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The "Aberdeen Home Continence Stress Test": a novel objective assessment tool for female stress urinary incontinence. Int Urogynecol J 2023; 34:1961-1969. [PMID: 37052645 PMCID: PMC10415466 DOI: 10.1007/s00192-023-05530-4] [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: 12/31/2022] [Accepted: 03/06/2023] [Indexed: 04/14/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Clinical trials for stress urinary incontinence (SUI) require a robust, reliable, and responsive tool for objective assessment of SUI post-intervention. The Aberdeen Home Continence Stress Test (HCST) is a novel patient-reported objective assessment tool, aimed to be patient-friendly and reduce attrition rates by avoiding hospital appointments and prolonged pad-wearing. We aim to describe the HCST for the first time and evaluate its reliability, diagnostic accuracy, and response to change. METHODS A secondary analysis of the Single-Incision Mini-Slings (SIMS) study (a prospective multicentre randomised control trial (RCT) comparing two surgical treatments of SUI was performed. In SIMS (n = 600 women), the objective outcome was assessed by the 24-h pad test, while the patient-reported success rates were assessed using the Patient Global Impression of Improvement (PGI-I) at 15 months, 2 years and 3 years post-randomisation. Participants were instructed to perform the HCST before and after the 24-h pad test. The HCST was analysed in relation to reliability, validity, and the relationship between the 24-h pad test and HCST results and finally with regard to its responsiveness to change in PGI-I. (Trial registration-number ISRCTN93264234, registration date 14/01/2014). RESULTS Compared to the 24-h pad test, the sensitivity of the HCST ranged from 0.81-0.95, specificity was 0.76-0.79, negative predictive value was 0.96-0.99 and positive predictive value was 0.32-0.43. Reliability was indicated by high-performing Cronbach's alpha value (> 0.7). An improvement of ≥ 2 leakage groups on the HCST (for example from Large at baseline to Small leakage at follow-up) was strongly associated with patient-reported success on PGI-I (OR 4.38, 95% CI 2.31, 8.31). CONCLUSIONS The HCST is a valid and reliable patient-reported objective assessment tool that can be used for assessing SUI in surgical trials with good specificity, sensitivity, and consistency.
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Effect of Acupuncture for Mixed Urinary Incontinence in Women: A Systematic Review. Front Public Health 2022; 10:827853. [PMID: 35372235 PMCID: PMC8971660 DOI: 10.3389/fpubh.2022.827853] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 02/21/2022] [Indexed: 01/08/2023] Open
Abstract
Background Mixed urinary incontinence increasingly undermines women's quality of life. Previous studies showed some effects of acupuncture for MUI, but no systematic review has been done to evaluate the efficacy and safety of acupuncture for MUI in women. Objective To systematically review the efficacy and safety of acupuncture for women with MUI. Methods Ten databases (i.e., PubMed, Web of Science, Embase, ClinicalTrials.gov, the Cochrane Library, CBM, Scoups, CNKI, VIP and WANFANG DATA) were searched up to July 19th, 2021, using tailored search strategies with keywords not limited to “female,” “mixed urinary incontinence,” “acupuncture,” and “randomized controlled trial,” etc. RCTs and quasi-RCTs were included if investigating effect of any type of acupuncture for female patients with MUI. Data were extracted from eligible studies, and risks of bias were assessed according to the Cochrane Handbook from seven aspects using the RevMan 5.4 software. Results A total of three randomized studies with 591 women were included. The risk of bias among the studies varied, with major concerns on blinding of participants and outcome assessor. Liu's study (497) mainly showed that electroacupuncture's effect on reduction of numbers of incontinence, urgency, nocturia episodes, and amount of urine leakage etc. was not inferior to that of PFMT-Solifenacin group at 12, 24, and 36 weeks. Zhan's study (60) showed that electroacupuncture reduced significantly more amount of urine leakage than Tolterodine at 8 weeks, with no data on incontinence episodes frequency. All 3 studies reported that acupuncture significantly increased the quality of life assessed by ICIQ score. In addition, incidence of acupuncture-related adverse events was rare, while antimuscarinic agents related adverse events were common in two studies. Conclusion Although acupuncture showed some benefit for women with MUI, more evidences were required to draw a solid conclusion of effectiveness and safety of acupuncture for women with MUI. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO, identifier: CRD42021224600.
