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Aim: Urinary incontinence (UI) causes long-term physical and psychological suffering to patients. Risk factors for different UI subtypes and symptom severity are still unclear, as well as their associations. We aimed to examine the potential influencing factors of UI episodes, UI severity and UI subtypes, and the associations among them., Methods: A total of 611 women were recruited in Shantou, China. Clinical and demographic data were collected through electronic medical records, measurements and self-reports. UI diagnosis, subtypes and symptom severity were confirmed according to international uniform standards. The health burden of UI was evaluated by the Incontinence Impact Questionnaire. Multivariate logistic and linear regression models were carried out to examine the potential risk factors and associations among UI subtypes, symptom severity, and health burdens., Results: Age, body mass index, comorbidity, lower urinary tract symptoms and constipation were associated with UI episodes and UI severity. Mixed UI patients had worse severity than urgency UI and stress UI, especially in leak times/week and daily life obstructing. Mixed UI patients also had higher health burdens, including mental health burdens, than urgency UI and stress UI patients. UI severity was positively associated with higher health burdens (β = 0.46, 95% CI 0.34-0.60), especially in physical activities, travel and social relationship burden (β = 0.61, 95% CI 0.40-0.85; β = 0.55, 95% CI 0.19-0.76; β = 0.65, 95% CI 0.38-0.91; respectively)., Conclusions: Age, body mass index, comorbidity, somnipathy and constipation were associated with UI episodes and symptom severity. Mixed UI showed the highest symptoms severity and health burdens. Worse UI severity increased the patient's physical health burden, but was not obvious for mental health burden. Geriatr Gerontol Int 2022; 22: 219-226., (© 2022 Japan Geriatrics Society.)

Objective: To investigate how GPs manage women with urinary incontinence (UI) in the Netherlands and to assess whether this is in line with the relevant Dutch GP guideline. Because UI has been an underreported and undertreated problem for decades despite appropriate guidelines being created for general practitioners (GPs)., Design: Retrospective cohort study., Setting: Routine primary care data for 2017 in the Netherlands., Subjects: We included the primary care records of women aged 18-75 years with at least one contact registered for UI, and then extracted information about baseline characteristics, diagnosis, treatment, and referral to pelvic physiotherapy or secondary care., Results: In total, 374 records were included for women aged 50.3 ± 15.1 years. GPs diagnosed 31.0%, 15.2%, and 15.0% women with stress, urgency, or mixed UI, respectively; no diagnosis of type was recorded in 40.4% of women. Urinalysis was the most frequently used diagnostic test (42.5%). Education was the most common treatment, offered by 17.9% of GPs; however, no treatment or referral was reported in 15.8% of cases. As many as 28.7% and 21.7% of women were referred to pelvic physiotherapy and secondary care, respectively., Conclusion: Female UI is most probably not managed in line with the relevant Dutch GP guideline. It is also notable that Dutch GPs often fail to report the type of UI, to use available diagnostic approaches, and to provide appropriate education. Moreover, GPs referred to specialists too often, especially for the management of urgency UI.Key pointsUrinary incontinence (UI) has been an underreported and undertreated problem for decades. Despite various guidelines, UI often lies outside the GPs comfort zone.•According to this study: general practitioners do not treat urinary incontinence according to guidelines.•The type of incontinence is frequently not reported and diagnostic approaches are not fully used.•We believe that increased awareness will help improve treatment and avoidable suffering.

Introduction: Complications due to prosthetic surgery with mesh implantation may be misunderstood due to the insidious clinical presentation and inexperience of many surgeons if not adequately trained for the purpose., Case Report: A 45-year-old female underwent a trans obturator tape procedure to correct severe stress urinary incontinence 3 months after surgery she developed urethral pain. The sling was partially removed, but the pain persisted. No residue sling was visualized by cystoscopies after surgery, and the pain was attributed to a psychiatric problem. She was treated with opioids, pregabalin without improvement of pain, until an extrusion of the sling into the urethra has been diagnosed by a careful urethrocystoscopy., Conclusion: It has been treated in our department by the removal of the residual sling, plus urethroplasty. The patient was followed up at 6 months with resolution of the painful symptoms.

Introduction: Obesity is a well-known risk factor for lower urinary tract disorders. Lifestyle plays an essential role in the etiology of the symptoms, negatively affecting self-esteem and quality of social, professional, and sexual life., Objectives: To assess the prevalence of lower urinary tract symptoms and urodynamic patterns in obese women and to compare to nonobese volunteers., Methods: Overactive bladder (OAB) questionaries (International Consultation on Incontinence Questionnaire [ICIQ]-OAB) and stress urinary incontinence (SUI) (ICIQ-short form) were applied to the participants. They underwent a physical exam and urodynamics except for the control group., Results: A total of 109 women completed the protocol and 20 were in the control group. The average age was 43.0 years, and the average body mass index was 45.12 ± 7.64 kg/m 2 and control was 44.5 years, and 29.95 ± 5.08 kg/m 2 . The OAB symptoms in the obese group were 31.20%, 55.95% higher than the control group (20.0%). The prevalence of SUI in the obese group was 20.20%, an increase of 34.53% compared with the control group (15.00%). The urodynamic study (UDS) showed that the morbidly obese women have a first sensation earlier than the obese or severely obese, as well as the first desire to void. The Valsalva leak point pressure of morbidly obese women was significantly higher than the others., Conclusion: Among obese women, either the prevalence of SUI or OAB is significantly higher than the nonobese female population. Regarding UDS, the pattern is similar to the clinic diagnostic. The grade of obesity is directly associated with an impairment of the patient's cystometric capacity., (© 2021 Wiley Periodicals LLC.)

