Urinary incontinence prevalence: results from the National Health and Nutrition Examination Survey

Lower Urinary Tract Symptoms in Relation to Leiomyoma Volume, Location, and Position in Reproductive-aged Women in the USA

INTRODUCTION AND HYPOTHESIS

Uterine leiomyomata are widely believed to contribute to lower urinary tract symptoms in women, but it is unclear whether leiomyoma size, position, and location have important implications for these symptoms. We assessed whether greater leiomyoma volume, anterior position, and subserosal location were associated with urinary incontinence and frequent urination in a racially diverse, nationwide sample of premenopausal women in the USA.

METHODS

A cross-sectional analysis of 477 premenopausal women from 12 USA sites undergoing evaluation for laparoscopic radiofrequency ablation or myomectomy for leiomyomata was carried out. Multivariable logistic regression models examined associations between leiomyoma volume, position, and location documented in clinical imaging reports and participant-reported urinary incontinence and distressing urination frequency, adjusting for age, race, parity, and body mass index.

RESULTS

Among the 477 participants, 27.9% reported at least weekly incontinence, 72.8% distressing daytime urination frequency, and 63.4% frequent night-time urination. Greater total leiomyoma volume was associated with at least weekly incontinence of any type (OR 1.05, 95% CI 1.02-1.07, per 20-ml increase) and at least weekly stress-predominant incontinence (OR 1.04, 95% CI 1.01-1.07, per 20-ml increase), but not distressing daytime or night-time urination frequency. Although subserosal leiomyoma position was associated with a 2.01-fold (95% CI 1.14-3.56) greater odds of frequent night-time urination, no significant associations between leiomyomata location or position and incontinence were detected.

CONCLUSION

In this multicenter sample of women seeking treatment for symptomatic leiomyomata, greater leiomyomata volume was associated with weekly any-type and stress-type incontinence, but leiomyoma position and location were not independently associated with urinary incontinence.

The impact of appendicular skeletal muscle index and trunk muscle index on stress urinary incontinence risk in female adults: a retrospective study

Objective

This study sought to examine the effect of the appendicular skeletal muscle index (ASMI) and trunk muscle index (TMI) on the likelihood of stress urinary incontinence (SUI) among female adults.

Methods

This investigation utilized data from the National Health and Nutrition Examination Survey from 2001 to 2006 and 2011-2018. To evaluate the impact of ASMI and TMI on the likelihood of SUI, the study utilized restricted cubic splines (RCS) and weighted multivariable logistic regression models. Subgroup and interaction analyses were conducted to investigate how other covariates influenced their relationship.

Results

In total, 11,168 female adults participated in the analysis. Multivariable logistic regression analysis revealed that high TMI was associated with a decreased likelihood of SUI (OR = 0.34; 95% CI: 0.16-0.75; p = 0.013). ASMI was not correlated with the likelihood of SUI. RCS analysis demonstrated a linear correlation between TMI and SUI risk, showing a decreasing trend in SUI risk as TMI increases (p for overall <0.001, p for nonlinearity = 0.73).

Conclusion

Our study results showed that there was no association between ASMI and the risk of SUI, while a high TMI reduced the risk of SUI. This suggested that the ratio of muscle mass and BMI in different body regions has varying effects on SUI.

The Association Between Blood Lead Levels and Urgency Urinary Incontinence Among Adult Females: A Retrospective Study Based on NHANES 2005-2020

The purpose of this study is to investigate whether blood lead levels influence the risk of urgency urinary incontinence (UUI) in adult females. This study utilized data from the National Health and Nutrition Examination Survey from 2005 to 2020, involving 9509 adult women aged 20 and older. The effect of blood lead levels on UUI was assessed using weighted multivariate logistic regression models. Additionally, the relationship between the two was illustrated using restricted cubic splines. Stratified analyses based on covariate categories were used to explore if factors influenced the relationship between blood lead levels and UUI. Adjusted multivariate logistic regression analysis indicated that for each unit increase in blood lead levels, the risk of UUI increased by 10% (OR = 1.10; 95% CI, 1.02-1.17; P = 0.01). After categorizing blood lead levels into weighted tertiles, compared to the first tertile, the third tertile increased the risk of UUI by 1.34 times in Model 1 (OR = 1.34; 95% CI, 1.13-1.59; P < 0.001). A restricted cubic spline analysis demonstrated a nonlinear relationship between blood lead levels and UUI (P for nonlinearity = 0.016). Stratified analysis revealed that baseline characteristics such as age, BMI, and PIR did not have an impact on the association between blood lead levels and UUI. This study demonstrated a close association between the risk of blood lead levels and UUI in adult women aged 20 and above. High blood lead levels were found to increase the risk of UUI.

Developing a urinary incontinence primary care pathway: a mixed methods study

BACKGROUND

While nearly 50% of adult women report at least one episode of urinary incontinence (UI), most never receive treatment.

OBJECTIVE

To better integrate primary and specialty UI care, we conducted (i) an environmental scan to assess the availability of key pathway resources in primary care, (ii) interviews with primary care providers to understand barriers to care, and (iii) a pilot UI care pathway intervention.

METHODS

Environmental scan: Clinic managers from all primary care clinics within a Midwestern healthcare system were invited to participate in an interview covering the availability of clinic resources. Provider interviews: Primary care providers were invited to participate in an interview covering current practices and perceived barriers to UI care. Pilot UI care pathway: Patients who screened positive for UI were provided resources for first-line behavioral management. Pilot patients completed questionnaires at baseline, 8 weeks, and 6 months.

RESULTS

While many clinics had point-of-care urinalysis (17/21, 81%), most did not have a working bladder ultrasound (14/21, 67%) or on-site pelvic floor physical therapy (18/21, 86%). Providers (n = 5) described barriers to completing almost every step of diagnosis and treatment for UI. The most persistent barrier was lack of time. Patients (n = 15) reported several self-treatment strategies including avoiding bladder irritants (7/15, 47%) and performing Kegel exercises (4/15, 27%). Five patients (33%) requested follow-up care. At 6 months, patients reported small improvements in UI symptoms.

CONCLUSION

Promising results from a novel UI care pathway pilot indicate that streamlining UI care may assist primary care providers in the first-line treatment of UI.

Association between serum cotinine levels and urinary incontinence in adults in the United States: a population-based cross-sectional analysis

Environmental tobacco smoke (ETS) exposure has been shown to be associated with a variety of diseases, but evidence regarding the association between it and urinary incontinence (UI) is limited. Cotinine, a metabolite of nicotine in the human body, can more accurately quantify the level of human exposure to tobacco smoke. The study utilized data from seven survey cycles (2007-March 2020 Pre-pandemic) of the National Health and Nutrition Examination Survey (NHANES) program. Weighted multivariable logistic regression analysis, subgroup analysis, interaction tests, smooth curve fitting, and threshold effect models were used to analyze the relationship between serum cotinine and UI. Additionally, a 1:1 nearest neighbor propensity score matching (PSM) method was employed to minimize the impact of confounding factors. Before and after PSM, serum cotinine levels were higher in individuals with UI than those without (P < 0.05). Both before and after PSM, UI was positively correlated with serum cotinine levels, with a significantly increased risk of urinary incontinence when serum cotinine levels were in the Q3 range (before PSM: OR = 1.89, 95% CI = 1.59-2.24; after PSM: OR = 1.60, 95% CI = 1.28-2.00). Smooth curve fitting before and after PSM showed an approximate J-shaped non-linear dose-response relationship between log-transformed serum cotinine levels and UI. This study indicates that among American adults, there is a positive relationship between serum cotinine levels and UI, which is also significant in self-reported non-smoking populations. Therefore, reducing exposure to environmental tobacco smoke (e.g., avoiding second-hand smoke) in work and daily life may help alleviate the occurrence of UI, and serum cotinine levels have the potential to be a tool for predicting the degree of risk of developing UI.

