1
|
Jha S, Jeppson PC, Dokmeci F, Marquini GV, Sartori MGF, Moalli P, Malik SA. Management of mixed urinary incontinence: IUGA committee opinion. Int Urogynecol J 2024; 35:291-301. [PMID: 38252279 PMCID: PMC10908639 DOI: 10.1007/s00192-023-05694-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 11/06/2023] [Indexed: 01/23/2024]
Abstract
INTRODUCTION AND HYPOTHESIS Mixed urinary incontinence (MUI) is defined by the International Urogynecology Association (IUGA) and International Continence Society as the complaint of involuntary leakage of urine associated with urgency and also with exertion, effort, sneezing or coughing. It therefore implies the coexistence of both stress urinary incontinence (SUI) and urgency urinary incontinence (UUI). MUI is a heterogeneous diagnosis that requires an assessment of its individual components of SUI and UUI. Management requires an individualised approach to the symptom components. The aim of this review is to identify the assessment/investigations and management options for MUI. METHODS A working subcommittee from the IUGA Research & Development (R&D) Committee was created and volunteers invited from the IUGA membership. A literature review was performed to provide guidance focused on the recommended assessment and management of MUI. The document was then evaluated by the entire IUGA R&D Committee and IUGA Board of Directors and revisions made. The final document represents the IUGA R&D Committee Opinion. RESULTS The R&D Committee MUI opinion paper provides guidance on the assessment and management of women with MUI and summarises the evidence-based recommendations. CONCLUSIONS Mixed urinary incontinence is a complex problem and successful management requires alleviation of both the stress and urge components. Care should be individualised based on patient preferences. Further research is needed to guide patients in setting goals and to determine which component of MUI to treat first. The evidence for many of the surgical/procedural treatment options for MUI are limited and needs to be explored in more detail.
Collapse
Affiliation(s)
- Swati Jha
- Department of Urogynecology, Jessop Wing, Sheffield Teaching Hospitals NHS Foundation Trust & University of Sheffield, Sheffield, UK.
| | - Peter C Jeppson
- The Woman's Center for Advanced Pelvic Surgery, The University of Arizona, Phoenix, AZ, USA
| | - Fulya Dokmeci
- Department of Obstetrics & Gynecology, Ankara School of Medicine, Ankara University, Ankara, Türkiye
| | - Gisele V Marquini
- Federal University of Uberlândia (UFU), Minas Gerais, Brazil and Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Marair G F Sartori
- Urogynecology Division, Gynecology Department, Federal University of São Paulo, São Paulo, Brazil
| | - Pamela Moalli
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Shazia A Malik
- Female Pelvic Medicine & Reconstructive Surgery, Department of Ob/Gyn, University of Arizona COMPhoenix, Tucson, AZ, USA
| |
Collapse
|
2
|
Karbalaiee M, Daneshpajooh A, Khanjani N, Sohbati S, Mehrabani M, Mehrbani M, Mehrabani M. Efficacy of frankincense‐based herbal product in urinary incontinence: A randomized, double‐blind, placebo‐ and active‐controlled clinical trial. Phytother Res 2022; 37:1754-1770. [PMID: 36442480 DOI: 10.1002/ptr.7691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 10/11/2022] [Accepted: 10/16/2022] [Indexed: 11/30/2022]
Abstract
Urinary incontinence is a silent epidemic that has a serious impact on a person's quality of life (QOL). This study aimed to evaluate the efficacy of frankincense-based herbal product (FHP) in urinary incontinence compared with placebo and solifenacin. In this randomized, double-blind clinical trial, 120 postmenopausal women with mixed urinary incontinence were randomized to one of the three groups of FHP, placebo, and standard treatment (solifenacin). Frequency, amount of leakage, and score of urinary incontinence as well as the QOL were measured at the end of the second and fourth weeks and 2 weeks after the interruption of the treatment. The ICIQ-UI SF and I-QOL questionnaires were used for the measurements. Mean frequency of urinary incontinence and amount of leakage significantly decreased in the FHP and solifenacin groups in the fourth week compared to the placebo group. In addition, 2 weeks after treatment completion, the effects of the FHP were significant compared to the solifenacin group. Due to the effect of FHP on improving the QOL and also the prolonged effect of this drug, the use of FHP in urinary incontinence, as a complementary treatment could be suggested.
