The purpose of this study was to identify the effectiveness of bladder training on self voiding after removal of catheter in female patients with craniotomy, finally to develop a bladder rehabilitation program for cognitive impaired patients. Nonequivalent control group posttest design was used. The population of this study consisted of 34 hospitalized neurosurgical patients, all patients have been received craniotomy. 17 patients were assigned to the experimental group and another 17 patients to the control group. The homogeneity of general characteristics of the subjects was no significant difference. Bladder training program consisted of pre-training education, the bladder training, positive verbal reinforcement. The experimental group has been received bladder training and the control group has been received gravity drainage. The dependent variables, the frequency of voiding trial untill self voiding achieves, the frequency of urinary retention, the amount of residual urine, the occurrence of urinary incontinence, were measured during 3 days after catheter removed. The data analyzed with SPSSWIN : frequency, percentage, t-test and chi-test were used to analyze homogeneity of general characteristics of subjects between the experimental and the control group. T-test, Mann-Whitney U test, and chi-test were used to determine the effect of bladder training. The results of the study were as follows : There was significant difference in the frequency of voiding trial untill self voiding achieves between the experimental group and the control group. There was no significant difference in the frequency of urinary retention between the experimental group and the control group. There was no significant difference in the amount of residual urine between the experimental group and the control group. However, there was significant difference in the amount of residual urine in urinary retention patients. There was significant difference in the occurrence of urinary incontinence between the experimental group and the control group. In conclusion, bladder training program as a nursing intervention was effective in increasing self voiding ability after removal of catheter for craniotomy patients. Therefore, it is recommended to use the bladder training program clinically for the bladder management of cognitive impaired patients.
Catheters* ; Craniotomy* ; Drainage ; Education ; Female* ; Gravitation ; Humans ; Nursing ; Rehabilitation ; Reinforcement, Verbal ; Urinary Bladder* ; Urinary Incontinence ; Urinary Retention

INTRODUCTION: Several different methods of enhancing pelvic floor functions have been developed and modified. The aim of this investigation was to compare the usage of a new vaginal cone (double cone) with conventional FES-Biofeedback therapy for female urinary incontinence cases with respect to the effects on pelvic floor rehabilitation. MATERIALS AND METHODS: It was performed on a multi-center based study. One hundred patients, who desired a non-surgical treatment for their urinary incontinence, were divided into two groups randomly. They were: (1) the FES-Biofeedback group (or BFB group); and (2) the new vaginal cone group (or cone group). For a period of six weeks, two sessions each week were carried out for the BFB group. The new 150-gram dumbbell- shaped vaginal cone, made up of fine ceramics material, was developed domestically. A therapist instructed these patients in the cone group for using the new cone for pelvic floor exercises and directed them to repeat the exercises at home daily, as these patients had follow-up visits every week. RESULTS: Objective improvements were obvious in both of these groups. 88% of the cone group and 92% of the BFB group showed an improvement after treatment. There was no significant difference in the improvement of dissatisfaction scores between the two groups. CONCLUSION: The new vaginal cone is relatively easy to use at home and aids in pelvic floor muscle exercises. Consequently, the new vaginal cone could be another treatment modality in non-surgical approaches to female stress urinary incontinence.
Ceramics ; Exercise ; Female ; Follow-Up Studies ; Humans ; Pelvic Floor ; Prospective Studies* ; Rehabilitation ; Urinary Incontinence*

PURPOSE: This study was designed to provide the basic data for the development of the urinary incontinence nursing management program by identifying voiding patterns and pressure ulcer prevalence of residents in long term care facilities. MATERIALS AND METHODS: The study was performed from January to February, 2003. The subjects consisted of 92 residents in long term care facilities around S city. Researcher visited the facilities and assessed their voiding patterns, voiding management, and skin. To investigate the voiding patterns of the residents, care givers in the facilities were educated how to fill up voiding diaries and the diaries were made for two days. The data were analyzed by t-test and x2-test with using SAS program. RESULTS: The mean score for the activities of daily living of the subjects was 17.7+/-10.3 indicating medium. Mean score for mental status was 2.5+/-3.5 indicating very low. Among the subjects, self-voiding group was 40.8%, the group with self-voiding at daytime and diapers at night 10.9%, the group managed with diapers all the time 41.1%. In UI status of self-voiding group, urge urinary incontinence 22.8%, mixed urinary incontinence 13.6%, stress urinary incontinence 6.8%, and 56.8% had no urinary incontinence. About 9.8% of the subjects suffered from pressure ulcers and 15% of the group managed with diapers all the time had skin problems at perineal area. Between the group with pressure ulcer and the group without pressure ulcer, there were significant differences by length of residence, activities of daily living, mental status, and Braden scale. CONCLUSION: The above findings indicated that the care programs for the group managed with diaper change and the group with skin problems were required to improve, and the voiding management focusing on rehabilitation rather than simple diaper change should be encouraged.
Activities of Daily Living ; Caregivers ; Humans ; Long-Term Care* ; Nursing ; Pressure Ulcer* ; Prevalence ; Rehabilitation ; Skin ; Urinary Incontinence

