An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction

Biofeedback-Assisted pelvic floor muscle training combined with a short-duration drug regimen is safe and effective in women with overactive bladder: A randomized controlled trial

OBJECTIVE

We hypothesized that combination therapy would provide a synergistic effect to improve treatment outcomes for overactive bladder (OAB), thus enhancing the motivation for continuous exercise, and that it would be associated with fewer adverse events than monotherapy. Therefore, we investigated whether biofeedback-assisted pelvic floor muscle training (PFMT), drug therapy, or a combination of both would be more effective in improving the symptoms of OAB.

STUDY DESIGN

This randomized controlled trial included women diagnosed with OAB. Group 1 received biofeedback-assisted pelvic muscle floor training (PFMT) for 12 weeks; group 2 took 5 mg of solifenacin/day for 12 weeks; and group 3 received 5 mg of solifenacin/day in combination with biofeedback-assisted PFMT during the first 4 weeks and biofeedback-assisted PFMT for another 8 weeks. All participants had 5 follow-up visits. The primary outcomes were objective improvement of OAB symptoms and quality of life. The secondary outcomes were treatment-related adverse events, subjective improvement of OAB symptoms, and electromyographic activity of pelvic floor muscle (PFM) contraction.

RESULTS

All participants reported significant improvement of OAB symptoms and quality of life. Participants in group 2 experienced more pronounced adverse events than those in group 3. Intervention duration was positively associated with subjective improvement in OAB symptoms in groups 2 and 3. Drug-related adverse events, including dry mouth, myalgia, and restlessness, had a negative impact on the subjective improvement of OAB symptoms in group 2. In group 1, exercise adherence was positively correlated with subjective improvement of OAB symptoms, whereas in group 3, PFM contraction and biofeedback effect were positively correlated with symptom improvement.

CONCLUSION

Combination therapy is efficacious in treating women with OAB.

Psychometric properties and feasibility of three scales assessing the level of knowledge and awareness about pelvic floor health

OBJECTIVE

Despite high prevalence and burden of pelvic floor dysfunctions (PFD), there is a limited number of scales assessing knowledge of pelvic floor health (PFH), and no studies comparing their psychometric or feasibility properties. The study aimed both to investigate the psychometric properties and feasibility of Incontinence Quiz (IQ), Prolapse and Incontinence Knowledge Questionnaire (PIKQ) and Pelvic Floor Health Knowledge Questionnaire (PFHKQ), and to compare level of PFH knowledge in women with and without PFD.

STUDY DESIGN

In this prospective cross-sectional study, a total of 150 women were included. After recording physical-sociodemographic characteristics, obstetric histories and menstrual status, Pelvic Floor Distress Inventory-20 and Female Sexual Function Index were administered to classify them into study groups as women with and without PFD. Their PFH knowledge was assessed using IQ, PIKQ and PFHKQ, which were filled twice with one week interval for the test-retest purpose. The scores, reliability, validity, ceiling-floor effects and feasibility of the knowledge scales were compared with each other, and between the study groups.

RESULTS

IQ, PIKQ, and PFHKQ scores of women with and without PFD were similar. Based on response patterns to items, PFHKQ had the highest internal consistency followed by PIKQ and IQ. The PIKQ was the most stable scale across the total sample and in the PFD group. The PFHKQ had the highest ICC value in women without PFD. There was a strong correlation between the total scores of knowledge scales in both groups. Scores of knowledge and symptom scales were not significantly correlated. IQ was completed in the shortest time, and was easier to complete than PFHKQ. Only the diagnosis/treatment subscale of PFHKQ had a ceiling effect.

CONCLUSION

It was concluded that PFH knowledge of women with and without PFD were at a low-moderate level and similar to each other; IQ, PIKQ and PFHKQ were reliable, valid and feasible scales, which can be used in measuring knowledge level about PFH.

The Effects of Running Foot Strike Manipulation on Pelvic Floor Muscle Activity in Healthy Nulliparous Females

Vertical loading rate (VLR) and pelvic floor muscle activity (PFA) increase with running velocity, which may indicate a relationship between VLR and PFA. Foot strike pattern has been shown to influence VLR while running, but little is known about its influence on PFA. Twenty healthy women ran on a treadmill for 2 conditions: with a rearfoot strike and with a forefoot strike. PFA was measured with electromyography. Running kinematics associated with VLR were collected using inertial measurement units and tibial accelerometers. Change scores between conditions were calculated for average PFA and running kinematics: peak vertical tibial acceleration, vertical excursion of the center of mass (VO), and cadence. Paired t tests assessed differences between running conditions for all variables. Pearson correlations assessed the relationships between changes in PFA and running kinematics. PFA was significantly higher during the forefoot compared with the rearfoot strike condition. Change in vertical tibial acceleration was positively correlated with change in PFA during the right stance. Change in cadence was negatively correlated, and change in vertical excursion of the center of mass was positively correlated with change in PFA during left stance. The average PFA increased during the forefoot strike pattern condition. Changes in PFA were correlated with changes in running kinematics associated with VLR.

Assessment of perineal body properties in women with stress urinary incontinence using Transperineal shear wave elastography

Limited data on the correlation between the perineal body (PB) and stress urinary incontinence (SUI) are available. The objectives of this study were to quantify the PB using shear wave elastography (SWE) technology with a high-frequency linear array probe to evaluate the relationship between the properties of PB and stress urinary incontinence (SUI). This study included 64 women with SUI and 70 female control participants. The length, height, perimeter, and area of PB in all participants were calculated using transperineal ultrasound, and the elasticity of PB was assessed by SWE at rest and during the maximal Valsalva maneuver, respectively. In addition, the comparison of PB parameters between the patients with SUI and the healthy participants was conducted. The transperineal ultrasound and SWE examination was performed in 134 participants, and the elastic modulus values were significantly increased from participants at rest to those during the maximal Valsalva maneuver in all participants (Emax: 35.59 versus 53.13 kPa, P < 0.001; and Emean: 26.97 versus 40.25 kPa, P < 0.001). Emax and Emean of PB exhibited significant differences during the maximal Valsalva maneuver between the SUI group and the control group (47.73 versus 58.06 kPa, P < 0.001; and 35.78 versus 44.33 kPa, P < 0.001) and had a negative correlation with SUI. The BMI and PB height during the maximal Valsalva maneuver in the SUI group were found to be significantly higher than that in healthy volunteers. Emax and Emean of PB negatively correlated with BMI during the maximal Valsalva maneuver (r = -0.277, P = 0.001 and r = -0.211, P = 0.014). ROC curve analysis demonstrated that PB perimeter of less than 12.68mm was strongly associated with SUI during the maximal Valsalva maneuver, and an Emax of less than 55.76 kPa had a 100% specificity in predicting SUI. SWE can quantify the elasticity of PB, identifying a significant difference between participants at rest and during Valsalva maneuver. In addition, the stiffness of the PB was significantly lower in women with SUI than in healthy women, which may provide a noninvasive clinical practice in SUI prediction.

Experiences of women with symptoms of vaginal laxity - a qualitative study

BACKGROUND

Vaginal laxity (VL) is rarely discussed among patients and their physicians possibly due to the lack of evidence-based treatments, embarrassment, and lack of knowledge in recognizing this condition. We aimed to understand the meanings that women attribute to the sensation of VL.

METHODS

This is a qualitative study using in-depth interviews and thematic analysis. Sixteen participants were intentionally selected from February 2020 to December 2021. One researcher interviewed each participant in a private room guaranteeing that rapport was established. Two independent researchers performed a complete transcript of each interview immediately after its end. The sample size was achieved according to the Information Power analysis. We followed the thematic analysis proposed by Braun and Clarke.

RESULTS

Of 16 patients, only one did not undergo delivery. Her complaint was not different from the rest of the group. Five major themes and subthemes were identified: the long and lonely pathway: from the identification of symptoms of VL to diagnosis (from the invisibility of VL to the perception of their symptoms; "everything will fall out!":shame, guilt and stigma as diagnosis barriers and "but I had no idea of looking for a treatment." Women's strategies to begin a help-seeking process), "the label of vaginal laxity is a heavy burden to bear" meanings associated with VL complaints, effect of VL on sexual intercourse and "I know it changed everything!" relationship with the partner.

CONCLUSION

VL is a symptom that is still little understood by women, and little explored by health professionals, with repercussions on personal and marital life.

Reliability of Uroflowmetry Pattern Interpretation in Adult Women

INTRODUCTION

Uroflowmetry is often used to assess lower urinary tract symptoms (LUTS). Criteria for characterization of flow patterns are not well established, and subjective interpretation is the most common approach for flow curve classification. We assessed the reliability of uroflowmetry curve interpretation in adult women.

MATERIALS AND METHODS

Uroflowmetry studies were obtained in 296 women who participated in an observational cohort study. Four investigators with expertise in female LUTS and urodynamics reviewed and categorized each tracing for interrater reliability. A random subset of 50 tracings was re-reviewed by each investigator for intrarater reliability. The uroflowmetry tracings were rated using categories of continuous, continuous fluctuating, interrupted, and prolonged. Other parameters included flow rate, voided volume, time to maximum flow, and voiding time. Agreement between raters is summarized with kappa (k) statistics and percentage where at least three raters agreed.

RESULTS

The mean age of participants was 44.8 ± 18.3 years. Participant age categories were 18-24 years: 20%; 25-34 years: 17%; 35-64 years: 42%; 65+ years: 18%. Nine percent described their race as Asian, 31% Black, 62% White, and 89% were of non-Hispanic ethnicity. The interrater reliability was highest for the continuous flow category (k = 0.65), 0.47 for prolonged, 0.41 for continuous fluctuating, and 0.39 for interrupted flow curves. Agreement among at least three raters occurred in 74.3% of uroflow curves (69% for continuous, 33% for continuous fluctuating, 23% for interrupted, and 25% for prolonged). For intrarater reliability, the mean k was 0.72 with a range of 0.57-0.85.

CONCLUSIONS

Currently accepted uroflowmetry pattern categories have fair to moderate interrater reliability, which is lower for flow curves that do not meet "continuous" criteria. Given the subjective nature of interpreting uroflowmetry data, more consistent and clear parameters may enhance reliability for use in research and as a screening tool for LUTS and voiding dysfunction.

TRIAL REGISTRATION

Parent trial: Validation of Bladder Health Instrument for Evaluation in Women (VIEW); ClinicalTrials.gov ID: NCT04016298.

