Urinary Incontinence - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

URINARY INCONTINENCE A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES...

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URINARY

INCONTINENCE A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES

J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS

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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright 2004 by ICON Group International, Inc. Copyright 2004 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Urinary Incontinence: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-597-84671-5 1. Urinary Incontinence-Popular works. I. Title.

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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International, Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this book.

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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on urinary incontinence. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.

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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications. Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.

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About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes&Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health

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Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON URINARY INCONTINENCE ........................................................................ 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Urinary Incontinence.................................................................. 18 E-Journals: PubMed Central ....................................................................................................... 73 The National Library of Medicine: PubMed ................................................................................ 74 CHAPTER 2. NUTRITION AND URINARY INCONTINENCE ............................................................ 119 Overview.................................................................................................................................... 119 Finding Nutrition Studies on Urinary Incontinence ................................................................ 119 Federal Resources on Nutrition ................................................................................................. 122 Additional Web Resources ......................................................................................................... 122 CHAPTER 3. ALTERNATIVE MEDICINE AND URINARY INCONTINENCE ...................................... 125 Overview.................................................................................................................................... 125 The Combined Health Information Database............................................................................. 125 National Center for Complementary and Alternative Medicine................................................ 126 Additional Web Resources ......................................................................................................... 145 General References ..................................................................................................................... 148 CHAPTER 4. DISSERTATIONS ON URINARY INCONTINENCE ........................................................ 149 Overview.................................................................................................................................... 149 Dissertations on Urinary Incontinence ..................................................................................... 149 Keeping Current ........................................................................................................................ 150 CHAPTER 5. PATENTS ON URINARY INCONTINENCE ................................................................... 151 Overview.................................................................................................................................... 151 Patents on Urinary Incontinence............................................................................................... 151 Patent Applications on Urinary Incontinence........................................................................... 177 Keeping Current ........................................................................................................................ 205 CHAPTER 6. BOOKS ON URINARY INCONTINENCE....................................................................... 207 Overview.................................................................................................................................... 207 Book Summaries: Federal Agencies............................................................................................ 207 Book Summaries: Online Booksellers......................................................................................... 209 Chapters on Urinary Incontinence ............................................................................................ 213 Directories.................................................................................................................................. 222 CHAPTER 7. MULTIMEDIA ON URINARY INCONTINENCE ............................................................ 223 Overview.................................................................................................................................... 223 Video Recordings ....................................................................................................................... 223 Audio Recordings....................................................................................................................... 225 CHAPTER 8. PERIODICALS AND NEWS ON URINARY INCONTINENCE ......................................... 227 Overview.................................................................................................................................... 227 News Services and Press Releases.............................................................................................. 227 Newsletters on Urinary Incontinence........................................................................................ 231 Newsletter Articles .................................................................................................................... 231 Academic Periodicals covering Urinary Incontinence............................................................... 234 CHAPTER 9. RESEARCHING MEDICATIONS .................................................................................. 235 Overview.................................................................................................................................... 235 U.S. Pharmacopeia..................................................................................................................... 235 Commercial Databases ............................................................................................................... 236 APPENDIX A. PHYSICIAN RESOURCES .......................................................................................... 241 Overview.................................................................................................................................... 241 NIH Guidelines.......................................................................................................................... 241 NIH Databases........................................................................................................................... 243

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Other Commercial Databases..................................................................................................... 245 APPENDIX B. PATIENT RESOURCES ............................................................................................... 247 Overview.................................................................................................................................... 247 Patient Guideline Sources.......................................................................................................... 247 Finding Associations.................................................................................................................. 269 APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 271 Overview.................................................................................................................................... 271 Preparation................................................................................................................................. 271 Finding a Local Medical Library................................................................................................ 271 Medical Libraries in the U.S. and Canada ................................................................................. 271 ONLINE GLOSSARIES................................................................................................................ 277 Online Dictionary Directories ................................................................................................... 278 URINARY INCONTINENCE DICTIONARY .......................................................................... 281 INDEX .............................................................................................................................................. 363

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FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with urinary incontinence is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about urinary incontinence, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to urinary incontinence, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on urinary incontinence. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to urinary incontinence, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on urinary incontinence. The Editors

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From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.

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CHAPTER 1. STUDIES ON URINARY INCONTINENCE Overview In this chapter, we will show you how to locate peer-reviewed references and studies on urinary incontinence.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and urinary incontinence, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type “urinary incontinence” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is what you can expect from this type of search: •

Professional Information About Urinary Incontinence on the World Wide Web: Is it Timely? Is it Accurate? Source: Journal of WOCN. Journal of Wound, Ostomy and Continence Nurses. 28(1): 5562. January 2001. Contact: Available from Journal of WOCN, Mosby-Year Book, Inc. 11830 Westline Industrial Drive, St. Louis, MO 63146. (800) 453-4351. Summary: Access to timely and accurate information about urinary continence and incontinence is important to the assessment and treatment of adults with urinary incontinence (UI). This article reports on a study undertaken to identify current Web sites containing information about urinary continence that are easily accessible to health

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care providers and to determine the timeliness and accuracy of the information included on these Web sites. The World Wide Web was searched for sites devoted to health care provider information about urinary continence and incontinence. Two external content reviewers evaluated content in terms of timeliness and accuracy. Of 265 sites located, only 15 met the inclusion criteria. Readability levels ranged from 6.2 to 14.5 years. All sites provided links, and 53 percent had internal search engines. Most information located was accurate; however, some sites contained outdated information. Forty percent of the sites were not dated, and thus determining the currency of the information was impossible. The authors conclude that the WWW is a valuable tool containing state of the art knowledge about urinary continence that WOC (wound, ostomy and continence) nurses can use to educate themselves and others. However, using critical skills to evaluate the information posted on these and any other sites is essential. The article includes a table outlining each site's credibility, content, and function. 2 tables. 15 references. •

Treatment of Urinary Incontinence in Men with Electrical Stimulation: Is Practice Evidence-Based? Source: Journal of WOCN. Journal of Wound, Ostomy and Continence Nurses. 27(1): 2031. January 2000. Contact: Available from Journal of WOCN, Mosby-Year Book, Inc. 11830 Westline Industrial Drive, St. Louis, MO 63146. (800) 453-4351. Summary: Electrical stimulation is frequently recommended for the treatment of urinary incontinence (UI) in men, a problem with a significant impact on quality of life. However, few randomized, controlled trials allow practitioners to evaluate the evidence base for this practice. This article describes a literature review undertaken to determine whether adequate evidence exists to support the use of electrical stimulation as a treatment of male UI. A brief review of the neurophysiology of voiding is followed by a discussion of the conservative applications of electrical stimulation to urge, stress, or overflow incontinence. (Urge, stress, and overflow incontinence are evaluated separately.) Therapies discussed include transcutaneous electrical nerve stimulation (TENS), bladder neck stimulation, and transrectal stimulation. This review led to 3 conclusions: theoretical and urodynamic evidence exists to support the use of electrical stimulation for urge incontinence; conflicting evidence exists in the use of electrical stimulation for stress UI; and treatment of overflow incontinence in men has not been evaluated in a systematic way. The authors conclude that for both stress urinary or overflow incontinence, practitioners should consider the existing research before recommending electrical stimulation as a first line of treatment. However, for urge incontinence, electrical stimulation may be an effective first line treatment strategy. 3 figures. 4 tables. 36 references.

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Grades of Intrinsic Sphincteric Deficiency (ISD) Associated with Female Stress Urinary Incontinence Source: International Urogynecology Journal. 13(2): 99-105. 2002. Contact: Available from Springer-Verlag New York Inc. 175 Fifth Avenue, New York, NY 10010. (212) 460-1500. Fax (212) 473-6272. Summary: Intrinsic urethral sphincter deficiency (ISD) is a clinical entity that should be suspected in women with stress urinary incontinence (SUI). If ISD is not diagnosed prior to surgery, it poses a significant risk factor for repair failure. In this article, the authors propose a classification of ISD based on the videofluorourodynamic (VFUD)

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and abdominal leak point pressures (ALPP). The authors report on their study of these tests in 100 female patients with SUI due to ISD. The ISD was classified into subtypes according to the findings of VFUD and ALPP; findings were then correlated with the clinical presentation, etiology (cause), and proposed patient management. The authors describe the three types and their diagnosis, noting that based on these data, the treatment options vary from one subtype to another. A patient management algorithm is provided. 4 figures. 4 tables. 25 references. •

Managing Urinary Incontinence Following Radical Prostatectomy Source: Journal of WOCN. Journal of Wound, Ostomy and Continence Nurses. 27(3): 138-145. May 2000. Contact: Available from Journal of WOCN, Mosby-Year Book, Inc. 11830 Westline Industrial Drive, St. Louis, MO 63146. (800) 453-4351. Summary: New diagnoses of prostate cancer more than tripled between 1990 and 1996, largely because of improved methods of detection and heightened public awareness. Radical prostatectomy (removal of the prostate) is often undertaken in men with prostate cancer who are expected to live at least 10 more years and who have tumors confined to the prostate gland. Because of high 10 year survival rates, the demand for radical prostatectomy has increased steadily during the past decade. Survival benefits aside, however, radical prostatectomy carries a significant risk of urinary incontinence, which can dramatically impair quality of life. This article reviews the clinical presentation and pathophysiology of post prostatectomy incontinence (PPI, involuntary loss of urine), including assessment and treatment options. Behavioral and pharmacologic (drug) interventions are the first line of treatment for PPI and are often continued as part of the therapeutic regimen for as long as PPI persists. Surgical interventions are reserved for patients with PPI that persists beyond 6 months to 1 year following radical prostatectomy. Behavioral treatments include pelvic muscle exercise, inhibition techniques, bladder training, modifications in diet and fluid intake, and electrical stimulation. Surgical treatments include bulking injections, sling procedures, artificial urinary sphincters, and augmentation cystoplasty. Supportive options include skin care, drip collectors, absorbent pads or briefs, condom catheters, and penile compression devices. The author concludes that nurses who specialize in wound care, ostomy care, and continence have both the skills and knowledge to assess and manage PPI in men. 2 figures. 51 references.

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Urinary Incontinence in Nursing Homes Source: Journal of WOCN. Journal of Wound, Ostomy and Continence Nurses. 29(1): 45. January 2002. Contact: Mosby, Inc. Periodicals Department, 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452. Summary: Nurses profess belief in behavioral interventions in nursing homes, but despite the evidence of their effectiveness that has accumulated over the years, it appears that little continence restoration or incontinence prevention occurs in nursing homes. In this editorial, the author considers regulatory tag 315 (urinary incontinence: catheterization) and regulatory tag 316 (urinary incontinence: prevent infection). The author reports on a panel of clinicians, researchers, and surveyors that was assembled in May 2001 to assist in an ongoing process to develop severity levels for deficiency behaviors under these regulatory tags. With use of specific protocols, a 4 level severity scale was developed. Revised interpretative guidance for surveyors was also developed.

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The guidance includes terminology, definitions, types of incontinence, and standard assessment techniques. During a facility's survey, surveyors will be looking for assurances that a facility uses an indwelling catheter for only medically valid reasons; the catheter is removed as soon as clinically warranted; efforts are applied to restore or improve bladder function as much as possible; and while the catheter is inserted efforts are made to prevent infection. Nursing behavior, then, will be shaped by these changes in the regulatory survey process. The author encourages nurses to also consider some of the issues regarding incontinence care in nursing homes, including strategies to increase the use of prompted voiding techniques rather than absorbent products to manage incontinence. 7 references. •

National Coverage Decision for Reimbursement for Biofeedback and Pelvic Floor Electrical Stimulation for Treatment of Urinary Incontinence Source: Journal of WOCN. Journal of Wound, Ostomy and Continence Nurses. 29(1): 1119. January 2002. Contact: Mosby, Inc. Periodicals Department, 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452. Summary: On October 6, 2000, the Centers for Medicare and Medicaid Services (CMS, formerly the Health Care Financing Administration or HCFA) issued a national coverage decision for the use of biofeedback and pelvic floor electrical stimulation in the treatment of urinary incontinence (involuntary loss of urine). This decision was the first major health care coverage decision made using CMS's new 'open' process. The new process included the use of a panel of physicians to evaluate adequacy of evidence to support the utilization of the modalities. This article discusses this national coverage decision. From the very beginning, there were indications that CMS was not favorably disposed toward the use of these modalities, and there was a real threat that coverage could be withdrawn or that no decision would be made. The organized and cohesive response of the health care community influenced CMS to make a positive coverage decision; CMS announced its decision to support reimbursement for biofeedback and pelvic floor electrical stimulation therapy. The author concludes that through the diligent and tenacious work of a group of nurses called the SUNA WOCN Continent Coalition, professional organizations and prominent individuals were brought together to approach CMS with one message and one voice. 4 tables. 18 references.

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Understanding the Problem of Urinary Incontinence Source: JAAPA. Journal of the American Academy of Physician Assistants. 15(1): 45-50. January 2002. Contact: Available from Medical Economics. 5 Paragon Drive, Montvale, NJ 07645. (800) 432-4570. Fax (201) 573-4956. Summary: Patients are hesitant to discuss urinary incontinence (involuntary loss of urine) and clinicians ask about it infrequently. In this article, physician assistants are encouraged to ask their patients about urinary incontinence, and to diagnose and treat this condition in order to improve the quality of life for their patients. The author reviews the four types of incontinence: detrusor overactivity, overflow incontinence, stress incontinence, and functional incontinence. The author then discusses the patient history and physical exam, the urinalysis, agents (including drugs) that can cause incontinence, the medical causes of incontinence, and treatment options, including behavioral techniques, drug therapy, surgery, and alternative therapies. The author concludes that if one therapy fails, another may prove successful, although the most

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effective treatment may not resolve the problem of incontinence completely. However, an improved quality of life, with less frequent and more manageable symptoms, will boost the patient's independence and self-esteem, a significant concern to the person affected by this disorder. 4 tables. 26 references. •

Quality of Life in Men with Urinary Incontinence After Prostate Cancer Surgery Source: Journal of WOCN. Journal of Wound, Ostomy and Continence Nurses. 27(3): 174-178. May 2000. Contact: Available from Journal of WOCN, Mosby-Year Book, Inc. 11830 Westline Industrial Drive, St. Louis, MO 63146. (800) 453-4351. Summary: Quality of life assessment is significant to health care providers because it helps them to understand the experience of well being as it relates to an illness and its severity. Attempting to deduce the influence of illness on quality of life is complex; however, this area of research has demonstrated that the measurement of quality of life is as important in providing comprehensive care as the treatment itself. This article considers quality of life in men with urinary incontinence (UI) after surgery for prostate cancer. Prostate cancer is the most prevalent cancer in American men and radical prostatectomy (removal of the prostate) is frequently considered the treatment of choice for localized prostate cancer. Despite its widespread use, considerable morbidity exists, including erectile dysfunction (ED, formerly called impotence) and UI. Although not all men who undergo radical prostatectomy will experience UI, those who do find that it influences their daily lives, affecting the clothes they wear, their activities, sleep patterns, social relationships, and self esteem. The severity of voiding symptoms seems to be a major factor in determining the effect of radical prostatectomy on quality of life (QOL). The response of health care professionals to men before and after prostatectomy also influences their QOL. Despite this link between information, appraisal, and coping, few studies have focused on the informational needs of patients with treatment related morbidities. The author concludes by discussing the implications of these findings on the care offered by WOC (wound, ostomy and continence) nurses. Nursing interventions likely to improve QOL in patients undergoing treatment for prostate cancer include providing accurate information about what to expect after surgery and about treatment for postoperative UI. 31 references.

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Review of the Anatomy of the Male Continence Mechanism and the Cause of Urinary Incontinence After Prostatectomy Source: Journal of Wound, Ostomy and Continence Nurses. 26(2): 86-93. March 1999. Contact: Available from Journal of WOCN, Mosby-Year Book, Inc. 11830 Westline Industrial Drive, St. Louis, MO 63146. (800) 453-4351. Summary: Radical prostatectomy was first described in 1905 as a treatment for prostate cancer. Since that time, urinary incontinence has been reported as a significant postsurgical problem. This article presents the current knowledge concerning the cause of postprostatectomy urinary incontinence (UI) and illustrates the complexity of the problem. An overview of the anatomy of the male continence mechanism is presented, followed by a discussion of the cause and risk factors implicated in postprostatectomy incontinence, as well as considerations for future research. Urinary leakage after radical prostatectomy is not, as traditionally thought, a simple case of stress UI. Instead, it represents a complex, multifactorial problem that continues to challenge practitioners and researchers alike. Preservation of the bladder neck and the prostatic urethra has been reported by some to improve continence without compromising cancer control.

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The author notes that until the cause of UI after radical prostatectomy is understood, it is likely that treatment will be, at best, moderately successful. Sphincteric injury plays a major role in UI in the early postoperative phase. However, the assumption that all men with urinary leakage after radical prostatectomy have pure intrinsic sphincter deficiency may be incorrect, particularly in cases of long standing UI. The author calls for a greater participation of nurses in the ongoing postoperative care of these patients. 3 figures. 1 table. 65 references. (AA-M). •

Radiofrequency Bladder Neck Suspension for the Treatment of Genuine Stress Urinary Incontinence Source: Current Urology Reports. 3(5): 378-381. October 2002. Contact: Current Science, Inc. 400 Market Street, Suite 700, Philadelphia, PA 19106 (800) 427-1796. Fax (215) 574-2225. E-mail: [email protected]. Website: http://www.current-reports.com. Summary: Radiofrequency energy has been used for numerous medical applications, including orthopedic, oncologic, and ophthalmologic indications. Characteristics of this energy source also allow it to be used for precisely controlled thermal therapy directed at soft tissues so as to induce such changes as collagen deposition and tissue shrinkage. These soft tissue effects have recently been used for the treatment of genuine stress urinary incontinence in women; this article describes this technique. As experience with this modality has matured, improved and less invasive methods of energy application have been developed. Large-scale clinical trials using this energy modality via laparoscopic and transvaginal approaches have either recently been completed or are near completion. A completely noninvasive approach is presently undergoing early clinical trials. The efficacy and safety profiles of this therapy support radiofrequency treatment of the endopelvic fascia as an option for the management of stress urinary incontinence (SUI) in women. 9 references.

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Quality Indicators for the Management of Urinary Incontinence in Vulnerable Community-Dwelling Elders Source: Annals of Internal Medicine. 135(8 part 2): 752-758. October 16, 2001. Contact: Available from American College of Physicians. American Society of Internal Medicine. 190 North Independence Mall West, Philadelphia, PA 19106-1572. Website: www.acponline.org. Summary: The prevalence of urinary incontinence in noninstitutionalized (community dwelling) persons older than 60 years of age is 15 to 35 percent; of these, 25 to 30 percent have frequent episodes of urinary incontinence (UI). In nursing homes, strategies have been designed and implemented to treat UI successfully. This article describes incontinence quality indicators that can be applied to vulnerable community-dwelling elders who may be treated across the spectrum of care, from primary care physicians to surgical specialists. On the basis of a literature study and the authors' expertise, 16 potential quality indicators were proposed; subsequently, 9 of these were judged valid by an expert panel. This article summarizes the literature that support each of these indicators. Indicators include initial evaluation, detection of incontinence, targeted history, targeted physical examination, diagnostic tests, treatment options, behavioral therapy, urodynamic testing, surgery for stress incontinence, and catheter use. The authors conclude that these quality indicators may provide a baseline for measures that can discriminate between quality and substandard care. 61 references.

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Copy Task Performance and Urinary Incontinence in Alzheimer's Disease Source: Journal of the American Geriatrics Society. 39(5): 467-471. May 1991. Summary: The relationship between behavioral symptoms and cognitive impairment in Alzheimer's disease is only poorly understood. The aim of this study was to examine cognitive correlates of urinary incontinence in Alzheimer's disease. Although incontinence is generally accepted as an accompaniment of Alzheimer's disease, it is the authors' clinical impression that it correlated poorly with global measures of cognitive impairment. A retrospective pilot study of 17 incontinent demented patients and 17 continent patients, matched for age, sex, and total score on the Folstein Mini-Mental Status Exam (MMSE), revealed a striking association between an inability to do a copy task and urinary incontinence. A prospective study confirmed this finding in a sample of 45 patients meeting DSMIII-R diagnostic criteria for dementia, probably Alzheimer's disease. The 17 incontinent patients did not differ from the 28 continent patients in age, sex distribution, or total score on the MMSE. However, the incontinent subjects scored significantly lower on a cube copying task. Qualitative analysis revealed that the drawings by incontinent patients showed features comparable with those observed in the drawings by patients with right-sided parietal lesions, in particular, poor representation of perspective and spatial orientation. Further investigation of the relationship between copying performance and incontinence may have implications for understanding the cortical mechanisms of urinary incontinence. The present results also underscore the limitations of the MMSE as a measure of dementia severity and suggest there are areas of cognitive ability which are inadequately assessed by MMSE but which may be of major importance in understanding the loss of functional skills in the patient with dementia. 18 references. (AA).

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Evaluation of Urinary Incontinence Source: Journal of the American Medical Directors Association. 3(Suppl. 1): S2-S10. January-February 2002. Summary: The safe and effective treatment of urinary incontinence (UI) requires correct identification of the underlying cause of this syndrome. UI is a symptom, not a disease or disorder, and may be caused by any of several pathophysiological mechanisms or a combination of mechanisms. This article reviews the evaluation of UI in nursing home residents, first reviewing normal urinary tract anatomy and neurophysiology to provide the necessary background knowledge. The author then offers a rationale for the diagnostic process. Specific topics include the anatomy and physiology of micturition (urination); types of UI, including temporary, urge, stress, overflow, functional, and mixed; the evaluation of UI; prevention strategies; the importance of the patient history in diagnosing the cause of UI; and the indications for postvoid residual urine volume (the amount of urine remaining in the bladder after urination) testing. The author emphasizes that the multifactorial nature of UI often results in symptoms that are not in concordance with physical findings and the results of tests; a referral to a urologist is warranted in this situation. 5 figures. 5 tables. 15 references.

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Nonpharmalogical Treatments for Urinary Incontinence in Long-Term Care Residents Source: Journal of the American Medical Directors Association. 3(Suppl. 1): S25-S30. January-February 2002. Summary: This article discusses the available nonpharmacological (non drug) management strategies for use in residents in long term care (LTC) settings for urinary

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incontinence (UI). The author provides an overview of the available modalities, their advantages, and their limitations; a special section covers the approach to the frail resident in LTC. There are two broad categories of behavioral strategies used in the treatment of UI: resident-dependent and caregiver-dependent behavioral interventions. Resident-dependent behavioral interventions (such as pelvic muscle exercises with biofeedback or timed voiding) require an active, attentive resident who is capable of learning and practicing new skills. Caregiver-dependent interventions require that someone assist the resident to manage wetness. The most tested and prescribed behavioral treatments for UI in the LTC setting are caregiver-dependent behavioral interventions, including scheduled voiding, habit training, and prompted voiding (PV). The author reviews the barriers to implementing these programs and the elements of implementing such a program. The article also discusses catheters, diapers and absorbent undergarments, and surgical intervention. Each of these options has limitations, including expense, staff time, resident preferences, and regulatory issues. Guidelines recommend the use of behaviorally based techniques as the first treatment option. 5 tables. 42 references. •

Managing Urinary Incontinence in Persons With Alzheimer's Disease Source: American Journal of Alzheimer's Care and Related Disorders and Research. 2(5): 13-19. September-October 1987. Contact: Available from Prime National Publishing Corp. 470 Boston Post Road, Weston, MA 02193. (617) 899-2702. PRICE: Single issue $8.00. Call for information. Summary: This article offers advice on the management of incontinence in patients with Alzheimer's disease. It reviews the effects of normal aging on urinary continence, the causes of urinary incontinence in the elderly, and the differences in appropriate management of incontinence in normal aging and in Alzheimer's disease. Practical advice is given for each stage of Alzheimer's, from clothing modification for easy removal, to fluid intake monitoring, to clean intermittent catheterization. The article also considers the implications for future research.

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Management of Chronic Complex Urinary Problems in Children: Urinary Incontinence Associated with Spina Bifida and Spinal Cord Injury Source: Family Urology. 5(1): 9-11. 2000. Contact: Available from American Foundation for Urologic Disease. 1126 North Charles Street, Baltimore, MD 21201. (800) 242-2383 or (410) 468-1800. Fax (410) 468-1808. Website: www.afud.org. Summary: This article on the management of chronic complex urinary problems in children focuses on urinary incontinence (UI) associated with spina bifida and spinal cord injury. The author addresses several of the complex problems that have a lifelong impact on the child and family. These problems include UI associated with the birth defect spina bifida and the acquired problem of UI associated with spinal cord injury. The author reviews the medical conditions involved, diagnostic considerations, basic management strategies, and the emotional impact of chronic illness. The author notes that regular physician visits with comprehensive evaluation of the function and structure of the bladder and kidneys are only one step in managing urinary incontinence. The emotional and developmental considerations of each individual child and family situation may impact a medical or surgical decision. The author also briefly considers the importance of a multidisciplinary care team for these children with complex medical concerns. 1 figure.

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Program Development for Promoting Adherence During and After Exercise Therapy for Urinary Incontinence Source: Patient Education and Counseling. 48(2): 147-160. October 2002. Contact: Available from Elsevier Science, Inc. Journal Information Center, 655 Avenue of the Americas, New York, NY 10010. (212) 633-3750. Fax (212) 633-3764. Summary: This article presents the development process of a health education program to promote adherence to a pelvic floor muscle exercise (PFME) therapy for women with urinary incontinence (UI). The development process started with a needs assessment phase in which the health problem, health related quality of life, and behavioral and environmental determinants were assessed. Guided by the intervention mapping (IM) approach, program objectives were formulated and, on the basis of both empirical and theoretical data, intervention methods for influencing determinants of adherence to PFME therapy were chosen and translated into practical strategies. This information was assimilated to a transparent description of the program design. The theoretical rationale of this program was based on the transtheoretical model, the self-regulation theory, and principles of targeted communication and sex-specific health care. 3 tables. 81 references.

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Stigma Associated with Postprostatectomy Urinary Incontinence Source: Journal of WOCN. Journal of Wound, Ostomy and Continence Nurses. 27(3): 168-173. May 2000. Contact: Available from Journal of WOCN, Mosby-Year Book, Inc. 11830 Westline Industrial Drive, St. Louis, MO 63146. (800) 453-4351. Summary: This article reports a collective case study that explored the social implications of postprostatectomy urinary incontinence (UI). The study featured three men older than 60 who had urinary incontinence following prostatectomy. Unstructured, indepth interviews were thematically analyzed and presented in the form of a collective case study. Participants articulated two separate entities: a private and public identity. In their public identity, the participants went to great lengths to appear as a person who was continent, and they expressed fear that their UI would be exposed. In revising their private identity, men used knowledge of their anatomy and physiology, family history, and life events to reject the cultural attitudes toward UI and renegotiate a new sense of self that was accepting of their leaking body. The author concludes that a stigma exists for men who experience UI following prostatectomy; this stigma affects both public and private identity. Naturalistic inquiry methods such as the collective case study described here provide new knowledge for continence nurses as they help these patients manage their UI within a social context. 23 references.

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Long-Term Results of the FemSoft Urethral Insert for the Management of Female Stress Urinary Incontinence Source: International Urogynecology Journal. 13(2): 88-95. 2002. Contact: Available from Springer-Verlag New York Inc. 175 Fifth Avenue, New York, NY 10010. (212) 460-1500. Fax (212) 473-6272. Summary: This article reports on a 5 year, ongoing controlled multicenter study that enrolled 150 women with stress urinary incontinence (SUI) in a test of the FemSoft urethral insert. Outcome measures included pad weight tests (PWT), voiding diary (VD), quality of life (QOL), and satisfaction questionnaires. Outcome measures during

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the baseline period were compared to evaluations during followup. Concurrent evaluations with and without device use were also performed. Statistically significant reductions in overall daily incontinence episodes and PWT urine loss were observed with the device at all followup intervals, and 93 percent of women had a negative PWT at 12 months. Women were satisfied with ease of use of device, comfort, and dryness. Significant improvements in QOL were observed. Subgroup analysis revealed that the insert was effective, despite the presence of urgency, low leak point pressure, failed surgery, and advanced age. Adverse events (AE) included symptomatic urinary tract infection (UTI) in 31.3 percent, mild trauma with insertion in 6.7 percent, hematuria (blood in the urine) in 3.3 percent, and migration in 1.3 percent of women. Women were satisfied and significant improvements in QOL were observed. AE were transient and required minimal or no treatment. The authors conclude that the urethral insert should be considered as an option for the management of SUI. 5 figures. 5 tables. 11 references. •

Quality of Life Assessment in Men and Women with Urinary Incontinence Source: Journal of Urology. 168(3): 896-905. September 2002. Contact: Available from Lippincott Williams and Wilkins. 12107 Insurance Way, Hagerstown, MD 21740. (800) 638-3030 or (301) 714-2334. Fax (301) 824-7290. Summary: This article reports on a literature review (1993 to 2001 publications) on assessment of quality of life, undertaken to evaluate and compare existing measures through their psychometric value and make adequate recommendations on their clinical use and future research. The authors note that several quality of life generic or diseasespecific questionnaires have been published for male and female urinary incontinence. However, their psychometric value is far from uniform and for most of them, responsiveness is weak or has never been reported. The authors conclude that few quality of life questionnaires are at an advanced enough stage of development to be applied in clinical practice. However, even with these questionnaires, more study remains to be done to make them shorter, more specific, and easier to use in different populations. 4 tables. 97 references.

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Male Sling for Stress Urinary Incontinence: A Prospective Study Source: Journal of Urology. 167(2 Part 1): 597-601. February 2002. Contact: Available from Lippincott Williams and Wilkins. 12107 Insurance Way, Hagerstown, MD 21740. (800) 638-3030 or (301) 714-2334. Fax (301) 824-7290. Summary: This article reports on a prospective study of the male sling surgical technique used for treating stress urinary incontinence (SUI). A total of 21 men underwent sling surgery. There were 2 titanium screws loaded with polypropylene suture placed in each descending pubic ramus through a 3.5 centimeter perineal incision at the level of the bulbar urethra. A polypropylene mesh was placed over the urethra and tied to the bone anchors, adjusting sling tension to a compression of 60 centimeters water. Followup was done with the incontinence section of the University of California, Los Angeles RAND Prostate Cancer Index. Mean followup was 12 months (range 5 to 21 months). Overall, incontinence was cured in 16 patients (76 percent), substantially improved (SUI very small or small problem, 1 pad daily) in 3 patients (14 percent), somewhat improved in 1 patient (5 percent), and no improvement in 1 patient (5 percent). The patients with SUI after undergoing transurethral prostatectomy (TURP) were cured, as was the individual with myelomeningocele. Of the 18 patients with SUI after radical prostatectomy, 13 were cured, including 1 of 2 who underwent previous artificial urinary sphincter placement and 2 of adjuvant radiation. There was significant

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improvement in each survey question, and the total score improved. The author concludes that this minimally invasive sling surgery has not been associated with any significant complication, and early results compare favorably with artificial urinary sphincter. Prior radiation or artificial urinary sphincter does not appear to be a contraindication to sling surgery. An editorial comment is appended to the article. 4 figures. 30 references. •

Results and Complications of Tension-Free Vaginal Tape (TVT) for Surgical Treatment of Female Stress Urinary Incontinence Source: International Urogynecology Journal. 12(6): 370-372. 2001. Contact: Available from Springer-Verlag New York Inc. 175 Fifth Avenue, New York, NY 10010. (212) 460-1500. Fax (212) 473-6272. Summary: This article reports on a study in which 31 patients with stress urinary incontinence (SUI) were operated on using tension-free vaginal tape (TVT). All patients were evaluated preoperatively with urodynamics, pad test, and stress test. Conservative treatment was without significant effect. Three months after the operation, no patients had stress incontinence, but 1 with mixed incontinence experienced deterioration of her urge, incontinence and 2 experienced de novo (new) urge incontinence. The new urge incontinence was significantly improved and the urodynamic investigation normal after approximately 5 months. One patient with a previous operation with Kelly sutures under the urethra developed a urethrovaginal fistula (opening from the urethra into the vagina). Fifteen patients were observed for 1 year. One patient who was continent after 3 months developed slight stress incontinence. 1 table. 5 references.

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Sphincteric Urinary Incontinence: Relationship of Vesical Leak Point Pressure, Urethral Mobility and Severity of Incontinence Source: Journal of Urology. 169(3): 999-1002. March 2003. Contact: Available from Lippincott Williams and Wilkins. 12107 Insurance Way, Hagerstown, MD 21740. (800) 638-3030 or (301) 714-2334. Fax (301) 824-7290. Summary: This article reports on a study of the relationships among urethral hypermobility, intrinsic sphincter deficiency, and incontinence in women. A total of 65 consecutive women with stress urinary incontinence (SUI) and 28 women with lower urinary tract symptoms not associated with SUI were evaluated with videourodynamics, 24 hour voiding diaries and pad tests, vesical leak point pressure measurement, and the cotton swab test. The incidence of urethral hypermobility was 32 percent in the SUI group and 36 percent in the lower urinary tract symptoms group. The authors conclude that intrinsic sphincteric deficiency and urethral hypermobility may coexist and they do not define discrete classes of patients with SUI. Urethral hypermobility did not appear to have an independent effect on the frequency or severity of incontinence. Patients with SUI can still be characterized by vesical leak point pressure and change in the urethral angle, although these variables do not always define discrete classes. 1 figure. 3 tables. 19 references.

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Urodynamics in Climacteric Women with Urinary Incontinence: Correlation with Route of Delivery Source: International Urogynecology Journal. 13(6): 366-371. 2002. Contact: Available from Springer-Verlag New York Inc. 175 Fifth Avenue, New York, NY 10010. (212) 460-1500. Fax (212) 473-6272.

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Summary: This article reports on a study that compared the urodynamic findings among climacteric (at menopause) women complaining of urinary incontinence who had only vaginal deliveries (n = 19) with those who had only cesarean sections (n = 11). Vaginal delivery was significantly associated with a reduced normal and strong desire to void and maximum cystometric capacity, compared to women who delivered only by Cesarean section. Detrusor instability was four to five times more frequent among women who had had only vaginal deliveries. There was no difference between the two groups concerning uroflowmetry parameters. The authors conclude that climacteric women with urinary incontinence who had had only vaginal deliveries are at a higher risk of urodynamic abnormalities. 5 tables. 29 references. •

Management of Urinary Incontinence and Nocturnal Enuresis in Attention-Deficit Hyperactivity Disorder Source: Journal of Urology. Volume 170: 1347-1350. October 2003. Summary: This article reports on a study undertaken to determine whether attentiondeficit hyperactivity disorder (ADHD) influences the resolution of urinary incontinence (UI) and monosymptomatic nocturnal enuresis (NE, nighttime bedwetting). The authors performed a retrospective review of patients with ADHD, UI and NE. Individuals with UI were treated with timed voiding, and anticholinergics were added only after timed voiding failed. Patients with NE were treated with either an enuretic alarm, desmopressin, or imipramine. Statistical comparisons used a control population matched for age, sex, IQ, and urinary and gastrointestinal symptoms. The results showed the presence of ADHD had a negative effect on the resolution of incontinence, with 68 percent of the patients with ADHD becoming continent compared to 91 percent of control. Two factors impact the resolution of wetness in patients with ADHD: treatment noncompliance and IQ. Treatment noncompliance was found in 48 percent of the patients with ADHD compared to 14 percent of controls. The IQ of patients with ADHD affected success, with 32 percent of children with an IQ of less than 84 achieving continence compared to 80 percent of those with an IQ of 84 or greater. Patients with ADHD and NE responded similarly to controls when using desmopressin and imipramine. However, they were less likely to exhibit a durable response following management with an enuretic alarm. The authors conclude that treatment of urinary incontinence in children with ADHD is impaired compared to those without ADHD, and is directly affected by compliance and IQ. 3 tables. 21 references.

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Pharmacotherapy of Urinary Incontinence Source: Journal of the American Medical Directors Association. 3(Suppl. 1): S16-S24. January-February 2002. Summary: This article reviews the use of drug therapy to treat urinary incontinence (UI), particularly how medications can be used in nursing home residents. The most effective pharmacotherapy (drugs) for decreasing the strength of detrusor contractions, improving bladder storage of urine, and improving patient symptoms is the use of anticholinergic antispasmodic agents. From this category of drugs, oxybutynin immediate release (OIR), oxybutynin extended release (OXL), tolterodine immediate release (TIR), and tolterodine extended release (TLA) tablets constitute first line therapies. Differences in effectiveness, adverse effects, drug interactions, patient tolerability, administration convenience, and drug cost determine drug selection. The author explores each of these factors, including the use of these drugs for stress UI, mixed UI, and obstructive overflow incontinence (with or without neurogenic bladder). The author concludes by noting that many elderly people lack the compulsory cognitive

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or physical functioning and motivation to successfully execute many behavioral interventions. For this and other reasons, drug therapy often constitutes a first line approach to managing UI in this population. In addition, drug therapy can be an important adjunct to behavioral therapy. 2 tables. 125 references. •

Keeping Dry: Help for Urinary Incontinence Source: Diabetes Self-Management. 13(1): 46-50, 52. January-February 1996. Contact: Available from R.A. Rapaport Publishing, Inc. 150 West 22nd Street, New York, NY 10011. (800) 234-0923. Summary: This article updates readers on treatment options for female urinary incontinence. Topics include the incidence of urinary incontinence in women with diabetes; the types of incontinence and the symptoms of each; the causes of incontinence; diagnosis of a urinary incontinence problem; and treatment options, including Kegel exercises, bladder neck support prostheses, clean intermittent catheterization, and surgery. The article includes the addresses for two organizations through which readers can obtain more information. 3 references.

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Effects of Patterned Urge-Response Toileting (PURT) on Urinary Incontinence Among Nursing Home Residents Source: Journal of the American Geriatrics Society. 40(2): 135-141. February 1992. Summary: This journal article describes a 37-week study designed to test, over time, an individualized form of habit training for urinary incontinence (UI) among long stay cognitively and/or physically impaired elderly residents of four nonprofit nursing homes. The study involved 113 elderly persons, randomized by nursing home unit into experimental and control groups. Eighty-eight persons completed the study. All were physically and/or mentally impaired, averaged age 85, and had either urge or urge/stress urinary incontinence. Baseline wet checks were done hourly for one 24hour period at 3-week intervals over 12 weeks followed by 72 hours of continuous electronic monitoring to establish precise voiding patterns for each individual. The 12week intervention period was administered by regular staff after they attended a 4-hour urinary incontinence educational program. The residents were followed an additional 12 weeks to determine the extent of maintenance of the intervention among staff and study patients. Urinary incontinence was significantly decreased during the 3-month period in the experimental group. Eighty-six percent showed improvement over baseline while one third improved 25 percent or more over their baseline rate. During the same period of time, the control group's urinary incontinence increased. The authors conclude that the training program was effective in reducing urinary incontinence, although compliance among nursing staff averaged only 70 percent of the prescribed toileting times. They note that this individualized approach supports the recent regulatory thrust to individualize care to promote and maintain functional abilities and autonomy. 26 references. (AA-M).

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Urinary Incontinence in Nursing Home Residents With Dementia: The MobilityCognition Paradigm Source: Applied Nursing Research. 3(3): 112-117. August 1990. Summary: This journal article describes a study that evaluated various patient factors associated with urinary incontinence in nursing homes. The goal of the study was to identify the importance of these factors in predicting urinary incontinence in patients

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with cognitive impairment. The sample consisted of 61 elderly residents of a rural skilled nursing facility who had some type of chronic degenerative brain disease. Of the 61 patients, 29 were incontinent and 32 were continent. The residents' cognitive ability and patient mobility were measured using direct interviews, a mental status questionnaire, a visual counting test, and the set test. The cognitive ability and mobility differed significantly between the incontinent and continent patients. Mobility was determined to be the best predictor of a patient's urine control, with cognitive impairment being the next best predictor. The authors assert that these findings demonstrate the importance of examining patient mobility issues when dealing with urinary incontinence in nursing home residents. 21 references. •

Epidemiology and Natural History of Urinary Incontinence Source: International Urogynecology Journal. 11(5): 301-319. 2000. Contact: Available from Springer-Verlag New York Inc. 175 Fifth Avenue, New York, NY 10010. (212) 460-1500. Fax (212) 473-6272. Summary: This lengthy article examines the current state of knowledge of the epidemiology (prevalence and incidence) of urinary incontinence (UI). The population studied was community dwelling noninstitutionalized persons. The review includes discussion of the prevalence, incidence, natural history and presence of racial and ethnic differences in the epidemiology of UI. The authors cover the epidemiology of enuresis (bedwetting) and UI in children, UI in women, risk factors (age, pregnancy, childbirth, menopause, hysterectomy, obesity, functional impairment, cognitive impairment, and occupational risks), UI in men, and differences in prevalence estimates. The authors also review correlates and potential risk factors that have been revealed in epidemiological studies. The authors also discuss differences between epidemiological and clinical approaches to a health problem, help seeking behavior, and methodological issues for research. The authors note that there is an absence of epidemiological data in developing countries; research regarding prevalence, incidence, and other epidemiological data in such countries should be encouraged. The authors caution that prevalence estimates can change dramatically when the nuisance, frequency, and amount of leakage are considered. In addition, there is also selection bias through the health care system. 5 figures. 11 tables. 161 references.

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Urinary Incontinence Associated With Dementia Source: Journal of the American Geriatrics Society. 43(3): 286-294. March 1995. Summary: This paper critically reviews the literature on urinary incontinence associated with Alzheimer's disease and vascular (multi-infarct) dementia, with particular reference to its prevalence, etiology, assessment, and management. Urinary incontinence is common in patients with dementia and is more prevalent in people with dementia than in older people without dementia. It occurs with equal or greater frequency in males than in females. Research on the management of urinary incontinence in patients with dementia has focused almost exclusively on toileting programs and drug treatments for detrusor hyperactivity. To date, anticholinergic and antispasmodic medications have not been shown to be effective in treating incontinence in people with dementia. Few studies have been undertaken involving patients who are severely mentally and physically deteriorating, and these medications may have greater efficacy in less impaired people. Prompted voiding regimens have been shown to reduce incontinence by an average of 32 percent and appear to be a useful approach in managing incontinence in some of these patients. However, according to the authors,

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unless staff management systems are used, staff compliance with these programs diminishes with time and the labor costs involved may limit their applicability in nursing homes. Patients who are the most severely cognitively impaired, least mobile, and have the greatest frequency of incontinence derive the least benefit from toileting programs, and palliative measures may be more appropriate in these cases. 2 tables, 96 references. •

Urinary Incontinence and Dementia: The Perils of Guilt by Association Source: Journal of the American Geriatrics Society. 43(3): 310-311. March 1995. Summary: This paper discusses the flaws in an argument that dementia causes incontinence. Research suggests that overactivity of the muscles of the bladder wall was the most common type of lower urinary tract dysfunction in nursing home residents regardless of cognitive function. Realization that the etiology of incontinence in people with dementia is multifactorial and often complex is changing the approach to incontinence in the nursing home. According to the authors, the prevalence, morbidity, and cost of incontinence demand that certain questions be addressed thoughtfully and expediently; these questions are listed. 13 references.

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Management of Urinary Retention and Obstruction Following Surgery for Stress Urinary Incontinence Source: Current Urology Reports. 3(5): 354-359. October 2002. Contact: Current Science, Inc. 400 Market Street, Suite 700, Philadelphia, PA 19106 (800) 427-1796. Fax (215) 574-2225. E-mail: [email protected]. Website: http://www.current-reports.com. Summary: Urethral obstruction is a potential consequence of all types of antiincontinence surgery. This article reviews the management of urinary retention and obstruction following surgery for stress urinary incontinence (SUI) in females. Not all patients will present with obvious urinary retention: the surgeon must have a high index of suspicion to make the correct diagnosis in these cases. Important considerations in the diagnosis of these patients include the timing and methodology of evaluation. Formal urethrolysis in a variety of approaches has demonstrated similar cure rates and recurrent stress incontinence rates (approximately 15 percent). Sling incision may provide an easier and less morbid approach to relieving obstruction caused by a pubovaginal sling with equal efficacy. The authors describe the procedures and anticipated outcomes. 1 table. 24 references.

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Model for Predicting Motor Urge Urinary Incontinence Source: Nursing Research. 50(2): 116-122. March-April 2001. Contact: Available from Educational Services Division, American Journal of Nursing Company. 555 West 57th Street, New York, NY 10019-2961. (800) 627-0484 or (303) 6041464. Summary: While the historical interview (taking a patient's history and symptoms) has been shown to diagnose stress urinary incontinence (UI) with reasonable accuracy, it is less accurate in the diagnosis of urge or mixed UI. This article reports on a study undertaken to construct an optimal model for the diagnosis of motor urge UI, and to refine this model into a simplified instrument that can be used to diagnose motor urge UI during a routine incontinence evaluation. Initially, an optimal model was developed that used three key symptoms, age, gender, a history of neurologic disorder, obstruction

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diagnosed via voiding pressure study, and the urethral resistance algorithm to diagnose motor urge UI. A simplified model was then constructed using factors such as symptoms of motor urge UI, age, and gender that were readily accessible to the nurse when completing a routine UI evaluation. This simplified model was then used to develop an instrument for the clinical diagnosis of motor urge UI. Results showed that while the agreement between clinical and urodynamic diagnosis was relatively high among patients with genuine stress UI (93 percent accuracy rate), it was considerably less among patients with urge and mixed UI, yielding accuracy rates of 63 percent and 35 percent, respectively. An optimal model for diagnosing motor urge UI was constructed and provided an overall accuracy rate of 91 percent; the simplified model used the combination of age, gender, and three key symptoms (diurnal or daytime frequency of urination, nocturia or nighttime urination, and urge incontinence) to provide an accurate and clinically useful method for the diagnosis of motor urge UI. 2 figures. 2 tables. 24 references. •

Conquering Urinary Incontinence: Knowledge is Key (editorial) Source: Contemporary Urology. 14(3): 11. March 2002. Contact: Available from Medical Economics Publishing Inc. Montvale, NJ 07645. (800) 432-4570. Summary: With the aging of America, urinary incontinence is becoming progressively more common. In addition, the most common cause for institutionalization and transfer from minimal or moderate to higher intensity care in nursing homes is the loss of urinary or bowel control. For patients in the community, because of their embarrassment and distress, those experiencing urinary incontinence often avoid revealing their condition to their friends, family, and physicians. Many older patients mistakenly believe that this problem is a normal consequence of aging and therefore seek little or no medical help. This brief editorial encourages urologists to continue their efforts to identify and manage patients with urinary incontinence. Better understanding of the anatomy and the use of sophisticated evaluation systems (including videourodynamics and ambulatory urodynamics) now allow better identification of the cause of urinary incontinence, so that treatment can be directed based on the specific abnormality. Introduction of new medications for the overactive bladder, for benign prostatic hyperplasia (BPH), and for lower urinary tract symptoms has also improved the lives of incontinent patients. The author concludes that a combination of careful urodynamic evaluation, new and traditional surgical techniques, and pharmacologic therapies will permit urologists to improve functional status in many of these patients, allowing them to return to an active lifestyle and normal socialization.

Federally Funded Research on Urinary Incontinence The U.S. Government supports a variety of research studies relating to urinary incontinence. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. 2

Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

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Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to urinary incontinence. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore urinary incontinence. The following is typical of the type of information found when searching the CRISP database for urinary incontinence: •

Project Title: A MODEL FOR USE OF THE UI GUIDELINE IN US NURSING HOMES Principal Investigator & Institution: Watson, Nancy M.; None; University of Rochester Orpa - Rc Box 270140 Rochester, Ny 14627 Timing: Fiscal Year 2002; Project Start 01-SEP-2000; Project End 31-AUG-2004 Summary: This study will test the effectiveness of a new model of care to translate the AHCPR Urinary Incontinence (UI) Guideline into practice in nursing homes. The model will utilize nurse practitioners in nursing homes to implement a carefully designed and focused effort to identify, work up, treat and follow up new cases of urinary incontinence on an ongoing basis -- in collaboration with medical and nursing staff. The model will be tested utilizing existing nurse practitioners in nursing homes, but has potential application for all nursing homes -- regardless of whether they have nurse practitioners on staff -- since the nurse practitioners' work could be effectively accomplished by consulting nurse practitioners and could likely be reimbursed under existing HCFA mechanisms. A quasi-experimental design will be used to evaluate the practice performance of five experimental nurse practitioners at experimental nursing home sites and five control nurse practitioners at control nursing home sites who will be followed prospectively for 15 months prior to the intervention and 15 months during the intervention using detailed chart review by blind nurse reviewers. A total of 200 cases of new UI prior to the intervention and 200 cases of new UI during the intervention will allow comparison of changes or lack of changes in key practice performance areas. The study will determine the feasibility of this focused approach by nurse practitioners for improving specifically targeted areas of UI care in nursing homes (i.e., case identification, treatment of reversible causes of UI, basic physical examination, rectal examination, post-void residual testing, bladder training, use of recommended UI medications) as well as the effectiveness of the model in,reducing UI in nursing homes, preventing the complications associated with UI and improving the quality of life of nursing home residents and families. The cost of the model will also be determined and compared to usual care. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: A NOVEL ACCESSORY FOR URINARY LEGBAGS Principal Investigator & Institution: Sarangapani, Shantha; Innovative Chemical/Environmental Tech Environmental Technologies, Inc Norwood, Ma 02062 Timing: Fiscal Year 2001; Project Start 01-MAY-1999; Project End 30-SEP-2004 Summary: The phase I effort on the testing and performance of a biocidal device (Foley Guard) placed between the catheters and urinary leg bags to prevent ascending infections from leg bags into the urinary catheters was successfully completed. An in vitro apparatus mimicking a catheterized bladder with infected leg bags was used. A multi channel pump and manifolds allowed comparison between the controls and the

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experimental devices under the same conditions. The addition of a biocidal device as an accessory to the leg bags resulted in the complete absence of any microorganisms near the catheter base for over 10-14 days, which was the duration of the experiment. All of the corresponding controls showed high levels of the bacteria near the catheter base within 3-9 days. These in vitro tests suggest a useful role for the device in controlling infection in patients undergoing short and long term indwelling catheterization. A continuous challenge of three pathogens in human urine medium, showed that for up to 30 days the materials inhibited all the bacteria completely. The broad-spectrum activities of the phase I biocidal material used in this Foley guard has been well established by the PI. (toward bacteria, mold, and candida-type yeast species). A two week rabbit- muscle implantation study of the biocidal material resulted in a non-toxic response. The phase II will optimize the formulation and the manufacturing protocols. A series of microbiological tests using the strains from catheterized patients will be performed to assess: the biocidal potency per unit weight of the material, the potency before and after extensive washing in synthetic urine and the bactericidal activity and the longevity of the device under in vitro conditions. The biocide release concentrations will be established firmly for our claims. Finally, human clinical trials will be conducted to establish the efficacy and performance and compared to controls. PROPOSED COMMERCIAL APPLICATIONS: In 1992 the number of urogenital devices in North America was substantial. About 1.6 billion incontinence pads and devices, 16 million catheters and 58 billion diapers were reportedly used. (Reid, 1994 J. of industrial microbiology, 13 90-96) Estimates of the cost of treating catheter-related UTI have ranged as high as $39,960 per patient per year including the increase in nursing care required. As the senior population grows this problem is becoming more common. We believe if our accessories are used by 20% of the leg bag users, a market at least million accessories exists. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: A RANDOMIZED SURGICAL TRIAL: BURCH VS. SLING Principal Investigator & Institution: Brubaker, Linda T.; Professor & Fellowship Director; Obstetrics and Gynecology; Loyola University Medical Center Lewis Towers, 13Th Fl Chicago, Il 60611 Timing: Fiscal Year 2002; Project Start 01-SEP-2001; Project End 30-JUN-2005 Summary: (Provided by Applicant): The Loyola team plans participation in the Urinary Incontinence Treatment Network in order to advance our understanding of the clinical care for women with genuine stress urinary incontinence. Our multi-disciplinary team has the volume and proven ability to participate in clinical trials. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: A SYSTEM FOR MEASURING PELVIC MUSCLE STRENGTH IN WOMEN Principal Investigator & Institution: Cole, Neil Martin.; President; Bio Logic Engineering, Inc. 1675 N Lima Center Rd Dexter, Mi 48130 Timing: Fiscal Year 2002; Project Start 30-SEP-2000; Project End 31-JUL-2004 Summary: (provided by applicant): One in nine women suffer from pelvic floor dysfunction, including urinary incontinence and vaginal wall or uterine prolapse (VUP). Stress urinary incontinence (SUI) affects 38% of women over the age of 65 years and over 13 million women in the United States. Pelvic muscle strength is commonly assessed in these patients. However, current measurement techniques are either

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subjective or produce artifact, due to their non-isometric nature or contamination by intraabdominal pressure. During Phase I, we developed a second generation system that measures the isometric strength and contractile properties of female pelvic floor muscles. The system centerpiece is a novel intravaginal transducer that differentiates between intraabdominal pressure and levator ani force. During Phase II, system mechanics, electronics and software will be refined to improve system sensitivity, accuracy, and ease-of-use. Laptop- and Personal Data Assistant-based systems will be developed and validated. Clinical device performance will be confirmed by testing the null hypothesis in 120 women (40 healthy continent, 40 with VUP, 40 with SUI) that localized pelvic floor muscle defects visible on MR scans will correlate with pelvic muscle weakness. The system allows assessment of pelvic floor function and exercise intervention efficacy, and can provide biofeedback and adherence data during training. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ADIPOSE INCONTINENCE

DERIVED

STEM

CELLS

FOR

TREATMENT

OF

Principal Investigator & Institution: Rodriguez, Larissa V.; Urology; University of California Los Angeles 10920 Wilshire Blvd., Suite 1200 Los Angeles, Ca 90024 Timing: Fiscal Year 2004; Project Start 01-APR-2004; Project End 31-MAR-2009 Summary: (provided by applicant): Stress urinary incontinence (SUI) is a devastating condition affecting millions of American women. For these patients urinary incontinence is not only an embarrassing condition significantly eroding quality of life, it is also a significant cause of hospitalization. In 1995 the annual cost of incontinence in the United States was estimated to be 26.3 billion dollars. It affects women of reproductive age who are at risk after vaginal deliveries. Its incidence increases with advancing age, making it a major quality of life issue for the elderly. Developing a minimally invasive procedure with high and durable cure rates would have a significant impact on the way physicians treat incontinence and a positive financial impact on health care expenditures. More importantly, it will dramatically improve the quality of life of these patients. With aging there is atrophy of the smooth musculature of the urethra contributing to poor urethral resistance and involuntary loss of urine. Bioengineering new functional tissue in order to increase urethral resistance and improve function has enormous clinical potential for the treatment of stress urinary incontinence. The long-term objective of this application is to apply tissue-engineering techniques exploiting the properties of adult stem cells derived from adipose tissue to develop an effective, minimally invasive treatment for stress incontinence. Our central hypothesis is that human adipose tissue contains a population of pluripotent stem cells capable of differentiating into functional smooth muscle. Specifically, this proposal aims at developing an injectable combination of cells, factors, and matrix to promote the development of vascularized, longlasting functional urethral musculature. The specific aims of this application are: (1) to investigate the ability of human adipose derived stem cells to form functional smooth muscle, (2) to investigate the ability of human adipose derived stem cells to be delivered, survive, and function as normal smooth musculature in the lower urinary tract, (3) to determine the ability of these cells to repair the atrophic nonfunctional urethra of stress incontinence. We will accomplish these aims by evaluating the ability of clonal populations of adipose derived stem cells to differentiate phenotypically and functionally into smooth muscle. Lastly, we will use an animal model of incontinence and decreased urethral resistance to test the hypothesis that these cells can be used to reconstruct a functional urethra as a treatment of stress incontinence. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Urinary Incontinence

Project Title: ADVANCING THE TREATMENT OF FECAL & URINARY INCONTINENCE Principal Investigator & Institution: Whitehead, William E.; Professor of Medicine; Interntl Fdn for Funct Gastro Disorders Gastrointestinal Disorders Milwaukee, Wi 53217 Timing: Fiscal Year 2002; Project Start 01-SEP-2002; Project End 31-AUG-2003 Summary: (provided by applicant): Fecal and urinary incontinence are major public health problems that disproportionately affect women and the elderly. Fecal incontinence affects 2.2% of community dwelling adults and is present in 45% of nursing home residents, while urinary incontinence severe enough to interfere with quality of life affects an estimated 6% of American adults. Together, fecal and urinary incontinence account for an estimated $26 billion in health care costs. Behavioral, medical (drug), and surgical approaches have been described for the treatment of both fecal and urinary incontinence, but the majority of patients are managed palliatively with diapers and pads. This is due in part to the fact that very few randomized, controlled trials have been done to evaluate the efficacy of these treatments and to determine which patients are most likely to benefit from them. As a consequence, insurers are reluctant to reimburse for the treatment of incontinence, and many clinicians remain skeptical. However, clinical trial methodology has evolved to the point that pivotal studies can now be done. In preparation for such trials, we propose to hold a conference to (1) bring together established researchers to exchange information on research design, (2) define research priorities from the perspective of all the professional subspecialties involved in the treatment of incontinence, (3) publish the proceedings of the conference as state of the art guidelines for conducting clinical trials in this area, and (4) request NIH to issue a Request for Applications to fund such trials. The conference will be organized by the International Foundation for Functional Gastrointestinal Disorders with the guidance of a steering committee of gastroenterologists, urologists, surgeons, gynecologists, gerontologists, psychologists, nurses, patient advocates, and NIH program staff. The conference is scheduled to take place November 3-5, 2002, in Milwaukee, and half of the invitees have accepted invitations to speak. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: ALPHA1-ADRENOCEPTOR PATHOPHYSIOLOGY

SUBTYPES

&

ROLE

IN

Principal Investigator & Institution: Perez, Dianne M.; Associate Staff; Cleveland Clinic Foundation 9500 Euclid Ave Cleveland, Oh 44195 Timing: Fiscal Year 2003; Project Start 15-JUL-1999; Project End 30-JUN-2007 Summary: (provided by applicant): This is a request for years 05-9 of a project designed to further our understanding of the molecular and biochemical mechanisms of signal transduction and physiology mediated by alpha1-adrenergic receptor (AR) subtypes. Alpha1-ARs (a1A, a1B and a1D) are members of the G-protein-coupled receptor family of proteins that mediate the sympathetic nervous system by binding the endogenous catecholamines, epinephrine and norepinephrine. These receptors are a current therapeutic target in the management of hypertension, benign prostatic hypertrophy, and urinary incontinence through their role in smooth muscle contraction. Alterations in the signaling pathways and/or receptors themselves may contribute to the pathogenesis of these diseases. Thus, a detailed understanding of the structure-function of these receptors and their signal transduction mechanisms will be crucial to our understanding of the pathology and treatment of these diseases. The current state of knowledge in alpha1-AR subtype pharmacology (i.e. localization, signaling differences

Studies

23

and pathology) are impaired due to the lack of specific antibodies, agonists and antagonists that have enough selectivity to prevent cross-binding among the subtypes. In past grants, our laboratory has made significant contributions to the structurefunction of alpha1-AR subtypes by characterizing determinants in the binding pocket that contribute to agonist and antagonist binding and to subtype selectivity. We have also developed transgenic mice that systemically overexpress the alpha1B-AR subtype and showed that it causes neurological as well as cardiovascular pathology. Significant progress has been made in the current funding period and this application builds upon these observations. Based on these results, we now propose to determine how similar or different the alpha1-AR subtypes control various aspects of their function. This application integrates molecular and cellular methodologies with state of the art in vitro and in vivo approaches in an comprehensive experimental design that will significantly increase our understanding of the subtype-specific binding pocket, the localization, signaling and functional differences between alpha1-subtypes that will enhance our knowledge of drug design and therapeutic strategies. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ALTERNATE THERAPIES FOR BENIGN PROSTATE SYMPTOMS Principal Investigator & Institution: Dixon, Chistopher M.; Urology; New York University School of Medicine 550 1St Ave New York, Ny 10016 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 31-MAR-2009 Summary: (provided by applicant): Over the past 10 years, medical therapy for men with symptomatic benign prostatic hyperplasia (BPH) has become first-line therapy. Well-designed clinical trials have defined the role of medical therapy for symptom reduction, improved quality of life and diminished the likelihood of disease progression. Phytotherapy for BPH has long been a popular therapeutic option in spite of the lack of compelling scientific information about the mechanism(s) of action, magnitude of symptom improvement, adverse effects or long-term preventative role of these extracts. The primary objective of this application is to determine whether the long-term use of saw palmetto or pygeum africanum delays or prevents the progression of clinical BPH as compared to placebo. Clinical progression will be specifically defined as symptom progression, acute urinary retention, recurrent infection or urosepsis, urinary incontinence or renal insufficiency. Patients will also be classified if they crossover to other BPH treatment options (watchful waiting, medical or invasive treatment). The secondary research questions include an assessment of the natural history of BPH in a well-defined population, differences over time between the 3 cohorts with respect to symptom score, quality of life, urinary flow rates, post void urinary residual, sexual function and prostate volume. The subgroup hypotheses will assess whether treatment response is related to symptom severity, urinary flow rate, residual urine, prostate size or prostate specific antigen hopefully providing some insight into the mechanism of action should these agents be proven effective. The study will enroll approximately 3000 men at 10 centers during the first 2 years. Patients will be followed at 3-month intervals for 4 to 6 years using standard outcome measures. This trial will determine whether saw palmetto or pygeum africanum are worthwhile alternative for the treatment of men with symptomatic BPH. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Urinary Incontinence

Project Title: HYPERPLASIA

ALTERNATIVE

THERAPIES

FOR

BENIGN

PROSTATIC

Principal Investigator & Institution: Nickel, J Curtis.; Queen's University at Kingston Kingston K7l 3N6, Canada Kingston, Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 31-MAR-2009 Summary: (provided by applicant): Serenoa repens (saw palmetto) and Pygeum africanum appear to have modest benefit on the pathophysiology of established benign prostatic hyperplasia (BPH) but even more importantly these agents may affect the pathogenesis of the progressive disease process. Almost every individual study, systematic review and meta-analysis report analyzing the effect of these phytotherapeutic agents on BPH have come to the same conclusion: further research is needed to determine the long term safety and effectiveness and ability to prevent complications associated with progressive BPH. The primary objective of this study is to determine if serenoa repens or pygeum africanum delays or prevents clinical progression of benign prostatic hyperplasia compared to placebo treatment. Secondary objectives will compare relative efficacy of these two treatments and also determine whether either of these agents ameliorate symptoms of BPH, improve BPH specific quality of life, improve maximum flow rate and reduce residual urine in men with BPH. Men with mild to moderate symptoms of BPH who do not desire or require immediate medical or surgical treatment will be randomized to placebo, serenoa repens or pygeum africanum after placebo run in and will be followed for disease progression for a minimum of four years. Progression will be defined as an increase in AUA symptom score of 4 or more points from baseline, or occurrence of any of the following complications of BPH; acute urinary retention, incontinence, obstructive uropathy (measured as increased creatinine) or BPH related urinary tract infection. The Canadian BPH Research Group (Canadian CETC) have demonstrated experience and expertise in designing and implementing multi-center clinical trials in BPH and are the most successful research group in Canada in recruiting patients to multi-center BPH trials. The principal investigator has been a successful and effective collaborator in studies funded by NIH-NIDDK. The members of this group have demonstrated their willingness and ability to work in an effective and congenial manner in collaborative international multi-center studies including NIH sponsored collaborative groups. The Canadian BPH study group would be a valuable partner in the proposed NIH phytotherapeutic BPH prevention trial. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ALTERNATIVE THERAPIES FOR BENIGN PROSTATIC SYMPTOMS Principal Investigator & Institution: Naslund, Michael J.; Surgery; University of Maryland Balt Prof School Baltimore, Md 21201 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 31-MAR-2009 Summary: (provided by applicant): The purpose of this request is to establish a cooperative group of approximately 10 prostate evaluation and treatment centers nationwide which will develop and conduct a prospective, randomized, double-blind, placebo controlled clinical trial to determine whether Saw Palmetto(SP) and/or Pygeum Africanum(AP) can prevent the clinical progression of benign prostatic hyperplasia (BPH). BPH is a common disease in men over 50 which can lead to bothersome voiding symptoms, urinary retention, permanent bladder damage, renal failure, urinary tract infections, urosepsis or urinary incontinence. Treatment options with documented efficacy include medication, several thermotherapy options, and surgical prostatectomy.

Studies

25

Phytotherapy is another treatment option for BPH which is used widely in Europe and is experiencing increasing utilization in the United States. Two common phytotherapeutic agents SP and PA. Despite the widespread use of these substances, there is no convincing data in the literature which demonstrates efficacy for the treatment of BPH. These phytotherapeutic substances do appear to be safe from the patients' perspective. The objective of this trial is to determine if SP and/or PA can prevent the clinical progression of BPH, as defined by the development of: acute urinary retention, renal insufficiency due to BPH, recurrent urinary tract infections, urinary incontinence, or an increase in the international prostate symptom score (IPSS) of 4 or more points over a four year trial. Parameters to be assessed in the subjects enrolled in this trial include IPSS, peak urinary flow rate, post void residual volumes, quality of life and sexual health questionnaires, prostate size determined by prostatic ultrasound, blood count and blood chemistries, urinalysis, serum hormone levels, a history and physical examination. Patients will be assessed every 3 months over a four year trial period. The chosen group of collaborators will meet to design the protocol including diagnostic criteria, inclusion/exclusion criteria, safety measurements and quality of life outcome measurements. The trial will commence after the protocol has been developed, an operations manual has been completed and data collection techniques have been established. Each site will obtain IRB approval of the final protocol. When the study is complete and the data has been analyzed, publication of relevent results will be done. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ALTERNATIVE VARIABLILITY

THERAPIES

FOR

BPH,

MULTIETHNIC

Principal Investigator & Institution: Kaplan, Steven A.; Professor of Urology, Vice Chair; Urology; Columbia University Health Sciences Po Box 49 New York, Ny 10032 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 31-MAR-2009 Summary: (provided by applicant): Benign prostatic hyperplasia (BPH) is the most common affliction of men over the age of 50. There has been a rapid increase in the use of alternative therapies and specifically, phytotherapuetic agents, to treat BPH. Published studies have focused on the relative efficacy, i.e. symptoms, urinary flow rate and nocturia and side effect profile of these therapies. To date, there have been no studies which have described the natural history of BPH progression in those who are treated with phytotherapeutic agents such as Serenoa repens (Saw palmetto berry) or Pygeurn africanum (African plum tree). Moreover, the natural history of BPH in various age and ethnic groups have been poorly characterized. The Prostate Canter and the The Center for Holistic Urology at The New York Presbyterian Hospital evaluates and treats an ethnically diverse group of more than 3,200 men per year with lower urinary tract symptoms secondary to BPH. It is well positioned to meet the recruitment and patient retention goals as a CETC in this important multi - center, 7 year trial. This trial will provide enormous insight into the progression of BPH and related symptoms in both an untreated population, i.e. placebo versus one treated with phytotherapeutic agents. This is of particular importance because efficacy can be truly determined only with an understanding of the untreated natural history of BPH. Our primary objective is to ascertain if Serenoa repens or Pygeum africanum delays or prevents the clinical progression of BPH. Patients will be classified as 1) Progression of disease as defined by one of the following: rise in baseline AUA Symptom Score of 4 points; urinary retention; incontinence; or recurrent urinary tract infections; 2) Crossover to known therapy, i.e. medical or invasive prior to clinical progression; 3) non - compliance with the coded medication treatment regimen including patients who elect watchful waiting or open -

26

Urinary Incontinence

label phytotherapy. Secondary outcomes include comparative efficacy between Serenoa repens and Pygeum africanum as defined by symptoms and urodynamic measurements. Through this full scale BPH trial, we hope to ascertain: A) the effects, if any, of phytotherapeutic agents on the clinical progression of BPH, B) the optimal temporal intervention in the treatment of BPH, C) whether specific ethnic groups manifest various forms of BPH resulting in different rates of progression and differential response to therapy? and, D) whether concomitant prostate conditions such as prostatitis are effected by phytotherapeutic intervention for BPH? Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: BALTIMORE CONTINENCE TREATMENT CENTER Principal Investigator & Institution: Chai, Toby C.; Associate Professor; Surgery; University of Maryland Balt Prof School Baltimore, Md 21201 Timing: Fiscal Year 2002; Project Start 01-SEP-2001; Project End 30-JUN-2005 Summary: (Provided by Applicant): Urinary incontinence (UI) is a common problem that diminishes the quality of life in millions of people. The annual cost of treating UI is estimated to be $16 billion making this an economic issue as well. Despite the high prevalence of UI, the evaluation and treatment of UI are not standardized. Outcome data from treating UI are also variable making comparisons among different treatment options difficult. While UI may be due to several etiologies, this proposal will examine the outcomes in surgical management of UI in females. We propose a multidisciplinary approach to standardize this process utilizing a collaborative effort between urologists and urogynecologists who specialize in UI and have published and/or participated in clinical research in this field. These investigators who practice and perform surgeries at University of Maryland Medical Systems (UMMS), Baltimore Veterans Administration Medical Center (BVAMC), Johns Hopkins Hospital (JHH), Johns Hopkins-Bayview Medical Center (JHU-BMC), and Greater Baltimore Medical Center (GBMC) have formed the Baltimore Continence Treatment Center (BCTC). We propose that the BCTC be part of the collaborative network of CTCs selected to participate in long-term cohort studies examining outcomes related to surgical treatment of UI. Because the design of the cohort study already has been developed by the vanguard CTCs, the BCTC proposes these further Specific Aims 1. Maximize total enrollment of UI patients info selected cohort studies through the collaboration of five institutions within the Baltimore metropolitan area; 2. Maximize recruitment of minority subjects through advertisement, public announcements, and public educational programs; 3. Maximize patient retention in cohort studies by financial and other incentives. The blend of academic practices and community-based practice in the BCTC will allow recruitment of a diversity of UI patients that will more accurately reflect the spectrum of care for this problem in the United States. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

•

Project Title: BEAUMONT/DETROIT CONTINENCE TREATMENT CENTER Principal Investigator & Institution: Diokno, Ananias C.; Professor and Chief; William Beaumont Hospital 3601 W Thirteen Mile Rd Royal Oak, Mi 480736769 Timing: Fiscal Year 2002; Project Start 30-SEP-2000; Project End 30-JUN-2005 Summary: One of the major goals of this project is to determine the long term effects and outcomes including complications of the' most commonly used surgical procedures for urinary incontinence. Extensive review of the literature shows that the success rate (continence) and improvement rate appear to be similar among all of the three surgical

Studies

27

techniques proposed in this CTC. Although the complications may be more unique with one or the other, it also appears that the morbidity rate is similar. Therefore, we do not believe that a power calculation can be performed to estimate the total number of subjects needed to be enrolled in each group. Therefore, we believe that the total number of subjects may have to be arbitrarily decided by the network to assure an adequate number of patients to be observed to gather all the necessary information to satisfy the objectives of this study. The principal goal of incontinence therapy is to improve the quality of life for the patient. Patient satisfaction in long-term follow-up has not been adequately reported in the literature. This study can provide the extensive review of these issues. However, the criteria on which the comparisons are made will necessarily be agreed upon by the collective investigators. In addition, the economics of the proposed procedures will also have a bearing on the overall medicoeconomic outcomes. Due to the similarities between the reported treatment success rates, differences in long term cost effectiveness and ultimate patient satisfaction may be a better predictor of overall treatment success than improvement of incontinence symptoms alone. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: BEHAVIORAL THERAPY FOR UI IN AFRICAN AMERICAN WOMEN Principal Investigator & Institution: Ruff, Coralease C.; To Be Determined; Howard University Washington, Dc 20059 Timing: Fiscal Year 2002; Project Start 30-SEP-2000; Project End 31-AUG-2004 Summary: This project is designed to achieve the health promotion and disease prevention goals of the nation by stimulating nursing research into health problems through the development of a research career of an RN investigator. The health problem being addressed in this project is urinary incontinence (UI). The research aims are: to increase knowledge of complex research designs and analysis; to develop an ongoing research program that will contribute to nursing knowledge; and to improve the quality of life for African American women with UI through the use of behavioral therapy. The purpose of this study is to determine the effectiveness of a behavioral therapy management program in reducing the severity of incontinence and improving the quality of life in African American women. The design is quasi-experimental with random assignment to groups. The population for this study is African American women 50 years of age and above. A convenience sample of 200 will be selected from the Observational Study of the Women's Health Initiative. The research aims are to compare the effectiveness of Biofeedback taught pelvic muscle exercise, verbal taught pelvic muscle exercise and no treatment in the severity of urinary incontinence, to examine the impact of the methods of exercises on the quality of life, and compare adherence and relapse rates of subjects that receive VPME, BTPME and no treatment. Data will be collected at baseline and post treatment (six weeks later) from incontinence history and pelvic examination, Bladder Diary, Incontinence Questionnaire, and Quality of Life Scale. Follow up will occur at 3, 6, 9 and 12 month intervals post treatment to determine adherence and relapse rates. Data will be analyzed using descriptive statistics to denote frequencies and other measures of central tendency. Bladder Diaries will be coded and analyzed to address the research aims and appropriate statistical analysis will be conducted including ANOVA. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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•

Urinary Incontinence

Project Title: CAREER TRAINING IN BLADDER CONTROL NEURAL PROTHESES Principal Investigator & Institution: Gustafson, Kenneth J.; Biomedical Engineering; Case Western Reserve University 10900 Euclid Ave Cleveland, Oh 44106 Timing: Fiscal Year 2002; Project Start 01-SEP-2001; Project End 31-AUG-2006 Summary: (Adapted from Application's Description): Dr. Gustafson is an engineer committed to establishing a career in applied neurophysiology research and development of neural prosthetic devices to restore function in individuals with neurological disorders. His short-term career goals are to develop solid foundations in electrophysiological experimental techniques, neural prostheses, genitourinary anatomy and current medical practices. The proposed career development plan will train Dr. Gustafson in 1) electrophysiological experimental techniques and neuroprostheses; 2) genitourinary-related anatomy, physiology and medical practices, and rehabilitative issues for individuals with spinal cord injury (SCI); and 3) independent career development and translational research. Mentors at Case Western Reserve University (CWRU), MetroHealth Medical Center (MHMC) and the Cleveland Functional Electrical Stimulation Center (FESC) will provide training and expertise, and monitor and support Dr. Gustafson's career advancement. The existing collaborative nature of this research and training environment is suited to the multi-disciplinary nature of the project and Dr. Gustafson's career goals in biomedical research. In addition to didactic instruction and structured clinical training, parallel research projects in both animals and humans with SCI are integrated into the career development plan. The research plan will investigate the underlying neurophysiology involved in control of continence and micturition using selective electrical recording and stimulation of individual nerve fascicles of the pudendal nerve. First, the individual pudendal nerve branches that allow the greatest efficacy to sense the onset of reflex bladder contractions, abolish reflex bladder contractions and elicit coordinated micturition will be identified. Second, selective control of these 3 functions with a single nerve cuff placed on the pudendal nerve will be examined. Anatomical cadaver studies and finite element modeling will be combined to evaluate and improve device selectivity. Loss of bladder control is a significant problem in individuals with neurological disorders and SCI; development of an effective, peripherally located neuroprosthesis would significantly improve clinical options for these individuals. This career development plan will establish Dr. Gustafson as an independent investigator in biomedical research and prepare him to lead research efforts in the development of neural prostheses. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: CHILDBIRTH-RELATED PELVIC FLOOR INJURY Principal Investigator & Institution: Leveno, Kenneth J.; Professor; Obstetrics and Gynecology; University of Texas Sw Med Ctr/Dallas Dallas, Tx 753909105 Timing: Fiscal Year 2002; Project Start 01-APR-2000; Project End 31-MAR-2005 Summary: (Adapated from Applicant's Description): This proposal is submitted in response to RFA HD-99-003 "Basic Science Research on Female Pelvic Floor Disorders." Described in this application is a comprehensive multidisciplinary basic and clinical science research program focused specifically on the relationship of childbirth to pelvic floor injury. Three research components are presented to include (1) a prospective analysis of the relationship between precise obstetrical events and subsequent pelvic floor dysfunction in 11,000 primiparous women; (2) a randomized trial of the effects of coached maternal pushing during the second stage of labor on postpartum pelvic floor function; and (3) utilization of a novel animal model to study the effects of vaginal

Studies

29

trauma during pregnancy on lower urinary tract smooth muscle contractility and contractile protein gene expression. Sample sizes for the aims described in this application are based upon ad hoc power analyses. This proposal also describes the qualifications and experience of basic and clinical investigators at the University of Texas Southwestern Medical Center and Parkland Hospital who are committed to the study of childbirth related pelvic floor injury. Included are individuals with expertise in maternal-fetal medicine, urogynecology, and smooth muscle physiology. Existing resources include operational laboratories to support the basic science research described, a well functioning computerized perinatal database to support analysis of precise obstetrical events related to pelvic floor injury and an established, wellfunctioning infrastructure capable of completing randomized clinical trials. Integral to this infrastructure is a well-functioning state-of-the-art urogynecologic clinical laboratory. The major focus of this application is on its theme of multidisciplinary basic and clinical research focused specifically on childbirth which is the singular most important, predisposing factor to pelvic floor injury. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DISORDERS

CLINICAL

TRIALS

NETWORK-FEMALE

PELVIC

FLOOR

Principal Investigator & Institution: Fine, Paul M.; Associate Professor and Chief, Female Pe; Obstetrics and Gynecology; Baylor College of Medicine 1 Baylor Plaza Houston, Tx 77030 Timing: Fiscal Year 2002; Project Start 01-SEP-2001; Project End 30-JUN-2006 Summary: (provided by applicant): The Baylor Pelvic Floor Dysfunction Unit as part of the NICHD Clinical Trials Network will be a productive and dynamic center. Close collaboration among the Departments of Obstetrics and Gynecology, Urology, and Surgery combined with a large public and private patient population will facilitate subject enrollment. This unit treats over 1500 patients annually with pelvic floor disorders. Facilities include three private hospitals, a public hospital, and a Veteran?s Administration hospital. These have a combined bed total over 3000. The Baylor Pelvic Floor Dysfunction Unit as part of the NICHD Clinical Trials Network would provide special and unique strengths that include: (1) Ten very experienced pelvic floor surgeons willing to randomize patients (2) A large minority patient base (40%) coupled with our Spanish-speaking Principal Investigator provides the ability for substantial minority recruitment (3) This unit has expertise in outcomes research and epidemiology (4) The Baylor Department of Obstetrics and Gynecology has exceptional strength in molecular and human genetics, exemplified by multiple NIH funded investigators and physicians trained in obstetrics and gynecology as well as clinical and molecular genetics. The applicant highlights his strengths with this proposal which has as its underlying hypothesis that genetic predisposition is important to the development of pelvic floor relaxation - specifically stress urinary incontinence (SUI). There are two principal arms of this proposal, basic science and clinical. Each interacts with and is dependent on the other in order to succeed in its aims. The basic science arm takes advantage of the quantitative nature of urodynamic testing. To this end a genome wide scan will be performed to identify areas of the genome unique to those patients with SUI. Sub-analysis will be based on multiple demographic and clinical variables. This aim will proceed with the follow-up of genomic regions of interest by searching for genes using genome databases, in addition to identifying mutations/ polymorphisms of suspect genes. Natural candidates include genes that encode collagens and those responsible for turnover of extracellular matrix glycosaminoglycans. Early analysis will

30

Urinary Incontinence

include a candidate gene approach to genome wide scanning. The clinical arm takes advantage of unique strengths described above. Patients with genuine SUT (absence of detrusor instability) will undergo urodynamic and urethral mobility testing. Participating patients will be prospectively randomized to undergo either Burch urethropexy or pubovaginal sling. Outcomes analysis will address success of surgical intervention at twelve and thirty months. Genomic variation among those with a successful repair versus those that failed will be compared before and after stratification. Furthermore, genomic variation as a function of preoperative clinical presentation and diagnostic testing will be analyzed before and after stratification by demographic and clinical variables. The findings of genomic variability will offer insight into the specific genes responsible for stress urinary incontinence. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: COGNITIVE SCREENING FOR CI THERAPY AFTER STROKE Principal Investigator & Institution: Mark, Victor W.; Physical Medicine & Rehabilitation; University of Alabama at Birmingham Uab Station Birmingham, Al 35294 Timing: Fiscal Year 2003; Project Start 15-APR-2003; Project End 31-MAR-2005 Summary: (provided by applicant): Stroke is the leading neurologic disorder and a major cause of chronic disability. Functional deficits following stroke can be ameliorated through rehabilitation, but until recently there has been little development of testable models of stroke therapies. Furthermore, despite the identification of several predictors of treatment outcomes, comprehensive models to account for how such variables affect therapy outcomes have not been developed. Constraint-Induced Movement Therapy (CI therapy) is a treatment for chronic stroke hemiparesis that has controlled evidence for efficacy on actual daily living tasks. The treatment was developed from basic neuroscience research that postulates that learned non-use is a major determinant of chronic hemiparesis and can be reversed through intensive practice. The intensive practice is associated with massive cortical reorganization on functional imaging studies. The PIs hypothesize that several cognitive mechanisms are essential to the therapeutic benefits of intensive practice: sustained attention, declarative memory, and emotional regulation. About one-third of patients in the CI therapy clinic demonstrate impaired cognitive regulation or memory disturbances, and they tend to have reduced treatment gains and retention of benefits after discharge. The purpose of this pilot application will be to prospectively assess CI therapy clinic patients on the above cognitive functions, and then through multivariable regression analysis determine their contributions to treatment outcomes in comparison to other predictors of general stroke rehabilitation outcomes (age, lesion findings, stroke severity, pre-treatment function, incontinence). The findings will indicate whether specific cognitive processes are importantly involved with the mechanism hypothesized to account for treatment benefit. Understanding of cognitive contributions to CI therapy benefit will help to propose treatment modifications for patients with behavioral disorders who undergo therapy, and as well to better inform prospective patients of their likely treatment benefit. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: CORE--BIOSTATISTIC CORE Principal Investigator & Institution: Vittinghoff, Eric; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 941222747

Studies

31

Timing: Fiscal Year 2002; Project Start 01-SEP-2002; Project End 31-AUG-2007 Summary: The UCSF Specialized Center of Research (SCOR) Biostatistics and Data Management Core (BDMC) will provide all needed data management and statistical support to the SCOR investigators. The objective of the BDMC is to apply state-of-theart science in biostatistics and data management to support the design, conduct, quality assurance, analysis, and reporting of the projects which comprise the UCSF SCOR. By providing expert methodologic support, this Core will ensure rigorous and timely initiation and completion of the projects. Specifically, the BDMC will provide: 1. Assistance to SCOR investigators with study design and planning of analyses. 2. Review of forms for clarity, internal consistency, andimplications for analysis. 3. Efficient data management and quality control. 4. Study monitoring. 5. State of the art data analysis, including economic analyses. The BDMC will play a number of important roles in this SCOR. Centralization of data management and analysis has a number of compelling advantages. In particular, because two of the proposed studies will use data from the Reproductive Risk of Incontinence Study at Kaiser 2 (RRISK2) cohort, centralization will provide efficiencies of scale, improved quality control, and cross-fertilization across the two studies. It will also foster communication between SCOR investigators by stimulating discussion of design, analysis, and interpretive issues, and thus contribute to the interaction of basic research and clinical investigation. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DEPRESSION INTERVENTIONS

IN

OBGYN:

EPIDEMIOLOGY/SERVICES

Principal Investigator & Institution: Melville, Jennifer; Obstetrics and Gynecology; University of Washington Grant & Contract Services Seattle, Wa 98105 Timing: Fiscal Year 2004; Project Start 05-APR-2004; Project End 31-MAR-2009 Summary: (provided by applicant): Depressive disorders are twice as prevalent in women as in men and frequently comorbid with gynecologic disorders such as urinary incontinence (UI). OB-GYNs have exceptional access to women during the reproductive years, which is the time of peak incidence of depression. OB-GYNs therefore have a unique but unrealized opportunity to detect and initiate treatment or referral for depression in reproductive age and postmenopausal women. The increased prevalence of current major depression in women with UI indicates that this disorder may provide a useful avenue for improving detection of depression in the OB-GYN clinical setting. The goal of this 5-year Mentored Patient-Oriented Research Career Development Award is to enable the applicant to obtain the necessary skills and training to become an independent women's mental health investigator working at the interface of Psychiatry and OB-GYN, with specific focus on elucidating interactions between depression and UI and on developing health services interventions to improve treatment outcomes of depression in women with UI in the OB-GYN clinical setting. This career development award will consist of coursework, mentorship, and supervised investigations focusing on: 1) determining the prevalence and impact of major depression in women with UI, 2) examining reciprocal relationships between major depression and UI, and 3) developing health services interventions in the OB-GYN clinical setting to improve treatment outcomes of depression in women with UI. Career development activities will be applied to three mentored research studies. In Study 1, analyses of two existing population data sets will be used to develop a conceptual framework for the relationship between major depression and UI in women. In Study 2, in-depth qualitative assessments of women with major depression and UI will assess how incontinent women with depression view their depression and how comorbid disease

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influences illness perceptions and care seeking behaviors. In Study 3, findings from Studies l and 2 will be integrated with award training activities to design and implement a pilot intervention to improve treatment outcomes of depression in women with UI in the OB-GYN clinical setting. Results from this study will be used to prepare an R01 clinical effectiveness trial. This K23 award will enable the applicant to bridge the gap between OB-GYN and mental health services research, an alignment that is necessary to integrate these fields and improve women's mental health. The award will provide crucial support for the applicant's ongoing development as an investigator in the area of depression in women. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DIABETES AND UROGENITAL SMOOTH MUSCLE FUNCTION IN VIVO Principal Investigator & Institution: Melman, Arnold; Professor & Chairman; Albert Einstein College of Medicine Timing: Fiscal Year 2003; Project Start 01-DEC-2002; Project End 30-NOV-2007 Summary: Neuronal alterations, as a consequence of diabetes mellitus, aging, or other diseases, can cause organ dysfunciton ranging from mild to severe in scope. Urinary incontinence and erectile dysfunction are two such aspects of the human condition that may be caused by neuronal dysfunction. Each condition can have a severely adverse effect on the quality of life at great monetary expense and emotional distress to the individual. In addition to diabetes and the aging process (which affects the entire population) the neuropathies caused by stroke, Parkinson's disease, and multiple sclerosis, are examples of common illnesses that millions of people with potential bladder and penile dysfunction. We will employ the Streptozotocin (STZ) and BBAN rat diabetic models in vivo, to study the effects of diabetic neuropathy on bladder and erectile function. The effects of 1-8 months of diabetic neurepathy on bladder and erectile function be studied on consecutive days in THE SAME MALE RAT in vivo. The working hypothesis is that bladder and erectile tissue are imbued w{th significnat plasticity and that the neuronal loss, in each organ, induces a series of compensatory and/or adaptive tissue, cellular and subcellular changes. The Project, which is designed to measure the physiological effects of diabetic neuropathy, is divided into three Specific Aims. In Specific Aim #1 we will study IN THE SAME RAT ON CONSECUTIVE DAYS, the effects of diabetic neuropathy on bladder (cystometry) and erectile (cavernosometry) function, in vivo. In Specific Aim #2 we will use immunohistochemistry to study the extent of the structural changes in neural status in bladder and erectile tissue from the SAME RAT used in Aim #1; thus permitting us to directly evaluate the effects of neuronal changes on organ function in the SAME RAT. In Specific Aim #3, we will utilize microarray gene chip technologies to study diabetes-related changes in gene expression in bladder and erectile tissue obtained from animals whom have already been evaluated in Aim #1; again, permitting us to evaluate the relationship between diabetic neuropathy, organ function and gene expression. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: EFFICACY OF BIOFEEDBACK TO TREAT UI IN WOMEN Principal Investigator & Institution: Kincade, Jean E.; None; University of North Carolina Chapel Hill Aob 104 Airport Drive Cb#1350 Chapel Hill, Nc 27599 Timing: Fiscal Year 2002; Project Start 01-APR-2000; Project End 31-DEC-2004 Summary: This abstract is not available.

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Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ELECTRICAL TREATMENT OF REFLEX INCONTINENCE Principal Investigator & Institution: Thrope, Geoffrey B.; Ndi Medical 22799 Holmwood Rd Shaker Heights, Oh 44122 Timing: Fiscal Year 2003; Project Start 01-APR-2003; Project End 31-MAR-2005 Summary: (provided by applicant): Incontinence is a significant medical problem effecting over 13 million Americans that is not adequately addressed by current treatment options. The rapid growth in the aging demographic suggests that this market will see significant growth in the near and long terms. Electrical stimulation to treat incontinence has been tested and proven effective in both animal models and humans. However the methods of delivery are problematic and have led to sub-optimal performance and slow adoption of the treatment NDI. Medical has developed a new approach to electrical stimulation for control of urge incontinence that will have greater efficacy and a simpler method of delivery. The long-term goal is to develop and commercialize an innovative, proprietary neural prosthesis to control urinary incontinence by inhibiting the bladder via electrical stimulation of the dorsal genital nerves. The immediate goals of this Phase I project are to determine the feasibility of our approach to inhibit bladder contractions in humans with urge incontinence and to determine the feasibility of a minimally invasive surgical technique for electrode implantation. We will conduct non-invasive acute laboratory investigations and shortterm home trials to determine whether electrical stimulation of the dorsal genital nerves is an effective treatment for the symptoms of urge incontinence. Cadaver dissections will be conducted to develop and evaluate the electrode implantation technique. At the conclusion of this Phase I project we will have determined the feasibility of treating urge incontinence by electrical stimulation of the dorsal genital nerves and defined the initial requirements for the implanted electrode. In Phase II we will design and fabricate prototype implanted electrodes and conduct a small-scale clinical trial to test the safety, efficacy, and clinical utility of our approach. If successful, this development will result in a new treatment option for persons with urge incontinence that is expected to have greater clinical efficacy, a simpler surgical installation, and a more reliable candidate screening procedure than presently available devices. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: EPIDEMIOLOGY AND MECHANISMS OF FECAL INCONTINENCE Principal Investigator & Institution: Bharucha, Adil E.; Mayo Clinic Rochester 200 1St St Sw Rochester, Mn 55905 Timing: Fiscal Year 2002; Project Start 01-SEP-2001; Project End 31-JUL-2006 Summary: Fecal incontinence (FI) is a socially devastating symptom in older women and may contribute to institutionalization. The epidemiology and pathophysiology of "idiopathic" FI is incompletely understood. Current concepts based on tertiary-care studies heavily emphasize the role of anal sphincter defects visualized by endoanal ultrasound. Preliminary studies suggest that the prevalence of FI in Olmsted County in women greater than or equal to 50 years is 17.8 percent with a median age of onset of 61 years. Obstetric events, diarrhea/urgency and obesity are risk factors for FI. Our novel "fluoroscopic" single-shot fast spin-echo MRI techniques visualize pelvic floor descent during defecation in real-time. In contrast to US, endoanal MRI depicts external sphincter defects and atrophy, puborectalis thinning and global pelvic floor laxity. The hypothesis is that fecal incontinence is not attributable to obstetric trauma alone, but the

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cumulative result of pelvic floor weakness caused by obstetric trauma, excessive straining, obesity, aging and menopause, compounded by diarrhea. This hypothesis will be addressed by combining the data infrastructure of the Rochester Epidemiology Project with state- of-the-art physiological measurements in a community-based sample. A questionnaire will be mailed to a cohort of approximately 1,000 women surveyed previously to ascertain the incidence and natural history of FI, and, a new sample of 5,000 women to determine the prevalence and frequency of FI. Putative risk factors for pelvic floor injury (obstetric trauma, chronic straining, obesity and estrogen depletion) and FI (diarrhea and rectal urgency) will be evaluated in a case-control study of approximately 200 patients with FI at least once a month and approximately 200 controls. approximately 100 patients with FI and approximately 100 controls will have MRI fluoroscopy to characterize the specific global pelvic floor abnormality (i.e., anal sphincter defects, sphincter atrophy, puborectalis thinning and pelvic floor laxity) associated with FI. These studies will refine our understanding of the epidemiology of FI, identify the obstetric risk factors responsible for delayed manifestations of pelvic floor injury, i.e. FI, underscore the importance of non- obstetric risk factors for FI and provide novel insights into the specific pattern of pelvic floor injury associated with FI in a community. These steps are necessary for reducing the incidence of pelvic floor damage by risk factor modification, identifying patients at higher risk of progressing to symptomatic FI, and designing appropriate interventions to halt this process. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: EPIDEMIOLOGY OF FEMALE PELVIC FLOOR DISORDERS Principal Investigator & Institution: Kjerulff, Kristen H.; Gynecology and Obstetrics; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2001; Project Start 01-AUG-2001; Project End 31-JUL-2004 Summary: Female pelvic floor disorders are a significant public health problem, cause major impairments in quality of life, and impose a substantial burden on individuals and on society as a whole. Uterine prolapse is the most common indication for hysterectomy among women aged 60-79, and the second most common indication among women in their fifties. Estimates of the prevalence of urinary incontinence among women overall ages range from 10 percent to 58 percent. However, there have been surprisingly few studies of any female pelvic floor disorders conducted in the national health data sets. Consequently, even basic statistical information concerning female pelvic floor disorders among American women is not available. It is critically important that epidemiologic studies be conducted in national health data sets in order to further our understanding of the scope and nature of the problems experienced by women due to pelvic floor disorders. In this application we propose to conduct a descriptive study of the epidemiology of and recent trends in outpatient visits, inhospital stays, and surgical procedutes for female pelvic follr disorders utilizing the National Ambulatory Medical Care Survey (NAMCS), the National Hospital Ambulatory Medical Care Survey (NHAMCS), the National Hospital Discharge Survey (NHDS), the Nationwide Inpatient Sample (NIS) and the National Survey of Ambulatory Surgery (NSAS). These data sets have been specifically designed to provide objective, reliable, population-based information and could be utilized to address several key issues concerning female pelvic floor disorders including outpatient health care utilization, in- hospital and ambulatory operative treatments, physician specialty differences in treatments, characteristics of women seeking treatment and the economic burden imposed by these disorders. Utilizing these data sets we will accomplish the following specific aims: 1.)Describe hospitalizations for female pelvic floor disorders

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including vaginal vault prolapse, uterine prolapse, uterovaginal prolapse, vaginal enterocele, fecal incontinence, and urinary incontinence in the NHDS and NIS data sets, 2.) Describe ambulatory operative procedures used as treatment for female pelvic floor disorders in the NSAS, and 3.) Describe office-based visits for female pelvic floor disorders in the NAMCS and the NHAMCS. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: FEMALE PELVIC FLOOR DISORDERS--DATA COORDINATING CENTER Principal Investigator & Institution: Brown, Morton B.; Professor; Biostatistics; University of Michigan at Ann Arbor 3003 South State, Room 1040 Ann Arbor, Mi 481091274 Timing: Fiscal Year 2002; Project Start 01-SEP-2001; Project End 30-JUN-2006 Summary: (provided by applicant) Pelvic floor disorders, including urinary incontinence, pelvic prolapse, and fecal incontinence, are common and significant health-related problems in the United States. Outcomes following surgical intervention for pelvic floor disorders have not been adequately evaluated. As a result, data necessary to fully inform patients and to make important policy decisions are unavailable. The long-term objective of the Clinical Trials Network for Female Pelvic Floor Disorders is to systematically evaluate these outcomes. This application to be the Data Coordinating Center (DCC) for the pelvic floor disorders network brings together experienced investigators from biostatistics, gynecology, urology, quality of life and health services research to prospectively assess the outcomes from various surgical interventions for female pelvic floor disorders using a novel design. The DCC will: 1. Provide expertise in the design of the studies to be performed by the network, 2. Provide expertise in the measurement of quality of life and in the selection of the instruments to assess treatment outcomes, 3. Provide expertise in the assessment of cost-effectiveness and in the development of the instruments to measure costs of alternative treatments, 4. Coordinate the implementation of the study protocols approved by the Steering Committee, including centralized database management with either centralized or remote data entry, 5. Monitor the sites with respect to data quality, and 6. Develop the plan for data analysis, perform the analysis and collaborate on the preparation of reports/publications that result from these studies. In this application the applicant proposes a randomized clinical trial to compare surgical procedures for pelvic organ prolapse. This design will provide valid comparisons of the surgical outcomes and allow for the prospective evaluation of the process of care, although surgeons will be able to specify the operative procedures that they are willing to perform. Since randomization may not be acceptable for all eligible subjects, either due to subject or surgeon preferences, the applicant proposes that the non-randomized, but eligible, subjects be enrolled into an observations study that, combined with the randomized subjects undergoing the same surgical procedure, enables the applicant to have greater numbers to evaluate factors that affect the success rate of a specific procedure. It is recognized that the Steering Committee will select the actual protocol to be implemented. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: GAMMA RAY SPECTROSCOPY FOR DOSE RATE CONSTANTS Principal Investigator & Institution: Nath, Ravinder; Professor; Therapeutic Radiology; Yale University 47 College Street, Suite 203 New Haven, Ct 065208047

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Urinary Incontinence

Timing: Fiscal Year 2004; Project Start 14-JAN-2004; Project End 31-DEC-2006 Summary: (provided by applicant): Permanent implantation of either iodine-125 seeds or palladium-103 radioactive seeds in the prostate has become a popular form of radiation therapy for carefully selected prostate cancer patients. The procedure is minimally invasive and is usually performed in a one-day surgery unit on an outpatient basis. The treatment related morbidity such as urinary incontinence and sexual impotence is fairly low for seed implantation, and control of the cancer in selected patients is as good as that with other treatment modalities such as surgery. For these reasons the public interest in seed implantation is growing rapidly. The clinical success of radiation therapy has been highly dependent on the capability of delivering a desired prescription dose. For prostate seed implant, such a capability is impinged on both the accuracy of placing the radioactive seeds in a predesigned spatial pattern for adequate spatial dose coverage and on the accuracy of the fundamental dosimetry properties of each individual seed. The primary objective of this project is to develop a new method for determination of dose rate constant, the only absolute quantity in the AAPM TG-43 formalism, for interstitial brachytherapy seeds that are used for prostate seed implants. The new method utilizes high-resolution gamma ray spectrometry and would be capable of determining the dose rate constant without the need of knowing the air kerma strength. Our hypothesis is that the proposed new method based on gamma ray spectrometry is superior to currently accepted standard experimental method using LiF TLDs. It has the potential of improving the accuracy and consistency of the dosimetry of prostate seed implants. This improvement in absolute dosimetry will impact the clinical practice of all brachytherapy patients because unlike random errors, errors in absolute dosimetry parameters for different models of brachytherapy sources affect all patients in a systematic fashion and in the same direction. Since prostate brachytherapy has now become a treatment method of choice for selected patients and this popularity has led to the introduction of many new designs of seeds for clinical implementation, we hypothesize that gamma ray spectroscopy can be used to reduce the uncertainty in dose rate constants and improve the dosimetry in a large number of prostate cancer patients. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: GENE THERAPY FOR BLADDER HYPERACTIVITY IN DIABETIC RATS Principal Investigator & Institution: Christ, George J.; Professor; Urology; Yeshiva University 500 W 185Th St New York, Ny 10033 Timing: Fiscal Year 2002; Project Start 01-SEP-2001; Project End 31-AUG-2003 Summary: (provided by applicant) Diabetes mellitus affects more than 100 million people worldwide. Neuronal alterations, as a consequence of diabetes mellitus can cause bladder dysfunction ranging from mild to severe in scope. In fact, urinary incontinence occurs in up to 80 percent of diabetic patients, and the manifestations include decreased bladder sensation, increased residual urine or detrusor instability (i.e., bladder overactivity or hyperactivity). These conditions have a severely adverse effect on the quality of life of the individual, at great monetary as well as emotional expense. These diabetes-related changes in bladder function are permanent and require medical therapy to reverse the symptoms. Current medical therapies lack both efficacy and specificity. To this end, we propose to evaluate the efficacy of K channel gene therapy to ameliorate the bladder hyperactivity associated with the most commonly used animal model of diabetic neuropathy (as determined by reference citations), that is, the streptozotocin (STZ)-diabetic rat. We shall study the effects of STZ-induced diabetes on bladder function in vivo in MALE and FEMALE rats. In Specific Aim #1 we will utilize the

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micturition reflex to study bladder function in conscious and freely moving rats, and thereby identify those animals exhibiting STZ-induced bladder overactivity. Rats with documented bladder hyperactivity will receive a single injection of the hSlo/pcDNA, which encodes the alpha subunit of the human maxi-K (potassium) channel. In Specific Aim #2 we will utilize in situ hybridization techniques to establish the relationship between recombinant transgene expression (i.e., hSlo/pcDNA expression) and bladder function in the same animal. Such studies will permit us to firmly establish the relationship between transfection efficiency and organ function in vivo in the same animal. In Specific Aim #3, we will utilize microarray gene chip analysis to study the effects of STZ-Diabetes on gene expression in the bladder of rats that have already been characterized with respect to the degree of bladder dysfunction in vivo. Moreover, we will also examine the effects of hSlo gene therapy on gene expression. As such, we anticipate being able to establish definite relationships between the degree of transgene expression, and the effects of these molecular changes on bladder function in vivo. In year 2 of this proposal we will study the prophylactic ability and duration of this gene therapy approach. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: HOMEBOUND CONTINENCE

ELDERLY--MAINTAINING

POSTTREATMENT

Principal Investigator & Institution: Engberg, Sandra; Health Promotion & Development; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, Pa 15260 Timing: Fiscal Year 2002; Project Start 10-SEP-1998; Project End 31-MAY-2004 Summary: (Adapted from the Investigator's Abstract): The purposes of this study are to (1) examine the effectiveness of a relapse prevention intervention based on Self-efficacy theory and Marlatt s model of relapse prevention in sustaining post-treatment continence levels; (2) examine the impact of standard behavioral therapy and the relapse prevention intervention with respect to adherence, relapse, cost and cost-effectiveness; (3) examine the direct economic incentive for home health care agencies to provide both the standard behavioral therapy and the relapse prevention intervention for urinary incontinence (UI); and (4) examine the impact of standard and relapse prevention behavioral therapy on the quality of life and self-efficacy of homebound older adults. In addition, we will explore the development of a predictive model to identify patients who are likely to relapse following the behavioral treatment of UI. This study will collect baseline cost data relative to UI on all subjects for a two month period prior to randomization (Phase I). Subjects will then be randomized to receive a 6 week behavioral therapy intervention (relapse prevention behavioral therapy, RBT) consisting of two additional in-home visits and three telephone interventions over a period of four months (Phase II). All subjects will be followed every three months for one year after completing the initial behavioral therapy. The specific aims of this study of cognitively intact homebound older adults are to: (1) examine the effectiveness of RBT in sustaining or improving post-treatment continence levels during follow-up compared to SBT. (2) Compare adherence rates of subjects who receive RBT to the rate for subject who receive SBT. (3) Compare the relapse rates of subject who receive RBT to the rate for subjects who receive SBT. (4) Estimate the cost and cost-effectiveness of RBT and SBT. (5). Examine the direct economic incentive for home health care agencies to provide RBT and SBT for UI to Medicare recipients. (6) Examine the impact of RBT and SBT on UI on quality of life measures. Secondarily, we will (7) Determine whether changes in selfefficacy are associated with improvements in UI. (8) Determine whether self-efficacy at

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the end of treatment predict relapse. (9) Determine if self efficacy at the end of treatment predicts maintenance of post-treatment continence levels at 3, 6, 9 and 12 months post treatment. (10) Explore the development of a predictive model of patients who relapse during follow-up. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: IMPROVING OUTCOMES OF HOSPITALIZED ELDERS AND CAREGIVERS Principal Investigator & Institution: Li, Hong; None; University of Rochester Orpa - Rc Box 270140 Rochester, Ny 14627 Timing: Fiscal Year 2003; Project Start 01-APR-2003; Project End 31-DEC-2006 Summary: (provided by applicant): More than 12 million elderly people are hospitalized each year in the United States, frequently resulting in functional decline. Family care of hospitalized elders is important given the increasing numbers of hospitalized elders, needs for elder care in the home after hospital discharge, and responsibilities of family caregivers for providing this care. Involving family caregivers in the hospital care of their loved ones may result in positive outcomes for both the elderly patients and their family caregivers. However, there is a paucity of empirical studies that have been conducted to evaluate the effectiveness of interventions to enhance family participation in caring for hospitalized elders. In the proposed study, we will build upon our prior work that has demonstrated the positive effects of theoretically-driven interventions with families of hospitalized patients and older adults at home. The unique contributions of this study include: (a) a randomized controlled design, (b) testing of a theoretically-driven, reproducible intervention that can be easily translated into clinical practice and widely disseminated; (c) the testing of an explanatory model to explain the effects of the intervention, (d) a prospective cost-effectiveness analysis; (e) an intervention that begins early in the hospital stay, and (f) measurement of outcomes both during and up to 2 months following hospitalization. The primary aim of this study is to evaluate the effects of a theoretically-driven, reproducible intervention (CARE: Creating Avenues for Relative Empowerment) on the process and outcomes of hospitalized elders and their family caregivers. The secondary aims are to: (a) explore if type of relationship with the elderly patient moderates the effects of the CARE program, and (b) determine the cost-effectiveness of the CARE program. A randomized controlled trial will be used with 280 family caregivers of hospitalized elders. Measures of both process and outcome variables include family caregivers' outcomes (beliefs, anxiety, worry, depression, role performance, role strain, role adaptation, and role rewards); outcomes of quality of relationship between family caregiver and patient (mutuality); as well as elderly patients outcomes (dysfunctional syndrome, length of hospital stay, readmission, depression, and cognitive status) during hospitalization and after hospital discharge. Findings from a recent pilot study with 49 family caregiver-elder dyads support undertaking this full-scale clinical trial in that family caregivers who received the CARE program, versus those who received a comparison program, had more positive outcomes (e.g., decreased anxiety, depression, and worry during hospital stay, increased care participation and preparedness for follow-up care, decreased role strain and increased role reward during and after hospitalization). Additionally, their hospitalized elderly relatives had more positive outcomes (e.g., decreased confusion, decreased urinary incontinence rate during hospitalization, improved cognitive status and less depression symptoms, shorter hospital stay, and lower readmission rate) during and after hospitalization. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: IOWA PELVIC FLOOR DISORDERS CLINICAL TRIALS NETWORK Principal Investigator & Institution: Nygaard, Ingrid E.; Associate Professor; Obstetrics and Gynecology; University of Iowa Iowa City, Ia 52242 Timing: Fiscal Year 2002; Project Start 01-SEP-2001; Project End 30-JUN-2006 Summary: Urge and mixed urinary incontinence are common conditions, affecting 1020% of American women. While several treatment modalities exist, pharmacotherapy remains the mainstay of treatment. Much of the research pertaining to treatment for urge and mixed incontinence is limited by short duration of follow-up, homogeneous patient populations, stringent exclusion criteria, poorly defined outcome measures, and lack of placebo control. Factors that predict success or failure of specific treatments are poorly understood. The broad objectives of this prospective randomized clinical trial are to describe and compare the efficacy (Phase 1) and the longer term effectiveness (Phase 2) of several treatments for urge and mixed incontinence, to determine the predictive value of pre-treatment urodynamics, and to understand factors associated with treatment efficacy and effectiveness. 400 women with urge incontinence or mixed incontinence with urge as the predominant symptom will be randomly assigned to one of four treatment groups: (1) tolterodine, (2) physiotherapy plus placebo, (3) physiotherapy plus tolterodine, and (4) placebo alone. The primary outcome measure used to define treatment efficacy at three months (Phase 1) is at least a 50% reduction from baseline in the number of incontinent episodes per week (of at least 60. Secondary outcomes measures include (1) voiding frequency, (2) patient satisfaction as recorded on a visual analogue scale, (3) adverse events, (4) urge incontinence specific quality of life measure, (5) pelvic floor distress inventory, (6) sexual function assessment tool, and (7) generic quality of life measure. Following evaluation of Phase 1 outcomes, women will continue to be followed every 3 months for 1 year. Women unsuccessfully treated will be offered alternative therapy. Medium term (one year) effectiveness of treatments for urge and mixed incontinence will be described by comparing baseline and one-year outcome measures. All data will be analyzed in an intent-to-treat fashion. The specific aims of this study are 1) to describe and compare the 3- month and 1-year efficacy of urge incontinence treatment among the 4 groups stated above, 2) to determine whether specific pre-treatment urodynamic variables are predictive of treatment efficacy, 3) to identify factors associated with treatment efficacy, and 4) to describe the difference in clinical course and quality of life among treatment groups and as compared to baseline after 3 months and 1 year of intervention. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: MECHANISMS OF INCONTINENCE FOLLOWING VAGINAL DISTENSION Principal Investigator & Institution: Damaser, Margot S.; Research Biomedical Engineer; Urology; Loyola University Medical Center Lewis Towers, 13Th Fl Chicago, Il 60611 Timing: Fiscal Year 2002; Project Start 05-APR-2000; Project End 31-MAR-2005 Summary: (Adapted from Applicant's Description): One of the most common symptoms of pelvic floor dysfunction is Stress Urinary Incontinence (SUL), the leakage of urine with increased stress, such as during laughing or coughing. The epidemiologic factors most strongly associated with the development of SUI are vaginal delivery and advanced age. In addition to other contributing factors, there is clinical evidence that the pudendal nerve is damaged during vaginal delivery and that women with SUI have greater nerve damage. Decrease in concentrations of circulating gonadal steroid hormones may be a precipitating factor for post-menopausal development of SUL. The