Objective: To evaluate pain improvement and recurrent stress incontinence (SUI) following painful synthetic midurethral sling (MUS) removal., Methods: We conducted a retrospective review of patients who underwent synthetic MUS removal at our institution from 2009-2016 for the indication of pain. We recorded sling type (transobturator vs retropubic), complete vs partial removal, and presenting symptoms. Postoperative pain improvement was categorized as resolved (pain resolved, requiring no further therapy), improved (pain less bothersome, may require further therapy), or unresolved (no/minimal improvement, requiring further management). Recurrent incontinence and further reconstructive procedures were assessed., Results: 87 patients (49 complete and 38 partial removal) with pain as the primary indication for removal were included. Median age at intervention was 54 years with median follow-up of 8 months. Overall, pain improved or resolved in 78.1% of cases. Complete removal was associated with significantly greater percentage of pain resolution (63.3%) compared to partial removal (26.3%) (P = 0.002) regardless of sling type. No significant differences in recurrent SUI were noted in complete vs partial removal. Additional reconstructive procedures were performed in 28 patients, most commonly sling placement, with no significant difference in complete (20.4%) vs partial (28.9%) removal groups (P = 0.36). The overall complication rate was low (5.7%), a majority of which were transfusions (4.6%)., Conclusion: Following MUS removal, most patients experienced resolution or improvement of pain. Complete sling removal was associated with significantly greater percentage of pain resolution compared to partial removal in both retropubic and transobturator slings. Rates of recurrent SUI and reintervention for SUI were not related to the extent of sling removal., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: Pelvic floor muscle training can cure or alleviate stress urinary incontinence. This study aimed to evaluate maximum voluntary contractions of the pelvic floor muscle in sportswomen and verify the association with leg stiffness and muscle power, both maximal and submaximal., Methods: The sample consisted of 41 sportswomen between 18 and 42 years of age. Pelvic floor muscle strength was measured by the manometer. The sportswomen were instructed to perform 3 maximum voluntary contractions of the perineum, held for 3 seconds. Maximal and submaximal leg stiffness and muscle power were measured with a force platform, in two conditions: 1st condition was the sub-maximal, double leg hop test, which was performed allowing sportswomen to self-select their preferred frequency and 2nd condition was the maximal double leg hop test, which was performed asking athletes to maximize hop height and minimize contact time on the top of the force platform for 6 consecutive hops., Findings: Maximal and submaximal leg stiffness values increase with increasing age, weight, height, and body mass index, showing positive and significant (p <0.05) or close correlations. There are strong positive correlations between maximal and submaximal leg stiffness (r = 0.759) and between maximal and submaximal muscle power. Maximum voluntary contractions values decrease with increasing leg stiffness: the correlation is significant with maximal leg stiffness., Interpretation: Maximum voluntary contractions values decrease with increasing leg stiffness and increase with increasing muscle power values. If the training program aims to increase muscle power, it may also increase maximum voluntary contractions., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Introduction: Pelvic floor muscle training (PFMT) exercises and neuromuscular electrical stimulation (NMES) are described as conservative interventions to prevent or treat female stress urinary incontinence (SUI). However, it has not been described yet the effect of PFMT associated to intravaginal NMES which evaluated the cost-effectiveness and cost-utility of treating., Aims: To evaluate the effects of intravaginal NMES associated with the PFMT protocol on urinary loss and quality of life in women with SUI and to evaluate the cost-effectiveness and cost-utility and pelvic floor muscle in women with SUI., Methods: Randomized controlled trial study with economic evaluation. Inclusion criteria are woman (biological), aged ≥ 18 years old and with a report of SUI ≥ once/week. Exclusion criteria are presence of vaginal or urinary infection, virginity, being in the gestational or puerperium period, or neurological disease. Participants will undergo physical therapy assessment and intervention: anamnesis, pelvic floor muscle assessment by vaginal palpation and manometry (Peritron TM ), questionnaires (Short-Form 6 Dimensions-Brazil (SF-6D), King's Health Questionnaire (KHQ) and King´s Health Questionnaire for Scoring Algorithm), health costs, and voiding diary. Participants will be randomly allocated into 3 groups: CG (control group), IG 1 (intervention group 1, PFMT), and IG2 (intervention group 2, PFMT + NMES). The statistical analysis will be performed by intention to treat, and multivariate analysis of mixed effects will be used to compare outcomes. Effect size measurements will be calculated and will be provided by Cohen's d test. A significance level of 5% will be adopted. Additionally, the incremental cost-effectiveness and incremental cost-utility ratios will be used., Discussion: This protocol can corroborate with the literature in order to identify the effect of techniques, based on the possibility of confirming the hypothesis that the NMES associated with PFMT performed concurrently will be the best treatment option; considering the effectiveness, cost-effectiveness, and cost-utility analysis, it will be used as an option for optimization of the treatment of SUI., Trial Registration: Brazilian Registry of Clinical Trials (ReBEC) ID: RBR-6gtzg4 . Registered on September 3, 2019., (© 2021. The Author(s).)

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)., (© 2021. The Author(s).)

Aims: To assess the role of detrusor underactivity (DUA), diagnosed by different urodynamic criteria, on outcomes of women underwent middle urethral sling (MUS) for stress urinary incontinence (SUI)., Methods: In this prospective study, DUA criteria of women with SUI, naïve for SUI surgery, candidates to MUS were: I Pdet@Qmax ≤10 cm H2O and Qmax ≤12 mL/s (Jeong et al.) ii Pdet@Qmax<30 cm H2O and Qmax<10 mL/s (Abarbanel and Marcus) iii Pdet@Qmax<20 cm H2O and Qmax<15 mL/s and BVE < 90% (BVE criteria) iv Pdet@Qmax<20 cm H2O + Qmax (PIP1 Griffiths) Control group (CG) comprised non-DUA patients. Preoperative and at 2-years follow-up evaluation included physical examination, uroflowmetry, post void residual urine (PVR), ICIQ-FLUTS., Results: 102 patients fulfilled 2-years controls. DUA rate range was 16.7% (BVE) - 53.9% (PIP1-Griffith). The POUR rate varied: 20% (PIP1-Griffith) - 35.3% (BVE), 10% in CG. Tape incision rate for POUR was 3.4% in DUA, 4.5% in CG. No patients had urinary retention at 2-years follow-up. In DUA groups, Qmax did not change significantly after surgery and PVR was low. SUI recurrence rate was 2.8% in DUA, 4.5% in CG. Preoperatively, urgency and post-micturition dribble were the most (82.4%) and the less (26.7%) reported symptoms, respectively. At follow-up, frequency was the most prevalent (56.1%), reduced sensation/bladder pain the less usual (23.1%). ICIQ-FLUTS scores were higher in DUA groups., Conclusions: DUA did not have a negative impact on MUS outcomes in a mid-term follow-up. Early postoperative voiding complication rates changed according to the type of DUA urodynamic criteria., (© 2021 Wiley Periodicals LLC.)

Purpose: To develop and validate a predictive nomogram for early stress urinary incontinence (SUI) after endoscopic enucleation of the prostate (EEP) in patients with benign prostatic hyperplasia (BPH)., Methods: The records of 458 patients who underwent plasmakinetic- or diode-based EEP at our center from March 2016 to December 2019 were reviewed. Among these, 326 and 132 cases were randomly assigned to the training and validation set, respectively. A predictive nomogram was constructed based on multivariate logistic regression analysis. Receiver operating characteristic (ROC) analysis and calibration curves were employed to evaluate its performance., Results: 65 years ≤ age < 70 years, 75 years ≤ age, 25 kg/m 2  ≤ BMI < 30 kg/m 2 , 30 kg/m 2  ≤ BMI, 5 years ≤ LUTS duration, and 75 ml ≤ prostate volume were finally selected as independent predictors of early SUI into the multivariate logistics regression model. It was visualized as a concise nomogram with satisfactory discrimination and accuracy in both training and validation sets., Conclusions: A concise nomogram was developed and validated as a useful clinical tool for predicting early SUI post-EEP., (© 2021. The Author(s).)

Purpose: Limited data exist regarding sexual function after single incision sling (SIS) surgery. We compared sexual function 36 months postoperatively between patients undergoing SIS and transobturator sling (TMUS) for treatment of stress urinary incontinence., Materials and Methods: Assessment of sexual function was a planned secondary objective of this prospective, multi-center study that enrolled women to Solyx SIS or Obtryx II TMUS. The primary study aim was to compare efficacy and safety using non-inferiority design at 36 months . Patient-reported outcomes of sexual function were assessed at baseline and 6, 12, 18, 24 and 36 months using Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). Changes in sexual function were analyzed within and between groups. Outcomes for patients requiring surgical retreatment were determined., Results: Baseline characteristics were balanced using propensity score stratification (N=141 SIS, N=140 TMUS). Groups were similar in age, body mass index and concomitant surgery performed. Average length of followup was 30 months. Baseline sexual activity was similar (123/141 SIS, 114/140 TMUS, p=0.18). Severity of urinary incontinence did not correlate with baseline sexual activity. Mean PISQ-12 scores increased significantly from baseline to 36 months for both groups, indicating better sexual function at each visit. There were no significant differences in PISQ-12 scores between groups except at 36 months, where the difference was small (-2.5, 95% CI [-4.7, 0.2]). Among patients undergoing surgical retreatment (9/281, 3%), improvement in sexual function was maintained. De novo dyspareunia was rare following both treatments (SIS 1/141, TMUS 0/140, p=1.00)., Conclusions: Patients have significant improvement in sexual function after SIS and TMUS. De novo sexual pain is low after sling surgery.

