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Özden F, Özkeskin M, Sarı Z, Ekici E, Yüceyar N. Association of Urinary Incontinence with Sensory-Motor Performance in Women with Multiple Sclerosis. Int Urogynecol J 2024:10.1007/s00192-024-05854-9. [PMID: 38976027 DOI: 10.1007/s00192-024-05854-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 06/04/2024] [Indexed: 07/09/2024]
Abstract
INTRODUCTION AND HYPOTHESIS The relationship between somatosensory and motor components of urinary incontinence in individuals with MS has not been extensively addressed. The study was aimed at investigating the association of urinary incontinence severity with motor and sensory performance in women with multiple sclerosis (MS). METHODS A cross-sectional single-center prospective study was conducted in 337 women with MS. The severity of MS symptoms was assessed using the SymptoMScreen questionnaire. The urinary incontinence status of the participants was evaluated using the Urinary Incontinence Inventory (UDI-6) and the Incontinence Impact Questionnaire (IIQ-7). Physical performance was considered with the Timed Up and Go (TUG) test and the 5-Times Sit-to-Stand (5TSTS) test. In addition, the sensory performance of the individuals with MS was queried using the Somatosensory Amplification Scale (SSAS) and Sensory Sensitivity Scale (SeSS). RESULTS The UDI-6 (r=0.685, p<0.05) and IIQ-7 (r=0.759, p<0.05) correlated highly with SymptoMScreen. Among the physical performance measures, TUG (r=0.012, p<0.05) and 5TSTS (r=0.096, p<0.05) were weakly associated with UDI-6, but not statistically significantly. Similarly, there was a low correlation between IIQ-7 and TUG (r=-0.005, p<0.05) and 5TSTS (r=0.068, p<0.05). UDI-6 (0.360, p<0.05) and IIQ-7 (0.378, p<0.05) correlated moderately with SASS. On the other hand, SeSS had a low correlation coefficient with UDI-6 (0.305, p<0.05) and IIQ-7 (0.272, p<0.05). CONCLUSIONS The results revealed that sensory performance was more associated with urinary incontinence in women with MS than physical performance. The urinary incontinence severity was also related to MS symptoms (bladder control, walking, spasticity, stiffness cognitive function). Future studies should consider the potential impact of sensory performance on urinary incontinence and focus on explaining the mechanism behind this relationship.
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Affiliation(s)
- Fatih Özden
- Köyceğiz Vocational School of Health Services, Department of Health Care Services, Muğla Sıtkı Koçman University, 48800, Köyceğiz, Muğla, Turkey.
| | - Mehmet Özkeskin
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Ege University, İzmir, Turkey
| | - Zübeyir Sarı
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Marmara University, İstanbul, Turkey
| | - Ece Ekici
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Toros University, Mersin, Turkey
| | - Nur Yüceyar
- Faculty of Medicine, Department of Neurology, Ege University, İzmir, Turkey
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Brady SS, Arguedas A, Huling JD, Hellemann G, Yaffe K, Lewis CE, Fok CS, Van Den Eeden SK, Markland AD. Cognitive function and bladder health among midlife adult women in the Coronary Artery Risk Development in Young Adults (CARDIA) study. Menopause 2024:00042192-990000000-00333. [PMID: 38860942 DOI: 10.1097/gme.0000000000002377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Abstract
OBJECTIVE The aim of this study was to examine whether different aspects of women's cognitive function are associated with lower urinary tract symptoms (LUTS) and their impact. METHODS In 2010-2011, women aged 42 to 57 years in the Coronary Artery Risk Development in Young Adults study completed different tests of cognitive function, including the Digit Symbol Substitution Test, Rey Auditory Verbal Learning Test, and Stroop test. Two years later, data on LUTS and their impact were collected. LUTS/impact, a four-level composite variable ranging from bladder health to mild, moderate, and severe LUTS/impact, was regressed on each cognitive test separately, as well as a cognitive function composite variable. The analytic sample was composed of 1,021 women with complete data. RESULTS When adjusting for sociodemographic variables (age, race, education) and gynecologic/obstetric variables (parity, menopausal status, hysterectomy, hormonal use), better performance on the cognitive function composite and Digit Symbol Substitution Test were both associated with lower odds of membership to a more severe LUTS/impact category (odds ratio, 0.90 [95% confidence interval, 0.83-0.98] and 0.89 [95% confidence interval, 0.82-0.97], respectively). These associations became nonsignificant when additionally adjusting for mechanisms that might explain an association between cognitive function and LUTS/impact, including health behaviors and health conditions that may covary with cerebral and peripheral vascular health and cognitive function. CONCLUSIONS In this sample of midlife adult women, a modest association was found between better cognitive function and lower likelihood of LUTS/impact. Longitudinal studies are needed to further investigate the association between cognitive function and LUTS/impact, as well as potential explanatory mechanisms, particularly as women age and cognitive function varies to a greater degree.
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Affiliation(s)
- Sonya S Brady
- From the Program in Health Disparities Research, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN
| | - Andrés Arguedas
- Division of Biostatistics, University of Minnesota School of Public Health, Minneapolis, MN
| | - Jared D Huling
- Division of Biostatistics, University of Minnesota School of Public Health, Minneapolis, MN
| | - Gerhard Hellemann
- Department of Biostatistics, University of Alabama at Birmingham School of Public Health, Birmingham, AL
| | | | - Cora E Lewis
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | - Cynthia S Fok
- Department of Urology, University of Minnesota Medical School, Minneapolis, MN
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Takacs P, Rátonyi D, Koroknai E, van Raalte H, Lucente V, Egorov V, Krasznai ZT, Kozma B. Biomechanical Integrity Score of the Female Pelvic Floor for Stress Urinary Incontinence. Int Urogynecol J 2024; 35:1245-1253. [PMID: 38739290 PMCID: PMC11245433 DOI: 10.1007/s00192-024-05797-1] [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: 01/19/2024] [Accepted: 03/26/2024] [Indexed: 05/14/2024]
Abstract
INTRODUCTION AND HYPOTHESIS This study is aimed at developing and validating a new integral parameter, the Biomechanical Integrity score (BI-score) of the female pelvic floor for stress urinary incontinence conditions. METHODS A total of 130 subjects were included in the observational cohort study; 70 subjects had normal pelvic floor conditions, and 60 subjects had stress urinary incontinence (SUI). A Vaginal Tactile Imager (VTI) was used to acquire and automatically calculate 52 biomechanical parameters for eight VTI test procedures (probe insertion, elevation, rotation, Valsalva maneuver, voluntary muscle contractions in two planes, relaxation, and reflex contraction). Statistical methods were applied (t test, correlation) to identify the VTI parameters sensitive to the pelvic SUI conditions. RESULTS Twenty-seven parameters were identified as statistically sensitive to SUI development. They were subdivided into five groups to characterize tissue elasticity (group 1), pelvic support (group 2), pelvic muscle contraction (group 3), involuntary muscle relaxation (group 4), and pelvic muscle mobility (group 5). Every parameter was transformed to its standard deviation units using the dataset for normal pelvic conditions, similar to the T-score for bone density. Linear combinations with specified weights led to the composition of five component parameters for groups 1-5 and to the BI-score in standard deviation units. The p value for the BI-score has p = 4.0 × 10-28 for SUI versus normal conditions. CONCLUSIONS Quantitative transformations of the pelvic tissues, support structures, and functions under diseased conditions may be studied with the SUI BI-score in future research and clinical applications.
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Affiliation(s)
- Peter Takacs
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Eastern Virginia Medical School, Norfolk, VA, USA
- Faculty of Medicine, Department of Obstetrics and Gynecology, University of Debrecen, Nagyerdei Krt 98, 4032, Debrecen, Hungary
| | - Dávid Rátonyi
- Faculty of Medicine, Department of Obstetrics and Gynecology, University of Debrecen, Nagyerdei Krt 98, 4032, Debrecen, Hungary
| | - Erzsébet Koroknai
- Faculty of Medicine, Department of Obstetrics and Gynecology, University of Debrecen, Nagyerdei Krt 98, 4032, Debrecen, Hungary
| | - Heather van Raalte
- The Institute for Female Pelvic Medicine & Reconstructive Surgery, Allentown, PA, USA
| | | | | | - Zoard Tibor Krasznai
- Faculty of Medicine, Department of Obstetrics and Gynecology, University of Debrecen, Nagyerdei Krt 98, 4032, Debrecen, Hungary
| | - Bence Kozma
- Faculty of Medicine, Department of Obstetrics and Gynecology, University of Debrecen, Nagyerdei Krt 98, 4032, Debrecen, Hungary.
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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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Hellman-Bronstein AT, Luukkaala TH, Ala-Nissilä SS, Nuotio MS. Associated factors of stress, urgency, and mixed urinary incontinence in a geriatric outpatient assessment of older women with hip fracture. Eur Geriatr Med 2024:10.1007/s41999-024-00997-w. [PMID: 38802641 DOI: 10.1007/s41999-024-00997-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 05/14/2024] [Indexed: 05/29/2024]
Abstract
PURPOSE Urinary incontinence (UI) is known to be common among older female hip fracture patients. Little is known about different subtypes of UI among these patients. Our aim was to identify factors associated with subtypes of UI in a cross-sectional design. METHODS 1,675 female patients aged ≥ 65 and treated for their first hip fracture in Seinäjoki Central Hospital, Finland, during 2007-2019, were included in a prospective cohort study. Of these, 1,106 underwent comprehensive geriatric assessment (CGA), including questions on continence, at our geriatric outpatient clinic 6 month post-fracture. A multivariable-adjusted multinomial logistic regression model was used to examine factors associated with UI subtypes. RESULTS Of the 779 patients included, 360 (46%) were continent and 419 (54%) had UI 6-month post-fracture. Of the women with UI, 117 (28%) had stress UI, 183 (44%) had urgency UI and 119 (28%) had mixed UI, respectively. Mean age of the patients was 82 ± 6,91. In multivariable analysis, depressive mood and poor mobility and functional ability were independently associated with stress UI. Fecal incontinence (FI) and Body Mass Index (BMI) over 28 were independently associated with urgency UI. Mixed UI shared the aforementioned factors with stress and urgency UI and was independently associated with constipation. CONCLUSIONS Mixed UI was associated with most factors, of which depressive mood and impaired mobility and poor functional ability were shared with stress UI, and FI and higher BMI with urgency UI. CGA is key in assessing UI in older hip fracture patients, regardless of subtype.
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Affiliation(s)
- Aino T Hellman-Bronstein
- Department of Geriatric Medicine, Turku University Hospital and University of Turku, Turku, Finland.
| | - Tiina H Luukkaala
- Research, Development and Innovation Center, Tampere University Hospital, Tampere, Finland
- Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Seija S Ala-Nissilä
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland
| | - Maria S Nuotio
- Department of Geriatric Medicine, Turku University Hospital and University of Turku, Turku, Finland
- Department of Geriatric Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
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Zhang Y, Engberg SJ, Courtney KL, Kariuki JK, Matthews JT. Effect of a Bladder Control Self-Management Program Delivered Through a Health Kiosk. J Wound Ostomy Continence Nurs 2024; 51:213-220. [PMID: 38820219 PMCID: PMC11147162 DOI: 10.1097/won.0000000000001073] [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] [Indexed: 06/02/2024]
Abstract
PURPOSE The purpose of this study was to examine the feasibility of delivering a bladder control self-management program through a multiuser health kiosk and to evaluate the program's effect on urinary incontinence (UI) and incontinence-specific quality of life (QoL). DESIGN Secondary analysis of data collected during participants' interactions with the Bladder Control Module (BCM) from the parent study. SUBJECTS AND SETTING One hundred eleven participants from the parent study were eligible to be included in this secondary analysis. Their mean age was 72.8 years, and most were female (n = 95, 85.6%); 81 (75.7%) identified themselves as Caucasian. Each participant could access the BCM at a health kiosk situated at one of several sites: senior centers, subsidized senior housing, retirement communities, and a public library. METHODS The BCM comprised 6 sessions self-administered at least 1 week apart. The content focused on lifestyle modification, pelvic floor muscle training, and bladder (habit) retraining, with encouragement of behavioral self-monitoring between sessions. The feasibility of delivering the intervention was measured by the proportion of participants completing each session. The effect of the BCM on incontinence episodes and incontinence-specific QoL was measured, respectively, by a 7-day bladder diary and the Incontinence Impact Questionnaire Short Form. RESULTS Sixty-one of the 111 eligible participants accessed the BCM. Participants recording incontinence episodes in their baseline bladder diary and completing at least 3 BCM sessions experienced significant decreases in median total UI (P = .01), urge UI (P < .001), and stress UI (P = .02) episodes per day. Incontinence-related QoL significantly improved (P = .03). CONCLUSIONS Our findings support the potential effectiveness of providing community-based, kiosk-enabled access to a conservative behavioral intervention designed to improve incontinence-related outcomes among older adults with UI. Additional research with a larger sample is warranted.