Evaluating the impact of a new clean intermittent self-catheterisation device: experiences of male patients

Urinary incontinence is common and has many causes. A main one is urinary retention, and clean intermittent self-catheterisation is the gold standard for managing it. There are, however, complications associated with performing this, which affect patient experience, quality of life and compliance with the procedure. The most common complication is urinary tract infection (UTI), which can be debilitating and have serious consequences. On average, patients experience 2.7 UTIs a year. Infection often arises from residual urine left behind, this can be caused by mucosal suction into catheter eyelets giving the impression that the bladder has finished emptying and leading to early withdrawal of the catheter. Mucosal suction by catheter eyelets can also lead to micro-trauma. Hydrophilic catheters have long been used to prevent micro-trauma. A catheter using Micro-hole Zone Technology instead of conventional two eyelets was developed with the aim of reducing UTI risk by addressing risk factors for bladder micro-trauma and incomplete voiding. A recent evaluation of Coloplast's Luja male intermittent catheter found that 97% of nurses would recommend Luja, 96% of nurses felt confident their patients will learn how to completely empty their bladder with Luja, and 88% of nurses were less worried that their patients are at risk of getting UTIs due to incomplete bladder emptying.

Prevalence and risk factors for overactive bladder symptoms in patients with artificial urinary sphincter

To demonstrate the prevalence and risk factors for overactive bladder symptoms associated with artificial urinary sphincter implantation, we investigated the patients who underwent primary artificial urinary sphincter implantation with severe urinary stress incontinence. Forty-eight patients who completely answered the questionnaires of the overactive bladder symptom score before surgery were included. Patient characteristics, urinary status at pre and 1, 3, 6, and 12 months post-device activation, and predictive factors for overactive bladder symptoms were examined. Sixty percent of the patients had preoperative overactive bladder symptoms. Until 12 months after device activation, 35-40% of all patients had overactive bladder symptoms. The rate of persistent and de novo postoperative overactive bladder symptoms was 44.8% and 26.3%, respectively. Daily pad use was not different between patients w/wo overactive bladder symptoms. The only risk factor for postoperative overactive bladder symptoms was a max cystometoric capacity < 200 mL measured by a preoperative urodynamic study. Attention must be given to both persistent and de novo overactive bladder symptoms associated with artificial urinary sphincter implantation for patients with stress incontinence. Counsel should equally be provided for preoperative overactive bladder symptoms, especially in cases with a cystometric capacity < 200 mL.

Body image and pelvic floor dysfunction in pregnancy and postpartum: A prospective one-year follow-up cohort study

OBJECTIVE

To determine the prevalence of pelvic floor dysfunction (PFD) among pregnant women, their clustering and their association with body image disturbance (BID) up to 1 year postpartum.

DESIGN

Monocentric prospective cohort study.

SETTING

University Hospitals Leuven.

POPULATION

Pregnant women attending for pregnancy care, first assessed prior to 14 weeks of gestation and agreeing to follow-up until 1 year postpartum.

METHODS

Standardised questionnaires reporting on PFD and BID at 12-14 and 28-32 weeks of gestation, and again at 6-8 weeks and 1 year postpartum. We calculated the prevalence of PFD, how the cases clustered and how the cases correlated with BID using a linear mixed-model analysis. A minimum of 174 women with complete follow-up were required.

MAIN OUTCOME MEASURES

The questionnaires used were the International Consultation on Incontinence Questionnaire - Urinary Incontinence Short Form (ICIQ-UI SF), St. Mark's Incontinence Score (SMIS), Patient Assessment of Constipation Symptoms (PAC-SYM), Pelvic Organ Prolapse Distress Inventory (POPDI), Pelvic Organ Prolapse/Incontinence Sexual Questionnaire IUGA Revised (PISQ-IR) and the Body Image Disturbance Questionnaire (BIDQ).

RESULTS

Out of 208 women, 92.8% reported one or multiple symptoms of PFD at 28-32 weeks of gestation, dropping to 73.6% by 1 year postpartum. The most common symptoms were constipation (65.3% at 28-32 weeks of gestation and 42.8% at 1 year postpartum) and urinary incontinence (56.8% at 28-32 weeks of gestation and 35.1% at 1 year postpartum). After correcting for body mass index, parity and mode of delivery, the severity of BID was associated with the ICIQ-UI SF score (β = 0.016, range 0.007-0.024), the PAC-SYM score (β = 0.006, range 0.002-0.011) and the POPDI score (β = 0.009, range 0.005-0.012), but not with the SMIS score (β = 0.015, range -0.001 to 0.031) or the PISQ-IR score, in sexually active women.

CONCLUSIONS

Urinary incontinence, constipation and symptoms of prolapse have a measurable impact on BID.

Single incision mini sling for the treatment of urodynamic stress incontinence: Surgical outcomes and preoperative predictors of failure

OBJECTIVE

To evaluate the surgical outcomes and predictors of failure of Single Incision Mini Sling (Ophira) in women with urodynamic stress incontinence.

MATERIALS AND METHODS

Records of 115 women underwent anti-incontinence procedure using Ophira Mini Sling from June 2019 to September 2020 reviewed. Subjective evaluation was assessed using validated IIQ-7, UDI-6, POPDI-6 and PISQ-12 questionnaires. Multichannel urodynamics, 1-h pad test and 72-h voiding diary was performed as objective evaluation. Primary outcome was the objective cure rate of negative urine leak on provocative filling cystometry and 1-h pad test weight <2 g, and subjective cure rate was negative response to question 3 of UDI-6. Secondary outcome was to identify risk factors associated with failure for Ophira.

RESULTS

Total of 108 women were evaluated. The objective cure rate was 91.7% with subjective cure rate of 86.1%. Comparison of clinical outcome shows significant improvement of USI post-operatively (p < 0.001) and reflected in 1-h pad test (p < 0.001). Improvement in all subjective evaluation parameters is seen except for POPDI-6. Failure of Ophira correlate significantly in women age >66 years, presence of asthma, pre-operative Intrinsic Sphincter Deficiency (ISD), and Maximum Urethral Closure Pressure (MUCP) value < 40 cmH20.

CONCLUSION

Ophira Single Incision Mini Sling is safe and effective treatment option for USI, showing high objective and subjective cure rates with low incidence of complications. Non-modifiable risks of age ≥66 years, asthma status, pre-operative intrinsic sphincteric deficiency and low maximal urethral closure pressure were the factors of failure for Ophira.

Randomized Trial of Single-Incision Midurethral Sling and Laparoscopic Burch Colposuspension: Postoperative Surgical Outcomes and Complications

STUDY OBJECTIVE

Various retropubic and midurethral sling techniques have shown high cure rates in the treatment of stress urinary incontinence (SUI). This study aimed to compare single-incision midurethral sling (SIMS) and laparoscopic Burch colposuspension (LBC) procedures in patients with SUI in terms of the effectiveness, patient satisfaction, surgical complications and results.

DESIGN

This is a prospective randomized study.

SETTING

A university tertiary hospital.

PATIENTS

Forty patients with clinically and/or urodynamically proven SUI who agreed to surgical treatment were randomized to the SIMS and LBC groups and included in the study.

INTERVENTIONS

Patients were treated with SIMS and LBC operations.

MEASUREMENTS AND MAIN RESULTS

Demographic characteristics of patients, physical and pelvic examination, preoperative and postoperative clinical findings, Kings Health Questionnaire form, Female Sexual Function Index and Prolapse Quality of Life Questionnaire form, postoperative day 1 visual analog scale score, and postoperative complications were recorded. Objective and subjective success rates were recorded by re-evaluating the patients in the first and sixth months of the operation. Objective success was defined as having a negative stress test and subjective success was defined as the absence of stress-induced urine leakage after surgery in a validated questionnaire. The primary result of our study was considered to be objective success, whereas the secondary result was subjective success and life quality tests. Twenty patients each in the SIMS group and the LBC group were included in the study. No significant difference was found in objective success (90% vs 85%, p = .633) or subjective success (85% vs 75%, p = .695) between the 2 groups at 6-month follow-up. A significant improvement in life quality was observed in the postoperative period for both groups; however, the difference between the groups was not significant. There was an improvement in sexual function in both groups. Nonetheless, although this improvement was significant in the SIMS group, it was not significant in the LBC group. In addition, surgery time, catheterization time, and hospitalization time were shorter in the SIMS group than in the LBC group. The visual analog scale score on postoperative day 1 was lower in the SIMS group. Groups were not different in terms of preoperative and postoperative complications.

CONCLUSION

This preliminary study is the first randomized study that compares the LBC and SIMS procedures in the literature. It shows that SIMS and LBC procedures have not different objective and subjective success rates in the short term. It was also observed that they increase both sexual and life quality results in a positive and similar way.

What maximal urethral closure pressure threshold predicts failure of mid-urethral sling surgery?

OBJECTIVE

Low Maximal Urethral Closure Pressure (MUCP) is linked to unfavourable outcome of anti-incontinence surgery, however the cut-off value varied within studies. This study aimed to predict the cut-off value of MUCP that contributes to poor outcome of Mid-Urethral Sling (MUS) surgery in Urinary Stress Incontinence (USI) patients.

MATERIALS AND METHODS

Records of 729 women underwent MUS procedure from January 2004 to April 2017 reviewed. Patients were divided into four MUCP groups, which were <20 cmH2O (≥20 and < 40) cmH2O (≥40 and ≤ 60) cmH2O and >60 cmH2O. Objective evaluation comprising 72-h voiding diary, multichannel urodynamic study (UDS) and post-operative bladder neck angle measurement. Subjective evaluation through validated urinary symptoms questionnaires. Primary outcome was objective cure rate of negative urine leak on provocative filling cystometry and 1-h pad test weight <2 g, and subjective cure rate was negative response to question 3 of UDI-6. Secondary outcome was identifying risk factors of cure failure for MUS in low MUCP groups. To identify the risk factors of cure failure, MUCP groups were narrowed down into <40 cmH2O or ≥40 cmH2O.

RESULTS

Total of 688 women evaluated. Overall objective cure rate was 88.2% with subjective cure rate of 85.9%. Objective and subjective cure rates were lower in groups with low MUCP <40 cmH2O. Failure of MUS correlate significantly in patients with low MUCP <40 cmH20, bladder neck angle <30° and Functional urethral length (FUL) < 2 cm.

