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Ullman KE, Diem S, Forte ML, Ensrud K, Sowerby C, Zerzan N, Anthony M, Landsteiner A, Greer N, Butler M, Wilt TJ, Danan ER. Complementary and Alternative Therapies for Genitourinary Syndrome of Menopause : An Evidence Map. Ann Intern Med 2024. [PMID: 39250808 DOI: 10.7326/annals-24-00603] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/11/2024] Open
Abstract
BACKGROUND Women seeking nonhormonal interventions for vulvovaginal, urinary, and sexual symptoms associated with genitourinary syndrome of menopause (GSM) may seek out complementary and alternative medicine or therapies (CAMs). PURPOSE To summarize published evidence of CAMs for GSM. DATA SOURCES Ovid MEDLINE, EMBASE, and CINAHL from inception through 11 December 2023. STUDY SELECTION Randomized controlled trials (RCTs) 8 weeks or more in duration that evaluated the effectiveness or harms of CAMs for postmenopausal women with GSM and reported 1 or more outcomes of interest, with sample sizes of 20 or more participants randomly assigned per group. DATA EXTRACTION Data were abstracted by 1 reviewer and verified by a second. DATA SYNTHESIS An evidence map approach was used to organize and describe trials. Studies were organized by type of intervention, with narrative summaries for population, study characteristics, interventions, and outcomes. Fifty-seven trials were identified that investigated 39 unique interventions. Studies were typically small (n < 200), and most were done in Iran (k = 24) or other parts of Asia (k = 9). Few trials evaluated similar combinations of populations, interventions, comparators, or outcomes. Most studies (k = 44) examined natural products (that is, herbal or botanical supplements and vitamins), whereas fewer reported on mind and body practices (k = 6) or educational programs (k = 7). Most studies reported 1 or 2 GSM symptoms, mainly sexual (k = 44) or vulvovaginal (k = 30). Tools used to measure outcomes varied widely. Most trials reported on adverse events (k = 33). LIMITATIONS Only English-language studies were used. Effect estimates, risk of bias, and certainty of evidence were not assessed. CONCLUSION There is a large and heterogeneous literature of CAM interventions for GSM. Trials were small, and few were done in North America. Standardized population, intervention, comparator, and outcomes reporting in future RCTs are needed. PRIMARY FUNDING SOURCE Agency for Healthcare Research and Quality and Patient-Centered Outcomes Research Institute. (PROSPERO: CRD42023400684).
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Affiliation(s)
- Kristen E Ullman
- Center for Care Delivery and Outcomes Research, VA Health Care System, Minneapolis, Minnesota (K.E.U., C.S., N.Z., M.A., A.L., N.G.)
| | - Susan Diem
- Center for Care Delivery and Outcomes Research, VA Health Care System, and Department of Medicine, University of Minnesota, Minneapolis, Minnesota (S.D., E.R.D.)
| | - Mary L Forte
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota (M.L.F., M.B.)
| | - Kristine Ensrud
- Center for Care Delivery and Outcomes Research, VA Health Care System, and Department of Medicine and Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota (K.E.)
| | - Catherine Sowerby
- Center for Care Delivery and Outcomes Research, VA Health Care System, Minneapolis, Minnesota (K.E.U., C.S., N.Z., M.A., A.L., N.G.)
| | - Nicholas Zerzan
- Center for Care Delivery and Outcomes Research, VA Health Care System, Minneapolis, Minnesota (K.E.U., C.S., N.Z., M.A., A.L., N.G.)
| | - Maylen Anthony
- Center for Care Delivery and Outcomes Research, VA Health Care System, Minneapolis, Minnesota (K.E.U., C.S., N.Z., M.A., A.L., N.G.)
| | - Adrienne Landsteiner
- Center for Care Delivery and Outcomes Research, VA Health Care System, Minneapolis, Minnesota (K.E.U., C.S., N.Z., M.A., A.L., N.G.)
| | - Nancy Greer
- Center for Care Delivery and Outcomes Research, VA Health Care System, Minneapolis, Minnesota (K.E.U., C.S., N.Z., M.A., A.L., N.G.)
| | - Mary Butler
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota (M.L.F., M.B.)
| | - Timothy J Wilt
- Center for Care Delivery and Outcomes Research, VA Health Care System, and Department of Medicine and Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota (T.J.W.)
| | - Elisheva R Danan
- Center for Care Delivery and Outcomes Research, VA Health Care System, and Department of Medicine, University of Minnesota, Minneapolis, Minnesota (S.D., E.R.D.)
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Okui N, Okui M. Frailty and the Correlation Between Total Testosterone Levels and Urinary Incontinence Among Elderly Women. Int Urogynecol J 2024:10.1007/s00192-024-05906-0. [PMID: 39215809 DOI: 10.1007/s00192-024-05906-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Accepted: 07/30/2024] [Indexed: 09/04/2024]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to explore the correlation between total testosterone levels and stress urinary incontinence (SUI) and urgency urinary incontinence (UUI) in older patients, emphasizing frailty. METHODS This prospective cross-sectional study included 1,328 women over 60 years of age at an incontinence specialty clinic. Participants were assessed for UI, frailty, using the Japanese Frailty Scale, and total testosterone levels. Analysis of a logistic regression model was employed for age, body mass index (BMI), and vaginal deliveries adjustment, with association and multivariate analyses to evaluate the associations with SUI and UUI. RESULTS The frailty and nonfrailty groups each consisted of 664 individuals. After age, BMI, and the number of vaginal deliveries adjustment, the analysis showed a negative association between total testosterone levels and both SUI (p < 0.001) and UUI (p < 0.001) in the frailty group. Multivariate analysis revealed that, in the nonfrailty group, factors such as low total testosterone levels (p = 0.0145), diabetes (p = 0.0052), and cerebral infarction (p = 0.0254) were related to SUI, whereas no significant factors were associated with UUI. In the frailty group, factors associated with SUI included low total testosterone levels (p < 0.0001), the number of vaginal deliveries (p < 0.0001), smoking (p = 0.0240), chronic lung disease (p < 0.0248), and hypertension (p < 0.0265). Factors associated with UUI were age (p < 0.0001), low total testosterone levels (p = 0.0025), diabetes (p < 0.0001), and the number of vaginal deliveries (p = 0.0152). CONCLUSIONS The study highlights the significance of incorporating the assessment of frailty and testosterone levels in addressing UI among older women, particularly in the aged population, underscoring the need for tailored approaches in this demographic.
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Affiliation(s)
- Nobuo Okui
- Yokosuka Urogynecology and Urology Clinic, Ootaki 2-6, Yokosuka, Kanagawa, 238-0008, Japan.
- Kanagawa Dental University, Inaoka-Cyou 82, Yokosuka, Kanagawa, 238-0003, Japan.
| | - Machiko Okui
- Yokosuka Urogynecology and Urology Clinic, Ootaki 2-6, Yokosuka, Kanagawa, 238-0008, Japan
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Xu W, Zheng B, Su L, Xiang Y. Association of plasma high-density lipoprotein cholesterol level with risk of stress urinary incontinence in women: a retrospective study. Lipids Health Dis 2024; 23:171. [PMID: 38849942 PMCID: PMC11157702 DOI: 10.1186/s12944-024-02137-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 05/08/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Studies have found that high density lipoprotein cholesterol (HDL-C) levels are linked to a variety of diseases. However, evidence for the relationship between stress urinary incontinence (SUI) and HDL-C remain limited. METHODS 590 eligible women were enrolled. Basic characteristic, gynecological examinations and blood sampling were collected. The examination of the possible link between HDL-C and SUI was done using univariate and multivariate logistic regression. Feature importance ranking and Receiver operating characteristic (ROC) curves were performed to further evaluate the association between HDL-C and SUI in women. RESULTS A significant association was found between HDL-C and SUI in women, revealing higher HDL-C levels were related to a lower risk of SUI (OR 0.238; 95%CI: 0.091-0.623; P < 0.01) after adjustment for potential key confounders. The AUC for the SUI predicted by the combined HDL-C was 0.845 (95%CI: 0.798-0.891, P < 0.001). The feature importance ranking revealed that vaginal delivery, HDL-C were the top two important factors. CONCLUSIONS HDL-C levels were correlated with the development of SUI. In addition to physical and surgical treatments, HDL-C may offer the possibility of potential targeted treatment and prevention of SUI afterwards.
