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Porto M, Marôco J, Mascarenhas T, Pimenta F. Corrigendum: Beliefs and strategies about urinary incontinence: a possible moderation role between symptoms and sexual function, and quality of life. Front Psychol 2024; 15:1359674. [PMID: 38406304 PMCID: PMC10885343 DOI: 10.3389/fpsyg.2024.1359674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 01/17/2024] [Indexed: 02/27/2024] Open
Abstract
[This corrects the article DOI: 10.3389/fpsyg.2023.1252471.].
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Affiliation(s)
- Marta Porto
- William James Center for Research, Ispa – Instituto Universitário, Lisbon, Portugal
| | - João Marôco
- William James Center for Research, Ispa – Instituto Universitário, Lisbon, Portugal
- FLU Pedagogy, Nord University, Bodø, Norway
| | - Teresa Mascarenhas
- Department of Obstetrics and Gynecology, CHSJ-EPE/Faculty of Medicine, University of Porto, Porto, Portugal
| | - Filipa Pimenta
- William James Center for Research, Ispa – Instituto Universitário, Lisbon, Portugal
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Zhang JJ, Yang C, DU SH, Chen S, DU S, Zhao JP. Exploring the application value of the modified Delphi method in the development process of acupuncture and moxibustion guideline recommendations based on the WFAS Clinical Practice Guideline for Female Urinary Incontinence. Zhongguo Zhen Jiu 2023; 43:1449-1453. [PMID: 38092548 DOI: 10.13703/j.0255-2930.20230605-k0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Taking the recommendations development of the World Federation of Acupuncture-Moxibustion Societies (WFAS) standard Clinical Practice Guideline for Female Urinary Incontinence as an example, this study analyzed the consensus expert composition, specific consensus process, and results in the development of the guideline's recommendations. It systematically examined the advantages of using the modified Delphi method in the formation of recommendations for acupuncture and moxibustion clinical practice guideline, with the aim of providing reference for the development of acupuncture and moxibustion guidelines in the same field.
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Affiliation(s)
- Jia-Jia Zhang
- Department of Acupuncture and Moxibustion, Dongzhimen Hospital of Beijing University of CM, Beijing 100700, China
| | - Chao Yang
- Department of Acupuncture and Moxibustion, Dongzhimen Hospital of Beijing University of CM, Beijing 100700, China
| | - Shi-Hao DU
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences
| | - Sheng Chen
- Department of Acupuncture and Moxibustion, Dongzhimen Hospital of Beijing University of CM, Beijing 100700, China
| | - Shuo DU
- Department of Acupuncture and Moxibustion, Dongzhimen Hospital of Beijing University of CM, Beijing 100700, China
| | - Ji-Ping Zhao
- Department of Acupuncture and Moxibustion, Dongzhimen Hospital of Beijing University of CM, Beijing 100700, China.
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Porto M, Marôco J, Mascarenhas T, Pimenta F. Beliefs and strategies about urinary incontinence: a possible moderation role between symptoms and sexual function, and quality of life. Front Psychol 2023; 14:1252471. [PMID: 38098533 PMCID: PMC10720902 DOI: 10.3389/fpsyg.2023.1252471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 11/09/2023] [Indexed: 12/17/2023] Open
Abstract
Background Urinary Incontinence (UI) has numerous repercussions in women's lives, and it is underreported/underdiagnosed. Objective The present study aimed to understand: (1) the differences between women with and without urine loss regarding Quality of Life (QoL) and Sexual Function (SF); (2) the possible moderation role of UI-related beliefs and strategies on the relationship between UI-symptom severity and SF and QoL, in women with UI. Methods Cross-sectional Design. Participants: Primary aim: Overall, 2,578 women aged 40-65 (Mage = 49.94, DPage = 6.76) were collected online. Secondary aim: 1,538 women who self-reported having urine loss occasionally/frequently (Mage = 50.19, DPage = 6.58). All data analyses were done with IBM SPSS Statistics and R statistical system 4.0 through RStudio. Statistical Path analysis was performed with the lavaan package to study the hypothetical association and moderating effects between the variables. Results Primary aim: women without UI had a better SF [t(2576) = 3.13, p = 0.002; 95% C.I., 0.18 to 0.80] and QoL [t(2576) = 7.71, p < 0.001; 95% C.I., 3.14 to 5.28] than their counterparts with UI. Secondary aim: UI-related coping strategies attenuated the impact of UI-symptom severity on SF(β = -0.07; p = 0.041); the more dysfunctional the UI-related beliefs were, the poorer QoL was (β = -0.06; p = 0.031); the more frequent the UI-related hiding/defensive strategies were, the poorer QoL was (β = -0.26; p < 0.001). Discussion Limitations: online data collection, which thwarted the clarification of participants, if needed; absence of a UI medical diagnosis (only self-reported measures were used). Strengths and practical implications: (i) the crucial role of UI-related beliefs and strategies in the QoL of women with UI; (ii) the impact that UI-concealing/defensive strategies have in attenuating the impact of UI-symptom severity on SF, which might be perceived as a short-term benefit and hence contribute to maintaining the UI condition and constitute a barrier to help-seeking, (iii) impact of UI-symptom severity on QoL and SF (including a comparison group entailing women without UI, which is scarcely used); and (iv) the use of gold-standard and psychometrically robust instruments. Conclusion Changing dysfunctional UI-related beliefs and strategies in clinical settings may improve the QoL; UI-concealing strategies may reinforce themselves by immediate effects on SF, but are not functional in the long term.
