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Peinado Molina RA, Martínez Vázquez S, Martínez Galiano JM, Rivera Izquierdo M, Khan KS, Cano-Ibáñez N. Prevalence of depression and anxiety in women with pelvic floor dysfunctions: A systematic review and meta-analysis. Int J Gynaecol Obstet 2024. [PMID: 38859723 DOI: 10.1002/ijgo.15719] [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: 02/05/2024] [Accepted: 05/23/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND Female pelvic floor dysfunction (PFD) is a common condition affecting the emotional well-being of women. OBJECTIVE To estimate the prevalence of depressive and anxiety symptoms in women with PFD. SEARCH STRATEGY, SELECTION CRITERIA, DATA COLLECTION AND ANALYSIS: Following prospective registration (PROSPERO CRD42022362095) we conducted a search of three electronic databases (PubMed, Web of Science and Scopus) from inception to April 2023 without language restriction to capture studies reporting the prevalence of depression/anxiety among women with PFD (chronic pelvic pain [CPP], urinary incontinence [UI], pelvic organ prolapse [POP], and/or fecal incontinence [FI]). Only studies with validated tools were included. Data extraction and study quality assessment were performed by two independent reviewers. Stratifying by type of PFD, rates of depression and anxiety were pooled using random effects model computing 95% confidence interval (CI) and assessing heterogeneity using the I2 statistic. Funnel plots were used to detect potential reporting biases and small-study effects. MAIN RESULTS The search yielded 767 articles, from which 54 studies containing 632 605 women were included. All the studies were high quality. The prevalence of depression was: CPP 26.8% (95% CI: 19.2-34.4, I2 = 98.7%; 12 studies, 4798 participants with 491 cases; Egger's P value = 0.009); UI 26.3% (95% CI: 19.4-33.2, I2 = 99.9%; 26 studies, a total of 346 114 participants with 25 050 cases; Egger's P value = 0.944); POP 34.9% (95% CI: 24.3-45.6, I2 = 68%; three studies, 297 participants with 104 cases; Egger's P value = 0.973); and FI 25.3% (95% CI: 0.68-49.9, I2 = 99.7%; six studies, 14 663 participants with 1773 cases; Egger's P value = 0.780). The prevalence of anxiety was: CPP 29.5% (95% CI: 16.3-42.7, I2 = 97.7%; nine studies, 2483 participants with 349 cases; Egger's P value = 0.001); UI 46.91% (95% CI: 39.1-54.6, I2 = 99.6%; 11 studies, 198 491 participants with 40 058 cases; Egger's P value = 0.337); and POP 28% (95% CI: 13.6-42.4, I2 = 89%; three studies with 355 participants with 90 cases; Egger's P value = 0.306). CONCLUSION The prevalence of mental health illness was variable in the different types of PFDs. This meta-analysis helps quantify the burden of depression and anxiety in PFD and will help inform the policies regarding screening of emotional well-being by healthcare professionals engaged in care of women with PFD.
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Affiliation(s)
| | | | - Juan Miguel Martínez Galiano
- Department of Nursing, University of Jaen, Jaén, Spain
- Consortium for Biomedical Research in the Epidemiology and Public Health Network (CIBERESP), Madrid, Spain
| | - Mario Rivera Izquierdo
- Consortium for Biomedical Research in the Epidemiology and Public Health Network (CIBERESP), Madrid, Spain
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria (ibs. Granada), Granada, Spain
| | - Khalid Saeed Khan
- Consortium for Biomedical Research in the Epidemiology and Public Health Network (CIBERESP), Madrid, Spain
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Granada, Granada, Spain
| | - Naomi Cano-Ibáñez
- Consortium for Biomedical Research in the Epidemiology and Public Health Network (CIBERESP), Madrid, Spain
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria (ibs. Granada), Granada, Spain
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Yang C, Wang SZ, Chen S, Du S, Wang GQ, Guo W, Xie XL, Peng BH, Du SH, Zhao JP. Clinical practice guideline for acupuncture and moxibustion: Female urinary incontinence. JOURNAL OF INTEGRATIVE MEDICINE 2024; 22:258-269. [PMID: 38677968 DOI: 10.1016/j.joim.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 03/18/2024] [Indexed: 04/29/2024]
Abstract
Urinary incontinence (UI) is a common problem worldwide. It has a major impact on physical and social activities and interpersonal relationships. UI is common in women, but is under-reported and under-treated. It affects the quality of life of female patients severely. Acupuncture and moxibustion have been proposed as potentially effective interventions for female UI. Hence, for the benefit of acupuncture practitioners around the world, the World Federation of Acupuncture-moxibustion Societies initiated a project to develop a clinical practice guideline (CPG) for the use of acupuncture and moxibustion to treat female UI. This CPG was developed according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology, referring to the principles of the World Health Organization Handbook for Guideline Development. During the development of the CPG, the guideline development group (GDG) played an important role. The clinical questions, recommendations and therapeutic protocols were all formulated by GDG using the modified Delphi method. This CPG contains ten recommendations about the use of acupuncture and moxibustion interventions for ten clinical questions, which include nine conditional recommendations for the intervention and one conditional recommendation for either the intervention or the comparison. This CPG also provides one protocol for conventional filiform needle therapy, two therapy protocols for deep needling stimulation on lumbosacral acupoints, and four moxibustion therapy protocols, based on the protocols presented in randomized controlled trials reviewed by the GDG. Please cite this article as: Yang C, Wang SZ, Chen S, Du S, Wang GQ, Guo W, Xie XL, Peng BH, Du SH, Zhao JP. Clinical practice guideline for acupuncture and moxibustion: Female urinary incontinence. J Integr Med. 2024; 22(3): 258-269.
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Affiliation(s)
- Chao Yang
- Department of Acupuncture and Moxibustion, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
| | - Shan-Ze Wang
- Department of Acupuncture and Moxibustion, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou 510120, Guangdong Province, China
| | - Sheng Chen
- Department of Acupuncture and Moxibustion, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
| | - Shuo Du
- Department of Acupuncture and Moxibustion, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
| | - Guan-Qun Wang
- Department of Acupuncture and Moxibustion, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
| | - Wei Guo
- Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Xiao-Long Xie
- Department of Acupuncture and Moxibustion, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
| | - Bi-Hui Peng
- Department of Acupuncture and Moxibustion, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
| | - Shi-Hao Du
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China.
| | - Ji-Ping Zhao
- Department of Acupuncture and Moxibustion, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China.
