Prevalence, incidence, and awareness in the treatment of menopausal urinary incontinence

Quality of life and the prevalence of urinary incontinence after surgical treatment for gynecologic cancer: a questionnaire survey

Background

Although there have been a number of reports on urinary voiding symptoms associated with surgical interventions for gynecologic cancer and post-voiding symptoms, there have been few reports on urinary storage symptoms such as urinary incontinence (UI) and overactive bladder (OAB). The purpose of this study was to examine the rates and impact on quality of life (QOL) of urinary storage symptoms after gynecologic cancer surgery.

Methods

A questionnaire survey, including Japanese-language versions of the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), Overactive Bladder Symptom Score (OABSS), and Incontinence Impact Questionnaire-7 (IIQ-7), was distributed to gynecologic cancer patients who underwent hysterectomy between 2008 and 2013.

Results

Of the 145 patients analyzed, 49 (33.8%) had UI pre-surgery, and 76 (52.4%) had UI post-surgery, including 34 (35.4%) first-time UI patients, with a significant difference between pre- and post-surgery. Of the 49 subjects with UI pre-surgery, 43 (87.7%) had stress incontinence, while of the 76 patients with UI post-surgery, 44 (57.1%) had stress incontinence, and 24 (31.2%) had mixed incontinence. Seven (4.8%) subjects had OAB pre-surgery, whereas 19 (13.1%) had OAB symptoms post-surgery (including 15 first-time OAB patients), with a significant difference between pre- and post-surgery. IIQ-7 scores were markedly higher for patients with mixed incontinence post-surgery than for those with stress incontinence, indicating a lower QOL. Logistic regression analysis identified the number of Cesarean sections and days of urinary bladder catheterization as risk factors for postoperative UI.

Conclusions

UI and OAB rates were higher after gynecologic cancer surgery than in the general female population. The mixed incontinence rate was markedly higher post-surgery; QOL was low for such patients due to the combination of urge and stress incontinence. Multiple Cesarean sections and urinary bladder catheterization post-surgery were risk factors for post-surgical UI.

Urinary incontinence and sleep complaints in community dwelling older adults

Sleep disorder is associated with poor quality of life in old age. Therefore, it is imperative to identify contributing factors leading to sleep disorder. The current study aimed to examine the impact of urinary incontinence on sleep complaint after controlling for potential sociodemographic and health covariates. Materials and Methods: A cross-sectional study was conducted on a sample of 184 community dwelling older adults 60 years and older in Yazd, Iran, 2016. In order to obtain the sample a multistage proportional random sampling technique was employed. Sociodemographic characteristics, sleep complaint, and urinary incontinence were collected from medical records. Statistical analyses were performed using SPSS version 24. A multiple logistic regression analysis was used to examine the impact of urinary incontinence on sleep complaint after controlling for potential covariates. Findings: A total of 184 respondents with a mean age of 68.48±6.65 years (age range, 60-87 years) were included in the study. About 70% of the respondents were women, 72.8% were married, 68.5% were not formally educated, and 21.7% were living alone. The prevalence of sleep complaint and urinary incontinence were 27.2% (95% CI: 21-34) and 22.3% (95% CI: 17-29), respectively. The results of the multiple logistic regression analysis revealed respondents with urinary incontinence were four times more likely to suffer from sleep complaint than those without urinary incontinence after adjusting for potential covariates (AOR=4.04, 95% CI: 1.74-9.35, p<0.001). Conclusion: Based on the results of this present study, which showed that urinary incontinence independently contributed to sleep complaint among older adults, it is necessary to employ effective interventions for controlling urinary incontinence to reduce sleep complaints.

Aerobic exercise affects myostatin expression in aged rat skeletal muscles: a possibility of antiaging effects of aerobic exercise related with pelvic floor muscle and urethral rhabdosphincter

PURPOSE

Aging-induced loss of muscle mass and subsequent reduction of strength is a fundamental cause of frailty, functional decline, and disability. And this may lead to muscular dysfunction, voiding dysfunction, or urinary incontinence due to pelvic muscle weakness induced by aging. Physical exercise has been recommended for the prevention and the treatment of these age-related frail states. We investigated the effects of treadmill exercise on muscle strength, myostatin mRNA and protein expression, and gastrocnemius myocytes proliferation in aged rats to investigate the possible antiaging effects of aerobic exercise on skeletal muscles such as pelvic floor muscles and urethral rhabdosphincter muscle.

