Understanding the basic assessment and treatment of lower urinary tract symptoms in older women.

Lower urinary tract symptoms (LUTS) are prevalent in older women. These symptoms are often under-reported due to the potentially embarrassing nature of the symptoms and a belief that they are an inevitable consequence of ageing. LUTS such as urinary incontinence have a significant negative effect on people's quality of life; however, with the appropriate assessment and management, improvements can be achieved. This article reviews the different types of LUTS and their causes, assessment and treatment, focusing on older women. It aims to provide nurses with an understanding of LUTS so that they can identify appropriate interventions.

Evaluation of the outcomes of care of nurse-led continence care clinics for Chinese patients with lower urinary tract symptoms, a 2-year prospective longitudinal study.

AIM: The aim of this study was to evaluate the 24-month outcomes of a nurse-led continence care service for Chinese primary care patients with lower urinary tract symptoms. BACKGROUND: Most studies evaluating the outcomes of continence care services have had short follow-up durations with limited knowledge on whether benefits are sustained beyond 12 months. DESIGN: Twenty-four month cohort study. METHODS: Two comparison groups were recruited: (1) Patients with lower urinary tract symptoms attending a nurse-led community-based continence care programme; (2) Primary care patients with lower urinary tract symptoms identified by screening, receiving usual medical care. Self-reported symptom severity, health-related quality of life, patient enablement and general health perception were measured at baseline and 24 months. Data collection occurred from March 2013-August 2015. RESULTS: Baseline and 24-month data were available for 170 continence care and 158 usual care subjects. After controlling for baseline characteristics, the continence care group was observed to have greater reductions in symptom severity and larger improvements in disease-specific health-related quality of life, patient enablement and general health perception than the usual care group. Deterioration in the mental components of generic health-related quality of life was observed in the usual care group, but not in the continence care group. CONCLUSION: Over 24 months, when compared with usual medical care, nurse-led continence care services were effective in reducing symptom severity and improving health-related quality of life, patient enablement and general health perception and provided protection against deterioration in the mental components of health-related quality of life in patients with lower urinary tract symptoms.

The Experience of Women Who Care for Spouses With Parkinson's Disease and Lower Urinary Tract Symptoms.

OBJECTIVE: To describe the symptoms, bother, impact, and attribution of lower urinary tract symptoms (LUTS) and management strategies from the perspective of the spouse caregiver. DESIGN: A qualitative descriptive design with semistructured interviews was guided by the Theory of Unpleasant Symptoms and family systems theory. SETTING: Women were recruited from a Parkinson's Center at a Veterans Affairs hospital in the northeastern part of the United States. Their veteran husbands received care for Parkinson's disease at the center. PARTICIPANTS: Participants were 15 female spouse caregivers of men with Parkinson's disease and associated LUTS. METHODS: Purposive sampling was used to select caregiver participants for audiotaped interviews. Semistructured interviews were conducted with the participants. A directed content analysis was used to code transcribed interviews and field notes. RESULTS: The cognitive, affective, and behavioral dimensions of caring for a spouse with LUTS were identified. Participants were knowledgeable about the direct effect of Parkinson's disease on the bladder. Their affective responses included experiencing bother, emotional distress from the impact of LUTS on their lives, and empathy for their husbands. Participants tried many behavioral strategies to manage LUTS but received limited professional assistance for daily LUTS management. CONCLUSION: Multidisciplinary, patient- and family-centered approaches that provide education, treatment, and support are needed to promote better management of LUTS, maintain patient dignity, and reduce burden for the patient and family.

Lower urinary tract symptoms of prostate cancer patients undergoing treatments over eight-month follow-up.

AIMS AND OBJECTIVES: To examine the changes in lower urinary tract symptoms after open radical prostatectomy, laparoscopic radical prostatectomy and brachytherapy and to determine which treatment resulted in improved lower urinary tract symptoms at 8 months follow-up. BACKGROUND: Lower urinary tract symptoms are a primary side effect after prostate cancer treatment. DESIGN: A time-series survey design with descriptive and comparative elements. METHODS: A sample of 51 prostate cancer patients was recruited: open radical prostatectomy = 20, laparoscopic radical prostatectomy = 23 and brachytherapy = 8. Data were collected at six time points: before treatment/baseline, 1 week post-treatment, 1 month post-treatment, 2 month post-treatment, 3 month post-treatment and 8 months post-treatment. The lower urinary tract symptoms were assessed using the International Prostate Symptom Score, with a higher score indicating a worse condition. One-way anova was used to predict the progress of urinary symptoms after treatments. Bootstrap re-sampling was conducted to assess the stability of the outcomes. RESULTS: Although there were no significant differences in the lower urinary tract symptoms among the three groups after treatments, the laparoscopic radical prostatectomy group had the lowest International Prostate Symptom Score score at baseline. Compared with the baseline symptoms for patients undergoing each treatment, there were significant improvements after 2 months in the open radical prostatectomy and brachytherapy groups, and after 3 months in the laparoscopic radical prostatectomy group. CONCLUSIONS: The prostate cancer patients undergoing the three treatments have similar lower urinary tract symptoms over 8-month follow-up although different lower urinary tract symptoms were presented before treatments. RELEVANCE TO CLINICAL PRACTICE: Results could be applied to educating and counselling prostate cancer patients regarding symptoms during recovery after surgery. It could also help patients better understand the outcomes related to the differing treatment methods.

Lower urinary tract symptoms in men with Parkinson disease.

PURPOSE: The aim of this study was to examine the prevalence, presentation, and predictors of lower urinary tract symptoms (LUTS) in men with idiopathic Parkinson disease (PD). METHODS: Guided by the Theory of Unpleasant Symptoms, this retrospective exploratory study used data abstracted from admission clinical records of 271 male patients with idiopathic PD enrolled in a movement disorders clinic at a large metropolitan Veterans Affairs Medical Center in the eastern region of the United States. Data from the admission questionnaire, Unified Parkinson's Disease Rating Scale, and Mini Mental State Examination were abstracted by trained research assistants. Interrater reliability for the abstraction process was 0.99 in a randomly selected 10% sample of records. Descriptive statistics were used to determine the prevalence of LUTS. Logistic regression was used to determine LUTS risk factors and predictors. RESULTS: At least one LUTS was reported by 40.2% of participants. Incontinence was the most prevalent symptom, affecting almost 25% of participants, followed by nocturia (14.8%) and frequency (13.7%). Of the 10 identified risk factors for LUTS, four significant predictors were discovered: number of non-PD medications (p < .05), PD duration (p < .05), number of comorbidities (p < .05), and history of a hernia diagnosis (p < .05). CONCLUSIONS: Assessment for LUTS should be a component of every evaluation of a patient with PD. Our findings offer a preliminary profile of the male PD patient with LUTS, which is an important step toward effective screening, detection, and access to care and treatment. Next steps in research include further work to identify predictors of LUTS in both male and female PD populations, explore patient perspectives, begin trials of interventions for LUTS in the PD population, and analyze the economic impact.