Stress urinary incontinence in younger women in primary care: prevalence and opportunistic intervention

Improving the Accuracy of a Wearable Uroflowmeter for Incontinence Monitoring Under Dynamic Conditions: Leveraging Machine Learning Methods

Urinary incontinence affects many women, yet there are no monitoring devices capable of accurately capturing flow dynamics during everyday activities. Building on our initial development of a wearable personal uroflowmeter, this study enhances the device's performance under realistic, dynamic conditions similar to those encountered in daily living. We integrated an optimized eight-vane Etoile flow conditioner with a 0.2D opening into the device. Both computational fluid dynamics simulations and experimental tests demonstrated that this flow conditioner significantly reduced turbulence intensity by 82% and stabilized the axial velocity profile by 67%, increasing the R2 of flow rate measurements from 0.44 to 0.92. Furthermore, our machine learning framework-utilizing a support vector machine (SVM) and an extreme gradient boosting (XGBoost) model with principal component analysis (PCA)-accurately predicted the true flow rate with high correlations, robust performance, and minimal overfitting. For the test dataset, the SVM achieved a correlation of 0.86, an R2 of 0.74, and an MAE of 2.8, whereas the XGBoost-PCA model exhibited slightly stronger performance, with a correlation of 0.88, an R2 of 0.76, and an MAE of 2.6. These advances established a solid foundation for developing a reliable, wearable uroflowmeter capable of effectively monitoring urinary incontinence in real-world settings.

Innovative decision making tools using discrete mathematics for stress urinary incontinence treatment

In this study, we applied graph theory to clinical decision-making for Stress Urinary Incontinence (SUI) treatment. Utilizing discrete mathematics, we developed a system to visually understand the shortest path to the desired treatment outcomes by considering various patient variables. Focusing on women aged 35-50, we examined the effectiveness of Tension-free Vaginal Tape (TVT) surgery and Vaginal Erbium Laser (VEL) treatment for over 15 years. The TVT group consisted of 102 patients who underwent surgery using either the Advantage Fit mid-urethral sling system (Boston Scientific Co., MA, USA) or the GYNECARE TVT retropubic system (Ethicon Inc., NJ, USA). The VEL group included 113 patients treated with a non-ablative Erbium: YAG laser (FotonaSmooth™ XS; Fotona d.o.o., Ljubljana, Slovenia), and there were 112 patients in the control group. We constructed a network diagram analyzing the correlations between health, demographic factors, treatment methods, and patient outcomes. By calculating the shortest path using heuristic functions, we identified significant correlations and treatment effects. This approach supports patient decision making by choosing between TVT and VEL treatments based on individual objectives. Our findings provide new insights into SUI treatment, highlighting the value of a data-driven personalized approach for clinical decision-making. This interdisciplinary study bridges the gap between mathematics and medicine, demonstrating the importance of a data-centric approach in clinical decisions.

A mixed methods systematic literature review of barriers and facilitators to help-seeking among women with stigmatised pelvic health symptoms

BACKGROUND

Women's pelvic health is a globally important subject, included in international and United Kingdom health policies, emphasising the importance of improving information and access to pelvic health services. Consequences of pelvic symptoms are intimate, personal, and varied, often causing embarrassment and shame, affecting women's quality of life and wellbeing.

AIM

To understand the experience of seeking healthcare for stigmatised pelvic health symptoms by synthesising all types of published primary research and mapping the results to behavioural theory, to identify potential targets for intervention.

METHODS

Systematic search of MEDLINE, CINAHL, PsycINFO, SocINDEX, PubMED databases, CDSR and CENTRAL registers, from inception to May 2023 for all types of research capturing women's views and experiences of seeking help with stigmatised urogenital and bowel symptoms. Studies only reporting prevalence, predictors of help-seeking, non-health related help-seeking, or written in languages other than English, German, French, Spanish and Swedish were excluded. Reference checking and forward citation searching for all included studies was performed. A results-based synthesis approach was used to integrate quantitative and qualitative data. Themes were mapped to the Common-Sense model and Candidacy framework. The Mixed Methods Appraisal Tool was used for critical appraisal. Grading of Recommendations Assessment, Development and Evaluation - Confidence in Evidence from Reviews of Qualitative research for assessing certainty of review findings.

