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Gomes LTDC, de Sena MO, Dantas PB, Barbosa AIDS, Holanda VAD, Oliveira JIN, Gavioli EC, da Silva Junior ED. Smooth muscle contraction of the fundus of stomach, duodenum and bladder from mice exposed to a stress-based model of depression. Physiol Behav 2023; 272:114374. [PMID: 37806511 DOI: 10.1016/j.physbeh.2023.114374] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 06/09/2023] [Accepted: 10/05/2023] [Indexed: 10/10/2023]
Abstract
Several reports have demonstrated that depressive disorder is related to somatic symptoms including gastrointestinal or genitourinary alterations. The pathophysiological mechanisms underlying the gastrointestinal or genitourinary alterations associated with the depression are still not fully understood. Therefore, this study aimed to evaluate the motor activity of gastrointestinal (fundus of stomach and duodenum) and genitourinary tract (bladder) in a stress-based animal model of depression. Adult male mice were submitted to uncontrollable and unpredictable stress (learned helplessness model), controllable stress and non-stressful situations (control). Then, animals were euthanized and the fundus of stomach, duodenum segments or whole bladder were isolated and mounted in a standard organ bath preparation. We evaluated the contractile effects induced by KCl 80 mM for 5 min or carbachol (acetylcholine receptor agonist). The relaxant effects of isoproterenol (β-adrenoceptor agonist) were also checked. Animals submitted to the learned helplessness model developed a helpless (depressive-like behavior) or resilient (does not exhibit depressive-like behavior) phenotype. The contractions induced by carbachol were diminished in fundus of stomach isolated from helpless and resilient animals. The isoproterenol-induced fundus of stomach relaxation was reduced in resilient but not helpless mice. The contractions/relaxation of duodenum segments isolated from helpless or resilient animals were not altered. Both helpless and resilient animals showed an increase in the bladder contractions induced by carbachol while the relaxant effects of isoproterenol were reduced when compared to control. Conversely, mice underwent a controllable stress situation did not exhibit alterations in the fundus of stomach or duodenum contraction/relaxation induced by pharmacological agents although a decrease in the bladder contraction induced by carbachol was found. In conclusion, incontrollable and unpredictable stress and not depressive phenotype (helpless animals) or controllable stress could be related to the alterations in motor activity of the fundus of stomach and bladder.
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Affiliation(s)
- Luana Talinne da Costa Gomes
- Department of Biophysics and Pharmacology, Federal University of Rio Grande do Norte, Av. Senador Salgado Filho, s/n Campus Universitário - Lagoa Nova, Natal, RN 59072-970, Brazil
| | - Maele Oliveira de Sena
- Department of Biophysics and Pharmacology, Federal University of Rio Grande do Norte, Av. Senador Salgado Filho, s/n Campus Universitário - Lagoa Nova, Natal, RN 59072-970, Brazil
| | - Pedro Brüch Dantas
- Department of Biophysics and Pharmacology, Federal University of Rio Grande do Norte, Av. Senador Salgado Filho, s/n Campus Universitário - Lagoa Nova, Natal, RN 59072-970, Brazil
| | - Aldemara Ingrid da Silva Barbosa
- Department of Biophysics and Pharmacology, Federal University of Rio Grande do Norte, Av. Senador Salgado Filho, s/n Campus Universitário - Lagoa Nova, Natal, RN 59072-970, Brazil
| | - Victor Anastácio Duarte Holanda
- Department of Biophysics and Pharmacology, Federal University of Rio Grande do Norte, Av. Senador Salgado Filho, s/n Campus Universitário - Lagoa Nova, Natal, RN 59072-970, Brazil
| | - Jonas Ivan Nobre Oliveira
- Department of Biophysics and Pharmacology, Federal University of Rio Grande do Norte, Av. Senador Salgado Filho, s/n Campus Universitário - Lagoa Nova, Natal, RN 59072-970, Brazil
| | - Elaine Cristina Gavioli
- Department of Biophysics and Pharmacology, Federal University of Rio Grande do Norte, Av. Senador Salgado Filho, s/n Campus Universitário - Lagoa Nova, Natal, RN 59072-970, Brazil
| | - Edilson Dantas da Silva Junior
- Department of Biophysics and Pharmacology, Federal University of Rio Grande do Norte, Av. Senador Salgado Filho, s/n Campus Universitário - Lagoa Nova, Natal, RN 59072-970, Brazil.
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Zalewski M, Kołodyńska G, Fink-Lwow F, Mucha A, Andrzejewski W. The Relationship between Anxiety and Depression Levels and General Health Status before and 12 Months after SUI Treatment in Postmenopausal Women from the Lower Silesian Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5156. [PMID: 35564551 PMCID: PMC9103203 DOI: 10.3390/ijerph19095156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 04/19/2022] [Accepted: 04/20/2022] [Indexed: 11/16/2022]
Abstract
Menopause is often the cut-off point from which most cases of stress urinary incontinence (SUI) in women begin. This dysfunction affects not only the physical experience of the patient, but is also related to the psychological aspects, leading to a reduced quality of life. Despite the large number of patients with SUI and the frequent use of surgical treatment for this condition, there are few scientific reports evaluating the effectiveness of the procedure in terms of reducing depressive symptoms or improving overall health. The aim of this study was to evaluate the relationship between anxiety and depression and general health status before and 12 months after surgical treatment for SUI in postmenopausal women. Seventy-five patients qualified for the study, but due to the long study duration, both sets of questionnaires were eventually obtained from 60 postmenopausal patients. All patients that qualified for the study had a trans obturator tape (TOT) procedure. All patients enrolled in the project were given the Hospital Anxiety and Depression Scale (hAdS) and King's Health Questionnaire (KHQ). After 12 months of surgery with midurethral slings, symptoms of depression were present in only a small number of subjects, 11.7%, and anxiety was present in 13.3% of the entire group. The study confirms that patients with a general poor health condition may suffer from depression or anxiety, and therefore may also need psychological treatment. Patients with SUI should therefore receive therapeutic care from a multidisciplinary team, in which therapeutic activities are divided between doctors, nurses, physiotherapists and psychologists. As a result of the treatment, after 12 months, we confirmed a significant improvement in patients with depression and anxiety disorders.
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Affiliation(s)
- Maciej Zalewski
- Department of Gynaecology and Obstetrics, Faculty of Health Sciences, Medical University of Wrocław, 50-367 Wrocław, Poland;
- Department of Gynaecology, Independent Public Health Care Center of the Ministry of the Interior and Administration in Wroclaw, 50-233 Wrocław, Poland
| | - Gabriela Kołodyńska
- Department of Physiotherapy, Wroclaw University of Health and Sport Sciences, 51-612 Wrocław, Poland; (F.F.-L.); (W.A.)
| | - Felicja Fink-Lwow
- Department of Physiotherapy, Wroclaw University of Health and Sport Sciences, 51-612 Wrocław, Poland; (F.F.-L.); (W.A.)
| | - Anna Mucha
- Department of Genetics, Wrocław University of Environmental and Life Sciences, 50-375 Wrocław, Poland;
| | - Waldemar Andrzejewski
- Department of Physiotherapy, Wroclaw University of Health and Sport Sciences, 51-612 Wrocław, Poland; (F.F.-L.); (W.A.)
