Bothersome Urinary Incontinence Research Articles

(292) Impact of Urinary Incontinence on Sexual Function in Patients Presenting for Lower Urinary Tract Symptoms

Abstract Introduction Patients with low urinary tract symptoms (LUTS) frequently complain some sexual dysfunction and sometimes even episodes of bothersome urinary incontinence (UI). Objective We aimed to assess the relationship between UI (as measured with the ICIQ-UI-SF), and sexual disfunction (as measured with the IIEF), in men presenting with LUTS at a tertiary-referral centre. Methods In this cross-sectional study, data were retrospectively retrieved from 938 consecutive patients aged >18 years seeking first medical help for self-reported LUTS (i.e., all patients had IPSS≥1). All patients had a complete clinical assessment and completed the IPSS, the ICIQ-UI-SF, the OAB-q and the IIEF questionnaires. Patients were stratified into “no UI” (ICIQ-UI-SF=0), “mild UI” (ICIQ-UI-SF=1-7), “moderate UI” (ICIQ-UI-SF=8-13) or “severe UI” (ICIQ-UI-SF=14-21). ANOVA test assessed differences in baseline characteristics among these groups. Spearman correlation test was applied to evaluate the correlation between ICIQ-UI-SF and IIEF domain scores. A linear regression analyses tested putative risk factors associated with increased ICIQ-UI-SF scores. Results Of 938, 589 (63%) patients had no UI, 237 (25%) had mild UI, 76 (8%) moderate UI and 36 (4%) severe UI. There were no substantial differences in total PSA levels and uroflowmetry parameters among UI groups, whereas prostate volume, IPSS and OAB-q scores were higher as UI symptoms increased (all p≤ 0.03). A negative correlation was found between IIEF-total, IIEF-Erectile Function, IIEF-Intercourse Satisfaction and IIEF-Overall Satisfaction scores and ICIQ-UI-SF scores (i.e., the worse UI symptoms, the worse the overall sexual function (rho= -0.12; p<0.001), IIEF-EF (rho= -0.15; p<0.001), IIEF-IS (rho = -0.1; p=0.004) and IIEF-OS (rho = -0.12; p<0.001). Sexual desire and orgasmic function domains were not correlated with ICIQ-UI-SF. Finally, higher BMI (Coeff 0.12; 95% CI 0.03-0.32; p=0.011), diabetes (Coeff 1.76; 0.35-3.18; p=0.015) and presence of comorbidities (Coeff: 0.9; 0.06-0.1.74; p=0.035) were associated with higher ICIQ-UI-SF scores. Main limitations of the study were that ICIQ-UI-SF does not discriminate between urge or stress UI. Conclusions In patients presenting with LUTS, the presence of urinary incontinence was associated with worsening of overall sexual function (i.e., erectile function, intercourse satisfaction and overall satisfaction). Disclosure No

