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Valipour R, Narouie B, Dadpour M, Torabinavid P, Momeni H, Radpour N, Ahmadzade M, Rouientan H, Danesh H, Emami MA. Impacts of Bariatric Surgery on Improvement of Incontinence Among Obese Asian Women: A Prospective Study and Literature Review. Obes Surg 2024; 34:1425-1431. [PMID: 38517646 DOI: 10.1007/s11695-024-07172-x] [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: 10/25/2023] [Revised: 03/12/2024] [Accepted: 03/13/2024] [Indexed: 03/24/2024]
Abstract
INTRODUCTION Limited studies investigate bariatric surgery's role in improving UI status among Asians, specifically Middle Eastern Asian women. The aim of this study is to investigate the effect of bariatric surgery on the three most prevalent urine incontinence (UI).We also reviewed the current literature exploring the studies performed in Asian countries. MATERIALS AND METHODS A total of 77 women out of 200 who had UI and indications for bariatric surgery completed demographic information and the questionnaire (QUID) prior to surgery and 6 months after the surgery. For statistical analysis, the Mann-Whitney U test, Wilcoxon test, and Friedman test were utilized. We also performed a literature review with the aim of investigating studies performed in Asian countries. RESULTS Among the initial analysis of 200 participants, 50.5% reported UI symptoms before surgery. The average weight loss was 29 kg, with a standard deviation of 7 kg. The mean BMI dropped 11.2 kg/m2, and the standard deviation was 2.5 after weight loss. Post-surgery, significant reductions in UI scores were observed across all severity levels, with a notable 44% achieving complete symptom resolution, indicating a substantial decrease in urinary incontinence. Stress, urine incontinence, and mixed urine incontinence symptoms had improved in 75%, 71%, and 30% of women, respectively. Notably, age and gynecological history were identified as critical factors influencing the extent of UI improvement. CONCLUSION This study reveals significant improvements in urinary incontinence scores, with age and gynecological history playing pivotal roles in UI improvement.
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Affiliation(s)
- Reza Valipour
- Department of Urology, Tehran Medical Sciences Branch, Islamic Azad University of Medical Sciences, Tehran, Iran
| | - Behzad Narouie
- Department of Urology, Zahedan University of Medical Sciences, Zahedan, Iran.
| | - Mehdi Dadpour
- Department of Urology, Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parham Torabinavid
- Department of Pediatric Urology and Regenerative Medicine Research Center, Children's Medical Center, Pediatric Center of Excellence, Tehran University of Medical Science, Tehran, Iran
| | - Hamidreza Momeni
- Department of Urology, Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Negar Radpour
- Department of Urology, Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohadese Ahmadzade
- Department of Urology, Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamidreza Rouientan
- Department of Urology, Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hoseinali Danesh
- Department of Surgery, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Mohammad Aref Emami
- Department of Surgery, Zahedan University of Medical Sciences, Zahedan, Iran
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Koenig JB, Burnett LA. Understanding the Role of Obesity and Metabolism in Pelvic Floor Disorders. UROGYNECOLOGY (PHILADELPHIA, PA.) 2024; 30:389-393. [PMID: 38564623 DOI: 10.1097/spv.0000000000001478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Affiliation(s)
- Jenny B Koenig
- From the Department of Obstetrics, Gynecology, and Reproductive Sciences
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An D, Wang J, Zhang F, Jing H, Gao Y, Cong H, Su G, Ye M, Hu C, Wu J, Liao L. Effect of Pilates combined with pelvic floor muscle training on continence of post-prostatectomy incontinence in patients with different body mass index. BMC Urol 2024; 24:74. [PMID: 38549067 PMCID: PMC10976754 DOI: 10.1186/s12894-024-01451-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 03/07/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND Urinary incontinence symptoms severely affect older people with different body mass index (BMI).To compare the efficacy of the pelvic floor muscle training (PFMT) in patients with post-prostatectomy incontinence with different BMI. METHODS Thirty-seven patients with post-prostatectomy incontinence were included. They were divided into group A (BMI ≤ 25,12), group B (26 ≤ BMI ≤ 30,14), and group C (BMI ≥ 31,11) based on difference BMI. Three groups of patients underwent the same Pilates combined with kegel training. Participants were assessed with 1-hour pad test, the number of incontinence episodes, International Consultation on Incontinence Questionnaire and Oxford Grading Scale. RESULTS In the 1-hour pad test, the differences before and after training were statistically significant in all three groups of participants. Group A decreased from 81.83 ± 8.79 to 31.08 ± 5.64 g (P < 0.01). Group B decreased from 80.57 ± 8.87 to 35.85 ± 5.66 g (P < 0.01). Group C decreased from 83.55 ± 10.24 to 40.18 ± 7.01 g (P < 0.01). The number of incontinent episodes in group A decreased from 9.33 ± 1.07 to 3.25 ± 0.62 (P < 0.01). Group B decreased from 8.86 ± 1.09 to 3.79 ± 0.80 (P < 0.01). Group C decreased from 9.27 ± 1.10 to 4.09 ± 0.70 (P < 0.01). The correlation between the three groups of participants and the 1-hour pad test, with an R2 of 0.51. The correlation between the three groups of participants and the number of urinary incontinence episodes with a R2 of 0.43. CONCLUSIONS Pelvic floor muscle training can affect the recovery of urinary continence in patients with different BMI. Maintaining a lower BMI can be beneficial for improving urinary control. TRIAL REGISTRATION Date of trial registration: November 27, 2023.
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Affiliation(s)
- Di An
- Department of physiotherapy 2 (PT2), China Rehabilitation Research Center the School of Rehabilitation, Capital Medical University, NO 10, Jiaomen Beilu, Fengtai district, Beijing, 100068, China
| | - Jianxia Wang
- Department of Intensive Care Unit, Cancer Hospital Chinese Academy of Medical Science, National Cancer Center/ National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Chaoyang District, Beijing, China
| | - Fan Zhang
- Department of Urology, China Rehabilitation Research Center, Fengtai district, Beijing, China
| | - Huafang Jing
- Department of Urology, China Rehabilitation Research Center, Fengtai district, Beijing, China
| | - Yi Gao
- Department of Urology, China Rehabilitation Research Center, Fengtai district, Beijing, China
| | - Huiling Cong
- Department of Urology, China Rehabilitation Research Center, Fengtai district, Beijing, China
| | - Guodong Su
- Department of physiotherapy 3(PT3), China Rehabilitation Research Center, Fengtai district, Beijing, China
| | - Miao Ye
- Department of physiotherapy 2 (PT2), China Rehabilitation Research Center the School of Rehabilitation, Capital Medical University, NO 10, Jiaomen Beilu, Fengtai district, Beijing, 100068, China
| | - Chunying Hu
- Department of physiotherapy 2 (PT2), China Rehabilitation Research Center the School of Rehabilitation, Capital Medical University, NO 10, Jiaomen Beilu, Fengtai district, Beijing, 100068, China
| | - Juan Wu
- Department of Urology, China Rehabilitation Research Center, Fengtai district, Beijing, China
| | - Limin Liao
- China Rehabilitation Research Center (CRRC), Department of Urology of Beijing Boai Hospital, Department of Urology of Capital Medical University, NO 10, Jiaomen Beilu, Beijing, 100068, China.
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Khan J, Shaw S. Risk of multiple lower and upper urinary tract problems among male older adults with type-2 diabetes: a population-based study. Aging Male 2023; 26:2208658. [PMID: 37256730 DOI: 10.1080/13685538.2023.2208658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/10/2023] [Accepted: 04/21/2023] [Indexed: 06/02/2023] Open
Abstract
AIM This study explores the risk of diabetes-associated lower and upper urinary tract diseases among male older adults aged 45 and above in India. METHODS Longitudinal Ageing Study in India (LASI), 2017-2018 data was used in this study. The prevalence of various urinary tract problems and diabetes among male older adults was estimated by background characteristics using bivariate cross-tabulation. In addition, multivariate logistic regression was applied to examine the likelihood of urological disorders associated with diabetes. RESULT The prevalence of incontinence was highest among male older adults with diabetes, followed by kidney stones, benign prostatic hyperplasia, and chronic renal failure. Multivariate logistic regression estimation showed that men diagnosed with diabetes were 80% more likely to experience chronic renal failure, 78% more likely to suffer from incontinence, and 37% more likely to suffer from kidney stones than those without diabetes when controlling for various socio-demographic, behavioral, and co-morbidity status of the older adults. CONCLUSIONS The study findings suggest that diabetes is associated with multiple urinary complications among male older adults in India and needs more careful investigation of the phenomenon. Independent risk factors such as changes in lifestyle with regular monitoring and diagnosis may help to prevent the progression of diabetes and reduce the risk of diabetes-associated lower and upper urinary tract diseases among male older adults.
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Affiliation(s)
- Junaid Khan
- International Institute for Population Sciences, Mumbai, India
| | - Subhojit Shaw
- International Institute for Population Sciences, Mumbai, India
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Getaneh FW, Ringel N, Kolm P, Iglesia CB, Dieter AA. The effect of 12-month postoperative weight change on outcomes following midurethral sling for stress urinary incontinence: a secondary analysis of the ESTEEM and TOMUS randomized trials. Int Urogynecol J 2023; 34:2809-2816. [PMID: 37750917 DOI: 10.1007/s00192-023-05654-7] [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: 07/10/2023] [Accepted: 09/08/2023] [Indexed: 09/27/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Prior studies demonstrate mixed results on the impact of obesity on the success of midurethral slings (MUS), with little known about how postoperative weight change affects outcomes. We aimed to examine the effect of postoperative weight change on outcomes 12 months after MUS for stress urinary incontinence (SUI). METHODS This secondary analysis utilized data from two multicenter randomized trials of women undergoing MUS placement. Subjects were categorized into cohorts based on change in body weight at 12 months postoperatively: weight gain (≥5% increase); weight loss (≥5% decrease), and weight stable (<5% change). The primary outcome was SUI cure (no SUI episodes in a 3-day bladder diary). Patients with mixed urinary incontinence (MUI) were analyzed for changes in daily average urge incontinence (UUI) episodes in a 3-day diary. Penalized logistic regression assessed the impact of demographic and perioperative variables on the primary outcome. RESULTS Of the 918 women included, 635 (70%) were weight stable, 144 (15%) had weight gain, and 139 (15%) had weight loss. Patients in the weight loss cohort had a higher smoking rate and a higher baseline body mass index (SD 0.29, 2.7 respectively). All cohorts experienced high SUI cure rates ranging from 77 to 81%, with no significant difference in SUI cure between cohorts (p = 0.607). Of 372 subjects with MUI, the weight loss cohort had significantly greater improvement in UUI episodes. CONCLUSIONS Weight change at 12 months postoperatively did not significantly alter efficacy of MUS for treatment of SUI. Patients with MUI who lost ≥5% body weight had significantly greater improvement in UUI episodes.
