Continence Current Awareness Bulletin - August 2021 - DOCUMENT TITLE ...

Continence
Current Awareness Bulletin
August 2021
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Title: Evaluating bowel movements, self-initiations, and problem behavior with the
emergence of urinary continence.

Citation: Journal of Applied Behavior Analysis; Jun 2021; vol. 54 (no. 3); p. 1111-1125
Author(s): Perez ; Morris, Samuel L.; Bacotti, Janelle K.; Vollmer, Timothy R.

Abstract: Much of the research evaluating toilet training interventions for children with ASD has
focused on urinations as the primary dependent variable. As a result, the effects that toilet training
interventions targeting urinations may have on other related dependent variables remains unclear.
We conducted a retrospective analysis of data obtained by Perez et al. (2020), who evaluated the
effects of a treatment package on urinary continence in children with ASD. We examined the
relation between the emergence of urinary continence and multiple nontargeted dependent
variables: bowel movements, self-initiation correspondence, percentage of appropriate urinations
that were self-initiated, self-initiation rate, and problem behavior. Results showed that
improvements in urinary continence were strongly correlated with improvements in all nontargeted
dependent variables. Implications for future research and clinical practice are discussed.

Title: Treatment for overactive bladder: A meta-analysis of transcutaneous tibial nerve
stimulation versus percutaneous tibial nerve stimulation.

Citation: Medicine; May 2021; vol. 100 (no. 20); p. 1-7
Author(s): Department of Urology, Chengdu Second People’s Hospital.; Liu-Ni Zhao; Ming-Xing
Qiu; Yang, Ding-Yuan; Zhao, Liu-Ni; Qiu, Ming-Xing

Abstract: Background: We aim to compare the safety and effectiveness of transcutaneous tibial
nerve stimulation (TTNS) versus percutaneous tibial nerve stimulation (PTNS) in treating
overactive bladder.
Methods: A systematical search on PubMed, Embase, clinicalTrial.gov, and Cochrane Library
Central Register of Controlled Trials from January 1, 1999 to November 1, 2020 was performed.
The primary outcomes were the changes in a 3-day voiding diary. Quality of life scores were also
evaluated. Review Manager 5.3 (Cochrane Collaboration, Oxford, UK) was applied to conduct all
statistical analyses.
Results: A total of 4 trials (2 randomized controlled trials, 1 retrospective study, and 1 before-after
study) with 142 patients were eventually enrolled. Compared with PTNS, TTNS had a similar
performance in the voiding frequency in 24 hours (mean difference [MD] = -0.65, 95% confidence
interval [CI]: -1.35 to 0.05, P = .07), the number of urgency episodes in 24 hours (MD = 0.13, 95% CI:
-0.36 to 0.62, P = .60), the number of incontinence episodes in 24 hours (MD = 0.01, 95% CI: -0.13
to 0.14, P = .93), as well as in the nocturia frequency (MD = -0.14, 95% CI: -0.52 to 0.24, P = .47).
Moreover, comparable results were observed regarding HRQL scores (P = .23) and incontinence
quality of life scores (P = .10) in both groups. The total complication rate in the current study was
2.1% (3/142). No adverse events were identified in the TTNS group.
Conclusion: Current data supported that TTNS is as effective as PTNS for the treatment of
overactive bladder, moreover, with no reported adverse events. However, the evidence is low-
grade and well-designed prospective studies with a large sample size are warranted to verify our
findings.

Title: Mind-body (hypnotherapy) treatment of women with urgency urinary incontinence:
changes in brain attentional networks.

Author(s): Ketai ; Komesu, Yuko M.; Schrader, Ronald M.; Rogers, Rebecca G.; Sapien, Robert
E.; Dodd, Andrew B.; Mayer, Andrew R.
Citation: American Journal of Obstetrics & Gynecology; May 2021; vol. 224 (no. 5); p. 498.e1

