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This research evaluates the readability and quality of patient information material about female urinary incontinence (fUI) in ten popular artificial intelligence (AI) supported chatbots. We used the most recent versions of 10 widely-used chatbots, including OpenAI's GPT-4, Claude-3 Sonnet, Grok 1.5, Mistral Large 2, Google Palm 2, Meta's Llama 3, HuggingChat v0.8.4, Microsoft's Copilot, Gemini Advanced, and Perplexity. Prompts were created to generate texts about UI, stress type UI, urge type UI, and mix type UI. The modified Ensuring Quality Information for Patients (EQIP) technique and QUEST (Quality Evaluating Scoring Tool) were used to assess the quality, and the average of 8 well-known readability formulas, which is Average Reading Level Consensus (ARLC), were used to evaluate readability. When comparing the average scores, there were significant differences in the mean mQEIP and QUEST scores across ten chatbots (p = 0.049 and p = 0.018). Gemini received the greatest mean scores for mEQIP and QUEST, whereas Grok had the lowest values. The chatbots exhibited significant differences in mean ARLC, word count, and sentence count (p = 0.047, p = 0.001, and p = 0.001, respectively). For readability, Grok is the easiest to read, while Mistral is highly complex to understand. AI-supported chatbot technology needs to be improved in terms of readability and quality of patient information regarding female UI. [ABSTRACT FROM AUTHOR]

Urgency urinary incontinence (UUI) refractory to medical treatment poses significant challenges despite advancements. This study evaluates the efficacy of intravesical botulinum toxin for UUI and identifies factors influencing treatment outcomes. Among 368 women receiving botulinum toxin injections, 74.5% achieved a complete discontinuation of pad usage. Predictors of efficacy included lower pre-treatment pad usage and the absence of prior sling placement. Patients often required repeat injections (60.3%), with younger age and satisfaction correlating with treatment repetition. The interval between injections averaged 18 months, influenced by logistical challenges and patient preferences. Despite concerns about diminishing efficacy, subjective perceptions did not align with objective findings. Limitations include retrospective analysis and heterogeneous clinical records. In conclusion, intravesical botulinum toxin is effective for UUI, with pre-treatment pad usage and sling placement history influencing outcomes and patient characteristics influencing treatment repetition. [ABSTRACT FROM AUTHOR]

Introduction and objectives: Artificial urinary sphincter (AUS) is a treatment option for women with stress urinary incontinence (SUI) after failure of previous surgery or as a primary procedure in severe intrinsic sphincter deficiency (ISD). The aim of the study was to assess the long-term efficacy and risk factors for surgical revision and definitive explantation of AUS laparoscopic implantation in female patients. Methods: A retrospective review of all women submitted to AUS implantation between April 2005 and March 2023 was conducted. The AUS was implanted via transperitoneal laparoscopic approach, by two experienced surgeons. The primary endpoint was postoperative continence. Continence was defined as no leakage and no pad usage or leakage and/or pad usage with no impact on social life and failure as leakage and/or pad usage impacting social life. As secondary outcomes, clinical predictive factors for AUS revision and definitive explantation were evaluated. Results: In the last 18 years, females with a mean age of 68 ± 12 years-old were submitted to laparoscopic implantation of AUS. Early overall complication rate was 16%, but only one case was Clavien-Dindo = 3. After a median follow-up of 67 months, 22.2% of the patients needed a device revision, the majority due to mechanical device dysfunction. AUS definitive explantation was performed in 16%, mainly due to urethral/vaginal erosion (9.9%) and infection (6.2%). Patients with age = 70 years and follow-up = 10 years significantly predisposed for device revision. At the time of the last follow-up, 72% of the patients were keeping the urinary continency. Conclusions: Laparoscopic AUS implantation in females is an effective treatment for SUI due to ISD. Meanwhile, adequate patient selection, multidisciplinary evaluation and careful expectation management are essential to achieving good results, concerning their significant complication rate. [ABSTRACT FROM AUTHOR]

Background: Urinary Incontinence (UI) has numerous repercussions in women's lives, and it is underreported/underdiagnosed. Objective: The present study aimed to understand: (1) the differences between women with and without urine loss regarding Quality of Life (QoL) and Sexual Function (SF); (2) the possible moderation role of UI-related beliefs and strategies on the relationship between UI-symptom severity and SF and QoL, in women with UI. Methods: Cross-sectional Design. Participants: Primary aim: Overall, 2,578 women aged 40-65 (Mage = 49.94, DPage = 6.76) were collected online. Secondary aim: 1,538 women who self-reported having urine loss occasionally/frequently (Mage = 50.19, DPage = 6.58). All data analyses were done with IBM SPSS Statistics and R statistical system 4.0 through RStudio. Statistical Path analysis was performed with the lavaan package to study the hypothetical association and moderating effects between the variables. Results: Primary aim: women without UI had a better SF [t(2576) = 3.13, p = 0.002; 95% C.I., 0.18 to 0.80] and QoL [t(2576) = 7.71, p < 0.001; 95% C.I., 3.14 to 5.28] than their counterparts with UI.Secondary aim: UI-related coping strategies attenuated the impact of UI-symptom severity on SF(β = -0.07; p = 0.041); the more dysfunctional the UI-related beliefs were, the poorer QoL was (β = -0.06; p = 0.031); the more frequent the UI-related hiding/defensive strategies were, the poorer QoL was (β = -0.26; p < 0.001). Discussion: Limitations: online data collection, which thwarted the clarification of participants, if needed; absence of a UI medical diagnosis (only self-reported measures were used). Strengths and practical implications: (i) the crucial role of UI-related beliefs and strategies in the QoL of women with UI; (ii) the impact that UI-concealing/defensive strategies have in attenuating the impact of UIsymptom severity on SF, which might be perceived as a short-term benefit and hence contribute to maintaining the UI condition and constitute a barrier to help-seeking, (iii) impact of UI-symptom severity on QoL and SF (including a comparison group entailing women without UI, which is scarcely used); and (iv) the use of gold-standard and psychometrically robust instruments. Conclusion: Changing dysfunctional UI-related beliefs and strategies in clinical settings may improve the QoL; UI-concealing strategies may reinforce themselves by immediate effects on SF, but are not functional in the long term. [ABSTRACT FROM AUTHOR]

Background: Urinary Incontinence (UI) has numerous repercussions in women's lives, and it is underreported/underdiagnosed. Objective: The present study aimed to understand: (1) the differences between women with and without urine loss regarding Quality of Life (QoL) and Sexual Function (SF); (2) the possible moderation role of UI-related beliefs and strategies on the relationship between UI-symptom severity and SF and QoL, in women with UI. Methods: Cross-sectional Design. Participants: Primary aim: Overall, 2,578 women aged 40-65 (Mage = 49.94, DPage = 6.76) were collected online. Secondary aim: 1,538 women who self-reported having urine loss occasionally/frequently (Mage = 50.19, DPage = 6.58). All data analyses were done with IBM SPSS Statistics and R statistical system 4.0 through RStudio. Statistical Path analysis was performed with the lavaan package to study the hypothetical association and moderating effects between the variables. Results: Primary aim: women without UI had a better SF [t(2576) = 3.13, p = 0.002; 95% C.I., 0.18 to 0.80] and QoL [t(2576) = 7.71, p < 0.001; 95% C.I., 3.14 to 5.28] than their counterparts with UI.Secondary aim: UI-related coping strategies attenuated the impact of UI-symptom severity on SF(β = -0.07; p = 0.041); the more dysfunctional the UI-related beliefs were, the poorer QoL was (β = -0.06; p = 0.031); the more frequent the UI-related hiding/defensive strategies were, the poorer QoL was (β = -0.26; p < 0.001). Discussion: Limitations: online data collection, which thwarted the clarification of participants, if needed; absence of a UI medical diagnosis (only self-reported measures were used). Strengths and practical implications: (i) the crucial role of UI-related beliefs and strategies in the QoL of women with UI; (ii) the impact that UI-concealing/defensive strategies have in attenuating the impact of UIsymptom severity on SF, which might be perceived as a short-term benefit and hence contribute to maintaining the UI condition and constitute a barrier to help-seeking, (iii) impact of UI-symptom severity on QoL and SF (including a comparison group entailing women without UI, which is scarcely used); and (iv) the use of gold-standard and psychometrically robust instruments. Conclusion: Changing dysfunctional UI-related beliefs and strategies in clinical settings may improve the QoL; UI-concealing strategies may reinforce themselves by immediate effects on SF, but are not functional in the long term. [ABSTRACT FROM AUTHOR]

