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Objective The objective of this study was to elicit research ideas, priorities and outcome measures from women who suffer from urinary incontinence. Design Citizens’ juries gather participants together for a combination of education and deliberation on a specific topic. The juries were held in November 2007. Setting Women living in the community with urinary incontinence. Sample Purposively selected responders to public advertisements in Dunedin, New Zealand, were grouped into two juries dependent on whether stress urinary incontinence or urge urinary incontinence was the predominant problem. Methods The juries had a day of education in incontinence and research-related issues, with a half day for deliberation and reporting. Main outcome measures Ideas for areas where research may help the lives of women with incontinence in priority order and how best to measure the outcome of that research. Results The juries identified five main areas for incontinence research with only minor differences depending on which jury. These are, in priority order, making seeking help easier, making day-to-day life more manageable, finding out total costs, more knowledge about causes and the effects of lifestyle. Quality of life was considered by far the most important outcome. Conclusions Citizens’ juries are able to come up with ideas for research and prioritise these. Research in the areas suggested would be likely to improve the lives of women with urinary incontinence and may lead to a different mix of research projects than is currently the case. [ABSTRACT FROM AUTHOR]

Abstract: Urinary incontinence (UI) is a common female dysfunction, affecting women in all ages. Experienced physiotherapists and experts on low back pain (LBP) have since long observed and discussed the empirical association between LBP and UI. The aim of this study was to describe the occurrence of UI in women with LBP and to compare this group with a reference group of comparable age, language, culture and parity. The authors of this study had previously collected all original data from the reference group. A validated questionnaire concerning UI was answered by 200 consecutive women with LBP visiting specialised physiotherapy clinics in the area of Stockholm. Inclusion criteria were LBP, female, not pregnant, Swedish speaking, age between 17 and 45 years. Seventy-eight percent of the women with LBP reported UI. In comparison with the reference group, the prevalence of UI and signs of dysfunctional pelvic floor muscles (PFM) were greatly increased (p<0.001) in the LBP group. Logistic regression analysis showed that the condition LBP and PFM dysfunction i.e. inability to interrupt the urine flow (p<0.001) were risk factors for UI irrespective of parity. Physiotherapists treating patients with LBP should be aware of possible incontinence problems in this patient group. [Copyright &y& Elsevier]

To evaluate the measurement properties of the EuroQoL EQ-5D and two condition-specific patient-reported outcome measures—the Symptom Severity Index (SSI) and the Urinary Incontinence-Specific Quality of Life instrument (I-QoL)—in women with urinary incontinence. A questionnaire comprising all instruments was completed by women taking part in a clinical trial of physiotherapy for urinary incontinence. Follow-up questionnaires were at 6 weeks and 5 months. Data quality, internal consistency reliability, validity and responsiveness were assessed. One hundred and seventy-four patients taking part in the clinical trial completed the questionnaire. Instruments had low levels of missing data. The EQ-5D had a large ceiling effect and poor responsiveness. The SSI had poor validity and responsiveness. The I-QoL had levels of reliability that supported application in group assessment, and in some cases, individual assessment, and good evidence of validity. The I-QoL was the most responsive instrument at both 6 weeks and 5 months. The I-QoL was the best performing instrument and is recommended as a continence-specific measure of quality of life in a clinical trial setting. The SSI and EQ-5D are not recommended. Alternative generic instruments, which support economic evaluation, require further evaluation in trials of female urinary incontinence. [ABSTRACT FROM AUTHOR]

The article discusses a study which emphasizes the complexity of care-seeking behaviors in women with long-term urinary incontinence (UI). In a secondary analysis of women's narratives concerning long-term UI, care-seeking behaviors and examples of possible relationships between UI and sexuality and intimacy are investigated. It is recommended that healthcare providers should examine how their practice can best support a care setting and community outreach efforts.

Objective. Our study was aimed at evaluating the efficacy of therapy with promestriene, a synthetic diethyl-ether of estradiol with no distal hormonal effects, in patients undergoing surgical correction for stress urinary incontinence (SUI). Materials and methods. Ninety-eight healthy, postmenopausal women, non-users of hormone replacement therapy, with a diagnosis of SUI and vulvovaginal dystrophy, were recruited and openly randomized into two main groups. Group I (48 patients) received promestriene 10 mg daily, by vaginal capsule, for 21 days before the operation. Group II (50 patients) underwent the surgical procedure with TVT (Tension-free Vaginal Tape) directly, without pharmacological preparation. The results were collected and analyzed using SAS software (version 8). Results. The two groups were homogeneous in terms of age, parity and body mass index. There were no significant differences between the two groups with respect to the time required to accomplish the TVT, blood loss, length of hospital stay, blood component measurements and postoperative subjective symptoms. There were slight differences postoperatively in problems during intercourse and the appearance of new genital symptoms, but again they were not shown to be statistically significant. Conclusions. Our results, although preliminary and subjective, confirm the efficacy of remedial surgical treatment of SUI with TVT. Preoperative administration of promestriene seems to favor trophism and vascularization of the whole muscular and fascial support of the pelvic floor and facilitates performance of the operation, but is not supported statistically. [ABSTRACT FROM AUTHOR]

