Prevalence of urinary incontinence

Stigmatization as a Barrier to Urologic Care: A Review

Heavy societal stigma of certain conditions has created an environment where individuals may be hesitant to seek professional care. Urology is a specialized field that focuses on many of these conditions that society has deemed taboo to discuss. In this review, we address barriers that have prevented patients from seeking urologic care in order to better understand and elucidate important concerns within development of the physician-patient relationship. Recognizing these concerns can also assist in public health outreach approaches to motivate patients for seeking urologic care. The scope of this review was limited to three highly prevalent conditions affecting both men and women, including urinary incontinence, erectile dysfunction, and genitourinary syndrome of menopause.

Urinary incontinence prevalence and factors associated with patients talking with doctors about urine control

Objectives

Patient perceptions of their doctors may influence talking to them about urinary incontinence (UI). We estimated prevalence of UI among Medicare beneficiaries and assessed association between beneficiaries' demographic and clinical characteristics and whether they spoke to their doctor about UI and association between beneficiaries' perceptions of their doctor and whether they spoke to their doctor about UI.

Methods

This study was approved by the Purdue University Institutional Review Board (IRB) and determined exempt, category 4 (protocol number 1907022503, approval on August 5th, 2019). Medicare Current Beneficiary Survey (MCBS) 2016 data were analyzed. Beneficiaries who indicated that they lost urine control 2-3 times a month or above were classified as experiencing UI. An 11-item patient perception of their physician scale was created based on MCBS items. Perceptions were categorized as favorable or unfavorable. SAS version 9.4 for Unix was used for all analyses. PROC LOGISTIC was used to assess multi-variable association between beneficiaries' perceptions of their doctors and talking to their doctor about UI.

Results

Among 7466 persons meeting inclusion criteria, 1856 (24.9%) had UI. The perception of doctor scale scores ranged from 15 to 44, with mean score = 36.57 (standard deviation = 5.29). The scale Cronbach alpha reliability was 0.93. Using sensitivity and receiver operating characteristic analysis, a cutoff of 30 or higher was identified as a favorable perception. Beneficiaries with favorable perceptions of their doctor were more likely to speak to their doctor about experiencing UI than beneficiaries with unfavorable perceptions (odds ratio = 1.55, 95% confidence interval = 1.03 to 2.35, P-value = 0.038).

Conclusion

Overall, the more favorable the perception of their physicians, the more likely beneficiaries were to speak to them about their UI.

Does the climacteric influence the prevalence, incidence and type of urinary incontinence?

Divergent opinions have been reported in the literature regarding the influence of the climacteric on the prevalence, incidence and types of urinary incontinence. In addition, the influence of hormonal therapy in the climacteric (HRT) on the occurrence of urinary incontinence in the perimenopausal period has been the subject of much discussion. This review evaluates the current literature regarding any possible association between the climacteric and the prevalence, incidence and types of urinary incontinence as well as illustrating the possible influence of HRT on urinary incontinence. Urinary incontinence is more common in women than in men and there is evidence to suggest that the prevalence of urinary incontinence in women increases in a linear fashion with age. There is no conclusive evidence to support a specific increase in the prevalence of urinary incontinence at the time of the menopause. Stress urinary incontinence is more common in premenopausal women and urgency urinary incontinence and mixed incontinence are more common in postmenopausal women. Women receiving systemic estrogen, with or without progestogen, are more likely to develop or experience worsening of incontinence.

Multiparity and Aging Impact Chondrogenic and Osteogenic Potential at Symphyseal Enthesis: New Insights into Interpubic Joint Remodeling

Pregnancy and childbirth cause adaptations to the birth canal to allow for delivery and fast recovery. To accommodate delivery through the birth canal, the pubic symphysis undergoes changes that lead to the interpubic ligament (IpL) and enthesis formation in primiparous mice. However, successive deliveries influence joint recovery. We aimed to understand tissue morphology and chondrogenic and osteogenic potential at symphyseal enthesis during pregnancy and postpartum in primiparous and multiparous senescent female mice. Morphological and molecular differences were found at the symphyseal enthesis among the study groups. Despite the apparent incapacity to restore cartilage in multiparous senescent animals, the symphyseal enthesis cells are active. However, these cells have reduced expression of chondrogenic and osteogenic markers and are immersed in densely packed collagen fibers contiguous to the persistent IpL. These findings may indicate alterations of key molecules in the progenitor cell population maintenance of the chondrocytic and osteogenic lineages at the symphyseal enthesis in multiparous senescent animals, possibly compromising the mouse joint histoarchitecture recovery. This sheds light on the distention of the birth canal and the pelvic floor that may play a role in pubic symphysis diastasis (PSD) and pelvic organ prolapse (POP), both in orthopedic and urogynecological practice in women.

Microhematuria in Women Presenting for Overactive Bladder

PURPOSE OF REVIEW

Microscopic hematuria and overactive bladder are two common urologic conditions. The objective of this review is to provide an overview of current literature as well as highlight important guidelines that will aid physicians in the diagnostic workup of microscopic hematuria in patients experiencing symptoms of overactive bladder.

RECENT FINDINGS

Updated microscopic hematuria guidelines provide a structured and appropriate workup for women based on risk factors, which stratifies patients to prevent unnecessary procedures and imaging. Women presenting with microscopic hematuria in the setting of overactive bladder should undergo microscopic hematuria workup according to their risk stratification while receiving appropriate treatment for their overactive bladder. The physician should consider the presence of irritative voiding symptoms during the investigation and management of microscopic hematuria in patients with overactive bladder and should not delay overactive bladder treatment due to the presence of microscopic hematuria.

An epidemiological profile of women suffering from urinary incontinence residing at one of the cities of western India: A mixed method approach study

Introduction

Urinary incontinence (UI), a discomforting condition is predominantly seen in women. Affected women are forced to modify their lifestyles to alleviate symptoms and associated complications.

Objectives

To find the prevalence, determinants and association of UI with Socio-demographic, obstetrical, gynecological and personal history and its impact on quality of life.

Methods

Research was conducted with a mixed method approach (quantitative and qualitative assessment) among women residing in urban slum of Ahmedabad city, India. Sample size calculated was 457. The study was conducted in urban slums served by one of the Urban Health Centre (UHC) of Ahmedabad city. A modified pre-evaluated standard questionnaire developed by International Consultation on Incontinence Questionnaire (ICIQ) was used for quantitative part. Qualitative part consisted of Focused Group Discussions (FGD) which was carried out amongst the women in batches of 5-7 per discussion at the nearest anganwadi center.

