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Zhang F, Li W. Correlation Between Metabolic Dysfunction-Associated Steatotic Liver Disease and the Risk of Urinary Incontinence in Adult Women. Int J Womens Health 2024; 16:1607-1624. [PMID: 39372666 PMCID: PMC11451464 DOI: 10.2147/ijwh.s489959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2024] [Accepted: 09/25/2024] [Indexed: 10/08/2024] Open
Abstract
Objective This study examined the relationship between metabolic dysfunction-associated steatotic liver disease (MASLD) and urinary incontinence in adult women and evaluated the potential contribution of the fatty liver index (FLI) in this context. Methods The study utilized data from the National Health and Nutrition Examination Survey (NHANES) database, spanning from 2001 to 2018. The study included 17,221 adult female participants. Individuals exhibiting FLI values of 60 or greater were diagnosed with hepatic steatosis. Incontinence type and MASLD status were evaluated by analyzing questionnaire data and calculating the FLI. Logistic regression models were employed to examine the correlation between FLI, MASLD, and urinary incontinence, with potential confounding variables controlled through multivariate adjustment models. Furthermore, restricted cubic spline curve (RCS) modeling and subgroup analysis were employed to elucidate the relationship between variables further. Results The median age of participants in the MASLD group was higher than that of the non-MASLD group (53 vs 46 years, P < 0.001). The findings indicated a positive association between FLI and MASLD and the risk of urinary incontinence. Specifically, the risk of stress urinary incontinence (SUI), urgency urinary incontinence (UUI), and mixed urinary incontinence (MUI) all increased significantly with increasing quartiles of FLI (OR 2.44, 1.91, 2.30, respectively, P < 0.001). In the multivariate-adjusted model, SUI, UUI, and MUI risk was 76%, 50%, and 69% higher in patients with MASLD than those without MASLD. RCS analysis demonstrated a significant nonlinear positive correlation between FLI and the risk of SUI, UUI, and MUI, respectively. Conclusion This study's findings indicate a significant association between MASLD and the risk of developing urinary incontinence. Additionally, the results suggest that FLI and MASLD may act as independent risk factors for urinary incontinence.
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Affiliation(s)
- Fan Zhang
- Changzhou Clinical College, Xuzhou Medical University, Changzhou, Jiangsu, People’s Republic of China
- Department of Endocrinology, Changzhou Third People’s Hospital, Changzhou, Jiangsu, People’s Republic of China
- Department of Clinical Nutrition, Changzhou Third People’s Hospital, Changzhou, Jiangsu, People’s Republic of China
| | - Wenjian Li
- Changzhou Clinical College, Xuzhou Medical University, Changzhou, Jiangsu, People’s Republic of China
- Department of Urology, Changzhou Third People’s Hospital, Changzhou, Jiangsu, People’s Republic of China
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Garzón-Alfaro MT, Cruz-Medel I, Alcaraz-Clariana S, García-Luque L, Carmona-Pérez C, Garrido-Castro JL, Alburquerque-Sendín F, Rodrigues-de-Souza DP. Muscle mechanical properties of pelvic floor and paravertebral muscles in women with and without urge urinary incontinence: a case-control study. Braz J Phys Ther 2024; 28:101114. [PMID: 39260020 PMCID: PMC11416211 DOI: 10.1016/j.bjpt.2024.101114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 10/28/2023] [Accepted: 08/19/2024] [Indexed: 09/13/2024] Open
Abstract
BACKGROUND Muscle mechanical properties (MMPs) are relevant in the pathophysiology of lumbopelvic disorders. However, they have not been described in the pelvic floor muscles (PFM) and lumbar paravertebral muscles (LPM) of women with urge urinary incontinence (UUI). OBJECTIVE To identify differences between MMPs of PFM and LPM in patients with UUI and healthy controls. Secondarily also aimed to observe the relationship between sociodemographic and clinical variables with the PFM and LPM MMPs. METHODS The participants of this case-control study comprised 34 women with UUI (UUI group) and 34 continent women (control group). Sociodemographic variables were obtained together with data on the clinical status of the pelvic floor. The MMPs, i.e., frequency (tone), stiffness, decrement (inverse of elasticity), and viscoelastic properties (VP), such as relaxation time and creep, of PFM and LPM were assessed with a hand-held tonometer. Between-group differences and intra-group correlations were identified. RESULTS The UUI group presented higher frequency and stiffness, as well as lower relaxation time in PFM, whereas the LPM had lower tone and stiffness, and higher VP, compared to the control group (p < 0.05). The UUI group showed a pattern of moderate correlations (|0.403| CONCLUSION The presence of UUI may influence MMPs at PFM and LPM levels, increasing the tone and stiffness of PFM, whereas these properties are reduced in LPM. These findings emphasize the clinical interest of the lumbopelvic determination of MMPs, obtained through externally applied hand-held instruments, in the pathophysiology of UUI.
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Affiliation(s)
- María Teresa Garzón-Alfaro
- Department of Nursing, Pharmacology and Physical Therapy, Faculty of Medicine and Nursing, University of Córdoba, Córdoba, Spain
| | - Inés Cruz-Medel
- Department of Nursing, Pharmacology and Physical Therapy, Faculty of Medicine and Nursing, University of Córdoba, Córdoba, Spain
| | - Sandra Alcaraz-Clariana
- Department of Nursing, Pharmacology and Physical Therapy, Faculty of Medicine and Nursing, University of Córdoba, Córdoba, Spain
| | - Lourdes García-Luque
- Department of Nursing, Pharmacology and Physical Therapy, Faculty of Medicine and Nursing, University of Córdoba, Córdoba, Spain
| | - Cristina Carmona-Pérez
- Department of Nursing, Pharmacology and Physical Therapy, Faculty of Medicine and Nursing, University of Córdoba, Córdoba, Spain
| | - Juan Luis Garrido-Castro
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Spain; Department of Computer Science and Numerical Analysis, Rabanales Campus, University of Córdoba, Córdoba, Spain
| | - Francisco Alburquerque-Sendín
- Department of Nursing, Pharmacology and Physical Therapy, Faculty of Medicine and Nursing, University of Córdoba, Córdoba, Spain; Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Spain.
| | - Daiana Priscila Rodrigues-de-Souza
- Department of Nursing, Pharmacology and Physical Therapy, Faculty of Medicine and Nursing, University of Córdoba, Córdoba, Spain; Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Spain
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Wang J, Ye H, Zhang C, Zhang A. Association of diarrhea or constipation with urinary incontinence in adults: A cross-sectional analysis of the National Health and Nutrition Examination Survey. Neurourol Urodyn 2024; 43:1674-1685. [PMID: 38693849 DOI: 10.1002/nau.25480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/05/2024] [Accepted: 04/11/2024] [Indexed: 05/03/2024]
Abstract
AIMS This study aimed to investigate the association between diarrhea or constipation and urinary incontinence (UI) in adults. METHODS Data from the National Health and Nutrition Examination Survey for 2009-2010 was used to include 4686 adults aged 20 and over in the analysis. Stress urinary incontinence (SUI) and urgency urinary incontinence (UUI) were used as outcome variables, with diarrhea and constipation as exposure factors. We first compared the baseline characteristics of those with and without SUI, as well as those with and without UUI. The impact of diarrhea or constipation on SUI and UUI was assessed using multivariate logistic regression models. To ensure the stability of the results, subgroup and stratified analyses were conducted. RESULTS The prevalence rates of UUI and SUI were 22.49% and 23.39%, respectively. Adjusted multivariate logistic regression analysis revealed that the risk of UUI was increased by either diarrhea (OR 1.66, 95% CI 1.36-2.04) or constipation (OR 1.42, 95% CI 1.11-1.83). The risk of SUI was also elevated by either diarrhea (OR 1.36, 95% CI 1.11-1.67) or constipation (OR 1.32, 95% CI 1.06-1.63). Subgroup analysis revealed no significant differences in the interaction tests between constipation or diarrhea and UI. CONCLUSIONS This study found that both constipation and diarrhea increase the risk of UUI and SUI.
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Affiliation(s)
- Junwei Wang
- Department of Urology, Wenling Hospital Affiliated to Wenzhou Medical University (The First People's Hospital of Wenling), Taizhou, Zhejiang, China
| | - Haibo Ye
- Department of Urology, Wenling Hospital Affiliated to Wenzhou Medical University (The First People's Hospital of Wenling), Taizhou, Zhejiang, China
| | - Cunming Zhang
- Department of Urology, Wenling Hospital Affiliated to Wenzhou Medical University (The First People's Hospital of Wenling), Taizhou, Zhejiang, China
| | - Aiwei Zhang
- Department of Ultrasound, Wenling Hospital Affiliated to Wenzhou Medical University (The First People's Hospital of Wenling), Taizhou, Zhejiang, China
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Zhu J, Pang H, Wang P, Chen Y, Li H, Liu Q, Wang L, Jin H, Gong L, Xie J, Lai T, Li A, Liu L, Yan M, Zhou L, Luan Y, Wang L, Li X, Luo X, Fu Y, Niu J, Zhao W, Liu Q, Zhao R, Lou W, Morse AN, Yin J, Dang L, Yang H, Li L, Lv J, Zhu L. Female urinary incontinence in China after 15 years' efforts: Results from large-scale nationwide surveys. Sci Bull (Beijing) 2024:S2095-9273(24)00559-0. [PMID: 39214741 DOI: 10.1016/j.scib.2024.04.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 04/22/2024] [Accepted: 04/23/2024] [Indexed: 09/04/2024]
Abstract
Urinary incontinence (UI) is a disease that quietly yet seriously impacts women's health and represents a global health burden that is often neglected. This study aims to systematically assess the prevalence and dynamics of female UI in China, and can inform further policies and have international implications. This study used three nationwide investigations: A national cross-sectional survey in 2021; another nationwide cross-sectional survey in 2006; and data regarding the institutions and physicians providing pelvic floor rehabilitation services from 2005 to 2019. The weighted prevalence of female UI and its subtypes, including stress UI (SUI), urgency UI (UUI), and mixed UI (MUI), were estimated as primary outcomes. Knowledge, attitude and care-seeking behaviors of UI were evaluated. It was found that the weighted prevalence of female UI was 16.0 % (95% CI, 13.3 %-19.1%) with SUI remaining the predominant subtype (7.0%) in 2021, followed by MUI (6.5%) and UUI (1.9%). The estimated absolute number of Chinese adult women with UI was 85.8 million in 2021. 52.7% (95% CI, 45.9%-59.4 %) of women were aware that UI was a medical condition, and only 10.1% of women with UI sought health care. After 15 years of development, there were 8400 pelvic floor rehabilitation institutions and nearly 10,000 relevant physicians in China-they were found to be associated with UI prevalence. The UI prevalence in China was significantly lower in 2021 compared to that in 2006. Despite the achievement, UI remains a public health problem, especially given China's fast aging and three-child policy. More innovations, especially those that can facilitate care seeking, are needed to address this prevalent yet treatable condition.
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Affiliation(s)
- Jiming Zhu
- Vanke School of Public Health, Institute for Healthy China, Tsinghua University, Beijing 100084, China
| | - Haiyu Pang
- Institute of Clinical Medicine, National Infrastructures for Translational Medicine, State Key Laboratory of Common Mechanism Research for Major Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Peicheng Wang
- Vanke School of Public Health, Institute for Healthy China, Tsinghua University, Beijing 100084, China
| | - Yanhua Chen
- Vanke School of Public Health, Institute for Healthy China, Tsinghua University, Beijing 100084, China
| | - Huihui Li
- School of Economics and Wang Yanan Institute for Studies in Economics, Xiamen University, Xiamen 361005, China
| | - Qing Liu
- Department of Gynecology, Gansu Provincial Maternity and Child-Care Hospital, Gansu Provincial Central Hospital, Lanzhou 730050, China
| | - Luwen Wang
- Department of Gynecology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Hangmei Jin
- Department of Gynecology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China
| | - Liyan Gong
- Department of Pelvic Floor Rehabilitation, Hubei Maternity and Childcare Hospital, Hubei Province Women and Children Hospital, Wuhan 430070, China
| | - Jingyan Xie
- Department of Gynecology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
| | - Ting Lai
- Department of Gynecology, Guiyang Maternal and Child Health Care Hospital, Guiyang 550003, China
| | - Aiyang Li
- Beijing Miyun District Hospital, Beijing 101500, China
| | - Lubin Liu
- Department of Obstetrics and Gynecology, Women and Children's Hospital of Chongqing Medical University, Chongqing 401147, China
| | - Mengsha Yan
- Vanke School of Public Health, Institute for Healthy China, Tsinghua University, Beijing 100084, China
| | - Lifei Zhou
- Department of Gynecology, Shijiazhuang Maternal and Child Health Hospital, Shijiazhuang 050051, China
| | - Yanqiu Luan
- Maternal and Child Health Hospital of Beijing Dongcheng District, Beijing 100007, China
| | - Lin Wang
- Department of Gynecology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830001, China
| | - Xiaoli Li
- Department of Gynecology, Shanxi Maternal and Child Health Hospital, Taiyuan 030009, China
| | - Xiping Luo
- Department of Gynecology, Guangdong Province Women and Children Hospital, Guangzhou 511442, China
| | - Yingjie Fu
- Ministry of Women's Health, Harbin Maternal and Child Health Care and Family Planning Service Center, Harbin 150010, China
| | - Jumin Niu
- Department of Gynecology, Shenyang Women's and Children's Hospital, Shenyang 110011, China
| | - Wen Zhao
- Haidian District Maternal and Child Health Care Hospital, Beijing 100080, China
| | - Qiming Liu
- Department of Gynecology and Obstetrics, Maternal and Child Health Hospital of Yanqing District, Beijing 102100, China
| | - Renfeng Zhao
- Department of Gynecology and Obstetrics, Guangxi Academy of Medical Sciences, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, China
| | - Wenjia Lou
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Abraham N Morse
- Department of OBGYN, Tufts University School of Medicine, Boston 02111, USA
| | - Jiahui Yin
- Department of Public Health, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Le Dang
- Department of Gynecology and Obstetrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing 100730, China
| | - Hua Yang
- Department of Gynecology and Obstetrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing 100730, China
| | - Liming Li
- School of Public Health, Peking University Health Science Center, Peking University Center for Public Health and Epidemic Preparedness & Response, Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing 100191, China.
| | - Jun Lv
- School of Public Health, Peking University Health Science Center, Peking University Center for Public Health and Epidemic Preparedness & Response, Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, State Key Laboratory of Vascular Homeostasis and Remodeling, Peking University, Beijing 100191, China.
| | - Lan Zhu
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, State Key Laboratory of Common Mechanism Research for Major Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
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Akan N, Sancar B. Frequency of urinary incontinence and attitudes towards urinary incontinence of women in Mersin, Turkey. Pak J Med Sci 2024; 40:1448-1453. [PMID: 39092057 PMCID: PMC11255790 DOI: 10.12669/pjms.40.7.8134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 05/30/2023] [Accepted: 03/27/2024] [Indexed: 08/04/2024] Open
Abstract
Objectives Urinary incontinence (UI) is the involuntary loss of urine or the inability to control urination. The International Continence Society defines UI as any complaint of involuntary loss of urine. UI is a very important health problem that affects women's quality of life. It can lead to a decrease in women's self-confidence and prevent them from participating in social activities. This study was conducted to investigate the prevalence of UI in women living in Turkey, the factors affecting it, and women's attitudes toward UI. Methods This descriptive and cross-sectional study included 903 women who applied to 17 family health centers in Mersin, Turkey, between May 10th to June 10th 2019 for any reason. The data of the study were obtained using the descriptive information form and the Urinary Incontinence Attitude Scale (UIAS). Data analysis was performed with SPSS-21 using percentiles, mean±standard deviation, and Pearson chi-square tests. Results According to the results obtained, 28.9% of the women had UI problems, more than half (54.6%) of the women with UI did not present to a health institution for this problem, and 54.8% did not receive any treatment. In addition, the frequency of experiencing UI was higher in those with a chronic disease (59.2%) than in those without any chronic disease, and the difference was significant. Conclusion The demographic and fertility characteristics of the women influenced the frequency of experiencing UI. In addition, among the women participating in the study, those with negative attitudes toward UI experienced more UI problems. There should be greater efforts to raise awareness among women on this subject.