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Affiliation(s)
- Feven W Getaneh
- Department of Obstetrics and Gynecology, MedStar Georgetown Washington Hospital Center, 110 Irving St NW, Washington, DC, 20010, USA.
| | - Nancy Ringel
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - Paul Kolm
- Medstar Health Research Institute, Washington, DC, USA
| | - Cheryl B Iglesia
- Department of Obstetrics and Gynecology, MedStar Georgetown Washington Hospital Center, 110 Irving St NW, Washington, DC, 20010, USA
| | - Alexis A Dieter
- Department of Obstetrics and Gynecology, MedStar Georgetown Washington Hospital Center, 110 Irving St NW, Washington, DC, 20010, USA
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Chen X, Jiang S, Yao Y. Association between obesity and urinary incontinence in older adults from multiple nationwide longitudinal cohorts. COMMUNICATIONS MEDICINE 2023; 3:142. [PMID: 37821658 PMCID: PMC10567749 DOI: 10.1038/s43856-023-00367-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 09/06/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Obesity and urinary incontinence (UI) among older adults, particularly older men, are yet to be fully explored. Utilizing multiple nationwide prospective longitudinal cohorts representative of the US, UK, and European samples, we examined the association of body mass index (BMI) and waist circumference (WC) with UI among both older women and men. METHODS We derived the data from multiple longitudinal cohorts that surveyed UI. Participants were asked if they had experienced urine leakage within the past 12 months or within the past six months. The measure of obesity was based on BMI and WC. We employed a random-effect logistic model to associate BMI and WC with UI, adjusting for covariates including age, race, education, residence area, marital status, number of children, smoking, drinking, hypertension, diabetes, cancer, stroke, functional ability, and cognitive impairment. We visualized the associations by using restricted cubic spline curves. RESULTS A total of 200,717 participants with 718,822 observations are included in the baseline analysis. Compared to those without UI, both female and male participants with UI demonstrate a higher BMI and WC. Among females, the fully adjusted models show linear associations between BMI, WC, and UI (Ps < 0.001). However, we observe U-shaped associations of BMI, WC with UI among males. The lowest likelihood of having UI is found among male participants with a BMI between 24 and 35 kg/m2. CONCLUSIONS Interventions aimed at preventing UI among older adults must take sex into account. Weight loss intervention could be an effective treatment among older females who are overweight and with obesity as well as older males with obesity rather than all older males.
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Affiliation(s)
- Xiyin Chen
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Shaoxiang Jiang
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Yao Yao
- China Center for Health Development Studies, Peking University, Beijing, China.
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China.
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Friedman T, Dietz HP. Does obesity change the perception of pelvic organ prolapse? Arch Gynecol Obstet 2022; 305:1491-1495. [PMID: 35192039 DOI: 10.1007/s00404-022-06430-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 02/02/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND HYPOTHESIS There is a complex relationship between obesity and pelvic organ prolapse. The objective of our study was to evaluate whether body mass index (BMI) changes the relationship between signs and symptoms of prolapse. METHODS This was a retrospective observational study based on datasets of women seen in a tertiary urogynecological center with symptoms of pelvic floor and lower urinary tract dysfunction between April 2012 and October 2015. Patients underwent a structured interview, clinical examination (based on the POP-Q) and 4D transperineal ultrasound (TPUS). Offline assessment of sonographic organ descent was undertaken later, blinded to all patient data. RESULTS Weight and BMI affect the relationship between symptoms and signs of prolapse. This effect is statistically highly significant. The more obese a patient is, the less likely she is to notice a given degree of objective prolapse, regardless of whether it is diagnosed clinically or on imaging. CONCLUSIONS In this retrospective study, we found a highly significant effect of weight and BMI on prolapse perception in the sense that obesity seems to mask prolapse while a low BMI increases the likelihood of a given degree of prolapse being noticed by the patient.
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Affiliation(s)
- Talia Friedman
- Sydney Medical School Nepean, The University of Sydney, Sydney, NSW, Australia. .,Chaim Sheba Medical Center, Tel Hashomer, Tel Aviv University, Ramat Gan, Israel.
| | - Hans Peter Dietz
- Sydney Medical School Nepean, The University of Sydney, Sydney, NSW, Australia
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Sheridan W, Da Silva AS, Leca BM, Ostarijas E, Patel AG, Aylwin SJ, Vincent RP, Panagiotopoulos S, El-Hasani S, le Roux CW, Miras AD, Cardozo L, Dimitriadis GK. Weight loss with bariatric surgery or behaviour modification and the impact on female obesity-related urine incontinence: A comprehensive systematic review and meta-analysis. Clin Obes 2021; 11:e12450. [PMID: 33955687 DOI: 10.1111/cob.12450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 02/14/2021] [Accepted: 03/05/2021] [Indexed: 11/29/2022]
Abstract
Women with obesity are at risk of pelvic floor dysfunction with a 3-fold increased incidence of urge urinary incontinence (UUI) and double the risk of stress urinary incontinence (SUI). The National Institute for Health and Care Excellence (NICE) and European Association of Urology (EAU) recommend that women with a body mass index ≥30 kg/m2 should consider weight loss prior to consideration for incontinence surgery. This systematic review and meta-analysis will assess this recommendation to aid in the counselling of women with obesity-related urinary incontinence (UI). Medical Literature Analysis and Retrieval System online (MEDLINE), EMBASE, Cochrane, ClinicalTrials.gov, and SCOPUS were systematically and critically appraised for all peer reviewed manuscripts that suitably fulfilled the inclusion criteria established a priori and presented original, empirical data relevant to weight loss intervention in the management of urinary incontinence. Thirty-three studies and their outcomes were meta-analysed. Weight loss interventions were associated in a decreased prevalence in UI (OR 0.222, 95% CI [0.147, 0.336]), SUI (OR 0.354, 95% CI [0.256, 0.489]), UUI (OR 0.437, 95% CI [0.295, 0.649]) and improved quality of life (PFDI-20, SMD -0.774 (95% CI [-1.236, -0.312]). This systematic review and meta-analysis provide evidence that weight loss interventions are effective in reducing the prevalence of obesity-related UI symptoms in women. Bariatric surgery in particular shows greater sustained weight loss and improvements in UI prevalence. Further large scale, randomized control trials assessing the effect of bariatric surgery on women with obesity-related UI are needed to confirm this study's findings.
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Affiliation(s)
- William Sheridan
- Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, UK
| | - Ana Sofia Da Silva
- Department of Urogynaecology, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK
| | - Bianca M Leca
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Eduard Ostarijas
- Institute for Translational Medicine, University of Pecs Medical School, Pécs, Hungary
| | - Ameet G Patel
- Department of Minimal Access Surgery, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK
| | - Simon Jb Aylwin
- Department of Endocrinology ASO/EASO COM, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK
| | - Royce P Vincent
- Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, UK
- Department of Clinical Biochemistry, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK
| | - Spyros Panagiotopoulos
- Department of Minimal Access Surgery, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK
| | - Shamsi El-Hasani
- Minimal Access and Bariatric Unit, Princess Royal University Hospital, King's College Hospital NHS Foundation Trust, Orpington, UK
| | - Carel W le Roux
- Diabetes Complication Research Centre, School of Medicine and Medical Science, UCD Conway Institute, University College Dublin, Belfield, Ireland
| | - Alexander D Miras
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Linda Cardozo
- Department of Urogynaecology, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK
| | - Georgios K Dimitriadis
- Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, UK
- Department of Endocrinology ASO/EASO COM, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK
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Elshatanoufy S, Matthews A, Yousif M, Jamil M, Gutta S, Gill H, Galvin SL, Luck AM. Effect of Morbid Obesity on Midurethral Sling Efficacy for the Management of Stress Urinary Incontinence. Female Pelvic Med Reconstr Surg 2020; 25:448-452. [PMID: 29734200 DOI: 10.1097/spv.0000000000000594] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES The aim of our study was to assess midurethral sling (MUS) failure rate in the morbidly obese (body mass index [BMI] ≥40 kg/m) population as compared with normal-weight individuals. Our secondary objective was to assess the difference in complication rates. METHODS This is a retrospective cohort study. We included all patients who underwent a synthetic MUS procedure from January 1, 2008, to December 31, 2015, in our health system. Failure was defined as reported stress urinary incontinence symptoms or treatment for stress urinary incontinence. Variables collected were BMI; smoking status; comorbidities; perioperative (≤24 hours), short-term (≤30 days), and long-term (>30 days) complications; and follow-up time. Statistics include analysis of variance, χ test, logistic regression, Kaplan-Meier method, and Cox regression. RESULTS There were 431 patients included in our analysis. Forty-nine patients were in class 3 with a BMI mean of 44.9 ± 5.07 kg/m. Median follow-up time was 52 months (range, 6-119 months). Class 3 obesity (BMI ≥40 kg/m) was the only group that had an increased risk of failure when compared with the normal-weight group (P = 0.03; odds ratio, 2.47; 95% confidence interval, 1.09-5.59). Obesity was not a significant predictor of perioperative, short-term, or long-term postoperative complications (P = 0.19, P = 0.28, and P = 0.089, respectively) after controlling for other comorbidities. CONCLUSIONS Patients in the class 3 obesity group who are treated with an MUS are 2 times as likely to fail when compared with those in the normal-weight category on long-term follow-up with similar low complication rates.
