Search

Reference ECOS-ARTICLE-2006-049View record in Web of Science Record created on 2006-10-23, modified on 2016-08-08

Objective: The aim of the study was to study the influence of urinary disorders as urinary incontinence on the prevalence of hip fracture in 85-year-old women. Methods: A representative community-based population study was performed at the geriatric outpatient department of a university hospital in a sample consisting of 658 85-year-old women, of which 69% were living at home and 31% were living in institutions. The prevalence of hip fractures was registered and measurement with dual photon absorptiometry of the right calcaneum was performed. The subjects were questioned covering sociodemographic background, the occurrence, type, frequency and amount of urinary incontinence, medical examinations and investigations of the prevalence of hip fracture. Results: Hip fracture was significantly associated with urinary incontinence (P < 0.001) for women and the odds ratio of hip fracture was twice that found in general population (OR = 2.42). Body mass index and weight were both significant higher (P < 0.01) among women with urinary incontinence and hip fracture. The frequency of urinary incontinence was also significant correlated to hip fracture (P < 0.001). Subjects with diabetes had a tendency to be associated with urinary incontinence (P < 0.06) In a logistic multiple regression analysis, body mass index, urinary incontinence and cancers were the only explanatory factors for hip fractures at 85 years of age. Conclusion: The association between postmenopausal urinary incontinence and hip fracture are multifactorial and whether this is a result of decreasing estrogen levels or a result of general aging process is still under debate. Women with urinary incontinence and earlier atrumatic multiple postmenopausal fractures should be considered a special target group for estrogen prophylaxis in order to prevent further severe fractures.

The aim of this study was to identify which types of absorbent pads were being used by the inhabitants of two nursing home wards and to determine to what extent the pads were adapted to the patient's leakage volume. An objective assessment of urinary leakage was performed in all the men (age 80.2 ± 8.0 years) and women (age 84.8 ± 6.5 years), from the two wards, who used incontinent aids ( n =41). Subjects were assessed by weighing all incontinence aids on a precision weight scale before and after use during a period of 7 days. The number of patients experiencing wetting of external clothing or bedding was recorded. During the assessment period 1146 pads were used and the mean urinary leakage per patient during the day was 260 ± 212 ml and during the night 413 ± 230 ml. Wetting of external clothing or bedding occured during the day time in 16% and in 40% at night time despite the use of pads. Only 22% of the pads were adapted to the patients degree of urinary incontinence. Many of the nursing home inhabitants were using larger pads than necessary. If the pads had been adapted to the patient's urinary leakage volume, costs for incontinence aids would have been reduced by 31%.

The influence of age, parity, duration of previous oral contraceptive use, hysterectomy and menopause on the prevalence of urinary incontinence was evaluated by means of a postal questionnaire in women 46 to 86 years old who resided in the city of Göteborg, Sweden. A sample of 10,000 women from the 7 birth cohorts of 1900 to 1940 was obtained at random from the population register. The overall response rate was 74.6%. The prevalence of urinary incontinence increased (p0.001) in a linear fashion from 12.1% in the 1940 birth cohort to 24.6% in the 1900 birth cohort. The prevalence of urinary incontinence in nulliparous women was 7.7% in the 1930 birth cohort and 5.5% in the 1940 birth cohort. The corresponding figures for women who had experienced 1 delivery were 11.1% and 10.6%, compared to 14.0% and 16.4% among women who had had 3 or more deliveries. Urinary incontinence was more prevalent in women who had undergone hysterectomy (p0.05). The prevalence of urinary incontinence was unaffected by the duration of previous oral contraceptive use and there was no evidence to suggest that the prevalence of urinary incontinence increased at the time of the last menstrual period.

The prevalence of fractures in women aged 45-86 years resident in the city of Gothenburg, Sweden, was investigated by means of a postal questionnaire. A sample of 10,000 women from seven birth cohorts (1900-1940) was obtained at random from the population register. The response rate was 70.1% in the 1900-1920 and 81.0% in the 1930 and 1940 birth cohorts. When the prevalence of fractures sustained between 25 and 46 years of age was analyzed a higher figure emerged for women from the 1930 and 1940 birth cohorts than for those from the 1900-1920 cohorts, indicating an increasing incidence of fractures over time. There was a significant independent correlation between early menopausal age and a high rate of fractures. Menopausal age decreased with increasing tobacco consumption. There was also a significant independent correlation between tobacco-smoking and a high fracture rate. The prevalence of tobacco-smoking increased from 30.0 to 38.1% between the 1930 and 1940 birth cohorts, which may further increase the fracture risk in future years. Despite increasing vitality and longevity among the elderly in Gothenburg, there are indications that the number of fractures will increase in the future.

