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Li S, Zou J, Wang Z, Wang M, Yuan Y, Lv H. Correlation Between Insulin Resistance and Urinary Incontinence in Female Patients with Type 2 Diabetes Mellitus. Int Urogynecol J 2024; 35:431-440. [PMID: 38189852 DOI: 10.1007/s00192-023-05715-x] [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: 09/06/2023] [Accepted: 12/06/2023] [Indexed: 01/09/2024]
Abstract
INTRODUCTION AND HYPOTHESIS Patients with type 2 diabetes mellitus (T2DM) are at a high risk of developing urinary incontinence; however, its pathogenesis is unclear. The purpose of this study is to explore the relationship between insulin resistance and urinary incontinence and its severity in female patients with T2DM. METHODS A total of 366 women with T2DM aged ≥18 years were enrolled in this study. Insulin resistance was evaluated by the homeostasis model insulin resistance (HOMA-IR) index and urinary incontinence was assessed by the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF). All subjects were divided into four groups according to HOMA-IR quartiles. Logistic regression analysis was performed to investigate the relationship between insulin resistance and urinary incontinence and its severity. RESULTS Among the 366 patients, 186 (50.8%) had urinary incontinence. The prevalence of urinary incontinence increased significantly with HOMA-IR quartiles (p < 0.001). Adjusted logistic regression analysis showed that compared with HOMA-IR ≤ 1.76, 2.81 ≤ HOMA-IR ≤ 4.27 was associated with a significantly increased risk of moderate incontinence (OR = 2.197, 95% CI 1.031-4.683, p = 0.041), and HOMA-IR ≥ 4.28 was associated with a significantly increased risk of severe incontinence (OR = 5.699, 95% CI 1.685-19.276, p = 0.005). Binary logistic regression analysis showed that HOMA-IR was the independent risk factor for urinary incontinence (p < 0.001). CONCLUSIONS Higher levels of insulin resistance are associated with urinary incontinence and its severity in female patients with type 2 diabetes mellitus.
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Affiliation(s)
- Shuyun Li
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, Gansu, China
| | - Jingyi Zou
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, Gansu, China
| | - Zhen Wang
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, Gansu, China
| | - Mengke Wang
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, Gansu, China
| | - Yue Yuan
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, Gansu, China
| | - Haihong Lv
- Department of Endocrinology, The First Hospital of Lanzhou University, 1 Donggang West Road, Lanzhou, 730000, Gansu, 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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Saei Ghare Naz M, Ramezani Tehrani F, Behroozi-Lak T, Mohammadzadeh F, Kholosi Badr F, Ozgoli G. Polycystic Ovary Syndrome and Pelvic Floor Dysfunction: A Narrative Review. Res Rep Urol 2020; 12:179-185. [PMID: 32440514 PMCID: PMC7213900 DOI: 10.2147/rru.s249611] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 04/14/2020] [Indexed: 01/06/2023] Open
Abstract
Pelvic floor dysfunction is one of the most common disorders in women that is associated with social and economic consequences. In general, this disorder imposes direct and indirect costs on the economy of various societies. This review aimed to investigate pelvic floor dysfunction in women with polycystic ovary syndrome (PCOS). In this narrative review, the published articles on pelvic floor dysfunction were examined in PubMed, Scopus, Web of Sciences and Google Scholar. We searched for terms related to polycystic ovary syndrome and pelvic floor dysfunction. Inclusion criteria of this research were observational, experimental, and review studies. In this investigation, the complications associated with polycystic ovary syndrome were examined as risk factors for pelvic floor dysfunction. In this narrative review, we discuss about changes in hormone levels, obesity and overweight, hormonal medications and complications such as diabetes and metabolic disorders and obstetric complications of PCOS can be involved in the pathophysiology of pelvic floor dysfunctions, including stress urinary incontinence and pelvic organ prolapse in women with PCOS. This review highlights knowledge gaps about protective effect of hyperandrogenism on pelvic floor dysfunction as well as destructive effect of metabolic changes on pelvic floor dysfunction in women with PCOS. Further cohort and prospective studies are recommended in women with PCOS to investigate the concept of pelvic organ dysfunction in these women.
