Gender differences in healthcare-seeking behaviour for urinary incontinence in Alexandria

Urinary incontinence [UI] is a common condition, but previous studies have shown that only about 20% of individuals with UI seek medical care for treatment of their symptoms. The determincnts of treatment seeking are not well understood. Little is known about the effect of gender on health care-seeking behaviors. The objective of this study was to determine gender differentials in factors associated with patients' decisions to seek treatment for urinary incontinence This was a descriptive, hospital based case series study. It was carried out during the first half of the year 2008 in the Urology and Obstetrics and Gynaecology departments of Main University Hospital and El-Shatby University Hospital, Alexandria. As part of purposeful sampling, all participants were selected from the clinic and admission lists. All studied subjects were enrolled by the investigators after signing informed consent and provided they complied with inclusion/exclusion criteria. Data were collected using pre-tested, precoded interview format. In-depth interview was carried out by the investigators themselves to answer the questions because the topic is poorly understood and the research is perception-oriented. We hypothesized that gender differences in treatment seeking for UI would not be explained only by socio-demographic factors, clinical presentation, and symptom impact, but also some important psychosocialfactors of the respondent as well. To test the hypothesis, we developed a multivariate logistic regression modelfor each gender. Information was collected from 353 UI patients out of a total of 374 patients registered in those clinics and admission list during the recruitment period of the study. Thus the response rate was 94.4%. There were 113 [32.0%] males and 240 [68.0%] females. Thus male to female ratio was 1: 2.12. The present study found differences in males and females regarding specific psychosocial factors motivating health care-seeking behaviour. Certain inequality was observed in hospital admission, use of diagnostic procedures, days of hospital stay and surgeries in thai they proved less frequent among women. More women suffered from at least one negative impact on their social lives compared to men. Additionally, the impact of UI on sexual life was not associating with seeking treatment for both men and women. The impact of symptoms on quality of life appears to be the main trigger for seeking help for UI in both men and women. After adjustment for confounders, women's decisions to seek treatment for urinary incontinence were significantly associated with mixed type of UI, severe UI, perceptions about underlying causes of UI, attitude towards health care use, worse social impact score and worse diseasespecific quality of life scores. However, illiteracy and self care practices were adversely affect women's care seeking behavior. In men help-seeking was related to the presence of co-morbid condition, severe UI, associated lower urological complaints, satisfaction with medical care offered, high expectation of benefit from treatment and worse disease-specific quality of life scores. Since the present results revealed gender differences in determinants of UI health care seeking behaviour, strategies to enhance care-seeking for urinary incontinence should consider the role of gender in personal knowledge, needs and behaviors for UI management in adults. Educating physicians and the public about the factors associated with treatment seeking as well as the available treatment options may help women and men to seek and receive more timely care for incontinence symptoms

Telomerase activity, cytokeratin 20 and cytokeratin 19 in urine cells of bladder cancer patients

This work aims to search for markers suitable for the screening of bladder cancer, which should be specific, sensitive, reproducible, non-invasive and at acceptable cost. The study included 50 patients diagnosed as bladder cancer [35 TCC, 15 SCC] of different stages and grades, 30 patients with various urothelial diseases, besides 20 apparently healthy subjects of matched age and sex to the malignant group. A random midstream urine sample was collected in a sterile container for the determination of telomerase by RT-PCR, keratin 19 by ELSA CYFRA 21-i IRMA kit, keratin 20 by RT-PCR and immunohistochemical staining, and urine cytology. For all parameters [telomerase, Ki9, K20 and cytology] the malignant group was significantly different from both the benign and the control groups. None of the four studied parameters was correlated to the stage of the disease, and when it comes to grade, only Ki9 showed a significant positive correlation with grade both in TCC and SCC. When ROC curves for all parameters were compared, Ki9 had the largest area under the curve, and then comes K20. K 19 may be used as a biological marker for the diagnosis of bladder cancer Ki9 could not be used for differential diagnosis of different types of bladder cancer, meanwhile it could be a marker for differentiation that decreases in less differentiated tumors. As a tumor marker, K20 reflects inability to differentiate tumor type or grade in TCC, while in SCC of the bladder it is correlated with the grade. As a method, RT-PCR is superior to immunostaining for the detection of bladder cancer, meanwhile K20 immunohistochemistry [IHC] results were much better than urine cytology as a bladder cancer screening test. Haematuria and inflammation reduced the specificity of telomerase assay, which reduced its validity as a tumor marker of bladder cancer. Ki9 and K20 are the best candidates as screening tests for the diagnosis of bladder cancer, representing the highest sensitivity and specificity, beside the radiological and histopathology. Meanwhile, telomerase, although it was a sensitive enough marker, it reflected a high false positive rate

Modified supratrigonal bladder transection for the treatment of severe resistant detrusor instability

