Impact of stress urinary incontinence and overactive bladder on micturition patterns and health-related quality of life

The role of in-person focus groups in the management of urinary incontinence in women from a mixed-methods, randomized pilot study

PURPOSE

To assess the quantitative and qualitative components of in-person focus groups as a potential intervention for female patients with urinary incontinence.

METHODS

Women over the age of 18 seeking treatment for UI were randomized to standard care with focus group participation or to standard care alone. All participants completed validated questionnaires: MESA, UDI-6, OAB-SAT-q, PGI-S, PGI-I, SQoL-F, PHQ-9, IPAQ at the beginning and conclusion of the study. Questionnaires were analyzed with repeated measures of ANOVA models in an intention-to-treat manner. Three moderated focus group sessions were held and audio recorded. Recordings were transcribed and categorized by frequency into themes using grounded theory methodology.

RESULTS

A total of ten control and eight intervention participants agreed to participate. Seven women attended all three focus group sessions and were included in the final analysis. Transcripts from focus group sessions observed women identified most with (1) urinary incontinence (UI) as a chronic disease, (2) shame managing UI, and (3) social constraints of toileting. Participants self-reported appreciation of focus group participation and desire for on-going sessions. Analysis of the questionnaires did not demonstrate statistically significant differences.

CONCLUSION

Data ascertained from questionnaires were unable to demonstrate a meaningful effect in improved treatment outcomes for control and intervention participants. Grounded theory analysis of transcripts identified four primary themes: (1) appreciation of the focus group, (2) UI as a gendered issue, (3) lack of public awareness, and (4) history of negative provider interactions. All focus group participants self-reported interest in attending future focus group sessions.

Urinary incontinence and quality of life: a systematic review and meta-analysis

BACKGROUND

Urinary incontinence (UI) and low quality of life (QoL) are two common conditions. Some recent literature proposed that these two entities can be associated. However, no attempt was made to collate this literature. Therefore, the aim of this study was to conduct a systematic review and meta-analysis of existing data to estimate the strength of the association between UI and QoL.

METHODS

An electronic search of major databases up to 18th April 2020 was carried out. Meta-analysis of cross-sectional and case-control studies comparing mean values in QoL between patients with UI and controls was performed, reporting random-effects standardized mean differences (SMDs) ± 95% confidence intervals (CIs) as the effect size. Heterogeneity was assessed with the I2.

RESULTS

Out of 8279 articles initially screened, 23 were finally included for a total of 24,983 participants, mainly women. The mean age was ≥ 50 years in 12/23 studies. UI was significantly associated with poor QoL as assessed by the short-form 36 (SF-36) total score (n = 6 studies; UI: 473 vs. 2971 controls; SMD = - 0.89; 95% CI - 1.3 to - 0.42; I2 = 93.5) and by the sub-scales of SF-36 and 5/8 of the domains included in the SF-36. Similar results were found using other QoL tools. The risk of bias of the studies included was generally high.

CONCLUSIONS

UI is associated with a poor QoL, with a strong level of certainty. This work, however, mainly based on cross-sectional and case-control studies, highlights the necessity of future longitudinal studies for better understanding the importance of UI on QoL.

Predictors of persistent stress urinary incontinence after transvaginal mesh repair

BACKGROUND

We evaluated the effect of transvaginal mesh (TVM) surgery for voiding function and continence using noninvasive examination and questionnaire. The present study aimed to ascertain which categories of patients need concomitant mid-urethral sling (MUS) after TVM surgery.

METHODS

We included women who underwent TVM procedure between November 2009 and October 2013. Data from noninstrumented uroflowmetry and questionnaires about urinary symptoms were analyzed.

RESULTS

The present study investigated the cases of 961 women who underwent TVM surgery. The persistence of stress urinary incontinence (SUI) was 57.6%. Almost all the parameters measured using uroflowmetry and questionnaires significantly improved in all types of urinary incontinence 12 months after surgery. A history of hysterectomy, preoperative high flow (corrected maximum flow rate > 1.5), and preoperative urge urinary incontinence were independent risk factors for the persistence of SUI.

CONCLUSIONS

TVM for pelvic organ prolapse improved subjective and objective voiding function. Mixed urinary incontinence (MUI) patients with high urinary flow may be suitable for concomitant MUS with TVM because of the high level of SUI persistence.

