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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., (© 2023. The International Urogynecological Association.)

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., (© 2023. The International Urogynecological Association.)

Introduction and Hypothesis: The use of valid patient-reported outcome measurements is essential in clinical and research settings. The structure of the Brazilian version of the King's Health Questionnaire (Br-KHQ) has not been evaluated. Thus, this study sought to evaluate the structural validity and internal consistency of the multi-item domains of the Br-KHQ in women with urinary incontinence (UI)., Methods: A total of 462 Brazilian Portuguese speakers with UI aged 18 years or older were included in this study. Participants answered the Br-KHQ, and a questionnaire containing demographic and personal information. The structure of the Br-KHQ was examined through Exploratory Factor Analysis (EFA) with the implementation of parallel analysis and evaluated using confirmatory factor analysis (CFA). For the latter, several goodness-of-fit indices were considered to evaluate the model fit of the structures tested in this study. Internal consistency was assessed using Cronbach's alpha, composite reliability, and coefficient omega., Results: The EFA showed that the questionnaire has a five-factor structure, i.e., limitations of daily life, personal relationship, emotions, sleep/energy, and severity measures. The CFA demonstrated that this structure presented the most adequate goodness-of-fit indices and the lowest values of Akaike information criterion and Bayesian information criterion, compared with the original and Portuguese structure. High values (>0.70) of internal consistency were found., Conclusions: The Brazilian version of the KHQ is composed of a five-factor structure. Further studies should evaluate other measurement properties of the Br-KHQ to ensure reliable interpretation of this patient-reported outcome measure in clinical practice., (© 2022. The International Urogynecological Association.)

Introduction and Hypothesis: To systematically review evaluation guidelines of uncomplicated urinary incontinence (UI) in community-dwelling adult women to assess guidance available to the full range of providers treating UI., Methods: Systematic literature search of eight bibliographic databases. We included UI evaluation guidelines written for medical providers in English after January 1, 2008., Exclusion Criteria: guidelines for children, men, institutionalized women, peripartum- and neurologic-related UI. A quantitative scoring system included assessed components and associated recommendation level and clarity., Results: Twenty-two guidelines met the criteria. All guidelines included: history taking, UI characterization, physical examination (PE) performance, urinalysis, and post-void residual volume assessment. At least 75% included medical and surgical history assessment, other disease process exclusion, medication review, impact on quality of life ascertainment, observing stress UI, mental status assessment, performing a pelvic examination, urine culture, bladder diary, and limiting more invasive diagnostics procedures. Fifty to 75% included other important evaluation components (i.e., assessing obstetric history, bowel symptoms, fluid intake, patient expectations/preferences/values, obesity, physical functioning/mobility, other PE [abdominal, rectal, pelvic muscle, and neurologic], urethral hypermobility, and pad testing. Less than 50% of guidelines included discussing patient treatment goals. Guidelines varied in level of detail and clarity, with several instances of unclear or inconsistent recommendations within the same guideline and evaluation components identified only by inference from treatment recommendations. Non-specialty guidelines reported fewer components with a lesser degree of clarity, but this difference was not statistically significant (p = 0.20)., Conclusions: UI evaluation guidelines varied in level of comprehensiveness, detail, and clarity. This variability may lead to inconsistent evaluations in the work-up of UI, contributing to missed opportunities for individualized care., (© 2021. The International Urogynecological Association.)

Introduction and Hypothesis: This qualitative interview study explores aspects women with urinary incontinence(UI) reflect upon when considering whether or not to have surgery. Conducted prior to the recent mesh pause in the UK, the article provides insights for current and future approaches to shared decision-making., Methods: Qualitative in-depth interviews of 28 patients referred to secondary care for stress and mixed UI who were considering UI surgery. Participants were recruited from four urogynaecology clinics in the Midlands and South England, UK. Interviews were conducted in clinics, in patient homes, and by telephone. Data analysis was based on the constant comparative method., Results: Participants' accounts comprised three key concerns: their experience of symptoms, the extent to which these impacted a variety of social roles and demands, and overcoming embarrassment. Accounts drew on individual circumstances, values, and concerns rather than objective or measurable criteria. In combination, these dimensions constituted a personal assessment of the severity of their UI and hence framed the extent to which women prioritized addressing their condition., Conclusions: Acknowledging women's personal accounts of UI shifts the concept of 'severity' beyond a medical definition to include what is important to patients themselves. Decision-making around elective surgery must endeavour to link medical information with women's own experiences and personal criteria, which often change in priority over time. We propose that this research provides insight into how the controversy around the use of mesh in the UK emerged. This study also suggests ways in which facilitating shared decision-making should be conducted in future.

