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Objective: To determine outcomes after removal of two synthetic mid‐urethral slings (MUS) at a tertiary care center. Methods: Following IRB approval, a retrospective chart review of non‐neurogenic, symptomatic women requiring re‐operation after ≥2 MUS was performed. Data reviewed by a third party included: demographics, prior anti‐incontinence surgery, complications, pelvic/urinary symptoms, subsequent investigations, surgical repair and outcomes (including UDI‐6/IIQ‐7 questionnaires) at a minimum 6 months follow‐up. Cure was defined as being continent, no dyspareunia, and no additional surgical therapy. Results: Between 2007 and 2014, 21 women met the inclusion criteria. Mean age was 57 years (range: 40–82) and mean follow‐up was 30.2 months (range: 6–78). The majority of patients presented with one or more symptoms of voiding dysfunction (95%), urinary incontinence (86%), irritative voiding symptoms (62%), dyspareunia (57%), recurrent urinary tract infections (UTIs) (29%), vaginal extrusion (20%) and erosion involving the urinary tract (5%). Patients had a mean of 2 prior anti‐incontinence procedures (range 2–3). Over two‐thirds had a combination of retropubic and transobturator MUS. Mean number of pre‐operative investigations was 3.5 (1–6) including voiding cystourethrogram, cystoscopy and urodynamics. Two patients had complete remission, 14 partial remission, and five failed. Mean postoperative total UDI‐6 and IIQ‐7 scores at last clinic visit were 10 (range: 0–16/SD 4.1) and 11 (range: 0–28/SD 10.3), respectively. Conclusion: The management of women with suboptimal outcomes following two synthetic MUS from transvaginal excision results in modest symptomatic improvement but low permanent complete remission and frequent need for additional therapies. [ABSTRACT FROM AUTHOR]

It is possible that the controversy involving prostheses implanted into women with pelvic floor problems might result in the majority of, or even all such products being restricted, banned or withdrawn in certain jurisdictions. A clear distinction between “tapes” for urinary incontinence and “mesh” for prolapse has been made in the enquiries and subsequent rulings in Australia and New Zealand. Transvaginal “mesh” will be unavailable with the range of “tapes” much more restricted in those countries from January 2018. The Chair of the all‐party parliamentary group on surgical mesh implants in the United Kingdom was reported as describing the New Zealand announcement as “hugely significant” and “it's precisely what we've been calling for the UK.” The title of this article has changed from a hypothetical piece to a potential reality review. Where does that leave the clinicians treating stress urinary incontinence (SUI) and the large number of female sufferers? “Tapes” (synthetic midurethral slings—MUS) have become very popular over the last 20 years since their original development and introduction in Scandanavia. Evidence‐based medicine has shown their advantages over previous surgeries, in terms of ease of use, safety and efficacy. This article outlines the options which countries potentially rejecting the use of tapes, must now resort to for women with SUI. Those countries considering such action need the note of caution that none of the options are as good as tapes. [ABSTRACT FROM AUTHOR]

Allied health-led models of care have been shown to be effective in providing diagnostic evaluation and management of many health conditions, improved access to care, and reduced specialist outpatient waiting lists. An audit of a new physiotherapy-led pelvic health clinic for women on the urogynaecology waiting list was undertaken, from its inception in January 2017 until October 2017. The objective of this audit was to document the patient journey, clinical outcomes and patient satisfaction of 105 women who provided consent for their information to be included in the audit. Following the introduction of the physiotherapy-led clinic, participants reported shorter waiting times to attend appointments compared to the traditional medical model, improved clinical outcomes and high patient satisfaction. Many participants (65%) were discharged without requiring a urogynaecology specialist appointment. This audit supports the model of a physiotherapy-led pelvic health clinic as an effective model of care. [ABSTRACT FROM AUTHOR]

Aims: The use of orthotropic neobladder (ONB) construction in women has increased in popularity. With increasing numbers so have complications distinct to this procedure. Neobladder vaginal fistula (NVF) is a rare but challenging complication. We present our experience correcting this problem. Methods: An IRB approved database of female patients with an ONB was retrospectively reviewed. Patients with a history of NVF were identified and charts reviewed. Our standard technique of radical cystectomy and orthotopic diversion in female patients includes interposition of omentum between the neobladder and anterior vaginal wall and sacrocolpopexy. Results: Two hundred and forty‐nine female patients underwent cystectomy and ONB construction between 1995 and 2015. Fourteen patients were diagnosed with a NVF (5.6% incidence). The average age and follow‐up was 67 years and 33.7 months, respectively. Surgery for fistula closure was attempted in 13 patients. One repair was combined abdominal and transvaginal; the remaining 12 were performed transvaginally. Location of NVF was categorized as at the urethra‐neobladder anastomosis (UNA, nine patients) and anterior vaginal wall (AVW, four patients). Eight patients had a successful fistula repair (61.5%) but only five patients ultimately retained their ONB (39%). Conclusions: Patients with a NVF pose a surgical challenge. Successful fistula repair does not necessarily result in adequate continence due to an incompetent outlet. NVF location at the UNA is the more common location and is more challenging in regard to successful resolution of the NVF as well as possible urinary incontinence post‐NVF repair. [ABSTRACT FROM AUTHOR]

Introduction: To evaluate the cost-utility of incontinence treatments, particularly anticholinergic therapy, by examining costs and quality-adjusted life years. Materials and methods: A prospective cohort study of women who were consecutively referred by general practitioners (GPs) to the Urology Department because of urinary incontinence. The primary outcome was evaluation of the cost-utility of incontinence treatments (surgery, medical therapy and physiotherapy) for stress and/or urgency incontinence by examining costs and quality-adjusted life years. Results: 137 consecutive female patients (mean age 60.6 ± 11.6; range 36-81) were enrolled and stratified according to pathologies: SUI and UUI. Group A: SUI grade II-III: 43 patients who underwent mid-urethral sling (MUS); Group B: SUI grade I-II 57 patients who underwent pelvic floor muscle exercise and Group C: UUI: 37 patients who underwent antimuscarinic treatment with 5 mg solifenacin daily. The cost utility ratio (CUR) was estimated as saving more than €1200 per QALY for surgery and physiotherapy and as costing under € 100 per QALY for drug therapy. Conclusions: This study shows that appropriate diagnosis and treatment of a patient with incontinence lowers National Health Service costs and improves the benefits of treatment and quality of life.

