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Objectives: To evaluate the relationships between physical activity, both work and recreational, and urinary incontinence among women., Methods: We assessed women aged 20 years and older in 2008-2018 NHANES (National Health and Nutrition Examination Survey) cycles who answered self-reported urinary incontinence and physical activity questions. Weighted, multivariate logistic regression model was used to determine the association between incontinence and physical activity levels after adjusting for age, body mass index, diabetes, race, parity, menopause and smoking., Results: A total of 30,213 women were included in analysis, of whom 23.15% had stress incontinence, 23.16% had urge incontinence, and 8.42% had mixed incontinence (answered "yes" to both stress and urge incontinence). Women who engaged in moderate recreational activity were less likely to report stress and urge incontinence (OR 0.79, 95% CI 0.62-0.99 and OR 0.66, 95% CI 0.48-0.90, respectively). Similarly, women who engaged in moderate activity work were less likely to report stress, urge and mixed incontinence (OR 0.84, 95% CI 0.70-0.99; OR 0.84, 95% CI 0.72-0.99; and OR 0.66 95% CI 0.45-0.97, respectively)., Conclusions: Moderate physical activity and greater time spent participating in moderate physical activity are associated with a decreased likelihood of stress, urge and mixed incontinence in women. This relationship holds for both recreational and work-related activity. We hypothesize that the mechanism of this relationship is multifactorial, with moderate physical activity improving pelvic floor strength and modifying neurophysiological mediators (such as stress) involved in the pathogenesis of incontinence., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objective: Urinary incontinence (UI) subtypes may have some effects on sexual function because of diverse pathophysiological mechanisms. The objective of our study is to compare UI subtypes' effects on women's sexual function and quality of life (QoL)., Methods: In this descriptive and comparative study, a total of 239 women with UI were included (89 with stress urinary incontinence [SUI], 65 with urge urinary incontinence [UUI], and 85 with mixed urinary incontinence [MUI]). Sexual function was assessed with the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12), and QoL was assessed with the Incontinence Impact Questionnaire-7 (IIQ-7)., Results: In our study, the mean total PISQ-12 score for the UI subtypes was 29.49 ± 6.38 for SUI, 31.43 ± 5.46 for UUI, and 23.12 ± 5.54 for MUI. Women with MUI had significantly more sexual dysfunctions than the other groups (P < .001). The mean total IIQ-7 score according to UI subtypes was 60.61 ± 31.49 for SUI, 64.40 ± 28.20 for UUI, and 70.51 ± 25.09 for MUI. As regards the scores of the IIQ-7, UI had a negative impact on QoL for women of all groups, especially for women with MUI and UUI, but was not significantly different between the groups (P > .05)., Conclusion: The sexual function of women with MUI was affected more adversely than the other UI subtypes. There was no statistically significant difference between the UI subtypes according to IIQ-7 scores, but when we examined the scores, MUI and UUI were found to have more negative effects on QoL. Clinicians and continence nurses should make routine evaluations of sexual function and QoL for women according to UI subtypes., (© 2020 John Wiley & Sons Australia, Ltd.)

Background: Urinary and faecal incontinence substantially impacts upon physical health and is associated with significant psychological distress and reduced quality of life. Due to stigma and embarrassment, many patients do not present for management of their incontinence., Aim: The objective of this article is to summarise the forms and causes of urinary and faecal incontinence, highlight the psychological mechanisms and psychopathology associated with incontinence, and provide management recommendations., Conclusion: Urinary and faecal incontinence can have a significant impact on an individual's psychological wellbeing and quality of life. Psychological factors may either contribute to or arise from incontinence and should be addressed as part of the overall management plan., Competing Interests: Nil.

Objective: to assess the level of urinary incontinence and its impact on the quality of life of patients undergoing radical prostatectomy., Method: cross-sectional study carried out with prostatectomized patients. The data were collected from the following instruments: sociodemographic questionnaire, Pad Test, International Consultation on Incontinence Questionnaire - Short Form and King Health Questionnaire. Data were submitted to descriptive and bivariate statistical analysis. The level of significance was set at 0.05., Results: a total of 152 patients participated, with a mean age of 67 years. Among incontinent patients, there was a predominance of mild urinary incontinence. Urinary incontinence had a very severe impact on the general assessment of quality of life in the first months and severe impact after six months of surgery. The greater the urinary loss, the greater the impact on the quality of life domains Physical Limitations, Social Limitations, Impact of Urinary Incontinence and Severity Measures. Most participants reported no erection after surgery and therefore did not respond to the question of the presence of urinary incontinence during sexual intercourse., Conclusion: the present study evidenced the occurrence of urinary incontinence after radical prostatectomy at different levels and its significant impact on the quality of life of men, which reveals the need of interventions for controlling it.