Purpose: Urinary incontinence (UI) is a common condition in women. The aim of this study is to analyze women with self-reported UI, focusing on socio-demographic data, health-related conditions and comorbidities, and their impact on healthcare resources. Methods: We analyzed data from a population-based survey with a representative sample of Portuguese women aged ≥ 18 years (n = 10,465). Women with self-reported symptoms of UI were distributed according to age, education level, and household income. The comparison of comorbidities and use of healthcare resources between the UI and non-UI groups was adjusted for age, education, and body mass index. We computed weighted prevalence and adjusted prevalence ratios with 95% confidence intervals using Poisson regression. Results: Female UI prevalence was 9.9%, increasing with age (6.3% for 18- to 39-year-old, 40.8% for 75- to 85-year-old women). The prevalence decreased with education level (36.8% in women with no education, 4.6% in women with more than 12 years of education) and household income (29.8% in the 2nd quintile of income, 9.9% in the 5th quintile). Women with UI had a higher level of comorbidities, especially cardiovascular, respiratory, and mental health disorders. UI was also associated with higher consumption of healthcare resources. Conclusion: UI is highly prevalent among Portuguese women. It increases with age, low education level, and low household income. The use of healthcare resources was higher, possibly related with associated comorbidities. Though obtained in a single European country, these data may be useful to design a comprehensive management of UI in other parts of the western world. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: The objective of the study is to evaluate the reliability and quality of the most-viewed female urinary incontinence-related TikTok and YouTube posts. Our second goal is to analyze the differences in the quality and content of videos between these platforms. Methods: We searched for the keyword "female urinary incontinence" on TikTok and YouTube on 1 March 2023. We sorted the videos that appeared out of searches for this keyword by "top" results on TikTok and by "relevance" on YouTube. We excluded the videos that were not in English, whose narrator was unclear, unrelated videos, advertising videos, and duplicate videos. In this study, we included the top 50 videos on both platforms that were directly related to female urinary incontinence. The characteristics of the videos, such as likes, video duration, views, and type of narrator (patient, physician, nonphysician practitioner, and health care company), and DISCERN scores were analyzed. Results: We observed that the median view count (p<0.001) and the median video duration (p<0.001) were higher and longer respectively on YouTube than on TikTok. In addition, the median DISCERN score of these videos was higher on YouTube than on TikTok (p<0.001). Similarly, the overall quality of videos was higher on YouTube than on TikTok (p=0.002). Only in two TikTok and two YouTube videos have the narrators cited a reference. Conclusions: Our findings emphasize the present lack of high-quality content available on TikTok and YouTube from both health care and nonhealth care experts. To address this lack of information, health care providers, especially urologists, should take an active role in creating video content. [ABSTRACT FROM AUTHOR]

Aims: Since formal evidence demonstrating the value of urodynamic studies (UDS) in functional urology remains elusive, we aimed to consider how best to design robust research for this purpose in female urinary incontinence. Methods: An expert group was convened to debate the following considerations: (a) precedents for formally proving the value of a gold standard diagnostic test, (b) key research principles, (c) defining a study population, (d) selecting endpoints, (e) defining interventional and controls arms, (f) blinding, (g) powering the study, and (h) duration of follow‐up. In each case, we considered the strengths and weaknesses of different approaches in terms of scientific validity, ethical acceptability, practicality, and likelihood of bias. Results: We agreed that unlike evaluating therapies, attempting to judge the value of a diagnostic test based on eventual treatment success is conceptually flawed. Nonetheless, we explored the design of a hypothetical randomized controlled trial for this purpose, agreeing that: (1) the study population must sufficiently reflect its real‐world counterpart; (2) clinical endpoints should include not only continence status but also other lower urinary tract symptoms and risks of management; (3) participants in the interventional arm should receive individualized management based on their UDS findings; (4) the most scientifically valid approach to the control arm—empiric treatment—is ethically problematic; (5) sufficient statistical power is imperative; and (6) ≥ 2 years' follow‐up is needed to assess the long‐term impact of management. Conclusions: Although a perfect protocol does not exist, we recommend careful consideration of our observations when reflecting on past studies or planning new prospective research. [ABSTRACT FROM AUTHOR]

Objective: Pelvic organ prolapse (POP) is a common condition. With increasing lifespan and emphasis on quality of life worldwide, older women with POP may prefer surgical treatment, including colpocleisis. We reviewed the outcome of POP in a case series of colpocleisis. Methods: This study was conducted between 2006 and 2011. Patients had confirmed POP on examination and underwent partial and total colpocleisis. We compared patients’ demographic characteristics, POP severity and surgical outcomes. Results: In total, 55 patients were included. The patients were aged 78.9 + 6.7 years and had body mass index (BMI) of 26.9 ± 4.2. Among the total, 44 (80%) and 11 patients (20%) underwent partial and total colpocleisis respectively. Patients undergoing partial colpocleisis had procidentia less often than those undergoing total colpocleisis (18% v 64%, p=0.01). Mean blood loss and operative time were 157.6 ml ± 119.0 and 65.1 ± 20.3 minutes respectively. Partial colpocleisis had less blood loss (mean 135.7 v 227.2 ml, p=0.02) and shorter operative time (mean 62.6 v 75.0 min, p=0.18). Conclusion: Partial compared to total colpocleisis was associated with shorter operative time and less blood loss. Colpocleisis is a suitable surgical treatment for POP in elderly women who do not wish to preserve the vagina for sexual intercourse. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: To determine the prevalence, severity, risk factors and self-perception of female urinary incontinence (UI) in rural Fujian, China. Methods: This population-based cross-sectional study was conducted between June and October 2022. Women aged 20 to 70 years from rural communities in Fujian Province were selected by multistage random sampling. Data from respondents were collected by completing standardised questionnaires through face-to-face interviews. The main outcome was prevalence and self-perception of UI. Results: A total of 5659 valid questionnaires were collected. The overall prevalence of female UI was 23.6% (95% CI 22.5–24.7). The most common type was stress UI with a prevalence of 14.0% (95% CI 13.1–14.9), followed by mixed UI with a prevalence of 6.1% (95% CI 5.5–6.7), and finally urgency UI with a prevalence of 3.5% (95% CI 3.0–3.9). Multivariate regression analysis suggested that older age, obesity, postmenopausal status, multiple vaginal deliveries, macrosomia, instrumental vaginal delivery and previous pelvic floor surgeries were independently associated with UI (P < 0.05). The overall awareness rate of UI was 24.7%, and older age, lower level of education, and income were significantly associated with a decrease in awareness (P < 0.05). Only 33.3% of respondents believed they should seek medical help for UI. Conclusion: UI affects more than one-fifth of women in rural Fujian, and several factors are thought to be associated with its development. Rural women have a poor self-perception of UI, which is exacerbated by older age, lower levels of education, and lower income. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the prevalence, risk factors, and impact on quality of life (QOL) of female urinary incontinence (UI) in a region of southeastern China.Patients and Methods: This cross-sectional study, conducted between June 2022 and March 2023, included 9584 women aged 20– 70 years who completed a standardized questionnaire through face-to-face interviews. This sample size represents almost 10% of the population in the target area.Results: The prevalence of female UI was found to be 24.8%, with stress UI being the most common subtype (12.7%), followed by mixed UI (8.0%) and urgency UI (4.1%). Notably, the prevalence of UI increased progressively with age and body mass index (BMI). The study also revealed several risk factors for UI, including urban residence, postmenopausal status, multiple vaginal deliveries, instrumental vaginal deliveries, previous delivery of macrosomia, and prior history of pelvic floor surgery as determined by multivariate analysis. Furthermore, the study showed that 89.5% of women who reported UI experienced varying degrees of negative impact on their QOL. The incontinence quality of life (I-QOL) scale had an average score of 79.70± 19.03, which decreased with increasing severity of UI. Despite the adverse effects on QOL, only 20.6% of women with UI had sought medical help.Conclusion: UI is common among women in the survey area. UI has been observed to have varying degrees of adverse effects on the QOL of those affected, but most of them do not seek treatment for several reasons, highlighting the urgent need for health authorities to develop effective UI intervention strategies. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to perform a systematic review of studies reporting the outcomes of ACT® balloons in female patients with stress urinary incontinence (SUI) due to intrinsic sphincter deficiency (ISD). Methods: In accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) standards, a systematic search of the PubMed (Medline) and Scopus electronic database was performed in June 2022. Terms used for the query were ("female" or "women") and ("adjustable continence therapy" OR "periurethral balloons"). Results: Thirteen studies were included. All were retrospective or prospective case series. The success rates ranged from 13.6% to 68% and the improvement rates from 16% to 83%. The intraoperative complication rate ranged from 3.5 to 25% and consisted of urethral, bladder, or vaginal perforations. The rate of postoperative complications varied from 11 to 56% without major complications. Between 6% and 38% of ACT® balloons were explanted and subsequently reimplanted in 15.2–63% of cases. Conclusion: ACT® balloons can be considered as an option to treat SUI due to ISD in female patients with a relatively modest success rate and quite a high complication rate. Well-designed prospective studies and long-term follow-up data are needed to fully elucidate their role. [ABSTRACT FROM AUTHOR]