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Affiliation(s)
- Wenning Xu
- Health Management Center, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Baojia Zheng
- Health Management Center, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Lili Su
- Health Management Center, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Yali Xiang
- Health Management Center, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China.
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Li W, Wang Z, Li X, Luo R, Huang J, Liu B, Zhou X. Associations Between Serum Estrogen Levels and Urinary Incontinence in Women: A Cross-sectional Analysis of NHANES 2013 to 2016. Urology 2024; 188:63-69. [PMID: 38670273 DOI: 10.1016/j.urology.2024.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 04/13/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024]
Abstract
OBJECTIVE To explore the relationship between serum estrogen levels and urinary incontinence in a nationally representative female population. MATERIALS AND METHODS We included women who had serum estradiol measurements and self-reported urinary incontinence problems in the 2013-2016 National Health and Nutrition Examination Survey cycles. A weighted multivariable logistic regression model was used to determine the association between urinary incontinence and serum estrogen levels after adjusting for age, race, Body Mass Index, diabetes, venipuncture, hypertension, poverty-to-income ratio, smoking, marital status, alcohol use, education, and menopause. RESULT A total of 4114 individuals were ultimately included in our study. Of these women, 1200 (29.17%) complained of urge urinary incontinence (UUI), 1674 (40.69%) complained of stress urinary incontinence (SUI), 730 (17.74%) complained of mixed urinary incontinence (MUI). Women in the lowest quartile of serum estrogen were more likely to complain of UUI compared to those in the highest quartile (OR=1.885; 95% CI=1.042-3.412, P = .039). No association was noted between serum estrogen levels and SUI or MUI. CONCLUSION Our study shows a significant association between low serum estrogen level and the increased likelihood of UUI in women. Further research is required to validate our findings, elucidate the physiological mechanisms that underlie them, and assess potential therapeutic implications.
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Affiliation(s)
- Wenshuang Li
- Department of Urology, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, PR China
| | - Ziqiao Wang
- Department of Urology, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, PR China
| | - Xiaoyang Li
- Department of Urology, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, PR China
| | - Ruixiang Luo
- Department of Urology, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, PR China
| | - Junlong Huang
- Department of Urology, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, PR China
| | - Bolong Liu
- Department of Urology, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, PR China
| | - Xiangfu Zhou
- Department of Urology, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, PR China.
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Jiang J, Chen B, Tang B, Li J, Zhang C, Tan D, Zhang T, Wei Q. Urinary phenols and parabens exposure in relation to urinary incontinence in the US population. BMC Public Health 2024; 24:515. [PMID: 38373965 PMCID: PMC10875867 DOI: 10.1186/s12889-024-17872-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 01/24/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Our study aimed to investigate the impact of urinary concentrations of personal care products (PCPs)-related phenols (PNs) and parabens (PBs), including Triclosan (TCS), Bisphenol A (BPA), Benzophenone-3 (BP-3), Butylparaben (BPB), Ethylparaben (EPB), Methylparaben (MPB), and Propylparaben (PPB), on urinary incontinence (UI) occurrence. METHOD We conducted a cross-sectional analysis using data from the National Health and Nutrition Examination Survey (NHANES) spanning the years 2007 to 2016. Regression analysis was employed to investigate the relationship between exposure to PCPs-related substances, various levels of exposure, and UI within both the general population and the female demographic. Additionally, the Bayesian Kernel Machine Regression (BKMR) model was used to assess the effects of mixtures on UI. RESULTS Our analysis comprised 7,690 participants who self-reported their diagnosis. Among them, 12.80% experienced stress urinary incontinence (SUI), 11.80% reported urge urinary incontinence (UUI), and 10.22% exhibited mixed urinary incontinence (MUI). In our fully adjusted multivariable models, BP-3 exposure exhibited a positive association with SUI (OR 1.07, 95% CI 1.02-1.14, p = 0.045). BPA exposure correlated with an increased risk of UUI (OR 1.21, 95% CI 1.01-1.44, p = 0.046) and MUI (OR 1.26, 95% CI 1.02-1.54, p = 0.029). TCS exposure displayed a negative correlation with the incidence of MUI (OR 0.87, 95% CI 0.79-0.97, p = 0.009). No significant links were observed between parabens and urinary incontinence. Notably, among the female population, our investigation revealed that BPA exposure heightened the risk of MUI (OR 1.28, 95% CI 1.01-1.63, p = 0.043). Participants in the highest tertile of BP-3 exposure demonstrated elevated likelihoods of SUI and MUI compared to those in the lowest tertile. In the BKMR analysis, negative trends were observed between the mixture and the risks of UUI and MUI when the mixture ranged from the 25th to the 40th and 35th to the 40th percentiles or above, respectively. Additionally, a positive trend was identified between the mixture and MUI when it was in the 40th to 55th percentile. CONCLUSION In conclusion, our findings suggest that exposure to BPA, TCS, and BP-3 may contribute to the development of urinary incontinence.
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Affiliation(s)
- Jinjiang Jiang
- Department of Urology, Institute of Urology, West China Hospital of Sichuan University, No. 37, Guoxue Lane, Chengdu, Sichuan, China
| | - Bo Chen
- Department of Urology, Institute of Urology, West China Hospital of Sichuan University, No. 37, Guoxue Lane, Chengdu, Sichuan, China
| | - Bo Tang
- Department of Urology, Institute of Urology, West China Hospital of Sichuan University, No. 37, Guoxue Lane, Chengdu, Sichuan, China
| | - Jinze Li
- Department of Urology, Institute of Urology, West China Hospital of Sichuan University, No. 37, Guoxue Lane, Chengdu, Sichuan, China
| | - Chensong Zhang
- State Key Laboratory of Biotherapy and Cancer Center, Frontiers Science Center for Disease-Related Molecular Network, and National Clinical Research Center for Geriatrics, Sichuan University, Chengdu, Sichuan, China
| | - Daqing Tan
- Department of Urology, Institute of Urology, West China Hospital of Sichuan University, No. 37, Guoxue Lane, Chengdu, Sichuan, China
| | - Ting Zhang
- School of Basic Medicine, Harbin Medical Hospital, Harbin, China
| | - Qiang Wei
- Department of Urology, Institute of Urology, West China Hospital of Sichuan University, No. 37, Guoxue Lane, Chengdu, Sichuan, China.
