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Young C, Cooper D, Mostafa A, Abdel-Fattah M. The "Aberdeen Home Continence Stress Test": a novel objective assessment tool for female stress urinary incontinence. Int Urogynecol J 2023; 34:1961-1969. [PMID: 37052645 PMCID: PMC10415466 DOI: 10.1007/s00192-023-05530-4] [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: 12/31/2022] [Accepted: 03/06/2023] [Indexed: 04/14/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Clinical trials for stress urinary incontinence (SUI) require a robust, reliable, and responsive tool for objective assessment of SUI post-intervention. The Aberdeen Home Continence Stress Test (HCST) is a novel patient-reported objective assessment tool, aimed to be patient-friendly and reduce attrition rates by avoiding hospital appointments and prolonged pad-wearing. We aim to describe the HCST for the first time and evaluate its reliability, diagnostic accuracy, and response to change. METHODS A secondary analysis of the Single-Incision Mini-Slings (SIMS) study (a prospective multicentre randomised control trial (RCT) comparing two surgical treatments of SUI was performed. In SIMS (n = 600 women), the objective outcome was assessed by the 24-h pad test, while the patient-reported success rates were assessed using the Patient Global Impression of Improvement (PGI-I) at 15 months, 2 years and 3 years post-randomisation. Participants were instructed to perform the HCST before and after the 24-h pad test. The HCST was analysed in relation to reliability, validity, and the relationship between the 24-h pad test and HCST results and finally with regard to its responsiveness to change in PGI-I. (Trial registration-number ISRCTN93264234, registration date 14/01/2014). RESULTS Compared to the 24-h pad test, the sensitivity of the HCST ranged from 0.81-0.95, specificity was 0.76-0.79, negative predictive value was 0.96-0.99 and positive predictive value was 0.32-0.43. Reliability was indicated by high-performing Cronbach's alpha value (> 0.7). An improvement of ≥ 2 leakage groups on the HCST (for example from Large at baseline to Small leakage at follow-up) was strongly associated with patient-reported success on PGI-I (OR 4.38, 95% CI 2.31, 8.31). CONCLUSIONS The HCST is a valid and reliable patient-reported objective assessment tool that can be used for assessing SUI in surgical trials with good specificity, sensitivity, and consistency.
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Affiliation(s)
- Catriona Young
- The Aberdeen Centre for Women's Health Research, University of Aberdeen, Foresterhill, AB25 2ZD, Aberdeen, UK.
| | - David Cooper
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Alyaa Mostafa
- The Aberdeen Centre for Women's Health Research, University of Aberdeen, Foresterhill, AB25 2ZD, Aberdeen, UK
| | - Mohamed Abdel-Fattah
- The Aberdeen Centre for Women's Health Research, University of Aberdeen, Foresterhill, AB25 2ZD, Aberdeen, UK
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Te West NID, Harris K, Jeffrey S, de Nie I, Parkin K, Roovers JP, Moore KH. The effect of 12 weeks of estriol cream on stress urinary incontinence post-menopause: A prospective multinational observational study. Neurourol Urodyn 2023; 42:799-806. [PMID: 36840920 DOI: 10.1002/nau.25165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 02/09/2023] [Accepted: 02/11/2023] [Indexed: 02/26/2023]
Abstract
OBJECTIVE To quantitate the changes in stress urinary incontinence (SUI) outcome measures after 12 weeks of vaginal estriol cream in women with stress incontinence. METHODS A prospective multicentre observational study conducted in tertiary urogynaecology centers. Postmenopausal women with pure SUI or stress predominant mixed urinary incontinence (MUI), not receiving any other treatment for their incontinence were given written instructions regarding digital application of a standard dose of vaginal estriol cream. Outcomes were measured at baseline and 12 weeks. The primary objective outcome was vaginal pH. The primary subjective outcome was the stress domain of the Urogenital Distress Inventory-6 (UDI-6). The secondary objective outcome used was the erect cough stress test. Two quality of life questionnaires and two patient reported outcomes were also included. RESULTS The 46 postmenopausal recruits had a median age of 62.1 interquartile range (IQR 56.2-65.4). At follow up, the primary subjective outcome SUI domain [UDI-6] significantly improved from 83.3 (IQR 50-100) to 33.3 (33.3-66.7, p ≤ 0.001) as did vaginal pH [from 5.1 (4.9-5.9) to 4.9 (4.6-5.0] p ≤ 0.001; 18/43 patients (42%) were dry on cough stress test. CONCLUSIONS Twelve weeks of vaginal estriol cream significantly reduced symptoms of stress urinary incontinence in this sample of postmenopausal women.
