Does the Urinary Microbiome Play a Role in Urgency Urinary Incontinence and Its Severity?

OBJECTIVES

Traditionally, the urinary tract has been thought to be sterile in the absence of a clinically identifiable infection. However, recent evidence suggests that the urinary tract harbors a variety of bacterial species, known collectively as the urinary microbiome, even when clinical cultures are negative. Whether these bacteria promote urinary health or contribute to urinary tract disease remains unknown. Emerging evidence indicates that a shift in the urinary microbiome may play an important role in urgency urinary incontinence (UUI). The goal of this prospective pilot study was to determine how the urinary microbiome is different between women with and without UUI. We also sought to identify if characteristics of the urinary microbiome are associated with UUI severity.

METHODS

We collected urine from clinically well-characterized women with UUI (n = 10) and normal bladder function (n = 10) using a transurethral catheter to avoid bacterial contamination from external tissue. To characterize the resident microbial community, we amplified the bacterial 16S rRNA gene by PCR and performed sequencing using Illumina MiSeq. Sequences were processed using the workflow package QIIME. We identified bacteria that had differential relative abundance between UUI and controls using DESeq2 to fit generalized linear models based on the negative binomial distribution. We also identified relationships between the diversity of the urinary microbiome and severity of UUI symptoms with Pearson's correlation coefficient.

RESULTS

We successfully extracted and sequenced bacterial DNA from 95% of the urine samples and identified that there is a polymicrobial community in the female bladder in both healthy controls and women with UUI. We found the relative abundance of 14 bacteria significantly differed between control and UUI samples. Furthermore, we established that an increase in UUI symptom severity is associated with a decrease in microbial diversity in women with UUI.

CONCLUSIONS

Our study provides further characterization of the urinary microbiome in both healthy controls and extensively phenotyped women with UUI. Our results also suggest that the urinary microbiome may play an important role in the pathophysiology of UUI and that the loss of microbial diversity may be associated with clinical severity.

Arterial hypertension related to the injection of onabotulinumtoxinA in the detrusor

OBJECTIVE AND IMPORTANCE

We want to report on a first case reported of a 50-year-old female with repetitive and clinical significant hypertension after each injection of onabotulinumtoxinA. This is a retrospective chart review and prospective evaluation of the natriuresis and blood pressure at baseline and after injection therapy. The aim was to explore the mechanism of action of this apparent onabotulinumtoxinA related hypertension.

CASE PRESENTATION

Retrospectively hypertension appeared after 7 days and vanished after 4-5 months following injection of 300 units of onabotulinumtoxinA in the detrusor, bladder symptoms disappeared after 2 weeks and reoccurred after 5 months. Urological, nephrological, cardiological and endocrinological evaluations were normal.

INTERVENTION

In the prospective evaluation a 3-day bladder diary at baseline revealed a bladder capacity of 131 ± 57 ml and at 1 month when full effect was experienced 173 ± 50 ml. At 1 month there were no leakages with six episodes of intermittent catheterization per day. The 24-hour blood pressure registration demonstrated the onset of hypertension at day 7 together with a reversal of the urinary sodium/creatinine ratios on the renal function profile.

CONCLUSION

The increasing natriuresis coinciding with the hypertension is a normal compensatory mechanism suggesting that the hypertension has a central cause rather than it is caused by haematogenous spreading.

Major odorants released as urinary volatiles by urinary incontinent patients

In this study, volatile urinary components were collected using three different types of samples from patients suffering from urinary incontinence (UI): (1) urine (A); (2) urine + non-used pad (B); and (3) urine + used pad (C). In addition, urine + non-used pad (D) samples from non-patients were also collected as a reference. The collection of urinary volatiles was conducted with the aid of a glass impinger-based mini-chamber method. Each of the four sample types (A through D) was placed in a glass impinger and incubated for 4 hours at 37 °C. Ultra pure air was then passed through the chamber, and volatile urine gas components were collected into Tedlar bags at the other end. These bag samples were then analyzed for a wide range of VOCs and major offensive odorants (e.g., reduced sulfur compounds (RSCs), carbonyls, trimethylamine (TMA), ammonia, etc.). Among the various odorants, sulfur compounds (methanethiol and hydrogen sulfide) and aldehydes (acetaldehyde, butylaldehyde, and isovaleraldehyde) were detected above odor threshold and predicted to contribute most effectively to odor intensity of urine incontinence.

