Prognostic factors for long-term maintenance of urinary continence in patients with incontinence managed by diapers or indwelling catheters.

Abstract

We examined the prognostic factors for longterm maintenance of continence following nonsurgical treatments in hospitalized patients with urinary incontinence. 313 inpatients (average age: 64 years) in whom urinary incontinence had originally been managed with diapers (n = 158) or indwelling Foley catheters (n = 155) first received nonsurgical rehabilitative treatments. The patients who became continent with these treatments were then evaluated for being either continuously continent or recurrently incontinent during the 5-year follow-up period after discharge from hospital. A multivariate logistic regression analysis was then performed to determine significant risk factors for recurrent urinary incontinence. By initial treatments (mean duration: 144 days), 294 of the 313 patients (94%) were continent and free from diapers or catheters. After the 5-year follow-up period, urinary continence was maintained in 103 (66%) and 62 patients (45%) initially managed with diapers (n = 157) and catheters (n = 137), respectively. Multivariate logistic analysis revealed that in both patient groups, poor posttherapeutic activities of daily living or loss of home care service lowered the maintenance rate of continence. Dementia also lowered the maintenance rate in patients with catheters, but not in those with diapers. In addition, a long history of Foley catheter drainage for over 1 year prior to the initial treatment reduced the maintenance rate (highest odds ratio). Physical disability and poor therapeutic assistance at home are more prominent risk factors for long-term maintenance of urinary continence in elderly patients than problems within the urinary tract.