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Affiliation(s)
- Marta Porto
- William James Center for Research, Ispa – Instituto Universitário, Lisbon, Portugal
| | - João Marôco
- William James Center for Research, Ispa – Instituto Universitário, Lisbon, Portugal
- FLU Pedagogy, Nord University, Bodø, Norway
| | - Teresa Mascarenhas
- Department of Obstetrics and Gynecology, CHSJ-EPE/Faculty of Medicine, University of Porto, Porto, Portugal
| | - Filipa Pimenta
- William James Center for Research, Ispa – Instituto Universitário, Lisbon, Portugal
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Tarcan T, Finazzi-Agrò E, Kessler TM, Serati M, Solomon E, Rosier PFWM. How should prospective research be designed to legitimately assess the value of urodynamic studies in female urinary incontinence? Neurourol Urodyn 2023; 42:1639-1646. [PMID: 37638391 DOI: 10.1002/nau.25273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 08/18/2023] [Indexed: 08/29/2023]
Abstract
AIMS Since formal evidence demonstrating the value of urodynamic studies (UDS) in functional urology remains elusive, we aimed to consider how best to design robust research for this purpose in female urinary incontinence. METHODS An expert group was convened to debate the following considerations: (a) precedents for formally proving the value of a gold standard diagnostic test, (b) key research principles, (c) defining a study population, (d) selecting endpoints, (e) defining interventional and controls arms, (f) blinding, (g) powering the study, and (h) duration of follow-up. In each case, we considered the strengths and weaknesses of different approaches in terms of scientific validity, ethical acceptability, practicality, and likelihood of bias. RESULTS We agreed that unlike evaluating therapies, attempting to judge the value of a diagnostic test based on eventual treatment success is conceptually flawed. Nonetheless, we explored the design of a hypothetical randomized controlled trial for this purpose, agreeing that: (1) the study population must sufficiently reflect its real-world counterpart; (2) clinical endpoints should include not only continence status but also other lower urinary tract symptoms and risks of management; (3) participants in the interventional arm should receive individualized management based on their UDS findings; (4) the most scientifically valid approach to the control arm-empiric treatment-is ethically problematic; (5) sufficient statistical power is imperative; and (6) ≥ 2 years' follow-up is needed to assess the long-term impact of management. CONCLUSIONS Although a perfect protocol does not exist, we recommend careful consideration of our observations when reflecting on past studies or planning new prospective research.
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Affiliation(s)
- Tufan Tarcan
- Department of Urology, Marmara University School of Medicine and Koç University School of Medicine, Istanbul, Turkey
| | - Enrico Finazzi-Agrò
- Department of Surgical Sciences, University of Rome Tor Vergata and UOSD Urologia, Policlinico Tor Vergata, Rome, Italy
| | - Thomas M Kessler
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Maurizio Serati
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy
| | | | - Peter F W M Rosier
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
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Wang Q, Que YZ, Wan XY, Lin CQ. Prevalence, Risk Factors, and Impact on Life of Female Urinary Incontinence: An Epidemiological Survey of 9584 Women in a Region of Southeastern China. Risk Manag Healthc Policy 2023; 16:1477-1487. [PMID: 37581111 PMCID: PMC10423612 DOI: 10.2147/rmhp.s421488] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/19/2023] [Indexed: 08/16/2023] Open
Abstract
Purpose To investigate the prevalence, risk factors, and impact on quality of life (QOL) of female urinary incontinence (UI) in a region of southeastern China. Patients and Methods This cross-sectional study, conducted between June 2022 and March 2023, included 9584 women aged 20-70 years who completed a standardized questionnaire through face-to-face interviews. This sample size represents almost 10% of the population in the target area. Results The prevalence of female UI was found to be 24.8%, with stress UI being the most common subtype (12.7%), followed by mixed UI (8.0%) and urgency UI (4.1%). Notably, the prevalence of UI increased progressively with age and body mass index (BMI). The study also revealed several risk factors for UI, including urban residence, postmenopausal status, multiple vaginal deliveries, instrumental vaginal deliveries, previous delivery of macrosomia, and prior history of pelvic floor surgery as determined by multivariate analysis. Furthermore, the study showed that 89.5% of women who reported UI experienced varying degrees of negative impact on their QOL. The incontinence quality of life (I-QOL) scale had an average score of 79.70±19.03, which decreased with increasing severity of UI. Despite the adverse effects on QOL, only 20.6% of women with UI had sought medical help. Conclusion UI is common among women in the survey area. UI has been observed to have varying degrees of adverse effects on the QOL of those affected, but most of them do not seek treatment for several reasons, highlighting the urgent need for health authorities to develop effective UI intervention strategies.
