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Swenson CW, DePorre JA, Haefner JK, Berger MB, Fenner DE. Postpartum depression screening and pelvic floor symptoms among women referred to a specialty postpartum perineal clinic. Am J Obstet Gynecol 2018; 218:335.e1-335.e6. [PMID: 29229409 DOI: 10.1016/j.ajog.2017.11.604] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 10/26/2017] [Accepted: 11/30/2017] [Indexed: 01/30/2023]
Abstract
BACKGROUND Postpartum depression and pelvic floor disorders are both common conditions that affect women; however, the association between the 2 has yet to be determined. OBJECTIVE The aims of our study are to: (1) determine the prevalence of a positive postpartum depression screen in a specialty postpartum perineal clinic, and (2) identify risk factors for postpartum depression in this population. STUDY DESIGN A retrospective chart review was performed of 294 women referred to a specialty postpartum perineal clinic at the University of Michigan from March 30, 2012, through May 3, 2016. Women who completed a new patient intake form, including the Edinburgh Postnatal Depression Scale, were included. The prevalence of a positive Edinburgh Postnatal Depression Scale screen (≥10) was determined. Bivariate analyses were used to compare demographics, delivery characteristics, referral indications, and postpartum pelvic floor symptoms between women with and without a positive Edinburgh Postnatal Depression Scale screen. Significant variables identified in the analyses were then used to perform logistic regression to identify factors independently associated with a positive Edinburgh Postnatal Depression Scale screen. RESULTS In all, 15.6% (46/294) of women had a positive postpartum depression screen. Average age was 30.6 ± 4.8 years, average body mass index was 28.9 ± 5.06 kg/m2, 68.0% (200/294) were Caucasian, 79.6% (234/294) were primiparous, and 86.0% (245/285) were breast-feeding. Using multivariable logistic regression, women with a positive postpartum depression screen had higher odds of being non-Caucasian (adjusted odds ratio, 2.72; 95% confidence interval, 1.27-5.832; P = .01), having a history of depression and/or anxiety (adjusted odds ratio, 2.77; 95% confidence interval, 1.23-6.24; P = .01), having been referred for pain (adjusted odds ratio, 2.61; 95% confidence interval, 1.24-5.49; P = .01), and reporting urinary incontinence during and after pregnancy (adjusted odds ratio, 3.81; 95% confidence interval, 1.57-9.25; P = .003). CONCLUSION Urinary incontinence during and after pregnancy and referral for pain were pelvic floor symptoms independently associated with a positive postpartum depression screen in women referred to a specialty perineal clinic. Therefore, consideration should be given to depression screening in women presenting with perinatal urinary incontinence and persistent postpartum pain, as these women may be at increased risk of developing postpartum depression.
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102
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Wasenda EJ, Kirby AC, Lukacz ES, Nager CW. The female continence mechanism measured by high resolution manometry: Urethral bulking versus midurethral sling. Neurourol Urodyn 2018; 37:1809-1814. [PMID: 29464812 DOI: 10.1002/nau.23529] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 01/29/2018] [Indexed: 11/10/2022]
Abstract
AIMS Traditional technology to characterize urethral pressure changes during dynamic conditions is limited by slow response times or artifact-inducing withdrawal maneuvers. The 8F high-resolution manometry (HRM) catheter (ManoScan™ ESO, Covidien) has advantages of fast response times and the ability to measure urethral pressures along the urethral length without withdrawal. Our objective was to determine static and dynamic maximum urethral closure pressures (MUCPs) and resting functional urethral length (FUL) in women using HRM before and after transurethral bulking and compare results to other women who underwent midurethral sling (MUS). METHODS We recorded rest, cough, and strain MUCPs and FUL in 24 women before and after transurethral bulking with polydimethylsiloxane (Macroplastique®) using the HRM catheter and compared these changes to HRM values from 26 women who had the same measures before and after MUS. RESULTS At rest, MUCPs increased minimally after both urethral bulking and MUS (3 vs 0.4 cm H2 O respectively, P = 0.4). Under dynamic conditions there were statistically insignificant small increases in MUCP and these increases were markedly less than after MUS (cough: 1.5 vs 63.8 cm H2 O, P < 0.001 and strain: 11.5 vs 57.7 cm H2 O, P < 0.001). FUL increased by 0.5 cm after transurethral bulking (P = 0.003), and decreased by 0.25 cm after MUS placement (P = 0.012). CONCLUSIONS The mechanism of continence after urethral bulking differs from MUS. While MUS increases dynamic MUCP, bulking may rely on increasing the length of the continence zone.
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Affiliation(s)
- Erika J Wasenda
- Atlantic Health System, Department of Obstetrics and Gynecology, Division of Urogynecology and Pelvic Reconstructive Surgery, Morristown, New Jersey
| | - Anna C Kirby
- Department of Obstetrics and Gynecology, Division of Urogynecology, University of Washington, Seattle, Washington
| | - Emily S Lukacz
- UC San Diego Health, Department of Reproductive Medicine, Division of Female Pelvic Medicine and Reconstructive Surgery, La Jolla, California
| | - Charles W Nager
- UC San Diego Health, Department of Reproductive Medicine, Division of Female Pelvic Medicine and Reconstructive Surgery, La Jolla, California
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103
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Urinary incontinence in nulliparous women before and during pregnancy: prevalence, incidence, type, and risk factors. Int Urogynecol J 2018; 29:353-362. [DOI: 10.1007/s00192-018-3554-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Accepted: 01/04/2018] [Indexed: 10/18/2022]
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Mauseth SA, Skurtveit S, Skovlund E, Langhammer A, Spigset O. Medication use and association with urinary incontinence in women: Data from the Norwegian Prescription Database and the HUNT study. Neurourol Urodyn 2018; 37:1448-1457. [PMID: 29336066 DOI: 10.1002/nau.23473] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 12/01/2017] [Indexed: 11/08/2022]
Abstract
AIMS To investigate the association between medication use and urinary incontinence (UI) in women. METHODS In a cross-sectional population-based study we analyzed questionnaire data on UI, including type and severity, from 21 735 women included in the Nord-Trøndelag Health Study (HUNT) in Norway. These data were linked to data on filled prescriptions retrieved from the Norwegian Prescription Database. A multivariate logistic regression model was used to calculate the odds for having UI related to the number of filled prescriptions for selected drug groups during the 6 months prior to participation in HUNT, after adjustment for numerous confounding factors. RESULTS Significant associations with UI were found for selective serotonin reuptake inhibitors (SSRIs) and lamotrigine with OR 1.52 (1.30-1.78) and 2.73 (1.59-4.68) for two or more filled prescriptions. Both for SSRIs and lamotrigine, the associations were pronounced for mixed UI, whereas there were no clear-cut increased risk of stress UI and urgency UI. The relations were strongest in women with the most severe symptoms. One filled prescription of antipsychotics, but not two or more, was also found to be related to UI with OR 1.91 (1.35-2.71). No associations were found for benzodiazepines, zopiclone/zolpidem, beta blockers, and diuretics. CONCLUSIONS The odds for having UI were found to be about 1.5-fold in women using SSRIs and almost threefold in women using lamotrigine. The association with lamotrigine has not been reported previously, and should be further evaluated in future studies.
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Affiliation(s)
- Siri A Mauseth
- Faculty of Medicine and Health Sciences, Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Svetlana Skurtveit
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway
| | - Eva Skovlund
- Department of Pharmacoepidemiology, Norwegian Institute of Public Health, Oslo, Norway.,Faculty of Medicine and Health Sciences, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Arnulf Langhammer
- Faculty of Medicine and Health Sciences, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Olav Spigset
- Faculty of Medicine and Health Sciences, Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Clinical Pharmacology, St. Olav University Hospital, Trondheim, Norway
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Komesu YM, Amundsen CL, Richter HE, Erickson SW, Ackenbom MF, Andy UU, Sung VW, Albo M, Gregory WT, Paraiso MF, Wallace D. Refractory urgency urinary incontinence treatment in women: impact of age on outcomes and complications. Am J Obstet Gynecol 2018; 218:111.e1-111.e9. [PMID: 29031894 PMCID: PMC5803754 DOI: 10.1016/j.ajog.2017.10.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 09/13/2017] [Accepted: 10/03/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND Women with refractory urgency urinary incontinence (ie, unresponsive to behavioral and pharmacological interventions) are treated with onabotulinumtoxinA or sacral neuromodulation. OBJECTIVE The objective of the study was to compare treatment efficacy and adverse events in women <65 and ≥65 years old treated with onabotulinumtoxinA or sacral neuromodulation. STUDY DESIGN This study was a planned secondary analysis of a multicenter, randomized trial that enrolled community-dwelling women with refractory urgency urinary incontinence to onabotulinumtoxinA or sacral neuromodulation treatments. The primary outcome was a change in mean daily urgency urinary incontinence episodes on a bladder diary over 6 months. Secondary outcomes included ≥75% urgency urinary incontinence episode reduction, change in symptom severity/quality of life, treatment satisfaction, and treatment-related adverse events. RESULTS Both age groups experienced improvement in mean urgency urinary incontinence episodes per day following each treatment. There was no evidence that mean daily urgency urinary incontinence episode reduction differed between age groups for onabotulinumtoxinA (adjusted coefficient, -0.127, 95% confidence interval, -1.233 to 0.979; P = .821) or sacral neuromodulation (adjusted coefficient, -0.698, 95% confidence interval, -1.832 to 0.437; P = .227). Among those treated with onabotulinumtoxinA, women <65 years had 3.3-fold greater odds of ≥75% resolution than women ≥65 years (95% confidence interval, 1.56 -7.02). Women <65 years had a greater reduction in Overactive Bladder Questionnaire Short Form symptom bother scores compared with women ≥65 years by 7.49 points (95% confidence interval, -3.23 to -11.74), regardless of treatment group. There was no difference between quality of life improvement by age. Women ≥65 years had more urinary tract infections following onabotulinumtoxinA and sacral neuromodulation (odds ratio, 1.9, 95% confidence interval, 1.2-3.3). There was no evidence of age differences in sacral neuromodulation revision/removal or catheterization following onabotulinumtoxinA treatment. CONCLUSION Younger women experienced greater absolute continence, symptom improvement, and fewer urinary tract infections; both older and younger women had beneficial urgency urinary incontinence episode reduction, similar rates of other treatment adverse events, and improved quality of life.