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Affiliation(s)
- Marzieh Saei Ghare Naz
- Student Research Committee, Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Tahereh Behroozi-Lak
- Reproductive Health Research Center, Department of Infertility, Urmia University of Medical Sciences, Urmia, Iran
| | - Farnaz Mohammadzadeh
- Department of Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farhnaz Kholosi Badr
- Department of Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Giti Ozgoli
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Bae S, Lee KW, Jeong HC, Park BH, Bae WJ, Lee YS, Han CH, Kang SH, Kim SW. Effects of low-frequency intravaginal electrical stimulation on female urinary incontinence, quality of life, and urinary symptoms: A pilot study. Low Urin Tract Symptoms 2019; 12:25-32. [PMID: 31595693 DOI: 10.1111/luts.12278] [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: 12/10/2018] [Revised: 04/17/2019] [Accepted: 06/27/2019] [Indexed: 11/29/2022]
Abstract
This study investigated the effects of a low-frequency home-based incontinence therapy device on quality of life (QoL) and urinary symptoms in women with urinary incontinence. From May 2017 to February 2018, 34 patients, aged ≥ 20 years, with involuntary urine leakage >2 times/week, were recruited to this study. Patients with severe pelvic organ prolapse, pregnancy, virgin status, and psychological problems were excluded. The incontinence home-care device treatments were administered in 12-minute sessions, twice daily for 8 weeks. Simultaneously, hyperthermic conditions of 35°C to 40°C and microvibrations were administered. All patients completed urinary incontinence questionnaires (King's Health Questionnaire [KHQ], Bristol Female Lower Urinary Tract Symptoms [BFLUTS] questionnaire, and the Overactive Bladder Symptom Score [OABSS]) before treatment, as well as 4 and 8 weeks into treatment. Changes in the questionnaire responses over time were compared. Two participants dropped out of the study and there was one screening failure, leaving 31 patients for analysis. After 4 weeks treatment, there were significant improvements in symptoms, such as role limitation, physical limitation, social limitation, personal relationship, emotion, sleep/energy, and severity measures. After 8 weeks treatment, almost all parameters on the KHQ revealed symptomatic improvement. On the BFLUTS, voiding times during activity, nocturia, urgency, urge incontinence, incontinence frequency, stress incontinence, volume leakage, strain to start, intermittency, reduced stream, acute retention, incomplete emptying, and stopping flow showed significant improvements. On the OABSS, almost all storage symptoms improved. Low-frequency electrical stimulation devices were effective at improving urinary incontinence, which became evident as the duration of treatment increased. Improvement of urgency and frequency was more evident after treatment.