We have analyzed the impact of stroke with subsequent hemiparesis and sensory loss on in vivo mediated immune functions. The delayed-type hypersensitivity (DTH) reaction to purified protein derivate (PPD, tuberculin) was used as a measure of antigen-specific T-cell reactivity, and subcutaneous immunization with influenza vaccine was employed to evaluate T-cell-dependent B-cell function. Thirty-two of the 50 stroke patients tested displayed positive DTH reaction to PPD. All but two showed equal or stronger DTH reaction on the paretic arm compared to the contralateral side (p less than 0.0001). This stroke-induced enhancement of DTH reactivity was evident in patients with combined motor and sensory deficit as well as in subjects with hemiparesis alone. In contrast, immunization of stroke patients with influenza vaccine, a T-cell-dependent B-cell antigen, raised equal antigen-specific serum IgG, IgA and IgM antibody responses irrespective of side (paretic or not paretic). We conclude that stroke enhances antigen-specific T-cell reactivity on the affected side of the body, and that motor but not sensory deficit seems to be required for this enhancement. Antigen-specific B-cell reactivity was not significantly influenced by the hemiparesis.

The ability of 37 urinary incontinent 85-year old men and women to perform the 48-h pad test in their home environment was studied. Assessment of the magnitude of urinary incontinence by the 48-h pad test was compared with a subjective assessment, performed by the men and women themselves. Twenty-eight of the 37 men and women successfully performed the 48-h pad test. Early signs of dementia and defective vision were the main reasons for not completing the test successfully. The six women who considered their urinary incontinence to be slight had a maximum leakage per pad of 5.3 +/- 1.4 g. The corresponding figure for women with moderate incontinence was 48.8 +/- 12.3 g. None of the women considered their incontinence to be severe, even though eight of the women had a leakage per pad of greater than 30 g. Six men considered their incontinence to be moderate (25.0 +/- 8.1 g) and one man considered his incontinence to be severe (31 g/pad). Fourteen of the 28 men and women underestimated the magnitude of their urinary incontinence.

The assessment and treatment of urinary incontinence and related urogenital symptoms using an algorithm model was evaluated in 364 elderly women complaining of urinary incontinence. The women (age 72.1 +/- 1.5 years, range 65-84 years) were assessed by a 48-hour pad test, a cough provocation test, micturition lists and a gynecological examination which included a smear test, measurement of vaginal pH and bacterial cultures. The diagnosis of urinary incontinence was confirmed in 346 women (stress 26.3%; urge: 32.7%; mixed: 41.0%). Women suffering from stress incontinence were younger (p less than 0.05) and had experienced a larger number of deliveries (p less than 0.05) than women with urge incontinence. All the women were treated with oral estriol, 3 mg daily for 4 weeks followed by 1-2 mg daily. The total urinary leakage per 48 hours (p less than 0.01) and maximum single leakage (p less than 0.05) were reduced in women with mixed incontinence, while the frequency of micturition decreased (p less than 0.05) in women with urge incontinence after 12 weeks treatment with oral estriol. There were no significant changes in any of the objective micturition parameters in women with stress incontinence following treatment. Karyopyknotic index and the presence of lactobacilli were increased (p less than 0.001), and vaginal pH decreased (p less than 0.001) following treatment in women with all types of incontinence. More than 70% of all the women treated in this algorithm model judged themselves to be improved, much improved or cured.

The effect of oral oestriol (3 mg/day for 4 weeks followed by 2 mg/day for a further 6 weeks) on the vaginal bacterial flora, vaginal cytology and urogenital symptoms was assessed in a double-blind, placebo-controlled study in 35 women with symptoms of the urogenital oestrogen deficiency syndrome. No significant differences were observed with regard to the occurrence or severity of urogenital symptoms, vaginal pH, karyopyknotic index (KPI) or the baseline results of vaginal bacterial cultures in the 18 patients (mean age 71.6 +/- 1.0 years) treated with oestriol and the 17 women (mean age 72.6 +/- 1.4 years) who received placebo tablets. A decrease in both vaginal pH (P less than 0.001) and the proportion of faecal-type bacteria (P less than 0.05), and an increase in the KPI (P less than 0.01) and the proportion of lactobacilli (P less than 0.001) were recorded after 10 weeks of treatment with oral oestriol. At the end of the following 10 medication-free weeks all of these parameters except vaginal pH had returned to values that were not significantly altered from the corresponding baseline levels. In the patients treated with placebo no significant changes occurred in vaginal pH, KPI or the proportion of lactobacilli in vaginal cultures during the course of this study. Urogenital symptoms improved in both groups after medication (and even after the medication-free period) in relation to the baseline assessment, which reflects the latter's subjective nature.