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Pad test for urinary incontinence diagnosis in adults: Systematic review of diagnostic test accuracy. Neurourol Urodyn 2022; 41:696-709. [PMID: 35114027 DOI: 10.1002/nau.24878] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 12/20/2021] [Accepted: 01/06/2022] [Indexed: 02/01/2023]
Abstract
INTRODUCTION The pad test is an assessment tool for urinary incontinence (UI) severity classification and therapeutic response monitoring. However, the reliability and reproducibility of this test have been questioned. OBJECTIVES To summarize the evidence regarding the accuracy measures and reproducibility of different pad test protocols for assessing UI. METHODS A systematic review of the diagnostic accuracy of this tool was performed (CRD42020219392). Eligibility criteria: Studies reporting data on the accuracy measures and reproducibility of the pad test when used for detecting UI in adult men and women. DATA SOURCES MEDLINE, Science Direct, Cochrane, Web of Science, LILACS, and Pedro. DATA EXTRACTION AND SYNTHESIS Two reviewers independently screened the articles, extracted the data, and evaluated the risk of bias (RoB) using the QUADAS-2 tool. RESULTS From 1048 studies, 18 studies were included. Eight of these reported accuracy data, and 12 reported reproducibility properties. A total of 1070 individuals were analyzed, whose mean age ranged from 20 to 90 years. The accuracy of the long-duration protocols was generally moderate to high (sensitivity, 60%-93%; specificity, 60%-84%). The 1-h protocols obtained higher accuracy values. The overall reproducibility was moderate to high (κ ≥ 0.66). LIMITATIONS The RoB was high and, due to different cutoff points adopted by studies, the bivariate model was not satisfied to perform a meta-analysis. DISCUSSION The 1-h pad test was more accurate but less reproducible when compared to the long-duration tests. Pad test results should be used with caution in clinical practice.
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The effect of pelvic floor exercises performed with EMG biofeedback or a vaginal cone on incontinence severity, pelvic floor muscle strength, and quality of life in women with stress urinary incontinence: a randomized, 6-month follow-up study. Int Urogynecol J 2022; 33:2773-2779. [PMID: 35028701 DOI: 10.1007/s00192-021-05006-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 09/27/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to assess the effectiveness of pelvic floor exercises performed with electromyographic (EMG) biofeedback or a vaginal cone on incontinence severity, muscle strength, social activity level, quality of life, treatment success, and treatment satisfaction in women with stress urinary incontinence (SUI). METHODS This prospective, randomized study included 40 female patients diagnosed with SUI. Patients were randomly divided into two groups as the group receiving pelvic floor muscle exercise (PFME) with a vaginal cone at home (n = 20) and the group receiving PFME with EMG biofeedback in the hospital (n = 20). The measurement of urinary incontinence severity with a 1-h pad test, assessment of social activity with the social activity index (SAI), assessment of incontinence-specific quality of life, manual measurement of pelvic floor muscle strength, and the assessment of treatment satisfaction were performed in the pre-treatment period and post-treatment at 3 and 6 months. RESULTS In intragroup analyses, an improvement was observed in both groups in the pad test, muscle strength, SAI, quality of life, and treatment satisfaction measurement compared with the pre-treatment period (p < 0.05). No significant difference was found between the groups in terms of assessment parameters in intergroup analyses during follow-up (p > 0.05). CONCLUSION It was concluded that both EMG biofeedback assisted PFME and PFME with a vaginal cone had curative effects on incontinence in patients with SUI. We believe that both protocols can be used as acceptable and effective conservative therapy methods in the treatment of women with SUI considering their preference.
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Efficacy of transcutaneous perineal electrostimulation versus intracavitary anal electrostimulation in the treatment of urinary incontinence after a radical prostatectomy: randomized controlled trial study protocol. BMC Urol 2021; 21:12. [PMID: 33509164 PMCID: PMC7842059 DOI: 10.1186/s12894-020-00718-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 09/14/2020] [Indexed: 01/05/2023] Open
Abstract
Background Radical prostatectomy is the gold standard treatment for men with localized prostate cancer. This technique is associated with post-operative urinary incontinence. Pelvic floor physiotherapy is a conservative, painless and economical treatment for this specific situation. Kegel exercises and perineal electrostimulation are common techniques to train pelvic floor muscles. The perineal electrostimulation can be applied to the patient with surface electrodes or by an intra-cavitary anal probe. This study proposes that transcutaneous perineal electrostimulation is as effective as intra-cavitary electrostimulation in reducing urinary incontinence secondary to radical prostatectomy. The main objective is to compare the efficacy of the treatment with transcutaneous perineal electrostimulation versus the same intra-cavitary treatment to reduce the magnitude of urinary incontinence after radical prostatectomy, and the impact on the quality of life. Methods This single-blind equivalence randomized controlled trial will include 70 man who suffer urinary incontinence post radical prostatectomy. Participants will be randomized into surface electrodes group and intra-anal probe group. The groups will receive treatment for 10 consecutive weeks. Outcomes include changes in the 24-h Pad Test, and ICIQ-SF, SF-12 and I-QoL questionnaires. Clinical data will be collected at baseline, 6 and 10 weeks after the first session, and 6 months after the end of treatment. Discussion The results will allow us to prescribe the most beneficial perineal electrostimulation technique in the treatment of urinary incontinence derived from radical prostatectomy. Trial registration ClinicalTrials.gov Identifier: NCT03587402. 27/06/2018