RESULTS

86 studies representing over 20,000 women from 24 high income countries were included. Confidence was high that barriers to help-seeking were similar across all study types and pelvic symptoms: stigma, lack of knowledge, women's perception that clinicians dismissed their symptoms, and associated normalising and deprioritising of low bother symptoms. Supportive clinicians and increased knowledge were key facilitators.

CONCLUSIONS

Using the Common-Sense Model to explore women's help-seeking behaviour with stigmatised pelvic symptoms reveals problems with cognitive representation of symptom identity, emotional representations of embarrassment and shame, and a subjective norm that women believe their symptoms will be trivialised by clinicians. Together these barriers frustrate women's identification of their candidacy for healthcare. Addressing these issues through behavioural change interventions for women and clinicians, will help to achieve universal access to pelvic healthcare services (United Nations Sustainable Development Goal 3.7).

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42021256956.

Between-sexes differences in lumbopelvic muscle mechanical properties of non-climacteric adults: a cross-sectional design

The lumbopelvic muscle mechanical properties (MMPs) are clinically relevant, but their dependence on sex remains unknown. Therefore, this study aimed to identify if lumbopelvic MMPs depend on the sex in a young adult population. Thirty-five healthy nulliparous women and 35 healthy men were analyzed (age range: 18-50). Lumbopelvic MMPs, that is, tone, stiffness, elasticity, relaxation and creep, assessed with MyotonPRO®, and pelvic floor (PF) health questionnaires were compared between-sexes. Intra-group correlations between sociodemographic and clinical data, and MMPs were also determined. The MMPs of PF were different between healthy non-climacteric adults of both sexes, with women showing higher values of tone and stiffness and lower values of elasticity and viscoelastic properties than men (in all cases, p < 0.03). At lumbar level, tone and stiffness were higher for men at both sides (in all cases, p < 0.04), and relaxation was lower at left side (p = 0.02). The MMPs showed few correlations with sociodemographic data within women. However, within males, there were positive correlations for PF stiffness and viscoelastic parameters with age, BMI and function (0.334 < r < 0.591) and, at lumbar level, negative correlations for tone and stiffness ( - 0.385 < r < -0.590) and positive correlations for viscoelastic properties (0.564 < r < 0.719), with BMI. This indicated that between-sexes differences of lumbopelvic MMPs depend on the specific location of assessment in healthy non-obese young individuals. Women show higher tone and stiffness and lower elasticity and viscoelasticity than men, at PF level.

Prevalence and Influencing Factors of Help-Seeking Behavior Among Women with Urinary Incontinence: A Systematic Review and Meta-Analysis

Purpose: This systematic review and meta-analysis aimed to investigate the mean (weighted) prevalence of help-seeking behavior among women with urinary incontinence (UI) in relevant subgroups and the related influencing factors. Materials and Methods: Six English and four Chinese databases were systematically searched between 1996 and July 10, 2022. Two researchers independently screened the literature, extracted data, and evaluated the quality of the included studies. All statistical analyses were conducted using RevMan 5.4. Results: The mean (weighted) prevalence of help-seeking behavior based on the 41 included studies, including a total of 32,640 women with UI, was 28% (95% confidence interval [CI]: 22%-34%). We performed a subgroup analysis based on UI type, population, region, publication time, case definition of help-seeking, and use of validated tools to determine UI. The results of the subgroup analysis showed that the pooled prevalence of help-seeking behavior was 23% (95% CI: 14%-32%) among pregnant and maternity women, 27% (95% CI: 19%-35%) among menopausal women, 24% (95% CI: 14%-35%) among 20- to 50-year-old women, 31% (95% CI: 25%-36%) among those older than 50 years, 24% (95% CI: 17%-30%) in Asia, and 33% (95% CI: 22%-44%) in Europe. Meanwhile, the pooled odds ratio showed that education level, UI type, UI severity, and quality of life significantly influenced help-seeking behavior among women with UI. Conclusions: This systematic review revealed that the pooled prevalence of help-seeking behaviors among women with UI is 28%. These influencing factors have important implications for adapting to health care and social care systems.

