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Sun D, He H, Luo B, Xie B. The association between weight-adjusted-waist index and stress urinary incontinence in female adults: a population-based study. Int Urol Nephrol 2024; 56:1851-1858. [PMID: 38289545 DOI: 10.1007/s11255-023-03928-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 12/24/2023] [Indexed: 05/14/2024]
Abstract
INTRODUCTION Obesity has a significant impact on female stress urinary incontinence. The weight-adjusted-waist index (WWI), a newly explored metric for measuring physical obesity and stress urine incontinence, has not been investigated. METHODS Cross-sectional data were obtained from the 2011 to 2018 National Health and Nutrition Examination Survey (NHANES) of participants with complete data for WWI and SUI. The independent connection between WWI and SUI was examined using weighted multivariable logistic regression analyses. Smoothed curve fitting was used to study their relationship. In addition, subgroup analyses were performed, and interaction tests were undertaken. RESULTS In 2,361 female participants over 20, WWI and SUI showed a positive association. Model 3 found that for each one-unit increase in WWI, SUI prevalence increased by 38% [1.38 (1.20, 1.59)]. The prevalence of SUI was 84% higher among participants in the highest quartile of WWI compared to those in the lowest quartile [1.84 (1.32, 2.57)]. Observed nonlinear positive correlation between WWI and SUI was revealed through smoothed curve fitting. In addition, we found that WWI was more strongly associated with SUI than traditional indicators of obesity, including BMI and weight. CONCLUSIONS Females with higher weight-adjusted waist index levels were more likely to develop stress urinary incontinence and have a stronger correlation than traditional indicators of obesity. According to our research, WWI may help detect women's stress urinary incontinence (SUI), and managing obesity through the WWI index may reduce SUI prevalence rates.
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Affiliation(s)
- Dakai Sun
- Department of Urology Surgery, The Second People's Hospital of Qujing, Yunnan, China
| | - Haoyang He
- Department of Urology Surgery, The Second People's Hospital of Qujing, Yunnan, China
| | - Baqiang Luo
- Department of Urology Surgery, The Second People's Hospital of Qujing, Yunnan, China
| | - Botao Xie
- Department of Urology Surgery, The Second People's Hospital of Qujing, Yunnan, China.
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Shen SH, Zeng X, Zhang J, Shen H, Luo DY. Correlation between obesity-related measurements and initial and initial resting intravesical and abdominal pressures in urodynamic study using air-filled catheter system. Neurourol Urodyn 2023; 42:1647-1654. [PMID: 37718613 DOI: 10.1002/nau.25288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 07/18/2023] [Accepted: 09/05/2023] [Indexed: 09/19/2023]
Abstract
OBJECTIVES To establish the initial (before pressure equilibrium) and initial resting intravesical and abdominal pressure in the sitting position using air-filled catheters, to assess the correlation between these pressures and obesity-related measurements, and to estimate if obesity-related measurements can be a guide to interpret initial and initial resting pressures in urodynamic testing. METHODS Patients with non-neurogenic lower urinary tract symptoms referred for urodynamic testing in our center were consecutively enrolled in a prospective study from August 2022 to October 2022. The correlation between the initial and initial resting pressures (before and after pressure equilibrium) and obesity-related measurements were analyzed using Pearson's correlation coefficient and multiple linear regression analysis. RESULTS Ninety-eight patients aged 56 ± 16 were studied. The 95% range of the initial intravesical and abdominal pressure were 18-42 cmH2 O and 21-60 cmH2 O, respectively. The initial resting intravesical, abdominal, and detrusor pressure in the 95% range were 17-41, 16-42, and -5 to 4 cmH2 O, respectively. Over the multiple analysis, abdominal fat thickness, and body mass index (BMI) correlated independently with initial intravesical pressure, and only visceral fat grade correlated with initial abdominal pressure. BMI correlated independently with initial resting intravesical pressure. CONCLUSIONS Our results determined the ranges of values of both initial and initial resting pressures in the air-charged system. Meanwhile, the present study indicated the obesity-related measurements may be used as a guide to interpret the initial and initial resting pressures in urodynamic testing, and may provide a reference for the quality control of these pressures.
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Affiliation(s)
- Si-Hong Shen
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Xiao Zeng
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Jie Zhang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Hong Shen
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - De-Yi Luo
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
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Chilaka C, Toozs-Hobson P, Chilaka V. Pelvic floor dysfunction and obesity. Best Pract Res Clin Obstet Gynaecol 2023; 90:102389. [PMID: 37541114 DOI: 10.1016/j.bpobgyn.2023.102389] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 06/27/2023] [Accepted: 07/06/2023] [Indexed: 08/06/2023]
Abstract
Obesity is a growing condition within the society and more patients, who have underlying obesity, are presenting with lower urinary tract symptoms (LUTS) and pelvic floor dysfunction (PFD). The effect of obesity on general health has been well documented, and its impact on the cardiovascular, endocrine, and musculoskeletal systems has been extensively studied. There is now a growing body of evidence on the effects of obesity on the female urogenital system. It seems to influence the prevalence, presentation, assessment, management, and outcome of various types of LUTS and PFD. A holistic approach is needed to assess and manage these patients. A clear understanding of the functions of the pelvic floor and the way it can be affected by obesity is essential in providing holistic care to this group. A frank discussion about patient weight is required in the clinics handling PFD. A multimodal approach to weight loss would help improve PFD symptoms and progression. Patients with obesity should still be offered standard treatment options for all PFDs and should not be forced to lose weight as a prerequisite before starting treatment. However, they should also be made aware of the impediments that being overweight adds to their care and their expectations should be managed accordingly.
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Affiliation(s)
| | | | - Victor Chilaka
- Women's Wellness and Research Centre, Hamad Medical Corporation, Doha, Qatar.
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Padoa A, Levy E, Fligelman T, Tomashev-Dinkovich R, Tsviban A, Serati M. Predictors of persistent overactive bladder following surgery for advanced pelvic organ prolapse. Int Urogynecol J 2023; 34:759-767. [PMID: 35907022 DOI: 10.1007/s00192-022-05313-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 07/14/2022] [Indexed: 01/16/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Reliable risk factors for persistent urgency following pelvic organ prolapse (POP) surgery are still unclear. We aimed to identify preoperative parameters related to persistent postoperative urgency in a cohort of women following surgery for POP stage 3-4 with concomitant overactive bladder (OAB). METHODS In this retrospective analysis, women with POP stage 3-4 and OAB who underwent POP repair during November 2012-December 2020 were included. Preoperative evaluation included history, Pelvic Organ Prolapse Quantification (POP-Q), multi-channel urodynamic studies and Pelvic Floor Distress Inventory (PFDI-20). Surgical procedures included: anterior and posterior colporrhaphy, sacrospinous ligament suspension, anterior vaginal wall mesh repair and robotic-assisted laparoscopic sacrocolpopexy. At the 12-month follow-up, urogynecological history, POP-Q evaluation, cough stress test and the PFDI-20 questionnaire were repeated. RESULTS One hundred seventy-three patients were included in the analysis. Resolution of urgency was observed in 56% of women. Variables associated with persistent postoperative urgency included body mass index (BMI) (27 kg/m2 vs 25.7 kg/m2, p = 0.04), preoperative increased daytime frequency (46.39% vs 61.84%, p = 0.05), urgency urinary incontinence (UUI) (51.46% vs 80.26%, p = 0.0001), detrusor overactivity (DO) (40.2% vs 61.84%, p = 0.009) and lower maximum flow rate on UDS (13.9 ml/s vs 15 ml/s, p = 0.04). Multivariate analysis confirmed preoperative DO (OR: 12.2 [95% CI: 1.4-16.6]; p = 0.01), preoperative UUI (OR 3.8 [95% CI: 1.3-11.0]; p = 0.008) and BMI > 25 kg/m2 (OR 1.8 [95% CI: 1.1-7.2]; p = 0.04) as predictive factor for persistent urgency. CONCLUSIONS In women with advanced POP and OAB, being overweight, preoperative UUI and DO are related to persistent postoperative urgency. These findings will guide our future preoperative counseling and reinforce the role of UDS in POP management.
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Affiliation(s)
- Anna Padoa
- Department of Obstetrics and Gynecology, Shamir Assaf Harofe Medical Center, Tsrifin, Israel. .,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Eyal Levy
- Department of Obstetrics and Gynecology, Bnai Zion Medical Center, Haifa, Israel.,Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Tal Fligelman
- Department of Obstetrics and Gynecology, Shamir Assaf Harofe Medical Center, Tsrifin, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roni Tomashev-Dinkovich
- Department of Obstetrics and Gynecology, Shamir Assaf Harofe Medical Center, Tsrifin, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anna Tsviban
- Department of Obstetrics and Gynecology, Shamir Assaf Harofe Medical Center, Tsrifin, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Maurizio Serati
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy
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Impact of Urinary Incontinence on Physical Function and Respiratory Muscle Strength in Incontinent Women: A Comparative Study between Urinary Incontinent and Apparently Healthy Women. J Clin Med 2022; 11:jcm11247344. [PMID: 36555959 PMCID: PMC9788047 DOI: 10.3390/jcm11247344] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
Patients with stress urinary incontinence (SUI) may be afraid to increase intra-abdominal pressure to avoid incontinence. This could lead to weak expiratory muscles. The aim of this study was to investigate the association between respiratory muscle strength, physical function, and SUI in patients with SUI. A cross-sectional study was conducted in the Physical Medicine and Functional Rehabilitation Department. Thirty-one incontinent women (IG) and twenty-nine women in a control group (CG) were enrolled in this study. Anthropometric data, respiratory muscle strength (maximal inspiratory pressure; maximal expiratory pressure), SUI (Urogenital Distress Inventory-6; Incontinence Impact Questionnaire-7; Pad test), and physical function (waist circumference; timed-up-and-go test; abdominal muscle strength) were assessed. Body fat, body mass index, body weight, and waist circumference were higher in IG than CG (p < 0.01), while postural gait and abdominal muscles were lower (p < 0.001). Respiratory muscle strength displayed moderate correlations with SUI severity, especially for maximal expiratory pressure (p < 0.01). Maximal expiratory pressure was moderately associated with physical function. Deterioration in respiratory muscle strength is a characteristic of women with SUI. In this population, pelvic floor muscle training may be prescribed to improve continence. By feeling more confident about increasing intra-abdominal pressure, women with SUI would strengthen their expiratory muscles and eventually improve their physical function.
