Urininkontinens (UI) innebär att individen får ett ofrivilligt och besvärligt urinläckage.  Problemet är ett av våra största folkhälsoproblem och kan uppkomma hos alla i olika åldrar men det är främst kvinnor som drabbas. Resultatet är byggt på tio intervjuer som fokuserat på kvinnors upplevelser av att leva med UI efter vaginal förlossning. Att läcka urin efter en vaginal förlossning anses av många kvinnor som ett normalt tillstånd därför dröjer de med att söka hjälp. De försöker istället att hantera situationen på bästa sätt genom olika strategier för att klara det dagliga livet. Det innebär exempelvis att kvinnor minskar intag av dryck samt att de kissar innan de lämnar hemmet. Kvinnor blir begränsad i deras dagliga liv eftersom de inte kan utföra och delta i vissa fysiska aktiviteter och att umgås med andra på grund av rädsla att läcka och lukta urin. Kvinnor upplever att UI har negativ inverkan på deras sexualliv samt kan leda till en försämring i deras sexuella relationer. Kvinnor upplever även att de blir nonchalant bemötta av vårdpersonalen samt att det saknas kunskaper kring UI. Det framkommer känslor hos kvinnorna att vårdpersonalen struntar och ignorerar deras UI problem samt att ingen inom vården följer upp dem. Vårdpersonalen måste få ökad förståelse och kunskap för kvinnor med UI, för att bättre stödja och hjälpa dessa kvinnor så att de kan få en bättre livskvalitet. / Background: Urinary incontinence (UI) is an involuntary urinary leakage that affects the individual’s social life and quality of life. Urinary incontinence may occur in both sexes, but it is more common in women than men. Women may suffer from UI after vaginal delivery. Although UI causes a lot of suffering for women, there are few who seek help. In order for health professionals to be able to help and support these women, it is important to have knowledge and understanding of how UI affects women’s world of living. Aim: The aim of the study was to describe women’s experience of living with urinary incontinence after vaginal delivery. Method: Semi-structured qualitative interviews were performed with ten women with urinary incontinence after vaginal delivery. Qualitative content analysis was used for the analysis which resulted in seven categories. Results: The results show how UI affects women in daily life and how they handle the situation in the best way. The women experienced mixed feelings about the meeting with healthcare professionals. Seven categories emerged: How to handle urinary incontinence that is seen as a normal state, Experiencing limitations in life, To hide or share experiences with others, Urinary incontinence affects relationships, Urinary incontinence affects sex life, Meeting healthcare professionals and Experiencing urinary incontinence treatments. Conclusion: Women may suffer from urinary incontinence after vaginal delivery. They find it difficult to talk to others about this sensitive subject, which indicates that they are suffering in silence. Healthcare professionals and district nurses have an important role to catch, help and take these women's UI trouble seriously.

Diss. (sammanfattning) Uppsala : Univ., 2002. / Härtill 5 uppsatser.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2005. / Härtill 5 uppsatser.

Base teórica A incontinência urinária (IU) é um sintoma comum, afetando mulheres em todas as idades, com prevalência estimada em 30%. A incontinência urinária aos esforços (IUE) pode representar cerca de metade dos casos. O treinamento da musculatura do assoalho pélvico (TMAP), associado a medidas comportamentais e reeducação vesical constitui a primeira linha de tratamento. Apesar dos bons resultados em curto e médio prazo, pode haver perda de motivação e adesão ao tratamento em longo prazo. Técnicas complementares como o biofeedback (BIO) podem auxiliar no treinamento inicial e contribuir para melhores resultados, mas permanece indefinido o