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Affiliation(s)
- Yuko M Komesu
- University of New Mexico Health Sciences Center, Albuquerque, NM.
| | | | | | | | | | | | - Vivian W Sung
- Women and Infants Hospital of Rhode Island, Providence, RI
| | - Michael Albo
- University of California, San Diego, San Diego, CA
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106
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Mauseth SA, Skurtveit S, Langhammer A, Spigset O. Incidence of and factors associated with anticholinergic drug use among Norwegian women with urinary incontinence. Int Urogynecol J 2017; 29:489-495. [PMID: 29103164 DOI: 10.1007/s00192-017-3499-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 10/05/2017] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The aims of this study were to investigate patterns of prescribing anticholinergic drugs among women with urinary incontinence (UI) and to identify factors associated with prescription of these drugs. METHODS We analysed questionnaire data on UI from 21,735 women older than 20 years who participated in a cross-sectional population-based study in Nord-Trøndelag county, Norway (the HUNT study). These data were linked at the individual level to a national prescription database, and analysed using a multivariate logistic regression model. RESULTS Among the women with UI, 4.5% had been prescribed an anticholinergic drug during the previous 12 months. Prescription was most frequent in women with urge UI (10.5%) and mixed UI (7.0%). Of women with UI without treatment with an anticholinergic drug, 1.8% obtained such a prescription during the subsequent 12 months, corresponding to 3.1% of women with urge UI and 3.0% of women with mixed UI. Characteristics significantly associated with starting treatment were age above 50 years, urge or mixed UI, severe or very severe symptoms, consumption of four or more cups of coffee per day, and having visited a doctor for UI. No association was found with marital status, parity, smoking, alcohol, body mass index or anxiety/depression. CONCLUSIONS In this population-based study, 4.5% of women with UI were prescribed an anticholinergic drug, and the 12-month incidence of starting treatment was 1.8%. Age above 50 years, urge or mixed UI, severe symptoms, high coffee consumption and having visited a doctor for UI were factors associated with first-time drug prescription.
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Affiliation(s)
- Siri A Mauseth
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, 7491, Trondheim, Norway.
| | - Svetlana Skurtveit
- Department of Pharmacoepidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Arnulf Langhammer
- Department of Public Health and Nursing and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Olav Spigset
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, 7491, Trondheim, Norway.,Department of Clinical Pharmacology, St. Olav University Hospital, Trondheim, Norway
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107
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Characterizing the Functional Decline of Older Women With Incident Urinary Incontinence. Obstet Gynecol 2017; 130:1025-1032. [PMID: 29016492 DOI: 10.1097/aog.0000000000002322] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To characterize change in physical performance and differential prevalence of low skeletal muscle mass and strength (sarcopenia) and lower 25-hydroxyvitamin D concentrations among older women who developed urinary incontinence (UI) symptoms. METHODS This is a secondary analysis of the Health, Aging, and Body Composition Study. Urinary incontinence symptoms were assessed using validated questions. The Short Physical Performance Battery measured physical performance. Sarcopenia, defined by low muscle mass and strength, was determined using validated cutoffs for gait speed, grip strength, and appendicular skeletal muscle mass. All parameters were evaluated at baseline and year 4. Serum 25-hydroxyvitamin D concentrations were assessed at year 2. The primary outcome was change in Short Physical Performance Battery total scores. Sarcopenia and lower serum 25-hydroxyvitamin D concentrations have been independently associated with poor physical performance and UI and were therefore included as secondary outcomes. Univariate and multivariate analyses were used to characterize the associations of change in physical performance from baseline to year 4, incidence of sarcopenia, and lower serum 25-hydroxyvitamin D on the development of UI symptoms. RESULTS Of the 1,583 women enrolled, 910 were excluded (730 had baseline UI; 180 with missing data). Six hundred seventy-three women were continent at baseline; 223 (33%) developed UI symptoms at year 4. SPPB total scores significantly declined in women with UI versus continent women (mean difference continent-incident UI 0.32, 95% CI 0.04-0.60, P=.02). Of subscale measures, standing balance showed the greatest decline at 0.20 (0.05-0.36; continent-incident UI, respectively; P=.009). Sarcopenia developed at a higher rate with incident UI (adjusted odds ratio [OR] 1.7, 95% CI 1.0-2.9). Low 25-hydroxyvitamin D was not associated with incident UI (adjusted OR 1.1, 95% CI 0.7-1.6 and 1.1, 95% CI 0.7-1.6 for deficient or insufficient versus sufficient status, respectively). CONCLUSION We observed a significant decline in standing balance among older women who developed UI symptoms. This decline may be associated with coinciding development of sarcopenia.
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108
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Southall K, Tuazon JR, Djokhdem AH, van den Heuvel EA, Wittich W, Jutai JW. Assessing the stigma content of urinary incontinence intervention outcome measures. J Rehabil Assist Technol Eng 2017; 4:2055668317738943. [PMID: 31186943 PMCID: PMC6453035 DOI: 10.1177/2055668317738943] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 10/05/2017] [Indexed: 11/15/2022] Open
Abstract
The goal of this narrative review is to evaluate the efficacy of available
questionnaires for assessing the outcomes of “continence difficulty”
interventions and to assess the selected questionnaires concerning aspects of
stigmatization. The literature was searched for research related to urinary
incontinence, as well as questionnaires and rating scale outcome measurement
tools. The following sources were searched: Cochrane Library, EMBASE, Medline,
and PubMed. The following keywords were used separately or in combination:
“Urinary incontinence,” “therapy,” ”treatment outcome,” “patient satisfaction,”
“quality of life,” “systematic reviews,” “aged 65+ years,” and “questionnaire.”
The search yielded 194 references, of which 11 questionnaires fit the inclusion
criteria; 6 of the 11 questionnaires did not have any stigma content and the
content regarding stigma that was identified in the other five was very limited.
A representative model of how stigma impacts continence difficulty interventions
was proposed. While the 11 incontinence specific measurement tools that were
assessed were well researched and designed specifically to measure the outcomes
of incontinence interventions, they have not been used consistently or
extensively and none of the measures thoroughly assess stigma. Further studies
are required to examine how the stigma associated with continence difficulty
impacts upon health care interventions.
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Affiliation(s)
- Kenneth Southall
- Centre de Recherché, Institute Universitaire de Gériatrie de Montréal, Montréal, Québec, Canada.,School of Social Work, McGill University, Montreal, Quebec, Canada
| | - Joshua R Tuazon
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Abdul H Djokhdem
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.,Bruyère Research Institute, Ottawa, ON, Canada
| | | | - Walter Wittich
- School of Optometry, Université de Montréal, Montréal, Québec, Canada.,MAB-Mackay Rehabilitation Centre, Montreal, QC, Canada
| | - Jeffrey W Jutai
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.,Bruyère Research Institute, Ottawa, ON, Canada
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Huang WC, Yang JM. Menopause is associated with impaired responsiveness of involuntary pelvic floor muscle contractions to sudden intra-abdominal pressure rise in women with pelvic floor symptoms: A retrospective study. Neurourol Urodyn 2017; 37:1128-1136. [DOI: 10.1002/nau.23433] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 09/21/2017] [Indexed: 11/05/2022]
Affiliation(s)
- Wen-Chen Huang
- Department of Obstetrics and Gynecology; Cathay General Hospital; Taipei Taiwan
- Department of Obstetrics and Gynecology; School of Medicine; College of Medicine; Taipei Medical University; Taipei Taiwan
- Graduate Institute of Clinical Medicine; College of Medicine; National Taiwan University; Taipei Taiwan
| | - Jenn-Ming Yang
- Department of Obstetrics and Gynecology; School of Medicine; College of Medicine; Taipei Medical University; Taipei Taiwan
- Department of Obstetrics and Gynecology; Taipei Medical University-Shuan Ho Hospital, New Taipei; New Taipei Taiwan
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Oberg J, Verelst M, Jorde R, Cashman K, Grimnes G. High dose vitamin D may improve lower urinary tract symptoms in postmenopausal women. J Steroid Biochem Mol Biol 2017; 173:28-32. [PMID: 28323043 DOI: 10.1016/j.jsbmb.2017.03.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 03/14/2017] [Accepted: 03/17/2017] [Indexed: 12/28/2022]
Abstract
Lower urinary tract symptoms (LUTS) are common in postmenopausal women, and have been reported inversely associated with vitamin D intake and serum 25-hydroxyvitamin D (25(OH)D) levels. The aim of this study was to investigate if high dose vitamin D supplementation would affect LUTS in comparison to standard dose. In a randomized controlled study including 297 postmenopausal women with low bone mineral density, the participants were allocated to receive capsules of 20 000IU of vitamin D3 twice a week (high dose group) or similar looking placebo (standard dose group). In addition, all the participants received 1g of calcium and 800IU of vitamin D daily. A validated questionnaire regarding LUTS was filled in at baseline and after 12 months. At baseline, 76 women in the high dose group and 82 in the standard dose group reported any LUTS. Levels of serum 25(OH)D increased significantly more in the high dose group (from 64.7 to 164.1nmol/l compared to from 64.1 to 81.8nmol/l, p<0.01). No differences between the groups were seen regarding change in LUTS except for a statistically significant reduction in the reported severity of urine incontinence in the high dose group as compared to the standard dose group after one year (p<0.05). The results need confirmation in a study specifically designed for this purpose.
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Affiliation(s)
- Johanna Oberg
- Tromsø Endocrine Research Group, Institute of Clinical Medicine, UiT-The Arctic University of Norway, Tromsø, Norway
| | - Margareta Verelst
- Department of Obstetrics and Gynecology, University Hospital of North Norway, Tromsø, Norway
| | - Rolf Jorde
- Tromsø Endocrine Research Group, Institute of Clinical Medicine, UiT-The Arctic University of Norway, Tromsø, Norway; Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Kevin Cashman
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, Cork, Ireland; Department of Medicine, University College Cork, Cork, Ireland
| | - Guri Grimnes
- Tromsø Endocrine Research Group, Institute of Clinical Medicine, UiT-The Arctic University of Norway, Tromsø, Norway; Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway.
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Cimino S, Voce S, Palmieri F, Favilla V, Castelli T, Privitera S, Giardina R, Reale G, Russo GI, Morgia G. Transurethral resection of the prostate (TURP) vs GreenLight photoselective vaporization of benign prostatic hyperplasia: analysis of BPH6 outcomes after 1 year of follow-up. Int J Impot Res 2017; 29:240-243. [PMID: 28814812 DOI: 10.1038/ijir.2017.30] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 05/23/2017] [Accepted: 07/14/2017] [Indexed: 11/09/2022]
Abstract
The surgical treatment of benign prostatic obstruction is changing over the time, thanks the increase evidence about the successful role of laser techniques in this surgery. We aimed to compare prostatic GreenLight photovaporization (PVP) to bipolar transurethral resection of the prostate (TURP) with regard to lower urinary tract symptoms (LUTS) improvement through the evaluation of BPH6. We enrolled 220 consecutive subjects affected by LUTS. We performed a propensity score matching using prostate volume, peak flow and International Prostate Symptoms Score (IPSS). A total of 110 (55 TURP and 55 PVP) were analyzed. We found after 1 year of follow-up that the rate of subjects resulting in greater BPH6 recovery in the PVP group vs TURP (45.6% vs 18.2%; P=0.001). The TURP treatment showed greater catheterization time (4.67 vs 1.25; P<0.01) while PVP showed greater recovery experience (82.4 vs 58.2; <0.01). Postoperative ejaculatory dysfunctions were observed in both groups, 58.8% in TURP and 34.5% in PVP group. The multivariate logistic regression analysis, adjusted for preoperative variables, showed that PVP was independently associated with BPH6 recovery end point (odds ratio=3.77; P<0.01). This study showed data in favor of PVP. Although IPSS and peak flow improvements were similar, PVP showed better clinical outcomes.