METHODS

In this study, 5-month-old male Sprague-Dawley rats were used as the young-age group (n=20) and 24-month-old rats were used as the old-age group (n=20). Each group was randomly divided into two groups (n=10 in each group): the sedentary and the treadmill exercise group. The rats in the exercise groups were forced to run on a motorized treadmill for 30 minutes, once a day, for 6 weeks. For this study, a weight load test, hematoxylin and eosin staining, real-time and reverse transcription polymerase chain reaction for myostatin mRNA, myostatin western blot, and 5-bromo-2'-deoxyuridine immunohistochemistry were performed in the gastrocnemius muscle.

RESULTS

The age-induced reduction of muscle mass and strength was associated with a decrease in myocyte proliferation and an increase in myostatin mRNA and protein expression in the gastrocnemius. However, treadmill exercise improved muscle mass and strength through suppression of myostatin mRNA and protein expression, and myocyte proliferation increase in the gastrocnemius against the aging process.

CONCLUSIONS

Aerobic exercise is a useful strategy for enhancing muscle function against aging-induced loss of skeletal muscle mass and functions.

Regenerative medicine as a new therapeutic strategy for lower urinary tract dysfunction

The use of regenerative medicine for the treatment of organic and functional disorders intractable to conventional treatment has increased worldwide. This innovative medical field might particularly hold promise for the treatment of life-threatening diseases or healing of irreplaceable organs, such as the heart, liver and brain. Dysfunction of the urogenital tract and associated organs other than the kidney might not have immediate life-threatening implications; furthermore, the effectiveness of alternative therapy, such as enterocystoplasty for bladder cancer, has been shown. Therefore, most physicians or scientists do not give much importance to these disorders. However, urological disease has increased in developed societies in recent years. Furthermore, medical costs have also escalated. Disorders of the lower urinary tract, such as urinary disturbance or incontinence, can lead to other complications, impairing quality of life and ultimately increasing short- and long-term medical expenses. Regenerative medicine might hold potential solutions to these problems. Recent advances in urogenital regenerative medicine are reviewed in the present article, with particular reference to lower urinary tract reconstruction. The potential of regenerative medicine for the treatment of intractable lower urinary tract dysfunction compared with conventional treatment is also discussed.

Myostatin inhibits proliferation of human urethral rhabdosphincter satellite cells

OBJECTIVES

Myostatin, a member of the transforming growth factor-β superfamily, is a negative regulator of myogenesis in skeletal muscle. We examined the effect of myostatin and myostatin inhibition by an antagonistic agent, follistatin, on growth of human urethral rhabdosphincter satellite cells (muscle stem cells) to develop a new strategy for treatment of stress urinary incontinence.

METHODS

Rhabdosphincter satellite cells were cultured and selected by magnetic affinity cell sorting using an anti-neural cell adhesion molecule antibody. The cells were transfected with simian virus-40 antigen to extend their lifespan. A cell proliferation assay, a cell cycle analysis and an investigation of signal transduction were carried out. The autocrine action of endogenous myostatin by western blotting, real-time reverse transcription polymerase chain reaction and immunoneutralization using an anti-myostatin antibody was also evaluated.

RESULTS

Selectively cultured cells expressed markers of striated muscles and successfully differentiated into myotubes. Myostatin inhibited proliferation of these cells through Smad2 phosphorylation and cell cycle arrest. Inhibitory effects of myostatin were reversed by addition of follistatin. However, rhabdosphincter satellite cells did not appear to use autocrine secretion of myostatin to regulate their proliferation.

CONCLUSIONS

Inhibition of myostatin function might be a useful pathway in the development of novel strategies for stimulating rhabdosphincter cells regeneration to treat stress urinary incontinence.