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Affiliation(s)
- Solafa Elshatanoufy
- From the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Henry Ford Health System
- Wayne State University
| | | | - Mairy Yousif
- Department of Obstetrics and Gynecology, Henry Ford Health System
| | | | - Sravanthi Gutta
- Department of Obstetrics and Gynecology, Henry Ford Health System
- Wayne State University, Detroit, MI
| | - Harmanjit Gill
- Department of Obstetrics and Gynecology, Henry Ford Health System
- Wayne State University, Detroit, MI
| | - Shelley L Galvin
- Division of Research, Grants and Library Services, Mountain Area Health Education Center.,Department of Obstetrics and Gynecology, UNC School of Medicine, Asheville, NC
| | - Ali M Luck
- From the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Henry Ford Health System
- Wayne State University
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10
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American Urogynecologic Society Systematic Review: The Impact of Weight Loss Intervention on Lower Urinary Tract Symptoms and Urinary Incontinence in Overweight and Obese Women. Female Pelvic Med Reconstr Surg 2020; 26:16-29. [DOI: 10.1097/spv.0000000000000802] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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11
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Chapitre 5 : Santé urogénitale. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41 Suppl 1:S73-S81. [DOI: 10.1016/j.jogc.2019.02.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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12
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No Author. Chapitre 1 : Évaluation et gestion des risques chez les femmes ménopausées. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41 Suppl 1:S36-S48. [DOI: 10.1016/j.jogc.2019.02.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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13
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Wessells H, Braffett BH, Holt SK, Jacobson AM, Kusek JW, Cowie C, Dunn RL, Sarma AV. Burden of Urological Complications in Men and Women With Long-standing Type 1 Diabetes in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Cohort. Diabetes Care 2018; 41:2170-2177. [PMID: 30104298 PMCID: PMC6150428 DOI: 10.2337/dc18-0255] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 06/29/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Type 1 diabetes has been associated with high rates of urinary and sexual problems, but the cumulative burden and overlap of these complications are unknown. We sought to determine prevalence of urological complications in persons with type 1 diabetes, associations with clinical and diabetes-related factors, and rates of emergence, persistence, and remission. RESEARCH DESIGN AND METHODS This ancillary longitudinal study among participants in the Diabetes Control and Complications Trial (DCCT) and observational follow-up study Epidemiology of Diabetes Interventions and Complications (EDIC) (652 women and 713 men) was conducted in 2003 and 2010/2011. Urinary incontinence (UI), lower urinary tract symptoms, urinary tract infection, female sexual dysfunction, erectile dysfunction, low male sexual desire, and orgasmic dysfunction were measured with validated instruments. Logistic regression determined association of complications with demographics and clinical characteristics. RESULTS Of sexually active women completing the 2010/2011 survey, 35% reported no complications, 39% had one, 19% two, 5% three, and 2% four. In men, 31% had no complications, 36% had one, 22% two, 9% three, and 3% four. Sexual dysfunction was most prevalent (42% women and 45% men) followed by UI in women (31%) and low sexual desire in men (40%). Urological complications were associated with age, BMI, and HbA1c. Remission rates ranged from 4 to 12% over the 7-year interval between surveys. CONCLUSIONS Urological complications are prevalent and frequently co-occur in persons with type 1 diabetes. Remission rates in a minority subset indicate a rationale for future studies to mitigate the onset or impact of urological complications of diabetes.
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Affiliation(s)
- Hunter Wessells
- Department of Urology and Diabetes Research Center, University of Washington, Seattle, WA
| | | | - Sarah K Holt
- Department of Urology and Diabetes Research Center, University of Washington, Seattle, WA
| | - Alan M Jacobson
- NYU Winthrop Research Institute, NYU Winthrop Hospital, Mineola, NY
| | - John W Kusek
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Catherine Cowie
- Division of Diabetes, Endocrinology, and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Rodney L Dunn
- Departments of Urology and Epidemiology, University of Michigan, Ann Arbor, MI
| | - Aruna V Sarma
- Departments of Urology and Epidemiology, University of Michigan, Ann Arbor, MI
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Nazir J, Hakimi Z, Guelfucci F, Khemiri A, Fatoye F, Blázquez AMM, González MH. A retrospective study of treatment persistence and adherence to mirabegron versus antimuscarinics, for the treatment of overactive bladder in Spain. BMC Urol 2018; 18:76. [PMID: 30180826 PMCID: PMC6122705 DOI: 10.1186/s12894-018-0390-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 08/24/2018] [Indexed: 12/19/2022] Open
Abstract
Background Persistence on-treatment with antimuscarinics in patients with overactive bladder (OAB) is reported to be sub-optimal. This retrospective, longitudinal, observational cohort study assessed treatment persistence with β3-adrenoceptor agonists (i.e. mirabegron) and antimuscarinics, both classes of OAB pharmacotherapy, in patients with OAB in Spain. Methods Adults who received mirabegron or an antimuscarinic in routine clinical practice (1 June–31 October 2014), were identified from anonymised prescription data within the Spanish Cegedim Electronic Medical Records database. The primary endpoint, treatment persistence (time to treatment discontinuation [TTD] and the proportion of patients remaining on-treatment after 12 months), was unadjusted for potential confounders. Multivariate Cox regression models of persistence, adjusted for baseline characteristics, were used to compare differences in treatment groups. Adjusted subgroup analyses (target OAB drug, age, treatment status and sex) and sensitivity analyses (extending the time used to define treatment discontinuation from 30 days [base-case] to 45, 60 or 90 days without prescription renewal) were also performed. Results Overall, 1798 patients received mirabegron (N = 1169) or an antimuscarinic (N = 629); the mean age was 66.42 years. Median TTD was longer for mirabegron versus antimuscarinics (90 vs 56 days) and a higher proportion of patients who received mirabegron were persistent after 12 months (20.2% vs 10.2%); multivariate analyses indicated significantly greater persistence with mirabegron versus antimuscarinics (hazard ratio [HR]: 1.52; 95% confidence interval [CI]: 1.37–1.70; p < 0.001). Significant differences were also observed in subgroup analyses of mirabegron versus individual antimuscarinics (median TTD: 90 vs [range] 28–60 days; HR range: 1.21–2.17; p ≤ 0.013) and in all other subgroups assessed (p < 0.001). Sensitivity analysis showed that the median TTD for mirabegron increased by up to 31 days, and was significantly longer versus antimuscarinics across all adjusted periods (HR range: 1.43–1.53; all p < 0.001). Conclusions Patients with OAB in Spain who received mirabegron experienced longer persistence on-treatment than those who received antimuscarinics and the proportion of patients persistent on-treatment at 12 months with mirabegron was two-times higher versus antimuscarinics. These data may provide strategic insights for clinicians and policy makers involved in the management of OAB. Electronic supplementary material The online version of this article (10.1186/s12894-018-0390-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jameel Nazir
- Astellas Pharma Europe Ltd, 2000 Hillswood Drive, Chertsey, KT16 0PS, UK.
| | | | | | - Amine Khemiri
- Creativ-Ceutical Ltd., Tunis, Tunisia.,Present Address: Keyrus Biopharma, Tunis, Tunisia
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Fuselier A, Hanberry J, Margaret Lovin J, Gomelsky A. Obesity and Stress Urinary Incontinence: Impact on Pathophysiology and Treatment. Curr Urol Rep 2018; 19:10. [PMID: 29468457 DOI: 10.1007/s11934-018-0762-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW Obesity is highly prevalent and is associated with stress urinary incontinence (SUI). The purposes of this review are to assess the pathophysiology of SUI in the obese female and review the outcomes of weight loss and anti-incontinence surgery in this population. RECENT FINDINGS While increased intra-abdominal pressure appears to be the common pathophysiologic link between obesity and SUI, neurogenic and metabolic pathways have been proposed. Both surgical and non-surgical weight loss continue to have beneficial effects on SUI; however, long-term outcomes are largely absent. Midurethral sling (MUS) surgery is largely effective in the obese population, with a complication profile similar to that in non-obese women. Obesity has been shown to be a risk factor for failure of MUS. While weight loss should be the primary modality to improve SUI in the obese woman, MUS remains an effective and safe option in those women undertaking surgery.
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Affiliation(s)
- Alex Fuselier
- Department of Urology, Louisiana State University Health-Shreveport, 1501 Kings Highway, Shreveport, LA, 71130, USA
| | - Jordan Hanberry
- Department of Urology, Louisiana State University Health-Shreveport, 1501 Kings Highway, Shreveport, LA, 71130, USA
| | - J Margaret Lovin
- Department of Urology, Louisiana State University Health-Shreveport, 1501 Kings Highway, Shreveport, LA, 71130, USA
| | - Alex Gomelsky
- Department of Urology, Louisiana State University Health-Shreveport, 1501 Kings Highway, Shreveport, LA, 71130, USA.