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Affiliation(s)
- S Cimino
- Department of Surgery, Urology Section, University of Catania, Catania, Italy
| | - S Voce
- Urology Division, Lugo of Romagna Hospital, Ravenna, Italy
| | - F Palmieri
- Urology Division, Lugo of Romagna Hospital, Ravenna, Italy
| | - V Favilla
- Department of Surgery, Urology Section, University of Catania, Catania, Italy
| | - T Castelli
- Department of Surgery, Urology Section, University of Catania, Catania, Italy
| | - S Privitera
- Department of Surgery, Urology Section, University of Catania, Catania, Italy
| | - R Giardina
- Department of Surgery, Urology Section, University of Catania, Catania, Italy
| | - G Reale
- Department of Surgery, Urology Section, University of Catania, Catania, Italy
| | - G I Russo
- Department of Surgery, Urology Section, University of Catania, Catania, Italy
| | - G Morgia
- Department of Surgery, Urology Section, University of Catania, Catania, Italy
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Li D, Xu Y, Nie Q, Li Y, Mao G. Predictors of urinary incontinence between abdominal obesity and non-obese male adults. Postgrad Med 2017; 129:747-755. [PMID: 28724322 DOI: 10.1080/00325481.2017.1357419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To investigate factors that may be associated with urinary incontinence (UI) in abdominal obese and non-obese adult males. METHODS Data were analyzed for 2671 men (≥40 years of age) who participated in the National Health and Nutrition Examination Survey (2005-2008). We define abdominal obesity as a waist circumference >102 cm. Men with Incontinence Severity Index ≥3 were defined as having UI. Logistic regression analyses were used to identify factors associated with stress and urge UI. RESULTS Multivariate analysis found that in abdominal obese men, stress UI was associated with enlarged prostate (odds ratio [OR] = 2.20, 95% confidence interval [CI]: 1.16-4.16), chronic respiratory tract disease (OR = 2.78, 95% CI: 1.55-4.97), and major depression (OR = 4.79, 95% CI: 1.79-12.84). In non-obese men, arthritis was associated with stress UI (odds ratio = 3.37, 95% CI: 1.06-10.73). Urge UI in abdominally obese men was associated with age ≥65 years (OR = 1.67, 95% CI: 1.05-2.67), being non-Hispanic black (OR = 1.63, 95% CI: 1.06-2.52), and with enlarged prostate (OR = 2.30, 95% CI: 1.54-3.40), arthritis (OR = 1.39, 95% CI: 1.03-1.88), and major depression (OR = 2.96, 95% CI: 1.89-4.64). Urge UI in non-obese men was associated with current smoking (OR = 1.79, 95% CI: 1.01-3.17), major depression (OR = 2.60, 95% CI: 1.33-5.09) and vitamin D deficiency (OR = 1.61, 95% CI: 1.01-2.59). CONCLUSION Factors associated with urinary incontinence varied with abdominal obesity status and type of UI. The findings identify important contributors to urinary incontinence that clinicians should consider to help manage and effectively treat the condition.
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Affiliation(s)
- Dongmei Li
- a Department of Neurovascular Surgery , The General Hospital of Chinese People's Armed Police Forces , Beijing , China
| | - Yi Xu
- a Department of Neurovascular Surgery , The General Hospital of Chinese People's Armed Police Forces , Beijing , China
| | - Qingbin Nie
- a Department of Neurovascular Surgery , The General Hospital of Chinese People's Armed Police Forces , Beijing , China
| | - Yan Li
- b Department of Neurosurgery, Liangxiang Teaching Hospital , Capital Medical University , Beijing , China
| | - Gengsheng Mao
- a Department of Neurovascular Surgery , The General Hospital of Chinese People's Armed Police Forces , Beijing , China
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113
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Are we underestimating the rates of incontinence after prostate cancer treatment? Results from NHANES. Int Urol Nephrol 2017; 49:1715-1721. [DOI: 10.1007/s11255-017-1660-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 07/10/2017] [Indexed: 11/26/2022]
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Erekson EA, Cong X, Townsend MK, Ciarleglio MM. Ten-Year Prevalence and Incidence of Urinary Incontinence in Older Women: A Longitudinal Analysis of the Health and Retirement Study. J Am Geriatr Soc 2017; 64:1274-80. [PMID: 27321606 DOI: 10.1111/jgs.14088] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To measure the incidence of urinary incontinence (UI) over 10 years in older women who did not report UI at baseline in 1998, to estimate the prevalence of female UI according to severity and type, and to explore potential risk factors for development of UI. DESIGN Secondary analysis of a prospective cohort. SETTING Health and Retirement Study. PARTICIPANTS Women participating in the Health and Retirement Study between 1998 and 2008 who did not have UI at baseline (1998). MEASUREMENTS UI was defined as an answer of "yes" to the question, "During the last 12 months, have you lost any amount of urine beyond your control?" UI was characterized according to severity (according to the Sandvik Severity Index) and type (according to International Continence Society definitions) at each biennial follow-up between 1998 and 2008. RESULTS In 1998, 5,552 women aged 51 to 74 reported no UI. The cumulative incidence of UI in older women was 37.2% (95% confidence interval (CI)=36.0-38.5%). The most common incontinence type at the first report of leakage was mixed UI (49.1%, 95% CI=46.5-51.7%), and women commonly reported their symptoms at first leakage as moderate to severe (46.4%, 95% CI=43.8-49.0%). CONCLUSION Development of UI in older women was common and tended to result in mixed type and moderate to severe symptoms.
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Affiliation(s)
- Elisabeth A Erekson
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Dartmouth College, Hanover, New Hampshire.,The Dartmouth Institute for Health Care Policy and Clinical Practice, Hanover, New Hampshire
| | - Xiangyu Cong
- Center for Analytical Sciences, Yale University, New Haven, Connecticut
| | - Mary K Townsend
- Department of Medicine, Channing Division of Network Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts
| | - Maria M Ciarleglio
- Department of Biostatistics, School of Public Health, Yale University, New Haven, Connecticut
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Ahmed M A, Khalifa M, Farag MA, Abd El AAM, Ali SS, Ahmed NT. Assessment of Psychological Symptoms and Quality of Life among Women with Urinary Incontinence. JOURNAL OF GYNECOLOGICAL RESEARCH AND OBSTETRICS 2017; 3:064-069. [DOI: 10.17352/jgro.000041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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116
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Saiki L, Meize-Grochowski R. Urinary Incontinence and Psychosocial Factors Associated With Intimate Relationship Satisfaction Among Midlife Women. J Obstet Gynecol Neonatal Nurs 2017; 46:555-566. [PMID: 28477970 DOI: 10.1016/j.jogn.2017.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2017] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To explore associations among symptoms of urinary incontinence, severity of symptoms, and measures of psychosocial health that may be assessed during a well-woman screening examination and the possible contribution of these variables to the relationship satisfaction of partnered midlife women living with urinary incontinence. DESIGN Exploratory correlational design using self-report questionnaires. SETTING Community recruitment by posted fliers, advertisements, and social media. PARTICIPANTS Partnered women, ages 45 to 65 years, with urinary incontinence (N = 57). METHODS Self-report measures of severity of incontinence symptoms, relationship satisfaction, self-concept/emotional health (self-esteem, body image, depression, anxiety), and relationship factors (sexual quality of life, incontinence-related communication). Data were analyzed using Spearman rho correlation with an exploration of the contribution of study factors to relationship satisfaction through standard multiple regression. RESULTS The severity of urinary incontinence symptoms had no significant correlation with scores on relationship satisfaction or psychosocial health. Measures of self-concept/emotional health and relationship factors were significantly correlated with each other (rs = .40-.75, p < .01) and with relationship satisfaction (rs = .35-.71, p < .05). Preliminary exploration of the contribution of study factors to relationship satisfaction through exploratory regression analysis showed unique contributions from sexual quality of life (18.7%, p < .001) and depression (8.7%, p = .004). CONCLUSION Midlife women with urinary incontinence, regardless of symptom severity, might benefit from screening for poorer sexual quality of life and mild depression symptoms because these two study factors significantly contributed to poorer intimate relationship satisfaction among this study's participants.
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Segal S, John G, Sammel M, Andy UU, Chu C, Arya LA, Brown J, Schmitz K. Urinary incontinence and other pelvic floor disorders after radiation therapy in endometrial cancer survivors. Maturitas 2017; 105:83-88. [PMID: 28396018 DOI: 10.1016/j.maturitas.2017.03.313] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 03/10/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To investigate radiation therapy as a risk factor for urinary or fecal incontinence, pelvic organ prolapse, and sexual dysfunction in endometrial cancer survivors. STUDY DESIGN We performed a retrospective cohort study of endometrial cancer survivors. Data were collected using a mailed survey and the medical record. Validated questionnaires were used to generate rates of urinary incontinence and other pelvic floor disorders. The incidence rates of pelvic floor disorders were compared across groups with different exposures to radiation. RESULTS Of the 149 endometrial cancer survivors, 41% received radiation therapy. Fifty-one percent of women reported urine leakage. The rates of urinary incontinence in women exposed and not exposed to vaginal brachytherapy (VBT) or whole-pelvis radiation were 48% and 58%, respectively (p=0.47). The incidence of fecal incontinence did not differ between groups, but the score for overall sexual function was significantly higher in women who did not undergo radiation therapy. On multivariable analysis, significant risk factors for urinary incontinence were age (AOR 1.06 95% CI 1.02, 1.10) and BMI (AOR 1.07 95% CI 1.02, 1.11), but treatment with radiation was not significantly associated with urinary incontinence, or fecal incontinence (p>0.05). Age, BMI, and radiation exposure were independent predictors of decreased sexual function score (p<0.01). CONCLUSION Local or regional radiation is not associated with urinary or fecal incontinence, but may contribute to sexual dysfunction in endometrial cancer survivors.