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Group-Based vs Individual Pelvic Floor Muscle Training to Treat Urinary Incontinence in Older Women: A Randomized Clinical Trial. JAMA Intern Med 2020; 180:1284-1293. [PMID: 32744599 PMCID: PMC7400216 DOI: 10.1001/jamainternmed.2020.2993] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
IMPORTANCE Urinary incontinence is one of the most prevalent health concerns experienced by older women (aged ≥60 years). Individual pelvic floor muscle training (PFMT) is the recommended first-line treatment for stress or mixed urinary incontinence in women, but human and financial resources limit its delivery. Whether group-based PFMT performs as well as individual PFMT in this population remains unclear. OBJECTIVE To assess the efficacy of group-based PFMT relative to individual PFMT for urinary incontinence in older women. DESIGN, SETTING, AND PARTICIPANTS The Group Rehabilitation or Individual Physiotherapy (GROUP) study is a single-blind, randomized, noninferiority trial conducted in 2 Canadian research centers, from July 1, 2012, to June 2, 2018. A total of 362 community-dwelling women aged 60 years or older with symptoms of stress or mixed urinary incontinence were enrolled. INTERVENTIONS After an individual session conducted to learn how to contract pelvic floor muscles, participants completed 12-week PFMT as part of a group of 8 women (n = 178) or in individual sessions (n = 184). MAIN OUTCOMES AND MEASURES The primary outcome measure was the percentage reduction in urinary incontinence episodes at 1 year, as reported in a 7-day bladder diary and relative to pretreatment baseline. Secondary outcomes included lower urinary tract-related signs, symptoms, and quality of life immediately following treatment and at 1 year. Per-protocol analysis was used. RESULTS Among 362 women who were randomized (mean [SD] age, 67.9 [5.8] years), 319 women (88%) completed the 1-year follow-up and were included in the per-protocol analysis. Median percentage reduction in urinary incontinence episodes was 70% (95% CI, 44%-89%) in individual PFMT compared with 74% (95% CI, 46%-86%) in group-based PFMT. The upper boundary of the 95% CI for the difference in the percentage reduction in urinary incontinence episodes at 1 year was lower than the prespecified margin for noninferiority of 10% (difference, 4%; 95% CI, -10% to 7%; P = .58), confirming noninferiority. Individual PFMT and group-based PFMT had similar effectiveness for all secondary outcomes at 1 year. Adverse events were minor and uncommon. CONCLUSIONS AND RELEVANCE Results of the GROUP study suggest that group-based PFMT is not inferior to the recommended individual PFMT for the treatment of stress and mixed urinary incontinence in older women. Widespread use in clinical practice may help increase continence-care affordability and treatment availability. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02039830.
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The relationship between running kinematics and the pelvic floor muscle function of female runners. Int Urogynecol J 2019; 31:155-163. [PMID: 31104073 DOI: 10.1007/s00192-019-03968-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 04/22/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS To date, no study has investigated the correlation between pelvic floor muscle function and urinary incontinence in female runners. The aim of the study was to investigate the relationship between pelvic floor muscle function and to correlate urinary leakage as measured by the modified pad test with kinematic variables of running. METHODS The sample consisted of 11 incontinent and 17 continent runners. On day 1, they performed a maximum velocity test on a treadmill using an incremental protocol. Their pelvic floor muscles were evaluated using vaginal palpation and manometry, and the adapted pad test was used to evaluate the severity of urinary incontinence. Then, running kinematics were evaluated on a treadmill using a circuit camera to capture vertical displacement, knee flexion during the load response phase, and the initial contact of the foot with the ground for subsequent analysis. The pad test was performed during the kinematic evaluation. RESULTS The vaginal squeeze pressure of the continent group (mean = 43.40 mmHg, SD = 21.75) was higher in descriptive terms than that of the incontinent group (mean = 38.94 mmHg, SD = 31.08), but the difference was not statistically significant (p = 0.66). There was an association between the weekly training load and urinary leakage. No associations were found between pelvic floor muscle function or urinary leakage and the kinematic variables. CONCLUSIONS Despite the correlation between the weekly training load and the severity of urinary leakage, no relationships were found between pelvic floor muscle functioning and the kinematics of running.
