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Luebke MC, Neuner JM, Balza J, Davidson ERW, Hokanson JA, Marowski S, Corey O'Connor R, Schmitt E, Winn AN, Flynn KE. Developing a urinary incontinence primary care pathway: a mixed methods study. Fam Pract 2024:cmae035. [PMID: 39026426 DOI: 10.1093/fampra/cmae035] [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] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND While nearly 50% of adult women report at least one episode of urinary incontinence (UI), most never receive treatment. OBJECTIVE To better integrate primary and specialty UI care, we conducted (i) an environmental scan to assess the availability of key pathway resources in primary care, (ii) interviews with primary care providers to understand barriers to care, and (iii) a pilot UI care pathway intervention. METHODS Environmental scan: Clinic managers from all primary care clinics within a Midwestern healthcare system were invited to participate in an interview covering the availability of clinic resources. Provider interviews: Primary care providers were invited to participate in an interview covering current practices and perceived barriers to UI care. Pilot UI care pathway: Patients who screened positive for UI were provided resources for first-line behavioral management. Pilot patients completed questionnaires at baseline, 8 weeks, and 6 months. RESULTS While many clinics had point-of-care urinalysis (17/21, 81%), most did not have a working bladder ultrasound (14/21, 67%) or on-site pelvic floor physical therapy (18/21, 86%). Providers (n = 5) described barriers to completing almost every step of diagnosis and treatment for UI. The most persistent barrier was lack of time. Patients (n = 15) reported several self-treatment strategies including avoiding bladder irritants (7/15, 47%) and performing Kegel exercises (4/15, 27%). Five patients (33%) requested follow-up care. At 6 months, patients reported small improvements in UI symptoms. CONCLUSION Promising results from a novel UI care pathway pilot indicate that streamlining UI care may assist primary care providers in the first-line treatment of UI.
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Affiliation(s)
- Marie C Luebke
- Medical College of Wisconsin, Milwaukee, WI, United States
| | - Joan M Neuner
- Medical College of Wisconsin, Milwaukee, WI, United States
| | - Joanna Balza
- Medical College of Wisconsin, Milwaukee, WI, United States
| | | | | | - Sarah Marowski
- Medical College of Wisconsin, Milwaukee, WI, United States
| | | | - Emily Schmitt
- Medical College of Wisconsin, Milwaukee, WI, United States
| | - Aaron N Winn
- Medical College of Wisconsin, Milwaukee, WI, United States
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Tabei SS, Baas W, Mahdy A. Pharmacotherapy in Stress Urinary Incontinence; A Literature Review. Curr Urol Rep 2024; 25:141-148. [PMID: 38727982 PMCID: PMC11196290 DOI: 10.1007/s11934-024-01205-9] [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] [Accepted: 04/12/2024] [Indexed: 06/26/2024]
Abstract
PURPOSE OF REVIEW Stress urinary incontinence (SUI) is a commonly observed condition in females, as well as in males who have undergone prostatectomy. Despite the significant progress made in surgical techniques, pharmacotherapy has not yielded substantial outcomes within the clinical domain. This review aims to present a comprehensive overview of the existing pharmacotherapy options for stress urinary incontinence (SUI) and the emerging therapeutic targets in this field. RECENT FINDINGS One meta-analysis demonstrated that α-adrenergic medications are more efficacious in improving rather than curing SUI symptoms. One trial showed reduced pad weight gain with PSD-503, a locally administered α-adrenergic receptor agonist. New data show that duloxetine's risk outweighs its benefits. One small-scale trial was found to support the use of locally administered estriol in improving subjective outcomes. Emerging targets include serotonin 5HT2C agonists, selective inhibitors of norepinephrine uptake, and myostatin inhibitors. Only one of the evaluated drugs, duloxetine, has been approved by some countries. Currently, trials are evaluating novel targets. Systemic adverse effects such as gastrointestinal upset with duloxetine and orthostatic hypotension with α-adrenoceptor agonists have hampered the efficacy of drugs used to treat SUI in women and men.
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Affiliation(s)
- Seyed Sajjad Tabei
- Division of Urology, Department of Surgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH, 45267, USA
| | - Wesley Baas
- Division of Urology, Department of Surgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH, 45267, USA
| | - Ayman Mahdy
- Division of Urology, Department of Surgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH, 45267, USA.
- R. Bruce and Barbara Bracken Endowed Chair in Surgical Urology, Department of Surgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way, ML 0589, Cincinnati, OH, 45267, USA.
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Neuner J, Schmitt E, Winn A, Davidson E, O'Connor RC, Marowski S, Luebke M, Balza J, Attewell M, Flynn KE. Urinary Incontinence Medications: Patient-Initiated Concerns in Primary Care. UROGYNECOLOGY (PHILADELPHIA, PA.) 2024:02273501-990000000-00241. [PMID: 38954604 DOI: 10.1097/spv.0000000000001540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Abstract
IMPORTANCE Guideline-recommended medications for overactive bladder and urge urinary incontinence (OAB/UUI) are effective but have high costs and side effects. Little is known about patient concerns regarding these medications when prescribed by their primary care providers (PCPs). OBJECTIVE The aim of the study was to describe PCP-patient interactions when prescribing medications for OAB/UUI, specifically clinical concerns, cost and authorization issues, and mode of communication for these interactions. STUDY DESIGN Using electronic health records, we identified a retrospective cohort of women aged 18-89 years who were prescribed a medication for OAB/UUI during a primary care office visit from 2017 to 2018. We examined the electronic health record from initial prescription through 15 subsequent months for documentation of prior authorization requests and patient concerns about cost, side effects, or ineffectiveness. The association of patient demographics, comorbidity, and medication class with these concerns was examined with logistic regression models. RESULTS Overall, 46.2% of patients (n = 123) had 1 or more OAB/UUI medication concerns, and 52 reported outside an office visit. Only higher comorbidity was associated with reduced concern of any type. Although the overall percent age of patients reporting concerns was similar by medication type, the patterns of concern type varied. Compared with those taking short-acting antimuscarinics, patients taking long-acting antimuscarinics other than oxybutynin were less likely to have side effect concerns (adjusted odds ratio 0.35, 95% CI 0.16-0.78) and more likely to have cost concerns (adjusted odds ratio 5.10, 95% CI 1.53-17.03). CONCLUSIONS Patient concerns regarding OAB/UUI medications were common in primary care practices and frequently reported outside of office visits. However, the patterns of concerns (cost vs side effects) varied between medication classes.
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Affiliation(s)
- Joan Neuner
- From the Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Emily Schmitt
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Aaron Winn
- Department of Pharmacy Systems, Outcomes and Policy, School of Pharmacy, University of Illinois at Chicago, Chicago, IL
| | - Emily Davidson
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI
| | | | | | | | | | - Madeline Attewell
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
| | - Kathryn E Flynn
- From the Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
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Luebke MC, Davidson ERW, Crotty BH, Fergestrom N, O'Connor RC, Schmitt E, Winn AN, Flynn KE, Neuner JM. Referral and Prescription Patterns for Female Patients With Urinary Incontinence. UROGYNECOLOGY (PHILADELPHIA, PA.) 2024; 30:489-497. [PMID: 37881958 PMCID: PMC11002977 DOI: 10.1097/spv.0000000000001423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
IMPORTANCE Although behavioral modifications, medications, and other interventions can improve urinary incontinence (UI), many women never receive them. OBJECTIVES To better characterize UI treatment patterns in primary care, we examined prescriptions and referrals to pelvic floor physical therapy (PFPT) and specialist physicians within a large Midwestern academic health system. STUDY DESIGN Electronic health records were queried to identify a cohort of adult female patients receiving a new UI diagnosis during outpatient primary care visits from 2016 to 2020. Urinary incontinence referrals and referral completion were examined for the overall cohort, and medication prescriptions were examined for women with urgency or mixed UI. Logistic regression was used to assess the association of prescriptions and/or referrals with patient demographics, comorbidities, and UI diagnosis dates. RESULTS In the year after primary care UI diagnosis, 37.2% of patients in the overall cohort (n = 4,382) received guideline-concordant care. This included 20.6% of women who were referred for further management: 17.7% to urology/urogynecology and 3.2% to PFPT. Most women who were referred attended an initial appointment. Among those with urgency (n = 2,398) or mixed UI (n = 552), 17.1% were prescribed medication. Women with stress (odds ratio [OR], 3.10; 95% CI, 2.53-3.79) and mixed UI (OR, 6.17; 95% CI, 4.03-9.66) were more likely to be referred for further management, and women diagnosed during the COVID-19 pandemic were less likely to be referred for further care (OR, 0.39; 95% CI, 0.29, 0.48). CONCLUSION Only slightly above 1 in 3 women with a new diagnosis of UI in primary care received guideline-based medications or referrals within 1 year, suggesting missed opportunities for timely care.