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Long T, Cheng B, Zhang K. Abdominal obesity as assessed by anthropometric measures associates with urinary incontinence in females: findings from the National Health and Nutrition Examination Survey 2005-2018. BMC Womens Health 2024; 24:212. [PMID: 38566030 PMCID: PMC10986057 DOI: 10.1186/s12905-024-03059-2] [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: 09/07/2023] [Accepted: 03/28/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Urinary incontinence (UI) is significantly link to abdominal obesity. This study aimed to assess the association between anthropometric indices of abdominal obesity, including body roundness index (BRI), conicity index (CI), and waist-to-height ratio (WHtR), and UI risk in adult females. METHODS We analyzed data from 10, 317 adult females in the National Health and Nutrition Examination Survey (NHANES) database (2005-2018). Weighted multivariable-adjusted regression analysis was conducted to determine the odds ratio (OR) and 95% confidence intervals (CI) for the association between BRI, CI, WHtR, and UI. Stratified analyses revealed the association based on the population type. Receiver operating characteristic curve (ROC) analyses were used to assess the predictive value of UI. RESULTS All indices of abdominal obesity investigated were positively and independently associated with the prevalence and severity of three types of UI. After adjusting for all relevant confounding variables, a significantly positive association between BRI and the prevalence of UI were observed (OR quartile 4 vs. quartile 1: urge UI (UUI): 1.93, 95% CI 1.61-2.30; stress UI (SUI): 2.29, 95% CI 1.94-2.70; mixed UI (MUI): 2.26, 95% CI 1.82-2.82; all P < 0.0001, P for trend < 0.0001, respectively), as well as WHtR and CI, which particularly prominent for female in premenopausal. Moreover, a one-unit increment of BRI was significantly associated with an increased severity index of UUI (β: 0.06, 95% CI 0.04-0.09, P < 0.0001), SUI (β: 0.10, 95% CI 0.07-0.13, P < 0.0001) and MUI (β: 0.07, 95% CI 0.04-0.10, P < 0.0001), which this trend was also observed in each subtype of UI for WHtR and CI. Furthermore, the ROC analysis demonstrated a higher diagnostic efficacy of BRI and WHtR compared with BMI in discriminating UI with an AUC of 0.600 for SUI, 0.617 for UUI, and 0.622 for MUI (all P < 0.05). CONCLUSIONS An increased BRI, CI, and WHtR are significantly associated with higher prevalence and severity of UI in females.
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Affiliation(s)
- Ting Long
- Department of Pelvic Floor, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, 410007, China
| | - Bohuai Cheng
- Department of Otorhinolaryngology Head and Neck Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, China
| | - Ke Zhang
- Department of Pelvic Floor, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, 410007, China.
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Geynisman-Tan J, Cherupally M, Alexandria SJ, Brown T, Collins S, Mathews A, Pedamallu H, Kenton KS, Persell SD. Urinary Incontinence in Primary Care-The Gap Between Recommendations and Real World. UROGYNECOLOGY (PHILADELPHIA, PA.) 2024:02273501-990000000-00203. [PMID: 38624025 DOI: 10.1097/spv.0000000000001471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
IMPORTANCE Routine screening for urinary incontinence (UI) by primary care providers (PCPs) is recommended. OBJECTIVES We aimed to describe the rate of incident UI diagnosed at annual PCP visits, the prevalence of UI in a large primary care population, and estimate the rate of screening for UI during primary care preventive and annual wellness visits. Secondary aims were to describe PCP knowledge and behavior as they relate to UI screening and diagnosis. STUDY DESIGN The electronic health record was used to abstract the number of adult female patients seen by PCPs within a regional health system with a diagnosis of UI before our study period and with a new diagnosis over a 2-year period. Additional new diagnoses and screening practices were found on chart review of an additional 824 representative charts. Primary care providers within the health system were surveyed about their screening practices and knowledge about UI. RESULTS There were 192,053 women primary care patients seen over 2 years. A total of 5.7% had a UI diagnosis preceding the study period and 3.4% had a UI diagnosis during the study period. A total of 42% of PCPs reported that they screen for UI at least half the time and none were completely satisfied with their ability to screen for UI. Sixteen percent of annual wellness visits had any documentation of screening for UI. CONCLUSION In a large primary care population, screening for and detection of UI in women was low.
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Affiliation(s)
- Julia Geynisman-Tan
- From the Division of Female Pelvic Medicine and Reconstructive Surgery, Northwestern University
| | | | - Shaina J Alexandria
- Department of Preventive Medicine (Biostatistics), Northwestern University Feinberg School of Medicine, Evanston
| | - Tiffany Brown
- Division of General Internal Medicine, Northwestern University
| | - Sarah Collins
- Section of Urogynecology and Pelvic Reconstructive Surgery, University of Chicago, Chicago
| | | | | | - Kimberly S Kenton
- Section Chief of Urogynecology and Reconstructive Pelvic Surgery and Vice Chair of Research, University of Chicago, Chicago
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Smith AL, Berry A, Brubaker L, Cunningham SD, Gahagan S, Low LK, Mueller M, Sutcliffe S, Williams BR, Brady SS. The brain, gut, and bladder health nexus: A conceptual model linking stress and mental health disorders to overactive bladder in women. Neurourol Urodyn 2024; 43:424-436. [PMID: 38078701 PMCID: PMC10872494 DOI: 10.1002/nau.25356] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/28/2023] [Accepted: 11/25/2023] [Indexed: 02/06/2024]
Abstract
OBJECTIVE A small, but growing literature links stressors and mental health disorders (MHDs) across the life course to overactive bladder (OAB) and urinary incontinence symptoms. Mechanisms by which stressors and MHDs may impact bladder health are not fully understood, limiting novel prevention and treatment efforts. Moreover, potential biopsychosocial mechanisms involving the brain and gut have not been considered in an integrated, comprehensive fashion. METHODS Members of the prevention of lower urinary tract symptoms Research Consortium developed conceptual models to inform research on biopsychosocial mechanisms through which stress and MDHs may impact bladder health among girls and women, focusing on brain and gut physiology. RESULTS Two conceptual models were developed-one to explain central (brain-based) and peripheral (gut-based) mechanisms linking stressors and MHDs to OAB and bladder health, and one to highlight bidirectional communication between the brain, gut, and bladder. Traumatic events, chronic stressors, and MHDs may lead to a maladaptive stress response, including dysregulated communication and signaling between the brain, gut, and bladder. Gut bacteria produce molecules and metabolites that alter production of neurotransmitters, amino acids, short-chain fatty acids, and inflammatory immune response molecules that mediate communication between the gut and brain. Microbiota signal neurogenesis, microglia maturation, and synaptic pruning; they also calibrate brain-gut-bladder axis communication through neurotransmission and synaptogenesis, potentially influencing bladder symptom development. Life course trajectories of risk may be prevented or interrupted by central and peripheral resources for neuropsychological resilience. CONCLUSIONS Depicted pathways, including brain-gut-bladder communication, have implications for research and development of novel prevention and treatment approaches.