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Alves CA, Ferreira DCC, Lima MFD, Coimbra KA, Vaz CT. Prevalência de incontinência urinária, impacto na qualidade de vida e fatores associados em usuárias de Unidades de Atenção Primária à Saúde. FISIOTERAPIA EM MOVIMENTO 2022. [DOI: 10.1590/fm.2022.35604.0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo Introdução: A incontinência urinária (IU) causa considerável impacto negativo na qualidade de vida, ocasionando prejuízo psicossocial, emocional e higiênico, além de alto custo para o sistema de saúde e limitações nas atividades de vida diária. Objetivo: Descrever a proporção de mulheres com IU e o seu impacto na qualidade de vida, bem como investigar os fatores associados a essa condição de saúde entre usuárias de Unidades de Atenção Primária à Saúde (UAPS) do município de Governador Valadares, MG. Métodos: Estudo transversal realizado entre mulheres usuárias de UAPS do município. Um questionário elaborado pelas pesquisadoras foi utilizado para coleta de dados. As participantes que relataram queixa de perda urinária em qualquer situação responderam ao International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF). Resultados: Participaram do estudo 201 mulheres. A proporção de mulheres com incontinência urinária foi de 36,32% e entre essas o escore do ICIQ-SF teve mediana igual a 7 pontos, indicando impacto moderado na qualidade de vida. A incontinência urinária associou-se à idade, renda, índice de massa corporal e paridade. Conclusão: A proporção de mulheres com IU está de acordo com a prevalência descrita pela International Continence Society (ICS), impactando moderadamente na qualidade de vida, o que indica uma normalização do problema. Ademais, a IU esteve associada à idade, renda, IMC e número de gestações. Assim, estratégias de educação em saúde para esse grupo são necessárias, a fim de prevenir e tratar a IU nas UAPS, bem como ações intersetoriais para melhorar a renda da população, no sentido de controlar os fatores de risco que são modificáveis.
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Alves CA, Ferreira DCC, Lima MFD, Coimbra KA, Vaz CT. Prevalence of urinary incontinence, impact on quality of life and associated factors in users of Primary Health Care Units in Governador Valadares. FISIOTERAPIA EM MOVIMENTO 2022. [DOI: 10.1590/fm.2022.35604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction: Urinary incontinence (UI) has a considerable negative impact on quality of life, resulting in psychosocial, emotional and health impairment, high costs to the health system and limited activities of daily living. Objective: To describe the proportion of women with UI and its impact on quality of life (QOL), and investigate the factors associated with this condition among users of Primary Health Care Units (PHCUs) in the municipality of Governador Valadares, Minas Gerais state (MG), Brazil. Methods: Cross-sectional study with female users of the municipal PHCUs. A questionnaire compiled by the researchers was used for data collection. Participants who reported urine leakage in any situation completed the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF). Results: A total of 201 women took part in the study, 36.32% of whom had UI and obtained a score of 7, indicating a moderate impact on their QOL. Urinary incontinence was associated with age, income, body mass index and parity. Conclusion: The proportion of women with UI corroborates the prevalence described by the International Continence Society (ICS), moderately impacting quality of life and indicating normalization of the problem. Urinary incontinence was also correlated with age, income, BMI and number of pregnancies. This demonstrates the need for health education strategies at PHCUs to prevent and treat UI in this group, as well as intersectoral activities to improve the income of the population in order to control modifiable risk factors.
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Hashimoto M, Shimizu N, Nishimoto M, Minami T, Fujita K, Yoshimura K, Hirayama A, Uemura H. Sarcopenia and Visceral Obesity are Significantly Related to Severe Storage Symptoms in Geriatric Female Patients. Res Rep Urol 2021; 13:557-563. [PMID: 34395328 PMCID: PMC8357624 DOI: 10.2147/rru.s321323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 07/23/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose This study aimed to elucidate the relationship of psoas muscle atrophy and visceral obesity with lower urinary tract symptoms in geriatric female patients. Patients and Methods We retrospectively reviewed the medical records of female patients aged ≥65 years. The psoas muscle index was defined, using computed tomography, as the cross-sectional area of the psoas muscle at the third lumbar vertebral level divided by the body surface area. We also measured visceral fat area at the umbilical level using computed tomography. We used logistic regression analysis to examine the relationships between the International Prostate Symptom Score (total score, voiding subscore, and storage subscore) and variables, such as age, body mass index, psoas muscle index, and visceral fat area. The International Prostate Symptom Score was categorized as mild, moderate, or severe. Results One hundred thirty-nine patients were included in our study. In the logistic regression analysis, we found statistically significant relationships between severe (versus mild-to-moderate) International Prostate Symptom Score storage subscore and variables, including low and high levels of psoas muscle index and visceral fat area, respectively. We could not find any significant relationships between the International Prostate Symptom Score total score and voiding subscore and the variables. Conclusion Psoas muscle atrophy and visceral fat accumulation are potential risk factors for severe storage symptoms in female patients aged ≥65 years.
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Affiliation(s)
- Mamoru Hashimoto
- Department of Urology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Nobutaka Shimizu
- Department of Urology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Mitsuhisa Nishimoto
- Department of Urology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Takafumi Minami
- Department of Urology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Kazutoshi Fujita
- Department of Urology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Kazuhiro Yoshimura
- Department of Urology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Akihide Hirayama
- Department of Urology, Kindai Nara Hospital, Osaka-Sayama, Japan
| | - Hirotsugu Uemura
- Department of Urology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
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Does Bariatric Surgery Improve Faecal Incontinence? A Systematic Review and Meta-analysis. Obes Surg 2021; 31:2942-2953. [PMID: 33852150 PMCID: PMC8175321 DOI: 10.1007/s11695-021-05360-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 03/08/2021] [Accepted: 03/16/2021] [Indexed: 12/14/2022]
Abstract
Introduction Obesity increases the risk of pelvic floor disorders in individuals with obesity, including faecal incontinence. Faecal incontinence (FI) is a condition with important clinical and psychosocial consequences. Though it is associated with obesity, the effect of bariatric surgery on the prevalence and severity of FI is not well reported. Objective To assess the effect of bariatric surgery on the prevalence and severity of FI in adult patients with obesity. Methods This systematic review was conducted in accordance with the PRISMA statement. Two independent reviewers performed a literature search in MEDLINE, PubMed, Cochrane and Embase from 1 January 1980 to 12 January 2019. We included published English-language randomized control trials and observational studies assessing pre- and post-bariatric surgery prevalence or severity of FI. Random-effects models with DerSimonian and Laird’s variance estimator were used for meta-analysis. Results Thirteen studies were included, eight assessing prevalence (678 patients) and 11 assessing severity of FI (992 patients). There was no significant difference in prevalence post-operatively overall, though it trended towards a reduction [pooled OR=0.55; =0.075]. There was a significant reduction of FI prevalence in women post-bariatric surgery [95% CI 0.22 to 0.94, p=0.034]. There was a statistically significant reduction in FI prevalence following Roux-en-Y gastric bypass and one anastomosis gastric bypass [0.46, 95% CI 0.26 to 0.81; p=0.007]. There was no significant reduction of incontinence episodes post-operatively [pooled mean difference =−0.17, 95% CI −0.90 to 0.56; p=0.65]. Quality of life (QOL) was not significantly improved post-bariatric surgery [mean differences for the following facets of QOL: behaviour −0.35, 95% CI −0.94 to 0.24; depression 0.04, 95% CI −0.12 to 0.2; lifestyle −0.33, 95% CI −0.98 to 0.33; p values of 0.25, 0.61 and 0.33, respectively]. Discussion There was a significant reduction in FI prevalence in women and those who underwent Roux-en-Y or one anastomosis gastric bypass. Our results for FI prevalence overall, FI severity and impact on quality of life were not statistically significant. Larger studies are needed in this under-researched area to determine the true effect of bariatric surgery on FI. Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s11695-021-05360-7.
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Pan J, Liang E, Cai Q, Zhang D, Wang J, Feng Y, Yang X, Yang Y, Tian W, Quan C, Han R, Niu Y, Chen Y, Xin Z. Progress in studies on pathological changes and future treatment strategies of obesity-associated female stress urinary incontinence: a narrative review. Transl Androl Urol 2021; 10:494-503. [PMID: 33532337 PMCID: PMC7844519 DOI: 10.21037/tau-20-1217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
With the increasing prevalence of obesity worldwide, obesity-related female stress urinary incontinence (FSUI) has become a key health problem. Recent studies indicated that FSUI is primarily caused by obesity-related pathological changes, such as fat droplet deposition, and results in pelvic floor nerve, vascular, and urethral striated muscle injury. Meanwhile, treatments for obesity-associated FSUI (OA-FSUI) have garnered much attention. Although existing OA-FSUI management strategies, including weight loss, pelvic floor muscle exercise, and urethral sling operation, could play a role in symptomatic relief; they cannot reverse the pathological changes in OA-FSUI. The continued exploration of safe and reliable treatments has led to regenerative therapy becoming a particularly promising area of researches. Specifically, micro-energy, such as low-intensity pulsed ultrasound (LIPUS), low-intensity extracorporeal shock wave therapy (Li-ESWT), and pulsed electromagnetic field (PEMF), have been shown to restore the underlying pathological changes of OA-FSUI, which might be related by regulation endogenous stem cells (ESCs) to restore urine control function ultimately in animal experiments. Therefore, ESCs may be a target for repairing pathological changes of OA-FSUI. The aim of this review was to summarize the OA-FSUI-related pathogenesis, current treatments, and to discuss potential therapeutic options. In particular, this review is focused on the effects and related mechanisms of micro-energy therapy for OA-FSUI to provide a reference for future basically and clinical researches.