Abstract: Background: To determine risk factors for the appearance of de novo urgency symptoms, and subsequent accompanying problems, after the tension-free vaginal tape (TVT) procedure in women with stress urinary incontinence. Method: A structured preoperative analysis of the incontinence symptoms was made. A mailed questionnaire was distributed to 970 women that underwent the TVT procedure between 1995 and 2001. Average follow-up was 5.2 years (range 2–8 years). The questionnaire included specific questions on current urinary symptoms and incontinence. The disease-specific quality of life instruments IIQ-7 and UDI-6 were used to compare women with, and those without de novo urgency. Results: Seven hundred and sixty women (78.3%) responded and 463 of those were identified as genuine stress incontinence preoperatively. De novo urgency occurred in 67 (14.5%) of the women. The frequency was similar irrespective of duration since the TVT procedure. The women that reported de novo urgency symptoms were compared with those without symptoms. Risk factors for occurrence of de novo urgency symptoms were older age (64.7 years versus 60.9 years; p =0.01), parity (2.6 versus 2.3; p =0.05), history of cesarean section (9.5% versus 2.5%; odds ratio 5.4), and history of recurrent urinary infections (29.7% versus 18.8%; odds ratio 1.6, but non-significant. De novo urgency had a severe impact on quality of life, as compared to the remaining study population. Conclusion: Old age, parity and history of cesarean section were risk factors for de novo urgency after TVT surgery. Postoperative de novo urgency symptoms are as bothersome for the patient as the preoperative stress urinary incontinence. [Copyright &y& Elsevier]

Abstract: Objective: To investigate the association between patient characteristics and disease-specific and generic quality of life (QOL) as well as the degree of bother in women seeking treatment for urinary incontinence (UI). Methods: The Prospective Urinary Incontinence Research (PURE) was a 6-mo observational study with 1055 physicians from 15 European countries enrolling 9487 women. QOL was assessed at the enrolment visit using the urinary Incontinence Quality of Life questionnaire (I-QOL) and the generic EQ-5D. A single-item instrument was used to measure the degree of bother. UI severity was assessed using the Sandvik Index. UI was categorised into stress (SUI), mixed (MUI), and urge (UUI) urinary incontinence by a patient-administered instrument (Stress and Urge Incontinence Questionnaire [S/UIQ]). Multivariate linear (I-QOL, EQ-5D Visual Analogue Scale) and logistic (bother, EQ-5D health state index) regressions were performed. Results: Mean total I-QOL scores were significantly and independently associated with UI severity, nocturia, age, UI subtype, number of selected concomitant medical conditions, length of suffering from UI before contacting a doctor, smoking status, ongoing use of UI medication, and country. After adjusting for all the covariates, the total I-QOL scores for SUI, MUI, and UUI were 62.7, 53.8 and 60.1, respectively. As with I-QOL, UI severity was also the most important predictor for bother. The number of concomitant medical conditions, together with UI severity, was the variable most strongly associated with EQ-5D. Conclusion: In addition to the UI subtypes, severity of UI should be given more importance in treatment algorithms and in treatment decision-making by both the patient and the physician. [Copyright &y& Elsevier]

Abstract: The purpose of this study is to examine the subjective experience of long-term urinary incontinence and to show how a cultural model helps define that experience. Using a narrative approach within a cultural models framework, the specific aims are to describe and analyze: (1) what urinary incontinence means; and (2) how that meaning is constructed and negotiated by women living with urinary incontinence. 17 community-dwelling women (from Philadelphia, USA, and its immediate suburbs) participated in semi-structured interviews. Plot types and shared themes were compared with themes that emerged from media representations of female incontinence, and a cultural model was developed. Findings suggest: (1) the meaning of long-term female urinary incontinence is constructed and negotiated as a result of individual and shared experiences; (2) the cultural model constructed by women differs significantly from the professional, primarily biomedical model; and (3) women''s narratives provide a method for accommodating similarities and differences between lay and professional models. [Copyright &y& Elsevier]

Summary: Female urinary incontinence is a common but underreported condition. Initial investigation and treatment can in most cases be undertaken without urodynamic or other detailed tests. History by the use of validated symptom and quality of life questionnaires is key to the initial investigation. Initial treatment includes pelvic floor muscle training (PFMT) regardless of the type of incontinence; lifestyle interventions and bladder retraining, anticholinergics and serotonin/noradrenaline reuptake inhibitors (e.g. duloxetine) are also included depending on the type of symptoms. In mixed incontinence the predominant symptom should be treated first. When this initial treatment is ineffective, further investigation should be offered prior to specialised treatment. Urodynamics should be considered for all patients prior to surgery. Imaging and cystoscopy to exclude pathology, for example in elderly patients with an overactive bladder, are also necessary. Newer surgical interventions should be offered after careful consideration of the risk:benefit ratio for each individual woman and the amount of evidence that is currently available to support their use. [Copyright &y& Elsevier]

