Background: Radical prostatectomy is the gold-standard treatment for clinically organ-confined cancer of the prostate. However, urinary incontinence and erectile dysfunction are major clinical problems, despite advances in surgical techniques. Pelvic floor muscle training is still the first-line treatment used to restore pelvic floor or bladder function after radical prostatectomy although its role is still inconclusive. Objectives: To determine the benefit of starting pelvic floor muscle training three weeks before radical prostatectomy in order to find by the end of three months after surgery: (1) any degree of continence regained in the intervention group, measured by 24-hour and one-hour pad tests; (2) any positive improvement in the quality of life in that group. Methods: Sixty-six eligible participants were randomised into either the intervention or the control group before radical prostatectomy. The former received three weeks’ pre-operative pelvic floor muscle training from an advanced practice nurse, while the latter received only standard care. Urine loss by 24-hour pad test was compared in the two groups as the primary outcome, and the questionnaires on incontinence impact, functional assessment on prostate cancer and potency satisfaction at one, two, three and six months after surgery were compared as secondary outcomes. Results: The intervention group regained continence significantly (p=0.002) earlier than the control group at the end of three months after surgery, as measured by the 24-hour pad test. The intervention group also reported a significantly better quality of life in the questionnaire on ‘incontinence impact’ than the control group. Interestingly, the Functional Assessment of Cancer Therapy-Prostate questionnaire showed no statistical significant difference between the groups, despite significantly less urine loss in the intervention group, which also had a higher potency satisfaction score on the International Index of Erectile Function (p=0.005) by the end of three months after surgery. Discussion: The present study found that three weeks’ pre-operative pelvic floor muscle training decreased the duration and severity of incontinence after radical prostatectomy, as measured by the 24-hour pad test of urine loss (in grams). Some other studies counted the number of pads used as the comparative data between the groups; however, there might be divergent findings in different studies. In one previous study of pelvic floor muscle training initiated two to four weeks before surgery but showing no benefit, it was found that patients received only one training session before surgery without further monitoring. A limitation of present study is that participants were followed-up for six months after surgery. It is possible that a longer period, perhaps one or two years, of post-prostatectomy follow-up might provide further important information. Conclusions: This is the first comprehensive study in Hong Kong to examine the efficacy of three weeks’ pre-operative pelvic floor muscle training in reducing post-prostatectomy urinary incontinence, and to evaluate the continence-related quality of life and potency satisfaction of intervention and control groups. The results demonstrated that such training not only significantly hastens the recovery of urinary continence after surgery but also leads to a better continence-related quality of life and potency satisfaction in the intervention group. / published_or_final_version / Nursing Studies / Doctoral / Doctor of Nursing

The purpose of this study is to develop a better understanding how the social and cultural constructions of UI influences aging Korean American women's help-seeking behavior (HSB). Specific aims are to test the psychometric properties of newly translated Korean versions of instruments and test a conceptual framework derived from a systemic perspective.This study uses a cross-sectional correlation descriptive design to understand relationships among predisposing (culture, health beliefs, and social structure), enabling (family and community resources), and need factors (perceived need) within the framework of socio-structural and cultural context. A sample of 149 Korean American women with UI was recruited from local religious organizations in Arizona. Data analysis includes descriptive statistics and multiple regression to test the conceptual framework.The results of research question one showed that reliabilities of the four newly translated measures and a validity of the Social Support Scale were appropriate to measure HSB among Korean target population. Results of research question two indicated that 35.8% of explained variance in HSB was explained by the conceptual framework. Significant predictors of HSB were severity of UI, Incontinence-quality of life (QOL) and social support. The results of research question four showed that there are moderator effects of enabling factors (health care support and social support) on perceived need (severity of UI and Incontinence-QOL) to facilitate seeking help.It is noteworthy that the notion of UI among Korean American women was influenced by social and cultural construction. Particularly, collectivism of social construction and ageism, and fatalism of cultural construction of UI has permeated to Korean women's beliefs about incontinence.

No description available.

