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Introduction and hypothesis This study was aimed at exploring the mediating role of the prolonged second stage of labor (PSSL) in the association between delivery mode and urinary incontinence (UI) among postpartum women in Shandong, China. Methods A cross-sectional study involving postnatal women from the Women's Pelvic Floor Functional Health Center in Shandong, China, was conducted. An electronic questionnaire was used to collect the data between June 2020 and February 2021. UI was assessed using the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF). Logistic regression and multiple linear regression were employed to explore the association among delivery mode, PSSL, and UI, and the mediating role of PSSL. Results Among the total of 5,586 postpartum women included in this study, the prevalence of UI was 13.3%. Among the 742 patients with UI, the prevalence of stress urinary incontinence (78.3%) was greater than urge urinary incontinence (8.6%), mixed urinary incontinence (9.3%), and others (3.8%). After adjusting for controlling variables, delivery mode was found to be significantly associated with PSSL, whereby women with vaginal delivery were more likely to be in PSSL, and women with PSSL had a higher probability of suffering from UI. PSSL played a partial mediating effect in delivery mode and UI. Conclusions This study provided evidence that the effect of delivery mode on UI was partially mediated by PSSL among postpartum women in Shandong, China. Strategies to prevent PSSL should be actively adopted to reduce the risk of UI in women.

AIM This study focused on women with chronic lower urinary tract symptoms (LUTS) who simultaneously suffered from obsessive-compulsive disorder (OCD) to evaluate the association between micturition abnormality and OCD. METHODS A cohort case study was conducted on 128 women with chronic LUTS who visited the academic clinic from 2012 to 2018. The participants with a history of OCD were grouped together, whereas the other group consisted of those with no psychiatric issues. Data were analyzed using the Kolmogorov-Smirnov test and also the nonparametric Kruskal-Wallis and χ2 tests. RESULTS The participants with OCD had a lower mean age (41.7 vs. 48.8 years) and longer symptom duration than the control group. Moreover, voiding phase problems were more prevalent among OCD patients (mean voiding score: 9.3 vs. 6.9). Urge urinary incontinence (UUI) was the most common type of urinary incontinence in OCD patients, and the most important urodynamic study finding was bladder outlet obstruction (45% and 17% in the OCD and control groups, respectively). Voiding disorders resulted in chronic renal failure in two patients (3.12%). It was shown that bladder outlet obstruction (odds ratio (OR) 4.43, 95% confidence interval [CI] 1.53-12.78, p = 0.006] was the strongest predictor of OCD and stress urinary incontinence (OR 0.20, 95% CI 0.07-0.53, p

Objective: The aim of this study was to translate and verify the validity and reliability of the Bengali translated questionnaire for Urinary Incontinence Diagnosis (QUID), to ensure the diagnosis of urinary incontinence in Bangladesh.Material and Methods: Adaptation and psychometric properties testing of the Bengali-QUID were conducted with 67 respondents. Twenty respondents were included for pre-testing and adaptation; whereas, 47 respondents were considered for test-retest reliability. The content validity of the questionnaire was measured by expert opinion. Cornbach’s alpha statistical test was used to measure the internal consistency of the questionnaire, while the test-retest reliability was measured using the Intra-Class Correlation (2,1) model.Results: Content validity for all items of the questionnaire was >0.75. In addition, the Cronbach's Alpha values for interitem correlation for Stress Urinary Incontinence and Urge Urinary Incontinence were (α>0.8) and (α>0.7), respectively. Furthermore, the reliability of the Bengali-QUID questionnaire had an Intra-class correlation score of 0.76.Conclusion: This study demonstrated that the Bengali version of QUID questionnaire was highly valid, and reliable for diagnosis of urinary incontinence among Bangladeshi women.

INTRODUCTION A critical appraisal of the literature regarding female urethral function and dysfunction is needed in light of recent evidence showing the urethra's role in causing stress and urge urinary incontinence. METHODS An evidence assessment was conducted using selected articles from the literature that contained mechanistic data on factors affecting urethral function and failure. RESULTS Maximal urethral closure pressure (MUCP) is 40% lower in stress urinary incontinence (SUI) than normal controls. Evidence from five women shows relatively equal contributions to MUCP from striated/smooth muscle, vascular-plexus, connective tissue. MUCP varies twofold in individuals of similar age and declines 15% per decade even in nulliparous women. Age explains 57% of the variance in MUCP. This parallels with striated/smooth muscle loss and reduced nerve density. Factors influencing pressure variation minute-to-minute and decade-to-decade are poorly understood. Connective tissue changes have not been investigated. MUCP in de novo SUI persisting 9-months postpartum is 25% less than in age and parity-matched controls. Longitudinal studies do not show significant changes in urethral function after vaginal birth suggesting that changes in urethral support from birth may unmask pre-existing sphincter weakness and precipitate SUI. Mechanisms of interaction between support injury, pre-existing urethral weakness, and neuropathy are unclear. CONCLUSION Urethral failure is the predominant cause of SUI and a contributing factor for UUI; potentially explaining why mixed symptoms predominate in epidemiological studies. Age-related striated muscle loss and differences between women of similar age are prominent features of poor urethral closure. Yet, connective tissue changes, vasculature function, and complex interactions among factors are poorly understood.

Pei Shan Yang,1,2 Sophia Delpe,2 Casey G Kowalik,2 W Stuart Reynolds,2 Melissa R Kaufman,2 Roger R Dmochowski2 1Department of Urologic Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan; 2Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USACorrespondence: Pei Shan YangDepartment of Urologic Surgery, Chang Gung Memorial Hospital and Chang Gung University, No. 5, Fuxing Street, Guishan District, Taoyuan, 333, TaiwanTel +886 328-1200Email dr.yang.uro@gmail.comIntroduction: Pubovaginal sling is an efficient and safe procedure for stress urinary incontinence without the complications of synthetic sling. Urine retention and de novo urgency are bothersome aftermath of this procedure. We aim to identify potential risk factors for de novo urgency after autologous pubovaginal sling.Methods: From 2013 to 2016, 347 patients underwent autologous pubovaginal sling. Age, BMI, pelvic irradiation, use of anticholinergic medication, previous vaginal related surgical histories, “over-tight” technique, and concomitant surgeries were examined for potential risk factors. De novo urgency/urge incontinence was defined as treatment (medication, botulinum toxin injection, sacral neuromodulation) for urge postoperatively and was not noted before surgery. Chi-square and fisher’s exact tests were used as statistical analysis.Results: A total of 109 patients underwent autologous rectus fascia pubovaginal sling, after excluding status post urethral diverticulectomy, concomitant diverticulectomy, and concomitant abdominal surgery. Twenty-three (21.1%) patients were treated for de novo urge/urge incontinence, 18 (78.2%) with anticholinergic, 4 (17.3%) with botox injection and 2 (8.69%) with sacral neuromodulation. None but prior pelvic organ prolapse surgery was associated with developing de novo urge/urge incontinence (p=0.026).Discussion: Patients with prior pelvic organ prolapse surgery were more likely to be at risk of de novo urgency after autologous pubovaginal sling. This study provided more information for preoperative consultation for patients undergoing incontinence surgery.Keywords: autologous fascial sling, de novo urgency, stress urinary incontinence, urge urinary incontinence

Introduction: Overactive bladder and urge urinary incontinence affect millions of women and men and results in billions of dollars in health-care expenses. First- and second-line therapy includes b...

Objectives: The aim of this study is to assess the impact of life change and social distancing measures, during the Covid-19 outbreak, on the OAB symptoms and quality of life in women underwent different types of treatment. Materials and methods: Observational survey analysis in OAB treated patients was performed. The women showed a greater than 50% improvement during specific therapy for OAB. Population had previously completed bladder diary, OAB-Q symptom, OAB HRQL scale, SF-36 and PGI-I questionnaires. Four weeks after the introduction of the restrictive measures, these women were invited to complete the same questionnaires by e-mail for new evaluation during Covid-19 outbreak. Primary endpoint was changes in number of voids/24h, urgent micturitions/24h, urinary incontinence events/24h, nocturia events. Secondary endpoints were the assessment of the change in the OAB-SF, SF-36 questionnaires and PGI-I satisfaction. Results: Six hundred seventy-three patients were considered. The mean age was 63.21 ± 10.24 years. Four weeks after the start of the social distancing measures, the increase in mean number of voids/24h (7.13 ± 1.08 vs 9.76 ± 2.12, p

Overactive bladder is a medical condition that requires management. If left untreated, it may severely affect quality of life. When first- and second-line treatments fail, sacral neuromodulation can be a safe and effective option for patients with refractory overactive bladder. This article reviews the rechargeable sacral neuromodulation (Axonics).

