Costs of urinary incontinence and overactive bladder in the United States: a comparative study

Evaluating repetitive transcranial magnetic stimulation for neurogenic overactive bladder management in stroke survivors: A randomized sham-controlled trial protocol

BACKGROUND

Neurogenic overactive bladder (OAB) is a distressing condition in stroke. Existing neurogenic OAB management is expensive, unstandardized regimens, or invasive. Evaluating the effectiveness of repetitive transcranial magnetic stimulation (rTMS) remains crucial. We aimed to (1) compare the effectiveness of active-rTMS with sham-rTMS on neurogenic OAB symptoms, (2) analyze whether rTMS is cost-effective, and (3) explore the rTMS's experiences on participants' symptoms.

METHODS

This is a randomized, sham-controlled, double-blinded trial with embedded qualitative and cost-effectiveness studies. A total of 110 stroke survivors with neurogenic OAB symptoms were screened for eligibility; 60 participants were eligible for inclusion and were randomly assigned to either the active (n = 30) or sham-rTMS (n = 30) groups using a computer-generated randomization schedule. The active-rTMS group received low-frequency rTMS of 1200 pulses per session lasting 20 min thrice weekly to pelvic floor muscle representation at the contralesional primary motor cortex. The sham-rTMS group received low-frequency stimulation at a 20 % resting motor threshold using the same coil as the active-rTMS but was configured to reduce the TMS-induced electrical fields significantly. The primary and secondary outcome measures were assessed at baseline, post-intervention (week 4) and follow-up (week 8). The analysis of covariance (ANCOVA) analysis compared changes in the study groups. Quality-adjusted life-years (QALY) were measured to evaluate the cost-effectiveness while EQ-5D-5L estimated QALY changes. Additionally, the focus group discussion data were thematically analyzed.

CONCLUSIONS

The findings from this rTMS intervention study will be useful in alleviating neurogenic OAB symptoms and enhancing patient satisfaction in a cost-effective way.

Mobile Phone Apps for Pelvic Floor Disorders

IMPORTANCE

Up to 50% of patients report not readily seeking treatment for pelvic floor disorders (PFDs). The increase in phone applications (apps) for health care information is an opportunity to increase access to care.

OBJECTIVE

The aim of the study was to systematically evaluate content and function of apps for patients with PFDs.

STUDY DESIGN

Apps were screened using PFD-related search terms. Included apps were on the Apple store, in English, and targeted patients with PFDs. The primary outcome was app quality based on the APPLICATIONS scoring system (scored 0-16). Secondary outcomes included professional medical involvement, iTunes rating details, the presence of a voiding/bowel diary, tracking of diet, pain/symptoms, exercise, and medication, graphing or social functions, reminders, disease information, and decision support. Data was reported with descriptive statistics (medians (ranges) and n (percentages).

RESULTS

Eight hundred forty apps were identified and 83 were analyzed. The top 3 PFD categories represented were defecatory dysfunction (29), overactive bladder (28), and stress incontinence (27). The median APPLICATIONS score was 7 (3-12). Most apps (78%) were developed without professional medical involvement. Most apps were free, while the remainder ranged from $1.99 to $4.99. No app had all features. Twenty-five apps (30%) included a voiding diary, 33 (40%) had a bowel diary, 27 (33%) included exercise tracking, and 44 (53%) had reminder systems.

CONCLUSIONS

Most apps had reasonable, but not high, functionality. Current apps provide varying degrees of overall utility, with limited disease information and decision support. Further collaboration with medical providers in app development would support better integration of clinician and patient needs.

Implementation of an external female urinary catheter strategy on prevention of skin breakdown in acute care: A quality improvement study

AIM(S)

To evaluate the incidence of skin-related complications attributable to incontinence-associated dermatitis (IAD) using an external female urinary catheter device strategy for urinary incontinent (UI) patients in acute care.

DESIGN

Multicenter quality improvement study.

METHODS

Randomized allocation of two commercially available external female urinary catheter devices was used in hospitalized UI female patients. Daily nursing skin assessments were documented in the electronic health record before, during and after external catheter device application. Methods and results were reported following SQUIRE guidelines.

RESULTS

Three hundred and eighty-one patients from 57 inpatient care units were included in the analysis. Both catheter devices were associated with an overall low risk (5 %) of new or worsening skin breakdown.

CONCLUSION

The overall benefit of external catheters is most persuasive for skin integrity, rather than infection prevention.

IMPACT

Significant negative outcomes are associated with UI patients. External female urinary catheters are a non-invasive alternative strategy to reduce exposure of regional skin to urine contamination and IAD-related skin complications. Use of external female urinary catheters in hospitalized UI female patients offers low risk (5%) of new or worsening overall skin breakdown.

PATIENT CONTRIBUTION

Hospitalized UI female patients were screened for external catheter device eligibility by the bedside nurse. The quality improvement review committee waved consent because the intervention was considered standard care.

Rates of subjective and objective cure, satisfaction, and pain 10-20 years after tension-free vaginal tape (TVT) surgery: A retrospective cohort study

OBJECTIVE

To evaluate rates of subjective and objective cure, treatment satisfaction, pain, and the correlation between cure and body mass index (BMI), at 10 and 20 years after tension-free vaginal tape (TVT) surgery.

DESIGN

Retrospective cohort study.

SETTING

Multicentre study including 19 units in Norway.

POPULATION

Women undergoing TVT surgery for stress urinary incontinence (SUI) during 2001-2006 (20-year cohort) and 2011-2012 (10-year cohort).

METHODS

The Norwegian Female Incontinence Registry was used to identify women eligible for the study, who answered validated questionnaires about urinary incontinence, pain and satisfaction.

MAIN OUTCOME MEASURES

Subjective cure of SUI (with stress index of <3, range 0-12), objective cure (<3 g on stress test) and persisting pain and satisfaction after TVT (scored on a five-point Likert scale).

RESULTS

In total, 1210 of 1903 (64%) patients responded. The subjective cure rate was 68% after 10 years, versus 59% after 20 years, and did not significantly differ after adjusting for age, BMI, parity and preoperative stress index (adjusted OR 1.27, 95% CI 0.82-1.94). The objective cure rate was 100% versus 93% (P < 0.001), with 89% versus 76% reporting subjective satisfaction (P < 0.001), and with 4.7% versus 2.7% reporting persisting pain (P < 0.001), after 10 versus 20 years, respectively. Women in obesity classes I and II, compared with women of normal weight, had an increased risk of not being subjectively cured (crude OR 2.02, 95% CI 1.42-2.90; OR 2.95, 95% CI 1.60-5.46, respectively).

CONCLUSIONS

Tension-free vaginal tape (TVT) provided high rates of subjective and objective cure at 10 and 20 years after surgery, with no significant difference between the two cohorts. Although 3%-5% of women experienced persisting pain, most women were satisfied with TVT surgery. Obesity was associated with a lower cure rate.

Pelvic Floor Muscle Training Using the Perifit Device for the Treatment of Urinary Incontinence: A Pragmatic Trial Using Real-World Data

Introduction

There is a need for home-based alternatives for women to self-manage urinary incontinence (UI). Using a real-world data approach, the aim of this analysis was to evaluate whether training with the Perifit device was effective in reducing UI symptoms.

Materials and Methods

A total of 6060 women (45 ± 10 years) with UI who purchased the Perifit device, completed a validated symptoms questionnaire before training (T1) and again at one or several predefined timepoints during training: T2, after completing 40-60 games; T3, after 90-120 games; and/or T4, after 280-300 games.

Results

UI symptom score decreased progressively from 8.4 ± 4.8 points at T1; to 6.3 ± 4.7 points, 5.5 ± 4.5 points, and 4.6 ± 4.5 points at T2, T3, and T4, respectively (all p < 0.001). The percentage of respondents reporting objective improvement in UI symptoms increased from 71%, to 79%, to 85% at T2, T3, and T4, respectively. Effect size was medium (T2) to large (T3, T4). Higher symptom score at baseline was associated with higher likelihood of improvement. There was no effect of other characteristics including respondent age, menopausal status, time since childbirth, prolapse, or baseline strength on symptom improvement.

Conclusions

This analysis of responses from over 6000 real-world users suggests that home training with the Perifit may be an effective way to reduce UI symptoms in women of all ages. Given the quality of life, economic, and social burdens of living with UI symptoms, home-based pelvic floor muscle training with the Perifit may be a promising tool to allow women to self-manage UI.

Predictors of Care-Seeking Behavior for Treatment of Urinary Incontinence in Women

IMPORTANCE

Urinary incontinence (UI) is a common and treatable medical condition among women, but only approximately one third of women seek care.

