Joyce Colling

Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence.

Objective To determine the incidence of surgically managed pelvic organ prolapse and urinary incontinence in a population-based cohort, and to describe their clinical characteristics. Methods Our retrospective cohort study included all patients undergoing surgical treatment for prolapse and incontinence during 1995; all were members of Kaiser Permanente Northwest, which included 149,554 women age 20 or older. A standardized data-collection form was used to review all inpatient and outpatient charts of the 395 women identified. Variables examined included age, ethnicity, height, weight, vaginal parity, smoking history, medical history, and surgical history, including the preoperative evaluation, procedure performed, and details of all prior procedures. Analysis included calculation of age-specific and cumulative incidences and determination of the number of primary operations compared with repeat operations performed for prolapse or incontinence. Results The age-specific incidence increased with advancing age. The lifetime risk of undergoing a single operation for prolapse or incontinence by age 80 was 11.1%. Most patients were older, postmenopausal, parous, and overweight. Nearly half were current or former smokers and one-fifth had chronic lung disease. Reoperation was common (29.2% of cases), and the time intervals between repeat procedures decreased with each successive repair. Conclusion Pelvic floor dysfunction is a major health issue for older women, as shown by the 11.1% lifetime risk of undergoing a single operation for pelvic organ prolapse and urinary incontinence, as well as the large proportion of reoperations. Our results warrant further epidemiologic research in order to determine the etiology, natural history, and long-term treatment outcomes of these conditions.

The Effects of Patterned Urge‐Response Toileting (PURT) on Urinary Incontinence among Nursing Home Residents

To test an individualized form of habit training for urinary incontinence (UI) among long‐stay cognitively and/or physically impaired elderly nursing home residents over time.

Sterile vs Clean Urinary Catheterization

To the Editor-Intermittent urethral catheterization (IC) has been recommended for nursing home patients who require bladder drainage to reduce chronic indwelling catheter use and its attendant complications.’ However, nursing homes rarely use IC, citing lack of acceptance by nursing staff, concerns about urinary infection, and cost of sterile supplies as barriers to its implementation.’ Self-catheterization using clean technique substantially lowers costs but frequently cannot be performed by nursing home patient^.^ There are no studies of such catheterization of the elderly by nursing staff in an institutional setting. Accordingly, we conducted a pilot study of intermittent urinary catheterization in elderly nursing home patients utilizing a new modification of clean technique and conventional sterile technique. Between August 1987 and September 1989, 14 male patients over 50 years of age in the Nursing Home Care Unit (NHCU) were randomized to receive 16 weeks of either standard sterile or modified clean IC performed by nursing staff. Patient characteristics and details of study participation are listed in Table 1. Patients gave informed consent prior to starting the study which was approved by the Subcommittee for Human Studies and the Research and Development Committee of the Portland Veterans Affairs Medical Center. Patients were catheterized three to four times a day as directed by their physicians. Sterile catheterizations were performed by nursing staff using a disposable sterile kit and standard sterile technique^.^ Patients in the modified clean group were catheterized by nursing staff wearing clean latex gloves and using a lubricated single use sterile red rubber catheter. No drapes were used. The meatus was cleaned with a Castile soap pledget, and urine was drained into the patient’s urinal. A new catheter was used for each catheterization. The standard clean self-catheterization protocol employs a reuseable catheter with a soap and water washing between each use. However, using a disposable catheter increased acceptability for the nursing staff, and the additional nursing time required for catheter care offset the small savings in supply cost by reusing the catheter. Urinalysis and culture were obtained weekly, and patients were followed clinically for infection. Bacteriuria was defined by a urine culture with greater than 100,000 bacteria per mL. Physicians caring for the patients were blinded to the method of catheterization used. Patients were followed for an average of 10.9 weeks in the clean group and 11.5 weeks in the sterile group. One patient in each group had a major urinary tract infection, characterized by temperature >38OC, bacteriuria, and transfer to acute care (Table 2). Neither patient was bacteremic. In addition, there were three minor infections diagnosed on the basis of dysuria or frequency without elevation of temperature. Two of these infections were in the sterile group and one in the clean group. Both episodes were treated with oral antibiotics in the NHCU. Hence, there was a total of three symptomatic infections in the sterile group (all in the same patient) and two in the clean group (in two different patients). The procedure was generally well tolerated and there were no local complications. Patients in both groups had asymptomatic bacteriuria the majority of the time (87%), often with multiple organisms. In both groups, the most frequent urinary isolates were Gramnegative organisms. The cost of supplies was

A guideline for the nation: Managing urinary incontinence

2.03 for each sterile catheterization and

The effects of a continence program on frail community-dwelling elderly persons.

.48 for each clean Catheterization. In this study, the catheterization costs for the sterile group were

Urinary incontinence in the frail elderly: even when it's too late to prevent a problem, you can still slow its progress.

3,404. If the clean technique had been used, the cost would have been

Behavioral management strategies for urinary incontinence.

800. TABLE 1. PATIENT CHARACTERISTICS

Urinary incontinence in adults.

The urinary incontinence (UI) guideline recommends a multidisciplinary approach to the treatment of incontinence, one of the most costly, widely underreported and underdiagnosed health problems in the United States today. While nurses are not the only deliverers of care, the guideline places them on the front line in the identification, treatment, and prevention of incontinence.