Introduction and Hypothesis: Urinary incontinence (UI) is one of the most serious problems during pregnancy and after delivery. It can influence the quality of life and cause psychological problems that lead to depression and decreased self-esteem. We aimed to investigate the maternal, obstetrical and neonatal risk factors of urinary incontinence 3 to 12 months after childbirth., Methods: The Cochrane Library, Medline, Science Direct and Web of Science were searched for studies published from the inception of the databases up to December 2019, including any observational full-text papers. All data were analyzed using Review Manager 5.3. Of 338 articles reviewed, 20 studies were considered for meta-analysis., Results: The results of our study showed that vaginal delivery in contrast to cesarean section (OR = 3.74, 95% CI: [2.71, 5.15], P < 0.00001), UI in pregnancy (OR = 5.27, 95% CI: [3.40, 8.17], P < 0.00001), episiotomy (OR = 1.23, 95% CI: [1.05, 1.45], P < 0.01), perineal tear > grade 2, instrumental delivery in contrast to cesarean section, epidural or spinal anesthesia, maternal age, pre-pregnancy BMI and neonatal birthweight have a direct relationship with UI., Conclusions: This study confirmed that urinary incontinence during pregnancy and vaginal births had the strongest relationship with postpartum urinary incontinence. Also, the maternal upright positions during labor did not reduce the likelihood of urinary incontinence. The awareness of this issue helps find effective strategies to reduce the likelihood of female urinary incontinence.

Introduction and Hypothesis: As noted in the 6th International Consultation on Incontinence (ICI) chapter "Initial Management of Urinary Incontinence in Women" recommendations call for including physiotherapy as a first-line therapy., Methods: Building on this, checking available scientific evidence and using the International Classification of Functioning, Disabilities and Health, the following represents a holistic physiotherapist approach for initial evaluation of the health problem of urinary incontinence., Results: This paper proposes a teaching module for every relevant health care professional dealing with the assessment of adult female urinary incontinence, focusing on optimal patient selection and appropriate treatment choice., Conclusion: The assessment stage involves the explicit decision as to whether "physiotherapy" is the treatment indicated for the patient, based on the findings of the physiotherapy assessment and supplemented by any medical information that accompanied the referral and evaluation.

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.

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.

Introduction and Hypothesis: Lower urinary tract symptoms (LUTS) impact upon quality of life and occur in women of all ages. The National Institute for Clinical Excellence states that ambulatory urodynamic monitoring (AUM) should be used as a second-line investigational modality; however, its use is becoming more frequent. AUM provides a valid second line to conventional urodynamic methods that may be more widely used., Method: A literature review was undertaken to assess evidence for the use of AUM alongside a retrospective review of patients undergoing AUM at a tertiary care centre and symptom reporting at a follow-up visit. Both these methods included evidence for pathology detection, technical ease of use, recreation of symptoms and patient experience, allowing comparison of literature results to those experienced in day-to-day use., Results: The literature shows AUM to have sensitivity superior to that of other urodynamic investigations. However, evidence suggests this correlates less well with clinical effectiveness. Patients felt AUM was superior in recreating their symptoms, and they tolerated the procedure well. The increased technical demands of AUMs, however, meant that traces were more commonly harder to interpret than with conventional urodynamics. Our experience correlates well with the existing literature, suggesting increased symptom diagnosis; 63.2 % of diagnoses correlated well with symptoms., Conclusion: AUM remains an important urodynamic method to supplement conventional urodynamics. Evidence suggests it is superior in LUTS diagnosis, but its technical difficulty can affect results.