perfil de casos que pode realmente se beneficiar desta abordagem. Novos estudos e a implementação de dispositivos facilitadores do tratamento são necessários, pois a adesão é etapa fundamental para manutenção dos resultados. Objetivo Determinar o efeito do TMAP associado ao BIO comparados ao treinamento vesical (TV), considerando resultados com questionários de sintomas, qualidade de vida (QV) e função sexual (FS). Investigação adicional a partir de dados do diário miccional (DM), avaliação da funcionalidade dos músculos do assoalho pélvico por meio de palpação manual e perineométrica do assoalho, gerando informações adicionais sobre o efeito de ambos os tratamentos. Métodos Ensaio clínico randomizado, paralelo, aberto, incluindo mulheres acima de 18 anos com IUE na ausência de prolapso genital. Recrutamento de casos de forma consecutiva em ambulatório de uroginecologia, com alocação aleatória para TV ou BIO, sendo comparadas a resposta aos sintomas, força muscular, escores de QV e FS ao final de 3 meses de tratamento supervisionado com fisioterapeuta. Para o cálculo amostral foi considerada a detecção de uma diferença de 42 pontos percentuais entre os grupos e estimadas 26 pacientes em cada grupo para um α=0,05 e β-80%. Resultados Ao final do estudo, das 53 pacientes inicialmente recrutadas, 28 pacientes foram analisadas, 14 em cada grupo. Ambos os grupos apresentaram melhores resultados em número de perdas diárias (P<0.001), micções noturnas (P<0.002) e no questionário de sintomas (p<0.001). Na FS, não houve diferença individual e entre os grupos. Alguns domínios do questionário de qualidade de vida foram significativamente melhores nas pacientes que fizeram o treinamento vesical (TV), mas a percepção geral de saúde não se modificou de forma significativa ao longo do tempo e entre os grupos TV (P=0.157) e BIO (P=0.795). Apesar de ter havido melhora subjetiva da contração perineal, esse achado não se correlacionou com aumento de força muscular (rs=0.428 P=0.144). Conclusão No presente estudo, os resultados em ambos os grupos foram equivalentes em termos de melhora clínica, nas ferramentas de medida utilizadas, não sendo possível demonstrar um efeito significativo do biofeedback. O desenvolvimento de tecnologias para melhorar a adesão e motivação dos pacientes para o tratamento conservador segue sendo um desafio atual. / Objective: To compare the effect of pelvic exercises combined with biofeedback, against bladder training, using questionnaires on symptoms, quality of life, and sexual function. Methods: Randomized clinical trial. Women over the age of 18 with stress urinary incontinence, but without genital prolapse, were recruited at a urogynecology clinic and assigned to bladder training or pelvic floor restoration at home with biofeedback. Results for muscle strength and symptoms, quality of life, and sexual function questionnaires were compared after 3 months of physiotherapist-supervised treatment. Results: Fourteen patients in each group were analyzed at the end of the study. Both groups exhibited improved results for number of daily leakages (P<0.001), nighttime micturitions (P<0.002) and symptoms (P<0.001). For sexual function, there were no individual or intragroup differences. Some quality of life domains were significantly better in the bladder training patients, but perceived general health did not change significantly and did not differ between the BT (P=0.157) and BIO (P=0.795) groups. Improvements in perineal contraction were not correlated with increased muscle strength (rs=0.428 P=0.144). Conclusion: The two methods had equivalent results, but larger patient samples could change certain findings. It remains a challenge to develop technologies to improve patients’ motivation and adherence to conservative treatment. Registration: Plataforma ReBec (Brazilian Clinical Trials Register - http://www.ensaiosclinicos.gov.br/). Reference code REQ:7854.

