Dowd TT, Campbell JM, Jones JA.
Fluid intake and urinary incontinence in older community-dwelling women.
J Community Health Nurs. 1996;13(3):179-86. doi: 10.1207/s15327655jchn1303_5.
Abstract/Text
Urinary incontinence (UI) is a common problem and requires adjustment to self-care. Noninvasive methods to manage UI should be tried first. Although many individuals restrict fluid intake to reduce incontinent episodes, clinical hunches suggest that adequate hydration is more useful in the management of UI. This study was conducted to determine the effects of hydration on the number of UI episodes. Women were randomly assigned to 1 of 3 groups: increase fluid intake by 500 cc, maintain fluid intake at baseline level, or decrease by 300 cc. Thirty-two women kept fluid intake and output diaries for 5 weeks. Adherence to fluid intake protocols was poor, and consequently, quantitative results were nonsignificant. However, follow-up interviews revealed that 20 women reported decreased UI episodes since participating in the study and felt that the most significant learning was their recognition of the need to increase fluid intake. Community health nurses can provide guidance in self-assessment of fluid intake patterns to help manage UI.
Bryant CM, Dowell CJ, Fairbrother G.
Caffeine reduction education to improve urinary symptoms.
Br J Nurs. 2002 Apr 25-May 8;11(8):560-5. doi: 10.12968/bjon.2002.11.8.10165.
Abstract/Text
Caffeine reduction is an internationally accepted treatment strategy for patients with urinary symptoms. However, there is little trial evidence in support of a caffeine/urinary symptom effect. A prospective randomized trial was conducted among 95 consecutive adult patients with urinary symptoms presenting to two nurse continence advisers. Frequency, urgency and leakage outcomes were tested 1 month postenrolment. Trial findings indicate that caffeine intake was reduced (P<0.0001) in the experimental group and that urgency (P=0.002) and frequency (P=0.037) outcomes were significantly improved. Caffeine practices and habits were surveyed and self-reports of caffeine effects indicate that urinary symptoms figured prominently as a reported effects but less so as a driver of caffeine reduction.
Abrams P, Chapple C, Khoury S, Roehrborn C, de la Rosette J; International Scientific Committee.
Evaluation and treatment of lower urinary tract symptoms in older men.
J Urol. 2009 Apr;181(4):1779-87. doi: 10.1016/j.juro.2008.11.127. Epub 2009 Feb 23.
Abstract/Text
PURPOSE: The 6th International Consultation on New Developments in Prostate Cancer and Prostate Diseases met from June 24-28, 2005 in Paris, France to review new developments in benign prostatic disease.
MATERIALS AND METHODS: A series of committees were asked to produce recommendations on the evaluation and treatment of lower urinary tract symptoms in older men. Each committee was asked to base recommendations on a thorough assessment of the available literature according to the International Consultation on Incontinence level of evidence and grading system adapted from the Oxford system.
RESULTS: The Consultation endorsed the appropriate use of the current terminology lower urinary tract symptoms/benign prostatic hyperplasia/benign prostate enlargement and benign prostatic obstruction, and recommended that terms such as "clinical benign prostatic hyperplasia" or "the benign prostatic hyperplasia patient" be abandoned, and asked the authorities to endorse the new nomenclature. The diagnostic evaluation describes recommended and optional tests, and in general places the focus on the impact (bother) of lower urinary tract symptoms on the individual patient when determining investigation and treatment. The importance of symptom assessment, impact on quality of life, physical examination and urinalysis is emphasized. The frequency volume chart is recommended when nocturia is a bothersome symptom to exclude nocturnal polyuria. The recommendations are summarized in 2 algorithms, 1 for basic management and 1 for specialized management of persistent bothersome lower urinary tract symptoms.
CONCLUSIONS: The use of urodynamics and transrectal ultrasound should be limited to situations in which the results are likely to benefit the patient such as in selection for surgery. It is emphasized that imaging and endoscopy of the urinary tract have specific indications such as dipstick hematuria. Treatment should be holistic, and may include conservative measures, lifestyle interventions and behavioral modifications as well as medication and surgery. Only treatments with a strong evidence base for their clinical effectiveness should be used.
Homma Y, Ando T, Yoshida M, Kageyama S, Takei M, Kimoto K, Ishizuka O, Gotoh M, Hashimoto T.
Voiding and incontinence frequencies: variability of diary data and required diary length.
Neurourol Urodyn. 2002;21(3):204-9. doi: 10.1002/nau.10016.