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Affiliation(s)
- Qi Wang
- Department of Gynecology, Fujian Provincial Key Laboratory of Women and Children’s Critical Diseases Research, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, People’s Republic of China
| | - Yan-Zhen Que
- Department of Gynecology and Obstetrics, Shaxian General Hospital, Sanming, People’s Republic of China
| | - Xiao-Ying Wan
- Department of Gynecology and Obstetrics, Shaxian General Hospital, Sanming, People’s Republic of China
| | - Chao-Qin Lin
- Department of Gynecology, Fujian Provincial Key Laboratory of Women and Children’s Critical Diseases Research, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, People’s Republic of China
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Diamantidis D, Tsakaldimis G, Lailisidis S, Panagiotopoulos N, Kafalis C, Giannakopoulos S, Kalaitzis C. Severe Complications of Artificial Urinary Sphincter Placement in a Young Woman With Neurogenic Urinary Incontinence: A Case Report. Cureus 2023; 15:e41097. [PMID: 37519492 PMCID: PMC10381096 DOI: 10.7759/cureus.41097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2023] [Indexed: 08/01/2023] Open
Abstract
This article reports a case of a 40-year-old woman with a history of myelomeningocele and neurogenic urinary incontinence who developed erosion and fistula formation following the placement of an artificial urinary sphincter (AUS) when she was 18 years old. The patient had a long-standing history of urinary incontinence that was unresponsive to prior surgeries for meningomyelocele. She reported the loss of uro-fecal material from the vagina but did not seek further medical evaluation until the age of 40. Clinical examination revealed protruding tubes from the suprapubic region. The administration of a contrast agent through one of the two tubes led to the visualization of intestinal loops, and the administration of a contrast agent through the urethra confirmed the connection between the rectum, urinary bladder, and vagina. Due to the absence of reliable surgical history and in the absence of abdominal discomfort, bilateral nephrostomies were initially performed to prevent further uro-fecal material loss. The patient showed significant improvement, decided to not seek further evaluation and surgical treatment, and remained socially integrated during the follow-up period of 20 years. This case highlights the severe consequences of AUS placement in a young woman with neurogenic urinary incontinence and emphasizes the importance of proper patient selection and management in the presence of underlying neurological disorders.
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Affiliation(s)
- Dimitrios Diamantidis
- Department of Urology, University General Hospital of Alexandroupolis, Alexandroupolis, GRC
| | - Georgios Tsakaldimis
- Department of Urology, University General Hospital of Alexandroupolis, Alexandroupolis, GRC
| | - Stavros Lailisidis
- Department of Urology, University General Hospital of Alexandroupolis, Alexandroupolis, GRC
| | | | - Charalampos Kafalis
- Department of Urology, University General Hospital of Alexandroupolis, Alexandroupolis, GRC
| | | | - Christos Kalaitzis
- Department of Urology, University General Hospital of Alexandroupolis, Alexandroupolis, GRC
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Alexander JW, Karjalainen P, Ow LL, Kulkarni M, Lee JK, Karjalainen T, Leitch A, Ryan G, Rosamilia A. CO 2 surgical laser for treatment of stress urinary incontinence in women: a randomized controlled trial. Am J Obstet Gynecol 2022; 227:473.e1-473.e12. [PMID: 35662546 DOI: 10.1016/j.ajog.2022.05.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 05/07/2022] [Accepted: 05/22/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Stress urinary incontinence is a common condition that can be treated conservatively and/or surgically. Given the risks of surgery, developing effective nonsurgical treatment options would be beneficial. Some studies have suggested that laser therapy may improve or cure stress urinary incontinence. However, there is a lack of sham-controlled randomized controlled trials to judge treatment efficacy. OBJECTIVE This study aimed to compare the effects of CO2 vaginal laser vs sham therapy for treating stress urinary incontinence. STUDY DESIGN This was a multicenter, participant-blinded, sham-controlled, parallel group (1:1) superiority randomized controlled trial performed in outpatient clinics in 2 hospitals. We included women aged 18 to 80 years with objective and subjective stress urinary incontinence. Participants had undertaken or declined supervised pelvic floor muscle training. Intervention was performed using a CO2 fractionated vaginal laser. Participants underwent 3 treatments, 4 weeks apart, with increasing energy and density settings. Sham treatment was performed using an identical technique with a deactivated pedal. The primary outcome was the subjective stress urinary incontinence rate (proportion with leak with cough, sneeze, or laughter) at 3 months after completion of treatment. Secondary outcomes included objective stress urinary incontinence, change in the disease-specific patient-reported outcomes, health-related quality of life, and adverse effects. Categorical outcomes were compared using the chi square test and continuous outcomes using analysis of covariance, adjusting for the baseline score. RESULTS There were 52 participants who received laser and 49 who received sham treatment. One participant in each group withdrew from the study before the endpoint, and 2 participants in the laser group did not participate in the follow-up visits. Participant mean age was 53 (34-79) years. Mean body mass index was 26.1 (18.1-49.6); 90% were vaginally parous. At 3 months, there was no difference between the sham and active treatment arm in subjective stress urinary incontinence (46 [96%] vs 48 [98%]; relative risk, 0.98 [95% confidence interval, 0.91-1.05]; P=.55) or in objective stress urinary incontinence (37 [80%] vs 33 [80%]; relative risk, 0.99 [95% confidence interval, 0.81-1.23]; P=.995). Patient-reported outcomes and health-related quality of life were also comparable between the groups. Vaginal bleeding occurred in 3 participants after laser and 1 participant after sham treatment. Pain during treatment did not differ between laser and sham treatment. CONCLUSION We were unable to show an improvement in stress urinary incontinence after CO2 vaginal laser therapy compared with sham treatment.
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Affiliation(s)
- James W Alexander
- Department of Obstetrics and Gynaecology, Monash Health, University of New South Wales Sydney, Melbourne, Victoria, Australia
| | - Paivi Karjalainen
- Department of Obstetrics and Gynaecology, Monash Health, Melbourne, Victoria, Australia; Department of Obstetrics and Gynecology, Hospital Nova, Central Finland Healthcare District, Jyväskylä, Finland; Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland; Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Lin Li Ow
- Department of Obstetrics and Gynaecology, Monash Health, Melbourne, Victoria, Australia
| | - Mugdha Kulkarni
- Department of Obstetrics and Gynaecology, Monash Health, Melbourne, Victoria, Australia
| | - Joseph K Lee
- Department of Obstetrics and Gynaecology, Monash Health, Melbourne, Victoria, Australia
| | - Teemu Karjalainen
- Department of Surgery, Hospital Nova, Central Finland Healthcare District, Jyväskylä, Finland
| | - Alison Leitch
- Department of Obstetrics and Gynaecology, Monash Health, Melbourne, Victoria, Australia
| | | | - Anna Rosamilia
- Department of Obstetrics and Gynaecology, Monash Health, Melbourne, Victoria, Australia; Cabrini Hospital, Monash University, Melbourne, Victoria, Australia.