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Affiliation(s)
- Nevine I D Te West
- Department of Urogynaecology, St George Hospital, School of Women's and Children's Health, University of New South Wales, Sydney, Australia
| | - Katie Harris
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Steven Jeffrey
- Department of Obstetrics and Gynaecology, Groote Schuur Hospital, Cape Town, South Africa
| | - Iris de Nie
- Department of Obstetrics and Gynaecology, Groote Schuur Hospital, Cape Town, South Africa.,Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, The Netherlands
| | - Katrina Parkin
- Department of Urogynaecology, St George Hospital, School of Women's and Children's Health, University of New South Wales, Sydney, Australia
| | - Jan-Paul Roovers
- Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, The Netherlands
| | - Kate H Moore
- Department of Urogynaecology, St George Hospital, School of Women's and Children's Health, University of New South Wales, Sydney, Australia
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Long Z, Chen H, Yu S, Wang X, Liu Z. Effect of Acupuncture for Mixed Urinary Incontinence in Women: A Systematic Review. Front Public Health 2022; 10:827853. [PMID: 35372235 PMCID: PMC8971660 DOI: 10.3389/fpubh.2022.827853] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 02/21/2022] [Indexed: 01/08/2023] Open
Abstract
Background Mixed urinary incontinence increasingly undermines women's quality of life. Previous studies showed some effects of acupuncture for MUI, but no systematic review has been done to evaluate the efficacy and safety of acupuncture for MUI in women. Objective To systematically review the efficacy and safety of acupuncture for women with MUI. Methods Ten databases (i.e., PubMed, Web of Science, Embase, ClinicalTrials.gov, the Cochrane Library, CBM, Scoups, CNKI, VIP and WANFANG DATA) were searched up to July 19th, 2021, using tailored search strategies with keywords not limited to “female,” “mixed urinary incontinence,” “acupuncture,” and “randomized controlled trial,” etc. RCTs and quasi-RCTs were included if investigating effect of any type of acupuncture for female patients with MUI. Data were extracted from eligible studies, and risks of bias were assessed according to the Cochrane Handbook from seven aspects using the RevMan 5.4 software. Results A total of three randomized studies with 591 women were included. The risk of bias among the studies varied, with major concerns on blinding of participants and outcome assessor. Liu's study (497) mainly showed that electroacupuncture's effect on reduction of numbers of incontinence, urgency, nocturia episodes, and amount of urine leakage etc. was not inferior to that of PFMT-Solifenacin group at 12, 24, and 36 weeks. Zhan's study (60) showed that electroacupuncture reduced significantly more amount of urine leakage than Tolterodine at 8 weeks, with no data on incontinence episodes frequency. All 3 studies reported that acupuncture significantly increased the quality of life assessed by ICIQ score. In addition, incidence of acupuncture-related adverse events was rare, while antimuscarinic agents related adverse events were common in two studies. Conclusion Although acupuncture showed some benefit for women with MUI, more evidences were required to draw a solid conclusion of effectiveness and safety of acupuncture for women with MUI. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO, identifier: CRD42021224600.
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Affiliation(s)
- Zilin Long
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Huan Chen
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Shudan Yu
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xinlu Wang
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Zhishun Liu
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- *Correspondence: Zhishun Liu
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Medeiros Araujo C, de Morais NR, Sacomori C, de Sousa Dantas D. Pad test for urinary incontinence diagnosis in adults: Systematic review of diagnostic test accuracy. Neurourol Urodyn 2022; 41:696-709. [PMID: 35114027 DOI: 10.1002/nau.24878] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 12/20/2021] [Accepted: 01/06/2022] [Indexed: 02/01/2023]
Abstract
INTRODUCTION The pad test is an assessment tool for urinary incontinence (UI) severity classification and therapeutic response monitoring. However, the reliability and reproducibility of this test have been questioned. OBJECTIVES To summarize the evidence regarding the accuracy measures and reproducibility of different pad test protocols for assessing UI. METHODS A systematic review of the diagnostic accuracy of this tool was performed (CRD42020219392). Eligibility criteria: Studies reporting data on the accuracy measures and reproducibility of the pad test when used for detecting UI in adult men and women. DATA SOURCES MEDLINE, Science Direct, Cochrane, Web of Science, LILACS, and Pedro. DATA EXTRACTION AND SYNTHESIS Two reviewers independently screened the articles, extracted the data, and evaluated the risk of bias (RoB) using the QUADAS-2 tool. RESULTS From 1048 studies, 18 studies were included. Eight of these reported accuracy data, and 12 reported reproducibility properties. A total of 1070 individuals were analyzed, whose mean age ranged from 20 to 90 years. The accuracy of the long-duration protocols was generally moderate to high (sensitivity, 60%-93%; specificity, 60%-84%). The 1-h protocols obtained higher accuracy values. The overall reproducibility was moderate to high (κ ≥ 0.66). LIMITATIONS The RoB was high and, due to different cutoff points adopted by studies, the bivariate model was not satisfied to perform a meta-analysis. DISCUSSION The 1-h pad test was more accurate but less reproducible when compared to the long-duration tests. Pad test results should be used with caution in clinical practice.