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Affiliation(s)
- Yuchen Zhang
- Yuchen Zhang, BSN-H, RN , School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
- Sandra J. Engberg, PhD, RN, CRNP, FAAN , School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
- Karen L. Courtney, PhD, MSN, RN , School of Health Information Science, University of Victoria, Victoria, British Columbia, Canada
- Jacob K. Kariuki, PhD, AGNP-BC , School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
- Judith Tabolt Matthews, PhD, MPH , University Center for Social and Urban Research, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sandra J Engberg
- Yuchen Zhang, BSN-H, RN , School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
- Sandra J. Engberg, PhD, RN, CRNP, FAAN , School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
- Karen L. Courtney, PhD, MSN, RN , School of Health Information Science, University of Victoria, Victoria, British Columbia, Canada
- Jacob K. Kariuki, PhD, AGNP-BC , School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
- Judith Tabolt Matthews, PhD, MPH , University Center for Social and Urban Research, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Karen L Courtney
- Yuchen Zhang, BSN-H, RN , School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
- Sandra J. Engberg, PhD, RN, CRNP, FAAN , School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
- Karen L. Courtney, PhD, MSN, RN , School of Health Information Science, University of Victoria, Victoria, British Columbia, Canada
- Jacob K. Kariuki, PhD, AGNP-BC , School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
- Judith Tabolt Matthews, PhD, MPH , University Center for Social and Urban Research, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jacob K Kariuki
- Yuchen Zhang, BSN-H, RN , School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
- Sandra J. Engberg, PhD, RN, CRNP, FAAN , School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
- Karen L. Courtney, PhD, MSN, RN , School of Health Information Science, University of Victoria, Victoria, British Columbia, Canada
- Jacob K. Kariuki, PhD, AGNP-BC , School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
- Judith Tabolt Matthews, PhD, MPH , University Center for Social and Urban Research, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Judith Tabolt Matthews
- Yuchen Zhang, BSN-H, RN , School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
- Sandra J. Engberg, PhD, RN, CRNP, FAAN , School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
- Karen L. Courtney, PhD, MSN, RN , School of Health Information Science, University of Victoria, Victoria, British Columbia, Canada
- Jacob K. Kariuki, PhD, AGNP-BC , School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
- Judith Tabolt Matthews, PhD, MPH , University Center for Social and Urban Research, University of Pittsburgh, Pittsburgh, Pennsylvania
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Harvie HS, Richter HE, Sung VW, Chermansky CJ, Menefee SA, Rahn DD, Amundsen CL, Arya LA, Huitema C, Mazloomdoost D, Thomas S. Trial Design for Mixed Urinary Incontinence: Midurethral Sling Versus Botulinum Toxin A. UROGYNECOLOGY (PHILADELPHIA, PA.) 2024; 30:478-488. [PMID: 38212101 PMCID: PMC11058039 DOI: 10.1097/spv.0000000000001422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
IMPORTANCE Mixed urinary incontinence (MUI) is common and can be challenging to manage. OBJECTIVES We present the protocol design and rationale of a trial comparing the efficacy of 2 procedures for the treatment of women with MUI refractory to oral treatment. The Midurethral sling versus Botulinum toxin A ( MUSA) trial compares the efficacy of intradetrusor injection of 100 U of onabotulinimtoxinA (an office-based procedure directed at the urgency component) versus midurethral sling (MUS) placement (a surgical procedure directed at the stress component). STUDY DESIGN The MUSA is a multicenter, randomized trial of women with MUI electing to undergo procedural treatment for MUI at 7 clinical centers in the NICHD Pelvic Floor Disorders Network. Participants are randomized to either onabotulinumtoxinA 100 U or MUS. OnabotulinimtoxinA recipients may receive an additional injection between 3 and 6 months. Participants may receive additional treatment (including crossover to the alternative study intervention) between 6 and 12 months. The primary outcome is change from baseline in Urogenital Distress Inventory (UDI) at 6 months. Secondary outcomes include change in UDI at 3 and 12 months, irritative and stress subscores of the UDI, urinary incontinence episodes, predictors of poor treatment response, quality of life and global impression outcomes, adverse events, use of additional treatments, and cost effectiveness. RESULTS Recruitment and randomization of 150 participants is complete and participants are currently in the follow-up phase. CONCLUSIONS This trial will provide information to guide care for women with MUI refractory to oral treatment who seek surgical treatment with either onabotulinumtoxinA or MUS.
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Affiliation(s)
| | - Holly E Richter
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL
| | - Vivian W Sung
- Department of Obstetrics and Gynecology, Alpert Medical School of Brown University/Women and Infants Hospital, Providence, RI
| | | | - Shawn A Menefee
- Department of Obstetrics and Gynecology, Kaiser Permanente San Diego, San Diego, CA
| | - David D Rahn
- Department of Obstetrics and Gynecology, University of Texas Southwestern, TX
| | - Cindy L Amundsen
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham
| | - Lily A Arya
- From the Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania
| | | | - Donna Mazloomdoost
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
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Rotchild M, Shelef G, Sade S, Shoham-Vardi I, Weintraub AY. Obesity is not an independent risk factor for peri- and post-operative complications following mid-urethral sling (MUS) surgeries for the treatment of stress urinary incontinence (SUI). Arch Gynecol Obstet 2024; 309:1119-1125. [PMID: 37695373 DOI: 10.1007/s00404-023-07210-6] [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: 07/01/2023] [Accepted: 08/30/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVE To inquire whether obesity is a risk factor of peri- and post-operative complications following Mid-urethral sling (MUS) surgeries for SUI repair using the Clavien-Dindo classification system (CDcs). METHODS This retrospective cohort included 304 women who undergone a MUS in a 1000 beds tertiary University medical center between the years 2012-2018. Univariate analysis was conducted to compare clinical and operative traits by BMI group and to examine associations of obesity and complications rates and severity according to the CDcs. Multivariate analysis was conducted to assess the risk for post-operative complications and adjust to potential confounders. RESULTS The study group included 106 (34.9%) women with BMI 30 or higher and the comparison group included 198 (65.1%) women with BMI lower than 30. In the study group we found a significantly higher prevalence of hypertension (P = 0.019), previous abdominal surgeries (P = 0.012) including cesarean section (P = 0.025), previous pelvic floor surgeries (P = 0.005) and pelvic organ prolapse (P = 0.02). In the control group we found a significantly higher rates of concomitant hysterectomy which performed during the MUS (P = 0.005). Obesity was not associated with increased rates of peri and post-operative complications (P = 0.973). CONCLUSIONS In our study, obesity was not associated with peri- and post-operative complications following MUS.
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Affiliation(s)
- Matan Rotchild
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, POB 151, 84101, Beer Sheva, Israel.
| | - Goni Shelef
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, POB 151, 84101, Beer Sheva, Israel
| | - Shanny Sade
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, POB 151, 84101, Beer Sheva, Israel
| | - Ilana Shoham-Vardi
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Adi Yehuda Weintraub
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, POB 151, 84101, Beer Sheva, Israel
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Taastrøm K, Kjeldsen AC, Hjorth S, Gommesen D, Axelsen SM, Nohr EA. Urinary Incontinence in Midlife According to Weight Changes Across and After Childbearing Years. Int Urogynecol J 2024; 35:579-588. [PMID: 38214717 PMCID: PMC11024002 DOI: 10.1007/s00192-023-05713-z] [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: 08/29/2023] [Accepted: 11/28/2023] [Indexed: 01/13/2024]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to investigate how weight change across and after the childbearing years was associated with urinary incontinence (UI) in midlife. METHODS Data were obtained from 35,645 women responding to the Maternal Follow-up questionnaire in the Danish National Birth Cohort in 2013-2014. Outcome was self-reported UI and its subtypes. Exposures were changes in body mass index (BMI) across and after the childbearing years. Adjusted odds ratios were estimated using logistic regression. RESULTS At follow-up, the mean age was 44 years and 32% experienced UI. Compared with stable weight, weight gain across the childbearing years of > 1 to 3, > 3 to 5 or > 5 BMI units increased the odds of any UI by 15%, 27%, and 41% respectively. For mixed UI, the odds increased by 23%, 41%, and 68% in these groups. Weight gain after childbearing showed the same pattern, but with a higher increase in the odds of mixed UI (25%, 60%, and 95% in the respective groups). Women with any weight loss during this period had 9% lower odds of any UI than women with a stable weight. CONCLUSIONS Weight gain across and after childbearing increased the risk of UI in midlife, especially the subtype mixed UI. Weight loss after childbearing decreased the risk.
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Affiliation(s)
- Katja Taastrøm
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark.
- Research Unit for Gynecology and Obstetrics, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Anne Cathrine Kjeldsen
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark
- Research Unit for Gynecology and Obstetrics, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Sarah Hjorth
- Research Unit for Gynecology and Obstetrics, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ditte Gommesen
- Research Unit for Gynecology and Obstetrics, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Susanne M Axelsen
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark
| | - Ellen A Nohr
- Research Unit for Gynecology and Obstetrics, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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González-Castro A, Leirós-Rodríguez R, Rodríguez-Nogueira Ó, Álvarez-Álvarez MJ, Pinto-Carral A, Andrade-Gómez E. Proposal for a physiotherapy assessment form for the evaluation of women patients with uro-gynecological disorders: A Delphi study. PLoS One 2023; 18:e0296092. [PMID: 38150427 PMCID: PMC10752553 DOI: 10.1371/journal.pone.0296092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 12/05/2023] [Indexed: 12/29/2023] Open
Abstract
BACKGROUND The correct selection of treatment techniques and methods in physiotherapy depends directly on a well-structured anamnesis, examination and assessment. Within urogynecological and obstetric physiotherapy there is no standardized and protocolized assessment that allows to follow established steps. For all this, the main objective of this study was to identify the assessment items that should be included in the a physiotherapeutic uro-gynecological assessment. METHODS Delphi study through a group of experts. Prior to this, a systematic search was carried out, accompanied by a review of grey literature, to obtain the possible items to be included in the forms. Subsequently, a Delphi study with two consecutive rounds of questionnaires was developed. A total of 6 expert physiotherapists participated in the study. RESULTS The initial questionnaire had 97 items and after two rounds one item was eliminated to obtain a total of 96 items in the final questionnaire. CONCLUSIONS The experts agreed on most of the choices and finally obtained a standardized and protocolized assessment in uro-gynecological physiotherapy. Furthermore, this proposal should be considered by other professionals involved in the process of evaluation and treatment of pelvi-perineal alterations.
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Affiliation(s)
- Ana González-Castro
- Nursing and Physical Therapy Department, University of León, Ponferrada, Spain
| | - Raquel Leirós-Rodríguez
- SALBIS Research Group, Nursing and Physical Therapy Department, University of León, Ponferrada, Spain
| | - Óscar Rodríguez-Nogueira
- SALBIS Research Group, Nursing and Physical Therapy Department, University of León, Ponferrada, Spain
| | - Mª José Álvarez-Álvarez
- SALBIS Research Group, Nursing and Physical Therapy Department, University of León, Ponferrada, Spain
| | - Arrate Pinto-Carral
- SALBIS Research Group, Nursing and Physical Therapy Department, University of León, Ponferrada, Spain
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11
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Li Q, Cheng Y, Shi H, Xue K, Zhou F. Advances in the natural history of urinary incontinence in adult females. J OBSTET GYNAECOL 2023; 43:2171774. [PMID: 36772931 DOI: 10.1080/01443615.2023.2171774] [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: 02/12/2023]
Abstract
The aim of this review is to summarise the related characteristics of the natural history of female urinary incontinence (UI) using a narrative descriptive approach. PubMed, EMBASE and Web of Science were searched for articles published from 1 January 2010 to 1 January 2020 on the natural history of female UI, which including incidence, persistence, progression, remission, and regression of a single subtype of UI and the mutual influence of different UI subtypes. This literature review includes 15 articles published, indicates that UI is highly dynamic, with symptoms varying according to disease severity and subtype and influenced by multiple factors at different disease stages. Recent studies have increased our understanding of the natural history of UI. Future research should systematically analyse the progression of each subtype of UI and interactions between subtypes to prevent the progression of UI across females life course.
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Affiliation(s)
- Qianqian Li
- School of Nursing, Xuzhou Medical University, Xuzhou, China
| | - Yun Cheng
- Xuzhou Maternity and Child Health Care Hospital, Xuzhou, China
| | - Hongli Shi
- School of Nursing, Xuzhou Medical University, Xuzhou, China
| | - Kaikai Xue
- Jiangsu College of Nursing, Huai'an, China
| | - Fang Zhou
- Dean of School of Nursing, Xuzhou Medical University, Xuzhou, China
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12
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Tassawer QUA, Noor R, Ikram M, Bashir MS. Translation and validation of Incontinence Impact Questionnaire Short Form in the Urdu language. Int Urogynecol J 2023; 34:2285-2292. [PMID: 37115206 DOI: 10.1007/s00192-023-05554-w] [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: 03/24/2023] [Indexed: 04/29/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The Incontinence Impact Questionnaire Short Form (IIQ-7 SF) is a self-administered questionnaire that is used to assess the impact of urinary incontinence on the quality of life in women. It is translated into different languages; however, there is currently no official Urdu version of this tool. The main purpose of this study was to translate the IIQ-7 SF into the Urdu language and to find out its validity and reliability in women with urinary incontinence. METHODS The IIQ-7 was translated into the Urdu language by following the standardized steps. The original version was translated into Urdu by two translators and the back translation into English was done by an independent translator. A panel of experts reviewed the translations and a final version was drafted. Fifteen women with urinary incontinence were involved in the pilot study. The validity and reliability were then assessed on 70 women with urinary incontinence. RESULTS The content validity index (CVI) of each question ranged from 0.91 to 0.94. The convergent validity with UDI-6 was determined by using Spearman's correlation coefficient (r=0.90). Cronbach's α showed the internal consistency, which is 0.87. The test-retest reliability was calculated by the intra-class correlation coefficient, ICC=0.95. The scree plot showed the two components have eigen values greater than 1. CONCLUSIONS The Urdu version of the IIQ-7 has shown good validity and reliability in incontinence patients, according to the findings.