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long term goal of this project is to develop novel clinical methods for enhancing recovery of patients with SUL. Specifically, the neuro-anatomical and functional effects of vaginal distension will be investigated as well as the role of steroid hormones in enhancing recovery from incontinence. The hypotheses to be tested are 1. Vaginal distension causes traumatic injuries, including injury to the distal pudendal nerve, and leads to development of SUI, and 2. Treatment with gonadal steroid hormones will accelerate pudendal nerve regeneration and will lead to accelerated functional recovery of SUI after vaginal distension. These hypotheses will be tested by 4 Specific Aims: SAl. Demonstration that vaginal distension leads to incontinence symptoms followed by recovery, SA2. Demonstration that the SUI and recovery that results from vaginal distension is associated with a specific pattern of neural damage and regeneration, SA3. Determination if treatment with estrogen reduces the severity of and/or accelerates recovery from incontinence symptoms and nerve damage after vaginal distension, and SA4. Determination if treatment with dihydrotestosterone reduces the severity of and/or accelerates recovery from incontinence symptoms and nerve damage after vaginal distension. These Specific Aims will be tested in an established animal model of vaginal distension by urodynamic testing, histological evidence, and 3u tubulin mRNA levels in pudendal motoneurons determined using in situ hybridization. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MEMS VALVE FOR AN INTRAURETHRAL CONTINENCE PROSTHESIS Principal Investigator & Institution: Natarajan, Ananth; Ceo; Infinite Biomedical Technologies, Llc 2850 N Charles St, Ste 100 Baltimore, Md 21218 Timing: Fiscal Year 2003; Project Start 01-NOV-1999; Project End 31-JAN-2005 Summary: (provided by applicant): Urinary incontinence affects 15 - 35% of adult American women and accounts for a direct health care cost of over $26 Billion per year. It is associated with deterioration in quality of life and causes significant concern to many women. Current surgical therapies have significant morbidity associated with them. Therefore, a minimally invasive, nonsurgical treatment would be a great solution. We propose to address this challenge using microelectromechanical systems (MEMS) technology to develop a valve suitable for use in an artificial urethral sphincter. The Intraurethral Continence Prosthesis (INCOPRO) will use an innovative sphincter design based on biomimetic polymer technology to control urine flow. During Phase I, we successfully obtained proof-of-concept of the polypyrrole valve mechanism including testing in human urine. Further, we demonstrated micro-miniaturization using a MEMS fabrication process. In Phase II, we propose to further this work by developing a matrix of microvalves, which serves as a functional sphincter. We aim to extensively test the performance of the valve in vitro in a phantom model and further evaluate it in vivo in a porcine model. It is our long-term goal to incorporate this technology into a miniature device suitable for use in patients suffering from the debilitating problem of stress incontinence. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: MODEL FOR PELVIC FLOOR DISORDERS Principal Investigator & Institution: Clark, Amanda L.; Interim Director, Center for Women's Hea; Obstetrics and Gynecology; Oregon Health & Science University Portland, or 972393098 Timing: Fiscal Year 2002; Project Start 12-APR-2000; Project End 31-MAR-2005

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Summary: Women's health is severely impacted by pelvic organ prolapse (pop), a highly prevalent condition that results from abnormal elongation and breaks of the connective tissue of the vaginal walls and its paravaginal attachments. The functional consequences of POP include vaginal protrusion, urinary incontinence, and voiding disorders, conditions that often demand surgical treatment. The underlying causes of POP are unknown, through hormonal deprivation, multiparity, and aging are all impacted. The work proposed addresses the role of steroid hormones, aging and parity in the rhesus macaque vagina. Preliminary data indicate that this model system is a valid and clinically relevant one for the study of pelvic floor disorders. The working hypothesis is that hormonal deprivation will lead to decreases in specific measurable endpoints, including steroid receptor levels, collagen density, elastin density and extracellular matrix components in the vaginal wall, and that these changes will be associated with decreases in biomechanical strength. Further aspects of the hypothesis are that matrix metalloproteinases will be up-regulated in hormonally deficient environments and that these degradative enzymes play a role in weakening the vaginal wall. Finally it is hypothesized that the degradative changes caused by hormonal deprivation can be reversed by appropriate hormonal replacement therapy, and that the response may vary with aging and parity. To examine these hypotheses the above mentioned endpoints will be measured in the vaginal fibromuscular wall and its paravaginal attachments and will be correlated with changes in biomechanical strength in both multiparous and nulliparous macaques. The specific aims will evaluate: 1) hormone replacement immediately after ovariectomy, 2) hormonal replacement after long term estrogen deprivation, 3) the rate of matrix metalloproteinase up-regulation after ovariectomy, and 4) properties of the vaginal wall in naturally aged macaques. Special attention will be paid to the effects of a SERM (raloxifene) as there are tow reports that experimental SERMs increase the incidence of POP. The SERM (raloxifene) as there are two reports that experimental SERMS increase the incidence of POP. The results will provide entirely novel data on the role of hormonal deprivation, parity and age on the anterior vaginal wall and its paravaginal attachments in a rigorously controlled primate model of direct clinical relevance to POP. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MOLECULAR AND BIOCHEMICAL STUDY OF COLLAGEN IN PROLAPSE Principal Investigator & Institution: Visco, Anthony G.; Assistant Professor; Obstetrics and Gynecology; University of North Carolina Chapel Hill Aob 104 Airport Drive Cb#1350 Chapel Hill, Nc 27599 Timing: Fiscal Year 2002; Project Start 01-APR-2000; Project End 31-MAR-2004 Summary: (Adapted from Applicant's Description): Pelvic floor dysfunction including urinary incontinence and pelvic organ prolapse is a major health issue for women resulting in an 11 percent lifetime risk of requiring surgery. The cost of urinary incontinence alone in 1995 alone was estimated at $26 billion in the United States. Several studies have identified pregnancy related risk factors for pelvic floor dysfunction including vaginal parity, increased infant birth weight, forceps and vacuum assisted vaginal delivery, episiotomy and prolonged second stage of labor. However, vaginal delivery fails to fully explain the genesis and progression of pelvic floor dysfunction since severe pelvic organ prolapse has been observed in nulliparous women and most women who deliver vaginally do not develop prolapse. Pelvic organ prolapse and urinary incontinence result from failure of the support mechanism derived from pelvic fascia and muscles. Many researchers have hypothesized that a parturition-

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Urinary Incontinence

related denervation injury to the female pelvic floor leads to weakness of the levator ani muscles which in turn results in marked stress placed on the uterosacral cardinal ligaments and endopelvic fascia, ultimately leading to secondary failure of the fascia and development of prolapse. Other studies suggest a primary failure of the fascia. Associations have been reported between prolapse, joint hypermobility and abdominal striac suggesting a generalized connective tissue defect affecting pelvic organ support, joints and skin. One explanation is a defect in collagen biosynthesis. Such a generalized connective tissue disorder might affect collagen's biomechanical strength and be explained at the genetic level. The long-term objective, therefore, is to gain insight into the mechanisms of pelvic floor dysfunction through the study of collagen at the molecular and biochemical levels. Collagen cross-linking is critical for the stability and mechanical strength of the collagen molecule and for the cohesiveness of the collagen fibrils. Hydroxylation of lysine is critical for the cross-linking process and the level of hydroxylation varies among tissues, Lysyl oxidase and lysyl hydroxylase are two enzymes involved in the early steps of the cross-linking process. We hypothesize that alterations in the intermolecular cross-linking may result in weakened connective tissue which may lead to pelvic floor dysfunction. Few studies have examined the biochemical nature of connective tissue or genetic differences in women with pelvic floor dysfunction. The specific aims are to compare: 1. total collagen content, 2. the six characterized collagen cross-links, 3. the ratio of Type I/III collagen, 4. the level of lysine hydroxylation, 5. collagen solubility, and 6. the genes coding for lysyl oxidase and the three isoforms of lysyl hydroxylase (LH1, LH2, LH3), in patients with advanced-stage pelvic organ prolapse and age and parity matched controls. This study would be the first large-scale comprehensive description of collagen cross-linking, lysine hydroxylation, and of genes coding for enzymes involved in the cross-linking process, in patients with pelvic organ prolapse. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MUSCLE CELLS MEDIATED GENE THERAPY FOR INCONTINENCE Principal Investigator & Institution: Chancellor, Michael B.; Professor; Urology; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, Pa 15260 Timing: Fiscal Year 2002; Project Start 30-SEP-1998; Project End 31-AUG-2006 Summary: (provided by applicant): Urinary incontinence is a major health care problem in the United States and an area of high priority for NIDDK. This DK55387 competitive renewal grant will explore several new developments using muscle derived stem cells (MDSC) as a treatment of stress urinary incontinence. We were extremely productive during the initial ROl grant funding period and we would like to thank NIDDK for their support. All key objectives of the previous grant were successfully completed. This resulted in 7 peer review papers, 3 more manuscripts are in press and 3 are near completion and will be submitted. Our findings were publicized at 16 international meetings and through 24 submitted abstracts. As a result of our work, we won 3 international contests and submitted 3 patents. A NTDDK Ki 2 Physician Scientist fellow, 3 PhDs. 2 Ph.D. candidates and 3 medical students entering urology worked on our project. Among them are 3 women (1 African American) and 2 African American men. What questions have been left unresolved? The experiments during the present grant identified new issues. We have evidence that bladder injection of MDSC rather than myoblasts persist in the bladder up to 6 months. MDSC can differentiate into smooth muscle. Most importantly, MDSC were able to improve the contractility of damaged bladder muscle while myoblasts were not. In the renewal grant, we want to investigate several important issues, such as: 1. Will MDSC injection improve function

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in a damaged urethral sphincter? 2. What is the potential for MDSC to differentiate into neurons and improve urologic function? 3. If MDSC becomes neurons, what neurons do they become, afferent, sympathetic, and/or parasympathetic? 4. Do MDSC become neurons in normal conditions or under conditions of acute or chronic stress and neuropathy? The Key Aims of this grant include: 1. Evaluation of the long-term safety and persistence of allogenic MDSC versus myoblasts urethral injection, 2. Measure urethral MDSC injection to improve sphincter function by assessing leak point pressure (LPP) and urethral strip contractility, 3. Assessment of MDSC ability to improve peripheral nerve functions and differentiate into neurons, and 4. Isolation, purification, and proliferation of human MDSC that would be suitable for clinical trial. We want to strongly emphasize that our stem cell research is in complete compliance with the federal guideline on embryonic stem cell research. We want to underscore that these stem cells have not been obtained from embryos (animal or human) or cell lines of embryonic stem cells. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: NATIONAL SOCIAL LIFE, HEALTH AND AGING PROJECT Principal Investigator & Institution: Waite, Linda J.; Professor; National Opinion Research Center 1155 E 60Th St Chicago, Il 60637 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 31-AUG-2008 Summary: (provided by applicant): This study will explore health and well-being in American men and women age 57-84. We propose a nationally representative in-home survey of 3,000 non-institutionalized people to describe, for the first time, distributions of physical and psychocognitive health, illness, medication use, intimacy and sexuality among older adults and to evaluate the relationships among these components of health in different sociocultural contexts. Specifically, we aim to: 1) Describe health of older community-residing Americans: A)Describe distributions of physical and psychocognitive health, social networks and capital, illness, medication use and sexuality among older adults. B) Evaluate the relationships among these components of health in different sociocultural contexts. C) Evaluate the relationship between quality of life and health behaviors among older adults, including: sexuality, physical activity; nutrition; sleep; alcohol, tobacco and other substance use. 2. Evaluate the relationship between health and older adult sexuality, focusing on: A) Physical illness and disability: arthritis, Alzheimer's disease, cancer, cardiovascular disease, diabetes, obesity, urinary incontinence and sexually transmitted diseases including HIV/AIDS; B) Mental illness: depression, dementia, stress, anxiety, low self-esteem, poor bodyimage; C) Medication use: prescription, self-medication, and alternative remedies. 3) Examine sexuality within social networks and the encompassing sociocultural context: A) Evaluate the relationship of older adult sexuality to important life stages (retirement, divorce, widowhood, and formation of new partnerships including remarriage). B) Evaluate the relationship between sexuality and social embeddedness including: sociability, independence, loneliness, physical, emotional, and sexual abuse. C) Ascertain older adults' perceptions about the relationship of sexuality to health and their needs for physician-patient communication and health care services in this domain. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: NEURAL PROSTHETIC CONTROL OF CONTINENCE AND MICTURITION Principal Investigator & Institution: Grill, Warren M.; Assistant Professor; Biomedical Engineering; Case Western Reserve University 10900 Euclid Ave Cleveland, Oh 44106

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Urinary Incontinence

Timing: Fiscal Year 2002; Project Start 25-SEP-2001; Project End 31-AUG-2004 Summary: (provided by applicant): Loss of bladder control as a result of neurological disease or injury such as spinal cord injury (SCI) has devastating effects. SCI results in loss of voluntary control of bladder evacuation, bladder hyper-reflexia, and bladder sphincter dysynergia. These factors often lead to ureteric reflux and obstruction, infection of the kidneys, long-term renal damage, episodes of autonomic dysreflexia with dangerous rises in blood pressure, incontinence which contributes to skin breakdown, as well as frequent urinary tract infections. Loss of bladder control also has profound social impact and leads to decreased quality of life, as well as large direct medical costs from procedures, supplies, and medication. The long-term goal of this research is to develop a neural prosthesis to restore bladder function (continence and micturition) in persons with neurological disorders, particularly spinal cord injury. Restoration of bladder evacuation and continence in individuals with SCI by electrical stimulation of the sacral nerve roots and surgical transection of sacral sensory nerve roots (dorsal rhizotomy) has resulted in documented medical, quality of life, and financial benefits. However, the widespread application of existing technology is limited by the objection of potential candidates to the irreversible dorsal rhizotomy and the complex surgical implant procedure. The PIs propose an innovative approach to restoration of bladder function using a single multi-electrode nerve cuff implanted on the pudendal nerve to detect the onset of hyper-reflexive bladder contractions by electrical recording, to arrest nascent hyper-reflexive bladder contractions by electrical stimulation of pudendal genital afferent nerve fibers, and to produce on-demand bladder evacuation by electrical stimulation of pudendal urethral afferent nerve fibers. This innovative approach differs substantially from existing approaches using electrical stimulation of the spinal roots in that it does not require a spinal laminectomy, does not require irreversible surgical transection of the sacral sensory nerve roots, and stimulates the afferent rather than the efferent side of the system. This is expected to increase the population of individuals who can benefit from neural prosthetic technology, while mantaining the documented benefits. The objective of the proposed work is to demonstrate the feasibility of this approach using complementary experiments in an animal model and in persons with spinal cord injury. Successful completion of this project will lead to the development of an effective neural prosthetic system for restoration of bladder function. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: NEUROMUSCULAR INJURY AND RECOVERY AFTER VAGINAL DELIVERY Principal Investigator & Institution: Weidner, Alison C.; Obstetrics and Gynecology; Duke University Durham, Nc 27706 Timing: Fiscal Year 2002; Project Start 30-SEP-1999; Project End 31-AUG-2004 Summary: The broad, long-term objectives of the Neuromuscular Injury and Recovery after Vaginal Delivery project are 1) to document the specific labor event or combination of events associated with the greatest evidence of short and long term neuromuscular maternal injury, and 2) to determine differences in these injury mechanisms between minority and Caucasian women. Immediate specific aims of this longitudinal study are: 1) documenting normal neuromuscular function and radiologic anatomy of pelvic and perineal muscles in nulliparous African-American and Hispanic women, 2) identifying, enrolling, and following a cohort of 135 primigravid women of representative ethnic groups to participate in antepartum, intrapartum, and postpartum electromyographic studies of pelvic and perineal muscle function, 3) studying the effects of epidural

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analgesia on striated muscle of maternal pelvis and perineum, and 4) comparing magnetic resonance imaging (MRI) studies of the pelvic anatomy of these women and correlating those findings to the functional EMG findings. These studies will provide a greater understanding of the mechanism of maternal pelvic injury at the time of vaginal delivery, which is the single greatest contributor to the risk of developing urinary incontinence (UI) and pelvic floor dysfunction (PFD). Furthermore, we will help close a gap in our significant knowledge deficit regarding racial differences in female pelvic floor function. The first phase of the study will involve the recruitment of nulliparous African-American and Hispanic women to establish normative values of pelvic musculature for that group via quantitative electromyography (QEMG) and pelvic MRI. This data, and normative data in Caucasian women from previous studies, will be used for the second phase of the study, which will study events in women of diverse racial backgrounds undergoing their first vaginal delivery. In this phase, primigravid subjects will undergo ~QEMG exam in the third trimester, again immediately prior to the second stage of labor, one day or two days postpartum, and 6 months postpartum. Precise measures of intrapartum events, including the descent of the fetal head in the pelvis, and time to actual delivery, will allow correlation with QEMG data. During the intrapartum phase, subjects will undergo QEMG exam before and after the placement of epidural analgesia, to precisely document the effect of epidural on the function of striated muscles of the pelvis. These subjects will also undergo pelvic MRI studies to provide anatomic correlation with functional QEMG data. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: NEUROPHYSIOLOGY AND BIOMECHANICS OF URETHRA IN SUI Principal Investigator & Institution: Yoshimura, Naoki; Associate Professor; Pharmacology; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, Pa 15260 Timing: Fiscal Year 2004; Project Start 01-APR-2004; Project End 31-MAR-2009 Summary: (provided by applicant): Stress urinary incontinence (SUI) is defined as involuntary loss of urine secondary to an increase in abdominal pressure during events such as sneezing, coughing or laughing in the absence of bladder contractions. This disorder is a significant gynecological/urological problem currently affecting approximately 25 million American women. These SUI patients exhibit the high incidence of intrinsic sphincter deficiency, characterized by a malfunction of the urethral sphincter mechanism resulting in the low-pressure urethra. However, normal physiology and pathophysiology of the urethral continence mechanism in relation to SUI are not well elucidated. Thus, utilizing both in-vivo and ex-vivo techniques developed in our laboratory, we propose to perform systematic analyses of urethral continence mechanisms under stress conditions. First, in-vivo neurophysiological analyses will be performed in normal animals and animal models of SUI. Next, ex-vivo biomechanical analyses will be performed of the normal and SUI urethra. Finally, based on these results, we will also seek to explore potential pharmacotherapies of SUI. In this proposal, we hypothesize: 1) the detailed neurophysiological and biomechanical properties contributing to normal urethral continence mechanisms at different positions along the urethra can be identified in normal rats, 2) pathological changes in neurophysiological and biomechanical properties of urethral continence mechanisms can be identified in two different animals models of SUI, and 3) pharmacological treatments using serotonine/norepinephrine reuptake inhibitors and/or adrenoceptor agonists can improve urethral continence mechanisms in two animal models of SUL The Specific Aims of this grant are: I) to characterize the normal physiological and

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Urinary Incontinence

biomechanical properties of the urethral closure mechanisms in normal animals using: a) microtip transducer catheters to measure bladder and urethral responses in-vivo during sneezing or passive increases in intravesical pressure, b) in-vivo leak point pressure measurements during sneezing or passive increases in intravesical pressure, and c) ex-vivo whole urethra biomechanical studies; II) to investigate the pathological changes in the above measurements in two rat models of SUI (vaginal over distension or transection of the nerves to external urethral sphincter and pelvic floor muscles); and III) to investigate possible pharmacotherapies for improving the urethral closure mechanism in the two rat models of SUI. By defining the detailed urethral pathology of SUI, we can offer the hope of prevention and reversal of this potentially devastating condition. This is recognized as a high priority in the urologic/gynecologic care of SUI patients. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: NEUROTROPHINS, INCONTINENCE

HORMONES

AND

POSTPAROUS

Principal Investigator & Institution: Smith, Peter G.; Professor; Molecular & Integrative Phys; University of Kansas Medical Center Msn 1039 Kansas City, Ks 66160 Timing: Fiscal Year 2002; Project Start 01-APR-2000; Project End 31-MAR-2005 Summary: (Adapted from Applicant's Description): Traumatic labor and vaginal delivery during childbirth can produce permanent dysfunction of the pelvic musculature, in many cases leading to urinary and fecal incontinence. Damage to the pelvic nerves and failure to achieve complete reinnervation account for much of the deficit. Factors that modulate regrowth of damaged axons therefore may influence functional recovery. The investigators have shown recently that smooth muscle of the reproductive tract, which shares many similarities with urethral and anal sphincter smooth muscle, undergoes dramatic changes in innervation as a consequence of hormonal fluctuations. Elevated plasma estrogen results in marked reductions in numbers of sympathetic nerves, while other neuronal populations are unaffected. Preliminary data suggest that these changes are related to decreased nerve growth factor (NGF) synthesis. The investigators hypothesize that the high levels of estrogen in periparous females result in depressed neurotrophin synthesis in pelvic smooth muscle. Accordingly, sympathetic nerves, whose presence is essential for normal sphincter contractile tone, fail to regenerate to their full potential after nerve injury. In Specific Aim 1, the investigators will determine the effects of estrogen and pregnancy on protein and mRNA levels of NGF and the related neurotrophin, NT3, in urethral and anal sphincter smooth muscle using in situ hybridization, quantitative competitive polymerase chain reaction, immunohistochemistry and enzyme-linked immunoassays. In the second aim, they will use quantitative in situ hybridization and immunohistochemistry to determine the extent to which estrogen and pregnancy influence expression of the neurotrophin receptors trkA and p75NTR, which mediate the sympathetic nerve response to NGF and NT3. In aim 3, they will use immunohistochemistry to examine the effects of estrogen and pregnancy on the normal innervation of the urethral and anal sphincter smooth muscles. Aim 4 will employ immunohistochemistry and physiological and pharmacological measurements of urethral and anal smooth muscle contractile function to assess the effects of estrogen on sphincter reinnervation following a noradrenergic neurotoxin lesion with 6hydroxydopamine, or pelvic distension to simulate childbirth trauma, and these will be compared with injury of normal delivery. The fifth aim uses collagen gel co-cultures of sphincter smooth muscle and sympathetic ganglia in the presence of selective

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neutralizing antibodies to ascertain the roles of neurotrophins in modulating sympathetic neurite sprouting toward smooth muscle of estrogen-treated or pregnant rats. These studies should provide important new information on how hormones may affect neurotrophin synthesis by smooth muscle of the organs of continence, and how this in turn may alter sympathetic reinnervation of sphincters after axonal damage due to traumatic vaginal delivery, thus leading to urinary and fecal incontinence. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: NON-ADDICTING CANNABINOID MEDICATIONS Principal Investigator & Institution: Malan, Thomas P.; Professor; Anesthesiology; University of Arizona P O Box 3308 Tucson, Az 857223308 Timing: Fiscal Year 2003; Project Start 01-AUG-2003; Project End 31-MAY-2006 Summary: (provided by applicant): As a physician, I see many patients with medical conditions for which adequate therapy is not available. CB2 cannabinoid receptorselective agonist medications may prove useful in treating some of these disease states. One is moderate-to-severe pain, where the use of opioid medications, the most effective therapy, is often limited due to concerns over addiction. In addition, opioids prescribed as analgesics are subject to diversion and abuse. We have shown that CB2 receptorselective agonists produce strong antinociceptive effects in animal models, suggesting that they may be useful as analgesic medications for humans. Unlike cannabinoids with agonist activity at CB1 receptors, CB2 receptor-selective agonists are predicted not to produce the rewarding properties associated with drug abuse, since CB2 receptors are not found in the CNS. By reducing the need for opioids, CB2 receptor-selective medications would diminish the problem of addiction with its severe individual and social costs. CB2 receptor-selective agonists, however, are likely to have important medical applications beyond analgesia. In this proposal, we hypothesize that CB2 receptor-selective agonists will be useful in the treatment of the prevalent and challenging problems of urinary incontinence; irritable bowel syndrome, inflammatory bowel disease and visceral hypersensitivity; and opioid resistant neuropathic pain. Our goal is to combine state-of-the-art chemistry and biology to develop CB2 receptorselective agonists as medications. Aim one will test the hypothesis that CB2 receptorselective agonists will have therapeutically desirable properties beyond analgesic effects. We will explore the activity of CB2 receptor-selective agonists in experimental models relevant to urinary incontinence; inflammatory bowel disease and other conditions associated with sensitization or increased activity of C-fibers. We will also test the hypothesis that CB2 receptor-selective agonists will not produce a withdrawal syndrome or provide reward. Aim two will use a lead optimization strategy to improve the medicinal properties of AM1241, our structural lead compound. This will be accomplished by a structure-activity relationship study involving the systematic manipulation of each of the molecule's pharmacophoric groups using drug design principles. Novel compounds will be evaluated for their affinity at and selectivity for CB2 cannabinoid receptors in vitro and for desired properties in vivo. The successful completion of these aims will provide physicians a therapeutic option that may provide relief for patients with difficult medical conditions and decrease the use of opioids, minimizing opportunities for abuse. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: NURSING PROSTATECTOMY

INTERVENTIONS

AND

OUTCOMES

POST

Principal Investigator & Institution: Cunningham, Regina S.; None; University of Pennsylvania 3451 Walnut Street Philadelphia, Pa 19104 Timing: Fiscal Year 2002; Project Start 07-JUN-2002; Project End 31-MAY-2003 Summary: (provided by applicant): Prostate cancer is the most frequently diagnosed malignant solid tumor in U.S. males and is the second leading cause of male cancerrelated death. In concert with the increased incidence of prostate cancer, the number of prostatectomies performed in the United States has escalated over the past few decades. The trend towards increasingly limited hospitalization has led to earlier discharge of this population, requiring patients to manage complex post-surgical issues in the home setting. Preliminary studies have indicated that selected clinical outcomes can be improved in this population when Advanced Practice Nurses (APN) provide care following discharge; however, reasons for this have not been clearly explicated. The proposed descriptive quantitative study will explore this issue by examining how the process of APN care provided to men following prostatectomy affects selected clinical outcomes. A recently completed clinical trial examining the effects of APN interventions in men with clinically localized prostate cancer who have undergone radical prostatectomy provides a unique opportunity to investigate this issue. The proposed secondary analysis has two specific aims: The first of these is to determine the level of consistency between interventions recorded in the documentation logs maintained by APNs during the parent study and core elements of the Agency for Healthcare Research and Quality Clinical Practice Guidelines (CPGs) on three intermediate clinical outcome variables of interest (pain, depressive symptoms, and incontinence). Documentation logs will be examined, subject to content analysis, coded, and compared to core elements of established CPGs. The level of consistency (i.e., "consistent," "partially consistent," "not consistent") between documented interventions and core CPG elements will be established. The second specific aim will determine if APN interventions that are "consistent" or "partially consistent" with core elements of CPGs result in better intermediate clinical outcomes (i.e., less pain, fewer depressive symptoms, less incontinence). Regression techniques that control for age, race, level of education, number of preoperative symptoms, and Gleason score will be used to determine if higher levels of consistency resulted in differential outcomes. The three intermediate outcome variables will be investigated at two different post-operative time points. Pain outcomes will be evaluated at four weeks post surgery, and pain, depressive symptoms, and incontinence outcomes will be studied at eight weeks following surgical intervention. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ORWH: SCOR ON SEX AND GENDER FACTORS AFFECTING WOMEN'S * Principal Investigator & Institution: Brown, Jeanette S.; Professor and Director; Obstetrics, Gynecology and Reproductive Sciences; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 941222747 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 31-AUG-2007 Summary: (provided by applicant): The proposed Specialized Centers of Research (SCOR) on Sex and Gender Factors affecting Women's Health is a unique opportunity to create a premier center in basic and clinical research at UCSF in the area of lower urinary tract function and urinary incontinence. The proposed UCSF SCOR will

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provide the organizational structure to further develop and support multi-disciplinary, collaborative research projects from both basic and clinical investigators. The focus of the proposed Center will be to expand basic knowledge about female urethral, bladder, and pelvic floor function; improve understanding of the natural history of incontinence; and provide information for the development of novel treatments for female urinary incontinence. The long term goals of this SCOR are to: * Foster the growth of innovative translational research on female lower urinary tract structure, function, and dysfunction. * Identify pathogenetic mechanisms with implications for clinical practice. * Increase understanding of lower urinary tract biology using animal models and in vitro studies. * Use basic and clinical research to develop and evaluate novel, innovative treatments for female urinary incontinence. * Create a collection of relevant human specimens for analysis. To achieve our overall goal of innovative translational research on the female lower urinary tract, the UCSF SCOR has strong institutional support, leadership and a cadre of senior and junior investigators with a record of productivity. The SCOR will integrate laboratory and clinical research on lower urinary tract function and incontinence in women with a "bench to bedside" collaborative research paradigm that will facilitate direct translation of scientific results to improved patient care. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PARTURITION INDUCED PELVIC FLOOR NEUROPATHY Principal Investigator & Institution: Thor, Karl B.; Research Scientist; Surgery; Duke University Durham, Nc 27706 Timing: Fiscal Year 2002; Project Start 23-AUG-1999; Project End 31-JUL-2004 Summary: Pelvic organ prolapse (descent of the bladder, vagina, and rectum) and associated bladder and bowel dysfunction are problems for many women. Prolapse results from loss of support by pelvic floor musculature (predominantly levator ani muscles) and connective tissue. Given the high correlation between parity and pelvic organ prolapse, it is our overarching hypothesis that damage to the innervation of the pelvic floor during labor is a predisposing condition for pelvic organ and incontinence. This hypothesis has not been rigorously tested due to lack of a suitable animal model. Recently, we established the squirrel monkey as a model of parturition-associated prolapse. Squirrel monkeys are required to meet the specific aims that examine parturition-induced neuropathy. Studies are also proposed in the rat to provide a less expensive, neurologically well-studied, and phylogenitically lower species in which to establish basic parameters of pelvic floor innervation common to all mammals, e.g. neuronal responses to injury. Despite the obvious importance of pelvic floor innervation for maintenance of pelvic visceral support and continence, there is a considerable degree of confusion regarding normal pelvic floor innervation. While prior studies have thus focused on the pudendal nerve and its damage in pelvic organ prolapse and incontinence, our preliminary data suggest that the levator ani muscle has distinct innervation. Thus, specific aim 1 proposes to carefully define the peripheral innervation of the levator ani (LA), identify LA motor neurons and their dendritic arborizations using retrograde tracing techniques, describe the central distribution of LA primary afferent projections in the spinal cord using transganglionic tracing, and identify and characterize the transmitter phenotype of LA primary afferent neurons using retrograde tracing combined with immunohistochemistry. To test the hypothesis that parturitionassociated damage to the LA nerves is a component of prolapse, specific aim 2 will a) compare pelvic organ prolapse produced by LA nerve versus pudendal nerve lesions, b) determine cellular responses of experimentally-induced nerve injury in LA primary afferent neurons and motor neurons and muscle changes that occur following nerve

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injury, c) examine expression of neurogenic injury markers and muscle changes following parturition, and d) compare neurogenic injury markers and myogenic changes in monkeys with no prolapse to those with severe prolapse. Specific aim 3 will examine neurotrophin systems associated with LA innervation and mechanisms of denervation, e.g. neuronal apoptosis, axonal atrophy, etc. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: TRANSPORT

PATHOPHYSIOLOGY

OF

ARPKD:

ROLE

OF

ABERRANT

Principal Investigator & Institution: Satlin, Lisa M.; Professor; Pediatrics; Mount Sinai School of Medicine of Nyu of New York University New York, Ny 10029 Timing: Fiscal Year 2002; Project Start 01-SEP-2002; Project End 31-JUL-2003 Summary: The hereditary forms of polycystic kidney disease (PKD) include the common autosomal dominant form (ADPKD), affecting 1 in approximately 1000 of the population, and the less common autosomal recessive form (ARPKD), affecting 1 in approximately 20,000 live births. Both diseases are characterized by the formation and expansion of cysts derived from specific segments of the nephron. In ADPKD, the gradual destruction of normal renal parenchyma by cysts arising in multiple nephron segments lead to renal failure in approximately 50% of patients by the sixth decade of life. ARPKD, a disease with high infant morbidity, is characterized by the progressive dilatation of collecting ducts, the nephron segment responsible for the final renal regulation of Na, K, acid-base and water balance. Three mechanisms have been implicated in the process of cyst formation and expansion: cell proliferation, abnormal extracellular matrix and adhesion, and net transepithelial fluid. Whereas data exists to implicate the former two processes in the pathogenesis of ARPKD, little is known about the regulation of transepithelial solute and water transport in this disease. Our long term goal is to identify alterations in the expression and regulation of epithelial cell transport pathways that contribute not only to cyst expansion, but also the early onset of hypertension and polyuria in APRKD. The hypotheses we propose to examine in this 5year application are focused on (I) characterizing the molecular and functional expression of ion channels, transporters, and receptors, and (II, III) exploring the mechanisms by which aberrant autocrine/paracrine signaling and/or cellular responses to biomechanical forces lead to dysregulated transepithelial transport in ARPKD collecting dust cysts. To best understand the pathogenesis of human disease, we propose to perform most studies described in this application in immortalized principal cell lines derived from human ARPKD collecting duct cysts or age-matched normal human kidney (NHK). Parallel studies will also be performed in the orpk murine model of ARPKD, whose microdissected tubules can be isolated and microperfused in vitro. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PATIENT-CENTERED GOALS FOR PELVIC FLOOR DYSFUNCTION Principal Investigator & Institution: Hullfish, Kathie L.; Obstetrics and Gynecology; University of Virginia Charlottesville Box 400195 Charlottesville, Va 22904 Timing: Fiscal Year 2003; Project Start 01-SEP-2003; Project End 31-AUG-2005 Summary: (provided by applicant): Outcomes of pelvic floor dysfunction (PFD) treatments remain poorly measured, precluding scientific conclusions about their effectiveness. Currently available surgical and non-surgical therapies for these common conditions have not been rigorously scrutinized with regard to subsequent impact on individual quality-of-life [QOL] or morbidity reduction. Although patient subjective

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opinions concerning surgical results are important, they are subject to interpretative difficulties. Several PFD-specific QOL scales have been developed and validated. These measures, however, do not assess the specific treatment goals of individual patients, and therefore, are limited when incorporating patient-centered goals into therapy. This prospective cohort study will classify and compare patient subjective goals and outcomes with respect to treatment interventions for disorders of the female pelvic floor. Preliminary investigation indicates an ample patient base for recruiting participants, and feasibility of recruitment and follow-up. We will enroll and follow 405 patients with PFD, expecting 270 in the conservative management arm and 135 in the surgical management arm. The primary outcome will be self-reported achievement of patientderived goals. Data will be collected from patient interviews, questionnaires, physical examination, and laboratory testing. Patient-derived goals will be defined at baseline and followed over 12 months to determine the degree to which patient-derived goals are reported to have been met. Goal achievement among surgical patients will be compared to that among non-surgically managed patients. The study will provide the first estimates of goals and goal attainment in PFD, and determine whether goal attainment in surgically and non-surgically managed PFD is likely to differ. In addition, objective outcome measures and established QOL instruments will be compared and contrasted with the perception of goal achievement. While QOL measures allow consistent assessment of general PFD outcomes, assessing patient-centered goals allows individually tailored care of women with pelvic floor dysfunction. Patient goals, combined with clinical and QOL measures, may be used to provide comprehensive, multidisciplinary, patient-centered approaches to prevention, management, treatment, and rehabilitation. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PELVIC FLOOR BIOMECHANICS AND BIRTH INJURY Principal Investigator & Institution: Ashton-Miller, James A.; Distinguished Senior Research Scientist; University of Michigan at Ann Arbor 3003 South State, Room 1040 Ann Arbor, Mi 481091274 Timing: Fiscal Year 2002; Project Start 01-SEP-2002; Project End 31-AUG-2007 Summary: NIDDK's Bladder Progress Review Group and NICHD workshop on Female Pelvic Floor Disorders have identified the lack of an understanding of the biomechanics of the female pelvic floor as a critical knowledge gap impeding research. The aims of this research are therefore to use human anatomical material to: (1) Characterize the mechanical properties and architecture of the passive and active structural elements comprising the female pelvic floor, the vesical neck support system, and the urethra; (2) Test the null hypotheses that neither age nor parity affects the number of (a) striated muscle cells, (b) smooth muscle cells, (c) number of nerves or the elastic moduli of passive tissue elements; (3) Develop a 3-D biomechanical pelvic floor model with representations of fetal head geometry, muscles and nerves based on anatomic material and probabilistic atlas data from 30 young, 30 middle-age, 30 elderly continent women MR data; (4) Develop a three-muscle-layer 3-D biomechanical model of the urethra and compare predicted values to urethral closure pressure behavior measured in 90 Project 1 nullipara, as well as Project 2 and 3 patients; (5) Use 2- and 3-D lumped parameter and finite element models to simulate different aspects of vaginal birth and test hypotheses that (a) largest muscle strain occurs in the nulliparous' puboperineus muscle, and (b) largest nerve strain occurs in the nulliparous' inferior hemorrhoidal nerve; analyze effects of normal vs. abnormal fetal head size and orientation (e.g. occipito-posterior), rapid-descent (forceps) vs. slow second stage (epidural) as well as geometry, timing and

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Urinary Incontinence

extent of episiotomy. These observations will yield insight into pelvic floor biomechanics that can help direct future research into these long-neglected but important issues. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PITTSBURGH INCONTINENCE COLLABORATIVE TREATMENT PROGRAM Principal Investigator & Institution: Zyczynski, Halina M.; Associate Professor; MageeWomen's Health Corporation 204 Craft Ave Pittsburgh, Pa 152133180 Timing: Fiscal Year 2002; Project Start 30-SEP-2000; Project End 30-JUN-2005 Summary: Faculty of the University of Pittsburgh School of Medicine Departments of Urology and Obstetrics and Gynecology has formed a collaborative urinary incontinence program. Our health care system with over 25 hospitals and outpatient facilities is an outstanding resource for research subject recruitment. Our proven ability to hold leadership positions in NIH sponsored multicenter surgical trials and to perform a large number of bladder suspension operations per year make us valuable contributors to the Urinary Incontinence Treatment Network (UITN). Dr. Chancellor, the principal investigator [P.I.], was funded by the NIH as PI in 1994-1998 to run a multicenter prospective randomized study between sphincterotomy and sphincter stent in spinal cord injured patients. This involved a complex surgical trial at four major spinal cord injury centers. The study was successfully finished with complete recruitment. The results were published in the Journal of Urology [Appendix 1]. In addition, Dr. Halina Zyczynski [Co-P.I.], who is the director of the Urogynecology Program at Magee-Womens Hospital, has developed a large pelvic floor dysfunction treatment program. Together, Urogynecology and Urology performed 357 stress incontinence operations this past year. We propose a protocol that prospectively compares non-invasive history exam with urodynamic evaluation. The patients will then be randomized to either the pubovaginal sling or the Burch procedure. Coexisting detrusor instability (DI) will not be treated preoperatively to determine its outcome after surgery. Persistent or denovo DI at 12 weeks will be randomized to pharmaceutical or behavioral intervention. Urodynamics studies will be performed 12 months postoperative. We are committed to adhering to the final protocol of UITN upon the activation of this grant. In conclusion we are enthusiastic about this RFA. All five investigators are experienced surgeons with similar techniques for both incontinence operations. We believe we have the unique resources and talent to become successful contributing members of the UITN. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: PLASTICITY OF LUT INTERNEURONS FOLLOWING SPINAL CORD INJ Principal Investigator & Institution: Vizzard, Margaret A.; Associate Professor; Neurology; University of Vermont & St Agric College 340 Waterman Building Burlington, Vt 05405 Timing: Fiscal Year 2002; Project Start 28-SEP-2000; Project End 31-AUG-2005 Summary: Micturition is regulated by neural circuits in the brain and spinal cord that coordinate the activity of the smooth and striated muscles of the lower urinary circuit. Disruption of these voluntary controls, as often occurs with spinal cord injury above the lumbosacral spinal cord, leads to the re-emergence of involuntary (reflex) voiding and incontinence. Detailed information about bladder reflex mechanisms and the manner in

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which they are modulated within the CNS is essential for understanding the pathophysiology of bladder hyperactivity and incontinence and for developing new therapeutic approaches to treat this disorder. It is proposed that reorganization of spinal micturition circuitry occurs in response to degeneration of bulbospinal axons as well as changes in neuron to target organ interactions. The overall goal of this proposal is to examine the effects of SCI on the neurochemical and organizational properties of spinal neurons (interneurons and preganglionic parasympathetic neurons) involved in the micturition reflex pathway. Three specific aims are proposed: 1. To determine the organization of urinary bladder interneurons and parasympathetic neurons in the lumbosacral spinal cord (L6-S1) using a combination of transneuronal tracing with pseudorabies virus (PRV) and conventional retrograde dye tracing techniques (Fluorogold) in control and SCI animals. The chemical phenotype of PRV-labeled urinary bladder interneurons in the L6-S1 spinal cord will be determined with immunohistochemistry for neuroactive compounds in control and SCI animals. 2. To determine the chemical phenotype of urinary bladder interneurons specifically responding to bladder afferent information (non-noxious and noxious) in control and SCI animals. Fos protein expression, as an indicator of cellular activation will be combined with immunohistochemistry for neuroactive compounds. 3. Previous studies have demonstrated significant increases in urinary bladder neurotrophic factor mRNA following chronic SCI. Thus, the role of neurotrophic factors (NGF and BDNF) play in mediating neurochemical and organizational plasticity of bladder interneurons following chronic SCI will be examined with chronic administration of neurotrophic factors or neurotrophic factor neutralizing antibodies in vivo. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DISORDERS

POPULATION

BASE

MULTI-ETHNIC

STUDY

OF

PELVIC

Principal Investigator & Institution: Daneshgari, Firouz; Associate Professor; Cleveland Clinic Foundation 9500 Euclid Ave Cleveland, Oh 44195 Timing: Fiscal Year 2002; Project Start 09-AUG-2002; Project End 31-JUL-2007 Summary: (provided by applicant): This resubmission has undergone major revisions according to the suggestions of the reviewers. A population-based case-control study is proposed to examine risk factors of Female Pelvic Floor Disorders (FPFD: urinary incontinence, fecal incontinence, and pelvic organ prolapse) in conjunction with an ongoing case-control study of breast cancer now underway. The SHINE Women's Health Study (formerly the Four Corners Study) is being conducted collaboratively through separate NCI R01 s funded in the states of CO, AZ, NM and UT. The current proposal will include all the SHINE study subjects in Colorado (controls and with breast cancer: 1400 women: 700 Hispanic and 700 White). Blood samples are collected for genetic and metabolic factors. In-person interviews for new subjects will include FPFD-related instruments. Subjects previously interviewed will be recontacted by telephone for FPFDrelated information. We will use data from the SHINE Study's Health & Lifestyle History Questionnaire and Diet History Questionnaire, as well as data on cancer chemotherapy and hormonal therapy from case-patients. All subjects will respond to an FPFD Screening Questionnaire and Obstetrical History Interview. Those with evidence of FPFD will further respond to two condition-specific quality of life questionnaires, the Pelvic Floor Distress Inventory and Pelvic Floor Impact Questionnaire. For a 10% sample of subjects, data pertinent to FPFD will be compared to medical records. Because the subjects in the SHINE Study are in the same age group as those affected by FPFD, and because half will be Hispanic and half non-Hispanic White by design, this plan

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Urinary Incontinence

offers a special opportunity for examination in important minority populations of previously-suggested FPFD risk factors, as well as additional behavioral, hormonal, and genetic variables that may also be related to FPFD. In addition, we will assess the frequency of FPFD in recently diagnosed cancer patients, its relation to their therapy, and impact on their quality of life. Highly qualified research teams at the University of Colorado and the Cleveland Clinic Foundation, with extensive experience in clinical and epidemiological studies, will collaborate in the conduct of this study. By capitalizing on an NCI-funded study already collecting manyvariables of interest to us, we have the opportunity for a very cost-effective population-based epidemiological study of a category of ailments, FPFD, that ultimately trouble a high percentage of the female population (and perhaps a higher proportion of cancer patients), and for which ethnic variation is of substantial interest but epidemiological data are now quite limited. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: POPULATION STUDY OF PREGNANCY AND PELVIC FLOOR DISORDERS Principal Investigator & Institution: Luber, Karl M.; Director, Section of Urogynecology; Kaiser Foundation Research Institute 1800 Harrison St, 16Th Fl Oakland, Ca 946123433 Timing: Fiscal Year 2002; Project Start 01-JUL-2002; Project End 30-JUN-2005 Summary: The prevalence, natural history and risk factors for female pelvic floor disorders (PFD) are poorly understood. These disorders, which include urinary incontinence, anal incontinence and pelvic organ prolapse, have a profound effect upon women's lives and impact a large percentage of the adult female population in the United States. Despite years of research, the fundamental question of the effects of pregnancy versus parity versus aging alone on the development of these disorders remains unanswered. The primary aims of this study are to (1) to determine whether the effects of pregnancy, vaginal delivery or aging act as independent risk factors for the development of PFD, (2) to establish the prevalence of individual PFDs across a full age spectrum of a multi-ethnic population, and, (3) to validate and implement a multifaceted questionnaire for large population screening that includes information related to urinary incontinence (stress and urge), anal incontinence, and prolapse symptomatology. In order to control for potential confounders, race/ethnicity, socioeconomic status, physical activities, smoking, menopause, hormone use, and comorbid medical conditions will be measured and their relative contributions to PFD will be evaluated. The association between prolapse symptoms and incontinence symptoms will also be examined. Validation of a questionnaire to evaluate PFD will be done with female patients recruited from the Gynecology and Female Pelvic Medicine clinics in Kaiser Permanente's San Diego Service Area. The subjects for the population-based study will be drawn from approximately one million female members of Kaiser Foundation Health Plan that reside in the Southern California region who are between the ages of 25 and 84 years. For the population-based study, women will be invited to complete a self-administered, mailed questionnaire after receiving an introductory letter in the mail explaining the study. Responses from the questionnaire will be analyzed to ascertain the impact of age, pregnancy, and vaginal birth on PFD. It remains unknown whether vaginal delivery increases the risk of PFD independent of other risk factors, specifically pregnancy and aging. To answer these questions, large population based studies on the prevalence of these disorders among women of all ages and various reproductive histories, specifically nulliparas, those delivered by elective cesarean section alone and those with a history of vaginal delivery, are needed. The answer to these questions will direct future research in both treatment and prevention of PFDs,

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and enable physicians to counsel their patients on the risk of vaginal delivery as it relates to PFD particularly for women with a history of cesarean section delivery. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PRESURGICAL STRESS REDUCTION MENTAL HEALTH AND CANCER Principal Investigator & Institution: Cohen, Lorenzo; Associate Professor; Behavioral Science; University of Texas Md Anderson Can Ctr Cancer Center Houston, Tx 77030 Timing: Fiscal Year 2002; Project Start 01-AUG-1998; Project End 31-JUL-2004 Summary: Stress associated with a life threatening illness contributes to poor adjustment and psychological and physiological consequences harmful to adaptation and recovery from surgical treatment. Cancer and its treatment are associated with considerable distress, impaired quality of life, poor mental health, and reduced physical function. This is particularly true for men with prostate cancer undergoing a radical prostatectomy (RP), the surgical treatment of prostate cancer. Recovery from RP is often associated with urinary and sexual dysfunction in addition to more common sources of stress associated with surgery. At least 50 percent of RP patients have permanent impotence and many experience prolonged periods of urinary incontinence. In addition to the distress associated with these quality of life changes, prostate cancer patients face the fear of recurrence, progression, and death. Recent research has found that psychosocial and psychoeducational interventions can increase quality of life and mental health of cancer patients, and may also improve immune status, pain indices, hospital costs, and length of survival. Despite the dramatic increase in research on psychosocial aspects of cancer and of interventions for cancer patients, relatively little work has considered prostate cancer or the specific impact of surgery for cancer. The proposed study will randomly assign prostate cancer patients undergoing RP to a presurgical stress management group, an attention control group, or a usual care control group. Dimensions of response to surgery and recovery will include measures of mental health and psychological status, quality of life, and immune, endocrine, and cardiovascular function, as well as pain, use of analgesic medication, and length of hospital stay post- surgery. This design will allow characterization of distress associated with prostate cancer and RP and examination of psychological, physiological, and quality of life changes associated with surgery and short- and long-term recovery. We will also evaluate a theoretical model developed to examine dispositional and environmental factors as predictors of response to surgery and long-term recovery. We hypothesize that pre-surgical stress management will reduce the negative impact of RP assessed by psychological, physiological, and quality of life measures. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: PROMOTING SELF-CARE TO PREVENT URINARY INCONTINENCE Principal Investigator & Institution: Sampselle, Carolyn M.; Professor of Nursing; None; University of Michigan at Ann Arbor 3003 South State, Room 1040 Ann Arbor, Mi 481091274 Timing: Fiscal Year 2002; Project Start 30-SEP-2000; Project End 30-JUN-2005 Summary: Self-efficacy, the personal judgment of one's ability to carry out a particular course of action, is a phenomenon that is central to nursing. Despite widespread recognition of the pivotal role played by self-efficacy in adoption of health behavior, its ability to predict a sustained behavioral change has not been well studied; long-term follow-up studies of even one year are rare. The specific aims of the project proposed

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Urinary Incontinence

here are to: 1) Determine the capacity of self-efficacy to predict maintenance of behavioral change at four years post-intervention; 2) Explore individual attitudes and strategies that facilitate or deter behavioral change using a mixed method approach; 3) Determine the four-year incidence of urinary incontinence (UI) in women who have been instructed in a behavioral modification program (BMP) as compared to their noninstructed counterparts. This project will expand and extend data from the currently funded randomized controlled trial entitled "The MESA Project: Prevention of Urinary Incontinence" that is testing the effectiveness of the BMP in reducing the incidence of UI among postmenopausal women 55 to 80 years of age. We will follow 200 treated cases from the parent project for four years post-intervention to assess the contribution of selfefficacy and other factors to long-term behavioral change. We will recruit an additional 200 cases to comprise an untreated control group in order to assess the impact of treatment on four-year incidence of UI. Because the parent project is the first to test a prevention intervention, the project proposed here provides a singularly unique opportunity to gain knowledge about long-term behavioral change and continence outcomes. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PROPOSAL FOR UCSD INCONTINENCE TREATMENT CENTER Principal Investigator & Institution: Albo, Michael; Surgery; University of California San Diego La Jolla, Ca 920930934 Timing: Fiscal Year 2002; Project Start 01-SEP-2001; Project End 30-JUN-2005 Summary: The goal of this proposal is to establish the University of California, San Diego (UCSD) as one of the Continence Treatment Centers (CTC) in the Urinary Incontinence Treatment Network (UITN). As a member of the UITN, UCSD will collaborate with the other centers in the Network to assess the short and long-term outcomes of the multiple therapeutic modalities utilized in the treatment of women with stress and mixed urinary incontinence and participate in the enrollment of patients and data into any databases which may be developed. The treatment of women with stress and mixed urinary incontinence includes observation, behavioral, medical and surgical therapies. The indications for which of these therapies should be used for which type of patients varies greatly both regionally and between physicians in different specialties. There are few scientifically rigorous studies that evaluate the outcomes of these therapies, their morbidity and the effects they have on quality of life and other pelvic floor functions. In fact, each year more therapeutic options are offered without comparing them to any set standard. The UITN will have as a secondary goal the establishment of standardized definitions, evaluation and quality of life measurements. Vital to the success of this endeavor is the recruitment of a sufficient number of patients, establishment of a standardized protocol for evaluation and follow-up. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: PROSTATE CANCER--FAMILY CARE FOR PATIENTS AND SPOUSES Principal Investigator & Institution: Northouse, Laurel L.; Professor of Nursing; None; University of Michigan at Ann Arbor 3003 South State, Room 1040 Ann Arbor, Mi 481091274 Timing: Fiscal Year 2002; Project Start 01-APR-2001; Project End 31-MAR-2006 Summary: Prostate Cancer: Family Care for Patients and Spouses Prostate cancer is the most common cancer among men in the United States. Treatments for prostate cancer

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are often accompanied by devastating complications such as sexual impotence, urinary incontinence, and bowel dysfunction that can severely affect the quality of life of men and their spouses. The purpose of this study is to determine if a family-based intervention (The FOCUS Program) can improve the long-term quality of life of men with prostate cancer and their spouses. There are two specific aims for this study. The first aim is to determine if the family-based intervention can improve proximal clinical outcomes (better family communication, higher self-efficacy, more problem-focused coping, and less threat, uncertainty, and hopelessness) and improve the distal clinical outcome, better quality of life, in a culturally and socioeconomically diverse sample of men with prostate cancer and their spouses. The second aim is to test a stress-coping model designed to predict which prostate cancer patients and their spouses are at increased risk of poorer long-term quality of life. The model includes antecedent, mediating, and outcome variables. The specific aims will be accomplished with a longitudinal, randomized-block clinical trial in which a cohort of men with prostate cancer and their spouses (N=222 dyads) will be followed over a 12 month period of time. Dyads will be stratified by three phases of illness: 1) newly diagnosed-localized phase, following prostatectomy or radiation therapy, 2) post-primary treatment phase with rising PSA (biochemical recurrence), and 3) advanced/metastatic phase with evidence of disease progression; and by type of treatment received. Following stratification, dyads will be randomized to the control (standard care) or experimental group (standard care plus FOCUS Program). The FOCUS Program is administered in three face-to-face home visits and two follow-up phone calls and provides core content in five areas: Family involvement, Optimistic attitude, Coping effectiveness, Uncertainty reduction, and Symptom management. The program also has tailored content related to phase of illness and treatment received. Data will be collected four times: baseline, prior to the intervention (Time 1); 4 months, shortly after the completion of the intervention (Time 2); 8 months (Time 3); and 12 months (Time 4) with a set of established standardized instruments. The main analysis to meet Aim 1(test of the intervention) will be the MANOVA approach to repeated measures ANOVA (intervention x time), and the main analysis for Aim 2 will use manifest variable structural equation modeling. Overall, this study will test the effectiveness of a family-based program of care in improving clinical outcomes, and test the ability of a model to predict which patients and spouses are at increased risk of poorer quality of life. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: QUALITATIVE STUDY OF PROSTATE CANCER SYMPTOM MANAGEMENT Principal Investigator & Institution: Latini, David M.; Urology; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 941222747 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 31-AUG-2005 Summary: (provided by applicant.) Prostate cancer is the second-most common cancer among American men Various options for treatment exist, with approximately equal effectiveness However, the choice of treatment can result in different side effects that severely impact quality of life These side-effects include medical problems, such as erectile dysfunction and urinary and bowel incontinence The experience of those sideeffects can cause a number of emotional and psychological concerns, including changes in self-concept, difficulties in a man's primary relationship, and social isolation to avoid the embarrassment of incontinence in a social setting Numerous interventions have been developed for patients with other types of cancers, but few interventions have been developed for men with localized prostate cancer None of the existing prostate cancer

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Urinary Incontinence

interventions focus on symptom management, an important part of the prostate cancer survivor's quality of life Moreover, interventions that target more general cancer symptoms (e g, pain or nausea) have less relevance for the unique needs of men with localized prostate cancer Our study proposes to use the Critical Incident Technique to collect data on how patients with treatment-related side-effects are able to successfully manage the physical and psychosocial impact of their symptoms The critical incident reports will be organized into a taxonomy of effective and ineffective symptom management practices. As part of the proposed study, the investigator will accomplish the following aims: 1. Collect qualitative data describing effective and ineffective symptom management knowledge, skills, and behaviors in men treated for localized prostate cancer from prostate cancer patients, their partners, and health care providers. 2. Analyze the critical incidents to develop a hierarchical classification or taxonomy of critical symptom management competencies. 3. Using the taxonomy of symptom management competencies from Specific Aim 2, develop the instructional objectives for a tailored intervention that will help men treated for prostate cancer manage their treatment-related side-effects and related psychosocial concerns more effectively. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: RACE DIFFERENCES IN FEMALE UI: EPIDEMIOLOGY AND BIOLOGY Principal Investigator & Institution: Delancey, John Ol.; Norman F. Miller Professor; Obstetrics and Gynecology; University of Michigan at Ann Arbor 3003 South State, Room 1040 Ann Arbor, Mi 481091274 Timing: Fiscal Year 2002; Project Start 19-SEP-2001; Project End 31-AUG-2006 Summary: (provided by applicant): The prevalence of urinary incontinence is often reported to be lower in black women than in white women. Whether or not this is true has not been confirmed in population based studies of younger women. In addition, the reasons for this prevalence difference are also unknown. This proposed population based, cross-sectional study will test the null hypothesis that no difference exists in the overall prevalence of urinary incontinence in black and white women. A telephone survey concerning occurrence of urinary incontinence (UT) and factors possible associated with UT will be administered to a regional sample of 1000 white women and 1500 black women age 30-60 years. A sub-sample of 130 black and white stress urinary incontinent, 100 black and white urge incontinent and 100 black and white continent women will undergo clinical testing in the form of pelvic floor testing to quantify bladder and urethra function. This survey will achieve the following aims: Aim lA: Define the prevalence of urinary incontinence in black and white women. Aim 1B: Determine the prevalence of stress and urge incontinence in black and white women. Aim 2: Identify demographic and personal factors that might explain the prevalence differences between the races. The clinical testing will accomplish the following aim. Aim 3: Compare the urethral and pelvic floor function of black and white women and continent and incontinent women. The survey and clinical components combined will achieve the final aim. Aim 4: Identify both epidemiologic and clinical factors associated with urinary incontinence. This research will confirm the reported race differences in the prevalence of urinary incontinence. It will also identify which epidemiologic and clinical factors contribute to this difference. Knowledge of these factors can then provide the basis for risk factor identification and the development of preventive strategies appropriate to different racial groups. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: RISK FACTORS FOR URINARY INCONTINENCE IN WOMEN Principal Investigator & Institution: Grodstein, Francine; Assistant Professor; Brigham and Women's Hospital 75 Francis Street Boston, Ma 02115 Timing: Fiscal Year 2002; Project Start 23-SEP-2002; Project End 31-MAR-2007 Summary: (provided by applicant): Incontinence is a common condition that few women discuss with their medical provider. In this grant application, we propose to capitalize on the availability of two large prospective studies of women aged 37-85 years, to examine the epidemiology of urinary incontinence (UI) across varying age groups. Although parity is an established predictor of incontinence, detailed data on reproductive characteristics are sparse, and large prospective epidemiologic studies on additional risk factors are rare; in particular, since lifestyle may change as a result of incontinence, it is essential to identify and confirm associations in prospective data so that cause and effect are not misappropriated. We plan to examine prospectively the relation of reproductive characteristics, body weight and physical activity, and hormonal factors to the incidence of UI, to different types of UI (urge, stress, or mixed incontinence), to its severity, its progression, and to its impact on women s daily lives. The investigation will utilize the Nurses Health Study and the Nurses Health Study II, observational studies of 121,701 and 116.678 female nurses, respectively. Extensive data are collected via biennial, mailed questionnaires (since 1976 for NHS and since 1989 for NHSII) regarding lifestyle and numerous diseases. This includes updated reproductive information, body weight, exercise habits, menopause, exogenous hormone use, and many other items. Details regarding incontinence will be established via a comprehensive supplementary questionnaire to all women who report leaking on the main questionnaires; this will elicit data on type of incontinence, treatment, and extent to which the incontinence is bothersome or restrictive. Based on preliminary data from NHS, the 33.8% prevalence of incontinence is similar to that reported by other groups, and the 3.2% four-year incidence rate is comparable to that in the few existing follow-up studies. These similarities indicate the nurse participants report incontinence accurately and that our data are generalizable to other populations. Both NHS and NHSII have maintained extremely high participation (over 909~ in both studies to date). These two existing cohorts provide a cost-efficient basis for conducting a prospective study of UI, allowing better understanding of the epidemiology of UI, and identification of preventive strategies. In addition, the establishment of these cohorts for studying incontinence will allow future investigations of many other issues, such as the effect of diet and various lifestyle habits. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: SAN INCONTINENCE

ANTONIO

CONSORTIUM

FOR

RESEARCH

ON

Principal Investigator & Institution: Cespedes, R D.; Surgery; University of Texas Hlth Sci Ctr San Ant 7703 Floyd Curl Dr San Antonio, Tx 78229 Timing: Fiscal Year 2002; Project Start 30-SEP-2000; Project End 30-JUN-2005 Summary: The San Antonio consortium for Research on Incontinence and urinary Dysfunction (SARID) is a multi-institutional study designed to compare in a prospective, randomized clinical trial, the two most effective treatments for Stress Urinary Incontinence due to urethral hypermobility (SUI-UH). Female patients with SUI-UH will undergo rigorous pre-treatment evaluation to ensure a diagnosis of SUIUH and will be followed closely to assess not only the control of SUI but also a variety of important quality of life parameters. SARlD will also evaluate those factors that

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predict the long- term success of surgical management of SUI-UH, including factors that are very common in the South Texas Hispanic population including diabetes mellitus. The San Antonio consortium plans to accrue patients from military, Veterans Administration, and the general metropolitan San Antonio region, including a large number of underserved and minority patients to allow an evaluation of the efficacy of treatments among these different populations. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: SAW PROGRESSION

PALMETTO

AND

PYGEUM

AFRICANUM

ON

BPH

Principal Investigator & Institution: Mcvary, Kevin T.; Associate Professor; Urology; Northwestern University Office of Sponsored Research Chicago, Il 60611 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 31-MAR-2009 Summary: (provided by applicant): The proposal is a response for a research project (cooperative agreement) by the NIH-NIDDK for consideration for one of 10 Clinical Evaluation and Treatment Centers (CETC) forming a consortium to develop and conduct a randomized placebo controlled trial to evaluate whether the use of Saw palmetto (SP) or Pygeum africanum (PA) can prevent the progression of BPH. Health Relatedness: BPH is the most common neoplastic condition afflicting men and constitutes a major factor impacting Americans. Current studies estimate 30% of American males will require a surgical procedure to correct this problem sometime in their life. Increasing attention has been paid to plant extracts (or phytotherapy) use by patients to self-treat medical ailments such as BPH. Until more appropriately conducted trials are undertaken, the efficacy of phytotherapeutic agents will remain unproven. This study will be crucial to answering that question as well as others pertaining to the progression of BPH. Specific Aims: The primary aim of this study is to address whether SP or PA alter BPH progression or simply delay the time to surgical therapy. The data accumulated should provide evidence regarding long term effects of these therapies on objective parameters of BPH including the AUA symptom score, maximal urinary flow rates, or prostate size and how these medications compare in their impact on the same. Design and Method: In three treatment arms 1000 patients with symptoms of BPH will be assigned to either SP, PA or placebo and followed for 4-6 years. Progression parameters will include: 1) changes in the AUA symptom score, 2) urinary retention, 3) recurrent UTI, 4) renal insufficiency, 5) urinary incontinence or 6) crossover to known therapy. Objective parameters of BPH will include prostate size, maximal urinary flow rates, and AUA symptom score. Secondary Aim: Unique to this submission is whether a chief complaint analysis, sleep scale measures or direct/indirect healthcare costs analysis provides reliable or useful information. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: SELECTION CRITERIA FOR PELVIC MUSCLE THERAPY IN SUI Principal Investigator & Institution: Miller, Janis M.; University of Michigan at Ann Arbor 3003 South State, Room 1040 Ann Arbor, Mi 481091274 Timing: Fiscal Year 2002; Project Start 01-SEP-2002; Project End 31-AUG-2007 Summary: The long-term goal is to develop an effective behavioral therapy for stress urinary incontinence (SUI). Estimated prevalence rates of urinary incontinence range from 15-43% of women, with SUI as the most prevalent. The project will test Knack therapy, a self-help treatment for SUI that teaches women a pelvic floor muscle contractions simultaneously with a event known to trigger leakage. By doing so,

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momentary closure pressure is imposed on the urethra and risk for leakage is immediately reduced. This proposal aims to develop and test, in a general population of women with SUI, a model for predicting who will succeed in a costly surgery and time consuming Kegel's exercises). Specific Aims are to: (1) develop a logistic regression model to predict success with the Knack, (2) validate the model by determining the proportion of people who succeed according to who is predicted to succeed, and (3) develop long-term effectiveness of the Knack (1-year). The project will be implemented in three phases: model development (n=160 women), model validation (n approximately 160), and long-term follow-up of women who demonstrate response. The short-term outcome of "positive response" is defined as able to reduce leakage during coughing to under 2 ml or 50% decrease from baseline (whichever is more stringent). This will be evaluated immediately and at 1 month. Leakage is evaluated in simple fashion with a paper towel test in the clinic. Long-term success (3-month and 1-year) is defined both by the paper towel test criteria and by documentation of at least 50% reduction of leakage in diary to reflect success at home. ROC curve analysis will be used to analyze model data, t-test and descriptives to analyze response. Anticipated results include that 1) the treatment group will demonstrate significantly less urine leakage than a control group immediately post-instruction and at 1-month follow-up; and 2) over time (1-, 3-, and 12months) at least 80% of women selected by the predictive model who receive the Knack intervention will reach and sustain a greater than 50% reduction in urine loss from baseline. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: SHARED IMPAIRMENTS FOR GERIATRIC SYNDROMES & DISABILITY Principal Investigator & Institution: Tinetti, Mary E.; Professor; Internal Medicine; Yale University 47 College Street, Suite 203 New Haven, Ct 065208047 Timing: Fiscal Year 2002; Project Start 15-FEB-2000; Project End 31-JAN-2003 Summary: (adapted from Investigator's abstract) As proposed by several investigators, a substantial decrease in disability among older persons might be achieved by identifying, and then focusing preventive efforts at, modifiable impairments that have been shown to adversely effect a range of geriatric disability-related outcomes. The necessary first step is to identify such impairments. The primary aim of this project is, therefore, to determine whether impairments in four potentially modifiable domains, namely affect , sensory (vision and hearing), upper extremity ability, and lower extremity ability are associated with decline in mobility and social/productive activities and with the onset of falls, incontinence, and disability in self-care ADLs among three cohorts of community-living older persons over three years. The secondary aim is to determine if the relationship between these four impairment domains and the outcomes is modified by cognitive status and/or social supports. The three cohorts include: 1) Project Safety, a probability sample of 1,103 persons greater than or equal to 72 years of age; 2) MacArthur, a sample of 1,189 "above average" persons aged 70-90 at initiation; and 3) PEP-a stratified random sample of 750 members of a large general group practice. Baseline data available on the three cohorts include: 1) measures of the four targeted impairments: depressive symptoms, sensory (vision + hearing), upper extremity ability, and lower extremity ability; 2) potential modifying variables-cognitive status, emotional and instrumental social support; and 3) other covariates-demographic, psychosocial, and health variables. Outcomes ascertained over three years of follow-up include: 1) decline in mobility; 2) decline in social-productive activities; 3) onset of self-care disability; 4) occurrence of more than two falls; and 5) onset of weekly incontinence.

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Analyses will be structured to determine whether the targeted impairments are independently and additively related to the outcomes, and whether the relationships between the targeted impairments and the outcomes are modified by cognitive status or social supports. The goal is to determine whether there exists the epidemiologic evidence to suggest that these four, potentially modifiable, impairments should serve as targets in a shared impairment intervention strategy aimed at reducing the risk of geriatric syndromes and disability. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: STRUCTURAL CHANGES IN BKCA CHANNELS DURING GATING Principal Investigator & Institution: Olcese, Riccardo; Anesthesiology; University of California Los Angeles 10920 Wilshire Blvd., Suite 1200 Los Angeles, Ca 90024 Timing: Fiscal Year 2003; Project Start 01-DEC-2002; Project End 30-NOV-2006 Summary: (provided by applicant): Large conductance Voltage and Ca2+ activated K+ channels (BK) are membrane proteins that play a fundamental role in controlling smooth muscle tone and neuronal excitability. In most of the tissues, they form complexes composed by the pore-forming alpha subunit and by regulatory subunits. Similarly the other voltage dependent ion channels, BK posses a voltage sensor that is mainly represented by the S4 transmembrane segment. Changes in potential across the membrane displace the voltage sensor, producing a conformational change of the protein. Eventually, for adequate depolarizations, the consequent conformational change brings the channel into a state that allows ion conduction. Very little is known about structures that regulate the opening and closing of BK channels, and no information exists about the dynamical rearrangements produced in BK channels by changes in the membrane potential. One of the aims of this project is to investigate the structural changes underlying the operation of BK channel. Conformational changes of both a and b subunits will be assessed by residue specific fluorescent labeling of the channel protein. The short-term objective is to obtain a more realistic view of BK protein by identifying regions of motion that underlie voltage sensing, and that are couple to activation, inactivation and deactivation, and regions of relative staticity, involved in other channel functions. In addition the role of charged residues in pore region will be investigated. BK channel activators are now under close investigation for treatment of urinary incontinence and as stroke neuroprotectant. This study will contribute to set a framework for the design of new therapeutic agents or for the amelioration of the one already adopted by the medical practice. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: THE HARVARD UROLOGIC RESEARCH CENTER Principal Investigator & Institution: Freeman, Michael R.; Director; Children's Hospital (Boston) Boston, Ma 021155737 Timing: Fiscal Year 2003; Project Start 15-SEP-2003; Project End 31-AUG-2008 Summary: The absence of fundamental knowledge of the genitourinary tract severely limits the development of new and innovative therapeutic options for a variety of common illnesses, including age-related and post-partum urinary incontinence, various forms of bladder instability, urinary tract complications of benign prostatic disease, chronic pelvic pain, and voiding dysfunction originating from congenital anomalies. In the following pages we describe our vision for a research center of excellence in urology, which we have named the Harvard Urologic Research Center (HURC). Our major goal in developing this program has been to assemble an interdisciplinary team of

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investigators who employ state-of-the-art approaches in basic science and translational research, who have had a history of highly successful collaborative relationships, and who are committed to working together to bring a broad range of technical and scientific expertise to fundamental studies of urological disease. The integrative theme of the HURC is "Tissue Renewal in the Genitourinary Tract". Implicit in this theme is the recognition that many functional deficits observed clinically in urologic practice might be reversed or restored if sufficient knowledge about tissue architecture and remodeling, intercellular circuitry and cell signaling, and other processes characteristic of the cells and tissues of the urogenital system were understood in fundamental terms. The long-range objective of this program will be to integrate knowledge in basic cell biology, tissue engineering, biochemistry, molecular biology, proteomics, and genomics into a scientific network of collaboration that has not existed before. The four "missions" of the HURC will be to: (1) significantly expand the fundamental knowledge of the hollow organs of the urinary tract (ureter, bladder and urethra); (2) direct new, cuttingedge technologies specifically toward clinical urological problems, including cancer; (3) create a center of research and teaching excellence that will attract investigators nationally and internationally; and (4) establish a mentoring environment that will encourage outstanding new investigators to focus on urologic diseases in their career path. To support the "Tissue Renewal" theme, the investigators in the HURC will be clustered within three primary areas of scientific focus that will serve as anchor disciplines for the Center: (1) Tissue Engineering, (2) Signal Transduction and (3) Angiogenesis/Vascular Biology. We seek to create a totally new program in urology research, one that has the potential to develop into one of the strongest and most innovative investigative programs focused on urologic disease in the world. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: THERAPIES

TRANSLATING

SCIENCE

INTO

INNOVATIVE

UROLOGIC

Principal Investigator & Institution: Leng, Wendy W.; Urology; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, Pa 15260 Timing: Fiscal Year 2003; Project Start 01-AUG-2003; Project End 31-JUL-2008 Summary: (provided by applicant):To date, few urologists have the research skills to translate promising scientific findings into objectively designed, carefully monitored human trials of innovative urologic therapies. To capitalize upon the promise of new biotechnologies in the fields of neurourology and female urology, the next-generation academic urologist must be equipped with the advanced skills to work effectively with a network of basic scientists, biostatisticians, and epidemiologists. This is the primary goal of the K23 grant I have proposed.At the University of Pittsburgh Medical Center, I feel I am uniquely positioned to take advantage of two spheres of world-class research excellence. On one hand, the neurourology basic science research headed by William de Groat PhD and Michael Chancellor MD, offers a successful track record of innovative projects and junior faculty mentorship, as evidenced by their Physician Scientist MD [K12-DK02656] and Post-Doctoral PhD [T32-DK07774] training center grants. On the other hand, clinical research resources at the university offer an NIH K30-funded Clinical Research Training Program designed for academic physicians. My clinical research education will be enhanced by the expertise of Katherine Detre, MD., DrPH; and Sheryl Kelsey, PhD. Together they serve as Director and Deputy Director of the Graduate School of Public Health's Epidemiology Data Center (EDC), with a 20-year track record of coordinating large-scale NIH-sponsored clinical trials.With this combination of resources, I will design and implement Project #1 [Phase II trial:

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intravesical resiniferatoxin therapy for neurogenic bladder dysfunction], and Project #2 [Phase I pilot study: urethral injection of autologous muscle derived stem cells for treatment of stress urinary incontinence].The objectives of this grant are to: 1) undertake a degree-granting clinical research training curriculum, and 2) develop practical scientific and management skills pertinent to conducting pilot studies of new treatment modalities. This K23 award will allow me to develop the translational research skills to address important questions in urology. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: TREATMENT INCONTINENCE

OF

PERSISTENT

POSTPROSTATECTOMY

Principal Investigator & Institution: Goode, Patricia S.; Medicine; University of Alabama at Birmingham Uab Station Birmingham, Al 35294 Timing: Fiscal Year 2003; Project Start 01-AUG-2003; Project End 31-JUL-2007 Summary: (provided by applicant): Post-prostatectomy incontinence (PPI) has significant medical, psychological and social consequences. Although severe incontinence is temporary for most men after prostatectomy, persistent stress incontinence and detrusor instability are not uncommon. Conservative treatments for PPI include behavioral training (pelvic floor muscle exercises, self-monitoring with bladder diaries, regular office visits, fluid management, and bladder control techniques to control urgency and stress-induced leakage) with and without biofeedback (BF) and pelvic muscle electrical stimulation (ES). These treatments have demonstrated efficacy in small clinical series; however, randomized, controlled trials of behavioral treatments for PPI are lacking. Also the role of technologies (BF and ES) in behavioral training for PPI remains to be discerned. Specific Aim 1 is to test the effectiveness of behavioral treatment with and without the use of BF and ES technology. This project is a prospective, randomized, controlled, 3-arm trial in which 204 men, at least one year post-prostatectomy, will be stratified by type and severity of incontinence. Subjects will be randomized to 8 weeks of (1) behavioral training with BF and ES, (2) behavioral training without technologies, or (3) no treatment. Bladder diaries, 24-hour pad tests, and quality of life (QoL) instruments completed by subjects prior to randomization and following the last treatment session will be used to calculate reduction of the frequency and volume of incontinence and impact on QoL. Because long-term outcome data for conservative treatments of PPI are absent from the literature, outcome data will also be obtained at 6 and 12 months. Specific Aim 2 is to examine the cost-effectiveness of both conservative treatments using the most widely adopted method for the economic evaluation of health interventions, cost-effectiveness analysis (CEA). Cost data are essential to assist third party payors and clinicians in selection of appropriate, costeffective therapy for PPI. Specific Aim 3 is to characterize subjects on pre-treatment variables with potential predictive value to explore useful selection criteria for behavioral treatments with and without technology, data essential for development of clinical pathways. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: UAB CONTINENCE TREATMENT CENTER Principal Investigator & Institution: Richter, Holly E.; Obstetrics and Gynecology; University of Alabama at Birmingham Uab Station Birmingham, Al 35294 Timing: Fiscal Year 2002; Project Start 01-SEP-2001; Project End 30-JUN-2005

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Summary: Urinary incontinence is a major problem with significant medical, psychological, social and financial consequences. Currently, there is a lack of prospectively evaluated, unbiased short- and long-term data regarding the most appropriate means of evaluation, therapeutic, intervention and measurement of treatment outcomes with respect to the surgical management of stress incontinence. The establishment of a Urinary Incontinence Treatment Network (UITN) with up to 7 Continence Treatment Centers (CTC) would help to recruit a significant cohort of female patients in which to vigorously address these important issues regarding the surgical treatment of incontinence. The primary purpose of this proposal is to outline our ability to participate as a Continence Treatment Center in the Urinary Incontinence Network and to participate in a four-year prospective cohort study of women who have undergone different surgical procedures for urinary incontinence. The Division of Medical Surgical Gynecology, Urology and Geriatric Medicine at the University of Alabama at Birmingham (UAB) have a unique liaison in the evaluation and treatment of women with urinary incontinence working together at the UAB Genitourinary Disorder Center (GDC). The Center will easily facilitate participation in and contribute greatly to the success of this important trial. We have extensive experience in performing incontinence clinical trials, including multicenter trials and a strong supporting research infrastructure. Existing facilities, equipment, recruitment resources and trained personnel will be utilized in the service of the UITN protocols and projects. Our investigators have over 20 years experience in incontinence research and have contributed greatly to the literature in that regard. Expanded details of our capability will be provided in this application. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: UCSF-KAISER SCHOLARSHIP

WOMEN'S

HEALTH

INTERDISCIPLINARY

Principal Investigator & Institution: Grady, Deborah; Professor; Medicine; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 941222747 Timing: Fiscal Year 2002; Project Start 20-SEP-2000; Project End 31-AUG-2005 Summary: The University of California, San Francisco (UCSF) and the Division of Research (DOR) for Northern California Kaiser (Kaiser) join in Women's Health Interdisciplinary Scholarship Program for Research (WHISPR) program to train successful and independent clinical investigators in women health and chronic diseases. We have organized our strengths in women's health and chronic disease into 12 Interdisciplinary Research Areas: 6 disease areas (Cardiovascular; Breast Cancer; Skeletal Health; Neuropsychiatric Disorders -- Dementia, Depression; Substance Abuse; Urinary Incontinence; and HIV in Women) and five cross-cutting research areas (Sex Hormones, Woman's Imaging. Complementary and Alternative Medicine, Health Services Research, and Aging). 12 senior faculty (7 women), serve as Senior Mentors. All Senior Mentors have successful research careers in women's health or relevant chronic diseases and strong track records of training and mentoring. UCSF and Kaiser train over 350 fellows annually and have many other clinical faculty who would be excellent candidates for this Scholarship. We will also recruit talented and diverse Scholars from outside UCSF and Kaiser. In consultation with her Senior Mentor, each Scholar will develop a Training Plan tailored to her background and interests. The Plan starts with coursework, drawn from UCSF's Clinical Research Training Program and Program in Biomedical Science. Each Plan is built around milestones toward independence: publications, presentations and independent funding. Scholarships will last 2 or 3 years, depending on the Scholar's background. Scholars who want time for family caregiving

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may plan 1/2 or 2/3-time programs that last 3 or 4 years. A Core Seminar in Women's Health will teach scholars about a range of women's health issues from biological to social aspects of gender and disease. Scholars, Senior Mentors and our Advisory Board will meet in an annual retreat to strengthen relationships and reevaluate the program. Dr. Steve Cummings, Assist. Dean for Clinical Research at UCSF, Dr. Joe Selby, Director of the Kaiser DOR, and Dr. Deborah Grady, Vice Chair of the Dept of Epidemiology and Biostatistics (Program Director at UCSF) have major institutional roles that guarantee strong support for this Scholarship. For example, UCSF has given space to establish a Center for Women's Health Research and Kaiser has committed salary support for Scholars. Our goal is to create a model national resource for training successful investigators in women's health. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: UI TREATMENT NETWORK--BIOSTATISTICAL COORDINATING CENTER Principal Investigator & Institution: Tennstedt, Sharon L.; Vice President and Director; New England Research Institutes, Inc. 9 Galen St Watertown, Ma 02472 Timing: Fiscal Year 2002; Project Start 30-SEP-2000; Project End 30-JUN-2005 Summary: The overall goal of this cooperative prospective cohort study is to assess the long-term outcomes of the most commonly utilized surgical interventions to correct urinary incontinence in adult women as well as the utilization of concomitant medical and behavioral therapy. More specifically, the aims of this cooperative study are to: design and develop a protocol, including diagnostic entry criteria, standardized diagnostic and outcome measures, and patient relevant outcomes; and conduct the observational study to assess the long-term outcomes of the selected surgical procedures. This proposal describes the role of the Biostatistical Coordinating Center (BCC) providing leadership and expertise in the following areas: (1) technical assistance with the design of the study, including development of the measurement battery, sample size estimates and power calculations, and entry criteria; (2) design of a Webbased distributed data management system for use by the Clinical Treatment Centers (CTCs); (3) quality control activities, including development of a Manual of Operations and forms, training and monitoring of CTC staff to ensure standard implementation of the protocol across sites; (4) monitoring of all data acquisition to ensure high quality data bases; (5) primary analyses of study outcomes; and (6) communication and meeting support. The NERI team of investigators offer the following: extensive experience with BCC activities in complex multi-site studies; an innovative Web- based data management system; tested and effective quality control procedures; experience with the development of condition-specific quality of life measures; and a highly experienced staff of statisticians with expertise in prospective cohort studies and clinical trials as well as techniques for longitudinal analyses and dealing with non-random missing data. Expertise in urology, urogynecology and conservative therapies will be provided through a subcontract with Massachusetts General Hospital. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: UNIVERSITY OF MICHIGAN O'BRIEN CENTER FOR UROLOGY RES. Principal Investigator & Institution: Day, Mark L.; Associate Professor; Urology; University of Michigan at Ann Arbor 3003 South State, Room 1040 Ann Arbor, Mi 481091274

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Timing: Fiscal Year 2003; Project Start 15-SEP-2003; Project End 31-AUG-2008 Summary: The O'Brien Urology Research Center at the University of Michigan aims to address a broad range of basic, translational, and clinical concerns relevant to urological diseases. The center will build on a critical mass of urology investigators that comprise a well-established urology research program at the University of Michigan. Toward the O'Brien Center objective, five urology research projects have been assembled that reflect a wide range of investigation across various, different urological diseases. This broad spectrum of investigation is proposed to reflect the unique objective of the O'Brien Award mechanism, that being the advancement of urology research in general. The breadth of our proposed work thus spans from pediatric to adult urological diseases, and from basic science to clinical research. In Project 1, Dr. Jill Macoska will use cDNA microarray expertise, and a unique age-specific stromal and epithelial prostate model, to identify gene expression differences consequent to effects of aging on stromal-epithelial interaction. The findings will have implications for the pathophysiology of benign prostatic hyperplasia (BPH). In Project 2, Dr. John Park will use unique knockout models and cDNA microarrays to further characterize obstruction-induced COX-2 function in collecting duct cells, based on preliminary data implicating increased COX-2 expression in obstructive nephropathy. The findings may guide therapy development for obstructive nephropathy. In Project 3, Dr. Martin Sanda will use hybrid transgenic mouse models to characterize the role of FAS-mediated T cell death as a mediator of prostate-specific T cell tolerance. The findings will have implications for possible immune intervention in benign and malignant prostate diseases. In Project 4, Dr. John Wei and Dr. John Delancey will conduct clinical studies to identify intervention-specific, physiological/anatomic and racial determinants of urinary incontinence natural history and outcome. For this purpose they will use the Incontinence Symptom Index (ISI), a biometrically robust, validated, and broadly applicable instrument for measuring incontinence in multiple domains that they developed in preliminary studies. The findings should improve selection and evaluation of effective interventions for urinary incontinence. In Project 5, Dr. Mark Day will build on preliminary data implicating Rb and androgen receptor (AR) interaction in the regulation of prostate growth to characterize how Rb/E2F1 regulates AR trasncription and activity in vitro and in vivo. The findings have relevance to prostate growth and BPH. These 5 projects will be complemented by a Developmental Award Program that will further broaden the scope of this O'Brien Center to include new investigators in areas such as infertility and urological epidemiology, among others. Interaction between Projects will be facilitated by arl Administrative Core that will provide scientific oversight in the form of a multidisciplinary Center Advisory Board as well as biostatistical support in the form of biostatisticians with expertise in eDNA array analysis and in standard analyses for preclinical and clinical models. By embracing a broad range of urology investigation that spans from clinical to basic science, from pediatric to adult urology concerns, the University of Michigan O'Brien Center aims at advances centered on the broad yet common theme of urological research, as uniquely defined by the O'Brien Urology Centers funding mechanism. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: URINARY INCONTINENCE TREATMENT NETWORK Principal Investigator & Institution: Zimmern, Philippe E.; Professor; Urology; University of Texas Sw Med Ctr/Dallas Dallas, Tx 753909105 Timing: Fiscal Year 2002; Project Start 01-SEP-2001; Project End 30-JUN-2005

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Urinary Incontinence

Summary: (Provided by Applicant) This application emphasizes the ability of UT Southwestern group of investigators from the Departments of Urology and Urogynecology and their sub-contractor at North Texas Center for Urinary Control in Ft. Worth, TX to prospectively recruit a large cohort of women candidates, including ethnic minority women, for urinary incontinence surgery and follow them prospectively postsurgery. The five sites selected for participation in the Urinary Incontinence Treatment Network represent the most active, productive, and respected treatment centers for urinary incontinence in the current Dallas/Ft. Worth "market." In addition to this unique grouping of talents and resources, the strengths of this application stem from: 1) broad clinical and surgical experience of the investigators with established reputations in female urology and urogynecology; 2) specialized and fully-dedicated patient care facilities with state-of-the-art urodynamic equipment and adjunctive modalities such as biofeedback; 3) well organized, efficient, and experienced clinical trial offices with documented on-going leadership in recruitment and retention of subjects through highly qualified, technical and administrative staff; 4) full institutional and multidepartmental support for the proposed program; 5) established collaborative relationship between the investigators in each sub-specialty; 6) recognized experience of the Principal investigator (PI) and most co-investigators in multi-centric cooperative projects; 7) close proximity and easy access to computerized database to ensure complete and timely transmission and management of all study data; and finally 8) a balanced budget encouraging the full participation of all five sites. This unique compilation of skill, experience, and facilities should contribute to a large enrollment of ethnically diverse women with urinary incontinence suitable for this trial. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: URINARY INCONTINENCE: MOLECULAR MECHANISM&MATRIXBASED T Principal Investigator & Institution: Lue, Tom F.; Professor of Urology; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 941222747 Timing: Fiscal Year 2002; Project Start 01-SEP-2002; Project End 31-AUG-2007 Summary: It is estimated that 100 million men and women are affected by urinary incontinence (UI). The prevalence of UI is generally higher in women than in men, women being between two (older age groups) and four times (younger and middleaged) more likely to be incontinent than men. In the past 3 years, supported by an NIH grant, we have studied the effect of pregnancy, delivery, birth trauma, ovariectomy and aging on the ultrastructure and function of the continence mechanism. We have learned that the final common pathway of stress urinary incontinence in the rat model is the alteration of nervous, vascular, and muscular components of the continence mechanism. We therefore propose to further study the molecular mechanism involved in the pathogenesis of female stress urinary incontinence. We hypothesize that pregnancy/delivery, birth trauma, and hormonal deficiency (menopause) alter the gene and protein expression of many factors. We propose to use the state-of-the-art technique such as gene microarray, realtime PCR, multiple PCR etc to identify genes that are associated with female stress urinary incontinence and to further study the molecular mechanism. Further more, we have obtained encouraging results from using organ specific acellular matrix as a scaffold for the repair of bladder and ureteral defects in our lab. We propose to study whether the acellular matrix with or without growth factors can be used for the treatment of stress urinary incontinence. The hypotheses will be tested by completing the following specific aims. Specific aim 1: To identify gene that are associated with stress incontinence and to elucidate the molecular mechanism of

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stress urinary incontinence associated with pregnancy/delivery, birth trauma, and ovariectomy. Specific aim 2: To identify the best growth factor combinations that can enhance angiogenesis, neural growth and urethral smooth/striated muscle proliferation in a novel in vitro assay system. Specific aim 3: To apply acellular matrix with or without growth factors identified from specific aim 2 to animals with stress urinary incontinence. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: URINARY INCONTINENCE: REPRODUCTIVE/HORMONAL RISK FACTORS Principal Investigator & Institution: Thom, David H.; Assistant Professor; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 941222747 Timing: Fiscal Year 2002; Project Start 01-SEP-2002; Project End 31-AUG-2007 Summary: Urinary incominence (UI) is a common problem in middle aged and older women that substantiMly impacts quality of life, increases caregiver burden and risk of institutionalization, and results in biUiom of dollars in health care expenditures annuaUy. Our studies, and those of other investigators, have identified several established and potential risk factors for incominence, including childbirth, hormone use, diabetes, obesity and surgery, urinary tract infections, pelvic organ prolapse, and physical activity. Dr. Lue, another UCSF SCOR investigator, have used animal models to investigate several major risk factors identified epidemiologically, including vaginal birth (normal and traumatic), obesity, hysterectomy, menopause, and oral estrogen therapy. In vitro studies of hormone receptors using tissue cultures from the lower urinary tract of laboratory animals and humans by investigators at UCSF and elsewhere have advanced our understanding of the complex interaction between exogenous and endogenous hormones and urogenital physiology. The primary objective for the proposed study is to increase our understanding of risk factors for incontinence by identifying risk factors for incident UI, assessing biologic markers as risk factors for prevalent UI, and integratmg our investigations with laboratory investigation in this area. We will accomplish this by prospectively following a population-based, ethically diverse cohort of 2100 middle-aged and older women over 5 years to: (1)determine the incidence of and risk factors for new urinary incontinence; (2) determine the incidence of and risk factors for major changes in incominence frequency; and (3) investigate serum 17-13-cstradiol and progesterone as risk factors for prevalent incontinence. A major strength of this study is our retrospective cohort of 2100 women for who we have detailed data on lifetime reproductive events from abstraction of up to 50 years of medical records, detailed interviews, and linkage to excellent pharmacy, laboratory, outpatient and hospital databases. Another strength is our established relationships with laboratory investigators in this area. Combining a prospective epidemiologic study of our unique cohort with laboratory studies will help translate findings into new preventive and theraocutic aooroaches to reduce the individual and social burden of urinary incontinence. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: URINE LOSS AND PROLAPSE IN NUNS AND THEIR PAROUS SISTERS Principal Investigator & Institution: Buchsbaum, Gunhilde M.; Assistant Professor; Obstetrics and Gynecology; University of Rochester Orpa - Rc Box 270140 Rochester, Ny 14627 Timing: Fiscal Year 2002; Project Start 29-SEP-2001; Project End 31-AUG-2004

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Urinary Incontinence

Summary: (provided by applicant): This proposal is submitted in response to RFA: HDO0-012 entitled "Epidemiologic Research on Female Pelvic Floor Disorders." Urinary incontinence (UT) and pelvic organ prolapse (POP) are common health problems in older women, for which the etiologies are poorly understood. Injuries to the pelvic floor at the time of vaginal delivery and genetic predisposition have been implicated as factors associated with UT and POP. However, the epidemiological evidence for these relationships is scant and controversial. Our data from a survey study of 149 nulliparous nuns found the same prevalence of stress urinary incontinence (S UT) as was reported for parous women. The major objective of our proposed study is to determine whether vaginal delivery and familiality are associated with the development of urinary incontinence and pelvic organ prolapse by comparing the prevalence of objectively confirmed incontinence and prolapse in nuns (nulliparous women) with the corresponding rates in their biological sisters who have had at least one vaginal delivery. To achieve this objective, we will: recruit the nuns' biological sisters who have had at least one vaginal delivery; collect data from nuns and their sisters about the presence of any symptoms of UT and POP, and on any risk factors for these conditions; and examined nuns and sisters for objective evidence of UT and POP. The examiner will be blinded to the subjects' identity as to nun or sister, and to the presence or absence of symptoms. Women with signs or symptoms of UT and POP will undergo further urodynamic testing. Finally, the data collected will be tested in a matched pair analysis. We will determine whether nulliparous nuns differ from their biological sisters with regard to UT and POP. A matched pair logistic regression will be performed to obtain an adjusted estimate of the impact of familiality and vaginal delivery in UT and POP, taking into account other risk factors. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: USE OF A NOVEL INCONTINENCE SEVERITY TOOL (ISI) TO IDENTIFY DETERMINANTS OF URINA Principal Investigator & Institution: Wei, John T.; Assistant Professor; University of Michigan at Ann Arbor 3003 South State, Room 1040 Ann Arbor, Mi 481091274 Timing: Fiscal Year 2003; Project Start 01-JUL-2003; Project End 30-JUN-2008 Summary: In 2002, the National Institute of Diabetes & Digestive & Kidney Diseases convened the first Bladder Progress Review Group to the examine research needs related to bladder conditions. Their executive summary identified urinary incontinence as a condition especially in need of research and recommended new research initiatives to "Improve understanding of the mechanisms of urinary incontinence" and to "Develop preventive and therapeutic approaches to urinary incontinence that are sensitive to gender, race and culture and develop the means of measuring outcomes for treatment." For women with urinary incontinence, it is essential that outcomes assessments be expanded beyond the traditional measures of "cure, improved, or unchanged." The newly validated Incontinence Symptom Index (ISI) is a practical, 10-item, patient selfadministered symptom severity measure designed to assess urinary incontinence outcomes in both the clinical and research settings. Existing tools are typically lengthy and burdensome; thus, they are applied only in the research setting where patient selection is often restricted. Although this provides excellent scientific evidence, generalizability is often limited. The goal of this project is to apply the ISI, a pragmatic clinical and research tool, to identify intervention-specific, physiological/anatomic and racial determinants of urinary incontinence natural history and outcome. This wilt be achieved through three specific aims that will encompass both a clinical and a community based sample of women. Specific aim 1 will apply the ISI in a

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multidisciplinary clinical setting and assess the effects of a broad range of interventions on the severity of urinary incontinence and the type of symptoms. Specific aim 2 will examine the relationships between anatomic and physiologic factors with the severity of urinary incontinence as measured by the ISI. Finally, specific aim 3 will examine the longitudinal changes in urinary incontinence symptom severity over a 4-year period and compare the natural history between White and African American women. The findings from this project will facilitate patient counseling by providing valid estimates of outcomes using a standardized tool and will provide direction for the next sets of studies to better define the treatment options, clinical course and racial disparities in urinary incontinence. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: UTAH CONTINENCE TREATMENT CENTER (CTC) Principal Investigator & Institution: Norton, Peggy A.; Associate Professor; ObstetricsGynecology; University of Utah Salt Lake City, Ut 84102 Timing: Fiscal Year 2002; Project Start 01-SEP-2001; Project End 30-JUN-2005 Summary: Urinary incontinence constitutes a common and significant public health challenge in the United States, a challenge that is continuously compounded by the "graying" of America and by the ever improving life expectancy for women. Outcomes following surgery for urinary incontinence have not been ,adequately evaluated. As a result, objective, rigorously-obtained data, required to fully inform patients and on which to base important policy decisions, are unavailable. The long-term objective of the Urinary Incontinence Treatment Network (UITN) is to systematically evaluate the longterm outcomes of commonly utilized therapeutic approaches for urinary incontinence. This proposal describes the strengths that the University of Utah Continence Center would bring if it were to become a member Continence Treatment Center (CTC) of the UITN. Specifically, we will demonstrate the extensive expertise of the Utah Continence Center in the evaluation and treatment of urinary incontinence, including non-surgical and surgical approaches. We will further document that the Utah Continence Center has the- necessary ability to participate in or lead multicenter clinical trials, and that the Department of Obstetrics and Gynecology at the University of Utah Health Sciences Center, 14th'in the nation in NIH awards, has a proven track record in participating and managing NIH-driven multicenter network studies. Finally, we propose to carry out a prospective, randomized clinical trial for the two proposed surgical procedures (Bunch colposuspension versus pubovaginal sling) rather than a prospective cohort study, since the three investigators-surgeons for the Utah CTC can perform both procedures with equal expertise. Thus, inclusion of the proposed Utah CTC will increase the likelihood that the UITN will be in a position to complete a randomized controlled trial as the final outcome. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: VULVAR DISEASE AND BLADDER AND BOWEL SYMPTOMS Principal Investigator & Institution: Kennedy, Colleen M.; Associate Professor; Medicine; University of Iowa Iowa City, Ia 52242 Timing: Fiscal Year 2004; Project Start 01-JAN-2004; Project End 31-DEC-2008 Summary: (provided by applicant): Patient-oriented research in vulvar and vaginal disorders has primarily been descriptive. In addition to lack of formal training and education of clinical researchers in this field, pelvic disorders are divided among various specialties. Each pelvic organ is compartmentalized and treated without regard

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to global or systemic effect. Despite identification of various pelvic and vulvar disease entities such as vulvodynia, little is known about their etiology, treatment, or prevention. Case-series have noted the presence of painful bladder syndrome in women who have vulvodynia and vestibulitis. We propose an epidemiologic study to determine the extent to which painful bladder syndrome and functional bowel disorders overlap with specific vulvar diseases and to determine whether the rate of painful bladder syndrome and functional bowel disorders differ between women with vulvar disease and controls. This will establish whether the association noted in the case-series is significant. In addition to expanding current knowledge regarding the epidemiology of vulvodynia and vestibulitis, this will provide a foundation for global evaluation of pelvic disorders in general. This in turn may encourage a more effective multidisciplinary approach to the management of pelvic floor disorders including vulvodynia. Dr. Colleen Kennedy is committed to a career as a productive academic clinical researcher studying vulvar and vaginal diseases. This award would allow Kennedy to pursue a clinical investigation foundation through didactic training, mentoring, and research development. Further training in research methodology and advanced statistical techniques will increase her potential to make significant contributions to the field of vulvar and vaginal diseases. The overarching aim of this research program is to significantly improve the quality of care of women with vulvar and vaginal diseases. Dr. Kennedy's immediate goals during the award period include: 1) further didactic training in patient-oriented research methods, and enhance ongoing mentoring relationships, 2) gain further experience in the area of vulvar and vaginal disease, by working with experts in vulvar disease, by reviewing current literature, and by attending professional meetings, 3) conduct research to further the knowledge of vulvar vaginal disease manifestation, treatment, and outcomes, and 4) further pursue an academic career through clinical research, teaching, and mentoring. Her long-term career objectives include: 1) advance the state of the science in vulvar vaginal diseases, 2) improve quality and outcomes of care for women with these disorders, and 3) serve as a role model, and train new clinical scientists who are interested in vulvar vaginal and pelvic floor disorders. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: WEIGHT REDUCTION FOR INCONTINENCE NETWORK Principal Investigator & Institution: Wing, Rena R.; Professor of Psychiatry; Miriam Hospital Providence, Ri 029062853 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 30-JUN-2008 Summary: There is no text on file for this abstract. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: WEIGHT REDUCTION FOR INCONTINENCE NETWORK (WIN) Principal Investigator & Institution: Franklin, Frank A.; Professor of Pediatrics; Pediatrics; University of Alabama at Birmingham Uab Station Birmingham, Al 35294 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 30-JUN-2008 Summary: There is no text on file for this abstract. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: WIRELESS SENSORS FOR NEED-BASED CARE OF THE ELDERLY Principal Investigator & Institution: Friedman, Mark B.; President; Augmentech, Inc. 5001 Baum Blvd Pittsburgh, Pa 15213 Timing: Fiscal Year 2002; Project Start 15-SEP-2002; Project End 31-AUG-2004 Summary: (provided by applicant): Whether at home or at an institution, those unable or unwilling to ask for continence and repositioning assistance typically receive their care on a schedule that is suggested by various standards setting organizations based on the best available evidence about pressure ulcer and urinary tract infection prevention procedures. The practice of scheduling routine preventive care, rather than giving it just when it is actually needed by an impaired individual, is predicated on the enormous difficulty and labor intensity of determining just when any particular individual needs a particular kind of care. At heart, prescribed schedules of routine care rather than needbased care giving is done for the convenience and cost effectiveness of care delivery staff, rather than the quality of life of the recipient of that care. This is especially true of institutional care. We propose developing a moderately priced wireless sensor-based system to facilitate the giving of individualized continence and positioning assistance as it is needed. By eliminating the labor associated with those scheduled care giving episodes that are unnecessary, our system should both improve the timeliness of care delivery and improve the recipients quality of life, without incurring increased total care costs. If care delivery can be made more timely while simultaneously labor costs are reduced, there are significant implications for current concerns about nursing home staffing levels. PROPOSED COMMERCIAL APPLICATION: Nursing homes are under increasing scrutiny to demonstrate that they give good care. If successful, our project will allow nursing home staff to deliver more timely, personalized incontinence and pressure ulcer preventing repositioning care at less labor cost. Furthermore, it can document that timely care has been delivered. Because the sensors are included in disposable diapers, no additional modules need to be worn. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

E-Journals: PubMed Central3 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).4 Access to this growing archive of e-journals is free and unrestricted.5 To search, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Pmc, and type “urinary incontinence” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for urinary incontinence in the PubMed Central database: •

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Effects of carrying a pregnancy and of method of delivery on urinary incontinence: a prospective cohort study. by Eason E, Labrecque M, Marcoux S, Mondor M.; 2004; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=375532

Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html.

With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 5 The value of PubMed Central, in addition to its role as an archive, lies in the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print.

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Health information and interaction on the internet: a survey of female urinary incontinence. by Sandvik H.; 1999 Jul 3; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=28152

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Interventions led by nurse continence advisers in the management of urinary incontinence: a randomized controlled trial. by Borrie MJ, Bawden M, Speechley M, Kloseck M.; 2002 May 14; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=111077

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Prevalence of urinary incontinence in Andorra: impact on women's health. by Avellanet M, Fiter M, Cirera E, Coll M.; 2003; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=169172

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Questionnaire survey of urinary incontinence in women with cystic fibrosis. by Orr A, McVean RJ, Webb AK, Dodd ME.; 2001 Jun 23; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=33391

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The impact of urinary incontinence on self-efficacy and quality of life. by Broome BA.; 2003; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=194226

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Validity study of the severity index, a simple measure of urinary incontinence in women. by Hanley J, Capewell A, Hagen S.; 2001 May 5; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=31262

The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.6 The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with urinary incontinence, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “urinary incontinence” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for urinary incontinence (hyperlinks lead to article summaries): •

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A behavioral approach to the treatment of urinary incontinence in a disabled population. Author(s): Fried GW, Goetz G, Potts-Nulty S, Cioschi HM, Staas WE Jr. Source: Archives of Physical Medicine and Rehabilitation. 1995 December; 76(12): 11204. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8540787

PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.