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Effect of Electronic Video Education on Patient's Self-Assessed Knowledge About Obesity and Pelvic Floor Disorders: A Randomized Controlled Trial. Female Pelvic Med Reconstr Surg 2017; 25:257-261. [PMID: 29252823 DOI: 10.1097/spv.0000000000000537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to study the effect of electronic video education on patient's self-assessed perception of knowledge about pelvic floor disorders in relation to obesity in a prospective randomized controlled trial. METHODS From June to July 2015, women with a body mass index of 25 kg/m or higher seeking care at a single urogynecology center were recruited and randomized into either a standard visit with an 8-minute video (group A) or a standard visit control (group B). Randomization was performed with computer-generated number blocks of 4. Allocation sequence was concealed from the caregiver, in sequentially numbered, opaque, and sealed envelopes. Immediately after their visit, patients answered a series of 3 questionnaires, which were statistically analyzed using unpaired t tests, Wilcoxon rank sum and analysis of variance tests, presented as mean and standard deviation. Primary outcome was a difference in self-assessed perception of knowledge questionnaire scores. Secondary outcome was a difference in motivation to lose weight. RESULTS Forty-eight women enrolled, and 40 completed all questionnaires, 20 in each group. Representation in both groups was demographically similar. The mean (SD) answers for the postvisit survey measuring participant's self-assessed perception of knowledge was 3.9 (0.8) for group A and 3.5 (1.1) for group B (P = 0.002). Ninety percent of women in group A reported motivation to lose weight, compared with 75% in group B (P = 0.4). CONCLUSIONS Participants who received electronic video education scored significantly higher on self-assessed perception of knowledge questionnaire about pelvic floor disorders in relation to obesity. The video did not increase motivation to lose weight.
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The Role of Obesity in Success and Complications in Patients Undergoing Retropubic Tension-Free Vaginal Tape Surgery. Female Pelvic Med Reconstr Surg 2017; 22:161-5. [PMID: 26825406 DOI: 10.1097/spv.0000000000000241] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVES The aim of this study was to examine the impact of obesity on the success rate of and complications from retropubic tension-free vaginal tape (TVT) midurethral slings for stress urinary incontinence (SUI). METHODS A retrospective, cohort study was performed on patients with retropubic TVT surgery between 2008 and 2014. Demographic, outcome, and complication data were obtained from electronic medical records and analyzed using logistic regression, analysis of variance, and multivariate regression analysis. Short-term (1-2 weeks) and long-term (2 months) outcomes were measured. RESULTS Two hundred twenty-seven patients were included; 100 (44%) were of normal weight, 71 (31%) were overweight, and 56 (24%) were obese. Overall SUI cure rates were high, although the obese group had a lower cure rate. Compared with normal weight, overweight patients had a 2.43 times higher odds (P = 0.14) of short-term complaints of persistent SUI, whereas obese patients had a 3.56 times higher odds (P = 0.03). Similar failure rates were seen at 2 months among the groups. Odds of intraoperative complications did not differ between overweight and normal weight (odds ratio [OR], 0.64; P = 0.319) and obese and normal weight (OR, 0.90; P = 0.83) patients. Postoperative complications did not differ between overweight and normal weight (OR, 0.40; P = 0.27) and obese and normal weight (OR, 1.45; P = 0.54) patients. CONCLUSIONS Obese women undergoing retropubic TVT surgery had a 3.56 increased odds of short-term complaints of SUI compared with normal weight patients, but 2-month failure rates were similar. Obese and overweight patients were equally likely to have complications from TVT.
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Skolarus TA, Metreger T, Hwang S, Kim HM, Grubb RL, Gingrich JR, Hawley ST. Optimizing veteran-centered prostate cancer survivorship care: study protocol for a randomized controlled trial. Trials 2017; 18:181. [PMID: 28420419 PMCID: PMC5395886 DOI: 10.1186/s13063-017-1925-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 03/30/2017] [Indexed: 11/17/2022] Open
Abstract
Background Although prostate cancer is the most common cancer among veterans receiving care in the Veterans Health Administration (VA), more needs to be done to understand and improve survivorship care for this large population. This study, funded by VA Health Services Research & Development (HSR&D), seeks to address the need to improve patient-centered survivorship care for veterans with prostate cancer. Methods/Design This is a two-armed randomized controlled trial (RCT) with a target enrollment of up to 325 prostate cancer survivors per study arm (total anticipated n = 600). Patients will be recruited from four VA sites. Patient eligibility criteria include age range of 40–80 years, one to ten years post-treatment, and currently experiencing prostate cancer symptom burden. We will compare the “Building Your New Normal” program, a personally-tailored automated telephone symptom management intervention for improving symptom self-management to usual care enhanced with a non-tailored newsletter about symptom management. Primary outcomes include changes in symptom burden, bother, and health services utilization at five and 12 months after enrollment. Secondary outcomes include long-term psychosocial outcomes (e.g. subjective health, perceived cancer control). We will use multivariable regression analysis to evaluate the impact of the intervention on primary and secondary outcomes. We will conduct a process evaluation to understand the effective intervention components and explore possibilities for broader implementation and dissemination. Discussion Our central hypothesis is that intervention group participants will have improved and more confident symptom self-management and prostate cancer quality of life following the intervention and that these outcomes will translate to more efficient use of health services. The study results will provide much needed information about how to optimize the quality of care, and life, of veteran prostate cancer survivors. Trial registration ClinicalTrials.gov ID NCT01900561; Registered on 22 July 2013. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-1925-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ted A Skolarus
- VA HSR&D Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI, 48105, USA.,Department of Urology, Dow Division of Health Services Research, University of Michigan, Ann Arbor, MI, USA
| | - Tabitha Metreger
- VA HSR&D Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI, 48105, USA
| | - Soohyun Hwang
- VA HSR&D Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI, 48105, USA
| | - Hyungjin Myra Kim
- VA HSR&D Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI, 48105, USA.,University of Michigan Center for Consulting for Statistics, Computing and Analytics Research, Ann Arbor, MI, USA
| | - Robert L Grubb
- Department of Surgery (Urology), St. Louis VA Medical Center, Washington University School of Medicine, 915 North Grand Blvd., St. Louis, MO, 63106, USA
| | - Jeffrey R Gingrich
- Department of Urology, VA Pittsburgh Healthcare System, University of Pittsburgh, 7180 Highland Drive, Pittsburgh, PA, 15206, USA
| | - Sarah T Hawley
- VA HSR&D Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI, 48105, USA. .,Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
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Dellú MC, Schmitt ACB, Cardoso MRA, Pereira WMP, Pereira ECA, Vasconcelos ÉDSF, Aldrighi JM. Prevalence and factors associated with urinary incontinence in climacteric. Rev Assoc Med Bras (1992) 2017; 62:441-6. [PMID: 27656854 DOI: 10.1590/1806-9282.62.05.441] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Accepted: 06/08/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To estimate the prevalence and identify associated factors to urinary incontinence (UI) in climacteric women. METHOD In a cross-sectional study with a stratified random sample, 1,200 women aged between 35 and 72 years were studied, enrolled in the Family Health Strategy in the city of Pindamonhangaba, São Paulo. Urinary incontinence was investigated using the International Consultation of Incontinence Questionnaire - Short Form, while associated factors were assessed based on a self-reported questionnaire with socio-demographic, obstetric and gynecological history, morbidities and drug use. The prevalence of urinary incontinence was estimated with a 95% confidence interval (95CI) and the associated factors were identified through multiple logistic regression model performed using Stata software, version 11.0. RESULTS Women had a mean age of 51.9 years, most were in menopause (59.4%), married (87.5%), Catholic (48.9%), and declared themselves black or brown (47.2%). The mean age of menopause of women with UI was 47.3 years. The prevalence of UI was 20.4% (95CI: 17.8-23.1%). The factors associated with UI were urinary loss during pregnancy (p=0.000) and after delivery (p=0.000), genital prolapse (p=0.000), stress (p=0.001), depression (p=0.002), and obesity (p=0.006). CONCLUSION The prevalence of UI was lower but similar to that found in most similar studies. Factors associated with the genesis of UI were urinary loss during pregnancy and after delivery, genital prolapse and obesity.
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Affiliation(s)
- Máyra Cecilia Dellú
- PhD - Lecturer of the Department of Physiotherapy, Universidade de Taubaté (Unitau), Taubaté, SP, Brazil
| | - Ana Carolina Basso Schmitt
- PhD - Lecturer of the Department of Physical Therapy, Speech Therapy, and Occupational Therapy, Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
| | - Maria Regina Alves Cardoso
- PhD - Lecturer of the Department of Epidemiology, Faculdade de Saúde Pública, Universidade de São Paulo (FSP/USP), São Paulo, SP, Brazil
| | - Wendry Maria Paixão Pereira
- PhD - Lecturer of the Department of Physiotherapy, Universidade de Taubaté (Unitau), Taubaté, SP, Brazil.,PhD - Lecturer at Fundação Universitária Vida Cristã, Pindamonhangaba, SP, Brazil
| | | | | | - José Mendes Aldrighi
- PhD - Lecturer of the Department of Mother and Child Health, FSP/USP, São Paulo, SP, Brazil
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20
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Predicting urinary incontinence in women in later life: A systematic review. Maturitas 2016; 94:110-116. [PMID: 27823729 DOI: 10.1016/j.maturitas.2016.09.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 09/09/2016] [Indexed: 11/21/2022]
Abstract
Urinary incontinence (UI) affects 10-40% of the population and treatment costs in the UK are estimated to be £233 million per annum. A systematic review of online medical databases between July 1974 and 2016 was conducted to identify studies that had investigated risk and prediction strategies of UI in later life. Eighteen prospective longitudinal studies fulfilled the search criteria. These were analysed systematically (as per the PRISMA checklist) and bias risk through study design was minimised where possible upon data analysis. One paper proposed a predictive assessment tool called the 'continence index'. It was derived following secondary analysis of a cohort study and its predictive threshold had suboptimal sensitivity (79%) and specificity (65%) rates. Seventeen studies identified multiple strong risk factors for UI but despite a large selection of papers on the topic, no robust risk assessment tool prospectively identified patients at risk of UI in later life. Thus more research in this field is required. Clinicians should be aware particularly of modifiable UI risk factors to help reduce the clinical burden of UI in the long term.