Anticholinergic drugs and behavioral interventions are effective methods for the treatment of OAB and UUI. This randomized controlled, prospective, and quasi-experimental study determined the effect of healthy lifestyle behavior training, based on the Health Promotion Model (HPM), on the treatment of women with Overactive Bladder (OAB). The study sample included intervention and control groups with a sample size of 100 women diagnosed with OAB who received pharmacological treatment and agreed to participate in the study. The data were collected using an Introductory Information Form, Urinary Diary, OAB Questionnaire (OAB-V8), King’s Health Questionnaire (KHQ), Healthy Life Style Behavior Scale II (HLSB II), Brief Symptom Inventory (BSI), and 24-hour Pad Test. The intervention group was administered a 45-minute training program based on Pender’s HPM. There was a statistically significantly higher level of decrease in urgency (z = −3,259;p = 0,001), nocturia (z = −3,691;p < 0,001), urge urinary incontinence (z = −2,391;p = 0,017), and urinary frequency (χ2 = 17,420;p < 0,001) in the intervention group during the posttest period. The study found a significant decrease in the total posttest scores of the women in the intervention group on the OAB-V8 (t = −6.955;p < 0.001), KHQ (t = −5.354;p < 0.001), and BSI (t = −6.463;p < 0.001) scales whereas a statistically significant increase was found in their total score on the HLSB II (t = 9.139;p < 0.001) scale. The study concluded that HLSB training, which was prepared based on HPM, reduced OAB symptoms among women, improved the quality of their lives, changed their HLSBs, and positively affected their psychological symptoms.

We examined obstetric and maternal-newborn factors and UI history for stress urinary incontinence (UI) and urge UI during pregnancy and the first year postpartum. This prospective cohort study included 1447 pregnant women who underwent prenatal examinations and completed an Incontinence Questionnaire-Urinary Incontinence Short Form before pregnancy, during early, mid- and late pregnancy, and at five visits during the first year postpartum. Data were analyzed using univariate/multivariate generalized estimating equation (GEE) logistic regression analyses. The prevalence rates of stress UI during late pregnancy (42.5%) and urge UI at 3–5 days postpartum (10.4%) were the highest throughout pregnancy and the first year postpartum. After adjusting for covariates, gestational age increased the risks of stress UI (p

Introduction Overactive bladder syndrome (OBS) is a urological disorder characterized by urinary urgency, increased frequency, nocturia, and may be associated with urge urinary incontinence (UI). Posterior tibial nerve peripheral neuromodulation (PTNS) is globally recognized within the treatment options available, although an optimal protocol has not been tested. The objective of this review is to collect the evidence available on the most widely used protocol of the PTNS technique in obtaining good results in the treatment for women with OBS. Evidence acquisition A systematic review of the scientific literature was carried out in PubMed, Embase, WoS and Scopus databases. A total of 222 results were obtained, with 58 duplicates, of which 8 studies met the established inclusion criteria, all of them randomized clinical trials. Evidence synthesis The included works show that the most widely used PTNS technique with beneficial results in women with OBS is the percutaneous route with a needle placed 5−6 cm proximal to the tibial malleolus, posterior to the edge of the tibia, with the following parameters: 1 weekly session of 30 min duration for 12 weeks, the use of pulse widths of 200 µs with frequency of 20 Hz. Conclusion PTNS may have beneficial and safe short-term effects in women with OBS. Despite showing statistically significant improvements in clinical symptoms, further research is needed to obtain clear scientific evidence on the optimal protocol for treating women with OBS.

Urinary incontinence can be characterised as 'the protest of any automatic spillage of urine. Under this more extensive definition, there are various indications, similar to Stress urinary incontinence, Urge urinary incontinence and mixed urinary incontinence. Postpartum urinary incontinence is here and there an unavoidable inconvenience of vaginal conveyance, particularly in the event that it happens to be a woman's first vaginal conveyance. Weaker pelvic muscle has reduced inability to stop the flow of urine among postnatal mothers. The study supports the need for nurses to educate the postnatal mothers about methods to reduce urinary incontinence by using the first line of treatment, i.e., pelvic floor muscle strengthening exercise. The present study aims to assess the effectiveness of pelvic floor muscle exercise to reduce urinary incontinence among postnatal mothers. A quantitative pre-experimental, one group pretest and post test research design were chosen to conduct the investigation among 60 postnatal mothers. Convenience sampling technique was used to select the postnatal mothers. Modified Sandviketal Severity Index tool was chosen to assess the pretest and post test level of urinary incontinence. The assessment includes on frequency (involuntary loss of urine occurs), incontinence with daily living and amount of urine leaks. The study results show most of the postnatal mothers had severe urinary incontinence and after the administration, pelvic floor muscle exercises most of the postnatal mothers had moderate urinary incontinence and this emphasizes the need to educate the postnatal mothers and promote them to perform PMRT so that they come through the postnatal period and for the betterment of life.

Purpose of review To review current evidence on gene expression in women with urinary incontinence and pelvic organ prolapse (POP). Recent findings Our literature review revealed numerous genes that are associated with urinary incontinence and POP. For overactive bladder and urge urinary incontinence, four genes were highlighted: adrenergic receptor β3, Rho guanine nucleotide exchange factor 10, Rho-associated coiled-coil containing protein kinase 2, and potassium two pore domain channel subfamily K member-1. For Stress Urinary incontinence (SUI), 13 genes were included: skin-derived antileukoproteinase, collagen type XVII alpha 1 chain, plakophilin 1, keratin 16, decorin, biglycan, protein bicaudal D homolog 2, growth factor receptor-bound protein 2, signal transducer and activator of transcription 3, apolipoprotein E, Golgi SNAP receptor complex member 1, fibromodulin, and glucocerebrosidase. For POP seven genes were identified: homeobox A13, matrix metallopeptidase 9, estrogen receptor 2, collagen type XIV alpha 1 chain, collagen type V alpha 1 chain, collagen type IV alpha 2 chain, and catenin beta 1. Summary The current review highlights many genes which are potential biomarkers and targets for drug development.

ObjectivesUrinary incontinence is estimated to affect up to 34% of women with gynecologic cancers. Chemotherapeutic effects on urinary symptoms have been scarcely studied. The aim of our study was to examine the impact of carboplatin/paclitaxel chemotherapy on urinary symptoms.MethodsThis was a prospective cohort study of all women undergoing adjuvant chemotherapy with carboplatin/paclitaxel after their primary debulking surgery for ovarian, fallopian tube, peritoneal, or endometrial cancers performed at a tertiary medical center by board certified gynecologic oncologists. We used validated questionnaires (incontinence impact questionnaire (IIQ-7), medical, epidemiologic, and social aspects of aging (MESA), urogenital distress inventory (UDI-6), the Sandvik severity index, and functional assessment of cancer therapy/GynecologicOncology Group-neurotoxicity (FACT/GOG-Ntx)) to assess the effects of carboplatin/paclitaxel therapy on the incidence and severity of urinary incontinence at three time points during the participants’ chemotherapy regimen: start of chemotherapy (pretreatment), during the fifth chemotherapy cycle (mid-cycle), and during the 6–12 week post-chemotherapy visit (post-treatment).ResultsWe identified 62 women with ovarian, fallopian, peritoneal, and endometrial cancer who received carboplatin/paclitaxel therapy between May 2009 and December 2012 who met all of the inclusion criteria. Analysis of median IIQ-7 scores, across all time points, showed a statistically significant difference (0.0 (0.0 to 4.8), 0.0 (0.0 to 7.1), 0.0 (0.0 to 0.0), p=0.002, respectively). Examining pairwise differences between two treatment points, IIQ-7 pretreatment versus mid-treatment and pretreatment versus post-treatment, did not achieve significance (0.0 (0.0 to 2.4), p=0.13 and 0.0 (0.0 to 0.0), p>0.999, respectively), but the decrease in IIQ-7 mid-treatment versus post-treatment was statistically significant (0.0 (−2.4 to 0.0), p=0.003). Generalized estimating equation model analysis also showed significant changes in both median MESA for urge urinary incontinence (MESA-UUI) and median MESA for stress urinary incontinence (MESA-SUI) across all time points (p=0.003 and p=0.009, respectively). MESA-UUI and MESA-SUI pretreatment versus mid-treatment analysis achieved significance (2.0 (0.0 to 4.0), p=0.003 and 0.0 (0.0 to 2.0), p=0.01, respectively), demonstrating an increase in the incidence of stress urinary incontinence and urge urinary incontinence. There was a statistically significant association between the changes in FACT and UDI-6 scores from pretreatment versus mid-treatment, with a correlation coefficient of 0.37 (95% CI 0.08 to 0.61, p=0.005).ConclusionThe study achieved its primary aim in demonstrating an impact of carboplatin/paclitaxel therapy on urinary incontinence severity and suggests if may be a factor leading to new onset or worsening urinary incontinence. As quality of life can be significantly impacted by these chemotherapeutic changes, further investigation is warranted to determine if the effects on urinary incontinence and neuropathy are transient or permanent.