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Affiliation(s)
| | - Nívea Rosa de Morais
- Physiotherapy Department, Universidade Federal de Pernambuco (UFPE), Recife, Brazil
| | - Cinara Sacomori
- Facultad de Medicina Clinica Alemana, Universidad del Desarrollo, Santiago, Chile
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Khouri RK, Yi YA, Ortiz NM, Baumgarten AS, Ward EE, VanDyke ME, Hudak SJ, Morey AF. Standing cough test stratification of moderate male stress urinary incontinence. Int Braz J Urol 2021; 47:415-422. [PMID: 33284545 PMCID: PMC7857773 DOI: 10.1590/s1677-5538.ibju.2020.0551] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 08/18/2020] [Indexed: 11/22/2022] Open
Abstract
PURPOSE Patient-reported history of pads per day (PPD) is widely recognized as a fundamental element of decision-making for anti-incontinence procedures. We hypothesize that SUI severity is often underestimated among men with moderate SUI. We sought to compare patient history of incontinence severity versus objective in-office physical examination findings. MATERIALS AND METHODS We retrospectively reviewed our single-surgeon male SUI surgical database from 2007-2019. We excluded patients with incomplete preoperative or postoperative data and those who reported either mild or severe SUI, thus having more straightforward surgical counseling. For men reported to have moderate SUI, we determined the frequency of upgrading SUI severity by recording the results of an in-office standing cough test (SCT) using the Male Stress Incontinence Grading Scale (MSIGS). The correlation of MSIGS with sling success rate was calculated. Failure was defined as >1 PPD usage or need for additional incontinence procedure. RESULTS Among 233 patients with reported moderate SUI (2-3 PPD), 89 (38%) had MSIGS 3-4 on SCT, indicating severe SUI. Among patients with 2-3 PPD preoperatively, sling success rates were significantly higher for patients with MSIGS 0-2 (76/116, 64%) compared to MSIGS 3-4 (6/18, 33%) (p <0.01). CONCLUSIONS Many men with self-reported history of moderate SUI actually present severe SUI observed on SCT. The SCT is a useful tool to stratify moderate SUI patients to more accurately predict sling success.
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Affiliation(s)
- Roger K. Khouri
- University of Texas Southwestern Medical CenterDepartment of UrologyDallasTexasUSADepartment of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
| | - Yooni A. Yi
- University of Texas Southwestern Medical CenterDepartment of UrologyDallasTexasUSADepartment of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
| | - Nicolas M. Ortiz
- University of Texas Southwestern Medical CenterDepartment of UrologyDallasTexasUSADepartment of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
| | - Adam S. Baumgarten
- University of Texas Southwestern Medical CenterDepartment of UrologyDallasTexasUSADepartment of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
| | - Ellen E. Ward
- University of Texas Southwestern Medical CenterDepartment of UrologyDallasTexasUSADepartment of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
| | - Maia E. VanDyke
- University of Texas Southwestern Medical CenterDepartment of UrologyDallasTexasUSADepartment of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
| | - Steven J. Hudak
- University of Texas Southwestern Medical CenterDepartment of UrologyDallasTexasUSADepartment of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
| | - Allen F. Morey
- University of Texas Southwestern Medical CenterDepartment of UrologyDallasTexasUSADepartment of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Correspondence address: Allen F. Morey, MD, Department of Urology, University of Texas, Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, USA. 75390-9110 Telephone: + 1 214 648-0202 E-mail:
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Comparison of Methods to Identify Stress Urinary Incontinence in Women With Pelvic Organ Prolapse. Female Pelvic Med Reconstr Surg 2021; 27:e127-e132. [PMID: 33369965 DOI: 10.1097/spv.0000000000000858] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to compare which test is most sensitive in identifying stress urinary incontinence (SUI) in women with pelvic organ prolapse using urodynamics (UDS) as the criterion standard: cough stress test (CST) or pyridium pad test. METHODS This was a prospective study of women with pelvic organ prolapse stage II or greater who desired surgical management for prolapse. Each patient underwent preoperative urinary testing: UDS, CST, and a 24-hour pyridium pad test. RESULTS A total of 84 patients were analyzed. Using UDS as the criterion standard, both the CST and the pyridium pad test showed a fair agreement with UDS outcomes (κ = 0.27 for both tests). There was no statistically significant difference between the CST and pyridium pad test, with estimated sensitivities of 34.4% versus 60.6% (P = 0.791) and specificities of 90.4% versus 84.6% (P = 0.508). The pyridium pad test was found to have a statistically significant difference in identifying the subjective complaint of SUI (38.6%, P = 0.003) compared with other tests. Patients with occult incontinence were identified 42.5%, 17.5%, and 10% of the time during UDS, CST, and pyridium pad testing, respectively. CONCLUSION Our data suggest that the sensitivities of the CST and pyridium pad test for stress incontinence and occult stress incontinence in patients with pelvic organ prolapse are low when compared with UDS as the criterion standard. Urodynamics has an important role in preoperative identification of occult SUI.
