Search

Objective: To investigate how reproductive history was associated with urinary incontinence in midlife. Design: A follow‐up study. Setting: Denmark. Population: A total of 39 977 mothers who participated in the Maternal Follow up (2013–2014) in the Danish National Birth Cohort. National registries provided their reproductive history. Methods: How parity, mode of birth and obstetric tears associated with urinary incontinence were estimated with adjusted odds ratios (OR) and 95% CI using logistic regression. Main outcome measures: Self‐reported urinary incontinence including subtypes stress, urge and mixed urinary incontinence. Results: At an average age of 44 years, the prevalence of any urinary incontinence was 32% (21% stress, 2% urge, and 8% mixed urinary incontinence). Women with two births more often had urinary incontinence than women with one birth (OR 1.20, 95% CI 1.10–1.31). Compared with women with only spontaneous births, a history of only caesarean sections was associated with much lower odds of urinary incontinence (OR 0.39, 95% CI 0.35–0.42) and a history of instrumental births with slightly lower odds (OR 0.92, 95% CI 0.86–0.98). Compared with no tear/first‐degree tear as the largest tear, episiotomy was associated with less urinary incontinence (OR 0.91, 95% CI 0.86–0.97) whereas third/fourth‐degree tears were associated with more (OR 1.14, 95% CI 1.04–1.25). Findings were mainly explained by similar associations with stress and mixed urinary incontinence. Conclusions: Vaginal birth was associated with a higher risk of long‐term urinary incontinence, but our results indicate that this risk may be reduced by shortening the second stage of birth. [ABSTRACT FROM AUTHOR]

Introduction: Staged sacral neuromodulation (SNM) testing has been shown to have a high rate of progression to permanent implantation for the management of voiding dysfunction. Stage 1 lead placement (SNM‐I) can be performed under monitored anesthesia care (MAC) or general anesthesia (GA). MAC allows for interpretation of sensory and motor responses to optimize lead placement while GA only permits for motor assessment. However, patient discomfort and movement can make lead placement challenging during MAC. Herein we evaluate whether the anesthesia type impacts the progression rate to permanent implantation (SNM‐II). Materials and Methods: A retrospective chart review was performed for patients who underwent SNM‐I in the operating room for wet overactive bladder between 2005 and 2023. Patients were divided into two groups based on the type of anesthesia used, MAC or GA. Clinical variables and progression to SNM‐II were compared between cohorts. Progression to SNM‐II was based on ≥50% symptomatic improvement during a 1−2 week trial period following SNM‐I. Results: Of 121 patients included in the study, 95 (79%) underwent MAC and 26 (21%) GA for SNM‐I. No difference in the progression rate to SNM‐II was noted between groups (MAC, 68/95 patients, 72%; GA, 19/26, 73%; p = 0.39). We also found no difference when comparing the GA group to the 26 most recent MAC patients (MAC, 20/26 patients, 77%; GA, 19/26, 73%; p = 0.48). Conclusion: Types of anesthesia for SNM‐I did not affect rate of progression to SNM‐II. The result lends support to the reliance on motor responses alone for lead placement during SNM‐I. [ABSTRACT FROM AUTHOR]

Increased urinary incontinence is one of the most common changes during menopause. This study aimed to investigate the effect of Nigella sativa L. seed oil on urinary incontinence and quality of life (QoL) (primary outcomes) and sexual function (secondary outcome) in menopausal women. In this triple‐blind randomized controlled trial, 60 women in Tabriz‐Iran were equally allocated into two treatment and control groups using block randomization. The women applied 2–3 drops of Nigella sativa L. seed oil or placebo on their stomachs below the novel twice a day for 8 weeks. The data collection instruments were completed at baseline and just after the intervention. After intervention, the mean rank score of mixed urinary incontinence was significantly lower (p =.04) and the mean score of the incontinence‐QoL was significantly higher (mean difference 12.63, 95% CI 2.33 to 22.93; p =.017) in the treatment group than the control group. However, there were no significant differences in stress incontinence, urge incontinence, sexual function, and menopause‐specific QoL of women between the groups (p >.05). The results indicated the positive effect of the Nigella sativa L. seed oil on mixed incontinence and incontinence‐QoL; nevertheless, to make a certain conclusion, further studies are required. [ABSTRACT FROM AUTHOR]

Subject of the Debate: "Urethral failure is a critical factor in female urinary incontinence Now what?" The CASE FOR by Hokanson, DeLancey pinpointed inadequacy of bladder causation for urgency urinary incontinence (UUI) and poor urethral support for stress urinary incontinence (SUI) as responsible for long‐standing lack of progress in incontinence science. They proposed "Urethral failure" as causation for SUI and UUI. The CASE AGAINST, by Peter Petros agrees "abnormal detrusor function as cause for (UUI) is a failed concept, and SUI surgery results are sometimes suboptimal, but rejects "urethral failure" as cause for UUI and SUI. In answer to, "Now what?," Petros presents the Integral Theory System. SUI and UUI are dysfunctions of the bladder's binary control mechanism, mainly ligament laxity because of defective collagen/elastin. The urethra is an emptying tube. Pelvic muscle forces reflexly contract against ligaments to close urethra, open it (micturition) and stretch the vagina underlying urethelial stretch receptors to mechanically support them, preventing premature activation of micturition (UUI). High validated cure rates for SUI and UUI by repair of weakened ligaments question viability of the "urethral failure" concept. Conclusions: The major achievement of this debate (both sides) is not what causes UUI or SUI, or what doesn't, though clearly, this is important. It is calling out a 50‐year ossification of the whole construct of UUI, ranging from flawed definitions to systematic denial of known cures, all of which have stalled treatment of the one billion women who suffer with incontinence. The time has come for change. [ABSTRACT FROM AUTHOR]