Abstract: Objectives: To describe the patient-reported impact of urinary incontinence (UI) in treatment-seeking women in Europe. Design: PURE was a non-interventional, observational study, which aimed to describe the direct costs of treatment for European women seeking treatment for UI. A secondary study objective was to describe the impact of UI on health-related quality of life (HRQoL) by UI subtype and severity of disease. This paper presents the results from quality of life assessments as well as bothersomeness and interference with daily activities from the first study observation. Subjects: Nine thousand four hundred and eighty-seven European women who had UI symptoms in the last 12 months were enrolled. Their UI symptoms were frequently those defined as mixed urinary incontinence (MUI) and were moderate to severe in nature. Measurements: HRQoL was assessed at the first observation using the urinary Incontinence-specific Quality of Life Questionnaire (I-QOL) and the EQ-5D, a generic quality of life questionnaire. Data collected from EQ-5D provided insight into the patients’ general health perception, while the I-QOL data indicated how affected the women were about their UI symptoms. Higher EQ-5D and I-QOL scores represent better quality of life. Patients were asked to indicate how much UI symptoms limited selected activities and to indicate the degree to which they found their symptoms to be bothersome. Results: Overall, the median self-rated health status on the EQ-5D visual analogue scale (VAS) was 70.0 and the median EQ-5D health state index was 0.85, with small but noticeable differences observed between countries. Of the five health dimensions of the EQ-5D, patients’ self-care appeared to be the least affected by UI, with fewer than 10% of the women reporting that they had some problems. Between 20 and 40% of patients had some problems with their mobility and usual activities, or had pain/discomfort or anxiety/depression. However, the impact of existing co-morbidity was not assessed and may have affected some women''s scoring of the EQ-5D domains. The mean total I-QOL score overall was 57.7 and of the three subscales of the I-QOL, psychosocial impact had the highest overall scores, representing fewer problems, with lower scores observed for the avoidance and limiting behaviour subscale, and even lower scores for the social embarrassment subscale. The greatest patient-reported impact of UI symptoms on activities was on exercise, with more than 45% of patients moderately to totally limited in this activity. In most of the countries, more than 60% of the women reported that they were moderately to extremely bothered by their UI symptoms. Conclusions: There was considerable impact of UI on HRQoL in a treatment seeking population, as demonstrated by the disease-specific quality of life scale and by the high percentage of patients who were bothered by their symptoms. [Copyright &y& Elsevier]

Abstract: Objective: To describe the characteristics of women seeking treatment for symptoms of urinary incontinence (UI) in European countries. Design: Prospective urinary incontinence research (PURE) was a 6-month, observational, pan-European study, primarily aimed at determining the direct costs of urinary incontinence treatment. The secondary objectives of PURE were to describe the impact of UI on health-related quality of life (HRQoL) in treatment seeking patients and to illustrate the treatment patterns for UI in Europe. Setting: One thousand and Fifty-five physicians from 14 European countries, including general practitioners (GPs), gynaecologists, urologists and geriatricians, observed women seeking treatment for their UI and recorded data at the first observation and then prospectively at 3 and 6 months after the first observation during the normal course of therapy. Subjects: Women of at least 18 years of age who had experienced urinary leakage in the 12 months prior to enrolment in the study, who were seeking treatment or under treatment for UI and who presented within the normal course of UI care were included in the 6 months study. The first observation characteristics of the patients are described here. Methods: Demographic characteristics, as well as disease and treatment status at first observation were explored using descriptive summary statistics to gain an understanding of the population studied. Results: In total, 9487 women took part in PURE, with the largest patient groups from Germany, Spain and the UK/Ireland. The majority of women were post-menopausal and had a mean age of 60.7 years, were not current smokers and tended to be overweight (BMI>25.0). Overall, mixed UI symptoms were more common than SUI and UUI, as defined by clinical opinion (SUI 38%, MUI 42% and UUI 18%), and by a two-item questionnaire, the S/UIQ (SUI 29%, MUI 58% and UUI 13%). Around half of the patients (48%) suffered from their symptoms for less than 2 years before consulting a physician; 28% delayed seeking treatment for 3–5 years, with 13% waiting for 6–10 years and the remaining 11% waiting for 11 or more years. Conclusions: Some of the described patients’ characteristics may provide important information to clinicians to enable them to take a more active approach to case-finding, which will ultimately benefit the incontinent patient. [Copyright &y& Elsevier]

Abstract: Background: Female urinary incontinence is a prevalent condition, but only about one-third of women seek treatment. Objectives: To describe the health care provision for women with urinary incontinence from a European perspective, selecting France, Germany, Spain, Sweden, and the United Kingdom as examples, and to investigate whether specific barriers for treatment exist. Methods: Available health care system information, a literature review and clinical expert information identified patterns of treatment provision. Results: In Spain, Sweden, and the UK, access to medical care in general is primarily through the general practitioners. However, in Spain and Sweden, women with urinary incontinence can directly visit specialists. In France and Germany, women have equal access to either general practitioners or specialists. Aside from general practitioners, gynaecologists play a major role in urinary incontinence care in all countries except the UK. In Germany, urologists are also involved in initial female urinary incontinence care; however, only in about 16% of women. There are no waiting lists in France and Germany for appointments with physicians or procedures, contrary to Spain, which has long waiting lists. Access to general practitioners in the UK is unrestricted whereas advanced diagnosis and treatment in secondary care requires long waits. A specific Swedish policy mandates that no woman is required to wait longer than 3 months for incontinence visits and related surgery. In Sweden and the UK, specialist nurses and other health care workers provide incontinence services. Almost all treatment options for urinary incontinence are at least in part reimbursed. However, various co-payments and fees in France, Germany, Spain and Sweden exist and constitute out-of-pocket expenses for women if no complementary additional private health insurance is available. In some countries, financial incentives for physicians to provide incontinence services are low, raising concerns about their interest to engage in continued patient care. Conclusions: Information about service provision in Europe for women with urinary incontinence is limited and makes it difficult to understand barriers to treatment seeking. A broad European perspective may promote optimised treatment access in the future for this widespread and under-recognised condition. [Copyright &y& Elsevier]