Collapse
Affiliation(s)
- Mahbubeh Karbalaiee
- Physiology Research Center, Institute of Neuropharmacology Kerman University of Medical Sciences Kerman Iran
- Department of Traditional Medicine, Faculty of Persian Medicine Kerman University of Medical Sciences Kerman Iran
| | - Azar Daneshpajooh
- Department of Urology, Shahid Bahonar Hospital Kerman University of Medical Sciences Kerman Iran
| | - Narges Khanjani
- Neurology Research Center Kerman University of Medical Sciences Kerman Iran
| | - Samira Sohbati
- Department of Obstetrics and Gynecology, Clinical Research Development Unit, Afzalipour Hospital Kerman University of Medical Sciences Kerman Iran
| | - Mehrnaz Mehrabani
- Physiology Research Center, Institute of Neuropharmacology Kerman University of Medical Sciences Kerman Iran
| | - Mehrzad Mehrbani
- Herbal and Traditional Medicines Research Center Kerman University of Medical Sciences Kerman Iran
| | - Mitra Mehrabani
- Herbal and Traditional Medicines Research Center Kerman University of Medical Sciences Kerman Iran
| |
Collapse
|
3
|
Dmochowski RR, Haab F, Robinson D. A randomized, placebo-controlled clinical development program exploring the use of litoxetine for treating urinary incontinence. Neurourol Urodyn 2021; 40:1515-1523. [PMID: 34184772 DOI: 10.1002/nau.24690] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 03/22/2021] [Accepted: 04/07/2021] [Indexed: 11/09/2022]
Abstract
AIMS To investigate the safety and efficacy of litoxetine, a serotonin reuptake inhibitor, in treating urinary incontinence (UI) and mixed urinary incontinence (MUI). METHODS Two randomized, double-blind, placebo-controlled clinical trials (RCT1 and RCT2) were conducted. RCT1, which included 196 women aged 18-75 with MUI randomized 1:1:1:1 to receive 10, 20, or 40 mg litoxetine or placebo orally twice daily (BID) for 12 weeks, investigated the efficacy (including changes in patient reported outcomes) and safety of litoxetine compared to placebo. RCT2, which included 82 men and women aged 18-70 with any UI type randomly assigned 2:1 to receive 30 mg litoxetine or placebo orally BID for 8 weeks including a 2 week dose titration period, investigated the safety (including psychiatric safety) and efficacy of litoxetine compared to placebo. Efficacy was measured as the change in number of incontinence episodes per week and assessed using an analysis of covariance with missing data imputed by Predictive Mean Matching. Safety was assessed by adverse events (AEs) and physical examinations and analyzed using descriptive statistics. RESULTS The 30-mg and placebo groups in RCT2 showed no difference in frequency of AEs, and litoxetine reduced the number of incontinence episodes per week compared to placebo. Although RCT1 suffered an unexpectedly high placebo response, and therefore did not meet the primary efficacy endpoint, 71% of participants receiving 40 mg litoxetine reported a clinically meaningful improvement in the King's Health Questionnaire. CONCLUSIONS Litoxetine may be a safe, effective and well-tolerated treatment for patients with UI.