Pad per day usage, urinary incontinence and urinary tract infections in nursing home residents

BACKGROUND

many elderly suffer from urinary incontinence and use absorbent pads. Pad use per day (PPD) is a frequently used measure of urinary incontinence. Nursing home residents are often dependent on help from nursing staff to change pads. This study was performed in order to determine whether PPD is a reliable method to quantify urinary incontinence in nursing home residents. Furthermore, the association between urinary tract infections (UTIs), PPD and fluid intake was studied.

METHODS

data were retrieved from a multicentre, prospective surveillance among nursing home residents. Data on the use of absorbent pads, fluid intake and incontinence volumes were collected during 48 h. During a 1-year follow-up period, data on UTIs were collected.

RESULTS

in this study, 153 residents were included, of whom 118 (77%) used absorbent pads. Residents who used absorbent pads were at increased risk of developing UTIs compared to residents who did not use pads (41 vs 11%; P = 0.001). Daily fluid intake was not associated with UTIs (P = 0.46). The number of pad changes showed no correlation with the risk of developing UTIs (P = 0.62). Patients with a given PPD presented a wide range of incontinence volumes.

CONCLUSION

the use of absorbent pads is associated with an increased risk of developing UTIs. PPD and daily fluid intake are not correlated with the risk of developing UTIs. PPD is an unreliable measure of urinary incontinence in nursing home residents.

Increased excretion of glycosaminoglycans in children with urinary incontinence compared to those with monosymptomatic nocturnal enuresis

OBJECTIVE

To analyse the urinary excretion of glycosaminoglycans (GAGs) in patients with either urinary incontinence or nocturnal enuresis.

MATERIAL AND METHODS

The study population comprised 65 patients with either nocturnal enuresis (n=34) or urinary incontinence (n=31) and 67 controls. Excretion of urinary GAGs was assessed using the sodium tetraborate-carbazole method.

RESULTS

GAG excretion in patients with urinary incontinence was significantly higher than that in controls (p<0.000129) and in children with nocturnal enuresis (p<0.016). There were no age or sex differences in GAG excretion in the three groups studied.

CONCLUSION

Increased GAG excretion in patients with urinary incontinence suggests an association with urothelial/detrusor pathology.

[Treatment of chronic cystitis in postmenopausal women]

A randomized double blind controlled trial of intravaginal cream ovestin (estriol) was conducted in 102 postmenopausal females with chronic cystitis. The patients were divided into two groups. Group 1 (n = 52) received standard therapy, group 2 (n = 50) received standard therapy plus ovestin (daily intravaginal administration for 2 weeks, then twice a week). Final results were evaluated 1 year after therapy. Before the treatment 94% patients had subnormal levels of blood estradiol. One year after the treatment positive results were achieved in 91.3% patients of group 2 and 65.8% of group 1 (p < 0.001). In group 2 patients ovestin significantly reduced pollakiuria, nocturia, episodes of urgent urinary incontinence, painful voiding. Percentage of patients with leukocyturia diminished from 100 to 8%, bacteriuria--from 74 to 4%, with vaginal lactobacilli increased from 0 to 56%, enterobacterial contamination of the vagina fell from 66 to 12%. Vaginal pH decreased from 6.0 to 3.6. Addition of ovestin to standard therapy reduced the number of cystitis recurrences 11-fold, days of antibacterial therapy--12.4-fold. Side effects of ovestin (vaginal pruritus) were seen in 4% patients.

