Pharmacologic management of asymptomatic bacteriuria and urinary tract infections in women.

Many factors influence the decision to institute treatment for the common problems of urinary tract symptoms and/or the presence of microorganisms in the urine of women. This article summarizes current evidence related to treatment choice and compares selected treatment practice guidelines. Evidence related to prevention of recurrent infection without the use of antibiotics is included.

Long-term efficacy of the pubovaginal Mersilene mesh sling.

OBJECTIVE: The objective of the study was to determine the efficacy of the pubovaginal Mersilene mesh sling (PVMMS) for complicated urodynamic stress incontinence (USI). STUDY DESIGN: Between 1990 and 2008, patients with USI plus an at-risk diagnosis underwent a PVMMS by a single surgeon. They were followed up with urodynamics (UDE) and Pelvic Floor Distress Inventory-short form 20 (PFDI-20). Stratification was in an at-risk hierarchy: intrinsic sphincter deficiency (ISD) greater than recurrent USI (RUSI) greater than USI with chronically increased intraabdominal pressure (CI-IAP). A cough stress test determined objective cure. PFDI question 17 assessed subjective cure. RESULTS: Three hundred six patients with ISD (43.5%), RUSI (26.8%), and CI-IAP (29.7%) had objective cure rates of 89.2% in the short term, 86.7% in the intermediate term, and 91.2% in the long term. A group of 48 patients with both short- and long-term UDEs showed cures of 100% and 91.7%. Long-term objective cure rates were: ISD, 90.5% (n = 21); RUSI, 84.2%, (n = 19); CI-IAP, 100% (n = 17). The mean score of postoperative PFDI question 17 was 0.57 (n = 119). Mean symptom improvement was -2.98 (n = 52; P < .0001). CONCLUSION: We demonstrated PVMMS to be subjectively and objectively effective in long-term treatment of complicated forms of USI.

'I'd rather just go on as I am'--pelvic floor care preferences of frail, elderly women in residential care.

Little is known about how frail, elderly women in assisted living and long-term care facilities view pelvic floor dysfunctions and treatments. Twenty-five residents reflect on these issues, and quality of life.

It's not all about birth: biomechanics applied to pelvic organ prolapse prevention.

Pelvic organ prolapse is a common and costly women's health problem. Prevention of prolapse continues to play a role in the debate about the risks and benefits of elective cesarean section, making this an important topic for midwives to understand. While some women appear to be at higher risk for prolapse because of intrinsic anatomic and physiologic factors, others have modifiable risk factors that can be addressed by health care providers. This article discusses the current knowledge related to the etiology of prolapse and related components of pelvic anatomy. Biomechanical principles are then applied to enhance the understanding of prolapse development and prevention. Clinical recommendations are based on current evidence regarding topics such as physical activity during pregnancy, treatment of vaginal atrophy, and optimal pelvic floor muscle exercises.

Vaginal pressure during lifting, floor exercises, jogging, and use of hydraulic exercise machines.

We recorded vaginal pressure in 12 women without risk factors for prolapse during two activity and exercise sessions, compared exercise and cough pressure, and evaluated method reproducibility and patterns of relative pressure. Portable urodynamic equipment, repeated measures descriptive design, and purposeful sampling were used with nonparametric analysis and visual comparison of pressure graphs. Mean participant age was 31.1 years (range 20-51), and mean body mass index was 22.7 (range 18.5-29.3). Mean pressures (in cm H(2)O): cough, 98.0 (48.0-133.7); standing, 24.0 (15.9-28.5); supine exercise, 34.0 (6.3-91.9); exercise machines, 37.0 (20.3-182.3). Repeated measures correlations for selected measures ranged from 0.66 (p

Midline anterior repair alone vs anterior repair plus vaginal paravaginal repair: a comparison of anatomic and quality of life outcomes.

