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• Calculated person-year incidence of urinary incontinence in hypertensive female patients. • The incidence rates of UI in hypertensive women were significantly higher than that in normotensive women. • Hypertension was an independent risk factor for new-onset UI and SUI in Chinese adult women. To determine the incidence of UI (urinary incontinence) and its subtypes in hypertensive women and examine the association between hypertension and new-onset UI. We conducted a cohort study on women aged ≥20 years in six regions of China. This cohort study was carried out from 2014 to 2016 at baseline, with follow-up completed in 2018. Information on sociodemographic characteristics, physiological and health behaviours were collected. We calculated the standardized person-year incidence of UI in hypertensive women, and used logistic regression to evaluate the association between hypertension and UI and its subtypes. The standardized incidence of UI, stress UI (SUI), urgency UI (UUI), and mixed UI (MUI) in hypertensive women was 32.2, 21.9, 4.1, and 6.1 per 1000 person-years. Compared with normotensive women, the unadjusted and adjusted OR (odd ratio) for UI in hypertensive women was 2.62 (95 % confidence interval [CI], 2.16–3.18) and 1.70 (95 % CI, 1.14–2.53), respectively; The unadjusted and adjusted OR for SUI in women with hypertension was 2.44 (95 % CI, 1.92–3.09) and 2.60 (95 % CI, 1.68–4.04), respectively; The unadjusted and adjusted OR for UUI in women with hypertension was 2.80 (95 % CI, 1.79–4.37) and 0.54 (95 % CI, 0.13–3.66), respectively; The unadjusted and adjusted OR for MUI in women with hypertension was 2.49 (95 % CI, 1.92–3.09) and 0.60 (95 % CI, 0.19–1.91), respectively. The incidence of UI in hypertensive women was 32.2/1000 person-years. Hypertension was an independent risk factor for new-onset UI and SUI in Chinese adult women. [ABSTRACT FROM AUTHOR]

Urinary incontinence (UI) is common in women and affects the quality of life in female patients severely. But the clinical consideration and treatment are insufficient. Acupuncture and-moxibustion has been proposed as a potentially effective intervention for female UI. Hence, the World Federation of Acupuncture-moxibustion Societies (WFAS) have initiated a project to develop the clinical practice guideline (CPG) on acupuncture and moxibustion for female UI towards global acupuncture practitioners. The CPG was developed according to the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) methodology, referring to the principles of the World Health Organization Handbook for Guideline Development. During the development of the CPG, the guideline development group (GDG) played an important role, which is composed of multi-national and multi-disciplinary experts. The clinical questions, recommendations and therapeutic protocols were all formulated by GDG using the modified Delphi method and basing on the results of the latest systematic review. This article focuses on the recommendations in the CPG. The CPG contains ten recommendations for ten clinical questions, including nine conditional recommendations for the intervention, one conditional recommendations for either the intervention or the comparison. The CPG also provides one conventional filiform needle therapy protocol, two deep puncturing stimulation on lumbosacral acupoints therapy protocols, and four moxibustion therapy protocols, extracted from the included clinical evidence of this CPG. [ABSTRACT FROM AUTHOR]