[Sample collection methods for urine culture and analysis]

A review of the scientific evidence available on the validity of existing sample collection methods for urine culture and analysis in childhood is presented. Few studies evaluating diagnostic tests have analyzed the various available techniques with respect to valid patterns of reference. Except for clean catch midstream urine samples, there are no estimators of validity (sensitivity, specificity, probability quotients) that can be generalized to most of the techniques and that could guide decision making. Consequently, data from descriptive studies on the risk of contamination, feasibility, safety and acceptability of each technique will have to be considered in decision making. Urine collection by means of adhesive perineal bag is the most widely used method in Spain in children who do not control urine emission. Nevertheless, this technique has a high risk of contamination and a very low positive predictive value, limiting its diagnostic utility. Urethral catheterization and suprapubic bladder aspiration are considered the tests of choice; however, because these tests are invasive, their use is restricted. Therefore, when choosing the technique to be used, the patient's circumstances and our working environment will have to be considered.

Nerve growth factor and prostaglandins in the urine of female patients with overactive bladder

PURPOSE

NGF and PGs in the bladder can be affected by pathological changes in the bladder and these changes can be detected in urine. We investigated changes in urinary NGF and PGs in women with OAB.

MATERIALS AND METHODS

The study groups included 65 women with OAB and 20 without bladder symptoms who served as controls. Evaluation included patient history, urinalysis, a voiding diary and urodynamic studies. Urine samples were collected. NGF, PGE2, PGF2alpha and PGI2 were measured using enzyme-linked immunosorbent assay and compared between the groups. In addition, correlations between urinary NGF and PG, and urodynamic parameters in patients with OAB were examined.

RESULTS

Urinary NGF, PGE2 and PGF2alpha were significantly increased in patients with OAB compared with controls (p <0.05). However, urinary PGI2 was not different between controls and patients with OAB. In patients with OAB urinary PGE2 positively correlated with volume at first desire to void and maximum cystometric capacity (p <0.05). Urinary NGF, PGF2alpha and PGI2 did not correlate with urodynamic parameters in patients with OAB.

CONCLUSIONS

NGF and PGs have important roles in the development of OAB symptoms in female patients. Urinary levels of these factors may be used as markers to evaluate OAB symptoms.

Changes of urinary nerve growth factor and prostaglandins in male patients with overactive bladder symptom

AIM

Nerve growth factor (NGF) and prostaglandins (PG) in the urinary bladder can be affected by pathology of bladder, and this change can be noted in the urine. This study was performed to investigate the changes in urinary NGF and PG in male patient with overactive bladder (OAB) symptoms.

METHODS

The study group included 75 male patients with OAB symptoms and 20 males without bladder symptoms as controls. Evaluation included history-taking, urinalysis, International Prostate Symptom Score (IPSS) and urodynamic study. The NGF, PGE2, PGF(2alpha) and PGI2 levels in voided urine were analyzed by enzyme linked immunosorbent assay and these results were compared in control and OAB patients. Also, the urinary levels of NGF and PG were correlated with IPSS score and urodynamic parameters in OAB patients.

RESULTS

The urinary levels of NGF and PGE2 were signi fi cantly increased in patients with OAB compared with control (P < 0.05). The urodynamic study in OAB patients showed that more than half of the patients had detrusor overactivity and bladder outlet obstruction. The incidence of detrusor underactivity was noted in seven patients in the OAB group. The urinary level of PGE2 was decreased in patients with detrusor underactivity compared with patients without detrusor underactivity (P < 0.05), and negatively correlated with maximum bladder capacity in OAB patients (P < 0.05).

CONCLUSIONS

NGF and PG may have important role in male patients with OAB, and the urinary level of PGE2 can change according to detrusor function. Therefore, these results may be used as urinary markers to evaluate the OAB symptoms.

TOLTERODINE TREATMENT FOR CHILDREN WITH SYMPTOMS OF URINARY URGE INCONTINENCE SUGGESTIVE OF DETRUSOR OVERACTIVITY: RESULTS FROM 2 RANDOMIZED, PLACEBO CONTROLLED TRIALS

PURPOSE

We report the results of the first 2 large randomized controlled trials designed to evaluate the efficacy and safety of tolterodine extended release in children 5 to 10 years old with symptoms of urinary urge incontinence suggestive of detrusor overactivity.