OBJECTIVE

The objective of this study was to determine factors associated with care-seeking behavior in women with UI.

STUDY DESIGN

This was a cross-sectional study using patient-reported survey data collected by the National Association for Continence from November 2018 to January 2019. This survey included 60 questions and was conducted using SurveyMonkey. Descriptive statistics were used for baseline characteristics, the χ2 test was used for categorical variables, and multivariate logistic regression was used to determine predictors of care-seeking behavior.

RESULTS

Four hundred eighty-five women completed the survey, 30.7% were not care seeking, and 69.3% were care seeking for UI. Most women were 55 years or older and had UI for more than 4 years. Care-seeking women had more overactive bladder symptoms. Women who sought care were more likely to report feelings of anger, depression, hopelessness, isolation, and report greater social effects from UI than non-care-seeking women. Less than 10% of women who sought care were asked about their UI by a medical professional. In the multivariate logistic regression expenditure of $5 or more on monthly incontinence maintenance, daily UI and older age were associated with seeking care.

CONCLUSIONS

Most women in our study population sought care for UI. Factors associated with seeking care were expenditure greater than $5 per month on incontinence, daily UI, and age. This information demonstrates the need for effective implementation of screening interventions to increase treatment access.

Transurethral injection of autologous muscle precursor cells for treatment of female stress urinary incontinence: a prospective phase I clinical trial

INTRODUCTION AND HYPOTHESIS

The purpose was to investigate the safety and feasibility of transurethral injections of autologous muscle precursor cells (MPCs) into the external urinary sphincter (EUS) to treat stress urinary incontinence (SUI) in female patients.

METHODS

Prospective and randomised phase I clinical trial. Standardised 1-h pad test, International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI-SF), urodynamic study, and MRI of the pelvis were performed at baseline and 6 months after treatment. MPCs gained through open muscle biopsy were transported to a GMP facility for processing and cell expansion. The final product was injected into the EUS via a transurethral ultrasound-guided route. Primary outcomes were defined as any adverse events (AEs) during follow-up. Secondary outcomes were functional, questionnaire, and radiological results.

RESULTS

Ten female patients with SUI grades I-II were included in the study and 9 received treatment. Out of 8 AEs, 3 (37.5%) were potentially related to treatment and treated conservatively: 1 urinary tract infection healed with antibiotics treatment, 1 dysuria and 1 discomfort at biopsy site. Functional urethral length under stress was 25 mm at baseline compared with 30 mm at 6 months' follow-up (p=0.009). ICIQ-UI-SF scores improved from 7 points at baseline to 4 points at follow-up (p=0.035). MRI of the pelvis revealed no evidence of tumour or necrosis, whereas the diameter of the EUS muscle increased from 1.8 mm at baseline to 1.9 mm at follow-up (p=0.009).

CONCLUSION

Transurethral injections of autologous MPCs into the EUS for treatment of SUI in female patients can be regarded as safe and feasible. Only a minimal number of expected and easily treatable AEs were documented.

Urinary Incontinence, Quality of Life, and Risk Factors in a Geriatric Cohort

INTRODUCTION

The aim of the study was to evaluate the prevalence of urinary incontinence (UI) and its subtypes, associated clinical factors, and impact on quality of life (QoL) in a geriatric population aged 80 years or older.

METHODS

Male and female residents (inclusion criterion: 80 years or older) of three Viennese senior citizen homes were personally interviewed with the aid of a structured questionnaire based on the Bristol Female Lower Urinary Tract Symptom Questionnaire within a 12-month period. UI was defined as any involuntary loss of urine during the past 4 weeks. Several demographic parameters were obtained additionally.

RESULTS

434 participants with a mean age of 86.8 years (women: 87.6 years; men: 86.1 years) were included. UI was present in 52.5% (57% female vs. 23% male, p < 0.001), stress UI affected 36% (41% female vs. 5% male, p < 0.001), urge UI 38% (40.5% female vs. 23% male, p < 0.01), and mixed UI 28% (24% female vs. 5.0% male, p < 0.01). While the overall prevalence of UI remained rather stable in the four age cohorts (80-84 years, 85-89 years, 90-94 years, >94 years), there was a constant decline of SUI paralleled by an increase of UI and - to a lesser extent - of MUI with age. 36.5% (33% female vs. 57% male) participants did not report any negative impact on QoL, while a severe reduction of QoL was present in 31% of cases (35% female vs. 10.0% male). Risk factors for UI and its subtypes included female sex, reduced/no mobility, hysterectomy, and number of births.

CONCLUSION

This study provides data on the high prevalence of UI in a low-morbid geriatric cohort and evaluates gender-specific differences in UI prevalence, associated risk factors, and QoL.

Urinary incontinence prevalence and factors associated with patients talking with doctors about urine control

Objectives

Patient perceptions of their doctors may influence talking to them about urinary incontinence (UI). We estimated prevalence of UI among Medicare beneficiaries and assessed association between beneficiaries' demographic and clinical characteristics and whether they spoke to their doctor about UI and association between beneficiaries' perceptions of their doctor and whether they spoke to their doctor about UI.

Methods

This study was approved by the Purdue University Institutional Review Board (IRB) and determined exempt, category 4 (protocol number 1907022503, approval on August 5th, 2019). Medicare Current Beneficiary Survey (MCBS) 2016 data were analyzed. Beneficiaries who indicated that they lost urine control 2-3 times a month or above were classified as experiencing UI. An 11-item patient perception of their physician scale was created based on MCBS items. Perceptions were categorized as favorable or unfavorable. SAS version 9.4 for Unix was used for all analyses. PROC LOGISTIC was used to assess multi-variable association between beneficiaries' perceptions of their doctors and talking to their doctor about UI.

Results

Among 7466 persons meeting inclusion criteria, 1856 (24.9%) had UI. The perception of doctor scale scores ranged from 15 to 44, with mean score = 36.57 (standard deviation = 5.29). The scale Cronbach alpha reliability was 0.93. Using sensitivity and receiver operating characteristic analysis, a cutoff of 30 or higher was identified as a favorable perception. Beneficiaries with favorable perceptions of their doctor were more likely to speak to their doctor about experiencing UI than beneficiaries with unfavorable perceptions (odds ratio = 1.55, 95% confidence interval = 1.03 to 2.35, P-value = 0.038).

Conclusion

Overall, the more favorable the perception of their physicians, the more likely beneficiaries were to speak to them about their UI.

Transcutaneous tibial neurostimulation and Solifenacin in urgent incontinence of postmenopausal women

Symptoms of overactive bladder syndrome (OAB), including urinary incontinence, affect a person's quality of life and cause many personal, social and economic problems. Patients were randomly divided into three groups and received transcutaneous tibial nerve stimulation (cTTNS) with fixed parameters or with variable parameters (vTTNS) and Solifenacin drug. The main outcomes including quality of life questionnaire and OAB score and other secondary outcomes were evaluated before and after treatment for 6 weeks. ANOVA test did not show any significant difference between the three groups in quality of life score (p=0.672), OAB symptom score (p=0.159) and incontinence severity (p=0.422). The t-test demonstrated that the post treatment average quality of life score, OAB score, and incontinence severity were significantly different when compared with before treatment in all three groups (p < 0.05). All three methods were effective in treating symptoms of OAB. However, based on the clinical symptoms, cTTNS is recommended as a preferred and acceptable and safe strategy for the treatment of OAB in women over 50 years old.

High-density spinal cord stimulation selectively activates lower urinary tract nerves

Objective.Epidural spinal cord stimulation (SCS) is a potential intervention to improve limb and autonomic functions, with lumbar stimulation improving locomotion and thoracic stimulation regulating blood pressure. Here, we asked whether sacral SCS could be used to target the lower urinary tract (LUT) and used a high-density epidural electrode array to test whether individual electrodes could selectively recruit LUT nerves.Approach. We placed a high-density epidural SCS array on the dorsal surface of the sacral spinal cord and cauda equina of anesthetized cats and recorded the stimulation-evoked activity from nerve cuffs on the pelvic, pudendal and sciatic nerves.Main results. Here we show that sacral SCS evokes responses in nerves innervating the bladder and urethra and that these nerves can be activated selectively. Sacral SCS always recruited the pelvic and pudendal nerves and selectively recruited both of these nerves in all but one animal. Individual branches of the pudendal nerve were always recruited as well. Electrodes that selectively recruited specific peripheral nerves were spatially clustered on the arrays, suggesting anatomically organized sensory pathways.Significance.This selective recruitment demonstrates a mechanism to directly modulate bladder and urethral function through known reflex pathways, which could be used to restore bladder and urethral function after injury or disease.