PURPOSE: The purposes of this study were to examine the effectiveness of a behavioral intervention program combining pelvic floor muscle exercise with bladder training for urinary incontinence and also to conduct follow-up assessment after self-training. METHODS: This study was conducted using a non-equivalent control group, pretest-posttest design. The subjects were 60 middle-aged women (control group, n=30; intervention group, n=30) who experienced an episode of urinary incontinence at least once a week. The program was run over a 4 week period (once a week) and composed of urinary incontinence education, pelvic floor muscle exercise, and bladder training. RESULTS: Overall, there was a significant difference in urinary incontinence symptoms and psycho-social wellbeing related to urinary incontinence between the treatment and control group. Of the variables, weekly leakage frequencies, leakage amounts on each occasion, leakage index, frequencies of nocturia, and quality of life were significantly different between the groups. Follow-up assessment (9th week) indicated that overall incontinence symptoms and psycho-social well-being were significantly different between the posttest and follow-up assessments. Most variables of incontinence symptoms and psycho-social well-being were significantly improved at follow-up assessment versus posttest. CONCLUSIONS: The program was overall effective in terms of relieving symptoms and improving psycho-social well-being related to urinary incontinence, and this effect continued after a 4-weeks self-training period. In the respect that this is a community-based application study, the results can be meaningful and applicable.
Urinary Incontinence/*rehabilitation ; *Pelvic Floor ; Multivariate Analysis ; Middle Aged ; Humans ; Female ; Exercise Therapy/*methods ; Behavior Therapy/*methods ; Adult

Since Dr. Kegel first reported good outcomes for pelvic floor muscle training in women with urinary incontinence this therapy has become used for women with various pelvic floor disorders. The incidence of pelvic floor disorders such as urinary incontinence and pelvic organ prolapse has been steadily increasing. Although surgery or medications are commonly used, behavioral modification and pelvic floor rehabilitation are gaining in popularity both as primary treatment and as alternatives to surgery. The goal of this article is to review the pelvic floor rehabilitation with emphasis on biofeedback and electrical stimulation and examine the evidence of effectiveness and application of pelvic floor rehabilitation.
Biofeedback, Psychology ; Electric Stimulation ; Female ; Humans ; Incidence ; Pelvic Floor Disorders ; Pelvic Floor* ; Pelvic Organ Prolapse ; Rehabilitation* ; Urinary Incontinence