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Group physiotherapy compared to individual physiotherapy to treat urinary incontinence in aging women: study protocol for a randomized controlled trial. Trials 2017; 18:544. [PMID: 29145873 PMCID: PMC5689182 DOI: 10.1186/s13063-017-2261-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 10/17/2017] [Indexed: 11/23/2022] Open
Abstract
Background Urinary incontinence (UI), one of the most prevalent health concerns confronting women aged over 60 years, affects up to 55% of older community-dwelling women—20–25% with severe symptoms. Clinical practice guidelines recommend individualized pelvic floor muscle training (PFMT) as a first-line treatment for stress or mixed UI in women, although lack of human and financial resources limits delivery of this first-line treatment. Preliminary data suggest that group-based treatments may provide the answer. To date, no adequately powered trials have evaluated the effectiveness or cost-effectiveness of group compared to individual PFMT for UI in older women. Given demographic projections, high prevalence of UI in older women, costly barriers, and group PFMT promising results, there is a clear need to rigorously compare the short- and long-term effectiveness and cost-effectiveness of group vs individual PFMT. Methods/Design The study is designed as a non-inferiority randomized controlled trial, conducted in two facilities (Montreal and Sherbrooke) in the Canadian province of Quebec. Participants include 364 ambulatory, community-dwelling women, aged 60 years and older, with stress or mixed UI. Randomly assigned participants will follow a 12-week PFMT, either in one-on-one sessions or as part of a group, under the supervision of a physiotherapist. Blinded assessments at baseline, immediately post intervention, and at one year will include the seven-day bladder diary, the 24-h pad test, symptoms and quality of life questionnaires, adherence and self-efficacy questionnaire, pelvic floor muscle function, and cost assessments. Primary analysis will test our main hypothesis that group-based treatment is not inferior to individualized treatment with respect to the primary outcome: relative (%) reduction in the number of leakages. Discussion Should this study find that a group-based approach is not less effective than individual PFMT, and more cost-effective, this trial will impact positively continence-care accessibility and warrant a change in clinical practice. Trial registration ClinicalTrials.gov, NCT02039830. Registered on 12 December 2013; Study protocol version 2; 21 November 2013. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2261-4) contains supplementary material, which is available to authorized users.
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Pelvic Floor Muscle Training With and Without Electrical Stimulation in the Treatment of Lower Urinary Tract Symptoms in Women With Multiple Sclerosis. J Wound Ostomy Continence Nurs 2017; 43:414-9. [PMID: 27014935 DOI: 10.1097/won.0000000000000223] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study was to evaluate the effect of intravaginal neuromuscular electrical stimulation (NMES) and transcutaneous tibial nerve stimulation (TTNS) on lower urinary tract symptoms (LUTS) and health-related quality of life in women undergoing pelvic floor muscle (PFM) training (PFMT) with multiple sclerosis (MS) and to compare the efficacy of these 2 approaches. DESIGN Randomized controlled trial. METHODS Thirty women with MS and LUTS were randomly allocated to 1 of 3 groups and received treatment for 12 weeks. Ten women in group 1 received PFMT with electromyographic (EMG) biofeedback and sham NMES. Ten women in group 2 underwent PFMT with EMG biofeedback and intravaginal NMES, and 10 subjects in group 3 received PFMT with EMG biofeedback and TTNS. Multiple assessments, performed before and after treatment, included a 24-hour pad test, 3-day bladder diary, assessment of PFM function (strength and muscle tone), urodynamic studies, and validated questionnaires including Overactive Bladder Questionnaire (OAB-V8), International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), and Qualiveen instrument. RESULTS All groups showed reductions in pad weight, frequency of urgency and urge urinary incontinence episodes, improvement in all domains of the PFM assessment, and lower scores on the OAB-V8 and ICIQ-SF questionnaires following treatment. Subjects in group 2 achieved significantly greater improvement in PFM tone, flexibility, ability to relax PFMs, and OAB-V8 scores when compared to subjects in groups 1 and 3. CONCLUSION Results suggest that PFMT alone or in combination with intravaginal NMES or TTNS is effective in the treatment of LUTS in patients with MS. The combination of PFMT and NMES offers some advantage in the reduction of PFM tone and symptoms of overactive bladder.
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Comparison of the efficacy of perineal and intravaginal biofeedback assisted pelvic floor muscle exercises in women with urodynamic stress urinary incontinence. Neurourol Urodyn 2017; 36:2132-2141. [PMID: 28345778 DOI: 10.1002/nau.23257] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 02/17/2017] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To assess the effectiveness of intravaginal pressure biofeedback (P-BF) and perineal electromyographic biofeedback (EMG-BF) assisted pelvic floor muscle (PFM) exercises in women with stress urinary incontinence (SUI). MATERIAL AND METHODS Fifty-three women with SUI were randomized into three groups as follows: the Group 1 received PFM home exercise program alone (n:18); the Group 2 received PFM home exercise program plus intravaginal P-BF assisted PFM exercise program (n:17); and the Group 3 received PFM home exercise program plus perineal EMG-BF assisted PFM exercise program (n:18). Subjects were also assessed with the 1-h pad test (severity of incontinence), perineometer (PFM strength), social activity index (SAI), IIQ7 (quality of life associated with incontinence), treatment success (cure and improvement rate) and treatment satisfaction. RESULTS A statistically significant improvement was found in all parameters for all groups at 4th week and 8th week compared to the baseline values. It was found that severity of incontinence, PFM strength, and SAI scores were significantly improved in both BF groups compared to the Group 1 at 8th week. Also, statistically higher cure and improvement rate and treatment satisfaction values were detected in both BF groups compared to the Group 1. There was no statistically significant difference between Group 2 and Group 3 in all parameters evaluated at the follow-up period. CONCLUSIONS We conclude that both the home exercises plus intravaginal P-BF and home exercises plus perineal EMG-BF are superior to home exercises in women with SUI. Intravaginal P-BF and perineal EMG-BF were similarly effective and they can be used as their alternatives.
