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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Chen YC, Chen HW, Kuo HC. Bladder neck incompetence could be an etiology of overactive bladder syndrome in women with stress urinary incontinence after anti-incontinence surgery: insights from transrectal sonography. World J Urol 2023; 41:3083-3089. [PMID: 37775546 DOI: 10.1007/s00345-023-04639-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 09/10/2023] [Indexed: 10/01/2023] Open
Abstract
PURPOSE To investigate the prevalence of bladder neck incompetence (BNI) and the anatomic differences between different types of urinary incontinence (UI) and overactive bladder (OAB) by transrectal sonography, and to investigate these differences among those with stress UI (SUI) or mixed UI (MUI) who exhibited de novo or persistent OAB symptoms following anti-incontinence surgery. METHODS A retrospective analysis was conducted on a total of 184 patients with SUI, MUI, urge UI (UUI), or OAB dry who underwent transrectal ultrasound between 2017 and 2022. The presence of BNI and urethral incompetence assessed by transrectal ultrasound were recorded in all included patients, and recorded preoperatively and postoperatively among patients with SUI and MUI who underwent anti-incontinence surgery. RESULTS Among the patients, 91%, 84%, 76%, and 71% exhibited BNI in MUI, SUI, UUI, OAB dry group, respectively. Significantly higher rate of patients with BNI were found in MUI than in OAB dry group. Patients with OAB symptoms after anti-incontinence surgery exhibited significantly higher rates of BNI and urethral incompetence than those who did not have postoperative OAB symptoms. Among MUI patients with preoperative BNI, significantly lower rate of postoperative BNI and urethral incompetence was observed in individuals who had improved OAB symptoms after surgery, compared to those without improvement. CONCLUSION A higher BNI rate was observed in the MUI group. A significantly higher BNI rate was observed in women with OAB symptoms after anti-incontinence surgery. Patients with MUI had improved OAB symptoms if BNI was successfully corrected after anti-incontinence surgery.
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Affiliation(s)
- Yu-Chen Chen
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Regenerative Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hao-Wei Chen
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Hann-Chorng Kuo
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Tzu Chi University, No.707 Sec.3, Zhongyang Rd., Hualien City, 970473, Taiwan, ROC.
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Kennady EH, Zillioux J, Ali M, Hutchison D, Farhi J, DeNovio A, Barquin D, Rapp DE. Longitudinal urgency outcomes following robotic-assisted laparoscopic prostatectomy. World J Urol 2023; 41:1885-1889. [PMID: 37296234 DOI: 10.1007/s00345-023-04458-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 05/25/2023] [Indexed: 06/12/2023] Open
Abstract
PURPOSE Stress urinary incontinence (SUI) is a well-known adverse outcome following robotic-assisted laparoscopic prostatectomy (RALP). Although postoperative SUI has been extensively studied, little focus has been placed on understanding the natural history and impact of urgency symptoms following RALP. The UVA prostatectomy functional outcomes program (PFOP) was developed to comprehensively assess and optimize continence outcomes following RALP. The present study focuses on assessing urgency outcomes in this cohort. METHODS PFOP patients with a minimum of 6-months follow up following RALP were included. The PFOP includes prospectively assessed incontinence and quality of life outcomes utilizing ICIQ-MLUTS, Urgency Perception Score (UPS), and IIQ-7 questionnaires. The primary study outcome was urgency urinary incontinence (UUI) as determined by ICIQ-MLUTS UUI domain. Secondary outcomes included urgency (UPS score) and quality of life (IIQ-7). RESULTS Forty patients were included with median age 63.5 years. Fourteen (35%) patients reported UUI at baseline. UUI and QOL scores worsened compared to baseline at all time-points. Urgency worsened at 3-weeks and 3-months but returned to baseline by 6-months. Notably, 63% of patients without baseline UUI reported de-novo UUI at 6 months. Although QOL was lower in patients with versus without UUI (IIQ-7 score 3.0 vs 0.0, p = 0.009), severity of UUI was not associated with QOL when controlling for SUI severity. CONCLUSION Our data demonstrate significantly worsened UUI from baseline and a large incidence of de-novo UUI following RALP. Further study is needed to inform how urgency and UUI and its treatment affect health-related quality of life following RALP.
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Affiliation(s)
- Emmett H Kennady
- Department of Urology, University of Virginia, UVA Medical Center, 500 Ray C. Hunt Drive, Charlottesville, VA, USA
| | - Jacqueline Zillioux
- Department of Urology, University of Virginia, UVA Medical Center, 500 Ray C. Hunt Drive, Charlottesville, VA, USA
| | - Marwan Ali
- Department of Urology, University of Virginia, UVA Medical Center, 500 Ray C. Hunt Drive, Charlottesville, VA, USA
| | - Dylan Hutchison
- Department of Urology, University of Virginia, UVA Medical Center, 500 Ray C. Hunt Drive, Charlottesville, VA, USA
| | - Jacques Farhi
- Department of Urology, University of Virginia, UVA Medical Center, 500 Ray C. Hunt Drive, Charlottesville, VA, USA
| | - Anthony DeNovio
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | - David Barquin
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | - David E Rapp
- Department of Urology, University of Virginia, UVA Medical Center, 500 Ray C. Hunt Drive, Charlottesville, VA, USA.
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Lai HH, Wiseman JB, Helmuth ME, Smith AR, Amundsen CL, Cameron AP, Glaser AP, Hendrickson WK, Kirkali Z, Kenton K. Phenotyping of Urinary Urgency Patients Without Urgency Incontinence, and Their Comparison to Urgency Incontinence Patients: Findings From the LURN Study. J Urol 2023; 209:233-242. [PMID: 36067368 PMCID: PMC9742334 DOI: 10.1097/ju.0000000000002939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 08/10/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE We characterize patients with urinary urgency with vs without urgency urinary incontinence who presented to clinics actively seeking treatment for their symptoms. MATERIALS AND METHODS Participants who enrolled in the Symptoms of Lower Urinary Tract Dysfunction Research Network were categorized into urinary urgency with vs without urgency urinary incontinence. Participants were followed for 1 year; their urinary symptoms, urological pain, psychosocial factors, bowel function, sleep disturbance, physical activity levels, physical function, and quality of life were compared. Mixed effects linear regression models were used to examine the relationships between urgency urinary incontinence and these factors. RESULTS Among 683 participants with urinary urgency at baseline, two-thirds (n=453) also had urgency urinary incontinence; one-third (n=230) had urinary urgency-only without urgency urinary incontinence. No differences were detected in urological pain between urinary urgency-only and urgency urinary incontinence. Those with urgency urinary incontinence had more severe urgency and frequency symptoms, higher depression, anxiety, perceived stress scores, more severe bowel dysfunction and sleep disturbance, lower physical activity levels, lower physical function, and worse quality of life than those with urinary urgency-only. Among those with urinary urgency-only at baseline, 40% continued to have urinary urgency-only, 15% progressed to urgency urinary incontinence, and 45% had no urgency at 12 months. Fifty-eight percent with urgency urinary incontinence at baseline continued to report urgency urinary incontinence at 12 months, while 15% improved to urinary urgency-only, and 27% had no urgency. CONCLUSIONS Patients with urgency urinary incontinence have severe storage symptoms, more psychosocial symptoms, poorer physical functioning, and worse quality of life. Our data suggested urgency urinary incontinence may be a more severe manifestation of urinary urgency, rather than urinary urgency and urgency urinary incontinence being distinct entities.
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Affiliation(s)
- H. Henry Lai
- Division of Urologic Surgery, Departments of Surgery and Anesthesiology, Washington University School of Medicine, St. Louis MO
| | | | | | | | - Cindy L. Amundsen
- Department of Obstetrics and Gynecology, Division of Urogynecology, Duke University, Durham NC
| | | | | | - Whitney K. Hendrickson
- Department of Obstetrics and Gynecology, Division of Urogynecology, Duke University, Durham NC
| | - Ziya Kirkali
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda MD
| | - Kimberly Kenton
- Department of Obstetrics & Gynecology, Division of Female Pelvic Medicine & Reconstructive Surgery, Northwestern University, Chicago IL
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Esteban-Fuertes M, Prieto-Chaparro L, Arlandis-Guzmán S, Salinas-Casado J, Gago-Ramos JL. Is there concordance between overactive bladder and detrusor overactivity in men with predominant storage urinary symptoms referred to Functional Urology and Urodynamics Units? Actas Urol Esp 2021; 46:41-48. [PMID: 34848162 DOI: 10.1016/j.acuroe.2021.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 06/03/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To assess the diagnostic concordance of overactive bladder (OAB) and detrusor overactivity (DO) in male patients with predominant storage lower urinary tract symptoms (LUTS) and evaluate their clinical and urodynamic profile according to DO presence and degree of obstruction. MATERIAL AND METHODS Epidemiological, cross-sectional multicenter study. A 3-day bladder diary (3dBD), International Prostate Symptom Score (IPSS) and Bladder Control Self-Assessment Questionnaire (B-SAQ) questionnaires were analyzed. Prostate volume was determined by ultrasound. Urodynamic study (UDS) tests were performed. The prevalence of OAB and DO and the degree of clinical concordance (kappa index) were investigated. Descriptive analysis of clinical variables and UDS results was performed, followed by comparisons based on the presence of DO and degree of obstruction. RESULTS A total of 445 patients were included. The mean age was (SD) 54.8 (9.9) years. According to 3dBD, 89.9% presented increased urinary frequency, 87.9% nocturia, 72.1% urgency, and 31.9% urge urinary incontinence (UUI). Obstruction was present in 36.8%. Concomitant OAB and DO were present in 54.5%. The degree of diagnostic concordance between OAB and DO was low (κ = 0.1772). There were more patients with DO presenting urgency (3dBD and B-SAQ; p < 0.001), UUI (3dBD; p = 0.008) and nocturia (B-SAQ; p < 0.001). Differences were found in terms of prostate volume, IPSS-voiding, maximum flow (Qmax) and post-void residual (p < 0.05) according to the obstruction degree. CONCLUSIONS Approximately 50% of male patients aged 18-65 years old with predominant storage LUTS, referred to specialized units, have both OAB and DO. Obstruction is present on 1/3. Diagnostic concordance between OAB and DO is poor.