CONCLUSION

Women with MUCP <40cmH2O, bladder neck angle <30° and FUL < 2 cm are more likely to have unfavorable outcome following MUS surgery. We proposed the cut-off low MUCP <40cmH2O as predictor for fail MUS surgery in SUI patients.

Association of diarrhea or constipation with urinary incontinence in adults: A cross-sectional analysis of the National Health and Nutrition Examination Survey

AIMS

This study aimed to investigate the association between diarrhea or constipation and urinary incontinence (UI) in adults.

METHODS

Data from the National Health and Nutrition Examination Survey for 2009-2010 was used to include 4686 adults aged 20 and over in the analysis. Stress urinary incontinence (SUI) and urgency urinary incontinence (UUI) were used as outcome variables, with diarrhea and constipation as exposure factors. We first compared the baseline characteristics of those with and without SUI, as well as those with and without UUI. The impact of diarrhea or constipation on SUI and UUI was assessed using multivariate logistic regression models. To ensure the stability of the results, subgroup and stratified analyses were conducted.

RESULTS

The prevalence rates of UUI and SUI were 22.49% and 23.39%, respectively. Adjusted multivariate logistic regression analysis revealed that the risk of UUI was increased by either diarrhea (OR 1.66, 95% CI 1.36-2.04) or constipation (OR 1.42, 95% CI 1.11-1.83). The risk of SUI was also elevated by either diarrhea (OR 1.36, 95% CI 1.11-1.67) or constipation (OR 1.32, 95% CI 1.06-1.63). Subgroup analysis revealed no significant differences in the interaction tests between constipation or diarrhea and UI.

CONCLUSIONS

This study found that both constipation and diarrhea increase the risk of UUI and SUI.

Efficacy and safety of gefapixant in women with chronic cough and cough-induced stress urinary incontinence: a phase 3b, randomised, multicentre, double-blind, placebo-controlled trial

BACKGROUND

Approximately two-thirds of women with chronic cough have cough-induced stress urinary incontinence (CSUI). We aimed to evaluate the efficacy and safety of gefapixant in reducing CSUI episodes in women with refractory or unexplained chronic cough.

METHODS

This phase 3b, double-blind, randomised, placebo-controlled trial done at 90 sites in 12 countries enrolled women aged 18 years or older who had chronic cough for at least 1 year, a diagnosis of refractory or unexplained chronic cough, a cough severity visual analogue scale score of 40 mm or more (100 mm maximum), and CSUI for 3 months or more. Participants were randomised 1:1 to oral gefapixant or placebo for 12 weeks. The primary outcome was percentage change from baseline in daily CSUI episodes (7-day average) at week 12. This study is registered with ClinicalTrials.gov (NCT04193176).

FINDINGS

From May 10, 2020, to Sept 2, 2022, 375 participants were randomised to and treated with gefapixant 45 mg twice daily (n=185) or placebo (n=190). Mean age was 56·4 years (SD 11·4), with mean chronic cough duration of 5·2 years (SD 6·6) and SUI duration of 4·0 years (SD 5·9). Least-squares mean percentage change from baseline in daily CSUI episodes was -52·8% (95% CI -58·4 to -47·1%) for gefapixant and -41·1% (-46·7 to -35·4%) for placebo (estimated treatment difference: -11·7% [95% CI -19·7 to -3·7]; p=0·004). 129 (70%) of 185 participants who received gefapixant and 71 (37%) of 190 participants who received placebo had at least one adverse event. Safety and tolerability were consistent with previous trials of gefapixant; the most frequent adverse events were taste related.

INTERPRETATION

Gefapixant 45 mg twice daily is the first treatment to show efficacy versus placebo in reducing CSUI episodes in participants with refractory or unexplained chronic cough.

FUNDING

Merck Sharp & Dohme, a subsidiary of Merck & Co.

Videourodynamics - role, benefits and optimal practice

Videourodynamics (VUDS) is an advanced diagnostic procedure that simultaneously combines functional and anatomical evaluation of the lower urinary tract. The goal of this synchronous assessment is to promote accurate diagnosis of the aetiology responsible for patient symptoms, improving therapeutic decision-making. Overall, high-quality VUDS is advocated when other tests such as traditional urodynamics might not provide sufficient data to guide therapy, particularly in patients with complex, persistent or recurrent dysfunctions of the lower urinary tract. Additionally, VUDS is often crucial in the follow-up monitoring of many patients with these dysfunctions. A VUDS study is frequently considered a gold standard in patients with neurogenic lower urinary tract dysfunction, female bladder outlet obstruction or congenital anomalies of the lower urinary tract. Nevertheless, this specialized test should be limited to patients in whom VUDS data add value. Particularly, reliable studies comparing the effect of diagnosis with and without imaging on management outcomes are lacking, and no standardized procedures for undertaking VUDS are available. Additionally, patients should be carefully selected for VUDS evaluation, considering the increased cost and risks associated with radiological imaging. In routine practice, clinicians should balance the additional value of synchronous imaging and the enhanced diagnostic precision of VUDS against the limitations of this approach, which mainly include an uncertain effect of VUDS on final treatment outcomes.

The True Impact of Voiding Dysfunctions after Transobturator Sub-Urethral Tape Procedures: A Systematic Review of Literature

Introduction: Transobturator techniques are frequently used for the surgical treatment of female stress urinary incontinence (SUI), due to their high success rates and few intraoperative complications. However, controversial results have been reported in the literature regarding their incidence. The aim of this study is to analyze the real incidence and trend over time of such complications, especially voiding dysfunctions and overactive bladder (OAB) symptoms. Methods: A comprehensive search using PubMed/MEDLINE, Scopus, and Cochrane databases was performed. The search string used was the following: (female stress urinary incontinence) AND (complication) AND ((midurethral sling) OR (transobturator tape) OR (TVT-O) OR (voiding dysfunctions) OR (de novo OAB) OR (recurrent UTI) OR (vaginal erosion)). We included randomized controlled trials, prospective controlled studies, prospective and retrospective observational studies. All selected articles were screened based on titles and abstracts. Relevant data were extracted and tabulated. Results: A total of 39 studies were included in our analysis. Transobturator tape procedures show a high objective cure rate for SUI, from 76.9% to 100%. Postoperative voiding dysfunctions are shown to be quite common, ranging from 0-22% of cases. Despite that, this percentage decreases to 0-1% after 12 months. De novo OAB incidence ranges from 3% to 14% at 12 months, with variability over time due to multiple factors. Tape-related complications usually occur after 12 months, with a variable incidence up to 7%. Urinary tract infections (UTIs) are quite common in the immediate postoperative period but sometimes can be recurrent, requiring long-term prophylactic antibiotic treatment. Conclusions: Voiding dysfunctions are generally transient complications, while de novo OAB may persist over time. An adequate preoperative counseling, along with accurate written informed consent, could enhance patient tolerance of these issues and contribute to long-term patient satisfaction.

Cardiovascular health assessed by the new life's essential 8 and the prevalence of urinary incontinence in adults

OBJECTIVE

To explore the association between cardiovascular health (CVH) measured by Life's Essential 8 (LE8) and the prevalence of urinary incontinence (UI).

METHOD

A cross-section study was conducted using data from the National Health and Nutrition Examination Survey 2007-2012. 22,609 people aged ≥ 20 years with complete information on LE8 metrics and UI questionnaires were enrolled. Participants were divided into three groups (low: < 50, moderate: ≥ 50 and < 80, high: ≥ 80) based on the cut-off of LE8. Weighted proportions, multivariable logistic regression analysis and stratified logistic regression were performed to examine the association between LE8 and the prevalence of three types of UI separately (stress UI (SUI), urge UI (UUI), mixed UI (MUI)) by confounding factors adjusted. Spline smooth was conducted to find whether a linear relationship existed. In addition, sensitive analyses were also conducted to observe the stability.

RESULT

A total of 22,609 adults were involved in the study, and participants were divided into three groups (low 42.2 ± 6.3, moderate 66.1 ± 8.1, high 86.8 ± 5.1) according to the cut-off points of LE8. The multivariable logistic regression suggested that LE8 is inversely associated with the prevalence of SUI (OR = 0.98, 95%CI 0.98 to 0.99), UUI (OR = 0.98, 95%CI 0.98 to 0.99), and MUI (OR = 0.98, 95%CI 0.97 to 0.98) in the fully-adjusted model. Compared with the low group, people with high scores of LE8 had a lower prevalence of SUI (OR = 0.45, 95%CI 0.37 to 0.55), UUI (OR = 0.49, 95%CI 0.40 to 0.60), and MUI (OR = 0.41, 95%CI 0.30 to 0.55). The result of the sensitive analysis showed the robustness of the main analysis.

CONCLUSION

The prevalence of UI (SUI, UUI, or MUI) is inversely associated with the LE8 score, which suggests that maintaining a good CVH with a higher LE8 score is accompanied by lower prevalence rates of UUI, SUI, and MUI.

Tolterodine Tartrate Loaded Cationic Elastic Liposomes for Transdermal Delivery: In Vitro, Ex Vivo, and In Vivo Evaluations

OBJECTIVE

Tolterodine tartrate (TOTA) is a first-line therapy to treat overactive urinary bladder (OAB). Oral delivery causes high hepatic clearance, xerostomia, headache, constipation, and blurred vision. We addressed Hansen solubility parameter (HSP) and Design Expert oriented optimized cationic elastic liposomes for transdermal application.

METHODS

The experimental solubility was conducted in HSPiP predicted excipients to tailor formulations using surfactants, stearylamine, ethanol, and phosphatidylcholine (PC). These were evaluated for formulation characteristics. The optimized OTEL1 and OTEL1-G (gel) were compared against the drug solution (DS) and liposomes. In vitro and ex vivo studies were accomplished to investigate the insights into the mechanistic understanding of TOTA release and permeation ability. Finally, confocal laser scanning microscopy (CLSM) supported ex vivo results.

RESULTS

HSP values of TOTA were closely related to tween-80, stearylamine, and human's skin. The size (153 nm), %EE (87.6%), and PDI (0.25) values of OTEL1 were in good agreement to the predicted values (161 nm, 80.4%, and 0.31) with high desirability (0.963). Spherical and smooth OTEL1 (including OTEL1-G and liposomes) vesicles followed non-Fickian drug release as compared to DS (Fickian) as evidence with n > 0.5 (Korsmeyer and Peppas coefficient). OTEL1 (containing lipid and surfactant as 90 mg and 13.8 mg, respectively) exhibited 2.6 and 1.8-folds higher permeation flux than DS and liposomes, respectively. Biocompatible cationic OTEL1 was safe and non-hemolytic.