MATERIALS AND METHODS

Two double-blind, placebo controlled trials were conducted sequentially. Children 5 to 10 years old with incontinence suggestive of detrusor overactivity (1 or more diurnal incontinence episodes per 24 hours) were randomized to tolterodine (2 mg daily) or placebo for 12 weeks. The primary end point was the change from baseline to week 12 in the number of incontinence episodes per week. Changes from baseline in the number of voids per 24 hours and volume of urine per void were also evaluated. Exploratory analyses were conducted to determine whether particular subsets of patients showed differential responses to treatment.

RESULTS

A total of 224 and 487 children (mean age 8 years) were randomized to placebo and tolterodine, respectively. Differences in the number of incontinence episodes per week, voids per 24 hours, and volume of urine per void between tolterodine and placebo did not reach statistical significance. This finding may be explained by a high placebo response and under dosage of tolterodine among children with greater body weight. Tolterodine was well tolerated.

CONCLUSIONS

Analysis of the primary efficacy outcome did not reveal a statistically significant effect of treatment. However, secondary analyses demonstrated that tolterodine was well tolerated among 5 to 10-year-old children with diurnal incontinence. Exploratory analyses also showed that children weighing 35 kg or less with detrusor overactivity characterized by incontinence and/or frequent voiding benefited most from tolterodine treatment, suggesting that a weight adjusted dosing regimen may be required for optimal response among older and heavier children.

Utility of urine reagent strip in screening women with incontinence for urinary tract infection

The aim of this study was to determine the utility of urine reagent strips in screening women with urinary incontinence for urinary tract infections. Subjects were all women presenting with urinary incontinence. A urine specimen was screened for urinary tract infection with a urine reagent strip and urine culture. Using the urine culture result as the gold standard, the sensitivity, specificity, and positive and negative predictive values of the urine reagent strips were calculated. A total of 265 pairs of reagent strips and urine cultures were evaluated. Thirty-one cultures grew out of a single organism; nine of these had a positive urine reagent strip, yielding a sensitivity of 29%. The specificity of the urine reagent strip was 99%, the positive predictive value was 82% and the negative predictive value was 92%. For women presenting with urinary incontinence, the sensitivity of a urine reagent test for diagnosing urinary tract infection was low.

One 24-hour frequency-volume chart in a woman with objective urinary motor urge incontinence is sufficient

OBJECTIVES

To determine whether one 24-hour frequency-volume (FV) chart in a woman with objective urinary motor urge incontinence is sufficient to gain insight into her voiding habits.

METHODS

Retrospectively, women 18 years old and older with urodynamically confirmed urinary motor urge incontinence without neurologic disease or other urologic pathologic findings, who correctly completed two or three 24-hour FV charts during normal daily life, were studied. For each patient, we compared the voiding parameters (mean voided volume, diuria, nocturia, minimum and maximum voided volumes, and total voided volume) and fluid intake calculated from the first FV chart with the same data calculated from all the FV charts.

RESULTS

Ninety-eight adult women were recruited. A marked dropout occurred, and 60 patients remained to be evaluated (mean age 54.5 +/- 15.5 years). The calculated voiding parameters agreed with those in published reports. Strong associations existed between all voiding parameters and fluid intake calculated from the first FV chart and those calculated from all FV charts (P <0.001 for all parameters). Compared with the well-known variability, the differences between the voiding parameters calculated from the first FV chart and those from all charts were small. These results agreed with studies in other patient groups (benign prostatic hyperplasia and interstitial cystitis) that analyzed the use of only one 24-hour FV chart.

CONCLUSIONS

The use of only one 24-hour FV chart completed during normal daily life by a woman with objective urinary motor urge incontinence is sufficient to gain insight into her voiding habits.