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Affiliation(s)
- Nazife Akan
- Nazife Akan, Assistant Professor, Department of Nursing, Faculty of Health Sciences, Toros University, 45 Evler Campus, Mersin, Turkey
| | - Behire Sancar
- Behire Sancar, Assistant Professor, Department of Nursing, Faculty of Health Sciences, Toros University, 45 Evler Campus, Mersin, Turkey
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Qatawneh A, Lari FN, Sawas WA, Alsabree FA, Alowaisheer MK, Aldarawsheh MA, Alshareef RA. Management of Stress Urinary Incontinence by Obstetricians and Gynecologists in Jordan: A Nationwide Survey Study. Healthcare (Basel) 2024; 12:1489. [PMID: 39120192 PMCID: PMC11311483 DOI: 10.3390/healthcare12151489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 07/20/2024] [Accepted: 07/22/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND Stress urinary incontinence (SUI) is a common condition that can significantly impact a patient's quality of life. Although multiple diagnostic and treatment options exist, significant variability in SUI management exists between countries. Since women's SUI prevalence in Jordan is high, and Jordan is a lower-middle-income country, this study aimed to investigate how obstetricians and gynecologists (OBGYNs) across Jordan manage and treat women with SUI. METHOD A Google Forms survey was prepared and sent out to Jordanian OBGYNs via WhatsApp. The results were collected and arranged in Microsoft Excel and then transferred to SPSS for statistical analysis. RESULTS Out of the 804 Jordanian registered OBGYNs, 497 could be reached, 240 conduct gynecological surgeries, and 94 completed the survey, providing a response rate of 39.2%. Most of the respondents were females between 41 and 55 years old. More than 70% of the OBGYNs worked in the private sector, and 88.3% operated in the capital of Jordan. Most of the respondents favored lifestyle and behavior therapy (43.6%) or pelvic floor physiotherapy (40.4%) as the first-line management for SUI. The transobturator mid-urethral sling (MUS) was the most common initial surgical treatment option. The physicians preferred two-staged procedures for the repair of pelvic organ prolapse alongside concomitant SUI. In the case of recurrent SUI following surgery, 77% of the respondents chose to refer to a urologist or urogynecologist. CONCLUSIONS The Jordanian OBGYNs preferred using lifestyle/behavioral therapy and pelvic floor muscle physiotherapy as the first-line treatment to manage SUI. Secondly, the MUS would be the most frequently preferred surgical choice. To effectively manage SUI, adequate training in urogynecology and referral resources are essential in lower-middle-income countries.
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Affiliation(s)
- Ayman Qatawneh
- Department of Obstetrics and Gynecology, The University of Jordan, Amman 11942, Jordan
| | - Fatemah N. Lari
- Department of Medicine, The University of Jordan, Amman 11942, Jordan; (F.N.L.); (W.A.S.); (F.A.A.); (M.K.A.); (M.A.A.); (R.A.A.)
| | - Wedad A. Sawas
- Department of Medicine, The University of Jordan, Amman 11942, Jordan; (F.N.L.); (W.A.S.); (F.A.A.); (M.K.A.); (M.A.A.); (R.A.A.)
| | - Fatemah A. Alsabree
- Department of Medicine, The University of Jordan, Amman 11942, Jordan; (F.N.L.); (W.A.S.); (F.A.A.); (M.K.A.); (M.A.A.); (R.A.A.)
| | - Mariam Kh. Alowaisheer
- Department of Medicine, The University of Jordan, Amman 11942, Jordan; (F.N.L.); (W.A.S.); (F.A.A.); (M.K.A.); (M.A.A.); (R.A.A.)
| | - Marah A. Aldarawsheh
- Department of Medicine, The University of Jordan, Amman 11942, Jordan; (F.N.L.); (W.A.S.); (F.A.A.); (M.K.A.); (M.A.A.); (R.A.A.)
| | - Renad A. Alshareef
- Department of Medicine, The University of Jordan, Amman 11942, Jordan; (F.N.L.); (W.A.S.); (F.A.A.); (M.K.A.); (M.A.A.); (R.A.A.)
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Er-Rabiai Y, Torres-Lacomba M, Casaña J, López-Bueno R, Núñez-Cortés R, Calatayud J. The Effectiveness of Adding Transvaginal Radiofrequency to Pelvic Floor Muscle Training for 6 Weeks in Women with Stress Urinary Incontinence. A Double-Blind Randomised Controlled Trial. Int Urogynecol J 2024:10.1007/s00192-024-05874-5. [PMID: 39060727 DOI: 10.1007/s00192-024-05874-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 06/30/2024] [Indexed: 07/28/2024]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to evaluate the clinically beneficial effect of adding transvaginal monopolar non-ablative radiofrequency (RF) to pelvic floor muscle training (PFMT) on leakage severity, quality of life and urinary incontinence-related symptoms in women with stress urinary incontinence (SUI). METHODS A double-blind randomised controlled trial was conducted, with a 6-week intervention and a 6-month follow-up. Participants were randomly assigned to the experimental group (PFMT plus RF; n = 18) or the control group (PFMT plus placebo; n = 20). The primary outcome was the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF). Secondary outcomes included the Pelvic Floor Distress Inventory-20 (PFDI-20) and the Pelvic Floor Impact Questionnaire-7 (PFIQ-7), self-efficacy, female sexual function, pelvic floor muscle dynamometry, 1-h pad test and number of SUI episodes per week. Inferential analyses of the data were performed using a two-factor analysis of variance. RESULTS Both groups achieved a statistically significant improvement in ICIQ-SF over time. However, the differences observed in the experimental group exceeded the minimal clinically important differences by 4 points (MD = -9.4, 95% CI = -12.6 to -6.3), which was not observed in the control group (MD = -3.9, 95% CI = -6.9 to -1.0). This was maintained at the 6-month follow-up with a significant time*group interaction (p < 0.001, ηp2 = 0.150). There was no time*group interaction in the other variables (p > 0.05). Additionally, a significant difference in favour of the experimental group was observed in the 1-h pad test and episodes of SUI per week (p < 0.05). CONCLUSIONS This study highlights the beneficial effects of adding transvaginal RF to PFMT on the severity and amount of leakage, as well as on the quality of life and urinary incontinence-related symptoms in women with moderate SUI. Future trials are needed to assess the effects of this intervention in women with severe SUI.
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Affiliation(s)
- Yasmin Er-Rabiai
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - María Torres-Lacomba
- Physiotherapy in Women's Health (FPSM) Research Group, Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, Madrid, Spain
| | - José Casaña
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Rubén López-Bueno
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain
- Department of Physical Medicine and Nursing, University of Zaragoza, Zaragoza, Spain
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Rodrigo Núñez-Cortés
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain.
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile.
| | - Joaquín Calatayud
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain
- National Research Centre for the Working Environment, Copenhagen, Denmark
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Cao S, Hu X, Tang Y, Wu K, Yang W, Li X. Weight-adjusted-waist index is positively associated with urinary incontinence: results from the National Health and Nutrition Examination Survey (NHANES) 2001-2018. Eur J Med Res 2024; 29:368. [PMID: 39014459 PMCID: PMC11253391 DOI: 10.1186/s40001-024-01971-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 07/10/2024] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND Urinary incontinence (UI) is closely related to obesity. The aim of this study is to evaluate the association of a novel anthropometric indicator weight-adjusted-waist index (WWI) with UI. METHODS This cross-sectional study used the data from National Health and Nutrition Examination Survey (NHANES) 2001-2018. Weighted multivariable logistic regression was used to evaluate the relationship between WWI and three types of UI [stress UI (SUI), urgency UI (UUI), and mixed UI (MUI)]. The receiver operating characteristic (ROC) curve and Delong et al.'s test were utilized for comparison of the predictive capability for UI between WWI and body mass index (BMI), waist circumference (WC). RESULTS A total of 41,614 participants were included in this study, of whom 23.57% had SUI, 19.24% had UUI, and 9.43% had MUI. In the fully adjusted model, WWI was positively associated with three types of UI [SUI: odds ratio (OR) = 1.19, 95%Confidence interval (CI) 1.13-1.25; UUI: OR = 1.18, 95%CI 1.13-1.24; MUI: OR = 1.19, 95%CI 1.11-1.27, all p < 0.001]. Compared to the lowest WWI interval, the positive correlation between WWI and UI still existed in the highest WWI group after converting WWI to a categorical variable by quartiles (SUI: OR = 1.52, 95%CI 1.35-1.71, p < 0.001; UUI: OR = 1.50, 95%CI 1.33-1.69, p < 0.001; MUI: OR = 1.55, 95%CI 1.32-1.83, p < 0.001). WWI had a stronger prediction for three types of UI than BMI and WC (all p < 0.001). CONCLUSION A higher WWI was linked with an increased likelihood of three types of UI (SUI, UUI, and MUI) in the United State population. Compared to BMI and WC, WWI had a stronger predictive power for UI. WWI may be a better adiposity parameter for evaluating UI.
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Affiliation(s)
- Shangqi Cao
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, China
| | - Xu Hu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, China
| | - Yaxiong Tang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, China
| | - Kang Wu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, China
| | - Weixiao Yang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, China
| | - Xiang Li
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, China.
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9
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González Enguita C, Garranzo García-Ibarrola M, Tufet I Jaumont JJ, Garde García H, González López R, Quintana Franco LM, Torres Zambrano GM, García-Arranz M. Cell Therapy in the Treatment of Female Stress Urinary Incontinence: Current Status and Future Proposals. Life (Basel) 2024; 14:861. [PMID: 39063615 PMCID: PMC11278173 DOI: 10.3390/life14070861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 07/01/2024] [Accepted: 07/02/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Stress urinary incontinence (SUI) is a common condition with a significant impact on the quality of life of female patients. The limitations of current treatment strategies have prompted the exploration of new effective and minimally invasive alternative approaches, including cell therapy. METHODS A literature search was conducted to update the current clinical status of stem cell therapy in the management of female stress urinary incontinence. RESULTS Over thirty clinical studies have been designed to assess the feasibility, safety and efficacy of cell therapy for female SUI. Despite differences in cell types and protocols, the overall treatment procedures were similar. Standard subjective and objective assessment tools, and follow-up periods ranged from 6 weeks to 6 years have been used. Cell injection has shown to be a safe therapy in the treatment of female SUI. However, the results from more recent randomized trials have shown less promising results than expected in restoring continence. Heterogeneous research methodologies using different cell types and doses make it difficult to draw conclusions about effectiveness. Several key points remain that need to be further explored in future clinical trials. CONCLUSION To advance in the development of cell therapy, it is essential to know the mechanisms involved to be able to direct it properly, its efficacy and the durability of the injected cells. Rigorous and homogenized preclinical and clinical studies that demonstrate its scope and improve its application are necessary for validation in the treatment of female SUI.
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Affiliation(s)
- Carmen González Enguita
- Urology Department, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain; (J.J.T.I.J.); (H.G.G.); (R.G.L.); (L.M.Q.F.)
| | - María Garranzo García-Ibarrola
- Urology Department, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain; (J.J.T.I.J.); (H.G.G.); (R.G.L.); (L.M.Q.F.)
| | - Jaime Jorge Tufet I Jaumont
- Urology Department, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain; (J.J.T.I.J.); (H.G.G.); (R.G.L.); (L.M.Q.F.)
| | - Héctor Garde García
- Urology Department, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain; (J.J.T.I.J.); (H.G.G.); (R.G.L.); (L.M.Q.F.)
| | - Raquel González López
- Urology Department, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain; (J.J.T.I.J.); (H.G.G.); (R.G.L.); (L.M.Q.F.)
| | - Luis Miguel Quintana Franco
- Urology Department, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain; (J.J.T.I.J.); (H.G.G.); (R.G.L.); (L.M.Q.F.)
| | | | - Mariano García-Arranz
- Instituto Investigaión Sanitaria Fundación Jiménez Díaz (IIS-FJD), 28040 Madrid, Spain;
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10
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Grosman Y, Kalichman L. Bidirectional Relationships between Sarcopenia and Pelvic Floor Disorders. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:879. [PMID: 39063456 PMCID: PMC11276977 DOI: 10.3390/ijerph21070879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Revised: 07/03/2024] [Accepted: 07/03/2024] [Indexed: 07/28/2024]
Abstract
Sarcopenia and pelvic floor disorders (PFDs) are prevalent and often cooccurring conditions in the aging population. However, their bidirectional relationship and underlying mechanisms remain underexplored. This narrative review aims to elucidate this relationship by exploring potential causative interplays, shared pathophysiological mechanisms, and common risk factors. A comprehensive literature search was conducted to identify relevant studies focusing on epidemiological associations, interaction mechanisms, and implications for patient care. While epidemiological studies demonstrate associations between sarcopenia and PFDs, our findings reveal a cyclical relationship where sarcopenia may exacerbate PFDs through mechanisms such as decreased muscle strength and mobility. Conversely, the presence of PFDs often leads to reduced physical activity due to discomfort and mobility issues, which in turn exacerbate the muscle atrophy associated with sarcopenia. Additionally, shared risk factors such as physical inactivity, nutritional deficiencies, metabolic syndrome, and menopausal hormonal changes likely contribute to the onset and progression of both conditions. These interactions underscore the importance of concurrently integrated care approaches that address both conditions. Effective management requires comprehensive screening, the recognition of contributing factors, and tailored exercise regimens supported by a multidisciplinary approach. Future research should focus on longitudinal studies tracking disease progression and evaluating the efficacy of multidisciplinary care models in optimizing patient outcomes.
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Affiliation(s)
- Yacov Grosman
- Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 653, Beer Sheva 84105, Israel
- Department of Physical Therapy, Meuhedet Health Maintenance Organization, Hadera 3824242, Israel
| | - Leonid Kalichman
- Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 653, Beer Sheva 84105, Israel
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11
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Jagadeeswari J, Kalabarathi S, Bhuvaneswari G. Impact of Knack Manoeuvre Among Women with Urinary Incontinence: A Quasi Experimental Study. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2024; 16:S2000-S2002. [PMID: 39346196 PMCID: PMC11426615 DOI: 10.4103/jpbs.jpbs_533_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 05/18/2024] [Accepted: 05/20/2024] [Indexed: 10/01/2024] Open
Abstract
Objective The Objective of the study is to assess the effectiveness of Knack manoeuvre among women with urinary incontinence. Methods A quasi-experimental study with a repeated measures design was used to conduct study at Saveetha Medical College Hospital. Experimental group received Knack manoeuvre for 6 months and control group received routine care. The sample size was 100, which was recruited by purposive sampling technique. The data were collected with structured questionnaire, and questionnaire for urinary incontinence diagnosis and biophysiological parameters were assessed by abdominal leak peak pressure (ALPP). Results The study results depict that frequency and percentage distribution of pretest and post-test level of ALPP. Between group comparison of post-test at 6 months of control and experimental showed significance (P < 0.001). There was a progressive decrease in ALPP of control and experimental groups. Conclusion To our knowledge, this is the first prospective nonrandomized study that assesses the efficacy of the Knack manoeuvre on urine incontinence by assessing biophysiological parameters.
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Affiliation(s)
- J Jagadeeswari
- Ph.D Scholar, Department of Obstetrics and Gynecology, Saveetha College of Nursing, Saveetha Institute of Medical and Technical Sciences, Thandalam, Chennai, Tamil Nadu, India
| | - S. Kalabarathi
- Department of Obstetrics and Gynecology, Saveetha College of Nursing, Saveetha Institute of Medical and Technical Sciences, Thandalam, Chennai, Tamil Nadu, India
| | - G. Bhuvaneswari
- Department of Community Health Nursing, Saveetha College of Nursing, Saveetha Institute of Medical and Technical Sciences, Thandalam, Chennai, Tamil Nadu, India
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12
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Syeda F, Pandit U. Urinary Incontinence in Female Athletes: A Systematic Review on Prevalence and Physical Therapy Approaches. Cureus 2024; 16:e64544. [PMID: 39144856 PMCID: PMC11322629 DOI: 10.7759/cureus.64544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2024] [Indexed: 08/16/2024] Open
Abstract
Urinary incontinence (UI) is an involuntary leakage of urine and is classified as stress, mixed, or urge. It is more common in females due to anatomical and physiological body differences. Moreover, the literature remarks an evident presence of UI with high-intensity physical activities. Therefore, the present integrative systematic review focused on the studies aimed at investigating the prevalence of UI in nulliparous sportswomen, studies illustrating sport-specific prevalence of UI, and studies demonstrating the impact of physical therapy intervention on UI. A literature search was carried out systematically on electronic databases consisting of Cochrane and Google Scholar databases from 2018 to December 2023. The keywords utilized to perform the literature search and include relevant articles consisted of "urinary incontinence," AND "nulliparous," AND "sportswomen," OR "female athletes," AND "physical therapy". A total of nine studies were included in the present systematic review. The quality assessment of the studies was performed by using a measurement tool to assess systematic reviews (AMSTAR 2) scale, and the Mixed Methods Appraisal Tool was used for cross-sectional and randomized controlled trial studies. The data extracted included first author and year of publication, study design, sample or number of individuals involved in the study, age range of the participants, type of UI, type of sports involved, purpose of the study, methodological part, outcome measures derived, conclusion, and quality assessment of the studies. The review concluded that nulliparous athletes, especially those participating in high-impact activities, have a significant prevalence of UI. In addition, the physical therapy intervention consisting of pelvic floor muscle training (PFMT) along with education about pertinent pelvic anatomy was mostly performed on female athletes for the prevention and management of UI.