Objective: Urinary incontinence (UI) subtypes may have some effects on sexual function because of diverse pathophysiological mechanisms. The objective of our study is to compare UI subtypes’ effects on women's sexual function and quality of life (QoL). Methods: In this descriptive and comparative study, a total of 239 women with UI were included (89 with stress urinary incontinence [SUI], 65 with urge urinary incontinence [UUI], and 85 with mixed urinary incontinence [MUI]). Sexual function was assessed with the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ‐12), and QoL was assessed with the Incontinence Impact Questionnaire‐7 (IIQ‐7). Results: In our study, the mean total PISQ‐12 score for the UI subtypes was 29.49 ± 6.38 for SUI, 31.43 ± 5.46 for UUI, and 23.12 ± 5.54 for MUI. Women with MUI had significantly more sexual dysfunctions than the other groups (P .05). Conclusion: The sexual function of women with MUI was affected more adversely than the other UI subtypes. There was no statistically significant difference between the UI subtypes according to IIQ‐7 scores, but when we examined the scores, MUI and UUI were found to have more negative effects on QoL. Clinicians and continence nurses should make routine evaluations of sexual function and QoL for women according to UI subtypes.

Urinary incontinence is defined as an involuntary leakage of urine and is categorized into three types: stress urinary incontinence (SUI), urge urinary incontinence (UUI), and mixed urinary incontinence, which includes symptoms of SUI and UUI. As the underlying mechanisms of SUI and UUI are different, no drug is approved to treat all three types of urinary incontinence. TAS-303 is a selective norepinephrine reuptake inhibitor and has therapeutic potential for patients with SUI. In this report, we describe newly discovered pharmacological properties of TAS-303 and its effects on bladder function. Radioligand binding studies showed that TAS-303 inhibits M3 muscarinic receptor binding, with a Ki value of 547 nM. TAS-303 at 1, 3, and 10 mg/kg dose-dependently prolonged the intercontraction interval of carbachol-induced detrusor overactivity in rats, exhibiting a maximal effect that was comparable to tolterodine. These effects may result from coordinated regulation of bladder afferent activity via M3 muscarinic inhibition and β3 adrenoreceptor activation by norepinephrine elevation due to norepinephrine transporter inhibition. Moreover, TAS-303 at the effective dose for bladder function did not induce dry mouth or constipation in rats, showing that this compound may have a lower risk of antimuscarinic side effects. Thus, TAS-303 is expected to be a new profile agent with therapeutic potential for all types of urinary incontinence. SIGNIFICANCE STATEMENT: Urinary incontinence is categorized into stress, urge, and mixed urinary incontinence, but because the underlying mechanisms of each differ, no drugs are available that treat all three. TAS-303 has therapeutic potential for stress urinary incontinence. This study describes newly discovered pharmacological properties of TAS-303, which ameliorated bladder afferent activity partly via M3 muscarinic inhibition, indicating improvement in urge urinary incontinence, and highlights the potential of TAS-303 as a new therapeutic agent for all types of urinary incontinence.

Purpose Holmium-laser enucleation of the prostate (HoLEP) has been a promising prostate surgery since its first introduction. Although there are 10 different HoLEP techniques in the literature, stress urinary incontinence (SUI) is common, because surgery is not performed based on the topographic anatomy of the external sphincter. We have developed a new HoLEP method named as the ''Omega Sign technique", which is based on the topographic anatomy of the external sphincter and could provide better continence outcomes by decreasing SUI rates. Materials and methods The data of 400 patients who underwent HoLEP by a single surgeon between May 2016 and February 2019 were retrospectively reviewed. The patients were divided into two groups, the first underwent the Gilling's technique (Group 1) and the second the novel ''Omega Sign'' technique (Group 2). Continence status and post-micturition symptoms (PMS) were evaluated according to the standards recommended by the international continence status. Results The data of 400 HoLEP procedures between May 2016 and February 2019 were analyzed, comparing Group 1 (n = 200) and Group 2(n = 200). SUI rate was significantly lower in Group 2 at the day of catheter removal and first month (p < 0.005). In addition, urge urinary incontinence (UUI) rate and PMS were significantly lower in Group 2. Conclusions We could demonstrate improved continence results, comparable functional outcomes and equally minimal complications with the standard HoLEP technique. We believe that, the novel 'Omega sign' technique decreases SUI rates and will become standardised and easy to understand, thereby bringing and creating a shorter learning curve.

Urge urinary incontinence significantly impacts quality of life. We investigated the association between urge urinary incontinence and socioeconomic status in a nationally representative adult population.We analyzed the 2005 to 2016 NHANES (National Health and Nutrition Examination Survey), a United States population based, cross-sectional study. Urge urinary incontinence was determined by self-report of leaking urine before reaching the toilet. Socioeconomic status was represented by the poverty income ratio, which reflects the family income relative to poverty thresholds specific to that year and household size. Survey weighted logistic regression models were used to analyze the relationship between socioeconomic status and the poverty income ratio. Multiplicative terms were applied to test for interaction in prespecified subgroups of interest.A total of 25,553 participants were included in the final analysis, representing 180 million people in the United States. Of the participants 19.4% reported any urge urinary incontinence, 4.2% reported weekly urge urinary incontinence and 1.6% reported daily urge urinary incontinence. In the fully adjusted multivariable models those with a poverty income ratio less than 2.00 showed significantly higher odds of any urge urinary incontinence compared to the group with a poverty income ratio of 2.00 or greater (OR 1.17, 95% CI 1.05-1.30, p=0.003). There was increasing strength of association for weekly and daily urge urinary incontinence (OR 1.31, 95% CI 1.12-1.55, p0.001, and OR 1.60, 95% CI 1.23-2.09, p=0.001, respectively). Individual interaction analyses revealed no significant effect of female gender, age greater than 50 years, body mass index 30 kg/mThis study revealed a significant association between urge urinary incontinence and socioeconomic status after meaningful adjustment for covariates. Health care interventions targeting low socioeconomic status individuals with urge urinary incontinence are needed to address this disparity.

Urge urinary incontinence (UUI) is one of the most troublesome complications of surgery of the prostate whether for malignancy or benign conditions. For many decades, there have been attempts to reduce the morbidity of this outcome with variable results. Since its development in the 1970s, the artificial urinary sphincter (AUS) has been the “gold standard” for treatment of the most severe cases of UUI. Other attempts including injectable bulking agents, previous sphincter designs, and slings have been developed, but largely abandoned because of poor long-term efficacy and significant complications. The AUS has had several sentinel redesigns since its first introduction to reduce erosion and infection and increase efficacy. None of these changes in the basic AUS design have occurred in the past three decades, and the AUS remains the same despite newer technology and materials that could improve its function and safety. Recently, newer compressive devices and slings to reposition the bladder neck for men with mild-to-moderate UUI have been developed with success in select patients. Similarly, the AUS has had applied antibiotic coating to all portions except the pressure-regulating balloon (PRB) to reduce infection risk. The basic AUS design, however, has not changed. With newer electronic technology, the concept of the electronic AUS or eAUS has been proposed and several possible iterations of this eAUS have been reported. While the eAUS is as yet not available, its development continues and a prototype device may be available soon. Possible design options are discussed in this review.

