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Introduction and hypothesis: We evaluated whether vaginal tampon training (VTT) combined with pelvic floor muscle training (PFMT) results in better outcomes than PFMT alone for treating stress urinary incontinence (SUI).Methods: This was a randomized, controlled study. Patients were allocated to either the combined program, consisting of PFMT and VTT over 12 weeks [PFMT and VTT group (n = 24)] or to PFMT alone [PFMT group (n = 24)]. The primary outcome measure was self-reported improvement, while secondary outcome measures were severity of incontinence, quality of life (QoL), urinary parameters, and pelvic floor muscle strength (PFMS) and endurance (PFME). Values were analyzed with Friedman, Mann-Whitney U, Wilcoxon, and chi-square tests.Results: Between-group analysis showed no statistically significant differences in self-reported improvement, severity of incontinence, symptom distress score, PFMS, PFME, urinary parameters, and all domains of QoL scores, except social limitations, at weeks 4, 8, and 12 (p > 0.05). However, the increase in PFMS and PFME between baseline and week 12 and earlier improvement was significantly greater in the PFMT and VTT than in the PFMT group (both p < 0.05) Conclusion: Short-term results demonstrated that PFMT with and without VT exercises had similar effectiveness on the symptoms of SUI and QoL. [ABSTRACT FROM AUTHOR]

Introduction Accidental urine leakage is a distressing problem that affects around one in three women. The main types of urinary incontinence (UI) are stress, urgency and mixed, with stress being most common. Current UK guidelines recommend that women with UI are offered at least 3 months of pelvic floor muscle training (PFMT). There is evidence that PFMT is effective in treating UI, however it is not clear how intensively women have to exercise to give the maximum sustained improvement in symptoms, and how we enable women to achieve this. Biofeedback is an adjunct to PFMT that may help women exercise more intensively for longer, and thus may improve continence outcomes when compared with PFMT alone. A Cochrane review was inconclusive about the benefit of biofeedback, indicating the need for further evidence. Methods and analysis This multicentre randomised controlled trial will compare the effectiveness and costeffectiveness of PFMT versus biofeedback-mediated PFMT for women with stress UI or mixed UI. The primary outcome is UI severity at 24 months after randomisation. The primary economic outcome measure is incremental cost per quality-adjusted life-year at 24 months. Six hundred women from UK community, outpatient and primary care settings will be randomised and followed up via questionnaires, diaries and pelvic floor assessment. All participants are offered six PFMT appointments over 16 weeks. The use of clinic and home biofeedback is added to PFMT for participants in the biofeedback group. Group allocation could not be masked from participants and healthcare staff. An intention-to-treat analysis of the primary outcome will estimate the mean difference between the trial groups at 24 months using a general linear mixed model adjusting for minimisation covariates and other important prognostic covariates, including the baseline score. Ethics and dissemination Approval granted by the West of Scotland Research Ethics Committee 4 (16/ LO/0990). Written informed consent will be obtained from participants by the local research team. Serious adverse events will be reported to the data monitoring and ethics committee, the ethics committee and trial centres as required. A Standard Protocol Items: Recommendations for Interventional Trials checklist and figure are available for this protocol. The results will be published in international journals and included in the relevant Cochrane review. [ABSTRACT FROM AUTHOR]

Introduction Female urinary incontinence (UI) is common affecting up to 45% of women. Pelvic floor muscle training (PFMT) is the first-line treatment but there is uncertainty whether intensive PFMT is better than basic PFMT for long-term symptomatic improvement. It is also unclear which factors influence women's ability to perform PFMT long term and whether this has impacts on long-term outcomes. OPAL (optimising PFMT to achieve long-term benefits) trial examines the effectiveness and cost-effectiveness of basic PFMT versus biofeedback-mediated PFMT and this evaluation explores women's experiences of treatment and the factors which influence effectiveness. This will provide data aiding interpretation of the trial findings; make recommendations for optimising the treatment protocol; support implementation in practice; and address gaps in the literature around long-term adherence to PFMT for women with stress or mixed UI. Methods and analysis This evaluation comprises a longitudinal qualitative case study and process evaluation (PE). The case study aims to explore women's experiences of treatment and adherence and the PE will explore factors influencing intervention effectiveness. The case study has a two-tailed design and will recruit 40 women, 20 from each trial group; they will be interviewed four times over 2 years. Process data will be collected from women through questionnaires at four time-points, from health professionals through checklists and interviews and by sampling 100 audio recordings of appointments. Qualitative analysis will use case study methodology (qualitative study) and the framework technique (PE) and will interrogate for similarities and differences between the trial groups regarding barriers and facilitators to adherence. Process data analyses will examine fidelity, engagement and mediating factors using descriptive and interpretative statistics. Ethics and dissemination Approval from West of Scotland Research Ethics Committee 4 (16/LO/0990). Findings will be published in journals, disseminated at conferences and through the final report. [ABSTRACT FROM AUTHOR]

