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O'Reilly N, Nelson HD, Conry JM, Frost J, Gregory KD, Kendig SM, Phipps M, Salganicoff A, Ramos D, Zahn C, Qaseem A. Screening for Urinary Incontinence in Women: A Recommendation From the Women's Preventive Services Initiative. Ann Intern Med 2018; 169:320-328. [PMID: 30105360 DOI: 10.7326/m18-0595] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
DESCRIPTION Recommendation on screening for urinary incontinence in women by the Women's Preventive Services Initiative (WPSI), a national coalition of women's health professional organizations and patient representatives. The WPSI's recommendations are intended to guide clinical practice and coverage of services for the Health Resources and Services Administration and other stakeholders. The target audience for this recommendation includes all clinicians providing preventive health care for women, particularly in primary care settings. This recommendation applies to women of all ages, as well as adolescents. METHODS The WPSI developed this recommendation after evaluating evidence regarding the benefits and harms of screening for urinary incontinence in women. The evaluation included a systematic review of the accuracy of screening instruments and the benefits and harms of treatments. Indirect evidence was used to link screening and health outcomes in the chain of evidence that might support screening in the absence of direct evidence. The WPSI also considered the effect of screening on symptom progression and avoidance of costly and complex treatments, as well as implementation factors. RECOMMENDATION The WPSI recommends screening women for urinary incontinence annually. Screening ideally should assess whether women experience urinary incontinence and whether it affects their activities and quality of life. The WPSI recommends referring women for further evaluation and treatment if indicated.
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Affiliation(s)
- Nancy O'Reilly
- American College of Obstetricians and Gynecologists, Washington, DC (N.O., J.M.C., C.Z.)
| | - Heidi D Nelson
- Oregon Health & Science University, Portland, Oregon (H.D.N.)
| | - Jeanne M Conry
- American College of Obstetricians and Gynecologists, Washington, DC (N.O., J.M.C., C.Z.)
| | - Jennifer Frost
- American Academy of Family Physicians, Leawood, Kansas (J.F.)
| | | | - Susan M Kendig
- National Association of Nurse Practitioners in Women's Health, Washington, DC (S.M.K.)
| | - Maureen Phipps
- Women and Infants Hospital of Rhode Island, Providence, Rhode Island (M.P.)
| | | | - Diana Ramos
- California Department of Public Health, Sacramento, California (D.R.)
| | - Christopher Zahn
- American College of Obstetricians and Gynecologists, Washington, DC (N.O., J.M.C., C.Z.)
| | - Amir Qaseem
- American College of Physicians, Philadelphia, Pennsylvania (A.Q.)
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Nelson HD, Cantor A, Pappas M, Miller L. Screening for Urinary Incontinence in Women: A Systematic Review for the Women's Preventive Services Initiative. Ann Intern Med 2018; 169:311-319. [PMID: 30105353 DOI: 10.7326/m18-0225] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Urinary incontinence is infrequently addressed during routine health care despite its high prevalence and adverse effects on health. PURPOSE To evaluate whether screening for urinary incontinence in women not previously diagnosed improves outcomes (symptoms, quality of life, and function) and to evaluate the accuracy of screening methods and potential harms of screening. DATA SOURCES English-language searches of Ovid MEDLINE, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews (1 January 1996 to 30 March 2018); ClinicalTrials.gov (April 2018); and reference lists of studies and reviews. STUDY SELECTION Randomized trials, cohort studies, systematic reviews of studies that enrolled nonpregnant women without previously diagnosed urinary incontinence and compared clinical outcomes and adverse effects between women who were and were not screened, and diagnostic accuracy studies that reported performance measures of screening tests. DATA EXTRACTION Dual extraction and quality assessment of individual studies. DATA SYNTHESIS No studies evaluated the overall effectiveness or harms of screening. Seventeen studies evaluated the diagnostic accuracy of 18 screening questionnaires against a clinical diagnosis or results of diagnostic tests. Of these, 14 poor-quality studies were based in referral clinics, enrolled only symptomatic women, or had other limitations. One good-quality and 2 fair-quality studies (evaluating 4 methods) enrolled women not recruited on the basis of symptoms. Areas under the receiver-operating characteristic curve for stress, urge, and any type of incontinence in these studies were 0.79, 0.88, and 0.88 for the Michigan Incontinence Symptom Index; 0.85, 0.83, and 0.87 for the Bladder Control Self-Assessment Questionnaire; and 0.68, 0.82, and 0.75 for the Overactive Bladder Awareness Tool. The Incontinence Screening Questionnaire had a sensitivity of 66% and specificity of 80% for any type of incontinence. LIMITATION Studies enrolled few participants, often from symptomatic referral populations; used various reference standards; and infrequently reported CIs. CONCLUSION Evidence is insufficient on the overall effectiveness and harms of screening for urinary incontinence in women. Limited evidence in general populations suggests fairly high accuracy for some screening methods. PRIMARY FUNDING SOURCE Health Resources and Services Administration.
