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Aims: To investigate typical pad weight gain (PWG) in asymptomatic women who have never reported any episodes of urinary incontinence., Methods: An observational study was performed by measuring the increase in weight of small sanitary pads worn by 35 healthy, female volunteers of a median age 36 (range, 23-56) years. Each pad was worn for a minimum of 5 h which is the typical maximum duration of an ambulatory urodynamics study., Results: The median duration of pad wear was 6 h (interquartile range [IQR], 5-8). The median PWG was 0.111 g (IQR, 0.047-0.255). The maximum recorded PWG was 0.621 g and the minimum was 0.012 g. PWG was not significantly affected by age, parity, years since last delivery, body mass index, or menopausal status., Conclusions: PWG over a median duration of 6 h (IQR, 5-8) is typically <0.7 g in women who are asymptomatic of urinary incontinence. Therefore, PWGs in excess of 0.7 g over a 5-h ambulatory urodynamics study in symptomatic women are likely to be diagnostic of urinary incontinence., (© 2020 Wiley Periodicals LLC.)

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

Abstract Objective Urodynamic studies (UDSs) are a set of tests that assess the storage and emptying of urine, and they are widely used by gynecologists and urologists in the management of urinary incontinence (UI), despite the discussion about its indications. The objectives of the present study were to verify whether UDSs are routinely used in the conservative and surgical approaches to female UI, their other clinical indications, and to compare the responses of Brazilian gynecologists and urologists. Methods The present is an opinion survey applied from August 2020 to January 2021 through a semistructured questionnaire about the clinical practice sent by e-mail to all participants. The responses were compared through statistical analyses. Results Of the 329 participants, 238 were gynecologists (72.3%) and 91, urologists (27.7%). Most gynecologists (73.5%) and urologists (86.6%) do not request UDSs before the conservative treatment of UI; but UDSs are indicated in the preoperative period of anti-incontinence surgeries. Most participants request UDSs in the initial approach to overactive bladder (gynecologists: 88.2%; urologists: 96.7%), and the urologist has greater chance to request this study (odds ratio [OR] = 3.9). For most participants, it is necessary to request uroculture before the UDSs. Conclusion Most Brazilian gynecologists and urologists who participated in the present study do not request UDSs before the conservative treatment of UI, according to national and internacional guidelines, and often request it before the surgical treatment for female UI. The indication of this exam in the initial approach of idiopathic overactive bladder should be reviewed by the participants.

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

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

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

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

Objective: To describe a new device for home treatment of urinary incontinence (UI) by comparing 3 conservative techniques and monitoring compliance and performance.Methods: Thirty-two patients with UI were allocated to 1 of 3 intervention groups: pelvic floor muscle exercises (PFME; n=11) alone; PFME combined with biofeedback (n=10); or PFME combined with electrical stimulation (n=11). The outcomes assessed were: changes in quality of life score (QLS), urodynamic and perineometric parameters, episodes of urine loss, subjective assessment of improvement, and actual compliance and performance with treatment.Results: Increased pelvic muscle contraction strength (P<0.05), improvement in QLS (P<0.02), and fewer episodes of urine leakage were observed in all 3 groups (P<0.05). Compliance was similar among the groups (P=0.201).Conclusion: All 3 techniques were effective for home treatment of UI, with significant control of symptoms and improved quality of life. The device effectively monitored compliance and performance of exercises. [ABSTRACT FROM AUTHOR]

To determine the effectiveness of transvaginal electrical stimulation (TES) in treating urinary incontinence, and to assess the clinical improvement 6 months after ending the treatment. In a double-blind randomized controlled clinical trial, 36 women (24 patients and 12 controls) with stress, urge or mixed urinary incontinence were chosen to use TES or placebo (identical equipment but with no electrical current). The patients had their treatment at home twice a day (20-min sessions) for 12 weeks. They completed a voiding diary and had a urodynamic study at the beginning and end of treatment. They were clinically re-evaluated after 6 months. The mean time of use of TES was similar in both groups (≈ 40 h); the treatment group had a significant increase in maximum bladder capacity ( P < 0.02), a significant reduction in the total number of voids (over 24 h; P < 0.02), in the number of episodes of voiding urgency ( P < 0.001) and, importantly, in the number of episodes of urinary incontinence ( P < 0.001). At the first evaluation, after ending the treatment, 88% of the patients had a significant reduction in symptoms or went into remission. At the 6-month re-evaluation, a third of the patients required another therapeutic approach. TES is a practical alternative with few side-effects, and is effective for treating the main forms of female urinary incontinence. [ABSTRACT FROM AUTHOR]

