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Charette M, Pacheco-Brousseau L, Poitras S, Ashton R, McLean L. Management of urinary incontinence in females by primary care providers: a systematic review. BJU Int 2024; 133:498-512. [PMID: 38037509 DOI: 10.1111/bju.16234] [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: 12/02/2023]
Abstract
OBJECTIVE To describe primary care provider (PCP) practices for the assessment and management of females with urinary incontinence (UI), and appraise these practices relative to recommendations made in high-quality clinical guidelines. METHODS Studies were searched in four databases (MEDLINE, EMBASE, CINAHL, Web of Science) from their respective inception dates to 6 March 2023. All studies describing UI evaluation and management practices used by PCPs for female patients were eligible. Two reviewers independently selected studies assessed their quality and extracted data. A narrative synthesis of included studies was performed to describe practices. Relevant evaluation and management practices were then compared to recommendations that were consistent across current high-quality UI guidelines. Pharmacotherapy, referrals, and follow-ups were reported descriptively only. RESULTS A total of 3475 articles were retrieved and, among those, 31 were included in the review. The majority reported a poor-moderate adherence to performing a pelvic examination (reported adherence range: 23-76%; based on eight studies), abdominal examination (0-87%; three studies), pelvic floor muscle assessment (9-36%; two studies), and bladder diary (0-92%; nine studies), while there was high adherence to urine analysis (40-97%; nine studies). For the conservative management of UI, studies revealed a poor-moderate adherence to recommendations for pelvic floor muscle training (5-82%; nine studies), bladder training (2-53%; eight studies) and lifestyle interventions (1-71%; six studies). Regarding pharmacotherapy, PCPs predominantly prescribed antimuscarinics (2-46%; nine studies) and oestrogen (2-77%; seven studies). Lastly, PCPs referred those reporting UI to medical specialists (5-37%; 14 studies). Referrals were generally made <30 days after diagnosis with urologists being the most sought out professional to assess and treat UI. CONCLUSION This review revealed poor-moderate adherence to clinical practice guideline recommendations. While these findings reflect high variability in reporting, the key message is that most aspects of patient care for female UI provided by PCPs needs to improve.
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Affiliation(s)
- Marylène Charette
- Population Health, Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Lissa Pacheco-Brousseau
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Stéphane Poitras
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Rosalind Ashton
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Rideau Friel Medical Centre, Ottawa, Ontario, Canada
| | - Linda McLean
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
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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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Iles-Smith H, McMillan IM, Evans-Cheung T, Haas Eckersley R, Russell M, Wood J, McCarthy RE, Rosson L, Doxford-Hook L, Fu Y, McGowan L. Investigating mortality and morbidity associated with UrINary incontinence during Older Womens Secondary Care Admissions and exploring nurses experiences of delivering related care (U-INconti): a mixed methods research protocol. BMJ Open 2023; 13:e067937. [PMID: 37899148 PMCID: PMC10619080 DOI: 10.1136/bmjopen-2022-067937] [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: 09/01/2022] [Accepted: 08/08/2023] [Indexed: 10/31/2023] Open
Abstract
INTRODUCTION Urinary incontinence (UI) is associated with increasing age and is more frequently experienced by women. Despite 40% prevalence in the community, little is known about the prevalence/incidence of UI in older women during hospital admission. UI during hospital admissions, within this group, has also been under-researched in terms of its relationship to specific clinical conditions and mortality rates. Given that UI has serious implications for both patient care and women's general health and well-being on discharge, this protocol describes a planned research project which aims to determine mortality, morbidity, prevalence and incidence of UI in older women (≥55 years) during hospital admission to inform nursing practice. Additionally, it aims to explore the experience of nurses who deliver women's care. METHODS AND ANALYSIS This is an explanatory mixed-methods study consisting of two phases: (1) retrospecitive analysis of electronic patient care records (EPCR) to determine prevalence/incidence of UI, clinical conditions most likely associated with UI and any associations between UI and death, (2) nurse interviews to explore views, knowledge and perceptions of performing the nursing assessment and providing care for older women (≥55 years) with UI during admission. EPCR will be gained from a National Health Service (NHS) teaching hospital. Nurse interviews will be conducted with nurses from an alternative but similar-sized NHS hospital. ETHICS AND DISSEMINATION Ethical approval is provided by the University of Salford Ethics Committee and regulatory approval by the NHS Health Research Authority (Integrated Research Application System project ID: 303118). Local NHS trust approval to access electronic care records for the purposes of analysis of anonymised data has been provided by one of the two collaborating NHS hospitals. Findings will be disseminated through open-access geriatric or urogynaecology journals and presented to relevant stakeholders at local, national and international meetings including scientific meetings such as the UK Continence Society and International Continence Society.