INTRODUCTION Urinary incontinence (UI) is a common condition in all demographics of women and consists of stress UI (SUI), Urgency UI (UUI), and mixed UI (MUI). Treatment includes lifestyle modifications, medical treatment, and surgery depending on the type of UI and severity of symptoms. This review is an update on the evaluation and management of UI in women., Materials and Methods: This review article covers the evaluation and management options for UI in women and includes the most recent guidelines from the American Urological Association (AUA) as well as recently published literature on the management of UI., Results: Any evaluation of UI should include a thorough targeted history and physical, and counseling for treatment should consider patient goals and desired outcomes. For both SUI and UUI, behavioral therapy and lifestyle modifications are effective first line treatments. Patients with UUI can benefit from medical therapy which includes anticholinergics and ß3-agonist medications, as well as neuromodulation in treatment refractory patients. SUI patients may further benefit from mechanical inserts which prevent leaks, urethral bulking agents, and surgical treatments such as the mid urethral sling and autologous fascial pubovaginal sling., Conclusions: Treatment of UI in women requires a graded approach that considers patient goals and symptom severity, beginning with lifestyle and behavioral modifications before progressing to more aggressive interventions.

Objective: To describe the health characteristics and current treatment choices of male stress urinary incontinence (mSUI) patients to inform patient-centered decision-making., Methods: We identified a cohort of mSUI patients aged ≥65 at UCSF and San Francisco VA. Using retrospective chart review and telephone interviews, we ascertained demographics, incontinence characteristics, Charlson Comorbidity Index (score ≥ 4 indicates significant morbidity), frailty with Timed Up and Go (TUG) test, functional dependence with activities of daily living (ADL), calculated life expectancy, and assessed mental health and quality of life (QOL). Bivariate analysis evaluated associations between subject characteristics and ultimate treatment type (conservative vs surgery; sling vs sphincter). Logistic multivariable models evaluating treatment choice were also constructed., Results: The 130 participants had a mean age of 75 and a mean incontinence score of 14.2 representing moderately bothersome incontinence. Nearly 80% had significant morbidity, three-quarters had >50% 10-year mortality risk, 10% needed help with 1 + ADL and 22% had a TUG >10 seconds indicating frailty. The mean physical and mental QOL scores were similar to the general population. Anxiety and depression were reported by 3.9% and 10%. In univariate and multivariable analysis, only incontinence characteristics were associated with conservative vs surgical treatment choice (P < .01)., Conclusion: Multi-morbidity, functional dependence, frailty, and limited life expectancy are common among older men with mSUI, yet current treatment choices appear to be driven by incontinence characteristics. As such, mSUI surgery should be considered among men across the spectrum of health and life expectancy., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Purpose: Although artificial urinary sphincter (AUS) has become an established treatment for moderate to severe stress urinary incontinence (SUI), implantation can be challenging. This study aimed to review the outcomes of laparoscopic AUS (LAUS) implantation and revision in women presenting with SUI., Methods: We reviewed the files of female patients presenting with moderate to severe SUI treated with LAUS implantation from October 2007 to July 2017. Surgeries were performed by one surgeon experienced in open AUS implantation and starting LAUS implantation. The primary endpoint was postoperative urinary continence, which was divided into three categories: complete continence, improved continence, and unchanged incontinence. The secondary outcomes were complications, explantation-free and revision-free time., Results: A total of 49 women (mean age 64 years, range 40-80) had LAUS implantation. Among the 42 patients (85.7%) with an AUS in place at the last follow-up, 25 (59.5%) were fully continent, 16 (38.1%) had improved continence, and 1 (2.4%) had unchanged incontinence. At the last follow-up, 29 (59.2%) patients had their initial AUS and 13 (26.5%) had at least one reintervention. There were 9 (18.4%) intraoperative complications and 25 (51%) postoperative complications, of which 9 (18.4%) were Clavien⩾3. After a median follow-up of 4 years, 9 (18.4%) explantations and 11 (22.5%) revisions occurred. The average period without explantation or revision was 3.7 and 3.1 years, respectively., Conclusion: Our study shows that the laparoscopic approach for AUS implantation is an efficient treatment option for women with moderate to severe SUI., (© 2021. Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Stress urinary incontinence (SUI) is a subtype of urinary incontinence that occurs more commonly amongst women. The pelvic floor muscle training (PFMT) is considered the gold standard for treating SUI. Another technique called the Knack postulated that pre-contraction of the pelvic floor muscles (PFM) during activities of increasing intra-abdominal pressure prevents urinary loss. Currently, there are no studies supporting the Knack for the treatment of SUI. Thus, the aim of this study is to test the hypothesis that voluntary pre-contraction of PFM can treat SUI. For this purpose, the following parameters will be analysed and compared amongst (1) the Knack, (2) PFMT and (3) the Knack + PFMT groups: urine leakage as assessed by the pad test, urinary symptoms, muscle function, quality of life, subjective cure, adherence to exercises in the outpatient setting and at home and perceived self-efficacy of PFM exercises., Methods: A single-centre, double-blind (investigator and outcome assessor) randomised controlled trial with a 3-month follow-up of supervised treatment and an additional 3 months of follow-up (unsupervised) for a total of 6 months of follow-up. Two hundred ten women with mild to moderate SUI will be included, aged between 18 and 70 years. To compare the primary and secondary outcome measures within and between the groups studied (before and after intervention), the ANOVA statistical test will be used. Primary and secondary outcome measures will be presented as mean, standard deviation, 95% confidence interval and median and minimum and maximum values., Discussion/significance: This study closes a gap, as voluntary PFM pre-contraction (the Knack) has not yet been included in the physiotherapeutic treatment of SUI, and if shown successful could be implemented in clinical practice., Trial Registration: ClinicalTrials.gov NCT03722719 . Registered on October 29, 2018. Study protocol version 1. Was this trial prospectively registered? Yes Funded by: The present study did not receive funding. Anticipated completion date: The anticipated trial commencement and completion dates are October 2018 and October 2021, respectively. Provenance: Not invited. Peer reviewed. Human research ethics approval committee: Research Ethical Board of the Universidade Federal de São Paulo (UNIFESP), Brazil. Human research ethics approval number: 2.517.312., (© 2021. The Author(s).)

Background: Stress urinary incontinence (SUI) is common after radical prostatectomy and likely to persist despite conservative treatment. The sling is an emerging operation for persistent SUI, but randomised controlled trial (RCT) comparison with the established artificial urinary sphincter (AUS) is lacking., Objective: To compare the outcomes of surgery in men with bothersome urodynamic SUI after prostate surgery., Design, Setting, and Participants: A noninferiority RCT was conducted among men with bothersome urodynamic SUI from 27 UK centres. Blinding was not possible due the surgeries., Intervention: Participants were randomly assigned (1:1) to the male transobturator sling (n = 190) or the AUS (n = 190) group., Outcome Measurements and Statistical Analysis: The primary outcome was patient-reported SUI 12 mo after randomisation, collected from postal questionnaire using a composite outcome from two items in validated International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form questionnaire (ICIQ-UI SF). Noninferiority margin was 15%, thought to be of acceptable lower effectiveness, in return for reduced adverse events (AEs) and easier operation, for the sling. Secondary outcomes were operative and postoperative details, patient-reported measures, and AEs, up to 12 mo after surgery., Results and Limitations: A total of 380 participants were included. At 12 mo after randomisation, incontinence rates were 134/154 (87.0%) for male sling versus 133/158 (84.2%) for AUS (difference 3.6% [95% confidence interval {CI} -11.6 to 4.6], p NI  = 0.003), showing noninferiority. Incontinence symptoms (ICIQ-UI SF) reduced from scores of 16.1 and 16.4 at baseline to 8.7 and 7.5 for male sling and AUS, respectively (mean difference 1.4 [95% CI 0.2-2.6], p =  0.02). Serious AEs (SAEs) were few: n = 6 and n = 13 for male sling and AUS (one man had three SAEs), respectively. Quality of life scores improved, and satisfaction was high in both groups. All other secondary outcomes that show statistically significant differences favour the AUS., Conclusions: Using a strict definition, urinary incontinence rates remained high, with no evidence of difference between male sling and AUS. Symptoms and quality of life improved significantly in both groups, and men were generally satisfied with both procedures. Overall, secondary and post hoc analyses were in favour of AUS., Patient Summary: Urinary incontinence after prostatectomy has considerable effect on men's quality of life. MASTER shows that if surgery is needed, both surgical options result in fewer symptoms and high satisfaction, despite most men not being completely dry. However, most other results indicate that men having an artificial urinary sphincter have better outcomes than those who have a sling., (Copyright © 2021 The Authors. Published by Elsevier B.V. All rights reserved.)