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Affiliation(s)
- Qurat-Ul-Ain Tassawer
- Faculty of Rehabilitation and Allied Health Sciences, Riphah International University, Lahore Campus, Islamabad, Pakistan
| | - Rabiya Noor
- Faculty of Rehabilitation and Allied Health Sciences, Riphah International University, Lahore Campus, Islamabad, Pakistan
| | - Mehwish Ikram
- Faculty of Rehabilitation and Allied Health Sciences, Riphah International University, Lahore Campus, Islamabad, Pakistan.
| | - Muhammad Salman Bashir
- Faculty of Rehabilitation and Allied Health Sciences, Riphah International University, Lahore Campus, Islamabad, Pakistan
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Lucente V, Wright M, Pisan J, Shenoy S, Yedlock R. Single Incision Midurethral Sling Site of Care: Office-based Ambulatory Surgical Unit versus Hosptial-based Ambulatory Surgical Unit Setting. J Minim Invasive Gynecol 2023; 30:665-671. [PMID: 37088282 DOI: 10.1016/j.jmig.2023.04.006] [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: 07/25/2022] [Revised: 04/03/2023] [Accepted: 04/11/2023] [Indexed: 04/25/2023]
Abstract
STUDY OBJECTIVE To compare the economic difference in terms of overall costs between two Ambulatory Surgical Unit (ASU) settings in which a midurethral single incision sling (MSIS) can be performed. DESIGN A retrospective cohort study was carried out, examining the implanting of an MSIS performed at two different ASU settings by a single surgeon. Total cost was determined by assessing differences in charges and subsequent reimbursement associated with the procedure at each ASU setting. Time was measured using an EMR system for tracking both patient entry/exit from the facility as well as intraoperative time. Adverse events commonly associated with the procedure and patient-reported unanticipated adverse events were collected. A validated Surgical Satisfaction Questionnaire was administered postoperatively. SETTING University Health Network Teaching Hospital. PATIENTS A total of 125 women with stress urinary incontinence. INTERVENTION MSIS. MEASUREMENT AND MAIN RESULTS Between January 2016 until August 2020, 125 women underwent an MSIS procedure. The total office-based ASU (O-ASU) charges averaged $4564.00 (reimbursement of $2642.07). The total hospital-based ASU (H-ASU) charges averaged $40 136 (reimbursement of $9000), as well as an anesthesia average charge of $800 (reimbursement of $500). The average O-ASU total patient encounter time was 53.76 minutes versus 344.702 minutes for the H-ASU. There was no difference between commonly associated or unanticipated adverse events nor global patient satisfaction. CONCLUSIONS Based on overall cost, total encounter time, and global patient satisfaction, a certified O-ASU is an optimal site of care for MSIS for surgical management of female stress urinary incontinence.
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Affiliation(s)
- Vincent Lucente
- Institute for Female Pelvic Medicine and Reconstructive Surgery (Drs. Lucente and Wright), Allentown, PA.
| | - Micah Wright
- Institute for Female Pelvic Medicine and Reconstructive Surgery (Drs. Lucente and Wright), Allentown, PA; Department of Minimally Invasive Gynecology (Drs. Wright and Pisan), St. Luke's University Health Network, Bethlehem, PA; Council Oak Comprehensive Health Care (Dr. Wright), Tulsa, OK
| | - John Pisan
- Department of Minimally Invasive Gynecology (Drs. Wright and Pisan), St. Luke's University Health Network, Bethlehem, PA
| | - Sachin Shenoy
- Department of Minimally Invasive Gynecologic Surgery (Dr. Shenoy), University of Alabama, Tuscaloosa, AL
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Brady SS, Shan L, Markland AD, Huling JD, Arguedas A, Fok CS, Van Den Eeden SK, Lewis CE. Trajectories of depressive symptoms over 20 years and subsequent lower urinary tract symptoms and impact among women. Menopause 2023; 30:723-731. [PMID: 37159879 PMCID: PMC10313766 DOI: 10.1097/gme.0000000000002193] [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] [Indexed: 05/11/2023]
Abstract
OBJECTIVE The aim of the study is to examine the association between depressive symptoms and subsequent lower urinary tract symptoms (LUTS) and impact (a composite outcome) among women (N = 1,119) from the Coronary Artery Risk Development in Young Adults study. METHODS The Center for Epidemiologic Studies-Depression Scale (CES-D) was administered in 1990-1991 and every 5 years through 2010-2011. In 2012-2013, LUTS and impact data were collected for the first time. Accumulation of risk was examined in the following three ways: (1) mean CES-D score across 20 years (5 observations); (2) depressive symptom trajectory group, determined by group-based trajectory modeling; and (3) intercepts and slopes obtained from women's individual CES-D score trajectories through two-stage mixed effects modeling. For each approach, ordinal logistic regression analyses examined odds of having "greater LUTS/impact" for each unit change in a depressive symptom variable. RESULTS (1) With each one-unit increase in mean CES-D score over the 20-year period, women were 9% more likely to report greater LUTS/impact (odds ratio [OR] = 1.09, 95% CI = 1.07-1.11). (2) In comparison with women with consistently low depressive symptoms, women with consistently threshold depression or consistently high depressive symptoms were twice (OR = 2.07, 95% CI = 1.59-2.69) and over five times (OR = 5.55, 95% CI = 3.07-10.06) as likely, respectively, to report greater LUTS/impact. (3) Women's individual symptom intercept and slope interacted. Increases in depressive symptoms across 20 years (greater slopes) were associated with greater LUTS/impact when women's initial CES-D score (intercept) was in the moderate-to-high range relative to the sample. CONCLUSIONS Depressive symptoms over 20 years, examined with different degrees of nuance, were consistently associated with subsequently measured LUTS and impact.
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Affiliation(s)
- Sonya S. Brady
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health
| | - Liang Shan
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL
| | - Alayne D. Markland
- Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham School of Medicine and Birmingham VA Medical Center, Birmingham, AL
| | - Jared D. Huling
- Division of Biostatistics, University of Minnesota School of Public Health, Minneapolis, MN
| | - Andrés Arguedas
- Division of Biostatistics, University of Minnesota School of Public Health, Minneapolis, MN
| | - Cynthia S. Fok
- Department of Urology, University of Minnesota Medical School, Minneapolis, MN
| | - Stephen K. Van Den Eeden
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
- Department of Urology, University of California, San Francisco, San Francisco, CA
| | - Cora E. Lewis
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
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15
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Brady SS, Arguedas A, Huling JD, Shan L, Lewis CE, Fok CS, Van Den Eeden SK, Markland AD. Interpersonal Stressors and Resources for Support: Associations with Lower Urinary Tract Symptoms and Impact Among Women. J Womens Health (Larchmt) 2023; 32:693-701. [PMID: 37040312 PMCID: PMC10278020 DOI: 10.1089/jwh.2022.0483] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023] Open
Abstract
Background: This study utilizes Coronary Artery Risk Development in Young Adults (CARDIA) data to examine whether women's perceived emotional support and interpersonal stressors are associated with lower urinary tract symptoms (LUTS) and their impact on quality of life. Materials and Methods: Emotional support was assessed at baseline/year 0 (1985-86), year 2 (1987-88), year 15 (2000-01), and year 20 (2005-06); interpersonal stressors were assessed at years 15 and 20. In 2012-13, LUTS and impact were assessed. LUTS/impact category (a composite variable ranging from bladder health to mild, moderate, and severe LUTS/impact) was regressed on trajectory groups of emotional support from years 0 to 20. Separately, LUTS/impact was regressed on mean emotional support and interpersonal stressors across years 15-20. Analyses were adjusted for age, race, education, and parity (n = 1104). Results: In comparison to women whose support trajectory from years 0 to 20 was consistently high, women whose support decreased from high to low had over twice the odds (odds ratio [OR] = 2.72; 95% confidence interval [CI] = 1.76-4.20) of being classified into a more burdensome LUTS/impact category. Mean support and interpersonal stressors across years 15-20 were independently associated with lower odds (OR = 0.59; 95% CI = 0.44-0.77) and greater odds (OR = 1.52; 95% CI = 1.19-1.94), respectively, of being classified into a more burdensome LUTS/impact category. Conclusions: In the CARDIA cohort, quality of women's interpersonal relationships, assessed between 1985-86 and 2005-06, was associated with LUTS/impact assessed in 2012-13. Additional research collecting LUTS/impact data at multiple time points is needed to test potential bidirectional associations of emotional support and interpersonal stressors with LUTS/impact, as well as potential mechanisms of association.
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Affiliation(s)
- Sonya S. Brady
- Division of Epidemiology and Community Health, and University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Andrés Arguedas
- Division of Biostatistics, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Jared D. Huling
- Division of Biostatistics, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Liang Shan
- University of Alabama at Birmingham School of Nursing, Birmingham, Alabama, USA
| | - Cora E. Lewis
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Cynthia S. Fok
- Department of Urology, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Stephen K. Van Den Eeden
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
- Department of Urology, University of California, San Francisco, San Francisco, California, USA
| | - Alayne D. Markland
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care and the Birmingham/Atlanta Geriatrics Research, Education, and Clinical Center, University of Alabama at Birmingham School of Medicine and Birmingham VA Health Care System, Birmingham, Alabama, USA
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16
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LUKACZ ES, FALKE C, GEYNISMAN-TAN J, WYMAN JF, MUELLER ER, MARKLAND AD, RICKEY L, LOWDER JL, RUDSER K, LOW LKANE, NEWMAN DK. Healthy bladder storage and emptying functions in community-dwelling women measured by a 2-day bladder health diary. Neurourol Urodyn 2023; 42:725-735. [PMID: 36891924 PMCID: PMC10101892 DOI: 10.1002/nau.25169] [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: 11/08/2022] [Revised: 02/08/2023] [Accepted: 02/25/2023] [Indexed: 03/10/2023]
Abstract
INTRODUCTION The prevalence of healthy bladder storage and emptying function in community-dwelling women is not well established. METHODS A planned secondary analysis of a US cross-sectional study designed to validate a bladder health instrument was conducted in women aged ≥18 years. A subset was invited to complete the novel 2-day bladder health diary capturing bladder storage and emptying experiences. Overall healthy bladder function was defined as ≤8 waking/daytime voids and ≤1 void during sleeping/nighttime; along with the absence of leakage, urgency, emptying difficulties (initiation, flow, efficacy, relief of urge sensation) and pain. Descriptive statistics of healthy bladder functions and regression models of factors associated with healthy function are reported. RESULTS Of the 383 invited, 237 (62%) eligible women returned complete dairies. Of these, 12% (29/237) met criteria for overall healthy bladder function. Most (96%) denied pain, 74% had healthy daytime and 83% had healthy nighttime voiding frequency, 64% were continent, 36% reported healthy emptying and 30% denied any urgency episodes. Middle income (odds ratio [OR]:95% confidence interval [CI] = 11.4:1.9-67.4 for $75k-$99 999 vs. $25 000-$49 999), Graduate education (4.8:1.4-17) and previously seeking treatment for bladder problems (OR:95%CI = 0.1; 0-0.9) were associated with overall healthy function. CONCLUSION The prevalence of overall healthy bladder function was very low based on our strict definition of health as measured on a 2-day diary. However, most women had healthy voiding frequency and denied pain or urinary leakage. Postvoid dribbling and urgency most commonly contributed to an overall unhealthy bladder. Further investigation is needed to determine whether these diary derived measures are meaningful for patient-oriented bladder health research.
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Affiliation(s)
- Emily S. LUKACZ
- University of California San Diego, Department of Obstetrics, Gynecology & Reproductive Sciences, La Jolla, CA
| | - Chloe FALKE
- Division of Biostatistics, University of Minnesota, Minneapolis, MN
| | - Julia GEYNISMAN-TAN
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL
| | - Jean F. WYMAN
- School of Nursing, University of Minnesota, Minneapolis, MN
| | - Elizabeth R MUELLER
- Departments of Urology & Obstetrics/Gynecology, Loyola University Medical Center, Loyola University, Chicago, IL
| | - Alayne D. MARKLAND
- Department of Medicine, Division of Gerontology, Geriatrics and Palliative Care, University of Alabama at Birmingham, Birmingham, AL and the Birmingham/Atlanta Geriatric Research, Education, and Clinical Center
| | - Leslie RICKEY
- Departments of Urology & Obstetrics/Gynecology, Yale University School of Medicine, New Haven, CT
| | - Jerry L. LOWDER
- Department of Obstetrics and Gynecology, Washington University in St Louis School of Medicine, St Louis, MO
| | - Kyle RUDSER
- Division of Biostatistics, University of Minnesota, Minneapolis, MN
| | - Lisa KANE LOW
- School of Nursing, University of Michigan, Ann Arbor, MI
| | - Diane K. NEWMAN
- Division of Urology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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17
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O'Shea SD, Pope R, Freire K, Orr R. Prevalence of lower urinary tract symptoms in a cohort of Australian servicewomen and female veterans. Int Urogynecol J 2023; 34:885-896. [PMID: 35763047 PMCID: PMC10038961 DOI: 10.1007/s00192-022-05254-x] [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: 12/19/2021] [Accepted: 05/27/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Lower urinary tract symptoms (LUTS) are common in the general female population. It was hypothesised that Australian female military personnel and veterans would experience similar types and prevalence of LUTS as the broader Australian female population. METHODS An online cross-sectional survey was utilised to explore the pelvic health of active servicewomen and veterans in the Australian Defence Force (ADF). For the purposes of this report, only the demographic and LUTS data (excluding urinary tract infections) were extracted and descriptively analysed. RESULTS A total of 491 complete survey responses were received and analysed. Respondent characteristics were comparable to those documented in a departmental report regarding ADF servicewomen. No LUTS were reported by 38% of respondents. Regular symptoms of urinary incontinence were experienced by 27% of respondents (stress urinary incontinence = 23%, urge urinary incontinence = 16%, mixed urinary incontinence = 13%), bladder storage issues by 20-27%, and various voiding impairments by 9-27%. In addition, 41% reported regularly experiencing two or more LUTS, and for over two thirds of respondents, LUTS were an ongoing issue. Relationships between age, parity, and symptoms of urinary incontinence were also seen. CONCLUSIONS Consistent with wider research in Australian female populations, LUTS were commonly experienced during service by ADF female military personnel and veterans. Given the high likelihood of female military personnel experiencing LUTS during their service, and a proportion experiencing ongoing symptoms, tailored monitoring and support for urinary health should be available to enhance occupational health, safety, and performance.