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Affiliation(s)
- Jiancheng Pan
- Male Reproductive and Sexual Medicine, Department of Urology, the Second Hospital of Tianjin Medical University, Tianjin, China.,Laboratory of Male Reproductive Medicine, Tianjin Urology Institute, Tianjin, China
| | - Enli Liang
- Male Reproductive and Sexual Medicine, Department of Urology, the Second Hospital of Tianjin Medical University, Tianjin, China.,Laboratory of Male Reproductive Medicine, Tianjin Urology Institute, Tianjin, China
| | - Qiliang Cai
- Male Reproductive and Sexual Medicine, Department of Urology, the Second Hospital of Tianjin Medical University, Tianjin, China.,Laboratory of Male Reproductive Medicine, Tianjin Urology Institute, Tianjin, China
| | - Dingrong Zhang
- Male Reproductive and Sexual Medicine, Department of Urology, the Second Hospital of Tianjin Medical University, Tianjin, China.,Laboratory of Male Reproductive Medicine, Tianjin Urology Institute, Tianjin, China
| | - Jiang Wang
- Male Reproductive and Sexual Medicine, Department of Urology, the Second Hospital of Tianjin Medical University, Tianjin, China.,Laboratory of Male Reproductive Medicine, Tianjin Urology Institute, Tianjin, China
| | - Yuhong Feng
- Male Reproductive and Sexual Medicine, Department of Urology, the Second Hospital of Tianjin Medical University, Tianjin, China.,Laboratory of Male Reproductive Medicine, Tianjin Urology Institute, Tianjin, China
| | - Xiaoqing Yang
- Male Reproductive and Sexual Medicine, Department of Urology, the Second Hospital of Tianjin Medical University, Tianjin, China.,Laboratory of Male Reproductive Medicine, Tianjin Urology Institute, Tianjin, China
| | - Yongjiao Yang
- Male Reproductive and Sexual Medicine, Department of Urology, the Second Hospital of Tianjin Medical University, Tianjin, China.,Laboratory of Male Reproductive Medicine, Tianjin Urology Institute, Tianjin, China
| | - Wenjie Tian
- Department of Urology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Changyi Quan
- Male Reproductive and Sexual Medicine, Department of Urology, the Second Hospital of Tianjin Medical University, Tianjin, China.,Laboratory of Male Reproductive Medicine, Tianjin Urology Institute, Tianjin, China
| | - Ruifa Han
- Male Reproductive and Sexual Medicine, Department of Urology, the Second Hospital of Tianjin Medical University, Tianjin, China.,Laboratory of Male Reproductive Medicine, Tianjin Urology Institute, Tianjin, China
| | - Yuanjie Niu
- Male Reproductive and Sexual Medicine, Department of Urology, the Second Hospital of Tianjin Medical University, Tianjin, China.,Laboratory of Male Reproductive Medicine, Tianjin Urology Institute, Tianjin, China
| | - Yegang Chen
- Male Reproductive and Sexual Medicine, Department of Urology, the Second Hospital of Tianjin Medical University, Tianjin, China.,Laboratory of Male Reproductive Medicine, Tianjin Urology Institute, Tianjin, China
| | - Zhongcheng Xin
- Male Reproductive and Sexual Medicine, Department of Urology, the Second Hospital of Tianjin Medical University, Tianjin, China.,Laboratory of Male Reproductive Medicine, Tianjin Urology Institute, Tianjin, China.,Andrology Center, Peking University First Hospital, Peking University, Beijing, China
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The effect of bariatric surgery on the improvement of lower urinary tract symptoms in morbidly obese male patients. Prostate Cancer Prostatic Dis 2020; 24:380-388. [PMID: 32963287 DOI: 10.1038/s41391-020-00285-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/27/2020] [Accepted: 09/10/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND Lower urinary tract symptoms (LUTS) are strongly linked with obesity. Whether bariatric surgery can effectively alleviate LUTS in morbidly obese men is unknown. The objective of the present study was to evaluate the effectiveness of bariatric surgery in reducing the prevalence and severity of male LUTS in obese patients. METHODS This was a prospective observational study on consecutive morbidly obese men undergoing bariatric surgery. The International Prostate Symptom Score (IPSS) was used to assess for LUTS before and at 1-3 years after surgery. The 3-year changes in IPSS, the changes in LUTS severity, and the factors associated with LUTS improvement were evaluated. RESULTS This study recruited 143 morbidly obese men (mean age 43.0 ± 10.4 years) undergoing sleeve gastrectomy (n = 89) and Roux-en-Y gastric bypass (n = 54). The rates of follow-up after surgery were 94.4% (n = 119/126) at 1 year, 90.6% (n = 96/106) at 2 years, and 81.2% (n = 69/85) at 3 years. After surgery, there was significant body mass index reduction from 39.1 ± 5.2 kg/m2 preoperatively to 30.1 ± 4.8 kg/m2 at 1 year and 31.5 ± 4.9 kg/m2 at 3 years (P < 0.001). There was significant reduction in IPSS total symptom score, quality of life score, frequency score, and nocturia score (P < 0.05). The prevalence of moderate to severe LUTS reduced from 35.0% (29.4% moderate; 5.6% severe) preoperatively to 21.8% (19.3% moderate; 2.5% severe) at 1 year and 30.4% (24.6% moderate; 5.8% severe) at 3 years (P < 0.001). LUTS improvement was significantly associated with body fat percentage reduction (P = 0.012) and was not associated with weight loss or improvement of metabolic parameters. CONCLUSIONS Bariatric surgery was an effective and durable intervention for alleviating the prevalence and severity of LUTS in morbidly obese men for up to 3 years.
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Barco-Castillo C, Plata M, Zuluaga L, Serrano A, Gómez A, Santander J, Caicedo JI, Azuero J, Echeverry M, Trujillo CG. Obesity as a risk factor for poor outcomes after sling surgery in women with stress urinary incontinence: A systematic review and meta-analysis. Neurourol Urodyn 2020; 39:2153-2160. [PMID: 32794648 DOI: 10.1002/nau.24459] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 06/11/2020] [Accepted: 07/08/2020] [Indexed: 11/12/2022]
Abstract
PURPOSE Obesity is one of the main risk factors for stress urinary incontinence (SUI) and has also been associated with worse surgical outcomes. However, the literature is heterogeneous and inconclusive. The goal of this study was to perform a systematic review and meta-analysis to evaluate cure rates and perioperative complications in obese women. MATERIALS AND METHODS A literature search of OVID, MEDNAR, Embase, Scopus, Web of Science, PubMed, and CENTRAL databases was conducted. Randomized controlled trials comparing cure rates and failure of treatment in normal and obese patients, who underwent mid-urethral sling surgery, were identified. A systematic review of subjective and objective cure rates, and complications was performed. Meta-analyses of dichotomous data under the random-effects model were applied using Review Manager 5.3. Nonrandomized comparative studies and gray literature were excluded. RESULTS A total of 219 studies were identified. Four randomized controlled trials were included for evaluation. The risk of bias evaluation was performed according to the Cochrane Handbook for Systematic Reviews of Interventions. One study was excluded due to missing data on the outcomes. Patients were stratified according to their body mass index as obese (>30 kg/m2 ) and nonobese (<30 kg/m2 ). Complications could not be meta-analyzed. The meta-analysis of subjective (risk ratio [RR] = 1.69 [95% confidence interval [CI]: 1.32-2.16]) and objective (RR = 1.62 [95% CI: 1.26-2.07]) cure rates disfavored obese women. CONCLUSIONS This meta-analysis shows that obesity is a risk factor for the nonsuccessful treatment of SUI with tension-free mid-urethral sling. Differences in regards to the surgical approach and its association with obesity could not be established with the current evidence.
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Affiliation(s)
- Catalina Barco-Castillo
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá DC, Colombia.,School of Medicine, Universidad de los Andes School of Medicine, Bogotá DC, Colombia
| | - Mauricio Plata
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá DC, Colombia.,School of Medicine, Universidad de los Andes School of Medicine, Bogotá DC, Colombia
| | - Laura Zuluaga
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá DC, Colombia.,School of Medicine, Universidad de los Andes School of Medicine, Bogotá DC, Colombia
| | - Adolfo Serrano
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá DC, Colombia.,School of Medicine, Universidad de los Andes School of Medicine, Bogotá DC, Colombia
| | - Andrea Gómez
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá DC, Colombia.,School of Medicine, Universidad de los Andes School of Medicine, Bogotá DC, Colombia
| | - Jessica Santander
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá DC, Colombia.,School of Medicine, Universidad de los Andes School of Medicine, Bogotá DC, Colombia
| | - Juan I Caicedo
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá DC, Colombia.,School of Medicine, Universidad de los Andes School of Medicine, Bogotá DC, Colombia
| | - Julián Azuero
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá DC, Colombia.,School of Medicine, Universidad de los Andes School of Medicine, Bogotá DC, Colombia
| | - Mariana Echeverry
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá DC, Colombia.,School of Medicine, Universidad de los Andes School of Medicine, Bogotá DC, Colombia
| | - Carlos Gustavo Trujillo
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá DC, Colombia.,School of Medicine, Universidad de los Andes School of Medicine, Bogotá DC, Colombia
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Urinary Incontinence and Surgery for Obesity and Weight-Related Diseases: Are There Predictors of Improvement? Obes Surg 2018; 29:109-113. [PMID: 30178155 DOI: 10.1007/s11695-018-3482-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE The aim of this study was to evaluate changes in urinary incontinence (UI) before and after surgery for obesity in female patients and to identify factors related to the remission of symptoms. MATERIALS AND METHODS This was a prospective cohort study with female patients over 18 years old who underwent surgery for obesity and weight-related diseases between June 2016 and September 2017. Urinary symptoms and quality of life related to UI were assessed based on a structured interview and the results of the validated questionnaires. RESULTS Two hundred twenty-one patients were assessed pre-operatively, and 118 (53.3%) reported UI. Eighty-eight patients (74.6%) completed the pre- and postoperative questionnaires. After 6 to 12 months, patients were revaluated, and 50 (56.8%) were considered to be in remission of urinary symptoms. Women who had only a cesarean birth had a 117% increase in the probability of achieving remission of UI compared with women who had both vaginal and cesarean deliveries, and patients with an additional point in the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) score at the beginning had a 4% lower probability of having remission of symptoms. CONCLUSIONS Improvement in UI may be an important outcome of surgery for obesity and weight-related diseases. In this study, previous cesarean section was only associated with the highest rate of remission of symptoms, and patients with higher scores in the ICIQ-UI-SF had a lower probability of remission.