Collapse
Affiliation(s)
| | | | - Dudley Robinson
- Department of Urogynaecology, Kings College Hospital, London, UK
| |
Collapse
|
4
|
Neves da Costa J, Oliveira Lopes MV, Baena de Moraes Lopes MH. Simultaneous Concept Analysis of Diagnoses Related to Urinary Incontinence. Int J Nurs Knowl 2020; 31:109-123. [DOI: 10.1111/2047-3095.12254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 07/06/2019] [Accepted: 07/08/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Juliana Neves da Costa
- School of Nursing (FEnf)Universidade Estadual de Campinas (Unicamp) Campinas São Paulo Brazil
| | | | | |
Collapse
|
5
|
Lo TS, Uy-Patrimonio MC, Kao CC, Chua S, Huang TX, Wu MP. Urodynamics mixed type urinary incontinence with advanced pelvic organ prolapse, management and outcomes. Sci Rep 2020; 10:1944. [PMID: 32029796 PMCID: PMC7005146 DOI: 10.1038/s41598-020-58594-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 11/18/2019] [Indexed: 11/23/2022] Open
Abstract
Patients with pelvic organ prolapse (POP) often have accompanying lower urinary tract symptoms. Symptoms such as stress urinary incontinence(SUI-UD) and detrusor overactivty(DO) would co-exist in a number of patients. Management entails relieving the obstructive element. To determine the clinical outcome of patients with urodynamics mixed type urinary incontinence(MUI-U) after vaginal pelvic reconstructive surgery(PRS), a retrospective study was conducted. MUI-U was defined as having urodynamic findings of both of DO/DOI (derusor overactivity incontinence) and SUI-UD. Main outcome measures: Objective cure- absence of involuntary detrusor contraction on filling cystometry and no demonstrable leakage of urine during increased abdominal pressure; Subjective cure- assessment index score of <1 on UDI-6 question #2 and #3. Of the 82 patients evaluated, 14 underwent vaginal PRS with concomitant mid-urethral sling(MUS) insertion while 68 had vaginal PRS alone. Pre-operatively, 49(60%) patients had stage III and 33(40%) had stage IV prolapse. Post-operatively, 1-year data shows an objective cure of 56% (46/82) and subjective cure of 54% (44/82). MUI-U was significantly improved. Improvement of SUIUD and results of the 1-hour pad test were more pronounced in patients with concomitant MUS insertion. Ergo, vaginal PRS cures symptoms of MUI-U in >50% of patients and concomitant MUS can be offered to SUI predominant MUI.
Collapse
Affiliation(s)
- Tsia-Shu Lo
- Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, Republic of China. .,Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung Medical Center, Keelung, Taiwan, Republic of China. .,Chang Gung University, School of Medicine, Taoyuan, Taiwan, Republic of China.
| | - Ma Clarissa Uy-Patrimonio
- Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, Republic of China.,Department of Obstetrics and Gynecology, Dr. Pablo O. Torre Memorial Hospital, Bacolod City, Philippines
| | - Chuan Chi Kao
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung Medical Center, Keelung, Taiwan, Republic of China
| | - Sandy Chua
- Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, Republic of China.,Department of Obstetrics and Gynecology, Cebu Velez General Hospital, Cebu City, Philippines
| | - Ting-Xuan Huang
- Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, Republic of China
| | - Ming-Ping Wu
- Division of Urogynecology and Pelvic Floor Reconstruction, Department of Obstetrics and Gynecology, Chi Mei Foundation Hospital, Tainan, Taiwan.,Center of General Education, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| |
Collapse
|
6
|
Najeeya AGF, Sultana A. Efficacy of mace (Arils of Myristica fragrans Houtt) plus PFMT on symptoms in mixed urinary incontinence: a randomized placebo-controlled trial. Integr Med Res 2018; 7:307-315. [PMID: 30519527 PMCID: PMC6260249 DOI: 10.1016/j.imr.2018.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 05/01/2018] [Accepted: 10/12/2018] [Indexed: 11/26/2022] Open
Abstract
Background It is not only to evaluate the efficacy and safety of mace (Arils of Myristica fragrans Houtt) but also to compare pelvic floor muscle training vs. pelvic floor muscle training (PFMT) for improving symptoms and health-related quality of life (HRQoL) of woman with mixed urinary incontinence (MUI). Methods A prospective, single-blind randomized controlled study was conducted. Patients (n = 60) were randomly allocated (1:1) to receive either mace powder or placebo (1.5 g) orally twice daily along with pelvic floor muscle training in both groups for three consecutive months. The primary outcomes included symptom evaluation with Patient Global Impression Index of Improvement (PGI-I) and the Patient Global Impression Index of Severity (PGI-S) for MUI. For safety, clinical examination and biochemical parameters were assessed. Secondary