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Affiliation(s)
| | | | | | | | - J L Gago-Ramos
- Hospital Germans Trias i Pujol y Universidad Autónoma de Barcelona, Badalona, Barcelona, Spain
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Abdel-Fattah M, Chapple C, Guerrero K, Dixon S, Cotterill N, Ward K, Hashim H, Monga A, Brown K, Drake MJ, Gammie A, Mostafa A, Bladder Health UK, Breeman S, Cooper D, MacLennan G, Norrie J. Female Urgency, Trial of Urodynamics as Routine Evaluation (FUTURE study): a superiority randomised clinical trial to evaluate the effectiveness and cost-effectiveness of invasive urodynamic investigations in management of women with refractory overactive bladder symptoms. Trials 2021; 22:745. [PMID: 34702331 PMCID: PMC8546752 DOI: 10.1186/s13063-021-05661-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 09/24/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Overactive bladder (OAB) syndrome is a symptom complex affecting 12-14% of the UK adult female population. Symptoms include urinary urgency, with or without urgency incontinence, increased daytime urinary frequency and nocturia. OAB has a negative impact on women's social, physical, and psychological wellbeing. Initial treatment includes lifestyle modifications, bladder retraining, pelvic floor exercises and pharmacological therapy. However, these measures are unsuccessful in 25-40% of women (refractory OAB). Before considering invasive treatments, such as Botulinum toxin injection or sacral neuromodulation, most guidelines recommend urodynamics to confirm diagnosis of detrusor overactivity (DO). However, urodynamics may fail to show evidence of DO in up to 45% of cases, hence the need to evaluate its effectiveness and cost-effectiveness. FUTURE (Female Urgency, Trial of Urodynamics as Routine Evaluation) aims to test the hypothesis that, in women with refractory OAB, urodynamics and comprehensive clinical assessment is associated with superior patient-reported outcomes following treatment and is more cost-effective, compared to comprehensive clinical assessment only. METHODS FUTURE is a pragmatic, multi-centre, superiority randomised controlled trial. Women aged ≥ 18 years with refractory OAB or urgency predominant mixed urinary incontinence, and who have failed/not tolerated conservative and medical treatment, are considered for trial entry. We aim to recruit 1096 women from approximately 60 secondary/tertiary care hospitals across the UK. All consenting women will complete questionnaires at baseline, 3 months, 6 months and 15 months post-randomisation. The primary outcome is participant-reported success at 15 months post-randomisation measured using the Patient Global Impression of Improvement. The primary economic outcome is incremental cost per quality-adjusted life year gained at 15 months. The secondary outcomes include adverse events, impact on other urinary symptoms and health-related quality of life. Qualitative interviews with participants and clinicians and a health economic evaluation will also be conducted. The statistical analysis of the primary outcome will be by intention-to-treat. Results will be presented as estimates and 95% CIs. DISCUSSION The FUTURE study will inform patients, clinicians and policy makers whether routine urodynamics improves treatment outcomes in women with refractory OAB and whether it is cost-effective. TRIAL REGISTRATION ISRCTN63268739 . Registered on 14 September 2017.
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Affiliation(s)
- M Abdel-Fattah
- Aberdeen Centre for Women's Health Research, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
| | - C Chapple
- Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - K Guerrero
- Department of Urogynaecology, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - S Dixon
- Health Economics and Decision Science, University of Sheffield, Sheffield, UK
| | - N Cotterill
- Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - K Ward
- Warrell Unit, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - H Hashim
- Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK
- Bristol Urological Institute, University of Bristol, Bristol, UK
| | - A Monga
- Department of Gynaecology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - K Brown
- Department of Gynaecology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - M J Drake
- Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK
- Bristol Urological Institute, University of Bristol, Bristol, UK
| | - A Gammie
- Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK
| | - A Mostafa
- Aberdeen Centre for Women's Health Research, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | | | - S Breeman
- Centre for Healthcare Randomised Trials, University of Aberdeen, Aberdeen, UK
| | - D Cooper
- Centre for Healthcare Randomised Trials, University of Aberdeen, Aberdeen, UK
| | - G MacLennan
- Centre for Healthcare Randomised Trials, University of Aberdeen, Aberdeen, UK
| | - J Norrie
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK
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Denisenko AA, Clark CB, D'Amico M, Murphy AM. Evaluation and management of female urinary incontinence. Can J Urol 2021; 28:27-32. [PMID: 34453426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
UNLABELLED INTRODUCTION Urinary incontinence (UI) is a common condition in all demographics of women and consists of stress UI (SUI), Urgency UI (UUI), and mixed UI (MUI). Treatment includes lifestyle modifications, medical treatment, and surgery depending on the type of UI and severity of symptoms. This review is an update on the evaluation and management of UI in women. MATERIALS AND METHODS This review article covers the evaluation and management options for UI in women and includes the most recent guidelines from the American Urological Association (AUA) as well as recently published literature on the management of UI. RESULTS Any evaluation of UI should include a thorough targeted history and physical, and counseling for treatment should consider patient goals and desired outcomes. For both SUI and UUI, behavioral therapy and lifestyle modifications are effective first line treatments. Patients with UUI can benefit from medical therapy which includes anticholinergics and ß3-agonist medications, as well as neuromodulation in treatment refractory patients. SUI patients may further benefit from mechanical inserts which prevent leaks, urethral bulking agents, and surgical treatments such as the mid urethral sling and autologous fascial pubovaginal sling. CONCLUSIONS Treatment of UI in women requires a graded approach that considers patient goals and symptom severity, beginning with lifestyle and behavioral modifications before progressing to more aggressive interventions.
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Affiliation(s)
- Andrew A Denisenko
- Department of Urology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Rangan V, Nee J, Singh P, Ballou S, Iturrino J, Hirsch W, Lembo A. Fecal Urgency: Clinical and Manometric Characteristics in Patients With and Without Diarrhea. Dig Dis Sci 2020; 65:3679-3687. [PMID: 32468228 DOI: 10.1007/s10620-020-06349-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 05/12/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Fecal urgency is classically associated with diarrhea, but is also common in individuals with normal bowel habits or constipation. Its etiology, particularly in non-diarrhea individuals, is unclear. METHODS We examined data from 368 individuals with and without diarrhea who underwent three-dimensional high-resolution anorectal manometry and balloon expulsion test. All patients completed the Rome III constipation module and the pelvic floor distress inventory (PDFI-20) survey. Patients were considered to have fecal urgency if they reported being bothered "moderately" or "quite a bit" by it in the past 3 months. RESULTS A total of 103 patients (28.0%) met our definition of fecal urgency. These patients were significantly more likely to meet criteria for irritable bowel syndrome and to report fecal incontinence, urinary incontinence, and diarrhea. Fecal urgency was associated with rectal hypersensitivity in those with diarrhea, but not in those without diarrhea. Fecal urgency was associated with urinary urge incontinence in those without diarrhea, but not those with diarrhea. CONCLUSIONS In patients with diarrhea, fecal urgency is associated with rectal hypersensitivity, whereas in patients without diarrhea, fecal urgency is associated with urinary urge incontinence. This suggests that fecal urgency has different pathophysiological mechanisms in patients with different underlying bowel habits.
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Affiliation(s)
- Vikram Rangan
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
| | - Judy Nee
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Prashant Singh
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Sarah Ballou
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Johanna Iturrino
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - William Hirsch
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Anthony Lembo
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
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Padilha JF, Avila MA, Seidel EJ, Driusso P. Different electrode positioning for transcutaneous electrical nerve stimulation in the treatment of urgency in women: a study protocol for a randomized controlled clinical trial. Trials 2020; 21:166. [PMID: 32046754 PMCID: PMC7014940 DOI: 10.1186/s13063-020-4096-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 01/20/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Urgency is a complaint of sudden, compelling desire to pass urine, which is difficult to defer, caused by involuntary contraction of the detrusor muscle during the bladder-filling stage. To enable detrusor inhibition, electrotherapy resources such as transcutaneous tibial nerve stimulation (TTNS) and parasacral transcutaneous electrical stimulation (PTES) have been used. The objective this study is to publish the study protocol that aims to investigate whether urgency decreases after treatment with both of the techniques. METHODS This randomized controlled clinical trial will include 99 women, aged more than 18 years old, with urgency (score ≥ 8 in the Overactive Bladder-Validated 8-Question Awareness Tool [OAB-V8]). Women will be randomly allocated into three groups: TTNS, PTES, and placebo. The following questionnaires will be applied: the Anamnesis Record, the Incontinence Questionnaire Overactive Bladder, the King's Health Questionnaire, the 24-Hour Voiding Diary, and the OAB-V8, at four different time points: at baseline prior to the first session, at the 6th session, the 12th session and at follow-up. The current used for the transcutaneous electrical stimulation will be a symmetrical balanced biphasic pulsed current, for 12 sessions, twice a week, for 20 minutes. Qualitative variables will be displayed as frequency and percentage, quantitative variables as mean and standard deviation. Comparison of urgency severity among groups will be performed with a repeated measures ANOVA, considering the effect of the three groups and the four evaluations, and interactions among them. DISCUSSION The present study aims to contribute evidence for a more in-depth discussion on electrode positioning for electrostimulation used in urgency treatment. It should be emphasized that, based on the possibility of confirming the hypothesis that urgency will decrease in a similar way after both treatments (TTNS and PTES), the PTES will be used as an option for positioning the electrodes alternatively to the tibial nerve region in special populations, such as amputees or people with severe lower limb sensory impairment. TRIAL REGISTRATION Brazilian Registry of Clinical Trials (ReBEC) ID: RBR-9rf33n, date of registration: 17 May 2018.