Association between body mass index, trunk and total body fat percentage with urinary incontinence in adult US population

INTRODUCTION AND HYPOTHESIS

To assess the association of body mass index (BMI), trunk and total body fat percentage with the prevalence and severity of urinary incontinence (UI) stratified by gender among a US adult population.

METHODS

A representative cross-sectional survey of participants aged ≥ 20 years was conducted using the data from the 2011-2018 National Health and Nutrition Examination Survey. Multivariate logistic and linear regression models were used to explore the association among the three obesity measures above with the prevalence and severity of UI.

RESULTS

A total of 6964 individuals (4168 males and 2796 females) enrolled for the final analysis. Among males, the weighted prevalence of UI was 7.8%, with 1.3% stress urinary incontinence, 5.8% urge urinary incontinence and 0.7% mixed urinary incontinence. For females, the weighted prevalence of UI was 54.2%, with 31.9% stress urinary incontinence, 7.0% urge urinary incontinence and 15.6% mixed urinary incontinence. Multivariate logistic regression revealed increased BMI and trunk fat percentage significantly increased odds of UI (BMI: OR = 1.05 [per 1 kg/m²], 95% CI: 1.03-1.07, P < 0.001; trunk fat percentage: OR = 1.15 [per 5% increase in trunk fat percentage], 95% CI: 1.06-1.25, P = 0.002) in females. Similar trends were observed in the severity of UI (BMI: β = 0.07, 95% CI: 0.05-0.09, P < 0.001; trunk fat percentage: β = 0.18, 95% CI: 0.10-0.26, P < 0.001) by a multivariate linear regression. In males, no significant association was observed (BMI: OR = 0.99 [per 1 kg/m²], 95% CI: 0.97-1.02, P = 0.663; trunk fat percentage: OR = 0.95 [per 5% increase in trunk fat percentage], 95% CI: 0.84-1.08, P = 0.430; total fat percentage: OR = 0.94 [per 5% increase in total fat percentage], 95% CI: 0.80-1.10, P = 0.424).

CONCLUSIONS

An increased BMI and trunk fat percentage are significantly associated with higher prevalence and severity of UI in females.

Noncancerous Genitourinary Conditions as a Public Health Priority: Conceptualizing the Hidden Burden

OBJECTIVE

To provide a conceptual framework to guide investigations into burdens of noncancerous genitourinary conditions (NCGUCs), which are extensive and poorly understood.

METHODS

The National Institute of Diabetes and Digestive and Kidney Diseases convened a workshop of diverse, interdisciplinary researchers and health professionals to identify known and hidden burdens of NCGUCs that must be measured to estimate the comprehensive burden. Following the meeting, a subgroup of attendees (authors of this article) continued to meet to conceptualize burden.

RESULTS

The Hidden Burden of Noncancerous Genitourinary Conditions Framework includes impacts across multiple levels of well-being and social ecology, including individual (ie, biologic factors, lived experience, behaviors), interpersonal (eg, romantic partners, family members), organizational/institutional (eg, schools, workplaces), community (eg, public restroom infrastructure), societal (eg, health care and insurance systems, national workforce/economic output), and ecosystem (eg, landfill waste) effects. The framework acknowledges that NCGUCs can be a manifestation of underlying biological dysfunction, while also leading to biological impacts (generation and exacerbation of health conditions, treatment side effects).

CONCLUSION

NCGUCs confer a large, poorly understood burden to individuals and society. An evidence-base to describe the comprehensive burden is needed. Measurement of NCGUC burdens should incorporate multiple levels of well-being and social ecology, a life course perspective, and potential interactions between NCGUCs and genetics, sex, race, and gender. This approach would elucidate accumulated impacts and potential health inequities in experienced burdens. Uncovering the hidden burden of NCGUCs may draw attention and resources (eg, new research and improved treatments) to this important domain of health.

Managing incontinence in low-and middle income-countries: A qualitative case study from Pakistan

Background

Incontinence is a complex health and social issue, which involves the involuntary loss of urine or faeces or both. Individuals with disabilities are particularly vulnerable to incontinence. The management of incontinence has largely been overlooked in low and middle-income settings (LMICs). This study aimed to explore the incontinence management strategies employed by disabled people with severe incontinence and their caregivers in Sindh Province, Pakistan.

Methods

Incontinence management was explored through in-depth interviews with people with incontinence (PWI) and their caregivers, photovoice, and a market survey and product attribute assessment. Data was analysed thematically through inductive coding and evaluated against existing disability and caregiver frameworks.

Results

Incontinence management affected all aspects of daily life for PWI and caregivers. Effective management of incontinence was prioritised because caregivers viewed it to be part of their familial duty and a requirement for the household to remain pure in the eyes of God. Coping strategies included strict adherence to routines, reducing food and drink intake, creative uses of locally available natural resources, and a heavy reliance on soap and water for maintaining hygiene. Products such as adult diapers were largely unavailable, costly and were not deemed suitable for regular use. There were no social or medical interventions in the region to support incontinence management. The main impacts of incontinence on the household were social isolation, stigma, role shifts within the family, the development of physical ailments among caregivers, and decreased income.

Conclusion

The complex health, psychological, social, economic, and cultural impacts of incontinence are exacerbated in LMICs due a lack of recognition of the condition, the absence of social or medical interventions and limited access to basic WASH infrastructure, and assistive devices or products. Appropriate solutions need to be developed in partnership with PWI and caregivers and need to be contextualised, affordable and sustainable.

Group-based pelvic floor muscle training is a more cost-effective approach to treat urinary incontinence in older women: economic analysis of a randomised trial

QUESTION(S)

How cost-effective is group-based pelvic floor muscle training (PFMT) for treating urinary incontinence in older women?

DESIGN

Economic evaluation conducted alongside an assessor-blinded, multicentre randomised non-inferiority trial with 1-year follow-up.

PARTICIPANTS

A total of 362 women aged ≥ 60 years with stress or mixed urinary incontinence.

INTERVENTION

Twelve weekly 1-hour PFMT sessions delivered individually (one physiotherapist per woman) or in groups (one physiotherapist per eight women).

OUTCOME MEASURES

Urinary incontinence-related costs per woman were estimated from a participant and provider perspective over 1 year in Canadian dollars, 2019. Effectiveness was based on reduction in leakage episodes and quality-adjusted life years. Incremental cost-effectiveness ratios and net monetary benefit were calculated for each of the effectiveness outcomes and perspectives.

RESULTS

Both group-based and individual PFMT were effective in reducing leakage and promoting gains in quality-adjusted life years. Furthermore, group-based PFMT was ≥ 60% less costly than individual treatment, regardless of the perspective studied: -$914 (95% CI -970 to -863) from the participant's perspective and -$509 (95% CI -523 to -496) from the provider's perspective. Differences in effects between study arms were minor and negligible. Adherence to treatment was high, with low loss to follow-up and no between-group differences.

CONCLUSION

Compared with standard individual PFMT, group-based PFMT was less costly and as clinically effective and widely accepted. These results indicate that patients and healthcare decision-makers should consider group-based PFMT to be a cost-effective first-line treatment option for urinary incontinence.

TRIAL REGISTRATION

ClinicalTrials.govNCT02039830.

A prospective survey study of lower urinary tract dysfunction in childhood cancer survivors after vincristine and/or doxorubicin chemotherapy

BACKGROUND

Two chemotherapeutic agents used widely in pediatric oncology are vincristine (VCR) and doxorubicin (DOX), which may cause neuropathy and myopathy, respectively. The study hypothesis is that neurotoxic effects of VCR and/or myotoxic effects of DOX affect bladder physiology and manifest clinically as lower urinary tract dysfunction (LUTD).

PROCEDURE

Based on a priori power analysis, 161 children divided evenly by gender were recruited. Children aged 5-10 years completed the dysfunctional voiding scoring system (DVSS) survey. The study cohort comprised cancer survivors treated with VCR and/or DOX. Healthy controls were recruited from well-child clinic visits. Exclusion criteria included pelvic-based malignancy, pelvic irradiation, pre-existing LUTD, neurologic abnormalities, and treatment with cyclophosphamide/ifosfamide. DVSS scores and presence of LUTD, defined as DVSS scores above gender-specific thresholds (males ≥9, females ≥6), were compared across cohorts.