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Espuña-Pons M, Diez-Itza I, Anglès-Acedo S, Covernton PJO. Cough stress tests to diagnose stress urinary incontinence in women with pelvic organ prolapse with indication for surgical treatment. Neurourol Urodyn 2020; 39:819-825. [PMID: 32040873 PMCID: PMC7078860 DOI: 10.1002/nau.24288] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 01/13/2020] [Indexed: 02/03/2023]
Abstract
AIMS To evaluate the diagnostic ability of different cough stress tests (CSTs) in women with pelvic organ prolapse (POP), performed during outpatient urogynaecological exams. METHODS Prospective, multicentre observational study involving women on waiting lists for POP surgery. With a subjectively full bladder, patients were asked to perform five different CSTs: without prolapse reduction ([a] standing, followed by [b] semilithotomy position); keeping semilithotomy position with prolapse reduced (by [c] posterior speculum, followed by [d] pessary); [e] standing again with the pessary in place. Primary outcome was positive CST in at least one of the five CSTs. Bladder volume was measured and symptoms of stress urinary incontinence (SUI) were detected by two validated questionnaires. RESULTS A total of 297 women completed all CSTs and were included in the analyses. Mean (SD) age, parity, and body mass index were 64.8 (9.9) years, 2.7 (1.3) deliveries, and 26.6 (3.4) kg/m2 , respectively. In total, 99 women (33.3%) reported SUI symptoms. At least one positive CST was recorded in 152 patients (51.1%), and in 90 (59.2%) of these 152, a positive CST was observed only when POP was reduced (occult SUI). The CST was positive in 92 (92.9%) of the 99 patients with coexisting SUI symptoms and in 60 (30.3%) of the 205 asymptomatic patients. The percentage of patients with a positive CST was significantly lower when bladder volume was <200 mL vs ≥200 mL (P = .046). CONCLUSIONS The identification of urinary leakage cases with CSTs is best achieved using multiple different patient positions, different prolapse reduction methods, and bladder volumes ≥200 mL.
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Affiliation(s)
- Montserrat Espuña-Pons
- Department and Clinical Institute of Gynaecology, Obstetrics and Neonatology, Hospital Clinic I Provincial, University of Barcelona, Barcelona, Spain
| | - Irene Diez-Itza
- Department of Obstetrics and Gynaecology, Donostia University Hospital, San Sebastián, Spain
| | - Sònia Anglès-Acedo
- Department and Clinical Institute of Gynaecology, Obstetrics and Neonatology, Hospital Clinic I Provincial, University of Barcelona, Barcelona, Spain
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Dufour S, Wu M. No. 397 - Conservative Care of Urinary Incontinence in Women. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 42:510-522. [PMID: 32303295 DOI: 10.1016/j.jogc.2019.04.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To outline the evidence for conservative care, including both assessment and management options, for urinary incontinence in women. INTENDED USERS Relevant primary care providers and medical specialists including but not limited to physicians, nurses, midwives, and pelvic health physiotherapists. TARGET POPULATION Women (>18 years of age) with urinary incontinence. OPTIONS Assessment options include gathering of a detailed history, physical examination, laboratory analysis, urodynamic evaluation, and cystoscopy. Conservative management options include lifestyle management, pelvic floor muscle training, behavioural management, and mechanical devices. OUTCOMES To provide an evaluation-based summary of current available evidence concerning efficacy of conservative care (assessment and management) strategies for urinary incontinence in women. EVIDENCE The Cochrane Library and Medline (2013-2018) were searched to find articles related to conservative care of urinary incontinence in women (>18 years). Articles were appraised, and the collective evidence was graded. VALIDATION METHODS The evidence obtained was reviewed and evaluated by the Society of Obstetricians and Gynaecologists of Canada (SOGC) Urogynecology Committee under the leadership of the principal authors. The quality of evidence was rated using the criteria described in the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology framework. BENEFITS, HARMS, AND COSTS Evidence for the efficacy of conservative care (assessment and management) options for women with urinary incontinence is strong. Furthermore, these options carry minimal or no harm and confer an established cost benefit. GUIDELINE UPDATE This SOGC Clinical Practice Guideline will be automatically reviewed 5 years after publication. SUMMARY STATEMENTS RECOMMENDATIONS.