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Affiliation(s)
- Juliana Falcão Padilha
- Physical Therapy Department, Federal University of Sao Carlos (UFSCar), Rodovia Washington Luis Km 235, São Carlos, São Paulo CEP 13565-905 Brazil
| | - Mariana Arias Avila
- Physical Therapy Department, Federal University of Sao Carlos (UFSCar), Rodovia Washington Luis Km 235, São Carlos, São Paulo CEP 13565-905 Brazil
| | - Enio Júnior Seidel
- Department of Statistics, Federal University of Santa Maria (UFSM), Av Roraima 1000, Santa Maria, Rio Grande do Sul CEP 97105-900 Brazil
| | - Patricia Driusso
- Physical Therapy Department, Federal University of Sao Carlos (UFSCar), Rodovia Washington Luis Km 235, São Carlos, São Paulo CEP 13565-905 Brazil
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Dropkin BM, Kowalik CG, Jaunarena JH, Delpe SD, Reynolds WS, Dmochowski RR, Kaufman MR. Proximal location of explanted midurethral slings is associated with urinary storage symptoms. Neurourol Urodyn 2019; 38:1611-1615. [PMID: 31059638 DOI: 10.1002/nau.24022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 03/07/2019] [Accepted: 04/16/2019] [Indexed: 11/07/2022]
Abstract
AIM To examine the location of midurethral slings (MUS) at the time of excision to determine associations between presenting symptoms and sling location at explant. METHODS We performed an IRB approved, retrospective review of MUS explants between January 2011 and March 2016. Symptoms and physical examination findings were compared between women with slings explanted from the mid-urethra (MU) and women with slings explanted from the proximal urethra/bladder neck (PU/BN). RESULTS We included 95 consecutive women who underwent MUS explant in the analysis. Presenting symptoms included pain in 69 women (72.6%), urinary urgency in 66 (66.5%), voiding dysfunction in 55 (57.9%), urge urinary incontinence (UUI) in 41 (43.2%), stress urinary incontinence in 34 (35.8%), and recurrent urinary tract infections in 22 (23.2%). At sling explant, 2 (2.1%) slings were found at the distal urethra, 33 (34.7%) at the MU and 60 (63.2%) at the PU/BN. Women with slings explanted from the PU/BN were more likely to present with urgency (78.3% vs 54.5%; P = 0.017) and UUI (53.3% vs 27.3%; P = 0.015) and less likely to present with pain on examination (48.3% vs 75.8%; P = 0.01). CONCLUSIONS The majority of MUS requiring explant in this cohort were found at the PU/BN. The most common presenting symptom before MUS explant was pain, followed by urgency and voiding dysfunction. PU/BN location of MUS is likely a factor in the development of urgency and UUI in women who ultimately undergo explant.
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Affiliation(s)
- Benjamin M Dropkin
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Casey G Kowalik
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jorge H Jaunarena
- Department of Urology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Sophia D Delpe
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - William S Reynolds
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Roger R Dmochowski
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Melissa R Kaufman
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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Markland AD, Tangpricha V, Beasley TM, Vaughan CP, Richter HE, Burgio KL, Goode PS. Comparing Vitamin D Supplementation Versus Placebo for Urgency Urinary Incontinence: A Pilot Study. J Am Geriatr Soc 2019; 67:570-575. [PMID: 30578542 PMCID: PMC6403014 DOI: 10.1111/jgs.15711] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 10/30/2018] [Accepted: 10/31/2018] [Indexed: 01/18/2023]
Abstract
OBJECTIVES To estimate the efficacy of vitamin D supplementation to reduce urgency urinary incontinence (UUI) episodes. DESIGN Pilot, two-arm, randomized trial conducted from 2013 to 2017. Interventions were 12 weeks of weekly oral 50,000 IU vitamin D3 or placebo. SETTING Academic, university-based outpatient clinic. PARTICIPANTS Community-dwelling postmenopausal women, 50 years or older, with at least three UUI episodes on 7-day bladder diary and serum vitamin 25-hydroxyvitamin D (25[OH]D) of 30 ng/mL or less. MEASUREMENTS The primary efficacy estimate was the percentage change in UUI episodes. Secondary estimates included changes in other lower urinary tract symptoms, along with exploratory subgroup analysis by race/ethnicity and obesity. RESULTS We randomized 56 women (aged 50-84 years; mean = 60.5 ± 8.2 years), 28 to vitamin D and 28 to placebo; 51 completed treatments. Mean serum 25(OH)D at baseline (21.2 ± 5.2 and 18.2 ± 5.6, P = .30) improved to 57.9 ± 16.3 ng/mL with vitamin D3 and 21.9 ± 8.2 ng/mL with placebo (P < .001). UUI episodes per 24-hour day decreased by 43.0% with vitamin D3 compared to 27.6% with placebo (P = .22). Among black women (n = 33), UUI episodes decreased by 63.2% with vitamin D3 compared to 22.9% with placebo (P = .03). Among obese women, UUI episodes decreased by 54.1% with vitamin D compared to 32.7% with placebo (P = .29). For all women, changes in voiding frequency (P = .40), nocturia (P = .40), urgency (P = .90), incontinence severity (P = .81), and overactive bladder symptom severity (P = .47) were not different between arms. CONCLUSIONS Postmenopausal women with UUI and vitamin D insufficiency demonstrated a greater than 40% decrease in UUI episodes, which did not reach statistical significance compared to placebo, except in the subset of black women. The results of this pilot study support further investigation of vitamin D3 alone or in combination with other treatments for UUI, particularly for women in higher-risk subgroups. J Am Geriatr Soc 67:570-575, 2019.
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Affiliation(s)
- Alayne D. Markland
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Department of Veterans Affairs, Birmingham, AL and Atlanta, GA
- University of Alabama at Birmingham, Department of Medicine, Birmingham, AL
| | | | - T. Mark Beasley
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Department of Veterans Affairs, Birmingham, AL and Atlanta, GA
- University of Alabama at Birmingham, School of Public Health, Birmingham, AL
| | - Camille P. Vaughan
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Department of Veterans Affairs, Birmingham, AL and Atlanta, GA
- Department of Medicine, Emory University, Atlanta, GA
| | - Holly E. Richter
- University of Alabama at Birmingham, Department of Obstetrics and Gynecology, Birmingham, AL
| | - Kathryn L. Burgio
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Department of Veterans Affairs, Birmingham, AL and Atlanta, GA
- University of Alabama at Birmingham, Department of Medicine, Birmingham, AL
| | - Patricia S. Goode
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Department of Veterans Affairs, Birmingham, AL and Atlanta, GA
- University of Alabama at Birmingham, Department of Medicine, Birmingham, AL
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Abstract
The last 2 decades have brought an explosion of research, new products, and general attention to the problem of urinary urgency, and yet patients continue to be plagued by this symptom - especially the elderly. What is it? What does it mean? How can we guide patients successfully through this challenge? This paper presents a review of current thinking about urgency relevant to the practicing clinician, including the epidemiology, pathophysiology, evaluation, and treatment of these patients.