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Affiliation(s)
- Fizzia Syeda
- Department of Community Health Physiotherapy, D. Y. Patil School of Physiotherapy, D. Y. Patil University, Navi Mumbai, IND
| | - Unnati Pandit
- Department of Community Health Physiotherapy, D. Y. Patil School of Physiotherapy, D. Y. Patil University, Navi Mumbai, IND
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13
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Lee UJ, MacDiarmid S, Matthews CA, Gillespie E, Peters KM. Tibial Nerve Stimulation for Urge Urinary Incontinence and Overactive Bladder: Narrative Review of Randomized Controlled Trials and Applicability to Implantable Devices. Adv Ther 2024; 41:2635-2654. [PMID: 38748331 DOI: 10.1007/s12325-024-02864-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 04/01/2024] [Indexed: 06/29/2024]
Abstract
The tibial nerve is an established target for neuromodulation in the management of overactive bladder (OAB) and its associated symptoms, including urge urinary incontinence (UUI). Technologies are currently available to deliver tibial nerve stimulation (TNS) through percutaneous devices or through implantable devices. The benefits and safety of percutaneous TNS have led to it as a guideline-recommended therapy. However, patient compliance is limited by the burden of weekly office visits and the need for maintenance treatments. Further, insurance often only covers a limited number of lifetime visits for percutaneous TNS. These factors and others have led to the development, study, and utilization of implantable TNS devices. Implantable TNS devices deliver the same therapeutic mechanism of action for nerve stimulation with a permanent implanted device that provides at-home stimulation rather than in-office therapy delivery. Additionally, there is an added potential for dynamic and patient-centered stimulation. There is a large body of high-quality evidence published for TNS, including numerous randomized controlled trials published on percutaneous TNS which have consistently demonstrated superior efficacy to sham and similar efficacy to that of anticholinergic medications. Percutaneous TNS also performs better than conservative therapy including pelvic floor muscle training. The percutaneous and implantable approaches deliver nerve stimulation to the same target nerve, using the same mechanism of action. Therefore, data from randomized trials of percutaneous TNS are informative for implantable TNS devices. At the time of this article's publication, at least two implantable TNS devices have received marketing authorization from the Food and Drug Administration (FDA). The objective of this review is to discuss the mechanism of action for TNS and summarize the published literature from clinical trials of percutaneous TNS as a foundation of high-quality evidence for implantable devices targeting the tibial nerve.
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Affiliation(s)
- Una J Lee
- Virginia Mason Medical Center, 1100 Ninth Ave C7-URO, Seattle, WA, 98101, USA.
| | | | | | | | - Kenneth M Peters
- Corewell Health William Beaumont University Hospital, Royal Oak, MI, USA
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14
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Er-Rabiai Y, Torres-Lacomba M, Casaña J, Núñez-Cortés R, Calatayud J. Correlation of Self-Efficacy for Pelvic Floor Muscle Exercise with Symptoms of Stress Urinary Incontinence in Women. Int Urogynecol J 2024; 35:1487-1493. [PMID: 38861006 DOI: 10.1007/s00192-024-05818-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 04/24/2024] [Indexed: 06/12/2024]
Abstract
INTRODUCTION AND HYPOTHESIS Self-efficacy for pelvic floor exercises, i.e. confidence in achieving pelvic floor contractions, may predict adherence to treatment. However, there is a paucity of literature investigating the clinical relevance of this outcome. The aim was to determine the relationship between self-efficacy for pelvic floor exercise and symptom severity, pelvic floor distress and impact on quality of life, as well as sociodemographic characteristics and pelvic floor muscle strength in women with stress urinary incontinence (SUI). METHODS A cross-sectional study was conducted in women with SUI. The Spanish version of the Broome Pelvic Muscle Self-Efficacy Scale was used to assess self-efficacy for pelvic floor exercise. The dependent variables were: urinary incontinence symptoms using the International Consultation on Incontinence Questionnaire, short form (ICIQ-SF), pelvic floor distress symptoms using the Urogenital Distress Inventory-6, impact on quality of life using the Incontinence Impact Questionnaire (IIQ-7), leakage using the 1-h pad test, number of SUI episodes per week and pelvic floor muscle strength. RESULTS A total of 56 women with a median age of 44.5 years were included. Self-efficacy for pelvic floor exercise correlated negatively and moderately with the ICIQ-SF (r = -0.529; p < 0.001), IIQ-7 (r = -0.442; p = 0.001), 1-h pad test (rs = -0.467; p < 0.001); and number of SUI episodes/week (rs = -0.489; p < 0.001). Correlation with the other outcomes was weak or non-existent. Linear regression with forward selection showed that the ICIQ-SF was the variable most related to self-efficacy (β: -3.01, 95% CI: -4.03 to -1.69). CONCLUSIONS These findings highlight the importance of assessing self-efficacy for pelvic floor exercise in the treatment of women with SUI. Future prospective studies are needed to confirm these findings.
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Affiliation(s)
- Yasmin Er-Rabiai
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - María Torres-Lacomba
- Physiotherapy in Women's Health (FPSM) Research Group, Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, Madrid, Spain
| | - José Casaña
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Rodrigo Núñez-Cortés
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain.
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile.
| | - Joaquín Calatayud
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain
- National Research Centre for the Working Environment, Copenhagen, Denmark
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15
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Zhou C, Zhu L, Liu Z, Tong Y, Xu Y, Jiang L, Li X. Whole body vibration training promotes proprioceptive pathway for the treatment of stress urinary incontinence in rats. Transl Androl Urol 2024; 13:657-666. [PMID: 38855607 PMCID: PMC11157409 DOI: 10.21037/tau-23-675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 03/31/2024] [Indexed: 06/11/2024] Open
Abstract
Background Stress urinary incontinence (SUI) is the most ubiquitous form of urinary incontinence in women. The therapeutic management of patients with SUI is challenging. The aim of this study is to evaluate the efficacy of whole body vibration training (WBVT) for SUI. Methods Thirty-five female rats were randomly divided into a sham group (Sham group, n=5), SUI + WBVT group (n=15) and SUI + whole body rest group (SUI + WBR group, n=15). The SUI + WBVT group was trained as follows: frequency 30 Hz, amplitude four mm, one min/repeat, four min rest, repeated 10 times, five days/week. After the intervention, five rats were taken on the 7th, 14th and 21st day to observe the urodynamic changes, levator ani muscle and dorsal root ganglia (DRG) morphology, and to observe the expression of neurotrophic factor-3/tyrosine protein kinase C (NT-3/TrkC) by Western blot. Results The urodynamic results showed that the difference in bladder leak point pressure/abdominal leak point pressure (BLPP/ALPP) between the Sham group and the SUI + WBR group was statistically significant (P<0.001) on 7th day, indicating successful modeling. The BLPP/ALPP of the SUI + WBVT group and the SUI + WBR group improved on 7th, 14th, and 21st day, and the BLPP/ALPP of SUI + WBVT group was higher than the SUI + WBR group. Compared with the Sham group, pathological changes appeared in the muscle shuttles in the SUI + WBVT group and SUI + WBR group. Western blot showed a gradual up-regulation of NT-3/TrkC. Conclusions WBVT can be used to treat SUI by affecting the expression of NT-3/TrkC, improving the structural morphology of the proprioceptors, and restoring the urinary control function. This study provides evidence for the clinical practice of WBVT. Future studies could further refine the behavioral and electrophysiological aspects of the assessment.
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Affiliation(s)
- Chengyu Zhou
- Department of Rehabilitation Medicine, The 3rd Xiangya Hospital, Central South University, Changsha, China
| | - Liping Zhu
- Department of Rehabilitation Medicine, The 3rd Xiangya Hospital, Central South University, Changsha, China
| | - Zhaoxue Liu
- Department of Rehabilitation Medicine, The 3rd Xiangya Hospital, Central South University, Changsha, China
| | - Yao Tong
- Department of Rehabilitation Medicine, The 3rd Xiangya Hospital, Central South University, Changsha, China
| | - Yuting Xu
- Department of Rehabilitation Medicine, The 3rd Xiangya Hospital, Central South University, Changsha, China
| | - Li Jiang
- Department of Rehabilitation Medicine, The 3rd Xiangya Hospital, Central South University, Changsha, China
- Postdoctoral Research Station of Basic Medicine, The 3rd Xiangya Hospital, Central South University, Changsha, China
| | - Xuhong Li
- Department of Rehabilitation Medicine, The 3rd Xiangya Hospital, Central South University, Changsha, China
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Kjeldsen AC, Taastrøm KA, Gommesen D, Hjorth S, Axelsen S, Nohr EA. Reproductive history of parous women and urinary incontinence in midlife: A National Birth Cohort follow-up study. BJOG 2024. [PMID: 38800995 DOI: 10.1111/1471-0528.17862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 04/08/2024] [Accepted: 04/29/2024] [Indexed: 05/29/2024]
Abstract
OBJECTIVE To investigate how reproductive history was associated with urinary incontinence in midlife. DESIGN A follow-up study. SETTING Denmark. POPULATION A total of 39 977 mothers who participated in the Maternal Follow up (2013-2014) in the Danish National Birth Cohort. National registries provided their reproductive history. METHODS How parity, mode of birth and obstetric tears associated with urinary incontinence were estimated with adjusted odds ratios (OR) and 95% CI using logistic regression. MAIN OUTCOME MEASURES Self-reported urinary incontinence including subtypes stress, urge and mixed urinary incontinence. RESULTS At an average age of 44 years, the prevalence of any urinary incontinence was 32% (21% stress, 2% urge, and 8% mixed urinary incontinence). Women with two births more often had urinary incontinence than women with one birth (OR 1.20, 95% CI 1.10-1.31). Compared with women with only spontaneous births, a history of only caesarean sections was associated with much lower odds of urinary incontinence (OR 0.39, 95% CI 0.35-0.42) and a history of instrumental births with slightly lower odds (OR 0.92, 95% CI 0.86-0.98). Compared with no tear/first-degree tear as the largest tear, episiotomy was associated with less urinary incontinence (OR 0.91, 95% CI 0.86-0.97) whereas third/fourth-degree tears were associated with more (OR 1.14, 95% CI 1.04-1.25). Findings were mainly explained by similar associations with stress and mixed urinary incontinence. CONCLUSIONS Vaginal birth was associated with a higher risk of long-term urinary incontinence, but our results indicate that this risk may be reduced by shortening the second stage of birth.
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Affiliation(s)
- Anne Cathrine Kjeldsen
- Research Unit for Gynaecology and Obstetrics, Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
| | - Katja Albert Taastrøm
- Research Unit for Gynaecology and Obstetrics, Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
| | - Ditte Gommesen
- Research Unit for Gynaecology and Obstetrics, Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark
| | - Sarah Hjorth
- Research Unit for Gynaecology and Obstetrics, Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark
| | - Susanne Axelsen
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
| | - Ellen Aagaard Nohr
- Research Unit for Gynaecology and Obstetrics, Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark
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Wang Q, Jiang XX, Que YZ, Wan XY, Lin CQ. Development and Validation of a Risk Prediction Model for Female Stress Urinary Incontinence in Rural Fujian, China. Risk Manag Healthc Policy 2024; 17:1101-1112. [PMID: 38707519 PMCID: PMC11069356 DOI: 10.2147/rmhp.s457332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 04/19/2024] [Indexed: 05/07/2024] Open
Abstract
Purpose With China's rapidly aging population and the rising proportion of obese people, an increase in the number of women suffering from urinary incontinence (UI) is to be expected. In order to identify high-risk groups before leakage occurs, we aimed to develop and validate a model to predict the risk of stress UI (SUI) in rural women. Patients and methods This study included women aged 20-70 years in rural Fujian who participated in an epidemiologic survey of female UI conducted between June and October 2022. Subsequently the data was randomly divided into training and validation sets in a ratio of 7:3. Univariate and multivariate logistic regression analyses were used to identify independent risk factors as well as to further construct a nomogram for risk prediction. Finally, concordance index (C-index), calibration curve and decision curve analysis were applied to evaluate the performance of the predictive models. Results A total of 5290 rural females were enrolled, of whom 771 (14.6%) had SUI. Age, body mass index (BMI), postmenopausal status, number of vaginal deliveries, vaginal delivery of large infant, constipation and family history of pelvic organ prolapse (POP) and SUI were included in the nomogram. C-index of this prediction model for the training and validation sets was 0.835 (95% confidence interval [CI] = 0.818-0.851) and 0.829 (95% CI = 0.796-0.858), respectively, and the calibration curves and decision analysis curves for both the training and validation sets showed that the model was well-calibrated and had a positive net benefit. Conclusion This model accurately estimated the SUI risk of rural women in Fujian, which may serve as an effective primary screening tool for the early identification of SUI risk and provide a basis for further implementation of individualized early intervention. Moreover, the model is concise and intuitive, which makes it more operational for rural women with scarce medical resources.
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Affiliation(s)
- Qi Wang
- Department of Gynecology, Fujian Maternity and Child Health Hospital, Fujian Provincial Key Laboratory of Women and Children’s Critical Diseases Research, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, People’s Republic of China
| | - Xiao-Xiang Jiang
- Department of Gynecology, Fujian Maternity and Child Health Hospital, Fujian Provincial Key Laboratory of Women and Children’s Critical Diseases Research, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, People’s Republic of China
| | - Yan-Zhen Que
- Department of Gynecology and Obstetrics, Shaxian General Hospital, Sanming, People’s Republic of China
| | - Xiao-Ying Wan
- Department of Gynecology and Obstetrics, Shaxian General Hospital, Sanming, People’s Republic of China
| | - Chao-Qin Lin
- Department of Gynecology, Fujian Maternity and Child Health Hospital, Fujian Provincial Key Laboratory of Women and Children’s Critical Diseases Research, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, People’s Republic of China
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Garzón-Alfaro MT, Cruz-Medel I, Alcaraz-Clariana S, García-Luque L, Carmona-Pérez MC, Garrido-Castro JL, Alburquerque-Sendín F, Rodrigues-de-Souza DP. Influence of vaginal birth on lumbopelvic muscle mechanical properties on urinary incontinence. Clin Rehabil 2024; 38:558-568. [PMID: 38295335 DOI: 10.1177/02692155231224058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
OBJECTIVE To identify differences in the muscle mechanical properties of the pelvic floor (PF) and lumbar paravertebral (LP) muscles between young nulliparous and uni/multiparous women. Secondarily, specific behaviors, depending on the presence or absence or urinary incontinence (UI), were also researched. DESIGN Case-control study. SETTING Higher education institution. PARTICIPANTS One hundred young women participated, divided into two groups depending on whether they had vaginal birth (nulliparous or uni/multiparous). Each group included women with and without UI. MAIN MEASURES A muscle mechanical properties (tone, stiffness, decrement-inverse of elasticity-, and viscoelastic properties: relaxation and creep) assessment of the PF and LP muscles were performed with a hand-held tonometer. RESULTS Tone and stiffness of both sides of the PF presented group by UI interaction (p < 0.05), with uni/multiparous women with UI showing higher tone and stiffness compared to multiparous women without UI. In LP muscles, uni/multiparous women showed greater tone and stiffness on the right and left sides [-2.57 Hz (95% confidence interval -4.42,-0.72) and -79.74 N/m (-143.52,-15.97); -2.20 Hz (-3.82,-0.58) and -81.30 N/m (-140.66-,21.95), respectively], as well as a decrease in viscoelastic properties compared to nulliparous women [relaxation: 2.88 ms (0.31,5.44); creep: 0.15 (0.01,0.30); relaxation: 2.69 ms (0.13,5.25); creep: 0.14 (0,0.28), respectively]. CONCLUSIONS Vaginal birth and UI have a differential influence on the muscle mechanical properties of the PF and LP muscles. The determination of muscle mechanical properties by externally applied hand-held tonometry improves the knowledge of the lumbopelvic status, with applicability in clinical and research fields.
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Affiliation(s)
- María Teresa Garzón-Alfaro
- Department of Nursing, Pharmacology and Physical Therapy, Faculty of Medicine and Nursing, University of Córdoba, Córdoba, Spain
| | - Inés Cruz-Medel
- Department of Nursing, Pharmacology and Physical Therapy, Faculty of Medicine and Nursing, University of Córdoba, Córdoba, Spain
| | - Sandra Alcaraz-Clariana
- Department of Nursing, Pharmacology and Physical Therapy, Faculty of Medicine and Nursing, University of Córdoba, Córdoba, Spain
| | - Lourdes García-Luque
- Department of Nursing, Pharmacology and Physical Therapy, Faculty of Medicine and Nursing, University of Córdoba, Córdoba, Spain
| | - María Cristina Carmona-Pérez
- Department of Nursing, Pharmacology and Physical Therapy, Faculty of Medicine and Nursing, University of Córdoba, Córdoba, Spain
| | - Juan Luis Garrido-Castro
- Department of Computer Science and Numerical Analysis, Rabanales Campus, University of Córdoba, Córdoba, Spain
- GC05 Systemic and chronic inflammatory autoimmune diseases of the locomotor system and connective tissue, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Spain
| | - Francisco Alburquerque-Sendín
- Department of Nursing, Pharmacology and Physical Therapy, Faculty of Medicine and Nursing, University of Córdoba, Córdoba, Spain
- GC05 Systemic and chronic inflammatory autoimmune diseases of the locomotor system and connective tissue, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Spain
| | - Daiana Priscila Rodrigues-de-Souza
- Department of Nursing, Pharmacology and Physical Therapy, Faculty of Medicine and Nursing, University of Córdoba, Córdoba, Spain
- GC05 Systemic and chronic inflammatory autoimmune diseases of the locomotor system and connective tissue, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Spain
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19
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Williams BR, Brady SS, Levin EC, Brown O, Lipman TH, Klusaritz H, Nodora J, Coyne-Beasley T, Putnam S, Gahagan S, Burgio KL. Black women's perspectives on bladder health: Social-ecological and life course contexts. Neurourol Urodyn 2024; 43:849-861. [PMID: 38451032 PMCID: PMC11138321 DOI: 10.1002/nau.25437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/21/2024] [Accepted: 02/19/2024] [Indexed: 03/08/2024]
Abstract
AIMS This paper explores Black women's perspectives on bladder health using a social-ecological conceptual framework and life course perspective. METHODS We conducted a directed content analysis of data from the Study of Habits, Attitudes, Realities, and Experiences (SHARE), a focus group study by the Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium. Analysis was conducted on data from five focus groups and a member-checking session where all participants self-identified as Black or African American. RESULTS Forty-two participants aged 11-14 or 45+ years reported life course experiences with their bladder. The intersection of race and gender was the lens through which participants viewed bladder health. Participants' accounts of their perspectives on bladder health explicitly and implicitly revealed structural racism as an explanatory overarching theme. Participants described (a) historically-rooted and still pervasive practices of discrimination and segregation, engendering inequitable access to quality medical care and public facilities, (b) institutional barriers to toileting autonomy in educational and occupational settings, promoting unhealthy voiding habits, (c) internalized expectations of Black women's stereotyped role as family caregiver, compromising caregiver health, (d) lack of reliable information on bladder health, leading to unhealthy bladder behaviors, and (e) potentially stress-related comorbid chronic conditions and associated medication use, causing or exacerbating bladder problems. CONCLUSIONS Bladder health promotion interventions should address social-ecological and life course factors shaping Black women's bladder health, including social and structural barriers to accessing equitable health information and medical care.