Introduction and Hypothesis: The aim of this observational study was to investigate the influence of body mass index (BMI) smoking and age on the cure rate, rate of complications and patient satisfaction with mid-urethral sling (MUS) procedures., Methods: Pre-, peri- and postoperative (8 weeks and 1 year) data were retrieved from the Swedish National Register for Gynecological Surgery of MUS procedures (retropubic procedures, n = 4,539; transobturator procedures, n =1,769) performed between January 2006 and December 2011. Multiple logistic regression analyses were performed between the outcome variables and BMI and smoking, presented as adjusted odds ratios (adjOR) with 95 % confidence interval (CI)., Results: Subjective 1-year cure rate was 87.4 % for all MUS procedures (88.3 % with the retropubic technique and 85.2 % with the transobturator technique (p = 0.002). Preoperative daily urinary leakage and urgency were more common with increasing BMI, but surgery reduced symptoms in all BMI groups. Lower cure rate was seen in women with a BMI >30 (0.49; CI 0.33-0.73), in diabetics (0.50; CI 0.35-0.74) and women aged > 80 years (0.18; CI 0.06-0.51). Perioperative complications were more common in the retropubic group (4.7 % vs 2.3 % in the transobturator group, p=0.001) and in women with BMI < 25. Smoking did not influence any of the outcome variables., Conclusions: The overall 1-year cure rate for MUS procedures was 87 %, but was negatively influenced by BMI >30, diabetes and age > 80 years. Perioperative complications were more common with the retropubic procedure than with the transobturator technique, and in women with a BMI < 25. Smoking did not impact on any of the studied outcome variables.

Introduction and Hypothesis: The aim of this study was to assess whether bladder training (BT) combined with high-intensity pelvic floor muscle training (BT + PFMT) results in better outcomes in the short term than BT alone on female urinary incontinence (UI)., Methods: We randomly assigned 108 women with diagnoses of stress UI (SUI, n = 50), urgency UI (UUI, n = 16), or mixed UI (MUI, n = 42) to 6 weeks of BT + PFMT or BT alone (control group). The primary outcome measure was self-reported improvement. Secondary outcome measures were UI severity, symptom distress, quality of life (QOL), mean number of UI episodes and micturitions per day, and pelvic floor muscle strength and endurance (PFME)., Results: Overall and in the SUI and MUI subgroups, significantly more patients in the BT + PFMT group reported cured and improved symptoms. Overall and in SUI patients, the BT + PFMT group also improved to significantly greater degree in UI severity, symptom distress, QOL, daily UI episodes, and PFME. The only parameter showing more improvement in patients with UUI was QOL, and UI severity in patients with MUI (p < 0.05). There were no other significant differences between the two study groups in overall and subgroup analysis (p > 0.05)., Conclusions: High-intensity PFMT combined with BT is more effective than BT alone in the short term for treating UI or SUI. It appears that the combination therapy may also lead to greater benefits for patients with UUI and MUI. Based on the results of this study, further studies with larger sample sizes (for UUI) and long-term follow-ups are warranted.

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.

Introduction and Hypothesis: Although midurethral slings have become standard surgical methods to treat stress urinary incontinence (SUI), little is known about women who still have urinary incontinence (UI) after surgery. This study assesses and compares the patient-reported outcome 12 months after tension-free vaginal tape (TVT), tension-free vaginal tape-obturator (TVT-O), and transobturator tape (TOT), with a special focus on women who still have urinary leakage postoperatively., Methods: This study analyzed preoperative and 12-month postoperative data from 3,334 women registered in the Swedish National Quality Register for Gynecological Surgery., Results: Among the women operated with TVT (n = 2,059), TVT-O (n = 797), and TOT (n = 478), 67 %, 62 %, and 61 %, respectively, were very satisfied with the result at the 1-year follow-up. There was a significantly higher chance of becoming continent after TVT compared with TOT. In total, 977 women (29 %) still had some form of urinary leakage postoperatively. Among the postoperatively incontinent women who expressed a negative impact of UI on family, social, work, and sexual life preoperatively, considerably fewer reported a negative impact in all domains after surgery. Of those in the postoperatively incontinent group who had coital incontinence preoperatively, 63 % reported a cure of coital incontinence., Conclusions: The proportion of women very satisfied with the result of the operation did not differ between the three groups. TVT had a higher SUI cure rate than did TOT. Despite urinary leakage 1-year postoperatively, half of the women were satisfied with the result of the operation.