OBJECTIVE: The study aimed to evaluate the contributions of levator ani muscle (LAM) injury, vesical neck movement, urethral length and mobility, and urethral sphincter dysfunction observed on magnetic resonance imaging (MRI) towards stress urinary incontinence (SUI) after vaginal delivery. MATERIALS AND METHODS: Fifty primiparous women after 6 months of delivery (15 with SUI and 35 without) and 35 nulliparous as continent controls underwent MRI at rest and Valsalva maneuver. A published levator ani scoring system was used to characterize morphological changes of LAM. The severity of the injury was divided into three categories as none, minor, and major. A series of common parameters including levator plate angle, iliococcygeal angle, and levator hiatus were used to describe the functional conditions of LAM. Urethral mobility was defined based on the rotation of the urethra between Valsalva and rest status. Vesical neck movement was evaluated by its distance to the pubococcygeal line. Urethral sphincter dysfunction was defined as the widening of the proximal urethra and/or funneling at the urethrovesical junction during Valsalva. RESULTS: Primiparous incontinent (PI) women had additional major levator ani defects (33.3% vs. 17.1%) while less minor defects (0.7% vs. 31.4%) than primiparous continent (PC) women. Vesical neck downward movement in PI women was more obvious than PC women (28.5 mm vs. 24.2 mm, p = 0.006). Urethral mobility was more active in primiparous women than in nulliparous continent controls (57.4 vs. 52.4), whereas no difference was observed on urethral mobility in the primiparous group (p = 0.25). Urethral sphincter dysfunction and funneling were present in 80% of PI women versus 22.9% in PC women (p < 0.001). CONCLUSION: The MRI findings revealed that de novo SUI was associated with major LAM injury, vesical neck downward movement as well as urethral sphincter dysfunction. Vesical neck funneling on sagittal images can be treated as a valuable predictor for SUI. The intervention for the PI should focus on the elevation of vesical neck, rehabilitation of LAM as well as recovery of the urethral sphincter muscle.
Female ; Humans ; Magnetic Resonance Imaging* ; Neck ; Pelvic Floor Disorders ; Pelvic Floor* ; Rehabilitation ; Urethra ; Urinary Incontinence* ; Valsalva Maneuver

PURPOSE: Climacturia is involuntary loss of urine during orgasm. The mechanism of climacturia in men who undergo radical prostatectomy (RP) is not fully understood, while deficiency in bladder neck coaptation during orgasm may be the cause. We evaluated the prevalence and risk factors of climacturia after RP. MATERIALS AND METHODS: We retrospectively reviewed the medical records of prostate cancer patients who underwent RP from 2002 to 2013 and was able to have a vaginal intercourse postoperatively. RP was conducted using open or robot-assisted approach. We analysed the symptoms of climacturia, relationship between climacturia and several clinical factors. Also, we tried to find factors to predict the presence of climacturia. RESULTS: Total of 123 patients were analyzed in this study. The median age of the men was 65 year and postoperative follow-up period for the interview was 37 months. Of the total 123 patients, 29 (23.6%) complained of the climacturia. In climacturia group, robot-assisted RP (p=0.018), nerve-sparing (p=0.046) and penile rehabilitation (p=0.012) were significantly less frequent, and more pad were comsumed (p=0.001) compared to non-climacturia group. On multivariable analysis, post-prostatectomy incontinence (PPI) (OR 6.49, p=0.004) and penile rehabilitation (OR 0.22, p=0.036) were significant factors to predict the presence of climacturia. CONCLUSIONS: Climacturia occurs in more than 20% patients who were potent enough after RP in our study. PPI and penile rehabilitation were positive and negative factor to predict an occurrence of climacturia, respectively. Therefore, in addition to PPI and erectile dysfunction, patients must be informed of this complication before undergoing RP.
Erectile Dysfunction ; Follow-Up Studies ; Humans ; Male ; Medical Records ; Neck ; Orgasm ; Prevalence ; Prostatectomy* ; Prostatic Neoplasms ; Rehabilitation ; Retrospective Studies ; Risk Factors ; Urinary Bladder ; Urinary Incontinence

As the average life expectancy is longer and the prevalence of chronic disease increases in the elderly, the number of people who needs the care and treatment in the sanatorium is also growing. Voiding dysfunction is common disease in elderly people admitted in the sanatorium and it causes various problems such as fall and fracture. Urinary incontinence is the most frequent condition that decreases physical and mental ability and therefore, it is an important risk factor to reduce the quality of life in the elderly. Thus, investigation of the prevalence and actual practise about the care of urinary incontinence is necessary to reduce not only urinary incontinence but also combined problems in the sanatorium. About 48.1 - 65.3% of the elderly experienced urinary incontinence and the most common management for urinary incontinence was pad usage. However, pad usage without considering the each patient's condition induces poor hygiene, skin problem, and pressure ulcer. Therefore, care according to the each patient's type of urinary incontinence and condition is needed.
Aged ; Chronic Disease ; Hospitals, Convalescent* ; Humans ; Hygiene ; Life Expectancy ; Pressure Ulcer ; Prevalence ; Primary Health Care* ; Quality of Life ; Rehabilitation* ; Risk Factors ; Skin ; Urinary Incontinence

