Introduction: The prevalence of urinary incontinence increases with age. Especially in nursing homes people often do not only suffer from incontinence, in addition they present comorbidities, i.e. dementia or loss of mobility. In this study we assessed the severity of urinary incontinence and comorbidities of nursing home residents. Methods: We included 81 residents of nursing homes who underwent recordings of medical history, physical examination and ultrasound diagnostic of the urinary tract. Grading of urinary incontinence was assessed by the amount of pads used daily. Severity of immobility, dementia and malnutrition was assessed. Further examinations were urinalysis by dip stick and microbiological testing, geriatric depression scale, and QLQ-C30. Results: We found incontinence at different degrees present at 67/81 (83%) of nursing home residents. We could show, that more severe incontinence correlated with worse nutritional status (r = 0.53, p < 0.0001), increase in demential symptoms (r = 0.37, p = 0.0012) and worse mobility r = 0.71, p < 0.0001). There was no correlation for the severity of urinary incontinence with the prevalence of diabetes, intake of diuretics or the presence of urinary tract infections. Conclusions: Worsening of nutritional status, cognitive function and mobility not only correlate with the prevalence but also with the severity of urinary incontinence.

PurposeTo analyze perioperative complications and postoperative explantation rates for selected readjustable male sling systems and the perineal single-cuff artificial urinary sphincter (AUS) in a large, contemporary, multi-institutional patient cohort. MethodsTwo hundred eighty-two male patients who underwent implantation between 2010 and 2012 in 13 participating institutions were included in the study (n=127 adjustable male sling [n=95 Argus classic, n=32 Argus T], n=155 AUS). Perioperative characteristics and postoperative complications were analyzed. The explantation rates of the respective devices were assessed using the Fisher exact test and the Mann-Whitney U-test. A Kaplan-Meier curve was generated. Potential features associated with device explantation were analyzed using a multiple logistic regression model (P<0.05). ResultsWe found significantly increased intraoperative complication rates after adjustable male sling implantation (15.9% [adjustable male sling] vs. 4.2% [AUS], P=0.003). The most frequent intraoperative complication was bladder perforation (n=17). Postoperative infection rates did not vary significantly between the respective devices (P=0.378). Device explantation rates were significantly higher after AUS implantation (9.7% [adjustable male sling] vs. 21.5% [AUS], P=0.030). In multivariate analysis, postoperative infection was a strong independent predictor of decreased device survival (odds ratio, 6.556; P=0.001). ConclusionsComplication profiles vary between adjustable male slings and AUS. Explantation rates are lower after adjustable male sling implantation. Any kind of postoperative infections are independent predictors of decreased device survival. There is no significant effect of the experience of the implanting institution on device survival.

Introduction: We analysed the impact of predefined risk factors: age, diabetes, history of pelvic irradiation, prior surgery for stress urinary incontinence (SUI), prior urethral stricture, additional procedure during SUI surgery, duration of incontinence, ASA-classification and cause for incontinence on failure and complications in male SUI surgery. Materials and Methods: We retrospectively identified 506 patients with an artificial urinary sphincter (AUS) and 513 patients with a male sling (MS) in a multicenter cohort study. Complication rates were correlated to the risk factors in univariate analysis. Subsequently, a multivariate logistic regression adjusted to the risk factors was performed. A p value <0.05 was considered statistically significant. Results: A history of pelvic irradiation was an independent risk factor for explantation in AUS (p < 0.001) and MS (p = 0.018). Moreover, prior urethral stricture (p = 0.036) and higher ASA-classification (p = 0.039) were positively correlated with explantation in univariate analysis for AUS. Urethral erosion was correlated with prior urethral stricture (p < 0.001) and a history of pelvic irradiation (p < 0.001) in AUS. Furthermore, infection was correlated with additional procedures during SUI surgery in univariate analysis (p = 0.037) in MS. Conclusions: We first identified the correlation of higher ASA-classification and explantation in AUS. Nevertheless, only a few novel risk factors had a significant influence on the failure of MS or AUS.

Previous work has focused on positive feelings of mattering, which pertain to the human need to feel significant. In the current article, we examine a complementary yet distinct construct involving feelings of not mattering that may arise from being marginalized and experiences that heighten a sense of being insignificant to others. We also describe the development, validation, and research applications of the Anti-Mattering Scale. The Anti-Mattering Scale (AMS) is a five-item inventory assessing feelings of not mattering to other people. Psychometric analyses of data from samples of emerging adults and adolescents confirmed that the AMS comprises one factor with high internal consistency and adequate validity. Our findings suggest that individuals who feel like they do not matter to others have a highly negative self-view, insecure attachment, and perceived deficits in meeting key psychological needs. Analyses established that links between elevated AMS scores and levels of depression, social anxiety, and loneliness. Most notably, scores on this new measure predicted unique variance in key outcomes beyond the variance attributable to other predictors. Overall, these results attest to the research utility and clinical potential of the AMS as an instrument examining the tendency of certain people to experience a profound sense of not mattering to others in ways that represent a unique source of risk, social disconnection, and personal vulnerability.

No abstract