Cardiovascular health assessed by the new life's essential 8 and the prevalence of urinary incontinence in adults

OBJECTIVE

To explore the association between cardiovascular health (CVH) measured by Life's Essential 8 (LE8) and the prevalence of urinary incontinence (UI).

METHOD

A cross-section study was conducted using data from the National Health and Nutrition Examination Survey 2007-2012. 22,609 people aged ≥ 20 years with complete information on LE8 metrics and UI questionnaires were enrolled. Participants were divided into three groups (low: < 50, moderate: ≥ 50 and < 80, high: ≥ 80) based on the cut-off of LE8. Weighted proportions, multivariable logistic regression analysis and stratified logistic regression were performed to examine the association between LE8 and the prevalence of three types of UI separately (stress UI (SUI), urge UI (UUI), mixed UI (MUI)) by confounding factors adjusted. Spline smooth was conducted to find whether a linear relationship existed. In addition, sensitive analyses were also conducted to observe the stability.

RESULT

A total of 22,609 adults were involved in the study, and participants were divided into three groups (low 42.2 ± 6.3, moderate 66.1 ± 8.1, high 86.8 ± 5.1) according to the cut-off points of LE8. The multivariable logistic regression suggested that LE8 is inversely associated with the prevalence of SUI (OR = 0.98, 95%CI 0.98 to 0.99), UUI (OR = 0.98, 95%CI 0.98 to 0.99), and MUI (OR = 0.98, 95%CI 0.97 to 0.98) in the fully-adjusted model. Compared with the low group, people with high scores of LE8 had a lower prevalence of SUI (OR = 0.45, 95%CI 0.37 to 0.55), UUI (OR = 0.49, 95%CI 0.40 to 0.60), and MUI (OR = 0.41, 95%CI 0.30 to 0.55). The result of the sensitive analysis showed the robustness of the main analysis.

CONCLUSION

The prevalence of UI (SUI, UUI, or MUI) is inversely associated with the LE8 score, which suggests that maintaining a good CVH with a higher LE8 score is accompanied by lower prevalence rates of UUI, SUI, and MUI.

Demographic Comparisons of Self-Reported Fall Risk Factors Among Older Adults Attending Outpatient Rehabilitation

Purpose

Identify the prevalence and prevalence differences of fall risk factors by sex, clinic rurality, and race/ethnicity among older adults (≥65 years old) receiving outpatient rehabilitation.

Patients and Methods

Our secondary analysis used Electronic Health Record data of 108,751 older adults attending outpatient rehabilitation (2018-2022) within a large health system across 7 states and completed the Stay Independent Questionnaire. The mean age was 73.3 (±6.36), 58.1% were female, 84.3% were non-Hispanic White, and 88.8% attended an urban clinic. Fall risks were identified via the Centers for Disease Control and Prevention's Stay Independent Questionnaire.

Results

Older adults had a high prevalence of fall risks (44.3%), including history of falls (34.9%). The most prevalent fall-risk factors were impaired strength, gait, and balance. Compared to males, females had a higher prevalence of reporting a fall (4.3%), a fall with injury (9.9%), worrying about falling 9.1%), rushing to the toilet (8.5%), trouble stepping onto a curb (8.4%), taking medicine for sleep or mood (6.0%), feeling sad or depressed (5.3%), and feeling unsteady (4.6%). Males reported a higher prevalence of losing feeling in feet (9.4%), ≥1 fall in the past year (8.1%), and using hands to stand up (4.4%). Compared to White older adults, Native American/Alaska Natives had the highest prevalence of fall history (43.8%), Hispanics had the highest prevalence of falls with injury (56.1%), and Hispanics and Blacks had a higher prevalence of reporting 11/12 Stay Independent Questionnaire risk factors.

Conclusion

Older adults receiving outpatient rehabilitation have a high prevalence of fall risks, including falls and difficulties with strength, balance, or gait. Findings indicate that rehabilitation providers should perform screenings for these impairments, including incontinence and medication among females, loss of feeling in the feet among males, and all Stay Independent Questionnaire -related fall risk factors among Native American/Alaska Natives, Hispanics, and Blacks.

Impact of Preoperative Urinary Tract Infection Screening in Asymptomatic Women Undergoing Midurethral Sling

INTRODUCTION

There is limited information regarding the utility of preoperative urine culture (Ucx) screening to decrease postoperative UTI rates following midurethral sling (MUS).

HYPOTHESIS

The primary objective of this study was to determine if the rate of postoperative UTI within the first 6 weeks after surgery is lower in women undergoing MUS when preoperative Ucx is obtained compared to when it is not. Secondary objectives were to determine clinical factors associated with postoperative UTI risk.

METHODS

This is a retrospective cohort study of women who did not have symptoms of or a diagnosis of cystitis at the time of their preoperative evaluation and are undergoing MUS. Patients were grouped into those who had preoperative Ucx screening within 6 weeks preceding surgery and those who did not. UTI rates 6 weeks following surgery were compared between groups. Additionally, factors impacting the risk of developing a UTI within 6 weeks of surgery were assessed.

RESULTS

Among 661 patients, 13.2% had a UTI within the first 6 weeks. There was no significant difference in UTI rates between those who did and did not have preoperative Ucx, respectively (14.9% vs 10.2%, p = 0.09). On multivariable analysis, current smoker status (OR 3.02, 95% CI 1.10-8.26), history of recurrent UTI (OR 3.00, 95% CI 1.14-7.86), and requiring postoperative SIC (OR 8.75, 95% CI 1.83-41.74) were independently associated with a UTI within 6 weeks of MUS.

CONCLUSION

Obtaining preoperative Ucx in asymptomatic women prior to MUS does not appear to be associated with lower postoperative UTIs rates within 6 weeks of surgery.

Does vaginal surgery for correction of pelvic organ prolapse improve urinary function? A prospective cohort study

INTRODUCTION AND HYPOTHESIS

Pelvic organ prolapse (POP) is caused by an imbalance in the stability of the pelvic organs, resulting in loss of support. The most common types of POP, anterior and apical, are associated with lower urinary tract symptoms (LUTS) such as bladder outlet obstruction and detrusor overactivity (DO). Vaginal surgery may improve LUTS and overall urinary symptoms. We assessed urodynamic (UD) parameters and urinary symptoms before and after vaginal surgery for POP correction.

METHODS

A prospective cohort of 59 women with symptomatic anterior and/or apical POP associated with urinary symptoms and with indications for vaginal surgery were included. POP surgeries included anterior colporrhaphy and vaginal hysterectomy with culdoplasty (VH) and with/without concomitant posterior colporrhaphy and mid-urethral sling (MUS). All participants underwent UD evaluation and answered urinary symptom questionnaires pre- and 3 months post-surgery.

RESULTS

Anterior colporrhaphy was performed in all patients: 45.7% with associated VH and 54.2% with concomitant MUS. Preoperative ICIQ-OAB score >8 points was significantly associated with DO (p<0.02) and decreased after surgery (9±4.3 to 3.2±3.0, p<0.001). All other questionnaires demonstrated improvements in urinary symptoms. Stress urinary incontinence rate decreased from 59.6% to 21% (p<0.001). Post-void residual (PVR) volume and Valsalva maneuver also decreased (p<0.001).

CONCLUSIONS

Pelvic organ prolapse surgery reduced the prevalence of urgency symptoms, and all questionnaires on urinary symptoms showed clinically significant improvement. Vaginal surgery for POP, even combined with MUS, significantly reduced PVR volume and improved urgency symptoms.

Screening and Treating Urinary Incontinence in Primary Care: A Missed Opportunity

More than 60% of adult women in the United States have urinary incontinence (UI), with the prevalence increasing to over 80% in women over age 65. Despite its high prevalence, most patients do not seek care and few clinicians screen for UI. The Medicare Health Outcomes Survey queries patients about satisfaction with their provider's discussion and management of UI, but formal recommendations about screening, diagnosis, and treatment are lacking. This review presents a practical algorithm for primary care providers to incorporate management of UI into routine preventive care for women, and outlines UI prevalence, risk factors, screening, and non-surgical treatment options.