The impact of physical activity on urinary leakage (UL) has previously been considered, but not in relation to first pregnancy and delivery. The aim of this study was to describe physical activity and urinary leakage before, during and after the first childbirth. The subjects who were invited to participate in the study were taken consecutively from nine maternity clinics in the northwest part of Stockholm County, and the study group included 665 primiparous women. The mean age of the women was 28 (range 17–43) years. The women answered one questionnaire during the 36th gestation week and another 1 year post partum. Physical activity/exercises were classified according to their impact on the pelvic floor, and the women were divided into three groups: high-impact exercise (n=327), low-impact exercise (n=84) and the inactive group (n=254). The results showed a high intensity and frequency of physical activity in the participating primiparous women. Risk factors for UL were symptoms of a dysfunctional pelvic floor and connective tissue disorders and high-impact physical activity before pregnancy, while low-impact activity seemed to promote continence. If urinary leakage was present before pregnancy, it persisted in most women during pregnancy and 1 year post partum. [ABSTRACT FROM AUTHOR]

Abstract: Objective:: Clinical practice guidelines (CPGs) are tools that urinary incontinence (UI) specialists can use to update and communicate their expertise with other specialists, health authorities and general practitioners to help promote a more uniform approach to the initial management of women with UI. The objective of this paper was to assess available recommendations for the initial management of UI in women from urology organizations in Europe and North America and compare with the recommendation from the International Consultation on Continence (ICI). Methods:: A review of the medical literature was conducted to identify and compare relevant CPGs for the initial management of UI in women. Results:: The European Association of Urology (EAU) and the Spanish National Association of Urology (SNAU) have developed CPGs for the initial management of UI in women, both of which are similar to those developed by the ICI. Differences exist in the pharmaceutical treatment of both stress urinary incontinence (SUI) and urge urinary incontinence (UUI). Few treatment options are supported by sufficient scientific evidence to qualify as “A-level” recommendations. Conclusion:: The recommended initial management of UI in women from the EAU and SNAU is in general agreement with that from the ICI, but some treatment options have limited scientific support. Endorsement or simplification accepted by urologists may enhance the credibility of CPGs and promote their adoption by other practitioners without detailed UI experience and improve the quality and consistency of care for women with UI. [Copyright &y& Elsevier]

The purpose of this study was to establish a reliable and valid instrument to evaluate women's confidence in performing pelvic floor muscle exercise (PFME). Based on the researcher's own experience and with extended literature review, social cognitive theory and a health promotion model were utilized to formulate the 17-item Chen pelvic floor muscle exercise self-efficacy (PFMSE) scale. Data were collected from 106 urinarily incontinent women and the reliability and validity of the scale were tested. The results showed that the scale has a high Cronbach's alpha of .95 for its internal consistency. Test-retest reliability over 6-30 days was r = .86 (p < .001), showing acceptable stability of the Chen PFMSE scale. Exploratory factor analysis was used to test the initial construct validity, and two factors were extracted, which explained 34.16% and 32.55% of the total variance respectively, with a total of 66.71%. The two factors were named as (1) belief in PFME execution and its benefits, and (2) belief in performing PFME as scheduled and despite barriers. It is also evident that the Chen PFMSE scale satisfies concurrent validity when compared with well-developed and tested instruments such as general self-efficacy (GSE), perceived PFME benefits, and incontinence impact questionnaire-7 (IIQ-7). The results suggest that the Chen PFMSE scale has solid psychometric properties, and is a useful tool for clinicians to design appropriate interventions and to foster positive PFME self-efficacy during treatment for women with urinary incontinence and undergoing PFME training. [ABSTRACT FROM AUTHOR]

Objectives. – An increasing number of patients look for medical information on Internet, and find hardly accurate answers to their questions. The objective of this study was to assess the quality of information about urinary incontinence on free access Web-sites.Material and methods. – A search using the most used search engines in French speaking countries and key words given by patients located 24 Web-sites on female urinary incontinence to review. A general description of each site was done. Then a specially designed assessment scale, whose criteria were extracted from a literature review and from practice guidelines for the management of female urinary incontinence, was used by two reviewers to assess each Web-site content.Results. – Three key terms (urinary incontinence, urine loss, urine leak) were used on three search engine (Google, Yahoo, Voila) and the first 10 Web-sites located for each search were analyzed. The mean score was low (7.92 (±3.1) range 0–24, maximum 24) and only four sites received the “highly recommended” mention.Conclusions. – This study using medical evidence-based criteria to assess the quality content of French speaking Web-sites about female urinary incontinence highlights the poor quality of information available for Internet “typical users”. Doctors should play a greater role in evaluating these sites and/or developing their quality. [Copyright &y& Elsevier]

To evaluate the clinical and video-urodynamic outcome in women with by stress urinary incontinence (SUI) treated with a bone-anchored pubovaginal sling. The study included 70 women with SUI (as evaluated by a clinical examination, a voiding questionnaire, a short pad-test and video-urodynamics) who had a bone-anchor sling procedure, with or without cystocele repair, from January 1999 to December 2001; they were re-evaluated after a long-term follow-up (mean 30 months). The long-term outcome showed a success rate of > 95%; the clinical and video-urodynamic findings showed good functional and anatomical results, and an improvement in voiding performance in most patients. There was a low incidence of complications during and after surgery (2.8%). This approach gives, in highly selected patients, a high success rate and low incidence of complications. The technique is easy to learn and the costs to the financing bodies and public healthcare are low, making it a candidate for an alternative procedure to the standard techniques for SUI. [ABSTRACT FROM AUTHOR]