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Braga A, Castronovo F, Caccia G, Papadia A, Regusci L, Torella M, Salvatore S, Scancarello C, Ghezzi F, Serati M. Efficacy of 3 Tesla Functional Magnetic Stimulation for the Treatment of Female Urinary Incontinence. J Clin Med 2022; 11:2805. [PMID: 35628930 DOI: 10.3390/jcm11102805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/01/2022] [Accepted: 05/06/2022] [Indexed: 11/29/2022] Open
Abstract
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.
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McKinney JL, Keyser LE, Pulliam SJ, Ferzandi TR. Female Urinary Incontinence Evidence-Based Treatment Pathway: An Infographic for Shared Decision-Making. J Womens Health (Larchmt) 2021; 31:341-346. [PMID: 34747662 PMCID: PMC8972010 DOI: 10.1089/jwh.2021.0266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Objectives: Urinary incontinence (UI) is a highly prevalent burdensome condition among adult females in the United States, yet rates of care-seeking, evaluation, and treatment are nonoptimal. Components of evaluation and treatment are informed by research and professional society guidelines; however, a visual representation of this guidance does not exist. The objectives of this study are to review the literature regarding female UI care and to synthesize this information into a graphical format to facilitate health education, health care delivery, and shared decision-making. Methods: We reviewed published society guidelines, position statements, and associated references from the American College of Obstetrics and Gynecology, the Women's Preventive Services Initiative, American Academy of Family Physicians, American College of Physicians, the Society of Urodynamics and Female Urology, the American Urological Association, and the American Urogynecologic Society, and searched PubMed for related literature. We synthesized these findings into an evidence-based infographic depicting female UI risk factors, influences on care-seeking and provision, screening, evaluation, and a stepwise treatment approach. Results: This study summarizes current evidence and professional guidelines related to female UI into a compelling visual format and accompanying narrative. The infographic is intended as a tool for patient education, clinical practice, and research to facilitate shared decision-making and health care delivery. Conclusions: Female UI is highly prevalent, yet diagnosis and treatment are suboptimal. Use of an evidence-based infographic may positively impact patient knowledge and certainty about UI treatment and support health care provider counseling and decision-making.
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Affiliation(s)
- Jessica L McKinney
- School of Rehabilitation Sciences, Andrews University, Berrien Springs, Michigan, USA.,Renovia, Inc., Boston, Massachusetts, USA
| | - Laura E Keyser
- School of Rehabilitation Sciences, Andrews University, Berrien Springs, Michigan, USA.,Renovia, Inc., Boston, Massachusetts, USA
| | - Samantha J Pulliam
- Renovia, Inc., Boston, Massachusetts, USA.,Tufts Medical Center, Boston, Massachusetts, USA
| | - Tanaz R Ferzandi
- Urogynecology and Pelvic Reconstructive Surgery, Keck School of Medicine at University of Southern California, Los Angeles, California, USA
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Machado LDS, Marques Cerentini T, Laganà AS, Viana da Rosa P, Fichera M, Telles da Rosa LH. Pelvic floor evaluation in CrossFit® athletes and urinary incontinence: a cross-sectional observational study. Women Health 2021; 61:490-499. [PMID: 33993850 DOI: 10.1080/03630242.2021.1927288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Athletic urinary incontinence is characterized by urinary loss during sports practice. This condition occurs in the case of CrossFit®, a modality based on high intensity training and functional movements, it can also be considered as having a high impact on the pelvic floor. This study aimed to compare the force and the contraction capacity of the pelvic floor musculature and urinary incontinence between female CrossFit® practitioners (AG) and non-practitioners (CG). We performed a cross-sectional observational study in the period from December 2018 and May 2019. Complaints of urinary incontinence was assessed by the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF); the functional evaluation of the pelvic floor was performed by digital palpation; resting tone, maximum voluntary contraction, fast contractions and sustained contraction of the pelvic floor muscles was tested by electromyography. The prevalence of urinary incontinence was significantly higher in AG compared with CG (p < .001). Nevertheless, we did not find significant differences between the two groups for functional assessment and electromyographic parameters. The AG presented a prevalence 60% of UI, while CG only 9,5 (p < 0,001). Considering this point, tailored prevention strategies seem mandatory in this population, in order to allow early identification and management of urinary incontinence.