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Affiliation(s)
- Heidi D Nelson
- Oregon Health & Science University, Portland, Oregon (H.D.N., A.C., M.P., L.M.)
| | - Amy Cantor
- Oregon Health & Science University, Portland, Oregon (H.D.N., A.C., M.P., L.M.)
| | - Miranda Pappas
- Oregon Health & Science University, Portland, Oregon (H.D.N., A.C., M.P., L.M.)
| | - Liev Miller
- Oregon Health & Science University, Portland, Oregon (H.D.N., A.C., M.P., L.M.)
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LI R, Song Y, Ma M. Relationship between levator ani and bony pelvis morphology and clinical grade of prolapse in women. Clin Anat 2015; 28:813-9. [DOI: 10.1002/ca.22536] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Revised: 02/22/2015] [Accepted: 02/22/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Ran LI
- Department of Obstetrics and Gynecology; Fuzong Clinical College of Fujian Medical University; Fuzhou Fujian 350025 China
| | - Yanfeng Song
- Department of Obstetrics and Gynecology; Fuzong Clinical College of Fujian Medical University; Fuzhou Fujian 350025 China
| | - Ming Ma
- Department of Radiology; Fuzhou General Hospital; Fuzhou Fujian 350025 China
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Improving the clinical prediction of detrusor overactivity by utilizing additional symptoms and signs to overactive bladder symptoms alone. Int Urogynecol J 2014; 25:1115-20. [DOI: 10.1007/s00192-014-2362-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 02/19/2014] [Indexed: 10/25/2022]
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Townsend MK, Curhan GC, Resnick NM, Grodstein F. The incidence of urinary incontinence across Asian, black, and white women in the United States. Am J Obstet Gynecol 2010; 202:378.e1-7. [PMID: 20042169 PMCID: PMC2847676 DOI: 10.1016/j.ajog.2009.11.021] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2009] [Revised: 08/31/2009] [Accepted: 11/09/2009] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We calculated incidence rates of urinary incontinence by incontinence frequency and type over 4 years in Asian, black, and white women in the United States. STUDY DESIGN Prospective analyses included 76,724 participants aged 37-79 years in the Nurses' Health Study cohorts with no incontinence at baseline. RESULTS The 4-year incidence of incontinence at least monthly was higher in white women (7.3/100 person-years) compared with Asian (5.7/100 person-years; P = .003) and black women (4.8/100 person-years; P < .001). The incidence of at least weekly stress incontinence was significantly lower in black compared with white women (0.1 vs 0.8 per 100 person-years; P < .001). The difference between black and white women in the incidence of any incontinence and stress incontinence remained significant after adjusting for known risk factors (P < .001 for both). CONCLUSION Urinary incontinence incidence differs by race. Studies to confirm these results and better understand underlying mechanisms are needed.