Aims and objectives: Investigate evidence available on the efficacy, safety and acceptability of devices for the management of female urinary incontinence, in which clinical settings and specific female populations they have been tested. Learn more about healthcare professionals' perspectives and experiences regarding female urinary incontinence devices. Background: Urinary incontinence is defined as the involuntary leakage of urine, estimated to affect 25%–45% of women. Urinary incontinence predisposes the skin to urinary incontinence dermatitis, it is one of the most common documented causes of inappropriate urinary catheterisation, favouring catheter‐associated infection. Several products for managing female urinary incontinence are available, no accurate and systematic data on usability, effectiveness and associated outcomes of these products are available. Design and Methods: A scoping review was conducted, using a methodological framework including the following five steps: identification of the research question; identification of relevant documents; selection of documents included in the review; tracking of information and data; synthesis and reporting of results. Twenty‐one articles were selected. PRISMA‐ScR Checklist was followed. Results: The devices explored in the studies were as follows: female external urinary catheter; disposable sanitary pads, diapers or sanitary pads used to manage urinary incontinence in women; mechanical devices; a new prototype of underwear that tracks where pads lose; reusable underwear for light incontinence; a new intelligent system pad. Conclusions: New smart pads, urine suction systems and female external catheters appear to be effective in preventing and reducing urinary incontinence dermatitis. The female external catheter reduces the days of indwelling catheterisation and could reduce the incidence of catheter associated urinary tract infection; therefore, it should be recommended. [ABSTRACT FROM AUTHOR]

Purpose of Review: To review the current use of urethral bulking agents (UBAs) for the treatment of female stress urinary incontinence (SUI). Recent Findings: The newest FDA-approved agent, Bulkamid® (2022), which has demonstrated > 60% rate of improvement at 7 years. A systematic review published in 2021 showed similar long-term success rates between Bulkamid® (42–70%), Coaptite® (60–75%), and Macroplastique® (21–80%). To date, direct comparisons of UBAs have not been published. Bulkamid® may have a more favorable side effect profiles with no cases of erosion or migration reported. Summary: Multiple UBAs are available on the market have demonstrated similar improvements in SUI with minimal adverse events. Choice of UBA should be based on surgeon comfort with technique, as each has a unique injection technique, and consideration for potential side effects depending on the material of the agent. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the quality of randomized controlled trials (RCTs) of acupuncture on female urinary incontinence (UI). Methods: We searched for related RCTs of acupuncture on female UI from seven databases (PubMed, Embase, Cochrane library, Web of Science, Medline, ClinicalKey, and Clinical trials). We applied CONSORT (2010 year) and STRICTA criteria to evaluate the relevant factors of included RCTs. Two trained researchers scored independently, and concordance was assessed by Cohen's к-statistic. The median and interquartile range summarized the CONSORT and STRICTA scores of the included studies. In addition, two independent sample t tests were used to assess the differences in the study quality between the 2000–2010 and the 2011–2022 years. Results: A total of 25 RCTs were finally included, and the scores were consistent between different assessors. The average CONSORT score was 10.50 (IQR 9.0–15.0) (total score was 25.0). Overall, the studies generally included scientific background (24/25, 96%), inclusion and exclusion criteria (24/25, 96%), outcome indicators (24/25, 96%), randomization methods (21/25, 84%), generalizability (19/25, 76%), and financial support (15/25, 60%). Most lacked sample size calculation (5/25, 20%), type of randomization (5/25, 20%), blinding (6/25, 24%), case screening period and follow-up (4/25, 16%), and study registration (6/25, 24%), etc. The average STRICTA score was 3.380 (IQR 3.02–3.95) (total score was 6.0). There had a lack of education on treatment methods for patients (3/25, 12%) and the qualification of acupuncturists (6/25, 24%). Conclusion: The overall quality of RCTs on acupuncture treatment of female UI was suboptimal. It is still necessary to improve the research methods, especially the application of random methods, blinding, the interpretation of treatment, and the identification qualification of acupuncturists. [ABSTRACT FROM AUTHOR]

Background and objectives: Stress urinary incontinence (SUI) is the most common type of urinary incontinence, affecting approximately 46% of adult women. After failure of conservative treatment, the mid-urethral sling (MUS) is considered the most effective and safe surgical procedure for SUI. In 2012, Waltregny et al. introduced a new trans-obturator tension-free vaginal tape (TVT) procedure, named TVT-abbrevo (TVT-A). The aim of the present study is to evaluate the efficacy and safety of the TVT-A procedure in women with pure SUI at 5-year follow-up. Materials and Methods: All women who complained of pure SUI symptoms with concomitant urodynamic stress incontinence (USI) were prospectively enrolled and treated with the TVT-A procedure. Postoperative subjective outcome measures included: International Consultation on Incontinence Questionnaire–Short Form (ICI-Q SF), Patient Global Impression of Improvement (PGI-I) scale, and patient degree of satisfaction scale. A PGI-I score ≤ 2 and a patient-satisfaction score ≥8 were used to define subjective success. Objective success was defined as the absence of urine leakage during a cough stress test. Adverse events were collected according to the Clavien–Dindo classification during follow-up. Results: Univariable analysis was used to investigate outcomes. Fifty women who met the inclusion criteria underwent TVT-A implantation. At 5 years after TVT-A implantation, 38 out of 45 (84.4%) patients were subjectively cured (p for trend 0.05), and 40 out of 45 (88.9%) patients were objectively cured (p for trend 0.04). A significant trend of de novo OAB symptoms was reported (22.2% [10/45]) at the 5-year follow-up. No serious early or late complications such as urethral/bladder injury, persistent groin-thigh pain, and sexual dysfunction that required mesh removal were detected. The univariate analysis did not reveal any risk factors (i.e., age, body mass index (BMI), menopause, obstetric factors, and preoperative ICIQ- SF questionnaire) statistically associated with failure of the TVT-A procedure. Conclusions: In conclusion, the 5-year follow-up results of this study demonstrated that TVT-A is a safe and effective option for treatment of SUI with a very low rate of post-operative groin–thigh pain [ABSTRACT FROM AUTHOR]

Functional magnetic stimulation (FMS) is a new technique for the conservative treatment of Urinary incontinence (UI), based on magnetic induction. It induces controlled depolarization of the nerves, resulting in pelvic muscle contraction and sacral S2-S4 roots neuromodulation. The aim of this study was to assess the efficacy of the new 3 Tesla FMS chair, both in patients with pure stress urinary incontinence (SUI) and in women with pure overactive bladder (OAB) symptoms. A prospective observational study was conducted in our urogynaecologic unit. All the patients involved were consecutive women with pure SUI or pure OAB symptoms treated by a 3 Tesla electromagnetic chair. The primary outcome was a subjective outcome evaluation by the PGI-I Scale and a patient-satisfaction scale. The secondary outcome was the change score of the UDI-6, IIQ-7, ICIQ-SF and OAB-q SF questionnaires from baseline to final visit. At 2 months follow-up, 28 out of 60 patients (47%) with SUI symptoms and 20 out of 40 patients (50%) with OAB symptoms declared themselves cured. Considering cured and improved patients, the subjective cure rates were 68.3% (41/60) and 70% (28/40) for patients with SUI and OAB symptoms, respectively. The results of this study showed that the 3 Tesla electromagnetic chair may be an effective option for the treatment of UI. [ABSTRACT FROM AUTHOR]

Objective: To estimate the incidence of urinary incontinence (UI), including its subtypes stress UI (SUI), urgency UI (UUI) and mixed UI (MUI), and to examine risk factors for de novo SUI and UUI in Chinese women. Design: Nationwide longitudinal study. Setting: Six geographic regions of China. Participants: Women aged ≥20 years old were included using a multistage, stratified, cluster sampling method. Methods: This study was conducted between May 2014 and March 2016, with follow up in 2018. Data on demographics, medical history, lifestyle and physiological and anthropometric information were collected. Main outcome measurements: Incidence, rate ratio (RR). Results: Analyses included 24 985 women (mean age 41.9 years).The follow‐up response rate was 55.5%, median follow‐up time was 3.7 years. The standardised incidences of UI, SUI, UUI and MUI were 21.2, 13.1, 3.0 and 5.1 per 1000 person‐years, respectively. Risk factors for de novo SUI included delivery pattern (vaginal spontaneous delivery RR 2.12, 95% CI 1.62–2.78 and instrumental delivery RR 3.30, 95% CI 1.99–5.45), high body mass index (BMI) (overweight RR 1.52, 95% CI 1.33–1.74 and obesity RR 1.67, 95% CI 1.32–2.11), cigarette smoking (RR 1.54, 95% CI 1.12–2.12), chronic cough (RR 1.44, 95% CI 1.17–1.76), diabetes (RR 1.33, 95% CI 1.10–1.60) and older age (50–59 years RR 1.49, 95% CI 1.16–1.90 and 60–69 years RR 1.61, 95% CI 1.22–2.13).The risk factors significantly associated with de novo UUI were age (RR increased from 1.21, 95% CI 0.74–1.99, at 30–39 years to 6.3, 95% CI 3.85–10.30, at >70 years) and diabetes (RR 1.48, 95% CI 1.05–2.09). Conclusions: The incidence of female UI is 21.2 per 1000 person‐years in China. Delivery (vaginal spontaneous delivery, instrumental delivery), high BMI, cigarette smoking, chronic cough, diabetes and older age were risk factors. The incidence of female urinary incontinence was 21.2 per 1000 person‐years in China. Delivery, BMI, diabetes and old age are risk factors. The incidence of female urinary incontinence was 21.2 per 1000 person‐years in China. Delivery, BMI, diabetes and old age are risk factors. [ABSTRACT FROM AUTHOR]

