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Re: Incontinence Improves in Older Women After Intensive Pelvic Floor Muscle Training: An Assessor-Blinded Randomized Controlled Trial
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VOIDING FUNCTION, BLADDER PHYSIOLOGY AND PHARMACOLOGY, AND FEMALE UROLOGY
Re: Incontinence Improves in Older Women After Intensive Pelvic Floor Muscle Training: An Assessor-Blinded Randomized Controlled Trial M. Sherburn, M. Bird, M. Carey, K. Bø and M. P. Galea Rehabilitation Sciences Research Centre, Melbourne Physiotherapy School, University of Melbourne, Parkville, Victoria, Australia Neurourol Urodyn 2011; 30: 317–324.
Aims: To test the hypotheses that high intensity pelvic floor muscle training (PFMT) is effective in relief of stress urinary incontinence in community dwelling older women, and that intense PFMT improves stress urinary incontinence more than bladder training (BT) in this population. Methods: A two-center, assessor-blinded randomized controlled trial of 20 weeks duration with two active intervention arms: PFMT and BT. Assessments and interventions were undertaken at two metropolitan tertiary hospitals. Participants were community dwelling women over 65 years of age with urodynamic stress incontinence. Primary outcome measure was urinary leakage during a cough stress test. Secondary outcome measures included symptoms and bother (ICIQ-UI SF), participant global perception of change, leakage episodes (7-day accident diary), degree of “bother” (VAS) and health related quality of life (AQoL). Results: Eighty-three Caucasian women, 71.8 (SD 5.3) years participated in the study. Both groups improved over the intervention period; however, the PFMT group reported significantly lower amounts of leakage on the stress test [PFMT median 0.0 g, 95% CI: 0.2– 0.9; BT median 0.3 g, 95% CI: 0.2–1.7, P⫽0.006], improved symptoms and bother [PFMT mean 5.9, 95% CI: 4.8 –7.1; BT group mean 8.5, 95% CI: 7.1–9.9 and greater perception of change [PFMT 28 (73.6%); BT 12 (36.4%) (P⫽0.002)] after 5 months than the BT group. Conclusions: High intensity PFMT is effective in managing stress urinary incontinence and is more effective than BT in healthy older women. Editorial Comment: There seems to be a never ending conflict between those who do bladder training (defined in this article as a “comprehensive program of BT, continence education and general exercise but no pelvic floor muscle training”) and pelvic floor muscle training in the therapy of not just stress urinary incontinence, but also urinary incontinence in general. This is another such article. I always considered pelvic floor muscle training as a part of the overall program of behavioral modification, and I have always wondered why the two are not simply combined. Clearly both are effective, and each has a (presumably) different mechanism by which it improves the condition. Simple logic would dictate that the two together would work more effectively (not synergistically and maybe not even totally additive). If that is the case, the real question would be how best to communicate these principles in terms of efficacy and economics. These particular programs required once weekly visits for 20 weeks. The sessions were held in groups and each session lasted 1 hour. In this group of patients entrance requirements were medical stability, absence of detrusor overactivity, a score of more than 22 on the mini mental status examination, no neurological cause of their incontinence, no anorectal symptoms such as constipation and no difficulty “passing urine or starting your urine flow.” Alan J. Wein, M.D., Ph.D. (hon.)
Re: Reducing Nocturia in the Elderly: A Randomized Placebo-Controlled Trial of Staggered Furosemide and Desmopressin F. G. Fu, H. J. Lavery and D. L. Wu Department of Urology, TongJi Hospital, TongJi University School of Medicine, Shanghai, China Neurourol Urodyn 2011; 30: 312–316.