Urinary excretion of glycosaminoglycans in patients with isolated nocturnal enuresis or combined with diurnal incontinence

OBJECTIVE

To determine variations in the amount of glycosaminoglycans (GAGs) excreted by patients with nocturnal enuresis and/or diurnal incontinence.

PATIENTS, SUBJECTS AND METHODS

The study included 27 patients (aged 5-15 years) with nocturnal enuresis and/or diurnal incontinence, and 27 healthy age-matched children. Their urinary GAG excretion was assessed over 24 h using the sodium tetraborate-carbazole method.

RESULTS

Patients with nocturnal enuresis and/or diurnal incontinence had higher mean values of urinary GAG excretion than age-matched controls. There were significant differences in GAG excretion between those with nocturnal enuresis and diurnal incontinence and those with nocturnal enuresis alone.

CONCLUSIONS

GAG excretion in patients with nocturnal enuresis and/or diurnal incontinence was significantly higher than in normal children, suggesting that measuring urinary GAGs may be useful in evaluating physiopathological conditions of the bladder wall, and hence in monitoring potential damage in the bladder mucosa.

The role of the frequency-volume chart in the differential diagnostic of female urinary incontinence

OBJECTIVE

To investigate the differential diagnostic capacity of the frequency-volume chart in 132 women with urinary incontinence.

MATERIAL AND METHOD

For each patient, the readings of two 24-h frequency-volume charts were compared to the urodynamic diagnosis which was used as the gold standard in 73 genuine stress incontinent women, in 23 urge incontinent women, and in 36 women with mixed incontinence.

RESULTS

The total voided volume, the mean voided volume, the largest single voided volume, and the smallest single voided volume were statistically differentiating single parameters among the three groups (p<0.05). Applying logistic regression to the two well-defined groups of patients, the one with urge incontinence and the one with genuine stress incontinence, the frequency of micturition during nighttime revealed the best discriminatory power for these conditions.

CONCLUSION

This study shows that in the frequency-volume chart micturition during nighttime discriminates best between urge and stress incontinence.

Long-term ambulatory monitoring of urine leakage in the elderly: an evaluation of the validity and clinical applicability of thermistor signalling

This study evaluated the validity and applicability of a low-cost Urine Leakage Recording Device (ULRD) in a geriatric setting. The ULRD consisted of a thermistor, connected to a portable, digital datalogger. The thermistor was positioned on a commercially available adult diaper. Five healthy females were instructed to void urine in seven behavioural conditions comprising general motor activity patterns of the average, psychogeriatric elderly in-patient. Voids were verbally indicated by the subjects and concomitantly recorded by the ULRD and the observer. After comparing the ULRD records--scored by three independent assessors--with the subjects' reports, on average (SD) 5.3 (0.6) of a total of 10 voids were classified correctly, whereas 9.3 (1.3) false positive events were indicated. None of the subjects reported any inconvenience as a result of the recording procedure. Although the ULRD is easily applicable, we conclude that it seems to be of little value in its present form as a method for long-term ambulatory monitoring of urine leakage.

Urine specimen collection from incontinent female nursing home residents

OBJECTIVE

To determine if a clean catch technique can accurately diagnose bacteriuria among incontinent female nursing home residents.

DESIGN

Cultures and dipstick screening test results from paired urine specimens, one collected by a clean catch technique and the other collected by sterile in-and-out catheterization, were compared.

PARTICIPANTS

A total of 101 incontinent female nursing home residents who were being assessed for participation in a larger clinical intervention trial for incontinence.

MEASUREMENTS

Each urine was tested by a dipstick method for leukocyte esterase and nitrite and sent to a bioclinical laboratory for quantitative culture.

RESULTS

Positive and negative culture results matched in 92 of the 101 paired specimens. Using the catheter specimen as a gold standard, the clean catch had a sensitivity of 90%, specificity of 92%, positive predictive value of 81%, and a negative predictive value of 95%. In a population with symptoms suggestive of infection, among whom the prevalence of bacteriuria would likely be higher than in the asymptomatic residents we studied (e.g., 60% vs 30%), the positive predictive value would increase to 95%, but the negative predictive value would decrease to 86%. The concordance of the results of the urine screening tests was not as good, except for the detection of a positive leukocyte esterase test and a negative nitrite test.