[Truncated abstract] Approximately 35% of women worldwide have stress incontinence, which is defined as involuntary leakage of urine on effort, exertion, or on sneezing and coughing. There are various surgical techniques for stress incontinence; however, minimally invasive operations are increasingly being chosen by surgeons and their patients. Of these procedures, tension-free vaginal tape (TVT) has a cure rate of approximately 90% and is now perceived as the standard technique for stress incontinence. Reported complications of TVT include arterial laceration, bladder perforation, bowel perforation, de novo urgency, dyspareunia, excessive blood loss, haematoma, nerve injuries, urethral erosion, urge incontinence, urinary tract infection, vascular injury, vaginal mesh erosion, voiding dysfunction and death. Suprapubic urethral support sling (SPARC) is a very similar minimally invasive operation and early indications suggested that the success rate for treating stress incontinence was expected to be identical or better than those obtained with the earlier TVT approach, with possibly fewer adverse perioperative events. Our trial sought to establish equivalence between TVT and SPARC in relation to short-term complications and efficacy. OBJECTIVES The primary outcome was bladder perforation. Secondary outcomes were blood loss, voiding difficulty, urgency, and cure of stress incontinence symptoms. METHOD A randomised controlled one-sided equivalence trial (RCT) was conducted in Perth, Western Australia during 2003 and 2004 by researchers in the School of Population Health, University of Western Australia (UWA) and King Edward Memorial Hospital (KEMH). Patients were recruited from the public Urology/Urogynaecology Clinic at the primary women's hospital and the consultant surgeons' private practices. ... However, acute urinary retention requiring a return to theatre to loosen the tape (TVT 0%, SPARC 6.5%; OR: [infinity], 95% CL: 2.2, [infinity]; p=0.002) and subjective short-term cure (TVT 87.1%, SPARC 76.5%; OR: 2.07, 95% CL: 1.13, 3.81; p=0.03) were statistically significantly different. CONCLUSIONS The results are consistent with clinical equivalence between TVT and SPARC in relation to the incidence of bladder perforation. No statistically significant difference was found between TVT and SPARC in blood loss, urgency or short-term objective cure of stress incontinence at the six week post-discharge visit to the surgeon. However, the tapes were more difficult to adjust correctly in SPARC procedures and a statistically significant number of patients required a return to theatre for loosening of the tape (TVT 0/147, 0% and SPARC 10/154, 6.5%, p=0.002). Compared with SPARC, TVT was statistically significantly higher for subjective short-term cure. In ii relation to vaginal mesh erosion, TVT was lower than SPARC, though not statistically significantly. Overall, voiding difficulty (loosening of the tape), urgency and vaginal mesh erosion were the most important clinical problems. This randomised controlled trial demonstrates the importance of testing new devices which appear to be similar, but which may have clinically relevant differences. A follow up study to assess the long-term efficacy of tension-free vaginal tape and suprapubic urethral support sling and associated complications is planned.

Base teórica A incontinência urinária (IU) é um sintoma comum, afetando mulheres em todas as idades, com prevalência estimada em 30%. A incontinência urinária aos esforços (IUE) pode representar cerca de metade dos casos. O treinamento da musculatura do assoalho pélvico (TMAP), associado a medidas comportamentais e reeducação vesical constitui a primeira linha de tratamento. Apesar dos bons resultados em curto e médio prazo, pode haver perda de motivação e adesão ao tratamento em longo prazo. Técnicas complementares como o biofeedback (BIO) podem auxiliar no treinamento inicial e contribuir para melhores resultados, mas permanece indefinido o perfil de casos que pode realmente se beneficiar desta abordagem. Novos estudos e a implementação de dispositivos facilitadores do tratamento são necessários, pois a adesão é etapa fundamental para manutenção dos resultados. Objetivo Determinar o efeito do TMAP associado ao BIO comparados ao treinamento vesical (TV), considerando resultados com questionários de sintomas, qualidade de vida (QV) e função sexual (FS). Investigação adicional a partir de dados do diário miccional (DM), avaliação da funcionalidade dos músculos do assoalho pélvico por meio de palpação manual e perineométrica do assoalho, gerando informações adicionais sobre o efeito de ambos os tratamentos. Métodos Ensaio clínico randomizado, paralelo, aberto, incluindo mulheres acima de 18 anos com IUE na ausência de prolapso genital. Recrutamento de casos de forma consecutiva em ambulatório de uroginecologia, com alocação aleatória