permanent kidney failure requiring dialysis or transplant). Here are some simple guidelines: You can get Part A at age 65 without having to pay premiums if: ·
You are already receiving retirement benefits from Social Security or the Railroad Retirement Board.
·
You are eligible to receive Social Security or Railroad benefits but have not yet filed for them.
·
You or your spouse had Medicare-covered government employment.
If you are under 65, you can get Part A without having to pay premiums if: ·
You have received Social Security or Railroad Retirement Board disability benefit for 24 months.
·
You are a kidney dialysis or kidney transplant patient.
Medicare has two parts: ·
Part A (Hospital Insurance). Most people do not have to pay for Part A.
·
Part B (Medical Insurance). Most people pay monthly for Part B. Part A (Hospital Insurance)
Helps Pay For: Inpatient hospital care, care in critical access hospitals (small facilities that give limited outpatient and inpatient services to people in rural areas) and skilled nursing facilities, hospice care, and some home healthcare.
This section has been adapted from the Official U.S. Site for Medicare Information: http://www.medicare.gov/Basics/Overview.asp.
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Cost: Most people get Part A automatically when they turn age 65. You do not have to pay a monthly payment called a premium for Part A because you or a spouse paid Medicare taxes while you were working. If you (or your spouse) did not pay Medicare taxes while you were working and you are age 65 or older, you still may be able to buy Part A. If you are not sure you have Part A, look on your red, white, and blue Medicare card. It will show “Hospital Part A” on the lower left corner of the card. You can also call the Social Security Administration toll free at 1-800-772-1213 or call your local Social Security office for more information about buying Part A. If you get benefits from the Railroad Retirement Board, call your local RRB office or 1-800-808-0772. For more information, call your Fiscal Intermediary about Part A bills and services. The phone number for the Fiscal Intermediary office in your area can be obtained from the following Web site: http://www.medicare.gov/Contacts/home.asp. Part B (Medical Insurance) Helps Pay For: Doctors, services, outpatient hospital care, and some other medical services that Part A does not cover, such as the services of physical and occupational therapists, and some home healthcare. Part B helps pay for covered services and supplies when they are medically necessary. Cost: As of 2001, you pay the Medicare Part B premium of $50.00 per month. In some cases this amount may be higher if you did not choose Part B when you first became eligible at age 65. The cost of Part B may go up 10% for each 12-month period that you were eligible for Part B but declined coverage, except in special cases. You will have to pay the extra 10% cost for the rest of your life. Enrolling in Part B is your choice. You can sign up for Part B anytime during a 7-month period that begins 3 months before you turn 65. Visit your local Social Security office, or call the Social Security Administration at 1-800-7721213 to sign up. If you choose to enroll in Part B, the premium is usually taken out of your monthly Social Security, Railroad Retirement, or Civil Service Retirement payment. If you do not receive any of the above payments, Medicare sends you a bill for your part B premium every 3 months. You should receive your Medicare premium bill in the mail by the 10th of the month. If you do not, call the Social Security Administration at 1800-772-1213, or your local Social Security office. If you get benefits from the Railroad Retirement Board, call your local RRB office or 1-800-808-0772. For more information, call your Medicare carrier about bills and services. The
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phone number for the Medicare carrier in your area can be found at the following Web site: http://www.medicare.gov/Contacts/home.asp. You may have choices in how you get your healthcare including the Original Medicare Plan, Medicare Managed Care Plans (like HMOs), and Medicare Private Fee-for-Service Plans.
Medicaid Medicaid is a joint federal and state program that helps pay medical costs for some people with low incomes and limited resources. Medicaid programs vary from state to state. People on Medicaid may also get coverage for nursing home care and outpatient prescription drugs which are not covered by Medicare. You can find more information about Medicaid on the HCFA.gov Web site at http://www.hcfa.gov/medicaid/medicaid.htm. States also have programs that pay some or all of Medicare’s premiums and may also pay Medicare deductibles and coinsurance for certain people who have Medicare and a low income. To qualify, you must have: ·
Part A (Hospital Insurance),
·
Assets, such as bank accounts, stocks, and bonds that are not more than $4,000 for a single person, or $6,000 for a couple, and
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A monthly income that is below certain limits.
For more information on these programs, look at the Medicare Savings Programs brochure, http://www.medicare.gov/Library/PDFNavigation/PDFInterim.asp?Langua ge=English&Type=Pub&PubID=10126. There are also Prescription Drug Assistance Programs available. Find information on these programs which offer discounts or free medications to individuals in need at http://www.medicare.gov/Prescription/Home.asp.
NORD’s Medication Assistance Programs Finally, the National Organization for Rare Disorders, Inc. (NORD) administers medication programs sponsored by humanitarian-minded pharmaceutical and biotechnology companies to help uninsured or underinsured individuals secure life-saving or life-sustaining drugs.64 NORD Adapted from NORD: http://www.rarediseases.org/cgibin/nord/progserv#patient?id=rPIzL9oD&mv_pc=30.
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programs ensure that certain vital drugs are available “to those individuals whose income is too high to qualify for Medicaid but too low to pay for their prescribed medications.” The program has standards for fairness, equity, and unbiased eligibility. It currently covers some 14 programs for nine pharmaceutical companies. NORD also offers early access programs for investigational new drugs (IND) under the approved “Treatment INDs” programs of the Food and Drug Administration (FDA). In these programs, a limited number of individuals can receive investigational drugs that have yet to be approved by the FDA. These programs are generally designed for rare diseases or disorders. For more information, visit www.rarediseases.org.