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

Aims The objective of this study was to evaluate the reliability of strength and endurance dynamometric measurements of the pelvic floor musculature (PFM). Materials and Methods Twenty-nine female participants, primipara and multipara, aged between 27 and 42 and presenting different severity levels of stress urinary incontinence (SUI), participated in the study. They were evaluated using a new pelvic floor dynamometer, an instrumented speculum based on strain-gauged technology. Strength and endurance evaluations were repeated in three successive sessions, each followed by a 4-week period. Maximal strength values were recorded at three dynamometer openings (5 mm, 1 cm, and 1.5 cm between the two dynamometer branches). The maximal rate of force development (MRFD) and percentage of strength lost after 10 and 60 sec were computed from the endurance trial. The generalizability theory was applied to estimate the reliability of the PFM measurements. The reliability was quantified by the index of dependability and the corresponding standard error of measurement (SEM) for one and the mean of three trials performed in one session for the strength measurements and one trial completed in one session for the MRFD and endurance measurements. Results For the maximal strength measurements, the largest coefficient of dependability was obtained at the 1 cm opening, with a value of 0.88. The corresponding SEM reached 1.49 N. The reliability of the MRFD was also very good with a coefficient of 0.86 and an SEM of 0.056 N/sec. The reliability was minimally affected by the number of trials. The strength loss measurements at 10 and 60 sec were unreliable, with coefficient values of 0.38 and 0.10, respectively. Conclusions The results of the present study indicate that the reliability of the strength parameters (maximal strength and MRTD measurements) was high enough for future investigations on pelvic floor rehabilitation programs. Neurourol. Urodynam. 23:134-142, 2004. © 2004 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]

Objective: To investigate by questionnaire the prevalence and characteristics of urinary incontinence (UI) in a female population aged between 18 and 49. Study design: Of 44,095 females aged 18–49.9 living in our urban area a sample of 10,000 subjects was sent a questionnaire and 3557 replied. The age-based analysis was performed on 2900 of these. Results: The overall prevalence of UI was 20%. 11% had suffered from nocturnal enuresis before 18 years old, 47% of parous women noted a relationship between the beginning of UI and delivery. Among the incontinent women 83% lost urine with physical exertion, and 44% had urge incontinence, 18% used diapers, 20% had consulted a physician and half of these had been referred for medical, surgical or rehabilitative therapy, 50% reported past or present urinary infections, 8% complained also of faecal incontinence, 22% considered loss of urine embarrassing and humiliating but only 6% revealed frustration and 2% were obliged to stay at home for long periods of time. Of the incontinents 62% defined themselves anxious or nervous and 22% of these ascribed an increase of urinary leakage to anxiety or to nervousness, 9% reported use of antidepressant drugs, 85% had sexual intercourse and only 2% considered UI as an impediment to a satisfying sexual activity. Conclusions: UI is a common problem in young women. Urge incontinence seems to be prevalent in <30 aged women while stress incontinence occurs more frequently after this age. [Copyright &y& Elsevier]

Background: Urinary incontinence is common in women. How often incontinence occurs has been only briefly investigated. Studies on the prevalence of fecal incontinence are few. The epidemiology of genital prolapse symptoms is unknown. This epidemiological study describes a general population of women aged 40 and 60 years with regard to the prevalence and frequency of urinary and fecal incontinence and the prevalence of genital prolapse symptoms.Methods: A questionnaire on medical background, urinary and fecal incontinence, and genital prolapse symptoms was sent to 1000 40-year-old and 1000 60-year-old randomly selected women.Results: Sixty-seven per cent answered: 53% were continent for urine; 9% of the 40-year-olds and 19% of the 60-year-olds had urinary incontinence weekly or more often. Detrusor instability score was significantly higher in the 60-year-olds. Incontinence of flatus, weekly or more often, was reported by 9% and 19%, loose feces by 5% and 8%, and solid feces by 0.3% and 1.7% according to the 40- and 60-year-olds, respectively. Fifty-three per cent reported no flatus incontinence. Of the prolapse symptoms investigated, 15% of the females reported pelvic heaviness, 4% genital bulge, and 12% use of fingers in the vagina or perineum by defecation.Conclusions: Incontinence of urine is common in this population. Flatus incontinence is as common, but the concept must be operationalized if used as an endpoint in research. The International Continence Society's (ICS) definition of urinary incontinence is unpractical for use in epidemiological research. We suggest leakage weekly or more often as a criterion for significant incontinence in epidemiological research. [ABSTRACT FROM AUTHOR]