Objective: The increasing wealth of clinical data may become unmanageable for a physician to assimilate into optimal decision‐making without assistance. Utilizing a novel machine learning (ML) approach, we sought to develop algorithms to predict patient outcomes following the overactive bladder treatments OnabotulinumtoxinA (OBTX‐A) injection and sacral neuromodulation (SNM). Materials and Methods: ROSETTA datasets for overactive bladder patients randomized to OBTX‐A or SNM were obtained. Novel ML algorithms, using reproducing kernel techniques were developed and tasked to predict outcomes including treatment response and decrease in urge urinary incontinence episodes in both the OBTX‐A and SNM cohorts, in validation and test sets. Blinded expert urologists also predicted outcomes. Receiver operating characteristic curves were generated and AUCs calculated for comparison to lines of ignorance and the expert urologists' predictions. Results: Trained algorithms demonstrated outstanding accuracy in predicting treatment response (OBTX‐A: AUC 0.95; SNM: 0.88). Algorithms accurately predicted mean decrease in urge urinary incontinence episodes (MSE < 0.15) in OBTX‐A and SNM. Algorithms were superior to human experts in response prediction for OBTX‐A, and noninferior to human experts in response prediction for SNM. Conclusions: Novel ML algorithms were accurate, superior to expert urologists in predicting OBTX‐A outcomes, and noninferior to expert urologists in predicting SNM outcomes. Some aspects of the physician–patient interaction are subtle and uncomputable, and thus ML may complement, but not supplant, a physician's judgment. [ABSTRACT FROM AUTHOR]

Introduction: Management of idiopathic overactive bladder (iOAB) after the failure of sacral nerve modulation (SNM) is very challenging. To the best of our knowledge, no study has evaluated the use of botulinum toxin A (BoNT‐A) after SNM failure for iOAB. The aim of this study is to evaluate the tolerance and efficacy of BoNT‐A injection after the failure of SNM for iOAB. Methods: We conducted a retrospective multicentric analysis of all patients who had received either onabotulinumtoxinA or abobotulinumtoxinA intradetrusor injection for iOAB after SNM failure, between January 2004 and December 2017. The primary outcome was the percentage of success of first BoNT‐A injection (either resolution of their urinary incontinence or their frequency or more than 50% reduction in frequency). Secondary outcomes were results of urodynamic studies, complications, total number of injections, causes of withdrawal, and subsequent treatment. Results: Seventy‐six patients (62 female) were included. The percentage of success of first BoNT‐A injection was 43.4% (n = 33). All overactive bladder symptoms were significantly improved on the 3‐day bladder diary. Twenty‐eight patients (36.8%) were put under clean intermittent self‐catheterization transitory. After a mean follow‐up of 57.7 (±38.5) months, median number of injections was 2 (1‐15). Overall, 42 patients (55.2%) stopped injections during follow‐up. The estimated 36‐months discontinuation‐free rate was 48.1%. Mean cause of discontinuation was a primary failure (n = 32; 42.1%). Conclusion: BoNT‐A can be used in SNM nonresponders with a success rate of 43.4% but is associated with a high long‐term discontinuation rate. [ABSTRACT FROM AUTHOR]

Aims: To analyze factors related to the incidence and remission of stress urinary incontinence (SUI), urge urinary incontinence (UUI), and mixed urinary incontinence (MUI) among women at midlife. Methods: A total of 2115 women participants in a prospective longitudinal survey (GAZEL cohort) were included. In 2000 and 2008, a specific questionnaire about urinary incontinence (UI) symptoms was sent to all participants. Incidence, remission, and risk factors associated with each type of UI were considered. Results: Within our population followed up for 8 years, we observed an overall incidence rate of UI of 21.9% (95% CI, 19.6‐24.2%) and a remission rate of 33.3% (30.1‐36.5%). For the different UI types, the incidence and remission rates were respectively 14.9% (12.9‐24.2%) and 37.9% (37.8‐42.0%) for SUI, 3.2% (2.2‐4.2%) and 25.5% (3.5‐37.5%) for UUI, 3.1% (2.1‐4.1%) and 24.6% (19.3‐29.9%) for MUI. Educational level, increase in body mass index (BMI), BMI and depression at inclusion were associated with SUI incidence. The history of surgery for UI was associated with the incidence of UUI and MUI. Surgery for SUI was significantly associated with remission, while pelvic floor rehabilitation and vaginal delivery were significantly associated with a lower SUI remission. Vaginal delivery was also negatively associated with MUI remission. Conclusions: The influence of the standard risk factors seems to differ in each type of UI. [ABSTRACT FROM AUTHOR]