RESULTS

Median DVSS scores were higher in the study cohort (6 vs. 4, p = .003). Moreover, children in the study cohort were more likely to exceed threshold scores for LUTD (38.8% vs. 21%, p = .014; OR 1.8). Subanalysis by gender revealed female cancer survivors are more likely to report LUTD than controls (57.5% vs. 30%, p = .013, OR 1.9). This did not hold true for males (20% vs. 12.2%, p = .339).

CONCLUSIONS

Childhood cancer survivors who received VCR and/or DOX reported higher rates of LUTD than controls. Female cancer survivors appear more likely to suffer from LUTD than males. Further study with a positive control cohort of cancer survivors who received non-VCR, non-DOX chemotherapy is underway to elucidate the contribution of a cancer diagnosis to LUTD.

Incidence and risk factors of female urinary incontinence: a 4-year longitudinal study among 24 985 adult women in China

OBJECTIVE

To estimate the incidence of urinary incontinence (UI), including its subtypes stress UI (SUI), urgency UI (UUI) and mixed UI (MUI), and to examine risk factors for de novo SUI and UUI in Chinese women.

DESIGN

Nationwide longitudinal study.

SETTING

Six geographic regions of China.

PARTICIPANTS

Women aged ≥20 years old were included using a multistage, stratified, cluster sampling method.

METHODS

This study was conducted between May 2014 and March 2016, with follow up in 2018. Data on demographics, medical history, lifestyle and physiological and anthropometric information were collected.

MAIN OUTCOME MEASUREMENTS

Incidence, rate ratio (RR).

RESULTS

Analyses included 24 985 women (mean age 41.9 years).The follow-up response rate was 55.5%, median follow-up time was 3.7 years. The standardised incidences of UI, SUI, UUI and MUI were 21.2, 13.1, 3.0 and 5.1 per 1000 person-years, respectively. Risk factors for de novo SUI included delivery pattern (vaginal spontaneous delivery RR 2.12, 95% CI 1.62-2.78 and instrumental delivery RR 3.30, 95% CI 1.99-5.45), high body mass index (BMI) (overweight RR 1.52, 95% CI 1.33-1.74 and obesity RR 1.67, 95% CI 1.32-2.11), cigarette smoking (RR 1.54, 95% CI 1.12-2.12), chronic cough (RR 1.44, 95% CI 1.17-1.76), diabetes (RR 1.33, 95% CI 1.10-1.60) and older age (50-59 years RR 1.49, 95% CI 1.16-1.90 and 60-69 years RR 1.61, 95% CI 1.22-2.13).The risk factors significantly associated with de novo UUI were age (RR increased from 1.21, 95% CI 0.74-1.99, at 30-39 years to 6.3, 95% CI 3.85-10.30, at >70 years) and diabetes (RR 1.48, 95% CI 1.05-2.09).

CONCLUSIONS

The incidence of female UI is 21.2 per 1000 person-years in China. Delivery (vaginal spontaneous delivery, instrumental delivery), high BMI, cigarette smoking, chronic cough, diabetes and older age were risk factors.

TWEETABLE ABSTRACT

The incidence of female urinary incontinence was 21.2 per 1000 person-years in China. Delivery, BMI, diabetes and old age are risk factors.

Youtube videos as an information source about urinary incontinence

AIM

Youtube is one of the most popular video-sharing websites, and people use Youtube as a source of information. Patients with urinary incontinence may seek information about their condition on Youtube. This study aims to assess the videos on Youtube about urinary incontinence and evaluate the information regarding whether patients can understand and/or act accordingly.

METHODS

We performed a Youtube search with the keywords of "incontinence," "urinary incontinence," and "overactive bladder" in the English language with the incognito mode on the browser. All links were extracted and recorded in an excel file. Duplicated links were removed, and metadata of the videos were collected. A custom python language script was used to perform this operation. We selected the most viewed 150 videos for the assessment. After removing the non-related videos, 112 of them were included in the study. Two researchers separately evaluated all the videos with the Patients Education Material Assessment Tool (PEMAT, audiovisual version).

RESULTS

The total duration of all included (n:112) videos was 12.6 hours, and these videos had been watched 37,332,178 times until the query date. The vast majority of the videos were about information, management, and treatment options (Kegel exercises, surgery modalities) of incontinence, individual experiences of patients with incontinence, commercials about the diapers, and healthcare professionals who wanted to introduce themselves or their services. Mean understandability and actionability scores of the videos were 57.9% and, 44.7% respectively. Our analysis showed that only 12.5% of the videos on Youtube related to incontinence were understandable, as well as actionable, in terms of PEMAT scores.

CONCLUSION

According to our study, 87.5% of the videos about incontinence on Youtube.com in the English language were not understandable and actionable for users. Development of high-quality content about incontinence is needed.

[Mirror survey of patients with urge urinary incontinence and healthcare professionals]

BACKGROUND

This survey assessed how much of a taboo surrounds urge or mixed urinary incontinence (UI), through questions to affected patients and healthcare professionals using online questionnaires, with the objective to contrast the patients' perceptions with that of the doctors.

METHODS

This quantitative study was preceded by a qualitative phase carried out with general practitioners, specialists, and UI patients. Following these phases, questionnaires were made available on the internet. They covered questions pertaining to perceptions of UI, degree of embarrassment and its consequences, patient-doctor relationship, and treatments.

RESULTS

Overall, 310 UI patients of male or female gender participated in the study, as did 101 general practitioners, 50 urologists, and 30 gynecologists. The analysis revealed that 60% of patients felt embarrassment about UI, the condition representing for them a taboo topic similar to cancer. This taboo was shown to be seen further enhanced by doctors. UI was associated with a loss of self-esteem (51%) and restriction to daily life (44%). The patients' answers revealed that UI was only brought up by doctors in 6% of cases, whereas the patient was the first to bring it up in 55%, primarily with their general practitioner (80%). Thus, in 4 out of 10 cases, the issue was not addressed; 49% of patients stated they did not discuss their condition with their partner and 33% did not discuss it with anybody.

CONCLUSION

UI is still a major taboo and we have a long way to go to change attitudes.

LEVEL OF EVIDENCE

3.

Treatment of Stress Urinary Incontinence with Muscle Stem Cells and Stem Cell Components: Chances, Challenges and Future Prospects

Urinary incontinence (UI) is a major problem in health care and more than 400 million people worldwide suffer from involuntary loss of urine. With an increase in the aging population, UI is likely to become even more prominent over the next decades and the economic burden is substantial. Among the different subtypes of UI, stress urinary incontinence (SUI) is the most prevalent and focus of this review. The main underlying causes for SUI are pregnancy and childbirth, accidents with direct trauma to the pelvis or medical treatments that affect the pelvic floor, such as surgery or irradiation. Conservative approaches for the treatment of SUI are pelvic physiotherapy, behavioral and lifestyle changes, and the use of pessaries. Current surgical treatment options include slings, colposuspensions, bulking agents and artificial urinary sphincters. These treatments have limitations with effectiveness and bear the risk of long-term side effects. Furthermore, surgical options do not treat the underlying pathophysiological causes of SUI. Thus, there is an urgent need for alternative treatments, which are effective, minimally invasive and have only a limited risk for adverse effects. Regenerative medicine is an emerging field, focusing on the repair, replacement or regeneration of human tissues and organs using precursor cells and their components. This article critically reviews recent advances in the therapeutic strategies for the management of SUI and outlines future possibilities and challenges.

Higher Resource Utilization and Costs in Long-Term Nursing Home Residents With Overactive Bladder: A Retrospective Study of Medicare Beneficiaries

OBJECTIVES

To determine the all-cause health care resource utilization and costs among long-term nursing home (LTNH) residents with and without overactive bladder (OAB).

DESIGN

Retrospective cohort study.

SETTING AND PARTICIPANTS

Minimum Data Set (MDS)-linked Medicare Part A, B, and D claims data from 2013 to 2015 were analyzed. LTNH residents aged 65 years or older with a diagnosis of OAB (n = 216,731) were propensity score matched with LTNH residents without OAB (n = 300,327) (non-OAB cohort).

METHODS

We measured health care resource utilization and costs associated with OAB by setting (inpatient, outpatient, emergency department, or prescription) during the 6 months following nursing home admission. Descriptive and multivariate (negative binomial for health care resource utilization and 2-part model for costs) analyses were performed to examine the health care resource utilization and costs among LTNH residents with and without OAB. The annual cost attributed to OAB was calculated as the difference between total annual OAB costs and total annual non-OAB costs.