Objectives: Urinary incontinence (UI) is a highly prevalent burdensome condition among adult females in the United States, yet rates of care-seeking, evaluation, and treatment are nonoptimal. Components of evaluation and treatment are informed by research and professional society guidelines; however, a visual representation of this guidance does not exist. The objectives of this study are to review the literature regarding female UI care and to synthesize this information into a graphical format to facilitate health education, health care delivery, and shared decision-making. Methods: We reviewed published society guidelines, position statements, and associated references from the American College of Obstetrics and Gynecology, the Women's Preventive Services Initiative, American Academy of Family Physicians, American College of Physicians, the Society of Urodynamics and Female Urology, the American Urological Association, and the American Urogynecologic Society, and searched PubMed for related literature. We synthesized these findings into an evidence-based infographic depicting female UI risk factors, influences on care-seeking and provision, screening, evaluation, and a stepwise treatment approach. Results: This study summarizes current evidence and professional guidelines related to female UI into a compelling visual format and accompanying narrative. The infographic is intended as a tool for patient education, clinical practice, and research to facilitate shared decision-making and health care delivery. Conclusions: Female UI is highly prevalent, yet diagnosis and treatment are suboptimal. Use of an evidence-based infographic may positively impact patient knowledge and certainty about UI treatment and support health care provider counseling and decision-making. [ABSTRACT FROM AUTHOR]

Aims: Urinary incontinence (UI) is a common condition in women and might affect women's physical and psychological health in different aspects. This study evaluated the effects of UI on the quality of life (QoL) and sexual function in women of reproductive age. Methods: In this prospective case-control study, sexually active and premenopausal women who were admitted to the urogynecology outpatient clinic of our hospital with UI were included. Women without UI complaints were selected for the control group. All the women were asked to fill the Urogenital Distress Inventory-6 (UDI-6), the Incontinence Impact Questionnaire-7 (IIQ-7), and Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire-12 (PISQ-12). Results: There were 64 women [median age: 42 (12)] in the UI group and 58 women [median age: 40 (11)] in the control group. Although the median age was similar in the two groups, the UI group had significantly more gravidas [3 (1) vs. 2 (1); p<0.00] and parity [2.5 (1) vs. 2 (1); p<0.001], body mass index [27.9 (7.2) vs. 24.9 (5.1); p=0.002], and Pelvic Organ Prolapse-Quantification [0 (0) vs. 0 (0); p=0.03] levels. The most common UI type was mixed UI (64.1%) followed by the stress (20.3%) and urge UI (15.6%). The UI group had significantly higher scores in both the subscale and total scores in IIQ-7 and UDI-6 questionnaires (p<0.001). For the PSIQ-12 questionnaire, the behavioral-emotive subscale did not differ between the two groups, while physical and partner subscales and the total score were significantly lower in the UI group (p<0.001). Conclusions: This study showed that UI had a negative impact on QoL and sexual function in women of reproductive age. Sexual dysfunction occurs mainly on physical and partner-related issues. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: The physiotherapy-led pelvic health clinic (PLPHC) is an advanced practice clinic that manages women from the urogynaecology waitlist with pelvic organ prolapse (POP) and/or urinary incontinence (UI) at Gold Coast Health, Australia. This study was aimed at determining re-referral rates and reasons for re-presentation of women previously managed and discharged from the PLPHC. We hypothesised that there would be low representation rates for the same condition within 12 months of discharge. Methods: A retrospective audit was undertaken of all (n = 209) patients discharged between 1 January and 31 December 2017. Re-presentation rates and reasons for re-referral for women seen in the PLPHC and discharged without requiring urogynaecology medical specialist review were analysed and descriptive analysis performed. Result: Of the 209 patients, 67 were referred to, or had, urogynaecology medical specialist review after their initial physiotherapy care and were removed from further analysis. Of the remaining 142 patients, who were initially managed by physiotherapy only, 10 (7.1%) women were re-referred to specialist medical outpatient gynaecology and urology out-patient departments, for management of a different diagnosis, and 10 (7.1%) for their original diagnoses, within 12 months of discharge. Of the latter, 1 patient required further physiotherapy and urogynaecologist management; 7 patients required ongoing pessary management; 1 patient continued with urologist medical management; and 1 failed to attend. Conclusion: This study presents novel data on low re-presentation rates in the 12 months following discharge for patients with POP or UI managed in a PLPHC; and provides further support for advanced scope of practice physiotherapy gynaecological service models. [ABSTRACT FROM AUTHOR]

Female urine incontinence (UI) has negative impact on couple's sexual life. The aim of this study was to assess sexual function of females and their partners in the presence of female UI and identifying the effect of different types of UI on variable sexual domains. This is a comparative cross-sectional study, where 75 sexually active females with UI (patients' group) and 75 age and gender healthy volunteers serving as a control group were enrolled in this study. After urodynamic evaluation, incontinent patients were subdivided into three groups urgent (UUI), stress (SUI), and mixed (MUI). Female Function Index Questionnaire was filled out by all participants and International Index of Erectile Function was filled out by their partners. This study showed that UI in females has a negative impact of sexual life of couples. UUI was related to orgasmic dysfunction and dissatisfaction in females, while their partners suffered from less sexual functions in all sexual domains except in erectile function domain which was more noted in partners of women with SUI. Lubrication was dramatically decreased in SUI group. We concluded that different types of female UI have different impact on sexual domains of females and their partners. [ABSTRACT FROM AUTHOR]

Aims: To compare current General Medical Practitioner treatment as usual (TAU) for the treatment of female urinary incontinence with a novel disposable home electro-stimulation device (Pelviva). Methods: Open label, Primary Care post-market evaluation. 86 women with urinary incontinence were randomly assigned to one of two 12-week treatments: TAU or Pelviva for 30 min every other day plus TAU. Outcome measures included ICIQ-UI (primary), PISQ-IR, PGI-S / PGI-I and FSFI (secondary) at recruitment and immediately after intervention, 1-h pad test at recruitment and usage diaries throughout. Results: Pelviva plus TAU produced significantly better outcome than TAU alone: 3 versus 1 point for ICIQ-UI (Difference − 1.8 95% CI: − 3.5 to − 0.1, P = 0.033). Significant differences were also observed for PGI-I at both 6 weeks (P = 0.001) and 12 weeks (P < 0.001). In the Pelviva group, 17% of women described themselves as feeling very much better and 54% a little or much better compared to 0% and 15% in the TAU. Overall PISQ-IR score reached statistical significance (P = 0.032) seemingly related to impact (P = 0.027). No other outcome measures reached statistical significance. Premature termination due to COVID-19 meant only 86 women were recruited from a sample size of 264. TAU did not reflect NICE guidelines. Conclusions: This study suggests Pelviva is more successful than TAU in treating urinary incontinence in Primary Care. The study had reduced power due to early termination due to COVID-19 and suggests TAU does not follow NICE guidelines. [ABSTRACT FROM AUTHOR]

Athletic urinary incontinence is characterized by urinary loss during sports practice. This condition occurs in the case of CrossFit®, a modality based on high intensity training and functional movements, it can also be considered as having a high impact on the pelvic floor. This study aimed to compare the force and the contraction capacity of the pelvic floor musculature and urinary incontinence between female CrossFit® practitioners (AG) and non-practitioners (CG). We performed a cross-sectional observational study in the period from December 2018 and May 2019. Complaints of urinary incontinence was assessed by the International Consultation on Incontinence Questionnaire – Short Form (ICIQ-SF); the functional evaluation of the pelvic floor was performed by digital palpation; resting tone, maximum voluntary contraction, fast contractions and sustained contraction of the pelvic floor muscles was tested by electromyography. The prevalence of urinary incontinence was significantly higher in AG compared with CG (p <.001). Nevertheless, we did not find significant differences between the two groups for functional assessment and electromyographic parameters. The AG presented a prevalence 60% of UI, while CG only 9,5 (p < 0,001). Considering this point, tailored prevention strategies seem mandatory in this population, in order to allow early identification and management of urinary incontinence. [ABSTRACT FROM AUTHOR]