Correlation between urodynamic tests, history and clinical findings in treatment of women with urinary incontinence

ABSTRACT Objective: The aim of this study was to evaluate the role of urodynamic test in diagnosis of urinary incontinence, comparing detailed data of history and physical examination, and some easy- to-apply clinical tests. Methods: A cross-sectional retrospective study was carried out by reviewing the medical charts of 55 patients with complaint of loss of urine, seen at the Urogynecology Service of Women's Health Outpatient Clinic of Hospital Universitário de Jundiaí, between October 2006 and March 2007. The patients answered a specific questionnaire involving the epidemiological and physical examination variables considered in this study. They were submitted to physical examination and urodynamic tests. Results: The complaint of loss of urine upon exertion, either isolated or associated with urge incontinence, was confirmed by urodynamic tests in most women, and only 4 of 49 symptomatic women had negative results. The clinical sign was present in 35 patients (63.6%), and 46 patients (83.6%) had the exertion component in the urodynamic test. The exertion component was observed in 10 (18%) out of 15 patients without symptoms (30%). The positive and negative predictive values of the clinical sign for diagnosis of any type of urinary incontinence in this studied group were 97.1 and 26.7%, respectively. As for the clinical complaint of urinary loss upon exertion, the positive and negative predictive values for any type of urinary incontinence were 92 and 40%, respectively. For the clinical complaint of urge incontinence, the positive and negative predictive values of 92.5 and 23.1%, respectively. Conclusions: It was concluded that the urodynamic evaluation is an important instrument to evaluate the severity of incontinence, although it was not necessary to diagnose loss of urine. The finding of urinary loss during physical examination had low sensitivity and specificity in diagnosis of the type of loss of urine. Urodynamic tests had better performance in demonstrating urinary incontinence in patients with complaint of incontinence upon exertion and without loss of urine seen upon physical examination than in confirming urge incontinence in patients with those symptoms.

Incontinência urinária em mulheres no período pós-menopausa: um problema de saúde pública

Resumo Objetivo: verificar a prevalência de incontinência urinária em mulheres que estão vivenciando o período pós-menopausa e identificar os fatores relacionados a esta condição. Metodologia: estudo do tipo transversal-descritivo. A amostra foi constituída por 130 mulheres, com idade entre 50 e 65 anos, residentes no município de Catuípe (RS) e que apresentavam no mínimo um ano de amenorreia. A coleta de dados ocorreu por meio de entrevista, com auxílio de um instrumento contendo variáveis relacionadas aos aspectos sociodemográficos, histórico gineco-obstétrico e geniturinário. Também foi realizada a avaliação do peso e estatura, para estabelecer o índice de massa corporal. A análise descritiva foi utilizada no tratamento dos dados.Resultados: a média de idade das mulheres foi de 58±4,39 anos e o tempo médio de amenorreia 10,6±7,1 anos. Com relação às comorbidades, a hipertensão arterial sistêmica foi a mais prevalente. Quanto ao histórico gineco-obstétrico, a maioria das mulheres teve partos naturais. Em relação à perda de urina, 25,3% relatam afirmativamente, relacionada à realização de esforços como tossir e subir escadas. Observou-se que as mulheres com maior índice de massa corporal apresentaram maior frequência de incontinência.Conclusões: os dados deste estudo sugerem que a incontinência urinária tem prevalência importante entre as mulheres pós-menopausa e que esta condição se relaciona em parte a fatores que podem ser prevenidos, apontando para a necessidade de intervenção junto a esse estrato populacional.

Analysis of the value of the ICIQ-UI SF questionnaire and stress test in the differential diagnosis of the type of urinary incontinence

AIMS

Presently, there is no simple, universally accepted instrument for the initial diagnosis of urinary incontinence (UI), which is why physicians find it so difficult to integrate the diagnosis into their daily clinical practice. The objective of this study is to analyze the true value of the ICIQ-UI SF questionnaire (ICIQ), the stress test, and the combination of both for the diagnosis as to the type of UI.

METHODS

Cross-sectional study performed in 116 women consulting for UI symptoms in two specialized health care centers. The subjects completed the ICIQ and underwent a stress test and urodynamic testing which was used for the reference diagnosis. Sensitivity, specificity, positive and negative predictive values, and the statistical "likelihood ratio (LR)" were assessed.

RESULTS

According to the ICIQ, 45 women (38.8%) suffered from Stress UI (SUI); 19 (16.4%), Urgency UI (UUI), and 49 (42.2%), Mixed UI (MUI). According to the stress test, 75 (64.7%) presented SUI. According to the combination of both tests, the diagnosis was SUI in 35 (30.2%), UUI in 17 (14.7%), and MUI in 37 (31.9%). Regarding urodynamic testing, observations were as follows: USI in 45 subjects (38.8%), detrusor overactivity (DO) in 25 (21.6%), and combination of both (MUI) in 30 (25.9%). The combination of ICIQ-UI SF plus stress test showed good specificity and negative predictive value, and the best LR coefficients obtained were: 3.11 (USI); 6.64 (UUI); 2.64 (MUI), and 3.77 ("all" SUI).