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21
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Capon G, Caremel R, de Sèze M, Even A, Fontaine S, Loche CM, Bart S, Castel-Lacanal E, Duchêne F, Karsenty G, Mouracade P, Perrouin-Verbe MA, Phé V, Rey D, Scheiber-Nogueira MC, Gamé X. [The impact of mellitus diabetes on the lower urinary tract: A review of Neuro-urology Committee of the French Association of Urology]. Prog Urol 2015; 26:245-53. [PMID: 26452712 DOI: 10.1016/j.purol.2015.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 09/06/2015] [Accepted: 09/07/2015] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Specify urinary functional impairment associated with diabetic pathology. Propose guidance for screening, monitoring of clinical signs of lower urinary tract (LUTS) and describe the specifics of the urological treatment of patients. METHODS A review of literature using PubMed library was performed using the following keywords alone or in combination: "diabetes mellitus", "diabetic cystopathy", "overactive bladder", "bladder dysfunction", "urodynamics", "nocturia". RESULTS LUTS are more common in the diabetic population with an estimated prevalence between 37 and 70 %, and are probably underevaluated in routine practice. They are heterogeneous and are frequently associated with other diabetic complications. Both storage and voiding symptoms can coexist. Despite a major evaluation in the literature, no recommendation supervises the assessment and management of LUTS in this specific population. An annual screening including medical history, bladder and kidney ultrasound and post-void residual measurement is required in the follow-up of diabetic patients. Specific urologial referral and urodynamic investigations will be performed according to the findings of first-line investigations. The type of bladder dysfunction, the risk of urinary tract infections and dysautonomia should be considered in the specific urological management of these patients. CONCLUSION Diabetes mellitus significantly impacts on the lower urinary tract function. A screening of LUTS is required as well as other complications of diabetes. The management of LUTS must take into consideration the specific risks of the diabetic patient regarding the loss of bladder contractility, the possibility of dysautonomia and infectious complications.
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Affiliation(s)
- G Capon
- Service d'urologie, hôpital Pellegrin, CHU de Bordeaux, 33000 Bordeaux, France.
| | - R Caremel
- Service d'urologie, hôpital Charles-Nicolle, 76000 Rouen, France
| | - M de Sèze
- Cabinet de neuro-urologie, urodynamique et pelvipérinéologie, clinique Saint-Augustin, 33000 Bordeaux, France
| | - A Even
- Service de médecine physique et réadaptation, hôpital Raymond-Poincaré, AP-HP, 92340 Garches, France
| | - S Fontaine
- Service de médecine interne, endocrinologie, diabète, nutrition, hôpital Joseph-Ducuing, 31300 Toulouse, France
| | - C-M Loche
- Service de rééducation neurolocomotrice, CHU Henri-Mondor, AP-HP, 94010 Créteil, France
| | - S Bart
- Service d'urologie, centre hospitalier René-Dubos, 95300 Cergy-Pontoise, France
| | - E Castel-Lacanal
- Service de médecine physique et réadaptation, CHU Rangueil, 31400 Toulouse, France
| | - F Duchêne
- Service d'urologie, clinique de l'Alliance, 37540 Saint-Cyr-sur-Loire, France
| | - G Karsenty
- Service d'urologie et de transplantation rénale, hôpital de la Conception, AP-HM, Aix-Marseille université, 13005 Marseille, France
| | - P Mouracade
- Service d'urologie, hôpitaux universitaires de Strasbourg, 67000 Strasbourg, France
| | - M-A Perrouin-Verbe
- Service d'urologie, hôpital de la Cavale-Blanche, CHU de Brest, 29609 Brest, France
| | - V Phé
- Service d'urologie, hôpital de la Pitié-Salpêtrière, AP-HP, université Paris VI, 75013 Paris, France
| | - D Rey
- Clinique Saint-Augustin, 33000 Bordeaux, France
| | - M-C Scheiber-Nogueira
- Services d'urologie et d'explorations neurologiques, CHU Lyon Sud, 69495 Pierre-Bénite, France
| | - X Gamé
- Service d'urologie, CHU Rangueil, 31400 Toulouse, France
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Imamura M, Williams K, Wells M, McGrother C. Lifestyle interventions for the treatment of urinary incontinence in adults. Cochrane Database Syst Rev 2015; 2015:CD003505. [PMID: 26630349 PMCID: PMC8612696 DOI: 10.1002/14651858.cd003505.pub5] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Low cost, non-invasive alterations in lifestyle are frequently recommended by healthcare professionals or those presenting with incontinence. However, such recommendations are rarely based on good evidence. OBJECTIVES The objective of the review was to determine the effectiveness of specific lifestyle interventions (i.e. weight loss; dietary changes; fluid intake; reduction in caffeinated, carbonated and alcoholic drinks; avoidance of constipation; stopping smoking; and physical activity) in the management of adult urinary incontinence. SEARCH METHODS We searched the Cochrane Incontinence Group Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and MEDLINE in process, and handsearching of journals and conference proceedings (searched 3 July 2013), and the reference lists of relevant articles. We incorporated the results of these searches fully in the review. We undertook an updated search of the Specialised Register, which now includes searches of ClinicalTrials.gov and WHO ICTRP, on 27 October 2014; potentially eligible studies from this search are currently awaiting classification. SELECTION CRITERIA Randomised and quasi-randomised studies of community-based lifestyle interventions compared with no treatment, other conservative therapies, or pharmacological interventions for the treatment of urinary incontinence in adults. DATA COLLECTION AND ANALYSIS Two authors independently assessed study quality and extracted data. We collected information on adverse effects from the trials. Data were combined in a meta-analysis when appropriate. We assessed the quality of the evidence using the GRADE approach. MAIN RESULTS We included 11 trials in the review, involving a total of 5974 participants.Four trials involving 4701 women compared weight loss programmes with a control intervention. Low quality evidence from one trial suggested that more women following weight loss programmes reported improvement in symptoms of incontinence at six months (163/214 (76%) versus 49/90 (54%), risk ratio (RR) 1.40, 95% confidence interval (CI) 1.14 to 1.71), and this effect was sustained at 18 months (N = 291, 75% versus 62%, RR not estimable, reported P value 0.02). No data were available for self-reported cure and quality of life. One of the weight loss trials involving 1296 women reported very low quality evidence for a reduction in weekly urinary incontinence a mean of 2.8 years after following a lifestyle weight loss intervention that had been compared with a pharmacological weight loss intervention.Three trials involving 181 women and 11 men compared change in fluid intake with no change. Limited, very low quality evidence suggested that symptom-specific quality of life scores improved when fluid intake was reduced, although some people reported headaches, constipation or thirst. A further three trials involving 160 women and nine men compared reduction in caffeinated drinks with no change, and one trial involving 42 women compared a soy-rich diet with soy-free diet. However, it was not possible to reach any conclusions about the effects of these changes, due to methodological limitations, that resulted in very low quality evidence.Adverse effects appeared relatively uncommon for all interventions studied.All included studies had a high or unclear risk of bias across all bias parameters, but most notably for allocation concealment. The main factors for our downgrading of the evidence were risk of bias, indirect evidence (less than 12 months of follow-up; and not all participants having confirmed urinary incontinence at baseline in some studies), and imprecise results with wide confidence intervals.Other interventions such as reduction in consumption of sweetened fizzy or diet drinks; reduction in alcohol consumption; avoiding constipation; smoking cessation; restricting strenuous physical forces; or reducing high levels of, or increasing low levels of, physical activity, could not be assessed in this review, as no evidence from randomized controlled trials or quasi-randomised trials was available. AUTHORS' CONCLUSIONS Evidence for the effect of weight loss on urinary incontinence is building and should be a research priority. Generally, there was insufficient evidence to inform practice reliably about whether lifestyle interventions are helpful in the treatment of urinary incontinence.
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Affiliation(s)
- Mari Imamura
- University of AberdeenAcademic Urology UnitHealth Sciences BuildingForesterhillAberdeenUKAB25 2ZD
| | - Kate Williams
- University of LeicesterDepartment of Health Sciences22‐28 Princess Road WestLeicesterUKLE2 6GS
| | - Mandy Wells
- NHS DevonIntegrated Bladder and Bowel Care ServicesFranklyn House, Franklyn DriveSt ThomasExeterDevonUKEX2 9HS
| | - Catherine McGrother
- University of LeicesterDept of Health SciencesUniversity RoadLeicesterLeicestershireUKLE1 7RH
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Yuan Z, Tang Z, He C, Tang W. Diabetic cystopathy: A review. J Diabetes 2015; 7:442-7. [PMID: 25619174 DOI: 10.1111/1753-0407.12272] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 11/21/2014] [Accepted: 01/12/2015] [Indexed: 02/05/2023] Open
Abstract
Herein we review and discuss epidemiological, clinical, and experimental studies on diabetic cystopathy, a common chronic complication of diabetes mellitus with a variety of lower urinary tract symptoms, providing directions for future research. A search of published epidemiological, clinical, or preclinical trial literature was performed using the key words "diabetes", "diabetic cystopathy", "diabetic bladder dysfunction", "diabetic lower urinary tract dysfunction", "diabetic detrusor instability". The classic symptoms of diabetic cystopathy are decreased bladder sensation, increased bladder capacity, and impaired bladder emptying with resultant increased post-void residual volume. However, recent clinical evidence indicates a presence of storage symptoms, such as overactive bladder symptoms. The pathophysiology of diabetic cystopathy is multifactorial, including disturbances of the detrusor, neuron, urothelium, and urethra. Hyperglycemia, oxidative stress, and polyuria play important roles in inducing voiding dysfunction in diabetic individuals. Treatment choice depends on clinical symptoms and urodynamic abnormalities. Urodynamic evaluation is the cornerstone of diagnosis and determines management strategies. Diabetes mellitus could cause a variety of lower urinary tract symptoms, leading to diabetic cystopathy with broadly varied estimates of the prevalence rates. The exact prevalence and pathogenesis of diabetic cystopathy remains to be further investigated and studied in multicenter, large-scaled, or randomized basic and clinical trials, and a validated and standardized workup needs to be made, improving diabetic cystopathy management in clinical practice. Further studies involving only female diabetics are recommended.
