Association of physical activity and sedentary behavior with urinary incontinence in adult women: a systematic review and meta-analysis of observational studies.

Recent findings show that oxidative damage may contribute to lower urinary tract symptoms. Copper can induce oxidative stress while zinc is involved in the defense against oxidative stress. We examined the associations between serum copper and zinc levels and urinary incontinence (UI) in adult women. Data were retrieved from the 2011-2016 National Health and Nutrition Examination Surveys. Outcomes for multivariate logistic regression were any UI (AUI), urge UI (UUI), stress UI (SUI), mixed UI (MUI), and moderate/severe UI. Questions on urinary incontinence were asked by trained interviewers. The weighted UI prevalences were 44.89% for AUI, 28.12% for UUI, 41.64% for SUI, 17.27% for MUI, and 20.79% for moderate/severe UI in adult women. After adjusting for multiple factors, serum copper levels in the highest quartile were associated with UUI [odds ratios (95% confidence intervals): 1.74 (1.11-2.74)]. In women older than 50years, serum copper levels in the highest quartile were associated with UUI [2.94 (1.57-5.49)], AUI [1.97 (1.19-3.27)], MUI [2.43 (1.19-4.97)], and moderate/severe UI [2.37 (1.06-5.31)]. Serum copper levels in the second quartile were also associated with MUI overall [1.75 (1.03-2.97)] and in young women (20-49years) [2.29 (1.02-5.17)]. Positive associations were also found between serum copper levels and UUI in non-obese women. There were no associations between serum zinc levels and UI outcomes. Serum copper levels were associated with UUI, MUI, AUI, and moderate/severe UI in adult women, especially women older than 50years. Causality deserves to be confirmed further.

This study aimed to explore the association between sarcopenia and urinary incontinence in adult women younger than 60 and provide insights into their pathophysiological mechanisms. The study included 4,553 adult female participants aged <60, utilizing data from the National Health and Nutrition Examination Survey (NHANES) database between 2011 and 2018. The appendicular skeletal muscle mass index (ASMI) was assessed using dual-energy X-ray absorptiometry, and sarcopenia was determined based on the resulting ASMI values (< 0.512). The type of urinary incontinence was evaluated using the Kidney Condition-Urology Questionnaire, which categorized incontinence as stress urinary incontinence, urgency urinary incontinence, or mixed urinary incontinence based on the results of the questionnaire. Multivariate adjustment models were constructed to analyze the relationship between ASMI, sarcopenia, and different types of urinary incontinence. The model incorporated a range of sociodemographic characteristics, lifestyle habits, and medical histories as covariates. Restricted cubic spline model was employed to assess the non-linear dose-response relationship between ASMI and urinary incontinence. The results demonstrated a significant negative correlation between ASMI and the development of urinary incontinence. The risk of developing stress urinary incontinence, urgency urinary incontinence, and mixed urinary incontinence all increased significantly as ASMI decreased. The prevalence of urinary incontinence was significantly higher in patients with sarcopenia than in those without sarcopenia. Subgroup analysis demonstrated that the inverse relationship between ASMI and urinary incontinence persisted across most subgroups. This study identifies a significant inverse association between sarcopenia and urinary incontinence in adult women under 60, emphasizing the role of muscle health in bladder function. These findings provide valuable insights for clinical risk assessment and intervention strategies.