Introduction: To reduce the risk of avoidable damage to the patient when training surgeons, one must predefine what standards to achieve, as well as supervise and monitor trainees' performance. The aim of this study is to establish a quality reference, to devise comprehensive tension‐free vaginal tape (TVT) learning curves and to compare trainees' results to our quality reference. Material and methods: Using the Swedish National Quality Register for Gynecologic Surgery, we devised TVT learning curves for all Swedish TVT trainees from 2009 to 2017, covering their first 50 operations. These outcomes were compared with the results of Sweden's most experienced TVT surgeons for 14 quality variables. Results: In all, 163 trainees performed 2804 operations and 40 experienced surgeons performed 3482 operations. For our primary outcomes – perioperative bladder perforations and urinary continence after 1 year – as well as re‐admission, re‐operation and days to all daily living activities, there was no statistically significant difference between trainees and experienced surgeons at any time. For the first 10 trainee operations only, there were small differences in favor of the experienced surgeons: patient‐reported minor complications after discharge (14% vs 18.4%, P =.002), 1‐year patient‐reported improvement (95.9% vs 91.8%, P <.000), and patient satisfaction (90.9% vs 86.2%, P =.002). For both trainee operations 1‐10 and 11‐50, compared with experienced surgeons, operation time (33.8 vs 22.2 min, P <.000; 28.3 vs 22.2 min, P <.000) and hospital stay time (0.16 vs 0.06 days, P <.001; 0.1 vs 0.06 days, P <.001) were longer, perioperative blood loss was higher (27.7 vs 24.4 mL, P =.001; 26.5 vs 24.4 mL, P =.004), and patient‐reported catheterization within 8 weeks was higher (3.9% vs 1.8%, P <.000; 2.5% vs 1.8%, P =.001). One‐year voiding difficulties for trainee patients (operations 1‐10:14.2%, P =.260; operations 11‐50:14.5%, P =.126) were comparable to the experienced surgeons (12.4%). Conclusions: There is a learning curve for several secondary outcomes but the small effect size makes it improbable that the difference has clinical significance. Our national Swedish results show that it is possible to train new TVT surgeons without exposing patients to noteworthy extra risk and achieve results which are equivalent to the most experienced Swedish surgeons. [ABSTRACT FROM AUTHOR]

Aims: To investigate typical pad weight gain (PWG) in asymptomatic women who have never reported any episodes of urinary incontinence. Methods: An observational study was performed by measuring the increase in weight of small sanitary pads worn by 35 healthy, female volunteers of a median age 36 (range, 23–56) years. Each pad was worn for a minimum of 5 h which is the typical maximum duration of an ambulatory urodynamics study. Results: The median duration of pad wear was 6 h (interquartile range [IQR], 5–8). The median PWG was 0.111 g (IQR, 0.047–0.255). The maximum recorded PWG was 0.621 g and the minimum was 0.012 g. PWG was not significantly affected by age, parity, years since last delivery, body mass index, or menopausal status. Conclusions: PWG over a median duration of 6 h (IQR, 5–8) is typically <0.7 g in women who are asymptomatic of urinary incontinence. Therefore, PWGs in excess of 0.7 g over a 5‐h ambulatory urodynamics study in symptomatic women are likely to be diagnostic of urinary incontinence. [ABSTRACT FROM AUTHOR]

Introduction: The terminology for female pelvic floor fistulas (PFF) needs to be defined and organized in a clinically based consensus Report. Methods: This Report combines the input of members of the International Continence Society (ICS) assisted at intervals by external referees. Appropriate core clinical categories and a sub‐classification were developed to give a coding to definitions. An extensive process of 19 rounds of internal and external review was involved to examine each definition, with decision‐making by collective opinion (consensus). Results: A terminology report for female PFF, encompassing 416 (188 NEW) separate definitions, has been developed. It is clinically based with the most common diagnoses defined. Clarity and user‐friendliness have been key aims to make it interpretable by practitioners and trainees in different specialty groups involved in female pelvic floor dysfunction and PFF. Female‐specific imaging (ultrasound, radiology, and magnetic resonance imaging) and conservative and surgical PFF managements as well as appropriate figures have been included to supplement and clarify the text. Interval (5–10 years) review is anticipated to keep the document updated and as widely acceptable as possible. Conclusion: A consensus‐based terminology report for female PFF has been produced to aid clinical practice and research. [ABSTRACT FROM AUTHOR]

Background: Female urinary incontinence (UI) is common. Only scant information exists on the significance of UI for GPs' consultations.Objectives: (i) To assess the significance of female UI for GPs and to look at barriers that could be detrimental to treatment by comparing GPs from Denmark and Germany, with different health systems and access to UI guidelines. (ii) To assess whether GPs' gender and age were relevant to the discussion of UI.Methods: We conducted a cross-sectional survey. In the Fehmarn belt-region, a Danish-German border region, a self-developed questionnaire was sent to all the GPs (n = 930).Results: In total, 407 GPs returned the questionnaire (43%); 403 questionnaires were analysed. Using a scale from 0 (never) to 10 (always), addressing UI was reported with an average score of 3.8 (SD: 2.1) among Danish and 3.5 (SD: 2.1) among German GPs. The topic was discussed more frequently with female (4.2; SD 2.2) than with male GPs (3.2; SD 2.0). Danish GPs estimated the prevalence among their female patients at 10% (SD: 8.0) and German GPs at 14% (SD: 11.2). 61% of the Danish and 19% of the German GPs used UI guidelines. German GPs significantly more often reported the barrier 'uncertainty of how to treat UI' [OR = 5.39 (95% CI: 2.8; 10.4)].Conclusions: In consultations with female GPs, UI was discussed significantly more frequently than with male GPs. Compared with the Danish GPs, German GPs stated significantly more uncertainties regarding UI treatment measures, and tended not to use UI guidelines. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to determine how recommendations of gynaecologists on surgical treatment for stress urinary incontinence (SUI) were influenced by patient characteristics. Methods: Two hundred forty-five gynaecologists in the UK fully responded to an online questionnaire including 18 vignettes describing 7 clinical characteristics of women with SUI (age, body mass index, SUI type, previous SUI surgery, frequency of leakage, bother, physical status). The gynaecologists scored recommendations for surgery ranging from 1 'certainly not' to 5 'certainly yes'. Mean scores were used to calculate the relative impact ('weight') of each clinical characteristic. Latent class analysis was used to distinguish groups of gynaecologists with a particular practice style because they responded to the patient characteristics captured in the case vignettes in a similar way. Results: The gynaecologists' overall average recommendation score was 2.9 (interquartile range 2 to 4). All patient characteristics significantly influenced the recommendation scores (p always < 0.001) but their impact was relatively small. SUI type was most important (weight 23%), followed by previous SUI surgery (weight 21%). Latent class analysis identified five groups of gynaecologists with practice styles that differed mainly with respect to their mean recommendation score, ranging from 1.3 to 4.0. Conclusions: Surgical treatment advice in response to case vignettes was only minimally influenced by patient characteristics. There were five groups of gynaecologists whose inclination to recommend surgical treatment varied. This suggests that there is lack of consensus on the role of surgery as a treatment for SUI. A considerable number of gynaecologists were reluctant to recommend surgery. [ABSTRACT FROM AUTHOR]

Aims: To determine the prevalence of urinary incontinence, risk factors and impact on the quality of life in gynecological clinic attendees of a University Hospital. Methods: A cross sectional descriptive study was conducted amongst gynecological clinic attendees in a Teaching Hospital in Nigeria from 1st February to 31st July 2017. Structured questionnaires were used to ascertain the presence of urinary incontinence. Socio-demographic and medical factors; impact on daily activities and treatment history were assessed. Women with and without urinary incontinence were compared. Univariate, bivariate and multivariable analyses were performed. Results: There were 395 women of 25 - 67 years (mean age = 38.81±10.1). About 33% had experienced urinary incontinence in the previous 6 months with Urgency, Mixed and Stress urinary incontinence occurring in 18.0%, 7.6% and 7.3% respectively. Independent risk factors for urinary incontinence were age (odds ratio=0.49, 95% confidence interval [CI] =0.26 - 0.92, P =0.026), higher body mass index (odds ratio=1.92, 95% CI =1.53 - 3.00, P =0.004) and history of constipation (odds ratio=2.11, 95% CI =1.30 - 3.43, P =0.003). About 47% of those with urinary incontinence admitted to negative feelings like anxiety and depression; 45% had moderate to severe impact on their quality of life in all domains but only 27.7% sought help. Conclusions: Urinary incontinence is common and risk factors include older age, high body mass index and constipation. Despite its substantial impact on the quality of life, majority do not seek help. Addressing modifiable risks factors and improving treatment seeking behaviour will assist in reducing the prevalence of urinary incontinence. [ABSTRACT FROM AUTHOR]

