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Objective: To investigate how reproductive history was associated with urinary incontinence in midlife. Design: A follow‐up study. Setting: Denmark. Population: A total of 39 977 mothers who participated in the Maternal Follow up (2013–2014) in the Danish National Birth Cohort. National registries provided their reproductive history. Methods: How parity, mode of birth and obstetric tears associated with urinary incontinence were estimated with adjusted odds ratios (OR) and 95% CI using logistic regression. Main outcome measures: Self‐reported urinary incontinence including subtypes stress, urge and mixed urinary incontinence. Results: At an average age of 44 years, the prevalence of any urinary incontinence was 32% (21% stress, 2% urge, and 8% mixed urinary incontinence). Women with two births more often had urinary incontinence than women with one birth (OR 1.20, 95% CI 1.10–1.31). Compared with women with only spontaneous births, a history of only caesarean sections was associated with much lower odds of urinary incontinence (OR 0.39, 95% CI 0.35–0.42) and a history of instrumental births with slightly lower odds (OR 0.92, 95% CI 0.86–0.98). Compared with no tear/first‐degree tear as the largest tear, episiotomy was associated with less urinary incontinence (OR 0.91, 95% CI 0.86–0.97) whereas third/fourth‐degree tears were associated with more (OR 1.14, 95% CI 1.04–1.25). Findings were mainly explained by similar associations with stress and mixed urinary incontinence. Conclusions: Vaginal birth was associated with a higher risk of long‐term urinary incontinence, but our results indicate that this risk may be reduced by shortening the second stage of birth. [ABSTRACT FROM AUTHOR]

Background: Mixed urinary incontinence (MUI) has always represented a major therapeutic challenge and the management of this type of incontinence is often complicated by uncertain outcomes. Surgical options include interventions targeting both stress urinary incontinence (SUI) and urge urinary incontinence (UUI), although there are no international published guidelines that dictate whether it is better to start with surgical management to address the SUI or UUI component after the failure of conservative treatment. The aim of the present study is to evaluate the effectiveness of the Macroplastique (MPQ) procedure on overactive bladder (OAB) symptoms in women with MUI with a minimum follow-up of 1 year. Methods: A retrospective analysis of prospectively collected data was performed in two tertiary reference centers. We enrolled all women complaining of symptoms of SUI and OAB, dry or wet, with a urodynamically confirmed diagnosis of MUI [urodynamic stress incontinence (USI) with detrusor overactivity (DO)], who took a previous ineffective antimuscarinic treatment and underwent the MPQ procedure. We considered as objectively cured women who did not leak urine during the stress test and with a 1 h pad-test negative, while International Consultation on Incontinence Questionnaire–Short Form (ICIQ-SF), ICIQ-OAB, Patient Global Impression of Improvement (PGI-I) scale, and a Visual Analogue Scale (VAS) were used to assess subjective outcomes. Results: A total of forty-six patients who met the inclusion criteria and who underwent the MPQ procedure were considered for the analysis. At the 1-year mark of follow-up, 72% of patients were objectively cured at stress test and 65% were objectively cured at pad-test, while 72% of women declared themselves subjectively cured. OAB symptoms significantly improved after MPQ and a complete resolution of OAB was recorded in 35% of patients. Conclusions: This study demonstrated that MPQ is a safe and effective option for the treatment of female MUI. Furthermore, MPQ significantly improves the symptoms of OAB and is able to completely cure this condition in a relevant percentage of women with MUI when pharmacological treatment fails. [ABSTRACT FROM AUTHOR]

Urinary incontinence (UI), encompassing stress urinary incontinence (SUI) and urge urinary incontinence (UUI), is a prevalent and debilitating condition in patients with multiple sclerosis (MS), profoundly impacting their quality of life. This systematic review and meta-analysis aimed to elucidate the worldwide prevalence rates of SUI and UUI among MS patients. This study was conducted by examining observational studies published between 2000 and 2023. An exhaustive literature search was conducted across databases such as PubMed, MEDLINE, Web of Science, Scopus, ProQuest, and Google Scholar. The Meta-prop method facilitated pooled prevalence estimation of UUI and SUI, while Egger tests assessed publication bias. In total, 27 studies with 15,052 participants were included in the meta-analysis. The findings revealed a high random effect pooled prevalence of UUI at 41.02% (95% Confidence Interval [CI]: 30.57–51.89; I2 = 99%, p < 0.001) and SUI at 25.67% (95% CI: 19.30–32.58%; I2 = 94.9%, P < 0.001). Additionally, the pooled prevalence of mixed urinary incontinence (MUI) was reported at 18.81% (95% CI: 7.55–33.48; I2:95.44%, p < 0.001). The high heterogeneity observed suggests variable prevalence across populations and highlights the intricate nature of UI in MS. These findings underscore the critical need for dedicated supportive, therapeutic, and rehabilitative interventions to manage this common complaint in MS patients effectively. [ABSTRACT FROM AUTHOR]

Male urinary incontinence (UI) is a prevalent yet under-discussed condition that has a significant impact on patient quality of life and social, emotional and physical well-being. UI in men can arise as stress incontinence, urge incontinence, or mixed incontinence depending on the timing and manifestation of urinary leakage. The economic implications of UI are substantial, with UI in men leading to billions in healthcare costs annually in the United States alone. UI is associated with decreased quality of life and depression, particularly among socioeconomically vulnerable populations. For men, this condition can cause emotional and financial distress, affecting quality of life, social reintegration, and professional activities. Addressing the mental health aspects of UI through screening, open communication, and tailored interventions is crucial for improving patient outcomes and quality of life. The diagnostic process for UI begins with a thorough history and physical examination to classify the type and severity, which dictates the treatment approach. Other office-based diagnostic tools can help to accurately characterize symptoms and assess impact on quality of life. For complex cases or when standard diagnostics fail to clarify the condition, referrals to urologic specialists for advanced testing are recommended. Conservative management is always preferred as the first-line therapy for UI, including for stress, urge and mixed incontinence. Medications tend to be more effective and prevalent in the management and treatment for urge incontinence while surgical interventions are likely to give the best outcomes for stress incontinence. Referral to a urologic specialist is often necessitated in complex cases or for surgical treatment of UI. In this study, we provide a comprehensive analysis of male UI, enhance understanding and awareness of the condition, guide management practices to improve patient outcomes, and explore the economic burden and mental health implications of UI in men.

Abstract Objective The underlying mechanisms of Overactive Bladder (OAB) remain unclear. This research is designed to investigate the correlation between the intake of dietary live microorganisms and OAB. Methods This analysis encompasses a cross-sectional study of broad population information gathered from the National Health and Nutrition Examination Surveys (NHANES) spanning the years 2007 to 2018. Participants were categorized into three groups—low, medium, and high—according to their consumption of dietary live microorganisms, as per the Sanders Dietary Active Microbiota Classification System. We utilized a weighted logistic regression model, restricted cubic spline (RCS), and subgroup analyses to investigate the relationship between dietary live microorganism intake and OAB. Results This research encompassed 16,795 subjects. The incidence of OAB was reduced in the group consuming a high amount of live dietary microbes compared to the groups with low and medium intake of such microbes. After detailed adjustments for covariates, analysis revealed that participants in the high live dietary microbe group had notably reduced odds of OAB compared to those in the low live dietary microbe group (OR: 0.84, 95% CI: 0.71–0.99, p = 0.03). RCS analysis indicated a nonlinear correlation between high dietary active microbiota intake and the incidence of OAB. Conclusion This research emphasizes the potential advantages of a high dietary intake of active microbiota for preventing OAB. These findings support incorporating active microbiota into dietary guidelines, demonstrating their connection with a decreased incidence of OAB.