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Fuselier A, Hanberry J, Margaret Lovin J, Gomelsky A. Obesity and Stress Urinary Incontinence: Impact on Pathophysiology and Treatment. Curr Urol Rep 2018; 19:10. [PMID: 29468457 DOI: 10.1007/s11934-018-0762-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW Obesity is highly prevalent and is associated with stress urinary incontinence (SUI). The purposes of this review are to assess the pathophysiology of SUI in the obese female and review the outcomes of weight loss and anti-incontinence surgery in this population. RECENT FINDINGS While increased intra-abdominal pressure appears to be the common pathophysiologic link between obesity and SUI, neurogenic and metabolic pathways have been proposed. Both surgical and non-surgical weight loss continue to have beneficial effects on SUI; however, long-term outcomes are largely absent. Midurethral sling (MUS) surgery is largely effective in the obese population, with a complication profile similar to that in non-obese women. Obesity has been shown to be a risk factor for failure of MUS. While weight loss should be the primary modality to improve SUI in the obese woman, MUS remains an effective and safe option in those women undertaking surgery.
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Affiliation(s)
- Alex Fuselier
- Department of Urology, Louisiana State University Health-Shreveport, 1501 Kings Highway, Shreveport, LA, 71130, USA
| | - Jordan Hanberry
- Department of Urology, Louisiana State University Health-Shreveport, 1501 Kings Highway, Shreveport, LA, 71130, USA
| | - J Margaret Lovin
- Department of Urology, Louisiana State University Health-Shreveport, 1501 Kings Highway, Shreveport, LA, 71130, USA
| | - Alex Gomelsky
- Department of Urology, Louisiana State University Health-Shreveport, 1501 Kings Highway, Shreveport, LA, 71130, USA.
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Valdevenito JP, García-Mora A, Rodriguez J, Gammie A. Correlation of Xiphopubic Distance, Body Weight, Height and Body Mass Index with Intravesical and Abdominal Initial Resting Pressures in Urodynamic Testing in the Sitting Position. Low Urin Tract Symptoms 2017; 10:271-276. [PMID: 28707318 DOI: 10.1111/luts.12179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 02/06/2017] [Accepted: 03/07/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To compare the initial resting intravesical pressure (pves ) and abdominal pressure (pabd ) in the sitting position with the typical range of values, to assess the correlation between such pressures and patient xipho-pubic distance, body weight, height and body mass index (BMI), and to estimate if xipho-pubic distance can be a guide to interpret initial resting pressures in urodynamic testing. METHODS Women with lower urinary tract symptomatology referred for urodynamic testing were consecutively enrolled in a prospective study. Conventional cystometry was done following "good urodynamic practices". The correlation between initial resting pves and pabd and xipho-pubic distance, body weight, height and BMI were studied using simple and multiple linear regression analysis. Statistical significance was defined as P < 0.05. RESULTS One hundred women aged (mean ± SD) 59.2 ± 13.3 were studied. There was a significant correlation between both pves and pabd , and xipho-pubic distance, body weight and BMI and no correlation with height. Over the multiple analysis, xipho-pubic distance and body weight correlated independently with pves ; body weight correlated independently with pabd . Three patients had pves and/or pabd out of typical range, with BMIs values of 18.48, 18.72 and 35.81 kg/m2 . There was a wide range of difference between xipho-pubic distance and initial resting pressures. CONCLUSIONS Out of range initial resting pressures occur in underweight (or close to) or severely obese patients. Xipho-pubic distance and body weight correlated independently with pves . Body weight correlated independently with pabd . Xipho-pubic distance cannot be a guide to interpret the initial resting pressures.
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Affiliation(s)
- Juan P Valdevenito
- Urodynamics Unit, Department of Urology, Hospital Clinico Universidad de Chile, Santiago, Chile
| | - Arturo García-Mora
- Urodynamics Unit, Department of Urology, Instituto Nacional de Ciencias Medicas y Nutricion "Salvador Zubiran", Tlalpan, Distrito Federal, Mexico
| | - Jorge Rodriguez
- Biostatistics Program, School of Public Health, University of Chile, Santiago, Chile
| | - Andrew Gammie
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
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Swenson CW, Kolenic GE, Trowbridge ER, Berger MB, Lewicky-Gaupp C, Margulies RU, Morgan DM, Fenner DE, DeLancey JO. Obesity and stress urinary incontinence in women: compromised continence mechanism or excess bladder pressure during cough? Int Urogynecol J 2017; 28:1377-1385. [PMID: 28150033 DOI: 10.1007/s00192-017-3279-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 01/16/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We compared two hypotheses as to why obesity is associated with stress urinary incontinence (SUI): (1) obesity increases demand on the continence system (e.g. higher cough pressure) and (2) obesity compromises urethral function and urethrovaginal support. METHODS A secondary analysis was performed using data from a case-control study of SUI in women. Measurements of urethrovaginal support (POP-Q point Aa, urethral axis), urethral function (maximal urethral closure pressure, MUCP), and measures of continence system demand (intravesical pressures at rest and during maximal cough) were analyzed. Cases and controls were divided into three body mass index (BMI) groups: normal (18.5-24.9 kg/m2); overweight (25.0-29.9 kg/m2); and obese (≥30 kg/m2). Logistic regression models where created to investigate variables related to SUI for each BMI group. Structural equation modeling was used to test the direct and indirect relationships among BMI, SUI, maximal cough pressure, MUCP, and POP-Q point Aa. RESULTS The study included 108 continent controls and 103 women with SUI. MUCP was the factor most strongly associated with SUI in all BMI groups. Maximal cough pressure was significantly associated with SUI in obese women (OR 3.191, 95% CI 1.326, 7.683; p < 0.01), but not in normal weight or overweight women. Path model analysis showed a significant relationship between BMI and SUI through maximal cough pressure (indirect effect, p = 0.038), but not through MUCP (indirect effect, p = 0.243) or POP-Q point Aa (indirect effect, p = 0.410). CONCLUSIONS Our results support the first hypothesis that obesity is associated with SUI because of increased intravesical pressure, which therefore increases demand on the continence mechanism.
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Affiliation(s)
- Carolyn W Swenson
- Department of Obstetrics and Gynecology, L4000 Women's Hospital, University of Michigan, 1500 E. Medical Center Dr., SPC 5276, Ann Arbor, MI, 48109-5276, USA.
| | - Giselle E Kolenic
- Department of Obstetrics and Gynecology, L4000 Women's Hospital, University of Michigan, 1500 E. Medical Center Dr., SPC 5276, Ann Arbor, MI, 48109-5276, USA
| | | | - Mitchell B Berger
- Department of Obstetrics and Gynecology, L4000 Women's Hospital, University of Michigan, 1500 E. Medical Center Dr., SPC 5276, Ann Arbor, MI, 48109-5276, USA
| | | | | | - Daniel M Morgan
- Department of Obstetrics and Gynecology, L4000 Women's Hospital, University of Michigan, 1500 E. Medical Center Dr., SPC 5276, Ann Arbor, MI, 48109-5276, USA
| | - Dee E Fenner
- Department of Obstetrics and Gynecology, L4000 Women's Hospital, University of Michigan, 1500 E. Medical Center Dr., SPC 5276, Ann Arbor, MI, 48109-5276, USA
| | - John O DeLancey
- Department of Obstetrics and Gynecology, L4000 Women's Hospital, University of Michigan, 1500 E. Medical Center Dr., SPC 5276, Ann Arbor, MI, 48109-5276, USA
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Yonguc T, Aydogdu O, Bozkurt IH, Degirmenci T, Gunlusoy B, Sen V, Yarimoglu S. Do severe obese patients with stress urinary incontinence benefit from transobturator tape procedure? 3-year surgical outcome. Can Urol Assoc J 2015; 9:E546-50. [PMID: 26609331 DOI: 10.5489/cuaj.2770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We evaluate the impact of severe obesity on surgical outcomes of the transobturator tape (TOT) procedure in patients with stress urinary incontinence (SUI). METHODS In total, 32 women with severe obesity (body mass index [BMI] >35 kg/m(2)) were included in the study. All patients were preoperatively evaluated with history, pelvic examination, ultrasonography, and cough stress test. All patients completed the International Consultation on Incontinence Questionnaire-Short form (ICIQ-SF) preoperatively and at the postoperative follow-up. Cure of incontinence was defined as being completely dry after surgery. Cure was assessed subjectively and objectively. Subjective improvement defined as an International Consultation on Incontinence Questionnaire-Short form (ICIQ-SF) score ≤12 and satisfaction with surgery. Failure was defined as having no change or worsening of urinary incontinence after surgery. Postoperative patient satisfaction was assessed using a visual analog scale. RESULTS The mean follow-up time and mean BMI were 40.9 ± 20.9 months and 38 ± 3 kg/m(2), respectively. According to preoperative ICIQ-SF questionnaire scores, 20 patients (62.5%) had severe and 12 patients (37.5 %) had very severe urinary incontinence symptoms. No patient had slight or moderate symptoms. None of the patients experienced worsening symptoms after surgery. Objective cure, subjective cure, subjective improvement and patient satisfaction rates were 81.2%, 46.8%, 37.5%, and 84.3% respectively. Our overall complication rate was 9.3%. None of the patients experienced intraoperative complications. CONCLUSION In experienced hands, TOT is an effective and safe procedure to treat SUI, with minimal complications in severe obese women.
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Affiliation(s)
- Tarik Yonguc
- Izmir Bozyaka Training and Research Hospital, Urology Clinic, Turkey
| | - Ozgu Aydogdu
- Izmir Bozyaka Training and Research Hospital, Urology Clinic, Turkey
| | | | - Tansu Degirmenci
- Izmir Bozyaka Training and Research Hospital, Urology Clinic, Turkey
| | - Bulent Gunlusoy
- Izmir Bozyaka Training and Research Hospital, Urology Clinic, Turkey
| | - Volkan Sen
- Izmir Bozyaka Training and Research Hospital, Urology Clinic, Turkey
| | - Serkan Yarimoglu
- Izmir Bozyaka Training and Research Hospital, Urology Clinic, Turkey
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Kumsar Ş, Aydemir H, Köse O, Budak S, Sağlam HS, Adsan Ö. Comparison of one-year results of transobturator tape method in the stress incontinence treatment according to body mass index. Turk J Urol 2015; 41:143-8. [PMID: 26516598 DOI: 10.5152/tud.2015.08068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of this study was to compare the 1-year results of patients on whom we used the transobturator tape method for the stress incontinence treatment according to body mass index (BMI). MATERIAL AND METHODS Patients diagnosed with stress incontinence and treated with the transobturator tape method were divided into three groups according to BMI. We recorded the results of preoperative urodynamic studies; durations of operation, catheterization, and hospitalization; and complications of patients. Patients were evaluated 1 year after the operation with respect to the objective/subjective success rates of the operation, patient satisfaction rates, and possible late complications. RESULTS The obese group was observed to have a significantly higher duration of operation than the normal and overweight groups (p<0.001). The objective and subjective success rates were not significantly different between the groups (p=0.567 and p=0.245, respectively). There was no statistical difference between the groups with respect to the satisfaction rates (p=0.245). There was no significant difference between all three groups with respect to both preoperative and postoperative complication rates (p=0.096). CONCLUSION The transobturator tape method for stress incontinence treatment has similar objective and subjective success rates, independent of BMI. In the obese patients, the operation time is longer than the others, but there is no difference with respect to the complication rates.