- Faculty of Health Sciences, University of Opole, 45-040 Opole, Poland
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3
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Prevalence and clinical correlates for depression in women with urinary incontinence: a cross-sectional study. Int Urogynecol J 2022; 33:1303-1309. [DOI: 10.1007/s00192-022-05169-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 03/01/2022] [Indexed: 10/18/2022]
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Beckenbodeninsuffizienz und Sexualität aus gynäkologischer Sicht. COLOPROCTOLOGY 2021. [DOI: 10.1007/s00053-021-00552-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Erekson E, Menefee S, Whitworth RE, Amundsen CL, Arya LA, Komesu YM, Ferrando CA, Zyczynski HM, Sung VW, Rahn DD, Tan-Kim J, Mazloomdoost D, Gantz MG, Richter HE. The Design of a Prospective Trial to Evaluate the Role of Preoperative Frailty Assessment in Older Women Undergoing Surgery for the Treatment of Pelvic Organ Prolapse: The FASt Supplemental Trial. Female Pelvic Med Reconstr Surg 2021; 27:e106-e111. [PMID: 32217922 PMCID: PMC7381379 DOI: 10.1097/spv.0000000000000833] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE We present the rationale for and the design of a prospective trial to evaluate the role of preoperative frailty and mobility assessments in older women undergoing surgery for the treatment of pelvic organ prolapse (POP) as a planned prospective supplemental trial to the ASPIRe (Apical Suspension Repair for Vault Prolapse In a Three-Arm Randomized Trial Design) trial. The Frailty ASPIRe Study (FASt) examines the impact of preoperative frailty and mobility on surgical outcomes in older women (≥65 years) participating in the ASPIRe trial. The primary objective of FASt is to determine the impact of preoperative age, multimorbidity, frailty, and decreased mobility on postoperative outcomes in older women (≥65 years old) undergoing surgery for POP. METHODS The selection of the preoperative assessments, primary outcome measures, and participant inclusion is described. Frailty and mobility measurements will be collected at the preoperative visit and include the 6 Robinson frailty measurements and the Timed Up and Go mobility test. The main outcome measure in the FASt supplemental study will be moderate to severe postoperative adverse events according to the Clavien-Dindo Severity Classification. CONCLUSIONS This trial will assess impact of preoperative age, multimorbidity, frailty, and decreased mobility on postoperative outcomes in older women (≥65 years old) undergoing surgical procedures for the correction of apical POP. Information from this trial may help both primary care providers and surgeons better advise/inform women on their individual risks of surgical complications and provide more comprehensive postoperative care to women at highest risk of complications.
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Affiliation(s)
- Elisabeth Erekson
- From the Department of Obstetrics and Gynecology, The Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Shawn Menefee
- University of California, San Diego, and Kaiser Permanente, San Diego, CA
| | | | | | - Lily A Arya
- University of Pennsylvania, Philadelphia, PA
| | - Yuko M Komesu
- University of New Mexico Health Sciences Center, Albuquerque, NM
| | - Cecile A Ferrando
- Department of Obstetrics, Gynecology & Women's Health Institute, Cleveland Clinic, Cleveland, OH
| | - Halina M Zyczynski
- The Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Magee-Womens Research Institute, Pittsburgh, PA
| | - Vivian W Sung
- Alpert Medical School of Brown University, Providence, RI
| | - David D Rahn
- University of Texas Southwestern Medical Center, Dallas, TX
| | - Jasmine Tan-Kim
- University of California, San Diego, and Kaiser Permanente, San Diego, CA
| | - Donna Mazloomdoost
- The Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD
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Steibliene V, Aniuliene R, Aniulis P, Raskauskiene N, Adomaitiene V. Affective Symptoms and Health-Related Quality of Life Among Women with Stress Urinary Incontinence: Cross-Sectional Study. Neuropsychiatr Dis Treat 2020; 16:535-544. [PMID: 32158213 PMCID: PMC7047965 DOI: 10.2147/ndt.s236234] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 01/15/2020] [Indexed: 12/03/2022] Open
Abstract
PURPOSE To evaluate the relationship between affective symptoms, clinical variables of uro-gynaecological history and health-related quality of life (QoL) among women with stress urinary incontinence (SUI) in comparison to healthy controls. PATIENTS AND METHODS In a cross-sectional study, 80 women 30 to 80 years of age diagnosed with SUI and 97 controls without symptoms of SUI provided sociodemographic data and answered the King's Health Questionnaire (KHQ) for assessing the QoL among individuals with urinary incontinence. Symptoms of anxiety and depression were assessed by Hospital Anxiety and Depression (HAD) scale with a threshold ≥7. A multiple regression was performed to reveal the cross-sectional predictors of affective symptoms and QoL among women with SUI. RESULTS Women with SUI had a significantly higher prevalence of symptoms of anxiety and depression than the controls (50% vs 11% and 29% vs 3.1%, respectively; both p<0.001) and worse health-related QoL on all domains of the KHQ. In multiple logistic regression models adjusted for sociodemographic and clinical variables of uro-gynaecological history, perceived symptoms of mild-to-severe depression were associated with a higher amount of leakage (OR=3.59; 1.04-12.4), older age (≥55 years old vs <55 years old) (OR=5.82; 1.47-23.1) and higher BMI (OR=1.13; 1.01-1.27). In addition, when controlled for all domains of the KHQ, perceived depressive symptoms were associated with the "emotions" domain of the KHQ (OR=1.06; 1.02-1.09). Perceived anxiety symptoms (independent of age) were related to shorter duration of SUI, low parity, absence of comorbidities and to higher scores on the "personal relationships" and "emotions" domains of the KHQ. CONCLUSION Women with SUI have a significantly poorer QoL than their counterparts without SUI. It was determined that one-half of women with SUI had anxiety symptoms, while one-third of women with SUI had depressive symptoms. In addition, this study indicated that QoL was associated with anxiety symptoms in middle-aged women and with depressive symptoms in older women, especially those with a shorter duration of SUI.
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Affiliation(s)
- Vesta Steibliene
- Clinic of Psychiatry, Lithuanian University of Health Sciences, Kaunas, Lithuania
- Neuroscience Institute, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Rosita Aniuliene
- Department of Obstetrics and Gynaecology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Povilas Aniulis
- Department of Urology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Nijole Raskauskiene
- Neuroscience Institute, Lithuanian University of Health Sciences, Kaunas, Lithuania
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Özcan H, Kızılkaya Beji N. Elli yaş ve üzeri kadınlarda alt üriner sistem şikâyetleri ile sağlıklı yaşam biçimi davranışları ilişkisi. CUKUROVA MEDICAL JOURNAL 2019. [DOI: 10.17826/cumj.527322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Mühlstädt S, Mischner S, Kranz J, Anheuser P, Mohammed N, Steffens JA, Fornara P. Quo Vadis Botulinum Toxin: Normative Constraints and Quality of Life for Patients With Idiopathic OAB? Front Surg 2018; 5:61. [PMID: 30386782 PMCID: PMC6198085 DOI: 10.3389/fsurg.2018.00061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 09/14/2018] [Indexed: 01/10/2023] Open
Abstract
Background: Idiopathic overactive bladder (iOAB), with or without urge incontinence (UI), has significant psychosocial effects on patients' quality of life (QoL). The first choice of treatment for iOAB is anticholinergics and, alternatively, the β-3-adrenoceptor agonist mirabegron. However, systemic side effects and contraindications should be considered for both medications. Objective: We report the efficacy, safety and effects on QoL of botulinum toxin therapy (onabotulinum toxin type A, BOTOX®, Allergan) among patients with iOAB ± UI. Patients and Methods: Between 2005 and 2013, 51 patients were treated with onabotulinum toxin A (100 units). The inclusion criteria were the presence of confirmed iOAB ± UI with previous use of anticholinergic medication. Micturition frequency, pad count, postvoid residual volume and QoL were evaluated using two validated questionnaires [the Client Satisfaction Questionnaire-8 (CSQ-8) and the King's Health Questionnaire (KHQ)]. Statistical analysis was performed with SPSS 24.0 (p < 0.05). Results: After botulinum toxin injection, a significant improvement in iOAB ± UI symptoms was observed. The micturition frequency decreased from 10.4 ± 0.5 to 5.2 ± 0.4 micturitions per day (p = 0.026), and the pad count decreased from 3.6 ± 1.0 to 1.2 ± 0.3 pads per day (p = 0.033). Anticholinergics were not used during the administration of botulinum toxin therapy. Complications and postoperative need for intermittent self-catheterization (ISC) were not observed. Overall, 72 and 24% of patients reported being “satisfied” or “very satisfied” with the treatment. Additionally, 66% of patients would choose botulinum toxin again for the treatment of iOAB. Conclusion: Botulinum toxin therapy is an efficient, safe, and life-improving treatment for iOAB.