Objective: The underlying mechanisms of Overactive Bladder (OAB) remain unclear. This research is designed to investigate the correlation between the intake of dietary live microorganisms and OAB. Methods: This analysis encompasses a cross-sectional study of broad population information gathered from the National Health and Nutrition Examination Surveys (NHANES) spanning the years 2007 to 2018. Participants were categorized into three groups—low, medium, and high—according to their consumption of dietary live microorganisms, as per the Sanders Dietary Active Microbiota Classification System. We utilized a weighted logistic regression model, restricted cubic spline (RCS), and subgroup analyses to investigate the relationship between dietary live microorganism intake and OAB. Results: This research encompassed 16,795 subjects. The incidence of OAB was reduced in the group consuming a high amount of live dietary microbes compared to the groups with low and medium intake of such microbes. After detailed adjustments for covariates, analysis revealed that participants in the high live dietary microbe group had notably reduced odds of OAB compared to those in the low live dietary microbe group (OR: 0.84, 95% CI: 0.71–0.99, p = 0.03). RCS analysis indicated a nonlinear correlation between high dietary active microbiota intake and the incidence of OAB. Conclusion: This research emphasizes the potential advantages of a high dietary intake of active microbiota for preventing OAB. These findings support incorporating active microbiota into dietary guidelines, demonstrating their connection with a decreased incidence of OAB. [ABSTRACT FROM AUTHOR]

Purpose/Objective: Mixed urinary incontinence (MUI) is the coexistence of stress urinary incontinence (SUI) and urge urinary incontinence (UUI). MUI can be a challenging condition to treat, and there continues to be a demand for successful nonsurgical interventions if possible. This study evaluates the efficacy of combining bipolar radiofrequency (RF) energy to the vaginal canal, electrical muscle stimulation (EMS) of the pelvic floor, and patient education in the treatment of MUI in females. Methods: A prospective study that evaluates RF and EMS in female patients with moderate MUI. RF and EMS treatments were administered three times, 2 weeks apart. Patients were also educated on exactly what MUI is and how to appropriately utilize their pelvic floor muscles. Outcome measures assessed included both objective (cough stress test to measure pad weight) and subjective (Incontinence Quality of Life [iQOL]; Medical, Epidemiological, and Social Aspects of Aging [MESA] Urge Incontinence [UI], MESA Stress Incontinence [SI], Female Sexual Function Index [FsFI]; and Urogenital Distress Inventory-6 [UDI-6]). Results: In total, 31 women underwent the combination of RF, EMS, and patient education, resulting in significant improvement in MUI symptoms (PGI: 82% indicated feeling improvement) after 3 months of treatment in all measures. Conclusion: RF and EMS in conjunction with patient education via a three-treatment protocol was found to be efficacious and safe for treating women with MUI. Future studies should be done to further elucidate optimal treatment protocols for MUI and patients followed up for longer periods of time to determine the durability of this regimen. [ABSTRACT FROM AUTHOR]

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The tibial nerve is an established target for neuromodulation in the management of overactive bladder (OAB) and its associated symptoms, including urge urinary incontinence (UUI). Technologies are currently available to deliver tibial nerve stimulation (TNS) through percutaneous devices or through implantable devices. The benefits and safety of percutaneous TNS have led to it as a guideline-recommended therapy. However, patient compliance is limited by the burden of weekly office visits and the need for maintenance treatments. Further, insurance often only covers a limited number of lifetime visits for percutaneous TNS. These factors and others have led to the development, study, and utilization of implantable TNS devices. Implantable TNS devices deliver the same therapeutic mechanism of action for nerve stimulation with a permanent implanted device that provides at-home stimulation rather than in-office therapy delivery. Additionally, there is an added potential for dynamic and patient-centered stimulation. There is a large body of high-quality evidence published for TNS, including numerous randomized controlled trials published on percutaneous TNS which have consistently demonstrated superior efficacy to sham and similar efficacy to that of anticholinergic medications. Percutaneous TNS also performs better than conservative therapy including pelvic floor muscle training. The percutaneous and implantable approaches deliver nerve stimulation to the same target nerve, using the same mechanism of action. Therefore, data from randomized trials of percutaneous TNS are informative for implantable TNS devices. At the time of this article's publication, at least two implantable TNS devices have received marketing authorization from the Food and Drug Administration (FDA). The objective of this review is to discuss the mechanism of action for TNS and summarize the published literature from clinical trials of percutaneous TNS as a foundation of high-quality evidence for implantable devices targeting the tibial nerve. [ABSTRACT FROM AUTHOR]

Purpose:: To compare qualify of life outcomes in women with mixed urinary incontinence (MUI), urge (UUI) or stress (SUI) urinary incontinence after treatment with an anterior vaginal wall suspension (AVWS) to correct urethral hypermobility and concomitant anterior compartment prolapse (ACP). Methods:: Following IRB approval, a prospective long-term database of women who underwent an AVWS for urinary incontinence (UI) with early stage (stage ≤2) ACP was reviewed. Patients completed the Urogenital Distress Inventory short form (UDI-6 SF) and a one question visual analog scale (VAS) of quality of life (QoL) before and after AVWS. Indication for AVWS was based on demonstrable UI, with documented urethral hypermobility and cystocele on standing lateral cystogram comparing rest and straining views. Three groups (MUI, SUI, and UUI) were analyzed based on urge (Question 2) and stress (Question 3) predominant scores at baseline. Results:: From 1997 to 2018, 104 patients met study criteria: 54 with MUI, 30 SUI predominant, and 20 UUI predominant. Total UDI-6 and QoL scores improved significantly from baseline to 1-year post-AVWS and to the last visit (median 3.5 years) in all three groups. Patients with MUI had the most improvement based on UDI-6 total and QoL scores. Conclusions:: Regardless of the nature of baseline UI symptoms, restoring support of the anterior vaginal wall compartment can durably improve UI-specific quality of life scores in the short and long-term.

We aim to evaluate the incidence of incontinence following laser endoscopic enucleation of the prostate (EEP) comparing en-bloc (Group 1) versus 2-lobe/3-lobe techniques (Group 2). We performed a retrospective review of patients undergoing EEP for benign prostatic enlargement in 12 centers between January 2020 and January 2022. Data were presented as median and interquartile range (IQR). Univariable and multivariable logistic regression analysis was performed to evaluate factors associated with stress urinary incontinence (SUI) and mixed urinary incontinence (MUI). There were 1711 patients in Group 1 and 3357 patients in Group 2. Patients in Group 2 were significantly younger (68 [62–73] years vs 69 [63–74] years, P = 0.002). Median (interquartile range) prostate volume (PV) was similar between the groups (70 [52–92] ml in Group 1 vs 70 [54–90] ml in Group 2, P = 0.774). There was no difference in preoperative International Prostate Symptom Score, quality of life, or maximum flow rate. Enucleation, morcellation, and total surgical time were significantly shorter in Group 1. Within 1 month, overall incontinence rate was 6.3% in Group 1 versus 5.3% in Group 2 (P = 0.12), and urge incontinence was significantly higher in Group 1 (55.1% vs 37.3% in Group 2, P < 0.001). After 3 months, the overall rate of incontinence was 1.7% in Group 1 versus 2.3% in Group 2 (P = 0.06), and SUI was significantly higher in Group 2 (55.6% vs 24.1% in Group 1, P = 0.002). At multivariable analysis, PV and IPSS were factors significantly associated with higher odds of transient SUI/MUI. PV, surgical time, and no early apical release technique were factors associated with higher odds of persistent SUI/MUI.