Female urinary incontinence is a common and costly problem that affects the quality of life for many women. However, it can be managed using the correct strategies. There are several different types of female incontinence and this article discusses these along with the most common treatments, with particular emphasis on pharmacological treatments. The pharmacological treatments are discussed in detail, including dosages, side effects and monitoring. [ABSTRACT FROM AUTHOR]

AIMS To characterize the urinary incontinence observed in adult Gli2+/−; Gli3Δ699/+ female mice and identify the defects underlying the condition. METHODS Gli2+/− and Gli3Δ699/+ mice were crossed to generate: wild-type, mutant Gli2 ( Gli2+/−), mutant Gli3 ( Gli3Δ699/+), and double mutant ( Gli2+/−; Gli3Δ699/+) female mice, verified via Polymerase Chain Reactions. Bladder functional studies including cystometrogram (CMG), leak point pressure (LPP), and voiding testing were performed on adult female mice. Female bladders and urethras were also analyzed via ink injection and histological assays. RESULTS CMG tracing showed no signal corresponding to the filling of the Gli2+/−; Gli3Δ699/+ bladders. LPP were significantly reduced in Gli2+/−; Gli3Δ699/+ mice compared to wild-type mice. CMG studies revealed a decrease in peak micturition pressure values in Gli2+/−; Gli3Δ699/+ mice compared with all other groups. No significant differences between mutant and wild-type mice were detected in urinary output. Histological analyses revealed Gli2+/−; Gli3Δ699/+ mice exhibited a widened urethra and a decrease in smooth muscle layer thickness in the bladder outlet and urethra, with increased mucosal folding. CONCLUSIONS Gli2+/−; Gli3Δ699/+ adult female mice display persistent urinary incontinence due to the malformation of the bladder outlet and urethra. This presents a consistent and reliable genetic mouse model for female urinary incontinence and alludes to the key role of genetic factors involved in the condition. [ABSTRACT FROM AUTHOR]

Background Urinary incontinence ( UI) is likely to be high in Aboriginal women in rural Australia due to risk factors including high body mass index, parity and diabetes. However, UI appears to be under-reported with limited information on whether women access appropriate care. Aims To assess whether women who access specialist gynaecological services in rural and remote Top End Northern Territory ( NT) through the specialist outreach program ( SONT) are receiving care for UI aligned with best practice. Methods Review of all 1426 SONT referrals in 2012, with audit of management for those women referred for UI or prolapse. Results Of 1426 SONT referrals, there were 43/1426 (3%) women referred for UI, with 34/43 (79%) attending. Of those referred, 31/43 (72%) were Aboriginal. Of twenty-six women diagnosed with probable stress UI, less than a fifth, 5/26 (19%), were referred to physiotherapy, with 2/5 (40%) attending appointments. Referral occurred for 14/23 (61%) of those suitable for urodynamics but only 6/14 (43%) attended. Just under half of women 7/16 (14%) with stress UI were referred for surgery, with 6/7 (86%) attending. Conclusion In rural and remote Top End NT, specialist health service management of female UI could be improved by increased provision of current best-practice and an integrated multi-disciplinary team approach with allied health. Under-reporting and under-referral for female UI could be addressed by increasing awareness among community and primary healthcare providers of the problem of female UI and the conservative, medical and surgical treatments available. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: Some patients with hip osteoarthritis report that urinary incontinence (UI) is improved following total hip arthroplasty (THA). However, the type and severity of UI remain unclear. In this study, we hypothesize that both stress urinary incontinence (SUI) and urge urinary incontinence (UUI) are improved after THA. We assess the characteristics of UI and discuss the anatomical factors related to UI and THA for improved treatment outcome. Methods: Fifty patients with UI who underwent direct anterior-approach THA were evaluated. Type of UI was assessed using four questionnaires: Core Lower Urinary Tract Symptom Score (CLSS), Urogenital Distress Inventory Short Form (UDI-6), International Prostate Symptom Score (IPSS), and Overactive Bladder Symptom Score (OABSS). Uroflowmetry and postvoid residual urine were measured using ultrasound technology. Hip-joint function was evaluated using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and range of motion (ROM). Results: Of the 50 patients, 21 had SUI, 16 had mixed urinary incontinence (MUI), and eight had urgency urinary incontinence (UUI). In total, 36 patients were better than improved (72 %). The rate of cured and improved was 76 % for SUI, 100 % MUI, and 50 % UUI. The improvement of ROM was more significant in cured or improved patients than in stable or worse patients. Conclusions: Improvement in mild UI may be an added benefit for those undergoing THA for hip-joint disorders. These data suggest that for patients with hip-joint disorder, hip-joint treatment could prove to also be a useful treatment for UI. [ABSTRACT FROM AUTHOR]

Taking the recommendations development of the World Federation of Acupuncture-Moxibustion Societies (WFAS) standard Clinical Practice Guideline for Female Urinary Incontinence as an example, this study analyzed the consensus expert composition, specific consensus process, and results in the development of the guideline's recommendations. It systematically examined the advantages of using the modified Delphi method in the formation of recommendations for acupuncture and moxibustion clinical practice guideline, with the aim of providing reference for the development of acupuncture and moxibustion guidelines in the same field.

Introduction: Urinary incontinence (UI) is the involuntary loss of urine. It is highly prevalent in women and has a great biopsychosocial impact. Rehabilitation is established as the first-line treatment, although its use has not been protocolized., Objective: To identify which personal risk factors and type of treatment applied are statistically related to patient improvement., Study Design: Retrospective cohort study., Methods: Retrospective cohort study of female patients diagnosed with urinary incontinence who attended the Pelvic Floor Rehabilitation Clinic of the Río Hortega University Hospital, receiving rehabilitation treatment during the year 2021. The minimum follow-up period was 12 weeks. The presence or absence of improvement was evaluated according to seven objective and subjective variables, and improvement was established as positive evolution in at least five of the seven variables., Results: A total of 114 women with urinary incontinence were analyzed. The most frequent types of incontinence were stress (53%) and mixed (36%). The most important risk factors and associated pathology were episiotomy (68%), repeated urinary tract infections (61%), and constipation (40.9%). None of these factors showed a statistically significant relationship with patient improvement. The most used rehabilitative treatment was kinesitherapy+biofeedback (51%) which showed a statistically significant relationship with the improvement of these patients (P=.037) together with biofeedback+posterior tibial nerve electrostimulation (PTNS) (P=.044)., Conclusion: Biofeedback combined with kinesitherapy or PTNS are established as the most effective rehabilitative procedures., (Copyright © 2023 AEU. Published by Elsevier España, S.L.U. All rights reserved.)