The Experience of Women From Underrepresented Groups With Urinary Incontinence: A Systematic Review

INTRODUCTION

Urinary incontinence (UI) in women is a global public health issue. However, there is a limited understanding of the experience of women from underrepresented groups suffering from UI. The purpose of this systematic review was to examine current evidence regarding the experience of women with UI from these groups.

METHODOLOGY

A systematic search was undertaken to retrieve research studies that answered the research question. Four qualitative research studies were included. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guided this review.

RESULTS

Four themes emerged from this review: the perceived origin of UI, the physical, psychological, and social impact of UI, the impact of culture and religion on UI, and vice versa, and the interaction of women with health services.

DISCUSSION

Social determinants of health, such as religion and culture, need to be considered by professionals providing care if women from underrepresented groups experiencing UI are to receive optimal care.

Support of adult urinary incontinence products: recommendations to assure safety and regulatory compliance through application of a risk assessment framework

Urinary incontinence (UI) or involuntary loss of urine is a common chronic medical condition among women. It is estimated that 5%-70% of the population experiences incontinence with most studies suggesting 25%-45% of the population. Varying definitions of UI (e.g., stress, urgency, mixed) exist, and inconsistent symptom assessment tools, age, and gender can affect the estimate of incidence. Disposable Adult Incontinence products were first introduced into the market in the late 1970s and initially were used mostly in nursing homes and hospitals. However, during the 1980s, the market for incontinence products via retail outlets dramatically increased as awareness of the benefits of the products grew and stigma about their use declined. Today's products that manage urine loss have an extensive history and have evolved with time. Always products were introduced into the market in 2014 and are designed to meet the needs of women of all ages. Considered medical devices in some countries, regional regulations and global guidelines require clear planning, thorough assessment, and concise documentation of clinical safety. This manuscript will briefly review the regulatory landscape with a specific focus on European Union regulations. As previously published, the iterative, risk assessment framework used to assess the safety of Always incontinence products confirms that these products are compatible with skin and can be used safely. This manuscript will expand on the current literature highlighting additional steps that help assure the safety and compliance of the products from quality assurance programs through comprehensive post-market safety surveillance. Recommendations to help ensure several of the key regulatory requirements are met are outlined in the context of a risk assessment framework used to assure safety.

TReating Incontinence for Underlying Mental and Physical Health (TRIUMPH): a study protocol for a multicenter, double-blinded, randomized, 3-arm trial to evaluate the multisystem effects of pharmacologic treatment strategies for urgency-predominant urinary incontinence in ambulatory older women

BACKGROUND

Urgency-type urinary incontinence affects one in four older community-dwelling women and overlaps with other common aging-associated health syndromes such as cognitive impairment, physical mobility impairment, and depression. Observational studies have raised concern about potentially higher rates of delirium and dementia in older adults taking anticholinergic bladder medications, but few prospective data are available to evaluate the effects of these and other pharmacologic treatments for urgency incontinence on cognition and other multisystem functional domains important to older women.

METHODS

The TRIUMPH study is a randomized, double-blinded, 3-arm, parallel-group trial comparing the multisystem effects of anticholinergic versus beta-3-adrenergic agonist bladder therapy and versus no active bladder anti-spasmodic pharmacotherapy in older women with urgency incontinence. Women aged 60 years and older (target N = 270) who have chronic urgency-predominant urinary incontinence and either normal or mildly impaired cognition at baseline are recruited from the community by investigators based in northern California, USA. Participants are randomized in equal ratios to take identically encapsulated oral anticholinergic bladder therapy (in the form of tolterodine 2 mg extended release [ER]), oral beta-3 adrenergic agonist bladder therapy (mirabegron 25 mg ER), or placebo daily for 24 weeks, with the option of participant-directed dose titration (to tolterodine 4 mg ER, mirabegron 50 mg ER, or matching placebo daily). Participants also receive patient-oriented information and instructions about practicing first-line behavioral management strategies for incontinence. The primary outcome is change in composite cognitive function over 24 weeks assessed by a comprehensive battery of cognitive tests, with a secondary exploration of the persistence of change at 36 weeks. Secondary outcomes include changes over 24 and 36 weeks in domain-specific cognitive function; frequency, severity, and impact of urgency-associated urinary symptoms; physical function and balance; sleep quality and daytime sleepiness; psychological function; and bowel function.

DISCUSSION

The TRIUMPH trial addresses the need for rigorous evidence to guide counseling and decision-making for older women who are weighing the potential multisystem benefits and risks of pharmacologic treatments for urgency incontinence in order to preserve their day-to-day functioning, quality of life, and independence in older age.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05362292. Registered on May 5, 2022.

Prevalence and severity of urinary incontinence and associated factors in Iranian postmenopausal women: a cross-sectional study

BACKGROUND

Urinary incontinence (UI) is one of the most common symptoms during menopause, leading to a decreased quality of life and limited social activities. This study aimed to determine the prevalence and severity of urinary incontinence and associated risk factors in postmenopausal women.

METHODS

It was a cross-sectional study using cluster sampling on 433 postmenopausal women in Tabriz-Iran, 2021-2022. Data were collected using questionnaires of socio-demographic characteristics, Questionnaire for Urinary Incontinence Diagnosis (QUID), and International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UISF). Multivariate logistic regression was used to determine factors related to urinary incontinence.

RESULTS

The overall prevalence of urinary incontinence was 39.5%; 20.6% stress urinary incontinence (SUI), 10.4% urgency urinary incontinence (UUI), and 8.5% mixed urinary incontinence (MUI). Multivariate logistic regression analysis showed that the prevalence of SUI (aOR 0.38; 95% CI 0.18-0.77) and UUI (aOR 0.38; 95% CI 0.15-0.94) was significantly lower in women with three childbirths than the ones with fewer childbirths. Also, the odds of UUI increased significantly in women at the 50-55 age range (aOR 3.88; 95% CI 1.16-12.93) than those less than 50 years.

CONCLUSION

Due to the high prevalence of urinary incontinence in postmenopausal women, caregivers should screen for early diagnosis and appropriate treatment of urinary incontinence to prevent its destructive impact on the quality of life.

Variation in diagnosis of urinary incontinence in women by provider and patient demographic factors

INTRODUCTION

Urinary incontinence (UI) among women is under-recognized in primary care setting. We hypothesized that UI is, therefore, more commonly diagnosed by specialists. Our aim was to determine the rate of UI diagnosis by provider and patient demographics, and whether these factors affect the likelihood of UI diagnosis.

METHODS

Retrospective study using electronic medical records from 2010 to 2019. Ambulatory patient encounters by adult females were identified. Encounters with new diagnosis of UI (stress, urgency, mixed, or unspecified) were identified using ICD 9 and 10 codes. The following data were extracted: diagnosing provider specialty and sex, patient age, BMI, race, estimated household income, insurance coverage and type, and primary care provider (PCP). Rate of UI diagnosis was calculated using proportions. Univariable comparison and multivariable logistic regression were performed.

RESULTS

576,110 patient encounters were captured. 14,378 patient encounters had UI diagnosis (2.5%). UI population had the following characteristics: Mean age of 60.1 ± 15.5 years, 65.6% identified as white, 75.7% had a PCP, and 87.9% had insurance. UI diagnosis rate was < 1% for PCPs. Multivariable logistic regression showed that urogynecologists and female providers were more likely to diagnose UI; patient demographics associated with UI diagnosis included older age, elevated BMI, white race, commercial insurance, and having a PCP. Estimated household income did not have a significant effect.