Objective: Prior study of patients with urgency urinary incontinence by functional magnetic
resonance imaging showed altered function in areas of the brain associated with interoception and
salience and with attention. Our randomized controlled trial of hypnotherapy for urgency urinary
incontinence demonstrated marked improvement in urgency urinary incontinence symptoms at 2
months. A subsample of these women with urgency urinary incontinence underwent functional
magnetic resonance imaging before and after treatment. This study aimed to determine if
hypnotherapy treatment of urgency urinary incontinence compared with pharmacotherapy was
associated with altered brain activation or resting connectivity on functional magnetic resonance
imaging.
Study Design: A subsample of women participating in a randomized controlled trial comparing
hypnotherapy vs pharmacotherapy for treatment of urgency urinary incontinence was evaluated
with functional magnetic resonance imaging. Scans were obtained pretreatment and 8 to 12 weeks
after treatment initiation. Brain activation during bladder filling and resting functional connectivity
with an empty and partially filled bladder were assessed. Brain regions of interest were derived
from those previously showing differences between healthy controls and participants with
untreated urgency urinary incontinence in our prior work and included regions in the interoceptive
and salience, ventral attentional, and dorsal attentional networks.
Results: After treatment, participants in both groups demonstrated marked improvement in
incontinence episodes (P

condition on Youtube. This study aims to assess the videos on Youtube about urinary incontinence
and evaluate the information regarding whether patients can understand and/or act accordingly.
Methods: We performed a Youtube search with the keywords of "incontinence," "urinary
incontinence," and "overactive bladder" in the English language with the incognito mode on the
browser. All links were extracted and recorded in an excel file. Duplicated links were removed, and
metadata of the videos were collected. A custom python language script was used to perform this
operation. We selected the most viewed 150 videos for the assessment. After removing the non-
related videos, 112 of them were included in the study. Two researchers separately evaluated all
the videos with the Patients Education Material Assessment Tool (PEMAT, audiovisual version).
Results: The total duration of all included (n:112) videos was 12.6 hours, and these videos had
been watched 37,332,178 times until the query date. The vast majority of the videos were about
information, management, and treatment options (Kegel exercises, surgery modalities) of
incontinence, individual experiences of patients with incontinence, commercials about the diapers,
and healthcare professionals who wanted to introduce themselves or their services. Mean
understandability and actionability scores of the videos were 57.9% and, 44.7% respectively. Our
analysis showed that only 12.5% of the videos on Youtube related to incontinence were
understandable, as well as actionable, in terms of PEMAT scores.
Conclusion: According to our study, 87.5% of the videos about incontinence on Youtube.com in
the English language were not understandable and actionable for users. Development of high-
quality content about incontinence is needed.

Title: Women's barriers for contacting their general practitioner when bothered by urinary
incontinence: a population-based cross-sectional study.

Citation: BMC urology; Jul 2021; vol. 21 (no. 1); p. 99
Author(s): Jarbøl, Dorte Ejg; Haastrup, Peter Fentz; Rasmussen, Sanne; Søndergaard, Jens;
Balasubramaniam, Kirubakaran

Objective: Urinary incontinence (UI) is a frequently occurring condition among women and
increases with age. Effective treatments exist but many women hesitate to contact their general
practitioner (GP) regarding UI. Therefore, it is important to generate knowledge regarding barriers
for healthcare-seeking. Several factors such as age, duration and number of symptoms are
associated with healthcare-seeking. How socioeconomic status (SES) is associated with
experiencing barriers for healthcare-seeking for UI has not been explored. The objectives of this
study were to: (1) analyze frequencies of barriers for healthcare-seeking, and (2) investigate
associations between SES and barriers for contacting the GP, among women reporting
bothersome UI.
Method: A cross-sectional web-based questionnaire study of symptoms occurrence among 51,090
randomly selected women. This study investigates reported symptoms of three types of UI (stress
UI, urge UI and UI without stress or urge) and reported barriers for GP contact combined with
register data on SES.
Results: A total of 4,051 (16.4%) women reported to be bothered by either stress UI (9.1%), urge
UI (4.0%) or incontinence without stress or urge (2.4%) and 76.3%, 70%, and 64% respectively,
had not contacted their GP regarding the symptom(s). The most frequently reported barriers were
'being too embarrassed' (19.3%) and 'being too busy' (18.4%) for stress incontinence, and 'being
too embarrassed (19.0%) or 'worried about wasting the doctor's time' (16.9%) for women with
bothersome urge UI or UI without stress or urge. Younger women had higher odds of reporting
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barriers and the barriers embarrassment and being worried about what the doctor might find were
significantly associated with lower educational level.
Conclusion: Women with lower educational level have an increased risk of not seeking healthcare
for UI symptoms. The GP should be aware of identifying women bothered by UI for whom effective
treatment options to alleviate the symptoms are available.