CONCLUSIONS

OTEL1 was promised as a lead vesicular approach and an alternative to conventional oral therapy to treat OAB in children and advanced age patients.

Cognitive function and bladder health among midlife adult women in the Coronary Artery Risk Development in Young Adults (CARDIA) study

OBJECTIVE

The aim of this study was to examine whether different aspects of women's cognitive function are associated with lower urinary tract symptoms (LUTS) and their impact.

METHODS

In 2010-2011, women aged 42 to 57 years in the Coronary Artery Risk Development in Young Adults study completed different tests of cognitive function, including the Digit Symbol Substitution Test, Rey Auditory Verbal Learning Test, and Stroop test. Two years later, data on LUTS and their impact were collected. LUTS/impact, a four-level composite variable ranging from bladder health to mild, moderate, and severe LUTS/impact, was regressed on each cognitive test separately, as well as a cognitive function composite variable. The analytic sample was composed of 1,021 women with complete data.

RESULTS

When adjusting for sociodemographic variables (age, race, education) and gynecologic/obstetric variables (parity, menopausal status, hysterectomy, hormonal use), better performance on the cognitive function composite and Digit Symbol Substitution Test were both associated with lower odds of membership to a more severe LUTS/impact category (odds ratio, 0.90 [95% confidence interval, 0.83-0.98] and 0.89 [95% confidence interval, 0.82-0.97], respectively). These associations became nonsignificant when additionally adjusting for mechanisms that might explain an association between cognitive function and LUTS/impact, including health behaviors and health conditions that may covary with cerebral and peripheral vascular health and cognitive function.

CONCLUSIONS

In this sample of midlife adult women, a modest association was found between better cognitive function and lower likelihood of LUTS/impact. Longitudinal studies are needed to further investigate the association between cognitive function and LUTS/impact, as well as potential explanatory mechanisms, particularly as women age and cognitive function varies to a greater degree.

Curvilinear relationship was found between visceral adiposity index and stress urinary incontinence among US adult women: A cross-sectional study

AIMS

The purpose of this study was to find out the relation between visceral adipose index (VAI) levels and stress urinary incontinence (SUI) in adult women.

METHODS

From the National Health and Nutrition Examination Survey (NHANES) 2007-2020, females aged 20 or above were identified for this study. Visceral adiposity was determined using the VAI score, and the assessment of urinary incontinence was carried out through a correlation questionnaire. Logistic regression models and restricted cubic spline (RCS) regression were employed to analyze the relationship between VAI levels and SUI.

RESULTS

Among the 6522 participants, 2672 (41.0%) were reported SUI. Multivariate logistic regression revealed significantly higher odds of SUI with increasing VAI levels (Q4 vs. Q1), adjusted odds ratio (aOR) = 1.53 (CI: 1.29-1.81, p < 0.001). RCS regression indicated a curvilinear relationship between VAI and SUI (p = 0.003). In threshold analysis, aOR for developing SUI was 1.18 (CI: 1.11-1.26, p < 0.001) for participants with VAI < 4.73, suggesting an 18% increased risk of SUI with each unit increase in VAI. No association between VAI and SUI was observed when VAI was ≥4.73.

CONCLUSIONS

Our study has revealed a significant curvilinear relationship between VAI and SUI within a large and representative sample of women. Future research is necessary to evaluate the relationship between the two and explicate the underlying mechanisms of this relationship.

Does Urodynamic Stress Incontinence Increase After the Menopause?: Results from 2,994 Urodynamic Studies in Australian Women

INTRODUCTION AND HYPOTHESIS

Most studies attempting to estimate the age-related prevalence of urinary incontinence (UI) have used questionnaires. In the present study we analysed a consecutive series of urodynamic test results to determine the distribution of the different types of UI in pre- and post-menopausal women. We hypothesised that the prevalence of urodynamic stress incontinence (USI) would be significantly greater in pre-menopausal than in post-menopausal women.

METHODS

All women from a large tertiary urogynaecology department, who underwent urodynamic tests during the years 2000-2015 were included. Patient history and test results were collected. A sample size of 1,475 was calculated, based on the hypothesis that the prevalence of USI will be 20% larger in the pre- versus the post-menopausal group.

RESULTS

A total of 2,994 women with UI on urodynamics were available. There was a significant difference between pre- and post-menopausal status for each of the three diagnoses: USI 483 (59.3%) versus 912 (41.8%), detrusor overactivity (DO) 125 (15.4%) versus 399 (18.3%) and USI with concomitant DO 206 (25.3%) versus 869 (39.9%). A bimodal pattern of age was seen in women with USI, with a peak in the 46-50 and 61-65 age group, before decreasing with age. DO generally increased with age. USI with concomitant DO increased steadily after the menopause, becoming the predominant type after the age of 66.

CONCLUSIONS

In this large cohort of women attending urodynamics, we have shown that USI is the predominant type of incontinence in pre-menopausal women; however, USI with concomitant DO increases after menopause, eventually predominating.

Deprescribing as a Way to Reduce Inappropriate Use of Drugs for Overactive Bladder in Primary Care (DROP): Protocol for a Cluster Randomized Controlled Trial With an Embedded Explanatory Sequential Mixed Methods Study

BACKGROUND

Potentially inappropriate medication remains a significant concern in general practices, particularly in the context of overactive bladder (OAB) treatment for individuals aged 65 years and older. This study focuses on the exploration of alternative options for treating OAB and the deprescribing of anticholinergic drugs commonly used in OAB. The research aims to comprehensively evaluate the efficiency of deprescribing through a mixed methods approach, combining quantitative assessment and qualitative exploration of perceptions, experiences, and potential barriers among patients and health care personnel.

OBJECTIVE

This study aims to evaluate the efficiency and safety of the intervention in which health care staff in primary care encourage patients to participate in deprescribing their drugs for OAB. In addition, we aim to identify factors contributing to or obstructing the deprescribing process that will drive more informed decisions in the field of deprescribing and support effective and safe treatment of patients.

METHODS

The drugs for overactive bladder in primary care (DROP) study uses a rigorous research design, using a randomized controlled trial (RCT) with an embedded sequential explanatory mixed methods approach. All general practices within the North Denmark Region will be paired based on the number of general practitioners (GPs) and urban or rural locations. The matched pairs will be randomized into intervention and control groups. The intervention group will receive an algorithm designed to guide the deprescribing of drugs for OAB, promoting appropriate medication use. Quantitative data will be collected from the RCT including data from Danish registries for prescription analysis. Qualitative data will be obtained through interviews and focus groups with GPs, staff members, and patients. Finally, the quantitative and qualitative findings are merged to understand deprescribing for OAB comprehensively. This integrated approach enhances insights and supports future intervention improvement.

RESULTS

The DROP study is currently in progress, with randomization of general practices underway. While they have not been invited to participate yet, they will be. The inclusion of GP practices is scheduled from December 2023 to April 2024. The follow-up period for each patient is 6 months. Results will be analyzed through an intention-to-treat analysis for the RCT and a thematic analysis for the qualitative component. Quantitative outcomes will focus on changes in prescriptions and symptoms, while the qualitative analysis will explore experiences and perceptions.

CONCLUSIONS

The DROP study aims to provide an evidence-based intervention in primary care that ensures the deprescription of drugs for OAB when there is an unfavorable risk-benefit profile. The DROP study's contribution lies in generating evidence for deprescribing practices and influencing best practices in health care.

TRIAL REGISTRATION

ClinicalTrials.gov NCT06110975; https://clinicaltrials.gov/study/NCT06110975.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/56277.

The association between different levels of depression and overactive bladder: A cross-sectional study of the 2005-2018 National Health and Nutrition Examination Survey

BACKGROUND

There is growing evidence of a possible correlation between depression and overactive bladder (OAB). However, few studies have classified depression according to its severity. Whether there is an association between different levels of depression and OAB symptoms remains unclear.

METHODS

Participants with complete information about depression, OAB, and covariates in the National Health and Nutrition Examination Survey (NHANES) 2005-2018 were included in this study. Depression symptoms were assessed by the Patient Health Questionnaire-9. OAB symptoms were evaluated by the Overactive Bladder Symptom Score. Weighted multivariate logistic regression models were applied to analyze the relationship between depression and OAB.

RESULTS

A total of 30 359 participants were included in this study, consisting of 6245 OAB patients and 24 114 non-OAB participants. The multivariate logistic regression suggested depression independently correlated with OAB (odds ratio [OR] = 2.764, 95% confidence interval [CI] = 2.429-3.146, p < 0.001). Further, mild (OR = 2.355, 95% CI = 2.111-2.627, p < 0.001), moderate (OR = 3.262, 95% CI = 2.770-3.841, p < 0.001), and moderately severe to severe depression (OR = 3.927, 95% CI = 3.246-4.752, p < 0.001) were all associated with OAB. Additionally, depression was also correlated with urgency urinary incontinence (OR = 2.249, 95% CI = 1.986-2.548, p < 0.001) and nocturia (OR = 2.166, 95% CI = 1.919-2.446, p < 0.001).

CONCLUSION

This study indicated different levels of depression, even mild depression, were independent risk factors for OAB. Given the frequent coexistence and potential interactions between depression and OAB, clinicians should be aware of the importance of assessing both physical and psychological symptoms in these patients. Early diagnosis and holistic treatment may improve the treatment outcomes, particularly for those suffering from both conditions.

The association between triglyceride -glucose index and stress urinary incontinence in adult American women: A population-based study

PURPOSE

This investigation seeks to determine the triglyceride glucose (TyG) index's link to stress urinary incontinence (SUI) in American females of adult age.

METHODS

The investigation relied on data acquired via the National Health and Nutrition Examination Survey (NHANES) conducted over the period from 2011 to 2018. The independent relationship between TyG index and SUI was tested using multivariate logistic regression analysis. We applied a smooth curve fitting approach to analyze the interrelation of them. In addition, subgroup analysis was conducted and interaction experiments were conducted.