CONCLUSION

Diagnosis of UI is seldom made by PCPs. Race, insurance, and having a PCP may affect the likelihood of receiving UI diagnosis. Continued efforts to promote equity in recognizing UI may be warranted.

Urinary incontinence and quality of life: A longitudinal analysis from the English Longitudinal Study of Ageing

OBJECTIVES

To explore the longitudinal association between urinary incontinence (UI) and quality of life (QoL) in the English Longitudinal Study on Ageing, a large study of older UK adults with ten years of follow-up.

STUDY DESIGN

Cohort study.

MAIN OUTCOMES INTEREST

To determine the presence of UI, participants reported whether they had lost urine beyond their control in the last 12 months. Participants also reported whether UI lasted more than one month, indicating a more chronic problem. QoL was measured using the CASP (control, autonomy, self-realisation and pleasure)-19, with higher values indicating a higher QoL.

RESULTS

Of the 8028 participants (mean age: 65.2 years; 56.7% females) included, 1172 reported UI at baseline. No significant differences in CASP-19 score were found at baseline (p = 0.24). In people with UI, a significant decline in CASP-19 score (from 34.3 ± 14.0 at baseline to 30.9 ± 16.1 in wave 7) (p = 0.016) was observed. The results were stronger in men than in women and with a longer duration of UI.

CONCLUSION

UI was associated with poor QoL over ten years of follow-up in a large cohort of UK participants. Our findings further suggest the importance of UI as a potential risk factor for poor QoL.

Updated Prevalence of Urinary Incontinence in Women: 2015-2018 National Population-Based Survey Data

OBJECTIVES

This study aimed to update estimates of urinary incontinence (UI) prevalence and associated risk factors for adult women in the United States, using the National Health and Nutrition Examination Survey (NHANES).

METHODS

We used descriptive analysis of 2015-2018 NHANES weighted data for women to estimate prevalence and characterize UI types and severity. Logistic regression modeling determined adjusted associations with UI.

RESULTS

Complete data were available for 5,006 women. In weighted analyses, 61.8% had UI, corresponding to 78,297,094 adult U.S. women, with 32.4% of all women reporting symptoms at least monthly. Of those with UI, 37.5% had stress urinary incontinence, 22.0% had urgency urinary incontinence, 31.3% had mixed symptoms, and 9.2% had unspecified incontinence. The prevalence of moderate or more severe UI by Sandvik Severity Index was 22.1%, corresponding to 28,454,778 adult U.S. women. In multivariate models, increasing age, body mass index ≥25, prior vaginal birth, anxiety, depression, functional dependence, and non-Hispanic White ethnicity and race were associated with any and moderate UI. Urinary incontinence was not associated with diabetes, education level, prior hysterectomy, smoking status, physical activity level, or current pregnancy status.

CONCLUSIONS

More than 60% of community-dwelling adult women in the United States experience any UI and an increase from prior estimates (38%-49%) using NHANES data from 1999 to 2004; more than 20% experience moderate or more severe UI. Increases in UI prevalence may be related to population aging and increasing obesity prevalence. Age greater than 70 years, body mass index >40, and vaginal birth had the strongest association with UI in multivariate modeling.

The Impact of Provider Sex and Experience on the Quality of Care Provided for Women with Urinary Incontinence

BACKGROUND

Although specialists are skilled in the management of urinary incontinence, primary care clinicians are integral in early diagnosis and initiation of management in order to decrease overuse of specialty care and improve the quality of specialist visits. We measured the quality of incontinence care provided by primary care clinicians prior to referral to a specialist and evaluated the impact of provider variables on quality of care.

METHODS

We performed a retrospective review of 200 women referred for urinary incontinence to a Female Pelvic Medicine and Reconstructive Surgery specialist between March 2017 and July 2018. We measured primary care adherence to 12 quality indicators in the 12 months prior to specialist consultation. We stratified adherence to quality indicators by clinician sex and years of experience.

RESULTS

Half of women with incontinence underwent a pelvic examination or had a urinalysis ordered. Few patients with urge urinary incontinence were recommended behavioral therapy (14%) or prescribed medication (8%). When total aggregate scores were compared, female clinicians performed the recommended care 47% ± 25% of the time, compared with 35% ± 23% for male clinicians (P = .003). Increasing years of experience was associated with worse overall urinary incontinence care (r -0.157, P = .02).

CONCLUSIONS

We found low rates of adherence to a set of quality indicators for women with urinary incontinence, with male clinicians performing significantly worse than female clinicians. Improvement of incontinence care in primary care could significantly reduce costs of care and preserve outcomes.

Postoperative prophylactic antibiotics for retropubic mid-urethral slings

OBJECTIVES AND HYPOTHESIS

The primary objective is to measure the difference in urinary tract infection (UTI) rates within 6  weeks of placement of a retropubic mid-urethral sling (RMUS) in the setting of various postoperative prophylactic antibiotic regimens. UTI rates were measured by antibiotic prescriptions to treat UTI and/or culture. Secondary aims included determining risk factors for postoperative UTI.

METHODS

A retrospective chart review from 2014 to 2016 was performed at Baylor Scott and White Medical Center-Temple for CPT code 57288. Univariate comparisons were performed using chi-square and Student's t-test. Logistic regression analysis was performed for UTI risk factors with univariate p values ≤ 0.1.

RESULTS

One hundred twelve subjects were included. Seventeen (15%) were treated for postoperative UTI. Postoperative prophylactic antibiotics included trimethoprim (39.3%), nitrofurantoin (31.3%), trimethoprim-sulfamethoxazole (5.4%), ciprofloxacin (2.7%), and cephalexin (1.8%). Ninety subjects were prescribed postoperative prophylactic antibiotics (80.4%). The postoperative UTI rate was not significantly different between those who were prescribed postoperative prophylactic antibiotics (16%) and those who were not (14%). None of the treatments showed a significant difference on postoperative UTI rate compared to no treatment. Significant risk factors for UTI included catheterization past postoperative day 1 (OR 6.4, 95% CI 1.7 - 23.8; p  =  0.006).

CONCLUSIONS

There was no significant difference in postoperative UTI rate in the group without postoperative prophylactic antibiotics compared to those who did receive it. Catheterization past postoperative day 1 was significantly associated with postoperative UTI. However, definitive conclusions are limited by a lack of power.

The associations between organophosphate esters and urinary incontinence in the general US population

Organophosphate esters (OPEs) impact health in many ways. Since its relationship with urinary incontinence remains unknown, we aimed to explore their associations in the US general population. We combined the results of urine specimens test and self-reported urinary incontinence conditions from the National Health and Nutrition Examination Survey (NHANES) 2013-2014 among 2666 participants and then conducted linear regression and logistic regression to analyse associations between log2-transformed OPE concentrations and urinary incontinence. We found that 0.92% of men and 15.74% of women complained of mixed urinary incontinence (MUI). The concentrations of diphenyl phosphate (DPHP) were significantly correlated to MUI among women when treated as a continuous variable (adjusted odds ratio (OR) = 1.15; 95% confidence interval (CI), 1.01-1.31; p = 0.0369) and as a categorical variable (adjusted OR = 1.24; 95% CI, 1.03-1.49; p for trend = 0.0245), whereas no positive correlation was found in males. There were no significant associations between the other three OPEs: bis(2-chloroethyl) phosphate (BCEP), bis(1,3-dichloro-2-propyl) phosphate (BDCPP) and dibutyl phosphate (DBUP). The association of DPHP with an increased prevalence OR of MUI in women is a public health concern; future prospective studies are needed to explore its potential mechanism.

A randomized trial comparing continence pessary to continence device (Poise Impressa®) for stress incontinence

INTRODUCTION AND HYPOTHESIS

To conduct a multi-centered randomized trial evaluating stress urinary incontinence (SUI) treatment based on the Patient Global Impression of Improvement score after 4 weeks using a continence pessary (CP) or a disposable intravaginal continence device (DICD). The null hypothesis is no difference in treatment success between cohorts.