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Affiliation(s)
- Saya Segal
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, and Division of Urology, Department of Surgery, Rutgers - Robert Wood Johnson Medical School, New Brunswick, NJ, United States.
| | - Gabriella John
- Memorial Sloan-Kettering Cancer Center, New York, NY, United States
| | - Mary Sammel
- Center for Clinical Epidemiology and Biostatistics, and Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Uduak Umoh Andy
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Pennsylvania; Philadelphia, PA, United States
| | - Christina Chu
- Division of Gynecologic Oncology, Fox Chase Cancer Center, Philadelphia, PA, United States
| | - Lily A Arya
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Pennsylvania; Philadelphia, PA, United States
| | - Justin Brown
- Center for Clinical Epidemiology and Biostatistics, and Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Kathryn Schmitz
- Center for Clinical Epidemiology and Biostatistics, and Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
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118
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Nygaard IE, Clark E, Clark L, Egger MJ, Hitchcock R, Hsu Y, Norton P, Sanchez-Birkhead A, Shaw J, Sheng X, Varner M. Physical and cultural determinants of postpartum pelvic floor support and symptoms following vaginal delivery: a protocol for a mixed-methods prospective cohort study. BMJ Open 2017; 7:e014252. [PMID: 28073797 PMCID: PMC5253561 DOI: 10.1136/bmjopen-2016-014252] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Pelvic floor disorders (PFDs), including pelvic organ prolapse (POP), stress and urgency urinary incontinence, and faecal incontinence, are common and arise from loss of pelvic support. Although severe disease often does not occur until women become older, pregnancy and childbirth are major risk factors for PFDs, especially POP. We understand little about modifiable factors that impact pelvic floor function recovery after vaginal birth. This National Institutes of Health (NIH)-funded Program Project, 'Bridging physical and cultural determinants of postpartum pelvic floor support and symptoms following vaginal delivery', uses mixed-methods research to study the influences of intra-abdominal pressure, physical activity, body habitus and muscle fitness on pelvic floor support and symptoms as well as the cultural context in which women experience those changes. METHODS AND ANALYSIS Using quantitative methods, we will evaluate whether pelvic floor support and symptoms 1 year after the first vaginal delivery are affected by biologically plausible factors that may impact muscle, nerve and connective tissue healing during recovery (first 8 weeks postpartum) and strengthening (remainder of the first postpartum year). Using qualitative methods, we will examine cultural aspects of perceptions, explanations of changes in pelvic floor support, and actions taken by Mexican-American and Euro-American primipara, emphasising early changes after childbirth. We will summarise project results in a resource toolkit that will enhance opportunities for dialogue between women, their families and providers, and across lay and medical discourses. We anticipate enrolling up to 1530 nulliparous women into the prospective cohort study during the third trimester, following those who deliver vaginally 1 year postpartum. Participants will be drawn from this cohort to meet the project's aims. ETHICS AND DISSEMINATION The University of Utah and Intermountain Healthcare Institutional Review Boards approved this study. Data are stored in a secure password-protected database. Papers summarising the primary results and ancillary analyses will be published in peer-reviewed journals.
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Affiliation(s)
- Ingrid E Nygaard
- Department of Obstetrics and Gynecology, School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Erin Clark
- Department of Obstetrics and Gynecology, School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Lauren Clark
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
| | - Marlene J Egger
- Department of Family and Preventive Medicine, School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Robert Hitchcock
- Department of Bioengineering, College of Engineering, University of Utah, Salt Lake City, Utah, USA
| | - Yvonne Hsu
- Department of Obstetrics and Gynecology, School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Peggy Norton
- Department of Obstetrics and Gynecology, School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | | | - Janet Shaw
- Department of Health, Kinesiology, and Recreation, College of Health, University of Utah, Salt Lake City, Utah, USA
| | - Xiaoming Sheng
- Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Michael Varner
- Department of Obstetrics and Gynecology, School of Medicine, University of Utah, Salt Lake City, Utah, USA
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Sánchez-Ferrer M, Moya-Jiménez L, Mendiola J. Comparison of the anogenital distance and anthropometry of the perineum in patients with and without pelvic organ prolapse. Actas Urol Esp 2016; 40:628-634. [PMID: 27372734 DOI: 10.1016/j.acuro.2016.04.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Revised: 04/06/2016] [Accepted: 04/07/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To determine whether there are differences in the anthropometric measures of the perineum for women with symptomatic pelvic organ prolapse who are candidates for surgery, with or without urinary incontinence, and for patients without pelvic floor dysfunction. The main objective was to measure the anogenital distance in its 2 variants: anoclitoral and anofourchette. The anogenital distance appears to be determined prenatally and is influenced by the intrauterine hormonal environment. The secondary objective was to measure the length of the genital hiatus, the perineal body and the distance between the 2 ischial tuberosities. MATERIAL AND METHODS An observational case-control study was conducted with 58 patients. The cases (n=22) were patients with stages >II 2 in the Baden-Walker classification system. The controls were patients with normal pelvic floors. Measurements were performed with a digital calliper. The patients' tocogynecological history, lifestyle habits and risk factors were recorded. RESULTS The case patients had a significantly shorter anogenital anofourchette distance than that of the control patients (P=.001), a significantly longer anogenital anoclitoral distance than the control patients (P=.0001) and a significantly longer genital hiatus length than the control patients (P=.02). CONCLUSIONS This was an observational study with a small sample. We cannot determine whether the difference in these distances are caused by or are the result of this disease. Given that the anogenital distance appears to be determined prenatally, we question whether this changed distance could be a risk factor for developing pelvic floor dysfunction.
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120
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Amundsen CL, Richter HE, Menefee SA, Komesu YM, Arya LA, Gregory WT, Myers DL, Zyczynski HM, Vasavada S, Nolen TL, Wallace D, Meikle SF. OnabotulinumtoxinA vs Sacral Neuromodulation on Refractory Urgency Urinary Incontinence in Women: A Randomized Clinical Trial. JAMA 2016; 316:1366-1374. [PMID: 27701661 PMCID: PMC5399419 DOI: 10.1001/jama.2016.14617] [Citation(s) in RCA: 147] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Women with refractory urgency urinary incontinence are treated with sacral neuromodulation and onabotulinumtoxinA with limited comparative information. Objective To assess whether onabotulinumtoxinA is superior to sacral neuromodulation in controlling refractory episodes of urgency urinary incontinence. Design, Setting, and Participants Multicenter open-label randomized trial (February 2012-January 2015) at 9 US medical centers involving 381 women with refractory urgency urinary incontinence. Interventions Cystoscopic intradetrusor injection of 200 U of onabotulinumtoxinA (n = 192) or sacral neuromodulation (n = 189). Main Outcomes and Measures Primary outcome, change from baseline mean number of daily urgency urinary incontinence episodes over 6 months, was measured with monthly 3-day diaries. Secondary outcomes included change from baseline in urinary symptom scores in the Overactive Bladder Questionnaire Short Form (SF); range, 0-100, higher scores indicating worse symptoms; Overactive Bladder Satisfaction questionnaire; range, 0-100; includes 5 subscales, higher scores indicating better satisfaction; and adverse events. Results Of the 364 women (mean [SD] age, 63.0 [11.6] years) in the intention-to-treat population, 190 women in the onabotulinumtoxinA group had a greater reduction in 6-month mean number of episodes of urgency incontinence per day than did the 174 in the sacral neuromodulation group (-3.9 vs -3.3 episodes per day; mean difference, 0.63; 95% CI, 0.13 to 1.14; P = .01). Participants treated with onabotulinumtoxinA showed greater improvement in the Overactive Bladder Questionnaire SF for symptom bother (-46.7 vs -38.6; mean difference, 8.1; 95% CI, 3.0 to 13.3; P = .002); treatment satisfaction (67.7 vs 59.8; mean difference, 7.8; 95% CI, 1.6 to 14.1; P = .01) and treatment endorsement (78.1 vs 67.6; mean difference; 10.4, 95% CI, 4.3 to 16.5; P < .001) than treatment with sacral neuromodulation. There were no differences in convenience (67.6 vs 70.2; mean difference, -2.5; 95% CI, -8.1 to 3.0; P = .36), adverse effects (88.4 vs 85.1; mean difference, 3.3; 95% CI, -1.9 to 8.5; P = .22), and treatment preference (92.% vs 89%; risk difference, -3%; 95% CI, -16% to 10%; P = .49). Urinary tract infections were more frequent in the onabotulinumtoxinA group (35% vs 11%; risk difference, -23%; 95% CI, -33% to -13%; P < .001). The need for self-catheterization was 8% and 2% at 1 and 6 months in the onabotulinumtoxinA group. Neuromodulation device revisions and removals occurred in 3%. Conclusions and Relevance Among women with refractory urgency urinary incontinence, treatment with onabotulinumtoxinA compared with sacral neuromodulation resulted in a small daily improvement in episodes that although statistically significant is of uncertain clinical importance. In addition, it resulted in a higher risk of urinary tract infections and need for transient self-catheterizations.
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Affiliation(s)
- Cindy L Amundsen
- Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina
| | - Holly E Richter
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham
| | - Shawn A Menefee
- Department of Obstetrics and Gynecology, Kaiser Permanente San Diego, San Diego, California
| | - Yuko M Komesu
- Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque
| | - Lily A Arya
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia
| | - W Thomas Gregory
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland
| | - Deborah L Myers
- Department of Obstetrics and Gynecology, Brown University, Providence, Rhode Island
| | - Halina M Zyczynski
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Tracy L Nolen
- Social, Statistical and Environmental Sciences, RTI International, Research Triangle Park, North Carolina
| | - Dennis Wallace
- Social, Statistical and Environmental Sciences, RTI International, Research Triangle Park, North Carolina
| | - Susan F Meikle
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
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McClurg D, Pollock A, Campbell P, Hazelton C, Elders A, Hagen S, Hill DC. Conservative interventions for urinary incontinence in women: an Overview of Cochrane systematic reviews. Hippokratia 2016. [DOI: 10.1002/14651858.cd012337] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Doreen McClurg
- Glasgow Caledonian University; Nursing, Midwifery and Allied Health Professions Research Unit; Cowcaddens Road Glasgow UK G4 0BA
| | - Alex Pollock
- Glasgow Caledonian University; Nursing, Midwifery and Allied Health Professions Research Unit; Cowcaddens Road Glasgow UK G4 0BA
| | - Pauline Campbell
- Glasgow Caledonian University; Nursing, Midwifery and Allied Health Professions Research Unit; Cowcaddens Road Glasgow UK G4 0BA
| | - Christine Hazelton
- Glasgow Caledonian University; Nursing, Midwifery and Allied Health Professions Research Unit; Cowcaddens Road Glasgow UK G4 0BA
| | - Andrew Elders
- Glasgow Caledonian University; Nursing, Midwifery and Allied Health Professions Research Unit; Cowcaddens Road Glasgow UK G4 0BA
| | - Suzanne Hagen
- Glasgow Caledonian University; Nursing, Midwifery and Allied Health Professions Research Unit; Cowcaddens Road Glasgow UK G4 0BA
| | - David C Hill
- University of Stirling; NMAHP Research Unit; Unit 13 Scion House Stirling UK FK9 4NF
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Vaughan CP, Tangpricha V, Motahar-Ford N, Goode PS, Burgio KL, Allman RM, Daigle SG, Redden DT, Markland AD. Vitamin D and incident urinary incontinence in older adults. Eur J Clin Nutr 2016; 70:987-9. [PMID: 26979990 PMCID: PMC5014687 DOI: 10.1038/ejcn.2016.20] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 01/18/2016] [Accepted: 02/03/2016] [Indexed: 01/06/2023]
Abstract
BACKGROUND/OBJECTIVES The aim of this study is to determine whether vitamin D status is associated with incident urinary incontinence (UI) among community-dwelling older adults. SUBJECTS/METHODS The University of Alabama at Birmingham Study of Aging is a prospective cohort study of community-dwelling Medicare enrollees. Standardized assessment of UI was conducted using the validated Incontinence Severity Index. The analysis of 25-hydroxyvitamin D [25(OH)D] levels was performed on stored baseline sera. UI was assessed every 6-12 months for up to 42 months. The analyses included multivariable logistic regression and Cox proportional hazard models. RESULTS Of 350 participants (175 male, 147 black, mean age 73.6±5.8), 54% (189/350) were vitamin D deficient (25(OH)D <20 ng/ml) and 25% (87/350) were vitamin D insufficient (25(OH)D: 20 ng/ml to <30 ng/ml). Among the 187 subjects with no UI at baseline, 57% (107/187) were vitamin D deficient and 24% (45/187) were vitamin D insufficient. A total of 175 of the 187 subjects had follow-up evaluation for incident UI over 42 months, and incident UI occurred in 37% (65/175). After adjustment, cumulative incident UI at 42 months was associated with baseline vitamin D insufficiency (P=0.03) and demonstrated a trend association with deficiency (P=0.07). There was no association between baseline vitamin D status and the time to incident UI. CONCLUSIONS These preliminary results support an association between vitamin D and incident UI in community-dwelling older adults. Future studies may target specific at-risk groups, such as men with BPH or women with pelvic floor disorders for evaluation of the impact of vitamin D supplementation on urinary symptoms.