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

Abstract Objective The aim of our study was to analyze whether transabdominal and introital sonography can identify paravaginal defects and to determine changes that occur following paravaginal defect repair and Burch colposuspension. Methods Twenty women with genuine stress incontinence took part in this prospective study. The mobility of the bladder neck was assessed transperineally with a curved array probe following instillation of 300 mL saline. The same probe was used transabdominally to determine the presence of paravaginal defects. Introital examination using a transvaginal probe was then performed to determine the presence of paravaginal defects. The same measurements were performed following Burch colposuspension and paravaginal defect repair. Results There were significant differences in bladder neck position and mobility before and after surgical intervention. In 18 women before surgery, transabdominal ultrasound identified unilateral or bilateral paravaginal defects. Eight unilateral defects were found on the right side but only two were found on the left side. In eight women, the defect was bilateral. The introital approach obtained similar results apart from in two patients with a bilateral defect in whom it indicated a unilateral right defect. Between the first and second weeks following the operation transabdominal ultrasound found no paravaginal defects in 16 women and introital ultrasound found no paravaginal defects in 18 women. We were unable to visualize the region of the paravaginal defect in two women using transabdominal ultrasound because the abdominal wall was edematous after surgery. Five to 6 weeks after the operation, our results were confirmed by abdominal and introital ultrasound in all cases. No paravaginal defects were found in any of the patients after paravaginal defect repair. Conclusion Our clinical study suggests that ultrasound scanning should be performed to confirm the presence of paravaginal defects and that paravaginal... [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to evaluate the value of routine measurements of urinary flow rate and residual urine volume as a part of a "minimal care" assessment programme for women with urinary incontinence in detecting clinical significant bladder emptying problems. Material and Methods: Four hundred and eight women were examined and treated in an open-access, interdisciplinary incontinence clinic. A standardized programme for investigation and primarily non-surgical treatment of incontinence was applied. Results: Of the 408 women 43% reported subjectively incomplete bladder emptying. Twenty-six per cent had a maximum flow rate less than 15 ml/s, but only 4% at a voided volume ≥200 ml. Residual urine more than 149 ml was found in 6%. Two women had chronic retention with overflow incontinence. Both had typical symptoms with continuous leakage, stranguria and chronic cystitis. Another woman had an urethral stricture with massive bladder emptying symptoms. In the remaining 172 women with symptoms suggesting bladder emptying problems, all but 3 were managed by triple voiding and timed micturition. In these 3 patients, who also had chronic cystitis, the treatment was supplemented with clean intermittent self-catheterization. Conclusion: The few women (6 (1.5%)) in whom measurements of urinary flow rate and residual urine volume had a clinical therapeutic consequence, cannot justify these measurements to be routine in a "minimal care" programme for assessment of primary, uncomplicated female urinary incontinence. Thus, primary health care providers can assess women based on simple guidelines without expensive equipment for assessment of urine flow rate and residual urine. [ABSTRACT FROM AUTHOR]

Background: To evaluate the therapy-associated morbidity of all patients who underwent a TVT operation in Finland by the end of the year 1999.Methods: Questionnaires on the number of operations and on the number of different complications were sent to 38 hospitals where TVT operations had been independently performed after an obligatory TVT training period. The primary TVT training center and a hospital, which did not use the standard TVT equipment, were excluded.Results: Among the 38 hospitals there were four university, 13 central and 21 local hospitals. The total number of operations was 1455. The incidence of bladder perforation was 38/1000, that of intra-operative blood loss over 200 ml 19/1000, of major vessel injury 0.7/1000, of nerve injury 0.7/1000, of vaginal hematoma 0.7/1000 and of urethral lesion 0.7/1000. The incidence of minor voiding difficulty was 76/1000, that of urinary tract infection 41/1000, of complete postoperative urinary retention 23/1000, of retropubic hematoma 19/1000, of wound infection 8/1000 and of vaginal defect healing 7/1000. No case of tape rejection or life threatening complication occurred and the incidence of complications requiring laparotomy was 3.4/1000. The ratio of number of complications to TVT operations performed did not vary significantly between different hospital types (p>0.05).Conclusion: The TVT procedure is a safe method for the treatment of stress urinary incontinence provided that appropriate training is offered. [ABSTRACT FROM AUTHOR]

The structures of the pelvic floor are clinically important but difficult to assess. To facilitate the understanding of the complicated pelvic floor anatomy on sectional images obtained by CT and MR imaging, and to make the representation more vivid, a computer-aided 3D model was created from a male and a female torso to develop a teaching tool. A male and a female cadaver torso were investigated by means of CT, MR imaging, and serial-section sheet plastination. A 3D reconstruction of the pelvic floor and adjacent structures was performed by fusion of CT and MR imaging data sets with sheet plastination sections. Corresponding sections from all three methods could be compared and visualized in their 3D context. Sheet plastination allows distinction of connective tissue, muscles, and pelvic organs down to a microscopic level. In combination with CT, MR imaging, and sheet plastination a 3D model of the pelvic floor offers a better understanding of the complex pelvic anatomy. This knowledge may be applied in the diagnostic imaging of urinary incontinence or prolapse and prior to prostate surgery. [ABSTRACT FROM AUTHOR]

Abstract Objective Most of the relevant surgical procedures employed in the management of genuine stress urinary incontinence (GSI) involve the technique of bladder neck elevation. The appropriate level of suspension is an important (but frequently overlooked) consideration as the clinical consequences of over-correction of the posterior angle are voiding dysfunction and urgency symptoms. The aim of our study was to compare ultrasound characteristics in women with GSI with those of women before and after Burch colposuspension. The findings of our study should have implications for GSI management. Design Prospective randomized clinical study at the Department of Obstetrics and Eynecology, Charles University, Prague, Czech Republic. Setting Department of Obstetrics and Gynecology, Charles University, Prague, Czech Republic. Methods Seventy women with previously untreated GSI (properative group) and 52 women (42 of whom had been in the preoperative group) who were studied 3–12 months after receiving Burch colposuspension (postoperative group) took part in the study. The standard transperineal and introital ultrasound scans were performed. The mobility of the bladder neck was assessed transperineally with a curved array probe after instillation of 300 mL of saline. The bladder was then evacuated and the thickness of the urinary bladder wall in the sagittal plane in defined regions (base, vertex and anterior wall) was measured. Results We found significant differences in bladder neck position, mobility, and in bladder wall thickness. Where symptoms of urgency occurred, the average bladder wall thickness was > 5 mm, the gamma angle < 40°, and lower bladder neck mobility was evident. Conclusion These findings supported our hypothesis that signs of urgency follow over-elevation of the bladder neck. These results helped us significantly to refine our GSI management. [ABSTRACT FROM AUTHOR]

