Urinary incontinence, the involuntary loss of urine from the intact bladder, may be a major factor in determining whether or not an aged patient requires nursing home admission. Between 5% and 25% of aged men and 7% to 42% of aged women who reside in the community are urinary incontinent. Approximately 28% to 50% of nursing home patients (the majority of nursing home patients are women) are incontinent of urine. Management of urinary incontinence is particularly difficult for women since a device similar in function to a male condom catheter is not readily available. Although efforts to make an acceptable external urine incontinence device for women have been attempted for at least 20 years, most have failed to make it to the marketplace or remain in the marketplace. More recently, devices have been developed which use ostomy-type adhesives to secure the device to the peri-urethral floor and thus prevent urine leakage. We have evaluated such a device for 233 patient-days in 19 nursing home patients (21 consecutive days In 8 patients) and have found our patients were completely dry of urine following 90% of applications and that device use was not associated with adverse reactions that precluded continued usage. We now propose to study such a device in aged, urine incontinent women who use indwelling urethral catheters as a method of urinary care. Our hypotheses are that: 1. Prolonged use of the external device for urinary care of incontinent women will not be precluded by complications including: a. urine leakage b. peri-urethral erythema 2. In a randomized cross-over trial comparing external devices to indwelling urethral catheters, prolonged external device use will decrease: a. the weekly prevalence of bacteriuria b. the number of bacterial strains/urine specimen c. the incidence of new episodes of bacteriuria d. the incidence of febrile episodes of possible urinary origin 3. In a randomized trial comparing external devices to indwelling urethral catheters, external device use will decrease the prevalence at death of: a. acute pyelonephritis b. marked mononuclear cell infiltration in the kidneys
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