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A French multicenter clinical trial of SPARC for stress urinary incontinence. Author(s): Deval B, Levardon M, Samain E, Rafii A, Cortesse A, Amarenco G, Ciofu C, Haab F. Source: European Urology. 2003 August; 44(2): 254-8; Discussion 258-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12875946

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A new device for the treatment of female stress urinary incontinence. Author(s): van Veggel L, Morrell M, Harris C, Dormans-Linssen M. Source: Proceedings of the Institution of Mechanical Engineers. Part H, Journal of Engineering in Medicine. 2003; 217(4): 317-21. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12885203

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A new technique for sacral nerve stimulation: a percutaneous method for urinary incontinence caused by spinal cord injury. Author(s): Ishigooka M, Suzuki Y, Hashimoto T, Sasagawa I, Nakada T, Handa Y. Source: British Journal of Urology. 1998 February; 81(2): 315-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9488079

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A prospective randomized trial comparing tension-free vaginal tape and transobturator suburethral tape for surgical treatment of stress urinary incontinence. Author(s): deTayrac R, Deffieux X, Droupy S, Chauveaud-Lambling A, CalvaneseBenamour L, Fernandez H. Source: American Journal of Obstetrics and Gynecology. 2004 March; 190(3): 602-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15041987

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A randomized comparison of tension-free vaginal tape and endopelvic fascia plication in women with genital prolapse and occult stress urinary incontinence. Author(s): Meschia M, Pifarotti P, Spennacchio M, Buonaguidi A, Gattei U, Somigliana E. Source: American Journal of Obstetrics and Gynecology. 2004 March; 190(3): 609-13. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15041988

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A randomized crossover study to evaluate Ro 115-1240, a selective alpha1A/1Ladrenoceptor partial agonist in women with stress urinary incontinence. Author(s): Musselman DM, Ford AP, Gennevois DJ, Harbison ML, Laurent AL, Mokatrin AS, Stoltz RR, Blue DR. Source: Bju International. 2004 January; 93(1): 78-83. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14678373

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Adrenergic drugs for urinary incontinence in adults. Author(s): Alhasso A, Glazener CM, Pickard R, N'Dow J. Source: Cochrane Database Syst Rev. 2003; (2): Cd001842. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12804414

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Advancements in minimally invasive treatments for female stress urinary incontinence: radiofrequency and bulking agents. Author(s): Dmochowski R, Appell RA. Source: Curr Urol Rep. 2003 October; 4(5): 350-5. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14499056

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Advances in the management of urinary incontinence in children. Author(s): Van Savage J, Slaughenhoupt BL. Source: J Ky Med Assoc. 1997 June; 95(6): 226-34. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9198352

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Ambulatory procedures for urinary incontinence in the United States, 1994-1996. Author(s): Boyles SH, Weber AM, Meyn L. Source: American Journal of Obstetrics and Gynecology. 2004 January; 190(1): 33-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14749631

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An 89-year-old woman with urinary incontinence, 1 year later. Author(s): Daley J, Delbanco TL, Hartman EE. Source: Jama : the Journal of the American Medical Association. 1997 August 27; 278(8): 679. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9272902

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An alternative method of tension-free vaginal tape implantation for the treatment of female urinary incontinence. Author(s): Tong YC. Source: Urologia Internationalis. 2003; 71(1): 51-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12845261

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An assessment of the importance of pad testing in stress urinary incontinence and the effects of incontinence on the life quality of women. Author(s): Aslan E, Beji NK, Coskun A, Yalcin O. Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 2003 November; 14(5): 316-9; Discussion 320. Epub 2003 September 25. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14618307

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An exploration of acute care nurses' approach to assessment and management of people with urinary incontinence. Author(s): Cooper G, Watt E. Source: Journal of Wound, Ostomy, and Continence Nursing : Official Publication of the Wound, Ostomy and Continence Nurses Society / Wocn. 2003 November; 30(6): 305-13. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14615759

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Anal and urinary incontinence in women with obstetric anal sphincter rupture. Author(s): Sultan AH, Monga AK. Source: British Journal of Obstetrics and Gynaecology. 1997 June; 104(6): 754-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9197890

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Anal and urinary incontinence in women with obstetric anal sphincter rupture. Author(s): Malik A, Fenning N, O'Donnell E. Source: British Journal of Obstetrics and Gynaecology. 1997 June; 104(6): 753-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9197889

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Anal sphincter injury, fecal and urinary incontinence: a 34-year follow-up after forceps delivery. Author(s): Bollard RC, Gardiner A, Duthie GS, Lindow SW. Source: Diseases of the Colon and Rectum. 2003 August; 46(8): 1083-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12907903

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Approach to urinary incontinence in women. Diagnosis and management by family physicians. Author(s): O'Neil B, Gilmour D. Source: Can Fam Physician. 2003 May; 49: 611-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12790273

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Assessment of urinary incontinence. Author(s): Balmforth J, Cardozo L. Source: The Journal of the British Menopause Society. 2003 September; 9(3): 111-6. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14670196

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Behavior management improves urinary incontinence in older women living at home. Author(s): Rollins G. Source: Rep Med Guidel Outcomes Res. 2002 March 8; 13(5): 7-9. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12440409

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Behavioral and drug therapy for urinary incontinence. Author(s): Goode PS. Source: Urology. 2004 March; 63(3 Suppl 1): 58-64. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15013654

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Behavioral intervention for community-dwelling individuals with urinary incontinence. Author(s): Fantl JA. Source: Urology. 1998 February; 51(2A Suppl): 30-4. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9495733

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Behavioral intervention: the first-line treatment for women with urinary incontinence. Author(s): Sampselle CM. Source: Curr Urol Rep. 2003 October; 4(5): 356-61. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14499057

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Behavioral modification for institutionalized individuals with urinary incontinence. Author(s): O'Donnell PD. Source: Urology. 1998 February; 51(2A Suppl): 40-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9495735

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Behavioral therapy: practical approach to urinary incontinence. Author(s): Burgio KL. Source: Contemp Urol. 1994 February; 6(2): 24, 29-36, 41. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10146675

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Behavioral treatment options for urinary incontinence. Author(s): Burgio KL. Source: Gastroenterology. 2004 January; 126(1 Suppl 1): S82-9. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14978643

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Benzodiazepines and the risk of urinary incontinence in frail older persons living in the community. Author(s): Landi F, Cesari M, Russo A, Onder G, Sgadari A, Bernabei R; Silvernet-HC Study Group. Source: Clinical Pharmacology and Therapeutics. 2002 December; 72(6): 729-34. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12496754

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Beyond collagen: injectable therapies for the treatment of female stress urinary incontinence in the new millennium. Author(s): Kershen RT, Dmochowski RR, Appell RA. Source: The Urologic Clinics of North America. 2002 August; 29(3): 559-74. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12476520

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Biofeedback and behavioral therapy for the management of female urinary incontinence. Author(s): Gormley EA. Source: The Urologic Clinics of North America. 2002 August; 29(3): 551-7. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12476519

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Biofeedback for community-dwelling individuals with urinary incontinence. Author(s): Payne CK. Source: Urology. 1998 February; 51(2A Suppl): 35-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9495734

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Bladder neck funneling on ultrasound cystourethrography in primary stress urinary incontinence: a sign associated with urethral hypermobility and intrinsic sphincter deficiency. Author(s): Huang WC, Yang JM. Source: Urology. 2003 May; 61(5): 936-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12736011

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Bladder neck needle suspension for urinary incontinence in women. Author(s): Glazener CM, Cooper K. Source: Cochrane Database Syst Rev. 2002; (2): Cd003636. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12076494

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Bladder wall pedicle wraparound sling for neurogenic urinary incontinence in children. Author(s): Kurzrock EA, Lowe P, Hardy BE. Source: The Journal of Urology. 1996 January; 155(1): 305-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7490876

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Broad based tension-free synthetic sling for stress urinary incontinence: 5-year outcome. Author(s): Shah DK, Paul EM, Amukele S, Eisenberg ER, Badlani GH. Source: The Journal of Urology. 2003 September; 170(3): 849-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12913714

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Burch colposuspension and tension-free vaginal tape in the management of stress urinary incontinence in women. Author(s): Liapis A, Bakas P, Creatsas G. Source: European Urology. 2002 April; 41(4): 469-73. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12074820

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Burch colposuspension for stress urinary incontinence. 5-year results in 153 women. Author(s): Kinn AC. Source: Scandinavian Journal of Urology and Nephrology. 1995 December; 29(4): 449-55. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8719362

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Burch colposuspension performed at cesarean delivery in pregnancies complicated by genuine stress urinary incontinence. Author(s): Sapmaz E, Celik H. Source: J Reprod Med. 2003 March; 48(3): 191-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12698778

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Burden of stress urinary incontinence for community-dwelling women. Author(s): Fultz NH, Burgio K, Diokno AC, Kinchen KS, Obenchain R, Bump RC. Source: American Journal of Obstetrics and Gynecology. 2003 November; 189(5): 127582. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14634553

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Buttressing the divided bladder neck by a rectus abdominis muscle flap to prevent urethral recanalisation in paediatric urinary incontinence. Author(s): Sen S, Zachariah N, Chacko J, Thomas G. Source: Pediatric Surgery International. 2003 April; 19(1-2): 124-6. Epub 2003 March 26. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12721746

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Cadaveric fascia lata sling for stress urinary incontinence: a prospective quality-oflife analysis. Author(s): Richter HE, Burgio KL, Holley RL, Goode PS, Locher JL, Wright KC, Varner RE. Source: American Journal of Obstetrics and Gynecology. 2003 December; 189(6): 1590-5; Discussion 1595-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14710075

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Cesarean section: does it really prevent the development of postpartum stress urinary incontinence? A prospective study of 363 women one year after their first delivery. Author(s): Groutz A, Rimon E, Peled S, Gold R, Pauzner D, Lessing JB, Gordon D. Source: Neurourology and Urodynamics. 2004; 23(1): 2-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14694448

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Clinical Case of the Month: Urology. urinary incontinence in a male paraparetic patient (able to walk) with a mixed lower motor neuron lesion. Author(s): Madersbacher HG, Iwatsubo E, Perkash I, Stephenson TP, Stohrer M. Source: Spinal Cord : the Official Journal of the International Medical Society of Paraplegia. 1997 August; 35(8): 498-502. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9267913

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Collagen content of nonsupport tissue in pelvic organ prolapse and stress urinary incontinence. Author(s): Wong MY, Harmanli OH, Agar M, Dandolu V, Grody MH. Source: American Journal of Obstetrics and Gynecology. 2003 December; 189(6): 1597-9; Discussion 1599-1600. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14710077

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Collagen injection therapy for urinary incontinence. Author(s): Appell RA. Source: The Urologic Clinics of North America. 1994 February; 21(1): 177-82. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8284841

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Colpocleisis and urinary incontinence. Author(s): FitzGerald MP, Brubaker L. Source: American Journal of Obstetrics and Gynecology. 2003 November; 189(5): 1241-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14634547

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Combined fecal and urinary incontinence: an update. Author(s): Lacima G, Pera M. Source: Current Opinion in Obstetrics & Gynecology. 2003 October; 15(5): 405-10. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14501244

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Comparative efficacy and safety of transdermal oxybutynin and oral tolterodine versus placebo in previously treated patients with urge and mixed urinary incontinence. Author(s): Dmochowski RR, Sand PK, Zinner NR, Gittelman MC, Davila GW, Sanders SW; Transdermal Oxybutynin Study Group. Source: Urology. 2003 August; 62(2): 237-42. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12893326

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Comparison of anterior colporrhaphy and retropubic urethropexy for patients with genuine stress urinary incontinence. Author(s): Harris RL, Yancey CA, Wiser WL, Morrison JC, Meeks GR. Source: American Journal of Obstetrics and Gynecology. 1995 December; 173(6): 1671-4; Discussion 1674-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8610743

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Complications of periurethral collagen injection for stress urinary incontinence. Author(s): Stothers L, Goldenberg SL, Leone EF. Source: The Journal of Urology. 1998 March; 159(3): 806-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9474154

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Content validation of impaired skin integrity and urinary incontinence in the home health setting. Author(s): Lewis-Abney K, Rosenkranz CF. Source: Nursing Diagnosis : Nd : the Official Journal of the North American Nursing Diagnosis Association. 1994 January-March; 5(1): 36-42. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8192950

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Continence pessaries in the management of urinary incontinence in women. Author(s): Farrell SA, Singh B, Aldakhil L. Source: J Obstet Gynaecol Can. 2004 February; 26(2): 113-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14965476

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Coping with urinary incontinence: a conceptualization of the process. Author(s): Talbot LA. Source: Ostomy Wound Manage. 1994 March; 40(2): 28-30, 32, 34 Passim. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8043177

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Correction of recurrent stress urinary incontinence by needle urethropexy with a vaginal wall sling. Author(s): Pidutti RW, George SW, Morales A. Source: British Journal of Urology. 1994 April; 73(4): 418-22. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8199831

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Correlation between urodynamic test results, perineal ultrasound and degree of stress urinary incontinence. Author(s): Bai SW, Chung KA, Rha KH, Kim SU, Kim SK, Park KH. Source: J Reprod Med. 2003 September; 48(9): 718-22. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14562638

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Correlation of Valsalva leak point pressure with subjective degree of stress urinary incontinence in women. Author(s): Nitti VW, Combs AJ. Source: The Journal of Urology. 1996 January; 155(1): 281-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7490856

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Cost of stress urinary incontinence: a claims data analysis. Author(s): Birnbaum HG, Leong SA, Oster EF, Kinchen K, Sun P. Source: Pharmacoeconomics. 2004; 22(2): 95-105. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14731051

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Criterion validity, test-retest reliability and sensitivity to change of the St George Urinary Incontinence Score. Author(s): Blackwell AL, Yoong W, Moore KH. Source: Bju International. 2004 February; 93(3): 331-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14764131

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Current problems of diagnostics and treatment of urinary incontinence in females. Author(s): Hladik M, Dubravicky J, Pribylincova V, Blasko M. Source: Bratisl Lek Listy. 2003; 104(4-5): 163. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14604260

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Current treatments for patients with stress urinary incontinence. Author(s): Hasiam J. Source: Nurs Times. 2004 January 13-19; 100(2): 50-1. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14768155

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Delivery of injectable agents for treatment of stress urinary incontinence in women: evolving techniques. Author(s): Dmochowski RR, Appell RA. Source: Tech Urol. 2001 June; 7(2): 110-7. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11383988

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Depressive symptoms in women with urinary incontinence: a prospective study. Author(s): Meade-D'Alisera P, Merriweather T, Wentland M, Fatal M, Ghafar M. Source: Urologic Nursing : Official Journal of the American Urological Association Allied. 2001 December; 21(6): 397-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11998505

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Determinants of patient dissatisfaction after a tension-free vaginal tape procedure for urinary incontinence. Author(s): Deval B, Jeffry L, Al Najjar F, Soriano D, Darai E. Source: The Journal of Urology. 2002 May; 167(5): 2093-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11956447

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Development and testing of a measure of health-related quality of life for men with urinary incontinence. Author(s): Robinson JP, Shea JA. Source: Journal of the American Geriatrics Society. 2002 May; 50(5): 935-45. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12028184

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Development of a risk-adjusted urinary incontinence outcome measure of quality for nursing homes. Author(s): Mukamel DB, Watson NM, Meng H, Spector WD. Source: Medical Care. 2003 April; 41(4): 467-78. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12665711

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Diagnosis and management of urinary incontinence in the older patient. Author(s): Tannenbaum C, Perrin L, DuBeau CE, Kuchel GA. Source: Archives of Physical Medicine and Rehabilitation. 2001 January; 82(1): 134-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11239300

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Differences in coping strategies among community-residing older adults with functional urinary continence, dysfunctional urinary continence and actual urinary incontinence. Author(s): Talbot LA, Cox M. Source: Ostomy Wound Manage. 1995 November-December; 41(10): 30-2, 34-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8679048

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Differences in the quantity of elastic fibres and collagen type I and type III in endopelvic fascia between women with stress urinary incontinence and controls. Author(s): Cor A, Barbic M, Kralj B. Source: Urological Research. 2003 June; 31(2): 61-5. Epub 2003 April 02. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12677309

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Does fluid intake influence the risk for urinary incontinence, urinary tract infection, and bladder cancer? Author(s): Gray M, Krissovich M. Source: Journal of Wound, Ostomy, and Continence Nursing : Official Publication of the Wound, Ostomy and Continence Nurses Society / Wocn. 2003 May; 30(3): 126-31. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12761483

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Does urinary incontinence occurrence depend on the menstrual cycle phase? Author(s): Hvidman L, Foldspang A, Mommsen S, Bugge Nielsen J. Source: Acta Obstetricia Et Gynecologica Scandinavica. 2002 April; 81(4): 347-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11952467

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Don't ask, don't tell. Breaking the silence surrounding female urinary incontinence. Author(s): Peters S. Source: Adv Nurse Pract. 1997 May; 5(5): 41-4. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9459912

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Drug treatment options in urinary incontinence. Author(s): Wells M. Source: Community Nurse. 2000 February; 6(1): 11-2. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11144190

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Dry mouth with conventional and controlled-release oxybutynin in urinary incontinence. The Ditropan XL Study Group. Author(s): Versi E, Appell R, Mobley D, Patton W, Saltzstein D. Source: Obstetrics and Gynecology. 2000 May; 95(5): 718-21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10775736

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Duloxetine versus placebo for the treatment of North American women with stress urinary incontinence. Author(s): Dmochowski RR, Miklos JR, Norton PA, Zinner NR, Yalcin I, Bump RC; Duloxetine Urinary Incontinence Study Group. Source: The Journal of Urology. 2003 October; 170(4 Pt 1): 1259-63. Erratum In: J Urol. 2004 January; 171(1): 360. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14501737

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Duloxetine versus placebo in the treatment of European and Canadian women with stress urinary incontinence. Author(s): van Kerrebroeck P, Abrams P, Lange R, Slack M, Wyndaele JJ, Yalcin I, Bump RC; Duloxetine Urinary Incontinence Study Group. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2004 March; 111(3): 249-57. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14961887

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Duloxetine versus placebo in the treatment of stress urinary incontinence. Author(s): Norton PA, Zinner NR, Yalcin I, Bump RC; Duloxetine Urinary Incontinence Study Group. Source: American Journal of Obstetrics and Gynecology. 2002 July; 187(1): 40-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12114886

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Duloxetine vs placebo in the treatment of stress urinary incontinence: a fourcontinent randomized clinical trial. Author(s): Millard RJ, Moore K, Rencken R, Yalcin I, Bump RC; Duloxetine UI Study Group. Source: Bju International. 2004 February; 93(3): 311-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14764128

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Duloxetine: a serotonin-noradrenaline re-uptake inhibitor for the treatment of stress urinary incontinence. Author(s): Zinner NR. Source: Expert Opinion on Investigational Drugs. 2003 September; 12(9): 1559-66. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12943499

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Dynamic rectus abdominis tendon colposuspension for female stress urinary incontinence: a new procedure and its follow-up. Author(s): Goel MC, Roberts JG. Source: Urologia Internationalis. 2003; 71(1): 45-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12845260

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Dyspareunia and recurrent stress urinary incontinence after laparoscopic colposuspension with mesh and staples. A case report. Author(s): Sharp HT, Doucette RC, Norton PA. Source: J Reprod Med. 2000 November; 45(11): 947-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11127111

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Economic and personal impact of fecal and urinary incontinence. Author(s): Miner PB Jr. Source: Gastroenterology. 2004 January; 126(1 Suppl 1): S8-13. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14978633

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Education on adult urinary incontinence in nursing school curricula: can it be done in two hours? Author(s): Morishita L, Uman GC, Pierson CA. Source: Nursing Outlook. 1994 May-June; 42(3): 123-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8084761

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Effect of one interval vaginal delivery on the prevalence of stress urinary incontinence: a prospective cohort study. Author(s): Yip SK, Sahota D, Chang A, Chung T. Source: Neurourology and Urodynamics. 2003; 22(6): 558-62. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12951663

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Effect of raloxifene on urinary incontinence: a randomized controlled trial. Author(s): Waetjen LE, Brown JS, Modelska K, Blackwell T, Vittinghoff E, Cummings SR; MORE Study Group. Source: Obstetrics and Gynecology. 2004 February; 103(2): 261-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14754693

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Effective treatment for mixed urinary incontinence with a pubovaginal sling. Author(s): Chou EC, Flisser AJ, Panagopoulos G, Blaivas JG. Source: The Journal of Urology. 2003 August; 170(2 Pt 1): 494-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12853807

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Effectiveness of a geriatric urinary incontinence educational program for nursing staff. Author(s): Collette C, Leclerc G, Tu le M. Source: Can J Nurs Leadersh. 2003; 16(4): 99-109. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14983927

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Effectiveness of alpha1-adrenergic blockers in boys with low urinary flow rate and urinary incontinence. Author(s): Yang SS, Wang CC, Chen YT. Source: J Formos Med Assoc. 2003 August; 102(8): 551-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14569320

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Effectiveness of pelvic floor muscle exercise therapy supplemented with a health education program to promote long-term adherence among women with urinary incontinence. Author(s): Alewijnse D, Metsemakers JF, Mesters IE, van den Borne B. Source: Neurourology and Urodynamics. 2003; 22(4): 284-95. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12808702

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Effects of aging on generic SF-36 quality of life measurements in Hong Kong Chinese women with urinary incontinence. Author(s): Ho-Yin PL, Man-Wah P, Shing-Kai Y. Source: Acta Obstetricia Et Gynecologica Scandinavica. 2003 March; 82(3): 275-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12694125

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Electrical stimulation for the treatment of urinary incontinence. Author(s): Appell RA. Source: Urology. 1998 February; 51(2A Suppl): 24-6. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9495731

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Endoscopic treatment of urinary incontinence in children with primary epispadias. Author(s): Duffy PG, Ransley PG. Source: British Journal of Urology. 1998 February; 81(2): 309-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9488077

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Epidemiologic evaluation of reoperation for surgically treated pelvic organ prolapse and urinary incontinence. Author(s): Clark AL, Gregory T, Smith VJ, Edwards R. Source: American Journal of Obstetrics and Gynecology. 2003 November; 189(5): 1261-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14634551

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Epidemiology and natural history of urinary incontinence in women. Author(s): Hunskaar S, Burgio K, Diokno A, Herzog AR, Hjalmas K, Lapitan MC. Source: Urology. 2003 October; 62(4 Suppl 1): 16-23. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14550833

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Epidemiology of urinary incontinence in women. Author(s): Nihira MA, Henderson N. Source: Curr Womens Health Rep. 2003 August; 3(4): 340-7. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12844460

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Epidemiology, pathophysiology, and evaluation of urinary incontinence and overactive bladder. Author(s): Payne CK. Source: Urology. 1998 February; 51(2A Suppl): 3-10. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9495728

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Estrogen therapy in the management of urinary incontinence in postmenopausal women: a meta-analysis. First report of the Hormones and Urogenital Therapy Committee. Author(s): Fantl JA, Cardozo L, McClish DK. Source: Obstetrics and Gynecology. 1994 January; 83(1): 12-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8272292

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Evaluation and management of urinary incontinence in elderly women. Author(s): LaSala CA, Kuchel GA. Source: Conn Med. 2003 September; 67(8): 491-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14587130

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Evaluation and treatment of urinary incontinence in the adult. Author(s): Bushman W. Source: Compr Ther. 1994; 20(4): 224-31. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8004924

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Expanding treatment options for stress urinary incontinence in women. Author(s): Resnick NM, Griffiths DJ. Source: Jama : the Journal of the American Medical Association. 2003 July 16; 290(3): 395-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12865382

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Externally readjustable device to regulate sling tension in stress urinary incontinence: preliminary results. Author(s): Sousa-Escandon A, Lema Grille J, Rodriguez Gomez JI, Rios Tallon L, Uribarri Gonzalez C, Marques-Queimadelos A. Source: Journal of Endourology / Endourological Society. 2003 September; 17(7): 515-21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14565886

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Factors associated with women's decisions to seek treatment for urinary incontinence. Author(s): Kinchen KS, Burgio K, Diokno AC, Fultz NH, Bump R, Obenchain R. Source: Journal of Women's Health (2002). 2003 September; 12(7): 687-98. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14583109

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Factors contributing to urinary incontinence and pelvic prolapse in Nigeria. Author(s): Okonkwo JE, Obionu CO, Obiechina NJ. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 2001 September; 74(3): 301-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11543758

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Factors predictive of urinary retention after a tension-free vaginal tape procedure for female stress urinary incontinence. Author(s): Hong B, Park S, Kim HS, Choo MS. Source: The Journal of Urology. 2003 September; 170(3): 852-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12913715

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Factors that influence voiding function after the tension-free vaginal tape procedure for stress urinary incontinence. Author(s): Mutone N, Brizendine E, Hale D. Source: American Journal of Obstetrics and Gynecology. 2003 June; 188(6): 1477-81; Discussion 1481-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12824981

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Familial incidence of urinary incontinence. Author(s): Elia G, Bergman J, Dye TD. Source: American Journal of Obstetrics and Gynecology. 2002 July; 187(1): 53-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12114888

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Feasibility of performing TVT operation for stress urinary incontinence under general anaesthesia. Author(s): Kunde D, Varma R. Source: Journal of Obstetrics and Gynaecology : the Journal of the Institute of Obstetrics and Gynaecology. 2002 November; 22(6): 663-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12554259

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Fecal and urinary incontinence after vaginal delivery with anal sphincter disruption in an obstetrics unit in the United States. Author(s): Fenner DE, Genberg B, Brahma P, Marek L, DeLancey JO. Source: American Journal of Obstetrics and Gynecology. 2003 December; 189(6): 1543-9; Discussion 1549-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14710059

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Female Stress Urinary Incontinence Clinical Guidelines Panel summary report on surgical management of female stress urinary incontinence. The American Urological Association. Author(s): Leach GE, Dmochowski RR, Appell RA, Blaivas JG, Hadley HR, Luber KM, Mostwin JL, O'Donnell PD, Roehrborn CG. Source: The Journal of Urology. 1997 September; 158(3 Pt 1): 875-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9258103

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Female stress, urge, and mixed urinary incontinence are associated with a chronic and progressive pelvic floor/vaginal neuromuscular disorder: An investigation of 317 healthy and incontinent women using vaginal surface electromyography. Author(s): Gunnarsson M, Mattiasson A. Source: Neurourology and Urodynamics. 1999; 18(6): 613-21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10529709

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Female urinary incontinence health education on the Internet: pitfalls and opportunities. Author(s): Farrell KD, Robinson LM, Scott TA. Source: J Obstet Gynaecol Can. 2003 July; 25(7): 594-600. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12851672

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Female urinary incontinence. An overview of a report presented to the French Urological Association. Author(s): Ballanger P, Rischmann P. Source: European Urology. 1999 September; 36(3): 165-74. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10449997

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Female urinary incontinence: aetiology and pathophysiology. Author(s): Freeman RM. Source: Hosp Med. 2000 February; 61(2): 84-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10748783

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Female urinary incontinence: diagnosis, treatment and patients' concerns. Author(s): Hirai K, Sumi T, Kanaoka Y, Ishiko O. Source: Drugs Today (Barc). 2002 July; 38(7): 487-93. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12582465

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Female urinary incontinence: long-term follow-up after treatment in general practice. Author(s): Seim A, Hermstad R, Hunskaar S. Source: The British Journal of General Practice : the Journal of the Royal College of General Practitioners. 1998 November; 48(436): 1731-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10198478

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Female urinary incontinence--the role of the general practitioner. Author(s): Seim A, Hunskaar S. Source: Acta Obstetricia Et Gynecologica Scandinavica. 2000 December; 79(12): 1046-51. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11130085

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Findings of a three-year retrospective study to investigate prevalence and incidence of urinary incontinence and overactive bladder in a typical managed care setting. Author(s): Day PL. Source: Pharmacy Practice Management Quarterly. 2000 April; 20(1): 1-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10947537

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Five-year incidence and remission rates of female urinary incontinence in a Swedish population less than 65 years old. Author(s): Samuelsson EC, Victor FT, Svardsudd KF. Source: American Journal of Obstetrics and Gynecology. 2000 September; 183(3): 568-74. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10992175

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Fixed and dynamic urethral compression for the treatment of post-prostatectomy urinary incontinence: is history repeating itself? Author(s): Madjar S, Raz S, Gousse AE. Source: The Journal of Urology. 2001 August; 166(2): 411-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11458038

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Focal lingual dystonia, urinary incontinence, and sensory deficits secondary to low voltage electrocution: case report and literature review. Author(s): Baskerville JR, McAninch SA. Source: Emergency Medicine Journal : Emj. 2002 July; 19(4): 368-71. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12101168

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FPSUND: a new clinical classification of urinary incontinence. Author(s): Valiquette L, Duclos AJ, Lapointe SP. Source: Can J Urol. 2000 June; 7(3): 1038-42. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11118279

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GAX collagen in the treatment of urinary incontinence in elderly women: a two year follow up. Author(s): Khullar V, Cardozo LD, Abbott D, Anders K. Source: British Journal of Obstetrics and Gynaecology. 1997 January; 104(1): 96-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8988705

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General practitioners and women with urinary incontinence. Author(s): Grealish M, O'Dowd TC. Source: The British Journal of General Practice : the Journal of the Royal College of General Practitioners. 1998 February; 48(427): 975-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9624768

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General practitioners' management of female urinary incontinence. Medical records do not reflect patients' recall. Author(s): Sandvik H, Hunskaar S. Source: Scandinavian Journal of Primary Health Care. 1995 September; 13(3): 168-74. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7481168

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Genuine stress urinary incontinence in women. New laparoscopic paravaginal reconstruction. Author(s): Ostrzenski A. Source: J Reprod Med. 1998 June; 43(6): 477-82. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9653692

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Genuine stress urinary incontinence with low urethral pressure. Five-year follow-up after the Ball-Burch procedure. Author(s): Elia G, Bergman A. Source: J Reprod Med. 1995 July; 40(7): 503-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7473438

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Geriatric urinary incontinence. Author(s): Sirls LT, Rashid T. Source: Geriatric Nephrology and Urology. 1999; 9(2): 87-99. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10518252

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Giant vaginolith around an unusual foreign body--an uncommon cause of urinary incontinence in a girl. Author(s): Dalela D, Agarwal R, Mishra VK. Source: British Journal of Urology. 1994 November; 74(5): 673-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7827825

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Glutaraldehyde cross-linked collagen in the treatment of urinary incontinence in children. Author(s): Bomalaski MD, Bloom DA, McGuire EJ, Panzl A. Source: The Journal of Urology. 1996 February; 155(2): 699-702. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8558708

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Gore-Tex sling urethral suspension in type III female urinary incontinence: clinical results and urodynamic changes. Author(s): Barbalias GA, Liatsikos EN, Athanasopoulos A. Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 1997; 8(6): 344-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9609333

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Gracilis muscle neosphincter for treating urinary incontinence. Author(s): Perez-Abadia G, Van Aalst VC, Palacio MM, Werker PM, Ren X, Van Savage J, Fernandez AG, Kon M, Barker JH. Source: Microsurgery. 2001; 21(6): 271-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11746559

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Grades of intrinsic sphincteric deficiency (ISD) associated with female stress urinary incontinence. Author(s): Ghoniem GM, Elgamasy AN, Elsergany R, Kapoor DS. Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 2002; 13(2): 99-105; Discussion 105. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12054190

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Group learning behavior modification and exercise for women with urinary incontinence. Author(s): Gerard L. Source: Urologic Nursing : Official Journal of the American Urological Association Allied. 1997 March; 17(1): 17-22. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9110901

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Guidelines in gynaecology: evaluation in menorrhagia and in urinary incontinence. Author(s): Chadha Y, Mollison J, Howie F, Grimshaw J, Hall M, Russell I. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2000 April; 107(4): 535-43. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10759275

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Guidelines in gynaecology: in menorrhagia and in urinary incontinence. Author(s): Duckett J, Connell R. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2001 January; 108(1): 129-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11212993

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Health education improves older subjects' attitudes toward urinary incontinence and access to care: a randomized study in sheltered accommodation centers for the aged. Author(s): Beguin AM, Combes T, Lutzler P, Laffond G, Belmin J. Source: Journal of the American Geriatrics Society. 1997 March; 45(3): 391-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9063297

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Health information and interaction on the internet: a survey of female urinary incontinence. Author(s): Sandvik H. Source: Bmj (Clinical Research Ed.). 1999 July 3; 319(7201): 29-32. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10390457

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Health related quality of life significance of single pad urinary incontinence following radical prostatectomy. Author(s): Cooperberg MR, Master VA, Carroll PR. Source: The Journal of Urology. 2003 August; 170(2 Pt 1): 512-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12853811

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Healthcare personnel's attitudes towards patients with urinary incontinence. Author(s): Vinsnes AG, Harkless GE, Haltbakk J, Bohm J, Hunskaar S. Source: Journal of Clinical Nursing. 2001 July; 10(4): 455-62. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11822493

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Health-related quality of life measures for women with urinary incontinence: the Incontinence Impact Questionnaire and the Urogenital Distress Inventory. Continence Program in Women (CPW) Research Group. Author(s): Shumaker SA, Wyman JF, Uebersax JS, McClish D, Fantl JA. Source: Quality of Life Research : an International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation. 1994 October; 3(5): 291-306. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7841963

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Help seeking behaviour and health and social services utilisation by people suffering from urinary incontinence. Author(s): Roe B, Doll H, Wilson K. Source: International Journal of Nursing Studies. 1999 June; 36(3): 245-53. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10404294

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Helping women manage urinary incontinence. Author(s): Bates PM. Source: Advances in Skin & Wound Care. 2000 November-December; 13(6): 285-9. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12669675

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Help-seeking and associated factors in female urinary incontinence. The Norwegian EPINCONT Study. Epidemiology of Incontinence in the County of Nord-Trondelag. Author(s): Hannestad YS, Rortveit G, Hunskaar S. Source: Scandinavian Journal of Primary Health Care. 2002 June; 20(2): 102-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12184708

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High failure rate using allograft fascia lata in pubovaginal sling surgery for female stress urinary incontinence. Author(s): Huang YH, Lin AT, Chen KK, Pan CC, Chang LS. Source: Urology. 2001 December; 58(6): 943-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11744464

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High-resolution endovaginal MR imaging in stress urinary incontinence. Author(s): Stoker J, Rociu E, Bosch JL, Messelink EJ, van der Hulst VP, Groenendijk AG, Eijkemans MJ, Lameris JS. Source: European Radiology. 2003 August; 13(8): 2031-7. Epub 2003 April 12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12692675

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Historical aspects of the treatment of urinary incontinence. Author(s): Schultheiss D, Hofner K, Oelke M, Grunewald V, Jonas U. Source: European Urology. 2000 September; 38(3): 352-62. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10940713

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Home care for the frail elderly based on urinary incontinence level. Author(s): Shimanouchi S, Kamei T, Hayashi M. Source: Public Health Nursing (Boston, Mass.). 2000 November-December; 17(6): 468-73. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11115145

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Home electrical stimulation for urinary incontinence: a study of the diffusion ofa new technology. Author(s): Indrekvam S, Hunskaar S. Source: Urology. 2003 October; 62(4 Suppl 1): 24-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14550834

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Home uroflowmetry for the evaluation of boys with urinary incontinence. Author(s): Yang SS, Wang CC, Chen YT. Source: The Journal of Urology. 2003 April; 169(4): 1505-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12629404

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Home-based management of urinary incontinence: a pilot study with both frail and independent elders. Author(s): Bear M, Dwyer JW, Benveneste D, Jett K, Dougherty M. Source: Journal of Wound, Ostomy, and Continence Nursing : Official Publication of the Wound, Ostomy and Continence Nurses Society / Wocn. 1997 May; 24(3): 163-71. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9224024

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Hormone alternative doesn't worsen vasomotor symptoms or impact urinary incontinence in post-menopausal women. Author(s): Rollins G. Source: Rep Med Guidel Outcomes Res. 2004 March 5; 15(5): 7-9. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15025087

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How much society pays for urinary incontinence. Author(s): Newman DK. Source: Ostomy Wound Manage. 1997 January-February; 43(1): 18-20, 22, 24-5. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9087063

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How to assess and control urinary incontinence. Author(s): Thayer D. Source: The American Journal of Nursing. 1994 October; 94(10): 42-7; Quiz 48. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7943056

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Hysterectomy and urinary incontinence: a systematic review. Author(s): Brown JS, Sawaya G, Thom DH, Grady D. Source: Lancet. 2000 August 12; 356(9229): 535-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10950229

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Identification and intervention for urinary incontinence by community physicians and geriatric assessment teams. Author(s): McDowell BJ, Silverman M, Martin D, Musa D, Keane C. Source: Journal of the American Geriatrics Society. 1994 May; 42(5): 501-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8176144

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Identifying and treating reversible causes of urinary incontinence. Author(s): Wound, Ostomy, and Continence Nurses Society. Source: Ostomy Wound Manage. 2003 December; 49(12): 28-33. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14712008

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Identifying strategies for managing urinary incontinence with women who have multiple sclerosis. Author(s): Koch T, Kelly S. Source: Journal of Clinical Nursing. 1999 September; 8(5): 550-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10786527

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Impact of urinary incontinence after stroke: results from a prospective populationbased stroke register. Author(s): Kolominsky-Rabas PL, Hilz MJ, Neundoerfer B, Heuschmann PU. Source: Neurourology and Urodynamics. 2003; 22(4): 322-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12808707

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Impact of urinary incontinence and overactive bladder on quality of life. Author(s): Chiaffarino F, Parazzini F, Lavezzari M, Giambanco V; Gruppo Interdisciplinare di Studio Incontinenza Urinaria (GISIU). Source: European Urology. 2003 May; 43(5): 535-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12705999

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Incidence of concomitant procedures for pelvic organ prolapse and reconstruction in women who undergo surgery for stress urinary incontinence. Author(s): Ng CS, Rackley RR, Appell RA. Source: Urology. 2001 May; 57(5): 911-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11337293

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Indices for studying urinary incontinence and levator ani function in primiparous women. Author(s): Antonakos CL, Miller JM, Sampselle CM. Source: Journal of Clinical Nursing. 2003 July; 12(4): 554-61. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12790869

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Indifference and resignation of Japanese women toward urinary incontinence. Author(s): Hirai K, Ishiko O, Sumi T, Hyun Y, Nakagawa E, Ogita S. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 2001 October; 75(1): 89-91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11597629

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Influence of poststroke urinary incontinence on disability: the nursing home setting. Author(s): Bean JF, Kiely DK, Cairns KD, Morris JN. Source: American Journal of Physical Medicine & Rehabilitation / Association of Academic Physiatrists. 2003 March; 82(3): 175-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12595768

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Informal caregiving time and costs for urinary incontinence in older individuals in the United States. Author(s): Langa KM, Fultz NH, Saint S, Kabeto MU, Herzog AR. Source: Journal of the American Geriatrics Society. 2002 April; 50(4): 733-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11982676

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Injection therapy for the treatment of stress urinary incontinence in women. Author(s): Meschia M, Pifarotti P, Gattei U, Crosignani PG. Source: Gynecologic and Obstetric Investigation. 2002; 54(2): 67-72. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12566746

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Interventions led by nurse continence advisers in the management of urinary incontinence: a randomized controlled trial. Author(s): Borrie MJ, Bawden M, Speechley M, Kloseck M. Source: Cmaj : Canadian Medical Association Journal = Journal De L'association Medicale Canadienne. 2002 May 14; 166(10): 1267-73. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12041843

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Intestinal perforation as a complication of tension-free vaginal tape procedure for urinary incontinence. Author(s): Peyrat L, Boutin JM, Bruyere F, Haillot O, Fakfak H, Lanson Y. Source: European Urology. 2001 May; 39(5): 603-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11464045

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Intravaginal surface EMG probe design test for urinary incontinence patients. Author(s): Pauliina A, Jorma P, Paula I, Olavi A. Source: Acupuncture & Electro-Therapeutics Research. 2002; 27(1): 37-44. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12044019

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Introduction. Advancing the treatment of fecal and urinary incontinence through research. Author(s): Whitehead WE, Norton NJ, Wald A. Source: Gastroenterology. 2004 January; 126(1 Suppl 1): S1-2. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14978631

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Is diminished pubocervical fascia collagen content a risk factor for failure of surgical management of genuine stress urinary incontinence in women? Author(s): Skorupski P, Rechberger T, Postawski K, Woessner JF Jr, Jakowicki JA. Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2002 May 10; 102(2): 195-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11950490

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Is hormone replacement therapy (estrogen plus progestin) effective for the treatment of urinary incontinence in postmenopausal women? Author(s): Easton BT. Source: The Journal of Family Practice. 2001 May; 50(5): 470. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11350716

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Is there a role for drug therapy in the treatment of urinary incontinence in the elderly? Author(s): Whishaw DM, Fonda D. Source: The Medical Journal of Australia. 1994 April 4; 160(7): 430-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8007867

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Is tolterodine (Detrol) or oxybutynin (Ditropan) the best for treatment of urge urinary incontinence? Author(s): Blonski J. Source: The Journal of Family Practice. 2001 December; 50(12): 1017. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11742595

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Is urethral pressure profilometry a useful diagnostic test for stress urinary incontinence? Author(s): Weber AM. Source: Obstetrical & Gynecological Survey. 2001 November; 56(11): 720-35. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11711907

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Kegel exercises. Strengthening the weak pelvic floor muscles that cause urinary incontinence. Author(s): Kolcaba K, Dowd T, Winslow EH, Jacobson AF. Source: The American Journal of Nursing. 2000 November; 100(11): 59. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11103639

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Key components of patient education for pelvic floor stimulation in the treatment of urinary incontinence. Author(s): Gallo M, Sasso KC. Source: Urologic Nursing : Official Journal of the American Urological Association Allied. 1997 March; 17(1): 10-6. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9110900

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Labial fusion causing urinary incontinence in a postmenopausal female: a case report. Author(s): Julia J, Yacoub M, Levy G. Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 2003 November; 14(5): 360-1. Epub 2003 September 10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14618318

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Laparoscopic Burch colposuspension for recurrent stress urinary incontinence. Author(s): Moore RD, Speights SE, Miklos JR. Source: The Journal of the American Association of Gynecologic Laparoscopists. 2001 August; 8(3): 389-92. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11509779

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Laparoscopic colposuspension for urinary incontinence in women. Author(s): Moehrer B, Ellis G, Carey M, Wilson PD. Source: Cochrane Database Syst Rev. 2002; (1): Cd002239. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11869634

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Laparoscopic extraperitoneal bladder neck suspension (LEBNS) for stress urinary incontinence. Author(s): Yang SC, Park DS, Lee JM, Graham RW. Source: Journal of Korean Medical Science. 1995 December; 10(6): 426-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8924227

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Laparoscopic management of female urinary incontinence. Author(s): McDougall EM. Source: The Urologic Clinics of North America. 2001 February; 28(1): 145-9, X. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11277058

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Laparoscopic management of urinary incontinence, ureteric and bladder injuries. Author(s): Miklos JR, Kohli N, Moore RD. Source: Current Opinion in Obstetrics & Gynecology. 2001 August; 13(4): 411-7. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11452204

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Laparoscopic surgery for urinary incontinence. Author(s): Haylen BT. Source: The Medical Journal of Australia. 1994 January 3; 160(1): 42-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8271987

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Laparoscopic two-team slings for women with stress urinary incontinence. Author(s): Kung RC, Liu G, Lee PE, Lie KI, Morgan JE. Source: The Journal of the American Association of Gynecologic Laparoscopists. 2003 August; 10(3): 327-33. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14567806

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Laparoscopy in diagnosis and management of urinary incontinence caused by small ectopic dysplastic kidney. Author(s): Gupta NP, Goel A, Kumar P, Aron M. Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 2002; 13(5): 332-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12355296

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Leak point pressure measurement and stress urinary incontinence. Author(s): Weber AM. Source: Curr Womens Health Rep. 2001 August; 1(1): 45-52. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12112951

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Left frontal tumor in a 46-year-old man with urinary incontinence and gait disturbance. Author(s): Hirato J. Source: Neuropathology : Official Journal of the Japanese Society of Neuropathology. 2002 December; 22(4): 362-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12564781

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Lifetime medical costs for women: cardiovascular disease, diabetes, and stress urinary incontinence. Author(s): Birnbaum H, Leong S, Kabra A. Source: Women's Health Issues : Official Publication of the Jacobs Institute of Women's Health. 2003 November-December; 13(6): 204-13. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14675789

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Long-term continence and patient satisfaction after artificial sphincter implantation for urinary incontinence after prostatectomy. Author(s): Montague DK, Angermeier KW, Paolone DR. Source: The Journal of Urology. 2001 August; 166(2): 547-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11458065

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Long-term efficacy of periurethral collagen injection for the treatment of urinary incontinence secondary to myelomeningocele. Author(s): Block CA, Cooper CS, Hawtrey CE. Source: The Journal of Urology. 2003 January; 169(1): 327-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12478183

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Long-term results of Burch colposuspension and anterior colpoperineorraphy in the treatment of stress urinary incontinence and cystocele. Author(s): Cugudda A, Terrone C, Crivellaro S, Rossetti SR. Source: Annales D'urologie. 2002 May; 36(3): 176-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12056090

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Long-term results of surgical treatment for female stress urinary incontinence. Author(s): Kuo HC. Source: Urologia Internationalis. 2001; 66(1): 13-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11150944

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Long-term results of the FemSoft urethral insert for the management of female stress urinary incontinence. Author(s): Sirls LT, Foote JE, Kaufman JM, Lightner DJ, Miller JL, Moseley WG, Nygaard IE, Steidle CP. Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 2002; 13(2): 88-95; Discussion 95. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12054188

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Long-term results of the tension-free vaginal tape (TVT) procedure for surgical treatment of female stress urinary incontinence. Author(s): Nilsson CG, Kuuva N, Falconer C, Rezapour M, Ulmsten U. Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 2001; 12 Suppl 2: S5-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11450979

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Low back pain and urinary incontinence. A hypothetical relationship. Author(s): Eisenstein SM, Engelbrecht DJ, el Masry WS. Source: Spine. 1994 May 15; 19(10): 1148-52. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8059271

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Macroplastique implantation system for the treatment of female stress urinary incontinence. Author(s): Tamanini JT, D'Ancona CA, Tadini V, Netto NR Jr. Source: The Journal of Urology. 2003 June; 169(6): 2229-33. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12771756

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Management of urinary incontinence and nocturnal enuresis in attention-deficit hyperactivity disorder. Author(s): Crimmins CR, Rathbun SR, Husmann DA. Source: The Journal of Urology. 2003 October; 170(4 Pt 1): 1347-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14501767

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Management of urinary incontinence in women: clinical applications. Author(s): Holroyd-Leduc JM, Straus SE. Source: Jama : the Journal of the American Medical Association. 2004 February 25; 291(8): 996-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14982916

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Management of urinary incontinence in women: scientific review. Author(s): Holroyd-Leduc JM, Straus SE. Source: Jama : the Journal of the American Medical Association. 2004 February 25; 291(8): 986-95. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14982915

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Managing urinary incontinence across the lifespan. Author(s): Miller YD, Brown WJ, Smith N, Chiarelli P. Source: International Journal of Behavioral Medicine. 2003; 10(2): 143-61. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12763707

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Measuring the severity of stress urinary incontinence using the Incontinence Impact Questionnaire. Author(s): Handa VL, Massof RW. Source: Neurourology and Urodynamics. 2004; 23(1): 27-32. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14694453

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Mechanical properties of synthetic implants used in the repair of prolapse and urinary incontinence in women: which is the ideal material? Author(s): Cosson M, Debodinance P, Boukerrou M, Chauvet MP, Lobry P, Crepin G, Ego A. Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 2003 August; 14(3): 169-78; Discussion 178. Epub 2003 July 25. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12955338

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Medical and self-care practices reported by women with urinary incontinence. Author(s): Diokno AC, Burgio K, Fultz NH, Kinchen KS, Obenchain R, Bump RC. Source: Am J Manag Care. 2004 February; 10(2 Pt 1): 69-78. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15011807

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Medical management of urinary incontinence. Author(s): Diokno AC. Source: Gastroenterology. 2004 January; 126(1 Suppl 1): S77-81. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14978642

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Mixed urinary incontinence symptoms: urodynamic findings, incontinence severity, and treatment response. Author(s): Bump RC, Norton PA, Zinner NR, Yalcin I; Duloxetine Urinary Incontinence Study Group. Source: Obstetrics and Gynecology. 2003 July; 102(1): 76-83. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12850610

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Natural history of prostatism: high American Urological Association Symptom scores among community-dwelling men and women with urinary incontinence. Author(s): Roberts RO, Jacobsen SJ, Jacobson DJ, Reilly WT, Talley NJ, Lieber MM. Source: Urology. 1998 February; 51(2): 213-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9495700

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Need for sling surgery in patients with large cystoceles and masked stress urinary incontinence. Author(s): Yamada T, Ichiyanagi N, Kamata S, Sakai Y, Nagahama K, Tanizawa A, Watanabe T, Horiuchi S, Saitoh H. Source: International Journal of Urology : Official Journal of the Japanese Urological Association. 2001 November; 8(11): 599-603. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11903685

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Needs assessment of women with urinary incontinence in a district health authority. Author(s): MacKay K, Hemmett L. Source: The British Journal of General Practice : the Journal of the Royal College of General Practitioners. 2001 October; 51(471): 801-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11677702

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Neural control of the urethra and development of pharmacotherapy for stress urinary incontinence. Author(s): Fraser MO, Chancellor MB. Source: Bju International. 2003 May; 91(8): 743-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12709086

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New approaches to surgery for urinary incontinence and pelvic organ prolapse from the laparoscopic perspective. Author(s): Weber AM. Source: Clinical Obstetrics and Gynecology. 2003 March; 46(1): 44-60. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12686894

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New periurethral bulking agent for stress urinary incontinence: modified technique and early results. Author(s): Madjar S, Covington-Nichols C, Secrest CL. Source: The Journal of Urology. 2003 December; 170(6 Pt 1): 2327-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14634407

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No relationship between subjective assessment of urinary incontinence and pad test weight gain in a random population sample of menopausal women. Author(s): Ryhammer AM, Laurberg S, Djurhuus JC, Hermann AP. Source: The Journal of Urology. 1998 March; 159(3): 800-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9474152

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Nonintubated uroflowmetry as a predictor of normal pressure flow study in women with stress urinary incontinence. Author(s): Defreitas GA, Lemack GE, Zimmern PE. Source: Urology. 2003 November; 62(5): 905-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14624917

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Novel surgical technique for the treatment of female stress urinary incontinence: transobturator vaginal tape inside-out. Author(s): de Leval J. Source: European Urology. 2003 December; 44(6): 724-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14644127

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Nursing management of stress urinary incontinence in women. Author(s): Haslam J. Source: British Journal of Nursing (Mark Allen Publishing). 2004 January 8-21; 13(1): 3240. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14966450

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Objective and subjective cure rates after tension-free vaginal tape for treatment of urinary incontinence. Author(s): Jeffry L, Deval B, Birsan A, Soriano D, Darai E. Source: Urology. 2001 November; 58(5): 702-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11711344

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Occult stress urinary incontinence and the effect of vaginal vault prolapse on abdominal leak point pressures. Author(s): Gallentine ML, Cespedes RD. Source: Urology. 2001 January; 57(1): 40-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11164140

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Oestrogens for urinary incontinence in women. Author(s): Moehrer B, Hextall A, Jackson S. Source: Cochrane Database Syst Rev. 2003; (2): Cd001405. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12804406

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Open retropubic colposuspension for urinary incontinence in women. Author(s): Lapitan MC, Cody DJ, Grant AM. Source: Cochrane Database Syst Rev. 2003; (1): Cd002912. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12535443

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Outcome measures for urinary incontinence. Author(s): Blaivas JG. Source: Urology. 1998 February; 51(2A Suppl): 11-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9495729

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Outcome of sphincteroplasty combined with surgery for urinary incontinence and pelvic organ prolapse. Author(s): Halverson AL, Hull TL, Paraiso MF, Floruta C. Source: Diseases of the Colon and Rectum. 2001 October; 44(10): 1421-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11598469

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Outcome of tension-free vaginal tape (TVT) procedure in women with stress urinary incontinence--patients' perspective. Author(s): Qureshi A, Nicolaou J, Lynch CB, Anjum MI, Clay J. Source: Journal of Obstetrics and Gynaecology : the Journal of the Institute of Obstetrics and Gynaecology. 2003 May; 23(3): 297-300. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12850866

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Outcomes and surgical therapeutic index of Burch colposuspension in stress urinary incontinence. Author(s): Bai SW, Roh JL, Kim JY, Chung KA, Kim SK, Park KH. Source: J Reprod Med. 2003 February; 48(2): 102-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12621793

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Outcomes of a small group educational intervention for urinary incontinence: healthrelated quality of life. Author(s): McFall SL, Yerkes AM, Cowan LD. Source: Journal of Aging and Health. 2000 August; 12(3): 301-17. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11067699

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Oxybutynin for diagnosis of infravesical obstruction in boys with urinary incontinence. Author(s): de Kort LM, Klijn AJ, Dik P, Uiterwaal CS, de Jong TP. Source: Urology. 2003 July; 62(1): 127-30; Discussion 130-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12837438

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Pathophysiology of adult urinary incontinence. Author(s): Delancey JO, Ashton-Miller JA. Source: Gastroenterology. 2004 January; 126(1 Suppl 1): S23-32. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14978635

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Physiologic outcome measures for urinary incontinence. Author(s): Nygaard I. Source: Gastroenterology. 2004 January; 126(1 Suppl 1): S99-105. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14978645

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Postmenopausal hormone therapy and risk of developing urinary incontinence. Author(s): Grodstein F, Lifford K, Resnick NM, Curhan GC. Source: Obstetrics and Gynecology. 2004 February; 103(2): 254-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14754692

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Predictors of outcome in the behavioral treatment of urinary incontinence in women. Author(s): Burgio KL, Goode PS, Locher JL, Richter HE, Roth DL, Wright KC, Varner RE. Source: Obstetrics and Gynecology. 2003 November; 102(5 Pt 1): 940-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14672467

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Predictors of treatment response to behavioral therapy and pharmacotherapy for urinary incontinence. Author(s): Goode PS. Source: Gastroenterology. 2004 January; 126(1 Suppl 1): S141-5. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14978651

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Prevalence and severity of urinary incontinence in elderly Mexican-American women. Author(s): Espino DV, Palmer RF, Miles TP, Mouton CP, Lichtenstein MJ, Markides KP. Source: Journal of the American Geriatrics Society. 2003 November; 51(11): 1580-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14687387

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Prevalence and severity of urinary incontinence in kidney transplant recipients. Author(s): Heit M, Blackwell L, Thomas S, Ouseph R. Source: Obstetrics and Gynecology. 2004 February; 103(2): 352-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14754708

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Prevention of residual urinary incontinence following successful repair of obstetric vesico-vaginal fistula using a fibro-muscular sling. Author(s): Browning A. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2004 April; 111(4): 357-61. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15008773

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Prevention of urinary incontinence by behavioral modification program: a randomized, controlled trial among older women in the community. Author(s): Diokno AC, Sampselle CM, Herzog AR, Raghunathan TE, Hines S, Messer KL, Karl C, Leite MC. Source: The Journal of Urology. 2004 March; 171(3): 1165-71. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14767293

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Promoting social continence: products and devices in the management of urinary incontinence. Author(s): Lekan-Rutledge D, Doughty D, Moore KN, Wooldridge L. Source: Urologic Nursing : Official Journal of the American Urological Association Allied. 2003 December; 23(6): 416-28, 458; Quiz 429. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14725158

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Quality indicators for the management of urinary incontinence in vulnerable community-dwelling elders. Author(s): Schnelle JF, Smith RL. Source: Annals of Internal Medicine. 2001 October 16; 135(8 Pt 2): 752-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11601959

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Quality of life after a Marshall-Marchetti-Krantz procedure for stress urinary incontinence. Author(s): Zorzos I, Paterson PJ. Source: The Journal of Urology. 1996 January; 155(1): 259-62. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7490849

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Quality of life and seeking help in women with urinary incontinence. Author(s): Hagglund D, Walker-Engstrom ML, Larsson G, Leppert J. Source: Acta Obstetricia Et Gynecologica Scandinavica. 2001 November; 80(11): 1051-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11703207

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Quality of life assessment in men and women with urinary incontinence. Author(s): Corcos J, Beaulieu S, Donovan J, Naughton M, Gotoh M; Symptom Quality of Life Assesment Committee of the First International Consultation on Incontinence. Source: The Journal of Urology. 2002 September; 168(3): 896-905. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12187188

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Quality of life impact and treatment seeking of Chinese women with urinary incontinence. Author(s): Yu HJ, Wong WY, Chen J, Chie WC. Source: Quality of Life Research : an International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation. 2003 May; 12(3): 327-33. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12769145

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Quality of life in men with urinary incontinence after prostate cancer surgery. Author(s): Powel LL. Source: Journal of Wound, Ostomy, and Continence Nursing : Official Publication of the Wound, Ostomy and Continence Nurses Society / Wocn. 2000 May; 27(3): 174-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10814950

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Quality of life of persons with urinary incontinence: development of a new measure. Author(s): Wagner TH, Patrick DL, Bavendam TG, Martin ML, Buesching DP. Source: Urology. 1996 January; 47(1): 67-71; Discussion 71-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8560665

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Questionnaire survey of urinary incontinence in women with cystic fibrosis. Author(s): Orr A, McVean RJ, Webb AK, Dodd ME. Source: Bmj (Clinical Research Ed.). 2001 June 23; 322(7301): 1521. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11420273

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Questionnaire-based outcomes of urinary incontinence and satisfaction rates after radical prostatectomy in a national study population. Author(s): Sebesta M, Cespedes RD, Luhman E, Optenberg S, Thompson IM. Source: Urology. 2002 December; 60(6): 1055-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12475669

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Questionnaire-based survey on obstetricians and gynaecologists' attitudes towards the surgical management of urinary incontinence in women during their childbearing years. Author(s): Arunkalaivanan AS, Barrington JW. Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2003 May 1; 108(1): 85-93. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12694977

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Re: “Electric stimulation: does nursing have a role in the treatment of adult urinary incontinence”. Author(s): Sasso KC. Source: Urologic Nursing : Official Journal of the American Urological Association Allied. 1995 December; 15(4): 141. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8701336

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Re: A new technique for treatment of simple post-prostatectomy urinary incontinence: preliminary experience. Author(s): Pitts WR Jr. Source: The Journal of Urology. 1998 March; 159(3): 994. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9474212

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RE: Therapeutic efficacy of extended release oxybutynin chloride, and immediate release and long acting tolterodine tartrate in children with diurnal urinary incontinence. Author(s): Ellsworth P. Source: The Journal of Urology. 2003 September; 170(3): 928; Author Reply 928. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12913741

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Reasons why women with long-term urinary incontinence do not seek professional help: a cross-sectional population-based cohort study. Author(s): Hagglund D, Walker-Engstrom ML, Larsson G, Leppert J. Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 2003 November; 14(5): 296-304; Discussion 304. Epub 2003 August 29. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14618304

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Relationship between patient reports of urinary incontinence symptoms and quality of life measures. Author(s): Robinson D, Pearce KF, Preisser JS, Dugan E, Suggs PK, Cohen SJ. Source: Obstetrics and Gynecology. 1998 February; 91(2): 224-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9469280

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Reproducibility of instruments designed to measure subjective evaluation of female stress urinary incontinence. Author(s): Bo K. Source: Scandinavian Journal of Urology and Nephrology. 1994 March; 28(1): 97-100. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8009197

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Review of current technologies for urinary incontinence: strengths and limitations. Author(s): Fader M. Source: Proceedings of the Institution of Mechanical Engineers. Part H, Journal of Engineering in Medicine. 2003; 217(4): 233-41. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12885193

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Risk factors for stress, urge or mixed urinary incontinence in Italy. Author(s): Parazzini F, Chiaffarino F, Lavezzari M, Giambanco V; VIVA Study Group. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2003 October; 110(10): 927-33. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14550363

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Risks, comorbidities, complications and quality of life in patients with urinary incontinence. Author(s): Luber KM. Source: Director. 2003 Fall; 11(4): 166, 169-72; Quiz 173. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14608701

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Role of antimuscarinics in the treatment of nonneurogenic daytime urinary incontinence in children. Author(s): Nijman RJ. Source: Urology. 2004 March; 63(3 Suppl 1): 45-50. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15013652

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Self-care secrets. Talking about urinary incontinence. You're not alone. Loss of bladder control is more common than you think. Author(s): Hurst C. Source: Diabetes Forecast. 2003 February; 56(2): 94-5. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14765432

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Serotonin and norepinephrine involvement in efferent pathways to the urethral rhabdosphincter: implications for treating stress urinary incontinence. Author(s): Thor KB. Source: Urology. 2003 October; 62(4 Suppl 1): 3-9. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14550831

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Sling operations in the treatment of stress urinary incontinence: how to adjust sling tension. Author(s): Ezzat IM. Source: The Journal of Obstetrics and Gynaecology Research. 2003 December; 29(6): 3749. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14641684

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Stamey's abdominovaginal needle colposuspension for the correction of female genuine stress urinary incontinence--long-term results. Author(s): Wennberg AL, Edlund C, Fall M, Peeker R. Source: Scandinavian Journal of Urology and Nephrology. 2003; 37(5): 419-23. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14594692

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Stress urinary incontinence: feasibility of surgery after urethral injection. Author(s): Fianu-Jonasson A, Edwall L. Source: Acta Obstetricia Et Gynecologica Scandinavica. 2003 November; 82(11): 1060. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14616284

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Surgery versus collagen for female stress urinary incontinence: economic assessment in Ontario and Quebec. Author(s): Oremus M, Collet JP, Shapiro SH, Penrod J, Corcos J. Source: Can J Urol. 2003 August; 10(4): 1934-44. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14503939

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Surgical management of urinary incontinence. Author(s): Zyczynski HM, Howden NS. Source: Curr Womens Health Rep. 2003 October; 3(5): 399-404. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12959699

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Surgical treatment of urinary incontinence in women. Author(s): Brubaker L. Source: Gastroenterology. 2004 January; 126(1 Suppl 1): S71-6. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14978641

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Symptom severity and QOL scales for urinary incontinence. Author(s): Naughton MJ, Donovan J, Badia X, Corcos J, Gotoh M, Kelleher C, Lukacs B, Shaw C. Source: Gastroenterology. 2004 January; 126(1 Suppl 1): S114-23. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14978647

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Systematic review: efficacy of silicone microimplants (Macroplastique) therapy for stress urinary incontinence in adult women. Author(s): ter Meulen PH, Berghmans LC, van Kerrebroeck PE. Source: European Urology. 2003 November; 44(5): 573-82. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14572757

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The development of a national database of the results of surgery for urinary incontinence in women. Author(s): Kulseng-Hanssen S. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2003 November; 110(11): 975-82. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14592581

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The impact on health-related quality of life of stress, urge and mixed urinary incontinence. Author(s): Coyne KS, Zhou Z, Thompson C, Versi E. Source: Bju International. 2003 November; 92(7): 731-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14616456

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The micturition habits and prevalence of daytime urinary incontinence in Japanese primary school children. Author(s): Kajiwara M, Inoue K, Usui A, Kurihara M, Usui T. Source: The Journal of Urology. 2004 January; 171(1): 403-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14665943

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The perspective of a neurologist on treatment-related research in fecal and urinary incontinence. Author(s): Fowler CJ. Source: Gastroenterology. 2004 January; 126(1 Suppl 1): S172-4. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14978657

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The prevalence of male urinary incontinence in four centres: the UREPIK study. Author(s): Boyle P, Robertson C, Mazzetta C, Keech M, Hobbs FD, Fourcade R, Kiemeney L, Lee C; UrEpik Study Group. Source: Bju International. 2003 December; 92(9): 943-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14632852

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The prevalence of urinary incontinence in women in four European countries. Author(s): Hunskaar S, Lose G, Sykes D, Voss S. Source: Bju International. 2004 February; 93(3): 324-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14764130

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Transvaginal electrical stimulation in the treatment of urinary incontinence. Author(s): Barroso JC, Ramos JG, Martins-Costa S, Sanches PR, Muller AF. Source: Bju International. 2004 February; 93(3): 319-23. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14764129

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Treating urinary incontinence in the elderly--conservative therapies that work: a systematic review. Author(s): Teunissen TA, de Jonge A, van Weel C, Lagro-Janssen AL. Source: The Journal of Family Practice. 2004 January; 53(1): 25-30, 32. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14709263

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Treatment options for female urinary incontinence. Author(s): Sutherland SE, Goldman HB. Source: The Medical Clinics of North America. 2004 March; 88(2): 345-66. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15049582

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Trends toward less invasive treatment of female stress urinary incontinence. Author(s): Balmforth J, Cardozo LD. Source: Urology. 2003 October; 62(4 Suppl 1): 52-60. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14550838

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Urethral injection for stress urinary incontinence: long-term results with dextranomer/hyaluronic acid copolymer. Author(s): Stenberg AM, Larsson G, Johnson P. Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 2003 November; 14(5): 335-8; Discussion 338. Epub 2003 September 13. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14618311

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Urgency of voiding and abdominal pressure transmission in women with mixed urinary incontinence. Author(s): Cucchi A, Siracusano S, Di Benedetto P, Comelli M, Rovereto B. Source: Neurourology and Urodynamics. 2004; 23(1): 43-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14694456

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Urinary incontinence in a Finnish population aged 70 and over. Prevalence of types, associated factors and self-reported treatments. Author(s): Nuotio M, Jylha M, Luukkaala T, Tammela TL. Source: Scandinavian Journal of Primary Health Care. 2003 September; 21(3): 182-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14531512

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Urinary incontinence in older persons: a simple approach to a complex problem. Author(s): Tan TL. Source: Ann Acad Med Singapore. 2003 November; 32(6): 731-9. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14716940

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Urinary incontinence in the 12-month postpartum period. Author(s): Burgio KL, Zyczynski H, Locher JL, Richter HE, Redden DT, Wright KC. Source: Obstetrics and Gynecology. 2003 December; 102(6): 1291-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14662217

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Urinary incontinence. Solving a secret problem. Author(s): Shultz JM. Source: Nursing. 2003 November; Suppl: 5-6, 9-10. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14748153

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Urinary incontinence: newer pharmacotherapeutic trends. Author(s): Huggins ME, Bhatia NN, Ostergard DR. Source: Current Opinion in Obstetrics & Gynecology. 2003 October; 15(5): 419-27. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14501246

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Urodynamically defined stress urinary incontinence and bladder outlet obstruction coexist in women. Author(s): Bradley CS, Rovner ES. Source: The Journal of Urology. 2004 February; 171(2 Pt 1): 757-60; Discussion 760-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14713804

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Use of the Agency for Health Care Policy and Research Urinary Incontinence Guideline in nursing homes. Author(s): Watson NM, Brink CA, Zimmer JG, Mayer RD. Source: Journal of the American Geriatrics Society. 2003 December; 51(12): 1779-86. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14687358

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Utilization of preoperative urodynamic investigations by gynecologists who frequently operate for female urinary incontinence. Author(s): Duggan PM, Wilson PD, Norton P, Brown AD, Drutz HP, Herbison P. Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 2003 October; 14(4): 282-7; Discussion 286-7. Epub 2003 August 07. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14530842

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Vaginal delivery parameters and urinary incontinence: the Norwegian EPINCONT study. Author(s): Rortveit G, Daltveit AK, Hannestad YS, Hunskaar S. Source: American Journal of Obstetrics and Gynecology. 2003 November; 189(5): 126874. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14634552

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Vaginal surgery for stress urinary incontinence. Author(s): Wahle GR, Young GP, Raz S. Source: Urology. 1994 April; 43(4): 416-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8154063

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Vaginal ultrasonography versus colpo-cysto-urethrography in the evaluation of female urinary incontinence. Author(s): Mouritsen L, Strandberg C. Source: Acta Obstetricia Et Gynecologica Scandinavica. 1994 April; 73(4): 338-42. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8160543

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Validity study of the severity index, a simple measure of urinary incontinence in women. Author(s): Hanley J, Capewell A, Hagen S. Source: Bmj (Clinical Research Ed.). 2001 May 5; 322(7294): 1096-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11337439

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Vascular injury during tension-free vaginal tape procedure for stress urinary incontinence. Author(s): Walters MD, Tulikangas PK, LaSala C, Muir TW. Source: Obstetrics and Gynecology. 2001 November; 98(5 Pt 2): 957-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11704220

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Ventral hernia of the urinary bladder with mixed urinary incontinence: treatment with herniorrhaphy and allograft fascial sling. Author(s): Rovner ES, Gomes CM, Banner MP, Wein AJ. Source: Urology. 2000 January; 55(1): 145. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10754165

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Videourodynamic analysis of the relationship of Valsalva and cough leak point pressures in women with stress urinary incontinence. Author(s): Kuo HC. Source: Urology. 2003 March; 61(3): 544-8; Discussion 548-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12639643

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Videourodynamic results after pubovaginal sling procedure for stress urinary incontinence. Author(s): Kuo HC. Source: Urology. 1999 November; 54(5): 802-6; Discussion 806-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10565737

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Videourodynamic results in stress urinary incontinence patients after pelvic floor muscle training. Author(s): Kuo HC. Source: J Formos Med Assoc. 2003 January; 102(1): 23-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12684608

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Visual analogue scale, urinary incontinence severity score and 15 D--psychometric testing of three different health-related quality-of-life instruments for urinary incontinent women. Author(s): Stach-Lempinen B, Kujansuu E, Laippala P, Metsanoja R. Source: Scandinavian Journal of Urology and Nephrology. 2001 December; 35(6): 476-83. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11848427

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Weighted vaginal cones for urinary incontinence. Author(s): Herbison P, Plevnik S, Mantle J. Source: Cochrane Database Syst Rev. 2002; (1): Cd002114. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11869623

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Weighted vaginal cones for urinary incontinence. Author(s): Herbison P, Plevnik S, Mantle J. Source: Cochrane Database Syst Rev. 2000; (2): Cd002114. Review. Update In: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10796862

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What is the available evidence for hormone replacement therapy in women with stress urinary incontinence? Author(s): Al-Badr A, Ross S, Soroka D, Drutz HP. Source: J Obstet Gynaecol Can. 2003 July; 25(7): 567-74. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12851668

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What's new: the AHCPR guideline update on urinary incontinence. Author(s): Newman DK. Source: Ostomy Wound Manage. 1996 November-December; 42(10): 46-50, 52-4, 56 Passim. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9016151

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Why do only a minority of perimenopausal women with urinary incontinence consult a doctor? Author(s): Reymert J, Hunskaar S. Source: Scandinavian Journal of Primary Health Care. 1994 September; 12(3): 180-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7997696

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Why older community-dwelling adults do not discuss urinary incontinence with their primary care physicians. Author(s): Dugan E, Roberts CP, Cohen SJ, Preisser JS, Davis CC, Bland DR, Albertson E. Source: Journal of the American Geriatrics Society. 2001 April; 49(4): 462-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11347792

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CHAPTER 2. NUTRITION AND URINARY INCONTINENCE Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and urinary incontinence.

Finding Nutrition Studies on Urinary Incontinence The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements; National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: 301-435-2920, Fax: 301-480-1845, E-mail: [email protected]). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.7 The IBIDS includes references and citations to both human and animal research studies. As a service of the ODS, access to the IBIDS database is available free of charge at the following Web address: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. Now that you have selected a database, click on the “Advanced” tab. An advanced search allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “urinary incontinence” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.

7

Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.

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The following information is typical of that found when using the “Full IBIDS Database” to search for “urinary incontinence” (or a synonym): •

A new injectable bulking agent for treatment of stress urinary incontinence: results of a multicenter, randomized, controlled, double-blind study of Durasphere. Author(s): Mayo Clinic, Rochester, Minnesota, USA Source: Lightner, D Calvosa, C Andersen, R Klimberg, I Brito, C G Snyder, J Gleason, D Killion, D Macdonald, J Khan, A U Diokno, A Sirls, L T Saltzstein, D Urology. 2001 July; 58(1): 12-5 1527-9995

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A prospective, randomized controlled trial of inpatient versus outpatient continence programs in the treatment of urinary incontinence in the female. Author(s): Department of Gynaecology, Southern General Hospital, Glasgow, Scotland. Source: Ramsay, I N Ali, H M Hunter, M Stark, D McKenzie, S Donaldson, K Major, K Int-Urogynecol-J-Pelvic-Floor-Dysfunct. 1996; 7(5): 260-3

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Alternatives for the pharmacologic management of urge and stress urinary incontinence in the elderly. Author(s): Department of Urology, Tulane University School of Medicine, New Orleans 70112, USA. Source: Ghoniem, G M Hassouna, M J-Wound-Ostomy-Continence-Nurs. 1997 November; 24(6): 311-8 1071-5754

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Behavioral treatment of urinary incontinence: a complementary approach. Author(s): West Coast Continence Clinic, Cumberland, British Columbia, Canada. Source: Foster, P Ostomy-Wound-Manage. 1998 June; 44(6): 62-6, 68, 70 0889-5899

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Beta(3)-adrenoceptor agonists for the treatment of frequent urination and urinary incontinence: 2-[4-(2-[[(1S,2R)-2-hydroxy-2-(4-hydroxyphenyl)-1methylethyl]amino]ethyl)phenoxy]-2-methylpropionic acid. Author(s): Central Research Laboratory, Kissei Pharmaceutical Company Ltd., 4365-1, Hotaka, Nagano, 399-8304, Japan. [email protected] Source: Tanaka, N Tamai, T Mukaiyama, H Hirabayashi, A Muranaka, H Ishikawa, T Akahane, S Akahane, M Bioorg-Med-Chem. 2001 December; 9(12): 3265-71 0968-0896

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Clinical and radiographic findings compared with urodynamic findings in neutered female dogs with refractory urinary incontinence. Source: Nickel, R.F. Vink Noteboom, M. Brom, W.E. van den. Vet-rec. London : The British Veterinary Association. July 3, 1999. volume 145 (1) page 11-15. 0042-4900

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Colposuspension as a treatment for urinary incontinence in spayed dogs. Source: Rawlings, C.A. J-Am-Anim-Hosp-Assoc. Lakewood, Colo. : The American Animal Hospital Association. Mar/April 2002. volume 38 (2) page 107-110. 0587-2871

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Dietary caffeine, fluid intake and urinary incontinence in older rural women. Author(s): School of Nursing, Hawaii Pacific University, Honolulu 96813, USA. Source: Tomlinson, B U Dougherty, M C Pendergast, J F Boyington, A R Coffman, M A Pickens, S M Int-Urogynecol-J-Pelvic-Floor-Dysfunct. 1999; 10(1): 22-8

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Estrogens and phenylpropanolamine in combination for stress urinary incontinence in postmenopausal women. Author(s): Department of Urology, Karolinska Hospital, Stockholm, Sweden. Source: Kinn, A C Lindskog, M Urology. 1988 September; 32(3): 273-80 0090-4295

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Evaluation of a simple, non-surgical concept for management of urinary incontinence (minimal care) in an open-access, interdisciplinary incontinence clinic. Author(s): Department of Urology, Hvidovre Hospital, University of Copenhagen, Denmark.

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Source: Sander, P Mouritsen, L Andersen, J T Fischer Rasmussen, W Neurourol-Urodyn. 2000; 19(1): 9-17 0733-2467 •

Group learning behavior modification and exercise for women with urinary incontinence. Source: Gerard, L Urol-Nurs. 1997 March; 17(1): 17-22 1053-816X

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Long-term efficacy of nonsurgical urinary incontinence treatment in elderly women. Author(s): Department of Obstetrics and Gynecology, University of Wisconsin-Madison, USA. [email protected] Source: Weinberger, M W Goodman, B M Carnes, M J-Gerontol-A-Biol-Sci-Med-Sci. 1999 March; 54(3): M117-21 1079-5006

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Low-dose desmopressin in the treatment of nocturnal urinary incontinence in the exstrophy-epispadias complex. Author(s): Division of Paediatric Urology, 'Bambino Gesu' Children's Hospital, Rome, Italy. Source: Caione, P Nappo, S De Castro, R Prestipino, M Capozza, N BJU-Int. 1999 August; 84(3): 329-34 1464-4096

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Medical therapy of urinary incontinence in ovariectomised bitches: a comparison of the effectiveness of diethylstilboestrol and pseudoephedrine. Source: Nendick, P A Clark, W T Aust-Vet-J. 1987 April; 64(4): 117-8 0005-0423

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Nonsurgical treatment of urinary incontinence. Author(s): Case Western Reserve University, Division of Urogynecology, University MacDonald Womens Hospital, Cleveland, OH 44106. Source: Walters, M D Realini, J P Dougherty, M Curr-Opin-Obstet-Gynecol. 1992 August; 4(4): 554-8 1040-872X

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Patient history in the diagnosis of urinary incontinence and determining the quality of life. Author(s): Department of Obstetrics and Gynaecology, Tampere University Hospital, Finland. Source: Kujansuu, E Acta-Obstet-Gynecol-Scand-Suppl. 1997; 16615-8 0300-8835

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Postmenopausal urinary incontinence. Source: Zhao, C X J-Tradit-Chin-Med. 1987 December; 7(4): 305-6 0254-6272

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Self-esteem before and after treatment in children with nocturnal enuresis and urinary incontinence. Author(s): Department of Child and Adolescent Psychiatry, University Hospital of Umea, Sweden. Source: Hagglof, B Andren, O Bergstrom, E Marklund, L Wendelius, M Scand-J-UrolNephrol-Suppl. 1997; 18379-82 0300-8886

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The pharmacological treatment of urinary incontinence. Author(s): The Department of Clinical Pharmacology, Lund University Hospital, Lund, Sweden. [email protected] Source: Andersson, K E Appell, R Cardozo, L D Chapple, C Drutz, H P Finkbeiner, A E Haab, F Vela Navarrete, R BJU-Int. 1999 December; 84(9): 923-47 1464-4096

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The role of estrogen in female urinary incontinence and urogenital aging: a review. Author(s): Department of Obstetrics and Gynecology, University of Toronto, Mount Sinai Hospital, Ontario, Canada. Source: Lovatsis, D Drutz, H P Ostomy-Wound-Manage. 1998 June; 44(6): 48-53 08895899

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Treatment of bitches with acquired urinary incontinence with oestriol. Author(s): Referral Clinic De Wagenrenk, Wageningen, The Netherlands. Source: Mandigers, R J Nell, T Vet-Rec. 2001 December 22-29; 149(25): 764-7 0042-4900

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Understanding the problem of urinary incontinence. Author(s): Department of Physician Assistant Studies, University of North Texas Health Science Center, Fort Worth, USA. Source: Telford, Carolyn JAAPA. 2002 January; 15(1): 45-50

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Urinary incontinence and related urogenital symptoms in elderly women. Author(s): Continence Clinic, Vasa Hospital, Gothenburg, Sweden. Source: Molander, U Acta-Obstet-Gynecol-Scand-Suppl. 1993; 1581-22 0300-8835

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What's new: the AHCPR guideline update on urinary incontinence. Author(s): DKN & Associates, Inc., Philadelphia, Pennsylvania, USA. Source: Newman, D K Ostomy-Wound-Manage. 1996 Nov-December; 42(10): 46-50, 524, 56 passim 0889-5899

Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: •

healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0

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The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov

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The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov

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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/

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The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/

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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/

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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/

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Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/

Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats

Nutrition

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Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html

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Google: http://directory.google.com/Top/Health/Nutrition/

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Healthnotes: http://www.healthnotes.com/

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Open Directory Project: http://dmoz.org/Health/Nutrition/

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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/

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WebMDHealth: http://my.webmd.com/nutrition

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

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The following is a specific Web list relating to urinary incontinence; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

Vitamins Vitamin B12 Source: Healthnotes, Inc.; www.healthnotes.com

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CHAPTER 3. ALTERNATIVE MEDICINE AND URINARY INCONTINENCE Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to urinary incontinence. At the conclusion of this chapter, we will provide additional sources.

The Combined Health Information Database The Combined Health Information Database (CHID) is a bibliographic database produced by health-related agencies of the U.S. federal government (mostly from the National Institutes of Health) that can offer concise information for a targeted search. The CHID database is updated four times a year at the end of January, April, July, and October. Check the titles, summaries, and availability of CAM-related information by using the “Simple Search” option at the following Web site: http://chid.nih.gov/simple/simple.html. In the drop box at the top, select “Complementary and Alternative Medicine.” Then type “urinary incontinence” (or synonyms) in the second search box. We recommend that you select 100 “documents per page” and to check the “whole records” options. The following was extracted using this technique: •

Imagine This!: Infinite Uses of Guided Imagery in Women's Health Source: Journal of Holistic Nursing. 17(4): 317-330. December 1999. Summary: This journal article examines the range of applications for guided imagery in women's health. First, it presents background information about the history of imagery, definitions, theoretical foundations, and guided imagery techniques. Then, it reviews research supporting the effectiveness of imagery in various applications such as reducing labor pain, promoting successful lactation, decreasing postpartum depression, and decreasing stress during cancer treatment. Next, it describes an approach to introducing the techniques of guided imagery during routine office procedures such as the pelvic examination, so women will be prepared for crisis situations such as the birth of a child or the diagnosis and treatment of cancer. Finally, it suggests additional applications for guided imagery in women's health care, including other stressful office

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procedures, endometriosis, premenstrual syndrome, chemotherapy, high risk pregnancy, labor, menopause, urinary incontinence, and chronic illness. The article has 2 tables and 34 references.

National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov/) has created a link to the National Library of Medicine’s databases to facilitate research for articles that specifically relate to urinary incontinence and complementary medicine. To search the database, go to the following Web site: http://www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “urinary incontinence” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine that are related to urinary incontinence: •

A behavioral approach to the treatment of urinary incontinence in a disabled population. Author(s): Fried GW, Goetz G, Potts-Nulty S, Cioschi HM, Staas WE Jr. Source: Archives of Physical Medicine and Rehabilitation. 1995 December; 76(12): 11204. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8540787

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A comparison of effectiveness of bladder training and pelvic muscle exercise on female urinary incontinence. Author(s): Yoon HS, Song HH, Ro YJ. Source: International Journal of Nursing Studies. 2003 January; 40(1): 45-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12550149

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A conservative approach for a patient with traumatically induced urinary incontinence. Author(s): Stude DE, Bergmann TF, Finer BA. Source: Journal of Manipulative and Physiological Therapeutics. 1998 June; 21(5): 363-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9627868

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A long-term study of patient outcomes with pelvic muscle re-education for urinary incontinence. Author(s): Dattilo J. Source: Journal of Wound, Ostomy, and Continence Nursing : Official Publication of the Wound, Ostomy and Continence Nurses Society / Wocn. 2001 July; 28(4): 199-205. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11452256

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A new device for the treatment of female stress urinary incontinence. Author(s): van Veggel L, Morrell M, Harris C, Dormans-Linssen M.

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Source: Proceedings of the Institution of Mechanical Engineers. Part H, Journal of Engineering in Medicine. 2003; 217(4): 317-21. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12885203 •

A new technique for sacral nerve stimulation: a percutaneous method for urinary incontinence caused by spinal cord injury. Author(s): Ishigooka M, Suzuki Y, Hashimoto T, Sasagawa I, Nakada T, Handa Y. Source: British Journal of Urology. 1998 February; 81(2): 315-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9488079

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A pilot study to determine predictors of behavioral treatment completion for urinary incontinence. Author(s): Kincade JE, Peckous BK, Busby-Whitehead J. Source: Urologic Nursing : Official Journal of the American Urological Association Allied. 2001 February; 21(1): 39-44. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11998114

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A population based, randomized, controlled trial of conservative treatment for urinary incontinence in women. Author(s): Holtedahl K, Verelst M, Schiefloe A. Source: Acta Obstetricia Et Gynecologica Scandinavica. 1998 July; 77(6): 671-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9688247

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A tangible means of assessing progress. Biofeedback in the management of urinary incontinence. Author(s): Wells M. Source: Prof Nurse. 1991 April; 6(7): 396-7, 399. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2020682

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Addressing Medicare coverage for biofeedback in the treatment of urinary incontinence. Author(s): Jewell KE. Source: Ostomy Wound Manage. 1998 December; 44(12): 54-60, 62-6. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10026549

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An exploration of acute care nurses' approach to assessment and management of people with urinary incontinence. Author(s): Cooper G, Watt E. Source: Journal of Wound, Ostomy, and Continence Nursing : Official Publication of the Wound, Ostomy and Continence Nurses Society / Wocn. 2003 November; 30(6): 305-13. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14615759

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An interdisciplinary approach to the assessment and behavioral treatment of urinary incontinence in geriatric outpatients. Author(s): McDowell BJ, Burgio KL, Dombrowski M, Locher JL, Rodriguez E. Source: Journal of the American Geriatrics Society. 1992 April; 40(4): 370-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1556364

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An overview of urinary incontinence in adults: assessments and behavioral interventions. Author(s): Beckman NJ. Source: Clinical Nurse Specialist Cns. 1995 September; 9(5): 241-7, 274. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8697354

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Anal electrostimulation in urinary incontinence. Technical description of a new device. Author(s): Bergmann S, Eriksen BC. Source: Urologia Internationalis. 1986; 41(6): 411-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3824696

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Assessment and management of urinary incontinence among homebound older adults: a clinical trial protocol. Author(s): Engberg S, McDowell BJ, Weber E, Brodak I, Donovan N, Engberg R. Source: Adv Pract Nurs Q. 1997 Fall; 3(2): 48-56. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9432453

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Assessment for biofeedback and behavioral therapy for urinary incontinence. Author(s): Coxe J. Source: Urologic Nursing : Official Journal of the American Urological Association Allied. 1994 September; 14(3): 82-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7732422

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Behavior therapies for urinary incontinence in the elderly. Author(s): Burgio KL, Burgio LD. Source: Clinics in Geriatric Medicine. 1986 November; 2(4): 809-27. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3536064

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Behavioral and drug therapy for urinary incontinence. Author(s): Goode PS. Source: Urology. 2004 March; 63(3 Suppl 1): 58-64. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15013654

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Behavioral intervention: incontinence. Author(s): Sampselle CM.

the

first-line

treatment

for

women

with

urinary

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Source: Curr Urol Rep. 2003 October; 4(5): 356-61. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14499057 •

Behavioral therapy for urinary incontinence. Author(s): Wheeler JS Jr, Walter JS, Niecestro RM, Scalzo AJ. Source: J Et Nurs. 1992 March-April; 19(2): 59-65. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1558862

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Behavioral therapy: practical approach to urinary incontinence. Author(s): Burgio KL. Source: Contemp Urol. 1994 February; 6(2): 24, 29-36, 41. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10146675

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Behavioral training for post-prostatectomy urinary incontinence. Author(s): Burgio KL, Stutzman RE, Engel BT. Source: The Journal of Urology. 1989 February; 141(2): 303-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2913349

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Behavioral training for urinary incontinence in elderly ambulatory patients. Author(s): Burton JR, Pearce KL, Burgio KL, Engel BT, Whitehead WE. Source: Journal of the American Geriatrics Society. 1988 August; 36(8): 693-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3403874

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Behavioral treatment of exercise-induced urinary incontinence among female soldiers. Author(s): Sherman RA, Davis GD, Wong MF. Source: Military Medicine. 1997 October; 162(10): 690-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9339085

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Behavioral vs drug treatment for urge urinary incontinence in older women: a randomized controlled trial. Author(s): Lekan-Rutledge D. Source: Journal of Wound, Ostomy, and Continence Nursing : Official Publication of the Wound, Ostomy and Continence Nurses Society / Wocn. 1999 May; 26(3): 27A-28A. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10711115

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Behavioral vs drug treatment for urge urinary incontinence in older women: a randomized controlled trial. Author(s): Burgio KL, Locher JL, Goode PS, Hardin JM, McDowell BJ, Dombrowski M, Candib D.

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Source: Jama : the Journal of the American Medical Association. 1998 December 16; 280(23): 1995-2000. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9863850 •

Biofeedback and behavioral therapy for the management of female urinary incontinence. Author(s): Gormley EA. Source: The Urologic Clinics of North America. 2002 August; 29(3): 551-7. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12476519

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Biofeedback and electrical stimulation therapy for treating urinary incontinence and voiding dysfunction: one center's experience. Author(s): Abdelghany S, Hughes J, Lammers J, Wellbrock B, Buffington PJ, Shank RA 3rd. Source: Urologic Nursing : Official Journal of the American Urological Association Allied. 2001 December; 21(6): 401-5, 410. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11998506

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Biofeedback and physiotherapy versus physiotherapy alone in the treatment of genuine stress urinary incontinence. Author(s): Glavind K, Nohr SB, Walter S. Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 1996; 7(6): 339-43. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9203484

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Biofeedback for community-dwelling individuals with urinary incontinence. Author(s): Payne CK. Source: Urology. 1998 February; 51(2A Suppl): 35-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9495734

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Biofeedback in treatment of urinary incontinence in stroke patients. Author(s): Middaugh SJ, Whitehead WE, Burgio KL, Engel BT. Source: Biofeedback Self Regul. 1989 March; 14(1): 3-19. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2752058

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Biofeedback in urinary incontinence: past, present and future. Author(s): Weatherall M. Source: Current Opinion in Obstetrics & Gynecology. 2000 October; 12(5): 411-3. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11111884

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Biofeedback therapy technique for treatment of urinary incontinence. Author(s): O'Donnell PD, Doyle R.

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Source: Urology. 1991 May; 37(5): 432-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2024391 •

Biofeedback vs verbal feedback as learning tools for pelvic muscle exercises in the early management of urinary incontinence after radical prostatectomy. Author(s): Floratos DL, Sonke GS, Rapidou CA, Alivizatos GJ, Deliveliotis C, Constantinides CA, Theodorou C. Source: Bju International. 2002 May; 89(7): 714-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11966630

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Bladder training and related therapies for urinary incontinence in older people. Author(s): Hadley EC. Source: Jama : the Journal of the American Medical Association. 1986 July 18; 256(3): 372-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3723724

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Bladder training for urinary incontinence in adults. Author(s): Wallace S, Roe B, Williams K, Palmer M. Source: Cochrane Database Syst Rev. 2004; 1: Cd001308. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14973967

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Changes in urodynamic measurements after successful anal electrostimulation in female urinary incontinence. Author(s): Eriksen BC, Mjolnerod OK. Source: British Journal of Urology. 1987 January; 59(1): 45-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3493825

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Combined fecal and urinary incontinence: an update. Author(s): Lacima G, Pera M. Source: Current Opinion in Obstetrics & Gynecology. 2003 October; 15(5): 405-10. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14501244

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Comparative efficacy of behavioral interventions in the management of female urinary incontinence. Continence Program for Women Research Group. Author(s): Wyman JF, Fantl JA, McClish DK, Bump RC. Source: American Journal of Obstetrics and Gynecology. 1998 October; 179(4): 999-1007. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9790388

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Comparison of behavior therapy methods for urinary incontinence following prostate surgery: a pilot study. Author(s): Joseph AC, Chang MK.

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Source: Urologic Nursing : Official Journal of the American Urological Association Allied. 2000 June; 20(3): 203-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11998139 •

Compromising and containing: self-management strategies used by men and women who live with multiple sclerosis and urinary incontinence. Author(s): Eastwood S, Kralik D, Koch T. Source: Aust J Holist Nurs. 2002 April; 9(1): 33-43. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12056315

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Conservative care of urinary incontinence in the elderly. Author(s): Keating JC Jr, Schulte EA, Miller E. Source: Journal of Manipulative and Physiological Therapeutics. 1988 August; 11(4): 300-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3049892

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Conservative management for post prostatectomy urinary incontinence. Author(s): Moore KN, Cody DJ, Glazener CM. Source: Cochrane Database Syst Rev. 2001; (2): Cd001843. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11406013

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Conservative management for urinary incontinence. Author(s): Moore KH. Source: Bailliere's Best Practice & Research. Clinical Obstetrics & Gynaecology. 2000 April; 14(2): 251-89. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10897322

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Conservative treatment of female urinary incontinence with functional magnetic stimulation. Author(s): But I. Source: Urology. 2003 March; 61(3): 558-61. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12639647

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Conservative treatment of stress urinary incontinence in women: a systematic review of randomized clinical trials. Author(s): Berghmans LC, Hendriks HJ, Bo K, Hay-Smith EJ, de Bie RA, van Waalwijk van Doorn ES. Source: British Journal of Urology. 1998 August; 82(2): 181-91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9722751

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Conservative treatment of stress urinary incontinence in women: who will benefit? Author(s): Truijen G, Wyndaele JJ, Weyler J.

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Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 2001; 12(6): 386-90. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11795642 •

Conservative treatment of urge urinary incontinence in women: a systematic review of randomized clinical trials. Author(s): Berghmans LC, Hendriks HJ, De Bie RA, van Waalwijk van Doorn ES, Bo K, van Kerrebroeck PE. Source: Bju International. 2000 February; 85(3): 254-63. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10671878

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Coping with urinary incontinence: a conceptualization of the process. Author(s): Talbot LA. Source: Ostomy Wound Manage. 1994 March; 40(2): 28-30, 32, 34 Passim. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8043177

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Cues to action: pelvic floor muscle exercise compliance in women with stress urinary incontinence. Author(s): Gallo ML, Staskin DR. Source: Neurourology and Urodynamics. 1997; 16(3): 167-77. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9136139

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Development of a non-invasive treatment system for urinary incontinence using a functional continuous magnetic stimulator (FCMS). Author(s): Ishikawa N, Suda S, Sasaki T, Yamanishi T, Hosaka H, Yasuda K, Ito H. Source: Medical & Biological Engineering & Computing. 1998 November; 36(6): 704-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10367460

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Effect of anal electrostimulation with the 'Incontan' device in women with urinary incontinence. Author(s): Eriksen BC, Bergmann S, Mjolnerod OK. Source: British Journal of Obstetrics and Gynaecology. 1987 February; 94(2): 147-56. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3493802

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Effect of functional continuous magnetic stimulation for urinary incontinence. Author(s): Yamanishi T, Yasuda K, Suda S, Ishikawa N, Sakakibara R, Hattori T. Source: The Journal of Urology. 2000 February; 163(2): 456-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10647653

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Effects of carrying a pregnancy and of method of delivery on urinary incontinence: a prospective cohort study. Author(s): Eason E, Labrecque M, Marcoux S, Mondor M.

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Source: Bmc Pregnancy and Childbirth [electronic Resource]. 2004 February 19; 4(1): 4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15053837 •

Electric stimulation and urinary incontinence: research and alternatives. Author(s): Moore KN, Gray M, Rayome R. Source: Urologic Nursing : Official Journal of the American Urological Association Allied. 1995 September; 15(3): 94-6. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7481893

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Electric stimulation: does nursing have a role in the treatment of adult urinary incontinence? Author(s): Davis VM. Source: Urologic Nursing : Official Journal of the American Urological Association Allied. 1995 June; 15(2): 56-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7597450

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Electrical pelvic floor stimulation: a possible alternative treatment for reflex urinary incontinence in patients with spinal cord injury. Author(s): Ishigooka M, Hashimoto T, Hayami S, Suzuki Y, Nakada T, Handa Y. Source: Spinal Cord : the Official Journal of the International Medical Society of Paraplegia. 1996 July; 34(7): 411-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8963996

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Electrical stimulation for the treatment of urinary incontinence. Author(s): Appell RA. Source: Urology. 1998 February; 51(2A Suppl): 24-6. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9495731

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Electrical stimulation for the treatment of urinary incontinence: do we know enough to accept it as part of our practice? Author(s): Moore KN. Source: Journal of Advanced Nursing. 1994 December; 20(6): 1018-22. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7860846

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Electromagnetic pelvic floor stimulation for urinary incontinence and bladder disease. Author(s): Goldberg RP, Sand PK. Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 2001; 12(6): 401-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11795645

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Electrostimulation of the pelvic floor in female urinary incontinence. Author(s): Eriksen BC.

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Source: Acta Obstetricia Et Gynecologica Scandinavica. 1990; 69(4): 359-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2244472 •

Ethical and practice considerations for biofeedback therapists in the treatment of urinary incontinence. Author(s): Paul P, Cassisi JE, Larson P. Source: Biofeedback Self Regul. 1996 September; 21(3): 229-40. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8894056

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Extracorporeal magnetic innervation therapy for stress urinary incontinence. Author(s): Galloway NT, El-Galley RE, Sand PK, Appell RA, Russell HW, Carlan SJ. Source: Urology. 1999 June; 53(6): 1108-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10367836

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Female urinary incontinence. Management in primary care. Author(s): O'Connell HE, MacGregor RJ, Russell JM. Source: The Medical Journal of Australia. 1992 October 19; 157(8): 537-44. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1479975

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Female urinary incontinence--consultation behaviour and patient experiences: an epidemiological survey in a Norwegian community. Author(s): Seim A, Sandvik H, Hermstad R, Hunskaar S. Source: Family Practice. 1995 March; 12(1): 18-21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7665034

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Followup of ureterosigmoidostomy diversion for bladder exstrophy--behavioral biofeedback as an alternative treatment for fecal-urinary incontinence: a case report. Author(s): Purcell MH, Duckro PN, Schultz K, Gregory JG. Source: The Journal of Urology. 1987 May; 137(5): 945-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3573191

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Geriatric urinary incontinence. Author(s): Ouslander JG. Source: Disease-A-Month : Dm. 1992 February; 38(2): 65-149. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1732088

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Group learning behavior modification and exercise for women with urinary incontinence. Author(s): Gerard L.

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Source: Urologic Nursing : Official Journal of the American Urological Association Allied. 1997 March; 17(1): 17-22. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9110901 •

Help seeking behaviour and health and social services utilisation by people suffering from urinary incontinence. Author(s): Roe B, Doll H, Wilson K. Source: International Journal of Nursing Studies. 1999 June; 36(3): 245-53. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10404294

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Historical aspects of the treatment of urinary incontinence. Author(s): Schultheiss D, Hofner K, Oelke M, Grunewald V, Jonas U. Source: European Urology. 2000 September; 38(3): 352-62. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10940713

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Home electrical stimulation for urinary incontinence: a study of the diffusion ofa new technology. Author(s): Indrekvam S, Hunskaar S. Source: Urology. 2003 October; 62(4 Suppl 1): 24-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14550834

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Home-based management of urinary incontinence: a pilot study with both frail and independent elders. Author(s): Bear M, Dwyer JW, Benveneste D, Jett K, Dougherty M. Source: Journal of Wound, Ostomy, and Continence Nursing : Official Publication of the Wound, Ostomy and Continence Nurses Society / Wocn. 1997 May; 24(3): 163-71. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9224024

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Identifying strategies for managing urinary incontinence with women who have multiple sclerosis. Author(s): Koch T, Kelly S. Source: Journal of Clinical Nursing. 1999 September; 8(5): 550-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10786527

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Improving treatment of urinary incontinence. Author(s): Resnick NM. Source: Jama : the Journal of the American Medical Association. 1998 December 16; 280(23): 2034-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9863856

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In-home management of urinary incontinence. Author(s): Plymat KR, Turner SL.

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Source: Home Healthcare Nurse. 1988 July-August; 6(4): 30-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3204031 •

Innovative technologies for the treatment of urinary incontinence. Author(s): Godsey SG. Source: Ostomy Wound Manage. 1992 January-February; 38(1): 22-6. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1605825

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Intravaginal surface EMG probe design test for urinary incontinence patients. Author(s): Pauliina A, Jorma P, Paula I, Olavi A. Source: Acupuncture & Electro-Therapeutics Research. 2002; 27(1): 37-44. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12044019

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Long-term efficacy of nonsurgical urinary incontinence treatment in elderly women. Author(s): Weinberger MW, Goodman BM, Carnes M. Source: The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences. 1999 March; 54(3): M117-21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10191838

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Management of urinary incontinence in adult ambulatory care populations. Author(s): Wyman JF. Source: Annu Rev Nurs Res. 2000; 18: 171-94. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10918936

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Managing urinary incontinence in community-residing elderly persons. Author(s): Baigis-Smith J, Smith DA, Rose M, Newman DK. Source: The Gerontologist. 1989 April; 29(2): 229-33. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2753383

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Managing urinary incontinence with bladder training: a case study. Author(s): Wyman JF. Source: J Et Nurs. 1993 May-June; 20(3): 121-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8394146

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Non-invasive feedback of external pubococcegii muscle activity as a treatment for urinary incontinence. Author(s): Van Zak DB. Source: Int J Psychosom. 1993; 40(1-4): 56-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8070987

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Nonpharmacologic treatment of urinary incontinence. Author(s): Weiss BD. Source: American Family Physician. 1991 August; 44(2): 579-86. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1858614

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Nonsurgical therapies for urinary incontinence. Author(s): Amuzu BJ. Source: Clinical Obstetrics and Gynecology. 1998 September; 41(3): 702-11. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9742366

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Nonsurgical treatment of urinary incontinence. Author(s): Walters MD, Realini JP, Dougherty M. Source: Current Opinion in Obstetrics & Gynecology. 1992 August; 4(4): 554-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1354505

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Nursing interventions for urinary incontinence in home health. Author(s): Hiser V. Source: Journal of Wound, Ostomy, and Continence Nursing : Official Publication of the Wound, Ostomy and Continence Nurses Society / Wocn. 1999 May; 26(3): 142-60. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10711124

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Nursing management of stress urinary incontinence in women. Author(s): Haslam J. Source: British Journal of Nursing (Mark Allen Publishing). 2004 January 8-21; 13(1): 3240. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14966450

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Outcomes of a small group educational intervention for urinary incontinence: healthrelated quality of life. Author(s): McFall SL, Yerkes AM, Cowan LD. Source: Journal of Aging and Health. 2000 August; 12(3): 301-17. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11067699

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Pelvic floor muscle training for urinary incontinence in women. Author(s): Hay-Smith EJ, Bo Berghmans LC, Hendriks HJ, de Bie RA, van Waalwijk van Doorn ES. Source: Cochrane Database Syst Rev. 2001; (1): Cd001407. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11279716

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Pelvic floor rehabilitation in the female according to the integral theory of female urinary incontinence. First report. Author(s): Petros PP, Skilling PM.

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Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2001 February; 94(2): 264-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11165737 •

Pelvic muscle exercise/biofeedback for urinary incontinence after prostatectomy: an education program. Author(s): Mathewson-Chapman M. Source: Journal of Cancer Education : the Official Journal of the American Association for Cancer Education. 1997 Winter; 12(4): 218-23. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9440013

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Perineal biofeedback versus pelvic floor training in the treatment of urinary incontinence. Author(s): Ceresoli A, Zanetti G, Seveso M, Bustros J, Montanari E, Guarneri A, Tzoumas S. Source: Arch Ital Urol Androl. 1993 October; 65(5): 559-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8252086

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Physical therapy as an effective change agent in the treatment of patients with urinary incontinence. Author(s): McCandless S, Mason G. Source: J Miss State Med Assoc. 1995 September; 36(9): 271-4. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7473700

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Postmenopausal urinary incontinence. Author(s): Zhao CX. Source: J Tradit Chin Med. 1987 December; 7(4): 305-6. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3449717

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Preliminary results of muscle cuff cervicoplasty in the ewe for the treatment of urinary incontinence. Author(s): Pfister C, Vallancien G, Bougaran-Andre J, Grise P. Source: European Urology. 1997; 32(4): 448-54. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9412804

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Prompted voiding therapy for urinary incontinence in aged female nursing home residents. Author(s): Creason NS, Grybowski JA, Burgener S, Whippo C, Yeo S, Richardson B. Source: Journal of Advanced Nursing. 1989 February; 14(2): 120-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2703597

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Rehabilitative treatment of non-neurogenic female urinary incontinence. Clinical and urodynamic evaluation. Author(s): Vecchioli Scaldazza C. Source: Minerva Urol Nefrol. 1997 March; 49(1): 5-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9099056

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Relationship between health promotion lifestyle profiles and patient outcomes of biofeedback therapy for urinary incontinence. Author(s): Shinopulos NM, Jacobson J. Source: Urologic Nursing : Official Journal of the American Urological Association Allied. 1999 December; 19(4): 249-53. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10889768

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Role of antimuscarinics in the treatment of nonneurogenic daytime urinary incontinence in children. Author(s): Nijman RJ. Source: Urology. 2004 March; 63(3 Suppl 1): 45-50. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15013652

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Role of pharmacotherapy for urinary incontinence. Author(s): Weiss BD. Source: American Family Physician. 1997 April; 55(5): 1574, 1576. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9105189

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Stress urinary incontinence after radical prostatectomy. Author(s): Rayome RG, Johnson V, Gray M. Source: Journal of Wound, Ostomy, and Continence Nursing : Official Publication of the Wound, Ostomy and Continence Nurses Society / Wocn. 1994 November; 21(6): 264-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7704135

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Subjective and objective effects of intravaginal electrical myostimulation and biofeedback in patients with genuine stress urinary incontinence. Author(s): Meyer S, Dhenin T, Schmidt N, De Grandi P. Source: British Journal of Urology. 1992 June; 69(6): 584-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1638343

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Terodiline. A review of its pharmacological properties, and therapeutic use in the treatment of urinary incontinence. Author(s): Langtry HD, McTavish D. Source: Drugs. 1990 November; 40(5): 748-61. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2292235

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The influence of obesity, constitution and physical work on the phenomenon of urinary incontinence in women. Author(s): Sustersic O, Kralj B. Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 1998; 9(3): 140-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9745972

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The national coverage decision for reimbursement for biofeedback and pelvic floor electrical stimulation for treatment of urinary incontinence. Author(s): Thompson DL. Source: Journal of Wound, Ostomy, and Continence Nursing : Official Publication of the Wound, Ostomy and Continence Nurses Society / Wocn. 2002 January; 29(1): 11-9. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11810068

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The role of biofeedback in Kegel exercise training for stress urinary incontinence. Author(s): Burgio KL, Robinson JC, Engel BT. Source: American Journal of Obstetrics and Gynecology. 1986 January; 154(1): 58-64. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3946505

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The role of combined pelvic floor stimulation and biofeedback in female urinary incontinence: early experience. Author(s): Hirakawa S, Hassouna M, Deleon R, Elhilali MM. Source: Can J Urol. 1994 November; 1(4): 72-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12834544

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The role of muscular re-education by physical therapy in the treatment of genuine stress urinary incontinence. Author(s): Wall LL, Davidson TG. Source: Obstetrical & Gynecological Survey. 1992 May; 47(5): 322-31. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1570126

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Treating urinary incontinence in the elderly--conservative therapies that work: a systematic review. Author(s): Teunissen TA, de Jonge A, van Weel C, Lagro-Janssen AL. Source: The Journal of Family Practice. 2004 January; 53(1): 25-30, 32. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14709263

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Treatment of daytime urinary incontinence in children: a systematic review of randomized controlled trials. Author(s): Sureshkumar P, Bower W, Craig JC, Knight JF.

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Source: The Journal of Urology. 2003 July; 170(1): 196-200; Discussion 200. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12796688 •

Treatment of female urinary incontinence with EMG-controlled biofeedback home training. Author(s): Hirsch A, Weirauch G, Steimer B, Bihler K, Peschers U, Bergauer F, Leib B, Dimpfl T. Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 1999; 10(1): 7-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10207760

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Treatment of postprostatectomy urinary incontinence with behavioral methods. Author(s): Harris JL. Source: Clinical Nurse Specialist Cns. 1997 July; 11(4): 159-66. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9274154

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Treatment of stress urinary incontinence. Author(s): Fischer-Rasmussen W. Source: Annals of Medicine. 1990 December; 22(6): 455-65. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2076279

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Treatment of urinary incontinence in homebound older adults: interface between research and practice. Author(s): Engberg S, McDowell BJ, Donovan N, Brodak I, Weber E. Source: Ostomy Wound Manage. 1997 November-December; 43(10): 18-22, 24-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9460431

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Treatment of urinary incontinence in women in general practice: observational study. Author(s): Seim A, Sivertsen B, Eriksen BC, Hunskaar S. Source: Bmj (Clinical Research Ed.). 1996 June 8; 312(7044): 1459-62. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8664627

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Treatment options for women with stress urinary incontinence. Author(s): Lightner DJ, Itano NM. Source: Mayo Clinic Proceedings. 1999 November; 74(11): 1149-56. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10560604

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Type III stress urinary incontinence: physiotherapy. Author(s): Autry MG, Davis JW, Sanders R.

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interdisciplinary

pelvic

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Source: Urologic Nursing : Official Journal of the American Urological Association Allied. 2002 August; 22(4): 251-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12242897 •

Update on extracorporeal magnetic innervation (EXMI) therapy for stress urinary incontinence. Author(s): Galloway NT, El-Galley RE, Sand PK, Appell RA, Russell HW, Carlin SJ. Source: Urology. 2000 December 4; 56(6 Suppl 1): 82-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11114568

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Urinary incontinence following transurethral, transvesical and radical prostatectomy. Retrospective study of 489 patients. Author(s): Van Kampen M, De Weerdt W, Van Poppel H, Baert L. Source: Acta Urol Belg. 1997 December; 65(4): 1-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9497589

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Urinary incontinence in girls. Author(s): Abidari JM, Shortliffe LM. Source: The Urologic Clinics of North America. 2002 August; 29(3): 661-75, X. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12476529

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Urinary incontinence in older adults. Author(s): McCormick KA, Palmer MH. Source: Annu Rev Nurs Res. 1992; 10: 25-53. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1389465

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Urinary incontinence in primary health care. 1. Perceived knowledge and training among various categories of nursing personnel and care units. Author(s): Mansson-Linstrom A, Dehlin O, Isacsson A. Source: Scandinavian Journal of Primary Health Care. 1994 September; 12(3): 169-74. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7997694

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Urinary incontinence in the aged, Part 2: Management strategies. Author(s): Rousseau P, Fuentevilla-Clifton A. Source: Geriatrics. 1992 June; 47(6): 37-40, 45, 48. Review. Erratum In: Geriatrics 1992 September; 47(9): 87. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1592267

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Urinary incontinence in the elderly. Ways to relieve it without surgery. Author(s): Gregory JG, Purcell MH.

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Source: Postgraduate Medicine. 1986 August; 80(2): 253-62. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3526309 •

Urinary incontinence in the older man. Author(s): Johnson TM 2nd, Ouslander JG. Source: The Medical Clinics of North America. 1999 September; 83(5): 1247-66. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10503063

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Urinary incontinence. Author(s): Erickson DR. Source: The Journal of Urology. 1995 March; 153(3 Pt 1): 648-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7861505

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Urinary incontinence. Author(s): Haber PA. Source: Annals of Internal Medicine. 1986 March; 104(3): 429-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3946983

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Urinary incontinence. Not a 'normal' part of aging. Author(s): Baum N, Suarez G, Appell RA. Source: Postgraduate Medicine. 1991 August; 90(2): 99-102, 107-9. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1862054

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Urinary incontinence. Why people do not seek help. Author(s): Goldstein M, Hawthorne ME, Engeberg S, McDowell BJ, Burgio KL. Source: Journal of Gerontological Nursing. 1992 April; 18(4): 15-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1569296

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Urinary incontinence: primary care therapies for the older woman. Author(s): Butler RN, Maby JI, Montella JM, Young GP. Source: Geriatrics. 1999 November; 54(11): 31-4, 39-40, 43-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10570655

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Urinary incontinence: the basics. Author(s): Kennedy KL, Steidle CP, Letizia TM. Source: Ostomy Wound Manage. 1995 August; 41(7): 16-8, 20, 22 Passim; Quiz 33-4. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7662091

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Urinary incontinence: when to refer for procedural therapies. Author(s): Butler RN, Maby JI, Montella JM, Young GP.

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Source: Geriatrics. 1999 December; 54(12): 49-54, 56. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10605435 •

Using epidemiology in patient education for post-prostatectomy urinary incontinence. Author(s): Palmer MH. Source: Ostomy Wound Manage. 2001 December; 47(12): 20-5; Quiz 26-7. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11889725

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Weighted vaginal cones for urinary incontinence. Author(s): Herbison P, Plevnik S, Mantle J. Source: Cochrane Database Syst Rev. 2002; (1): Cd002114. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11869623

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Weighted vaginal cones for urinary incontinence. Author(s): Herbison P, Plevnik S, Mantle J. Source: Cochrane Database Syst Rev. 2000; (2): Cd002114. Review.

Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: •

Alternative Medicine Foundation, Inc.: http://www.herbmed.org/

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AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats

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Chinese Medicine: http://www.newcenturynutrition.com/

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drkoop.com: http://www.drkoop.com/InteractiveMedicine/IndexC.html

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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm

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Google: http://directory.google.com/Top/Health/Alternative/

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Healthnotes: http://www.healthnotes.com/

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MedWebPlus: http://medwebplus.com/subject/Alternative_and_Complementary_Medicine

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Open Directory Project: http://dmoz.org/Health/Alternative/

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HealthGate: http://www.tnp.com/

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WebMDHealth: http://my.webmd.com/drugs_and_herbs

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/

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The following is a specific Web list relating to urinary incontinence; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

General Overview Allergies and Sensitivities Source: Healthnotes, Inc.; www.healthnotes.com Diabetes Mellitus Source: Integrative Medicine Communications; www.drkoop.com Multiple Sclerosis Source: Healthnotes, Inc.; www.healthnotes.com Multiple Sclerosis Source: Integrative Medicine Communications; www.drkoop.com Prostate Cancer Source: Integrative Medicine Communications; www.drkoop.com Urinary Incontinence Source: Integrative Medicine Communications; www.drkoop.com

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Alternative Therapy Biofeedback Source: Integrative Medicine Communications; www.drkoop.com

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Chinese Medicine Baiguo Alternative names: Ginkgo Seed; Semen Ginkgo Source: Chinese Materia Medica Fupenzi Alternative names: Palmleaf Raspberry Fruit; Fructus Rubi Source: Chinese Materia Medica Haima Alternative names: Sea-horse; Hippocampus Source: Chinese Materia Medica Jineijin Alternative names: Chicken's Gizzard-skin; Endothelium Corneum Gigeriae Galli Source: Chinese Materia Medica Jiucaizi Alternative names: Tuber Onion Seed; Semen Allii Tuberosi Source: Chinese Materia Medica

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Lujiaoshuang Alternative names: Degelatined Deer-horn; Cornu Cervi Degelatinatum Source: Chinese Materia Medica Qianshi Alternative names: Gordon Euryale Seed; Semen Euryales Source: Chinese Materia Medica Sangpiaoxiao Alternative names: Egg Capsule of Mantid; Ootheca Mantidis Source: Chinese Materia Medica Shanzhuyu Alternative names: Asiatic Cornelian Cherry Fruit; Fructus Corni Source: Chinese Materia Medica Tusizi Alternative names: Dodder Seed; Semen Cuseutae Source: Chinese Materia Medica Wuweizi Alternative names: Chinese Magnoliavine Fruit; Fructus Schisandrae Source: Chinese Materia Medica Wuyao Alternative names: Combined Spicebush Root; Radix Linderae Source: Chinese Materia Medica Yizhi Alternative names: Sharpleaf Glangat Fruit; Fructus Alpiniae Oxyphyllae Source: Chinese Materia Medica •

Herbs and Supplements Eleuthero Alternative names: Siberian Ginseng, Eleuthero; Acanthopanax/Eleutherococcus senticosus Rupr. & Maxim. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Horsetail Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Pollen Source: Healthnotes, Inc.; www.healthnotes.com Royal Jelly Source: Healthnotes, Inc.; www.healthnotes.com Shephard's Purse Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca

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Thyme Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca

General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at http://www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources.

