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Qi Wang,1,* Yan-Zhen Que,2,* Xiao-Ying Wan,2 Chao-Qin Lin1 1Department of Gynecology, Fujian Provincial Key Laboratory of Women and Children’s Critical Diseases Research, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, People’s Republic of China; 2Department of Gynecology and Obstetrics, Shaxian General Hospital, Sanming, People’s Republic of China*These authors contributed equally to this workCorrespondence: Chao-Qin Lin, Department of Gynecology, Fujian Provincial Key Laboratory of Women and Children’s Critical Diseases Research, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, 18 Dao-shan street, Gu-lou District, Fuzhou, 350000, People’s Republic of China, Tel +8613950422970, Email lcqfjsfy@126.comPurpose: To investigate the prevalence, risk factors, and impact on quality of life (QOL) of female urinary incontinence (UI) in a region of southeastern China.Patients and Methods: This cross-sectional study, conducted between June 2022 and March 2023, included 9584 women aged 20– 70 years who completed a standardized questionnaire through face-to-face interviews. This sample size represents almost 10% of the population in the target area.Results: The prevalence of female UI was found to be 24.8%, with stress UI being the most common subtype (12.7%), followed by mixed UI (8.0%) and urgency UI (4.1%). Notably, the prevalence of UI increased progressively with age and body mass index (BMI). The study also revealed several risk factors for UI, including urban residence, postmenopausal status, multiple vaginal deliveries, instrumental vaginal deliveries, previous delivery of macrosomia, and prior history of pelvic floor surgery as determined by multivariate analysis. Furthermore, the study showed that 89.5% of women who reported UI experienced varying degrees of negative impact on their QOL. The incontinence quality of life (I-QOL) scale had an average score of 79.70± 19.03, which decreased with increasing severity of UI. Despite the adverse effects on QOL, only 20.6% of women with UI had sought medical help.Conclusion: UI is common among women in the survey area. UI has been observed to have varying degrees of adverse effects on the QOL of those affected, but most of them do not seek treatment for several reasons, highlighting the urgent need for health authorities to develop effective UI intervention strategies.Keywords: female urinary incontinence, epidemiology, prevalence, risk factors, quality of life, Southern Chinese

The article summarises the guidelines of the International Continence Society (ICI-7) for the management of male and female urinary incontinence. The author's opinion on the state of the problem from the perspective of its relevance in the field of modern practical urology is expressed.

Introduction and Hypothesis The aim was to conduct a scoping review of the literature on the use of machine learning (ML) in female urinary incontinence (UI) over the last decade. Methods A systematic search was performed among the Medline, Google Scholar, PubMed, and Web of Science databases using the following keywords: [Urinary incontinence] and [(Machine learning) or (Predict) or (Prediction model)]. Eligible studies were considered to have applied ML model to explore different management processes of female UI. Data analyzed included the field of application, type of ML, input variables, and results of model validation. Results A total of 798 papers were identified while 23 finally met the inclusion criteria. The vast majority of studies applied logistic regression to establish models (91.3%, 21/23). Most frequently ML was applied to predict postpartum UI (39.1%, 9/23), followed by de novo incontinence after pelvic floor surgery (34.8%, 8/23).There are also three papers using ML models to predict treatment outcomes and three papers using ML models to assist in diagnosis. Variables for modeling included demographic characteristics, clinical data, pelvic floor ultrasound, and urodynamic parameters. The area under receiver operating characteristic curve of these models fluctuated from 0.56 to 0.95, and only 11 studies reported sensitivity and specificity, with sensitivity ranging from 20% to 96.2% and specificity from 59.8% to 94.5%. Conclusion Machine learning modeling demonstrated good predictive and diagnostic abilities in some aspects of female UI, showing its promising prospects in near future. However, the lack of standardization and transparency in the validation and evaluation of the models, and the insufficient external validation greatly diminished the applicability and reproducibility, thus a focus on filling this gap is strongly recommended for future research.

Urinary Incontinence (UI) has been identified as a health priority by the World Health Organization. Despite being a widely discussed topic, UI remains an underrecognized condition: affected individuals often refrain from reporting it due to its status as a socially sensitive topic and a source of embarrassment. UI exhibits a markedly higher prevalence in the female population compared to males and significantly diminishes the quality of life for those affected. It impacts various personal, relational, and social domains in which women aged 40–65 years are often actively engaged. Moreover, the most recent Italian prevalence publications date back to the early 2000s. Consequently, an observational study focused on UI in Italy could provide valuable insights. This paper outlines a protocol designed to investigate the point prevalence, risk factors, quality of life, social impact and economic burden of UI in female patients, caregivers, healthcare and administrative workers aged 40–65 years across four hospitals in Northern Italy using a survey (UI SURVEY) and two questionnaires validated in Italian (ICIQ UI-SF and IIQ-7). The findings of this study could also inform nursing and midwifery practices in the management of women affected by UI.