Objectives: To systematically review and meta‐analyse the impact of bariatric surgery on obese patients with urinary incontinence (UI). Methods: A search of the Medical Literature Analysis and Retrieval System Online (MEDLINE), the Excerpta Medica dataBASE (EMBASE), Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and PubMed to June 2018 was performed using methods pre‐published on the International Prospective Register of Systematic Reviews (PROSPERO). Reporting followed the Preferred Reporting Items for Systematic Review and Meta‐analysis (PRISMA) guidelines. Studies comparing UI status in obese patients before and after bariatric surgery were included. Primary outcomes were the improvement or complete resolution of any UI, stress UI (SUI), and urgency UI (UUI). Secondary outcomes were validated UI questionnaire scores. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach assessed overall quality of evidence. Results: In all, 33 cohort studies (2910 patients) were included (median follow‐up 12 months). Bariatric surgery resulted in improvement or resolution of any UI in 56% (95% confidence interval [CI] 48–63%), SUI in 47% (95% CI 34–60%), and UUI in 53% (95% CI 32–73%) of patients. Moreover, bariatric surgery significantly decreased (P < 0.001) questionnaire scores such as: the Urogenital Distress Inventory by 13.4 points (95% CI 7.2–19.6), International Consultation on Incontinence Questionnaire by 4.0 points (95% CI 2.3–5.7), and Incontinence Impact Questionnaire by 5.3 points (95% CI 3.9–6.6). However, worsening or new onset of UI was present in 3% of patients. The quality of evidence was very low for all outcomes. Conclusion: Half of obese patients report improvement or resolution of UI after bariatric surgery, but overall the quality of evidence is very low. Comparative studies examining the benefits of bariatric surgery in obese patients with UI are warranted. [ABSTRACT FROM AUTHOR]

Aims: Overactive bladder (OAB) affects over 17% of the population and significantly effect the health‐related quality of life. The treatments for OAB include first line (lifestyle modification, pelvic floor muscle training), second line (anticholinergic or beta‐3 agonist medications), and third line therapies (intradetrusor botulinum toxin injection, sacral neurostimulation [SNM], or percutaneous tibial nerve stimulation [PTNS]). For those with urinary incontinence secondary to OAB, complete continence is the goal of therapy, though cure rates are only 5% to 40%. The use of combination therapies can be employed in refractory OAB, however, the efficacy of pooled modalities is relatively unknown. Our objective was to determine the volume of data supporting combination therapy in treating OAB. Methods: We systematically reviewed PubMed, EMBASE, the Cochrane Library, and Google Scholar for articles published before October 2018. Each was independently reviewed by two reviewers and examined in detail if they met inclusion criteria. Results: A total of 32 studies met inclusion criteria and were reviewed. Most large prospective studies evaluated combinations of medications with behavioral therapy or medications together. Combination therapy studies of third‐line treatments were rare and centered on medication with PTNS. No studies examined intradetrusor botulinum toxin injections in combination with another therapy and only one retrospective study briefly examined SNM therapy in combination with medication. Conclusion: Combination therapy, with certain first, second, and third‐line OAB therapies, appears to be efficacious. There is a further need for carefully designed combination therapy studies, particularly those including third line modalities. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present study was to investigate associations between urethral sensation and urge urinary incontinence (UUI) in patients with and without detrusor overactivity (DO). Methods: The medical records of 80 consecutive patients who underwent filling cystometry and urethral current perception threshold (CPT) tests were examined retrospectively. Following the exclusion of 4 patients not eligible for analysis, patients were classified into neurogenic DO, idiopathic DO, or DO‐negative groups based on neurological and cystometric findings (n = 30, 12, and 34, respectively). Eleven DO‐negative patients were defined as normal controls on cystometrograms (CMG) using the following exclusion criteria: bladder compliance <12.5 mL/cmH2O, volume >275 mL at first filling sensation, and comorbidities possibly affecting lower urinary tract function. Thus, 53 patients were finally included in the study. Proximal urethral CPT was evaluated with intraurethral square‐wave stimulation at 3 Hz to activate C‐fiber afferents. Results: Median CPT was higher in neurogenic and idiopathic DO than in the normal CMG group (11.3 and 9.0 vs. 2.8 mA, respectively; P < .05), as well as in patients with UUI (n = 19) compared with non‐UUI patients (n = 34; 12.5 vs. 5.4 mA, respectively; P < .05). The proportion of UUI patients was significantly greater in the DO‐positive groups than in the normal CMG group (P < .05). CPTs were not associated with bladder capacity at the first filling sensation (r = 0.11). Conclusion: Hyposensitive C‐fibers of the proximal urethra may contribute to the development of urodynamic DO as well as UUI in patients complaining of lower urinary tract symptoms. [ABSTRACT FROM AUTHOR]