The prevalence of urinary incontinence (UI) and related urogenital symptoms (UGS) was investigated in a random sample (n = 4206) of women from the 1900-20 birth cohorts residing in the city of Göteborg. It was reported by 16.9% of the respondents that they currently had UI and by 22.7% that they had regularly suffered from this complaint at some time in their lives. The prevalence of UI increased (P less than 0.001) with rising age, from 13.9% in the 1920 birth cohort to 24.6% in the 1900 birth cohort. Over 50% of the sufferers reported daily incontinence. An objective assessment was performed in a subsample (n = 300) of the women complaining of UI. In 14 cases (4.6%) the diagnosis could not be confirmed, while in the remainder UI was classified by type as follows: stress incontinence 24%, urge incontinence 49% and mixed incontinence 27%. The number of urinary tract infections (UTI) reported by the respondents increased (P less than 0.001) with rising age. UGS such as pruritus, burning, pain and vaginal discharge were reported by 11% of the respondents. The reported frequency of local vaginal discomfort did not increase with age, unlike that of UI and UTI. Systemic or local oestrogen treatment was being received by 9.2% of the respondents.

The prevalence of urinary incontinence and the use of incontinence aids was investigated in 85-year-old men and women resident in the city of Göteborg. The overall prevalence of urinary incontinence was 37.2%. Urinary incontinence was more prevalent (p less than 0.001) in women (43.2%) than men (24.0%), and in residents of a nursing home or hospital (83.9%) than in men and women living at home (29.4%). Urinary incontinence was more commonly encountered in men with neurological (p less than 0.001) and respiratory (p less than 0.05) illnesses, and in women suffering from cardiovascular (p less than 0.05), neurological (p less than 0.001) and urogenital (p less than 0.01) illnesses. Incontinence aids were used more often (p less than 0.001) by incontinent women (67.9%) then men (42.9%) living in the community, and were used by 86.4% of the incontinent men and 91.5% of the incontinent women living in an institution. Pads were the commonest form of incontinence aid used, irrespective of whether the men and women lived in the community or in an institution. Indwelling urinary catheters were used by only 2% of the 85-year-old men and women.

Patients with acute hemispheric stroke and ensuring urinary incontinence were randomly allocated to a ward using conventional methods of rehabilitation (n = 13) or to a ward practicing rehabilitation governed by Functional Independence Measure (FIM) (n = 21). All patients were assessed on admission and on discharge using the Katz activities of daily living (ADL) index, the psychological general well-being index, item G of the FIM index (FIM-G), and a mobility score. Patients admitted to the ward utilizing FIM were additionally evaluated using the total FIM on admission, repeatedly during the rehabilitation period and on discharge. An individual rehabilitation programme based on the latest FIM score was used throughout rehabilitation. There were no differences on admission between groups regarding clinical and demographic characteristics, ADL, mobility and mood. Twenty patients in the intervention group regained continence before discharge compared to 3 (p < 0.01) in the control group. There was also a greater improvement in well-being in the intervention group compared to the control group (p < 0.01). This study has indicated that rehabilitation governed by the use of FIM reduced urinary incontinence and enhanced well-being better than conventional methods of rehabilitation. The results warrant a larger study to further investigate rehabilitation of incontinent stroke patients using FIM.