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13
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Arribillaga L, Bengió RG, Ledesma M, Montedoro A, Orellana S, Pisano F, Bengió RH. [Comparison of the symptoms of overactive bladder in women with mixed urinary incontinence and idiopathic urge urinary incontinence.]. ARCH ESP UROL 2018; 71:531-536. [PMID: 29991661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Various authors argued that the voiding urgency component in mixed urinary incontinence (MUI) is different than urge urinary incontinence (UUI). In this last case they suggest that incontinence in MUI could be overdiagnosed in patients with SUI, misunderstanding the leak as UUI. OBJETIVES To evaluate clinical and urodynamic characteristics of patients with MUI and pure UUI. METHODS A retrospective study of our urodynamics database was performed evaluating 450 women with MUI and UUI. Patients with neurogenic bladder, fistulae, urethral diverticula, previous urogynecologic surgery, known infravesical obstruction, previous pelvic radiotherapy, urinary tract infection or psychiatric drugs intake. A full clinical history, physical exam, uroflowmetry, filling cystometry and pressure flow study were performed. RESULTS There is no difference relative to age, menopause and number of births. The presence of nocturia was bigger in the UUI group (66.4% vs. 46.1%, p 0.0004) the same as increased voiding frequency (53.6% vs. 34.6%, p 0.0006). The presence of urethral hypermobility and SUI in the physical exam was greater than MUI, meanwhile the presence of reduced vaginal trophism was bigger in the UUI group. Differences in sensibility or specificity were not found. The presence of overactive detrusor was 56.4% in pure UUI vs. 33.2% in MUI (p<0.0001). No differences in pressure flow study were found. CONCLUSIONS There is a significant difference in the clinical and urodynamic parameters between patients with MUI and pure UUI. The urgency in patients with pure UUI could be related to overactive detrusor. It is probable that many patients with MUI just have pure SUI which could lead to positive effects in the outcomes of anti-incontinence surgery.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Female
- Humans
- Middle Aged
- Retrospective Studies
- Urinary Bladder, Overactive/complications
- Urinary Bladder, Overactive/diagnosis
- Urinary Bladder, Overactive/physiopathology
- Urinary Incontinence, Stress/complications
- Urinary Incontinence, Stress/diagnosis
- Urinary Incontinence, Stress/physiopathology
- Urinary Incontinence, Urge/complications
- Urinary Incontinence, Urge/diagnosis
- Urinary Incontinence, Urge/physiopathology
- Urodynamics
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Affiliation(s)
| | | | - Marta Ledesma
- Centro Urológico Profesor Bengió. Córdoba. Argentina
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14
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Perucchini D, Betschart C, Fink D, Scheiner DA. [Not Available]. Praxis (Bern 1994) 2017; 106:37-44. [PMID: 28055318 DOI: 10.1024/1661-8157/a002573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Zusammenfassung. OAB (overactive bladder syndrome) ist zwar ein häufiges Leiden, doch wird es oft nicht diagnostiziert und deshalb nicht behandelt. Die Behandlung erfolgt symptomatisch. Im Praxisalltag muss vorgängig eine Basis-(Ausschluss)-Diagnostik durchgeführt werden. Das Führen eines Blasentagebuchs ist sowohl für die Diagnostik als auch für den Verlauf wichtig. Eine urogynäkologische Abklärung mit Urodynamik empfiehlt sich in unklaren Situationen und beim Vorliegen einer gemischten Symptomatik mit Symptomen einer Belastungsinkontinenz oder bei gleichzeitigem Vorliegen einer Blasenentleerungsstörung. Die Therapie erfolgt Schritt für Schritt. Schon einfache Verhaltensänderungen und ein Blasen- und Beckenbodentraining können die Symptomatik deutlich verbessern. Viele Patientinnen profitieren aber zusätzlich von der medikamentösen Therapie. Jahrzehntelang standen dazu alleinig Anticholinergika zur Verfügung. Doch die Langzeitcompliance ist unter diesen Medikamenten gering. Neu erweitern β3-Adrenorezeptor-Agonisten das therapeutische Spektrum: Bei ähnlicher Wirkung unterscheidet sich das Nebenwirkungsprofil unter anderem durch das Fehlen von Mundtrockenheit. Bei therapierefraktärer OAB steht die intravesikale Injektion von Onabotulinumtoxin A als sehr effektive Therapie zur Verfügung. In seltenen Fällen ist auch eine Neuromodulation indiziert.
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Affiliation(s)
- Daniele Perucchini
- 1 Blasenzentrum Zürich Stadelhofen und Klinik für Gynäkologie, Universitätsspital Zürich
| | - Cornelia Betschart
- 1 Blasenzentrum Zürich Stadelhofen und Klinik für Gynäkologie, Universitätsspital Zürich
| | - Daniel Fink
- 1 Blasenzentrum Zürich Stadelhofen und Klinik für Gynäkologie, Universitätsspital Zürich
| | - David A Scheiner
- 1 Blasenzentrum Zürich Stadelhofen und Klinik für Gynäkologie, Universitätsspital Zürich
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15
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Johnson TM, Clevenger CK, Elkins J. The vulnerable elderly and bladder dysfunction: is this 'urinary incompetence'? Int J Clin Pract 2016; 70:432-3. [PMID: 27238961 DOI: 10.1111/ijcp.12763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- T M Johnson
- Departments of Medicine and Epidemiology, Emory University and Atlanta VA Medical Center, Atlanta, GA, USA.
- School of Nursing, Emory University and Atlanta VA Medical Center, Atlanta, GA, USA.
| | - C K Clevenger
- School of Nursing, Emory University and Atlanta VA Medical Center, Atlanta, GA, USA
| | - J Elkins
- Departments of Medicine and Rehabilitation Medicine, Emory University and Atlanta VA Medical Center, Atlanta, GA, USA
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Abstract
PURPOSE We sought to understand variations in the expression and temporal relation of bladder control episodes among women with mixed urinary incontinence. MATERIALS AND METHODS A random sample of women 40 years old or older with mixed urinary incontinence on GLOBE-UI (General Longitudinal Overactive Bladder Evaluation-Urinary Incontinence) was recruited in a digital daily diary study using a smartphone application. When a bladder control event occurred, women were instructed to answer episode specific questions. Episodes were defined as urgency, and urinary incontinence with and urinary incontinence without urgency. Women and episodes were compared by the type of activity preceding each episode. Urinary incontinence episodes were further defined as stress urinary incontinence, urgency urinary incontinence, stress induced urgency urinary incontinence and other. The chi-square and Wilcoxon tests were used for categorical and continuous variables, respectively. RESULTS Of 40 women with a mean age of 65.5 years 35 provided complete 30-day diary data. Of the 950 bladder control episodes reported 25% were urgency only, 55% were urinary incontinence with urgency and 19% were urinary incontinence without urgency. Of the urinary incontinence episodes without urgency 82% occurred after a stress activity (eg coughing or sneezing). Notably, a stress activity also occurred just before 52.5% of the urgency urinary incontinence episodes (p <0.001). A total of 24 women (69%) reported at least 1 episode of stress induced urgency urinary incontinence, which was the most prevalent urinary incontinence subtype episode, followed by urgency urinary incontinence and stress urinary incontinence (29% vs 27% and 16%, respectively). The mean number of daily episodes was 1 or 2 across all groups. CONCLUSIONS Women with mixed urinary incontinence express a heterogeneous set of bladder control episodes with stress induced urgency urinary incontinence as the dominant type.
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Affiliation(s)
- Vatché A Minassian
- Brigham and Women's Hospital (VAM), Boston, Massachusetts; Sutter Health System, Sacramento, California; Geisinger Health System, Danville, Pennsylvania.
| | - Xiaowei S Yan
- Brigham and Women's Hospital (VAM), Boston, Massachusetts; Sutter Health System, Sacramento, California; Geisinger Health System, Danville, Pennsylvania
| | - James Pitcavage
- Brigham and Women's Hospital (VAM), Boston, Massachusetts; Sutter Health System, Sacramento, California; Geisinger Health System, Danville, Pennsylvania
| | - Walter F Stewart
- Brigham and Women's Hospital (VAM), Boston, Massachusetts; Sutter Health System, Sacramento, California; Geisinger Health System, Danville, Pennsylvania
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Hubert KC, Sideridis G, Sherlock R, Rosoklija I, Kringle G, Johnson K, Bauer SB, Nelson CP. Urinary incontinence in spina bifida: Initial instrument validation. Res Dev Disabil 2015; 40:42-50. [PMID: 25841183 DOI: 10.1016/j.ridd.2015.01.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 01/21/2015] [Accepted: 01/23/2015] [Indexed: 06/04/2023]
Abstract
The purpose of this study was to perform a psychometric assessment of the Incontinence Symptom Index-Pediatric (ISI-P) in a cohort of adolescents with spina bifida (SB) and neuropathic urinary incontinence (UI) to test its validity and reliability. The ISI-P, an 11-item instrument with domains for symptom severity and impairment, was self-administered by subjects 11-17 years old with SB and UI. Controls were 11-17 years old, with nephrolithiasis and no history of UI. Formal psychometric assessment included an evaluation of internal consistency, test re-test reliability and factor analysis. Of 78 study-eligible subjects we attempted to contact, 33 (66.7% female) with a median age of 13.1 years completed the ISI-P (42.3% response rate). 21 control patients also completed the ISI-P. Cronbach's alpha was 0.936 and 0.792 for the severity and bother factors respectively. The delta Chi-square test for the two-factor (vs. one-factor) model was significantly [χ(2)(89) = 107.823, p < 0.05] in favor of the former model with descriptive fit indices being excellent (e.g., comparative fit index = 0.969). Furthermore, category information analysis showed that all categories were associated with different threshold values, namely that each category contributed unique information for the measurement of the latent trait. In conclusion, the ISI-P has desirable psychometric properties for the measurement of UI symptom severity and impairment in adolescents with SB.
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MESH Headings
- Adolescent
- Child
- Cohort Studies
- Cross-Sectional Studies
- Diurnal Enuresis/diagnosis
- Diurnal Enuresis/etiology
- Diurnal Enuresis/psychology
- Factor Analysis, Statistical
- Female
- Humans
- Male
- Psychometrics
- Quality of Life
- Reproducibility of Results
- Severity of Illness Index
- Social Participation/psychology
- Spinal Dysraphism/complications
- Surveys and Questionnaires
- Urinary Bladder, Neurogenic/diagnosis
- Urinary Bladder, Neurogenic/etiology
- Urinary Bladder, Neurogenic/psychology
- Urinary Incontinence/diagnosis
- Urinary Incontinence/etiology
- Urinary Incontinence/psychology
- Urinary Incontinence, Stress/diagnosis
- Urinary Incontinence, Stress/etiology
- Urinary Incontinence, Stress/psychology
- Urinary Incontinence, Urge/diagnosis
- Urinary Incontinence, Urge/etiology
- Urinary Incontinence, Urge/psychology
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Affiliation(s)
- Katherine C Hubert
- Department of Urology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United States; Harvard Medical School, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United States.