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Affiliation(s)
- Sandra Mühlstädt
- Department of Urology and Kidney Transplantation, Martin-Luther-University, Halle (Saale), Germany
| | - Shahidul Mischner
- Department of Orthopaedics, Berufsgenossenschaftliche Kliniken Bergmannstrost, Halle (Saale), Germany
| | - Jennifer Kranz
- Department of Urology and Paediatric Urology, St. Antonius Hospital, Eschweiler, Germany
| | - Petra Anheuser
- Department of Urology, Asklepios Clinic, Hamburg, Germany
| | - Nasreldin Mohammed
- Department of Urology and Kidney Transplantation, Martin-Luther-University, Halle (Saale), Germany
| | - Joachim A Steffens
- Department of Urology and Paediatric Urology, St. Antonius Hospital, Eschweiler, Germany
| | - Paolo Fornara
- Department of Urology and Kidney Transplantation, Martin-Luther-University, Halle (Saale), Germany
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Hagan KA, Erekson E, Austin A, Minassian VA, Townsend MK, Bynum JPW, Grodstein F. A prospective study of the natural history of urinary incontinence in women. Am J Obstet Gynecol 2018; 218:502.e1-502.e8. [PMID: 29425839 DOI: 10.1016/j.ajog.2018.01.045] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 01/15/2018] [Accepted: 01/31/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Symptoms of urinary incontinence are commonly perceived to vary over time; yet, there is limited quantitative evidence regarding the natural history of urinary incontinence, especially over the long term. OBJECTIVE We sought to delineate the course of urinary incontinence symptoms over time, using 2 large cohorts of middle-aged and older women, with data collected over 10 years. STUDY DESIGN We studied 9376 women from the Nurses' Health Study, age 56-81 years at baseline, and 7491 women from the Nurses' Health Study II, age 39-56 years, with incident urinary incontinence in 2002 through 2003. Urinary incontinence severity was measured by the Sandvik severity index. We tracked persistence, progression, remission, and improvement of symptoms over 10 years. We also examined risk factors for urinary incontinence progression using logistic regression models. RESULTS Among women age 39-56 years, 39% had slight, 45% had moderate, and 17% had severe urinary incontinence at onset. Among women age 56-81 years, 34% had slight, 45% had moderate, and 21% had severe urinary incontinence at onset. Across ages, most women reported persistence or progression of symptoms over follow-up; few (3-11%) reported remission. However, younger women and women with less severe urinary incontinence at onset were more likely to report remission or improvement of symptoms. We found that increasing age was associated with higher odds of progression only among older women (age 75-81 vs 56-60 years; odds ratio, 1.84; 95% confidence interval, 1.51-2.25). Among all women, higher body mass index was strongly associated with progression (younger women: odds ratio, 2.37; 95% confidence interval, 2.00-2.81; body mass index ≥30 vs <25 kg/m2; older women: odds ratio, 1.93; 95% confidence interval, 1.62-2.22). Additionally, greater physical activity was associated with lower odds of progression to severe urinary incontinence (younger women: odds ratio, 0.86; 95% confidence interval, 0.71-1.03; highest vs lowest quartile of activity; older women: odds ratio, 0.68; 95% confidence interval, 0.59-0.80). CONCLUSION Most women with incident urinary incontinence continued to experience symptoms over 10 years; few had complete remission. Identification of risk factors for urinary incontinence progression, such as body mass index and physical activity, could be important for reducing symptoms over time.
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Affiliation(s)
- Kaitlin A Hagan
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA.
| | - Elisabeth Erekson
- Department of Obstetrics and Gynecology, Geisel School of Medicine at Dartmouth, Hanover, NH; Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Andrea Austin
- Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Vatche A Minassian
- Division of Urogynecology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA
| | - Mary K Townsend
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Julie P W Bynum
- Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Francine Grodstein
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA
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Lim YM, Lee SR, Choi EJ, Jeong K, Chung HW. Urinary incontinence is strongly associated with depression in middle-aged and older Korean women: Data from the Korean longitudinal study of ageing. Eur J Obstet Gynecol Reprod Biol 2017; 220:69-73. [PMID: 29175130 DOI: 10.1016/j.ejogrb.2017.11.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Revised: 07/24/2017] [Accepted: 11/20/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To investigate the relationship between urinary incontinence (UI) and depression in middle-aged and older Korean women. STUDY DESIGN A total of 1116 participants diagnosed with UI among 7486 respondents were included in this study, using data from a well-established survey that investigated a nationally representative population: the Korean Longitudinal Study of Ageing (KLoSA). Computer-assisted personal interviewing was used to assess the status of UI and depression. Depression was assessed using the 10-item Center for Epidemiological Studies-Depression (CES-D 10) scale. Odds ratios (ORs) and 95% confidence intervals (95% CIs) for depression were adjusted for age, household income level, marital status, education level, working status, smoking behavior, alcohol drinking behavior, exercise level, residence, and accompanying chronic diseases. RESULTS The proportion of patients with depression was significantly higher among women with UI (9.1%) than among women without UI (6.3%) (P<0.0001). The depression scores became worse with worsening UI symptoms (OR of better vs. same vs. worse, 1.00 vs. 1.51 vs. 2.15, respectively; P for trend=0.0001), with an increased number of days experiencing UI during the prior month during the 2 years of the panel study period (OR of none vs. 1≤days≤10days vs. 10days<were 1.00 vs. 2.15 vs. 4.36; P for trend=0.003). CONCLUSIONS Inadequately controlled and frequent UI is strongly associated with depression in middle-aged and older Korean women. The management of worsening UI may be of value as part of the assessment and management of depression.
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Affiliation(s)
- Young-Mee Lim
- Departments of Obstetrics and Gynecology, College of Medicine, Ewha Woman's University, Seoul, Republic of Korea
| | - Sa Ra Lee
- Departments of Obstetrics and Gynecology, College of Medicine, Ewha Woman's University, Seoul, Republic of Korea.
| | - Eun Ji Choi
- Departments of Obstetrics and Gynecology, College of Medicine, Ewha Woman's University, Seoul, Republic of Korea
| | - Kyungah Jeong
- Departments of Obstetrics and Gynecology, College of Medicine, Ewha Woman's University, Seoul, Republic of Korea
| | - Hye Won Chung
- Departments of Obstetrics and Gynecology, College of Medicine, Ewha Woman's University, Seoul, Republic of Korea
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The influence of duloxetine on detrusor overactivity in rats with depression induced by 13-cis-retinoic acid. Int Urogynecol J 2017; 29:987-995. [PMID: 28762178 PMCID: PMC6004276 DOI: 10.1007/s00192-017-3424-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 06/30/2017] [Indexed: 11/03/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The aim of this study was to assess the efficacy of duloxetine in an animal model of detrusor overactivity induced by depression. METHODS After 6 weeks of 13-cis-retinoic acid administration at a dose of 1 mg/kg/day, rats were given duloxetine at a dose of 1 mg/kg. This was followed by conscious cystometry, a forced swim test, and locomotor activity measurement. The levels of corticotropin-releasing factor (CRF) in the hypothalamus, amygdala and plasma were also determined. RESULTS Duloxetine treatment led to a reduction in detrusor overactivity symptoms induced by the retinoid. Decreases were observed in cystometric parameters including the detrusor overactivity index, and the amplitude and frequency of nonvoiding contractions, while increases were seen in bladder compliance and the volume threshold to elicit nonvoiding contractions. No statistically significant differences were found in basal pressure, threshold pressure, micturition voiding pressure, postvoid residual , volume threshold, voiding efficiency, intercontraction interval, bladder contraction duration or relaxation time. Duloxetine also reduced the immobility time to that observed in control animals, while it did not affect locomotor activity. Its effects also included lowering of the CRF levels in the hypothalamus, amygdala and plasma, which increased following the prior administration of the retinoid. The plasma level of 13-cis-retinoic acid in rats corresponded to the levels found in humans. CONCLUSIONS This is the first study showing the efficacy of duloxetine in an animal model of detrusor overactivity induced by depression. Further studies in patients with detrusor overactivity and coexisting depression are warranted to confirm these experimental results.