Additional Resources In addition to the references already listed in this chapter, you may need more information on health insurance, hospitals, or the healthcare system in general. The NIH has set up an excellent guidance Web site that addresses these and other issues. Topics include:65 ·
Health Insurance: http://www.nlm.nih.gov/medlineplus/healthinsurance.html
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Health Statistics: http://www.nlm.nih.gov/medlineplus/healthstatistics.html
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HMO and Managed Care: http://www.nlm.nih.gov/medlineplus/managedcare.html
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Hospice Care: http://www.nlm.nih.gov/medlineplus/hospicecare.html
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Medicaid: http://www.nlm.nih.gov/medlineplus/medicaid.html
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Medicare: http://www.nlm.nih.gov/medlineplus/medicare.html
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Nursing Homes and Long-term Care: http://www.nlm.nih.gov/medlineplus/nursinghomes.html
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Patient’s Rights, Confidentiality, Informed Consent, Ombudsman Programs, Privacy and Patient Issues: http://www.nlm.nih.gov/medlineplus/patientissues.html
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Veteran’s Health, Persian Gulf War, Gulf War Syndrome, Agent Orange: http://www.nlm.nih.gov/medlineplus/veteranshealth.html
You can access this information at: http://www.nlm.nih.gov/medlineplus/healthsystem.html.
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Vocabulary Builder Dizziness: An imprecise term which may refer to a sense of spatial disorientation, motion of the environment, or lightheadedness. [NIH] Episiotomy: Surgical incision into the perineum and vagina to prevent traumatic tearing during delivery. [EU] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH] Insomnia: Inability to sleep; abnormal wakefulness. [EU] Nausea: An unpleasant sensation, vaguely referred to the epigastrium and abdomen, and often culminating in vomiting. [EU] Resection: Excision of a portion or all of an organ or other structure. [EU] Vaginal Discharge: A common gynecologic disorder characterized by an abnormal, nonbloody discharge from the genital tract. [NIH]
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ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries and glossaries. The National Library of Medicine has compiled the following list of online dictionaries: ·
ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html
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MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp
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Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/
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Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html
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On-line Medical Dictionary (CancerWEB): http://www.graylab.ac.uk/omd/
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Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm
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Terms and Definitions (Office of Rare Diseases): http://rarediseases.info.nih.gov/ord/glossary_a-e.html
Beyond these, MEDLINEplus contains a very user-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia Web site address is http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a) and drkoop.com (http://www.drkoop.com/). Topics of interest can be researched by using keywords before continuing elsewhere, as these basic definitions and concepts will be useful in more advanced areas of research. You may choose to print various pages specifically relating to urinary incontinence and keep them on file. The NIH, in particular, suggests that patients with urinary incontinence visit the following Web sites in the ADAM Medical Encyclopedia:
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·
Basic Guidelines for Urinary Incontinence BPH Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000381.htm Stress incontinence Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000891.htm Urge incontinence Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001270.htm Urinary incontinence products Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003973.htm
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Signs & Symptoms for Urinary Incontinence Abdominal distention Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003122.htm Blurred vision Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003029.htm Constipation Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003125.htm Cough Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003072.htm Coughing Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003072.htm
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Difficulty urinating Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003143.htm Discomfort during intercourse Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003157.htm Dizziness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003093.htm Drowsiness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003208.htm Fatigue Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003088.htm Frequent urination Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003140.htm Incontinence Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003142.htm Incontinent Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003142.htm Increased urinary frequency or urgency Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003140.htm Insomnia Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003210.htm
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Muscle Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003193.htm Muscle contraction Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003193.htm Muscle weakness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003174.htm Nausea Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003117.htm Obesity Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003101.htm Pain during intercourse Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003157.htm Sneezing Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003060.htm Stress Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003211.htm Urgent need to urinate Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003140.htm Urinary urgency Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003140.htm
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Vaginal discharge Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003158.htm Weakness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003174.htm ·
Diagnostics and Tests for Urinary Incontinence Abdominal ultrasound Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003777.htm Cystoscopy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003903.htm Digital rectal exam Web site: http://www.nlm.nih.gov/medlineplus/ency/article/007069.htm EMG Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003929.htm Erosion Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003225.htm Heart rate Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003399.htm Myogram Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003929.htm Ultrasound Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003336.htm
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Urinalysis Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003579.htm Urine culture Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003751.htm ·
Nutrition for Urinary Incontinence Caffeine Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002445.htm H2O Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002471.htm
·