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Affiliation(s)
- Ariana L. Smith
- Division of Urology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Amanda Berry
- Division of Urology, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Linda Brubaker
- Department of Obstetrics, Gynecology, and Reproductive Sciences, UC San Diego School of Medicine, University of California San Diego, La Jolla, California
| | - Shayna D. Cunningham
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT
| | - Sheila Gahagan
- Department of Pediatrics, UC San Diego School of Medicine, University of California, San Diego CA
| | - Lisa Kane Low
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan
| | - Margaret Mueller
- Department of Ob/Gyn, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Siobhan Sutcliffe
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis, St. Louis, MO
| | - Beverly R. Williams
- Department of Medicine, Division of Gerontology, Geriatrics and Palliative Care, University of Alabama at Birmingham (UAB) and Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs
| | - Sonya S. Brady
- Division of Epidemiology & Community Health, University of Minnesota School of Public Health, Minneapolis, MN
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6
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Li Z, Lu X, Zhang K, Wu S, Yu W, Chen X, Zheng W. U-shaped association between serum 25-hydroxyvitamin D concentrations and urinary leakage among adult females aged 45 years and over in the United States: a cross-sectional study. BMC Womens Health 2024; 24:58. [PMID: 38263023 PMCID: PMC10804705 DOI: 10.1186/s12905-024-02906-6] [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: 05/23/2023] [Accepted: 01/13/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND The relationship between serum vitamin D status and urinary leakage (UL) among middle-aged females needs to be further studied. The aim of this study was to evaluate the association of serum 25-hydroxyvitamin D [25(OH)D] concentrations with UL among American females ages 45 years and over. METHODS Seven cycles of the National Health and Nutrition Examination Survey (NHANES) with self-report UL data, were used. A total of 9525 women aged 45 years and older were enrolled in this study. Univariate and multivariate logistic regression models and the smooth curve fitting were utilized to analyze the association between clinical UL and serum 25-hydroxyvitamin D [25(OH)D] concentrations. RESULTS A non-linear relationship between serum 25(OH)D concentrations and clinical ULwas observed. When serum 25(OH)D concentration was higher than the inflection point 63.5 nmol/L, a positive correlation was observed between serum 25(OH)D concentrations and clinical UL ([OR]: 1.007, 95%CI: 1.005-1.009, P < 0.01). However, when serum 25(OH)D concentration was below the inflection point 63.5 nmol/L, a negative correlation was observed between serum 25(OH)D concentrations and clinical UL ([OR]: 0.993, 95%CI: 0.989-0.996, P < 0.01). CONCLUSIONS The association between serum vitamin D and the risk of UL exhibited a U-shaped pattern among US middle-aged females, with an inflection point occurring at a serum 25(OH)D concentration of 63.5 nmol/L.
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Affiliation(s)
- Zeyu Li
- School of Basic Medical Sciences, Fujian Medical University, Fuzhou, China
| | - Xinzhuo Lu
- School of Basic Medical Sciences, Fujian Medical University, Fuzhou, China
| | - Keshuai Zhang
- School of Basic Medical Sciences, Fujian Medical University, Fuzhou, China
| | - Shuangyan Wu
- School of Basic Medical Sciences, Fujian Medical University, Fuzhou, China
| | - Wei Yu
- School of Basic Medical Sciences, Fujian Medical University, Fuzhou, China
| | - Xiaoling Chen
- Department of Intensive Care Unit, Fujian Medical University Union Hospital, Fuzhou, China.
| | - Wenzhong Zheng
- Department of Urology, Fujian Medical University Union Hospital, 29 Xinquan Road, Gulou District, Fuzhou, 200001, Fujian Province, P.R. China.
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Rogers RG. Everything About Urogynecologic Surgery That I Thought Was True But Is Not. UROGYNECOLOGY (PHILADELPHIA, PA.) 2024; 30:1-2. [PMID: 38133935 DOI: 10.1097/spv.0000000000001463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Affiliation(s)
- Rebecca G Rogers
- From the Department of Obstetrics and Gynecology, Albany Medical Center, Albany, NY
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8
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Cunningham SD, Carandang RR, Boyd LM, Lewis JB, Ickovics JR, Rickey LM. Psychosocial Factors Associated with Lower Urinary Tract Symptoms One Year Postpartum. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 21:40. [PMID: 38248505 PMCID: PMC10815698 DOI: 10.3390/ijerph21010040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/19/2023] [Accepted: 12/21/2023] [Indexed: 01/23/2024]
Abstract
Pregnancy carries substantial risk for developing lower urinary tract symptoms (LUTSs), with potential lifelong impacts on bladder health. Little is known about modifiable psychosocial factors that may influence the risk of postpartum LUTSs. We examined associations between depressive symptoms, perceived stress, and postpartum LUTSs, and the moderating effects of perceived social support, using data from a cohort study of Expect With Me group prenatal care (n = 462). One year postpartum, 40.3% participants reported one or more LUTS. The most frequent LUTS was daytime frequency (22.3%), followed by urinary incontinence (19.5%), urgency (18.0%), nocturia (15.6%), and bladder pain (6.9%). Higher odds of any LUTS were associated with greater depressive symptoms (adjusted odds ratio (AOR) 1.08, 95% confidence interval (CI) 1.04-1.11) and perceived stress (AOR 1.12, 95% CI 1.04-1.19). Higher perceived social support was associated with lower odds of any LUTS (AOR 0.94, 95% CI 0.88-0.99). Perceived social support mitigated the adverse effects of depressive symptoms (interaction AOR 0.99, 95% CI 0.98-0.99) and perceived stress (interaction AOR 0.97, 95% CI 0.95-0.99) on experiencing any LUTS. Greater depressive symptoms and perceived stress may increase the likelihood of experiencing LUTSs after childbirth. Efforts to promote bladder health among postpartum patients should consider psychological factors and social support.
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Affiliation(s)
- Shayna D Cunningham
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT 06030, USA
| | - Rogie Royce Carandang
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT 06030, USA
| | - Lisa M Boyd
- Virginia Polytechnic Institute, State University, Blacksburg, VA 24061, USA
| | - Jessica B Lewis
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06510, USA
| | - Jeannette R Ickovics
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT 06510, USA
| | - Leslie M Rickey
- Departments of Urology and Obstetrics, Gynecology & Reproductive Services, Yale School of Medicine, New Haven, CT 06510, USA
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Klein AJ, Eisenhauer C, Mollard E, Shade MY, Alappattu M. Methodologies Used in Studies of Self-Management Interventions for Urinary Incontinence in Adult Women: An Integrative Review. West J Nurs Res 2023; 45:1150-1164. [PMID: 37902161 DOI: 10.1177/01939459231208418] [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] [Indexed: 10/31/2023]
Abstract
BACKGROUND Urinary incontinence (UI) affects approximately 60% of women in the United States and negatively impacts self-esteem, sexual function, participation in social activities, and quality of life (QOL). Self-management interventions show promise for improving UI symptoms and QOL. Previous reviews of UI self-management studies have focused on outcomes for older women. However, the literature lacks a synthesis of methodologies of these studies. PURPOSE The purpose of this integrative review was to synthesize and evaluate methodologies used in studies of self-management interventions for UI in adult women. METHODS Using an integrative review approach, a search of PubMed, CINAHL, and Embase was conducted yielding 1404 results, 23 of which met inclusion criteria. Data abstracted from each article included author(s), year of publication, study design and purpose, sample, country and setting, measures of UI symptoms, and intervention description. RESULTS Findings showed methodological differences, particularly in design, assessment of UI subtypes, measures of UI symptoms, and intervention components. Multicomponent self-management interventions were used in 18 studies and 1 component used in 5 studies. Education, pelvic floor muscle exercises, and bladder training were the intervention components most frequently used, either alone or in combination; however, intervention components were not consistently aligned with the UI subtypes. Analysis of ethical matters revealed areas for improvement, specifically in reporting privacy and confidentiality and in methods to obtain informed consent. CONCLUSIONS Results highlight opportunities to improve the rigor of methodologies used in studies of self-management interventions for UI in adult women.