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]

Objective: Our aim was to study risk factors associated with the prevalence, incidence and remission of urinary incontinence (UI) between 4 and 24 months postpartum.Design: Longitudinal study (EDEN cohort).Setting: Two French university hospitals.Population: 1643 women completed the questionnaire at 4 months and 1409 at 24 months, including 1354 who completed it both times.Methods: Multivariate analyses identified risk factors for UI prevalence at 24 months postpartum, persistent UI versus remission, de novo UI versus continence, de novo UI versus persistent UI, and changes in IU severity between 4 and 24 months postpartum.Main Outcome Measures: Postnatal UI and Sandvik UI severity score.Results: UI prevalence was 20.7% (340/1643) at 4 months and 19.9% (280/1409) at 24 months. Significant factors associated with UI at 24 months were older age [OR = 1.07/year (95%CI 1.04-1.11)], BMI [2.35 (1.44-3.85) ≥30 versus <25 kg/m²], higher parity [1.77 (1.14-2.76) ≥3 versus 1], breastfeeding [1.54 (1.08-2.19) ≥3 versus < 3 months], pregnant at follow up [3.44 (2.25-5.26)], and caesarean delivery [0.62 (0.40-0.97) versus vaginal] [OR, odds ratio (CI, confidence interval)]. The likelihood of UI remission at 24 months was 51.9% (149/287). Caesarean delivery was associated with increased likelihood of UI remission [0.43 (0.19-0.97)]. The risk of de novo UI at 24 months was 12.5% (135/1067) and was associated with a new pregnancy [3.63 (2.13-6.20)].Conclusions: Between 4 and 24 months postpartum UI, remission occurred in half of the cases. These postnatal UI changes were essentially related to mode of delivery and subsequent pregnancy.Tweetable Abstract: Postnatal urinary incontinence progression is mostly related with mode of delivery and subsequent pregnancy. [ABSTRACT FROM AUTHOR]

Purpose: Supervised pelvic floor muscle training in patients of stress and mixed urinary incontinence has been recommended. Our aim was to assess the utilisation and effectiveness of our supervised pelvic floor muscle training service and assess the impact of incontinence scores before physiotherapy on the subsequent results of physiotherapy.Methods: All 271 patients referred to physiotherapy for symptoms of incontinence filled out the International Consultation on Incontinence Modular Questionnaire-Female Lower Urinary Tract Symptoms before starting treatment. Depending on pelvic floor muscle assessment, plans for exercises and follow up were made. If the strength of pelvic floor muscles was poor, electrical stimulation was offered. If awareness of the pelvic floor muscle contraction was poor, bio feedback was offered. Group sessions and vaginal cones were also used. Depending on the response to the treatment; patients were either discharged, referred to Urogynaecology clinic or continued physiotherapy. All patients who were discharged or referred for surgery were given a post treatment questionnaire to fill out.Results: 79 (56 %) of 132 women with stress, 49 (51 %) of 98 with mixed and 27 (66 %) of 41 with urge incontinence reported successful control of symptoms (overall success 54 %). However, 65 % of women with incontinence scores of 0-5 before physiotherapy, 64 % with 6-10, 42 % with 11-15 and mere 28 % with 16-20 achieved success with physiotherapy. 27 (10 %) were lost to follow up.Conclusion: 1 in 2 women referred to physiotherapy for incontinence, achieved successful control of symptoms without the need for invasive investigations or surgery. However, poor incontinence scores before the start of physiotherapy is a poor prognostic indicator for success. 90 % women utilised the service. [ABSTRACT FROM AUTHOR]

This article reports a case of a 40-year-old woman with a history of myelomeningocele and neurogenic urinary incontinence who developed erosion and fistula formation following the placement of an artificial urinary sphincter (AUS) when she was 18 years old. The patient had a long-standing history of urinary incontinence that was unresponsive to prior surgeries for meningomyelocele. She reported the loss of uro-fecal material from the vagina but did not seek further medical evaluation until the age of 40. Clinical examination revealed protruding tubes from the suprapubic region. The administration of a contrast agent through one of the two tubes led to the visualization of intestinal loops, and the administration of a contrast agent through the urethra confirmed the connection between the rectum, urinary bladder, and vagina. Due to the absence of reliable surgical history and in the absence of abdominal discomfort, bilateral nephrostomies were initially performed to prevent further uro-fecal material loss. The patient showed significant improvement, decided to not seek further evaluation and surgical treatment, and remained socially integrated during the follow-up period of 20 years. This case highlights the severe consequences of AUS placement in a young woman with neurogenic urinary incontinence and emphasizes the importance of proper patient selection and management in the presence of underlying neurological disorders., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Diamantidis et al.)

Introduction and hypothesis: The quality of Internet information on female urinary incontinence is considered variable. No comprehensive analysis exists to support this. We compared the quality of current Internet information for common layperson terminology on female urinary incontinence across four Western languages and a comparative analysis of website sponsors. Methods: World Health Organization Health on the Net (HON) principles may be applied to websites using an automated toolbar function. We used the Google search engine; 10,200 websites were identified using keywords related to female urinary incontinence and treatments in English, French, German and Spanish. The first 150 websites in each language had HON principles examined, whilst a further analysis of site sponsorship was undertaken. Results: The total number of websites for each term is variable. 'Female sling surgery' had the most websites with approximately 18 million, whereas 'colposuspension' had the least with only 159,890 websites. Regardless of language, very few female urinary incontinence websites were HON accredited ( p < 0.0001). Linguistically, French (18 %) and English (16 %) had the greatest percentage of HON-accredited sites. Tertiles (thirds) of the first 150 websites returned the higher percentage of HON-accredited websites ( p < 0.0001). Websites were largely sponsored by physicians/surgeons. Conclusions: The lack of validation of most female urinary incontinence websites should be appreciated by clinicians. Additionally, discrepancies exist in the quality and number of websites across conditions, languages and also between medical and alternative terms. Clinicians should participate in and encourage the development of informative, ethical and reliable health websites on the Internet and direct patients to them. [ABSTRACT FROM AUTHOR]