Purpose The aim of this study was to translate the questionnaire for urinary incontinence diagnosis (QUID) into German and to assess its psychometric properties in German-speaking women with urinary incontinence (UI). The QUID contains two subscales to measure symptom severity of stress urinary incontinence (SUI) and urge urinary incontinence (UUI) and to distinguish between both forms. Methods A total of 161 women with UI completed the QUID and the King’s Health Questionnaire (KHQ), each in the German version. To examine construct validity Spearman’s correlation coefficients between both questionnaires were computed. Furthermore, the internal consistency (Cronbach’s alpha) of the QUID and its criterion validity were examined. Looking at criterion validity, sensitivity, specificity, ROC curves, and Youden-indexes were computed for both subscales. Results The QUID showed good construct validity by strong correlations with related domains of the KHQ. Cronbach’s alpha values were good for both subscales of the QUID (SUI-subscale: 0.76; UUI-subscale: 0.86). Sensitivity and specificity were 83% (95% CI, 0.72–0.9) and 45% (95% CI, 0.25–0.67) for the SUI-subscale and 83% (95% CI, 0.7–0.91) and 56% (95% CI, 0.4–0.72) for the UUI-subscale. Youden-index was 0.28 for the SUI-subscale and 0.39 for the UUI-subscale at the given cut-off values. Conclusion Psychometric properties of the German-language QUID are principally good and support its use in the German-speaking area. However, the modest specificity when distinguishing between SUI and UUI should be taken into account. Trial registration number: DRKS00018777 (date of registration: 16-January-2020).

Objectives To evaluate the effectiveness of transcutaneous tibial nerve stimulation (TTNS) compared to percutaneous tibial nerve stimulation (PTNS) in sustaining symptom improvement over a 6-month period in women with idiopathic Overactive Bladder (OAB) who had responded to an initial 12-week course of PTNS. Design Randomized, active-controlled trial. Participants Twenty-four women diagnosed with idiopathic OAB successfully treated with PTNS were included in this study. Interventions Twelve subjects were allocated to receive monthly sessions of PTNS for six months, and twelve subjects followed a flexible home-based TTNS regime after instruction on the use of a TENS device for the same follow-up time. Outcomes Participants were assessed at six weeks, three months and six months after completing the initial course of PTNS. Primary outcomes were changes from baseline in urinary frequency, number of episodes of urgency and number of episodes of urge urinary incontinence (UUI). Subjectively reported severity of symptoms and quality of life (QoL) were assessed using the validated OAB questionnaire (OAB-q). Results Urinary frequency, episodes of urinary urgency and episodes of UUI did not change significantly between baseline and six months in either group. Similarly, OAB-q scores for severity of symptoms and QoL were maintained within both arms for the duration of the study. There were no statistically significant differences between the groups in any of the outcome measures at any of the study points. Conclusion TTNS is effective in the maintenance of symptom improvement in women with OAB who had positively responded to a course of 12 weekly PTNS sessions. The trial was registered in the Clinicaltrials.gov PRS database (Identifier: NCT02377765).

Background: Overactive Bladder (OAB) is defined by the International Continence Society (ICS) as urgency, with or without urge incontinence (UUI), usually with frequency and nocturia, if there is no proven infection or other etiology. Aim of Study: To evaluate the correlation between over-active bladder symptoms (OAB) and urodynamic Detrusor Overactivity (DO) in non neurogenic bladder in both genders. Patients and Methods: We reviewed the records of 202 patients who attended Al-Zahra'a Univesity Hospital between October 2013 and October 2018 with overactive bladder symptoms urgency, with or without urge urinary incontinence usually with frequency and nocturia, with presence or absence of DO in two groups. All patients were subjected to: Full history taking, voiding diary, clinical examination, laboratory investigations, radiological investigations, urodynamic studies (UDS) and cystoscopic biopsies for histopathological exam-ination. Also we evaluate OAB symptoms, urodynamic pa-rameters with histopathological findings. All patients under-went uroflowmetry: The maximum flow rate, average flow rate and voided volume were recorded. Post Voiding Residual urine (PVR) volume was recorded. Cystometry: The intravesi-cal, intra-abdominal, detrusor pressure, first desire to void, strong desire to void, Maximum Cystometric Capacity (MCC), total volume infused, bladder compliance and detrusor over-activity were evaluated. Cystoscopy and random bladder biopsies from all patients and stained with Hematoxylin and Eosin for histopathological examination of smooth muscle, the urothelium, lamina propria, and adventitia. We used another special stain Massons trichrome to visualize collagen and degenerative changes of smooth muscle bundles. Results: Detrusor overactivity DO was diagnosed in (63.36%) 128 OAB patients after urodynamic studies. Of men 42.9% and 36.1% of women with urgency had DO (OAB dry) while 57.1 % of male 63.9% of female patients with urgency and Urge Urinary Incontinence (UUI) were (OAB wet) had DO. Of women 23.8% with no DO were also OAB wet having urodynamic Stress Urinary Incontinence (SUI). Combination of symptoms was more precise in predicting DO in OAB patients. Patchy areas of myohypertrophic and degenerative histological pattern were observed more in group I in both male and female patients. Conclusions: We concluded that there was better correla-tion between OAB symptoms and the urodynamic diagnosis of DO in women than in men, wet OAB more in women than in men in the same group I. Urgency, frequency and UUI in men, nocturia and UUI in women were significantly increased in predicting DO. Combination of objective parameters from the bladder diary, filling cystometry and histopathological findings have a better correlation with the occurrence of DO.

INTRODUCTION AND OBJECTIVE:Overactive bladder (OAB) is characterized by urinary urgency, often accompanied by frequency and nocturia, with or without urge urinary incontinence (UUI), referred to as...

International audience; BackgroundLower urinary tract symptoms (LUTSs), especially overactive bladder, are frequent in people with multiple sclerosis (PwMS). Urinary urgency and urge urinary incontinence could lead to precipitation and thus could increase the risk of falling in these individuals.ObjectiveWe aimed to assess the association between severity of LUTSs and risk of falling in PwMS.MethodsPwMS with LUTSs were recruited in a neuro-urology department. Participants were asked about the number of falls in the past 3 months and their circumstances. Severity of LUTSs was assessed by the Urinary Symptoms Profile (USP) score, and individuals were classified as with or without urinary incontinence.ResultsThis cross-sectional study included 154 patients (69% women); the mean (SD) age was 50.1 (11.5) years and median EDSS was 5 (interquartile range 3–6). Overall, 20 (13%) patients reported one fall during the past 3 months, and 43 (28%) reported at least 2 falls. Only 9 (6%) patients reported a fall on the way to the toilet, 6 during a urinary urgency. No link was found between falls and urinary incontinence (P = 0.71), type or severity of urinary symptoms (overactivity, voiding dysfunction or stress incontinence, P > 0.05). Falls on the way to the bathroom was associated with high USP score related to overactive bladder (P = 0.03) and severe nocturia (> 2 nocturnal micturitions) (P < 0.01). Falling at night was also associated with severe nocturia (P < 0.001).ConclusionsThe severity of LUTSs and presence of urinary incontinence do not appear related to the risk of falling in PwMS and urinary disorders but rather to the specific risk of falling on the way to the bathroom. Severe nocturia increases the risk of falling at night. Further studies are needed to assess the impact of LUTS treatment on the risk of falling. ClinicalTrials.gov (NCT04338646).