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Yuan AS, Siggins CA, Erekson E. Perioperative Management of Older Women in Urogynecologic Surgery. CURRENT GERIATRICS REPORTS 2017. [DOI: 10.1007/s13670-017-0199-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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13
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Lai DWL, Bai X, Guo A. Mediating Effect of Social Participation on the Relationship between Incontinence and Depressive Symptoms in Older Chinese Women. HEALTH & SOCIAL WORK 2017; 42:94-101. [PMID: 28431101 DOI: 10.1093/hsw/hlx018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Accepted: 06/18/2016] [Indexed: 06/07/2023]
Abstract
Urinary and fecal incontinence affect older women's social participation and mental health. This study examined the relationship between incontinence severity and depressive symptoms, focusing on the mediating effect of social participation, based on secondary analysis of structured interview data collected in December 2010 from 467 women age 60 and over in mainland China. Incontinence was significantly and positively associated with depressive symptoms but negatively associated with social participation. Social participation was significantly and negatively associated with depressive symptoms and fully mediated the relationship between incontinence and depressive symptoms. These findings can inform mental health interventions for incontinent older women, including preventing and responding to depressive symptoms by promoting social participation.
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Affiliation(s)
- Daniel W L Lai
- Daniel W. L. Lai, PhD, is chair, professor of social work and gerontology, and head of Department of Applied Social Sciences, Hong Kong Polytechnic University, HJ403, Yuk Choi Road, Hung Hom, Kowloon, Hong Kong; e-mail: . Xue Bai, PhD, is assistant professor, Department of Applied Social Sciences, Hong Kong Polytechnic University, Hong Kong. Aimei Guo, PhD, is professor, Ginling Women's College, Nanjing Normal University, Nanjing, China
| | - Xue Bai
- Daniel W. L. Lai, PhD, is chair, professor of social work and gerontology, and head of Department of Applied Social Sciences, Hong Kong Polytechnic University, HJ403, Yuk Choi Road, Hung Hom, Kowloon, Hong Kong; e-mail: . Xue Bai, PhD, is assistant professor, Department of Applied Social Sciences, Hong Kong Polytechnic University, Hong Kong. Aimei Guo, PhD, is professor, Ginling Women's College, Nanjing Normal University, Nanjing, China
| | - Aimei Guo
- Daniel W. L. Lai, PhD, is chair, professor of social work and gerontology, and head of Department of Applied Social Sciences, Hong Kong Polytechnic University, HJ403, Yuk Choi Road, Hung Hom, Kowloon, Hong Kong; e-mail: . Xue Bai, PhD, is assistant professor, Department of Applied Social Sciences, Hong Kong Polytechnic University, Hong Kong. Aimei Guo, PhD, is professor, Ginling Women's College, Nanjing Normal University, Nanjing, China
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Swenson CW, Kolenic GE, Trowbridge ER, Berger MB, Lewicky-Gaupp C, Margulies RU, Morgan DM, Fenner DE, DeLancey JO. Obesity and stress urinary incontinence in women: compromised continence mechanism or excess bladder pressure during cough? Int Urogynecol J 2017; 28:1377-1385. [PMID: 28150033 DOI: 10.1007/s00192-017-3279-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 01/16/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We compared two hypotheses as to why obesity is associated with stress urinary incontinence (SUI): (1) obesity increases demand on the continence system (e.g. higher cough pressure) and (2) obesity compromises urethral function and urethrovaginal support. METHODS A secondary analysis was performed using data from a case-control study of SUI in women. Measurements of urethrovaginal support (POP-Q point Aa, urethral axis), urethral function (maximal urethral closure pressure, MUCP), and measures of continence system demand (intravesical pressures at rest and during maximal cough) were analyzed. Cases and controls were divided into three body mass index (BMI) groups: normal (18.5-24.9 kg/m2); overweight (25.0-29.9 kg/m2); and obese (≥30 kg/m2). Logistic regression models where created to investigate variables related to SUI for each BMI group. Structural equation modeling was used to test the direct and indirect relationships among BMI, SUI, maximal cough pressure, MUCP, and POP-Q point Aa. RESULTS The study included 108 continent controls and 103 women with SUI. MUCP was the factor most strongly associated with SUI in all BMI groups. Maximal cough pressure was significantly associated with SUI in obese women (OR 3.191, 95% CI 1.326, 7.683; p < 0.01), but not in normal weight or overweight women. Path model analysis showed a significant relationship between BMI and SUI through maximal cough pressure (indirect effect, p = 0.038), but not through MUCP (indirect effect, p = 0.243) or POP-Q point Aa (indirect effect, p = 0.410). CONCLUSIONS Our results support the first hypothesis that obesity is associated with SUI because of increased intravesical pressure, which therefore increases demand on the continence mechanism.
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Affiliation(s)
- Carolyn W Swenson
- Department of Obstetrics and Gynecology, L4000 Women's Hospital, University of Michigan, 1500 E. Medical Center Dr., SPC 5276, Ann Arbor, MI, 48109-5276, USA.
| | - Giselle E Kolenic
- Department of Obstetrics and Gynecology, L4000 Women's Hospital, University of Michigan, 1500 E. Medical Center Dr., SPC 5276, Ann Arbor, MI, 48109-5276, USA
| | | | - Mitchell B Berger
- Department of Obstetrics and Gynecology, L4000 Women's Hospital, University of Michigan, 1500 E. Medical Center Dr., SPC 5276, Ann Arbor, MI, 48109-5276, USA
| | | | | | - Daniel M Morgan
- Department of Obstetrics and Gynecology, L4000 Women's Hospital, University of Michigan, 1500 E. Medical Center Dr., SPC 5276, Ann Arbor, MI, 48109-5276, USA
| | - Dee E Fenner
- Department of Obstetrics and Gynecology, L4000 Women's Hospital, University of Michigan, 1500 E. Medical Center Dr., SPC 5276, Ann Arbor, MI, 48109-5276, USA
| | - John O DeLancey
- Department of Obstetrics and Gynecology, L4000 Women's Hospital, University of Michigan, 1500 E. Medical Center Dr., SPC 5276, Ann Arbor, MI, 48109-5276, USA
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Association between urinary incontinence and climacteric symptoms in postmenopausal women. Menopause 2017; 24:77-84. [DOI: 10.1097/gme.0000000000000727] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lai HH, Shen B, Rawal A, Vetter J. The relationship between depression and overactive bladder/urinary incontinence symptoms in the clinical OAB population. BMC Urol 2016; 16:60. [PMID: 27716241 PMCID: PMC5053341 DOI: 10.1186/s12894-016-0179-x] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 09/23/2016] [Indexed: 11/23/2022] Open
Abstract
Background To investigate the relationship between depression and overactive bladder (OAB)/urinary incontinence symptoms among the clinical OAB population. Methods Patients who were diagnosed with overactive bladder (OAB) and age-matched control subjects without OAB were enrolled. Depression symptoms were assessed using the Hospital Anxiety and Depression Scale (HADS-D). OAB/incontinence symptoms were assessed using the validated questionnaires: ICIQ-UI, ICIQ-OAB, UDI-6, IIQ-7, and OAB-q. Results 27.5 % of OAB patients in our study had depression (HADS ≥8), and 12 % of OAB patients had moderate to severe depression (HADS-D ≥11). OAB patients reported significantly higher HADS-D depression scores compared to age-matched controls (5.3 ± 3.9 versus 2.8 ± 3.9, p = 0.004). OAB patients with depression reported more severe incontinence symptoms (ICIQ-UI), greater bother and more impact on quality of life (UDI-6, IIQ-7) compared to OAB patients without depression (p = 0.001, 0.01, <0.001, respectively). However there were no differences in ICIQ-OAB and OAB-q. Among OAB patients, there were positive correlations between the severity of depression symptoms and OAB/incontinence symptoms (p-values <0.001 to 0.035). Conclusions 27.5 % of OAB patients have depression. OAB patients with depression reported more severe urinary incontinence symptoms, greater bother and more impact on quality of life compared to those without depression. Future studies are needed to further examine the mechanistic links between depression and OAB/urinary incontinence.