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CHAPTER 4. DISSERTATIONS ON URINARY INCONTINENCE Overview In this chapter, we will give you a bibliography on recent dissertations relating to urinary incontinence. We will also provide you with information on how to use the Internet to stay current on dissertations. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical dissertations that use the generic term “urinary incontinence” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on urinary incontinence, we have not necessarily excluded non-medical dissertations in this bibliography.

Dissertations on Urinary Incontinence ProQuest Digital Dissertations, the largest archive of academic dissertations available, is located at the following Web address: http://wwwlib.umi.com/dissertations. From this archive, we have compiled the following list covering dissertations devoted to urinary incontinence. You will see that the information provided includes the dissertation’s title, its author, and the institution with which the author is associated. The following covers recent dissertations found when using this search procedure: •

EXAMINING THE EFFECT OF PATIENT GUIDELINES ON CONSUMER PERCEPTIONS AND BEHAVIOR: AN EXTENDED UTILIZATION OF THE HEALTH BELIEF MODEL (URINARY INCONTINENCE) by OLSON, LISA K., PHD from The George Washington University, 1994, 167 pages http://wwwlib.umi.com/dissertations/fullcit/9426793

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Exploring elderly women's experiences with urinary incontinence in long-term care by MacDonald, Catherine Doreen; MN from Dalhousie University (Canada), 2003, 107 pages http://wwwlib.umi.com/dissertations/fullcit/MQ79516

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Urinary incontinence among community-dwelling older females by Dawson, Caroline; MSN from Medical College of Ohio at Toledo, 2003, 65 pages http://wwwlib.umi.com/dissertations/fullcit/1415788

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Keeping Current Ask the medical librarian at your library if it has full and unlimited access to the ProQuest Digital Dissertations database. From the library, you should be able to do more complete searches via http://wwwlib.umi.com/dissertations.

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CHAPTER 5. PATENTS ON URINARY INCONTINENCE Overview Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.8 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical patents that use the generic term “urinary incontinence” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on urinary incontinence, we have not necessarily excluded non-medical patents in this bibliography.

Patents on Urinary Incontinence By performing a patent search focusing on urinary incontinence, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. 8Adapted

from the United States Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.

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The following is an example of the type of information that you can expect to obtain from a patent search on urinary incontinence: •

Adjustable implantable genitourinary device Inventor(s): Burton; John H. (Minnetonka, MN), Cook; Timothy C. (Wayzata, MN) Assignee(s): Uromedica, Inc. (plymouth, Mn) Patent Number: 6,645,138 Date filed: June 11, 2002 Abstract: An implantable medical device and method for adjustably restricting a selected body lumen such as a urethra or ureter of a patient to treat urinary incontinence or ureteral reflux. The device includes an adjustable, self-sealing element having a continuous wall, including an inner surface defining a chamber. The adjustable element expands or contracts due to fluid volume introduced into the chamber for restricting a body lumen. After being implanted into a patient, the size of the adjustable element is altered by first locating the adjustable element implanted adjacent the body lumen, and then establishing fluid communication with the adjustable element. The volume of the adjustable element is then adjusted by either introducing or removing volume from the chamber of the adjustable element. Excerpt(s): The invention relates generally to implantable medical devices and in particular to implantable medical devices for treating urinary incontinence. Various implantable devices, such as distensible medical devices, are known in which the distensible medical devices are implanted into the tissue of a human to treat urinary incontinence. These devices have typically relied upon restricting or constricting the urethra of the patient to maintain continence. U.S. Pat. No. 4,733,393 to Haber et al. is an attempt at such a proposed device. U.S. Pat. No. 4,733,393 relates to a hypodermically implantable genitourinary prosthesis which provides an extensible, inflatable tissue expanding membrane to be located in proximal urethral tissue to add bulk to these tissues for overcoming urinary incontinence by localized increase in tissue volume. Web site: http://www.delphion.com/details?pn=US06645138__

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Aiming device for surgical instrument and method for use for treating female urinary incontinence Inventor(s): Hoepffner; Jochen (Belle Mead, NJ), Landgrebe; Susanne (Sulfeld, DE), Lehe; Jorn (Den Haag, NE), Stormby; Johan (Malmo, SE) Assignee(s): Ethicon, Inc. (somerville, Nj) Patent Number: 6,596,001 Date filed: April 23, 2001 Abstract: Described is a surgical instrument and method for treating female urinary stress incontinence. The instrument includes a curved needle-like element defining in part a curved shaft having a distal end and a proximal end. A tape attaches to the needle for implanting into the lower abdomen of a female to provide support to the urethra. The tape may be made from synthetic and natural materials. The needle and tape may also be modified to allow the surgeon to attach and detach the tape during the surgical operation. The needle attaches to a handle on which attaches a mechanical arm to track

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the position of the needle point as it passes through the body and exits the abdominal wall. Excerpt(s): The present invention relates generally to a surgical instrument and a method for treating female urinary incontinence and in particular to a needle and an external aiming device to facilitate navigation of the needle through the abdomen cavity. Women account for more than 11 million of incontinence cases. Moreover, a majority of women with incontinence suffer from stress urinary incontinence (SUI). Women with SUI involuntarily lose urine during normal daily activities and movements, such as laughing, coughing, sneezing and regular exercise. Normally, the urethra, when properly supported by strong pelvic floor muscles and healthy connective tissue, maintains a tight seal to prevent involuntary loss of urine. When a woman suffers from the most common form of SUI, however, weakened muscle and pelvic tissues are unable to adequately support the urethra in its correct position. As a result, during normal movements when pressure is exerted on the bladder from the diaphragm, the urethra cannot retain its seal, permitting urine to escape. Because SUI is both embarrassing and unpredictable, many women with SUI avoid an active lifestyle, shying away from social situations. Web site: http://www.delphion.com/details?pn=US06596001__ •

Apparatus and method for treating female urinary incontinence Inventor(s): Kammerer; Gene W. (14 Stephens Dr., East Brunswick, NJ 08818), Lehe; Jorn (Willerstwiete 15, D22415 Hamburg, DE) Assignee(s): None Reported Patent Number: 6,605,097 Date filed: October 18, 2000 Abstract: A surgical instrument for introducing a support strand into the body to treat female urinary incontinence has an elongated, curved shaft with a distal end insertable into the body. The shaft has a lumen therein extending at least a portion of the length of the shaft through which the support strand may pass in an axial direction. The shaft has a slot on an exterior surface thereof communicating with the lumen allowing the support strand to be laterally passed between the lumen to a position outside the shaft. A pointed element, is removably positionable on the distal end of the shaft for facilitating the insertion of the shaft through the body and is connectable at one end to the support strand. The pointed element may either be swaged directly to the strand or be in the form of an elongated needle with an eye to which the strand is removably attached. In an associated method, the shaft sequentially delivers the pointed element through the body twice, forming a loop around the urethra to relieve incontinence. The slot in the shaft permits the instrument to be disassociated from the strand without disturbing the loop. Excerpt(s): The present invention relates to surgical methods and apparatus, and more particularly to a surgical apparatus and associated method for treating female urinary incontinence by implanting a support band. Surgical apparatus and methods are known for implanting a support band or filament extending between the abdominal wall and the tissue proximate to the urethra to reposition and support the urethra to compensate for over stressed ligaments causing incontinence. U.S. Pat. No. 5,112,344 to Petros and U.S. Pat. No. 5,899,909 to Claren et al., both of which are described further below, each disclose pointed, curved surgical instruments having a shape and

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dimensions permitting them to be introduced into the vagina, extended through the vaginal wall, around the pubic bone and through the abdominal wall for the purpose of placing the supportive surgical band or suture. The present invention provides an alternative apparatus and method to the foregoing. The problems and disadvantages associated with the conventional techniques and devices utilized to place surgical supports to relieve female urinary incontinence are overcome by the present invention which includes a surgical instrument for introducing a support strand into the body to treat female urinary incontinence. The instrument has an elongated, curved shaft with a distal end insertable into the body. The shaft has a lumen therein extending at least a portion of the length of the shaft and terminating at the distal end and through which the support strand may pass in an axial direction. The shaft has a slot on an exterior surface thereof communicating with the lumen along at least a portion of the length thereof starting at the distal end with the slot allowing the support strand to be laterally passed between the lumen to a position outside the shaft. A pointed element, is removably positionable on the distal end of the shaft for facilitating the insertion of the shaft through the body and is connectable at one end to the support strand. The pointed element is dimensioned to prevent passage through the lumen when the shaft is inserted through the body. In accordance with an associated method, the instrument may be used to pass the strand through the vaginal wall and out the abdominal wall followed by a reinsertion of the instrument to carry the end of the strand terminating in the vagina through the vaginal wall and the abdominal wall to form a loop proximate the urethra. The slot in the shaft permits the instrument to be removed from the looped strand. Web site: http://www.delphion.com/details?pn=US06605097__ •

Benzimidazoles and benzothiazoles and uses thereof Inventor(s): Gluchowski; Charles (Wayne, NJ), Jeon; Yoon T. (Ridgewood, NJ) Assignee(s): Synaptic Pharmaceutical Corporation (paramus, Nj) Patent Number: 6,723,741 Date filed: October 22, 2002 Abstract: This invention is directed to novel indole and benzothiazole compounds which are selective for cloned human alpha 2 receptors. This invention is also related to uses of these compounds for any indication where use of an alpha 2 agonist may be appropriate. Specifically, this includes use as analgesic, sedative and anaesthetic agents. In addition, this invention includes using such compounds for lowering intraocular pressure, presbyopia, treating migraine, hypertension, alcohol withdrawal, drug addiction, rheumatoid arthritis, ischemic pain, spasticity, diarrhea, nasal decongestion, urinary incontinence as well as for use as cognition enhancers and ocular vasoconstriction agents. The invention further provides a pharmaceutical composition comprising a therapeutically effective amount of the above-defined compounds and a pharmaceutically acceptable carrier. Excerpt(s): Throughout this application, various references are referred to within parentheses. Disclosures of these publications in their entireties are hereby incorporated by reference into this application to describe more fully the state of the art to which this invention pertains. Alpha adrenergic receptors are plasma membrane receptors which are located in the peripheral and central nervous systems throughout the body. They are members of a diverse family of structurally related receptors which contain seven putative helical domains and transduce signals by coupling to guanine nucleotide

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binding proteins (G-proteins). These receptors are important for controlling many physiological functions and, thus, have been important targets for drug development during the past 40 years. Examples of alpha adrenergic drugs include clonidine, phenoxybenzamine and prazosin (for treatment of hypertension), naphazoline (for nasal decongestion), medetomidine (for veterinary analgesia), UK-14,304 and paminoclonidine (for glaucoma). However, most of these drugs produce undesirable side effects, possibly due to their interactions with other receptor subtypes. For example, clonidine is a well known centrally acting antihypertensive agent. However, it also produces untoward side effects such as analgesia, sedation, bradycardia and dry mouth which may be due to its lack of selectivity at.alpha.sub.2 receptors.alpha.-Adrenergic receptors were originally proposed to have only two (alpha and beta) subtypes (Berthelsen, S.; Pettinger W. Life Sci., 21, 595 (1977)). However, modern molecular biological and pharmacological techniques have led to the identification of at least 6 subtypes (.alpha.sub.1a,.alpha.sub.1b,.alpha.sub.1c,.alpha.sub.2a,.alpha.sub.2b and.alpha.sub.2c) of the adrenergic receptors (Bylund, D. B., Trends Pharmacol. Sci., 9, 356 (1988)). Web site: http://www.delphion.com/details?pn=US06723741__ •

Branched chain amino acid-dependent aminotransferase inhibitors and their use in the treatment of neurodegenerative diseases Inventor(s): Hays; Sheryl Jeanne (Ann Arbor, MI), Hu; Lain-Yen (Ann Arbor, MI), Lei; Huangshu (Ann Arbor, MI), Scholten; Jeffrey David (Ann Arbor, MI), Wustrow; David Juergen (Ann Arbor, MI) Assignee(s): Pfizer Inc. (new York, Ny) Patent Number: 6,632,831 Date filed: November 26, 2002 Abstract: The invention relates to BCAT inhibitors and the use thereof for treating or preventing neuronal loss associated with stroke, ischemia, CNS trauma, hypoglycemia and surgery, as well as treating neurodegenerative diseases including Alzheimer's disease, amyotrophic lateral sclerosis, Huntington's disease and Down's syndrome, treating or preventing the adverse consequences of the overstimulation of the excitatory amino acids, treating anxiety, psychosis, convulsions, aminoglycoside antibioticsinduced hearing loss, migraine headache, chronic pain, neuropathic pain, Parkinson's disease, diabetic retinopathy, glaucoma, CMV retinitis, urinary incontinence, opioid tolerance or withdrawal, and inducing anesthesia, as well as for enhancing cognition. Excerpt(s): This invention is related to branched chain amino acid-dependent amino transferase (BCAT) inhibitors. The invention is also directed to the use of BCAT inhibitors as neuro-protective agents for treating conditions such as stroke, cerebral ischemia, central nervous system trauma, hypoglycemia, anxiety, convulsions, aminoglycoside antibiotics-induced hearing loss, migraine headaches, chronic pain, neuropathic pain, glaucoma, CMV retinitis, diabetic retinopathy, psychosis, urinary incontinence, opioid tolerance or withdrawal, or neuro-degenerative disorders such as lathyrism, Alzheimer's disease, Parkinsonism, amyotrophic lateral sclerosis (ALS), and Huntington's Disease. Excessive excitation by neurotransmitters can cause the degeneration and death of neurons. It is believed that this degeneration is in part mediated by the excitotoxic actions of the excitatory amino acids (EAA) glutamate and aspartate at the N-methyl-D-aspartate (NMDA) receptor. This excitotoxic action is considered responsible for the loss of neurons in cerebrovascular disorders such as

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cerebral ischemia or cerebral infarction resulting from a range of conditions, such as thromboembolic or hemorrhagic stroke, cerebral vasospasms, hypoglycemia, cardiac arrest, status epilepticus, perinatal asphyxia, anoxia such as from drowning, pulmonary surgery and cerebral trauma, as well as lathyrism, Alzheimer's disease, Parkinson's disease, and Huntington's disease. Excitatory amino acid receptor antagonists that block NMDA receptors are recognized for usefulness in the treatment of disorders. NMDA receptors are intimately involved in the phenomenon of excitotoxicity, which may be a critical determinant of outcome of several neurological disorders. Disorders known to be responsive to blockade of the NMDA receptor include acute cerebral ischemia (stroke or cerebral trauma, for example), muscular spasm, convulsive disorders, neuropathic pain and anxiety, and may be a significant causal factor in chronic neurodegenerative disorders such as Parkinson's disease (Klockgether T., Turski L., Ann. Neurol., 1993;34:585-593), human immunodeficiency virus (HIV) related neuronal injury, amyotrophic lateral sclerosis (ALS), Alzheimer's disease (Francis P. T., Sims N. R., Procter A. W., Bowen D. M., J. Neurochem., 1993;60(5):1589-1604, and Huntington's disease (see Lipton S., TINS, 1993;16(12):527-532; Lipton S. A., Rosenberg P. A., New Eng. J. Med., 1994;330(9):613-622; and Bigge C. F., Biochem. Pharmacol., 1993;45:15471561, and referenced cited therein.) NMDA receptor antagonists may also be used to prevent tolerance to opiate analgesia or to help control withdrawal symptoms from addictive drugs (Eur. Pat. Appl. 488,959A). Web site: http://www.delphion.com/details?pn=US06632831__ •

Compounds and methods for modulation of estrogen receptors Inventor(s): Bhagwat; Shripad S. (San Diego, CA), Chao; Qi (San Diego, CA), GayoFung; Leah M. (San Diego, CA) Assignee(s): Signal Pharmaceuticals, Inc. (san Diego, Ca) Patent Number: 6,686,351 Date filed: February 27, 2002 Abstract: Compounds that modulate the estrogen receptor (ER) are disclosed, as well as pharmaceutical compositions containing the same. In a specific embodiment, the compounds are selective modulators for ER-.beta. over ER-.alpha. Methods are disclosed for modulating ER-.beta. in cell and/or tissues expressing the same, including cells and/or tissue that preferentially express ER-.beta. More generally, methods for treating estrogen-related conditions are also disclosed, including conditions such as is breast cancer, testicular cancer, osteoporosis, endometriosis, cardiovascular disease, hypercholesterolemia, prostatic hypertrophy, prostatic carcinomas, obesity, hot flashes, skin effects, mood swings, memory loss, urinary incontinence, hairloss, cataracts, natural hormonal imbalances, and adverse reproductive effects associated with exposure to environmental chemicals. Excerpt(s): This invention is generally directed to estrogen antagonists and agonists, including pharmaceutical compositions and uses thereof, and more specifically to compounds which selectively modulate estrogen receptor-beta (ER-.beta.) activity. The estrogen hormone has a broad spectrum of effects on tissues in both females and males. Many of these biological effects are positive, including maintenance of bone density, cardiovascular protection, central nervous system (CNS) function, and the protection of organ systems from the effects of aging. However, in addition to its positive effects, estrogen also is a potent growth factor in breast and endometrium that increases the risk of cancer. Until recently, it has been assumed that estrogen binds to a single estrogen

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receptor (ER) in cells, causing conformational changes that result in release from heat shock proteins and binding of the receptor as a dimer to the so-called estrogen response element in the promoter region of a variety of genes. Further, pharmacologists have generally believed that non-steroidal small molecule ligands compete for binding of estrogen to ER, acting as either antagonists or agonists in each tissue where the estrogen receptor is expressed. Thus, such ligands have traditionally been classified as either pure antagonists or agonists. This is no longer believed to be correct. Web site: http://www.delphion.com/details?pn=US06686351__ •

Control of urge incontinence Inventor(s): Cohen; Ehud (Ganai Tikva, IL), Gross; Yossi (Moshav, IL), Lifschitz; David (Zurich, CH), Nissenkorn; Israel (Tel Aviv, IL) Assignee(s): Bio Control Medical, Ltd. (yahud, Il) Patent Number: 6,652,449 Date filed: July 20, 2001 Abstract: A device (20) for treatment of a patient's urinary incontinence, including a sensor (44), which generates a signal responsive to a physiological characteristic indicative of a likelihood of incontinence. A control unit (22) receives the signal from the sensor. At least one electrode (29) is preferably implanted in the patient. The electrode is coupled to cause contraction of the pelvic muscle of the patient responsive to application of electrical energy to the electrode. Responsive to the signal, the control unit applies an electrical waveform to the electrode, so as to inhibit the incontinence. Excerpt(s): The present invention relates generally to medical electronic devices, and specifically to implantable electrical devices for treatment of urge incontinence. Urinary incontinence affects millions of people, causing discomfort and embarrassment sometimes to the point of social isolation. In the United States, it is estimated that 10-13 million patients seek medical care for incontinence each year. Urge incontinence is a common type of urinary incontinence, in which a sudden, urgent need to pass urine causes involuntary urination before the patient can get to a toilet. Urge incontinence may be caused by damage to nerve pathways from the brain to the bladder or by psychosomatic factors, leading to involuntary bladder contraction. Urge and stress incontinence may also occur together, particularly in older women. Web site: http://www.delphion.com/details?pn=US06652449__

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Controlled expansion sphincter augmentation media Inventor(s): Bley; Robert Steven (Menlo Park, CA) Assignee(s): Ethicon, Inc. (somerville, Nj) Patent Number: 6,592,859 Date filed: August 20, 1992 Abstract: A composition for injecting into tissues surrounding the urethra or ureter. It comprises a plurality of physiologically acceptable solid polymer particles dispersed in a physiologically acceptable biodissipatable liquid carrier. The polymer comprises a hydrophilic component and may also include a non-hydrophilic component. The polymer hydrates and swells to a predetermined volume as the liquid carrier dissipates.

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The composition is especially suitable in treating patients with urinary incontinence and patients with vesicoureteral reflux via injection into the tissues around the urethra or ureter. Excerpt(s): The invention relates to a composition comprising solid polymer particles dispersed in a biodissipatable, generally nonaqueous, solvent. The invention further relates to a method of exerting pressure on a selected tissue structure by inserting into tissues adjacent to the selected tissue structure such a composition. More specifically, the invention provides a treatment for those with urinary incontinence and/or vesicoureteral reflux. surgical implantation of artificial sphincters has often been employed to treat patients suffering from urinary incontinence. The surgical implantation of the artificial sphincter commonly requires hospitalization. In addition, such a procedure is relatively complex and expensive, and will usually require six to eight weeks of recovery time. Moreover, often time, the procedure is unsuccessful or the artificial sphincter malfunctions. As a result, additional surgery is required to adjust, repair or replace the implant. In the recent past, urinary incontinence may be successfully treated by using nonsurgical means. The most common and widely used method to treat patients with urinary incontinence is periurethral injection of a composition commercially sold as "Polytef". "Polytef" is a paste comprising a fifty-fifty (50/50) by weight (corresponding to about 64:36 by volume) mixture of glycerine liquid and Teflon particles. However, after injection, over a period of time the glycerine is readily dissipated into the body and then metabolized or eliminated, leaving only the Teflon particles. This means that only fifty (50) percent of the injected weight remains at the injection site. Consequently the surgeon must inject significantly more volume than he thinks he will need and at times must actually close down the urethra further than is desired. This closure could possibly be complete and thus put the patient into temporary urinary retention. Additionally, the fact that a large portion of the volume disappears makes it difficult for the surgeon to visually gauge how much is an appropriate amount of the Teflon paste to inject. As a result, the surgeon is likely to not inject enough paste volume. The procedure therefore may fail, and a second or even a third procedure to inject additional paste may be required. An additional drawback of the Teflon paste is that the Teflon particle size is sufficiently small so as to allow the particles to migrate to other locations of the body such as the lungs, brain, etc. Teflon particles have been known to induce tissue reaction and form Teflon-induced granulomas in certain individuals. This tissue reaction to Teflon has caused concerns for the patient's safety. Web site: http://www.delphion.com/details?pn=US06592859__ •

C-shaped vaginal incontinence insert Inventor(s): Velazquez; Herb F. (Neenah, WI), Zunker; MaryAnn (Oshkosh, WI) Assignee(s): Kimberly-clark Worldwide, Inc. (neenah, Wi) Patent Number: 6,676,594 Date filed: September 18, 2002 Abstract: A urinary incontinence device is disclosed. The device is an intra-vaginal flexible device that has a base portion connecting a proximal portion of a first leg and a proximal portion of a second leg to form a generally "C-shaped" configuration. The device also has a member that is an insertion member, a removal member, or both.

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Excerpt(s): The present invention relates to a urinary incontinence device and a method of using the same. More specifically, this invention relates to a cost-effective C-shaped device for alleviating female urinary incontinence, particularly during episodes of increased intra-abdominal pressure. The primary etiological factor producing genuine stress urinary incontinence is the incomplete transmission of abdominal pressure to the proximal urethra due to displacement from its intra-abdominal position. Some women, especially women who have given birth to one or more children, and older women, can experience incidences of involuntary urine loss due to stress urinary incontinence or combined stress and urge incontinence. A sneeze or cough increases the intra-abdominal pressure, which in turn increases the pressure on a person's bladder causing the involuntary release of urine. The frequency and severity of such urine loss can increase as the muscles and tissues near the urethro-vaginal myofascial area grow weaker. It has also been recognized that the urinary sphincter muscle, which is located at the upper end of the urethra, adjacent to the bladder, works well at sealing off the passing of urine from the bladder to the urethra when it has a round or circular cross-sectional configuration. Support of the proximal urethra elevates it above the pelvic floor and subjects it to increases in intra-abdominal pressure, thus allowing compression and maintenance of continence. When this passageway becomes distorted into a crosssectional configuration having more of an elliptical or oval appearance, however, the sphincter muscle can not close properly. Therefore, the tendency for involuntary urine loss increases. One must remember that the urethra and vagina are not separate structures. Because of their common derivation from the urogenital sinus, they are fused in the distal two-thirds of the urethra. In this region they are bound together by the endopelvic connective tissue so that the support of the urethra depends not only on the attachments of the urethra itself to adjacent structures but also on the connection of the vagina and periurethral tissues to the pelvic wall. Web site: http://www.delphion.com/details?pn=US06676594__ •

Derivatives of 3,3-diphenylpropylamines Inventor(s): Meese; Claus (Monheim, DE), Sparf; Bengt (Trangsund, SE) Assignee(s): Schwarz Pharma AG (monheim, De) Patent Number: 6,713,464 Date filed: January 2, 2001 Abstract: The invention concerns novel derivatives of 3,3-diphenylpropylamines, methods for their preparation, pharmaceutical compositions containing the novel compounds, and the use of the compounds for preparing drugs. More particularly, the invention relates to novel prodrugs of antimuscarinic agents with superior pharmacokinetic properties compared to existing drugs such as oxybutynin and tolterodine, methods for their preparation, pharmaceutical compositions containing them, a method of using said compounds and compositions for the treatment of urinary incontinence, gastrointestinal hyperactivity (irritable bowel syndrome) and other smooth muscle contractile conditions. Excerpt(s): The present invention relates to novel derivatives of 3,3diphenylpropylamines, methods for their preparation, pharmaceutical compositions containing the novel compounds, and the use of the compounds for preparing drugs. In man, normal urinary bladder contractions are mediated mainly through cholinergic muscarinic receptor stimulation. There is reason to believe that muscarinic receptors mediate not only normal bladder contractions, but also the main part of the contractions

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in the overactive bladder resulting in symptoms such as urinary frequency, Urgency and urge incontinence. For this reason, antimuscarinic drugs have been proposed for the treatment of bladder overactivity. Among the antimuscarinic drugs available on the market, oxybutynin is currently regarded as the gold standard for pharmacological treatment of urge incontinence and other symptoms related to bladder overactivity. The effectiveness of oxybutynin has been demonstrated in several clinical studies, but the clinical usefulness of oxybutynin is limited due to antimuscarinic side effects. Dryness of the mouth is the most common experienced side effect which may be severe enough to result in poor compliance or discontinuation of Treatment (Andersson, K.-E., 1988, Current concepts in the treatment of disorders of micturition, Drugs 35, 477-494; Kelleher et al. 1994). Web site: http://www.delphion.com/details?pn=US06713464__ •

Electrical clinical apparatus and electrical stimulation method using variant assignment method Inventor(s): Mo; Seung-Kee (#602, Blueheights, 379-3 Yangjae-dong, Seocho-ku, Seoul, 137-130, KR) Assignee(s): None Reported Patent Number: 6,631,297 Date filed: October 20, 2000 Abstract: An electrical stimulation method and an electrical clinical apparatus using a variant assignment method applied in treatment of dysfunction such as urinary incontinence is disclosed. The electrical clinical apparatus includes: a central control device for forming a plurality of protocols by converting frequencies of the electrical signals to be applied to a body part, and for generating a plurality of variants by assembling the protocols, and for respectively selecting protocols or variants to be assigned to each channel of the electrode out of the protocols and variants; a memory device for storing the protocols or variants produced by the central control device, or for re-inputting the stored protocols or variants back to the central control device according to a predetermined program; and an output device for outputting the selected protocol or variant to each channel of the electrode. Excerpt(s): The present invention relates to an electrical stimulation method and an electrical clinical apparatus including electrode for detecting electromyogram (EMG) signals from or for applying electrical stimulation signals to a body part; and, more particularly, an electrical stimulation method and an electrical clinical apparatus using variant assignment method applied in treatment of dysfunction such as urinary incontinence. An electrical clinical apparatus has been used in treatment of such dysfunction as urinary incontinence, constipation and fecal incontinence, pain relief, rehabilitation, and frigidity associated with reinnervation of damaged nerve such as pelvic floor muscle. Most electrical clinical apparatus use electromyogram (EMG) signals or current pulses as intensity of EMG is proportional to contractile force of vaginal (anal) muscle while current pulse is effective in nerve reinnervation. Although the frequency of EMG signals mostly lies in between approx. 20 and 800 Hz emitting higher frequency components than other bio signals, a conventional mechanism of energy transmission method contrarily uses only a few frequencies (12.5 Hz and/or 50 Hz) without using most of the wide range of frequency bandwidth. Web site: http://www.delphion.com/details?pn=US06631297__

Patents 161

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External magnetic actuation valve for intraurethral artificial urinary sphincter Inventor(s): Carballido Rodriguez; Joaquin (Madrid, ES), Garcia Paez; Jose Maria (Madrid, ES), Jorge Herrero; Eduardo (Madrid, ES), Multigner Dominguez; Marta (Las Rozas, ES), Rivero Rodriguez; Guillermo (Las Rozas, ES), Tendillo Cortijo; Francisco Javier (Madrid, ES) Assignee(s): Universidad Complutense DE Madrid (madrid, Es) Patent Number: 6,623,421 Date filed: January 11, 2001 Abstract: External magnetically actuated valve for an artificial intraurethral urinary sphincter. External magnetically actuated valve for an artificial intraurethral urinary sphincter, allowing urine control for people suffering from urinary incontinence or retention, by the application of an external magnetic field. After valve (1), object of the present invention, is placed in the patient's urethra (9), said patient may control urination. Urine is evacuated when a permanent magnet (3) is approached to the body of the patient. Closing is automatic. The system is provided with a safety system to prevent over pressures in bladder (8). Excerpt(s): The present invention relates to a valve model for an artificial urinary sphincter to be placed intraurethrally in humans, which performs the functions of the external urinary sphincter, meant for treating urinary incontinence and/or retention. Opening of said valve is controlled from outside the human body by the application of a magnetic field created by a permanent magnet. The valve is closed automatically by a permanent magnet placed inside the valve. The purpose of the present invention is the recovery of self-control of urination for those people who have lost it by means of an easily implanted prosthesis. Hitherto, people suffering from urinary incontinence or retention deal with said problem with soakers, or probes provided with urine collection bags. The former is uncomfortable and causes serious social problems, while the latter often causes infections, often with a fatal outcome due to kidney failure. Work has been directed for some time towards designing prostheses which may replace the function of the urinary sphincter, although there is none yet in widespread use. Web site: http://www.delphion.com/details?pn=US06623421__

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External urinary catheter device for the relief of male urinary incontinence Inventor(s): Guldfeldt; Signe Uhre (Hillerod, DK), Nielsen; Henrik Lindenskov (Smorum, DK), Tanghoj; Allan (Kokkedal, DK) Assignee(s): Coloplast A/s (humlebaek, Dk) Patent Number: 6,632,204 Date filed: January 9, 2001 Abstract: An external urinary catheter for the relief of male urinary incontinence is provided. The catheter comprises a contact member which is adapted to be engaged with at least the extreme portion of a penis, said contact member being connected to a discharge conduit via an opening in the distal end section of the contact member. The catheter is provided with an aperture. A membrane, which is capable of selectively passing gases but retaining urine, is fastened to the surface surrounding the aperture. The membrane is at least partly protected by a shield. At least one vent for allowing

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gases to be in substantially unhindered contact with the external surface of the membrane is arranged in the catheter. Excerpt(s): The present invention relates to an external urinary catheter device for the relief of male urinary incontinence, comprising a contact member which is adapted to be engaged with at least the extreme portion of a penis; an opening formed in a distal end section of the contact member and positioned substantially opposite the urethral orifice in the position of use, and a discharge conduit connected with the opening to provide a sealed urine flow passage extending in a substantial axial direction towards the exterior of the catheter device. The invention also pertains processes for manufacture of an external urinary catheter device for the relief of male urinary incontinence as well as uses of catheters of this kind. For the relief of male urinary incontinence external catheters are generally used in the form of condom-like tubular sheaths to be placed externally on penis and having a discharge spout which via a hose is connected with a urine collection bag. Such external catheters are known in numerous designs and in many cases serve as a satisfactory solution of male incontinence problems. However, the complete envelopment of penis may give rise to trouble, partly because the application which is effected by unrolling the catheter requires a certain length of penis, partly in use due to the fact that the envelopment of the full length of penis with the catheter, which is generally fastened adhesively either by means of a separate adhesive strip or by means of an internal adhesive layer, involves strain of the skin of penis. Furthermore, the constant humid environment from the delivered urine may cause skin problems, such as allergy and maceration and even ulceration. In recent years various suggestions have been presented in the prior art concerning the use in a urinary catheter of an inner member or a contact member, which in a position of use is positioned between the surface of the corona and the foreskin of the penis. Web site: http://www.delphion.com/details?pn=US06632204__ •

Female urinary incontinence device Inventor(s): Bennett; Patricia A. (1300 J.E. Woody Rd., Springtown, TX 78082) Assignee(s): None Reported Patent Number: 6,699,174 Date filed: June 22, 2001 Abstract: A female urinary incontinence management device having a base member that adhesively attaches to the patient, and a bag member that is sealingly and releasably attached to the base member. The base member is generally triangular having a top portion that, when attached to the patient, extends across and above the symphysis pubis, side portions that extend down along the groin area, and a short bottom portion that extends across the perineal area. The base member includes an upraised ridge portion into which is integrated a "female" part of a means for sealing the bag member with the base member. The bag member includes a similar upraised ridge portion into which is integrated a "male" part of the means for sealing the bag member with the base member. The bag member may be releasably and sealingly coupled to the base member by interlockingly squeezing the "male" and "female" parts together. In this manner, the bag member may be interchanged several times without having to remove the base member from the patient. Excerpt(s): The present invention relates to urinary incontinence devices. In particular, the present invention relates to devices for managing female urinary incontinence.

Patents 163

Urinary incontinence is believed to affect 15% to 30% of non-institutionalized people over the age of 60, and over 50% of the people in convalescent and nursing homes. Treatment for urinary incontinence generally falls into the following categories: (1) management devices, which either restrict the flow of urine, or simply redirect and retain the urine; (2) behavioral treatment, which involves bladder re-training by voiding on a timed schedule or the performance of exercises to strengthen pelvic muscles; (3) pharmacological treatment, which involves the long-term use of drugs; and (4) surgical treatment, which involves the performance of major surgery while the patient is under anesthesia. Although each of these categories of treatment offer some measure of relief, each has significant side effects. The present invention relates to the management of female urinary incontinence. There are many female urinary incontinence management and control devices on the market at this time, ranging from the most intrusive: urinary tract catheters; to the least intrusive: diapers. Neither of these devices, nor anything in between, offer the safe, comfortable, and non-traumatic control or management of female urinary incontinence. Although urinary tract catheters, such as Foley catheters, are often necessary, their intrusive nature often leads to urinary tract infections. In addition, the insertion and extraction of Foley catheters are quite traumatic for the patient. On the other hand, although diapers are quick and easy to use, and are nonintrusive, they often lead to skin breakdown, and are virtually useless when it is necessary to maintain an accurate measure of a patient's fluid intake and output. Web site: http://www.delphion.com/details?pn=US06699174__ •

Implantable article and method for treating urinary incontinence using means for repositioning the implantable article Inventor(s): Neisz; Johann J. (Coon Rapids, MN), Porter; Christopher H. (Woodinville, WA), Westrum, Jr.; John W. (Prior Lake, MN) Assignee(s): American Medical Systems, Inc. (minnetonka, Mn) Patent Number: 6,652,450 Date filed: July 27, 2001 Abstract: An implantable article and method of use are disclosed to treat urological disorders. The biocompatible device includes a sling assembly configured to be minimally invasive and provide sufficient support to the target site. In addition, the configuration of the sling assembly also allows the position of the sling to be permanently changed during and/or after implantation. Excerpt(s): Over 13 million American men and women of all ages suffer from urinary incontinence. The social implications for an incontinent patient include loss of selfesteem, embarrassment, restriction of social and sexual activities, isolation, depression and, in some instances, dependence on caregivers. Incontinence is the most common reason for institutionalization of the elderly. Incontinence may occur when the muscles of the urinary system malfunction or are weakened. Other factors, such as trauma to the urethral area, neurological injury, hormonal imbalance or medication side-effects, may also cause or contribute to incontinence. There are five basic types of incontinence: stress incontinence, urge incontinence, mixed incontinence, overflow incontinence and functional incontinence. Stress urinary incontinence (SUI) is the involuntary loss of urine that occurs due to sudden increases in intra-abdominal pressure resulting from activities such as coughing, sneezing, lifting, straining, exercise and, in severe cases, even simply changing body position. Urge incontinence, also termed "hyperactive bladder" "frequency/urgency syndrome" or "irritable bladder," occurs when an

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individual experiences the immediate need to urinate and loses bladder control before reaching the toilet. Mixed incontinence is the most common form of urinary incontinence. Inappropriate bladder contractions and weakened sphincter muscles usually cause this type of incontinence. Mixed incontinence is a combination of the symptoms for both stress and urge incontinence. Overflow incontinence is a constant dripping or leakage of urine caused by an overfilled bladder. Functional incontinence results when a person has difficulty moving from one place to another. It is generally caused by factors outside the lower urinary tract, such as deficits in physical function and/or cognitive function. A variety of treatment options are currently available to treat incontinence. Some of these treatment options include external devices, behavioral therapy (such as biofeedback, electrical stimulation, or Kegal exercises), injectable materials, prosthetic devices and/or surgery. Depending on age, medical condition, and personal preference, surgical procedures can be used to completely restore continence. One type of procedure, found to be an especially successful treatment option for SUI in both men and women, is a sling procedure. Web site: http://www.delphion.com/details?pn=US06652450__ •

Injectable microspheres for dermal augmentation and tissue bulking Inventor(s): Boschetti; Egisto (Gougenot, FR), Thomas; Richard (Belmont, MA), Vogel; Jean-Marie (Boxborouth, MA) Assignee(s): Biosphere Medical, Inc. (rockland, Ma) Patent Number: 6,660,301 Date filed: March 20, 2000 Abstract: The present invention relates to elastic, hydrophilic and substantially spherical microspheres useful for dermal augmentation and tissue bulking. The invention provides injectable compositions comprising the microspheres and a biocompatible carrier for use in dermal augmentation. The present invention further provides methods of dermal augmentation and tissue bulking, particularly for the treatment of skin contour deficiencies, Gastro-esophageal reflux disease, urinary incontinence, and urinary reflux disease, using the injectable compositions. Excerpt(s): The present invention relates to dermal augmentation and tissue bulking, particularly for the treatment of gastroesophageal reflux disease, urinary incontinence, urinary reflux disease, or skin contour deficiencies and wrinkles, using injectable microspheres. Although gastroesophageal reflux is a normal physiological phenomenon, in some cases it is a pathophysiological situation that can result in a variety of symptoms which may become severe in extreme cases. Gasiro-Esophageal Reflux Disease ("GERD"), describes a backflow of acidic and enzymatic liquid from the stomach to the esophagus. It causes burning sensations behind the sternum that may be accompanied by regurgitation of gastric acid into the mouth or even the lung. Complications of GERD which define the severity of the disease include esophageal tissue erosion, and esophageal ulcer wherein normal epithelium is replaced by a pathological tissue. Statistical data indicate that about 35% of the American population suffer from heartburn at least once a month and between 5 to 10% once a day. More importantly for this kind of disease about 2% of the American population suffer from GERD based on medical evidence data from endoscopic examination. This disease is related to the age of individuals and seems to increase after 40 years of age. (Nebel O. T. et al., Am. J. Dig. Dis., 21(11):953-956 (1976 )).

Patents 165

Web site: http://www.delphion.com/details?pn=US06660301__ •

Intraurethral device and method Inventor(s): Migachyov; Valery (San Antonio, TX), Pham; Tu T. (San Antonio, TX) Assignee(s): HK Medical Technologies, Inc. (san Antonio, Tx) Patent Number: 6,676,593 Date filed: July 18, 2001 Abstract: A device and method for treating female urinary incontinence is provided. A device in accordance with the invention includes a sheath having a distal portion, a proximal portion, and a lumen extending therebetween. A distal member is elastically hinged to the distal portion of the sheath. A flow control valve unit is disposed within a lumen of the sheath. The distal member may be urged into axial alignment with the sheath, and the device may be inserted into a female urethra. Once the device is inserted sufficiently distally into the female urethra, the distal member will return to a position which is not in axial alignment with the sheath. Excerpt(s): The present invention relates generally to devices and methods for treating female urinary incontinence. More particularly, the present invention relates to intraurethral devices and methods for controlling urine flow. Female urinary incontinence is a common medical condition, having widespread economic and social ramifications. The difficulty and embarrassment associated with urinary incontinence often causes the affected person to limit her social activities. In some cases, pads or diapers are used to absorb the uncontrolled seepage of urine. These absorbent items must be changed frequently, creating an ongoing economic burden. The wearing of absorbent undergarments may also restrict the type or style of clothing which the patient may wear. More seriously, skin irritation and other hygienic difficulties often result from the lingering presence of captured urine against tender urogenital tissues. An additional method of treating urinary incontinence is the use of bladder flow control devices, sometimes referred to as artificial sphincters or prosthetic urethral valves. A bladder flow control device may be positioned in the urethra of a patient to control the flow of urine out of the bladder. It is desirable for the placement of the bladder flow control apparatus in the urethra to be performed easily and non-surgically. Once the bladder flow control device is placed, it is desirable that it be safely and securely retained in the urethra. Optimally, the device surfaces which contact the human body will be formed of biocompatible materials, to lessen chances of inflammation in patients. Web site: http://www.delphion.com/details?pn=US06676593__

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Male urinary incontinence device Inventor(s): Bennett; Patricia A. (1300 J.E. Woody Rd, Springtown, TX 76082) Assignee(s): None Reported Patent Number: 6,635,037 Date filed: April 20, 2001 Abstract: The present invention is a male urinary incontinence management device comprising a base support portion, an external condom catheter portion, and an

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adjustable strap portion. The base support portion has a periphery of generally uniform thickness, a concave rear surface, a stiffened central support portion, and an aperture which passes through the central portion. The external condom catheter portion is attached to the base support portion and is in fluid communication with the aperture. An adjustment means is carried by the base support portion. The adjustable strap portion releasably and adjustably attaches to the base support portion at the adjustment means. The base support portion can be used with either conventional external condom catheters or external condom catheters according to the present invention. Excerpt(s): The present invention relates to urinary incontinence devices. In particular, the present invention relates to devices for managing male urinary incontinence. Urinary incontinence is believed to affect 15% to 30% of non-institutionalized people over the age of 60, and over 50% of the people in convalescent and nursing homes. Treatment for urinary incontinence generally falls into the following categories: (1) management devices, which either restrict the flow of urine, or simply redirect and retain the urine; (2) behavioral treatment, which involves bladder re-training by voiding on a timed schedule or the performance of exercises to strengthen pelvic muscles; (3) pharmacological treatment, which involves the long-term use of drugs; and (4) surgical treatment, which involves the performance of major surgery while the patient is under anesthesia. Although each of these categories of treatment offer some measure of relief, each has significant side effects. The present invention relates to the management of male urinary incontinence. There are many male urinary incontinence management devices on the market at this time, ranging from the most intrusive: urinary tract catheters; to the least intrusive: diapers. Neither of these devices, nor anything in between, offer the safe, comfortable, and non-traumatic control or management of male urinary incontinence. Although urinary tract catheters, such as Foley catheters, are often necessary, their intrusive nature often leads to urinary tract infections. In addition, the insertion and extraction of Foley catheters are quite traumatic for the patient. On the other hand, although diapers are quick and easy to use, they often lead to skin breakdown, and are virtually useless when it is necessary to maintain an accurate measure of a patient's fluid intake and output. Web site: http://www.delphion.com/details?pn=US06635037__ •

Muscarinic receptor antagonists Inventor(s): Aggen; James (San Francisco, CA), Griffin; John H. (Atherton, CA), Mammen; Mathai (San Mateo, CA), Marquess; Daniel (Half Moon Bay, CA), Moran; Edmund J. (San Francisco, CA), Oare; David (Belmont, CA) Assignee(s): Theravance, Inc. (south San Francisco, Ca) Patent Number: 6,693,202 Date filed: August 25, 2000 Abstract: Disclosed are multibinding compounds which are muscarinic receptor antagonists. The multibinding compounds of this invention containing from 2 to 10 ligands covalently attached to one or more linkers. Each ligand is, independently of each other, a muscarinic receptor antagonist or an allosteric modulator provided that at least one of said ligand is a muscarinic receptor antagonist. The multibinding compounds of this invention are useful in the treatment and prevention of diseases such as chronic obstructive pulmonary disease, chronic bronchitis, irritable bowel syndrome, urinary incontinence, and the like.

Patents 167

Excerpt(s): This invention relates to novel multibinding compounds (agents) that are muscarinic receptor antagonists, pharmaceutical compositions comprising such compounds, and methods of preparing these compounds. Accordingly, the multibinding compounds and pharmaceutical compositions of this invention are useful in the treatment and prevention of diseases mediated by these receptors such as chronic obstructive pulmonary disease, chronic bronchitis, irritable bowel syndrome, urinary incontinence, and the like.sup.1 Bonner, T. I. et al., Science (Washington D.C.) 1987, 237, 527-532.sup.2 Goyal, R. K., J. Med, 1989, 321, 1022. Web site: http://www.delphion.com/details?pn=US06693202__ •

Nitrosated and nitrosylated potassium channel activators, compositions and methods of use Inventor(s): Garvey; David S. (Dover, MA), Saenz de Tejada; Inigo (Madrid, ES) Assignee(s): Nitromed, Inc. (bedford, Ma) Patent Number: 6,693,122 Date filed: May 28, 2002 Excerpt(s): The present invention describes novel nitrosated and/or nitrosylated potassium channel activators, and novel compositions comprising at least one nitrosated and/or nitrosylated potassium channel activator, and, optionally, at least one compound that donates, transfers or releases nitric oxide, elevates endogenous levels of endothelium-derived relaxing factor, stimulates endogenous synthesis of nitric oxide or is a substrate for nitric oxide synthase and/or at least one vasoactive agent. The present invention also provides novel compositions comprising at least one potassium channel activator, and at least one compound that donates, transfers or releases nitric oxide, elevates endogenous levels of endothelium-derived relaxing factor, stimulates endogenous synthesis of nitric oxide or is a substrate for nitric oxide synthase and/or at least one vasoactive agent. The present invention also provides methods for treating or preventing sexual dysfunctions in males and females, for enhancing sexual responses in males and females, and for treating or preventing cardiovascular disorders, cerebrovascular disorders, hypertension, asthma, baldness, urinary incontinence, epilepsy, sleep disorders, gastrointestinal disorders, migraines, irritable bowel syndrome, and sensitive skin. Adequate sexual function is a complex interaction of hormonal events and psychosocial relationships. There are four stages to sexual response as described in the International Journal of Gynecology & Obstetrics, 51(3):265277 (1995). The first stage of sexual response is desire. The second stage of sexual response is arousal. Both physical and emotional stimulation may lead to breast and genital vasodilation and clitoral engorgement (vasocongestion). In the female, dilation and engorgement of the blood vessels in the labia and tissue surrounding the vagina produce the "orgasmic platform," an area at the distal third of the vagina where blood becomes sequestered. Localized perivaginal swelling and vaginal lubrication make up the changes in this stage of sexual response. Subsequently, ballooning of the proximal portion of the vagina and elevation of the uterus occurs. In the male, vasodilation of the cavernosal arteries and closure of the venous channels that drain the penis produce an erection. The third stage of sexual response is orgasm, while the fourth stage is resolution. Interruption or absence of any of the stages of the sexual response cycle can result in sexual dysfunction. One study found that 35% of males and 42% of females reported some form of sexual dysfunction. Read et al, J. Public Health Med., 19(4):387391 (1997). While there are obvious differences in the sexual response between males

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and females, one common aspect of the sexual response is the erectile response. The erectile response in both males and females is the result of engorgement of the erectile tissues of the genitalia with blood which is caused by the relaxation of smooth muscles in the arteries serving the genitalia. Web site: http://www.delphion.com/details?pn=US06693122__ •

Noninvasive devices, methods, and systems for shrinking of tissues Inventor(s): Carter; Garry L. (Pleasanton, CA), Claude; John P. (San Carlos, CA), Do; Paul (San Jose, CA), Ingle; Frank (Palo Alto, CA), Laird; Robert J. (Richmond, CA), Mosel; Brian J. (Dublin, CA) Assignee(s): Surx, Inc. (livermore, Ca) Patent Number: 6,629,535 Date filed: January 23, 2001 Abstract: The invention provides improved devices, methods, and systems for shrinking of collagenated tissues, particularly for treating urinary incontinence in a noninvasive manner by directing energy to a patient's own support tissues. This energy heats fascia and other collagenated support tissues, causing them to contract. The energy can be applied intermittently, often between a pair of large plate electrodes having cooled flat electrode surfaces, the electrodes optionally being supported by a clamp structure. Such cooled plate electrodes are capable of directing electrical energy through an intermediate tissue and into fascia while the cooled electrode surface prevents injury to the intermediate tissue, particularly where the electrode surfaces are cooled before, during, and after an intermittent heating cycle. Ideally, the plate electrode comprises an electrode array including discrete electrode surface segments so that the current flux can be varied to selectively target the fascia. Alternatively, chilled "liquid electrodes" may direct current through a selected portion of the bladder (or other body cavity) while also cooling the bladder wall, an insulating gas can prevent heating of an alternative bladder portion and the adjacent tissues, and/or ultrasound transducers direct energy through an intermediate tissue and into fascia with little or no injury to the intermediate tissue. Cooled electrodes may be used to chill an intermediate engaged tissue so as to cause the maximum temperature difference between the target tissue and the intermediate tissue prior to initiating RF heating. This allows the dimensions of tissue reaching the treatment temperature to be controlled and/or minimized, the dimensions of protected intermediate tissue to be maximized, and the like. Excerpt(s): The present invention generally relates to medical devices, methods, and systems. More specifically, the present invention provides techniques for selectively heating and shrinking tissues, particularly for the noninvasive treatment of urinary incontinence and hernias, for cosmetic surgery, and the like. Urinary incontinence arises in both women and men with varying degrees of severity, and from different causes. In men, the condition occurs most often as a result of prostatectomies which result in mechanical damage to the sphincter. In women, the condition typically arises after pregnancy where musculoskeletal damage has occurred as a result of inelastic stretching of the structures which support the genitourinary tract. Specifically, pregnancy can result in inelastic stretching of the pelvic floor, the external sphincter, and most often, to the tissue structures which support the bladder and bladder neck region. In each of these cases, urinary leakage typically occurs when a patient's intra-abdominal pressure increases as a result of stress, e.g. coughing, sneezing, laughing, exercise, or the like. Treatment of urinary incontinence can take a variety of forms. Most simply, the patient

Patents 169

can wear absorptive devices or clothing, which is often sufficient for minor leakage events. Alternatively or additionally, patients may undertake exercises intended to strengthen the muscles in the pelvic region, or may attempt behavior modification intended to reduce the incidence of urinary leakage. Web site: http://www.delphion.com/details?pn=US06629535__ •

Pharmaceutical compositions of O-desmethyl-N-mono-desmethyl-tramadol Inventor(s): Englberger; Werner (Stolberg, DE), Friderichs; Elmar (Stolberg, DE), Hennies; Hagen-Heinrich (Simmerath, DE), Koegel; Babette (Langerwehe, DE) Assignee(s): Gruenenthal Gmbh (aachen, De) Patent Number: 6,593,373 Date filed: October 12, 2001 Abstract: A method of producing pharmaceutical compositions using O-desmethyl-Nmono-desmethyl-tramadol for the treatment of pain and various related indications, pharmaceutical compositions containing O-desmethyl-N-mono-desmethyl-tramadol, and a method of treating pain, urinary incontinence, diarrhea or pruritus using Odesmethyl-N-mono-desmethyl-tramadol. Excerpt(s): This invention relates to the use of O-desmethyl-N-mono-desmethyltramadol for the production of pharmaceutical compositions for the treatment of pain and various related indications as well as pharmaceuticals comprising O-desmethyl-Nmono-desmethyl-tramadol. The treatment of pain conditions is of great importance in medicine. There is currently a world-wide need for additional pain therapy. The pressing requirement for a target-oriented treatment of pain conditions which is right for the patient which is to be understood as the successful and satisfactory treatment of pain for the patients is documented in the large number of scientific works which have recently and over the years appeared in the field of applied analgesics or on basic research on nociception. The underlying object of the present invention was to provide a substance useful in the treatment of pain and also related indications, as well as pharmaceutical compositions for such treatment. Web site: http://www.delphion.com/details?pn=US06593373__

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Resilient incontinence insert and a method of making the same Inventor(s): Velazquez; Herb F. (Neenah, WI), Zunker; MaryAnn (Oshkosh, WI) Assignee(s): Kimberly-clark Worldwide, Inc. (neenah, Wi) Patent Number: 6,679,831 Date filed: September 28, 2000 Abstract: An expandable vaginal insert device for reducing the occurrence of female urinary incontinence. The vaginal insert device includes at least a resilient member capable of expanding to transmit pressure to the urethro-vaginal myofascial area. Optionally, the device may include one or more non-absorbent layers in addition to the resilient member. The resilient member and any additional layers are formed into an elongated member, which may be then be shaped into a M-shaped shaped profile or a dome-shaped profile.

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Excerpt(s): This invention relates to an expandable urinary incontinence device and a method of making the device. More specifically, this invention relates to a nonabsorbent urinary incontinence device which is designed to be placed in a woman's vagina for providing support to a woman's urethra to prevent the involuntary urine loss commonly associated with stress urinary incontinence. Some women, especially women who have given birth to one or more children, and older women, can experience incidences of involuntary urine loss due to stress urinary incontinence or combined stress and urge incontinence. A sneeze or cough can increase the intra-abdominal pressure impinging on a person's bladder and cause the involuntary release of urine. The frequency and severity of such urine loss can increase as the muscles and tissues near the urethro-vaginal myofascial area grow weaker. It has also been recognized that the urinary sphincter muscle, which is located at the upper end of the urethra adjacent to the bladder, works well at sealing off the passing of urine from the bladder to the urethra when it has a round or circular cross-sectional configuration. However, when this passageway becomes distorted into a cross-sectional configuration having more of an elliptical or oval appearance, the sphincter muscle can not close properly, therefore, the tendency for involuntary urine loss increases. As the world's female population ages, there is an ever increasing need for a non-surgical procedure to reduce the involuntary urine loss commonly associated with "stress urinary incontinence." Today, there are a number of products available for this purpose. Essentially all of these products can only be purchased with a prescription and they need to be physically inserted and/or adjusted by a medical doctor or a nurse practitioner in order to perform correctly. Web site: http://www.delphion.com/details?pn=US06679831__ •

Sling system for treating incontinence Inventor(s): Kovac; S. Robert (Kettering, OH) Assignee(s): Ams Research Corporation (minnetonka, Mn) Patent Number: 6,641,524 Date filed: October 11, 2001 Abstract: A pubic bone-mounted urethra stabilization and support system and method therefor for the long term cure of recurrent female urinary incontinence. The system comprises, a pair of anchors affixed to the posterior/inferior pubic bone, sutures attach to the anchors and a mesh sling passing behind and about the urethra and the adjacent endopelvic fascia and having ends attached to the anchors by the anchor-mounted sutures. The method includes the steps of accessing said urethra with the endopelvic fascia therebehind and the pubic bone, properly locating and attaching the anchors to the pubic bone, properly locating the sling about the urethra and adjacent endopubic fascia and suturing and tensioning the ends of the sling to the anchors, causing said sling to restore, support and stabilize functional urethral continence anatomy and prevent urethral descent under intraabdominal pressure. Excerpt(s): The invention relates to a system and method for the effective long-term cure of recurrent female urinary incontinence, and more particularly to a urethra stabilization and support system attached to the posterior/inferior pubic bone and a method for accomplishing this in which the urethra is positioned in the anatomically proper position. The problem of recurrent female urinary incontinence, or the inability to control urination, is a major and debilitating one affecting millions of women in the United States alone. One particular type that frequently occurs in women is stress

Patents 171

urinary incontinence, which is precipitated by coughing, straining, or heavy lifting. Mild cases may be treated by exercises involving tightening and relaxing of the perineal and gluteal muscles or by sympathomimetic drug therapy. Severe cases, however, may require surgery to correct the underlying anatomic defect. It is this surgical correction which is the subject of the present invention. In general, continence is considered to be a function of urethral support and coaptation. For coaptation to successfully prevent or cure incontinence, the urethra must be supported and stabilized in its normal anatomic position. The female's natural support system for the urethra is a hammock-like supportive layer composed of endopelvic fascia, the anterior vaginal wall, and a distal attachment to the pubic bone. Weakening and elongation of the pubourethral ligaments and the arcus tendineus fascia pelvis, weakening of the endopelvic fascia and pubourethral prolapse of the anterior vaginal wall, and their complex interaction with intraabdominal forces are all suspected to play a role in the loss of pelvic support for the urethra and subsequent hypermobility to an unnaturally low non-anatomic position, leading to urinary incontinence. Web site: http://www.delphion.com/details?pn=US06641524__ •

Surgical apparatus and methods for delivery of a sling in the treatment of female urinary incontinence Inventor(s): Berger; Yitzhak (South Orange, NJ) Assignee(s): Ethicon, Inc. (somerville, Nj) Patent Number: 6,638,210 Date filed: September 26, 2001 Abstract: Surgical apparatus for treating female stress urinary incontinence include a pair of curved delivery needles, each defining a distal end and a proximal end and adopted to be inserted into the abdomen of a female and to be positioned on either side of the bladder neck so as to define a delivery path for a tape which may be removably attached to the proximal ends of the delivery needles through the vagina for implantation into the abdomen to provide support for the urethra. A pair of curved delivery sheaths, each adapted to be inserted into the abdomen around one of the delivery needles, allow withdrawal of the delivery needles from the abdomen such that the tape is conducted along the delivery path. In the preferred embodiment, the delivery needles also allow simultaneous introduction of a local anesthetic into the abdominal tissues. Methods for treatment of stress urinary incontinence utilizing the surgical apparatus are also disclosed. Excerpt(s): The present invention relates broadly to the field of human health care, and in particular, to the treatment of a certain type of urinary incontinence in human beings. More specifically, this invention relates to surgical apparatus and methods for treating stress urinary incontinence in human females. Many women suffer from leakage of urine when they cough, laugh, sneeze or engage in various types of physical exercise. This condition is called stress urinary incontinence ("SUI") and is related to weakness of the muscles within the pelvis that provide support for the urethra and the bladder neck. SUI may be caused by a functional defect of the tissue or ligaments connecting the vaginal wall with the pelvic muscles and pubic bone. Common contributory factors include repetitive straining of the pelvic muscles, childbirth, loss of pelvic muscle tone, and estrogen loss. Such a defect results in an improperly functioning urethra, but unlike other types of urinary incontinence, SUI is not a problem of the urinary bladder. Nonoperative treatment options for patients with SUI can be attempted, by instructing such

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patients to perform pelvic exercises, known as Kegel exercises, with the intention of strengthening the supporting muscles. However, when these exercises fail to reverse SUI, surgical repair is advised. Web site: http://www.delphion.com/details?pn=US06638210__ •

Thiazole and other heterocyclic ligands for mammalian dopamine, muscarinic and serotonin receptors and transporters, and methods of use thereof Inventor(s): Cuny; Gregory D. (Somerville, MA), Hauske; James R. (Concord, MA), Heffernan; Michele L. R. (Worcester, MA), Holland; Joanne M. (Brookline, MA), Persons; Paul E. (Westborough, MA), Radeke; Heike (South Grafton, MA) Assignee(s): Sepracor Inc. (marlborough, Ma) Patent Number: 6,699,866 Date filed: April 12, 2002 Abstract: One aspect of the present invention relates to novel heterocyclic compounds. A second aspect of the present invention relates to the use of the novel heterocyclic compounds as ligands for various mammalian cellular receptors, including G-protein coupled receptors. A third aspect of the present invention relates to the use of the novel heterocyclic compounds as ligands for mammalian dopamine, muscarinic or serotonin receptors or transporters. Another aspect of the present invention relates to the use of the novel heterocyclic compounds as ligands for mammalian dopamine, muscarinic or serotonin receptors. The compounds of the present invention will also find use in the treatment of numerous ailments, conditions and diseases which afflict mammals, including but not limited to addiction, anxiety, depression, sexual dysfunction, hypertension, migraine, Alzheimer's disease, obesity, emesis, psychosis, analgesia, schizophrenia, Parkinson's disease, restless leg syndrome, sleeping disorders, attention deficit hyperactivity disorder, irritable bowel syndrome, premature ejaculation, menstrual dysphoria syndrome, urinary incontinence, inflammatory pain, neuropathic pain, Lesche-Nyhane disease, Wilson's disease, Tourette's syndrome, psychiatric disorders, stroke, senile dementia, peptic ulcers, pulmonary obstruction disorders, and asthma. Excerpt(s): Dopamine is a neurotransmitter found in various parts of the central nervous system. It is most prevalent in the substantia nigra (A9), the neostriatum, and the ventral tegmental area (A10). Dopamine binds to two general classes of receptors, termed D1and D2-like receptors. These receptors are differentiated pharmacologically, biologically, physiologically, and in anatomical distribution. Furthermore, the D1-like receptor class consists of several subtypes, D.sub.1 and D.sub.5. Likewise, the D2-like receptor class also consists of several subtypes, D.sub.2, D.sub.3, and D.sub.4. All of the subtypes of dopamine receptors are coupling to and activate different G protein complexes. The D1-like receptors interact with the Gs complex to activate adenylyl cyclase, whereas the D2-like receptors interact with Gi to inhibit cAMP production. The D.sub.3 receptor subtype is found only in the CNS. It is found in greater abundance in the limbic regions of the brain, such as the nucleus accumbens. These regions receive dopamine input from the ventral tegmental area and are known to be associated with cognitive, emotional, and endocrine functions. It is relatively absent in the nigrostriatal system, suggesting that the D.sub.3 receptor may more likely be involved in the etiology of psychotic diseases, instead of locomotor abnormalities. Many clinically efficacious antipsychotic agents, such as eticlopride, haloperidol, and olanzapine, bind to the D.sub.3 receptor. However, most of these compounds also bind to the D.sub.2 receptor,

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in addition to a host of other receptors and ion channels. High affinity of ligands for the D.sub.2 receptor in the striatum is believed to be the cause of serious extrapyramidal side-effects that can result in termination of therapy. In addition, this also has made elucidating the role of D.sub.3 more difficult. Web site: http://www.delphion.com/details?pn=US06699866__ •

Treating urinary incontinence Inventor(s): Gellman; Barry N. (North Easton, MA) Assignee(s): Scimed Life Systems, Inc. (maple Grove, Mn) Patent Number: 6,689,047 Date filed: November 14, 2001 Abstract: A surgical device for use in a minimally invasive procedure to treat urinary incontinence can include a dilator coupled to a curved needle at one end and a sling at the opposite end. Urinary incontinence can be treated minimally invasively. One treatment includes positioning the sling on an anterior portion of the urethra to provide proper coaptation to the urethra. Excerpt(s): The present invention relates to devices and methods for treating urinary incontinence, such as urinary incontinence in women resulting from intrinsic sphincter deficiency. Urinary incontinence is a widespread problem throughout the world. Urinary incontinence affects people of all ages and can severely impact a patient both physiologically and psychologically. One form of urinary incontinence suffered by women is intrinsic sphincter deficiency (ISD), a condition in which the valve of the urethral sphincter does not function properly, thus preventing proper coaptation of the urethra. Without proper coaptation, a person is unable to control urinary leakage. ISD can arise from loss of urethral vasculature, thinning of urethral mucosa, loss of the urethral connective tissue elements, neurologic compromise of the sympathetic smooth muscle, or compromise of the external striated sphincter. Web site: http://www.delphion.com/details?pn=US06689047__

•

Treatment of urinary incontinence and other disorders by application of energy and drugs Inventor(s): Edwards; Stuart D. (Portola Valley, CA) Assignee(s): Novasys Medical, Inc. (newark, Ca) Patent Number: 6,692,490 Date filed: September 28, 1999 Abstract: The invention provides a method and system for treating disorders of the genito-urinary tract and other disorders in other parts of the body. A particular treatment can include one or more of, or some combination of ablation, nerve modulation, three-dimensional tissue shaping, drug delivery, mapping, stimulating, shrinking (by creation of a pattern of thermal lesions) and reducing strain on structures by altering the geometry thereof and providing bulk to particularly defined regions. The particular body structures or tissues can include one or more of, or some combination of regions, including the bladder, esophagus, vagina, penis, larynx, pharynx, aortic arch, abdominal aorta, thoracic aorta, large intestine, small intestine, sinus, auditory canal,

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uterus, vas deferens, trachea and all associated sphincters. In one aspect of the invention, a catheter is deployed in the body. It may enter the body via a natural orifice, a stoma, or a surgically created opening that is made for the purpose of inserting the catheter. Insertion may be facilitated with the use of a guide wire or a generic support structure or visualization apparatus. In second aspect of the invention, the treatment can include application of energy and substances to effect changes in the target tissue. Types of energy that can be applied include radiofrequency, laser, microwave, infrared waves, ultrasound or some combination thereof. Types of substances that can be applied include pharmaceutical agents such as analgesics, antibiotics and anti-inflammatory drugs, bulking agents such as biologically nonreactive particles, cooling fluids or dessicants such as liquid nitrogen for use in cryo-based treatments. Excerpt(s): This invention relates to treating body tissue, particularly to treating body tissue by altering the shape, density, relative geometry or tension of that body tissue using energy or substances deployed from an interstitial location in the body. Urinary incontinence results from a number of factors. Increasing age, injury from childbirth and related stresses can cause the relative tone of the bladder and accessory muscles to weaken, which, in turn, causes an impaired ability to retain urine. Weight gain and overall deterioration of muscle tone can cause increased abdominal pressure which overcomes sphincter resistance. Nerve pathways that cause the "urge" to urinate can become hyperactive. The relative tension of the urethra can change with age, causing poor urinary control. Injury to the detrusor muscles or to the trigone area also results in impaired urinary continence. These factors do not usually occur by themselves. The typical patient usually presents with two or more of them. Therefore, it is desirable to provide a treatment that can address many of these factors. Web site: http://www.delphion.com/details?pn=US06692490__ •

Urethral compression device Inventor(s): Beane; Richard (Hingham, MA), Cheng; Gordon (Carlisle, MA), Kumar; Sanjaya (Southboro, MA), Simmers; Richard (Gloucester, MA) Assignee(s): Uroscientific Incorporated (woburn, Ma) Patent Number: 6,609,522 Date filed: September 17, 2001 Abstract: A urethral compression device prevents male urinary incontinence by compressing the urethra. The device has a pressure-applying element. The urethral compression device compress the urethra. The device is designed to allow the user to manipulate the device using only one hand, if so desired. Excerpt(s): Male urinary incontinence can result from a variety of physical or neurological conditions. The incidence of incontinence increases with advanced age. Surgical treatment of prostate cancer or benign prostatic hyperplasia (BPH), such as radical prostatectomies, open or transurethral prostatectomy, and trauma to the membranous urethra or bladder neck can all cause temporary or permanent incontinence in men. Existing external compressive incontinence control devices are based on the principle that if the entire cross-section of the penile shaft is sufficiently compressed, the urethra will be correspondingly flattened to prevent any urine leakage. In order to prevent the urine leakage, the penis must be flattened to about 40% or more of the normal penile diameter. When a conventional penile clamp is used with this level of compression, the major side effect is constriction of blood vessels and prevention of

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blood circulation to the penis. While most users of the penile clamps of these types learn to periodically remove the clamps to temporarily restore blood circulation, it is nonetheless a major inconvenience. In addition, these conventional devices are heavy and bulky, uncomfortable and insufficiently discreet. Others have recognized that it would be desirable to selectively compress the urethra, which is situated along the central underside of the penile shaft, without exerting undue compression of the entire penile shaft. While these devices compress the urethra more than the body of penis, the devices are either too bulky, which detracts from the user's comfort level and privacy, or are comprised of many components which increase the complexity and cost of the device and the probability of failure. Also, many of the devices require two hands for application or removal. Web site: http://www.delphion.com/details?pn=US06609522__ •

Urinary incontinence treatment apparatus Inventor(s): Forsell; Peter (Zug, CH) Assignee(s): Obtech Medical AG (baar, Ch) Patent Number: 6,709,385 Date filed: November 19, 2002 Abstract: A urinary incontinence treatment apparatus includes an adjustable noninflatable restriction device implanted in a patient suffering from urinary incontinence. The restriction device engages the urethra or urine bladder to restrict the urine passageway. An adjustment device mechanically adjusts the restriction device to restrict the urine passageway or temporarily release the urine passageway to allow the patient to urinate. Excerpt(s): The present invention relates to a urinary incontinence treatment apparatus for treatment of a patient, who suffers from urinary incontinence, comprising an adjustable restriction device implantable in the patient for engaging a portion of the urethra or urine bladder of the patient to restrict a urine passageway therein, and an operable adjustment device adapted to mechanically adjust the restriction device to change the restriction of the urine passageway. Urine incontinence is a widespread problem. Many people are helped through training of the muscles in the pelvic floor but too many have severe problems with urine leakage. Many different solutions to this problem have been tried. For example, there is a prior manually operated urine incontinence treatment apparatus having an artificial hydraulic sphincter device engaging the urethra and connected to an elastic reservoir implanted in the scrotum or in the region of the labia major. A disadvantage of this prior apparatus is that over time hard fibrosis is developed around the reservoir that may cause malfunction of pumping components. Furthermore, it is a rather complicated task to manually squeeze the elastic implanted reservoir to pump hydraulic fluid to open the sphincter device when the patient needs to urinate. In particular women can get their fingers wet. The created fibrosis will sooner or later become a hard fibrotic layer that may make it even more difficult to pump the reservoir. Yet a further disadvantage is that the use of hydraulic fluid always entails a risk of fluid leaking from implanted hydraulic components. A prior, hydraulic apparatus designed to compress the urethra is disclosed in U.S. Pat. No. 5,520,606. Prosthetic sphincters with an inflatable cuff that surrounds the urethra or encloses it on two sides are disclosed in for example U.S. Pat. Nos. 4,571,749 and 4,222,377. U.S. Pat. No. 4,969,474 discloses a hydraulic method for treating both men and women with urinary incontinence problems in the same way. The apparatus of U.S.

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Pat. No. 4,969,474 includes a reservoir containing fluid and an inflatable compression means designed to compress urethra without risking tissue loss or necrosis to occur. An artificial hydraulically operated urethra sphincter employing an external magnet to achieve closure of the urethra cuff is disclosed in U.S. Pat. No. 5,562,598. Web site: http://www.delphion.com/details?pn=US06709385__ •

Use of 2-amino-1-(4-hydroxy-2-methanesulfonamidophenyl)ethanol for treating urinary incontinence Inventor(s): Esser; Franz (Ingelheim, DE), Ishiguro; Naoki (Osaka, JP), Kitagawa; Hisato (Osaka, JP), Muramatsu; Ikunobu (Fukui, JP), Pouzet; Pascale (Biberach, DE) Assignee(s): Boehringer Ingelheim Pharma KG (ingelheim, De) Patent Number: 6,660,772 Date filed: January 30, 2002 Abstract: A method of treating urinary incontinence in a patient in need thereof, the method comprising administering to the patient an effective amount of 2-amino-1-(4hydroxy-2-methanesulfonamidophenyl)ethanol or a pharmacologically acceptable salt thereof, and pharmaceutical compositions. Excerpt(s): The present invention relates to medicaments containing 2-amino-1-(4hydroxy-3-methanesulfonamidophenyl)ethanol, one of the two optical isomers thereof, and/or the pharmacologically acceptable salts thereof, particularly for treating urinary incontinence. By incontinence is meant an involuntary release of urine, i.e., weakness of the bladder. The various manifestations of urinary incontinence include urge incontinence, reflex incontinence, overflow incontinence, and stress incontinence. The most common form of urinary incontinence is stress incontinence. Women, in particular, are affected by this after more or less difficult childbirth. The reason for this is that pregnancy and labor easily lead to a weakening of the pelvic floor. Other causes of incontinence may lie, for example, in damage to the nerves of the pelvic floor, a congenitally short urethra, or damage to the sphincter muscle. According to WO 96/32939 it is beneficial to use alpha-1L-agonists in the treatment of urinary incontinence, as they act selectively on the adrenoreceptors of the bladder and thus have a crucial effect on the tonicity of the urethra, without significantly affecting the cardiac circulatory system. Web site: http://www.delphion.com/details?pn=US06660772__

•

Use of a preparation of cimicifuga racemosa Inventor(s): Gessler; Andrea C. (Gleichen-Reinhausen, DE), Nisslein; Thomas (Gottingen, DE) Assignee(s): Schaper & Brummer Gmbh & Co. KG (salzgitter, De) Patent Number: 6,713,097 Date filed: September 26, 2002 Abstract: A preparation of Cimicifuga racemosa can be used to successfully treat urinary incontinence in female mammals following an ovariohysterectomy. Positive results can also be expected for the treatment of women following a hysterectomy or after the menopause.

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Excerpt(s): The invention relates to the use of a preparation of Cimicifuga racemosa (Black Snakeroot), in particular an extract thereof, and more particularly an extract of the rhizome (Rhizoma cimicifugae racemosae). Extracts of Cimicifuga racemosa are used in gyniatrics for the treatment of menopause complaints, such as hot flushes, sweating, sleep disorders, irritability, and depressive disgruntlement. The extract is regarded as a phytosubstitute for oestrogen replacement therapy. Extracts of Cimicifuga racemosa play no significant role in allopathic veterinary medicine. It has been found, surprisingly, that preparations of Cimicifuga racemosa are therapeutically effective against urinary incontinence. Web site: http://www.delphion.com/details?pn=US06713097__

Patent Applications on Urinary Incontinence As of December 2000, U.S. patent applications are open to public viewing.9 Applications are patent requests which have yet to be granted. (The process to achieve a patent can take several years.) The following patent applications have been filed since December 2000 relating to urinary incontinence: •

1-(2-m-methanesulfonamidophenylethyl)-4-(m-trifluoromethylphenyl) and pharmaceutically acceptable salts and solvents thereof

piperazine

Inventor(s): Schaus, John Mehnert; (Zionsville, IN), Thompson, Dennis Charles; (Indianapolis, IN), Thor, Karl Bruce; (Morrisville, NC) Correspondence: Robert Craig Tucker; Eli Lilly And Company; Patent Division; P O Box 6288; Indianapolis; IN; 46206-6288; US Patent Application Number: 20040067962 Date filed: May 21, 2003 Abstract: The present invention provides a compound of the formula (I), and the pharmaceutically acceptable salts and solvates thereof, which is useful for treating bladder over-activity or urinary incontinence. Excerpt(s): Bladder over-activity and urinary incontinence are common conditions that present various symptoms that are at best embarrassing and at worst disabling. These conditions are a frequent cause of elderly people's confinement to nursing homes and other protected environments. While they are more common among women than among men, at all ages, these conditions afflict significant numbers of both sexes. It is well known that many children past the usual age of toilet-training suffer from nocturnal enuresis, and that the elderly are quite likely to develop bladder over-activity or urinary incontinence as they grow older. However, some studies have reported daily incontinence among as many as 17% of young, apparently healthy, women. Thus, it is clear that reliable and safe methods of treating bladder over-activity and urinary incontinence are seriously needed. Bladder over-activity and urinary incontinence can result from various neurological disorders; such as Parkinson's Disease, multiple sclerosis, spinal cord injury, stroke, and Alzheimer's Disease. Bladder over-activity can also result from various disorders localized to the lower urinary tract; such as prostatitis, prostatodynia, urethritis, interstitial cystitis, urinary tract infection, outlet obstruction, benign prostate hyperplasia, radiation therapy of the pelvic viscera, diabetes, or 9

This has been a common practice outside the United States prior to December 2000.

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vulvodynia. Bladder over-activity can also be idiopathic. Thus, it is clear that bladder over-activity and urinary incontinence are major disorders of today. It is believed to afflict approximately 12 million people in the United States alone, and to occur in from 15 to 30% of the population over the age of 60. Its treatment at present is quite unsatisfactory. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

3-aza- and 1,4-diaza-bicyclo[4.3.0]nonanes, and methods of use thereof Inventor(s): Hauske, James R.; (Concord, MA), Holland, Joanne M.; (Brookline, MA), Radeke, Heike S.; (South Grafton, MA) Correspondence: Foley Hoag, Llp; Patent Group, World Trade Center West; 155 Seaport Blvd; Boston; MA; 02110; US Patent Application Number: 20040038983 Date filed: March 27, 2003 Abstract: One aspect of the present invention relates to novel heterocyclic compounds. A second aspect of the present invention relates to the use of the novel heterocyclic compounds as ligands for various cellular receptors, including serotonin receptors and dopamine receptors. The compounds of the present invention will find use in the treatment of numerous ailments, conditions and diseases which afflict mammals, including but not limited to addiction, anxiety, depression, sexual dysfunction, hypertension, migraine, Alzheimer's disease, obesity, emesis, psychosis, analgesia, schizophrenia, Parkinson's disease, restless leg syndrome, sleeping disorders, attention deficit hyperactivity disorder, irritable bowel syndrome, premature ejaculation, menstrual dysphoria syndrome, urinary incontinence, inflammatory pain, neuropathic pain, Lesche-Nyhane disease, Wilson's disease, Tourette's syndrome, psychiatric disorders, stroke, and senile dementia. Excerpt(s): This application claims the benefit of the filing date of U.S. Provisional Patent Application serial No. 60/372,325, filed Apr. 12, 2002. Serotonin (5-hydroxytryptamine, 5-HT) is widely distributed in animals and plants, occurring in vertebrates, fruits, nuts, and venoms. A number of congeners of serotonin are also found in nature and have been shown to possess a variety of peripheral and central nervous system activities. Serotonin may be obtained from a variety of dietary sources; however, endogenous 5HT is synthesized in situ from tryptophan through the actions of the enzymes tryptophan hydroxylase and aromatic L-amino acid decarboxylase. Both dietary and endogenous 5-HT are rapidly metabolized and inactivated by monoamine oxidase and aldehyde dehydrogenase to the major metabolite, 5-hydroxyindoleacetic acid (5-HIAA). Serotonin is implicated in the etiology or treatment of various disorders, particularly those of the central nervous system, including anxiety, depression, obsessivecompulsive disorder, schizophrenia, stroke, sexual dysfunction, obesity, pain, hypertension, vascular disorders, migraine, and nausea. Recently, understanding of the role of 5-HT in these and other disorders has advanced rapidly due to increasing understanding of the physiological role of various serotonin receptor subtypes. Most of the 5-HT receptors are G-protein coupled receptors, except for 5-HT.sub.3, which is an ion channel. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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•

ABSORBABLE PUBOVAGINAL SLING SYSTEM AND METHOD Inventor(s): Zappala, Stephen M.; (Andover, MA) Correspondence: Jenifer E. Haeckl, ESQ.; Mirick, O'connell, Demallie & Lougee, Llp; 1700 West Park Drive; Westborough; MA; 01581; US Patent Application Number: 20040015044 Date filed: July 16, 2002 Abstract: An absorbable pubovaginal sling system for surgical management of urinary incontinence, generally comprising: a latex-free, synthetic sling made entirely of absorbable materials of which at least one of the materials is adapted to stimulate fibroblast interposition; and a looped monofilament suture that is adapted to be transposed to the suprapubic position, supported by an external adjustable tension device, and connected to said sling. Excerpt(s): The invention relates to novel systems and methods for surgically managing urinary incontinence that feature an absorbable pubovaginal sling and an external tension adjuster. The pubovaginal sling has gained widespread acceptance in the surgical management of stress urinary incontinence. The surgical procedure has undergone several modifications in an attempt to improve clinical outcomes including modifying the sling material to include, in whole or in part, synthetic, homologous, autologous, or porcine materials; altering the location of the suspension anchor among suprapubic, retropubic, and bone locations; and modifying the surgical position of the sling. It is apparent that a very delicate balance exists between urinary incontinence and retention, regardless of the sling material employed or the location of the sling suspension. Indeed, the primary factor to predict clinical success is related to the sling tension at the midurethra/bladder neck/sphincteric mechanism. If the tension of the pubovaginal sling is too loose, incontinence persists. If the sling is too tight at the bladder neck, urinary retention will develop. Previous attempts to regulate sling tension have not proven successful and the recommendation for sling tension is for surgeons to utilize "clinical judgment". However, once the surgeon sets the tension during surgery, the tension cannot be adjusted after the surgery is completed. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Absorbent core, a process of making the absorbent core and a disposable absorbent article with the absorbent core Inventor(s): Aledo, Eduardo Cezar Andreo; (Sao Jose Do Campos, BR), Macedo Jr, Carlos Da Silva; (Sao Jose Dos Campos, BR), Vitor, Altair De Paula; (Sao Jose Do Campos, BR), Vladivia Hernandez, Francisco J; (Campos, ES) Correspondence: Philip S. Johnson; Johnson & Johnson; One Johnson & Johnson Plaza; New Brunswick; NJ; 08933-7003; US Patent Application Number: 20040073182 Date filed: December 3, 2003 Abstract: The present disclosure relates to an absorbent core and to the process of making the absorbent core. The process involves no loss of material during manufacturing of absorbent core. The absorbent core has an anatomic format enabling a comfortable use with high absorption power, which may be used in various disposable absorbent products for urinary incontinence, disposable diapers or sanitary napkin.

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Excerpt(s): The present invention relates to an absorbent core and to a process of making the absorbent core for use in disposable absorbent products for urinary incontinence, disposable diapers and sanitary napkins. The absorbent core of known disposable absorbent products is usually formed of a cellulose fiber pulp, often comprising superabsorbent polymers capable of forming a gel in contact with liquids as well. Other absorbent cores are also known such as tissue paper, peat moss, artificial fibers and foams and like. Processes for preparing and cutting absorbent cores from a continuous sheet of absorbent material are also known in the art. The cuts are made by knives, ultrasound, laser or water under pressure and the like, in order to obtain absorbent products cut from the continuous sheet of absorbent material either along a longitudinal or transverse direction of the continuous sheet. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Aminoadamantane derivatives as therapeutic agents Inventor(s): Larrick, James W.; (Woodside, CA), Lipton, Stuart A.; (Rancho Santa Fe, CA), Stamler, Jonathan S.; (Chapel Hill, NC), Wang, Yuqiang; (Mountain View, CA), Ye, Wenqing; (Fremont, CA) Correspondence: Mintz, Levin, Cohn, Ferris,; Glovsky And Popeo, P.C.; One Financial Center; Boston; MA; 02111; US Patent Application Number: 20040029929 Date filed: August 4, 2003 Abstract: The present invention provides novel aminoadamantane derivatives, methods of making the derivatives, compositions including the novel aminoadamantane derivatives, and methods for the treatment and prevention of neurological diseases using the derivatives and compositions. There are a variety of neurological disorders that can be treated using the present invention, including, for example, the following: neurological disorders arising from trauma, ischemic or hypoxic conditions that can be treated include stroke, hypoglycemia, cerebral ischemia, cardiac arrest, spinal cord trauma, head trauma, perinatal hypoxia, cardiac arrest and hypoglycemic neuronal damage; neurodegenerative disorders such as epilepsy, Alzheimer's disease, Huntington's disease Parkinsonism, and amyotrophic lateral sclerosis; other diseases or disorders such as convulsion, pain, depression, anxiety, schizophrenia, muscle spasms, migraine headaches, urinary incontinence, nicotine withdrawal, opiate tolerance and withdrawal, emesis, brain edema, tardive dyskinesia, AIDS-induced dementia, ocular damage, retinopathy, cognitive disorders, and neuronal injury associated with HIVinfection such as dysfunction in cognition, movement and sensation. Excerpt(s): Certain adamantane derivatives have been used to treat illnesses. Rimantadine (1-(1-aminoethyl)adamantane) is used for the prophylaxis and treatment of influenza in humans. Amantadine has been used for the treatment of both influenza and Parkinson's disease (Schwab et al., J. Am. Med. Assoc. (1969) 208:1168). Another derivative, memantine, is currently under clinical investigation for the treatment of various neurodegenerative diseases and has been licensed for the treatment of Parkinson's associated spasticity in Germany (Schneider et al., Dtsch. Med. Wschr. (1984) 109:987). Memantine protects cortical and retinal neuron cultures from the toxicity of glutamate, NMDA and the HIV-1 coat protein gp120 (Dreyer et al., Science (1990) 248:364). Recent studies demonstrate that it prevents quinolinic acid-induced hippocampal damage in rats (Kelhoff and Wolf., Eur. J. Pharmacol. (1992) 219:451). Memantine demonstrates antiphypoxic properties in vitro and in vivo. It is thought that

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memantine exerts a neuroprotective effect because it is a micromolar antagonist of the NMDA receptor (Bormann J., Eur. J. Pharmacol. (1989) 166:591). While memantine is being used to treat neurological disorders, the variety and severity of neurological diseases presents a need for other neuroprotective agents. The present invention provides novel compounds, compositions and methods for the treatment of neurological diseases. The present invention also provides methods of making the novel compounds. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Aminoalcohol derivatives Inventor(s): Hattori, Kouji; (Osaka-shi, JP), Imanishi, Masashi; (Osaka-shi, JP), Tomishima, Yasuyo; (Osaka-shi, JP) Correspondence: Oblon, Spivak, Mcclelland, Maier & Neustadt, P.C.; 1940 Duke Street; Alexandria; VA; 22314; US Patent Application Number: 20040006143 Date filed: June 26, 2003 Abstract: The present invention relates to a compound formula [I]: 1wherein 2Y is bond, --O--(CH.sub.2).sub.n-- (in which n is 1, 2, 3 or 4), etc.,Z is cyano, tetrazolyl, etc.,R.sup.1 is hydrogen, lower alkyl, etc.,R.sup.2 is hydrogen or an amino protective group,R.sup.3 is hydrogen or lower alkyl,R.sup.4 is hydrogen or lower alkyl,R.sup.5 and R.sup.8 are each independently hydrogen, halogen, hydroxy, lower alkyl, etc.,R.sup.6 is hydrogen, lower alkyl, etc.,R.sup.9 is hydrogen or lower alkyl, andi is 1 or 2,or a salt thereof. The compound [I] of the present invention and pharmaceutically acceptable salts thereof are useful for the prophylactic and/or the therapeutic treatment of pollakiurea or urinary incontinence. Excerpt(s): This invention relates to new aminoalcohol derivatives and salts thereof which are beta-3 (.beta.sub.3) adrenergic receptor agonists and useful as a medicament. International Publications No. WO 90/06299, published Jun. 14, 1990, describes derivatives of phenylethanolamines as having an effect on the metabolism, preferably reduction of the blood sugar level and body fat, and International Publication No. WO 02/32897, published Apr. 25, 2002, describes derivatives of alpha-aryl ethanolamines useful as.beta.sub.3 adrenergic receptor agonists. This invention relates to new aminoalcohol derivatives which are.beta.sub.3 adrenergic receptor agonists and salts thereof. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

•

Apparatus and method for inserting an adjustable implantable genitourinary device Inventor(s): Burton, John H.; (Minnetonka, MN), Cook, Timothy C.; (Wayzata, MN) Correspondence: Schwegman, Lundberg, Woessner & Kluth, P.A.; P.O. Box 2938; Minneapolis; MN; 55402; US Patent Application Number: 20040015045 Date filed: May 5, 2003 Abstract: An implantable medical device and method for adjustably restricting a selected body lumen such as a urethra or ureter of a patient to treat urinary incontinence or ureteral reflux. The device includes an adjustable element and a tubular

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elongate body, where the adjustable element includes a chamber and the tubular elongate body includes at least a first interior passageway which extends longitudinally in the tubular elongate body from a first opening at the proximal end to a second opening in fluid communication with the chamber. Fluid volume passed through the first passageway is used for adjustably expanding or contracting the adjustable element. The implantable medical device further includes a sheath, where the sheath includes a wall having an inner surface which defines a channel through which at least a portion of the implantable device can pass. Alternatively, the implantable medical device includes a tip suitable to penetrate tissue so that the implantable medical device can be implanted within the tissue of a patient. Excerpt(s): The invention relates generally to implantable medical devices and in particular to implantable medical devices for coaptation of a body lumen. Various implantable devices, such as inflatable/distensible medical devices, are known in which the distensible medical devices are implanted into the tissue of a human to treat urinary incontinence. These devices have typically relied upon restricting or constricting the urethra of the patient to maintain continence. U.S. Pat. No. 4,733,393 to Haber et al. is an attempt at such a proposed device. U.S. Pat. No. 4,733,393 relates to a hypodermically implantable genitourinary prosthesis which provides an extensible, inflatable tissue expanding membrane to be located in proximal urethral tissue to add bulk to these tissues for overcoming urinary incontinence by localized increase in tissue volume. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Carbamates derivatived from arylakylamines Inventor(s): Balsa Lopez, Dolors; (Badalona, ES), Bonilla Navarro, Jose Ignacio; (Daganzo de Arriba, ES), Catena Ruiz, Juan Lorenzo; (L'Hospitalet de Llobregat, ES), Farrerons Gallemi, Carles; (Mataro, ES), Fernandez Garcia, Andres; (Barcelona, ES), Fernandez Serrat, Anna; (Sant Cugat del Valles, ES), Lagunas Arnal, Carmen; (L'Hospitalet de Llobregat, ES), Miquel Bono, Ignacio Jose; (L'Hospitalet de Llobregat, ES), Salcedo Roca, Carolina; (Corbera, ES) Correspondence: Merchant & Gould PC; P.O. Box 2903; Minneapolis; MN; 55402-0903; US Patent Application Number: 20040063950 Date filed: July 28, 2003 Abstract: The invention relates to carbamates having general structure (I), wherein: R1, R2 and R3 are H, OH, SH, CN, F, Cl, Br, I, (C.sub.1-C.sub.4)-alkylthi- o, (C.sub.1C.sub.4)-alkoxyl, (C.sub.1-C.sub.4)-alkoxyl substituted by one or several F radicals, carbamoylamine, (C.sub.1-C.sub.4)-alkyl and (C.sub.1-C.sub.4)-alkyl substituted by one or several F or OH radicals; R4 represents a substituted or non-substituted cycloalkyl or cycloaryl radical (a heteroalkyl radical or not). The amine of the quinuclidine ring can also be forming quatemary ammonium salts or in an oxidized state (N-oxide). Carbamates (I) are antagonists of the M.sub.3 muscarinic receptor, and selectively, the M.sub.2 receptor. Hence, they can be used in the treatment of urinary incontinence (particularly due to bladder instability), irritable bowel syndrome, diseases of the respiratory tract (particularly chronic obstructive pulmonary disease, chronic bronchitis, asthma, emphysema and rhinitis) and in ophthalmologic operations. Excerpt(s): The present invention relates to new compounds of type quinuclidyl Nphenyl-N-alkyl carbamate acting as muscarinic receptor antagonists, to the preparation

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of such compounds, and to the use of the same in the prevention and treatment of diseases related with respiratory tract, digestive tract, and urinary system. It is known that compounds having a muscarinic receptor antagonizing effect induce bronchodilation, gastrointestinal motility inhibition, gastric acid secretion reduction, dry mouth, mydriasis, tachycardita, as well as urinary bladder contraction inhibition. Between 1983 and 1993, continuous advances were produced in the knowledge of muscarinic receptor pharmacology. During this period, a total of five human genes codifying muscarinic-receptor subtypes (m1, m2, m3, m4 and m5) were cloned and expressed, which encoded five functional receptors (M.sub.1, M.sub.2, M.sub.3, M.sub.4 and M.sub.5). Although M.sub.5 is not completely characterized, it is already considered a functional receptor according to NC-IUPHAR Guidelines (M. P. Caulfield et al.; Pharmacol. Rev. 1998, 50, 279-290). Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Carbocyclic and heterocyclic substituted semicarbazones and thiosemicarbazones and the use thereof Inventor(s): Cai, Sui Xiong; (San Diego, CA), Ilyin, Victor I; (Irvine, CA), Keana, John FW; (Eugene, OR), Lan, Nancy C.; (Altadena, CA), Wang, Yan; (San Diego, CA), Weber, Eckard; (San Diego, CA) Correspondence: Sterne, Kessler, Goldstein & Fox Pllc; 1100 New York Avenue, N.W.; Washington; DC; 20005; US Patent Application Number: 20030225080 Date filed: June 18, 2003 Abstract: This invention is related to carbocyclic and heterocyclic substituted semicarbazones and thiosemicarbazones represented by Formula I: 1or a pharmaceutically acceptable salt or prodrug thereof, wherein: Y is oxygen or sulfur; R.sub.1, R.sub.21, R.sub.22 and R.sub.23 are independently hydrogen, alkyl, cycloalkyl, alkenyl, alkynyl, haloalkyl, aryl, aminoalkyl, hydroxyalkyl, alkoxyalkyl or carboxyalkyl; or R.sub.22 and R.sub.23, together with the N, form a heterocycle; A.sub.1 and A.sub.2 are independently aryl, heteroaryl, saturated or partially unsaturated carbocycle or saturated or partially unsaturated heterocycle, any of which is optionally substituted; X is one or O, S, NR.sub.24, CR.sub.25R.sub.26, C(O), NR.sub.24C(O), C(O)NR.sub.24, SO, SO.sub.2 or a covalent bond; where R.sub.24, R.sub.25 and R.sub.26 are independently hydrogen, alkyl, cycloalkyl, alkenyl, alkynyl, haloalkyl, aryl, aminoalkyl, hydroxyalkyl, alkoxyalkyl or carboxyalkyl. The invention also is directed to the use of carbocycle and heterocycle substituted semicarbazones and thiosemicarbazones for the treatment of neuronal damage following global and focal ischemia, for the treatment or prevention of neurodegenerative conditions such as amyotrophic lateral sclerosis (ALS), for the treatment and prevention of otoneurotoxicity and eye diseases involving glutamate toxicity and for the treatment, prevention or amelioration of pain, as anticonvulsants, and as antimanic depressants, as local anesthetics, as antiarrhythmics and for the treatment or prevention of diabetic neuropathy and urinary incontinence. Excerpt(s): This invention is in the field of medicinal chemistry. In particular, the invention relates to carbocyclic and heterocyclic substituted semicarbazones and thiosemicarbazones, and the discovery that these compounds act as blockers of sodium (Na.sup.+) channels. Several classes of therapeutically useful drugs, including local anesthetics such as lidocaine and bupivacaine, antiarrhythmics such as propafenone and amioclarone, and anticonvulsants such as lamotrigine, phenytoin and carbamazepine,

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have been shown to share a common mechanism of action by blocking or modulating Na.sup.+ channel activity (Catterall, W. A., Trends Pharmacol. Sci. 8:57-65 (1987)). Each of these agents is believed to act by interfering with the rapid influx of Na.sup.+ ions. Recently, other Na.sup.+ channel blockers such as BW619C89 and lifarizine have been shown to be neuroprotective in animal models of global and focal isehemia and are presently in clinical trials (Graham et al., J. Pharmacol. Exp. Ther. 269:854-859 (1994); Brown et al., British J. Pharmacol. 115:1425-1432 (1995); SCRIP 1870:8 (1993); SCRIP 1773:14 (1992)). Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Combination drugs Inventor(s): Doi, Takayuki; (Osaka-shi, JP), Hashimoto, Tadatoshi; (Ibaraki-shi, JP), Kamo, Izumi; (Amagasaki-shi, JP) Correspondence: Foley And Lardner; Suite 500; 3000 K Street NW; Washington; DC; 20007; US Patent Application Number: 20040058914 Date filed: June 23, 2003 Abstract: A pharmaceutical agent containing an NK-1 receptor antagonist, an NK-2 receptor antagonist and/or an anti-cholinergic drug in combination is provided, which is useful as a prophylactic or therapeutic agent of urinary frequency, urinary incontinence, asthma, chronic obstructive pulmonary disease, rheumatoid arthritis, osteoarthritis, pain, cough, irritable bowel syndrome, emesis, depression, anxiety, manic depressive psychosis or schizophrenia. More particularly, a pharmaceutical agent is provided, which contains a compound represented by the formula (I), wherein M ring is a heterocyclic ring having --N.dbd.C<, --CO--N< or --CS--N< as a partial structure -XY<; R.sup.a and R.sup.b are bonded to each other to form ring A, or the same or different and each is a hydrogen atom or a substituent for ring M; ring A and ring B are each a homocyclic or heterocyclic ring optionally having substituents and at least one of them is a heterocyclic ring optionally having substituents; ring C is a homocyclic or heterocyclic ring optionally having substituents; ring Z is an optionally substituted heterocyclic ring containing nitrogen; and n is an integer of 1 to 6, or a salt thereof or a prodrug thereof, and an NK-2 receptor antagonist and/or an anti-cholinergic drug in combination. 1 Excerpt(s): The present invention relates to a pharmaceutical agent comprising an NK-1 receptor antagonist, an NK-2 receptor antagonist and/or an anti-cholinergic drug in combination. n is an integer of 1 to 6, or a salt thereof has a tachykinin receptor antagonistic action, a substance P receptor antagonistic action, and a neurokinin A receptor antagonistic action. The present invention aims at providing a pharmaceutical agent that can be widely applied to the diseases such as urinary frequency, urinary incontinence, asthma, chronic obstructive pulmonary disease, rheumatoid arthritis, osteoarthritis, pain, cough, irritable bowel syndrome, emesis, depression, anxiety, manic depressive psychosis, schizophrenia and the like. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Detection of implanted wireless energy receiving device Inventor(s): Forsell, Peter; (Zug, CH) Correspondence: Nixon & Vanderhye P.C.; 8th Floor; 1100 North Glebe Road; Arlington; VA; 22201; US Patent Application Number: 20040055610 Date filed: September 25, 2002 Abstract: An apparatus is disclosed for detecting a wireless energy receiving device subcutaneously implanted in a patient's body to enable accurate positioning of a wireless energy transmission device outside the patient's body relative to the energy receiving device. Also disclosed is a method for detecting the wireless energy receiving device whereby an energy transmission device can be positioned to efficiently transmit wireless energy to the implanted energy receiving device. The apparatus includes a magnetic device that is subcutaneously implanted in the patient adjacent to the energy receiving device to emit a local magnetic field through the patient's skin adjacent to the energy receiving device. A magnetic detector movable externally along the patient's body is capable of detecting the local magnetic field emitted by the magnetic device. This allows the energy transmission device to be located for the efficient transmission of wireless energy to the implanted energy receiving device. Alternatively, the apparatus can include a magnetic detector subcutaneously implanted in the patient at the energy receiving device and an exterior magnetic device movable along the patient's skin to emit a magnetic field that is detected by the implanted magnetic detector. Preferably, the magnetic detector includes a semiconductor circuit that is comprised of at least one Hall element. The magnetic device may be a solenoid or a permanent magnet. The energy receiving device can be used to control a restriction device implant designed for treating reflux disease, urinary incontinence, impotence, anal incontinence or obesity. Excerpt(s): The present invention relates to apparatuses and methods for detecting a wireless energy receiving device subcutaneously implanted in a patient to enable accurate positioning of an exterior wireless energy transmission device. The present invention also relates to surgical methods for providing a patient with such an apparatus. In new generations of implants wireless energy transmission is used for supply of energy in connection with implants. To optimise the transfer efficiency of the wireless energy it is important to locate the patient's wireless energy receiver, typically subcutaneously implanted, in order to be able to put an exterior energy transmission device close to the implanted energy receiving device. The object of the present invention is to provide an inexpensive apparatus for accurate detection of a wireless energy receiving device subcutaneously implanted in a patient, and further to provide an apparatus with parts to be implanted that are relatively small. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Device for the treatment of urinary incontinence Inventor(s): Grise, Philippe; (Bihorel, FR) Correspondence: Young & Thompson; 745 South 23rd Street 2nd Floor; Arlington; VA; 22202 Patent Application Number: 20030199729 Date filed: April 15, 2003

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Abstract: Constitution of a suburethral sling connected to two balloons located on each side of the urethra.The device preferably consists of two subassemblies (12a and 12b) each comprising an inflatable balloon (13) and a strip (16) one end of which is attached to the surface of the balloon. The two strips (16) are connected together to form a suburethral sling. Excerpt(s): The invention concerns a device for the treatment of urinary incontinence, in particular stress incontinence (due to coughing, walking, etc.) in women. The device according to the invention can be implanted by means of a new non-traumatic surgical procedure. Urinary incontinence in women can result from a lack of support in the cervico-urethral area, sometimes associated with an insufficiency of the urethral sphincter. Several surgical procedures have been proposed to prevent such incontinence. Among the most efficacious of these known methods is a suburethral support in the form of a band designed to lift the urethra, which is implanted via a small vaginal incision. This tape, or sling, is attached to a needle that the surgeon engages in the pelvic aponeurosis. The sling is then tunneled from one side of the urethra to the other, under the bladder, and the surgeon brings out the needle through the lower part of the anterior abdominal wall. This method has two drawbacks, however. The first is a risk of perforation of the bladder during the operation. The second, post-operatively, is the risk of excessive tension of the sling, hindering urination. The tension is difficult to set during the operation, and cannot be adjusted afterwards. In some cases a second operation is necessary to release the tension of the sling. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Devices, methods, and systems for shrinking tissues Inventor(s): Carter, Garry; (Pleasanton, CA), Ingle, Frank; (Palo Alto, CA), Laufer, Michael D.; (Menlo Park, CA) Correspondence: Townsend And Townsend And Crew, Llp; Two Embarcadero Center; Eighth Floor; San Francisco; CA; 94111-3834; US Patent Application Number: 20030195593 Date filed: April 30, 2003 Abstract: Devices, systems, and method for treating urinary incontinence generally rely on energy delivered to a patient's own pelvic support tissue to selectively contract or shrink at least a portion of that pelvic support tissue so as to reposition the bladder. The energy will preferably be applied to the endopelvic fascia and/or an arcus tendineus fascia pelvis. The invention provides a variety of devices and methods for applying gentle resistive heating of these and other tissues to cause them to contract without imposing significant injury on the surrounding tissue structures. Alternatively, heatapplying probes are configured to heat tissue structures which comprise or support a patient's urethra. By applying sufficient energy over a predetermined time, the tissue can be raised to a temperature which results in contraction without significant necrosis or other tissue damage. By selectively contracting the support tissues, the bladder neck, sphincter, and other components of the urinary tract responsible for the control of urinary flow can be reconfigured or supported in a manner which reduces urinary leakage. Excerpt(s): This application is a continuation of and claims the benefit of priority from U.S. patent application Ser. No. 09/598,076, filed Jun. 20, 2000, which is a divisional of U.S. patent application Ser. No. 08/910,370, filed Aug. 13, 1997 and now U.S. Pat. No.