We aim to evaluate the incidence of incontinence following laser endoscopic enucleation of the prostate (EEP) comparing en-bloc (Group 1) versus 2-lobe/3-lobe techniques (Group 2). We performed a retrospective review of patients undergoing EEP for benign prostatic enlargement in 12 centers between January 2020 and January 2022. Data were presented as median and interquartile range (IQR). Univariable and multivariable logistic regression analysis was performed to evaluate factors associated with stress urinary incontinence (SUI) and mixed urinary incontinence (MUI). There were 1711 patients in Group 1 and 3357 patients in Group 2. Patients in Group 2 were significantly younger (68 [62-73] years vs 69 [63-74] years, P = 0.002). Median (interquartile range) prostate volume (PV) was similar between the groups (70 [52-92] ml in Group 1 vs 70 [54-90] ml in Group 2, P = 0.774). There was no difference in preoperative International Prostate Symptom Score, quality of life, or maximum flow rate. Enucleation, morcellation, and total surgical time were significantly shorter in Group 1. Within 1 month, overall incontinence rate was 6.3% in Group 1 versus 5.3% in Group 2 (P = 0.12), and urge incontinence was significantly higher in Group 1 (55.1% vs 37.3% in Group 2, P < 0.001). After 3 months, the overall rate of incontinence was 1.7% in Group 1 versus 2.3% in Group 2 (P = 0.06), and SUI was significantly higher in Group 2 (55.6% vs 24.1% in Group 1, P = 0.002). At multivariable analysis, PV and IPSS were factors significantly associated with higher odds of transient SUI/MUI. PV, surgical time, and no early apical release technique were factors associated with higher odds of persistent SUI/MUI. [ABSTRACT FROM AUTHOR]

Purpose: Intradetrusor onabotulinum toxin A (BTX-A) has been demonstrated to be an effective treatment option for overactive bladder (OAB). However, concerns about frailty and frequent injections may deter its use in the elderly. This study aims to assess the safety, efficacy, and treatment duration of BTX-A in managing OAB in elderly women. Methods: We retrospectively reviewed female patients aged 70 and above who were diagnosed with OAB with predominant urge urinary incontinence and underwent intravesical BTX-A treatment. We collected demographic and clinical data, with repeat BTX-A injections re-administered upon patient-reported symptom recurrence. Results: Twenty-one female patients, median age 77 (range 71–92), were included. The median time between the first and second injection was 185 (84–448) days, 186 (105–959) days between the second and third injection, and increased to 206.5 (84–256) days between the third and fourth injection. However, the median interval trended downward after the fourth injection (Fig. 1). Patients with four or more injections had a shorter median interval between injections, 154 days, compared to those with fewer injections, 210 days. Two patients (6.9%) experienced urinary retention after the initial treatment, with 1 (2.2%) among a total of 46 subsequent treatments (Table 3). There were ten (13.3%) episodes of UTIs within 2 weeks of treatment. Patients reported improvement in symptoms following 93.3% of the injections. Conclusion: This real-world study demonstrates that BTX-A effectively controls OAB symptoms in elderly women, with just two injections annually. BTX-A appears safe and efficacious for treating OAB in elderly females. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: The objective was to explore the association between urge urinary incontinence (UUI) and lax uterosacral ligaments (USL) using MRI. Methods: Sixty-seven female participants were recruited prospectively: 41 continent volunteers (control group) and 26 patients with UUI. Static proton density- and T2-weighted turbo spin echo sequences of MR images were used. A radiologist employed a standardized grid system to record structural observations of the USLs on sequentially numbered axial MR images and then applied a four-point grading scale to assess ligament visibility. MR images were interpreted by a radiologist and a urologist, and then validated by an expert radiologist. Results: The comparison between the mean length of uterosacral ligaments in the control and UUI groups was highly statistically significant (p < 0.001). The mean length of the right USL was 38 ± 11 mm, and the left USL was 35 ± 12 mm in the UUI group. In the control group, the mean length of the USL was 22 ± 9 mm on the right side and 18 ± 9 mm on the left side, along their craniocaudal extent. The highest inter-observer agreement was on the level of origin and insertion (image numbers), whereas the lowest agreement was on the anatomical site of origin and insertion of the USL in both the control and UUI groups. Conclusions: The average length of USLs in patients with UUI is significantly longer than that in healthy continent women, indicating laxity. Our findings support the relationship between the laxity of the USL and UUI symptoms and have therapeutic implications. [ABSTRACT FROM AUTHOR]

Introduction: Staged sacral neuromodulation (SNM) testing has been shown to have a high rate of progression to permanent implantation for the management of voiding dysfunction. Stage 1 lead placement (SNM‐I) can be performed under monitored anesthesia care (MAC) or general anesthesia (GA). MAC allows for interpretation of sensory and motor responses to optimize lead placement while GA only permits for motor assessment. However, patient discomfort and movement can make lead placement challenging during MAC. Herein we evaluate whether the anesthesia type impacts the progression rate to permanent implantation (SNM‐II). Materials and Methods: A retrospective chart review was performed for patients who underwent SNM‐I in the operating room for wet overactive bladder between 2005 and 2023. Patients were divided into two groups based on the type of anesthesia used, MAC or GA. Clinical variables and progression to SNM‐II were compared between cohorts. Progression to SNM‐II was based on ≥50% symptomatic improvement during a 1−2 week trial period following SNM‐I. Results: Of 121 patients included in the study, 95 (79%) underwent MAC and 26 (21%) GA for SNM‐I. No difference in the progression rate to SNM‐II was noted between groups (MAC, 68/95 patients, 72%; GA, 19/26, 73%; p = 0.39). We also found no difference when comparing the GA group to the 26 most recent MAC patients (MAC, 20/26 patients, 77%; GA, 19/26, 73%; p = 0.48). Conclusion: Types of anesthesia for SNM‐I did not affect rate of progression to SNM‐II. The result lends support to the reliance on motor responses alone for lead placement during SNM‐I. [ABSTRACT FROM AUTHOR]

Background: Urinary incontinence (UI) has been identified as a World Health Organization health priority. In particular, urge UI (UUI) refers to urine leakage associated with a sudden and compelling desire to void urine. It affects quality of life more than other kinds of UI, but it is not always treated adequately. For these reasons, this study aimed to evaluate the effectiveness of conservative treatment practices to counteract UUI in women aged 40–65 years old. Methods: This systematic review was conducted following the Joanna Briggs Institute (JBI) methodology. According to the protocol registered in PROSPERO, a systematic search was carried out in the CINAHL, Embase, PubMed, PsycInfo, Scopus and Web of Science databases up to October 2022, to find primary studies meeting the inclusion criteria. Results: Fourteen studies were included. The scientific literature reported different strategies dealing with the problem of UUI, some purely physical, others physical and psycho-educational and others exclusively psychological. Conclusion: Conservative treatments are useful to aid the reduction in UUI episodes in middle-aged women. However, none of them can be considered more effective than others due to the impossibility of conducting meta-analytical analyses. Further studies comparing the effectiveness of conservative treatments for UUI are needed. [ABSTRACT FROM AUTHOR]

Introduction We report a case of refractory overactive bladder with cough‐associated detrusor overactivity treated by onabotulinumtoxin A. Case presentation A 79‐year‐old woman who underwent mid‐urethral sling surgery 8 years ago complained mainly of urinary incontinence following abdominal pressure. Various medicines to treat overactive bladder symptoms were ineffective. Cystometry revealed cough‐associated detrusor overactivity. Onabotulinumtoxin A injections in her bladder improved subjective symptoms, and cough‐associated detrusor overactivity disappeared on cystometry. Conclusions Onabotulinumtoxin A injection effectively resolved refractory overactive bladder with urgency urinary incontinence due to cough‐associated detrusor overactivity.

Background: Urinary incontinence (UI) has been identified as a World Health Organization health priority. In particular, urge UI (UUI) refers to urine leakage associated with a sudden and compelling desire to void urine. It affects quality of life more than other kinds of UI, but it is not always treated adequately. For these reasons, this study aimed to evaluate the effectiveness of conservative treatment practices to counteract UUI in women aged 40–65 years old. Methods: This systematic review was conducted following the Joanna Briggs Institute (JBI) methodology. According to the protocol registered in PROSPERO, a systematic search was carried out in the CINAHL, Embase, PubMed, PsycInfo, Scopus and Web of Science databases up to October 2022, to find primary studies meeting the inclusion criteria. Results: Fourteen studies were included. The scientific literature reported different strategies dealing with the problem of UUI, some purely physical, others physical and psycho-educational and others exclusively psychological. Conclusion: Conservative treatments are useful to aid the reduction in UUI episodes in middle-aged women. However, none of them can be considered more effective than others due to the impossibility of conducting meta-analytical analyses. Further studies comparing the effectiveness of conservative treatments for UUI are needed.