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Affiliation(s)
- Mary K Townsend
- Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
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The prevalence of pelvic organ prolapse symptoms and signs and their relation with bladder and bowel disorders in a general female population. Int Urogynecol J 2009; 20:1037-45. [PMID: 19444368 PMCID: PMC2721135 DOI: 10.1007/s00192-009-0902-1] [Citation(s) in RCA: 155] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2008] [Accepted: 04/21/2009] [Indexed: 12/03/2022]
Abstract
Introduction and hypothesis In selected populations, pelvic organ prolapse (POP) was associated with bladder/bowel symptoms, but data on the general female population are lacking. Our aim was to obtain normative data on the prevalence of POP and pelvic floor dysfunction (PFD) symptoms and signs and to identify associations. Methods Validated questionnaires on POP and PFD (urogenital distress inventory, (UDI) and defaecation distress inventory (DDI)) were sent to a general population of 2,979 women (aged 45–85 years). Data were analysed using the Kruskal–Wallis test, chi square test and Spearman’s rank correlation coefficient. Results Response rate was 62.7%. Associations between POP stage and parity (0.002) and vaginal bulging (<0.001) are significant. Anatomical locations of POP and PFD symptoms correlated significantly with incontinence of flatus, feeling anal prolapse, manual evacuation of stool, vaginal bulging, constipation and pain during faecal urge (p ≤ 0.005). Conclusions Strategies should be developed to alleviate obstructive bowel disorders associated with POP.
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Andersson G, Johansson JE, Nilsson K, Sahlberg-Blom E. Perceptions of Urinary Incontinence Among Syrian Christian Women Living in Sweden. J Transcult Nurs 2009; 20:296-303. [DOI: 10.1177/1043659609334850] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose: The purpose of this study was to describe the perception of urinary incontinence (UI) among Syrian women living in Sweden. Design: A qualitative, descriptive design with focus group discussions (FGDs) was used and analyzed with content analysis. Fourteen Syrian women were interviewed in three FGDs. Findings: Three categories emerged, “Thoughts on UI,” “Managing UI,” and “Communication With the Health Care System.” Among the interviewees, UI was a common, and expected, problem, which could be managed. However, some expressed shame and embarrassment. Some talked about communication problems with health care. Discussion and Implications for Practice: The health care system should be adjusted to the women's needs, with awareness of the communication difficulties, which could result in misunderstanding and neglected treatments.
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Sears CLG, Wright J, O'Brien J, Jezior JR, Hernandez SL, Albright TS, Siddique S, Fischer JR. The Racial Distribution of Female Pelvic Floor Disorders in an Equal Access Health Care System. J Urol 2009; 181:187-92. [DOI: 10.1016/j.juro.2008.09.035] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2008] [Indexed: 11/28/2022]
Affiliation(s)
- Christine L. Gray Sears
- National Institutes of Health/National Capital Consortium Fellowship Program, Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Walter Reed Army Medical Center, Washington, D. C
- Department of Urology, Walter Reed Army Medical Center, Washington, D. C
| | - Johnnie Wright
- National Institutes of Health/National Capital Consortium Fellowship Program, Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Walter Reed Army Medical Center, Washington, D. C
| | - Jennie O'Brien
- National Institutes of Health/National Capital Consortium Fellowship Program, Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Walter Reed Army Medical Center, Washington, D. C
| | - James R. Jezior
- Department of Urology, Walter Reed Army Medical Center, Washington, D. C
| | - Sandra L. Hernandez
- National Institutes of Health/National Capital Consortium Fellowship Program, Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Walter Reed Army Medical Center, Washington, D. C
| | | | - Sohail Siddique
- National Institutes of Health/National Capital Consortium Fellowship Program, Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Walter Reed Army Medical Center, Washington, D. C
| | - John R. Fischer
- National Institutes of Health/National Capital Consortium Fellowship Program, Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Walter Reed Army Medical Center, Washington, D. C