Aims/Introduction: To investigate the effect of endurance training on hippocampus DJ‐1 and cannabinoid receptor type 2 (CB2) protein and blood glucose concentration in diabetic rats. Materials and Methods: A total of 32 rats were randomly divided into diabetic (D), diabetic and exercise (DE), exercise (E) and control (C) groups. The endurance training was carried out five times per week for 6 weeks. The hippocampus DJ‐1 and CB2 were measured using an enzyme‐linked immunosorbent assay method. Results: The level of DJ‐1 in the D group was significantly higher than the other groups (P ≤ 0.01). However, the level of DJ‐1 was not significantly different between the C, E and DE groups. In addition, the level of CB2 was significantly lower in the D group compared with the other groups (P ≤ 0.01). Blood glucose was significantly higher in the D group compared with the DE group (P ≤ 0.05). Furthermore, a significant positive correlation between the level of DJ‐1 and blood glucose was observed (r = 0.67, P ≤ 0.001). There was also a significant inverse correlation between the level of CB2 and blood glucose (r = −0.77, P ≤ 0.001). Conclusions: The results of this study suggest that the level of DJ‐1 and CB2 might change in response to diabetes, and regular aerobic exercise could mediate the effect of DJ‐1 and CB2 on diabetes‐induced neurodegenerative diseases. Diabetes may change the levels of DJ‐1 and CB2. These two proteins may play an important role in neural health in diabetic patients. Regular physical activity may reduce the negative effect of high blood glucose on the level of DJ‐1 and CB2. [ABSTRACT FROM AUTHOR]

Stress urinary incontinence (SUI) is a little-discussed but perhaps surprisingly common condition in elite athletes involved in high-impact sports. This article discusses the possible causes of SUI (which is more complex than simply weak pelvic floor muscles), methods of SUI assessment and the various options for therapy. This will enable you to tailor a training regimen to suit your patient and create the best chances of a successful outcome, allowing your client to continue their sport with confidence and dignity. [ABSTRACT FROM AUTHOR]

Aims: To characterize levator ani muscle (LAM) activity in nulligravidas using magnetomyography (MMG) and define MMG characteristics associated with LAM activity with and without accessory muscle contributions. Methods: MMG data were collected from eight nulligravidas during rest and voluntary LAM contractions (Kegels) of varying intensity. We utilized simultaneous vaginal manometry and surface electromyography (sEMG) to evaluate for accessory muscle recruitment. Moderate Kegel (MK) MMG trials were sub‐selected based on the presence or absence of accessory muscle interaction. Amplitude and spectral‐related indicators were calculated across MK epochs: root‐mean square (RMS) amplitude, percentage amplitude relative to rest, and relative power spectrum density (rPSD) in three frequency bands (low, middle, high). Ternary diagram characterized rPSD from selected Kegels and ROC analysis was performed to identify cut‐points to differentiate MKs from interacting MKs. Results: Nineteen MMG recordings were obtained. Amplitude and spectral parameters were significantly different between isolated and interacting MK epochs. Mean RMS and power values of the isolated MK were, respectively, 120.66 ± 43.8 fT and 1.72 ± 1.44 (T2/Hz)*10−28. Amplitudes of MK were 64% and 117 higher than baseline activities for the isolated and interacting epochs, respectively. ROC curves reveled cut‐off points on low and middle frequency bands that achieved perfect separation (ROC‐AUC = 1.0) between isolated and interacting MK. Conclusions: Our study demonstrates that MMG, a novel biomagnetic technique, allows precise detection and characterization of normal female pelvic floor function. Results show that isolated moderate voluntary contraction of the LAMs produces distinct MMG amplitude and spectral characteristics compared with Kegels involving co‐activation of other muscle groups. [ABSTRACT FROM AUTHOR]

Introduction: Complex functional movements such as jumping typically provoke stress urinary incontinence (SUI) in women. The aim of this study was to investigate pelvic floor muscle (PFM) activity in young, healthy women during jumps to explore their activity characteristics.Methods: Surface electromyography (EMG) from PFMs was measured in 16 healthy women with a tripolar vaginal probe during drop landings from heights of 15, 30 and 45 cm (DL 15, 30, 45) as well as during mini-trampolining with a pace of 90 and 75 jumps per minute (MT 90, 75). Time of foot strike and body weight force (BWF) in % (= ground reaction force, normalised to body weight) was determined by force plates. Root mean square values of the EMG signals were analyzed from 30 ms before to 150 ms after foot strike. Peak activity during maximum voluntary contraction (MVC) was set as 100% for EMG normalization. The PFM onset threshold was determined as the mean of rest activity plus 2 standard deviations. Data were analysed with non-parametric statistical methods.Results: EMG activity during all jumps was above the PFM onset threshold. Mean pre- and reflex activity increased significantly with jumping height (p < 0.05) as well as with increasing BWF. The PFM activation pattern of DL was with peak activity of 115-182 %MVC between 34 and 44 ms after foot strike, which was different from MT with peak PFM activity of 85-115 %MVC reached at 133 ms.Conclusions: Jumping and mini-trampolining provoked significant PFM activity in healthy volunteers. The next research step will be to examine the PFM activity of women suffering from SUI during jumps. [ABSTRACT FROM AUTHOR]