(1) Background: The purpose of our prospective, single-blinded, randomized, sham-controlled study was to investigate the effect of the additional extracorporeal magnetic stimulation (ExMI) to pharmacological treatment in overactive bladder syndrome (OAB) in women. (2) Methods: We recruited 56 women with OAB, who were allocated into two study groups: the active group received mirabegron 50 mg daily and a total of 16 sessions of ExMI in 8 weeks, whereas the sham group received mirabegron 50 mg daily and sham stimulation following the same treatment protocol. Treatment success was evaluated after 4 and 8 weeks. (3) Results: Both groups experienced significant reduction in daytime urinary frequency, nocturia, and number of weekly incontinence episodes after 8 weeks. There were no statistically significant differences in end-point daytime urinary frequency and nocturia between groups. However, the overall average reduction rate in weekly number of incontinence episodes was 43.7% in treatment group and 24.2% in the control group. The number of urinary incontinence episodes in the treatment and control group was reduced for 3.8 ± 11.8 vs. 2.5 ± 4.3 episodes at week 4 and additional 3.3 ± 6 vs. 0.4 ± 3.2 episodes at week 8, respectively (p = 0.013). Moreover, IIQ-7 score showed a significantly greater score reduction and patients' evaluated improvement of symptoms was higher in the active group. (4) Conclusions: The addition of ExMI to mirabegron in OAB treatment further improves the weekly incontinence episode reduction rate and also leads to grater improvement in symptoms. [ABSTRACT FROM AUTHOR]

IntroductionUrinary incontinence (UI) is highly prevalent in low- and middle-income countries (LMIC). Concurrently, the availability of surgical or conservative UI treatments in LMIC is limited.MethodsWe conducted a prospective feasibility study of Belize women with UI treated with pelvic floor physical therapy (PFPT) and education (PFE). Patients received individual PFPT/PFE over 2 days, consisting of biofeedback-enhanced PFMT in addition to behavioral, dietary, and general pelvic education. Patient completed a daily 6-month home regimen including 7 PFMT exercises (total 70 repetitions) comprising both endurance and quick flick exercises. Patients also performed comprehensive dietary and behavioral modification activities. Outcomes were assessed at baseline and 6-months, including validated symptom (ICIQ-FLUTS) and QOL (IIQ-7) questionnaires, and strength testing (PERFECT score, perineometry).ResultsTwenty-eight patients underwent baseline assessment. Four patients were lost to in-person 6-month follow-up, with two of these patients completing subjective assessment only by telephone. The mean (±SD) patient age, BMI, and parity were 50.0 (±10.0) years, 33.2 (±5.8), and 2.8 (±1.5). Provider assessment demonstrated patient comprehension of basic, endurance, and quick flick pelvic floor contractions in 28 (100%), 24 (86%), and 24 (86%) patients, respectively. At 6-month follow-up, significant improvements were seen across multiple validated questionnaire and strength measurement assessments. Median patient-reported improvement level was 7.0 on a 10-point Likert scale.DiscussionStudy patients demonstrated good understanding of PFMT/PFE and program completion was associated with significant improvements across a variety of subjective incontinence and quality of life outcomes, as well as objective strength testing.

Introduction and hypothesis: Prior studies demonstrate mixed results on the impact of obesity on the success of midurethral slings (MUS), with little known about how postoperative weight change affects outcomes. We aimed to examine the effect of postoperative weight change on outcomes 12 months after MUS for stress urinary incontinence (SUI). Methods: This secondary analysis utilized data from two multicenter randomized trials of women undergoing MUS placement. Subjects were categorized into cohorts based on change in body weight at 12 months postoperatively: weight gain (≥5% increase); weight loss (≥5% decrease), and weight stable (<5% change). The primary outcome was SUI cure (no SUI episodes in a 3-day bladder diary). Patients with mixed urinary incontinence (MUI) were analyzed for changes in daily average urge incontinence (UUI) episodes in a 3-day diary. Penalized logistic regression assessed the impact of demographic and perioperative variables on the primary outcome. Results: Of the 918 women included, 635 (70%) were weight stable, 144 (15%) had weight gain, and 139 (15%) had weight loss. Patients in the weight loss cohort had a higher smoking rate and a higher baseline body mass index (SD 0.29, 2.7 respectively). All cohorts experienced high SUI cure rates ranging from 77 to 81%, with no significant difference in SUI cure between cohorts (p = 0.607). Of 372 subjects with MUI, the weight loss cohort had significantly greater improvement in UUI episodes. Conclusions: Weight change at 12 months postoperatively did not significantly alter efficacy of MUS for treatment of SUI. Patients with MUI who lost ≥5% body weight had significantly greater improvement in UUI episodes. [ABSTRACT FROM AUTHOR]

BackgroundThe relationship between exposure to organophosphate esters (OPEs) and the risk of developing overactive bladder (OAB) is uncertain. The purpose of this study is to examine the potential link between urinary metabolites of organophosphate esters and OAB.MethodData from the National Health and Nutrition Examination Survey (NHANES) database of the 2011–2016 cycles were utilized. Four urinary metabolites of organophosphate esters: diphenyl phosphate (DPHP), bis (1,3-dichloro-2-propyl) phosphate (BDCPP), bis (2-chloroethyl) phosphate (BCEP), and dibutyl phosphate (DBUP) were included in the study. Multivariate logistic regression and restricted cubic spline (RCS) were used to evaluate the relationship between urinary OPEs metabolites and OAB. Interaction analysis was conducted on subgroups to confirm the findings.ResultsA total of 3,443 United States (US) adults aged 20 years or older were included in the study, of whom 597 participants were considered to have OAB. After adjusting for potential confounding factors, we found a positive association between DPHP and the risk of overactive bladder. The risk of overactive bladder increased with increasing DPHP concentrations compared with quartile 1 (quartile 2, OR = 1.19, 95% CI, 0.82–1.73, P = 0.34; quartile 3, OR = 1.67, 95% CI, 1.10–2.53, P = 0.02; Q4, OR = 1.75, 95% CI, 1.26–2.43, P = 0.002). However, after dividing the participants by gender, only the female group retained consistent results. Additionally, restricted cubic spline analysis revealed a nonlinear dose-response correlation between DPHP and OAB in female participants. In the subgroup analysis based on age, race, body mass index (BMI), recreational activity, smoking status, drinking status, hypertension, diabetes, and stroke, the interaction analysis revealed that the findings were uniform.ConclusionOur findings indicate that exposure to DPHP could elevate the risk of OAB in US adult females. Further experimental studies are needed to explore the underlying mechanism in the future.

Introduction and hypothesis: Conflicting results have been reported on the effect of vitamin D supplementation on urinary incontinence (UI). Therefore, the aim of this study was to evaluate the effect of consuming vitamin D oral supplements on improving urge UI (UUI) in postmenopausal women with vitamin D deficiency. Methods: This randomized clinical trial was conducted in 2019–2020 in postmenopausal women with UUI or nocturia more than once at night with vitamin D levels less than 30 ng/ml. After recording the severity of UI and its impact on the patient's daily life, patients were randomly divided into two groups of 45 patients: one taking vitamin D3 (50,000 IU) tablets and one taking placebo weekly for 8 weeks. Results: There was no significant difference between the two groups in terms of the severity of UI and the frequency of nocturia before treatment. However, after treatment, in the vitamin D group, the severity of UI and the frequency of nocturia significantly reduced. Before treatment, the impact of UI on patients' daily life was reported to be high in more than 70% of patients in both groups, which was not significantly different; however, after treatment, its impact was significantly reduced in the vitamin D group. Conclusions: The findings of the present study showed that in postmenopausal women with UUI or nocturia, weekly use of vitamin D 50,000 IU tablets for 8 weeks can reduce the severity of UI and the frequency of nocturia, and reduce their impact on disruption in daily life. [ABSTRACT FROM AUTHOR]