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Chen Y, Song X, Fang W, Lv T, Huang J, Cai Z, Lv J. Correlation of serum circulating testosterone levels with stress urinary incontinence in postmenopausal women. World J Urol 2023; 41:3651-3656. [PMID: 37906265 DOI: 10.1007/s00345-023-04681-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 10/06/2023] [Indexed: 11/02/2023] Open
Abstract
OBJECTIVES Our study aimed to elucidate the possible relationship between endogenous circulating testosterone and the beginning and development of stress urinary incontinence (SUI) in postmenopausal women. PATIENTS AND METHODS The clinical data of female patients with SUI who underwent surgery at our hospital from January 2014 to February 2023 and healthy female volunteers recruited during the same period were retrospectively analyzed according to age and body mass index (BMI). Venous blood samples were taken from all subjects, and levels of estradiol, luteinizing hormone, prolactin, follicle-stimulating hormone, progesterone, and testosterone were measured by radioimmunoassay. After adjusting for age, BMI, hypertension, mode of delivery, hysterectomy, and profession, multiple logistic regression analysis was used to determine the relationship between SUI and serum testosterone levels in postmenopausal women. RESULTS Serum testosterone levels were significantly lower in women with SUI than in healthy control women (0.92 ± 0.67 vs. 1.28 ± 1.10; P < 0.05). Further comparison of testosterone levels between postmenopausal SUI women and healthy postmenopausal women in postmenopausal subjects revealed that testosterone levels were significantly lower in postmenopausal SUI women than in healthy postmenopausal women (0.84 ± 0.64 vs. 1.23 ± 1.10; P < 0.05). This difference in testosterone levels remained significant after controlling for age, BMI, hypertension, mode of delivery, hysterectomy, and profession in postmenopausal women. CONCLUSION The results of the present study indicate that low levels of serum testosterone are associated with an increased likelihood of stress urinary incontinence in women. Low serum testosterone levels may be a risk factor for SUI in postmenopausal women.
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Affiliation(s)
- Yingxiu Chen
- Department of Urology, Gongli Hospital of Shanghai Pudong New Area, 219 Miao Pu Road, Shanghai, 200135, China
- Department of Urology, Hainan Western Central Hospital, Danzhou, Hainan, China
| | - Xin Song
- Department of Urology, Gongli Hospital of Shanghai Pudong New Area, 219 Miao Pu Road, Shanghai, 200135, China
| | - Weilin Fang
- Department of Urology, Gongli Hospital of Shanghai Pudong New Area, 219 Miao Pu Road, Shanghai, 200135, China
| | - Tingting Lv
- Department of Urology, Gongli Hospital of Shanghai Pudong New Area, 219 Miao Pu Road, Shanghai, 200135, China
| | - Jin Huang
- Department of Urology, Gongli Hospital of Shanghai Pudong New Area, 219 Miao Pu Road, Shanghai, 200135, China
| | - Zhikang Cai
- Department of Urology, Gongli Hospital of Shanghai Pudong New Area, 219 Miao Pu Road, Shanghai, 200135, China
| | - Jianwei Lv
- Department of Urology, Gongli Hospital of Shanghai Pudong New Area, 219 Miao Pu Road, Shanghai, 200135, China.
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Wang XX, Zhang L, Lu Y. Advances in the molecular pathogenesis and cell therapy of stress urinary incontinence. Front Cell Dev Biol 2023; 11:1090386. [PMID: 36846586 PMCID: PMC9944745 DOI: 10.3389/fcell.2023.1090386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/30/2023] [Indexed: 02/11/2023] Open
Abstract
Stress urinary incontinence (SUI) is very common in women. It affects patients' mental and physical health, and imposed huge socioeconomic pressure. The therapeutic effect of conservative treatment is limited, and depends heavily on patient persistence and compliance. Surgical treatment often brings procedure-related adverse complications and higher costs for patients. Therefore, it is necessary to better understand the potential molecular mechanisms underlying stress urinary incontinence and develop new treatment methods. Although some progress has been made in the basic research in recent years, the specific molecular pathogenic mechanisms of SUI are still unclear. Here, we reviewed the published studies on the molecular mechanisms associated with nerves, urethral muscles, periurethral connective tissue and hormones in the pathogenesis of SUI. In addition, we provide an update on the recent progresses in research on the use of cell therapy for treating SUI, including research on stem cells therapy, exosome differentiation and gene regulation.
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Affiliation(s)
- Xiao-xiao Wang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Lei Zhang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
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Wu M, Guo Y, Wei S, Xue L, Tang W, Chen D, Xiong J, Huang Y, Fu F, Wu C, Chen Y, Zhou S, Zhang J, Li Y, Wang W, Dai J, Wang S. Biomaterials and advanced technologies for the evaluation and treatment of ovarian aging. J Nanobiotechnology 2022; 20:374. [PMID: 35953871 PMCID: PMC9367160 DOI: 10.1186/s12951-022-01566-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 07/17/2022] [Indexed: 12/26/2022] Open
Abstract
Ovarian aging is characterized by a progressive decline in ovarian function. With the increase in life expectancy worldwide, ovarian aging has gradually become a key health problem among women. Over the years, various strategies have been developed to preserve fertility in women, while there are currently no clinical treatments to delay ovarian aging. Recently, advances in biomaterials and technologies, such as three-dimensional (3D) printing and microfluidics for the encapsulation of follicles and nanoparticles as delivery systems for drugs, have shown potential to be translational strategies for ovarian aging. This review introduces the research progress on the mechanisms underlying ovarian aging, and summarizes the current state of biomaterials in the evaluation and treatment of ovarian aging, including safety, potential applications, future directions and difficulties in translation.
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Affiliation(s)
- Meng Wu
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.,National Clinical Research Center for Obstetrical and Gynecological Diseases, Wuhan, 430030, Hubei, China.,Key Laboratory of Cancer Invasion and Metastasis, Ministry of Education, Wuhan, 430030, Hubei, China
| | - Yican Guo
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.,National Clinical Research Center for Obstetrical and Gynecological Diseases, Wuhan, 430030, Hubei, China.,Key Laboratory of Cancer Invasion and Metastasis, Ministry of Education, Wuhan, 430030, Hubei, China
| | - Simin Wei
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.,National Clinical Research Center for Obstetrical and Gynecological Diseases, Wuhan, 430030, Hubei, China.,Key Laboratory of Cancer Invasion and Metastasis, Ministry of Education, Wuhan, 430030, Hubei, China
| | - Liru Xue
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.,National Clinical Research Center for Obstetrical and Gynecological Diseases, Wuhan, 430030, Hubei, China.,Key Laboratory of Cancer Invasion and Metastasis, Ministry of Education, Wuhan, 430030, Hubei, China
| | - Weicheng Tang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.,National Clinical Research Center for Obstetrical and Gynecological Diseases, Wuhan, 430030, Hubei, China.,Key Laboratory of Cancer Invasion and Metastasis, Ministry of Education, Wuhan, 430030, Hubei, China
| | - Dan Chen
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.,National Clinical Research Center for Obstetrical and Gynecological Diseases, Wuhan, 430030, Hubei, China.,Key Laboratory of Cancer Invasion and Metastasis, Ministry of Education, Wuhan, 430030, Hubei, China
| | - Jiaqiang Xiong
- Department of Obstetrics and Gynecology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China
| | - Yibao Huang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.,National Clinical Research Center for Obstetrical and Gynecological Diseases, Wuhan, 430030, Hubei, China.,Key Laboratory of Cancer Invasion and Metastasis, Ministry of Education, Wuhan, 430030, Hubei, China
| | - Fangfang Fu
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.,National Clinical Research Center for Obstetrical and Gynecological Diseases, Wuhan, 430030, Hubei, China.,Key Laboratory of Cancer Invasion and Metastasis, Ministry of Education, Wuhan, 430030, Hubei, China
| | - Chuqing Wu
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.,National Clinical Research Center for Obstetrical and Gynecological Diseases, Wuhan, 430030, Hubei, China.,Key Laboratory of Cancer Invasion and Metastasis, Ministry of Education, Wuhan, 430030, Hubei, China
| | - Ying Chen
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.,National Clinical Research Center for Obstetrical and Gynecological Diseases, Wuhan, 430030, Hubei, China.,Key Laboratory of Cancer Invasion and Metastasis, Ministry of Education, Wuhan, 430030, Hubei, China
| | - Su Zhou
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.,National Clinical Research Center for Obstetrical and Gynecological Diseases, Wuhan, 430030, Hubei, China.,Key Laboratory of Cancer Invasion and Metastasis, Ministry of Education, Wuhan, 430030, Hubei, China
| | - Jinjin Zhang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.,National Clinical Research Center for Obstetrical and Gynecological Diseases, Wuhan, 430030, Hubei, China.,Key Laboratory of Cancer Invasion and Metastasis, Ministry of Education, Wuhan, 430030, Hubei, China
| | - Yan Li
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.,National Clinical Research Center for Obstetrical and Gynecological Diseases, Wuhan, 430030, Hubei, China.,Key Laboratory of Cancer Invasion and Metastasis, Ministry of Education, Wuhan, 430030, Hubei, China
| | - Wenwen Wang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China. .,National Clinical Research Center for Obstetrical and Gynecological Diseases, Wuhan, 430030, Hubei, China. .,Key Laboratory of Cancer Invasion and Metastasis, Ministry of Education, Wuhan, 430030, Hubei, China.