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Funada S, Luo Y, Uozumi R, Watanabe N, Goto T, Negoro H, Ueno K, Ichioka K, Segawa T, Akechi T, Ogawa O, Akamatsu S, Kobayashi T, Furukawa TA. Multicomponent Intervention for Overactive Bladder in Women: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e241784. [PMID: 38477920 PMCID: PMC10938174 DOI: 10.1001/jamanetworkopen.2024.1784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 01/19/2024] [Indexed: 03/14/2024] Open
Abstract
Importance Although the cognitive components of behavioral therapy for overactive bladder (OAB) are widely recognized, there is a lack of studies evaluating the effectiveness of multicomponent interventions that include cognitive components as a treatment for OAB. Objective To examine the efficacy of a multicomponent intervention in improving health-related quality of life (HRQOL) for women with moderate to severe OAB. Design, Setting, and Participants This multicenter, open-label, randomized clinical trial was conducted in Japan among women aged 20 to 80 years who had moderate to severe OAB. Participants were recruited from 4 institutions between January 16, 2020, and December 31, 2022, through self-referral via advertisement or referral from the participating institutions. Interventions Participants were randomized 1:1 by minimization algorithm using an internet-based central cloud system to four 30-minute weekly sessions of a multicomponent intervention or waiting list. Both groups continued to receive baseline treatment throughout the study period. Main Outcomes and Measures The primary outcome was the least-squares mean changes from baseline through week 13 in HRQOL total scores of the OAB questionnaire between 2 groups. Secondary outcomes included OAB symptom score and frequency volume chart. Results A total of 79 women were randomized to either the intervention group (39 participants; mean [SD] age, 63.5 [14.6] years) or the waiting list control group (40 participants; mean [SD] age, 63.5 [12.9] years). One participant from each group dropped out from the allocated intervention, while 5 participants in the intervention group and 2 in the control group dropped out from the primary outcome assessment at week 13. Thirty-six participants (92.3%) in the intervention group and 35 (87.5%) in the control group had moderate OAB. The change in HRQOL total score from baseline to week 13 was 23.9 points (95% CI, 18.4-29.5 points) in the intervention group and 11.3 points (95% CI, 6.2-16.4 points) in the waiting list group, a significant difference of 12.6 points (95% CI, 6.6-18.6 points; P < .001). Similar superiority of the intervention was confirmed for frequency of micturition and urgency but not for OAB symptom score. Conclusions and Relevance These findings demonstrate that a multicomponent intervention improves HRQOL for women with moderate to severe OAB and suggest that the cognitive component may be an effective treatment option for women with OAB. Trial Registration UMIN Clinical Trials Registry Identifier: UMIN000038513.
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Affiliation(s)
- Satoshi Funada
- Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Department of Health Promotion and Human Behavior, School of Public Health, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
| | - Yan Luo
- Department of Health Promotion and Human Behavior, School of Public Health, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ryuji Uozumi
- Department of Industrial Engineering and Economics, Tokyo Institute of Technology, Tokyo, Japan
| | - Norio Watanabe
- Department of Psychiatry, Soseikai General Hospital, Kyoto, Japan
| | - Takayuki Goto
- Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hiromitsu Negoro
- Department of Urology, Institute of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Kentaro Ueno
- Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | | | - Tatsuo Akechi
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
| | - Osamu Ogawa
- Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shusuke Akamatsu
- Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takashi Kobayashi
- Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Toshi A. Furukawa
- Department of Health Promotion and Human Behavior, School of Public Health, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Jha S, Jeppson PC, Dokmeci F, Marquini GV, Sartori MGF, Moalli P, Malik SA. Management of mixed urinary incontinence: IUGA committee opinion. Int Urogynecol J 2024; 35:291-301. [PMID: 38252279 PMCID: PMC10908639 DOI: 10.1007/s00192-023-05694-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: 08/18/2023] [Accepted: 11/06/2023] [Indexed: 01/23/2024]
Abstract
INTRODUCTION AND HYPOTHESIS Mixed urinary incontinence (MUI) is defined by the International Urogynecology Association (IUGA) and International Continence Society as the complaint of involuntary leakage of urine associated with urgency and also with exertion, effort, sneezing or coughing. It therefore implies the coexistence of both stress urinary incontinence (SUI) and urgency urinary incontinence (UUI). MUI is a heterogeneous diagnosis that requires an assessment of its individual components of SUI and UUI. Management requires an individualised approach to the symptom components. The aim of this review is to identify the assessment/investigations and management options for MUI. METHODS A working subcommittee from the IUGA Research & Development (R&D) Committee was created and volunteers invited from the IUGA membership. A literature review was performed to provide guidance focused on the recommended assessment and management of MUI. The document was then evaluated by the entire IUGA R&D Committee and IUGA Board of Directors and revisions made. The final document represents the IUGA R&D Committee Opinion. RESULTS The R&D Committee MUI opinion paper provides guidance on the assessment and management of women with MUI and summarises the evidence-based recommendations. CONCLUSIONS Mixed urinary incontinence is a complex problem and successful management requires alleviation of both the stress and urge components. Care should be individualised based on patient preferences. Further research is needed to guide patients in setting goals and to determine which component of MUI to treat first. The evidence for many of the surgical/procedural treatment options for MUI are limited and needs to be explored in more detail.
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Affiliation(s)
- Swati Jha
- Department of Urogynecology, Jessop Wing, Sheffield Teaching Hospitals NHS Foundation Trust & University of Sheffield, Sheffield, UK.
| | - Peter C Jeppson
- The Woman's Center for Advanced Pelvic Surgery, The University of Arizona, Phoenix, AZ, USA
| | - Fulya Dokmeci
- Department of Obstetrics & Gynecology, Ankara School of Medicine, Ankara University, Ankara, Türkiye
| | - Gisele V Marquini
- Federal University of Uberlândia (UFU), Minas Gerais, Brazil and Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Marair G F Sartori
- Urogynecology Division, Gynecology Department, Federal University of São Paulo, São Paulo, Brazil
| | - Pamela Moalli
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Shazia A Malik
- Female Pelvic Medicine & Reconstructive Surgery, Department of Ob/Gyn, University of Arizona COMPhoenix, Tucson, AZ, USA
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Park S, So A. A Multisite Study on the Effect of a Urinary Incontinence Self-Management Program on Community-Dwelling Older Women in Korea. J Wound Ostomy Continence Nurs 2024; 51:61-65. [PMID: 38215299 DOI: 10.1097/won.0000000000001036] [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: 01/14/2024]
Abstract
PURPOSE The purpose of this study was to evaluate the effects of a urinary incontinence (UI) self-management program on UI symptoms, knowledge, and self-efficacy in community-dwelling older women. DESIGN A 1-group pretest-posttest design. SUBJECTS AND SETTING Participants were recruited from 14 primary healthcare posts (PHCPs) in South Chungcheong Province, rural South Korea. A total of 163 women participated in a 5-session UI self-management program. METHODS The UI self-management program was sequentially conducted across 14 PHCPs between May and November 2016. In each PHCP, 6 to 22 women participated in the program. The program consisted of weekly 90-minute sessions that were conducted across 5 weeks. Each session included a lecture on UI, reflective discussion, pelvic floor muscle training, and the assignment of homework (exercises and a daily bladder diary). Main outcome variables were measured using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), Urinary Incontinence Knowledge Scale (UIKS), and Geriatric Self-Efficacy Index for Urinary Incontinence (GSE-UI), which were administered before and after the intervention. Descriptive statistics were computed, and Wilcoxon signed-rank tests analyzed the data. RESULTS The intervention resulted in a significant decrease in the ICIQ-SF scores, which was indicative of improvement in UI severity (pretest: 6.64 [SD 6.15], posttest: 4.76 [SD 5.08], P = .001), significant increases in the UIKS (pretest: 15.69 [SD 6.36], posttest: 23.14 [SD 5.54], P = .001] and GSE-UI (pretest: 75.34 [SD 31.80], [posttest: 86.20 [SD 27.06], P = .001) scores. CONCLUSIONS The UI self-management program improved UI symptoms, knowledge, and self-efficacy among community-dwelling older women.
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Affiliation(s)
- Sunah Park
- Sunah Park, PhD, RN, Department of Nursing, Gangneung-Wonju National University, Wonju-si, Gangwon-do, South Korea
- Aeyoung So, PhD, MPH, RN, Department of Nursing, Gangneung-Wonju National University, Wonju-si, Gangwon-do, South Korea
- The authors declare no conflicts of interest
| | - Aeyoung So
- Sunah Park, PhD, RN, Department of Nursing, Gangneung-Wonju National University, Wonju-si, Gangwon-do, South Korea
- Aeyoung So, PhD, MPH, RN, Department of Nursing, Gangneung-Wonju National University, Wonju-si, Gangwon-do, South Korea
- The authors declare no conflicts of interest
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Liu W, Sun X, Gao Y, Sun H, Feng H, Tan H, Chen Q, Peng L, Wu IX. Comparative effectiveness of nonsurgical interventions for urinary incontinence in older women: A systematic review and network meta-analysis. Arch Gerontol Geriatr 2024; 116:105214. [PMID: 37832271 DOI: 10.1016/j.archger.2023.105214] [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: 07/26/2023] [Revised: 09/11/2023] [Accepted: 09/23/2023] [Indexed: 10/15/2023]
Abstract
PURPOSE To compare the effectiveness of existing nonsurgical interventions to improve or cure urinary incontinence in older women. METHODS Five English databases (Medline, EMBASE, Web of Science, PsychINFO and the Cochrane Library) were searched from January 1, 2018, until August 27, 2023. Studies published before 2018 were directly extracted from a review published in 2019 on a similar research question. Three Chinese databases (China National Knowledge Infrastructure (CNKI), Wanfang and SinoMed) were searched from January 1, 2000, until August 27, 2023. Randomized controlled trials of nonsurgical interventions for women aged ≥ 60 years with urinary incontinence were considered eligible. The primary outcome was the rate of improvement and cure. Pairwise meta-analysis and network meta-analysis were performed, with the pooled risk ratio (RR) and 95 % confidence interval (CI) being reported. RESULTS There were 15 intervention categories among the included 32 randomized controlled trials for older women with urinary incontinence. The combination of behavioral therapy with other interventions, including Chinese herbal medicine, electrical stimulation, and acupuncture were effective for both improvement and cure rates. Behavioral therapy plus Chinese herbal medicine was the most effective intervention category for both improvement and cure rates. CONCLUSION Behavioral therapy plus Chinese herbal medicine was currently the optimal selection for the management of older women with urinary incontinence. However, the clinicians should carefully consider the effectiveness and quality of evidence because of the limited quality and quantity of the randomized controlled trials included.