RESULTS

A total of 214,505 patients were included in each matched cohort. Across all health care resource categories, LTNH residents with OAB had higher health care resource utilization and costs compared to the non-OAB cohort (all P < .001). The mean annual direct total cost was $57,984 in the OAB cohort compared with $54,285 in the non-OAB cohort. The annual cost of OAB in nursing homes was estimated at $793 million. Adjusted analyses revealed that the OAB cohort was 9% more likely to have hospitalization and emergency department visits, 15% more likely to have outpatient visits, 27% more likely to have physician visits, and 12% more likely to have prescription counts compared with the non-OAB cohort.

CONCLUSIONS AND IMPLICATIONS

The study findings suggest that LTNH residents with OAB have significantly more health care resource utilization compared with patients without OAB. These results provide health care decision makers with recent estimates of the burden of OAB in LTNH to assist them with resource planning.

Efficacy and safety of dose escalation in male patients with overactive bladder showing poor efficacy after low-dose antimuscarinic treatment: A retrospective multicenter study

Purpose

To analyze the efficacy and safety of standard-dose antimuscarinic treatment on male patients with overactive bladder (OAB) symptoms showing poor efficacy after low-dose antimuscarinics.

Materials and Methods

We retrospectively reviewed the data of 566 male patients aged ≥40 with OAB symptoms between January 2017 and June 2018. They were treated with low-dose antimuscarinics for at least 4 weeks and showed poor efficacy; therefore, they were switched to standard dose antimuscarinic treatment (5 mg of solifenacin) for ≥12 weeks. The international prostate symptom score (IPSS) and overactive bladder symptom score (OABSS) at baseline (V0), 4 weeks (V1), and 12 weeks (V2) were analyzed. Post void residual urine volume (PVR) was also recorded.

Results

The median age, body mass index, and prostate-specific antigen levels were 69.0 years, 24.2 kg/m², and 1.24 ng/dL, respectively. The mean value of the total IPSS and OABSS significantly decreased between V0 and V2 (from 16.73 to 13.69 and 7.33 to 5.34, respectively, all p<0.001). All component scores from each questionnaire demonstrated a significant decrease except for numbers three and six on the IPSS questionnaire. PVR was increased from V0 to V2 (36.40 to 68.90 mL, p=0.015). Four and nine patients experienced constipation and thirst, respectively, and all adverse effects were graded as ≤2.

Conclusions

Standard dose antimuscarinic treatment using solifenacin (5 mg) may be a safe and effective treatment for patients with OAB symptoms refractory to low-dose antimuscarinic treatment.

Urinary Incontinence: Evaluation and Management

Urinary incontinence is a major public health issue in the United States with physical, mental, social, and economic repercussions. History and in-office evaluation are paramount to diagnosis and formation of an appropriate treatment plan. Lifestyle modifications, which include pelvic floor muscle training and behavioral changes, are appropriate for initial management. Patients with overactive bladder syndrome whose symptoms are not adequately controlled with conservative treatment can be offered medical or procedural management. Stress urinary incontinence refractory to first-line treatment can be treated with surgical options such as mesh midurethral slings.

Costo-efectividad de las cintas de uretra media comparada con el tratamiento convencional de la incontinencia urinaria femenina de esfuerzo en Colombia

Objetivo Estimar la costo-efectividad de las cintas de uretra media comparada con la colposuspensión retropúbica y el cabestrillo pubovaginal en pacientes con incontinencia urinaria femenina de esfuerzo en Colombia.

Métodos Se construyó un árbol de decisión donde se comparó las cintas de uretra media con la colposuspensión retropúbica y el cabestrillo pubovaginal en el tratamiento quirúrgico de la incontinencia urinaria femenina de esfuerzo. La perspectiva fue la del tercer pagador incluyendo todos los costos directos. Todas las cifras monetarias se expresaron en pesos colombianos de 2019. La unidad de resultado fue la mejoría clínica definida como paciente continente o seca. Los datos de efectividad y seguridad se extrajeron de la literatura. Se calculó la razón de costo-efectividad incremental. Se realizaron análisis de sensibilidad univariados y probabilísticos para los costos, efectos y supuestos del modelo.

Resultados Los resultados del modelo indican que el costo por un caso adicional de mejoría clínica del cabestrillo comparado con la colposuspensión fue de $ 14 452 753 (4314 USD). El costo por un caso adicional de mejoría clínica de las cintas comparadas con el cabestrillo fue de $ 8 098 875 (2417 USD).

Conclusión Desde el punto de vista económico, bajo los supuestos del modelo y desde el punto de vista del tercer pagador, las cintas de uretra media para el tratamiento de mujeres con incontinencia urinaria de esfuerzo, son costo-efectivas para Colombia. Los resultados fueron sensibles a los costos de los procedimientos quirúrgicos y a la efectividad de los mismos.

Antimuscarinic Discontinuation in Patients with Overactive Bladder in Nursing Homes: A Retrospective Study of Medicare Beneficiaries

Introduction

Although antimuscarinics form the first-line therapy in overactive bladder (OAB), little is known regarding antimuscarinic discontinuation among OAB patients in nursing homes. This study examined treatment patterns and predictors of antimuscarinic discontinuation among long-term nursing home (LTNH) residents with OAB.

Methods

The study cohort included LTNH residents (defined as residents staying ≥ 101 consecutive days) from the Minimum Data Set linked 2013–2015 Medicare claims data. Patients with OAB were defined by OAB-related claims and medication codes. Treatment patterns and discontinuation (medication gap ≥ 30 days) were characterized by examining OAB-specific antimuscarinics prescribed during LTNH stays. The Andersen Behavioral Model was used to identify predisposing, enabling and need factors that predict discontinuation. Kaplan-Meier curves and multivariable Cox proportional hazards regression model were used to assess the unadjusted and adjusted times to discontinuation, respectively, among different antimuscarinics.

Results

The mean age of the study cohort (n = 11,012) was 81.6 years (± 8.5), 74.6% were female, and 89.8% were non-Hispanic White. The mean duration of nursing home stay was 530.1 (± 268.4) days. The most commonly prescribed OAB-specific antimuscarinic was oxybutynin (69.8%). Overall, 66.5% of the study cohort discontinued the index antimuscarinic. Multivariable Cox PH regression analysis revealed that compared to LTNH residents who initiated treatment with oxybutynin, treatment discontinuation was lower with solifenacin or fesoterodin and discontinuation was more frequent when treatment was initiated with tolterodine, darifenacin or trospium compared with oxybutynin. In addition, several need factors (comorbidities, medication use and anticholinergic burden, etc.) were associated with antimuscarinic discontinuation.

Conclusion

About  two-thirds of LTNH residents with OAB discontinued their index antimuscarinic during their nursing home stay. There was significant variation in discontinuation based on the index antimuscarinic agent with lowest risk of discontiuation with solifenacin and fesoterodin. Concerted efforts to optimize antimuscarinic use are needed to improve the management of OAB in nursing homes.

Electronic Supplementary Material

The online version of this article (10.1007/s12325-020-01412-z) contains supplementary material, which is available to authorized users.

Feasibility of Tele-Prompt: A tablet-based prompted voiding intervention to support informal caregivers of older adults with urinary incontinence

Urinary incontinence (UI) is a highly prevalent condition, burdening older adults and their informal caregivers. This study explored the development and feasibility of a 6-week evidence-based, educational/skill building program delivered via tablet-personal computer aimed at developing informal caregiver UI knowledge; and enhancing informal caregiver skill set in prompted voiding and toileting strategies. Caregivers also received individualized weekly coaching sessions from a nurse expert. Feasibility and preliminary efficacy were tested in three caregiver/care-recipient dyads. Recruitment of eligible participants through community-based resources was a challenge to feasibility. Most caregivers found the technology acceptable, but adherence to prompted voiding was inconsistent. All caregivers rated the intervention highly, reported improvements in their care-recipient's urine leakage, found access to a UI expert beneficial, and would recommend it to a friend. The results suggest that the tablet-facilitated intervention was feasible and acceptable to informal caregivers and showed promise for improving both caregiver and care recipient outcomes.

The association of depression with lower urinary tract symptoms: data from the National Health and Nutrition Examination Survey, 2005-2008

BACKGROUND

To identify the factors associated with lower urinary tract symptoms (LUTS), we investigated associations between psychological factors, including depression and sleep disorders, and LUTS using the National Health and Nutrition Examination Survey (NHANES) database.