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Affiliation(s)
- Heather Iles-Smith
- School of Health and Society, University of Salford, Greater Manchester, UK
| | | | | | - Ruth Haas Eckersley
- Rochdale Care Organisation, Northern Care Alliance NHS Foundation Trust, Greater Manchester, UK
| | - Margaret Russell
- Salford Royal NHS Foundation Trust, Northern Care Alliance NHS Foundation Trust, Greater Manchester, UK
| | - Julie Wood
- Salford Community Bladder and Bowel Services, Northern Care Alliance NHS Foundation Trust, Greater Manchester, UK
| | | | - Lyndsey Rosson
- School of Health and Society, University of Salford, Greater Manchester, UK
| | | | - Yu Fu
- Department of Primary Care & Mental Health, University of Liverpool, Liverpool, UK
| | - Linda McGowan
- Faculty of Medicine & Health, University of Leeds, Leeds, UK
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Lane GI, Erekson E, Austin A, Carmichael D, Minassian VA, Grodstein F, Bynum JP. Treatment for Urinary Incontinence in Women Older Than 65 Years. UROGYNECOLOGY (PHILADELPHIA, PA.) 2023; 29:687-695. [PMID: 37490708 DOI: 10.1097/spv.0000000000001335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
IMPORTANCE Urinary incontinence (UI) is common among women older than 65 years and negatively affects quality of life. However, the prevalence of UI treatment and determinants of treatment are largely unknown. OBJECTIVES The aim of this study was to identify rates of UI treatment and factors associated with treatment in older women with self-reported UI. STUDY DESIGN This is a retrospective cohort analysis of a data set linking UI symptoms from the Nurses' Health Study to Medicare claims. We evaluated use of pharmacotherapy, noninvasive, and procedural treatments for UI within 1 year before symptom survey. For pharmacotherapy, we used multivariable logistic regression to estimate odds ratios (ORs) of UI treatment. RESULTS Of the 67,587 Nurses' Health Study respondents, 15,088 had linkage to Medicare, subscribed to part D, and answered UI questions. Of these, 8,332 (55.2%) women reported UI, and 10.9% with UI had a Medicare claim for treatment; pharmacotherapy represented 94.6% of all treatments.On regression analysis, women with more severe and longer-term UI had higher odds of treatment (severe vs slight UI: OR, 3.1; 95% confidence interval [CI], 2.2-4.3) (longer vs new UI: OR, 1.9; 95% CI, 1.5-2.3). Women with mixed (OR, 2.5; 95% CI, 1.9-3.2) or urgency UI (OR, 3.0; 95% CI, 2.2-3.9) had greater odds of treatment compared with women with stress UI. CONCLUSIONS We estimate that only approximately 1 in 9 older women with self-reported UI underwent treatment within the year before reporting symptoms, of which pharmacotherapy was the most common UI intervention, and women with more severe and longer duration of symptoms were most often treated.
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Affiliation(s)
- Giulia I Lane
- From theDepartment of Urology, University of Michigan Medical School, Ann Arbor, MI
| | - Elisabeth Erekson
- Department of Obstetrics and Gynecology at Maine Medical Center, Portland, ME
| | - Andrea Austin
- The Dartmouth Institute for Health Policy and Clinical Practice at the Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Donald Carmichael
- The Dartmouth Institute for Health Policy and Clinical Practice at the Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Vatche A Minassian
- Division of Urogynecology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA
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Geary RS, Gurol-Urganci I, Mamza JB, Lynch R, El-Hamamsy D, Wilson A, Cohn S, Tincello D, van der Meulen J. Variation in availability and use of surgical care for female urinary incontinence: a mixed-methods study. HEALTH SERVICES AND DELIVERY RESEARCH 2021. [DOI: 10.3310/hsdr09070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Urinary incontinence affects between 25% and 45% of women. The availability and quality of services is variable and inequitable, but our understanding of the drivers is incomplete.