Results

Prevalence of UI was found to be 30% among study-participants. A statistical significant relation was seen between the presence of UI and age, marital status, parity, past history of abortion, and occurrence of urinary tract infection (UTI) in last year (P < 0.05). Comparison of severity of UI by calculating ICIQ score showed statistical significant relation of same with age, occupation, literacy, socioeconomic status, and parity (P < 0.05). More than 50% of women suffering from UI were having chronic constipation, reduced daily sleep, and diabetes. Only 7% of the total women suffering from UI had consulted doctor for their problem.

Conclusion

Prevalence of UI was found to be 30% in study participants. Sociodemographic factors like age, marital status and socio-economic class were found to have statistical significant effect on existing UI at the time of interview. ICIQ categories of UI were found to be influenced statistically with age, occupation, literacy, socio-economic classe, parity and obstetric factors like place of delivery and facilitator of delivery. Majority of participants (93%) had never consulted doctor for various reasons/myths like perception that it shall resolve on its' own, Belief that it is an age-related normal phenomenon, shyness to discuss issue with male doctors/members of family and financial reasons.

Risk factors for the development of acute pyelonephritis in women with a positive urine culture

INTRODUCTION

In treating lower urinary tract symptoms (LUTS), the risk of overtreatment with antibiotics must be reconciled with the risk of an untreated urinary tract infection (UTI) progressing to acute pyelonephritis (APN). Using Cerner HealthFacts, a longitudinal clinical informatics database, we aimed to determine risk factors associated with the development of APN from UTI in an effort to guide the initiation of empiric antibiotics.

METHODS

We queried the Cerner HealthFacts database for women over age 18 with a positive urine culture. Any patient with an International Classification of Disease (ICD) code indicating chronic pyelonephritis was excluded. Development of APN within 30 days of the positive culture, specified by ICD coding, was our primary outcome. Patient and facility factors were assessed as potential risk factors for the development of APN using multivariable regression.

RESULTS

Out of 58 344 women with a positive urine culture, 3.9% (2296) developed APN. Mean patient age was 54.4 ± 25.3 years. Overall, 12 variables were predictive for APN and 11 variables were protective against APN. Presence of obstructive and reflux uropathies (OR 4.58), presentation to an acute care facility (OR 3.19), urinary retention (OR 2.30), history of UTI (OR 2.19), and renal comorbidities (OR 2.07) conferred the highest odds of APN development. The most protective variable against APN development was cognitive impairment (OR 0.49).

CONCLUSIONS

Identified risk factors associated with APN development may aid decisions regarding empiric antibiotic initiation for patients presenting with LUTS while awaiting urine culture results. The relationship between cognitive impairment and progression to APN deserves further study.

Efficacy of 3 Tesla Functional Magnetic Stimulation for the Treatment of Female Urinary Incontinence

Functional magnetic stimulation (FMS) is a new technique for the conservative treatment of Urinary incontinence (UI), based on magnetic induction. It induces controlled depolarization of the nerves, resulting in pelvic muscle contraction and sacral S2-S4 roots neuromodulation. The aim of this study was to assess the efficacy of the new 3 Tesla FMS chair, both in patients with pure stress urinary incontinence (SUI) and in women with pure overactive bladder (OAB) symptoms. A prospective observational study was conducted in our urogynaecologic unit. All the patients involved were consecutive women with pure SUI or pure OAB symptoms treated by a 3 Tesla electromagnetic chair. The primary outcome was a subjective outcome evaluation by the PGI-I Scale and a patient-satisfaction scale. The secondary outcome was the change score of the UDI-6, IIQ-7, ICIQ-SF and OAB-q SF questionnaires from baseline to final visit. At 2 months follow-up, 28 out of 60 patients (47%) with SUI symptoms and 20 out of 40 patients (50%) with OAB symptoms declared themselves cured. Considering cured and improved patients, the subjective cure rates were 68.3% (41/60) and 70% (28/40) for patients with SUI and OAB symptoms, respectively. The results of this study showed that the 3 Tesla electromagnetic chair may be an effective option for the treatment of UI.

Prevalence and cost of surgical treatment for female stress urinary incontinence in Brazil: A comparison between abdominal and vaginal approaches

OBJECTIVE

Report the progress of the treatment of female stress urinary incontinence (SUI) in Brazil through vaginal and abdominal approaches and the direct costs by hospitalisation, using DATASUS-a public entity of the Strategic and Participative Management Secretary of Health Ministry, with the responsibility of collecting, processing, and disseminating public health information.

DESIGN

Epidemiological study using the Brazilian Public Health Data Center System (DATASUS).

PARTICIPANTS/MATERIALS, SETTING, AND METHODS

Data were collected on all hospital admissions associated with treatment from 2008 to 2019 from the DATASUS. We analysed the records of hospitalisations associated with an abdominal or vaginal surgical SUI treatment.

RESULTS

The total number of procedures for the treatment of female SUI performed from 2008 to 2019 was 84.378, of which 70 238 were vaginal and 14 140 abdominal. There was an overall decrease in the number of SUI procedures in Brazil over the years analysed (F = 52.72; P < .0001); only exception was the South region (F = 1.38; P = .267). A declining trend was identified for the abdominal approach, with an increased trend of the vaginal approach (F = 170.11; P < .0001). A declining number of hospitalisation days was noted in the vaginal procedures (P = .002). Despite the fact that no differences were noted between abdominal and vaginal expenses (P = .054), hospital expenditure increased over the years for both vaginal and abdominal approaches, with no significant differences between either approaches. However, a statistically significant professional expenditure was observed in the abdominal approach (P < .001). Analysing hospitalisation and professional expenses, the total mean in the period was statistically higher for the abdominal approach (P < .0001).

CONCLUSIONS

The number of procedures to treat female SUI in Brazil has decreased from 2008 to 2019. Total financial expenditure per procedure and length of hospital stay were both higher for the abdominal approach (Burch colposuspension). A preference for a vaginal approach (pubovaginal sling or midurethral sling) has increased significantly since 2008, and our study favours this approach.