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6,091,995, which is a continuation-in-part of U.S. patent application Ser. No. 08/748,527, filed Nov. 8, 1996 and now abandoned, and U.S. patent application Ser. No. 08/862,875, filed May 23, 1997 and now abandoned, the full disclosures of which are incorporated herein by reference. This application is related to U.S. patent applications Ser. No. 08/910,775, now U.S. Pat. No. 6,480,746, Ser. No. 08/910,369, now U.S. Pat. No. 6,035,238, and Ser. No. 08/910,371, now U.S. Pat. No. 6,081,749, all filed Aug. 13, 1997, the full disclosures of which are also incorporated herein by reference. The present invention generally relates to medical devices, methods, and systems. In a particular aspect, the present invention provides devices, methods, and systems for shrinking tissues, and which are particularly useful for treatment of urinary incontinence in a laparoscopic or minimally invasive manner. Urinary incontinence arises in both women and men with varying degrees of severity, and from different causes. In men, the condition occurs almost exclusively as a result of prostatectomies which result in mechanical damage to the sphincter. In women, the condition typically arises after pregnancy where musculoskeletal damage has occurred as a result of inelastic stretching of the structures which support the genitourinary tract. Specifically, pregnancy can result in inelastic stretching of the pelvic floor, the external vaginal sphincter, and most often, the tissue structures which support the bladder and bladder neck region. In each of these cases, urinary leakage typically occurs when a patient's intra-abdominal pressure increases as a result of stress, e.g. coughing, sneezing, laughing, exercise, or the like. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

DNA encoding a human melanin concentrating hormone receptor (MCH1) and uses thereof Inventor(s): Craig, Douglas A.; (Emerson, NJ), Laz, Thomas M.; (Kennilworth, NJ), Nagorny, Raisa; (Fair Lawn, NJ), Salon, John A.; (Santa Paula, CA), Wilson, Amy E.; (New York, NY) Correspondence: John P. White; Cooper & Dunham Llp; 1185 Avenue OF The Americas; New York; NY; 10036; US Patent Application Number: 20040038855 Date filed: January 14, 2003 Abstract: This invention provides an isolated nucleic acid encoding a human MCH1 receptor, a purified human MCH1 receptor, vectors comprising isolated nucleic acid encoding a human MCH1 receptor, cells comprising such vectors, antibodies directed to a human MCH1 receptor, nucleic acid probes useful for detecting nucleic acid encoding human MCH1 receptors, antisense oligonucleotides complementary to unique sequences of nucleic acid encoding human MCH1 receptors, transgenic, nonhuman animals which express DNA encoding a normal or mutant human MCH1 receptor, methods of isolating a human MCH1 receptor, methods of treating an abnormality that is linked to the activity of a human MCH1 receptor, as well as methods of determining binding of compounds to mammalian MCH1 receptors. This invention further provides a method of treating a subject suffering from urinary incontinence which comprises administering to the subject an amount of an MCH1 antagonist effective to treat the subject's urinary incontinence. Excerpt(s): This application (1) is a continuation-in-part of U.S. Ser. No. 09/899,732, filed Jul. 5, 2001, which is a continuation-in-part of U.S. Ser. No. 09/610,635, filed Jul. 5, 2000, which is a continuation-in-part of PCT International Application No. PCT/US99/31169,

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filed Dec. 30, 1999; (2) is a continuation-in-part of U.S. Ser. No. 10/188,434, filed Jul. 3, 2002; and (3) is a continuation-in-part of U.S. Ser. No. 10/189,168, filed Jul. 3, 2002, the contents of all of which are hereby incorporated by reference into the subject application. Throughout this application, various publications are referenced in parentheses by author and year. Full citations for these references may be found at the end of the specification immediately preceding the sequence listings and the claims. The disclosure of these publications in their entireties are hereby incorporated by reference into this application to describe more fully the state of the art to which this invention pertains. Neuroregulators comprise a diverse group of natural products that subserve or modulate communication in the nervous system. They include, but are not limited to, neuropeptides, amino acids, biogenic amines, lipids and lipid metabolites, and other metabolic byproducts. Many of these neuroregulator substances interact with specific cell surface receptors which transduce signals from the outside to the inside of the cell. G-protein coupled receptors (GPCRs) represent a major class of cell surface receptors with which many neurotransmitters interact to mediate their effects. GPCRs are predicted to have seven membrane-spanning domains and are coupled to their effectors via G-proteins linking receptor activation with intracellular biochemical sequelae such as stimulation of adenylyl cyclase. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Fem Inventor(s): Nelson, Georgina Victoria; (Penticton, CA) Correspondence: Georgina Victoria Nelson; # 17 - 150 Van Horne Street; Penticton; BC; V2a 4k2; CA Patent Application Number: 20030229933 Date filed: June 13, 2002 Abstract: Currently, the undergarments used for urinary incontinence are belted and/or bulky and require constant changes. Fem is an undergarment that is form fitted, prevents leakage and require none other that usual daily changes.This new concept is an invention designed to prevent leakage unlike today's garments, which are designed as receptacles. The way this unit works is that the thong section of the garment puts pressure on the urethra and arrests any leakage. The garment is designed to be light, comfortable, and efficient. Because of its stretch composition, it will conform readily to bodily movements creating an exciting sense of confidence and freedom.It must be stressed that this garment does not obstruct, impede, nor impair the calls or demands of Mother Nature.For those who require this item, this garment will certainly change their lives. Excerpt(s): The invention is a garment designed for women who suffer from urinary incontinence. Unlike anything on the market, this garment, rather than act as a receptacle, prevents leakage of urine. The stretch garment is comprised of two [triangles] with a thong extension. The thong here is an elongated strip of fabric situated at the crotch and is an extension of each triangle. When these two pieces are sewn together and a waistband attached, the garment resembles a diminished bikini. When worn, the combination of the triangles, lycra and the thong creates pressure on the urethra and subsequently prohibits the leakage of urine. To create this garment, prepare a pattern using the dimensions given in the drawing. Place the pattern on the appropriate stretch fabric and cut out one back and one front. With wrong sides together sew the thong first (D). This seam will be on the outside. The other two will be on the

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inside. A zigzag stitch or small serge works perfect for these applications. Sew the side seams next. Then using a zigzag stitch, attach the leg banding, without stretching either the garment or the banding. Finally, attach the non-roll elastic waistband which will have to be stretched a little to compensate for the difference in length. Primarily, fem is designed for the active woman I today's society. Use of fem is unlimited. Perfect for walking, jogging, running, or doing a thousand things that must be done in a day. Lightweight, travels easy, it can be worn for hours, anywhere, anytime, with complete and total confidence. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

FLUORENES AND ANTHRACENES CONTAINING RECEPTORS

THAT

INHIBIT

P2X3

AND

P2X2/3

Inventor(s): Bayburt, Erol; (Gurnee, IL), Gomtsyan, Arthur; (Vernon Hills, IL), Jiang, Meiqun; (Gurnee, IL), Lee, Chih-Hung; (Vernon Hills, IL), Perner, Richard; (Gurnee, IL), Zheng, Guo Zhu; (Lake Bluff, IL) Correspondence: Steven F. Weinstock; Abbott Laboratories; 100 Abbott Park Road; DEPT. 377/ap6a; Abbott Park; IL; 60064-6008; US Patent Application Number: 20040019042 Date filed: July 26, 2002 Abstract: Compounds of formula (I) 1are novel P2X.sub.3 and P2X.sub.2/P2X.sub.3 containing receptor antagonists and are useful in treating pain, urinary incontinence, and bladder overactivity. Excerpt(s): The present invention relates to compounds of formula (I), which are useful for treating diseases or conditions caused by or exacerbated by P2X receptor activity, pharmaceutical compositions containing compounds of formula (I) and methods of treatment using compounds of formula (I). P2X receptors function as homomultimeric cation-permeable ion channels and, in some cases, as heteromeric channels consisting of two different P2X receptor subtypes. At least one pair of P2X receptor subtypes, P2X.sub.2 and P2X.sub.3, functions as a heteromeric channel in rat nodose ganglion neurons where it exhibits distinct pharmacological and electrophysiological properties. With respect to individual receptors, the rat P2X.sub.2 containing receptor is expressed in the spinal cord, and in the nodose and dorsal root ganglia, while rat P2X.sub.3 containing receptor expression is found primarily in a subset of neurons of the sensory ganglia. The distribution of both receptors is consistent with a role in pain transmission. The P2X.sub.2 and P2X.sub.3 subunits form functional channels when expressed alone, and can also form a functional heteromultimeric channel that has properties similar to currents seen in native sensory channels when co-expressed. Evidence from studies in rat nodose ganglia indicate that both P2X.sub.2/P2X.sub.3 heteromeric channels and P2X.sub.2 homomeric channels contribute to adenosine triphosphate-induced currents. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Gnrh analogues for treatment of urinary incontinence Inventor(s): Arnold, Susi; (US), Hubler, Madeleine; (Wernetshausen, CH), Reichler, Iris; (Z?uuml;rich, CH) Correspondence: Rothwell, Figg, Ernst & Manbeck, P.C.; 1425 K Street, N.W.; Suite 800; Washington; DC; 20005; US Patent Application Number: 20040023878 Date filed: April 30, 2003 Abstract: The use of at least one GnRH analogue for the preparation of a medicament for the prevention and/or treatment of side effects of ovarectomy or symptoms associated with reproductive senescence in female mammals, in particular urinary incontinence, hot flushes, and skin/hair changes are disclosed. Excerpt(s): The present invention provides pharmaceutical compositions for the prevention and treatment of side effects of ovarectomy or symptoms associated with reproductive senescence, especially urinary incontinence, as well as mood changes, skin changes, hair changes, vasomotor symptoms, especially hot flushes, in mammalian females, particularly in post menopausal women and in spayed bitches. Connected with such treatments is the prevention of urinary tract infections. If the endocrine activity of the gonads decreases or if the gonads are removed, women and dogs show similar changes. With the reproductive senescence in women, as well as after ovarectomy in the bitch, symptoms such as urinary incontinence, vasomotor symptoms, in particular hot flushes, changes of the mood, skin and hair increasingly occur. After ovarectomy, as well as at the beginning of the reproductive senescence, corresponding hormonal changes occur with a great increase in serum concentrations of FSH (Follicle stimulating hormone) and LH (Luteinising hormone). Urinary incontinence is defined by the International Continence Society [1] as the objective demonstration of involuntary loss of urine consequent to bladder and/or urethral sphincter dysfunction. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Injection port Inventor(s): Forsell, Peter; (Zug, CH) Correspondence: Nixon & Vanderhye P.C.; 8th Floor; 1100 North Glebe Road; Arlington; VA; 22201-4714; US Patent Application Number: 20040064110 Date filed: October 1, 2002 Abstract: An injection port and implantable pump for adding fluid to, or withdrawing fluid from, a surgical implant inside a patient's body is disclosed. Also disclosed is a surgical method for treating diseases using the injection port and pump. The injection port and implantable pump includes a rigid base member and an injection membrane penetrable by an injection needle and attached to the base member. The membrane and base member define a chamber for holding fluid. The membrane is displaceable relative to the base member between a first position in which the volume of the fluid chamber is maximal and a second position, in which the volume of the chamber is minimal. According to the method, the membrane is manually displaced from time to time to distribute fluid between the fluid chamber of the injection port and the implant to operate the implant, which is typically a hydraulic restriction device. The implant can be

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designed for treating reflux disease, urinary incontinence, impotence, anal incontinence or obesity. Excerpt(s): The present invention relates to an injection port and an implantable pump for adding fluid to, or withdrawing fluid from, a surgical implant inside a human body. The present invention also relates to surgical methods for treating diseases using the injection port and pump. Traditional so called injection ports are used for post-operation adjustments of hydraulic implants. The injection port comprises a thick wall member of silicone mounted under tension to create a membrane through which it is possible to inject a specific type of needle for injecting hydraulic fluid into the interior of the port, without afterwards creating leakage through the membrane. The needle has a lateral opening and does not cut out any remaining hole in the silicone membrane. It just moves the silicone aside. The silicone membrane of traditional injection ports comprises a relatively hard (typically a hardness of about 60 Shore) and thick solid silicone. Since the thickness of the membrane normally is about 6 mm for a normal-sized injection port, it is difficult to find a proper location in the patient for subcutaneous implantation of the injection port. Besides, traditional injection ports are not suited for hydraulically adjustable implants that need to be adjusted frequently, i.e., several times a day. An object of the present invention is to provide an injection port and an implantable pump, which are thinner and smaller than those of the prior art, and, therefore, more easily implanted subcutaneously. Another object of the present invention is to provide an injection port and an implantable pump, which are more versatile than those of the prior art. A further object of the present invention is to provide an injection port and an implantable pump that are easy and cheap to manufacture. Yet another object of the present invention is to provide surgical methods by using an injection port. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Medicine comprising dicyanopyridine derivative Inventor(s): Harada, Hironori; (Ibaraki, JP), Hirano, Yuusuke; (Ibaraki, JP), Kawaguchi, Kenichi; (Ibaraki, JP), Okazaki, Toshio; (Ibaraki, JP), Saitoh, Chikasi; (Ibaraki, JP), Takuwa, Tomofumi; (Ibaraki, JP), Watanuki, Susumu; (Ibaraki, JP) Correspondence: Finnegan, Henderson, Farabow, Garrett & Dunner; Llp; 1300 I Street, NW; Washington; DC; 20005; US Patent Application Number: 20030232860 Date filed: January 17, 2003 Abstract: Compounds having a high conductance-type of calcium-activated K channel opening effect and a smooth muscle relaxant effect for bladder based on the K-channel opening effect, which can be used in treating pollakiuria and urinary incontinence, are provided. 3,5-Dicyanopyridine derivatives or their salts. Excerpt(s): The present invention relates to pharmaceutical compositions comprising 3,5-dicyanopyridine derivatives or their pharmaceutically acceptable salts as effective components, a high conductance-type of calcium-activated K channel opening agents, smooth muscle relaxants for bladder and agents for treating pollakiuria and urinary incontinence, as well as novel 3,5-dicyanopyridine derivatives or their pharmaceutically acceptable salts. It is known that the K channel plays an important role in generation of resting membrane potential or action potential in cells and the opening of the K channel induces hyperpolarizaiton of the cell membrane to suppress excitability of the cells and exhibit the effect of smooth muscle relaxation (J. Urol., 154, 1914-20, 1995). The high

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conductance-type of calcium-activated K channel (also referred to as maxi-K channel or BK channel) is one of calcium-activated K channels that open when an increase in Ca level in the cells and depolarization of membrane is detected, and which are widely distributed in the living body to have an important function as an excitable negative feedback system (Am. J. Physiol., 291, C.sub.9-C.sub.34, 1996). Thus, the drugs of opening the maxi-K channel are expected to have the effects for protecting or improving the function of a variety of organs by exhibiting relaxation in the smooth muscle or suppression of the hyper excitation in the neurocytes. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Method for inducing production of fibrous organic tissue Inventor(s): Diaz, Roberto Obando; (Bogota, CO), Madris, Leandra G.; (New York, NY) Correspondence: Henry D. Coleman; 714 Colorado Avenue; Bridgeport; CT; 06605; US Patent Application Number: 20040076653 Date filed: August 8, 2003 Abstract: A method and composition for inducing the production of fibrous tissue can be used to treat urinary incontinence or in the creation of cosmetic enhancements such as wrinkle reduction or removal or to treat burn victims by facilitating tissue growth in conjunction with skin grafting. The method includes injecting an effective amount of a pure hydrocarbon petroleum jelly composition into a predetermined location in a mammalian subject. Excerpt(s): This application claims the benefit of priority of provisional application No. 60/403,117, filed Aug. 13, 2002. This invention relates to a method for inducing the generation of fibrous tissue in organic tissues of an individual. The method is useful in the treatment of certain medical conditions, as well as in cosmetic applications. This invention also relates to the use of a harmless compound which induces the production of fibrous tissue in the user's/patient's organic tissues. The product is useful to treat a number of human and animal conditions as well as for cosmetic applications. It is estimated that 5 percent of the adult population of the world suffers from urinary incontinence. Persons of any age or sex can suffer from urinary incontinence, but the disease tends mainly to affect women. It is estimated that 15 to 20 percent of elderly persons (60 years and over) are incontinent. This is not to suggest that incontinence is a naturally occurring symptom of the aging process. Presently less than half of those suffering from basic urinary incontinence seek medical care. This may be due to the social stigma attached. Given population trends this will become an ever-growing problem needing our attention. The percentage of people with urinary incontinence varies from one country to another. In developing countries, the incidence of urinary incontinence is greater than in other countries. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Method for the treatment of urinary incontinence Inventor(s): Caruso, Frank S.; (Colts Neck, NJ) Correspondence: Peter G. Dilworth, ESQ.; Dilworth & Barrese, Llp; 333 Earle Ovington BLVD.; Uniondale; NY; 11553; US Patent Application Number: 20030199484 Date filed: March 21, 2003 Abstract: Urinary incontinence is alleviated in a mammal by administering to the mammal a urinary incontinence alleviating amount of dextromethorphan, dextrorphan, their mixtures and/or pharmaceutically acceptable salts, alone or in combination with a pharmacologically active agent such as an anticholinergic, sympathomimetic, tricyclic antidepressant, antispasmodic, direct-acting smooth muscle relaxant, estrogen, compound having estrogen-like activity, or any combination of the foregoing. Excerpt(s): The present invention relates to a method for treating urinary incontinence. Urinary incontinence is a fairly common medical problem in which urine is involuntarily lost. Urinary incontinence may be transient or persistent. Common causes of transient urinary incontinence include infection, atrophic urethritis, administration of diuretics and delirium. Persistent urinary incontinence is classified into four types: (1) stress incontinence which involves involuntary loss of urine during coughing, sneezing, laughing, or other physical activity; (2) urge incontinence which involves involuntary loss of urine associated with an abrupt or strong desire to void; (3) overflow incontinence which involves involuntary loss of urine associated with over-distension of the bladder; and (4) mixed incontinence which involves a combination of at least two of the above types. Persistent urinary incontinence can result from spastic or hyperactive bladder smooth muscle such as detrusor originating incontinence. In certain instances such incontinence is caused by loss of control resulting from spinal injury, parkinsonism, multiple sclerosis or recurrent bladder infection to name a few. Treatment of incontinence may involve surgery or administration of any of various pharmacological agents, e.g., a anticholinergic such as oxybutynin, atropine, propantheline, terodiline, dicyclomine and others, a sympathomimetic such as ephedrine, pseudoephedrine, phenylpropanolamine and others, a tricyclic antidepressant such as amitriptyline, imipramine, doxepin and others, an estrogen or a direct acting antispasmodic such as flavoxate. In addition to treating incontinence, such pharmacological agents may cause other powerful physiologic responses such as excitability (sympathomimetics), and dry mouth, drowsiness, dizziness or hallucinations (anticholinergics or tricyclic antidepressants). Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Method for treating urinary incontinence in women and implantable device intended to correct urinary incontinence Inventor(s): Delorme, Emmanuel; (Chalon Sur Saone, FR), Suslian, Patrice; (Gordes, FR) Correspondence: Fish & Richardson P.C.; 3300 Dain Rauscher Plaza; 60 South Sixth Street; Minneapolis; MN; 55402; US Patent Application Number: 20030199732 Date filed: June 4, 2003

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Abstract: The invention relates to a method and device for treating urinary incontinence in women. Excerpt(s): The invention relates to a method for treating urinary incontinence in women. It also relates to an implantable device intended to correct urinary incontinence in women. The said device is more particularly suited to the treatment of stress urinary incontinence. Various types of device have been proposed for treating phenomena of urinary incontinence in women. Thus, for example, document U.S. Pat. No. 5,899,909 describes a tape of constant width, made of a material of the meshed or knitted polypropylene type ensuring fibroblast colonization and thus anchorage into the tissues along its entire length. Once an incision has been made in the wall of the vagina this tape is positioned under the urethra, the tape being led upwards on each side of the bladder to be anchored into the abdominal wall. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Molar shaped vaginal incontinence insert Inventor(s): Zunker, MaryAnn; (Oshkosh, WI) Correspondence: G. Peter Nichols; Brinks Hofer Gilson & Lione; P.O. Box 10395; Chicago; IL; 60610; US Patent Application Number: 20040054252 Date filed: September 18, 2002 Abstract: A molar shaped urinary incontinence device is disclosed. The device is a flexible molar shaped insert having a cross-sectional area at the top that is larger than the cross-sectional area of the bottom. The top respectively contacts at least two opposed vaginal walls. A channel may be provided to connect an aperture on the top surface and an aperture on the bottom surface to allow normal discharge of secretions. A removal member may be provided on the device such that when the removal member is pulled in a direction away from the device, the top collapses upon itself. Excerpt(s): The present invention relates to a urinary incontinence device and a method of using the same. More specifically, this invention relates to a molar-shaped device for alleviating female urinary incontinence, particularly during episodes of increased intraabdominal pressure. The primary etiological factor producing genuine stress urinary incontinence is the incomplete transmission of abdominal pressure to the proximal urethra due to displacement from its intra-abdominal position. Some women, especially women who have given birth to one or more children, and older women, can experience incidences of involuntary urine loss due to stress urinary incontinence or combined stress and urge incontinence. A sneeze or cough increases the intra-abdominal pressure which in turn increases the pressure on a person's bladder causing the involuntary release of urine. The frequency and severity of such urine loss can increase as the muscles and tissues near the urethro-vaginal myofascial area grow weaker. It has also been recognized that the urinary sphincter muscle, which is located at the upper end of the urethra, adjacent to the bladder, works well at sealing off the passing of urine from the bladder to the urethra when it has a round or circular cross-sectional configuration. Support of the proximal urethra elevates it above the pelvic floor and subjects it to increases in intra-abdominal pressure, thus allowing compression and maintenance of continence. When this passageway becomes distorted into a cross-sectional configuration having more of an elliptical or oval appearance, however, the sphincter muscle can not close properly. Therefore, the tendency for involuntary urine loss

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increases. One must remember that the urethra and vagina are not separate structures. Because of their common derivation from the urogenital sinus, they are fused in the distal two-thirds of the urethra. In this region they are bound together by the endopelvic connective tissue so that the support of the urethra depends not only on the attachments of the urethra itself to adjacent structures but also on the connection of the vagina and periurethral tissues to the pelvic wall. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Molecules that modulate Galphaq avtivity and methods of treating urinary incontinence Inventor(s): Cockett, Mark; (Newton, PA), Doberstein, Stephen Kohl; (Pasadena, CA), Fitzgerald, Kevin; (Lambertville, NJ), Kindt, Rachel M.; (San Carlos, CA), Kopczynski, Jenny; (Chapel Hill, NC), Lodge, Nicholas J.; (Madison, CT), Moore, Lisa; (San Francisco, CA), Ramanathan, Chandra; (Wallingford, CT), Stouch, Terry; (West Windsor, NJ) Correspondence: Stephen B. Davis; Bristol-myers Squibb Company; Patent Department; P O Box 4000; Princeton; NJ; 08543-4000; US Patent Application Number: 20040014135 Date filed: January 27, 2003 Abstract: The present invention provides methods that are useful for the treatment or prevention of smooth muscle disorders such as urinary incontinence and compounds that are useful in such methods. Excerpt(s): This application is entitled to and claims priority to U.S. Provisional Application Ser. No. 60/352,720, filed Jan. 28, 2002, which is hereby incorporated by reference in its entirety. The present invention provides methods for treating and/or preventing conditions in smooth muscle such as urinary incontinence and compounds useful in such methods. In certain embodiments of the invention, the compounds are capable of modulating G.alpha.q and RGS complex activity. In one aspect, the invention provides compounds and methods for identifying compounds that have agonizing effects on RGS and that affect the RGS/G.alpha.q complex. The compounds are capable of altering G-protein coupled receptor protein pathway signals in vitro or in vivo. Urinary incontinence is a common condition that is a frequent cause of confinement to nursing homes among the elderly. It afflicts significant numbers among both men and women of all ages. Urinary incontinence is believed to currently affect over 12 million people in the United States alone, and to occur in between 15 and 30% of the population over the age of 60. In addition, studies show some degree of daily incontinence reported among as many as 17% of young, apparently healthy women. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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NMDA receptor agonist pharmaceutical compositions Inventor(s): Hong, Jinyang; (Stonington, CT), Kim, Yesook; (Brandford, CT) Correspondence: Pfizer Inc; 150 East 42nd Street; 5th Floor - Stop 49; New York; NY; 10017-5612; US Patent Application Number: 20040039022 Date filed: August 19, 2003

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Abstract: This invention relates to stable pharmaceutical compositions of the NMDA receptor agonist, (1S,2S)-1-(4-hydroxyphenyl)-2-(4-hydroxy-4-phenylpiperi- din-1-yl)-1propanol], methods of preparing such pharmaceutical compositions and methods of treating stroke, spinal cord trauma, traumatic brain injury, multiinfarct dementia, CNS degenerative diseases such as Alzheimer's disease, senile dementia of the Alzheimer's type, Huntington's disease, Parkinson's disease, epilepsy, amyotrophic lateral sclerosis, pain, AIDS dementia, psychotic conditions, drug addictions, migraine, hypoglycemia, anxiolytic conditions, urinary incontinence and an ischemic event arising from CNS surgery, open heart surgery or any procedure during which the function of the cardiovascular system is compromised using the pharmaceutical compositions. Excerpt(s): This invention provides stable pharmaceutical compositions of the Nmethyl-D-aspartic acid (NMDA) receptor antagonist, (1S,2S)-1-(4-hydroxyphenyl)-2-(4hydroxy-4-phenylpiperidin-1-yl)-1-propanol, methods of preparing such pharmaceutical compositions and methods of treating stroke, spinal cord trauma, traumatic brain injury, multiinfarct dementia, CNS degenerative diseases such as Alzheimer's disease, senile dementia of the Alzheimer's type, Huntington's disease, Parkinson's disease, epilepsy, amyotrophic lateral sclerosis, pain, AIDS dementia, psychotic conditions, drug addictions, migraine, hypoglycemia, anxiolytic conditions, urinary incontinence and an ischemic event arising from CNS surgery, open heart surgery or any procedure during which the function of the cardiovascular system is compromised, using the pharmaceutical compositions of this invention. (1S,2S)-1-(4Hydroxyphenyl)-2-(4-hydroxy4-phenylpiperidin-1-yl)-1-p- ropanol (hereafter referred to as the "Compound") is a neuroprotecting agent that is useful for the treatment of stroke, spinal cord trauma, traumatic brain injury, multiinfarct dementia, CNS degenerative diseases such as Alzheimer's disease, senile dementia of the Alzheimer's type, Huntington's disease, Parkinson's disease, epilepsy, amyotrophic lateral sclerosis, pain, AIDS dementia, psychotic conditions, drug addictions, migraine, hypoglycemia, anxiolytic conditions, urinary incontinence and an ischemic event arising from CNS surgery, open heart surgery or any procedure during which the function of the cardiovascular system is compromised. The Compound exhibits activity as an NMDA receptor antagonist. NMDA is an excitatory amino acid involved in excitatory neurotransmission in the central nervous system. NMDA antagonists are compounds that block the NMDA receptor by interacting with the receptor's binding site. Antagonists of neurotransmission at NMDA receptors are useful therapeutic agents for the treatment of neurological disorders. U.S. Pat. No. 4,902,695 is directed to series of competitive NMDA antagonists useful for the treatment of neurological disorders, including epilepsy, stroke, anxiety, cerebral ischemia, muscular spasms, and neurodegenerative disorders such as Alzheimer's disease and Huntington's disease. U.S. Pat. No. 4,968,878 is directed to a second series of competitive NMDA receptor antagonists useful for the treatment of similar neurological disorders and neurodegenerative disorders. U.S. Pat. No. 5,192,751 discloses a method of treating urinary incontinence in a mammal, which comprises administering an effective amount of a competitive NMDA antagonist. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Piperidinylaminomethyl trifluoromethyl cyclic ether compounds as substance P antagonists Inventor(s): Satake, Kunio; (Aichi-ken, JP) Correspondence: Pfizer Inc; 150 East 42nd Street; 5th Floor - Stop 49; New York; NY; 10017-5612; US Patent Application Number: 20030208079 Date filed: April 21, 2003 Abstract: This invention provides a compound of the formula: 1and its pharmaceutically acceptable salts, wherein R.sup.1 is C.sub.1-C.sub.6 alkyl; R.sup.2 is hydrogen, C.sub.1C.sub.6 alkyl, halo C.sub.1-C.sub.6 alkyl or phenyl; R.sup.3 is hydrogen or halo; R.sup.4 and R.sup.5 are independently hydrogen, C.sub.1-C.sub.6 alkyl or halo C.sub.1-C.sub.6 alkyl; and n is one, two or three.These compounds are useful as analgesics or antiinflammatory agents, or in the treatment of cardiovascular diseases, allergic disorders, angiogenesis, CNS disorders, emesis, gastrointestinal disorders, sunburn, urinary incontinence, or diseases, disorders or adverse conditions caused by Helicobacter pylori, or the like, in a mammalian subject, especially humans. Intermediates for preparation of the compounds of Formula (I) are also disclosed. Excerpt(s): This invention relates to novel piperidinylaminomethyl trifluoromethyl cyclic ether compounds and their pharmaceutically acceptable salts, pharmaceutical compositions containing such compounds, and the use of such compounds as substance P antagonists. Substance P is a naturally occurring undecapeptide belonging to the tachykinin family of peptides, the latter being so-named because of their prompt stimulatory action on smooth muscle tissue. More specifically, substance P is a pharmaceutically active neuropeptide that is produced in mammals (having originally been isolated from gut) and possesses a characteristic amino acid sequence that is illustrated by D. F. Veber et al. in U.S. Pat. No. 4,680,283. The wide involvement of substance P and other tachykinins in the pathophysiology of numerous diseases has been amply demonstrated in the art. For instance, substance P has recently been shown to be involved in the transmission of pain or migraine, as well as in central nervous system disorders such as anxiety and schizophrenia, in respiratory and inflammatory diseases such as asthma and rheumatoid arthritis, respectively, and in gastrointestinal disorders and diseases of the GI tract, like ulcerative colitis irritable bowel syndrome, Crohn's disease, etc. It is also reported that tachykinin antagonists are useful for the treatment of cardiovascular diseases, allergic conditions, immunoregulation, vasodilation, bronchospasm, reflex or neuronal control of the viscera, senile dementia of the Alzheimer type, emesis, sunburn and Helicobacter pylori infection. International Patent Publication No. WO 97/08144 discloses a wide variety of substituted piperidine compounds, including piperidine compounds having a substituent comprising a fused ring moiety including an oxygen atom, as substance P antagonists. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Preventives/remedies for emotional disorders Inventor(s): Ban, Toshikazu; (Nara, JP), Doi, Takayuki; (Osaka, JP) Correspondence: Foley And Lardner; Suite 500; 3000 K Street NW; Washington; DC; 20007; US Patent Application Number: 20040023843 Date filed: March 26, 2003 Abstract: An agent for the prophylaxis or treatment of an emotional disorder, which contains the NK-1 receptor antagonist having particular properties of (1) having no serotonin uptake inhibitory effect, (2) being capable of migrating into the hypothalamus, or (3) having an inhibitory effect on micturition reflex, an agent for the prophylaxis or treatment of depression accompanied by urinary frequency, urinary incontinence and/or irritable bowel syndrome, which contains an NK-1 receptor antagonist, an agent for the prophylaxis or treatment of a mood disorder of patients with urinary frequency and urinary incontinence, and a circadian rhythm controller for the hypothalamic endocrine system are provided. Excerpt(s): The present invention relates to an agent for the prophylaxis or treatment of an emotional disorder, particularly an agent for the prophylaxis or treatment of depression or a mood disorder, which contains an NK-1 receptor antagonist having particular property, a circadian rhythm controller for the hypothalamic endocrine system, and a screening method of an NK-1 receptor antagonist having such particular property. Moreover, the present invention relates to novel pharmaceutical use of an NK1 receptor antagonist. It has been reported that an NK-1 receptor antagonist is effective for the treatment of depression (WO98/15277, WO98/24438, WO98/24441), anxiety (WO98/15277, WO98/24469), consciousness disorder (WO98/24447), schizophrenia (WO98/2445) and the like. However, the above-mentioned conventionally known compounds have been reported to show a side effect such as hypogonadism and the like, whereas a pharmaceutical agent, which is capable of preventing or treating an emotional disorder, particularly depression, a mood disorder, abnormal circadian rhythm of the hypothalamic endocrine system, and the like, and which shows remarkably reduced side effect, has not been reported. The present invention aims at solving the above-mentioned problems and providing a pharmaceutical agent, which is capable of preventing or treating an emotional disorder, particularly depression, a mood disorder, abnormal circadian rhythm of the hypothalamic endocrine system, and the like, and which shows remarkably reduced side effects. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Regulation of human adenylate cyclase Inventor(s): Zhu, Zhimin; (Waban, MA) Correspondence: Banner & Witcoff; 1001 G Street N W; Suite 1100; Washington; DC; 20001; US Patent Application Number: 20040063174 Date filed: October 14, 2003 Abstract: Reagents which regulate human adenylate cyclase and reagents which bind to human adenylate cyclase gene products can play a role in preventing, ameliorating, or correcting dysfunctions or diseases including, but not limited to, peripheral and central

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nervous system disorders, disorders of the genito-urinary system including but not limited to benign prostatic hyperplasia and urinary incontinence, obesity, COPD and diabetes. Excerpt(s): This application incorporates by reference U.S. provisional applications Serial No. 60/247,005 filed Nov. 13, 2000 and U.S. 60/267,181 filed Feb. 8, 2001. The invention relates to a novel human adenylate cyclase and its regulation for therapeutic uses. Cyclases play important roles in the transduction of extracellular signals via their synthesis of "secondary messengers" such as adenosine 3',5'-cyclic phosphate (cyclic adenosine monophosphate, cAMP) and guanosine 3',5'-cyclic phosphate (cyclic guanosine monophosphate, cGMP). Cell surface receptors mediate the transduction of an extracellular signal, such as the binding of a ligand to a receptor, into a signal that is transmitted internally within the cell. The internal signal is carried by secondary messengers, which typically are produced in response to the binding of an external signal. The secondary messengers in turn activate particular proteins and other regulators within the cell which have the potential to regulate expression of specific genes or to alter a metabolic process. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Regulation of human nmda receptor Inventor(s): Kossida, Sophia; (Basel, CH) Correspondence: Banner & Witcoff; 1001 G Street N W; Suite 1100; Washington; DC; 20001; US Patent Application Number: 20040053835 Date filed: May 15, 2003 Abstract: Reagents which regulate human NMDA receptor and reagents which bind to human NMDA receptor gene products can play a role in preventing, ameliorating, or correcting dysfunctions or diseases including, but not limited to, Asthma, genito-urinary system disorders including but not limited to urinary incontinence and benign prostate hyperplasia, or peripheral and central nervous system disorders. Excerpt(s): The invention relates to the regulation of human NMDA receptor. Glutamic acid (glutamate) is a so-called excitatory amino acid, whose activity manifests itself in its interaction with specific receptors. Among these receptors, a subtype, designated NMDA (N-methyl-D-aspartate) receptors, appears to be implicated in the central nervous system of mammals, in many processes such as neuronal plasticity, long-term potentiation and also neuronal death or certain degenerative disorders. Pharmacological and molecular biology studies have recently made it possible to demonstrate and clone rat NMDA receptors, the receptor NMDAR1 [Moriyoshi et al., Nature 354 (1991) 31] and the receptor NMDAR2 [Monyer et al., Science 256 (1992) 12], and a mouse NMDA receptor [Yamazaki et al., Febs Lett. 300 (1992) 39]. U.S. Pat. No. 5,648,259. Because of their importance, there is a need in the art to identify related human receptors which can be regulated to provide therapeutic effects. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Regulation of human secretin receptor-like gpcr Inventor(s): Liou, Jiing-Ren; (Belmont, MA) Correspondence: Banner & Witcoff; 1001 G Street N W; Suite 1100; Washington; DC; 20001; US Patent Application Number: 20040048273 Date filed: October 8, 2003 Abstract: Reagents which regulate human secretin receptor-like GPCR and reagents which bind to human secretin-like GPCR gene products can play a role in preventing, ameliorating, or correcting dysfunctions or diseases including, but not limited to, cardiovascular disorders, urinary incontinence, benign prostate hyperplasia, obesity and diseases related to obesity, cancer, diabetes, osteoporosis, anxiety, depression, hypertension, migraine, compulsive disorders, schizophrenia, autism neurodegenerative disorders, such as Alzheimer's disease, Parkinsonism, and Huntington's chorea, and cancer chemotherapy-induced vomiting. Excerpt(s): This application incorporates by reference Ser. No. 60/238,125 filed Oct. 6, 2000. The invention relates to the area of regulation of G protein-coupled receptors. Many medically significant biological processes are mediated by signal transduction pathways that involve G-proteins (Lefkowitz, Nature 351, 353-354, 1991). The family of G protein-coupled receptors (GPCR) includes receptors for hormones, neurotransmitters, growth factors, and viruses. Specific examples of GPCRs include receptors for such diverse agents as calcitonin, adrenergic hormones, endothelin, cAMP, adenosine, acetylcholine, serotonin, dopamine, histamine, thrombin, kinin, follicle stimulating hormone, opsins, endothelial differentiation gene-1, rhodopsins, odorants, cytomegalovirus, G proteins themselves, effector proteins such as phospholipase C, adenyl cyclase, and phosphodiesterase, and actuator proteins such as protein kinase A and protein kinase C. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Simplified resiniferatoxin analogues as vanilloid receptor agonist showing excellent analgesic activity and the pharmaceutical compositions containing the same Inventor(s): Lee, Jee Woo; (Seoul, KR) Correspondence: David A. Einhorn, ESQ.; Anderson Kill & Olick, P.C.; 1251 Avenue OF The Americas; New York; NY; 10020; US Patent Application Number: 20040063786 Date filed: December 18, 2002 Abstract: The present invention is related to new vanilloid analogues containing resiniferatoxin pharmacophores, pharmaceutical compositions that have such analogues, and their uses as vanilloid receptor agonists and potent analgesics. The present invention provides a pharmaceutical composition for preventing, alleviating or treating pain, acute pain, chronic pain, neuropathic pain, post-operative pain, migraine, arthralgia, neutopathies, nerve injury, diabetic neuropathy, neurodegeneration, neurotic skin disorder, stroke, urinary bladder hypersensitiveness, irritable bowel syndrome, a respiratory disorder such as asthma or chronic obstructive pulmonary disease, irritation of skin, eye or mucous membrane, fervescence, stomach-duodenal ulcer, inflammatory bowel disease, inflammatory disease or urgent urinary incontinence.

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Excerpt(s): This application is a continuation patent application of PCT Patent Application No. PCT/KR02/01746, which was filed on Sep. 18, 2002, designating the United States of America, now abandoned. The present invention is related to new vanilloid analogues containing resiniferatoxin pharmacophores, pharmaceutical compositions comprising such analogues, and their uses as vanilloid receptor agonists and potent analgesics. The present invention provides a pharmaceutical composition for preventing, alleviating or treating pain, acute pain, chronic pain, neuropathic pain, postoperative pain, migraine, arthralgia, neutopathies, nerve injury, diabetic neuropathy, neurodegeneration, neurotic skin disorder, stroke, urinary bladder hypersensitiveness, irritable bowel syndrome, a respiratory disorder such as asthma or chronic obstructive pulmonary disease, irritation of skin, eye or mucous membrane, fervescence, stomachduodenal ulcer, inflammatory bowel disease, inflammatory disease or urgent urinary incontinence. The present invention relates to vanilloid analogues containing resiniferatoxin pharmacophores, pharmaceutical compositions comprising such analogues, and methods of using such analogues as vanilloid receptor agonists and potent analgesics. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Substituted 3,4-dihydropyrido[1,2-a]pyrimidines Inventor(s): Gerlach, Matthias; (Brachttal, DE), Jagusch, Utz-Peter; (Aachen, DE), Maul, Corinna; (Aachen, DE) Correspondence: Crowell & Moring Llp; Intellectual Property Group; P.O. Box 14300; Washington; DC; 20044-4300; US Patent Application Number: 20030229104 Date filed: April 11, 2003 Abstract: Substituted 3,4-dihydropyrido[1,2-a]pyrimidines of formula I 1and processes for the production thereof Also disclosed are substance libraries and pharmaceutical compositions containing the compound, and methods of treatment for pain, urinary incontinence, pruritus, tinnitus and/or diarrhoea using the pharmaceutical composition. Excerpt(s): The present application is a continuation of International Patent Application No. PCT/EP01/11700, filed Oct. 10, 2001, designating the United States of America and published in German as WO 02/30933 A1, the entire disclosure of which is incorporated herein by reference. Priority is claimed based on Federal Republic of Germany Patent Application No. 100 50 662.3, filed Oct. 13, 2000. The present application relates to substituted 3,4-dihydropyrido[1,2-a]pyrimidines, to processes for the production thereof, to substance libraries containing them, to pharmaceutical preparations containing these compounds, to the use of these compounds for the production of pharmaceutical preparations, and methods for the treatment of pain, urinary incontinence, pruritus, tinnitus and/or diarrhea and to pharmaceutical compositions containing these compounds. The treatment of chronic and non-chronic pain is of great significance in medicine. There is a worldwide requirement for effective therapeutic methods for providing tailored and targeted treatment of chronic and non-chronic pain, especially effective and satisfactory pain treatment from the patient's standpoint. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Substituted propane-1,3-diamine derivatives and the pharmaceutical use thereof Inventor(s): Buschmann, Helmut; (Esplugues de Llobregat, DE), Koegel, BabetteYvonne; (Langerwehe-Hamich, DE), Merla, Beatrix; (Aachen, DE), Risch, Nikolaus; (Lemgo, DE), Sundermann, Bernd; (Aachen, DE) Correspondence: Crowell & Moring Llp; Intellectual Property Group; P.O. Box 14300; Washington; DC; 20044-4300; US Patent Application Number: 20040067928 Date filed: August 21, 2003 Abstract: Substituted propane-1,3-diamine derivatives, methods for producing such derivatives, and medicaments and pharmaceutical compositions containing such derivatives useful for the treatment or prophylaxis of pain, urinary incontinence, itching, tinitus aurium, or diarrhea are provided. Excerpt(s): This application is a continuation of International Patent Application No. PCT/EP02/01765, filed Feb. 20, 2002, designating the United States of America, and published in German as WO 02/66432, the entire disclosure of which is incorporated herein by reference. Priority is claimed based on Federal Republic of Germany Patent Application No. DE 101 08 307.6, filed Feb. 21, 2001. The present invention relates to substituted propane-1,3-diamine derivatives, processes for their preparation, medicaments and pharmaceutical compositions comprising them and their use for the preparation of medicaments for treatment and/or prophylaxis of pain, urinary incontinence, itching, tinnitus aurium and/or diarrhoea. Treatment of chronic and nonchronic states of pain is of great importance in medicine. There is a world-wide need for pain therapies which have a good action for target-orientated treatment of chronic and non-chronic states of pain appropriate for the patient, by which is to be understood successful and satisfactory pain treatment for the patient. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Surgical instrument and method for treating female urinary incontinence Inventor(s): Kammerer, Gene W.; (East Brunswick, NJ), Ulmsten, Ulf; (Danderyd, SE) Correspondence: Audley A. Ciamporcero JR.; Johnson & Johnson; One Johnson & Johnson Plaza; New Brunswick; NJ; 08933-7003; US Patent Application Number: 20030191480 Date filed: April 1, 2003 Abstract: The invention relates to a surgical instrument and a method for treating female urinary incontinence. A tape or mesh is permanently implanted into the body as a support for the urethra. In one embodiment, portions of the tape comprise tissue growth factors and adhesive bonding means for attaching portions of the tape to the pubic bone. In a further embodiment, portions of the tape comprise attachment means for fastening portions of the tape to fascia within the pelvic cavity. In both embodiments the tape is implanted with a single incision through the vaginal wall. Excerpt(s): This application claims the benefit of earlier-filed U.S. provisional patent application, serial No. 60/252,561, filed on Nov. 22, 2000, which is incorporated herein by reference in its entirety. The invention relates to a surgical instrument and a method for treating female urinary incontinence, i.e. the incapacity of controlling the discharge of urine. Women account for more than 11 million of incontinence cases. Moreover, a

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majority of women with incontinence suffer from stress urinary incontinence (SUI). Women with SUI involuntarily lose urine during normal daily activities and movements, such as laughing, coughing, sneezing and regular exercise. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Therapeutic agents useful for treating pain Inventor(s): Gharagozloo, Parviz; (Pennington, NJ), Islam, Khondaker; (Langhorne, PA), Kyle, Donald J.; (Newtown, PA), Sun, Qun; (Princeton, NJ), Tafesse, Laykea; (Robinsville, NJ), Whitehead, John William Frank; (Newtown, PA), Yang, Ji; (Princeton Junction, NJ), Zhou, Xiaoming; (Plainsboro, NJ) Correspondence: Jones Day; 222 East 41st Street; New York; NY; 10017; US Patent Application Number: 20040053914 Date filed: May 2, 2003 Abstract: A compound of formula 1(wherein A, R.sub.1, R.sub.2, R.sub.6, m and n are disclosed herein) or a pharmaceutically acceptable salt thereof (a "Piperazine Compound"); pharmaceutical compositions comprising a Piperazine Compound; and methods for treating pain, urinary incontinence (UI), an addictive disorder, Parkinson's disease, parkinsonism, anxiety, epilepsy, stroke, a seizure, a pruritic condition, psychosis, a cognitive disorder, a memory deficit, restricted brain function, Huntington's chorea, amyotrophic lateral sclerosis (ALS), dementia, retinopathy, a muscle spasm, a migraine, vomiting, dyskinesia and depression in an animal comprising administering to an animal in need thereof an effective amount of a Piperazine Compound are disclosed. Excerpt(s): This application claims the benefit of U.S. provisional application No. 60/376,803, filed May 2, 2002, and U.S. provisional application No. ______ (Pennie & Edmonds LLP docket no. 6750-210-888), filed Apr. 3, 2003, the disclosure of each provisional application being incorporated by reference herein in its entirety. The present invention relates to Piperazine Compounds, compositions comprising a Piperazine Compound and methods for treating or preventing a condition such as pain, urinary incontinence (UI), an addictive disorder, Parkinson's disease, parkinsonism, anxiety, epilepsy, stroke, a seizure, a pruritic condition, psychosis, a cognitive disorder, a memory deficit, restricted brain function, Huntington's chorea, amyotrophic lateral sclerosis (ALS), dementia, retinopathy, a muscle spasm, a migraine, vomiting, dyskinesia or depression comprising administering to the animal in an animal in need thereof an effective amount of a Piperazine Compound. Pain is the most common symptom for which patients seek medical advice and treatment. Pain can be acute or chronic. While acute pain is usually self-limited, chronic pain persists for 3 months or longer and can lead to significant changes in a patient's personality, lifestyle, functional ability and overall quality of life (K. M. Foley, Pain, in Cecil Textbook of Medicine 100107 (J. C. Bennett and F. Plum eds., 20th ed. 1996)). Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Treatments with autologous fibroblast Inventor(s): Boss, William K. JR.; (Essex Fells, NJ), Marko, Olga; (Houston, TX) Correspondence: Fish & Richardson P.C.; 45 Rockefeller Plaza, Suite 2800; New York; NY; 10111; US Patent Application Number: 20040013652 Date filed: April 22, 2003 Abstract: The invention provides compositions containing autologous, passaged fibroblasts and, optionally, autologous, passaged muscle cells, biodegradable acellular matrix components, and/or biodegradable acellular fillers. The invention also provides methods for making the compositions, as well as devices and methods for administering the compositions to treat conditions such as urinary incontinence, vesicoureteral reflux, and gastroesophageal reflux. Excerpt(s): This application claims priority of U.S. Provisional Application No. 60/379,344, filed May 10, 2002. The disclosure of U.S. Provisional Application No. 60/379,344 is incorporated herein by reference in its entirety. This invention relates to treatment of urinary incontinence, vesicoureteral reflux, and gastroesophageal reflux. Urinary incontinence is an extremely prevalent condition throughout the United States. The U.S. Department of Health and Human Services reported in 1996 that 13 million people in this country suffer from urinary incontinence. The condition is far more prevalent in women than men. In the general population aged 15 to 64 years old, 10-30% of women versus 1.5-5% of men are affected. At least 50% of nursing home residents are affected and of that number, 70% are women. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Urinary incontinence therapy Inventor(s): Agersborg, Helmer P.K.; (Blue Bell, PA), Cruz, Francisco; (Porto, PT) Correspondence: Greenlee, Winner And Sullivan, P.C.; STE. 201; 5370 Manhattan Circle; Boulder; CO; 80303; US Patent Application Number: 20040039052 Date filed: July 1, 2003 Abstract: The invention includes a method of treating neurogenic urinary dysfunction that comprises contacting urinary bladder mucosa of a patient afflicted with neurogenic urinary dysfunction with an effective dose of a homovanilloid compound, in particular a compound selected from the group RTX, TYX, 20-homovanillyl-mezerein or 20homovanillyl-12-deoxyphorbol-13-- phenylacetate. The invention includes treatment of urge incontinence due to detrusor hyperreflexia (DH). The invention also includes treatment of sensory hypersensitivity of the bladder resulting from prostate hypertrophy or interstial cystitis, as well as other neurogenic conditions resulting in increased micturition frequency or decreased bladder capacity, with or without frank incontinence. Excerpt(s): This application is a divisional application of U.S. application Ser. No. 09/138,448 filed Aug. 21, 1998 and claims priority from U.S. Provisional Application No. 60/057,385 filed Aug. 28, 1997. Not applicable. Certain homovanilloid compounds, notably the homovanillyl diterpene esters resiniferatoxin (RTX) and tinyatoxin (TYX) are known to have physiological effects similar to capsaicin (CAP). Depending on which

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physiological response is measured, the homovanilloids are more potent than CAP, on a molar basis, by a factor of 10-10,000. In particular, RTX, TYX and other homovanilloids have been shown to be effective for desensitizing sensory nerves in a manner similar to CAP but at lower dosage (U.S. Pat. Nos. 4,939,149 and 5,021,450, incorporated herein by reference). Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Use of 1-phenyl-3-dimethylaminopropane compounds for treatment of urinary incontinence Inventor(s): Christoph, Thomas; (Aachen, DE), Friderichs, Elmar; (Stolberg, DE) Correspondence: Crowell & Moring Llp; Intellectual Property Group; P.O. Box 14300; Washington; DC; 20044-4300; US Patent Application Number: 20040034105 Date filed: May 30, 2003 Abstract: The invention relates to the use of 1-phenyl-3-dimethylaminopropane compounds for treating increased urinary urgency or urinary incontinence, as well as to the production of corresponding medicaments. Excerpt(s): This application is a continuation of International Patent Application No. PCT/EP01/13918, filed Nov. 28, 2001, designating the United States of America, and published in German as WO 02/43715, the entire disclosure of which is incorporated herein by reference. Priority is claimed based on Federal Republic of Germany patent application no. DE 100 59 412.3, filed Nov. 30, 2000. The present invention relates to the use of 1-phenyl-3-dimethylamin- opropane compounds as free bases and/or in the form of physiologically compatible salts for the production of a medicament for treating increased urinary urgency or urinary incontinence, as well as corresponding medicaments and methods for treating increased urinary urgency or urinary incontinence. Urinary incontinence is the involuntary passing of urine. This occurs in an uncontrolled manner if the pressure within the bladder exceeds the pressure required to close the urethra. Causes may include on the one hand an increased internal bladder pressure (e.g. due to detrusor instability) resulting in urgency incontinence, and on the other hand a reduced sphincter pressure (e.g. after childbirth or surgical intervention) resulting in stress incontinence. The detrusor is the collection of coarse bundles forming the multilayered muscular wall of the bladder, whose contraction leads to the voiding of urine, and the sphincter is the constrictor muscle of the urethra. Mixed forms of these types of incontinence as well as so-called overflow incontinence (e.g. in the case of benign prostatic hyperplasia) or reflex incontinence (e.g. following damage to the spinal cord) occur. Further details may be found in Chutka, D. S. and Takahashi, P. Y., 1998, Drugs 560: 587-595. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

Keeping Current In order to stay informed about patents and patent applications dealing with urinary incontinence, you can access the U.S. Patent Office archive via the Internet at the following Web address: http://www.uspto.gov/patft/index.html. You will see two broad options: (1)

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Issued Patent, and (2) Published Applications. To see a list of issued patents, perform the following steps: Under “Issued Patents,” click “Quick Search.” Then, type “urinary incontinence” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on urinary incontinence. You can also use this procedure to view pending patent applications concerning urinary incontinence. Simply go back to http://www.uspto.gov/patft/index.html. Select “Quick Search” under “Published Applications.” Then proceed with the steps listed above.

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CHAPTER 6. BOOKS ON URINARY INCONTINENCE Overview This chapter provides bibliographic book references relating to urinary incontinence. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on urinary incontinence include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.

Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “urinary incontinence” (or synonyms) into the “For these words:” box. You should check back periodically with this database which is updated every three months. The following is a typical result when searching for books on urinary incontinence: •

Managing Incontinence: A Guide to Living with Loss of Bladder Control Source: Ottawa, IL: Jameson Books, Inc. 1985. 126 p. Contact: Available from Jameson Books, Inc. 722 Columbus Street, Ottawa, IL 61350. (815) 434-7905. ISBN: 091546313X. PRICE: $12.95; plus shipping and handling. Summary: This book offers information and practical advice for people with urinary incontinence. The authors offer medical advice, practical help, product information, and conversations with others who have urinary incontinence (because of disease, injuries, operations, or birth anomalies). The book includes interviews with people with incontinence who speak frankly about accidents, isolation, sexuality, and fear of being unattractive; clear explanations and illustrations of the way the urinary system functions; psychological strategies for building confidence; illustrations and descriptions of products for people coping with incontinence, and an appendix with information

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from manufacturers of these products; a guide to sexuality for people who have urinary incontinence; a look at public and medical attitudes about people with incontinence; and a discussion of the ways society has treated the subject in the past. Each chapter is written by experts in that topic area, and the book concludes with a brief biographical description of each contributor. The book is illustrated with black and white drawings, cartoons, and photographs. •

Urinary Incontinence in Adults: Acute and Chronic Management. Clinical Practice Guideline Update Source: Rockville, MD: Agency for Health Care Policy and Research (AHCPR). March 1996. 154 p. Contact: Available from Agency for Health Care Policy and Research (AHCPR) Publications Clearinghouse. P.O. Box 8547, Silver Spring, MD 20907-8547. (800) 3589295. PRICE: $6.00. AHCPR publication number 96-0682. Summary: This clinical practice guideline was developed by an expert panel of health care professionals sponsored by the Agency for Health Care Policy and Research, and represents the 1996 update of guidelines originally released in 1992. The authors address major evaluative, diagnostic, treatment, and management issues of urinary incontinence (UI) in adults. Topics addressed include the methodology for updating the guideline; incidence and prevalence of UI; quality of life; risk factors and prevention; costs; identification and evaluation of types UI; principles of diagnostic evaluation; treatment of UI, including behavioral techniques, pharmacologic treatment, surgical treatment, and other measures and supportive devices; long-term management of chronic intractable UI; and public and professional education about UI. The volume includes a glossary, biographical information about the guideline panel, and a subject index.

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Urinary Incontinence in the Elderly: Pharmacotherapy Treatment Source: Binghamton, NY: Pharmaceutical Products Press. 1997. 72 p. Contact: Available from Haworth Press, Inc. 10 Alice Street, Binghamton, NY 139041580. (800) 429-6784. Fax (800) 895-0582. E-mail: [email protected]. PRICE: $24.95. ISBN: 0789003279. Summary: This reference text covers how to educate health care providers and the public about urinary incontinence (UI) and how physicians, directors of nursing, and other health care providers can begin and maintain a comprehensive, science-based approach to diagnosing and treating UI. The volume begins with the AHCPR guidelines on UI for clinicians. Subsequent chapters are extensions of the AHCPR panel efforts directed at the consumer, caregivers, and directors of nursing. Topics include teaching women about gestational and postpartum pelvic muscle exercises; proper bladder emptying techniques; behavioral, pharmacologic, and surgical treatment of UI; risk factors associated with UI; stress incontinence; and how the body makes, stores, and releases urine (physiology). The text features tables and charts to help readers diagnose the patient's condition, identify the causes for UI, and select appropriate treatment methods. The book also provides a list of helpful questions to assist in the identification and assessment of UI and sample bladder records with which patients can keep track of voluntary and involuntary urine voidings. The book concludes with an annotated bibliography of selected pharmacotherapy studies of the treatment of UI compiled by the editor. 15 references. (AA-M).

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Managing and Treating Urinary Incontinence Source: Baltimore, MD: Health Professions Press. 2002. 304 p. Contact: Available from Health Professions Press. P.O. Box 10624, Baltimore, MD 21285. (888) 337-8808. Fax (410) 337-8808. E-mail: [email protected]. Website: www.healthpropress.com. PRICE: $31.00; plus shipping and handling. ISBN: 878812823. Summary: Urinary incontinence (involuntary loss of urine) is a leading cause for nursing facility placement and a significant social and public health problem that caregivers in any setting can successfully manage or even eliminate. This book helps nurses and other caregivers understand the full range of treatment options for urinary incontinence (UI), how they work, and how and when to use them with patients or residents. The book covers the types and causes of UI and overactive bladder; the contribution of bowel irregularity to UI; the use and care of products available for collecting or absorbing urine or feces; the efficacy of behavioral treatments, such as bladder retraining and toileting programs; the role of surgery and drug therapy; the value of incontinence education for both caregivers and care recipients; and the psychological, social, health, and economic implications of poorly managed incontinence. The book is illustrated with black-and-white photographs and line drawings and includes educational handouts, detailed assessment forms, a glossary of clinical terminology, product and professional organization listings, and a subject index.

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Urinary Incontinence in Primary Care Source: Oxford, England: Isis Medical Media, Ltd. 2000. 136 p. Contact: Available from Isis Medical Media Ltd. 59 St Aldates, Oxford, OX1 1ST United Kingdom. 01865202939. Fax: 01865202940. Website: www.isismedical.com. PRICE: $25.00 plus shipping and handling. ISBN: 1901865681. Summary: Urinary incontinence (UI) regularly disrupts the lives of about 5 percent of home dwelling adults and is a common problem at all ages. Inadequate training remains a major obstacle to the improved management of UI in primary care: few family practitioners have received postgraduate education or have any specialist knowledge on the subject. This handy sized practical reference guide helps the family care practitioner manage UI in the primary care setting. After an introductory chapter that offers an overview from the primary care perspective, the book includes 11 chapters on anatomy and physiology, the development of urinary incontinence, patient history and examination, investigations (diagnostic tests), coping strategies, treatment of genuine stress incontinence, treatment of detrusor instability, treatment of voiding disorders, other causes of incontinence, practical management, and misconceptions and frequently asked questions. The book includes full color illustrations, flowcharts and algorithms, and a special chapter on case studies to illustrate the practical applications of the concepts presented. A subject index concludes the handbook. 55 figures. 21 tables. 13 references.

Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes&Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in Print). IMPORTANT

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NOTE: Online booksellers typically produce search results for medical and non-medical books. When searching for “urinary incontinence” at online booksellers’ Web sites, you may discover non-medical books that use the generic term “urinary incontinence” (or a synonym) in their titles. The following is indicative of the results you might find when searching for “urinary incontinence” (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): •

American College of Physicians Home Medical Guide: Urinary Incontinence in Women by David R. Goldmann (Editor), David A. Horowitz (Editor); ISBN: 0789441713; http://www.amazon.com/exec/obidos/ASIN/0789441713/icongroupinterna

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Conservative Treatment of Male Urinary Incontinence and Erectile Dysfunction by Grace Dorey; ISBN: 1861563027; http://www.amazon.com/exec/obidos/ASIN/1861563027/icongroupinterna

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Cure Your Urinary Incontinence in Five Weeks: Without Pain, Drugs, Surgery, or Invasive Procedures with This Groundbreaking New Treatment by Bryce Finley; ISBN: 1896245064; http://www.amazon.com/exec/obidos/ASIN/1896245064/icongroupinterna

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Disorders of the Female Urethra and Urinary Incontinence by William G. Slate; ISBN: 0683077465; http://www.amazon.com/exec/obidos/ASIN/0683077465/icongroupinterna

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Disorders of the female urethra and urinary incontinence; ISBN: 0683077481; http://www.amazon.com/exec/obidos/ASIN/0683077481/icongroupinterna

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Evaluation and treatment of urinary incontinence; ISBN: 4260143069; http://www.amazon.com/exec/obidos/ASIN/4260143069/icongroupinterna

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Evaluation and Treatment of Urinary Incontinence (Topics in Clinical Urology) by Jerry G. Blaivas (Editor); ISBN: 0896403068; http://www.amazon.com/exec/obidos/ASIN/0896403068/icongroupinterna

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Female Urinary Incontinence by Nils-Otto Sjoberg (Editor), et al; ISBN: 1850704937; http://www.amazon.com/exec/obidos/ASIN/1850704937/icongroupinterna

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Female Urinary Incontinence by G.J. Jarvis; ISBN: 0902331507; http://www.amazon.com/exec/obidos/ASIN/0902331507/icongroupinterna

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Female Urinary Incontinence: Diagnostics and Treatment by Attila Tanko; ISBN: 9630565307; http://www.amazon.com/exec/obidos/ASIN/9630565307/icongroupinterna

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Freedom Regained - Female Urinary Incontinence Can Be Overcome by Anadem Publishing, Jong M. Choe; ISBN: 1890018260; http://www.amazon.com/exec/obidos/ASIN/1890018260/icongroupinterna

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Functional Models in the Search for Pharmacological Treatment of Urinary Incontinence: The Role of Adrenergic, Cholinergic & Serotonergic Receptors (Comprehensive Summaries of Uppsala Dissertations from the Faculty of mediciNe, 1137) by Ali-Reza Modiri; ISBN: 9155452787; http://www.amazon.com/exec/obidos/ASIN/9155452787/icongroupinterna

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Identifying and Evaluating Urinary Incontinence in a Female Population Outcome Research: Success Criteria in Bph Management: Symposia Held During the Meeting of the European Association of Urology (Eau), Paris, September 1996 (European Urology) by Paul Abrams (Editor), Pierre Teillac (Editor); ISBN: 3805565399; http://www.amazon.com/exec/obidos/ASIN/3805565399/icongroupinterna

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Kidney and Urinary Tract Diseases and Disorders Sourcebook: Basic Information About Kidney Stones, Urinary Incontinence, Bladder Disease, End Stage Renal Disease, Dialysis, and More, Along With Statistical and (Health Reference Series, Vol 21) by Linda M. Ross (Editor), Peter Dresser (Editor); ISBN: 0780800796; http://www.amazon.com/exec/obidos/ASIN/0780800796/icongroupinterna

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Management of acute and chronic urinary incontinence in adults (SuDoc HE 20.6520/4:2) by U.S. Dept of Health and Human Services; ISBN: B00010XYMA; http://www.amazon.com/exec/obidos/ASIN/B00010XYMA/icongroupinterna

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Management of Urinary Incontinence in the Community by J.C. Brocklehurst (Editor); ISBN: 3805552467; http://www.amazon.com/exec/obidos/ASIN/3805552467/icongroupinterna

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Managing acute and chronic urinary incontinence (SuDoc HE 20.6520/2:2/UPDATE) by U.S. Dept of Health and Human Services; ISBN: B00010TSPC; http://www.amazon.com/exec/obidos/ASIN/B00010TSPC/icongroupinterna

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Managing and Treating Urinary Incontinence by Diane Kaschak Newman; ISBN: 1878812823; http://www.amazon.com/exec/obidos/ASIN/1878812823/icongroupinterna

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Managing Urinary Incontinence in the Elderly by John F. Schnelle; ISBN: 0826173608; http://www.amazon.com/exec/obidos/ASIN/0826173608/icongroupinterna

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Natural Treatments for Urinary Incontinence: Using Butterbur and Other Natural Supplements to Treat Bladder Control Problems by Rita, M.H. Elkins; ISBN: 1580540856; http://www.amazon.com/exec/obidos/ASIN/1580540856/icongroupinterna

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Overcoming Urinary Incontinence by Richard J. Millard; ISBN: 0809571218; http://www.amazon.com/exec/obidos/ASIN/0809571218/icongroupinterna

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Overcoming Urinary Incontinence: A Simple Self-Help Guide by Richard J., Dr. Millard; ISBN: 0722516924; http://www.amazon.com/exec/obidos/ASIN/0722516924/icongroupinterna

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Practical Aspects of Urinary Incontinence (Developments in Surgery, Vol 7) by F.M.J. Debruyne, E.V.A. Van Kerrebroeck (Editor); ISBN: 0898387523; http://www.amazon.com/exec/obidos/ASIN/0898387523/icongroupinterna

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Saving the Whole Woman: Natural Alternatives to Surgery for Pelvic Organ Prolapse and Urinary Incontinence by Christine Ann Kent; ISBN: 0970144008; http://www.amazon.com/exec/obidos/ASIN/0970144008/icongroupinterna

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Side Effects of Male Cancers - Better Survival and Growing Social Acceptance of Impotence and Urinary Incontinence Equates to New Opportunities for Drug Therapies [DOWNLOAD: PDF] by Datamonitor (Author); ISBN: B00008R3WU; http://www.amazon.com/exec/obidos/ASIN/B00008R3WU/icongroupinterna

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The 2002 Official Patient's Sourcebook on Urinary Incontinence: A Revised and Updated Directory for the Internet Age by Icon Health Publications; ISBN: 0597832536; http://www.amazon.com/exec/obidos/ASIN/0597832536/icongroupinterna

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The American Urological Association Female Stress Urinary Incontinence Clinical Guidelines Panel: Report on the Surgical Management of Female Stress U by G. E. Leach, et al; ISBN: 0964970236; http://www.amazon.com/exec/obidos/ASIN/0964970236/icongroupinterna

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The Official Parent's Sourcebook on Urinary Incontinence With Children: A Revised and Updated Directory for the Internet Age by Icon Health Publications; ISBN: 0597832609; http://www.amazon.com/exec/obidos/ASIN/0597832609/icongroupinterna

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The Urinary Incontinence Handbook by Bryce Finley; ISBN: 189624503X; http://www.amazon.com/exec/obidos/ASIN/189624503X/icongroupinterna

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The Urinary Incontinence Sourcebook by Diane Kaschak Newman, Mary Dzurinko; ISBN: 1565656482; http://www.amazon.com/exec/obidos/ASIN/1565656482/icongroupinterna

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Understanding Female Urinary Incontinence by Linda Cardozo; ISBN: 1898205523; http://www.amazon.com/exec/obidos/ASIN/1898205523/icongroupinterna

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Understanding Urinary Incontinence by L. Cardozo, P. Toozs-Hobson; ISBN: 1898205949; http://www.amazon.com/exec/obidos/ASIN/1898205949/icongroupinterna

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Urinary Incontinence by Adolphe Steg (Editor); ISBN: 0443046433; http://www.amazon.com/exec/obidos/ASIN/0443046433/icongroupinterna

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Urinary Incontinence by Pat D. O'Donnell, Pat D. C'Donnell; ISBN: 081516517X; http://www.amazon.com/exec/obidos/ASIN/081516517X/icongroupinterna

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Urinary Incontinence by Mary H. Palmer; ISBN: 0943432227; http://www.amazon.com/exec/obidos/ASIN/0943432227/icongroupinterna

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Urinary Incontinence by S.S. Vasan; ISBN: 8125021108; http://www.amazon.com/exec/obidos/ASIN/8125021108/icongroupinterna

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Urinary Incontinence (Greenwich Medical Media) by James G. Malone-Lee (Editor), et al; ISBN: 1900151162; http://www.amazon.com/exec/obidos/ASIN/1900151162/icongroupinterna

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Urinary incontinence (SuDoc HE 20.3861:UR 3/996) by U.S. Dept of Health and Human Services; ISBN: B00010SG46; http://www.amazon.com/exec/obidos/ASIN/B00010SG46/icongroupinterna

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Urinary Incontinence and Genital Prolapse: A Prospective Population-Based Study by Eva Samuelsson; ISBN: 9155445101; http://www.amazon.com/exec/obidos/ASIN/9155445101/icongroupinterna

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Urinary Incontinence in Adults No. 2: Acute and Chronic by Usphs, Public Health; ISBN: 1883205263; http://www.amazon.com/exec/obidos/ASIN/1883205263/icongroupinterna

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Urinary incontinence in Alzheimer's disease (SuDoc Y 3.T 22/2:2 M 66/2/pt.3/urinary) by Thelma J. Wells; ISBN: B000107WUK; http://www.amazon.com/exec/obidos/ASIN/B000107WUK/icongroupinterna

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Urinary Incontinence in Primary Care by Linda Cardozo, et al; ISBN: 1901865681; http://www.amazon.com/exec/obidos/ASIN/1901865681/icongroupinterna

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Urinary Incontinence in the Elderly: Pharmacotherapy Treatment by James W. Cooper (Editor); ISBN: 0789003279; http://www.amazon.com/exec/obidos/ASIN/0789003279/icongroupinterna

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Urinary Incontinence in Women (Clinical Symposia, Vol 47, No 3); ISBN: 9996114953; http://www.amazon.com/exec/obidos/ASIN/9996114953/icongroupinterna

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Urinary Incontinence in Women : A Guide for Women by Dr. Joseph M. Khoury; ISBN: 1885274416; http://www.amazon.com/exec/obidos/ASIN/1885274416/icongroupinterna

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Urinary Incontinence: Market Update - Growing Market Brings Opportunities for New Drugs [DOWNLOAD: PDF] by Datamonitor (Author); ISBN: B0001EYJOI; http://www.amazon.com/exec/obidos/ASIN/B0001EYJOI/icongroupinterna

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Urinary Incontinence: World Pharma Market Analysis & Disease Management Impact [DOWNLOAD: PDF] by Theta Reports (Author); ISBN: B000218CZM; http://www.amazon.com/exec/obidos/ASIN/B000218CZM/icongroupinterna

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Urogynecology: Evaluation and Treatment of Urinary Incontinence - A CD-ROM course for physicians and others with an interest in women's healthcare. by Bruce Rosenweig MD, et al; ISBN: 0966491556; http://www.amazon.com/exec/obidos/ASIN/0966491556/icongroupinterna

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Chapters on Urinary Incontinence In order to find chapters that specifically relate to urinary incontinence, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and urinary incontinence using the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” Type “urinary incontinence” (or synonyms) into the “For these words:” box. The following is a typical result when searching for book chapters on urinary incontinence: •

Injectable Bulking Agents in the Treatment of Urinary Incontinence Source: in Gearhart, J.P.; Rink, R.C.; Mouriquand, P.D. Pediatric Urology. Philadelphia, PA: W.B. Saunders Company. 2001. p. 1008-1013. Contact: Available from Elsevier, Health Sciences Division. The Curtis Center, 625 Walnut Street, Philadelphia, PA 19106. (800) 523-1649. E-mail: [email protected]. Website: www.us.elsevierhealth.com. PRICE: $239.00 plus shipping and handling. ISBN: 072168680X. Summary: Although not the treatment of choice for every patient, injectable bulking agents offer outpatient convenience, minimal discomfort, and in the appropriate patient, efficacy for the treatment of urinary incontinence. Bulking agents are a urological tool in evolution that continue to improve in terms of both patient safety and durability. This chapter on injectable bulking agents is from a comprehensive textbook on pediatric urology that emphasizes the pathophysiology of various disorders. The authors discuss the mechanisms of incontinence, diagnosis, treatment options, the history of bulking agents, endoscopic techniques, nonorganic injectables, nonautologous organic therapies, and autologous organic therapies. The authors conclude that when bladder capacity and compliance are favorable, with incontinence primarily due to an incompetent bladder outlet, bulking agents can provide a minimally invasive therapeutic option in achieving continence. To date, the quest for the ideal injectable agent remains elusive. The host's reaction to the agent appears key in determining safety and long term durability. Newer substances avoid problems with particle migration, granuloma formation, and the inflammatory response. 54 references.

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Stress Urinary Incontinence Source: in Seal, G.M. Patient's Guide to Urology: Plumbing Problems in Layman's Terms. Toledo, OH: High Oaks Publishing Company. 1995. p. 79-90. Contact: Available from bookstores and libraries and, at the wholesale level, from Baker and Taylor, (908) 722-8000. Also available in orders of 10 or more copies from High Oaks Publishing Company, Center Urology of Toledo, Inc. 3425 Executive Parkway, Suite 214, Toledo, OH 43606. (419) 531-1700. PRICE: $21.95 (cloth); $12.95 (paperback). ISBN: 0964577305 (cloth), 0964577313 (paper). Summary: In this chapter, from a patient's guide to urology, the author discusses stress urinary incontinence, or urine leakage associated with coughing, lifting, and straining. After the presentation of two case studies, the author discusses patient evaluation, including diagnostic tests such as urodynamics; and treatment regimens in three categories: behavior modification, medication, and surgery. The author notes that these treatment options allow a progressive treatment based upon the severity of the condition and the particular type of bladder and support which the patient possesses. The book concludes with a detailed glossary and brief subject index. 3 figures.

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Injectable Agents for Urinary Incontinence Source: in Carson, C.C., III. Urologic Prostheses: The Complete Practical Guide to Devices, Their Implantation, and Patient Follow up. Totowa, NJ: The Humana Press, Inc. 2002. p. 29-42. Contact: Humana Press, Inc. 999 Riverview Dr., Suite 208 Totowa, NJ 07512. (973) 2561699. Fax (973) 256-8341. E-mail: [email protected] PRICE: $125.00, plus shipping and handling. ISBN: 0896038947. Summary: Injectable materials have been sporadically used for the treatment of urinary incontinence for many years. This chapter on injectable agents for urinary incontinence is from a text that was compiled to provide a broad view of prosthetic devices used in urologic surgery. The author discusses incontinence subdivided by a specific type of urethral dysfunction; data on the use of collagen; antegrade injection; results in children; the use of other agents; carbon steel particles; and technical details, including patient selection and injection methods for men and women, collagen techniques, and durasphere techniques. 4 figures. 52 references.

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Urethral Lengthening for Urinary Incontinence Source: in Gearhart, J.P.; Rink, R.C.; Mouriquand, P.D. Pediatric Urology. Philadelphia, PA: W.B. Saunders Company. 2001. p. 980-994. Contact: Available from Elsevier, Health Sciences Division. The Curtis Center, 625 Walnut Street, Philadelphia, PA 19106. (800) 523-1649. E-mail: [email protected]. Website: www.us.elsevierhealth.com. PRICE: $239.00 plus shipping and handling. ISBN: 072168680X. Summary: The surgical treatment of urinary incontinence in children remains a difficult problem for urologists. Surgical procedures to achieve urinary continence are dictated by functional and anatomical deficiencies and by the ultimate goal of either continence (with normal voiding) or dryness (dependent on clean intermittent self-catheterization, CIC). This chapter on the use of urethral lengthening to treat urinary incontinence is from a comprehensive textbook on pediatric urology that emphasizes the pathophysiology of various disorders. The author describes only bladder neck

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reconstructive procedures (other chapters cover other techniques). Topics include the Young-Dees-Leadbetter (YDL) procedure, modifications of the YDL procedure, the Tanagho procedure, the Kropp procedure, and the Pippi Salle procedure. 9 figures. 3 tables. 65 references. •

Lifestyle Interventions in the Treatment of Urinary Incontinence Source: in Corcos, J.; Schick, E., eds. Urinary Sphincter. New York, NY: Marcel Dekker, Inc. 2001. p. 437-442. Contact: Available from Marcel Dekker, Inc. Cimarron Road, P.O. Box 5005, Monticello, NY 12701. (800) 228-1160 or (845) 796-1919. Fax (845) 796-1772. E-mail: [email protected]. International E-mail: [email protected]. Website: www.dekker.com. PRICE: $225.00 plus shipping and handling. ISBN: 0824704770. Summary: The urinary sphincter is the key to understanding both normal and abnormal function of the lower urinary tract. Its relationships with the bladder, the pelvic floor, and the bony structures of the pelvis are complex and incompletely understood. This chapter on lifestyle interventions in the treatment of urinary incontinence (UI) is from a textbook that presents a detailed and systematic account of the current knowledge on the anatomy, physiology, functional relationships, and range of dysfunctions that affect the urinary sphincter. Interventions often recommended by physicians include weight loss, changing activity, smoking cessation, and decreasing or changing fluid intake. In this chapter, the published evidence for recommending these and other lifestyle interventions are addressed. Although the data do strongly suggest that weight loss reduces incontinence in morbidly obese women, no studies have evaluated this intervention in the more commonly seen, moderately obese woman. Given current evidence, maintaining normal weight through adulthood may be an important factor in the prevention of incontinence. There is no strong evidence in the literature that associates smoking and incontinence in humans and no data have been reported concerning the effects of smoking cessation on incontinence. In addition, no randomized trials have assessed the effectiveness of caffeine restriction, fluid management, or dietary changes in the treatment of incontinence. Given that decreasing fluid intake may lead to urinary tract infections, constipation, or dehydration, this intervention should be reserved for patients with abnormally high fluid intakes. The author notes that further research is needed to delineate the role of straining with constipation and the pathogenesis (development) of incontinence. 32 references.

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What is Urinary Incontinence? Source: in King, B.D. and Harke, J. Coping with Bowel and Bladder Problems. San Diego, CA: Singular Publishing. 1994. p. 1-12. Contact: Available from Singular Publishing Group, Inc. 401 West A Street, Suite 325, San Diego, CA 92101-7904. (800) 521-8545 or (619) 238-6777. Fax (800) 774-8398 or (619) 238-6789. PRICE: $18.95. ISBN: 1565930681. Summary: This chapter is from a book in the Coping with Aging Series on managing bowel and bladder problems. The chapter provides a general overview of urinary incontinence for patients, their families, and other caregivers. Topics include a definition of urinary incontinence; ways that people try to control urine loss; the anatomy and function of the urinary system, including the kidneys, the ureters, the bladder, and the urethra; bladder function, including the role of the nervous system; changes that occur in the urinary system as people age; and the potential impact of chronic illness on the ability to maintain continence. 5 figures.

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Enuresis and Voiding Dysfunction in Children Source: in Hanno, P.M.; Malkowicz, S.B.; Wein, A.J. Clinical Manual of Urology. New York, NY: McGraw-Hill, Inc. 2001. p. 803-812. Contact: Available from McGraw-Hill, Inc. 1221 Avenue of the Americas, New York, NY 10020. (612) 832-7869. Website: www.bookstore.mcgraw-hill.com. PRICE: $54.95;plus shipping and handling. ISBN: 0071362010. Summary: This chapter is from a handbook that serves as a basic, portable reference tool for the busy medical student and house officer rotating on the urology service and that enables program directors to use the information presented as a framework on which to present their particular management styles and strategies. In addition, the handbook can serve as a ready reference for the primary care physician, who is often the first person to see the patient with what ultimately proves to be a urologic problem. This chapter considers enuresis (bedwetting) and voiding (urination) dysfunction in children. Topics include the neural (nerve) anatomy of the lower urinary system; the normal development of urinary continence; questions to consider in taking the patient history; the physical examination; radiographic imaging for diagnosis; the symptoms and etiology of dysfunctional voiding (including fecal symptoms); the use of urodynamics to help diagnose dysfunctional voiding; therapy choices; lazy bladder syndrome; vesicoureteral reflux (the return of urine from the bladder through the ureters back to the kidneys); non neurogenic bladder (Hinman Allen syndrome); Ochoa syndrome (urofacial syndrome); miscellaneous entities, including interstitial cystitis, giggle incontinence, and vaginal voiding; and the etiology, incidence, and therapy of nocturnal enuresis. The information in the chapter is presented in outline format, for ease of reference, and line drawings illustrate the chapter. The chapter concludes with a list of ten self-assessment questions and their answers. 9 references.

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Clinical Approach to Urinary Incontinence in the Elderly Source: in Andreucci, V.E., and Fine, L.G., eds. International Yearbook of Nephrology Dialysis Transplantation. 1995. p. 93-102. Contact: Available as a supplement to Nephrology Dialysis Transplantation, Volume 10. Oxford University Press, 2001 Evans Road, Cary, NC 27513-2009. (800) 334-4249. ISBN: 0192626493. Summary: This chapter of the International Yearbook of Nephrology, Dialysis, and Transplantation describes a clinial approach to urinary incontinence in the elderly. Topics include diagnosis and urodynamic assessment; urinalysis; the treatment of urinary incontinence; bladder retraining; stabilization of the bladder; correcting sphincter incompetence; treating voiding disorders; estrogen replacement therapy; and the science of urinary incontinence in the development of new pharmaceutical agents. 3 figures. 117 references.

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Injectable Agents for the Treatment of Stress Urinary Incontinence in Females Source: in Carlin, B.I. and Leong, F.C., eds. Female Pelvic Health and Reconstructive Surgery. New York, NY: Marcel Dekker, Inc. 2003. p. 107-119. Contact: Available from Marcel Dekker, Inc. 270 Madison Avenue, New York, NY 10016. (212) 696-9000. Fax (212) 685-4540. Website: www.dekker.com. PRICE: $185.00 plus shipping and handling. ISBN: 0824708229.

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Summary: This chapter on injectable agents for the treatment of stress urinary incontinence is from a textbook that provides comprehensive, authoritative coverage of female pelvic health and reconstructive surgery. The authors discuss the historical use of these agents, patient selection, surgical technique, expected results, complications, and future developments. As with any procedure, the results obtained with collagen injection therapy depend heavily on patient selection, expertise in performing the procedure, and the use of specialized equipment. Patient satisfaction depends on understanding the treatment options and, if collagen is selected, knowing that multiple injections will be necessary at greater than 4 week intervals with periodic reinjections after dryness is achieved to restore continence. Overall, collagen injections are easy to perform, minimally morbid, and remain very cost effective, especially when performed in the outpatient office setting. Nonetheless, the search for an inexpensive, easily injected, durable, but equally innocuous bulking agent continues. 6 figures. 1 table. 38 references. •

Epidemiology of Urinary Incontinence in Older Adults Source: in Ostergard, D.R. and Bent, A.E., eds. Urogynecology and Urodynamics: Theory and Practice. Baltimore, MD: Williams and Wilkins. 1996. p. 75-79. Contact: Available from Williams and Wilkins. 351 West Camden Street, Baltimore, MD 21201-2436. (800) 638-0672 or (410) 528-4223. Fax (800) 447-8438 or (410) 528-8550. E-mail: [email protected]. PRICE: $112.00. ISBN: 068306648X. Summary: This chapter on the epidemiology of urinary incontinence (UI) in older adults is from a textbook on urogynecology and urodynamics that is designed to promote a more active role for the obstetrician, gynecologist, urologist, and other physicians in the evaluation of the female lower urinary tract. UI is a prevalent, disruptive, and complex problem affecting a large number of older adults and constitutes a major burden on health and economic resources. UI is not a normal consequence of aging and is curable, or at least manageable, in most instances. However, many older adults with this condition are not seriously evaluated and treated by health care professionals. The prevalence and incidence of UI among communitydwelling older adults and in acute and long term care settings is difficult to measure because of methodological problems with study designs and underreporting. Estimates of UI prevalence in older adults in community settings range from 15 to 36 percent, from 15 to 25 percent in acute care settings, and from 40 to 70 percent in long term care settings. 51 references. (AA-M).

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Nonsurgical Treatment of Urinary Incontinence Source: in Carlin, B.I. and Leong, F.C., eds. Female Pelvic Health and Reconstructive Surgery. New York, NY: Marcel Dekker, Inc. 2003. p. 215-224. Contact: Available from Marcel Dekker, Inc. 270 Madison Avenue, New York, NY 10016. (212) 696-9000. Fax (212) 685-4540. Website: www.dekker.com. PRICE: $185.00 plus shipping and handling. ISBN: 0824708229. Summary: This chapter on the nonsurgical treatment of urinary incontinence is from a textbook that provides comprehensive, authoritative coverage of female pelvic health and reconstructive surgery. The author notes that urinary incontinence (UI) in women is disturbingly common, with a large number of women who do not report the problem and subsequently do not get help for the problem. The author briefly defines the different types of UI and then offers treatment strategies that may be used for inadequate bladder emptying, bladder overactivity (pelvic floor strengthening,

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pharmacological treatment, oral treatment), and stress incontinence (behavioral methods, bladder training, pelvic muscle strengthening, strengthening with vaginal cones, biofeedback, and functional electrical stimulation). The author concludes that nonsurgical treatment of both urge and stress incontinence is possible and can be effective. The use of medications and the availability of new medications for the treatment of urge incontinence have increased the armamentarium and also brought new awareness of a common problem to the public. 40 references. •

Artificial Urinary Sphincter for Treatment of Male Urinary Incontinence Source: in Carson, C.C., III. Urologic Prostheses: The Complete Practical Guide to Devices, Their Implantation, and Patient Follow up. Totowa, NJ: The Humana Press, Inc. 2002. p. 263-284. Contact: Humana Press, Inc. 999 Riverview Dr., Suite 208 Totowa, NJ 07512. (973) 2561699. Fax (973) 256-8341. E-mail: [email protected] PRICE: $125.00, plus shipping and handling. ISBN: 0896038947. Summary: This chapter on the use of the artificial urinary sphincter (AUS) for treatment of male urinary incontinence (involuntary loss of urine) is from a text that was compiled to provide a broad view of prosthetic devices used in urologic surgery. The authors note that insertion of the AUS in the male is presently still the most effective treatment for stress incontinence secondary to sphincter dysfunction. The authors discuss indications and patient selection for artificial urinary sphincter implantation, surgical techniques, postoperative followup, potential problems, and results with the AMS800 artificial urinary sphincter. The authors conclude that the AMS800 has proved successful and effective in the short and long term. Meticulous care in the patient workup preoperatively and during insertion is necessary, however, if maximum success is to be met. And, to meet with continued success after insertion, the patients must be monitored closely as long as the device is in place. Patients and physicians should be aware of signs of potential problems, changes in voiding habits, or signs of voiding dysfunction or infection. 10 figures. 18 references.

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Transabdominal Procedures for the Treatment of Stress Urinary Incontinence Source: in Carlin, B.I. and Leong, F.C., eds. Female Pelvic Health and Reconstructive Surgery. New York, NY: Marcel Dekker, Inc. 2003. p. 121-136. Contact: Available from Marcel Dekker, Inc. 270 Madison Avenue, New York, NY 10016. (212) 696-9000. Fax (212) 685-4540. Website: www.dekker.com. PRICE: $185.00 plus shipping and handling. ISBN: 0824708229. Summary: This chapter on transabdominal procedures for the treatment of stress urinary incontinence (SUI) is from a textbook that provides comprehensive, authoritative coverage of female pelvic health and reconstructive surgery. If the patient is continent at rest (sitting or lying down), the ideal treatment will be to simulate this situation while the patient is active (walking, coughing, sneezing, etc.). Transabdominal procedures can achieve this by stabilizing the anterior vaginal wall and, especially, the tissue next to and around the urethra. Starting with the Kelly plication, this chapter follows the evolution from the Marshall-Marchetti-Kranz (MMK) to the Burch procedure, along with some of its common modifications, and ends with a description of the paravaginal repair. While success rates vary from one operation to another, surgical technique is a factor in the eventual outcome of a procedure, making comparison between two different approaches difficult. With the advent of better surgical instruments and materials, and better understanding of the physiology of

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incontinence, overall success rates in the range of 85 to 95 percent can be expected. 10 figures. 36 references. •

Transvaginal Surgery for Stress Urinary Incontinence Source: in Carlin, B.I. and Leong, F.C., eds. Female Pelvic Health and Reconstructive Surgery. New York, NY: Marcel Dekker, Inc. 2003. p. 137-160. Contact: Available from Marcel Dekker, Inc. 270 Madison Avenue, New York, NY 10016. (212) 696-9000. Fax (212) 685-4540. Website: www.dekker.com. PRICE: $185.00 plus shipping and handling. ISBN: 0824708229. Summary: This chapter on transvaginal surgery for the treatment of stress urinary incontinence (SUI) is from a textbook that provides comprehensive, authoritative coverage of female pelvic health and reconstructive surgery. Presently, the surgical goal of correction of SUI is to enhance outlet resistance. In patients with urethral hypermobility, this can be accomplished by stabilizing the bladder neck and proximal urethra. In patients with intrinsic sphincter deficiency (ISD), this is accomplished by improving urethral support. There is often overlap of these two conditions, and ISD, as some suggest, exists in all forms of SUI. The surgical approach should reflect surgeon preference, patient comorbidities, concomitant surgical procedures to be performed, and experience of the surgeon. This chapter discusses needle suspension procedures, pubovaginal slings, the use of bone anchors in incontinence surgery, and expected urodynamic changes following incontinence surgery. The authors conclude that regardless of the choice of antiincontinence procedure, the keys to success continue to be proper patient selection, thorough preoperative evaluation and counseling, and diligent attention to detail intraoperatively. 5 figures. 3 tables. 98 references.

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Social Impact of Urinary Incontinence Source: in Raz, S., ed. Female Urology. 2nd ed. Philadelphia, PA: W.B. Saunders Company. 1996. p. 80-86. Contact: Available from W.B. Saunders Company. Order Fulfillment, 6277 Sea Harbor Drive, Orlando, FL 32887. (800) 545-2522. Fax (800) 874-6418 or (407) 352-3445. PRICE: $165.00 (as of 1996). ISBN: 0721667236. Summary: This chapter, from a medical text on female urology, covers the social impact of urinary incontinence. The author begins with a brief review of prevalence and psychosocial impact studies. Findings from two extensive surveys of people with incontinence are described. Topics include problems inherent in defining incontinence; social influences that affect attitudes and bladder habits in different age groups; and the difficulty of measuring the social impact of incontinence. The author concludes by presenting suggestions for improving current clinical practices in the management of women with urinary incontinence. 1 table. 52 references. (AA-M).

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Assessment and Investigation of Urinary Incontinence Source: in Jeter, K.F.; Faller, N.; Norton, C., eds. Nursing for Continence. Orlando, FL: W.B. Saunders Company. 1990. p. 25-63. Contact: Available from W.B. Saunders Company. 6277 Sea Harbor Drive, Orlando, FL 32887. (800) 545-2522. Fax (800) 874-6418. PRICE: $35.50 plus shipping. ISBN: 0721628923.

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Summary: This chapter, from a nursing textbook about the diagnosis, treatment, and management of incontinence, discusses the assessment and investigation of urinary incontinence. Four sections consider the clinical presentation of incontinence, taking the patient's history and conducting the interview, the physical examination, and urodynamic studies. A careful history, thoughtful physical examination, and simple urodynamic assessment offer a detailed picture of a patient's incontinence, as well as the physical, social, and psychological context within which incontinence occurs. The author notes that when symptoms are mixed or ambiguous, when surgery is contemplated, or when empiric treatment does not resolve urinary leakage, complex urodynamic testing is indicated. 8 figures. 1 table. 17 references. •

Urinary Incontinence in the Older Woman Source: in Kursh, E.D., and McGuire, E.J., eds. Female Urology. Philadelphia, PA: Lippincott-Raven Publishers. 1994. p. 475-494. Contact: Available from Lippincott-Raven Publishers. P.O. Box 1600, Hagerstown, MD 21741. (800) 638-3030 or (301) 714-2300. Fax (301) 824-7390. PRICE: $108.00 plus shipping. ISBN: 039751154X. Summary: This chapter, from a textbook on female urology, reviews urinary incontinence in the older woman. The author stresses that incontinence is abnormal at any age, and numerous studies have demonstrated that, regardless of age, mobility, or mental status, incontinence is a highly treatable and often curable disorder. Topics include the impact of age on incontinence; the causes of transient incontinence; lower urinary tract causes, including detrusor overactivity, stress incontinence, detrusor underactivity, and outlet obstruction; functional incontinence; the recommended diagnostic approach; the targeted physical examination; laboratory investigations; urodynamic testing; and therapy for detrusor overactivity, for stress incontinence, for outlet obstruction, and for the underactive detrusor. Treatment options discussed include drug therapy, behavioral training, collecting devices, pads and special undergarments, and catheterization. 11 tables. 67 references.

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Rectus Muscle Sling Procedure for Severe Stress Urinary Incontinence Source: in Graham, S.D., Jr., et al., eds. Glenn's Urologic Surgery. 5th ed. Philadelphia, PA: Lippincott Williams and Wilkins. 1998. p. 357-360. Contact: Available from Lippincott Williams and Wilkins. P.O. Box 1600, Hagerstown, MD 21741. (800) 638-3030 or (301) 714-2300. Fax (301) 824-7390. Website: lww.com. PRICE: $199.00 plus shipping and handling. ISBN: 0397587376. Summary: Type III stress urinary incontinence results from intrinsic dysfunction of the urethra and bladder neck incompetence. Effective surgical repair must restore closure of the deficient urethra. This chapter on the rectus muscle sling procedure used for severe stress urinary incontinence (SUI) is from an exhaustive textbook on urologic surgery. Current surgical techniques include the use of fascial slings, vaginal island slings, artificial urinary sphincter, or periurethral injections. Traditional indications would reserve sling procedures for those who have failed a primary surgical repair. In contemporary practice, the sling is also used as a primary procedure for patients with severe SUI. Clinical features would include leakage with a flood that occurs instantly with the first cough in a supine position, that occurs with a comfortably full bladder, or that occurs while standing without provocation. The authors detail the surgical technique using a combined abdominal and vaginal approach. Complications from this operation are few, but can include superficial wound infection and pelvic abscess. The

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authors note that voiding is quite normal for many of these patients after rectus muscle sling, and there are few complaints of irritative symptoms. 3 figures. 1 reference. •

Urethral Injection Treatment for Stress Urinary Incontinence Source: in Corcos, J.; Schick, E., eds. Urinary Sphincter. New York, NY: Marcel Dekker, Inc. 2001. p. 497-515. Contact: Available from Marcel Dekker, Inc. Cimarron Road, P.O. Box 5005, Monticello, NY 12701. (800) 228-1160 or (845) 796-1919. Fax (845) 796-1772. E-mail: [email protected]. International E-mail: [email protected]. Website: www.dekker.com. PRICE: $225.00 plus shipping and handling. ISBN: 0824704770. Summary: Urethral injectable agents (drugs injected directly into the urethra, the opening from the bladder to outside the body) have been used to treat urinary incontinence (involuntary loss of urine) resulting from intrinsic sphincteric deficiency (ISD). This chapter on ISD is from a textbook that presents a detailed and systematic account of the current knowledge on the anatomy, physiology, functional relationships, and range of dysfunctions that affect the urinary sphincter. The injection of bulking agents into the urethra is a minimally invasive procedure that can be done in the physician's office, as compared to the surgical procedures that have been used to treat ISD. The authors discuss the proposed mechanism of action of urethral injectable agents, the selection of the appropriate patient, various types of bulking agents, nuances of injection technique, and the outcomes in different patient groups. The two most commonly used urethral injectable agents are collagen and autologous (from the patient) fat. Contraindications to urethral injection include untreated urinary tract infection (UTI), unmanaged detrusor instability, or known hypersensitivity to bovine (cow) collagen. The technique is best suited for patients who have ISD associated with minimal urethral hypermobility, an adequate bladder capacity, and a stable detrusor muscle. The procedure is well tolerated by patients and is associated with minimal morbidity, which is usually transient. The authors conclude that this minimally invasive procedure can offer hope for those patients who are elderly or are poor surgical candidates, and will not preclude a surgical procedure for those who desire a more aggressive treatment for their urinary incontinence in the future. 2 figures. 5 tables. 71 references.

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Directories In addition to the references and resources discussed earlier in this chapter, a number of directories relating to urinary incontinence have been published that consolidate information across various sources. The Combined Health Information Database lists the following, which you may wish to consult in your local medical library:10 •

Continence Specialists Registry: A Guide to Professional Continence Providers Source: Philadelphia, PA: Access to Continence Care and Treatment, Inc. (ACCT). 1996. 250 p. Contact: Available from Access to Continence Care and Treatment, Inc. (ACCT). Ben Franklin House, 834 Chestnut Street, Suite T-171, Philadelphia, PA 19107. (215) 923-1492. Fax (215) 923-9024. PRICE: $100.00 plus $1.75 shipping and handling. Summary: This directory lists over 300 health care professionals who provide direct patient services in the area of urinary incontinence (UI). Registry listings include doctors, nurses, nurse practitioners, clinical nurse specialists, and physical and occupational therapists. The publication is designed to meet the need for referral and networking resources by UI practitioners and insurers, as well as to serve as a reference tool for the health profession in general. The main listing includes a list of programs (ranging from private practice to large urban hospital clinics), the contact information, staff titles, continence services provided, specialties, the site of practice, affiliations, and comments. Extensive indexes are also provided: personal names of providers, location, provider specialties, and services provided. Programs and individuals included were referred to the Registry or submitted their own entries; professional readers are invited to participate in future editions of the directory.

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You will need to limit your search to “Directory” and “urinary incontinence” using the "Detailed Search" option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find directories, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Select your preferred language and the format option “Directory.” Type “urinary incontinence” (or synonyms) into the “For these words:” box. You should check back periodically with this database as it is updated every three months.

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CHAPTER 7. MULTIMEDIA ON URINARY INCONTINENCE Overview In this chapter, we show you how to keep current on multimedia sources of information on urinary incontinence. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine.

Video Recordings An excellent source of multimedia information on urinary incontinence is the Combined Health Information Database. You will need to limit your search to “Videorecording” and “urinary incontinence” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Videorecording (videotape, videocassette, etc.).” Type “urinary incontinence” (or synonyms) into the “For these words:” box. The following is a typical result when searching for video recordings on urinary incontinence: •

Management of Urinary Incontinence in Long-Term Care Source: Baltimore, MD: University of Maryland at Baltimore School of Medicine. 1996. (videocassette). Contact: Available from Video Press, University of Maryland at Baltimore School of Medicine. Suite 133, 100 Penn Street, Baltimore, MD 21201-1082. (800) 328-7450 or (410) 706-5497. Fax (410) 706-8471. PRICE: $100.00 for 2-week rental; $300.00 for purchase. Summary: Greater than 75 percent of long-term care residents are affected by incontinence. The impact of this problem profoundly affects residents as well as staff. In this videotape, the Johns Hopkins team presents specific management programs that can minimize incontinence. Team roles of the physician, nurse, and nursing assistant are examined, with emphasis on the essential contributions of the nursing assistant. Topics include evaluation of residents to identify potential causes, documentation, behavioral

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interventions, and other management programs. Support print materials include bladder record sample, short assessment form, and behavioral instructions. (AA-M). •

Surgery for Urinary Incontinence in Women Source: Timonium, MD: Milner-Fenwick, Inc. 1995. Contact: Available from Milner-Fenwick, Inc. 2125 Greenspring Drive, Timonium, MD 21093. (800) 432-8433. Fax (410) 252-6316. PRICE: $175 (as of 1995). Order Number OB135. Summary: This patient education videotape is for female patients with stress incontinence who are being recommended for surgery. The program describes the various operations that may be performed and their associated length of recovery in hospital or at home. Techniques include the open abdominal, laparoscopic, and vaginal approaches to bladder surgery. The program also provides general information on the risks involved with bladder surgery, including infection, bleeding, reaction to anesthesia, injury to the bladder or urethra, and difficulty urinating. The videotape depicts a patient discussing these options with her physician. This video is also available with closed captioning. (AA-M).

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Periurethral Injection of Cross-Linked Collagen for Urinary Incontinence: An Investigational Device Source: Purchase, NY: P.C. Communication, Inc. 1990. Contact: Available from VideoUrology Times Inc. 270 Madison Avenue, New York, NY 10016. (800) 342-8244. (One of six video presentations comprising a videocassette program representing Program 1 of Volume 3 of VideoUrology. PRICE: $59.95 for 6-title set; $150 for 24-title set. Summary: This program, from a video journal on urology, demonstrates the technique of periurethral injection of collagen for increasing urethral resistance to the flow of urine in patients with incontinence. (AA-M).

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Bladder Leakage (Urinary Incontinence): Don't Suffer in Silence! Source: Royal Palm Beach, FL: Hepworth International, Inc. 1996. (videocassette). Contact: Available from SRS Medical Systems, Inc. 14950 NE 95th Street, Redmond, WA 98052. (800) 345-5642 or (425) 882-1101. PRICE: $19.95 each. Item number 4632B. Summary: This videotape program educates the public about treatments for bladder leakage. The program features experts in the field of urinary incontinence (UI) explaining the various treatment options. Topics covered include the types and causes of bladder leakage, prevention strategies (particularly before and after surgery, including childbirth), a structured program of pelvic muscle exercises (Kegels), foods and beverages that cause frequent urination, how to control the urge to urinate, treatment options including surgery and drug therapy, and where to find additional help and information. The program emphasizes that education and knowledge are the first steps toward successful treatment. The video comes with a self-test that helps viewers determine if they are a candidate for medical treatment for bladder leakage (UI). This viewer insert also lists beverages and foods to avoid if UI is a problem. (AAM).

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Leg Bags for Managing Urinary Incontinence Source: Libertyville, IL: Hollister Incorporated. 1992. (videocassette). Contact: Available from Hollister Incorporated. 2000 Hollister Drive, Libertyville, IL 60048. (800) 323-4060. PRICE: Single copy free. Summary: This videotape program familiarizes nurses with the use of urinary leg bags for people with urinary incontinence (UI). The program covers the incidence of UI, etiologic considerations, and the three primary types of UI; for each type, the etiology and treatment are covered. The program then notes the various products available from the Hollister company, focusing on the urinary leg bag. The features of the two types of urinary leg bag (vented and nonvented) are outlined. The program also includes a brief discussion of clinical applications for the leg bag in addition to male UI.

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Urinary Incontinence in Elderly Women Source: Chapel Hill, NC: Health Sciences Consortium. 1992. Contact: Available from Health Sciences Consortium. Distribution Department, 201 Silver Cedar Court, Chapel Hill, NC 27514-1517. (919) 942-8731. Fax (919) 942-3689. PRICE: $276.50 for HSC members, $395 for nonmembers (as of 1996). Item Number C920-VI-049. Rentals: $55 (HSC members); $80 (nonmembers). Summary: Urinary incontinence is a problem for many elderly people, especially women. This videotape program describes ways to help people manage their urinary incontinence, critiques incontinence supplies, and reviews issues of concern for health professionals. The program also covers the types of incontinence and treatment options for each. (AA-M).

Audio Recordings The Combined Health Information Database contains abstracts on audio productions. To search CHID, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find audio productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Sound Recordings.” Type “urinary incontinence” (or synonyms) into the “For these words:” box. The following is a typical result when searching for sound recordings on urinary incontinence: •

Urinary Incontinence: The Scope of the Problem-The Solutions on the Horizon Source: Dumont, NJ: Center for Bio-Medical Communication, Inc. 1997. (audiocassette). Contact: Available from Center for Bio-Medical Communication, Inc. 80 West Madison Avenue, Dumont, NJ 07628. (201) 385-8080. PRICE: Single copy free. Summary: This audiotape and accompanying monograph present highlights of a roundtable convened to identify and evaluate current and future therapies for urinary incontinence (UI), particularly UI due to the overactive bladder. Current concepts related to epidemiology, pathophysiology, diagnosis, monitoring, and treatment are presented. The pros and cons of current treatment options are weighted, and special considerations in the elderly, community-dwelling individuals, and institutionalized individuals are addressed. Among the therapies discussed are behavioral modification, pharmacologic treatments, electrical stimulation, and surgery. UI affects approximately

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13 million Americans, or 6 percent of the population, and costs the US economy $16 billion per year. The prevalence of the disorder increases progressively with age. At present, no validated, reproducible, well accepted efficacy instruments are available for the assessment of treatment outcomes in patients with UI. Primary outcome measures include the patient's own assessment of success, the number of incontinent episodes, volume of urine loss, and type of incontinence. UI is common in the elderly population, and the disorder tends to be more complex than in younger individuals. Electrical stimulation has been used to manage both bladder and urethral dysfunction in individuals with UI. When conservative management of detrusor instability (DI) is unsuccessful, surgical intervention may be indicated to control chronic, intractable symptoms or to circumvent the effects of a contracted bladder. Behavioral therapy for UI assumes that some individuals with incontinence can relearn continence control. In patients who are institutionalized, behavioral therapy may not control UI, but these techniques can be expected to reduce the severity of UI and improve the quality of life for the patient. Pharmacologic therapy for improving urine storage may be directed toward inhibiting bladder contractility, reducing sensory input, or increasing bladder capacity. The program requires a total of 150 minutes of study time and is approved for 2.5 CME credits. (AA-M).

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CHAPTER 8. PERIODICALS AND NEWS ON URINARY INCONTINENCE Overview In this chapter, we suggest a number of news sources and present various periodicals that cover urinary incontinence.

News Services and Press Releases One of the simplest ways of tracking press releases on urinary incontinence is to search the news wires. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing. PR Newswire To access the PR Newswire archive, simply go to http://www.prnewswire.com/. Select your country. Type “urinary incontinence” (or synonyms) into the search box. You will automatically receive information on relevant news releases posted within the last 30 days. The search results are shown by order of relevance. Reuters Health The Reuters’ Medical News and Health eLine databases can be very useful in exploring news archives relating to urinary incontinence. While some of the listed articles are free to view, others are available for purchase for a nominal fee. To access this archive, go to http://www.reutershealth.com/en/index.html and search by “urinary incontinence” (or synonyms). The following was recently listed in this archive for urinary incontinence: •

Magnetic chair shows promise as treatment for female urinary incontinence Source: Reuters Industry Breifing Date: April 06, 2004

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Duloxetine safe for urinary incontinence: study Source: Reuters Health eLine Date: October 29, 2003

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Lilly gets conditional approval of duloxetine for urinary incontinence Source: Reuters Medical News Date: September 03, 2003

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HRT may increase risk of stress and urge urinary incontinence Source: Reuters Industry Breifing Date: April 30, 2003

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Hormone therapy ups urinary incontinence risk Source: Reuters Health eLine Date: April 30, 2003

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Novasys gets CE Mark for system to treat stress urinary incontinence Source: Reuters Industry Breifing Date: April 22, 2003

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More women having surgery for urinary incontinence Source: Reuters Health eLine Date: April 01, 2003

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Smoking, tea drinking tied to urinary incontinence Source: Reuters Health eLine Date: March 06, 2003

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Vaginal delivery increases risk of urinary incontinence Source: Reuters Medical News Date: March 05, 2003

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Pelvic floor muscle training during pregnancy prevents urinary incontinence Source: Reuters Medical News Date: February 06, 2003

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Bard gains option to acquire Genyx urinary incontinence treatment Source: Reuters Industry Breifing Date: January 24, 2003

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Yamanouchi files for US approval of urinary incontinence drug Source: Reuters Industry Breifing Date: January 09, 2003

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Post-op antibiotics not needed after sling procedure for urinary incontinence Source: Reuters Industry Breifing Date: November 08, 2002

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Weight reduction improves female urinary incontinence Source: Reuters Medical News Date: October 17, 2002

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Weight loss improves female urinary incontinence Source: Reuters Health eLine Date: October 17, 2002

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Medical Technology Innovations gets FDA okay for urinary incontinence device Source: Reuters Industry Breifing Date: May 23, 2002

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Sling surgery shows promise as treatment for male urinary incontinence Source: Reuters Medical News Date: February 20, 2002

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NicOx to begin US testing of urinary incontinence drug Source: Reuters Industry Breifing Date: January 07, 2002

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Tutogen, Mentor in new distribution deal for urinary incontinence graft Source: Reuters Industry Breifing Date: November 15, 2001

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Estrogen replacement linked to urinary incontinence following hysterectomy Source: Reuters Medical News Date: October 08, 2001

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Natural menopause not a significant risk factor for urinary incontinence Source: Reuters Medical News Date: October 01, 2001

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Transdermal oxybutynin treats urge urinary incontinence with less side effects Source: Reuters Industry Breifing Date: July 13, 2001

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Medicare to cover sacral nerve stimulation for urinary incontinence Source: Reuters Medical News Date: June 29, 2001

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Medicare to cover novel treatment for urinary incontinence Source: Reuters Industry Breifing Date: June 29, 2001

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Anterior urethral stitch reduces urinary incontinence after radical prostatectomy Source: Reuters Medical News Date: May 15, 2001

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Protein Polymer partner to begin human trials of urinary incontinence drug in UK Source: Reuters Industry Breifing Date: May 01, 2001

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Urinary incontinence commonly follows hysterectomy Source: Reuters Medical News Date: August 14, 2000

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Successful phase II results for Sepracor's urinary incontinence therapy Source: Reuters Industry Breifing Date: June 20, 2000

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Urinary incontinence common, but underreported, among male veterans Source: Reuters Medical News Date: April 24, 2000

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Continuous magnetic stimulator effective in treatment of urinary incontinence Source: Reuters Medical News Date: February 01, 2000

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Rochester Medical receives FDA approval for female urinary incontinence device Source: Reuters Medical News Date: October 04, 1999

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Advanced UroScience gets FDA approval for urinary incontinence agent Source: Reuters Medical News Date: September 21, 1999

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Age-related loss of striated muscle cells a cause of elderly urinary incontinence Source: Reuters Medical News Date: September 16, 1999

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Adult urinary incontinence linked to childhood enuresis Source: Reuters Medical News Date: August 03, 1999

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Female urinary incontinence device gets EU marketing approval Source: Reuters Medical News Date: July 23, 1999 The NIH

Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine. Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name. Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to Market Wire’s home page at http://www.marketwire.com/mw/home, type “urinary incontinence” (or synonyms) into the search box, and click on “Search News.” As this service is technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests. Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “urinary incontinence” (or synonyms). If you know the name of a company that is relevant to urinary incontinence, you can go to any stock trading Web site (such as

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http://www.etrade.com/) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. Google offers a similar service at http://news.google.com/. BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “urinary incontinence” (or synonyms).

Newsletters on Urinary Incontinence Find newsletters on urinary incontinence using the Combined Health Information Database (CHID). You will need to use the “Detailed Search” option. To access CHID, go to the following hyperlink: http://chid.nih.gov/detail/detail.html. Limit your search to “Newsletter” and “urinary incontinence.” Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter.” Type “urinary incontinence” (or synonyms) into the “For these words:” box. The following list was generated using the options described above: •

Fat Injection Offers Another Alternative for Incontinence Tx Source: Urology Times. 22(3): 1, 24. March 1994. Contact: Available from Advanstar Communications, Inc. Corporate and Editorial Offices, 7500 Old Oak Boulevard, Cleveland, OH 44130. (216) 243-8100. Summary: This newsletter article report that 1-year results are making autologous fat injection look like a good alternative to surgery for stress urinary incontinence, possibly as good as collagen injection, but at lower cost and with less risk. Topics include results of a study in which 25 women have undergone the treatment; the need for second injections; complications encountered; the potential advantages of autologous fat over bovine collagen; the procedure itself; and patient selection issues. The researchers conclude that this promising procedure deserves further development and longer-term follow-up for analysis.

Newsletter Articles Use the Combined Health Information Database, and limit your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” Type “urinary incontinence” (or synonyms) into the “For these words:” box. You should check back periodically with this database as it is updated every three months. The following is a typical result when searching for newsletter articles on urinary incontinence:

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Needle Bladder Suspension for the Treatment of Stress Urinary Incontinence in Women Source: HIP Report. Help for Incontinent People Report. 11(2): 4. Spring 1993. Contact: Available from National Association for Continence (NAFC) (formerly Help for Incontinent People, or HIP). P.O. Box 8310, Spartanburg, SC 29305-8310. (800) BLADDER or (864) 579-7900. Fax (864) 579-7902. Summary: The transvaginal needle suspension of the bladder neck is a safe and effective operation used to restore urinary control to women with stress incontinence due to weak urethral support. This article explains the technique of needle bladder suspension and how it works. A brief prefatory section discusses the different types of urinary incontinence. Other topics include postoperative care, temporary urinary diversion after surgery, intermittent catheterization after surgery, and the use of pelvic muscle exercises to either avoid the need for surgery or to help with bladder control after surgery.

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Acupuncture as a Treatment for Urinary Incontinence Source: Quality Care. 18(3): 3. Summer 2000. Contact: Available from National Association for Continence. P.O. Box 8310, Spartanburg, SC 29305-8310. (800) 252-3337 or (864) 579-7900. Fax (864) 579-7902. Summary: This brief article considers the role of acupuncture in the treatment of patients with urinary incontinence (involuntary loss of urine). There are two versions of acupuncture: traditional and modern. Traditional acupuncture believes that one part of the body cannot be treated alone; it must be considered and balanced. Treatment for urinary incontinence (UI) would be guided by conducting a patient history and performing two basic diagnostic tests: the examination of the tongue and the character of the pulse at the wrist. In traditional acupuncture, specific trigger points along the energy paths (meridians) are stimulated by inserting very small needles through the skin. Modern acupuncture differs from traditional in many ways. Instead of examining the pulse and the tongue, the practitioner performs the customary examination of the body with a more detailed physical exam, paying close attention to the trigger points. The practitioner may then use fewer needles for a shorter period of time. The article concludes with a brief discussion of what patients can expect after a sessions of acupuncture. An acute condition may respond in only one session. A chronic condition, like urinary incontinence, may take 6 to 12 sessions, each lasting about 30 to 60 minutes. The author concludes that the effect of acupuncture differs for each person and accumulates with time.