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Affiliation(s)
- H Henry Lai
- Department of Surgery, Division of Urologic Surgery, Washington University School of Medicine, 4960 Children's Place, Campus Box 8242, St Louis, MO, 63110, USA. .,Department of Anesthesiology, Washington University School of Medicine, 4960 Children's Place, Campus Box 8242, St Louis, MO, 63110, USA.
| | - Baixin Shen
- Department of Surgery, Division of Urologic Surgery, Washington University School of Medicine, 4960 Children's Place, Campus Box 8242, St Louis, MO, 63110, USA
| | - Amar Rawal
- Department of Surgery, Division of Urologic Surgery, Washington University School of Medicine, 4960 Children's Place, Campus Box 8242, St Louis, MO, 63110, USA
| | - Joel Vetter
- Department of Surgery, Division of Urologic Surgery, Washington University School of Medicine, 4960 Children's Place, Campus Box 8242, St Louis, MO, 63110, USA
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Abstract
OBJECTIVE This study aims to identify factors associated with greater impact of vaginal symptoms on the functioning and well-being of postmenopausal women. METHODS Postmenopausal women who reported vaginal dryness, itching, irritation, or pain with sexual activity completed the multidimensional Day-to-day Impact of Vaginal Aging (DIVA) questionnaire and underwent assessment of multiple sociodemographic and clinical factors that have the potential to influence the impact of vaginal symptoms. Multivariable linear regression analyses examined relationships between selected participant characteristics and DIVA scale scores assessing symptom impact on activities of daily living, emotional well-being, self-concept and body image, and sexual functioning. RESULTS Among 745 symptomatic participants, the mean (SD) age was 56 (9) years, and 66% were racial/ethnic minorities. Women with comorbid depression reported greater impact of vaginal symptoms on all dimensions of functioning and well-being measured by the DIVA questionnaire (11%-22% estimated increase in impact scores associated with every three-point increase in Hospital and Anxiety Depression Scale scores). Women with urinary incontinence also reported greater impact of vaginal symptoms on activities of daily living, emotional well-being, and self-concept and body image (27%-37% estimated increase in impact scores). Age, partner status, frequency of sexual activity, general health, and body mass index also predicted greater impact on at least one domain. CONCLUSIONS Findings suggest that special efforts should be made to identify and treat vaginal symptoms in postmenopausal women known to have depression or urinary incontinence, as these women may experience greater impact of vaginal symptoms on multiple domains of functioning and quality of life.
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Functional disability and compromised mobility among older women with urinary incontinence. Female Pelvic Med Reconstr Surg 2016; 21:170-5. [PMID: 25185600 DOI: 10.1097/spv.0000000000000136] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Our objective was to determine the prevalence of functional disability among older women with urinary incontinence (UI). METHODS We conducted a secondary analysis of the 2005-2006 National Social Life, Health and Aging Project. Daily UI was defined as answering "daily" to the question, "How frequently… have you had difficulty controlling your bladder, including leaking small amounts of urine, leaking when you cough or sneeze, or not being able to make it to the bathroom on time?" We then explored functional status. Women were asked about 7 basic activities of daily living (ADLs). Statistical analyses with percentage estimates and 95% confidence intervals (CIs) were performed. Logistic regression was performed to assess the association between functional status and daily UI. RESULTS In total, 1412 women were included in our analysis. Daily UI was reported by 177 (12.5%) women. Functional dependence or disability with any activities of daily living was reported in 62.1% (95% CI, 54.2%-70.1%) of women with daily UI. Among women with daily UI, 23.6% (95% CI, 16.8%-30.5%) reported specific difficulty or dependence with using the toilet, signifying functional limitations which may contribute to urine leakage. After adjusting for age category, race/ethnicity, education level, and parity, women with daily UI had 3.31 increased odds of functional difficulty or dependence compared with continent older women. CONCLUSIONS More than 60% of older women with daily UI reported functional difficulty or dependence and one fourth of women with daily UI specifically reported difficulty or dependence with using the toilet.
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Jung HB, Kim HJ, Cho ST. A current perspective on geriatric lower urinary tract dysfunction. Korean J Urol 2015; 56:266-75. [PMID: 25874039 PMCID: PMC4392025 DOI: 10.4111/kju.2015.56.4.266] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 02/09/2015] [Indexed: 01/17/2023] Open
Abstract
Lower urinary tract dysfunction-such as urinary incontinence (UI), detrusor overactivity, and benign prostatic hyperplasia-is prevalent in elderly persons. These conditions can interfere with daily life and normal functioning and lead to negative effects on health-related quality of life. UI is one of the most common urologic conditions but is poorly understood elderly persons. The overall prevalence of UI increases with age in both men and women. Elderly persons often neglect UI or dismiss it as part of the normal aging process. However, UI can have significant negative effects on self-esteem and has been associated with increased rates of depression. UI also affects quality of life and activities of daily living. Although UI is more common in elderly than in younger persons, it should not be considered a normal part of aging. UI is abnormal at any age. The goal of this review is to provide an overview of the cause, classification, evaluation, and management of geriatric lower urinary tract dysfunction.
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Affiliation(s)
- Ha Bum Jung
- Department of Urology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Hyung Jee Kim
- Department of Urology, Dankook University College of Medicine, Cheonan, Korea
| | - Sung Tae Cho
- Department of Urology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
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Browne C, Salmon N, Kehoe M. Bladder dysfunction and quality of life for people with multiple sclerosis. Disabil Rehabil 2015; 37:2350-8. [PMID: 25801920 DOI: 10.3109/09638288.2015.1027007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Bladder dysfunction affects 75% of people with multiple sclerosis (MS). People with MS are reluctant to seek treatment for this distressing symptom. This is the first-known study to explore in depth how bladder dysfunction interferes with quality of life for people with MS. METHODS Nineteen individual semi-structured interviews were conducted (M = 8, F = 11). Participants had a definite diagnosis of MS, aged between 37 and 64 years and had at least one bladder dysfunction symptom. The audio-recorded interviews lasted up to 90 min and were transcribed verbatim. RESULTS Thematic analysis within NVivo10 yielded two key themes: (1) Disruptions and loss and (2) ways of knowing. "Disruptions and Loss" explores how bladder dysfunction interrupted daily living activities and how this contributed to experiencing loss. "Ways of knowing" portrays the types of knowledge that existed around bladder dysfunction. Participants described using their experiential knowledge to self-manage bladder symptoms without advice from healthcare providers. CONCLUSIONS Bladder dysfunction imposes major disruptions on daily life. People with MS attempt to self-manage their bladder symptoms, despite current barriers to navigating existing healthcare infrastructure. Understanding these barriers and the individual strategies employed by people with MS are the first steps in facilitating independent management of bladder dysfunction. Implications for Rehabilitation Each individual's experience of bladder dysfunction is unique. Healthcare professionals must be prepared to discuss all disruptions and losses associated with bladder dysfunction for people with MS. People with MS have a vast range of knowledge in relation to their own bladder symptoms and healthcare professionals need to explore their existing self-management strategies during assessment. People with MS and healthcare professionals need to be educated on the wider health implications relating to bladder dysfunction.
