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Urinary tract disorders
Published in Henry J. Woodford, Essential Geriatrics, 2022
Bladder training is a technique where individuals are taught to control their bladder activity and then gradually increase the time interval between micturitions. Depending on the initial frequency, intervals are commenced at 30 to 60-minute gaps and then extended by 30 minutes each week. The aim is to be able to have three-hour gaps between toilet visits without the emergence of UI. A study compared a six-week bladder training programme to a control group in community-dwelling women (n = 123; mean age 68) who had either stress or urge UI without marked cognitive impairment (Mini Mental State Examination [MMSE] score > 23).101 The treatment group had a significant reduction in the number of incontinent episodes per week compared to the controls (mean 21 pre-treatment falling to nine post-treatment [57% reduction], v 22 falling to 19 episodes [14% reduction], respectively). The benefits appeared to be maintained at a six-month follow-up assessment. Guidance recommends offering bladder training for predominant urge symptoms for a minimum of six weeks.87
Meeting personal needs: elimination
Published in Nicola Neale, Joanne Sale, Developing Practical Nursing Skills, 2022
Based on limited evidence, bladder training may be helpful for the treatment of urinary incontinence (Wallace et al. 2009). Bladder training aims to increase the interval between voids so that continence might be regained and is widely used for the treatment of urinary incontinence (Wallace et al. 2009). For example, the person might initially be asked to go to the toilet every hour. This is then gradually extended by half an hour at a time. NICE (2019) recommends that, for women with overactive bladders, with or without urge incontinence, bladder training for a minimum of 6 weeks should be offered. Education of individuals and carers, use of a continence chart and continuous encouragement are all important elements. Carers need to praise to build up confidence and reinforce behaviour and they should be patient and understanding.
SBA Answers
Published in Justin C. Konje, Complete Revision Guide for MRCOG Part 2, 2019
A Bladder trainingNICE recommends that bladder training should be offered for a minimum of 6 weeks as the first-line treatment to women with urgency or mixed urinary incontinence. Although the symptoms here are non-specific, the fact that an overactive bladder is suspected points to symptoms of urgency or mixed urinary incontinence. If the woman fails to achieve satisfactory benefit from bladder training programmes, the combination of OAB drugs with bladder training should be considered if frequency is a troublesome symptom. (Urinary Incontinence: The Management of Urinary Incontinence in Women. NICE Guideline No. 171, September 2013)
Feasibility of early postoperative bladder catheter removal without prior bladder-training exercises after laparoscopic nerve sparing radical hysterectomy
Published in Journal of Obstetrics and Gynaecology, 2019
Khaled Gaballa, Adel Denewer, Ashraf Khater, Valerio Gallotta, Carmine Conte, Alex Federico, Hossam Elfeki, Giovanni Scambia
Several authors had adopted the need for postoperative bladder-training exercises before removal of the urinary catheter (Raspagliesi et al. 2004; Tseng et al. 2012) in order to accelerate the recovery of the bladder function and decrease the period of postoperative bladder catheterisation. The necessity of postoperative bladder-training exercises was recently questioned. Fanfani et al.’s (2015) prospective randomised trial reported equal postoperative bladder catheterisation duration in two groups of patients with and without postoperative bladder training following LNSRH and open NSRH. Gong et al. (2017) evaluated the need for postoperative bladder-training exercises before bladder catheter removal by a prospective randomised controlled study and reported no significant differences between the group of patients who underwent intermittent bladder catheter clamping and the group who did not, as regards the period of postoperative bladder catheterisation (13.2 vs. 13.3) days (p = .167) and the need of re-catheterisation (p = .915). However, this study was also conducted upon patients who underwent type-C RH irrespective of whether the operation was nerve-sparing (C1) or not (C2) and whether it was done by laparoscopy or open technique.
Cardiovascular effects of antimuscarinic agents and beta3-adrenergic receptor agonist for the treatment of overactive bladder
Published in Expert Opinion on Drug Safety, 2018
Gian Marco Rosa, Danilo Baccino, Alberto Valbusa, Carolina Scala, Fabio Barra, Claudio Brunelli, Simone Ferrero
Various measures may be used to generally improve this condition and to prevent worsening. These may include bladder training, pelvic floor muscle exercises, and lifestyle modifications [4]. Pharmacological therapy is second-line treatment. Antimuscarinics (AMs) are still the main drugs used. However, they have a conspicuously low compliance rate, as they often cause adverse effects (AEs) such as dry mouth, constipation, and blurred vision [5,6]. Mirabegron, the only β3-adrenoceptor agonist approved for clinical use, has an efficacy comparable to that of AMs, but has a better safety profile, often similar to that of placebo [7]. In fact, as OAB often involves elderly people, who may have various cardiovascular (CV) comorbidities [8], a good safety profile is necessary. Anyway, both muscarinic and β-adrenergic receptors are present in both the CV and urinary systems [9]. Consequently, drugs that interact with these receptors have to necessarily exert CV effects. The issue of the CV safety of these drugs has therefore aroused great interest. The aim of this systematic review is to analyze the CV AEs of drugs administered for the treatment of OAB.
Primary care diagnostic and treatment pathways in Dutch women with urinary incontinence
Published in Scandinavian Journal of Primary Health Care, 2022
Miranda C. Schreuder, Nadine A. M. van Merode, Antal P. Oldenhof, Feikje Groenhof, Marlous F. Kortekaas, Hedy Maagdenberg, Johannes C. van der Wouden, Henk van der Worp, Marco H. Blanker
Bladder training is the mainstay of treatment for UUI according to Dutch GP guidelines [4]. Despite the plethora of evidence on their benefits [26], GPs rarely prescribed anticholinergic drugs. They should be considered if bladder training is ineffective. In line with a report by the Dutch Institute of Responsible Medication Use [27], we found that solifenacin and tolterodine were the preferred drugs. However, this conflicts with the Dutch GP guideline that recommends tolterodine with extended-release or transdermal oxybutynin, based on lower costs and comparable safety and effectiveness, as side effects are common [4]. The guidelines also recommend that treatment should be evaluated after 4 to 6 weeks [1,4].