| | - Georgios Sideridis
- Clinical Research Program, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United States; Harvard Medical School, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United States
| | - Rebecca Sherlock
- Department of Urology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United States
| | - Ilina Rosoklija
- Department of Urology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United States
| | - Greta Kringle
- Department of Urology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United States
| | - Kathryn Johnson
- Department of Urology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United States
| | - Stuart B Bauer
- Department of Urology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United States; Harvard Medical School, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United States
| | - Caleb P Nelson
- Department of Urology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United States; Harvard Medical School, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United States
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18
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Morelli M, Mocciaro R, Venturella R, Albano A, Sacchinelli A, Zullo F. Hyaluronic acid-chondroitin sulfate: a potential factor to select pure stress urinary incontinence in patients with interstitial cystitis⁄painful bladder syndrome and mixed incontinence symptoms. Minerva Ginecol 2015; 67:121-125. [PMID: 25763801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
AIM Aim of the study was to validate the Hyaluronic acid-Chondroitin sulfate (HA-CS) as ex adiuvantibus criteria to identified patients with urgency symptoms related to interstitial cystitis/painful bladder syndrome (IC/PBS) and to obtained a population of patients with pure stress urinary incontinence. METHODS We retrospectively analysed clinical data of 17 patients with clinical suspect of IC/PBS, which received intravescical HA-CS to reduce pelvic pain and urgency symptoms waiting for surgical treatment for stress urinary incontinence. The main outcomes were reduction of urinary frequency, urgency, and bladder pain. RESULTS Compared to baseline, a significant decrease in pain, urgency and frequency were observed. Of the 17 patients, 82.3% reported resolution of pain and urge symptoms and in patients with persistence of urge symptoms the urodynamic assessment showed an overactive bladder syndrome (OAB). CONCLUSION HA-CS treatment induces an improvement in pain and urgency symptoms in patients with IC⁄PBS that referred also stress urinary incontinence. Therefore, HA-CS treatment could be use as clinical adjunctive parameter to select patients with pure stress urinary incontinence.
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Affiliation(s)
- M Morelli
- Department of Obstetrics and Gynecology, "Magna Graecia" University, Catanzaro, Italy -
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19
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Yang X, Tan C, An F, Sun X, Wang J. [Perspective study of urodynamic factors with pre- and post-operation overactive bladder symptoms for anterior vaginal prolapse]. Zhonghua Fu Chan Ke Za Zhi 2014; 49:829-833. [PMID: 25603907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To identify pre-operative demographic and urodynamic (UD) parameters related to overactive bladder (OAB) symptoms of pre-operation and persistence of after pelvic organ prolapse (POP) repair. METHODS From Jan 1, 2010 to Oct 31, 2012, this perspective study examined demographic and UD data of 175 patients undergoing POP surgery. Pre- and post- operative urinary distress inventory 6 (UDI- 6) scores for frequency and urge urinary incontinence (UUI) were analyzed, and correlations between scores and pre-operative UD data were also analyzed. RESULTS (1)Surgery resulted in a improvement of frequency (71.0% , 71/100) and UUI (69.2% , 63/91) at 12-24 months follow-up. (2)Pre-operative UD parameters: first desire of bladder <100 ml, 6.3% (11/175); detrusor overactivity, 14.9% (26/175); post-void residual ≥50 ml, 11.4% (20/175); maximal flow rate (Qmax), (16±7) ml/s. (3)Comparison of pre- operative UD datas between patients with OAB symptoms and without, with OAB symptoms group had more patients of type III stress urinary incontinence [5% (5/91) versus 0 (0/84), P = 0.022]. (4)Qmax was higher in improvement in UUI group than that in persistent UUI after POP repair [(17±7) ml/s versus (13±5) ml/s, P < 0.01]. CONCLUSIONS POP repair significantly reduces OAB symptoms; however, there had not exact predictor for symptoms of persistent frequency, UUI after POP repair. Persistent UUI symptom may be related to Qmax of pre-operative UD.
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Affiliation(s)
- Xin Yang
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing 100044, China.
| | - Cheng Tan
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing 100044, China
| | - Fang An
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing 100044, China
| | - Xiuli Sun
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing 100044, China
| | - Jianliu Wang
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing 100044, China
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20
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Padmanabhan P, Dmochowski R. Urinary incontinence in women: a comprehensive review of the pathophysiology, diagnosis and treatment. Minerva Ginecol 2014; 66:469-478. [PMID: 25078140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Urinary incontinence (UI) or involuntary leakage of urine is a distressing and serious health problem. It has a significant psychosocial and economic burden leading to significant quality of life issues. UI is more prevalent than most chronic diseases yet largely underreported. Aging and age-related changes in the bladder play a significant role in the development of UI. This in combination with cognitive dysfunction, functional impairment, pharmacotherapy, smoking, childbearing, obesity and coexisiting comorbidities worsen the condition. Due to the burden UI places on the individual, their family and society, it is important for providers to diagnose and have ready treatment options available. The three most common types of UI are stress urinary incontinence (SUI), urge urinary incontinence (UUI), or a combination of both, mixed urinary incontinence (MUI). This review describes the pathophysiology of incontinence; and diagnosis and treatment (conservative, pharmacological, and surgical therapies) of incontinence in women.
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Affiliation(s)
- P Padmanabhan
- Department of Urology, University of Kansas Kansas City, KS, USA -
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Abstract
IMPORTANCE Mixed urinary incontinence, a condition of both stress and urge urinary incontinence, is prevalent in 20% to 36% of women and is challenging to diagnosis and treat because urinary symptoms are variable and guidelines for treatment are not clear. OBJECTIVE To review the diagnosis and management of mixed urinary incontinence in women, with a focus on current available evidence. EVIDENCE REVIEW MEDLINE was searched from January 1, 1992, to December 31, 2013. Additional citations were obtained from references of the selected articles and reviews. Articles that discussed the prevalence, diagnosis, results, and treatment of mixed urinary incontinence were selected for review. Evidence was graded using Oxford Centre for Evidence-Based Medicine levels of evidence for treatment recommendations. FINDINGS The MEDLINE search resulted in 785 articles. After selection and obtainment of additional citations, a total of 73 articles were reviewed. There is high-quality (level 1) evidence for treating urinary incontinence with weight loss, for treating stress urinary incontinence by performing anti-incontinence procedures of both traditional and mid-urethral slings and retropubic urethropexies, and for managing urge urinary incontinence with anticholinergic medications. However, direct high-quality evidence for treatment of women with mixed urinary incontinence is lacking, as are clear diagnostic criteria and management guidelines. CONCLUSION AND RELEVANCE High-quality, level 1 evidence for urinary incontinence therapy can guide clinicians in the treatment of the components of mixed urinary incontinence. Because high-quality evidence is lacking regarding the treatment of mixed urinary incontinence, treatment generally begins with conservative management emphasizing the most bothersome component. Randomized trials in women with mixed urinary incontinence populations are needed.
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Affiliation(s)
- Deborah L Myers
- Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
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22
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Bedoya-Ronga A, Currie I. Improving the management of urinary incontinence. Practitioner 2014; 258:21-3. [PMID: 24791407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Urinary incontinence (UI) is the complaint of any involuntary loss of urine and is a common condition that is likely to be under-reported. In the UK, the prevalence is estimated to be 17-40%, and rates are higher in the elderly. UI is more common in women than men. Its frequency increases with age, parity, high BMI, and associated comorbidities. The common types are stress UI, overactive bladder (OAB) or urge UI, and mixed UI a combination of the two. In stress UI there is involuntary loss of urine that occurs in association with an increase in intra-abdominal pressure. OAB is caused by overactivity of the detrusor muscle. This may be idiopathic or secondary to lesions affecting the motor or sensory pathways to the muscle. The history should include the circumstances in which the incontinence occurs, the duration and how it affects the patient's quality of life. The initial assessment should include enquiring for symptoms of urinary tract infection and carrying out a urine dipstick test. Abdominal examination should exclude a large pelvic-abdominal mass and a palpable bladder post micturition. Vulval-vaginal examination should assess for atrophic vaginitis and prolapse, masses and pelvic floor muscle contraction. Involving a skilled continence nurse or dedicated pelvic physiotherapist will improve care and can reduce referrals to secondary care. When conservative measures for OAB are unsuccessful, the next step is pharmacological treatment. Referral to secondary care should be offered when the response to two drugs has not been satisfactory. For stress UI, referral is indicated after failure of pelvic floor muscle training.
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Asoglu MR, Selcuk S, Cam C, Cogendez E, Karateke A. Effects of urinary incontinence subtypes on women's quality of life (including sexual life) and psychosocial state. Eur J Obstet Gynecol Reprod Biol 2014; 176:187-90. [PMID: 24630299 DOI: 10.1016/j.ejogrb.2014.02.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 01/11/2014] [Accepted: 02/02/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Our aim was to investigate the effects of urinary incontinence subtypes on women's quality of life (including sexual life) and psychosocial state. STUDY DESIGN The patients, who applied to our clinic from March 2011 to August 2011, were identified and stratified into three groups: those with stress incontinence proved urodynamically (USI), those with urge incontinence (UI), and those with mixed incontinence urge incontinence (UI) proved by urodynamic and clinic evaluation. Scores on the Beck anxiety inventory (BAI), pelvic organ prolapse/urinary incontinence sexual questionnaire (PISQ-12), urogenital distress inventory (UDI-6), and incontinence impact questionnaire (IIQ-7) were compared between the urinary incontinence subtypes. RESULTS According to urodynamic and clinical examination of 111 women with urinary incontinence, 59 (53%) had USI, 35 (32%) had UI, and 17 (15%) had MI. BAI-scores significantly differed between the USI and UI groups (p=0.030) and between the USI and MI groups (p=0.011) not between the UI and MI groups (p=0.597). UDI-6 scores did not significantly differ between the three groups (p=0.845). IIQ-7 scores significantly differed between the USI and MI groups (p=0.003) and between the UI and MI groups (p=0.006) but not between the USI and UI groups. Patients with USI had significantly lower PISQ-12 scores than those with UI (p=0.015). CONCLUSIONS These differences in the effects of incontinence subtypes should be kept in mind in the evaluation of patients with urinary incontinence. Psychiatric assessment may improve the management of incontinence in women, especially UI and MI.