Title: Injection of Aluminum Potassium Sulfate and Tannic Acid in the Treatment of Fecal
Incontinence: A Single-Center Observational Study.

Citation: Annals of coloproctology; Jul 2021
Author(s): Abe, Tatsuya; Kunimoto, Masao; Hachiro, Yoshikazu; Ohara, Kei; Inagaki, Mitsuhiro

Objective: Perianal injection of bulking agents is an attractive treatment option for patients with
mild to moderate fecal incontinence (FI). Various bulking agents have been used for injection
therapy, but the optimal injection materials and methods are yet to be standardized. This study
aimed to evaluate the effects of injection therapy using aluminum potassium sulfate and tannic
acid (ALTA) in the management of FI.
Methods: This study included consecutive patients who underwent ALTA injection therapy for FI at
our institution. The procedure was performed with the patient in the jackknife position, under
caudal epidural anesthesia. The procedure consisted of a 4-step injection to the 3 main cushions
and a multipoint injection to the remaining submucosa of the anal canal.
Results: Seventy-seven patients (mean age, 76 years) were enrolled in the study. The mean
Cleveland Clinic incontinence score of 11.9 ± 4.1 at baseline significantly improved to 7.3 ± 5.2 at
3 months following treatment. The mean maximal resting pressure also increased significantly 3
months after the intervention. Postoperative complications were observed in 3 patients (3.9%), and
all events were mild. The mean duration of postoperative follow-up was 17.5 months. The
cumulative recurrence-free rate at 3 years was 72.4%.
Conclusion: ALTA injection for FI is safe, easy to perform, and provides reasonable mid-term
outcomes. Moreover, concomitant anorectal diseases that may be contraindicated by other
injectable bulking agents could be treated simultaneously. Therefore, ALTA injection is a promising
alternative in the absence of other injectable agents.

Title: Physical multimorbidity and incident urinary incontinence among community-dwelling
adults aged ≥50 years: findings from a prospective analysis of the Irish Longitudinal Study
on Ageing.

Citation: Age and ageing; Jul 2021
Author(s): Smith, Lee; Shin, Jae Il; Ghayda, Ramy Abou; Hijaz, Adonis; Sheyn, David; Pope,
Rachel; Hong, Sun Hwi; Kim, Sung Eun; Ilie, Petre Cristian; Carrie, Anne Marie; Ippoliti, Simona;
Soysal, Pinar; Barnett, Yvonne; Pizzol, Damiano; Koyanagi, Ai

Objective: There are no prospective studies on the association between multimorbidity and
urinary incontinence (UI), while mediators in this association are unknown. Thus, we aimed to (i)
investigate the longitudinal association between multimorbidity and UI in a large sample of Irish

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adults aged ≥50 years and (ii) investigate to what extent physical activity, polypharmacy, cognitive
function, sleep problems, handgrip strength and disability mediate the association.
Methods: Data on 5,946 adults aged ≥50 years old from the Irish Longitudinal Study on Aging
were analysed. The baseline survey was conducted between 2009 and 2011 and follow-up after 2
years was conducted. Information on self-reported occurrence of UI in the past 12 months and
lifetime diagnosis of 14 chronic conditions were obtained. Multivariable logistic regression and
mediation analysis were conducted.
Results: After adjustment for potential confounders, compared to having no chronic conditions at
baseline, having three (odds ratio [OR] = 1.79; 95% confidence interval [CI] = 1.30-2.48) and four or
more (OR = 1.86; 95% CI = 1.32-2.60), chronic conditions were significantly associated with
incident UI. Mediation analysis showed that polypharmacy, sleep problems and disability explained
22.7, 17.8 and 14.7% of the association between multimorbidity (i.e. two or more chronic
conditions) and incident UI, respectively.
Conclusion: A greater number of chronic conditions at baseline were associated with a higher risk
for incident UI at 2-year follow-up among adults aged ≥50 years in Ireland. Considering the effects
of different medications on UI and improving sleep quality and disability among people aged
≥50 years with multimorbidity may reduce the incidence of UI.

Title: Do patients discharged from the physiotherapy-led pelvic health clinic re-present to
the urogynaecology service?