Objetivo: analisar os resultados cirúrgicos após slings com mucosa vaginal, realizados pelo setor de Uroginecologia e Cirurgia Vaginal da UNIFESP/EPM, no tratamento de mulheres incontinentes com hipermobilidade do colo vesical, que apresentam alto risco de falha cirúrgica para outras técnicas ou naquelas com defeito esfincteriano intrínseco e, ainda, recidivas cirúrgicas. Métodos: foram avaliadas 21 pacientes submetidas à cirurgia para correção de incontinência urinária pela técnica de sling vaginal, no período de dezembro de 1997 a fevereiro de 1999, com seguimento pós-operatório que variou de 1 a 14 meses (média de 8,2). A média de idade das pacientes foi de 56 anos (39 a 77 anos), sendo que 15 (71,4%) encontravam-se na menopausa e 6 (28,6%) no menacme. Todas as pacientes foram avaliadas antes da cirurgia por meio de anamnese, exame clínico, estudo ultra-sonográfico e urodinâmico, sendo o grau de perda urinária acentuado em 66,7% e moderado em 33,3% das pacientes. Todas as pacientes apresentavam hipermobilidade da junção uretrovesical (superior a 10 mm) e 12 pacientes apresentavam cirurgia prévia para correção de incontinência urinária. Ao estudo urodinâmico, as pacientes apresentavam perda urinária com pressão máxima de fechamento uretral (PMFU) variando de 20 a 124 cmH2O (média de 55,2) e "Valsalva leak point pressure" (VLPP) variando de 18 a 128 cmH2O (média de 60,3). As indicações das cirurgias foram: defeito esfincteriano (11 pacientes - 52,4%), obesidade (5 pacientes - 23,8%), defeito esfincteriano e obesidade (2 pacientes - 9,5%), recidiva cirúrgica (2 pacientes - 9,5%) e defeito esfincteriano e prolapso uterino de 1º grau (1 paciente - 4,8%). Resultados: como complicações, 6 pacientes (28,6%) apresentaram retenção urinária temporária no pós-operatório, 1 (4,8%) infecção do trato urinário, 1 (4,8%) presença de fio de polipropileno na vagina, 1 (4,8%) infecção da ferida cirúrgica, 4 pacientes (19%) evoluíram com urgência/incontinência, 1 (4,8%) com urgência miccional e 1 (4,8%) com dificuldade para urinar (elevado resíduo pós-miccional). O grau de satisfação das pacientes foi satisfatório, com 15 pacientes (71,4%) referindo cura, 3 (14,3%) melhora, 2 (9,5%) quadro de perda urinária inalterado e 1 (4,8%) piora da perda urinária. Conclusões: a cirurgia de sling com mucosa vaginal é eficaz para o tratamento de casos específicos de incontinência urinária de esforço, destacando-se defeito esfincteriano, recidivas cirúrgicas e fatores predisponentes para falha de outras técnicas.Purpose: to analyze the surgical results after slings with vaginal wall, performed by the Urogynecology and Vaginal Surgery Sector of UNIFESP/EPM, for the treatment of incontinent women with hypermobility of the bladder neck, who show great risk of surgery failure with other techniques or in those with intrinsic sphincteric deficiency (ISD) and, also, surgery recurrence. Methods: we studied 21 patients submitted to surgery in order to correct urinary incontinence by the vaginal wall sling technique, in the period from December 1997 to February 1999, with postoperative follow-up which varied between 1 and 14 months (average 8.2). The mean age of patients was 56 years (39 to 77 years), 15 (71.4%) were in menopause and 6 (28.6%) in menacme. All patients were evaluated before the surgery through medical interview, physical examination, ultrasound and urodynamic study, the grade of urinary loss being high in 66.7% and moderate in 33.3% of the patients. All patients showed hypermobility of the bladder neck (more than 10 mm) and 12 patients had previous surgery to correct the urinary incontinence. Regarding the urodinamic study, the patients manifested urinary loss with maximum pressure of urethral closure (MPUC) varying from 20 to 124 cmH2O (average 55.2) and Valsalva leak point pressure (VLPP) varying from 18 to 128 cmH2O (average 60.3). The indications of surgery were: ISD (11 patients -- 52.4%), obesity (5 patients -- 23.8%), ISD and obesity (2 patients -- 9.5%), surgery recurrence (2 patients -- 9.5) and ISD and first grade womb prolapse (1 patient -- 4.8%). Results: as complications, 6 patients (28.6%) showed temporary urinary retention after surgery, 1 patient (4.8%) infection in the urinary tract, 1 patient (4.8%) presence of polypropylene suture in the vagina, 1 patient (4.8%) infection of the surgery wound, 4 patients (19%) developed urgency/incontinence, 1 (4.8%) urgency and 1 (4.8%) difficulty in urinating (high postvoiding residue). The grade of the patients' satisfaction was satisfactory, with 15 patients (71.4%) referring cure, 3 patients (14.3%) improvement, in 2 patients (9.5%) the urinary loss remained unchanged and in 1 patient (4.8%) the urinary loss got worse. Conclusions: the vaginal wall sling surgery is efficient for the treatment of specific cases of stress urinary incontinence, emphasizing intrinsic urethral sphincteric incompetence, surgery recurrence and predisposing factors to failure of other techniques.

Objective To assess the prevalence of nocturnal enuresis (NE) in Egyptian women, its relation to urinary incontinence (UI), and the impact on their quality of life (QoL). Subjects and methods This was a cross-sectional study involving 350 women, using multistage sampling to recruit them. The inclusion criterion was women aged ⩾18 years who lived in the Ismailia governorate. Four trained nurses interviewed the women at their houses in two areas selected randomly, one rural and one urban. The Arabic validated International Consultation on Incontinence Questionnaire-Short Form was used to assess the symptoms of UI, frequency and severity of urinary leakage, impact on QoL, and the presence of NE. The results were analysed statistically using appropriate methods. Results The mean age of the women was 42.46 years. The prevalence of adult-onset NE was 12/350 (3.4%), and this increased significantly with increasing age and history of previous surgery (e.g., hysterectomy) ( P < 0.05). There was a statistically significant association between NE and UI, as 11 of 12 women with NE had UI; most (seven of the 12) had mixed UI. The mean QoL score of NE, UI alone and normal subjects was 6.8, 4.7 and 0.02, respectively ( P < 0.05). Conclusions The overall prevalence of adult-onset NE was 3.4% amongst Egyptian women. The presence of NE correlated positively with UI, and UI had a negative impact on the QoL of women, but NE had a greater impact. [ABSTRACT FROM AUTHOR]