Purpose: Stress urinary incontinence (SUI) is a well-known adverse outcome following robotic-assisted laparoscopic prostatectomy (RALP). Although postoperative SUI has been extensively studied, little focus has been placed on understanding the natural history and impact of urgency symptoms following RALP. The UVA prostatectomy functional outcomes program (PFOP) was developed to comprehensively assess and optimize continence outcomes following RALP. The present study focuses on assessing urgency outcomes in this cohort. Methods: PFOP patients with a minimum of 6-months follow up following RALP were included. The PFOP includes prospectively assessed incontinence and quality of life outcomes utilizing ICIQ-MLUTS, Urgency Perception Score (UPS), and IIQ-7 questionnaires. The primary study outcome was urgency urinary incontinence (UUI) as determined by ICIQ-MLUTS UUI domain. Secondary outcomes included urgency (UPS score) and quality of life (IIQ-7). Results: Forty patients were included with median age 63.5 years. Fourteen (35%) patients reported UUI at baseline. UUI and QOL scores worsened compared to baseline at all time-points. Urgency worsened at 3-weeks and 3-months but returned to baseline by 6-months. Notably, 63% of patients without baseline UUI reported de-novo UUI at 6 months. Although QOL was lower in patients with versus without UUI (IIQ-7 score 3.0 vs 0.0, p = 0.009), severity of UUI was not associated with QOL when controlling for SUI severity. Conclusion: Our data demonstrate significantly worsened UUI from baseline and a large incidence of de-novo UUI following RALP. Further study is needed to inform how urgency and UUI and its treatment affect health-related quality of life following RALP. [ABSTRACT FROM AUTHOR]

About 50% of women experience urinary incontinence at least once during their lifetime, and half of these patients suffer from stress urinary incontinence. Pelvic floor muscle training is the first choice, but for patients with moderate to severe incontinence or mild incontinence but poor quality of life, midurethral sling (MUS) surgery is the gold standard. MUS can be performed with either TVT (Tensionfree vaginal tape) or TOT (Transobturator tape), both of which have high success rates. The surgical technique is relatively easy, but the adjustment of tape tension is critical to the success or failure of the procedure and requires careful attention. Urinary incontinence decreases QOL, and patients have high expectations regarding surgery, so it is necessary to select the appropriate case and provide sufficient explanation prior to surgery. For refractory urge urinary incontinence, intravesical botulinum toxin injections have been covered by insurance since 2020. This treatment can be performed on an outpatient basis, is safe, and has good outcomes. Periurethral injection is effective for patients with intrinsic sphincter deficiency, but there is no bulking agent available in Japan. It is expected that silicone particles, polyacrylamide gels and regenerative stem cells derived from autologous subcutaneous adipose tissue will be put to practical use. It is our sincere hope that the next decade will bring more treatment options for patients with urinary incontinence and further contribute towards the health and longevity of elderly women. [ABSTRACT FROM AUTHOR]

Introduction: Urinary incontinence (UI) is defined as the involuntary loss of urine. The condition can happen in both genders, but more frequently in women. There are multiple known risk factors for UI. For women, multiparity, previous vaginal deliveries, and menopause are known risk factors for UI. To diagnose UI, three steps should be done, including the patient history, physical examination, and laboratory tests. The options management of UI includes conservative, medical, and surgical, a trial of conservative treatment is recommended by all guidelines before medical or invasive surgical therapy. Conservative therapies include behavioral therapy, physical therapy, and timed voiding. Aim: Our aim in this study is to estimate the prevalence of UI in admitted women and the general population and to compare UI between the general population and admitted women in Al-Kharj city. Material: A quantitative cross-sectional study of 108 women admitted to maternity and children's hospital and 435 women from the general population of Al Kharj city, Saudi Arabia, between January and March 2021, aged 18+ years. A hard copy questionnaire was distributed to admitted patients at maternity and children's hospital, and an electronic questionnaire was distributed by social media to the general population. Result: The prevalence of UI in the general population was reported by 132 women (30%). Seventy-four out of 132 women have stress UI (56%), 45 women have urge UI (34%), and the remaining 13 women have mixed UI (10%). The prevalence in admitted women was reported by 38 out of 108 women (35%). Twenty-four out of 38 women have stress UI (63%), 10 women have urgency UI (26%), and the remaining four women have mixed UI (11%). Conclusion: UI is a common health problem in our society. Risk factors for UI are advanced age, multi parity, chronic disease, and obesity.

Increased urinary incontinence is one of the most common changes during menopause. This study aimed to investigate the effect of Nigella sativa L. seed oil on urinary incontinence and quality of life (QoL) (primary outcomes) and sexual function (secondary outcome) in menopausal women. In this triple‐blind randomized controlled trial, 60 women in Tabriz‐Iran were equally allocated into two treatment and control groups using block randomization. The women applied 2–3 drops of Nigella sativa L. seed oil or placebo on their stomachs below the novel twice a day for 8 weeks. The data collection instruments were completed at baseline and just after the intervention. After intervention, the mean rank score of mixed urinary incontinence was significantly lower (p =.04) and the mean score of the incontinence‐QoL was significantly higher (mean difference 12.63, 95% CI 2.33 to 22.93; p =.017) in the treatment group than the control group. However, there were no significant differences in stress incontinence, urge incontinence, sexual function, and menopause‐specific QoL of women between the groups (p >.05). The results indicated the positive effect of the Nigella sativa L. seed oil on mixed incontinence and incontinence‐QoL; nevertheless, to make a certain conclusion, further studies are required. [ABSTRACT FROM AUTHOR]

(1) Background: Women experience pelvic floor dysfunction symptoms during pregnancy. This study is the first to investigate and compare variances in the prevalence and severity of pelvic floor symptoms between trimesters using a valid pregnancy-targeted questionnaire. (2) Methods: A retrospective cohort study was conducted between August 2020 to January 2021 at two university-affiliated tertiary medical centers. Pregnant women (n = 306) anonymously completed the Pelvic Floor Questionnaire for Pregnancy and Postpartum with its four domains (bladder, bowel, prolapse, and sexual). (3) Results: Thirty-six women (11.7%) were in the 1st trimester, eighty-three (27.1%) were in the 2nd trimester, and one hundred and eighty-seven (61.1%) were in the 3rd trimester. The groups were similar in age, pregestational weight, and smoking habits. A total of 104 (34%) had bladder dysfunction, 112 (36.3%) had bowel dysfunction, and 132 (40.4%) reported sexual inactivity and/or sexual dysfunction. Least prevalent (33/306; 10.8%) were prolapse symptoms. Increased awareness of prolapse and significantly higher rates of nocturia and the need to use pads due to incontinence were recorded in the 3rd trimester. Sexual dysfunction or abstinence were equally distributed in all three trimesters. (4) Conclusions: Bladder and prolapse symptoms, equally frequent throughout pregnancy, significantly intensified in the 3rd trimester. Bowel and sexual symptoms, equally frequent throughout pregnancy, did not intensify in the third trimester. [ABSTRACT FROM AUTHOR]

ObjectiveTo explore the association between the prevalence of circadian syndrome (CircS) and overactive bladder (OAB).Materials and methodsCross-section analysis was based on the National Health and Nutrition Examination Survey 2005–2018. Data regarding OAB was collected from questionnaires. The association between the prevalence of CircS and OAB was elucidated using three multivariable logistic regression models. Stratified and interaction analyses were performed to find whether some factors can modify the association.ResultsTotally 8,033 males and 8,065 females were included. People with CircS had a significantly higher prevalence of OAB compared to the non-CircS group in the fully-adjusted model (OR = 1.238, 95%CI 1.080–1.419). A significant positive correlation between the number of CircS components and the prevalence of OAB was observed when the components were ≥ 6 (OR = 1.975, 95%CI 1.463–2.665). No significant interaction was seen in the three models.ConclusionThere is a positive association between the prevalence of CircS and OAB. When the number of components is ≥6, the prevalence of OAB shows a strongly positive correlation with the number of CircS components.