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Affiliation(s)
- Catherine Browne
- a Department of Clinical Therapies , University of Limerick , Limerick , Ireland and
| | - Nancy Salmon
- a Department of Clinical Therapies , University of Limerick , Limerick , Ireland and
| | - Maria Kehoe
- b Community Physiotherapy Department , Kildare/West Wicklow, Co. Kildare , Ireland
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Vrijens D, Drossaerts J, van Koeveringe G, Van Kerrebroeck P, van Os J, Leue C. Affective symptoms and the overactive bladder - a systematic review. J Psychosom Res 2015; 78:95-108. [PMID: 25499886 DOI: 10.1016/j.jpsychores.2014.11.019] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Revised: 11/17/2014] [Accepted: 11/20/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND Overactive bladder syndrome (OAB) is characterised by urgency symptoms, with or without urgency incontinence, usually with frequency and nocturia. Although literature suggest an association between OAB, depression and anxiety, no systematic review has been presented. OBJECTIVE Systematically review the literature on the association of affective conditions with OAB. METHODS Systematic review according to the PRISMA guidelines. This review is registered in the PROSPERO register (CRD4201400664). RESULTS Forty-three articles were included, describing more than 80,000 subjects. Depression and OAB were positively associated in 26 studies, anxiety and OAB in 6 studies. Longitudinal studies reported: a) OAB subjects who developed depression/anxiety or b) depressed/anxious subjects developing OAB, or c) both. The quality of evidence in studies reporting an association between the co-occurrence of OAB and depression was rated level 3 in accordance with the GRADE framework. Evidence reporting on the co-occurrence of anxiety and OAB was rated GRADE level 2. Longitudinal associations between new onset of OAB in depressive subjects was GRADE level 2. Evidence reporting association of OAB with anxiety in longitudinal studies was of GRADE level 1. CONCLUSION To our knowledge, this systematic review is the first to give a comprehensive qualitative overview on the association between OAB and affective symptoms. Many evaluated studies failed to note longitudinal changes and lacked evidence of causality. Still, results revealed an association between OAB and affective symptoms and there is evidence for new onset of OAB in depressive subjects, but further research is necessary to examine the strength of the effect.
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Affiliation(s)
- Desiree Vrijens
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands; Pelvic Care Centre Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands.
| | - Jamie Drossaerts
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands.
| | - Gommert van Koeveringe
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands; Pelvic Care Centre Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands.
| | - Philip Van Kerrebroeck
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands; Pelvic Care Centre Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands.
| | - Jim van Os
- Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University Medical Centre, Maastricht, The Netherlands; King's College London, King's Health Partners, London, Institute of Psychiatry, United Kingdom.
| | - Carsten Leue
- Pelvic Care Centre Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands; Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University Medical Centre, Maastricht, The Netherlands.
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Wheeler TL, Illston JD, Markland AD, Goode PS, Richter HE. Life Space Assessment in Older Women Undergoing Non-Surgical Treatment for Urinary Incontinence. ACTA ACUST UNITED AC 2014; 4:809-816. [PMID: 25525562 DOI: 10.4236/ojog.2014.414112] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES Urinary incontinence (UI) impacts all aspects of life activities. This study aims to characterize change in mobility within the community utilizing the Life Space Assessment (LSA) questionnaire in women undergoing non-surgical UI treatment. DESIGN Prospective cohort study, performed from July 2007 to March 2009, which followed women seeking non-surgical UI treatment and assessed their mobility and symptoms using LSA, Urogenital Distress Inventory (UDI-6), and Incontinence Impact Questionnaire (IIQ-7) at baseline and 2, 6, and 12 months post-treatment. Estimated Percent Improvement (EPI) and Patient Satisfaction Question (PSQ) were obtained post-treatment. SETTING Outpatient tertiary-care clinic. PARTICIPANTS 70 ambulatory, community-dwelling women, aged 65 years or older, seeking non-surgical care for UI. INTERVENTION Multi-component behavioral and/or pharmacologic therapies. MEASUREMENTS We hypothesized LSA would improve with treatment. Repeated measures analysis with Tukey's HSD and backwards selection linear regression model were performed. RESULTS LSA score decreased from baseline to 2 months (mean±SD; 63±29 to 56±28, p<0.001) and was sustained at 6 and 12 months (54±28, 54±28). UDI scores improved from 36±23 to 25±24, p<0.001, at 2 months, and improvement persisted at 6 and 12 months (22±22, 21±24). Improvements in UDI and patient perceived improvement in UI were not associated with LSA change. Age, race, and depression impacted LSA, which decreased 1-point for each additional year of age (p=0.004), 6-points for each point higher on the Geriatric Depression Scale (GDS) (p=0.002), and 6-points for African American race (p=0.048). CONCLUSION Decreased mobility represented by LSA was related to age, depression, and race, but not UI symptom improvement.
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Affiliation(s)
- Thomas L Wheeler
- Department of Obstetrics and Gynecology, University of South Carolina School of Medicine-Greenville, Greenville, SC
| | - Jana D Illston
- Department of Obstetrics and Gynecology, University of South Carolina School of Medicine-Greenville, Greenville, SC
| | - Alayne D Markland
- Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, AL
| | - Patricia S Goode
- Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, AL
| | - Holly E Richter
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL
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Saribacak A, Altinbaş K, Yilmaz H, Özkan A, Özkan L, Oral T. Affective Temperament Profiles of Overactive Bladder Patients. Noro Psikiyatr Ars 2014; 51:263-266. [PMID: 28360636 DOI: 10.4274/npa.y6889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Accepted: 01/05/2013] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Overactive bladder (OAB) is generally characterized by urinary urgency with or without incontinence and increased frequency of voiding and nocturia. Although animal studies have demonstrated the relationship between defective serotonergic neurotransmission and OAB, its etiology is still unclarified. Temperament profiles are hypothesized to be related with serotonergic activity and are studied in many psychosomatic disorders. Thus, we assume that OAB is related with a certain type of temperament. METHOD 29 patients, who were admitted to the urology outpatient clinic at Kocaeli University and clinically diagnosed with OAB syndrome, were recruited for the study. Temperament profiles were evaluated with the Temperament Evaluation of Memphis Pisa Paris and San Diego Autoquestionnaire (TEMPS-A). Depressive, hyperthymic, cyclothymic, anxious and irritable temperament scores in patients were compared with those in 25 healthy controls. RESULTS Patient and control groups were similar in terms of age (p=.65), sex (p=.64) and educational level (p=.90). Anxious temperament scores were higher (p=.02) and hyperthymic temperament scores were lower (p=.02) in patients with OAB compared to controls. Depressive, cyclothymic and irritable temperament scores were similar in both groups. There was no significant differences between men and women in both groups in terms of different temperament profile scores. CONCLUSION Hypothetically, there might be an association between anxious temperament and OAB syndrome reflecting serotonergic dysfunction. However, OAB syndrome must be considered from the aspect of the interdependence of psychosomatic implications in a narrow sense and psychosomatic dimensions due to the psychological predisposition in the individual case.