Objectives: We aimed to evaluate management strategies for female urinary incontinence, specifically stress urinary incontinence (SUI), and anterior vaginal prolapse (pelvic organ prolapse, POP), emphasizing diagnostic methods, treatment options, and factors influencing surgical outcomes. Methods: We conducted a thorough literature review examining diagnostic tools, including physical examinations, urodynamic testing, and pessary evaluations, alongside treatment options for SUI and POP. Both surgical interventions, such as mid-urethral sling placement and anterior colporrhaphy, and non-surgical methods, including pelvic floor exercises, were analyzed. This review assesses these approaches’ efficacy, complications, and outcomes, incorporating current clinical guidelines and evidence-based practices. Results: Evidence indicates that SUI frequently coexists with POP, with a notable proportion of cases being occult until a prolapse is reduced. Diagnostic methods such as pessary testing and urodynamic evaluations are essential in identifying masked SUI, though their predictive accuracy varies. Surgical techniques such as using mid-urethral slings are highly effective but pose risks, including voiding dysfunction and lower urinary tract injury. Long-term data emphasize the need for personalized treatment strategies, with combined procedures showing superior outcomes for the concurrent management of POP and SUI in select cases. Conclusions: Effective management of SUI and POP requires a personalized approach, factoring in the severity of a prolapse and the likelihood of postoperative incontinence. While conservative treatments are practical initial options, surgical solutions, such as mid-urethral slings and apical suspension procedures, offer robust, lasting results for advanced cases. Preoperative diagnostics, collaborative decision-making, and tailored treatment plans are essential to optimize success and minimize complications. Future research should prioritize enhancing diagnostic precision and refining surgical methods to further advance patient care.

Abstract Background The minimal important difference is a valuable metric in ascertaining the clinical relevance of a treatment, offering valuable guidance in patient management. There is a lack of available evidence concerning this metric in the context of outcomes related to female urinary incontinence, which might negatively impact clinical decision-making. Objectives To summarize the minimal important difference of patient-reported outcome measures associated with urinary incontinence, calculated according to both distribution- and anchor-based methods. Methods This is a systematic review conducted according to the PRISMA guidelines. The search strategy including the main terms for urinary incontinence and minimal important difference were used in five different databases (Medline, Embase, CINAHL, Web of Science, and Scopus) in 09 June 2021 and were updated in January 09, 2024 with no limits for date, language or publication status. Studies that provided minimal important difference (distribution- or anchor-based methods) for patient-reported outcome measures related to female urinary incontinence outcomes were included. The study selection and data extraction were performed independently by two different researchers. Only studies that reported the minimal important difference according to anchor-based methods were assessed by credibility and certainty of the evidence. When possible, absolute minimal important differences were calculated for each study separately according to the mean change of the group of participants that slightly improved. Results Twelve studies were included. Thirteen questionnaires with their respective minimal important differences reported according to distribution (effect size, standard error of measurement, standardized response mean) and anchor-based methods were found. Most of the measures for anchor methods did not consider the smallest difference identified by the participants to calculate the minimal important difference. All reports related to anchor-based methods presented low credibility and very low certainty of the evidence. We pooled 20 different estimates of minimal important differences using data from primary studies, considering different anchors and questionnaires. Conclusions There is a high variability around the minimal important difference related to patient-reported outcome measures for urinary incontinence outcomes according to the method of analysis, questionnaires, and anchors used, however, the credibility and certainty of the evidence to support these is still limited.

Urinary incontinence (UI) is a common health condition that may interfere with the quality of life. A comprehensive evaluation of female UI helps with effective and safe treatments. Ultrasound has gained popularity to explore UI recently because it can collect crucial information for treatment planning and counseling. Translabial and introital approaches are commonly and reliably applied to ultrasound. The images can be obtained using two-dimensional and three-dimensional ultrasounds. Ultrasound is the only modality capable of confirming the presence or absence of a mid-urethral sling (MUS) and is able to demonstrate bulking agents as well. Although some of the ultrasound findings may only be incidental or supplementary to the patient's symptoms, ultrasound benefits for investigating the pathophysiology of UI and surgical outcomes of MUS procedures. It is anticipated that standardization in terminology, measurement techniques, and reporting can be established in the near future.