Aims To compare the efficacy and safety of Kegel exercises performed with or without, vaginal spheres as treatment for women with urinary incontinence. Methods Multicentre parallel-group, open, randomized controlled trial. Women were allocated to either a pelvic floor muscle-training program consisting of Kegel exercises performed twice daily, 5 days/week at home, over 6 months with vaginal spheres, or to the same program without spheres. The primary endpoint was women's report of urinary incontinence at 6 months using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-UI-SF). Secondary outcome measures were the 1 hr pad-test, King's Health Questionnaire (KHQ) and a five-point Likert scale for subjective evaluation. Adherence was measured with the Morisky-Green test. Results Thirty-seven women were randomized to the spheres group and 33 to the control group. The primary endpoint was evaluated in 65 women (35 in the spheres group vs. 30 controls). ICIQ-UI-SF results improved significantly at 1-month follow-up in the spheres group ( P < 0.01) and at 6 months in the controls. The 1 hr pad-test improved in the spheres group but not in the control group. No significant differences were found in the KHQ results or in the subjective evaluation of efficacy and safety. Adherence was higher in the spheres group but differences were not significant. Mild transient side effects were reported in four patients in the spheres group and one in the control group. Conclusions Both treatments improved urinary incontinence but women who performed the exercises with vaginal spheres showed an earlier improvement. Vaginal spheres were well tolerated and safe. Neurourol. Urodynam. 34:533-538, 2015. © 2014 Wiley Periodicals, Inc. [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]

Aims Our main objective was to analyze individual determinants that lead middle-aged women to seek medical care for urinary incontinence (UI). Methods Observational longitudinal study among GAZEL cohort participants: 2,640 women aged 50-62 completed a self-administered questionnaire at baseline. Eight years later (2008) 2,273 (86%) responded to a follow-up questionnaire. Seeking care for UI was defined as any consultation for UI during the 8-year follow-up period. Individual determinants considered in the regression analysis were social and demographic characteristics, social relations, UI type and severity, and other health factors. Results Among 1,192 women reporting incontinence at baseline, 24.4% had visited a physician at least once for UI during the follow-up period (56.0% of those reporting severe UI). The care-seeking rate increased with age at baseline. Multivariate analysis showed that women who reported severe UI (OR = 4.1; 95% CI 2.6-6.5), mixed UI (2.0; 1.3-3.0), or neurologic disease (1.6; 1.1-2.6), had weak social support (1.4; 1.0-2.0), or talked about their UI with close friends or family (1.5; 1.0-2.1) were more likely to seek care for UI. A model including these factors had a 78% probability of correctly differentiating women with incontinence who chose to seek care from those who did not. Our analysis could not take factors related to the organization of health services into account. Conclusions Women do not always seek care for UI, even when it is severe. Besides UI severity and type, consultation is associated with aging, weak social support, conversation about it with close friends and family, and neurologic disorders. Neurourol. Urodynam. 33:1116-1122, 2014. © 2013 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Key content Urinary incontinence ( UI) affects up to 69% of the female population at some point in their lives but remains under-reported. There are three main types of UI: stress, urgency and mixed., It is recommended to try conservative approaches as first-line measures in the management of all types of UI. These include lifestyle interventions such as adjustment of fluid intake and weight loss, physical and behavioural therapies (pelvic floor muscle training, electrical stimulation, vaginal cones and bladder training programmes) and occasionally containment devices., Initial management of UI, in most cases, renders itself to primary care settings: this involves appropriate assessment of women's symptoms, including quality of life ( QOL) assessment, appropriate simple investigations (such as urine analysis) and conservative treatment., Appropriate referral pathways to secondary and tertiary levels of care are necessary. Regular audit should take place to assess the efficacy of management options and referral pathways., UI has significant adverse affects on women's QOL. Hence patient reported outcome measures ( PROMs) have been highlighted in recent NHS reports as a means of assessing effectiveness of care from the patient's perspective by gauging patient health status or health-related QOL., Learning objectives To gain an understanding of the assessment and various conservative management options for common types of UI in women., To explore the existing evidence base for such conservative management modalities and to analyse the effect of the current economic climate and reorganisation of services on the conservative management approach., To recognise the important role of patient reported outcome measures as well as service and user involvement, in the assessment of clinical and cost-effectiveness of various treatment options of UI in women., Ethical issues Should conservative measures such as weight loss and smoking cessation be a pre-requisite for offering further management options?, In the present climate of scarce health resources should more emphasis be placed on the active role of patients in their own management? Will reorganisation of the NHS pose any threat to the conservative measures for treating UI in women?, Is it acceptable to take a 'one size fits all' approach to management of common types of UI? [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: Perceptions about urinary incontinence (UI) may have a differential impact on treatment-seeking behaviors. Thus, we aimed to systematically review perceptions regarding UI in women of different racial and ethnic populations. Methods: MEDLINE, EMBASE, Scirus, Google Scholar, Open J-Gate, AgeLine, and Global Health (CABI) were searched from January 1980 to August 2011. We included qualitative studies that described knowledge, perception, or personal views about UI in women. Studies were excluded if they did not specify race/ethnicity of subjects, if they reported on non-UI urinary symptoms, or if they were performed exclusively in men. Three independent reviewers screened all studies. The relevance, appropriateness, transparency, and soundness (RATS) scale for qualitative research was used to assess study quality. Because of the qualitative data, meta-analyses were not performed. Results: Of 3,676 citations, 23 studies met the inclusion criteria. Based on the RATS scale, these were categorized into 11 high-, 2 moderate-, and 10 low-quality studies. Dominant themes fell into two categories, UI management and UI experience, and were similar across racial/ethnic groups. Across multiple studies, women reiterated a preference for discussing UI with other women, even if this was not a physician. Non-white women expressed self-blame and perceived UI as a negative outcome from childbirth or prior sexual experiences. Latina women maintained more secrecy around this issue, even amongst family members. Conclusions: Women across different racial and ethnic groups share similar UI management strategies and UI experiences. However, perceptions about UI may differ in certain populations. These findings could be useful when considering future educational strategies regarding UI in women. [ABSTRACT FROM AUTHOR]

Purpose: (1) To describe the minimally invasive adjustable continence therapy (ACT) balloon placement surgical technique. (2) To analyse the results of ACT balloon in the treatment for female stress urinary incontinence (SUI). Method: A review of the literature was performed by searching the PubMed database using the following search terms: ACT balloons, female urinary incontinence, and female continence. Results: Eight studies were published between 2007 and 2013. The mean follow-up of these studies was 1-6 years. The mean age of the patients ranged between 62 and 73 years; 40-100 % of patients had already been treated surgically for their SUI. A significant reduction in the number of pads used per day was observed after ACT balloon placement, with improvement of short pad tests from 49.6 to 77.3 g preoperatively to 11.2-25.7 g after ACT balloon placement. Fifteen to 44 % of patients considered that their SUI had been cured and 66-78.4 % were satisfied with the result. The explantation rate ranged between 18.7 and 30.8 %. Quality of life was significantly improved, and no major complication was reported. Conclusion: ACT balloons constitute a reasonable, minimally invasive alternative for the treatment for female SUI due to intrinsic sphincter disorder, especially in patients who have already experienced failure of standard surgical treatment and in clinical settings incompatible with invasive surgical placement of an artificial urinary sphincter (especially women over the age of 80 years). Long-term results are essential to evaluate the efficacy of this treatment. [ABSTRACT FROM AUTHOR]

A retrospective study of patients of the Urogynaecological Unit in Siena is reported. Out of 228 women examined, 141 had urinary incontinence (stress incontinence 110, urge incontinence 18, mixed 13). Predisposing factors and risk factors were investigated. A parallel study in a non-selected population of women was performed by means of a questionnaire of self-evaluation for urinary incontinence. About 20% of this population had urinary incontinence to some degree, but only a small percentage of these women had already sought medical advice.