Current status of stem cell treatments and innovative approaches for stress urinary incontinence

Stem cells are capable of self-renewal, differentiation, and the promotion of the release of chemokines and progenitor cells essential for tissue regeneration. Stem cells have the potential to develop into specialized cells if given the right conditions, to self-renew and maintain themselves, to generate a large number of new differentiated cells if injured, and to either generate new tissues or repair existing ones. In the last decade, it has become clear that treating lower urinary tract dysfunction with the patient's own adult stem cells is an effective, root-cause method. Regenerative medicine is predicated on the idea that a damaged rhabdosphincter can be repaired, leading to enhanced blood flow and improved function of the sphincter's exterior (striated) and internal (smooth) muscles. Stem cell therapy has the potential to cure stress urinary incontinence according to preclinical models. In contrast, stem cell treatment has not been licensed for routine clinical usage. This article reviews the current state of stem cell for stres urinary incontinence research and recommends future avenues to facilitate practical uses of this potential therapy modality.

Morphological and histological changes in the urethra after intraurethral nonablative erbium YAG laser therapy: an experimental study in beagle dogs

The purpose of this study was to investigate the morphological and histological changes in the urethra in beagle dogs after intraurethral Er:YAG laser irradiation in nonablative mode to confirm the safety of this therapy. Six 2-year-old healthy female virgin beagle dogs (13 ± 1.51 kg) were used in this study. The animals were divided into 2 groups: the sham group, which received sham treatment (n = 3) involving insertion of an intraurethral cannula and laser delivery handpiece into the urethra without laser irradiation, and the experimental group (n = 3), which received intraurethral Er:YAG laser irradiation. The laser irradiation parameters were set according to clinical criteria (4 mm spot size, 1.5 J/cm², 1.4 Hz, and 4 pulses) in nonablative mode. All animals received three sequential sessions at 4-week intervals. Urethrography and urethroscopy were performed in the 12th week and 13th week, respectively, after the first treatment. After urethroscopy, the animals were sacrificed, and urethral tissue was harvested for histological investigations. All procedures were performed under general anesthesia (40 mg/kg 3% sodium pentobarbital, i.v.). Transforming growth factor β1 (TGF-β1) and α-smooth muscle actin (α-SMA) expression levels were measured to evaluate the biochemical characteristics of the scar. Urethral stricture was not found by urethrography or urethroscopy in either group. Urethral epithelium thickness and collagen expression under the urethral mucosa were significantly increased in the experimental group compared with the sham group. However, there were no significant differences in TGF-β1 and α-SMA expression between the experimental group and sham group (p > 0.05). Urethral stricture is not found in beagle dogs after clinically relevant intraurethral nonablative mode Er:YAG laser irradiation. Proliferation of urethral collagen and the urethral mucosa may be one of the mechanisms by which urine leakage symptoms can be improved.

Efficacy of Community-based Pelvic Floor Muscle Training to Improve Pelvic Floor Dysfunction in Chinese Perimenopausal Women: A Randomized Controlled Trial

To evaluate the effectiveness of pelvic floor muscle training (PFMT) on perimenopausal women with pelvic floor dysfunction (PFD). A two-group longitudinal experimental design with multiple comparisons. The intervention group (n = 37) received a 3-month intervention combining Kegel and yoga exercise. The control group (n = 37) received Kegel exercise. The combined training alleviated PFD symptoms, improved life quality and increased pelvic floor muscle strength of perimenopausal women. Women with PDF symptoms can integrate PFMT and yoga exercise to promote rehabilitation and improved outcomes. Combined exercise should be taught and practiced under supervision by qualified health professionals.

Urinary incontinence in women: state of the art and medical treatment

INTRODUCTION

Urinary incontinence, the involuntary loss of urine, is a common condition that affects approximately 50% of adult women. This condition increases with age, affecting 10% to 20% of all women and up to 77% of elderly women residing in nursing homes.