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Affiliation(s)
- Sangrak Bae
- Department of Urology, Uijeongbu St.Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyu Won Lee
- Department of Urology, Seoul St.Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyun Cheol Jeong
- Department of Urology, Kangdong Sacred Heart Hospital, Seoul, South Korea
| | - Bong Hee Park
- Department of Urology, Uijeongbu St.Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Woong Jin Bae
- Department of Urology, Seoul St.Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yong Seok Lee
- Department of Urology, Uijeongbu St.Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chang Hee Han
- Department of Urology, Uijeongbu St.Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung Hak Kang
- Department of Urology, Uijeongbu St.Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sae Woong Kim
- Department of Urology, Seoul St.Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Park YW, Lee JH. Female urinary incontinence and obesity assessed by anthropometry and dual-energy X-ray absorptiometry: Analysis from the 2008-09 Korean National Health and Nutrition Examination Survey. Low Urin Tract Symptoms 2017; 11:O28-O33. [PMID: 29119694 DOI: 10.1111/luts.12207] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 08/21/2017] [Accepted: 09/11/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE In the present study we evaluated the association between obesity, assessed by dual energy X-ray absorptiometry (DEXA), and urinary incontinence (UI). METHODS The study was performed on 5792 women who had taken part in the Korean National Health and Nutrition Examination Survey. UI was deemed to be present if a woman answered "yes" to the question "Do you have current UI?". Obesity was assessed using anthropometry and DEXA. Data were analyzed using Chi-squared tests, t-tests, receiver operating characteristic curves, and logistic regression analysis. RESULTS The UI group had significantly higher mean (±SD) waist circumference (78.5 ± 10.0 vs, 82.4±9.1 kg) and body mass index (23.3 ± 3.4 vs. 24.2 ± 3.1 kg/m2 ) than the non-UI group. In addition, total fat mass (18.5 ± 5.3 vs. 19.4 ± 4.9 kg), trunk fat mass (9.3 ± 3.4 vs. 10.1 ± 3.2 kg), the trunk fat/leg fat (mass) ratio (1.58 ± 0.54 vs. 1.73 ± 0.50), total body fat percentage (32.3 ± 5.4% vs. 33.0 ± 5.0%), and trunk fat percentage (32.4 ± 7.3% vs. 33.9 ± 6.6%) were significantly higher in the UI group. Of these parameters, the trunk fat/leg fat ratio showed highest sensitivity (83.6%), with a cut-off value of 1.272. Before and after adjustment, trunk fat/leg fat ratio >1.272 was significantly related to UI and had the highest odds ratio (OR) among all DEXA parameters (adjusted OR 1.807; 95% confidence interval 1.343-2.431). CONCLUSION Obesity parameters obtained using DEXA are closely related to UI. Of these parameters, the trunk fat/leg fat ratio is the strongest in predicting the presence of UI. In addition, the present study has found a novel trunk fat/leg fat ratio cut-off value for defining obesity related to the UI.
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Affiliation(s)
- Yeon Won Park
- Department of Urology, National Police Hospital, Seoul, Korea
| | - Jun Ho Lee
- Department of Urology, National Police Hospital, Seoul, Korea
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Abstract
OBJECTIVE Metabolic syndrome (MetS) is a cluster of risk factors for cardiovascular disease and diabetes. Menopause is associated with an increased risk for MetS. The purpose of this meta-analysis is to better understand the relationship between MetS and menopause. METHODS MEDLINE and EMBASE were searched for all the associated articles on (1) MetS components in postmenopausal women vs. premenopausal women, (2) comparison of MetS incidence between surgical menopause and natural menopause, (3) the effect of hormone therapy (HT) with 17β-estradiol (E2) compared to conjugated equine estrogen (CEE) on MetS components among postmenopausal women. A meta-analysis was applied by Review Manager 5.3 software. RESULTS All comparable indicators were significantly unfavorably changed in postmenopausal women compared to premenopausal women except for high density lipoprotein cholesterol. Women who underwent surgical menopause suffered a 1.51-fold higher risk for MetS compared to those with natural menopause. HT with E2 provided more benefits for levels of triglyceride and diastolic blood, while CEE showed a better effect on both high and low density lipoprotein cholesterol levels. CONCLUSIONS Menopause nearly adversely affects all components of MetS, and surgical menopause may lead to a higher incidence of MetS compared to natural menopause. HT with various preparations may have different effects on MetS components. These results may clarify the management of menopause-related MetS in clinical practice.