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Affiliation(s)
- Zhengyong Yuan
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ziwei Tang
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Changxiao He
- Department of Urology, Dujiangyan Medical Center, Dujiangyan, China
| | - Wei Tang
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Ramalingam K, Monga A. Obesity and pelvic floor dysfunction. Best Pract Res Clin Obstet Gynaecol 2015; 29:541-7. [PMID: 25805440 DOI: 10.1016/j.bpobgyn.2015.02.002] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 02/05/2015] [Indexed: 10/24/2022]
Abstract
Obesity is associated with a high prevalence of pelvic floor disorders. Patients with obesity present with a range of urinary, bowel and sexual dysfunction problems as well as uterovaginal prolapse. Urinary incontinence, faecal incontinence and sexual dysfunction are more prevalent in patients with obesity. Uterovaginal prolapse is also more common than in the non-obese population. Weight loss by surgical and non-surgical methods plays a major role in the improvement of these symptoms in such patients. The treatment of symptoms leads to an improvement in their quality of life. However, surgical treatment of these symptoms may be accompanied by an increased risk of complications in obese patients. A better understanding of the mechanism of obesity-associated pelvic floor dysfunction is essential.
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Affiliation(s)
| | - Ash Monga
- Princess Anne Hospital, University Hospitals Southampton NHS Trust, United Kingdom
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Luke S, Addison B, Broughton K, Masters J, Stubbs R, Kennedy-Smith A. Effects of bariatric surgery on untreated lower urinary tract symptoms: a prospective multicentre cohort study. BJU Int 2014; 115:466-72. [DOI: 10.1111/bju.12943] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Serge Luke
- Department of Urology; Dunedin Hospital; Dunedin New Zealand
| | - Ben Addison
- Department of Urology; Auckland City Hospital; Auckland New Zealand
| | | | - Jonathan Masters
- Department of Urology; Auckland City Hospital; Auckland New Zealand
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RETIRED: Managing Menopause Chapter 5 Urogenital Health. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2014. [DOI: 10.1016/s1701-2163(15)30461-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Managing Menopause Chapter 1 Assessment and Risk Management of Menopausal Women. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2014. [DOI: 10.1016/s1701-2163(15)30457-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Saleh S, Majumdar A, Williams K. The conservative (non-pharmacological) management of female urinary incontinence. ACTA ACUST UNITED AC 2014. [DOI: 10.1111/tog.12110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Sepeedeh Saleh
- North Western Deanery; Three Piccadilly Place; Manchester M1 3BN UK
| | - Amitabha Majumdar
- University Hospital of South Manchester; Southmoor Road Manchester M23 9LT UK
| | - Kate Williams
- Department of Health Sciences; University of Leicester; 22-28 Princess Road West Leicester LE1 6TP UK
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Vissers D, Neels H, Vermandel A, De Wachter S, Tjalma WAA, Wyndaele JJ, Taeymans J. The effect of non-surgical weight loss interventions on urinary incontinence in overweight women: a systematic review and meta-analysis. Obes Rev 2014; 15:610-7. [PMID: 24754672 DOI: 10.1111/obr.12170] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 03/03/2014] [Accepted: 03/04/2014] [Indexed: 01/24/2023]
Abstract
Although the aetiology of urinary incontinence can be multifactorial, in some cases weight loss could be considered as a part of the therapeutic approach for urinary incontinence in people who are overweight. The objective of this study was to review and meta-analyse the effect of non-surgical weight loss interventions on urinary incontinence in overweight women. Web of Science, PubMed, Pedro, SPORTDiscus and Cochrane were systematically searched for clinical trials that met the a priori set criteria. Data of women who participated in non-surgical weight loss interventions (diet, exercise, medication or a combination) were included in the meta-analysis. After removing duplicates, 62 articles remained for screening on title, abstract and full text. Six articles (totalling 2,352 subjects in the intervention groups) were included for meta-analysis. The mean change in urinary incontinence (reported as frequency or quantity, depending on the study) after a non-surgical weight loss intervention, expressed as standardized effect size and corrected for small sample sizes (Hedges' g), was -0.30 (95%CI = -0.47 to -0.12). This systematic review and meta-analysis shows evidence that a non-surgical weight loss intervention has the potential to improve urinary incontinence and should be considered part of standard practice in the management of urinary incontinence in overweight women.
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Affiliation(s)
- D Vissers
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Risk factors for the development of stress urinary incontinence during pregnancy in primigravidae: a review of the literature. Eur J Obstet Gynecol Reprod Biol 2014; 178:27-34. [DOI: 10.1016/j.ejogrb.2014.04.010] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 02/10/2014] [Accepted: 04/08/2014] [Indexed: 12/30/2022]
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Abstract
OBJECTIVE To estimate the prevalence and trends of these pelvic floor disorders in U.S. women from 2005 to 2010. METHODS We used the National Health and Nutritional Examination Survey from 2005-2006, 2007-2008, and 2009-2010. A total of 7,924 nonpregnant women (aged 20 years or older) were categorized as having: urinary incontinence (UI)-moderate to severe (3 or higher on a validated UI severity index, range 0-12); fecal incontinence-at least monthly (solid, liquid, or mucus stool); and pelvic organ prolapse-seeing or feeling a bulge. Potential risk factors included age, race and ethnicity, parity, education, poverty income ratio, body mass index ([BMI] less than 25, 25-29, 30 or greater), comorbidity count, and reproductive factors. Using appropriate sampling weights, weighted χ analysis and multivariable logistic regression models with odds ratios and 95% confidence intervals (95% CIs) were reported. RESULTS The weighted prevalence rate of one or more pelvic floor disorders was 25.0% (95% CI 23.6-26.3), including 17.1% (95% CI 15.8-18.4) of women with moderate-to-severe UI, 9.4% (95% CI 8.6-10.2) with fecal incontinence, and 2.9% (95% CI 2.5-3.4) with prolapse. From 2005 to 2010, no significant differences were found in the prevalence rates of any individual disorder or for all disorders combined (P>.05). After adjusting for potential confounders, higher BMI, greater parity, and hysterectomy were associated with higher odds of one or more pelvic floor disorders. CONCLUSION Although rates of pelvic floor disorders did not change from 2005 to 2010, these conditions remain common, with one fourth of adult U.S. women reporting at least one disorder. LEVEL OF EVIDENCE III.
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Clinical and urodynamic evaluation of women referred with diabetes mellitus. Int Urogynecol J 2014; 25:979-83. [DOI: 10.1007/s00192-014-2354-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 02/07/2014] [Indexed: 01/19/2023]
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Abstract
Despite the clear benefits of physical activity for women, few women obtain the recommended levels of physical activity. To address adherence to physical activity in this group, it is important to understand the barriers to physical activity that affect women. These barriers may include lack of time; anticipated lack of enjoyment; self-consciousness about body size, shape, and physical activity ability; and urinary incontinence. By addressing barriers to physical activity, health care providers may experience greater success in their efforts to increase physical activity in their female patients.
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Affiliation(s)
- Jennette P. Moreno
- USDA/ARS Children’s Nutrition Research Center, Department of Pediatrics-Nutrition, Baylor College of Medicine, Houston, Texas
| | - Craig A. Johnston
- USDA/ARS Children’s Nutrition Research Center, Department of Pediatrics-Nutrition, Baylor College of Medicine, Houston, Texas
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Scozzari G, Rebecchi F, Giaccone C, Chiaro P, Mistrangelo M, Morino M. Bariatric surgery improves urinary incontinence but not anorectal function in obese women. Obes Surg 2014; 23:931-8. [PMID: 23475788 DOI: 10.1007/s11695-013-0880-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND While the association between obesity and urinary incontinence (UI) in women has been clearly documented, the relationship with anal incontinence (AI) is less well defined; moreover, while bariatric surgery has been shown to improve UI, its effect on AI is still unclear. METHODS A total of 32 obese women were studied by means of PFDI-20 and PFIQ-7 questionnaires and anorectal manometry before and after bariatric surgery and compared with 71 non-obese women. RESULTS Obese women showed worse overall questionnaire results (OR 5.18 for PFDI-20 and 2.66 for PFIQ-7). Whereas obese women showed worse results for urinary sub-items and a higher urge UI incidence (43.8 vs 18.3 %, p = 0.013), they did not show worsening in colorecto-anal symptoms. Post-operatively, median PFDI-20 total score did not change (24.2 vs 26.6, p = ns), while there was an improvement in urinary score (14.6 vs 8.3, p < 0.001); median PFIQ-7 improved (4.8 vs 0.0, p = 0.044), but while the urinary score improved (2.4 vs 0.0, p = 0.033), the colorecto-anal score did not change significantly. Although after surgery urge UI decreased from 43.8 to 15.6 % (p = 0.029), the incidence of any AI increased from 28.1 to 40.6 % (p = ns) and flatus incontinence increased from 18.8 to 37.5 % (p = ns). Anorectal manometry did not show significant changes after surgery. CONCLUSIONS Obese women had worse questionnaire results, but while showing a higher incidence of UI, they did not experience anorectal function worsening. After bariatric surgery, there was a slight improvement in PFD symptoms related to UI, but anorectal function did not change significantly and flatus incontinence increased.
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Affiliation(s)
- Gitana Scozzari
- Department of Surgical Sciences, University of Torino, C.so AM Dogliotti, 14, 10126, Turin, Italy
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Iavazzo C. Role of bariatric surgery in the pelvic floor disorders. World J Obstet Gynecol 2013; 2:16-20. [DOI: 10.5317/wjog.v2.i2.16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 03/27/2013] [Indexed: 02/05/2023] Open
Abstract
Pelvic floor disorders are very frequent among women. Weight loss can help them to achieve urinary and faecal continence again. In this narrative review, the possible mechanisms of pelvic floor disorders in obese women, their symptoms and the role of bariatric surgery in changing their quality of life are presented. We retrieved the included results of our study after performing a systematic, electronic search in PubMed (December 17, 2012) and Scopus (December 17, 2012). The main mechanism causing the development of pelvic floor disorders is chronically increased abdominal pressure as it overts structural damage or neurologic dysfunction predisposing to prolapse and incontinence. The symptoms include a sensation of vaginal fullness or pressure, uterine descent, sacral back pain with standing, vaginal spotting from ulceration of the protruding cervix or vagina, coital difficulty, lower abdominal discomfort, and voiding and defecatory difficulties. Evidence indicates that massive weight loss (45 to 50 kg) improves incontinence in morbidly obese women after bariatic surgery. Faecal incontinence is also improved after bariatric surgery. This review highlights the role of bariatric surgery in weight reduction of obese women that could act as a treatment for the pelvic floor disorders faced by those women offering improvement in incontinence as well as quality of life.