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Tseng LH, Liang CC, Tsay PK, Wang AC, Lo TS, Lin YH. Factors Affecting Voiding Function in Urogynecology Patients. Taiwan J Obstet Gynecol 2008; 47:417-21. [DOI: 10.1016/s1028-4559(09)60009-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Fenner DE, Trowbridge ER, Patel DL, Fultz NH, Miller JM, Howard D, DeLancey JOL. Establishing the prevalence of incontinence study: racial differences in women's patterns of urinary incontinence. J Urol 2008; 179:1455-60. [PMID: 18295278 PMCID: PMC2879624 DOI: 10.1016/j.juro.2007.11.051] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2007] [Indexed: 10/22/2022]
Abstract
PURPOSE We examine racial differences in urinary incontinence prevalence, frequency, quantity, type, and risk factors in a population based sample of community dwelling black and white women. MATERIALS AND METHODS Women 35 to 64 years old were sampled from telephone records from 3 southeast Michigan counties. Women self-identifying as black or white race completed a telephone interview that assessed demographics, health history, lifestyle factors and urinary incontinence experience. Statistical analysis included descriptive statistics, factor analysis and multivariable logistic regression to determine adjusted odds of urinary incontinence. Estimates were weighted to reflect probability and nonresponse characteristics of the sample, and to increase generalizability of the findings. RESULTS Interviews were completed by 1,922 black and 892 white women (response rate = 69%). The overall prevalence of urinary incontinence was 26.5%. By race, urinary incontinence prevalence was 14.6% for black women and 33.1% for white women (p <0.001). Among incontinent women there was no difference by race in the frequency of urinary incontinence. However, black women reported more urine loss per episode (p <0.05). A larger proportion of white women with incontinence (39.2%) reported symptoms of pure stress incontinence compared to black women (25.0%), whereas a larger proportion of black women (23.8%) reported symptoms of pure urge incontinence compared to white women (11.0%). Risk factors for urinary incontinence were generally similar for white and black women. CONCLUSIONS In this population based study we observed racial differences in prevalence, quantity and type of urinary incontinence. Frequency of and risk factors for urinary incontinence were generally similar for white and black women.
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Affiliation(s)
- Dee E. Fenner
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
- Pelvic Floor Research Group, University of Michigan, Ann Arbor, Michigan, USA
| | - Elisa R. Trowbridge
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
- Pelvic Floor Research Group, University of Michigan, Ann Arbor, Michigan, USA
| | - Divya L. Patel
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
- Pelvic Floor Research Group, University of Michigan, Ann Arbor, Michigan, USA
| | - Nancy H. Fultz
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
- Pelvic Floor Research Group, University of Michigan, Ann Arbor, Michigan, USA
| | - Janis M. Miller
- School of Nursing, University of Michigan, Ann Arbor, Michigan, USA
- Pelvic Floor Research Group, University of Michigan, Ann Arbor, Michigan, USA
| | | | - John O. L. DeLancey
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
- Pelvic Floor Research Group, University of Michigan, Ann Arbor, Michigan, USA
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Downing KT, Hoyte LP, Warfield SK, Weidner AC. Racial differences in pelvic floor muscle thickness in asymptomatic nulliparas as seen on magnetic resonance imaging-based three-dimensional color thickness mapping. Am J Obstet Gynecol 2007; 197:625.e1-4. [PMID: 18060955 DOI: 10.1016/j.ajog.2007.08.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2007] [Revised: 05/05/2007] [Accepted: 08/06/2007] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The objective of the study was to compare levator and obturator thickness between asymptomatic black and white nulliparas using three-dimensional (3D) magnetic resonance imaging (MRI) color mapping. STUDY DESIGN 3D color-mapped MRI of pelvic muscles were evaluated in 22 similar nulliparas (12 black, 10 white). Levator and obturator (OI) were divided into right and left. Levator was subdivided into puborectalis (PR) and ileococcygeus (IC) portions. Maximal thickness of each muscle was recorded and compared between groups. Nonparametric testing was applied, with significance at P = .05. RESULTS Levator thickness was significantly greater in blacks bilaterally (median right PR, 8.5 vs 6.0 mm; P = .001; right IC, 6.5 vs 4.5 mm; P = .002; left PR, 9.5 vs 5.75 mm; P = .0002; left IC, 6.5 vs 5.75 mm; P = .02). Obturator thicknesses were similar (right OI, 20.0 vs 19.5 mm; left OI, 19.25 vs 19.25 mm; P = NS). CONCLUSION Significantly thicker levators but similar obturators were seen in black nulliparas, compared with white nulliparas. These levator differences may influence pelvic floor dysfunction risk. The clinical significance of these findings is under study.