Stress urinary incontinence in female patients is characterised by loss of urine without the need to urinate. Causes are manifold and require a good knowledge of the pelvic floor structures and the functionality of the bladder's occlusion system. Before any treatment can be initiated, differentiated diagnostic investigation must uncover the causes in order to be able to show incontinent women the ideal therapeutic options. In addition to conservative treatment strategies, there are several surgical alternatives available that can be used depending on the functional and/or anatomical deficit. Surgical correction produces good results, although a minor rate of possible complications must be accepted., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Stress urinary incontinence (SUI) is a common condition in women and associated with extra-cellular matrix (ECM) reconstruction, which is mainly regulated by fibroblasts. However, the underlying mechanism remains obscure. Small extracellular vesicles (sEVs) play fundamental biological roles in various cellular functions. Some studies suggested that the sEVs were involved in the metabolism of ECM and the function of fibroblasts. The purpose of our study was to investigate the effect of sEVs secreted by vaginal fibroblasts on the pathogenesis of SUI. We showed that the fibroblasts of female anterior vaginal wall secreted sEVs. Moreover, fibroblasts of females with SUI had significantly elevated secretion of sEVs. The collagen contents, proliferation and migration capacity of fibroblasts were decreased when fibroblasts were co-cultured with fibroblasts-derived sEVs (fibroblast-sEVs) from SUI patients. Proteomic analysis revealed that fibroblast-sEVs contained various differentially expressed proteins including TIMP2, TGF-β and ABCC4, which were involved in signaling pathways of fibroblasts regulation. Therefore, we suggested that fibroblast-sEVs contributed to the pathogenesis of SUI through various proteins including TIMP2, TGF-β and ABCC4., Competing Interests: The authors have declared that no competing interests exist.

INTRODUCTION Patient-reported pads per day use is a widely used metric in grading the severity of stress urinary incontinence and guiding surgical decision-making, particularly in mild-to-moderate cases. We sought to compare patient-reported stress urinary incontinence severity by pads per day with objective findings on standing cough test. We hypothesize that patient-reported pads per day often underestimates stress urinary incontinence severity., Materials and Methods: We retrospectively reviewed our male stress urinary incontinence surgical database and identified 299 patients with self-reported mild-to-moderate stress urinary incontinence who were evaluated with standing cough test prior to surgical intervention between 2007 and 2019. Patients were evaluated with the Male Stress Incontinence Grading Scale for urinary leakage during a standing cough test. This test has been shown to reliably and accurately predict surgical success. Binary logistic regression analysis was used to identify parameters associated with stress urinary incontinence upgrading in a multivariable model., Results: Among 299 patients with reported mild-to-moderate stress urinary incontinence, 101 (34%) were upgraded to severe stress urinary incontinence by standing cough test. Prior stress urinary incontinence surgery (OR 4.1, 95% CI 2.0-8.0, p < 0.0001) and radiation (OR 3.2, 95% CI 1.7-5.7, p < 0.0001) were significantly associated with Male Stress Incontinence Grading Scale upgrading in multivariable analysis., Conclusions: Roughly one-third of men who report mild-to-moderate stress urinary incontinence actually have severe incontinence observed on physical examination. All men being evaluated for stress urinary incontinence should undergo standing cough test to accurately grade incontinence severity and guide surgical management.

Objective: To describe urinary symptoms and urodynamic findings in patients with advanced pelvic organ prolapse. MATERIAL AND METHODS: A descriptive and retrospective evaluation with advanced POP referred for urodynamic test before surgical repair between 2015 and 2017 were included. All patients under went a urogynexam, physical examination, uroflow and urodynamics exam. Clinical features (filling and emptying symptoms, stress incontinence questionnaire (ISIQ-SF) and urodynamics (sensitivity, capacity and hyperactive detrusor, internal sphincter deficiency and voiding symptoms). RESULTS: A total of 170 patients with advanced PRP were evaluated. The most prevalent symptoms were urgency (63%), urinary stream disturbance (64%), incomplete voiding (63%). Mixt urinary incontinence wasthe most commonly reported (30%). Only 11% had anormal urodynamics exam. 36% had a hidden stress incontinence. 47% had voiding symptoms related to infravesical obstruction (30%). CONCLUSIONS: Patients with advanced POP havea wide variety of urinary symptoms such as urgency, voiding dysfunction and mixt urinary incontinence. Urodynamics studies provide relevant information regardingat the bladder dysfunction that may decrease surgical outcomes.

Purpose: Patient-reported history of pads per day (PPD) is widely recognized as a fundamental element of decision-making for anti-incontinence procedures. We hypothesize that SUI severity is often underestimated among men with moderate SUI. We sought to compare patient history of incontinence severity versus objective in-office physical examination findings., Materials and Methods: We retrospectively reviewed our single-surgeon male SUI surgical database from 2007-2019. We excluded patients with incomplete preoperative or postoperative data and those who reported either mild or severe SUI, thus having more straightforward surgical counseling. For men reported to have moderate SUI, we determined the frequency of upgrading SUI severity by recording the results of an in-office standing cough test (SCT) using the Male Stress Incontinence Grading Scale (MSIGS). The correlation of MSIGS with sling success rate was calculated. Failure was defined as >1 PPD usage or need for additional incontinence procedure., Results: Among 233 patients with reported moderate SUI (2-3 PPD), 89 (38%) had MSIGS 3-4 on SCT, indicating severe SUI. Among patients with 2-3 PPD preoperatively, sling success rates were significantly higher for patients with MSIGS 0-2 (76/116, 64%) compared to MSIGS 3-4 (6/18, 33%) (p <0.01)., Conclusions: Many men with self-reported history of moderate SUI actually present severe SUI observed on SCT. The SCT is a useful tool to stratify moderate SUI patients to more accurately predict sling success., Competing Interests: None declared., (Copyright® by the International Brazilian Journal of Urology.)