Citation: International urogynecology journal; Jul 2021
Author(s): Nucifora, Jennifer; Howard, Zara; Weir, Kelly A

Objective: The physiotherapy-led pelvic health clinic (PLPHC) is an advanced practice clinic that
manages women from the urogynaecology waitlist with pelvic organ prolapse (POP) and/or urinary
incontinence (UI) at Gold Coast Health, Australia. This study was aimed at determining re-referral
rates and reasons for re-presentation of women previously managed and discharged from the
PLPHC. We hypothesised that there would be low representation rates for the same condition
within 12 months of discharge.
Methods: A retrospective audit was undertaken of all (n = 209) patients discharged between 1
January and 31 December 2017. Re-presentation rates and reasons for re-referral for women seen
in the PLPHC and discharged without requiring urogynaecology medical specialist review were
analysed and descriptive analysis performed.
Result: Of the 209 patients, 67 were referred to, or had, urogynaecology medical specialist review
after their initial physiotherapy care and were removed from further analysis. Of the remaining 142
patients, who were initially managed by physiotherapy only, 10 (7.1%) women were re-referred to
specialist medical outpatient gynaecology and urology out-patient departments, for management of
a different diagnosis, and 10 (7.1%) for their original diagnoses, within 12 months of discharge. Of
the latter, 1 patient required further physiotherapy and urogynaecologist management; 7 patients
required ongoing pessary management; 1 patient continued with urologist medical management;
and 1 failed to attend.
Conclusion: This study presents novel data on low re-presentation rates in the 12 months
following discharge for patients with POP or UI managed in a PLPHC; and provides further support
for advanced scope of practice physiotherapy gynaecological service models.

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Title: The Effects of Pelvic Floor Muscle Training and Behavioral Training on Sexual
Dysfunction, Incontinence, Physical Activity Level and Quality of Life in the Elderly.

Citation: Sexuality & Disability; Sep 2021; vol. 39 (no. 3); p. 555-568
Author(s): Buyuk ; Cetin, Sebahat Yaprak; Sakinci, Mehmet

Abstract: Alterations in hormonal balance, especially with ageing, cause many pelvic floor
problems such as urinary incontinence, lack of interest in or desire for sex and inactivity. The aim
of this study was to explore the effects of pelvic floor muscle exercise and behavioral training
programs on sexual function, incontinence, quality of life and physical activity level in the elderly. A
total of 94 elderly subjects were separated into two groups as the pelvic floor muscle training
(PFMT) group and the behavioral training for pelvic floor dysfunctions (BT) group. A (1-h program
was applied twice a week for 8 weeks). Evaluations pre and post-training were made using the
Female Sexual Function Inventory, the International Index of Erectile Function, International
Consultation on Incontinence Questionnaire-Short Form, SEAPI quality of life scale, and Physical
Activity Scale for the Elderly. In the post-treatment comparisons, the PFMT group was superior to
the BT group in all parameters (z: − 4.21–0.00, p:0.00–0.02). The results of this study suggest that
pelvic floor muscle training could be beneficial if added to rehabilitation programs for the elderly to
obtain less sexual dysfunction and, incontinence, and better incontinence-related quality of life and
physical activity levels.

Title: The Effect of Electrical Stimulation Therapy With Pelvic Floor Muscle Exercise on
Stress Urinary Incontinence in Middle-Aged Women: A Nonequivalent Comparison Cohort
Study.

Citation: Journal of Wound, Ostomy & Continence Nursing; Jul 2021; vol. 48 (no. 4); p. 325-331
Author(s): Lim ; Kang, Jung A.; Park, Hyojung

Objective: The purpose of this study was to evaluate the effects of combined pelvic floor muscle
exercises (PFMEs) and a novel electrical stimulation (ES) device versus PFMEs alone on lower
urinary tract symptoms, urinary incontinence–related quality of life, and pelvic floor muscle
contractions (PFMCs).
Design: Nonrandomized comparison cohort study.
Subjects and setting: The sample comprised 54 community-dwelling middle-aged women with
stress urinary incontinence recruited from churches and cultural centers in Gyeonggi Province,
South Korea. Comparisons of demographic and pertinent clinical characteristics revealed no
significant differences between the experimental and comparison groups.
Methods: Participants allocated to the combined intervention group (n = 27) performed self-
exercises of the pelvic floor muscles 3 times a day under weekly telephone coaching, and they
used the ES device twice daily for 8 weeks. Participants in the comparison group (n = 27) received
the PFMEs alone without telephone coaching. The 3 main outcomes including lower urinary tract
symptoms, urinary incontinence–related quality of life, and PFMCs were measured using the
Bristol Female Lower Urinary Tract Symptom instrument (BFLUTS), King's Health Questionnaire
(KHQ), and a perineometer, respectively. Study outcomes were measured at baseline and at the
end of the 8-week period. RESULTS: Participants in the experimental group achieved significantly
greater reductions in lower urinary tract symptoms (t = −4.07, P

incontinence–related quality of life (P =.006), peak PFMC pressure (P =.004), mean pelvic muscle
contraction (PMC) pressure (P

Title: Efficacy of prompted voiding for reversing urinary incontinence in older adults
hospitalized in a functional recovery unit: Study protocol.