Objectives
The objectives of the study were to model patient, specialist clinician, primary and secondary care, and geographical factors associated with referral and surgery for urinary incontinence, and to explore women’s experiences of urinary incontinence and expectations of treatments.
Design
This was a mixed-methods study.
Setting
The setting was NHS England.
Participants
Data were collected from all women with a urinary incontinence diagnosis in primary care data, and all women undergoing mid-urethral mesh tape surgery for stress urinary incontinence were included. Interviews were also carried out with 28 women from four urogynaecology clinics who were deciding whether or not to have surgery, and surveys were completed by 245 members of the Royal College of Obstetricians and Gynaecologists with a specialist interest in urinary incontinence.
Data sources
The sources were patient-level data from Hospital Episode Statistics, the Clinical Practice Research Datalink and the Office for National Statistics mortality data linked to Hospital Episode Statistics. Interviews were conducted with women. An online vignette survey was conducted with members of the Royal College of Obstetricians and Gynaecologists.
Main outcome measures
The main outcome measures were the rates of referral from primary to secondary care and surgery after referral, the rates of stress urinary incontinence surgery by geographical area, the risk of mid-urethral mesh tape removal and reoperation after mid-urethral mesh tape insertion.
Results
Almost half (45.8%) of women with a new urinary incontinence diagnosis in primary care were referred to a urinary incontinence specialist: 59.5% of these referrals were within 30 days of diagnosis. In total, 14.2% of women referred to a specialist underwent a urinary incontinence procedure (94.5% of women underwent a stress urinary incontinence procedure and 5.5% underwent an urgency urinary incontinence procedure) during a follow-up period of up to 10 years. Not all women were equally likely to be referred or receive surgery. Both referral and surgery were less likely for older women, those who were obese and those from minority ethnic backgrounds. The stress urinary incontinence surgery rate was 40 procedures per 100,000 women per year, with substantial geographical variation. Among women undergoing mid-urethral mesh tape insertion for stress urinary incontinence, the 9-year mesh tape removal rate was 3.3%. Women’s decision-making about urinary incontinence surgery centred on perceptions of their urinary incontinence severity and the seriousness/risk of surgery. Women judged urinary incontinence severity in relation to their daily lives and other women’s experiences, rather than frequency or quantity of leakage, as is often recorded and used by clinicians. Five groups of UK gynaecologists could be distinguished who differed mainly in their average inclination to recommend surgery to hypothetical urinary incontinence patients. The gynaecologists’ recommendations were also influenced by urinary incontinence subtype and the patient’s history of previous surgery.
Limitations
The primary and secondary care data lacked information on the severity of urinary incontinence.
Conclusions
There was substantial variation in rates of referrals, surgery, and mesh tape removals, both geographically and between women of different ages and women from different ethnic backgrounds. The variation persisted after adjustment for factors that were likely to affect women’s preferences. Growing safety concerns over mid-urethral mesh tape surgery for stress urinary incontinence during the period from which the data are drawn are likely to have introduced more uncertainty to women’s and clinicians’ treatment decision-making.
Future work
Future work should capture outcomes relevant to women, including ongoing urinary incontinence and pain that is reported by women themselves, both before and after mesh and non-mesh procedures, as well as following conservative treatments. Future research should examine long-term patient-reported outcomes of treatment, including for women who do not seek further health care or surgery, and the extent to which urinary incontinence severity explains observed variation in referrals and surgery.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 7. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Rebecca S Geary
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
- Royal College of Obstetricians and Gynaecologists Centre for Quality Improvement and Clinical Audit, Royal College of Obstetricians and Gynaecologists, London, UK
| | - Ipek Gurol-Urganci
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
- Royal College of Obstetricians and Gynaecologists Centre for Quality Improvement and Clinical Audit, Royal College of Obstetricians and Gynaecologists, London, UK
| | - Jil B Mamza
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
- Royal College of Obstetricians and Gynaecologists Centre for Quality Improvement and Clinical Audit, Royal College of Obstetricians and Gynaecologists, London, UK
| | - Rebecca Lynch
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Dina El-Hamamsy
- Department of Obstetrics and Gynaecology, Leicester General Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Andrew Wilson
- Department of Health Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Simon Cohn
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Douglas Tincello
- Department of Health Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Jan van der Meulen
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
- Royal College of Obstetricians and Gynaecologists Centre for Quality Improvement and Clinical Audit, Royal College of Obstetricians and Gynaecologists, London, UK
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