Understanding the Sensitive Skin Subject to Achieve a More Holistic Diagnosis

Sensitive skin Syndrome (SSS) is a complex global clinical phenomenon that is defined by the self-reported presence of different sensory perceptions, including tightness, stinging, burning, tingling, pain and pruritus and often without objective signs. Due to the subjective nature of this clinical condition, the diagnosis is complex and there is often a disconnect between what subjects feel and what medical professionals can observe. This chapter reviews the known underlying physiology, some of the triggering factors associated with SSS, co-morbidities as well as the psychological impact on individuals suffering from this condition. The goal is to bridge the gap between the physicians’ understanding and the subjects’ perceptions of this real-life condition that affects so many.

Prevalence and risk factors of urinary incontinence among Iranian women

BACKGROUND

Urinary incontinence is a common condition among women. Although it is not a life-threatening condition, it dramatically influences the quality of life. This study aimed to estimate the prevalence of urinary incontinence and its risk factors among Iranian women in Kerman, Iran.

METHODS

This cross-sectional, population-based study was conducted on 3100 Iranian women aged 15-80 years in 2017 in Kerman, Iran. The participants were selected via cluster sampling and were invited to complete the questionnaires. Their demographic information and medical history were assessed, the urinary incontinence questionnaire was completed, and the associated risk factors were also recorded. Quantitative variables are reported as mean ± SD, while qualitative and ranked variables are expressed in percentage. All analyses were conducted in Stata version 12 (Stata Corp.).

RESULTS

The mean age of the participants was 46 years, and the overall prevalence of urinary incontinence was estimated to be 63%. The highest and lowest prevalence rates of urinary incontinence were reported in the elderly and the youth, respectively (79% and 41%, respectively). Age, increase of body mass index (BMI), pregnancy, diabetes, anxiety, and depression were the associated risk factors.

CONCLUSION

We found that the prevalence of urinary incontinence is high in Iran. Therefore, to control this condition and improve women's quality of life, effective plans are needed.

Urinary incontinence in men with Duchenne and Becker muscular dystrophy

The prevalence of urinary incontinence in Duchenne and Becker muscular dystrophy (D/BMD) is reported to be between 15–29%, this however includes ages across the lifespan, and with no description of impact on daily life. The present study, aimed to determine the prevalence of urinary incontinence in men with D/BMD, and to identify which aspects of daily life were impacted by urinary incontinence. Twenty-seven adult males, 11 with BMD and 16 with DMD, aged 20–57 years, volunteered to participate in this study. Six questionnaires were completed to provide an overview of participant mobility, urinary incontinence and distress caused by urinary incontinence. These included: The Barthel index of disability, International Consultation on Incontinence Questionnaire—Urinary Incontinence Form, Incontinence Impact Questionnaire Short Form, The Urogenital Distress Inventory, and the Brooke and Vignos scale. The prevalence of urinary incontinence within the present men with D/BMD was 37%, assessed as urine leakage of once a week or more. Those with urinary incontinence all reported only a “small amount” of urine leakage, with urinary incontinence frequency of once a week in 5/10 participants, two or three times a week in 2/10 participants, and once a day in 3/10 participants. Of those with urinary incontinence 8/10 experienced some impact on their daily life from urine leakage including travel (4/10), social aspects (5/10), and emotional aspects (8/10). All participants with urinary incontinence were bothered by some aspect, including urine leakage (9/10), and frequent urination (4/10). In conclusion, 37% of the present men with D/BMD experience urinary incontinence on a weekly or daily basis and negatively impacted aspects of life related to travel, social and emotional wellbeing. Urine leakage, and frequent urination should be considered a meaningful problem by care providers, and discussed openly with those with D/BMD.

Three-year follow-up in patients with urinary stress incontinence treated with Altis® single-incision sling

BACKGROUND

The purpose of the study is to report three years follow-up of single incision slings for the treatment of stress urinary incontinence (SUI). The main outcomes are to evaluate the efficacy of the device and to assess safety, adverse events, quality of life, demographic features of treated women and prognostic factors for SUI.

METHODS

We performed a retrospective, double-center, single-arm study. Data were collected by medical records and a telephone interview 3 years after the implant of the mini-sling. Complication rate, subjective efficacy and degree of satisfaction were investigated.

RESULTS

Fifty-four patients were treated between March 2015 and March 2017, of which 47 answered the survey. Forty-one of 47 procedures (87.2%) were considered effective. Among more relevant complications, there was one case of extrusion of mesh and three cases of new onset of urinary disfunction, of which two cases of urgency urinary incontinence (UUI) and one case of de-novo SUI. Most complications were solved within few days after the procedure. Concerning the subjective impression of improvement, investigated by using the Patient Global Impression of Improvement (PGI-I) questionnaires, 41 patients reported subjective satisfaction, three reported no change in quality of life and three patients had worsening of symptoms.

CONCLUSIONS

The procedure was safe and effective for the treatment of SUI but more data are needed to confirm our preliminary results.

Sensitive Skin in the Genital Area

When evaluating sensitive skin, it is common to focus on the face. However, it is becoming increasingly clear that individuals can have different perceptions about the degree of skin sensitivity at distinct anatomic sites. Structural variations in the skin of different body sites can contribute to differences in barrier function, which may contribute to differences in skin sensitivity. Potential triggering factors for skin sensitivity would be expected to vary by body site. For example, the face is exposed to all ambient environmental conditions in the course of daily life, and to several products (e.g., cosmetics for women) and practices (e.g., shaving for men) that may lead to adverse sensations associated with sensitive skin. In contrast, the skin of the genital area is protected from ambient environmental conditions. However, the genital area can be exposed to conditions of higher temperature, different habits and practices and moisture due to the semi-occlusive environment. For some individuals, additional challenges such as incontinence can provide triggering factors for skin sensitivity that effect only the genital area. This article reviews data on the perception of sensitive skin of the genital area, differences based on gender, age, racial differences, and the effects of incontinence on skin sensitivity. The effects of menopause are also considered with regards to sensitive skin perceptions and to emerging differences in biomolecular and physical measures of the urogenital skin.

Injection of Urethral Bulking Agents

Urethral injection is a safe and minimally invasive method of treating female stress urinary incontinence with multiple bulking agents currently commercially available. Although there are numerous studies that demonstrate efficacy, long-term success is not yet proven. This article aims to describe the mechanism of action and properties of various agents, patient selection factors, available techniques for injection, outcomes of urethral injections, and complications associated with the procedure.