Introduction and Hypothesis: Older studies suggesting an association between detrusor overactivity and bacteriuria used an outdated microbiological threshold. We hypothesised that bacteriuria ≥10(3) CFU/ml would be more prevalent in women with urinary incontinence than continent controls., Methods: A prospective, cross-sectional study of prevalence of bacteriuria ≥10(3) colony-forming units (CFU)/ml on catheter specimens. Sample estimates suggested 62 women per arm would yield 80% power. Multivariate regression analysis was performed using risk factors including, age, diabetes, menopausal status, sexual activity and cystocele., Results: Among 213 participants, bacteriuria ≥10(3) CFU/ml was more prevalent in incontinent women than continent controls (odds ratio [OR] 4.06; p = 0.036). Two thirds of bacteriuric specimens grew "low-count" bacteriuria. On multivariate analysis, only cystocele ≥ grade II was independently associated with bacteriuria (p = 0.025). On sub-analysis by diagnosis, the only significant finding was with bladder oversensitivity (OR 13.8; p = 0.0017)., Conclusions: Bacteriuria, including "low-count" bacteriuria, is more prevalent in urinary incontinence when compared to continent female controls.

Introduction and Hypothesis: Vaginal weight cone (VWC) versus assisted pelvic floor muscle training (APFMT) in the treatment of urinary incontinence (UI) in women., Methods: One hundred three incontinent women were randomly distributed into two groups: group G1 (n = 51) treated with VWC and G2 (n = 52), APFMT. The following parameters were performed initially and after treatment: (1) clinical questionnaire, (2) visual analogue scale (VAS), (3) 60-min pad test, and (4) subjective and objective assessment of pelvic floor muscle (PFM)., Results: There was a significant decrease in nocturia and urine loss after treatment in both groups (p < 0.05). In VAS, there was a significant improvement of all parameters in both groups (p < 0.05). The pad test showed significant decrease in both groups (p < 0.05). There was a significant increase of PFM strength in both groups (p < 0.05)., Conclusion: There was no difference between groups treated with VWC and APFMT.

Introduction and Hypothesis: We estimated the current prevalence of urinary incontinence (UI) in the female Greek population, estimated the prevalence of the subtypes of UI, and assessed its impact on patients' quality of life., Methods: The study was performed by personal interview based on structured questionnaires, and 2,000 Greek women (from the whole of Greece) aged between 20 and 80 years old participated in the study., Results: The prevalence of UI in a female Greek population comprising women aged between 20 and 80 years was 27%. The impact was proportional to the frequency and severity of the UI. UI had no effect or only a mild effect on patients' quality of life., Conclusion: Significant improvement is required in patient information about the nature of UI and its effects on life, and about available treatments (conservative and surgical), and their efficacy and complications.

The primary cause of stress incontinence is birth traumata. However, obesity, asthma, chronic constipation or hard physical work can also overtax the pelvic floor and lead to injury of the connective tissue and a slackening of the ligamentous apparatus. Pelvic floor defects are initially diagnosed simply through a thorough urogynaecological examination. To predict the success of a surgical treatment, the functions can be tested by performing simulated operations.

Through modern surgical procedures, a reconstruction approaching the physiological anatomical conditions can be achieved. According to the integral theory, the typical symptoms are assigned to an anterior, middle and posterior zone of damage. Surgical treatment of female urinary incontinence consists of refixation of the slackened supporting ligaments of the vagina, bladder and urethra. Furthermore, the slackening of the vaginal wall, which arose from the defects of the pelvic floor are corrected. With the aid of minimally invasive interventions usually using the vaginal approach, tapes and meshes are introduced that are also used to repair hernias.

Several million women suffer from urinary incontinence in Germany. Stress and urge incontinence are especially clinically relevant. Training of the pelvic floor muscles (vaginal cones, electrical stimulation, biofeedback, and so forth) plays a central role in the conservative therapy of stress incontinence. The use of devices such as incontinence tampons and urethral pessaries is also common. A medication for the therapy of stress incontinence, which improves the closure of the urethral sphincter, has been on the market since 2004. In the operative area,the insertion of a tension-free vaginal tape (TVT) has gained acceptance in recent years. Anticholinergics are the primary medication used in the treatment of urge incontinence. Local estrogens, low frequency electrical stimulation, phytotherapeutics and the like have supportive effects.

The conventional investigations, gynaecological examination and cystoscopy give very little information about the causes of incontinence. History taking makes it possible to divide the symptoms into either stress- or urge incontinence. Cystometry, lateral voiding cysto-urethrography and urodynamic examination including sphincter EMG enable us to divide the pathological conditions into suspension defects and bladder dysfunctions. The suspension defects are bladder base insufficiency, vesical descensus and trigonocele. The operation of choice for these conditions depends on whether the suspension defect is anterior or posterior. The bladder dysfunctions are supranuclear and infranuclear neurogenic dysfunctions. The treatment in these cases will ordinarily be medical.