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Assessing variability of the 24-hour pad weight test in men with post-prostatectomy incontinence. Int Braz J Urol 2017; 42:327-33. [PMID: 27256187 PMCID: PMC4871394 DOI: 10.1590/s1677-5538.ibju.2014.0506] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 02/15/2015] [Indexed: 11/21/2022] Open
Abstract
Purpose: Decision-making regarding surgery for post-prostatectomy incontinence (PPI) is challenging. The 24-hour pad weight test is commonly used to objectively quantify PPI. However, pad weight may vary based upon activity level. We aimed to quantify variability in pad weights based upon patient-reported activity. Materials and Methods: 25 patients who underwent radical prostatectomy were prospectively enrolled. All patients demonstrated clinical stress urinary incontinence without clinical urgency urinary incontinence. On three consecutive alternating days, patients submitted 24-hour pad weights along with a short survey documenting activity level and number of pads used. Results: Pad weights collected across the three days were well correlated to the individual (ICC 0.85 (95% CI 0.74–0.93), p<0.001). The mean difference between the minimum pad weight leakage and maximum leakage per patient was 133.4g (95% CI 80.4–186.5). The mean increase in 24-hour leakage for a one-point increase in self-reported activity level was 118.0g (95% CI 74.3–161.7, p<0.001). Pad weights also varied significantly when self-reported activity levels did not differ (mean difference 51.2g (95% CI 30.3–72.1), p<0.001). Conclusions: 24-hour pad weight leakage may vary significantly on different days of collection. This variation is more pronounced with changes in activity level. Taking into account patient activity level may enhance the predictive value of pad weight testing.
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The effect of EMG biofeedback assisted pelvic floor muscle therapy on symptoms of the overactive bladder syndrome in women: A randomized controlled trial. Neurourol Urodyn 2016; 36:1796-1803. [PMID: 27869312 DOI: 10.1002/nau.23180] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 10/28/2016] [Indexed: 12/16/2022]
Abstract
AIMS The overactive bladder syndrome (OAB) is defined as urinary urgency, usually accompanied by frequency and nocturia, with or without urgency urinary incontinence. Biofeedback-assisted pelvic muscle therapy (BAPFMT) is a first-line treatment option for OAB. The aims of this study were to determine the efficacy and effectiveness of BAPFMT on symptoms of OAB after 9 weeks of treatment and to detect changes EMG activity of individual pelvic floor muscles (PFM) with the MAPLe. METHODS Patients were randomly divided into an intervention group that received BAPFMT with the MAPLe or into a control group which received only toilet behavior and lifestyle instructions. The Pelvic Floor Inventories (PeLFIs), the King's Health Questionnaire (KHQ), a voiding dairy, a 24 h pad-test, and vaginal EMG registration of the pelvic floor with the MAPLe were used at inclusion and after 9 weeks follow-up to determine the effect of BAPFMT on complaints of OAB and Quality of Life (QoL). RESULTS Fifty-eight patients were included. The PeLFIs, KHQ, voiding dairy, and 24 h pad-test showed significant improvements in the intervention group compared to the control group in complaints of OAB and QoL. EMG activity showed significant improvements for specific individual muscles at the different sides and depths for rest, maximal voluntary contraction, and endurance. CONCLUSIONS EMG BAPFMT is effective in the OAB syndrome in women. It significantly reduces symptoms and complaints of OAB and increases QoL for patients. It shows that EMG changes in individual PFM, measured with the MAPLe, are relevant and related to symptom reduction.
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Incontinence in nursing home residents with dementia. Z Gerontol Geriatr 2016; 51:48-53. [DOI: 10.1007/s00391-016-1120-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 06/08/2016] [Accepted: 07/15/2016] [Indexed: 10/21/2022]
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The correlation between retrograde leak point pressure and 24-hour pad weight. Neurourol Urodyn 2016; 36:1119-1123. [PMID: 27376718 DOI: 10.1002/nau.23063] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 06/17/2016] [Indexed: 11/09/2022]
Abstract
AIM To assess the correlation between retrograde leak point pressure (RLPP) and 24-hr pad weight (24PW) in men with post-prostatectomy incontinence. METHODS We performed RLPP and 24PW measurements on 61 patients with a history of post-prostatectomy stress urinary incontinence (SUI). We examined the relationship of RLPP and 24PW. We also reviewed the urodynamic and clinical data of these patients to explain our findings. RESULTS The mean age was 70 years (SD ± 7.4, range: 51-87). The mean RLPP was 36.8 cmH2 O (SD ± 15.3, range: 9-76), the mean 24PW was 499 g (±677 g, range: 16.5-3,177 g). There was a good and significant negative correlation between RLPP and 24PW (r = 0.56, P < 0.01). RLPP was able to differentiate between cases of mild/moderate (<400 g) and severe (≥400 g) incontinence. Patients with RLPP <30 cmH2 O had significantly higher 24PW (mean 825 g, median 768 g) when compared with patients with RLPP >30 cmH2 O (mean 257.8 g, median 100 g, P < 0.01). CONCLUSIONS RLPP could be used as an objective and potentially more reliable substitute to pad weight to objectify and stratify SUI in post-prostatectomy patients. Neurourol. Urodynam. 36:1119-1123, 2017. © 2016 Wiley Periodicals, Inc.