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Affiliation(s)
- Simone D O'Shea
- School of Allied Health, Exercise and Sport Sciences, Charles Sturt University, PO Box 789, Albury, NSW, 2640, Australia.
| | - Rod Pope
- School of Allied Health, Exercise and Sport Sciences, Charles Sturt University, PO Box 789, Albury, NSW, 2640, Australia
- Tactical Research Unit, Bond University, Robina, Australia
| | - Katharine Freire
- Three Rivers Department of Rural Health, Charles Sturt University, Albury, Australia
| | - Robin Orr
- Tactical Research Unit, Bond University, Robina, Australia
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18
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Haddad R, Panicker JN, Verbakel I, Dhondt K, Ghijselings L, Hervé F, Petrovic M, Whishaw M, Bliwise DL, Everaert K. The low dopamine hypothesis: A plausible mechanism underpinning residual urine, overactive bladder and nocturia (RON) syndrome in older patients. Prog Urol 2023; 33:155-171. [PMID: 36710124 DOI: 10.1016/j.purol.2023.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 12/21/2022] [Accepted: 01/09/2023] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Aging is associated with a combination of several lower urinary tract (LUT) signs and symptoms, including residual urine, overactive bladder and nocturia. One of the mechanisms of this LUT dysfunction that has not been discussed in dept so far is the role of dopamine (DA). METHODS In this narrative review, we explore the dopaminergic hypothesis in the development of this combination of LUT signs and symptoms in older adults. RESULTS DA is one of the neurotransmitters whose regulation and production is disrupted in aging. In synucleinopathies, altered DAergic activity is associated with the occurrence of LUTS and sleep disorders. Projections of DAergic neurons are involved in the regulation of sleep, diuresis, and bladder activity. The low dopamine hypothesis could explain the genesis of a set of LUT signs and symptoms commonly seen in this population, including elevated residual urine, Overactive bladder syndrome and Nocturia (discussed as the RON syndrome). This presentation is however also common in older patients without synucleinopathies or neurological disorders and therefore we hypothesise that altered DAergic activity because of pathological aging, and selective destruction of DAergic neurons, could underpin the presentation of this triad of LUT dysfunction in the older population. CONCLUSION The concept of RON syndrome helps to better understand this common phenotypic presentation in clinical practice, and therefore serves as a useful platform to diagnose and treat LUTS in older adults. Besides recognizing the synucleinopathy "red flag" symptoms, this set of multi-causal LUT signs and symptoms highlights the inevitable need for combination therapy, a challenge in older people with their comorbidities and concomitant medications.
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Affiliation(s)
- R Haddad
- Department of Urology, NOPIA Research Group, Ghent University Hospital, Ghent, Belgium; GRC 001 GREEN Neuro-Urology Research Group, Sorbonne Université, Rothschild Academic Hospital, AP-HP, 75012 Paris, France.
| | - J N Panicker
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery and Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, United Kingdom
| | - I Verbakel
- Department of Urology, NOPIA Research Group, Ghent University Hospital, Ghent, Belgium
| | - K Dhondt
- Department of Psychiatry, Pediatric sleep center, Ghent University Hospital, Ghent, Belgium
| | - L Ghijselings
- Department of Urology, NOPIA Research Group, Ghent University Hospital, Ghent, Belgium
| | - F Hervé
- Department of Urology, NOPIA Research Group, Ghent University Hospital, Ghent, Belgium; Department of Urology, Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - M Petrovic
- Department of Geriatrics, Ghent University Hospital, Ghent, Belgium
| | - M Whishaw
- Department of Aged Care, Royal Melbourne Hospital, Melbourne, Australia
| | - D L Bliwise
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - K Everaert
- Department of Urology, NOPIA Research Group, Ghent University Hospital, Ghent, Belgium
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19
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Batur EB, Batur AF. Letter to the editor: Is vitamin D replacement effective in the treatment of postpartum urinary incontinence? Int Urogynecol J 2023; 34:1109. [PMID: 36847785 DOI: 10.1007/s00192-023-05493-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 02/10/2023] [Indexed: 03/01/2023]
Affiliation(s)
- Elif Balevi Batur
- Department of Physical Medicine and Rehabilitation, Selcuk University School of Medicine, Konya, Turkey
| | - Ali Furkan Batur
- Urology Institution, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA. .,Department of Urology, Selcuk University School of Medicine, Celal Bayar Cd. No:313, Selçuklu, 42130, Konya, Turkey.
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20
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John G, Zanatta E, Polito P, Piantoni S, Fredi M, Coattrenec Y, Guemara R, Franceschini F, Truchetet ME, Cozzi F, Airò P, Chizzolini C. Urinary incontinence in systemic sclerosis: a prospective multicentre cohort study. Rheumatol Int 2022; 42:2141-2150. [PMID: 35945297 PMCID: PMC9548477 DOI: 10.1007/s00296-022-05178-1] [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: 05/23/2022] [Accepted: 07/25/2022] [Indexed: 11/28/2022]
Abstract
Investigate the natural history of urinary incontinence (UI) in systemic sclerosis (SSc) and assess its impact on quality of life (QoL). A longitudinal, international observational study followed 189 patients with SSc for a median duration of 5 years (IQR: 4.8–5.3). Presence, subtype and severity of UI, hospital admission and QoL were assessed using serial self-administered questionnaires. Mortality data came from national death registries. Multilevel mixed-effect logistic regressions explored factors associated with UI. Cox models adjusted the effects of UI on hospitalization and death for age, sex and subtype of SSc. Mean annual rates of new-onset UI and remission were 16.3% (95%CI 8.3%–24.2%) and 20.8% (95%CI 12.6–29.1), respectively. Among UI patients, 57.9% (95%CI 51.8–64.0) changed from one UI subtype to another. Between annual questionnaires, the severity of UI was the same in 51.1% (95%CI 40.8–61.4), milder or resolved in 35.2% (95%CI 25.3–44.9), and worse in 13.8% (95%CI 6.7–20.9). Anti-centromere antibodies, digestive symptoms, sex, age, neurological or urological comorbidities, diuretics and puffy fingers were all associated with UI. The two strongest predictors of UI and UI subtypes were a recent UI episode and the subtype of previous leakage episodes. UI at inclusion was not associated with hospital admission (adjusted HR: 1.86; 95%CI 0.88–3.93), time to death (aHR: 0.84; 95%CI 0.41–1.73) or change in QoL over time. Self-reported UI among SSc patients is highly dynamic: it waxes and wanes, changing from one subtype to another over time.
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Affiliation(s)
- Gregor John
- Department of Internal Medicine, Neuchâtel Hospital Network, Rue de la Maladière 45, CH-2000, Neuchâtel, Switzerland. .,Department of Medicine, Geneva University, Michel-Servet 1, 1206, Geneva, Switzerland.
| | - Elisabetta Zanatta
- Department of Medicine, Rheumatology Unit, University Hospital of Padova, 35121, Padova, Italy
| | - Pamela Polito
- Department of Medicine, Rheumatology Unit, University Hospital of Padova, 35121, Padova, Italy
| | - Silvia Piantoni
- Rheumatology and Clinical Immunology Unit, Department of Clinical and Experimental Sciences, ASST Spedali Civili and University of Brescia, 25123, Brescia, Italy
| | - Micaela Fredi
- Rheumatology and Clinical Immunology Unit, Department of Clinical and Experimental Sciences, ASST Spedali Civili and University of Brescia, 25123, Brescia, Italy
| | - Yann Coattrenec
- Department of Pathology and Immunology, University Medical Centre, Geneva University, Rue Michel-Servet 1, CH-1211, Geneva, Switzerland
| | - Romain Guemara
- Department of Internal Medicine, Neuchâtel Hospital Network, Rue de la Maladière 45, CH-2000, Neuchâtel, Switzerland
| | - Franco Franceschini
- Rheumatology and Clinical Immunology Unit, Department of Clinical and Experimental Sciences, ASST Spedali Civili and University of Brescia, 25123, Brescia, Italy
| | - Marie-Elise Truchetet
- Department of Rheumatology, Bordeaux University and Bordeaux Hospital, Bordeaux, France
| | - Franco Cozzi
- Department of Medicine, Rheumatology Unit, University Hospital of Padova, 35121, Padova, Italy
| | - Paolo Airò
- Rheumatology and Clinical Immunology Unit, Department of Clinical and Experimental Sciences, ASST Spedali Civili and University of Brescia, 25123, Brescia, Italy
| | - Carlo Chizzolini
- Department of Pathology and Immunology, University Medical Centre, Geneva University, Rue Michel-Servet 1, CH-1211, Geneva, Switzerland.,Department of Medicine, Geneva University, Michel-Servet 1, 1206, Geneva, Switzerland
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21
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Abakay H, Doğan H, Yetkin MF, Güç A, Talay Çaliş H, Demir Çaltekin M. The effects of incontinence on functionality, disability, and quality of life in male and female patients with multiple sclerosis. Mult Scler Relat Disord 2022; 66:104010. [PMID: 35849991 DOI: 10.1016/j.msard.2022.104010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 06/20/2022] [Accepted: 07/01/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE To determine the effects of incontinence on male and female patients with multiple sclerosis in terms of functionality, disability, and quality of life. METHODS The study included 90 patients (45 male, 45 female) with multiple sclerosis (MS) with a median age of 37 years. After recording the sociodemographic characteristics, urinary incontinence was evaluated in terms of quality of life with the International Consultation of Incontinence Questionnaire-Short Form (ICIQ-SF), overactive bladder symptoms with Overactive Bladder Questionnaire-V8 (OAB-V8), quality of life with Multiple Sclerosis Quality of Life Questionnaire-54 (MSQOL-54), and function was evaluated with the Lower Extremity Functional Scale (LEFS). RESULTS The demographic and clinical features, types of incontinence, total and sub-dimensions of ICIQ-SF, LEFS, OAB-V8, MSQOL-54 were determined to be similar in both males and females with MS (p>0.05). The education level of males was higher than that of females (p<0.05). A positive correlation was found between the mean LEFS score and MSQOL-total, MSQOL-PHC(physical health composite) and MSQOL-MHC(mental health composite) scores, and a negative correlation was found between the mean LEFS score and the ICIQ-SF and OAB-V8 scores (p<0.05). CONCLUSION Urinary incontinence, overactive bladder and lower extremity functionality may be similar in males and females with MS. It should not be ignored that lower extremity functionality may negatively affect incontinence symptoms.
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Affiliation(s)
- Hanife Abakay
- Sarıkaya School of Physiotherapy and Rehabilitation, Yozgat Bozok University, Yozgat,Turkey.
| | - Hanife Doğan
- Sarıkaya School of Physiotherapy and Rehabilitation, Yozgat Bozok University, Yozgat,Turkey
| | - M Fatih Yetkin
- Faculty of Medicine, Internal Medicine, Department of Neurology, Erciyes University, Kayseri, Turkey
| | - Ayşe Güç
- Physical Therapy and Rehabilitation Hospital, Kayseri City Hospital, Kayseri, Turkey
| | - Havva Talay Çaliş
- Physical Therapy and Rehabilitation Hospital, Kayseri City Hospital, Kayseri, Turkey
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Gross L, Ganer Herman H, Gonen N, Rockenshtein O, Ginath S, Kovo M. Is there an association between the length of the second stage of labour and urinary incontinence in multiparous women? Eur J Obstet Gynecol Reprod Biol 2022; 274:96-100. [PMID: 35623156 DOI: 10.1016/j.ejogrb.2022.05.016] [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: 10/26/2021] [Revised: 02/11/2022] [Accepted: 05/16/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES It is unclear whether the length of the second stage of labour plays a role in the development of urinary incontinence (UI). This study aimed to investigate the association between the cumulative length of the second stage of labour in multiparous women and UI. METHODS This was a longitudinal cohort study of women who had undergone three vaginal deliveries (VDs) between 2008 and 2017. UI was assessed using the Urinary Distress Inventory (UDI-6) questionnaire. Women with a cumulative length of the second stage of labour for three deliveries in the upper 90th percentile (study group) were compared with women with a cumulative length of the second stage of labour below the 90th percentile (control group). A sample size of 280 women was needed to detect a 15-point difference in the UDI-6 score between the groups. RESULTS Thirty-one women were included in the study group and 275 women were included in the control group. Demographic and obstetric characteristics were similar in both groups. There was no between-group difference in mean UDI-6 score: 12.3 ± 17.5 in the study group and 14.9 ± 18.2 in the control group (p = 0.55). No association was found between the cumulative length of the second stage of labour and the UDI score. A linear regression model revealed that maternal body mass index was independently associated with UDI-6 score (correlation coefficient 0.67, 95% confidence interval 0.19-1.15; p = 0.006). CONCLUSION The cumulative length of the second stage of labour in multiparous women is not associated with UI.