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Affiliation(s)
- Keith T Downing
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Lewis JB, Ng AV, O'Connor RC, Guralnick ML. Are there differences between women with urge predominant and stress predominant mixed urinary incontinence? Neurourol Urodyn 2007; 26:204-7. [PMID: 17078089 DOI: 10.1002/nau.20359] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE We sought to determine if there are differences in clinical and urodynamic parameters between women with urge predominant and those with stress predominant mixed urinary incontinence (MUI). METHODS Charts of 99 female patients with complaints of MUI were reviewed. Patients were divided into two groups based on the subjective predominance of either stress incontinence (MSUI) or urge incontinence (MUUI). All patients completed a subjective evaluation including an AUA Symptom Index, Urogenital Distress Inventory (UDI-6), and Incontinence Impact Questionnaire (IIQ-7). Objective non-invasive measures included physical exam, 48-hr voiding diary, and a 24-hr pad test. Videourodynamics studies (VUDS), performed in all patients, were reviewed and the presence and characteristics of detrusor overactivity (DO) and stress incontinence were noted. RESULTS There were no significant differences between groups with respect to symptom scores. MUUI patients had significantly higher pad usage, and lower maximum and average voided volumes than MSUI patients. They were also more likely to have lower urodynamic bladder capacities and demonstrable DO (70% vs. 26%) on VUDS with contractions occurring at lower bladder volumes and with higher amplitude. MSUI patients were more likely to have demonstrable SUI on physical examination (63% vs. 16%) and on VUDS (100% vs. 61%). CONCLUSIONS There do appear to be differences in clinical and urodynamic parameters between patients with stress predominant and urge predominant MUI. These may help to determine which component of the mixed incontinence is more problematic.
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Affiliation(s)
- Jack B Lewis
- Department of Urology, Medical College of Wisconsin, 9200 W. Wisconsin Avenue, Milwaukee, WI 53226, USA
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Huang AJ, Brown JS, Thom DH, Fink HA, Yaffe K. Urinary incontinence in older community-dwelling women: the role of cognitive and physical function decline. Obstet Gynecol 2007; 109:909-16. [PMID: 17400853 DOI: 10.1097/01.aog.0000258277.01497.4b] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To examine the association between cognitive decline, physical function decline, and urinary incontinence in older community-dwelling women. METHODS This was an observational study of 6,361 community-dwelling women aged 65 years and older participating in the Study of Osteoporotic Fractures. Clinical frequency and functional disruptiveness of incontinence were assessed by self-report questionnaires. Cognitive function was assessed at visits using the modified Mini-Mental State Examination, Trails B test, and Digit Symbol Substitution Test. Physical function was assessed by measuring walking speed over a 6-meter course and time needed to complete five chair stands. Women were considered to have recent, significant decline in cognitive or physical function if their cognitive or physical performance declined by greater than 1 standard deviation beyond the mean decline in the 6 years preceding assessment of incontinence. RESULTS Women with recent physical function decline were more likely to report weekly incontinence (odds ratio [OR] 1.31, 95% confidence interval [CI] 1.09-1.56 for walking speed decline; OR 1.40, 95% CI 1.19-1.64 for chair stand decline), after adjusting for multiple characteristics. Women with recent cognitive decline were more likely to report incontinence that interfered with activities (OR 1.55, 95% CI 1.10-2.17 for modified Mini-Mental State Examination decline; OR 1.53, 95% CI 1.01-2.31 for Digit Symbol Substitution Test decline), after adjusting for multiple characteristics. CONCLUSION Both cognitive and physical function decline are likely important contributors to incontinence in community-dwelling women aged 65 years and older. Although cognitive decline may not be associated with greater frequency of incontinence, women with cognitive decline may have more difficulty coping with incontinence symptoms. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Alison J Huang
- Veterans Affairs Medical Center, San Francisco, and University of California San Francisco, San Francisco, California 94121, USA.
