Stress Urinary Incontinence in Women

Brain-Derived Neurotrophic Factor Is an Important Therapeutic Factor in Mesenchymal Stem Cell Secretions for Treatment of Traumatic Peripheral Pelvic Injuries

Traumatic neuromuscular injury to the pudendal nerve and urethra during childbirth does not regenerate well and contributes to stress urinary incontinence in women. Mesenchymal stem cells (MSCs) can improve neuroregeneration via their secretions, or secretome, which includes brain-derived neurotrophic factor (BDNF). In this study, we investigated whether BDNF is a key factor in the secretome of MSCs for the facilitation of functional recovery following a dual simulated childbirth injury. BDNF knockdown (KD) MSCs were created using an anti-BDNF shRNA lentivirus vector. A scrambled sequence was used as a transduction control (scrambled). Cells were cultured for 24 h before media was concentrated 50x to create concentrated conditioned media (CCM) containing MSC secretome. CCM of unmanipulated MSCs was screened for high BDNF expression (high BDNF CCM). Concentrated control media (CM) was created by concentrating media not conditioned by cells. Female Sprague-Dawley rats underwent bilateral pudendal nerve crush and vaginal distension (Injury) or sham injury. One hour and 1 week after injury, sham injured rats received CM, and injured rats received CM, high BDNF CCM, KD CCM, or scrambled CCM (300 μl intraperitoneally). Three weeks after injury, rats underwent leak point pressure (LPP) and pudendal nerve sensory branch potential (PNSBP) recordings. The urethra and pudendal nerve were harvested for anatomical assessment. ANOVA followed by the Student-Newman-Keuls test determined significant differences between groups (p < 0.05). BDNF KD CCM had significantly decreased BDNF concentration compared to scrambled CCM, while the concentration in high BDNF CCM was significantly increased. LPP was significantly decreased in CM and KD CCM treated animals compared to sham injury, but not with scrambled or high BDNF CCM. PNSBP firing rate showed a significant decrease with CM treatment compared to sham injury. Neuromuscular junctions in the urethral sphincter in KD CCM, scrambled CCM, and high BDNF CCM were healthier than CM treated rats. While anatomical and nerve function tests demonstrate regeneration of the pudendal nerve with any CCM treatment, LPP results suggest it takes longer to recover continence with reduced BDNF in CCM. BDNF in MSC CCM is an important factor for the acceleration of recovery from a dual nerve and muscle injury.

Ferrans and Powers' Quality of life index applied in urinary incontinence research--a pilot study

BACKGROUND

The aim of this study was to explore the usefulness of applying a global, evaluation-based quality of life (QoL) questionnaire in assessing the impact of urinary incontinence (UI) on women's lives.

METHODS

The study population comprised long-term gynaecological cancer survivors (n=160) and controls from the general population (n=493). The presence of UI was assessed by the question 'Do you leak urine?' while UI perceived as a problem was assessed on a five-point scale from 'No problem' to 'A very large problem'. QoL was measured by Ferrans & Powers' QoL index (QLI), generic version II.

RESULTS

UI was distributed equally among women with a history of gynaecological cancer and among women from the general population (34%). UI has a negative impact on overall QLI as well as a wide range of items. Approximately 20% of the incontinent women defined UI as no problem, with QLI scores similar to continent women. Only 5% experienced UI as a large/very large problem; with exceptionally low QLI scores. The psychometric testing of QLI (acceptability, internal consistency reliability and known-group validity) supports the use of QLI in UI-studies.

CONCLUSIONS

The Ferrans & Powers' QLI is considered an acceptable tool for UI research, but further psychometric testing is required.

Goal achievement as a patient-generated outcome measure for stress urinary incontinence

OBJECTIVES

To explore women's goals and goal attainment for the conservative and surgical treatment of stress urinary incontinence (SUI), and to examine the feasibility of Goal Attainment Scaling (GAS) as an outcome measure in this population.

BACKGROUND

Despite the range of treatments for SUI, little is known about the outcomes patients consider important. Current instruments measure the impact of SUI on the ability to live a 'normal' life without addressing what normal looks like for the patient. Patient-generated measures that address what a patient aims to achieve may fill this gap.