CONCLUSION

Incontinent female nursing home residents do not necessarily have to be catheterized in order to obtain an accurate quantitative urine culture. Our results using a careful clean catch technique are comparable to those previously reported using urine obtained from a urine-soiled diaper as well as those using a condom catheter technique in men.

Single-blind, randomised, parallel group study of the Bard Biocath catheter and a silicone elastomer coated catheter

A group of 69 community patients undergoing long-term urethral catheterisation for urinary incontinence took part in this study; 33 patients with a mean age of 70.03 years (+/- 16.6) received the Dow Corning Silastic catheter (16 F 10-ml balloon) and 36 patients with a mean age of 75.61 years (+/- 12.6) received the Bard Biocath catheter (16 F 10-ml balloon). Over a 16-week period catheters were monitored every 2 weeks and changed as necessary. The Bard Biocath catheter remained in situ for an average of 89.61 days (+/- 35.31) and the Silastic catheter remained in situ for an average of 56.7 days (+/- 38.8); this difference was statistically significant. Used catheters were analysed for encrustation using scanning electron microscopy (SEM). The average time in situ for non-encrusted Biocath catheters was 83.7 days and 25.28 days for non-encrusted Silastic catheters. It was found that 70% of patients who received Biocath catheters preferred them to their previous catheters whereas only 30% of patients in the Silastic group preferred the trial catheter. The incidence of bypassing was 28% in the Biocath group and 52.8% in the Silastic group.

Pad weighing test--a simple method to quantitate urinary incontinence

This paper reviews the litterature on pad weighing tests designed to measure urinary incontinence. These can be divided into short-term (one to two hours), as suggested by the International Continence Society, or long-term (12 to 48 hours). Apart from practical disadvantages the short-term tests have a low sensitivity and require retrograde filling of the bladder to reach acceptable reproducibility. The long-term tests have practical advantages, better sensitivity and acceptable reproducibility. The validity of the long-term test as a measure of the symptom of incontinence is evident, whereas it is unclear what the short term test measures. An evaluation of the value of pad-weighing tests in different kinds of incontinence is lacking.

Urodynamic tests for female geriatric urinary incontinence

Most urodynamic tests currently in use in the evaluation of female urinary incontinence have not been applied to a community-based sample to determine their specificity. In this study of a random sample of noninstitutionalized elderly, 258 self-reported continent and 198 self-reported incontinent women sixty years and older, who participated in a household survey, underwent a clinic evaluation (history, physical examination, and urinalysis); of these 67 continent and 100 incontinent female respondents underwent urodynamic testing. The uroflowmetry, cystometry, and supine static urethral pressure profilometry (UPP) findings did not differ significantly between continent and incontinent subjects (whether based on a self-report or a clinician's diagnosis of urinary continence status). Standing static and dynamic UPP and lateral cystography showed significant differences between self-reported continent and incontinent respondents. The provocative stress test significantly distinguishes continence from incontinence, and stress incontinence from other types. The sensitivity of the provocative stress test was 39.5 percent, whereas its specificity is 98.5 percent. Urodynamic testing including uroflow study, static UPP, and lateral cystography should not be used as a screening test but rather selectively as a confirmatory test, and to determine the therapeutic approach, and to assess the outcome of therapy.