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Hollard AL, Wing DA, Chung JH, Rumney PJ, Saul L, Nageotte MP, Lagrew D. Ethnic disparity in the success of vaginal birth after cesarean delivery. J Matern Fetal Neonatal Med 2007; 19:483-7. [PMID: 16966113 DOI: 10.1080/14767050600847809] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To estimate whether maternal race/ethnicity is independently associated with successful vaginal birth after cesarean delivery (VBAC). STUDY DESIGN A retrospective cohort study from January 1, 1997 to July 30, 2002 of women with singleton pregnancies and a previous cesarean delivery. The odds ratio (OR) for successful VBAC as a function of ethnicity was corrected for age >35 years, parity, weight gain, diabetes mellitus, hospital site, prenatal care provider, gestational age, induction, labor augmentation, epidural analgesia, and birth weight >4000 g. RESULTS Among 54 146 births, 8030 (14.8%) occurred in women with previous cesarean deliveries. The trials of labor rates were similar among Caucasian (46.6%), Hispanic (45.4%), and African American (46.0%) women. However, there was a significant difference among ethnic groups for VBAC success rates (79.3% vs. 79.3% vs. 70.0%, respectively). When compared to Caucasian women, the adjusted OR for VBAC success was 0.37 (95% confidence interval (CI) 0.27-0.50) for African American women and 0.63 (95% CI 0.51-0.79) for Hispanic women. CONCLUSION African American and Hispanic women are significantly less likely than Caucasian women to achieve successful VBAC.
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Affiliation(s)
- Amie L Hollard
- Division of Maternal-Fetal Medicine, Women's Hospital, Long Beach Memorial Medical Center, Long Beach, CA, USA
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Hoyte L, Thomas J, Foster RT, Shott S, Jakab M, Weidner AC. Racial differences in pelvic morphology among asymptomatic nulliparous women as seen on three-dimensional magnetic resonance images. Am J Obstet Gynecol 2005; 193:2035-40. [PMID: 16325611 DOI: 10.1016/j.ajog.2005.06.060] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2005] [Revised: 05/15/2005] [Accepted: 06/14/2005] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Compare pelvic morphology between asymptomatic African-American and white nulliparous women. STUDY DESIGN Resting supine T2-weighted magnetic resonance (MR) images were obtained in 12 African-American (AA) and 10 white American (WA) women without pelvic floor dysfunction. Three-dimensional models were reconstructed from the MR images by a masked investigator, and predefined bony and soft tissue pelvic floor parameters were measured and compared. Nonparametric statistics were used, with significance considered at P < .05. RESULTS Subjects were similar in age and body mass index. Levator ani volume was significantly greater in the AA versus the WA group (mean = 26.8 vs 19.8 cm3, P = .002). The levator-symphysis gap was smaller in the AA (left-18.2, right-18.8 mm) versus the WA group (22.4, 22.6 mm, P = .003, .048) on the left and right. Significant differences were seen in bladder neck position, urethral angle, and the pubic arch angle. CONCLUSION The increased muscle bulk and closer puborectalis attachment seen among the African-American nulliparous women may impact the development of pelvic floor dysfunction. These findings need further study.
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Hopkins LM, Caughey AB, Glidden DV, Laros RK. Racial/ethnic differences in perineal, vaginal and cervical lacerations. Am J Obstet Gynecol 2005; 193:455-9. [PMID: 16098870 DOI: 10.1016/j.ajog.2004.12.007] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2004] [Revised: 11/22/2004] [Accepted: 12/02/2004] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine if variation exists between ethnicities for risk of perineal, vaginal, and cervical laceration at vaginal delivery. STUDY DESIGN Retrospective cohort study of nulliparous women who underwent vaginal delivery of a vertex presentation. Predictor variable was ethnicity with outcome variables cervical, vaginal, and second-, third-, or fourth-degree perineal laceration. Logistic regression analysis was conducted to control for confounders. RESULTS Of the 17,216 who met criteria, Filipino (OR = 1.92, 95% CI 1.64-2.25) and Chinese (OR = 1.60, 95% CI 1.33-1.92) women were at greatest risk for third- and fourth-degree laceration. Only Filipino (OR = 1.32, 95% CI 1.10-1.57) and other Asian (OR = 1.23, 95% CI 1.08-1.41) women were at slightly increased risk of vaginal laceration. No differences were seen for cervical laceration. CONCLUSION Different ethnicities are at widely varying risk of perineal laceration, but little difference exists for vaginal or cervical lacerations. Research into the mechanisms behind this should investigate differences in perineal anatomy.