Background: Pelvic floor muscle function (PFMF) is a target of the physical therapist intervention for women with urinary incontinence (UI). However, possible variations in PFMF terminology might hamper communication among researchers and health care professionals in Women's Health., Objective: The objective of this study was to investigate the terminology of PFMF regarding clear terms, conceptual definitions, and operational definitions., Data Sources: Data sources include PUBMED, CINAHL, LILACS, and SCIELO., Study Selection: Observational studies investigating any PFMF in women with or without UI, published in English, Spanish, or Portuguese from 2005 through 2017, were considered., Data Extraction: The risk of bias was assessed by a questionnaire on the quality of observational studies. Data on terminology were extracted as terms, conceptual definitions, and operational definitions of PFMF and were synthesized according to key words, key ideas, and key operationalization, respectively. Consistencies and variations were identified for the most frequently investigated PFMF., Data Synthesis: Sixty-four studies were included, and a low risk of bias was identified. All studies presented terms and operational definitions of PFMF, but only 29.7% presented conceptual definitions of those terms. One hundred ninety-six different terms referred to PFMF. According to similarities in terminology, 161 PFMF terms could be grouped under 26 terms; the other 35 were left ungrouped. Therefore, a total of 61 different PFMF terms were identified in the literature., Limitations: A limitation in the study was that only observational studies were included., Conclusions: A large variation in PFMF terminology was identified, precluding data gathering and meta-analysis. The lack of use of standardized terminology delays the progress of scientific knowledge and evidence-based practice dissemination. Efforts toward creating a collaborative, consensual terminology based on a sound framework are necessary.

Purpose: The purpose of this study was to evaluate a revised version of the Incontinence-Associated Skin Damage Severity instrument (IASD.D.2) using 3 different groups of nursing staff. Revisions to the instrument included renumbering 1 body area where incontinence-associated dermatitis (IAD) occurs into 2 areas (right and left), which raised the total possible score from 52 to 56, and defining the borders of the body areas., Design: Observational, evaluative design., Sample and Setting: Five clinical experts certified in wound, ostomy, and/or continence (WOC) nursing evaluated content validity. Evaluators were attendees at the WOC Nurses (WOCN) Society 2014 conference, hospital nurses, and nursing staff at a nursing home. Evaluators were attendees at the WOCN Society's 2014 National Conference, hospital nurses at a community hospital with Magnet designation, and nursing staff at a skilled nursing home in the Midwestern United States. The evaluator group comprised 198 conference attendees (all nurses; age 53 ± 8.2 years, mean ± SD), 67 hospital nurses (age 37 ± 11 years), and 34 nursing home nursing staff (age 45 ±13.8 years). The majority of evaluators (>75%) in each of the groups were female., Methods: Clinical experts evaluated the content validity of the revised instrument. Evaluators scored 5 to 9 photographic cases using the revised instrument. Four of the cases were scored by all evaluators. The agreement of case scores among all evaluators was analyzed to assess interrater reliability. The scores of evaluators grouped by evaluators' self-identified skin color or nursing experience (<10 years vs ≥10 years) were also tested for differences. To provide evidence for criterion validity, the agreement of evaluators' scores with experts' scores (considered a "gold standard" in this study) was analyzed., Results: The agreement of the IASD.D.2 scores among all evaluators within each group ranged from 0.74 to 0.79, suggesting good interrater reliability. The agreement of each group of evaluators with the experts for all case scores ranged from 0.82 to 0.85, suggesting good criterion validity. There was no significant difference in scores by evaluators' skin color or nursing experience., Conclusion: The revised IASD.D.2 has good content and criterion validity and interrater reliability. The instrument has potential to standardize reporting of IAD severity in research and clinical practice and assist communication about IAD among nursing staff.

Objectives: To show the efficacy of propiverine hydrochloride in the management of symptoms of stress urinary incontinence in female patients with mixed-type urinary incontinence., Methods: The study was carried out as a multicenter single-arm clinical trial at 64 institutions in Japan. The participants were female patients aged ≥20 years with mixed-type urinary incontinence. The frequency of stress urinary incontinence and urgency urinary incontinence was evaluated at baseline and 4, 8 and 12 weeks after treatment with propiverine hydrochloride. Subjective symptoms were evaluated using the Overactive Bladder Symptom Score and the International Consultation on Incontinence Questionnaire-Short Form. Functional urethral length and maximum urethral closing pressure were also measured at baseline and 12 weeks after treatment at the institutions where the urethral pressure profile was taken., Results: In total, 49 mixed-type urinary incontinence patients were enrolled in the present study. The number of cases of urgency urinary incontinence was reduced time-dependently, which showed statistically significant differences between baseline and 4, 8 and 12 weeks after treatment. A similar statistically different reduction was also observed for stress urinary incontinence. The mean reduction rates of urgency urinary incontinence and stress urinary incontinence at 12 weeks after treatment were 63.9% and 44.3%, respectively. The total scores of International Consultation on Incontinence Questionnaire-Short Form and Overactive Bladder Symptom Score were gradually reduced, and the differences were statistically significant. Functional urethral length and maximum urethral closing pressure at 12 weeks after treatment did not show any statistical differences compared with those at baseline., Conclusions: Propiverine hydrochloride can be an effective therapeutic option for stress urinary incontinence in patients with mixed-type urinary incontinence., (© 2018 The Japanese Urological Association.)

