Identification of learning needs of patients hospitalized at a University Hospital.

OBJECTIVES:  This study was designed as a descriptive trial aimed at identifying learning needs of patients hospitalized at a university hospital and understanding whether these learning needs vary depending on certain patient characteristics. METHODS:  The study sample consisted of 1190 patients/caregivers hospitalized at all departments except for the psychiatry clinic, who were planned to be discharged from the hospital. Data were collected using Patient Information Form and the Patient Learning Needs Scale (PLNS). RESULTS:  The evaluation of responses to the PLNS and its subscales revealed that the mean scores were 26.93±10.62 for drugs; 26.15±11.43 for activities of living; 19.78±5.54 for community and follow up; 16.86± 5.47 for feelings related to condition; 34.3±6.99 for treatment and complications; 28.20±7.40 for enhancing quality of life; and 13.64±6.54 for skin care. The PLNS total mean score was 165.95±45.44. Conclusion : According to the evaluation of the PLNS total score, patient learning needs vary depending on age, gender, occupation, level of education, the departments at which the respondent is treated, and whether the respondent is the patient him/herself or the caregiver.

Comparison of the effects of electrical stimulation and posterior tibial nerve stimulation in the treatment of overactive bladder syndrome.

AIM: To compare the effects of transvaginal electrical stimulation (ES) and posterior tibial nerve stimulation (PTNS) in the treatment of overactive bladder syndrome (OAB). METHODS: Women applying with symptoms of urgency, frequency, and nocturia with or without incontinence and diagnosed with OAB were divided into an ES or PTNS group. Bladder diary, urodynamics, 1-hour pad test, and King's Health Questionnaire were performed before and after treatment. ES was applied for 20 min, 6-8 weeks with pulses of 10-50 Hz square waves at a 300-µs or 1-ms pulse duration and a maximal output current of 24-60 mA with 5-10 Hz frequency, three times per week. PTNS was applied for 30 min once a week for 12 weeks. RESULTS: Thirty-five patients received ES, 17 patients received PTNS. Pad test, urinary diary, and quality of life parameters after both treatments decreased significantly; the decrease in the ES group was greater. The number of patients who describe themselves as cured was higher in the ES group. CONCLUSION: PTNS and ES are both effective in the treatment of OAB with significant improvement in objective and subjective parameters. Objective results show no significant difference between the two groups; however, the number of patients who describe themselves as cured in the ES group was significantly higher.

Randomized trial of graft materials in transobturator tape operation: biological versus synthetic.

OBJECTIVE: To compare the outcome of outside-in biological and synthetic transobturator tape (TOT) operation, including subjective and objective success rates, urodynamics, and quality of life. MATERIALS AND METHODS: One hundred patients suffering from clinical and/or urodynamic stress urinary incontinence (SUI) were randomized into biological material TOT (PELVILACE® TO) or synthetic material TOT (ALIGN®TO Urethral Support System) groups. Preoperative and at 1 year postoperative urogynecological symptom assessment, 1-h pad test, 4-day bladder diary, stress test, Q-tip test, and urodynamics were performed. For the evaluation of quality of life, the King's Health Questionnaire, Urogenital Distress Inventory-6, Incontinence Impact Questionnaire-7, and Prolapse Quality of Life were used. RESULTS: There was no significant difference between the two groups regarding objective and subjective cure rates and quality of life. At 1-year follow-up, the subjective cure rate was 68 % in the biological material TOT and 70 % in the synthetic material TOT group. No perioperative complications developed. Groin pain developed in 2 patients in the biological TOT group and 1 patient had dehiscence in the periurethral incision, which healed with local estrogen. Two patients had transient urinary retention in the synthetic TOT group, 1 patient developed groin pain, and 1 patient had mesh erosion observed at the 1-year follow-up. CONCLUSION: Transobturator tape with biological material in the management of SUI has a rate of success and patient satisfaction similar to those of synthetic material at 1-year follow-up. Studies with longer follow-up and larger cohorts are necessary to evaluate possible autolysis and degradation of biological slings and a possible reduction in efficacy over time.

Is There a Relationship between Vitamin B12 and Stress Urinary Incontinence?

OBJECTIVE: Pelvic floor, which includes collagen, elastin, and smooth muscle, is very important in preventing urinary incontinence (UI). Studies suggest that vitamin B12 is involved in collagen synthesis. In the present study we aimed to determine the association of vitamin B12 deficiency with stress UI in a sample of Turkish women. METHODS: Forty-two women with stress UI or mixed UI who met the inclusion criteria from a group of 541 women with stress UI or mixed UI, were included in the study. The study group was compared with a control group of 20 healthy women without UI who matched to the study group's demographic data and met the inclusion criteria. Demographic data as well as duration of symptoms and vitamin B12 levels were analyzed and compared. RESULTS: The mean ages of the study and the control groups were 50.04 ± 4.6 and 49.02 ± 5.1 years, respectively. Vitamin B12 level was 300.95 ± 142.9 pg/mL in the study group, whereas in the control group it was 598.98 ± 120.3 pg/mL (P < 0.001). In the study group, 66.6% of the patients with stress UI had vitamin B12 levels less than 300 pg/mL. When the duration of symptoms and vitamin B12 levels were compared, women with vitamin B12 levels less than 200 pg/mL had symptoms for a longer duration (P < 0.01). CONCLUSION: One of the main etiologic factors for stress UI is a defect in pelvic floor support. Vitamin B12 is lower in women with stress UI. Analysis of vitamin B12 levels should also be considered in the evaluation of women with stress UI.