METHODS

This parallel group, active treatment comparative effectiveness trial randomized women with SUI to either CP or DICD for 4 weeks in a 1:1 allocation ratio. Exclusion criteria included pregnancy, UTI, postmenopausal bleeding, neurogenic bladder, urinary retention, prolapse, contraindication to or prior treatment with CP/DICD, and prior SUI surgery. Assuming an 80% power, an alpha of 5% and 20% dropout, we needed 138 participants to detect 50% success with CP versus 25% with DICD. Due to slow enrollment, the study was stopped after 16 months with 50 participants enrolled.

RESULTS

Of the 50 women enrolled, 25 (50%) were randomized to CP and 25 (50%) to DICD. Thirty-five of 50 (70%) completed a fitting, and 22/50 (44%) completed 4-week and 17/50 (34%) completed 6-month follow-up. Baseline characteristics were similar, and there was high treatment success in each cohort [80% (8/10) CP vs. 75% (9/12) DICD; p = 1.0]. DICD patients showed improvement on all questionnaires but had higher use of other therapies over 6 months. CP patients showed improvements except for lower sexual function scores at 4 weeks. No serious adverse events occurred.

CONCLUSIONS

Most women fitted with a CP/DICD experienced treatment success after 4 weeks without serious adverse events.

Applying a Health Equity Lens to Urinary Incontinence

Health equity is attained when everyone has the opportunity achieve the health they envision; however, health disparities are a barrier to health equity. As health disparities specific to urogynecology exist, it is critical to examine and contextualize them in a framework that improves understanding of what factors may drive these disparities to craft effective solutions. This article will review what we currently know about urinary incontinence disparities and provide a framework for evaluation as well as a framework for advancing health equity in the care of diverse patient populations with urinary incontinence.

Management of Urgency and Mixed Urinary Incontinence

Urinary incontinence (UI) is a prevalent disorder that significantly affects quality of life. This article reviews management of urgency and mixed UI by breaking the management algorithm down into observation, lifestyle and behavioral changes, pharmacologic therapy, and procedural management. Stress UI is best managed with mid-urethral slings and is covered in other chapters. Behavioral and pharmacologic management are equally efficacious for urgency UI, but procedural therapy is superior. Mixed UI is conventionally treated by first managing whichever UI subtype is most bothersome. The management of overflow UI is directed at its underlying etiology: detrusor underactivity or bladder outlet obstruction.

Efficacy and Safety of Once-Daily Vibegron for Treatment of Overactive Bladder in Patients Aged ≥65 and ≥75 Years: Subpopulation Analysis from the EMPOWUR Randomized, International, Phase III Study

BACKGROUND

Overactive bladder (OAB) is common among older adults. The efficacy and safety of vibegron for the treatment of OAB were demonstrated in the international, phase III EMPOWUR trial. This subpopulation analysis from EMPOWUR assessed the efficacy and safety of vibegron in patients aged ≥ 65 and ≥ 75 years.

METHODS

In EMPOWUR, patients with OAB were randomly assigned 5:5:4 to receive once-daily vibegron 75 mg, placebo, or tolterodine 4 mg extended release, respectively, once daily for 12 weeks. Coprimary efficacy endpoints were change from baseline at week 12 in average daily number of micturitions and urge urinary incontinence (UUI) episodes; a key secondary efficacy endpoint was change from baseline at week 12 in average daily number of urgency episodes. Safety was assessed through adverse events (AEs). Efficacy analyses compared vibegron with placebo; no efficacy comparisons were made between vibegron and tolterodine.

RESULTS

Of the 1463 patients with evaluable efficacy data, 628 patients were aged ≥ 65 years, and 179 were aged ≥ 75 years. After 12 weeks, patients treated with once-daily vibegron 75 mg in both age subgroups showed significant improvements from baseline versus placebo in all three symptoms of OAB: daily micturitions (≥ 65 years, P < 0.0001; ≥75 years, P < 0.05), UUI episodes (≥ 65 years, P < 0.001; ≥ 75 years, P < 0.0001), and urgency episodes (≥ 65 years, P < 0.01; ≥ 75 years, P < 0.01). Significant reductions from baseline versus placebo in daily micturitions, UUI episodes, and urgency episodes were observed beginning at week 2 for patients aged ≥ 65 years treated with vibegron. In patients aged ≥ 65 years, 50.0% of those receiving vibegron versus 29.8% receiving placebo experienced a ≥ 75% reduction in UUI episodes at week 12 (P < 0.0001). Rates of cardiovascular-associated AEs were low for patients receiving vibegron (<2% of patients in either age subgroup) and similar to rates in patients receiving placebo. In patients aged ≥ 65 years, hypertension was reported by 1.2%, 3.1%, and 2.9% of patients receiving vibegron, placebo, and tolterodine, respectively; in patients aged ≥ 75 years, hypertension was reported by 1.3%, 3.3%, and 2.1%, respectively.

CONCLUSIONS

In this subpopulation analysis of patients with OAB aged ≥ 65 and ≥ 75 years from the EMPOWUR study, once-daily vibegron 75 mg showed rapid onset and robust efficacy versus placebo and was generally safe and well tolerated, consistent with results from the overall population.

TRIAL REGISTRATION

ClinicalTrials.gov identifier NCT03492281; registered April 10, 2018.

Effect of Preoperative Urodynamic Study on Urinary Outcomes after Transobturator Sling

OBJECTIVE

 To evaluate whether performing preoperative urodynamic study influences postoperative urinary symptoms of women with stress urinary incontinence that underwent transobturator sling.

METHODS

 Retrospective analysis of patients treated for stress urinary incontinence by transobturator sling from August 2011 to October 2018. Predictor variables included preoperative urodynamic study, age, incontinence severity, body mass index, preoperative storage symptoms and previous anti-urinary incontinence procedure. Outcome variables were postoperative subjective continence status, storage symptoms and complications. Logistic regression after propensity score was employed to compare outcomes between patients who underwent or not pre-operative urodynamic study.

RESULTS

 The present study included 88 patients with an average follow-up of 269 days. Most patients (n = 52; 59.1%) described storage symptoms other than stress urinary incontinence, and 38 patients (43.2%) underwent preoperative urodynamic studies. Logistic regression after propensity score did not reveal an association between urinary continence outcomes and performance of preoperative urodynamic study (odds ratio 0.57; confidence interval [CI]: 0.11-2.49). Among women that did not undergo urodynamic study, there was a subjective improvement in urinary incontinence in 92% of the cases versus 87% in those that underwent urodynamic study (p = 0.461). Furthermore, postoperative storage symptoms were similar between women who did not undergo urodynamic study and those who underwent urodynamic study, 13.2% versus 18.4%, respectively (p = 0.753).

CONCLUSION

 Preoperative urodynamic study had no impact on urinary incontinence cure outcomes as well as on urinary storage symptoms after the transobturator sling in women with stress urinary incontinence.

Urinary incontinence and quality of life: a systematic review and meta-analysis

BACKGROUND

Urinary incontinence (UI) and low quality of life (QoL) are two common conditions. Some recent literature proposed that these two entities can be associated. However, no attempt was made to collate this literature. Therefore, the aim of this study was to conduct a systematic review and meta-analysis of existing data to estimate the strength of the association between UI and QoL.

METHODS

An electronic search of major databases up to 18th April 2020 was carried out. Meta-analysis of cross-sectional and case-control studies comparing mean values in QoL between patients with UI and controls was performed, reporting random-effects standardized mean differences (SMDs) ± 95% confidence intervals (CIs) as the effect size. Heterogeneity was assessed with the I2.