Urinary incontinence (UI) is a common condition that bothers women's lives, including stress urinary incontinence (SUI), urgency urinary incontinence (UUI) and mixed urinary incontinence (MUI). The current non-surgical treatment of Western medicine includes pelvic floor muscle training (PFMT), medication, electric stimulation, etc., all of which have varied limitations. For instance, the patients are poor in compliance with PFMT and medication results in frequent adverse effects. Being one of the featured treatments of TCM, moxibustion has several merits including safety, low cost and simple operation. In recent years, the clinical evidences prove increasingly that moxibustion may be effective for women with UI. However, there is no high-quality systematic review of moxibustion for this disease. To evaluate the effect and safety of moxibustion on UI (including SUI, UUI and MUI) among women. From the inception to October 13, 2022, the data of the randomized controlled trials (RCTs) of moxibustion on UI among women were collected from CNKI, WanFang Data, VIP, SinoMed, Web of Science, Pubmed, EMBASE and Cochrane Library databases. Two investigators screened the articles independently and extracted the data according to the inclusion and exclusion criteria developed in advance. Using the risk of bias assessment tool of Cochrane Handbook, the included RCTs were evaluated. With RevMan 5.3 software, meta-analysis was performed, and the GRADE tool was adopted to assess evidence certainty of different outcomes. A total of 1176 articles were retrieved and 19 of them with 1397 patients were eligible and included in the review. In experimental groups, moxibustion combined with PFMT was used, while in control groups PFMT was applied alone. And the subjects were all women with SUI. Meta-analysis showed that compared with PFMT alone, moxibustion combined with PFMT reduced the urine leakage volume (1-hour pad test) (MD = -1.95g, 95% CI [-2.32, -1.57], P < 0.001), the frequency of UI in 24-hour (MD = -0.64, 95% CI [-0.88, -0.40], P < 0.001) and the score of the short form of International Consultation on Incontinence Questionnaire (ICIQ-SF) of women with SUI (MD = -2.53, 95% CI [-3.43, -1.63], P < 0.001); and this combined intervention measure did not increase significantly the adverse events (RR = 0.82, 95% CI [0.15, 4.6], P = 0.82). GRADE assessment showed that the UI frequency in 24-hour and the incidence of adverse events were rated as low quality, the urine leakage volume of 1-hour pad test and ICIQ-SF score were very low quality. Compared with PFMT alone, the intervention combined with moxibustion greatly reduced the urine leakage volume and UI frequency and improved the quality of life (QoL) among women with SUI with favorable safety. Moxibustion could be effective supplementary therapy on SUI among women. However, due to the high risk of bias of the included trials and low certainty of evidence, more high-quality clinical studies are needed to verify the above findings. Registered on PROSPERO: CRD42022297643. [ABSTRACT FROM AUTHOR]

Recurrent stress urinary incontinence (rSUI) represents a major challenge for most clinicians as there is little evidence in the literature on the best option after sling failure. The objective of this study is to summarise the findings on the use of urethral bulking agents (UBAs) in the management of rSUI after the failure of a mid-urethral sling (MUSs). We performed a systematic review and meta-analysis, according to PRISMA 2020 guidelines, and selected eleven publications for inclusion in the analysis. We found that the overall cure and improvement rate ranged from 64% to 85% in the included studies, with a pooled value of 75%, compared with pooled failure and re-operation rates of 32% (95% CI: 22%-43%) and 25% (95% CI: 17%-34%), respectively. The I2 test indicated significant statistical heterogeneity among the studies in relation to all the outcome measures; however, no risk of publication bias was found. To explore this heterogeneity in more depth, we performed a sub-group analysis of the two most commonly used bulking agents (Bulkamid and Macroplastique). The pooled values of the cure and improvement rate were 84% (95% CI: 77.0%-90.0%) and 80% (95% CI: 74.0%-85.0%) for Macroplastique and Bulkamid, respectively. We did not find significant heterogeneity or significant differences in the outcome measures in either group. For the first time in literature, our study provides an insight into the use of UBAs after failed MUSs. Although the results seem very promising, future studies with shared protocols are needed in order to recommend the use of UBAs in the treatment of recurrent cases. [ABSTRACT FROM AUTHOR]