Objective: To identify the most frequent type of urinary incontinence in women assisted in two outpatient clinics of urogynecology, and to compare general and specific quality of life among the different types of incontinence measured through validated questionnaires., Method: Cross-sectional study conducted at the urogynecology outpatient clinic. The following questionnaires were used for quality of life assessment: Medical Outcomes Study 36-item Short-Form Health Survey (SF-36), International Consultation Incontinence Questionnaire Short-Form (ICIQ-SF), King's Health Questionnaire (KHQ), and Pelvic Organ Prolapse Incontinence Sexual Questionnaire (PISQ-12)., Results: The study included 556 women. Mixed Urinary Incontinence was the most frequent type (n=348/62.6%), followed by Stress Urinary Incontinence (n=173/31.1%) and Urge Urinary Incontinence (n=35/6.3%). Women with mixed urinary incontinence had greater impact on the general (SF-36) and specific quality of life (KHQ and ICIQ-SF) compared to the others (p<0.05). In the evaluation of sexual function (PISQ-12), there was no difference between groups (p=0.28)., Conclusion: All types of urinary incontinence interfere both in the general and specific quality of life, but women with mixed urinary incontinence are the most affected.

Objective: To evaluate the effects of different subtypes of urinary incontinence (UI) on sexual function and quality of life (QoL)., Materials and Methods: Ninety-three women with UI were enrolled in the observational study. By the urodynamic findings, 32 women (34.5 %) were diagnosed with stress urinary incontinence (SUI), 35 (37.6%) with urgency urinary incontinence (UUI), and 26 (27.9%) with mixed urinary incontinence (MUI). The Short Form-36 questionnaire was used to investigate the QoL, and the Female Sexual Function Index and Female Sexual Distress Scale questionnaires were used to study sexual function and sexual distress, respectively., Results: Low mean total Female Sexual Function Index scores and high mean Female Sexual Distress Scale total scores were obtained for each group. However, women with MUI showed a significantly higher impairment of female sexual function (P <.05) compared with others. Women with MUI and UUI had more orgasmic disorder than those with SUI, and women with MUI and SUI had mainly lower sexual desire than those with UUI. QoL was worse in women of all groups, particularly in those with UUI and MUI., Conclusion: UI, whatever its nature, has a significant impact on sexual function; notwithstanding, the subgroups of UI, namely SUI, UUI, and MUI, may have their sexual function affected in different ways. All subtypes of UI can have severe consequences on perception of QoL, but when compared, a significantly high impairment of QoL was observed in the MUI and the UUI groups., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Women are affected dramatically by urinary incontinence (UI). This disease is currently considered as epidemic., Objective: The objective of this review is to identify, through the best available evidence, how women experience UI worldwide., Inclusion Criteria Types of Participants: The current review included studies of adult women who had experienced UI., Phenomena of Interest: Women with UI from various social and cultural settings were included in this review., Types of Studies: Qualitative data including, but not limited to, study designs such as phenomenology, grounded theory, ethnography, action research and feminist research were included in this review., Outcomes: All aspects related to the experience of UI endured by women were considered., Search Strategy: An initial search of MEDLINE (PubMed) and CINAHL was done, followed by the exploration of all the databases and all identified studies, published in English, Spanish, French and Portuguese. The databases searched were CINAHL, PubMed, PsycINFO, Lilacs, Scielo, BVS, BVS-Psi, Scopus, Embase, Sociological Abstracts, Dissertation Abstracts International and the University of São Paulo Dissertations and Thesis bank and gray literature., Methodological Quality: Each primary study was assessed by two independent reviewers for methodological quality. The Joanna Briggs Institute Qualitative Appraisal and Review Instrument (JBI-QARI) data extraction form for interpretive and critical research was used to appraise the methodological quality of all papers., Data Extraction: Qualitative data were extracted using the JBI-QARI., Data Synthesis: Qualitative research findings were synthesized using the JBI-QARI., Results: From the 28 studies were included, 189 findings were extracted and they were grouped into 25 categories and eight synthesized findings: (i) cultural and religious backgrounds and personal reluctance contribute to delays in seeking UI treatment; (ii) the inevitable and regrettable problem of UI endured silently and alone affects women's daily activities and their social roles; (iii) poor knowledge and the vague nature of the symptoms mask the fact that UI is a disease; (iv) the experiences provoked by UI and the sense of shame regarding the condition have contributed to impair women's lives; (v) UI has provoked negative effects on women's intimacy and sexual satisfaction and provoked changes in the ways they experience their sexuality and sexual function; (vi) UI is considered a consequence of pregnancy and childbirth, inherent to aging or a religious punishment; (vii) the women affected by UI adopt several strategies to improve their health status; and (viii) women have personal preferences toward care providers and treatments; they confront difficulties through UI treatment and some care needs are not met., Conclusion: Personal and tailored health care should be provided, and preferences and expectations should be taken into consideration in the provision of health care to the people affected by UI.

Male urinary incontinence is an underestimated and frequently not broached issue. The urinary incontinence is divided into stress-, urge incontinence and hybrid forms as well as overflow incontinence. The fact that there are increasingly more men over 60 means that the prevalence of the urinary incontinence is up to 40%, and urinary incontinence will increasingly gain importance in daily routine practice. Many investigations and therapies can be realized by the general practitioner. Already simple therapy approaches can lead to a considerable clinical improvement of male urinary incontinence. If the initial therapy fails or pathological results (i. e. microhaematuria, recurrent urinary tract infections, raised residual urine and so on) are found, the patient should be referred to a urologist.