| | - Jun Dai
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.,National Clinical Research Center for Obstetrical and Gynecological Diseases, Wuhan, 430030, Hubei, China.,Key Laboratory of Cancer Invasion and Metastasis, Ministry of Education, Wuhan, 430030, Hubei, China
| | - Shixuan Wang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China. .,National Clinical Research Center for Obstetrical and Gynecological Diseases, Wuhan, 430030, Hubei, China. .,Key Laboratory of Cancer Invasion and Metastasis, Ministry of Education, Wuhan, 430030, Hubei, China.
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Yuan X, Balog BM, Lin DL, Hanzlicek B, Kuang M, Yan H, Majerus SJA, Damaser MS. Brain-Derived Neurotrophic Factor Is an Important Therapeutic Factor in Mesenchymal Stem Cell Secretions for Treatment of Traumatic Peripheral Pelvic Injuries. Front Cell Neurosci 2022; 16:866094. [PMID: 35663428 PMCID: PMC9157419 DOI: 10.3389/fncel.2022.866094] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 04/12/2022] [Indexed: 11/18/2022] Open
Abstract
Traumatic neuromuscular injury to the pudendal nerve and urethra during childbirth does not regenerate well and contributes to stress urinary incontinence in women. Mesenchymal stem cells (MSCs) can improve neuroregeneration via their secretions, or secretome, which includes brain-derived neurotrophic factor (BDNF). In this study, we investigated whether BDNF is a key factor in the secretome of MSCs for the facilitation of functional recovery following a dual simulated childbirth injury. BDNF knockdown (KD) MSCs were created using an anti-BDNF shRNA lentivirus vector. A scrambled sequence was used as a transduction control (scrambled). Cells were cultured for 24 h before media was concentrated 50x to create concentrated conditioned media (CCM) containing MSC secretome. CCM of unmanipulated MSCs was screened for high BDNF expression (high BDNF CCM). Concentrated control media (CM) was created by concentrating media not conditioned by cells. Female Sprague-Dawley rats underwent bilateral pudendal nerve crush and vaginal distension (Injury) or sham injury. One hour and 1 week after injury, sham injured rats received CM, and injured rats received CM, high BDNF CCM, KD CCM, or scrambled CCM (300 μl intraperitoneally). Three weeks after injury, rats underwent leak point pressure (LPP) and pudendal nerve sensory branch potential (PNSBP) recordings. The urethra and pudendal nerve were harvested for anatomical assessment. ANOVA followed by the Student-Newman-Keuls test determined significant differences between groups (p < 0.05). BDNF KD CCM had significantly decreased BDNF concentration compared to scrambled CCM, while the concentration in high BDNF CCM was significantly increased. LPP was significantly decreased in CM and KD CCM treated animals compared to sham injury, but not with scrambled or high BDNF CCM. PNSBP firing rate showed a significant decrease with CM treatment compared to sham injury. Neuromuscular junctions in the urethral sphincter in KD CCM, scrambled CCM, and high BDNF CCM were healthier than CM treated rats. While anatomical and nerve function tests demonstrate regeneration of the pudendal nerve with any CCM treatment, LPP results suggest it takes longer to recover continence with reduced BDNF in CCM. BDNF in MSC CCM is an important factor for the acceleration of recovery from a dual nerve and muscle injury.
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Affiliation(s)
- Xiaoyi Yuan
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
- Advanced Platform Technology Center, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, United States
- Department of Urology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Brian M. Balog
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
- Advanced Platform Technology Center, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, United States
- Department of Biology, University of Akron, Akron, OH, United States
| | - Dan Li Lin
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
- Advanced Platform Technology Center, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, United States
| | - Brett Hanzlicek
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
- Advanced Platform Technology Center, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, United States
| | - Mei Kuang
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Hao Yan
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
- Department of Urology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Steve J. A. Majerus
- Advanced Platform Technology Center, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, United States
| | - Margot S. Damaser
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
- Advanced Platform Technology Center, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, United States
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, United States
- *Correspondence: Margot S. Damaser
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Siddle N, Versi E. Stress urinary incontinence and the forgotten female hormones. Int Urogynecol J 2022; 33:1711-1716. [PMID: 35460344 DOI: 10.1007/s00192-022-05178-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 03/21/2022] [Indexed: 10/18/2022]
Abstract
The use of hormones to treat stress urinary incontinence (SUI) has fallen out of favor because of concerns over safety following publication of the Women's Health Initiative study. In addition, there are data that suggest that estrogen treatment does not help SUI. As women age, the decline in androgen output mirrors the increasing prevalence of SUI implying a potential causal association. Therefore, we suggest that androgens are the 'forgotten female hormone.' Vaginal estrogens can treat pelvic floor structures without significant systemic effects; we suggest that vaginal androgens can act similarly and thereby avoid the unwanted systemic effects of androgenization in women. Based on available preclinical and clinical data, we suggest that research should investigate vaginal treatment with androgen hormones as adjunctive therapy to pelvic floor exercises for SUI. In a postmenopausal woman, this could be supplemented with estrogens if trial data warrant it.
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Affiliation(s)
| | - Eboo Versi
- Department of Obstetrics, Gynecology and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, NJ, 08901, USA.
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McLean L, Hickling D. Reply to "Androgen deficiency and stress urinary incontinence". Int Urogynecol J 2022; 33:1355-1356. [PMID: 35348800 DOI: 10.1007/s00192-022-05161-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 03/04/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Linda McLean
- Faculty of Health Sciences, University of Ottawa, Ottawa, Canada.
| | - Duane Hickling
- Department of Surgery, Division of Urology, The Ottawa Hospital, Ottawa, Canada
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Post WM, Widomska J, Grens H, Coenen MJH, Martens FMJ, Janssen DAW, IntHout J, Poelmans G, Oosterwijk E, Kluivers KB. Molecular Processes in Stress Urinary Incontinence: A Systematic Review of Human and Animal Studies. Int J Mol Sci 2022; 23:ijms23063401. [PMID: 35328824 PMCID: PMC8949972 DOI: 10.3390/ijms23063401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/10/2022] [Accepted: 03/18/2022] [Indexed: 02/01/2023] Open
Abstract
Stress urinary incontinence (SUI) is a common and burdensome condition. Because of the large knowledge gap around the molecular processes involved in its pathophysiology, the aim of this review was to provide a systematic overview of genetic variants, gene and protein expression changes related to SUI in human and animal studies. On 5 January 2021, a systematic search was performed in Pubmed, Embase, Web of Science, and the Cochrane library. The screening process and quality assessment were performed in duplicate, using predefined inclusion criteria and different quality assessment tools for human and animal studies respectively. The extracted data were grouped in themes per outcome measure, according to their functions in cellular processes, and synthesized in a narrative review. Finally, 107 studies were included, of which 35 used animal models (rats and mice). Resulting from the most examined processes, the evidence suggests that SUI is associated with altered extracellular matrix metabolism, estrogen receptors, oxidative stress, apoptosis, inflammation, neurodegenerative processes, and muscle cell differentiation and contractility. Due to heterogeneity in the studies (e.g., in examined tissues), the precise contribution of the associated genes and proteins in relation to SUI pathophysiology remained unclear. Future research should focus on possible contributors to these alterations.