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Kapoor DS, Davila GW, Rosenthal RJ, Ghoniem GM. Pelvic Floor Dysfunction in Morbidly Obese Women: Pilot Study. ACTA ACUST UNITED AC 2012; 12:1104-7. [PMID: 15292474 DOI: 10.1038/oby.2004.138] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the impact of obesity on pelvic floor function in women. RESEARCH METHODS AND PROCEDURES This was a prospective controlled study of 20 morbidly obese female patients planning to undergo gastric bypass surgery and 20 age-matched female controls. Subjects completed symptom and impact questionnaires, including the Incontinence Impact Questionnaire (IIQ-7), Urogenital Distress Inventory (UDI), the Kobashi Prolapse Symptom Inventory and Quality-of-Life Questionnaire (PSI-QOL), and Index of Female Sexual Function. Data were analyzed with Wilcoxon or ratio chi2 tests. RESULTS Mean weight was 295.7 +/- 87.9 lbs in the study group and 144.79 +/- 33.07 lbs in the control group. Mean BMI was 52.65 +/-14.49 kg/m2 in the study group and 25.11 +/- 5.27 kg/m2 in the control group. According to the IIQ-7, urinary incontinence significantly affected lifestyle in the study group. The total IIQ-7 score was also significantly affected in the study group (p = 0.03). The UDI indicated more urinary leakage with activity (p = 0.04) and more incidents of small amounts of leakage (p = 0.02) in the study group. According to the PSI-QOL, women in the study group experienced constipation more often because of difficulty in emptying the rectum (p = 0.04). The PSI-QOL score was higher in the study group (6.75 +/- 6.84) than in the control group (2.65 +/- 3.03; p = 0.04). There were no significant differences between groups regarding sexual function. DISCUSSION Morbid obesity is associated with a significant negative impact on urogenital health. Sexual function did not seem to be affected in women who are morbidly obese.
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Affiliation(s)
- Dharmesh S Kapoor
- Section of Female Urology and Voiding Dysfunction, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL 33331, USA
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Whitcomb EL, Horgan S, Donohue MC, Lukacz ES. Impact of surgically induced weight loss on pelvic floor disorders. Int Urogynecol J 2012; 23:1111-6. [PMID: 22527554 DOI: 10.1007/s00192-012-1756-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Accepted: 03/18/2012] [Indexed: 12/22/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Given the increased prevalence of obesity and pelvic floor disorders (PFDs), we estimated changes in prevalence, bother, and quality of life (QOL) for PFDs in obese women undergoing bariatric surgery. We hypothesized PFDs would improve after surgical weight loss. METHODS The prevalence, bother, and QOL impact of PFDs were estimated using validated measures. McNemar's and paired t tests were used to compare pre- and postprocedural outcomes. Power calculations deemed that 90 individuals would achieve at least 80 % power to detect a decrease in prevalence of 12 %. RESULTS The baseline mean (± standard deviation) age and body mass index (BMI) of the 98 women were 43.3 ± 11.8 years and 39.7 ± 6.2 kg/m.(2) BMI decreased to 34.4 ± 5.8 at 6 months and 34.0 ± 5.6 at 12 months. Whereas the overall prevalence of stress urinary incontinence (SUI) decreased from 22/69 (32 %) at baseline to 10/69 (15 %) at 6 months (p = 0.006) and 14/69 (20 %) at 12 months (p = 0.027), there were no significant decreases in overall prevalence of other PFDs. However, for women with SUI, overactive bladder (OAB), and anal incontinence at baseline, 11/23 (48 %), 8/11 (73 %) and 4/20 (20 %) resolved at 12 months, respectively. Pelvic Floor Impact Questionnaire scores decreased from baseline to 12 months (p < 0.001). Mean visual analog scores for women with SUI, OAB, and anal incontinence decreased at 12 months. CONCLUSIONS Surgical weight loss resulted in resolution of symptoms in nearly half of women with SUI and three quarters of women with OAB and was associated with significant improvement in QOL.
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Jun KK, Oh SM, Choo GY, Park HK, Paick SH, Lho YS, Kim HG. Long-term clinical outcomes of the tension-free vaginal tape procedure for the treatment of stress urinary incontinence in elderly women over 65. Korean J Urol 2012; 53:184-8. [PMID: 22468214 PMCID: PMC3312067 DOI: 10.4111/kju.2012.53.3.184] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2011] [Accepted: 01/25/2012] [Indexed: 12/05/2022] Open
Abstract
Purpose The aim of this study was to assess the long-term clinical outcomes of the tension-free vaginal tape (TVT) procedure for stress urinary incontinence (SUI) in elderly women and to identify the factors influencing failure in these cases. Materials and Methods Women with SUI who underwent a TVT procedure were studied. "Cure" was defined as no urine leakage at all in any circumstances and "improvement" was defined as some urine leakage but a score of over 4 points out of 5 in a satisfaction inquiry. Patients were divided into two groups (middle-aged, <65 years and elderly, ≥65 years) for comparison of clinical outcomes. In the elderly group, patients were subdivided into two groups (cure and no cure groups) and were compared to identify the factors influencing failure. Results A total of 136 women (middle-aged group, 106; elderly group, 30) were enrolled in the study. The mean ages of the patients in the 2 groups were 53.5±5.9 and 72.0±5.0 years and the mean follow-up times were 50.5±9.4 and 48.8±9.1 months, respectively. The cure and improvement rates in the middle-aged and elderly groups were 80.2% vs. 66.7% and 4.7% vs. 3.3%, respectively (p>0.05). The satisfaction scores in the middle-aged and elderly groups were 3.8±1.1 vs. 3.3±1.5 points (p>0.05). In the elderly group, the body mass index of the cure and no cure groups were 24.6±3.3 kg/m2 and 26.6±1.0 kg/m2, and body mass index was the only factor that differed significantly between the two subgroups (p=0.028). Conclusions Our long-term results suggest that TVT is an effective treatment even in elderly women. However, elderly women who are obese should be counseled carefully about the success rate.
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Affiliation(s)
- Kyung Kyu Jun
- Department of Urology, Konkuk University School of Medicine, Seoul, Korea
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Abstract
BACKGROUND The purpose of this research was review the epidemiology of the association of obesity and urinary incontinence, and to summarize the published data on the effect of weight loss on urinary incontinence. METHODS A literature review of the association between urinary incontinence and overweight/obesity in women was performed. Case series and clinical trials reporting the effect of surgical, behavioral, and/or pharmacological weight loss on urinary incontinence are summarized. RESULTS Epidemiological studies demonstrate that obesity is a strong and independent risk factor for prevalent and incident urinary incontinence. There is a clear dose-response effect of weight on urinary incontinence, with each 5-unit increase in body mass index associated with a 20%-70% increase in risk of urinary incontinence. The maximum effect of weight on urinary incontinence has an odds ratio of 4-5. The odds of incident urinary incontinence over 5-10 years increase by approximately 30%-60% for each 5-unit increase in body mass index. There appears to be a stronger association between increasing weight and prevalent and incident stress incontinence (including mixed incontinence) than for urge incontinence. Weight loss studies indicate that both surgical and nonsurgical weight loss leads to significant improvements in prevalence, frequency, and/or symptoms of urinary incontinence. CONCLUSION Epidemiological studies document overweight and obesity as important risk factors for urinary incontinence. Weight loss by both surgical and more conservative approaches is effective in reducing urinary incontinence symptoms and should be strongly considered as a first line treatment for overweight and obese women with urinary incontinence.