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Affiliation(s)
- Wenqi Liu
- Department of Epidemiology and Biostatistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Xuemei Sun
- Department of Epidemiology and Biostatistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Yinyan Gao
- Department of Epidemiology and Biostatistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Hui Sun
- Department of Epidemiology and Biostatistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Hui Feng
- Xiangya Nursing School, Central South University, Changsha, Hunan, China
| | - Hongzhuan Tan
- Department of Epidemiology and Biostatistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Qiong Chen
- Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Linlin Peng
- Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Irene Xy Wu
- Department of Epidemiology and Biostatistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China; Hunan Provincial Key Laboratory of Clinical Epidemiology, Changsha, China.
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Huang J, Fan Y, Zhao K, Yang C, Zhao Z, Chen Y, Yang J, Wang T, Qu Y. Comparative Efficacy of Neuromodulation Technologies for Overactive Bladder in Adults: A Network Meta-Analysis of Randomized Controlled Trials. Neuromodulation 2023; 26:1535-1548. [PMID: 35989159 DOI: 10.1016/j.neurom.2022.06.004] [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: 02/25/2022] [Revised: 05/09/2022] [Accepted: 06/29/2022] [Indexed: 10/15/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the comparative efficacy of neuromodulation technologies for overactive bladder (OAB) syndrome in adults. DATA SOURCES A computerized search was conducted of Cochrane Library, EMBASE, MEDLINE (via PubMed), Web of Science, CNKI, Wan Fang Data, and ClinicalTrials.gov up to April 21, 2022. STUDY SELECTION The search selected clinical trials with random allocation to percutaneous tibial nerve stimulation (PTNS), transcutaneous tibial nerve stimulation (TTNS), vaginal electrical stimulation (VES), sacral neuromodulation (SNM), parasacral stimulation (PS), pudendal neuromodulation, or placebo. DATA EXTRACTION The main outcomes were the voiding diary, OAB-related quality of life, and positive response rate. The Cochrane Risk of Bias tool (RoB 2.0) was used to assess the risk of bias of each included study, and the Grading of Recommendations Assessment, Development, and Evaluation tool was used to evaluate the overall evidence quality of key outcomes. DATA SYNTHESIS The study included 21 randomized controlled trials involving 1433 participants, and all trials were used for the meta-analysis. In the network meta-analyses, five of six neuromodulation technologies, including PTNS, TTNS, VES, SNM, and PS, were related to higher efficacy than the placebo. Ranking probability showed that SNM was the most efficacious therapy for improving OAB-related quality of life, urinary episodes, and urinary frequency. For urgency incontinence episodes and the number of pads, PTNS and TTNS were the most efficacious modalities, respectively. CONCLUSION Neuromodulation technologies, including PTNS, TTNS, VES, SNM, and PS, may be effective and safe solutions for OAB syndrome in adults. Moreover, SNM is the most efficacious regimen for OAB-related quality of life, urinary episodes, and urinary frequency. PTNS and TTNS are the most efficacious modalities for reducing urgency incontinence episodes and the number of pads, respectively. Future studies should pay more attention to the quality of study design and report, patients who may benefit the most from neuromodulation, and the long-term effect, cost-effectiveness, and satisfaction of neuromodulation.
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Affiliation(s)
- Jiapeng Huang
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Research Laboratory of Neurorehabilitation, Research Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ye Fan
- Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China; The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou , Guangdong, China
| | - Kehong Zhao
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Research Laboratory of Neurorehabilitation, Research Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chunlan Yang
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Research Laboratory of Neurorehabilitation, Research Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ziqi Zhao
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Research Laboratory of Neurorehabilitation, Research Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yin Chen
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Research Laboratory of Neurorehabilitation, Research Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jiaen Yang
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Research Laboratory of Neurorehabilitation, Research Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Department of Rehabilitation Medicine, Affiliated Foshan Gaoming Hospital of Guangdong Medical University, Foshan, Guangdong, China
| | - Tingting Wang
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Research Laboratory of Neurorehabilitation, Research Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yun Qu
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Research Laboratory of Neurorehabilitation, Research Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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Patel UJ, Moureau MK, Neuner JM, Brown HW. Screening and Treating Urinary Incontinence in Primary Care: A Missed Opportunity. OBM GERIATRICS 2023; 7:252. [PMID: 38567050 PMCID: PMC10986360 DOI: 10.21926/obm.geriatr.2304252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
More than 60% of adult women in the United States have urinary incontinence (UI), with the prevalence increasing to over 80% in women over age 65. Despite its high prevalence, most patients do not seek care and few clinicians screen for UI. The Medicare Health Outcomes Survey queries patients about satisfaction with their provider's discussion and management of UI, but formal recommendations about screening, diagnosis, and treatment are lacking. This review presents a practical algorithm for primary care providers to incorporate management of UI into routine preventive care for women, and outlines UI prevalence, risk factors, screening, and non-surgical treatment options.
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Affiliation(s)
- Ushma J Patel
- University of Wisconsin School of Medicine and Public
Health, Department of Obstetrics and Gynecology, 1010 Mound Street 4th floor,
Madison, WI, USA
| | - Madeline K Moureau
- University of Wisconsin School of Medicine and Public
Health, Department of Obstetrics and Gynecology, 1010 Mound Street 4th floor,
Madison, WI, USA
| | - Joan M Neuner
- Medical College of Wisconsin, Division of General Internal
Medicine, Milwaukee, WI, USA
| | - Heidi W Brown
- Kaiser Permanente, Department of Obstetrics and
Gynecology, 3250 Fordham Street, San Diego, CA, USA
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11
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Prognostic factors of urinary incontinence in women: A cohort study in a third-level hospital. Actas Urol Esp 2023:S2173-5786(23)00015-X. [PMID: 36842707 DOI: 10.1016/j.acuroe.2023.01.007] [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: 12/15/2022] [Accepted: 01/26/2023] [Indexed: 02/27/2023]
Abstract
INTRODUCTION Urinary incontinence (UI) is the involuntary loss of urine. It is highly prevalent in women and has a great biopsychosocial impact. Rehabilitation is established as the first-line treatment, although its use has not been protocolized. OBJECTIVE To identify which personal risk factors and type of treatment applied are statistically related to patient improvement. STUDY DESIGN Retrospective cohort study. METHODS Retrospective cohort study of female patients diagnosed with urinary incontinence who attended the Pelvic Floor Rehabilitation Clinic of the Río Hortega University Hospital, receiving rehabilitation treatment during the year 2021. The minimum follow-up period was 12 weeks. The presence or absence of improvement was evaluated according to seven objective and subjective variables, and improvement was established as positive evolution in at least five of the seven variables. RESULTS A total of 114 women with urinary incontinence were analyzed. The most frequent types of incontinence were stress (53%) and mixed (36%). The most important risk factors and associated pathology were episiotomy (68%), repeated urinary tract infections (61%), and constipation (40.9%). None of these factors showed a statistically significant relationship with patient improvement. The most used rehabilitative treatment was kinesitherapy + biofeedback (51%) which showed a statistically significant relationship with the improvement of these patients (P = .037) together with biofeedback + posterior tibial nerve electrostimulation (PTNS) (P = .044). CONCLUSION Biofeedback combined with kinesitherapy or PTNS are established as the most effective rehabilitative procedures.
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12
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Game X, Dmochowski R, Robinson D. Mixed urinary incontinence: Are there effective treatments? Neurourol Urodyn 2023; 42:401-408. [PMID: 36762411 PMCID: PMC10092712 DOI: 10.1002/nau.25065] [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: 04/28/2022] [Revised: 09/06/2022] [Accepted: 10/07/2022] [Indexed: 11/10/2022]
Abstract
The aim of this debate article is to discuss whether effective treatments are available for mixed urinary incontinence (MUI). Because patients with MUI have both stress and urgency urinary incontinence (SUI and UUI) episodes and current treatment guidelines currently recommend treating the predominant symptom first, this article presents standard and emerging treatments for both SUI and UUI before discussing how well these treatments meet the medical needs of patients with MUI. Standard treatments presented include noninvasive options such as lifestyle changes and pelvic floor exercises, pharmacological agents, and surgery. Treatment of all three types of urinary incontinence (UI) is usually initiated with noninvasive options, after which treatment options diverge based on UI subtype. Multiple pharmacological agents have been developed for the treatment of UUI and overactive bladder, whereas surgery remains the standard option for SUI and stress-predominant MUI. The divide between UUI and SUI options seems to be propagated in emerging treatments, with most novel pharmacological agents still targeting UUI and even having SUI and stress-predominant MUI as exclusion criteria for participation in clinical trials. Considering that current treatment options focus almost exclusively on treating the predominant symptom of MUI and that emerging pharmacological treatments exclude patients with stress-predominant MUI during the development phase, effective treatments for MUI are lacking both in standard and emerging practice. Ideally, agents with dual mechanisms of action could provide symptom benefit for both the stress and urgency components of MUI.