Background: Stress urinary incontinence is a common condition that can be treated conservatively and/or surgically. Given the risks of surgery, developing effective nonsurgical treatment options would be beneficial. Some studies have suggested that laser therapy may improve or cure stress urinary incontinence. However, there is a lack of sham-controlled randomized controlled trials to judge treatment efficacy.Objective: This study aimed to compare the effects of CO2 vaginal laser vs sham therapy for treating stress urinary incontinence.Study Design: This was a multicenter, participant-blinded, sham-controlled, parallel group (1:1) superiority randomized controlled trial performed in outpatient clinics in 2 hospitals. We included women aged 18 to 80 years with objective and subjective stress urinary incontinence. Participants had undertaken or declined supervised pelvic floor muscle training. Intervention was performed using a CO2 fractionated vaginal laser. Participants underwent 3 treatments, 4 weeks apart, with increasing energy and density settings. Sham treatment was performed using an identical technique with a deactivated pedal. The primary outcome was the subjective stress urinary incontinence rate (proportion with leak with cough, sneeze, or laughter) at 3 months after completion of treatment. Secondary outcomes included objective stress urinary incontinence, change in the disease-specific patient-reported outcomes, health-related quality of life, and adverse effects. Categorical outcomes were compared using the chi square test and continuous outcomes using analysis of covariance, adjusting for the baseline score.Results: There were 52 participants who received laser and 49 who received sham treatment. One participant in each group withdrew from the study before the endpoint, and 2 participants in the laser group did not participate in the follow-up visits. Participant mean age was 53 (34-79) years. Mean body mass index was 26.1 (18.1-49.6); 90% were vaginally parous. At 3 months, there was no difference between the sham and active treatment arm in subjective stress urinary incontinence (46 [96%] vs 48 [98%]; relative risk, 0.98 [95% confidence interval, 0.91-1.05]; P=.55) or in objective stress urinary incontinence (37 [80%] vs 33 [80%]; relative risk, 0.99 [95% confidence interval, 0.81-1.23]; P=.995). Patient-reported outcomes and health-related quality of life were also comparable between the groups. Vaginal bleeding occurred in 3 participants after laser and 1 participant after sham treatment. Pain during treatment did not differ between laser and sham treatment.Conclusion: We were unable to show an improvement in stress urinary incontinence after CO2 vaginal laser therapy compared with sham treatment. [ABSTRACT FROM AUTHOR]

Introduction: To evaluate the cost-utility of incontinence treatments, particularly anticholinergic therapy, by examining costs and quality-adjusted life years. Materials and methods: A prospective cohort study of women who were consecutively referred by general practitioners (GPs) to the Urology Department because of urinary incontinence. The primary outcome was evaluation of the cost-utility of incontinence treatments (surgery, medical therapy and physiotherapy) for stress and/or urgency incontinence by examining costs and quality-adjusted life years. Results: 137 consecutive female patients (mean age 60.6 ± 11.6; range 36-81) were enrolled and stratified according to pathologies: SUI and UUI. Group A: SUI grade II-III: 43 patients who underwent mid-urethral sling (MUS); Group B: SUI grade I-II 57 patients who underwent pelvic floor muscle exercise and Group C: UUI: 37 patients who underwent antimuscarinic treatment with 5 mg solifenacin daily. The cost utility ratio (CUR) was estimated as saving more than €1200 per QALY for surgery and physiotherapy and as costing under € 100 per QALY for drug therapy. Conclusions: This study shows that appropriate diagnosis and treatment of a patient with incontinence lowers National Health Service costs and improves the benefits of treatment and quality of life. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To determine the cost-utility and cost-effectiveness of the surgical treatment of female urinary incontinence using suburethral slings and prolapse meshes compared with therapeutic abstention. Study design: An economic analysis was performed on 69 women receiving surgical treatment for urinary incontinence using suburethral slings and prolapse meshes. To calculate the procedure's cost-effectiveness, an incremental analysis up to one year was performed using the incremental cost-effectiveness ratio (ICER). The costs were calculated using a cost-by-process model. Answers to the health-related quality of life questionnaires EQ-5D (generic) and International Consultation Incontinence Questionnaire Short-form (specific) were collected before the operation and as well as one month and one year post-operation to calculate the utility, using quality-adjusted life years (QALY), and the effectiveness, respectively. To complete the economic evaluation, we derived confidence ellipses and acceptability curves. The analysis was conducted for the entire sample and also for each type of urinary incontinence. Results: In total, 45 women presented with stress incontinence, 15 with mixed incontinence and 9 with incontinence associated with prolapse. The average cost per patient at one year post-operation was 1220 €. The QALY achieved at one year was 0.046. The results reveal an ICER at one year of 26,288 €/QALY, which is below the cost-effectiveness threshold considered acceptable, and this value was lower for stress incontinence (21,191 €/QALY). The cost-effectiveness was 106.5 €/International Consultation Incontinence Questionnaire Short-form unit. Conclusion: Surgery for female urinary incontinence using slings is cost-effective compared with abstention in our public health environment. [Copyright &y& Elsevier]

