The management of urinary incontinence in residential and nursing homes for older people.

We assessed the management of urinary incontinence amongst older people in residential and nursing homes and examined strategies for continence care in the homes. A random sample of local authority and private residential and nursing homes was drawn from an earlier census of long-term care. Strategies for continence care, the standard of care provided and the need for more help were determined by means of a structured questionnaire and the observations of a continence adviser.

Long-term follow-up of habit retraining for bladder instability in elderly patients.

Sixty patients with detrusor instability were contacted 2 to 3 years after their initial diagnosis and treatment. When first treated, 40 had improved, nine were catheterized and the remainder were unchanged. By the time of the first outpatient appointment 1 month later, a further 6% had been catheterized and 26% had lost control.

Locally advanced adenocarcinoma of the breast without distant metastasis treated with multimodal therapies.

Locally advanced breast cancer has been treated with a variety of primary treatments with or without adjuvant therapies. This study combines radiation, chemotherapy, and surgery as a multimodal program for Stage III breast cancer. Radiation was started on day 1: 4600 rad were administered to the breast and 4500 rad were administered to the axilla and supraclavicular areas.

A profile of disordered micturition in the elderly at home.

A prevalence survey of disturbed micturition in the elderly identified 7% with important degrees of disorder, 1% with lesser disorder and 1% who were catheterized. Incontinence, urgency, frequency and nocturia were the symptoms most commonly reported. Fifty-three per cent of people describing incontinence used preventive aids but one third of these continued to experience wetting of external clothing.

Urodynamic findings in sacrococcygeal chordoma.

The clinical and urodynamic findings in two cases of sacrococcygeal chordoma are described. The urodynamic findings suggest that the urinary problems in this condition are caused by an incomplete lower motor neurone lesion.

The Continence Nurse Adviser's role in the British Health Care System.

The continence nurse adviser (CNA) has an important role in assessing and treating patients, many of whom can be diagnosed and managed at a nursing level. The CNA also has a large teaching commitment and is actively involved in research and liaison.

Double-blind study of imipramine and placebo for incontinence due to bladder instability.

We compared imipramine with placebo in a double-blind study in Leicester, in elderly incontinent patients. The results revealed that 14 out of 19 patients became dry after imipramine and six out of 14 after placebo treatment. Patients on imipramine also tended to become drier sooner.

Provision of services for incontinent elderly people at home.

Results of a survey of elderly people living at home suggest that 8% suffer from important degrees of urinary dysfunction and are accessible to community based services. Supply of NHS incontinence aids was inadequate, and improvements in provision are recommended. Attendance at a continence clinic established for the survey period suggests a need for additional specialist services to be made available close to home.

Factors influencing outcome in elderly patients with urinary incontinence and detrusor instability.

The majority of elderly incontinent patients with detrusor instability in whom various medical treatments had been tried and failed, became dry or very significantly improved following attendance at a Continence Clinic. The reason for this was not only because this clinic had access to specialized investigational equipment, but also because patients received individual psychological and practical management of their incontinence. All were given time to discuss their problems, had imipramine titrated against effect, and practised habit-retraining programmes.

Urinary tract infection after cystometry.

Eighteen of 67 patients who underwent cystometry for assessment of incontinence had a urinary tract infection 72 hours later. Though four of the 18 had an infection prior to cystometry, the true postcystometry infection was still high at 21%. Clinical details and urodynamic studies on these patients showed no correlation with sex, mobility, mental score, random blood sugar, renal function, initial residual volume of urine, previous pelvic operations or the type of bladder abnormality diagnosed on cystometry.

Hepatic arterial and systemic chemotherapy for the treatment of primary and secondary malignancies of the liver.

Twenty-two patients with metastatic and primary cancer of the liver were treated with 5-fluoro-2'-deoxyuridine (5FUDR), Mitomycin C (Mito C), and 1 (-2-chlorethyl)-4(methyl-cyclohexyl)-1-nitrosourea (MeCCNU). 5FUDR 0.3 mg/kg/day was administered as a continuous infusion via the hepatic artery.

The effect of physiotherapy on stress incontinence.

Physiotherapy is a safe and effective means of decreasing the symptoms and signs of stress incontinence. Fourteen out of 19 women became dry or improved sufficiently not to warrant wearing any protective garment over a 4-week treatment period. The use of a novel machine to measure pelvic floor squeeze did not improve the success of physiotherapy alone in this condition but may have an important role in instructing the patient on the correct use of the pelvic floor muscles.

In vivo and in vitro studies on the effect of sodium antagonists on the bladder in man and rat.

The effect of oral mexiletine and intravenous lignocaine was examined in elderly patients with urinary incontinence associated with detrusor instability. Lignocaine had no demonstrable urodynamic effect in 13 patients, but 12 out of 20 patients who completed the study with mexiletine benefited, 10 becoming dry. The incidence of side-effects was high.

Clinical and urodynamic effects of ephedrine in elderly incontinent patients.

The effect of ephedrine, an adrenergic receptor agonist, was investigated in 24 elderly patients with urinary incontinence associated with unstable detrusor contractions. After 3 weeks of oral ephedrine repeat cystometry showed mean increases of 21 per cent in bladder capacity and of 23 per cent in urethral pressure. Of 21 patients studied 7 became continent and 12 were improved.

VP-16 and adriamycin in patients with advanced breast cancer.

Twenty-eight patients with advanced adenocarcinoma of the breast were treated with a combination of VP-16 and adriamycin (VAD). Two complete (CR), and eight partial (PR) remissions were observed. The CR plus PR produced a 36% response rate in this study.

Guidelines for controlling urinary incontinence without drugs or catheters.

Catheterization of the elderly incontinent patient is frequently unnecessary. It is also often unsuccessful, as most patients have unstable bladders and therefore leakage continues around the tube. Simple measures, like toileting regimens and restricting fluids in the evening, are often effective alone.

Clinical and urodynamic studies in 100 elderly incontinent patients.

Clinical details were noted and urodynamic studies carried out on 100 elderly patients referred to an incontinence clinic, of whom 48 attended as day patients. Thirty patients had no problem apart from their incontinence, and only 38 had a clinically detectable neurological lesion. The average mental orientation score in 48 of the patients was 7.