To determine whether a history of childhood dysfunctional voiding is associated with urinary incontinence in adulthood. Using a case-control study, we surveyed patients presenting with or without urinary incontinence. Cases were patients referred to a tertiary urogynecology clinic, and controls were patients referred to a general gynecology clinic. Patients completed a validated childhood questionnaire about dysfunctional voiding. A total score of 6 or more in girls is indicative of dysfunctional voiding, a condition characterized by urgency, frequency, constipation, urinary or fecal incontinence, and/or urinary tract infections. Using an alpha of 0.05, a power of 80%, and a baseline prevalence of dysfunctional voiding of 8%, we determined that 170 patients were needed to show a 3-fold difference between groups. Cases (n = 84) and controls (n = 86) had similar baseline characteristics except for body mass index and incidence of previous pelvic surgery. Although the total dysfunctional voiding score was higher in cases than controls (7.3 versus 5.0, respectively; P = .001), the difference in the number (%) of patients with history of childhood dysfunctional voiding between the 2 groups was not significant (47 [56%] versus 36 [42%], respectively; odds ratio 1.76, 95% confidence interval 0.96-3.24; P = .07). When all patients from both groups were combined, there was a higher prevalence of a history of childhood dysfunctional voiding in women with or without current urinary frequency (P = .004), urgency (P = .03), stress incontinence (P = .01), and urge incontinence (P = .009). Women with adult lower urinary tract symptoms may have a higher prevalence of history of childhood dysfunctional voiding. II-2.

This study examined the relationship between metabolic dysfunction-associated steatotic liver disease (MASLD) and urinary incontinence in adult women and evaluated the potential contribution of the fatty liver index (FLI) in this context. The study utilized data from the National Health and Nutrition Examination Survey (NHANES) database, spanning from 2001 to 2018. The study included 17,221 adult female participants. Individuals exhibiting FLI values of 60 or greater were diagnosed with hepatic steatosis. Incontinence type and MASLD status were evaluated by analyzing questionnaire data and calculating the FLI. Logistic regression models were employed to examine the correlation between FLI, MASLD, and urinary incontinence, with potential confounding variables controlled through multivariate adjustment models. Furthermore, restricted cubic spline curve (RCS) modeling and subgroup analysis were employed to elucidate the relationship between variables further. The median age of participants in the MASLD group was higher than that of the non-MASLD group (53 vs 46 years, P < 0.001). The findings indicated a positive association between FLI and MASLD and the risk of urinary incontinence. Specifically, the risk of stress urinary incontinence (SUI), urgency urinary incontinence (UUI), and mixed urinary incontinence (MUI) all increased significantly with increasing quartiles of FLI (OR 2.44, 1.91, 2.30, respectively, P < 0.001). In the multivariate-adjusted model, SUI, UUI, and MUI risk was 76%, 50%, and 69% higher in patients with MASLD than those without MASLD. RCS analysis demonstrated a significant nonlinear positive correlation between FLI and the risk of SUI, UUI, and MUI, respectively. This study's findings indicate a significant association between MASLD and the risk of developing urinary incontinence. Additionally, the results suggest that FLI and MASLD may act as independent risk factors for urinary incontinence.

Urinary Incontinence Incidence: Quantitative Meta-Analysis of Factors that Explain Variation

Systematic review: efficacy of silicone microimplants (Macroplastique) therapy for stress urinary incontinence in adult women.

To evaluate if urethrovaginal reflux (UVR) is an underestimated cause of insensible or postmicturition incontinence in adult women. An observational and retrospective study was carried out on the computerized records of a neuro-urology department. Female patients who had insensible or postmicturition incontinence were investigated. Retrograde and voiding urethrocystography (UCG), urodynamic evaluation, urethral pressure profilometry, and anamnestic and clinical examination had to be available. Among the 79 adult female patients with insensible or postmicturition incontinence in whom the whole set of required evaluations was achieved, 16 had a UVR (mean age 47 ± 15 years). There were no urethral diverticula, urethrocele, vesicovaginal, or urethrovaginal fistula on their UCG. All of them also had a cystoscopy and a CT urography which did not establish any abnormality. UVR is not an exclusive pathology of children. This mechanism seems to be an underestimated cause of urinary incontinence in adult women. Retrograde and voiding UCG appears to be the gold standard to confirm the intravaginal reflux.