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Affiliation(s)
- C P Vaughan
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs, Atlanta, GA, USA
- Atlanta VA Medical Center, Decatur, GA, USA
- Department of Medicine, Emory University, Atlanta, GA, USA
| | - Vin Tangpricha
- Atlanta VA Medical Center, Decatur, GA, USA
- Department of Medicine, Emory University, Atlanta, GA, USA
| | - N Motahar-Ford
- Atlanta VA Medical Center, Decatur, GA, USA
- Department of Medicine, Emory University, Atlanta, GA, USA
| | - P S Goode
- Birmingham/Atlanta GRECC, Department of Veterans Affairs, Birmingham, AL, USA
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Comprehensive Center for Healthy Aging, University of Alabama at Birmingham, Birmingham, AL, USA
| | - K L Burgio
- Birmingham/Atlanta GRECC, Department of Veterans Affairs, Birmingham, AL, USA
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Comprehensive Center for Healthy Aging, University of Alabama at Birmingham, Birmingham, AL, USA
| | - R M Allman
- Department of Veterans Affairs, Office of Geriatrics and Extended Care, Washington, DC, USA
| | - S G Daigle
- Birmingham/Atlanta GRECC, Department of Veterans Affairs, Birmingham, AL, USA
| | - D T Redden
- Birmingham/Atlanta GRECC, Department of Veterans Affairs, Birmingham, AL, USA
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - A D Markland
- Birmingham/Atlanta GRECC, Department of Veterans Affairs, Birmingham, AL, USA
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Comprehensive Center for Healthy Aging, University of Alabama at Birmingham, Birmingham, AL, USA
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Brennand EA, Kim-Fine S. A randomized clinical trial of how to best position retropubic slings for stress urinary incontinence: Development of a study protocol for the mid-urethral sling tensioning (MUST) trial. Contemp Clin Trials Commun 2016; 3:60-64. [PMID: 29736458 PMCID: PMC5935876 DOI: 10.1016/j.conctc.2016.04.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 03/28/2016] [Accepted: 04/11/2016] [Indexed: 11/21/2022] Open
Abstract
The goal of this trial is to compare two techniques for tensioning retropubic midurethral slings: a Mayo scissor between the tape and urethra vs. a Babcock clamp creating a measured loop underneath the urethra. The primary outcome is a composite of abnormal bladder function at 12 months post surgery. Abnormal bladder function is defined as bothersome stress incontinence or worsening over active bladder symptoms, a positive cough stress test, re-treatment of stress urinary incontinence, post-operative urinary retention requiring either catheterization beyond 6 weeks or surgical intervention. Secondary outcomes include the duration of post operative urinary retention, quality of life scores, and physical examination. This article describes the rationale and design of this clinical trial, which will be of interest to those who care for patient with pelvic floor disorders such as stress urinary incontinence.
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Affiliation(s)
- Erin A. Brennand
- Department of Obstetrics & Gynecology, University of Calgary, Calgary, AB, Canada
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Mueller ER, Damaser MS, Mallampalli MP, Losada L. Women's Urological Health as a Priority to the Woman Well Visit. Womens Health Issues 2016; 26:476-7. [PMID: 27448751 DOI: 10.1016/j.whi.2016.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 03/10/2016] [Indexed: 11/24/2022]
Affiliation(s)
- Elizabeth R Mueller
- Departments of Urology & Obstetrics/Gynecology Loyola University Chicago, Stritch School of Medicine/Loyola University Medical Center, Maywood, Il
| | - Margot S Damaser
- Biomedical Engineering Department and Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Research Service, Louis Stokes Cleveland Dept of Veterans Affairs Medical Center, Cleveland, OH
| | - Monica P Mallampalli
- Vice President, Scientific Affairs, Society for Women's Health Research, Washington D.C
| | - Liliana Losada
- Associate Director, Scientific Affairs, Society for Women's Health Research, Washington D.C
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Pierce H, Perry L, Chiarelli P, Gallagher R. A systematic review of prevalence and impact of symptoms of pelvic floor dysfunction in identified workforce groups. J Adv Nurs 2016; 72:1718-34. [PMID: 26887537 DOI: 10.1111/jan.12909] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2015] [Indexed: 11/27/2022]
Abstract
AIM To investigate the prevalence and impact of symptoms of pelvic floor dysfunction in identified workforce groups. BACKGROUND Productivity of workforce groups is a concern for ageing societies. Symptoms of pelvic floor dysfunction are associated with ageing and negatively influence psychosocial health. In the general population, lower urinary tract symptoms negatively influence work productivity. DESIGN A systematic review of observational studies. DATA SOURCES Electronic searches of four academic databases. Reference lists were scanned for relevant articles. The search was limited to English language publications 1990-2014. REVIEW METHODS The Centre for Reviews and Dissemination procedure guided the review method. Data extraction and synthesis was conducted on studies where the workforce group was identified and the type of pelvic floor dysfunction defined according to accepted terminology. Quality appraisal of studies was performed using a Joanna Briggs Institute critical appraisal tool. RESULTS Twelve studies were identified of variable quality, all on female workers. Nurses were the most frequently investigated workforce group and urinary incontinence was the most common subtype of pelvic floor dysfunction examined. Lower urinary tract symptoms were more prevalent in the studied nurses than related general populations. No included study investigated pelvic organ prolapse, anorectal or male symptoms or the influence of symptoms on work productivity. CONCLUSION Lower urinary tract symptoms are a significant issue among the female nursing workforce. Knowledge of the influence of symptoms on work productivity remains unknown. Further studies are warranted on the impact of pelvic floor dysfunction subtypes in workforce groups.
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Affiliation(s)
- Heather Pierce
- Faculty of Health, University of Technology Sydney, New South Wales, Australia
| | - Lin Perry
- Faculty of Health, University of Technology Sydney, New South Wales, Australia.,Nursing Research and Practice Development, Prince of Wales Hospital & Sydney, Sydney Eye Hospitals, New South Wales, Australia
| | - Pauline Chiarelli
- School of Health Sciences, University of Newcastle, Callaghan, New South Wales, Australia
| | - Robyn Gallagher
- Faculty of Health, University of Technology Sydney, New South Wales, Australia.,Charles Perkins Centre, Sydney School of Nursing, University of Sydney, New South Wales, Australia
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Bridging the gap: determinants of undiagnosed or untreated urinary incontinence in women. Am J Obstet Gynecol 2016; 214:266.e1-266.e9. [PMID: 26348382 DOI: 10.1016/j.ajog.2015.08.072] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 08/07/2015] [Accepted: 08/31/2015] [Indexed: 01/01/2023]
Abstract
BACKGROUND More than a third of middle-aged or older women suffer from urinary incontinence, but less than half undergo evaluation or treatment for this burdensome condition. With national organizations now including an assessment of incontinence as a quality performance measure, providers and health care organizations have a growing incentive to identify and engage these women who are undiagnosed and untreated. OBJECTIVE We sought to identify clinical and sociodemographic determinants of patient-provider discussion and treatment of incontinence among ethnically diverse, community-dwelling women. STUDY DESIGN We conducted an observational cohort study from 2003 through 2012 of 969 women aged 40 years and older enrolled in a Northern California integrated health care delivery system who reported at least weekly incontinence. Clinical severity, type, treatment, and discussion of incontinence were assessed by structured questionnaires. Multivariable regression evaluated predictors of discussion and treatment. RESULTS Mean age of the 969 participants was 59.9 (±9.7) years, and 55% were racial/ethnic minorities (171 black, 233 Latina, 133 Asian or Native American). Fifty-five percent reported discussing their incontinence with a health care provider, 36% within 1 year of symptom onset, and with only 3% indicating that their provider initiated the discussion. More than half (52%) reported being at least moderately bothered by their incontinence. Of these women, 324 (65%) discussed their incontinence with a clinician, with 200 (40%) doing so within 1 year of symptom onset. In a multivariable analysis, women were less likely to have discussed their incontinence if they had a household income < $30,000/y vs ≥ $120,000/y (adjusted odds ratio [AOR], 0.49, 95% confidence interval [CI], 0.28-0.86) or were diabetic (AOR, 0.71, 95% CI, 0.51-0.99). They were more likely to have discussed incontinence if they had clinically severe incontinence (AOR, 3.09, 95% CI, 1.89-5.07), depression (AOR, 1.71, 95% CI, 1.20-2.44), pelvic organ prolapse (AOR, 1.98, 95% CI, 1.13-3.46), or arthritis (AOR, 1.44, 95% CI, 1.06-1.95). Among the subset of women reporting at least moderate subjective bother from incontinence, black race (AOR, 0.45, 95% CI, 0.25-0.81, vs white race) and income < $30,000/y (AOR, 0.37, 95% CI, 0.17-0.81, vs ≥ $120,000/y) were associated with a reduced likelihood of discussing incontinence. Those with clinically severe incontinence (AOR, 2.93, 95% CI, 1.53-5.61, vs low to moderate incontinence by the Sandvik scale) were more likely to discuss it with a clinician. CONCLUSION Even in an integrated health care system, lower income was associated with decreased rates of patient-provider discussion of incontinence among women with at least weekly incontinence. Despite being at increased risk of incontinence, diabetic women were also less likely to have discussed incontinence or received care. Findings provide support for systematic screening of women to overcome barriers to evaluation and treatment.