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Urinary Incontinence and Sexuality Source: Quality Care. 16(3): 5. Summer 1998. Contact: Available from National Association for Continence. P.O. Box 8310, Spartanburg, SC 29305-8310. (800) 252-3337 or (864) 579-7900. Fax (864) 579-7902. Summary: This brief newsletter article reviews the problem of urinary incontinence and its impact on the patient's sexuality. The impact of incontinence may upset an established love life or create particular difficulties with a new relationship. Intimacy is about being close, and incontinence or the fear of leakage might be an obstacle, both mentally and physically. Problems may be greatest for those who have known continence but have lost it as a result of a difficult childbirth or surgery. This surgery

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can include hysterectomy or prolapse surgeries for women and prostatectomy for men. Loss of orgasm can also occur after surgery. There is often embarrassment, anger, and frustration with these adverse outcomes. Some causes for leakage include pelvic floor muscle weakness, overactive bladder contractions, or incomplete bladder emptying. The author notes that incontinence episodes with sex can sometimes be cured, often improved, but always managed by optimal care. The author briefly summarizes the principles of successful management: make sure the bladder and bowel are empty before sexual activity, use warmed lubricating gel, avoid a position that may provoke leakage, and share concerns with the sexual partner. The author encourages readers to work with their health care providers to manage urinary incontinence problems. •

Urinary Incontinence and Alzheimer's Disease Source: HIP Report. Help for Incontinent People Report. 12(3): 1. Summer 1994. Contact: Available from National Association for Continence (NAFC). (formerly Help For Incontinent People). P.O. Box 8310, Spartanburg, SC 29305-8310. (800) BLADDER or (864) 579-7900. Fax (864) 579-7902. Summary: This newsletter article discusses urinary incontinence (UI) and Alzheimer's disease. The author notes that UI is rarely seen in early or middle stages of Alzheimer's disease, because changes in the brain that affect urinary control do not occur until quite late in the course of the disease. Topics include the causes of UI, including urinary tract infection; difficulties with locating the bathroom; difficulties with clothing; suggestions for environmental adaptations to help patients use the toilet; and the timing of fluid intake and voiding intervals. The article concludes with the address and telephone number of the Alzheimer's Association, through which readers can obtain more information.

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Urinary Incontinence: Putting an End to the Embarrassment Source: Harvard Health Letter. 24(7): 6-7. May 1999. Contact: Available from Harvard Medical School Health Publications Group. Harvard Health Letter, P.O. Box 420300, Palm Coast, FL 32142-0300. (800) 829-9045. E-mail: [email protected]. Summary: This newsletter article encourages readers to learn about urinary incontinence (UI) and seek health care for managing any UI problems. Although UI affects both women and men, it is more common in women, and it is not a problem just in older people. The author stresses that incontinence is not considered normal at any age, and it should not be seen as an inevitable part of growing older. However, many people are too embarrassed to discuss the problem with a doctor, so they resign themselves to wearing adult diapers or pads. Fortunately, incontinence can be treated or even cured in most people by strengthening the pelvic muscles, taking medication, or both. The article briefly reviews the anatomy of the urinary tract, then defines three types of incontinence: stress, urge, and overflow. Individuals may be asked to keep a diary during the week prior to the doctor's visit to keep track of how much and how often they urinated or leaked urine. Tests performed in the office may include a pelvic or rectal exam, a urinalysis to test for infection, and a noninvasive imaging scan to check for residual urine in the bladder. Strengthening pelvic floor muscles with Kegel exercises has been shown to reduce urine leakage in 50 to 75 percent of women and cure it in 20 percent with stress incontinence. Other treatment options covered include bladder retraining, biofeedback, drug therapy, dietary changes (cutting back on alcohol and caffeine), and surgery. The author concludes that surgery is generally considered a

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last resort and is mainly used to strengthen pelvic muscles or lift the bladder to alleviate stress incontinence. 1 figure. •

Sexual Function and Urinary Incontinence Source: Quality Care. 19(4): 1,5. Fall 2001. Contact: Available from National Association for Continence. P.O. Box 8310, Spartanburg, SC 29305-8310. (800) 252-3337 or (864) 579-7900. Fax (864) 579-7902. Summary: This newsletter article helps women with urinary incontinence (UI) understand the impact of UI on sexual function. Some women experience loss of urine during sexual activity. Causes of leakage can include pelvic floor muscle weakness, overactive bladder contractions, or incomplete bladder emptying. With minimal arousal, the pelvic muscles can relax and allow drops of leakage. With penetration (intercourse) a woman may experience bladder contractions, or with orgasm, involuntary relaxation may cause a flood. When this happens, women may avoid sexual activity altogether. In addition, constant wetness from UI may lead to irritation in the vulvar area, and this can cause discomfort with sexual activity. This author offers strategies to prevent these problems, focusing on the surgical options. Surgery is an effective treatment option for some women with UI, particularly the stress type of incontinence (leaking provoked by physical stress such as coughing, sneezing, running, or jumping). Stress incontinence can occur in combination with pelvic organ prolapse (when the vagina, uterus, or bladder have lost support and dropped down). The author briefly describes the surgical techniques that are usually used for UI. The article concludes with four suggestions to help manage UI during sexual activity.

Academic Periodicals covering Urinary Incontinence Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to urinary incontinence. In addition to these sources, you can search for articles covering urinary incontinence that have been published by any of the periodicals listed in previous chapters. To find the latest studies published, go to http://www.ncbi.nlm.nih.gov/pubmed, type the name of the periodical into the search box, and click “Go.” If you want complete details about the historical contents of a journal, you can also visit the following Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/, you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”

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CHAPTER 9. RESEARCHING MEDICATIONS Overview While a number of hard copy or CD-ROM resources are available for researching medications, a more flexible method is to use Internet-based databases. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.

U.S. Pharmacopeia Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications recommended for urinary incontinence. One such source is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the U.S. Pharmacopeia (USP). Today, the USP is a non-profit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at http://www.usp.org/. The USP currently provides standards for over 3,700 medications. The resulting USP DI Advice for the Patient can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database, located at http://www.fda.gov/cder/da/da.htm. While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopeia (USP). Below, we have compiled a list of medications associated with urinary incontinence. If you would like more information on a particular medication, the provided hyperlinks will direct you to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.).

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The following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to urinary incontinence: Antidepressants, Tricyclic •

Systemic - U.S. Brands: Anafranil; Asendin; Aventyl; Elavil; Endep; Norfranil; Norpramin; Pamelor; Sinequan; Surmontil; Tipramine; Tofranil; Tofranil-PM; Vivactil http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202055.html

Antidyskinetics •

Systemic - U.S. Brands: Akineton; Artane; Artane Sequels; Cogentin; Kemadrin; Parsidol; Trihexane; Trihexy http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202057.html

Desmopressin •

Systemic - U.S. Brands: DDAVP Injection; DDAVP Nasal Spray; DDAVP Rhinal Tube; DDAVP Tablets; Stimate Nasal Spray http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202186.html

Racemethionine •

Systemic - U.S. Brands: M-Caps; Pedameth; Uracid http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202727.html

Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. Or, you may be able to access these sources from your local medical library.

Mosby’s Drug Consult Mosby’s Drug Consult database (also available on CD-ROM and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Subscription information is available at the following hyperlink: http://www.mosbysdrugconsult.com/. PDRhealth The PDRhealth database is a free-to-use, drug information search engine that has been written for the public in layman’s terms. It contains FDA-approved drug information adapted from the Physicians’ Desk Reference (PDR) database. PDRhealth can be searched by brand name, generic name, or indication. It features multiple drug interactions reports. Search PDRhealth at http://www.pdrhealth.com/drug_info/index.html.

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Other Web Sites Drugs.com (www.drugs.com) reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. (http://www.medletter.com/) which allows users to download articles on various drugs and therapeutics for a nominal fee. If you have any questions about a medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1-888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.

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APPENDICES

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APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.

NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute11: •

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

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National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/

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National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html

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National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25

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National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm

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National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm

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National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375

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National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/

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These publications are typically written by one or more of the various NIH Institutes.

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National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm

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National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/

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National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm

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National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm

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National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/

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National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/

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National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm

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National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html

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National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm

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National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm

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National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm

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National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html

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National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm

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Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp

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National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/

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National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp

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Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html

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Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm

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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.12 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:13 •

Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html

•

HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html

•

NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html

•

Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/

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Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html

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Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html

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Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/

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Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html

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Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html

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Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html

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MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html

12

Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 13 See http://www.nlm.nih.gov/databases/databases.html.

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•

Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html

•

Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html

The NLM Gateway14 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.15 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “urinary incontinence” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total

Items Found 17508 386 753 21 245 18913

HSTAT16 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.17 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.18 Simply search by “urinary incontinence” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

14

Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.

15

The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 16 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 17 18

The HSTAT URL is http://hstat.nlm.nih.gov/.

Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations.

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Coffee Break: Tutorials for Biologists19 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.20 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.21 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.

Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: •

CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.

•

Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.

19 Adapted 20

from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html.

The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 21 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.

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APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on urinary incontinence can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.

Patient Guideline Sources The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to urinary incontinence. Due to space limitations, these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. The National Institutes of Health The NIH gateway to patients is located at http://health.nih.gov/. From this site, you can search across various sources and institutes, a number of which are summarized below. Topic Pages: MEDLINEplus The National Library of Medicine has created a vast and patient-oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages” which list links to available materials relevant to urinary incontinence. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following when searched for “urinary incontinence”:

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Bladder Cancer http://www.nlm.nih.gov/medlineplus/bladdercancer.html Bladder Diseases http://www.nlm.nih.gov/medlineplus/bladderdiseases.html Kidney Diseases http://www.nlm.nih.gov/medlineplus/kidneydiseases.html Kidney Stones http://www.nlm.nih.gov/medlineplus/kidneystones.html Prostate Cancer http://www.nlm.nih.gov/medlineplus/prostatecancer.html Sleep Disorders http://www.nlm.nih.gov/medlineplus/sleepdisorders.html Toilet Training and Bedwetting http://www.nlm.nih.gov/medlineplus/toilettrainingandbedwetting.html Urinary Tract Infections http://www.nlm.nih.gov/medlineplus/urinarytractinfections.html

Within the health topic page dedicated to urinary incontinence, the following was listed: •

General/Overviews Coping with Bladder Problems http://www.fda.gov/opacom/lowlit/bladprb.html Incontinence: Frequently Asked Questions Source: National Association for Continence http://www.nafc.org/about_incontinence/faq.htm Urinary Incontinence: Embarrassing but Treatable Source: American Academy of Family Physicians http://familydoctor.org/189.xml

•

Diagnosis/Symptoms Cystoscopy and Ureteroscopy Source: National Kidney and Urologic Diseases Information Clearinghouse http://kidney.niddk.nih.gov/kudiseases/pubs/cystoscopy/index.htm Imaging of the Urinary Tract Source: National Kidney and Urologic Diseases Information Clearinghouse http://kidney.niddk.nih.gov/kudiseases/pubs/imagingut/index.htm Urinalysis Source: American Association for Clinical Chemistry http://www.labtestsonline.org/understanding/analytes/urinalysis/test.html Urination Problems Source: American Academy of Family Physicians http://familydoctor.org/535.xml

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Urodynamic Testing Source: National Kidney and Urologic Diseases Information Clearinghouse http://kidney.niddk.nih.gov/kudiseases/pubs/urodynamic/index.htm •

Treatment Surgical Management of Urinary Incontinence Source: American Urological Association http://urologyhealth.org/adult/index.cfm?cat=03&topic=133 Treatment Options for Incontinence Source: National Association for Continence http://www.nafc.org/about_incontinence/treatment.htm

•

Specific Conditions/Aspects JAMA Patient Page: Stress Incontinence Source: American Medical Association http://www.medem.com/medlb/article_detaillb.cfm?article_ID=ZZZJG5O35ID&s ub_cat=318 Nerve Disease and Bladder Control Source: National Institute of Diabetes and Digestive and Kidney Diseases http://kidney.niddk.nih.gov/kudiseases/pubs/nervedisease/index.htm Talking to Your Doctor About Incontinence Source: Simon Foundation for Continence http://www.simonfoundation.org/html/e/reprints/toc.htm Your Medicines and Bladder Control Source: National Kidney and Urologic Diseases Information Clearinghouse http://kidney.niddk.nih.gov/kudiseases/pubs/medicine_ez/index.htm

•

Latest News Magnetic Chair Helps Women with Bladder Problems Source: 04/06/2004, Reuters Health http://www.nlm.nih.gov//www.nlm.nih.gov/medlineplus/news/fullstory_16987 .html

•

Men Urinary Incontinence in Men Source: National Kidney and Urologic Diseases Information Clearinghouse http://kidney.niddk.nih.gov/kudiseases/pubs/uimen/index.htm

•

Organizations American Foundation for Urologic Disease http://www.afud.org/ American Urological Association http://www.auanet.org/ National Association for Continence http://www.nafc.org/

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National Institute of Diabetes and Digestive and Kidney Diseases http://www.niddk.nih.gov/ National Kidney and Urologic Diseases Information Clearinghouse Source: National Institute of Diabetes and Digestive and Kidney Diseases http://kidney.niddk.nih.gov/ Simon Foundation for Continence http://www.simonfoundation.org/html/ •

Women Bladder Control for Women http://kidney.niddk.nih.gov/kudiseases/pubs/bcw_ez/index.htm Cystocele (Fallen Bladder) Source: National Kidney and Urologic Diseases Information Clearinghouse http://kidney.niddk.nih.gov/kudiseases/pubs/cystocele/index.htm Exercising Your Pelvic Muscles Source: National Kidney and Urologic Diseases Information Clearinghouse http://kidney.niddk.nih.gov/kudiseases/pubs/exercise_ez/index.htm Menopause and Bladder Control Source: National Kidney and Urologic Diseases Information Clearinghouse http://kidney.niddk.nih.gov/kudiseases/pubs/menopause_ez/index.htm Pessary: What It Is and How to Use One Source: American Academy of Family Physicians http://familydoctor.org/578.xml Pregnancy, Childbirth and Bladder Control Source: National Kidney and Urologic Diseases Information Clearinghouse http://kidney.niddk.nih.gov/kudiseases/pubs/pregnancy_ez/index.htm Talking to Your Health Care Team about Bladder Control http://kidney.niddk.nih.gov/kudiseases/pubs/talk_ez/ Treatments for Urinary Incontinence in Women Source: National Institute of Diabetes and Digestive and Kidney Diseases http://kidney.niddk.nih.gov/kudiseases/pubs/treatmentsuiwomen/index.htm

You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on urinary incontinence. CHID offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to

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http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: •

Treatments for Urinary Incontinence in Women Source: Bethesda, MD: National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). 2003. 6 p. Contact: Available from National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). 3 Information Way, Bethesda, MD 20892-3580. (800) 891-5390 or (301) 654-4415. Fax (301) 634-0716. E-mail: [email protected]. Website: http://www.niddk.nih.gov/health/kidney/nkudic.htm. PRICE: Full-text available online at no charge; single copy free; bulk orders available. NIH Publication number: 035104. Summary: Millions of women experience loss of bladder control (urinary incontinence, UI). UI can be slightly bothersome or totally debilitating. No single treatment works for everyone, but most women can be treated without surgery. This brochure describes treatments for urinary incontinence in women. Many women try the simpler treatment options first, such as changing a few habits and doing exercises to strengthen the muscles that hold urine in the bladder. The brochure reviews behavioral remedies, including bladder retraining and Kegel exercises; medicines for overactive bladder; electrical stimulation for nerve problems; vaginal devices (pessaries) for stress incontinence; injections for stress incontinence; surgery for stress incontinence; and current research in this area. One sidebar describes specific steps for performing Kegel exercises. The brochure concludes with the contact information for four resource organizations, and a brief description of the activities of the National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC), a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). 5 figures.

•

Answers to Your Questions About Urinary Incontinence: Loss of Bladder Control Source: Baltimore, MD: Bladder Health Council. 1993. 16 p. Contact: Available from American Foundation for Urologic Disease. 1126 North Charles Street, Baltimore, MD 21201. (800) 242-2383 or (410) 468-1800. Fax (410) 468-1808. Website: www.afud.org. PRICE: Single copy free. Summary: This booklet briefly describes the different types of urinary incontinence. Written for patients newly diagnosed with urinary incontinence, the booklet describes diagnostic tests that may be used and the types of treatments available. Specific topics include who is affected and why; some possible causes of incontinence; urinary tract anatomy and physiology; different types of incontinence, including stress, urge, mixed, overflow, environmental or functional, and nocturnal enuresis; diagnostic tests, including urinalysis, post-void residual measurement, ultrasound, cystoscopy, stress test, and urodynamic testing; treatment options, including behavioral therapy, medicine, surgery, and absorbent products and devices. The booklet includes a brief pre-test and answers, and a glossary of terms. Also included is a blank bladder diary for the reader to use for recording fluid intake and problems with incontinence. 3 figures. 1 table.

•

Urinary Incontinence in Women: A Guide for Women Source: San Ramon, CA: Health Information Network, Inc. 1997. 32 p.

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Contact: Available from HIN, Inc. 231 Market Place, Number 331, San Ramon, CA 94583. (800) HIN-1121. Fax (925) 358-4377. Website: www.hinbooks.com. PRICE: $2.95 suggested list price; professional discount price $1.35 with bulk discounts available. Order number 303. ISBN: 1885274416. Summary: This booklet familiarizes readers with urinary incontinence in women. Urinary incontinence (UI) is defined as uncontrolled leakage of urine from the bladder. The author stresses that many treatment choices exist for UI, even when a complete cure may not be possible. UI can be caused by infection, injury, hormonal changes, pregnancy, childbirth, use of certain medications, and illness. The booklet describes how the urinary system works, the types of UI, treating UI, what to expect at the doctor's office, the role of support groups, behavioral techniques used to treat UI, biofeedback, the use of absorbent products, medications (drug therapy), and surgical options used to treat the problem. The booklet teaches readers how to perform pelvic floor exercises (Kegel exercises) as one option for treatment. Other treatment options described in detail are bladder exercises and intermittent self-catheterization. One sidebar emphasizes the importance of adequate skin care, especially for those persons using absorbent products on a regular basis. The booklet concludes with a glossary of related terms and a list of resource organizations through which readers can get more information. 14 references. 1 table. •

Confronting Urinary Incontinence: A Guidebook for the Aging Network Source: Tampa, FL: University of South Florida. 1994. 30 p. Contact: Available from National Eldercare Institute on Long Term Care and Alzheimer's Disease at the Suncoast Gerontology Center, University of South Florida. 12901 Bruce B. Downs Boulevard, Tampa, FL 33612-4799. (813) 974-4355; FAX (813) 9744251. PRICE: $5.00. Summary: This booklet is designed to help service providers in the aging network deal with urinary incontinence (UI) in service settings and provides material for nonclinical staff training. It includes information about UI in people with Alzheimer's disease (AD). Part I discusses the problems caused by UI, different types of UI, and treatments for UI, and offers guidelines for the assessment and management of UI in service settings such as adult day-care centers. It includes two UI questionnaires, one for general use and one for use in adult day-care settings. The section on UI and AD explains how impaired thinking, disorientation, and loss of fine motor skills can cause functional incontinence and suggests interventions to compensate for these cognitive and motor deficits. Part II provides summary sheets which can be used as training materials for staff. These sheets include information about UI facts, the urinary tract, causes and types of UI, pelvic muscle exercises, and intervention approaches.

•

Urinary Incontinence: Treating Loss of Urine Control Source: New York, NY: National Kidney Foundation. 1996. 7 p. Contact: National Kidney Foundation. 30 East 33rd Street, New York, NY 10016. (800) 622-9010. Website: www.kidney.org. PRICE: Single copy free; bulk copies available. Summary: This brief brochure from the National Kidney Foundation reviews the treatment options for urinary incontinence. Written in an easy to read, question and answer format, the brochure discusses the possible causes of urinary incontinence, including aging, pregnancy, and diseases (diabetes, stroke, and nerve disease); how to define urinary incontinence; treatment methods including drugs, behavior therapy,

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exercise, biofeedback, electrical stimulation, and surgery; the use of absorbent protective pads and catheterization; and the impact of urinary incontinence on sexual activity. The brochure stresses that incontinence can be treated and often can be cured. •

Urinary Incontinence in Women Source: American Family Physician. 62(11): 2452. December 1, 2000. Contact: Available from American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. (800) 274-2237. Website: www.aafp.org. Summary: This brief fact sheet reviews urinary incontinence (involuntary leakage of urine) in women. Many things can cause urinary incontinence; these will be determined during the patient history and examination. The two most common types of UI are stress incontinence, when one leaks urine during an activity that causes pressure on the bladder (such as sneezing), and urge incontinence, when one leaks urine before reaching the bathroom. Various treatments are available, some of which involve surgery and some of which involve exercises or use of special devices, including biofeedback or electrical stimulation. Surgery can cure most women with stress incontinence. One new type of surgery, called the tension free vaginal tape sling, can be done on an outpatient basis with local anesthesia. However, potential problems from surgery may include difficulty emptying the bladder and the development of urge incontinence. The fact sheet concludes with the web sites and other contact information for resources for readers wishing to find out more about urinary incontinence.

•

How Common is Urinary Incontinence? Source: St. Louis, MO: Society of Gynecologic Surgeons (SGS). 2004. 1 p. Contact: Available from Society of Gynecologic Surgeons (SGS). 621 S. New Ballas Road, Suite 2009, St. Louis, MO 63141. (314) 569-6881. Fax: (314) 995-4376. Email: [email protected] or [email protected]. Website: www.sgsonline.org. PRICE: Fulltext available online at no charge. Summary: This brief online fact sheet considers the epidemiology of urinary incontinence. The author briefly summarizes a recent (1998) study of the prevalence of urinary incontinence. Of the 489 women in the study, some urine leakage was reported by 47 percent and regular urine leakage was reported by 31 percent. For 19 percent of the women, leakage was confirmed on physical exam and claimed to be a social or hygienic problem. Incontinence was associated with heavier body weight, with poor ability to contract pelvic floor muscles, and with previous gynecological operations, excluding hysterectomy. From the study, the authors concluded that in women aged 50 to 74 years, about one in five will need treatment of some sort. Urinary incontinence is a chronic condition with little tendency to go away without treatment.

•

Injection Therapy: For Urinary Incontinence Source: Spartanburg, SC: National Association for Continence. 1997. 2 p. Contact: Available from National Association for Continence. P.O. Box 8310, Spartanburg, SC 29305-8310. (800) 252-3337 or (864) 579-7900. Fax (864) 579-7902. PRICE: $1.00 for members, $1.50 for nonmembers. Summary: This brochure explains the use of injection therapy for urinary incontinence, particularly that caused by intrinsic sphincteric deficiency (ISD), defined as poor function of the sphincter mechanism at the neck of the bladder. This can be a result of a

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neurologic injury, surgical trauma, or congenital problems like spina bifida. One technique of treating this type of incontinence is with the injection of bulking material into the tissues around the urethra. This bulk protects against incontinence by increasing the resistance to the outflow of urine. After many years of research, the use of collagen (Contigen implant) has been established as a safe and effective treatment for sphincter malfunction. The brochure outlines patient selection, treatment technique, postinjection patient care, and expected results. Since therapy with contigen implant can usually be performed with local anesthesia alone, a significant number of patients who are not candidates for surgical procedures may benefit from this treatment. Eighty percent of women are dry or improved after three treatments; 77 percent will remain dry once this has been attained. Unfortunately, results in men are not as favorable, since only 40 percent attain dryness. The brochure lists related publications available through the National Association for Continence. 3 figures. •

Simple Facts: Male Urinary Incontinence Source: Neenah, WI: Kimberly-Clark Corporation. 2000. 13 p. Contact: Available from Kimberly-Clark Corporation. 2001 Marathon Avenue, Neenah, WI 54956. (800) 558-6423. PRICE: Single copy free. Summary: This brochure provides basic information about the causes, diagnosis, and treatment of male urinary incontinence. Topics include incontinence following prostate surgery, the use of pelvic muscle exercises, variations in the severity of urinary incontinence, male incontinence not related to prostate surgery, the role of diet and general health in managing urinary incontinence, and absorbent products available. The brochure concludes with a list of suggested reading, as well as a description of a few resource organizations and self-help groups through which readers can obtain more information. This brochure is also available, in slightly different form, in Spanish ('La Realidad Sobre La Incontinencia Urinaria'). 2 figures.

•

Urinary Incontinence in Men: Regaining Control Source: San Bruno, CA: Krames Communications. 1996. 2 p. Contact: Available from Krames Communications. Order Department, 1100 Grundy Lane, San Bruno, CA 94066. (800) 333-3032. Fax (415) 244-4512. PRICE: $0.40 each (as of 1996); bulk prices available. Summary: This brochure provides information about urinary incontinence in men. Topics include the types of incontinence, i.e., stress, urge, and overflow; treatment options, including medications, catheters, behavioral changes, and surgery; and the anatomy of the male lower urinary tract. The brochure notes that short-term causes of all types of incontinence include medication side effects, infection, surgery, or mobility problems. Incontinence due to nerve or muscle damage may be longer term. The brochure encourages readers to seek treatment for any urinary incontinence problems.

•

Urinary Incontinence: Embarrassing But Treatable Source: Kansas City, MO: American Academy of Family Physicians. 2000. 2 p. Contact: Available from American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. (800) 274-2237. Website: www.aafp.org. PRICE: $22 for 100 copies (AAFP members), $33 for 100 copies (nonmembers). Item Number 1552.

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Summary: This brochure provides readers with basic information about urinary incontinence and its treatment. Written in a question and answer format, the brochure defines urinary incontinence and then discusses the causes of incontinence; the different types of incontinence, including stress, urge, and overflow incontinence; agerelated urinary incontinence and its management; treatment options,including Kegel exercises, bladder training, losing weight, and biofeedback; and the role of drug therapy or surgery. The brochure includes a sidebar that describes the technique for performing Kegel exercises and another sidebar that lists the causes of urinary incontinence. •

Kegel's Exercises and Devices for Stress Urinary Incontinence Source: St. Louis, MO: Society of Gynecologic Surgeons (SGS). 2004. [3 p.]. Contact: Available from Society of Gynecologic Surgeons (SGS). 621 S. New Ballas Road, Suite 2009, St. Louis, MO 63141. (314) 569-6881. Fax: (314) 995-4376. Email: [email protected] or [email protected]. Website: www.sgsonline.org. PRICE: Fulltext available online at no charge. Summary: This fact sheet describes the use of Kegel exercises and devices for managing stress urinary incontinence (SUI). Topics include the history of Kegel exercises, how to learn to do Kegel exercises, isometric Kegel exercise versus that with a vaginal device, the different types of devices available, and the long-term use of Kegel exercises to prevent surgery for stress incontinence. The author notes that the Kegel exercises have generally been more effective in women with mild stress incontinence, but if there is severe incontinence or moderate to severe prolapse involved, then surgery is much more effective. If a woman is successful initially in the exercises producing continence, then it is fairly likely (66 percent) that she can avoid surgery in the long run. Also, if she learns to give a quick squeeze of the bulbocavernosus muscle (perineal lock) just before any sudden increase in intraabdominal pressure from a sneeze or a cough, that can be the most effective mechanism for maintaining long term success.

•

Urinary Incontinence: A Difficult Topic to Talk About Source: Tampa, FL: National Eldercare Institute on Long Term Care and Alzheimer's Disease at the Suncoast Gerontology Center, University of South Florida. 1993. 2 p. Contact: National Eldercare Institute on Long Term Care and Alzheimer's Disease. Suncoast Gerontology Center, USF Health Sciences Center, 12901 Bruce B. Downs Boulevard, MDC Box 50, Tampa, FL 33612-4799. (813) 974-4355. Fax (813) 974-4251. PRICE: $1 (as of 1995). Reproducible in some situations (see document for details). Summary: This fact sheet familiarizes readers with a variety of issues pertinent to urinary incontinence (UI) in older people. Topics covered include the incidence of UI; stress incontinence; causes of UI; treatment options, including Kegel exercises, treatment of urinary tract infections, and behavior modification; and resource organizations that can provide information and support to people with UI. The fact sheet concludes with some advice for coping with UI.

•

Five Facts About Urinary Incontinence: Plus Ten Things You Can Do About Urinary Incontinence Source: Rockville, MD: Urology Wellness Center. 1998. [2 p.]. Contact: Available from Urology Wellness Center. 14820 Physicians Lane, Suite 241, Rockville, MD 20850. (301) 424-5661. Fax (301) 424-3734. PRICE: Single copy free.

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Urinary Incontinence

Summary: This straightforward brochure first lists 5 facts about urinary incontinence (the involuntary leakage of urine), then offers 10 strategies for preventing or managing urinary incontinence (UI). The facts are: UI is not an inevitable part of aging; UI is a symptom, not a disease; UI can be helped without surgery in 70 percent of people with the problem; the absorbent products that many people with UI use instead of seeking treatment can be very expensive; and UI causes increased admission to nursing homes, urinary tract infections (UTIs), skin diseases, and falls. The strategies offered to manage UI include maintaining a record of urinary activity, evaluating the diary (with or without a health care provider's input), urinating every 3 hours, eliminating bladder irritants from the diet (caffeine, aspartame, alcohol, and orange juice), not restricting water and other fluids, learning how to do Kegel exercises (pelvic floor exercises), doing Kegel exercises regularly, and managing urge incontinence. The back section of the brochure lists four types of UI and their causes: stress UI, urge UI, overflow UI, and functional UI. The brochure concludes with the telephone numbers of three organizations through which readers can get additional information. •

New Therapies for Urinary Incontinence: News Briefings for Science Writers on Transplantation, Dialysis and Kidney Research (memorandum) Source: New York, NY: National Kidney Foundation, Inc. March 26-27, 1990. 8 p. Contact: Available from National Kidney Foundation, Inc. 30 East 33rd Street, New York, NY 10016. (800) 622-9010 or (212) 889-2210. PRICE: Single copy free; call for bulk rates. Summary: This technical paper prepared for the National Kidney Foundation's 1990 science writers news briefing on transplantation, dialysis, and kidney/urology research discusses urinary incontinence. Urinary incontinence, the involuntary loss of urine, affects approximately 12-24 million Americans at an annual cost of over 10 billion dollars. Incontinence is curable in the vast majority of patients, but less than 10 percent of persons with urinary incontinence actually seek care. The most promising new treatments include a daily pill to stop the bladder from contracting involuntarily; a nasal spray to decrease the amount of urinary output; and non-surgical implantations of substances which enhance the function of the urinary sphincter. Sections discuss new advances in the treatment of urinary incontinence including medications, behavioral therapy, biofeedback, electrical stimulation, periurethral injections, and reconstructive surgery.

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Talking Together About Bladder Control: Frequently Asked Questions About Urinary Incontinence Source: Westmount, Quebec: Canadian Continence Foundation. 2006. 14 p. Contact: Canadian Continence Foundation. B.P/P.O. 30, Succ. Victoria Branch, Westmount, Quebec, Canada, H3Z 2V4. (514) 488-8379. Email: [email protected]. Website: www.continence-fdn.ca. PRICE: Contact organization for print copies. Summary: Urinary incontinence (UI) is the loss of bladder control. This booklet helps readers who are experiencing urine leakage to learn about UI and how to discuss it with a health care professional. Written in a question and answer format, the booklet covers a definition of UI, temporary versus ongoing UI, statistics about UI, the causes of UI, the anatomy and physiology of the bladder and urinary system, the symptoms of different types of UI (urge, stress, overflow), tests used to diagnose UI (blood tests, cystoscopy, post-void residual measurement, stress test, urinalysis, and urodynamic testing), treatment options (bladder retraining, pelvic floor muscle exercises, biofeedback,

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medication, surgery, intermittent catheterization), and products available to help manage incontinence. The booklet concludes with a list of healthy bladder habits, including those regarding fluid intake, use of caffeine and alcohol, and urination habits. The booklet contains a tear-out symptom checklist and bladder diary that readers can complete and bring to their health care provider. Medical terms highlighted in bold type are defined in a glossary at the end of the booklet. The brochure includes a description of the goals and activities of the Canadian Continence Foundation (TCCF), encouraging readers to contact them for more information (www.continence-fdn.ca). 1 figure. 2 tables. •

Reversible Causes of Urinary Incontinence: A Guide for Patients Source: Glenview, IL: Wound, Ostomy, and Continence Nurses Society. 2002. 2 p. Contact: Wound, Ostomy, and Continence Nurses Society. (WOCN). 4700 W. Lake Avenue, Glenview, IL 60025. (888) 224-WOCN. Fax: (866) 615-8560. Website: www.wocn.org. Price: Contact organization for print copies. Summary: Urinary incontinence (UI) is typically classified as either acute or persistent. Acute UI has an abrupt onset and is usually related to some reversible condition. When the condition is corrected, incontinence is often resolved. Persistent UI continues after correction of reversible conditions. This brochure helps readers understand nine reversible factors that can contribute to UI: atrophic urethritis or vaginitis, bladder infection, constipation or stool impaction, decreased mobility (leg use) or dexterity (hand use), delirium, depression, exposure to irritants, use of medications (pharmaceuticals), urinary retention, passing very large amounts of urine (polyuria). For each factor, the brochure describes the condition and explains why there may be an impact on urination, resulting in urinary incontinence. The brochure includes a list of resource organizations for readers who want more information and a list of suggestions to help keep one's bladder healthy.

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Urinary Incontinence in Children Source: Bethesda, MD: National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). 1997. 6 p. Contact: Available from National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). 3 Information Way, Bethesda, MD 20892-3580. (800) 891-5390 or (301) 654-4415. Fax (301)634-0716. E-mail: [email protected]. Website: www.niddk.nih.gov/health/kidney/nkudic.htm. PRICE: Full-text available online at no charge; single copy free; bulk orders available. Order number: KU-119. Summary: This fact sheet presents basic information about urinary incontinence in children. The introduction emphasizes that occasional incontinence is a normal part of growing up and that treatment is available for most children who have difficulty controlling their bladders. The fact sheet covers how the urinary system works; the causes of nighttime incontinence, including slower physical development, excessive output of urine during sleep, anxiety, genetics, and structural problems; the causes of daytime incontinence, including an overactive bladder, infrequent voiding, and some of the same factors that cause nighttime incontinence; and treatment options, including no treatment (the child 'outgrows' the incontinence), medications, bladder training and related strategies, and moisture alarms. The fact sheet notes that after age 5, incontinence disappears naturally at a rate of 15 percent of cases per year. One sidebar defines the different types of incontinence (or enuresis). A list of four organizations that can provide readers with more information is provided.

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Controlling Urinary Incontinence Source: Washington, DC: Alliance for Aging Research. National Institute on Aging. 1995. 2 p. Contact: Available from National Institute on Aging Information Center. P.O. Box 8057, Gaithersburg, MD 20898-8057. (800) 222-2225. Also available from Alliance for Aging Research. 2021 K Street NW., Suite 305, Washington, DC 20006. (202) 293-2856. PRICE: Single copy free; bulk copies available. Summary: This fact sheet provides information for patients on controlling urinary incontinence. Topics include diagnostic considerations; treatment options; bladder control; bladder training; and determining success of treatment. The fact sheet explains the bladder training process and how to handle it. The author stresses that the majority of patients who have used the bladder training technique report some improvement. The fact sheet concludes by reemphasizing that treatment for urinary incontinence is available and that the condition can always be managed, if not cured. 2 figures.

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Clinical Bulletin: Treating Patients With Urinary Incontinence Source: Washington, DC: Alliance for Aging Research. National Institute on Aging. 1992. 44 p. Contact: Available from National Institute on Aging (NIA) Information Center. P.O. Box 8057, Gaithersburg, MD 20898-8057. (800) 222-2225 or (301) 495-3450. Fax (301) 589-3014. TTY (800) 222-4225. E-mail: [email protected]. Also available from Alliance for Aging Research. 2021 K Street NW., Suite 305, Washington, DC 20006. (202) 293-2856. PRICE: Single copy free; bulk copies available. Summary: This information packet keeps primary care providers informed of the latest treatment information for their patients with urinary incontinence (UI). Included in the packet is a summary of findings from the clinical trial of bladder training supported by the National Institutes of Health (NIH); a reprint from the Journal of the American Medical Association describing the trial; a vocabulary of UI terms; and the Statement of the NIH Consensus Development Conference on UI in Adults. Patient information materials include a pad of fact sheets on controlling urinary incontinence through bladder training; a brochure on incontinence; and an Age Page about urinary incontinence. The packet also includes request cards to obtain additional copies of the patient education brochure, as well as a copy of the UI treatment guideline available from the Agency for Health Care Policy and Research (AHCPR). The materials are gathered in a folder.

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Drugs That Cause Urinary Incontinence Source: St. Louis, MO: Society of Gynecologic Surgeons (SGS). 2004. [3 p.]. Contact: Available from Society of Gynecologic Surgeons (SGS). 621 S. New Ballas Road, Suite 2009, St. Louis, MO 63141. (314) 569-6881. Fax: (314) 995-4376. Email: [email protected] or [email protected]. Website: www.sgsonline.org. PRICE: Fulltext available online at no charge. Summary: This online fact sheet explores the problem of medications that can cause or contribute to urinary incontinence (the involuntary loss of urine). The author notes that many medications actually worse or cause urinary leakage. The author describes how drugs can cause urinary incontinence, then considers specific drugs, including antihypertensive medicines (drugs prescribed for high blood pressure), anti-

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Parkinsonism drugs, and drugs for gastrointestinal problems (including motility disorders). A final section offers suggestions for monitoring for side effects that may lead to urinary incontinence. •

Special Care Problems: Urinary Incontinence Source: Minneapolis, MN: Department of Veterans Affairs, Geriatric Research, Education and Clinical Center, Office of Geriatrics, Veterans Health Services and Research Administration. August 1989. 14 p. Contact: Available from Department of Veterans Affairs. Publications Office, 6307 Gravel Road, Alexandria, VA 22310. PRICE: Single copies free. Summary: This pamphlet is part of a series prepared by the Department of Veterans Affairs Medical Center's Geriatric Research, Education, and Clinical Center. It is designed to serve as a guide for families and primary caregivers caring for persons with dementia-related diseases, provides basic information and guidance concerning how to recognize and handle the special care problems posed by urinary incontinence that may be exhibited by such patients. Particular attention is given to: the particular types of problems raised by these actions, and how to look for signs of these particular problems: how such special problem areas can be treated (or, if not, how it can be managed); and practical tips to help in communicating with a patient having these types of special problems. The increased difficulty for a caregiver in caring for such patients is discussed, and the importance of the caregiver taking proper care of their own health is emphasized. Included is a list of further recommended readings.

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Urinary Incontinence Source: Washington, DC: American College of Obstetricians and Gynecologists. December 1990. 4 p. Contact: Available from American College of Obstetricians and Gynecologists. 409 12th Street, SW, Washington, DC 20024-2188. (202) 638-5577. PRICE: Single copy free; 50 for $12. Summary: This pamphlet outlines the characteristics, degrees of symptoms, and common causes of urinary incontinence in women and the methods used to diagnose and treat this condition. Causes discussed include urinary tract diseases and hormone changes, pelvic support defects, abnormalities in the urinary tract, neuromuscular disorders, and some types of drug therapy. Diagnostic measures are briefly listed. Treatments include antibiotics to combat infection, estrogen to relieve urinary incontinence of women past menopause, other medications, electrical stimulation of muscles surrounding the bladder and urethra, the use of pessaries, surgery when necessary, and special (Kegel) exercises to help restore normal urine voiding. A glossary of terms is appended.

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Pelvic Floor Stimulation for Urinary Incontinence Source: Midvale, UT: Utah Medical Products, Inc. 1995. 6 p. Contact: Available from Utah Medical Products, Inc. 7043 South 300 West, Midvale, UT 84047. (800) 533-4984 or (801) 566-1200. Fax (801) 566-2062. PRICE: Single copy free. Summary: This pamphlet provides an overview of urinary incontinence therapy using the Liberty System from Utah Medical Products for pelvic floor stimulation (PFS). The pamphlet discusses the incidence of urinary incontinence in women, the benefits of

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PFS, the anatomy and normal function of the urinary tract, stress incontinence, urge incontinence, mixed incontinence, the use of PFS in conjunction with pelvic floor exercises (Kegels), and how the Liberty System works. The pamphlet concludes with a list of patient selection guidelines for PFS therapy. 2 figures. •

Understanding Urinary Incontinence in Women: A Common and Treatable Condition Source: San Bruno, CA: StayWell Company. 2000. 15 p. Contact: Available from Staywell Company. Order Department, 1100 Grundy Lane, San Bruno, CA 94066-9821. (800) 333-3032. Fax (650) 244-4512. PRICE: $1.35 per copy; plus shipping and handling. Order number 11230. Summary: This patient education booklet reviews the diagnosis and therapy of urinary incontinence (UI) in women. The booklet begins with a description of the different types of UI: stress incontinence, in which urine leaks out when stress (pressure) is put on the bladder; urge incontinence, characterized by a strong, uncontrollable need to urinate; overflow incontinence, in which the bladder does not empty normally; and mixed incontinence. The booklet lists the symptoms of each type of incontinence. The booklet reviews the normal urinary system, how urine is normally kept in the bladder, and how urination normally occurs. Tests that may be used to diagnose UI include the pelvic examination, urinalysis and culture (to test for infection), cystoscopy, cystogram, and urodynamics (tests that show how well the bladder is working). Treatment options can include Kegel exercises, special therapies, medication (drug therapy), timed voiding, bladder retraining, collagen injections, self catheterization, and surgery. The booklet describes how to perform Kegel (pelvic floor) exercises and explains how adjunctive therapies such as biofeedback and electrical stimulation can be utilized. A final section offers an overview of pelvic floor surgery, including preoperative care, the surgery itself, risks and complications, and postoperative recovery. The booklet includes a series of checklists and a bladder diary for readers to complete and bring to their physician, to help in the diagnosis of UI. The booklet concludes with the toll free telephone numbers of three related resource organizations. The booklet is illustrated with full color line drawings. 26 figures. 1 table.

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What You Should Know About Urinary Incontinence: Loss of Urine Control Source: West Haven, CT: Miles, Inc., Pharmaceutical Division. 1992. 4 p. Contact: Available from Miles, Inc. Pharmaceutical Division, 400 Morgan Lane, West Haven, CT 06516. (800) 468-0894. PRICE: Free. Summary: This patient education brochure provides an introduction to urinary incontinence. Written in a question-and-answer format, the brochure covers a definition of urinary incontinence; the causes of incontinence; the urinary tract; symptoms of different types of incontinence, including stress, overflow, and urge incontinence; diagnosing incontinence; and treatments, including pelvic exercises, medical treatment, and surgical treatment. The brochure includes space for the health care provider to individualize instructions for the reader.

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Getting Control Over Urinary Incontinence Source: American Family Physician. 54(2): 683-685. August 1996. Summary: This patient education fact sheet, designed to be duplicated and distributed by physicians, provides information on getting control over urinary incontinence. Topics include the incidence of urinary incontinence, its causes, the three types of

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incontinence (stress, urge, overflow), and treatment options, including Kegel exercises, bladder training, and drug therapy. The fact sheet concludes with a brief section on the adverse effect some medications have on urinary incontinence. The fact sheet also lists publications for readers who wish to obtain additional information. 5 references. •

Treating Urinary Incontinence: A Guide to Behavioral Methods for Patients and Caregivers Source: Charlottesville, VA: Family Health Media. 1994. Contact: Available from Family Health Media. P.O. Box 1842, Charlottesville, VA 22903. (800) 366-3641. Fax (804) 296-2289. PRICE: $99 plus $5 shipping and handling (as of 1995); free preview available. ISBN: 1885279019. Summary: This patient education videotape presents an overview of the behavioral methods used to treat urinary incontinence. Topics covered include the anatomy and physiology of the urinary system; urge versus stress incontinence; pelvic muscle exercises; bladder training; and dietary recommendations. The accompanying teacher's guide is designed to help in the preparation of in-service programs. It contains program objectives, an outline of the video content, pre-and post-tests, a glossary of terms used in the video, and a bibliography. Also included is a fact sheet based on the content of the video. The fact sheet illustrates and summarizes pelvic muscle exercises, and summarizes bladder training and dietary factors. There is room on the fact sheet for the educator to enter comments or instructions specific to each patient's needs.

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Urinary Incontinence in Adults Source: New York, NY: Nidus Information Services, Inc. 1996. 8 p. Contact: Available from Nidus Information Services, Inc. 175 Fifth Avenue, Suite 2338, New York, NY 10010. (800) 334-9355 or (212) 260-4268. Fax (212) 529-2349. E-mail: [email protected]. PRICE: $5.95; bulk discounts available. Summary: This report, updated in 1996, provides information about urinary incontinence in adults. Written in a question and answer format, the report covers topics including a definition of urinary incontinence; the four types of incontinence, including stress, urge, overflow, and functional; the incidence and prevalence of incontinence; the causes of each of the types of incontinence; the diagnostic tests and methods used to confirm urinary incontinence, including catheterization, ultrasound, cystometrography, urinary flow rate (uroflowmetry), cystoscopy or cystourethroscopy, intravenous pyelograms and other radiographic studies, and urodynamics; the effects of urinary incontinence, including complications and psychosocial effects; and treatment options, including behavioral techniques, medications, and surgery. One final section discusses the management of chronic incontinence, including the use of absorbent products, external collection devices, and catheterization. The report concludes with a list of four resource organizations through which readers can obtain more information. The National Guideline Clearinghouse™

The National Guideline Clearinghouse™ offers hundreds of evidence-based clinical practice guidelines published in the United States and other countries. You can search this site located at http://www.guideline.gov/ by using the keyword “urinary incontinence” (or synonyms). The following was recently posted:

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(1) Best practice evidence-based guideline for the appropriate prescribing of hormone replacement therapy. (2) Guideline update: hormone replacement therapy Source: Effective Practice Institute, University of Auckland - Academic Institution; 2001 May (revised information released on 2002 September 30); 185 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3107&nbr=2333&a mp;string=urinary+AND+incontinence

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ACR Appropriateness Criteriatm for dementia Source: American College of Radiology - Medical Specialty Society; 1996 (revised 1999); 9 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2445&nbr=1671&a mp;string=urinary+AND+incontinence

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ACR Appropriateness Criteriatm for neurodegenerative disorders Source: American College of Radiology - Medical Specialty Society; 1999; 9 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2452&nbr=1678&a mp;string=urinary+AND+incontinence

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Adult low back pain Source: Institute for Clinical Systems Improvement - Private Nonprofit Organization; 1994 June (revised 2002 Sep); 61 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3498&nbr=2724&a mp;string=urinary+AND+incontinence

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Altered mental states Source: American Health Care Association - Professional Association; 1998 (reviewed 2003); 20 pages http://www.guideline.gov/summary/summary.aspx?doc_id=1804&nbr=1030&a mp;string=urinary+AND+incontinence

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American Gastroenterological Association medical position statement on anorectal testing techniques Source: American Gastroenterological Association - Medical Specialty Society; 1998 July 24 (reviewed 2001); 4 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3066&nbr=2292&a mp;string=urinary+AND+incontinence

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American Gastroenterological Association medical position statement on obesity Source: American Gastroenterological Association - Medical Specialty Society; 2002 September; 3 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3490&nbr=2716&a mp;string=urinary+AND+incontinence

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American Gastroenterological Association medical position statement: guidelines for the evaluation and management of chronic diarrhea Source: American Gastroenterological Association - Medical Specialty Society; 1998 November 8 (reviewed 2001); 3 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3065&nbr=2291&a mp;string=urinary+AND+incontinence

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Benign prostatic hyperplasia Source: Finnish Medical Society Duodecim - Professional Association; 2001 April 30 (revised 2002 March 22); Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=3811&nbr=3037&a mp;string=urinary+AND+incontinence

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Chemotherapy and biotherapy: guidelines and recommendations for practice Source: Oncology Nursing Society - Professional Association; 2001; 226 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3209&nbr=2435&a mp;string=urinary+AND+incontinence

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Determining the volume of residual urine by ultrasonography Source: Finnish Medical Society Duodecim - Professional Association; 2000 May 9; Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=2853&nbr=2079&a mp;string=urinary+AND+incontinence

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Evidence based clinical practice guideline for patients 6 years of age or less with a first time acute urinary tract infection (UTI) Source: Cincinnati Children's Hospital Medical Center - Hospital/Medical Center; 1999 March 28 http://www.guideline.gov/summary/summary.aspx?doc_id=1970&nbr=1196&a mp;string=urinary+AND+incontinence

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Evidence-based clinical practice guideline. Continence for women Source: Association of Women's Health, Obstetric, and Neonatal Nurses - Professional Association; 2000 January; 27 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2925&nbr=2151&a mp;string=urinary+AND+incontinence

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Functional constipation and soiling in children Source: University of Michigan Health System - Academic Institution; 1997 September (revised 2003 Feb); 10 pages http://www.guideline.gov/summary/summary.aspx?doc_id=4113&nbr=3158&a mp;string=urinary+AND+incontinence

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Guideline for prevention and management of pressure ulcers Source: Wound, Ostomy, and Continence Nurses Society - Professional Association; 2003; 52 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3860&nbr=3071&a mp;string=urinary+AND+incontinence

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Health professional's guide to rehabilitation of the patient with osteoporosis Source: American Academy of Orthopaedic Surgeons - Medical Specialty Society; 2003; 31 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3863&nbr=3074&a mp;string=urinary+AND+incontinence

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Low back pain or sciatica in the primary care setting Source: Department of Defense - Federal Government Agency [U.S.]; 1999 May; Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=2578&nbr=1804&a mp;string=urinary+AND+incontinence

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Management of non-muscle-invasive bladder cancer Source: American Urological Association, Inc. - Medical Specialty Society; 1999; 66 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2143&nbr=1369&a mp;string=urinary+AND+incontinence

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Management of patients with stroke. Rehabilitation, prevention and management of complications, and discharge planning. A national clinical guideline Source: Scottish Intercollegiate Guidelines Network - National Government Agency [Non-U.S.]; 1998 April (revised 2002 Nov); 48 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3538&nbr=2764&a mp;string=urinary+AND+incontinence

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Osteoporosis: prevention and treatment Source: University of Michigan Health System - Academic Institution; 2002 March; 12 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3541&nbr=2767&a mp;string=urinary+AND+incontinence

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Practice guideline for evaluation of fever and infection in long-term care facilities Source: Infectious Diseases Society of America - Medical Specialty Society; 2000 September; 14 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2664&nbr=1890&a mp;string=urinary+AND+incontinence

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Practice parameter: management of dementia (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology Source: American Academy of Neurology - Medical Specialty Society; 2001 May; 13 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2818&nbr=2044&a mp;string=urinary+AND+incontinence

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Pressure ulcers Source: American Medical Directors Association - Professional Association; 1996 (reviewed January 2001, 2002, and 2003); 20 pages http://www.guideline.gov/summary/summary.aspx?doc_id=1811&nbr=1037&a mp;string=urinary+AND+incontinence

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Preventing falls in acute care Source: The John A. Hartford Foundation Institute for Geriatric Nursing - Academic Institution; 2003; 32 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3510&nbr=2736&a mp;string=urinary+AND+incontinence

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Prevention of constipation in the older adult population Source: Registered Nurses Association of Ontario - Professional Association; 2002 January; 38 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3710&nbr=2936&a mp;string=urinary+AND+incontinence

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Promoting continence using prompted voiding Source: Registered Nurses Association of Ontario - Professional Association; 2002 January; 40 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3711&nbr=2937&a mp;string=urinary+AND+incontinence

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Prompted voiding for persons with urinary incontinence Source: University of Iowa Gerontological Nursing Interventions Research Center, Research Dissemination Core - Academic Institution; 1999; 47 pages http://www.guideline.gov/summary/summary.aspx?doc_id=1724&nbr=950&am p;string=urinary+AND+incontinence

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Recommendation for the management of stress and urge urinary incontinence in women Source: University of Texas at Austin School of Nursing, Family Nurse Practitioner Program - Academic Institution; 2002 May; 13 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3227&nbr=2453&a mp;string=urinary+AND+incontinence

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Risk assessment and prevention of pressure ulcers Source: Registered Nurses Association of Ontario - Professional Association; 2002 January; 56 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3713&nbr=2939&a mp;string=urinary+AND+incontinence

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Screening for prostate cancer: recommendations and rationale Source: United States Preventive Services Task Force - Independent Expert Panel; 1996 (revised 2002 Nov); 13 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3404&nbr=2630&a mp;string=urinary+AND+incontinence

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Smallpox vaccination and adverse reactions. Guidance for clinicians Source: Centers for Disease Control and Prevention - Federal Government Agency [U.S.]; 2003 January 24; 29 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3597&nbr=2823&a mp;string=urinary+AND+incontinence

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Specialty referral guidelines for people with diabetes Source: American Healthways, Inc - Public For Profit Organization; 1998 (revised 1999); 22 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2005&nbr=1231&a mp;string=urinary+AND+incontinence

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Surgical management of hemorrhoids Source: Society for Surgery of the Alimentary Tract, Inc - Medical Specialty Society; 1996 (revised 2000); 3 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2171&nbr=1397&a mp;string=urinary+AND+incontinence

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The management of benign prostatic hyperplasia Source: American Urological Association, Inc. - Medical Specialty Society; 2003; Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=3740&nbr=2966&a mp;string=urinary+AND+incontinence

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Treatment of pressure ulcers Source: Agency for Healthcare Research and Quality - Federal Government Agency [U.S.]; 1994 December (reviewed 2000); 154 pages http://www.guideline.gov/summary/summary.aspx?doc_id=810&nbr=8&st ring=urinary+AND+incontinence

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Urinary incontinence Source: American Medical Directors Association - Professional Association; 1996 (reviewed January 2001, 2002 and 2003); 16 pages http://www.guideline.gov/summary/summary.aspx?doc_id=1812&nbr=1038&a mp;string=urinary+AND+incontinence

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Urinary incontinence Source: The John A. Hartford Foundation Institute for Geriatric Nursing - Academic Institution; 2003; 14 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3507&nbr=2733&a mp;string=urinary+AND+incontinence

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Urinary incontinence in women Source: Finnish Medical Society Duodecim - Professional Association; 2001 January 4; Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=3400&nbr=2626&a mp;string=urinary+AND+incontinence

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Wheelchair biking for the treatment of depression Source: University of Iowa Gerontological Nursing Interventions Research Center, Research Dissemination Core - Academic Institution; 2003 February; 53 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3682&nbr=2908&a mp;string=urinary+AND+incontinence Healthfinder™

Healthfinder™ is sponsored by the U.S. Department of Health and Human Services and offers links to hundreds of other sites that contain healthcare information. This Web site is located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database: •

Urinary Incontinence Summary: Incontinence does not happen because of aging. It may be caused by changes in your body due to disease. For example, incontinence may be the first and only symptom of a urinary tract infection. Source: National Institute on Aging, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=808

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Urinary Incontinence in Children Summary: Although it affects many young people, it usually disappears naturally over time, which suggests that incontinence, for some people, may be a normal part of growing up. Source: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=832

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Urinary Incontinence in Women Summary: Overview of the types of urinary incontinence in women and its diagnosis and treatment. Source: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6544 The NIH Search Utility

The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to urinary incontinence. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively

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rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats

•

Family Village: http://www.familyvillage.wisc.edu/specific.htm

•

Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/

•

Med Help International: http://www.medhelp.org/HealthTopics/A.html

•

Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/

•

Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/

•

WebMDHealth: http://my.webmd.com/health_topics

Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to urinary incontinence. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with urinary incontinence. The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about urinary incontinence. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “urinary incontinence” (or a synonym), and you will receive information on all relevant organizations listed in the database.

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Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “urinary incontinence”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “urinary incontinence” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “urinary incontinence” (or a synonym) into the search box, and click “Submit Query.”

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APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.

Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.22

Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.

Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of

22

Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.

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libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)23: •

Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/

•

Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)

•

Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm

•

California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html

•

California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html

•

California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html

•

California: Gateway Health Library (Sutter Gould Medical Foundation)

•

California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/

•

California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp

•

California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html

•

California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/

•

California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/

•

California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/

•

California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html

•

California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/

•

Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/

•

Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/

•

Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/

23

Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.

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•

Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml

•

Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm

•

Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html

•

Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm

•

Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp

•

Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/

•

Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm

•

Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html

•

Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/

•

Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm

•

Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/

•

Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/

•

Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/

•

Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm

•

Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html

•

Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm

•

Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/

•

Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/

•

Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10

•

Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/

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•

Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html

•

Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp

•

Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp

•

Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/

•

Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html

•

Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm

•

Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp

•

Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/

•

Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html

•

Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/

•

Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm

•

Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/

•

Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html

•

Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm

•

Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330

•

Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)

•

National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html

•

National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/

•

National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/

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•

Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm

•

New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/

•

New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm

•

New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm

•

New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/

•

New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html

•

New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/

•

New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html

•

New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/

•

Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm

•

Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp

•

Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/

•

Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/

•

Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml

•

Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html

•

Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html

•

Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml

•

Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp

•

Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm

•

Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/

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•

South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp

•

Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/

•

Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/

•

Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72

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ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •

ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html

•

MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp

•

Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/

•

Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html

•

On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/

•

Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp

•

Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm

Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a). The NIH suggests the following Web sites in the ADAM Medical Encyclopedia when searching for information on urinary incontinence: •

Basic Guidelines for Urinary Incontinence BPH Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000381.htm Enuresis Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001556.htm Urinary incontinence products Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003973.htm

•

Signs & Symptoms for Urinary Incontinence Incontinence Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003142.htm Incontinent Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003142.htm

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Muscle weakness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003174.htm Weakness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003174.htm •

Diagnostics and Tests for Urinary Incontinence Digital rectal exam Web site: http://www.nlm.nih.gov/medlineplus/ency/article/007069.htm Ultrasound Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003336.htm Urine volume Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003425.htm Vasopressin Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003702.htm

•

Nutrition for Urinary Incontinence H2O Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002471.htm

•

Surgery and Procedures for Urinary Incontinence Transurethral resection of the prostate Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002996.htm

•

Background Topics for Urinary Incontinence Kegel exercises Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003975.htm Penis Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002279.htm Physical examination Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002274.htm

Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •

Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical

•

MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html

Online Glossaries 279

•

Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/

•

Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine

281

URINARY INCONTINENCE DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. 1-Propanol: A colorless liquid made by oxidation of aliphatic hydrocarbons that is used as a solvent and chemical intermediate. [NIH] Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Abdominal Pain: Sensation of discomfort, distress, or agony in the abdominal region. [NIH] Aberrant: Wandering or deviating from the usual or normal course. [EU] Ablation: The removal of an organ by surgery. [NIH] Abscess: A localized, circumscribed collection of pus. [NIH] Accommodation: Adjustment, especially that of the eye for various distances. [EU] Acetylcholine: A neurotransmitter. Acetylcholine in vertebrates is the major transmitter at neuromuscular junctions, autonomic ganglia, parasympathetic effector junctions, a subset of sympathetic effector junctions, and at many sites in the central nervous system. It is generally not used as an administered drug because it is broken down very rapidly by cholinesterases, but it is useful in some ophthalmological applications. [NIH] Acetylgalactosamine: The N-acetyl derivative of galactosamine. [NIH] Acetylglucosamine: The N-acetyl derivative of glucosamine. [NIH] Actin: Essential component of the cell skeleton. [NIH] Adamantane: A tricyclo bridged hydrocarbon. [NIH] Adaptability: Ability to develop some form of tolerance to conditions extremely different from those under which a living organism evolved. [NIH] Adaptation: 1. The adjustment of an organism to its environment, or the process by which it enhances such fitness. 2. The normal ability of the eye to adjust itself to variations in the intensity of light; the adjustment to such variations. 3. The decline in the frequency of firing of a neuron, particularly of a receptor, under conditions of constant stimulation. 4. In dentistry, (a) the proper fitting of a denture, (b) the degree of proximity and interlocking of restorative material to a tooth preparation, (c) the exact adjustment of bands to teeth. 5. In microbiology, the adjustment of bacterial physiology to a new environment. [EU] Adenine: A purine base and a fundamental unit of adenine nucleotides. [NIH] Adenosine: A nucleoside that is composed of adenine and d-ribose. Adenosine or adenosine derivatives play many important biological roles in addition to being components of DNA and RNA. Adenosine itself is a neurotransmitter. [NIH] Adenosine Monophosphate: Adenylic acid. Adenine nucleotide containing one phosphate group esterified to the sugar moiety in the 2'-, 3'-, or 5'-position. [NIH] Adenosine Triphosphate: Adenosine 5'-(tetrahydrogen triphosphate). An adenine nucleotide containing three phosphate groups esterified to the sugar moiety. In addition to its crucial roles in metabolism adenosine triphosphate is a neurotransmitter. [NIH]

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Adenylate Cyclase: An enzyme of the lyase class that catalyzes the formation of cyclic AMP and pyrophosphate from ATP. EC 4.6.1.1. [NIH] Adipose Tissue: Connective tissue composed of fat cells lodged in the meshes of areolar tissue. [NIH] Adjustment: The dynamic process wherein the thoughts, feelings, behavior, and biophysiological mechanisms of the individual continually change to adjust to the environment. [NIH] Adjuvant: A substance which aids another, such as an auxiliary remedy; in immunology, nonspecific stimulator (e.g., BCG vaccine) of the immune response. [EU] Adrenal Cortex: The outer layer of the adrenal gland. It secretes mineralocorticoids, androgens, and glucocorticoids. [NIH] Adrenal Medulla: The inner part of the adrenal gland; it synthesizes, stores and releases catecholamines. [NIH] Adrenergic: Activated by, characteristic of, or secreting epinephrine or substances with similar activity; the term is applied to those nerve fibres that liberate norepinephrine at a synapse when a nerve impulse passes, i.e., the sympathetic fibres. [EU] Adverse Effect: An unwanted side effect of treatment. [NIH] Aetiology: Study of the causes of disease. [EU] Afferent: Concerned with the transmission of neural impulse toward the central part of the nervous system. [NIH] Affinity: 1. Inherent likeness or relationship. 2. A special attraction for a specific element, organ, or structure. 3. Chemical affinity; the force that binds atoms in molecules; the tendency of substances to combine by chemical reaction. 4. The strength of noncovalent chemical binding between two substances as measured by the dissociation constant of the complex. 5. In immunology, a thermodynamic expression of the strength of interaction between a single antigen-binding site and a single antigenic determinant (and thus of the stereochemical compatibility between them), most accurately applied to interactions among simple, uniform antigenic determinants such as haptens. Expressed as the association constant (K litres mole -1), which, owing to the heterogeneity of affinities in a population of antibody molecules of a given specificity, actually represents an average value (mean intrinsic association constant). 6. The reciprocal of the dissociation constant. [EU] Age Groups: Persons classified by age from birth (infant, newborn) to octogenarians and older (aged, 80 and over). [NIH] Age of Onset: The age or period of life at which a disease or the initial symptoms or manifestations of a disease appear in an individual. [NIH] Aged, 80 and Over: A person 80 years of age and older. [NIH] Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Agoraphobia: Obsessive, persistent, intense fear of open places. [NIH] Akathisia: 1. A condition of motor restlessness in which there is a feeling of muscular quivering, an urge to move about constantly, and an inability to sit still, a common extrapyramidal side effect of neuroleptic drugs. 2. An inability to sit down because of intense anxiety at the thought of doing so. [EU] Aldehyde Dehydrogenase: An enzyme that oxidizes an aldehyde in the presence of NAD+ and water to an acid and NADH. EC 1.2.1.3. Before 1978, it was classified as EC 1.1.1.70.

Dictionary 283

[NIH]

Alertness: A state of readiness to detect and respond to certain specified small changes occurring at random intervals in the environment. [NIH] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alkaline: Having the reactions of an alkali. [EU] Alkaloid: A member of a large group of chemicals that are made by plants and have nitrogen in them. Some alkaloids have been shown to work against cancer. [NIH] Allergen: An antigenic substance capable of producing immediate-type hypersensitivity (allergy). [EU] Allograft: An organ or tissue transplant between two humans. [NIH] Allylamine: Possesses an unusual and selective cytotoxicity for vascular smooth muscle cells in dogs and rats. Useful for experiments dealing with arterial injury, myocardial fibrosis or cardiac decompensation. [NIH] Alpha Particles: Positively charged particles composed of two protons and two neutrons, i.e., helium nuclei, emitted during disintegration of very heavy isotopes; a beam of alpha particles or an alpha ray has very strong ionizing power, but weak penetrability. [NIH] Alpha-1: A protein with the property of inactivating proteolytic enzymes such as leucocyte collagenase and elastase. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Ambulatory Care: Health care services provided to patients on an ambulatory basis, rather than by admission to a hospital or other health care facility. The services may be a part of a hospital, augmenting its inpatient services, or may be provided at a free-standing facility. [NIH]

Ameliorated: A changeable condition which prevents the consequence of a failure or accident from becoming as bad as it otherwise would. [NIH] Ameliorating: A changeable condition which prevents the consequence of a failure or accident from becoming as bad as it otherwise would. [NIH] Amine: An organic compound containing nitrogen; any member of a group of chemical compounds formed from ammonia by replacement of one or more of the hydrogen atoms by organic (hydrocarbon) radicals. The amines are distinguished as primary, secondary, and tertiary, according to whether one, two, or three hydrogen atoms are replaced. The amines include allylamine, amylamine, ethylamine, methylamine, phenylamine, propylamine, and many other compounds. [EU] Amino Acid Sequence: The order of amino acids as they occur in a polypeptide chain. This is referred to as the primary structure of proteins. It is of fundamental importance in determining protein conformation. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH]

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Aminoethyl: A protease inhibitor. [NIH] Aminopropionitrile: 3-Aminopropanenitrile. Reagent used as an intermediate in the manufacture of beta-alanine and pantothenic acid. [NIH] Amitriptyline: Tricyclic antidepressant with anticholinergic and sedative properties. It appears to prevent the re-uptake of norepinephrine and serotonin at nerve terminals, thus potentiating the action of these neurotransmitters. Amitriptyline also appears to antaganize cholinergic and alpha-1 adrenergic responses to bioactive amines. [NIH] Ammonia: A colorless alkaline gas. It is formed in the body during decomposition of organic materials during a large number of metabolically important reactions. [NIH] Amphetamine: A powerful central nervous system stimulant and sympathomimetic. Amphetamine has multiple mechanisms of action including blocking uptake of adrenergics and dopamine, stimulation of release of monamines, and inhibiting monoamine oxidase. Amphetamine is also a drug of abuse and a psychotomimetic. The l- and the d,l-forms are included here. The l-form has less central nervous system activity but stronger cardiovascular effects. The d-form is dextroamphetamine. [NIH] Ampulla: A sac-like enlargement of a canal or duct. [NIH] Anaesthesia: Loss of feeling or sensation. Although the term is used for loss of tactile sensibility, or of any of the other senses, it is applied especially to loss of the sensation of pain, as it is induced to permit performance of surgery or other painful procedures. [EU] Anaesthetic: 1. Pertaining to, characterized by, or producing anaesthesia. 2. A drug or agent that is used to abolish the sensation of pain. [EU] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Analgesic: An agent that alleviates pain without causing loss of consciousness. [EU] Analog: In chemistry, a substance that is similar, but not identical, to another. [NIH] Analogous: Resembling or similar in some respects, as in function or appearance, but not in origin or development;. [EU] Analytes: A component of a test sample the presence of which has to be demonstrated. The term "analyte" includes where appropriate formed from the analyte during the analyses. [NIH]

Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Anchorage: In dentistry, points of retention of fillings and artificial restorations and appliances. [NIH] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH] Anesthetics: Agents that are capable of inducing a total or partial loss of sensation, especially tactile sensation and pain. They may act to induce general anesthesia, in which an unconscious state is achieved, or may act locally to induce numbness or lack of sensation at a targeted site. [NIH] Aneurysm: A sac formed by the dilatation of the wall of an artery, a vein, or the heart. [NIH] Angiogenesis: Blood vessel formation. Tumor angiogenesis is the growth of blood vessels from surrounding tissue to a solid tumor. This is caused by the release of chemicals by the tumor. [NIH] Animal model: An animal with a disease either the same as or like a disease in humans. Animal models are used to study the development and progression of diseases and to test new treatments before they are given to humans. Animals with transplanted human cancers

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or other tissues are called xenograft models. [NIH] Anions: Negatively charged atoms, radicals or groups of atoms which travel to the anode or positive pole during electrolysis. [NIH] Annealing: The spontaneous alignment of two single DNA strands to form a double helix. [NIH]

Anomalies: Birth defects; abnormalities. [NIH] Anorectal: Pertaining to the anus and rectum or to the junction region between the two. [EU] Anoxia: Clinical manifestation of respiratory distress consisting of a relatively complete absence of oxygen. [NIH] Antagonism: Interference with, or inhibition of, the growth of a living organism by another living organism, due either to creation of unfavorable conditions (e. g. exhaustion of food supplies) or to production of a specific antibiotic substance (e. g. penicillin). [NIH] Antecedent: Existing or occurring before in time or order often with consequential effects. [EU]

Anterior Cerebral Artery: Artery formed by the bifurcation of the internal carotid artery. Branches of the anterior cerebral artery supply the caudate nucleus, internal capsule, putamen, septal nuclei, gyrus cinguli, and surfaces of the frontal lobe and parietal lobe. [NIH] Antibacterial: A substance that destroys bacteria or suppresses their growth or reproduction. [EU] Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH]

Antibodies: Immunoglobulin molecules having a specific amino acid sequence by virtue of which they interact only with the antigen that induced their synthesis in cells of the lymphoid series (especially plasma cells), or with an antigen closely related to it. [NIH] Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Anticholinergic: An agent that blocks the parasympathetic nerves. Called also parasympatholytic. [EU] Anticoagulant: A drug that helps prevent blood clots from forming. Also called a blood thinner. [NIH] Anticonvulsant: An agent that prevents or relieves convulsions. [EU] Antidepressant: A drug used to treat depression. [NIH] Antidiuretic: Suppressing the rate of urine formation. [EU] Antiemetic: An agent that prevents or alleviates nausea and vomiting. Also antinauseant. [EU]

Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Antihypertensive: An agent that reduces high blood pressure. [EU]

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Anti-infective: An agent that so acts. [EU] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Anti-Inflammatory Agents: Substances that reduce or suppress inflammation. [NIH] Antipsychotic: Effective in the treatment of psychosis. Antipsychotic drugs (called also neuroleptic drugs and major tranquilizers) are a chemically diverse (including phenothiazines, thioxanthenes, butyrophenones, dibenzoxazepines, dibenzodiazepines, and diphenylbutylpiperidines) but pharmacologically similar class of drugs used to treat schizophrenic, paranoid, schizoaffective, and other psychotic disorders; acute delirium and dementia, and manic episodes (during induction of lithium therapy); to control the movement disorders associated with Huntington's chorea, Gilles de la Tourette's syndrome, and ballismus; and to treat intractable hiccups and severe nausea and vomiting. Antipsychotic agents bind to dopamine, histamine, muscarinic cholinergic, a-adrenergic, and serotonin receptors. Blockade of dopaminergic transmission in various areas is thought to be responsible for their major effects : antipsychotic action by blockade in the mesolimbic and mesocortical areas; extrapyramidal side effects (dystonia, akathisia, parkinsonism, and tardive dyskinesia) by blockade in the basal ganglia; and antiemetic effects by blockade in the chemoreceptor trigger zone of the medulla. Sedation and autonomic side effects (orthostatic hypotension, blurred vision, dry mouth, nasal congestion and constipation) are caused by blockade of histamine, cholinergic, and adrenergic receptors. [EU] Antipsychotic Agents: Agents that control agitated psychotic behavior, alleviate acute psychotic states, reduce psychotic symptoms, and exert a quieting effect. They are used in schizophrenia, senile dementia, transient psychosis following surgery or myocardial infarction, etc. These drugs are often referred to as neuroleptics alluding to the tendency to produce neurological side effects, but not all antipsychotics are likely to produce such effects. Many of these drugs may also be effective against nausea, emesis, and pruritus. [NIH] Antispasmodic: An agent that relieves spasm. [EU] Antitussive: An agent that relieves or prevents cough. [EU] Anuria: Inability to form or excrete urine. [NIH] Anus: The opening of the rectum to the outside of the body. [NIH] Anxiety: Persistent feeling of dread, apprehension, and impending disaster. [NIH] Anxiolytic: An anxiolytic or antianxiety agent. [EU] Aorta: The main trunk of the systemic arteries. [NIH] Aorta, Thoracic: The portion of the descending aorta proceeding from the arch of the aorta and extending to the diaphragm. [NIH] Aperture: A natural hole of perforation, especially one in a bone. [NIH] Aponeurosis: Tendinous expansion consisting of a fibrous or membranous sheath which serves as a fascia to enclose or bind a group of muscles. [NIH] Apoptosis: One of the two mechanisms by which cell death occurs (the other being the pathological process of necrosis). Apoptosis is the mechanism responsible for the physiological deletion of cells and appears to be intrinsically programmed. It is characterized by distinctive morphologic changes in the nucleus and cytoplasm, chromatin cleavage at regularly spaced sites, and the endonucleolytic cleavage of genomic DNA (DNA fragmentation) at internucleosomal sites. This mode of cell death serves as a balance to mitosis in regulating the size of animal tissues and in mediating pathologic processes associated with tumor growth. [NIH] Applicability: A list of the commodities to which the candidate method can be applied as

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presented or with minor modifications. [NIH] Aqueous: Having to do with water. [NIH] Arginine: An essential amino acid that is physiologically active in the L-form. [NIH] Argipressin: Cys-Tyr-Phe-Gln-Asn-Cys-Pro-Arg-Gly-NH2, cyclic 1-6 disulfide. The usual mammalian antidiuretic hormone, it is a cyclic nonapeptide with arginine in position 8 of the chain. Argipressin is used to treat diabetes insipidus and as hemostatic because of its vasoconstrictor action. [NIH] Aromatic: Having a spicy odour. [EU] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Arterioles: The smallest divisions of the arteries located between the muscular arteries and the capillaries. [NIH] Arteriovenous: Both arterial and venous; pertaining to or affecting an artery and a vein. [EU] Arthralgia: Pain in the joint. [NIH] Articular: Of or pertaining to a joint. [EU] Aspartame: Flavoring agent sweeter than sugar, metabolized as phenylalanine and aspartic acid. [NIH] Aspartate: A synthetic amino acid. [NIH] Aspartic: The naturally occurring substance is L-aspartic acid. One of the acidic-amino-acids is obtained by the hydrolysis of proteins. [NIH] Aspartic Acid: One of the non-essential amino acids commonly occurring in the L-form. It is found in animals and plants, especially in sugar cane and sugar beets. It may be a neurotransmitter. [NIH] Asphyxia: A pathological condition caused by lack of oxygen, manifested in impending or actual cessation of life. [NIH] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Astrocytes: The largest and most numerous neuroglial cells in the brain and spinal cord. Astrocytes (from "star" cells) are irregularly shaped with many long processes, including those with "end feet" which form the glial (limiting) membrane and directly and indirectly contribute to the blood brain barrier. They regulate the extracellular ionic and chemical environment, and "reactive astrocytes" (along with microglia) respond to injury. Astrocytes have high- affinity transmitter uptake systems, voltage-dependent and transmitter-gated ion channels, and can release transmitter, but their role in signaling (as in many other functions) is not well understood. [NIH] Atrophy: Decrease in the size of a cell, tissue, organ, or multiple organs, associated with a variety of pathological conditions such as abnormal cellular changes, ischemia, malnutrition, or hormonal changes. [NIH] Atropine: A toxic alkaloid, originally from Atropa belladonna, but found in other plants, mainly Solanaceae. [NIH] Auditory: Pertaining to the sense of hearing. [EU] Autoimmune disease: A condition in which the body recognizes its own tissues as foreign and directs an immune response against them. [NIH] Autologous: Taken from an individual's own tissues, cells, or DNA. [NIH]

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Autonomic: Self-controlling; functionally independent. [EU] Autonomic Dysreflexia: That part of the nervous system concerned with the unconscious regulation of the living processes of the body. [NIH] Autonomic Nervous System: The enteric, parasympathetic, and sympathetic nervous systems taken together. Generally speaking, the autonomic nervous system regulates the internal environment during both peaceful activity and physical or emotional stress. Autonomic activity is controlled and integrated by the central nervous system, especially the hypothalamus and the solitary nucleus, which receive information relayed from visceral afferents; these and related central and sensory structures are sometimes (but not here) considered to be part of the autonomic nervous system itself. [NIH] Axonal: Condition associated with metabolic derangement of the entire neuron and is manifest by degeneration of the distal portion of the nerve fiber. [NIH] Axons: Nerve fibers that are capable of rapidly conducting impulses away from the neuron cell body. [NIH] Back Pain: Acute or chronic pain located in the posterior regions of the trunk, including the thoracic, lumbar, sacral, or adjacent regions. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bacterial Physiology: Physiological processes and activities of bacteria. [NIH] Bactericidal: Substance lethal to bacteria; substance capable of killing bacteria. [NIH] Bacteriophage: A virus whose host is a bacterial cell; A virus that exclusively infects bacteria. It generally has a protein coat surrounding the genome (DNA or RNA). One of the coliphages most extensively studied is the lambda phage, which is also one of the most important. [NIH] Bacteriuria: The presence of bacteria in the urine with or without consequent urinary tract infection. Since bacteriuria is a clinical entity, the term does not preclude the use of urine/microbiology for technical discussions on the isolation and segregation of bacteria in the urine. [NIH] Barbiturates: A class of chemicals derived from barbituric acid or thiobarbituric acid. Many of these are medically important as sedatives and hypnotics (sedatives, barbiturate), as anesthetics, or as anticonvulsants. [NIH] Basal Ganglia: Large subcortical nuclear masses derived from the telencephalon and located in the basal regions of the cerebral hemispheres. [NIH] Basal Ganglia Diseases: Diseases of the basal ganglia including the putamen; globus pallidus; claustrum; amygdala; and caudate nucleus. Dyskinesias (most notably involuntary movements and alterations of the rate of movement) represent the primary clinical manifestations of these disorders. Common etiologies include cerebrovascular disease; neurodegenerative diseases; and craniocerebral trauma. [NIH] Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Basement Membrane: Ubiquitous supportive tissue adjacent to epithelium and around smooth and striated muscle cells. This tissue contains intrinsic macromolecular components such as collagen, laminin, and sulfated proteoglycans. As seen by light microscopy one of its subdivisions is the basal (basement) lamina. [NIH]

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Behavior Therapy: The application of modern theories of learning and conditioning in the treatment of behavior disorders. [NIH] Behavioral Symptoms: Observable manifestions of impaired psychological functioning. [NIH]

Belladonna: A species of very poisonous Solanaceous plants yielding atropine (hyoscyamine), scopolamine, and other belladonna alkaloids, used to block the muscarinic autonomic nervous system. [NIH] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]

Benign prostatic hyperplasia: A benign (noncancerous) condition in which an overgrowth of prostate tissue pushes against the urethra and the bladder, blocking the flow of urine. Also called benign prostatic hypertrophy or BPH. [NIH] Bewilderment: Impairment or loss of will power. [NIH] Bifida: A defect in development of the vertebral column in which there is a central deficiency of the vertebral lamina. [NIH] Bilateral: Affecting both the right and left side of body. [NIH] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Bile Acids: Acids made by the liver that work with bile to break down fats. [NIH] Biliary: Having to do with the liver, bile ducts, and/or gallbladder. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biocompatible Materials: Synthetic or natural materials, other than drugs, that are used to replace or repair any body tissue or bodily function. [NIH] Biogenic Amines: A group of naturally occurring amines derived by enzymatic decarboxylation of the natural amino acids. Many have powerful physiological effects (e.g., histamine, serotonin, epinephrine, tyramine). Those derived from aromatic amino acids, and also their synthetic analogs (e.g., amphetamine), are of use in pharmacology. [NIH] Biological therapy: Treatment to stimulate or restore the ability of the immune system to fight infection and disease. Also used to lessen side effects that may be caused by some cancer treatments. Also known as immunotherapy, biotherapy, or biological response modifier (BRM) therapy. [NIH] Biological Transport: The movement of materials (including biochemical substances and drugs) across cell membranes and epithelial layers, usually by passive diffusion. [NIH] Biomechanics: The study of the application of mechanical laws and the action of forces to living structures. [NIH] Biopsy: Removal and pathologic examination of specimens in the form of small pieces of tissue from the living body. [NIH] Biosynthesis: The building up of a chemical compound in the physiologic processes of a living organism. [EU] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and

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protein structure function analysis and prediction. [NIH] Bladder: The organ that stores urine. [NIH] Bladder Exstrophy: Congenital eversion of the urinary bladder. It is characterized by the absence of a portion of the lower abdominal wall and the anterior vesical wall, with eversion of the posterior vesical wall through the deficit. [NIH] Bloating: Fullness or swelling in the abdomen that often occurs after meals. [NIH] Blood Coagulation: The process of the interaction of blood coagulation factors that results in an insoluble fibrin clot. [NIH] Blood Glucose: Glucose in blood. [NIH] Blood Platelets: Non-nucleated disk-shaped cells formed in the megakaryocyte and found in the blood of all mammals. They are mainly involved in blood coagulation. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Body Fluids: Liquid components of living organisms. [NIH] Bone Density: The amount of mineral per square centimeter of bone. This is the definition used in clinical practice. Actual bone density would be expressed in grams per milliliter. It is most frequently measured by photon absorptiometry or x-ray computed tomography. [NIH] Bone Marrow: The soft tissue filling the cavities of bones. Bone marrow exists in two types, yellow and red. Yellow marrow is found in the large cavities of large bones and consists mostly of fat cells and a few primitive blood cells. Red marrow is a hematopoietic tissue and is the site of production of erythrocytes and granular leukocytes. Bone marrow is made up of a framework of connective tissue containing branching fibers with the frame being filled with marrow cells. [NIH] Bone scan: A technique to create images of bones on a computer screen or on film. A small amount of radioactive material is injected into a blood vessel and travels through the bloodstream; it collects in the bones and is detected by a scanner. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Bowel Movement: Body wastes passed through the rectum and anus. [NIH] Brachytherapy: A collective term for interstitial, intracavity, and surface radiotherapy. It uses small sealed or partly-sealed sources that may be placed on or near the body surface or within a natural body cavity or implanted directly into the tissues. [NIH] Bradycardia: Excessive slowness in the action of the heart, usually with a heart rate below 60 beats per minute. [NIH] Bradykinin: A nonapeptide messenger that is enzymatically produced from kallidin in the blood where it is a potent but short-lived agent of arteriolar dilation and increased capillary permeability. Bradykinin is also released from mast cells during asthma attacks, from gut walls as a gastrointestinal vasodilator, from damaged tissues as a pain signal, and may be a neurotransmitter. [NIH] Brain Ischemia: Localized reduction of blood flow to brain tissue due to arterial obtruction or systemic hypoperfusion. This frequently occurs in conjuction with brain hypoxia. Prolonged ischemia is associated with brain infarction. [NIH]

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Brain Stem: The part of the brain that connects the cerebral hemispheres with the spinal cord. It consists of the mesencephalon, pons, and medulla oblongata. [NIH] Branch: Most commonly used for branches of nerves, but applied also to other structures. [NIH]

Breakdown: A physical, metal, or nervous collapse. [NIH] Broad-spectrum: Effective against a wide range of microorganisms; said of an antibiotic. [EU] Bronchi: The larger air passages of the lungs arising from the terminal bifurcation of the trachea. [NIH] Bronchial: Pertaining to one or more bronchi. [EU] Bronchitis: Inflammation (swelling and reddening) of the bronchi. [NIH] Bronchospasm: Spasmodic contraction of the smooth muscle of the bronchi, as occurs in asthma. [EU] Bulbar: Pertaining to a bulb; pertaining to or involving the medulla oblongata, as bulbar paralysis. [EU] Bulking Agents: Laxatives that make bowel movements soft and easy to pass. [NIH] Bupivacaine: A widely used local anesthetic agent. [NIH] Cadaver: A dead body, usually a human body. [NIH] Caffeine: A methylxanthine naturally occurring in some beverages and also used as a pharmacological agent. Caffeine's most notable pharmacological effect is as a central nervous system stimulant, increasing alertness and producing agitation. It also relaxes smooth muscle, stimulates cardiac muscle, stimulates diuresis, and appears to be useful in the treatment of some types of headache. Several cellular actions of caffeine have been observed, but it is not entirely clear how each contributes to its pharmacological profile. Among the most important are inhibition of cyclic nucleotide phosphodiesterases, antagonism of adenosine receptors, and modulation of intracellular calcium handling. [NIH] Calcitonin: A peptide hormone that lowers calcium concentration in the blood. In humans, it is released by thyroid cells and acts to decrease the formation and absorptive activity of osteoclasts. Its role in regulating plasma calcium is much greater in children and in certain diseases than in normal adults. [NIH] Calcium: A basic element found in nearly all organized tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH] Cannabidiol: Compound isolated from Cannabis sativa extract. [NIH] Cannabinoids: Compounds extracted from Cannabis sativa L. and metabolites having the cannabinoid structure. The most active constituents are tetrahydrocannabinol, cannabinol, and cannabidiol. [NIH] Cannabinol: A physiologically inactive constituent of Cannabis sativa L. [NIH] Capsaicin: Cytotoxic alkaloid from various species of Capsicum (pepper, paprika), of the Solanaceae. [NIH] Carbamazepine: An anticonvulsant used to control grand mal and psychomotor or focal seizures. Its mode of action is not fully understood, but some of its actions resemble those of phenytoin; although there is little chemical resemblance between the two compounds, their three-dimensional structure is similar. [NIH]

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Carbohydrates: The largest class of organic compounds, including starches, glycogens, cellulose, gums, and simple sugars. Carbohydrates are composed of carbon, hydrogen, and oxygen in a ratio of Cn(H2O)n. [NIH] Carcinogenic: Producing carcinoma. [EU] Cardiac: Having to do with the heart. [NIH] Cardiac arrest: A sudden stop of heart function. [NIH] Cardiovascular: Having to do with the heart and blood vessels. [NIH] Cardiovascular disease: Any abnormal condition characterized by dysfunction of the heart and blood vessels. CVD includes atherosclerosis (especially coronary heart disease, which can lead to heart attacks), cerebrovascular disease (e.g., stroke), and hypertension (high blood pressure). [NIH] Cardiovascular System: The heart and the blood vessels by which blood is pumped and circulated through the body. [NIH] Carotene: The general name for a group of pigments found in green, yellow, and leafy vegetables, and yellow fruits. The pigments are fat-soluble, unsaturated aliphatic hydrocarbons functioning as provitamins and are converted to vitamin A through enzymatic processes in the intestinal wall. [NIH] Case report: A detailed report of the diagnosis, treatment, and follow-up of an individual patient. Case reports also contain some demographic information about the patient (for example, age, gender, ethnic origin). [NIH] Case series: A group or series of case reports involving patients who were given similar treatment. Reports of case series usually contain detailed information about the individual patients. This includes demographic information (for example, age, gender, ethnic origin) and information on diagnosis, treatment, response to treatment, and follow-up after treatment. [NIH] Cataracts: In medicine, an opacity of the crystalline lens of the eye obstructing partially or totally its transmission of light. [NIH] Catecholamine: A group of chemical substances manufactured by the adrenal medulla and secreted during physiological stress. [NIH] Catheter: A flexible tube used to deliver fluids into or withdraw fluids from the body. [NIH] Catheterization: Use or insertion of a tubular device into a duct, blood vessel, hollow organ, or body cavity for injecting or withdrawing fluids for diagnostic or therapeutic purposes. It differs from intubation in that the tube here is used to restore or maintain patency in obstructions. [NIH] Cations: Postively charged atoms, radicals or groups of atoms which travel to the cathode or negative pole during electrolysis. [NIH] Cauda Equina: The lower part of the spinal cord consisting of the lumbar, sacral, and coccygeal nerve roots. [NIH] Caudal: Denoting a position more toward the cauda, or tail, than some specified point of reference; same as inferior, in human anatomy. [EU] Caudate Nucleus: Elongated gray mass of the neostriatum located adjacent to the lateral ventricle of the brain. [NIH] Causal: Pertaining to a cause; directed against a cause. [EU] Cecum: The beginning of the large intestine. The cecum is connected to the lower part of the small intestine, called the ileum. [NIH]

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Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell Death: The termination of the cell's ability to carry out vital functions such as metabolism, growth, reproduction, responsiveness, and adaptability. [NIH] Cell Differentiation: Progressive restriction of the developmental potential and increasing specialization of function which takes place during the development of the embryo and leads to the formation of specialized cells, tissues, and organs. [NIH] Cell Division: The fission of a cell. [NIH] Cell membrane: Cell membrane = plasma membrane. The structure enveloping a cell, enclosing the cytoplasm, and forming a selective permeability barrier; it consists of lipids, proteins, and some carbohydrates, the lipids thought to form a bilayer in which integral proteins are embedded to varying degrees. [EU] Cell proliferation: An increase in the number of cells as a result of cell growth and cell division. [NIH] Cell Survival: The span of viability of a cell characterized by the capacity to perform certain functions such as metabolism, growth, reproduction, some form of responsiveness, and adaptability. [NIH] Cellobiose: A disaccharide consisting of two glucose units in beta (1-4) glycosidic linkage. Obtained from the partial hydrolysis of cellulose. [NIH] Cellulose: A polysaccharide with glucose units linked as in cellobiose. It is the chief constituent of plant fibers, cotton being the purest natural form of the substance. As a raw material, it forms the basis for many derivatives used in chromatography, ion exchange materials, explosives manufacturing, and pharmaceutical preparations. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Central Nervous System Infections: Pathogenic infections of the brain, spinal cord, and meninges. DNA virus infections; RNA virus infections; bacterial infections; mycoplasma infections; Spirochaetales infections; fungal infections; protozoan infections; helminthiasis; and prion diseases may involve the central nervous system as a primary or secondary process. [NIH] Cerebellum: Part of the metencephalon that lies in the posterior cranial fossa behind the brain stem. It is concerned with the coordination of movement. [NIH] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebral Infarction: The formation of an area of necrosis in the cerebrum caused by an insufficiency of arterial or venous blood flow. Infarcts of the cerebrum are generally classified by hemisphere (i.e., left vs. right), lobe (e.g., frontal lobe infarction), arterial distribution (e.g., infarction, anterior cerebral artery), and etiology (e.g., embolic infarction). [NIH]

Cerebral Palsy: Refers to a motor disability caused by a brain dysfunction. [NIH] Cerebrovascular: Pertaining to the blood vessels of the cerebrum, or brain. [EU] Cerebrovascular Disorders: A broad category of disorders characterized by impairment of blood flow in the arteries and veins which supply the brain. These include cerebral infarction; brain ischemia; hypoxia, brain; intracranial embolism and thrombosis; intracranial arteriovenous malformations; and vasculitis, central nervous system. In common usage, the term cerebrovascular disorders is not limited to conditions that affect the cerebrum, but refers to vascular disorders of the entire brain including the diencephalon; brain stem; and cerebellum. [NIH]

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Cerebrum: The largest part of the brain. It is divided into two hemispheres, or halves, called the cerebral hemispheres. The cerebrum controls muscle functions of the body and also controls speech, emotions, reading, writing, and learning. [NIH] Cervix: The lower, narrow end of the uterus that forms a canal between the uterus and vagina. [NIH] Cesarean Section: Extraction of the fetus by means of abdominal hysterotomy. [NIH] Character: In current usage, approximately equivalent to personality. The sum of the relatively fixed personality traits and habitual modes of response of an individual. [NIH] Chemoreceptor: A receptor adapted for excitation by chemical substances, e.g., olfactory and gustatory receptors, or a sense organ, as the carotid body or the aortic (supracardial) bodies, which is sensitive to chemical changes in the blood stream, especially reduced oxygen content, and reflexly increases both respiration and blood pressure. [EU] Chemotherapy: Treatment with anticancer drugs. [NIH] Chin: The anatomical frontal portion of the mandible, also known as the mentum, that contains the line of fusion of the two separate halves of the mandible (symphysis menti). This line of fusion divides inferiorly to enclose a triangular area called the mental protuberance. On each side, inferior to the second premolar tooth, is the mental foramen for the passage of blood vessels and a nerve. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Cholinergic: Resembling acetylcholine in pharmacological action; stimulated by or releasing acetylcholine or a related compound. [EU] Chorea: Involuntary, forcible, rapid, jerky movements that may be subtle or become confluent, markedly altering normal patterns of movement. Hypotonia and pendular reflexes are often associated. Conditions which feature recurrent or persistent episodes of chorea as a primary manifestation of disease are referred to as choreatic disorders. Chorea is also a frequent manifestation of basal ganglia diseases. [NIH] Choreatic Disorders: Acquired and hereditary conditions which feature chorea as a primary manifestation of the disease process. [NIH] Chorioretinitis: Inflammation of the choroid in which the sensory retina becomes edematous and opaque. The inflammatory cells and exudate may burst through the sensory retina to cloud the vitreous body. [NIH] Choroid: The thin, highly vascular membrane covering most of the posterior of the eye between the retina and sclera. [NIH] Chromaffin System: The cells of the body which stain with chromium salts. They occur along the sympathetic nerves, in the adrenal gland, and in various other organs. [NIH] Chromatin: The material of chromosomes. It is a complex of DNA, histones, and nonhistone proteins (chromosomal proteins, non-histone) found within the nucleus of a cell. [NIH] Chromosome: Part of a cell that contains genetic information. Except for sperm and eggs, all human cells contain 46 chromosomes. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Chronic Disease: Disease or ailment of long duration. [NIH] Chronic Obstructive Pulmonary Disease: Collective term for chronic bronchitis and emphysema. [NIH] Chronic renal: Slow and progressive loss of kidney function over several years, often resulting in end-stage renal disease. People with end-stage renal disease need dialysis or

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transplantation to replace the work of the kidneys. [NIH] Circadian: Repeated more or less daily, i. e. on a 23- to 25-hour cycle. [NIH] Circadian Rhythm: The regular recurrence, in cycles of about 24 hours, of biological processes or activities, such as sensitivity to drugs and stimuli, hormone secretion, sleeping, feeding, etc. This rhythm seems to be set by a 'biological clock' which seems to be set by recurring daylight and darkness. [NIH] Circulatory system: The system that contains the heart and the blood vessels and moves blood throughout the body. This system helps tissues get enough oxygen and nutrients, and it helps them get rid of waste products. The lymph system, which connects with the blood system, is often considered part of the circulatory system. [NIH] CIS: Cancer Information Service. The CIS is the National Cancer Institute's link to the public, interpreting and explaining research findings in a clear and understandable manner, and providing personalized responses to specific questions about cancer. Access the CIS by calling 1-800-4-CANCER, or by using the Web site at http://cis.nci.nih.gov. [NIH] Clamp: A u-shaped steel rod used with a pin or wire for skeletal traction in the treatment of certain fractures. [NIH] Climacteric: Physiologic period, characterized by endocrine, somatic, and psychic changes with the termination of ovarian function in the female. It may also accompany the normal diminution of sexual activity in the male. [NIH] Clinical series: A case series in which the patients receive treatment in a clinic or other medical facility. [NIH] Clinical study: A research study in which patients receive treatment in a clinic or other medical facility. Reports of clinical studies can contain results for single patients (case reports) or many patients (case series or clinical trials). [NIH] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Clitoral: Pertaining to the clitoris. [EU] Clone: The term "clone" has acquired a new meaning. It is applied specifically to the bits of inserted foreign DNA in the hybrid molecules of the population. Each inserted segment originally resided in the DNA of a complex genome amid millions of other DNA segment. [NIH]

Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Cochlear: Of or pertaining to the cochlea. [EU] Cochlear Diseases: Diseases of the cochlea, the part of the inner ear that is concerned with hearing. [NIH] Codeine: An opioid analgesic related to morphine but with less potent analgesic properties and mild sedative effects. It also acts centrally to suppress cough. [NIH] Cognition: Intellectual or mental process whereby an organism becomes aware of or obtains knowledge. [NIH] Cognitive restructuring: A method of identifying and replacing fear-promoting, irrational beliefs with more realistic and functional ones. [NIH] Cohort Studies: Studies in which subsets of a defined population are identified. These groups may or may not be exposed to factors hypothesized to influence the probability of

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the occurrence of a particular disease or other outcome. Cohorts are defined populations which, as a whole, are followed in an attempt to determine distinguishing subgroup characteristics. [NIH] Colchicine: A major alkaloid from Colchicum autumnale L. and found also in other Colchicum species. Its primary therapeutic use is in the treatment of gout, but it has been used also in the therapy of familial Mediterranean fever (periodic disease). [NIH] Colitis: Inflammation of the colon. [NIH] Collagen: A polypeptide substance comprising about one third of the total protein in mammalian organisms. It is the main constituent of skin, connective tissue, and the organic substance of bones and teeth. Different forms of collagen are produced in the body but all consist of three alpha-polypeptide chains arranged in a triple helix. Collagen is differentiated from other fibrous proteins, such as elastin, by the content of proline, hydroxyproline, and hydroxylysine; by the absence of tryptophan; and particularly by the high content of polar groups which are responsible for its swelling properties. [NIH] Collapse: 1. A state of extreme prostration and depression, with failure of circulation. 2. Abnormal falling in of the walls of any part of organ. [EU] Combination Therapy: Association of 3 drugs to treat AIDS (AZT + DDC or DDI + protease inhibitor). [NIH] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such

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as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complete remission: The disappearance of all signs of cancer. Also called a complete response. [NIH] Compliance: Distensibility measure of a chamber such as the lungs (lung compliance) or bladder. Compliance is expressed as a change in volume per unit change in pressure. [NIH] Compress: A plug used to occludate an orifice in the control of bleeding, or to mop up secretions; an absorbent pad. [NIH] Compulsions: In psychology, an irresistible urge, sometimes amounting to obsession to perform a particular act which usually is carried out against the performer's will or better judgment. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Computed tomography: CT scan. A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized tomography and computerized axial tomography (CAT) scan. [NIH] Computerized axial tomography: A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called CAT scan, computed tomography (CT scan), or computerized tomography. [NIH] Concomitant: Accompanying; accessory; joined with another. [EU] Conduction: The transfer of sound waves, heat, nervous impulses, or electricity. [EU] Cones: One type of specialized light-sensitive cells (photoreceptors) in the retina that provide sharp central vision and color vision. [NIH] Confusion: A mental state characterized by bewilderment, emotional disturbance, lack of clear thinking, and perceptual disorientation. [NIH] Congestion: Excessive or abnormal accumulation of blood in a part. [EU] Conjunctiva: The mucous membrane that lines the inner surface of the eyelids and the anterior part of the sclera. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue Cells: A group of cells that includes fibroblasts, cartilage cells, adipocytes, smooth muscle cells, and bone cells. [NIH] Consciousness: Sense of awareness of self and of the environment. [NIH] Constipation: Infrequent or difficult evacuation of feces. [NIH] Constitutional: 1. Affecting the whole constitution of the body; not local. 2. Pertaining to the constitution. [EU] Constrict: Tighten; narrow. [NIH] Constriction: The act of constricting. [NIH] Constriction, Pathologic: The condition of an anatomical structure's being constricted

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beyond normal dimensions. [NIH] Consultation: A deliberation between two or more physicians concerning the diagnosis and the proper method of treatment in a case. [NIH] Consumption: Pulmonary tuberculosis. [NIH] Contamination: The soiling or pollution by inferior material, as by the introduction of organisms into a wound, or sewage into a stream. [EU] Continence: The ability to hold in a bowel movement or urine. [NIH] Contractility: Capacity for becoming short in response to a suitable stimulus. [EU] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Control group: In a clinical trial, the group that does not receive the new treatment being studied. This group is compared to the group that receives the new treatment, to see if the new treatment works. [NIH] Controlled clinical trial: A clinical study that includes a comparison (control) group. The comparison group receives a placebo, another treatment, or no treatment at all. [NIH] Convulsion: A violent involuntary contraction or series of contractions of the voluntary muscles. [EU] Convulsive: Relating or referring to spasm; affected with spasm; characterized by a spasm or spasms. [NIH] Cooperative group: A group of physicians, hospitals, or both formed to treat a large number of persons in the same way so that new treatment can be evaluated quickly. Clinical trials of new cancer treatments often require many more people than a single physician or hospital can care for. [NIH] Coordination: Muscular or motor regulation or the harmonious cooperation of muscles or groups of muscles, in a complex action or series of actions. [NIH] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary heart disease: A type of heart disease caused by narrowing of the coronary arteries that feed the heart, which needs a constant supply of oxygen and nutrients carried by the blood in the coronary arteries. When the coronary arteries become narrowed or clogged by fat and cholesterol deposits and cannot supply enough blood to the heart, CHD results. [NIH] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Corpus: The body of the uterus. [NIH] Corpus Luteum: The yellow glandular mass formed in the ovary by an ovarian follicle that has ruptured and discharged its ovum. [NIH] Corpus Striatum: Striped gray and white matter consisting of the neostriatum and paleostriatum (globus pallidus). It is located in front of and lateral to the thalamus in each cerebral hemisphere. The gray substance is made up of the caudate nucleus and the lentiform nucleus (the latter consisting of the globus pallidus and putamen). The white matter is the internal capsule. [NIH] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU]

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Cortical: Pertaining to or of the nature of a cortex or bark. [EU] Cranial: Pertaining to the cranium, or to the anterior (in animals) or superior (in humans) end of the body. [EU] Craniocerebral Trauma: Traumatic injuries involving the cranium and intracranial structures (i.e., brain; cranial nerves; meninges; and other structures). Injuries may be classified by whether or not the skull is penetrated (i.e., penetrating vs. nonpenetrating) or whether there is an associated hemorrhage. [NIH] Creatinine: A compound that is excreted from the body in urine. Creatinine levels are measured to monitor kidney function. [NIH] Cross-Sectional Studies: Studies in which the presence or absence of disease or other health-related variables are determined in each member of the study population or in a representative sample at one particular time. This contrasts with longitudinal studies which are followed over a period of time. [NIH] Curare: Plant extracts from several species, including Strychnos toxifera, S. castelnaei, S. crevauxii, and Chondodendron tomentosum, that produce paralysis of skeletal muscle and are used adjunctively with general anesthesia. These extracts are toxic and must be used with the administration of artificial respiration. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Cutaneous: Having to do with the skin. [NIH] Cyclic: Pertaining to or occurring in a cycle or cycles; the term is applied to chemical compounds that contain a ring of atoms in the nucleus. [EU] Cyst: A sac or capsule filled with fluid. [NIH] Cysteine: A thiol-containing non-essential amino acid that is oxidized to form cystine. [NIH] Cystitis: Inflammation of the urinary bladder. [EU] Cystocele: Fallen bladder. When the bladder falls or sags from its normal position down to the pelvic floor, it can cause either urinary leakage or urinary retention. [NIH] Cystoscopy: Endoscopic examination, therapy or surgery of the urinary bladder. [NIH] Cytomegalovirus: A genus of the family Herpesviridae, subfamily Betaherpesvirinae, infecting the salivary glands, liver, spleen, lungs, eyes, and other organs, in which they produce characteristically enlarged cells with intranuclear inclusions. Infection with Cytomegalovirus is also seen as an opportunistic infection in AIDS. [NIH] Cytoplasm: The protoplasm of a cell exclusive of that of the nucleus; it consists of a continuous aqueous solution (cytosol) and the organelles and inclusions suspended in it (phaneroplasm), and is the site of most of the chemical activities of the cell. [EU] Cytosine: A pyrimidine base that is a fundamental unit of nucleic acids. [NIH] Cytotoxic: Cell-killing. [NIH] Data Collection: Systematic gathering of data for a particular purpose from various sources, including questionnaires, interviews, observation, existing records, and electronic devices. The process is usually preliminary to statistical analysis of the data. [NIH] Databases, Bibliographic: Extensive collections, reputedly complete, of references and citations to books, articles, publications, etc., generally on a single subject or specialized subject area. Databases can operate through automated files, libraries, or computer disks. The concept should be differentiated from factual databases which is used for collections of data and facts apart from bibliographic references to them. [NIH] De novo: In cancer, the first occurrence of cancer in the body. [NIH]

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Deamination: The removal of an amino group (NH2) from a chemical compound. [NIH] Decarboxylation: The removal of a carboxyl group, usually in the form of carbon dioxide, from a chemical compound. [NIH] Decongestant: An agent that reduces congestion or swelling. [EU] Decubitus: An act of lying down; also the position assumed in lying down. [EU] Decubitus Ulcer: An ulceration caused by prolonged pressure in patients permitted to lie too still for a long period of time. The bony prominences of the body are the most frequently affected sites. The ulcer is caused by ischemia of the underlying structures of the skin, fat, and muscles as a result of the sustained and constant pressure. [NIH] Defecation: The normal process of elimination of fecal material from the rectum. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Dehydration: The condition that results from excessive loss of body water. [NIH] Deletion: A genetic rearrangement through loss of segments of DNA (chromosomes), bringing sequences, which are normally separated, into close proximity. [NIH] Delirium: (DSM III-R) an acute, reversible organic mental disorder characterized by reduced ability to maintain attention to external stimuli and disorganized thinking as manifested by rambling, irrelevant, or incoherent speech; there are also a reduced level of consciousness, sensory misperceptions, disturbance of the sleep-wakefulness cycle and level of psychomotor activity, disorientation to time, place, or person, and memory impairment. Delirium may be caused by a large number of conditions resulting in derangement of cerebral metabolism, including systemic infection, poisoning, drug intoxication or withdrawal, seizures or head trauma, and metabolic disturbances such as hypoxia, hypoglycaemia, fluid, electrolyte, or acid-base imbalances, or hepatic or renal failure. Called also acute confusional state and acute brain syndrome. [EU] Delivery of Health Care: The concept concerned with all aspects of providing and distributing health services to a patient population. [NIH] Delusions: A false belief regarding the self or persons or objects outside the self that persists despite the facts, and is not considered tenable by one's associates. [NIH] Dementia: An acquired organic mental disorder with loss of intellectual abilities of sufficient severity to interfere with social or occupational functioning. The dysfunction is multifaceted and involves memory, behavior, personality, judgment, attention, spatial relations, language, abstract thought, and other executive functions. The intellectual decline is usually progressive, and initially spares the level of consciousness. [NIH] Denaturation: Rupture of the hydrogen bonds by heating a DNA solution and then cooling it rapidly causes the two complementary strands to separate. [NIH] Dendrites: Extensions of the nerve cell body. They are short and branched and receive stimuli from other neurons. [NIH] Dendritic: 1. Branched like a tree. 2. Pertaining to or possessing dendrites. [EU] Density: The logarithm to the base 10 of the opacity of an exposed and processed film. [NIH] Depolarization: The process or act of neutralizing polarity. In neurophysiology, the reversal of the resting potential in excitable cell membranes when stimulated, i.e., the tendency of the cell membrane potential to become positive with respect to the potential outside the cell. [EU] Deprivation: Loss or absence of parts, organs, powers, or things that are needed. [EU] Dermal: Pertaining to or coming from the skin. [NIH]

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Desmopressin: A synthetic analog of the natural hormone 8-arginine vasopressin (argipressin). Its action is mediated by the vasopressin receptor V2. It has prolonged antidiuretic activity, but little pressor effects. It also modulates levels of circulating factor VIII and von Willebrand factor. [NIH] Detergents: Purifying or cleansing agents, usually salts of long-chain aliphatic bases or acids, that exert cleansing (oil-dissolving) and antimicrobial effects through a surface action that depends on possessing both hydrophilic and hydrophobic properties. [NIH] Deuterium: Deuterium. The stable isotope of hydrogen. It has one neutron and one proton in the nucleus. [NIH] Developing Countries: Countries in the process of change directed toward economic growth, that is, an increase in production, per capita consumption, and income. The process of economic growth involves better utilization of natural and human resources, which results in a change in the social, political, and economic structures. [NIH] Dexmedetomidine: A selective inhibitor of receptors, adrenergic alpha-2 that has analgesic and sedative properties. Medetomidine is the other racemic form. [NIH] Dexterity: Ability to move the hands easily and skillfully. [NIH] Dextromethorphan: The d-isomer of the codeine analog of levorphanol. Dextromethorphan shows high affinity binding to several regions of the brain, including the medullary cough center. This compound is a NMDA receptor antagonist (receptors, N-methyl-D-aspartate) and acts as a non-competitive channel blocker. It is used widely as an antitussive agent, and is also used to study the involvement of glutamate receptors in neurotoxicity. [NIH] Dextrorphan: Dextro form of levorphanol. It acts as a noncompetitive NMDA receptor antagonist, among other effects, and has been proposed as a neuroprotective agent. It is also a metabolite of dextromethorphan. [NIH] Diabetes Mellitus: A heterogeneous group of disorders that share glucose intolerance in common. [NIH] Diabetic Retinopathy: Retinopathy associated with diabetes mellitus, which may be of the background type, progressively characterized by microaneurysms, interretinal punctuate macular edema, or of the proliferative type, characterized by neovascularization of the retina and optic disk, which may project into the vitreous, proliferation of fibrous tissue, vitreous hemorrhage, and retinal detachment. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Diaphragm: The musculofibrous partition that separates the thoracic cavity from the abdominal cavity. Contraction of the diaphragm increases the volume of the thoracic cavity aiding inspiration. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Diarrhoea: Abnormal frequency and liquidity of faecal discharges. [EU] Diastolic: Of or pertaining to the diastole. [EU] Dicyclomine: A muscarinic antagonist used as an antispasmodic and in urinary incontinence. It has little effect on glandular secretion or the cardiovascular system. It does have some local anesthetic properties and is used in gastrointestinal, biliary, and urinary tract spasms. [NIH] Diencephalon: The paired caudal parts of the prosencephalon from which the thalamus, hypothalamus, epithalamus, and subthalamus are derived. [NIH] Diffusion: The tendency of a gas or solute to pass from a point of higher pressure or concentration to a point of lower pressure or concentration and to distribute itself