A new technique for transvaginal closure of the urethra and placement of a suprapubic catheter in 4 patients with total urinary incontinence gave excellent results with all patients remaining dry and accepting the suprapubic catheter. Suspension of the invaginated, closed urethra by sutures, passed through the bladder, is believed to reduce the risk of inadequate healing of the urethra. However, extreme obesity and extensive fibrosis of the periurethral tissue especially with adhesions to the pubic bone are contraindications to the transvaginal approach.

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., (© 2021. Crown.)

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.

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.

Introduction and Hypothesis: Accurate identification of female populations at high risk for urinary incontinence (UI) and early intervention are potentially effective initiatives to reduce the prevalence of UI. We aimed to apply machine-learning techniques to establish, internally validate, and provide interpretable risk assessment tools., Methods: Data from a cross-sectional epidemiological survey of female urinary incontinence conducted in 2022 were used. Sociodemographic and obstetrics-related characteristics, comorbidities, and urinary incontinence questionnaire results were used to develop multiple prediction models. Seventy percent of the individuals in the study cohort were employed in model training, and the remainder were used for internal validation. Model performance was characterized by area under the receiver-operating characteristic curve (AUC) and calibration curves, as well as Brier scores. The best-performing model was finally selected to develop an online prediction tool., Results: The results showed that bothersome stress urinary incontinence (BSUI) occurred in 9.6% (849 out of 8,830) of parous women. The XGBoost model achieved the best prediction performance (training set: AUC 0.796, 95% confidence interval [CI]: 0.778-0.815, validation set: AUC 0.720, 95% CI: 0.686-0.754). Additionally, the XGBoost model achieved the lowest (best) Brier score among the models, with sensitivity of 0.657, specificity of 0.690, accuracy of 0.688, positive predictive value of 0.231, and negative predictive value of 0.948. Based on this model, the top five risk factors for the development of BSUI among parous women were ranked as follows: body mass index, age, vaginal delivery, constipation, and maximum fetal birth weight. An online calculator was provided for clinical use., Conclusion: The application of machine-learning algorithms provides an acceptable, though not perfect, prediction of BSUI risk among parous women, requiring further validation and improvement in future research., Competing Interests: Declarations. Ethics Approval: Ethical approval was granted by the Ethical Review Committee of Fujian Maternity and Child Health Hospital, Fuzhou, PR China (Number:2023KYLLR01045). Conflicts of Interest: None., (© 2024. The International Urogynecological Association.)

Introduction and Hypothesis: Identifying the factors influencing the development of female urinary incontinence (UI) may facilitate early intervention, potentially delaying its progression. This study was aimed at investigating the impact of lifestyle habits on the severity of UI among women in East China., Methods: This study included 414 women from six communities in East China who reported symptoms of UI and was conducted between September and December 2020. Data were collected using a general information questionnaire, the Toileting Behaviours: Women's Elimination Behaviours scale, and the International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form Chinese Version. Participants were categorised into two groups: those with mild UI and those with moderate-to-severe UI. Propensity-score matching was performed to balance confounding factors, and logistic regression was used to explore the relationship between lifestyle behaviours and UI severity., Results: A total of 117 pairs were successfully matched. Logistic regression analysis revealed that daily perineal cleaning significantly protected against moderate-to-severe UI (p < 0.05). Conversely, living alone, poor sleep quality and hovering over the toilet while voiding were identified as independent risk factors for moderate-to-severe UI (p < 0.05)., Conclusion: Several lifestyle habits significantly impact the severity of UI among adult women. Screening for mild urinary leakage symptoms and implementing timely interventions are crucial for preventing the aggravation of UI and improving ability to work and quality of life., (© 2024. The International Urogynecological Association.)