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Affiliation(s)
- Lotem Gross
- Department of Obstetrics and Gynaecology, Edith Wolfson Medical Centre, Holon, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hadas Ganer Herman
- Department of Obstetrics and Gynaecology, Edith Wolfson Medical Centre, Holon, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noa Gonen
- Department of Obstetrics and Gynaecology, Edith Wolfson Medical Centre, Holon, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Omer Rockenshtein
- Department of Obstetrics and Gynaecology, Edith Wolfson Medical Centre, Holon, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shimon Ginath
- Department of Obstetrics and Gynaecology, Edith Wolfson Medical Centre, Holon, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Kovo
- Department of Obstetrics and Gynaecology, Edith Wolfson Medical Centre, Holon, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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23
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Rieger MM, Wong M, Burnett LA, Sesillo FB, Baynes BB, Alperin M. Mechanisms governing protective pregnancy-induced adaptations of the pelvic floor muscles in the rat preclinical model. Am J Obstet Gynecol 2022; 226:708.e1-708.e13. [PMID: 34801444 PMCID: PMC9172206 DOI: 10.1016/j.ajog.2021.11.1353] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/21/2021] [Accepted: 11/14/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND The intrinsic properties of pelvic soft tissues in women who do and do not sustain birth injuries are likely divergent. However, little is known about this. Rat pelvic floor muscles undergo protective pregnancy-induced structural adaptations-sarcomerogenesis and increase in intramuscular collagen content-that protect against birth injury. OBJECTIVE We aimed to test the following hypotheses: (1) the increased mechanical load of a gravid uterus drives antepartum adaptations; (2) load-induced changes are sufficient to protect pelvic muscles from birth injury. STUDY DESIGN The independent effects of load uncoupled from the hormonal milieu of pregnancy were tested in 3- to 4-month-old Sprague-Dawley rats randomly divided into the following 4 groups, with N of 5 to 14 per group: (1) load-/pregnancy hormones- (controls), (2) load+/pregnancy hormones-, (3) reduced load/pregnancy hormones+, and (4) load+/pregnancy hormones+. Mechanical load of a gravid uterus was simulated by weighing uterine horns with beads similar to fetal rat size and weight. A reduced load was achieved by unilateral pregnancy after unilateral uterine horn ligation. To assess the acute and chronic phases required for sarcomerogenesis, the rats were sacrificed at 4 hours or 21 days after bead loading. The coccygeus, iliocaudalis, pubocaudalis, and nonpelvic tibialis anterior musles were harvested for myofiber and sarcomere length measurements. The intramuscular collagen content was assessed using a hydroxyproline assay. An additional 20 load+/pregnancy hormones- rats underwent vaginal distention to determine whether the load-induced changes are sufficient to protect from mechanical muscle injury in response to parturition-associated strains of various magnitude. The data, compared using 2-way repeated measures analysis of variance followed by pairwise comparisons, are presented as mean±standard error of mean. RESULTS An acute increase in load resulted in significant pelvic floor muscle stretch, accompanied by an acute increase in sarcomere length compared with nonloaded control muscles (coccygeus: 2.69±0.03 vs 2.30±0.06 μm, respectively, P<.001; pubocaudalis: 2.71±0.04 vs 2.25±0.03 μm, respectively, P<.0001; and iliocaudalis: 2.80±0.06 vs 2.35±0.04 μm, respectively, P<.0001). After 21 days of sustained load, the sarcomeres returned to operational length in all pelvic muscles (P>.05). However, the myofibers remained significantly longer in the load+/pregnancy hormones- than the load-/pregnancy hormones- in coccygeus (13.33±0.94 vs 9.97±0.26 mm, respectively, P<.0001) and pubocaudalis (21.20±0.52 vs 19.52±0.34 mm, respectively, P<.04) and not different from load+/pregnancy hormones+ (12.82±0.30 and 22.53±0.32 mm, respectively, P>.1), indicating that sustained load-induced sarcomerogenesis in these muscles. The intramuscular collagen content in the load+/pregnancy hormones- group was significantly greater relative to the controls in coccygeus (6.55±0.85 vs 3.11±0.47 μg/mg, respectively, P<.001) and pubocaudalis (5.93±0.79 vs 3.46±0.52 μg/mg, respectively, P<.05) and not different from load+/pregnancy hormones+ (7.45±0.65 and 6.05±0.62 μg/mg, respectively, P>.5). The iliocaudalis required both mechanical and endocrine cues for sarcomerogenesis. The tibialis anterior was not affected by mechanical or endocrine alterations. Despite an equivalent extent of adaptations, load-induced changes were only partially protective against sarcomere hyperelongation. CONCLUSION Load induces plasticity of the intrinsic pelvic floor muscle components, which renders protection against mechanical birth injury. The protective effect, which varies between the individual muscles and strain magnitudes, is further augmented by the presence of pregnancy hormones. Maximizing the impact of mechanical load on the pelvic floor muscles during pregnancy, such as with specialized pelvic floor muscle stretching regimens, is a potentially actionable target for augmenting pregnancy-induced adaptations to decrease birth injury in women who may otherwise have incomplete antepartum muscle adaptations.
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Affiliation(s)
- Mary M Rieger
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, La Jolla, CA
| | - Michelle Wong
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, La Jolla, CA
| | - Lindsey A Burnett
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, La Jolla, CA
| | - Francesca Boscolo Sesillo
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, La Jolla, CA
| | - Brittni B Baynes
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, La Jolla, CA
| | - Marianna Alperin
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, La Jolla, CA.
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Wang X, Jin Y, Xu X, Wang H, Feng S. Development and validation of a predictive model for urinary incontinence postpartum: a prospective longitudinal study. Int Urogynecol J 2022; 33:1609-1615. [PMID: 35182156 DOI: 10.1007/s00192-022-05105-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 01/18/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Urinary incontinence is a common and burdensome problem amongst women. Although it can be prevented, little progress has been made. Identifying individuals at risk remains the key to the prevention of urinary incontinence. METHODS Eligible women were enrolled in the obstetric wards of a tertiary maternity hospital in 2020. Urinary incontinence was measured using a well-accepted questionnaire. Logistic regression with a backward stepwise process was used for predictor selection. The discrimination and calibration of the nomogram were measured using the area under the ROC curve (AUC), Hosmer-Lemeshow test and calibration curve respectively. Bootstrapping procedure with 1000 resamples was used for internal validity. A temporal split (7:3) was made and data collected from the later period were used for temporal validation. RESULTS Seven predictors including birth mode, urinary incontinence before and during pregnancy, place of residence, feeding pattern, parity, and age at first birth remained in the final model. The AUC was 0.757 (95% CI: 0.72-0.80) and 0.759 (95% CI: 0.70-0.82) in the derivation and validation cohorts respectively. No significant differences were detected in the Hosmer-Lemeshow test and calibration curve in both cohorts. CONCLUSIONS The nomogram proved to be a convenient and reliable tool in the clinical setting for risk assessment of postpartum incontinence, which can be applied during pregnancy and the postnatal period for individual risk estimates of postpartum incontinence.
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Affiliation(s)
- Xiaojuan Wang
- Zhejiang University School of Medicine, No.866 Yu Hang Tang Road, Hangzhou, 310058, Zhejiang Province, China
| | - Ying Jin
- Women's Hospital, School of Medicine Zhejiang University, No.1 Xue Shi Road, Zhejiang Province, 310006, Hangzhou, China
| | - Xuefen Xu
- Women's Hospital, School of Medicine Zhejiang University, No.1 Xue Shi Road, Zhejiang Province, 310006, Hangzhou, China
| | - Hongyan Wang
- Women's Hospital, School of Medicine Zhejiang University, No.1 Xue Shi Road, Zhejiang Province, 310006, Hangzhou, China
| | - Suwen Feng
- Women's Hospital, School of Medicine Zhejiang University, No.1 Xue Shi Road, Zhejiang Province, 310006, Hangzhou, China.
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Gabriel I, Vitonis AF, Missmer SA, Fadayomi A, DiVasta AD, Terry KL, Minassian VA. Association between endometriosis and lower urinary tract symptoms. Fertil Steril 2022; 117:822-830. [PMID: 35109981 DOI: 10.1016/j.fertnstert.2022.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 12/28/2021] [Accepted: 01/04/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To determine if women with endometriosis experience lower urinary tract symptoms (LUTSs) more often than those without. DESIGN Cross-sectional analysis at enrollment in a longitudinal cohort. SETTING Enrollment at 2 academic hospitals and from the local community. PATIENT(S) This analysis included 1,161 women with (n = 520) and without (n = 641) surgically confirmed endometriosis who were enrolled in the Women's Health Study: from Adolescence to Adulthood between 2012 and 2018. INTERVENTION(S) Not applicable. MAIN OUTCOME MEASURE(S) Prevalence of LUTSs, including stress incontinence, urgency and frequency, straining with urination, incomplete bladder emptying, hematuria, dysuria, and bladder pain using standardized questionnaires. RESULT(S) The primary outcomes were that women with endometriosis reported the following more often than those without: difficulty passing urine (7.9% vs. 2%; crude odds ratio [OR], 4.14 [95% confidence interval {CI}, 2.19-7.80]; adjusted OR [aOR], 4.31 [95% CI, 2.07-8.95]); still feeling full after urination (18.8% vs. 4.7%; crude OR, 4.73 [95% CI, 3.08-7.25]; aOR, 4.67 [95% CI, 2.88-7.56]); having to urinate again within minutes of urinating (33.1% vs. 17.0%; crude OR, 2.41 [95% CI, 1.83-3.18]; aOR, 2.49 [95% CI, 1.81-3.43]), dysuria (11.7% vs. 4.9%; crude OR, 2.55 [95% CI, 1.62-4.01]; aOR, 2.38 [95% CI, 1.40-4.02]); and pain when the bladder is full (23.0% vs. 4.9%; crude OR, 5.79 [95% CI, 3.82-8.78]; aOR, 6.04 [95% CI, 3.74-9.76]). For the secondary outcomes, among female participants with endometriosis, we observed that the odds of LUTS did not differ by the revised American Society for Reproductive Medicine stage (I/II vs. III/IV) or duration of endometriosis-associated symptoms. CONCLUSION(S) Women with surgically confirmed endometriosis were more likely to report LUTS than those without.
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Affiliation(s)
- Iwona Gabriel
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts; Department of Gynecology, Obstetrics and Oncological Gynecology, Medical University of Silesia, Bytom, Poland.
| | - Allison F Vitonis
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts; Boston Center for Endometriosis, Boston Children's Hospital and Brigham and Women's Hospital, Boston, Massachusetts
| | - Stacey A Missmer
- Boston Center for Endometriosis, Boston Children's Hospital and Brigham and Women's Hospital, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University College of Human Medicine, Grand Rapids, Michigan
| | - Ayòtúndé Fadayomi
- Boston Center for Endometriosis, Boston Children's Hospital and Brigham and Women's Hospital, Boston, Massachusetts; Department of Anesthesiology and Perioperative Medicine, University of Massachusetts Memorial Medical Center, Worcester, Massachusetts
| | - Amy D DiVasta
- Boston Center for Endometriosis, Boston Children's Hospital and Brigham and Women's Hospital, Boston, Massachusetts; Division of Adolescent and Young Adult Medicine, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Kathryn L Terry
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts; Boston Center for Endometriosis, Boston Children's Hospital and Brigham and Women's Hospital, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Vatche A Minassian
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts
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Roman P, Spinelli V, Gauer APM, Fiório FB, Mucke AC, Azzi VJB. Prevalence and factors associated with urinary incontinence in women farmers. FISIOTERAPIA EM MOVIMENTO 2022. [DOI: 10.1590/fm.2022.35606] [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) is any involun-tary loss of urine, exhibiting a relationship with pelvic floor muscle weakness and overload. The physical exertion required of the woman farmer may predispose her to higher frequency of UI. Objective: To evaluate the prevalence of UI and associated factors in women farmers. Methods: Cross-sectional study, with appli-cation of an evaluation form and the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) in women aged between 25 and 50 years old. Women with urinary loss responded to the King's Health Questionnaire (KHQ). Data were collected by individual interview. The data were analyzed by absolute and relative frequency, using the Mann-Whitney test for intergroups and Spearman's Correlation Coefficient to relate the variables, considering p < 0.05. Results: Two hundred farmers were interviewed, where 52 (26%) reported involuntary urine loss. The incontinent group had a higher number of annual urinary infection (3.23 ± 1.40). Most incontinent women reported escape 1x/week or less (73.08%), in small amounts (82.69%), during stress (57.69%). Quality of life was classified as very good by 59.62%. The intensity of the work was considered strong by 25% of the incontinent women. Only 30.5% of the volunteers were able to define UI and 97.7% considered it not normal. Conclusion: The prevalence of UI was equivalent to the average of the female population in general, with urinary infection as an associated factor. The loss occurs mainly to stress, and lack of knowledge can reflect in the identification treatment.
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Affiliation(s)
- Priscila Roman
- Universidade do Oeste de Santa Catarina (UNOESC), Brazil
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Silva RLDCDA, Pinto SVDO, Nascimento SLD, Moreira MA. Provável sarcopenia e obesidade em mulheres com incontinência urinária no climatério. FISIOTERAPIA EM MOVIMENTO 2022. [DOI: 10.1590/fm.2022.356013.0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Introdução: Sarcopenia e obesidade têm relação com diversas condições de saúde. Poucos estudos, entretanto, têm analisado a presença destas condições em mulheres incontinentes no climatério, e não está claro se existe associação destas com a gravidade da incontinência urinária (IU). Objetivo: Analisar provável sarcopenia, sarcopenia e obesidade em mulheres com diferentes gravidades de IU na fase do climatério e a associação da sarcopenia com a gravidade da IU. Métodos: Estudo transversal realizado em maternidade pública do nordeste do Brasil, em mulheres com IU a partir de 40 anos. Foram avaliadas questões sociodemográficas, histórico uroginecológico, gravidade da IU (Incontinence Severity Index - ISI), força de preensão e medidas antropométricas (circunferência abdominal e índice de massa corporal - IMC). Foram analisadas médias e desvios-padrão, frequências absolutas e relativas, teste T e exato de Fisher (significância de 5%). Resultados: Amostra de 177 mulheres com média de 56,3 (± 9,7) anos. Sobre a IU, 69 (39,0%) mulheres apresentavam IU mista e 53,1% gravidade moderada. Apenas 18,1% apresentavam IMC normal, 46,8% obesidade geral e 80,3% obesidade abdominal. Provável sarcopenia (baixa força) foi observada em 35 (20%) mulheres e sarcopenia em 3,4%. Mulheres com IU grave ou muito grave apresentaram menor força de preensão (p = 0,02) e maior IMC (p = 0,04). A sarcopenia foi associada à maior gravidade de IU (p = 0,005). Conclusão: Observou-se provável sarcopenia e maior IMC em mulheres com maior gravidade de IU e associação da sarcopenia com a maior gravidade de IU. São necessárias medidas preventivas quanto a tais condições, evitando futuras complicações.
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Silva RLDCDA, Pinto SVDO, Nascimento SLD, Moreira MA. Probable sarcopenia and obesity in women with urinary incontinence in the climacteric period. FISIOTERAPIA EM MOVIMENTO 2022. [DOI: 10.1590/fm.2022.356013] [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
Abstract Introduction: Sarcopenia and obesity are associated with several health conditions. Few studies, however, have analyzed the presence of these conditions in climacteric women with incontinence, and the association between these conditions and the severity of urinary incontinence (UI) is not clear. Objective: To analyze probable sarcopenia, sarcopenia, and obesity in climacteric women with different UI severities, and the association between sarcopenia and UI severity. Methods: This was a cross-sectional study in a public maternity hospital in Northeast Brazil, with women aged ≥ 40 years. Sociodemographic issues, urogynecological history, UI severity (Incontinence Severity Index - ISI), grip strength, and anthropometric measures (waist circumference and body mass index - BMI) were evaluated. Means, standard deviations, absolute and relative frequencies, T test, and Fisher exact test were used (significance at 5%). Results: The sample comprised 177 women, with a mean age of 56.3 (± 9.7) years. Regarding UI, 69 (39.0%) women presented mixed UI, and 53.1% presented moderate UI severity. Only 18.1% women had normal BMIs, and 46.8% had general obesity and 80.3% had abdominal obesity. Probable sarcopenia (low strength) was observed in 35 (20%) women, and sarcopenia, in 3.4%. Women with severe/very severe UI presented lower grip strengths (p = 0.02) and higher BMIs (p = 0.04). Sarcopenia was associated with greater UI severity (p = 0.005). Conclusion: Probable sarcopenia and higher BMI were observed in women with greater UI severities, and sarcopenia was associated with greater UI severity. Preventive measures are needed in such conditions to avoid future complications.