outcomes included Short form of Urogenital Distress Inventory Questionnaire-6 (UDI-6) and quality of life assessment with questionnaire tools such as Short form of Incontinence Impact Questionnaire-7 (IIQ-7), Short form of the Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) and ICIQ-SF. The data were statistically interpreted with 5% level of significance. Results After treatment (at third month), the patient reported cure for PGI-I and PGI-S was 46.66% and 90% for the mace group, whereas 0% and 16.66% for the control group, respectively (P < 0.001), statistically significant. No side effects were reported in the mace group. The mean difference noted in terms of scores, at the third month from baseline for UDI-6 (51.09 vs. 24.78), IIQ-7 (45.48 vs. 23.49), PISQ (11.33 vs. 5.40), and ICIQ-SF (8.10 vs. 2.43) scores were higher in the mace than that in the control group (P < 0.001). Conclusion Mace is effective and safe for the subjective improvement of mixed urinary incontinence symptoms and for the improvement of women's HRQoL than the placebo. Clinical Trial Registry No.: CTRI/2017/04/008342
Collapse
Affiliation(s)
| | - Arshiya Sultana
- Department of Amraze Niswan wa Ilmul Qabalat (Gynecology and Obstetrics), National Institute of Unani Medicine, Bengaluru, India
| |
Collapse
|
7
|
Kanakubo K, Palm CA, Korner AL, Culp WTN. Treatment of urethral obstruction secondary to caudal bladder displacement, trigonal invagination, and urethral kinking in a dog. J Am Vet Med Assoc 2017; 251:818-823. [PMID: 28967822 DOI: 10.2460/javma.251.7.818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
CASE DESCRIPTION A 15-year-old spayed female mixed-breed dog was evaluated for a 7-week history of stranguria, pollakiuria, and intermittent urethral obstruction. CLINICAL FINDINGS On initial evaluation, the patient had persistent stranguria with lack of urine production; after multiple unsuccessful attempts to urinate, a large volume of urine was produced. Prior to voiding the large volume, the urinary bladder was not palpable during examination. Abdominal ultrasonography confirmed caudal displacement of the urinary bladder, and the urethra and trigone could not be located ultrasonographically. Positive-contrast cystourethrography and CT confirmed caudal displacement of the urinary bladder and also revealed trigonal invagination and urethral kinking; dysuria was attributed to these findings. TREATMENT AND OUTCOME Surgical repositioning of the lower urinary tract was performed. The urinary bladder was moved cranially and was fixed in place along the left lateral aspect of the body wall by cystopexy. After surgery, positive-contrast cystourethrography revealed a more cranial positioning of the urinary bladder and straightening of the urethra with no urethral kinking or trigonal invagination. Immediately after surgery, stranguria had resolved and the patient was able to void normally. Two years after surgery, the dog was reported to be urinating normally. CLINICAL RELEVANCE Surgical correction of caudal urinary bladder displacement with cystopexy led to resolution of trigonal invagination, urethral kinking, and urethral obstruction in the dog of the present report. Trigonal invagination and urethral kinking, although uncommon findings, should be considered as possible causes of dysuria in dogs.
Collapse
|
8
|
Chughtai B, Laor L, Dunphy C, Lee R, Te A, Kaplan S. Diagnosis, Evaluation, and Treatment of Mixed Urinary Incontinence in Women. Rev Urol 2016; 17:78-83. [PMID: 27222643 DOI: 10.3909/riu0653] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Mixed urinary incontinence (MUI) is a common clinical problem in the community and hospital setting. The broad definition of the term makes it difficult to diagnose, as well as determine effective treatment strategies. There are no current guidelines recommended for physicians. The estimated prevalence of this condition is approximately 30% in all women with incontinence. It has also been suggested that patients with MUI report more bothersome symptoms than either stress or urge incontinence; approximately 32% of 40- to 64-year-olds with MUI report symptoms of depression. The authors examine the diagnosis, evaluation, and treatment of patients with MUI.
Collapse
Affiliation(s)
- Bilal Chughtai
- Department of Urology, Weill Cornell Medical College, New York, NY
| | - Leanna Laor
- Department of Urology, Weill Cornell Medical College, New York, NY
| | - Claire Dunphy
- Department of Urology, Weill Cornell Medical College, New York, NY
| | - Richard Lee
- Department of Urology, Weill Cornell Medical College, New York, NY
| | - Alexis Te
- Department of Urology, Weill Cornell Medical College, New York, NY
| | - Steven Kaplan
- Department of Urology, Weill Cornell Medical College, New York, NY
| |
Collapse
|
9
|
|