DESIGN

A mixed-methods exploratory design combined semi-structured interviews with validated questionnaires and individualized rating of goal achievement. SETTING AND PARTICIPANTS PARTICIPANTS: with SUI (n = 18) were interviewed in their homes prior to initiation of treatment and 3-6 months afterwards.

MAIN VARIABLES

Participants reported individualized goals pre-treatment and rated goal attainment after surgical and conservative therapy. Quality of life impact and change were measured using short forms of the Incontinence Impact Questionnaire and Urinary Distress Inventory.

RESULTS

Women expressed a median of four highly individualized treatment-related goals but goal achievement following conservative treatment was poor. GAS was not feasible as an outcome measure; women readily identified personal goals but could not independently identify graded levels of attainment for each goal.

CONCLUSIONS

Although further work is needed to examine the most feasible, valid, and reliable method of measuring goal achievement in research, asking patients with UI to identify pre-treatment goals may provide useful information to guide treatment-related decision making.

Help-seeking behaviors of women with urinary incontinence: an integrative literature review

Urinary incontinence (UI) affects approximately 17 million American women. Women with UI have reported a lower quality of life than women who do not experience UI. In many cases, UI affects a woman's ability to take part in a variety of recreational and social activities, and has negative psychological effects including depression, anxiety, and frustration. Studies show that fewer than 50% of women with UI discuss their symptoms with their health care provider. Although researchers have examined help-seeking behaviors in people with UI, few have examined women of all ages with all types of UI. The purpose of this integrative literature review is to summarize the help-seeking behaviors for UI symptoms among noninstitutionalized women of all ages with all types of UI. Five studies were reviewed. In all of the studies, less than 38% of women sought help for their UI symptoms. Factors affecting help seeking included quality of life scores, perceptions women had regarding the normalcy of UI, and beliefs about treatment options available for the problem. Age, type of UI, severity of UI, and embarrassment were found to be significantly related to help-seeking in most, but not all of the studies.

Aferição simultânea da pressão abdominal na avaliação ultra-sonográfica de mulheres com incontinência urinária de esforço

OBJETIVO: Determinar a influência da aferição da pressão intra-abdominal na avaliação ultra-sonográfica da junção uretrovesical (JUV) e da uretra proximal (UP) em pacientes com incontinência urinária de esforço (IUE). MATERIAIS E MÉTODOS: Estudo prospectivo de corte transversal realizado na Unidade de Pesquisa em Incontinência Urinária da Universidade Federal de Pernambuco, de janeiro de 2002 a janeiro de 2005. Trinta e seis pacientes com queixas de IUE foram submetidas a ultra-sonografia perineal para avaliação da JUV e da UP com a bexiga praticamente vazia (< 50 ml), com aferição simultânea de pressão intra-abdominal. Para as avaliações, foi utilizado aparelho de ultra-som com transdutor vaginal de 7 MHz e seletor eletrônico de mensuração de imagem real, equipado com computador e câmera fotográfica de resolução instantânea. Para a medida da pressão intra-abdominal, foi utilizado aparelho de urodinâmica com cateter de 10 fr retal acoplado a um balão de sensor para medida da pressão intra-abdominal. RESULTADOS: As pacientes tinham idade entre 25 e 69 anos (média de 46,4 ± 10,2 anos). À manobra de Valsalva, a pressão intra-abdominal variou entre 7 cmH2O e 193 cmH2O (média de 99,3 ± 51,8 cmH2O; mediana de 99,5 cmH2O). Oito das 31 (25,8%) pacientes com hipermobilidade da JUV apresentaram pressão intra-abdominal inferior a 60 cmH2O. Não foi detectada relação estatisticamente significante entre a variação de pressão intra-abdominal e os parâmetros ultra-sonográficos em questão. CONCLUSÃO: Há um índice específico de pressão de deslocamento uretral para cada mulher com IUE. Porém, não há associação significativa entre o aumento de pressão intra-abdominal e aumento de mobilidade da JUV e UP em mulheres com quadro clínico de IUE.