Pelvic floor muscle training programs are the recommended first-line treatment for urinary incontinence; however, research reports and clinical guidelines reveal incomplete reporting of program elements. To explore the experiences and information needs of clinicians who recommend pelvic floor muscle training for continence management, data were collected from focus groups, and interviews and a themed analysis was undertaken. Participants were recruited from among physiotherapists and continence nurses with Australian Health Practitioner Registration Agency registration. Recruitment occurred until saturation/data adequacy was reached. Twenty-eight physiotherapists and one continence nurse consented to participate. The main findings were that clinicians drew on research evidence, experts, and experiential learning but need research reports and clinical guidelines to incorporate more detail about pelvic floor muscle training regimens. Perceived barriers included: inadequate exercise program details; limited access to evidence; default to exercise physiology; time constraints; and consumer beliefs. Perceived enablers included: pelvic floor muscle training-specific cues; "expert" status; clinical reasoning skills; mentorship; individualised programs; and consumer opportunity. Pelvic floor exercises can improve incontinence and are most effective when clinicians use evidence-based practice. Clinicians reported difficulty interpreting inadequately reported programs but suggested solutions to overcome perceived barriers. These included: comprehensive reporting of exercises, a "bank" of verbal prompts/cues and improved access to pelvic floor muscle training evidence. Clinicians who use pelvic floor muscle training for the treatment of urinary incontinence would benefit from explicit details of the interventions found to be effective in research. [ABSTRACT FROM AUTHOR]

Aims: The experiences and information needs of clinicians who use pelvic floor muscle training to manage urinary incontinence were explored. Methods: Qualitative methods were used to conduct thematic analysis of data collected from clinician focus groups and interviews. Participants were registered physiotherapists and continence nurses in Melbourne, Australia. Recruitment was through a combination of purposive and "snowball" sampling and continued until data adequacy was reached. Results: Twenty‐eight physiotherapists and one continence nurse participated in seven focus groups and one interview. The main finding communicated by the participants was that pelvic floor muscle training requires comprehensive descriptions of program details in order for clinicians to implement evidence‐based interventions. The following themes were identified: (1) pelvic floor muscle training tailored to the needs of each individual is essential; (2) training‐specific cues and verbal prompts assist patients to learn and engage with exercises; and (3) clinicians can benefit from research summaries and reports that provide explicit and comprehensive descriptions and decision rules about intervention content and progression. The data indicated that some clinicians can have difficulty interpreting and applying research findings because it is not always well reported. Conclusions: Clinicians who use pelvic floor muscle training to treat urinary incontinence advised can benefit from accessing explicit details of interventions tested in research and reported as effective. They viewed tailoring therapy to individual goals and the use of verbal prompts and visualization cues as important engagement strategies for effective exercise performance. Explicit reporting could be facilitated by using an exercise guideline template, such as the Consensus on Exercise Reporting Template (CERT). [ABSTRACT FROM AUTHOR]

Abstract: Aim: Parity and age are risk factors for urinary incontinence (UI). The aim of this study was to compare grand multipara women (GMP) to non‐grand multipara (NGMP) women concerning UI types (stress urinary incontinence [SUI], urge urinary incontinence [UUI]), symptoms, and quality of life. Methods: This correlation–comparative study used three tools: a demographic/health questionnaire, Questionnaire for Urinary Incontinence Diagnosis (QUID), and Incontinence Quality of Life (I‐QOL). Results: The sample included 132 women, from 50–88 years of age: 65 NGMP women (mean age: 67.23 years) and 67 GMP women (mean age: 65.04 years). The GMP group had a higher score, compared to the NGMP group, for UI type (by QUID) and a lower QOL (by I‐QOL) , with none of the scores found to be statistically significant. By dividing the sample into age groups, 50–59 and ≥60 years, the interaction between the parity and the age groups was found to be significant for both the SUI and UUI. Conclusion: The innovation of this study is the in‐depth insight into the association between parity and age regarding UI type. [ABSTRACT FROM AUTHOR]

Introduction: New methods of conservative treatment of female stress urinary incontinence are needed. We investigated whether superimposed vibration mechanosignals during Kegel exercises could reduce the amount of urinary leakage after 4 and 6 weeks of training.Material and Methods: Sixty women with stress urinary incontinence were included in this prospective cohort study. Vibration mechanosignals were superimposed during Kegel exercises using an intravaginal device. Each training session consisted of 15 maximal contractions of pelvic floor muscles for 5 s. The women performed training (5 min/day) at home for 4 (n = 60) and 6 (n = 36) weeks. Urine leakage (g) during stress test with standardized bladder volume, and contraction force without and with superimposed mechanical stimulations were measured at inclusion (T0 ), and after 4 (T2 ) and 6 (T3 ) weeks of training using an intravaginal device. Incontinence Questionnaire-Short Form was recorded at T0 , and in a sub-cohort of women (n = 36) at 2 years follow up.Results: Mean urine leakage reduced significantly from 20.5 (± 12.2) g at T0 to 4.8 (± 6.7) g at T2 and 1.5 (± 6.7) g at T3 . After 4 and 6 weeks of training, urinary leakage was ≤ 4 g on stress test in 44 and 49 of the 60 women, respectively. At T0 , the mean Incontinence Questionnaire-Short Form score was 13 (± 2.4), and at 2 years follow up, the score was 6.3 (± 3.75).Conclusions: Superimposed mechanical stimulation with Kegel exercises significantly reduced urinary leakage in women with stress urinary incontinence. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Academic Research in Nursing (JAREN) is the property of Hemsirelikte Egitim ve Arastirma Dergisi 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.)