RESULTS

Out of 8279 articles initially screened, 23 were finally included for a total of 24,983 participants, mainly women. The mean age was ≥ 50 years in 12/23 studies. UI was significantly associated with poor QoL as assessed by the short-form 36 (SF-36) total score (n = 6 studies; UI: 473 vs. 2971 controls; SMD = - 0.89; 95% CI - 1.3 to - 0.42; I2 = 93.5) and by the sub-scales of SF-36 and 5/8 of the domains included in the SF-36. Similar results were found using other QoL tools. The risk of bias of the studies included was generally high.

CONCLUSIONS

UI is associated with a poor QoL, with a strong level of certainty. This work, however, mainly based on cross-sectional and case-control studies, highlights the necessity of future longitudinal studies for better understanding the importance of UI on QoL.

MSC-based therapy in female pelvic floor disorders

Mesenchymal stem cells (MSCs), also referred to as multipotent stromal cells or mesenchymal stromal cells, are present in multiple tissues and capable of differentiating into diverse cell lineages, holding a great promise in developing cell-based therapy for a wide range of conditions. Pelvic floor disorders (PFDs) is a common degenerative disease in women and may diminish a woman's quality of life at any age. Since the treatments for this disease are limited by the high rates of recurrence and surgical complications, seeking an ideal therapy in the restoration of pelvic floor function is an urgent issue at present. Herein, we summarize the cell sources of MSCs used for PFDs and discuss the potential mechanisms of MSCs in treating PFDs. Specifically, we also provide a comprehensive review of current preclinical and clinical trials dedicated to investigating MSC-based therapy for PFDs. The novel therapy has presented promising therapeutic effects which include relieving the symptoms of urinary or fecal incontinence, improving the biological properties of implanted meshes and promoting the injured tissue repair. Nevertheless, MSC-based therapies for PFDs are still experimental and the unstated issues on their safety and efficacy should be carefully addressed before their clinical applications.

Therapeutic potential of muscle growth promoters in a stress urinary incontinence model

Weakness of urinary sphincter and pelvic floor muscles can cause insufficient urethral closure and lead to stress urinary incontinence. Bimagrumab is a novel myostatin inhibitor that blocks activin type II receptors, inducing skeletal muscle hypertrophy and attenuating muscle weakness. β₂-Adrenergic agonists, such as 5-hydroxybenzothiazolone derivative (5-HOB) and clenbuterol, can enhance muscle growth. We hypothesized that promoting muscle growth would increase leak point pressure (LPP) by facilitating muscle recovery in a dual-injury (DI) stress urinary incontinence model. Rats underwent pudendal nerve crush (PNC) followed by vaginal distension (VD). One week after injury, each rat began subcutaneous (0.3 mL/rat) treatment daily in a blinded fashion with either bimagrumab (DI + Bim), clenbuterol (DI + Clen), 5-HOB (DI + 5-HOB), or PBS (DI + PBS). Sham-injured rats underwent sham PNC + VD and received PBS (sham + PBS). After 2 wk of treatment, rats were anesthetized for LPP and external urethral sphincter electromyography recordings. Hindlimb skeletal muscles and pelvic floor muscles were dissected and stained. At the end of 2 wk of treatment, all three treatment groups had a significant increase in body weight and individual muscle weight compared with both sham-treated and sham-injured rats. LPP in DI + Bim rats was significantly higher than LPP of DI + PBS and DI + Clen rats. There were more consistent urethral striated muscle fibers, elastin fibers in the urethra, and pelvic muscle recovery in DI + Bim rats compared with DI + PBS rats. In conclusion, bimagrumab was the most effective for increasing urethral pressure and continence by promoting injured external urethral sphincter and pelvic floor muscle recovery.

The clinical pharmacology of the medical treatment for overactive bladder in adults

INTRODUCTION

Overactive bladder is a prevalent symptom complex that affects the patient's quality of life. Any disruption between the neuronal micturition pathway can lead to bladder overactivity. Neurogenic causes, myogenic causes, aging, bladder outlet obstruction, sex, and psychological factors are some of the factors contributing to bladder overactivity. The complaint of any symptoms of OAB, which is highly prevalent and affects overall QOL, often needs therapeutic interventions. When conservative therapy methods fail, the addition of medications is recommended. The most commonly used agents for the treatment of OAB are antimuscarinic drugs. New classes of drugs, such as beta-3 agonists, have enriched our pharmacologic armamentarium.

AREAS COVERED

In this review, with a special focus on oral pharmacological treatments, we discussed the definition, etiology, symptoms, diagnosis, and management of OAB.

EXPERT OPINION

OAB is a multifactorial condition with every patient presenting with a different collection of symptoms and signs. Medical therapies should be given in conjunction with behavioral therapies. Using high or low doses, flexible doses, and stopping or changing the medications are interchangeable strategies based on the level of treatment efficacy and patient satisfaction.

Stress Urinary Incontinence Surgery in Washington State Before and After Introduction of the Mesh Midurethral Sling

OBJECTIVES

Mesh midurethral slings (MUSs) are safe, effective treatments for female stress urinary incontinence (SUI), but many companies have ceased production because of controversies surrounding transvaginal mesh. To determine if introduction of MUS has increased the complication rate associated with SUI surgery, we compared women undergoing SUI surgery in the MUS era to those who had surgery prior its introduction.

METHODS

This was a retrospective cohort study of a statewide hospital discharge database. Stress urinary incontinence surgeries from 1987 to 1996 and 2007 to 2013 were identified using International Classification of Diseases, Ninth Revision codes.

RESULTS

A total of 30,723 SUI surgeries were performed during the study periods. After 2006, slings accounted for 91.8% of SUI surgeries. Patients were older (54.5 vs 53.0 years, P < 0.001) and sicker (22.6% vs 9.7% had ≥1 comorbid condition, P < 0.0001). Blood transfusion was more common in the MUS era (1.2% vs 0.4%, P < 0.001) however, other complications were either similar between groups or less common in the MUS era including 30-day readmission (2.5% vs 2.4%, P = 0.543), reoperation for urinary retention (0.1% vs 0.2%, P < 0.0375), and wound infection (0.1% vs 0.5%, P < 0.001), despite more concomitant prolapse surgeries (69.0 vs 26.9%, P < 0.001) and hysterectomies (53.0 vs 35.4%, P < 0.001) in the MUS era. Hospital stays were shorter after 2006 (1.0 vs 3.0 days, P < 0.001), and fewer women required reoperation for SUI within 2 years (0.5% vs 1.8%, P < 0.001).

CONCLUSIONS

Following introduction of MUS, women who underwent SUI surgery were slightly older with more medical comorbidities yet did not appear to experience increased surgical complications. Fewer women underwent reoperation for recurrent SUI, and hospital stays were shorter, suggesting an improvement in care. This study supports the continued availability and use of MUSs.

Urodynamics mixed type urinary incontinence with advanced pelvic organ prolapse, management and outcomes

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 SUI_UD 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.

Urinary incontinence and chronic conditions in the US population age 50 years and older

INTRODUCTION AND HYPOTHESIS

Urinary incontinence is common among older adults with chronic conditions. The purpose of this study is to examine the association of urinary incontinence with chronic conditions in the US population.

METHODS

We used data from the 2001-2014 National Health and Nutrition Examination Survey; 7226 women and 7239 men age > 50 years answered questions regarding urinary symptoms. The analysis accounted for the complex survey design, and prevalence reflects estimates within the non-institutionalized US population.