EVIDENCE ACQUISITION

Systematic data search performed using PubMed/MEDLINE database up to July 20, 2020. Focus was only for English language publications of original studies on urinary incontinence.

EVIDENCE SYNTHESIS

Given the basis of published evidence and the consensus of European experts, this study provides an updated overview on clinical applications and surgical procedures of urinary incontinence.

CONCLUSIONS

Urinary incontinence is an underestimated health problem. Patients need an overview of their health condition through a detailed anamnestic collection and physical examination to identify the type of incontinence and offer the best treatment.

A feasibility study with a novel, dynamic, and disposable over-the-counter device for the management of stress urinary incontinence

AIMS

This study aimed to evaluate the initial efficacy, safety, and usability of a novel, dynamic, and disposable intravaginal device in women suffering from stress urinary incontinence (SUI).

METHODS

Twenty-six women with SUI were recruited to perform a modified 1-h Pad Weight Gain (PWG) test. In this test, women drank 250-500 ml of water, were given a pre-weighed pad, and asked to perform a set of incontinence-inducing activities. At the end of the activities session, the pad was removed and weighed. This test was performed both with and without the Nolix device. Three efficacy endpoints measured were continuous percent reduction in urine leakage, dryness (defined as pad weight increase by no more than 1 g), and improvement in pad weight (measured as continuous percent reduction in PWG ≥ 50%). Any adverse events, reported by subjects during the device use were recorded. The usability and user's satisfaction were assessed using the Benefit, Satisfaction, and Willingness to Continue and Nolix Satisfaction questionnaires.

RESULTS

The average reduction in PWG was 79.4%. The average reduction in urine leakage while using the device was at least 70%. In addition, in 79.5% of tests, the clinically meaningful level of improvement in PWG was achieved. Use of the device produced substantial improvement in the patient's perceived quality of life. No adverse events were reported during the study.

CONCLUSION

The Nolix device served as a noninvasive, effective, and well-tolerated treatment option for reducing SUI in a modified 1-h PWG test with a set of incontinence-inducing activities.

Urinary incontience after stroke

Normal bladder function is achieved by most in childhood. Stroke affects 15 million people worldwide every year, with incontinence affecting over half these individuals in the initial post-stroke phase. Statistically it has been shown that incontinence can increase the morbidity risk of stroke victims. The social taboo surrounding continence issues has been a challenge for many years with individuals experiencing shame and isolation. This article looks at the normal physiology associated with continence and stroke. It suggests possible treatment options during the post-stroke rehabilitation phase to encourage improved patient experience and professionals' confidence and knowledge base when treating this group of patients.

Factors affecting doctor visits of postmenopausal women with urinary incontinence

OBJECTIVE

This study analyzed the reasons for avoiding visiting a doctor among women aged ≥50 years with urinary incontinence (UI), as well as factors influencing visits to the doctor.

METHODS

In all, 402 women aged ≥50 years who were enrolled in Bursa healthcare centers, 150 with UI and 252 without UI, participated in the study. This study was conducted between January 2018 and August 2018. Participants were asked to complete the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) questionnaire. Quality of life was evaluated using the Incontinence Impact Questionnaire, Short Form (IIQ-7) questionnaire.

RESULTS

The prevalence of UI was 37%. Of the women with UI, 52 (34.67%) visited a doctor for complaints. The most frequent reason for seeing a doctor because of UI was that it had started to affect activities of daily living. The most frequent reason for avoiding visiting a doctor was the belief that UI was normal. Scores on the ICIQ-SF were higher among women who visited a doctor. Physical activity, social relationships, and mental health scores on the IIQ-7 were also higher among patients who visited a doctor.

CONCLUSIONS

Patients who suffer from severe UI and whose quality of life is affected more negatively are more likely to visit a doctor. Women who believe that UI is normal are less likely to visit a doctor. Awareness about UI should be increased in order to increase the rate of visiting a doctor for this condition.