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Affiliation(s)
- Xavier Game
- Department of Urology, CHU Rangueil, Toulouse, France
| | - Roger Dmochowski
- Department of Urology, Vanderbilt University, Nashville, Tennessee, USA
| | - Dudley Robinson
- Department of Urogynaecology, Kings College Hospital, London, UK
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13
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Chow PM, Chuang YC, Hsu KCP, Shen YC, Liu SP. Impact of Female Stress Urinary Incontinence on Quality of Life, Mental Health, Work Limitation, and Healthcare Seeking in China, Taiwan, and South Korea (LUTS Asia): Results from a Cross-Sectional, Population-Based Study. Int J Womens Health 2022; 14:1871-1880. [PMID: 36597480 PMCID: PMC9805714 DOI: 10.2147/ijwh.s383651] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 11/17/2022] [Indexed: 12/29/2022] Open
Abstract
Background Stress urinary incontinence (SUI) is common among adult women with negative effects on psychosocial well-being, mental health, and health-related quality of life. The purpose of the research is to determine if SUI in women is a factor implicated in changes in health-related quality of life (HRQoL) in both physical and mental health domains and in work difficulties. Methods Data of women 40 years or older from a cross-sectional, population-based, internet survey were examined post-hoc. The effect of SUI frequency on HRQoL (SF12 score), in physical and mental health domains, was assessed. In addition, multivariate and univariate analyses were used to show the influence of SUI on HADS (Hospital Anxiety and Depression Scale) depression score and HADS anxiety score. The effects of demographic factors and physical ailments and SUI on work difficulties were similarly analyzed using multivariate logistic regression. Results A total of 4208 women with mean age of 60 were included in the analysis. The more frequent SUI episodes were associated with a greater reduction of HRQoL in both physical and mental health domains. In addition, both multivariate and univariate analyses showed that SUI could be correlated with a negative effect on HADS anxiety score (OR 1.617, CI 1.335-1.958, p=0.000) and HADS depression score (OR 1.263, CI 1.044-1.527, p=0.016). Univariate analyses suggested that work difficulties were correlated with SUI. Available data revealed that many sufferers, including up to 40% of individuals with SUI frequency rating 1 (less than once a month) to 3 (a few times a week), failed to seek treatment. Conclusion SUI, common in women ≥40 years of age, impairs quality of life in both physical and mental health domains. SUI is an independent risk factor for anxiety and depression and has been linked to significant work dysfunctions. Trial Registration This study is registered at ClinicalTrials.gov: NCT02618421 (Date of registration: December 1, 2015).
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Affiliation(s)
- Po-Ming Chow
- Department of Urology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Yao-Chi Chuang
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Karina Chin Po Hsu
- Medical Affairs Department, Former Employee of Astellas Pharma Taiwan, Inc., Taipei, Taiwan
| | - Yuan-Chi Shen
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shih-Ping Liu
- Department of Urology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan,Correspondence: Shih-Ping Liu, Department of Urology, National Taiwan University Hospital and College of Medicine, No. 7, Chung Shan South Road, Taipei, 10002, Taiwan, Tel +886 2 2312-3456 ext. 62135, Fax +886 2 2321-9145, Email
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14
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Karbalaiee M, Daneshpajooh A, Khanjani N, Sohbati S, Mehrabani M, Mehrbani M, Mehrabani M. Efficacy of frankincense‐based herbal product in urinary incontinence: A randomized, double‐blind, placebo‐ and active‐controlled clinical trial. Phytother Res 2022; 37:1754-1770. [PMID: 36442480 DOI: 10.1002/ptr.7691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 10/11/2022] [Accepted: 10/16/2022] [Indexed: 11/30/2022]
Abstract
Urinary incontinence is a silent epidemic that has a serious impact on a person's quality of life (QOL). This study aimed to evaluate the efficacy of frankincense-based herbal product (FHP) in urinary incontinence compared with placebo and solifenacin. In this randomized, double-blind clinical trial, 120 postmenopausal women with mixed urinary incontinence were randomized to one of the three groups of FHP, placebo, and standard treatment (solifenacin). Frequency, amount of leakage, and score of urinary incontinence as well as the QOL were measured at the end of the second and fourth weeks and 2 weeks after the interruption of the treatment. The ICIQ-UI SF and I-QOL questionnaires were used for the measurements. Mean frequency of urinary incontinence and amount of leakage significantly decreased in the FHP and solifenacin groups in the fourth week compared to the placebo group. In addition, 2 weeks after treatment completion, the effects of the FHP were significant compared to the solifenacin group. Due to the effect of FHP on improving the QOL and also the prolonged effect of this drug, the use of FHP in urinary incontinence, as a complementary treatment could be suggested.
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Affiliation(s)
- Mahbubeh Karbalaiee
- Physiology Research Center, Institute of Neuropharmacology Kerman University of Medical Sciences Kerman Iran
- Department of Traditional Medicine, Faculty of Persian Medicine Kerman University of Medical Sciences Kerman Iran
| | - Azar Daneshpajooh
- Department of Urology, Shahid Bahonar Hospital Kerman University of Medical Sciences Kerman Iran
| | - Narges Khanjani
- Neurology Research Center Kerman University of Medical Sciences Kerman Iran
| | - Samira Sohbati
- Department of Obstetrics and Gynecology, Clinical Research Development Unit, Afzalipour Hospital Kerman University of Medical Sciences Kerman Iran
| | - Mehrnaz Mehrabani
- Physiology Research Center, Institute of Neuropharmacology Kerman University of Medical Sciences Kerman Iran
| | - Mehrzad Mehrbani
- Herbal and Traditional Medicines Research Center Kerman University of Medical Sciences Kerman Iran
| | - Mitra Mehrabani
- Herbal and Traditional Medicines Research Center Kerman University of Medical Sciences Kerman Iran
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15
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Sawettikamporn W, Sarit-apirak S, Manonai J. Attitudes and barriers to pelvic floor muscle exercises of women with stress urinary incontinence. BMC Womens Health 2022; 22:477. [DOI: 10.1186/s12905-022-02067-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 11/11/2022] [Indexed: 11/28/2022] Open
Abstract
Abstract
Background
Pelvic floor muscle exercise (PFME) is a first-line treatment for stress urinary incontinence (SUI), but adherence to PFME is often problematic. The aim of this study was to better understand the attitudes and barriers to practicing pelvic floor muscle exercise among women with SUI.
Methods
We conducted a qualitative study using semi-structured interviews. Purposive sampling was used to approach eligible participants. The interview included questions focused on women’s perceptions regarding SUI and PFME, sources of information, support, and barriers and motivators of PFME. In-depth interviews were conducted until data saturation occurred. After several readings of written interview transcripts, codes were retrieved, and thematic analysis was conducted.
Results
Seven women participated in the study (average age 53.2 years), and most (4/7) were retired. Three salient themes emerged from the data: (1) perception of SUI, (2) barriers to PFME, and (3) motivators to exercise. Participants highlighted various barriers to PFME: (1) lack of self-discipline owing to both intrinsic and extrinsic factors, (2) lack of confidence in how to perform the exercises properly, and (3) skepticism regarding the efficacy of treatment according to women’s direct and indirect experiences. Achievement of desired outcomes, symptom severity, women’s expectations, and fear of surgery were motivators to regularly perform PFME.
Conclusions
The main barriers to regular PFME were inadequate self-discipline, knowledge, and confidence in performing the exercises, and a poor perception about the effectiveness of PFME.
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16
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Li CH, Chung MH, Liao CH, Su CC, Lin YK, Liao YM. Urinary Incontinence and Sleep Quality in Older Women with Type 2 Diabetes: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15642. [PMID: 36497716 PMCID: PMC9739322 DOI: 10.3390/ijerph192315642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 11/18/2022] [Accepted: 11/22/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Urinary incontinence (UI) and poor sleep negatively affect health-related quality of life (HRQoL). This study explored the UI-related factors and the relationships between UI, sleep quality, and HRQoL. METHODS This cross-sectional study collected data from 237 women with type 2 diabetes. Multivariate logistic regression was conducted to identify the factors associated with UI. One-way analysis of variance was used to compare the mean sleep quality and HRQoL scores of women without UI and those who experienced UI of varying severities. Correlation coefficients were estimated, and multivariate linear regression was conducted to examine the relationships between UI severity, sleep quality, and HRQoL. RESULTS Of the 237 women, 115 (48.52%) experienced UI and 139 (58.65%) were poor sleepers. The three factors associated with UI were advanced age, a higher body mass index, and a history of vaginal delivery. Significant associations between UI severity and sleep quality and between sleep quality and HRQoL were revealed. UI severity and night-time voiding frequency were both associated with sleep quality. CONCLUSIONS One factor associated with UI (body mass index) is modifiable. UI severity is associated with sleep quality as the possible influence of night-time voiding frequency on sleep quality has been considered.
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Affiliation(s)
- Chia-Hui Li
- School of Nursing, College of Nursing, Taipei Medical University, Taipei City 110, Taiwan, Republic of China (R.O.C.)
- Department of Surgery, Cardinal Tien Hospital, New Taipei City 231, Taiwan, Republic of China (R.O.C.)
| | - Min-Huey Chung
- School of Nursing, College of Nursing, Taipei Medical University, Taipei City 110, Taiwan, Republic of China (R.O.C.)
| | - Chun-Hou Liao
- Department of Surgery, Cardinal Tien Hospital, New Taipei City 231, Taiwan, Republic of China (R.O.C.)