Introduction: The aim of the study was to analyse the correlation of subjective complaints and urethral pressure profilometry (UPP) data in women with different types of urinary incontinence (UI): stress UI (SUI), urgency UI (UUI), and mixed UI (MixUI)., Methods: A study group of 405 women with complaints about UI were surveyed (UDI-6; ICIQ-UI) to determine the subjectively dominant type of UI, and UPP was performed for all these women. The variables analysed by UPP were the maximum urethral closure pressure at rest (MUCPrest), maximum urethral closure pressure at cough stress (MUCPstress), functional urethral length at rest (FULrest), functional urethral length during cough stress (FULstress) test and pressure transmission ratio (PTR). The statistical variation between different groups of UI patients was calculated for all the analysed variables., Results: The value of PTR was statistically and significantly higher in the group of patients with isolated UUI, compared to the SUI and MixUI groups. The MUCPrest and MUCPstress values were consistently lower in women with isolated SUI, compared to isolated UUI. The FULrest and FULstress values showed no statistically significant difference between the groups with different types of UI., Conclusions: The PTR value is a result of UPP test that helps in distinguishing objectively between UUI, SUI, and MixUI. The PTR value can be used to characterise the hypermobility of urethra. The MUCPrest and MUCPstress values are consistently lower in women with isolated SUI, compared to those with isolated UUI. MUCP can be used as an objective criterion for differentiation of these 2 groups of patients., (© 2016 S. Karger AG, Basel.)

Urinary incontinence, the involuntary leakage of urine, is caused by a variety of factors and may result in a wide range of urinary symptoms that can affect women's physical, psychological, and social well-being and sometimes can impose significant lifestyle restrictions. Identifying the etiology of each woman's urinary incontinence symptoms and developing an individualized treatment plan is essential for improving her quality of life. The purpose of this joint document of the American College of Obstetricians and Gynecologists and the American Urogynecologic Society is to review information on the current understanding of urinary incontinence in women and to outline guidelines for diagnosis and management that are consistent with the best available scientific evidence.

Purpose: To identify the impact of urinary incontinence (UI) on quality of life (QoL), to compare the scores of QoL domains in women with stress urinary incontinence (SUI), overactive bladder (OAB) and mixed incontinence (MUI) and to establish the association between the clinical type of UI and the impact on QoL., Methods: Data of 181 incontinent women attended at a public hospital were collected regarding age, body mass index (BMI) and co-morbidities. King's Health Questionnaire (KHQ) was applied and patients were classified into two groups according to the self-assessment of incontinence impact. KHQ scores were compared by the Mann-Whitney test. Depending on their urinary symptoms, women were divided into SUI, OAB and MUI groups and their scores in the KHQ domains were compared by the Kruskal-Wallis and Dunn tests. The odds ratio (OR) of a woman reporting a worse effect of UI on QoL was estimated using the binary logistic model. The control variables were: age, BMI and number of co-morbidities., Results: A significant difference was found between the two groups of self-assessment of UI impact for all KHQ domains. The MUI group showed worse scores than the SUI group for all domains, and OAB group, for limitation of physical and daily activities. There was a significant difference between the odds of the women in the SUI and MUI groups reporting worse effects of UI on QoL (OR=2.9; p=0.02)., Conclusion: As reported at other reference services, MUI was the most commom type, and urinary loss had a moderate/major impact on QoL, affecting mainly role limitations domain. The adjusted analysis showed that women with MUI had almost three times greater odds of reporting worse impact on QoL than women with SUI.

This article aims to assist urologic nurses in the assessment and management of adults with urinary incontinence, with special consideration given to the geriatric patient. Additionally, discussion will include classifications of the disorder, risk factors, and applicable age-related impacts.

Aims: To evaluate the relationship between body mass index (BMI) and urinary incontinence (UI) in adults ≥40 from the United States, United Kingdom, and Sweden., Methods: This was a secondary analysis of EpiLUTS-a population-representative, cross-sectional, Internet-based survey conducted to assess the prevalence and HRQL impact of urinary symptoms. UI was evaluated by the LUTS Tool and categorized by subgroups: no UI, urgency urinary incontinence (UUI), stress urinary incontinence (SUI), mixed urinary incontinence (MUI) (UUI + SUI), UUI + other UI (OI), SUI + OI, and OI. Descriptive statistics were used. Logistic regressions examined the relationship of BMI to UI controlling for demographics and comorbid conditions., Results: Response rate was 59%; 10,070 men and 13,178 women were included. Significant differences in BMI were found across UI subgroups. Obesity rates were highest among those with MUI (men and women), SUI + OI (women), UUI and UUI + OI (men). Logistic regressions of each UI subgroup showed that BMI ≥ 30 (obese) was associated with UI in general and MUI (women) and UUI + OI (men). Among women, being obese increased the odds of having SUI and SUI + OI. Women with BMI 25-29.9 (overweight) were more likely to have UI in general and SUI with and without other incontinence (SUI, MUI, and SUI + OI). Being overweight was unrelated to any form of UI in men., Conclusions: Results were consistent with prior research showing BMI is associated with higher risk of UI. These findings indicate substantial differences in obesity by gender and UI subtype, suggesting different mechanisms for UI other than purely mechanical stress on the bladder., (© 2013 Wiley Periodicals, Inc.)