Urinary incontinence volume measurement in elderly male inpatients

Urinary incontinence is a debilitating disease in the elderly and is a leading cause of nursing home placement for aged patients in our society. Accurate measurement of urinary incontinence in elderly inpatients is necessary to determine the severity of the disease and to evaluate the efficacy of any treatment methods being investigated. The technique required for evaluation of elderly chronic care inpatients is different from methods that can be used in patients who do not have the ambulatory and cortical impairment that is common among chronic care inpatients. Since chronic care nursing staff involvement is necessary for accurate measurement and recording of incontinence episodes, a procedure for measurement must be well defined and clearly outlined in a sequence that can be followed easily. This study provides a method of incontinence volume assessment for elderly inpatients that can be performed by inpatient nursing staff to provide accurate incontinence volume measurements. Quantitative urinary incontinence volume measurements were done over ten days in 42 elderly men. Urinary incontinence presented as a significant problem in these patients over a wide range of both frequency and volume of urinary incontinence episodes. The volume measurement technique described allowed the nursing staff to identify, measure, and record incontinence severity over a wide range of frequency and volume while monitoring multiple patients simultaneously.

The severity of urinary incontinence in women. Comparison of subjective and objective tests

The subjective assessment of urine loss in 84 incontinent women was quantified by using a 10-cm visual analogue scale. These results were compared with the results of a 2-h pad weighing test. We found no relationship between a patient's subjective impression of the severity of her incontinence and the corresponding objective assessment by a 2-h pad weighing test.

Blockage of urinary catheters: role of microorganisms and constituents of the urine on formation of encrustations

Long-term indwelling urinary catheters may become blocked in some patients by formation of encrustations made up of aggregated struvite crystals while other patients rarely develop blocked catheters. We have designated these groups as "blockers", "intermediates" or "non-blockers". To further understand this phenomenon we followed 32 catheterized elderly women in a nursing home. Catheters were changed six times at 2 week intervals. Patients tended to remain as "blockers", "intermediates" or "non-blockers" consistently over time. There were no significant differences in use of antibiotics, clinical manifestations of urinary infection or fever among the groups. "Blockers" were significantly more often colonized with Proteus mirabilis and Providencia stuartii than "non-blockers", and significantly less often with Klebsiella pneumoniae. However, there was no evidence of interference among the organisms. "Blockers" excreted a significantly more alkaline urine, and lesser amounts of magnesium, urea and phosphate in their urine. Two "blockers" in whom Proteus sp. were eliminated by coincidental antimicrobial therapy converted to "non-blockers". These findings support the concept that "blockers" are patients who have prolonged colonization with urease producing Proteus mirabilis and Providencia stuartii.

Relationship between drug use and urinary incontinence in elderly women

Two hundred older women with urinary incontinence were studied to observe the influence of their prescription and nonprescription drug use on symptoms of incontinence. Ninety percent of women reported using medication, with an average use of four drugs. Medications statistically associated with urinary incontinence symptomatology were prostaglandin inhibitors, diuretics, and estrogen therapy. Further studies are needed to clarify the relationship between medication usage and the presence and severity of urinary incontinence.

Urinary incontinence verification in elderly men

This study considered the problem of verifying the amount and frequency of incontinent urine loss in an outpatient population. The sample consisted of elderly male community-dwelling veterans who experienced urinary incontinence. Two amount tests (60-minute and 3-day) were completed by 46 volunteer subjects and 7-day frequency records were kept by an additional 44 volunteers. Results indicated that 60-minute and 3-day absorbent pad tests for amount of urine loss classified 59% (n = 27) of the subjects the same way (normal or abnormal). Thus, the shorter test appears useful as a screening test and offers advantages of lower cost and more accurate reporting. If abnormal urine loss is not identified with the short test, the long test should be used to detect infrequent episodes. Three-day tests for incontinence frequency classified 86% (n = 28) of subjects the same as 4-day tests. Therefore, a 3-day test appears adequate to determine the number and pattern of incontinent episodes as well as associations with relevant events such as activity levels and fluid intake.

The urine smell around patients with urinary incontinence. The production of ammonia in ordinary diapers and in diapers impregnated with copper acetate

The foul smell of urine around patients with urine incontinence is thought to be due mainly to the production of ammonia from urea by bacterial ureases. The production of ammonia was thus measured by infrared spectrophotometry in control diapers and in test diapers impregnated with copper acetate (CA), after use by urine-incontinent patients with persistent bacteriuria. The CA-impregnated diapers produced significantly less ammonia than the control diapers. The CA-impregnated diapers were not bactericidal, however. The results are consistent with the hypothesis that the smell reduction of the CA-impregnated diapers is due to a bacteriostatic action or an inhibition of bacterial ureases by CA.