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throughout the available space; a major mechanism of biological transport. [NIH] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Digestive tract: The organs through which food passes when food is eaten. These organs are the mouth, esophagus, stomach, small and large intestines, and rectum. [NIH] Dihydrotestosterone: Anabolic agent. [NIH] Dilatation: The act of dilating. [NIH] Dilatation, Pathologic: The condition of an anatomical structure's being dilated beyond normal dimensions. [NIH] Dilation: A process by which the pupil is temporarily enlarged with special eye drops (mydriatic); allows the eye care specialist to better view the inside of the eye. [NIH] Dilator: A device used to stretch or enlarge an opening. [NIH] Diploid: Having two sets of chromosomes. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Discrete: Made up of separate parts or characterized by lesions which do not become blended; not running together; separate. [NIH] Disease Progression: The worsening of a disease over time. This concept is most often used for chronic and incurable diseases where the stage of the disease is an important determinant of therapy and prognosis. [NIH] Disinfectant: An agent that disinfects; applied particularly to agents used on inanimate objects. [EU] Disorientation: The loss of proper bearings, or a state of mental confusion as to time, place, or identity. [EU] Dissociation: 1. The act of separating or state of being separated. 2. The separation of a molecule into two or more fragments (atoms, molecules, ions, or free radicals) produced by the absorption of light or thermal energy or by solvation. 3. In psychology, a defense mechanism in which a group of mental processes are segregated from the rest of a person's mental activity in order to avoid emotional distress, as in the dissociative disorders (q.v.), or in which an idea or object is segregated from its emotional significance; in the first sense it is roughly equivalent to splitting, in the second, to isolation. 4. A defect of mental integration in which one or more groups of mental processes become separated off from normal consciousness and, thus separated, function as a unitary whole. [EU] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Diuresis: Increased excretion of urine. [EU] Diurnal: Occurring during the day. [EU] Dizziness: An imprecise term which may refer to a sense of spatial disorientation, motion of the environment, or lightheadedness. [NIH] Dopamine: An endogenous catecholamine and prominent neurotransmitter in several systems of the brain. In the synthesis of catecholamines from tyrosine, it is the immediate precursor to norepinephrine and epinephrine. Dopamine is a major transmitter in the extrapyramidal system of the brain, and important in regulating movement. A family of dopaminergic receptor subtypes mediate its action. Dopamine is used pharmacologically for its direct (beta adrenergic agonist) and indirect (adrenergic releasing) sympathomimetic effects including its actions as an inotropic agent and as a renal vasodilator. [NIH]

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Dorsal: 1. Pertaining to the back or to any dorsum. 2. Denoting a position more toward the back surface than some other object of reference; same as posterior in human anatomy; superior in the anatomy of quadrupeds. [EU] Dorsum: A plate of bone which forms the posterior boundary of the sella turcica. [NIH] Dosimetry: All the methods either of measuring directly, or of measuring indirectly and computing, absorbed dose, absorbed dose rate, exposure, exposure rate, dose equivalent, and the science associated with these methods. [NIH] Double-blind: Pertaining to a clinical trial or other experiment in which neither the subject nor the person administering treatment knows which treatment any particular subject is receiving. [EU] Doxepin: A dibenzoxepin tricyclic compound. It displays a range of pharmacological actions including maintaining adrenergic innervation. Its mechanism of action is not fully understood, but it appears to block reuptake of monoaminergic neurotransmitters into presynaptic terminals. It also possesses anticholinergic activity and modulates antagonism of histamine H(1)- and H(2)-receptors. [NIH] Drip: The continuous slow introduction of a fluid containing nutrients or drugs. [NIH] Drug Design: The molecular designing of drugs for specific purposes (such as DNAbinding, enzyme inhibition, anti-cancer efficacy, etc.) based on knowledge of molecular properties such as activity of functional groups, molecular geometry, and electronic structure, and also on information cataloged on analogous molecules. Drug design is generally computer-assisted molecular modeling and does not include pharmacokinetics, dosage analysis, or drug administration analysis. [NIH] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Drug Tolerance: Progressive diminution of the susceptibility of a human or animal to the effects of a drug, resulting from its continued administration. It should be differentiated from drug resistance wherein an organism, disease, or tissue fails to respond to the intended effectiveness of a chemical or drug. It should also be differentiated from maximum tolerated dose and no-observed-adverse-effect level. [NIH] Duct: A tube through which body fluids pass. [NIH] Duodenal Ulcer: An ulcer in the lining of the first part of the small intestine (duodenum). [NIH]

Duodenum: The first part of the small intestine. [NIH] Dyskinesia: Impairment of the power of voluntary movement, resulting in fragmentary or incomplete movements. [EU] Dyspareunia: Painful sexual intercourse. [NIH] Dysphoria: Disquiet; restlessness; malaise. [EU] Dystonia: Disordered tonicity of muscle. [EU] Ectopic: Pertaining to or characterized by ectopia. [EU] Edema: Excessive amount of watery fluid accumulated in the intercellular spaces, most commonly present in subcutaneous tissue. [NIH] Effector: It is often an enzyme that converts an inactive precursor molecule into an active second messenger. [NIH] Efferent: Nerve fibers which conduct impulses from the central nervous system to muscles and glands. [NIH]

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Efferent Pathways: Nerve structures through which impulses are conducted from a nerve center toward a peripheral site. [NIH] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Ejaculation: The release of semen through the penis during orgasm. [NIH] Elastic: Susceptible of resisting and recovering from stretching, compression or distortion applied by a force. [EU] Elasticity: Resistance and recovery from distortion of shape. [NIH] Elastin: The protein that gives flexibility to tissues. [NIH] Elective: Subject to the choice or decision of the patient or physician; applied to procedures that are advantageous to the patient but not urgent. [EU] Electrode: Component of the pacing system which is at the distal end of the lead. It is the interface with living cardiac tissue across which the stimulus is transmitted. [NIH] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Electromyography: Recording of the changes in electric potential of muscle by means of surface or needle electrodes. [NIH] Electrons: Stable elementary particles having the smallest known negative charge, present in all elements; also called negatrons. Positively charged electrons are called positrons. The numbers, energies and arrangement of electrons around atomic nuclei determine the chemical identities of elements. Beams of electrons are called cathode rays or beta rays, the latter being a high-energy biproduct of nuclear decay. [NIH] Electrophysiological: Pertaining to electrophysiology, that is a branch of physiology that is concerned with the electric phenomena associated with living bodies and involved in their functional activity. [EU] Embolus: Bit of foreign matter which enters the blood stream at one point and is carried until it is lodged or impacted in an artery and obstructs it. It may be a blood clot, an air bubble, fat or other tissue, or clumps of bacteria. [NIH] Embryo: The prenatal stage of mammalian development characterized by rapid morphological changes and the differentiation of basic structures. [NIH] Emesis: Vomiting; an act of vomiting. Also used as a word termination, as in haematemesis. [EU]

Emphysema: A pathological accumulation of air in tissues or organs. [NIH] Empiric: Empirical; depending upon experience or observation alone, without using scientific method or theory. [EU] Empirical: A treatment based on an assumed diagnosis, prior to receiving confirmatory laboratory test results. [NIH] Endocrine Glands: Ductless glands that secrete substances which are released directly into the circulation and which influence metabolism and other body functions. [NIH] Endocrine System: The system of glands that release their secretions (hormones) directly into the circulatory system. In addition to the endocrine glands, included are the chromaffin system and the neurosecretory systems. [NIH] Endocrinology: A subspecialty of internal medicine concerned with the metabolism, physiology, and disorders of the endocrine system. [NIH]

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Endogenous: Produced inside an organism or cell. The opposite is external (exogenous) production. [NIH] Endometrial: Having to do with the endometrium (the layer of tissue that lines the uterus). [NIH]

Endometriosis: A condition in which tissue more or less perfectly resembling the uterine mucous membrane (the endometrium) and containing typical endometrial granular and stromal elements occurs aberrantly in various locations in the pelvic cavity. [NIH] Endometrium: The layer of tissue that lines the uterus. [NIH] Endorphins: One of the three major groups of endogenous opioid peptides. They are large peptides derived from the pro-opiomelanocortin precursor. The known members of this group are alpha-, beta-, and gamma-endorphin. The term endorphin is also sometimes used to refer to all opioid peptides, but the narrower sense is used here; opioid peptides is used for the broader group. [NIH] Endoscope: A thin, lighted tube used to look at tissues inside the body. [NIH] Endoscopic: A technique where a lateral-view endoscope is passed orally to the duodenum for visualization of the ampulla of Vater. [NIH] Endothelium: A layer of epithelium that lines the heart, blood vessels (endothelium, vascular), lymph vessels (endothelium, lymphatic), and the serous cavities of the body. [NIH] Endothelium, Lymphatic: Unbroken cellular lining (intima) of the lymph vessels (e.g., the high endothelial lymphatic venules). It is more permeable than vascular endothelium, lacking selective absorption and functioning mainly to remove plasma proteins that have filtered through the capillaries into the tissue spaces. [NIH] Endothelium, Vascular: Single pavement layer of cells which line the luminal surface of the entire vascular system and regulate the transport of macromolecules and blood components from interstitium to lumen; this function has been most intensively studied in the blood capillaries. [NIH] Endothelium-derived: Small molecule that diffuses to the adjacent muscle layer and relaxes it. [NIH] End-stage renal: Total chronic kidney failure. When the kidneys fail, the body retains fluid and harmful wastes build up. A person with ESRD needs treatment to replace the work of the failed kidneys. [NIH] Enhancers: Transcriptional element in the virus genome. [NIH] Enkephalins: One of the three major families of endogenous opioid peptides. The enkephalins are pentapeptides that are widespread in the central and peripheral nervous systems and in the adrenal medulla. [NIH] Enterocele: A hernia in the intestine. [NIH] Enuresis: Involuntary discharge of urine after the age at which urinary control should have been achieved; often used alone with specific reference to involuntary discharge of urine occurring during sleep at night (bed-wetting, nocturnal enuresis). [EU] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]

Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Ephedrine: An alpha- and beta-adrenergic agonist that may also enhance release of norepinephrine. It has been used in the treatment of several disorders including asthma,

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heart failure, rhinitis, and urinary incontinence, and for its central nervous system stimulatory effects in the treatment of narcolepsy and depression. It has become less extensively used with the advent of more selective agonists. [NIH] Epidemiologic Factors: Events, characteristics, or other definable entities that have the potential to bring about a change in a health condition or other defined outcome. [NIH] Epidemiologic Studies: Studies designed to examine associations, commonly, hypothesized causal relations. They are usually concerned with identifying or measuring the effects of risk factors or exposures. The common types of analytic study are case-control studies, cohort studies, and cross-sectional studies. [NIH] Epidemiological: Relating to, or involving epidemiology. [EU] Epidural: The space between the wall of the spinal canal and the covering of the spinal cord. An epidural injection is given into this space. [NIH] Epilepticus: Repeated and prolonged epileptic seizures without recovery of consciousness between attacks. [NIH] Epinephrine: The active sympathomimetic hormone from the adrenal medulla in most species. It stimulates both the alpha- and beta- adrenergic systems, causes systemic vasoconstriction and gastrointestinal relaxation, stimulates the heart, and dilates bronchi and cerebral vessels. It is used in asthma and cardiac failure and to delay absorption of local anesthetics. [NIH] Episiotomy: An incision of the posterior vaginal wall and a portion of the pudenda which enlarges the vaginal introitus to facilitate delivery and prevent lacerations. [NIH] Epispadias: Congenital absence of the upper wall of the urethra. [NIH] Epithelial: Refers to the cells that line the internal and external surfaces of the body. [NIH] Epithelial Cells: Cells that line the inner and outer surfaces of the body. [NIH] Epithelium: One or more layers of epithelial cells, supported by the basal lamina, which covers the inner or outer surfaces of the body. [NIH] Erectile: The inability to get or maintain an erection for satisfactory sexual intercourse. Also called impotence. [NIH] Erection: The condition of being made rigid and elevated; as erectile tissue when filled with blood. [EU] ERV: The expiratory reserve volume is the largest volume of gas that can be expired from the end-expiratory level. [NIH] Erythema: Redness of the skin produced by congestion of the capillaries. This condition may result from a variety of causes. [NIH] Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks containing hemoglobin whose function is to transport oxygen. [NIH] Esophageal: Having to do with the esophagus, the muscular tube through which food passes from the throat to the stomach. [NIH] Esophageal Ulcer: A sore in the esophagus. Caused by long-term inflammation or damage from the residue of pills. The ulcer may cause chest pain. [NIH] Esophagitis: Inflammation, acute or chronic, of the esophagus caused by bacteria, chemicals, or trauma. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]

Estrogen: One of the two female sex hormones. [NIH]

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Estrogen Antagonists: Compounds which inhibit or antagonize the action or biosynthesis of estrogen. [NIH] Estrogen receptor: ER. Protein found on some cancer cells to which estrogen will attach. [NIH]

Estrogen Replacement Therapy: The use of hormonal agents with estrogen-like activity in postmenopausal or other estrogen-deficient women to alleviate effects of hormone deficiency, such as vasomotor symptoms, dyspareunia, and progressive development of osteoporosis. This may also include the use of progestational agents in combination therapy. [NIH]

Ethanol: A clear, colorless liquid rapidly absorbed from the gastrointestinal tract and distributed throughout the body. It has bactericidal activity and is used often as a topical disinfectant. It is widely used as a solvent and preservative in pharmaceutical preparations as well as serving as the primary ingredient in alcoholic beverages. [NIH] Ethanolamine: A viscous, hygroscopic amino alcohol with an ammoniacal odor. It is widely distributed in biological tissue and is a component of lecithin. It is used as a surfactant, fluorimetric reagent, and to remove CO2 and H2S from natural gas and other gases. [NIH] Ether: One of a class of organic compounds in which any two organic radicals are attached directly to a single oxygen atom. [NIH] Ethnic Groups: A group of people with a common cultural heritage that sets them apart from others in a variety of social relationships. [NIH] Eukaryotic Cells: Cells of the higher organisms, containing a true nucleus bounded by a nuclear membrane. [NIH] Evacuation: An emptying, as of the bowels. [EU] Excitability: Property of a cardiac cell whereby, when the cell is depolarized to a critical level (called threshold), the membrane becomes permeable and a regenerative inward current causes an action potential. [NIH] Excitation: An act of irritation or stimulation or of responding to a stimulus; the addition of energy, as the excitation of a molecule by absorption of photons. [EU] Excitatory: When cortical neurons are excited, their output increases and each new input they receive while they are still excited raises their output markedly. [NIH] Excitatory Amino Acids: Endogenous amino acids released by neurons as excitatory neurotransmitters. Glutamic acid is the most common excitatory neurotransmitter in the brain. Aspartic acid has been regarded as an excitatory transmitter for many years, but the extent of its role as a transmitter is unclear. [NIH] Excitotoxicity: Excessive exposure to glutamate or related compounds can kill brain neurons, presumably by overstimulating them. [NIH] Excrete: To get rid of waste from the body. [NIH] Exercise Therapy: Motion of the body or its parts to relieve symptoms or to improve function, leading to physical fitness, but not physical education and training. [NIH] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Expiration: The act of breathing out, or expelling air from the lungs. [EU] Expiratory: The volume of air which leaves the breathing organs in each expiration. [NIH] Expiratory Reserve Volume: The extra volume of air that can be expired with maximum effort beyond the level reached at the end of a normal, quiet expiration. Common abbreviation is ERV. [NIH] External-beam radiation: Radiation therapy that uses a machine to aim high-energy rays at

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the cancer. Also called external radiation. [NIH] Extracellular: Outside a cell or cells. [EU] Extracellular Matrix: A meshwork-like substance found within the extracellular space and in association with the basement membrane of the cell surface. It promotes cellular proliferation and provides a supporting structure to which cells or cell lysates in culture dishes adhere. [NIH] Extracellular Matrix Proteins: Macromolecular organic compounds that contain carbon, hydrogen, oxygen, nitrogen, and usually, sulfur. These macromolecules (proteins) form an intricate meshwork in which cells are embedded to construct tissues. Variations in the relative types of macromolecules and their organization determine the type of extracellular matrix, each adapted to the functional requirements of the tissue. The two main classes of macromolecules that form the extracellular matrix are: glycosaminoglycans, usually linked to proteins (proteoglycans), and fibrous proteins (e.g., collagen, elastin, fibronectins and laminin). [NIH] Extracellular Space: Interstitial space between cells, occupied by fluid as well as amorphous and fibrous substances. [NIH] Extracorporeal: Situated or occurring outside the body. [EU] Extraction: The process or act of pulling or drawing out. [EU] Extrapyramidal: Outside of the pyramidal tracts. [EU] Extremity: A limb; an arm or leg (membrum); sometimes applied specifically to a hand or foot. [EU] Faecal: Pertaining to or of the nature of feces. [EU] Fallopian Tubes: Two long muscular tubes that transport ova from the ovaries to the uterus. They extend from the horn of the uterus to the ovaries and consist of an ampulla, an infundibulum, an isthmus, two ostia, and a pars uterina. The walls of the tubes are composed of three layers: mucosal, muscular, and serosal. [NIH] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Fat: Total lipids including phospholipids. [NIH] Fatal Outcome: Death resulting from the presence of a disease in an individual, as shown by a single case report or a limited number of patients. This should be differentiated from death, the physiological cessation of life and from mortality, an epidemiological or statistical concept. [NIH] Fecal Incontinence: Failure of voluntary control of the anal sphincters, with involuntary passage of feces and flatus. [NIH] Feces: The excrement discharged from the intestines, consisting of bacteria, cells exfoliated from the intestines, secretions, chiefly of the liver, and a small amount of food residue. [EU] Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [NIH] Fibrin: A protein derived from fibrinogen in the presence of thrombin, which forms part of the blood clot. [NIH] Fibrinogen: Plasma glycoprotein clotted by thrombin, composed of a dimer of three nonidentical pairs of polypeptide chains (alpha, beta, gamma) held together by disulfide bonds. Fibrinogen clotting is a sol-gel change involving complex molecular arrangements: whereas fibrinogen is cleaved by thrombin to form polypeptides A and B, the proteolytic action of other enzymes yields different fibrinogen degradation products. [NIH] Fibroblasts: Connective tissue cells which secrete an extracellular matrix rich in collagen

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and other macromolecules. [NIH] Fibrosis: Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. [NIH] Fistula: Abnormal communication most commonly seen between two internal organs, or between an internal organ and the surface of the body. [NIH] Fixation: 1. The act or operation of holding, suturing, or fastening in a fixed position. 2. The condition of being held in a fixed position. 3. In psychiatry, a term with two related but distinct meanings : (1) arrest of development at a particular stage, which like regression (return to an earlier stage), if temporary is a normal reaction to setbacks and difficulties but if protracted or frequent is a cause of developmental failures and emotional problems, and (2) a close and suffocating attachment to another person, especially a childhood figure, such as one's mother or father. Both meanings are derived from psychoanalytic theory and refer to 'fixation' of libidinal energy either in a specific erogenous zone, hence fixation at the oral, anal, or phallic stage, or in a specific object, hence mother or father fixation. 4. The use of a fixative (q.v.) to preserve histological or cytological specimens. 5. In chemistry, the process whereby a substance is removed from the gaseous or solution phase and localized, as in carbon dioxide fixation or nitrogen fixation. 6. In ophthalmology, direction of the gaze so that the visual image of the object falls on the fovea centralis. 7. In film processing, the chemical removal of all undeveloped salts of the film emulsion, leaving only the developed silver to form a permanent image. [EU] Flatus: Gas passed through the rectum. [NIH] Flavoxate: A drug that has been used in various urinary syndromes and as an antispasmodic. Its therapeutic usefulness and its mechanism of action are not clear. It may have local anesthetic activity and direct relaxing effects on smooth muscle as well as some activity as a muscarinic antagonist. [NIH] Fluoroscopy: Production of an image when X-rays strike a fluorescent screen. [NIH] Foetoplacental: Pertaining to the fetus and placenta. [EU] Follow-Up Studies: Studies in which individuals or populations are followed to assess the outcome of exposures, procedures, or effects of a characteristic, e.g., occurrence of disease. [NIH]

Foramen: A natural hole of perforation, especially one in a bone. [NIH] Forearm: The part between the elbow and the wrist. [NIH] Frail Elderly: Older adults or aged individuals who are lacking in general strength and are unusually susceptible to disease or to other infirmity. [NIH] Friction: Surface resistance to the relative motion of one body against the rubbing, sliding, rolling, or flowing of another with which it is in contact. [NIH] Frigidity: Coldness; especially, lack of sexual response in the female. [EU] Frontal Lobe: The anterior part of the cerebral hemisphere. [NIH] Fungi: A kingdom of eukaryotic, heterotrophic organisms that live as saprobes or parasites, including mushrooms, yeasts, smuts, molds, etc. They reproduce either sexually or asexually, and have life cycles that range from simple to complex. Filamentous fungi refer to those that grow as multicelluar colonies (mushrooms and molds). [NIH] Gait: Manner or style of walking. [NIH] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Gamma Rays: Very powerful and penetrating, high-energy electromagnetic radiation of

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shorter wavelength than that of x-rays. They are emitted by a decaying nucleus, usually between 0.01 and 10 MeV. They are also called nuclear x-rays. [NIH] Ganglia: Clusters of multipolar neurons surrounded by a capsule of loosely organized connective tissue located outside the central nervous system. [NIH] Ganglion: 1. A knot, or knotlike mass. 2. A general term for a group of nerve cell bodies located outside the central nervous system; occasionally applied to certain nuclear groups within the brain or spinal cord, e.g. basal ganglia. 3. A benign cystic tumour occurring on a aponeurosis or tendon, as in the wrist or dorsum of the foot; it consists of a thin fibrous capsule enclosing a clear mucinous fluid. [EU] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gastric: Having to do with the stomach. [NIH] Gastric Acid: Hydrochloric acid present in gastric juice. [NIH] Gastric Juices: Liquids produced in the stomach to help break down food and kill bacteria. [NIH]

Gastrin: A hormone released after eating. Gastrin causes the stomach to produce more acid. [NIH]

Gastroesophageal Reflux: Reflux of gastric juice and/or duodenal contents (bile acids, pancreatic juice) into the distal esophagus, commonly due to incompetence of the lower esophageal sphincter. Gastric regurgitation is an extension of this process with entry of fluid into the pharynx or mouth. [NIH] Gastroesophageal Reflux Disease: Flow of the stomach's contents back up into the esophagus. Happens when the muscle between the esophagus and the stomach (the lower esophageal sphincter) is weak or relaxes when it shouldn't. May cause esophagitis. Also called esophageal reflux or reflux esophagitis. [NIH] Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastrointestinal tract: The stomach and intestines. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]

Gene Expression: The phenotypic manifestation of a gene or genes by the processes of gene action. [NIH] Gene Therapy: The introduction of new genes into cells for the purpose of treating disease by restoring or adding gene expression. Techniques include insertion of retroviral vectors, transfection, homologous recombination, and injection of new genes into the nuclei of single cell embryos. The entire gene therapy process may consist of multiple steps. The new genes may be introduced into proliferating cells in vivo (e.g., bone marrow) or in vitro (e.g., fibroblast cultures) and the modified cells transferred to the site where the gene expression is required. Gene therapy may be particularly useful for treating enzyme deficiency diseases, hemoglobinopathies, and leukemias and may also prove useful in restoring drug sensitivity, particularly for leukemia. [NIH] General practitioner: A medical practitioner who does not specialize in a particular branch of medicine or limit his practice to a specific class of diseases. [NIH] Genetic Code: The specifications for how information, stored in nucleic acid sequence (base sequence), is translated into protein sequence (amino acid sequence). The start, stop, and order of amino acids of a protein is specified by consecutive triplets of nucleotides called codons (codon). [NIH]

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Genetic testing: Analyzing DNA to look for a genetic alteration that may indicate an increased risk for developing a specific disease or disorder. [NIH] Genetics: The biological science that deals with the phenomena and mechanisms of heredity. [NIH] Genital: Pertaining to the genitalia. [EU] Genitourinary: Pertaining to the genital and urinary organs; urogenital; urinosexual. [EU] Genomics: The systematic study of the complete DNA sequences (genome) of organisms. [NIH]

Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Geriatric: Pertaining to the treatment of the aged. [EU] Geriatric Assessment: Evaluation of the level of physical, physiological, or mental functioning in the older population group. [NIH] Gestation: The period of development of the young in viviparous animals, from the time of fertilization of the ovum until birth. [EU] Gestational: Psychosis attributable to or occurring during pregnancy. [NIH] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Glomerular: Pertaining to or of the nature of a glomerulus, especially a renal glomerulus. [EU]

Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. [NIH] Glucose Intolerance: A pathological state in which the fasting plasma glucose level is less than 140 mg per deciliter and the 30-, 60-, or 90-minute plasma glucose concentration following a glucose tolerance test exceeds 200 mg per deciliter. This condition is seen frequently in diabetes mellitus but also occurs with other diseases. [NIH] Glutamate: Excitatory neurotransmitter of the brain. [NIH] Glutamic Acid: A non-essential amino acid naturally occurring in the L-form. Glutamic acid (glutamate) is the most common excitatory neurotransmitter in the central nervous system. [NIH]

Glycine: A non-essential amino acid. It is found primarily in gelatin and silk fibroin and used therapeutically as a nutrient. It is also a fast inhibitory neurotransmitter. [NIH] Glycoprotein: A protein that has sugar molecules attached to it. [NIH] Glycosaminoglycans: Heteropolysaccharides which contain an N-acetylated hexosamine in a characteristic repeating disaccharide unit. The repeating structure of each disaccharide involves alternate 1,4- and 1,3-linkages consisting of either N-acetylglucosamine or Nacetylgalactosamine. [NIH] Gonad: A sex organ, such as an ovary or a testicle, which produces the gametes in most multicellular animals. [NIH] Gonadal: Pertaining to a gonad. [EU] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Gp120: 120-kD HIV envelope glycoprotein which is involved in the binding of the virus to its membrane receptor, the CD4 molecule, found on the surface of certain cells in the body.

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[NIH]

Graft: Healthy skin, bone, or other tissue taken from one part of the body and used to replace diseased or injured tissue removed from another part of the body. [NIH] Grafting: The operation of transfer of tissue from one site to another. [NIH] Granulocytes: Leukocytes with abundant granules in the cytoplasm. They are divided into three groups: neutrophils, eosinophils, and basophils. [NIH] Granuloma: A relatively small nodular inflammatory lesion containing grouped mononuclear phagocytes, caused by infectious and noninfectious agents. [NIH] Gravidity: Pregnancy; the condition of being pregnant, without regard to the outcome. [EU] Groin: The external junctural region between the lower part of the abdomen and the thigh. [NIH]

Group Practice: Any group of three or more full-time physicians organized in a legally recognized entity for the provision of health care services, sharing space, equipment, personnel and records for both patient care and business management, and who have a predetermined arrangement for the distribution of income. [NIH] Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH] Growth factors: Substances made by the body that function to regulate cell division and cell survival. Some growth factors are also produced in the laboratory and used in biological therapy. [NIH] Guanine: One of the four DNA bases. [NIH] Guanylate Cyclase: An enzyme that catalyzes the conversion of GTP to 3',5'-cyclic GMP and pyrophosphate. It also acts on ITP and dGTP. (From Enzyme Nomenclature, 1992) EC 4.6.1.2. [NIH] Gynecology: A medical-surgical specialty concerned with the physiology and disorders primarily of the female genital tract, as well as female endocrinology and reproductive physiology. [NIH] Habitual: Of the nature of a habit; according to habit; established by or repeated by force of habit, customary. [EU] Haematemesis: The vomiting of blood. [EU] Haloperidol: Butyrophenone derivative. [NIH] Haploid: An organism with one basic chromosome set, symbolized by n; the normal condition of gametes in diploids. [NIH] Haptens: Small antigenic determinants capable of eliciting an immune response only when coupled to a carrier. Haptens bind to antibodies but by themselves cannot elicit an antibody response. [NIH] Headache: Pain in the cranial region that may occur as an isolated and benign symptom or as a manifestation of a wide variety of conditions including subarachnoid hemorrhage; craniocerebral trauma; central nervous system infections; intracranial hypertension; and other disorders. In general, recurrent headaches that are not associated with a primary disease process are referred to as headache disorders (e.g., migraine). [NIH] Headache Disorders: Common conditions characterized by persistent or recurrent headaches. Headache syndrome classification systems may be based on etiology (e.g., vascular headache, post-traumatic headaches, etc.), temporal pattern (e.g., cluster headache, paroxysmal hemicrania, etc.), and precipitating factors (e.g., cough headache). [NIH] Health Behavior: Behaviors expressed by individuals to protect, maintain or promote their

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health status. For example, proper diet, and appropriate exercise are activities perceived to influence health status. Life style is closely associated with health behavior and factors influencing life style are socioeconomic, educational, and cultural. [NIH] Health Care Costs: The actual costs of providing services related to the delivery of health care, including the costs of procedures, therapies, and medications. It is differentiated from health expenditures, which refers to the amount of money paid for the services, and from fees, which refers to the amount charged, regardless of cost. [NIH] Health Education: Education that increases the awareness and favorably influences the attitudes and knowledge relating to the improvement of health on a personal or community basis. [NIH] Health Expenditures: The amounts spent by individuals, groups, nations, or private or public organizations for total health care and/or its various components. These amounts may or may not be equivalent to the actual costs (health care costs) and may or may not be shared among the patient, insurers, and/or employers. [NIH] Health Promotion: Encouraging consumer behaviors most likely to optimize health potentials (physical and psychosocial) through health information, preventive programs, and access to medical care. [NIH] Health Services: Services for the diagnosis and treatment of disease and the maintenance of health. [NIH] Health Status: The level of health of the individual, group, or population as subjectively assessed by the individual or by more objective measures. [NIH] Heart attack: A seizure of weak or abnormal functioning of the heart. [NIH] Heart failure: Loss of pumping ability by the heart, often accompanied by fatigue, breathlessness, and excess fluid accumulation in body tissues. [NIH] Heartburn: Substernal pain or burning sensation, usually associated with regurgitation of gastric juice into the esophagus. [NIH] Hematoma: An extravasation of blood localized in an organ, space, or tissue. [NIH] Hematuria: Presence of blood in the urine. [NIH] Hemiparesis: The weakness or paralysis affecting one side of the body. [NIH] Hemodialysis: The use of a machine to clean wastes from the blood after the kidneys have failed. The blood travels through tubes to a dialyzer, which removes wastes and extra fluid. The cleaned blood then flows through another set of tubes back into the body. [NIH] Hemoglobinopathies: A group of inherited disorders characterized by structural alterations within the hemoglobin molecule. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hemorrhagic stroke: A disorder involving bleeding within ischemic brain tissue. Hemorrhagic stroke occurs when blood vessels that are damaged or dead from lack of blood supply (infarcted), located within an area of infarcted brain tissue, rupture and transform an "ischemic" stroke into a hemorrhagic stroke. Ischemia is inadequate tissue oxygenation caused by reduced blood flow; infarction is tissue death resulting from ischemia. Bleeding irritates the brain tissues, causing swelling (cerebral edema). Blood collects into a mass (hematoma). Both swelling and hematoma will compress and displace brain tissue. [NIH] Hemorrhoids: Varicosities of the hemorrhoidal venous plexuses. [NIH] Hemostasis: The process which spontaneously arrests the flow of blood from vessels carrying blood under pressure. It is accomplished by contraction of the vessels, adhesion and aggregation of formed blood elements, and the process of blood or plasma coagulation.

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[NIH]

Hepatic: Refers to the liver. [NIH] Hereditary: Of, relating to, or denoting factors that can be transmitted genetically from one generation to another. [NIH] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Hernia: Protrusion of a loop or knuckle of an organ or tissue through an abnormal opening. [NIH]

Herniorrhaphy: An operation to repair a hernia. [NIH] Heterogeneity: The property of one or more samples or populations which implies that they are not identical in respect of some or all of their parameters, e. g. heterogeneity of variance. [NIH]

Histamine: 1H-Imidazole-4-ethanamine. A depressor amine derived by enzymatic decarboxylation of histidine. It is a powerful stimulant of gastric secretion, a constrictor of bronchial smooth muscle, a vasodilator, and also a centrally acting neurotransmitter. [NIH] Histidine: An essential amino acid important in a number of metabolic processes. It is required for the production of histamine. [NIH] Histology: The study of tissues and cells under a microscope. [NIH] Homogeneous: Consisting of or composed of similar elements or ingredients; of a uniform quality throughout. [EU] Homologous: Corresponding in structure, position, origin, etc., as (a) the feathers of a bird and the scales of a fish, (b) antigen and its specific antibody, (c) allelic chromosomes. [EU] Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormonal therapy: Treatment of cancer by removing, blocking, or adding hormones. Also called hormone therapy or endocrine therapy. [NIH] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Hormone Replacement Therapy: Therapeutic use of hormones to alleviate the effects of hormone deficiency. [NIH] Hormone therapy: Treatment of cancer by removing, blocking, or adding hormones. Also called endocrine therapy. [NIH] Hospital Charges: The prices a hospital sets for its services. Hospital costs (the direct and indirect expenses incurred by the hospital in providing the services) are one factor in the determination of hospital charges. Other factors may include, for example, profits, competition, and the necessity of recouping the costs of uncompensated care. [NIH] Hospital Costs: The expenses incurred by a hospital in providing care. The hospital costs attributed to a particular patient care episode include the direct costs plus an appropriate proportion of the overhead for administration, personnel, building maintenance, equipment, etc. Hospital costs are one of the factors which determine hospital charges (the price the hospital sets for its services). [NIH] Host: Any animal that receives a transplanted graft. [NIH] Hybrid: Cross fertilization between two varieties or, more usually, two species of vines, see also crossing. [NIH] Hybridization: The genetic process of crossbreeding to produce a hybrid. Hybrid nucleic

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acids can be formed by nucleic acid hybridization of DNA and RNA molecules. Protein hybridization allows for hybrid proteins to be formed from polypeptide chains. [NIH] Hydrogel: A network of cross-linked hydrophilic macromolecules used in biomedical applications. [NIH] Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hydrolysis: The process of cleaving a chemical compound by the addition of a molecule of water. [NIH] Hydrophilic: Readily absorbing moisture; hygroscopic; having strongly polar groups that readily interact with water. [EU] Hydroxylation: Hydroxylate, to introduce hydroxyl into (a compound or radical) usually by replacement of hydrogen. [EU] Hydroxylysine: A hydroxylated derivative of the amino acid lysine that is present in certain collagens. [NIH] Hydroxyproline: A hydroxylated form of the imino acid proline. A deficiency in ascorbic acid can result in impaired hydroxyproline formation. [NIH] Hygienic: Pertaining to hygiene, or conducive to health. [EU] Hypercholesterolemia: Abnormally high levels of cholesterol in the blood. [NIH] Hyperplasia: An increase in the number of cells in a tissue or organ, not due to tumor formation. It differs from hypertrophy, which is an increase in bulk without an increase in the number of cells. [NIH] Hyperreflexia: Exaggeration of reflexes. [EU] Hypersensitivity: Altered reactivity to an antigen, which can result in pathologic reactions upon subsequent exposure to that particular antigen. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hypertrophy: General increase in bulk of a part or organ, not due to tumor formation, nor to an increase in the number of cells. [NIH] Hypoglycaemia: An abnormally diminished concentration of glucose in the blood, which may lead to tremulousness, cold sweat, piloerection, hypothermia, and headache, accompanied by irritability, confusion, hallucinations, bizarre behaviour, and ultimately, convulsions and coma. [EU] Hypoglycemia: Abnormally low blood sugar [NIH] Hypoglycemic: An orally active drug that produces a fall in blood glucose concentration. [NIH]

Hypogonadism: Condition resulting from or characterized by abnormally decreased functional activity of the gonads, with retardation of growth and sexual development. [NIH] Hypokinesia: Slow or diminished movement of body musculature. It may be associated with basal ganglia diseases; mental disorders; prolonged inactivity due to illness; experimental protocols used to evaluate the physiologic effects of immobility; and other conditions. [NIH] Hypotension: Abnormally low blood pressure. [NIH]

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Hypothalamic: Of or involving the hypothalamus. [EU] Hypothalamus: Ventral part of the diencephalon extending from the region of the optic chiasm to the caudal border of the mammillary bodies and forming the inferior and lateral walls of the third ventricle. [NIH] Hypoxia: Reduction of oxygen supply to tissue below physiological levels despite adequate perfusion of the tissue by blood. [EU] Hypoxic: Having too little oxygen. [NIH] Hysterectomy: Excision of the uterus. [NIH] Hysterotomy: An incision in the uterus, performed through either the abdomen or the vagina. [NIH] Id: The part of the personality structure which harbors the unconscious instinctive desires and strivings of the individual. [NIH] Idiopathic: Describes a disease of unknown cause. [NIH] Imipramine: The prototypical tricyclic antidepressant. It has been used in major depression, dysthymia, bipolar depression, attention-deficit disorders, agoraphobia, and panic disorders. It has less sedative effect than some other members of this therapeutic group. [NIH]

Immune response: The activity of the immune system against foreign substances (antigens). [NIH]

Immunization: Deliberate stimulation of the host's immune response. Active immunization involves administration of antigens or immunologic adjuvants. Passive immunization involves administration of immune sera or lymphocytes or their extracts (e.g., transfer factor, immune RNA) or transplantation of immunocompetent cell producing tissue (thymus or bone marrow). [NIH] Immunodeficiency: The decreased ability of the body to fight infection and disease. [NIH] Immunohistochemistry: Histochemical localization of immunoreactive substances using labeled antibodies as reagents. [NIH] Immunology: The study of the body's immune system. [NIH] Impaction: The trapping of an object in a body passage. Examples are stones in the bile duct or hardened stool in the colon. [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] Implant radiation: A procedure in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near the tumor. Also called [NIH] Implantable pump: A small device installed under the skin to administer a steady dose of drugs. [NIH] Implantation: The insertion or grafting into the body of biological, living, inert, or radioactive material. [EU] Impotence: The inability to perform sexual intercourse. [NIH] In situ: In the natural or normal place; confined to the site of origin without invasion of neighbouring tissues. [EU] In Situ Hybridization: A technique that localizes specific nucleic acid sequences within intact chromosomes, eukaryotic cells, or bacterial cells through the use of specific nucleic acid-labeled probes. [NIH] In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH]

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In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] Incision: A cut made in the body during surgery. [NIH] Incompetence: Physical or mental inadequacy or insufficiency. [EU] Incontinence: Inability to control the flow of urine from the bladder (urinary incontinence) or the escape of stool from the rectum (fecal incontinence). [NIH] Incontinence Pads: Absorbent pads made of various materials used for personal hygiene usually in urinary incontinence and usually in the elderly. They may be worn as underpants or as pants liners. They are made of absorbent materials such as fluff wood pulp and hydrogel absorbent with viscose rayon, polyester, polypropylene, or polyethylene coverstock. [NIH] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Industrial Microbiology: The study, utilization, and manipulation of those microorganisms capable of economically producing desirable substances or changes in substances, and the control of undesirable microorganisms. [NIH] Infant, Newborn: An infant during the first month after birth. [NIH] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]

Infertility: The diminished or absent ability to conceive or produce an offspring while sterility is the complete inability to conceive or produce an offspring. [NIH] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Inflammatory bowel disease: A general term that refers to the inflammation of the colon and rectum. Inflammatory bowel disease includes ulcerative colitis and Crohn's disease. [NIH]

Influenza: An acute viral infection involving the respiratory tract. It is marked by inflammation of the nasal mucosa, the pharynx, and conjunctiva, and by headache and severe, often generalized, myalgia. [NIH] Ingestion: Taking into the body by mouth [NIH] Initiation: Mutation induced by a chemical reactive substance causing cell changes; being a step in a carcinogenic process. [NIH] Inlay: In dentistry, a filling first made to correspond with the form of a dental cavity and then cemented into the cavity. [NIH]

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Innervation: 1. The distribution or supply of nerves to a part. 2. The supply of nervous energy or of nerve stimulus sent to a part. [EU] Inotropic: Affecting the force or energy of muscular contractions. [EU] Insight: The capacity to understand one's own motives, to be aware of one's own psychodynamics, to appreciate the meaning of symbolic behavior. [NIH] Insomnia: Difficulty in going to sleep or getting enough sleep. [NIH] Institutionalization: The caring for individuals in institutions and their adaptation to routines characteristic of the institutional environment, and/or their loss of adaptation to life outside the institution. [NIH] Insulator: Material covering the metal conductor of the lead. It is usually polyurethane or silicone. [NIH] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Internal radiation: A procedure in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near the tumor. Also called brachytherapy, implant radiation, or interstitial radiation therapy. [NIH] Interneurons: Most generally any neurons which are not motor or sensory. Interneurons may also refer to neurons whose axons remain within a particular brain region as contrasted with projection neurons which have axons projecting to other brain regions. [NIH] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU] Intervertebral: Situated between two contiguous vertebrae. [EU] Intervertebral Disk Displacement: An intervertebral disk in which the nucleus pulposus has protruded through surrounding fibrocartilage. This occurs most frequently in the lower lumbar region. [NIH] Intestine: A long, tube-shaped organ in the abdomen that completes the process of digestion. There is both a large intestine and a small intestine. Also called the bowel. [NIH] Intoxication: Poisoning, the state of being poisoned. [EU] Intracellular: Inside a cell. [NIH] Intracellular Membranes: Membranes of subcellular structures. [NIH] Intracranial Embolism: The sudden obstruction of a blood vessel by an embolus. [NIH] Intracranial Embolism and Thrombosis: Embolism or thrombosis involving blood vessels which supply intracranial structures. Emboli may originate from extracranial or intracranial sources. Thrombosis may occur in arterial or venous structures. [NIH] Intracranial Hypertension: Increased pressure within the cranial vault. This may result from several conditions, including hydrocephalus; brain edema; intracranial masses; severe systemic hypertension; pseudotumor cerebri; and other disorders. [NIH] Intraocular: Within the eye. [EU] Intraocular pressure: Pressure of the fluid inside the eye; normal IOP varies among individuals. [NIH] Intravenous: IV. Into a vein. [NIH] Intravenous pyelogram: IVP. A series of x-rays of the kidneys, ureters, and bladder. The xrays are taken after a dye is injected into a blood vessel. The dye is concentrated in the urine, which outlines the kidneys, ureters, and bladder on the x-rays. [NIH] Intravesical: Within the bladder. [NIH] Intrinsic: Situated entirely within or pertaining exclusively to a part. [EU]

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Intubation: Introduction of a tube into a hollow organ to restore or maintain patency if obstructed. It is differentiated from catheterization in that the insertion of a catheter is usually performed for the introducing or withdrawing of fluids from the body. [NIH] Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU]

Involuntary: Reaction occurring without intention or volition. [NIH] Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH] Ion Channels: Gated, ion-selective glycoproteins that traverse membranes. The stimulus for channel gating can be a membrane potential, drug, transmitter, cytoplasmic messenger, or a mechanical deformation. Ion channels which are integral parts of ionotropic neurotransmitter receptors are not included. [NIH] Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH] Irritable Bowel Syndrome: A disorder that comes and goes. Nerves that control the muscles in the GI tract are too active. The GI tract becomes sensitive to food, stool, gas, and stress. Causes abdominal pain, bloating, and constipation or diarrhea. Also called spastic colon or mucous colitis. [NIH] Irritants: Drugs that act locally on cutaneous or mucosal surfaces to produce inflammation; those that cause redness due to hyperemia are rubefacients; those that raise blisters are vesicants and those that penetrate sebaceous glands and cause abscesses are pustulants; tear gases and mustard gases are also irritants. [NIH] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Joint: The point of contact between elements of an animal skeleton with the parts that surround and support it. [NIH] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Kidney Disease: Any one of several chronic conditions that are caused by damage to the cells of the kidney. People who have had diabetes for a long time may have kidney damage. Also called nephropathy. [NIH] Kidney Failure: The inability of a kidney to excrete metabolites at normal plasma levels under conditions of normal loading, or the inability to retain electrolytes under conditions of normal intake. In the acute form (kidney failure, acute), it is marked by uremia and usually by oliguria or anuria, with hyperkalemia and pulmonary edema. The chronic form (kidney failure, chronic) is irreversible and requires hemodialysis. [NIH] Kidney Failure, Acute: A clinical syndrome characterized by a sudden decrease in glomerular filtration rate, often to values of less than 1 to 2 ml per minute. It is usually associated with oliguria (urine volumes of less than 400 ml per day) and is always associated with biochemical consequences of the reduction in glomerular filtration rate such as a rise in blood urea nitrogen (BUN) and serum creatinine concentrations. [NIH] Kidney Failure, Chronic: An irreversible and usually progressive reduction in renal function in which both kidneys have been damaged by a variety of diseases to the extent

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that they are unable to adequately remove the metabolic products from the blood and regulate the body's electrolyte composition and acid-base balance. Chronic kidney failure requires hemodialysis or surgery, usually kidney transplantation. [NIH] Kidney Pelvis: The flattened, funnel-shaped expansion connecting the ureter to the kidney calices. [NIH] Lacerations: Torn, ragged, mangled wounds. [NIH] Lactation: The period of the secretion of milk. [EU] Large Intestine: The part of the intestine that goes from the cecum to the rectum. The large intestine absorbs water from stool and changes it from a liquid to a solid form. The large intestine is 5 feet long and includes the appendix, cecum, colon, and rectum. Also called colon. [NIH] Larynx: An irregularly shaped, musculocartilaginous tubular structure, lined with mucous membrane, located at the top of the trachea and below the root of the tongue and the hyoid bone. It is the essential sphincter guarding the entrance into the trachea and functioning secondarily as the organ of voice. [NIH] Latent: Phoria which occurs at one distance or another and which usually has no troublesome effect. [NIH] Lathyrism: A paralytic condition of the legs caused by ingestion of lathyrogens, especially beta-aminopropionitrile, found in the seeds of plants of the genus Lathyrus. [NIH] Least-Squares Analysis: A principle of estimation in which the estimates of a set of parameters in a statistical model are those quantities minimizing the sum of squared differences between the observed values of a dependent variable and the values predicted by the model. [NIH] Lectin: A complex molecule that has both protein and sugars. Lectins are able to bind to the outside of a cell and cause biochemical changes in it. Lectins are made by both animals and plants. [NIH] Lens: The transparent, double convex (outward curve on both sides) structure suspended between the aqueous and vitreous; helps to focus light on the retina. [NIH] Lesion: An area of abnormal tissue change. [NIH] Lethal: Deadly, fatal. [EU] Leucocyte: All the white cells of the blood and their precursors (myeloid cell series, lymphoid cell series) but commonly used to indicate granulocytes exclusive of lymphocytes. [NIH]

Leukemia: Cancer of blood-forming tissue. [NIH] Levorphanol: A narcotic analgesic that may be habit-forming. It is nearly as effective orally as by injection. [NIH] Library Services: Services offered to the library user. They include reference and circulation. [NIH]

Lidocaine: A local anesthetic and cardiac depressant used as an antiarrhythmia agent. Its actions are more intense and its effects more prolonged than those of procaine but its duration of action is shorter than that of bupivacaine or prilocaine. [NIH] Life Expectancy: A figure representing the number of years, based on known statistics, to which any person of a given age may reasonably expect to live. [NIH] Ligament: A band of fibrous tissue that connects bones or cartilages, serving to support and strengthen joints. [EU] Ligands: A RNA simulation method developed by the MIT. [NIH]

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Likelihood Functions: Functions constructed from a statistical model and a set of observed data which give the probability of that data for various values of the unknown model parameters. Those parameter values that maximize the probability are the maximum likelihood estimates of the parameters. [NIH] Limbic: Pertaining to a limbus, or margin; forming a border around. [EU] Linear Models: Statistical models in which the value of a parameter for a given value of a factor is assumed to be equal to a + bx, where a and b are constants. The models predict a linear regression. [NIH] Linkage: The tendency of two or more genes in the same chromosome to remain together from one generation to the next more frequently than expected according to the law of independent assortment. [NIH] Lipid: Fat. [NIH] Lithium: An element in the alkali metals family. It has the atomic symbol Li, atomic number 3, and atomic weight 6.94. Salts of lithium are used in treating manic-depressive disorders. [NIH]

Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Liver scan: An image of the liver created on a computer screen or on film. A radioactive substance is injected into a blood vessel and travels through the bloodstream. It collects in the liver, especially in abnormal areas, and can be detected by the scanner. [NIH] Lobe: A portion of an organ such as the liver, lung, breast, or brain. [NIH] Localization: The process of determining or marking the location or site of a lesion or disease. May also refer to the process of keeping a lesion or disease in a specific location or site. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Locomotion: Movement or the ability to move from one place or another. It can refer to humans, vertebrate or invertebrate animals, and microorganisms. [NIH] Locomotor: Of or pertaining to locomotion; pertaining to or affecting the locomotive apparatus of the body. [EU] Logistic Models: Statistical models which describe the relationship between a qualitative dependent variable (that is, one which can take only certain discrete values, such as the presence or absence of a disease) and an independent variable. A common application is in epidemiology for estimating an individual's risk (probability of a disease) as a function of a given risk factor. [NIH] Loneliness: The state of feeling sad or dejected as a result of lack of companionship or being separated from others. [NIH] Longitudinal study: Also referred to as a "cohort study" or "prospective study"; the analytic method of epidemiologic study in which subsets of a defined population can be identified who are, have been, or in the future may be exposed or not exposed, or exposed in different degrees, to a factor or factors hypothesized to influence the probability of occurrence of a given disease or other outcome. The main feature of this type of study is to observe large numbers of subjects over an extended time, with comparisons of incidence rates in groups that differ in exposure levels. [NIH] Long-Term Care: Care over an extended period, usually for a chronic condition or disability, requiring periodic, intermittent, or continuous care. [NIH] Long-Term Potentiation: A persistent increase in synaptic efficacy, usually induced by

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appropriate activation of the same synapses. The phenomenological properties of long-term potentiation suggest that it may be a cellular mechanism of learning and memory. [NIH] Loop: A wire usually of platinum bent at one end into a small loop (usually 4 mm inside diameter) and used in transferring microorganisms. [NIH] Low Back Pain: Acute or chronic pain in the lumbar or sacral regions, which may be associated with musculo-ligamentous sprains and strains; intervertebral disk displacement; and other conditions. [NIH] Lower Esophageal Sphincter: The muscle between the esophagus and stomach. When a person swallows, this muscle relaxes to let food pass from the esophagus to the stomach. It stays closed at other times to keep stomach contents from flowing back into the esophagus. [NIH]

Lubricants: Oily or slippery substances. [NIH] Lubrication: The application of a substance to diminish friction between two surfaces. It may refer to oils, greases, and similar substances for the lubrication of medical equipment but it can be used for the application of substances to tissue to reduce friction, such as lotions for skin and vaginal lubricants. [NIH] Lumbar: Pertaining to the loins, the part of the back between the thorax and the pelvis. [EU] Lumen: The cavity or channel within a tube or tubular organ. [EU] Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. [NIH] Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] Lymphatic system: The tissues and organs that produce, store, and carry white blood cells that fight infection and other diseases. This system includes the bone marrow, spleen, thymus, lymph nodes and a network of thin tubes that carry lymph and white blood cells. These tubes branch, like blood vessels, into all the tissues of the body. [NIH] Lymphocyte: A white blood cell. Lymphocytes have a number of roles in the immune system, including the production of antibodies and other substances that fight infection and diseases. [NIH] Lymphoid: Referring to lymphocytes, a type of white blood cell. Also refers to tissue in which lymphocytes develop. [NIH] Lysine: An essential amino acid. It is often added to animal feed. [NIH] Maceration: The softening of a solid by soaking. In histology, the softening of a tissue by soaking, especially in acids, until the connective tissue fibres are so dissolved that the tissue components can be teased apart. In obstetrics, the degenerative changes with discoloration and softening of tissues, and eventual disintegration, of a fetus retained in the uterus after its death. [EU] Magnetic Resonance Imaging: Non-invasive method of demonstrating internal anatomy based on the principle that atomic nuclei in a strong magnetic field absorb pulses of radiofrequency energy and emit them as radiowaves which can be reconstructed into computerized images. The concept includes proton spin tomographic techniques. [NIH] Malaise: A vague feeling of bodily discomfort. [EU] Malignant: Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body. [NIH] Malnutrition: A condition caused by not eating enough food or not eating a balanced diet. [NIH]

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Mammary: Pertaining to the mamma, or breast. [EU] Mandible: The largest and strongest bone of the face constituting the lower jaw. It supports the lower teeth. [NIH] Mania: Excitement of psychotic proportions manifested by mental and physical hyperactivity, disorganization of behaviour, and elevation of mood. [EU] Manic: Affected with mania. [EU] Manic-depressive psychosis: One of a group of psychotic reactions, fundamentally marked by severe mood swings and a tendency to remission and recurrence. [NIH] Manifest: Being the part or aspect of a phenomenon that is directly observable : concretely expressed in behaviour. [EU] Matrix metalloproteinase: A member of a group of enzymes that can break down proteins, such as collagen, that are normally found in the spaces between cells in tissues (i.e., extracellular matrix proteins). Because these enzymes need zinc or calcium atoms to work properly, they are called metalloproteinases. Matrix metalloproteinases are involved in wound healing, angiogenesis, and tumor cell metastasis. [NIH] Medetomidine: An agonist of receptors, adrenergic alpha-2 that is used in veterinary medicine for its analgesic and sedative properties. It is the racemate of dexmedetomidine. [NIH]

Mediate: Indirect; accomplished by the aid of an intervening medium. [EU] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Medical Records: Recording of pertinent information concerning patient's illness or illnesses. [NIH] Medicament: A medicinal substance or agent. [EU] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Medullary: Pertaining to the marrow or to any medulla; resembling marrow. [EU] Meiosis: A special method of cell division, occurring in maturation of the germ cells, by means of which each daughter nucleus receives half the number of chromosomes characteristic of the somatic cells of the species. [NIH] Melanin: The substance that gives the skin its color. [NIH] Memantine: Amantadine derivative that has some dopaminergic effects. It has been proposed as an antiparkinson agent. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Membrane Proteins: Proteins which are found in membranes including cellular and intracellular membranes. They consist of two types, peripheral and integral proteins. They include most membrane-associated enzymes, antigenic proteins, transport proteins, and drug, hormone, and lectin receptors. [NIH] Memory: Complex mental function having four distinct phases: (1) memorizing or learning, (2) retention, (3) recall, and (4) recognition. Clinically, it is usually subdivided into immediate, recent, and remote memory. [NIH] Meninges: The three membranes that cover and protect the brain and spinal cord. [NIH]

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Menopause: Permanent cessation of menstruation. [NIH] Menorrhagia: Excessive menstrual flow. [NIH] Menstrual Cycle: The period of the regularly recurring physiologic changes in the endometrium occurring during the reproductive period in human females and some primates and culminating in partial sloughing of the endometrium (menstruation). [NIH] Menstruation: The normal physiologic discharge through the vagina of blood and mucosal tissues from the nonpregnant uterus. [NIH] Mental Disorders: Psychiatric illness or diseases manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function. [NIH] Mental Health: The state wherein the person is well adjusted. [NIH] Mental Health Services: Organized services to provide mental health care. [NIH] Mesolimbic: Inner brain region governing emotion and drives. [NIH] Meta-Analysis: A quantitative method of combining the results of independent studies (usually drawn from the published literature) and synthesizing summaries and conclusions which may be used to evaluate therapeutic effectiveness, plan new studies, etc., with application chiefly in the areas of research and medicine. [NIH] Metabolite: Any substance produced by metabolism or by a metabolic process. [EU] Metastasis: The spread of cancer from one part of the body to another. Tumors formed from cells that have spread are called "secondary tumors" and contain cells that are like those in the original (primary) tumor. The plural is metastases. [NIH] Metastatic: Having to do with metastasis, which is the spread of cancer from one part of the body to another. [NIH] Methionine: A sulfur containing essential amino acid that is important in many body functions. It is a chelating agent for heavy metals. [NIH] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Microbe: An organism which cannot be observed with the naked eye; e. g. unicellular animals, lower algae, lower fungi, bacteria. [NIH] Microbiological: Pertaining to microbiology : the science that deals with microorganisms, including algae, bacteria, fungi, protozoa and viruses. [EU] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Microorganism: An organism that can be seen only through a microscope. Microorganisms include bacteria, protozoa, algae, and fungi. Although viruses are not considered living organisms, they are sometimes classified as microorganisms. [NIH] Microspheres: Small uniformly-sized spherical particles frequently radioisotopes or various reagents acting as tags or markers. [NIH]

labeled

with

Micturition: The passage of urine; urination. [EU] Migration: The systematic movement of genes between populations of the same species, geographic race, or variety. [NIH] Milliliter: A measure of volume for a liquid. A milliliter is approximately 950-times smaller than a quart and 30-times smaller than a fluid ounce. A milliliter of liquid and a cubic centimeter (cc) of liquid are the same. [NIH]

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Mitochondrial Swelling: Increase in volume of mitochondria due to an influx of fluid; it occurs in hypotonic solutions due to osmotic pressure and in isotonic solutions as a result of altered permeability of the membranes of respiring mitochondria. [NIH] Mitosis: A method of indirect cell division by means of which the two daughter nuclei normally receive identical complements of the number of chromosomes of the somatic cells of the species. [NIH] Mobility: Capability of movement, of being moved, or of flowing freely. [EU] Modeling: A treatment procedure whereby the therapist presents the target behavior which the learner is to imitate and make part of his repertoire. [NIH] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Modulator: A specific inductor that brings out characteristics peculiar to a definite region. [EU]

Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecular Structure: The location of the atoms, groups or ions relative to one another in a molecule, as well as the number, type and location of covalent bonds. [NIH] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monitor: An apparatus which automatically records such physiological signs as respiration, pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other procedures. [NIH] Monoamine: Enzyme that breaks down dopamine in the astrocytes and microglia. [NIH] Monoamine Oxidase: An enzyme that catalyzes the oxidative deamination of naturally occurring monoamines. It is a flavin-containing enzyme that is localized in mitochondrial membranes, whether in nerve terminals, the liver, or other organs. Monoamine oxidase is important in regulating the metabolic degradation of catecholamines and serotonin in neural or target tissues. Hepatic monoamine oxidase has a crucial defensive role in inactivating circulating monoamines or those, such as tyramine, that originate in the gut and are absorbed into the portal circulation. (From Goodman and Gilman's, The Pharmacological Basis of Therapeutics, 8th ed, p415) EC 1.4.3.4. [NIH] Monoclonal: An antibody produced by culturing a single type of cell. It therefore consists of a single species of immunoglobulin molecules. [NIH] Mononuclear: A cell with one nucleus. [NIH] Monophosphate: So called second messenger for neurotransmitters and hormones. [NIH] Motility: The ability to move spontaneously. [EU] Motion Sickness: Sickness caused by motion, as sea sickness, train sickness, car sickness, and air sickness. [NIH] Motor nerve: An efferent nerve conveying an impulse that excites muscular contraction. [NIH]

Motor Neurons: Neurons which activate muscle cells. [NIH] Motor Skills: Performance of complex motor acts. [NIH] Movement Disorders: Syndromes which feature dyskinesias as a cardinal manifestation of the disease process. Included in this category are degenerative, hereditary, post-infectious, medication-induced, post-inflammatory, and post-traumatic conditions. [NIH]

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Mucinous: Containing or resembling mucin, the main compound in mucus. [NIH] Mucosa: A mucous membrane, or tunica mucosa. [EU] Mucus: The viscous secretion of mucous membranes. It contains mucin, white blood cells, water, inorganic salts, and exfoliated cells. [NIH] Multicenter study: A clinical trial that is carried out at more than one medical institution. [NIH]

Multiparous: 1. Having had two or more pregnancies which resulted in viable fetuses. 2. Producing several ova or offspring at one time. [EU] Multiple sclerosis: A disorder of the central nervous system marked by weakness, numbness, a loss of muscle coordination, and problems with vision, speech, and bladder control. Multiple sclerosis is thought to be an autoimmune disease in which the body's immune system destroys myelin. Myelin is a substance that contains both protein and fat (lipid) and serves as a nerve insulator and helps in the transmission of nerve signals. [NIH] Muscle Contraction: A process leading to shortening and/or development of tension in muscle tissue. Muscle contraction occurs by a sliding filament mechanism whereby actin filaments slide inward among the myosin filaments. [NIH] Muscle relaxant: An agent that specifically aids in reducing muscle tension, as those acting at the polysynaptic neurons of motor nerves (e.g. meprobamate) or at the myoneural junction (curare and related compounds). [EU] Muscle Relaxation: That phase of a muscle twitch during which a muscle returns to a resting position. [NIH] Muscle Spindles: Mechanoreceptors found between skeletal muscle fibers. Muscle spindles are arranged in parallel with muscle fibers and respond to the passive stretch of the muscle, but cease to discharge if the muscle contracts isotonically, thus signaling muscle length. The muscle spindles are the receptors responsible for the stretch or myotactic reflex. [NIH] Muscle tension: A force in a material tending to produce extension; the state of being stretched. [NIH] Musculature: The muscular apparatus of the body, or of any part of it. [EU] Mustard Gas: Severe irritant and vesicant of skin, eyes, and lungs. It may cause blindness and lethal lung edema and was formerly used as a war gas. The substance has been proposed as a cytostatic and for treatment of psoriasis. It has been listed as a known carcinogen in the Fourth Annual Report on Carcinogens (NTP-85-002, 1985) (Merck, 11th ed). [NIH] Myalgia: Pain in a muscle or muscles. [EU] Mydriasis: Dilation of pupils to greater than 6 mm combined with failure of the pupils to constrict when stimulated with light. This condition may occur due to injury of the pupillary fibers in the oculomotor nerve, in acute angle-closure glaucoma, and in Adie syndrome. [NIH]

Mydriatic: 1. Dilating the pupil. 2. Any drug that dilates the pupil. [EU] Myelin: The fatty substance that covers and protects nerves. [NIH] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Myosin: Chief protein in muscle and the main constituent of the thick filaments of muscle fibers. In conjunction with actin, it is responsible for the contraction and relaxation of muscles. [NIH] Naphazoline: An adrenergic vasoconstrictor agent used as a decongestant. [NIH]

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Narcolepsy: A condition of unknown cause characterized by a periodic uncontrollable tendency to fall asleep. [NIH] Narcotic: 1. Pertaining to or producing narcosis. 2. An agent that produces insensibility or stupor, applied especially to the opioids, i.e. to any natural or synthetic drug that has morphine-like actions. [EU] Nasal Mucosa: The mucous membrane lining the nasal cavity. [NIH] Nausea: An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. [NIH] Necrosis: A pathological process caused by the progressive degradative action of enzymes that is generally associated with severe cellular trauma. It is characterized by mitochondrial swelling, nuclear flocculation, uncontrolled cell lysis, and ultimately cell death. [NIH] Need: A state of tension or dissatisfaction felt by an individual that impels him to action toward a goal he believes will satisfy the impulse. [NIH] Needs Assessment: Systematic identification of a population's needs or the assessment of individuals to determine the proper level of services needed. [NIH] Neoplasia: Abnormal and uncontrolled cell growth. [NIH] Neoplasm: A new growth of benign or malignant tissue. [NIH] Neoplastic: Pertaining to or like a neoplasm (= any new and abnormal growth); pertaining to neoplasia (= the formation of a neoplasm). [EU] Neostriatum: The phylogenetically newer part of the corpus striatum consisting of the caudate nucleus and putamen. It is often called simply the striatum. [NIH] Nephron: A tiny part of the kidneys. Each kidney is made up of about 1 million nephrons, which are the working units of the kidneys, removing wastes and extra fluids from the blood. [NIH] Nephropathy: Disease of the kidneys. [EU] Nerve: A cordlike structure of nervous tissue that connects parts of the nervous system with other tissues of the body and conveys nervous impulses to, or away from, these tissues. [NIH] Nerve Fibers: Slender processes of neurons, especially the prolonged axons that conduct nerve impulses. [NIH] Nerve Growth Factor: Nerve growth factor is the first of a series of neurotrophic factors that were found to influence the growth and differentiation of sympathetic and sensory neurons. It is comprised of alpha, beta, and gamma subunits. The beta subunit is responsible for its growth stimulating activity. [NIH] Nerve Regeneration: Renewal or physiological repair of damaged nerve tissue. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Networks: Pertaining to a nerve or to the nerves, a meshlike structure of interlocking fibers or strands. [NIH] Neural: 1. Pertaining to a nerve or to the nerves. 2. Situated in the region of the spinal axis, as the neutral arch. [EU] Neurodegenerative Diseases: Hereditary and sporadic conditions which are characterized by progressive nervous system dysfunction. These disorders are often associated with atrophy of the affected central or peripheral nervous system structures. [NIH] Neurogenic: Loss of bladder control caused by damage to the nerves controlling the

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bladder. [NIH] Neuroleptic: A term coined to refer to the effects on cognition and behaviour of antipsychotic drugs, which produce a state of apathy, lack of initiative, and limited range of emotion and in psychotic patients cause a reduction in confusion and agitation and normalization of psychomotor activity. [EU] Neurologic: Having to do with nerves or the nervous system. [NIH] Neurologist: A doctor who specializes in the diagnosis and treatment of disorders of the nervous system. [NIH] Neuromuscular: Pertaining to muscles and nerves. [EU] Neuromuscular Junction: The synapse between a neuron and a muscle. [NIH] Neuronal: Pertaining to a neuron or neurons (= conducting cells of the nervous system). [EU] Neuronal Plasticity: The capacity of the nervous system to change its reactivity as the result of successive activations. [NIH] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neuropathy: A problem in any part of the nervous system except the brain and spinal cord. Neuropathies can be caused by infection, toxic substances, or disease. [NIH] Neuropeptide: A member of a class of protein-like molecules made in the brain. Neuropeptides consist of short chains of amino acids, with some functioning as neurotransmitters and some functioning as hormones. [NIH] Neurophysiology: The scientific discipline concerned with the physiology of the nervous system. [NIH] Neuroprotective Agents: Drugs intended to prevent damage to the brain or spinal cord from ischemia, stroke, convulsions, or trauma. Some must be administered before the event, but others may be effective for some time after. They act by a variety of mechanisms, but often directly or indirectly minimize the damage produced by endogenous excitatory amino acids. [NIH] Neuroretinitis: Inflammation of the optic nerve head and adjacent retina. [NIH] Neurosecretory Systems: A system of neurons that has the specialized function to produce and secrete hormones, and that constitutes, in whole or in part, an endocrine organ or system. [NIH] Neurosis: Functional derangement due to disorders of the nervous system which does not affect the psychic personality of the patient. [NIH] Neurotic: 1. Pertaining to or characterized by neurosis. 2. A person affected with a neurosis. [EU]

Neurotoxicity: The tendency of some treatments to cause damage to the nervous system. [NIH]

Neurotoxin: A substance that is poisonous to nerve tissue. [NIH] Neurotransmitter: Any of a group of substances that are released on excitation from the axon terminal of a presynaptic neuron of the central or peripheral nervous system and travel across the synaptic cleft to either excite or inhibit the target cell. Among the many substances that have the properties of a neurotransmitter are acetylcholine, norepinephrine, epinephrine, dopamine, glycine, y-aminobutyrate, glutamic acid, substance P, enkephalins, endorphins, and serotonin. [EU] Neurotrophins: A nerve growth factor. [NIH]

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Neutrons: Electrically neutral elementary particles found in all atomic nuclei except light hydrogen; the mass is equal to that of the proton and electron combined and they are unstable when isolated from the nucleus, undergoing beta decay. Slow, thermal, epithermal, and fast neutrons refer to the energy levels with which the neutrons are ejected from heavier nuclei during their decay. [NIH] Niacin: Water-soluble vitamin of the B complex occurring in various animal and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic properties. [NIH] Nicotine: Nicotine is highly toxic alkaloid. It is the prototypical agonist at nicotinic cholinergic receptors where it dramatically stimulates neurons and ultimately blocks synaptic transmission. Nicotine is also important medically because of its presence in tobacco smoke. [NIH] Nitric Oxide: A free radical gas produced endogenously by a variety of mammalian cells. It is synthesized from arginine by a complex reaction, catalyzed by nitric oxide synthase. Nitric oxide is endothelium-derived relaxing factor. It is released by the vascular endothelium and mediates the relaxation induced by some vasodilators such as acetylcholine and bradykinin. It also inhibits platelet aggregation, induces disaggregation of aggregated platelets, and inhibits platelet adhesion to the vascular endothelium. Nitric oxide activates cytosolic guanylate cyclase and thus elevates intracellular levels of cyclic GMP. [NIH]

Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Nocturia: Excessive urination at night. [EU] Nodose: Having nodes or projections. [EU] Nodose Ganglion: The inferior (caudal) ganglion of the vagus (10th cranial) nerve. The unipolar nodose ganglion cells are sensory cells with central projections to the medulla and peripheral processes traveling in various branches of the vagus nerve. [NIH] Norepinephrine: Precursor of epinephrine that is secreted by the adrenal medulla and is a widespread central and autonomic neurotransmitter. Norepinephrine is the principal transmitter of most postganglionic sympathetic fibers and of the diffuse projection system in the brain arising from the locus ceruleus. It is also found in plants and is used pharmacologically as a sympathomimetic. [NIH] Nuclear: A test of the structure, blood flow, and function of the kidneys. The doctor injects a mildly radioactive solution into an arm vein and uses x-rays to monitor its progress through the kidneys. [NIH] Nuclei: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nucleic acid: Either of two types of macromolecule (DNA or RNA) formed by polymerization of nucleotides. Nucleic acids are found in all living cells and contain the information (genetic code) for the transfer of genetic information from one generation to the next. [NIH] Nucleic Acid Hybridization: The process whereby two single-stranded polynucleotides form a double-stranded molecule, with hydrogen bonding between the complementary bases in the two strains. [NIH] Nucleic Acid Probes: Nucleic acid which complements a specific mRNA or DNA molecule, or fragment thereof; used for hybridization studies in order to identify microorganisms and for genetic studies. [NIH]

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Nucleus: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nucleus Accumbens: Collection of pleomorphic cells in the caudal part of the anterior horn of the lateral ventricle, in the region of the olfactory tubercle, lying between the head of the caudate nucleus and the anterior perforated substance. It is part of the so-called ventral striatum, a composite structure considered part of the basal ganglia. [NIH] Nulliparous: Having never given birth to a viable infant. [EU] Nurse Practitioners: Nurses who are specially trained to assume an expanded role in providing medical care under the supervision of a physician. [NIH] Nursing Care: Care given to patients by nursing service personnel. [NIH] Nursing Research: Research carried out by nurses, generally in clinical settings, in the areas of clinical practice, evaluation, nursing education, nursing administration, and methodology. [NIH] Nursing Staff: Personnel who provide nursing service to patients in an organized facility, institution, or agency. [NIH] Observational study: An epidemiologic study that does not involve any intervention, experimental or otherwise. Such a study may be one in which nature is allowed to take its course, with changes in one characteristic being studied in relation to changes in other characteristics. Analytical epidemiologic methods, such as case-control and cohort study designs, are properly called observational epidemiology because the investigator is observing without intervention other than to record, classify, count, and statistically analyze results. [NIH] Obsessive-Compulsive Disorder: An anxiety disorder characterized by recurrent, persistent obsessions or compulsions. Obsessions are the intrusive ideas, thoughts, or images that are experienced as senseless or repugnant. Compulsions are repetitive and seemingly purposeful behavior which the individual generally recognizes as senseless and from which the individual does not derive pleasure although it may provide a release from tension. [NIH] Obstetrics: A medical-surgical specialty concerned with management and care of women during pregnancy, parturition, and the puerperium. [NIH] Occult: Obscure; concealed from observation, difficult to understand. [EU] Ocular: 1. Of, pertaining to, or affecting the eye. 2. Eyepiece. [EU] Oculomotor: Cranial nerve III. It originate from the lower ventral surface of the midbrain and is classified as a motor nerve. [NIH] Oculomotor Nerve: The 3d cranial nerve. The oculomotor nerve sends motor fibers to the levator muscles of the eyelid and to the superior rectus, inferior rectus, and inferior oblique muscles of the eye. It also sends parasympathetic efferents (via the ciliary ganglion) to the muscles controlling pupillary constriction and accommodation. The motor fibers originate in the oculomotor nuclei of the midbrain. [NIH] Odour: A volatile emanation that is perceived by the sense of smell. [EU] Oestrogen: A generic term for oestrus-producing steroid compounds; the female sex hormones. In humans, oestrogen is formed in the ovary, possibly the adrenal cortex, the testis, and the foetoplacental unit; it has various functions in both sexes. It is responsible for the development of the female secondary sex characteristics, and during the menstrual cycle it acts on the female genitalia to produce an environment suitable for the fertilization, implantation, and nutrition of the early embryo. Oestrogen is used in oral contraceptives and as a palliative in cancer of the breast after menopause and cancer of the prostate; other uses include the relief of the discomforts of menopause, inhibition of lactation, and

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treatment of osteoporosis, threatened abortion, and various functional ovarian disorders. [EU]

Office Visits: Visits made by patients to health service providers' offices for diagnosis, treatment, and follow-up. [NIH] Ointments: Semisolid preparations used topically for protective emollient effects or as a vehicle for local administration of medications. Ointment bases are various mixtures of fats, waxes, animal and plant oils and solid and liquid hydrocarbons. [NIH] Oliguria: Clinical manifestation of the urinary system consisting of a decrease in the amount of urine secreted. [NIH] Opacity: Degree of density (area most dense taken for reading). [NIH] Ophthalmologic: Pertaining to ophthalmology (= the branch of medicine dealing with the eye). [EU] Ophthalmology: A surgical specialty concerned with the structure and function of the eye and the medical and surgical treatment of its defects and diseases. [NIH] Opiate: A remedy containing or derived from opium; also any drug that induces sleep. [EU] Opium: The air-dried exudate from the unripe seed capsule of the opium poppy, Papaver somniferum, or its variant, P. album. It contains a number of alkaloids, but only a few morphine, codeine, and papaverine - have clinical significance. Opium has been used as an analgesic, antitussive, antidiarrheal, and antispasmodic. [NIH] Opsin: A protein formed, together with retinene, by the chemical breakdown of metarhodopsin. [NIH] Optic Chiasm: The X-shaped structure formed by the meeting of the two optic nerves. At the optic chiasm the fibers from the medial part of each retina cross to project to the other side of the brain while the lateral retinal fibers continue on the same side. As a result each half of the brain receives information about the contralateral visual field from both eyes. [NIH]

Optic cup: The white, cup-like area in the center of the optic disc. [NIH] Optic Disk: The portion of the optic nerve seen in the fundus with the ophthalmoscope. It is formed by the meeting of all the retinal ganglion cell axons as they enter the optic nerve. [NIH]

Optic Nerve: The 2nd cranial nerve. The optic nerve conveys visual information from the retina to the brain. The nerve carries the axons of the retinal ganglion cells which sort at the optic chiasm and continue via the optic tracts to the brain. The largest projection is to the lateral geniculate nuclei; other important targets include the superior colliculi and the suprachiasmatic nuclei. Though known as the second cranial nerve, it is considered part of the central nervous system. [NIH] Organ Culture: The growth in aseptic culture of plant organs such as roots or shoots, beginning with organ primordia or segments and maintaining the characteristics of the organ. [NIH] Orgasm: The crisis of sexual excitement in either humans or animals. [NIH] Orthostatic: Pertaining to or caused by standing erect. [EU] Osteoarthritis: A progressive, degenerative joint disease, the most common form of arthritis, especially in older persons. The disease is thought to result not from the aging process but from biochemical changes and biomechanical stresses affecting articular cartilage. In the foreign literature it is often called osteoarthrosis deformans. [NIH] Osteoclasts: A large multinuclear cell associated with the absorption and removal of bone.

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An odontoclast, also called cementoclast, is cytomorphologically the same as an osteoclast and is involved in cementum resorption. [NIH] Osteoporosis: Reduction of bone mass without alteration in the composition of bone, leading to fractures. Primary osteoporosis can be of two major types: postmenopausal osteoporosis and age-related (or senile) osteoporosis. [NIH] Ostomy: Surgical construction of an artificial opening (stoma) for external fistulization of a duct or vessel by insertion of a tube with or without a supportive stent. [NIH] Outpatient: A patient who is not an inmate of a hospital but receives diagnosis or treatment in a clinic or dispensary connected with the hospital. [NIH] Ovariectomy: The surgical removal of one or both ovaries. [NIH] Ovaries: The pair of female reproductive glands in which the ova, or eggs, are formed. The ovaries are located in the pelvis, one on each side of the uterus. [NIH] Ovary: Either of the paired glands in the female that produce the female germ cells and secrete some of the female sex hormones. [NIH] Overactive bladder: A condition in which the patient experiences two or all three of the following conditions: [NIH] Overexpress: An excess of a particular protein on the surface of a cell. [NIH] Ovum: A female germ cell extruded from the ovary at ovulation. [NIH] Oxidation: The act of oxidizing or state of being oxidized. Chemically it consists in the increase of positive charges on an atom or the loss of negative charges. Most biological oxidations are accomplished by the removal of a pair of hydrogen atoms (dehydrogenation) from a molecule. Such oxidations must be accompanied by reduction of an acceptor molecule. Univalent o. indicates loss of one electron; divalent o., the loss of two electrons. [EU]

Oxygenation: The process of supplying, treating, or mixing with oxygen. No:1245 oxygenation the process of supplying, treating, or mixing with oxygen. [EU] Paediatric: Of or relating to the care and medical treatment of children; belonging to or concerned with paediatrics. [EU] Painful bladder syndrome: Another name for interstitial cystitis. [NIH] Palladium: A chemical element having an atomic weight of 106.4, atomic number of 46, and the symbol Pd. It is a white, ductile metal resembling platinum, and following it in abundance and importance of applications. It is used in dentistry in the form of gold, silver, and copper alloys. [NIH] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Pancreatic: Having to do with the pancreas. [NIH] Pancreatic Juice: The fluid containing digestive enzymes secreted by the pancreas in response to food in the duodenum. [NIH] Panic: A state of extreme acute, intense anxiety and unreasoning fear accompanied by disorganization of personality function. [NIH] Panic Disorder: A type of anxiety disorder characterized by unexpected panic attacks that last minutes or, rarely, hours. Panic attacks begin with intense apprehension, fear or terror

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and, often, a feeling of impending doom. Symptoms experienced during a panic attack include dyspnea or sensations of being smothered; dizziness, loss of balance or faintness; choking sensations; palpitations or accelerated heart rate; shakiness; sweating; nausea or other form of abdominal distress; depersonalization or derealization; paresthesias; hot flashes or chills; chest discomfort or pain; fear of dying and fear of not being in control of oneself or going crazy. Agoraphobia may also develop. Similar to other anxiety disorders, it may be inherited as an autosomal dominant trait. [NIH] Paralysis: Loss of ability to move all or part of the body. [NIH] Parenchyma: The essential elements of an organ; used in anatomical nomenclature as a general term to designate the functional elements of an organ, as distinguished from its framework, or stroma. [EU] Parietal: 1. Of or pertaining to the walls of a cavity. 2. Pertaining to or located near the parietal bone, as the parietal lobe. [EU] Parietal Lobe: Upper central part of the cerebral hemisphere. [NIH] Parity: The number of offspring a female has borne. It is contrasted with gravidity, which refers to the number of pregnancies, regardless of outcome. [NIH] Parkinsonism: A group of neurological disorders characterized by hypokinesia, tremor, and muscular rigidity. [EU] Partial remission: The shrinking, but not complete disappearance, of a tumor in response to therapy. Also called partial response. [NIH] Particle: A tiny mass of material. [EU] Partnership Practice: A voluntary contract between two or more doctors who may or may not share responsibility for the care of patients, with proportional sharing of profits and losses. [NIH] Parturition: The act or process of given birth to a child. [EU] Patch: A piece of material used to cover or protect a wound, an injured part, etc.: a patch over the eye. [NIH] Pathogenesis: The cellular events and reactions that occur in the development of disease. [NIH]

Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Pathologic Processes: The abnormal mechanisms and forms involved in the dysfunctions of tissues and organs. [NIH] Pathophysiology: Altered functions in an individual or an organ due to disease. [NIH] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]

Patient Satisfaction: The degree to which the individual regards the health care service or product or the manner in which it is delivered by the provider as useful, effective, or beneficial. [NIH] Patient Selection: Criteria and standards used for the determination of the appropriateness of the inclusion of patients with specific conditions in proposed treatment plans and the criteria used for the inclusion of subjects in various clinical trials and other research protocols. [NIH] Pedicle: Embryonic link between the optic vesicle or optic cup and the forebrain or diencephalon, which becomes the optic nerve. [NIH]

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Peer Review: An organized procedure carried out by a select committee of professionals in evaluating the performance of other professionals in meeting the standards of their specialty. Review by peers is used by editors in the evaluation of articles and other papers submitted for publication. Peer review is used also in the evaluation of grant applications. It is applied also in evaluating the quality of health care provided to patients. [NIH] Pelvic: Pertaining to the pelvis. [EU] Pelvis: The lower part of the abdomen, located between the hip bones. [NIH] Penis: The external reproductive organ of males. It is composed of a mass of erectile tissue enclosed in three cylindrical fibrous compartments. Two of the three compartments, the corpus cavernosa, are placed side-by-side along the upper part of the organ. The third compartment below, the corpus spongiosum, houses the urethra. [NIH] Pepsin: An enzyme made in the stomach that breaks down proteins. [NIH] Peptic: Pertaining to pepsin or to digestion; related to the action of gastric juices. [EU] Peptic Ulcer: An ulceration of the mucous membrane of the esophagus, stomach or duodenum, caused by the action of the acid gastric juice. [NIH] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Perception: The ability quickly and accurately to recognize similarities and differences among presented objects, whether these be pairs of words, pairs of number series, or multiple sets of these or other symbols such as geometric figures. [NIH] Percutaneous: Performed through the skin, as injection of radiopacque material in radiological examination, or the removal of tissue for biopsy accomplished by a needle. [EU] Perforation: 1. The act of boring or piercing through a part. 2. A hole made through a part or substance. [EU] Perfusion: Bathing an organ or tissue with a fluid. In regional perfusion, a specific area of the body (usually an arm or a leg) receives high doses of anticancer drugs through a blood vessel. Such a procedure is performed to treat cancer that has not spread. [NIH] Perimenopausal: The time of a woman's life when menstrual periods become irregular. Refers to the time near menopause. [NIH] Perinatal: Pertaining to or occurring in the period shortly before and after birth; variously defined as beginning with completion of the twentieth to twenty-eighth week of gestation and ending 7 to 28 days after birth. [EU] Perineal: Pertaining to the perineum. [EU] Perineum: The area between the anus and the sex organs. [NIH] Peripheral Nervous System: The nervous system outside of the brain and spinal cord. The peripheral nervous system has autonomic and somatic divisions. The autonomic nervous system includes the enteric, parasympathetic, and sympathetic subdivisions. The somatic nervous system includes the cranial and spinal nerves and their ganglia and the peripheral sensory receptors. [NIH] Petroleum: Naturally occurring complex liquid hydrocarbons which, after distillation, yield combustible fuels, petrochemicals, and lubricants. [NIH] PH: The symbol relating the hydrogen ion (H+) concentration or activity of a solution to that of a given standard solution. Numerically the pH is approximately equal to the negative logarithm of H+ concentration expressed in molarity. pH 7 is neutral; above it alkalinity increases and below it acidity increases. [EU] Phantom: Used to absorb and/or scatter radiation equivalently to a patient, and hence to

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estimate radiation doses and test imaging systems without actually exposing a patient. It may be an anthropomorphic or a physical test object. [NIH] Pharmaceutical Preparations: Drugs intended for human or veterinary use, presented in their finished dosage form. Included here are materials used in the preparation and/or formulation of the finished dosage form. [NIH] Pharmacokinetic: The mathematical analysis of the time courses of absorption, distribution, and elimination of drugs. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Pharmacotherapy: A regimen of using appetite suppressant medications to manage obesity by decreasing appetite or increasing the feeling of satiety. These medications decrease appetite by increasing serotonin or catecholamine—two brain chemicals that affect mood and appetite. [NIH] Pharynx: The hollow tube about 5 inches long that starts behind the nose and ends at the top of the trachea (windpipe) and esophagus (the tube that goes to the stomach). [NIH] Phenotype: The outward appearance of the individual. It is the product of interactions between genes and between the genotype and the environment. This includes the killer phenotype, characteristic of yeasts. [NIH] Phenoxybenzamine: An alpha-adrenergic anatagonist with long duration of action. It has been used to treat hypertension and as a peripheral vasodilator. [NIH] Phenyl: Ingredient used in cold and flu remedies. [NIH] Phenylacetate: A drug being studied in the treatment of cancer. [NIH] Phenylalanine: An aromatic amino acid that is essential in the animal diet. It is a precursor of melanin, dopamine, noradrenalin, and thyroxine. [NIH] Phenylpropanolamine: A sympathomimetic that acts mainly by causing release of norepinephrine but also has direct agonist activity at some adrenergic receptors. It is most commonly used as a nasal vasoconstrictor and an appetite depressant. [NIH] Phenytoin: An anticonvulsant that is used in a wide variety of seizures. It is also an antiarrhythmic and a muscle relaxant. The mechanism of therapeutic action is not clear, although several cellular actions have been described including effects on ion channels, active transport, and general membrane stabilization. The mechanism of its muscle relaxant effect appears to involve a reduction in the sensitivity of muscle spindles to stretch. Phenytoin has been proposed for several other therapeutic uses, but its use has been limited by its many adverse effects and interactions with other drugs. [NIH] Phosphodiesterase: Effector enzyme that regulates the levels of a second messenger, the cyclic GMP. [NIH] Phospholipases: A class of enzymes that catalyze the hydrolysis of phosphoglycerides or glycerophosphatidates. EC 3.1.-. [NIH] Phospholipids: Lipids containing one or more phosphate groups, particularly those derived from either glycerol (phosphoglycerides; glycerophospholipids) or sphingosine (sphingolipids). They are polar lipids that are of great importance for the structure and function of cell membranes and are the most abundant of membrane lipids, although not stored in large amounts in the system. [NIH] Phosphorus: A non-metallic element that is found in the blood, muscles, nevers, bones, and teeth, and is a component of adenosine triphosphate (ATP; the primary energy source for the body's cells.) [NIH] Photoreceptors: Cells specialized to detect and transduce light. [NIH]

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Physical Examination: Systematic and thorough inspection of the patient for physical signs of disease or abnormality. [NIH] Physical Fitness: A state of well-being in which performance is optimal, often as a result of physical conditioning which may be prescribed for disease therapy. [NIH] Physical Therapy: The restoration of function and the prevention of disability following disease or injury with the use of light, heat, cold, water, electricity, ultrasound, and exercise. [NIH]

Physician Assistants: Persons academically trained, licensed, or credentialed to provide medical care under the supervision of a physician. The concept does not include nurses, but does include orthopedic assistants, surgeon's assistants, and assistants to other specialists. [NIH]

Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]

Physiology: The science that deals with the life processes and functions of organismus, their cells, tissues, and organs. [NIH] Pigments: Any normal or abnormal coloring matter in plants, animals, or micro-organisms. [NIH]

Pilot study: The initial study examining a new method or treatment. [NIH] Placenta: A highly vascular fetal organ through which the fetus absorbs oxygen and other nutrients and excretes carbon dioxide and other wastes. It begins to form about the eighth day of gestation when the blastocyst adheres to the decidua. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Plasma cells: A type of white blood cell that produces antibodies. [NIH] Plasticity: In an individual or a population, the capacity for adaptation: a) through gene changes (genetic plasticity) or b) through internal physiological modifications in response to changes of environment (physiological plasticity). [NIH] Platelet Activation: A series of progressive, overlapping events triggered by exposure of the platelets to subendothelial tissue. These events include shape change, adhesiveness, aggregation, and release reactions. When carried through to completion, these events lead to the formation of a stable hemostatic plug. [NIH] Platelet Aggregation: The attachment of platelets to one another. This clumping together can be induced by a number of agents (e.g., thrombin, collagen) and is part of the mechanism leading to the formation of a thrombus. [NIH] Platelets: A type of blood cell that helps prevent bleeding by causing blood clots to form. Also called thrombocytes. [NIH] Platinum: Platinum. A heavy, soft, whitish metal, resembling tin, atomic number 78, atomic weight 195.09, symbol Pt. (From Dorland, 28th ed) It is used in manufacturing equipment for laboratory and industrial use. It occurs as a black powder (platinum black) and as a spongy substance (spongy platinum) and may have been known in Pliny's time as "alutiae". [NIH]

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Pleomorphic: Occurring in various distinct forms. In terms of cells, having variation in the size and shape of cells or their nuclei. [NIH] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Polycystic: An inherited disorder characterized by many grape-like clusters of fluid-filled cysts that make both kidneys larger over time. These cysts take over and destroy working kidney tissue. PKD may cause chronic renal failure and end-stage renal disease. [NIH] Polyethylene: A vinyl polymer made from ethylene. It can be branched or linear. Branched or low-density polyethylene is tough and pliable but not to the same degree as linear polyethylene. Linear or high-density polyethylene has a greater hardness and tensile strength. Polyethylene is used in a variety of products, including implants and prostheses. [NIH]

Polymerase: An enzyme which catalyses the synthesis of DNA using a single DNA strand as a template. The polymerase copies the template in the 5'-3'direction provided that sufficient quantities of free nucleotides, dATP and dTTP are present. [NIH] Polymerase Chain Reaction: In vitro method for producing large amounts of specific DNA or RNA fragments of defined length and sequence from small amounts of short oligonucleotide flanking sequences (primers). The essential steps include thermal denaturation of the double-stranded target molecules, annealing of the primers to their complementary sequences, and extension of the annealed primers by enzymatic synthesis with DNA polymerase. The reaction is efficient, specific, and extremely sensitive. Uses for the reaction include disease diagnosis, detection of difficult-to-isolate pathogens, mutation analysis, genetic testing, DNA sequencing, and analyzing evolutionary relationships. [NIH] Polymers: Compounds formed by the joining of smaller, usually repeating, units linked by covalent bonds. These compounds often form large macromolecules (e.g., polypeptides, proteins, plastics). [NIH] Polypeptide: A peptide which on hydrolysis yields more than two amino acids; called tripeptides, tetrapeptides, etc. according to the number of amino acids contained. [EU] Polysaccharide: A type of carbohydrate. It contains sugar molecules that are linked together chemically. [NIH] Polyuria: Urination of a large volume of urine with an increase in urinary frequency, commonly seen in diabetes. [NIH] Port: An implanted device through which blood may be withdrawn and drugs may be infused without repeated needle sticks. Also called a port-a-cath. [NIH] Port-a-cath: An implanted device through which blood may be withdrawn and drugs may be infused without repeated needle sticks. Also called a port. [NIH] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Postmenopausal: Refers to the time after menopause. Menopause is the time in a woman's life when menstrual periods stop permanently; also called "change of life." [NIH] Postnatal: Occurring after birth, with reference to the newborn. [EU] Postoperative: After surgery. [NIH] Postsynaptic: Nerve potential generated by an inhibitory hyperpolarizing stimulation. [NIH] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in

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the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Potentiating: A degree of synergism which causes the exposure of the organism to a harmful substance to worsen a disease already contracted. [NIH] Potentiation: An overall effect of two drugs taken together which is greater than the sum of the effects of each drug taken alone. [NIH] Practicability: A non-standard characteristic of an analytical procedure. It is dependent on the scope of the method and is determined by requirements such as sample throughout and costs. [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Prazosin: A selective adrenergic alpha-1 antagonist used in the treatment of heart failure, hypertension, pheochromocytoma, Raynaud's syndrome, prostatic hypertrophy, and urinary retention. [NIH] Preclinical: Before a disease becomes clinically recognizable. [EU] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Predisposition: A latent susceptibility to disease which may be activated under certain conditions, as by stress. [EU] Premenstrual: Occurring before menstruation. [EU] Premenstrual Syndrome: A syndrome occurring most often during the last week of the menstrual cycle and ending soon after the onset of menses. Some of the symptoms are emotional instability, insomnia, headache, nausea, vomiting, abdominal distension, and painful breasts. [NIH] Preoperative: Preceding an operation. [EU] Presbyopia: The normal decreasing elasticity of the crystalline lens that leads to loss of accommodation. [NIH] Presynaptic: Situated proximal to a synapse, or occurring before the synapse is crossed. [EU] Presynaptic Terminals: The distal terminations of axons which are specialized for the release of neurotransmitters. Also included are varicosities along the course of axons which have similar specializations and also release transmitters. Presynaptic terminals in both the central and peripheral nervous systems are included. [NIH] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Private Practice: Practice of a health profession by an individual, offering services on a person-to-person basis, as opposed to group or partnership practice. [NIH] Probe: An instrument used in exploring cavities, or in the detection and dilatation of strictures, or in demonstrating the potency of channels; an elongated instrument for exploring or sounding body cavities. [NIH] Procaine: A local anesthetic of the ester type that has a slow onset and a short duration of action. It is mainly used for infiltration anesthesia, peripheral nerve block, and spinal block.