Objectives To evaluate the relationships between physical activity, both work and recreational, and urinary incontinence among women. Methods We assessed women aged 20 years and older in 2008-2018 NHANES (National Health and Nutrition Examination Survey) cycles who answered self-reported urinary incontinence and physical activity questions. Weighted, multivariate logistic regression model was used to determine the association between incontinence and physical activity levels after adjusting for age, body mass index, diabetes, race, parity, menopause and smoking. Results A total of 30,213 women were included in analysis, of whom 23.15% had stress incontinence, 23.16% had urge incontinence, and 8.42% had mixed incontinence (answered "yes" to both stress and urge incontinence). Women who engaged in moderate recreational activity were less likely to report stress and urge incontinence (OR 0.79, 95% CI 0.62-0.99 and OR 0.66, 95% CI 0.48-0.90, respectively). Similarly, women who engaged in moderate activity work were less likely to report stress, urge and mixed incontinence (OR 0.84, 95% CI 0.70-0.99; OR 0.84, 95% CI 0.72-0.99; and OR 0.66 95% CI 0.45-0.97, respectively). Conclusions Moderate physical activity and greater time spent participating in moderate physical activity are associated with a decreased likelihood of stress, urge and mixed incontinence in women. This relationship holds for both recreational and work-related activity. We hypothesize that the mechanism of this relationship is multifactorial, with moderate physical activity improving pelvic floor strength and modifying neurophysiological mediators (such as stress) involved in the pathogenesis of incontinence.

The aims of this study were to evaluate pelvic floor dysfunction symptoms one year after delivery and investigate whether adverse functional outcomes after childbirth were related to the degree of perineal injury. A prospective cohort of 776 primiparas were included. Self-reported pelvic floor function data were obtained using a web-based questionnaire. Women with no/first-degree injuries, second-degree injuries, third-/fourth-degree injuries (obstetric anal sphincter injury, OASI) and cesarean section were compared. A total of 511 women (66%) responded. Second-degree tears were a risk factor for stress incontinence (aOR 2.6 (95% CI 1.3–5.1)). Cesarean section was protective against stress incontinence (aOR 0.2 (95% CI 0.1–0.9)). OASI was a risk factor for urge incontinence (aOR 4.8 (95% CI 1.6–15)), prolapse (aOR 7.7 (95% CI 2.1–29)) and pelvic pain (OR 3.3 (95% CI 1.1–10)). Dyspareunia was reported by 38% of women, 63% of women in the OASI group (aOR 3.1 (95% CI 1.1–9.0)). Women with OASI reported that the injury affected daily life (OR 18 (95% CI 5.1–59)). Pelvic floor dysfunction is common after childbirth, even in women with moderate injury. Women with OASI had significantly higher risks of symptoms of prolapse, urge urinary incontinence, pain, dyspareunia and impacts on daily life.

Overactive bladder syndrome (OAB) is defined as urinary urgency, usually with urinary frequency and nocturia, with or without urge urinary incontinence. The prevalence of OAB in adult women ranges between 11% and 42%, is particularly common in elderly people, and can overlap with the genitourinary syndrome of menopause (GSM). There is a wide approach to the treatment of symptoms, often in a stepwise fashion, including lifestyle changes, bladder retraining and pelvic floor muscle rehabilitation, drug therapy, intra-vesical botulinum toxin injections or neuromodulation. Recently, vaginal laser therapy has been proposed as an emerging minimal invasive effective treatment option for women with OAB. We explore this further.

Background: Midurethral slings are one of the first-line surgical treatments for stress urinary incontinence. The aim of the present study was to evaluate the intraoperative and postoperative complications of retropubic and transobturator midurethral slings and the associated risk factors. Material and methods: A retrospective case series was conducted on 105 women within the time frame of 2016 to 2018. The women were divided into 2 groups: those that underwent retropubic sling placement (n=28) and those that underwent transobturator sling placement (n=77). Demographic variables, risk factors, intraoperative complications, and postoperative complications were analyzed. Descriptive statistics and correlations between variables were performed utilizing the SPSS version 17.0 program and statistical significance was set at a p ≤ 0.05. Results: Mean patient age was 56.7 ± 8.8 years. A total of 31.4% (n=33) of the patients presented with stress incontinence, 65.7% (n=69) with mixed incontinence, and 2.9% (n=3) with occult stress incontinence. The overall complication rate was 29.5% (n=31). The most common intraoperative complication was bladder perforation in 3.8% of the retropubic group patients and was associated with obesity (odds ratio:12.9). The postoperative complications were related to the transobturator sling (p=0.049) and included urinary tract infection (11.4%), inguinal pain (7.6%), and others (6.9%). The risk for postoperative urinary infection was associated with stress incontinence (p=0.03) and the absence of treatment for mixed urinary incontinence (p=0.04), increasing the postoperative urge urinary incontinence rate. Conclusions: The intraoperative complication rates with the transobturator approach were low, compared with the retropubic approach. The most common complication in our case series was urinary tract infection, showing the need for randomized prospective studies to be conducted.

Introduction and hypothesis: The aim of this study was to compare the long-term subjective outcomes of an adjustable single-incision sling (Ajust®) vs standard mid-urethral slings (SMUS) for the treatment of women with stress urinary incontinence. Methods: This study was designed as a multicenter prospective randomized trial. Women under 60 years old with objectively verified stress urinary incontinence were included from seven centers in three countries. Women with mixed urinary incontinence were also included. Randomization was held in blocks for operation with either Ajust® or SMUS. Women analyzed at 1-year follow-up received the International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form (ICIQ-UI-SF), International Consultation on Incontinence Questionnaire Overactive Bladder, Pelvic Organ Prolapse/Urinary Incontinence/Sexual Function Questionnaire-12, Patient Global Impression of Severity, and Patient Global Impression of Improvement questionnaires, together with a bladder diary to fill out at least 3 years after the procedure. The main outcome evaluated was the subjective cure rate as reported through the ICIQ-UI-SF questionnaire at 3 years. Results: In total, 205 women participated in the 3-year follow-up: 107 in the Ajust® and 98 in the SMUS group. No significant difference was observed between the groups regarding subjective cure rate (50.9% vs 51.5%, p = 0.909) or dyspareunia. Both groups demonstrated similar postoperative perception of improvement in addition to reduced urgency and urge urinary incontinence. The postoperative improvement remained at the same level after 3 years as it was at 1-year follow-up for both Ajust® and SMUS. Conclusions: Ajust® appears to be equally effective and safe as SMUS with regard to long-term follow-up of patient-reported outcomes.

To determine the prevalence of somatic and psychological triggers for bladder storage symptoms among men and women who have not been diagnosed with overactive bladder (OAB) and to determine their impact on individuals’ quality of life (QoL). Randomly selected male and female volunteers were screened for the presence of bladder storage symptoms and their impact on their QoL using the UDI-6 and IIQ-7 questionnaires. They were also asked about somatic and psychological triggers for these symptoms using the validated SOPSETO questionnaire. Individuals who had previously been diagnosed with or treated for OAB, prostatic hypertrophy, neurological disease or cancer were excluded. Sixty-six women and 40 men were included. There was a significantly higher prevalence of urinary urgency (41% vs. 19%, p = 0.021), urge urinary incontinence (22% vs. 0%, p = 0.002) and stress urinary incontinence (30% vs. 3%, p = 0.001) among women than men. Total UDI-6 (17± 15 vs. 9± 8, p = 0.04) and IIQ-7 (21± 10 vs. 15± 4, p = 0.02) scores were also higher among women than men. Of the total 34 triggers evaluated, 18 were ranked significantly higher among women than among men. There was a good correlation between the SOPSETO and the UDI-6 and IIQ-7 scores primarily in women (r = 0.46, p

Objective To evaluate the clinical and urodynamic differences associated with the presence or absence of detrusor overactivity (DO) in women with overactive bladder (OAB) referred to Functional Urology and Urodynamic Units in Spain. Material and methods Observational, cross-sectional, multicenter and prospective study conducted in Spain in women with clinical diagnosis of OAB, who had been referred to urodynamic study (UDS) of which centralized reading was performed. Patients completed the 3-day bladder diary (DM3d) with the PPIUS scale (Patient Perception of Intensity of Urgency Scale), the B-SAQ (Bladder control Self-Assessment Questionnaire) and the OABq-SF (Overactive Bladder Questionnaire Short Form). The questionnaires and UDS variables of women with OAB, with or without DO, were compared using the Mann-Whitney test (continuous variables) and the chi-square test (χ2) (categorical variables). Results A total of 247 women with OAB were evaluated, and 103 of them had DO. According to the presence or absence of DO, significant differences were observed in the number of episodes of urge urinary incontinence (UUI), urinary frequency, nocturia, mean micturition volume and number of pads (p Conclusions The presence of DO in women with OAB is related to a more severe alteration of the bladder storage phase.

