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Tertiary individual prevention of occupational skin diseases: a decade's experience with recalcitrant occupational dermatitis
- C. Skudlik,
- B. Wulfhorst,
- G. Gediga,
- M. Bock,
- H. Allmers,
- S. M. John
- … show all 6 hide
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Get AccessAbstract
If employees are threatened to loose their job due to a severe occupational skin disease (OSD), intensive interdisciplinary measures of tertiary individual prevention (TIP) are required. TIP comprises 2–3-weeks in-patient treatment plus intensive health-pedagogic counseling, and consecutive 3-weeks out-patient treatment by the local dermatologists. Each patient (pt) will stay off work for a total of usually 6 weeks to allow full barrier-recovery.
All 1,486 TIP-pts from various high-risk-professions, treated in our institution in the period 1994–2003, were followed up 1 year after the TIP by a standardised questionnaire, which was returned by 1,164 (78%) pts.
Seven hundred and sixty-four (66%) of the responding 1,164 TIP-pts had successfully remained in their (risk-)professions. It could be demonstrated that to remain in the workplace was dependent on the individual motivation to use skin protection (P < 0.001), the provision of skin protection by the employer (P < 0.001), (higher) age of pt (P < 0.001) and the duration of continued out-patient-treatment by the local dermatologist (P < 0.001). However, there were no significant differences concerning the likelihood of successful job-continuation in the various high-risk-professions, e.g. hairdressers, nurses, metal-workers, food handlers, construction-workers.
The obtained data from TIP reveal remarkable pertinent options for interdisciplinary pt-management in severe OSD in all risk-professions.
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- Bauer A, Kelterer D, Stadeler M, Schneider W, Kleesz P, Wollina U, Elsner P (2001) The prevention of occupational hand dermatitis in bakers, confectioners and employees in the catering trades. Preliminary results of a skin prevention program. Contact Dermatitis 44:85–88. http://amedeo.com/lit.php?id=11205409 CrossRef
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- Diepgen TL, Radulescu M, Bock M, Weisshaar E (2005) Rehabilitation after work related skin diseases. Hautarzt 56:637–643. http://amedeo.com/lit.php?id=15924227 CrossRef
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- Frosch PJ, Aberer W, August PJ, Adams R, Agner T, Beck MH, Constandt L, Conde-Salazar L, Hannuksela M, John SM, Le Coz C, Maqueda J, Maibach HI, Muston HL, Nixon RL, Rast H, Rycroft RJG, van Tichelen WI, Wahlberg J (2006) International legal aspects of worker's compensation for occupational contact dermatitis. In: Frosch PJ, Menné T, Lepoittevin JP (eds) Textbook of contact dermatitis, 4th edn. Springer, Berlin, pp 875–892
- Held E, Agner T (2006) The Danish experience: prevention of skin problems in wet work employees. In: Frosch PJ, Menné T, Lepoittevin JP (eds) Textbook of contact dermatitis, 4th edn. Springer, Berlin, pp 864–867
- Hengge UR, Ruzicka T, Schwartz RA, Cork MJ (2006) Adverse effects of topical glucocorticosteroids. J Am Acad Dermatol 54:1–15. http://amedeo.com/lit.php?id=16384751 CrossRef
- John SM, Diepgen TL, Elsner P, Kollner A, Richter G, Rothe A, Schindera I, Stary A, Wehrmann W, Schwanitz HJ (2004) Four years of quality assurance of dermatologic procedures: report from the ABD clearing institution. J Dtsch Dermatol Ges 2:717–721. http://amedeo.com/lit.php?id=16279239 CrossRef
- John SM, Skudlik C (2006a) New forms of management in dermatology. Integrated in-patient-out-patient prevention of severe occupational dermatoses: cornerstones for an effective integrated management in clinics and practices. Gesundheitswesen 68:769–774. http://amedeo.com/lit.php?id=17203451 CrossRef
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- Kolbe L, Kligman AM, Schreiner V, Stoudemayer T (2001) Corticosteroid-induced atrophy and barrier impairment measured by non-invasive methods in human skin. Skin Res Technol 7:73–77. http://amedeo.com/lit.php?id=11393207 CrossRef
- Loffler H, Bruckner T, Diepgen T, Effendy I (2006) Primary prevention in health care employees: a prospective intervention study with a 3-year training period. Contact Dermatitis 54:202–209. http://amedeo.com/lit.php?id=16650095 CrossRef