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Affiliation(s)
| | - Kürşat Altinbaş
- Çanakkale Onsekiz Mart University Faculty of Medicine, Department of Psychiatry, Çanakkale, Turkey
| | - Hasan Yilmaz
- Seka State Hospital, Clinic of Urology, Kocaeli, Turkey
| | - Alp Özkan
- Kocaeli University Faculty of Medicine, Department of Urology, Kocaeli, Turkey
| | - Levend Özkan
- Kocaeli University Faculty of Medicine, Department of Urology, Kocaeli, Turkey
| | - Timuçin Oral
- İstanbul Commerce University, Department of Psychology, İstanbul, Turkey
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Urinary incontinence, depression, and economic outcomes in a cohort of women between the ages of 54 and 65 years. Obstet Gynecol 2014; 123:822-7. [PMID: 24785611 DOI: 10.1097/aog.0000000000000186] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To estimate the association between urinary incontinence (UI) and probable depression, work disability, and workforce exit. METHODS The analytic sample consisted of 4,511 women enrolled in the population-based Health and Retirement Study cohort. The analysis baseline was 1996, the year that questions about UI were added to the survey instrument, and at which time study participants were 54-65 years of age. Women were followed-up with biennial interviews until 2010-2011. Outcomes of interest were onset of probable depression, work disability, and workforce exit. Urinary incontinence was specified in different ways based on questions about experience and frequency of urine loss. We fit Cox proportional hazards regression models to the data, adjusting the estimates for baseline sociodemographic and health status variables previously found to confound the association between UI and the outcomes of interest. RESULTS At baseline, 727 participants (survey-weighted prevalence, 16.6%; 95% confidence interval [CI] 15.4-18.0) reported any UI, of which 212 (survey-weighted prevalence, 29.2%; 95% CI 25.4-33.3) reported urine loss on more than 15 days in the past month; and 1,052 participants were categorized as having probable depression (survey-weighted prevalence, 21.6%; 95% CI 19.8-23.6). Urinary incontinence was associated with increased risks for probable depression (adjusted hazard ratio, 1.43; 95% CI 1.27-1.62) and work disability (adjusted hazard ratio, 1.21; 95% CI 1.01-1.45), but not workforce exit (adjusted hazard ratio, 1.06; 95% CI 0.93-1.21). CONCLUSION In a population-based cohort of women between ages 54 and 65 years, UI was associated with increased risks for probable depression and work disability. Improved diagnosis and management of UI may yield significant economic and psychosocial benefits.
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Maserejian NN, Minassian VA, Chen S, Hall SA, McKinlay JB, Tennstedt SL. Treatment status and risk factors for incidence and persistence of urinary incontinence in women. Int Urogynecol J 2014; 25:775-82. [PMID: 24477545 DOI: 10.1007/s00192-013-2288-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 11/19/2013] [Indexed: 11/24/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The objective of this analysis was to describe urinary incontinence (UI) incidence and persistence over 5 years in association with treatment status, sociodemographic, medical, and lifestyle factors, in a racially/ethnically diverse population-based female sample. METHODS The Boston Area Community Health Survey enrolled 3,201 women aged 30-79 years of black, Hispanic, and white race/ethnicity. Five-year follow-up was completed by 2,534 women (conditional response rate 83.4 %), allowing population-weighted estimates of UI incidence and persistence rates. Predictors of UI were determined using multivariate logistic regression models. RESULTS Incidence of UI at least monthly was 14.1 % and weekly 8.9 %. Waist circumference at baseline and increasing waist circumference over 5-year follow-up were the most robust predictors of UI incidence in multivariate models (P ≤ 0.01). Among 475 women with UI at baseline, persistence was associated with depression symptoms [monthly UI, odds ratio (OR) = 2.39, 95 % confidence interval (CI) 1.14-5.02] and alcohol consumption (weekly UI, OR = 3.51, 95 % CI 1.11-11.1). Among women with weekly UI at baseline, 41.7 % continued to report weekly UI at follow-up, 14.1 % reported monthly UI, and 44.2 % had complete remission. Persistence of UI was not significantly higher (58.2 % vs. 48.0 %, chi-square P = 0.3) among untreated women. Surgical or drug treatment for UI had little impact on estimates for other risk factors or for overall population rates of persistence or remission. CONCLUSIONS Women with higher gains in waist circumference over time were more likely to develop UI, but waist circumference was not predictive of UI persistence. UI treatments did not affect associations for other risk factors. Additional research on the role of alcohol intake in UI persistence is warranted.
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Affiliation(s)
- Nancy N Maserejian
- Department of Epidemiology, New England Research Institutes, 9 Galen Street, Watertown, MA, 02472, USA,
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Kafri R, Kodesh A, Shames J, Golomb J, Melzer I. Depressive symptoms and treatment of women with urgency urinary incontinence. Int Urogynecol J 2013; 24:1953-9. [PMID: 23673440 DOI: 10.1007/s00192-013-2116-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 04/18/2013] [Indexed: 12/30/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Depression is more common in patients with urinary incontinence (UI). Drug or rehabilitation therapy have been shown to be effective in reducing urgency UI (UUI) symptoms, but whether these treatments can ameliorate the negative impact of UUI on the psychological aspects of quality of life is unclear. METHODS A secondary analysis of an assessor-blinded randomized controlled trial was performed. The number of depressive symptoms was the primary outcome as measured by the Center for Epidemiologic Studies Depression scale (CES-D). RESULTS Thirty-six (22%) subjects had a CES-D score >16 at baseline, the cutoff for having depressive symptoms. A significant association was found between having a CES-D score >16 and lower quality of life related to UI at baseline. The mean CES-D score among those with depressive symptoms at baseline was significantly reduced throughout the study, with a mean of 23.7 at baseline, to 18.3 and 15.2 at the 3-month and 1-year follow-up (p < 0.001), respectively. The number of participants who had depressive symptoms decreased during the study period only in the physical therapy groups, from 31 at baseline to 28 and 25, at 3 and 12 months, respectively, while there was no such change in the drug group. CONCLUSIONS Patients with UUI who had depressive symptoms showed significant improvement in their depressive symptoms with treatment over 1 year. This improvement occurred regardless of the type of treatment. This study emphasizes the increasingly recognized problem of undiagnosed depression among middle-aged women with UUI.
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Affiliation(s)
- Rachel Kafri
- Department of Physical Therapy, Schwartz Movement Analysis & Rehabilitation Laboratory, Physical Therapy Department, Recanati School for Community Health Professions, Faculty of Health Science, Ben-Gurion University of Negev, PO Box 653, Beer-Sheva, 84105, Israel
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Yip SO, Dick MA, McPencow AM, Martin DK, Ciarleglio MM, Erekson EA. The association between urinary and fecal incontinence and social isolation in older women. Am J Obstet Gynecol 2013; 208:146.e1-7. [PMID: 23159696 DOI: 10.1016/j.ajog.2012.11.010] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2012] [Revised: 10/24/2012] [Accepted: 11/12/2012] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To describe the association between social isolation and urinary incontinence and fecal incontinence in older women. METHODS We conducted a secondary database analysis of the National Social Life, Health and Aging Project for women aged 57 to 85 years old. Our primary outcome was self-report of often feeling isolated. We explored self-report of daily urinary incontinence and weekly fecal incontinence. Two logistic regression analyses were performed to assess the association between often feeling isolated and (1) daily urinary incontinence and (2) weekly fecal incontinence. RESULTS A total of 1412 women were included in our analysis. Daily urinary incontinence was reported by 12.5% (177/1412) of community-dwelling older women. More women with daily urinary incontinence reported often feeling isolated (6.6%; 95% confidence interval [CI], 1.3-11.9 vs 2.6%; 95% CI, 1.7-3.5; P = .04) compared with women without daily urinary incontinence. Women with daily urinary incontinence had 3.0 (95% CI, 1.1-7.6) increased odds of often feeling isolated after adjusting for depressive symptoms, age, race, education, and overall health. Weekly fecal incontinence was reported by 2.9% (41/1412) of women. Weekly fecal incontinence and often feeling isolated were associated on univariable analysis (crude odds ratio, 4.6; 95% CI, 1.4-15.1). However, after adjusting for depressive symptoms, age, race, education, and overall health the association between weekly fecal incontinence and often feeling isolated was not significant (adjusted odds ratio, 0.65; 95% CI, 0.1-5.3; P = .65). CONCLUSION After adjusting for confounders, daily urinary incontinence was significantly associated with often feeling isolated. Weekly fecal incontinence was not found to be associated with often feeling isolated on multivariable logistic regression.
