Purpose: Ultrasonically measured intravesical prostatic protrusion may be a promising noninvasive method of assessing bladder outlet obstruction. Previous investigations of this technique focused on patients with acute urinary retention and symptomatic men identified in urology clinics, which may not reflect the distribution of intravesical prostatic protrusion in community dwelling men. Materials and Methods: In 2006 a total of 322 white men residing in Olmsted County, Minnesota underwent transrectal ultrasound examination which permitted direct measurement of intravesical prostatic protrusion. Cross-sectional associations between lower urinary tract symptoms/benign prostatic enlargement and intravesical prostatic protrusion were measured. Rapid increases in lower urinary tract symptoms/benign prostatic enlargement measures as predictors of severe intravesical prostatic protrusion were also assessed. Results: Overall 10% of these men had an intravesical prostatic protrusion of 10 mm or greater. Greater intravesical prostatic protrusion was weakly correlated with greater prostate volume (rs = 0.28), higher obstructive symptoms (rs = 0.18) and lower peak urinary flow rate (rs = -0.18). Men with the most rapidly growing prostate before intravesical prostatic protrusion measurement were 3 times more likely to have an intravesical prostatic protrusion of 10 mm or greater. Men with an intravesical prostatic protrusion of 10 mm or greater were more likely to use medications for lower urinary tract symptoms/benign prostatic enlargement compared to those with an intravesical prostatic protrusion less than 10 mm (adjusted OR 2.95, 95% CI 1.23-7.06). Conclusions: These population based data provide reference ranges for future studies of intravesical prostatic protrusion as a predictor of adverse urological outcomes. Intravesical prostatic protrusion is significantly correlated with greater prostate volume, higher obstructive symptoms and lower peak urinary flow rate, suggesting that it may have clinical usefulness in predicting the need for treatment.

This dissertation aims to explore the role of patient and family engagement in the context of two current health issues: catheter-associated urinary tract infections (CAUTI) and antibiotic resistance. Chapter One contains an introduction to patient and family engagement, CAUTI, and antibiotic resistance, followed by gaps in the science, a description of the theoretical framework, and specific aims addressed in this dissertation. Chapter Two is a systematic review of existing CAUTI prevention interventions that involve patient and family engagement. Chapter Three is a study designed to meet the learning needs of parents by developing a graphically-enhanced CAUTI-prevention educational resource using participatory design methods. Chapter Four is an environmental scan that summarizes the content and format of existing resources about antibiotic resistance and antibiotic use available from children’s hospital websites across the United States. Finally, Chapter Five contains an overall summary of the findings of this dissertation, a discussion of results within the guiding theoretical framework, practice and policy implications, and suggestions for future research.

The purpose of this study was to examine factors that influence the experience of urinary incontinence (UI) as it relates to sexual intimacy for older women. Additionally, I wanted to identify perceived areas of intervention that might positively influence the experience of UI as it relates to sexual intimacy for participants. The sample consisted of 10 women who ranged in age from 65 to 81. The theoretical framework guiding this study was a systemic perspective in which how participants make meaning is given prominence. Symbolic interactionism, social constructionism, and systems perspective are interwoven to provide the foundation for this study. Data were collected utilizing in-depth interviews. Self-portraits were introduced to enrich conversation during the second interview. Three conclusions were drawn from this study. First, feelings of secrecy that permeated this project were manifested in the lack of willing participants as well as brevity of responses during interactions with participants. Second, participants indicated a tendency to minimize their incontinence and to manage their symptoms without formal medical intervention. Third, participants offered perceived potential interventions that might positively influence the experience of UI. These included the provision information related to UI in a way that does not require individuals to request the information, such as brochures at physicians' offices, post-surgical follow-up, and individuals from whom participants would be most comfortable receiving such information. / Ph. D.