Background: Stress urinary incontinence is a common condition that can be treated conservatively and/or surgically. Given the risks of surgery, developing effective nonsurgical treatment options would be beneficial. Some studies have suggested that laser therapy may improve or cure stress urinary incontinence. However, there is a lack of sham-controlled randomized controlled trials to judge treatment efficacy.Objective: This study aimed to compare the effects of CO2 vaginal laser vs sham therapy for treating stress urinary incontinence.Study Design: This was a multicenter, participant-blinded, sham-controlled, parallel group (1:1) superiority randomized controlled trial performed in outpatient clinics in 2 hospitals. We included women aged 18 to 80 years with objective and subjective stress urinary incontinence. Participants had undertaken or declined supervised pelvic floor muscle training. Intervention was performed using a CO2 fractionated vaginal laser. Participants underwent 3 treatments, 4 weeks apart, with increasing energy and density settings. Sham treatment was performed using an identical technique with a deactivated pedal. The primary outcome was the subjective stress urinary incontinence rate (proportion with leak with cough, sneeze, or laughter) at 3 months after completion of treatment. Secondary outcomes included objective stress urinary incontinence, change in the disease-specific patient-reported outcomes, health-related quality of life, and adverse effects. Categorical outcomes were compared using the chi square test and continuous outcomes using analysis of covariance, adjusting for the baseline score.Results: There were 52 participants who received laser and 49 who received sham treatment. One participant in each group withdrew from the study before the endpoint, and 2 participants in the laser group did not participate in the follow-up visits. Participant mean age was 53 (34-79) years. Mean body mass index was 26.1 (18.1-49.6); 90% were vaginally parous. At 3 months, there was no difference between the sham and active treatment arm in subjective stress urinary incontinence (46 [96%] vs 48 [98%]; relative risk, 0.98 [95% confidence interval, 0.91-1.05]; P=.55) or in objective stress urinary incontinence (37 [80%] vs 33 [80%]; relative risk, 0.99 [95% confidence interval, 0.81-1.23]; P=.995). Patient-reported outcomes and health-related quality of life were also comparable between the groups. Vaginal bleeding occurred in 3 participants after laser and 1 participant after sham treatment. Pain during treatment did not differ between laser and sham treatment.Conclusion: We were unable to show an improvement in stress urinary incontinence after CO2 vaginal laser therapy compared with sham treatment. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To determine the cost-utility and cost-effectiveness of the surgical treatment of female urinary incontinence using suburethral slings and prolapse meshes compared with therapeutic abstention. Study design: An economic analysis was performed on 69 women receiving surgical treatment for urinary incontinence using suburethral slings and prolapse meshes. To calculate the procedure's cost-effectiveness, an incremental analysis up to one year was performed using the incremental cost-effectiveness ratio (ICER). The costs were calculated using a cost-by-process model. Answers to the health-related quality of life questionnaires EQ-5D (generic) and International Consultation Incontinence Questionnaire Short-form (specific) were collected before the operation and as well as one month and one year post-operation to calculate the utility, using quality-adjusted life years (QALY), and the effectiveness, respectively. To complete the economic evaluation, we derived confidence ellipses and acceptability curves. The analysis was conducted for the entire sample and also for each type of urinary incontinence. Results: In total, 45 women presented with stress incontinence, 15 with mixed incontinence and 9 with incontinence associated with prolapse. The average cost per patient at one year post-operation was 1220 €. The QALY achieved at one year was 0.046. The results reveal an ICER at one year of 26,288 €/QALY, which is below the cost-effectiveness threshold considered acceptable, and this value was lower for stress incontinence (21,191 €/QALY). The cost-effectiveness was 106.5 €/International Consultation Incontinence Questionnaire Short-form unit. Conclusion: Surgery for female urinary incontinence using slings is cost-effective compared with abstention in our public health environment. [Copyright &y& Elsevier]

Objective: To elucidate the influence of recreational physical activity, body mass index (BMI), and waist circumference on the risk of specific types of urinary incontinence.Study Design: We conducted a population-based cross-sectional survey in Gansu, China among 2603 women aged 20 years or older.Results: The study found that BMI was positively associated with urinary incontinence (P for trend=0.008) and the association was mainly observed for stress urinary incontinence (OR=1.4, 95% CI: 1.1, 1.9 for BMI=24.0-27.9 kg/m²; OR=2.3, 95% CI: 1.5, 3.6 for BMI ≥ 28.0 kg/m²; P for trend=0.0005). A positive association between stress incontinence (OR=1.7, 95% CI: 1.2, 2.5) and waist circumference was observed for women who had waist circumference between 70 cm and 75 cm compared to waist circumference less than 70 cm. Recreational physical activity was inversely associated with overall and mixed urinary incontinence (P for trend <0.0001 for both). A significant interaction between physical activity and waist circumference was found for overall (P=0.0007) and stress incontinence (P=0.001).Conclusions: The findings that physical activity inversely associated with urinary incontinence and its interaction with waist circumference warrant further investigation, particularly in prospective studies. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To outline serum estradiol levels in perimenopausal women with stress, mixed or urge incontinence. We believe the majority of urgency symptoms in perimenopausal women to be caused by a pelvic floor dysfunction and a hypermobility of the bladder neck. If this is the case, there would be no difference in estradiol levels between the groups. Study design: Setting: University hospital. In the observational Women''s Health in the Lund Area study, a subset of 400/2221 women reporting urinary incontinence completed a detailed questionnaire regarding lower urinary tract symptoms and had their serum steroid hormone levels measured. Statistical analyses were made by Chi-square test, nonparametrical tests, ANOVA, multi- and univariate logistic regression analysis. Results: Stress incontinence was reported by 196, mixed incontinence by 153 and urge incontinence by 43 women; in 369, serumestradiol values were available. Serum estradiol did not differ significantly between stress incontinent (median 49.5pmo/l, range 2.63–875.4), urge incontinent (median 31.6pmol/l, range 2.63–460.7) or mixed incontinent women (median 35.5pmol/l, range 2.63–787.9, p =0.62). Logistic regression analysis correcting for age, parity, hormonal status, smoking, hysterectomy and BMI also failed to show any difference in estradiol levels between the groups (p =0.41–0.58). Conclusion: No significant differences in serum estradiol levels between stress, mixed or urge incontinent perimenopausal women could be demonstrated. [Copyright &y& Elsevier]