MATERIALS AND METHODS

The NHANES database was examined for the period of 2005 to 2008. Men older than 40 years, who had completed questionnaires surveying their kidney/urologic, prostate, mental health, and sleep conditions were included in this study. LUTS was defined as the presence of two or more of the following symptoms: incomplete emptying, urinary hesitancy, urinary frequency, and nocturia. Multivariable models using logistic regression were used to compare groups of men with or without LUTS.

RESULTS

Of 1,820 participants, 110 (6.1%) men reported depression, and 235 (12.9%) presented with LUTS. Men with LUTS were older and had a significantly higher prevalence of depression and unemployment. Sleep disorder was not associated with LUTS. Multivariable logistic regression models demonstrated that men reporting moderate depression had the highest age-adjusted odds (odds ratio = 5.89, 95% CI [3.44-10.11]; p < 0.001) of reporting clinical LUTS.

CONCLUSIONS

A significant association was observed between LUTS and depression, and between LUTS and employment status. Although the pathophysiology of these relationships is unclear, physicians should consider multi-disciplinary evaluation and treatment approaches for LUTS.

Medical evaluation and management of male and female voiding dysfunction: a review

A significant workforce shortage of urologists available to serve the US population has been projected to occur over the next decade. Accordingly, much of the management of urologic patients will need to be assumed by other specialties and practitioners. Since primary care physicians are often first evaluate common urologic complaints, it makes sense that these physicians are in an excellent position to intervene in the management of these patients when appropriate. One of the most common complaints in urology is voiding dysfunction. The incidence of voiding dysfunction increases with age, with conservative estimates showing that over 50% of elderly patients suffer. Despite this high prevalence and its negative impact on quality of life, however, few seek or receive treatment, as many do not readily disclose these impactful yet personal symptoms. We sought to summarize the typical presentation, evaluation, assessment and therapeutic options for both male and female patients presenting with voiding dysfunction.

Prevalence and Risk Factors of Stress Urinary Incontinence Among Perimenopausal Women and Its Influence on Daily Life in Women with Sexual Desire Problem

The prevalence of, and related factors to, stress urinary incontinence (SUI) among perimenopausal Chinese women and its impact on daily life among those women with sexual desire problem in Hubei province were investigated. In this study, 1519 perimenopausal women aged 40 to 65 years were selected from three urban communities in the Wuhan area, and two impoverished, mountainous communities in Hubei province, and followed from April to October 2014. Detailed information about demographic characteristics, menstruation, pregnancy, sexual life and chronic diseases was collected. A cross-sectional survey was carried out following information collection by Chi-square test and multiple logistic regression analysis. Univariate and multivariate logistic regression analysis demonstrated that the potential factors associated with developing SUI were old age (OR=3.4, 95% CI: 1.92-6.04), vaginal delivery (OR=0.623, 95% CI: 0.45-0.87), low income (OR=0.063, 95% CI: 0.40-0.92), atrophic vaginitis (OR=1.4, 95% CI: 1.03-1.80), pelvic organ prolapse (OR=2.81, 95% CI: 1.36-5.80), chronic pelvic pain (OR=2.17, 95% CI: 1.90-4.03), constipation (OR=1.44, 95% CI: 1.07-1.93) and incontinence of feces (OR=3.32, 95% CI: 2.03-5.43). Moreover, the ratio of SUI (33.2%) was higher than the ratio of urgency urinary incontinence (24.1%) or the ratio of mixed urinary incontinence (17.4%), and SUI had a greater impact on daily life among women with decreased sexual desire. In conclusion, SUI is a common disorder affecting over one third of the women surveyed, and has a severe impact on the daily life of perimenopausal women with declined sexual desire. Age, mode of delivery, and monthly income are major risk factors involved in the development of SUI.

Midurethral slings for treatment of stress urinary incontinence review

PURPOSE

The midurethral sling (MUS) has largely been regarded as the "gold standard" in treatment of stress urinary incontinence (SUI). Recently the safety and use of the MUS has come under scrutiny following concerns about the use of mesh implants. The aim of this review was to detail the background to SUI which has led to the development of MUS, to highlight the issues surrounding the use of mesh under the current climate of mesh controversies and to provide an update on current evidence on the use of MUS.

MATERIALS AND METHODS

We conducted a review of the literature looking at the efficacy and safety of MUS.

RESULTS

MUS has good rates of subjective cure in the short and into the longer term. The overall rates of complications are low including those associated with the use of mesh implants. When compared to other continence procedures, MUS is equally effective in regard to cure but has lower rates of complications and more favorable operative outcomes. The use of mesh has been supported by major Urogynaecological Societies along with the reports from government driven enquiries into the use of mesh.

CONCLUSIONS

Overall, MUS have been shown to be an effective and safe surgical treatment for management of stress urinary incontinence.

Pessários vaginais na incontinência urinária: revisão integrativa

Objetivo: Analisar os tipos de pessários, as indicações e o impacto no tratamento da incontinência urinária (IU). Métodos: Trata-se de revisão integrativa com publicações de 2007 a 2017 indexadas nas bases de dados Biblioteca Virtual em Saúde, Medical Literature Analysis and Retrieval System Online, Scopus Info Site, Cumulative Index to Nursing and Allied Health Literature e Web of Science. Resultados: Selecionaram-se oito artigos. Os pessários indicados foram prato, anel, Uresta® e Contiform®. A redução ou resolução da IU de esforço (IUE) em mulheres foi observada por análise de parâmetros objetivos, como avaliação urodinâmica e questionários de qualidade de vida. Destacou-se viabilidade econômica. Evidenciaram-se desajuste, dificuldades no uso, incômodo e manutenção de perdas urinárias entre os motivos de não adesão. Prolapso avançado e comprimento vaginal curto foram preditivos de insucesso. Identificaram-se eventos adversos em baixa incidência: retenção urinária e leucorreia. Conclusão: A terapia pessária é eficaz no tratamento da IUE quando acompanhada por profissionais capacitados. Características individuais e percepções sobre o dispositivo são determinantes no sucesso terapêutico. Estudos de maior amostragem, tempo de seguimento e qualidade, bem como estimulo a publicações nacionais, são necessários para investigação de medidas objetivas de IU, fatores clínicos e demográficos em relação ao sucesso do pessário.

Vaginal pessaries in urinary incontinence: integrative review

Objectives: To analyze the types of pessaries, indications and impact in the treatment of urinary incontinence (UI). Methods: This is an integrative review with publications from 2007 to 2017 indexed in the Biblioteca Virtual em Saúde, Medical Literature Analysis and Retrieval System Online databases, Scopus Info Site, Cumulative Index to Nursing and Allied Health Literature and Web of Science. Results: Eight articles were selected. The pessaries indicated were the dish, ring, Uresta®, and Contiform®. The reduction or resolution of stress UI in women was observed by analysis of objective parameters such as urodynamic evaluation and quality of life questionnaires. Economic viability was highlighted. Disability, difficulties in use, discomfort, and maintenance of urinary losses were evidenced among the reasons for non-adherence. Advanced prolapse and short vaginal length were predictive of failure. Adverse events were identified in low incidence: urinary retention and leukorrhea. Conclusion: Pessary therapy is effective in the treatment of SUI when accompanied by trained professionals. Individual characteristics and perceptions about the device are determinants of therapeutic success. Studies of greater sampling, follow-up time and quality, as well as stimulation to national publications, are necessary for the investigation of objective measures of UI, clinical and demographic factors in relation to the success of the pessary.

Psychometric Evaluation of the Toileting Behaviors: Women's Elimination Behaviors Scale in a Sample of College Women

BACKGROUND

Lower urinary tract symptoms in women including urinary incontinence and overactive bladder are common women's health conditions with negative financial, health, and quality of life consequences. Certain behaviors are associated with symptom presentation. Identifying and modifying these behaviors could decrease symptom presentation and progression. The Toileting Behaviors: Women's Elimination Behaviors (TB-WEB) scale is the only known theory-based tool to date designed to assess urinary toileting behaviors in women. It has been validated in middle-aged women, but it has not been validated in a younger population.

OBJECTIVES

The purpose of this study was to assess the psychometric properties of the TB-WEB in a sample of college-aged women.

METHODS

Surveys were sent to senior-level undergraduates electronically via university email addresses. One hundred ninety-three women responded to the survey. Those who had missing responses on the TB-WEB were excluded from psychometric analyses. Demographic characteristics from those with missing data were not statistically different from those with complete responses.

RESULTS

The total Cronbach α for the 18-item TB-WEB was 0.846, and the 5 previously identified subscales ranged between 0.528 and 0.919. A 5-factor structure was identified, similar to previous testing of the TB-WEB. Higher scores were significantly correlated with frequency of urinary incontinence episodes (rs= 0.311; P < 0.001).