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Affiliation(s)
- Abbey Jo Klein
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Elizabeth Mollard
- College of Nursing, University of Nebraska Medical Center, Lincoln, NE, USA
| | - Marcia Y Shade
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA
| | - Meryl Alappattu
- College of Public Health and Health Professional, University of Florida, Gainesville, FL, USA
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Klein AJ, Eisenhauer C, Mollard E, Alappattu M, Shade MY, Struwe L, Berger AM. "The constant worry": Urinary incontinence self-management in rural women: A qualitative study. Res Nurs Health 2023; 46:603-615. [PMID: 37792276 DOI: 10.1002/nur.22341] [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: 04/25/2023] [Revised: 09/01/2023] [Accepted: 09/17/2023] [Indexed: 10/05/2023]
Abstract
Urinary incontinence (UI) is experienced by approximately 60% of women in the United States and has a negative impact on self-esteem, sexual function, social participation, and quality of life. Rural women, who are underrepresented in the UI literature, face many health disparities and unique barriers to accessing care. The purpose of this qualitative descriptive study was to explore UI self-management behaviors in rural women with UI, including the contextual factors that influence their approach to self-management. This study recruited rural women, ages 30-60 years, using purposive sampling via social media. Demographic information was collected. A semi-structured interview guide was used to conduct individual, in-depth interviews via Zoom. Interview data were analyzed using qualitative description. Sections of interview text were coded using a priori and emergent codes, grouped into categories, and distilled into themes. A total of 31 participants (mean age = 47.2 years) met inclusion/exclusion criteria, enrolled, and completed the study. Qualitative analysis revealed rural as a cross-cutting theme and five major themes: self-management behaviors, familial influence, medical encounters, talking about UI, and resource scarcity. Participants described the rural environment as having a substantial impact on their approach to UI self-management. Specifically, rural social enmeshment made seeking care for UI in rural communities challenging. Findings shed light on how the rural environment influences various aspects of UI self-management in midlife women. Diverse perspectives in UI self-management are needed to advance knowledge in this field.
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Affiliation(s)
- Abbey Jo Klein
- University of Nebraska Medical Center, College of Nursing, Omaha, Nebraska, USA
| | - Christine Eisenhauer
- Nebraska Total Care Clinical Advisory Board, Centene Corporation, Omaha, Nebraska, USA
| | - Elizabeth Mollard
- University of Nebraska Medical Center, College of Nursing, Lincoln, Nebraska, USA
| | - Meryl Alappattu
- Department of Physical Therapy, University of Florida, Gainesville, Florida, USA
| | - Marcia Y Shade
- University of Nebraska Medical Center, College of Nursing, Omaha, Nebraska, USA
| | - Leeza Struwe
- Niedfelt Nursing Research Center, University of Nebraska Medical Center, Lincoln, Nebraska, USA
| | - Ann M Berger
- University of Nebraska Medical Center, College of Nursing, Omaha, Nebraska, USA
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Li Q, Cheng Y, Shi H, Xue K, Zhou F. Advances in the natural history of urinary incontinence in adult females. J OBSTET GYNAECOL 2023; 43:2171774. [PMID: 36772931 DOI: 10.1080/01443615.2023.2171774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
The aim of this review is to summarise the related characteristics of the natural history of female urinary incontinence (UI) using a narrative descriptive approach. PubMed, EMBASE and Web of Science were searched for articles published from 1 January 2010 to 1 January 2020 on the natural history of female UI, which including incidence, persistence, progression, remission, and regression of a single subtype of UI and the mutual influence of different UI subtypes. This literature review includes 15 articles published, indicates that UI is highly dynamic, with symptoms varying according to disease severity and subtype and influenced by multiple factors at different disease stages. Recent studies have increased our understanding of the natural history of UI. Future research should systematically analyse the progression of each subtype of UI and interactions between subtypes to prevent the progression of UI across females life course.
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Affiliation(s)
- Qianqian Li
- School of Nursing, Xuzhou Medical University, Xuzhou, China
| | - Yun Cheng
- Xuzhou Maternity and Child Health Care Hospital, Xuzhou, China
| | - Hongli Shi
- School of Nursing, Xuzhou Medical University, Xuzhou, China
| | - Kaikai Xue
- Jiangsu College of Nursing, Huai'an, China
| | - Fang Zhou
- Dean of School of Nursing, Xuzhou Medical University, Xuzhou, China
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Brady SS, Shan L, Markland AD, Huling JD, Arguedas A, Fok CS, Van Den Eeden SK, Lewis CE. Trajectories of depressive symptoms over 20 years and subsequent lower urinary tract symptoms and impact among women. Menopause 2023; 30:723-731. [PMID: 37159879 PMCID: PMC10313766 DOI: 10.1097/gme.0000000000002193] [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] [Indexed: 05/11/2023]
Abstract
OBJECTIVE The aim of the study is to examine the association between depressive symptoms and subsequent lower urinary tract symptoms (LUTS) and impact (a composite outcome) among women (N = 1,119) from the Coronary Artery Risk Development in Young Adults study. METHODS The Center for Epidemiologic Studies-Depression Scale (CES-D) was administered in 1990-1991 and every 5 years through 2010-2011. In 2012-2013, LUTS and impact data were collected for the first time. Accumulation of risk was examined in the following three ways: (1) mean CES-D score across 20 years (5 observations); (2) depressive symptom trajectory group, determined by group-based trajectory modeling; and (3) intercepts and slopes obtained from women's individual CES-D score trajectories through two-stage mixed effects modeling. For each approach, ordinal logistic regression analyses examined odds of having "greater LUTS/impact" for each unit change in a depressive symptom variable. RESULTS (1) With each one-unit increase in mean CES-D score over the 20-year period, women were 9% more likely to report greater LUTS/impact (odds ratio [OR] = 1.09, 95% CI = 1.07-1.11). (2) In comparison with women with consistently low depressive symptoms, women with consistently threshold depression or consistently high depressive symptoms were twice (OR = 2.07, 95% CI = 1.59-2.69) and over five times (OR = 5.55, 95% CI = 3.07-10.06) as likely, respectively, to report greater LUTS/impact. (3) Women's individual symptom intercept and slope interacted. Increases in depressive symptoms across 20 years (greater slopes) were associated with greater LUTS/impact when women's initial CES-D score (intercept) was in the moderate-to-high range relative to the sample. CONCLUSIONS Depressive symptoms over 20 years, examined with different degrees of nuance, were consistently associated with subsequently measured LUTS and impact.