Abstract: Urinary incontinence (UI) is a common female dysfunction, affecting women in all ages. Experienced physiotherapists and experts on low back pain (LBP) have since long observed and discussed the empirical association between LBP and UI. The aim of this study was to describe the occurrence of UI in women with LBP and to compare this group with a reference group of comparable age, language, culture and parity. The authors of this study had previously collected all original data from the reference group. A validated questionnaire concerning UI was answered by 200 consecutive women with LBP visiting specialised physiotherapy clinics in the area of Stockholm. Inclusion criteria were LBP, female, not pregnant, Swedish speaking, age between 17 and 45 years. Seventy-eight percent of the women with LBP reported UI. In comparison with the reference group, the prevalence of UI and signs of dysfunctional pelvic floor muscles (PFM) were greatly increased (p<0.001) in the LBP group. Logistic regression analysis showed that the condition LBP and PFM dysfunction i.e. inability to interrupt the urine flow (p<0.001) were risk factors for UI irrespective of parity. Physiotherapists treating patients with LBP should be aware of possible incontinence problems in this patient group. [Copyright &y& Elsevier]

Abstract: Background: To determine risk factors for the appearance of de novo urgency symptoms, and subsequent accompanying problems, after the tension-free vaginal tape (TVT) procedure in women with stress urinary incontinence. Method: A structured preoperative analysis of the incontinence symptoms was made. A mailed questionnaire was distributed to 970 women that underwent the TVT procedure between 1995 and 2001. Average follow-up was 5.2 years (range 2–8 years). The questionnaire included specific questions on current urinary symptoms and incontinence. The disease-specific quality of life instruments IIQ-7 and UDI-6 were used to compare women with, and those without de novo urgency. Results: Seven hundred and sixty women (78.3%) responded and 463 of those were identified as genuine stress incontinence preoperatively. De novo urgency occurred in 67 (14.5%) of the women. The frequency was similar irrespective of duration since the TVT procedure. The women that reported de novo urgency symptoms were compared with those without symptoms. Risk factors for occurrence of de novo urgency symptoms were older age (64.7 years versus 60.9 years; p =0.01), parity (2.6 versus 2.3; p =0.05), history of cesarean section (9.5% versus 2.5%; odds ratio 5.4), and history of recurrent urinary infections (29.7% versus 18.8%; odds ratio 1.6, but non-significant. De novo urgency had a severe impact on quality of life, as compared to the remaining study population. Conclusion: Old age, parity and history of cesarean section were risk factors for de novo urgency after TVT surgery. Postoperative de novo urgency symptoms are as bothersome for the patient as the preoperative stress urinary incontinence. [Copyright &y& Elsevier]

Abstract: Objective: To investigate the association between patient characteristics and disease-specific and generic quality of life (QOL) as well as the degree of bother in women seeking treatment for urinary incontinence (UI). Methods: The Prospective Urinary Incontinence Research (PURE) was a 6-mo observational study with 1055 physicians from 15 European countries enrolling 9487 women. QOL was assessed at the enrolment visit using the urinary Incontinence Quality of Life questionnaire (I-QOL) and the generic EQ-5D. A single-item instrument was used to measure the degree of bother. UI severity was assessed using the Sandvik Index. UI was categorised into stress (SUI), mixed (MUI), and urge (UUI) urinary incontinence by a patient-administered instrument (Stress and Urge Incontinence Questionnaire [S/UIQ]). Multivariate linear (I-QOL, EQ-5D Visual Analogue Scale) and logistic (bother, EQ-5D health state index) regressions were performed. Results: Mean total I-QOL scores were significantly and independently associated with UI severity, nocturia, age, UI subtype, number of selected concomitant medical conditions, length of suffering from UI before contacting a doctor, smoking status, ongoing use of UI medication, and country. After adjusting for all the covariates, the total I-QOL scores for SUI, MUI, and UUI were 62.7, 53.8 and 60.1, respectively. As with I-QOL, UI severity was also the most important predictor for bother. The number of concomitant medical conditions, together with UI severity, was the variable most strongly associated with EQ-5D. Conclusion: In addition to the UI subtypes, severity of UI should be given more importance in treatment algorithms and in treatment decision-making by both the patient and the physician. [Copyright &y& Elsevier]

