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The pre- and postsurgical nursing of women with stress incontinence
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
1996 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 23, no 3, 502-511 p.Article in journal (Refereed) Published
Abstract [en]

The aim of the present study was to evaluate subjective and objective methods used for the investigation of stress urinary incontinence (SUI) and to compare the outcome of two different surgical techniques regarding cure rate, postoperative nursing, bladder drainage and postoperative pain relief. The study included 45 women with SUI, randomized either to retropubic urethrocystopexy (n = 30) or pubococcygeal repair (n = 15). The assessment included medical history, gynaecological examination, urine analysis and culture, residual urine, pad test, frequency-continence charts, water urethrocystoscopy, continence test, and cystometry with micturition analysis. Moreover, Beck's Depression Inventory and the Eysenck Personality Inventory were used before surgery. One year after surgery no significant difference in subjective cure rate was found between the two surgical methods (73% vs. 80%, respectively). According to pad tests, 67% of the women in the urethrocystopexy group and 47% in the pubococcygeal repair group had ceased to leak urine. The bladder volume increased significantly in both groups. Sixty-three per cent of the women in the urethrocystopexy and 33% in the pubococcygeal repair group experienced severe to very severe postoperative pain. In these groups, significantly more dysphoric women were found as compared with the group of women with less postoperative pain. Furthermore, the women with more severe pain scored higher on the neuroticism scale. These findings indicate the importance of personality factors in the treatment and nursing of women with SUI.

Place, publisher, year, edition, pages
Wiley-Blackwell, 1996. Vol. 23, no 3, 502-511 p.
Keyword [en]
Stress Incontinence -- Surgery, Postoperative Care, Medical-Surgical Nursing, Personality Tests, Funding Source, Sweden, Random Assignment, Clinical Research, Wilcoxon Signed Rank Test, Chi Square Test, Beck Depression Inventory, Revised Edition, Prospective Studies, Outcomes Research, Descriptive Statistics, Surgery, Urogenital -- Methods, Postoperative Pain, Urodynamics -- Evaluation, Preoperative Care, Adult, Middle Age, Female, Human
National Category
Urology and Nephrology
Identifiers
URN: urn:nbn:se:umu:diva-98418DOI: 10.1111/j.1365-2648.1996.tb00012.xPubMedID: 8655825OAI: oai:DiVA.org:umu-98418DiVA: diva2:782707
Available from: 2015-01-22 Created: 2015-01-22 Last updated: 2017-12-05Bibliographically approved
In thesis
1. A holistic view of urinary stress incontinence in women
Open this publication in new window or tab >>A holistic view of urinary stress incontinence in women
1995 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The present study group consists of 45 women with genuine stress incontinence who were selected for surgical treatment and randomized either to retropubic urethrocystopexy (n=30) or pubococcygeal repair (n=15). The preoperative assessment included medical history, gynecological examination, urine analysis and culture, residual urine, pad test, frequency-continence charts, water urethrocystoscopy, continence test and cystometry with analysis of micturition. Moreover, five semistructured interviews were performed with the women and two with their partner. The following questionnaires were used measuring a) personality characteristics: Karolinska Scales of Personality (KSP), Eysenck Personality Inventory (EPI), b) depression: Beck Depression Inventory (BDI) and c) social support: Interview Schedule for Social Interaction (ISSI).

The results have shown that there was no difference in the subjective cure rate between the two surgical methods (73% vs. 80 % respectively). The bladder volume had increased in both groups and the intravesical pressure of the bladder filled to maximum had increased in the pubococcygeal repair group. Other urodynamic variables were unchanged by the operation. Pad tests have demonstrated that 67 % of the women in the urethrocystopexy group and 47 % in the pubococcygeal repair group ceased to leak urine. Postoperatively, 63 % of the women in the urethrocystopexy group needed high doses of analgesics compared with only 33 % in the pubococcygeal repair group. Among the women experiencing severe to very severe pain dysphoric subjects were overrepresented. Postoperative residual urine was a minor nursing problem in both groups.

Women with SUI of long duration scored significantly higher than controls on the KSP scales of somatic anxiety, psychic anxiety, psychasthenia, suspicion and on the EPI lie-scale. There was no significant difference in sexual activity before and after surgery. One or two sexual dysfunctions within the desire, excitement, orgasmic and resolution phase were reported by the majority of women both before and after surgical intervention.

The cured women reported a higher level of overall activities before surgery than the improved (i.e. not cured) women, whereas post surgery both the cured and the improved women obtained about the same level of activities. Regarding social support, no differences between the cured or improved women occured as concerns attachment. The cured women showed a higher degree of adequacy of social integration compared with the improved women.

In order to delineate predictive factors for the surgical outcome the following variables were investigated: age of patient, duration of urine leakage, parity, personality, psychological and social factors. The following predictors of the outcome of surgical treatment emerged: duration of stress incontinence, neuroticism and age of patient.

The results of the present study indicate the ecessity of a multidisciplinary approach to the treatment and nursing of women with SUI.

Place, publisher, year, edition, pages
Umeå: Umeå University, 1995. 41 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 443
Keyword
Stress urinary incontinence, surgical treatment, urodynamics, pad test, nursing, personality characteristics, leisure time, spouse relationship, sexuality, social network, predictors, outcome
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:umu:diva-96892 (URN)91-7191-086-7 (ISBN)
Public defence
1995-09-22, Rosa salen, 9 tr, Tandläkarhögskolan i Umeå, Umeå universitet, Umeå, 09:00
Projects
digitalisering@umu
Note

Diss. (sammanfattning) Umeå : Umeå universitet, 1995

Available from: 2015-01-20 Created: 2014-12-05 Last updated: 2015-04-08Bibliographically approved

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