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Measurement of dynamic urethral pressures with a high-resolution manometry system in continent and incontinent women. Female Pelvic Med Reconstr Surg 2016; 21:106-10. [PMID: 25185595 DOI: 10.1097/spv.0000000000000135] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Female stress urinary incontinence is caused by urethral dysfunction during dynamic conditions, but current technology has limitations in measuring urethral pressures under these conditions. An 8-French high-resolution manometry (HRM) catheter currently in clinical use in gastroenterology may accurately measure urethral pressures under dynamic conditions because it has a 25-millisecond response rate and circumferential pressure sensors along the length of the catheter (ManoScan ESO; Given Imaging, Yoqneam, Israel). We evaluated the concordance, repeatability, and tolerability of this catheter. METHODS We measured resting, cough, and strain maximum urethral closure pressures (MUCPs) using HRM and measured resting MUCPs with water-perfusion side-hole catheter urethral pressure profilometry (UPP) in 37 continent and 28 stress-incontinent subjects. Maneuvers were repeated after moving the HRM catheter along the urethral length to evaluate whether results depend on catheter positioning. Visual analog pain scores evaluated the comfort of HRM compared to UPP. RESULTS The correlation coefficient for resting MUCPs measured by HRM versus UPP was high (r = 0.79, P < 0.001). Repeatability after catheter repositioning was high for rest, cough, and strain with HRM: r = 0.92, 0.89, and 0.89. Mean MUCPs (rest, cough, and strain) were higher in continent than in incontinent subjects (all P < 0.001) and decreased more in incontinent subjects than in continent subjects during cough and strain maneuvers compared to rest. CONCLUSIONS This preliminary study shows that HRM is concordant with standard technology, repeatable, and well tolerated in the urethra. Incontinent women have more impairment of their urethral closure pressures during cough and strain than continent women.
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128
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Plastic reconstructive surgery techniques using VRAM or gracilis flaps in order to successfully treat complex urogenital fistulas. J Plast Reconstr Aesthet Surg 2016; 69:128-37. [DOI: 10.1016/j.bjps.2015.08.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 08/13/2015] [Accepted: 08/23/2015] [Indexed: 11/21/2022]
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Weinberg AE, Leppert JT, Elliott CS. Biochemical Measures of Diabetes are Not Independent Predictors of Urinary Incontinence in Women. J Urol 2015; 194:1668-74. [DOI: 10.1016/j.juro.2015.06.074] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2015] [Indexed: 01/08/2023]
Affiliation(s)
| | - John T. Leppert
- Stanford University School of Medicine, Stanford, California
- Stanford, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Christopher S. Elliott
- Stanford University School of Medicine, Stanford, California
- Santa Clara Valley Medical Center, San Jose, California
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130
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Ganann R, Sword W, Thabane L, Newbold B, Black M. Predictors of Postpartum Depression Among Immigrant Women in the Year After Childbirth. J Womens Health (Larchmt) 2015; 25:155-65. [PMID: 26447838 DOI: 10.1089/jwh.2015.5292] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Immigrant women are at increased risk for postpartum depression (PPD). The factors that influence PPD among immigrant women are poorly understood. The purpose of this study was to identify individual- and community-level factors predictive of PPD among immigrant women living in a large Ontario city at 6 weeks, 6 months, and 1 year postpartum. METHODS The study involved a secondary analysis of a prospective cohort study, The Ontario Mother and Infant Study 3. This study included 519 immigrant women who were recruited from two hospitals in one urban city and delivered full-term singleton infants. Women completed a written questionnaire in hospital, followed by structured telephone interviews at 6 weeks, 6 months, and 1 year after hospital discharge. Generalized estimating equations were used to explore factors associated with PPD, measured using the Edinburgh Postnatal Depression Scale (EPDS) and two thresholds for depression (≥12 and ≥9). RESULTS Rates of PPD at all time points were 8%-10% for EPDS scores of ≥12. For EPDS scores of ≥9, rates of PPD more than doubled at all time points. A lack of social support was strongly associated with PPD in all analyses. Living in Canada for ≤2 years, poor perceptions of health, and lower mental health functioning were other important predictors of PPD. Living in communities with a high prevalence of immigrants and low income also was associated with PPD. CONCLUSIONS Complex individual and community-level factors are associated with PPD in immigrant women. Understanding these contextual factors can inform a multifaceted approach to addressing PPD.
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Affiliation(s)
- Rebecca Ganann
- 1 School of Nursing, McMaster University , Hamilton, Canada
| | - Wendy Sword
- 2 School of Nursing, University of Ottawa , Ottawa, Canada
| | - Lehana Thabane
- 3 Department of Clinical Epidemiology and Biostatistics, McMaster University , Hamilton, Canada
| | - Bruce Newbold
- 4 School of Geography and Earth Sciences, McMaster University , Hamilton, Canada
| | - Margaret Black
- 1 School of Nursing, McMaster University , Hamilton, Canada
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Sønksen J, Barber NJ, Speakman MJ, Berges R, Wetterauer U, Greene D, Sievert KD, Chapple CR, Montorsi F, Patterson JM, Fahrenkrug L, Schoenthaler M, Gratzke C. Prospective, Randomized, Multinational Study of Prostatic Urethral Lift Versus Transurethral Resection of the Prostate: 12-month Results from the BPH6 Study. Eur Urol 2015; 68:643-52. [DOI: 10.1016/j.eururo.2015.04.024] [Citation(s) in RCA: 111] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 04/16/2015] [Indexed: 12/21/2022]
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Jacobson AM, Braffett BH, Cleary PA, Dunn RL, Larkin ME, Wessells H, Sarma AV. Relationship of urologic complications with health-related quality of life and perceived value of health in men and women with type 1 diabetes: the Diabetes Control and Complications Trial/Epidemiology of Interventions and Complications (DCCT/EDIC) cohort. Diabetes Care 2015. [PMID: 26203062 PMCID: PMC4580606 DOI: 10.2337/dc15-0286] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Limited information exists about the influence of urologic complications on health-related quality of life (HRQOL) in patients with type 1 diabetes. RESEARCH DESIGN AND METHODS We studied 664 men and 580 women from the Diabetes Control and Complications Trial/Epidemiology of Interventions and Complications Study: mean ages were 51.6 ± 6.6 and 50.6 ± 7.2 years and duration of diabetes was 29.5 ± 4.8 and 29.8 ± 5.1 years, respectively. We assessed associations of sexual dysfunction, lower urinary tract symptoms (LUTS), and, in women, urinary incontinence (UI) with general quality of life (SF-36), perceived value of health (EuroQol-5), diabetes-related quality of life (Diabetes Quality of Life Scale [DQOL]), and psychiatric symptoms (Symptom Checklist 90-R). RESULTS In both men and women, urologic complications adversely affected HRQOL and psychiatric symptoms, even after accounting for history of depression leading to treatment. Multivariable analyses accounting for the presence of diabetic retinopathy, neuropathy, and nephropathy also revealed substantial independent effects. In men, for example, the odds (95% CI) of a low DQOL score (≤25th percentile) were 3.01 (1.90-4.75) times greater with erectile dysfunction and 2.65 (1.68-4.18) times greater with LUTS and in women, 2.04 (1.25-3.35) times greater with sexual dysfunction and 2.71 (1.72-4.27) times greater with UI/LUTS combined compared with men and women without such complications. Similar effects were observed for the other measures. CONCLUSIONS Sexual dysfunction and urinary complications with type 1 diabetes are associated with decreased quality of life and perceived value of health and with higher levels of psychiatric symptoms, even after accounting for other diabetes complications and depression treatment.
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Affiliation(s)
- Alan M Jacobson
- Research Institute, Winthrop University Hospital, Mineola, NY
| | - Barbara H Braffett
- The Biostatistics Center, The George Washington University, Rockville, MD
| | - Patricia A Cleary
- The Biostatistics Center, The George Washington University, Rockville, MD
| | - Rodney L Dunn
- Department of Urology, University of Michigan, Ann Arbor, MI
| | - Mary E Larkin
- Diabetes Research Center, Massachusetts General Hospital, Boston, MA
| | - Hunter Wessells
- Department of Urology, University of Washington, Seattle, WA
| | - Aruna V Sarma
- Department of Urology, University of Michigan, Ann Arbor, MI
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Minassian VA, Yan XS, Sun H, Platte RO, Stewart WF. Clinical validation of the Bladder Health Survey for urinary incontinence in a population sample of women. Int Urogynecol J 2015; 27:453-61. [PMID: 26386565 DOI: 10.1007/s00192-015-2849-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 09/10/2015] [Indexed: 10/23/2022]
Abstract
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.
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Affiliation(s)
- Vatché A Minassian
- Department of OB/GYN, Brigham and Women's Hospital, 75 Francis Street, ASB1 3 -Room 073, Boston, MA, 02115, USA.
| | | | - Haiyan Sun
- Geisinger Health System, Danville, PA, USA
| | - Raissa O Platte
- Female Pelvic Medicine & Reconstructive Surgery Institute of Michigan, Grand Rapids, MI, USA
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Guerquin B. [Physics of materials and female stress urinary continence: New concepts: I) Elasticity under bladder]. J Gynecol Obstet Hum Reprod 2015; 44:591-596. [PMID: 25865797 DOI: 10.1016/j.jgyn.2015.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Revised: 02/26/2015] [Accepted: 03/09/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Improving the understanding of the adaptation to stress of urinary continence. METHOD A transversal analysis between physics of materials and the female anatomy. Laws of physics of the materials and of their viscoelastic behavior are applied to the anatomy of the anterior vaginal wall. RESULT The anterior vaginal wall may be divided into two segments of different viscoelastic behavior, the vertical segment below the urethra and the horizontal segment below the bladder. If the urethra gets crushed on the first segment according to the hammock theory, the crushing of the bladder on the second segment is, on the other hand, damped by its important elasticity. The importance of this elasticity evokes an unknown function: damping under the bladder that moderates and delays the increase of intravesical pressure. This damping function below the bladder is increased in the cystocele, which is therefore a continence factor; on the other hand, it is impaired in obesity, which is therefore a factor of SUI. CONCLUSION It is necessary to include in the theory of stress continence, the notion of a damping function below the bladder.
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Affiliation(s)
- B Guerquin
- Service de gynécologie-obstétrique, centre hospitalier d'Orange (84100), avenue de Lavoisier, CS20184, 84104 Orange cedex, France.
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135
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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] [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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136
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Kaya S, Akbayrak T, Toprak Çelenay Ş, Dolgun A, Ekici G, Beksaç S. Reliability and validity of the Turkish King’s Health Questionnaire in women with urinary incontinence. Int Urogynecol J 2015. [DOI: 10.1007/s00192-015-2786-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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137
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Xu D, Liu N, Qu H, Chen L, Wang K. Relationships among symptom severity, coping styles, and quality of life in community-dwelling women with urinary incontinence: a multiple mediator model. Qual Life Res 2015. [PMID: 26198664 DOI: 10.1007/s11136-015-1070-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE To investigate the relationships among symptom severity, coping styles, and quality of life (QOL) in community-dwelling women with urinary incontinence (UI). METHODS A total of 592 women with UI participated in this cross-sectional study. Bivariate Pearson's correlation was used to examine the correlations between symptom severity, coping styles, and QOL. Multivariate regression models and Sobel tests were used to test the mediating effect of coping styles. Additionally, a multiple mediator model was used to examine the mediating role of coping styles collectively. All regression models were adjusted for age, education, marital status, income, duration of UI, and type of UI. RESULTS Participants tended to use avoidant and palliative coping styles and not use instrumental coping style. Avoidant and palliative coping styles were associated with poor QOL, and partially mediated the association between symptom severity and QOL. Nearly 73% of the adverse effect of symptom severity on QOL was mediated by avoidant and palliative coping styles. CONCLUSIONS The use of avoidant and palliative coping styles was higher with more severe urine leakage, and QOL tended to be poorer. Coping styles should be addressed in UI management. It may be of particular value to look closely at negative coping styles and implement education and training of patients in improving their coping skills related to managing UI, which will in turn improve their QOL.