Introduction and hypothesis Urinary incontinence (UI) is associated with pregnancy and parity and can cause health problems for women. Our objective was to explore risk factors for UI and its effect on women’s daily activities, psychological health and wellbeing 9–12 months postpartum in a low-risk primiparous population. Methods In this prospective cohort study, first-time mothers in a low-risk population with a spontaneous vaginal birth reported the occurrence of UI and its effect on daily activities and on their psychological health and wellbeing in a questionnaire completed 1 year after birth. Descriptive and comparative statistics were employed for the analysis. Results A total of 410 women (75.7%) completed the questionnaire. The self-reported rates of stress urinary incontinence, urge urinary incontinence and mixed urinary incontinence were 45.4%, 38.0% and 27.0% respectively. Neither the duration of the second stage of labour, the baby’s head circumference or its birth weight were associated with the incidence of UI. There was an association between reported negative impact on daily activities and more negative psychological wellbeing (p

Objective To investigate the extent of lower urinary tract symptoms (LUTS) during pregnancy and 7 years after birth in primipara and their association with delivery mode history and other factors. Methods A longitudinal cohort study was conducted in 12 hospitals representative of the diversity of the seven administrative regions of China. Of 10 098 women recruited at the third trimester, 3862 (38.25%) responded at 1 year, and 1115 (11.04%) responded at 7 years. A modified Chinese Bristol Female Lower Urinary Tract Symptoms questionnaire was administered. No intervention was implemented. Results Among the participants, 75.4% reported nocturia during gestation, followed by frequency (58.4%), which gradually decreased after delivery. The prevalence of urge urinary incontinence (UUI) increased from 5.7% during pregnancy to 22.8% at 1 year after delivery and 10.2% at 7 years postpartum. The prevalence of stress urinary incontinence (SUI) increased from 29.9% during pregnancy to 46.4% at 1 year postpartum and 23.7% at 7 years after delivery. The odds of storage LUTS and voiding LUTS 7 years after delivery were lower for the cesarean section (CS) group than for the vaginal delivery (VD) group (OR = 0.49, 95%CI, 0.36-0.68; OR = 0.25, 95%CI, 0.09-0.70). The most frequent moderately to severely bothersome LUTS after VD was SUI (19.18%), while that for CS was UUI (19.18%). Conclusion The incidence of storage LUTS was higher than that of voiding LUTS both during pregnancy and postpartum. The most frequently reported LUTS during pregnancy were nocturia and frequency, while the most frequent LUTS after delivery were urgency and SUI. CS was associated with a decreased prevalence of both storage and voiding LUTS after delivery.

Introduction. Pelvic organ prolapse is commonly associated with symptomatic stress urinary incontinence, in up to 50% of patients. The aim of our research was to examine the quality of life of women with urinary incontinence and pelvic organ prolapse after conventional surgical treatment. Material and Methods. The research included 50 patients with stress urinary incontinence and pelvic organ prolapse that underwent vaginal hysterectomy with anterior and posterior colporrhaphy. The pelvic organ prolapse-quantification system was used to determine the degree of genital prolapse. All patients completed a questionnaire to determine the ?stress and urge? score preoperatively, as well as the Urinary Distress Inventory-6 and Urinary Impact Questionnaire-7 during the follow-up examination, a year after the surgery. Results. One year after surgery, 20 patients (40%) presented with a recurrence of cystocele. The average value of the Urinary Distress Inventory-6 questionnaire a year after surgery was 29.0 ? 10.8, while the average value of the Urinary Impact Questionnaire-7 questionnaire was 3.7 ? 16.3. After the surgery, 6 patients (12%) had persistent stress urinary incontinence and 4 patients (8%) had urge urinary incontinence. Among patients with persistent stress urinary incontinence, two patients reported pronounced symptoms of stress urinary incontinence and reoperation was performed. Conclusion. The classical surgical treatment of pelvic organ prolapse with anterior and posterior colporrhaphy leads to improvement in the quality of life of patients with pelvic organ prolapse and stress urinary incontinence. If the symptoms of stress urinary incontinence persist after classical surgical treatment, other anti-incontinence surgical modalities should be considered.

Purpose: Women with lower urinary tract symptoms are often diagnosed based on a predefined symptom complex or a predominant symptom. There are many limitations to this paradigm as often patients present with multiple urinary symptoms which do not perfectly fit the preestablished diagnoses. We used cluster analysis to identify novel, symptom based subtypes of women with lower urinary tract symptoms.Materials and Methods: We analyzed baseline urinary symptom questionnaire data obtained from 545 care seeking female participants enrolled in the LURN (Symptoms of Lower Urinary Tract Dysfunction Research Network) Observational Cohort Study. Symptoms were measured with the LUTS (lower urinary tract symptoms) Tool and the AUA SI (American Urological Association Symptom Index), and analyzed using a probability based consensus clustering algorithm.Results: Four clusters were identified. The 138 women in cluster F1 did not report incontinence but experienced post-void dribbling, frequency and voiding symptoms. The 8...

Women with obesity are at risk of pelvic floor dysfunction with a 3-fold increased incidence of urge urinary incontinence (UUI) and double the risk of stress urinary incontinence (SUI). The National Institute for Health and Care Excellence (NICE) and European Association of Urology (EAU) recommend that women with a body mass index ≥30 kg/m2 should consider weight loss prior to consideration for incontinence surgery. This systematic review and meta-analysis will assess this recommendation to aid in the counselling of women with obesity-related urinary incontinence (UI). Medical Literature Analysis and Retrieval System online (MEDLINE), EMBASE, Cochrane, ClinicalTrials.gov, and SCOPUS were systematically and critically appraised for all peer reviewed manuscripts that suitably fulfilled the inclusion criteria established a priori and presented original, empirical data relevant to weight loss intervention in the management of urinary incontinence. Thirty-three studies and their outcomes were meta-analysed. Weight loss interventions were associated in a decreased prevalence in UI (OR 0.222, 95% CI [0.147, 0.336]), SUI (OR 0.354, 95% CI [0.256, 0.489]), UUI (OR 0.437, 95% CI [0.295, 0.649]) and improved quality of life (PFDI-20, SMD -0.774 (95% CI [−1.236, −0.312]). This systematic review and meta-analysis provide evidence that weight loss interventions are effective in reducing the prevalence of obesity-related UI symptoms in women. Bariatric surgery in particular shows greater sustained weight loss and improvements in UI prevalence. Further large scale, randomized control trials assessing the effect of bariatric surgery on women with obesity-related UI are needed to confirm this study's findings.\ud \ud

Objective: To examine the impact of electroacupuncture (EA) at the ‘four sacral points’ on urge urinary incontinence (UUI). Methods: Twenty-five patients diagnosed with UUI or urgency-predominant mixed urinary incontinence (MUI) were treated by EA at the ‘four sacral points’. EA was performed in the sacrococcygeal region using disposable sterile 0.40-mm-diameter acupuncture needles that were either 100 or 125 mm in length. Treatments were delivered once every other day. Before and after treatment, a questionnaire measuring symptom severity and quality of life associated with UUI was administered. Results: The median total score (interquartile range) from the severity of symptoms and the quality of life questionnaire (Q-score) of the participants was significantly reduced from 12 (7.5, 15) before treatment to 3 (0, 6) after 6 (6, 12) EA treatments. The Q-score of urgency-predominant MUI and UUI was 8 (5, 14.5) and 12.5 (11, 15), respectively, before treatment; after treatment these were reduced to 2 (0, 7.5) and 4.5 (2, 6), respectively. There was no statistically significant difference in the Q-score between urgency-predominant MUI and UUI before and after treatment. Upon treatment completion, seven patients (28%) were ‘cured’ (improvement rate 100%). Treatments were considered ‘markedly effective’ (improvement rate 75% to Conclusion: EA at the ‘four sacral points’ was associated with statistically significant improvements in UUI.