Recurrent Urinary Tract Infections in Females and the Overlap with Overactive Bladder

PURPOSE OF REVIEW

There are an estimated 33 million men and women with overactive bladder (OAB) in the USA. Despite the prevalence of OAB, it remains a frequently misdiagnosed condition. OAB has shared symptomatology with other common urologic conditions, namely recurrent urinary tract infections (UTIs). Here, we will review key distinguishing features of OAB that aid in establishing an accurate diagnosis and recent advances in OAB management.

RECENT FINDINGS

Recent studies have shown that among women presenting with lower urinary tract symptoms, the majority were diagnosed with UTIs and treated without performing a urine culture as routine care. The authors found that when urine cultures were obtained, less than half of women had a positive urine culture, suggesting that empiric treatment of UTIs without cultures commonly led to a misdiagnosis of UTI. The symptoms of OAB have overlap with other common conditions, most notably UTI, BPH, and bladder cancer/carcinoma in situ. Despite the shared symptomatology of OAB and UTI, the timing of symptom onset is usually very different between the two. UTI symptoms are generally acute, whereas those of OAB are generally chronic. OAB and UTI share the common features of urgency, frequency, and nocturia. However, dysuria and hematuria are not features of OAB, while they are frequently seen in UTI. Of note, urgency, frequency, and nocturia are rarely seen in bladder cancer/carcinoma in situ; when these symptoms do occur, it is generally in the setting of microhematuria. One study of patients with carcinoma in situ found that 41% had macroscopic hematuria and 44% had microscopic hematuria at presentation. In patients with lower urinary tract symptoms, it is important to perform a urinalysis (UA) to evaluate for microhematuria to rule out the possibility of malignancy. First-line treatment of OAB (outside the setting of UTI) involves behavioral modification, including bladder training, fluid management, and pelvic floor exercises. Numerous studies have supported behavioral modification strategies as the most efficacious initial step in treatment. Although routinely given for recurrent UTIs and vaginal atrophy in postmenopausal women, several review articles have shown that vaginal estrogen is an effective treatment of lower urinary tract symptoms. The importance of distinguishing OAB from other conditions presenting with similar symptoms is key in preventing misdiagnosis, treatment delays, and antibiotic overuse. Here, we have reviewed key parameters distinguishing OAB from UTI, the most commonly misdiagnosed condition among those presenting with lower urinary tract symptoms (LUTS). Given that UTI is the most commonly misdiagnosed condition among women with OAB, we recommend relying on urine cultures and the constellation of acute-onset dysuria, frequency, and urgency as more important diagnostic factors in distinguishing these conditions.

Nonataxia symptoms in Friedreich Ataxia: Report from the Registry of the European Friedreich's Ataxia Consortium for Translational Studies (EFACTS)

OBJECTIVE

To provide a systematic evaluation of the broad clinical variability in Friedreich ataxia (FRDA), a multisystem disorder presenting mainly with afferent ataxia but also a complex phenotype of nonataxia symptoms.

METHODS

From the large database of the European Friedreich's Ataxia Consortium for Translational Studies, 650 patients with genetically confirmed FRDA were included. Detailed data of medical history documentation, questionnaires, and reports on clinical features were analyzed to provide in-depth description of the clinical profile and frequency rates of phenotypical features with a focus on differences between typical-onset and late-onset FRDA. Logistic regression modeling was used to identify predictors for the presence of the most common clinical features.

RESULTS

The most frequent clinical features beyond afferent ataxia were abnormal eye movements (90.5%), scoliosis (73.5%), deformities of the feet (58.8%), urinary dysfunction (42.8%), cardiomyopathy and cardiac hypertrophy (40.3%), followed by decreased visual acuity (36.8%); less frequent features were, among others, depression (14.1%) and diabetes (7.1%). Most of these features were more common in the typical-onset group compared to the late-onset group. Logistic regression models for the presence of these symptoms demonstrated the predictive value of GAA repeat length on the shorter allele and age at onset, but also severity of ataxia signs, sex, and presence of neonatal problems.

CONCLUSIONS

This joint European effort demonstrates the multisystem nature of this neurodegenerative disease encompassing most the central nervous, neuromuscular, cardiologic, and sensory systems. A distinct and deeper knowledge of this rare and chronic disease is highly relevant for clinical practice and designs of clinical trials.

Urinary incontinence and sleep complaints in community dwelling older adults

Sleep disorder is associated with poor quality of life in old age. Therefore, it is imperative to identify contributing factors leading to sleep disorder. The current study aimed to examine the impact of urinary incontinence on sleep complaint after controlling for potential sociodemographic and health covariates. Materials and Methods: A cross-sectional study was conducted on a sample of 184 community dwelling older adults 60 years and older in Yazd, Iran, 2016. In order to obtain the sample a multistage proportional random sampling technique was employed. Sociodemographic characteristics, sleep complaint, and urinary incontinence were collected from medical records. Statistical analyses were performed using SPSS version 24. A multiple logistic regression analysis was used to examine the impact of urinary incontinence on sleep complaint after controlling for potential covariates. Findings: A total of 184 respondents with a mean age of 68.48±6.65 years (age range, 60-87 years) were included in the study. About 70% of the respondents were women, 72.8% were married, 68.5% were not formally educated, and 21.7% were living alone. The prevalence of sleep complaint and urinary incontinence were 27.2% (95% CI: 21-34) and 22.3% (95% CI: 17-29), respectively. The results of the multiple logistic regression analysis revealed respondents with urinary incontinence were four times more likely to suffer from sleep complaint than those without urinary incontinence after adjusting for potential covariates (AOR=4.04, 95% CI: 1.74-9.35, p<0.001). Conclusion: Based on the results of this present study, which showed that urinary incontinence independently contributed to sleep complaint among older adults, it is necessary to employ effective interventions for controlling urinary incontinence to reduce sleep complaints.

Anterior vaginal repair for urinary incontinence in women

BACKGROUND

Anterior vaginal repair (anterior colporrhaphy) is an operation traditionally used for moderate or severe stress urinary incontinence (SUI) in women. About a third of adult women experience urinary incontinence. SUI imposes significant health and economic burden to the society and the women affected.

OBJECTIVES

To determine the effects of anterior vaginal repair (anterior colporrhaphy) on urinary incontinence in comparison with other management options.

SEARCH METHODS

We searched the Cochrane Incontinence Group Specialised Trials Register (searched 1 September 2009) and the reference lists of relevant articles.