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Evaluation of Transobturator Tension-Free Vaginal Tapes in the Surgical Management of Mixed Urinary Incontinence: 3-Year Outcomes of a Randomized Controlled Trial. J Urol 2014; 191:114-9. [DOI: 10.1016/j.juro.2013.07.035] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2013] [Indexed: 11/15/2022]
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Effect of preoperative pelvic floor muscle therapy with biofeedback versus standard care on stress urinary incontinence and quality of life in men undergoing laparoscopic radical prostatectomy: A randomised control trial. Neurourol Urodyn 2013; 34:144-50. [DOI: 10.1002/nau.22523] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 10/10/2013] [Indexed: 11/07/2022]
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The efficacy and safety of electroacupuncture for women with pure stress urinary incontinence: study protocol for a multicenter randomized controlled trial. Trials 2013; 14:315. [PMID: 24079823 PMCID: PMC3850726 DOI: 10.1186/1745-6215-14-315] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 09/16/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although available evidence relating to its effectiveness is weak, acupuncture is used as an alternative therapy for stress urinary incontinence. We report a protocol of a randomized controlled trial using electroacupuncture (the passing of a weak current between inserted acupuncture needles) to treat women with pure stress urinary incontinence. METHODS/DESIGN This is a large-scale multicenter subject-blinded randomized controlled trial. A total of 500 women with pure stress urinary incontinence will be randomly assigned to two groups: a treatment group and a control group. The treatment group will receive electroacupuncture with deep needling at acupuncture points BL33 and BL35. The control group will receive sham electroacupuncture with non-penetrating needling at sham locations for the acupuncture points of BL33 and BL35. Participants will be given three sessions a week for 6 weeks. A 24-week-long follow-up will be conducted. The primary outcome will be the change in amount of urine leakage at the sixth week from a baseline measured by a 1-h pad test. The secondary outcomes include: the 72-h incontinence episode frequency based on a 72-h bladder diary; the score of International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form; the degree of urinary incontinence based on a 72-h bladder diary; self-assessment of the therapeutic effect; weekly consumption of pads; application of other treatments for stress urinary incontinence; and subgroup analysis stratified by incontinence severity. The safety of electroacupuncture will also be assessed. DISCUSSION This trial will help to identify whether electroacupuncture is effective for stress urinary incontinence, and, if so, whether it is a therapeutic effect rather than a placebo effect. TRIAL REGISTRATION Clinical Trials.gov NCT01784172.
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Efficacy of Botulinum Toxin A Intradetrusor Injections for Non-neurogenic Urinary Urge Incontinence: A Randomized Double-Blind Controlled Trial. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2013; 35:53-60. [DOI: 10.1016/s1701-2163(15)31049-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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What predicts and what mediates the response of urge urinary incontinence to biofeedback? Neurourol Urodyn 2012; 32:408-15. [PMID: 23168606 DOI: 10.1002/nau.22347] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2012] [Accepted: 10/04/2012] [Indexed: 11/11/2022]
Abstract
AIMS To better target a behavioral approach for urge urinary incontinence (UUI) and enhance its efficacy by (1) identifying predictors of response to biofeedback-assisted pelvic muscle training (BFB), and (2) determining factors that mediate response. METHODS BFB (four biweekly visits) was administered to 183 women > 60 years (mean = 73.6). Before and after intervention, all underwent comprehensive evaluation and videourodynamic testing. Postulated predictors and mediators from four urodynamic domains, specified a priori, were correlated with reduction in UUI frequency. RESULTS Median UUI frequency decreased from 3.2/day to 1/day (P =0.0001). UUI improved by ≥50% in 55% of subjects and by 100% in 13% of subjects. Frequent UUI predicted poor response (P < 0.01). Of the urodynamic parameters, only high amplitude and briskness of detrusor overactivity (DO) predicted decreased response (P < 0.05 and P < 0.01) and these could be measured only in the 43% of subjects with elicitable DO. Decreased DO elicitability was the only urodynamic variable that changed in concert with improvement and thus was a candidate mediator. Response was neither predicted nor mediated by proprioception/warning, cystometric capacity, detrusor contractility, sphincter strength, or baseline DO elicitability. CONCLUSIONS Severe DO predicts poor response to BFB. Good response is mediated by reduction in DO elicitability. Other than baseline UUI frequency, there are no other clinically or urodynamically important predictors or mediators of BFB response in this population. BFB may be best for patients with less severe DO. Future research to enhance its efficacy might better focus on the brain than on the lower urinary tract.