The association between urinary disorders, such as ongoing urinary incontinence (UI), history of urinary incontinence (HIST-UI) and urinary tract infections (UTI), and fractures in peri- and postmenopausal women was assessed in an epidemiological study.The sample consisted of 10000 women from seven birth cohorts, born between 1900 and 1940, who were investigated regarding urinary disorders, fractures and reproductive history by means of a postal questionnaire.The overall response rate was 74.6%. The respondents (n = 7459) represented 53% of the total population from the respective birth cohorts. There was a significant independent correlation between UI, HIST-UI and UTI, respectively, and fractures after the age of 30. In subjects with HIST-UI, tobacco smokers compared to non-smokers had significant more fractures in both the 1930 and 1940 birth cohorts (P0.01). Logistic multiple regression in the 1930 and 1940 cohorts demonstrated that age (P0.001), HIST-UI (P0.001) and tobacco smoking (P0.05), respectively, had an independent explanatory value for fractures.The prevalence of fractures increased with increasing age, in smokers compared to non-smokers and in women with a history of UI.

The influence of dementia on the prevalence of urinary and faecal incontinence was investigated in a random sample ( n =485) of the total population of 85-year-olds from the city of Gothenburg, Sweden. The subjects were assessed by a psychiatric interview, physical examinations, computed tomography of the head and analysis of cerebrospinal fluid. Urinary and faecal incontinence were assessed by a urotherapist. Dementia, urinary and faecal incontinence were defined according to strict, internationally accepted criteria. The prevalences of urinary and faecal incontinence, and dementia were 38%, 17% and 29% respectively. Demented men (50%) and women (60%) were more often urinary incontinent than non-demented men (18%) and women (36%). Faecal incontinence was more prevalent in demented (34.8%) than non-demented subjects (6.7%). Both urinary and faecal incontinence were more prevalent in women (43% and 20% respectively) than men (27% and 11%, respectively). The prevalences of urinary and faecal incontinence, and dementia were higher in residents of a nursing home or hospital (74%, 51% and 92%, respectively) than in subjects living at home (32%, 9% and 18%, respectively). Of the demented subjects resident in an institution, 78% were incontinent compared with 37% living at home. Incontinence aids were used by 18% of the men and 33% of the women, and their use increased with increasing severity of dementia. Dementia influenced the prevalence of urinary incontinence, and both conditions independently of each other strongly influenced the need for institutional care.

To evaluate factors influencing the vaginal micro-environment in elderly women.Vaginal pH, cytology (Karyopyknotic index, KPI) and bacterial cultures were assessed in 350 women (age 72.2 +/- 1.4 years, range 65-84 years) who were not taking estrogens.Vaginal pH was 6.5 +/- 0.1, KPI was 3.0 +/- 0.9% and bacteria of fecal type dominated. However, in some women the vaginal micro-environment resembled that of fertile women, with a predominance of lactobacilli (n = 68), low pH (n = 41) and an increased maturation index (n = 57). KPI was higher (p0.001) in women weighingor = 85 kg, or with a body massor = 9th decentile or with a diastolic blood pressureor = 100 mmHg and in women (p0.05) with a high menopausal age (or = 53 years). Vaginal pH was lower (p0.001), KPI was higher (p0.01) and there was an increased (p0.05) presence of lactobacilli in smokers compared to non-smokers.The latter finding is somewhat paradoxical as cigarette smoking has previously been shown to negatively influence estrogen metabolism. The influence of cigarette smoking on the vaginal micro-environment may be a direct local effect of nicotine.

The quality of life assessed by the Nottingham Health Profile Questionnaire was compared in a group of women (n = 120) suffering from urinary incontinence (age 75.4 +/- 1.9, range 65-84 years) and an age-matched representative sample of the total population (n = 313). There were no significant differences between the two groups of women in occurrence of other illnesses or social characteristics. Women suffering from urinary incontinence obtained higher scores in the domains of emotional disturbances (p < 0.05) and social isolation (p < 0.001) than women from the control group. When subdividing the incontinent women by type of incontinence it was found that women suffering from urge and mixed incontinence reported emotional disturbances (p < 0.05) more than women from the control group. There was, however, no difference within the domain of emotional disturbances between stress-incontinent women and the control group. Women suffering from urge incontinence reported more disturbance of sleep (p < 0.05) than the control group. Women suffering from all types of urinary incontinence (p < 0.05) were socially more isolated than those from the age-matched group of women from the total population. Urinary incontinence in women has a detrimental effect on their daily lives and causes them to avoid social contacts.