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Affiliation(s)
- Sonya S. Brady
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health
| | - Liang Shan
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL
| | - Alayne D. Markland
- Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham School of Medicine and Birmingham VA Medical Center, Birmingham, AL
| | - Jared D. Huling
- Division of Biostatistics, University of Minnesota School of Public Health, Minneapolis, MN
| | - Andrés Arguedas
- Division of Biostatistics, University of Minnesota School of Public Health, Minneapolis, MN
| | - Cynthia S. Fok
- Department of Urology, University of Minnesota Medical School, Minneapolis, MN
| | - Stephen K. Van Den Eeden
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
- Department of Urology, University of California, San Francisco, San Francisco, CA
| | - Cora E. Lewis
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
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Chen L, Zhang D, Li T, Liu S, Hua J, Cai W. Effect of a Mobile App-Based Urinary Incontinence Self-Management Intervention Among Pregnant Women in China: Pragmatic Randomized Controlled Trial. J Med Internet Res 2023; 25:e43528. [PMID: 37368465 DOI: 10.2196/43528] [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: 10/14/2022] [Revised: 03/30/2023] [Accepted: 05/27/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Urinary incontinence (UI) is a highly prevalent health concern commonly observed during and after pregnancy that can substantially impact women's physical and psychological well-being and quality of life. Owing to its numerous advantages, mobile health may be a promising solution; however, it is unclear whether the app-based intervention can effectively improve UI symptoms during and after pregnancy. OBJECTIVE This study aimed to evaluate the effectiveness of the Urinary Incontinence for Women (UIW) app-based intervention for UI symptom improvement among pregnant women in China. METHODS Singleton pregnant women without incontinence before pregnancy who were aged ≥18 years and between 24 and 28 weeks of gestation were recruited from a tertiary public hospital in China and were randomly allocated (1:1) to either an experimental group (n=63) or a control group (n=63). The experimental group received the UIW app intervention and oral pelvic floor muscle training (PFMT) instructions, whereas the control group received oral PFMT instructions alone. Neither the participants nor the researchers were blinded to the intervention. The primary outcome was UI severity. The secondary outcomes included quality of life, self-efficacy with PFMT, and knowledge of UI. All data were collected at baseline, 2 months after randomization, and 6 weeks post partum through electronic questionnaires or by checking the electronic medical record system. Data analysis followed the intention-to-treat principle. A linear mixed model was used to examine the intervention effect on primary and secondary outcomes. RESULTS Participants in the experimental and control groups were comparable at baseline. Of the 126 overall participants, 117 (92.9%) and 103 (81.7%) women completed follow-up visits at 2 months after randomization and 6 weeks after delivery, respectively. A statistically significant difference in UI symptom severity was observed between the experimental group and control group (2 months after randomization: mean difference -2.86, 95% CI -4.09 to -1.64, P<.001; 6 weeks post partum: mean difference -2.68, 95% CI -3.87 to -1.49, P<.001). For the secondary outcomes, a statistically significant intervention effect on the quality of life, self-efficacy, and UI knowledge was found at the 2-month follow-up (all P<.05) and 6 weeks post partum (all P<.001). CONCLUSIONS The app-based UI self-management intervention (UIW) effectively improved UI symptom severity, quality of life, self-efficacy with PFMT, and knowledge of UI during the late pregnancy and early postnatal periods. Larger multicenter studies with a longer postpartum follow-up are required to further extend these findings. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR1800016171; http://www.chictr.org.cn/showproj.aspx?proj=27455. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/22771.
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Affiliation(s)
- Ling Chen
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, China
- School of Nursing, Southern Medical University, Guangzhou, China
| | - Danli Zhang
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, China
- School of Nursing, Southern Medical University, Guangzhou, China
| | - Tiantian Li
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, China
| | - Sha Liu
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, China
- School of Nursing, Southern Medical University, Guangzhou, China
| | - Jie Hua
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, China
- School of Nursing, Southern Medical University, Guangzhou, China
| | - Wenzhi Cai
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, China
- School of Nursing, Southern Medical University, Guangzhou, China
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Deinstadt RTM, Sternin S, Reissing ED. Urinary Symptoms and their Impact on Young Women's Sexual Function and Quality of Life. JOURNAL OF SEX & MARITAL THERAPY 2023; 49:917-931. [PMID: 37317557 DOI: 10.1080/0092623x.2023.2222728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Sexuality and urinary function have received scarce research attention in younger women. In this cross-sectional survey study, prevalence, type, severity, and impact of urinary incontinence (UI), and its relationship with sexuality was investigated in 261 nulliparous women aged 18-27 (M = 19.08 years). Modules of the International Consultation on Incontinence Questionnaire and the Female Sexual Function Index assessed UI, sexual function, and quality of life. Thirty percent of the sample experienced UI, and 26% reported sexual function problems. A significant small negative correlation was found between UI and sexual lubrication (p = .017). Forty-three percent of participants in the total sample reported that they were bothered by urinary symptoms, and 13% avoided sexual activity due to urinary symptoms. Of those classified as incontinent, 90% were bothered by their symptoms. Urinary symptoms are impactful on the quality of life and sexual lives of young women, but despite their high prevalence, they remain a largely understudied and undertreated issue in this age group. Further research is crucial for improving awareness and access to treatment for this underserved population.
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Affiliation(s)
| | - Shulamit Sternin
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
| | - Elke D Reissing
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
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Chen J, Peng L, Xiang L, Li B, Shen H, Luo D. Association between body mass index, trunk and total body fat percentage with urinary incontinence in adult US population. Int Urogynecol J 2022; 34:1075-1082. [PMID: 35960315 DOI: 10.1007/s00192-022-05317-z] [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: 04/11/2022] [Accepted: 06/30/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND HYPOTHESIS To assess the association of body mass index (BMI), trunk and total body fat percentage with the prevalence and severity of urinary incontinence (UI) stratified by gender among a US adult population. METHODS A representative cross-sectional survey of participants aged ≥ 20 years was conducted using the data from the 2011-2018 National Health and Nutrition Examination Survey. Multivariate logistic and linear regression models were used to explore the association among the three obesity measures above with the prevalence and severity of UI. RESULTS A total of 6964 individuals (4168 males and 2796 females) enrolled for the final analysis. Among males, the weighted prevalence of UI was 7.8%, with 1.3% stress urinary incontinence, 5.8% urge urinary incontinence and 0.7% mixed urinary incontinence. For females, the weighted prevalence of UI was 54.2%, with 31.9% stress urinary incontinence, 7.0% urge urinary incontinence and 15.6% mixed urinary incontinence. Multivariate logistic regression revealed increased BMI and trunk fat percentage significantly increased odds of UI (BMI: OR = 1.05 [per 1 kg/m2], 95% CI: 1.03-1.07, P < 0.001; trunk fat percentage: OR = 1.15 [per 5% increase in trunk fat percentage], 95% CI: 1.06-1.25, P = 0.002) in females. Similar trends were observed in the severity of UI (BMI: β = 0.07, 95% CI: 0.05-0.09, P < 0.001; trunk fat percentage: β = 0.18, 95% CI: 0.10-0.26, P < 0.001) by a multivariate linear regression. In males, no significant association was observed (BMI: OR = 0.99 [per 1 kg/m2], 95% CI: 0.97-1.02, P = 0.663; trunk fat percentage: OR = 0.95 [per 5% increase in trunk fat percentage], 95% CI: 0.84-1.08, P = 0.430; total fat percentage: OR = 0.94 [per 5% increase in total fat percentage], 95% CI: 0.80-1.10, P = 0.424). CONCLUSIONS An increased BMI and trunk fat percentage are significantly associated with higher prevalence and severity of UI in females.
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Affiliation(s)
- Jiawei Chen
- Department of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Liao Peng
- Department of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Liyuan Xiang
- Department of Clinical Research Management, West China Hospital, No. 37, Guoxue Alley, Chengdu, Sichuan Province, China
| | - Boya Li
- Department of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Hong Shen
- Department of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Deyi Luo
- Department of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China.