Objective: To analyze via the Andersen model what leads women with urinary incontinence (UI) to seek help and remain in the healthcare system.Methods: An interpretative phenomenologic study enrolling women aged 18 years or older who were diagnosed with UI at a tertiary care hospital in Chile between January and March 2016. Data were collected by semi-structured interview. The categories explored experience with UI and reasons for seeking health care, and included the dimensions of the Andersen model.Results: Ten women were enrolled. Characteristics that eased or hindered healthcare seeking were identified to come from the women (frequency and quantity of symptoms, coping strategies, and beliefs about its causes) and from their environment (reaction of partner, family, or coworkers to her condition). Some were associated with primary care (human and/or technical resources) and some with secondary care (pelvic floor units).Conclusion: The results reflect the complexities of asking for health care for women with UI, especially in a country such as Chile with different healthcare levels. Raising awareness of this complexity and developing an approach that includes all stakeholders (institution, community, and family) is crucial for professionals who want to offer both medical therapy and wellness-focused healthcare. [ABSTRACT FROM AUTHOR]

Abstract: Aim: The aim of this study was to compare the efficacy and tolerability of solifenacin and mirabegron in patients with overactive bladder (OAB) syndrome. Methods: We carried out a retrospective analysis in 342 women affected by OAB syndrome; 168 were treated with solifenacin 5 mg/daily and 174 with mirabegron 50 mg/daily. A clinical evaluation, 3‐day voiding diary, and urodynamic testing was performed. Patients completed the Overactive Bladder Questionnaire – Short Form, the King's Health Questionnaire, and the Patient Global Impression of Improvement questionnaire. The adverse effects were evaluated. The two groups were compared at baseline and at 12 weeks. Results: After 12 weeks, a significant reduction in the mean number/24 h of voids and urgent micturition episodes/24 h was observed in both groups. Detrusor overactivity decreased from 58.3% to 13.1% in the solifenacin group and from 58% to 11% in the mirabegron group. Twenty (12%) and 18 (10.7%) patients taking solifenacin reported constipation and dry mouth, respectively, versus four (2.3%) and five (2.9%) patients taking mirabegron, respectively, but there was no difference between the groups in the change in vital signs. The Overactive Bladder Questionnaire – Short Form and King's Health Questionnaire scores did not demonstrate significant differences and the abandonment rates in the solifenacin and mirabegron groups were 25.5% and 20%, respectively. Conclusion: Solifenacin and mirabegron showed the same efficacy in the treatment of OAB but solifenacin had more adverse effects. [ABSTRACT FROM AUTHOR]

Aims The overactive bladder syndrome (OAB) is defined as urinary urgency, usually accompanied by frequency and nocturia, with or without urgency urinary incontinence. Biofeedback-assisted pelvic muscle therapy (BAPFMT) is a first-line treatment option for OAB. The aims of this study were to determine the efficacy and effectiveness of BAPFMT on symptoms of OAB after 9 weeks of treatment and to detect changes EMG activity of individual pelvic floor muscles (PFM) with the MAPLe. Methods Patients were randomly divided into an intervention group that received BAPFMT with the MAPLe or into a control group which received only toilet behavior and lifestyle instructions. The Pelvic Floor Inventories (PeLFIs), the King's Health Questionnaire (KHQ), a voiding dairy, a 24 h pad-test, and vaginal EMG registration of the pelvic floor with the MAPLe were used at inclusion and after 9 weeks follow-up to determine the effect of BAPFMT on complaints of OAB and Quality of Life (QoL). Results Fifty-eight patients were included. The PeLFIs, KHQ, voiding dairy, and 24 h pad-test showed significant improvements in the intervention group compared to the control group in complaints of OAB and QoL. EMG activity showed significant improvements for specific individual muscles at the different sides and depths for rest, maximal voluntary contraction, and endurance. Conclusions EMG BAPFMT is effective in the OAB syndrome in women. It significantly reduces symptoms and complaints of OAB and increases QoL for patients. It shows that EMG changes in individual PFM, measured with the MAPLe, are relevant and related to symptom reduction. [ABSTRACT FROM AUTHOR]

Aims Mechanisms underlying pain perception and afferent hypersensitivity, such as central sensitization, may impact overactive bladder (OAB) symptoms. However, little is known about associations between OAB symptom severity, pain experience, and presence of comorbid chronic pain syndromes. This study examined relationships between OAB symptoms, somatic symptoms, and specific chronic pain conditions in which central sensitization is believed to play a primary role, in a community-based sample of adult women with OAB. Methods We recruited adult women with OAB to complete questionnaires assessing urinary symptoms, pain and somatic symptoms, and preexisting diagnoses of central sensitivity syndromes. We analyzed the effects of overall bodily pain intensity, general somatic symptoms, and diagnoses of central sensitivity syndromes on OAB symptom bother and health-related quality of life. Results Of the 116 women in this study, over half (54%) stated their urge to urinate was associated with pain, pressure, or discomfort. Participants reported a wide range of OAB symptoms and health-related quality of life. There was a significant, positive correlation between OAB symptoms and somatic symptoms as well as overall pain intensity. Only 7% of women met diagnostic criteria for fibromyalgia; yet these women demonstrated significantly increased OAB symptom burden and decreased OAB quality of life compared to those without fibromyalgia. Conclusion Women with more severe OAB symptoms reported increased general somatic symptom burden and increased overall body pain intensity, especially women with fibromyalgia. These findings suggest that attributes of pain and co-morbidity with chronic pain conditions may impact the experience of OAB symptoms for many women. Neurourol. Urodynam. 36:1113-1118, 2017. © 2016 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Anticholinergic therapy vs. onabotulinumtoxinA for urgency urinary incontinence. Artificial intelligence, machine learning, overactive bladder, prognostication, urge urinary incontinence, onabotulinumtoxinA Keywords: artificial intelligence; machine learning; onabotulinumtoxinA; overactive bladder; prognostication; urge urinary incontinence EN artificial intelligence machine learning onabotulinumtoxinA overactive bladder prognostication urge urinary incontinence 1041 1042 2 04/29/22 20220401 NES 220401 Urologic pathologies often have multiple effective treatment options. [Extracted from the article]