Citation: Journal of advanced nursing; Aug 2021; vol. 77 (no. 8); p. 3542-3552
Author(s): Martín-Losada, Laura; Parro-Moreno, Ana Isabel; Serrano-Gallardo, María Pilar;
González-Blázquez, Cristina; Sánchez-García, Marta; González-Álvaro, Nuria; Huerta-Ruiz, María;
De Souza-Lucio, Jorge; Fernández-Guijarro, Pilar; Carrillo-Alcalá, María Elena; Solís-Muñoz,
Montserrat

Objective: To assess the efficacy of a prompted voiding programme for restoring urinary
continence at discharge in hospitalized older adults who presented with reversible urinary
incontinence (UI) on admission to a functional recovery unit (FRU). To assess the maintenance of
the outcomes achieved after hospitalization. To identify modifiable and unmodifiable factors
associated with the success of the prompted voiding programme.
Design: Quasi-experimental, pre-/post-intervention study without a control group.
Methods: Participants were aged 65 and over with a history of reversible UI in the previous year
who had been admitted to a FRU and were on a prompted voiding programme throughout their
hospitalization period. The sample consisted of 221 participants. A non-probabilistic sampling
method, in order of recruitment after signing the informed consent form, was used. The primary
outcomes were UI assessed at discharge and 1 month, 3 months and 6 months after discharge.
Funding was granted in July 2019 by the Spain Health Research Fund (PI19/00168, Ministry of
Health). The proposal was approved by the Spanish Research Ethics Committee.
Discussion: The prompted voiding programme described can reverse UI or decrease the
frequency and amount of urine loss in hospitalized older adults.
Impact: Urinary incontinence is highly prevalent in hospitalized older adults. There is a need for
care aimed at prevention, recovery and symptom control. Prompted voiding is a therapy provided
by the nursing team during hospitalization and can also be provided by family caregivers at home
after receiving proper training by the nursing team. Prompted voiding will enhance the health,
functional ability and quality of life of older adults with UI, resulting in the reduction of associated
healthcare costs and the risk of developing complications.

Title: Combination therapy with botulinum toxin and bulking agent-An efficient, sustainable,
and safe method to treat elderly women with mixed urinary incontinence.

Citation: Neurourology and urodynamics; Aug 2021
Author(s): Viereck, Volker; Gamper, Marianne; Walser, Claudia; Fesslmeier, Debra; Münst, Julia;
Zivanovic, Irena

Objective: To evaluate the efficacy, sustainability and safety of combined botulinum toxin and
polyacrylamide hydrogel (PAHG) therapy to treat urgency and stress components of therapy-
refractory mixed urinary incontinence (MUI) in an elderly study population.
Methods: Fifty-five women with therapy-refractory MUI were treated with botulinum toxin and
PAHG in one surgical procedure. Urgency urinary incontinence (UUI) and stress urinary
incontinence (SUI) outcomes were separately assessed after 4 and 12 months by objective UUI
episodes/24 h and cough test, subjective impact of UUI and SUI on quality of life, and subjective

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International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-
UI SF). MUI outcome was calculated by combining UUI and SUI outcomes. Complications were
monitored throughout the study.
Results: At 4 months, objective cure rates were 73%, 53%, and 42%, and subjective cure rates
were 71%, 52%, and 50% for SUI, UUI, and MUI. At 12 months, objective cure rates were 73%,
56%, 50% and subjective cure rates were 78%, 42%, and 40% for SUI, UUI, and MUI. The ICIQ-UI
SF score decreased by 9.0 and 8.7 points after 4 and 12 months. All complications were transient
and included 22% clean intermittent catheterization immediately after surgery, 33% postvoid
residual volumes >100 ml at 14 days, and 13% symptomatic urinary tract infection within the first
postoperative month.
Conclusions: The combination of botulinum toxin and PAHG is effective, sustainable and safe to
treat therapy-refractory MUI, even in an elderly and frail study population. Patients benefit from the
short surgical procedure without the need for general anaesthesia or discontinuation of
anticoagulation.