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Affiliation(s)
- Emily L Whitcomb
- Southern California Permanente Medical Group, Female Pelvic Medicine and Reconstructive Surgery, Orange County-Irvine Medical Center, Irvine, CA, USA
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Abstract
Objectives: In this review, we discuss the treatment of refractory overactive bladder (OAB) that has not adequately responded to medication therapy and we propose an appropriate care pathway to the treatment of OAB. We also attempt to address the cost of OAB treatments. Materials and Methods: A selective expert review of the current literature on the subject of refractory OAB using MEDLINE was performed and the data is summarized. We also review our experience in treating refractory OAB. The role and outcomes of various treatment options for refractory OAB are discussed and combined therapy with oral anticholinergics is explored. Emerging remedies including intravesical botulinum toxin injection and pudendal neuromodulation are also reviewed, along with conventional surgical options. Results: In general behavioral therapy, pelvic floor electrical stimulation, magnetic therapy and posterior tibial nerve stimulation (PTNS), have shown symptom decreases in 50-80% of patients with OAB. Depending on the study, combination therapy with oral anticholinergics seems to improve efficacy of behavioral therapy and PTNS in approximately 10-30%. In multicenter, long-term randomized controlled trials, sacral neuromodulation has been shown to improve symptoms of OAB and OAB incontinence in up to 80% of the patients treated. Studies involving emerging therapies such as pudendal serve stimulation suggest that there may be a 15-20% increase in efficacy over sacral neuromodulation, but long-term studies are not yet available. Another emerging therapy, botulinum toxin, is also showing similar success in reducing OAB symptoms in 80-90% of patients. Surgical approaches, such as bladder augmentation, are a last resort in the treatment of OAB and are rarely used at this point unless upper tract damage is a concern and all other treatment options have been exhausted. Conclusion: The vast majority of OAB patients can be managed successfully by behavioral options with or without anticholinergic medications. When those fail, neuromodulation or intravesical botulinum toxin therapies are successful alternatives for most of the remaining group. We encourage practitioners responsible for the care of OAB patients to gain experience with these options. More research is needed to assess the cost-effectiveness of various OAB treatments
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Affiliation(s)
- Ronald W Glinski
- Center for Continence Care and Female Urology, Metro Urology Specialists, 2550 University Avenue West, Suite 240N, St. Paul, MN 55114
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Poylin V, Serrot FJ, Madoff RD, Ikramuddin S, Mellgren A, Lowry AC, Melton GB, Melton GB. Obesity and bariatric surgery: a systematic review of associations with defecatory dysfunction. Colorectal Dis 2011; 13:e92-103. [PMID: 21564470 DOI: 10.1111/j.1463-1318.2011.02584.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Obesity rates are rapidly growing in the developed world. While upper gastrointestinal disturbances and urinary incontinence are independently associated with obesity, the relationship between obesity and defecatory dysfunction is less well defined. OBJECTIVES To summarize the literature on faecal incontinence, diarrhoea and constipation in obese patients and its effects of bariatric surgery. SEARCH STRATEGY A Medline search was carried out on articles published from January 1966 to March 2010. SELECTION CRITERIA Original articles on adult obese or morbidly obese patients were identified, including results following bariatric surgery that reported faecal incontinence, diarrhoea or constipation. Other forms of pelvic floor dysfunction were excluded. Main outcome measures included faecal incontinence, diarrhoea and constipation rates and their severity in obese patients and following bariatric surgery. RESULTS Twenty studies reported defecatory outcomes in obese patients (n = 14) and after bariatric surgery (n = 6). While constipation rates were similar, the rates of faecal incontinence and diarrhoea were higher in obese patients compared with non-obese patients. The exact rates of these conditions, and the correlations between body mass index (BMI) and faecal incontinence, diarrhoea and constipation, were not clear. Faecal incontinence improved after Roux-en-Y gastric bypass in studies with preoperative data. The effects of bariatric surgery on diarrhoea were unclear. CONCLUSION Few studies have assessed the correlations between obesity and defecatory function and the effect of bariatric surgery. Studies were often not well controlled and used non-uniform instruments to assess bowel function. Obesity appears to be correlated with higher rates of faecal incontinence and diarrhoea. The effects of bariatric surgery on these conditions are not well defined. Well-controlled studies correlating outcome with physiological pelvic floor function are needed.
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Affiliation(s)
- V Poylin
- Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA
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Golbidi S, Laher I. Bladder dysfunction in diabetes mellitus. Front Pharmacol 2010; 1:136. [PMID: 21833175 PMCID: PMC3153010 DOI: 10.3389/fphar.2010.00136] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Accepted: 10/29/2010] [Indexed: 12/15/2022] Open
Abstract
Diabetic cystopathy is a well-recognized complication of diabetes mellitus, which usually develops in middle-aged or elderly patients with long-standing and poorly controlled disease. It may have broad spectrum clinical presentations. Patients may be asymptomatic, or have a wide variety of voiding complaints from overactive bladder and urge incontinence to decreased bladder sensation and overflow incontinence. This review focuses on pathophysiological mechanisms responsible for urologic complications of diabetes and emphasizing on recent developments in our understanding of this condition. We also tried to shed some light on therapeutic modalities like behavioral, pharmacological, and surgical approaches.
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Affiliation(s)
- Saeid Golbidi
- Department of Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia Vancouver, BC, Canada
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Imamura M, Williams K, Wells M, McGrother C. Lifestyle interventions for the treatment of urinary incontinence in adults. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2010. [DOI: 10.1002/14651858.cd003505.pub4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Abstract
BACKGROUND Morbidly obese women have markedly high rates of urinary and fecal incontinence. Weight loss reduces prevalence and severity of urinary incontinence; however, the effect of weight loss on fecal incontinence is unknown. AIMS The aim of this study was to document the prevalence of urinary and fecal incontinence in subjects who underwent bariatric surgery and associated weight loss. METHODS We mailed a detailed survey to all 404 adults who underwent bariatric surgery at the University of Wisconsin prior to May 2006. Type and severity of urinary and fecal incontinence was obtained using previously validated questionnaires. Perceived effect of surgery on bowel and bladder function was also assessed. RESULTS Forty-eight percent (193) of the surveys were returned. Urinary incontinence was reported in 72% of the women, 39% of whom perceived improvement after surgery. Only 21% of the men reported urinary incontinence. In contrast, fecal incontinence was common in both men and women; 48% of the women and 42% of the men reported liquid stool incontinence and 21% of the women and 30% of the men reported solid stool incontinence. Fifty-five percent of the women and 31% of the men with fecal incontinence perceived worsening after surgery. Women with diarrhea were four times more likely to report fecal incontinence (P<0.0001). Furthermore, women who perceived worsening of diarrhea after surgery were significantly more likely to have fecal incontinence (P=0.003). CONCLUSIONS Both fecal and urinary incontinence were common after bariatric surgery. Risk factors for fecal incontinence in women after bariatric surgery include diarrhea and worsening of diarrhea; we suggest that such surgery may uncover prior weaknesses in the continence mechanism.
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Walsh JME, Beattie MS, Charney P. Update in women's health. J Gen Intern Med 2010; 25:363-8. [PMID: 20020220 PMCID: PMC2842556 DOI: 10.1007/s11606-009-1199-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2009] [Revised: 10/06/2009] [Accepted: 11/11/2009] [Indexed: 11/26/2022]
Affiliation(s)
- Judith M E Walsh
- Division of General Internal Medicine, Women's Health Clinical Research Center, University of California, San Francisco, CA 94115, USA.
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Subak LL, Richter HE, Hunskaar S. Obesity and urinary incontinence: epidemiology and clinical research update. J Urol 2010; 182:S2-7. [PMID: 19846133 DOI: 10.1016/j.juro.2009.08.071] [Citation(s) in RCA: 170] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2009] [Indexed: 01/20/2023]
Abstract
PURPOSE We reviewed the epidemiological literature on the association of obesity and urinary incontinence, and summarized clinical trial data on the effect of weight loss on urinary incontinence. MATERIALS AND METHODS We systematically searched for published community based prevalence studies with bivariate or multivariate analysis of the association of urinary incontinence and overweight/obesity in women. Case series and randomized controlled trials of the effect of surgical, behavioral and pharmacological weight loss on urinary incontinence are summarized. RESULTS Epidemiological studies showed that obesity is a strong independent risk factor for prevalent and incident urinary incontinence. There was a clear dose-response effect of weight on urinary incontinence with each 5-unit increase in body mass index associated with about a 20% to 70% increase in the urinary incontinence risk, and the maximum effect of weight rarely exceeded an OR of greater than 4 to 5 on well controlled analyses. The odds of incident urinary incontinence during 5 to 10 years increased by approximately 30% to 60% for each 5-unit increase in body mass index. There may be a stronger association of increasing weight with prevalent and incident stress incontinence, including mixed incontinence, than with urge incontinence and overactive bladder syndrome. Weight loss studies indicated that surgical and nonsurgical weight loss led to significant improvements in urinary incontinence symptoms. CONCLUSIONS Epidemiological studies document overweight and obesity as important risk factors for urinary incontinence. Weight loss by surgical and more conservative approaches is effective to decrease urinary incontinence symptoms and should be strongly considered a first line treatment in this patient population.
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Affiliation(s)
- Leslee L Subak
- University of California-San Francisco/Mt. Zion Women's Health Clinical Research Center, San Francisco, California, USA.
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Richter HE, Kenton K, Huang L, Nygaard I, Kraus S, Whitcomb E, Chai TC, Lemack G, Sirls L, Dandreo KJ, Stoddard A. The impact of obesity on urinary incontinence symptoms, severity, urodynamic characteristics and quality of life. J Urol 2010; 183:622-8. [PMID: 20018326 PMCID: PMC3311463 DOI: 10.1016/j.juro.2009.09.083] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE We compared urinary incontinence severity measures and the impact of stress urinary incontinence in normal, overweight and obese women. MATERIALS AND METHODS Baseline characteristics of subjects in the SISTEr (655) and the TOMUS (597) were analyzed. Body mass index was defined as normal (less than 25 kg/m(2)), overweight (25 to less than 30 kg/m(2)) and obese (30 kg/m(2) or greater). Independent urinary incontinence severity measures included a 3-day diary including incontinence episode frequency, Urogenital Distress Inventory scores and Valsalva leak point pressure from urodynamic testing. Impact was measured using the Incontinence Impact Questionnaire. Multivariable regression models were fit for each severity measure (Urogenital Distress Inventory, incontinence episode frequency, Valsalva leak point pressure and Incontinence Impact Questionnaire) on weight category. Covariates included age, race, diabetes and variables significantly associated with body mass index on bivariate analysis. RESULTS Mean age (SD) of participants was 51.9 (10.3) in SISTEr and 52.9 (11.0) in TOMUS. In each trial 45% of subjects were obese. In SISTEr multivariable regression analyses showed that higher weight category was independently associated with higher mean Urogenital Distress Inventory score (p = 0.003), incontinence episode frequency (p <0.0001), Valsalva leak point pressure (p = 0.003) and Incontinence Impact Questionnaire score (p = 0.0004). In TOMUS higher weight category was not associated with Urogenital Distress Inventory score (p = 0.24) but was associated with higher incontinence episode frequency (p = 0.0003), Valsalva leak point pressure (p = 0.0006) and Incontinence Impact Questionnaire score (p <0.0001). CONCLUSIONS Obese women undergoing surgery for stress urinary incontinence report more incontinence episodes, more symptom distress and worse quality of life despite better measure of urethral function (higher Valsalva leak point pressure) on urodynamics.
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Affiliation(s)
- Holly E Richter
- University of Alabama at Birmingham, Birmingham, Alabama, USA.
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