- Department of Urology, Cardinal Tien Hospital, New Taipei City 231, Taiwan, Republic of China (R.O.C.)
- College of Medicine, Fu Jen Catholic University, New Taipei City 242, Taiwan, Republic of China (R.O.C.)
| | - Ching-Chieh Su
- Department of Endocrinology, Cardinal Tien Hospital, New Taipei City 231, Taiwan, Republic of China (R.O.C.)
- Dr. Su Diabetes Clinic, New Taipei City 231, Taiwan, Republic of China (R.O.C.)
| | - Yen-Kuang Lin
- Graduate Institute of Athletics and Coaching Science, National Taiwan Sport University, Taoyuan 333, Taiwan, Republic of China (R.O.C.)
| | - Yuan-Mei Liao
- Institute of Clinical Nursing, College of Nursing, National Yang Ming Chiao Tung University, Taipei City 112, Taiwan, Republic of China (R.O.C.)
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17
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Vesentini G, O'Connor N, Elders A, Le Berre M, Nabhan AF, Wagg A, Cacciari L, Dumoulin C. Interventions for treating urinary incontinence in older women: a network meta-analysis. Hippokratia 2022. [DOI: 10.1002/14651858.cd015376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Giovana Vesentini
- School of Rehabilitation; Faculty of Medicine, University of Montreal; Montreal, QC Canada
| | - Nicole O'Connor
- Cochrane Incontinence; Newcastle University; Newcastle upon Tyne UK
| | - Andrew Elders
- Nursing, Midwifery and Allied Health Professions Research Unit; Glasgow Caledonian University; Glasgow UK
| | - Mélanie Le Berre
- School of Rehabilitation; Faculty of Medicine, University of Montreal; Montreal, QC Canada
| | - Ashraf F Nabhan
- Department of Obstetrics and Gynaecology, Faculty of Medicine; Ain Shams University; Cairo Egypt
| | - Adrian Wagg
- Divisional Director, Geriatric Medicine; University of Alberta; Alberta USA
| | - Licia Cacciari
- School of Rehabilitation; Faculty of Medicine, University of Montreal; Montreal, QC Canada
| | - Chantale Dumoulin
- School of Rehabilitation; Faculty of Medicine, University of Montreal; Montreal, QC Canada
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18
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Kopcsay KS, Marczak TD, Jeppson PC, Cameron AP, Khavari R, Tefera E, Gutman RE. Treatment of refractory overactive bladder with OnabotulinumtoxinA vs PTNS: TROOP trial. Int Urogynecol J 2022; 33:851-860. [PMID: 34993598 DOI: 10.1007/s00192-021-05030-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 10/19/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We hypothesized that patients with refractory overactive bladder (rOAB) have similar improvement with percutaneous tibial nerve stimulation (PTNS) and OnabotulinumtoxinA (BTX). METHODS This multicenter cohort study compared BTX and PTNS in women with rOAB. Baseline information included Overactive Bladder Questionnaire (OABq) short form, Urinary Distress Inventory-6 (UDI-6), and voiding diary. Primary outcome was cure, defined as "very much better" or "much better" on the Patient Global Impression of Improvement (PGII) AND a reduction in OABq symptom severity scale (SSS) ≥10 at 3 months after treatment. Assuming 80% power to detect a ten-point difference in OABq-SSS, 80 participants were required per group. RESULTS A total of 150 patients were enrolled; 97 completed 3 months of therapy and were included. At baseline, BTX patients had more detrusor overactivity (70% vs 40%, p = 0.025), urgency incontinence (UUI; OABq-SSS#6 4 vs 3, p = 0.02, SSS 65 vs 56, p = 0.04), but similar health-related quality of life (HRQL 49 vs 54, p = 0.28), voids (7 vs 8, p = 0.13), and UUI episodes (2 vs 2, p = 1.0). At 3 months, cure rates were similar: BTX 50% vs PTNS 44.2% (p = 0.56). Both groups had improved SSS (-37 vs -29, p = 0.08) and HRQL (31 vs 24, p = 0.14). Patients receiving BTX had a greater improvement in urgency (ΔOABq-SSS#2-3 vs -2; p = 0.02) and UUI (ΔOABq-SSS#6-2 vs -1; p = 0.02). No characteristics were predictive of cure. CONCLUSIONS BTX resulted in significantly greater improvement in urgency and UUI than PTNS, but no difference in success based on PGII and OABq-SSS, which may be due to a lack of power.
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Affiliation(s)
- Katelyn Smithling Kopcsay
- Obstetrics & Gynecology, Division of Urogynecology, Baystate Health, 759 Chestnut St, S1681, Springfield, MA, 01199, USA.
| | - Tara Doyle Marczak
- Obstetrics & Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Mount Auburn Hospital/Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Peter C Jeppson
- Obstetrics & Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, University of New Mexico, Albuquerque, NM, USA
| | - Anne P Cameron
- Urology, Division of Neurourology and Pelvic Reconstruction, University of Michigan, Ann Arbor, MI, USA
| | - Rose Khavari
- Urology, Houston Methodist Hospital, Houston, TX, USA
| | - Eshetu Tefera
- Department of Biostatistics and Epidemiology, MedStar Health Research Institute, Hyattsville, MD, USA
| | - Robert E Gutman
- Obstetrics & Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Georgetown University/MedStar Washington Hospital Center, Washington, DC, USA
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19
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Steenstrup B, Lopes F, Cornu JN, Gilliaux M. Cognitive-behavioral therapy and urge urinary incontinence in women. A systematic review. Int Urogynecol J 2021; 33:1091-1101. [PMID: 34716765 DOI: 10.1007/s00192-021-04989-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/24/2021] [Indexed: 12/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS UUI co-exists with numerous health conditions, having a substantial negative impact on health-related quality of life and mental health. Cognitive-behavioral therapy (CBT) could help patients manage these problems by changing the way they think and behave. METHODS We carried out a systematic review of the literature assessing the modalities and effects of CBT as a stand-alone strategy, without adding PFMT, on symptoms and clinical signs, in women with UUI. Our secondary objective was to report modalities and effects of CBT on health-related quality of life, psychological symptoms and patient-reported satisfaction. The PRISMA methodology was used to carry out this systematic review. A literature search was conducted in PubMed, PEDro, Web of Science and Cochrane Library databases from inception to December 2020. The PICO approach was used to determine the eligibility criteria. RESULTS Twelve papers were included in the present review which showed beneficial effects on both symptom severity (p < 0.05) and more subjective areas such as quality of life, psychological symptoms or patient satisfaction level (p < 0.05), respectively). However, results on the effectiveness of CBT on clinical signs remains conflicting. CONCLUSION Based on the available literature, this review suggested a high level of evidence for the effectiveness of CBT on symptom severity and a moderate level of evidence for the effectiveness of CBT on quality of life, psychological symptoms and patient satisfaction. However, we highlighted no evidence for the effects of CBT on clinical signs.
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Affiliation(s)
| | - Floriane Lopes
- La Musse Physiotherapy Training Institute, Saint-Sébastien-de-Morsent, France
| | | | - Maxime Gilliaux
- Clinical Research Department, La Musse Hospital, Saint-Sébastien-de-Morsent, France.,CETAPS Laboratory, Rouen University, EA, 3882, Rouen, France
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20
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Liu N, Xing L, Mao W, Chen S, Wu J, Xu B, Chen M. Relationship Between Blood Glucose and Hemoglobin A1c Levels and Urinary Incontinence in Women. Int J Gen Med 2021; 14:4105-4116. [PMID: 34366679 PMCID: PMC8336994 DOI: 10.2147/ijgm.s324332] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 07/21/2021] [Indexed: 11/23/2022] Open
Abstract
Objective The purpose of this study was to evaluate the associations between blood glucose and hemoglobin A1c (HbA1c) levels with the degree of stress urinary incontinence (SUI) and urgency urinary incontinence (UUI) in women. Methods We conducted a cross-sectional study of female participants in the National Health and Nutrition Examination Survey (NHANES) database between 2007 and 2012. Univariate and multivariate logistic regressions were used to assess the relationship between blood glucose and HbA1c levels and the degree of SUI and UUI. Results A total of 3821 participants were enrolled in the study, of whom 2421 (63.4%) had no SUI, 1133 (29.7%) had monthly SUI, 267 (7.0%) had weekly SUI; 2883 (75.5%) had no UUI, 735 (19.2%) had monthly UUI, 203 (5.3%) had weekly UUI. The levels of blood glucose and HbA1c were positively correlated with SUI and UUI, and increased with increasing degree of UUI. Multivariate logistic regression showed that there was a positive association between blood HbA1c level and degree of SUI. Conclusion Our study found that blood glucose and HbA1c levels can be used as indicators of SUI and UUI severity in women.