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Roman P, Spinelli V, Gauer APM, Fiório FB, Mucke AC, Azzi VJB. Prevalência e fatores associados à incontinência urinária em agricultoras. FISIOTERAPIA EM MOVIMENTO 2022. [DOI: 10.1590/fm.2022.35606.0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Introdução: Incontinência urinária (IU) é qualquer perda involuntária de urina, apresentando relação com sobrecarga e fraqueza da musculatura do assoalho pélvico. O esforço físico exigido da mulher agricultora pode predispor à maior frequência de IU. Objetivo: Avaliar a prevalência e fatores associados à IU em mulheres agricultoras. Métodos: Estudo de corte transversal, com aplicação de ficha de avaliação e do International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) em mulheres com idade entre 25 e 50 anos. As mulheres com perda urinária responderam ao King’s Health Questionnaire (KHQ). A coleta de dados foi por entrevista individual. Os dados foram analisados por frequência absoluta e relativa, sendo empregado o teste de Mann-Whitney para intergrupos e o coeficiente de correlação de Spearman para relacionar as variáveis, considerando p < 0,05. Resultados: Duzentas mulheres agricultoras foram entrevistadas, das quais 52 (26%) referiram perda involuntária de urina. O grupo incontinente apresentou maior número de infecção urinária anual (3,23 ± 1,40). A maior parte das mulheres incontinentes referiram escape 1x/semana ou menos (73,08%), em pequena quantidade (82,69%) e durante o esforço (57,69%). A qualidade de vida foi classificada como muito boa por 59,62%. A intensidade do trabalho foi considerada forte por 25% das mulheres incontinentes. Apenas 30,5% das voluntárias souberam definir IU a e 97,7% consideram não ser normal. Conclusão: A prevalência de IU foi equivalente à média da população feminina em geral, tendo a infecção urinária como fator associado. A perda ocorre principalmente por conta de esforços e a falta de conhecimento pode dificultar a identificação e procura por tratamento.
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Affiliation(s)
- Priscila Roman
- Universidade do Oeste de Santa Catarina (UNOESC), Brazil
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Relationship Between Blood Glucose Level and Prevalence and Frequency of Stress Urinary Incontinence in Women. Female Pelvic Med Reconstr Surg 2021; 28:304-310. [PMID: 34593685 PMCID: PMC9071020 DOI: 10.1097/spv.0000000000001112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to evaluate the relationship between blood glucose level and the prevalence and frequency of stress urinary incontinence (SUI) in women.
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Invited Commentary: Beyond female stress urinary incontinence. Curr Urol 2021; 15:129-130. [PMID: 34552450 PMCID: PMC8451317 DOI: 10.1097/cu9.0000000000000038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 08/12/2021] [Indexed: 11/25/2022] Open
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Characteristics Associated With Treatment Failure 1 Year After Midurethral Sling in Women With Mixed Urinary Incontinence. Obstet Gynecol 2021; 138:199-207. [PMID: 34237755 PMCID: PMC10184494 DOI: 10.1097/aog.0000000000004444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 04/15/2021] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To evaluate characteristics associated with treatment failure 1 year after midurethral sling in women with mixed urinary incontinence. METHODS Four-hundred three women who participated in a randomized trial that compared midurethral sling and behavioral and pelvic floor muscle therapy (combined group) compared with midurethral sling alone for mixed incontinence with 1-year follow-up data were eligible for this planned secondary analysis. Overall treatment failure was defined as meeting criteria for subjective or objective failure or both. Subjective failure was defined as not meeting the minimal clinical important difference for improvement on the UDI (Urogenital Distress Inventory) total score (26.1 points). Objective failure was defined as not achieving 70% improvement on mean incontinence episodes of any type per day or having undergone any additional treatment for persistent urinary symptoms at 12 months postoperative. Logistic regression models for treatment failure were constructed. Independent variables included site and treatment group, and clinical and demographic variables based on bivariate comparisons (P<.2). Treatment group interaction effects were evaluated. RESULTS One hundred twelve of 379 (29.6%) women had overall treatment failure, with 56 of 379 (14.7%) undergoing additional treatment but only two needing intervention for stress incontinence. Previous overactive bladder (OAB) medication (unadjusted odds ratio [OR] 2.19, adjusted odds ratio [aOR] 1.96, 95% CI 1.17-3.31); detrusor overactivity on cystometrogram (OR 2.25, aOR 2.82, 95% CI 1.60-4.97); and higher volume at first urge (OR 1.03, aOR 1.04, 95% CI 1.01-1.07) were associated with overall failure. Worse UDI-urgency scores were associated with failure, with an added interaction effect in the midurethral sling-alone group. CONCLUSIONS Certain clinical and urodynamic variables are associated with treatment failure after midurethral sling in women with mixed urinary incontinence. Women with more severe urgency symptoms at baseline may benefit from perioperative behavioral and pelvic floor muscle therapy combined with midurethral sling. Overall, the need for additional urinary treatment was low and primarily for OAB. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT01959347.
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Velázquez-Saornil J, Méndez-Sánchez E, Gómez-Sánchez S, Sánchez-Milá Z, Cortés-Llorente E, Martín-Jiménez A, Sánchez-Jiménez E, Campón-Chekroun A. Observational Study on the Prevalence of Urinary Incontinence in Female Athletes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115591. [PMID: 34073782 PMCID: PMC8197179 DOI: 10.3390/ijerph18115591] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/19/2021] [Accepted: 05/21/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE To study the prevalence of UI in female athletes, the category of sports with the highest number of cases, the most incident risk factors and the bio-psycho-social consequences. METHODS Preparation of a survey, based on two validated questionnaires answered by 63 participants, to carry out an analytical, transversal and observational study. All participants were European, adult, female athletes (mean age 30.78 years, standard deviation 12.16 years). RESULTS UI has a high prevalence (44.4%) in female athletes (compared to 10% in non-athletes), being more frequent in those who practice long-distance running. As age and years of sport practice increase, the incidence of this pathology increases. Absorbent pads are used by more than half of women with incontinence, while the rest wet their underwear. Menopause, childbirth and surgery in the region are risk factors for UI, while the presence of urinary tract infections or candidiasis is not. The results state that urine loss does not cause anxiety or depression, but it does affect sporting life. CONCLUSIONS The prevalence of UI in this study is very high and more common in female athletes and the incidence increases with age and other risk factors. The salient consequence of this study is that urine loss affects their sporting environment, but does not induce depression or anxiety.
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Affiliation(s)
- Jorge Velázquez-Saornil
- Department of Physiotherapy, Faculty of Health Sciences, Universidad Católica de Ávila, 05005 Ávila, Spain; (E.M.-S.); (S.G.-S.); (Z.S.-M.); (A.M.-J.); (E.S.-J.); (A.C.-C.)
- Correspondence: ; Tel.: +34-920-251-020
| | - Encarnación Méndez-Sánchez
- Department of Physiotherapy, Faculty of Health Sciences, Universidad Católica de Ávila, 05005 Ávila, Spain; (E.M.-S.); (S.G.-S.); (Z.S.-M.); (A.M.-J.); (E.S.-J.); (A.C.-C.)
| | - Sonia Gómez-Sánchez
- Department of Physiotherapy, Faculty of Health Sciences, Universidad Católica de Ávila, 05005 Ávila, Spain; (E.M.-S.); (S.G.-S.); (Z.S.-M.); (A.M.-J.); (E.S.-J.); (A.C.-C.)
| | - Zacarías Sánchez-Milá
- Department of Physiotherapy, Faculty of Health Sciences, Universidad Católica de Ávila, 05005 Ávila, Spain; (E.M.-S.); (S.G.-S.); (Z.S.-M.); (A.M.-J.); (E.S.-J.); (A.C.-C.)
| | | | - Ana Martín-Jiménez
- Department of Physiotherapy, Faculty of Health Sciences, Universidad Católica de Ávila, 05005 Ávila, Spain; (E.M.-S.); (S.G.-S.); (Z.S.-M.); (A.M.-J.); (E.S.-J.); (A.C.-C.)
| | - Elena Sánchez-Jiménez
- Department of Physiotherapy, Faculty of Health Sciences, Universidad Católica de Ávila, 05005 Ávila, Spain; (E.M.-S.); (S.G.-S.); (Z.S.-M.); (A.M.-J.); (E.S.-J.); (A.C.-C.)
| | - Angélica Campón-Chekroun
- Department of Physiotherapy, Faculty of Health Sciences, Universidad Católica de Ávila, 05005 Ávila, Spain; (E.M.-S.); (S.G.-S.); (Z.S.-M.); (A.M.-J.); (E.S.-J.); (A.C.-C.)
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Miller JM, Hood MM, Karvonen-Gutierrez CA, Richards-McCullough KC, Harlow SD. Paper towel test as independently self-administered to quantify cough-related urine loss: Compliance and comparisons with survey-only data in SWAN. Neurourol Urodyn 2021; 40:1207-1216. [PMID: 33973662 DOI: 10.1002/nau.24683] [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: 05/28/2020] [Revised: 03/21/2021] [Accepted: 03/30/2021] [Indexed: 11/09/2022]
Abstract
AIMS The epidemiologic Study of Women's Health Across the Nation (SWAN) includes urinary incontinence (UI) questionnaire items. We introduced an independently self-administered paper towel test (PTT-ISA; invention disclosure #2021-347) to objectively demonstrate UI. Aims were to determine: (1) PTT-ISA compliance and (2) relationship to questionnaire results. METHODS 276 community women were invited to complete both SWAN questionnaire and PTT-ISA. For PTT-ISA, a woman holds a trifold brown paper towel against her perineum while coughing hard three times. She checks the towel for wetness and compares it with pictorial showing wetted area gradations (dry towel through >6 ml/saturated). She then selects the best photo match for her towel. A newly conceptualized variable constructed as PTT-ISA plus questionnaire results was formed. RESULTS Of 276 women, noncompliance with PTT-ISA was 2.2% (6 women). Four others (1.5%) were missing questionnaires. For the remaining 266 women, conceptual cohesiveness between questionnaire-only and PTT-ISA + questionnaire was demonstrated in 165 (62.0%). Lack of cohesiveness occurred in 101 (38.9%), including 41 women who said "no" to the questionnaire item indicative of stress UI and had leakage on PTT-ISA; leakage degree varied across the full pictorial spectrum from drops to saturated. CONCLUSION PTT-ISA demonstrates high compliance, with rate comparable to survey compliance. It is a novel measure for objective sign of urine loss when independently self-administered by community women outside of a clinic environment. Further research comparing PTT-ISA with clinician-observed cough test is warranted. As independently self-administered, PTT-ISA is simple, noninvasive, inexpensive, and an acceptable test that adds value to otherwise survey-dependent research.
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Affiliation(s)
- Janis M Miller
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, Michigan, USA.,Department of Obstetrics and Gynecology, School of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Michelle M Hood
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | | | | | - Sioban D Harlow
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
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Concurrent Retropubic Midurethral Sling and OnabotulinumtoxinA for Mixed Urinary Incontinence: A Randomized Controlled Trial. Obstet Gynecol 2021; 137:12-20. [PMID: 33278293 DOI: 10.1097/aog.0000000000004198] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 08/06/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate whether retropubic midurethral sling combined with onabotulinumtoxinA is more effective than sling alone in improving mixed urinary incontinence symptoms. METHODS We conducted a prospective, double-blind, randomized, controlled trial of women with mixed urinary incontinence, planning to undergo midurethral sling. Women were randomly assigned to receive 100 unites of intradetrusor onabotulinumtoxinA or placebo during surgery. Participants completed the PGI-S (Patient Global Impression of Severity), the UDI-6 (Urinary Distress Inventory, Short Form), and the PFIQ-7 (Pelvic Floor Impact Questionnaire-Short Form 7) before and 3 months after surgery, and the primary outcome, PGI-I (Patient Global Impression of Improvement), 3 months postoperatively. Primary outcome was PGI-I score at 3 months for overall incontinence. We considered women "improved" with answers of "very much better" or "much better" on the PGI-I. Assuming a PGI-I response of "improved" in 66% of placebo and 93% of onabotulinumtoxinA participants, 68 women were needed to show a significant difference with 80% power at 0.05 significance level. RESULTS From March 2016 to November 2019, 78 women completed a 3-month follow-up (onabotulinumtoxinA: 41; placebo: 37). Mean age was 51 years (±10). On the PGI-I, the number who "improved" did not differ between groups at 3 months (83% vs 84%, P=1.0). The onabotulinumtoxinA group had less severe urgency symptoms as indicated by median urgency PGI-S scores (1 [interquartile range 1-2] vs 2 [interquartile range 1-3], P=.033) and greater improvement in urgency symptoms based on median urgency PGI-I score (1 [interquartile range 1-3] vs 2 [interquartile range 2-4], P=.028). At 3 months, median UDI-6, PFIQ-7, and PGI-S scores improved significantly from baseline in both groups. Similarly, UDI-6 and PFIQ-7 scores did not differ between groups. More women in the onabotulinumtoxinA arm initiated intermittent self-catheterization, (3% placebo; 12% onabotulinumtoxinA, P=.20) and experienced urinary tract infections (5% placebo; 22% onabotulinumtoxinA, P=.051), but these did not differ statistically. CONCLUSION Concurrent intradetrusor onabotulinumtoxinA injection did not improve overall incontinence symptoms at 3 months compared with placebo among women with mixed urinary incontinence undergoing midurethral sling placement. Women with mixed urinary incontinence undergoing sling report significant improvement in overall incontinence symptoms, regardless of the addition of onabotulinumtoxinA injections, but those receiving concurrent onabotulinumtoxinA injections reported less urgency severity and greater improvement in urgency symptoms at 3 months. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT02678377.