Surgery and Procedures for Urinary Incontinence Episiotomy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002920.htm MMK Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002992.htm Transurethral resection of the prostate Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002996.htm
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Background Topics for Urinary Incontinence Allergic reaction Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000005.htm ANTERIOR Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002232.htm
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Biofeedback Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002241.htm Blood clots Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001124.htm Chronic Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002312.htm Exercise Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001941.htm Fistula Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002365.htm Inspection Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002388.htm Irritant Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002229.htm Kegel exercises Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003975.htm Mucosa Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002264.htm Penis Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002279.htm
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Physical activity Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001941.htm Physical examination Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002274.htm Scrotum Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002296.htm Systemic Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002294.htm Vagina Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002342.htm Wound Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000043.htm
Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries and glossaries: ·
Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical
·
MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html
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Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/
·
Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine
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URINARY INCONTINENCE GLOSSARY The following is a complete glossary of terms used in this sourcebook. The definitions are derived from official public sources including the National Institutes of Health [NIH] and the European Union [EU]. After this glossary, we list a number of additional hardbound and electronic glossaries and dictionaries that you may wish to consult. Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Abscess: A localized collection of pus caused by suppuration buried in tissues, organs, or confined spaces. [EU] Acetylcholine: A neurotransmitter. Acetylcholine in vertebrates is the major transmitter at neuromuscular junctions, autonomic ganglia, parasympathetic effector junctions, a subset of sympathetic effector junctions, and at many sites in the central nervous system. It is generally not used as an administered drug because it is broken down very rapidly by cholinesterases, but it is useful in some ophthalmological applications. [NIH] Adjuvant: A substance which aids another, such as an auxiliary remedy; in immunology, nonspecific stimulator (e.g., BCG vaccine) of the immune response. [EU] Adrenergic: Activated by, characteristic of, or secreting epinephrine or substances with similar activity; the term is applied to those nerve fibres that liberate norepinephrine at a synapse when a nerve impulse passes, i.e., the sympathetic fibres. [EU] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alopecia: Baldness; absence of the hair from skin areas where it normally is present. [EU] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH]
Anorectal: Pertaining to the anus and rectum or to the junction region between the two. [EU] Anticholinergic: An agent that blocks the parasympathetic nerves. Called also parasympatholytic. [EU] Antidepressant: An agent that stimulates the mood of a depressed patient,
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including tricyclic antidepressants and monoamine oxidase inhibitors. [EU] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized Tlymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Antispasmodic: An agent that relieves spasm. [EU] Anus: The distal or terminal orifice of the alimentary canal. [EU] Apnea: A transient absence of spontaneous respiration. [NIH] Aspartame: Flavoring agent sweeter than sugar, metabolized as phenylalanine and aspartic acid. [NIH] Auditory: Pertaining to the sense of hearing. [EU] Autonomic: Self-controlling; functionally independent. [EU] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bacteriuria: The presence of bacteria in the urine with or without consequent urinary tract infection. Since bacteriuria is a clinical entity, the term does not preclude the use of urine/microbiology for technical discussions on the isolation and segregation of bacteria in the urine. [NIH] Benign: Not malignant; not recurrent; favourable for recovery. [EU] Bilateral: Having two sides, or pertaining to both sides. [EU] Bulbar: Pertaining to a bulb; pertaining to or involving the medulla oblongata, as bulbar paralysis. [EU] Calculi: An abnormal concretion occurring mostly in the urinary and biliary tracts, usually composed of mineral salts. Also called stones. [NIH] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, poly- and heterosaccharides. [EU] Carcinoma: A malignant new growth made up of epithelial cells tending to infiltrate the surrounding tissues and give rise to metastases. [EU]
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Cardiovascular: Pertaining to the heart and blood vessels. [EU] Catheter: A tubular, flexible, surgical instrument for withdrawing fluids from (or introducing fluids into) a cavity of the body, especially one for introduction into the bladder through the urethra for the withdraw of urine. [EU]
Catheterization: The employment or passage of a catheter. [EU] Causal: Pertaining to a cause; directed against a cause. [EU] Cerebrovascular: Pertaining to the blood vessels of the cerebrum, or brain. [EU]
Cetirizine: A potent second-generation histamine H1 antagonist that is effective in the treatment of allergic rhinitis, chronic urticaria, and polleninduced asthma. Unlike many traditional antihistamines, it does not cause drowsiness or anticholinergic side effects. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Chronic: Persisting over a long period of time. [EU] Collagen: The protein substance of the white fibres (collagenous fibres) of skin, tendon, bone, cartilage, and all other connective tissue; composed of molecules of tropocollagen (q.v.), it is converted into gelatin by boiling. collagenous pertaining to collagen; forming or producing collagen. [EU] Confusion: Disturbed orientation in regard to time, place, or person, sometimes accompanied by disordered consciousness. [EU] Constipation: Infrequent or difficult evacuation of the faeces. [EU] Contraceptive: conception. [EU] Contractility: stimulus. [EU]
An agent that diminishes the likelihood of or prevents Capacity for becoming short in response to a suitable
Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Cortical: Pertaining to or of the nature of a cortex or bark. [EU] Criterion: A standard by which something may be judged. [EU] Cystectomy: Used for excision of the urinary bladder. [NIH] Cystitis: Inflammation of the urinary bladder. [EU] Cystoscopy: Direct visual examination of the urinary tract with a cystoscope. [EU] Defecation: The normal process of elimination of fecal material from the rectum. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the