RESULTS

The mean age was 64.2 years [standard error (SE) 0.2] among women and 62.9 (SE 0.1) years among men. Bothersome stress, urgency and mixed incontinence were reported by 6.7% (SE 0.4), 4.8% (SE 0.4) and 19.3% (SE 0.59) of women, respectively, and 0.6% (SE 0.1), 3.5% (SE 0.2) and 1.9% (SE 0.2) of men, respectively. Among chronic conditions, heart failure was associated with higher prevalence of mixed incontinence in women and urgency incontinence in men. Among women, heart failure was associated with significantly increased odds of bothersome mixed incontinence (OR 2.35; 95% CI 1.62, 3.42) and lower odds of stress (OR 0.50; 95% CI 0.3, 0.9) or urgency incontinence (OR 0.43; 95% CI 0.19, 0.98) after adjustment for covariates. Among men, heart failure was associated with higher odds of stress (OR 1.99; 95% CI 0.39, 10.22), urgency (1.65; 95% CI 0.91, 2.99) and mixed incontinence (OR 1.54; 95% CI 0.91, 2.62) but associations were not statistically significant.

CONCLUSIONS

Heart failure is associated with higher odds of bothersome incontinence, especially among women.

Prevalence, risk factors, and treatment for women with stress urinary incontinence in a racially and ethnically diverse population

AIMS

Black women may have lower rates of SUI than Whites, whereas the rate of SUI in Hispanic women varies. Most studies have been conducted in predominantly White populations, making it difficult to evaluate race and SUI. The objective of this study was to estimate the prevalence of SUI in a diverse population and examine racial/ethnic differences in risk factors and treatment.

METHODS

This is a retrospective cohort study of women ≥21 years with SUI seen at our medical center from June 1, 2013 to June 30, 2016. Risk factors measured included age, BMI, SES, diabetes, smoking, Charlson comorbidity index, hysterectomy, and pregnancy. SUI management included consultation with a specialist and active treatment (physical therapy, pessary use, or incontinence surgery). ANOVA, chi-square, and multivariable logistic regression were used to evaluate race and SUI.

RESULTS

The prevalence rate was 4.65 per 100 women (5557 cases/119 452 women). Hispanics comprised the majority (54.13% n = 3008), followed by Blacks (23.54% n = 1308), Other (12.74% n = 708), and Whites (9.59% n = 532). Black women were less likely to consult with a specialist or undergo treatment compared to White and Hispanic women, which persisted in multivariable analysis. Women classified as other were more likely to undergo active treatment in the logistic regression model.

CONCLUSION

SUI prevalence was highest in Hispanics, despite risk factors being more common in Black women. Black women were less likely to consult with a specialist. Mixed or unknown race/ethnicity women were more likely to undergo active treatment. Future studies will evaluate if racial/ethnic differences in SUI management are due to patient preference or provider practices.

Prevalence, Awareness, and Understanding of Pelvic Floor Disorders in Adolescent and Young Women

OBJECTIVES

The objective of this study was to characterize symptom prevalence, awareness of pelvic floor disorders (PFDs) in family/friends, and understanding of factors contributing to the development of PFDs in women aged 19 to 30 years.

METHODS

This study is a cross-sectional study via online questionnaire survey of female students aged 19 to 30 years enrolled at the University of Alabama at Birmingham. Results of "adolescent women" aged 19 to 24 years were compared with "young women" aged 25 to 30 years.

RESULTS

A total of 1092 questionnaires were completed with the mean age being 23.5 ± 3.1 years. The overall rate of urinary incontinence (UI) was 10.3% without a difference between adolescent and young women (P = 0.61). There were no differences in rates of urgency UI (P = 0.061), stress UI (P = 0.29), or pelvic organ prolapse (POP) symptoms (P = 0.56) between groups. There was no difference between groups in awareness of family members with UI, fecal incontinence (FI), or POP symptoms (P ≥ 0.24). However, logistic regression showed that the young women were more likely to have received education regarding UI (adjusted odds ratio [aOR], 2.6; 95% confidence interval [CI], 1.8-3.6), FI (aOR, 3.3; 95% CI, 2.2-4.8), POP (aOR, 2.9; 95% CI, 2.1-4.2), and have greater understanding regarding causes of UI (aOR, 2.9; 95% CI, 1.7-4.8), FI (aOR, 1.6; 95% CI, 1.1-2.3), and POP (aOR, 1.9; 95% CI, 1.3-2.9).

CONCLUSIONS

Women aged 25 to 30 years had more awareness and understanding of PFDs compared with adolescent women. These data may have implications for primary prevention strategies of PFDs.

Mediating Effect of Social Participation on the Relationship between Incontinence and Depressive Symptoms in Older Chinese Women

Urinary and fecal incontinence affect older women's social participation and mental health. This study examined the relationship between incontinence severity and depressive symptoms, focusing on the mediating effect of social participation, based on secondary analysis of structured interview data collected in December 2010 from 467 women age 60 and over in mainland China. Incontinence was significantly and positively associated with depressive symptoms but negatively associated with social participation. Social participation was significantly and negatively associated with depressive symptoms and fully mediated the relationship between incontinence and depressive symptoms. These findings can inform mental health interventions for incontinent older women, including preventing and responding to depressive symptoms by promoting social participation.

Mediating effect of decline in social activities on urinary incontinence and negative mood: Do sex and marital differences exist?

AIM

We tested the mediating effect of decline in social participation on urinary incontinence (UI) and negative mood in older adults by sex and marital status.

METHODS

We carried out secondary analysis of data collected from 5301 Chinese adults aged 60 years or older in Hong Kong who had completed an initial screening instrument for subsidized long-term care services in 2010. Path analysis within structural equation modeling was carried out.

RESULTS

Satisfactory model fit was obtained: male-married group (n = 1949, standardized root means squared residual [SRMR] = 0.034, robust root mean square error of approximation [R-RMSEA] = 0.045, robust comparative fit index [R-CFI] = 0.965), male-other group (n = 519, SRMR = 0.023, R-RMSEA = 0.011, R-CFI = 0.988), female-married group (n = 948, SRMR = 0.018, R-RMSEA = 0.002, R-CFI = 1.000) and female-other group (n = 2251, SRMR = 0.023, R-RMSEA = 0.048, R-CFI = 0.970). In the male-married subsample, UI had both a significant direct effect (β = 0.046) and significant indirect effect on mood through decline in social participation (β = 0.021); for the female-other subsample, UI (β = 0.058) and decline in social participation (β = 0.335) had significant direct effects on negative mood. Decline in social participation had a significant direct effect on negative mood in the male-other subsample (β = 0.306) and the female-married subsample (β = 0.325).

CONCLUSIONS

Decline in social participation mediated the relationship between UI and negative mood in married older men, but not male-other group or women. It is important to recognize these sex and marital status differences, and expand social participation opportunities for UI patients. Geriatr Gerontol Int 2017; 17: 1829-1836.

Risk factors for urinary incontinence among postmenopausal Mexican women

INTRODUCTION AND HYPOTHESIS

Previous studies of racial/ethnic variation in urinary incontinence (UI) suggest that population-specific studies of UI risk factors are needed to develop appropriate public health recommendations. We assessed UI risk factors among postmenopausal Mexican women enrolled in the Mexican Teachers' Cohort.

METHODS

We conducted a cross-sectional study among 15,296 postmenopausal women who completed the 2008 questionnaire. UI cases were women who reported experiencing UI during menopause. Self-reported potential UI risk factors included age, reproductive variables, smoking status, adiposity, and several health conditions. We estimated multivariate-adjusted odds ratios (ORs) and 95 % confidence intervals (CIs) for UI using multivariable logistic regression.

RESULTS

Among these postmenopausal women, the prevalence of UI was 14 %. Odds of UI were higher among women with ≥4 children vs nulliparous women (OR 1.43, 95 % CI 1.04-1.96) or body mass index (BMI) ≥30 vs <22 kg/m² (OR 2.00, 95 % CI: 1.55-2.57). Age at first birth <20 vs 20-24 years, past or current vs never smoking, larger waist-to-hip ratio, and history of asthma, high blood pressure, or diabetes were also associated with higher odds of UI (OR 1.2-1.3). We found a trend of lower odds of UI with older age.