Background/Objectives: To investigate the utility of transperineal ultrasound in detecting stress urinary incontinence (SUI) and identify optimal anatomical and functional parameters. Methods: Thirty-four women presenting with SUI with or without pelvic organ prolapse between 2012 and 2016 were studied. The control group included patients without SUI who underwent surgery for mild gynecologic disorders or pelvic organ prolapse. The relationship between selected ultrasound parameters and SUI was determined. Results: Among the 20 variables measured in ultrasonography using 4 angles and the bladder–symphysis distance (BSD) values, we found that the difference in the BSD obtained at rest and during the Valsalva maneuver (odds ratio [OR]: 1.15, 95% confidence interval [CI]: 1.05–1.27, p = 0.004), the mean urethral diameter (UD; OR: 4.29, 95% CI: 2.07–8.83, p = 0.0001), and the occurrence of the funneling sign during the Valsalva maneuver (OR: 21; 95% CI: 6.1–71.9, p < 0.0001) were associated with urinary incontinence in the logistic regression analysis. The optimal cut-off point for BSD was >8 mm (area under the curve (AUC), 0.71; sensitivity, 91.2%; specificity, 56.8%; p = 0.001) and that for UD was >6 mm (AUC, 0.84; sensitivity, 82.1%; specificity, 73%; p < 0.001). Conclusions: Transperineal ultrasonography is a useful tool for detecting SUI. Our findings highlighted the utility of several sonographic parameters, mainly the urethral diameter, in the diagnosis of urinary incontinence.

Background: Factors predictive of the efficacy of pelvic floor muscle training (PFMT) in stress urinary incontinence (SUI) or mixed urinary incontinence (MUI) are poorly defined. Identifying these factors is crucial for guiding treatment decisions, determining training repetitions, and predicting PFMT outcomes., Objective: This study aimed to identify clinical factors predictive of PFMT outcomes in women with primary SUI., Methods: We retrospectively reviewed data from 188 consecutive women with either SUI ( n = 90) or MUI ( n = 98) with a primary stress component. All participants underwent a 3-month PFMT program. Predictive factors for 50% improvement and complete cure of incontinence were assessed through urogynecological history/examination, medical history, digital pelvic floor muscle (PFM) evaluation ( n = 87), and 3-day bladder diaries. Logistic regression analyses were conducted for the overall group and separately for the SUI and MUI subpopulations., Results: At 3 months, 10% of SUI patients and 11.2% of MUI patients achieved complete SUI cure, while 35.7% of MUI patients were free from urge urinary incontinence (UUI). A complete cure of SUI was correlated with a negative or mildly positive results of stress test ( p = 0.014). For MUI patients, complete UUI cure was linked to initial digital PFM evaluation results ( p = 0.003) and negative ( p = 0.005) or mildly positive findings of stress tests ( p = 0.003). The absence of prior surgery and digital evaluation predicted a 50% improvement in MUI ( p = 0.021 and p = 0.026, respectively). Endurance improvement was related independently with >50% improvement in MUI patients (odds ratio = 3.794, p = 0.019)., Conclusion: Negative or mildly positive stress tests and digital PFM evaluation predict better outcomes with PFMT. Further prospective studies are needed to validate these findings., Competing Interests: The authors declare no conflict of interest., (© 2024 Bladder, All rights reserved.)

Introduction: Urinary incontinence is a common complaint of both general practitioners and specialists. An accurate basic diagnosis with a structured medical history and bladder diary, urine analysis, gynaecological examination including pelvic floor assessment and a full bladder cough test can be supplemented by sonography, cystoscopy and urodynamic testing. This will help to differentiate between the different types of urinary incontinence, such as urge incontinence, stress incontinence and overflow incontinence. Treatment should be based on the type of urinary incontinence. Conservative treatments such as pelvic floor physiotherapy and pessaries can be supplemented by electrical stimulation for OAB and overflow incontinence, and various procedures such as TVT or bulking agents for stress incontinence, sacral neurostimulation for OAB and overflow incontinence., Competing Interests: Die Autorinnen und Autoren haben keine Interessenkonflikte im Zusammenhang mit diesem Artikel deklariert., (© 2024 Aerzteverlag medinfo AG.)