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16
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Yang C, Feng Z, Chen Z, Xu D, Li Y, Lai K, Yi F. The risk factors for urinary incontinence in female adults with chronic cough. BMC Pulm Med 2022; 22:276. [PMID: 35850673 PMCID: PMC9295435 DOI: 10.1186/s12890-022-02069-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 07/07/2022] [Indexed: 12/05/2022] Open
Abstract
Background Female patients with chronic cough are more likely to suffer from urinary incontinence (UI). However, there are few data in regard of risks related with UI in female adults with chronic cough. Method We recruited female adult patients with chronic cough from the cough specialist clinic. Demographic information and clinical characteristics including age, BMI, duration of cough, severity of cough, nature and timing of cough, cough triggers, concomitant symptoms, comorbidities and UI condition were collected. The demographics and clinical features of patients with UI and those without UI were compared. Result A total of 700 female patients with the main symptom of chronic cough were included, of whom 351 (50.1%) presented with UI. As compared with patients without UI, patients with UI showed a longer mean age (years) (49.5 vs. 42.4, p < 0.001), a more severe cough symptom (median of cough Visual Analogue Scale: 65 vs. 50, p < 0.001), a higher prevalence of chronic sinusitis (17.6% vs. 8.6%, p = 0.002), and combined with a higher incidence of abdominal muscle pain due to cough (39.6% vs. 18.7%, p < 0.001).In addition, patients in UI group whose cough were more easily triggered by exercise (28.2% vs. 17.2%, p = 0.048). Multivariate logistic regression analysis indicated the above five variables were risk factors for UI in female adult patients with chronic cough. Conclusion Urinary incontinence is a common complication in female patients with chronic cough. Older age, severe cough, combing with a higher proportion of chronic sinusitis and abdominal muscle pain, a cough easily triggered by exercise are identified as risk factors for urinary incontinence. We should pay more attention to female chronic coughers with these risk factors in clinics. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-02069-w.
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Affiliation(s)
- Cunzhen Yang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 28 middle Qiaozhong Rd, Liwan District, Guangzhou, Guangdong, People's Republic of China
| | - Zien Feng
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 28 middle Qiaozhong Rd, Liwan District, Guangzhou, Guangdong, People's Republic of China
| | - Zhiyin Chen
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 28 middle Qiaozhong Rd, Liwan District, Guangzhou, Guangdong, People's Republic of China
| | - Dongting Xu
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 28 middle Qiaozhong Rd, Liwan District, Guangzhou, Guangdong, People's Republic of China
| | - Yuling Li
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 28 middle Qiaozhong Rd, Liwan District, Guangzhou, Guangdong, People's Republic of China
| | - Kefang Lai
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 28 middle Qiaozhong Rd, Liwan District, Guangzhou, Guangdong, People's Republic of China.
| | - Fang Yi
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 28 middle Qiaozhong Rd, Liwan District, Guangzhou, Guangdong, People's Republic of China.
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Assessment of the Effectiveness of the Sonofeedback Method in the Treatment of Stress Urinary Incontinence in Women-Preliminary Report. J Clin Med 2022; 11:jcm11030659. [PMID: 35160108 PMCID: PMC8837105 DOI: 10.3390/jcm11030659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 11/28/2022] Open
Abstract
Urinary incontinence is a common problem that affects postmenopausal women. This ailment has a negative impact on many aspects of life, significantly limiting everyday functioning related to professional work, physical activity or the intimate sphere. The aim of the study was to assess the effectiveness of the sonofeedback method in reducing the severity of urinary incontinence in postmenopausal women with a urinary incontinence problem. A total of 60 patients aged 45–65 with stress urinary incontinence, confirmed by a gynecologist, were qualified for the study. All persons qualified for the study were randomly assigned to study group A (n = 20), comparative B (n = 20) and control C (n = 20). Patients from group A were treated with sonofeedback of the pelvic floor muscles. In group B, the combined electrostimulation method was used with biofeedback training. Group C was a control group in which only the measured parameters were measured at the same time interval as those carried out in groups A and B. In all patients, three times: before the therapy, after the fifth procedure and after the end of the therapy, the incidence and severity of stress urinary incontinence were assessed—Gaudenz questionnaire and the intensity of urinary incontinence—a modified 1 h pad test. The obtained results have an application value giving the possibility of using effective therapy with sonofeedback in women in whom the recommended electrostimulation method cannot be used due to health and behavioral reasons.
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18
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Cardot V, Campagne-Loiseau S, Roulette P, Peyrat L, Vidart A, Wagner L, Thuillier C, Klap J, Hurel S, Hermieu JF, Girard F, Even L, Donon L, Charles T, Tibi B, Bosset PO, Berrogain N, Meyer F, Cornu JN, Deffieux X. 2021 opinion from the CUROPF on THE efficacy and safety of mid-urethral slings used in women WITH urinary stress incontinence. Prog Urol 2021; 32:247-257. [PMID: 34920924 DOI: 10.1016/j.purol.2021.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 10/23/2021] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To determine the usefulness of mid-urethral slings (MUS) in the surgical management of women presenting with urinary stress incontinence (USI) METHOD: A consensus committee of multidisciplinary experts (CUROPF) was convened and focused on PICO questions concerning the efficacy and safety of MUS surgery compared to other procedures and concerning which approach (retropubic (RP) vs transobturator (TO)) should be proposed as a first-line MUS surgery for specific subpopulations (obese; intrinsic sphincteric deficiency (ISD); elderly) RESULTS: As compared to other procedures (urethral bulking agents, traditional slings and open colposuspension), the MUS procedure should be proposed as the first-line surgical therapy (strong agreement). MUS surgery can be associated with complications and proper pre-operative informed consent is mandatory (strong agreement). Mini-slings (SIS/SIMS) should only be proposed in clinical trials (strong agreement). Both RP and TO approaches may be proposed for the insertion of MUS (strong agreement). However, if the woman is willing to accept a moderate increase in per-operative risk, the RP approach should be preferred (strong agreement) since it is associated with higher very long-term cure rates and as it is possible to completely remove the sling surgically if a severe complication occurs. The RP approach should be used for the insertion of MUS in a woman presenting with ISD (strong agreement). Either the RP or TO approach should be used for the insertion of MUS in an obese woman presenting with USI (strong agreement). In very obese women (BMI ≥35-40kg/m2), weight loss should be preferred prior to MUS surgery and bariatric surgery should be discussed (strong agreement) CONCLUSION: The current Opinion provides an appropriate strategy for both the selection of patients and the best therapeutic approach in women presenting with USI.