CONCLUSIONS

Our data suggest that information about UI and UI prevention strategies might be particularly useful for Mexican postmenopausal women with 4 or more children or higher BMI. Further studies with longitudinal UI data, in addition to data on UI severity and subtype, are needed to provide more specific information about UI risk factors to Mexican women.

Association of 17-β Estradiol with Adipose-Derived Stem Cells: New Strategy to Produce Functional Myogenic Differentiated Cells with a Nano-Scaffold for Tissue Engineering

The increased incidence of stress urinary incontinence (SUI) in postmenopausal women has been proposed to be associated with a reduction in the level of 17-β estradiol (E2). E2 has also been shown to enhance the multi-differentiation ability of adipose-derived stem cells (ASCs) in vitro. However, studies on the potential value of E2 for tissue engineering in SUI treatment are rare. In the present study, we successfully fabricated myogenically differentiated ASCs (MD-ASCs), which were seeded onto a Poly(l-lactide)/Poly(e-caprolactone) electrospinning nano-scaffold, and incorporated E2 into the system, with the aim of improving the proliferation and myogenic differentiation of ASCs. ASCs were collected from the inguinal subcutaneous fat of rats. The proliferation and myogenic differentiation of ASCs, as well as the nano-scaffold biocompatibility of MD-ASCs, with or without E2 supplementation, were investigated. We demonstrated that E2 incorporation enhanced the proliferation of ASCs in vitro, and the most optimal concentration was 10-9 M. E2 also led to modulation of the MD-ASCs phenotype toward a concentrated type with smooth muscle-inductive medium. The expression of early (alpha-smooth muscle actin), mid (calponin), and late-stage (myosin heavy chain) contractile markers in MD-ASCs was enhanced by E2 during the different differentiation stages. Furthermore, the nano-scaffold was biocompatible with MD-ASCs, and cell proliferation was significantly enhanced by E2. Taken together, these results demonstrate that E2 can enhance the proliferation and myogenic differentiation of ASCs and can be used to construct a biocompatible cell/nano-scaffold. These scaffolds with desirable differentiation cells show promising applications for tissue engineering.

An approach to improve the care of mid-life women through the implementation of a Women's Health Assessment Tool/Clinical Decision Support toolkit

The objectives of this study are to describe the implementation process of the Women's Health Assessment Tool/Clinical Decision Support toolkit and summarize patients' and clinicians' perceptions of the toolkit. The Women's Health Assessment Tool/Clinical Decision Support toolkit was piloted at three clinical sites over a 4-month period in Washington State to evaluate health outcomes among mid-life women. The implementation involved a multistep process and engagement of multiple stakeholders over 18 months. Two-thirds of patients (n = 76/110) and clinicians (n = 8/12) participating in pilot completed feedback surveys; five clinicians participated in qualitative interviews. Most patients felt more prepared for their annual visit (69.7%) and that quality of care improved (68.4%) while clinicians reported streamlined patient visits and improved communication with patients. The Women's Health Assessment Tool/Clinical Decision Support toolkit offers a unique approach to introduce and address some of the key health issues that affect mid-life women.

Prevalence and degree of bother of pelvic floor disorder symptoms among women from primary care and specialty clinics in Lebanon: an exploratory study

INTRODUCTION AND HYPOTHESIS

The prevalence of pelvic floor disorders (PFD) and their impact on quality of life of women vary among different populations. The purpose of this study was to assess the prevalence of symptoms of PFD, and their degree of bother in a convenience sample of Lebanese women, and to evaluate health-care seeking (HCS) behavior related to PFD.

METHODS

Women visiting clinics in a University Medical Center in Beirut, Lebanon, completed the self-filled validated Arabic version of the Global Pelvic Floor Bother Questionnaire (PFBQ). Data covering demographics, comorbidities, and HCS behavior related to PFD were collected. Total individual PFBQ scores, individual PFD symptom scores and HCS behavior were correlated to demographic data and comorbidities.

RESULTS

The study participants included 900 women. PFBQ scores were significantly higher in women of older age, women with a lower level of education, women with higher vaginal parity, and women who engaged in heavy lifting/physical activity. BMI >25 kg/m² was the strongest independent risk factor for the presence of PFD symptoms. The overall prevalence of urinary incontinence was 42 %. Anal incontinence was the most bothersome PFD. Almost two thirds of the women reported HCS due to any aspect of PFD. Among symptomatic women who believed that their PFD warranted HCS, financial concern was the most common obstacle irrespective of age and educational level.

CONCLUSIONS

In this convenience sample of Lebanese women, PFD symptoms were common and were significantly correlated with demographic characteristics and self-reported comorbidities. The key reason for not seeking health care related to PFD was financial concern.

Methods for a multicenter randomized trial for mixed urinary incontinence: rationale and patient-centeredness of the ESTEEM trial

INTRODUCTION AND HYPOTHESIS

Mixed urinary incontinence (MUI) can be a challenging condition to manage. We describe the protocol design and rationale for the Effects of Surgical Treatment Enhanced with Exercise for Mixed Urinary Incontinence (ESTEEM) trial, designed to compare a combined conservative and surgical treatment approach versus surgery alone for improving patient-centered MUI outcomes at 12 months.

METHODS

ESTEEM is a multisite, prospective, randomized trial of female participants with MUI randomized to a standardized perioperative behavioral/pelvic floor exercise intervention plus midurethral sling versus midurethral sling alone. We describe our methods and four challenges encountered during the design phase: defining the study population, selecting relevant patient-centered outcomes, determining sample size estimates using a patient-reported outcome measure, and designing an analysis plan that accommodates MUI failure rates. A central theme in the design was patient centeredness, which guided many key decisions. Our primary outcome is patient-reported MUI symptoms measured using the Urogenital Distress Inventory (UDI) score at 12 months. Secondary outcomes include quality of life, sexual function, cost-effectiveness, time to failure, and need for additional treatment.

RESULTS

The final study design was implemented in November 2013 across eight clinical sites in the Pelvic Floor Disorders Network. As of 27 February 2016, 433 total/472 targeted participants had been randomized.

CONCLUSIONS

We describe the ESTEEM protocol and our methods for reaching consensus for methodological challenges in designing a trial for MUI by maintaining the patient perspective at the core of key decisions. This trial will provide information that can directly impact patient care and clinical decision making.

Diabetes, Glycemic Control, and Urinary Incontinence in Women

OBJECTIVES

To estimate the association between urinary incontinence and glycemic control in women ages 20 to 85 years.

METHODS

We included 7270 women from the 2005 to 2010 National Health and Nutrition Examination Survey, stratified into three groups of glycemic control defined by hemoglobin A1c (HbA1c): (i) those below the diagnostic threshold (HbA1c < 6.5%), (ii) those with relatively controlled diabetes (HbA1c, 6.5-8.5%), and (iii) those with poorly controlled diabetes (HbA1c > 8.5%) to allow for a different relationship between glycemic control and urinary incontinence within each group. The primary outcomes were the presence of any, only stress, only urgency, and mixed urinary incontinence. We calculated adjusted risk ratios using Poisson regressions with robust variance estimates.

RESULTS

The survey-weighted prevalence was 52.9% for any, 27.2% for only stress, 9.9% for only urgency, and 15.8% for mixed urinary incontinence. Among women with relatively controlled diabetes, each one-unit increase in HbA1c was associated with a 13% (95% confidence interval, 1.03-1.25) increase for any urinary incontinence and a 34% (95% confidence interval, 1.06-1.69) increase in risk for only stress incontinence but was not significantly associated with only urgency and mixed incontinence. Other risk factors included body mass index, hormone replacement therapy, smoking, and physical activity.

CONCLUSIONS

Worsening glycemic control is associated with an increased risk for stress incontinence for women with relatively controlled diabetes. For those either below the diagnostic threshold or with poorly controlled diabetes, the risk may be driven by other factors. Further prospective investigation of HbA1c as a modifiable risk factor may motivate measures to improve continence in women with diabetes.