Objective: To determine outcomes after removal of two synthetic mid‐urethral slings (MUS) at a tertiary care center. Methods: Following IRB approval, a retrospective chart review of non‐neurogenic, symptomatic women requiring re‐operation after ≥2 MUS was performed. Data reviewed by a third party included: demographics, prior anti‐incontinence surgery, complications, pelvic/urinary symptoms, subsequent investigations, surgical repair and outcomes (including UDI‐6/IIQ‐7 questionnaires) at a minimum 6 months follow‐up. Cure was defined as being continent, no dyspareunia, and no additional surgical therapy. Results: Between 2007 and 2014, 21 women met the inclusion criteria. Mean age was 57 years (range: 40–82) and mean follow‐up was 30.2 months (range: 6–78). The majority of patients presented with one or more symptoms of voiding dysfunction (95%), urinary incontinence (86%), irritative voiding symptoms (62%), dyspareunia (57%), recurrent urinary tract infections (UTIs) (29%), vaginal extrusion (20%) and erosion involving the urinary tract (5%). Patients had a mean of 2 prior anti‐incontinence procedures (range 2–3). Over two‐thirds had a combination of retropubic and transobturator MUS. Mean number of pre‐operative investigations was 3.5 (1–6) including voiding cystourethrogram, cystoscopy and urodynamics. Two patients had complete remission, 14 partial remission, and five failed. Mean postoperative total UDI‐6 and IIQ‐7 scores at last clinic visit were 10 (range: 0–16/SD 4.1) and 11 (range: 0–28/SD 10.3), respectively. Conclusion: The management of women with suboptimal outcomes following two synthetic MUS from transvaginal excision results in modest symptomatic improvement but low permanent complete remission and frequent need for additional therapies. [ABSTRACT FROM AUTHOR]

It is possible that the controversy involving prostheses implanted into women with pelvic floor problems might result in the majority of, or even all such products being restricted, banned or withdrawn in certain jurisdictions. A clear distinction between “tapes” for urinary incontinence and “mesh” for prolapse has been made in the enquiries and subsequent rulings in Australia and New Zealand. Transvaginal “mesh” will be unavailable with the range of “tapes” much more restricted in those countries from January 2018. The Chair of the all‐party parliamentary group on surgical mesh implants in the United Kingdom was reported as describing the New Zealand announcement as “hugely significant” and “it's precisely what we've been calling for the UK.” The title of this article has changed from a hypothetical piece to a potential reality review. Where does that leave the clinicians treating stress urinary incontinence (SUI) and the large number of female sufferers? “Tapes” (synthetic midurethral slings—MUS) have become very popular over the last 20 years since their original development and introduction in Scandanavia. Evidence‐based medicine has shown their advantages over previous surgeries, in terms of ease of use, safety and efficacy. This article outlines the options which countries potentially rejecting the use of tapes, must now resort to for women with SUI. Those countries considering such action need the note of caution that none of the options are as good as tapes. [ABSTRACT FROM AUTHOR]

Allied health-led models of care have been shown to be effective in providing diagnostic evaluation and management of many health conditions, improved access to care, and reduced specialist outpatient waiting lists. An audit of a new physiotherapy-led pelvic health clinic for women on the urogynaecology waiting list was undertaken, from its inception in January 2017 until October 2017. The objective of this audit was to document the patient journey, clinical outcomes and patient satisfaction of 105 women who provided consent for their information to be included in the audit. Following the introduction of the physiotherapy-led clinic, participants reported shorter waiting times to attend appointments compared to the traditional medical model, improved clinical outcomes and high patient satisfaction. Many participants (65%) were discharged without requiring a urogynaecology specialist appointment. This audit supports the model of a physiotherapy-led pelvic health clinic as an effective model of care. [ABSTRACT FROM AUTHOR]

Aims: The use of orthotropic neobladder (ONB) construction in women has increased in popularity. With increasing numbers so have complications distinct to this procedure. Neobladder vaginal fistula (NVF) is a rare but challenging complication. We present our experience correcting this problem. Methods: An IRB approved database of female patients with an ONB was retrospectively reviewed. Patients with a history of NVF were identified and charts reviewed. Our standard technique of radical cystectomy and orthotopic diversion in female patients includes interposition of omentum between the neobladder and anterior vaginal wall and sacrocolpopexy. Results: Two hundred and forty‐nine female patients underwent cystectomy and ONB construction between 1995 and 2015. Fourteen patients were diagnosed with a NVF (5.6% incidence). The average age and follow‐up was 67 years and 33.7 months, respectively. Surgery for fistula closure was attempted in 13 patients. One repair was combined abdominal and transvaginal; the remaining 12 were performed transvaginally. Location of NVF was categorized as at the urethra‐neobladder anastomosis (UNA, nine patients) and anterior vaginal wall (AVW, four patients). Eight patients had a successful fistula repair (61.5%) but only five patients ultimately retained their ONB (39%). Conclusions: Patients with a NVF pose a surgical challenge. Successful fistula repair does not necessarily result in adequate continence due to an incompetent outlet. NVF location at the UNA is the more common location and is more challenging in regard to successful resolution of the NVF as well as possible urinary incontinence post‐NVF repair. [ABSTRACT FROM AUTHOR]

Female urinary incontinence is a common and costly problem that affects the quality of life for many women. However, it can be managed using the correct strategies. There are several different types of female incontinence and this article discusses these along with the most common treatments, with particular emphasis on pharmacological treatments. The pharmacological treatments are discussed in detail, including dosages, side effects and monitoring. [ABSTRACT FROM AUTHOR]

AIMS To characterize the urinary incontinence observed in adult Gli2+/−; Gli3Δ699/+ female mice and identify the defects underlying the condition. METHODS Gli2+/− and Gli3Δ699/+ mice were crossed to generate: wild-type, mutant Gli2 ( Gli2+/−), mutant Gli3 ( Gli3Δ699/+), and double mutant ( Gli2+/−; Gli3Δ699/+) female mice, verified via Polymerase Chain Reactions. Bladder functional studies including cystometrogram (CMG), leak point pressure (LPP), and voiding testing were performed on adult female mice. Female bladders and urethras were also analyzed via ink injection and histological assays. RESULTS CMG tracing showed no signal corresponding to the filling of the Gli2+/−; Gli3Δ699/+ bladders. LPP were significantly reduced in Gli2+/−; Gli3Δ699/+ mice compared to wild-type mice. CMG studies revealed a decrease in peak micturition pressure values in Gli2+/−; Gli3Δ699/+ mice compared with all other groups. No significant differences between mutant and wild-type mice were detected in urinary output. Histological analyses revealed Gli2+/−; Gli3Δ699/+ mice exhibited a widened urethra and a decrease in smooth muscle layer thickness in the bladder outlet and urethra, with increased mucosal folding. CONCLUSIONS Gli2+/−; Gli3Δ699/+ adult female mice display persistent urinary incontinence due to the malformation of the bladder outlet and urethra. This presents a consistent and reliable genetic mouse model for female urinary incontinence and alludes to the key role of genetic factors involved in the condition. [ABSTRACT FROM AUTHOR]