RESULTS

Among 4459 female participants aged 20 and above, TyG index and SUI demonstrated a favorable correlation. Model 3 indicated that with every single-unit rise in the TyG index, the incidence of SUI increases by 18% [1.18 (1.01, 1.38)]. In contrast to individuals in the lowest tertile, subjects within the highest tertile of the TyG index exhibited a 68% increase in SUI incidence [1.68 (95% CI: 1.26, 2.23), 0.0004]. By using smooth curve fitting, a nonlinear positive evidence of an interconnection of the TyG index to SUI was identified.

CONCLUSIONS

Women exhibiting increased TyG index levels are at a heightened risk of SUI. TyG index displays a stronger correlation than that observed with BMI. According to our findings, the TyG index is viewed as a potential tool for identifying SUI in women, and monitoring the value of TyG index may be helpful for predicting the occurrence of SUI.

Weight-adjusted-waist index is positively associated with urinary incontinence: results from the National Health and Nutrition Examination Survey (NHANES) 2001-2018

BACKGROUND

Urinary incontinence (UI) is closely related to obesity. The aim of this study is to evaluate the association of a novel anthropometric indicator weight-adjusted-waist index (WWI) with UI.

METHODS

This cross-sectional study used the data from National Health and Nutrition Examination Survey (NHANES) 2001-2018. Weighted multivariable logistic regression was used to evaluate the relationship between WWI and three types of UI [stress UI (SUI), urgency UI (UUI), and mixed UI (MUI)]. The receiver operating characteristic (ROC) curve and Delong et al.'s test were utilized for comparison of the predictive capability for UI between WWI and body mass index (BMI), waist circumference (WC).

RESULTS

A total of 41,614 participants were included in this study, of whom 23.57% had SUI, 19.24% had UUI, and 9.43% had MUI. In the fully adjusted model, WWI was positively associated with three types of UI [SUI: odds ratio (OR) = 1.19, 95%Confidence interval (CI) 1.13-1.25; UUI: OR = 1.18, 95%CI 1.13-1.24; MUI: OR = 1.19, 95%CI 1.11-1.27, all p < 0.001]. Compared to the lowest WWI interval, the positive correlation between WWI and UI still existed in the highest WWI group after converting WWI to a categorical variable by quartiles (SUI: OR = 1.52, 95%CI 1.35-1.71, p < 0.001; UUI: OR = 1.50, 95%CI 1.33-1.69, p < 0.001; MUI: OR = 1.55, 95%CI 1.32-1.83, p < 0.001). WWI had a stronger prediction for three types of UI than BMI and WC (all p < 0.001).

CONCLUSION

A higher WWI was linked with an increased likelihood of three types of UI (SUI, UUI, and MUI) in the United State population. Compared to BMI and WC, WWI had a stronger predictive power for UI. WWI may be a better adiposity parameter for evaluating UI.

Caesarean section and anal incontinence in women after obstetric anal sphincter injury: A systematic review and meta-analysis

BACKGROUND

Approximately 50% women who give birth after obstetric anal sphincter injury (OASI) develop anal incontinence (AI) over their lifetime.

OBJECTIVE

To evaluate current evidence for a protective benefit of planned caesarean section (CS) to prevent AI after OASI.

SEARCH STRATEGY

MEDLINE/PubMed, Embase 1974-2024, CINAHL and Cochrane to 7 February 2024 (PROSPERO CRD42022372442).

SELECTION CRITERIA

All studies reporting outcomes after OASI and a subsequent birth, by any mode.

DATA COLLECTION AND ANALYSIS

Eighty-six of 2646 screened studies met inclusion criteria, with nine studies suitable to meta-analyse the primary outcome of 'adjusted AI' after OASI and subsequent birth. Subgroups: short-term AI, long-term AI, AI in asymptomatic women.

SECONDARY OUTCOMES

total AI, quality of life, satisfaction/regret, solid/liquid/flatal incontinence, faecal urgency, AI in women with and without subsequent birth, change in AI pre- to post- subsequent birth.

MAIN RESULTS

There was no evidence of a difference in adjusted AI after subsequent vaginal birth compared with CS after OASI across all time periods (OR = 0.92, 95% CI 0.72-1.20; 9 studies, 2104 participants, I2 = 0% p = 0.58), for subgroup analyses or secondary outcomes. There was no evidence of a difference in AI in women with or without subsequent birth (OR = 1.00 95% CI 0.65-1.54; 10 studies, 970 participants, I2 = 35% p = 0.99), or pre- to post- subsequent birth (OR = 0.79 95% CI 0.51-1.25; 13 studies, 5496 participants, I2 = 73% p = 0.31).

CONCLUSIONS

Due to low evidence quality, we are unable to determine whether planned caesarean is protective against AI after OASI. Higher quality evidence is required to guide personalised decision-making for asymptomatic women and to determine the effect of subsequent birth mode on long-term AI outcomes.

A nomogram for predicting neurogenic lower urinary tract dysfunction in patients with acute ischemic stroke: A retrospective study

AIMS

To investigate the risk factors for neurogenic lower urinary tract dysfunction (NLUTD) in patients with acute ischemic stroke (AIS), and develop an internally validated predictive nomogram. The study aims to offer insights for preventing AIS-NLUTD.

METHODS

We conducted a retrospective study on AIS patients in a Shenzhen Hospital from June 2021 to February 2023, categorizing them into non-NLUTD and NLUTD groups. The bivariate analysis identified factors for AIS-NLUTD (p < 0.05), integrated into a least absolute shrinkage and selection operator (LASSO) regression model. Significant variables from LASSO were used in a multivariate logistic regression for the predictive model, resulting in a nomogram. Nomogram performance and clinical utility were evaluated through receiver operating characteristic curves, calibration curves, decision curve analysis (DCA), and clinical impact curve (CIC). Internal validation used 1000 bootstrap resamplings.

RESULTS

A total of 373 participants were included in this study, with an NLUTD incidence rate of 17.7% (66/373). NIHSS score (OR = 1.254), pneumonia (OR = 6.631), GLU (OR = 1.240), HGB (OR = 0.970), and hCRP (OR = 1.021) were used to construct a predictive model for NLUTD in AIS patients. The model exhibited good performance (AUC = 0.899, calibration curve p = 0.953). Internal validation of the model demonstrated strong discrimination and calibration abilities (AUC = 0.898). Results from DCA and CIC curves indicated that the prediction model had high clinical utility.

CONCLUSIONS

We developed a predictive model for AIS-NLUTD and created a nomogram with strong predictive capabilities, assisting healthcare professionals in evaluating NLUTD risk among AIS patients and facilitating early intervention.

Prevalence and impact on daily life of lower urinary tract symptoms in Japan: Results of the 2023 Japan Community Health Survey (JaCS 2023)

OBJECTIVES

A large-scale nationwide epidemiological survey of lower urinary tract symptoms (LUTS) was conducted via the Internet in 2023 to clarify the current prevalence of LUTS and evaluate its impact on daily life in Japan.

METHODS

The survey was conducted among individuals aged 20-99 years old who had anonymously registered with a Japanese online research company. The survey consisted of 48 questions related to LUTS and daily life.

RESULTS

A total of 6210 participants (3088 females and 3122 males), who were selected by probability sampling based on the composition of the Japanese population (age range: 20-99), were recruited. The overall prevalence of LUTS was 77.9% among the subjects aged ≥20 and 82.5% among those aged ≥40. The prevalence of LUTS differed between the sexes and trends toward significant increases in prevalence with age were seen for almost all LUTS. Furthermore, the prevalence of overactive bladder (OAB) was 11.9% among the subjects aged ≥20 and 13.8% among those aged ≥40. This study also showed that LUTS negatively affected daily life. However, the percentage of subjects who visited a physician to receive treatment for LUTS was low, including for participants with a history of treatment for LUTS, although this increased with age.

CONCLUSION

The prevalence of LUTS, including OAB, increased with age and negatively affected daily life. However, since the percentage of patients who visit a physician to receive treatment for LUTS remains low, further educational activities regarding LUTS are necessary.

The impact of bladder problems on well-being in multiple sclerosis - A cross-sectional study

BACKGROUND

Persons with multiple sclerosis (pwMS) frequently suffer from bladder problems that are not identified and managed optimally, reducing quality of life and increasing risk of health consequences.

OBJECTIVE

This study aimed to investigate associations between bladder problems and well-being of pwMS.

METHODS

The study included 1872 pwMS from France, Germany, Italy, and the UK self-reporting on demographics, MS status, bladder problems and management, and well-being. Logistic regression analyses were performed to investigate associations with self-reported well-being.

RESULTS

Population mean age was 51 years and 79 % were women. Among pwMS, 55 % reported bladder problems indicating overactive bladder (OAB), and 40 % reported self-experienced urinary retention. Self-management of bladder problems was reported by 32 %, 33 % were yet to have problem resolution, and 45 % reported a wish to receive bladder management help. Additionally, 35 % of pwMS reported that bladder problem onset preceded awareness of a link to MS. OAB, problem self-management, and urinary complications were significantly associated with lower well-being.

CONCLUSION

Bladder problems affect pwMS across disease subtypes and many attempt self-management. Consequently, pwMS with bladder problems are more likely to experience lower well-being, suggesting an unmet need. Raising awareness of the link between bladder problems and well-being could benefit pwMS living with bladder problems.

A retrospective study on the prevalence and risk factors of neurogenic lower urinary tract dysfunction for acute ischemic stroke in China: A case-control study

PURPOSE

This study identified risk factors for neurogenic lower urinary tract dysfunction (NLUTD) in patients with acute ischemic stroke (AIS) through multidimensional analysis of the medical records of patients, aiming to reduce the incidence of NLUTD, improve prognosis, and facilitate rehabilitation.

MATERIALS AND METHODS

In this case-control study, patients with AIS were recruited from two tertiary general hospitals in Shenzhen, China, from March 2021 to October 2023. Patients were divided into NLUTD and non-NLUTD groups based on the presence and absence of NLUTD, respectively. Comparative analysis was performed using the Mann-Whitney U and chi-square tests, with significant variables being included in logistic regression analysis.

RESULTS

Of the 652 participants enrolled in this study, 119 participants (18.3%) developed NLUTD. Bivariate analysis showed that 39 of 54 screened factors exhibited a significant correlation (p<0.05) with the incidence of NLUTD after AIS. Significant variables identified through logistic regression analysis included Glasgow coma scale (GCS) and National Institutes of Health Stroke Scale (NIHSS) scores, anemia, aphasia, pneumonia, brainstem involvement, multiple lesions, urine clarity (CLA), random venous blood glucose (GLU) and hemoglobin (HGB) levels, and white blood cell (WBC) count.