- Nienhaus A, Rojahn K, Skudlik C, Wulfhorst B, Dulon M, Brandenburg S (2004) Secondary individual prevention and rehabilitation in female hairdressers suffering from skin diseases. Gesundheitswesen 66:759–764. http://amedeo.com/lit.php?id=15562347 CrossRef
- Schurer NY, Klippel U, Schwanitz HJ (2005) Secondary individual prevention of hand dermatitis in geriatric nurses. Int Arch Occup Environ Health 78:149–157. Epub 2005 Feb 25. http://amedeo.com/lit.php?id=15731919 CrossRef
- Schwanitz HJ, Riehl U, Schlesinger T, Bock M, Skudlik C, Wulfhorst B (2003) Skin care management: educational aspects. Int Arch Occup Environ Health 76:374–381. Epub 2003 Apr 29. http://amedeo.com/lit.php?id=12719982 CrossRef
- Skudlik C, Schwanitz HJ (2004) Tertiary prevention of occupational skin diseases. J Dtsch Dermatol Ges 2:424–433. http://amedeo.com/lit.php?id=16281599 CrossRef
- Weisshaar E, Radulescu M, Bock M, Albrecht U, Diepgen TL (2006) Educational and dermatological aspects of secondary individual prevention in healthcare workers. Contact Dermatitis 54:254–260. http://amedeo.com/lit.php?id=16689809 CrossRef
- Wigger-Alberti W, Maraffio B, Wernli M, Elsner P (1997) Training workers at risk for occupational contact dermatitis in the application of protective creams: efficacy of a fluorescence technique. Dermatology 195:129–133. http://amedeo.com/lit.php?id=9310718 CrossRef
- Wulfhorst B, Bock M, Skudlik C, John SM (2006) Worker education and teaching programs: the German experience. In: Frosch P, Menné T, Lepoittevin JP (eds) Textbook of contact dermatitis, 4th edn. Springer, Berlin, pp 855–861
- Title
- Tertiary individual prevention of occupational skin diseases: a decade's experience with recalcitrant occupational dermatitis
- Journal
International Archives of Occupational and Environmental Health
Volume 81, Issue 8 , pp 1059-1064
- Cover Date
- 2008-08-01
- 10.1007/s00420-008-0300-x
- Print ISSN
- 0340-0131
- Online ISSN
- 1432-1246
- Publisher
- Springer-Verlag
- Additional Links
- Topics
- Keywords
- Occupational dermatitis
- Tertiary individual prevention (TIP)
- Health-pedagogics
- Skin protection
- Interdisciplinary patient management
- Industry Sectors
- Authors
- C. Skudlik (1)
- B. Wulfhorst (1)
- G. Gediga (2)
- M. Bock (1)
- H. Allmers (1)
- S. M. John (1)
- Author Affiliations
- 1. Department of Dermatology, Environmental Medicine, Health Theory, Faculty of Human Sciences, University of Osnabrueck, Sedanstrasse 115, 49090, Osnabrueck, Germany
- 2. Department of Psychology, Institute V: Evaluation, University of Muenster, Muenster, Germany


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Treating stress urinary incontinence in female patients with neuropathic bladder: the value of the autologous fascia rectus sling
- Anastasios Athanasopoulos,
- Konstantinos Gyftopoulos,
- Edward J. McGuire
- … show all 3 hide
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Get AccessAbstract
The aim of this study was to evaluate the efficacy of the autologous fascia rectus sling in treating stress urinary incontinence in female patients with neuropathic bladder. Furthermore, correlations between preoperative parameters and outcome were evaluated.
Methods and design
We retrospectively reviewed operative logs from a single surgeon (EM) of 33 female patients with neuropathic bladder treated over a 3-year period for stress urinary incontinence by implantation of an autologous fascia rectus sling. Efficacy was evaluated objectively in terms of the number of pads used per day, while subjective patient satisfaction was also recorded using a global assessment question. Possible correlations between age, obesity, preoperative Valsalva leak point pressure and incontinence severity and outcome were investigated using univariate analysis.
Outcome measures and results
The mean follow-up time was 52 months, while the mean age of the patients was 37 years. Causes of neuropathic bladder were myelomeningocele in 21 (63.63 %) and spinal cord injury in 12 patients (36.36 %). A total of 30 patients were successfully treated and satisfied with the outcome of the operation (90.9 %). Twenty-five patients (75.75 %) were totally dry, while 5 patients (15.15 %) had markedly improved but still required one pad per day. The complication rate was 15.20 %. Univariate analysis failed to show any correlation between the final outcome and the checked parameters.
The free autologous rectus fascia sling is a highly effective technique for the treatment of female stress incontinence in patients with neuropathic bladder, while the morbidity is mild.