BACKGROUND: Although specialists are skilled in the management of urinary incontinence, primary care clinicians are integral in early diagnosis and initiation of management in order to decrease overuse of specialty care and improve the quality of specialist visits. We measured the quality of incontinence care provided by primary care clinicians before referral to a specialist and evaluated the impact of provider variables on quality of care. METHODS: We performed a retrospective review of 200 women referred for urinary incontinence to a Female Pelvic Medicine and Reconstructive Surgery specialist between March 2017-July 2018. We measured primary care adherence to twelve quality indicators in the twelve-months prior to specialist consultation. We stratified adherence to quality indicators by clinician gender and years of experience. RESULTS: Half of women with incontinence underwent a pelvic exam or had a urinalysis ordered. Few patients with urge urinary incontinence were recommended behavioral therapy (14%) or prescribed medication (8%). When total aggregate scores were compared, female clinicians performed the recommended care 47 +/− 25% of the time compared to 35 +/− 23% for male clinicians (p=0.003). Increasing years of experience was associated with worse overall UI care (r −0.157, p=0.02). CONCLUSIONS: We found low rates of adherence to a set of quality indicators for women with urinary incontinence, with male clinicians performing significantly worse than female clinicians. Improvement of incontinence care in primary care could significantly reduce costs of care and preserve outcomes.

The objective was to report the management of post-operative urinary incontinence after midurethral sling (MUS) revision for chronic pelvic pain (CPP), and to report functional outcomes. From November 2004 to February 2018, a total of 89 women who underwent removal or section of MUS for CPP, were enrolled. Patients were divided into the transobturator tape (TOT) group (50 patients) and the tension-free vaginal tape (TVT) group (37 patients); 2 patients had had both slings implanted. We report the rate of stress urinary incontinence (SUI) recurrence, the rate of de novo urge urinary incontinence (UUI), the need for subsequent SUI or UUI surgery, and functional outcomes (pain and continence). Median follow-up was 41.4 months [0.9–138.8]. SUI recurrence or de novo UUI occurred in 52 cases (58.4%): 19 (51.3%) patients in the TVT group, 31 (62%) in the TOT group, and both patients (100%) who underwent total removal of both slings. Among patients with SUI recurrence or de novo UUI, 39 (75%) had pain relief after sling removal. Seventeen patients (32.6%) refused any treatment, 14 (26.9%) were cured with conservative therapy, and 21 (40.3%) underwent SUI or UUI surgery. One patient had de novo pelvic pain after reoperation. The overall continence rate for all patients who underwent sling revision was 82% (73 out of 89) at the last follow-up. After MUS revision for CPP, post-operative UI may occur in 58.4% of patients, of which, one-fourth may be managed with conservative measures only. Forty percent of them had redo surgery with a low risk of pain recurrence and a high rate of urinary continence.

Objective: The aim of this study was to evaluate the safety and efficacy of fractional CO2 laser for treatment of vulvovaginal atrophy. Materials and methods: In this clinical trial study, we evaluated the laser effect on vulvovaginal atrophy in 47 women aged 43-80 years. Each woman was treated with fractional CO2 laser, SmartXide2V2LR, DEKA, Monalisa Touch, vaginal 360o probe and cosmetic probe. The severity of vulvovaginal atrophy symptoms was evaluated before first session of laser and every 4 weeks after laser treatment until 12 weeks. Adverse effects including pain and itching were assessed at all visits. The statistical analysis was performed using SPSS version 23. Results: The response to laser therapy for vaginal dryness was significantly (p

Urinary incontinence is a common problem affecting 25–45% women. Effective management can have a huge impact on a patient’s quality of life and many treatments are available. Management should be dictated by the degree of bother the symptoms are having, and vary depending on the type on incontinence. Conservative measures should always be initiated, including optimisation of body mass index and smoking cessation. Overactive bladder and urge urinary incontinence can be improved with bladder retraining and avoidance of bladder stimulants. Medical treatment then includes anticholinergic medications or Mirabegron. More invasive options include Botulinum Toxin A (Botox®) injections, sacral nerve stimulation or urological surgery. Stress urinary incontinence should be managed initially with pelvic floor exercises, and input from a specialist nurse or physiotherapist is beneficial. The surgical options for managing stress incontinence have changed considerably over the years, but include bladder neck injections, mid-urethral slings, colposuspension or autologous fascial slings. Mixed urinary incontinence is more challenging to manage, but all conservative measures should be started. Further treatment is directed towards the predominant symptom, but overactivity should be controlled before surgical measures for stress urinary incontinence are performed.

Objective This study aimed to adapt the Questionnaire for Urinary Incontinence Diagnosis (QUID) into Brazilian Portuguese (QUID-Br) and evaluate its measurement properties, given as reliability, validity, and responsiveness in women with urinary incontinence. Study design It was a methodological study which enrolled 168 women (mean age = 55.1, standard deviation = 17.9 years old). Translation and cross-cultural adaptation were done and subsequently analysis of the measurement properties of QUID-Br were tested: structural validity (by exploratory and confirmatory factory analysis) internal consistency (Cronbach’s α) construct validity (Pearson Correlation), and test-retest reliability (Intraclass Correlation Coefficient). Results The QUID-Br two-factor was confirmed showing two domains with three items each: stress urinary incontinence (SUI) and urge urinary incontinence (UUI). Furthermore, QUID-Br showed acceptable internal consistency for both scales (Cronbach’s α > 0.70), reliability [intraclass correlation coefficient (ICC = 0.85 for SUI and 0.87 for UUI)] with 95 % confidence interval (CI) and construct validity - with all the hypothesis raised a priori being confirmed. Conclusions The results of the present investigation showed that the QUID-Br is a valid, reliable, and consistent instrument to be administered to Brazilian women and its use is recommended in clinical practice and research.

To evaluate change in fecal incontinence symptom severity after 8 weeks of darifenacin therapy in patients with double incontinence-urgency urinary incontinence (UUI) and fecal incontinence. Important secondary outcomes included fecal incontinence symptom distress and impact on quality of life, fecal incontinence episodes, global impression of improvement and overactive bladder symptom distress and impact. Prospective open-label cohort study of women presenting primarily with UUI, diagnosed with double incontinence and electing antimuscarinic therapy for UUI. Women ≥ 18 years with moderate or greater bothersome UUI and fecal incontinence of liquid/solid stool with St. Marks (Vaizey) score ≥ 12 were included. Subjects were treated with darifenacin 15 mg daily for 8 weeks. The primary outcome was change in fecal incontinence symptom severity using the St. Marks (Vaizey) score after 8 weeks. Sample size was based on the minimally important difference of the St. Marks, −5, and standard deviation, ± 8.5; 30 subjects provided 80% power and type I error of 0.05, including a 15% attrition rate. Thirty-two women were consented with mean baseline St. Marks (Vaizey) score of 18.0 ± 3.0. Mean age was 66.5 ± 10.3 years. Twenty-eight subjects (29/32, 87.5%) completed assessments. St. Marks (Vaizey) score significantly improved from 18.0 to 11.0 [mean difference − 7.0, 95% confidence interval (CI): −8.7, −5.3], and 19 subjects (19/32,67.9%) met the minimally important difference. Statistically significant improvements were also noted in fecal incontinence frequency, quality of life, and overactive bladder symptom bother and quality of life (all p

