International Continence Society (ICS) report on the terminology for nocturia and nocturnal lower urinary tract function.

INTRODUCTION: The terminology for nocturia and nocturnal lower urinary tract function is reviewed and updated in a clinically and practically-based consensus report. METHODS: This report has been created by a Working Group under the auspices and guidelines of the International Continence Society (ICS) Standardisation Steering Committee (SSC). All relevant definitions were updated on the basis of research over the last 16 years since the publication of the first nocturia standardization document in 2002. An extensive process of 16 rounds of internal and external reviews was involved to examine each definition exhaustively, with decision-making by collective opinion (consensus). RESULTS: A clinically-based terminology report for nocturia and nocturnal lower urinary tract function, encompassing five key definitions divided into signs and symptoms has been developed. Clarity and user-friendliness have been key aims to make it interpretable by healthcare professionals and allied healthcare practitioners involved in the care of individuals with nocturnal lower urinary tract function. CONCLUSION: A consensus-based terminology report for nocturia and nocturnal lower urinary tract function has been produced to aid clinical practice and research.

Continence care for people with dementia living at home in Europe: a review of literature with a focus on problems and challenges.

AIMS AND OBJECTIVES: To report the findings of a review of literature relating to the continence care of community-dwelling people with dementia in Europe. BACKGROUND: More than two-thirds of people with dementia live at home, and many experience continence problems. Incontinence is a significant contributor towards institutionalisation. Care and support is often inadequate or inappropriate, and guidelines are lacking. This represents a failure to respect the human rights and dignity of this group. DESIGN: A structured review of the literature relating to the continence care of community-dwelling people with dementia in Europe with a focus on problems and challenges. METHODS: Search terms reflecting dementia, continence, care/management and guidelines for community-dwelling people with dementia were applied to four databases. Hand-searching was also carried out. A total of 208 articles were searched for content relating to problems and challenges linked to continence care for this group. RESULTS: Six relevant articles were fully reviewed. The main difficulties and challenges included the following: (1) perceptions, (2) availability/provision of support and care, (3) financial cost, (4) mobility and the environment, (5) relationships and social inclusion and (6) emotional issues. CONCLUSION: Dementia and incontinence have profound effects on quality of life. The dearth of good quality data within this area and the findings of the review confirm the need for expert, consensus-based guidelines and appropriate research to ensure that the rights and dignity of people with dementia are respected. RELEVANCE TO CLINICAL PRACTICE: The findings of the review will hopefully raise awareness amongst healthcare professionals in community practice of unmet needs of people with dementia and continence problems, and their caregivers, especially those related to social, financial, emotional and relational issues. The review does not provide solutions or guidance but is helpful in highlighting some of the key areas where special attention is needed.

Managing Urinary Incontinence in Patients with Dementia: Pharmacological Treatment Options and Considerations.

Urinary incontinence and lower urinary tract symptoms are highly prevalent in late life and are strongly associated with dementia and frailty. Incontinence is extremely common among those living in long-term care and is most commonly due to urgency incontinence. Although national and international guidelines for continence care exist, they often fail to consider the complex comorbidity found in patients with dementia and are often not followed; continence practices in long-term care may promote rather than prevent incontinence. The majority of those with dementia living in the community can be managed successfully with standard treatments, both pharmacological and non-pharmacological; the expectations and aims of treatment of both the patient and their caregivers should be considered. A dementia diagnosis does not preclude management of incontinence, but treatment options may be more limited in those with advanced dementia who are unable to retain information and modify behaviors. High-quality data to guide the choice of pharmacological agent in those with dementia are lacking. Oxybutynin has been shown to have significant adverse cognitive effects, but data to support the use of trospium, solifenacin, darifenacin, and fesoterodine are limited. No data are available for mirabegron. Neither age, frailty, nor dementia should be considered a barrier to pharmacological management, but consideration should be given to the total anticholinergic load. Evidence to guide the treatment of incontinence in this vulnerable patient group is scarce, and available guidelines adapted for each individual's situation should be applied.

Does fesoterodine have a role in the treatment of poorly managed patients with overactive bladder?

Overactive bladder (OAB), a clinically defined symptom complex comprising urinary urgency, usually accompanied by urinary frequency and nocturia, with or without urgency incontinence, is common and has a markedly negative impact on the sufferer's quality of life. Following conservative and lifestyle management, the current pharmacological mainstay of treatment is antimuscarinic therapy. This review explores the role of fesoterodine, a relatively recently introduced antimuscarinic agent, in the treatment of patients who may have had a suboptimal response to initial therapy, who have switched treatment from tolterodine, or may be at risk of receiving poor treatment because of either multimorbidity or complex polypharmacy.

A comparison of the effect of age on levator ani and obturator internus muscle cross-sectional areas and volumes in nulliparous women.

AIMS: Functional tests have demonstrated minimal loss of vaginal closure force with age. So we tested the null hypotheses that age neither affects the maximum cross-sectional area (CSA) nor the volume of the levator muscle. Corresponding hypotheses were also tested in the adjacent obturator internus muscle, which served as a control for the effect of age on appendicular muscle in these women. METHODS: Magnetic resonance images of 15 healthy younger (aged 21-25 years) and 12 healthy older nulliparous women (aged >63 years) were selected to avoid the confounding effect of childbirth. Models were created from tracing outlines of the levator ani muscle in the coronal plane, and obturator internus in the axial plane using 3D Slicer v. 3.4. Muscle volumes were calculated using Slicer, while CSA was measured using Imageware™ at nine locations. The hypotheses were tested using repeated measures analysis of variance with P < 0.05 being considered significant. RESULTS: The effect of age did not reach statistical significance for the decrease in levator ani muscle maximum CSA or the decrease in volume (4.3%, P = 0.62 and 10.9%, 0.12, respectively). However, age did significantly adversely decrease obturator internus muscle maximum CSA and volume (24.5% and 28.2%, P < 0.001, respectively). Significant local age-related changes were observed dorsally in both muscles. CONCLUSIONS: Unlike the adjacent appendicular muscle, obturator internus, the levator ani muscle in healthy nullipara does not show evidence of significant age-related atrophy.

A cross-sectional study of ultrasound estimated bladder weight in a sample of men and women without lower urinary tract symptoms.

AIMS: A non-invasive ultrasound method of estimating bladder weight (UEBW) has been proposed as diagnostic for outflow tract obstruction and detrusor overactivity in men and women. There are no data on asymptomatic men and women. This study aimed to examine the relationship between UEBW, age, height, body mass index (BMI), and body surface area (BSA). METHODS: Healthy volunteers of either sex were recruited from hospital staff, visitors, and patients. All were screened as asymptomatic using a validated tool and variables recorded. Bladder scans were performed using the Bladderscan BVM 6500 (Verathon, Aylesbury, England). RESULTS: Thirty men and 40 women were included in the study. There was no correlation between UEBW and BMI or age. There was a statistically significant correlation between height and UEBW (r(s) = 0.78 (95% CI 0.66-0.86), P < 0.0001), span and UEBW (M,r(s) = 0.68, P < 0.0001, F,r(s) = 0.36, P < 0.02), BSA and UEBW (M,r(s) = 0.75, P < 0.0001, F,r(s) = 0.34, P < 0.035), and height and UEBW (r(s) = 0.78 (95% CI 0.66-0.86), P < 0.0001) for both men and women. CONCLUSIONS: This study has described a highly significant association between UEBW and height, and span and BSA in a group of asymptomatic individuals of both sexes. Caution should be taken when ascribing pathological significance to observations made in the absence of understanding of normal physiology.