Aims and Methods The role of combination therapy using oral antimuscarinic medications for the treatment of overactive bladder was proposed at the 2014 International Consultation on Incontinence-Research Society in Bristol, UK to identify key factors to consider when making clinical decisions and to guide future research design. Results Combination therapy is justified if monotherapy is associated with suboptimal efficacy or bothersome side effects. Combination therapy has the potential to improve efficacy with fewer side effects than monotherapy. Two Phase 2 studies comparing combination therapy that included an antimuscarinic demonstrated improvement in mean voided volume, the primary outcome chosen, with some combinations showing improved micturition frequency and quality of life. The two studies found no evidence of an increased safety risk with combination therapy compared to monotherapy. Future studies should use clinically meaningful or patient reported outcomes such as incontinence episodes when comparing efficacy. If surrogate measures are used, a clear justification should be provided. Cost analyses should be planned for clinical research trials evaluating combination drug therapy. Conclusions Combination therapy is reasonable when monotherapy has suboptimal efficacy or bothersome side effects. Future research studies evaluating combination therapy for urgency urinary incontinence should ideally1 be performed as part of a randomized clinical trial,2 evaluate non-responders to monotherapy,3 evaluate combination therapy using medications with different mechanisms of action,4 include clinically meaningful and patient reported outcomes when evaluating efficacy, and5 include cost-effectiveness analyses to justify any increased cost by showing improvement in efficacy or reduction in side effects. Neurourol. Urodynam. 35:288-292, 2016. © 2016 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Objectives To investigate the association between urinary incontinence and female sexual function in a non-clinical population. Methods A self-administered questionnaire was distributed to 2159 female employees of two hospitals. Results Of the 883 sexually active participants, pure stress urinary incontinence was reported in 18.3%, pure urge urinary incontinence in 6.8%, mixed urinary incontinence in 15.1% and no urinary incontinence in 59.8%. The prevalence of female sexual difficulty, defined by the Female Sexual Function Index total score ≤26.55, was 52.0%, 56.1%, 54.3% and 42.2%, respectively ( P < 0.05). After adjustment of age, menstrual status, length of marriage, having children and relationship with the partner, all types of urinary incontinence showed a significant association with female sexual difficulty with an odds ratio of 1.6-1.8. Taking into consideration the individual domains, pure urge urinary incontinence was a risk factor for decreased sexual lubrication and more sexual pain, and mixed urinary incontinence was a risk factor for less sexual satisfaction, whereas pure stress urinary incontinence was not related to a difficulty in individual domains. Conclusions Stress urinary incontinence and urge urinary incontinence are associated with general impairment of female sexual function to a mild degree. Only urge urinary incontinence is related to sexual difficulty in specific domains including sexual lubrication and sexual pain. [ABSTRACT FROM AUTHOR]