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Affiliation(s)
- Şükrü Kumsar
- Department of Urology, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Hüseyin Aydemir
- Department of Urology, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Osman Köse
- Department of Urology, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Salih Budak
- Department of Urology, Tepecik Training and Research Hospital, İzmir, Turkey
| | - Hasan Salih Sağlam
- Department of Urology, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Öztuğ Adsan
- Department of Urology, Sakarya University Training and Research Hospital, Sakarya, Turkey
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Agarwal A, Patnaik P, Shaw D, Rathee V, Khan SW, Jain M, Trivedi S, Dwivedi US. Influence of Demographic and Clinical Factors on Surgical Outcomes of the Transobturator Tape Procedure in Patients with Stress Urinary Incontinence. Curr Urol 2015; 8:126-32. [PMID: 26889131 DOI: 10.1159/000365703] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 12/11/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Stress urinary incontinence (SUI) is a prevalent problem within the female population with associated high psycho-social impact. Transobturator tape procedure is a well-established procedure to treat the same, but the results may be influenced by various preoperative demographic and clinical factors. PATIENTS AND METHODS The study group comprised of 50 female patients with genuine SUI, who were then divided into subgroups based on demographic and clinical factors. Outcomes were compared between these subgroups at 6 and 12 months using self-reported questionnaires and provocative stress test. RESULTS Our results show positive correlation with statistically significant better surgical outcomes in premenopausal patients, patients aged <50 years and those having urethral mobility > 30 degrees. Statistically significant poor outcomes were seen in those having undergone hysterectomy or Caesarean section. No correlation was found with history of smoking or the patient's body mass index. CONCLUSIONS In conclusion, the transobturator tape procedure appears to be more effective in premenopausal women, women aged < 50 years, women without history of hysterectomy/lower section Caesarean section, and presence of urethral hypermobility > 30 degrees. On the other hand, outcomes do not appear to be influenced by the patient's body mass index or smoking status.
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Affiliation(s)
- Abhinav Agarwal
- Department of Urology, Institute Of Medical Sciences, BHU, Varanasi, India
| | - Pranab Patnaik
- Department of Urology, Institute Of Medical Sciences, BHU, Varanasi, India
| | - Dipak Shaw
- Department of Urology, Institute Of Medical Sciences, BHU, Varanasi, India
| | - Vazir Rathee
- Department of Urology, Institute Of Medical Sciences, BHU, Varanasi, India
| | - Sartaj W Khan
- Department of Urology, Institute Of Medical Sciences, BHU, Varanasi, India
| | - Madhu Jain
- Department of Obstetrics & Gynaecology, Institute Of Medical Sciences, BHU, Varanasi, India
| | - Sameer Trivedi
- Department of Urology, Institute Of Medical Sciences, BHU, Varanasi, India
| | - U S Dwivedi
- Department of Urology, Institute Of Medical Sciences, BHU, Varanasi, India
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Romero-Talamás H, Unger CA, Aminian A, Schauer PR, Barber M, Brethauer S. Comprehensive evaluation of the effect of bariatric surgery on pelvic floor disorders. Surg Obes Relat Dis 2015; 12:138-43. [PMID: 26686304 DOI: 10.1016/j.soard.2015.08.499] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 07/17/2015] [Accepted: 08/07/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The association of pelvic floor disorders (PFD) with obesity is well documented. The spectrum of PFD includes stress urinary incontinence (SUI), urge urinary incontinence (UUI), pelvic organ prolapse (POP), and fecal incontinence (FI). Resolution or improvement of SUI after bariatric surgery has been previously reported. However, the data regarding UUI and other forms of PFD with objective testing are sparse. OBJECTIVES Prospectively evaluate the effects of bariatric surgery on the prevalence and severity of pelvic floor disorders. SETTING U.S. Academic Hospital. METHODS From December 2008 to December 2012, patients who screened positive on a screening questionnaire were asked to participate in the study. Participants completed 3 validated condition-specific questionnaires before surgery and 6-12 months after. A subgroup consented to gynecologic examination (Pelvic Organ Prolapse Quantification [POP-Q] test) and urodynamic testing at similar time points. RESULTS Seventy-two study patients underwent laparoscopic gastric bypass (n = 65), sleeve gastrectomy (n = 5), and gastric banding (n = 2). Mean BMI decreased from 47.5 to 32.7 kg/m(2) 1 year after surgery (P<.001). Based on questionnaires, the most prevalent PFD was SUI, identified in 60 (83.3%) patients at baseline and 32 (44.4%, P<.001) at follow-up. There was significant improvement in PFD-related symptoms, quality of life, POP, and sexual function at follow-up. Decrease in prevalence of SUI after surgery was also confirmed with urodynamic testing (from 76.9% to 30.8%, P = .01). There was no significant change in prevalence and severity of POP based on POP-Q exam. CONCLUSIONS Bariatric surgery is associated with a decrease in prevalence and severity of diverse forms of urinary incontinence as well as improvement in quality of life and sexual function of morbidly obese women.
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Affiliation(s)
- Héctor Romero-Talamás
- Digestive Disease Institute, Section of Bariatric and Metabolic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Cecile A Unger
- Department of Obstetrics & Gynecology, Women's Health Institute, Division of Female Pelvic Medicine & Reconstructive Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Ali Aminian
- Digestive Disease Institute, Section of Bariatric and Metabolic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Philip R Schauer
- Digestive Disease Institute, Section of Bariatric and Metabolic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Matthew Barber
- Department of Obstetrics & Gynecology, Women's Health Institute, Division of Female Pelvic Medicine & Reconstructive Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Stacy Brethauer
- Digestive Disease Institute, Section of Bariatric and Metabolic Surgery, Cleveland Clinic, Cleveland, Ohio.
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Faiena I, Patel N, Parihar JS, Calabrese M, Tunuguntla H. Conservative Management of Urinary Incontinence in Women. Rev Urol 2015; 17:129-39. [PMID: 26543427 PMCID: PMC4633656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Urinary incontinence in women has a high prevalence and causes significant morbidity. Given that urinary incontinence is not generally a progressive disease, conservative therapies play an integral part in the management of these patients. We conducted a nonsystematic review of the literature to identify high-quality studies that evaluated the different components of conservative management of stress urinary incontinence, including behavioral therapy, bladder training, pelvic floor muscle training, lifestyle changes, mechanical devices, vaginal cones, and electrical stimulation. Urinary incontinence can have a severe impact on our healthcare system and patients' quality of life. There are currently a wide variety of treatment options for these patients, ranging from conservative treatment to surgical treatment. Although further research is required in the area of conservative therapies, nonsurgical treatments are effective and are preferred by some patients.
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Affiliation(s)
- Izak Faiena
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Neal Patel
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | | | - Marc Calabrese
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Hari Tunuguntla
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
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Wang L, Wang L, Shi G, Zeng L, Yang Y, Zhang T, Liu H. Efficacy and safety of ginger-salt-indirect moxibustion for urge urinary incontinence after stroke: protocol for a pilot multicentre randomised controlled trial. BMJ Open 2014; 4:e006326. [PMID: 25335962 PMCID: PMC4208054 DOI: 10.1136/bmjopen-2014-006326] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 09/19/2014] [Accepted: 09/24/2014] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Ginger-salt-indirect moxibustion is widely applied to treat urge urinary incontinence after stroke, which is a common complication in stroke survivors. Moxa cone moxibustion and moxa box moxibustion are the main techniques of ginger-salt-indirect moxibustion. Our previous study had shown that ginger-salt-indirect moxibustion using moxa cones was feasible and effective for urination disorders post-stroke. This pilot study aims to assess the feasibility of conducting research to evaluate the efficacy and safety of ginger-salt-indirect moxibustion for patients with post-stroke urge urinary incontinence. METHODS AND ANALYSIS This is a multicentre, prospective, single-blinded, pilot randomised controlled trial. 120 eligible patients will be randomly allocated to three groups. Treatment group A (n=40) will receive moxa cone moxibustion and routine care; treatment group B (n=40) will receive moxa box moxibustion and routine care; control group (n=40) will only receive routine care for stroke recovery. The entire moxibustion treatment will consist of a total of 28 sessions during the course of 4 weeks. The primary outcome measure will be the increase in mean volume per void assessed at week 4 from the first moxibustion session (baseline). Secondary outcome measures will include mean frequency of urination per day and quality of life assessments measured by completion of the Incontinence Quality of Life Questionnaire and Barthel Index. All outcome measures will be assessed at baseline and at 4 and 16 weeks from baseline. Adverse events in the three groups will be recorded to assess the safety of moxibustion. ETHICS AND DISSEMINATION Research ethics was approved by the Research Ethical Committee of Beijing Hospital of Traditional Chinese Medicine Affiliated to the Capital Medical University (ref: 2013BL-094). Written informed consent will be obtained from all participants. Study results will be published in peer reviewed journals. TRIAL REGISTRATION NUMBER ISRCTN 44706974.