Introduction and Hypothesis: The differential diagnosis of urinary symptoms may allow health professionals to establish a therapeutic objective and to choose the appropriate treatment for the patient's complaint. The aim of this study was to cross-culturally adapt the Three Incontinence Questionnaire (3IQ) into Brazilian Portuguese (3IQ-Br) and to analyze test-retest reliability, construct, and criterion validity in women., Methods: The cross-cultural adaptation of the 3IQ-Br included forward-translation, back-translation, and consensus among an expert committee. Participants with and without urinary incontinence (UI) completed the 3IQ-Br, King's Health Questionnaire (KHQ), and Questionnaire for Female Urinary Incontinence Diagnosis (QUID-Br). Only women with UI answered 3IQ-Br after 7-10 days. Test-retest reliability and construct validity were analyzed using the Cohen linear kappa (k). The 3IQ-Br accuracy was analyzed using the area under the curve (AUC) of the receiver-operating characteristic (ROC) curve, considering the sensitivity and specificity to correctly classify women with and without UI., Results: The reliability of each question from the 3IQ-Br was considered substantial in the test-retest. The agreement among 3IQ-Br, QUID-Br, and KHQ was almost perfect for UI diagnosis (k > 0.8). The 3IQ-Br was considered to have good accuracy in distinguishing women with UI considering the KHQ (AUC 0.83, 95% confidence interval [CI] 0.78 to 0.87, p < 0.001), and fair to the QUID-Br (AUC 0.73, 95% CI 0.68 to 0.78; p < 0.001)., Conclusions: The results of this study showed that this version of the 3IQ-Br has acceptable measurement properties for identifying and differentiating UI symptoms in Brazilian women., (© 2022. The International Urogynecological Association.)

Introduction and Hypothesis: The association of vitamin D deficiency with female urinary incontinence is unclear., Methods: A systematic review of English and non-English articles was conducted. All observational studies in databases including PubMed, EMBASE, the Cochrane Library Trials Register, and Google Scholar were searched until 5 October 2020. Additional studies were identified by contacting clinical experts and searching the bibliographies and abstracts of the compiled articles. Search terms included urinary incontinence and vitamin D. Article data, including study quality indicators, were independently extracted by two authors using predefined data fields., Results: Two cohort studies, four case-control studies and five cross-sectional studies were included in the qualitative synthesis. Two cohort studies and one cross-sectional study, with a total of 2501 females, were included in the meta-analysis. Heterogeneity among the three studies was not observed (I2 = 0.0%, P = 0.69). All pooled analyses were based on fixed-effects models. No difference in vitamin D level was observed between the urinary incontinence group and the control group (mean difference 0.07 ng/ml; 95% confidence interval [CI] -0.57-0.72, P = 0.81, I2 = 0%)., Conclusions: Our meta-analysis revealed that adult females with urinary incontinence did not have lower serum vitamin D levels than control females., (© 2021. The International Urogynecological Association.)

Objective: To determine the distribution of urinary incontinence (UI) symptoms and their relation to childbirth events., Methods: This cross-sectional study used a structured self-administered questionnaire that included the Questionnaire for Female Urinary Incontinence Diagnosis and the Urogenital Distress Inventory Short Form. The study included 802 women sampled from four primary health care centers in Dammam, KSA. A chi-square test and adjusted logistic regression models were used to examine the relation between UI symptoms and obstetric events., Results: Of the participants, 56.6% (n = 454) had at least one UI symptom. Symptoms were most commonly associated with grand multiparity (80.47%), a history of abortion (72%), assisted vaginal delivery (70%), an age of ≤ 18 years at first birth (66.67%) and ≥ 35 years at last birth (75.48%), and a history of macrosomia (84.62%) and episiotomy (67.89%). Unlike the risk of urgency UI, the risk of stress UI was statistically significantly linked to obstetric events. Grand multiparity was associated with a higher risk of both stress UI (odds ratio [OR]: 3.75, confidence interval [95% CI]: 1.68-8.40) and urgency UI (OR: 2.87, 95% CI: 1.07-7.73)., Conclusion: UI symptoms are common among grand multiparas. Unlike urgency UI, stress UI is associated with previous obstetric events.

Introduction and Hypothesis: The objective of this study was to utilize objective citation analyses to describe the 100 most cited articles in the field of Female Pelvic Medicine & Reconstructive Surgery (FPMRS) and to review their characteristics., Methods: We searched the Thomas Reuters Web of Science database for the most cited articles within all journals classified as Obstetrics and Gynecology (Ob/Gyn), Urology (Uro), Colorectal Surgery (CRS), and vital General Medicine (GM) journals (New England Journal of Medicine; Journal of the American Medical Association; Lancet; The BMJ). We reviewed search results for FPMRS content and compiled a list of the top 100 most cited articles relevant to FPMRS., Results: We screened 34,934 articles yielded by the initial search and compiled the 100 most cited articles relevant to FPMRS. Of these 100 titles, 40% (42 out of 105) were published in Ob/Gyn, 46.7% (49 out of 105) in Uro, 1.9% (2 out of 105) in CRS, and 11.4% (12 out of 105) in GM journals. The most cited FPMRS article was "The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society" (3,810 total and 242 citations per year). Over half the articles were observational in nature and the majority (58%) of them were related to urinary incontinence in women., Conclusions: Highly cited FPMRS articles come from a variety of journals, and nearly 50% of the 100 most cited FPMRS articles are from the urology literature. The most cited articles were largely observational rather than interventional studies and mostly related to female urinary incontinence.