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Affiliation(s)
- Ning Liu
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, 210009, People's Republic of China
| | - Li Xing
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, 210009, People's Republic of China
| | - Weipu Mao
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, 210009, People's Republic of China.,Surgical Research Center, Institute of Urology, Southeast University Medical School, Nanjing, 210009, People's Republic of China.,Department of Urology, Nanjing Lishui District People's Hospital, Zhongda Hospital Lishui Branches, Southeast University, Nanjing, 211200, People's Republic of China
| | - Shuqiu Chen
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, 210009, People's Republic of China
| | - Jianping Wu
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, 210009, People's Republic of China
| | - Bin Xu
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, 210009, People's Republic of China
| | - Ming Chen
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, 210009, People's Republic of China.,Surgical Research Center, Institute of Urology, Southeast University Medical School, Nanjing, 210009, People's Republic of China.,Department of Urology, Nanjing Lishui District People's Hospital, Zhongda Hospital Lishui Branches, Southeast University, Nanjing, 211200, People's Republic of China
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21
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Prevalence and Treatment of Postpartum Stress Urinary Incontinence: A Systematic Review. Female Pelvic Med Reconstr Surg 2021; 27:e139-e145. [DOI: 10.1097/spv.0000000000000866] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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22
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Huang Z, Yang T, Shao L, Yang B, Yang S, Wang G, Li P, Li J. Regenerated Cell Therapy for Stress Urinary Incontinence: A Meta-Analysis. J INVEST SURG 2020; 34:1366-1376. [PMID: 33198535 DOI: 10.1080/08941939.2020.1805654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate the efficacy and safety of regenerated cell therapy for stress urinary incontinence (UI) in humans. METHODS We searched articles from PubMed, Embase, and the Cochrane Library database published before February 24, 2020. Of 396 records identified, 23 articles on human clinical research met our criteria, including a total of 890 patients. Stata/SE12.0 software was used to analyze cure, efficiency (cure rate plus improvement rate), and complication rates. RESULTS No significant differences in cure rates and effective rates were observed for any cell type in males. However, in females, the myocytes with fibroblasts subgroup (82%) and nucleated cells with platelets subgroup (89%) exhibited significantly higher cure rates compared with the other two subgroups (25% and 36%). Pooled effective rates of myocytes and fibroblasts (92%) and nucleated cells with platelets (97%) were also higher compared with the other two subgroups (72% and 60%). Pooled complication rates were 23% and 26% in males and females, respectively, and there were some differences among subgroups. Although some studies reported postoperative complications, no serious complications were reported and most recovered within 1-2 weeks. CONCLUSIONS Limited studies have indicated the safety and effectiveness of regenerated cells for treating stress UI in the follow-up period, which may be an ideal method to treat stress UI in the future. Moreover, nucleated cells with platelets and myocytes with fibroblasts were markedly effective, but whether cell injection therapies elicit superior effects need further confirmation.
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Affiliation(s)
- Ziye Huang
- The Department of Urology, Kunming Medical University and The Second Affiliated Hospital, Kunming, P. R. China
| | - Tongxin Yang
- The Department of Urology, Kunming Medical University and The Second Affiliated Hospital, Kunming, P. R. China
| | - Lishi Shao
- The Department of Imageology, Kunming Medical University and The Second Affiliated Hospital, Kunming, P. R. China
| | - Bowei Yang
- The Department of Urology, Kunming Medical University and The Second Affiliated Hospital, Kunming, P. R. China
| | - Shunhang Yang
- The Department of Urology, Kunming Medical University and The Second Affiliated Hospital, Kunming, P. R. China
| | - Guang Wang
- The Department of Urology, Kunming Medical University and The Second Affiliated Hospital, Kunming, P. R. China
| | - Pei Li
- The Department of Urology, Kunming Medical University and The Second Affiliated Hospital, Kunming, P. R. China
| | - Jiongming Li
- The Department of Urology, Kunming Medical University and The Second Affiliated Hospital, Kunming, P. R. China
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23
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Zhang J, Yi B, Wang L, Hu Y. Research progress of single nucleotide polymorphism in stress urinary incontinence. Eur J Obstet Gynecol Reprod Biol 2020; 260:56-58. [PMID: 33743357 DOI: 10.1016/j.ejogrb.2020.11.022] [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: 08/20/2020] [Revised: 10/27/2020] [Accepted: 11/06/2020] [Indexed: 11/26/2022]
Abstract
Stress urinary incontinence (SUI), as one of the manifestations of pelvic floor dysfunction diseases with high incidence, seriously affects women's physical and mental health and quality of life. The etiology and pathogenesis of SUI are complex and not yet completely clear, now believed to be involved with environmental factors, genetic factors and cross-cutting factors between the two. SUI genetic susceptibility may be related to single nucleotide polymorphism. This article reviews the current studies on SUI-related single nucleotide polymorphisms.
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Affiliation(s)
- Jinyi Zhang
- Departments of Obstetrics/Gynecology, The 2nd Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Lucheng,325000, Zhejiang, China
| | - Baozhu Yi
- Departments of Obstetrics/Gynecology, The 2nd Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Lucheng,325000, Zhejiang, China
| | - Ledan Wang
- Departments of Obstetrics/Gynecology, The 2nd Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Lucheng,325000, Zhejiang, China
| | - Yue Hu
- Departments of Obstetrics/Gynecology, The 2nd Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Lucheng,325000, Zhejiang, China.
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24
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Linzenbold W, Jäger L, Stoll H, Abruzzese T, Harland N, Bézière N, Fech A, Enderle M, Amend B, Stenzl A, Aicher WK. Rapid and precise delivery of cells in the urethral sphincter complex by a novel needle-free waterjet technology. BJU Int 2020; 127:463-472. [PMID: 32940408 DOI: 10.1111/bju.15249] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To investigate the therapy of stress urinary incontinence in a preclinical setting cells were injected into the urethrae of minipigs; however, cells injected by William's needle were frequently misplaced or lost; thus, we investigated if needle-free cell injections using a novel waterjet technology facilitates precise injections in the urethral sphincter complex. MATERIALS AND METHODS Porcine adipose tissue-derived stromal cells (pADSCs) were isolated from boars, expanded, labelled, and injected in the sphincter of female pigs by waterjet employing two different protocols. After incubation for 15 min or 3 days, the urethrae of the pigs were examined. Injected cells were visualised by imaging and fluorescence microscopy of tissue sections. DNA of injected male cells was verified by polymerase chain reaction (PCR) of the sex-determining region (SRY) gene. Cell injections by William's needle served as controls. RESULTS The new waterjet technology delivered pADSCs faster and with better on-site precision than the needle injections. Bleeding during or after waterjet injection or other adverse effects, such as swelling or urinary retention, were not observed. Morphologically intact pADSCs were detected in the urethrae of all pigs treated by waterjet. SRY-PCR of chromosomal DNA and detection of recombinant green fluorescent protein verified the injection of viable cells. In contrast, three of four pigs injected by William's needle displayed no or misplaced cells. CONCLUSION Transurethral injection of viable pADSCs by waterjet is a simple, fast, precise, and yet gentle new technology. This is the first proof-of-principle concept study providing evidence that a waterjet injects intact cells exactly in the tissue targeted in a preclinical in vivo situation. To further explore the clinical potential of the waterjet technology longer follow-up, as well as incontinence models have to be studied.
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Affiliation(s)
| | | | - Hartmut Stoll
- Department of Urology, University of Tübingen Hospital, Tübingen, Germany
| | - Tanja Abruzzese
- Department of Urology, University of Tübingen Hospital, Tübingen, Germany
| | - Niklas Harland
- Department of Urology, University of Tübingen Hospital, Tübingen, Germany
| | - Nicolas Bézière
- Department of Preclinical Imaging and Radiopharmacy, Werner Siemens Imaging Center, Eberhard Karls University Tübingen, Tübingen, Germany
| | | | | | - Bastian Amend
- Department of Urology, University of Tübingen Hospital, Tübingen, Germany
| | - Arnulf Stenzl
- Department of Urology, University of Tübingen Hospital, Tübingen, Germany
| | - Wilhelm K Aicher
- Department of Urology, University of Tübingen Hospital, Tübingen, Germany
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25
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Funada S, Watanabe N, Goto T, Negoro H, Akamatsu S, Ueno K, Uozumi R, Ichioka K, Segawa T, Akechi T, Furukawa TA, Ogawa O. Cognitive behavioral therapy for overactive bladder in women: study protocol for a randomized controlled trial. BMC Urol 2020; 20:129. [PMID: 32819331 PMCID: PMC7439638 DOI: 10.1186/s12894-020-00697-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 08/14/2020] [Indexed: 11/17/2022] Open
Abstract
Background Overactive bladder (OAB) symptoms affect daily life by decreasing health-related quality of life (HRQol). However, there remain no very effective treatment for OAB. Pharmacotherapy is one of the best treatments, but it is not always efficient and may incur adverse events. Although behavioral therapy is another effective treatment, there are very few structured treatment manuals on how to prescribe behavioral therapy to treat OAB for whom. Cognitive behavioral therapy (CBT) is a psychotherapy consisting of structured sessions to solve problems with the collaborative empiricism between therapists and patients. OAB symptoms are supposed to worsen with cognitive distortion, and CBT is expected to be effective in treating OAB by modifying such cognitive processes. In this trial, we will evaluate the efficacy of CBT for OAB. Methods A randomized, controlled, open-label, multicenter parallel-group superiority trial will be conducted. Participants with moderate to severe OAB symptoms with or without pharmacotherapy will be recruited and will be randomly allocated 1:1 to two different groups by minimization (age, baseline OAB severity, treatment status, types of intervention, and treating institutions). The intervention group will be prescribed an individual CBT program covering six techniques in 4 sessions (30 min each), with or without pharmacotherapy. The primary outcome is the change scores in an OAB-questionnaire (OAB-q) from baseline to the end of the trial (week 13). Secondary outcomes will include other patient reported outcome measures and the frequency volume chart. All analyses will be conducted on an intention-to-treat principle. Discussion This trial will determine the efficacy of CBT to treat OAB using a rigorous methodology. The effectiveness of CBT with a structured manual may not only lead to a new treatment option for patients suffering from OAB symptoms, but may also reduce the social burden by OAB. Trial registration UMIN-CTR Clinical Trial, CTR-UMIN000038513. Registered on November 7, 2019.