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Affiliation(s)
- Wilke M. Post
- Department of Obstetrics and Gynecology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (W.M.P.); (H.G.)
| | - Joanna Widomska
- Department of Human Genetics, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (J.W.); (G.P.)
| | - Hilde Grens
- Department of Obstetrics and Gynecology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (W.M.P.); (H.G.)
| | - Marieke J. H. Coenen
- Radboud Institute of Health Sciences, Department of Human Genetics, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands;
| | - Frank M. J. Martens
- Department of Urology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (F.M.J.M.); (D.A.W.J.); (E.O.)
| | - Dick A. W. Janssen
- Department of Urology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (F.M.J.M.); (D.A.W.J.); (E.O.)
| | - Joanna IntHout
- Department of Health Evidence, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands;
| | - Geert Poelmans
- Department of Human Genetics, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (J.W.); (G.P.)
| | - Egbert Oosterwijk
- Department of Urology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (F.M.J.M.); (D.A.W.J.); (E.O.)
| | - Kirsten B. Kluivers
- Department of Obstetrics and Gynecology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (W.M.P.); (H.G.)
- Correspondence:
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13
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Kreydin E, Siddle N, Versi E. Androgen deficiency and stress urinary incontinence. Int Urogynecol J 2022; 33:1353. [DOI: 10.1007/s00192-022-05116-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 01/22/2022] [Indexed: 11/28/2022]
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14
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Farag AGA, El Shazly MA, Badr EAE, El Desoqy BAA, Elsayed Elshaib M. Relationship of steroid sex hormones with female sexual dysfunction in female patients having urinary incontinence. Steroids 2022; 179:108963. [PMID: 35121167 DOI: 10.1016/j.steroids.2022.108963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 12/17/2021] [Accepted: 01/03/2022] [Indexed: 10/19/2022]
Abstract
To investigate serum estradiol, progesterone and dehydroepiandrosterone levels on FSD in females having urinary incontinence (UI), we studied 150 females [100 having UI (50 with FSD and 50 without FSD) and 50 controls]. There were significant lower estradiol and progesterone and higher DHEA serum levels in patients than controls (P = 0.001for all). In UI patients, females having sexual disruption had significantly low levels of estradiol (p = 0.001). Low estradiol serum level represented an isolated predictive factor for sexual dysfunction in incontinent female patients (p = 0.001). A low estradiol serum level might be a possible risk factor for FSD in women having UI.
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Affiliation(s)
- Azza G A Farag
- Dermatology, Andrology and STDs Department, Faculty of Medicine, Menoufia University, Egypt
| | | | - Eman A E Badr
- Medical Biochemistry and Molecular Biology Department, Faculty of Medicine, Menoufia University, Egypt.
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Application of estrogen for the treatment of stress urinary incontinence in mice. Arch Gynecol Obstet 2022; 305:1115-1125. [PMID: 35174407 DOI: 10.1007/s00404-022-06435-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 02/02/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Stress urinary incontinence (SUI) is a pervasive health tissue among women, which seriously affects the quality of life. The etiology of SUI is complex and diverse in women, with past studies having demonstrated that estrogen deficiency plays an important role in pelvic floor muscle atrophy and urethral degeneration. We comprehensively investigated the effects of estrogen in the treatment of SUI in female mice at cellular and animal levels. METHODS L929 fibroblasts mechanical injury model was established by four-point bending device, and SUI mouse model was established by vaginal dilation method commonly used to simulate labor injury. After estrogen treatment, the expressions of Collagen I, Collagen III, Elastin, TIMP-1, TIMP-2, MMP-2, and MMP-9 were detected, the leak point pressure (LPP) and abdominal leak point pressure (ALPP) of mice in each group were detected, and both the effect of estrogen on extracellular matrix remodeling of mouse urethra and anterior vaginal wall was observed from the histological level. RESULTS The results revealed that an appropriate amount of estrogen can promote the expression of Collagen I, Collagen III, Elastin, TIMP-1, and TIMP-2, decrease the expression of MMP-2 and MMP-9, and maintain the dynamic balance of MMPs/TIMPs at both cellular and animal levels. Meanwhile, we determined that estrogen can increase the LPP and ALPP values of SUI mice. The collagen fibers' content in the mice treated with estrogen was significantly greater than in the control group mice. CONCLUSIONS The estrogen may alleviate the symptoms of SUI by reconstituting ECM, thus laying a solid foundation for further exploration of estrogen therapy.
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Carlin GL, Kimberger O, Morgenbesser R, Umek W, Kölbl H, Bodner K, Bodner-Adler B. COVID-19-Pandemie: ein Belastungstest für urogynäkologische Patientinnen. Geburtshilfe Frauenheilkd 2021. [DOI: 10.1055/a-1336-8527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Carlin GL, Morgenbesser R, Kimberger O, Umek W, Bodner K, Bodner-Adler B. Does the choice of pelvic organ prolapse treatment influence subjective pelvic-floor related quality of life? Eur J Obstet Gynecol Reprod Biol 2021; 259:161-166. [PMID: 33677372 DOI: 10.1016/j.ejogrb.2021.02.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 01/29/2021] [Accepted: 02/18/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The relationship between pelvic organ prolapse (POP) treatment and subjective pelvic-floor related quality of life (QoL) was examined. STUDY DESIGN 130 postmenopausal women with symptomatic POP were included: 45 % (59/130) were treated conservatively with pessary and 55 % (71/130) underwent pelvic floor surgery. All participants answered the validated German pelvic floor questionnaire at the time of baseline examination, as well as three months later. RESULTS Our results demonstrated a significant improvement regarding mean score in the domains "prolapse" (p = 0.001) and "sexual function" (p = 0.001) three months after prolapse surgery, whereas in the pessary group only the score in the "prolapse" domain improved (p < 0.001). When comparing the two treatment arms after three months, patients reported a significant advancement regarding their "sexual function" domain in the surgery group (p < 0.0001). Furthermore, univariate analysis revealed a significant positive correlation between "prolapse" domain score (correlation coefficient = 0.0001) as well as "bladder" domain score (correlation coefficient <0.001) and POP-Q stage. Additionally, a significant negative correlation between "sexual function" domain score and POP-Q stage was found (correlation coefficient = 0.0001). CONCLUSION Our results revealed that three months after prolapse surgery, pelvic-floor related QoL showed significant improvement in the domain "sexual function" compared to three months pessary treatment. Besides, advanced prolapse stage correlated with higher symptom burden and worse sexual function.
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Affiliation(s)
- Greta L Carlin
- Department of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Austria
| | - Raffaela Morgenbesser
- Department of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Austria
| | - Oliver Kimberger
- Department of Anesthesiology, Medical University of Vienna, Austria; Outcomes Research Consortium, Cleveland, OH, USA
| | - Wolfgang Umek
- Department of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Austria; Karl Landsteiner Institute, Department of Special Gynecology and Obstetrics, Austria
| | - Klaus Bodner
- Department of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Austria
| | - Barbara Bodner-Adler
- Department of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Austria; Karl Landsteiner Institute, Department of Special Gynecology and Obstetrics, Austria.