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Dufour S, Wu M. Directive clinique no 397 – Prise en charge conservatrice de l'incontinence urinaire chez les femmes. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 42:523-537. [DOI: 10.1016/j.jogc.2020.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Yi YA, Keith CG, Graziano CE, Davenport MT, Bergeson RL, Christine BS, Morey AF. Strong correlation between standing cough test and 24-hour pad weights in the evaluation of male stress urinary incontinence. Neurourol Urodyn 2019; 39:319-323. [PMID: 31692080 DOI: 10.1002/nau.24200] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 10/21/2019] [Indexed: 11/08/2022]
Abstract
AIMS We sought to compare in-office physical exam findings via standing cough test (SCT) versus 24-hour pad weights among men seeking treatment for postprostatectomy stress urinary incontinence (SUI). METHODS A retrospective review of a single surgeon database of incontinence procedures was performed. Documentation of SUI severity (grades 0-4) was completed by SCT preoperatively utilizing the Male Stress Incontinence Grading Scale (MSIGS). All patients had pads per day (PPD) and 24-hour pad weights obtained. We determined the Spearman's correlation coefficient between these variables. RESULTS We identified 104 men who underwent anti-incontinence surgery (AdVance Sling or artificial urinary sphincter [AUS]). In the sling group (65 patients), nearly all (97%) had minimal incontinence with SCT (MSIGS = 0-2). In the AUS group (39 patients), most patients (69%) had an MSIGS 3 or 4 with SCT. Spearman's coefficient between quantification of SCT and pad weight for the overall group was ρ = .68 (P < .0001) demonstrating a strong positive correlation. PPD was also strongly correlated with pad weight (ρ = .55, P < .0001). As seen previously, SCT and PPD were correlated (ρ = .47, P < .0001). In a multivariable model predicting pad weight, the effect of SCT was greater than PPD (β = 83 [54-111], P < .0001 vs 45 [2169], P = .0004). CONCLUSIONS SCT findings strongly correlate to 24-hour pad weights in the evaluation of male SUI. The SCT shows promise as a rapid, reliable, noninvasive measure of SUI severity before anti-incontinence surgery.
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Affiliation(s)
- Yooni A Yi
- Department of Urology, UT Southwestern Medical Center, Dallas, Texas
| | | | | | | | - Rachel L Bergeson
- Department of Urology, UT Southwestern Medical Center, Dallas, Texas
| | | | - Allen F Morey
- Department of Urology, UT Southwestern Medical Center, Dallas, Texas
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Soto González M, Da Cuña Carrera I, Lantarón Caeiro EM, Gutiérrez Nieto M. [Circumstances that may decrease the reliability of instruments to assess male urinary incontinence]. Rehabilitacion (Madr) 2019; 53:8-12. [PMID: 30929835 DOI: 10.1016/j.rh.2018.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 08/30/2018] [Accepted: 09/01/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To identify situations that may alter the results of the 1-hour and 24-hour Pad test and the short-form International Consultation in Incontinence Questionnaire (SF-ICIQ). PARTICIPANTS Five physiotherapists, who conducted the interviews and treatment of 81 patients undergoing radical prostatectomy. METHOD A qualitative descriptive phenomenological study was carried out, using a focus group technique with five people (4 women and 1 man) responsible for the treatment and assessment of patients with urinary incontinence after prostatectomy. Recordings were transcribed and the Atlas.ti7 programme was used to carry out the coding of the variables. RESULTS Important factors were identified in the use of measuring instruments for the diagnosis and assessment of urinary incontinence in all the tools used. CONCLUSIONS Some situations can modify the objectivity of the various tests for the assessment of urinary incontinence. Some of the factors identified were lower fluid intake, less activity, use of manual clamp or urinals to avoid leakage, as well as the interference of certain drugs.
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Affiliation(s)
- M Soto González
- Facultad de Fisioterapia, Universidad de Vigo, Pontevedra, España.