Objective: To compare the efficacy of artificial urinary sphincter (AUS) vs retrourethral transobturator sling (RTS) in men with moderate post-prostatectomy urinary incontinence (PPI) using propensity score-matching analysis to enhance the validity of the comparison (Canadian Task Force classification II-2)., Patients and Methods: Consecutive men with moderate (3-5 pads/day) stress-prevalent PPI were included if implanted with a RTS (TiLOOP ® Male; pfm medical, Köln, Germany) or AUS (AMS800 ® ; Boston Scientific, Boston, MA, USA) since July 2011 to December 2017 and with ≥12 months of follow-up. Preoperative assessment included 24-h pad usage, International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), urethrocystoscopy, and urodynamics if indicated. Propensity score-matching analysis was based on age, body mass index, Charlson Comorbidity Index, pad usage, previous radiotherapy, and urethrotomy. The primary outcome was at least 'much improved' response at 12-months according to the Patient Global Impression of Improvement questionnaire, without additional PPI surgery or prosthesis explantation., Results: Of 109 included patients, 70 patients were matched and the study groups were well balanced for the baseline matched variables. The median baseline 24-h pad usage was four in both groups (P = 0.10), and median follow-up was 51.2 months for AUS and 47.2 months (P = 0.5) for RTS patients. In the AUS and RTS cohorts, respectively, 33 (94.3%) and 24 (68.6%) patients achieved the primary outcome (P < 0.001), the 0-1 pad/day rates was 94.3% vs 68.6% (P = 0.012) at 12 months, and 91.4% vs 68.6% (P = 0.034) at last follow-up. At the last follow-up, the median 24-h leakage volumes, median ICIQ-SF scores and satisfaction rates were 0 vs 15 mL (P = 0.017), 4 vs 10 (P = 0.001), and 94.3% vs 68.6% (P = 0.012) in the AUS and RTS cohorts, respectively. There were no significant differences in overall rates of complications and re-interventions, although Clavien-Dindo Grade III complications (n = 3) occurred only in the AUS group. At sensitivity analysis, the study was reasonably robust to hidden bias., Conclusion: We found that AUS implantation significantly outperformed RTS in patients with moderate PPI for both subjective and objective outcomes., (© 2020 The Authors BJU International © 2020 BJU International Published by John Wiley & Sons Ltd.)

Objective: The aim of the study was to determine the performance of a previously published stress urinary incontinence (SUI) risk calculator in women undergoing minimally invasive or transvaginal apical suspensions., Methods: Using a database of stress-continent women who underwent minimally invasive or transvaginal apical suspensions, we calculated 2 prediction risks for development of SUI within 12 months based on inclusion of a "prophylactic" midurethral sling at the time of prolapse surgery. Observed subjective and objective continence status was abstracted from medical records. Regression models were created for the outcome of de novo SUI to generate receiver operating curves. Concordance (c) indices were estimated for the overall and procedure subgroups to determine the calculator's ability to discriminate between SUI outcomes., Results: Analyses included 502 women. De novo SUI was observed in 23.5% of women. The mean ± SD calculated risk of de novo SUI if a sling was performed was 18.9% ± 13.9 at 12 months compared with 36.4% ± 8.3 without sling. The calculator's discriminative ability for those with a planned sling was moderate (c-index = 0.55, P = 0.037). The calculator failed to discriminate continence outcomes when a sling was not planned in the overall group (c-index = 0.50, P = 0.799) and individual apical procedures., Conclusions: The SUI risk calculator is significantly limited in its ability to predict de novo SUI in our population of women planning minimally invasive apical suspensions. Refinements to the calculator model are needed to improve its utility in clinical practice., (Copyright © 2019 American Urogynecologic Society. All rights reserved.)

Objective: The aim of the study was to compare which test is most sensitive in identifying stress urinary incontinence (SUI) in women with pelvic organ prolapse using urodynamics (UDS) as the criterion standard: cough stress test (CST) or pyridium pad test., Methods: This was a prospective study of women with pelvic organ prolapse stage II or greater who desired surgical management for prolapse. Each patient underwent preoperative urinary testing: UDS, CST, and a 24-hour pyridium pad test., Results: A total of 84 patients were analyzed. Using UDS as the criterion standard, both the CST and the pyridium pad test showed a fair agreement with UDS outcomes (κ = 0.27 for both tests). There was no statistically significant difference between the CST and the pyridium pad test, with estimated sensitivities of 34.4% versus 40.6% (P = 0.791), specificities of 90.4% versus 84.6% (P = 0.508). The pyridium pad test was found to have a statistically significant difference in identifying the subjective complaint of SUI (38.6%, P = 0.003) compared with other tests. Patients with occult incontinence were identified 42.5%, 17.5%, and 10% of the time during UDS, CST, and pyridium pad testing, respectively., Conclusion: Our data suggest that the sensitivities of the CST and pyridium pad test for stress incontinence and occult stress incontinence in patients with pelvic organ prolapse are low when compared with UDS as the criterion standard. Urodynamics has an important role in preoperative identification of occult SUI., Competing Interests: The authors have declared they have no conflicts of interest., (Copyright © 2020 American Urogynecologic Society. All rights reserved.)

Objectives: There is a paucity of data on postoperative exercise and how it relates to surgical failure, specifically after midurethral sling (MUS) surgery. We aimed to assess if women with higher self-reported activity levels as measured by strenuous exercise are more likely to experience stress urinary incontinence (SUI) symptoms after MUS than women with lower self-reported activity., Methods: This is a secondary analysis of Operations and Pelvic Muscle Training in the Management of Apical Support Loss: the OPTIMAL Trial, a randomized trial comparing sacrospinous ligament suspension versus uterosacral ligament suspension, both with concomitant retropubic MUS. Participants completed a validated assessment of activity preoperatively and postoperatively. Women in the upper quartile for strenuous exercise (≥90 minutes per week) were compared with the remaining participants. Symptomatic SUI was defined as retreatment or reoperation for SUI and/or any positive response to Pelvic Floor Disorders Inventory stress incontinence questions 20 to 22., Results: A total of 351 participants in the OPTIMAL study received MUS along with their prolapse repair and had postoperative exercise and Pelvic Floor Disorders Inventory data. At 2 years, 87 (29%) of 305 exercised strenuously for at least 90 minutes per week, and 63 (23%) of 277 experienced SUI. Women who were less active at 2 years were significantly more likely to experience SUI than women who were more active (26.6% vs 12.8%, P = 0.0138)., Conclusions: In this study, symptomatic SUI occurred more frequently in women with lower self-reported exercise levels 2 years after MUS surgery., Competing Interests: The authors have declared they have no conflicts of interest., (Copyright © 2020 American Urogynecologic Society. All rights reserved.)

Introduction: The aim of this study was to evaluate long-term safety and efficacy of the suprapubic arc (SPARC) procedure for the surgical treatment of stress urinary incontinence (SUI)., Materials and Methods: 139 female patients treated by SPARC were included in this retrospective analysis, whereby 126 patients were available for follow-up after 1 year, 70 after 6 years, and 41 after 9 years. The cough test, pad test, uroflowmetry, and post-void residual volume measurements were performed. Severity of bother (visual analogous scale [VAS] 0-10), continence, and the satisfaction rate were assessed. Objective cure was defined as a negative cough test and pad weight ≤1 g, subjective cure as no urine loss during daily activities and no usage of pads. The VAS, pad weight, number of pads per day, and maximal flow rate were compared preoperatively and postoperatively., Results: Objective cure rates at 1, 6, and 9 years were 78.6, 71.4, and 70.7% and subjective cure rates were 72.2, 55.7, and 65.8%, respectively. The VAS, pad weight, number of pads, and maximal flow rate decreased significantly. Study limitations include a relatively small sample size and the retrospective fashion of the analysis., Conclusions: In the long-term context, SPARC showed to represent an efficient and safe procedure for treatment of female SUI., (© 2021 The Author(s). Published by S. Karger AG, Basel.)