Background: Urinary incontinence (UI) is a common condition in female. Oxidative stress and inflammation levels play important roles in UI progression. Mediterranean diet (MD) as a healthy anti-inflammatory dietary pattern has been reported to be associated with several inflammatory diseases. This study aimed to assess the association between the adherence to Mediterranean diet (aMED) and female UI., Methods: Data of study women aged ≥18 years old and diagnosed as stress UI and urgency UI were extracted from the National Health and Nutrition Examination Survey (NHANES) 2005-2018. Dietary intake information was obtained by 24-h dietary recall interview. Covariates included sociodemographic information, physical examination, and history of diseases and medication were extracted from the database. The weighted univariable and multivariate logistic regression models were used to assess the association between aMED and different types of UI, with odds ratios (ORs) and 95% confidence intervals (CIs). Subgroup analysis were further evaluated this association based on different age, body mass index (BMI), neutrophil to lymphocyte ratio (NLR), depression and smoking., Results: Totally, 13,291 women were included, of whom 5,921 (44.55%) had stress UI, 4276 (32.17%) had urgency UI and 2570 (19.34%) had mixed UI. After adjusted all covariates, high aMED score was associated with the lower odds of urgency (OR = 0.86, 95%CI: 0.75-0.98) and mixed UI (OR = 0.84, 95%CI: 0.70-0.99), especially in female, aged 45-60 years old, NLR ≥1.68 and had smoking history. No relationship was found between the aMED and stress UI (P >0.05)., Conclusion: Greater aMED was connected with the low odds of urgency UI and mixed UI among female. Adherence to an anti-inflammatory diet in daily life are a promising intervention to be further explored in female UI., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Xie et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

This study aims to demonstrate the effectiveness of high-intensity focused ultrasound, a noninvasive treatment, for managing urinary incontinence (UI) in women. This is a single-center, retrospective study involving 28 women. Patients, aged between 32 and 65, were included. Patients with insulin-dependent diabetes, neurological disease, active urinary tract infection, undiagnosed vaginal bleeding, who had incontinence surgery, and receiving estrogen therapy were excluded from the study. Incontinence severity was evaluated with the International Incontinence Consultation Questionnaire Short Form (ICIQ-SF). Patients were evaluated before treatment and 6 months after treatment using the ICIQ-SF and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Assessment short form. In the analysis of numerical variables independent or paired t test or linear mixed effects models were used. Least square means were used in post hoc comparisons. Mean age of the patients was 45.50 ± 7.59 years. There were 18 (64%) stress urinary incontinence (SUI) and 10 (36%) mixed urinary incontinence (MUI). Six months after treatment, mean ICIQ-SF and Pelvic Organ Prolapse/Urinary Incontinence Short Form Questionnaire scores showed a significant positive change. After the procedure, UI completely disappeared in 43% of the patients. The rate of severe UI decreased from 39% to 8%, and very severe UI decreased from 8% to 0%. Incontinence severity was significantly different in the MUI and SUI groups before and after the procedure. After the procedure, UI completely disappeared in 67% of the patients in the SUI group, while it remained at a mild level in 33%. The decrease in ICIQ-SF score in the SUI group was significantly higher than that in the MUI group. There were no severe adverse events, in 4 patients there was mild vaginal discharge which resolved in 1 week. This study showed that high-intensity focused ultrasound treatment, can be effective and safe even in a single session. Selection and recall biases are potential biases in retrospective studies. Lacking a control group is another limitation. Although advances in technology are very important for medical treatments, their effectiveness and safety need to be proven. Future research in this area with a larger sample size and a prospective design will offer further evidence supporting effectiveness of this treatment model., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Introduction: Through methodological quality assessment, this paper summarized the report quality and evidence level of systematic reviews (SRs)/meta-analyses (MAs) of acupuncture and its related treatment of female urinary incontinence (UI)., Evidence Acquisition: We conducted a comprehensive search in four internationally recognized databases (PubMed, Embase, Web of Science, Cochrane Library) for SRs/MAs pertaining to the treatment of female UI using acupuncture and its related therapies. We evaluated the methodological quality of the SRs/MAs using the "Assessing the Methodological Quality of Systematic Reviews 2" (AMSTAR-2) tool, assessed the quality of evidence using the "Grading of Recommendations, Assessment, Development, and Evaluation" (GRADE) system, and evaluated the reporting quality of the SRs/MAs using the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020" (PRISMA-2020) guidelines. This overview is registered with PROSPERO, CRD42024557600., Evidence Synthesis: In the final selection of 7 SRs/MAs, a consistent finding of the superiority of acupuncture and related therapies in the treatment of female UI was observed. Methodological quality was classified according to AMSTAR-2, with three rated as "high," two as "moderate," and two as "low." The main sources of downgrading included the absence of funding sources, failure to provide a reasonable explanation for heterogeneity, and not reporting potential conflicts of interest. According to the GRADE system, the quality of evidence ranged from moderate to very low. The most common reason for downgrading the evidence quality was the repeated utilization of the same original randomized controlled trials. Some results were also downgraded due to inconsistency, imprecision, and potential publication bias. According to the PRISMA-2020 statement, most SR/MAs clearly presented their title information, and almost all of them correctly used meta-analysis methods. However, some of them lacked comprehensive analysis and discussion of bias risk and consistency of results and were deficient in terms of protocol registration and documentation., Conclusions: Acupuncture and related therapies demonstrate superiority in terms of efficacy and safety for the treatment of female urinary incontinence (UI). The overall quality of the SRs/MAs seems to be satisfactory, particularly when compared to studies of acupuncture for the treatment of other conditions. However, attention should still be given to the proper use of methods and ensuring completeness in reporting.