A brief investigation was made of various organic and inorganic solvents for the dissolution of urinary calculi in vitro and Albright’s (1) citric acid buffer and a solvent designated in this investigation simply as “G” (33) were shown to be the most efficient solvents. Further investigation showed that something was necessary to increase the efficiency of these solvents, as the dissolution would proceed to a certain point where the solvent ceased to act. It was at this point that the investigation changed its course and the attack was centered on the organic colloidal matrix in the structure of the stone. It is a well known fact that this organic matrix is resistant to weak acids and bases (30) and therefore the course of the investigation pointed to those most remarkable agents, “the enzymes”, which due to their enormous amount of surface energy are capable of producing astonishing results. The enzymes investigated were not selected for their specific action, but they were selected for the purpose of studying the effect of their surface energy on the colloidal matrix of urinary calculi. The investigation indicates that a calculus pretreated with urease for fifteen minutes, followed by a 6 hour irrigation with “G” (33) solution is sufficient to cause dissolution and disintegration in nearly all of the one hundred calculi selected at random. (See Table 5) The ability of urease to hasten disintegration may be due to its activity on the colloidal matrix, causing it to swell, thereby giving back the former hydrotropic properties mentioned by Snapper (52). Colloidal material was isolated from a large calculus and was subjected to the action of urease. After 6 hours the colloids from the calculus had swollen approximately five hundred times their original volume, and changed from a dark brown-colored material to a white translucent gel. These organic colloidal matrices of urinary calculi are apparently of a reversible nature and irreversible as investigators have assumed in the past (30). Investigations were made and reported in various sections of this paper on the ability of other enzymes, peroxide, and acids to act as dissolution agents or as aids to dissolution. An efficient in vitro irrigator Fig. 1 is described and its merit in the irrigation of urinary calculi lies in the facts that its construction is simple, its rate of flow can be accurately regulated by a slight manipulation, and the calculus can be treated in various ways without removing it from the original crucible. It now remains for the urologist to investigate the possibility of in vitro dissolution, using the above auxiliary agent. It is suggested that the urease might be used simultaneously with the irrigation solvent. / Ph. D.

No description available.

published_or_final_version / Nursing Studies / Master / Master of Nursing

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand,Johannesburg, in partial fulfillment of the requirements for the degree of Master of Medicine in Obstetrics and Gynaecology. MMed (O & G) Johannesburg 2015 / Background: Stress urinary incontinence is a common problem in a woman’s life and has a negative affect on her quality of life (QOL). The trans obturator tape (TOT) is a safe procedure used to treat urinary incontinence. The operative change in the quality of life was determined using the Kings Health Questionnaire (KHQ). This study assesses patient reported outcomes of the TOT procedure as the primary measure of success. Objectives: The primary objectives of the study were to determine the subjective outcome of the QOL and symptoms for women that underwent the TOT procedure using the King’s Health Questionnaire (KHQ) in a tertiary academic centre. The secondary objectives assessed the cure rate of the impact on QOL and the subjective symptoms, evaluated the outcome of pre-operative urgency and determined if post-operative change in urinary incontinence correlates with personal relationships (sexual function). Method: This was a prospective cohort study design whereby patients answered the KHQ pre operatively on admission and post operatively at 6-24 months from January 2010 until June 2013. Seventy-seven patients took part in this study. Ten of these patients were excluded. The results were analysed separately in 3 groups.Stress urinary incontinence SUI (n=50), Mixed urinary incontinence MUI (n=4), SUI with a sensation of urgency (n=13). Logistic regression was used to determine the results. Results: Those patients who improved their QOL score by >75% for the SUI and MUI groups were 83% and 50% respectively. The positive improved change in QOL for the SUI and MUI groups were 98% and 100% respectively. Those patients who improved their subjective symptoms score by >75% for the SUI and MUI groups were 69%, and 92% respectively. The positive change in improvement of the symptoms for SUI and MUI groups were 100% and 75% respectively. Those patients who improved their stress symptoms score by >75% for SUI and MUI groups were 91% and 82% respectively. The subjective disappearance of urgency post operatively was 69% for the SUI with sensation of urgency group and 25% for the MUI group. Conclusions The trans obturator tape procedure conclusively improves the quality of life for women with stress urinary incontinence.There are very few studies that use subjective outcomes as their primary outcome measure. While most studies use the objective cure rate by using a negative cough test and more stringently a pad weight test. It is important to compare the study outcome results to other comparative studies using subjective outcomes rather than objective outcomes. Women should be counseled preoperatively about realistic expectations after surgery as this effects the operative outcome. In other studies subjective cure has been inconsistently assessed. There is a strong need for a standardized definition for subjective cure rate by the International Continence Society.

Issued also as thesis, Paris.

Diss. (sammanfattning) Göteborg : Göteborgs universitet, 2010.

published_or_final_version / Nursing Studies / Master / Master of Nursing