Our aim was to study the anatomic recurrence rates and quality of life outcomes of patients who had undergone either anterior colporrhaphy (AC) or anterior colporrhaphy and vaginal paravaginal repair (AC + VPVR) as part of surgery for pelvic organ prolapse. Chart reviews were used to identify anatomic prolapse recurrence. Phone interviews assessed quality of life outcomes [Urogenital Distress Inventory (UDI) and the Incontinence Impact Questionnaire (IIQ)] outcomes. There was a trend towards longer time to anatomic recurrence (any compartment > or =grade 2) in the AC group compared with the AC + VPVR group (median 24 vs 13 months, p=0.069). If only patients who had undergone previous surgery were compared, time to anatomic recurrence appeared significantly longer in the AC group (median 41 vs 12 months, p=0.022). There were 55% of women in the AC group and 46% of women in the AC + VPVR group who reported significant bladder or bulge symptoms based on responses to the phone-administered UDI and IIQ (p=0.89). Our retrospective study did not suggest that adding VPVR was superior in terms of anatomic or quality of life outcomes. Prospective assessment of the role of VPVR in the treatment of pelvic organ prolapse is needed.

Common problems of urination in nonpregnant women: causes, current management, and prevention strategies.

This article uses a case-based approach to review common problems of urination in nonpregnant women, including overactive bladder; stress, urge, and mixed incontinence; and retention and prolapse. Up-to-date clinical issues related to assessment, diagnosis, treatment, and follow-up are reviewed, with a discussion of underlying pathophysiology and prevention strategies. Suggestions are made for relevant curriculum content at both the basic and advanced levels of advanced practice education.

Not the surgery for a young person: women's experience with vaginal closure surgery for severe prolapse.

INTRODUCTION: Vaginal prolapse can be debilitating, due to pelvic organ prolapse and herniation of the bladder, uterus, intestines and/or support tissues in the vaginal opening. However, there is little published information that documents women's experiences in the months and years after surgery to correct prolapse. OBJECTIVE: This phenomenologic study aimed to increase understanding of the specific experiences that patients report after vaginal closure surgery. METHOD: Participants were recruited via a mailing to surgical patients from a large urogynecologic practice. Semi-structured interviews were tape-recorded and transcribed for analysis. RESULTS: Six women participated in the study. After analyzing the results, five major themes emerged: awareness and confusion, feeling alone in silence, trusting recommendation, acceptance of changed sexuality, and still coping. CONCLUSIONS: This small study shows that vaginal closure affects an intimate body part and can impact self-image, but the women did not regret their changed sexuality. The larger issues for these women were ones of communication, information, and isolation, particularly during their followup care.

Analyzing qualitative data.

Data analysis in qualitative research is a creative process. As the instrument of data analysis, the researcher explores and reflects on the meaning of the data. In most qualitative traditions, the data analysis phase overlaps the data collection phase. As data analysis proceeds, the researcher moves back and forth between data analysis and data collection in order to create and explain the findings. Using data from the authors' research, common techniques of data analysis in qualitative research are presented.

Case and grounded theory as qualitative research methods.

Case and grounded theory are two methods of qualitative research. Both methods have their roots in sociology and are focused on understanding, explaining, and/or predicting human behavior. They are ideal methods for nursing research, as they are useful for exploring human responses to health problems. The theoretical underpinnings, methodologies, strategies for data collection, requirements for trustworthiness, and examples of research using case and grounded theory are described.

Prevention of urinary incontinence in adults: population-based strategies.

BACKGROUND: Urinary incontinence (UI) affects large numbers of adults, especially older adults, with an estimated 200 million adults worldwide having this life-altering condition. OBJECTIVES: To identify key populations at risk for urinary incontinence and propose population-based strategies to promote continence with a substantive focus on UI prevention. METHODS: Critical review of extant literature and iterative synthesis were undertaken to generate an action plan to guide future UI prevention research. RESULTS: Key populations identified to be at risk for UI are women in selected occupations, childbearing women, older adults with lifestyle risk factors, older adults with comorbid conditions, and nursing home residents. Population-based research activities are proposed. Growing evidence supports the benefit of pelvic floor muscle training to prevent childbirth and prostatectomy-related UI. Bladder training has demonstrated preventive capacity. CONCLUSIONS: Because of its high prevalence and chronic but preventable nature, UI is most appropriately considered a public health problem. Nursing research is needed to test prevention programs for UI using a population-based public health focus.