Introduction and Background: Benign Prostatic Hyperplasia (BPH) affects the micturition cycle. Lower urinary tract symptoms (LUTS) refers to storage symptoms such as urinary frequency, urgency, urge urinary incontinence and nocturia. Surgical options for bladder outlet obstruction (BOO) are currently offered for symptomatic improvement. However, 30% of patients report persistent LUTS after BOO procedures. Neuroplasticity induced by BPH and BOO can be contributory in these men, having different brain activation patterns during the micturition cycle. Our multimodal functional Magnetic Resonance Imaging (fMRI) study will identify for the first time, structural and functional brain contributions to LUTS in men with BPH and BOO at baseline and following BOO procedures. We hypothesize that men with symptomatic BPH with persistent LUTS following BOO procedures have a distinct brain activation pattern in regions of interest (ROIs) of the micturition cycle. Methods: Male patients older than 45 years of age undergoing BOO procedures will be enrolled and categorized in two groups. Group 1: patients with BPH with significant improvement in storage symptoms after BOO procedures. Group 2: patients with BPH with persistent storage symptoms after BOO procedures. Our control group are male patients without LUTS undergoing radical prostatectomy. Patients will complete subjective questionnaires and post void residual at clinic visits. BOLD signals at full urge will be measured at baseline and following BOO procedures. All patients will undergo fMRI studies at baseline and at 6 months. Clinical data will be correlated to BOLD signal changes as well as to structural changes in white matter tracts. Ethics and dissemination: After IRB approval, patients will be recruited and properly consented before enrolling to this study. Results of neural contribution to lower urinary tract symptoms will be presented at national and international meetings and will be published in scholarly journals. Keywords: Functional MRI, Benign prostatic hyperplasia, LUTS, BOO

OBJECTIVES: To evaluate the effect of transcutaneous tibial nerve stimulation (TTNS) and transcutaneous parasacral stimulation on the treatment of overactive bladder (OAB) in elderly people and to compare the final results between groups. METHODS: Fifty female volunteers, mean age 68.62 (±5.9) years, were randomly allocated into two groups: those receiving TTNS (G1, N=25) and those receiving transcutaneous parasacral stimulation (G2, N=25). The primary outcome was the International Consultation on Incontinence Questionnaire (ICIQ-OAB) score, and secondary outcomes were the International Consultation on Incontinence Questionnaire - short form (ICIQ-SF) score and 3-day bladder diary measurements. Volunteers were assessed before and after the treatment. Clinical Trials (ReBeC): RBR-9Q7J7Y. RESULTS: Both groups’ symptoms improved as measured by the ICIQ-OAB (G1 =

Introduction The aim of this review was to assess the prevalence of gastrointestinal (GI) and lower urinary tract symptoms (LUTS) in sportswomen having high intensity training and to determine whether the type of sport might also affect LUTS and GI symptoms. Evidence acquisition A systematic review of the literature was performed by searching PubMed, CINAHL, Cochrane Library and Web of Science up to November 2018. The search strategy included several keywords concerning pelvic floor disorders, urinary dysfunction, bowel dysfunction, sportswomen, and elite sports. Inclusion criteria were studies of women who performed any kind of sport with a prevalence of LUTS and/or bowel symptoms without any restriction for age, sport modality or frequency of training. Outcomes were prevalence of LUTS and GI symptoms and meta-analyses and moderator analyses to identify risk factors for the occurrence of these symptoms in female athletes. Evidence synthesis During the search, 1263 records were screened, 31 of which met the methodological criteria for qualitative analysis and 5 for meta-analysis. Sportswomen during daily activity showed a threefold higher risk to develop urinary incontinence (UI) than controls (OR 3.13; 95% CI: 2.39-4.00). No differences were found stratifying data for UI types. Cumulative prevalence rates were: 58.7% of all kinds of UI (daily life together with sport time), 32.8% at rest (during daily life out of sport time), 36.3% during sport time; 23% of stress urinary incontinence (SUI) during sport time versus 38.6% at rest; 11% of urge urinary incontinence (UUI) during sport time versus 17.8% at rest; 11.9% of mixed urinary incontinence (MUI) during sport time versus 20.7% at rest. Prevalence rates of GI symptoms before sport time were 57.6%, during sport competition 35.2% and 58.2% after competition. Conclusions All the analyzed studies showed bias. This meta-analysis indicated that competitive sport activities represent a risk factor for urinary incontinence and gastrointestinal disorders. To prevent urinary leakage athletes should be instructed to strengthen the pelvic floor muscles.

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.

Female urinary incontinence: diagnosis and treatment Abstract. Urinary incontinence (UI) is a common condition that may affect women of all ages, with a wide range of severity and nature. Although rarely life threatening, UI may seriously influence the physical, psychological and social wellbeing of affected individuals. The two main types are Stress and Urge Urinary Incontinence. A new and important term is used, the overactive bladder syndrome (OAB), which is defined as urgency that occurs with or without urge UI and usually with frequency and nocturia. Stress Urinary Incontinence (SUI) is the result of weak urethral muscle and support. Urge Urinary Incontinence (UUI) is the result of over active bladder muscle. History and physical examination, including vaginal exam and measuring postvoidal residual volume establish the diagnosis, and a urinary tract infection should be ruled out. Therapy consists of behavioral modification. For SUI pelvic floor physiotherapy (Kegel exercises with or without aid of physical therapist) is important, also, devices such as a pessary or urethral insert can be used. When symptoms persist, surgery (typically a synthetic mesh sling) is indicated. In selected cases, transurethral bulking agent injections can be discussed. For OAB or UUI also physiotherapy as well as medications such as antimuscarinics or the recently released beta-3-adrenoreceptor-agonist Mirabegron are well established. In case of failure intravesical botox application is a good option.

Aims The purpose of this scoping review was to map out the existing literature on caffeine intake and lower urinary tract symptoms (LUTS) in adults. Methods In this scoping review, we searched for all studies available until June 2019 in MEDLINE, Embase, CINAHL, Cochrane Central Register, PsycINFO, LILACS, LiSSa, Web of Science, and Joanna Briggs Institute electronic databases, in addition to a hand search of the bibliographies of all relevant articles and a gray literature search. Both intervention studies on the effects of caffeine reduction in adults with LUTS and observational studies on the association between caffeine intake and LUTS-related outcomes in adults were included and assessed for methodological quality by two independent reviewers. Results Fourteen intervention and 12 observational studies were included. Overall, there was a decrease in urgency episodes (level of evidence 2, grade of recommendation B) and nocturnal enuresis episodes (4, C) with caffeine reduction. Observational studies reported an unclear association between caffeine intake and LUTS-related outcomes. Most importantly, this present review highlighted high heterogeneity in the studied populations, caffeine measures, and reported outcomes. There was also unknown or high risk of bias in most identified studies. Conclusions Caffeine reduction appears to reduce LUTS. Future studies on caffeine reduction interventions should target populations with urgency and urge urinary incontinence, which show the most promising results, and include valid and reliable measures of caffeine intake and LUTS. Finally, future studies should also use reporting guidelines to ensure lower risk of bias.

Background:. This study is aimed to determine the trimester-based changes in urogenital symptoms and their impact on the quality of life in pregnant women. Materials and methods:. Fifty-one pregnant women participated in this study. Self-reported symptom-based questionnaires, Urogenital Distress Inventory-Short Form (UDI-6), Incontinence Severity Index (ISI), and Incontinence Impact Questionnaire (IIQ-7) were administered to determine urogenital symptoms, incontinence severity, and the quality of life in all participants in the first, second, and third trimesters. The findings obtained were analyzed with the Friedman and Spearman tests. Results:. Irritative (urgency and frequency) and stress incontinence symptoms showed statistically significant changes (p 0.05) according to the scores of UDI-6 subscales over the trimesters. There were negative, weak-moderate correlations between stress incontinence symptoms and IIQ-7 in the first, second, and third trimester. There was a negative, moderate correlation between irritative symptoms and IIQ-7 only in the third trimester, but there were not any correlations between the other urogenital symptoms and IIQ-7 (p > 0.05). In the prepregnancy period, stress urinary incontinence (SUI) and urge urinary incontinence (UUI) occurred in 9.8% and 7.8% of the patients, respectively, whereas there were no women with mixed urinary incontinence (MUI) preconceptionally. The presence of SUI, UUI, and MUI were 13.7%, 7.8%, and 0% in the first, 26%, 9.8%, and 3.9% in the second, and 41.2%, 27.5%, and 13.7% in the third trimester, respectively. ISI scores showed statistically significant changes in the first, second, and third trimesters of women with SUI, UUI, and MUI (p