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Affiliation(s)
- Mehmet Resit Asoglu
- The University of Texas-Houston MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
| | - Selcuk Selcuk
- Zeynep Kamil Training and Education Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey
| | - Cetin Cam
- Zeynep Kamil Training and Education Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey
| | - Ebru Cogendez
- Zeynep Kamil Training and Education Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey
| | - Ates Karateke
- Zeynep Kamil Training and Education Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey
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Marotte JB, Johnson B, Johnson DM, Sams JO. Using the 3 incontinent questions (3IQ) to distinguish between urge urinary incontinence (UUI) and stress urinary incontinence (SUI) in the practitioner adult female population. J Ark Med Soc 2014; 110:164-165. [PMID: 24511860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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25
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Macotela-Nakagaki KA, del Puerto HS, Valente-Acosta B, Chabat-Manzanera P. [Relationship between urinary incontinence and pelvic organ prolapse]. Ginecol Obstet Mex 2013; 81:711-715. [PMID: 24620525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Urinary incontinence affects up to 70% of women and pelvic organ prolapse has a prevalence of 41% in postmenopausal women over 60 years, but most are not clinically affected. OBJECTIVE Sought to assess the relationship of pelvic organ prolapse in patients with urinary incontinence diagnosed by urodynamic and which of the sub-types is related to a greater extent. MATERIAL AND METHODS We performed an observational, retrospective, descriptive, in which we reviewed records of patients with symptoms of urinary incontinence undergoing urodynamic study, evaluating a total of 85 patients. RESULTS Prolapse was noted in mixed incontinence by 80%, compared to 46.9% with urge incontinence or stress incontinence 34.9%, p 0.034. 89.5% of women with prolapse had some form of incontinence, associated with an OR = 2.38 (CI 1844-3078, p = 0.023).
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Digesu GA, Derpapas A, Hewett S, Tubaro A, Puccini F, Fernando R, Khullar V. Does the onset or bother of mixed urinary incontinence symptoms help in the urodynamic diagnosis? Eur J Obstet Gynecol Reprod Biol 2013; 171:381-4. [PMID: 24207052 DOI: 10.1016/j.ejogrb.2013.09.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2012] [Revised: 10/03/2012] [Accepted: 09/28/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine whether evaluation of the first occurring symptom and bother of mixed urinary incontinence (MUI) might help in the clinical assessment of incontinent women. STUDY DESIGN Prospective observational study carried out in a tertiary referral urogynaecology unit in London. Women who underwent urodynamic investigations for MUI were asked whether stress or urgency incontinence was the first occurring symptom and which was the most bothersome one. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for the first occurring symptom and most bothersome component of their mixed urinary incontinence symptoms in relation to the urodynamic diagnosis were calculated. RESULTS One hundred and eighty women with MUI were studied. Initial or most bothersome urgency urinary incontinence (UUI) had a good specificity and PPV for diagnosing detrusor overactivity (DO). When UUI was the initial and most bothersome symptom the specificity and NPV increased up to 93% and 73%. Stress urinary incontinence (SUI) as first occurring or most bothersome had a moderate specificity, PPV and NPV for diagnosing urodynamic stress incontinence (USI). When SUI was the initial and most bothersome symptom the specificity, PPV and NPV increased up to 91%, 70% and 78%. Initial or most bothersome UUI with antecedent or most bothersome SUI had a high specificity and good NPV for a mixed urodynamic diagnosis of DO and USI. CONCLUSIONS Determination of the first occurring and most bothersome symptom in women with MUI relates closely to the urodynamic diagnosis. Therefore, our symptom-guided approach may in some cases provide useful information directing the clinician towards a more appropriate therapy when urodynamics are inconclusive or cannot be performed.
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Affiliation(s)
- G Alessandro Digesu
- Department of Urogynaecology, St. Mary's Hospital, Imperial College NHS Trust, London, United Kingdom.
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Huang AJ, Hess R, Arya LA, Richter HE, Subak LL, Bradley CS, Rogers RG, Myers DL, Johnson KC, Gregory WT, Kraus SR, Schembri M, Brown JS. Pharmacologic treatment for urgency-predominant urinary incontinence in women diagnosed using a simplified algorithm: a randomized trial. Am J Obstet Gynecol 2012; 206:444.e1-11. [PMID: 22542122 DOI: 10.1016/j.ajog.2012.03.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Revised: 02/06/2012] [Accepted: 03/05/2012] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate clinical outcomes associated with the initiation of treatment for urgency-predominant incontinence in women diagnosed by a simple 3-item questionnaire. STUDY DESIGN We conducted a multicenter, double-blinded, 12-week randomized trial of pharmacologic therapy for urgency-predominant incontinence in ambulatory women diagnosed by the simple 3-item questionnaire. Participants (N = 645) were assigned randomly to fesoterodine therapy (4-8 mg daily) or placebo. Urinary incontinence was assessed with the use of voiding diaries; postvoid residual volume was measured after treatment. RESULTS After 12 weeks, women who had been assigned randomly to fesoterodine therapy reported 0.9 fewer urgency and 1.0 fewer total incontinence episodes/day, compared with placebo (P ≤ .001). Four serious adverse events occurred in each group, none of which was related to treatment. No participant had postvoid residual volume of ≥ 250 mL after treatment. CONCLUSION Among ambulatory women with urgency-predominant incontinence diagnosed with a simple 3-item questionnaire, pharmacologic therapy resulted in a moderate decrease in incontinence frequency without increasing significant urinary retention or serious adverse events, which provides support for a streamlined algorithm for diagnosis and treatment of female urgency-predominant incontinence.
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Affiliation(s)
- Alison J Huang
- Department of Medicine, University of California San Francisco School of Medicine, San Francisco, CA, USA.
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Abstract
AIM There is considerable overlap between symptoms of interstitial cystitis/painful bladder syndrome (IC/PBS) and bladder oversensitivity, thereby making it difficult to differentiate between the two based on symptoms alone. We investigated factors that could potentially be used to differentiate between IC/PBS and bladder oversensitivity in women. MATERIALS AND METHODS Video-urodynamic study (VUDS) results in women with lower urinary tract symptoms (LUTS) were retrospectively analysed. Patients classified as having increased bladder sensation (IBS) were selected for analysis. A potassium chloride (KCl) test was performed and pain or urgency elicited was considered positive response. Cystoscopic hydrodistention demonstrating glomerulation was considered diagnosis of IC/PBS; otherwise bladder oversensitivity was diagnosed. LUTS, urodynamic variables and results of the KCl test were used to predict IC/PBS in these women. RESULTS A total of 405 women with IBS and 272 symptomatic controls with normal VUDS findings were included. Among 227 IBS patients undergoing KCl test, a positive result was found in 190 and a negative test result was found in 37. Characteristic glomerulation was noted in 170 patients, including 165 with a positive and five with a negative KCl test. We found that storage symptoms and pain had a positive predictive value of 45.3% for IC/PBS. When a CBC ≤ 350 ml was added the positive predictive value was 65% for IC/PBS. A combination of storage symptoms, a CBC ≤ 350 ml, a positive KCl test result with an increase of ≥ 2 on the visual analogue pain scale (VAS) provided 100% predictive of IC/PBS. CONCLUSION A diagnosis of IC/PBS can be made without cystoscopic hydrodistention in women with increased bladder sensation, having storage symptoms, a CBC ≤ 350 ml, a positive KCl test result and a VAS score ≥ 2.
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Affiliation(s)
- Y-C Kuo
- Department of Urology, Taipei City Hospital, Yangming Branch, Taipei, Taiwan
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Abdel-fattah M, Mostafa A, Young D, Ramsay I. Evaluation of transobturator tension-free vaginal tapes in the management of women with mixed urinary incontinence: one-year outcomes. Am J Obstet Gynecol 2011; 205:150.e1-6. [PMID: 21640964 DOI: 10.1016/j.ajog.2011.03.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Revised: 01/31/2011] [Accepted: 03/08/2011] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To assess the efficacy of transobturator tapes in the management of women with urodynamic mixed urinary incontinence (UI). STUDY DESIGN A secondary analysis of a prospective randomized study; 83 women with mixed UI on urodynamics and predominant stress UI symptoms were recruited and randomly assigned to undergo "outside-in" or inside-out transobturator tapes. Preoperative assessment included urodynamic assessment and completion of validated symptom severity and quality of life (QoL) questionnaires. The primary outcome was patient-reported success rates at 1-year as assessed by the Patient Global Impression of Improvement (very much/much improved). Secondary outcomes included changes in preoperative urgency/urgency incontinence, changes in QoL scores and comparison between the 2 types of transobturator tapes. RESULTS Seventy-seven women completed 1-year follow-up (outside-in [n=42] vs inside-out [n=35]). The patient-reported success rate and objective cure rate were 75% and 90%, respectively. At 1-year follow-up; 40 women (52%) and 31 women (57.4%) reported cure in their preoperative urgency and urgency incontinence, respectively. A total of 74% reported≥10 point improvement in QoL scores. CONCLUSION In women with urodynamic mixed incontinence and predominant stress UI, transobturator tapes were associated with good patient-reported success rate at 1 year. Urgency/ urgency incontinence are cured in over 50% of women.