Introduction: Urinary incontinence (UI) is defined as the involuntary loss of urine. The condition can happen in both genders, but more frequently in women. There are multiple known risk factors for UI. For women, multiparity, previous vaginal deliveries, and menopause are known risk factors for UI. To diagnose UI, three steps should be done, including the patient history, physical examination, and laboratory tests. The options management of UI includes conservative, medical, and surgical, a trial of conservative treatment is recommended by all guidelines before medical or invasive surgical therapy. Conservative therapies include behavioral therapy, physical therapy, and timed voiding. Aim: Our aim in this study is to estimate the prevalence of UI in admitted women and the general population and to compare UI between the general population and admitted women in Al-Kharj city. Material: A quantitative cross-sectional study of 108 women admitted to maternity and children's hospital and 435 women from the general population of Al Kharj city, Saudi Arabia, between January and March 2021, aged 18+ years. A hard copy questionnaire was distributed to admitted patients at maternity and children's hospital, and an electronic questionnaire was distributed by social media to the general population. Result: The prevalence of UI in the general population was reported by 132 women (30%). Seventy-four out of 132 women have stress UI (56%), 45 women have urge UI (34%), and the remaining 13 women have mixed UI (10%). The prevalence in admitted women was reported by 38 out of 108 women (35%). Twenty-four out of 38 women have stress UI (63%), 10 women have urgency UI (26%), and the remaining four women have mixed UI (11%). Conclusion: UI is a common health problem in our society. Risk factors for UI are advanced age, multi parity, chronic disease, and obesity. [ABSTRACT FROM AUTHOR]

Background: Urinary incontinence (UI) is a common dysfunction of the pelvic floor, affecting 10–20% of all women, and up to 70% in the elderly general prevalence of 17% 20-year-old women and 38% in women over 60 years. It is estimated that only 25% of patients seek treatment for this debilitating condition. Aim: The aim of this study was to evaluate the efficacy of a device based on top flat magnetic stimulation to treat pelvic floor disorders especially female urinary incontinence. Methods: A total of 33 volunteer patients were divided into 5 groups according to the type of complaint. Subjects received 8 treatment sessions, with a frequency of twice a week with two different settings. Pelvic Floor Bother Questionnaire (PFBQ), Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ-12) and Urinary Incontinence Short Form (ICIQ-UI-SF) were compiled by all patients at the beginning and after 3 months from the end of the last treatment (3MFU). Results: The patient's scores from validated Questionnaires significantly decreased (p < 0.01) from baseline up to 3MFU inside most of the groups. Conclusions: The noninvasiveness and safety of device make this approach an interesting tool as alternative approach for pelvic floor dysfunctions. [ABSTRACT FROM AUTHOR]

Introduction: To examine the relationship between depression and bladder symptoms, especially the impact of change in depression on changes in bladder symptoms, for women with urge and stress urinary incontinence undergoing a course of PFMT.Method: 106 adult females with pelvic-floor dysfunction (PFD), consecutively referred to an outpatient pelvic-floor muscle training (PFMT) programme for either urge, stress, or mixed incontinence, participated in a prospective observational study. Participants reported subjective views of their pelvic floor problems (Queensland), and their levels of depression (HADS_D), and data relating to age and BMI were collected. The trial was registered on clinicaltrials.gov (NCT02549157).Results: There was a positive relationship between depression and bladder symptoms at intake. Levels of initial depression significantly predicted levels of bladder symptoms at completion of PFMT, and ability to complete the PFMT programme. Change in depression significantly predicted change in bladder symptoms, over and above intake patient characteristics and symptoms.Discussion: These data imply a multidisciplinary focus, including psychological input, for PFD may be a highly effective strategy for its management. [ABSTRACT FROM AUTHOR]

Abstract Background Overactive bladder (OAB) affects 12 to 30% of the world’s population. The accompanying urinary urgency, frequency and incontinence can have a profound effect on quality of life, leading to depression, social isolation, avoidance of sexual activity and loss of productivity. Conservative measures such as lifestyle modification and pelvic floor physical therapy are the first line of treatment for overactive bladder. Patients who fail these may go on to take medications, undergo neuromodulation or receive injection of botulinum toxin into the bladder wall. While effective, medications have side effects and suffer from poor adherence. Neuromodulation and botulinum toxin injection are also effective but are invasive and not acceptable to some patients. Methods We have developed a novel transcutaneous spinal cord neuromodulator (SCONE™,) that delivers multifrequency electrical stimulation to the spinal cord without the need for insertion or implantation of stimulating electrodes. Previously, multifrequency transcutaneous stimulation has been demonstrated to penetrate to the spinal cord and lead to motor activation of detrusor and external urethral sphincter muscles. Here, we report on eight patients with idiopathic overactive bladder, who underwent 12 weeks of SCONE™ therapy. Results All patients reported statistically significant clinical improvement in multiple symptoms of overactive bladder, such as urinary urgency, frequency and urge incontinence. In addition, patients reported significant symptomatic improvements as captured by validated clinical surveys. Conclusion SCONE™ therapy represents the first of its kind therapy to treat symptoms of urgency, frequency and urge urinary incontinence in patients with OAB. Trial registration The study was listed on clinicaltrials.gov ( NCT03753750 ).

The European Association of Urology Non-neurogenic Male Lower Urinary Tract Symptoms Panel has comprehensively reviewed the available literature of male incontinence. This review provides the latest information on the diagnosis and management of stress and urge urinary incontinence in males. Urinary incontinence (UI) is a common condition in elderly men causing a severe worsening of quality of life, and a significant cost for both patients and health systems. To report a practical, evidence-based, guideline on definitions, pathophysiology, diagnostic workup, and treatment options for men with different forms of UI. A comprehensive literature search, limited to studies representing high levels of evidence and published in the English language, was performed. Databases searched included Medline, EMBASE, and the Cochrane Libraries. A level of evidence and a grade of recommendation were assigned. UI can be classified into stress urinary incontinence (SUI), urge urinary incontinence (UUI), and mixed urinary incontinence. A detailed description of the pathophysiology and diagnostic workup has been reported. Simple clinical interventions, behavioural and physical modifications, and pharmacological treatments comprise the initial management for all kinds of UI. Surgery for SUI includes bulking agents, male sling, and compression devices. Surgery for UUI includes bladder wall injection of botulinum toxin A, sacral nerve stimulation, and cystoplasty/urinary diversion. This 2022 European Association of Urology guideline summary provides updated information on definition, pathophysiology, diagnosis, and treatment of male UI. Male urinary incontinence comprises a broad subject area, much of which has been covered for the first time in the literature in a single manuscript. The European Association of Urology Non-neurogenic Male Lower Urinary Tract Symptoms Guideline Panel has released this new guidance, with the aim to provide updated information for urologists to be able to follow diagnostic and therapeutic indications for optimising patient care. [ABSTRACT FROM AUTHOR]

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The aim of this study was to determine the relationship between diabetes mellitus (DM) and urinary complications, such as effort urinary incontinence, urge urinary incontinence, and nocturia in women. Through medical history and self-answered questionnaires, it was found that DM exacerbates urinary incontinence, urge urinary incontinence, and nocturia symptoms. [ABSTRACT FROM AUTHOR]