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Guralnick ML, Fritel X, Tarcan T, Espuna-Pons M, Rosier PFWM. ICS Educational Module: Cough stress test in the evaluation of female urinary incontinence: Introducing the ICS-Uniform Cough Stress Test. Neurourol Urodyn 2018; 37:1849-1855. [DOI: 10.1002/nau.23519] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 01/08/2018] [Indexed: 01/06/2023]
Affiliation(s)
| | - Xavier Fritel
- Faculté de Médecine et Pharmacie; Université de Poitiers; Poitiers France
| | - Tufan Tarcan
- Marmara University School of Medicine; Istanbul Turkey
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A Randomized Comparative Study Evaluating Various Cough Stress Tests and 24-Hour Pad Test with Urodynamics in the Diagnosis of Stress Urinary Incontinence. J Urol 2018; 199:1557-1564. [DOI: 10.1016/j.juro.2017.11.073] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2017] [Indexed: 11/23/2022]
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Luginbuehl H, Baeyens JP, Kuhn A, Christen R, Oberli B, Eichelberger P, Radlinger L. Pelvic floor muscle reflex activity during coughing - an exploratory and reliability study. Ann Phys Rehabil Med 2016; 59:302-307. [PMID: 27265846 DOI: 10.1016/j.rehab.2016.04.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 02/22/2016] [Accepted: 04/18/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Activities that provoke stress urinary incontinence (SUI) rapidly increase the intra-abdominal pressure and the impact loading on the pelvic floor muscles (PFMs). Coughing can cause urinary leakage and is often used to test SUI. However, PFM characteristics during coughing, including their reliability, have not been investigated. Here, we used electromyography (EMG) to describe PFM pre-activity and reflexivity during coughing and examined the reliability of the measurements. METHODS This was an exploratory and reliability study including 11 young healthy women to characterize EMG reflex activity in PFMs during coughing. We describe 6 variables, averaged over 3 coughs per subject, and tested their reliability (intraclass correlation coefficient 3,1 [ICC(3,1)] and ICC(3,k), related standard error of measurement (SEM) and minimal difference [MD]). The variables represented the mean EMG activity for PFMs during 30-ms time intervals of pre-activity (initial time point of coughing [T0] and minus 30ms) and reflex activity (T0-30, 30-60, 60-90, 90-120 and 120-150ms after T0) of stretch-reflex latency responses. RESULTS The mean %EMG (normalized to maximal voluntary PFM contraction) for EMG variables was 35.1 to 52.2 and was significantly higher during coughing than for PFM activity at rest (mean 24.9±3.7%EMG; P<0.05). ICC(3,k) ranged from 0.67 to 0.91 (SEM 6.1-13.3%EMG and MD 16.7-36.8%EMG) and was higher than ICC(3,1) (range 0.40-0.77; SEM 9.0-18.0%EMG, MD 24.9-50.0%EMG). CONCLUSIONS PFM activity during reflex latency response time intervals during coughing was significantly higher than at rest, which suggests PFM pre-activity and reflex activity during coughing. Although we standardized coughing, EMG variables for PFM activity showed poor reliability [good to excellent ICC(3,k) and fair to excellent ICC(3,1) but high SEM and MD]. Therefore, coughing is expected to be heterogeneous, with low reliability, in clinical test situations. Potential crosstalk from other muscles involved in coughing could limit the interpretation of our results.
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Affiliation(s)
- Helena Luginbuehl
- Bern University of Applied Sciences, Health, Discipline of Physiotherapy, Murtenstrasse 10, 3008 Bern, Switzerland; Vrije Universiteit Brussel, Faculty of Physical Education and Physiotherapy, Pleinlaan 2, 1050 Elsene, Belgium.