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character of or involving degeneration; causing or tending to cause degeneration. [EU] Dehydration: The condition that results from excessive loss of body water. Called also anhydration, deaquation and hypohydration. [EU] Dementia: An acquired organic mental disorder with loss of intellectual abilities of sufficient severity to interfere with social or occupational functioning. The dysfunction is multifaceted and involves memory, behavior, personality, judgment, attention, spatial relations, language, abstract thought, and other executive functions. The intellectual decline is usually progressive, and initially spares the level of consciousness. [NIH] Diaphragm: The musculofibrous partition that separates the thoracic cavity from the abdominal cavity. Contraction of the diaphragm increases the volume of the thoracic cavity aiding inspiration. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Dicyclomine: A muscarinic antagonist used as an antispasmodic and in urinary incontinence. It has little effect on glandular secretion or the cardiovascular system. It does have some local anesthetic properties and is used in gastrointestinal, biliary, and urinary tract spasms. [NIH] Dienestrol: A synthetic, non-steroidal estrogen structurally related to stilbestrol. It is used, usually as the cream, in the treatment of menopausal and postmenopausal symptoms. [NIH] Disorientation: The loss of proper bearings, or a state of mental confusion as to time, place, or identity. [EU] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Diverticulum: A pathological condition manifested as a pouch or sac opening from a tubular or sacular organ. [NIH] Dizziness: An imprecise term which may refer to a sense of spatial disorientation, motion of the environment, or lightheadedness. [NIH] Dorsal: 1. pertaining to the back or to any dorsum. 2. denoting a position more toward the back surface than some other object of reference; same as posterior in human anatomy; superior in the anatomy of quadrupeds. [EU] Dyspareunia: Difficult or painful coitus. [EU] Electrophysiological: Pertaining to electrophysiology, that is a branch of physiology that is concerned with the electric phenomena associated with living bodies and involved in their functional activity. [EU] Empiric: Empirical; depending upon experience or observation alone, without using scientific method or theory. [EU]
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Endocrinology: A subspecialty of internal medicine concerned with the metabolism, physiology, and disorders of the endocrine system. [NIH] Enuresis: Involuntary discharge of urine after the age at which urinary control should have been achieved; often used alone with specific reference to involuntary discharge of urine occurring during sleep at night (bedwetting, nocturnal enuresis). [EU] Epidemic: Occurring suddenly in numbers clearly in excess of normal expectancy; said especially of infectious diseases but applied also to any disease, injury, or other health-related event occurring in such outbreaks. [EU] Epidemiological: Relating to, or involving epidemiology. [EU] Epidural: Situated upon or outside the dura mater. [EU] Episiotomy: Surgical incision into the perineum and vagina to prevent traumatic tearing during delivery. [EU] Epispadias: Congenital absence of the upper wall of the urethra. [NIH] Estradiol: The most potent mammalian estrogenic hormone. It is produced in the ovary, placenta, testis, and possibly the adrenal cortex. [NIH] Estrogens: A class of sex hormones associated with the development and maintenance of secondary female sex characteristics and control of the cyclical changes in the reproductive cycle. They are also required for pregnancy maintenance and have an anabolic effect on protein metabolism and water retention. [NIH] Extracellular: Outside a cell or cells. [EU] Fathers: Male parents, human or animal. [NIH] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH] Fibroblasts: Connective tissue cells which secrete an extracellular matrix rich in collagen and other macromolecules. [NIH] Fistula: An abnormal passage or communication, usually between two internal organs, or leading from an internal organ to the surface of the body; frequently designated according to the organs or parts with which it communicates, as anovaginal, brochocutaneous, hepatopleural, pulmonoperitoneal, rectovaginal, urethrovaginal, and the like. Such passages are frequently created experimentally for the purpose of obtaining body secretions for physiologic study. [EU] Flavoxate: A drug that has been used in various urinary syndromes and as an antispasmodic. Its therapeutic usefulness and its mechanism of action are not clear. It may have local anesthetic activity and direct relaxing effects on smooth muscle as well as some activity as a muscarinic antagonist. [NIH]
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Fluoroscopy: screen. [NIH]
Production of an image when x-rays strike a fluorescent
Genitourinary: Pertaining to the genital and urinary organs; urogenital; urinosexual. [EU] Glucose: D-glucose, a monosaccharide (hexose), C6H12O6, also known as dextrose (q.v.), found in certain foodstuffs, especially fruits, and in the normal blood of all animals. It is the end product of carbohydrate metabolism and is the chief source of energy for living organisms, its utilization being controlled by insulin. Excess glucose is converted to glycogen and stored in the liver and muscles for use as needed and, beyond that, is converted to fat and stored as adipose tissue. Glucose appears in the urine in diabetes mellitus. [EU] Glycopyrrolate: A muscarinic antagonist used as an antispasmodic, in some disorders of the gastrointestinal tract, and to reduce salivation with some anesthetics. [NIH] Gonadal: Pertaining to a gonad. [EU] Gynecology: A medical-surgical specialty concerned with the physiology and disorders primarily of the female genital tract, as well as female endocrinology and reproductive physiology. [NIH] Hematology: A subspecialty of internal medicine concerned with morphology, physiology, and pathology of the blood and blood-forming tissues. [NIH] Hematuria: Presence of blood in the urine. [NIH] Heparin: Heparinic acid. A highly acidic mucopolysaccharide formed of equal parts of sulfated D-glucosamine and D-glucuronic acid with sulfaminic bridges. The molecular weight ranges from six to twenty thousand. Heparin occurs in and is obtained from liver, lung, mast cells, etc., of vertebrates. Its function is unknown, but it is used to prevent blood clotting in vivo and vitro, in the form of many different salts. [NIH] Hepatic: Pertaining to the liver. [EU] Hormonal: Pertaining to or of the nature of a hormone. [EU] Hydrocephalus: A condition marked by dilatation of the cerebral ventricles, most often occurring secondarily to obstruction of the cerebrospinal fluid pathways, and accompanied by an accumulation of cerebrospinal fluid within the skull; the fluid is usually under increased pressure, but occasionally may be normal or nearly so. It is typically characterized by enlargement of the head, prominence of the forehead, brain atrophy, mental deterioration, and convulsions; may be congenital or acquired; and may be of sudden onset (acute h.) or be slowly progressive (chronic or primary b.). [EU]