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Validity testing of the stopwatch urine stream interruption test in radical prostatectomy patients. J Wound Ostomy Continence Nurs 2012; 39:545-51. [PMID: 22825573 PMCID: PMC3436943 DOI: 10.1097/won.0b013e3182648055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To assess convergent validity of the stopwatch urine stream interruption test (UST). Specific aims were to describe relationships among stopwatch UST scores and 4 common clinical indices of pelvic floor muscle strength: 24-hour urine leakage, confidence in performing pelvic muscle exercise, 24-hour pad count, and daily pelvic muscle exercise count. DESIGN Secondary analysis; instrumentation study. METHODS The final sample consisted of baseline stopwatch UST scores and measurements of comparison variables from 47 participants in a randomized clinical trial of 3 approaches to pelvic floor training for patients with urinary incontinence following radical prostatectomy. The sample size provided 80% power to detect correlations of moderate strength or higher. The stopwatch UST was conducted in an examination room at the study site by trained study personnel (MP, ADC, JP, SM). Measurements of comparison variables were obtained from 3 instruments: 24-hour pad test, Broome pelvic muscle self-efficacy scale, and 3-day bladder diary. Relationships among study variables were evaluated with Pearson correlation coefficients. RESULTS Stopwatch UST scores were moderately correlated with 24-hour urine leakage on the 24-hour pad test (r = 0.35, P < .05), the most robust comparison measure. Correlations between stopwatch UST scores and all other comparison measures were in the appropriate direction, although weak, and did not reach statistical significance. CONCLUSION Findings suggest that the stopwatch UST may be a valid index of pelvic floor muscle strength in men following radical prostatectomy. With further testing, the stopwatch UST could become a valuable clinical tool for assessing pelvic floor muscle strength in radical prostatectomy patients with urinary incontinence.
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Comparison of the cough stress test and 24-h pad test in the assessment of stress urinary incontinence. Int Urogynecol J 2011; 23:429-33. [DOI: 10.1007/s00192-011-1602-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Accepted: 10/28/2011] [Indexed: 10/15/2022]
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Does patient activity level affect 24-hr pad test results in stress-incontinent women? Neurourol Urodyn 2011; 31:143-7. [DOI: 10.1002/nau.21169] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Accepted: 05/12/2011] [Indexed: 11/05/2022]
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Pelvic floor muscle training in the treatment of lower urinary tract dysfunction in women with multiple sclerosis. Neurourol Urodyn 2011; 29:1410-3. [PMID: 20976816 DOI: 10.1002/nau.20941] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
AIMS Evaluate the role of pelvic floor muscle training (PFMT) on the treatment of lower urinary tract dysfunction (LUTD) in multiple sclerosis (MS) patients. METHODS In this randomized controlled trial, twenty seven female patients with a diagnosis of MS and LUTD complaints were randomized, in two groups: Treatment group (GI) (N = 13) and Sham group (GII) (N = 14). Evaluation included urodynamic study, 24-hr Pad testing, three day voiding diary and pelvic floor evaluation according to PERFECT scheme. Intervention was performed twice a week for 12 weeks in both groups. GI intervention consisted of PFMT with assistance of a vaginal perineometer. GII received a sham treatment consisted on the introduction of a perineometer inside the vagina with no contraction required. RESULTS At the end of the treatment GI was complaining less about storage and voiding symptoms than GII. Furthermore, differences found between groups were: reduction of pad weight (P = 0.00) (Mean: 87,51 grams initial and 6,03 grams final in GI. 69,46 grams initial and 75,88 grams final in GII), number of pads (P = 0.01) (Mean: 3,61 initial and 2,15 final in GI. 3,42 initial and 3,28 final in GII) and nocturia events (P < 0.00) (Mean: 2,38 initial and 0,46 final in GI. 2,55 initial and 2,47 final in GII) and improvements of muscle power (P = 0.00), endurance (P < 0.00), resistance (P < 0.00) and fast contractions (P < 0.00), domains of PERFECT scheme. CONCLUSIONS PFMT is an effective approach to treat LUTD in female with MS.