Overview of the social impact of urinary incontinence with a focus on Turkish women.

Although urinary incontinence is a common problem among women and can seriously affect their quality of life, more than half of women report no discomfort with the disorder, and most do not seek medical help. In Turkey, women traditionally prefer not to seek medical advice for a urinary incontinence problem. Except for treatment-seeking behaviors, women practice coping methods for the management of urinary incontinence. The problem of urinary incontinence has been gaining more importance in recent years, and nurses' roles and responsibilities have been increased in this area. Consequently, there have been developments in Turkey related to the education of nurses.

The prevalence of and the related factors for urinary and fecal incontinence among older residing in nursing homes.

AIMS AND OBJECTIVES: To determine the prevalence of urinary incontinence and fecal incontinence among older people residing in nursing homes in Istanbul. BACKGROUND: Urinary incontinence (UI) is a multifactorial condition associated with age-related changes and disorders of the genitourinary system and systemic problems affecting normal micturition. The impact of UI and fecal incontinence (FI) on older people living in nursing homes is more significant than those living in the community. DESIGN: Cross-sectional study. METHODS: This study was performed with 1110 older people who were 60 years and older residing in five government rest homes on the European side of Istanbul in Turkey. An interview was conducted with the residents that had sufficient cognitive function and agreed to participate. Demographic findings and complaints about incontinence were analyzed using a special questionnaire. RESULTS: The total number of older people who participated was 694; 56.5% females and 43.5% males; 43.4% of females and 20.9% of males. Urge incontinence was common in both groups. FI was more common among females (14%, males 6%) and the mean duration of symptoms was longer. The related factors for UI among older females revealed that history of an episiotomy, frequency, urgency, fecal incontinence and functional incapacity among males; whereas history of stroke and pulmonary disorders were independent variables that increased the incidence of frequency, recurrent urinary tract infections and fecal incontinence. The related factors for fecal incontinence among older females included history of stroke and functional status. Diabetes mellitus requiring medical treatment, frequency, functional incapacity and urinary incontinence were significant related factors for fecal incontinence among males. CONCLUSIONS: According to similar studies, the urinary and fecal incontinence rates in nursing home residents were lower compared to the other countries. Incontinence was more common among females according to males. Understanding related factors of incontinence are important for providing care and counseling in nursing homes. RELEVANCE TO CLINICAL PRACTICE: Nurses can provide appropriate information and support at each step in the protecting, screening, diagnosis and treatment process so that elders' incontinence is minimized.

Urinary incontinence (UI) and quality of life (QoL) of the elderly residing in residential homes in Turkey.

The objective of this study was to evaluate urinary incontinence (UI) and its effect on the quality of life (QoL) of older people dwelling in residential homes in Turkey. A cross-sectional study was applied in residential homes. A total of 1110 people older than 60 years residing in five selected residential homes were studied. An interview was conducted with the residents who had sufficient cognitive function and agreed to participate. The QoL and the mental and the functional state of the residents were analyzed using the King's Health Questionnaire (KHQ), Mini Mental State Examination (MMSE), and the Rankin Scale, respectively: Of the total pool, 694 residents were included in the study of which 56.48% (n=392) were female and 43.52% (n=302) were male. UI was present in 170 women and 63 men. Pad usage was more common in women (88%) than that in men (29.1%). The QoL subdimensions showed that women had higher scores than men. Urge UI (UUI) had more impact on the QoL than that on functional, mixed or stress incontinence. We concluded that UI negatively affects the QoL of older people living in residential homes. In particular, women and patients suffering from UUI are more severely affected.

Effect of urinary leakage on sexual function during sexual intercourse.

AIM: This study was planned to determine the effect of urinary leakage on sexual function during sexual intercourse. METHODS: The study group included 32 incontinent women who had urinary leakage during sexual intercourse and the control group consisted of 60 women with no such problem. The Sexual History Form of Schover and Jensen was completed in face-to-face interviews in a private room. RESULTS: When compared with the women without any problem, the women with urinary incontinence were 4.7 times less satisfied with their sexual life and their partners had ejaculation without full erection 3.1 times more. In order to cope with the problem of urinary incontinence during coitus the women themselves adopted several methods. Trying to keep their partners unaware of the problem and deferring the intercourse were among the most frequently adopted methods. 43.7% of the study group indicated that this problem affected their sex life. CONCLUSIONS: The results of this study support the view that urinary leakage during coitus affects women's sex life adversely.

The effect of pelvic floor training on sexual function of treated patients.

The aim of this study was to determine the effects of improvements in urinary incontinence resulting from pelvic floor rehabilitation on the sexual function of patients. The study involved 42 clinic patients who received pelvic floor rehabilitation treatment. Their sexual histories were obtained through face-to-face interviews. Pelvic muscle strength was measured with a perineometer. Improvement in incontinence was measured with the pad test. Seventeen women reported decreased sexual desire before the treatment; 5 of these indicated improvement after treatment. Nine of 17 women who experienced dyspareunia prior to treatment reported an improvement afterwards, and four women reported complete relief from pain. Five of 15 women who complained of difficulty in reaching climax before the treatment experienced improvement in this area. In conclusion, an improvement in sexual desire, performance during coitus and achievement of orgasm were observed in women who received pelvic floor muscle rehabilitation. No change was seen in the arousal and resolution stages of sexual activity.