Introduction and hypothesis: Urinary incontinence is a common condition in women, with a reported prevalence ranging from 25% to 51%. Of these women, an estimated 38% suffer from stress urinary incontinence (SUI). A European research consortium is investigating an innovative system based on information and communication technology for the conservative treatment of women with SUI. When introducing a new intervention, implementation barriers arise and need to be identified. Therefore, we investigated healthcare providers' experience with and attitude towards innovative care options. Methods: We performed an online survey to assess (1) the characteristics and practice of healthcare providers, (2) current protocols for SUI, (3) current use of biofeedback, and (4) knowledge about serious gaming. The survey was sent to members of professional societies in Europe (EUGA), UK (BSUG) and The Netherlands (DPFS). Results: Of 341 questionnaires analyzed (response rate between 18% and 30%), 64% of the respondents had access to a protocol for the treatment of SUI, and 31% used biofeedback when treating patients with SUI. However, 92% considered that biofeedback has a clear or probable added value, and 97% of those who did not use biofeedback would change their practice if research evidence supported its use. Finally, 89% of respondents indicated that they had no experience of serious gaming, but 92% considered that it could be useful. Conclusions: Although inexperienced, European urogynecologists and physical therapists welcome innovative treatment options for the conservative treatment of SUI such as portable wireless biofeedback and serious gaming. Scientific evidence is considered a prerequisite to incorporate such innovations into clinical practice. [ABSTRACT FROM AUTHOR]

Objective To assess the effectiveness of intravaginal pressure biofeedback (P-BF) and perineal electromyographic biofeedback (EMG-BF) assisted pelvic floor muscle (PFM) exercises in women with stress urinary incontinence (SUI). Material and Methods Fifty-three women with SUI were randomized into three groups as follows: the Group 1 received PFM home exercise program alone ( n:18); the Group 2 received PFM home exercise program plus intravaginal P-BF assisted PFM exercise program ( n:17); and the Group 3 received PFM home exercise program plus perineal EMG-BF assisted PFM exercise program ( n:18). Subjects were also assessed with the 1-h pad test (severity of incontinence), perineometer (PFM strength), social activity index (SAI), IIQ7 (quality of life associated with incontinence), treatment success (cure and improvement rate) and treatment satisfaction. Results A statistically significant improvement was found in all parameters for all groups at 4th week and 8th week compared to the baseline values. It was found that severity of incontinence, PFM strength, and SAI scores were significantly improved in both BF groups compared to the Group 1 at 8th week. Also, statistically higher cure and improvement rate and treatment satisfaction values were detected in both BF groups compared to the Group 1. There was no statistically significant difference between Group 2 and Group 3 in all parameters evaluated at the follow-up period. Conclusions We conclude that both the home exercises plus intravaginal P-BF and home exercises plus perineal EMG-BF are superior to home exercises in women with SUI. Intravaginal P-BF and perineal EMG-BF were similarly effective and they can be used as their alternatives. [ABSTRACT FROM AUTHOR]

AIMS To test if biofeedback (BF) added to pelvic floor muscle training (PFMT) increases the frequency of home exercises performed by women with stress urinary incontinence (SUI). METHODS 72 incontinent women were randomized to BF (outpatient BF + home PFMT) or PFMT (outpatient PFMT + home PFMT) groups. Assessments: baseline, after 3 months of supervised treatment, at 9-month follow-up (after six additional months of home PFMT only). Primary outcome: frequency of monthly exercises sets performed (exercise diary) after 3-month treatment. Secondary outcomes: adherence, urinary symptoms, severity and cure of SUI (pad test <2 g leakage), muscle function, quality of life, and subject cure (satisfaction report with no desire for different treatment) at the two time-points. Statistical analyses: ANOVA and Student's t-test with 5% cut-off for significance. RESULTS It was observed similar frequency of monthly home exercises sets performed by BF (67.9 out of 82) and PFMT (68.2 out of 82) groups at 3 months. Secondarily, equal satisfaction, but superior objective cure of SUI for BF group after 3-month treatment ( P = 0.018; OR: 3.15 [95% CI: 1.20-8.25]). At 9-month follow-up, the adherence to home exercises was similar (around 50%) and significantly dropped in both groups compared to the 3-month results (around 85%). No difference was detected in the objective and subjective cure of SUI between the groups after 9 months. Both therapies similarly improved the muscle function and quality of life during the study ( P < 0.005). CONCLUSIONS Adjunct BF did not increase the frequency of home exercises performed by SUI patients. [ABSTRACT FROM AUTHOR]

Importance: Urinary incontinence, the involuntary loss of urine, is a common health condition that may decrease quality of life. Ten to twenty percent of women and up to 77% of women residing in nursing homes have urinary incontinence, yet only 25% seek or receive treatment.Observations: This review summarizes the evaluation and therapeutic options for women affected by urinary incontinence. The initial assessment should focus on understanding the effect of incontinence on quality of life, the patient's goals and preferences for treatment, the results of previous treatments, and the presence of concomitant conditions, such as advanced pelvic organ prolapse, that may require referral. Infection and hematuria need to be ruled out. In the absence of urinary infection or serious underlying pathology (such as cancer or serious neurologic disease) associated with urinary incontinence, the clinician should initiate unsupervised pelvic muscle exercises and lifestyle modifications appropriate to the patient to reduce her symptoms. These recommendations can include weight loss, adequate hydration, avoidance of excessive fluids, and regular voiding intervals that reduce urgency incontinence episodes. Urgency incontinence medications, with timely reassessment of symptoms, can be started without extensive evaluation. Specialist treatments for urgency incontinence include onabotulinumtoxinA and percutaneous or implanted neuromodulators. Stress incontinence surgery, the midurethral sling, is associated with symptom improvement in 48% to 90% of women and has low rates of mesh complications (<5%).Conclusions and Relevance: Urinary incontinence is common in women, although few seek care despite many effective treatment options. Clinicians should prioritize urinary incontinence detection, identify and treat modifiable factors, incorporate patient preference into evaluation and treatment, initiate conservative and medical therapy, and refer to specialists when underlying pathology is identified or conservative measures are ineffective. [ABSTRACT FROM AUTHOR]