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Affiliation(s)
- Linpeng Wang
- Acupuncture and Moxibustion Department, Beijing Hospital of Traditional Chinese Medicine affiliated to Capital Medical University, Beijing, China
| | - Lichen Wang
- Acupuncture and Moxibustion Department, Beijing Hospital of Traditional Chinese Medicine affiliated to Capital Medical University, Beijing, China
| | - Guangxia Shi
- Acupuncture and Moxibustion Department, Beijing Hospital of Traditional Chinese Medicine affiliated to Capital Medical University, Beijing, China
| | - Lin Zeng
- Research Center of Clinical Epidemiology Affiliated to Peking University, Beijing, China
| | - Yi Yang
- Acupuncture and Moxibustion Department, Beijing Hospital of Traditional Chinese Medicine affiliated to Capital Medical University, Beijing, China
| | - Tao Zhang
- Acupuncture and Moxibustion Department, Beijing Hospital of Traditional Chinese Medicine affiliated to Capital Medical University, Beijing, China
| | - Huilin Liu
- Acupuncture and Moxibustion Department, Beijing Hospital of Traditional Chinese Medicine affiliated to Capital Medical University, Beijing, China
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Imayama I, Alfano CM, Neuhouser ML, George SM, Wilder Smith A, Baumgartner RN, Baumgartner KB, Bernstein L, Wang CY, Duggan C, Ballard-Barbash R, McTiernan A. Weight, inflammation, cancer-related symptoms and health related quality of life among breast cancer survivors. Breast Cancer Res Treat 2014; 140:159-76. [PMID: 23797178 DOI: 10.1007/s10549-013-2594-y] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 05/30/2013] [Indexed: 11/28/2022]
Abstract
Maintaining weight is important for better prognosis of breast cancer survivors. The associations between weight and cancer-related symptoms are not known. We examined associations among weight, weight change, inflammation, cancer-related symptoms, and health-related quality of life (HRQOL) in a cohort of stage 0-IIIA breast cancer survivors. Participants were recruited on average 6 months (2–12 months) after diagnosis. Height, weight, and C-reactive protein (CRP) were assessed at approximately 30 months post-diagnosis; cancer-related symptoms (chest wall and arm symptoms, vasomotor symptoms, urinary incontinence, vaginal symptoms, cognition/mood problems, sleep, sexual interest/function), and HRQOL (SF-36) were assessed at approximately 40 months post-diagnosis. Weight was measured at baseline in a subset. Data on 661 participants were evaluable for body mass index (BMI); 483 were evaluable for weight change. We assessed associations between BMI (<25.0, 25.0–29.9, ≥30.0 kg/m2), post-diagnosis weight change (lost ≥5 %, weight change <5 %, gained ≥5 %), and CRP (tertile) with cancer-related symptoms and HRQOL using analysis of covariance. Higher symptoms scores indicate more frequent or severe symptoms. Higher HRQOL scores indicate better HRQOL. Compared with those with BMI <25 kg/m2, women with BMI ≥30 kg/m2 had the following scores: increased for arm symptoms (+25.0 %), urinary incontinence (+40.0 %), tendency to nap (+18.9 %), and poorer physical functioning (−15.6 %, all p < 0.05). Obese women had lower scores in trouble falling asleep (−9.9 %; p < 0.05). Compared with weight change <5 %, participants with ≥5 % weight gain had lower scores in physical functioning (−7.2 %), role-physical (−15.5 %) and vitality (−11.2 %), and those with weight loss ≥5 % had lower chest wall (−33.0 %) and arm symptom scores (−35.5 %, all p < 0.05). Increasing CRP tertile was associated with worse scores for chest wall symptoms, urinary incontinence, physical functioning, role-physical, vitality and physical component summary scores (all P trend < 0.05). Future studies should examine whether interventions to maintain a healthy weight and reduce inflammation could alleviate cancer-related symptoms and improve HRQOL.
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Affiliation(s)
- Ikuyo Imayama
- Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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Osborn DJ, Strain M, Gomelsky A, Rothschild J, Dmochowski R. Obesity and Female Stress Urinary Incontinence. Urology 2013; 82:759-63. [DOI: 10.1016/j.urology.2013.06.020] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 06/10/2013] [Accepted: 06/13/2013] [Indexed: 10/26/2022]
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Tannenbaum C, Gray M, Hoffstetter S, Cardozo L. Comorbidities associated with bladder dysfunction. Int J Clin Pract 2013; 67:105-13. [PMID: 23305472 DOI: 10.1111/ijcp.12085] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- C Tannenbaum
- Faculties of Pharmacy and Medicine, University of Montreal, Montreal, QC, Canada
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Does body mass index impact passing voiding trial after midurethral sling procedures for stress urinary incontinence? Female Pelvic Med Reconstr Surg 2013; 16:358-61. [PMID: 22453622 DOI: 10.1097/spv.0b013e3181ff394e] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE : To test the hypothesis that body mass index (BMI) is a factor associated with passing a voiding trial after midurethral sling procedures for stress urinary incontinence (SUI). STUDY DESIGN : The medical records of 136 consecutive patients who underwent placement of either tension-free vaginal tape (TVT) or transobturator tape (TOT) for SUI during a 1-year period (September 1, 2007 to August 31, 2008) were retrospectively reviewed. Variables assessed were BMI, age, and passing or failing a postoperative urinary voiding trial. Patients with concomitant pelvic organ prolapse surgeries were not included in this analysis. RESULTS : Sixty-seven patients underwent TVT, whereas 69 had TOT procedures. In the TVT group, 30 patients (42%) were unable to void immediately postoperatively compared with 11 patients (16%) in the TOT group (P = 0.0003). The mean (SD) age and BMI of patients who failed or passed voiding trials was 58.6 (12.0) years and 28.0 (4.9) kg/m or 53.5 (12.3) years and 29.8 (5.7) kg/m, respectively. Of 38 patients who did not pass a voiding trial on the day of the procedure, 31 (82%) passed on postoperative day 1, and all patients had passed a voiding trial by postoperative day 11. The mean (SD) BMI for 7 patients who did not pass voiding trial by postoperative day 1 was 28.3 (5.2) kg/m. CONCLUSIONS : Women with higher BMIs were more likely to pass voiding trials after midurethral sling procedures. Patients who had TOT placement had greater success passing a postprocedure voiding trial than did patients who had TVT placement.
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Fitz FF, Costa TF, Feitosa SM, Yuaso DR, Alves GA, Sartori MGF, Girão MJBC, Castro RA. Qual o índice de massa corporal de mulheres com disfunções dos músculos do assoalho pélvico que procuram tratamento fisioterapêutico? FISIOTERAPIA E PESQUISA 2012. [DOI: 10.1590/s1809-29502012000400003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Sobrepeso e obesidade são relatados como importantes fatores de risco para desenvolvimento de disfunções do assoalho pélvico (AP) feminino. Assim, objetivou-se averiguar o índice de massa corporal (IMC) de mulheres com disfunções do AP que procuraram tratamento fisioterapêutico, e comparar com as estatísticas nacionais. Trata-se de um estudo observacional. Foram avaliados os prontuários de mulheres com disfunções do AP atendidas pelo Setor de Fisioterapia no período de 2004 à 2010, e incluídas todas as mulheres com a presença de algum sintoma de disfunção do AP. Calculou-se o IMC de 312 mulheres com disfunção do AP. A média de IMC foi de 28,1 kg/m². Dessas mulheres, cerca de 70% apresentavam sobrepeso ou obesidade, resultado maior do que o índice nacional de 59%. A base fisiopatológica da relação entre obesidade e disfunções do AP está na correlação entre o IMC e a pressão intra-abdominal. A identificação do sobrepeso e da obesidade deve fazer parte dos programas de reabilitação do AP, uma vez que a redução do peso corporal pode contribuir para redução da severidade da disfunção. Com o presente estudo observa-se que as mulheres que procuram tratamento fisioterapêutico para disfunções do AP apresentam índice de obesidade maior do que a população feminina nacional.
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Relationship between Body Mass Index and Overactive Bladder in Women and Correlations with Urodynamic Evaluation. Int Neurourol J 2012; 16:126-31. [PMID: 23094218 PMCID: PMC3469831 DOI: 10.5213/inj.2012.16.3.126] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2012] [Accepted: 09/09/2012] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Overactive bladder (OAB) is a common condition. In women, studies have shown that the prevalence of OAB is positively related to increasing body mass index (BMI). Our objective was to define a relationship between BMI and OAB through correlation with urodynamic study (UDS). METHODS A prospective study was conducted. Ambulatory women aged 18 years or older who had symptoms of OAB for at least 3 months were enrolled. Patients answered a questionnaire, had their weight and height recorded, and underwent UDS. Patients were categorized into 3 groups as follows: group 1, BMI<25; group 2, BMI 25 to 29.9; and group 3, BMI≥30. RESULTS A total of 113 patients were examined (group 1, n=32; group 2, n=40; group 3, n=41). The patients' mean ages were 50, 55, and 59 years for groups 1, 2, and 3, respectively (P<0.05). Group 3 showed a significant increase in the incidence of subjective mixed leakage and the number of pads used compared with groups 1 and 2. No significant differences were seen among the groups in duration of symptoms, OAB V-8 score, or the incidence of subjective urgency or stress leakage. The UDS parameters of groups 1, 2, and 3 showed no statistically significant differences for most variables. Group 3 showed a significant increase in the incidence of urge leakage by UDS compared with group 2 only. CONCLUSIONS Increasing BMI was age related. A BMI≥30 showed a higher incidence of subjective urinary mixed leakage and pad use. UDS showed no significant correlation between OAB and any BMI category for most UDS parameters.
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Berger MB, Doumouchtsis SK, DeLancey JO. Bony pelvis dimensions in women with and without stress urinary incontinence. Neurourol Urodyn 2012; 32:37-42. [PMID: 22674676 DOI: 10.1002/nau.22275] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Accepted: 04/24/2012] [Indexed: 11/06/2022]
Abstract
AIMS To test the null hypothesis that bony pelvis dimensions are similar in women with and without stress urinary incontinence (SUI), both in the postpartum and midlife periods. METHODS Secondary analyses were performed of two case-control studies comparing women with SUI to asymptomatic controls. One study examined primiparas in the first 9-12 months postpartum; the other study involved middle-aged women. SUI was confirmed by full-bladder stress test. All subjects underwent pelvic magnetic resonance imaging. The interspinous and intertuberous diameters, subpubic angle, and sacrococcygeal joint-to-the inferior pubic point distance were measured from the images independently by two authors. RESULTS In the young cohorts, we compared primiparas with de novo postpartum SUI to both continent primiparas and nulliparas. Postpartum SUI is associated with a wider subpubic angle. There is also a trend towards wider interspinous and intertuberous diameters in the stress-incontinent primiparas as compared to the continent cohorts, although this did not reach statistical significance with our sample sizes. By contrast, no significant differences in bony pelvis dimensions were identified when comparing middle-aged women with SUI and their continent controls. CONCLUSIONS Bony pelvis dimensions are different in women with SUI than in matched continent controls. However, these differences are only identified in young primiparas in the postpartum period, not in middle-aged women.