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Affiliation(s)
- Beverly R Williams
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham, Alabama, USA
| | - Sonya S Brady
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Elise C Levin
- Division of Community Health Services, School of Public Health, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Oluwateniola Brown
- Division of Female Pelvic Medicine and Reconstructive Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Terri H Lipman
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Heather Klusaritz
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jesse Nodora
- Division of Applied Sciences, Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California, USA
| | - Tamera Coyne-Beasley
- Department of Pediatrics, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Sara Putnam
- Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Sheila Gahagan
- Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, California, USA
| | - Kathryn L Burgio
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham, Alabama, USA
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20
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Carlson K, Andrews M, Bascom A, Baverstock R, Campeau L, Dumoulin C, Labossiere J, Locke J, Nadeau G, Welk B. 2024 Canadian Urological Association guideline: Female stress urinary incontinence. Can Urol Assoc J 2024; 18:83-102. [PMID: 38648655 PMCID: PMC11034962 DOI: 10.5489/cuaj.8751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Affiliation(s)
- Kevin Carlson
- Southern Alberta Institute of Urology & Section of Urology, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Matthew Andrews
- Division of Urology, Department of Surgery, Memorial University, St. John’s, NL, Canada
| | | | - Richard Baverstock
- Southern Alberta Institute of Urology & Section of Urology, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Lysanne Campeau
- Division of Urology, Department of Surgery, McGill University, Montreal, QC, Canada
| | | | - Joe Labossiere
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | | | - Geneviève Nadeau
- Division of Urology, Department of Surgery, Université Laval, Quebec, QC, Canada
| | - Blayne Welk
- Division of Urology, Department of Surgery, Western University, London, ON, Canada
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21
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Xu X, Guo P, Xu P, Chen DD, Chen W, Wang H, Jin Y, Wang X, Zhang W, Xie F, Mao M, Zhao R, Feng S. Effectiveness of web-based interventions for women with urinary incontinence: protocol for a systematic review and meta-analysis of randomised controlled trials. BMJ Open 2024; 14:e081731. [PMID: 38553066 PMCID: PMC10982709 DOI: 10.1136/bmjopen-2023-081731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 03/08/2024] [Indexed: 04/02/2024] Open
Abstract
INTRODUCTION Urinary incontinence (UI) is one of the most common chronic diseases among women, which can endanger their physical and mental health and incur a heavy financial burden on both individuals and society. Web-based interventions (WBIs) have been applied to manage women's UI, but their effectiveness has remained inconclusive. This systematic review and meta-analysis aims to explore the effectiveness of WBIs on self-reported symptom severity, condition-specific quality of life, adherence to pelvic floor muscle training (primary outcomes) and other extensive secondary outcomes among women with UI. We also aimed to investigate whether intervention characteristics (format, interactivity and main technology) have impacts on the effectiveness of primary outcomes. METHODS AND ANALYSIS This systematic review protocol was developed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols guidelines. 10 electronic databases will be comprehensively searched from their inception to 1 May 2024, along with grey literature searches and manual reviews of relevant reference lists to identify eligible randomised controlled trials. The methodological quality of the included studies will be assessed by two reviewers based on the Cochrane Risk of Bias Tool. Meta-analyses will be conducted via Stata V.12.0. Leave-one-out sensitivity analyses will be performed, and publication bias will be evaluated using funnel plots and Egger's test. Subgroup analyses regarding intervention format, interactivity and main technology will be carried out. ETHICS AND DISSEMINATION No ethics approval is needed for this review since no primary data are to be collected. The results of this review will help develop an optimal WBI for women with UI, thereby providing them with maximum benefits. The findings will be disseminated via a peer-reviewed journal or conference presentation. PROSPERO REGISTRATION NUMBER CRD42023435047.
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Affiliation(s)
- Xuefen Xu
- Women's Hospital School of Medicine Zhejiang University, Hangzhou, Zhejiang, China
| | - Pingping Guo
- Women's Hospital School of Medicine Zhejiang University, Hangzhou, Zhejiang, China
| | - Ping Xu
- Women's Hospital School of Medicine Zhejiang University, Hangzhou, Zhejiang, China
| | - Dan Dan Chen
- Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou, China
| | - Weijing Chen
- Department of Obstetrics, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hongyan Wang
- Women's Hospital School of Medicine Zhejiang University, Hangzhou, Zhejiang, China
| | - Ying Jin
- Women's Hospital School of Medicine Zhejiang University, Hangzhou, Zhejiang, China
| | - Xiaojuan Wang
- Women's Hospital School of Medicine Zhejiang University, Hangzhou, Zhejiang, China
| | - Wei Zhang
- Women's Hospital School of Medicine Zhejiang University, Hangzhou, Zhejiang, China
| | - Fang Xie
- Women's Hospital School of Medicine Zhejiang University, Hangzhou, Zhejiang, China
| | - Minna Mao
- Women's Hospital School of Medicine Zhejiang University, Hangzhou, Zhejiang, China
| | - Rujia Zhao
- Women's Hospital School of Medicine Zhejiang University, Hangzhou, Zhejiang, China
| | - Suwen Feng
- Women's Hospital School of Medicine Zhejiang University, Hangzhou, Zhejiang, China
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22
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Moura ACRD, Rocha RDO, Araujo AKDSD, Castro SSD, Moreira MA, Nascimento SLD. Reliability and validity of the Brazilian version of the world health organization disability assessment schedule (WHODAS 2.0) questionnaire for women with urinary incontinence. Disabil Rehabil 2024:1-6. [PMID: 38465521 DOI: 10.1080/09638288.2024.2327479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 03/04/2024] [Indexed: 03/12/2024]
Abstract
PURPOSE To analyze the reliability and validity of the WHODAS 2.0 instrument for women with urinary incontinence (UI). METHODS This is a methodological study with Brazilian women with complaints of urge, stress or mixed UI, over 18 years old, without cognitive disorders. The WHODAS 2.0 (36-item version) and the auxiliary instruments were applied through face-to-face and telephone interviews after 7-14 d. The psychometric properties evaluated were: Cronbach's alpha for internal consistency, intraclass correlation coefficient (ICC) for intra-rater test-retest, Spearman's correlation coefficient (rho) for construct validity of WHODAS 2.0 with auxiliary instruments; and ANOVA for discriminative validity with UI severity. RESULTS 101 women with UI with a mean age of 50.71 ± 10.39 were included. WHODAS 2.0 showed good reliability in all domains and excellent reliability in the total score (>0.80). The intra-evaluator test-retest showed ICC values between 0.59 and 0.87 (p < 0.001). We observed a positive correlation between the WHODAS 2.0 domains and the instruments recommended by International Continence Society (ICS), with greater emphasis on moderate correlation with the Urinary Impact Questionnaire (IUQ-7) subscale (rho = 0.730 p < 0.001). CONCLUSION The WHODAS 2.0 instrument is a reliable and valid questionnaire for investigating the functioning and disability of women with UI.
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23
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Garg P, Goyal LD, Goyal S, Verma M. Utility of opportunistic screening to assess the impact of urinary incontinence on quality of life and barriers to seeking treatment among women attending a tertiary healthcare centre in North India. BMC Urol 2024; 24:50. [PMID: 38431583 PMCID: PMC10909260 DOI: 10.1186/s12894-024-01434-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 02/20/2024] [Indexed: 03/05/2024] Open
Abstract
INTRODUCTION Urinary incontinence (UI) is a common but frequently neglected problem in females, significantly impacting their psychosocial health. The available estimates are an underestimation of a bigger problem. Thus, the study aimed to estimate the prevalence of UI, its associated risk factors, its impact on the Quality of life (QoL), and barriers to treatment-seeking behaviour in women attending tertiary healthcare centres. METHODS We conducted a cross-sectional study using an opportunistic screening among women visiting a tertiary care hospital in Punjab recruited using multi-stage systematic random sampling. UI was classified as Stress (SUI), Urge (UUI), mixed (MUI), and No Incontinence (UI less than once a week or a month or no complaints) using the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF). Bivariate analyses were done using the chi-square test to test the association between the dependent and independent variables. The predictors of UI were explored using univariable and multivariable binary logistic regression and depicted using Odds ratio with 95% confidence intervals. The impact of UI on Quality of Life (QoL) was assessed using the Incontinence Impact Questionnaire-Short Form (IIQ-7), and compared among the three UI types using One-Way ANOVA. Treatment barriers were explored using open-ended questions. RESULTS Of the 601 women, 19.6% reported UI (stress UI: 10.1%, mixed UI: 6.0%, and urge UI: 3.5%). There were significant clinical-social factors that predicted different types of UI. The UI depicted a significant effect on QoL across all domains of the IIQ-7 (total mean score: 50.8 ± 21.9) compared to women with no incontinence (0.1 + 1.9). The score was highest in women with MUI, followed by SUI and UUI. About two-thirds of the affected women never consulted a doctor and considered it a non-serious condition or a normal ageing process. CONCLUSIONS The present study found a high prevalence of UI through opportunistic screening across all the women's age groups with different conditions. Due to the associated stigma, clinicians should make every attempt to talk more about this, especially in women with medical conditions that can precipitate UI. Furthermore, the results call for generating more robust estimates through community-based screening studies.
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Affiliation(s)
- Priyanka Garg
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Bathinda, Punjab, India.
| | - Lajya Devi Goyal
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Bathinda, Punjab, India
| | - Suresh Goyal
- Department of Urology, All India Institute of Medical Sciences, Bathinda, Punjab, India
| | - Madhur Verma
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bathinda, Punjab, India
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24
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de Melo GASC, Fernandes VDO, Costa HS, Lacerda ACR, Nobre LN, F de M Vitorino D, de Carvalho Bastone A. Urinary incontinence in middle-aged and older women with hip and knee osteoarthritis: An outpatient study of frequency and risk factors. Neurourol Urodyn 2024; 43:672-679. [PMID: 38247352 DOI: 10.1002/nau.25395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 12/12/2023] [Accepted: 01/03/2024] [Indexed: 01/23/2024]
Abstract
AIMS To investigate the frequency and the factors associated with urinary incontinence (UI) in a sample of middle-aged and older women with lower limb osteoarthritis (OA). METHODS Women aged 50 years or older with clinical hip/knee OA diagnoses were recruited for this cross-sectional study. Self-reported UI and type, sociodemographic characteristics, medical conditions, physical activity level, anthropometric and body composition measurements, muscle strength, and physical function were assessed. Uni and multivariable logistic regression were used to investigate the factors associated with UI. RESULTS Among 100 middle-aged and older women (mean 67.27 ± 8.77 SD years), 67% reported UI. In the UI group, 33% reported stress UI, 36% reported urgency UI, and 31% reported mixed UI. In the univariate analysis, age, level of physical activity, pulmonary disease, number of medications, body mass index (BMI), number of deliveries, and activity limitation were significantly associated with UI. In the multivariable analysis, older age (60-69 years OR: 4.91, 95% CI: 1.25-19.36; ≥70 years OR: 8.06, 95% CI: 1.96-33.22), compared to 50-59 years, morbid obesity (OR: 14.10, 95% CI: 1.36-146.48), compared to BMI < 30 kg/m2 , and activity limitation (OR: 5.31, 95% CI: 1.61-17.54), assessed as short physical performance battery ≤8, remained significantly associated with UI. CONCLUSIONS UI was highly frequent among middle-aged and older women with hip/knee OA. Older age, activity limitation, and morbid obesity were independently associated with UI. Interventions targeting physical function and weight management must be considered to prevent and treat UI in this population.
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Affiliation(s)
- Gisele A S C de Melo
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri/UFVJM, Campus JK, Diamantina, Brazil
| | - Vanessa de O Fernandes
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri/UFVJM, Campus JK, Diamantina, Brazil
| | - Henrique Silveira Costa
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri/UFVJM, Campus JK, Diamantina, Brazil
| | - Ana Cristina Rodrigues Lacerda
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri/UFVJM, Campus JK, Diamantina, Brazil
| | - Luciana N Nobre
- Department of Nutrition, Universidade Federal dos Vales do Jequitinhonha e Mucuri/UFVJM, Campus JK, Diamantina, Brazil
| | - Débora F de M Vitorino
- Department of Physical Therapy, Universidade Federal dos Vales do Jequitinhonha e Mucuri/UFVJM, Campus JK, Diamantina, Brazil
| | - Alessandra de Carvalho Bastone
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri/UFVJM, Campus JK, Diamantina, Brazil
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25
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Clearwater WL, Panushka K, Najor A, Laudano M, Fleischmann N. Reconstruction of Urethral Sphincter With Polyacrylamide Hydrogel. UROGYNECOLOGY (PHILADELPHIA, PA.) 2024; 30:293-299. [PMID: 38484245 DOI: 10.1097/spv.0000000000001470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
IMPORTANCE Urethral bulking is an alternative to synthetic midurethral sling for the treatment of stress urinary incontinence (SUI) in women. Urethral bulking agents, which are injected in the submucosal tissues of the proximal urethra/bladder neck, have demonstrated less adverse effects with similar satisfaction rates but lower subjective and objective cure rates when compared with midurethral sling. Cystoscopic Reconstruction of External Sphincter Technique (CREST) is a novel technique, which reinforces the natural closure mechanism of the external urinary sphincter (EUS). OBJECTIVE The aim of the study was to provide safety and efficacy data for injecting polyacrylamide hydrogel (PAHG) in the components of the female EUS. STUDY DESIGN This was a retrospective chart review of patients using CREST with PAHG as initial treatment for SUI by a single surgeon from January 2022 to October 2022. Exclusion criteria are as follows: younger than 18 years, prior SUI surgery, concomitant pelvic organ prolapse or reconstructive procedure, neurological conditions, or history of radiation. Subjective and objective cure rates were measured by patient-reported symptoms and cough stress test. Urinary retention, postoperative urinary infection, and de novo urinary urgency were assessed. RESULTS One hundred and thirteen consecutive patients met inclusion criteria with median follow-up of 3 months. Eighty-five percent of participants reported subjective improvement, 69% reported subjective cure, and 69% demonstrated objective cure. Nine patients reported transient postoperative retention, 8 reported postoperative urinary tract infections, and 5 reported de novo urgency. There were no serious adverse events. CONCLUSIONS CREST is a novel technique for injection of PAHG, into the EUS to treat SUI. Our data suggest that this technique could improve urethral injection outcomes with minimal complications.
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Affiliation(s)
| | | | - Anna Najor
- Urology, Albert Einstein College of Medicine, Montefiore Hospital
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26
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Taastrøm K, Kjeldsen AC, Hjorth S, Gommesen D, Axelsen SM, Nohr EA. Urinary Incontinence in Midlife According to Weight Changes Across and After Childbearing Years. Int Urogynecol J 2024; 35:579-588. [PMID: 38214717 PMCID: PMC11024002 DOI: 10.1007/s00192-023-05713-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/28/2023] [Indexed: 01/13/2024]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to investigate how weight change across and after the childbearing years was associated with urinary incontinence (UI) in midlife. METHODS Data were obtained from 35,645 women responding to the Maternal Follow-up questionnaire in the Danish National Birth Cohort in 2013-2014. Outcome was self-reported UI and its subtypes. Exposures were changes in body mass index (BMI) across and after the childbearing years. Adjusted odds ratios were estimated using logistic regression. RESULTS At follow-up, the mean age was 44 years and 32% experienced UI. Compared with stable weight, weight gain across the childbearing years of > 1 to 3, > 3 to 5 or > 5 BMI units increased the odds of any UI by 15%, 27%, and 41% respectively. For mixed UI, the odds increased by 23%, 41%, and 68% in these groups. Weight gain after childbearing showed the same pattern, but with a higher increase in the odds of mixed UI (25%, 60%, and 95% in the respective groups). Women with any weight loss during this period had 9% lower odds of any UI than women with a stable weight. CONCLUSIONS Weight gain across and after childbearing increased the risk of UI in midlife, especially the subtype mixed UI. Weight loss after childbearing decreased the risk.