Effectiveness of Physiotherapy Treatment for Urinary Incontinence in Women: A Systematic Review

BACKGROUND

Urinary incontinence (UI) may be defined as involuntary urine loss, which can be diagnosed based on patient-reported measures and is a hygiene and social problem in those who have it, affecting their quality of life negatively.

OBJECTIVE

The study aimed to determine the effectiveness of distinct physiotherapy techniques used in the treatment of UI in women through a systematic review of the existing literature. The scales and instruments used for the assessment and follow-up of UI were described.

METHODS

On searching the PubMed, Dialnet, PEDro, and SciELo databases, 16 articles, with information on 1220 patients that comply with the inclusion criteria and conform to the proposed objectives were obtained, limiting the publication period to 2007-2016. The PRISMA statement was adopted.

RESULTS

The "Pad Test" is a commonly used diagnostic test and bladder diaries on paper; the Oxford scale was used in the assessment of pelvic floor muscle strength. Distinct protocols and techniques have been described in the treatment of UI in women, namely, pelvic floor exercises, vaginal cones, biofeedback, and electrostimulation. Upon analysis of the content of the articles, the quality of the included clinical trials was determined using the PEDro scale.

CONCLUSIONS

Studies included in this work propose that physiotherapy treatment may improve UI, the patients' quality of life, and social relations in women. It is necessary to establish group treatment protocols for women with UI, supervised by a physiotherapist to reduce the financial burden incurred from this health problem.

Prevalence of Stress Urinary Incontinence in Women with Premature Ovarian Insufficiency

Background: To determine the prevalence of stress urinary incontinence (SUI) and associated factors in women with premature ovarian insufficiency (POI). Materials and Methods: The study included 149 patients with POI and 303 control women without POI. Age, body mass index (BMI), gestational history, time since onset of POI, and status of hormone therapy (HT) for POI were recorded. Results: There was no statistical difference in the mean age, BMI, and parity between the two groups. The prevalence of SUI in the POI group tended to be higher than that in the control group (20.9%, 30/149 vs. 16.2%, 49/303), although not significantly (p = 0.297). About 41.6% (62/149) of patients with POI received HT. Patients with POI and SUI were older (p = 0.018) and had higher BMI (p = 0.007) than women with POI without SUI (p = 0.007). Compared to nulliparas, primiparas were more likely to have SUI (p = 0.046). However, SUI developed irrespective of time since onset of oligomenorrhea/amenorrhea or HT use. Furthermore, regression analysis showed that the prevalence of SUI was higher in women 30-39 years of age (odds ratio [OR] = 3.27, p = 0.002) and older than 40 years (OR = 7.78, p = 0.001). Primiparas (OR = 2.89, p = 0.001) and vaginal delivery (OR = 2.58, p = 0.023) were associated with SUI. Conclusions: The prevalence of SUI was fairly high among patients with POI, and age, parity, and vaginal delivery were the main risk factors. However, duration of POI and HT use had no effect on SUI. Increasing awareness of the importance of urinary system health in this population will improve the quality of life for these women.

No incision and tension-free vaginal sling for stress urinary incontinence: The role of knotless barbed suture

Midurethral mesh sling is the most performed incontinence procedure. This hypotheses propose knotless barbed suture could be positioned as a tension-free trans-vaginal sling under the mid-urethra without vaginal incision. Knotless suture sling support and stabilize mid-urethra when intraabdominal pressure increase. This procedure is designed to replace midurethral mesh sling operation, aiming at reducing complications. It is completed in a similar way with retropubic mesh sling procedure, and less invasive. This involve the passage of fine needle from suprapubic skin to midurethral vaginal wall, and knotless suture passing through in fine needle as a U shape. The foundational promises for this hypothesis pertain to two clinical facts: midurethral sling procedure is a gold standard treatment, and the knotless suture offer superior tissue holding or fixation strength originated from the unique barbed design.

What do Cochrane systematic reviews say about non-surgical interventions for urinary incontinence in women?

BACKGROUND

Urinary incontinence is a highly prevalent condition that impacts self-esteem and overall quality of life. Many non-surgical treatment options are available, ranging from pharmacological approaches to pelvic exercises. We aimed to summarize the available evidence regarding these non-surgical interventions.