Abstract/Text
Frequencies of voiding and urinary incontinence are commonly measured by a patient's recall or a diary. The recommended diary length varies from 1 to 14 days, with 7 days apparently being most common. To examine the statistical precision of these different modalities, we analyzed recall data and diary data of 74 patients with urinary frequency, incontinence, or both. Recall data on voiding and incontinence frequency were systematically higher and more variable than diary data. Longer diary length provided less variable diary data. The confidence interval of diary data was calculated by applying the normal distribution to daytime voiding frequency and the Poisson distribution to daytime incontinence frequency. For daytime voiding frequency, the 95% confidence interval was estimated to be (x - 2.65, x + 2.65) (x - 1.53, x + 1.53) (x - 1, x + 1), where x is the 1-day, 3-day, and 7-day diary mean, respectively. For daytime incontinence frequency, the confidence interval depended on both the diary length and the diary mean. It was estimated to be (0, 6.39), (1.72, 4.28), (2.36, 3.64), by using a diary mean of 3 or 1-day, 7-day, and 28-day diaries, respectively. Also, it was estimated to be (0, 1.02), (1.72, 4.28), (7.66, 12.34), when the 7-day diary mean was 0.5, 3, and 10, respectively. Studies with different samples of genuine stress incontinence (n = 37) and urge incontinence (n = 25) confirmed these results. In conclusion, we believe the 7-day diary is highly reliable for estimating voiding frequency and is a reasonable option for predicting incontinence episodes. However, the diary length should be extended in a patient with rarer events of incontinence, and it should be shortened for those who are incontinent more often or who are diagnosed with voiding frequency only.
Copyright 2002 Wiley-Liss, Inc.
Schick E, Jolivet-Tremblay M, Dupont C, Bertrand PE, Tessier J.
Frequency-volume chart: the minimum number of days required to obtain reliable results.
Neurourol Urodyn. 2003;22(2):92-6. doi: 10.1002/nau.10079.
Abstract/Text
AIMS: There is wide variation in the number of days necessary to maintain a diary and still furnish reliable data on which to base a sound clinical assessment. Estimates range from 1 day to 2 weeks, 7 days probably being the criterion standard. The goal of this retrospective study was to evaluate how much the 7-day period could be shortened without compromising the reliability of data.
METHODS: Various lengths of frequency-volume (FV) charts (from 1 day to 6 days) were compared with the standard 7-day charts on 14 FV parameters.
RESULTS: Overall results show that a 4-day dairy is nearly identical to the 7-day chart (most r > or = 0.95). Results of the 1-, 2-, and 3-day charts were frequently different statistically from the 7-day chart, whereas comparison of the 4-day chart with the 7-day chart showed no statistically significant differences. In addition, results of 4-day FV charts from a new control cohort showed no significant differences from the 7-day charts of the main cohort.
CONCLUSIONS: In conclusion, our study indicates that the 4-day chart is as reliable as the 7-day chart. This reduction in the length of time, although easier for the patients, does not compromise the diagnostic value of the FV charts.
Copyright 2003 Wiley-Liss, Inc.
Ku JH, Jeong IG, Lim DJ, Byun SS, Paick JS, Oh SJ.
Voiding diary for the evaluation of urinary incontinence and lower urinary tract symptoms: prospective assessment of patient compliance and burden.
Neurourol Urodyn. 2004;23(4):331-5. doi: 10.1002/nau.20027.
Abstract/Text
AIMS: Voiding diary duration may be related to patient compliance and burden. To test this hypothesis, we evaluated patient compliance and burden.
METHODS: Between January and July 2002, we prospectively evaluated 162 patients (57 males and 105 females, mean age 53.0, range 20-81 years) with stress urinary incontinence or lower urinary tract symptoms. At the initial visit, all patients underwent a detailed clinical evaluation including an International Prostate Symptom Score (I-PSS) assessment and were randomly requested to complete 2-day, 3-day, or 7-day voiding diaries (the three study groups). At the second visit, a simple self-administered questionnaire was completed by all patients. The questionnaire included 11 items on subject demographics and voiding diary-keeping.
RESULTS: No significant differences were found in either the accuracy of diary-keeping or the daily average number of omissions when the three groups were compared. However, as the diary duration increased, the mean burden scores increased (P = 0.005), and the mean preferred duration of the diary in the 7-day group was significantly higher than that of the 2-day or 3-day groups (P < 0.001). After categorizing patients into two groups according to the degree of patient burden, members of the group with a greater perceived burden were found to have a significantly higher I-PSS quality of life score (P = 0.045) and to have kept a diary for a longer time (P = 0.038).
CONCLUSIONS: Our results suggest that keeping a diary for 7 days may increase patient burden and thus, we recommend that the 7-day diary should be reduced to cover fewer days.
Copyright 2004 Wiley-Liss, Inc.