Objective: To determine the sensitivity to change of question 6 (Q6) of the modified short form version of the Urogenital Distress Inventory (UDI-6) before and after synthetic sling removal (SSR)., Methods: Following IRB approval, a prospectively maintained database of mid-urethral sling (MUS) complications identified women with UDI-6 Q6 data before and after SSR. Q6 were compared pre- and postoperatively and against patient self-report of pain in women undergoing -SSR for pain (SSR-P) and in a control group when pain was not the primary indication for SSR (SSR-C). Women with missing pre-SSR or insufficient (<6 months) follow-up measures of pain were excluded. Three hypotheses were tested. (1) Correlation of Q6 scores with patients' self-reported pain pre- and post-SSR, (2) Higher pre-SSR Q6 scores in the SSR-P group than in the SSR-C group, and (3) Decrease in Q6 scores in the SSR-P group., Results: Between 2005 and 2017, 116 of 435 women referred to our institution met study criteria. Q6 scores were significantly (P <.0001) associated with self-reported pain with increasing likelihood of self-reporting pain as Q6 score increased. Mean pre-SSR Q6 scores in SSR-C (n = 42) was 1.0 ± 1.2 while mean pre-SSR Q6 scores in SSR-P (n = 74) was 2.3 ± 1.1 (P <.0001). Mean improvement in Q6 score after SSR was -0.19 ± 1.2 (P = 0.3) in SSR-C and -0.88 ± 1.4 (P <0.0001) in SSR-P., Conclusion: In women undergoing SSR for MUS-related complications, Q6 scores were correlated to self-reported pain and responsive to surgical intervention for pain relief., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Q-tip test offers a simple approach for identifying urethral hypermobility. Considering surgical treatment, stress urinary incontinence (SUI) must be classified and the contribution of intrinsic sphincter deficiency (ISD) and/or urethral hypermobility must be determine. We believe there's a correlation between abdominal leak point pressure (ALPP) and urethral mobility degree, and the aim of this study is to explore it using Q-tip. We conducted a prospective study, between years 2014 and 2016. Females over 18 years presenting with signs and symptoms of SUI according to the 2002 ICS Standardization of Terminology were included. Assessment was made with the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF), the Q-tip test and invasive urodynamics. Urethral mobility (UM) and ALPP were analyzed. We built two composite variables based on reported risk factors for ISD, defined as composite variable A (equal to a Q-tip test < 30° AND ICIQ-SF ≥ 10 points) and composite variable B (equal to low urethral mobility AND/OR hypoestrogenism AND/OR history of radiotherapy AND/OR previous pelvic surgery). Correlation analyzes were made according to the type of variable. A total of 221 patients were included. Incontinence was rated as moderate and severe by 65.3% and 6.8%, respectively. The analysis showed a 61.75%, 51.61% and 70.6% agreement between ALPP and UM, ALPP and composite variable A and ALPP and composite variable B respectively. Correlation and concordances were low (r = 0.155, r&#95;s = - 0.053 and r&#95;s = - 0.008), (rho&#95;c = 0.036, k = 0.116 and k = 0.016). Neither the degree of UM, nor the composite variables, correlate or agree with urethral function tests in UDS, suggesting that the ALPP cannot be predicted using the Q-tip test or the ICIQ-SF for classifying patients with SUI.

Introduction: Historically a positive Bonney maneuver indicates the need for surgical management of stress urinary incontinence. This maneuver is regularly used in French daily practice without formal proof of its predictive value., Material: A Medline search was performed with the terms "Bonney test" and "urinary incontinence" to include 10 relevant articles in this review., Results: Eight articles study the mechanism of the maneuver or its derivatives, evoking a direct pressure on the urethra. Two studies are interested in the real predictivity of the maneuvers on the success of surgical treatment by urethral strip, reporting a positive predictive value of the Bonney maneuver between 96.2 and 100%., Conclusion: Further studies are needed to objectify the utility of this maneuver., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

Background: Examination of pelvic floor muscle function is very important before starting exercises in patients with urine leakage and other pelvic floor dysfunctions. Perineometer and palpation examination is currently being used. A new trend in physiotherapy is the ultrasound examination of pelvic floor muscles. The examination can be performed by abdominal approach or perineal approach. We evaluate 2D and 3/4D images of pelvic floor muscles., Methods: The International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form (ICIQ-UI SF). OAB-q - overactive bladder questionnaire - short form. The Urinary Incontinence Quality of Life scale (I-QoL) - self-assessment scale for assessing the quality of life of patients with urinary incontinence. Adjusted Oxford scale to assess pelvic floor muscle strength. PERFECT scheme by Laycock and Jerwood. Pelvic floor examination by perineometer (Peritron-Ontario, L4V, Canada). Pelvic floor examination by 2D and 3/4D ultrasound examination (Volunson-i BT 11 Console, VCI volume contrast imaging software, (GE Healthcare Austria GmbH & Co OG, Zipf, Austria, RAB4-8-RS 3D/4D 4-8 MHz probe). High intensity exercise of pelvic floor muscles with stabilization elements., Conclusion: The effect of pelvic floor muscle training was objectively proved by the above mentioned objectivization methods with subjective improvement of quality of life. There was also a significant effect of education in USG exercise.

Risk of urinary incontinence (UI) increases with age and can have detrimental effects on patients and caregivers. UI should not be considered a normal part of aging and warrants a comprehensive evaluation. Treatment of UI in the aging male requires special consideration, particularly when it comes to comorbid conditions and potential side effects of intervention. The aim of this review is to discuss the evaluation of, risk factors for, and management of UI in the aging male.

Objective: To analyze the content of nursing diagnoses related to urinary incontinence according to NANDA International and others identified in the literature., Method: Methodological study conducted with judges who were experts in urinary dysfunctions and nursing diagnosis. The analysis included diagnoses of Stress Urinary Incontinence, Urgency Urinary Incontinence, Functional Urinary Incontinence, Urinary Incontinence due to Neurogenic Detrusor Overactivity (previously denominated Reflex Urinary Incontinence in NANDA International's taxonomy), Mixed Urinary Incontinence, and Transient Urinary Incontinence. Wilcoxon test was applied and Content Validity Index ≥ 0.85 was considered appropriate., Results: Fifty-one judges participated in this study. The judges recommended modifications in elements of all diagnoses (inclusion, exclusion or change of previous element type)., Conclusion: The four diagnoses analyzed in NANDA International's taxonomy are recommended to be maintained with modifications; inclusion of nursing diagnoses Mixed and Transient Urinary Incontinence is also recommended.

Urinary incontinence is a common health problem that impacts the quality of life of women at different ages. Its physiopathology is not unequivocal, and it is necessary to consider the stress urinary incontinence (SUI), the overactive bladder syndrome and the mixed incontinence (MUI). According to the type of incontinence, its impact on the quality of life and age of the patients, therapeutic strategies are currently summarized in physiotherapy, surgery and drug treatments. We already know the benefit/risk ratio of each of these strategies. Our objective is to evaluate the potential effectiveness and safety of the VEL, an innovative vaginal laser technique (VEL - Vaginal Erbium Laser, erbium yttrium-aluminum-garnet -Er: YAG) a non-invasive laser proposed as a treatment for SUI, overactive bladder syndrome and MUI. The mechanisms of action of lasers are discussed in general and those of VEL in particular with the description of the Smooth® mode. To do this, we have collected the 21 published studies including the first randomized vs. placebo and two pilot studies of intra-urethral VEL. In conclusion: VEL procedures already have their place between the rehabilitation of the perineal floor and surgery. Further properly sized, randomized studies are needed to evaluate the laser treatments in comparison with other therapies, as well as to assess the duration of the therapeutic effects and the safety of repeated applications., (© 2020 Walter de Gruyter GmbH, Berlin/Boston.)