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Affiliation(s)
- V Cardot
- Clinique de Meudon-Clamart, 3, avenue de Villacoublay, 92360 Meudon, France
| | - S Campagne-Loiseau
- Service de gynécologie obstétrique, CHU Estaing, Clermont Ferrand, 1, place Lucie et Raymond-Aubrac, 63000 Clermont Ferrand, France
| | - P Roulette
- Service d'urologie, CH Cahors, 30, avenue de la voie Romaine, 06000 Nice, France
| | - L Peyrat
- Service d'urologie, Clinique de Turin, 13, rue de Turin, 75008 Paris, France
| | - A Vidart
- Service d'urologie, hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - L Wagner
- Servie d'urologie, CHU Carémeau, place du Pr Robert Debré, 30029 Nîmes, France
| | - C Thuillier
- Service d'urologie, CHU Grenoble-Alpes, 38000 Grenoble, France
| | - J Klap
- Service d'urologie, hôpital Privé Claude Galien, 20, route de Boussy Saint-Antoine, 91480 Quincy sous Sénart, France
| | - S Hurel
- Service d'urologie, hôpital Européen Georges-Pompidou (AP-HP), 20, rue Leblanc, 75015 Paris, France
| | - J F Hermieu
- Service d'urologie, hôpital Bichat (AP-HP), 46, rue Henri-Huchard, 75018 Paris, France
| | - F Girard
- Service d'urologie, clinique oudinot fondation Cognacq-Jay, 2 rue Rousselet, 75007 Paris, France
| | - L Even
- Cabinet d'urologie, Espace Santé 3, 521, avenue de Rome, 83500 La Seyne-sur-Mer, France
| | - L Donon
- Service d'urologie, Polyclinique de la Côte Basque Sud, 7, rue Léonce Goyetche, 64500 Saint Jean de Luz, France
| | - T Charles
- Service d'urologie, CHU La Miletrie, 2, rue de la Milétrie, 86021 Poitiers, France
| | - B Tibi
- Service d'urologie, CH Cahors, 30, avenue de la voie Romaine, 06000 Nice, France
| | - P O Bosset
- Service d'urologie, Clinique de Turin, 13, rue de Turin, 75008 Paris, France
| | - N Berrogain
- Service d'URologie, Clinique Ambroise Pare, 387, route de Saint-Simon, 31100 Toulouse, France
| | - F Meyer
- Service d'urologie, hôpital Saint Louis (APHP), 1, avenue Claude Vellefaux, 75010 Paris, France
| | - J-N Cornu
- Service d'urologie, hôpital Charles-Nicolle, université de Rouen, 1, rue de Germont, 76000 Rouen, France
| | - X Deffieux
- Service de gynécologie obstétrique, hôpital Antoine-Béclère (APHP), 157, rue de la Porte de Trivaux, 92140 Clamart, France.
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Pang H, Lv J, Xu T, Li Z, Gong J, Liu Q, Wang Y, Wang J, Xia Z, Li Z, Li L, Zhu L. Incidence and risk factors of female urinary incontinence: a 4-year longitudinal study among 24 985 adult women in China. BJOG 2021; 129:580-589. [PMID: 34536320 PMCID: PMC9298368 DOI: 10.1111/1471-0528.16936] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/05/2021] [Accepted: 06/25/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To estimate the incidence of urinary incontinence (UI), including its subtypes stress UI (SUI), urgency UI (UUI) and mixed UI (MUI), and to examine risk factors for de novo SUI and UUI in Chinese women. DESIGN Nationwide longitudinal study. SETTING Six geographic regions of China. PARTICIPANTS Women aged ≥20 years old were included using a multistage, stratified, cluster sampling method. METHODS This study was conducted between May 2014 and March 2016, with follow up in 2018. Data on demographics, medical history, lifestyle and physiological and anthropometric information were collected. MAIN OUTCOME MEASUREMENTS Incidence, rate ratio (RR). RESULTS Analyses included 24 985 women (mean age 41.9 years).The follow-up response rate was 55.5%, median follow-up time was 3.7 years. The standardised incidences of UI, SUI, UUI and MUI were 21.2, 13.1, 3.0 and 5.1 per 1000 person-years, respectively. Risk factors for de novo SUI included delivery pattern (vaginal spontaneous delivery RR 2.12, 95% CI 1.62-2.78 and instrumental delivery RR 3.30, 95% CI 1.99-5.45), high body mass index (BMI) (overweight RR 1.52, 95% CI 1.33-1.74 and obesity RR 1.67, 95% CI 1.32-2.11), cigarette smoking (RR 1.54, 95% CI 1.12-2.12), chronic cough (RR 1.44, 95% CI 1.17-1.76), diabetes (RR 1.33, 95% CI 1.10-1.60) and older age (50-59 years RR 1.49, 95% CI 1.16-1.90 and 60-69 years RR 1.61, 95% CI 1.22-2.13).The risk factors significantly associated with de novo UUI were age (RR increased from 1.21, 95% CI 0.74-1.99, at 30-39 years to 6.3, 95% CI 3.85-10.30, at >70 years) and diabetes (RR 1.48, 95% CI 1.05-2.09). CONCLUSIONS The incidence of female UI is 21.2 per 1000 person-years in China. Delivery (vaginal spontaneous delivery, instrumental delivery), high BMI, cigarette smoking, chronic cough, diabetes and older age were risk factors. TWEETABLE ABSTRACT The incidence of female urinary incontinence was 21.2 per 1000 person-years in China. Delivery, BMI, diabetes and old age are risk factors.
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Affiliation(s)
- H Pang
- Medical Research Center, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - J Lv
- School of Public Health, Peking University Health Science Center, Beijing, China
| | - T Xu
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Z Li
- Department of Gynaecology and Obstetrics, Children's Hospital of Shanxi Province, Shanxi, China
| | - J Gong
- Department of Gynaecology and Obstetrics, Maternal and Child Health Hospital of Wuxi, Jiangsu, China
| | - Q Liu
- Department of Gynaecology and Obstetrics, Maternal and Child Health Hospital of Gansu Province, Lanzhou, China
| | - Y Wang
- Department of Gynaecology and Obstetrics, Maternal and Child Health Hospital of Foshan, Guangdong, China
| | - J Wang
- Department of Gynaecology and Obstetrics, Maternal and Child Health Hospital of Guiyang, Guizhou, China
| | - Z Xia
- Department of Gynaecology and Obstetrics, Sheng Jing Hospital of China Medical University, Liaoning, China
| | - Z Li
- Department of Gynecology and Obstetrics, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - L Li
- School of Public Health, Peking University Health Science Center, Beijing, China
| | - L Zhu
- Department of Gynecology and Obstetrics, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Rogowski A, Krowicka-Wasyl M, Chotkowska E, Kluz T, Wróbel A, Berent D, Mierzejewski P, Sienkiewicz-Jarosz H, Wichniak A, Wojnar M, Samochowiec J, Kilis-Pstrusinska K, Bienkowski P. Psychiatric History and Overactive Bladder Symptom Severity in Ambulatory Urogynecological Patients. J Clin Med 2021; 10:jcm10173988. [PMID: 34501436 PMCID: PMC8432447 DOI: 10.3390/jcm10173988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 08/27/2021] [Accepted: 08/31/2021] [Indexed: 12/05/2022] Open
Abstract
Introduction and hypothesis: A link between psychiatric comorbidities and overactive bladder symptomatology has been suggested by preclinical and clinical studies. Given this, we hypothesized that a psychiatric history and current treatment with psychotropic medications could be related to the severity of overactive bladder and incontinence symptoms in patients referred to a tertiary care urogynecological center. Methods: One hundred and twenty-seven female patients diagnosed with an overactive bladder were screened for a lifetime history of psychiatric disorders and the type and number of psychotropic medications currently taken. The overall severity of overactive bladder symptoms was assessed using the Indevus Urgency Severity Scale. The severity and impact of urinary incontinence on the quality of life were quantified with the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form. Urinary incontinence was further quantified with the aid of the Urinary Distress Inventory-6. The patients were screened for stress urinary incontinence using the Stamey Incontinence Score. Results: A psychiatric history, as well as current use of at least two psychotropic medications, was associated with increased severity of overactive bladder symptoms. A history of depression and current treatment with any selective serotonin reuptake inhibitor was associated with increased severity of stress urinary incontinence symptoms. Current treatment with other psychotropic medications, including sedative-hypnotics and drugs with anticholinergic properties was not related to the severity of overactive bladder and incontinence symptoms.