Recurrent stress urinary incontinence (rSUI) represents a major challenge for most clinicians as there is little evidence in the literature on the best option after sling failure. The objective of this study is to summarise the findings on the use of urethral bulking agents (UBAs) in the management of rSUI after the failure of a mid-urethral sling (MUSs). We performed a systematic review and meta-analysis, according to PRISMA 2020 guidelines, and selected eleven publications for inclusion in the analysis. We found that the overall cure and improvement rate ranged from 64% to 85% in the included studies, with a pooled value of 75%, compared with pooled failure and re-operation rates of 32% (95% CI: 22%-43%) and 25% (95% CI: 17%-34%), respectively. The I 2 test indicated significant statistical heterogeneity among the studies in relation to all the outcome measures; however, no risk of publication bias was found. To explore this heterogeneity in more depth, we performed a sub-group analysis of the two most commonly used bulking agents (Bulkamid and Macroplastique). The pooled values of the cure and improvement rate were 84% (95% CI: 77.0%-90.0%) and 80% (95% CI: 74.0%-85.0%) for Macroplastique and Bulkamid, respectively. We did not find significant heterogeneity or significant differences in the outcome measures in either group. For the first time in literature, our study provides an insight into the use of UBAs after failed MUSs. Although the results seem very promising, future studies with shared protocols are needed in order to recommend the use of UBAs in the treatment of recurrent cases., Competing Interests: The authors declare that they have no competing interest., (Copyright © 2022. Published by Elsevier B.V.)

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 CO 2 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 CO 2 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 CO 2 vaginal laser therapy compared with sham treatment., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Functional magnetic stimulation (FMS) is a new technique for the conservative treatment of Urinary incontinence (UI), based on magnetic induction. It induces controlled depolarization of the nerves, resulting in pelvic muscle contraction and sacral S2-S4 roots neuromodulation. The aim of this study was to assess the efficacy of the new 3 Tesla FMS chair, both in patients with pure stress urinary incontinence (SUI) and in women with pure overactive bladder (OAB) symptoms. A prospective observational study was conducted in our urogynaecologic unit. All the patients involved were consecutive women with pure SUI or pure OAB symptoms treated by a 3 Tesla electromagnetic chair. The primary outcome was a subjective outcome evaluation by the PGI-I Scale and a patient-satisfaction scale. The secondary outcome was the change score of the UDI-6, IIQ-7, ICIQ-SF and OAB-q SF questionnaires from baseline to final visit. At 2 months follow-up, 28 out of 60 patients (47%) with SUI symptoms and 20 out of 40 patients (50%) with OAB symptoms declared themselves cured. Considering cured and improved patients, the subjective cure rates were 68.3% (41/60) and 70% (28/40) for patients with SUI and OAB symptoms, respectively. The results of this study showed that the 3 Tesla electromagnetic chair may be an effective option for the treatment of UI.

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

Ultrasound is a complementary evaluation for the study of female urinary incontinence which allows functionalmorphological documentation. A reliable urogynecologic examination is based on the patient's history, clinical evaluation, urodynamics and imaging. Training in sonography of the female lower urinary tract should be performed within the scope of urogynecological evaluations. [ABSTRACT FROM AUTHOR]

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

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

Full urodynamic assessment, including urethral profiles at rest and under stress, was made before and after surgery for severe urogenital prolapse in 40 continent women. Profilometry was also recorded after reduction of the prolapse by a vaginal pessary. The aim of this study was to try to determine criteria to prevent postoperative incontinence. After surgery, 6 patients (15%) became stress incontinent. The operation tends to diminish urethral obstruction (diminution of the residual volume) and negatively affects urodynamic urethral parameters (diminution of the residual continence area). The pessary test was not predictive of postoperative incontinence. Preoperative transmission ratio <100% and/or maximum urethral closure pressure <35 cmHO are proposed as predisposing factors for postoperative iatrogenic incontinence. Therapeutic implications are discussed. [ABSTRACT FROM AUTHOR]

Perineal physiotherapy without electrostimulation was applied in 129 women with stress (59), urge (49) or mixed (15) incontinence (66 stable bladders and urethras, 22 unstable bladders. 46 unstable urethras), and in 10 women presenting only enuresis (7) or only pollakisuria (3). The exercises consisted of two parts: 1) awareness of the perineal muscles involved by biofeedback, and 2) thorough training of these muscles by individually adapted schemes. A large group of patients (26%) discontinued this treatment because of the active involvement it requires. 36% of patients are completely dry within 3 months, another 28% report some amelioration. [ABSTRACT FROM AUTHOR]