Background Urinary incontinence ( UI) is likely to be high in Aboriginal women in rural Australia due to risk factors including high body mass index, parity and diabetes. However, UI appears to be under-reported with limited information on whether women access appropriate care. Aims To assess whether women who access specialist gynaecological services in rural and remote Top End Northern Territory ( NT) through the specialist outreach program ( SONT) are receiving care for UI aligned with best practice. Methods Review of all 1426 SONT referrals in 2012, with audit of management for those women referred for UI or prolapse. Results Of 1426 SONT referrals, there were 43/1426 (3%) women referred for UI, with 34/43 (79%) attending. Of those referred, 31/43 (72%) were Aboriginal. Of twenty-six women diagnosed with probable stress UI, less than a fifth, 5/26 (19%), were referred to physiotherapy, with 2/5 (40%) attending appointments. Referral occurred for 14/23 (61%) of those suitable for urodynamics but only 6/14 (43%) attended. Just under half of women 7/16 (14%) with stress UI were referred for surgery, with 6/7 (86%) attending. Conclusion In rural and remote Top End NT, specialist health service management of female UI could be improved by increased provision of current best-practice and an integrated multi-disciplinary team approach with allied health. Under-reporting and under-referral for female UI could be addressed by increasing awareness among community and primary healthcare providers of the problem of female UI and the conservative, medical and surgical treatments available. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: Some patients with hip osteoarthritis report that urinary incontinence (UI) is improved following total hip arthroplasty (THA). However, the type and severity of UI remain unclear. In this study, we hypothesize that both stress urinary incontinence (SUI) and urge urinary incontinence (UUI) are improved after THA. We assess the characteristics of UI and discuss the anatomical factors related to UI and THA for improved treatment outcome. Methods: Fifty patients with UI who underwent direct anterior-approach THA were evaluated. Type of UI was assessed using four questionnaires: Core Lower Urinary Tract Symptom Score (CLSS), Urogenital Distress Inventory Short Form (UDI-6), International Prostate Symptom Score (IPSS), and Overactive Bladder Symptom Score (OABSS). Uroflowmetry and postvoid residual urine were measured using ultrasound technology. Hip-joint function was evaluated using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and range of motion (ROM). Results: Of the 50 patients, 21 had SUI, 16 had mixed urinary incontinence (MUI), and eight had urgency urinary incontinence (UUI). In total, 36 patients were better than improved (72 %). The rate of cured and improved was 76 % for SUI, 100 % MUI, and 50 % UUI. The improvement of ROM was more significant in cured or improved patients than in stable or worse patients. Conclusions: Improvement in mild UI may be an added benefit for those undergoing THA for hip-joint disorders. These data suggest that for patients with hip-joint disorder, hip-joint treatment could prove to also be a useful treatment for UI. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: The aim of the study was to investigate the correlation between mean bladder wall thickness (BWT) and treatment success in patients diagnosed with urinary incontinence, based on urodynamic test results. Methods: In this prospective study, patient urinary incontinence type was identified using urodynamic tests. Patients ( N = 125) were categorized into three groups: urodynamic stress incontinence (SUI), detrusor over-activity (DO) and mixed urinary incontinence. Measurements from the bladder dome, anterior wall and trigone were averaged to calculate BWT. Student's t test and Mann-Whitney U test were used to compare pre-treatment BWT. Receiver operating characteristic (ROC) curve analysis was used to determine optimal cut-off values for BWT to predict treatment success. Results: Mean pre-treatment BWT significantly differed between success and non-success groups for each urinary incontinence type ( p value for the SUI, DO and MUI groups was 0.043, 0.001 and 0.002 respectively). Using ROC curves to anticipate the treatment success, a threshold was calculated for mean pre-treatment BWT; 5.05 mm for SUI (sensitivity 74 %, specificity 66 %, positive predictive value [PPV] 85 %, negative predictive value [NPV] 50 %), 4.98 mm for DO (sensitivity 73 %, specificity 92 %, PPV 95 %, NPV 63 %) and 5.31 mm for mixed type (sensitivity 88 %, specificity 73 %, PPV 79 %, NPV 85 %). Conclusions: The study results suggest a significant relationship between the pre-treatment BWT and the success of urinary incontinence treatment. The mean BWT may be used as a benchmark in assessing the responsiveness to treatment of urinary incontinence types. [ABSTRACT FROM AUTHOR]

Objective: Our aim was to study risk factors associated with the prevalence, incidence and remission of urinary incontinence (UI) between 4 and 24 months postpartum.Design: Longitudinal study (EDEN cohort).Setting: Two French university hospitals.Population: 1643 women completed the questionnaire at 4 months and 1409 at 24 months, including 1354 who completed it both times.Methods: Multivariate analyses identified risk factors for UI prevalence at 24 months postpartum, persistent UI versus remission, de novo UI versus continence, de novo UI versus persistent UI, and changes in IU severity between 4 and 24 months postpartum.Main Outcome Measures: Postnatal UI and Sandvik UI severity score.Results: UI prevalence was 20.7% (340/1643) at 4 months and 19.9% (280/1409) at 24 months. Significant factors associated with UI at 24 months were older age [OR = 1.07/year (95%CI 1.04-1.11)], BMI [2.35 (1.44-3.85) ≥30 versus <25 kg/m²], higher parity [1.77 (1.14-2.76) ≥3 versus 1], breastfeeding [1.54 (1.08-2.19) ≥3 versus < 3 months], pregnant at follow up [3.44 (2.25-5.26)], and caesarean delivery [0.62 (0.40-0.97) versus vaginal] [OR, odds ratio (CI, confidence interval)]. The likelihood of UI remission at 24 months was 51.9% (149/287). Caesarean delivery was associated with increased likelihood of UI remission [0.43 (0.19-0.97)]. The risk of de novo UI at 24 months was 12.5% (135/1067) and was associated with a new pregnancy [3.63 (2.13-6.20)].Conclusions: Between 4 and 24 months postpartum UI, remission occurred in half of the cases. These postnatal UI changes were essentially related to mode of delivery and subsequent pregnancy.Tweetable Abstract: Postnatal urinary incontinence progression is mostly related with mode of delivery and subsequent pregnancy. [ABSTRACT FROM AUTHOR]

Purpose: Supervised pelvic floor muscle training in patients of stress and mixed urinary incontinence has been recommended. Our aim was to assess the utilisation and effectiveness of our supervised pelvic floor muscle training service and assess the impact of incontinence scores before physiotherapy on the subsequent results of physiotherapy.Methods: All 271 patients referred to physiotherapy for symptoms of incontinence filled out the International Consultation on Incontinence Modular Questionnaire-Female Lower Urinary Tract Symptoms before starting treatment. Depending on pelvic floor muscle assessment, plans for exercises and follow up were made. If the strength of pelvic floor muscles was poor, electrical stimulation was offered. If awareness of the pelvic floor muscle contraction was poor, bio feedback was offered. Group sessions and vaginal cones were also used. Depending on the response to the treatment; patients were either discharged, referred to Urogynaecology clinic or continued physiotherapy. All patients who were discharged or referred for surgery were given a post treatment questionnaire to fill out.Results: 79 (56 %) of 132 women with stress, 49 (51 %) of 98 with mixed and 27 (66 %) of 41 with urge incontinence reported successful control of symptoms (overall success 54 %). However, 65 % of women with incontinence scores of 0-5 before physiotherapy, 64 % with 6-10, 42 % with 11-15 and mere 28 % with 16-20 achieved success with physiotherapy. 27 (10 %) were lost to follow up.Conclusion: 1 in 2 women referred to physiotherapy for incontinence, achieved successful control of symptoms without the need for invasive investigations or surgery. However, poor incontinence scores before the start of physiotherapy is a poor prognostic indicator for success. 90 % women utilised the service. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: The quality of Internet information on female urinary incontinence is considered variable. No comprehensive analysis exists to support this. We compared the quality of current Internet information for common layperson terminology on female urinary incontinence across four Western languages and a comparative analysis of website sponsors. Methods: World Health Organization Health on the Net (HON) principles may be applied to websites using an automated toolbar function. We used the Google search engine; 10,200 websites were identified using keywords related to female urinary incontinence and treatments in English, French, German and Spanish. The first 150 websites in each language had HON principles examined, whilst a further analysis of site sponsorship was undertaken. Results: The total number of websites for each term is variable. 'Female sling surgery' had the most websites with approximately 18 million, whereas 'colposuspension' had the least with only 159,890 websites. Regardless of language, very few female urinary incontinence websites were HON accredited ( p < 0.0001). Linguistically, French (18 %) and English (16 %) had the greatest percentage of HON-accredited sites. Tertiles (thirds) of the first 150 websites returned the higher percentage of HON-accredited websites ( p < 0.0001). Websites were largely sponsored by physicians/surgeons. Conclusions: The lack of validation of most female urinary incontinence websites should be appreciated by clinicians. Additionally, discrepancies exist in the quality and number of websites across conditions, languages and also between medical and alternative terms. Clinicians should participate in and encourage the development of informative, ethical and reliable health websites on the Internet and direct patients to them. [ABSTRACT FROM AUTHOR]

Aims To compare the efficacy and safety of Kegel exercises performed with or without, vaginal spheres as treatment for women with urinary incontinence. Methods Multicentre parallel-group, open, randomized controlled trial. Women were allocated to either a pelvic floor muscle-training program consisting of Kegel exercises performed twice daily, 5 days/week at home, over 6 months with vaginal spheres, or to the same program without spheres. The primary endpoint was women's report of urinary incontinence at 6 months using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-UI-SF). Secondary outcome measures were the 1 hr pad-test, King's Health Questionnaire (KHQ) and a five-point Likert scale for subjective evaluation. Adherence was measured with the Morisky-Green test. Results Thirty-seven women were randomized to the spheres group and 33 to the control group. The primary endpoint was evaluated in 65 women (35 in the spheres group vs. 30 controls). ICIQ-UI-SF results improved significantly at 1-month follow-up in the spheres group ( P < 0.01) and at 6 months in the controls. The 1 hr pad-test improved in the spheres group but not in the control group. No significant differences were found in the KHQ results or in the subjective evaluation of efficacy and safety. Adherence was higher in the spheres group but differences were not significant. Mild transient side effects were reported in four patients in the spheres group and one in the control group. Conclusions Both treatments improved urinary incontinence but women who performed the exercises with vaginal spheres showed an earlier improvement. Vaginal spheres were well tolerated and safe. Neurourol. Urodynam. 34:533-538, 2015. © 2014 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Aim Recently a miniature version of the Monarc suburethral sling has been introduced. This paper aims to evaluate the postoperative recovery, effectiveness and complications of these two types of suburethral sling. Methods This was a prospective randomized series of 50 female patients with stress incontinence who underwent either a Monarc or Miniarc suburethral sling. Results The only significant intraoperative difference was a shorter operation time for the Miniarc (18.8 vs 22.4 min). The success rates were similar at 6 weeks and 6 months. Conclusion There were no significant differences between the Miniarc and Monarc, except for a significantly shorter Miniarc sling operating time. [ABSTRACT FROM AUTHOR]