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Affiliation(s)
- D Pu
- a State Key Laboratory of Reproductive Medicine, Department of Obstetrics and Gynecology , The First Affiliated Hospital of Nanjing Medical University/Jiangsu Province Hospital, Nanjing Medical University , Nanjing , China
| | - R Tan
- a State Key Laboratory of Reproductive Medicine, Department of Obstetrics and Gynecology , The First Affiliated Hospital of Nanjing Medical University/Jiangsu Province Hospital, Nanjing Medical University , Nanjing , China
| | - Q Yu
- b Department of Obstetrics and Gynecology , Peking Union Medical College Hospital, Chinese Academy of Medical Sciences , Beijing , China
| | - J Wu
- a State Key Laboratory of Reproductive Medicine, Department of Obstetrics and Gynecology , The First Affiliated Hospital of Nanjing Medical University/Jiangsu Province Hospital, Nanjing Medical University , Nanjing , China
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Choi JB, Yoon BI, Han KD, Hong SH, Ha US. Urinary incontinence is associated with the development of peptic ulcers in adult women: Data from the KNHANES IV. Medicine (Baltimore) 2017; 96:e8266. [PMID: 29068994 PMCID: PMC5671827 DOI: 10.1097/md.0000000000008266] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
The aim of this study was to investigate the association between urinary incontinence (UI) and peptic ulcer (PU) and how this is related to psychological stress in Korean women by analyzing the data from the Korea National Health and Nutrition Examination Survey IV (KNHANES).A nationally representative sample of data on 7475 Korean women ≥19 years of age from the KNHANES 2008 to 2010 was included. Physician-diagnosed UI and PU were assessed using questionnaires and surveys. Psychological stress was assessed through a questionnaire using a 4-point Likert scale. Data were analyzed using logistic regression to determine the association between UI and PU according to the level of psychological stress perception.PU was found in 1.41% of the total population. Breaking this down by the existence of UI, PU was found in 3.5% of the population with UI, and 1.4% of the population without UI, which showed a significant difference. A statistically significant trend for increasing prevalence of UI and PU with increasing psychological stress perception levels was found among the study population. Multivariable logistic regression analyses for PU showed that UI was significantly associated with a higher probability of PU in an adjusted model, which means that members of the population with UI were more likely to have PU than those without UI. A higher level of psychological stress perception was also significantly associated with increased odds of PU in the adjusted model.UI could potentiate the development of PU through increasing levels of psychological stress perception.
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Affiliation(s)
- Jin Bong Choi
- Department of Urology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon
| | - Byung Il Yoon
- Department of Urology, International St Mary's Hospital, The Catholic Kwandong University of Korea, Incheon
| | | | - Sung-Hoo Hong
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - U-Syn Ha
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Lee JH, Lee HS. Nutrient intake and urinary incontinence in Korean women: A propensity score-matched analysis from the Korea National Health and Nutrition Examination Survey data. Int J Urol 2017; 24:793-797. [PMID: 28845528 DOI: 10.1111/iju.13439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Accepted: 07/27/2017] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To evaluate the relationship between dietary nutrients and female urinary incontinence using nationally representative data from Korea. METHODS We included 8090 women aged >20 years who had participated in the Korea National Health and Nutrition Examination Survey IV. We carried out a propensity-matched study by identifying women with urinary incontinence. Women without urinary incontinence, matched for age, body mass index, menopause, delivery history, hypertension, diabetes, hypercholesterolemia, stroke, asthma, chronic obstructive pulmonary disease and amount of total food intake, were included as a control group at a 2:1 ratio (661 women with urinary incontinence; 1322 women without urinary incontinence). Data were analyzed using the χ2 -test, Mann-Whitney test, Fisher's exact test and logistic regression. RESULTS Following propensity score matching, 661 women with urinary incontinence and 1322 women without urinary incontinence were included; the confounders were evenly dispersed and did not differ significantly between the groups. There was no significant difference in the intake of water, fat, protein, calcium, phosphorus, iron, sodium, potassium, vitamin A, carotene, riboflavin, niacin and vitamin C. However, carbohydrate intake was significantly higher in the urinary incontinence group than in the control group (median [interquartile range]: 282.3 g/day [214.7; 352.0] vs 267.7 g/day [212.6; 339.1]; P = 0.041). CONCLUSION High carbohydrate intake seems to be significantly related to female urinary incontinence in the Korean population.
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Affiliation(s)
- Jun Ho Lee
- Department of Urology, National Police Hospital, Seoul, Korea
| | - Hyo Serk Lee
- Department of Urology, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine, Seoul, Korea
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