CONCLUSIONS

The validated TB-WEB can be used reliably in a younger sample of women (mean age, 22 years) enrolled in college. It may be useful to identify problematic toileting behaviors and women at risk for having or developing lower urinary tract symptoms.

Long-term (>5 years) outcomes of patients implanted with artificial urinary sphincter: A single-center experience

Introduction

This study is conducted to evaluate the long-term outcomes, including effectiveness and complications, of artificial urinary sphincter (AUS) implantation in men with primarily stress urinary incontinence.

Materials and Methods

Consecutive patients with complete data sets and a continuous follow-up with the device in place for 5 years or more were included. We analyzed effectiveness through pads per day use, and complications were assessed based on device revisions and explantations. Various risk factors for revisions were evaluated and revision free-survival at 15 years was estimated.

Results

Thirty-four male patients were implanted and followed for a mean of 116.5 months (range: 60-285). Mean pads per day use was significantly decreased from 3.6 at baseline to 0.6 at 1 year, 1.1 at 5 years, and 1.06 at last visit (P < 0.0001). During follow-up, 12 patients (35%) required between 1 and 3 device revisions and 1 (3%) required 5. The device revision-free survival was 76% (confidence interval [CI] 58%-87%) at 5 years and 56% (CI 32%-75%) at 15 years. A higher mean number of dilations or incisions for bladder neck contractures was a statistically significant risk factor for revisions in univariate analysis (odds ratio 1.8; 95% CI 1.02-3.2). No other significant risk factors for revisions were found. Explantations were performed in four patients for device erosion at 60, 69, 153, and 200 months.

Conclusions

The AUS provides excellent long-term outcomes with continued improvement in continence rates and <50% of patients requiring revisions at 15 years. The previous history of bladder neck contractures and dilations may predispose to an increased rate of revisions.

Identifying the most reliable and valid bladder health screening tool: a systematic review

Purpose: Lower urinary tract symptoms are common in advancing age and a major cause of disability through avoidance of activity and social engagement. This systematic review aimed to identify the most valid and reliable brief screening tool for these symptoms or bladder problems, to incorporate into a health promotion programme for older adults to facilitate discussion about self-management.Method: Review eligibility criteria included studies published between 1990 and November 2018, reporting the validity, reliability and/or acceptability of bladder health screening tools. Six electronic databases were searched.Results: Twenty-two studies were included. Three screening tools met the criteria: International Prostate Symptom Score (IPSS); International Consultation on Incontinence Questionnaire Urinary Incontinence Short-Form; Bladder Control Self-Assessment Questionnaire (B-SAQ). Test-retest reliability for total scores of the IPSS and International Consultation on Incontinence Questionnaire Urinary Incontinence Short-Form was acceptable. All three questionnaires showed evidence of acceptable levels of internal consistency and of convergent validity.Conclusion: Having favourable psychometric scores compared to the B-SAQ and for ease of use and trustworthiness of a simple questionnaire, the IPSS and International Consultation on Incontinence Questionnaire Urinary Incontinence Short-Form met the criteria for recommendation for raising awareness and bladder health promoting interventions to reduce associated disability.Implications for RehabilitationLower urinary tract symptoms are common in advancing age and a major cause of disability through avoidance of activity and social engagement.Lower urinary tract symptoms can be prevented or improved through self-management strategies.Help-seeking levels for lower urinary tract symptoms is low but could be improved through continence promotion interventions.The International Prostate Symptom Score and the International Consultation on Incontinence Questionnaire - Urinary Incontinence Short Form are bladder health screening questionnaires which would be appropriate to use as part of a continence promotion intervention to help prompt discussions and raise awareness and subsequently improve symptoms and associated disability.

Efficacy and Safety of Incontinence Surgery According to the Surgeon's Specialty and Performance of a Preoperative Urodynamic Study

Purpose

The aim of this study was to analyze the efficacy and to estimate the complication rate of incontinence surgery according to the surgeon’s specialty and whether a preoperative urodynamic study (UDS) was performed, using a nationally representative dataset.

Methods

We enrolled 356,155 women over 20 years old who had undergone surgery for stress urinary incontinence between 2006 and 2015. Patients were followed for up to 3 years to analyze the reoperation and complication rates. Data were obtained from the National Health Claims Database of the National Health Insurance Service (NHIS) of Korea. Multiple Cox regression analysis was conducted to examine the efficacy and safety of incontinence surgery according to the surgeon’s specialty and whether a preoperative UDS was performed.

Results

The hazard ratio (HR) for reoperation was significantly higher for procedures performed by nonurologists than for procedures performed by urologists (HR, 1.174; 95% confidence interval [CI], 1.103–1.249). Acute urinary retention, postoperative infections, procedure-associated pain, and other complications were also more common in procedures performed by nonurologists than in those performed by urologists. When stratified by whether a preoperative UDS was performed, the HR for reoperation according to the surgeon’s specialty varied by performance of a preoperative UDS. While the reoperation rate was significantly higher in procedures performed by non-urologists when a preoperative UDS was performed (HR, 1.208; 95% CI, 1.122–1.3), there was no significant difference in the HRs for reoperation according to specialty when a preoperative UDS was not performed.

Conclusions

This population-based study showed that the postoperative outcomes of incontinence surgery were dependent upon the surgeon’s specialty and that the reoperation rate according to the surgeon’s specialty varied based on whether a preoperative UDS was performed.

Tension-free vaginal tape-obturator for the treatment of stress urinary incontinence: a 12-year prospective follow-up

OBJECTIVE

To evaluate the long-term safety and effectiveness of inside-out transobturator tape (tension-free vaginal tape-obturator, TVT-O) for the treatment of stress urinary incontinence (SUI).

PATIENTS AND METHODS

Between August 2004 and August 2006, 87 consecutive patients with SUI who underwent TVT-O were enrolled in this prospective cohort study. Patients with mixed UI, or pelvic organ prolapse requiring surgery, were excluded. Data relating to long-term postoperative complications, subjective satisfaction rate (Patient Global Impression of Improvement), objective cure rate (stress test), quality of life (QoL), and sexual function, were collected during follow-up. The Incontinence Impact Questionnaire (IIQ-7) and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) were used to assess QoL and sexual function, respectively. Statistical analyses were performed using paired-sample t-tests.

RESULTS

At the 12-year follow-up, 73 patients (84%) were available for evaluation. Overall, the long-term complication rate was 45.2%. De novo overactive bladder was observed in 12.3% of patients. None of the patients reported severe voiding dysfunction that required treatment by tape removal or catheterisation. However, 16 patients (16/73, 21.9%) had voiding changes compared with their preoperative status. Persistent groin pain was reported in 1.4% of the patients, and tape exposure occurred in 5.5%. The subjective satisfaction rate and objective cure rate were 80.8% and 82.2%, respectively. Compared with preoperative scores, the IIQ-7 score decreased significantly (P < 0.05), whilst there was no significant difference in the PISQ-12 score (P = 0.893).

CONCLUSIONS

This 12-year follow-up study showed that TVT-O is a highly effective procedure for the treatment of SUI. The long-term complication rate appears to be slightly high, which should raise concern.

Trends in Ambulatory Management of Urinary Incontinence in Women in the United States

OBJECTIVES

Urinary incontinence (UI) is a common condition, but despite the availability of guidelines, variations exist in the care of patients. We sought to assess the changes in assessment and management of women with UI over time in the United States.

METHODS

The National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey are annual surveys from a nationally representative sample of visits to physicians. From 1999 through 2010, we identified visits by women to physicians where the chief complaint was UI using reason-for-visit and International Classification of Diseases, Ninth Revision codes.

RESULTS

Using 2-year intervals between 1999-2000 and 2009-2010, the number of visits by women with UI to physicians increased (5.3 million to 6.8 million). There was no difference in patient age, race/ethnicity, or physician specialty (primary care, urology, gynecology). The majority did not have their incontinence characterized (42.4%-47.4%). The use of urinalysis significantly decreased (53%-37.2%, P = 0.02), whereas antimuscarinic use significantly increased (16.7%-35%, P = 0.006). There was an overall increased trend in number of referrals to another physician (5.8%-14.7%, P = 0.06). Urologists had a significant increase in antimuscarinic use (23.5%-44.2%, P = 0.003). All physician specialties demonstrated a decreased trend in use of urinalysis between 1999 and 2010. Although imaging rates were low, they were at highest rates among urologists.