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Affiliation(s)
- Katja Taastrøm
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark.
- Research Unit for Gynecology and Obstetrics, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Anne Cathrine Kjeldsen
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark
- Research Unit for Gynecology and Obstetrics, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Sarah Hjorth
- Research Unit for Gynecology and Obstetrics, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ditte Gommesen
- Research Unit for Gynecology and Obstetrics, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Susanne M Axelsen
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark
| | - Ellen A Nohr
- Research Unit for Gynecology and Obstetrics, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Nohr EA, Taastrøm KA, Kjeldsen ACM, Wu C, Pedersen FH, Brown WJ, Davis DL. Parity, mode of birth, and long-term gynecological health: A follow-up study of parous and nonparous women in the Australian Longitudinal Study on Women's Health cohort. Birth 2024; 51:198-208. [PMID: 37849409 DOI: 10.1111/birt.12781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 07/11/2023] [Accepted: 09/22/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Although gynecological health issues are common and cause considerable distress, little is known about their causes. We examined how birth history is associated with urinary incontinence (UI), severe period pain, heavy periods, and endometriosis. METHODS We studied 7700 women in the Australian Longitudinal Study on Women's Health with an average follow-up of 10.9 years after their last birth. Surveys every third year provided information about birth history and gynecological health. Logistic regression was used to estimate how parity, mode of birth, and vaginal tears were associated with gynecological health issues. Presented results are adjusted odds ratios (OR) with 95% confidence intervals. RESULTS UI was reported by 16%, heavy periods by 31%, severe period pain by 28%, and endometriosis by 4%. Compared with women with two children, nonparous women had less UI (OR 0.35 [0.26-0.47]) but tended to have more endometriosis (OR 1.70 [0.97-2.96]). Also, women with only one child had less UI (OR 0.77 [0.61-0.98]), but more severe period pain (OR 1.24 [1.01-1.51]). Women with 4+ children had more heavy periods (OR 1.42 [1.07-1.88]). Compared with women with vaginal birth(s) only, women with only cesarean sections or vaginal birth after cesarean section had less UI (ORs 0.44 [0.34-0.58] and 0.55 [0.40-0.76]), but more endometriosis (ORs 1.91 [1.16-3.16] and 2.31 [1.25-4.28]) and heavy periods (ORs 1.21 [1.00-1.46] and 1.35 [1.06-1.72]). Vaginal tear(s) did not increase UI after accounting for parity and birth mode. CONCLUSION While women with vaginal childbirth(s) reported more urinary incontinence, they had less menstrual complaints and endometriosis.
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Affiliation(s)
- Ellen A Nohr
- Department of Clinical Research, Research Unit of Obstetrics and Gynaecology, University of Southern Denmark, Odense, Denmark
| | - Katja A Taastrøm
- Department of Clinical Research, Research Unit of Obstetrics and Gynaecology, University of Southern Denmark, Odense, Denmark
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
| | - Anne Cathrine M Kjeldsen
- Department of Clinical Research, Research Unit of Obstetrics and Gynaecology, University of Southern Denmark, Odense, Denmark
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
| | - Chunsen Wu
- Department of Clinical Research, Research Unit of Obstetrics and Gynaecology, University of Southern Denmark, Odense, Denmark
| | | | - Wendy J Brown
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, QLD, and Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Deborah L Davis
- ACT Government, Health Directorate and Faculty of Health, University of Canberra, New South Wales, Australia
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Jiang J, Chen B, Tang B, Li J, Zhang C, Tan D, Zhang T, Wei Q. Urinary phenols and parabens exposure in relation to urinary incontinence in the US population. BMC Public Health 2024; 24:515. [PMID: 38373965 PMCID: PMC10875867 DOI: 10.1186/s12889-024-17872-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 01/24/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Our study aimed to investigate the impact of urinary concentrations of personal care products (PCPs)-related phenols (PNs) and parabens (PBs), including Triclosan (TCS), Bisphenol A (BPA), Benzophenone-3 (BP-3), Butylparaben (BPB), Ethylparaben (EPB), Methylparaben (MPB), and Propylparaben (PPB), on urinary incontinence (UI) occurrence. METHOD We conducted a cross-sectional analysis using data from the National Health and Nutrition Examination Survey (NHANES) spanning the years 2007 to 2016. Regression analysis was employed to investigate the relationship between exposure to PCPs-related substances, various levels of exposure, and UI within both the general population and the female demographic. Additionally, the Bayesian Kernel Machine Regression (BKMR) model was used to assess the effects of mixtures on UI. RESULTS Our analysis comprised 7,690 participants who self-reported their diagnosis. Among them, 12.80% experienced stress urinary incontinence (SUI), 11.80% reported urge urinary incontinence (UUI), and 10.22% exhibited mixed urinary incontinence (MUI). In our fully adjusted multivariable models, BP-3 exposure exhibited a positive association with SUI (OR 1.07, 95% CI 1.02-1.14, p = 0.045). BPA exposure correlated with an increased risk of UUI (OR 1.21, 95% CI 1.01-1.44, p = 0.046) and MUI (OR 1.26, 95% CI 1.02-1.54, p = 0.029). TCS exposure displayed a negative correlation with the incidence of MUI (OR 0.87, 95% CI 0.79-0.97, p = 0.009). No significant links were observed between parabens and urinary incontinence. Notably, among the female population, our investigation revealed that BPA exposure heightened the risk of MUI (OR 1.28, 95% CI 1.01-1.63, p = 0.043). Participants in the highest tertile of BP-3 exposure demonstrated elevated likelihoods of SUI and MUI compared to those in the lowest tertile. In the BKMR analysis, negative trends were observed between the mixture and the risks of UUI and MUI when the mixture ranged from the 25th to the 40th and 35th to the 40th percentiles or above, respectively. Additionally, a positive trend was identified between the mixture and MUI when it was in the 40th to 55th percentile. CONCLUSION In conclusion, our findings suggest that exposure to BPA, TCS, and BP-3 may contribute to the development of urinary incontinence.
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Affiliation(s)
- Jinjiang Jiang
- Department of Urology, Institute of Urology, West China Hospital of Sichuan University, No. 37, Guoxue Lane, Chengdu, Sichuan, China
| | - Bo Chen
- Department of Urology, Institute of Urology, West China Hospital of Sichuan University, No. 37, Guoxue Lane, Chengdu, Sichuan, China
| | - Bo Tang
- Department of Urology, Institute of Urology, West China Hospital of Sichuan University, No. 37, Guoxue Lane, Chengdu, Sichuan, China
| | - Jinze Li
- Department of Urology, Institute of Urology, West China Hospital of Sichuan University, No. 37, Guoxue Lane, Chengdu, Sichuan, China
| | - Chensong Zhang
- State Key Laboratory of Biotherapy and Cancer Center, Frontiers Science Center for Disease-Related Molecular Network, and National Clinical Research Center for Geriatrics, Sichuan University, Chengdu, Sichuan, China
| | - Daqing Tan
- Department of Urology, Institute of Urology, West China Hospital of Sichuan University, No. 37, Guoxue Lane, Chengdu, Sichuan, China
| | - Ting Zhang
- School of Basic Medicine, Harbin Medical Hospital, Harbin, China
| | - Qiang Wei
- Department of Urology, Institute of Urology, West China Hospital of Sichuan University, No. 37, Guoxue Lane, Chengdu, Sichuan, China.
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Carletti V, Yacoub V, Grilli D, Morgani C, Palazzetti PL, Zullo MA, Luffarelli P, Valensise HC, Maneschi F, Spina V, Schiavi MC. Sequential combined approach in patients with mixed urinary incontinence: surgery followed by posterior tibial nerve stimulation. Minerva Obstet Gynecol 2024; 76:7-13. [PMID: 35785925 DOI: 10.23736/s2724-606x.22.05106-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND The aim of the study was to demonstrate the efficacy of sequential combined treatment with transobturator tape (TOT) followed by posterior tibial nerve stimulation (PTNS) in patients with mixed urinary incontinence (MUI); quality of life and patients' satisfaction was also assessed. METHODS Retrospective analysis on women affected by MUI with prevalent Stress Urinary Incontinence (SUI) component. Women, divided in 2 groups, underwent different treatments, TOT vs. TOT+PTNS. Population was assessed by medical history, previous pelvic surgery, clinical exam, urodynamic exams, pelvic ultrasound examination, and questionnaires (The International Consultation on Incontinence Questionnaire Short Form, Overactive Bladder Questionnaire, Health Related Quality of Life) comparing them before and after 12 weeks after treatment. RESULTS One hundred twelve women were enrolled in the study. The mean age was 57.96±7.34 in the first group (N.=60) and 58.29±6.14 in the second group (N.=52). Peak flow (mL/s) statistically improved after treatment, 22.23±4.29 (TOT) vs. 24.81±5.8 (TOT+PTNS). First voiding desire (mL) improved significantly between the two groups 108.72±19.24 vs. 142.43±19.98. Maximum cystometric capacity (mL) in the TOT group at 12-weeks was 328.76±82.44 vs. TOT+PTNS group of 396.26±91.21. Detrusor pressure at peak flow(cmH2O) showed a greater improvement in TOT+PTNS than TOT alone 14.45±6.10 vs. 11.89±54.49. At 12-week, urinary diary and quality of life improved in terms of urgent urination events, mean number of voids, urge symptoms and nocturia events. The Patient Impression of Global Improvement (PGI-I) after 3 months was better in combined group. CONCLUSIONS Combined and sequential TOT+PTNS is more effective compared to TOT alone in MUI patients with prevalent SUI component.
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Affiliation(s)
- Valerio Carletti
- Department of Obstetrics and Gynecology, Tor Vergata University, Rome, Italy -
| | - Veronica Yacoub
- Department of Obstetrics and Gynecology, Tor Vergata University, Rome, Italy
| | - Debora Grilli
- Department of Obstetrics and Gynecology, Tor Vergata University, Rome, Italy
- Department of Obstetrics and Gynecology, Sandro Pertini Hospital, Rome, Italy
| | - Claudia Morgani
- Department of Obstetrics and Gynecology, Tor Vergata University, Rome, Italy
- Department of Obstetrics and Gynecology, Sandro Pertini Hospital, Rome, Italy
| | - Pier L Palazzetti
- Department of Obstetrics and Gynecology, Sandro Pertini Hospital, Rome, Italy
| | - Marzio A Zullo
- Department of Surgery-Week Surgery, Campus Bio-Medico University, Rome, Italy
| | - Paolo Luffarelli
- Department of Surgery-Week Surgery, Campus Bio-Medico University, Rome, Italy
| | - Herbert C Valensise
- Department of Obstetrics and Gynecology, Tor Vergata University, Rome, Italy
- Department of Obstetrics and Gynecology, Casilino Hospital, Rome, Italy
| | - Francesco Maneschi
- Department of Obstetrics and Gynecology, San Giovanni Addolorata Hospital, Rome, Italy
| | - Vincenzo Spina
- Maternal and Child Department, San Camillo de Lellis Hospital, Rieti, Italy
| | - Michele C Schiavi
- Department of Obstetrics and Gynecology, Sandro Pertini Hospital, Rome, Italy
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Dos Santos Sousa AJ, Cordeiro Rodrigues J, Falcão Padilha J, Garcia Godoy A, Menezes Degani A, Danna-Santos A, Driusso P. Effects of health education on women with urinary incontinence: systematic review and meta-analysis. Int Urogynecol J 2024; 35:273-289. [PMID: 38099941 DOI: 10.1007/s00192-023-05693-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 11/06/2023] [Indexed: 03/03/2024]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to investigate the effects of health education (HE) on urinary symptoms and quality of life in women with urinary incontinence (UI). METHODS A systematic review and meta-analysis of trials evaluating HE for women with UI. The risk of bias was assessed using the revised Cochrane risk-of-bias tool for randomized trials. RESULTS The search identified 5,118 articles. Eighteen papers were considered eligible. The interventions investigated included health education (HE), combined intervention, self-management (SM), and structured training (ST). Outcomes included quality of life (QoL), UI frequency, UI severity, impression of improvement, incontinence symptoms, urine leakage, fear of leakage, urgency, and incontinence impact. Compared with the control group there was a significant improvement in the frequency, severity, and impact on the QoL for women with UI (assessed by the total score of the International Consultation on Incontinence Questionnaire Short Form (ICIQ SF); RR = -1.47, 95% CI [-2.07, -0.88]; two trials; low certainty of the evidence). CONCLUSIONS This review shows that HE seems to be beneficial in the treatment of women with UI when compared with control women (no treatment or general health care), improving the frequency, severity, and impact on QoL assessed by the ICIQ SF total score. However, the certainty of this evidence is low.
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Affiliation(s)
- Ana Jéssica Dos Santos Sousa
- Women's Health Research Laboratory, Department of Physical Therapy, Federal University of São Carlos, Rodovia Washington Luís, km 235, São Carlos, SP, CEP: 13565-905, Brazil
| | - Jéssica Cordeiro Rodrigues
- Women's Health Research Laboratory, Department of Physical Therapy, Federal University of São Carlos, Rodovia Washington Luís, km 235, São Carlos, SP, CEP: 13565-905, Brazil
| | - Juliana Falcão Padilha
- Urogynecological Physiotherapy Laboratory, Department of Physical Therapy, Federal University of Amapá, Macapá, AP, Brazil
| | - Amanda Garcia Godoy
- Women's Health Research Laboratory, Department of Physical Therapy, Federal University of São Carlos, Rodovia Washington Luís, km 235, São Carlos, SP, CEP: 13565-905, Brazil
| | - Adriana Menezes Degani
- Laboratory for Advancements in Rehabilitation Sciences, Department of Physical Therapy, Western Michigan University, Kalamazoo, MI, USA
| | - Alessander Danna-Santos
- Laboratory for Advancements in Rehabilitation Sciences, Department of Physical Therapy, Western Michigan University, Kalamazoo, MI, USA
| | - Patricia Driusso
- Women's Health Research Laboratory, Department of Physical Therapy, Federal University of São Carlos, Rodovia Washington Luís, km 235, São Carlos, SP, CEP: 13565-905, Brazil.
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Smith AL, Berry A, Brubaker L, Cunningham SD, Gahagan S, Low LK, Mueller M, Sutcliffe S, Williams BR, Brady SS. The brain, gut, and bladder health nexus: A conceptual model linking stress and mental health disorders to overactive bladder in women. Neurourol Urodyn 2024; 43:424-436. [PMID: 38078701 PMCID: PMC10872494 DOI: 10.1002/nau.25356] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/28/2023] [Accepted: 11/25/2023] [Indexed: 02/06/2024]
Abstract
OBJECTIVE A small, but growing literature links stressors and mental health disorders (MHDs) across the life course to overactive bladder (OAB) and urinary incontinence symptoms. Mechanisms by which stressors and MHDs may impact bladder health are not fully understood, limiting novel prevention and treatment efforts. Moreover, potential biopsychosocial mechanisms involving the brain and gut have not been considered in an integrated, comprehensive fashion. METHODS Members of the prevention of lower urinary tract symptoms Research Consortium developed conceptual models to inform research on biopsychosocial mechanisms through which stress and MDHs may impact bladder health among girls and women, focusing on brain and gut physiology. RESULTS Two conceptual models were developed-one to explain central (brain-based) and peripheral (gut-based) mechanisms linking stressors and MHDs to OAB and bladder health, and one to highlight bidirectional communication between the brain, gut, and bladder. Traumatic events, chronic stressors, and MHDs may lead to a maladaptive stress response, including dysregulated communication and signaling between the brain, gut, and bladder. Gut bacteria produce molecules and metabolites that alter production of neurotransmitters, amino acids, short-chain fatty acids, and inflammatory immune response molecules that mediate communication between the gut and brain. Microbiota signal neurogenesis, microglia maturation, and synaptic pruning; they also calibrate brain-gut-bladder axis communication through neurotransmission and synaptogenesis, potentially influencing bladder symptom development. Life course trajectories of risk may be prevented or interrupted by central and peripheral resources for neuropsychological resilience. CONCLUSIONS Depicted pathways, including brain-gut-bladder communication, have implications for research and development of novel prevention and treatment approaches.