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Affiliation(s)
- Lisandra da Silva Machado
- Postgraduate Program in Rehabilitation Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - Taís Marques Cerentini
- Postgraduate Program in Rehabilitation Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Patrícia Viana da Rosa
- Physiotherapy Department, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - Michele Fichera
- Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Luís Henrique Telles da Rosa
- Postgraduate Program in Rehabilitation Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
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Nüssler EK, Löfgren M, Lindkvist H, Idahl A. The tension-free vaginal tape operation: Is the inexperienced surgeon a risk factor? Learning curve and Swedish quality reference. Acta Obstet Gynecol Scand 2020; 100:471-479. [PMID: 33111326 PMCID: PMC8048431 DOI: 10.1111/aogs.14033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 10/12/2020] [Accepted: 10/18/2020] [Indexed: 12/27/2022]
Abstract
Introduction To reduce the risk of avoidable damage to the patient when training surgeons, one must predefine what standards to achieve, as well as supervise and monitor trainees' performance. The aim of this study is to establish a quality reference, to devise comprehensive tension‐free vaginal tape (TVT) learning curves and to compare trainees' results to our quality reference. Material and methods Using the Swedish National Quality Register for Gynecologic Surgery, we devised TVT learning curves for all Swedish TVT trainees from 2009 to 2017, covering their first 50 operations. These outcomes were compared with the results of Sweden's most experienced TVT surgeons for 14 quality variables. Results In all, 163 trainees performed 2804 operations and 40 experienced surgeons performed 3482 operations. For our primary outcomes – perioperative bladder perforations and urinary continence after 1 year – as well as re‐admission, re‐operation and days to all daily living activities, there was no statistically significant difference between trainees and experienced surgeons at any time. For the first 10 trainee operations only, there were small differences in favor of the experienced surgeons: patient‐reported minor complications after discharge (14% vs 18.4%, P = .002), 1‐year patient‐reported improvement (95.9% vs 91.8%, P < .000), and patient satisfaction (90.9% vs 86.2%, P = .002). For both trainee operations 1‐10 and 11‐50, compared with experienced surgeons, operation time (33.8 vs 22.2 min, P < .000; 28.3 vs 22.2 min, P < .000) and hospital stay time (0.16 vs 0.06 days, P < .001; 0.1 vs 0.06 days, P < .001) were longer, perioperative blood loss was higher (27.7 vs 24.4 mL, P = .001; 26.5 vs 24.4 mL, P = .004), and patient‐reported catheterization within 8 weeks was higher (3.9% vs 1.8%, P < .000; 2.5% vs 1.8%, P = .001). One‐year voiding difficulties for trainee patients (operations 1‐10:14.2%, P = .260; operations 11‐50:14.5%, P = .126) were comparable to the experienced surgeons (12.4%). Conclusions There is a learning curve for several secondary outcomes but the small effect size makes it improbable that the difference has clinical significance. Our national Swedish results show that it is possible to train new TVT surgeons without exposing patients to noteworthy extra risk and achieve results which are equivalent to the most experienced Swedish surgeons.
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Affiliation(s)
- Emil K Nüssler
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden
| | - Mats Löfgren
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden
| | - Håkan Lindkvist
- Department of Mathematics and Mathematical Statistics, Umeå University, Umeå, Sweden
| | - Annika Idahl
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden
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Elsner S, Juergensen M, Faust E, Niesel A, Pedersen LS, Rudnicki PM, Waldmann A. Urinary incontinence in women: treatment barriers and significance for Danish and German GPs. Fam Pract 2020; 37:367-373. [PMID: 31758169 DOI: 10.1093/fampra/cmz077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Female urinary incontinence (UI) is common. Only scant information exists on the significance of UI for GPs' consultations. OBJECTIVES (i) To assess the significance of female UI for GPs and to look at barriers that could be detrimental to treatment by comparing GPs from Denmark and Germany, with different health systems and access to UI guidelines. (ii) To assess whether GPs' gender and age were relevant to the discussion of UI. METHODS We conducted a cross-sectional survey. In the Fehmarn belt-region, a Danish-German border region, a self-developed questionnaire was sent to all the GPs (n = 930). RESULTS In total, 407 GPs returned the questionnaire (43%); 403 questionnaires were analysed. Using a scale from 0 (never) to 10 (always), addressing UI was reported with an average score of 3.8 (SD: 2.1) among Danish and 3.5 (SD: 2.1) among German GPs. The topic was discussed more frequently with female (4.2; SD 2.2) than with male GPs (3.2; SD 2.0). Danish GPs estimated the prevalence among their female patients at 10% (SD: 8.0) and German GPs at 14% (SD: 11.2). 61% of the Danish and 19% of the German GPs used UI guidelines. German GPs significantly more often reported the barrier 'uncertainty of how to treat UI' [OR = 5.39 (95% CI: 2.8; 10.4)]. CONCLUSIONS In consultations with female GPs, UI was discussed significantly more frequently than with male GPs. Compared with the Danish GPs, German GPs stated significantly more uncertainties regarding UI treatment measures, and tended not to use UI guidelines.
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Affiliation(s)
- Susanne Elsner
- Institute for Social Medicine and Epidemiology, Lübeck, Germany
| | - Martina Juergensen
- Institute for the History of Medicine and Science Studies, University of Lübeck, Lübeck, Germany
| | - Elke Faust
- Gynäkologische Praxisklinik, Hamburg, Germany
| | | | | | | | - Annika Waldmann
- Institute for Social Medicine and Epidemiology, Lübeck, Germany.,Hamburg Cancer Registry, Hamburg, Germany
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Abstract
INTRODUCTION The pharmacological treatment of urinary incontinence and overactive bladder (OAB) has been, for a longer time, based on antimuscarinic agents. In recent years, two other pharmacological principles have been introduced for the treatment of OAB and urgency urinary incontinence: the β3-adrenergic agent mirabegron and botulinum neurotoxin. Meanwhile, there is lack of effective drugs for the treatment of stress incontinence. AREAS COVERED This literature review presents synthetic compounds aimed to treat female urinary incontinence that are in phase II-III clinical development. EXPERT OPINION Antimuscarinic agents will continue to represent the current gold standard for the first-line pharmacological management of OAB and urgency urinary incontinence. The class of β3-agonists will certainly expand with the discovery and clinical development of novel agents. Combination therapy of antimuscarinic agents and β3-agonists could offer an alternative treatment in these patients, including those with symptoms refractory to first-line monotherapy. A huge number of preclinical studies are underway in this field exploring the therapeutic potential of many novel compounds while some have advanced to clinical phases of development.