Coffee intake, health-related quality of life, and associated factors of overactive bladder in older Korean women living in rural South Korea

Overactive bladder (OAB) is a common health problem in older women. The aim of the study was to investigate coffee consumption, health-related quality of life (HRQOL), and associated factors of OAB in older Korean women living in rural South Korea. A total of 248 women aged 65 years and older participated in this study. Chi-square tests, t-tests, and multivariable logistic regressions were performed. The means of coffee consumption between OAB and non-OAB groups were not significantly different. Women with OAB showed significantly lower HRQOL than women with stress urinary incontinence only. OAB was associated with high body mass index and poor health status.

The Impact of Stress Urinary Incontinence on Individual Components of Quality of Life in Malaysian Women

OBJECTIVE

To assess the impact of stress urinary incontinence (SUI) on individual components of quality of life (QoL) using both condition-specific and generic questionnaires, and to compare the results of the 2 instruments with a control group.

METHODS

Women with or without SUI aged ≥21 years old were recruited. Subjects completed the International Consultation of Incontinence-Urinary Incontinence Short Form (ICIQ-UI-SF), International Consultation of Incontinence-Lower Urinary Tract Symptoms Quality of Life (ICIQ-LUTSqol), and EQ-5D questionnaires.

RESULTS

A total of 120 women with SUI and 145 controls participated. The ICIQ-LUTSqol total score (mean ± standard deviation) was significantly higher in the SUI group (38.96 ± 10.28) compared with the control group (20.78 ± 2.73) (P <.001). When adjusted for significant confounders, the SUI group continued to have significantly poorer QoL compared with the control group (P <.001). The negative effect of SUI on "physical activities" and "jobs" were the 2 most frequently reported and burdensome components of the ICIQ-LUTSqol, with approximately 50% of women with SUI affected "moderately" or "a lot." When measured using the EQ-5D questionnaire, there were significantly higher percentages of patients with SUI who had problems with usual activities, pain or discomfort, and anxiety or depression (P <.05).

CONCLUSION

Women suffering from SUI have significantly poorer QoL compared with continent women when measured using both condition-specific and generic QoL measures. Clinicians should pay closer attention to the impact of SUI on individual components of QoL, particularly limitations on physical activities and jobs, which were the 2 most impairing and frequently reported components of QoL.

Association of lower urinary tract symptoms and OAB severity with quality of life and mental health in China, Taiwan and South Korea: results from a cross-sectional, population-based study

Background

Lower urinary tract symptoms (LUTS) and overactive bladder (OAB) symptoms have a substantial effect on quality of life (QoL). We report QoL and mental health results from a LUTS prevalence study in three Asian countries.

Methods

A cross-sectional, population-representative, internet-based study among individuals aged ≥40 years in China, Taiwan and South Korea. Instruments included: Overactive Bladder Symptom Score (OABSS); International Prostate Symptom Score (IPSS); other International Continence Society (ICS) symptom questions; health-related QoL 12-item short-form (HRQoL-SF12v2); Work Limitations Questionnaire (WLQ); Hospital Anxiety and Depression Scale (HADS). Presence of LUTS was determined according to ICS criteria, with three symptom groups (storage, voiding and post-micturition). Post-stratification weighting matched the age and sex population distribution per country. Initial data analyses were based on descriptive statistics. Significance testing undertaken post hoc included: independent-samples t-test (differences in HRQoL between sexes and between individuals with/without LUTS; relationship between HRQoL score and OABSS; differences in HADS anxiety and depression scores between individuals with/without LUTS; association between HADS anxiety/depression scores and OABSS), chi-square test (association between LUTS prevalence and workplace productivity) and analysis of variance (differences in HRQoL score and in HADS anxiety/depression scores between individuals with different symptom groups, association between HADS anxiety/depression scores and IPSS).

Results

In total, 8284 participants were included. HRQoL scores were significantly worse (p < 0.001) among individuals with versus without LUTS (ICS criteria): mean physical health domain scores were 61.1 (standard deviation [SD], 20.1) and 76.7 (17.0), respectively; corresponding mental health domain scores were 34.8 (12.7) and 43.7 (10.7). Workplace productivity was best among individuals without LUTS (difficulties reported by 2–3% of individuals), and worst in those with all three ICS symptom groups (difficulties reported by 29–38% of individuals; p = 0.001). Mean HADS scores showed significantly worse (p < 0.001) levels of anxiety and depression among individuals with versus without LUTS: anxiety, 6.5 (SD, 3.7) and 4.0 (3.3); corresponding mean depression scores were 6.8 (4.3) and 4.2 (3.6). Increasing OAB severity was also associated with decreasing HRQoL physical and mental health scores.