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Affiliation(s)
- Ariana L. Smith
- Division of Urology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Amanda Berry
- Division of Urology, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Linda Brubaker
- Department of Obstetrics, Gynecology, and Reproductive Sciences, UC San Diego School of Medicine, University of California San Diego, La Jolla, California
| | - Shayna D. Cunningham
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT
| | - Sheila Gahagan
- Department of Pediatrics, UC San Diego School of Medicine, University of California, San Diego CA
| | - Lisa Kane Low
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan
| | - Margaret Mueller
- Department of Ob/Gyn, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Siobhan Sutcliffe
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis, St. Louis, MO
| | - Beverly R. Williams
- Department of Medicine, Division of Gerontology, Geriatrics and Palliative Care, University of Alabama at Birmingham (UAB) and Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs
| | - Sonya S. Brady
- Division of Epidemiology & Community Health, University of Minnesota School of Public Health, Minneapolis, MN
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Dong L, Tao X, Gong C, Long Y, Xiao L, Luo Y, Wang M, Zhong Y. Effects of central-peripheral FMS on urinary retention after spinal cord injury: a pilot randomized controlled trial protocol. Front Neurol 2024; 14:1274203. [PMID: 38249751 PMCID: PMC10797019 DOI: 10.3389/fneur.2023.1274203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 11/16/2023] [Indexed: 01/23/2024] Open
Abstract
Background Urinary retention is a common complication of spinal cord injury (SCI), which can seriously affect the quality of life of patients. Function magnetic stimulation (FMS) has been widely used in the recovery of neurological function in various diseases, but its application in urinary retention after SCI remains unclear. Therefore, we would like to conduct a pilot randomized controlled trial (RCT) to observe the feasible effect of FMS on urinary retention after SCI, to explore its mechanism of action. Method/design This is a single-center pilot RCT, which 60 patients with urinary retention after SCI will be selected, numbered in chronological order of hospitalization, and randomly divided into 4 groups using the random number table method, Groups A (control group), Group B, Group C, and Group D; Each group will receive the same conventional rehabilitation treatment. The whole intervention period 2 weeks and will be evaluated before and after treatment to collect data on residual bladder volume, functional near-infrared spectroscopy (fNIRS), changes in voiding condition, changes in surface electromyography (SEMG) values of pelvic floor muscle and quality of life scores (QoL). Study hypothesis We hypothesized that FMS for the treatment of urinary retention after SCI would have a significant clinical feasible effect;and that peripheral combined with central FMS would be more effective than single-site FMS for the treatment of urinary retention after SCI. Objective (1) To illustrate the clinical effectiveness of FMS in the treatment of urinary retention after SCI and to provide a new treatment modality for the patients; (2) Comparison of the differences in the efficacy of central and peripheral single FMS and combined central and peripheral FMS in the treatment of urinary retention after SCI; (3) To explore the central control mechanisms of bladder function recovery after SCI in conjunction with changes in fNIRS. Trial registration This study has been ethically approved by the Scientific and Ethics Committee of the First Affiliated Hospital of Gannan Medical university with approval number (LLSC-2022112401). It has been registered with the China Clinical Trials Registry with the registration number: ChiCTR2200067143.
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Affiliation(s)
- Lingyan Dong
- Gannan Medical University, Ganzhou, Jiangxi, China
| | - Xi Tao
- Gannan Medical University, Ganzhou, Jiangxi, China
| | - Cheng Gong
- Gannan Medical University, Ganzhou, Jiangxi, China
| | - Yi Long
- Gannan Medical University, Ganzhou, Jiangxi, China
| | - Li Xiao
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Yun Luo
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Maoyuan Wang
- Ganzhou Key Laboratory of Rehabilitation Medicine, Ganzhou, China
- Ganzhou Intelligent Rehabilitation Technology Innovation Center, Ganzhou, China
| | - Yanbiao Zhong
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
- Ganzhou Key Laboratory of Rehabilitation Medicine, Ganzhou, China
- Ganzhou Intelligent Rehabilitation Technology Innovation Center, Ganzhou, China
- Key Laboratory of Prevention and Treatment of Cardiovascular and Cerebrovascular Diseases, Ministry of Education, Gannan Medical University, Ganzhou, China
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Arroyo-Huidobro M, de la Fuente JL, Pagespetit MR, Perez OM, Morera JR, López AMA, Casanova DA, Garcia-Lerma E, Pérez-López C, Rodríguez-Molinero A. Incidence of urinary incontinence after hip fracture surgery and associated risk factors: a prospective study. BMC Geriatr 2024; 24:3. [PMID: 38166670 PMCID: PMC10763427 DOI: 10.1186/s12877-023-04597-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 12/14/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND The contribution of the postoperative process to developing or worsening urinary incontinence (UI) after hip fracture surgery (HFS) remains unclear. We aimed to evaluate UI incidence and worsening among older patients undergoing HFS, and explore associated risk factors. METHODS This prospective cohort study included patients ≥ 75 years admitted between October 2019 and October 2021 to the Traumatology Service of three hospitals in the Consorci Sanitari de Alt-Penedès i Garraf (Barcelona, Spain) with hip fracture requiring surgical treatment. UI was assessed using the first two questions of the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) at baseline and at days 30 (± 3 days) and 90 (± 3 days) after HFS. Surgery-related data and post-surgical complications were recorded. RESULTS A total of 248 patients with a mean (SD) age of 85.8 (6.78) years were included; 77.8% were female and 154 (62.1%) had UI at baseline. After HFS, 3.24% experienced urinary tract infections (UTIs), 3.64%, acute urinary retention (AUR), 8.57%, constipation, and 53.9%, prolonged catheterization (> 24 h). Fifty-eight patients without baseline UI developed UI at 30 days, resulting in a UI incidence of 61.7% (95% CI 51.1-71.54) between days 0 and 30. Of the 248 patients, 146 (59.1%) experienced worsening of UI. AUR and UTIs were identified as risk factors for UI development and worsening after HFS, respectively. CONCLUSION The incidence of UI in older patients after HFS is significant. Patient management protocols should consider AUR and UTIs to reduce or eliminate the incidence of UI in older patients undergoing HFS.
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Affiliation(s)
- Marta Arroyo-Huidobro
- Hospital Residencia Sant Camil, Consorci Santiari Alt'Pènedes i Garraf, Sant Pere de Ribes, Barcelona, Spain.
- Geriatrics Unit, Department of Internal Medicina, Hospital Clinic de Barcelona, C. de Villarroel, 170, Barcelona, 08036, Spain.
| | - Josefa López de la Fuente
- Hospital Residencia Sant Camil, Consorci Santiari Alt'Pènedes i Garraf, Sant Pere de Ribes, Barcelona, Spain
| | - Mar Riera Pagespetit
- Hospital Residencia Sant Camil, Consorci Santiari Alt'Pènedes i Garraf, Sant Pere de Ribes, Barcelona, Spain
| | - Oscar Macho Perez
- Hospital Residencia Sant Camil, Consorci Santiari Alt'Pènedes i Garraf, Sant Pere de Ribes, Barcelona, Spain
| | - Jaume Roig Morera
- Geriatrics Area, Hospital Vilafranca, Consorci Santiari Alt'Pènedes i Garraf, Vilafranca del Penedès, Barcelona, Spain
| | - Anna Maria Abelleira López
- Geriatrics Area, Hospital Vilafranca, Consorci Santiari Alt'Pènedes i Garraf, Vilafranca del Penedès, Barcelona, Spain
| | - David Aivar Casanova
- Hospital Residencia Sant Camil, Consorci Santiari Alt'Pènedes i Garraf, Sant Pere de Ribes, Barcelona, Spain
| | - Esther Garcia-Lerma
- Biostatistics Unit, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospital de Llobregat, Barcelona, Spain
| | - Carlos Pérez-López
- Area de Recerca, Consorci Sanitari Alt'Pènedes I Garraf, Villafranca del Penedès, Barcelona, Spain
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Mao W, Jiang M, Chen W, Du J, Xiao Q. The effect of using mobile phone applications for intelligent pelvic floor rehabilitation on elderly female patients with stress urinary incontinence. Technol Health Care 2024; 32:229-241. [PMID: 37393449 DOI: 10.3233/thc-220845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/03/2023]
Abstract
BACKGROUND Stress urinary incontinence is prevalent among women and the incidence increases with age. OBJECTIVE To explore the effect of intelligent pelvic floor muscle rehabilitation on elderly female patients with incontinence. METHODS A total of 209 patients with urinary incontinence who were treated with pelvic floor muscle rehabilitation at Peking University International Hospital from September 2020 to January 2022 were selected by convenient sampling. All subjects were divided into the 50-60 year old patient group (n= 51) and over 60 years old patient group according to age (n= 158). The subjects of different age group were divided into an experimental group and a control group. The patients in the control group received routine nursing and health education, and the patients in the observation group received a combination of mobile application use and smart dumbbells. Based on this, we constructed an intervention model for intelligent, continuous pelvic floor rehabilitation. After 7 and 12 weeks, pelvic floor muscle function knowledge and exercise compliance in the two groups were evaluated. The improvement of urinary incontinence symptoms, pelvic floor muscle strength grades and quality-of-life scales were evaluated. RESULTS The results showed that pelvic floor knowledge and exercise compliance in the experimental group were better than in the control group at 7 and 12 weeks after intervention (P< 0.05). There was no significant difference in pelvic floor muscle strength and quality of life between the two groups at 7 weeks after intervention (P> 0.05). However, there was a significant difference in pelvic floor muscle strength and quality of life between the two groups at 12 weeks after intervention (P< 0.05). There was no significant difference between different age groups. CONCLUSION The intelligent pelvic floor rehabilitation model that combines a mobile application with smart dumbbells can maintain and strengthen the clinical treatment effect for elderly patients with urinary incontinence.
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Affiliation(s)
- Wenjuan Mao
- Gynecological Ward of Peking University International Hospital, Beijing, China
| | - Mingzhu Jiang
- Gynecological Ward of Peking University International Hospital, Beijing, China
| | - Wenduo Chen
- Gynecological Ward of Peking University International Hospital, Beijing, China
| | - Juan Du
- Gynecological Ward of Peking University International Hospital, Beijing, China
| | - Qian Xiao
- Nursing School, Capital Medical University, Beijing, China
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Cheng C, Li Q, Lin G, Opara EC, Zhang Y. Neurobiological insights into lower urinary tract dysfunction: evaluating the role of brain-derived neurotrophic factor. AMERICAN JOURNAL OF CLINICAL AND EXPERIMENTAL UROLOGY 2023; 11:559-577. [PMID: 38148930 PMCID: PMC10749380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 11/17/2023] [Indexed: 12/28/2023]
Abstract
Lower urinary tract dysfunction (LUTD) encompasses a range of debilitating conditions that affect both sexes and different age groups. Understanding the underlying neurobiological mechanisms contributing to LUTD has emerged as a critical avenue for the development of targeted therapeutic strategies. Brain-derived neurotrophic factor (BDNF), a prominent member of the neurotrophin family, has attracted attention due to its multiple roles in neural development, plasticity, and maintenance. This review examines the intricate interplay between neurobiological factors and LUTD, focusing on the central involvement of BDNF. The review emphasizes the bidirectional relationship between LUTD and BDNF and explores how LUTD-induced neural changes may affect BDNF dynamics and vice versa. Growth factor therapy and the combined administration of controlled release growth factors and stem cells are minimally invasive treatment strategies for neuromuscular injury. Among the many growth factors and cytokines, brain-derived neurotrophic factor (BDNF) plays a prominent role in neuromuscular repair. As an essential neurotrophin, BDNF is involved in the modulation of neuromuscular regeneration through tropomyosin receptor kinase B (TrkB). Increasing BDNF levels facilitates the regeneration of the external urethral sphincter and contributes to the regulation of bladder contraction. Treatments targeting the BDNF pathway and sustained release of BDNF may become novel treatment options for urinary incontinence and other forms of lower urinary tract dysfunction. This review discusses the applications of BDNF and the theoretical basis for its use in the treatment of lower urinary tract dysfunction, including urinary incontinence (UI), overactive bladder (OAB), and benign prostatic hyperplasia (BPH), and in the clinical diagnosis of bladder dysfunction.
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Affiliation(s)
- Chen Cheng
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of MedicineShanghai 200011, China
| | - Qingfeng Li
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of MedicineShanghai 200011, China
| | - Guiting Lin
- Knuppe Molecular Urology Laboratory, Department of Urology, School of Medicine, University of CaliforniaSan Francisco, CA 94143, USA
| | - Emmanuel C Opara
- Wake Forest Institute for Regenerative Medicine, Wake Forest University Health SciencesWinston-Salem, NC 27101, USA
| | - Yuanyuan Zhang
- Wake Forest Institute for Regenerative Medicine, Wake Forest University Health SciencesWinston-Salem, NC 27101, USA
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Li T, Li Y, Wu S. Global status quo and trends of research on urinary incontinence: a bibliometric and visualized study. Bladder (San Franc) 2023; 10:e21200014. [PMID: 38163007 PMCID: PMC10754693 DOI: 10.14440/bladder.2023.873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 11/23/2023] [Accepted: 11/26/2023] [Indexed: 01/03/2024] Open
Abstract
Background Urinary incontinence (UI) is highly prevalent and poses a considerable social and economic burden on both victims and the society at large. This study reviewed the UI-related literature to present the current status and predict future trends of UI researh. Methods Studies related to UI published between 2012 and 2022 were retrieved from the Web of Science Core Collection. The bibliometric analysis and visualized study were performed by using VOSviewer. Results A total of 3092 publications were retrieved for further analysis. The United States ranked the first in terms of the total number of publications, citations, the H-index of publications. The institutions with the most cited publications was the N8 Research Partnership. Neurourology and Urodynamics published most papers, was cited most frequently, and scored the highest H-index. The author with the most citations, and the greatest average citations per article was Nitti VW. The author with the highest H-index was Herschorn S. Articles were divided into five main clusters based on keyword analysis: epidemiological studies, diagnosis studies, therapy studies, female urinary incontinence studies, and male urinary incontinence studies. UI-related epidemiology, therapies and male UI will continue to be the hot topics. Conclusions This study indicated that the UI research is more intensive in Europe and North America, Neurourology and Urodynamics was the most influencial journal in the field. Moreover, epidemiology, therapy and male urinary incontinence will continue to be hot topics. Our study contributes to a more comprehensive understanding of the status quo and provides clues to future research directions of UI.
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Affiliation(s)
| | | | - Song Wu
- Department of Urology, South China Hospital of Shenzhen University, Shenzhen 518111, China
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Cao S, Meng L, Lin L, Hu X, Li X. The association between the metabolic score for insulin resistance (METS-IR) index and urinary incontinence in the United States: results from the National Health and Nutrition Examination Survey (NHANES) 2001-2018. Diabetol Metab Syndr 2023; 15:248. [PMID: 38041100 PMCID: PMC10693039 DOI: 10.1186/s13098-023-01226-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 11/20/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND The association between insulin resistance and urinary incontinence (UI) has not been investigated widely. The purpose of this study is to assess the relationship between a novel indicator for assessing insulin resistance the metabolic score for insulin resistance (METS-IR) index and urinary incontinence (UI). METHODS This study utilized data from National Health and Nutrition Examination Survey (NHANES) 2001-2018. Weighted multivariable logistic regression models were conducted to explore the association of METS-IR index with three types of UI [stress UI (SUI), urgency UI (UUI), and mixed UI (MUI)]. Smooth curve fitting was utilized to investigate the linear relationship. Subgroup analysis was used to examine the stability of the connection between METS-IR index and UI in different stratifications. RESULTS A total of 17,474 participants were included in this study, of whom 23.76% had SUI, 20.05% had UUI, and 9.59% had MUI. METS-IR index was positively associated with three types of UI with full adjustment [SUI: odds ratio (OR) = 1.023, 95% confidence interval (CI) 1.019-1.027; UUI: OR = 1.015, 95% CI 1.011-1.019; MUI: OR = 1.020, 95% CI 1.016-1.025, all p < 0.001]. After transferring METS-IR index into a categorical variable by quartiles, the positive connection between METS-IR index and UI was still observed in the highest METS-IR group compared to the lowest METS-IR interval (SUI: OR = 2.266, 95% CI 1.947-2.637, p < 0.001; UUI: OR = 1.534, 95% CI 1.344-1.750, p < 0.001; MUI: OR = 2.044, 95% CI 1.707-2.448, p < 0.001). The analysis of smooth curves fitting showed that METS-IR index was positively linearly related to three types of UI. Moreover, the association between METS-IR index and SUI was more significant in females compared to males (p for interaction < 0.05). CONCLUSION An elevated METS-IR index was related to increased risks of three types of UI (SUI, UUI, and MUI) in the United States population. METS-IR index was more significantly connected to SUI in females than males. The association between insulin resistance and UI needs to be explored with more studies.
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Affiliation(s)
- Shangqi Cao
- Institute of Urology, Department of Urology, West China Medical School, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, China
| | - Linghao Meng
- Institute of Urology, Department of Urology, West China Medical School, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, China
| | - Lede Lin
- Institute of Urology, Department of Urology, West China Medical School, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, China
| | - Xu Hu
- Institute of Urology, Department of Urology, West China Medical School, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, China.
| | - Xiang Li
- Institute of Urology, Department of Urology, West China Medical School, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, China.