The main aims of this prospective, multicentre, analytical observational study were to investigate the outcomes of physiotherapy treatment for stress urinary incontinence by continence physiotherapists in clinical settings, to estimate the costs of treatment and to develop a predictive model for treatment outcomes. / A systematic review of the relevant literature of the last 10 years, revealed a paucity of literature world-wide on the clinical effectiveness of physiotherapy despite strong evidence from randomized controlled trials of the efficacy of pelvic floor muscle training either alone, or in combination with other treatment modalities. Furthermore, no reports were found on the costs of physiotherapy management of stress urinary incontinence. A review of factors possibly associated with treatment outcome was undertaken to inform baseline data collection for later predictive modelling. / Two preliminary studies were carried out. A tool to objectively measure urine loss in the clinical setting, the Expanded Paper Towel Test, was developed as the pad tests recommended by the International Continence Society were impractical for clinicians to use. This new test proved to be efficient and simple to apply in clinical practice and allowed sensitive and accurate measurement of urine loss under provocation. It was reproducible to within one millilitre. The new test was found to have clinical applicability, providing continence physiotherapists with a robust measure of urine loss for women with mild to moderate stress urinary incontinence. / In a second preliminary study, physiotherapists who expressed interest in participating in the main study were tested for their reliability in the digital assessment of pelvic floor muscle strength. This was carried out in six centres around Australia and was a prerequisite for study participation. The results suggested that agreement was adequate to have confidence in baseline measures of pelvic floor muscle strength for subsequent regression analysis. / An observational study design was employed in the main study to investigate the outcomes of treatment by clinicians at the end of an episode of care, and at follow-up one year later. A before-after study design was employed using subjective, objective and quality of life outcome measures. Data were also collected on the characteristics of patients and episodes of care. Costs of treatment were calculated for comparison with the costs of surgery. / Thirty nine continence physiotherapists in private practice and public institutions around Australia participated in the study and, through 1999-2000, 274 adult women with either a clinical or urodynamic diagnosis of stress urinary incontinence were recruited. The inclusion criteria were broad to represent the type of subjects commonly treated in clinical practice. / Treatment was a physiotherapy management package which could include any form of conventional treatment for stress urinary incontinence. The content of this package and the length of treatment were the responsibility of the treating physiotherapist, and were based on a clinically reasoned process. No restriction was placed on the nature or length of treatment, or the number of occasions of service in an episode of care. However, all data collection protocols were standardised. / The results of this study support the implementation of continence physiotherapy as first-line treatment for stress urinary incontinence in Australia. Considering all outcome measures, treatment was effective for approximately 80% of women who completed treatment both at end of an episode of care and at one year follow-up. Five percent of subjects had surgery for their stress incontinence within the timeframe of the study. There were no reports of adverse events or complications. / The number of treatments in a typical episode of care was established, information which was hitherto lacking from randomized controlled trials, but necessary to underpin cost calculations. From a health economics perspective, the finding that physiotherapy was effective, had no serious risks and was approximately one-twentieth the estimated cost of surgery, provides a strong basis for health policy development to promote physiotherapy as first line treatment for stress urinary incontinence. Other characteristics of a continence physiotherapy management package in Australian clinical practice were also described. Predictive modelling was based on real-life data and identified factors associated with improved treatment outcomes where scant evidence previously existed. Areas for future research were identified, including the investigation of the referral patterns of medical practitioners for women with stress urinary incontinence and the adequacy of existing physiotherapy training and services within Australia. / Thesis (PhDHealthSciences)--University of South Australia, 2006.

Diss. (sammanfattning) Uppsala : Univ., 2002. / Härtill 4 uppsatser.

Thesis (M.S.)--Virginia Polytechnic Institute and State University, 1991. / Vita. Abstract. Includes bibliographical references (leaves 44-51). Also available via the Internet.

Thesis (Ph. D.)--University of Hong Kong, 1997. / Includes bibliographical references (leaf 165-188).

Thesis (doctoral)--Freie Universität Berlin, 1979.

Thesis (Ph. D.)--University of Texas at Austin, 2006. / Vita. Includes bibliographical references.

Made available in DSpace on 2014-06-11T19:23:46Z (GMT). No. of bitstreams: 0 Previous issue date: 2012-02-29Bitstream added on 2014-06-13T19:30:19Z : No. of bitstreams: 1 vasconcellos_al_me_jabo.pdf: 364796 bytes, checksum: faa48323c2af56deebee2125936ba7e6 (MD5) / Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) / Os cães podem ser acometidos por diversos tipos de doenças vesicais incluindo cistites, neoplasias e urolitíases, dentre outras. A variedade da etiopatogenia e das formas de apresentação clínica das cistites constitui um fator complicante para o diagnóstico. O presente estudo teve por objetivo evidenciar a importância da inclusão de alguns exames complementares com vistas ao diagnóstico correto das afecções vesicais. Foi realizado um estudo prospectivo para o diagnóstico da condição vesical de 46 animais, machos e fêmeas, selecionados ao acaso dentre os encaminhados para check-up de rotina e os pacientes com algum tipo de sinal ou achado sugestivo de doença vesical. A avaliação consistiu de exame clínico completo e exame específico do trato urinário incluindo urinálise, exame microbiológico da urina por meio de cultura em lâmina e cultura tradicional, e avaliação vesical por meio do exame ultrassonográfico. Os dados foram submetidos à analise estatística descritiva e ao Teste Exato de Fisher para associações. Os resultados evidenciaram que os sinais clínicos e os achados de sedimentoscopia da urina não são específicos, dada a semelhança das manifestações das diversas doenças vesicais. A urocultura e a ultrassonografia vesical foram exames complementares decisivos que possibilitaram o diagnóstico dos casos de cistite bacteriana (n=32) bem como das doenças vesicais coexistentes (n=3) e das doenças vesicais não infecciosas (n=2). Concluiu-se que o exame clínico de rotina, mesmo que a urinálise seja incluída, não é apropriado para diagnosticar doenças vesicais e que a urocultura e o exame ultrassonográfico contribuem de modo decisivo para o diagnóstico correto dos cães com ou sem sinais clínicos de cistite / Dogs can be affected by several types of bladder diseases including cystitis, neoplasia, and urolithiasis, among others. The variety of etiopathology and clinical presentation forms of cystitis is a complicating factor for the diagnosis. The aim of this study was to show the importance of some additional exams inclusion in order to achieve the correct diagnosis for bladder diseases. A prospective study was conducted for bladder condition diagnosis in 46 animals, males and females, taken for random among dogs referred for routine checkup and the patients with some type of signs or finding suggestive of bladder disease. The evaluation included complete clinical exam and specific examination of the urinary tract including urinalysis, urine microbiologic examination by commercially manufactured screening urine culture kit and traditional culture, and ultrasound bladder evaluation. The data were analyzed by descriptive statistic and Fisher’s Exact Text. The results showed that clinical signs and urine sediment findings are nonspecific, given the similarity of the bladder diseases manifestations. The urine culture and bladder ultrasound were decisive additional exams that enable the diagnosis of bacterial cystitis (n=32), as well as of the coexisting bladders diseases (n=3) and non infectious bladder diseases (n=2). It was concluded that the routine clinical examination, even when the urinalysis is included, isn`t appropriated for bladder diseases diagnosis, moreover the urine culture and the ultrasonographyc exam contribute in a decisive way for the correct diagnosis of dogs showing or not clinical signs of cystitis