SELECTION CRITERIA

Randomised or quasi-randomised trials that included anterior vaginal repair for the treatment of urinary incontinence.

DATA COLLECTION AND ANALYSIS

Two review authors independently extracted data and assessed trial quality. Three trial investigators were contacted for additional information.

MAIN RESULTS

Ten trials were identified which included 385 women having an anterior vaginal repair and 627 who received comparison interventions.A single small trial provided insufficient evidence to assess anterior vaginal repair in comparison with physical therapy. The performance of anterior repair in comparison with bladder neck needle suspension appeared similar (risk ratio (RR) for failure after one year 1.16, 95% confidence interval (CI) 0.86 to 1.56), but clinically important differences could not be confidently ruled out. No trials compared anterior repair with suburethral sling operations or laparoscopic colposuspensions, or compared alternative vaginal operations.Anterior vaginal repair was less effective than open abdominal retropubic suspension based on patient-reported cure rates in eight trials both in the medium term (failure rate within one to five years after anterior repair 97/259 (38%) versus 57/327 (17%); RR 2.29, 95% confidence Interval (CI) 1.70 to 3.08) and in the long term (after five years, (49/128 (38%) versus 31/145 (21%); RR 2.02, 95% CI 1.36 to 3.01). There was evidence from three of these trials that this was reflected in a need for more repeat operations for incontinence (25/107 (23%) versus 4/164 (2%); RR 8.87, 95% CI 3.28 to 23.94). These findings held, irrespective of the co-existence of prolapse (pelvic relaxation). Although fewer women had a prolapse after anterior repair (RR 0.24, 95% CI 0.12 to 0.47), later prolapse operation appeared to be equally common after vaginal (3%) or abdominal (4%) operation.In respect of the type of open abdominal retropubic suspension, most data related to comparisons of anterior vaginal repair with Burch colposuspension. The few data describing comparison of anterior repair with the Marshall-Marchetti-Krantz procedure were consistent with those for Burch colposuspension.

AUTHORS' CONCLUSIONS

There were not enough data to allow comparison of anterior vaginal repair with physical therapy or needle suspension for primary urinary stress incontinence in women. Open abdominal retropubic suspension appeared to be better than anterior vaginal repair judged on subjective cure rates in eight trials, even in women who had prolapse in addition to stress incontinence (six trials). The need for repeat incontinence surgery was also less after the abdominal operation. However, there was not enough information about postoperative complications and morbidity.A Brief Economic Commentary (BEC) identified one study suggesting that vaginoplasty may be more cost-effective compared with tension-free vaginal tape (TVT-O).

A populational-based survey on the prevalence, incidence, and risk factors of urinary incontinence in older adults-results from the "SABE STUDY"

AIMS

To estimate the prevalence and incidence of urinary incontinence (UI) and identify the associated risk factors in a cohort of elderly individuals in Brazil.

METHODS

In 2006, individuals aged ≥60 years were selected from the SABE Study (Health, Well-being, and Aging). The dependent variable was reported UI in 2009. UI was assessed using the International Consultation on Incontinence Questionnaire Urinary Incontinence-Short Form (ICIQ-UI SF). Incidence was measured in units of 1000 person-years, and Cox regression was applied for data analysis. Multivariate analysis was used to assess risk factors for UI. Incidence risk ratio (IRR) was used for comparison.

RESULTS

This is the first study to examine the incidence of UI in Brazilian elderly individuals. In total, 1413 individuals were included; the mean age was 74.5 years, and 864 (61.8%) participants were female. The risk of UI was greater among women with cancer (other than skin) and among those with diabetes. In men, the risk of UI was greater for those in Instrumental Activities of Daily Living (IADL) category "5-8" and those who self-reported a "fair" health status. The prevalence of UI was 14.2% and 28.2% for men and women, respectively. The incidence rate of UI was 25.6 and 39.3 (×1000 person-years) for men and women, respectively.

CONCLUSIONS

The incidence rate of UI among older adults in the Brazilian community was high for elderly individuals. The identified risk factors were diabetes and IADL category 5-8 (women) as well as cancer (other than skin) and self-reported health status (male).

Network mirroring for drug repositioning

Background

Although drug discoveries can provide meaningful insights and significant enhancements in pharmaceutical field, the longevity and cost that it takes can be extensive where the success rate is low. In order to circumvent the problem, there has been increased interest in ‘Drug Repositioning’ where one searches for already approved drugs that have high potential of efficacy when applied to other diseases. To increase the success rate for drug repositioning, one considers stepwise screening and experiments based on biological reactions. Given the amount of drugs and diseases, however, the one-by-one procedure may be time consuming and expensive.

Methods

In this study, we propose a machine learning based approach for efficiently selecting candidate diseases and drugs. We assume that if two diseases are similar, then a drug for one disease can be effective against the other disease too. For the procedure, we first construct two disease networks; one with disease-protein association and the other with disease-drug information. If two networks are dissimilar, in a sense that the edge distribution of a disease node differ, it indicates high potential for repositioning new candidate drugs for that disease. The Kullback-Leibler divergence is employed to measure difference of connections in two constructed disease networks. Lastly, we perform repositioning of drugs to the top 20% ranked diseases.

Results

The results showed that F-measure of the proposed method was 0.75, outperforming 0.5 of greedy searching for the entire diseases. For the utility of the proposed method, it was applied to dementia and verified 75% accuracy for repositioned drugs assuming that there are not any known drugs to be used for dementia.

Conclusion

This research has novelty in that it discovers drugs with high potential of repositioning based on disease networks with the quantitative measure. Through the study, it is expected to produce profound insights for possibility of undiscovered drug repositioning.

Electronic supplementary material

The online version of this article (doi:10.1186/s12911-017-0449-x) contains supplementary material, which is available to authorized users.

Is there an association between back pain and stress incontinence in adults with cystic fibrosis? A retrospective cross-sectional study

BACKGROUND

Back pain and stress urinary incontinence (SUI) are common in adults with cystic fibrosis (CF). This study aimed to establish whether there is an association between back pain, lung function and stress urinary incontinence and its relative risk.

METHOD

This was a cross-sectional, retrospective analysis of the Manchester Musculoskeletal Screening Tool (MMST) data. It includes pain, (Short Form McGill Pain Questionnaire (SF-MPQ and VAS)) and International Consultation on Incontinence Short Form (ICIQ-UI-SF) measures. Associations were tested using Spearman's rank correlation coefficient. Relative risk of developing symptoms was calculated the sig level was p=0.05.