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Yuk JS, Cho IC, Lee JH. The Risk of Stress Urinary Incontinence After Hysterectomy for Uterine Fibroids. Int Neurourol J 2023; 27:252-259. [PMID: 38171325 PMCID: PMC10762370 DOI: 10.5213/inj.2346192.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 10/10/2023] [Indexed: 01/05/2024] Open
Abstract
PURPOSE We evaluated the relationship between previous hysterectomy for uterine fibroids and subsequent stress urinary incontinence (SUI). METHODS This study analyzed national health insurance data. The hysterectomy group (aged 40 to 59) comprised patients who underwent hysterectomy for uterine fibroids between January 1, 2011 and December 31, 2014, and the control group (aged 40 to 59) comprised patients who visited a medical facility for a checkup during the same time span. One-to-one propensity score matching was performed to balance confounders. SUI was defined as the need for SUI surgery accompanied by a diagnosis code for SUI. RESULTS After matching, 81,373 cases (hysterectomy group) and 81,373 controls (nonhysterectomy group) were enrolled. The mean follow-up period was 7.9 years for the cases and 7.8 years for the controls. The incidence of anti-incontinence surgery was slightly but significantly higher in the cases than in the controls (2.0% vs. 1.7%, P<0.001). Compared to the control group, abdominal hysterectomy significantly increased the likelihood of anti-incontinence surgery both before (hazard ratio [HR], 1.235; 95% confidence interval [CI], 1.116-1.365) and after adjusting for confounders (HR, 1.215; 95% CI, 1.097-1.347). In contrast, laparoscopic hysterectomy, laparoscopic hysterectomy with adnexal surgery, and abdominal hysterectomy with adnexal surgery were not associated with an increased rate of anti-incontinence surgery. The significant association between abdominal hysterectomy and an elevated rate of anti-incontinence surgery persisted even after stratifying patients by age group. CONCLUSION Prior abdominal hysterectomy without adnexal surgery was associated with an increased incidence of subsequent anti-urinary incontinence surgery.
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Affiliation(s)
- Jin-Sung Yuk
- Department of Obstetrics and Gynecology, Inje University Sanggye Paik Hospital, School of Medicine, Inje University, Seoul, Korea
| | - In-Chang Cho
- Department of Urology, National Police Hospital, Seoul, Korea
| | - Jun Ho Lee
- Department of Urology, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
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Pang H, Yin Y, Xue J, Chen X, Pang J, Zhang J, Sun Y. Associations between visceral adipose index and stress urinary incontinence among US adult women: a cross-sectional study. World J Urol 2023; 41:3671-3678. [PMID: 37921934 PMCID: PMC10693499 DOI: 10.1007/s00345-023-04667-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 09/26/2023] [Indexed: 11/05/2023] Open
Abstract
OBJECTIVE Visceral adipose index (VAI) is a novel parameter for the evaluation of visceral obesity. The present study aimed to investigate the association between VAI levels and stress urinary incontinence (SUI) in a nationally representative population. MATERIALS AND METHODS The National Health and Nutrition Examination Survey (NHANES) women population aged > 20 years were analyzed from 2001 to 2018. SUI was determined by self-reported questions. VAI was calculated using physical examination data and laboratory tests. Survey-weighted logistic regression models were used to analyze the correlation between SUI and VAI. RESULTS The final analysis included 9709 women. Among them, 4032 (41.53%) were any SUI, 1130 (11.64%) were at least weekly SUI, and 506 (5.21%) were at least daily SUI. In multivariate analysis, the odds ratio (OR) for overall SUI increased slightly after full adjustment (OR 1.06, 95% CI 1.03-1.10, P = 0.001). Similar results were observed in weekly (OR 1.04, 95% CI 1.00-1.08, P = 0.0327) and daily (OR 1.04, 95% CI 1.00-1.09, P = 0.0702) SUI. The analysis of VAI categorized showed an increased OR of any, weekly, and daily SUI in the highest compared to the lowest tertile (OR 1.44, 95% CI 1.26-1.65, P < 0.0001 for trend, OR 1.38, 95% CI 1.07-1.78, P = 0.0153 for trend, OR 1.33, 95% CI 0.94-1.87, P = 0.094 for trend). CONCLUSION This study revealed a significant association between SUI and VAI among US adult women. VAI is an easily applicable index for the evaluation of visceral fat dysfunction, which might be useful for the calculation of SUI risk.
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Affiliation(s)
- Haigang Pang
- Department of Urology, No.971 Hospital of the PLA Navy, Qingdao, 266071, China
| | - Yuxin Yin
- Department of Urology, No.971 Hospital of the PLA Navy, Qingdao, 266071, China
| | - Juan Xue
- Department of Nursing, No.971 Hospital of the PLA Navy, Qingdao, 266071, China
| | - Xi Chen
- Department of Urology, No.971 Hospital of the PLA Navy, Qingdao, 266071, China
| | - Jian Pang
- Department of Urology, No.971 Hospital of the PLA Navy, Qingdao, 266071, China
| | - Jinping Zhang
- Department of Urology, No.971 Hospital of the PLA Navy, Qingdao, 266071, China.
| | - Yi Sun
- Department of Urology, No.971 Hospital of the PLA Navy, Qingdao, 266071, China.
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Gabriel I, Delaney ML, Au M, Courtepatte A, Bry L, Minassian VA. Impact of microbiota and host immunologic response on the efficacy of anticholinergic treatment for urgency urinary incontinence. Int Urogynecol J 2023; 34:3041-3050. [PMID: 37837459 DOI: 10.1007/s00192-023-05664-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 09/11/2023] [Indexed: 10/16/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Studies within the past decade have suggested associations among composition of the urinary microbiota, local immune responses, and urinary incontinence symptoms. To investigate these relationships, we evaluated the structure of the urinary microbiome, local inflammatory markers, and patient responses prior to and at 6-weeks after treatment with anticholinergic medication for urgency urinary incontinence (UUI). METHODS Using a prospective pilot study, we enrolled women who presented with UUI symptoms and were prescribed treatment with anticholinergics. Catheterized urine samples were collected from participants at their baseline and 6-week follow-up visits for microbiological (standard and 16S rRNA gene phylotyping analyses) and cytokine analysis along with the UDI-6 questionnaire and 2-day bladder diary. RESULTS Patients were Caucasian, post- menopausal, with a median age of 64 and median BMI of 30.1 kg/m2. Among the patients, 75% had UUI symptoms for less than 2 years, but with a frequency of at least a few times a week or every day. Most women were prescribed 10 mg oxybutynin ER daily at enrollment. Patients had varied urinary microbiota by culture and 16S phylotyping, with species of Lactobacillus being the most common, in six samples, in addition to taxa associated with Enterococcus, Staphylococcus, and mixed flora. Cytokine levels showed no differences before and after treatment with anticholinergics, nor correlation with urinary bacteria or microbiome composition. CONCLUSIONS Our pilot study suggests factors in addition to the urinary microbiome and local immune responses may be involved in patients' response to anticholinergics for UUI.
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Affiliation(s)
- Iwona Gabriel
- Division of Urogynecology, Brigham and Women's Hospital, 500 Brookline Ave, Suite E, Boston, MA, 02115, USA
- Department of Gynecology, Obstetrics and Oncological Gynecology, Medical University of Silesia, Bytom, Poland
| | - Mary Louise Delaney
- Massachusetts Host-Microbiome Center, Department of Pathology, Brigham & Women's Hospital, Boston, MA, USA
| | - Matthew Au
- Evans Biomedical Research Center, Boston, MA, USA
| | - Alexa Courtepatte
- Division of Urogynecology, Brigham and Women's Hospital, 500 Brookline Ave, Suite E, Boston, MA, 02115, USA.
| | - Lynn Bry
- Massachusetts Host-Microbiome Center, Department of Pathology, Brigham & Women's Hospital, Boston, MA, USA
| | - Vatche A Minassian
- Division of Urogynecology, Brigham and Women's Hospital, 500 Brookline Ave, Suite E, Boston, MA, 02115, USA
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Six JC, Pinsard M, Guerin S, Gasmi A, Coiffic J, Richard C, Haudebert C, Nyangoh Timoh K, Hascoet J, Peyronnet B. Risk factors for stress urinary incontinence recurrence after midurethral sling revision. Int J Urol 2023; 30:1008-1013. [PMID: 37439555 DOI: 10.1111/iju.15248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 06/27/2023] [Indexed: 07/14/2023]
Abstract
OBJECTIVES The purpose of this study was to report the rate of stress urinary incontinence (SUI) recurrence after sling revision, and to determine predictive factors of SUI recurrence. METHODS We conducted a retrospective cohort study in a single academic center between 2005 and 2022, of patients who underwent sling revision. Four surgical techniques were used for sling revision (loosening, section, partial, and total excision). The primary endpoint was recurrence of SUI at 3 months postoperatively, and the other outcome of interest was the rate of subsequent anti-incontinence surgical procedure. RESULTS Sixty-nine patients were included for analysis. SUI recurred in 46.4% of patients. Fifteen patients underwent a subsequent anti-incontinence procedure (21.8%). The time to revision was significantly longer in the group with recurrent SUI (median: 84.5 vs. 44.8 months; p = 0.004). The recurrence rate differed significantly depending on the revision technique: 7.7% after sling loosening, 22.2% after sling section, 60% after partial excision, and 66.7% after complete sling removal (p = 0.001). The risk of SUI recurrence was lower for those whose indication of reoperation was voiding dysfunction (27.3% vs. 66.7%; p = 0.002), and was higher for those who underwent a trans-obturator tap rather than a tension-free vaginal tape revision (68.4% vs. 35.7%; p = 0.02). In multivariate analysis, only the revision technique remained significantly associated with the risk of recurrence of SUI (complete excision vs. section: odds ratio = 4.66; p = 0.04). CONCLUSION The risk of SUI recurrence may differ widely according to the techniques used, and it seems that the less extensive the surgical procedure is, the lower the risk is.
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Affiliation(s)
- Jeanne-Claire Six
- Department of Obstetrics, Gynecology and Human Reproduction, University of Rennes, Rennes, France
| | - Marion Pinsard
- Department of Obstetrics, Gynecology and Human Reproduction, University of Rennes, Rennes, France
| | - Sonia Guerin
- Department of Obstetrics, Gynecology and Human Reproduction, University of Rennes, Rennes, France
| | - Anis Gasmi
- Department of Urology, University of Rennes, Rennes, France
| | - Jerry Coiffic
- Department of Obstetrics, Gynecology and Human Reproduction, University of Rennes, Rennes, France
| | - Claire Richard
- Department of Urology, University of Rennes, Rennes, France
| | | | - Krystel Nyangoh Timoh
- Department of Obstetrics, Gynecology and Human Reproduction, University of Rennes, Rennes, France
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Zhao S, Fang M, Li Y, Wang F, Li H, Wang L. Fabrication and in vitro investigation of hyperbranched poly-lysine-grafted warp knitted polypropylene sling for potential treatment of stress urinary incontinence. Biomater Sci 2023; 11:6504-6523. [PMID: 37577866 DOI: 10.1039/d3bm00943b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Polypropylene (PP) sling implantation is the most commonly performed procedure for women with stress urinary incontinence (SUI). However, concerns have arisen regarding complications caused by slings, including the common issue of erosion, which can be attributed to various factors such as the body's response and bacterial contamination. To address these concerns, we have developed a rectangular mesh self-locking edge sling with a large pore size and lightweight design. Promising results have been obtained from preliminary in vivo mechanical reliability tests, including uniaxial tensile tests. In comparative in vitro fixed load tensile tests and simulated Tension-free Vaginal Tape (TVT) and Transobturator Vaginal Tape inside-out (TVT-O) technique tests using commercial slings, our sling demonstrated less transverse wrinkling. Both slings achieved an effective porosity of over 45% under the TVT technique. However, the commercial sling experienced a significant reduction in effective porosity during the TVT-O technique, whereas our sling maintained a stable effective porosity with minimal wrinkling. Furthermore, we successfully developed cationic hydration rejection-driven antibacterial-anti-fouling coatings on the surface of our sling by grafting hyperbranched poly-lysine (HBPL) mediated by polynorepinephrine. The HBPL coating imparts a positive charge and hydrophilicity to the sling, resulting in elevated bactericidal activity and reducing protein adhesion. An optimal grafting concentration of 20 mg mL-1 was selected, confirming the stability and biocompatibility of the sling coating. This coating is expected to reduce the likelihood of postoperative erosion. Overall, our research represents significant advancements in improving the safety and performance of PP slings for stress urinary incontinence, potentially leading to a reduction in complications following surgery.
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Affiliation(s)
- Shuying Zhao
- Key Laboratory of Textile Science & Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai, China.
- Key Laboratory of Textile Industry for Biomedical Textile Materials and Technology, Donghua University, Shanghai, China
| | - Meiqi Fang
- Key Laboratory of Textile Science & Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai, China.
- Key Laboratory of Textile Industry for Biomedical Textile Materials and Technology, Donghua University, Shanghai, China
| | - Yan Li
- Key Laboratory of Textile Science & Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai, China.
- Key Laboratory of Textile Industry for Biomedical Textile Materials and Technology, Donghua University, Shanghai, China
| | - Fujun Wang
- Key Laboratory of Textile Science & Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai, China.
- Key Laboratory of Textile Industry for Biomedical Textile Materials and Technology, Donghua University, Shanghai, China
| | - Hao Li
- Shanghai Hongyu Medical Technology Co., Ltd, Shanghai, China
| | - Lu Wang
- Key Laboratory of Textile Science & Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai, China.
- Key Laboratory of Textile Industry for Biomedical Textile Materials and Technology, Donghua University, Shanghai, China
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Tsui WL, Deng GH, Hsieh TC, Ding DC. Association between vaginal or cesarean delivery and later development of stress urinary incontinence or pelvic organ prolapse: A retrospective population-based cohort study. Int Urogynecol J 2023; 34:2041-2047. [PMID: 36917258 DOI: 10.1007/s00192-023-05504-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 02/14/2023] [Indexed: 03/15/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Child delivery mode may be associated with pelvic floor disorders. We explored the association between different delivery modes and later development of stress urinary incontinence (SUI) and pelvic organ prolapse (POP) in Taiwanese women. METHODS This was a retrospective population-based cohort study. Women who delivered babies between January 1, 2000, and December 31, 2018, were selected for this study. The study used Taiwan's National Health Insurance (NHI) Research Database. After propensity score matching, 51,587 women who underwent cesarean section (C/S) and 51,587 women who underwent vaginal delivery (VD) were recruited. Primary outcomes were the presence of SUI and POP after delivery. RESULTS The incidence of SUI (1.6/1000 person-years) and POP (1.5/1000 person-years) was higher in the VD group than in the C/S group (0.8 and 0.6 in 1000 person-years). VD was associated with an increased risk of SUI [hazard ratio (HR): 2.79, 95% confidence interval (CI): 2.45-3.17] and POP (HR: 1.96, 95% CI: 1.75-2.19) compared to C/S. We also found that age (HR: 1.06, 95% CI: 1.05-1.08 in SUI, HR: 1.08, 95% CI: 1.07-1.09 in POP) and Charlson Comorbidity Index (CCI) (HR: 1.28, 95% CI: 1.12-1.46 in SUI, HR: 1.27, 95% CI: 1.13-1.43 in POP) were associated with an increased risk of SUI and POP. The cumulative incidence of SUI and POP was higher in the VD group than in the C/S group (log-rank test, P < 0.05). CONCLUSIONS The current study was the largest retrospective cohort study regarding the influence of delivery mode on SUI and POP so far. VD was found to be associated with an increased risk of SUI and POP compared with C/S. Postpartum care for pelvic physical therapy should be provided particularly to women undergoing VD.
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Affiliation(s)
- Wing Lam Tsui
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Tzu Chi University, Hualien, 970, Taiwan
| | - Guang-Hong Deng
- Tzu Chi University Research Center for Big Data Teaching, Research and Statistic Consultation, Tzu Chi University, Hualien, 970, Taiwan
| | - Tsung-Cheng Hsieh
- Tzu Chi University Research Center for Big Data Teaching, Research and Statistic Consultation, Tzu Chi University, Hualien, 970, Taiwan
- Institute of Medical Sciences, Tzu Chi University, Hualien, 970, Taiwan
| | - Dah-Ching Ding
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Tzu Chi University, Hualien, 970, Taiwan.
- Institute of Medical Sciences, Tzu Chi University, Hualien, 970, Taiwan.