Introduction and Hypothesis: Studies have observed a significant heterogeneity in efficacy data for single-incision minislings (SIMS) as surgical treatment for female urinary incontinence (UI). Our study aim was to test the hypothesis that different vaginal kits for SIMS have different long-term outcomes., Methods: One hundred and twenty women with stress (SUI) or mixed (MUI) UI were enrolled in a multicenter randomized clinical trial (registration number NCT00751088) and treated with three different SIMS (Ajust, MiniArc, or TVT Secur System). Duration of follow-up was at least 24 months from surgery. The primary outcome was the subjective cure rate at 24 months from surgery; secondary outcomes were rates of total failure and reoperations for UI., Results: At study end, no difference was detected between groups in terms of total subjective cure rate [21 (52.5%) vs. 26 (65.0%) vs. 21 (52.5%), in Ajust, MiniArc, and TVT Secur System group, respectively; P = 0.412] or in terms of total failure rate [24 (60.0%) vs. 22 (55.0 %) vs. 27 (67.5 %), in Ajust, MiniArc, and TVT Secur System group, respectively; P = 0.432]. The proportion of patients who received a second surgery for UI was also not significantly different between groups [13 (32.5%) vs. 10 (25.0%) vs. 13 (32.5%), in Ajust, MiniArc, and TVT Secur System, respectively; P = 0.831]., Conclusion: The long-term efficacy of SIMS does not differ between the vaginal kits examined.

Introduction and Hypothesis: The purpose of this study is to assess the incidence of female urinary incontinence (UI), risk factors, severity, and functional limitation using a cross-sectional survey in an Italian region., Methods: The method employed in this study was a questionnaire-based interview on non-institutionalized women. Outcomes were the UI prevalence, severity, associated factors, and functional limitation (ICIQ score)., Results: From October 2008 to February 2009, 1,346 women were interviewed and 15.3% were affected by UI. Univariate analysis found different risk factors, but multivariate analysis revealed only pelvic floor surgery, diabetes, vaginal deliveries, age, and educational level as significant. The involuntary loss of stools was more common in incontinent patients compared with healthy participants. The ICIQ values were significantly different between healthy and incontinent participants and a positive correlation existed with the estimated daily urine loss (r = 0.885, p < 0.001)., Conclusions: Symptoms of UI affected a substantial proportion of the population investigated. Pelvic floor surgery, diabetes, and vaginal deliveries are the most significant risk factors implicated.

Purpose: To determine effectiveness of Group BMP in managing female urinary incontinence (UI), using a standardized protocol taught to adult incontinent women., Materials and Methods: Forty-four adult women with slight to severe UI had baseline parameters collected (UI questionnaires, 3-day voiding diary, pelvic floor muscle strength testing, 24-h pad test, and cough stress test) and were randomized to a control group (CG) with no treatment and a treatment group (TG) who underwent a single group session lecture by two trained urology nurses on BMP followed 2-4 weeks later with individualized assessment of knowledge acquired and reinforcements if needed. The same baseline measures were collected after 6-8 weeks, and statistical analysis comparing changes within groups and between CG and TG were performed., Results: Baseline data for both groups showed no statistically significant difference except for an age difference. At 6-8 weeks post-intervention, a statistically significant higher proportion of the TG (52.2%) improved when compared to the CG (16.7%). Also, the TG showed statistically significant improvement in 24-h voids, reduced leak diameter on cough test, improved pelvic muscle strength in pressure score, displacement, and duration, respectively, compared to their baseline pre-intervention data. The CG had only a statistically significant change for displacement score., Conclusions: Group session teaching of BMP by trained urology nurses reduces UI severity, increases pelvic floor muscle strength, and reduces voiding frequency. This pilot study may precede establishment of single session Group BMP as both preventive and therapeutic for a cost-effective broad-based program in the future.