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Validating the Incontinence Symptom Severity Index: A Self-Assessment Instrument for Voiding Symptom Severity in Women. J Urol 2009; 182:2384-91. [DOI: 10.1016/j.juro.2009.07.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2009] [Indexed: 10/20/2022]
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Lower Urinary Tract Symptoms in Older Adults Undergoing Hip Arthroplasty. J Wound Ostomy Continence Nurs 2008; 35:334-40. [DOI: 10.1097/01.won.0000319134.37101.c4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Evaluation and outcome measures in the treatment of female urinary stress incontinence: International Urogynecological Association (IUGA) guidelines for research and clinical practice. Int Urogynecol J 2008; 19:5-33. [PMID: 18026681 PMCID: PMC2096636 DOI: 10.1007/s00192-007-0495-5] [Citation(s) in RCA: 127] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2007] [Accepted: 10/14/2007] [Indexed: 02/06/2023]
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A statistical comparison of pad numbers versus pad weights in the quantification of urinary incontinence. Neurourol Urodyn 2007; 26:3-7. [PMID: 17080415 DOI: 10.1002/nau.20352] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AIMS Pad per day (PPD) usage is a frequently utilized measure of urinary incontinence. The 24-hour pad weight test (24PWT) is a reproducible test for quantifying incontinence volumes. We investigated whether PPD validly reports the magnitude of urinary incontinence. METHODS This was a retrospective review of patients undergoing stress incontinence surgery from July 2002 to 2005. Inclusion criteria were a documented 24PWT and patient-reported PPD usage. Grams of urine loss per pad (GPP) provided a third measure of incontinence. Descriptive statistics and correlations between all variables and significance were noted. Factor analysis was performed on the three measures of leakage and age for all patients over age 50. RESULTS One hundred forty-five male and 116 female patients met inclusion criteria. Correlated against 24PWT, GPP has the strongest association with a correlation of 0.80 for males and 0.88 for females. PPD has a weaker correlation of 0.64 for males and 0.61 for females (R2 = 0.38 overall). Factor analysis identified two components associated with incontinence. A "leakage" component correlated best with 24PWT and GPP. Additionally, an "age" component implies that despite stable 24PWT values, older patients increase GPP while PPD decreases. CONCLUSIONS Self-reported PPD is an unreliable measure of incontinence as this variable only measures 38% of the variation of urinary incontinence volume. Patients at a given PPD level present with a wide range of 24PWT values. Older patients have higher per-pad leakage. Future incontinence studies should report 24PWT to ensure the most reliable and uniform data.
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In patients undergoing neuromodulation for intractable urge incontinence a reduction in 24-hr pad weight after the initial test stimulation best predicts long-term patient satisfaction. Neurourol Urodyn 2007; 26:213-7. [PMID: 17009252 DOI: 10.1002/nau.20330] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
AIMS To evaluate long-term patient satisfaction of sacral neuromodulation and to correlate satisfaction with incontinence parameters. METHODS Patients at least 1-year remote from sacral neuromodulation were mailed a questionnaire to evaluate satisfaction and assess incontinence symptoms. RESULTS Fifty-two patients were consecutively enrolled in the study. Forty-nine questionnaires (94.2%) were returned. The average interval between implantation and questionnaire completion was 27.2 (range 12-52) months. 83.7% of respondents were satisfied and 79.6% of patients would "do it all over again." Compared to dissatisfied subjects during test stimulation, the satisfied patients had a significant decrease in 24-hr pad weight (84.5% vs. 60.6%, P = 0.002) but did not differ in daily pad usage (4.5 fewer pads per day vs. 3.4, P = 0.190). At long-term follow-up, satisfied patients noted significantly greater improvement in their Incontinence Impact Questionnaire score versus dissatisfied patients (mean improvement 53 vs. 10 points, P = 0.0003). Using multiple logistic regression, change in 24-hr pad weight, but not change in average daily pad usage, was correlated with long-term satisfaction. CONCLUSIONS Eighty-four percent of patients were satisfied with sacral neuromodulation at a mean of 27 months. An 84.5% reduction in 24-hr pad weight correlated with long-term patient satisfaction. In addition to lack of efficacy, device pain was a contributing factor to dissatisfaction.
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Abstract
PURPOSE OF REVIEW The aim of this article is to use evidence-based criteria to review recent publications on the evaluation and management of stress urinary incontinence in women. RECENT FINDINGS Longitudinal studies suggest that a familial predisposition towards stress urinary incontinence may exist. There is mounting evidence that cesarean section may play a protective role against pelvic floor damage due to labor, but this continues to be investigated. Objective parameters in the evaluation of stress urinary incontinence, such as questionnaires, pad test, and urodynamic studies, continue to undergo refinements to become more clinically relevant outcome tools. Non-invasive and minimally-invasive therapies for stress urinary incontinence are expanding. The search continues for the optimal non-autologous material in the pubovaginal sling procedure. Despite concerns over the use of synthetic material and better defined early complications, midurethral slings continue to enjoy popularity with short-term and intermediate success. SUMMARY Further research into the cause of stress urinary incontinence is necessary. There is still no unified protocol in the evaluation of the condition and its severity. Mid-urethral slings appear to be as efficacious as more established procedures (bladder neck suspensions, pubovaginal slings), but long-term results on safety and efficacy remain scarce.
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