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Objectives: This study explored reasons why older adults with urinary incontinence (UI) do not initiate discussions with or seek treatment for UI from their primary care provider., Design: A randomized, prospective controlled trial involving 41 primary care sites., Setting: Primary care practice sites., Participants: 49 older adults age 60 and older not previously screened for UI by their primary care doctor., Measurements: Demographic data, self-reported bladder-control information using questionnaires, and health status., Results: Adults who did not discuss UI were older, had less-frequent leaking accidents and fewer nighttime voids and were less bothered by UI than those who did. The two main reasons why patients did not seek help were the perceptions that UI was not a big problem (45%) and was a normal part of aging (19%)., Conclusions: Embarrassment or lack of awareness of treatment options were not significant barriers to discussing UI. Adults with a fairly high frequency of UI (average of 1.7 episodes per day) did not view UI as abnormal or a serious medical condition.

Objectives: To examine the relationship of urinary incontinence (UI) and depressive symptoms (DS) in older adults., Design: A randomized, controlled trial to determine the effects of clinical practice guideline implementation on provider attitudes and behavior, and patients' UI, health status, quality of life, and satisfaction with care. Baseline and endpoint data were collected from patients via computer-assisted telephone interviewing., Setting: Forty-one nonacademic primary care practices (PCP) in North Carolina., Participants: A total of 668 community-dwelling adults (age > 60) who had visited the one of the selected PCPs., Intervention: PCPs in the intervention group were given instruction in the detection and management of UI, educational materials for providers and patients, office system supports, and academic detailing., Measurements: The dependent measure was assessed using an eight-item screener for DS. UI (status, frequency, amount), health (physical, mental), and demographic (age, gender, marital status) and self-report information about bladder control served as predictors., Results: Wilcoxon rank sum tests showed that UI status was associated with moderate to severe DS (43% vs 30%, P = .05). Multivariate analyses showed that UI status, physical and mental health, and gender were significant predictors of DS. Among UI adults (n = 230), physical and mental health, life satisfaction, and the perception that UI interfered with daily life were significant predictors of DS., Conclusions: This study provides clear evidence that UI is related to DS in older adults.

Twenty-nine patients with symptomatic segmental renal disorders were studied by regional renography. Twenty-three patients had duplex kidneys and 6 had other segmental disease. Abnormal gamma camera findings included ureteroureteric reflux, vesicoureteric reflux, impaired function, obstruction and non-obstructive dilatation. Comparison between renography and radiology in duplex kidneys showed agreement in 10 cases. In 7 kidneys the gamma camera provided additional information and in 6 cases the X-rays alone were abnormal. It is concluded that regional renography should be performed wherever possible to complement conventional radiology in the functional and urodynamic evaluation of segmental renal disease.

Posterior iliac osteotomy is a recognised method employed to facilitate and support anterior abdominal wall closure in patients with bladder exstrophy, but it adds considerably to the already lengthy procedure of bladder exstrophy surgery. Anterior pelvic osteotomy of the superior ramus of the pubic bone was developed to overcome this problem and to achieve a stable anterior pelvic ring with tension-free soft tissue closure. It can easily be performed after completing the bladder closure, without the need to turn the patient.

Twenty-seven children undergoing surgery for suspected pelviureteric junction obstruction were studied by pre-operative diuresis renography. The results obtained by this test were compared with histological and histochemical studies of the resected specimens of renal pelvis. A significant correlation was found between these methods of assessment. In addition, the morphological appearances of the renal pelvis tended to show more marked changes in the younger children.