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Castelán F, Cuevas-Romero E, Martínez-Gómez M. The Expression of Hormone Receptors as a Gateway toward Understanding Endocrine Actions in Female Pelvic Floor Muscles. Endocr Metab Immune Disord Drug Targets 2021; 20:305-320. [PMID: 32216732 DOI: 10.2174/1871530319666191009154751] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 07/06/2019] [Accepted: 07/19/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To provide an overview of the hormone actions and receptors expressed in the female pelvic floor muscles, relevant for understanding the pelvic floor disorders. METHODS We performed a literature review focused on the expression of hormone receptors mainly in the pelvic floor muscles of women and female rats and rabbits. RESULTS The impairment of the pelvic floor muscles can lead to the onset of pelvic floor dysfunctions, including stress urinary incontinence in women. Hormone milieu is associated with the structure and function alterations of pelvic floor muscles, a notion supported by the fact that these muscles express different hormone receptors. Nuclear receptors, such as steroid receptors, are up till now the most investigated. The present review accounts for the limited studies conducted to elucidate the expression of hormone receptors in pelvic floor muscles in females. CONCLUSION Hormone receptor expression is the cornerstone in some hormone-based therapies, which require further detailed studies on the distribution of receptors in particular pelvic floor muscles, as well as their association with muscle effectors, involved in the alterations relevant for understanding pelvic floor disorders.
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Affiliation(s)
- Francisco Castelán
- Department of Cellular Biology and Physiology, Biomedical Research Institute, National Autonomous University of Mexico, Mexico City, Mexico.,Tlaxcala Center for Behavioral Biology, Autonomous University of Tlaxcala, Tlaxcala, Mexico
| | - Estela Cuevas-Romero
- Tlaxcala Center for Behavioral Biology, Autonomous University of Tlaxcala, Tlaxcala, Mexico
| | - Margarita Martínez-Gómez
- Department of Cellular Biology and Physiology, Biomedical Research Institute, National Autonomous University of Mexico, Mexico City, Mexico.,Tlaxcala Center for Behavioral Biology, Autonomous University of Tlaxcala, Tlaxcala, Mexico
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Russo E, Caretto M, Giannini A, Bitzer J, Cano A, Ceausu I, Chedraui P, Durmusoglu F, Erkkola R, Goulis DG, Kiesel L, Lambrinoudaki I, Hirschberg AL, Lopes P, Pines A, Rees M, van Trotsenburg M, Simoncini T. Management of urinary incontinence in postmenopausal women: An EMAS clinical guide. Maturitas 2020; 143:223-230. [PMID: 33008675 DOI: 10.1016/j.maturitas.2020.09.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 09/21/2020] [Accepted: 09/21/2020] [Indexed: 01/07/2023]
Abstract
INTRODUCTION The prevalence of urinary incontinence and of other lower urinary tract symptoms increases after the menopause and affects between 38 % and 55 % of women aged over 60 years. While urinary incontinence has a profound impact on quality of life, few affected women seek care. AIM The aim of this clinical guide is to provide an evidence-based approach to the management of urinary incontinence in postmenopausal women. MATERIALS AND METHODS Literature review and consensus of expert opinion. SUMMARY RECOMMENDATIONS Healthcare professionals should consider urinary incontinence a clinical priority and develop appropriate diagnostic skills. They should be able to identify and manage any relevant modifiable factors that could alleviate the condition. A wide range of treatment options is available. First-line management includes lifestyle and behavioral modification, pelvic floor exercises and bladder training. Estrogens and other pharmacological interventions are helpful in the treatment of urgency incontinence that does not respond to conservative measures. Third-line therapies (e.g. sacral neuromodulation, intravesical onabotulinum toxin-A injections and posterior tibial nerve stimulation) are useful in selected patients with refractory urge incontinence. Surgery should be considered in postmenopausal women with stress incontinence. Midurethral slings, including retropubic and transobturator approaches, are safe and effective and should be offered.
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Affiliation(s)
- Eleonora Russo
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56100, Pisa, Italy
| | - Marta Caretto
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56100, Pisa, Italy
| | - Andrea Giannini
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56100, Pisa, Italy
| | - Johannes Bitzer
- Department of Obstetrics and Gynecology, University Hospital, Basel, Switzerland
| | - Antonio Cano
- Department of Pediatrics, Obstetrics and Gynecology, University of Valencia and INCLIVA, Valencia, Spain
| | - Iuliana Ceausu
- Department of Obstetrics and Gynecology I, "Dr. I. Cantacuzino" Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Peter Chedraui
- Instituto de Investigación e Innovación de Salud Integral (ISAIN), Facultad de Ciencias Médicas, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador
| | - Fatih Durmusoglu
- İstanbul Medipol International School of Medicine, Istanbul, Turkey
| | - Risto Erkkola
- Department of Obstetrics and Gynecology, University Central Hospital, Turku, Finland
| | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Greece
| | - Ludwig Kiesel
- Department of Gynecology and Obstetrics, University of Münster, Münster, Germany
| | - Irene Lambrinoudaki
- Second Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Greece
| | - Angelica Lindén Hirschberg
- Department of Women's and Children's Health, Karolinska Institutet and Department of Gynecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Patrice Lopes
- Nantes, France Polyclinique de l'Atlantique Saint Herblain. F 44819 St Herblain France, Université de Nantes F, 44093, Nantes, Cedex, France
| | - Amos Pines
- Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Margaret Rees
- Women's Centre, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - Mick van Trotsenburg
- Department of Obstetrics and Gynecology, University Hospital St. Poelten, Lilienfeld, Austria
| | - Tommaso Simoncini
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56100, Pisa, Italy.
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21
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Affiliation(s)
- S. L. Johnston
- Department of Obstetrics and Gynaecology, Queen’s University, Kingston, ON, Canada
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22
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Tan R, Pu D, Cao J, Ge H, Chang X, Ye G, Wu J. Prevalence of Stress Urinary Incontinence in Women with Premature Ovarian Insufficiency. J Womens Health (Larchmt) 2018; 27:1508-1512. [PMID: 30484729 DOI: 10.1089/jwh.2018.6935] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: To determine the prevalence of stress urinary incontinence (SUI) and associated factors in women with premature ovarian insufficiency (POI). Materials and Methods: The study included 149 patients with POI and 303 control women without POI. Age, body mass index (BMI), gestational history, time since onset of POI, and status of hormone therapy (HT) for POI were recorded. Results: There was no statistical difference in the mean age, BMI, and parity between the two groups. The prevalence of SUI in the POI group tended to be higher than that in the control group (20.9%, 30/149 vs. 16.2%, 49/303), although not significantly (p = 0.297). About 41.6% (62/149) of patients with POI received HT. Patients with POI and SUI were older (p = 0.018) and had higher BMI (p = 0.007) than women with POI without SUI (p = 0.007). Compared to nulliparas, primiparas were more likely to have SUI (p = 0.046). However, SUI developed irrespective of time since onset of oligomenorrhea/amenorrhea or HT use. Furthermore, regression analysis showed that the prevalence of SUI was higher in women 30-39 years of age (odds ratio [OR] = 3.27, p = 0.002) and older than 40 years (OR = 7.78, p = 0.001). Primiparas (OR = 2.89, p = 0.001) and vaginal delivery (OR = 2.58, p = 0.023) were associated with SUI. Conclusions: The prevalence of SUI was fairly high among patients with POI, and age, parity, and vaginal delivery were the main risk factors. However, duration of POI and HT use had no effect on SUI. Increasing awareness of the importance of urinary system health in this population will improve the quality of life for these women.