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Hydrophilic: Readily absorbing moisture; hygroscopic; having strongly polar groups that readily interact with water. [EU] Hygienic: Pertaining to hygiene, or conducive to health. [EU] Hyperplasia: The abnormal multiplication or increase in the number of normal cells in normal arrangement in a tissue. [EU] Hyperreflexia: Exaggeration of reflexes. [EU] Hypersensitivity: A state of altered reactivity in which the body reacts with an exaggerated immune response to a foreign substance. Hypersensitivity reactions are classified as immediate or delayed, types I and IV, respectively, in the Gell and Coombs classification (q.v.) of immune responses. [EU] Hypertension: Persistently high arterial blood pressure. Various criteria for its threshold have been suggested, ranging from 140 mm. Hg systolic and 90 mm. Hg diastolic to as high as 200 mm. Hg systolic and 110 mm. Hg diastolic. Hypertension may have no known cause (essential or idiopathic h.) or be associated with other primary diseases (secondary h.). [EU] Hypertrophy: Nutrition) the enlargement or overgrowth of an organ or part due to an increase in size of its constituent cells. [EU] Hypotension: Abnormally low blood pressure; seen in shock but not necessarily indicative of it. [EU] Idiopathic: Of the nature of an idiopathy; self-originated; of unknown causation. [EU] Imipramine: The prototypical tricyclic antidepressant. It has been used in major depression, dysthymia, bipolar depression, attention-deficit disorders, agoraphobia, and panic disorders. It has less sedative effect than some other members of this therapeutic group. [NIH] Implantation: The insertion or grafting into the body of biological, living, inert, or radioactive material. [EU] Impotence: The inability to perform sexual intercourse. [NIH] Incision: 1. cleft, cut, gash. 2. an act or action of incising. [EU] Incompetence: Physical or mental inadequacy or insufficiency. [EU] Incontinence: Inability to control excretory functions, as defecation (faecal i.) or urination (urinary i.). [EU] Infiltration: The diffusion or accumulation in a tissue or cells of substances not normal to it or in amounts of the normal. Also, the material so accumulated. [EU] Innervation: 1. the distribution or supply of nerves to a part. 2. the supply of nervous energy or of nerve stimulus sent to a part. [EU] Insomnia: Inability to sleep; abnormal wakefulness. [EU]
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Institutionalization: The caring for individuals in institutions and their adaptation to routines characteristic of the institutional environment, and/or their loss of adaptation to life outside the institution. [NIH] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU] Intestinal: Pertaining to the intestine. [EU] Intravenous: Within a vein or veins. [EU] Intrinsic: Situated entirely within or pertaining exclusively to a part. [EU] Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH]
Irritants: Drugs that act locally on cutaneous or mucosal surfaces to produce inflammation; those that cause redness due to hyperemia are rubefacients; those that raise blisters are vesicants and those that penetrate sebaceous glands and cause abscesses are pustulants; tear gases and mustard gases are also irritants. [NIH] Lesion: Any pathological or traumatic discontinuity of tissue or loss of function of a part. [EU] Levodopa: The naturally occurring form of dopa and the immediate precursor of dopamine. Unlike dopamine itself, it can be taken orally and crosses the blood-brain barrier. It is rapidly taken up by dopaminergic neurons and converted to dopamine. It is used for the treatment of parkinsonism and is usually given with agents that inhibit its conversion to dopamine outside of the central nervous system. [NIH] Lidocaine: A local anesthetic and cardiac depressant used as an antiarrhythmia agent. Its actions are more intense and its effects more prolonged than those of procaine but its duration of action is shorter than that of bupivacaine or prilocaine. [NIH] Lumen: The cavity or channel within a tube or tubular organ. [EU] Malformation: A morphologic defect resulting from an intrinsically abnormal developmental process. [EU] Menopause: Cessation of menstruation in the human female, occurring usually around the age of 50. [EU] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU]
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Motility: The ability to move spontaneously. [EU] Musculature: The muscular apparatus of the body, or of any part of it. [EU] Narcotic: 1. pertaining to or producing narcosis. 2. an agent that produces insensibility or stupor, applied especially to the opioids, i.e. to any natural or synthetic drug that has morphine-like actions. [EU] Nausea: An unpleasant sensation, vaguely referred to the epigastrium and abdomen, and often culminating in vomiting. [EU] Neural: 1. pertaining to a nerve or to the nerves. 2. situated in the region of the spinal axis, as the neutral arch. [EU] Neuromuscular: Pertaining to muscles and nerves. [EU] Niacin: Water-soluble vitamin of the B complex occurring in various animal and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic properties. [NIH] Nickel: Nickel. A trace element with the atomic symbol Ni, atomic number 28, and atomic weight 58.69. It is a cofactor of the enzyme urease. [NIH] Nil: Nothing, zero. [EU] Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Nocturia: Excessive urination at night. [EU] Nulliparous: Having never given birth to a viable infant. [EU] Obstetrics: A medical-surgical specialty concerned with management and care of women during pregnancy, parturition, and the puerperium. [NIH] Orgasm: The apex and culmination of sexual excitement. [EU] Osteoporosis: Reduction in the amount of bone mass, leading to fractures after minimal trauma. [EU] Outpatients: Persons who receive ambulatory care at an outpatient department or clinic without room and board being provided. [NIH] Ovariectomy: The surgical removal of one or both ovaries. [NIH] Overdose: 1. to administer an excessive dose. 2. an excessive dose. [EU] Oxytocin: A nonapeptide posterior pituitary hormone that causes uterine contractions and stimulates lactation. [NIH] Paediatric: Of or relating to the care and medical treatment of children; belonging to or concerned with paediatrics. [EU] Palliative: 1. affording relief, but not cure. 2. an alleviating medicine. [EU]
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Paraplegia: Paralysis of the legs and lower part of the body. [EU] Parietal: 1. of or pertaining to the walls of a cavity. 2. pertaining to or located near the parietal bone, as the parietal lobe. [EU] Parity: The number of offspring a female has borne. It is contrasted with gravidity, which refers to the number of pregnancies, regardless of outcome. [NIH]
Particle: A tiny mass of material. [EU] Pathologic: 1. indicative of or caused by a morbid condition. 2. pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Pelvic: Pertaining to the pelvis. [EU] Penis: The male organ of copulation and of urinary excretion, comprising a root, body, and extremity, or glans penis. The root is attached to the descending portions of the pubic bone by the crura, the latter being the extremities of the corpora cavernosa, and beneath them the corpus spongiosum, through which the urethra passes. The glans is covered with mucous membrane and ensheathed by the prepuce, or foreskin. The penis is homologous with the clitoris in the female. [EU] Percutaneous: Performed through the skin, as injection of radiopacque material in radiological examination, or the removal of tissue for biopsy accomplished by a needle. [EU] Perineal: Pertaining to the perineum. [EU] Phenylephrine: An alpha-adrenergic agonist used as a mydriatic, nasal decongestant, and cardiotonic agent. [NIH] Phenylpropanolamine: A sympathomimetic that acts mainly by causing release of norepinephrine but also has direct agonist activity at some adrenergic receptors. It is most commonly used as a nasal vasoconstrictor and an appetite depressant. [NIH] Physiologic: Normal; not pathologic; characteristic of or conforming to the normal functioning or state of the body or a tissue or organ; physiological. [EU]