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Affiliation(s)
- Artur Rogowski
- Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszynski University in Warsaw, 01-938 Warsaw, Poland
- Department of Obstetrics and Gynecology, Mother and Child Institute, 01-211 Warsaw, Poland; (M.K.-W.); (E.C.)
- Correspondence: ; Tel.: +48-604-060-090
| | - Maria Krowicka-Wasyl
- Department of Obstetrics and Gynecology, Mother and Child Institute, 01-211 Warsaw, Poland; (M.K.-W.); (E.C.)
| | - Ewa Chotkowska
- Department of Obstetrics and Gynecology, Mother and Child Institute, 01-211 Warsaw, Poland; (M.K.-W.); (E.C.)
| | - Tomasz Kluz
- Department of Gynecology and Obstetrics, Institute of Medical Sciences, Medical College of Rzeszow University, 35-310 Rzeszów, Poland;
| | - Andrzej Wróbel
- Second Department of Gynecology, Medical University of Lublin, Jaczewskiego 8, 20-954 Lublin, Poland;
| | - Dominika Berent
- Regional Psychiatric Hospital Drewnica, 05-091 Zabki, Poland;
| | - Paweł Mierzejewski
- Departments of Pharmacology, Institute of Psychiatry and Neurology, 02-957 Warsaw, Poland;
| | | | - Adam Wichniak
- Department of Psychiatry III, Institute of Psychiatry and Neurology, 02-957 Warsaw, Poland;
| | - Marcin Wojnar
- Department of Psychiatry, Medical University of Warsaw, 02-091 Warsaw, Poland; (M.W.); (P.B.)
| | - Jerzy Samochowiec
- Department of Psychiatry, Pomeranian Medical University, 70-111 Szczecin, Poland;
| | | | - Przemyslaw Bienkowski
- Department of Psychiatry, Medical University of Warsaw, 02-091 Warsaw, Poland; (M.W.); (P.B.)
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Gao J, Liu X, Zuo Y, Li X. Risk factors of postpartum stress urinary incontinence in primiparas: What should we care. Medicine (Baltimore) 2021; 100:e25796. [PMID: 34011042 PMCID: PMC8137028 DOI: 10.1097/md.0000000000025796] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/14/2021] [Indexed: 01/05/2023] Open
Abstract
Stress urinary incontinence (SUI) is a common clinical postpartum complication. It is necessary to explore the risk factors of postpartum SUI in primiparas to provide evidence support for preventing and reducing the occurrence of SUI.Primiparas who were delivered in our hospital from March 2019 to October 2020 were identified, the personal information and related treatment details of SUI and no-SUI primiparas were collected and analyzed. Logistic regression analyses were conducted to identify the risk factors of postpartum SUI in primiparas.A total of 612 primiparas were included, the incidence of SUI in primiparas was 32.03%. There were significant differences in the body mass index (BMI) before pregnancy, diabetes, abortion, delivery method, newborn's weight, epidural anesthesia, and duration of second stage of labor (all P < .05) between SUI and no-SUI group, and there were no significant differences in the age, BMI at admission, hypertension and hyperlipidemia SUI and no-SUI group (all P > .05). Logistic regression analyses indicated that BMI before pregnancy ≥24 kg/m2 (odds ratio [OR]: 2.109, 95% confidence interval [CI]: 1.042-4.394), diabetes (OR: 2.250, 95% CI: 1.891-3.544), abortion history (OR: 3.909, 95% CI: 1.187-5.739), vaginal delivery (OR: 2.262, 95% CI: 1.042-4.011), newborn's weight ≥3 kg (OR: 1.613, 95% CI: 1.095-2.316), epidural anesthesia (OR: 2.015, 95% CI: 1.226-3.372), and duration of second stage of labor ≥90 minutes (OR: 1.726, 95% CI: 1.084-2.147) were the risk factors of postpartum SUI in primiparas (all P < .05).The clinical incidence of SUI in primiparas is relatively high. In clinical practice, medical staff should conduct individualized early screening for those risk factors, and take prevention measures to reduce the occurrence of SUI.
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Zhang H, Huang J, Liu J, Li Y, Gao Y. BMMSC-sEV-derived miR-328a-3p promotes ECM remodeling of damaged urethral sphincters via the Sirt7/TGFβ signaling pathway. Stem Cell Res Ther 2020; 11:286. [PMID: 32678010 PMCID: PMC7364490 DOI: 10.1186/s13287-020-01808-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 06/26/2020] [Accepted: 07/02/2020] [Indexed: 12/19/2022] Open
Abstract
Background Stress urinary incontinence (SUI) is a common and bothersome condition. Invasive surgery will always be considered after conservative treatment fails, but the rates of postoperative complications and long-term recurrence are high. Thus, a new treatment strategy is still needed. In recent years, bone marrow mesenchymal stem cells (BMMSC) have shown great promise for SUI treatment. The therapeutic effects of BMMSC on SUI are achieved mainly by paracrine pathway signaling molecules, such as small extracellular vesicles (sEV). sEV are recognized as essential mediators of cell-to-cell communication. However, the therapeutic effects and detailed mechanisms of BMMSC-derived sEV in SUI remain mostly unexplored. Methods The effects of BMMSC-sEV on extracellular matrix (ECM) metabolism were assessed in vitro and in vivo. In a SUI rat model, TGF-β1 signaling was examined with or without BMMSC-sEV stimulation. sEV miRNAs were deeply sequenced, and the most likely miRNAs were evaluated as mediators of the TGF-β1 signaling pathway. Results BMMSC-sEV enhanced the synthesis of ECM components, including elastin, collagen I, and collagen III, and improved urethral function. Furthermore, BMMSC-sEV activated TGF-β1 signaling in primary fibroblast cells and in rat urethras. Several differentially expressed miRNAs were identified in the BMMSC-sEV. Bioinformatics analysis and in vitro studies showed that BMMSC-sEV miR-328a-3p can be transferred from BMMSC to fibroblasts and can regulate the Sirt7/TGF-β1 signaling pathway. Conclusion BMMSC-sEV promote ECM remodeling of damaged urethral sphincters by transferring miR-328a-3p to regulate the Sirt7/TGF-β1 signaling pathway.
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Affiliation(s)
- Hanke Zhang
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Jiayu Huang
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Jiaying Liu
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yanhui Li
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
| | - Ying Gao
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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