Aims To develop a clinically relevant, easy to use, and validated instrument for assessing severity and bother related to urinary incontinence. Methods Survey items were piloted and refined following psychometric principles in five separate patient cohorts. Patient and expert endorsement of items, factor analyses, Spearman rank correlations and response distributions were employed for item selection. Formal reliability and validity evaluation were conducted for the final questionnaire items. Results Expert physicians and patient focus groups confirmed face and content validity for the measure. A 10-item measure called the Michigan Incontinence Symptom Index (M-ISI) was developed with two domains: a Total M-ISI Domain consisting of subdomains for stress urinary incontinence, urgency urinary incontinence, and pad use, and a Bother Domain. High construct validity was demonstrated with a Cronbach's alpha for the Total M-ISI Domain (items 1-8) of 0.90 and for the Bother Domain (items 9-10) of 0.82. Cronbach's alpha for the subdomains were all > 0.85. Construct validity, convergent and divergent validity, internal discriminant validity, and predictive validity were all robust. The minimally important difference for the measure was determined to be 4 points (out of 32) for the Total M-ISI Severity Domain, and 1-2 points (out of 8-12) for the individual subdomains. Conclusions The M-ISI is a parsimonious measure that has established reliability and validity on several levels and complements current clinical evaluative methods for patients with urinary incontinence. Neurourol. Urodynam. 33:1128-1134 , 2014. © 2013 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Objective To study the effect of one vaginal delivery ( VD) compared with one caesarean section ( CS) on the prevalence, severity and bothersomeness of urinary incontinence ( UI) subtypes-stress ( SUI), urge ( UUI) and mixed ( MUI)-20 years after delivery. Design Registry-based national cohort study. Setting Women who returned postal questionnaires (response rate 65.2%) in 2008. Population Primiparae with one birth in 1985-88 ( n = 5236) and no further births. Methods Medical Birth Register data were linked to a questionnaire. Analysis of variance and multivariate analysis were used to obtain adjusted prevalences and odds ratios (adj OR). Main outcome measures Prevalence, risk factors, severity, bothersomeness of UI subtypes. Results The prevalence of SUI, UUI and MUI was 15.3, 6.1, 14.4%, respectively, and was higher for all subtypes after VD versus CS. Moderate to severe incontinence was more prevalent after VD (21.3%) compared with CS (13.5%; adj OR 1.68, 95% confidence interval [95% CI] 1.40-2.03). Bothersome incontinence differed between MUI (38.9%), UUI (27.1%) and SUI (18.0%). The prevalence of bothersome UI was higher after VD compared with CS (11.2 versus 6.3%; adj OR 1.85, 95% CI 1.42-2.39) and consulting a doctor for UI was reported more often after VD than CS. Bothersome MUI occurred in 40.0% of incontinent women after VD compared with 29.9% after CS (adj OR 1.65, 95% CI 1.07-2.54). Symptomatic pelvic organ prolapse was an important modifier of UI with regard to its prevalence, duration, type and bothersomeness. Conclusion The prevalence of SUI, UUI and MUI was higher and moderate to severe UI and bothersome UI were reported more often after VD than CS 20 years after one delivery. [ABSTRACT FROM AUTHOR]

Aims To develop a means to measure the quality of care provided to women treated for urinary incontinence (UI) through the development of quality-of-care indicators (QIs). Methods We performed an extensive literature review to develop a set of potential quality indicators for the management of UI. QIs were modeled after those previously described in the Assessing the Care of Vulnerable Elders (ACOVE) project. Nine experts ranked the indicators on a nine-point scale for both validity and feasibility. We analyzed preliminary rankings of each indicator using the RAND Appropriateness Method. A forum was then held in which each indicator was thoroughly discussed by the panelists as a group, after which the indicators were rated a second time individually using the same nine-point scale. Results QIs were developed that addressed screening, diagnosis, work-up, and both non-surgical and surgical management. Areas of controversy included whether routine screening for incontinence should be performed, whether urodynamics should be performed before non-surgical management is initiated, and whether cystoscopy should be part of the pre-operative work-up of uncomplicated stress incontinence. Following the expert panel discussion, 27 of 40 potential indicators were determined to be valid for UI with a median score of at least seven on a nine-point scale. Conclusions We identified 2 7 quality indicators for the care of women with UI. Once these QIs are pilot-tested for feasibility, they will be applied on a larger scale to measure the quality of care provided to women with UI in the United States. Neurourol. Urodynam. 32:1058-1063, 2013. © 2013 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Please cite this paper as: Chuang C, Lin I, Horng H, Hsiao Y, Shyu I, Chou P. The impact of gestational diabetes mellitus on postpartum urinary incontinence: a longitudinal cohort study on singleton pregnancies. BJOG 2012;119:1334-1343. Objective To determine whether gestational diabetes mellitus (GDM) is an independent risk factor for postpartum urinary incontinence in singleton pregnancies. Design A longitudinal cohort study. Setting A single tertiary-care hospital in Taiwan. Population Pregnant women with term deliveries between 2002 and 2007 ( n = 6653) were consecutively recruited. Methods Logistic regression models were fitted based on generalised estimating equation methods to derive odds ratios for occurrences of type-specific urinary incontinence in the third trimester and at four time-points over 2 years during the postpartum period. Main outcome measures Evaluation of whether GDM is an independent risk factor for postpartum urinary incontinence. Results The full model analysis revealed that GDM was an independent risk factor for all type-specific urinary incontinence (odds ratio [95% confidence interval]: 1.97 [1.56-2.51], 3.11 [2.18-4.43] and 2.73 [1.70-4.40] for stress, urge and mixed incontinence, respectively]. Compared with women without GDM, women with GDM tended to exhibit more severe symptoms of stress incontinence for up to 2 years postpartum, whereas for urge or mixed incontinence, more severe symptoms were found only for 6 months postpartum. Evaluation of quality of life using the Incontinence Impact Questionnaire 7 suggested that women with GDM requiring insulin treatment had a higher likelihood of functional impairment than women with GDM requiring conservative treatment only or women without GDM ( P < 0.05, by the chi-square test for trend). Conclusions GDM was found to be an independent risk factor for postpartum urinary incontinence and had a significant impact on quality of life. Women with GDM should be provided with timely consultation and support once urinary incontinence occurs. [ABSTRACT FROM AUTHOR]