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Affiliation(s)
- Mohamed Abdel-fattah
- Division of Applied Health Sciences, School of Medicine and Dentistry, University of Aberdeen, Aberdeen, Scotland, UK
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30
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Bauer RM, Dannecker C, Füllhase C, Roosen A, Stief CG, Friese K, Gratzke C. [Diagnostics for female incontinence: two-stage assessment]. MMW Fortschr Med 2011; 153:35-36. [PMID: 21644290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Ricarda M Bauer
- Urologische Klinik und Poliklinik Klinikum der Universität München - Grosshadern Ludwig-Maximilians-Universität München.
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31
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Füllhase C, Gratzke C, Dannecker C, Stief CG, Friese K, Bauer RM. [Non-surgical treatment of female incontinence]. MMW Fortschr Med 2011; 153:37-39. [PMID: 21644291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Claudius Füllhase
- Urologische Klinik und Poliklinik Klinikum der Universität München - Grosshadern Ludwig-Maximilians-Universität München
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32
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Lindner UK. [Dysuria as the leading symptom. When urination malfunctions]. Pflege Z 2011; 64:310-312. [PMID: 21638884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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33
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Neubauer S. [Benign prostatic syndrome (BPS)]. MMW Fortschr Med 2010; 152:37-40. [PMID: 20608463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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34
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Lemcke J, Meier U. [Idiopathic normal pressure hydrocephalus--who benefits from surgery?]. MMW Fortschr Med 2010; 152:48-49. [PMID: 20557004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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35
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Handling the "stress" and "urge" of incontinence. Johns Hopkins Med Lett Health After 50 2009; 21:4-5. [PMID: 19994465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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36
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Wang AC, Chen MC, Kuo WY, Lin YH, Wang YC, Lo TS. Urgency-free time interval as primary endpoint for evaluating the outcome of a randomized OAB treatment. Int Urogynecol J 2009; 20:819-25. [PMID: 19495544 DOI: 10.1007/s00192-009-0860-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2008] [Accepted: 03/02/2009] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS This study was conducted to determine whether urgency-free interval (UFI) was effective to evaluate the outcome of overactive bladder (OAB) and the correlation of changes between this parameter and urgency episodes. METHODS A randomized placebo-controlled trial was conducted involving 73 women with OAB. The interventions for a 12-week period included a vaginal electric stimulation and oxybutynin (2.5 mg) or placebo three times per day. Identical preintervention and postintervention assessments included the measurement of UFI and warning time (WT). The King's Health Questionnaire, Spearman's correlation coefficient (SCC), Kruskal-Wallis, Mann-Whitney U, and Wilcoxon-signed rank tests were used for analysis. RESULTS A positive and significant correlation between the improvements of WT and UFI was noted in the oxybutynin group (p = 0.009). In all groups, none of the SCC revealed significant correlation between the improvement of UFI and urgency episodes (all p >or= 0.145). CONCLUSIONS The efficacy of UFI in evaluating treatment outcome of OAB was comparable with that of WT in selected modality.
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Affiliation(s)
- Alex C Wang
- Division of Female Pelvic Medicine and Reconstructive Surgery, Chang Gung Memorial Hospital, Linko, Taiwan.
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37
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Sung VW. Urinary incontinence. Med Health R I 2009; 92:16-19. [PMID: 19248421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Vivian W Sung
- The Warren Alpert Medical School of Brown University, USA.
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38
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Hameed N, Ali MA, Azim W. Urodynamic findings in female patients reporting with lower urinary tract symptoms. J Ayub Med Coll Abbottabad 2009; 21:8-10. [PMID: 20364730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE The study has been undertaken to determine the reproducibility of lower urinary tract symptoms in female patients after urodynamic investigations. DESIGN A Descriptive study with retrospective analysis of data. SETTING Combined Military Hospital Rawalpindi and Armed Forces Institute of Urology, Rawalpindi. METHODS Fifty consecutive women with a primary history of urinary incontinence were interviewed on a standard urinary incontinence questionnaire. They underwent structured clinical pelvic examination, along with cough stress test. Post void residual urine was measured. This was followed by a urine routine examination to exclude any urinary infection. Later these patients underwent a combination of urodynamic tests to predict their final diagnosis. The tests performed were filling cystometry and leak point pressures. RESULTS The clinical diagnosis was found to have a variable reproducibility on urodynamic investigations. Clinical stress incontinence translated as genuine stress incontinence in 61.5% of the cases. Patients with isolated symptoms of stress incontinence had an incidence of detrusor instability up to 33.3%. For the symptoms of urgency and urge incontinence, the diagnosis was reproducible in up to 50% of the cases. In cases of mixed symptoms, 20% patients were found to have stress incontinence and 33.3% cases were found to have an unstable bladder, whereas in 46.6% of the cases no objective abnormality was found on urodynamic investigations. CONCLUSION Urodynamic investigations should be performed in female patients with lower urinary tract symptoms, especially if irreversible procedure, e.g., surgery is being contemplated.
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Affiliation(s)
- Nazli Hameed
- Department of Obstetrics and Gynaecology, CMH, Kharian, Pakistan.
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39
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Waine E, Stott M. Changing treatments for overactive bladder. Nurs Times 2008; 104:45-48. [PMID: 18979960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Overactive bladder is a common urological diagnosis which is often untreated as patients fail to seek help for this embarrassing problem. Elizabeth Waine and Mark Stott summarise the symptoms and investigations for overactive bladder and provide an overview of the treatments available.
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MESH Headings
- Botulinum Toxins, Type A/adverse effects
- Botulinum Toxins, Type A/pharmacology
- Botulinum Toxins, Type A/therapeutic use
- Humans
- Muscarinic Antagonists/adverse effects
- Muscarinic Antagonists/pharmacology
- Muscarinic Antagonists/therapeutic use
- Neuromuscular Agents/adverse effects
- Neuromuscular Agents/pharmacology
- Neuromuscular Agents/therapeutic use
- Parasympatholytics/adverse effects
- Parasympatholytics/pharmacology
- Parasympatholytics/therapeutic use
- Urinary Bladder, Overactive/diagnosis
- Urinary Bladder, Overactive/drug therapy
- Urinary Bladder, Overactive/physiopathology
- Urinary Bladder, Overactive/therapy
- Urinary Incontinence, Urge/diagnosis
- Urinary Incontinence, Urge/drug therapy
- Urinary Incontinence, Urge/physiopathology
- Urinary Incontinence, Urge/therapy
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Kulseng-Hanssen S, Husby H, Schiotz HA. Erratum: the tension free vaginal tape operation for women with mixed incontinence: do preoperative variables predict the outcome? Neurourol Urodyn 2008; 27:360. [PMID: 18404618 DOI: 10.1002/nau.20597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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41
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McKertich K. Urinary incontinence-assessment in women: stress, urge or both? Aust Fam Physician 2008; 37:112-117. [PMID: 18345358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND The aims of assessing urinary incontinence in women are to define the diagnosis, exclude other pathology and guide management. Treatment can be initiated when urinary incontinence is categorised as stress, urge or mixed incontinence. Once conservative measures have been exhausted, the management of stress incontinence is largely surgical, while that of urge urinary incontinence is largely medical. OBJECTIVE This article discusses the clinical assessment of urinary incontinence in women with emphasis on the primary care assessment and indications for specialist referral. DISCUSSION History taking is the cornerstone of urinary incontinence assessment and in combination with physical examination allows categorisation of patients into stress, urge or mixed urinary incontinence. Basic assessment includes investigations such as urine testing, bladder residual volume measurement, and a bladder diary. Urodynamic testing is not required in all patients or before initiating conservative treatment. Indications for specialist referral and urodynamic testing are discussed.
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Affiliation(s)
- Karen McKertich
- Urology Department, Cabrini Medical Centre and The Alfred Hospital, Melbourne, Victoria
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Borello-France D, Dusi J, O'Leary M, Misplay S, Okonski J, Leng W, Cannon-Smith T, Chancellor M. Test-retest reliability of the Urge-Urinary Distress Inventory and Female Sexual Function Index in women with multiple sclerosis. Urol Nurs 2008; 28:30-35. [PMID: 18335695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Test-retest reliability of the Urge-Urinary Distress Inventory (U-UDI) and the Female Sexual Function Index (FSFI) was assessed in women with multiple sclerosis (MS) because it was undetermined whether or not either instrument would yield reliable and valid results in this population. Data from this study suggest that these tools can be reliably used to assess community-dwelling women with mild gait disability and MS-associated symptoms of urinary distress and sexual dysfunction.
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Granese R, Adile B. [Urinary incontinence in pregnancy and in puerperium: 3 months follow-up after delivery]. Minerva Ginecol 2008; 60:15-21. [PMID: 18277348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
AIM The aim of this clinic prospective study was to point out the predisposing risk factors for the development of urinary incontinence during pregnancy and postpartum and to understand how to prevent the symptomatology. METHODS Sixty seven primipara women at 32 weeks of pregnancy and 3 months after the delivery, were studied through an urogynecological work-up and a questionnaire on the main urinary symptoms. RESULTS At 32 weeks of pregnancy, 27 patients (40.29%) were affected by stress urinary incontinence (SUI) of type I and 22 (32.83%) by urge incontinence. Three months after delivery, it was observed SUI of type I in 8 patients (15.68%), SUI of type II in 9 patients (17.64%), SUI of type II and II degree cystouretrocele in 3 patients (5.8%) and urge incontinence in 14 patients (27.45%). The most frequent risk factors that were tracked down were: a vaginal delivery, with a prolonged labour, and the episiotomy. We didn't find either substantial changes in the weight between patients continent and incontinent or correlations with the patients' age or with the weight of the foetus and the symptomatology reported. CONCLUSION It is important to understand the beginning of the urinary symptoms in the pregnant women, to prevent the worsening of it. It is required, however, a long term follow-up on our patients to verify if the urinary incontinence persists or disappears by the time is needed.