- Albo ME, Richter HE, Brubaker L, Urinary Incontinence Treatment Network et al (2007) Burch colposuspension versus fascial sling to reduce urinary stress incontinence. N Engl J Med 356(21):2143–2155 CrossRef
- Hunskaar S et al (1999) Epidemiology and natural history of urinary incontinence. In: Abrams P, Khoury S, Wein AJ (eds) Incontinence, 1st edn. Health Publications Ltd, Plymouth, pp 199–226
- Athanasopoulos A, Gyftopoulos K, McGuire EJ (2011) Efficacy and preoperative prognostic factors of the autologous fascia rectus sling for the treatment of female stress urinary incontinence. Urology 78(5):1034–1039 CrossRef
- Stoffel JT, Smith G, Crivellaro S, Smith JJ 3rd, Bresette JF (2009) Self-reported pad use per day reflects patient quality of life after pubovaginal sling surgery. Int Urogynecol J Pelvic Floor Dysfunct 20(11):1321–1325 CrossRef
- Cameron AP, Clemens JQ, Latini JM, McGuire EJ (2009) Combination drug therapy improves compliance of the neurogenic bladder. J Urol 182(3):1062–1067 CrossRef
- Ghoneim GM, Shaaban A (1994) Sub-urethral slings for treatment of stress urinary incontinence. Int Urogynecol J 5:228–232 CrossRef
- McGuire EJ, O'Connell HE (1995) Surgical treatment of intrinsic urethral dysfunction. Slings. Urol Clin North Am 22:657–664
- Chaikin DC, Rosenthal J, Blaivas JG (1998) Pubovaginal fascial sling for all types of stress urinary incontinence: long-term analysis. J Urol 160:1312–1316 CrossRef
- Leach GE, Dmochowski RR, Appell RA, Blaivas JG, Hadley HR, Luber KM, Mostwin JL, O'Donnell PD, Roehrborn CG (1997) Female stress urinary incontinence clinical management guidelines panel summary report on surgical management of female stress urinary incontinence. J Urol 158:875–880 CrossRef
- Simsiman AJ, Powell CR, Stratford RR, Menefee SA (2005) Suburethral sling materials: best outcome with autologous tissue. Am J Obstet Gynecol 193(6):2112–2116 CrossRef
- Hamid R, Khastgir J, Arya M, Patel H, Shah P (2003) Experience of tension-free vaginal tape for the treatment of stress incontinence in females with neuropathic bladders. Spinal Cord 41:118–121 CrossRef
- Bosch JL, Klijn AJ, Schroder FH, Hop WC (2000) The artificial urinary sphincter in 86 patients with intrinsic sphincter deficiency: satisfactory actuarial adequate function rates. Eur Urol 38:156–160 CrossRef
- Austin PF, Westney OL, Leng WW, McGuire EJ, Ritchey ML (2001) Advantages of rectus fascial slings for urinary incontinence in children with neuropathic bladders. J Urol 165(6 Pt 2):2369–2371 (discussion 2371–22372)
- Blaivas JG, Jacobs BZ (1991) Pubovaginal fascial sling for the treatment of complicated stress urinary incontinence. J Urol 145:1214–1218
- Abdul-Rahman A, Attar KH, Hamid R, Shah PJ (2010) Long-term outcome of tension-free vaginal tape for treating stress incontinence in women with neuropathic bladders. BJU Int 106(6):827–830 CrossRef
- Title
- Treating stress urinary incontinence in female patients with neuropathic bladder: the value of the autologous fascia rectus sling
- Journal
International Urology and Nephrology
Volume 44, Issue 5 , pp 1363-1367
- Cover Date
- 2012-10-01
- 10.1007/s11255-012-0247-4
- Print ISSN
- 0301-1623
- Online ISSN
- 1573-2584
- Publisher
- Springer Netherlands
- Additional Links
- Topics
- Keywords
- Neuropathic bladder
- Stress incontinence
- Autologous fascia sling
- Prognostic factors
- Industry Sectors
- Authors
- Anastasios Athanasopoulos (1) (2)
- Konstantinos Gyftopoulos (3)
- Edward J. McGuire (1)
- Author Affiliations
- 1. Department of Urology, Medical School, University of Michigan, Ann Arbor, MI, USA
- 2. Urodynamic Urology Unit, Medical School, University of Patras, 38 Papadiamantopoulou Street, 26225, Patras, Greece
- 3. Department of Anatomy, Medical School, University of Patras, Patras, Greece


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