Introduction and hypothesis: The aims of the present study were to determine the types of UI among women visiting the urology department, to identify the potential risk factors associated with each type of UI, and to identify healthcare-seeking behaviors of affected women in our region. Methods: The data of 617 community-dwelling women, who were at least 18 years of age or older and who presented with a complaint of UI ongoing over a year, and those without UI, who were admitted for any other reason, from June 2010 to April 2012, were evaluated. Results: Mean age was 51.29 years (range 18-110 years); median parity was 3.54 (range 0-11) and 88.2 % of the women were married. Mean BMI was 28.01 kg/m. Very few women (18.5 %) accepted UI as a disease and searched for medical help by themselves; however, the remaining women (81.5 %) were brought or directed for evaluation by someone else. Stress UI was reported by 43 women (10.5 %), urge UI and mixed UI were noted by 153 (37.5 %) and 212 (52 %) women respectively. Conclusions: The most frequent type of UI was mixed UI in our region. Age, BMI, multiparity, and hypertension were identified to have a different importance for each type of UI, but diabetes mellitus, birth trauma, gynecological surgery, lumbar disc hernia (LDH), and multiple sclerosis (MS) were the other important related factors. However, a small number of patients accepted UI as a disease and searched for therapy. This reveals that the public should be informed in detail about female UI in developing countries. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: The objective of our study was to estimate the incidence and to identify the risk factors for reoperation of surgically treated stress urinary incontinence (SUI). Methods: We conducted a nested case-control study among 1,132 women who underwent SUI surgery from January 1988 to June 2007. Cases ( n = 35) were women who required reoperation for SUI following the first intervention up to December 2008. Controls ( n = 89) were women randomly selected from the same cohort who did not require reoperation. Results: The cumulative incidence of SUI reoperation was 3.1 % with a mean follow-up of 10.9 years (range 1.7-21.0). The main risk factor was the history of more than one vaginal delivery [adjusted odds ratio (OR) 3.5; 95 % confidence interval (CI) 1.0-12.6]. The use of synthetic midurethral slings was a protective factor compared to other surgical procedures for urinary incontinence (adjusted OR 0.1; 95 % CI 0.0-0.6). Conclusions: The risk of reoperation after SUI surgery appears to be low and associated with multiple vaginal deliveries. Synthetic slings at index surgery are associated with a lower risk of reoperation. [ABSTRACT FROM AUTHOR]

Aim To evaluate the prevalence and risk factors of urinary incontinence (UI) and its effects on quality of life in women aged between 35 and 64 years. Methods Data were obtained from the 2005 National Health Interview survey, in which 4,661 women aged between 35 and 64 years responded to questions concerning UI occurrence and health-related quality of life (HRQL), assessed using the Short Form 36, Taiwan version. Chi-square tests and multiple logistic regressions were applied to analyze comorbidity and risk factors of UI. Multivariable liner regression was used to evaluate the association between UI and HRQL. Results The weighted UI prevalence in Taiwanese women aged 35-44, 45-54 years, and 55-64 years were 14.7%, 24.7%, and 32.4%, respectively. After adjustment, increased age, greater parity, higher BMI (body mass index), former HRT use, having a psychiatric disease, hyperlipidemia, and respiratory disease were identified as significant UI risk factors. Women with UI had significantly lower scores on all SF-36 dimensions. After adjusting for other factors, UI remained a significant predictor of all domains of SF-36 and was associated with reduced physical (by 2.31 points) and mental (by 2.76 points) component summary scores. From a mental health perspective, UI had a greater influence on HRQL than diabetes, hyperlipidemia, and chronic kidney disease. Conclusion The UI prevalence of Taiwanese women is high, and its negative effects on quality of life are greater than those of other major chronic conditions, but are often overlooked and seldom intervened. Neurourol. Urodynam. 32: 371-376, 2013. © 2012 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Aims The findings are limited about the long-term effects of treatment with vaginal cones in women with stress urinary incontinence (SUI). The aim of this study was to investigate the long-term effects of vaginal cones and pelvic floor muscle training in post-menopausal women with SUI. Methods This randomized controlled trial included 45 post-menopausal women with SUI. They were randomly allocated in three groups: vaginal cones (VC, n = 15), pelvic floor muscle training (PFMT, n = 15), and control group (CG, n = 15). Women in VC and PFMT groups were treated for 6 weeks with twice weekly sessions. Women in VC group carried out the pelvic floor muscle strengthening with vaginal cones. The CG did not receive any treatment during the corresponding time. Women were evaluated before treatment, at the end, 3 and 12 months after treatment completion for primary outcome (urinary leakage) and secondary outcomes (pelvic floor muscle strength, quality of life, satisfaction with treatment, and continuity of training). Results There was a significant decrease of urinary leakage in the VC and PFMT group comparing values at the end of treatment, 3 and 12 months to baseline values. There were no differences between VC and PFMT group in primary outcome in any evaluations. Conclusions Treatments with and without vaginal cones can promote positive long-term effects on urinary leakage, pelvic floor muscle strength and quality of life in post-menopausal women with SUI in 6 weeks. Neurourol. Urodynam. 32: 48-52, 2013. © 2012 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: This study aims to investigate clinical therapeutic measures for women with urinary incontinence (UI) complicated with diabetes mellitus (DM). Methods: We performed a retrospective cohort study, including 462 female patients with UI complicated with DM (group A) and 901 patients with UI without DM (group B). Both A and B groups were divided into three subgroups according to their UI types (pure stress UI, mixed UI dominated by urge UI, and by overactive bladder syndrome) and received corresponding treatments. The subjective and objective effective rates were analyzed statistically. Results: The overall subjective effective rates were 62.99% and 85.23% and the overall objective effective rates were 67.53% and 87.24% for groups A and groups B, respectively; the subjective and objective effective rates were 73.68% and 89.47% for group A1 (patients with pure stress UI in group A). There was no statistical difference in group A1 between subjective and objective effective rates. Conclusion: Unsatisfactory clinical therapeutic efficacy was observed in women with UI complicated with DM; surgical operation should be deliberated cautiously for women with SUI complicated with DM. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To estimate the prevalence of female urinary incontinence (UI) in Jeddah, Saudi Arabia; to determine associated risk factors; and to identify healthcare-seeking behavior among affected women. Methods: A cross-sectional study of women attending Ministry of Health primary healthcare centers in Jeddah, Saudi Arabia, was conducted. Participants completed a questionnaire that evaluated factors associated with UI. Results: The mean age of the 379 participants was 35years and the median parity was 4. The overall prevalence of UI was 41.4% (95% CI, 36.6–46.5). Stress UI, urgency UI, and mixed UI were reported by 36.4% (95% CI, 31.7–41.4), 27.4% (95% CI, 23.2–32.1), and 22.2% (95% CI, 18.3–26.6), respectively. Urinary leakage was reported daily by 17.2%, and 25.5% experienced leakage more than once a week. Risk factors for UI included increased age (P <0.001); parity greater than 5 (P <0.001); menopause (P =0.004); and history of vaginal gynecologic surgery, chronic cough, or constipation (P ≤0.001). Medical advice was not sought by 85.5% of women with UI. Many of the women with UI reported adverse effects on their daily activities. Conclusion: Female UI is prevalent in Saudi Arabia; however, the majority of women with this condition did not seek medical advice. [Copyright &y& Elsevier]