Elimination disorders are common in childhood and adolescence. Enuresis is traditionally defined as wetting from the age of 5 years and encopresis as soiling from 4 years onwards - after all organic causes have been excluded. In the past decades, many subtypes of elimination disorders have been identified with different symptoms, etiologies, and specific treatment options. Unfortunately, the DSM-5 criteria did not integrate these new approaches. In contrast, classification systems of the International Children's Incontinence Society (ICCS) for enuresis and urinary incontinence as well as the ROME-III criteria for fecal incontinence offer new and relevant suggestions for both clinical and research purposes.

Purpose of Review: A review of the diagnosis of male urinary incontinence, with particular reference to studies published within the last year., Recent Findings: One of the most important studies from the last year is the drafting of a bladder diary, consistent with the International Consultation on Incontinence modular Questionnaire modules. Patients and clinicians have been consulted on content and format, and further phases are intended to test validity and reliability of the diary., Summary: Initial assessment of men with incontinence involves a focussed history, examination and simple investigations. It is imperative to accurately define terminology of lower urinary tract symptoms. Questionnaires and bladder diaries are important adjuncts. Further urodynamic assessment may also aid diagnosis, particularly in situations where surgery is contemplated.

Urinary incontinence isn't a fatality anymore. This pathology, which handicaps a large majority of the female population, should be treated in a global approach of the pelvic floor pathologies. Up to 25% of women over 65 years will suffer from urinary incontinence but age is not a discriminating factor in the appearance of this pathology. Comportemental and physiotherapeutical treatments are primordial. In case of lack of good results, surgery may offer good results in urinary incontinence and pharmacological treatment for urge urinary incontinence. In this text, the most common treatment options will be discussed.

Objective: To estimate how symptom severity, extent of bother, and quality of life differ across urinary incontinence (UI) subtypes., Methods: We evaluated prevalent UI cases from the Nurses' Health Studies, including women aged 41-83 years. Women with UI (leaking more than once per month) were subclassified according to reported symptoms such as stress UI (SUI, leakage with activity), urge UI (UUI, leakage with urgency), or mixed UI (SUI and UI co-occurring equally). The UI severity was assessed in 102,418 women based on the Sandvik severity index. In a subset of older women with weekly UI, we asked about bother (n=1,697) and quality of life (Incontinence Impact Questionnaire; n=1,748). The UI severity, bother, and quality of life were compared across subtypes using polytomous logistic regression, adjusting for other characteristics., Results: The distributions of UI subtypes were 51% SUI, 27% UUI, and 22% mixed UI. Approximately half had slight UI, 26% had moderate UI, and 23% had severe UI. Severe UI was more common in women reporting mixed UI (37%) than UUI (27%) or SUI symptoms (15%) (P<.001). More women with severe mixed (21%; P=.02) and UUI symptoms (13%; P=.1) reported being "greatly" bothered by their UI compared with SUI (10%). Women with severe mixed (mean 18.0; P<.001) and UUI symptoms (mean 13.4; P=.004) had higher mean incontinence effect scores compared with SUI (mean 9.8)., Conclusion: Women reporting mixed UI symptoms describe more severe and bothersome incontinence, with higher effect on quality of life., Level of Evidence: II.

Most cases of urinary incontinence in women fall under one of three major subtypes: urge, stress, or mixed. A stepped-care approach that advances from least invasive (behavioral modification) to more invasive (surgery) interventions is recommended. Bladder retraining and pelvic floor muscle exercises are first-line treatments for persons without cognitive impairment who present with urge incontinence. Neuromodulation devices, such as posterior tibial nerve stimulators, are an option for urge incontinence that does not respond to behavioral therapy. Pharmacologic therapy with anticholinergic medications is another option for treating urge incontinence if behavioral therapy is unsuccessful; however, because of adverse effects, these agents are not recommended in older adults. Other medication options for urge incontinence include mirabegron and onabotulinumtoxinA. Sacral nerve stimulators, which are surgically implanted, have also been shown to improve symptoms of urge incontinence. Pelvic floor muscle exercises are considered first-line treatment for stress incontinence. Noninvasive electrical and magnetic stimulation devices are also available. Alternatives for treating stress incontinence include vaginal inserts, such as pessaries, and urethral plugs. Limited or conflicting evidence exists for the use of medications for stress incontinence; no medications are approved by the U.S. Food and Drug Administration for this condition. Minimally invasive procedures, including radiofrequency denaturation of the urethra and injection of periurethral bulking agents, can be used if stress incontinence does not respond to less invasive treatments. Surgical interventions, such as sling and urethropexy procedures, should be reserved for stress incontinence that has not responded to other treatments., (Copyright © 2013 American Academy of Family Physicians.)

Urinary incontinence is common, increases in prevalence with age, and affects quality of life for men and women. The initial evaluation occurs in the family physician's office and generally does not require urologic or gynecologic evaluation. The basic workup is aimed at identifying possible reversible causes. If no reversible cause is identified, then the incontinence is considered chronic. The next step is to determine the type of incontinence (urge, stress, overflow, mixed, or functional) and the urgency with which it should be treated. These determinations are made using a patient questionnaire, such as the 3 Incontinence Questions, an assessment of other medical problems that may contribute to incontinence, a discussion of the effect of symptoms on the patient's quality of life, a review of the patient's completed voiding diary, a physical examination, and, if stress incontinence is suspected, a cough stress test. Other components of the evaluation include laboratory tests and measurement of postvoid residual urine volume. If the type of urinary incontinence is still not clear, or if red flags such as hematuria, obstructive symptoms, or recurrent urinary tract infections are present, referral to a urologist or urogynecologist should be considered., (Copyright © 2013 American Academy of Family Physicians.)