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Affiliation(s)
- Rongrong Tan
- State Key Laboratory of Reproductive Medicine, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Nanjing Medical University/Jiangsu Province Hospital, Nanjing Medical University, Nanjing, China
| | - Danhua Pu
- State Key Laboratory of Reproductive Medicine, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Nanjing Medical University/Jiangsu Province Hospital, Nanjing Medical University, Nanjing, China
| | - Jinxiang Cao
- State Key Laboratory of Reproductive Medicine, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Nanjing Medical University/Jiangsu Province Hospital, Nanjing Medical University, Nanjing, China
| | - Huan Ge
- State Key Laboratory of Reproductive Medicine, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Nanjing Medical University/Jiangsu Province Hospital, Nanjing Medical University, Nanjing, China
| | - Xiaoxia Chang
- State Key Laboratory of Reproductive Medicine, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Nanjing Medical University/Jiangsu Province Hospital, Nanjing Medical University, Nanjing, China
| | - Guihua Ye
- State Key Laboratory of Reproductive Medicine, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Nanjing Medical University/Jiangsu Province Hospital, Nanjing Medical University, Nanjing, China
| | - Jie Wu
- State Key Laboratory of Reproductive Medicine, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Nanjing Medical University/Jiangsu Province Hospital, Nanjing Medical University, Nanjing, China
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Ignácio Antônio F, Herbert RD, Bø K, Rosa-E-Silva ACJS, Lara LAS, Franco MDM, Ferreira CHJ. Pelvic floor muscle training increases pelvic floor muscle strength more in post-menopausal women who are not using hormone therapy than in women who are using hormone therapy: a randomised trial. J Physiother 2018; 64:166-171. [PMID: 29914808 DOI: 10.1016/j.jphys.2018.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 05/05/2018] [Accepted: 05/14/2018] [Indexed: 10/28/2022] Open
Abstract
QUESTION Are there differences in the effectiveness of pelvic floor muscle training on pelvic floor muscle strength and urinary incontinence symptoms in postmenopausal women who are and are not using hormone therapy? DESIGN Randomised, controlled trial with concealed allocation, blinded assessors, and intention-to-treat analysis. PARTICIPANTS Ninety-nine postmenopausal women, 38 of whom were using daily systemic oestrogen/progestogen therapy. INTERVENTION The experimental group (n=51) received an intensive supervised pelvic floor muscle training protocol, and the control group (n=48) received no intervention. The randomisation was stratified by hormone therapy use. OUTCOME MEASURES Change in pelvic floor muscle strength assessed with manometry at 12 weeks. Prevalence and severity of urinary incontinence symptoms were assessed using questionnaires. RESULTS Eighty-eight women provided data that could be included in the analysis. Pelvic floor muscle training increased pelvic floor muscle strength by 8.0 cmH2O (95% CI 3.4 to 12.6) in women not using hormone therapy and by -0.9 cmH20 (95% CI -6.5 to 4.8) in women using hormone therapy (interaction p=0.018). A sensitivity analysis showed that the greater training effect in women who were not using hormone therapy was still apparent if the analysis was conducted on percentage change in strength rather than absolute change in strength. There was also a significantly greater effect of training in women not using hormone therapy on prevalence of urinary incontinence symptoms (ratio of odds ratios=7.4; interaction p=0.028). The difference in effects on severity of urinary incontinence symptoms was not statistically significant (interaction p=0.37). CONCLUSION Pelvic floor muscle training increases pelvic floor muscle strength more in women who are not using hormone therapy than in women using hormone therapy. TRIAL REGISTRATION ClinicalTrials.gov NCT02549729. [Ignácio Antônio F, Herbert RD, Bø K, Rosa-e-Silva ACJS, Lara LAS, Franco MdM, Ferreira CHJ (2018) Pelvic floor muscle training increases pelvic floor muscle strength more in post-menopausal women who are not using hormone therapy than in women who are using hormone therapy: a randomised trial. Journal of Physiotherapy 64: 166-171].
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Affiliation(s)
- Flávia Ignácio Antônio
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Kari Bø
- Norwegian School of Sport Sciences Department of Sports Medicine, Oslo and Akershus University Hospital, Department of Obstetrics and Gynecology, Lørenskog, Norway
| | | | - Lúcia Alves Silva Lara
- Department of Obstetrics and Gynecology, Ribeirão Preto Medical School, Univesity of São Paulo, Ribeirão Preto, Brazil
| | - Maira de Menezes Franco
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
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Kim MM, Kreydin EI. The Association of Serum Testosterone Levels and Urinary Incontinence in Women. J Urol 2018; 199:522-527. [DOI: 10.1016/j.juro.2017.08.093] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Michelle M. Kim
- Department of Urology, Massachusetts General Hospital, Boston, Massachusetts
- Institute of Urology, Keck School of Medicine of University of Southern California (EIK), Los Angeles, California
| | - Evgeniy I. Kreydin
- Department of Urology, Massachusetts General Hospital, Boston, Massachusetts
- Institute of Urology, Keck School of Medicine of University of Southern California (EIK), Los Angeles, California
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Bodner-Adler B, Bodner K, Kimberger O, Halpern K, Koelbl H, Umek W. Association of endogenous circulating sex steroids and condition-specific quality of life domains in postmenopausal women with pelvic floor disorders. Arch Gynecol Obstet 2018; 297:725-730. [PMID: 29335782 PMCID: PMC5808066 DOI: 10.1007/s00404-018-4650-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 01/03/2018] [Indexed: 12/01/2022]
Abstract
Objective To examine the relationship between endogenous sex steroids and various condition-specific quality of life domains in postmenopausal women with pelvic floor disorders. We hypothesized that woman with lowest androgen and estradiol concentrations would report worse scores of quality of life domains. Methods Forty-six women with pelvic organ prolapse (POP) and 47 cases with stress urinary incontinence (SUI) answered the validated pelvic floor questionnaire and underwent serum sex steroid measurement. A multivariate logistic regression model was used to determine the association between subjective outcome parameters and serum hormonal levels after adjusting for confounders. Results Univariate analysis revealed a strong inverse correlation between serum estradiol level (E2) and prolapse domain score (correlation coefficient = 0.005) as well as a significant positive correlation between SHBG level and prolapse domain score (correlation coefficient = 0.019) in cases with POP. Furthermore, the sex domain score showed a significant negative correlation with the androstendion (correlation coefficient = 0.020), DHEAS (correlation coefficient = 0.046) and testosterone level (correlation coefficient = 0.032) in the POP group. In the multivariate model, high serum SHBG (CI: 0.007–0.046) remained independently associated with worse scores in the prolapse domain and low serum DHEAS (CI: − 0.989 to 1.320) persisted as a significant predictor for a worse score in the sex domain. Regarding SUI cases, no association was noted between serum hormonal levels and quality of life related pelvic floor domains (correlation coefficient > 0.05). Conclusion Our results suggest that pelvic floor related quality of life might also be affected by endogenous sex steroids in POP, but not in SUI cases.