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Affiliation(s)
- Mitchell B Berger
- Pelvic Floor Research Group, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA.
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Prolapse symptoms in overweight and obese women before and after weight loss. Female Pelvic Med Reconstr Surg 2012; 18:55-9. [PMID: 22453270 DOI: 10.1097/spv.0b013e31824171f9] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The objective of this study was to estimate the association between body mass index (BMI) and pelvic organ prolapse symptoms and bother among overweight and obese women with urinary incontinence before and after weight loss. METHODS Women (N = 338) were randomized to either an intensive 6-month weight loss or educational program (control); they were evaluated for prolapse symptoms at baseline and 6 months. Symptomatic prolapse was defined as a positive response to at least 1 prolapse subscale question of the Urogenital Distress Inventory. "Bother" was defined as responses of slight, moderate, or great. Women with prolapse symptoms were analyzed by baseline BMI category: overweight, obese, and severely obese at baseline and at 6 months. Proportional odds regression and χ tests for trend were used for analysis. RESULTS Age mean was 53 (SD, 10) years, BMI mean was 36 (SD, 6) kg/m, and 78% were white. A higher proportion of obese women reported feeling vaginal bulging compared with overweight women (13% vs 0%, P = <0.01). At baseline, 37% (n = 124) reported bothersome "lower abdominal pressure"; 18% (n = 62), bothersome "heaviness in the pelvic area"; and 14% (n = 48), bothersome "pelvic discomfort when standing." Nine percent (n = 31) reported bothersome "feeling," and 2% (n = 6) reported bothersome "seeing a bulge" in the vagina. At 6 months, there were no significant differences in improvement of self-reported bothersome prolapse symptoms in women in the weight loss or the control group. CONCLUSIONS In this study of overweight and obese women, increasing BMI was associated with only "feeling" a vaginal bulge. Weight loss did not improve bothersome prolapse symptoms.
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Hwang IS, Yu JH, Chung JY, Noh CH, Sung LH. One-year outcomes of mid-urethral sling procedures for stress urinary incontinence according to body mass index. Korean J Urol 2012; 53:171-7. [PMID: 22468212 PMCID: PMC3312065 DOI: 10.4111/kju.2012.53.3.171] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Accepted: 10/12/2011] [Indexed: 11/18/2022] Open
Abstract
Purpose The purpose of our study was to investigate the safety and efficacy of the suprapubic arch (SPARC) sling operation and the transobturator tape (MONARC) sling operation according to body mass index (BMI). Materials and Methods Between January 1, 2004, and July 12, 2009, a retrospective clinical trial was performed with 284 patients treated by the SPARC sling procedure and 49 patients treated by the MONARC sling procedure. The women were classified into 3 groups by BMI according to the WHO Expert Consultation: normal weight (A, BMI 18.5 to 22.9 kg/m2), overweight (B, BMI 23 to 27.5 kg/m2), and obese (C, BMI>27.6 kg/m2). Patients' characteristics and clinical outcomes of the operation were analyzed according to BMI at 1 year after surgery via questionnaires and interviews with the patients about their voiding symptoms and medical records. Results There were 103 patients in group A, 186 in group B, and 34 in group C. The objective cure rates for groups A, B, and C after the SPARC procedure were 94.4%, 96.7%, and 96.8%, respectively (p=0.321), and the subjective cure rates were 94.4%, 96.1%, and 96.8%, respectively (p=0.222). The objective cure rates for groups A, B, and C after the MONARC procedure were 100.0%, 90.9%, and 66.7%, respectively (p=0.742), and the subjective cure rates were 92.3%, 93.9%, and 66.7%, respectively (p=0.779). The complication rates were similar among the three study groups. Conclusions Mid-urethral sling procedures for urinary incontinence result in similar objective and subjective cure rates and postoperative complications irrespective of BMI.
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Affiliation(s)
- In Sung Hwang
- Department of Urology, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
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Sievert KD, Amend B, Toomey PA, Robinson D, Milsom I, Koelbl H, Abrams P, Cardozo L, Wein A, Smith AL, Newman DK. Can we prevent incontinence?: ICI-RS 2011. Neurourol Urodyn 2012; 31:390-9. [DOI: 10.1002/nau.22225] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2012] [Accepted: 01/13/2012] [Indexed: 01/31/2023]
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Stothers L, Friedman B. Risk factors for the development of stress urinary incontinence in women. Curr Urol Rep 2012; 12:363-9. [PMID: 21938471 DOI: 10.1007/s11934-011-0215-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Large-scale population-based surveys published in the past decade give new insights regarding risk factors for stress urinary incontinence (SUI) in women. Age plays a significant role in the development of all forms of urinary incontinence, but findings regarding the role of hormonal changes are inconsistent. Obesity is an increasingly prevalent health condition that was shown to have detrimental impact on SUI development, while weight reduction was proven to reduce SUI. Other modifiable risk factors, such as diabetes, also are related to SUI. Pregnancy, delivery, and pelvic floor surgery are risk factors discussed in the review. Recent genetic studies identified several genes encoding components of the extracellular matrix, which could be related to a predisposition to SUI. Identifying risk factors for SUI can facilitate prevention strategies in an aim to reduce SUI prevalence among women.
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Affiliation(s)
- Lynn Stothers
- University of British Columbia, Vancouver, British Columbia V5Z 1M9, Canada.
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Abstract
A panel of experts in urology, urogynecology, nursing, and behavioral therapy convened in 2010 to discuss the importance of a healthy bladder on overall health. They determined that a consensus statement was necessary to raise awareness among the general public, healthcare providers, payors, and policymakers, with the goals of minimizing the impact of poor bladder health and stimulating primary prevention of bladder conditions. In this statement, 'healthy' bladder function is described, as well as internal and external factors that influence bladder health. It is suggested that primary prevention strategies should be aimed at providing education regarding normal lower urinary tract structures and functioning to the public, including patients and healthcare providers. This education may promote the achievement of optimal bladder health by increasing healthy bladder habits and behaviors, awareness of risk factors, healthcare seeking, and clinician engagement and reducing stigma and other barriers to treatment. Promoting optimal bladder health may reduce the personal, societal and economic impact of bladder conditions, including anxiety and depression and costs associated with conditions or diseases and their treatment. While adopting healthy bladder habits and behaviors and behaviors may improve or maintain bladder health, it is important to recognize that certain symptoms may indicate the presence of conditions that require medical attention; many bladder conditions are treatable with a range of options for most bladder conditions. Lastly, the authors propose clinical directives based on persuasive and convergent research to improve and maintain bladder health. The authors hope that this statement will lead to promotion and achievement of optimal bladder health, which may improve overall health and help minimize the effects of bladder conditions on the public, healthcare professionals, educators, employers, and payors. The advisors are in consensus regarding the recommendations for improving and maintaining bladder health presented herein.
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Affiliation(s)
- E S Lukacz
- University of California, San Diego, San Diego, CA 92037, USA.
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Abstract
BACKGROUND The purpose of this research was review the epidemiology of the association of obesity and urinary incontinence, and to summarize the published data on the effect of weight loss on urinary incontinence. METHODS A literature review of the association between urinary incontinence and overweight/obesity in women was performed. Case series and clinical trials reporting the effect of surgical, behavioral, and/or pharmacological weight loss on urinary incontinence are summarized. RESULTS Epidemiological studies demonstrate that obesity is a strong and independent risk factor for prevalent and incident urinary incontinence. There is a clear dose-response effect of weight on urinary incontinence, with each 5-unit increase in body mass index associated with a 20%-70% increase in risk of urinary incontinence. The maximum effect of weight on urinary incontinence has an odds ratio of 4-5. The odds of incident urinary incontinence over 5-10 years increase by approximately 30%-60% for each 5-unit increase in body mass index. There appears to be a stronger association between increasing weight and prevalent and incident stress incontinence (including mixed incontinence) than for urge incontinence. Weight loss studies indicate that both surgical and nonsurgical weight loss leads to significant improvements in prevalence, frequency, and/or symptoms of urinary incontinence. CONCLUSION Epidemiological studies document overweight and obesity as important risk factors for urinary incontinence. Weight loss by both surgical and more conservative approaches is effective in reducing urinary incontinence symptoms and should be strongly considered as a first line treatment for overweight and obese women with urinary incontinence.
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Affiliation(s)
- Emily L Whitcomb
- Southern California Permanente Medical Group, Female Pelvic Medicine and Reconstructive Surgery, Orange County-Irvine Medical Center, Irvine, CA, USA
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Ballard AC, Richter HE. The Impact of Obesity and Weight Loss on Urinary and Bowel Incontinence Symptoms in Women. MENOPAUSAL MEDICINE : FOR CLINICIANS WHO PROVIDE CARE FOR WOMEN 2011; 19:S1-S7. [PMID: 25392849 PMCID: PMC4226402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Alicia C. Ballard
- Department of Obstetrics and Gynecology, Division of Urogynecology and Pelvic Reconstructive Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Holly E. Richter
- Department of Obstetrics and Gynecology, Division of Urogynecology and Pelvic Reconstructive Surgery, University of Alabama at Birmingham, Birmingham, AL
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Poylin V, Serrot FJ, Madoff RD, Ikramuddin S, Mellgren A, Lowry AC, Melton GB, Melton GB. Obesity and bariatric surgery: a systematic review of associations with defecatory dysfunction. Colorectal Dis 2011; 13:e92-103. [PMID: 21564470 DOI: 10.1111/j.1463-1318.2011.02584.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Obesity rates are rapidly growing in the developed world. While upper gastrointestinal disturbances and urinary incontinence are independently associated with obesity, the relationship between obesity and defecatory dysfunction is less well defined. OBJECTIVES To summarize the literature on faecal incontinence, diarrhoea and constipation in obese patients and its effects of bariatric surgery. SEARCH STRATEGY A Medline search was carried out on articles published from January 1966 to March 2010. SELECTION CRITERIA Original articles on adult obese or morbidly obese patients were identified, including results following bariatric surgery that reported faecal incontinence, diarrhoea or constipation. Other forms of pelvic floor dysfunction were excluded. Main outcome measures included faecal incontinence, diarrhoea and constipation rates and their severity in obese patients and following bariatric surgery. RESULTS Twenty studies reported defecatory outcomes in obese patients (n = 14) and after bariatric surgery (n = 6). While constipation rates were similar, the rates of faecal incontinence and diarrhoea were higher in obese patients compared with non-obese patients. The exact rates of these conditions, and the correlations between body mass index (BMI) and faecal incontinence, diarrhoea and constipation, were not clear. Faecal incontinence improved after Roux-en-Y gastric bypass in studies with preoperative data. The effects of bariatric surgery on diarrhoea were unclear. CONCLUSION Few studies have assessed the correlations between obesity and defecatory function and the effect of bariatric surgery. Studies were often not well controlled and used non-uniform instruments to assess bowel function. Obesity appears to be correlated with higher rates of faecal incontinence and diarrhoea. The effects of bariatric surgery on these conditions are not well defined. Well-controlled studies correlating outcome with physiological pelvic floor function are needed.