BackgroundUrinary incontinence (UI) affects millions of women with substantial health and quality-of-life impacts. Supervised pelvic floor muscle training (PFMT) is the recommended first-line treatment. However, multiple individual and institutional barriers impede women’s access to skilled care. Evidence suggests that digital health solutions are acceptable and may be effective in delivering first-line incontinence treatment, although these technologies have not yet been leveraged at scale. ObjectiveThe primary objective is to describe the effectiveness and safety of a prescribed digital health treatment program to guide PFMT for UI treatment among real-world users. The secondary objectives are to evaluate patient engagement following an updated user platform and identify the factors predictive of success. MethodsThis retrospective cohort study of women who initiated device use between January 1, 2022, and June 30, 2023, included users aged ≥18 years old with a diagnosis of stress, urgency, or mixed incontinence or a score of >33.3 points on the Urogenital Distress Inventory Short Form (UDI-6). Users are prescribed a 2.5-minute, twice-daily, training program guided by an intravaginal, motion-based device that pairs with a smartphone app. Data collected by the device or app include patient-reported demographics and outcomes, adherence to the twice-daily regimen, and pelvic floor muscle performance parameters, including angle change and hold time. Symptom improvement was assessed by the UDI-6 score change from baseline to the most recent score using paired 2-tailed t tests. Factors associated with meeting the UDI-6 minimum clinically important difference were evaluated by regression analysis. ResultsOf 1419 users, 947 met inclusion criteria and provided data for analysis. The mean baseline UDI-6 score was 46.8 (SD 19.3), and the mean UDI-6 score change was 11.3 (SD 19.9; P

Background: Urinary incontinence (UI) significantly affects women’s quality of life globally. Mid-urethral sling (MUS) procedures are common minimally invasive surgeries for treating stress urinary incontinence (SUI) and mixed urinary incontinence (MUI), but comparative outcome studies, especially regarding complication rates, are lacking. The purpose of this study was to assess and compare the efficacy and safety of the retropubic tension-free vaginal tape (TVT) and transobturator tape (TOT) approaches in treating SUI and MUI. The study also aimed to investigate predictive factors for intraoperative and postoperative complications. Methods: A retrospective cohort study was conducted at King Saud University Medical City from February 2016 to October 2022, involving 166 women who underwent either TVT or TOT surgeries. Data were collected on intraoperative and postoperative complications, with statistical analyses performed using chi-square tests and multivariate regression to identify significant predictors of morbidity. Results: The study included 166 patients who underwent MUS procedures, with 61% (n = 102) undergoing retropubic TVT and 39% (n = 64) undergoing TOT surgeries. The demographic characteristics were similar between the groups, with no significant differences in age (p = 0.559), body mass index (BMI) (p = 0.600), or presence of cystocele (p = 0.912). The TVT group experienced a significantly higher rate of intraoperative bladder/urethral perforation compared to the TOT group (9.8% vs. 0%, p = 0.008). Early postoperative complications, including urinary retention, were comparable between the groups (TVT: 10.8%, TOT: 12.5%, p = 0.600). Patients in the TOT group had shorter hospital stays, with 71.9% discharged within one day compared to 41.2% in the TVT group (p < 0.001). At long-term follow-up (>6 months), both groups reported high satisfaction, with 93.7% of TVT and 87.3% of TOT patients reporting good or very good comfort (p = 0.252). However, pain-free status was significantly higher in the TVT group (91.1% vs. 67.2%, p < 0.001). Both retropubic and transobturator MUS techniques are effective for managing SUI, with the transobturator approach showing fewer complications and shorter recovery times. Conclusions: Both retropubic and transobturator MUS techniques are effective for managing SUI, with the transobturator approach showing fewer complications and shorter recovery times. We recommend the formation of a national registry to track long-term outcomes and enhance procedural evidence.

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.