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Affiliation(s)
- Sallis O Yip
- Section of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, New Haven, CT, USA
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Tannenbaum C, Gray M, Hoffstetter S, Cardozo L. Comorbidities associated with bladder dysfunction. Int J Clin Pract 2013; 67:105-13. [PMID: 23305472 DOI: 10.1111/ijcp.12085] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- C Tannenbaum
- Faculties of Pharmacy and Medicine, University of Montreal, Montreal, QC, Canada
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Abstract
A panel of experts in urology, urogynecology, nursing, and behavioral therapy convened in 2010 to discuss the importance of a healthy bladder on overall health. They determined that a consensus statement was necessary to raise awareness among the general public, healthcare providers, payors, and policymakers, with the goals of minimizing the impact of poor bladder health and stimulating primary prevention of bladder conditions. In this statement, 'healthy' bladder function is described, as well as internal and external factors that influence bladder health. It is suggested that primary prevention strategies should be aimed at providing education regarding normal lower urinary tract structures and functioning to the public, including patients and healthcare providers. This education may promote the achievement of optimal bladder health by increasing healthy bladder habits and behaviors, awareness of risk factors, healthcare seeking, and clinician engagement and reducing stigma and other barriers to treatment. Promoting optimal bladder health may reduce the personal, societal and economic impact of bladder conditions, including anxiety and depression and costs associated with conditions or diseases and their treatment. While adopting healthy bladder habits and behaviors and behaviors may improve or maintain bladder health, it is important to recognize that certain symptoms may indicate the presence of conditions that require medical attention; many bladder conditions are treatable with a range of options for most bladder conditions. Lastly, the authors propose clinical directives based on persuasive and convergent research to improve and maintain bladder health. The authors hope that this statement will lead to promotion and achievement of optimal bladder health, which may improve overall health and help minimize the effects of bladder conditions on the public, healthcare professionals, educators, employers, and payors. The advisors are in consensus regarding the recommendations for improving and maintaining bladder health presented herein.
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Affiliation(s)
- E S Lukacz
- University of California, San Diego, San Diego, CA 92037, USA.
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Sexual satisfaction in the elderly female population: A special focus on women with gynecologic pathology. Maturitas 2011; 70:210-5. [PMID: 21943557 DOI: 10.1016/j.maturitas.2011.07.015] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Accepted: 07/16/2011] [Indexed: 11/23/2022]
Abstract
SEXUAL FUNCTION IN AGING WOMEN: Sexuality is an integral part of human expressions. Mental health plays a major role in sexuality. Several psychological interventions are proposed to increase the sexual quality of life in older women with diverse gynecologic pathology. A biopsychosocial approach utilizing brief strategies can be easily implemented in clinics to help women of all ages increase their sexual quality of life. THE IMPACT OF FEMALE PELVIC FLOOR DISORDERS ON SEXUAL FUNCTION IN OLDER WOMEN: Female pelvic floor disorders include urinary incontinence, pelvic organ prolapse, and fecal incontinence. These disorders increase dramatically with increasing age. Urinary incontinence has been demonstrated to have a negative impact on a woman's sexual function. Among sexually active older women with urinary incontinence, 22% report being moderately or extremely worried that sexual activity would cause urine loss. An increased prevalence of sexual distress [9% (6/76) vs. 1.3% (2/216), p=0.005] has been reported in sexually active women over 40 years old with urinary incontinence. Treatment of urinary incontinence can improve sexual function in older women. Among sexually active women (N=53) who underwent midurethral slings procedures for the correction of urinary incontinence, increased coital frequency, decrease fear of incontinence with coitus, decreased embarrassment due to incontinence was reported six months after surgery. Pelvic organ prolapse, a hernia of the vagina resulting in a visible vaginal bulge, has also been associated with a negative impact on sexual function. Women with advanced pelvic organ prolapse (POP-Q stage III or IV) have been demonstrated to have decreased body image reporting that they are more self-conscious about their appearance [adjusted odds ratio (AOR) 4.7; 95% confidence interval (CI) 2.9, 51], feel less feminine (AOR 4.0; 95% CI 1.2, 15) and less sexually attractive (AOR 4.6; 95% CI 1.4, 17) compared with women who have normal pelvic support. Both vaginal and abdominal approaches to surgical correction of pelvic organ prolapse have been demonstrated to improve sexual function. MENTAL HEALTH: Mental health plays a major role in older woman's sexuality. Sexual interest and satisfaction is tied to emotional expressivity, women's self-worth, feelings of depression and loneliness as well as cognitive function. Research has shown that both general practitioners and specialists lack training in sexual assessments. Behavioral health specialists, such as a psychologist, can play an integral role in helping to facilitate communication between the patient and the provider. A main focus of communication training is to facilitate open and genuine conversation between the provider and the patient. Providers are encouraged to ask open ended questions while patients are encouraged to discuss symptoms while coping with an internal state of anxiety. Despite the known prevalence of sexual dysfunction among older women, few studied empirically based interventions have been published with these women. This speaks to the general assumption among medical professionals that having the "sex talk" in older women with gynecological pathology is not important or relevant. A biopsychosocial approach utilizing some of the aforementioned brief strategies can be easily implemented in comprehensive gynecology clinics in order to help women of all ages increase their sexual quality of life.
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Martínez-Agulló E, Ruiz-Cerdá J, Arlandis S, Rebollo P, Pérez M, Chaves J. Análisis del síndrome de vejiga hiperactiva y de la incontinencia urinaria en mujeres laboralmente activas entre 25–64 años. Estudio EPICC. Actas Urol Esp 2010. [DOI: 10.1016/j.acuro.2010.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Impacto de la incontinencia urinaria y del síndrome de vejiga hiperactiva en la calidad de vida relacionada con la salud de pacientes de mediana edad laboralmente activos y mayores de 65 años institucionalizados. Actas Urol Esp 2010. [DOI: 10.1016/j.acuro.2009.09.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Vasudev K, Gupta AK. Incontinence and mood disorder: is there an association? BMJ Case Rep 2010; 2010:bcr07.2009.2118. [PMID: 22315640 DOI: 10.1136/bcr.07.2009.2118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
A variety of psychiatric disorders including depression have been reported in patients suffering from incontinence. It is uncertain if the association between incontinence and depression is causal or is related to a third common factor. We report the case of a 48-year-old man who presented with incontinence of urine and faeces along with a severe depressive episode. No organic cause could be identified for the incontinence. The depressive symptoms as well as the incontinence resolved with treatment with reboxetine and aripiprazole. However, the patient developed a manic episode. This case supports the hypothesis that incontinence and depression may share a common pathogenesis. The authors review the literature to investigate this linkage. The combination of aripiprazole and reboxetine should be used cautiously when treating first episode depression as it can induce a manic switch. Previous reports of manic switch with aripiprazole and reboxetine are reviewed.
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Affiliation(s)
- Kamini Vasudev
- NTW Trust, Early Intervention in Psychosis Service, 2nd Floor, Monkwearmouth Hospital, Sunderland, Sunderland SR5 1NB, UK
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Analysis of overactive bladder and urinary incontinence in working women aged between 25 and 64 years. EPICC study. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/s2173-5786(10)70150-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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