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Affiliation(s)
- Riccardo Bientinesi
- a Urology Department, Agostino Gemelli Academic Hospital Foundation IRCCS , Catholic University School of Medicine of Rome , Rome , Italy
| | - Emilio Sacco
- a Urology Department, Agostino Gemelli Academic Hospital Foundation IRCCS , Catholic University School of Medicine of Rome , Rome , Italy
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Gvozdev MY, Pushkar DY. [Sling procedures to treat urinary incontinence in the Russian Federation]. Urologiia 2017:97-101. [PMID: 28952701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Surgical treatment of urinary incontinence using synthetic slings is one of the most frequently used procedures in modern urogynecology. The availability of almost identical surgical sets manufactured by different companies can at times significantly hamper the choice of a synthetic sling for a particular patient. This article presents a brief overview of the literature on the efficacy and safety of sub-urethral synthetic slings registered in the Russian market.
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Affiliation(s)
- M Yu Gvozdev
- Department of Urology, A.I. Evdokimov MSUMD, Moscow, Russia
| | - D Yu Pushkar
- Department of Urology, A.I. Evdokimov MSUMD, Moscow, Russia
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Abstract
Stress urinary incontinence (SUI) has always been a major health issue for women. With the progression of technology and surgical techniques, mid urethral slings (MUS) used in both transvaginal and transobturator routes have become the gold standard in the treatment of SUI. There is ample short to mid-term data confirming the efficacy and safety in using MUS in treating SUI in women. However, long-term data supporting the use of MUS in women to treat SUI is scarce. There has been much controversy surrounding the US Food and Drug Administrations' (FDA) public notification of potential complications surrounding the use of transvaginal mesh, which has been magnified and generalised by the media; but despite this there has still been substantial growth and uptake of MUS for treating SUI. In this review, we aim to explore some of the issues with MUS, the factors around litigation with mesh use, the impact of FDA's notification on the uptake of MUS and ultimately, the results and efficacy of MUS for the treatment of SUI.
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Affiliation(s)
- John Chang
- Department of Urology, St George Hospital, Kogarah, Australia
| | - Dominic Lee
- Department of Urology, St George Hospital, Kogarah, Australia
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Lee D, Bacsu C, Dillon B, Zimmern PE. Complications Following the Insertion of Two Synthetic Mid-urethral Slings and Subsequent Removal. Low Urin Tract Symptoms 2017; 10:259-265. [PMID: 28657139 DOI: 10.1111/luts.12175] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Revised: 02/12/2017] [Accepted: 02/27/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine outcomes after removal of two synthetic mid-urethral slings (MUS) at a tertiary care center. METHODS Following IRB approval, a retrospective chart review of non-neurogenic, symptomatic women requiring re-operation after ≥2 MUS was performed. Data reviewed by a third party included: demographics, prior anti-incontinence surgery, complications, pelvic/urinary symptoms, subsequent investigations, surgical repair and outcomes (including UDI-6/IIQ-7 questionnaires) at a minimum 6 months follow-up. Cure was defined as being continent, no dyspareunia, and no additional surgical therapy. RESULTS Between 2007 and 2014, 21 women met the inclusion criteria. Mean age was 57 years (range: 40-82) and mean follow-up was 30.2 months (range: 6-78). The majority of patients presented with one or more symptoms of voiding dysfunction (95%), urinary incontinence (86%), irritative voiding symptoms (62%), dyspareunia (57%), recurrent urinary tract infections (UTIs) (29%), vaginal extrusion (20%) and erosion involving the urinary tract (5%). Patients had a mean of 2 prior anti-incontinence procedures (range 2-3). Over two-thirds had a combination of retropubic and transobturator MUS. Mean number of pre-operative investigations was 3.5 (1-6) including voiding cystourethrogram, cystoscopy and urodynamics. Two patients had complete remission, 14 partial remission, and five failed. Mean postoperative total UDI-6 and IIQ-7 scores at last clinic visit were 10 (range: 0-16/SD 4.1) and 11 (range: 0-28/SD 10.3), respectively. CONCLUSION The management of women with suboptimal outcomes following two synthetic MUS from transvaginal excision results in modest symptomatic improvement but low permanent complete remission and frequent need for additional therapies.
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Affiliation(s)
- Dominic Lee
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Chasta Bacsu
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Benjamin Dillon
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Philippe E Zimmern
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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17
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Bonner A, Boyle J. Are women's needs being met by specialist health services managing urinary incontinence in the remote Top End NT? Aust N Z J Obstet Gynaecol 2017; 57:351-357. [PMID: 28397253 DOI: 10.1111/ajo.12601] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 12/15/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Urinary incontinence (UI) is likely to be high in Aboriginal women in rural Australia due to risk factors including high body mass index, parity and diabetes. However, UI appears to be under-reported with limited information on whether women access appropriate care. AIMS To assess whether women who access specialist gynaecological services in rural and remote Top End Northern Territory (NT) through the specialist outreach program (SONT) are receiving care for UI aligned with best practice. METHODS Review of all 1426 SONT referrals in 2012, with audit of management for those women referred for UI or prolapse. RESULTS Of 1426 SONT referrals, there were 43/1426 (3%) women referred for UI, with 34/43 (79%) attending. Of those referred, 31/43 (72%) were Aboriginal. Of twenty-six women diagnosed with probable stress UI, less than a fifth, 5/26 (19%), were referred to physiotherapy, with 2/5 (40%) attending appointments. Referral occurred for 14/23 (61%) of those suitable for urodynamics but only 6/14 (43%) attended. Just under half of women 7/16 (14%) with stress UI were referred for surgery, with 6/7 (86%) attending. CONCLUSION In rural and remote Top End NT, specialist health service management of female UI could be improved by increased provision of current best-practice and an integrated multi-disciplinary team approach with allied health. Under-reporting and under-referral for female UI could be addressed by increasing awareness among community and primary healthcare providers of the problem of female UI and the conservative, medical and surgical treatments available.