CONCLUSIONS

A total of 11 risk factors for NLUTD were identified in this study. This finding provides valuable guidance for reducing the incidence of NLUTD after AIS and improving the quality of life of patients.

Tibial Nerve Stimulation for Urge Urinary Incontinence and Overactive Bladder: Narrative Review of Randomized Controlled Trials and Applicability to Implantable Devices

The tibial nerve is an established target for neuromodulation in the management of overactive bladder (OAB) and its associated symptoms, including urge urinary incontinence (UUI). Technologies are currently available to deliver tibial nerve stimulation (TNS) through percutaneous devices or through implantable devices. The benefits and safety of percutaneous TNS have led to it as a guideline-recommended therapy. However, patient compliance is limited by the burden of weekly office visits and the need for maintenance treatments. Further, insurance often only covers a limited number of lifetime visits for percutaneous TNS. These factors and others have led to the development, study, and utilization of implantable TNS devices. Implantable TNS devices deliver the same therapeutic mechanism of action for nerve stimulation with a permanent implanted device that provides at-home stimulation rather than in-office therapy delivery. Additionally, there is an added potential for dynamic and patient-centered stimulation. There is a large body of high-quality evidence published for TNS, including numerous randomized controlled trials published on percutaneous TNS which have consistently demonstrated superior efficacy to sham and similar efficacy to that of anticholinergic medications. Percutaneous TNS also performs better than conservative therapy including pelvic floor muscle training. The percutaneous and implantable approaches deliver nerve stimulation to the same target nerve, using the same mechanism of action. Therefore, data from randomized trials of percutaneous TNS are informative for implantable TNS devices. At the time of this article's publication, at least two implantable TNS devices have received marketing authorization from the Food and Drug Administration (FDA). The objective of this review is to discuss the mechanism of action for TNS and summarize the published literature from clinical trials of percutaneous TNS as a foundation of high-quality evidence for implantable devices targeting the tibial nerve.

Pelvic floor muscle strength and dysfunctions in women with pes planus: A case-control study

BACKGROUND/AIM

Distal extremity misalignment may give rise to pelvic floor dysfunctions (PFDs). This study aimed to compare pelvic floor muscle strength (PFMS) and dysfunctions in women with and without pes planus.

MATERIALS AND METHODS

Women with (pes planus group, n = 30) and without pes planus (control group, n = 30) were included. The presence of PFDs questioned. Pes planus with the Feiss Line Test, PFMS with the Modified Oxford Scale, and the severity of PFDs with the Pelvic Floor Distress Inventory-20 (PFDI-20), including three subscales (Pelvic Organ Distress Inventory-6 (POPDI-6) for pelvic organ prolapse, Colorectal-Anal Distress Inventory-8 (CRADI-8) for colorecto-anal symptoms, and Urinary Distress Inventory-6 (UDI-6) for urinary symptoms, were assessed.

RESULTS

It was seen that no difference was found between groups in terms of PFMS (p > 0.05). However, urinary incontinence and anal incontinence were higher in women with pes planus than in women without pes planus (p < 0.05). Only the PFDI-20, CRADI-8, and UDI-6 scores were higher in women with pes planus compared to controls (p < 0.05). There was no difference was found between groups in terms of POPDI-6 scores (p > 0.05).

CONCLUSION

The PFMS did not change according to the presence of pes planus. However, the prevalence of PFDs and their severity were higher in women with pes planus in comparison to controls. Posture assessments of individuals with PFDs, especially examination of foot posture, and pelvic floor assessments of individuals with posture disorders should be considered.

3D Observation of Pelvic Organs with Dynamic MRI Segmentation: A Bridge Toward Patient-Specific Models

INTRODUCTION AND HYPOTHESIS

Female pelvic organ prolapses are common, but their treatment is challenging. Notably, diagnosis and understanding of these troubles remain incomplete. Tridimensional observations of displacement and deformation of the pelvic organs during a strain could support a better understanding and help to develop comprehensive tools for preoperative planning.

METHODS

The present feasibility study evaluates tridimensional dynamic MRI in 12 healthy volunteers. Tridimensional acquisitions were approximated using five intersecting slices, each recorded twice per second. MRI was performed during rest and strain, with intrarectal and intravaginal contrast gel. Subject-specific dynamic 3D models were built for each volunteer through segmentation.

RESULTS

For each volunteer, pelvic organs could be segmented in three dimensions with a rate of acquisition of two cycles per second on five slices, allowing for a fluid observation of displacements and deformations during strain. Manual segmentation of a full strain required 2 h and 33 min on average. The upper limit of the rectum and the pelvic floor were the most difficult structures to identify. This technique is limited by its time-consuming manual segmentation, which impedes its implantation for routine clinical use. This method must be tried in patients with pelvic organ prolapse.

CONCLUSIONS

This multi-planar acquisition technique applied during a dynamic MRI allows for observation of displacement and deformations of pelvic organs during a strain.

Lower Urinary Tract Symptoms, Toileting Behaviors, and Pelvic Floor Health Knowledge in Younger and Older Women

INTRODUCTION AND HYPOTHESIS

The primary aim was to examine the relationship between lower urinary tract symptoms (LUTS), toileting behaviors, and pelvic floor health knowledge in younger and older women. The secondary aim was to compare LUTS, toileting behaviors, and pelvic floor health knowledge in younger and older women.

METHODS

The study included 85 younger women and 81 older women. LUTS were evaluated using the International Consultation on Incontinence Questionnaire-Female LUTS (ICIQ-FLUTS), toileting behaviors using Toileting Behavior-Women's Elimination Behaviors (TB-WEB), and pelvic floor health knowledge using the Pelvic Floor Health Knowledge Quiz (PFHKQ).

RESULTS

In terms of LUTS, the most common symptoms in younger women are urgency (31.8%), bladder pain (28.2%), and frequency of incontinence episodes (35.3%), whereas in older women, the most common symptoms observed are urgency (64.2%), frequency of incontinence episodes (61.7%), intermittency (46.9%), urgency urinary incontinence (58%), and frequency of incontinence episodes (49.4%). Most unhealthy toileting behaviors correlated with LUTS in both groups (p < 0.05). Although a weak negative correlation was detected between ICIQ-FLUTS total score and PFHKQ function in younger women (p < 0.05), no correlation was found in older women (p < 0.05). Whereas premature voiding, straining during voiding, TB-WEB total score were higher in older women than in younger women (p < 0.05), delayed voiding, position preference for voiding, and PFHKQ function/dysfunction scores were higher in younger women than in older women (p < 0.05).

CONCLUSIONS

Within the scope of preventive health services, it may be important to provide informative programs on healthy toileting behaviors and pelvic floor health to women of all ages in order to prevent LUTS.

Percutaneous tibial neuromodulation initial therapy compliance and subsequent third-line treatment patterns

PURPOSE

Percutaneous Tibial Neuromodulation (PTNM) is used to treat Overactive Bladder (OAB). This analysis summarizes patient adherence to PTNM treatment and examines trends of other third-line therapy use during and after PTNM.

METHODS

Optum's deidentified Clinformatics® Data Mart Database (CDM) and CMS Research Identifiable Files were queried for adults with OAB symptoms and who underwent PTNM treatment (2019-2020). We evaluated the proportion of patients who completed 12 visits within 1 year, and defined patients as treatment compliant if 12 PTNM visits were completed within 12 weeks. We then identified the proportion of patients who used other third-line therapies after PTNM and stratified these patients based on their PTNM therapy compliance status.

RESULTS

2302 patients met selection criteria from CDM and 16,473 patients from CMS. The proportion of patients completing a full PTNM treatment course increased over time; from 16% at week 12% to 42% by week 52 (CDM) and 24% to 38% (CMS). Other third-line therapy use increased over time and was higher for PTNM noncompliant versus compliant patients at 52 weeks: onabotulinumtoxinA was 6.5% versus 5.7% for noncompliant versus compliant (CMS, p = 0.0661) and 6.4% versus 4.9% (CDM, p = 0.035), SNM trial procedure was 6.5% versus 2.5% (CDM, p = 0.002) and 4.2% versus 2.0% (CMS, p = 0.010).

CONCLUSIONS

Most patients are noncompliant with recommended PTNM treatment regimen. Albeit low, third-line therapy was pursued more frequently by noncompliant patients. Given low compliance, the effectiveness of PTNM may be compromised. Alternative implantable technologies may be needed to assure effectiveness of neuromodulation.

Associated factors of stress, urgency, and mixed urinary incontinence in a geriatric outpatient assessment of older women with hip fracture

PURPOSE

Urinary incontinence (UI) is known to be common among older female hip fracture patients. Little is known about different subtypes of UI among these patients. Our aim was to identify factors associated with subtypes of UI in a cross-sectional design.

METHODS

1,675 female patients aged ≥ 65 and treated for their first hip fracture in Seinäjoki Central Hospital, Finland, during 2007-2019, were included in a prospective cohort study. Of these, 1,106 underwent comprehensive geriatric assessment (CGA), including questions on continence, at our geriatric outpatient clinic 6 month post-fracture. A multivariable-adjusted multinomial logistic regression model was used to examine factors associated with UI subtypes.

RESULTS

Of the 779 patients included, 360 (46%) were continent and 419 (54%) had UI 6-month post-fracture. Of the women with UI, 117 (28%) had stress UI, 183 (44%) had urgency UI and 119 (28%) had mixed UI, respectively. Mean age of the patients was 82 ± 6,91. In multivariable analysis, depressive mood and poor mobility and functional ability were independently associated with stress UI. Fecal incontinence (FI) and Body Mass Index (BMI) over 28 were independently associated with urgency UI. Mixed UI shared the aforementioned factors with stress and urgency UI and was independently associated with constipation.

CONCLUSIONS

Mixed UI was associated with most factors, of which depressive mood and impaired mobility and poor functional ability were shared with stress UI, and FI and higher BMI with urgency UI. CGA is key in assessing UI in older hip fracture patients, regardless of subtype.