Abstract: The purpose of this study is to examine the subjective experience of long-term urinary incontinence and to show how a cultural model helps define that experience. Using a narrative approach within a cultural models framework, the specific aims are to describe and analyze: (1) what urinary incontinence means; and (2) how that meaning is constructed and negotiated by women living with urinary incontinence. 17 community-dwelling women (from Philadelphia, USA, and its immediate suburbs) participated in semi-structured interviews. Plot types and shared themes were compared with themes that emerged from media representations of female incontinence, and a cultural model was developed. Findings suggest: (1) the meaning of long-term female urinary incontinence is constructed and negotiated as a result of individual and shared experiences; (2) the cultural model constructed by women differs significantly from the professional, primarily biomedical model; and (3) women''s narratives provide a method for accommodating similarities and differences between lay and professional models. [Copyright &y& Elsevier]

Summary: Female urinary incontinence is a common but underreported condition. Initial investigation and treatment can in most cases be undertaken without urodynamic or other detailed tests. History by the use of validated symptom and quality of life questionnaires is key to the initial investigation. Initial treatment includes pelvic floor muscle training (PFMT) regardless of the type of incontinence; lifestyle interventions and bladder retraining, anticholinergics and serotonin/noradrenaline reuptake inhibitors (e.g. duloxetine) are also included depending on the type of symptoms. In mixed incontinence the predominant symptom should be treated first. When this initial treatment is ineffective, further investigation should be offered prior to specialised treatment. Urodynamics should be considered for all patients prior to surgery. Imaging and cystoscopy to exclude pathology, for example in elderly patients with an overactive bladder, are also necessary. Newer surgical interventions should be offered after careful consideration of the risk:benefit ratio for each individual woman and the amount of evidence that is currently available to support their use. [Copyright &y& Elsevier]

Abstract: Objectives: To describe the patient-reported impact of urinary incontinence (UI) in treatment-seeking women in Europe. Design: PURE was a non-interventional, observational study, which aimed to describe the direct costs of treatment for European women seeking treatment for UI. A secondary study objective was to describe the impact of UI on health-related quality of life (HRQoL) by UI subtype and severity of disease. This paper presents the results from quality of life assessments as well as bothersomeness and interference with daily activities from the first study observation. Subjects: Nine thousand four hundred and eighty-seven European women who had UI symptoms in the last 12 months were enrolled. Their UI symptoms were frequently those defined as mixed urinary incontinence (MUI) and were moderate to severe in nature. Measurements: HRQoL was assessed at the first observation using the urinary Incontinence-specific Quality of Life Questionnaire (I-QOL) and the EQ-5D, a generic quality of life questionnaire. Data collected from EQ-5D provided insight into the patients’ general health perception, while the I-QOL data indicated how affected the women were about their UI symptoms. Higher EQ-5D and I-QOL scores represent better quality of life. Patients were asked to indicate how much UI symptoms limited selected activities and to indicate the degree to which they found their symptoms to be bothersome. Results: Overall, the median self-rated health status on the EQ-5D visual analogue scale (VAS) was 70.0 and the median EQ-5D health state index was 0.85, with small but noticeable differences observed between countries. Of the five health dimensions of the EQ-5D, patients’ self-care appeared to be the least affected by UI, with fewer than 10% of the women reporting that they had some problems. Between 20 and 40% of patients had some problems with their mobility and usual activities, or had pain/discomfort or anxiety/depression. However, the impact of existing co-morbidity was not assessed and may have affected some women''s scoring of the EQ-5D domains. The mean total I-QOL score overall was 57.7 and of the three subscales of the I-QOL, psychosocial impact had the highest overall scores, representing fewer problems, with lower scores observed for the avoidance and limiting behaviour subscale, and even lower scores for the social embarrassment subscale. The greatest patient-reported impact of UI symptoms on activities was on exercise, with more than 45% of patients moderately to totally limited in this activity. In most of the countries, more than 60% of the women reported that they were moderately to extremely bothered by their UI symptoms. Conclusions: There was considerable impact of UI on HRQoL in a treatment seeking population, as demonstrated by the disease-specific quality of life scale and by the high percentage of patients who were bothered by their symptoms. [Copyright &y& Elsevier]