para TV ou BIO, sendo comparadas a resposta aos sintomas, força muscular, escores de QV e FS ao final de 3 meses de tratamento supervisionado com fisioterapeuta. Para o cálculo amostral foi considerada a detecção de uma diferença de 42 pontos percentuais entre os grupos e estimadas 26 pacientes em cada grupo para um α=0,05 e β-80%. Resultados Ao final do estudo, das 53 pacientes inicialmente recrutadas, 28 pacientes foram analisadas, 14 em cada grupo. Ambos os grupos apresentaram melhores resultados em número de perdas diárias (P<0.001), micções noturnas (P<0.002) e no questionário de sintomas (p<0.001). Na FS, não houve diferença individual e entre os grupos. Alguns domínios do questionário de qualidade de vida foram significativamente melhores nas pacientes que fizeram o treinamento vesical (TV), mas a percepção geral de saúde não se modificou de forma significativa ao longo do tempo e entre os grupos TV (P=0.157) e BIO (P=0.795). Apesar de ter havido melhora subjetiva da contração perineal, esse achado não se correlacionou com aumento de força muscular (rs=0.428 P=0.144). Conclusão No presente estudo, os resultados em ambos os grupos foram equivalentes em termos de melhora clínica, nas ferramentas de medida utilizadas, não sendo possível demonstrar um efeito significativo do biofeedback. O desenvolvimento de tecnologias para melhorar a adesão e motivação dos pacientes para o tratamento conservador segue sendo um desafio atual. / Objective: To compare the effect of pelvic exercises combined with biofeedback, against bladder training, using questionnaires on symptoms, quality of life, and sexual function. Methods: Randomized clinical trial. Women over the age of 18 with stress urinary incontinence, but without genital prolapse, were recruited at a urogynecology clinic and assigned to bladder training or pelvic floor restoration at home with biofeedback. Results for muscle strength and symptoms, quality of life, and sexual function questionnaires were compared after 3 months of physiotherapist-supervised treatment. Results: Fourteen patients in each group were analyzed at the end of the study. Both groups exhibited improved results for number of daily leakages (P<0.001), nighttime micturitions (P<0.002) and symptoms (P<0.001). For sexual function, there were no individual or intragroup differences. Some quality of life domains were significantly better in the bladder training patients, but perceived general health did not change significantly and did not differ between the BT (P=0.157) and BIO (P=0.795) groups. Improvements in perineal contraction were not correlated with increased muscle strength (rs=0.428 P=0.144). Conclusion: The two methods had equivalent results, but larger patient samples could change certain findings. It remains a challenge to develop technologies to improve patients’ motivation and adherence to conservative treatment. Registration: Plataforma ReBec (Brazilian Clinical Trials Register - http://www.ensaiosclinicos.gov.br/). Reference code REQ:7854.

Base teórica A incontinência urinária (IU) é um sintoma comum, afetando mulheres em todas as idades, com prevalência estimada em 30%. A incontinência urinária aos esforços (IUE) pode representar cerca de metade dos casos. O treinamento da musculatura do assoalho pélvico (TMAP), associado a medidas comportamentais e reeducação vesical constitui a primeira linha de tratamento. Apesar dos bons resultados em curto e médio prazo, pode haver perda de motivação e adesão ao tratamento em longo prazo. Técnicas complementares como o biofeedback (BIO) podem auxiliar no treinamento inicial e contribuir para melhores resultados, mas permanece indefinido o perfil de casos que pode realmente se beneficiar desta abordagem. Novos estudos e a implementação de dispositivos facilitadores do tratamento são necessários, pois a adesão é etapa fundamental para manutenção dos resultados. Objetivo Determinar o efeito do TMAP associado ao BIO comparados ao treinamento vesical (TV), considerando resultados com questionários de sintomas, qualidade de vida (QV) e função sexual (FS). Investigação adicional a partir de dados do diário miccional (DM), avaliação da funcionalidade dos músculos do assoalho pélvico por meio de palpação manual e perineométrica do assoalho, gerando informações adicionais sobre o efeito de ambos os tratamentos. Métodos Ensaio clínico randomizado, paralelo, aberto, incluindo mulheres acima de 18 anos com IUE na ausência de prolapso genital. Recrutamento de casos de forma consecutiva em ambulatório de uroginecologia, com alocação aleatória para TV ou BIO, sendo comparadas a resposta aos sintomas, força muscular, escores de QV e FS ao final de 3 meses de tratamento supervisionado com fisioterapeuta. Para o cálculo amostral foi considerada a detecção de uma diferença de 42 pontos percentuais entre os grupos e estimadas 26 pacientes em cada grupo para um α=0,05 