Aims: The purpose of this study was to investigate efficacy, safety, and impact on quality of sleep of staggered furosemide and desmopressin in the treatment of nocturia in the elderly. Methods: Patients aged ⬎60 years with nocturia at least two voids per night were screened for enrollment into the study. A 3-week dose-titration phase established the optimum desmopressin dose (0.1, 0.2, or 0.4 mg). After
VOIDING FUNCTION, BLADDER PHYSIOLOGY AND PHARMACOLOGY, AND FEMALE UROLOGY
Re: Incontinence Improves in Older Women After Intensive Pelvic Floor Muscle Training: An Assessor-Blinded Randomized Controlled Trial M. Sherburn, M. Bird, M. Carey, K. Bø and M. P. Galea Rehabilitation Sciences Research Centre, Melbourne Physiotherapy School, University of Melbourne, Parkville, Victoria, Australia Neurourol Urodyn 2011; 30: 317–324.
Aims: To test the hypotheses that high intensity pelvic floor muscle training (PFMT) is effective in relief of stress urinary incontinence in community dwelling older women, and that intense PFMT improves stress urinary incontinence more than bladder training (BT) in this population. Methods: A two-center, assessor-blinded randomized controlled trial of 20 weeks duration with two active intervention arms: PFMT and BT. Assessments and interventions were undertaken at two metropolitan tertiary hospitals. Participants were community dwelling women over 65 years of age with urodynamic stress incontinence. Primary outcome measure was urinary leakage during a cough stress test. Secondary outcome measures included symptoms and bother (ICIQ-UI SF), participant global perception of change, leakage episodes (7-day accident diary), degree of “bother” (VAS) and health related quality of life (AQoL). Results: Eighty-three Caucasian women, 71.8 (SD 5.3) years participated in the study. Both groups improved over the intervention period; however, the PFMT group reported significantly lower amounts of leakage on the stress test [PFMT median 0.0 g, 95% CI: 0.2– 0.9; BT median 0.3 g, 95% CI: 0.2–1.7, P⫽0.006], improved symptoms and bother [PFMT mean 5.9, 95% CI: 4.8 –7.1; BT group mean 8.5, 95% CI: 7.1–9.9 and greater perception of change [PFMT 28 (73.6%); BT 12 (36.4%) (P⫽0.002)] after 5 months than the BT group. Conclusions: High intensity PFMT is effective in managing stress urinary incontinence and is more effective than BT in healthy older women. Editorial Comment: There seems to be a never ending conflict between those who do bladder training (defined in this article as a “comprehensive program of BT, continence education and general exercise but no pelvic floor muscle training”) and pelvic floor muscle training in the therapy of not just stress urinary incontinence, but also urinary incontinence in general. This is another such article. I always considered pelvic floor muscle training as a part of the overall program of behavioral modification, and I have always wondered why the two are not simply combined. Clearly both are effective, and each has a (presumably) different mechanism by which it improves the condition. Simple logic would dictate that the two together would work more effectively (not synergistically and maybe not even totally additive). If that is the case, the real question would be how best to communicate these principles in terms of efficacy and economics. These particular programs required once weekly visits for 20 weeks. The sessions were held in groups and each session lasted 1 hour. In this group of patients entrance requirements were medical stability, absence of detrusor overactivity, a score of more than 22 on the mini mental status examination, no neurological cause of their incontinence, no anorectal symptoms such as constipation and no difficulty “passing urine or starting your urine flow.” Alan J. Wein, M.D., Ph.D. (hon.)
Re: Reducing Nocturia in the Elderly: A Randomized Placebo-Controlled Trial of Staggered Furosemide and Desmopressin F. G. Fu, H. J. Lavery and D. L. Wu Department of Urology, TongJi Hospital, TongJi University School of Medicine, Shanghai, China Neurourol Urodyn 2011; 30: 312–316.
Aims: The purpose of this study was to investigate efficacy, safety, and impact on quality of sleep of staggered furosemide and desmopressin in the treatment of nocturia in the elderly. Methods: Patients aged ⬎60 years with nocturia at least two voids per night were screened for enrollment into the study. A 3-week dose-titration phase established the optimum desmopressin dose (0.1, 0.2, or 0.4 mg). After