Introduction: We investigated the long-term effects of using a mobile app to treat stress urinary incontinence with a focus on pelvic floor muscle training.Material and Methods: A previous randomized controlled trial of 123 women aged 27-72 years found that three months of self-managing stress urinary incontinence with support from the Tät® app was effective. We followed up the women in the app group (n = 62) two years after the initial trial with the same primary outcomes for symptom severity (International Consultation on Incontinence Questionnaire Short Form) and condition-specific quality of life (ICIQ-Lower Urinary Tract Symptom Quality of Life) and compared the scores with those at baseline.Results: Of the 62 women, 61 and 46 (75.4%), respectively, participated in three-month and two-year follow-ups. Baseline data did not differ between responders and non-responders at follow-up. The mean decreases in International Consultation on Incontinence Questionnaire Short Form and ICIQ-Lower Urinary Tract Symptom Quality of Life scores after two years were 3.1 (95% confidence interval 2.0-4.2) and 4.0 (95% confidence interval 2.1-5.9), respectively. Of the 46 women, four (8.7%) rated themselves as very much better, nine (19.6%) as much better, and 16 (34.8%) as a little better. The use of incontinence protection products decreased significantly (p = 0.04), and the proportion of women who felt they could contract their pelvic muscles correctly increased from 14/46 (30.4%) at baseline to 31/46 (67.4%) at follow-up (p < 0.001).Conclusions: Self-management of stress urinary incontinence with support from the Tät® app had significant and clinically relevant long-term effects and may serve as first-line treatment. [ABSTRACT FROM AUTHOR]

AimThis study aimed to explore, describe and enhance understanding of women’s experiences, beliefs and knowledge of urinary symptoms in the postpartum period and also sought to understand the perceptions of health professionals of these issues.BackgroundWomen often take no action with regard to urinary symptoms particularly in the postnatal period, which can lead to the adoption of coping mechanisms or normalisation of symptoms. The true prevalence is difficult to assess due to differing age groups and time spans in studies. There is only a small body of work available to try to understand the lack of action on the part of the women, and even less around the attitudes of health professionals.MethodsGrounded theory was selected for a qualitative inductive approach, to attempt to understand the social processes involved and generate new knowledge by examining the different interactions. Recruitment was by theoretical sampling. In total, 15 women were interviewed and two focus groups of health professionals were undertaken. In addition, an antenatal clinic and a postnatal mothers group were observed. All information was analysed manually using constant comparison.FindingsThe findings revealed that at times poor communication, lack of clear education and the power of relative’s stories of the past were barriers to help seeking, and were disempowering women, creating a climate for normalisation. Women were willing to talk but preferred the health professional to initiate discussion. In addition, health professionals were concerned about a lack of time and knowledge and were uncertain of the effect of pelvic floor muscle exercises due to some research indicating improvement may not be maintained over time. The core category was; ‘overcoming barriers to facilitate empowerment’, indicating that improving communication and education could reduce barriers and enable them to seek help. [ABSTRACT FROM PUBLISHER]

There is increasing attention and concern about managing the adverse effects of adjuvant endocrine therapy for women with early breast cancer as the side effects of therapy influence compliance and can impair quality of life (QoL). Most side effects associated with tamoxifen (TAM) and aromatase inhibitors (AIs) are directly related to estrogen deprivation, and the symptoms are similar to those experienced during natural menopause but appear to be more severe than that seen in the general population. Prolonged estrogen deprivation may lead to atrophy of the vulva, vagina, lower urinary tract and supporting pelvic structures, resulting in a range of genitourinary symptoms that can in turn lead to pain, discomfort, impairment of sexual function and negatively impact on multiple domains of QoL. The genitourinary side effects may be prevented, reduced and managed in most cases but this requires early recognition and appropriate treatment. We provide an overview of practical clinical approaches to understanding the pathophysiology and the management of genitourinary symptoms in postmenopausal women receiving adjuvant endocrine therapy for breast cancer. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: Urinary Incontinence (UI) in women is a condition that becomes more common with age. Pelvic floor muscle training (PFMT) is recommended as a first option of treatment for women with symptoms of stress urinary incontinence (SUI), mixed urinary incontinence (MUI), and for some with symptoms of urge urinary incontinence (UUI). PFMT can be performed in groups, individually, and at home, and there is no consensus as to which of the approaches is more efficient for the conservative treatment of UI. The objective was to perform a systematic review comparing the effects of group PFMT vs individual or home training in the treatment of women with UI. Methods: Cochrane's recommendations for systematic reviews were followed. The inclusion criteria were that the studies had been carried out in adult women who suffered from UI and who underwent PFMT in a group. Results: Ten studies that fit the criteria previously mentioned were included in this systematic review. The meta-analysis showed that there was no difference when comparing PFMT in groups vs individual PFMT. However, when comparing PFMT in groups vs PFMT at home, the group intervention was more efficient in the treatment of UI. Conclusion: PFMT is an efficient technique for the improvement of the symptoms of female UI. When PFMT was supervised by a physiotherapist, no significant difference was noted when comparing group with individual approaches. [ABSTRACT FROM AUTHOR]

Copyright of Der Gynäkologe 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.)