The importance of adapting incontinence aids according to the patients leakage volume and comfort was investigated in 28 urinary incontinent 85-year-old men and women who were living at home. The patients incontinence was quantified by a 48-hour pad test and was graded as slight (max. leakage per pad5 g; total leakage/48 h30 g), moderate (max. leakage per pad 5-15 g; total leakage/48 h 30-70 g) or severe (max. leakage per pad15 g; total leakage/48 h70 g). Four women had slight urinary incontinence, eight were moderately incontinent and nine were severely incontinent. The corresponding figures for the seven men were as follows: slight, one; moderate, one; severe, five. After the primary assessment, incontinence aids were prescribed based on the measured leakage volumes. The correctly selected and adapted incontinence aid brought the patient better comfort and security. The importance of careful information and instructions how to apply the pad is emphasised. There is also a need to see the patient again at intervals as leakage volumes may vary. Thus, smaller packages of pads should be supplied as the choice of pad may need to be modified. The latter is also important from a financial point of view as the expense of otherwise wasted pads would unnecessarily increase costs.

An evaluation of the acceptability of incontinence aids was performed in incontinent 85-year-old men and women (n = 355) resident in the city of Goteborg. Incontinence aids were used more often (P < 0.001) by incontinent women (67.9%) than men (42.9%) living in the community, and were used by 86.4% of the incontinent men and 91.5% of the incontinent women living in an institution. Pads were the commonest form of incontinence aid used, irrespective of whether the men (26.6%) and women (67.9%) lived in the community or in an institution (men, 59.1% and women, 86.2%). Urinary leakage and odour as a result of urinary incontinence limited daily life for many men (22.4% and 30.6%, respectively) and women (14.7% and 27.4%, respectively), and meant that 24% of the men and 18% of the women were dependent on another person. At the primary assessment 38.8% of the men and 26.8% of the women living at home were dissatisfied with their present form of incontinence aid. An individual assessment of the patients' requirements regarding incontinence aids was then performed by a urotherapist. Following intervention there was an increase in the number of men (61.2%, P < 0.01) and women (75.3%, P < 0.05) using incontinence aids. There was also an increase (P < 0.01) in the acceptability of the incontinence aids used as judged by the men (dissatisfied: before, 38.8%; after, 14.3%) and women (dissatisfied: before, 26.8%; after, 6.8%) living at home who were already using some form of incontinence aid at the primary assessment.

The concentration of secretory immunoglobulin A (IgA) in the vaginal fluid of 20 untreated post-menopausal women (aged 75.4 +/- 1.4 years) was compared with the levels in a group of 20 post-menopausal women (aged 73.2 +/- 1.5 years) treated with oral oestriol (E3) (2 mg/day) and a further group of 20 healthy, non-pregnant, fertile women (aged 28.2 +/- 1.8 years). Secretory IgA was determined using a paper disc modification of the single radial immunodiffusion technique. The vaginal concentration of IgA in the untreated women was 41.5 +/- 5.7 mg/l, which was higher than that recorded in those treated with E3 (20.8 +/- 5.7 mg/l, P less than 0.05) and in the fertile women (16.4 +/- 3.7 mg/l, P less than 0.01). Epithelial cells predominated in the wet smear preparations obtained from the women who received E3 and the fertile women, while a predominance of leucocytes was observed in the untreated women. Lactobacilli were found more frequently in the vaginal flora of the women in the E3 group (P less than 0.001) and the fertile women (P less than 0.001) than the untreated group. Faecal-type bacteria were seen more frequently in the vaginal flora of the untreated women than the E3 group (P less than 0.01) or the fertile women (P less than 0.001). The possible implications of the present findings with regard to the individual variation in the intensity of symptoms experienced by women suffering from the oestrogen deficiency syndrome are discussed.

837 geriatric patients were investigated on admission and 6 months later. Relatives and other involved persons were interviewed about background factors of importance for the patient's need of care. Every second male and every third female patient was urinary incontinent and it was evident that this was important for admission to hospital. A close relation was found between urinary incontinence and dementia, but the prevalence of somatic diseases was not greater than among continent patients. Six months after admission patients with urinary incontinence had a higher mortality rate or were living in nursing homes to a greater extent than continent patients. The study suggests that in many geriatric patients urinary incontinence is more closely related to general functional impairment than to specific medical conditions of the uro-genital organs and the central nervous system.

Zopiclone was given for 14 nights to 68 geriatric patients (mean age 81 years) with sleep problems. The patients were randomly allocated to four treatment groups: 3.75 mg, 5.0, 7.5, or 10.0 mg of zopiclone. Sleep quantity and quality, side effects, and influence on psychomotor performance (digit symbol substitution and letter cancellation test) were studied before treatment, during active treatment, and after withdrawal of the drug. All patients slept better on zopiclone compared to placebo. There were only slight differences between the different dose levels as regards quantity and quality. No influence on psychomotor performance could be shown. The side effects were mild. Zopiclone showed a good hypnotic efficacy, and 7.5 mg is probably the best dose for elderly patients.