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Affiliation(s)
- Barbara Bodner-Adler
- Department of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Klaus Bodner
- Department of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Oliver Kimberger
- Department of Anesthesiology, Medical University of Vienna, Vienna, Austria.,Outcomes Research Consortium, Cleveland, OH, USA
| | - Ksenia Halpern
- Department of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Heinz Koelbl
- Department of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Wolfgang Umek
- Department of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.,Department of Special Gynecology and Obstetrics, Karl Landsteiner Institute, Vienna, Austria
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Cruz Y, Lucio RA, Palacios JL. Neural and Endocrine Factors Contribute to the Comorbidity of Urinary and Sexual Dysfunctions. CURRENT SEXUAL HEALTH REPORTS 2017. [DOI: 10.1007/s11930-017-0129-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Park YW, Lee JH. Female urinary incontinence and obesity assessed by anthropometry and dual-energy X-ray absorptiometry: Analysis from the 2008-09 Korean National Health and Nutrition Examination Survey. Low Urin Tract Symptoms 2017; 11:O28-O33. [PMID: 29119694 DOI: 10.1111/luts.12207] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 08/21/2017] [Accepted: 09/11/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE In the present study we evaluated the association between obesity, assessed by dual energy X-ray absorptiometry (DEXA), and urinary incontinence (UI). METHODS The study was performed on 5792 women who had taken part in the Korean National Health and Nutrition Examination Survey. UI was deemed to be present if a woman answered "yes" to the question "Do you have current UI?". Obesity was assessed using anthropometry and DEXA. Data were analyzed using Chi-squared tests, t-tests, receiver operating characteristic curves, and logistic regression analysis. RESULTS The UI group had significantly higher mean (±SD) waist circumference (78.5 ± 10.0 vs, 82.4±9.1 kg) and body mass index (23.3 ± 3.4 vs. 24.2 ± 3.1 kg/m2 ) than the non-UI group. In addition, total fat mass (18.5 ± 5.3 vs. 19.4 ± 4.9 kg), trunk fat mass (9.3 ± 3.4 vs. 10.1 ± 3.2 kg), the trunk fat/leg fat (mass) ratio (1.58 ± 0.54 vs. 1.73 ± 0.50), total body fat percentage (32.3 ± 5.4% vs. 33.0 ± 5.0%), and trunk fat percentage (32.4 ± 7.3% vs. 33.9 ± 6.6%) were significantly higher in the UI group. Of these parameters, the trunk fat/leg fat ratio showed highest sensitivity (83.6%), with a cut-off value of 1.272. Before and after adjustment, trunk fat/leg fat ratio >1.272 was significantly related to UI and had the highest odds ratio (OR) among all DEXA parameters (adjusted OR 1.807; 95% confidence interval 1.343-2.431). CONCLUSION Obesity parameters obtained using DEXA are closely related to UI. Of these parameters, the trunk fat/leg fat ratio is the strongest in predicting the presence of UI. In addition, the present study has found a novel trunk fat/leg fat ratio cut-off value for defining obesity related to the UI.
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Affiliation(s)
- Yeon Won Park
- Department of Urology, National Police Hospital, Seoul, Korea
| | - Jun Ho Lee
- Department of Urology, National Police Hospital, Seoul, Korea
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Cuevas-Romero E, Sánchez-Cardiel A, Zamora-Gallegos AM, Cruz-Lumbreras R, Corona-Quintanilla DL, Castelán F, Martínez-Gómez M. Moderate-to-high normal levels of thyrotropin is a risk factor for urinary incontinence and an unsuitable quality of life in women over 65 years. Clin Exp Pharmacol Physiol 2017; 44 Suppl 1:86-92. [DOI: 10.1111/1440-1681.12788] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 04/17/2017] [Accepted: 05/12/2017] [Indexed: 01/03/2023]
Affiliation(s)
- Estela Cuevas-Romero
- Centro Tlaxcala de Biología de la Conducta; Universidad Autónoma de Tlaxcala; Tlaxcala Mexico
| | | | | | - Rosalía Cruz-Lumbreras
- Doctorado en Ciencias Biológicas; Universidad Autónoma de Tlaxcala; Tlaxcala Mexico
- Facultad de Ciencias de la Salud; Universidad Autónoma de Tlaxcala; Tlaxcala Mexico
| | | | - Francisco Castelán
- Centro Tlaxcala de Biología de la Conducta; Universidad Autónoma de Tlaxcala; Tlaxcala Mexico
- Instituto de Investigaciones Biomédicas; Universidad Autónoma de México; Tlaxcala Mexico
| | - Margarita Martínez-Gómez
- Centro Tlaxcala de Biología de la Conducta; Universidad Autónoma de Tlaxcala; Tlaxcala Mexico
- Instituto de Investigaciones Biomédicas; Universidad Autónoma de México; Tlaxcala Mexico
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Lee JH, Lee HS. Nutrient intake and urinary incontinence in Korean women: A propensity score-matched analysis from the Korea National Health and Nutrition Examination Survey data. Int J Urol 2017; 24:793-797. [PMID: 28845528 DOI: 10.1111/iju.13439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Accepted: 07/27/2017] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To evaluate the relationship between dietary nutrients and female urinary incontinence using nationally representative data from Korea. METHODS We included 8090 women aged >20 years who had participated in the Korea National Health and Nutrition Examination Survey IV. We carried out a propensity-matched study by identifying women with urinary incontinence. Women without urinary incontinence, matched for age, body mass index, menopause, delivery history, hypertension, diabetes, hypercholesterolemia, stroke, asthma, chronic obstructive pulmonary disease and amount of total food intake, were included as a control group at a 2:1 ratio (661 women with urinary incontinence; 1322 women without urinary incontinence). Data were analyzed using the χ2 -test, Mann-Whitney test, Fisher's exact test and logistic regression. RESULTS Following propensity score matching, 661 women with urinary incontinence and 1322 women without urinary incontinence were included; the confounders were evenly dispersed and did not differ significantly between the groups. There was no significant difference in the intake of water, fat, protein, calcium, phosphorus, iron, sodium, potassium, vitamin A, carotene, riboflavin, niacin and vitamin C. However, carbohydrate intake was significantly higher in the urinary incontinence group than in the control group (median [interquartile range]: 282.3 g/day [214.7; 352.0] vs 267.7 g/day [212.6; 339.1]; P = 0.041). CONCLUSION High carbohydrate intake seems to be significantly related to female urinary incontinence in the Korean population.
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Affiliation(s)
- Jun Ho Lee
- Department of Urology, National Police Hospital, Seoul, Korea
| | - Hyo Serk Lee
- Department of Urology, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine, Seoul, Korea
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Lee HS, Lee JH. Vitamin D and Urinary Incontinence among Korean Women: a Propensity Score-matched Analysis from the 2008-2009 Korean National Health and Nutrition Examination Survey. J Korean Med Sci 2017; 32:661-665. [PMID: 28244294 PMCID: PMC5334166 DOI: 10.3346/jkms.2017.32.4.661] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 12/11/2016] [Indexed: 12/18/2022] Open
Abstract
A recent study investigated the role of vitamin D in urinary incontinence (UI). However, very few data are available on this topic. Therefore, we evaluated these relationships using nationally representative data from Korea. We included 6,451 women over the age of 20 years who had participated in the Korea National Health and Nutrition Examination Survey IV. We conducted a propensity-matched study by identifying women with UI. Women without UI, matched for menopause, number of pregnancies, hypertension, diabetes, body mass index, age, stroke, asthma, and chronic obstructive pulmonary disease, were selected as a control group at a 2:1 ratio. The χ² test, t-test and logistic regression analyses were used. Following propensity score matching, 558 UI cases and 1,116 normal controls were included, and confounders (menopause, hypertension, diabetes mellitus, asthma, age, obesity, and number of pregnancies) were evenly dispersed and did not differ significantly between the groups. There was no significant difference between the mean vitamin D levels of the UI and normal groups (vitamin D: 18.4 ± 6.6 vs. 18.5 ± 7.0 ng/mL; P = 0.752). Additionally, there was no significant difference in the distribution of vitamin D levels (< 20 ng/mL, 20-30 ng/mL, > 30 ng/mL: 63.8%, 30.5%, and 5.7% in normal controls, 64.0%, 27.8%, and 8.2% in UI cases; P = 0.107). In conclusion, low serum vitamin D is not significantly and independently related to female UI after propensity score matching in representative Korean data.
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Affiliation(s)
- Hyo Serk Lee
- Department of Urology, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine, Seoul, Korea
| | - Jun Ho Lee
- Department of Urology, National Police Hospital, Seoul, Korea.
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