Aim: Prostatitis is an inflammation of the prostate tissue, its swelling. This term defines the inflammation of the prostate gland. Prostatitis can develop only in men. According to statistics, over the past 20 years the incidence of prostatitis increased about twice, and now, it suffers from almost half the world's population of men aged 20 to 50 year. The purpose of the present study was to design of booklet about all information of Kegel exercises by Arabic language as ahealthawarenessprogram from prostatitis. Methods: Ten Urologists (a doctor who specializes in diseases of the urinary tract and the male reproductive system) from faculty of medicine and ten personal trainers (Clinical experience years23.8 +/- 3.9 years) participated in this studyas an experts. The suggested booklet contain primary information's about nature of the disease, causes, symptoms, and Kegel exercises. All experts suggested and put their opinion into the booklet. Results: The data revealed that booklet is good, and all experts constant about the important of the Kegel exercises and contents of the booklet. Conclusions: The findings indicated that almost all studies, the positive effects of physical therapy on urge urinary incontinence (UUI). These results have to be taken into account by health ministry in order to better understand and implicated of these concepts in health awareness. [ABSTRACT FROM AUTHOR]

Aims To evaluate differences in motor learning of pelvic floor muscle (PFM) contraction between women with and without stress urinary incontinence (SUI) under transabdominal ultrasonography (TAUS)-guided PFM training. Methods Postpartum women received an intensive 3-month PFM training program from 3 to 6 months postpartum. The program consisted of home exercises and weekly group sessions with individual TAUS-guided training. Motor learning progress of PFM contraction was evaluated with TAUS at each weekly session. We regarded a woman who contracted her PFM correctly more than 9 times out of the 10 repetitions as having achieved the associative stage of motor learning. Women were evaluated before and after a 12-week intervention for PFM and SUI by using transperineal ultrasonography and questionnaire, respectively. Results Seventy-three women were included: 44 primiparous women (60.3%) and 64 vaginal deliveries (87.7%). Of 73 women, 22 (30.1%) were classified as the SUI group. By the fifth session, the proportion of women who could correctly contract their PFM > 9 out of the 10 repetitions had increased significantly more in the non-SUI group than in the SUI group (90.0% vs. 58.8%, P = 0.011). The proportion of women achieving the associative stage of correct PFM contraction was not different between the two groups after the sixth session. PF morphology and SUI were improved after intervention ( P < 0.05). Conclusions The proportion of women achieving the associative stage in women with SUI was less than that in women without SUI in the early phase of the combination of group and home PFM training with TAUS-guided training. Neurourol. Urodynam. 36:98-103, 2017. © 2015 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Overactive bladder (OAB) is a common condition affecting millions of men and women worldwide. It is an embarrassing condition with far-reaching consequences. Although many treatment options exist, no single treatment has been proven to be most effective. Often a combination of therapy is required to successfully manage OAB symptoms. In this review, we provide an overview of OAB, including risk factors for development of OAB; keys to diagnosis; therapeutic options including conservative and medical management, as well as treatments for refractory OAB; when to consider referral to a specialist; and resources for clinicians and patients. The aim of this review is to inform clinicians regarding OAB management in order to improve patient counseling and care. [ABSTRACT FROM AUTHOR]

The RELAX trial studied the efficacy of intra‐detrusor onabotulinum toxin A (onaBoNTA) for the treatment of detrusor overactivity (DO) in women. Our objectives in this study were to explore patients' experience and understanding of taking part in a randomised controlled trial (RCT) and their experience of the treatment itself. In addition we explored how patients felt about their bladder problem prior to treatment, conservative management strategies they had been offered, and anti‐muscarinic treatment. Purposive sampling was used to interview patients who had successful and unsuccessful outcomes. Interviewers were blinded to this sampling. Semi‐structured telephone interviews were conducted with all recruited women. Analysis was using a grounded theory approach. Transcripts were analysed thematically based on a constant comparative method until the point of data saturation, that is no new themes were identified. Fifteen women in total were interviewed. There were eight global themes identified. These were: quality of life, conservative management, study awareness, reasons for participation, role of the media, the extension study, intervention and experience of a RCT. The impact of overactive bladder (OAB) symptoms was a strong theme leading to feelings of anxiety. All of the women interviewed perceived pelvic floor exercises as a short term plan. Compliance was sporadic and most discontinued because of lack of efficacy. All women had been counselled about the risk of voiding dysfunction after onaBoNTA treatment and women found the actual process of being taught clean intermittent self‐catheterisation by another woman difficult, Patients stated they felt embarrassed and traumatised by the experience. OnaBoNTA is an effective treatment for patients with DO whose disease burden is considerable. This work highlights the value of incorporating qualitative research methods into the design of RCTs particularly when dealing with surgical procedures. [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]