Conclusion

LUTS and increasing OAB severity are both associated with impaired QoL, reduced workplace productivity, and increased tendency towards anxiety and depression. These results highlight the need to ensure that individuals with LUTS receive appropriate, effective treatment.

Trial registration

ClinicalTrials.gov identifier: NCT02618421, registered 26 November 2015 (retrospectively registered).

Effect of pulsed magnetic stimulation on quality of life of female patients with stress urinary incontinence: an IDEAL-D stage 2b study

INTRODUCTION AND HYPOTHESIS

We evaluated the effects of pulsed magnetic stimulation (PMS) on overall and different aspects of quality of life (QoL) in female patients with stress urinary incontinence (SUI).

METHODS

This study involved 120 female SUI subjects aged ≥21 years old randomized to either active or sham PMS. Treatment involved two PMS sessions per week for 2 months (16 sessions). After 2 months, subjects could opt for 16 additional sessions regardless of initial randomization. The primary response criterion was a 7-point reduction in the total score of the International Consultation on Incontinence Questionnaire-Lower Urinary Tract Symptoms Quality of Life (ICIQ-LUTSqol) questionnaire. Follow-ups were conducted at months 1, 2, 5, 8, and 14.

RESULTS

At 2 months, 35 out of 60 (58%) subjects in the active arm and 21 out of 60 (21%) in the sham arm were treatment responders (≥7-point reduction) (p = 0.006). There was a significant difference in changes in the mean ± SE ICIQ-LUTSqol total score between the active and sham arms (M_diff = -8.74 ± 1.25 vs -4.10 ± 1.08, p = 0.006). At 1-year post-treatment, regardless of number of PMS sessions (16 or 32 sessions), subjects who received active PMS (63 out of 94, 67%) were more likely to be treatment responders compared with subjects who did not receive any active PMS (3 out of 12, 25%; p < 0.001). The impact of PMS treatment was the greatest on the "physical activities" domain.

CONCLUSIONS

PMS resulted in significant short- and long-term improvements in overall and various physical, social, and psychological aspects of QoL.

[Consensus document on overactive bladder in older patients]

Overactive nladder (OAB) is a clinical entity with a high prevalence in the population, having a high impact on quality of life, especially when it occurs with urge urinary incontinence. It is very important to highlight the low rate of consultation of this condition by the older population. This appears to depend on several factors (educational, cultural, professional), and thus leads to the low percentage of older patients who receive appropriate treatment and, on the other hand, a large percentage of older patients with a significant deterioration in their quality of life. Therefore, Scientific societies and Working Groups propose the early detection of OAB in their documents and clinical guidelines. Its etiology is not well known, but is influenced by cerebrovascular processes and other neurological problems, abnormalities of the detrusor muscle of bladder receptors, and obstructive and inflammatory processes of the lower urinary tract. Its diagnosis is clinical, and in the great majority of the cases it can be possible to establish its diagnosis and etiopathogenic orientation, without the need for complex diagnostic procedures. Currently, there are effective treatments for OAB, and we should decide the most appropriate for each elderly patient, based on their individual characteristics. Based on the main clinical practice guidelines, a progressive treatment is proposed, with the antimuscarinics being the most recommended drug treatment. Therefore, a group of very involved professionals in clinical practice for the elderly, and representing two scientific Societies (Spanish Society of Geriatrics and Gerontology [SEGG], and the Spanish Society of Primary Care Physicians [SEMERGEN]) developed this consensus document with the main objective of establishing practices and valid strategies, focused to simplify the management of this clinical entity in the elderly population, and especially to improve their quality of life. The recommendations presented in this consensus document are the result of a comprehensive review and critical discussion of articles, documents and clinical guidelines on OAB, both nationally and internationally. Are, where possible, levels of evidence and grades of recommendation are included.

The psychological impact of overactive bladder: A systematic review

This review aimed to provide an overview of the current research on the psychological impact of overactive bladder. A systematic search yielded 32 papers. It was found that people with overactive bladder tended to have greater levels of depression, anxiety and embarrassment/shame; difficulties with social life; impact on sleep and sexual relationships; and a lower quality of life than people without overactive bladder. A psychological impact on family members was also found. Psychological health should be considered an important aspect of managing overactive bladder and further research is required to determine how best to provide psychological care and support in this area.