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Li T, Chen X, Wang J, Chen L, Cai W. Mobile App-Based Intervention for Pregnant Women With Stress Urinary Incontinence: Protocol for a Hybrid Effectiveness-Implementation Trial. JMIR Res Protoc 2021; 10:e22771. [PMID: 33688842 PMCID: PMC7991980 DOI: 10.2196/22771] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/20/2020] [Accepted: 11/30/2020] [Indexed: 01/23/2023] Open
Abstract
Background Stress urinary incontinence (SUI) is a common source of distress among women during and after pregnancy. It has a negative effect on quality of life but with poor care-seeking. Mobile health (mHealth) may be a promising solution with potential advantages. However, there is uncertainty whether a mobile app is effective for SUI symptom improvement during and after pregnancy. The implementation is also unclear. We developed an app named UIW (Urinary Incontinence for Women) aimed at improving perinatal incontinence. Objective The objective of this study is to evaluate the effectiveness of the UIW app-based intervention in improving SUI symptoms among pregnant women and explore the facilitators and barriers to using the UIW app to help refine and optimize the intervention. Methods This study is a hybrid effectiveness-implementation trial with a randomized controlled trial alongside a mixed-methods process evaluation according to the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Pregnant women with SUI (n=336) will be recruited from a university-affiliated hospital in China. They will be randomly allocated (1:1) to either the intervention group that receive usual care plus UIW app or control group that receive usual care alone. The intervention period will last 2 months. The 5 dimensions of the RE-AIM framework will be evaluated at recruitment (-T1), baseline (T0), immediately after intervention (T1), 42 days after delivery (T2), 3 months after delivery (T3), and 6 months after delivery (T4) through project documents, online questionnaires and a pelvic floor muscle training diary, surface electromyography, log data in the background management system, and qualitative interviews. Data analysis will follow the intention-to-treat principle. Descriptive statistics, t tests, chi-square tests, and a linear mixed model will be used to analyze the quantitative data. Deductive and inductive content analysis will be used to analyze the qualitative data. Results The effectiveness-implementation trial started in June 2020, trial recruitment was completed in October 2020, and the intervention will last for a 2-month period. Completion of the 6-month follow-up will be in July 2021, and we anticipate that the results of this study will be published in December 2021. Conclusions This study will evaluate both effectiveness and implementation of the UIW app-based intervention among pregnant women. The hybrid effectiveness-implementation trial design according to the RE-AIM framework with a mixed-methods approach will give valuable insights into the effects as well as facilitators and barriers to the implementation that will influence the effects of the UIW app-based intervention. Trial Registration Chinese Clinical Trial Registry ChiCTR1800016171; http://www.chictr.org.cn/showproj.aspx?proj=27455 International Registered Report Identifier (IRRID) PRR1-10.2196/22771
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Affiliation(s)
- Tiantian Li
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, China.,School of Nursing, Southern Medical University, Guangzhou, China
| | - Xiaomin Chen
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, China
| | - Jia Wang
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, China.,School of Nursing, Southern Medical University, Guangzhou, China
| | - Ling Chen
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, China
| | - Wenzhi Cai
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, China.,School of Nursing, Southern Medical University, Guangzhou, China
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Comparison of Lower Urinary System Symptoms of Women with Multiple Sclerosis and Healthy. ANADOLU KLINIĞI TIP BILIMLERI DERGISI 2020. [DOI: 10.21673/anadoluklin.781617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Costa JND, Lopes MHBDM, Lopes MVDO. Content analysis of nursing diagnoses related to urinary incontinence. Rev Esc Enferm USP 2020; 54:e03632. [PMID: 33263663 DOI: 10.1590/s1980-220x2019019803632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 12/09/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze the content of nursing diagnoses related to urinary incontinence according to NANDA International and others identified in the literature. METHOD Methodological study conducted with judges who were experts in urinary dysfunctions and nursing diagnosis. The analysis included diagnoses of Stress Urinary Incontinence, Urgency Urinary Incontinence, Functional Urinary Incontinence, Urinary Incontinence due to Neurogenic Detrusor Overactivity (previously denominated Reflex Urinary Incontinence in NANDA International's taxonomy), Mixed Urinary Incontinence, and Transient Urinary Incontinence. Wilcoxon test was applied and Content Validity Index ≥ 0.85 was considered appropriate. RESULTS Fifty-one judges participated in this study. The judges recommended modifications in elements of all diagnoses (inclusion, exclusion or change of previous element type). CONCLUSION The four diagnoses analyzed in NANDA International's taxonomy are recommended to be maintained with modifications; inclusion of nursing diagnoses Mixed and Transient Urinary Incontinence is also recommended.
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Characteristics Associated With Treatment Failure 1 Year After Midurethral Sling in Women With Mixed Urinary Incontinence. Obstet Gynecol 2020; 136:482-491. [PMID: 32769647 DOI: 10.1097/aog.0000000000003989] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate characteristics associated with treatment failure 1 year after midurethral sling in women with mixed urinary incontinence. METHODS Four hundred three women who participated in a randomized trial that compared midurethral sling and behavioral and pelvic floor muscle therapy (combined group) against midurethral sling alone for mixed incontinence with 1 year of follow-up data were eligible for this planned secondary analysis. Overall treatment failure was defined as meeting criteria for subjective failure, objective failure, or both. Subjective failure was defined as not meeting the minimal clinically important difference for improvement on the UDI (Urogenital Distress Inventory)-total score (26.1 points). Objective failure was not achieving 70% improvement on mean incontinence episodes of any type per day or having undergone any additional treatment for urinary symptoms at 12 months postoperative. Logistic regression models for treatment failure were constructed. Independent variables included site and treatment group, and clinical and demographic variables based on bivariate comparisons (P<.2). Treatment group interaction effects were evaluated. RESULTS Previous overactive bladder medication use (unadjusted odds ratio [OR] 2.19, adjusted odds ratio [aOR] 1.89, 95% CI 1.10-3.25), detrusor overactivity on cystometrogram (OR 2.25, aOR 2.72, 95% CI 1.53-4.84), body mass index (OR 1.29, aOR 1.27, 95% CI 1.03-1.57), and Valsalva leak point pressure less than 60 cm H2O (OR 1.96, aOR 3.13, 95% CI 1.65-5.94) were associated with overall failure. Worse UDI urgency scores were associated with failure in the midurethral sling-alone group. Sling type (retropubic vs transobturator) was not associated with failure. CONCLUSION Certain clinical and urodynamic variables are associated with treatment failure after midurethral sling among women with mixed urinary incontinence. Women with more severe urgency symptoms at baseline may benefit from perioperative behavioral and pelvic floor muscle therapy combined with midurethral sling. This information is helpful for counseling women with mixed incontinence who are considering surgery. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT01959347.
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Williams BR, Vargo K, Newman DK, Yvette Lacoursiere D, Mueller ER, Connett J, Low LK, James AS, Smith AL, Schmitz KH, Burgio KL. It's About Time: The Temporal Burden of Lower Urinary Tract Symptoms Among Women. UROLOGIC NURSING 2020; 40:10.7257/1053-816x.2020.40.6.277. [PMID: 33642840 PMCID: PMC7906293 DOI: 10.7257/1053-816x.2020.40.6.277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This secondary analysis studied 50 transcripts of women who shared day-to-day experiences of lower urinary tract symptoms (LUTS) and characterized temporal (time-associated) features of living with LUTS. Findings revealed two overarching time-associated themes: The Complexity of LUTS and The Quest for Empowerment over LUTS. Findings suggest that the temporal burden of LUTS is the accumulated impact of symptoms and symptom management on women's daily lives within multiple contexts across the life course. Increasing nurses' knowledge of the temporal context of LUTS may heighten awareness and improve symptom detection and management.
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Affiliation(s)
- Beverly Rosa Williams
- University of Alabama at Birmingham School of Medicine, Department of Veterans Affairs, Birmingham, AL
| | - Keith Vargo
- University of Minnesota School of Public Health
| | - Diane K Newman
- Division of Urology, Department of Surgery, University of Pennsylvania, Perelman School of Medicine
| | | | | | | | | | - Aimee S James
- Washington University in St. Louis School of Medicine
| | | | | | - Kathryn L Burgio
- University of Alabama at Birmingham School of Medicine, Department of Veterans Affairs, Birmingham, AL
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Pelvic floor dysfunction distress is correlated with quality of life, but not with muscle function. Arch Gynecol Obstet 2020; 303:143-149. [PMID: 32915304 DOI: 10.1007/s00404-020-05770-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 08/24/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To analyze the relationship between the symptoms of pelvic floor dysfunction (PFD) and quality of life (QoL), as well as the function of the pelvic floor muscle (PFM) in women with urinary incontinence (UI). METHODS A cross-sectional study conducted in two centers in Brazil (Northeast and Southeast regions) with women with stress urinary incontinence (SUI) and mixed urinary incontinence (MUI). Data on pelvic floor symptoms, discomfort and impact on QoL were collected using the Pelvic Floor Distress Inventory-short form (PFDI-SF-20) and the Pelvic Floor Impact Questionnaire (PFIQ-7) instruments. PFM function was assessed by palpation (PERFECT scale) and manometry. Pearson's correlation test, analysis of variance (ANOVA) and the Student's t test were used to discriminate the differences, adopting a significance level of 5%. RESULTS A total of 72 women participated in the study (mean age 51.7 ± 11.9 years). The presence and discomfort of pelvic floor symptoms (PFDI-SF-20) were correlated with QoL (PFIQ-7) (r = 0.52, p < 0.001). Deficits in PFM function (power and pressure) were observed, however, there was no correlation between these with the presence and discomfort of the pelvic floor symptoms (PFDI-SF-20). CONCLUSION Greater discomfort due to PFD symptoms were correlated with a worse QoL. However, the relationship between symptoms and PFM function was not significant. These results reinforce the need to assess the aspects of activity and participation which compose functionality and QoL, and not only the PFM functions in women with UI.
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Prevalence and determinants of non-fistulous urinary incontinence among Ghanaian women seeking gynaecologic care at a teaching hospital. PLoS One 2020; 15:e0237518. [PMID: 32810136 PMCID: PMC7433879 DOI: 10.1371/journal.pone.0237518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 07/28/2020] [Indexed: 11/19/2022] Open
Abstract
The study assessed the prevalence and determinants of non-fistulous urinary incontinence among gynaecologic care seekers as well as its interference with everyday life activities of affected women. A cross-sectional study involving 400 women was conducted in a tertiary facility in Ghana. Urinary incontinence was assessed using the International Consultation on Incontinence Questionnaire-short form (ICIQ-SF) which has not been validated locally. The questionnaire was administered mostly in the Asante Twi language with translation done at the time of the interview. The data was analysed for proportions and associations between selected variables. The prevalence of urinary incontinence was 12%, the common types being urgency (33.3%), stress (22.9%), and mixed (20.8%). Age ≥60 years compared to 18–39 years (OR 3.66 95%CI 1.48–9.00 P = 0.005), and a history of chronic cough (OR 3.80 95% CI 1.36–10.58 P = 0.01) were associated with urinary incontinence. Women with education beyond the basic level were 72% less likely to experience urinary incontinence (OR 0.28 95%CI 0.08–0.96 P = 0.04). Urinary incontinence interferes with everyday life activities of most affected women. Non-fistulous urinary incontinence is relatively common among gynaecologic care seekers yet very few women were referred with such a diagnosis. Advocacy measures aimed at urging affected women to report the condition and educating the general population on potential causes, prevention and treatment are needed.
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Brady SS, Brubaker L, Fok CS, Gahagan S, Lewis CE, Lewis J, Lowder JL, Nodora J, Stapleton A, Palmer MH. Development of Conceptual Models to Guide Public Health Research, Practice, and Policy: Synthesizing Traditional and Contemporary Paradigms. Health Promot Pract 2020; 21:510-524. [PMID: 31910039 PMCID: PMC7869957 DOI: 10.1177/1524839919890869] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This applied paper is intended to serve as a "how to" guide for public health researchers, practitioners, and policy makers who are interested in building conceptual models to convey their ideas to diverse audiences. Conceptual models can provide a visual representation of specific research questions. They also can show key components of programs, practices, and policies designed to promote health. Conceptual models may provide improved guidance for prevention and intervention efforts if they are based on frameworks that integrate social ecological and biological influences on health and incorporate health equity and social justice principles. To enhance understanding and utilization of this guide, we provide examples of conceptual models developed by the Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium. PLUS is a transdisciplinary U.S. scientific network established by the National Institutes of Health in 2015 to promote bladder health and prevent lower urinary tract symptoms, an emerging public health and prevention priority. The PLUS Research Consortium is developing conceptual models to guide its prevention research agenda. Research findings may in turn influence future public health practices and policies. This guide can assist others in framing diverse public health and prevention science issues in innovative, potentially transformative ways.