RESULTS

ICIQ-UI-SF was associated with back pain (SF-MPQ) (Rho=0.32, p<0.001) and pain (VAS) (Rho=0.23, p<0.01). RR of developing SUI with back pain was 2; RR of developing back pain with SUI was 1.3.

CONCLUSIONS

An association is indicated between back pain (SF-MPQ and VAS), and SUI in adults with CF. This information is important when developing management strategies in the CF population.

Relationship Between Back Pain and Urinary Incontinence in the Canadian Population

BACKGROUND

Back problems and urinary incontinence (UI) have been found to co-occur more frequently than would be predicted by chance.

OBJECTIVE

The aim of this study was to estimate the associations between UI and back problems in the Canadian men and women.

DESIGN

This was an observational, cross-sectional study.

METHODS

The 2011-2012 Statistics Canada Canadian Community Health Survey (CCHS) provided the data. The CCHS surveyed 125,645 adults, providing a representative sample of the Canadian population. Odds ratios (ORs) and 95% confidence intervals (CIs) were used to quantify the strength of the associations among the variables.

RESULTS

Having UI increased the risk of also having back problems in both men (OR = 2.45; 95% CI = 2.06-2.91) and women (OR = 2.97; 95% CI = 2.64-3.35) compared with not experiencing UI. Among those participants with UI, men and women were at equal risk of experiencing back problems.

LIMITATIONS

The CCHS data are cross-sectional and self-reported, which prevents determining causality and carries a risk of response bias. Also, various diagnoses were grouped under the back problems and UI categories, which makes it difficult to propose possible explanations for this pattern of comorbidity.

CONCLUSIONS

This study provides firm evidence to support clinically observed associations between UI and back problems. The strength of the associations was essentially equal in men and women. These findings reinforce the importance of screening for these frequently coincident conditions.

Urinary incontinence in nulliparous women aged 25-64 years: a national survey

BACKGROUND

A systematic survey of pelvic floor disorders in nulliparous women has not been presented previously.

OBJECTIVE

The purpose of this study was to determine the prevalence of urinary incontinence parameters in a large cohort of nonpregnant, nulliparous women, and thereby construct a reference group for comparisons with parous women.

STUDY DESIGN

This postal and World Wide Web-based questionnaire survey was conducted in 2014. The study population was identified from the Total Population Register in Sweden and comprised women who had not given birth and were aged 25-64 years. Four independent age-stratified, random samples comprising 20,000 women were obtained from the total number of eligible nullipara (n = 625,810). A 40-item questionnaire about pelvic floor symptoms, its severity, and its consequences were used. Age-dependent differences for various aspects of urinary incontinence were analyzed with the youngest group (25-34 years) serving as reference. Crude and body mass index-adjusted prevalence and its 95% confidence limits were calculated for each 10-year category.

RESULTS

The response rate was 52% and the number of study participants was 9197. Urinary incontinence increased >5-fold from 9.7% in the youngest women with a body mass index <25 kg/m² to 48.4% among the oldest women with a body mass index ≥35 kg/m². The prevalence of bothersome urinary incontinence almost tripled from 2.8-7.9% among all nulliparas. The proportion with bothersome urinary incontinence among incontinent women increased from 24.4% in the youngest age group to 32.3% in the age group 55-64 years. Nocturia ≥2/night increased 4-fold to 17.0% and leakage ≥1/wk increased 3-fold to 12.8% among the oldest women. Mixed urinary incontinence increased from 22.9-40.9% among the oldest 0-para with incontinence, whereas stress urinary incontinence decreased inversely from 43.6-33.0%. In the total cohort surgical treatment for urinary incontinence occurred in 3 per thousand.

CONCLUSION

Almost every aspect of urinary incontinence was present in nulliparous women of all ages and prevalence increased with advancing age between 25-64 years. This must be taken into account when using nullipara as a control group in comparisons with parous women to estimate the effect of pregnancy and childbirth.

Urogenital Ageing

Urogenital complaints such as vaginal discomfort, dysuria, dyspareunia, recurrent lower urinary tract infections and urinary incontinence are more common in women after the menopause. Epidemiological studies have demonstrated that more than 50% of postmenopausal women suffer from at least one of these symptoms. They cause not only discomfort, but may also negatively influence sexual health. Many women are so embarrassed that they are unable to discuss their dilemma with other women or their doctor. Embryologically the female genital tract and urinary systems develop in close proximity, both arising from the primitive urogenital sinus. Animal and human studies have shown that the urethra is oestrogen sensitive, and oestrogen receptors have been identified in the urethra, urinary bladder, the vagina and the pelvic floor muscles. There is now a wealth of evidence to support the efficacy of exogenous oestrogens in the treatment of urogenital symptoms caused by postmenopausal ovarian insufficiency.

Clinical trial of incontinence garments: recognition of the possible influence of the Hawthorne effect

The results of clinical trials must be interpreted with care, recognizing that they may be affected by factors other than the items being tested. Different garments were routinely supplied from two distribution centres in Edinburgh, Urocare to the majority of patients in North Lothian and Hygi to those in South Lothian. One hundred patients were recruited and a crossover comparative trial carried out. The response in the two areas was different. Whereas patients in South Lothian found no significant difference between the two garments, those in North Lothian rated the Hygi garment better in terms of comfort (p=0.01), leakage (p<0.001), odour (p=0.01) and avoidance of skin problems (p=0.01). It is suggested that the difference in response may be explained by the Hawthorne effect and this should be taken into account when planning future equipment trials.

Promoting Help-Seeking Behavior for Urinary Incontinence

The authors evaluated the effectiveness of a combined primary care physician education and public awareness campaign about urinary incontinence. The campaign was designed to (a) trig ger help-seeking behavior in older adults with urine leakage problems and (b) encourage pri mary care providers to offer appropriate treatment for urinary incontinence (UI). Outcome measures included datafrom helpline callers and physician surveys before and after the two in terventions. Most callers who later sought care turned to their primary care physician. The me dian estimated number of patients presenting with UI in primary care doctor's offices changed from 9 per month to 11 per month, a change that was not statistically significant. Physicians'op timism for the potential gains from incontinence treatment increased.