A random sample of 6,000 women from the birth cohorts 1900-1920 were invited to participate in an investigation of urinary incontinence by completing and returning an enclosed questionnaire. Of the 4,206 women who returned the completed questionnaire, 677 (16.9%) complained of urinary incontinence and accepted an invitation to be examined and treated at our clinic. The first 150 consecutive patients recruited via this questionnaire who attended the clinic underwent a detailed neurological examination. The prevalence of neurological signs amongst this group of women was low, only 2% were considered to have a focal encephalopathy, 1% had an organic brain syndrome, 2% had a myelopathy and a further 1% were considered to have a polyneuropathy. There was no significant difference in the prevalence of neurological signs between the group of women with urinary incontinence and an age-matched control group from the total population. Thus, urinary incontinence in an unselected population of elderly women appears to be mainly dependent on other aetiological factors rather than neurological dysfunction.

Histopathological examination of the urinary bladders of 63 patients dying in a geriatric clinic was performed. In 40 of 51 patients who had been treated with a urinary catheter, histological changes of polypoid cystitis were found. In 34 of the bladders the lesion engaged the posterior wall which corresponds to the localization of the tip of the catheter. The frequency of polypoid cystitis increased with increasing time of catheter treatment and reached its peak by three months. After that time the frequency was relatively constant. The frequency of polypoid cystitis seemed not to be influenced by bacterial urinary tract infection. Urothelial atypia was not seen after the catheter treatment.

Urinary incontinence and related urogenital symptoms can be considered to constitute a concealed yet widespread disease amongst elderly women. The problems are to a large extent related to hormonal changes associated with the ageing process. The syptoms have been reported to occur in more than 50% of elderly women. Like severe angina pectoris, osteoarthrosis of the hip and cataract, urinary incontinence and related symptoms may negatively influence the quality of life and reduce the individual's degree of independency. A health care programme, based on an algorithmic model, for the investigation and treatment of urinary incontinence and related symptoms is described. A representative sample of elderly women aged 65–85 yr suffering from urogenital symptoms are currently participating in this programme. The aim is to cure or alleviate urogenital symptoms amongst the elderly women concerned and to assess the value of the programme from a cost-benefit point of view.

The ability of 34 elderly women (79±6 years, range 71–95 years) with urinary incontinence to perform the 48-h perineal pad test in their home environment was investigated. The mean involuntary urinary loss during the 48-h observation period was 80±88 g (range (2–411 g). Thirty patients successfully compared the two perineal pad systems commercially available in Sweden (LIC and Molnlycke). Twelve women considered the systems to be equivalent. Thirteen women preferred the Molnlycke system while five women preferred the LIC system. There was a good correlation between the patients own weighing of the pads and control weighings at the clinic, performed on a precision weight scale ( LIC : n = 15, r = 0.99; M o lnlycke : n = 15, r = 0.99 ). The 48-h perineal pad test performed in the patients home environment should have a given place in the investigation of urinary incontinence amongst elderly women.

Indwelling catheters are almost invariably associated with characteristic mucosal lesions of the urinary bladder, commonly referred to as polypoid cystitis. In the present study, 20 male patients with indwelling catheters (due to benign prostatic hyperplasia) for 1-12 months were studied. Three non-catheter bearing male patients served as controls. Biopsies were taken from the posterior urethra in all patients and from the bladder in 16 of the 20 patients with indwelling catheters. All patients with catheters had endoscopic lesions in the urethra. The lesions varied from polypoid to bullous or oedematous, with or without hemorrhagic discoloration. In 11 of 20 patients the urethral lesions were histologically almost identical to polypoid cystitis. In the remaining 9 patients the reaction was less pronounced, and oedema, with or without mucosal hemorrhage, dominated. Due to the similarity between the catheter associated bladder lesions and the urethral lesions we suggest the term polypoid urethritis for the urethral lesions. There was no correlation between type of catheter used or how long it was used and the mucosal lesions. The results suggest mechanical irritation and/or pressure exerted by the catheter on the mucosa is responsible for the development of polypoid urethritis.