Plexus: A network or tangle; a general term for a network of lymphatic vessels, nerves, or veins. [EU] Postmenopausal: Occurring after the menopause. [EU] Postoperative: Occurring after a surgical operation. [EU] Postural: Pertaining to posture or position. [EU] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation
Glossary 297
in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Precipitation: The act or process of precipitating. [EU] Predisposition: A latent susceptibility to disease which may be activated under certain conditions, as by stress. [EU] Preoperative: Preceding an operation. [EU] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Procyclidine: A muscarinic antagonist that crosses the blood-brain barrier and is used in the treatment of drug-induced extrapyramidal disorders and in parkinsonism. [NIH] Prolapse: 1. the falling down, or sinking, of a part or viscus; procidentia. 2. to undergo such displacement. [EU] Propantheline: A muscarinic antagonist used as an antispasmodic, in rhinitis, in urinary incontinence, and in the treatment of ulcers. At high doses it has nicotinic effects resulting in neuromuscular blocking. [NIH] Prophylaxis: The prevention of disease; preventive treatment. [EU] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Prostatism: A symptom complex resulting from compression or obstruction of the urethra, due most commonly to hyperplasia of the prostate; symptoms include diminution in the calibre and force of the urinary stream, hesitancy in initiating voiding, inability to terminate micturition abruptly (with postvoiding dribbling), a sensation of incomplete bladder emptying, and, occasionally, urinary retention. [EU] Prosthesis: An artificial substitute for a missing body part, such as an arm or leg, eye or tooth, used for functional or cosmetic reasons, or both. [EU] Proteolytic: 1. pertaining to, characterized by, or promoting proteolysis. 2. an enzyme that promotes proteolysis (= the splitting of proteins by hydrolysis of the peptide bonds with formation of smaller polypeptides). [EU] Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Psychology: The science dealing with the study of mental processes and behavior in man and animals. [NIH]
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Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH] Receptor: 1. a molecular structure within a cell or on the surface characterized by (1) selective binding of a specific substance and (2) a specific physiologic effect that accompanies the binding, e.g., cell-surface receptors for peptide hormones, neurotransmitters, antigens, complement fragments, and immunoglobulins and cytoplasmic receptors for steroid hormones. 2. a sensory nerve terminal that responds to stimuli of various kinds. [EU] Rectal: Pertaining to the rectum (= distal portion of the large intestine). [EU] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Reflux: A backward or return flow. [EU] Refractory: Not readily yielding to treatment. [EU] Relaxant: 1. lessening or reducing tension. 2. an agent that lessens tension. [EU]
Remission: A diminution or abatement of the symptoms of a disease; also the period during which such diminution occurs. [EU] Reoperation: A repeat operation for the same condition in the same patient. It includes reoperation for reexamination, reoperation for disease progression or recurrence, or reoperation following operative failure. [NIH] Resection: Excision of a portion or all of an organ or other structure. [EU] Riboflavin: Nutritional factor found in milk, eggs, malted barley, liver, kidney, heart, and leafy vegetables. The richest natural source is yeast. It occurs in the free form only in the retina of the eye, in whey, and in urine; its principal forms in tissues and cells are as FMN and FAD. [NIH] Sclerosis: A induration, or hardening; especially hardening of a part from inflammation and in diseases of the interstitial substance. The term is used chiefly for such a hardening of the nervous system due to hyperplasia of the connective tissue or to designate hardening of the blood vessels. [EU] Selenium: An element with the atomic symbol Se, atomic number 34, and atomic weight 78.96. It is an essential micronutrient for mammals and other animals but is toxic in large amounts. Selenium protects intracellular structures against oxidative damage. It is an essential component of glutathione peroxidase. [NIH] Serum: The clear portion of any body fluid; the clear fluid moistening serous membranes. 2. blood serum; the clear liquid that separates from blood on clotting. 3. immune serum; blood serum from an immunized animal used for passive immunization; an antiserum; antitoxin, or antivenin. [EU] Silicon: Silicon. A trace element that constitutes about 27.6% of the earth's
Glossary 299
crust in the form of silicon dioxide. It does not occur free in nature. Silicon has the atomic symbol Si, atomic number 14, and atomic weight 28.09. [NIH] Sirolimus: A macrolide compound obtained from Streptomyces hygroscopicus that acts by selectively blocking the transcriptional activation of cytokines thereby inhibiting cytokine production. It is bioactive only when bound to immunophilins. Sirolimus is a potent immunosuppressant and possesses both antifungal and antineoplastic properties. [NIH] Sneezing: Sudden, forceful, involuntary expulsion of air from the nose and mouth caused by irritation to the mucous membranes of the upper respiratory tract. [NIH] Somatic: 1. pertaining to or characteristic of the soma or body. 2. pertaining to the body wall in contrast to the viscera. [EU] Spasmolytic: Checking spasms; antispasmodic. [EU] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Stabilization: The creation of a stable state. [EU] Steel: A tough, malleable, iron-based alloy containing up to, but no more than, two percent carbon and often other metals. It is used in medicine and dentistry in implants and instrumentation. [NIH] Stenosis: Narrowing or stricture of a duct or canal. [EU] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Stimulant: 1. producing stimulation; especially producing stimulation by causing tension on muscle fibre through the nervous tissue. 2. an agent or remedy that produces stimulation. [EU] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Suction: The removal of secretions, gas or fluid from hollow or tubular organs or cavities by means of a tube and a device that acts on negative pressure. [NIH] Surgical: Of, pertaining to, or correctable by surgery. [EU] Systemic: Pertaining to or affecting the body as a whole. [EU] Thermoregulation: Heat regulation. [EU]
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Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH] Tomography: The recording of internal body images at a predetermined plane by means of the tomograph; called also body section roentgenography. [EU]
Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Translating: Conversion from one language to another language. [NIH] Transurethral: Performed through the urethra. [EU] Tricyclic: Containing three fused rings or closed chains in the molecular structure. [EU] Trihexyphenidyl: A centrally acting muscarinic antagonist used in the treatment of parkinsonism and drug-induced extrapyramidal movement disorders and as an antispasmodic. [NIH] Trophic: Of or pertaining to nutrition. [EU] Tuberculosis: Any of the infectious diseases of man and other animals caused by species of mycobacterium. [NIH] Ulcer: A local defect, or excavation, of the surface of an organ or tissue; which is produced by the sloughing of inflammatory necrotic tissue. [EU] Urinalysis: Examination of urine by chemical, physical, or microscopic means. Routine urinalysis usually includes performing chemical screening tests, determining specific gravity, observing any unusual color or odor, screening for bacteriuria, and examining the sediment microscopically. [NIH] Urinary: Pertaining to the urine; containing or secreting urine. [EU] Urodynamics: The mechanical laws of fluid dynamics as they apply to urine transport. [NIH] Urology: A surgical specialty concerned with the study, diagnosis, and treatment of diseases of the urinary tract in both sexes and the genital tract in the male. It includes the specialty of andrology which addresses both male genital diseases and male infertility. [NIH] Uterus: The hollow muscular organ in female mammals in which the fertilized ovum normally becomes embedded and in which the developing embryo and fetus is nourished. In the nongravid human, it is a pear-shaped structure; about 3 inches in length, consisting of a body, fundus, isthmus, and cervix. Its cavity opens into the vagina below, and into the uterine tube on either side at the cornu. It is supported by direct attachment to the vagina and by indirect attachment to various other nearby pelvic structures. Called also metra. [EU]
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Vaginal Discharge: A common gynecologic disorder characterized by an abnormal, nonbloody discharge from the genital tract. [NIH] Veins: The vessels carrying blood toward the heart. [NIH] Viruses: Minute infectious agents whose genomes are composed of DNA or RNA, but not both. They are characterized by a lack of independent metabolism and the inability to replicate outside living host cells. [NIH]
General Dictionaries and Glossaries While the above glossary is essentially complete, the dictionaries listed here cover virtually all aspects of medicine, from basic words and phrases to more advanced terms (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): ·
Dictionary of Medical Acronymns & Abbreviations by Stanley Jablonski (Editor), Paperback, 4th edition (2001), Lippincott Williams & Wilkins Publishers, ISBN: 1560534605, http://www.amazon.com/exec/obidos/ASIN/1560534605/icongroupinterna
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Dictionary of Medical Terms : For the Nonmedical Person (Dictionary of Medical Terms for the Nonmedical Person, Ed 4) by Mikel A. Rothenberg, M.D, et al, Paperback - 544 pages, 4th edition (2000), Barrons Educational Series, ISBN: 0764112015, http://www.amazon.com/exec/obidos/ASIN/0764112015/icongroupinterna
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A Dictionary of the History of Medicine by A. Sebastian, CD-Rom edition (2001), CRC Press-Parthenon Publishers, ISBN: 185070368X, http://www.amazon.com/exec/obidos/ASIN/185070368X/icongroupinterna
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Dorland’s Illustrated Medical Dictionary (Standard Version) by Dorland, et al, Hardcover - 2088 pages, 29th edition (2000), W B Saunders Co, ISBN: 0721662544, http://www.amazon.com/exec/obidos/ASIN/0721662544/icongroupinterna
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Dorland’s Electronic Medical Dictionary by Dorland, et al, Software, 29th Book & CD-Rom edition (2000), Harcourt Health Sciences, ISBN: 0721694934, http://www.amazon.com/exec/obidos/ASIN/0721694934/icongroupinterna
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Dorland’s Pocket Medical Dictionary (Dorland’s Pocket Medical Dictionary, 26th Ed) Hardcover - 912 pages, 26th edition (2001), W B Saunders Co, ISBN: 0721682812, http://www.amazon.com/exec/obidos/ASIN/0721682812/icongroupinterna /103-4193558-7304618
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Melloni’s Illustrated Medical Dictionary (Melloni’s Illustrated Medical Dictionary, 4th Ed) by Melloni, Hardcover, 4th edition (2001), CRC PressParthenon Publishers, ISBN: 85070094X, http://www.amazon.com/exec/obidos/ASIN/85070094X/icongroupinterna
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Stedman’s Electronic Medical Dictionary Version 5.0 (CD-ROM for Windows and Macintosh, Individual) by Stedmans, CD-ROM edition (2000), Lippincott Williams & Wilkins Publishers, ISBN: 0781726328, http://www.amazon.com/exec/obidos/ASIN/0781726328/icongroupinterna
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Stedman’s Medical Dictionary by Thomas Lathrop Stedman, Hardcover 2098 pages, 27th edition (2000), Lippincott, Williams & Wilkins, ISBN: 068340007X, http://www.amazon.com/exec/obidos/ASIN/068340007X/icongroupinterna
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Tabers Cyclopedic Medical Dictionary (Thumb Index) by Donald Venes (Editor), et al, Hardcover - 2439 pages, 19th edition (2001), F A Davis Co, ISBN: 0803606540, http://www.amazon.com/exec/obidos/ASIN/0803606540/icongroupinterna
Index 303
INDEX A Abdomen ....145, 162, 177, 181, 277, 295, 299 Abdominal.......15, 16, 18, 23, 31, 33, 113, 121, 122, 145, 147, 148, 150, 155, 164, 165, 181, 290 Abrupt ..................................................105 Abscess ...............................................147 Acetylcholine .......................................115 Adjuvant.................................................76 Adrenergic .........21, 47, 81, 127, 188, 296 Adverse .......................109, 115, 116, 180 Algorithms......................................27, 130 Anatomical.....................31, 121, 144, 196 Anesthesia.................31, 34, 35, 155, 193 Anorectal .............................................125 Anticholinergic ...20, 21, 72, 118, 221, 289 Antidepressant.........................21, 46, 293 Antigen ................................................193 Antispasmodic ..45, 47, 72, 126, 127, 290, 291, 292, 297, 299, 300 Anus ............................107, 111, 125, 287 Aspartame .............................................33 Auditory .................................................23 Autonomic..............................15, 125, 287 B Bacteria ...........44, 48, 205, 246, 288, 299 Bacteriuria ...............................25, 48, 300 Benign .....................................16, 50, 137 Bilateral..................................................82 Bulbar ....................................76, 101, 288 C Calculi ..................................................192 Capsules..............................................249 Carbohydrate.........................45, 248, 292 Carcinoma .......................18, 24, 112, 117 Cardiovascular.........................20, 45, 290 Catheter ..44, 77, 112, 116, 122, 146, 193, 289 Catheterization .....30, 34, 36, 75, 77, 182, 190 Cerebral.................................15, 205, 292 Cholesterol ..................102, 246, 248, 299 Chronic ...12, 14, 15, 17, 21, 74, 107, 115, 131, 137, 146, 158, 178, 190, 205, 221, 266, 289, 292 Collagen .......30, 35, 36, 44, 85, 101, 141, 143, 157, 175, 189, 289, 291 Confusion ......................20, 195, 205, 290 Constipation.....................20, 76, 142, 165 Contraceptive ......................................144