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(From Martindale, The Extra Pharmacopoeia, 30th ed, p1016). [NIH] Prodrug: A substance that gives rise to a pharmacologically active metabolite, although not itself active (i. e. an inactive precursor). [NIH] Progesterone: Pregn-4-ene-3,20-dione. The principal progestational hormone of the body, secreted by the corpus luteum, adrenal cortex, and placenta. Its chief function is to prepare the uterus for the reception and development of the fertilized ovum. It acts as an antiovulatory agent when administered on days 5-25 of the menstrual cycle. [NIH] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Progressive disease: Cancer that is increasing in scope or severity. [NIH] Projection: A defense mechanism, operating unconsciously, whereby that which is emotionally unacceptable in the self is rejected and attributed (projected) to others. [NIH] Prolapse: The protrusion of an organ or part of an organ into a natural or artificial orifice. [NIH]

Proline: A non-essential amino acid that is synthesized from glutamic acid. It is an essential component of collagen and is important for proper functioning of joints and tendons. [NIH] Promoter: A chemical substance that increases the activity of a carcinogenic process. [NIH] Propafenone: An antiarrhythmia agent that is particularly effective in ventricular arrhythmias. It also has weak beta-blocking activity. The drug is generally well tolerated. [NIH]

Propantheline: A muscarinic antagonist used as an antispasmodic, in rhinitis, in urinary incontinence, and in the treatment of ulcers. At high doses it has nicotinic effects resulting in neuromuscular blocking. [NIH] Prophase: The first phase of cell division, in which the chromosomes become visible, the nucleus starts to lose its identity, the spindle appears, and the centrioles migrate toward opposite poles. [NIH] Prophylaxis: An attempt to prevent disease. [NIH] Proportional: Being in proportion : corresponding in size, degree, or intensity, having the same or a constant ratio; of, relating to, or used in determining proportions. [EU] Prospective Studies: Observation of a population for a sufficient number of persons over a sufficient number of years to generate incidence or mortality rates subsequent to the selection of the study group. [NIH] Prospective study: An epidemiologic study in which a group of individuals (a cohort), all free of a particular disease and varying in their exposure to a possible risk factor, is followed over a specific amount of time to determine the incidence rates of the disease in the exposed and unexposed groups. [NIH] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Prostate gland: A gland in the male reproductive system just below the bladder. It surrounds part of the urethra, the canal that empties the bladder, and produces a fluid that forms part of semen. [NIH] Prostatectomy: Complete or partial surgical removal of the prostate. Three primary approaches are commonly employed: suprapubic - removal through an incision above the

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pubis and through the urinary bladder; retropubic - as for suprapubic but without entering the urinary bladder; and transurethral (transurethral resection of prostate). [NIH] Prostatic Hyperplasia: Enlargement or overgrowth of the prostate gland as a result of an increase in the number of its constituent cells. [NIH] Prostatism: A symptom complex resulting from compression or obstruction of the urethra, due most commonly to hyperplasia of the prostate; symptoms include diminution in the calibre and force of the urinary stream, hesitancy in initiating voiding, inability to terminate micturition abruptly (with postvoiding dribbling), a sensation of incomplete bladder emptying, and, occasionally, urinary retention. [EU] Prostatitis: Inflammation of the prostate. [EU] Prosthesis: An artificial replacement of a part of the body. [NIH] Protease: Proteinase (= any enzyme that catalyses the splitting of interior peptide bonds in a protein). [EU] Protective Agents: Synthetic or natural substances which are given to prevent a disease or disorder or are used in the process of treating a disease or injury due to a poisonous agent. [NIH]

Protein C: A vitamin-K dependent zymogen present in the blood, which, upon activation by thrombin and thrombomodulin exerts anticoagulant properties by inactivating factors Va and VIIIa at the rate-limiting steps of thrombin formation. [NIH] Protein Conformation: The characteristic 3-dimensional shape of a protein, including the secondary, supersecondary (motifs), tertiary (domains) and quaternary structure of the peptide chain. Quaternary protein structure describes the conformation assumed by multimeric proteins (aggregates of more than one polypeptide chain). [NIH] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Proteolytic: 1. Pertaining to, characterized by, or promoting proteolysis. 2. An enzyme that promotes proteolysis (= the splitting of proteins by hydrolysis of the peptide bonds with formation of smaller polypeptides). [EU] Prothrombin: A plasma protein that is the inactive precursor of thrombin. It is converted to thrombin by a prothrombin activator complex consisting of factor Xa, factor V, phospholipid, and calcium ions. Deficiency of prothrombin leads to hypoprothrombinemia. [NIH]

Protocol: The detailed plan for a clinical trial that states the trial's rationale, purpose, drug or vaccine dosages, length of study, routes of administration, who may participate, and other aspects of trial design. [NIH] Protons: Stable elementary particles having the smallest known positive charge, found in the nuclei of all elements. The proton mass is less than that of a neutron. A proton is the nucleus of the light hydrogen atom, i.e., the hydrogen ion. [NIH] Protozoa: A subkingdom consisting of unicellular organisms that are the simplest in the animal kingdom. Most are free living. They range in size from submicroscopic to macroscopic. Protozoa are divided into seven phyla: Sarcomastigophora, Labyrinthomorpha, Apicomplexa, Microspora, Ascetospora, Myxozoa, and Ciliophora. [NIH] Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Pruritic: Pertaining to or characterized by pruritus. [EU]

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Pruritus: An intense itching sensation that produces the urge to rub or scratch the skin to obtain relief. [NIH] Pseudorabies: A highly contagious herpesvirus infection affecting the central nervous system of swine, cattle, dogs, cats, rats, and other animals. [NIH] Psychiatric: Pertaining to or within the purview of psychiatry. [EU] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Psychic: Pertaining to the psyche or to the mind; mental. [EU] Psychogenic: Produced or caused by psychic or mental factors rather than organic factors. [EU]

Psychometric testing: Psychological and mental testing and quantitative analysis of an individual's psychological traits or attitudes or mental processes. [NIH] Psychomotor: Pertaining to motor effects of cerebral or psychic activity. [EU] Psychosis: A mental disorder characterized by gross impairment in reality testing as evidenced by delusions, hallucinations, markedly incoherent speech, or disorganized and agitated behaviour without apparent awareness on the part of the patient of the incomprehensibility of his behaviour; the term is also used in a more general sense to refer to mental disorders in which mental functioning is sufficiently impaired as to interfere grossly with the patient's capacity to meet the ordinary demands of life. Historically, the term has been applied to many conditions, e.g. manic-depressive psychosis, that were first described in psychotic patients, although many patients with the disorder are not judged psychotic. [EU] Psychosomatic: Pertaining to the mind-body relationship; having bodily symptoms of psychic, emotional, or mental origin; called also psychophysiologic. [EU] Public Health: Branch of medicine concerned with the prevention and control of disease and disability, and the promotion of physical and mental health of the population on the international, national, state, or municipal level. [NIH] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Publishing: "The business or profession of the commercial production and issuance of literature" (Webster's 3d). It includes the publisher, publication processes, editing and editors. Production may be by conventional printing methods or by electronic publishing. [NIH]

Puerperium: Period from delivery of the placenta until return of the reproductive organs to their normal nonpregnant morphologic state. In humans, the puerperium generally lasts for six to eight weeks. [NIH] Pulmonary: Relating to the lungs. [NIH] Pulmonary Artery: The short wide vessel arising from the conus arteriosus of the right ventricle and conveying unaerated blood to the lungs. [NIH] Pulmonary Edema: An accumulation of an excessive amount of watery fluid in the lungs, may be caused by acute exposure to dangerous concentrations of irritant gasses. [NIH] Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH]

Pupil: The aperture in the iris through which light passes. [NIH] Purulent: Consisting of or containing pus; associated with the formation of or caused by

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pus. [EU] Putamen: The largest and most lateral of the basal ganglia lying between the lateral medullary lamina of the globus pallidus and the external capsule. It is part of the neostriatum and forms part of the lentiform nucleus along with the globus pallidus. [NIH] Pyramidal Tracts: Fibers that arise from cells within the cerebral cortex, pass through the medullary pyramid, and descend in the spinal cord. Many authorities say the pyramidal tracts include both the corticospinal and corticobulbar tracts. [NIH] Pyrimidines: A family of 6-membered heterocyclic compounds occurring in nature in a wide variety of forms. They include several nucleic acid constituents (cytosine, thymine, and uracil) and form the basic structure of the barbiturates. [NIH] Quality of Life: A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral and social environment. [NIH] Quinolinic: It is produced by immune cells and slowly infiltrates the brain tissues after an injury. [NIH] Quinolinic Acid: 2,3-Pyridinedicarboxylic acid. A metabolite of tryptophan with a possible role in neurodegenerative disorders. Elevated CSF levels of quinolinic acid are significantly correlated with the severity of neuropsychological deficits in patients who have AIDS. [NIH] Race: A population within a species which exhibits general similarities within itself, but is both discontinuous and distinct from other populations of that species, though not sufficiently so as to achieve the status of a taxon. [NIH] Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH] Radiation therapy: The use of high-energy radiation from x-rays, gamma rays, neutrons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body in the area near cancer cells (internal radiation therapy, implant radiation, or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. Also called radiotherapy. [NIH] Radical prostatectomy: Surgery to remove the entire prostate. The two types of radical prostatectomy are retropubic prostatectomy and perineal prostatectomy. [NIH] Radiculopathy: Disease involving a spinal nerve root (see spinal nerve roots) which may result from compression related to intervertebral disk displacement; spinal cord injuries; spinal diseases; and other conditions. Clinical manifestations include radicular pain, weakness, and sensory loss referable to structures innervated by the involved nerve root. [NIH]

Radioactive: Giving off radiation. [NIH] Radiolabeled: Any compound that has been joined with a radioactive substance. [NIH] Radiological: Pertaining to radiodiagnostic and radiotherapeutic procedures, and interventional radiology or other planning and guiding medical radiology. [NIH] Radiotherapy: The use of ionizing radiation to treat malignant neoplasms and other benign conditions. The most common forms of ionizing radiation used as therapy are x-rays, gamma rays, and electrons. A special form of radiotherapy, targeted radiotherapy, links a cytotoxic radionuclide to a molecule that targets the tumor. When this molecule is an antibody or other immunologic molecule, the technique is called radioimmunotherapy. [NIH] Raloxifene: A second generation selective estrogen receptor modulator (SERM) used to

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prevent osteoporosis in postmenopausal women. It has estrogen agonist effects on bone and cholesterol metabolism but behaves as a complete estrogen antagonist on mammary gland and uterine tissue. [NIH] Ramus: Most commonly used for branches of nerves, but applied also to other structures. [NIH]

Random Allocation: A process involving chance used in therapeutic trials or other research endeavor for allocating experimental subjects, human or animal, between treatment and control groups, or among treatment groups. It may also apply to experiments on inanimate objects. [NIH] Randomization: Also called random allocation. Is allocation of individuals to groups, e.g., for experimental and control regimens, by chance. Within the limits of chance variation, random allocation should make the control and experimental groups similar at the start of an investigation and ensure that personal judgment and prejudices of the investigator do not influence allocation. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Randomized clinical trial: A study in which the participants are assigned by chance to separate groups that compare different treatments; neither the researchers nor the participants can choose which group. Using chance to assign people to groups means that the groups will be similar and that the treatments they receive can be compared objectively. At the time of the trial, it is not known which treatment is best. It is the patient's choice to be in a randomized trial. [NIH] Randomized Controlled Trials: Clinical trials that involve at least one test treatment and one control treatment, concurrent enrollment and follow-up of the test- and control-treated groups, and in which the treatments to be administered are selected by a random process, such as the use of a random-numbers table. Treatment allocations using coin flips, odd-even numbers, patient social security numbers, days of the week, medical record numbers, or other such pseudo- or quasi-random processes, are not truly randomized and trials employing any of these techniques for patient assignment are designated simply controlled clinical trials. [NIH] Reality Testing: The individual's objective evaluation of the external world and the ability to differentiate adequately between it and the internal world; considered to be a primary ego function. [NIH] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Receptors, Adrenergic: Cell-surface proteins that bind epinephrine and/or norepinephrine with high affinity and trigger intracellular changes. The two major classes of adrenergic receptors, alpha and beta, were originally discriminated based on their cellular actions but now are distinguished by their relative affinity for characteristic synthetic ligands. Adrenergic receptors may also be classified according to the subtypes of G-proteins with which they bind; this scheme does not respect the alpha-beta distinction. [NIH] Receptors, Serotonin: Cell-surface proteins that bind serotonin and trigger intracellular changes which influence the behavior of cells. Several types of serotonin receptors have been recognized which differ in their pharmacology, molecular biology, and mode of action. [NIH] Recombinant: A cell or an individual with a new combination of genes not found together in either parent; usually applied to linked genes. [EU] Recombination: The formation of new combinations of genes as a result of segregation in crosses between genetically different parents; also the rearrangement of linked genes due to

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crossing-over. [NIH] Rectal: By or having to do with the rectum. The rectum is the last 8 to 10 inches of the large intestine and ends at the anus. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Red Nucleus: A pinkish-yellow portion of the midbrain situated in the rostral mesencephalic tegmentum. It receives a large projection from the contralateral half of the cerebellum via the superior cerebellar peduncle and a projection from the ipsilateral motor cortex. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Reflex: An involuntary movement or exercise of function in a part, excited in response to a stimulus applied to the periphery and transmitted to the brain or spinal cord. [NIH] Reflux: The term used when liquid backs up into the esophagus from the stomach. [NIH] Refraction: A test to determine the best eyeglasses or contact lenses to correct a refractive error (myopia, hyperopia, or astigmatism). [NIH] Refractory: Not readily yielding to treatment. [EU] Regeneration: The natural renewal of a structure, as of a lost tissue or part. [EU] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Regression Analysis: Procedures for finding the mathematical function which best describes the relationship between a dependent variable and one or more independent variables. In linear regression (see linear models) the relationship is constrained to be a straight line and least-squares analysis is used to determine the best fit. In logistic regression (see logistic models) the dependent variable is qualitative rather than continuously variable and likelihood functions are used to find the best relationship. In multiple regression the dependent variable is considered to depend on more than a single independent variable. [NIH]

Regurgitation: A backward flowing, as the casting up of undigested food, or the backward flowing of blood into the heart, or between the chambers of the heart when a valve is incompetent. [EU] Rehabilitative: Instruction of incapacitated individuals or of those affected with some mental disorder, so that some or all of their lost ability may be regained. [NIH] Relapse: The return of signs and symptoms of cancer after a period of improvement. [NIH] Relaxant: 1. Lessening or reducing tension. 2. An agent that lessens tension. [EU] Reliability: Used technically, in a statistical sense, of consistency of a test with itself, i. e. the extent to which we can assume that it will yield the same result if repeated a second time. [NIH]

Remission: A decrease in or disappearance of signs and symptoms of cancer. In partial remission, some, but not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although there still may be cancer in the body. [NIH] Renal failure: Progressive renal insufficiency and uremia, due to irreversible and progressive renal glomerular tubular or interstitial disease. [NIH] Reoperation: A repeat operation for the same condition in the same patient. It includes reoperation for reexamination, reoperation for disease progression or recurrence, or reoperation following operative failure. [NIH]

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Reproductive system: In women, this system includes the ovaries, the fallopian tubes, the uterus (womb), the cervix, and the vagina (birth canal). The reproductive system in men includes the prostate, the testes, and the penis. [NIH] Research Design: A plan for collecting and utilizing data so that desired information can be obtained with sufficient precision or so that an hypothesis can be tested properly. [NIH] Research Support: Financial support of research activities. [NIH] Resection: Removal of tissue or part or all of an organ by surgery. [NIH] Residual Volume: The volume of air remaining in the lungs at the end of a maximal expiration. Common abbreviation is RV. [NIH] Respiration: The act of breathing with the lungs, consisting of inspiration, or the taking into the lungs of the ambient air, and of expiration, or the expelling of the modified air which contains more carbon dioxide than the air taken in (Blakiston's Gould Medical Dictionary, 4th ed.). This does not include tissue respiration (= oxygen consumption) or cell respiration (= cell respiration). [NIH] Restoration: Broad term applied to any inlay, crown, bridge or complete denture which restores or replaces loss of teeth or oral tissues. [NIH] Retina: The ten-layered nervous tissue membrane of the eye. It is continuous with the optic nerve and receives images of external objects and transmits visual impulses to the brain. Its outer surface is in contact with the choroid and the inner surface with the vitreous body. The outer-most layer is pigmented, whereas the inner nine layers are transparent. [NIH] Retinal: 1. Pertaining to the retina. 2. The aldehyde of retinol, derived by the oxidative enzymatic splitting of absorbed dietary carotene, and having vitamin A activity. In the retina, retinal combines with opsins to form visual pigments. One isomer, 11-cis retinal combines with opsin in the rods (scotopsin) to form rhodopsin, or visual purple. Another, all-trans retinal (trans-r.); visual yellow; xanthopsin) results from the bleaching of rhodopsin by light, in which the 11-cis form is converted to the all-trans form. Retinal also combines with opsins in the cones (photopsins) to form the three pigments responsible for colour vision. Called also retinal, and retinene1. [EU] Retinitis: Inflammation of the retina. It is rarely limited to the retina, but is commonly associated with diseases of the choroid (chorioretinitis) and of the optic nerve (neuroretinitis). The disease may be confined to one eye, but since it is generally dependent on a constitutional factor, it is almost always bilateral. It may be acute in course, but as a rule it lasts many weeks or even several months. [NIH] Retinol: Vitamin A. It is essential for proper vision and healthy skin and mucous membranes. Retinol is being studied for cancer prevention; it belongs to the family of drugs called retinoids. [NIH] Retinopathy: 1. Retinitis (= inflammation of the retina). 2. Retinosis (= degenerative, noninflammatory condition of the retina). [EU] Retrograde: 1. Moving backward or against the usual direction of flow. 2. Degenerating, deteriorating, or catabolic. [EU] Retropubic: A potential space between the urinary bladder and the symphisis and body of the pubis. [NIH] Retropubic prostatectomy: Surgery to remove the prostate through an incision made in the abdominal wall. [NIH] Retrospective: Looking back at events that have already taken place. [NIH] Retrospective study: A study that looks backward in time, usually using medical records

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and interviews with patients who already have or had a disease. [NIH] Retroviral vector: RNA from a virus that is used to insert genetic material into cells. [NIH] Rheumatism: A group of disorders marked by inflammation or pain in the connective tissue structures of the body. These structures include bone, cartilage, and fat. [NIH] Rheumatoid: Resembling rheumatism. [EU] Rheumatoid arthritis: A form of arthritis, the cause of which is unknown, although infection, hypersensitivity, hormone imbalance and psychologic stress have been suggested as possible causes. [NIH] Rhinitis: Inflammation of the mucous membrane of the nose. [NIH] Ribose: A pentose active in biological systems usually in its D-form. [NIH] Ribosome: A granule of protein and RNA, synthesized in the nucleolus and found in the cytoplasm of cells. Ribosomes are the main sites of protein synthesis. Messenger RNA attaches to them and there receives molecules of transfer RNA bearing amino acids. [NIH] Rigidity: Stiffness or inflexibility, chiefly that which is abnormal or morbid; rigor. [EU] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Rod: A reception for vision, located in the retina. [NIH] Salivary: The duct that convey saliva to the mouth. [NIH] Salivary glands: Glands in the mouth that produce saliva. [NIH] Sanitary: Relating or belonging to health and hygiene; conductive to the restoration or maintenance of health. [NIH] Saponins: Sapogenin glycosides. A type of glycoside widely distributed in plants. Each consists of a sapogenin as the aglycon moiety, and a sugar. The sapogenin may be a steroid or a triterpene and the sugar may be glucose, galactose, a pentose, or a methylpentose. Sapogenins are poisonous towards the lower forms of life and are powerful hemolytics when injected into the blood stream able to dissolve red blood cells at even extreme dilutions. [NIH] Scans: Pictures of structures inside the body. Scans often used in diagnosing, staging, and monitoring disease include liver scans, bone scans, and computed tomography (CT) or computerized axial tomography (CAT) scans and magnetic resonance imaging (MRI) scans. In liver scanning and bone scanning, radioactive substances that are injected into the bloodstream collect in these organs. A scanner that detects the radiation is used to create pictures. In CT scanning, an x-ray machine linked to a computer is used to produce detailed pictures of organs inside the body. MRI scans use a large magnet connected to a computer to create pictures of areas inside the body. [NIH] Scatter: The extent to which relative success and failure are divergently manifested in qualitatively different tests. [NIH] Schizoid: Having qualities resembling those found in greater degree in schizophrenics; a person of schizoid personality. [NIH] Schizophrenia: A mental disorder characterized by a special type of disintegration of the personality. [NIH] Schizotypal Personality Disorder: A personality disorder in which there are oddities of thought (magical thinking, paranoid ideation, suspiciousness), perception (illusions, depersonalization), speech (digressive, vague, overelaborate), and behavior (inappropriate affect in social interactions, frequently social isolation) that are not severe enough to characterize schizophrenia. [NIH]

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Sciatica: A condition characterized by pain radiating from the back into the buttock and posterior/lateral aspects of the leg. Sciatica may be a manifestation of sciatic neuropathy; radiculopathy (involving the L4, L5, S1 or S2 spinal nerve roots; often associated with intervertebral disk displacement); or lesions of the cauda equina. [NIH] Sclerosis: A pathological process consisting of hardening or fibrosis of an anatomical structure, often a vessel or a nerve. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Scrotum: In males, the external sac that contains the testicles. [NIH] Sebaceous: Gland that secretes sebum. [NIH] Sebaceous gland: Gland that secretes sebum. [NIH] Secretin: A hormone made in the duodenum. Causes the stomach to make pepsin, the liver to make bile, and the pancreas to make a digestive juice. [NIH] Secretion: 1. The process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. Any substance produced by secretion. [EU] Sedative: 1. Allaying activity and excitement. 2. An agent that allays excitement. [EU] Sediment: A precipitate, especially one that is formed spontaneously. [EU] Seizures: Clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include abnormal motor, sensory and psychic phenomena. Recurrent seizures are usually referred to as epilepsy or "seizure disorder." [NIH] Selection Bias: The introduction of error due to systematic differences in the characteristics between those selected and those not selected for a given study. In sampling bias, error is the result of failure to ensure that all members of the reference population have a known chance of selection in the sample. [NIH] Selective estrogen receptor modulator: SERM. A drug that acts like estrogen on some tissues, but blocks the effect of estrogen on other tissues. Tamoxifen and raloxifene are SERMs. [NIH] Self-Help Groups: Organizations which provide an environment encouraging social interactions through group activities or individual relationships especially for the purpose of rehabilitating or supporting patients, individuals with common health problems, or the elderly. They include therapeutic social clubs. [NIH] Semen: The thick, yellowish-white, viscid fluid secretion of male reproductive organs discharged upon ejaculation. In addition to reproductive organ secretions, it contains spermatozoa and their nutrient plasma. [NIH] Seminal vesicles: Glands that help produce semen. [NIH] Senescence: The bodily and mental state associated with advancing age. [NIH] Senile: Relating or belonging to old age; characteristic of old age; resulting from infirmity of old age. [NIH] Sensibility: The ability to receive, feel and appreciate sensations and impressions; the quality of being sensitive; the extend to which a method gives results that are free from false negatives. [NIH] Sensitization: 1. Administration of antigen to induce a primary immune response; priming; immunization. 2. Exposure to allergen that results in the development of hypersensitivity. 3. The coating of erythrocytes with antibody so that they are subject to lysis by complement in the presence of homologous antigen, the first stage of a complement fixation test. [EU]

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Sensor: A device designed to respond to physical stimuli such as temperature, light, magnetism or movement and transmit resulting impulses for interpretation, recording, movement, or operating control. [NIH] Sequencing: The determination of the order of nucleotides in a DNA or RNA chain. [NIH] Serotonin: A biochemical messenger and regulator, synthesized from the essential amino acid L-tryptophan. In humans it is found primarily in the central nervous system, gastrointestinal tract, and blood platelets. Serotonin mediates several important physiological functions including neurotransmission, gastrointestinal motility, hemostasis, and cardiovascular integrity. Multiple receptor families (receptors, serotonin) explain the broad physiological actions and distribution of this biochemical mediator. [NIH] Serous: Having to do with serum, the clear liquid part of blood. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Sex Characteristics: Those characteristics that distinguish one sex from the other. The primary sex characteristics are the ovaries and testes and their related hormones. Secondary sex characteristics are those which are masculine or feminine but not directly related to reproduction. [NIH] Sex Distribution: The number of males and females in a given population. The distribution may refer to how many men or women or what proportion of either in the group. The population is usually patients with a specific disease but the concept is not restricted to humans and is not restricted to medicine. [NIH] Sexually Transmitted Diseases: Diseases due to or propagated by sexual contact. [NIH] Shock: The general bodily disturbance following a severe injury; an emotional or moral upset occasioned by some disturbing or unexpected experience; disruption of the circulation, which can upset all body functions: sometimes referred to as circulatory shock. [NIH]

Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Signal Transduction: The intercellular or intracellular transfer of information (biological activation/inhibition) through a signal pathway. In each signal transduction system, an activation/inhibition signal from a biologically active molecule (hormone, neurotransmitter) is mediated via the coupling of a receptor/enzyme to a second messenger system or to an ion channel. Signal transduction plays an important role in activating cellular functions, cell differentiation, and cell proliferation. Examples of signal transduction systems are the GABA-postsynaptic receptor-calcium ion channel system, the receptor-mediated T-cell activation pathway, and the receptor-mediated activation of phospholipases. Those coupled to membrane depolarization or intracellular release of calcium include the receptormediated activation of cytotoxic functions in granulocytes and the synaptic potentiation of protein kinase activation. Some signal transduction pathways may be part of larger signal transduction pathways; for example, protein kinase activation is part of the platelet activation signal pathway. [NIH] Signs and Symptoms: Clinical manifestations that can be either objective when observed by a physician, or subjective when perceived by the patient. [NIH] Skeletal: Having to do with the skeleton (boney part of the body). [NIH] Skeleton: The framework that supports the soft tissues of vertebrate animals and protects many of their internal organs. The skeletons of vertebrates are made of bone and/or cartilage. [NIH]

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Skin Care: Maintenance of the hygienic state of the skin under optimal conditions of cleanliness and comfort. Effective in skin care are proper washing, bathing, cleansing, and the use of soaps, detergents, oils, etc. In various disease states, therapeutic and protective solutions and ointments are useful. The care of the skin is particularly important in various occupations, in exposure to sunlight, in neonates, and in decubitus ulcer. [NIH] Skin graft: Skin that is moved from one part of the body to another. [NIH] Skull: The skeleton of the head including the bones of the face and the bones enclosing the brain. [NIH] Small intestine: The part of the digestive tract that is located between the stomach and the large intestine. [NIH] Smoking Cessation: Discontinuation of the habit of smoking, the inhaling and exhaling of tobacco smoke. [NIH] Smooth muscle: Muscle that performs automatic tasks, such as constricting blood vessels. [NIH]

Sneezing: Sudden, forceful, involuntary expulsion of air from the nose and mouth caused by irritation to the mucous membranes of the upper respiratory tract. [NIH] Soaps: Sodium or potassium salts of long chain fatty acids. These detergent substances are obtained by boiling natural oils or fats with caustic alkali. Sodium soaps are harder and are used as topical anti-infectives and vehicles in pills and liniments; potassium soaps are soft, used as vehicles for ointments and also as topical antimicrobials. [NIH] Sociability: The tendency of organisms to grow together with others of the same kind. [NIH] Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH] Social Isolation: The separation of individuals or groups resulting in the lack of or minimizing of social contact and/or communication. This separation may be accomplished by physical separation, by social barriers and by psychological mechanisms. In the latter, there may be interaction but no real communication. [NIH] Social Problems: Situations affecting a significant number of people, that are believed to be sources of difficulty or threaten the stability of the community, and that require programs of amelioration. [NIH] Social Support: Support systems that provide assistance and encouragement to individuals with physical or emotional disabilities in order that they may better cope. Informal social support is usually provided by friends, relatives, or peers, while formal assistance is provided by churches, groups, etc. [NIH] Socialization: The training or molding of an individual through various relationships, educational agencies, and social controls, which enables him to become a member of a particular society. [NIH] Sodium: An element that is a member of the alkali group of metals. It has the atomic symbol Na, atomic number 11, and atomic weight 23. With a valence of 1, it has a strong affinity for oxygen and other nonmetallic elements. Sodium provides the chief cation of the extracellular body fluids. Its salts are the most widely used in medicine. (From Dorland, 27th ed) Physiologically the sodium ion plays a major role in blood pressure regulation, maintenance of fluid volume, and electrolyte balance. [NIH] Soft tissue: Refers to muscle, fat, fibrous tissue, blood vessels, or other supporting tissue of the body. [NIH] Solid tumor: Cancer of body tissues other than blood, bone marrow, or the lymphatic system. [NIH]

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Solvent: 1. Dissolving; effecting a solution. 2. A liquid that dissolves or that is capable of dissolving; the component of a solution that is present in greater amount. [EU] Somatic: 1. Pertaining to or characteristic of the soma or body. 2. Pertaining to the body wall in contrast to the viscera. [EU] Sound wave: An alteration of properties of an elastic medium, such as pressure, particle displacement, or density, that propagates through the medium, or a superposition of such alterations. [NIH] Spasm: An involuntary contraction of a muscle or group of muscles. Spasms may involve skeletal muscle or smooth muscle. [NIH] Spastic: 1. Of the nature of or characterized by spasms. 2. Hypertonic, so that the muscles are stiff and the movements awkward. 3. A person exhibiting spasticity, such as occurs in spastic paralysis or in cerebral palsy. [EU] Spasticity: A state of hypertonicity, or increase over the normal tone of a muscle, with heightened deep tendon reflexes. [EU] Spatial disorientation: Loss of orientation in space where person does not know which way is up. [NIH] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Specificity: Degree of selectivity shown by an antibody with respect to the number and types of antigens with which the antibody combines, as well as with respect to the rates and the extents of these reactions. [NIH] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Sperm: The fecundating fluid of the male. [NIH] Spermatozoa: Mature male germ cells that develop in the seminiferous tubules of the testes. Each consists of a head, a body, and a tail that provides propulsion. The head consists mainly of chromatin. [NIH] Sphincter: A ringlike band of muscle fibres that constricts a passage or closes a natural orifice; called also musculus sphincter. [EU] Spina bifida: A defect in development of the vertebral column in which there is a central deficiency of the vertebral lamina. [NIH] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Spinal Nerve Roots: The paired bundles of nerve fibers entering and leaving the spinal cord at each segment. The dorsal and ventral nerve roots join to form the mixed segmental spinal nerves. The dorsal roots are generally afferent, formed by the central projections of the spinal (dorsal root) ganglia sensory cells, and the ventral roots efferent, comprising the axons of spinal motor and autonomic preganglionic neurons. There are, however, some exceptions to this afferent/efferent rule. [NIH] Spleen: An organ that is part of the lymphatic system. The spleen produces lymphocytes,

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filters the blood, stores blood cells, and destroys old blood cells. It is located on the left side of the abdomen near the stomach. [NIH] Sporadic: Neither endemic nor epidemic; occurring occasionally in a random or isolated manner. [EU] Sprains and Strains: A collective term for muscle and ligament injuries without dislocation or fracture. A sprain is a joint injury in which some of the fibers of a supporting ligament are ruptured but the continuity of the ligament remains intact. A strain is an overstretching or overexertion of some part of the musculature. [NIH] Stabilization: The creation of a stable state. [EU] Staging: Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from the original site to other parts of the body. [NIH]

Standardize: To compare with or conform to a standard; to establish standards. [EU] Status Epilepticus: Repeated and prolonged epileptic seizures without recovery of consciousness between attacks. [NIH] Steel: A tough, malleable, iron-based alloy containing up to, but no more than, two percent carbon and often other metals. It is used in medicine and dentistry in implants and instrumentation. [NIH] Stem Cells: Relatively undifferentiated cells of the same lineage (family type) that retain the ability to divide and cycle throughout postnatal life to provide cells that can become specialized and take the place of those that die or are lost. [NIH] Stent: A device placed in a body structure (such as a blood vessel or the gastrointestinal tract) to provide support and keep the structure open. [NIH] Sterility: 1. The inability to produce offspring, i.e., the inability to conceive (female s.) or to induce conception (male s.). 2. The state of being aseptic, or free from microorganisms. [EU] Sternum: Breast bone. [NIH] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Stimulant: 1. Producing stimulation; especially producing stimulation by causing tension on muscle fibre through the nervous tissue. 2. An agent or remedy that produces stimulation. [EU]

Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH] Stoma: A surgically created opening from an area inside the body to the outside. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stool: The waste matter discharged in a bowel movement; feces. [NIH] Strand: DNA normally exists in the bacterial nucleus in a helix, in which two strands are coiled together. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stress incontinence: An involuntary loss of urine that occurs at the same time that internal abdominal pressure is increased, such as with laughing, sneezing, coughing, or physical

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activity. [NIH] Stress management: A set of techniques used to help an individual cope more effectively with difficult situations in order to feel better emotionally, improve behavioral skills, and often to enhance feelings of control. Stress management may include relaxation exercises, assertiveness training, cognitive restructuring, time management, and social support. It can be delivered either on a one-to-one basis or in a group format. [NIH] Stress urinary: Leakage of urine caused by actions--such as coughing, laughing, sneezing, running, or lifting--that place pressure on the bladder from inside the body. Stress urinary incontinence can result from either a fallen bladder or weak sphincter muscles. [NIH] Striatum: A higher brain's domain thus called because of its stripes. [NIH] Stroke: Sudden loss of function of part of the brain because of loss of blood flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH] Stroma: The middle, thickest layer of tissue in the cornea. [NIH] Stromal: Large, veil-like cell in the bone marrow. [NIH] Structure-Activity Relationship: The relationship between the chemical structure of a compound and its biological or pharmacological activity. Compounds are often classed together because they have structural characteristics in common including shape, size, stereochemical arrangement, and distribution of functional groups. Other factors contributing to structure-activity relationship include chemical reactivity, electronic effects, resonance, and inductive effects. [NIH] Subacute: Somewhat acute; between acute and chronic. [EU] Subarachnoid: Situated or occurring between the arachnoid and the pia mater. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Subcutaneous: Beneath the skin. [NIH] Subspecies: A category intermediate in rank between species and variety, based on a smaller number of correlated characters than are used to differentiate species and generally conditioned by geographical and/or ecological occurrence. [NIH] Substance P: An eleven-amino acid neurotransmitter that appears in both the central and peripheral nervous systems. It is involved in transmission of pain, causes rapid contractions of the gastrointestinal smooth muscle, and modulates inflammatory and immune responses. [NIH]

Substrate: A substance upon which an enzyme acts. [EU] Sulfur: An element that is a member of the chalcogen family. It has an atomic symbol S, atomic number 16, and atomic weight 32.066. It is found in the amino acids cysteine and methionine. [NIH] Sunburn: An injury to the skin causing erythema, tenderness, and sometimes blistering and resulting from excessive exposure to the sun. The reaction is produced by the ultraviolet radiation in sunlight. [NIH] Supine: Having the front portion of the body upwards. [NIH] Supine Position: The posture of an individual lying face up. [NIH] Support group: A group of people with similar disease who meet to discuss how better to cope with their cancer and treatment. [NIH]

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Suppression: A conscious exclusion of disapproved desire contrary with repression, in which the process of exclusion is not conscious. [NIH] Surgical Instruments: Hand-held tools or implements used by health professionals for the performance of surgical tasks. [NIH] Survival Rate: The proportion of survivors in a group, e.g., of patients, studied and followed over a period, or the proportion of persons in a specified group alive at the beginning of a time interval who survive to the end of the interval. It is often studied using life table methods. [NIH] Sympathetic Nervous System: The thoracolumbar division of the autonomic nervous system. Sympathetic preganglionic fibers originate in neurons of the intermediolateral column of the spinal cord and project to the paravertebral and prevertebral ganglia, which in turn project to target organs. The sympathetic nervous system mediates the body's response to stressful situations, i.e., the fight or flight reactions. It often acts reciprocally to the parasympathetic system. [NIH] Sympathomimetic: 1. Mimicking the effects of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. 2. An agent that produces effects similar to those of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. Called also adrenergic. [EU] Symphysis: A secondary cartilaginous joint. [NIH] Symptomatic: Having to do with symptoms, which are signs of a condition or disease. [NIH] Symptomatology: 1. That branch of medicine with treats of symptoms; the systematic discussion of symptoms. 2. The combined symptoms of a disease. [EU] Synapses: Specialized junctions at which a neuron communicates with a target cell. At classical synapses, a neuron's presynaptic terminal releases a chemical transmitter stored in synaptic vesicles which diffuses across a narrow synaptic cleft and activates receptors on the postsynaptic membrane of the target cell. The target may be a dendrite, cell body, or axon of another neuron, or a specialized region of a muscle or secretory cell. Neurons may also communicate through direct electrical connections which are sometimes called electrical synapses; these are not included here but rather in gap junctions. [NIH] Synapsis: The pairing between homologous chromosomes of maternal and paternal origin during the prophase of meiosis, leading to the formation of gametes. [NIH] Synaptic: Pertaining to or affecting a synapse (= site of functional apposition between neurons, at which an impulse is transmitted from one neuron to another by electrical or chemical means); pertaining to synapsis (= pairing off in point-for-point association of homologous chromosomes from the male and female pronuclei during the early prophase of meiosis). [EU] Synaptic Transmission: The communication from a neuron to a target (neuron, muscle, or secretory cell) across a synapse. In chemical synaptic transmission, the presynaptic neuron releases a neurotransmitter that diffuses across the synaptic cleft and binds to specific synaptic receptors. These activated receptors modulate ion channels and/or secondmessenger systems to influence the postsynaptic cell. Electrical transmission is less common in the nervous system, and, as in other tissues, is mediated by gap junctions. [NIH] Systemic: Affecting the entire body. [NIH] Systolic: Indicating the maximum arterial pressure during contraction of the left ventricle of the heart. [EU] Tachykinins: A family of biologically active peptides sharing a common conserved Cterminal sequence, -Phe-X-Gly-Leu-Met-NH2, where X is either an aromatic or a branched

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aliphatic amino acid. Members of this family have been found in mammals, amphibians, and mollusks. Tachykinins have diverse pharmacological actions in the central nervous system and the cardiovascular, genitourinary, respiratory, and gastrointestinal systems, as well as in glandular tissues. This diversity of activity is due to the existence of three or more subtypes of tachykinin receptors. [NIH] Tardive: Marked by lateness, late; said of a disease in which the characteristic lesion is late in appearing. [EU] Tear Gases: Gases that irritate the eyes, throat, or skin. Severe lacrimation develops upon irritation of the eyes. [NIH] Temporal: One of the two irregular bones forming part of the lateral surfaces and base of the skull, and containing the organs of hearing. [NIH] Testicles: The two egg-shaped glands found inside the scrotum. They produce sperm and male hormones. Also called testes. [NIH] Testicular: Pertaining to a testis. [EU] Testis: Either of the paired male reproductive glands that produce the male germ cells and the male hormones. [NIH] Tetrahydrocannabinol: A psychoactive compound extracted from the resin of Cannabis sativa (marihuana, hashish). The isomer delta-9-tetrahydrocannabinol (THC) is considered the most active form, producing characteristic mood and perceptual changes associated with this compound. Dronabinol is a synthetic form of delta-9-THC. [NIH] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Thermal: Pertaining to or characterized by heat. [EU] Thigh: A leg; in anatomy, any elongated process or part of a structure more or less comparable to a leg. [NIH] Third Ventricle: A narrow cleft inferior to the corpus callosum, within the diencephalon, between the paired thalami. Its floor is formed by the hypothalamus, its anterior wall by the lamina terminalis, and its roof by ependyma. It communicates with the fourth ventricle by the cerebral aqueduct, and with the lateral ventricles by the interventricular foramina. [NIH] Thoracic: Having to do with the chest. [NIH] Thorax: A part of the trunk between the neck and the abdomen; the chest. [NIH] Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Thrombin: An enzyme formed from prothrombin that converts fibrinogen to fibrin. (Dorland, 27th ed) EC 3.4.21.5. [NIH] Thrombomodulin: A cell surface glycoprotein of endothelial cells that binds thrombin and serves as a cofactor in the activation of protein C and its regulation of blood coagulation. [NIH]

Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thrombus: An aggregation of blood factors, primarily platelets and fibrin with entrapment of cellular elements, frequently causing vascular obstruction at the point of its formation. Some authorities thus differentiate thrombus formation from simple coagulation or clot formation. [EU] Thyroid: A gland located near the windpipe (trachea) that produces thyroid hormone, which helps regulate growth and metabolism. [NIH]

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Time Management: Planning and control of time to improve efficiency and effectiveness. [NIH]

Tinnitus: Sounds that are perceived in the absence of any external noise source which may take the form of buzzing, ringing, clicking, pulsations, and other noises. Objective tinnitus refers to noises generated from within the ear or adjacent structures that can be heard by other individuals. The term subjective tinnitus is used when the sound is audible only to the affected individual. Tinnitus may occur as a manifestation of cochlear diseases; vestibulocochlear nerve diseases; intracranial hypertension; craniocerebral trauma; and other conditions. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tissue Culture: Maintaining or growing of tissue, organ primordia, or the whole or part of an organ in vitro so as to preserve its architecture and/or function (Dorland, 28th ed). Tissue culture includes both organ culture and cell culture. [NIH] Tolerance: 1. The ability to endure unusually large doses of a drug or toxin. 2. Acquired drug tolerance; a decreasing response to repeated constant doses of a drug or the need for increasing doses to maintain a constant response. [EU] Tomography: Imaging methods that result in sharp images of objects located on a chosen plane and blurred images located above or below the plane. [NIH] Tone: 1. The normal degree of vigour and tension; in muscle, the resistance to passive elongation or stretch; tonus. 2. A particular quality of sound or of voice. 3. To make permanent, or to change, the colour of silver stain by chemical treatment, usually with a heavy metal. [EU] Tonicity: The normal state of muscular tension. [NIH] Tonus: A state of slight tension usually present in muscles even when they are not undergoing active contraction. [NIH] Tooth Preparation: Procedures carried out with regard to the teeth or tooth structures preparatory to specified dental therapeutic and surgical measures. [NIH] Topical: On the surface of the body. [NIH] Torsion: A twisting or rotation of a bodily part or member on its axis. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxins: Specific, characterizable, poisonous chemicals, often proteins, with specific biological properties, including immunogenicity, produced by microbes, higher plants, or animals. [NIH] Trachea: The cartilaginous and membranous tube descending from the larynx and branching into the right and left main bronchi. [NIH] Traction: The act of pulling. [NIH] Training Support: Financial support for training including both student stipends and loans and training grants to institutions. [NIH] Tramadol: A narcotic analgesic proposed for severe pain. It may be habituating. [NIH]

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Transcutaneous: Transdermal. [EU] Transdermal: Entering through the dermis, or skin, as in administration of a drug applied to the skin in ointment or patch form. [EU] Transduction: The transfer of genes from one cell to another by means of a viral (in the case of bacteria, a bacteriophage) vector or a vector which is similar to a virus particle (pseudovirion). [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Translation: The process whereby the genetic information present in the linear sequence of ribonucleotides in mRNA is converted into a corresponding sequence of amino acids in a protein. It occurs on the ribosome and is unidirectional. [NIH] Translational: The cleavage of signal sequence that directs the passage of the protein through a cell or organelle membrane. [NIH] Transmitter: A chemical substance which effects the passage of nerve impulses from one cell to the other at the synapse. [NIH] Transplantation: Transference of a tissue or organ, alive or dead, within an individual, between individuals of the same species, or between individuals of different species. [NIH] Transurethral: Performed through the urethra. [EU] Transurethral resection: Surgery performed with a special instrument inserted through the urethra. Also called TUR. [NIH] Transurethral Resection of Prostate: Resection of the prostate using a cystoscope passed through the urethra. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Treatment Outcome: Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, practicability, etc., of these interventions in individual cases or series. [NIH]

Tremor: Cyclical movement of a body part that can represent either a physiologic process or a manifestation of disease. Intention or action tremor, a common manifestation of cerebellar diseases, is aggravated by movement. In contrast, resting tremor is maximal when there is no attempt at voluntary movement, and occurs as a relatively frequent manifestation of Parkinson disease. [NIH] Tricyclic: Containing three fused rings or closed chains in the molecular structure. [EU] Trigger zone: Dolorogenic zone (= producing or causing pain). [EU] Trophic: Of or pertaining to nutrition. [EU] Tryptophan: An essential amino acid that is necessary for normal growth in infants and for nitrogen balance in adults. It is a precursor serotonin and niacin. [NIH] Tryptophan Hydroxylase: An enzyme that catalyzes the hydroxylation of tryptophan to 5hydroxytryptophan in the presence of NADPH and molecular oxygen. It is important in the biosynthesis of serotonin. EC 1.14.16.4 [NIH] Tubercle: A rounded elevation on a bone or other structure. [NIH] Tubulin: A microtubule subunit protein found in large quantities in mammalian brain. It has also been isolated from sperm flagella, cilia, and other sources. Structurally, the protein is a dimer with a molecular weight of approximately 120,000 and a sedimentation coefficient

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of 5.8S. It binds to colchicine, vincristine, and vinblastine. [NIH] Tumour: 1. Swelling, one of the cardinal signs of inflammations; morbid enlargement. 2. A new growth of tissue in which the multiplication of cells is uncontrolled and progressive; called also neoplasm. [EU] Tyramine: An indirect sympathomimetic. Tyramine does not directly activate adrenergic receptors, but it can serve as a substrate for adrenergic uptake systems and monoamine oxidase so it prolongs the actions of adrenergic transmitters. It also provokes transmitter release from adrenergic terminals. Tyramine may be a neurotransmitter in some invertebrate nervous systems. [NIH] Tyrosine: A non-essential amino acid. In animals it is synthesized from phenylalanine. It is also the precursor of epinephrine, thyroid hormones, and melanin. [NIH] Ulcer: A localized necrotic lesion of the skin or a mucous surface. [NIH] Ulceration: 1. The formation or development of an ulcer. 2. An ulcer. [EU] Ulcerative colitis: Chronic inflammation of the colon that produces ulcers in its lining. This condition is marked by abdominal pain, cramps, and loose discharges of pus, blood, and mucus from the bowel. [NIH] Ultrasonography: The visualization of deep structures of the body by recording the reflections of echoes of pulses of ultrasonic waves directed into the tissues. Use of ultrasound for imaging or diagnostic purposes employs frequencies ranging from 1.6 to 10 megahertz. [NIH] Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [NIH] Uracil: An anticancer drug that belongs to the family of drugs called alkylating agents. [NIH] Uremia: The illness associated with the buildup of urea in the blood because the kidneys are not working effectively. Symptoms include nausea, vomiting, loss of appetite, weakness, and mental confusion. [NIH] Ureter: One of a pair of thick-walled tubes that transports urine from the kidney pelvis to the bladder. [NIH] Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [NIH]

Urethritis: Inflammation of the urethra. [EU] Urge urinary incontinence: Urinary leakage when the bladder contracts unexpectedly by itself. [NIH] Urinalysis: Examination of urine by chemical, physical, or microscopic means. Routine urinalysis usually includes performing chemical screening tests, determining specific gravity, observing any unusual color or odor, screening for bacteriuria, and examining the sediment microscopically. [NIH] Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urinary Retention: Inability to urinate. The etiology of this disorder includes obstructive, neurogenic, pharmacologic, and psychogenic causes. [NIH] Urinary tract: The organs of the body that produce and discharge urine. These include the kidneys, ureters, bladder, and urethra. [NIH] Urinary tract infection: An illness caused by harmful bacteria growing in the urinary tract. [NIH]

Urinary urgency: Inability to delay urination. [NIH]

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Urinate: To release urine from the bladder to the outside. [NIH] Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Urodynamic: Measures of the bladder's ability to hold and release urine. [NIH] Urogenital: Pertaining to the urinary and genital apparatus; genitourinary. [EU] Urogenital Diseases: Diseases of the urogenital tract. [NIH] Urogenital System: All the organs involved in reproduction and the formation and release of urine. It includes the kidneys, ureters, bladder, urethra, and the organs of reproduction ovaries, uterus, fallopian tubes, vagina, and clitoris in women and the testes, seminal vesicles, prostate, seminal ducts, and penis in men. [NIH] Urologic Diseases: Diseases of the urinary tract in both male and female. It does not include the male genitalia for which urogenital diseases is used for general discussions of diseases of both the urinary tract and the genitalia. [NIH] Urologist: A doctor who specializes in diseases of the urinary organs in females and the urinary and sex organs in males. [NIH] Urology: A surgical specialty concerned with the study, diagnosis, and treatment of diseases of the urinary tract in both sexes and the genital tract in the male. It includes the specialty of andrology which addresses both male genital diseases and male infertility. [NIH] Uterine Prolapse: Downward displacement of the uterus. It is classified in various degrees: in the first degree the cervix is within the vaginal orifice; in the second degree the cervix is outside the orifice; in the third degree the entire uterus is outside the orifice. [NIH] Uterus: The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a fetus develops. Also called the womb. [NIH] Vaccination: Administration of vaccines to stimulate the host's immune response. This includes any preparation intended for active immunological prophylaxis. [NIH] Vaccine: A substance or group of substances meant to cause the immune system to respond to a tumor or to microorganisms, such as bacteria or viruses. [NIH] Vagina: The muscular canal extending from the uterus to the exterior of the body. Also called the birth canal. [NIH] Vaginal: Of or having to do with the vagina, the birth canal. [NIH] Vaginitis: Inflammation of the vagina characterized by pain and a purulent discharge. [NIH] Vagus Nerve: The 10th cranial nerve. The vagus is a mixed nerve which contains somatic afferents (from skin in back of the ear and the external auditory meatus), visceral afferents (from the pharynx, larynx, thorax, and abdomen), parasympathetic efferents (to the thorax and abdomen), and efferents to striated muscle (of the larynx and pharynx). [NIH] Valves: Flap-like structures that control the direction of blood flow through the heart. [NIH] Vas Deferens: The excretory duct of the testes that carries spermatozoa. It rises from the scrotum and joins the seminal vesicles to form the ejaculatory duct. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vasculitis: Inflammation of a blood vessel. [NIH] Vasoactive: Exerting an effect upon the calibre of blood vessels. [EU] Vasoconstriction: Narrowing of the blood vessels without anatomic change, for which constriction, pathologic is used. [NIH] Vasodilation: Physiological dilation of the blood vessels without anatomic change. For

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dilation with anatomic change, dilatation, pathologic or aneurysm (or specific aneurysm) is used. [NIH] Vasodilator: An agent that widens blood vessels. [NIH] Vasomotor: 1. Affecting the calibre of a vessel, especially of a blood vessel. 2. Any element or agent that effects the calibre of a blood vessel. [EU] VE: The total volume of gas either inspired or expired in one minute. [NIH] Vector: Plasmid or other self-replicating DNA molecule that transfers DNA between cells in nature or in recombinant DNA technology. [NIH] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Venoms: Poisonous animal secretions forming fluid mixtures of many different enzymes, toxins, and other substances. These substances are produced in specialized glands and secreted through specialized delivery systems (nematocysts, spines, fangs, etc.) for disabling prey or predator. [NIH] Venous: Of or pertaining to the veins. [EU] Venous blood: Blood that has given up its oxygen to the tissues and carries carbon dioxide back for gas exchange. [NIH] Ventral: 1. Pertaining to the belly or to any venter. 2. Denoting a position more toward the belly surface than some other object of reference; same as anterior in human anatomy. [EU] Ventral Tegmental Area: A region in the mesencephalon which is dorsomedial to the substantia nigra and ventral to the red nucleus. The mesocortical and mesolimbic dopaminergic systems originate here, including an important projection to the nucleus accumbens. Overactivity of the cells in this area has been suspected to contribute to the positive symptoms of schizophrenia. [NIH] Ventricle: One of the two pumping chambers of the heart. The right ventricle receives oxygen-poor blood from the right atrium and pumps it to the lungs through the pulmonary artery. The left ventricle receives oxygen-rich blood from the left atrium and pumps it to the body through the aorta. [NIH] Ventricular: Pertaining to a ventricle. [EU] Venules: The minute vessels that collect blood from the capillary plexuses and join together to form veins. [NIH] Vertebrae: A bony unit of the segmented spinal column. [NIH] Vertebral: Of or pertaining to a vertebra. [EU] Vesicoureteral: An abnormal condition in which urine backs up into the ureters, and occasionally into the kidneys, raising the risk of infection. [NIH] Vestibulocochlear Nerve: The 8th cranial nerve. The vestibulocochlear nerve has a cochlear part (cochlear nerve) which is concerned with hearing and a vestibular part (vestibular nerve) which mediates the sense of balance and head position. The fibers of the cochlear nerve originate from neurons of the spiral ganglion and project to the cochlear nuclei (cochlear nucleus). The fibers of the vestibular nerve arise from neurons of Scarpa's ganglion and project to the vestibular nuclei. [NIH] Vestibulocochlear Nerve Diseases: Diseases of the vestibular and/or cochlear (acoustic) nerves, which join to form the vestibulocochlear nerve. Vestibular neuritis, cochlear neuritis, and acoustic neuromas are relatively common conditions that affect these nerves. Clinical manifestations vary with which nerve is primarily affected, and include hearing loss, vertigo, and tinnitus. [NIH] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and

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treatment of diseases in animals. [NIH] Vinblastine: An anticancer drug that belongs to the family of plant drugs called vinca alkaloids. It is a mitotic inhibitor. [NIH] Vincristine: An anticancer drug that belongs to the family of plant drugs called vinca alkaloids. [NIH] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Virulence: The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host. [NIH] Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and kill, tumor cells. [NIH] Viscera: Any of the large interior organs in any one of the three great cavities of the body, especially in the abdomen. [NIH] Visceral: , from viscus a viscus) pertaining to a viscus. [EU] Vitreous Hemorrhage: Hemorrhage into the vitreous body. [NIH] Vitro: Descriptive of an event or enzyme reaction under experimental investigation occurring outside a living organism. Parts of an organism or microorganism are used together with artificial substrates and/or conditions. [NIH] Vivo: Outside of or removed from the body of a living organism. [NIH] Void: To urinate, empty the bladder. [NIH] Volition: Voluntary activity without external compulsion. [NIH] Vulva: The external female genital organs, including the clitoris, vaginal lips, and the opening to the vagina. [NIH] Vulvar Diseases: Diseases of the vulva. [NIH] Wakefulness: A state in which there is an enhanced potential for sensitivity and an efficient responsiveness to external stimuli. [NIH] Watchful waiting: Closely monitoring a patient's condition but withholding treatment until symptoms appear or change. Also called observation. [NIH] Weight Gain: Increase in body weight over existing weight. [NIH] Windpipe: A rigid tube, 10 cm long, extending from the cricoid cartilage to the upper border of the fifth thoracic vertebra. [NIH] Withdrawal: 1. A pathological retreat from interpersonal contact and social involvement, as may occur in schizophrenia, depression, or schizoid avoidant and schizotypal personality disorders. 2. (DSM III-R) A substance-specific organic brain syndrome that follows the cessation of use or reduction in intake of a psychoactive substance that had been regularly used to induce a state of intoxication. [EU] Womb: A hollow, thick-walled, muscular organ in which the impregnated ovum is developed into a child. [NIH] Wound Healing: Restoration of integrity to traumatized tissue. [NIH] Wound Infection: Invasion of the site of trauma by pathogenic microorganisms. [NIH] Xenograft: The cells of one species transplanted to another species. [NIH] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH]

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Yeasts: A general term for single-celled rounded fungi that reproduce by budding. Brewers' and bakers' yeasts are Saccharomyces cerevisiae; therapeutic dried yeast is dried yeast. [NIH] Zymogen: Inactive form of an enzyme which can then be converted to the active form, usually by excision of a polypeptide, e. g. trypsinogen is the zymogen of trypsin. [NIH]

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INDEX 1 1-Propanol, 196, 281 A Abdomen, 152, 153, 171, 281, 290, 312, 316, 318, 321, 334, 351, 354, 358, 360 Abdominal Pain, 281, 319, 357 Aberrant, 50, 281 Ablation, 173, 281 Abscess, 220, 281 Accommodation, 94, 281, 330, 338 Acetylcholine, 200, 281, 294, 328, 329 Acetylgalactosamine, 281, 311 Acetylglucosamine, 281, 311 Actin, 281, 326 Adamantane, 180, 281 Adaptability, 281, 293 Adaptation, 38, 55, 281, 318, 336 Adenine, 281 Adenosine, 189, 199, 200, 281, 291, 335 Adenosine Monophosphate, 199, 281 Adenosine Triphosphate, 189, 281, 335 Adenylate Cyclase, 198, 199, 282 Adipose Tissue, 21, 282 Adjustment, 55, 166, 175, 281, 282 Adjuvant, 12, 282 Adrenal Cortex, 282, 330, 339 Adrenal Medulla, 282, 292, 305, 306, 329 Adrenergic, 22, 154, 181, 200, 210 Adverse Effect, 14, 23, 32, 36, 261, 282, 335, 348 Aetiology, 91, 282 Afferent, 43, 44, 49, 53, 282, 350 Affinity, 47, 173, 282, 287, 301, 343, 349 Age Groups, 59, 68, 219, 282 Age of Onset, 33, 282 Aged, 80 and Over, 282 Agonist, 23, 47, 75, 154, 195, 196, 200, 282, 302, 305, 323, 329, 335, 343 Agoraphobia, 282, 316, 333 Akathisia, 282, 286 Aldehyde Dehydrogenase, 178, 282 Alertness, 283, 291 Algorithms, 209, 283, 289 Alkaline, 283, 284, 291 Alkaloid, 283, 287, 291, 296, 329 Allergen, 283, 347 Allograft, 95, 116, 283 Allylamine, 283

Alpha Particles, 283, 342 Alpha-1, 176, 283, 284, 338 Alternative medicine, 125, 126, 148, 230, 283 Ambulatory Care, 137, 283 Ameliorated, 30, 283 Ameliorating, 198, 199, 200, 283 Amine, 182, 283, 314 Amino Acid Sequence, 197, 283, 285, 310 Amino Acids, 155, 188, 283, 287, 289, 307, 310, 328, 334, 337, 340, 346, 352, 356 Aminoethyl, 180, 284 Aminopropionitrile, 284, 320 Amitriptyline, 193, 284 Ammonia, 283, 284 Amphetamine, 284, 289 Ampulla, 284, 305, 308 Anaesthesia, 90, 284, 317 Anaesthetic, 154, 284 Anal, 33, 46, 54, 77, 90, 128, 131, 133, 160, 173, 185, 191, 284, 306, 308, 309, 321 Analgesic, 47, 55, 154, 200, 284, 295, 301, 320, 323, 331, 355 Analog, 284, 301 Analogous, 284, 303, 356 Analytes, 248, 284 Anatomical, 28, 40, 51, 172, 214, 284, 294, 297, 302, 316, 333, 347 Anchorage, 194, 284 Anesthesia, 155, 163, 166, 224, 253, 254, 284, 299, 338 Anesthetics, 183, 284, 288, 306 Aneurysm, 284, 359 Angiogenesis, 63, 69, 197, 284, 323 Animal model, 21, 28, 33, 36, 40, 44, 45, 47, 49, 69, 184, 284 Anions, 285, 319 Annealing, 285, 337 Anomalies, 62, 207, 285 Anorectal, 262, 285 Anoxia, 156, 285 Antagonism, 285, 291, 303 Antecedent, 57, 285 Anterior Cerebral Artery, 285, 293 Antibacterial, 285, 350 Antibiotic, 285, 291, 350 Antibodies, 23, 47, 53, 187, 285, 312, 316, 322, 336

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Antibody, 282, 285, 296, 312, 314, 317, 323, 325, 342, 347, 350 Anticholinergic, 14, 16, 193, 284, 285, 303 Anticoagulant, 285, 340 Anticonvulsant, 285, 291, 335 Antidepressant, 193, 284, 285, 316 Antidiuretic, 285, 287, 301 Antiemetic, 285, 286 Antigen, 23, 282, 285, 296, 314, 315, 317, 323, 347 Antihypertensive, 155, 258, 285 Anti-infective, 286, 319, 349 Anti-inflammatory, 174, 197, 286 Anti-Inflammatory Agents, 197, 286 Antipsychotic, 172, 286, 328 Antipsychotic Agents, 172, 286 Antispasmodic, 14, 16, 193, 286, 301, 309, 331, 339 Antitussive, 286, 301, 331 Anuria, 286, 319 Anus, 284, 285, 286, 290, 334, 344 Anxiety, 38, 43, 155, 172, 178, 180, 184, 196, 197, 198, 200, 203, 257, 282, 286, 330, 332 Anxiolytic, 196, 286 Aorta, 173, 286, 359 Aorta, Thoracic, 173, 286 Aperture, 161, 166, 194, 286, 341 Aponeurosis, 186, 286, 310 Apoptosis, 50, 286 Applicability, 17, 286 Aqueous, 287, 288, 299, 320 Arginine, 287, 301, 329 Argipressin, 287, 301 Aromatic, 178, 287, 289, 335, 353 Arterial, 283, 287, 290, 293, 315, 318, 340, 353 Arteries, 167, 286, 287, 290, 293, 298, 324 Arterioles, 287, 290 Arteriovenous, 287, 293 Arthralgia, 200, 201, 287 Articular, 287, 331 Aspartame, 256, 287 Aspartate, 155, 199, 287, 301 Aspartic, 196, 287, 307 Aspartic Acid, 196, 287 Asphyxia, 156, 287 Assay, 69, 287 Astrocytes, 287, 325 Atrophy, 21, 33, 50, 287, 327 Atropine, 193, 287, 289 Auditory, 173, 287, 358

Autoimmune disease, 287, 326 Autologous, 64, 179, 204, 213, 221, 231, 287 Autonomic, 44, 281, 286, 288, 289, 329, 334, 350, 353 Autonomic Dysreflexia, 44, 288 Autonomic Nervous System, 288, 289, 334, 353 Axonal, 47, 50, 288 Axons, 46, 53, 288, 318, 327, 331, 338, 350 B Back Pain, 102, 262, 264, 288 Bacteria, 20, 285, 288, 304, 306, 308, 310, 324, 350, 356, 357, 358 Bacterial Physiology, 281, 288 Bactericidal, 20, 288, 307 Bacteriophage, 288, 356 Bacteriuria, 288, 357 Barbiturates, 288, 342 Basal Ganglia, 286, 288, 294, 310, 315, 330, 342 Basal Ganglia Diseases, 288, 294, 315 Base, 4, 20, 29, 50, 51, 71, 73, 158, 162, 165, 190, 281, 288, 299, 300, 310, 319, 320, 354 Basement Membrane, 288, 308 Behavior Therapy, 131, 252, 289 Behavioral Symptoms, 9, 289 Belladonna, 287, 289 Benign, 18, 22, 23, 24, 25, 62, 67, 174, 177, 199, 200, 205, 263, 267 Benign prostatic hyperplasia, 18, 23, 24, 25, 67, 174, 199, 205, 263, 267, 289 Bewilderment, 289, 297 Bifida, 10, 254, 289 Bilateral, 289, 345 Bile, 289, 309, 310, 316, 321, 347, 351 Bile Acids, 289, 310, 351 Biliary, 289, 301 Biochemical, 22, 42, 57, 188, 289, 319, 320, 331, 348 Biocompatible Materials, 165, 289 Biogenic Amines, 188, 289 Biological therapy, 289, 312 Biological Transport, 289, 302 Biomechanics, 51, 289 Biopsy, 289, 334 Biosynthesis, 42, 289, 307, 356 Biotechnology, 73, 74, 230, 243, 289 Bladder Exstrophy, 135, 290 Bloating, 290, 319 Blood Coagulation, 290, 291, 354 Blood Glucose, 290, 315

365

Blood Platelets, 290, 348 Blood pressure, 44, 258, 285, 290, 292, 294, 315, 325, 349 Body Fluids, 290, 303, 349 Bone Density, 156, 290 Bone Marrow, 290, 310, 316, 322, 349, 352 Bone scan, 290, 346 Bowel, 18, 47, 49, 57, 72, 200, 201, 209, 215, 233, 284, 290, 291, 298, 317, 318, 351, 357 Bowel Movement, 290, 291, 298, 351 Brachytherapy, 36, 290, 318, 342 Bradycardia, 155, 290 Bradykinin, 290, 329 Brain Ischemia, 290, 293 Brain Stem, 291, 293 Branch, 256, 275, 291, 304, 310, 322, 331, 333, 341, 350, 353, 354 Breakdown, 44, 163, 166, 291, 302, 310, 331 Broad-spectrum, 20, 291 Bronchi, 291, 306, 355 Bronchial, 291, 314 Bronchitis, 166, 167, 182, 291, 294 Bronchospasm, 197, 291 Bulbar, 12, 291 Bulking Agents, 76, 174, 213, 221, 291 Bupivacaine, 183, 291, 320 C Cadaver, 28, 33, 291 Caffeine, 120, 215, 233, 256, 257, 291 Calcitonin, 200, 291 Calcium, 191, 291, 296, 323, 340, 348 Cannabidiol, 291 Cannabinoids, 47, 291 Cannabinol, 291 Capsaicin, 204, 291 Carbamazepine, 183, 291 Carbohydrates, 292, 293 Carcinogenic, 292, 317, 339, 351 Cardiac, 156, 176, 180, 283, 291, 292, 304, 306, 307, 320, 326, 351 Cardiac arrest, 156, 180, 292 Cardiovascular, 23, 43, 55, 65, 101, 156, 167, 196, 197, 200, 284, 292, 301, 348, 354 Cardiovascular disease, 43, 101, 156, 197, 292 Cardiovascular System, 196, 292, 301 Carotene, 292, 345 Case report, 86, 92, 100, 135, 292, 295, 308 Case series, 292, 295 Cataracts, 156, 292 Catecholamine, 292, 302, 335

Catheter, 6, 8, 20, 161, 162, 165, 174, 292, 319 Catheterization, 5, 10, 15, 20, 214, 220, 232, 252, 253, 257, 260, 261, 292, 319 Cations, 292, 319 Cauda Equina, 292, 347 Caudal, 292, 301, 316, 329, 330, 337 Caudate Nucleus, 285, 288, 292, 298, 327, 330 Causal, 156, 292, 306 Cecum, 292, 320 Cell Death, 67, 286, 293, 327 Cell Differentiation, 293, 348 Cell Division, 288, 293, 312, 323, 325, 336, 339 Cell membrane, 191, 289, 293, 300, 335 Cell proliferation, 50, 293, 348 Cell Survival, 293, 312 Cellobiose, 293 Cellulose, 180, 292, 293, 336 Central Nervous System Infections, 293, 312 Cerebellum, 293, 344 Cerebral Infarction, 156, 293 Cerebral Palsy, 293, 350 Cerebrovascular, 155, 167, 288, 292, 293 Cerebrovascular Disorders, 155, 167, 293 Cerebrum, 293, 294 Cervix, 294, 345, 358 Cesarean Section, 14, 54, 294 Character, 232, 294, 300 Chemoreceptor, 286, 294 Chemotherapy, 53, 126, 200, 263, 294 Chin, 121, 139, 294 Cholesterol, 289, 294, 298, 315, 343, 351 Cholinergic, 159, 184, 210, 284, 286, 294, 329 Chorea, 200, 203, 286, 294 Choreatic Disorders, 294 Chorioretinitis, 294, 345 Choroid, 294, 345 Chromaffin System, 294, 304 Chromatin, 286, 294, 350 Chromosome, 294, 312, 321 Chronic Disease, 65, 294 Chronic Obstructive Pulmonary Disease, 166, 167, 182, 184, 200, 201, 294 Chronic renal, 294, 337 Circadian, 198, 295 Circadian Rhythm, 198, 295 Circulatory system, 176, 295, 304 CIS, 295, 345

366

Urinary incontinence

Clamp, 168, 174, 295 Climacteric, 13, 14, 295 Clinical series, 64, 295 Clinical study, 295, 298 Clitoral, 167, 295 Clone, 199, 295 Cloning, 289, 295 Cochlear, 295, 355, 359 Cochlear Diseases, 295, 355 Codeine, 295, 301, 331 Cognition, 15, 154, 155, 180, 295, 328 Cognitive restructuring, 295, 352 Cohort Studies, 26, 66, 295, 306 Colchicine, 296, 357 Colitis, 197, 296, 319 Collagen, 8, 41, 42, 46, 214, 217, 221, 224, 231, 254, 260 Collapse, 291, 296 Combination Therapy, 296, 307 Complement, 296, 347 Complementary and alternative medicine, 125, 126, 148, 296 Complementary medicine, 126, 296 Complete remission, 297, 344 Compliance, 14, 15, 17, 25, 43, 133, 160, 213, 297 Compress, 174, 175, 297, 313 Compulsions, 297, 330 Computational Biology, 243, 297 Computed tomography, 290, 297, 346 Computerized axial tomography, 297, 346 Concomitant, 26, 66, 97, 219, 297 Conduction, 62, 297 Cones, 117, 145, 218, 297, 345 Confusion, 38, 49, 297, 302, 315, 328, 357 Congestion, 286, 297, 300, 306 Conjunctiva, 297, 317 Connective Tissue, 41, 42, 49, 153, 159, 173, 195, 290, 296, 297, 309, 310, 322, 346 Connective Tissue Cells, 297 Consciousness, 198, 284, 297, 300, 302, 306, 351 Constipation, 160, 215, 257, 264, 265, 286, 297, 319 Constitutional, 297, 345 Constrict, 297, 326 Constriction, 174, 297, 319, 330, 358 Constriction, Pathologic, 297, 358 Consultation, 65, 109, 135, 298 Consumption, 298, 301, 345 Contamination, 21, 298 Contractility, 29, 42, 226, 298

Contraindications, ii, 221, 298 Control group, 15, 55, 56, 61, 298, 343 Controlled clinical trial, 24, 298, 343 Convulsion, 180, 298 Convulsive, 156, 298 Cooperative group, 24, 298 Coordination, 293, 298, 326 Coronary, 292, 298, 324 Coronary heart disease, 292, 298 Coronary Thrombosis, 298, 324 Corpus, 298, 327, 334, 339, 354 Corpus Luteum, 298, 339 Corpus Striatum, 298, 327 Cortex, 298, 299, 342, 344 Cortical, 9, 30, 180, 299, 307, 347 Cranial, 293, 299, 312, 318, 329, 330, 331, 334, 358, 359 Craniocerebral Trauma, 288, 299, 312, 355 Creatinine, 24, 299, 319 Cross-Sectional Studies, 299, 306 Curare, 299, 326 Curative, 299, 329, 354 Cutaneous, 299, 319 Cyclic, 197, 199, 282, 287, 291, 299, 312, 329, 335 Cyst, 50, 299 Cysteine, 299, 352 Cystitis, 177, 204, 216, 299, 332 Cystocele, 102, 250, 299 Cystoscopy, 248, 251, 256, 260, 261, 299 Cytomegalovirus, 200, 299 Cytoplasm, 286, 293, 299, 312, 346 Cytosine, 299, 342 Cytotoxic, 291, 299, 342, 348 D Data Collection, 25, 299 Databases, Bibliographic, 243, 299 De novo, 13, 299 Deamination, 300, 325 Decarboxylation, 289, 300, 314 Decongestant, 300, 326 Decubitus, 300, 349 Decubitus Ulcer, 300, 349 Defecation, 33, 300 Degenerative, 16, 155, 196, 199, 300, 322, 325, 331, 345 Dehydration, 215, 300 Deletion, 286, 300 Delirium, 193, 257, 286, 300 Delivery of Health Care, 300, 313 Delusions, 300, 341

367

Dementia, 9, 15, 16, 17, 43, 65, 172, 178, 180, 196, 197, 203, 259, 262, 265, 286, 300 Denaturation, 300, 337 Dendrites, 300, 328 Dendritic, 49, 300 Density, 41, 156, 174, 290, 300, 331, 337, 350 Depolarization, 192, 300, 348 Deprivation, 41, 300 Dermal, 164, 300 Desmopressin, 14, 121, 236, 301 Detergents, 301, 349 Deuterium, 301, 315 Developing Countries, 16, 192, 301 Dexmedetomidine, 301, 323 Dexterity, 257, 301 Dextromethorphan, 193, 301 Dextrorphan, 193, 301 Diabetes Mellitus, 32, 36, 60, 146, 301, 311 Diabetic Retinopathy, 155, 301 Diagnostic procedure, 151, 230, 301 Diaphragm, 153, 286, 301 Diarrhea, 33, 154, 169, 201, 202, 263, 301, 319 Diarrhoea, 201, 202, 301 Diastolic, 301, 315 Dicyclomine, 193, 301 Diencephalon, 293, 301, 316, 333, 354 Diffusion, 96, 136, 289, 301 Digestion, 289, 290, 302, 318, 321, 334, 351 Digestive tract, 183, 302, 349 Dihydrotestosterone, 40, 302 Dilatation, 50, 284, 302, 338, 359 Dilatation, Pathologic, 302, 359 Dilation, 167, 290, 302, 326, 358 Dilator, 173, 302 Diploid, 302, 336 Discrete, 13, 168, 302, 321 Disease Progression, 23, 24, 57, 302, 344 Disinfectant, 302, 307 Disorientation, 252, 297, 300, 302 Dissociation, 282, 302 Distal, 40, 57, 152, 153, 154, 159, 161, 162, 165, 167, 171, 195 Diuresis, 291, 302 Diurnal, 18, 110, 302 Dizziness, 193, 302, 333 Dopamine, 172, 178, 200, 284, 286, 302, 325, 328, 335 Dorsal, 33, 44, 189, 303, 337, 350 Dorsum, 303, 310 Dosimetry, 36, 303

Double-blind, 24, 120, 303 Doxepin, 193, 303 Drip, 5, 303 Drug Design, 23, 47, 303 Drug Interactions, 14, 236, 303 Drug Tolerance, 303, 355 Duct, 50, 67, 284, 292, 303, 316, 332, 346, 358 Duodenal Ulcer, 200, 201, 303 Duodenum, 289, 303, 305, 332, 334, 347, 351 Dyskinesia, 180, 203, 286, 303 Dyspareunia, 86, 303, 307 Dysphoria, 172, 178, 303 Dystonia, 92, 286, 303 E Ectopic, 101, 303 Edema, 180, 301, 303, 313, 318, 326 Effector, 200, 281, 296, 303, 335 Efferent, 44, 111, 303, 304, 325, 350 Efferent Pathways, 111, 304 Efficacy, 8, 16, 17, 20, 21, 22, 24, 25, 28, 30, 33, 36, 37, 39, 55, 57, 60, 64, 74, 121, 131, 137, 209, 213, 226 Ejaculation, 172, 178, 304, 347 Elastic, 51, 84, 164, 175, 189, 304, 350 Elasticity, 304, 338 Elastin, 41, 296, 304, 308 Elective, 54, 304 Electrode, 33, 44, 157, 160, 168, 304 Electrolyte, 300, 304, 320, 337, 349 Electromyography, 45, 90, 304 Electrons, 288, 304, 319, 332, 342 Electrophysiological, 28, 189, 304 Embolus, 304, 317, 318 Embryo, 293, 304, 317, 330 Emesis, 172, 178, 180, 184, 197, 286, 304 Emphysema, 182, 294, 304 Empiric, 220, 304 Empirical, 11, 38, 304 Endocrine Glands, 304 Endocrine System, 198, 304 Endocrinology, 304, 312 Endogenous, 22, 69, 167, 178, 302, 305, 307, 328 Endometrial, 305 Endometriosis, 126, 156, 305 Endometrium, 156, 305, 324 Endorphins, 305, 328 Endoscope, 305 Endoscopic, 87, 164, 213, 299, 305 Endothelium, 146, 167, 305, 329

368

Urinary incontinence

Endothelium, Lymphatic, 305 Endothelium, Vascular, 305 Endothelium-derived, 167, 305, 329 End-stage renal, 294, 305, 337 Enhancers, 154, 305 Enkephalins, 305, 328 Enterocele, 35, 305 Enuresis, 14, 16, 103, 121, 177, 216, 230, 251, 257, 277, 305 Environmental Health, 242, 244, 305 Enzymatic, 164, 289, 291, 292, 296, 305, 314, 337, 345 Enzyme, 46, 282, 303, 305, 310, 312, 325, 334, 335, 337, 340, 348, 352, 354, 356, 360, 361 Ephedrine, 193, 305 Epidemiologic Factors, 39, 306 Epidemiologic Studies, 34, 59, 306 Epidemiological, 16, 54, 70, 135, 306, 308 Epidural, 44, 51, 306 Epilepticus, 156, 306 Epinephrine, 22, 282, 289, 302, 306, 328, 329, 343, 357 Episiotomy, 41, 52, 306 Epispadias, 87, 121, 306 Epithelial, 50, 67, 289, 306 Epithelial Cells, 306 Epithelium, 164, 288, 305, 306 Erectile, 7, 32, 57, 168, 210, 306, 334 Erection, 167, 306 ERV, 244, 306, 307 Erythema, 306, 352 Erythrocytes, 290, 306, 347 Esophageal, 164, 306, 310 Esophageal Ulcer, 164, 306 Esophagitis, 306, 310 Esophagus, 164, 173, 302, 306, 310, 313, 322, 334, 335, 344, 351 Estrogen, 34, 40, 41, 46, 69, 88, 99, 121, 156, 171, 193, 216, 229, 259, 306, 307, 343, 347 Estrogen Antagonists, 156, 307 Estrogen receptor, 156, 307 Estrogen Replacement Therapy, 216, 307 Ethanol, 176, 307 Ethanolamine, 307 Ether, 197, 307 Ethnic Groups, 25, 44, 307 Eukaryotic Cells, 307, 316 Evacuation, 44, 297, 307 Excitability, 62, 191, 193, 307 Excitation, 155, 192, 294, 307, 328 Excitatory, 155, 196, 199, 307, 311, 328

Excitatory Amino Acids, 155, 307, 328 Excitotoxicity, 156, 307 Excrete, 286, 307, 319 Exercise Therapy, 11, 87, 307 Exogenous, 59, 69, 305, 307 Expiration, 307, 345 Expiratory, 306, 307 Expiratory Reserve Volume, 306, 307 External-beam radiation, 307, 342 Extracellular, 29, 41, 50, 199, 287, 297, 308, 323, 349 Extracellular Matrix, 29, 41, 50, 297, 308, 323 Extracellular Matrix Proteins, 308, 323 Extracellular Space, 308 Extracorporeal, 135, 143, 308 Extraction, 163, 166, 294, 308 Extrapyramidal, 173, 282, 286, 302, 308 Extremity, 61, 308 F Faecal, 301, 308 Fallopian Tubes, 308, 345, 358 Family Planning, 243, 308 Fat, 181, 221, 231, 282, 290, 292, 298, 300, 304, 308, 321, 326, 346, 349 Fatal Outcome, 161, 308 Fecal Incontinence, 33, 35, 46, 53, 160, 308, 317 Feces, 209, 297, 308, 351 Fetus, 294, 308, 309, 322, 336, 358 Fibrin, 290, 308, 354 Fibrinogen, 308, 354 Fibroblasts, 204, 297, 308 Fibrosis, 74, 109, 175, 283, 309, 347 Fistula, 13, 108, 309 Fixation, 309, 347 Flatus, 308, 309, 310 Flavoxate, 193, 309 Fluoroscopy, 34, 309 Foetoplacental, 309, 330 Follow-Up Studies, 55, 59, 309 Foramen, 294, 309 Forearm, 290, 309 Frail Elderly, 95, 309 Friction, 309, 322 Frigidity, 160, 309 Frontal Lobe, 285, 293, 309 Fungi, 309, 324, 361 G Gait, 101, 309 Gallbladder, 281, 289, 309 Gamma Rays, 309, 342

369

Ganglia, 46, 189, 281, 288, 310, 327, 334, 350, 353 Ganglion, 189, 310, 329, 330, 331, 359 Gas, 168, 284, 301, 306, 307, 309, 310, 315, 319, 326, 329, 359 Gastric, 164, 183, 310, 313, 314, 334 Gastric Acid, 164, 183, 310 Gastric Juices, 310, 334 Gastrin, 310, 314 Gastroesophageal Reflux, 164, 204, 310 Gastroesophageal Reflux Disease, 164, 310 Gastrointestinal, 14, 22, 159, 167, 183, 197, 259, 290, 301, 306, 307, 310, 348, 351, 352, 354 Gastrointestinal tract, 307, 310, 348, 351 Gene, 29, 30, 32, 36, 67, 68, 153, 198, 199, 200, 202, 289, 310, 336 Gene Expression, 29, 32, 37, 67, 310 Gene Therapy, 36, 310 General practitioner, 91, 92, 310 Genetic Code, 310, 329 Genetic testing, 311, 337 Genetics, 29, 257, 311 Genital, 33, 44, 75, 167, 212, 311, 312, 358, 360 Genitourinary, 28, 62, 65, 152, 168, 181, 182, 187, 311, 354, 358 Genomics, 63, 311 Genotype, 311, 335 Geriatric, 61, 65, 87, 93, 97, 128, 135, 259, 265, 267, 311 Geriatric Assessment, 97, 311 Gestation, 311, 334, 336 Gestational, 208, 311 Gland, 5, 282, 294, 311, 332, 339, 343, 347, 351, 354 Glomerular, 311, 319, 344 Glucose, 290, 293, 301, 311, 315, 346 Glucose Intolerance, 301, 311 Glutamate, 155, 180, 183, 199, 301, 307, 311 Glutamic Acid, 311, 328, 339 Glycine, 311, 328 Glycoprotein, 308, 311, 354 Glycosaminoglycans, 29, 308, 311 Gonad, 311 Gonadal, 39, 311, 351 Governing Board, 311, 338 Gp120, 180, 311 Graft, 229, 312, 314 Grafting, 192, 312, 316 Granulocytes, 312, 320, 348 Granuloma, 213, 312

Gravidity, 312, 333 Groin, 162, 312 Group Practice, 61, 312 Growth factors, 68, 200, 202, 312 Guanine, 154, 312 Guanylate Cyclase, 312, 329 H Habitual, 294, 312 Haematemesis, 304, 312 Haloperidol, 172, 312 Haploid, 312, 336 Haptens, 282, 312 Headache, 155, 291, 312, 315, 317, 338 Headache Disorders, 312 Health Behavior, 43, 55, 312 Health Care Costs, 22, 313 Health Education, 11, 87, 90, 313 Health Expenditures, 313 Health Promotion, 27, 37, 140, 313 Health Services, iv, 18, 31, 35, 65, 244, 259, 300, 313 Health Status, 313 Heart attack, 292, 313 Heart failure, 306, 313, 338 Heartburn, 164, 313 Hematoma, 313 Hematuria, 12, 313 Hemiparesis, 30, 313 Hemodialysis, 313, 319, 320 Hemoglobinopathies, 310, 313 Hemorrhage, 299, 312, 313, 352, 360 Hemorrhagic stroke, 156, 313 Hemorrhoids, 267, 313 Hemostasis, 313, 348 Hepatic, 300, 314, 325 Hereditary, 50, 294, 314, 325, 327 Heredity, 310, 311, 314 Hernia, 116, 305, 314 Herniorrhaphy, 116, 314 Heterogeneity, 282, 314 Histamine, 200, 286, 289, 303, 314 Histidine, 314 Histology, 314, 322 Homogeneous, 39, 314 Homologous, 179, 310, 314, 347, 353 Hormonal, 41, 46, 53, 59, 68, 156, 163, 167, 190, 252, 287, 307, 314 Hormonal therapy, 53, 314 Hormone, 25, 41, 54, 59, 69, 96, 99, 107, 117, 156, 187, 190, 200, 228, 259, 262, 287, 291, 295, 301, 306, 307, 310, 314, 319, 323, 339, 346, 347, 348, 354

370

Urinary incontinence

Hormone Replacement Therapy, 99, 117, 262, 314 Hormone therapy, 107, 228, 314 Hospital Charges, 314 Hospital Costs, 55, 314 Host, 173, 213, 288, 314, 316, 358, 360 Hybrid, 67, 295, 314 Hybridization, 37, 40, 46, 314, 329 Hydrogel, 315, 317 Hydrogen, 181, 183, 184, 197, 283, 288, 292, 300, 301, 308, 315, 325, 329, 332, 334, 340 Hydrolysis, 287, 293, 315, 335, 337, 340 Hydrophilic, 157, 164, 301, 315 Hydroxylation, 42, 315, 356 Hydroxylysine, 296, 315 Hydroxyproline, 296, 315 Hygienic, 165, 253, 315, 349 Hypercholesterolemia, 156, 315 Hyperplasia, 24, 177, 199, 200, 315, 340 Hyperreflexia, 204, 315 Hypersensitivity, 47, 204, 221, 283, 315, 346, 347 Hypertension, 22, 50, 154, 155, 167, 172, 178, 200, 292, 315, 318, 335, 338 Hypertrophy, 22, 156, 204, 289, 315, 338 Hypoglycaemia, 300, 315 Hypoglycemia, 155, 180, 196, 315 Hypoglycemic, 180, 315 Hypogonadism, 198, 315 Hypokinesia, 315, 333 Hypotension, 286, 315 Hypothalamic, 198, 316 Hypothalamus, 198, 288, 301, 316, 354 Hypoxia, 180, 290, 293, 300, 316 Hypoxic, 180, 316 Hysterectomy, 16, 34, 69, 96, 176, 229, 233, 253, 316 Hysterotomy, 294, 316 I Id, 122, 145, 262, 263, 264, 265, 266, 267, 268, 269, 274, 276, 316 Idiopathic, 33, 178, 316 Imipramine, 14, 193, 316 Immune response, 282, 285, 287, 312, 316, 347, 352, 358, 360 Immunization, 316, 347 Immunodeficiency, 156, 316 Immunohistochemistry, 32, 46, 49, 53, 316 Immunology, 282, 316 Impaction, 257, 316

Impairment, 9, 16, 61, 289, 293, 300, 303, 316, 324, 341 Implant radiation, 316, 318, 342 Implantable pump, 190, 191, 316 Implantation, 20, 33, 36, 76, 101, 102, 158, 163, 171, 191, 214, 218, 316, 330 Impotence, 7, 36, 55, 57, 185, 191, 211, 306, 316 In situ, 37, 40, 46, 178, 316 In Situ Hybridization, 37, 40, 46, 316 In vitro, 19, 23, 40, 47, 49, 50, 67, 69, 180, 195, 310, 316, 317, 337, 355 In vivo, 23, 32, 36, 40, 47, 53, 67, 180, 195, 310, 316, 317 Incision, 12, 17, 186, 194, 202, 306, 316, 317, 319, 339, 345 Incompetence, 216, 220, 310, 317 Incontinence Pads, 20, 317 Indicative, 157, 210, 317, 333, 358 Induction, 286, 317 Industrial Microbiology, 20, 317 Infant, Newborn, 282, 317 Infarction, 156, 286, 290, 293, 298, 313, 317, 324 Infection, 5, 20, 23, 44, 180, 193, 197, 218, 224, 233, 252, 254, 257, 259, 260, 265 Infertility, 67, 317, 358 Inflammation, 165, 286, 291, 294, 296, 299, 306, 309, 317, 319, 328, 340, 345, 346, 357, 358 Inflammatory bowel disease, 47, 200, 201, 317 Influenza, 180, 317 Ingestion, 317, 320, 337 Initiation, 31, 61, 317 Inlay, 317, 345 Innervation, 46, 49, 135, 143, 303, 318 Inotropic, 302, 318 Insight, 23, 25, 30, 42, 52, 318 Insomnia, 318, 338 Institutionalization, 18, 33, 69, 163, 318 Insulator, 318, 326 Intermittent, 10, 15, 168, 214, 232, 252, 257, 318, 321 Internal radiation, 318, 342 Interneurons, 53, 318 Interstitial, 36, 174, 177, 216, 290, 308, 318, 332, 344 Intervertebral, 318, 322, 342, 347 Intervertebral Disk Displacement, 318, 322, 342, 347 Intestine, 173, 290, 305, 318, 320

371

Intoxication, 300, 318, 360 Intracellular, 188, 291, 317, 318, 323, 329, 337, 343, 348 Intracellular Membranes, 318, 323 Intracranial Embolism, 293, 318 Intracranial Embolism and Thrombosis, 293, 318 Intracranial Hypertension, 312, 318, 355 Intraocular, 154, 318 Intraocular pressure, 154, 318 Intravenous, 261, 318 Intravenous pyelogram, 261, 318 Intravesical, 46, 64, 318 Intrinsic, 4, 8, 13, 45, 79, 93, 173, 219, 220, 221, 253, 282, 288, 318 Intubation, 292, 319 Invasive, 8, 13, 21, 23, 25, 33, 36, 40, 52, 133, 137, 163, 173, 187, 210, 213, 221, 264 Iodine, 36, 319 Ion Channels, 50, 62, 173, 189, 287, 319, 335, 353 Ions, 184, 288, 302, 304, 315, 319, 325, 340 Irritable Bowel Syndrome, 47, 159, 166, 167, 172, 178, 182, 184, 197, 198, 200, 201, 319 Irritants, 256, 257, 319 Ischemia, 155, 180, 183, 196, 287, 290, 300, 313, 319, 328 J Joint, 42, 287, 319, 331, 351, 353 K Kb, 242, 319 Kidney Disease, 50, 70, 242, 248, 249, 250, 251, 268, 319 Kidney Failure, 161, 305, 319 Kidney Failure, Acute, 319 Kidney Failure, Chronic, 319 Kidney Pelvis, 320, 357 L Lacerations, 306, 320 Lactation, 125, 320, 330 Large Intestine, 173, 292, 302, 318, 320, 344, 349 Larynx, 173, 320, 355, 358 Latent, 320, 338 Lathyrism, 155, 320 Least-Squares Analysis, 320, 344 Lectin, 320, 323 Lens, 292, 320, 338 Lesion, 30, 46, 80, 312, 320, 321, 354, 357 Lethal, 288, 320, 326 Leucocyte, 283, 320

Leukemia, 310, 320 Levorphanol, 301, 320 Library Services, 274, 320 Lidocaine, 183, 320 Life Expectancy, 71, 320 Ligament, 320, 339, 351 Ligands, 157, 166, 172, 173, 178, 320, 343 Likelihood Functions, 321, 344 Limbic, 172, 321 Linear Models, 321, 344 Linkage, 69, 293, 321 Lipid, 188, 321, 326 Lithium, 286, 321 Liver, 281, 289, 299, 308, 309, 314, 321, 325, 346, 347 Liver scan, 321, 346 Lobe, 293, 321 Localization, 22, 316, 321 Localized, 7, 21, 48, 57, 152, 167, 177, 182, 281, 290, 309, 313, 317, 321, 325, 336, 357 Locomotion, 321, 336 Locomotor, 172, 321 Logistic Models, 321, 344 Loneliness, 43, 321 Longitudinal study, 44, 321 Long-Term Care, 9, 72, 149, 223, 265, 321 Long-Term Potentiation, 199, 321 Loop, 153, 154, 314, 322 Low Back Pain, 262, 322 Lower Esophageal Sphincter, 310, 322 Lubricants, 322, 334 Lubrication, 167, 322 Lumbar, 288, 292, 318, 322 Lumen, 152, 153, 154, 165, 181, 182, 305, 322 Lymph, 295, 305, 322 Lymphatic, 305, 317, 322, 349, 350 Lymphatic system, 322, 349, 350 Lymphocyte, 285, 322, 323 Lymphoid, 285, 320, 322 Lysine, 42, 315, 322 M Maceration, 162, 322 Magnetic Resonance Imaging, 45, 322, 346 Malaise, 303, 322 Malignant, 48, 67, 322, 327, 342 Malnutrition, 287, 322 Mammary, 323, 343 Mandible, 294, 323 Mania, 323 Manic, 184, 286, 321, 323, 341 Manic-depressive psychosis, 323, 341

372

Urinary incontinence

Manifest, 26, 57, 288, 323 Matrix metalloproteinase, 41, 323 Medetomidine, 155, 301, 323 Mediate, 22, 46, 159, 188, 199, 302, 323 Mediator, 67, 323, 348 Medical Records, 53, 69, 323, 345 Medicament, 181, 190, 205, 323 MEDLINE, 243, 323 Medullary, 301, 323, 342 Meiosis, 323, 353 Melanin, 187, 323, 335, 357 Memantine, 180, 323 Membrane, 62, 152, 154, 161, 182, 188, 190, 191, 200, 201 Membrane Proteins, 62, 323 Memory, 30, 156, 160, 203, 300, 322, 323 Meninges, 293, 299, 323 Menopause, 14, 16, 34, 54, 59, 68, 69, 126, 176, 177, 229, 250, 259 Menorrhagia, 94, 324 Menstrual Cycle, 84, 324, 330, 338, 339 Menstruation, 324, 338 Mental Disorders, 315, 324, 341 Mental Health, iv, 18, 31, 55, 242, 244, 324, 341 Mental Health Services, iv, 18, 32, 244, 324 Mesolimbic, 286, 324, 359 Meta-Analysis, 24, 88, 324 Metabolite, 178, 301, 324, 339, 342 Metastasis, 323, 324 Metastatic, 57, 324 Methionine, 324, 352 MI, 106, 155, 278, 324 Microbe, 324, 355 Microbiological, 20, 324 Microbiology, 20, 281, 288, 324 Microorganism, 324, 360 Microspheres, 164, 324 Micturition, 9, 28, 37, 44, 52, 113, 160, 198, 204, 324, 340 Migration, 12, 213, 324 Milliliter, 290, 324 Mitochondrial Swelling, 325, 327 Mitosis, 286, 325 Mobility, 13, 15, 16, 30, 61, 220, 254, 257, 325 Modeling, 28, 57, 303, 325 Modification, 10, 34, 56, 78, 93, 108, 121, 135, 169, 214, 225, 255, 325, 342 Modulator, 166, 325 Molecular Structure, 325, 356

Molecule, 42, 47, 157, 285, 288, 296, 302, 303, 305, 307, 311, 313, 315, 320, 325, 329, 332, 342, 343, 348, 359 Monitor, 28, 35, 299, 325, 329 Monoamine, 178, 284, 325, 357 Monoamine Oxidase, 178, 284, 325, 357 Monoclonal, 325, 342 Mononuclear, 312, 325 Monophosphate, 199, 325 Motility, 183, 259, 325, 348 Motion Sickness, 325, 327 Motor nerve, 325, 326, 330 Motor Neurons, 49, 325 Motor Skills, 252, 325 Movement Disorders, 286, 325 Mucinous, 310, 326 Mucosa, 173, 204, 326 Mucus, 326, 357 Multicenter study, 11, 326 Multiparous, 41, 326 Multiple sclerosis, 32, 97, 132, 136, 177, 193, 326 Muscle Contraction, 22, 60, 326 Muscle relaxant, 191, 193, 326, 335 Muscle Relaxation, 191, 326 Muscle Spindles, 326, 335 Muscle tension, 326 Musculature, 21, 45, 46, 49, 315, 326, 351 Mustard Gas, 319, 326 Myalgia, 317, 326 Mydriasis, 183, 326 Mydriatic, 302, 326 Myelin, 326 Myocardium, 324, 326 Myosin, 326 N Naphazoline, 155, 326 Narcolepsy, 306, 327 Narcotic, 320, 327, 355 Nasal Mucosa, 317, 327 Nausea, 58, 178, 285, 286, 327, 333, 338, 357 Necrosis, 176, 186, 286, 293, 317, 324, 327 Needs Assessment, 11, 327 Neoplasia, 327 Neoplasm, 327, 357 Neoplastic, 60, 327 Neostriatum, 172, 292, 298, 327, 342 Nephron, 50, 327 Nephropathy, 67, 319, 327 Nerve Fibers, 44, 327, 350 Nerve Growth Factor, 46, 327, 328

373

Nerve Regeneration, 40, 327 Nervous System, 154, 155, 156, 172, 178, 188, 196, 197, 199, 215 Networks, 43, 327 Neural, 28, 32, 33, 40, 44, 52, 69, 104, 216, 282, 325, 327 Neurodegenerative Diseases, 155, 180, 288, 327 Neurogenic, 14, 50, 64, 79, 140, 204, 216, 327, 357 Neuroleptic, 282, 286, 328 Neurologic, 17, 30, 173, 254, 328 Neurologist, 113, 328 Neuromuscular, 44, 90, 259, 281, 328, 339 Neuromuscular Junction, 281, 328 Neuronal, 32, 36, 46, 49, 62, 155, 156, 180, 183, 197, 199, 328 Neuronal Plasticity, 199, 328 Neurons, 43, 49, 53, 155, 189, 300, 307, 310, 318, 325, 326, 327, 328, 329, 350, 353, 359 Neuropathy, 32, 36, 43, 49, 183, 200, 201, 328, 347 Neuropeptide, 197, 328 Neurophysiology, 4, 9, 28, 300, 328 Neuroprotective Agents, 181, 328 Neuroretinitis, 328, 345 Neurosecretory Systems, 304, 328 Neurosis, 328 Neurotic, 200, 201, 328 Neurotoxicity, 301, 328 Neurotoxin, 46, 328 Neurotransmitter, 172 Neurotrophins, 47, 328 Neutrons, 283, 329, 342 Niacin, 329, 356 Nicotine, 180, 329 Nitric Oxide, 167, 329 Nitrogen, 174, 184, 283, 308, 309, 319, 329, 356 Nocturia, 18, 25, 329 Nodose, 189, 329 Nodose Ganglion, 189, 329 Norepinephrine, 22, 45, 111, 282, 284, 302, 305, 328, 329, 335, 343 Nuclear, 288, 304, 307, 310, 327, 329 Nuclei, 283, 285, 304, 310, 322, 325, 329, 330, 331, 337, 340, 359 Nucleic acid, 187, 299, 310, 315, 316, 329, 342 Nucleic Acid Hybridization, 315, 329 Nucleic Acid Probes, 187, 329 Nucleus, 172

Nucleus Accumbens, 172, 330, 359 Nulliparous, 41, 44, 51, 70, 330 Nurse Practitioners, 19, 222, 330 Nursing Care, 20, 330 Nursing Research, 15, 17, 27, 242, 330 Nursing Staff, 15, 19, 87, 330 O Observational study, 66, 142, 330 Obsessive-Compulsive Disorder, 178, 330 Occult, 75, 105, 330 Ocular, 154, 180, 330 Oculomotor, 326, 330 Oculomotor Nerve, 326, 330 Odour, 287, 330 Oestrogen, 177, 330 Office Visits, 64, 331 Ointments, 331, 349 Oliguria, 319, 331 Opacity, 292, 300, 331 Ophthalmologic, 8, 182, 331 Ophthalmology, 309, 331 Opiate, 156, 180, 331 Opium, 331 Opsin, 331, 345 Optic Chiasm, 316, 331 Optic cup, 331, 333 Optic Disk, 301, 331 Optic Nerve, 328, 331, 333, 345 Organ Culture, 331, 355 Orgasm, 167, 233, 234, 304, 331 Orthostatic, 286, 331 Osteoarthritis, 184, 331 Osteoclasts, 291, 331 Osteoporosis, 156, 200, 264, 265, 307, 331, 332, 343 Ostomy, 3, 4, 5, 6, 7, 11, 120, 121, 122, 126, 127, 129, 133, 136, 137, 138, 140, 141, 142, 144, 145, 257, 264 Outpatient, 34, 36, 52, 69, 120, 213, 217, 253, 332 Ovariectomy, 41, 68, 332 Ovaries, 308, 332, 345, 348, 358 Ovary, 298, 311, 330, 332 Overactive bladder, 18, 88, 91, 97, 160, 209, 225, 233, 234, 251, 257, 332 Overexpress, 23, 332 Ovum, 298, 311, 332, 339, 360 Oxidation, 281, 332 Oxygenation, 313, 332 P Paediatric, 80, 121, 332 Painful bladder syndrome, 72, 332

374

Urinary incontinence

Palladium, 36, 332 Palliative, 17, 330, 332, 354 Pancreas, 281, 332, 347 Pancreatic, 310, 332 Pancreatic Juice, 310, 332 Panic, 316, 332 Panic Disorder, 316, 332 Paralysis, 291, 299, 313, 333, 350 Parenchyma, 50, 333 Parietal, 9, 285, 333 Parietal Lobe, 285, 333 Parity, 41, 49, 51, 54, 59, 333 Parkinsonism, 155, 180, 193, 200, 203, 259, 286, 333 Partial remission, 333, 344 Particle, 158, 213, 333, 350, 356 Partnership Practice, 333, 338 Parturition, 41, 49, 330, 333 Patch, 333, 356 Pathogenesis, 22, 24, 50, 68, 215, 333 Pathologic, 286, 289, 298, 315, 333 Pathologic Processes, 286, 333 Pathophysiology, 5, 24, 33, 45, 53, 67, 88, 91, 107, 197, 213, 214, 225, 333 Patient Education, 11, 100, 145, 224, 250, 258, 260, 261, 272, 274, 279, 333 Patient Satisfaction, 27, 39, 101, 333 Patient Selection, 70, 214, 217, 218, 219, 231, 254, 260, 333 Pedicle, 79, 333 Peer Review, 42, 119, 334 Pelvis, 45, 171, 186, 215, 281, 322, 332, 334, 358 Penis, 161, 162, 167, 173, 174, 278, 304, 334, 345, 358 Pepsin, 334, 347 Peptic, 172, 334 Peptic Ulcer, 172, 334 Peptide, 291, 334, 337, 340 Perception, 51, 334, 346 Percutaneous, 75, 127, 334 Perforation, 98, 186, 286, 309, 334 Perfusion, 316, 334 Perimenopausal, 117, 334 Perinatal, 29, 156, 180, 334 Perineal, 12, 44, 82, 139, 162, 171, 255, 334, 342 Perineum, 45, 334 Peripheral Nervous System, 305, 327, 328, 334, 338, 352 Petroleum, 192, 334 PH, 18, 23, 24, 25, 67, 112, 174, 290, 334

Phantom, 40, 334 Pharmaceutical Preparations, 201, 293, 307, 335 Pharmacokinetic, 159, 335 Pharmacologic, 5, 18, 120, 208, 225, 284, 335, 355, 357 Pharmacotherapy, 14, 39, 104, 107, 140, 208, 212, 335 Pharynx, 173, 310, 317, 335, 358 Phenotype, 49, 53, 335 Phenoxybenzamine, 155, 335 Phenyl, 182, 197, 205, 335 Phenylacetate, 204, 335 Phenylalanine, 287, 335, 357 Phenylpropanolamine, 120, 193, 335 Phenytoin, 183, 291, 335 Phosphodiesterase, 200, 335 Phospholipases, 335, 348 Phospholipids, 308, 335 Phosphorus, 291, 335 Photoreceptors, 297, 335 Physical Examination, 8, 19, 25, 51, 216, 220, 336 Physical Fitness, 307, 336 Physical Therapy, 141, 336 Physician Assistants, 6, 336 Physiologic, 71, 107, 193, 282, 289, 295, 315, 324, 336, 343, 356 Pigments, 292, 336, 345 Pilot study, 9, 38, 64, 96, 127, 131, 136, 336 Placenta, 309, 336, 339, 341 Plants, 178, 283, 287, 289, 311, 320, 329, 336, 346, 355 Plasma, 46, 154, 285, 291, 293, 305, 308, 311, 313, 319, 336, 340, 347 Plasma cells, 285, 336 Plasticity, 32, 53, 199, 336 Platelet Activation, 336, 348 Platelet Aggregation, 329, 336 Platelets, 329, 336, 354 Platinum, 322, 332, 336 Pleomorphic, 330, 337 Poisoning, 300, 318, 327, 337 Polycystic, 50, 337 Polyethylene, 317, 337 Polymerase, 46, 337 Polymerase Chain Reaction, 46, 337 Polymers, 180, 337, 340 Polypeptide, 283, 296, 308, 315, 337, 340, 361 Polysaccharide, 285, 293, 337 Polyuria, 50, 257, 337

375

Port, 190, 191, 337 Port-a-cath, 337 Posterior, 51, 170, 284, 288, 290, 293, 294, 303, 306, 332, 337, 347 Postmenopausal, 31, 56, 88, 99, 100, 107, 120, 121, 139, 307, 332, 337, 343 Postnatal, 337, 351 Postoperative, 7, 8, 52, 218, 232, 260, 337 Postsynaptic, 337, 348, 353 Potassium, 37, 167, 337, 349 Potentiating, 284, 338 Potentiation, 199, 322, 338, 348 Practicability, 338, 356 Practice Guidelines, 48, 244, 261, 338 Prazosin, 155, 338 Preclinical, 67, 338 Precursor, 302, 303, 305, 329, 335, 338, 339, 340, 356, 357 Predisposition, 29, 70, 338 Premenstrual, 126, 338 Premenstrual Syndrome, 126, 338 Preoperative, 30, 48, 115, 219, 260, 338 Presbyopia, 154, 338 Presynaptic, 303, 328, 338, 353 Presynaptic Terminals, 303, 338 Prevalence, 8, 16, 17, 26, 31, 33, 34, 54, 58, 59, 60, 68, 70, 74, 208, 217, 219, 226, 253, 261 Private Practice, 222, 338 Probe, 98, 137, 338 Procaine, 320, 338 Prodrug, 183, 184, 339 Progesterone, 69, 339, 351 Progression, 23, 24, 25, 41, 55, 57, 59, 60, 284, 339 Progressive, 24, 50, 214 Progressive disease, 24, 339 Projection, 318, 329, 331, 339, 344, 359 Prolapse, 34, 35, 41, 49, 53, 54, 69, 70, 171, 211, 212, 233, 234, 255 Proline, 296, 315, 339 Promoter, 157, 339 Propafenone, 183, 339 Propantheline, 193, 339 Prophase, 339, 353 Prophylaxis, 180, 198, 202, 339, 358 Proportional, 160, 333, 339 Prospective Studies, 59, 339 Prospective study, 9, 12, 59, 80, 83, 321, 339 Prostate gland, 5, 339, 340

Prostatectomy, 5, 7, 11, 12, 24, 48, 55, 57, 64, 91, 101, 110, 129, 131, 132, 139, 140, 143, 145, 174, 229, 233, 339, 342 Prostatic Hyperplasia, 18, 23, 24, 25, 67, 174, 199, 205, 263, 267, 340 Prostatism, 104, 340 Prostatitis, 26, 177, 340 Prosthesis, 33, 40, 44, 152, 161, 182, 340 Protease, 284, 296, 340 Protective Agents, 155, 340 Protein C, 172, 178, 188, 195, 283, 288, 340 Protein Conformation, 283, 340 Protein S, 290, 310, 340, 346 Proteolytic, 283, 296, 308, 340 Prothrombin, 340, 354 Protocol, 25, 35, 52, 56, 66, 128, 160, 340 Protons, 283, 315, 340, 342 Protozoa, 324, 340 Proximal, 57, 152, 158, 159, 165, 167, 171, 182, 194, 219, 302, 338, 340 Pruritic, 203, 340 Pruritus, 169, 201, 286, 340, 341 Pseudorabies, 53, 341 Psychiatric, 172, 178, 324, 341 Psychiatry, 31, 72, 121, 309, 341 Psychic, 295, 328, 341, 347 Psychogenic, 341, 357 Psychometric testing, 117, 341 Psychomotor, 291, 300, 328, 341 Psychosis, 155, 172, 178, 184, 203, 286, 311, 341 Psychosomatic, 157, 341 Public Health, 22, 34, 63, 71, 95, 167, 209, 212, 244, 341 Public Policy, 243, 341 Publishing, 10, 15, 18, 73, 105, 138, 210, 214, 215, 341 Puerperium, 330, 341 Pulmonary, 156, 166, 167, 172, 182, 184, 200, 201, 290, 298, 319, 341, 359 Pulmonary Artery, 290, 341, 359 Pulmonary Edema, 319, 341 Pulse, 160, 232, 325, 341 Pupil, 302, 326, 341 Purulent, 341, 358 Putamen, 285, 288, 298, 327, 342 Pyramidal Tracts, 308, 342 Pyrimidines, 201, 342 Q Quinolinic, 180, 342 Quinolinic Acid, 180, 342

376

Urinary incontinence

R Race, 48, 54, 58, 70, 301, 324, 342 Radiation, 12, 36, 57, 177, 307, 309, 318, 334, 342, 346, 352, 360 Radiation therapy, 36, 57, 177, 307, 318, 342 Radical prostatectomy, 5, 7, 12, 48, 55, 94, 109, 131, 140, 143, 229, 342 Radiculopathy, 342, 347 Radioactive, 36, 290, 315, 316, 318, 321, 329, 342, 346 Radiolabeled, 342 Radiological, 334, 342 Radiotherapy, 290, 342 Raloxifene, 41, 86, 342, 347 Ramus, 12, 343 Random Allocation, 343 Randomization, 35, 37, 64, 343 Randomized clinical trial, 29, 35, 39, 59, 71, 85, 132, 133, 343 Randomized Controlled Trials, 141, 343 Reality Testing, 341, 343 Receptors, Adrenergic, 301, 323, 343 Receptors, Serotonin, 343, 348 Recombinant, 37, 343, 359 Recombination, 310, 343 Rectal, 19, 34, 233, 278, 344 Rectum, 49, 77, 106, 285, 286, 290, 300, 302, 309, 310, 317, 320, 339, 344 Recurrence, 55, 57, 295, 323, 344 Red Nucleus, 344, 359 Refer, 1, 144, 296, 302, 305, 309, 318, 321, 322, 328, 329, 341, 344, 348 Reflex, 28, 37, 52, 134, 176, 197, 198, 205, 326, 344 Reflux, 44, 152, 158, 164, 181, 185, 191, 204, 216, 310, 344 Refraction, 344, 350 Refractory, 120, 344 Regeneration, 40, 344 Regimen, 5, 25, 304, 335, 344 Regression Analysis, 30, 344 Regurgitation, 164, 310, 313, 344 Rehabilitative, 28, 140, 344 Relapse, 27, 37, 344 Relaxant, 191, 193, 335, 344 Reliability, 83, 344 Remission, 91, 323, 344 Renal failure, 24, 50, 300, 344 Reoperation, 88, 344 Reproductive system, 339, 345 Research Design, 22, 27, 345

Research Support, 125, 345 Resection, 278, 345, 356 Residual Volume, 25, 345 Respiration, 294, 299, 325, 345 Restoration, 5, 44, 336, 345, 346, 360 Retina, 294, 297, 301, 320, 328, 331, 345, 346 Retinal, 180, 301, 331, 345 Retinitis, 155, 345 Retinol, 345 Retinopathy, 155, 180, 203, 301, 345 Retrograde, 49, 53, 345 Retropubic, 81, 106, 179, 340, 342, 345 Retropubic prostatectomy, 342, 345 Retrospective, 9, 14, 69, 91, 143, 345 Retrospective study, 91, 143, 345 Retroviral vector, 310, 346 Rheumatism, 346 Rheumatoid, 154, 184, 197, 346 Rheumatoid arthritis, 154, 184, 197, 346 Rhinitis, 182, 306, 339, 346 Ribose, 281, 346 Ribosome, 346, 356 Rigidity, 333, 336, 346 Risk factor, 4, 7, 16, 33, 41, 53, 54, 58, 59, 69, 70, 99, 111, 208, 229, 306, 321, 339, 346 Rod, 295, 346 S Salivary, 299, 346 Salivary glands, 299, 346 Sanitary, 179, 180, 346 Saponins, 346, 351 Scans, 21, 346 Scatter, 334, 346 Schizoid, 346, 360 Schizophrenia, 172, 178, 180, 184, 197, 198, 200, 286, 346, 359, 360 Schizotypal Personality Disorder, 346, 360 Sciatica, 264, 347 Sclerosis, 32, 132, 136, 146, 155, 177, 180, 183, 193, 196, 203, 326, 347 Screening, 33, 53, 54, 198, 266, 295, 347, 357 Scrotum, 175, 347, 354, 358 Sebaceous, 319, 347 Sebaceous gland, 319, 347 Secretin, 200, 347 Secretion, 183, 295, 301, 314, 320, 326, 347 Sedative, 154, 284, 295, 301, 316, 323, 347 Sediment, 347, 357 Seizures, 291, 300, 306, 335, 347, 351

377

Selection Bias, 16, 347 Selective estrogen receptor modulator, 342, 347 Self-Help Groups, 254, 347 Semen, 146, 147, 304, 339, 347 Seminal vesicles, 347, 358 Senescence, 190, 347 Senile, 172, 178, 196, 197, 286, 332, 347 Sensibility, 284, 347 Sensitization, 47, 347 Sensor, 62, 73, 157, 348 Sequencing, 337, 348 Serotonin, 86, 111, 172, 178, 198, 200, 284, 286, 289, 325, 328, 335, 343, 348, 356 Serous, 305, 348 Serum, 25, 69, 190, 296, 319, 348 Sex Characteristics, 330, 348 Sex Distribution, 9, 348 Sexually Transmitted Diseases, 43, 348 Shock, 157, 348, 356 Signal Transduction, 22, 63, 200, 348 Signs and Symptoms, 344, 348 Skeletal, 65, 295, 299, 326, 348, 350 Skeleton, 281, 319, 348, 349 Skin Care, 5, 252, 349 Skin graft, 192, 349 Skull, 299, 349, 354 Small intestine, 173, 292, 303, 314, 318, 349 Smoking Cessation, 215, 349 Sneezing, 45, 153, 163, 168, 187, 193, 203, 218, 234, 253, 349, 351, 352 Soaps, 349 Sociability, 43, 349 Social Environment, 342, 349 Social Isolation, 57, 157, 346, 349 Social Problems, 161, 349 Social Support, 61, 349, 352 Socialization, 18, 349 Sodium, 183, 349 Soft tissue, 8, 290, 348, 349 Solid tumor, 48, 284, 349 Solvent, 158, 281, 307, 350 Somatic, 295, 323, 325, 334, 350, 358 Sound wave, 297, 350 Spasm, 156, 203, 286, 298, 350 Spastic, 193, 319, 350 Spasticity, 154, 180, 350 Spatial disorientation, 302, 350 Specialist, 128, 142, 209, 269, 302, 350 Species, 20, 49, 289, 291, 296, 299, 306, 314, 323, 324, 325, 342, 350, 352, 356, 360 Specificity, 36, 282, 350

Spectrum, 8, 20, 26, 54, 67, 156, 350 Sperm, 294, 350, 354, 356 Spermatozoa, 347, 350, 358 Spina bifida, 10, 254, 350 Spinal Nerve Roots, 342, 347, 350 Spleen, 299, 322, 350 Sporadic, 327, 351 Sprains and Strains, 322, 351 Stabilization, 170, 216, 335, 351 Staging, 346, 351 Standardize, 26, 351 Status Epilepticus, 156, 351 Steel, 214, 295, 351 Stem Cells, 21, 42, 64, 351 Stent, 52, 332, 351 Sterility, 317, 351 Sternum, 164, 351 Steroid, 39, 41, 330, 346, 351 Stimulant, 284, 291, 314, 351 Stimulus, 298, 304, 307, 318, 319, 344, 351, 354 Stoma, 174, 332, 351 Stomach, 164, 200, 201, 281, 302, 306, 310, 314, 322, 327, 334, 335, 344, 347, 349, 351 Stool, 257, 316, 317, 319, 320, 351 Strand, 153, 154, 337, 351 Stress management, 55, 352 Striatum, 173, 327, 330, 352 Stroke, 30, 32, 62, 130, 155, 172, 177, 178, 180, 196, 200, 201, 203, 242, 252, 264 Stroma, 333, 352 Stromal, 67, 305, 352 Structure-Activity Relationship, 47, 352 Subacute, 317, 352 Subarachnoid, 312, 352 Subclinical, 317, 347, 352 Subcutaneous, 191, 303, 352 Subspecies, 350, 352 Substance P, 197, 324, 347, 352 Substrate, 167, 352, 357 Sulfur, 183, 308, 324, 352 Sunburn, 197, 352 Supine, 220, 352 Supine Position, 220, 352 Support group, 252, 352 Suppression, 192, 353 Surgical Instruments, 153, 218, 353 Survival Rate, 5, 353 Sympathetic Nervous System, 22, 288, 353 Sympathomimetic, 171, 193, 284, 302, 306, 329, 335, 353, 357 Symphysis, 162, 294, 339, 353

378

Urinary incontinence

Symptomatic, 12, 23, 34, 353 Symptomatology, 54, 353 Synapses, 322, 353 Synapsis, 353 Synaptic, 154, 321, 328, 329, 348, 353 Synaptic Transmission, 329, 353 Systemic, 72, 236, 286, 290, 300, 306, 317, 318, 342, 353 Systolic, 315, 353 T Tachykinins, 197, 353 Tardive, 180, 286, 354 Tear Gases, 319, 354 Temporal, 26, 312, 354 Testicles, 347, 354 Testicular, 156, 354 Testis, 330, 354 Tetrahydrocannabinol, 291, 354 Therapeutics, 78, 98, 126, 132, 137, 237, 325, 354 Thermal, 8, 173, 302, 329, 337, 354 Thigh, 312, 354 Third Ventricle, 316, 354 Thoracic, 173, 288, 301, 354, 360 Thorax, 281, 322, 354, 358 Threshold, 307, 315, 354 Thrombin, 200, 308, 336, 340, 354 Thrombomodulin, 340, 354 Thrombosis, 318, 340, 352, 354 Thrombus, 298, 317, 336, 354 Thyroid, 291, 319, 354, 357 Time Management, 352, 355 Tinnitus, 201, 202, 355, 359 Tissue Culture, 69, 355 Tolerance, 67, 155, 180, 281, 311, 355 Tomography, 297, 355 Tone, 46, 62, 171, 174, 350, 355 Tonicity, 176, 303, 355 Tonus, 355 Tooth Preparation, 281, 355 Topical, 307, 349, 355 Torsion, 317, 355 Toxic, iv, 20, 287, 299, 328, 329, 355 Toxicity, 180, 183, 303, 355 Toxicology, 244, 355 Toxins, 285, 317, 355, 359 Trachea, 174, 291, 320, 335, 354, 355 Traction, 295, 355 Training Support, 258, 355 Tramadol, 169, 355 Transcutaneous, 4, 356 Transdermal, 81, 229, 356

Transduction, 22, 63, 199, 200, 348, 356 Transfection, 37, 289, 310, 356 Translation, 49, 356 Translational, 28, 49, 63, 64, 67, 356 Transmitter, 49, 281, 287, 302, 307, 319, 323, 329, 353, 356, 357 Transplantation, 216, 256, 295, 316, 320, 356 Transurethral, 12, 143, 174, 278, 340, 356 Transurethral resection, 278, 340, 356 Transurethral Resection of Prostate, 340, 356 Trauma, 12, 29, 33, 46, 68, 155, 163, 174, 180, 196, 254 Treatment Outcome, 30, 31, 35, 65, 226, 356 Tremor, 333, 356 Tricyclic, 193, 236, 284, 303, 316, 356 Trigger zone, 286, 356 Trophic, 193, 356 Tryptophan, 178, 296, 342, 348, 356 Tryptophan Hydroxylase, 178, 356 Tubercle, 330, 356 Tubulin, 40, 356 Tumour, 310, 357 Tyramine, 289, 325, 357 Tyrosine, 302, 357 U Ulcer, 73, 164, 200, 201, 300, 303, 306, 357 Ulceration, 162, 300, 334, 357 Ulcerative colitis, 197, 317, 357 Ultrasonography, 116, 263, 357 Unconscious, 284, 288, 316, 357 Uracil, 342, 357 Uremia, 319, 344, 357 Ureter, 63, 152, 157, 181, 320, 357 Urethritis, 177, 193, 257, 357 Urge urinary incontinence, 99, 129, 133, 228, 229, 266, 357 Urinalysis, 6, 25, 216, 233, 248, 251, 256, 260, 357 Urinary Retention, 17, 23, 24, 25, 60, 89, 158, 179, 257, 299, 338, 340, 357 Urinary tract infection, 12, 24, 25, 44, 69, 73, 163, 166, 177, 190, 215, 221, 233, 255, 256, 263, 268 Urinary urgency, 205, 357 Urinate, 164, 174, 175, 224, 260, 357, 358, 360 Urogenital, 20, 63, 69, 88, 94, 121, 122, 159, 165, 195, 311, 358 Urogenital Diseases, 358

379

Urogenital System, 63, 358 Urologic Diseases, 63, 248, 249, 250, 251, 257, 358 Urologist, 9, 63, 217, 358 Uterine Prolapse, 20, 35, 358 Uterus, 167, 174, 234, 294, 298, 305, 308, 316, 322, 324, 332, 339, 345, 358 V Vaccination, 266, 358 Vaccine, 282, 340, 358 Vagina, 13, 41, 49, 154, 159, 167, 170, 171, 173, 194, 195, 234, 294, 316, 324, 345, 358, 360 Vaginitis, 257, 358 Vagus Nerve, 329, 358 Valves, 165, 358 Vas Deferens, 174, 358 Vascular, 16, 63, 68, 116, 178, 283, 293, 294, 305, 312, 317, 329, 336, 354, 358 Vasculitis, 293, 358 Vasoactive, 167, 358 Vasoconstriction, 154, 306, 358 Vasodilation, 167, 197, 358 Vasodilator, 290, 302, 314, 335, 359 Vasomotor, 96, 190, 307, 359 VE, 229, 359 Vector, 356, 359 Vein, 284, 287, 318, 329, 359 Venoms, 178, 359 Venous, 167, 287, 293, 313, 318, 340, 359 Venous blood, 293, 359 Ventral, 116, 172, 316, 330, 350, 359 Ventral Tegmental Area, 172, 359 Ventricle, 292, 330, 341, 353, 354, 359 Ventricular, 339, 359 Venules, 290, 305, 359 Vertebrae, 318, 350, 359 Vertebral, 289, 350, 359 Vesicoureteral, 158, 204, 216, 359

Vestibulocochlear Nerve, 355, 359 Vestibulocochlear Nerve Diseases, 355, 359 Veterinary Medicine, 177, 243, 323, 359 Vinblastine, 357, 360 Vincristine, 357, 360 Viral, 317, 356, 360 Virulence, 355, 360 Virus, 53, 156, 288, 293, 305, 311, 346, 356, 360 Viscera, 177, 197, 350, 360 Visceral, 47, 49, 288, 358, 360 Vitreous Hemorrhage, 301, 360 Vitro, 20, 23, 40, 47, 49, 50, 67, 69, 180, 195, 360 Vivo, 23, 32, 37, 40, 45, 47, 53, 67, 180, 195, 360 Void, 14, 19, 23, 25, 193, 251, 256, 360 Volition, 319, 360 Vulva, 360 Vulvar Diseases, 72, 360 W Wakefulness, 300, 360 Watchful waiting, 23, 25, 360 Weight Gain, 105, 360 Windpipe, 335, 354, 360 Withdrawal, 47, 154, 155, 171, 180, 300, 360 Womb, 345, 358, 360 Wound Healing, 323, 360 Wound Infection, 220, 360 X Xenograft, 285, 360 X-ray, 290, 297, 309, 310, 318, 329, 342, 346, 360 Y Yeasts, 309, 335, 361 Z Zymogen, 340, 361

380

Urinary incontinence

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