Background: Genitourinary syndrome of menopause (GSM) is a prevalent condition with a constellation of symptoms including burning, dryness, dyspareunia, and irritative lower urinary tract symptoms that result from vulvovaginal atrophic changes. Though hormonal therapy is a mainstay of treatment in GSM, some patients may pursue nonhormonal therapies., Aim: To determine the efficacy of radiofrequency ablation of the vaginal canal with the MorpheusV applicator in reducing the symptoms of GSM., Methods: We conducted a multicenter prospective case series of women with GSM as confirmed by Vaginal Health Index Score (VHIS). Subjects received 3 treatments of radiofrequency ablation ~4 weeks apart with follow-up to 6-month posttreatment., Outcomes: The primary endpoint was VHIS at 6-month posttreatment. Secondary endpoints were VHIS at 3 months, Visual analog scale (VAS) pain with each treatment, 3- and 6-month measurements of urogenital distress inventory-6 (UDI-6), and female sexual function index (FSFI) questionnaires., Results: From 2021 to 2023, 71 women were enrolled in the study with 51 followed to the 6-month follow-up time point. Treatments were found to be low in VAS pain score with mean values of 2.13 ± 2.1, 2.55 ± 2.38, and 2.18 ± 2.14 at treatments 1, 2, and 3 respectively. An improvement in VHIS score was seen from baseline to 3 months after the last treatment (15.00 ± 5.37 vs. 19.62 ± 4.44) and sustained at 6 months (20.23 ± 4.12) (P < .001). Significant improvements in both UDI-6 and FSFI were also noted. Between baseline and 6 months after treatment (FSFI: 18.81 ± 9.57 vs. 22.81 ± 10.34, P < 0.001; UDI-6: 39.58 ± 15.98 vs. 22.42 ± 14.03, P < 0.001). No adverse events were encountered by any subject during this study., Clinical Implications: A therapy that is safe and effective in the treatment of both GSM and lower urinary tract symptoms without the use of hormonal methods is clinically impactful for the many patients who cannot receive or do not desire to receive these medications., Strengths and Limitations: Strengths of this study include the utilization of 3 treatment sessions, with follow-up of subjects to 6-month posttreatment with a comprehensive assessment of patient symptoms. Limitations include the unblinded nature of the study and the lack of a comparator group., Conclusion: The data from this study suggests that radiofrequency ablation of the vaginal canal by the MorpheusV applicator is a safe and effective intervention for GSM. It also shows subjective improvements in stress urinary incontinence, urge urinary incontinence, and sexual function., (© The Author(s) 2024. Published by Oxford University Press on behalf of The International Society for Sexual Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: Urinary incontinence (UI) is a prevalent condition with a negative impact on women's quality of life. Data about UI among Jordanian women are lacking; therefore, we aimed to investigate the prevalence, types, and associated factors., Methods: A cross sectional nationwide survey was conducted between 1 March 2020 and 15 April 2020. Women were included if they were 18 years of age or more and had access to the internet. Data collected included women's characteristics, UI types, and associated factors. UI was inventoried by asking women if they have UI (yes/no), and the Arabic language validated International Consultation on Incontinence Questionnaire Urinary Incontinence-Short Form was used. Age-group specific prevalence rates of UI were estimated, and associated factors were studied using logistic regression analyses., Results: Data from 2118 women were analysed. The median age was 40 (range 18-85) years; 58.3% gave birth three or more times; and 64.1% consistently reported having UI. Limited mobility and being multiparous increased the likelihood of reporting UI. Compared to women with normal body mass index, overweight and obese women were 1.9 times and 4.4 times more likely to report UI, respectively., Conclusion: The prevalence of UI among Jordanian women is 64.1%, with mixed UI and stress UI being the more prevalent types in women younger than 60 years old. Age, parity body mass index, and limited mobility are all associated factors with UI. The results of this study provide healthcare policy makers with the necessary information to increase awareness and knowledge regarding UI., Competing Interests: The authors declare no conflict of interest., (© 2024 Editorial Office of Asian Journal of Urology. Production and hosting by Elsevier B.V.)

Urge incontinence, often linked to prolapsed intervertebral disc (PIVD) due to nerve compression, involves sudden, involuntary urine leakage. Management includes behavioral therapy, bladder training, and pelvic floor muscle training (PFMT) to strengthen pelvic muscles and regulate voiding, effectively reducing symptoms and improving quality of life. A 40-year-old female patient presented with chief complaints of lower back pain radiating down the right lower limb below the knee, accompanied by a right-sided listing. Based on the McKenzie classification, she was diagnosed with McKenzie derangement VI, characterized by unilateral/asymmetrical pain across the L4-L5 region, radiating pain below the knee, and the presence of deformity, specifically trunk deviation away from the painful side that is the right side. Additionally, she reported experiencing urge urinary incontinence. Following surgery, she experienced significant reductions in pain and urinary incontinence, improved posture, and an enhanced quality of life. Surgical decompression and spinal fixation effectively alleviated neural compression and instability at the L4-L5 and L5-S1 levels. At the same time, the phased physiotherapy approach facilitated recovery through pain management, neuromuscular re-education, and functional restoration. Preoperative assessments such as the modified Schober's test, visual analogue scale (VAS), Revised Oswestry Disability Index (RODI), sciatica bothersome index, revised urinary incontinence scale (RUIS), and Michigan incontinence symptom index (MISI) were essential in guiding the rehabilitation process and measuring progress. The integration of these multidisciplinary interventions underscores the importance of a comprehensive treatment plan in achieving positive outcomes for PIVD, despite the potential for complications such as chronic pain and disability., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Kaur et al.)

Objectives: Whilst ambulatory urodynamics (aUDS) may be used as a second-stage test for patients with refractory lower urinary tract symptoms (LUTS) having non-diagnostic conventional urodynamics (UDS), the evidence for their use is limited. We have assessed the diagnostic utility and consequent symptomatic outcome of aUDS in patients with refractory LUTS. Methods: A retrospective review of a prospectively acquired urodynamics database was made of 84 consecutive patients (23 male) with a median age 50.5 years (range 18 to 79) having aUDS following non-diagnostic or contradictory baseline UDS over a 12-month period. Patient demographics and urodynamic and clinical diagnosis before and after aUDS were recorded. Forty-six patients (55%) had formal urinary symptom assessment recorded before and a minimum of 6 months following aUDS-related change in management. Results: Eighty-two patients (98%) had a urodynamic diagnosis made following aUDS, 57(68%) of whom had detrusor overactivity (DO); the final 2 patients had no abnormalities detected on aUDS. Change in primary UDS diagnosis occurred in 66 patients (79%). Of these 66 patients, 59 (89%) also had their clinical diagnosis changed, and 55 (83%) had their management pathway changed. There was a significant improvement in urinary symptoms 6 months following aUDS. Conclusion: Change in primary diagnosis following aUDS led to a significant change in treatment care pathway and resulted in significant improvement in urinary symptoms

Subject of the Debate: "Urethral failure is a critical factor in female urinary incontinence Now what?" The CASE FOR by Hokanson, DeLancey pinpointed inadequacy of bladder causation for urgency urinary incontinence (UUI) and poor urethral support for stress urinary incontinence (SUI) as responsible for long‐standing lack of progress in incontinence science. They proposed "Urethral failure" as causation for SUI and UUI. The CASE AGAINST, by Peter Petros agrees "abnormal detrusor function as cause for (UUI) is a failed concept, and SUI surgery results are sometimes suboptimal, but rejects "urethral failure" as cause for UUI and SUI. In answer to, "Now what?," Petros presents the Integral Theory System. SUI and UUI are dysfunctions of the bladder's binary control mechanism, mainly ligament laxity because of defective collagen/elastin. The urethra is an emptying tube. Pelvic muscle forces reflexly contract against ligaments to close urethra, open it (micturition) and stretch the vagina underlying urethelial stretch receptors to mechanically support them, preventing premature activation of micturition (UUI). High validated cure rates for SUI and UUI by repair of weakened ligaments question viability of the "urethral failure" concept. Conclusions: The major achievement of this debate (both sides) is not what causes UUI or SUI, or what doesn't, though clearly, this is important. It is calling out a 50‐year ossification of the whole construct of UUI, ranging from flawed definitions to systematic denial of known cures, all of which have stalled treatment of the one billion women who suffer with incontinence. The time has come for change. [ABSTRACT FROM AUTHOR]

Purpose of Review: In this review, we discuss the current literature concerning the use of patient education interventions for the improvement of outcomes and patient experience during third-line treatment for overactive bladder. Recent Findings: There are only a few prospective studies in the past decade which examine the role of patient education interventions in sacral neuromodulation and intradetrusor onabotulinum toxin treatments; these studies focus on the ability of the interventions to improve patient understanding and satisfaction around the procedure. Summary: Evidence for the use of patient education to optimize third-line overactive bladder therapies is scarce, but results show promise for using these types of interventions to enhance the patient experience. [ABSTRACT FROM AUTHOR]

