Diagnosis of urinary incontinence
ABSTRACT Urinary incontinence is common, increases in prevalence with age, and affects quality of life for men and women. The initial evaluation occurs in the family physician's office and generally does not require urologic or gynecologic evaluation. The basic workup is aimed at identifying possible reversible causes. If no reversible cause is identified, then the incontinence is considered chronic. The next step is to determine the type of incontinence (urge, stress, overflow, mixed, or functional) and the urgency with which it should be treated. These determinations are made using a patient questionnaire, such as the 3 Incontinence Questions, an assessment of other medical problems that may contribute to incontinence, a discussion of the effect of symptoms on the patient's quality of life, a review of the patient's completed voiding diary, a physical examination, and, if stress incontinence is suspected, a cough stress test. Other components of the evaluation include laboratory tests and measurement of postvoid residual urine volume. If the type of urinary incontinence is still not clear, or if red flags such as hematuria, obstructive symptoms, or recurrent urinary tract infections are present, referral to a urologist or urogynecologist should be considered.
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ABSTRACT: Object Minimally invasive (MI) transforaminal lumbar interbody fusion (TLIF) has been demonstrated in previous studies to offer improvement in pain and function comparable to those provided by the open surgical approach. However, comparative studies in the obese population are scarce, and it is possible that obese patients may respond differently to these two approaches. In this study, the authors compared the clinical benefit of open and MI TLIF in obese patients. Methods The authors conducted a retrospective cohort study based on review of electronic medical records at a single institution. Eligible patients had a body mass index (BMI) ≥ 30 kg/m(2), were ≥ 18 years of age, underwent single-level TLIF between 2007 and 2011, and outcome was assessed at a minimum 6 months postoperatively. The authors categorized patients according to surgical approach (open vs MI TLIF). Outcome measures included postoperative improvement in visual analog scale (VAS), Oswestry Disability Index (ODI), estimated blood loss (EBL), and hospital length of stay (LOS). Results A total 74 patients (21 open and 53 MI TLIF) were studied. Groups had similar baseline characteristics. The median BMI was 34.4 kg/m(2) (interquartile range 31.6-37.5 kg/m(2)). The mean follow-up time was 30 months (range 6.5-77 months). The mean improvement in VAS score was 2.8 (95% CI 1.9-3.8) for the open group (n = 21) and 2.4 (95% CI 1.8-3.1) for the MI group (n = 53), which did not significantly differ (unadjusted, p = 0.49; adjusted, p = 0.51). The mean improvement in ODI scores was 13 (95% CI 3-23) for the open group (n = 14) and 15 (95% CI 8-22) for the MI group (n = 45), with no significant difference according to approach (unadjusted, p = 0.82; adjusted, p = 0.68). After stratifying by BMI (< 35 kg/m(2) and ≥ 35 kg/m(2)), there was still no difference in either VAS or ODI improvement between the approaches (both unadjusted and adjusted, p > 0.05). Complications and EBL were greater for the open group than for the MI group (p < 0.05). Conclusions Obese patients experienced clinically and statistically significant improvement in both pain and function after undergoing either open or MI TLIF. Patients achieved similar clinical benefit whether they underwent an open or MI approach. However, patients in the MI group experienced significantly decreased operative blood loss and complications than their counterparts in the open group.Journal of neurosurgery. Spine 04/2014; 20(6). DOI:10.3171/2014.2.SPINE13794 · 2.36 Impact Factor
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ABSTRACT: Background Normal Pressure Hydrocephalus is a disease, which results from excess cerebral spinal fluid, it is often misdiagnosed for other degenerative diseases. Symptoms of Normal Pressure Hydrocephalus may be reversed with new treatment techniques such as shunting.AimsThe aim of this article is to review the pathophysiology of Normal Pressure Hydrocephalus, discuss how to distinguish it from other diseases and discuss treatment options, which show potential for treating Normal Pressure Hydrocephalus.Methods PubMed was used to conduct searches regarding the subject matter of this article.ResultsGait, dementia and urinary incontinence, which are also referred to as Adam's Triad, are typical associated with Normal Pressure Hydrocephalus. The pathophysiology of these conditions has been outlined in this article. Review articles have been outlined which discuss the potential certain shunt operations have to treat Normal Pressure Hydrocephalus.DiscussionThere are several known treatment options that have been successful when treating Normal Pressure Hydrocephalus. With the use of shunts to drain excess cerebral spinal fluid, it is possible to improve the patient's symptoms and thus improve their quality of life.Conclusion Normal Pressure Hydrocephalus should be considered when treating elderly patients that show signs of Adam's Triad. There are numerous types of treatment options available that show promise as to relieving some of the symptoms that are associated with Normal Pressure Hydrocephalus.08/2014; 2(6). DOI:10.1111/ncn3.117
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ABSTRACT: Objective The purposes of this study were to estimate the 1-month point prevalence of bowel and bladder symptoms (BBS) among adult chiropractic patients and to evaluate associations between these symptoms and low back pain (LBP). Methods Patients 18 years or older presenting to a chiropractic college academic health clinic between March 25 and April 25, 2013, were asked to complete a symptom screening questionnaire. Descriptive statistics, binary logistic regression, Fisher exact test, and P values were calculated from the sample. Results The sample included 140 of 1300 patients who visited the clinic during the survey period (11%). Mean age was 47.5 (range 18-79) years. LBP was the primary chief complaint in 42%. The 1-month point prevalence of any bladder symptoms was 75%, while the rate for bowel symptoms was 62%; 55% reported both BBS. Binary logistic regression analyses showed no statistically significant association between a chief complaint of LBP and combined BBS (OR = 1.67, P = .164). Conclusion The prevalence of bowel and bladder symptoms in chiropractic patients was high. There was no statistically significant association between these symptoms and LBP in this group of patients seeking care for LBP.Journal of chiropractic medicine 09/2014; 13(3):178-187. DOI:10.1016/j.jcm.2014.07.006