There are many options for nonsurgical management of stress urinary incontinence (SUI). With the growing aging population, there is increased incontinence and need for less invasive options for SUI treatment. Conservative strategies have long been a fundamental part of treatment and may be the only management required or only management possible in some patients. Lifestyle modification, anti-incontinence devices, and pelvic floor muscle exercises benefit a significant number of patients. This may be performed, with or without the addition of vaginal weighted cones or biofeedback. Pharmacological treatment exists, yet is not considered a standard of care. This is a comprehensive review of the non-surgical treatment options for SUI. [ABSTRACT FROM AUTHOR]

Objective: Evaluate effect of pelvic floor muscle training (PFMT) on vaginal symptoms and sexual matters, dyspareunia and coital incontinence in primiparous women stratified by major or no defects of the levator ani muscle.Design: Randomised controlled trial (RCT).Setting: Akershus University Hospital, Norway.Sample: About 175 primiparous women with a singleton vaginal delivery.Methods: Two-armed assessor blinded parallel group RCT from 6 weeks to 6 months postpartum comparing effect of PFMT versus control.Main Outcome Measures: International Consultation on Incontinence Modular Questionnaire-vaginal symptoms questionnaire (ICIQ-VS) and ICIQ sexual matters module (ICIQ-FLUTSsex).Results: Overall, analysis (n = 175) showed no difference between training and control groups in women having vaginal symptoms or symptoms related to sexual dysfunction 6 months postpartum. The majority of women (88%) had intercourse and there was no difference between groups. Unadjusted subgroup analysis of women with a major defect of the levator ani muscle (n = 55) showed that women in the training group had 45% less risk of having the symptom 'vagina feels loose or lax' compared with the control group (relative risk 0.55, 95% confidence interval 0.31, 0.95; P = 0.03).Conclusions: Unadjusted analysis showed that in women with major defect of the levator ani muscle, significantly fewer in the training group had the symptom 'vagina feels loose or lax' compared with the control group. No difference was found between groups for symptoms related to sexual dysfunction. More studies are needed to explore effect of PFMT on vaginal symptoms and sexual dysfunction.Tweetable Abstract: Unadjusted analysis shows that PFMT might prevent symptoms of 'vagina feels loose or lax'. [ABSTRACT FROM AUTHOR]

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Objectives To determine the feasibility and acceptability of traditional Chinese medicine (TCM) acupuncture and pelvic floor muscle training (PFMT) in reducing symptoms and bothersomeness in women with mixed urinary incontinence (MUI); and to estimate the sample size for a full scale trial. Methods Thirty-four women with MUI were randomly assigned to either 12 sessions of TCM acupuncture, 12 sessions of PFMT, or to a waiting list control group. Outcome measures included an assessment of interest to participate in the trial, identification of successful recruitment strategies, the appropriateness of eligibility criteria, and compliance with treatment. Clinical outcomes were assessed at baseline and 12 weeks, and included the International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form (ICIQ-UI SF), expectations of treatment effect, and adverse events. Results Recruitment was feasible and randomisation worked adequately by means of SurveyMonkey. SurveyMonkey does not permit stratification by ICIQ-UI SF baseline score. Fourteen of 22 women found the treatment options acceptable. The dropout rate was high, especially in the control group (6/12). Outcome forms were completed by 20 of 34 women. The median (IQR) changes of the ICIQ-UI SF scores in the acupuncture, physiotherapy, and waiting list group were 5.5 (2.3 to 6.8), 1.0 (-3.0 to 4.5), and 1.5 (-1.5 to 3.0), respectively, suggesting the need for a full scale trial. Conclusions Women with MUI were willing to participate in this study. There is a need for adjusting eligibility criteria. A sample size of 129 women, 43 in three arms, is required. No major adverse events occurred. [ABSTRACT FROM AUTHOR]

The objective of the article is to review key guidelines on the management of urinary incontinence (UI) to guide clinical management in a practical way. Guidelines produced by the European Association of Urology (updated in 2014), the Canadian Urological Association (updated in 2012), the International Consultation on Incontinence (updated in 2012), and the National Collaborating Centre for Women's and Children's Health (updated in 2013) were examined and their recommendations compared. In addition, specialised guidelines produced by the collaboration between the American Urological Association and the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction on overactive bladder and the use of urodynamics were reviewed. The Appraisal of Guidelines for Research and Evaluation II (AGREE) instrument was used to evaluate the quality of these guidelines. There is general agreement between the groups on the recommended initial evaluation and the use of conservative therapies for first-line treatment, with a limited role for imaging or invasive testing in the uncomplicated patient. These groups have greater variability in their recommendations for invasive procedures; however, generally the mid-urethral sling is recommended for uncomplicated stress UI, with different recommendations on the approach, as well as the comparability to other treatments, such as the autologous fascial sling. This 'Guideline of Guidelines' provides a summary of the salient similarities and differences between prominent groups on the management of UI. [ABSTRACT FROM AUTHOR]