The epidemiology of urinary incontinence: a case still open

Urinary incontinence (UI) is a widespread and well-known disorder affecting millions of women all over the world with impressive and probably still underestimated rebounds on personal and social wellbeing. Unfortunately, the available studies on the epidemiology of female UI have used different definitions of UI, obtaining data not homogeneous. In a very recently published article, Bedretdinova et al. have demonstrated that UI definitions and sampling strategies both influence estimates of UI prevalence among women. The ICIQ-UI-SF questionnaire appears to be appropriate for estimating national prevalence in representative samples.

Assessing the dermal compatibility of a new female incontinence product line

CONTEXT

We have developed a line of products designed to better meet the overall needs of women suffering from urinary incontinence. The products are more discrete and contain a unique odor neutralizing technology (ONT).

OBJECTIVE

This paper describes the overall skin compatibility program for this product line in which the new products were compared to negative controls and/or commercially marketed reference products with an established history of safe use.

MATERIALS AND METHODS

Test products consisted of several product forms (light pads/pantiliners, moderate pads, briefs and taped diapers) with ONT and having various degrees of protection. Studies were conducted using standard protocols for 4-day and 21-day cumulative irritation, the Human Repeat Insult Patch Test (HRIPT), and the Behind-the-Knee (BTK) test for mechanical and chemical irritation. In one 4-day irritation study and one HRIPT, test subjects consisted of individuals with self-assessed sensitive skin. In addition, one 4-day study was conducted using normal skin sites, and sites compromised by tape stripping. Nonirritant controls were physiologic saline and/or current, commercially marketed incontinence products. All responses were evaluated by visual scoring of erythema. In addition, in the BTK, transepidermal water loss (TEWL) and adverse sensory effects collected from panelists' daily diaries were also evaluated.

RESULTS AND DISCUSSION

Two 4-day cumulative irritation studies and one 21-day study demonstrated that a wide range of product forms (liners, light and moderate pads, briefs and adult diapers) produced skin reactions similar to the nonirritant controls. The 4-day study conducted using sensitive skin subjects showed good skin compatibility, and the test products were comparable to the nonirritant controls. In the 4-day study with both normal and compromised skin sites, test products produced mean erythema scores similar to the nonirritant controls. Three HRIPT separate studies confirm that the products do not induce contact sensitization, including one study conducted on individuals with self-assessed sensitive skin. In the BTK, test and control products produced similar irritation, as assessed by erythema, TEWL and sensory effects.

CONCLUSION

The results from the patch tests and mechanical irritation test demonstrate good skin compatibility of the new line of products with the unique ONT. In addition, the forms of the product (i.e. liner, pad or brief), were equally compatible with skin.

Frequency and Determinants of Urinary Incontinence in Adolescent and Young Nulliparous Women

STUDY OBJECTIVE

To investigate the rate of urinary incontinence (UI) in a sample of young nulligravid women and its potential risk factors and consequences on life habits.

DESIGN AND PARTICIPANTS

The study is based on an online self-administered questionnaire taken by nulligravid women aged 15 to 25 years.

MEASUREMENTS

The Questionnaire for Urinary Incontinence Diagnosis and part of The King's Health Questionnaire. Demographics and general characteristics are also recorded.

RESULTS

We collected 1936 questionnaires (mean age of participants, 21 years); 12.4% of the sample reported any UI (95% confidence interval [CI] 10.9% to 13.9%). The estimated incidence of UI subtypes was 7.2% (95% CI 6.0% to 8.4%) stress UI, 3.4% (95% CI 2.6% to 4.3%) urge UI, and 1.9% (95% CI 1.3% to 2.6%) mixed UI. Age younger than 19 years and body mass index of 30 kg/m(2) or greater were associated in the multivariate analysis with an increased risk of UI. A self-reported history of psychological disorders increased the risk of UI (adjusted odds ratio [AOR] 1.4 and 95% CI 1.1% to 1.9%), without significant differences among the UI subtypes. A current history of constipation (AOR 1.9 and 95% CI 1.3% to 2.6%) and enuresis after the age of 5 also increased the risk of UI (AOR 2.9 and 95% CI 2.0% to 4.3%).

CONCLUSION

In a sample of young nulligravid women, UI was not associated with any chronic risk factor known for elder age, but a prevention program may be proposed to women because of their young age (eg, educational session to promote the proper functioning of the pelvic floor). More detailed analyses are needed to better assess the prevalence of UI and risk factors in young nulligravid women.

Effect of isostretching on the quality of life of incontinent older women

Abstract Introduction : Urinary incontinence (UI) can be defined as a brief involuntary loss of urine. It is a hygienic and social problem that affects mainly older women and contributes to reduced quality of life (QoL). There are currently several therapeutic strategies available for the treatment of UI, including the method of Isometric Stretching, which is based on balance exercises that lead to greater flexibility and stronger joints, tendons and muscles. Objective : To investigate the effect of Isometric Stretching on the QoL of 10 institutionalized older women with complaint of UI. Materials and methods : We used the ICIQ-SF to assess women's QoL pre- and post-treatment. The study duration was 12 weeks. Results : 80% of the women showed a significant improvement in UI (p = 0.007061) and QoL (p = 0.011). Conclusion : We concluded that Isometric Stretching contributed to a significant improvement in urinary incontinence symptoms and quality of life in incontinent older women.

Clinical validation of the Bladder Health Survey for urinary incontinence in a population sample of women

INTRODUCTION AND HYPOTHESIS

Our aim was to clinically validate the Bladder Health Survey (BHS) for detecting urinary incontinence (UI) in population-based surveys.

METHODS

A random sample of women ≥40 years was recruited from primary care practices. We assessed the BHS content validity with an expert advisory board. Test-retest reliability of UI questions was measured. BHS UI definitions included noncases, active (more than three symptoms in the prior 6 months), inactive (past but no current symptoms), and incident (new onset over the past 2 years) cases. To assess criterion validity, we compared BHS diagnosis to an expert clinical diagnosis using structured history, pelvic exam, voiding diary, and urodynamics (if needed). Construct validity was assessed comparing the BHS UI score and case status to Sandvik's score.

RESULTS

Among 322 patients, the BHS identified 17 % as noncases, 70 % as active, 10 % as inactive, and 3 % as incident cases. Using the clinical diagnosis as the gold standard, the percent of true-positive UI cases was 98 % (active), 84 % (inactive), and 80 % (incident). A total of 75 % of BHS noncases were true negatives. The receiver operating characteristic c-statistic was 0.86. Sensitivity and specificity of the BHS were 91 % and 84 %, respectively. The Sandvik score for active cases (median = 4) was significantly greater than it was for inactive (median = 1), incident (median = 1), and noncases (median = 0) (p < 0.001). The BHS UI score was significantly correlated with the Sandvik severity score (r = 0.68, p < 0.01).