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

In a prospective blinded comparative clinical study 125 women underwent videocystourethrography and cystometry as well as transperineal ultrasound as part of their diagnostic work-up for urinary incontinence or after incontinence-correcting surgery. Comparisons between ultrasound and X-ray imaging were carried out on 117 women for whom complete data sets were available. Mean bladder neck descent was significantly greater with ultrasound compared to VCU (US: 2.1±1.2 cm vs. VCU: 1.8±0.9; P=0.003). Rotation of the proximal urethra was not always seen on X-ray, but when it was (44 patients) there was good correlation with US (US rotation 55±27° vs. VCU rotation 55°±29). There was also good agreement between both tests regarding visualization of funneling or opening of the proximal urethra, with both tests showing equivalent results in 95 out of 117 patients (Cohen's κ 0.58). On comparing extensive funneling to the midurethra on US with frank leakage on VCU the methods were in agreement for 90 out of 117 patients (κ 0.54). Overall a good correlation between ultrasound and radiological findings was observed. Both methods allow anatomic assessment of the bladder neck and have different strengths and weaknesses. Ultrasound imaging may be preferable as it is chaper, requires less technological back-up and avoids the risks of radiation exposure and allergic reactions to contrast medium. [ABSTRACT FROM AUTHOR]

Simultaneous perineal ultrasound and urodynamic evaluation was performed in 35 female patients suffering from urinary incontinence of varying etiologies and in 5 healthy continent women. The digitized ultrasound signals and urodynamic curves were simultaneously monitored on a computer screen. During cystometry, urethral pressure profile during stress, and micturition, this simultaneous technique correlates pressure measurements with the behavior of the urethrovesical junction. The influence of intra-abdominal pressure changes (coughing, straining) on the anatomy of the urethra and the urinary bladder, or the effect of pelvic floor and urethral sphincter contractions on the intraurethral and intravesical pressure, thereby becomes evident. The synchronous imaging of pressure variations and structural changes provides valuable information about the functional anatomy of the urethrovesical junction. On the one hand urodynamic phenomena, and on the other hand ultrasound findings, can be better understood than when the techniques are performed separately. With this simultaneous evaluation additional knowledge is acquired about the pathyophysiology of micturition disorders and incontinence. An advantage of ultrasound compared with radiological techniques is that the urethrovesical anatomy and the surrounding tissues are clearly imaged without irradiation and without the need for contrast medium. [ABSTRACT FROM AUTHOR]

This paper includes the preoperative, early (i.e. half a year) and late postoperative (on average 3.8 years) clinical, urodynamic and morphological findings of 145 stress incontinent women. An anterior vaginal repair was performed in 54 patients, while 91 received urethrovaginal fixation according to Burch. Early postoperative analysis of urodynamic parameters shows deterioration in the vaginal repair group and improvement of the colposuspension group. Comparison of early and late postoperative urodynamic findings indicates gradual deterioration as a function of time. Morphological findings prove that the abdominal operation elevated and attached the bladder neck better and more durably to the symphysis pubis, even though late postoperative examinations show impairment of these results with time. Follow-up showed that in the early postoperative period 91% of patients with urethrovaginal fixation were cured or improved, while the success rate for the vaginal repair was 76%; late postoperative results revealed 89% and 86% cure or improvement rates respectively. The results confirm that the success of operative repair is highly dependent on the selection of the correct procedure by proper preoperative diagnostic evaluation. [ABSTRACT FROM AUTHOR]