CONCLUSIONS

The majority of women do not have the type of UI characterized, whereas there is underutilization of urinalysis. Given the widespread prevalence of UI and its implications on quality of life, greater adherence to guidelines is warranted.

Morphological changes in rat rectus abdominis muscle induced by diabetes and pregnancy

The urethral muscle of diabetic pregnant rats is affected by long-term mild diabetes and short-term severe diabetes, which plays a crucial role in the pathogenesis of pelvic floor disorders. We hypothesized that muscles outside the pelvis are subject to similar changes. The current study aimed at analyzing the effects of long-term mild and short-term severe diabetes on the structure and ultrastructure of fiber muscles and collagen in rats' rectus abdominis (RA) muscle. Therefore, the RA muscle of virgin, pregnant, long-term mild diabetic, short-term severe diabetic, long-term mild diabetic pregnant and short-term severe diabetic pregnant 3-month-old Wistar rats were collected. The structure was analyzed by picrosirius red staining, immunohistochemistry for fast and slow muscle fibers and transmission electron microscopy. We investigated two levels of STZ- induced diabetes: long-term mild diabetes (blood glucose level: 120–200 mg/dL) and short-term severe diabetes (blood glucose level >300 mg/dL). Long-term mild diabetic pregnant and short-term severe diabetic pregnant rats had decreased fast fibers and increased slow fibers, disrupted areas of sarcomere, intermyofibrillar mitochondria and myelin figures in the RA muscle. Both groups enabled us to analyze the specific influence of pregnancy, separately from diabetes. The current study demonstrated that diabetes and pregnancy induced intramuscular transformation and reorganization of RA muscle with a switch of fiber type adjusting their architecture according to intensity and duration of hyperglycemic insult within pregnancy.

The increasing importance of a continence nurse specialist to improve outcomes and save costs of urinary incontinence care: an analysis of future policy scenarios

Background

In an ageing population, it is inevitable to improve the management of care for community-dwelling elderly with incontinence. A previous study showed that implementation of the Optimum Continence Service Specification (OCSS) for urinary incontinence in community-dwelling elderly with four or more chronic diseases results in a reduction of urinary incontinence, an improved quality of life, and lower healthcare and lower societal costs. The aim of this study was to explore future consequences of the OCSS strategy of various healthcare policy scenarios in an ageing population.

Methods

We adapted a previously developed decision analytical model in which the OCSS new care strategy was operationalised as the appointment of a continence nurse specialist located within the general practice in The Netherlands. We used a societal perspective including healthcare costs (healthcare providers, treatment costs, insured containment products, insured home care), and societal costs (informal caregiving, containment products paid out-of-pocket, travelling expenses, home care paid out-of-pocket). All outcomes were computed over a three-year time period using two different base years (2014 and 2030). Settings for future policy scenarios were based on desk-research and expert opinion.

Results

Our results show that implementation of the OSCC new care strategy for urinary incontinence would yield large health gains in community dwelling elderly (2030: 2592–2618 QALYs gained) and large cost-savings in The Netherlands (2030: health care perspective: €32.4 Million - €72.5 Million; societal perspective: €182.0 Million - €250.6 Million). Savings can be generated in different categories which depends on healthcare policy. The uncertainty analyses and extreme case scenarios showed the robustness of the results.

Conclusions

Implementation of the OCSS new care strategy for urinary incontinence results in an improvement in the quality of life of community-dwelling elderly, a reduction of the costs for payers and affected elderly, and a reduction in time invested by carers. Various realistic policy scenarios even forecast larger health gains and cost-savings in the future. More importantly, the longer the implementation is postponed the larger the savings foregone. The future organisation of healthcare affects the category in which the greatest savings will be generated.

Electronic supplementary material

The online version of this article (10.1186/s12875-018-0714-9) contains supplementary material, which is available to authorized users.

Effect of Trospium Chloride on Cognitive Function in Women Aged 50 and Older: A Randomized Trial

OBJECTIVES

This study aimed to investigate the effect of trospium chloride on cognitive function in postmenopausal women treated for overactive bladder (OAB).

METHODS

Randomized double-blind placebo-controlled trial conducted from April 2013 to April 2015. Women aged 50 years or older seeking treatment for OAB were randomized to either trospium chloride XR 60 mg daily or placebo. Baseline cognitive function was assessed via Hopkins Verbal Learning Test-Revised (HVLT-R), Mini Mental Status Exam, Mini Mental Status X, Digit Span, Trails A, Trails B, and Epworth Sleepiness Scale. Cognitive function was reassessed at week 1 and week 4. A priori power analysis determined that 21 subjects were needed per group.

RESULTS

Although 59 women were enrolled and randomized (28 trospium and 31 placebo), 45 completed assessment (21 trospium and 24 placebo). Mean age was 68 years, 78% were white, and 44% had previously taken OAB medication. For the primary outcome, there was no difference in HVLT-R total score between trospium and placebo groups at week 4 (P = 0.29). There were also no differences based on the other cognitive tests. There was a correlation between age and the following week-4 tests: HVLT-R total score (r = -0.3, P = 0.02), HVLT-R total recall subscale (r = -0.4, P = 0.007), Trails A (r = 0.4, P = 0.002), and Trails B (r = 0.4, P = 0.004). A linear regression model found that HVLT-R total score decreased by 0.372 points for each increased year of age.

CONCLUSIONS

In women aged 50 years and older, there were no changes in cognitive function between those taking trospium and placebo. Cognitive function was correlated with age.

Implantable Systems for Stress Urinary Incontinence

Stress urinary incontinence (SUI), the involuntary urine leakage due to failure of the urethral closure mechanism, is a global health challenge with substantial human suffering and socioeconomic costs. Approximately 167 million male and female patients are predicted to suffer from SUI in 2018, worldwide. A wide range of surgical interventions are available for the treatment of SUI. Severe cases, however, usually require the implantation of artificial urinary sphincter devices. This review comparatively presents and analyzes the working principles, as well as the challenges, associated with the current implantable SUI systems in clinical use. These include slings, urethral bulking agents, artificial urinary sphincters, and adjustable continence devices. It further reports on recent research progress and state-of-the-art in the field of SUI implants, including an original approach proposed by the authors with a pressure feedback sensory mechanism. The new emerging field of artificial muscle devices, including electroactive polymers, provides a promising innovative solution for replacing the weakened urethral sphincter in SUI patients.

Urinary incontinence is associated with the development of peptic ulcers in adult women: Data from the KNHANES IV

The aim of this study was to investigate the association between urinary incontinence (UI) and peptic ulcer (PU) and how this is related to psychological stress in Korean women by analyzing the data from the Korea National Health and Nutrition Examination Survey IV (KNHANES).A nationally representative sample of data on 7475 Korean women ≥19 years of age from the KNHANES 2008 to 2010 was included. Physician-diagnosed UI and PU were assessed using questionnaires and surveys. Psychological stress was assessed through a questionnaire using a 4-point Likert scale. Data were analyzed using logistic regression to determine the association between UI and PU according to the level of psychological stress perception.PU was found in 1.41% of the total population. Breaking this down by the existence of UI, PU was found in 3.5% of the population with UI, and 1.4% of the population without UI, which showed a significant difference. A statistically significant trend for increasing prevalence of UI and PU with increasing psychological stress perception levels was found among the study population. Multivariable logistic regression analyses for PU showed that UI was significantly associated with a higher probability of PU in an adjusted model, which means that members of the population with UI were more likely to have PU than those without UI. A higher level of psychological stress perception was also significantly associated with increased odds of PU in the adjusted model.UI could potentiate the development of PU through increasing levels of psychological stress perception.

Percutaneous tibial nerve stimulation versus electrical stimulation with pelvic floor muscle training for overactive bladder syndrome in women: results of a randomized controlled study

INTRODUCTION

This study compared percutaneous tibial nerve stimulation (PTNS) versus electrical stimulation with pelvic floor muscle training (ES + PFMT) in women with overactive bladder syndrome (OAB).

MATERIALS AND METHODS

60 women with OAB were enrolled. Patients were randomized into two groups. In group A, women underwent ES with PFMT, in group B women underwent PTNS.

RESULTS

A statistically significant reduction in the number of daily micturitions, episodes of nocturia and urge incontinence was found in the two groups but the difference was more substantial in women treated with PTNS; voided volume increased in both groups. Quality of life improved in both groups, whereas patient perception of urgency improved only in women treated with PTNS. Global impression of improvement revealed a greater satisfaction in patients treated with PTNS.

CONCLUSION

This study demonstrates the effectiveness of PTNS and ES with PFMT in women with OAB, but greater improvements were found with PTNS.