Detrusor instability causing severe urinary urge incontinence remains a complex problem for patients and clinicians. While standard treatment targets the bladder as the source of the problem, most of the patients with urge incontinence were not satisfied with those standard treatments. Bladder transection is another available surgical option for the treatment of severe resistant urge incontinence, which failed to respond to the standard conservative methods of treatment. Nine patients, six males and three females, aged 27 to 43 years [mean age 36 years] have undergone the procedure. All of them had symptoms of increased diurnal frequency, urgency, urge incontinence, nocturia and nocturnal eneuresis. None of the patients had evidence of neurological disease. All of them had urodynamically proven Detrusor Instability. The procedure was performed with undue difficulties in six patients. Operative time ranged between 105 and 165 minutes with a mean duration of 145 minutes. No major complication occured during or immidiatly after the procedure. All of the patients were followed for 6 to 24 months with a mean follow up of 18 months. Seven patients [77.7%] were either cured or improved initially. All of the seven patients [77.7%] had no nocturnal eneuresis, being invariably dry throughout the night. During daytime, six patients [66.6%] were dry. Another patient had more than 50% reduction in incontinence episodes. After one and half years of follow up, six patients [66.6%] maintained their good results. Modified Supra Trigonal bladder transaction offers a reasonable success rate of 67% after follow up period of 18 months. This result is comparable to other surgical procedures used in the treatment of severe resistant Detrusor Instability. Still, long-term follow up of such patients is required in larger group of patients to confirm the reasonable success rate of this procedure

Doxazosin versus finasteride for the treatment of large symptomatizing benign prostatic hyperplasia: a questionnaire and urodynamic based study

Urodynamic investigations provid an objective, quantitative evaluation of urinary function in patients with BPH. Uroflowmetry and pressure-flew studies are among the best methods of evaluation of the effects of different drugs used for the treatment of BPH. Schafer nomogram and the Obstruction Coefficient [OCO] have been used as a compatible numerical format for grading bladder ouflow conditions on a continuous scale. Aim of the study: To evvaluate and compare the efficacy of both Finasteride and Doxazosin in the treatment of moderately symptomatizing large-sized benign prostatic hyperplasia and to correlate symptomatic changes with alterations in ueodynamic measures using the OCO and DECO values. Patients and Medthods: Fifty male patients with moderately symptomatizing BPH, larger than 40 c.c., estimated by ultrasound, were randomized to receive either Finasteride [5 mg/day] or Doxazosin [1-4 mg/ day] for 12 months. Both Finasteride and Doxazosin significantly improved urinary flow rates. Pressure-flow studies confirmed that both Doxazosin and Finasteride were effective in decreasing opening detrusor pressure, detrusor pressure at maximal flow [Pdet Qmax] and detrusor pressure at least flow [Pdet least]. Also Schafer nomogram were applied and OCO values were found to be improved. Doxazosin group resulted in OCO value of 0.7, well bellow that level. this have shown that Finasteride gave a better results regarding the degree of improvement of blooder outled obstruction. CONCLUSIONS: The use of a compatible numerical format for grading of the degree of bladder outlet obstruction would even maximize the usefullness of pressure-flow study for obstructed patients. The use of the OCO value reveiled that Finasteride gave a siginificantly better results regarding the degree of improvement in obstruction by bening prostatic hyperplasia

Significance of rectal pressure changes during urodynamic testing

Rectal pressure is accepted as a means to determine the abdominal pressure. However, rectal pressure artifacts have been noticed in many urodynamic studies, but their significance and incidence were not adequately studied yet. Significance of rectal pressure changes was studied on 110 multichannel-urodynamic studies performed on 71 patients with benign prostatic hyperplasia. Multichannel-urodynamic studies were performed with a 6-channel Life Tech M-1406 Urovision machine, printed at 0.5 mm/sec paper speed and using a Bard, 8 F, 3-port, water filled, 2-marker urodynamic catheter. The bladder was filled with saline at a filling rate of 50 ml per minute. Urodynamic study included total vesical pressure measured by a urethral catheter, total abdominal pressure measured by a rectal balloon catheter, subtracted detrusor pressure [vesical minus abdominal], EMG [electromyography] recording of the external urethral sphincter and uroflow measurement. Twenty five patients [35%] had normal rectal pressure recording studies. Nineteen patients [27%] had rectal contractions Abnormal rectal pressure increase was present in 6 patients [8%], while rectal pressure decrease was present in 21 patients [30%]. There was good association between detrusor instability and rectal contractions. Rectal contractions occurred at high frequency in patients with detrusor instability [45.5%]. Rectal pressure changes observed in multichannel urodynamics are not randomly occurring events but their incidence and significance should be further studied. The association of rectal contractions with detrusor instability may indicate an underlying neurogenic pelvic floor dysfunction