The repeatability of the 20-min pad test has not been reported. The aim of this study was to evaluate the test-retest reliability of the 20-min pad test in women with urodynamic stress incontinence. Among 89 enrolled women, 67 (75%) women were diagnosed with urodynamic stress incontinence and were examined in this study. The mean strong-desire volume of all the women was 306.7 ± 115.7 mL. The pad weights of the test versus retest were 28.3 ± 41.2 g versus 28.4 ± 38.6 g, p = 0.29, respectively. The test and retest pad weight results had a Spearman's rho of 0.788 (p < 0.0001). The intraclass correlation coefficient was 0.793 (95% confidence interval, 0.704-0.882; p < 0.0001). The Bland-Altman plots all revealed good agreement between the test and the retest in the pad weights. In conclusion, the 20-min pad test infused with a strong-desired volume has good test-retest reliability to assess the severity of urine leakage for women with urodynamic stress incontinence.

Background: Approximately 30 to 50% of women are unable to correctly perform pelvic floor muscle (PFM) contractions. For women to benefit from a pelvic floor muscle training (PFMT) programme for stress urinary incontinence (SUI), the awareness phase of PFMT cannot be omitted. The purpose of this study is to evaluate whether vaginal palpation together with verbal instructions about PFMs and body awareness techniques helps women with SUI learn how to correctly contract the PFMs and improve their functions., Methods: This single-centre, double-blind randomized controlled trial with two intervention groups was designed following the standard protocol items for randomized interventional trials (SPIRIT). The results will be reported in a manner consistent with the Consolidated Standards of Reporting Trials (CONSORT) guidelines. Patients with SUI (n = 172) will be recruited. The experimental group will receive verbal instructions about PFM function and body awareness techniques together with vaginal palpation; the control group will receive similar protocol without vaginal palpation. The primary outcome includes the number of fast-twitch muscle fibres assessed by vaginal palpation and visual observation. Secondary outcomes include power and muscular endurance that will be assessed by visual observation and vaginal palpation (Oxford scale), the use of accessory muscles during the voluntary contraction of PFMs, and the self-efficacy and the expectations for the results using the self-efficacy scale of pelvic floor exercises., Discussion: This study will determine whether vaginal palpation can help women with SUI to correctly perform PFM contractions and improve their functions., Trial Registration: ClinicalTrials.gov NCT03325543 . Registered on 30 November 2017. Study protocol version 1; 30 November 2020. Prospectively registered.

Aims: We aimed to assess the value of the Valsalva urethral profile (VUP) in case of stress urinary incontinence (SUI)., Methods: Six hundred and ninety-four women without pelvic organ prolapse were included in this prospective monocentric study. SUI was diagnosed from symptoms using the International Continence Society definition, and severity using two validated questionnaires (USP and ICIQ-SF). The urodynamic parameters studied were maximal urethral closure pressure (MUCP) and functional length (FL). Both were performed at rest, during a Valsalva maneuver (v-MUCP and v-FL) and again at rest. Correlation analyses and ROC curves were used to assess the value of the clinical and urodynamic measurements., Results: In our population, based on the questionnaires, 172 (24.8%) women were diagnosed with pure SUI on symptoms, 71 (10.2%) with urgency urinary incontinence and 392 (56.5%) with mixed urinary incontinence; 59 (8.5%) women were continent. The v-MUCP was the most correlated parameter to the severity of SUI (ρ: -0.63) and the most predictive of SUI risk, with a threshold value of 35 cm H 2 O (Se = 0.82, Sp = 0.86). The v-FL was significantly shortened in case of SUI., Conclusions: The v-MUCP and v-FL are global measurements of urethral resistance during stress. With a threshold value of 35 cm H 2 O, the v-MUCP was the most discriminating parameter for the diagnosis of SUI, with a good reliability., (© 2020 Wiley Periodicals LLC.)

Aims: The aim of the present work is to analyze the safety profile, effectiveness, and favorable and unfavorable predictors of clinical outcome in urethral bulking with Bulkamid, and to better identify the ideal candidate for the procedure., Methods: We included all consecutive female patients treated with urethral bulking with Bulkamid at our institution within 2 years. Patients were affected by stress urinary incontinence (SUI) or mixed incontinence. Incontinence severity was classified as "mild" (urinary leakage <50 g/die), "moderate" (50-200 g/die), or "severe" (>200 g/die) at 24-hours pad test. Clinical success was defined as "dry" (no pads); clinical failure included "partial improvement" (>50% 24-hours pad test reduction) and "no benefit" (<50% 24-hours pad test reduction). The χ 2 and Mann-Whitney tests were performed to assess the predictors of clinical outcome., Results: The success rate was 36.1% (n = 35). Forty-three patients (44.3%) reported continence improvement. Complications included eight urinary retention cases (8.2%). Statistically significant correlation was observed between incontinence severity and clinical outcome in thee χ 2 test (P = .008). No significant correlation was found between functional outcome and urodynamic incontinence features, postoperative urinary retention, previous pelvic surgery, age, and other physiological, pathological, and urodynamics characteristics. Urinary retention following the surgical procedure appeared to be related to clinical success with nonsignificant P value (P = .10)., Conclusions: Bulkamid procedure could be proposed with good results in elderly patients or in patients requiring a low-invasive procedure with low risk of complications, affected either by SUI or mixed incontinence and with mild to moderate incontinence. Previous training to clean intermittent self-catheterization maneuver should be performed., (© 2020 Wiley Periodicals LLC.)

Objectives: To elucidate the treatment results and predictors for successful outcome in women with detrusor underactivity (DU) and stress urinary incontinence (SUI) undergoing suburethral sling procedure., Methods: Medical records of women with coexistent SUI and DU treated with a suburethral sling were retrospectively reviewed and we analyzed the association between treatment outcome and baseline demographics including etiology of DU and urodynamic variables. Patients who were dry and could urinate spontaneously were considered successful. Treatment failure was considered in those who were dry but needing clean intermittent catheterization (CIC) and patients who were still wet. Urogenital Distress Inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ-7) scores were used to assess the impact of surgery on the quality of life., Results: Among 71 patients, a successful outcome was noted in 39 (55%), failed outcome with CIC in 15 (21%), and totally treatment failure in 17 (24%). Treatment outcome did not differ among the etiology subgroups. Overall, UDI-6 and IIQ-7 scores significantly improved after surgery. Multivariable logistic regression analysis revealed that the IIQ-7 and maximum flow rate (Qmax) were two independent predictors for improvement after surgery. An IIQ-7 score ≤6, and Qmax ≥6 mL/s can predict improvement by receiver operating characteristic analysis. Qmax ≤6 mL/s can predict needing CIC after surgery., Conclusions: For women with SUI and coexistent DU who underwent suburethral sling procedure, low IIQ-7 (≤6) scores and higher Qmax (≥6 mL/s) are predictors for improvement of surgical outcome. A Qmax of <6 mL/s was the only predictor for CIC after surgery., (© 2019 John Wiley & Sons Australia, Ltd.)

Objective: The study investigated the prevalence and impact of stress urinary incontinence (SUI) among women in Jordan., Methods: A correlational study was conducted to evaluate 500 Jordanian women aged >20 years. Women with symptoms of dementia, delirium, neurodegenerative changes and osteodegenerative changes were excluded. Data were collected using self-administered questionnaires (Arabic version of the Urogenital Distress Inventory-6 and Incontinence Impact Questionnaire (IIQ-7) short forms)., Results: A total of 200 (40%) women reported SUI; 47% reported mild symptoms, 37% reported moderate symptoms and 16% reported severe symptoms. There were positive correlations between SUI prevalence and number of pregnancies, age and obesity. SUI had a substantial impact on all aspects of quality of life (QoL), as assessed by the IIQ-7., Conclusions: A moderate prevalence of SUI was reported. There was a significant association between development of SUI and age, higher body mass index and number of pregnancies. Because SUI is highly prevalent and has a major effect on QoL, healthcare professionals should inquire about this condition and refer patients to related specialties for treatment.