CONCLUSIONS

The combined use of the ICIQ plus stress test will aid in characterizing the type of UI at a basic health care level, favoring the prescription of the most appropriate treatment for each case.

Psychological morbidity and female urinary incontinence

Female urinary incontinence is a common yet distressing condition. It affects women of all ages, but is especially common in the elderly. Its prevalence ranges from 15 to 55%, depending on age and population studied. Despite the ubiquity of female urinary incontinence, many incontinent women do not voice their suffering, and urinary incontinence has therefore been dubbed 'the silent epidemic'. The physical impact and social isolation associated with urinary incontinence lead to impairment of quality of life and psychological well-being. It is the aim of this review to discuss the epidemiology and psychological impact of urinary incontinence. The recognition and management of incontinence-related psychological morbidity are also explored.

Magnetic resonance imaging to evaluate NASHA/Dx gel (Zuidex) for stress urinary incontinence

The Zuidex system for the treatment of stress urinary incontinence consists of non-animal stabilised hyaluronic acid/dextranomer (NASHA/Dx) gel and a precision guide, the Implacer. Whether the Implacer accurately deposits NASHA/Dx gel in the desired location within the urethral wall was investigated by magnetic resonance imaging (MRI), performed at a mean of 35 days post-treatment. Three or more deposits were observed in 11 of 16 patients (68.8%), with 39 of the 50 deposits clearly located within the urethral wall, as intended. Fourteen of 16 patients (87.5%) demonstrated improvement in their incontinence at 3 months, sustained at 12 months in 13 patients. No significant correlations between total implant volume and improvements in incontinence were observed at 3 months (p > or = 0.16) and 12 months (p > or = 0.30). In conclusion, accurate placement of NASHA/Dx gel into the desired location within the urethral wall was achieved in the majority of cases using the Implacer device, without endoscopic guidance.

The emergence of new drugs for overactive bladder

Overactive bladder is a common and distressing problem. Standard therapy is directed towards modifying the detrusor motor sensitivity and response via anticholinergic medication. Currently available medications are reviewed and alternative targets for treatment are presented.

Characteristics of female outpatients with urinary incontinence participating in a 6-month observational study in 14 European countries

OBJECTIVE

To describe the characteristics of women seeking treatment for symptoms of urinary incontinence (UI) in European countries.

DESIGN

Prospective urinary incontinence research (PURE) was a 6-month, observational, pan-European study, primarily aimed at determining the direct costs of urinary incontinence treatment. The secondary objectives of PURE were to describe the impact of UI on health-related quality of life (HRQoL) in treatment seeking patients and to illustrate the treatment patterns for UI in Europe.

SETTING

One thousand and Fifty-five physicians from 14 European countries, including general practitioners (GPs), gynaecologists, urologists and geriatricians, observed women seeking treatment for their UI and recorded data at the first observation and then prospectively at 3 and 6 months after the first observation during the normal course of therapy.

SUBJECTS

Women of at least 18 years of age who had experienced urinary leakage in the 12 months prior to enrolment in the study, who were seeking treatment or under treatment for UI and who presented within the normal course of UI care were included in the 6 months study. The first observation characteristics of the patients are described here.

METHODS

Demographic characteristics, as well as disease and treatment status at first observation were explored using descriptive summary statistics to gain an understanding of the population studied.

RESULTS

In total, 9487 women took part in PURE, with the largest patient groups from Germany, Spain and the UK/Ireland. The majority of women were post-menopausal and had a mean age of 60.7 years, were not current smokers and tended to be overweight (BMI > 25.0). Overall, mixed UI symptoms were more common than SUI and UUI, as defined by clinical opinion (SUI 38%, MUI 42% and UUI 18%), and by a two-item questionnaire, the S/UIQ (SUI 29%, MUI 58% and UUI 13%). Around half of the patients (48%) suffered from their symptoms for less than 2 years before consulting a physician; 28% delayed seeking treatment for 3-5 years, with 13% waiting for 6-10 years and the remaining 11% waiting for 11 or more years.

CONCLUSIONS

Some of the described patients' characteristics may provide important information to clinicians to enable them to take a more active approach to case-finding, which will ultimately benefit the incontinent patient.