Title: The Role of Obesity on Urinary and Anal Incontinence in women: a review.

Citation: BJOG : an international journal of obstetrics and gynaecology; Jul 2021
Author(s): Doumouchtsis, Stergios K; Loganathan, Jemina; Pergialiotis, Vasileios

Abstract: Obesity is increasing worldwide with significant healthcare implications. We searched
PubMed/MEDLINE, Embase and Cochrane Library for articles registered until June 2020 to
explore the relationship between obesity, urinary (UI) and anal incontinence (AI). Obesity is
associated with low-grade, systemic inflammation and pro-inflammatory cytokine release,
producing reactive oxygen species and oxidative stress (1). This alters collagen metabolism and,
in combination with increased intraabdominal pressure, contributes to UI development. Whereas in
AI, stool consistency may be a factor. Weight loss can reduce UI and should be a management
focus, however effect on AI is less clear. Keywords: Obesity, Urinary incontinence, Anal
incontinence.

Title: Effectiveness and safety of bulking agents versus surgical methods in women with
stress urinary incontinence: a systematic review and meta-analysis.

Citation: International urogynecology journal; Aug 2021
Author(s): Pivazyan, Laura; Kasyan, George; Grigoryan, Bagrat; Pushkar, Dmitry

Objective: The objective was to evaluate the efficacy and safety of bulking agents compared with
surgical methods for female stress urinary incontinence.
Methods: Inclusion and exclusion criteria: women with stress urinary incontinence. Bulking agents
versus any surgical treatment as a comparison. Patients with other types of incontinence and
treatment were excluded. Electronic databases (PubMed, MEDLINE, and the Cochrane Library)
were searched from 2000 until 2021 to identify articles evaluating the effectiveness and safety of
urethral bulking agents versus surgical methods. Risk-of-bias assessment tools recommended by
the Cochrane Society were used to evaluate the risk of bias in the studies included.

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Results: Six studies were included in the quantitative synthesis for a total of 710 patients. Our
systematic review and meta-analysis showed that bulking agents are less effective than surgical
procedures according to subjective improvement after treatment (RR = 0.70, 95% CI: 0.53 to 0.92,
p = 0.01). There was no statistically significant difference between these two methods with regard
to complications after the intervention (RR = 1.30, 95% CI: 0.30 to 5.66, p = 0.73).
Conclusion: The main limitation of this systematic review and meta-analysis was the absence of a
common objective outcome measure to evaluate effectiveness. However, it shows that bulking
agents are less effective than surgical procedures in subjective improvement. Safety analysis
showed no significant difference between these methods. Hence, we believe that the first and final
surgery is considered to be the best.

Title: A systematic review of utility-based and disease-specific quality of life measurement
instruments for women with urinary incontinence.

Citation: Neurourology and urodynamics; Aug 2021; vol. 40 (no. 6); p. 1275-1303
Author(s): Wuytack, Francesca; Moran, Patrick; Daly, Deirdre; Panda, Sunita; Hannon, Kathleen;
Cusack, Cinny; O'Donovan, Maggie

Objective: This systematic review aims to identify disease-specific and generic quality of life (QoL)
outcome measurement instruments used in populations of women with urinary incontinence (UI)
and to determine the most psychometrically robust and appropriate disease-specific and generic
tools for measuring the quality of life in this population.
Methods: A systematic search was conducted of PubMed, Embase, SCIELO, and CINAHL
databases for studies evaluating measurement properties of QoL instruments in women with UI.
The methodological quality of studies and the quality of measurement properties were evaluated
using the COnsensus-based Standards for the selection of health status Measurement INtruments
(COSMIN) checklist and quality criteria. Overall, evidence for measurement properties was graded
using the modified grading of recommendations, assessment, development & evaluation approach.
Results: A total of 73 studies were included, and 27 specific and 6 generic instruments were
identified. The Incontinence QoL questionnaire (IQoL) had the highest overall psychometric quality
for English-speaking populations and was the most widely translated tool. Evidence for generic
QoL tools in this population is limited. Few studies evaluated measurement error or cross-cultural
validity.
Conclusion: The IQoL is the most psychometrically robust disease-specific tool for use in this
population. More research is needed to determine the most psychometrically robust generic tool.
Future studies should also evaluate measurement error and cross-cultural validity as evidence for
these properties is particularly lacking.