Prevalence and trends in urinary incontinence among women in the United States, 2005–2018

The external urethral barrier for stress incontinence: a multicenter trial of safety and efficacy

Periurethral or transurethral injection of bulking agents is a minimally invasive surgical procedure used for the treatment of stress urinary incontinence in adult women. To assess the effects of periurethral or transurethral injection therapy on the cure or improvement of urinary incontinence in women. We searched the Cochrane Incontinence Group Specialised Trials Register (searched 8 November 2010) and the reference lists of relevant articles. All randomised or quasi-randomised controlled trials of treatment for urinary incontinence in which at least one management arm involved periurethral or transurethral injection therapy. Two review authors independently assessed methodological quality of each study using explicit criteria. Data extraction was undertaken independently and clarification concerning possible unreported data sought directly from the investigators. Excluding duplicate reports, we identified 14 trials (excluding one that was subsequently withdrawn from publication and not included in this analysis) including 2004 women that met the inclusion criteria. The limited data available were not suitable for meta-analysis because they all came from separate trials. Trials were small and generally of moderate quality.One trial of 45 women that compared injection therapy with conservative treatment showed early benefit for the injectable with respect to continence grade (risk ratio (RR) 0.7, 95% confidence interval (CI) 0.52 to 0.94) and quality of life (RR 0.54, 95% CI 0.16 to 0.92). Another, comparing Injection of autologous fat with placebo, terminated early because of safety concerns. Two trials that compared injection with surgical management found significantly better objective cure in the surgical group (RR 4.77, 95% CI 1.96 to 11.64; and RR 1.69, 95% CI 1.02 to 2.79), although the latter trial data did not reach statistical significance if an intention-to-treat analysis was used.Eight trials compared different agents and all results had wide confidence intervals. Silicone particles, calcium hydroxylapatite, ethylene vinyl alcohol, carbon spheres and dextranomer hyaluronic acid combination gave improvements which were not shown to be more or less efficacious than collagen. Dextranomer hyaluronic acid compound treated patients appeared to have significantly higher rates of injection site complications (16% with the hyaluronic acid compound versus none with collagen; RR 37.78, 95% CI 2.34 to 610) and this product has now been withdrawn from the market.A comparison of periurethral and transurethral methods of injection found similar outcomes but a higher (though not statistically significant) rate of early complications in the periurethral group. One trial of 30 women showed a weak (but not clinically significant) advantage for patient satisfaction (data not suitable for analysis in Revman) after mid-urethral injection in comparison to bladder neck injection but with no demonstrable difference in continence levels. The available evidence base remains insufficient to guide practice. In addition, the finding that placebo saline injection was followed by a similar symptomatic improvement to bulking agent injection raises questions about the mechanism of any beneficial effects. One small trial comparing silicone particles with pelvic floor muscle training was suggestive of benefit at three months but it is not known if this was sustained, and the treatment was associated with high levels of postoperative retention and dysuria. Greater symptomatic improvement was observed with surgical treatments, though the advantages need to be set against likely higher risks. No clear-cut conclusions could be drawn from trials comparing alternative agents, although dextranomer hyaluronic acid was associated with more local side effects and is no longer commercially available for this indication. There is insufficient evidence to show superiority of mid-urethral or bladder neck injection. The single trial of autologous fat provides a reminder that periurethral injections can occasionally cause serious side effects.

Urinary incontinence is a growing issue among adult women globally. Limited data exist examining the impact of occupational, environmental, and behavioral factors on urinary incontinence. This quantitative, cross-sectional pilot study examined the workplace behaviors of adult women experiencing urinary incontinence. It was hypothesized that specific jobs and work environments would be associated with increased urinary incontinence and urgency based on identified behaviors and work-related conditions. This study is a quantitative, cross-sectional survey. Adult women (18 years and older) with a history of urinary incontinence were recruited from August 2022 to February 2023 to complete a one-time survey consisting of multiple-choice and short answer questions identifying specific workplace behaviors and symptoms of urinary incontinence. Descriptive statistics and data categorization were used to observe outcomes and examine relationships between urinary incontinence and particular professions. Urinary incontinence and urgency-related symptoms affected healthcare and business professionals at a higher prevalence. The most commonly reported behaviors across all professions consisted of withholding urine and utilizing absorbance products. The results of this study will help guide women's health practitioners in exploring current workplace behaviors that may contribute to urinary incontinence in adult women. With this knowledge, practitioners can provide meaningful education to employers and employees to prioritize toileting behaviors in the workplace.