BACKGROUND: Comprehensive geriatric assessment is identified as a dynamic process responsive to the changes on health status that occurs over time in the context of extremely increasing trend in the numbers of the elderly people, their office visit, and the medical cost universally. We completed the comprehensive geriatric assessment and applied it to the Korean elderly through the multi-center trials. METHODS: We performed studies variables using questionnaires, with interviewing, physical examination to the number of total 312 elderly people who visited the department of family medicine or physical medicine and rehabilitation of the 11 university hospital or general hospital in Korea from July 1, 1999 through October 31, 1999. We, the geriatrician, met and discussed 3 times to complete the comprehensive geriatric assessment through the consensus panel. RESULTS: We found the sex ratio of 312 subjects was 1 to 2 (104 males and 208 females) and the average age was 73.2 years old. The orders of more frequency of self-reported health status of the respondents were hypertension, arthritis, cataract, gastrointestinal disturbance, diabetes mellitus, urinary/fecal incontinence, depression, cerebrovascular accident, anemia, and heart disease. Nearly 15% of those showed depression, 41.6% of those were in the status of socially isolation. We found 43.1% of those showed hypertension, 3.7% isolated systolic hypertension, and 20.2% orthostatic hypotension. Of those, cognitive impairment were measured in 37.1%, gait disturbance 13.0%, and the risk of malnutrition 39.6%. Geriatrician spent 21.1 minutes per person during the process of comprehensive geriatric assessment. CONCLUSION: We realized we could diagnose and intervene effectively certain hidden conditions/diseases, particularly urinary incontinence, falls, visual impairment, hearing impairment, pain, depression, social isolation, cognitive impairment, and orthostatic hypotension, with using the comprehensive geriatric assessment. These results reflected the fact that the comprehensive geriatric assessment might be necessary for the care of the elderly.
Aged* ; Anemia ; Arthritis ; Cataract ; Consensus ; Surveys and Questionnaires ; Depression ; Diabetes Mellitus ; Gait ; Geriatric Assessment* ; Hearing Loss ; Heart Diseases ; Hospitals, General ; Humans ; Hypertension ; Hypotension, Orthostatic ; Korea ; Male ; Malnutrition ; Office Visits ; Physical and Rehabilitation Medicine ; Physical Examination ; Sex Ratio ; Social Isolation ; Stroke ; Urinary Incontinence ; Vision Disorders

PURPOSE: The elderly with UI experienced urine leakage for a long time. The prevalence of UI has increased and it makes costly. Particularly, the elderly were reluctant to visit a hospital or a clinic for the reasons of modesty and poverty. To solve this problem, incontinence intervention programs should be provided at the elderly welfare center. The purpose of this research was to develop Incontinence Intervention Program for the Elderly Women (IIPE) and evaluate in its effect. METHODS: The study design was quasi-experimental with pre and post-test. The study was performed for ten weeks at one elderly welfare center, Seoul, Korea. The subjects were gathered through an official announcement and informed consent was obtained. IIPE, in this study, was consisted of diagnosis, education, exercise and evaluation. The study variables were PFM exercise adherence, pelvic muscle strength, Continence selfefficacy, geriatric depression and incontinence stress. The effects of the IIPE on PFM exercise adherence, pelvic muscle strength, Continence self-efficacy, geriatric depression and incontinence stress were also evaluated. RESULTS: The mean age of the subjects was 75.2 years. The average attendance was 6.2 times. The IIPE improved PFM exercise adherence, intra-vaginal contraction power and CSE significantly. But it was not significant in incontinence stress and geriatric depression. Other important results were that the two-finger test and urine stream interruption were more useful for elderly women with rigid vaginas in teaching and evaluating. CONCLUSION: The Findings suggest that IIPE is effective to the community-residing elderly. Further investigation is needed on a long-term basis with control group.
Aged ; Exercise Therapy/*organization & administration ; Female ; Geriatric Assessment ; Geriatric Nursing/*organization & administration ; Humans ; Korea/epidemiology ; Nursing Assessment ; Nursing Evaluation Research ; *Nursing Homes ; Parity ; Patient Acceptance of Health Care ; Patient Education as Topic/*organization & administration ; Pelvic Floor ; Prevalence ; Program Development ; Program Evaluation ; Questionnaires ; Risk Factors ; Self Efficacy ; Treatment Outcome ; Urinary Incontinence/diagnosis/epidemiology/psychology/*rehabilitation ; Urodynamics