e β-80%. Resultados Ao final do estudo, das 53 pacientes inicialmente recrutadas, 28 pacientes foram analisadas, 14 em cada grupo. Ambos os grupos apresentaram melhores resultados em número de perdas diárias (P<0.001), micções noturnas (P<0.002) e no questionário de sintomas (p<0.001). Na FS, não houve diferença individual e entre os grupos. Alguns domínios do questionário de qualidade de vida foram significativamente melhores nas pacientes que fizeram o treinamento vesical (TV), mas a percepção geral de saúde não se modificou de forma significativa ao longo do tempo e entre os grupos TV (P=0.157) e BIO (P=0.795). Apesar de ter havido melhora subjetiva da contração perineal, esse achado não se correlacionou com aumento de força muscular (rs=0.428 P=0.144). Conclusão No presente estudo, os resultados em ambos os grupos foram equivalentes em termos de melhora clínica, nas ferramentas de medida utilizadas, não sendo possível demonstrar um efeito significativo do biofeedback. O desenvolvimento de tecnologias para melhorar a adesão e motivação dos pacientes para o tratamento conservador segue sendo um desafio atual. / Objective: To compare the effect of pelvic exercises combined with biofeedback, against bladder training, using questionnaires on symptoms, quality of life, and sexual function. Methods: Randomized clinical trial. Women over the age of 18 with stress urinary incontinence, but without genital prolapse, were recruited at a urogynecology clinic and assigned to bladder training or pelvic floor restoration at home with biofeedback. Results for muscle strength and symptoms, quality of life, and sexual function questionnaires were compared after 3 months of physiotherapist-supervised treatment. Results: Fourteen patients in each group were analyzed at the end of the study. Both groups exhibited improved results for number of daily leakages (P<0.001), nighttime micturitions (P<0.002) and symptoms (P<0.001). For sexual function, there were no individual or intragroup differences. Some quality of life domains were significantly better in the bladder training patients, but perceived general health did not change significantly and did not differ between the BT (P=0.157) and BIO (P=0.795) groups. Improvements in perineal contraction were not correlated with increased muscle strength (rs=0.428 P=0.144). Conclusion: The two methods had equivalent results, but larger patient samples could change certain findings. It remains a challenge to develop technologies to improve patients’ motivation and adherence to conservative treatment. Registration: Plataforma ReBec (Brazilian Clinical Trials Register - http://www.ensaiosclinicos.gov.br/). Reference code REQ:7854.

This project was undertaken with the following aims: 1) To generate a data base concerning the management of children with congenital spinal anomalies, who are known to form a significant proportion of the patients being treated in the Department of Paediatric Urology at Red Cross Hospital. 2) To assess the results of the management of these children, with special attention to the goals of therapy, namely preservation of renal function, establishment of urinary continence and protection from urinary tract infection. 3) To compare the treatment methods and results obtained to those reported in the literature. 4) To evaluate critically the treatment methods and results obtained with a view to identifying areas where improvements are possible.

Bakgrund: Prostatacancer är den vanligaste cancerformen i Sverige. Urininkontinens och sexuell dysfunktion är vanligt förekommande efter prostatacancerbehandling. Tidigare forskning har visat att urininkontinens och sexuell dysfunktion försämrar livskvaliteten. Syfte: Att kartlägga vilka typer av rehabilitering som finns för män med prostatacancer gällande sexuell dysfunktion och urininkontinens samt att belysa rehabiliteringsbehov som inte tillgodoses. Metod: Litteraturstudie. Tio vetenskapliga originalartiklar inkluderades; åtta med kvantitativ metod och två med kvalitativ metod. Resultat: Det fanns flera olika typer av bäckenbottenträning för att fysiskt rehabilitera urininkontinens. Bäckenbottenträningen minskade urininkontinensen i samtliga studier. Ett samband mellan minskad urininkontinens efter bäckenbottenträning och en förbättrad livskvalitet hittades. Männen hittade strategier för att psykosocialt anpassa sig till sin urininkontinens. Bäckenbottenträningen gav ingen betydande förbättring av sexuell dysfunktion.  