Objective To evaluate the medium-term outcome of gluteraldehyde cross-linked (GAX) collagen in the treatment of genuine stress incontinence in women. Patients and methods The study comprised 111 women (age range 33-90 years) with genuine stress incontinence who were treated with para-urethral collagen injections between 1990 and 1995. The patients were followed prospectively and their clinical outcome documented. Pre- and post-operative urodynamic data were examined to determine any prognostic indicators. Results The overall results at a minimum 2-year follow-up (mean 3.3) showed 25% of patients to be dry and a further 40% improved. Although there were significant changes in some urodynamic values, no predictive factors of success were identified. Previous surgery for stress incontinence did not influence the final outcome. Conclusion Para-urethral collagen injection is a safe and relatively simple procedure with acceptable results at the medium-term follow-up. It could be offered as a primary or secondary procedure to women with genuine stress incontinence who are unable or unwilling to undergo surgical treatment. Objective urodynamic assessment revealed no factors of prognostic significance. [ABSTRACT FROM AUTHOR]

Objectives: Women often feel embarrassed about urinary incontinence, hesitate to see a doctor and search the internet to gain information on the disease. The objective of this study was to evaluate the quality of the most viewed YouTube™ pertaining to female urinary incontinence., Material and Methods: Sixty videos that met the inclusion criteria were assessed by two urologists through Quality Criteria for Consumer Health Information (DISCERN), Journal of the American Medical Association (JAMA) and Video Power Index (VPI) scoring systems. Videos' image type, video uploaders, general content, length, view counts, date of uploading, comment, like and dislike counts were also recorded and analyzed., Results: Forty videos included real and 20 animation images. Nine videos were uploaded directly by physicians, 32 videos by health channels, 14 videos by hospital channels, 2 videos by herbalists and 3 videos by other sources. The mean comment, like and dislike counts of the videos were found as 49.4 ± 172.9, 642.5 ± 2,112.9 and 66.7 ± 192.4. The mean DISCERN score was found as 38.2 ± 11.5, JAMA score as 1.4 ± 0.6 and VPI score as 85.1 ± 12.1. There was no significant difference between physicians and non-physicians and between real and animated videos in terms of DISCERN and JAMA scores (p>0.05)., Conclusions: The quality of the videos on YouTube™ pertaining to female urinary incontinence was at an average level. Healthcare professionals should be encouraged for uploading more accurate quality health related contents. Policy makers should develop policies for supervision of the videos uploaded on the internet., Competing Interests: Declaration of Competing Interest The authors declare no conflict of interest regarding this study., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Our objective was to assess the benefit of additional pelvic floor exercises, supervised by specialist physiotherapists, in the secondary care management of urinary stress incontinence. This is a retrospective cohort study in a UK University teaching hospital. A total of 317 women were referred from primary care to a specialist continence clinic for management of urinary stress incontinence. The cases were identified from the clinic database and a case note review performed. Data were collected on initial clinical assessment, suitability for pelvic floor exercises and outcome of treatment. The main outcome measures were adherence to primary care guidelines, suitability for further pelvic floor exercises and outcome of exercises. In total, 201 women were deemed suitable for a trial of further pelvic floor exercises, of whom 82 had previously attempted this in the primary care setting. After completing a course of physiotherapist supervised exercises, 105 women were able to be discharged from secondary care as a result of their symptoms improving. Of these women, 46 had previously attempted pelvic floor exercises in the community. It was seen that the primary care guidelines are poorly adhered to and where pelvic floor exercises are attempted in the community, the outcomes appear to be suboptimal. In appropriately selected women, a trial of additional physiotherapist-supervised exercises is beneficial and can reduce the urodynamic and surgical workload by 33%. [ABSTRACT FROM AUTHOR]

Background: Female urinary incontinence is underdiagnosed and undertreated in primary care. There is little evidence on factors that determine whether women with urinary incontinence are referred to specialist services. This study aimed to investigate characteristics associated with referrals from primary to specialist secondary care for urinary incontinence. Methods: We carried out a cohort study, using primary care data from over 600 general practices contributing to the Clinical Practice Research Datalink (CPRD) in the United Kingdom. We used multi-level logistic regression to estimate adjusted odds ratios (aOR) that reflect the impact of patient and GP practice-level characteristics on referrals to specialist services in secondary care within 30 days of a urinary incontinence diagnosis. All women aged ≥18 years newly diagnosed with urinary incontinence between 1 April 2004 and 31 March 2013 were included. One-year referral was estimated with death as competing event. Results: Of the 104,466 included women (median age: 58 years), 28,476 (27.3%) were referred within 30 days. Referral rates decreased with age (aOR 0.34, 95% CI 0.31–0.37, comparing women aged ≥80 with those aged 40–49 years) and was lower among women who were severely obese (aOR 0.84, 95% CI 0.78–0.90), smokers (aOR 0.94, 95% CI 0.90–0.98), women from a minority-ethnic backgrounds (aOR 0.76, 95% CI 0.65–0.89 comparing Asian with white women), women with pelvic organ prolapse (aOR 0.77, 95% CI 0.68–0.87), and women in Scotland (aOR 0.60, 95% CI 0.46–0.78, comparing women in Scotland and England). One-year referral rate was 34.0% and the pattern of associations with patient characteristics was almost the same as for 30-day referrals. Conclusions: About one in four women with urinary incontinence were referred to specialist secondary care services within one month after a UI diagnosis and one in three within one year. Referral rates decreased with age which confirms concerns that older women with UI are less likely to receive care according to existing clinical guidelines. Referral rates were also lower in women from minority-ethnic backgrounds. These finding may reflect clinicians' beliefs about the appropriateness of referral, differences in women's preferences for treatment, or other factors leading to inequities in referral for urinary incontinence. [ABSTRACT FROM AUTHOR]