| | - Jean-Pierre Baeyens
- Vrije Universiteit Brussel, Faculty of Physical Education and Physiotherapy, Pleinlaan 2, 1050 Elsene, Belgium
| | - Annette Kuhn
- Department of Gynecology, Division of Urogynecology, Inselspital and University of Bern, Effingerstrasse 102, Switzerland
| | - Regula Christen
- Bern University of Applied Sciences, Health, Discipline of Physiotherapy, Murtenstrasse 10, 3008 Bern, Switzerland
| | - Bettina Oberli
- Bern University of Applied Sciences, Health, Discipline of Physiotherapy, Murtenstrasse 10, 3008 Bern, Switzerland
| | - Patric Eichelberger
- Bern University of Applied Sciences, Health, Discipline of Physiotherapy, Murtenstrasse 10, 3008 Bern, Switzerland
| | - Lorenz Radlinger
- Bern University of Applied Sciences, Health, Discipline of Physiotherapy, Murtenstrasse 10, 3008 Bern, Switzerland
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Olgan S, Mantar OP, Okyay RE, Gulekli B. Quantitative Sonographic Differences in Mid-Urethra between Postmenopausal Women with and without Stress Urinary Incontinence. Gynecol Obstet Invest 2016; 81:256-61. [PMID: 27054827 DOI: 10.1159/000445748] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 03/23/2016] [Indexed: 11/19/2022]
Abstract
AIM The aim of this study was to evaluate midurethral tissue characteristics in continent and stress urinary incontinent postmenopausal women by using transvaginal ultrasound gray-level histogram. METHODS Thirty-seven patients with stress urinary incontinence (SUI) and 77 patients without SUI were evaluated. Vaginal ultrasound gray-level histograms were performed by 2 gynecologists blinded to patients' SUI statuses. The mean gray-level (MGL) of ultrasound gray-level histogram, representing the echogenicity of a region of interest, was measured in the anterior and posterior midurethral wall along a vertical ultrasound beam. The difference in MGL between anterior and posterior (AP difference) midurethra was calculated. RESULTS The MGL value of SUI patients was found to be lower in posterior (p = 0.008) and higher in anterior midurethral region (p = 0.001) when compared with control group. In addition, the difference in MGL between anterior and posterior midurethra (AP difference) was found to be higher in SUI group (p < 0.001). Multivariate analysis by logistic regression including confounding factors revealed that AP difference was independently associated with presence of SUI (adjusted OR 1.14, 95% CI 1.08-1.20, p < 0.001). Intra- and inter-observer reproducibility was found to be high with intraclass correlation coefficient of 0.83 and 0.78, respectively. CONCLUSION Postmenopausal SUI patients might have a distinct midurethral echogenicity pattern with the quantitative ultrasonography.
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Affiliation(s)
- Safak Olgan
- Department of Obstetrics and Gynecology, Akdeniz University School of Medicine, Antalya, Turkey
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16
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Treatment of stress urinary incontinence using polyacrylamide hydrogel in women after radiotherapy: 1-year follow-up. Int Urogynecol J 2015; 27:301-5. [DOI: 10.1007/s00192-015-2834-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 08/18/2015] [Indexed: 10/23/2022]
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17
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Outcome measures for stress urinary incontinence treatment: Can we minimally agree? World J Urol 2015; 33:1221-34. [DOI: 10.1007/s00345-015-1524-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 03/02/2015] [Indexed: 10/23/2022] Open
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18
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Nitti VW, Mourtzinos A, Brucker BM. Correlation of patient perception of pad use with objective degree of incontinence measured by pad test in men with post-prostatectomy incontinence: the SUFU Pad Test Study. J Urol 2014; 192:836-42. [PMID: 24650425 DOI: 10.1016/j.juro.2014.03.031] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Many investigators have used the number of pads to determine the severity of post-prostatectomy incontinence and yet the accuracy of this tool remains unproven. We determined whether the patient perception of pad use and urine loss reflects actual urine loss. We also identified a quality of life measure that distinguishes patients by severity of incontinence. MATERIALS AND METHODS We prospectively enrolled 235 men from a total of 18 sites 6 months or more after radical prostatectomy who had incontinence requiring protection. Patients completed a questionnaire on the perception of pad number, size and wetness, a quality of life question, several standardized incontinence questionnaires and a 24-hour pad test that assessed pad number, size and weight. SPSS® was used for statistical analysis. RESULTS Perception of the number of pads used closely agreed with the number of pads collected during a 24-hour pad test. Perceived and actual pad size had excellent concordance (76%, p <0.001). Patients with wet and soaked pads had statistically and clinically significantly different pad weights that were uniquely different from each other and from those of patients who were almost dry and slightly wet. Response to the quality of life question separated the men into 4 statistically significantly different groups based on mean 24-hour pad weight. CONCLUSIONS Patients accurately described the number, size and degree of wetness of pads collected during a 24-hour pad test. These values correlated well with actual urine loss. The single question, "To what extent does urine loss affect your quality of life?" separated men into distinct categories.