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Affiliation(s)
- Alexandra Bonner
- Department of O&G, Royal Darwin Hospital, Tiwi, Northern Territory, 0810, Australia
| | - Jacqueline Boyle
- Monash Centre for Health Research and Implementation - MCHRI, Women's Public Health Research, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, 3168, Australia
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Akbari P, Fathollahi A, Mo R, Kavran M, Episalla N, Hui CC, Farhat WA, Hijaz AK. A genetic female mouse model with congenital genitourinary anomalies and adult stages of urinary incontinence. Neurourol Urodyn 2017; 36:1981-1987. [PMID: 28244147 DOI: 10.1002/nau.23230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 12/28/2016] [Accepted: 01/10/2017] [Indexed: 11/10/2022]
Abstract
AIMS To characterize the urinary incontinence observed in adult Gli2+/- ; Gli3Δ699/+ female mice and identify the defects underlying the condition. METHODS Gli2+/- and Gli3Δ699/+ mice were crossed to generate: wild-type, mutant Gli2 (Gli2+/- ), mutant Gli3 (Gli3Δ699/+ ), and double mutant (Gli2+/- ; Gli3Δ699/+ ) female mice, verified via Polymerase Chain Reactions. Bladder functional studies including cystometrogram (CMG), leak point pressure (LPP), and voiding testing were performed on adult female mice. Female bladders and urethras were also analyzed via ink injection and histological assays. RESULTS CMG tracing showed no signal corresponding to the filling of the Gli2+/- ; Gli3Δ699/+ bladders. LPP were significantly reduced in Gli2+/- ; Gli3Δ699/+ mice compared to wild-type mice. CMG studies revealed a decrease in peak micturition pressure values in Gli2+/- ; Gli3Δ699/+ mice compared with all other groups. No significant differences between mutant and wild-type mice were detected in urinary output. Histological analyses revealed Gli2+/- ; Gli3Δ699/+ mice exhibited a widened urethra and a decrease in smooth muscle layer thickness in the bladder outlet and urethra, with increased mucosal folding. CONCLUSIONS Gli2+/- ; Gli3Δ699/+ adult female mice display persistent urinary incontinence due to the malformation of the bladder outlet and urethra. This presents a consistent and reliable genetic mouse model for female urinary incontinence and alludes to the key role of genetic factors involved in the condition.
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Affiliation(s)
- Pedram Akbari
- Program in Developmental & Stem Cell Biology, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Rong Mo
- Program in Developmental & Stem Cell Biology, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michael Kavran
- Department of Radiology, Case Western Reserve University, Cleveland, Ohio
| | - Nicole Episalla
- Georgetown University School of Medicine, Washington, DC, Washington
| | - Chi-Chung Hui
- Program in Developmental & Stem Cell Biology, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Walid A Farhat
- Program in Developmental & Stem Cell Biology, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Urology, Department of Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Adonis K Hijaz
- University Hospitals Cleveland Medical Center, Urology Institute, Cleveland, Ohio
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Quiboeuf E, Saurel-Cubizolles MJ, Fritel X. Trends in urinary incontinence in women between 4 and 24 months postpartum in the EDEN cohort. BJOG 2015; 123:1222-8. [PMID: 26292088 DOI: 10.1111/1471-0528.13545] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Our aim was to study risk factors associated with the prevalence, incidence and remission of urinary incontinence (UI) between 4 and 24 months postpartum. DESIGN Longitudinal study (EDEN cohort). SETTING Two French university hospitals. POPULATION 1643 women completed the questionnaire at 4 months and 1409 at 24 months, including 1354 who completed it both times. METHODS Multivariate analyses identified risk factors for UI prevalence at 24 months postpartum, persistent UI versus remission, de novo UI versus continence, de novo UI versus persistent UI, and changes in IU severity between 4 and 24 months postpartum. MAIN OUTCOME MEASURES Postnatal UI and Sandvik UI severity score. RESULTS UI prevalence was 20.7% (340/1643) at 4 months and 19.9% (280/1409) at 24 months. Significant factors associated with UI at 24 months were older age [OR = 1.07/year (95%CI 1.04-1.11)], BMI [2.35 (1.44-3.85) ≥30 versus <25 kg/m²], higher parity [1.77 (1.14-2.76) ≥3 versus 1], breastfeeding [1.54 (1.08-2.19) ≥3 versus < 3 months], pregnant at follow up [3.44 (2.25-5.26)], and caesarean delivery [0.62 (0.40-0.97) versus vaginal] [OR, odds ratio (CI, confidence interval)]. The likelihood of UI remission at 24 months was 51.9% (149/287). Caesarean delivery was associated with increased likelihood of UI remission [0.43 (0.19-0.97)]. The risk of de novo UI at 24 months was 12.5% (135/1067) and was associated with a new pregnancy [3.63 (2.13-6.20)]. CONCLUSIONS Between 4 and 24 months postpartum UI, remission occurred in half of the cases. These postnatal UI changes were essentially related to mode of delivery and subsequent pregnancy. TWEETABLE ABSTRACT Postnatal urinary incontinence progression is mostly related with mode of delivery and subsequent pregnancy.