Contractility ................................... 86, 159 Cortex ................... 15, 101, 221, 289, 291 Cortical.................................................. 74 Criterion ................................................ 24 Cystectomy ........................................... 22 Cystitis ............................ 50, 86, 140, 145 Cystoscopy ................................... 30, 190 D Dancing............................................... 166 Defecation............................... 46, 51, 293 Degenerative ................................ 74, 247 Dehydration......................................... 142 Dementia................................... 29, 72, 74 Diaphragm .................................. 150, 290 Diarrhea .............................................. 246 Dicyclomine................................... 20, 188 Disorientation ...................... 193, 277, 290 Distal .... 47, 106, 112, 116, 121, 125, 127, 288, 297, 298 Diverticulum ........................................ 157 Dorsal.................................................. 119 Dyspareunia........................................ 148 E Electrophysiological ............................ 124 Empiric .................................................. 19 Endocrinology ............................... 45, 292 Enuresis . 4, 109, 115, 126, 145, 170, 253, 291 Epidemic ............................................... 27 Epidemiological............................... 89, 93 Epispadias .......................................... 253 Extracellular .......................... 85, 101, 291 F Fathers................................................ 138 Fibroblasts ............................................ 85 Fistula ......................................... 148, 160 Flavoxate .............................................. 20 Fluoroscopy .......................................... 19 G Genitourinary ................................ 14, 122 Glucose............................. 18, 45, 76, 292 Glycopyrrolate............................. 108, 109 Gonadal ................................ 85, 102, 299 Gynecology ........................................... 13 H Hematology........................................... 10 Hematuria ............................................. 18 Heparin ............................................... 146 Hepatic................................................ 116 Hormonal ........................................ 34, 81 Hydrophilic .......................................... 117
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Hygienic .............................11, 31, 32, 191 Hyperplasia..............47, 50, 137, 297, 298 Hyperreflexia .........................................15 Hypersensitivity ...........................143, 188 Hypertrophy .....................................16, 18 Hypotension...........................................21 I Idiopathic .............................101, 137, 293 Imipramine.............................................21 Implantation .........................112, 117, 141 Incision ............................31, 76, 277, 291 Infiltration .....................................112, 117 Innervation.....................................93, 171 Institutionalization ................109, 115, 118 Intermittent...............................34, 75, 182 Interstitial .........................47, 50, 145, 298 Intestinal ..............................................246 Intravenous..................................190, 193 Intrinsic ...21, 35, 118, 143, 147, 180, 181, 189 Irritants.....................................33, 46, 294 L Lidocaine .............................................146 Lumen..........................................112, 116 M Malformation........................................119 Menopause .......14, 21, 81, 85, 149, 165, 168, 296 Micturition ......................................47, 297 Molecular ....10, 48, 81, 85, 102, 150, 186, 198, 199, 292, 298, 300 Motility .................................................115 Musculature .........................................104 N Neural ..................................................247 Neuromuscular ......47, 115, 125, 287, 297 Niacin...................................................247 Nitrogen .................................................18 Nocturia .................................................84 Nulliparous.............................................89 O Orgasm ........................................178, 180 Osteoporosis .......................................149 Ovariectomy ..........................................82 Overdose .............................................247 Oxytocin.................................................82 P Palliative ........................................73, 191 Parietal ..................................74, 102, 296 Parity ...............................................14, 16 Penis............................106, 119, 126, 296 Percutaneous ..............................108, 231 Perineal .........76, 109, 114, 118, 160, 193 Phenylephrine......................................105 Phenylpropanolamine....................21, 252
Physiologic ...... 12, 15, 27, 102, 150, 291, 298 Plexus ......................................... 111, 124 Postmenopausal .... 21, 83, 169, 221, 252, 290 Postoperative .... 30, 31, 33, 141, 156, 182 Postural................................................. 21 Potassium ........................................... 248 Precipitation .......................................... 20 Predisposition ....................................... 89 Preoperative ................... 30, 33, 156, 188 Prevalence ...... 13, 72, 83, 84, 86, 87, 89, 131, 145, 158, 165, 190 Procyclidine................................. 114, 115 Prolapse..... 34, 79, 85, 89, 146, 147, 178, 180, 254 Propantheline.............................. 118, 188 Prophylaxis ........................................... 85 Prostate.... 17, 18, 24, 31, 37, 47, 50, 107, 112, 116, 134, 136, 140, 146, 193, 236, 284, 297 Prostatism ............................................. 24 Prostatitis .............................................. 50 Prosthesis ..................................... 32, 146 Proteolytic ............................................. 85 Psychology............................................ 13 Pulse ................... 105, 111, 122, 123, 178 R Receptor ..................................... 205, 288 Rectal............................ 18, 179, 194, 283 Recurrence ................................... 47, 298 Reflux.................................................. 117 Refractory ........................................... 252 Relaxant........................................ 21, 118 Remission ..................... 14, 184, 252, 298 Reoperation .................................. 47, 298 Resection ............................................ 284 Riboflavin ............................................ 246 S Sclerosis ........................... 31, 32, 95, 201 Selenium ............................................. 248 Serum ..................................... 18, 48, 298 Silicon ................................................. 110 Sneezing ............. 123, 144, 164, 178, 181 Somatic ................................................. 15 Spasmolytic......................................... 115 Spectrum......................................... 10, 27 Stabilization................................. 108, 180 Steel.................................................... 141 Stenosis .............................................. 148 Steroid................................... 85, 102, 298 Stomach.............................................. 159 Suction ................................................ 193 Systemic ............................................... 12 T Thermoregulation................................ 246
Index 305
Thyroxine.............................................248 Tomography ........................................193 Translating.............................................81 Transurethral .........................................76 Tricyclic..............21, 43, 46, 188, 288, 293 Trophic...................................................86 Tuberculosis ..........................................22 U Urinalysis .....18, 30, 32, 48, 179, 188, 300
Urodynamics ......................... 30, 145, 190 Urology.............. 10, 13, 82, 137, 145, 157 Uterus ......................................... 178, 200 V Veins ........................... 119, 127, 294, 296 Viruses .................................................. 86 Visceral ................................................. 15
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