CONCLUSION

The BHS is highly reliable, with robust content and construct validity for detecting UI for use in population samples.

[Evolution of surgical activity related to the female stress urinary incontinence (SUI) with regard to the ageing of the French female population]

INTRODUCTION AND OBJECTIVE

One of the main factors associated with urinary incontinence of women is aging. The total female French population seems to grow for 10 years, with more and more women over 60 years. The authors wanted to assess the evolution of the surgical activity related to the treatment of the urinary incontinence with regard to the aging of the female French population.

MATERIALS AND METHODS

The number of surgical procedures for the treatment of stress urinary incontinence was obtained by querying the database of the Agence Technique de l'Information sur l'Hospitalisation (ATIH) for the period 2002-2013. The Catalogue Des Actes Médicaux (CDAM) and the Classification Commune des Actes Médicaux (CCAM) were used to extract the codes relating to surgery of the female urinary incontinence during this period. Demographics data were obtained from the website of the National Institute of Demographic studies (INED). The results were then compared.

RESULTS

On the 2002-2010 period, the total female French population increased by 5%. In the class of age over 60 years, it increased by 12.7%. Support-related surgical activity continued to decrease until 2013 with 17.3% interventions less than in 2002.

CONCLUSION

The evolution of surgical activity does not seem to follow the evolution of the ageing of the population, even if age is a risk factor essential for the female urinary incontinence. The improvement of risk factors (gynecological, obstetrical), over the past decade, could explain this evolution.

LEVEL OF EVIDENCE

3.

Urinary incontinence and poor functional status in fragility fracture patients: an underrecognized and underappreciated association

PURPOSE/INTRODUCTION

Urinary incontinence (UI) affects some 20 % of community-dwelling older people and 30-60 % of people in institutional care. UI is known as an independent predictor of falls, and likely impacts fracture rates. The aim of the study was to measure the prevalence of UI in a typical fragility fracture population, to evaluate the relationship of UI with functional disability in the post-acute setting.

METHODS

Our study is a retrospective cross-sectional study of patients admitted to rehabilitation setting after inpatient hospital management for a fragility fracture. We included all consecutively admitted fragility fracture patients aged over 65. All patients underwent standard clinical examination and Geriatric Assessment. We assessed UI using a two-stage process with a six-item UI screening questionnaire followed by an interview.

RESULTS

1,857 (80.7 % female) patients were available for analysis, mean age was 81.7 years. UI was identified in 59.2 % of all fragility fracture patients, and was more prevalent in females. Patients suffering from UI differed significantly in almost all measured functional and cognitive tests, with increased dependency/lower ADL scores, increased rates of immobility, and higher rates of cognitive dysfunction and depression.

CONCLUSION

This study confirms the high prevalence of UI in older fragility fracture patients, and the association between UI and functional impairments. The diagnostic work-up and treatment of patients should be focused on the special needs of these older patients. More efforts are needed to increase awareness about prevalence and consequences of UI among older fragility fracture patients.

The interaction of stress and urgency urinary incontinence and its effect on quality of life

INTRODUCTION AND HYPOTHESIS

The objective was to estimate the impact of stress and urgency urinary incontinence (UI) on the quality of life (QOL), and to determine whether the impact varies according to UI severity.

METHODS

We used data from the General Longitudinal Overactive Bladder Evaluation-UI study in women. Stress and urgency UI symptom severity scores ranged from 0 to 8. We used logistic regression to test the relation among different severity levels of stress and urgency UI, and their interaction with the Incontinence Impact Questionnaire (IIQ-7). This was categorized according to percentage ranges as 0-40% (reference), 41-80%, and 81-100%.

RESULTS

Both stress and urgency UI were significantly associated with IIQ-7. Higher scores had higher odds ratios (ORs). The OR for urgency vs stress UI was greater at the same severity level. For instance, comparing IIQ-7 quintiles (0-40% vs 41-80%), the OR for an association with an urgency UI score of 5-6 was 5.27 (95% CI = 3.78-7.33) vs 2.76 (95% CI = 2.07-3.68) for a stress UI score of 5-6. Both UI subtypes were more strongly related to the upper (81-100%) than the to the lower (41-80%) quintiles. There was a strong positive urgency UI and stress UI interaction with the upper (i.e., 81-100%) but not the two next lower (41-80%) quintiles.

CONCLUSION

The impact of UI subtypes on QOL varies according to the score of IIQ-7, stress and urgency UI, and their interaction. Urgency vs stress UI has a stronger impact. The effect is greatest for high IIQ-7 scores with a significant share mediated by the interaction of the two UI subtypes.

Spanish version of the broome pelvic muscle self-efficacy scale: validity and reliability

BACKGROUND

Self-efficacy appears to be an important predictor of functional recovery for women with urinary incontinence, but no specific Spanish-language questionnaires for measuring pelvic-floor exercise self-efficacy exist.

OBJECTIVE

The aim of this study was to design a valid and reliable Spanish version of the Broome Pelvic Muscle Self-Efficacy Scale to measure self-efficacy, as perceived by women with urinary incontinence, in performing pelvic-floor exercises.

DESIGN

This was an observational validation study.

METHODS

Translation-back translation was used to design the survey, and then the survey was validated with a sample of 119 women who were incontinent and had undergone a pelvic-floor exercise training program. The reliability and construct validity of the questionnaire were assessed. Descriptive statistics were used to score the questionnaire. Internal consistency was evaluated with the Cronbach alpha coefficient and the Pearson correlation coefficient. Exploratory factor analysis with both the principal components extraction method and the varimax rotation method was used to assess construct validity.

RESULTS

The reliability coefficient (Cronbach alpha=.91) and the correlations among items were high. The factor analysis revealed that 6 main factors accounted for 75.8% of the variance.

LIMITATIONS

Conclusions regarding the validity of the questionnaire should be drawn with caution because of the inability to assess criterion-related validity.

CONCLUSIONS

The Spanish version of the Broome questionnaire for self-efficacy appears to be useful as a measuring tool for a psychometrically accurate, clinically relevant estimation of women's self-efficacy in performing pelvic-floor exercises.