Pei Shan Yang,1,2 Sophia Delpe,2 Casey G Kowalik,2 W Stuart Reynolds,2 Melissa R Kaufman,2 Roger R Dmochowski2 1Department of Urologic Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan; 2Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USACorrespondence: Pei Shan YangDepartment of Urologic Surgery, Chang Gung Memorial Hospital and Chang Gung University, No. 5, Fuxing Street, Guishan District, Taoyuan, 333, TaiwanTel +886 328-1200Email dr.yang.uro@gmail.comIntroduction: Pubovaginal sling is an efficient and safe procedure for stress urinary incontinence without the complications of synthetic sling. Urine retention and de novo urgency are bothersome aftermath of this procedure. We aim to identify potential risk factors for de novo urgency after autologous pubovaginal sling.Methods: From 2013 to 2016, 347 patients underwent autologous pubovaginal sling. Age, BMI, pelvic irradiation, use of anticholinergic medication, previous vaginal related surgical histories, “over-tight” technique, and concomitant surgeries were examined for potential risk factors. De novo urgency/urge incontinence was defined as treatment (medication, botulinum toxin injection, sacral neuromodulation) for urge postoperatively and was not noted before surgery. Chi-square and fisher’s exact tests were used as statistical analysis.Results: A total of 109 patients underwent autologous rectus fascia pubovaginal sling, after excluding status post urethral diverticulectomy, concomitant diverticulectomy, and concomitant abdominal surgery. Twenty-three (21.1%) patients were treated for de novo urge/urge incontinence, 18 (78.2%) with anticholinergic, 4 (17.3%) with botox injection and 2 (8.69%) with sacral neuromodulation. None but prior pelvic organ prolapse surgery was associated with developing de novo urge/urge incontinence (p=0.026).Discussion: Patients with prior pelvic organ prolapse surgery were more likely to be at risk of de novo urgency after autologous pubovaginal sling. This study provided more information for preoperative consultation for patients undergoing incontinence surgery.Keywords: autologous fascial sling, de novo urgency, stress urinary incontinence, urge urinary incontinence

Objectives: The aim of this study is to assess the impact of life change and social distancing measures, during the Covid-19 outbreak, on the OAB symptoms and quality of life in women underwent different types of treatment. Materials and methods: Observational survey analysis in OAB treated patients was performed. The women showed a greater than 50% improvement during specific therapy for OAB. Population had previously completed bladder diary, OAB-Q symptom, OAB HRQL scale, SF-36 and PGI-I questionnaires. Four weeks after the introduction of the restrictive measures, these women were invited to complete the same questionnaires by e-mail for new evaluation during Covid-19 outbreak. Primary endpoint was changes in number of voids/24h, urgent micturitions/24h, urinary incontinence events/24h, nocturia events. Secondary endpoints were the assessment of the change in the OAB-SF, SF-36 questionnaires and PGI-I satisfaction. Results: Six hundred seventy-three patients were considered. The mean age was 63.21 ± 10.24 years. Four weeks after the start of the social distancing measures, the increase in mean number of voids/24h (7.13 ± 1.08 vs 9.76 ± 2.12, p

Introduction and hypothesis: UUI co-exists with numerous health conditions, having a substantial negative impact on health-related quality of life and mental health. Cognitive-behavioral therapy (CBT) could help patients manage these problems by changing the way they think and behave. Methods: We carried out a systematic review of the literature assessing the modalities and effects of CBT as a stand-alone strategy, without adding PFMT, on symptoms and clinical signs, in women with UUI. Our secondary objective was to report modalities and effects of CBT on health-related quality of life, psychological symptoms and patient-reported satisfaction. The PRISMA methodology was used to carry out this systematic review. A literature search was conducted in PubMed, PEDro, Web of Science and Cochrane Library databases from inception to December 2020. The PICO approach was used to determine the eligibility criteria. Results: Twelve papers were included in the present review which showed beneficial effects on both symptom severity (p < 0.05) and more subjective areas such as quality of life, psychological symptoms or patient satisfaction level (p < 0.05), respectively). However, results on the effectiveness of CBT on clinical signs remains conflicting. Conclusion: Based on the available literature, this review suggested a high level of evidence for the effectiveness of CBT on symptom severity and a moderate level of evidence for the effectiveness of CBT on quality of life, psychological symptoms and patient satisfaction. However, we highlighted no evidence for the effects of CBT on clinical signs. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: Coital incontinence (CI) is an underreported symptom among sexually active women. It has been assumed that incontinence at penetration (CIAP) is due to urodynamic stress incontinence (USI), while coital incontinence at orgasm (CIAO) is thought to be due to detrusor overactivity (DO). Methods: To evaluate demographic and urodynamic findings associated with coital incontinence (CI) and to confirm the hypotheses 'CIAP is associated with USI' and 'CIAO is associated with DO we performed a retrospective study of 661 sexually active women attending a tertiary clinic between January 2017 and December 2019 for pelvic floor dysfunction. All patients filled in a standardized questionnaire and had a clinical examination and multichannel urodynamic testing. Women were asked if they experienced urine leakage during intercourse and the timing of such leakage. Results: Of 661 sexually active women, one third (n = 220) reported coital incontinence. While 121 (18%) women experienced CIAP, 172 (26%) had CIAO and 76 (11.5%) suffered both. For women with pure USI, the prevalence of CIAP (61.7%) and CIAO (69.5%) was significantly higher than for women with pure DO, where only 12.3% had CIAP and 8.6% had CIAO. Factors significantly associated with CI were body mass index, mid-urethral closure pressure (MUCP) and abdominal leak point pressure (ALPP). When only women with pure USI or DO were included, USI remained associated with CI while DO was not. Conclusions: CI is clearly associated with SUI and USI and is likely to share etio-pathogenetic mechanisms. CI seems to be a manifestation of USI, even when it occurs during orgasm. [ABSTRACT FROM AUTHOR]

Objective: The goal of this study was to compare patient-reported efficacy of suburothelial versus intradetrusor onabotulinumtoxin A (BTX-A) in patients with refractory overactive bladder (OAB). Materials and Methods: This single-center, retrospective cohort study was a retrospective chart review of patients who received BTX-A injections to address refractory idiopathic OAB. The study was performed from 2014 to 2019 for 2 providers. Provider 1 used a suburothelial technique, while Provider 2 used an intradetrusor technique. Patients were excluded for lack of follow-up, co-injection with a urethral-bulking agent, and/or a diagnosis of neurogenic bladder. Patients included were BTX-A–naïve and all received a starting dose of 100 units. Results: After cases were excluded, 133 patient charts were analyzed (Provider 1, n = 83; Provider 2, n = 50). Provider 1 had 65% (n = 54) of patients report improvement, while Provider 2 had 82% (n = 41) of patients report improvement. This difference was statistically different (p = 0.036). There was no statistical difference between the 2 groups for postprocedure urinary retention (p = 0.749). The prevalence of urinary tract infections (UTIs) within 30 days following the procedure was not significantly different between the 2 providers' groups (p = 0.329). Conclusions: In this patient population, intradetrusor injection was more effective than suburothelial injection and there was no statistical difference in the secondary outcomes of urinary retention and UTIs. (J GYNECOL SURG 38:103) [ABSTRACT FROM AUTHOR]

Objective: The increasing wealth of clinical data may become unmanageable for a physician to assimilate into optimal decision‐making without assistance. Utilizing a novel machine learning (ML) approach, we sought to develop algorithms to predict patient outcomes following the overactive bladder treatments OnabotulinumtoxinA (OBTX‐A) injection and sacral neuromodulation (SNM). Materials and Methods: ROSETTA datasets for overactive bladder patients randomized to OBTX‐A or SNM were obtained. Novel ML algorithms, using reproducing kernel techniques were developed and tasked to predict outcomes including treatment response and decrease in urge urinary incontinence episodes in both the OBTX‐A and SNM cohorts, in validation and test sets. Blinded expert urologists also predicted outcomes. Receiver operating characteristic curves were generated and AUCs calculated for comparison to lines of ignorance and the expert urologists' predictions. Results: Trained algorithms demonstrated outstanding accuracy in predicting treatment response (OBTX‐A: AUC 0.95; SNM: 0.88). Algorithms accurately predicted mean decrease in urge urinary incontinence episodes (MSE < 0.15) in OBTX‐A and SNM. Algorithms were superior to human experts in response prediction for OBTX‐A, and noninferior to human experts in response prediction for SNM. Conclusions: Novel ML algorithms were accurate, superior to expert urologists in predicting OBTX‐A outcomes, and noninferior to expert urologists in predicting SNM outcomes. Some aspects of the physician–patient interaction are subtle and uncomputable, and thus ML may complement, but not supplant, a physician's judgment. [ABSTRACT FROM AUTHOR]