OBJECTIVE • To assess the measurement characteristics of the Patient Perception of Intensity of Urgency Scale (PPIUS) in patients with overactive bladder (OAB). PATIENTS AND METHODS • Adult women with at least a 3-month history of OAB. The design was a 4-week, double-blind, randomized, placebo-controlled trial of transdermal oxybutynin, with a 2-week placebo run-in and 8-week, open-label extension. • Symptom improvement was assessed using 3-day bladder diaries incorporating the PPIUS, and disease-specific health-related quality of life was assessed using the King’s Health Questionnaire (KHQ). Convergent validity was shown by correlation with the KHQ, and other bladder diary variables. Known groups validity was assessed by comparison of baseline mean urge ratings, and urgency episode frequency for continent and incontinent patients, and by comparison with the same measures from a historical control group of 40 asymptomatic female volunteers. • Between- and within-groups responsiveness was assessed using standardized effect sizes (Cohen’s d and effect size r ). Reliability was assessed for the two arms of the trial at different time points and intervals, using intraclass correlation (ICC) and a t -test for the difference between mean scores. RESULTS • In total, 96 women were randomized. Urgency episode frequency showed moderate correlation with total KHQ score ( r = 0.500, P < 0.001) and with daytime and night-time voiding frequency. • There were significant differences in continent and incontinent subgroups for mean urge ratings (difference in means, − 0.61/void, P < 0.001), and urgency episodes (difference in means, − 2.67 episodes/day, P < 0.001), as well as between OAB patients and normal controls (mean urge rating: difference in means 1.22 per void, P < 0.001; urgency episodes: difference in means 2.93 episodes/day, P < 0.001). • Between-groups analysis of effect size found that urgency episode frequency ( d = 0.679, r = 0.321) was more responsive than mean urge rating ( d = 0.480, r = 0.233). In both subgroups, urgency episode frequency ( d = 0.421-0.454, r = 0.206-0.222) had better within-groups responsiveness than mean urge rating. • Urgency episodes (ICC, 0.65-0.81) were measured more reliably than urgency urinary incontinence episodes (ICC, 0.50-0.65). CONCLUSIONS • Assessment of urgency episodes using the PPIUS shows good reliability, excellent known groups validity, high responsiveness and convergence with subjective measures of severity. • PPIUS is freely available, and should be useful in both clinical practice and research studies when assessing women with urgency, with or without urgency urinary incontinence. [ABSTRACT FROM AUTHOR]

OBJECTIVE To evaluate the urodynamic data before and 6 months after implantation of sacral neuromodulation (SNM, an established treatment for voiding dysfunction, including refractory urge urinary incontinence, UI) and to assess the correlation between the urodynamic data and clinical efficacy in patients with UI. PATIENTS AND METHODS In all, 111 patients with a >50% reduction in UI symptoms during a percutaneous nerve evaluation test qualified for surgical implantation of SNM. Patients were categorized in two subgroups, i.e. those with UI with or without confirmed detrusor overactivity (DO) at baseline. At the 6-month follow-up all patients had a second urodynamic investigation, with the stimulator switched on. RESULTS At baseline, there was urodynamically confirmed DO in 67 patients, while 44 showed no DO. A review of filling cystometry variables showed a statistically significant improvement in bladder volumes at first sensation of filling (FSF) and at maximum fill volume (MFV) before voiding for both UI subgroups, compared with baseline. In 51% of the patients with UI and DO at baseline, the DO resolved during the follow-up. However, those patients were no more clinically successful than those who still had DO ( P = 0.73). At the 6-month follow-up, 55 of 84 implanted patients showed clinical benefit, having a ≥50% improvement in primary voiding diary variables. Patients with UI but no DO had a higher rate of clinical success (73%) than patients with UI and DO (61%), but the difference was not statistically significant. CONCLUSION These urodynamic results show a statistically significant improvement in FSF and MFV in patients with UI with or with no DO after SNM. Although there was a urodynamic and clinical improvement in both groups, patients with UI but no DO are at least as successful as patients with UI and DO. Therefore in patients with UI, DO should not be a prerequisite selection criterion for using SNM. [ABSTRACT FROM AUTHOR]

OBJECTIVE To evaluate the effect of overactive bladder symptoms (OAB) on women's quality of life (QoL) during and after the first pregnancy, using self-reported symptom-based QoL questionnaires. PATIENTS AND METHODS In a prospective cohort study, 474 women were asked to complete four self-reported questionnaires. Urogenital symptoms were assessed with the Urogenital Distress Inventory (UDI) and the Incontinence Impact Questionnaire (IIQ). A women was considered to experience ‘dry’ OAB if she replied positively to the following two questions: ‘do you experience a strong feeling of urgency to empty your bladder?’; and ‘do you experience frequent urination?’. A women was considered to experience ‘wet’ OAB if she replied positively to all of the following questions: ‘do you experience a strong feeling of urgency to empty your bladder?’; ‘do you experience frequent urination?’; and ‘do you experience urine leakage related to the feeling of urgency?’. RESULTS In all, 344 (72.6%) women who returned all four questionnaires were included in the analysis. After first childbirth there was a rapid decline in the prevalence of dry OAB (45.2% to 7.9%, P < 0.001). In pregnancy the prevalence of wet OAB increased significantly, but a year after childbirth the prevalence of wet OAB decreased and was similar to that at 12 weeks of gestation ( P = 0.289). Women with wet OAB had higher scores on all IIQ domains than those with no OAB symptoms at 36 weeks of gestation. Women with dry or wet OAB all had higher scores on the mobility domain than those with no OAB. The scores on the physical, social and emotional functioning domains were low, suggesting a minimal restriction of lifestyle. CONCLUSION OAB symptoms are common during pregnancy; dry OAB had no negative effect on QoL, whereas wet OAB compromised QoL both during and after pregnancy, mainly in the ‘mobility’ and ‘embarrassment’ domains. The urge urinary incontinence symptom in wet OAB seems to profoundly compromise QoL. Apparently, in young mothers with wet OAB, limitations in mobility are especially stressful and these symptoms can be embarrassing. [ABSTRACT FROM AUTHOR]

