Novel clinically meaningful scores for the ICIQ-UI-SF and ICIQ-FLUTS questionnaires in women with stress incontinence

An optimized deep learning model based on transperineal ultrasound images for precision diagnosis of female stress urinary incontinence

Background

Transperineal ultrasound (TPUS) is widely utilized for the evaluation of female stress urinary incontinence (SUI). However, the diagnostic accuracy of parameters related to urethral mobility and morphology remains limited and requires further optimization.

Objective

This study aims to develop and validate an optimized deep learning (DL) model based on TPUS images to improve the precision and reliability of female SUI diagnosis.

Methods

This retrospective study analyzed TPUS images from 464 women, including 200 patients with SUI and 264 controls, collected between 2020 and 2024. Three DL models (ResNet-50, ResNet-152, and DenseNet-121) were trained on resting-state and Valsalva-state images using an 8:2 training-to-testing split. Model performance was assessed using diagnostic metrics, including area under the curve (AUC), accuracy, sensitivity, and specificity. A TPUS-index model, constructed using measurement parameters assessing urethral mobility, was used for comparison. Finally, the best-performing DL model was selected to evaluate its diagnostic advantages over traditional methods.

Results

Among the three developed DL models, DenseNet-121 demonstrated the highest diagnostic performance, achieving an AUC of 0.869, an accuracy of 0.87, a sensitivity of 0.872, a specificity of 0.761, a negative predictive value (NPV) of 0.788, and a positive predictive value (PPV) of 0.853. When compared to the TPUS-index model, the DenseNet-121 model exhibited significantly superior diagnostic performance in both the training set (z = -2.088, p = 0.018) and the testing set (z = -1.997, p = 0.046).

Conclusion

This study demonstrates the potential of DL models, particularly DenseNet-121, to enhance the diagnosis of female SUI using TPUS images, providing a reliable and consistent diagnostic tool for clinical practice.

Association between SMAD3 and SMAD7 gene polymorphisms and susceptibility to stress urinary incontinence in Chinese women

OBJECTIVE

This study aimed to investigate the correlation between single nucleotide polymorphisms (SNPs) in SMAD3 and SMAD7 genes and the genetic risk of stress urinary incontinence (SUI) in Chinese women.

METHODS

A case-control study was conducted with 117 women diagnosed with SUI and 103 healthy controls. SNPs in SMAD3 (rs28683050, rs12901499) and SMAD7 (rs12953717, rs4939827) were analyzed using polymerase chain reaction-restricted fragment length polymorphism (PCR-RFLP). Allele and genotype frequencies were assessed using the SHEsis online platform. Epidemiological, clinical, and laboratory data were collected retrospectively. SUI patients underwent pelvic floor muscle training (PFMT), and treatment outcomes were evaluated after 3 months.

RESULTS

The G allele and GG genotype of rs12901499 in SMAD3 were significantly more common in the SUI case group (p_allele < 0.001, p_genotype = 0.002). Similarly, the T allele and TT genotype at rs12953717 in SMAD7 were more frequent in the SUI case group (p_allele = 0.002, p_genotype = 0.007). Multivariate logistic regression revealed that body mass index (BMI), family history, and the rs12901499 and rs12953717 polymorphisms were significant risk factors for SUI (P < 0.05). Furthermore, the TT genotype at rs12953717 was associated with poorer PFMT treatment outcomes.

CONCLUSION

Our findings suggest that the rs12901499 and rs12953717 polymorphisms are potential risk factors for SUI in women. Additionally, the rs12953717 polymorphism may influence the effectiveness of PFMT in SUI treatment.

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

INTRODUCTION AND HYPOTHESIS

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

The minimal important difference of patient-reported outcome measures related to female urinary incontinence: a systematic review

BACKGROUND

The minimal important difference is a valuable metric in ascertaining the clinical relevance of a treatment, offering valuable guidance in patient management. There is a lack of available evidence concerning this metric in the context of outcomes related to female urinary incontinence, which might negatively impact clinical decision-making.

OBJECTIVES

To summarize the minimal important difference of patient-reported outcome measures associated with urinary incontinence, calculated according to both distribution- and anchor-based methods.

METHODS

This is a systematic review conducted according to the PRISMA guidelines. The search strategy including the main terms for urinary incontinence and minimal important difference were used in five different databases (Medline, Embase, CINAHL, Web of Science, and Scopus) in 09 June 2021 and were updated in January 09, 2024 with no limits for date, language or publication status. Studies that provided minimal important difference (distribution- or anchor-based methods) for patient-reported outcome measures related to female urinary incontinence outcomes were included. The study selection and data extraction were performed independently by two different researchers. Only studies that reported the minimal important difference according to anchor-based methods were assessed by credibility and certainty of the evidence. When possible, absolute minimal important differences were calculated for each study separately according to the mean change of the group of participants that slightly improved.

RESULTS

Twelve studies were included. Thirteen questionnaires with their respective minimal important differences reported according to distribution (effect size, standard error of measurement, standardized response mean) and anchor-based methods were found. Most of the measures for anchor methods did not consider the smallest difference identified by the participants to calculate the minimal important difference. All reports related to anchor-based methods presented low credibility and very low certainty of the evidence. We pooled 20 different estimates of minimal important differences using data from primary studies, considering different anchors and questionnaires.

CONCLUSIONS

There is a high variability around the minimal important difference related to patient-reported outcome measures for urinary incontinence outcomes according to the method of analysis, questionnaires, and anchors used, however, the credibility and certainty of the evidence to support these is still limited.