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Affiliation(s)
- Dongjuan Xu
- School of Nursing, Shandong University, No. 44, Wenhua Xi Road, Jinan, Shandong, China.,School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Nana Liu
- School of Nursing, Shandong University, No. 44, Wenhua Xi Road, Jinan, Shandong, China
| | - Haili Qu
- Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - Liqin Chen
- School of Nursing, Shandong University, No. 44, Wenhua Xi Road, Jinan, Shandong, China
| | - Kefang Wang
- School of Nursing, Shandong University, No. 44, Wenhua Xi Road, Jinan, Shandong, China.
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138
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Surgical outcome of a repeat midurethral sling procedure after failure of a first procedure. Int Urogynecol J 2015; 26:1759-66. [DOI: 10.1007/s00192-015-2773-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Accepted: 06/22/2015] [Indexed: 10/23/2022]
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139
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Gartland D, MacArthur C, Woolhouse H, McDonald E, Brown SJ. Frequency, severity and risk factors for urinary and faecal incontinence at 4 years postpartum: a prospective cohort. BJOG 2015; 123:1203-11. [DOI: 10.1111/1471-0528.13522] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2015] [Indexed: 11/27/2022]
Affiliation(s)
- D Gartland
- Healthy Mothers Healthy Families Research Group Murdoch Children's Research Institute Melbourne Vic. Australia
| | - C MacArthur
- Public Health, Epidemiology and Biostatistics School of Health and Population Sciences University of Birmingham Birmingham UK
| | - H Woolhouse
- Healthy Mothers Healthy Families Research Group Murdoch Children's Research Institute Melbourne Vic. Australia
| | - E McDonald
- Healthy Mothers Healthy Families Research Group Murdoch Children's Research Institute Melbourne Vic. Australia
| | - SJ Brown
- Healthy Mothers Healthy Families Research Group Murdoch Children's Research Institute Melbourne Vic. Australia
- General Practice and Primary Health Care Academic Centre The University of Melbourne Melbourne Vic. Australia
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140
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Nygaard IE, Shaw JM, Bardsley T, Egger MJ. Lifetime physical activity and female stress urinary incontinence. Am J Obstet Gynecol 2015; 213:40.e1-40.e10. [PMID: 25640047 DOI: 10.1016/j.ajog.2015.01.044] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 01/27/2015] [Indexed: 10/24/2022]
Abstract
OBJECTIVE We sought to estimate whether moderate/severe stress urinary incontinence (SUI) in middle-aged women is associated with overall lifetime physical activity (including leisure, household, outdoor, and occupational), as well as lifetime leisure (recreational), lifetime strenuous, and strenuous activity during the teen years. STUDY DESIGN Recruitment for this case-control study was conducted in primary-care-level family medicine and gynecology clinics. A total of 1538 enrolled women ages 39-65 years underwent a Pelvic Organ Prolapse Quantification examination to assess vaginal support. Based on Incontinence Severity Index scores, cases had moderate/severe and controls had no/mild SUI. We excluded 349 with vaginal descent at/below the hymen (pelvic organ prolapse), 194 who did not return questionnaires, and 110 with insufficient activity data for analysis. In all, 213 cases were frequency matched 1:1 by age group to controls. Physical activity was measured using the Lifetime Physical Activity Questionnaire, in which women recall activity from menarche to present. We created separate multivariable logistic regression models for activity measures. RESULTS SUI odds increased slightly with overall lifetime activity (odds ratio [OR], 1.20 per 70 additional metabolic equivalent of task-h/wk; 95% confidence interval [CI], 1.02-1.41), and were not associated with lifetime strenuous activity (OR, 1.11; 95% CI, 0.99-1.25). In quintile analysis of lifetime leisure activity, which demonstrated a nonlinear pattern, all quintiles incurred about half the odds of SUI compared to reference (second quintile; P = .009). Greater strenuous activity in teen years modestly increased SUI odds (OR, 1.37 per 7 additional h/wk; 95% CI, 1.09-1.71); OR, 1.75; 95% CI, 1.15-2.66 in sensitivity analysis adjusting for measurement error. The predicted probability of SUI rose linearly in women exceeding 7.5 hours of strenuous activity/wk during teen years. Teen strenuous activity had a similar effect on SUI odds when adjusted for subsequent strenuous activity during ages 21-65 years. CONCLUSION In middle-aged women, a slight increased odds of SUI was noted only after substantially increased overall lifetime physical activity. Increased lifetime leisure activity decreased and lifetime strenuous activity appeared unrelated to SUI odds. Greater strenuous activity during teen years modestly increased SUI odds.
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141
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Teunissen DTAM, Stegeman MM, Bor HH, Lagro-Janssen TALM. Treatment by a nurse practitioner in primary care improves the severity and impact of urinary incontinence in women. An observational study. BMC Urol 2015; 15:51. [PMID: 26063179 PMCID: PMC4464223 DOI: 10.1186/s12894-015-0047-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 06/03/2015] [Indexed: 12/05/2022] Open
Abstract
Background Urinary Incontinence (UI) is a common problem in women. The management of UI in primary care is time consuming and suboptimal. Shift of incontinence-care from General Practitioners (GP’s) to a nurse practitioner maybe improves the quality of care. The purpose of this observational (pre/post) study is to determine the effectiveness of introducing a nurse practitioner in UI care and to explore women’s reasons for not completing treatment. Methods Sixteen trained nurse practitioners treated female patients with UI. All patients were examined and referred by the GP to the nurse practitioner working in the same practice. At baseline the severity of the UI (Sandvik-score), the impact on the quality of life (IIQ) and the impressed severity (PGIS) was measured and repeated after three months Differences were tested by the paired t and the NcNemar test. Reasons for not completing treatment were documented by the nurse practitioner and differences between the group that completed treatment and the drop-out group were tested. Results We included 103 women, mean age 55 years (SD 12.6). The Sandvik severity categories improved significantly (P < 0.001), as did the impact on daily life (2.54 points, P = 0.012). Among the IIQ score the impact on daily activities increased 0.73 points (P = 0.032), on social functioning 0.60 points (P = 0.030) and on emotional well-being 0.63 points (P = 0.031). The PGIS-score improved in 41.3 % of the patients. The most important reasons for not completing the treatment were lack of improvement of the UI and difficulties in performing the exercises. Women who withdraw from guidance by the nurse practitioner perceived more impact on daily life (P = 0.036), in particular on the scores for social functioning (P = 0.015) and emotional well-being (P = 0.015). Conclusion Treatment by a trained nurse practitioner seems positively affects the severity of the UI and the impact on the quality of life. Women who did not complete treatment suffer from more impact on quality of life, experience not enough improvement and mention difficulties in performing exercises.
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Affiliation(s)
- Doreth T A M Teunissen
- Department Primary and Community Care, Gender & Women's Health, Radboud University Medical Centre Nijmegen, Internal postal code 118, P.O. Box 9101, , 6500 HB, Nijmegen, The Netherlands.
| | - Marjolein M Stegeman
- Department Primary and Community Care, Gender & Women's Health, Radboud University Medical Centre Nijmegen, Internal postal code 118, P.O. Box 9101, , 6500 HB, Nijmegen, The Netherlands.
| | - Hans H Bor
- Department Primary and Community Care, Gender & Women's Health, Radboud University Medical Centre Nijmegen, Internal postal code 118, P.O. Box 9101, , 6500 HB, Nijmegen, The Netherlands.
| | - Toine A L M Lagro-Janssen
- Department Primary and Community Care, Gender & Women's Health, Radboud University Medical Centre Nijmegen, Internal postal code 118, P.O. Box 9101, , 6500 HB, Nijmegen, The Netherlands.
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The efficacy of electroacupuncture for the treatment of simple female stress urinary incontinence - comparison with pelvic floor muscle training: study protocol for a multicenter randomized controlled trial. Trials 2015; 16:45. [PMID: 25887231 PMCID: PMC4336724 DOI: 10.1186/s13063-015-0560-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 01/09/2015] [Indexed: 11/10/2022] Open
Abstract
Background Previous research has shown that electroacupuncture therapy has a potential therapeutic effect for simple female stress urinary incontinence. In this study, pelvic floor muscle training, the first-line treatment for stress urinary incontinence in women based on meta-analysis of numerous randomized control trials and recommended by international clinical practice, is used as a control group to demonstrate whether electroacupuncture therapy is a better method for female stress urinary incontinence. Methods/design A randomized controlled trial has been designed to evaluate the therapeutic benefit of electroacupuncture for female stress urinary incontinence compared with pelvic floor muscle training. The safety of electroacupuncture and patient compliance will also be evaluated. Untoward reaction to the electroacupuncture, including a broken needle, fainting on acupuncture, or pain during acupuncture, will be recorded and the therapy will be stopped if an untoward reaction occurs. After we have received full ethical approval and patient consent, participants will be randomized to receive a series of 24 electroacupuncture or pelvic floor muscle training interventions. The frequency and amount of leakage will be measured as the primary outcome parameters. Secondary outcome parameters include the 1-hour pad test, the short-form of the International Consultation on Incontinence Questionnaire, patient subjective effectiveness evaluation, weekly usage of pad, and usage of specialty therapy for female stress urinary incontinence. Discussion This trial will help to determine whether electroacupuncture is a more effective treatment than pelvic floor muscle training for patients with female stress urinary incontinence. Trial registration ClinicalTrials.gov NCT01940432 (12 September 2013). Electronic supplementary material The online version of this article (doi:10.1186/s13063-015-0560-1) contains supplementary material, which is available to authorized users.
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143
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Kirby AC, Tan-Kim J, Nager CW. Dynamic maximum urethral closure pressures measured by high-resolution manometry increase markedly after sling surgery. Int Urogynecol J 2015; 26:905-9. [PMID: 25636909 DOI: 10.1007/s00192-014-2622-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 12/30/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The premise of midurethral sling (MUS) surgery is to apply a tension-free vaginal tape in the midurethra that does not constrict the urethra at rest but stabilizes the urethra and prevents downward descent and opening of the urethra during stress maneuvers, but current technology has limitations in measuring urethral pressures during dynamic conditions. Our objective was to describe the change in maximum urethral closure pressures (MUCPs) after MUS surgery using an 8F high-resolution manometry (HRM) system that can measure urethral pressures during cough and strain maneuvers (ManoScan® ESO; Covidien) without migration or withdrawal limitations. METHODS We measured rest, cough, and strain MUCPs in 26 women before and after retropubic or transobturator MUS for stress urinary incontinence using the HRM system. RESULTS The objective success rate after MUS was 92.3 % based on postoperative cough stress testing. Mean resting MUCPs measured by HRM did not change after surgery (59.3 before vs. 59.7 cm H2O after surgery; p = 1.0). Mean cough MUCPs measured by HRM increased from 36.9 to 100.7 cm H2O (p < 0.001), and strain MUCPs increased from 35.0 to 92.7 cm H2O (p < 0.001). CONCLUSIONS Advanced HRM technology to measure MUCPs under cough and strain conditions without withdrawal techniques provides new insights into the continence mechanism after tension-free MUS: MUCPs do not change at rest but do increase significantly during cough and strain maneuvers.