To assess the pharmacokinetics of a controlled-release formulation of oxybutynin (OROS®-O, ALZA Corp., Mountain View, CA) at different dosages, compared with immediate-release oxybutynin (IR-O), and to determine the pharmacodynamic properties in the severity-dependent reduction of urge urinary incontinence (UUI).In all, 105 patients were enrolled in this multicentre, randomized, double-blind study. Individual dose titration was used to assess the minimum effective, maximum tolerated or maximum allowed dose of either OROS-O or IR-O. Blood samples were collected during maintenance therapy with frequent sampling to analyse for R-oxybutynin and R-desethyloxybutynin concentrations. Pre-dose plasma levels before dosing were obtained as the minimum concentrations achieved at steady state during the dosing regimen. In parallel, UUI episodes were assessed at baseline and during maintenance therapy at the final dose level.For both IR-O and OROS-O, initial R-oxybutynin plasma concentrations increased in a dose-dependent fashion. For comparable dosages pre-dose plasma levels were higher for OROS-O than IR-O. After one dose of IR-O plasma concentrations peaked at≈ 27-fold after 1 h and decreased to baseline levels within 4–8 h. In contrast, plasma concentrations of R-oxybutynin remained constant for up to 24 h after taking OROS-O at all doses. The overall percentage reduction in weekly UUI episodes was 84% (to 4.8 episodes) and 88% (to 3.1 episodes) for OROS-O and IR-O, respectively (P < 0.05). Patients who titrated to final dose levels of 10, 15 and 20 mg OROS-O differed in their weekly UUI episodes at baseline (14.5, 30.3 and 42.0). Because of individual dose titration, UUI episodes/week were profoundly reduced at all applied doses (1.9–2.0, respectively). Fewer patients reported moderate to severe dry mouth with OROS-O than with IR-O (25% vs 46%,P < 0.05).The pharmacokinetics of OROS-O are proportional to dose, with minimal fluctuations between peak and trough concentrations, as associated with IR-O. In clinical practice OROS-O may thus facilitate the highly effective severity-dependent treatment of UUI with flexible dose adaptations based on the patients’ needs. [ABSTRACT FROM AUTHOR]

Urinary incontinence (UI) is any involuntary leakage of urine and can be further defined according to the patient''s symptoms or complaints. Stress urinary incontinence (SUI) is the complaint of involuntary leakage on effort or exertion, or on sneezing or coughing. Urge urinary incontinence (UUI) is characterized by the complaint of involuntary leakage accompanied by or immediately preceded by urgency. Mixed urinary incontinence (MUI) is the presence of both SUI and UUI symptoms. In order to effectively treat UI, an accurate diagnosis is necessary since treatment of SUI or UUI is very different. Assessment obtaining a detailed medical history includes making general assessments taking into account quality of life (QoL), performing an appropriate physical examination with cough stress test; and simple investigations namely a urinary diary, urine analysis and post-void residual assessment and, occasionally, simple urodynamics. These assessments should suffice to commence conservative treatment. Multichannel urodynamics are required in patients presenting with more complicated UI and prior to surgery. [Copyright &y& Elsevier]

Aims To verify the relationship between enuresis in childhood and the type of urinary incontinence in adults, considering the gender and age. Methods In this retrospective cohort study the database used contained the records of patients who had with urinary complaints and underwent urodynamic studies in the period from 1999 to 2008. A multinomial logistic regression model was adjusted for the type of UI. Results A total of 661 patient records were analyzed, 585 (88.5%) women and 76 (11.5%) men, with mean age 54 (SD = 13.3). Patients with urge urinary incontinence (UUI) were compared to those with stress urinary incontinence (SUI) and the variables associated were the presence of enuresis in childhood (OR = 2.37, IC: 1.43-3.92) and age >50 years (OR = 2.64, CI: 1.68-4.15). Comparing patients with mixed urinary incontinence (MUI) and SUI, the presence of enuresis was also associated ((OR = 1.77, CI: 1.15-2.73) and the age of more than 50 years (OR = 1.71, CI: 1.19-2.44). For both categories of urinary incontinence, the variable sex was not associated. Conclusions Individuals with MUI and UUI in adult life were more likely to have a history of enuresis in childhood than those with SUI. Neurourol. Urodynam. 31:634-636, 2012. © 2012 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]