The objective of this study was to evaluate comorbidity and risk factors associated with female urinary incontinence and to assess quality of life for women with different types of urinary incontinence. Subjects included 551 consecutive females who attended the outpatient clinic from 9 March to 8 July 2006 and did not have a chief complaint of incontinence. A four-item incontinence questionnaire and a Chinese version of the Incontinence-Quality of Life (I-QOL) questionnaire were completed in the waiting room. Patient characteristics and medical conditions were summarized from outpatient electronic databases. A total of 371 females were included for statistical analysis. Among them, 114 patients (30.7%) did not indicate any urinary incontinence, while 257 (69.3%) patients indicated symptoms of urge incontinence, stress incontinence, or mixed incontinence. Comorbidities significantly associated with incontinence included osteoarthritis (P = 0.001), peptic ulcer disease (P = 0.031), obesity (P < 0.001), and cardiac disease (P < 0.001). After multiple logistic regression analysis, obesity (OR 3.38, 95% CI 1.94-6.98) and postmenstrual status (OR 2.17, 95% CI 1.35-3.50) were found to be risk factors of incontinence (P < 0.001). Mixed incontinence patients exhibited the least satisfaction in quality of life, while no significant differences were observed between patients with urge incontinence and stress incontinence. In conclusion, the incidence of urinary incontinence may be greater in the outpatient population than previously thought. Osteoarthritis, peptic ulcer disease, and cardiac disease are more common in women with urinary incontinence, obesity and postmenopausal status appear predictive of incontinence, and women with mixed incontinence exhibit the least satisfying quality of life.

Unlabelled: Not only do anatomy and function of the pelvic floor play an important role as possible causes of female urinary incontinence, they are also crucial for its therapy. The aim of this case control study of female geriatric patients with symptoms of urinary incontinence was to determine the knowledge about their pelvic floor and to assess their ability to contract pelvic floor muscles voluntarily and reflexly., Methods: A total of 377 female geriatric patients with symptoms of urinary incontinence were investigated in a Basis Assessment for Urinary incontinence. The ability to contract their pelvic floor muscles was examined by a digital vaginal palpation. The extent of the registered muscle strength was graded by the Modified Oxford Grading Scale by Laycock (1994)., Results: Of the patients, 65.5% were not aware of their pelvic floor and were not able to contract the pelvic floor muscles (Grade 0 to 1 by Laycock), 22% had an inaccurate knowledge and only performed an insufficient pelvic floor muscle contraction (Grade 2 by Laycock). Only 12.5% could contract their pelvic floor muscles properly (Grade 3 to 4 by Laycock). A subgroup of 83 patients had already absolved pelvic floor exercises in the past, 80 patients with conventional instructions, 3 patients with digital vaginal control. In this subgroup 54.2% of the patients were not able to contract the pelvic floor muscles (Grade 0 to 1 by Laycock) 25.3% only performed an insufficient contraction (Grade 2 by Laycock), while 20% were able to perform a sufficient and powerful contraction (Grade 3 to 4 by Laycock). The three patients in the past controlled by a digital vaginal palpation were part of this group and managed a pelvic floor muscle strength Grade 4 by Laycock. A high percentage of female geriatric patients with symptoms of urinary incontinence have a lack of understanding regarding the position and function of their pelvic floor. These results suggest that conventional pelvic floor muscle exercises without specific control are not an appropriate method to improve geriatric patients' ability to contract their pelvic floor muscles and to prevent urine leakage.

The present work deals with the indication and results of 1102 urodynamic examinations on 776 patients, grouped according to the various medical departments from which they were assigned. The interdisciplinary importance of these examinations was emphasized by the fact that urodynamic examinations turned out to be necessary in patients from gynaecological, urological, neurological, pediatric, surgical and medical departments. After the usual gynaecological, urological, radiological and neurological examinations, a detailed case history was obtained with the help of a questionnaire and cystometry, uroflowmetry, and/or simultaneous vesico-urethrotonometry was carried out on each patient, depending on the medical evidence. The results, which were listed according to assignment from the various medical departments, show that urinary disturbances occur in all the medical fields mentioned above and that they cannot be treated successfully without a previous urodynamic examination. We were able to differentiate the various forms of female urinary incontinence of gynaecological patients, as well as various forms of neurogenic bladder disturbances of the patients from all the other medical departments. A broad discussion deals with the complexity of the subject and shows the possibilities of a small, but easily and quickly usable urodynamic examination programme at a general hospital.