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Affiliation(s)
- Satoshi Funada
- Department of Urology, Kyoto University Graduate School of Medicine, 54 Shogoinkawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan. .,Department of Health Promotion and Human Behavior, Kyoto University School of Public Health, Kyoto, Japan. .,Department of Psychiatry, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
| | - Norio Watanabe
- Department of Health Promotion and Human Behavior, Kyoto University School of Public Health, Kyoto, Japan
| | - Takayuki Goto
- Department of Urology, Kyoto University Graduate School of Medicine, 54 Shogoinkawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Hiromitsu Negoro
- Department of Urology, University of Tsukuba Hospital, Tsukuba, Japan
| | - Shusuke Akamatsu
- Department of Urology, Kyoto University Graduate School of Medicine, 54 Shogoinkawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Kentaro Ueno
- Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ryuji Uozumi
- Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | | | - Tatsuo Akechi
- Department of Psychiatry, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Toshiaki A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University School of Public Health, Kyoto, Japan
| | - Osamu Ogawa
- Department of Urology, Kyoto University Graduate School of Medicine, 54 Shogoinkawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
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Funada S, Watanabe N, Goto T, Negoro H, Akamatsu S, Uozumi R, Kishimoto S, Ichioka K, Segawa T, Furukawa TA, Ogawa O. Clinical feasibility and acceptability of adding cognitive behavioral therapy to pharmacotherapy for drug-resistant overactive bladder in women: A single-arm pilot study. Low Urin Tract Symptoms 2020; 13:69-78. [PMID: 32618414 DOI: 10.1111/luts.12333] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 05/08/2020] [Accepted: 05/19/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Drug-resistant overactive bladder (OAB) represents an unmet medical need in that treatment options are limited. We developed a treatment model based on cognitive behavioral therapy and evaluated its feasibility and acceptability for drug-resistant OAB in women. METHODS This was an open-label, single-arm, multicenter pilot study. We defined drug-resistant OAB as OAB with moderate to severe symptoms despite pharmacotherapy for more than 12 weeks. A face-to-face intervention was prescribed as six sessions (30 minutes each) over 6 to 12 weeks according to a treatment manual. The effects were assessed by self-reported questionnaires and frequency voiding charts (FVC) at baseline, during intervention, immediately after intervention, and at follow-up. RESULTS Ten patients participated in this study. Median age was 72 years, median OAB Symptom Score was nine points, and median duration of prior treatment for OAB was 5.5 years at baseline. Two participants dropped out of the study. Among the remaining patients, the scores of the OAB Questionnaire subscales improved (effect size: 0.75-1.73), and the mean urinary frequency in the FVC also improved from baseline (9.0 times, SD: 2.1) to follow-up (6.2 times, SD: 1.2). All participants were satisfied with the intervention. There were no adverse events during this study. CONCLUSIONS The new treatment based on cognitive behavioral therapy was well tolerated and feasible in women with drug-resistant OAB. Further randomized research is needed to rigorously evaluate the efficacy of the treatment.
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Affiliation(s)
- Satoshi Funada
- Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Department of Health Promotion and Human Behavior, Kyoto University School of Public Health, Kyoto, Japan
| | - Norio Watanabe
- Department of Health Promotion and Human Behavior, Kyoto University School of Public Health, Kyoto, Japan
| | - Takayuki Goto
- Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hiromitsu Negoro
- Department of Urology, University of Tsukuba Hospital, Ibaraki, Japan
| | - Shusuke Akamatsu
- Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ryuji Uozumi
- Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Sanae Kishimoto
- Department of Health Promotion and Human Behavior, Kyoto University School of Public Health, Kyoto, Japan
| | | | | | - Toshi A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University School of Public Health, Kyoto, Japan
| | - Osamu Ogawa
- Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Escura Sancho S, Ros Cerro C, Anglès-Acedo S, Bataller Sánchez E, Espuña-Pons M. [How did COVID-19 pandemic change the way we attend the patients in an urogynaecological unit]. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2020; 47:111-117. [PMID: 32834308 PMCID: PMC7321029 DOI: 10.1016/j.gine.2020.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 06/23/2020] [Indexed: 01/09/2023]
Abstract
The current SARS-coronavirus type 2 pandemic caused, in few weeks, important changes in the health system organization and in the way we attend the patients. Urogynaecological diseases affect quality of life, but without life risk in most cases, so it is possible to delay. Moreover, urogynaecological diseases affect mostly women over 65 years old (a high risk population for contracting COVID-19). In this manuscript we summarise the current evidence about telemedicine efectivity to manage to pelvic floor dysfunctions and, in addition, the recommendations of Urogynaecological scientific societies during state of alarm. We describe the management of the different pelvic floor dysfunctions during COVID-19 pandemic and a proposal to organize the urogynaecological services to diagnose (visits and diagnostic investigations) and to treat (conservative, pharmacological or surgery) in the interpandemic period and in the future.
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Affiliation(s)
- S. Escura Sancho
- Unidad de Suelo Pélvico, ICGON, Hospital Clínic de Barcelona, Barcelona, España
| | - C. Ros Cerro
- Unidad de Suelo Pélvico, ICGON, Hospital Clínic de Barcelona, Barcelona, España
| | - S. Anglès-Acedo
- Unidad de Suelo Pélvico, ICGON, Hospital Clínic de Barcelona, Barcelona, España
| | - E. Bataller Sánchez
- Unidad de Suelo Pélvico, ICGON, Hospital Clínic de Barcelona, Barcelona, España
| | - M. Espuña-Pons
- Unidad de Suelo Pélvico, ICGON, Hospital Clínic de Barcelona, Barcelona, España
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28
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Kim MS, Rhim HC, Park A, Kim H, Han KM, Patkar AA, Pae CU, Han C. Comparative efficacy and acceptability of pharmacological interventions for the treatment and prevention of delirium: A systematic review and network meta-analysis. J Psychiatr Res 2020; 125:164-176. [PMID: 32302794 DOI: 10.1016/j.jpsychires.2020.03.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 03/03/2020] [Accepted: 03/23/2020] [Indexed: 12/23/2022]
Abstract
We performed a network meta-analysis to build clear hierarchies of efficacy and tolerability of pharmacological interventions for the treatment and prevention of delirium. Electronic databases including PubMed, Google Scholar, Embase, Cochrane Central Register of Controlled Trials, PsycINFO, and MEDLINE were searched published up to February 22, 2019. A total of 108 randomized controlled trials (RCTs) investigating pharmacotherapy on delirium were included for analysis, and the strength of evidence (SoE) was evaluated for critical outcomes. In terms of treatment, quetiapine (low SoE), morphine (low SoE), and dexmedetomidine (moderate SoE) were effective in the intensive care unit (ICU) patients. In terms of prevention, dexmedetomidine (high SoE) and risperidone (high SoE) significantly reduced the incidence of delirium in ICU surgical patients, while ramelteon (high SoE) reduced the incidence of delirium in ICU medical patients. Despite the efficacy, dexmedetomidine and risperidone demonstrated higher drop-out rate (moderate to high SoE). Haloperidol and other antipsychotics, except for quetiapine and risperidone, showed no benefit. None of the agents showed benefit in non-ICU patients. In conclusion, dexmedetomidine may be a drug of choice for both treating and preventing delirium of the ICU and postsurgical patients. However, it may be less tolerable, and side-effects should be adequately managed. Current evidence does not support the routine use of antipsychotics. For medical patients, oral ramelteon might be useful for prevention.
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Affiliation(s)
- Min Seo Kim
- Korea University College of Medicine, Seoul, South Korea
| | - Hye Chang Rhim
- Korea University College of Medicine, Seoul, South Korea
| | - Ariel Park
- University of Central Florida, College of Medicine, Orlando, FL, USA
| | - Hanna Kim
- Ewha Womans University, College of Medicine, Seoul, South Korea
| | - Kyu-Man Han
- Department of Psychiatry, Korea University College of Medicine, Seoul, South Korea
| | - Ashwin A Patkar
- Department of Psychiatry and Behavioural Sciences, Duke University Medical Center, Durham, NC, USA
| | - Chi-Un Pae
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea & Department of Psychiatry and Behavioural Sciences, Duke University Medical Center, Durham, NC, USA
| | - Changsu Han
- Department of Psychiatry, Korea University College of Medicine, Seoul, South Korea.
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29
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Hassani D, Arya L, Andy U. Continence: Bowel and Bladder and Physical Function Decline in Women. CURRENT GERIATRICS REPORTS 2020; 9:64-71. [PMID: 32440467 DOI: 10.1007/s13670-020-00313-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Purpose of review The purpose of this article is to review the various forms of incontinence, highlight their impact on older women, and to explore current literature regarding the link between physical activity, physical function, and incontinence. Recent findings Both urinary and fecal incontinence become more prevalent with age, and are associated with significant morbidity. In parallel, there is a well-established decline in physical function that occurs with age. Furthermore, incontinence has a bidirectional relationship with physical function decline. Given the known link between increasing physical activity and preserved physical function, there is an emerging body of literature seeking to determine whether increases in physical activity may also improve incontinence outcomes. We review some recent data on this topic. Summary Continence and physical function are two closely linked entities. Further research is needed to determine whether interventions that increase physical activity might result in improved continence outcomes.