DESIGN AND SETTING

Review of systematic reviews, conducted in the Discipline of Evidence-Based Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-UNIFESP).

METHODS

A sensitive search was conducted to identify all Cochrane systematic reviews that fulfilled the inclusion criteria. Titles and abstracts were screened by two authors.

RESULTS

We included 20 Cochrane systematic reviews: 4 assessing methods of vesical training, 3 evaluating pharmacological interventions, 4 studying pelvic floor muscle training approaches and 9 aimed at other alternatives (such as urethral injections, weighted vaginal cone use, acupuncture, biostimulation and radiofrequency therapy). The reviews found that the evidence regarding the benefits of these diverse interventions ranged in quality from low to high.

CONCLUSIONS

This review included 20 Cochrane systematic reviews that provided evidence (of diverse quality) for non-pharmacological interventions for patients with urinary incontinence. Moderate to high quality of evidence was found favoring the use of pelvic floor muscle training among women with urinary incontinence. To establish solid conclusions for all the other comparisons, further studies of good methodological quality are needed.

Geriatric Urinary Incontinence

Urinary incontinence (UI) is an international problem, affecting a high percentage of geriatric women. Nurses caring for geriatric women of all ages should be aware of the problem of UI and familiarize themselves with the potential treatment options for these patients. This article focuses on the prevalence, burden, clinical application, and management recommendations for the different types of UI.

Urinary incontinence among Muslim women in Israel: risk factors and help-seeking behavior

INTRODUCTION AND HYPOTHESIS

The prevalence of urinary incontinence (UI) varies among women in different cultures. Muslim women with UI have complex issues related to the need for cleaning (ablution) before prayer. The aim was to assess the prevalence of UI, factors associated with it, its effect on quality of life, and help-seeking behavior among Muslim women.

METHODS

This was a cross-sectional study. Self-administered questionnaires completed by women 18-75 years of age who visited the primary care clinic between 21 June 2015 and 9 October 2015 and additional data collected from their medical records.

RESULTS

A total of 492 women (mean age 31.8 ± 9.5 years) participated in the study. Of these, 43% suffered from UI and 19% from severe to very severe UI. The mean score for interference in daily life (0-10) was 6.3 ± 3.7. Sixty percent of women with UI had stress incontinence, 23% urge incontinence, and 9% mixed incontinence. Only 10% had consulted previously with their physician regarding UI. Increased BMI (OR = 1.048, 95% CI 1.009-1.089) and polygamy (OR = 1.943, 95% CI 1.007-3.749) were associated with severe to very severe UI. Age, parity, and more severe degrees of UI were associated with help-seeking behavior (OR = 1.065 95% CI 1.008-1.125, OR = 0.763 95% CI 0.624-0.934, OR = 4.073 95% CI 1.410-11.765 respectively).

CONCLUSIONS

Urinary incontinence is very common among Muslim women in primary care in southern Israel and significantly impairs their quality of life. Only a small percentage consults with their physician.

Nonbiologic factors that impact management in women with urinary incontinence: review of the literature and findings from a National Institute of Diabetes and Digestive and Kidney Diseases workshop

INTRODUCTION AND HYPOTHESIS

Urinary incontinence (UI)-defined as a complaint of involuntary loss of urine-is common in women, with major public health, financial, and quality of life (QoL) implications. Despite the high toll of UI and the availability of effective conservative treatments, many women with UI do not seek care. Those who do often continue to experience symptoms. Improving UI treatment may require a comprehensive approach to urology research, including a broad set of potentially influential factors beyond biologic.

METHODS

To explore the effects of nonbiologic factors (NBF) on UI management and treatment response, the National Institute of Diabetes and Digestive and Kidney Diseases convened a workshop for clinical and psychosocial researchers. Participants proposed a UI treatment pathway: recognizing the problem, willingness to seek treatment, access to care, receiving quality treatment, engaging in self-management, and adhering to chosen treatments; discussed potential NBFs that may affect the pathway; and identified areas for future research. After the meeting, a rapid literature review was conducted to assess the current state of research on NBFs in women with UI.