Aims Our main objective was to analyze individual determinants that lead middle-aged women to seek medical care for urinary incontinence (UI). Methods Observational longitudinal study among GAZEL cohort participants: 2,640 women aged 50-62 completed a self-administered questionnaire at baseline. Eight years later (2008) 2,273 (86%) responded to a follow-up questionnaire. Seeking care for UI was defined as any consultation for UI during the 8-year follow-up period. Individual determinants considered in the regression analysis were social and demographic characteristics, social relations, UI type and severity, and other health factors. Results Among 1,192 women reporting incontinence at baseline, 24.4% had visited a physician at least once for UI during the follow-up period (56.0% of those reporting severe UI). The care-seeking rate increased with age at baseline. Multivariate analysis showed that women who reported severe UI (OR = 4.1; 95% CI 2.6-6.5), mixed UI (2.0; 1.3-3.0), or neurologic disease (1.6; 1.1-2.6), had weak social support (1.4; 1.0-2.0), or talked about their UI with close friends or family (1.5; 1.0-2.1) were more likely to seek care for UI. A model including these factors had a 78% probability of correctly differentiating women with incontinence who chose to seek care from those who did not. Our analysis could not take factors related to the organization of health services into account. Conclusions Women do not always seek care for UI, even when it is severe. Besides UI severity and type, consultation is associated with aging, weak social support, conversation about it with close friends and family, and neurologic disorders. Neurourol. Urodynam. 33:1116-1122, 2014. © 2013 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: Perceptions about urinary incontinence (UI) may have a differential impact on treatment-seeking behaviors. Thus, we aimed to systematically review perceptions regarding UI in women of different racial and ethnic populations. Methods: MEDLINE, EMBASE, Scirus, Google Scholar, Open J-Gate, AgeLine, and Global Health (CABI) were searched from January 1980 to August 2011. We included qualitative studies that described knowledge, perception, or personal views about UI in women. Studies were excluded if they did not specify race/ethnicity of subjects, if they reported on non-UI urinary symptoms, or if they were performed exclusively in men. Three independent reviewers screened all studies. The relevance, appropriateness, transparency, and soundness (RATS) scale for qualitative research was used to assess study quality. Because of the qualitative data, meta-analyses were not performed. Results: Of 3,676 citations, 23 studies met the inclusion criteria. Based on the RATS scale, these were categorized into 11 high-, 2 moderate-, and 10 low-quality studies. Dominant themes fell into two categories, UI management and UI experience, and were similar across racial/ethnic groups. Across multiple studies, women reiterated a preference for discussing UI with other women, even if this was not a physician. Non-white women expressed self-blame and perceived UI as a negative outcome from childbirth or prior sexual experiences. Latina women maintained more secrecy around this issue, even amongst family members. Conclusions: Women across different racial and ethnic groups share similar UI management strategies and UI experiences. However, perceptions about UI may differ in certain populations. These findings could be useful when considering future educational strategies regarding UI in women. [ABSTRACT FROM AUTHOR]

Key content Urinary incontinence ( UI) affects up to 69% of the female population at some point in their lives but remains under-reported. There are three main types of UI: stress, urgency and mixed., It is recommended to try conservative approaches as first-line measures in the management of all types of UI. These include lifestyle interventions such as adjustment of fluid intake and weight loss, physical and behavioural therapies (pelvic floor muscle training, electrical stimulation, vaginal cones and bladder training programmes) and occasionally containment devices., Initial management of UI, in most cases, renders itself to primary care settings: this involves appropriate assessment of women's symptoms, including quality of life ( QOL) assessment, appropriate simple investigations (such as urine analysis) and conservative treatment., Appropriate referral pathways to secondary and tertiary levels of care are necessary. Regular audit should take place to assess the efficacy of management options and referral pathways., UI has significant adverse affects on women's QOL. Hence patient reported outcome measures ( PROMs) have been highlighted in recent NHS reports as a means of assessing effectiveness of care from the patient's perspective by gauging patient health status or health-related QOL., Learning objectives To gain an understanding of the assessment and various conservative management options for common types of UI in women., To explore the existing evidence base for such conservative management modalities and to analyse the effect of the current economic climate and reorganisation of services on the conservative management approach., To recognise the important role of patient reported outcome measures as well as service and user involvement, in the assessment of clinical and cost-effectiveness of various treatment options of UI in women., Ethical issues Should conservative measures such as weight loss and smoking cessation be a pre-requisite for offering further management options?, In the present climate of scarce health resources should more emphasis be placed on the active role of patients in their own management? Will reorganisation of the NHS pose any threat to the conservative measures for treating UI in women?, Is it acceptable to take a 'one size fits all' approach to management of common types of UI? [ABSTRACT FROM AUTHOR]

Purpose: (1) To describe the minimally invasive adjustable continence therapy (ACT) balloon placement surgical technique. (2) To analyse the results of ACT balloon in the treatment for female stress urinary incontinence (SUI). Method: A review of the literature was performed by searching the PubMed database using the following search terms: ACT balloons, female urinary incontinence, and female continence. Results: Eight studies were published between 2007 and 2013. The mean follow-up of these studies was 1-6 years. The mean age of the patients ranged between 62 and 73 years; 40-100 % of patients had already been treated surgically for their SUI. A significant reduction in the number of pads used per day was observed after ACT balloon placement, with improvement of short pad tests from 49.6 to 77.3 g preoperatively to 11.2-25.7 g after ACT balloon placement. Fifteen to 44 % of patients considered that their SUI had been cured and 66-78.4 % were satisfied with the result. The explantation rate ranged between 18.7 and 30.8 %. Quality of life was significantly improved, and no major complication was reported. Conclusion: ACT balloons constitute a reasonable, minimally invasive alternative for the treatment for female SUI due to intrinsic sphincter disorder, especially in patients who have already experienced failure of standard surgical treatment and in clinical settings incompatible with invasive surgical placement of an artificial urinary sphincter (especially women over the age of 80 years). Long-term results are essential to evaluate the efficacy of this treatment. [ABSTRACT FROM AUTHOR]

Introduction: To evaluate the cost-utility of incontinence treatments, particularly anticholinergic therapy, by examining costs and quality-adjusted life years. Materials and methods: A prospective cohort study of women who were consecutively referred by general practitioners (GPs) to the Urology Department because of urinary incontinence. The primary outcome was evaluation of the cost-utility of incontinence treatments (surgery, medical therapy and physiotherapy) for stress and/or urgency incontinence by examining costs and quality-adjusted life years. Results: 137 consecutive female patients (mean age 60.6 ± 11.6; range 36-81) were enrolled and stratified according to pathologies: SUI and UUI. Group A: SUI grade II-III: 43 patients who underwent mid-urethral sling (MUS); Group B: SUI grade I-II 57 patients who underwent pelvic floor muscle exercise and Group C: UUI: 37 patients who underwent antimuscarinic treatment with 5 mg solifenacin daily. The cost utility ratio (CUR) was estimated as saving more than €1200 per QALY for surgery and physiotherapy and as costing under € 100 per QALY for drug therapy. Conclusions: This study shows that appropriate diagnosis and treatment of a patient with incontinence lowers National Health Service costs and improves the benefits of treatment and quality of life. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: The aims of the present study were to determine the types of UI among women visiting the urology department, to identify the potential risk factors associated with each type of UI, and to identify healthcare-seeking behaviors of affected women in our region. Methods: The data of 617 community-dwelling women, who were at least 18 years of age or older and who presented with a complaint of UI ongoing over a year, and those without UI, who were admitted for any other reason, from June 2010 to April 2012, were evaluated. Results: Mean age was 51.29 years (range 18-110 years); median parity was 3.54 (range 0-11) and 88.2 % of the women were married. Mean BMI was 28.01 kg/m. Very few women (18.5 %) accepted UI as a disease and searched for medical help by themselves; however, the remaining women (81.5 %) were brought or directed for evaluation by someone else. Stress UI was reported by 43 women (10.5 %), urge UI and mixed UI were noted by 153 (37.5 %) and 212 (52 %) women respectively. Conclusions: The most frequent type of UI was mixed UI in our region. Age, BMI, multiparity, and hypertension were identified to have a different importance for each type of UI, but diabetes mellitus, birth trauma, gynecological surgery, lumbar disc hernia (LDH), and multiple sclerosis (MS) were the other important related factors. However, a small number of patients accepted UI as a disease and searched for therapy. This reveals that the public should be informed in detail about female UI in developing countries. [ABSTRACT FROM AUTHOR]