Introduction and hypothesisThe purpose of the study was to investigate the relationship of diabetes mellitus and urinary incontinence in adult women.MethodsWe conducted a cross-sectional, comparative study with a case-control design. One thousand three hundred eighty-one women (aged 20–87 years) attending six Primary Healthcare Centers in Turkey were enrolled in this study, after giving their informed consent. Subjects were dichotomized into cases and controls according to presence of diabetes mellitus (DM) and were matched for the confounding factors age, body mass index (BMI), and reproductive history.ResultsNine hundred ten women were included: 273 diabetics and 637 non-diabetics. Diabetes was shown to be associated with a 2.5-fold risk increase for urinary incontinence (UI), and age and BMI were weakly associated with UI. UI was significantly more prevalent in diabetic women: 41% diabetic and 22.1% non-diabetic women reported UI (p < 0.001). Age, BMI, and DM were revealed as independent determinants of UI in adult women. Urge incontinence was more prevalent in non-diabetic women, whereas stress and mixed incontinence were more prevalent among diabetic women.ConclusionsDM is the most important independent determinant of UI.

Urinary incontinence is a common health problem among women that negatively impacts quality of life. Therefore, it is important that primary care physicians have an understanding of how to manage urinary incontinence effectively. To review the most recent, high-quality evidence regarding the etiology and management of urinary incontinence in women. Searches of MEDLINE, EMBASE, The Cochrane Library, and the ACP Journal Club were performed to identify English-language articles published between 1998-2003 that focused on the etiology or treatment of urinary incontinence in adult women. The references of each retrieved article were reviewed and an expert in the field was contacted to identify additional relevant articles. Using a combination of more than 80 search terms, we included articles of etiology that were cohort studies, case-control studies, cross-sectional studies, or systematic reviews of cohort, case-control, and/or cross-sectional studies. Studies of treatment had to be randomized controlled trials or systematic reviews of randomized controlled trials. The quality of each article was assessed independently by each author and inclusion (n = 66) was determined by consensus. Multiple factors have been found to be associated with urinary incontinence, some of which are amenable to modification. Factors associated with incontinence include age, white race, higher educational attainment, pregnancy-related factors, gynecological factors, urological and gastrointestinal tract factors, comorbid diseases, higher body mass index, medications, smoking, caffeine, and functional impairment. There are several effective nonpharmacological treatments including pelvic floor muscle training, electrical stimulation, bladder training, and prompted voiding. Anticholinergic drugs are effective in the treatment of urge urinary incontinence. Several surgical interventions are effective in the management of stress incontinence, including open retropubic colposuspension and suburethral sling procedure. Urinary incontinence in women is an important public health concern, and effective treatment options exist.

Percutaneous Tibial Nerve Stimulation for the Long-Term Treatment of Overactive Bladder: 3-Year Results of the STEP Study

Stress urinary incontinence (SUI) is prevalent in adult women and has a considerable impact on quality of life. However, it often remains undiagnosed and therefore untreated. Noninvasive treatment is likely to be offered in mild cases and may entail pelvic floor muscle re-education, minimally invasive devices or pharmacotherapy. Surgical intervention is widely considered as the only effective option for more severe SUI, although it is not suitable for all patients. Injection therapy with urethral bulking agents represents an alternative minimally invasive procedure and can be used for all types of SUI. Many bulking agents have been developed, although the ideal remains to be discovered. The safety and durability of agents remain a concern. No differences in agents from an efficacy point of view have been found. For many years urethral injection could only be administered endoscopically. The recent development of devices for blind injection has increased the speed and convenience of urethral injection, removing the need for surgical facilities. The subjective cure rate after injection therapy is higher than the objective one. A focus on the patient’s wishes and expectations with respect to success and risks of a treatment for SUI is required. In addition, randomized clinical trials are mandatory to establish the place and efficacy of urethral bulking agents compared with conservative therapy (pelvic floor muscle re-education) in treating SUI in adult women.