RESULTS

Participants identified several patient-level NBFs that may influence the UI management pathway, including QoL and perceived bother; stigma, shame, and embarrassment; knowledge and perceptions; social determinants of health; cultural and language characteristics; personal characteristics and skills; and physical abilities. Additionally, participants acknowledged that provider- and system-level factors also play a role and likely interact with patient-level factors.

CONCLUSIONS

NBFs that potentially affect the UI management pathway are not well understood, and a comprehensive, interdisciplinary approach to research is needed to understand and appropriately support effective UI treatment.

Analysis of the usage of continence pads and help-seeking behavior of women with stress urinary incontinence in Poland

Background

Urinary incontinence (UI) in women is a chronic disorder which has a negative impact on health-related quality of life. Only 45 % of the affected individuals report the problem with continence to their doctor. The aim of the study was to assess the duration of stress urinary incontinence (SUI), time from disease onset to the first medical consultation and in-depth diagnosis, as well as the need for using continence pads in various grades of SUI.

Methods

We conducted a cross-sectional study in women who presented at the urogynecologic ambulatory center and reported urinary incontinence. A total of 420 subjects were interviewed and underwent urogynecologic and urodynamic examinations. A group of 147 patients with urodynamic SUI was enrolled in the study.

Results

All women were graded according to the Stamey severity score: grade 1 – 56 (38.1 %), grade 2 – 68 (46.3 %), and grade 3 – 23 (15.6 %). Mean time elapsed between disease onset and presentation at the urogynecologic ambulatory center was 17.4 ± 11.8 years (grades 1, 2 and 3 for 11.6 ± 11.8, 14.9 ± 10.8, and 22.2 ± 12.1 years, respectively; p = 0.0002). Patients with SUI started perceiving their condition as a problem 4.7 ± 5.4 years before referral to urodynamics; 58.3 % of the SUI patients reported their problems with continence to a physician. Average time between the onset of UI symptoms and seeking medical help was 13.28 ± 12.3 years. Mean duration of using continence pads during the day was 4.2, 5.4 and 10.2 years in grades 1, 2 and 3, respectively (p = 0.0002). The number of patients using continence pads in and outside the home, as compared to outside only, was: grade 1 – 44.6 % vs. 28.6 %, grade 2 – 77.6 % vs. 13.4 %, and grade 3 – 86.4 % vs. 9.1 % (p = 0.004). Mean use of continence pads at night was 3.3, 6.1, and 9.1 years in grades 1, 2 and 3, respectively. The differences were not statistically significant. Protective continence products were used at night by 26.7 % of the SUI patients: 16.1 %, 25 % and 59.1 % in grades 1, 2 and 3, respectively (p = 0.004).

Conclusions

Women with SUI delay seeking medical help for over a decade. The severity of SUI is associated with duration and increased use of continence pads.

Nationwide database of surgical treatment pattern for patients with stress urinary incontinence in Korea

PURPOSE

Nationwide database regarding stress urinary incontinence (SUI) is important for evaluating treatment patterns for SUI and for establishing appropriate national policies regarding SUI management. The purpose of this present study was to investigate surgical treatment patterns for women with SUI and analyze the current status of SUI management in Korea by using a nationwide database.

METHODS

Data used for investigating the surgical trends and changes in Korea were retrieved from the Health Insurance Review & Assessment Service from 2008 to 2011.

RESULTS

The number of surgical cases of SUI decreased continuously from 2008 to 2011. The proportion of transvaginal surgery using a midurethral sling increased continuously. Sling procedures were most commonly performed for women in their 40s followed by women in their 50s. Transvaginal surgery using a single sling or a readjustable sling was performed from 5.6% to 6.1%, which showed no significant change in the number of surgical cases.

CONCLUSIONS

There is a growing need for an appropriate national welfare policy and budget to care for aged and super-aged women in Korea. The early detection and intervention of silent SUI should be actively considered as an important preventive strategy to improve the quality of life in younger women.