Objective: To classify the Expanded Prostate Cancer Index Composite (EPIC)-Short Form urinary domain (EPIC-UIN) scores, as part of a validated health-related quality of life instrument after prostate cancer treatment into clinically meaningful functional categories., Materials and Methods: Using a prospectively maintained database, approved by the institutional review board, of patients undergoing prostatectomy for malignancy, the patient and tumor factors and validated health-related quality of life instruments, including EPIC-UIN and the Incontinence Severity Index (ISI) were retrospectively reviewed. The questionnaires were completed preoperatively, at 3, 6, 9, and 12 months postoperatively, and yearly thereafter. Cutpoints were chosen for the EPIC-UIN scores to correlate with ISI, and statistical analysis querying this correlation was performed., Results: A total of 446 patients completing 764 questionnaires were reviewed. On average, the patients were 59.2 years old with a Gleason score of 6.75. All patients underwent robotic-assisted (n=224) or radical retropubic (n=222) prostatectomy. The range of ISI scores at the prescribed measurement points was "mild" (0-6), "moderate" (7-16), and "severe" (≥17) in 58.9%, 28.9%, and 11.3% of patients, respectively. An EPIC-UIN score of 0-49, 50-69, and 70-100 was chosen to correlate with the ISI score of "severe," "moderate," and "mild," with an agreement of 74.1% (weighted kappa coefficient 0.6541). Severe incontinence and moderate incontinence on the EPIC-UIN were associated with a sensitivity of 74% and 90.6% and specificity of 90.2% and 93.6%, respectively., Conclusion: Categorical EPIC-UIN groups were developed to represent the mild, moderate, and severe incontinence. These categories provided meaningful guides for assessing postoperative urinary incontinence and recovery of urinary function., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Objective: To determine the bothersomeness and effect on quality of life (QOL) of different types of urinary incontinence (UI) in married women living in eastern Turkey., Materials and Methods: A total of 1049 married women was evaluated in the present population-based, cross-sectional study. QOL was assessed using a validated form of the Turkish version of the Incontinence Impact Questionnaire Short Form. The effects of UI subtype on the overall QOL score and on the individual domain scores were determined. The relationship between several demographic characteristics such as age, weight, education level, number of pregnancies, number of live deliveries, and presence of pelvic organ prolapse and the QOL changes was examined., Results: The mean age of the women was 44.62 ± 11.01 years (range 17-80). Of the women with UI, 76.2% stated that the UI had a negative effect on their QOL. Women with mixed UI and severe UI had the worst QOL scores. The QOL changes for the different domains revealed that entertainment activities were affected least, and emotional health and feelings of frustration were the 2 domains that showed the most significant deterioration. Furthermore, older and unemployed women, housewives, women living in urban areas, and women with multiple births, difficult labor, and increased weight experienced significant negative effects on their QOL., Conclusion: Our results have shown that, regardless of different factors, UI has significant negative effects on QOL. The presented data emphasize the importance of the high prevalence of UI in our region and its negative effects on QOL. Thus, additional policies are needed for the prevention of the negative effects of UI., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Purpose: Overactive bladder is subtyped into overactive bladder-wet and overactive bladder-dry, based on the presence or absence, respectively, of urgency incontinence. To better understand patient and physician perspectives on symptoms among women with overactive bladder-wet and overactive bladder-dry, we performed patient focus groups and interviews with experts in urinary incontinence., Materials and Methods: Five focus groups totaling 33 patients with overactive bladder symptoms, including 3 groups of overactive bladder-wet and 2 groups of overactive bladder-dry patients, were conducted. Topics addressed patient perceptions of overactive bladder symptoms, treatments and outcomes. A total of 12 expert interviews were then done in which experts were asked to describe their views on overactive bladder-wet and overactive bladder-dry. Focus groups and expert interviews were transcribed verbatim. Qualitative data analysis was performed using grounded theory methodology, as described by Charmaz., Results: During the focus groups sessions, women screened as overactive bladder-dry shared the knowledge that they would probably leak if no toilet were available. This knowledge was based on a history of leakage episodes in the past. Those few patients with no history of leakage had a clinical picture more consistent with painful bladder syndrome than overactive bladder. Physician expert interviews revealed the belief that many patients labeled as overactive bladder-dry may actually be mild overactive bladder-wet., Conclusions: Qualitative data from focus groups and interviews with experts suggest that a spectrum exists between very mild overactive bladder-wet and severe overactive bladder-wet. Scientific investigations are needed to determine whether urgency without fear of leakage constitutes a unique clinical entity., (Copyright © 2012 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)

Urinary incontinence is a common problem in the elderly which is under-reported and under-treated.It can have profound effects on the quality-of-life of affected persons and their companion or caregiver. Though common, incontinence is not an inevitable consequence of aging, but multiple anatomic and physiologic age-related changes increase the risk of UI with advancing age. Many treatment modalities are available for managing UI, some more effective than others. Patient education, and careful selection of treatment modalities can significantly improve urinary incontinence, and in some cases cure it, but treatment complications and side effects are common and must be closely monitored for successful long-term management. Surgical management of stress incontinence is a safe and effective intervention that is underutilized.

