Risk factors for urinary incontinence in Taiwanese women aged 60 or over

Predicting urinary incontinence in women in later life: A systematic review

Urinary incontinence (UI) affects 10-40% of the population and treatment costs in the UK are estimated to be £233 million per annum. A systematic review of online medical databases between July 1974 and 2016 was conducted to identify studies that had investigated risk and prediction strategies of UI in later life. Eighteen prospective longitudinal studies fulfilled the search criteria. These were analysed systematically (as per the PRISMA checklist) and bias risk through study design was minimised where possible upon data analysis. One paper proposed a predictive assessment tool called the 'continence index'. It was derived following secondary analysis of a cohort study and its predictive threshold had suboptimal sensitivity (79%) and specificity (65%) rates. Seventeen studies identified multiple strong risk factors for UI but despite a large selection of papers on the topic, no robust risk assessment tool prospectively identified patients at risk of UI in later life. Thus more research in this field is required. Clinicians should be aware particularly of modifiable UI risk factors to help reduce the clinical burden of UI in the long term.

Obesity and urinary incontinence

Obesity is growing at an alarming rate worldwide. It poses a major health problem that in turn places a huge financial burden on health services. Medical conditions such as diabetes mellitus and ischaemic heart disease are commonly associated with obesity but less well documented is the association between obesity and urinary incontinence. This article reviews the current literature to see whether: (1) obesity predisposes to urinary incontinence; (2) weight loss improves urinary incontinence and (3) obesity affects the surgical outcome. It also covers the surgical and anaesthetic implications of obesity. New minimally invasive surgical techniques make surgical risks acceptable for the obese patient but the anaesthetic risks remain high. Obese patients should not be denied surgery but be made aware of the higher risks. Future research should focus on the impact of obesity on surgical outcomes for continence surgery particularly on intraoperative and postoperative complication rates as well as long-term cure rates.