Pelvic Floor Muscle Training on Stress Urinary Incontinence in Power- and Weightlifters: a Pilot Study

INTRODUCTION AND HYPOTHESIS

Stress urinary incontinence (SUI) is defined as involuntary leakage of urine on physical effort and is prevalent among power- and weightlifters. However, there is scant knowledge on treatment options for this population. The aim of this pilot study was to evaluate the potential outcomes and feasibility of a pelvic floor muscle training (PFMT) program on SUI in nulliparous female power- and weightlifters.

METHODS

This was a case-series study, including one weightlifter and two powerlifters aged 21-32 years. The participants conducted 12 weeks of PFMT at home, with weekly follow-up by a physiotherapist. Change in total score of the International Consensus of Incontinence Questionnaire Urinary Incontinence Short Form (ICIQ-UI-SF) was the primary outcome. Secondary outcome was perceived change assessed by the Patient Global Impression of Improvement (PGI-I) Scale and impact on sport participation. PFM strength, endurance, and resting pressure was measured using vaginal manometry. Feasibility was evaluated as adherence to training and self-efficacy (Self Efficacy Scale for Practicing Pelvic Floor Exercises).

RESULTS

One athlete reduced their ICIQ-UI-SF score and experienced improvement in symptoms. One athlete reported no change, and one reported a worsening of symptoms. All three participants improved PFM strength and endurance, completed the testing, and 12 weeks of PFMT, but adherence varied between 40 and 80%. Participants reported a lack of time and energy and forgetting to perform the exercises, as reasons for low adherence.

CONCLUSION

There were varying effects of a 12-week PFMT program on SUI in three strength athletes. The results can create the basis for a future randomized controlled trial.

The Comparison of Individual and Group Hybrid Telerehabilitation Methods in Women with Urinary Incontinence

INTRODUCTION AND HYPOTHESIS

The aim is to compare the effects of the progressive training program (PTP), a new protocol, with two different hybrid telerehabilitation methods, on the parameters related to urinary incontinence in women with urinary incontinence.

METHODS

A total of 50 participants with stress or mixed urinary incontinence participated in this two-arm, parallel-group, randomized, non-inferiority trial. Individual hybrid training (IHT) or group hybrid training (GHT) was given to women for 8 weeks. The Power, Endurance, Repetitions, Fast contractions, and Every Contraction Timed (PERFECT) scheme and surface electromyography were used to assess pelvic floor muscle function, whereas quality of life, exercise adherence, and symptoms were assessed by questionnaires and a 3-day bladder diary. An intention-to-treat analysis was performed. Linear mixed model analysis with the factors "time" and "group" was used to determine the effects of IHT and GHT.

RESULTS

The primary outcome was changes in pelvic floor muscle function as evaluated using the PERFECT scheme and surface electromyography at the 4th and 8th weeks relative to baseline. No statistical difference was found between the groups except for "power" of the PERFECT scheme and "nocturnal urination frequency" (p > 0.05). The GHT showed significant improvement in P and nocturnal urination frequency at the end of the 8th week (p < 0.05). From baseline to week 8, the effect size for the P value was found to be small (Cohen's d = 0.33).

CONCLUSION

Eight weeks of PTP did not lead to different results in incontinence-related parameters in either of the training methods. It may be better to conduct GHT in terms of implementing PTP in incontinence and training programs in terms of time, staff workload, and applicability.

The association between weight-adjusted-waist index and stress urinary incontinence in female adults: a population-based study

INTRODUCTION

Obesity has a significant impact on female stress urinary incontinence. The weight-adjusted-waist index (WWI), a newly explored metric for measuring physical obesity and stress urine incontinence, has not been investigated.

METHODS

Cross-sectional data were obtained from the 2011 to 2018 National Health and Nutrition Examination Survey (NHANES) of participants with complete data for WWI and SUI. The independent connection between WWI and SUI was examined using weighted multivariable logistic regression analyses. Smoothed curve fitting was used to study their relationship. In addition, subgroup analyses were performed, and interaction tests were undertaken.

RESULTS

In 2,361 female participants over 20, WWI and SUI showed a positive association. Model 3 found that for each one-unit increase in WWI, SUI prevalence increased by 38% [1.38 (1.20, 1.59)]. The prevalence of SUI was 84% higher among participants in the highest quartile of WWI compared to those in the lowest quartile [1.84 (1.32, 2.57)]. Observed nonlinear positive correlation between WWI and SUI was revealed through smoothed curve fitting. In addition, we found that WWI was more strongly associated with SUI than traditional indicators of obesity, including BMI and weight.

CONCLUSIONS

Females with higher weight-adjusted waist index levels were more likely to develop stress urinary incontinence and have a stronger correlation than traditional indicators of obesity. According to our research, WWI may help detect women's stress urinary incontinence (SUI), and managing obesity through the WWI index may reduce SUI prevalence rates.

Italian multicenter mid-term analysis of laparoscopic lateral suspension in women with pelvic organ prolapse: clinical, sexual and Quality of Life assessment after surgical intervention

BACKGROUND

The aim of this study was to evaluate effectiveness and safety of laparoscopic lateral suspension in women affected by high grade uterine prolapse associated to anterior defect. The secondary endpoint is to evaluate mid-term impact on Quality of Life and sexual function.

METHODS

A multicenter retrospective study on women undergoing laparoscopic lateral suspension for uterine prolapse ≥III stage was performed. We included 174 women, but due to exclusion criteria, 134 patients were enrolled for this study. Preoperative evaluation consisted of an urogynecological interview, clinical exam, 3-day voiding diary and urodynamic testing; the prolapse Quality of Life Questionnaire was used to quantify the impact of prolapse symptoms on Quality of Life and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire short form, the Female Sexual Function Index and the Female Sexual Distress Scale were administered to evaluate sexual function before surgical intervention and at median follow-up of 3.8 years.

RESULTS

We included 134 women with uterine prolapse ≥III stage. All patients underwent laparoscopic lateral suspension, 8 also posterior colporrhaphy and 5 also transobturator tape insertion. POP-Q classification score for anterior and apical compartment showed a significant average decrease. The surveys administered to patients showed an improvement in Quality of Life, an increase in the number of monthly intercourses and a significant improvement in sexual life after surgery.

CONCLUSIONS

Laparoscopic lateral suspension for pelvic organ prolapse correction is a safe and effective technique for uterine and anterior associated defect. Quality of Life and sexual function significantly improved after surgery.

Impact of pelvic floor muscle training on sexual function in women affected by stress urinary incontinence

Background

Pelvic floor muscle training can effectively improve pelvic floor muscle strength and activities; however, its impact on sexual function in women with stress urinary incontinence remains unclear.

Aim

The study sought to investigate the impact of pelvic floor muscle training on pelvic floor muscle and sexual function in women with stress urinary incontinence.

Methods

This was a retrospective observational study involving women who visited a urogynecologic clinic at a tertiary medical center. Patients with stress urinary incontinence without pelvic organ prolapse underwent pelvic floor muscle training programs that included biofeedback and intravaginal electrostimulation. Other evaluations included pelvic floor manometry, electromyography, and quality-of-life questionnaires, including the short forms of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire, Urogenital Distress Inventory, and Incontinence Impact Questionnaire.

Outcomes

Clinical characteristics, vaginal squeezing and resting pressure, maximal pelvic floor contraction, duration of sustained contraction, quality-of-life scores, and sexual function were compared between baseline and after the pelvic floor muscle training programs.

Results

There were 61 women included in the study. The mean number of treatment sessions was 12.9 ± 6.3, and the mean treatment duration was 66.7 ± 32.1 days. The short forms of the Urogenital Distress Inventory (7.7 ± 3.8 vs 1.8 ± 2.1; P < .001) and Incontinence Impact Questionnaire (5.9 ± 4.3 vs 1.8 ± 2.0; P < .001) scores significantly improved after the pelvic floor muscle training program. In addition, all pelvic floor muscle activities significantly improved, including maximal vaginal squeezing pressure (58.7 ± 20.1 cmH2O vs 66.0 ± 24.7 cmH2O; P = .022), difference in vaginal resting and maximal squeezing pressure (25.3 ± 14.6 cmH2O vs 35.5 ± 16.0 cmH2O; P < .001), maximal pelvic muscle voluntary contraction (24.9 ± 13.8 μV vs 44.5 ± 18.9 μV; P < .001), and duration of contraction (6.2 ± 5.7 s vs 24.9 ± 14.6 s; P < .001). Nevertheless, the short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire score demonstrated no significant improvement (28.8 ± 9.7 vs 29.2 ± 12.3; P = .752).

Clinical Implications

Pelvic floor muscle training programs may not improve sexual function in women with stress urinary incontinence.

Strengths and Limitations

The strength of this study is that we evaluated sexual function with validated questionnaires. The small sample size and lack of long-term data are the major limitations.

Conclusion

Pelvic floor muscle training can improve pelvic floor muscle activities and effectively treat stress urinary incontinence; however, it may not improve sexual function.

Efficacy and safety of tibial nerve stimulation using a wearable device for overactive bladder

OBJECTIVE

To evaluate the efficacy and safety of a wearable, smartphone-controlled, rechargeable transcutaneous tibial nerve stimulation (TTNS) device in patients with overactive bladder (OAB).

PATIENTS AND METHODS

This multicentre, prospective, single-blind, randomised clinical trial included eligible patients with OAB symptoms who were randomly assigned to the stimulation group or sham group. The primary efficacy outcome was change from baseline in voiding frequency/24 h after 4 weeks of treatment. The secondary efficacy outcomes included changes in bladder diary outcomes (urgency score/void, nocturia episodes/day, micturition volume/void, and incontinence episodes/day), questionnaires on Overactive Bladder Symptom Score (OABSS), Patient Perception of Bladder Condition (PPBC), and American Urological Association Symptom Index Quality of Life Score (AUA-SI-QoL) at baseline and after 4 weeks of treatment. Device-related adverse events (AEs) were also evaluated.

RESULTS

In the full analysis set (FAS), the mean (sd) change of voiding frequency/24 h in the stimulation group and sham group at 4 weeks were -3.5 (2.9) and -0.6 (2.4), respectively (P < 0.01). Similar results were obtained in the per-protocol set (PPS): -3.5 (2.9) vs -0.4 (2.3) (P < 0.01). In the FAS and PPS, micturition volume/void significantly improved at 4 weeks (P = 0.01 and P = 0.02). PPBC improvement almost reached significance in the FAS (P = 0.05), while it was significant in the PPS (P = 0.02). In the FAS and PPS, AUA-SI-QoL significantly improved at 4 weeks in the two groups (P < 0.01 and P < 0.01), whereas there were no significant differences in urgency score/void, nocturia episodes/day or OABSS between the groups. Also, no device-related serious AEs were reported.