Impact on quality of life of urinary incontinence and overactive bladder: a systematic literature review

The paper provides a systematization of the scientific evidence on quality of life of patients affected by urinary incontinence (UI) and overactive bladder (OAB) through a systematic literature review. A single search strategy was performed through the databases and papers collected are reviewed by independent researchers finally, including 39 papers. A strong heterogeneity of studies emerged from the evidence. The multidimensionality of the consequences produced by UI and OAB increased the attention on the identification of the most affected dimension of life quality (i.e. physical, emotional) and on the attempt of predicting life quality impairment through specific variables.

Reliability and validity of the King's Health Questionnaire for lower urinary tract symptoms in both genders

OBJECTIVE

To investigate the reliability and validity of the King's Health Questionnaire (KHQ) in both genders, which was originally developed as a health-related quality of life (HRQoL) questionnaire for female urinary incontinence for general lower urinary tract symptoms (LUTS).

SUBJECTS AND METHODS

Data from the International Prostate Symptom Score (IPSS) and KHQ obtained from 179 men and 75 women consulting urologists (Sample A) were analysed. Cronbach's alpha coefficient and inter-domain correlation were calculated for reliability and validity assessment, respectively. Factor analysis was used to explore the underlying factor structure of the KHQ. KHQ scores of sample A were compared with those of 330 men and 418 women consulting general practitioners (Sample B).

RESULTS

Internal consistency of KHQ was acceptable with a Crohnbach's alpha of 0.721-0.915 in the total population of sample A. Correlation analysis showed convergent validity among 'Physical Limitations', 'Role Limitation' and 'Social Limitations' and discriminant validity among 'Personal Relationship', 'Emotion's and 'Sleep/Energy'. Factor analysis showed three underlying components to explain convergent and discriminant validity. In both sample A and sample B, HRQoL was impaired in the eight domains according to IPSS severity. KHQ scores of domains other than 'General Health Perception' in sample B were lower than those in sample A.

CONCLUSION

The KHQ can be used as a HRQoL questionnaire for LUTS in both genders. In the future, it is expected that the KHQ could be used in clinical studies for benign prostate hyperplasia and other conditions.

The impact of fecal and urinary incontinence on quality of life 6 months after childbirth

OBJECTIVE

The objective of the study was to investigate the impact of postpartum fecal incontinence (FI) and urinary incontinence (UI) on quality of life (QOL).

STUDY DESIGN

Seven hundred fifty-nine primiparous women in the Childbirth and Pelvic Symptoms study were interviewed 6 months postpartum. FI and UI were assessed with validated questionnaires. We measured QOL with SF-12 summary scores, health utility index score (a measure of self-rated overall health), and the modified Manchester Health Questionnaire.

RESULTS

Women with FI had worse self-rated health utility index scores (85.1 +/- 9.8 vs 88.0 +/- 11.6, P = .02) and Medical Outcomes Study Short Form Health Survey (SF-12) mental summary scores (46.8 +/- 9.2 vs 51.1 +/- 8.7, P < .0001) than women without FI or flatal incontinence. Women with UI had worse SF-12 mental summary scores (48.3 +/- 9.8 vs 51.6 +/- 7.8, P < .01) and self-rated health utility index scores (84.1 +/- 12.5 vs 88.7 +/- 10.1, P < .01) than women without UI. Women with both FI and UI had the lowest SF-12 mental summary scores (44.5 +/- 9.0).

CONCLUSION

Six months after delivery, women experiencing FI or UI reported negative effects on health-related QOL. FI and UI together have a greater impact than either condition alone.

Follow-up of TVT operations in 1,113 women with mixed urinary incontinence at 7 and 38 months

A follow-up was done 7 and 38 months after tension-free vaginal tape (TVT) operation in 1,113 women with mixed urinary incontinence. Mixed incontinence and predominant bother were subjectively defined. The results were analyzed according to the women's predominant bother: stress incontinence, urge incontinence, or stress and urge incontinence equally. Across the groups, stress incontinence was cured in 87 and 83% of the women at 7 and 38 months, respectively, with no difference between the three groups. Women with predominant stress incontinence had significantly better results at both 7 and 38 months than those in the other groups, especially those predominantly bothered by urge incontinence. Women with mixed incontinence were significantly more often cured both objectively and subjectively at 7 than 38 months. Only 11% of the women experienced an increase in urge incontinence 38 months after TVT. Before a TVT operation, women with mixed urinary incontinence should be informed that their prognosis depends on their predominant bother. TVT is an appropriate treatment in mixed urinary incontinence, but women with predominant urge incontinence have poorer results than those with predominant stress incontinence.