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Affiliation(s)
- R Granese
- Dipartimento di Ginecologia Ostetricia, Fisiopatologia della Riproduzione Umana e Neonatologia , Policlinico Universitario G. Martino, Messina, Italy.
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Falconer C. [Female urinary incontinence is investigated and treated in primary health care. Specialist care in complicated cases--without long waiting time]. Lakartidningen 2007; 104:3455-3459. [PMID: 18072614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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45
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Song C, Park SH, Han JY, Lee KS, Choo MS. Identification of the optimal time to treat urgency after a midurethral sling procedure for stress urinary incontinence. Int Urogynecol J 2007; 19:573-6. [PMID: 17909690 DOI: 10.1007/s00192-007-0469-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2007] [Accepted: 09/11/2007] [Indexed: 11/30/2022]
Abstract
We followed 91 patients who had undergone transobturator tension-free vaginal tape procedure on their perioperative urgency symptom for 1 year to identify risk factors and optimal time to commence further treatment in the presence of postoperative urgency. Of the 59 patients with preexisting urgency, 54.2, 35.6, and 39.0% demonstrated symptom persistence at postoperative 1, 6, and 12 months, respectively. Of the 32 patients without preoperative urgency, 3.1 and 18.8% of patients demonstrated de novo urgency at 1 and 6 months, respectively, but symptom persistence to 12 months was observed in 6.2%. Overall, urgency lasting to 12 months was observed in 25 (27.5%) of the entire cohort. Preoperative urgency [p = 0.001, odds ratio (OR) 9.583] and urgency at 1 month (p = 0.001, OR 5.124) were associated with symptom persistence to 1 year after surgery. We recommend treatment if urgency is noted at 1 month postoperatively in patients with preexisting urgency, and after 6 months for those without preoperative urgency.
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Affiliation(s)
- Cheryn Song
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Songpa-Gu, Seoul, South Korea
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Anger JT, Rodríguez LV, Wang Q, Pashos CL, Litwin MS. The Role of Preoperative Testing on Outcomes After Sling Surgery for Stress Urinary Incontinence. J Urol 2007; 178:1364-8; discussion 1368-9. [PMID: 17706717 DOI: 10.1016/j.juro.2007.05.139] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2007] [Indexed: 10/22/2022]
Abstract
PURPOSE In this study we analyzed Medicare claims data to measure the effect of preoperative urodynamics and cystoscopy on outcomes after sling surgery. MATERIALS AND METHODS We analyzed 1999 to 2001 Medicare claims data on a 5% national random sample of beneficiaries. Women who underwent sling procedures between July 1, 1999 and December 31, 2000 were identified on the basis of the presence of CPT-4 code 57288 (sling operation for stress incontinence). Subjects were tracked for 6 months before surgery to identify type of preoperative studies performed (urodynamics and cystoscopy) and for 12 months after surgery to assess short-term complications. RESULTS Of 1,356 subjects 24.8% underwent preoperative cystoscopy and 27.4% underwent preoperative urodynamic testing. In postoperative year 1, 32.4% of subjects underwent cystoscopy and 30.5% underwent urodynamics. Patients who underwent preoperative urodynamics were more likely to be newly diagnosed with urge incontinence after surgery (21.9% vs 12.7%, p <0.0001). Those who underwent preoperative cystoscopy were significantly more likely to be diagnosed with (9.4% vs 6.1%, p <0.043) or treated for (10.6% vs 7.2%, p <0.047) outlet obstruction postoperatively than those who did not. Multivariate analysis revealed that subjects who underwent preoperative urodynamics were significantly less likely to undergo postoperative urodynamics than those who did not (OR 0.34, 95% CI 0.24-0.48). CONCLUSIONS Our findings of worse outcomes among women who underwent preoperative testing may be due in part to case selection. Our finding that women who underwent preoperative urodynamics were only a third as likely to undergo postoperative urodynamics as those who did not supports the use of urodynamics in the preoperative setting. However, the true effect of urodynamics on sling outcomes remains controversial.
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Affiliation(s)
- Jennifer T Anger
- Department of Urology, David Geffen School of Medicine and School of Public Health, University of California, Los Angeles, CA 90404, USA.
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Schorsch I, Soljanik I, Stanislaus P, Bauer R, Mayer M, Hocaoglu Y, Becker A, May F. [Causes and diagnosis of female urinary incontinence]. MMW Fortschr Med 2007; 149:27-29. [PMID: 18018410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The primary cause of stress incontinence is birth traumata. However, obesity, asthma, chronic constipation or hard physical work can also overtax the pelvic floor and lead to injury of the connective tissue and a slackening of the ligamentous apparatus. Pelvic floor defects are initially diagnosed simply through a thorough urogynaecological examination. To predict the success of a surgical treatment, the functions can be tested by performing simulated operations.
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Affiliation(s)
- I Schorsch
- Urologische Klinikum Groghadern, LMU Munchen.
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[Patient information. Urinary incontinence]. MMW Fortschr Med 2007; 149:35-6. [PMID: 18018413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
MESH Headings
- Adult
- Age Factors
- Autogenic Training
- Electric Stimulation
- Female
- Humans
- Internet
- Middle Aged
- Pelvic Floor
- Physical Therapy Modalities
- Risk Factors
- Sex Factors
- Urinary Incontinence/diagnosis
- Urinary Incontinence/epidemiology
- Urinary Incontinence/etiology
- Urinary Incontinence/physiopathology
- Urinary Incontinence/surgery
- Urinary Incontinence/therapy
- Urinary Incontinence, Stress/diagnosis
- Urinary Incontinence, Stress/etiology
- Urinary Incontinence, Stress/physiopathology
- Urinary Incontinence, Stress/surgery
- Urinary Incontinence, Stress/therapy
- Urinary Incontinence, Urge/diagnosis
- Urinary Incontinence, Urge/etiology
- Urinary Incontinence, Urge/physiopathology
- Urinary Incontinence, Urge/surgery
- Urinary Incontinence, Urge/therapy
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Löfgren OE. Re: Overactive bladder: a better understanding of pathophysiology, diagnosis and management. A. J. Wein and R. R. Rackley J Urol, suppl., 2006; 175: S5-S10. J Urol 2007; 178:1553; author reply 1553. [PMID: 17707052 DOI: 10.1016/j.juro.2007.05.173] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2007] [Indexed: 10/22/2022]
MESH Headings
- Behavior Therapy
- Combined Modality Therapy
- Humans
- Motor Neurons/drug effects
- Motor Neurons/physiology
- Muscarinic Antagonists/therapeutic use
- Neurons, Afferent/drug effects
- Neurons, Afferent/physiology
- Neurons, Efferent/drug effects
- Neurons, Efferent/physiology
- Urinary Bladder/innervation
- Urinary Bladder, Overactive/diagnosis
- Urinary Bladder, Overactive/physiopathology
- Urinary Bladder, Overactive/therapy
- Urinary Incontinence, Urge/diagnosis
- Urinary Incontinence, Urge/physiopathology
- Urinary Incontinence, Urge/therapy
- Urodynamics/drug effects
- Urodynamics/physiology
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Bing MH, Moller LA, Jennum P, Mortensen S, Lose G. Pathophysiological Aspects of Nocturia in a Danish Population of Men and Women Age 60 to 80 Years. J Urol 2007; 178:552-7. [PMID: 17570415 DOI: 10.1016/j.juro.2007.03.141] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2006] [Indexed: 11/22/2022]
Abstract
PURPOSE We applied the International Continence Society Guidelines and categorized men and women with nocturia 2 or more times a night in pathophysiological groups based on selected lower urinary tract symptoms, clinical examination, frequency volume charts and urodynamics, and categorized the most likely pathophysiological causes of nocturia. MATERIALS AND METHODS Participants were randomly selected among respondents in a population study of 4,000 individuals 60 to 80 years old living in Copenhagen County. Nocturia was assessed using the new and validated Nocturia, Nocturnal Enuresis, and Sleep-interruption Questionnaire. Nocturic (2 or more voids) or control (less than 1 void) status was assessed by a 3-day frequency volume chart. Participants were interviewed regarding lower urinary tract symptoms, and physical examination was performed. Nocturia pathophysiology was divided in 4 groups according to frequency volume chart variables, that is nocturnal polyuria, low bladder capacity, nocturnal polyuria and low bladder capacity in combination, and polyuria. Spontaneous flow rate and post-void residual urine were determined, and invasive urodynamic examination was performed in patients. RESULTS Of 1,111 eligible individuals 75 patients and 75 controls were included. More patients vs controls had daytime frequency, urgency and urge incontinence. However, the difference was not significant in men. Nocturnal polyuria was the only pathophysiological finding that differed significantly in prevalence between patients and controls. The most prevalent urodynamic finding in patients was detrusor overactivity incontinence (26%) in women and detrusor overactivity (64%) in men. CONCLUSIONS Urgency in women, and symptoms suggestive of bladder outlet obstruction in men were the major complaints. Frequency volume charts demonstrated that 55% of patients had nocturnal polyuria which was significantly more than controls. From frequency volume chart variables alone we could categorize 84% of the patients. When symptoms and urodynamic examination were added to the assessment, the most likely cause of nocturia was categorized in 96% of participants.
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Affiliation(s)
- M H Bing
- Department of Obstetrics and Gynecology, Glostrup County Hospital, University of Copenhagen, Glostrup, Denmark.
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