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Hentzen C, Cabrilo I, Malladi P, Simeoni S, Amarenco G, Zaidman N, Pakzad M, Shah S, Casey AT, Panicker JN. Sacral Tarlov cysts: Neurophysiology abnormalities and correlation with pelvic sensory and visceral symptoms. Eur J Neurol 2023; 30:2838-2848. [PMID: 37203934 DOI: 10.1111/ene.15869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 05/03/2023] [Accepted: 05/15/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND AND PURPOSE Recent studies suggest a possible association between Tarlov cysts (TCs), usually considered as incidental radiological findings, and neurological symptoms such as pain, numbness and urogenital complaints. The aim was to explore the relationship between TCs and sacral nerve root functions using pelvic neurophysiology tests, and to correlate changes with clinical symptoms and magnetic resonance imaging (MRI) findings. METHODS Consecutive patients with sacral TCs, referred for pelvic neurophysiology testing and presenting with at least one symptom related to the pelvic area, participated in a cross-sectional review of symptoms using validated questionnaires. Findings of pelvic neurophysiology (pudendal sensory evoked potentials, sacral dermatomal sensory evoked potentials, external anal sphincter electromyography) and urodynamics testing were collected retrospectively. The relationship between neurophysiology, MRI findings and patients' symptoms was assessed using Fisher and ANOVA tests. RESULTS Sixty-five females were included (mean age 51.2 ± 12.1 years). The commonest symptom was pain (92%). Urinary (91%), bowel (71%) and sexual (80%) symptoms were also frequently reported. Thirty-seven patients (57%) had abnormal neurophysiology findings reflecting sacral root dysfunction. No association was seen between MRI findings (size, location of the cysts, severity of compression) and neurophysiology. A negative association was observed between neurophysiology abnormalities and occurrence of urgency urinary incontinence (p = 0.03), detrusor overactivity (p < 0.01) and stress urinary incontinence (p = 0.04); however, there was no association with voiding difficulties. CONCLUSIONS Contrary to current understanding, TCs are associated with injury to the sacral somatic innervation in the majority of patients with presumed symptomatic cysts. However, urinary incontinence is unlikely to be related to TC-induced nerve damage.
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Affiliation(s)
- Claire Hentzen
- Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, London, UK
- GRC 01, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Sorbonne Université, Paris, France
| | - Ivan Cabrilo
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Prasad Malladi
- Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, London, UK
- Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Sara Simeoni
- Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, London, UK
- Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Gérard Amarenco
- GRC 01, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Sorbonne Université, Paris, France
| | - Nathalie Zaidman
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Mahreen Pakzad
- Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Sachit Shah
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Adrian T Casey
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
- Spinal Unit, Wellington Hospital, London, UK
| | - Jalesh N Panicker
- Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, London, UK
- Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London, London, UK
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Souza HDC, Pires LMT, Vieira GC, Castro EAB, Moura EA, Engelmann J, Fonseca DS. Prevalence of pelvic floor disorders and the associated quality of life among institutionalized and noninstitutionalized elderly women: A cross-sectional study. Curr Urol 2023; 17:184-187. [PMID: 37448617 PMCID: PMC10337817 DOI: 10.1097/cu9.0000000000000138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 09/17/2021] [Indexed: 11/27/2022] Open
Abstract
Background An increase in life expectancy has led to an increased elderly population. In turn, this aging population is more likely to develop health conditions, such as pelvic floor disorders (PFDs). This study aimed to assess the prevalence of these disorders and the associated quality of life in institutionalized and noninstitutionalized elderly women. Materials and methods A cross-sectional study was conducted with 80 female participants older than 60 years, divided into 2 groups: institutionalized and noninstitutionalized participants. The Pelvic Floor Distress Inventory Short-Form and a sociodemographic questionnaire were used. A chi-squared test was used to assess the differences in prevalence between groups. Results There was no statistically significant difference between the groups in the prevalence of PFDs or quality of life. In this study, the prevalence of PFDs was higher than that reported previously. In institutionalized women, a higher prevalence of PFDs and impaired quality of life were expected, although not observed. Conclusions There was a higher prevalence of pelvic disorders and impaired quality of life due to these disorders in elderly women.
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Affiliation(s)
- Heloisa da Costa Souza
- Programa de Graduação em Fisioterapia, Faculdade de Fisioterapia, Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil
| | - Lívia M. T. Pires
- Programa de Graduação em Fisioterapia, Faculdade de Fisioterapia, Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil
| | - Gláucia C. Vieira
- Programa de Pós-Graduação em Ciências da Reabilitação e Desempenho Físico Funcional, Faculdade de Fisioterapia, Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil
| | - Edna A. B. Castro
- Programa de Pós-Graduação em Enfermagem, Faculdade de Enfermagem, Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil
| | - Elaine A. Moura
- Programa de Pós-Graduação em Psicologia, Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil
| | - Júlia Engelmann
- Programa de Graduação em Fisioterapia, Faculdade de Fisioterapia, Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil
| | - Diogo S. Fonseca
- Programa de Graduação em Fisioterapia, Faculdade de Fisioterapia, Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil
- Programa de Pós-Graduação em Ciências da Reabilitação e Desempenho Físico Funcional, Faculdade de Fisioterapia, Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil
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Dasdelen MF, Almas F, Celik S, Celik N, Seyhan Z, Laguna P, Albayrak S, Horuz R, Kocak M, de la Rosette J. When Bladder and Brain Collide: Is There a Gender Difference in the Relationship between Urinary Incontinence, Chronic Depression, and Anxiety? J Clin Med 2023; 12:5535. [PMID: 37685602 PMCID: PMC10488595 DOI: 10.3390/jcm12175535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 08/23/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
In longitudinal and cross-sectional studies, depression and anxiety have been associated with urinary incontinence (UI) in women. However, this association has not been studied in men. Utilizing data from the 2008 Turkish Health Studies Survey conducted by the Turkish Statistical Institute, we analyzed 13,830 participants aged 15 years and above. We investigated the association of UI with psychological discomfort in both sexes using multivariable logistic regression. High psychological discomfort significantly correlated with UI in males (OR 2.30, 95% CI 1.43-3.71) and females (OR 2.78, 95% CI 1.80-4.29). Anxiety increased UI likelihood in females (OR 2.36, 95% CI 1.61-3.46) and males (OR 2.37, 95% CI 1.10-5.13). Depression related significantly to UI in females (OR 2.54, 95% CI 1.81-3.58) but not males (OR 1.63, 95% CI 0.71-3.76). Antidepressant and anxiolytic use was not significantly related to UI in either gender. Anxiety and psychological discomfort contribute to UI in both genders. While depression significantly correlates with UI in females, it does not show the same magnitude and significance in males. Antidepressant and anxiolytic use did not significantly influence the association. These findings underscore the psychological distress-UI link, advocating a holistic approach for managing UI in individuals with mental health conditions.
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Affiliation(s)
- Muhammed Furkan Dasdelen
- International School of Medicine, Istanbul Medipol University, 34810 Istanbul, Türkiye; (F.A.); (S.C.); (Z.S.); (P.L.); (R.H.); (M.K.)
| | - Furkan Almas
- International School of Medicine, Istanbul Medipol University, 34810 Istanbul, Türkiye; (F.A.); (S.C.); (Z.S.); (P.L.); (R.H.); (M.K.)
| | - Suleyman Celik
- International School of Medicine, Istanbul Medipol University, 34810 Istanbul, Türkiye; (F.A.); (S.C.); (Z.S.); (P.L.); (R.H.); (M.K.)
| | - Nursanem Celik
- School of Medicine, Istanbul Medipol University, 34810 Istanbul, Türkiye; (N.C.); (S.A.)
| | - Zuleyha Seyhan
- International School of Medicine, Istanbul Medipol University, 34810 Istanbul, Türkiye; (F.A.); (S.C.); (Z.S.); (P.L.); (R.H.); (M.K.)
| | - Pilar Laguna
- International School of Medicine, Istanbul Medipol University, 34810 Istanbul, Türkiye; (F.A.); (S.C.); (Z.S.); (P.L.); (R.H.); (M.K.)
- Department of Urology, Istanbul Medipol University, 34810 Istanbul, Türkiye
| | - Selami Albayrak
- School of Medicine, Istanbul Medipol University, 34810 Istanbul, Türkiye; (N.C.); (S.A.)
- Department of Urology, Istanbul Medipol University, 34810 Istanbul, Türkiye
| | - Rahim Horuz
- International School of Medicine, Istanbul Medipol University, 34810 Istanbul, Türkiye; (F.A.); (S.C.); (Z.S.); (P.L.); (R.H.); (M.K.)
- Department of Urology, Istanbul Medipol University, 34810 Istanbul, Türkiye
| | - Mehmet Kocak
- International School of Medicine, Istanbul Medipol University, 34810 Istanbul, Türkiye; (F.A.); (S.C.); (Z.S.); (P.L.); (R.H.); (M.K.)
- Department of Biostatistics and Medical Informatics, Istanbul Medipol University, 34810 Istanbul, Türkiye
| | - Jean de la Rosette
- International School of Medicine, Istanbul Medipol University, 34810 Istanbul, Türkiye; (F.A.); (S.C.); (Z.S.); (P.L.); (R.H.); (M.K.)
- Department of Urology, Istanbul Medipol University, 34810 Istanbul, Türkiye
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Wang Q, Que YZ, Wan XY, Lin CQ. Prevalence, Risk Factors, and Impact on Life of Female Urinary Incontinence: An Epidemiological Survey of 9584 Women in a Region of Southeastern China. Risk Manag Healthc Policy 2023; 16:1477-1487. [PMID: 37581111 PMCID: PMC10423612 DOI: 10.2147/rmhp.s421488] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/19/2023] [Indexed: 08/16/2023] Open
Abstract
Purpose To investigate the prevalence, risk factors, and impact on quality of life (QOL) of female urinary incontinence (UI) in a region of southeastern China. Patients and Methods This cross-sectional study, conducted between June 2022 and March 2023, included 9584 women aged 20-70 years who completed a standardized questionnaire through face-to-face interviews. This sample size represents almost 10% of the population in the target area. Results The prevalence of female UI was found to be 24.8%, with stress UI being the most common subtype (12.7%), followed by mixed UI (8.0%) and urgency UI (4.1%). Notably, the prevalence of UI increased progressively with age and body mass index (BMI). The study also revealed several risk factors for UI, including urban residence, postmenopausal status, multiple vaginal deliveries, instrumental vaginal deliveries, previous delivery of macrosomia, and prior history of pelvic floor surgery as determined by multivariate analysis. Furthermore, the study showed that 89.5% of women who reported UI experienced varying degrees of negative impact on their QOL. The incontinence quality of life (I-QOL) scale had an average score of 79.70±19.03, which decreased with increasing severity of UI. Despite the adverse effects on QOL, only 20.6% of women with UI had sought medical help. Conclusion UI is common among women in the survey area. UI has been observed to have varying degrees of adverse effects on the QOL of those affected, but most of them do not seek treatment for several reasons, highlighting the urgent need for health authorities to develop effective UI intervention strategies.
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Affiliation(s)
- Qi Wang
- Department of Gynecology, Fujian Provincial Key Laboratory of Women and Children’s Critical Diseases Research, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, People’s Republic of China
| | - Yan-Zhen Que
- Department of Gynecology and Obstetrics, Shaxian General Hospital, Sanming, People’s Republic of China
| | - Xiao-Ying Wan
- Department of Gynecology and Obstetrics, Shaxian General Hospital, Sanming, People’s Republic of China
| | - Chao-Qin Lin
- Department of Gynecology, Fujian Provincial Key Laboratory of Women and Children’s Critical Diseases Research, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, People’s Republic of China
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Blanco Gutiérrez V, Hundley VA, Way S. The Experience of Women From Underrepresented Groups With Urinary Incontinence: A Systematic Review. J Transcult Nurs 2023; 34:288-300. [PMID: 37199465 PMCID: PMC10265309 DOI: 10.1177/10436596231172205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023] Open
Abstract
INTRODUCTION Urinary incontinence (UI) in women is a global public health issue. However, there is a limited understanding of the experience of women from underrepresented groups suffering from UI. The purpose of this systematic review was to examine current evidence regarding the experience of women with UI from these groups. METHODOLOGY A systematic search was undertaken to retrieve research studies that answered the research question. Four qualitative research studies were included. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guided this review. RESULTS Four themes emerged from this review: the perceived origin of UI, the physical, psychological, and social impact of UI, the impact of culture and religion on UI, and vice versa, and the interaction of women with health services. DISCUSSION Social determinants of health, such as religion and culture, need to be considered by professionals providing care if women from underrepresented groups experiencing UI are to receive optimal care.
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Kharaji G, ShahAli S, Ebrahimi-Takamjani I, Sarrafzadeh J, Sanaei F, Shanbehzadeh S. Supervised versus unsupervised pelvic floor muscle training in the treatment of women with urinary incontinence - a systematic review and meta-analysis. Int Urogynecol J 2023; 34:1339-1349. [PMID: 36811635 PMCID: PMC9944784 DOI: 10.1007/s00192-023-05489-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 02/05/2023] [Indexed: 02/24/2023]
Abstract
INTRODUCTION AND HYPOTHESIS This study synthesized the effects of supervised and unsupervised pelvic floor muscle training (PFMT) programs on outcomes relevant to women's urinary incontinence (UI). METHODS Five databases were searched from inception to December 2021, and the search was updated until June 28, 2022. Randomized and non-randomized control trials (RCTs and NRCTs) comparing supervised and unsupervised PFMT in women with UI and reported urinary symptoms, quality of life (QoL), pelvic floor muscles (PFM) function/ strength, the severity of UI, and patient satisfaction outcomes were included. Risk of bias assessment of eligible studies was performed by two authors through Cochrane risk of bias assessment tools. The meta-analysis was conducted using a random effects model with the mean difference or standardized mean difference. RESULTS Six RCTs and one NRCT study were included. All RCTs were assessed as "high risk of bias", and the NRCT study was rated as "serious risk of bias" for almost all domains. The results showed that supervised PFMT is better than unsupervised for QoL and PFM function of women with UI. There was no difference between supervised and unsupervised PFMT for urinary symptoms and improvement of the severity of UI. Results of patient satisfaction were inconclusive due to the sparse literature. However, supervised and unsupervised PFMT with thorough education and regular reassessment showed better results than those for unsupervised PFMT without educating patients about correct PFM contractions. CONCLUSIONS Supervised and unsupervised PFMT programs can both be effective in treating women's UI if training sessions and regular reassessments are provided.
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Affiliation(s)
- Ghazal Kharaji
- Iranian Center of Excellence in Physiotherapy, Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Shabnam ShahAli
- Iranian Center of Excellence in Physiotherapy, Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.
| | - Ismail Ebrahimi-Takamjani
- Iranian Center of Excellence in Physiotherapy, Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Javad Sarrafzadeh
- Iranian Center of Excellence in Physiotherapy, Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Fateme Sanaei
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sanaz Shanbehzadeh
- Iranian Center of Excellence in Physiotherapy, Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
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Pavarini N, Valadares ALR, Varella GM, Brito LGO, Juliato CRT, Costa-Paiva L. Sexual function after energy-based treatments of women with urinary incontinence. A systematic review and meta-analysis. Int Urogynecol J 2023; 34:1139-1152. [PMID: 36680596 DOI: 10.1007/s00192-022-05419-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/17/2022] [Indexed: 01/22/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Urinary incontinence (UI) affects approximately 50% of adult women worldwide and is associated with declining sexual function (SF). Energy-based devices emerged as a minimally invasive alternative treatment. Nevertheless, their effect on sexuality is uncertain. We hypothesize that the UI energy treatment can lead to sexual function improvement. METHODS A search was performed in PubMed, Cochrane Library, Web of Science, Embase, and Scopus for randomized clinical trials (RCTs) and nonrandomized studies of intervention, which treated incontinent women using energy, with UI and sexual function (SF) as outcomes. Severe comorbidities, pelvic organ prolapse (POP)> grade 2, and use of medication to treat UI or that affects SF were excluded. Quality assessment and meta-analysis were performed. RESULTS From 322 articles, 11 RCTs were included for qualitative analysis. UI symptoms improved in all studies. Regarding SF, RCT with premenopausal women showed improvement in SF in the Er:Yag group (Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12 and Female Sexual Function Index). A prospective study showed improvement in SF independent of the grade of SUI. RF showed benefits for SF but was not superior to pelvic floor muscle training. One nonrandomized study of intervention with a High-Intensity Focused Electromagnetic Field showed significant improvement of SF in the Golombok Rust Inventory of Sexual Satisfaction total score, a decline in pain and dissatisfaction domains. Meta-analysis with 4 RCTs and 2 nonrandomized studies found no difference between groups (0.26 (95% CI -0.67 to 1.20, and -0.74 (95% CI -3.78 to 2.30) respectively). CONCLUSIONS This meta-analysis did not confirm that energy equipment improved the SF of women with UI.
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Affiliation(s)
- Nádia Pavarini
- School of Medical Science, University of Campinas (UNICAMP), Campinas, Brazil
| | - Ana L R Valadares
- Department of Obstetrics and Gynecology, School of Medicine, University of Campinas (UNICAMP), Rua Alexander Fleming, 101, Cidade Universitária Zeferino Vaz, Campinas, SP, 13083-881, Brazil.
| | - Glaucia M Varella
- School of Medical Science, University of Campinas (UNICAMP), Campinas, Brazil
| | - Luiz G O Brito
- Department of Obstetrics and Gynecology, School of Medicine, University of Campinas (UNICAMP), Rua Alexander Fleming, 101, Cidade Universitária Zeferino Vaz, Campinas, SP, 13083-881, Brazil
| | - Cássia R T Juliato
- Department of Obstetrics and Gynecology, School of Medicine, University of Campinas (UNICAMP), Rua Alexander Fleming, 101, Cidade Universitária Zeferino Vaz, Campinas, SP, 13083-881, Brazil
| | - Lúcia Costa-Paiva
- Department of Obstetrics and Gynecology, School of Medicine, University of Campinas (UNICAMP), Rua Alexander Fleming, 101, Cidade Universitária Zeferino Vaz, Campinas, SP, 13083-881, Brazil
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