Purpose: To validate the Persian version of the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) as a standard questionnaire for assessment of urinary incontinence (UI)., Materials and Methods: After translation and back translation of the questionnaire, the harmonized translation was pre-tested in a pilot study on 28 patients. The final Persian version of the ICIQ-UI SF was administered to 123 consecutive patients aged ≥ 16 years complaining of UI. The psychometric aspects of the questionnaire, such as reliability and construct validity, were assessed and compared with full urodynamics study's findings as the gold standard diagnostic test., Results: Mean age of the participants was 46.30 ± 13.14 years (range, 16 to 72 years). Based on ICIQ-UI SF, the prevalence of mixed urinary incontinence, stress urinary incontinence and urgency urinary incontinence was 35%, 34.1%, and 30.9%, respectively. Cronbach's alpha coefficient was calculated 0.75, which indicates the high reliability of this questionnaire in determination of UI. The obtained Weighted Kappa Index in determining the value of the test-retest was 0.70, and Pearson Correlation Coefficient was calculated 0.93 and intra-class correlation coefficient was 0.84., Conclusion: Persian version of ICIQ-UI SF is a simple, valid, and reliable method for evaluation of patients with UI. Significant correlation exists between ICIQ-UI SF score and urodynamics parameters.

Whilst symptoms of bladder outlet obstruction (BOO) and post micturition symptoms are more commonly reported in men a significant number of women may also complain of voiding dysfunction. However, despite the recent advances in the standardisation of terminology of lower urinary tract dysfunction there remains a lack of consensus regarding a precise diagnosis and definition of voiding abnormalities in women. In addition voiding symptoms may co-exist with storage symptoms as well as those associated with urinary incontinence. Consequently many patients present with a spectrum of different urinary symptoms, related to both storage and voiding, which may be multifactorial in origin or be related to one another. The purpose of this paper is to review the current literature in order to accurately define and classify female voiding dysfunction including causes and aetiology. In addition to reviewing the investigation and management of those women with voiding dysfunction recommendations are proposed for management in clinical practice as well as suggestions for future research., (Copyright © 2012 Wiley Periodicals, Inc.)

In this paper authors describe classification, preliminary diagnosis of urinary incontinence. They also show ways of pharmacological therapy and kinds of available medicines, which are administer in treatment of women with urinary incontinence symptoms of neurologic descent and overactive bladder.

Purpose: We determined the incidence and resolution rates of different types of urinary incontinence in Australian women and examined the course of urinary incontinence with or without treatment., Materials and Methods: A total of 506 women originally recruited from a community based research database completed a baseline questionnaire in 2006 and a followup questionnaire in 2008. Urinary incontinence incidence and resolution were assessed using the Questionnaire for Urinary Incontinence Diagnosis. The Bristol Female Lower Urinary Tract Symptoms questionnaire was used to assess the impact of urinary incontinence on quality of life., Results: At baseline and followup 442 women provided data. Mean ± SD age was 59.28 ± 12.1 years at followup. The total incidence of any new urinary incontinence was 17% (95% CI 12.4-21.6) in unaffected women and the total resolution rate was 16.8% (95% CI 11.4-22.2) in women with urinary incontinence during 2 years regardless of receiving treatment for urinary incontinence. There was also movement of women among the diagnoses of stress only, urge only and mixed urinary incontinence during followup. A total of 34 women reported having received treatment for urinary incontinence and 5 experienced resolution of the condition. All types of urinary incontinence were associated with impaired quality of life (p <0.001) and adversely impacted daily activity. A negative impact on quality of life (p = 0.02) was also observed in incident cases at followup compared with baseline., Conclusions: Our study shows that urinary incontinence is a highly dynamic clinical condition with movement among diagnostic subtypes of stress only, urge only and mixed urinary incontinence, and periods of resolution. Any urinary incontinence is significantly associated with impaired quality of life., (Copyright © 2011 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)

Purpose: We aimed to explore operational definitions of mixed urinary incontinence (MUI) for use in incontinence outcomes research for non-surgical patient populations., Methods: A secondary analysis of women with urge incontinence or urge predominant MUI enrolled in the Urinary Incontinence Treatment Network BE-DRI randomized clinical trial was performed. Subjects were characterized at baseline for urinary incontinence severity and incontinence subtype (stress or urge) using the Medical, Epidemiologic, and Social Aspects of Aging (MESA) questionnaire, the Urogenital Distress Inventory, and a 7-day urinary diary. Various different definitions of MUI, ranging from low to high threshold, were created using a combination of these baseline incontinence measures. Prevalence of MUI based on each definition was described and compared to treatment response. Logistic regression analysis was used to estimate the association between the study outcomes and the different definitions of MUI., Results: The 307 participants in the BE-DRI study had a mean age of 56.9 (± 13.9) years with a mean total MESA score of 21.7 (± 8.9) and a mean total UDI score of 120.5 (± 49.6). The proportion of women diagnosed with MUI varied significantly by definition ranging from 63.5% to 96.4%. Low threshold symptom-based definitions resulted in nearly universal diagnosis of MUI. No strict cut-off value for these baseline measures was identified to predict clinical outcomes., Conclusions: Current MUI definitions do not adequately categorize clinically relevant UI subgroups. For research purposes we believe it necessary to describe the severity of each incontinence subtype separately in subjects with MUI., (© 2010 Wiley-Liss, Inc.)