Relationship between the type of urinary incontinence and falls among frail elderly women in Japan

Urinary incontinence and falls are serious problem among elderly people, because of restriction of the Activities of Daily Living (ADL) and Quality of Life. Previous studies have examined the association between urinary incontinence and falls. However, results have been inconsistent. In Japan, with the rapid aging of the society, the number of elderly women who have urinary incontinence and are at risk of falling is increasing. We investigated the relationship between type of urinary incontinence and risk of falls among elderly users of day-care services in a long-term care system. Our study population comprised 118 ambulatory women. At baseline, we evaluated incontinent status, lower extremity muscle strength, balance ability, ADL, and Instrumental ADL. We asked subjects about number of falls every 4 months during a year. In univariate analysis, lower extremity muscle strength (p = 0.001) and mixed incontinence (p = 0.050) differed significantly according to the fall status. Stress and urge incontinence were not significantly associated with falls. In logistic regression analysis, subjects who had mixed incontinence were 3.05 (95% confidence interval 1.01-10.2) times more likely to fall than those without. These results suggest that mixed incontinence have independent associations with falls. Incontinent status should be considered to prevent falls among elderly persons who are partially dependent and need support.

The role of the nurse in community continence care: a systematic review

Urinary incontinence (UI) is a condition that is associated with decreased quality of life. Apart from this impact on quality of life, UI is also a very costly problem. It is recognised that 'usual care' for patients suffering from UI is not optimal. Specialised nurses can play an important role in the care for community-dwelling incontinent patients, as they have the appropriate interpersonal and technical skills to provide patient-tailored care. This systematic review analyses the effect of treatment by nurses on clinical and economic outcomes. A total of 12 randomised controlled trials (RCTs) were found, varying in terms of population, setting, outcome measurement and control/intervention. There is limited evidence that treatment by nurses results in a decrease in incontinence. No evidence was found for cost reduction. Recommendations are made for future studies.

Prevalence, awareness and determinants of health care-seeking behaviour for urinary incontinence in Qatari women: a neglected problem?

OBJECTIVES

The aim of this study was to determine the prevalence, awareness and determinants of urinary incontinence (UI) among Qatari women and the sociodemographic factors involved in their health care-seeking behaviour.

DESIGN

A cross-sectional study was used to determine the symptoms of UI experienced by Arabian Gulf women.

SETTING

Primary Health Care (PHC) Centres and community-based study in Qatar.

SUBJECTS

A multistage sampling design was used and a representative sample of 1000 Qatari women aged 45 years and above were included from January to June 2003.

MEASUREMENTS

Participants completed a questionnaire assessing UI in the previous 12 months and health care-seeking behavior for urinary symptoms.

RESULTS

Of 1000 women living in urban and semiurban areas who were asked, 798 (79.8%), representing the study sample, agreed to participate and completed the questionnaire. Of these, 164 (20.6%) were found to have UI. Overall, the reason for not seeking medical attention was mainly embarrassment (40.6%) at having to speak with doctor. Of the total study sample, 562 subjects (70.4%) believed that UI was abnormal and worth reporting to a doctor. Coping mechanisms among incontinent women included frequent washing (58.3%) and wearing a protective perennial pad (42.4%), changing underwear frequently (41.3%), decreasing fluid intake (19.8%) and stopping all work (4.9%). Sufferers were most troubled by their inability to pray (64%) and their marital relationship (47%), limitation of their social activities (20%), difficulty in doing housework (14%) and inconvenience during shopping (13%). Most (71.9%) of the incontinent subjects were self-conscious, ashamed of themselves and troubled by guilt (P < 0.001); 56% found it most embarrassing to discuss UI with their husbands. The majority of women (51.9%) believed child birth to be the major cause of UI, followed by ageing (49.5%), menopause (34.2%) and paralysis (25.3%). Most of the subjects (62.3%) believe that UI can cause infection, some (20.5%) believe that it can cause skin allergy and very few think that it can cause cancer or other disorders.

CONCLUSIONS

Our findings indicate that although UI is relatively common in the community, it is underreported by Qatari women because of social and cultural attitudes and-most importantly-lack of information. This findings suggest that strategies to promote care-seeking for incontinence must be developed and employed in the community.

A study on urogenital complaints of postmenopausal women aged 50 and over

OBJECTIVE

The objective of this study was to determine the prevalence of urogenital complaints in postmenopausal women aged 50 and over.