Objective: To elucidate the influence of recreational physical activity, body mass index (BMI), and waist circumference on the risk of specific types of urinary incontinence.Study Design: We conducted a population-based cross-sectional survey in Gansu, China among 2603 women aged 20 years or older.Results: The study found that BMI was positively associated with urinary incontinence (P for trend=0.008) and the association was mainly observed for stress urinary incontinence (OR=1.4, 95% CI: 1.1, 1.9 for BMI=24.0-27.9 kg/m²; OR=2.3, 95% CI: 1.5, 3.6 for BMI ≥ 28.0 kg/m²; P for trend=0.0005). A positive association between stress incontinence (OR=1.7, 95% CI: 1.2, 2.5) and waist circumference was observed for women who had waist circumference between 70 cm and 75 cm compared to waist circumference less than 70 cm. Recreational physical activity was inversely associated with overall and mixed urinary incontinence (P for trend <0.0001 for both). A significant interaction between physical activity and waist circumference was found for overall (P=0.0007) and stress incontinence (P=0.001).Conclusions: The findings that physical activity inversely associated with urinary incontinence and its interaction with waist circumference warrant further investigation, particularly in prospective studies. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To outline serum estradiol levels in perimenopausal women with stress, mixed or urge incontinence. We believe the majority of urgency symptoms in perimenopausal women to be caused by a pelvic floor dysfunction and a hypermobility of the bladder neck. If this is the case, there would be no difference in estradiol levels between the groups. Study design: Setting: University hospital. In the observational Women''s Health in the Lund Area study, a subset of 400/2221 women reporting urinary incontinence completed a detailed questionnaire regarding lower urinary tract symptoms and had their serum steroid hormone levels measured. Statistical analyses were made by Chi-square test, nonparametrical tests, ANOVA, multi- and univariate logistic regression analysis. Results: Stress incontinence was reported by 196, mixed incontinence by 153 and urge incontinence by 43 women; in 369, serumestradiol values were available. Serum estradiol did not differ significantly between stress incontinent (median 49.5pmo/l, range 2.63–875.4), urge incontinent (median 31.6pmol/l, range 2.63–460.7) or mixed incontinent women (median 35.5pmol/l, range 2.63–787.9, p =0.62). Logistic regression analysis correcting for age, parity, hormonal status, smoking, hysterectomy and BMI also failed to show any difference in estradiol levels between the groups (p =0.41–0.58). Conclusion: No significant differences in serum estradiol levels between stress, mixed or urge incontinent perimenopausal women could be demonstrated. [Copyright &y& Elsevier]

Copyright of Pelvi-Perineologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

OBJECTIVE To report the outcome of artificial urinary sphincter (AUS) in female patients for the treatment of stress urinary incontinence (SUI). PATIENTS AND METHODS We retrospectively reviewed all female patients with AUS implanted over the last 25 years in one institution. Patient demographics, renal tract imaging and urodynamics assessment were documented. Outcomes measures included complications, duration and cause of AUS failure. Urinary continence was defined as no pad use after AUS insertion. AUS failure was defined as malfunction, infection or erosion. AUS malfunction included either mechanical (fluid leak) or non-mechanical (infection or surgical damage to AUS). A Kaplan-Meier analysis was used to determine device failure over time. RESULTS In all, 47 consecutive women with a mean (range) age of 51 (17-78) years received an AUS for the treatment of UI. Of these, 35 women had failed anti-incontinence surgery previously. There were two wound infections after AUS insertion but no mortality. Of the 47 AUS implanted, 39 (83%) AUS remained in situ . Eight (17%) AUS were removed due to AUS erosion or infection. There were 20 AUS revisions, 16 of which were primary AUS revisions. Most of the AUS revisions were related to mechanical malfunctions. Comparison of the proportion of AUS device survival over time using Kaplan-Meier analysis showed > 80% of AUS remained functioning after 100 months. At the time of review, 83% of patients had a device in situ and the continence rate with no pads use was 59% with AUS only; this figure increased to 85% when concurrent clean intermittent self-catheterization was performed. CONCLUSIONS AUS is an effective and durable treatment option for female SUI. In properly selected women, high continence rates can be achieved. Most patients maintained satisfactory long-term continence rates despite revision surgery. [ABSTRACT FROM AUTHOR]

Copyright of Pelvi-Perineologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

In October 2006, the National Institute for Health and Clinical Excellence (NICE) released Guideline No. 40: The management of female urinary incontinence. The objective of this study was to investigate the opinions of members of the British Society of Urogynaecology (BSUG) regarding the recommendations contained in the guideline. A closed format questionnaire using stems taken directly from the NICE guideline was sent to all UK-based members of BSUG. There was a 64% response rate. When asked if the guidance overall reflected their current practice, 56.8% agreed/strongly agreed. In terms of changing their practice to comply fully with the guideline, 53.3% disagreed/strongly disagreed. There were two major areas of disagreement. Some 80% of respondents disagreed that preoperative cystometry was not necessary in 'clinically pure' stress urinary incontinence; 72% of respondents disagreed that immediate release oxybutynin should be the first-line treatment for women with an overactive bladder (OAB). A smaller proportion disagreed with the statements on the use of duloxetine. The majority of the guidance formalises current practice among gynaecologists and urogynaecologists practicing in the UK. There are significant concerns regarding some of the recommendations, and the results indicate that over half of the respondents would not change their practice to follow these recommendations. [ABSTRACT FROM AUTHOR]

Objective. To outline possible associations between urinary incontinence (UI) and serum levels of steroid hormones in middle-aged women. Design and setting. Community-based observational study. Sample. All women aged 50-59 living in the Lund area by December 1995 were invited to a screening procedure. Sixty-four percent (n=6,917) attended the screening that included physical and laboratory examinations and questionnaires. Methods. Serum levels of cortisol, testosterone, androstendione, SHBG (sex hormone-binding globulin), and estradiol were analyzed and the 2,221 (32%) women who reported urinary leakage causing a social or hygienic problem were compared to those who denied incontinence. Main outcome measure. Possible differences in serum levels of steroid hormones in continent and incontinent women. Results. There were no significant differences between continent and incontinent women regarding serum levels of cortisol, testosterone, androstendione, or testosterone + androstendione combined. Serum estradiol adjusted for body mass index, parity, smoking, and hysterectomy was significantly higher in incontinent women (87.1±138.4 pmol/l vs. 78.0±118.5 pmol/l, p=0.005), whereas the ratio estradiol/SHBG was not. These differences persisted when the group of women not on hormonal treatment was analyzed. Conclusions. UI in middle-aged women seems related to higher serum estradiol levels. This corroborates with studies showing a higher incidence and/or prevalence of UI in women on hormone therapy. No association between UI and serum levels of cortisol, testosterone, or androstendione wasfound. [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]