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Affiliation(s)
- Victor W Nitti
- New York University Langone Medical Center, New York, New York, and Tufts Medical School (AM), Boston, Massachusetts.
| | - Arthur Mourtzinos
- New York University Langone Medical Center, New York, New York, and Tufts Medical School (AM), Boston, Massachusetts
| | - Benjamin M Brucker
- New York University Langone Medical Center, New York, New York, and Tufts Medical School (AM), Boston, Massachusetts
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Terlikowski R, Dobrzycka B, Kinalski M, Kuryliszyn-Moskal A, Terlikowski SJ. Transvaginal electrical stimulation with surface-EMG biofeedback in managing stress urinary incontinence in women of premenopausal age: a double-blind, placebo-controlled, randomized clinical trial. Int Urogynecol J 2013; 24:1631-8. [PMID: 23443345 PMCID: PMC3779318 DOI: 10.1007/s00192-013-2071-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 02/09/2013] [Indexed: 01/09/2023]
Abstract
Introduction and hypothesis The aim of this study was to evaluate the results of conservative treatment of urodynamic stress urinary incontinence (SUI) using transvaginal electrical stimulation with surface-electromyography-assisted biofeedback (TVES + sEMG) in women of premenopausal age. Methods One hundred and two patients with SUI were divided into two groups: active (n = 68) and placebo (n = 34) TVES + sEMG. The treatment lasted for 8 weeks and consisted of two sessions per day. Women were evaluated before and after the intervention by pad test, voiding diary, urodynamic test, and the Incontinence Quality of Life Questionnaire (I-QOL). Results Mean urinary leakage on a standard pad test at the end of 8th week was significantly lower in the active than the placebo group (19.5 ± 13.6 vs. 39.8 ± 28.5). Mean urinary leakage on a 24-h pad test was significantly reduced in the active group at the end of 8th and 16th weeks compared with the placebo group (8.2 ± 14.8 vs. 14.6 ± 18.9 and 6.1 ± 11.4 vs. 18.2 ± 20.8, respectively). There was also a significant improvement in muscle strength as measured by the Oxford scale in the active vs the placebo group after 8 and 16 weeks (4.2 vs 2.6 and 4.1 vs 2.7, respectively). No significant difference was found between groups in urodynamic data before and after treatment. At the end of 8th week, the mean I-QOL score in the active vs the placebo group was 78.2 ± 17.9 vs 55.9 ± 14.2, respectively, and at the end of 16th week 80.8 ± 24.1 vs. 50.6 ± 14.9, respectively. Conclusion Our study showed that TVES + sEMG is a trustworthy method of treatment in premenopausal women with SUI; however, its reliability needs to be established.
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Affiliation(s)
- Robert Terlikowski
- Department of Rehabilitation, Medical University of Bialystok, Bialystok, Poland
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Moore RD, De Ridder D, Kennelly MJ. Two-year evaluation of the MiniArc in obese versus non-obese patients for treatment of stress urinary incontinence. Int J Urol 2012; 20:434-40. [PMID: 22989174 DOI: 10.1111/j.1442-2042.2012.03147.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Accepted: 08/12/2012] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Obesity is a well-established risk factor of stress urinary incontinence, which affects up to 35% of adult women worldwide. We evaluated whether there is a difference in outcomes with MiniArc sling for treatment of stress incontinence in obese women versus non-obese women at 24 months. METHODS A 2-year subanalysis of obese (body mass index >30 kg/m(2) ) versus non-obese patients enrolled into a multicenter, prospective study evaluating the effectiveness of MiniArc sling was carried out. Qualitative (Urogenital Distress Inventory 6 and Incontinence Impact Questionnaire 7) and quantitative measurements, including the cough stress test, were carried out. Secondary outcome measures included procedure time, estimated blood loss, length of stay, perioperative complications, Wong-Baker Faces Pain Scale and adverse events. RESULTS Of 188 patients, 62 were obese. The mean procedure time, blood loss and length of stay were no different between groups. Obese patients reported significantly more pain immediately postoperatively (2 vs 1, Wong-Baker, P = 0.042), but there was no difference at postoperative day 7. There was no difference in objective cure using the cough stress test (81% obese vs 86% non-obese; P = 0.449). Urogenital Distress Inventory 6 and Incontinence Impact Questionnaire 7 median scores showed no difference between groups in improvement (P = 0.126 and P = 0.087, respectively). No serious device-related complications were reported in either group. CONCLUSIONS The MiniArc sling represents a safe and effective treatment option for both obese and non-obese patients with stress incontinence. Comparable outcomes at 2 years can be obtained in terms of cure rates using the cough stress test or questionnaires, as well as complication rates.
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Affiliation(s)
- Robert D Moore
- Atlanta Urogynecology Associates, Atlanta, GA 30005, USA.
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Oyama T, Kawai Y, Oka M. Tramadol enhances urethral continence function through µ-opioid receptors in rats. Neurourol Urodyn 2012; 32:98-103. [DOI: 10.1002/nau.22274] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Accepted: 04/24/2012] [Indexed: 11/07/2022]
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