Abstract: Objective: To describe the characteristics of women seeking treatment for symptoms of urinary incontinence (UI) in European countries. Design: Prospective urinary incontinence research (PURE) was a 6-month, observational, pan-European study, primarily aimed at determining the direct costs of urinary incontinence treatment. The secondary objectives of PURE were to describe the impact of UI on health-related quality of life (HRQoL) in treatment seeking patients and to illustrate the treatment patterns for UI in Europe. Setting: One thousand and Fifty-five physicians from 14 European countries, including general practitioners (GPs), gynaecologists, urologists and geriatricians, observed women seeking treatment for their UI and recorded data at the first observation and then prospectively at 3 and 6 months after the first observation during the normal course of therapy. Subjects: Women of at least 18 years of age who had experienced urinary leakage in the 12 months prior to enrolment in the study, who were seeking treatment or under treatment for UI and who presented within the normal course of UI care were included in the 6 months study. The first observation characteristics of the patients are described here. Methods: Demographic characteristics, as well as disease and treatment status at first observation were explored using descriptive summary statistics to gain an understanding of the population studied. Results: In total, 9487 women took part in PURE, with the largest patient groups from Germany, Spain and the UK/Ireland. The majority of women were post-menopausal and had a mean age of 60.7 years, were not current smokers and tended to be overweight (BMI>25.0). Overall, mixed UI symptoms were more common than SUI and UUI, as defined by clinical opinion (SUI 38%, MUI 42% and UUI 18%), and by a two-item questionnaire, the S/UIQ (SUI 29%, MUI 58% and UUI 13%). Around half of the patients (48%) suffered from their symptoms for less than 2 years before consulting a physician; 28% delayed seeking treatment for 3–5 years, with 13% waiting for 6–10 years and the remaining 11% waiting for 11 or more years. Conclusions: Some of the described patients’ characteristics may provide important information to clinicians to enable them to take a more active approach to case-finding, which will ultimately benefit the incontinent patient. [Copyright &y& Elsevier]

Abstract: Background: Female urinary incontinence is a prevalent condition, but only about one-third of women seek treatment. Objectives: To describe the health care provision for women with urinary incontinence from a European perspective, selecting France, Germany, Spain, Sweden, and the United Kingdom as examples, and to investigate whether specific barriers for treatment exist. Methods: Available health care system information, a literature review and clinical expert information identified patterns of treatment provision. Results: In Spain, Sweden, and the UK, access to medical care in general is primarily through the general practitioners. However, in Spain and Sweden, women with urinary incontinence can directly visit specialists. In France and Germany, women have equal access to either general practitioners or specialists. Aside from general practitioners, gynaecologists play a major role in urinary incontinence care in all countries except the UK. In Germany, urologists are also involved in initial female urinary incontinence care; however, only in about 16% of women. There are no waiting lists in France and Germany for appointments with physicians or procedures, contrary to Spain, which has long waiting lists. Access to general practitioners in the UK is unrestricted whereas advanced diagnosis and treatment in secondary care requires long waits. A specific Swedish policy mandates that no woman is required to wait longer than 3 months for incontinence visits and related surgery. In Sweden and the UK, specialist nurses and other health care workers provide incontinence services. Almost all treatment options for urinary incontinence are at least in part reimbursed. However, various co-payments and fees in France, Germany, Spain and Sweden exist and constitute out-of-pocket expenses for women if no complementary additional private health insurance is available. In some countries, financial incentives for physicians to provide incontinence services are low, raising concerns about their interest to engage in continued patient care. Conclusions: Information about service provision in Europe for women with urinary incontinence is limited and makes it difficult to understand barriers to treatment seeking. A broad European perspective may promote optimised treatment access in the future for this widespread and under-recognised condition. [Copyright &y& Elsevier]