Title: Nurse Perspectives on Urinary Incontinence in the Home Hospice Setting.

Citation: Journal of pain and symptom management; Aug 2021; vol. 62 (no. 2); p. 383-390
Author(s): Stoddard, Michelina D; Russell, David; McDonald, Margaret V; Dignam, Ritchell;
Bowles, Kathryn H; Prigerson, Holly G; Chughtai, Bilal

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Objective: To date, no studies have characterized the impacts of urinary incontinence (UI) at the
end of life in the home hospice (HH) setting. UI is highly prevalent at the end of life and adversely
affects quality of life. This study aims to characterize HH nurses' perspectives on UI in HH patients.
Methods: We conducted a qualitative descriptive study of interviews between HH nurses and the
study investigator. Thirty-two interviews with HH nurses were transcribed and analyzed. Nurses
were mostly female, college-educated, and had several years of experience in HH nursing.
Results: We identified findings in four major themes: 1) HH nurses' definition and identification of
UI, 2) the absence of formal guidelines for diagnosing UI in HH patients, 3) UI's adverse effect on
HH patients and their families, and 4) the lack of standardized guidelines for the management of UI
in the HH setting. We found that there was a general lack of clarity on the subtypes of UI and no
standardized guidelines for management of UI in the HH setting. Nurses reported that UI was
bothersome to HH patients and their caregivers, citing patient discomfort, loss of dignity, and
additional labor burden as reasons for this. Management strategies for UI lacked standardization.
Conclusion: UI is a prevalent and debilitating condition in HH patients. There is a need for studies
to further characterize the impacts of UI on HH patients and their caregivers. Formal training on UI
subtypes and management is needed to facilitate proper documentation, research, and improve
patient outcomes.

Title: A Smart Diaper System Using Bluetooth and Smartphones to Automatically Detect
Urination and Volume of Voiding: Prospective Observational Pilot Study in an Acute Care
Hospital.

Citation: Journal of medical Internet research; Jul 2021; vol. 23 (no. 7); p. e29979
Author(s): Cho, Jae Ho; Choi, Jung-Yeon; Kim, Nak-Hyun; Lim, Yejee; Ohn, Jung Hun; Kim, Eun
Sun; Ryu, Jiwon; Kim, Jangsun; Kim, Yiseob; Kim, Sun-Wook; Kim, Kwang-Il

Objective: Caregivers of patients who wear conventional diapers are required to check for voiding
every hour because prolonged wearing of wet diapers causes health problems including diaper
dermatitis and urinary tract infections. However, frequent checking is labor intensive and disturbs
patients' and caregivers' sleep. Furthermore, assessing patients' urine output with diapers in an
acute care setting is difficult. Recently, a smart diaper system with wetness detection technology
was developed to solve these issues. We aimed to evaluate the applicability of the smart diaper
system for urinary detection, its accuracy in measuring voiding volume, and its effect on
incontinence-associated dermatitis (IAD) occurrence in an acute care hospital.
Methods: This prospective, observational, single-arm pilot study was conducted at a single tertiary
hospital. We recruited 35 participants aged ≥50 years who were wearing diapers due to
incontinence between August and November 2020. When the smart diaper becomes wet, the
smart diaper system notifies the caregiver to change the diaper and measures voiding volume
automatically. Caregivers were instructed to record the weight of wet diapers on frequency volume
charts (FVCs). We determined the voiding detection rate of the smart diaper system and compared
the urine volume as automatically calculated by the smart diaper system with the volume recorded
on FVCs. Agreement between the two measurements was estimated using a Bland-Altman plot.
We also checked for the occurrence or aggravation of IAD and bed sores.
Results: A total of 30 participants completed the protocol and 390 episodes of urination were
recorded. There were 108 records (27.7%) on both the FVCs and the smart diaper system, 258
(66.2%) on the FVCs alone, 18 (4.6%) on the smart diaper system alone, and 6 (1.5%) on the
FVCs with sensing device lost. The detection rate of the smart diaper system was 32.8%
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(126/384). When analyzing records concurrently listed in both the FVCs and the smart diaper
system, linear regression showed a strong correlation between the two measurements (R2=0.88,
P