This work develops a decision support system based on machine learning and scoring measures to determine the type of urinary incontinence in women with low urinary tract symptoms. This system has two main branches. The former consists of selecting the feature set which best defines the UI type from the set of features (age, weight, etc.) characterizing a patient. This feature set is computed from several scoring measures. The patients characterized by the optimum feature set are then classified according to C4.5 and SVM classifiers. The results are evaluated according to Sensitivity and Specificity evaluation measures. The management of the final system is simple and its performance is high, getting Sensitivities over 80% and Specificities near 100% for some configurations., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Aims: To determine the natural history of new-onset urinary incontinence by type and severity in middle-aged women., Methods: In 1997-1999 2229 randomly selected women aged 41-45 agreed to participate in the Hordaland Women's' Cohort, and six identical postal questionnaires were sent them during the following ten years. Response rate was 95.7% at inclusion and has remained 87% to 93% in subsequent waves. A total of 1274 women were continent at baseline and used as source population for this paper. Distribution of type and severity of new-onset urinary incontinence and changes in these variables during four years follow-up (two checkpoints) were measured., Results: Among 1274 continent women, 514 (40.3%) reported new-onset urinary incontinence during 10 years. Type distribution was 49.8%, 18.3% and 20.3% for stress, urgency and mixed incontinence, respectively. A majority of women (89.3%) started with slight urinary incontinence and none reported severe new-onset urinary incontinence. During four years follow-up of 337 women, 212 (62.9%) reported transient and 125 (37.1%) women reported persistent urinary incontinence. In the latter group 74.6% had the same type of urinary incontinence and 62.4% reported slight grade of incontinence in all reports., Conclusions: Our study demonstrates that in middle-aged women new-onset urinary incontinence is mainly of stress type and of slight severity. One third of the women developed persistent incontinence, with low tendency of shifting type and severity over several years. Mixed urinary incontinence is not a final stage of incontinence in this age group., (Copyright © 2010 Wiley-Liss, Inc.)

The German expert standard "Promotion of urinary continence in nursing" was developed and implemented to support nursing practice. The group of experts involved identified the assessment of (in)continence situations and the evaluation of outcomes as a central problem for successful continence care. They, therefore, developed an assessment instrument in the German language, namely six continence profiles, to help differentiate between continence and incontinence. It also takes into account the extent to which the relevant situation can be promoted or compensated by the application of measures, on the one hand, and independently or dependent on nursing staff assistance, on the other hand. The profiles were developed based on theories and implemented into practice as a model. The current paper describes the theoretical background and development process as well as early results from implementation and testing. However, a comprehensive scientific study must still be performed.

Aims: The aim of this article is to provide insight to clinicians who principally treat adults, about non-neurogenic lower urinary tract symptoms (LUTS) either pre-dating or presenting in adolescence. Assessment fundamentals, diagnostic classification, and rationale behind the process of care are discussed., Methods: Standardized terms are used to describe the current classification of symptoms of LUT dysfunction in young adults. The etiology and symptomatology of continuous and organic incontinence, along with the intermittent presentations of incontinence, nocturnal enuresis, and bowel dysfunction are presented. Minimally acceptable assessment processes are defined. Indications for the inclusion of urodynamic investigations are presented. Throughout the review specific needs of adolescents, as they apply to clinical management of LUTS, are highlighted., Results: Puberty and growth are likely to challenge compensatory mechanisms for a safe urinary system in young adults with organic/structural/developmental LUT disorders. The priority of care is to screen for and detect precursor signs of renal deterioration. In adolescents with non-neurogenic bladder dysfunction a clear diagnosis and identification of both incomplete bladder emptying and high detrusor pressure will minimize permanent changes to both the upper and lower urinary tracts., Conclusions: The assessment of adolescents with LUTS requires time, thoughtful enquiry, and communication. Dysfunction pre-dating young adulthood commonly inhibits autonomy, recreational and social activities thus impacting on the adolescent's self-esteem and adherence to treatment regimes., ((c) 2010 Wiley-Liss, Inc.)

Incontinence for urine and stool as well as genital prolapse and pain has been widely discussed in public media. Nevertheless patients suffering from these problems are still not ready to actively seek help. Therefore the general practitioner plays a major role to identify these women especially when medical help is necessary. According to the guidelines of the International Consultation of Incontinence the general practitioner also plays a major role when it comes to basic treatment options. Networking these patients with the urogenecology specialist is mandatory in order to get the best results possible for an individual patient.

Using prospective data from 983 British women born in 1946, the study aims to describe the profiles of symptoms of stress, urge, and severe incontinence, and to relate these to change in quality of life. Based on the longitudinal patterns of symptoms experienced, four groups of women were defined: 'low symptom', 'onset', 'recovering', and 'chronic'. Childhood enuresis was associated with being in the 'chronic' group for urge and severe incontinence. Women in the 'recovering' group for stress incontinence experienced an improvement in the physical health domain (regression coefficient (95% CI): 0.1(0.02, 0.18)) compared with women without symptoms. This relationship existed beyond the effects of ageing, menopausal status, current life stress, and reproductive, lifestyle, and social factors. More research is needed to understand the mechanism that link childhood enuresis to being in the 'chronic' group for urge and severe incontinence.