CONCLUSIONS

The non-invasive neuromodulation technique using the novel ambulatory TTNS device is effective and safe for treating OAB. Its convenience and easy maintenance make it a new potential home-based treatment modality. Future studies are warranted to confirm its longer-term efficacy.

European Urogynaecological Association Position Statement: The role of urodynamics in stress urinary incontinence evaluation and treatment decision

Stress urinary incontinence (SUI) is defined as a condition characterized by the involuntary leakage of urine during activities that increase intra-abdominal pressure which may decrease quality of life with a significant economic impact on health systems, necessitating the implementation of cost-effective management plans. Urodynamics (UDS) has been considered during the last decades as the gold standard for assessment of lower urinary tract symptoms (LUTS) due to their high reproducibility. At the same time, concerns about the systematic use of UDS before SUI surgery were raised due to a limited evidenced base to recommend their routine use. In uncomplicated female patients with SUI, UDS can offer further insights into LUTS, potentially assisting the physician in determining the appropriate therapeutic approach. However, it has not been shown that preoperative UDS can directly impact the surgical outcome for continence. Indeed, evidence supports the conclusion that pre-operative UDS in women with uncomplicated, clinically demonstrable, SUI does not improve the outcome of surgery for SUI. Nevertheless, asymptomatic detrusor overactivity (DO) identified by urodynamic testing or pre-existing voiding dysfunction are associated with an increased occurrence of postoperative overactive bladder (OAB) and voiding dysfunction, respectively. The EUGA Working Group concluded that the evidence does not support the systematic preoperative use of UDS for uncomplicated cases. However, in cases where mixed symptoms, voiding dysfunction, previous surgery, or concomitant prolapse are present, preoperative UDS are advised as they can be beneficial in anticipating postoperative outcomes. This aids in conducting comprehensive and thorough preoperative counseling. The Group recommend performing preoperative UDS considering the patient's specific clinical situation and the surgeon's judgment, with consideration given to the potential benefits, risks, and impact on treatment decisions and patient outcomes.

New TENSI+ Device for Transcutaneous Posterior Tibial Nerve Stimulation: A Prospective, Multicentre, Post-market Clinical Study

BACKGROUND AND OBJECTIVE

Our aim was to report the first clinical trial of TENSI+, a new device for transcutaneous posterior tibial nerve stimulation (TNS) for treatment of overactive bladder (OAB).

METHODS

A prospective, multicentre clinical trial was conducted in adults with OAB in seven French centres. The main exclusion criteria were prior percutaneous or transcutaneous TNS or invasive OAB treatment, current antimuscarinic use, 24-h polyuria, known bladder disease, postvoid residual volume >150 ml, and pelvic organ prolapse stage >2. Patients self-administered daily TTNS sessions of 20 min with TENSI+ at home after education by a specialized nurse. A bladder diary, Urinary Symptom Profile and OAB-q questionnaires, and Patient Global Impression of Improvement (PGI-I) scores were evaluated at baseline and 3 and 6 mo. The primary endpoint was efficacy, based on PGI-I and variations in bladder diary parameters. Success was defined as a PGI-I score ≤3 and any improvement ≥30% in bladder diary parameters.

KEY FINDINGS AND LIMITATIONS

The study included 78 patients (13 males). Nine patients had neurological disease, 21 had previously tried antimuscarinics, and 41 had wet OAB at baseline. At 3 mo, 65/78 patients had a full analysis set. Treatment was successful in 44/65 patients (67%), with 25/65 (38%) reporting both an objective improvement and high satisfaction. All OAB-related endpoints were significantly improved, except bladder capacity and total voided volume per 24 h. At 6 mo, only five of 44 patients had interrupted their treatment. No factor predictive of success was identified. Two adverse events (pain at stimulation site and/or pelvic pain) were reported and spontaneously resolved without treatment interruption.

CONCLUSIONS AND CLINICAL IMPLICATIONS

TENSI+ is a safe and effective TTNS treatment option for OAB management.

PATIENT SUMMARY

TENSI+ is a new device for nerve stimulation in patients with overactive bladder. Patients use the device at home every day. In our short-term trial, TENSI+ use improved symptoms in 67% of patients. Further evaluation over a longer period of time is needed.

Associated factors of vaginal laxity and female sexual function: a cross-sectional study

BACKGROUND

Female sexual dysfunction (FSD), including vaginal laxity (VL), can lead to a decrease in quality of life and affect partner relationships.

AIM

We aimed to investigate the associated factors of VL and FSD and their relationship with other pelvic floor disorders in a female population.

METHODS

This cross-sectional study was conducted at Chelsea and Westminster Hospital from July to December 2022. All women referred to clinical care at the urogynecology clinic were included. Participants were assessed according to sociodemographic and clinical aspects, the Pelvic Organ Prolapse Quantification system, sexual function, VL, sexual attitudes, sexual distress, sexual quality of life, vaginal symptoms, and pelvic floor disorders. Unadjusted and adjusted associated factors of VL and FSD were analyzed.

OUTCOMES

The primary outcome was the identification of the associated factors of VL and FSD in a female population, and secondary outcomes included the association between VL and pelvic organ prolapse (POP) with the questionnaire scores.

RESULTS

Among participants (N = 300), vaginal delivery, multiparity, perineal laceration, menopause, and gel hormone were significantly more frequent in those reporting VL (all P < .05). When compared with nulliparity, primiparity and multiparity increased the odds of VL by approximately 4 and 12 times, respectively (unadjusted odds ratio [OR], 4.26 [95% CI, 2.05-8.85]; OR, 12.77 [95% CI, 6.53-24.96]). Menopause and perineal laceration increased the odds of VL by 4 and 6 times (unadjusted OR, 4.65 [95% CI, 2.73-7.93]; OR, 6.13 [95% CI, 3.58-10.49]). In multivariate analysis, menopause, primiparity, multiparity, and POP remained associated with VL.

CLINICAL IMPLICATIONS

Parity, as an obstetric factor, and menopause and staging of POP, as clinical factors, were associated with VL.

STRENGTHS AND LIMITATIONS

The investigation of associated factors for VL will contribute to the understanding of its pathophysiology. The study design makes it impossible to carry out causal inference.

CONCLUSION

Menopause, primiparity, multiparity, and POP were highly associated with VL complaints in multivariate analysis.

Age-specific prevalence, clinical and urodynamic findings of detrusor underactivity and bladder outlet obstruction in female voiding dysfunction

OBJECTIVE

Female voiding dysfunction with cystocele have been widely studied, but there are no data regarding women without cystoceles. The present study aimed to evaluate the prevalence of detrusor underactivity (DU) and bladder outlet obstruction (BOO) without cystoceles in a large sample size.

METHODS

This was a retrospective cohort study. Between April 1996 and September 2018, 602 neurologically intact women with voiding dysfunction without cystoceles were enrolled. Detrusor pressure (DU) at the maximum flow rate (PdetQmax) <20 cmH2O, maximum flow rate (Qmax) <15 mL/s, and a bladder voiding efficiency <90% and BOO (PdetQmax ≥40 cmH2O and Qmax <12 mL/s) were diagnosed by urodynamic study. Otherwise, a non-DU/BOO diagnosis was made. The prevalence of DU and BOO was the primary outcome. The secondary outcomes were the analyses of the differences between these three groups in objective UDS parameters and subjective questionnaires and bladder diary parameters.

RESULTS

This study included 100 (17%) women with DU, 60 (10%) with BOO, and 442 (73%) with a non-DU/BOO diagnosis. DU increased with age, but BOO decreased as age increased. The women in the DU group were older, had higher parity and pad weights, and lower PdetQmax, maximum urethral closure pressure, and functional profile length than the BOO group. The urodynamic findings did not correlate well to subjective questionnaire parameters. None of the symptoms revealed a significant difference between the groups. The retrospective design was the limitation of the study.

CONCLUSION

The prevalence of DU increased with age in women with voiding dysfunction without advanced cystoceles. Conversely, BOO decreased with age. Prevalence intersected in the fourth decade. Diagnosis requires urodynamic evaluation, as subjective symptoms are inconclusive.

Sexual functioning is not, but psychological burden is predictive for receiving help in pelvic physical therapy practice: A cross-sectional study

Background

Pelvic floor complaints are common among women and often accompanied by sexual dysfunction and psychological burden. They are also associated with pregnancy and childbirth. However, not all women with these complaints receive help in pelvic physical therapy practice. This study explored if pregnancy, parity, pelvic floor complaints, sexual functioning, and psychological burden are predictive of receiving help in pelvic physical therapy practice.

Methods

In a cross-sectional exploratory design, women completed an online survey about pelvic floor complaints, sexual function, and psychological burden. Binary logistic analysis was used to analyze the predictive value of the above-mentioned factors.

Results

Data from 542 participants were analyzed. Pregnancy and parity, PFC severity, psychological burden, and the interaction between pelvic floor complaints and psychological burden were significant predictors of receiving help. Against expectations, sexual functioning was not predictive of receiving help.

Conclusions

Women's psychological burden is an important factor in determining if or when women receive help in PPT practice. More research is needed to unravel the role of sexual functioning in the context of pelvic floor complaints and women's psychological burden. More insight into this area of expertise could possibly improve and enhance pelvic health care for women with pelvic floor complaints.

The Treatment Selection for a 36-Year-Old Woman With Stress Urinary Incontinence Using a Discrete Mathematical Approach: A Case Report

This case report describes the treatment selection process for a 36-year-old woman with stress urinary incontinence (SUI) and an overactive bladder (OAB) who desired pregnancy. The patient had comorbidities of hypertension and type 2 diabetes, which required consideration to improve her quality of life and reproductive health. A recently developed decision support tool using a discrete mathematical approach was used to select a treatment method tailored to the patient's individual situation. The analysis determined that vaginal erbium laser (VEL) treatment (Renovalase SP Dynamis Fotona d.o.o, Ljubljana, Slovenia) was the most suitable for this patient. VEL treatment significantly improved both SUI and OAB and changing antihypertensive medication eliminated nocturia. This case suggests the potential application of graph theory in treatment selection for SUI patients.