METHODS

The study was carried out in the city of Istanbul on women within the age range of 50 and over. The statistical figures for these women were obtained from the latest national census. The number of sampling was determined to be 500, each representing a population of 10,000 women. Thus, the sampling consisted of 500 postmenopausal women who had applied to various health centers either to seek remedy for their health problems other than urinary incontinence (UI) or to accompany inpatients. Women in the surgical stage of menopause were excluded from the study group. A specifically designed questionnaire was used to gather data on urogenital complaints. The data obtained by this means was analyzed according to Thomas criteria, which classifies incontinence as rare, regularly and serious. UI was defined according to the International Continence Society (ICS) classification.

RESULTS

Of the interviewees 68.8% reported UI, 28.8% of whom had serious UI requires continuously the use of ped. It was determined that 37.2% of the women with UI had stress incontinence symptoms, 32.3% urge incontinence symptoms, and 30.5% mixed incontinence. Of the women 46.5% had UI problems for 5 years or longer, and 75% reported that their complaints had started after menopause; 18.2% of the women suffered from vaginal discharge and pruritus, while 23% experienced vaginal dryness; 51.2% of the women were sexually active. However, 83.6% of this group of women reported a decrease in sexual desire and frequency of intercourse. Likewise, 78.1% experienced a decline in sexual satisfaction, 77.7% difficulty in having orgasm, and 45.3% dyspareunia. Logistic regression analysis showed that existence of a chronic illness, frequent urethral infections, a high value of body mass index and chronic constipation increased the prevalence of UI.

CONCLUSIONS

Urinary incontinence and sexual problems, particularly decline in sexual desire, are widespread among postmenopausal women. Frequent urinary tract infections, obesity, chronic constipation and other chronic illnesses seem to be the predictors of UI.

Clinical efficacy and tolerability of extended-release tolterodine and immediate-release oxybutynin in Japanese and Korean patients with an overactive bladder: a randomized, placebo-controlled trial

OBJECTIVE

To compare extended-release (ER) tolterodine and immediate-release (IR) oxybutynin with placebo in Japanese and Korean patients with an overactive bladder (OAB).

PATIENTS AND METHODS

Men and women aged >or= 20 years with symptoms of urinary urgency, urinary frequency (>or= 8 micturitions/24 h), urge incontinence (>or= 5 episodes/week) and symptoms of OAB for >or= 6 months were randomized to double-blind treatment with tolterodine ER 4 mg once daily, oxybutynin IR 3 mg three times daily or placebo for 12 weeks. Efficacy assessments included changes from baseline in numbers of incontinence episodes per week, voids/24 h and mean volume voided/void. Patient perceptions of bladder condition, urgency and treatment benefit were also assessed.

RESULTS

In all, 608 patients were randomized to treatment with tolterodine (240), oxybutynin (246) or placebo (122). More patients prematurely withdrew on oxybutynin (23%) than with tolterodine (10.4%) or placebo (16.4%). After 12 weeks of treatment, the median number of incontinence episodes/week was reduced significantly more in the tolterodine (79%; P= 0.0027) and oxybutynin groups (76.5%; P= 0.0168) than on placebo (46.4%). There were also significantly greater improvements in the number of voids/24 h and volume voided/void with tolterodine and oxybutynin than with placebo. More patients in the tolterodine and oxybutynin than in the placebo groups reported improvements in perceived bladder condition, ability to hold urine and treatment benefit. Patients treated with oxybutynin reported more adverse events than those treated with tolterodine or placebo. Dry mouth was significantly more common with oxybutynin than with tolterodine (53.7% vs. 33.5%; P < 0.001), and occurred in 9.8% of placebo patients.

CONCLUSION

Tolterodine ER has similar efficacy but is better tolerated than oxybutynin IR in Japanese and Korean patients with OAB.

The impact on health-related quality of life of stress, urge and mixed urinary incontinence

OBJECTIVE

To examine the impact of each type of urinary incontinence (stress, urge, and mixed) on health-related quality of life (HRQL).

SUBJECTS AND METHODS

The USA National Overactive Bladder Evaluation (NOBLE) programme of prevalence was used to identify respondents with incontinence based upon telephone survey responses. A nested case-control study was then conducted on respondents with symptoms of an overactive bladder (OAB), and on age and gender-matched controls; this consisted of the respondents completing a series of questionnaires, including the OAB-q (an HRQL scale for OAB), the Medical Outcomes Study (MOS) Short-Form-36 (SF-36), the MOS Sleep Scale, and the Center for Epidemiological Studies - Depression (CES-D) scale. Respondents were categorized into subgroups according to the primary cause of urine loss, i.e. sudden/uncomfortable urge to urinate (urge, UI), physical pressure (stress, SI), or both (mixed, MI). Descriptive analyses, t-tests and analysis of variance with post hoc comparisons were used.