Abstract: Objective:: Clinical practice guidelines (CPGs) are tools that urinary incontinence (UI) specialists can use to update and communicate their expertise with other specialists, health authorities and general practitioners to help promote a more uniform approach to the initial management of women with UI. The objective of this paper was to assess available recommendations for the initial management of UI in women from urology organizations in Europe and North America and compare with the recommendation from the International Consultation on Continence (ICI). Methods:: A review of the medical literature was conducted to identify and compare relevant CPGs for the initial management of UI in women. Results:: The European Association of Urology (EAU) and the Spanish National Association of Urology (SNAU) have developed CPGs for the initial management of UI in women, both of which are similar to those developed by the ICI. Differences exist in the pharmaceutical treatment of both stress urinary incontinence (SUI) and urge urinary incontinence (UUI). Few treatment options are supported by sufficient scientific evidence to qualify as “A-level” recommendations. Conclusion:: The recommended initial management of UI in women from the EAU and SNAU is in general agreement with that from the ICI, but some treatment options have limited scientific support. Endorsement or simplification accepted by urologists may enhance the credibility of CPGs and promote their adoption by other practitioners without detailed UI experience and improve the quality and consistency of care for women with UI. [Copyright &y& Elsevier]

Objectives. – An increasing number of patients look for medical information on Internet, and find hardly accurate answers to their questions. The objective of this study was to assess the quality of information about urinary incontinence on free access Web-sites.Material and methods. – A search using the most used search engines in French speaking countries and key words given by patients located 24 Web-sites on female urinary incontinence to review. A general description of each site was done. Then a specially designed assessment scale, whose criteria were extracted from a literature review and from practice guidelines for the management of female urinary incontinence, was used by two reviewers to assess each Web-site content.Results. – Three key terms (urinary incontinence, urine loss, urine leak) were used on three search engine (Google, Yahoo, Voila) and the first 10 Web-sites located for each search were analyzed. The mean score was low (7.92 (±3.1) range 0–24, maximum 24) and only four sites received the “highly recommended” mention.Conclusions. – This study using medical evidence-based criteria to assess the quality content of French speaking Web-sites about female urinary incontinence highlights the poor quality of information available for Internet “typical users”. Doctors should play a greater role in evaluating these sites and/or developing their quality. [Copyright &y& Elsevier]

Objective: To investigate by questionnaire the prevalence and characteristics of urinary incontinence (UI) in a female population aged between 18 and 49. Study design: Of 44,095 females aged 18–49.9 living in our urban area a sample of 10,000 subjects was sent a questionnaire and 3557 replied. The age-based analysis was performed on 2900 of these. Results: The overall prevalence of UI was 20%. 11% had suffered from nocturnal enuresis before 18 years old, 47% of parous women noted a relationship between the beginning of UI and delivery. Among the incontinent women 83% lost urine with physical exertion, and 44% had urge incontinence, 18% used diapers, 20% had consulted a physician and half of these had been referred for medical, surgical or rehabilitative therapy, 50% reported past or present urinary infections, 8% complained also of faecal incontinence, 22% considered loss of urine embarrassing and humiliating but only 6% revealed frustration and 2% were obliged to stay at home for long periods of time. Of the incontinents 62% defined themselves anxious or nervous and 22% of these ascribed an increase of urinary leakage to anxiety or to nervousness, 9% reported use of antidepressant drugs, 85% had sexual intercourse and only 2% considered UI as an impediment to a satisfying sexual activity. Conclusions: UI is a common problem in young women. Urge incontinence seems to be prevalent in <30 aged women while stress incontinence occurs more frequently after this age. [Copyright &y& Elsevier]

Objectives: To compare the urodynamic characteristics in a group of middle-aged women with untreated urinary incontinence with the findings in a control group of healthy women.Methods: Sixty women with mild-to-moderate urinary incontinence and 28 symptom-free women, 53–63 years old, were randomly chosen out of a large health questionnaire study. All were investigated with a detailed history, gynaecological examination, urinalysis, frequency–volume chart, and urodynamics including cystometry and pressure-flow analysis.Results: The maximum urinary flow was significantly higher in the incontinent group of women, 22±1 ml/s, than in the healthy controls, 16±2 ml/s (p<0.01). The acceleration of flow, with a theoretical maximum of 0°, was also significantly faster in the incontinent, 20°, than in the healthy women, 32° (p=0.01). In the five women with urge incontinence only, maximum urinary flow was 26±2.4 ml/s and the flow acceleration 7°. In incontinent women, both a lower opening pressure and detrusor pressure at maximum flow were seen compared with the healthy women, though the difference did not reach statistical significance. The incontinent and the healthy women did not differ regarding bladder volumes or pressures during filling.Conclusion: The findings of this study indicate the presence of an increased efficiency of the urethral opening mechanism in incontinent women compared to normal, irrespective of the type(s) of symptoms present. [Copyright &y& Elsevier]