Reproducibility and reliability of urinary incontinence assessment with a 60 min test

Urinary incontinence was objectively assessed in 50 patients. The urine loss was measured as weight gain of perineal pads worn during a 60 min standardized activity period. The test was initiated by drinking 500 ml (not milk and soda water). The patients were instructed not to void before and during the test. After the test, the voided volume was collected. The test proved handy, reproducible and reliable compared to the subjective day-time incontinence. Prior to the actual test, 15 patients participated in a pilot study having an initial voiding and a test period of 3 1/2 hours. This longer test period was not found practical and the gain in positive diagnosis was minimal compared to the disadvantages with a higher number of unscheduled voidings.

Effect of chlorophyllin on urinary odor in incontinent geriatric patients

This randomized, double-blind, crossover, placebo-controlled study involved 20 incontinent geriatric patients; all had indwelling Foley catheters. Each patient received chlorophyllin 100 mg/d for two weeks and placebo daily for two weeks, separated by a washout period of one week. For each subject, the intensity of urinary odor was measured ten times during both the treatment and placebo regimen and three times during the washout period, using a visual analog scale. A decrease in urinary odor was associated with chlorophyllin in 12 patients and with placebo in 6 patients at the end of two weeks on each regimen. Chlorophyllin treatment was associated with about a 21-percent decrease in mean urinary odor intensity, whereas placebo increased the odor by about 9 percent. The mean intensity of urinary odor was lowest during the second week of chlorophyllin treatment. Despite the decrease in urinary odor in many patients receiving chlorophyllin, its effect was not significantly greater than that of placebo. Our data suggest that chlorophyllin 100 mg/d for two weeks may not be effective in incontinent geriatric patients with mild to moderate urinary odor.

Assessing the severity of urinary incontinence in women by weighing perineal pads

50 women with normal urinary control and 100 women with urinary incontinence wore a series of preweighed sanitary towels for 1 h. The pads were weighed again after use. Mean pad weight increase was less than 1 g/h in normal women and 12.2 g/h in women with incontinence. In each case the pad-weighing test provided information about the severity and the pattern of incontinence which was not easy to obtain either from patient interview or from clinical examination.

Comparative biochemical profiles in blood and urine of two strains of mink and changes associated with the incidence of wet belly disease

The blood and urine biochemical profiles of two color strains of mink, Demi-Buff and Pastel, were studied. Changes associated with the incidence of wet belly disease in some of them were determined by comparison with unaffected animals. Chloride and potassium were the only blood parameters significantly different between these two strains of mink. In blood, PO2 was the only significant difference detected between wet belly affected and unaffected mink. Pastel mink excreted significantly more potassium and nitrogen in the daily urine excretion than did the Demi-Buff strain. The most significant findings were observed in the urine of mink affected with wet belly disease when compared with unaffected animals. Twenty-four hour urine excretion volume was significantly reduced in mink with wet belly disease. Chloride, ammonia, and net acid were significantly higher than normal in the urine of mink with wet belly disease.

Do condom catheter collecting systems cause urinary tract infection?

A study was undertaken to determine whether use of a condom catheter collection system (CCCS) is associated with urinary tract infection (UTI). No UTI developed in 79 episodes of CCCS use in patients who were cooperative or because of paralysis were unable to manipulate the collecting system (mean time per patient, 21.2 days; total number of patient days, 1,677). By contrast, in 15 patients who were identified prospectively as being uncooperative and who repeatedly manipulated the CCS, UTI developed in eight (53.3%) within a mean of 9.6 days. Urethral catheterization in cooperative patients during CCCS use was followed by development of UTI. Repeated interference with the proper use of CCCS and urethral catheterization during CCCS use are associated with an increased risk of UTI.