Objective: Pelvic organ prolapse (POP) surgery may unmask occult stress urinary incontinence (OSUI) in otherwise asymptomatic patients. Preoperative urodynamic studies (UDSs) with prolapse reduction may, by potentially unmasking OSUI, assist surgical decision making. This study investigated the long-term objective postoperative rate of SUI, according to the presence of OSUI., Methods: This retrospective cohort study was conducted with a cross-sectional survey of women with no SUI or rare SUI presenting at Kingston General Hospital in Kingston, Ontario from 2003-2013 for POP. Patients were compared on the basis of preoperative UDS results and whether an anti-incontinence procedure was performed in addition to POP surgery. The study included a chart review of 1-year follow-up subjective results and a survey of long-term objective results (symptoms and quality of life) ascertained by validated questionnaires., Results: The study enrolled 113 women, 51 of whom had undergone anti-incontinence surgery (42 for identified OSUI, 9 prophylactically). In women whose UDS results indicated OSUI, 1-year subjective and long-term objective postoperative SUI results were, respectively, 8.8% and 12.5% among women undergoing POP and anti-incontinence surgery and 18.2% and 42.9% among those undergoing POP surgery alone. In women with negative UDS results, those rates were 0.0% and 50.0% and 12.8% and 27.6%, respectively. There was no significant difference in any outcomes, according to procedure choice in the OSUI-positive group. There were no predictors for postoperative SUI., Conclusion: Although a trend was seen for less long-term validated subjective SUI in women having a concomitant SUI procedure along with POP corrective surgery, no significant difference in outcomes was found, on the basis of procedure of choice, and no reliable predictors for postoperative SUI could be identified. UDS testing may be useful to rule in OSUI, but its clinical value in surgical decision making is uncertain., (Copyright © 2019 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.)

Aims: To evaluate the diagnostic ability of different cough stress tests (CSTs) in women with pelvic organ prolapse (POP), performed during outpatient urogynaecological exams., Methods: Prospective, multicentre observational study involving women on waiting lists for POP surgery. With a subjectively full bladder, patients were asked to perform five different CSTs: without prolapse reduction ([a] standing, followed by [b] semilithotomy position); keeping semilithotomy position with prolapse reduced (by [c] posterior speculum, followed by [d] pessary); [e] standing again with the pessary in place. Primary outcome was positive CST in at least one of the five CSTs. Bladder volume was measured and symptoms of stress urinary incontinence (SUI) were detected by two validated questionnaires., Results: A total of 297 women completed all CSTs and were included in the analyses. Mean (SD) age, parity, and body mass index were 64.8 (9.9) years, 2.7 (1.3) deliveries, and 26.6 (3.4) kg/m 2 , respectively. In total, 99 women (33.3%) reported SUI symptoms. At least one positive CST was recorded in 152 patients (51.1%), and in 90 (59.2%) of these 152, a positive CST was observed only when POP was reduced (occult SUI). The CST was positive in 92 (92.9%) of the 99 patients with coexisting SUI symptoms and in 60 (30.3%) of the 205 asymptomatic patients. The percentage of patients with a positive CST was significantly lower when bladder volume was <200 mL vs ≥200 mL (P = .046)., Conclusions: The identification of urinary leakage cases with CSTs is best achieved using multiple different patient positions, different prolapse reduction methods, and bladder volumes ≥200 mL., (© 2020 The Authors. Neurourology and Urodynamics published by Wiley Periodicals, Inc.)

Objective: To evaluate the prevalence and severity of urinary incontinence (UI) in women who participate in CrossFit classes compared with women who participate in non-CrossFit group fitness classes., Methods: The authors conducted a cross-sectional study of women who participate in either CrossFit or non-CrossFit group fitness classes using an online survey. Participants provided demographic information and completed the Incontinence Severity Index and Urinary Distress Inventory. Participants were recruited from local CrossFit and non-CrossFit gyms, online via social media, and an electronic CrossFit Newsletter. Associated comorbidities, exercises associated with UI, and coping mechanisms for urinary leakage were also assessed., Results: Four hundred twenty-three women meeting inclusion criteria completed the survey, including 322 CrossFit participants and 101 non-CrossFit participants. We found that CrossFit participants were older than non-CrossFit participants and more likely to self-identify as non-Hispanic white. CrossFit participants more commonly reported UI (84% vs 48%, P = <0.001), higher severity of UI (Urinary Distress Inventory score: 20.8 vs 12.5, P < 0.001), and specifically more stress UI (73% vs 47%, P < 0.001). Weightlifting and jumping movements were the most common exercises associated with UI in CrossFit participants. Age and participation in CrossFit are significant and independent predictors of UI., Conclusions: More than 80% of CrossFit participants reported UI and half of these reported moderate-severe UI, as compared with women who participate in non-CrossFit classes, less than half of whom reported UI with a small minority reporting moderate-severe UI. Exercises most associated with UI were jumping and weightlifting.

Background: Routine use of urodynamics (UDS) for the assessment of female stress urinary incontinence (SUI) appears to be in decline across Europe. The reasons for this trend appear multifactorial, but the implications are of significant concern., Objectives: To achieve an expert consensus viewpoint on the value of UDS in female SUI and current barriers to its use., Methodology: A multidisciplinary group of UDS experts from six European countries was convened, and a modified version of the Delphi method was utilised to reach a consensus viewpoint structured around five key questions., Results: Consensus was achieved on all five questions. The group was unanimous that the decline in routine use of UDS is unjustified and misguided, driven by restrictions in funding and accelerated by the publication-and subsequent influence-of two trials that had major limitations., Limitations: The authors comprised a selected group of UDS experts and the analysis is not a formal systematic review., Conclusions: Extensive experience and observational studies have demonstrated the value of UDS for the assessment of female SUI and the dangers of empiric management. This evidence base should not be eclipsed by the findings of two randomised controlled trials that had numerous shortcomings., Patient Summary: A group of experts were worried that, even though the cause of incontinence varies, doctors seem to be skipping a diagnostic test called urodynamics (UDS) in some patients and just providing treatment-even surgery-without knowing exactly what is wrong. These experts analysed the situation in detail and reached agreement that UDS testing should not be skipped., (Copyright © 2019 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

Aims: Overactive bladder (OAB) remains underdiagnosed with many patients never seeking medical help. Methods to aid early identification and treatment of OAB will be hugely beneficial, and to this end several case-finding tools have been developed. The aim of this review is to critically analyse the literature regarding case-finding tools that have been validated specifically for the detection of OAB in women., Methods: A literature search of the PubMed database was performed until July 2019 using the search terms screening and OAB or lower urinary tract symptoms (LUTS). Names of individual case-finding tools included in the sixth International Consultation on Incontinence were also searched on the PubMed database. Original articles on the validation of patient-reported screening questionnaires for the detection of OAB in women were included., Results: A total of 22 studies met the inclusion criteria and were included in this review. The validation studies of 11 case-finding tools were assessed. All demonstrated good sensitivity and specificity for OAB or incontinence symptoms, and five tools have been most extensively validated for this condition (bladder control self-assessment questionnaire [B-SAQ], OAB-V8, OAB-V3, OAB symptom score, and questionnaire for urinary incontinence diagnosis). B-SAQ and OAB-V8 demonstrated high sensitivity whilst actionable bladder symptom screening tool was the most specific. B-SAQ was the only tool in this review to encompass screening for "red-flag" symptoms (hematuria, pain), and it has also been validated in a primary care setting., Conclusions: Several case-finding tools have been demonstrated to have high accuracy for diagnosing OAB in women. B-SAQ encompasses other LUTS as well as "red-flag" symptoms; its use should be promoted in primary care., (© 2019 Wiley Periodicals, Inc.)