RESULTS

Of the 919 participants in the nested case-control study, 171 reported incontinence, i.e. UI (69), SI (62) and MI (40). Among this cohort, 82.5% were female, 85.4% were Caucasian and the population had a mean age of 55.9 years. All OAB-q subscale scores were significantly (P < 0.01) worse among those with MI than with SI. Respondents with UI reported significantly higher levels of symptom bother and lower sleep scores (both P < 0.001) than those with SI. There were no differences in HRQL between the MI and UI groups. Voiding frequency and nocturia episodes did not differ among the groups but compared with the SI group, both UI and MI groups reported significantly higher ratings of urinary urge intensity (P < 0.001) and rated their need for medical care significantly higher (P < 0.01). The MI group reported more incontinence episodes (P = 0.02) than the SI group.

CONCLUSION

Compared with SI, respondents with UI and MI reported not only significantly greater ratings of urinary urge intensity and more incontinence episodes, but also significantly worse HRQL. These results are consistent with previous findings which indicated a greater impact on HRQL for the urge component of MI than for the stress component.

Incontinence impact, symptom distress and treatment-seeking behavior in women with involuntary urine loss in Southern Taiwan

Urinary incontinence (UI) in women is common worldwide, but is studied more often in the West. This correlational study conducted in southern Taiwan employed two frequently used instruments, which were translated into Chinese. Incontinence impact, symptom distress, and treatment-seeking behavior were studied in 106 women with UI of whom 76 (72%) had not received UI treatment. Incontinence impact (mean=49.75; range=30-120) was significantly correlated (r=0.76, p<0.01) with symptom distress (mean=18.38; range=2-68). Women with high incontinence impact and symptom distress were more likely to seek treatment than those with lower impact and symptom distress.

beta(2)-adrenergic agonists and pelvic floor exercises for female stress incontinence

OBJECTIVE

We compared beta(2)-adrenergic agonist therapy with clenbuterol (DT) and physiological therapy (PT) in a randomized study to establish the first line therapy for stress incontinence (SI).

METHOD

The clinical efficacy of DT (group A), PT (group B), and a combination of DT and PT (group C) was investigated in 61 patients with SI by means of a 12-week randomized controlled study. The frequency and volume of SI and the patients' own impressions were used as the basis for the assessment of efficacy.

RESULTS

The SI improvement rates in groups A, B, and C were 76.9, 52.6, and 89. 5%, respectively (P=0.0361). A significant therapeutic effect on the frequency of SI was observed in group B and group C at 2 weeks after the start of treatment (both P<0.05), and in all groups at 6 weeks (all P<0.01). The efficacy rates based on the patients' own impressions in groups A, B, and C were 84.6, 31.6, and 68.4%, respectively (P=0.0064).

CONCLUSION

The beta(2)-adrenergic agonist appeared to be clinically useful as a drug of choice for SI.

Classification of female urinary incontinence by the scored incontinence questionnaire

OBJECTIVES

Our purpose was to investigate whether urinary incontinence (UI) severity could be graded by UI scores.

METHODS

The study included 168 UI patients diagnosed by conventional procedures as stress incontinence (SI, n=108) or urge incontinence (URI, n=60). A questionnaire containing 15 items scored for stress-score (s-s) and urge-score (u-s) was administered to patients to assess the correlation between pad test values (PTVs) and s-s in SI and u-s in URI.

RESULTS

Significant correlations were found between log[PTVs] and both s-s and u-s: log[PTV(SI)]=0.051s-s-0.207 (r=0.830, P<0.0001) and log[PTV(URI)]=0.064u-s-0.459 (r=0.827, P<0. 0001). Based on theoretical PTVs obtained using these equations, s-s of 26-24, 23-18, and 17-10 in SI were equivalent to severe, moderate, and mild, respectively, and u-s of 22-19 and 18-12 in URI were equivalent to moderate and mild, respectively, according to the classification of the International Continence Society.

CONCLUSION

The UI score should be a simple and useful procedure for use by general gynecologists to grade UI severity clinically.