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Affiliation(s)
- E Quiboeuf
- CHU de Bordeaux, Université Bordeaux-2, Bordeaux, France
| | - M-J Saurel-Cubizolles
- INSERM U1153, Obstetric, Perinatal and Paediatric Epidemiology Research Team, Research Centre for Epidemiology and Biostatistics Sorbonne-Paris-Cité (CRESS), Paris-Descartes Université, Paris, France
| | - X Fritel
- CHU de Poitiers, Université de Poitiers, Poitiers, France.,INSERM CIC1402, Poitiers, France.,INSERM U1018 CESP, Gender, Sexual and Reproductive Health, Kremlin-Bicêtre, France
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Porta-Roda O, Vara-Paniagua J, Díaz-López MA, Sobrado-Lozano P, Simó-González M, Díaz-Bellido P, Reula-Blasco MC, Muñoz-Garrido F. Effect of vaginal spheres and pelvic floor muscle training in women with urinary incontinence: a randomized, controlled trial. Neurourol Urodyn 2014; 34:533-8. [PMID: 25130167 DOI: 10.1002/nau.22640] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 04/29/2014] [Indexed: 11/10/2022]
Abstract
AIMS To compare the efficacy and safety of Kegel exercises performed with or without, vaginal spheres as treatment for women with urinary incontinence. METHODS Multicentre parallel-group, open, randomized controlled trial. Women were allocated to either a pelvic floor muscle-training program consisting of Kegel exercises performed twice daily, 5 days/week at home, over 6 months with vaginal spheres, or to the same program without spheres. The primary endpoint was women's report of urinary incontinence at 6 months using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-UI-SF). Secondary outcome measures were the 1 hr pad-test, King's Health Questionnaire (KHQ) and a five-point Likert scale for subjective evaluation. Adherence was measured with the Morisky-Green test. RESULTS Thirty-seven women were randomized to the spheres group and 33 to the control group. The primary endpoint was evaluated in 65 women (35 in the spheres group vs. 30 controls). ICIQ-UI-SF results improved significantly at 1-month follow-up in the spheres group (P < 0.01) and at 6 months in the controls. The 1 hr pad-test improved in the spheres group but not in the control group. No significant differences were found in the KHQ results or in the subjective evaluation of efficacy and safety. Adherence was higher in the spheres group but differences were not significant. Mild transient side effects were reported in four patients in the spheres group and one in the control group. CONCLUSIONS Both treatments improved urinary incontinence but women who performed the exercises with vaginal spheres showed an earlier improvement. Vaginal spheres were well tolerated and safe.
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Affiliation(s)
- Oriol Porta-Roda
- Service of Gynaecology and Obstetrics, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jesús Vara-Paniagua
- Service of Physical Medicine and Rehabilitation, Pelvic Floor Unit, Hospital Universitario, Madrid, Spain
| | - Miguel A Díaz-López
- Service of Gynaecology and Obstetrics, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Pilar Sobrado-Lozano
- Service of Physical Medicine and Rehabilitation, Pelvic Floor Unit, Hospital Universitario, Madrid, Spain
| | - Marta Simó-González
- Service of Gynaecology and Obstetrics, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Paloma Díaz-Bellido
- Service of Gynaecology and Obstetrics, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - María C Reula-Blasco
- Service of Gynaecology and Obstetrics, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
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Fritel X, Panjo H, Varnoux N, Ringa V. The individual determinants of care-seeking among middle-aged women reporting urinary incontinence: analysis of a 2273-woman cohort. Neurourol Urodyn 2013; 33:1116-22. [PMID: 23818427 DOI: 10.1002/nau.22461] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2012] [Accepted: 06/07/2013] [Indexed: 11/07/2022]
Abstract
AIMS Our main objective was to analyze individual determinants that lead middle-aged women to seek medical care for urinary incontinence (UI). METHODS Observational longitudinal study among GAZEL cohort participants: 2,640 women aged 50-62 completed a self-administered questionnaire at baseline. Eight years later (2008) 2,273 (86%) responded to a follow-up questionnaire. Seeking care for UI was defined as any consultation for UI during the 8-year follow-up period. Individual determinants considered in the regression analysis were social and demographic characteristics, social relations, UI type and severity, and other health factors. RESULTS Among 1,192 women reporting incontinence at baseline, 24.4% had visited a physician at least once for UI during the follow-up period (56.0% of those reporting severe UI). The care-seeking rate increased with age at baseline. Multivariate analysis showed that women who reported severe UI (OR = 4.1; 95% CI 2.6-6.5), mixed UI (2.0; 1.3-3.0), or neurologic disease (1.6; 1.1-2.6), had weak social support (1.4; 1.0-2.0), or talked about their UI with close friends or family (1.5; 1.0-2.1) were more likely to seek care for UI. A model including these factors had a 78% probability of correctly differentiating women with incontinence who chose to seek care from those who did not. Our analysis could not take factors related to the organization of health services into account. CONCLUSIONS Women do not always seek care for UI, even when it is severe. Besides UI severity and type, consultation is associated with aging, weak social support, conversation about it with close friends and family, and neurologic disorders.
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Affiliation(s)
- Xavier Fritel
- Poitiers University Hospital, INSERM CIC802, Poitiers, France; INSERM, CESP Centre for Research in Epidemiology and Population Health, U1018, Gender, Sexual and Reproductive Health Team, Univ Paris-Sud, Kremlin-Bicêtre, France; Institut National des Etudes Démographiques, Paris, France
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