Den psykosociala rehabiliteringen som finns vid sexuell dysfunktion är patientinformation, samtal i vården, gruppterapi, stödgrupper och par-kommunikation. Slutsats: Alla typer av bäckenbottenträning minskade urininkontinensen. På grund av den emotionella och sociala påverkan som urininkontinensen har kvarstår ett behov av psykosocial rehabilitering. Ingen evidens hittades för att bäckenbottenträning förbättrar sexuell dysfunktion. Mer forskning efterfrågas för att hitta fysiska rehabiliteringsmetoder vid sexuell dysfunktion. Psykosocial rehabilitering hjälpte männen att anpassa sig till den sexuella dysfunktionen. Dock finns ett behov av ett sammanställt program med olika typer av psykosocial rehabilitering som alla prostatacancerpatienter kan erbjudas. / Background: Prostate cancer is the most common form of cancer in Sweden. Urinary incontinence and sexual dysfunction are the general problems caused by prostate cancer treatment. Previous research has shown that quality of life is affected by urinary incontinence and sexual dysfunction. The aim: To review available rehabilitation in urinary incontinence and sexual dysfunction for men with prostate cancer, and to find rehabilitation needs that were not met in these men. Method: Literature review. Ten articles were included; eight quantitative and two with qualitative method. Results: Several types of pelvic floor muscle training were found to physically rehabilitate urinary incontinence. Pelvic floor muscle training improved urinary incontinence in all studies. A correlation between improved urinary incontinence after pelvic floor muscle training and higher quality of life was found. The men found strategies to psychosocially adjust to urinary incontinence. Pelvic floor muscle training was not effective in rehabilitating sexual dysfunction.  Patient information, consultations, group therapy, support groups and spousal communication was found to be psychosocial rehabilitation methods of sexual dysfunction. Conclusion: All pelvic floor muscle training decreased urinary incontinence. Because of the emotional and social impact of urinary incontinence a need for psychosocial rehabilitation remains. No evidence supports that pelvic floor muscle training improves sexual dysfunction. More research is required in finding physical rehabilitation methods for sexual dysfunction. Psychosocial rehabilitation helped the men to adjust to sexual dysfunction. But there is a need to assemble a program consisting of several types of psychosocial rehabilitation that can be given to all prostate cancer patients.

BAKGRUND: Prostatacancer (PCa) är den vanligaste cancerformen bland män i Sverige. Efter kirurgisk behandling, radikal prostatektomi (RP), drabbas många av urininkontinens och sexuella besvär. Studier på kvinnor visar att urininkontinens påverkar sexuell lust men det finns få liknande studier bland män. SYFTE: Syftet med studien är att jämföra självskattad sexuell lust bland män med och utan inkontinens, ett år efter RP. METOD: Denna kvantitativa tvärsnittstudie utgår från enkätmaterial insamlat i en pågående prospektiv studie. Data insamlat bland 1751 män, ett år efter RP, har analyserats och jämförts mellan två grupper (fall-kontrollstudie). RESULTAT: Resultatet visar att män med urininkontinens skattar lägre sexuell lust, ett år efter RP, än män utan urininkontinens samt att de i högre grad beskriver tanken på ett fortsatt liv med sina sexualproblem med negativa begrepp. KONKLUSION: Män som genomgått RP, och i synnerhet de som har urininkontinens, har nedsättningar i sexuallivet. Sjuksköterskan bör uppmärksamma och ge tid till samtal om påverkan på sexuallivet efter RP, med både patient och partner. Ökad kunskap inom området bidrar till ökad förståelse, och behövs för att sjuksköterskor ska kunna hjälpa dessa patienter. Nedsatt sexuell lust hos män är ett outforskat område och vidare forskning behövs. / BACKGROUND: Prostate cancer (PCa) is the most common form of cancer among Swedish men. Urinary incontinence and sexual dysfunction are two side effects that many men experience after surgery, radical prostatectomy (RP). Previous studies show that urinary incontinence has negative effects on women’s sexual desire. Few similar studies concern men. AIM: The aim of the study is to compare self-reported sexual desire among men with and without urinary incontinence, one year post-surgical treatment (RP). METHOD: This quantitative, cross-sectional study is based on a self-reported survey from an ongoing prospective study. Data collected from 1751 men, one year post-treatment, have been analyzed and compared between two groups (case-control study). RESULT: The result shows that men with urinary incontinence after RP have less sexual desire than men without urinary incontinence. These men are also less satisfied with the idea of spending the rest of their lives with their sexual problems. CONCLUSION: Men that have undergone RP, especially the ones who have urinary incontinence, experience sexual dysfunction. Nurses need to acknowledge and initiate dialogues with patients and their partners about effects on sexual life after RP. Research concerning men’s sexual desire will help nurses’ knowledge and ability to discuss sexual problems. More studies about men’s reduced sexual desire are necessary.