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Affiliation(s)
| | | | | | | | - Cora E Lewis
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Jerry L Lowder
- Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Jesse Nodora
- University of California San Diego, La Jolla, CA, USA
| | | | - Mary H Palmer
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Hermieu N, Schoentgen N, Aoun R, Neveu P, Grassano Y, Egrot C, Kassem A, Xylinas E, Ouzaid I, Hermieu JF. [Surgical management of suburethral sling complications and functional outcomes]. Prog Urol 2020; 30:402-410. [PMID: 32409239 DOI: 10.1016/j.purol.2020.04.022] [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: 04/14/2020] [Revised: 04/23/2020] [Accepted: 04/25/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To identify various clinical presentation leading to the diagnosis of mid-urethral sling (MUS) complications and to analyze the functional outcomes after surgical management of these complications. METHOD Retrospective observational monocentric study of all patients treated by MUS section or removal, between December 2005 and October 2019, in a pelviperineology centre. RESULTS During this study, 96 patients were included. MUS complications surgically managed were vaginal mesh exposure (48 %), urethral mesh exposure (17 %), bladder mesh exposure (10 %); dysuria (30 %), pain (6 %), and infection (3 %). The mean time to diagnosis was 2 years. This diagnosis delay was caused by a non-specific and heterogeneous symptomatology. Surgical management consisted in MUS partial removal (79 %) and MUS simple section (21 %) with low perioperative morbidity. At three months follow-up, 36 patients (53 %) had stress urinary incontinence (SUI), including 13 (19 %) de novo (meaning no SUI before MUS section/removal) and 19 (28 %) had overactive bladder, including 9 (13 %) de novo. Half of the patients with SUI after MUS section/removal were able to be treated by a second MUS with a success rate of 83 % at 3 years. CONCLUSION Clinical presentation of MUS complications is heterogeneous. Surgical treatment was associated with low morbidity in our study. Post-operatively, half of the patients had SUI and a second MUS was a relevant treatment option after proper evaluation. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- N Hermieu
- Service de chirurgie urologique, centre hospitalier universitaire Bichat Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France; Université de Paris, Paris, France
| | - N Schoentgen
- Service de chirurgie urologique, centre hospitalier universitaire Bichat Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France.
| | - R Aoun
- Service de chirurgie urologique, centre hospitalier universitaire Bichat Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France
| | - P Neveu
- Service de chirurgie urologique, centre hospitalier universitaire Bichat Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France; Université de Paris, Paris, France
| | - Y Grassano
- Service de chirurgie urologique, centre hospitalier universitaire Bichat Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France
| | - C Egrot
- Service de chirurgie urologique, centre hospitalier universitaire Bichat Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France
| | - A Kassem
- Service de chirurgie urologique, centre hospitalier universitaire Bichat Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France
| | - E Xylinas
- Service de chirurgie urologique, centre hospitalier universitaire Bichat Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France; Université de Paris, Paris, France
| | - I Ouzaid
- Service de chirurgie urologique, centre hospitalier universitaire Bichat Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France; Université de Paris, Paris, France
| | - J F Hermieu
- Service de chirurgie urologique, centre hospitalier universitaire Bichat Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France; Université de Paris, Paris, France
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Cost-Effectiveness of Sacral Neuromodulation versus OnabotulinumtoxinA for Refractory Urgency Urinary Incontinence: Results of the ROSETTA Randomized Trial. J Urol 2020; 203:969-977. [PMID: 31738113 PMCID: PMC7204548 DOI: 10.1097/ju.0000000000000656] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE Sacral neuromodulation and intradetrusor onabotulinumtoxinA injection are therapies for refractory urgency urinary incontinence. Sacral neuromodulation involves surgical implantation of a device that can last 4 to 6 years while onabotulinumtoxinA therapy involves serial office injections. We assessed the cost-effectiveness of 2-stage implantation sacral neuromodulation vs 200 units onabotulinumtoxinA for the treatment of urgency urinary incontinence. MATERIALS AND METHODS Prospective economic evaluation was performed concurrent with the ROSETTA (Refractory Overactive Bladder: Sacral NEuromodulation vs. BoTulinum Toxin Assessment) randomized trial of 386 women with 6 or more urgency urinary incontinence episodes on a 3-day diary. Analysis is from the health care system perspective with primary within-trial analysis for 2 years and secondary 5-year decision analysis. Costs are in 2018 U.S. dollars. Effectiveness was measured in quality adjusted life-years (QALYs) and reductions in urgency urinary incontinence episodes per day. We generated incremental cost-effectiveness ratios and cost-effectiveness acceptability curves. RESULTS Two-year costs were higher for sacral neuromodulation than for onabotulinumtoxinA ($35,680 [95% CI 33,920-37,440] vs $7,460 [95% CI 5,780-9,150], p <0.01), persisting through 5 years ($36,550 [95% CI 34,787-38,309] vs $12,020 [95% CI 10,330-13,700], p <0.01). At 2 years there were no differences in mean reduction in urgency urinary incontinence episodes per day (-3.00 [95% CI -3.38 - -2.62] vs -3.12 [95% CI -3.48 - -2.76], p=0.66) or QALYs (1.39 [95% CI 1.34-1.44] vs 1.41 [95% CI 1.36-1.45], p=0.60). The probability that sacral neuromodulation is cost-effective relative to onabotulinumtoxinA is less than 0.025 for all willingness to pay values below $580,000 per QALY at 2 years and $204,000 per QALY at 5 years. CONCLUSIONS Although both treatments were effective, the high cost of sacral neuromodulation is not good value for treating urgency urinary incontinence compared to 200 units onabotulinumtoxinA.
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Abstract
OBJECTIVES A significant body of knowledge implicates menopausal estrogen levels in the pathogenesis of the common pelvic floor disorders (PFDs). These health conditions substantially decrease quality of life, increase depression, social isolation, caregiver burden, and economic costs to the individuals and society. METHODS This review summarizes the epidemiology of the individual PFDs with particular attention to the understanding of the relationship between each PFD and menopausal estrogen levels, and the gaps in science and clinical care that affect menopausal women. In addition, we review the epidemiology of recurrent urinary tract infection (rUTI)-a condition experienced frequently and disproportionately by menopausal women and hypothesized to be potentiated by menopausal estrogen levels. RESULTS The abundance of estrogen receptors in the urogenital tract explains why the natural reduction of endogenous estrogen, the hallmark of menopause, can cause or potentiate PFDs and rUTIs. A substantial body of epidemiological literature suggests an association between menopause, and PFDs and rUTIs; however, the ability to separate this association from age and other comorbid conditions makes it difficult to draw definitive conclusions on the role of menopause alone in the development and/or progression of PFDs. Similarly, the causative link between the decline in endogenous estrogen levels and the pathogenesis of PFDs and rUTIs has not been well-established. CONCLUSIONS Innovative human studies, focused on the independent effects of menopausal estrogen levels, uncoupled from tissue and cellular senescence, are needed.
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Brady SS, Berry A, Camenga DR, Fitzgerald CM, Gahagan S, Hardacker CT, Harlow BL, Hebert-Beirne J, LaCoursiere DY, Lewis JB, Low LK, Lowder JL, Markland AD, McGwin G, Newman DK, Palmer MH, Shoham DA, Smith AL, Stapleton A, Williams BR, Sutcliffe S. Applying concepts of life course theory and life course epidemiology to the study of bladder health and lower urinary tract symptoms among girls and women. Neurourol Urodyn 2020; 39:1185-1202. [PMID: 32119156 PMCID: PMC7659467 DOI: 10.1002/nau.24325] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 01/23/2020] [Indexed: 01/18/2023]
Abstract
AIMS Although lower urinary tract symptoms (LUTS) may occur at different periods during the life course of women, a little research on LUTS has adopted a life course perspective. The purpose of this conceptual paper is to demonstrate how life course theory and life course epidemiology can be applied to study bladder health and LUTS trajectories. We highlight conceptual work from the Prevention of Lower Urinary Tract Symptoms Research Consortium to enhance the understanding of life course concepts. METHODS Consortium members worked in transdisciplinary teams to generate examples of how life course concepts may be applied to research on bladder health and LUTS in eight prioritized areas: (a) biopsychosocial ecology of stress and brain health; (b) toileting environment, access, habits, and techniques; (c) pregnancy and childbirth; (d) physical health and medical conditions; (e) musculoskeletal health; (f) lifestyle behaviors; (g) infections and microbiome; and (h) hormonal status across the life span. RESULTS Life course concepts guided consortium members' conceptualization of how potential risk and protective factors may influence women's health. For example, intrapartum interventions across multiple pregnancies may influence trajectories of bladder health and LUTS, illustrating the principle of life span development. Consortium members also identified and summarized methodologic and practical considerations in designing life course research. CONCLUSIONS This paper may assist researchers from a variety of disciplines to design and implement research identifying key risk and protective factors for LUTS and bladder health across the life course of women. Results from life course research may inform health promotion programs, policies, and practices.
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Affiliation(s)
- Sonya S Brady
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Amanda Berry
- Department of Surgery, Division of Urology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Deepa R Camenga
- Department of Emergency Medicine and Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | - Colleen M Fitzgerald
- Department of Obstetrics and Gynecology, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois
| | - Sheila Gahagan
- Department of Pediatrics, Division of Academic General Pediatrics, University of California San Diego School of Medicine, San Diego, California
| | | | - Bernard L Harlow
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Jeni Hebert-Beirne
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago, Illinois
| | - D Yvette LaCoursiere
- Department of Obstetrics, Gynecology, and Reproductive Sciences, UC San Diego School of Medicine, San Diego, California
| | - Jessica B Lewis
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Lisa K Low
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, Michigan
| | - Jerry L Lowder
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Alayne D Markland
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, School of Medicine, University of Alabama, Birmingham, Alabama
- Geriatric Research, Education, and Clinical Center, Birmingham VA Medical Center, Birmingham, Alabama
| | - Gerald McGwin
- Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham, Alabama
| | - Diane K Newman
- Department of Surgery, Division of Urology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mary H Palmer
- School of Nursing, University of North Carolina, Chapel Hill, North Carolina
| | - David A Shoham
- Department of Public Health Sciences, Loyola University Chicago, Maywood, Illinois
| | - Ariana L Smith
- Department of Surgery, Division of Urology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ann Stapleton
- Department of Medicine, Division of Allergy and Infectious Disease, University of Washington, Seattle, Washington
| | - Beverly R Williams
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, School of Medicine, University of Alabama, Birmingham, Alabama
| | - Siobhan Sutcliffe
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St. Louis, Missouri
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Neves da Costa J, Oliveira Lopes MV, Baena de Moraes Lopes MH. Simultaneous Concept Analysis of Diagnoses Related to Urinary Incontinence. Int J Nurs Knowl 2020; 31:109-123. [DOI: 10.1111/2047-3095.12254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 07/06/2019] [Accepted: 07/08/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Juliana Neves da Costa
- School of Nursing (FEnf)Universidade Estadual de Campinas (Unicamp) Campinas São Paulo Brazil
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Evaluation of Femaxeen® for control of urinary incontinence in women: A randomized, double-blind, placebo-controlled study. Maturitas 2020; 133:1-6. [DOI: 10.1016/j.maturitas.2019.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 11/25/2019] [Accepted: 12/10/2019] [Indexed: 11/20/2022]
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Minassian VA, Hagan KA, Erekson E, Austin AM, Carmichael D, Bynum JP, Grodstein F. The natural history of urinary incontinence subtypes in the Nurses' Health Studies. Am J Obstet Gynecol 2020; 222:163.e1-163.e8. [PMID: 31449803 DOI: 10.1016/j.ajog.2019.08.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 07/16/2019] [Accepted: 08/17/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Urinary incontinence subtypes often differ by symptom severity and treatment profiles; in particular, mixed urinary incontinence is generally associated with worse symptoms and less successful treatment. Yet, limited information exists on the natural history of different urinary incontinence subtypes, which could help to better identify and treat patients prior to development of more intractable disease. OBJECTIVE To evaluate the onset of urinary incontinence subtypes, and transitions between subtypes over 8 years, using 2 large cohorts of middle-aged and older women with incident urinary incontinence. MATERIALS AND METHODS We identified 10,349 women with incident urinary incontinence (stress, urgency, and mixed subtypes) from the Nurses' Health Study and the Nurses' Health Study II who were 41-83 years of age, using repeated mailed questionnaires. We defined stress urinary incontinence as leakage with coughing, sneezing, or activity; urgency urinary incontinence as urine loss with a sudden feeling of bladder fullness or when a toilet was inaccessible; and mixed urinary incontinence when women reported that stress and urgency symptoms occurred equally. In subsequent questionnaires 4 and 8 years later, we continued to track symptom severity and subtypes. In addition, to obtain predicted probabilities of urinary incontinence subtypes 4 years and 8 years after urinary incontinence onset, we used multivariable-adjusted generalized estimating equations with a multinomial outcome. RESULTS At urinary incontinence onset in 2004-2005, 56% of women reported stress urinary incontinence symptoms, 23% reported urgency urinary incontinence symptoms, and 21% reported mixed urinary incontinence symptoms. Women with stress urinary incontinence or urgency urinary incontinence at onset were likely to report the same urinary incontinence type 4 and 8 years later (stress urinary incontinence at onset: 70% and 60% reported stress urinary incontinence at years 4 and 8, respectively; urgency urinary incontinence at onset: 68% and 64% reported urgency urinary incontinence at years 4 and 8, respectively). Nonetheless, for both stress and urgency urinary incontinence, women with more severe symptoms at onset were more likely to progress to mixed urinary incontinence. Women with mixed urinary incontinence at onset had more variation over time, although the largest subset continued to report mixed urinary incontinence (45% reported mixed urinary incontinence at year 4; 43% reported mixed urinary incontinence at year 8). Few women across all urinary incontinence subtypes reported resolution of symptoms over 4-8 years of follow-up (4-12%). When considering the likelihood of remaining with or progressing to mixed urinary incontinence over follow-up, according to age, body mass index, and urinary incontinence severity, we found that older and younger women had similar predicted probability of remaining with or progressing to mixed urinary incontinence (eg, women <60 years of age at onset with severe mixed urinary incontinence had a 54% (95% confidence interval, 53-55) probability of mixed urinary incontinence 8 years later, vs 57% (95% confidence interval, 56-58) of women ≥70 years of age with severe mixed urinary incontinence at onset). Obese women were somewhat more likely to progress to mixed urinary incontinence regardless of urinary incontinence type at onset (eg, women with body mass index <25 kg/m2 at onset with severe stress urinary incontinence had a 30% predicted probability of mixed urinary incontinence 8 years after onset, vs 36% of women with body mass index of 30+ kg/m2 at onset with severe stress urinary incontinence). CONCLUSION Most women with incident stress and urgency urinary incontinence continued to experience similar subtype symptoms over 8 years. However, obese women and those with more severe symptoms were more likely to remain with or progress to mixed urinary incontinence.
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