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Affiliation(s)
- V Poylin
- Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA
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Gungor I, Beji NK. Lifestyle changes for the prevention and management of lower urinary tract symptoms in women. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2011. [DOI: 10.1111/j.1749-771x.2011.01112.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Chancellor MB, Oefelein MG, Vasavada S. Obesity is associated with a more severe overactive bladder disease state that is effectively treated with once-daily administration of trospium chloride extended release. Neurourol Urodyn 2010; 29:551-4. [PMID: 19634167 DOI: 10.1002/nau.20787] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
AIMS Obesity is an established risk factor for urinary incontinence, yet no information exists as to the efficacy of antimuscarinic agents in this population. The goal of this study is to examine the efficacy of once daily trospium chloride (Sanctura) XR in overweight and obese patients with the overactive bladder syndrome. METHODS The primary and secondary end-points of the 1,165 study subjects from the integrated trospium chloride XR pivotal trials were stratified by World Health Organization (WHO) obesity levels I and II. RESULTS Obesity (WHO level I, II criteria) was associated with a more severe baseline OAB disease state (P < 0.01). Trospium chloride XR was more effective than placebo at reducing the primary endpoints (toilet voids, UUI, P < 0.0001) and at improving the secondary end-points (percent patients continent and urgency severity, P < 0.0001) for WHO obesity levels I and II. CONCLUSIONS Obesity is associated with a more severe OAB disease state. Once daily trospium chloride XR is efficacious in the obese patient with the OAB syndrome.
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Influence of Obesity on Short-term Surgical Outcome of the Transobturator Tape Procedure in Patients with Stress Urinary Incontinence. Int Neurourol J 2010; 14:13-9. [PMID: 21120171 DOI: 10.5213/inj.2010.14.1.13] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2010] [Accepted: 04/26/2010] [Indexed: 11/08/2022] Open
Abstract
PURPOSE The purpose of our study was to evaluate the influence of obesity on clinical characteristics, quality of life (QoL), and outcomes in patients with stress urinary incontinence (SUI) who underwent the transobturator tape (TOT) surgery. MATERIALS AND METHODS The medical records of SUI patients who underwent the TOT operation from January 2007 to February 2009 were retrospectively reviewed. Patients with any neurologic diseases that affect the voiding pattern were excluded, and 107 patients were enrolled. The patients were divided into nonobese (BMI<25) and obese (BMI≥25) groups. The preoperative evaluation consisted of history taking, physical examination, cystometrography, 3-day frequency-volume chart, King's Health Questionnaire (KHQ), and symptom perception scale questionnaires. RESULTS The nonobese group consisted of 55 (51.4%) patients and the obese group of 52 (48.6%). The median age was 49.0 (range, 30.8-73.5) years in the nonobese group and 52.7 (range, 35.5-73.5) years in the obese group (p>0.05). The obese group showed a higher SUI symptom grade, urethral hypermobility, urgency, and urge incontinence scale than did the nonobese group (each p<0.05). Neither the domains of the KHQ nor the items on the 3-day frequency-volume chart differed between the two groups (each p>0.05). After the operation, the symptom scales and parameters in the 3-day frequency-volume chart of the obese group were similar to those of the nonobese group (each p>0.05). The objective success, recurrence, and complication rates at 1year were similar in the two groups (each p>0.05). CONCLUSIONS Obese SUI patients had worse SUI symptom grade, urgency, and urge incontinence symptoms than did nonobese patients. However, surgical correction by the TOT operation could restore the symptoms and voiding parameters as effectively in obese patients as in nonobese patients.
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Abstract
OBJECTIVE To estimate whether menopause transition stage is independently associated with the development of incontinence symptoms. METHODS We conducted a longitudinal analysis, using discrete proportional hazards models, of women who were continent at baseline in the Study of Women's Health Across the Nation (SWAN), a multicenter, multiracial, multiethnic prospective cohort study of community-dwelling midlife women transitioning through menopause. At baseline and each of the six annual visits, SWAN elicited frequency and type of incontinence in a self- administered questionnaire and classified menopausal stage from menstrual bleeding patterns. RESULTS Compared with premenopause, being in the early perimenopause (incidence 17.8 per 100 woman years) made it 1.34 times and in the late perimenopause (incidence 14.5 per 100 woman years) made it 1.52 times more likely for women to develop monthly or more frequent incontinence. In contrast, women in postmenopause (incidence 8.2 per 100 woman years) were approximately one half as likely to develop this degree of incontinence. This pattern of association across the menopausal transition was similar for stress and urge incontinence. However, menopausal stage was not associated with developing more frequent incontinence (leaking several times per week or more). Worsening anxiety symptoms, a high baseline body mass index, weight gain, and new onset diabetes were associated with developing more frequent incontinence. CONCLUSION Menopausal transition stage was associated with developing monthly or more frequent but not weekly or more frequent incontinence, suggesting that only infrequent incontinence symptoms were attributable to the perimenopause. Because modifiable factors such as anxiety, weight gain, and diabetes were associated with developing more frequent incontinence, determining whether healthy life changes and treating medical problems can prevent incontinence is a priority. LEVEL OF EVIDENCE II.
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Richter HE, Kenton K, Huang L, Nygaard I, Kraus S, Whitcomb E, Chai TC, Lemack G, Sirls L, Dandreo KJ, Stoddard A. The impact of obesity on urinary incontinence symptoms, severity, urodynamic characteristics and quality of life. J Urol 2010; 183:622-8. [PMID: 20018326 PMCID: PMC3311463 DOI: 10.1016/j.juro.2009.09.083] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE We compared urinary incontinence severity measures and the impact of stress urinary incontinence in normal, overweight and obese women. MATERIALS AND METHODS Baseline characteristics of subjects in the SISTEr (655) and the TOMUS (597) were analyzed. Body mass index was defined as normal (less than 25 kg/m(2)), overweight (25 to less than 30 kg/m(2)) and obese (30 kg/m(2) or greater). Independent urinary incontinence severity measures included a 3-day diary including incontinence episode frequency, Urogenital Distress Inventory scores and Valsalva leak point pressure from urodynamic testing. Impact was measured using the Incontinence Impact Questionnaire. Multivariable regression models were fit for each severity measure (Urogenital Distress Inventory, incontinence episode frequency, Valsalva leak point pressure and Incontinence Impact Questionnaire) on weight category. Covariates included age, race, diabetes and variables significantly associated with body mass index on bivariate analysis. RESULTS Mean age (SD) of participants was 51.9 (10.3) in SISTEr and 52.9 (11.0) in TOMUS. In each trial 45% of subjects were obese. In SISTEr multivariable regression analyses showed that higher weight category was independently associated with higher mean Urogenital Distress Inventory score (p = 0.003), incontinence episode frequency (p <0.0001), Valsalva leak point pressure (p = 0.003) and Incontinence Impact Questionnaire score (p = 0.0004). In TOMUS higher weight category was not associated with Urogenital Distress Inventory score (p = 0.24) but was associated with higher incontinence episode frequency (p = 0.0003), Valsalva leak point pressure (p = 0.0006) and Incontinence Impact Questionnaire score (p <0.0001). CONCLUSIONS Obese women undergoing surgery for stress urinary incontinence report more incontinence episodes, more symptom distress and worse quality of life despite better measure of urethral function (higher Valsalva leak point pressure) on urodynamics.
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Affiliation(s)
- Holly E Richter
- University of Alabama at Birmingham, Birmingham, Alabama, USA.
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Wyman JF, Burgio KL, Newman DK. Practical aspects of lifestyle modifications and behavioural interventions in the treatment of overactive bladder and urgency urinary incontinence. Int J Clin Pract 2009; 63:1177-91. [PMID: 19575724 PMCID: PMC2734927 DOI: 10.1111/j.1742-1241.2009.02078.x] [Citation(s) in RCA: 118] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Behavioural interventions are effective treatments for overactive bladder (OAB) and urgency urinary incontinence (UUI). They are in part aimed at improving symptoms with patient education on healthy bladder habits and lifestyle modifications, including the establishment of normal voiding intervals, elimination of bladder irritants from the diet, management of fluid intake, weight control, management of bowel regularity and smoking cessation. Behavioural interventions also include specific training techniques aimed at re-establishing normal voiding intervals and continence. Training techniques include bladder training, which includes a progressive voiding schedule together with relaxation and distraction for urgency suppression, and multicomponent behavioural training, which, in conjunction with pelvic floor muscle (PFM) exercises, includes PFM contraction to control urgency and increase the interval between voids. Guidelines for the conservative treatment of OAB and UUI have been published by several organisations and the physiological basis and evidence for the effectiveness of behavioural interventions, including lifestyle modifications, in the treatment of OAB and UUI have been described. However, many primary care clinicians may have a limited awareness of the evidence supporting the often straight-forward treatment recommendations and guidance for incorporating behavioural interventions into busy primary care practices, because most of this information has appeared in the specialty literature. The purpose of this review is to provide an overview of behavioural interventions for OAB and UUI that can be incorporated with minimal time and effort into the treatment armamentarium of all clinicians that care for patients with bladder problems. Practical supporting materials that will facilitate the use of these interventions in the clinic are included; these can be used to help patients understand lifestyle choices and voiding behaviours that may improve function in patients experiencing OAB symptoms and/or UUI as well as promote healthy bladder behaviours and perhaps even prevent future bladder problems. Interventions for stress urinary incontinence are beyond the scope of this review.
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Affiliation(s)
- J F Wyman
- School of Nursing, University of Minnesota, 308 Harvard Street S.E., Minneapolis, MN 55455, USA.
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