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Affiliation(s)
- Daisy Hassani
- Department of Obstetrics and Gynecology Hospital of the University of Pennsylvania 3400 Spruce Street Philadelphia, PA 19104
| | - Lily Arya
- Department of Obstetrics and Gynecology Hospital of the University of Pennsylvania 3400 Spruce Street Philadelphia, PA 19104
| | - Uduak Andy
- Department of Obstetrics and Gynecology Hospital of the University of Pennsylvania 3400 Spruce Street Philadelphia, PA 19104
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30
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Grimes CL, Balk EM, Crisp CC, Antosh DD, Murphy M, Halder GE, Jeppson PC, Weber LeBrun EE, Raman S, Kim-Fine S, Iglesia C, Dieter AA, Yurteri-Kaplan L, Adam G, Meriwether KV. A guide for urogynecologic patient care utilizing telemedicine during the COVID-19 pandemic: review of existing evidence. Int Urogynecol J 2020; 31:1063-1089. [PMID: 32342112 PMCID: PMC7185267 DOI: 10.1007/s00192-020-04314-4] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 12/17/2022]
Abstract
Introduction and hypothesis The COVID-19 pandemic and the desire to “flatten the curve” of transmission have significantly affected the way providers care for patients. Female Pelvic Medicine and Reconstructive Surgeons (FPMRS) must provide high quality of care through remote access such as telemedicine. No clear guidelines exist on the use of telemedicine in FPMRS. Using expedited literature review methodology, we provide guidance regarding management of common outpatient urogynecology scenarios during the pandemic. Methods We grouped FPMRS conditions into those in which virtual management differs from direct in-person visits and conditions in which treatment would emphasize behavioral and conservative counseling but not deviate from current management paradigms. We conducted expedited literature review on four topics (telemedicine in FPMRS, pessary management, urinary tract infections, urinary retention) and addressed four other topics (urinary incontinence, prolapse, fecal incontinence, defecatory dysfunction) based on existing systematic reviews and guidelines. We further compiled expert consensus regarding management of FPMRS patients in the virtual setting, scenarios when in-person visits are necessary, symptoms that should alert providers, and specific considerations for FPMRS patients with suspected or confirmed COVID-19. Results Behavioral, medical, and conservative management will be valuable as first-line virtual treatments. Certain situations will require different treatments in the virtual setting while others will require an in-person visit despite the risks of COVID-19 transmission. Conclusions We have presented guidance for treating FPMRS conditions via telemedicine based on rapid literature review and expert consensus and presented it in a format that can be actively referenced.
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Affiliation(s)
- Cara L Grimes
- Departments of Obstetrics and Gynecology and Urology, New York Medical College, 19 Bradhurst Avenue, Suite 2700 South Hawthorne, Valhalla, NY, 10532, USA.
| | - Ethan M Balk
- Center for Evidence Synthesis in Health, Brown School of Public Health, Brown University, Providence, RI, USA
| | - Catrina C Crisp
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, TriHealth, Cincinnati, OH, USA
| | - Danielle D Antosh
- Department of Obstetrics and Gynecology, Division of Urogynecology, Houston Methodist Hospital, Houston, TX, USA
| | - Miles Murphy
- Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Gabriela E Halder
- Department of Women's Health, Dell Medical School, University of Texas Austin, Austin, TX, USA
| | - Peter C Jeppson
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, NM, USA
| | - Emily E Weber LeBrun
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Florida, Gainesville, FL, USA
| | - Sonali Raman
- Department of Women's Health, Female Pelvic Medicine and Reconstructive Surgery, St. Elizabeth Healthcare, Fort Thomas, KY, USA
| | - Shunaha Kim-Fine
- Section of Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada
| | - Cheryl Iglesia
- Department of Obstetrics and Gynecology, Georgetown University School of Medicine, Washington, DC, USA
| | - Alexis A Dieter
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ladin Yurteri-Kaplan
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY, USA
| | - Gaelen Adam
- Center for Evidence Synthesis in Health, Brown School of Public Health, Brown University, Providence, RI, USA
| | - Kate V Meriwether
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, NM, USA
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31
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Fu Y, Nelson EA, McGowan L. An evidence-based self-management package for urinary incontinence in older women: a mixed methods feasibility study. BMC Urol 2020; 20:43. [PMID: 32312255 PMCID: PMC7171836 DOI: 10.1186/s12894-020-00603-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 03/13/2020] [Indexed: 11/12/2022] Open
Abstract
Background Urinary incontinence (UI) is a distressing condition that limits women’s quality of life and places a heavy burden on health care services. Behavioural treatments are recommended as a first-line treatment. An evidence-based self-management package was developed following the Medical Research Council (MRC) framework for complex interventions. This study aimed to evaluate the feasibility and acceptability of the intervention. Methods A mixed-methods approach was undertaken, namely a randomised controlled feasibility study with nested qualitative study. Fifty women aged 55 or over living with UI, recruited from community centres were randomly assigned to either a 3-month course with the package with a support session or a control group to receive the same package only 3 months later. Principal outcome measures were: self-reported quality of life, UI severity, self-efficacy and psychological status. Analysis of covariance was undertaken to estimate within- and between- group changes for all outcomes. Acceptability was explored using individual interviews at follow-up. Results Fifty women were randomised (24 to intervention, 26 to control); mean age of 69.7 (±9.1) years and mean UI frequency 2.2 (±2.2) episodes/day at baseline. Overall, 49 women (98%) completed 3-month follow-up (24 in the intervention, 25 in the control). A positive trend was detected in the impact of UI on their personal relationships (− 3.89, p = 0.088), symptom severity (− 1.77, p = 0.025), UI symptoms scale (− 1.87, p = 0.031) and anxiety status (− 2.31, p = 0.001), respectively. Changes in quality of life and self-efficacy did not differ significantly between groups. Majority of women (71%) in the intervention group reported subjective improvement after 3 months. Spearman correlation coefficient was 0.43 (p < 0.05) between their subjective perception of change and self-efficacy. Women perceived the package being acceptable and described that the package had the potential to increase their knowledge and confidence to manage symptoms and improve quality of life. Conclusions The study demonstrated that the self-management package is feasible and acceptable for older women with UI. Further studies are needed with a large sample size in clinical settings to evaluate the effectiveness of this package. Trial registration ISRCTN17194896. Registered on 11th September 2019 (retrospectively registered).
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Affiliation(s)
- Yu Fu
- Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9NL, UK.
| | - E Andrea Nelson
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Linda McGowan
- School of Healthcare, University of Leeds, Leeds, UK
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Abstract
An extensive review of new resources to support the provision of evidence-based care for women and infants. The current column includes a discussion of a new National Academy of Medicine report on planned place of birth and implications during the SARS-CoV-2 pandemic and commentaries on reviews focused on anorectal sexually transmitted infections and feeding methods following cleft lip repair in infants.
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Zhang N. Behavioural and pharmacological interventions are more effective than no treatment for urinary incontinence outcomes in women. Evid Based Nurs 2020; 23:55. [PMID: 31296610 DOI: 10.1136/ebnurs-2019-103126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2019] [Indexed: 06/09/2023]
Affiliation(s)
- Nicole Zhang
- Nursing, Hartwick College, Oneonta, New York, USA
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35
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Adverse Events Associated with Nonsurgical Treatments for Urinary Incontinence in Women: a Systematic Review. J Gen Intern Med 2019; 34:1615-1625. [PMID: 31062225 PMCID: PMC6667523 DOI: 10.1007/s11606-019-05028-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 02/06/2019] [Accepted: 03/28/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Urinary incontinence (UI) is a common malady in women. Numerous nonsurgical treatments are available, each associated with risk of adverse events (AEs). METHODS We systematically reviewed nonsurgical interventions for urgency, stress, or mixed UI in women, focusing on AEs. We searched MEDLINE®, Cochrane Central Trials Registry, Cochrane Database of Systematic Reviews, and Embase® through December 4, 2017. We included comparative studies and single-group studies with at least 50 women. Abstracts were screened independently in duplicate. One researcher extracted study characteristics and results with verification by another independent researcher. When at least four studies of a given intervention reported the same AE, we conducted random effects model meta-analyses of proportions. We also assessed the strength of evidence. RESULTS There is low strength of evidence that AEs are rare with behavioral therapies and neuromodulation, and that periurethral bulking agents may result in erosion and increase the risk of voiding dysfunction. High strength of evidence finds that anticholinergics and alpha agonists are associated with high rates of dry mouth and constitutional effects such as fatigue and gastrointestinal complaints. Onabotulinum toxin A (BTX) is also associated with increased risk of urinary tract infections (UTIs) and voiding dysfunction (moderate strength of evidence). DISCUSSION Behavioral therapies and neuromodulation have low risk of AEs. Anticholinergics and alpha agonists have high rates of dry mouth and constitutional effects. BTX is associated with UTIs and voiding dysfunction. Periurethral bulking agents are associated with erosion and voiding dysfunction. These AEs should be considered when selecting appropriate UI treatment options. AE reporting is inconsistent and AE rates across studies tended to vary widely. Trials should report AEs more consistently.
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Mayor S. Behavioural therapy is often more effective than drugs for urinary incontinence in women, finds review. BMJ 2019; 364:l1223. [PMID: 30885908 DOI: 10.1136/bmj.l1223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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