Objectives To evaluate the long-term effects of two non-face-to-face treatment programmes for stress urinary incontinence ( SUI) based on pelvic floor muscle training ( PFMT). Subjects and Methods The present study was a randomized controlled trial with online recruitment of 250 community-dwelling women aged 18-70 years with SUI ≥ one time/week. Diagnosis was based on validated self-assessed questionnaires, 2-day bladder diary and telephone interview with a urotherapist. Consecutive computer-generated block randomization was carried out with allocation by an independent administrator to 3 months of treatment with either an internet-based treatment programme ( n = 124) or a programme sent by post ( n = 126). Both interventions focused mainly on PFMT. The internet group received continuous e-mail support from a urotherapist, whereas the postal group trained on their own. Follow-up was performed after 1 and 2 years via self-assessed postal questionnaires. The primary outcomes were symptom severity ( International Consultation on Incontinence Questionnaire Short Form [ ICIQ- UI SF]) and condition-specific quality of life ( ICIQ- Lower Urinary Tract Symptoms Quality of Life [ ICIQ- LUTSqol]). Secondary outcomes were the Patient Global Impression of Improvement, health-specific quality of life ( EQ-visual analogue scale [ EQ- VAS]), use of incontinence aids, and satisfaction with treatment. There was no face-to-face contact with the participants at any time. Analysis was based on intention-to-treat. Results We lost 32.4% (81/250) of participants to follow-up after 1 year and 38.0% (95/250) after 2 years. With both interventions, we observed highly significant ( P < 0.001) improvements with large effect sizes (>0.8) for symptoms and condition-specific quality of life ( Qo L) after 1 and 2 years, respectively. No significant differences were found between the groups. The mean ( sd) changes in symptom score were 3.7 (3.3) for the internet group and 3.2 (3.4) for the postal group ( P = 0.47) after 1 year, and 3.6 (3.5) for the internet group and 3.4 (3.3) for the postal group ( P = 0.79) after 2 years. The mean changes ( sd) in condition-specific Qo L were 5.5 (6.5) for the internet group and 4.7 the for postal group (6.5) ( P = 0.55) after 1 year, and 6.4 (6.0) for the internet group and 4.8 (7.6) for the postal group ( P = 0.28) after 2 years. The proportions of participants perceiving they were much or very much improved were similar in both intervention groups after 1 year (internet, 31.9% [28/88]; postal, 33.8% [27/80], P = 0.82), but after 2 years significantly more participants in the internet group reported this degree of improvement (39.2% [29/74] vs 23.8% [19/80], P = 0.03). Health-specific Qo L improved significantly in the internet group after 2 years (mean change in EQ- VAS, 3.8 [11.4], P = 0.005). We found no other significant improvements in this measure. At 1 year after treatment, 69.8% (60/86) of participants in the internet group and 60.5% (46/76) of participants in the postal group reported that they were still satisfied with the treatment result. After 2 years, the proportions were 64.9% (48/74) and 58.2% (46/79), respectively. Conclusion Non-face-to-face treatment of SUI with PFMT provides significant and clinically relevant improvements in symptoms and condition-specific Qo L at 1 and 2 years after treatment. [ABSTRACT FROM AUTHOR]

Aim: Urinary incontinence is a major health problem among middle‐aged women. Pelvic muscle exercise is one of the primary interventions, but difficulty performing this exercise has led researchers to seek alternative or conjunctive exercise. This study aimed to examine the effect of a combined pelvic muscle exercise and yoga intervention program on urinary incontinence. Methods: A single group pre‐/post‐test design was used. Subjects were recruited from a community health center in Seoul, Korea, and a questionnaire survey was conducted. Fifty‐five women participated in the first day of the program, 34 of whom completed the 8 week, twice weekly intervention program. Urinary incontinence was measured by five domains of urinary tract symptoms: filling factor, voiding factor, incontinence factor, sexual function, and quality of life. Also measured were attitude toward pelvic muscle exercise and pelvic muscle strength. Results: Significant improvements were found in attitude toward pelvic muscle exercise, pelvic muscle strength, and incontinence factor. Daily performance of pelvic muscle exercise was positively correlated with improved incontinence factor and with quality of life related to urinary tract symptoms. Conclusion: A combined pelvic muscle exercise and yoga program was effective for improving overall urinary incontinence in community health center attendees in Korea. Further study is needed with a control group, different populations, and a longer intervention period. [ABSTRACT FROM AUTHOR]

Aims This review aims to locate and summarize the findings of qualitative studies exploring the experience of and adherence to pelvic floor muscle training (PFMT) to recommend future directions for practice and research. Methods Primary qualitative studies were identified through a conventional subject search of electronic databases, reference-list checking, and expert contact. A core eligibility criterion was the inclusion of verbatim quotes from participants about PFMT experiences. Details of study aims, methods, and participants were extracted and tabulated. Data were inductively grouped into categories describing 'modifiers' of adherence (verified by a second author) and systematically displayed with supporting illustrative quotes. Results Thirteen studies (14 study reports) were included; eight recruited only or predominantly women with urinary incontinence, three recruited postnatal women, and two included women with pelvic organ prolapse. The quality of methodological reporting varied. Six 'modifiers' of adherence were described: knowledge; physical skill; feelings about PFMT; cognitive analysis, planning, and attention; prioritization; and service provision. Conclusions Individuals' experience substantial difficulties with capability (particularly knowledge and skills), motivation (especially associated with the considerable cognitive demands of PFMT), and opportunity (as external factors generate competing priorities) when adopting and maintaining a PFMT program. Expert consensus was that judicious selection and deliberate application of appropriate behavior change strategies directed to the 'modifiers' of adherence identified in the review may improve PFMT outcomes. Future research is needed to explore whether the review findings are congruent with the PFMT experiences of antenatal women, men, and adults with fecal incontinence. Neurourol. Urodynam. 34:???-???, 2015. © 2015 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]