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Affiliation(s)
- Anna C Kirby
- Department of Obstetrics and Gynecology, Division of Urogynecology, University of Washington Medical Center, 1959 NE Pacific St, UW Box 356460, Seattle, WA, 98195, USA,
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Jung J, Park B, Lee JA, You S, Alraek T, Bian ZX, Birch S, Kim TH, Xu H, Zaslawski C, Kang BK, Lee MS. Standardization and future directions in pattern identification research: International brainstorming session. Chin J Integr Med 2014; 22:714-20. [PMID: 25491542 DOI: 10.1007/s11655-014-1989-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Indexed: 10/24/2022]
Abstract
An international brainstorming session on standardizing pattern identification (PI) was held at the Korea Institute of Oriental Medicine on October 1, 2013 in Daejeon, South Korea. This brainstorming session was convened to gather insights from international traditional East Asian medicine specialists regarding PI standardization. With eight presentations and discussion sessions, the meeting allowed participants to discuss research methods and diagnostic systems used in traditional medicine for PI. One speaker presented a talk titled "The diagnostic criteria for blood stasis syndrome: implications for standardization of PI". Four speakers presented on future strategies and objective measurement tools that could be used in PI research. Later, participants shared information and methodology for accurate diagnosis and PI. They also discussed the necessity for standardizing PI and methods for international collaborations in pattern research.
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Affiliation(s)
- Jeeyoun Jung
- Medical Research Division, Korea Institute of Oriental Medicine, Daejeon, 305-811, South Korea
| | - Bongki Park
- Medical Research Division, Korea Institute of Oriental Medicine, Daejeon, 305-811, South Korea
| | - Ju Ah Lee
- Medical Research Division, Korea Institute of Oriental Medicine, Daejeon, 305-811, South Korea
| | - Sooseong You
- Medical Research Division, Korea Institute of Oriental Medicine, Daejeon, 305-811, South Korea
| | - Terje Alraek
- National Research Center in Complementary and Alternative Medicine, Department of Community Medicine, UiT The Artic University of Norway, Tromso, 9037, Norway.,University College of Health Sciences, Campus Kristiania, Institute of Acupuncture, Oslo, 0855, Norway
| | - Zhao-Xiang Bian
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong SAR, China
| | - Stephen Birch
- University College of Health Sciences, Campus Kristiania, Institute of Acupuncture, Oslo, 0855, Norway
| | - Tae-Hun Kim
- College of Oriental Medicine, Gachon University, Seongnam, 461-701, South Korea
| | - Hao Xu
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Chris Zaslawski
- College of Traditional Chinese Medicine, University of Technology, Sydney, Post Box 123, Australia
| | - Byoung-Kab Kang
- Medical Research Division, Korea Institute of Oriental Medicine, Daejeon, 305-811, South Korea
| | - Myeong Soo Lee
- Medical Research Division, Korea Institute of Oriental Medicine, Daejeon, 305-811, South Korea.
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145
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Minassian VA, Sun H, Yan XS, Clarke DN, Stewart WF. The interaction of stress and urgency urinary incontinence and its effect on quality of life. Int Urogynecol J 2014; 26:269-76. [PMID: 25278207 DOI: 10.1007/s00192-014-2505-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 08/30/2014] [Indexed: 10/24/2022]
Abstract
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.
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146
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Short-term effect of adding pelvic floor muscle training to bladder training for female urinary incontinence: a randomized controlled trial. Int Urogynecol J 2014; 26:285-93. [PMID: 25266357 DOI: 10.1007/s00192-014-2517-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 09/14/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The aim of this study was to assess whether bladder training (BT) combined with high-intensity pelvic floor muscle training (BT + PFMT) results in better outcomes in the short term than BT alone on female urinary incontinence (UI). METHODS We randomly assigned 108 women with diagnoses of stress UI (SUI, n = 50), urgency UI (UUI, n = 16), or mixed UI (MUI, n = 42) to 6 weeks of BT + PFMT or BT alone (control group). The primary outcome measure was self-reported improvement. Secondary outcome measures were UI severity, symptom distress, quality of life (QOL), mean number of UI episodes and micturitions per day, and pelvic floor muscle strength and endurance (PFME). RESULTS Overall and in the SUI and MUI subgroups, significantly more patients in the BT + PFMT group reported cured and improved symptoms. Overall and in SUI patients, the BT + PFMT group also improved to significantly greater degree in UI severity, symptom distress, QOL, daily UI episodes, and PFME. The only parameter showing more improvement in patients with UUI was QOL, and UI severity in patients with MUI (p < 0.05). There were no other significant differences between the two study groups in overall and subgroup analysis (p > 0.05). CONCLUSIONS High-intensity PFMT combined with BT is more effective than BT alone in the short term for treating UI or SUI. It appears that the combination therapy may also lead to greater benefits for patients with UUI and MUI. Based on the results of this study, further studies with larger sample sizes (for UUI) and long-term follow-ups are warranted.
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147
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Xu D, Wang X, Li J, Wang K. The mediating effect of 'bothersome' urinary incontinence on help-seeking intentions among community-dwelling women. J Adv Nurs 2014; 71:315-25. [PMID: 25212267 DOI: 10.1111/jan.12514] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2014] [Indexed: 11/29/2022]
Abstract
AIM To explore the mediating effect of bother of urinary incontinence between urinary incontinence severity and help-seeking intentions and detect whether the International Consultation on Incontinence Questionnaire-UI Short Form could be a valid measure to delineate bothersome urinary incontinence. BACKGROUND Urinary incontinence is a common condition among women, which has a profound adverse effect on quality of life. However, many of them experiencing significant clinical symptoms do not seek medical help. DESIGN A cross-sectional survey design. METHODS Women with urinary incontinence (N = 620) from three randomized selected community health service centres from May-October 2011 participated in the study. Data were collected using a pencil-and-paper questionnaire. Multivariate regression models were used to test the role of bother as a mediator in the relation between urinary incontinence severity and help-seeking intentions. Receiver operating characteristic analysis was used to find the best cut-off International Consultation on Incontinence Questionnaire-UI Short Form score (range: 0-21) to delineate the bother of urinary incontinence. RESULTS Bothersome urinary incontinence mediated the relationship between urinary incontinence severity and help-seeking intentions. Age and duration of urine leakage had a negative association on help-seeking intentions, while educational level and previous help-seeking behaviours had a positive association. CONCLUSIONS Bother was a mediator in the relation between urinary incontinence severity and help-seeking intentions. The International Consultation on Incontinence Questionnaire-UI Short Form was a discriminative measure to delineate the bothersome urinary incontinence.
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Affiliation(s)
- Dongjuan Xu
- School of Nursing, Shandong University, Jinan, China; School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
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148
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Liu B, Wang Y, Xu H, Chen Y, Wu J, Mo Q, Liu Z. Effect of electroacupuncture versus pelvic floor muscle training plus solifenacin for moderate and severe mixed urinary incontinence in women: a study protocol. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2014; 14:301. [PMID: 25128002 PMCID: PMC4141945 DOI: 10.1186/1472-6882-14-301] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Accepted: 08/11/2014] [Indexed: 11/20/2022]
Abstract
Background In women with mixed urinary incontinence, pelvic floor muscle training and solifenacin is the recommended conservative treatment, while electroacupuncture is a safe, economical and effective option. Methods/Design In this prospective, multi-center, randomized controlled trial, five hundred women with mixed urinary incontinence, from 10 centers will be randomized to receive either electroacupuncture or pelvic floor muscle training plus solifenacin. Women in the acupuncture group will receive electroacupuncture for 3 sessions per week, over 12 weeks, while women in the control group will receive pelvic floor muscle training plus solifenacin (5 mg once daily) for 36 weeks. The primary outcome measure is the proportion of change in 72-hour incontinence episode frequency from baseline to week 12. The secondary outcome measures include eleven items, including proportion of participants with ≥50% decrease in average 72-h incontinence episode frequency, change from baseline in the amount of urine leakage and proportion of change from baseline in 72-h incontinence episode frequency in week 25–36, and so forth. Statistical analysis will include covariance analysis, nonparametric tests and t tests. Discussion The objective of this trial is to compare the efficacy and safety of electroacupuncture versus pelvic floor muscle training plus solifenacin in women with moderate and severe mixed urinary incontinence. Trial registration ClinicalTrials.gov Identifier: NCT02047032
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Voiding characteristics and related hormonal changes in peri-menopausal and post-menopausal women: a preliminary study. Maturitas 2014; 79:311-5. [PMID: 25150899 DOI: 10.1016/j.maturitas.2014.07.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 07/09/2014] [Accepted: 07/11/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To characterize voiding symptoms during the peri- and post-menopausal periods and to investigate related hormonal changes. METHODS We enrolled a total of 55 patients between February 10, 2013, and August 15, 2013, to participate in this cross-sectional study. To characterize patients' voiding symptoms, we administered voiding questionnaires, including the International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score (OABSS), and Sandvik Severity Index. Measured hormones included E2, FSH, TSH, prolactin, progesterone, and testosterone. RESULTS In the univariate analysis, there were significant intergroup differences for all of the hormones except progesterone. Among the voiding symptoms, straining (IPSS question 1), frequency (IPSS question 2), and SUI were significantly different between the two groups (p=0.039. 0.010, and 0.017, respectively). In the multivariate analysis, frequency (IPSS question 2) and SUI were significantly different between the two groups (p=0.020 and 0.011, respectively). Among the hormones, only testosterone was marginally different between the two groups (p=0.059). CONCLUSIONS During the transition to menopause, voiding symptoms, such as frequency, can potentially worsen in the peri-menopausal period, and SUI is more prevalent in the post-menopausal period. Additionally, testosterone may have a role in voiding changes that occur during the menopausal transition.
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150
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Brown S, Gartland D, Perlen S, McDonald E, MacArthur C. Consultation about urinary and faecal incontinence in the year after childbirth: a cohort study. BJOG 2014; 122:954-62. [DOI: 10.1111/1471-0528.12963] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2014] [Indexed: 11/26/2022]
Affiliation(s)
- S Brown
- Healthy Mothers Healthy Families Research Group; Murdoch Children's Research Institute; Parkville Vic. Australia
- General Practice and Primary Health Care Academic Centre; University of Melbourne; Melbourne Vic. Australia
| | - D Gartland
- Healthy Mothers Healthy Families Research Group; Murdoch Children's Research Institute; Parkville Vic. Australia
| | - S Perlen
- Healthy Mothers Healthy Families Research Group; Murdoch Children's Research Institute; Parkville Vic. Australia
| | - E McDonald
- Healthy Mothers Healthy Families Research Group; Murdoch Children's Research Institute; Parkville Vic. Australia
| | - C MacArthur
- Public Health, Epidemiology and Biostatistics; School of Health and Population Sciences; College of Medical and Dental Sciences; University of Birmingham; Birmingham UK
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