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Affiliation(s)
- Linda M Hopkins
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA.
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Teo REC, Yisa S, Mayne C, Tincello D. A comparison of urodynamic diagnoses and detrusor muscle function in white and South Indian Asian women. J Urol 2005; 174:184-6. [PMID: 15947623 DOI: 10.1097/01.ju.0000162074.42692.c7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We compared urodynamic data and the final diagnosis after testing between white and Asian women investigated for urinary incontinence. MATERIALS AND METHODS Urodynamic traces of consecutive women investigated between January 2002 and December 2003 were reviewed. Urodynamic diagnoses were classified as normal, urodynamic stress incontinence, detrusor overactivity (DOA) or mixed incontinence. In DOA cases the amplitude and number of detrusor contractions, and the volume at which the first involuntary contraction occurred were recorded. Data were compared by ethnic group. RESULTS The distribution of diagnoses was significantly different between Asian and white women (p <0.0001). In Asian and white women we noted urodynamic stress incontinence in 22% and 53% (OR 0.24, 95% CI 0.13 to 0.48), DOA in 28% and 17% (OR 1.88, 95% CI 0.98 to 3.60) and mixed incontinence in 22% and 7% (OR 3.74, 95% CI 1.70 to 8.22), respectively. Post-void residual volume (p = 0.02), volume at strong desire to void (p = 0.03) and cystometric capacity (p = 0.0002) were lower in Asian women. In those with DOA the first contraction occurred at a lower volume in Asian woman (57 vs 179 ml, p = 0.002). Asian women had more contractions (5 vs 3, p = 0.009) with higher maximum (50 vs 32 cm H2O, p = 0.004) and average (34.4 vs 25.3 cm H2O, p = 0.03) detrusor pressure. CONCLUSIONS In women who undergo urodynamics a greater proportion of Asian women have DOA and mixed incontinence compared with white women. Functional differences in detrusor contraction pressures exist, which may suggest a fundamental difference in bladder function or disease etiology. Exploration of this theory requires further study.
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Affiliation(s)
- Roderick Eng Chee Teo
- Women's and Perinatal Services, Leiscester General Hospital, Leicester, United Kingdom.
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Yip SK, Chan A, Pang S, Leung P, Tang C, Shek D, Chung T. The impact of urodynamic stress incontinence and detrusor overactivity on marital relationship and sexual function. Am J Obstet Gynecol 2003; 188:1244-8. [PMID: 12748492 DOI: 10.1067/mob.2003.273] [Citation(s) in RCA: 100] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE We assessed and compared the quality of life, marital relationship, and sexual function of women who had urodynamic stress incontinence (USI) or detrusor overactivity (DO) diagnosed. STUDY DESIGN Women with the following urodynamic diagnoses, normal, USI, or DO, were compared by using the psychometric questionnaires: King's Health Questionnaire (KHQ, for quality of life), Dyadic Adjustment Scale (DAS, for marital relationship), and Derogatis Sexual Functioning Inventory (DSFI, for sexual function). RESULTS Women with DO (n = 29) were younger than healthy women (n = 28) and women with USI (n = 36) (P <.05). Women with USI or DO had a poorer quality of life (P <.05), poorer marital relationship (P <.05), and less sexual satisfaction (P <.05), despite having no change in sexual drive (P >.05). Regression analyses showed that only sexual satisfaction and incontinence-related emotions were associated with marital relationship (P <.05). CONCLUSION Marital relationship and sexual function were negatively affected in women who had USI or DO.
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Affiliation(s)
- Shing-Kai Yip
- Department of Obstetrics and Gynaecology, Chinese University of Hong Kong, Shatin, Hong Kong, ROC
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