MP42-17 INCONTINENCE AFTER SUCCESSFUL ANATOMICAL CLOSURE OF VESICO-VAGINAL FISTULA; INCIDENCE AND MANAGEMENT

You have accessJournal of UrologyCME1 Apr 2023MP42-17 INCONTINENCE AFTER SUCCESSFUL ANATOMICAL CLOSURE OF VESICO-VAGINAL FISTULA; INCIDENCE AND MANAGEMENT Amaani Ahmad, Helena Gresty, Anthony Noah, Richard Nobrega, Mahreen Pakzad, Jeremy Ockrim, and Tamsin Greenwell Amaani AhmadAmaani Ahmad More articles by this author , Helena GrestyHelena Gresty More articles by this author , Anthony NoahAnthony Noah More articles by this author , Richard NobregaRichard Nobrega More articles by this author , Mahreen PakzadMahreen Pakzad More articles by this author , Jeremy OckrimJeremy Ockrim More articles by this author , and Tamsin GreenwellTamsin Greenwell More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003280.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Vesicovaginal fistula (VVF) is a rare condition in high resource settings. Significant urinary incontinence (UI) rates have been reported following VVF closure in low resource setting. We have reviewed our VVF series for anatomical closure and post closure UI rates. METHODS: Retrospective review of 132 patients having 1st surgical management of their VVF between 2004-2022. Median age was 51 (16-88) with a median follow-up of 14 months (2-150). Data was collated on demographics, fistula aetiology and characteristics, previous surgery, outcome in terms of anatomical closure and urinary continence, and any requirement for further surgery. Statistical analysis was carried out using chi-squared test, fisher test or students t-test as appropriate. RESULTS: Of the 132 patients identified, 127 (96.2%) had surgery to close their VVF whilst 5 (3.8%) had a primary ileal conduit. Successful anatomical closure was achieved in 118 (93.9%) at 1st attempt. Of the 9 failures, 6 had a 2nd VVF closure attempt, 2 had ileal conduit formation and 1 had recurrent carcinoma and did not proceed to further surgery. Vaginal closure was successful in 95% (97/102) after 1st attempt whilst abdominal closure was successful in 88% (22/25). Of the 6 failures having a 2nd attempt at VVF closure, 3 had an abdominal and 3 had a vaginal approach, with 100% successfully closed. Anatomical closure was confirmed in all patients by cystogram and/or cystoscopy. Of those with successful VVF closure 19 (15.2%) (16 vaginal and 3 abdominal approach) had bothersome post repair UI. This was pre-existing stress urinary incontinence (SUI) in 5 (4%), new onset SUI in 8 (6.4%), pre-existing urgency urinary incontinence (UUI) in 1 (0.8%), new onset UUI in 3 (2.4%) and new onset mixed urinary incontinence (MUI) in 2 (1.6%). 5 (26.3%) (4 with pre-existing SUI) required surgical intervention for management of their SUI (2 colposuspensions and 3 rectus fascial slings) whilst the patient with pre-existing UUI progressed to sacral neuromodulation, with resolution or significant improvement. The remaining 13 (68%) patients experienced resolution or significant improvement of their UI with conservative measures. CONCLUSIONS: Successful anatomical closure of VVF in high resource health care settings can be achieved in 92.9% after 1st repair and 100% after 2nd repair. Post closure bothersome urinary incontinence occurs in 15.2% and resolves with conservative measures in 68%. Surgical interventions for SUI or UUI post closure in 4.8%, with excellent results. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e574 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Amaani Ahmad More articles by this author Helena Gresty More articles by this author Anthony Noah More articles by this author Richard Nobrega More articles by this author Mahreen Pakzad More articles by this author Jeremy Ockrim More articles by this author Tamsin Greenwell More articles by this author Expand All Advertisement PDF downloadLoading ...

PD02-09 DECISIONAL REGRET IN ADULTS WITH SPINA BIFIDA REGARDING SURGERIES THEY HAD AS CHILDREN FOR NEUROGENIC BLADDER

You have accessJournal of UrologyCME1 May 2022PD02-09 DECISIONAL REGRET IN ADULTS WITH SPINA BIFIDA REGARDING SURGERIES THEY HAD AS CHILDREN FOR NEUROGENIC BLADDER Joshua Roth, Konrad Szymanski, and Rosalia Misseri Joshua RothJoshua Roth More articles by this author , Konrad SzymanskiKonrad Szymanski More articles by this author , and Rosalia MisseriRosalia Misseri More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002517.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To assess decisional regret (DR) amongst patients with spina bifida (SB) regarding the decisions caregivers made to manage their neurogenic bladder (NB) as children. METHODS: Consecutive adult patients with SB were surveyed at clinic appointments (6/18-1/20). Higher DR Scale scores indicated greater DR (range 0-100). We analyzed whether presence of a ventriculoperitoneal shunt (VPS), mobility, gender, age, history of a bladder augment, history of a catheterizable channel, history of a bladder neck procedure, history of a bladder stone, history of a catheterizable channel revision, urinary incontinence, bothersome urinary incontinence, or recurrent urinary tract infection (≥3/year) had any impact on DR. Non-parametric statistical tests were used. RESULTS: Ninety-six patients with a median age of 26.3 (79.2% shunted, 56.3% female) had childhood surgery for NB. Median DR score was 0 (mean 11.9). Overall, 60.4% reported no regret and of those who reported regret, 89.5% reported only mild-moderate regret. In total, 4.2% of patients reported strong or very strong regret. Having any regret was associated with having a bladder neck procedure (OR 3.45, p=0.007) or bothersome urinary incontinence (OR 5.59, p=0.001). Regret was not associated with other factors. CONCLUSIONS: Patients with SB and resultant NB reported low levels of DR after surgery to manage their NB in childhood. When present, DR is usually mild. DR is more likely in those with a bladder neck procedure or bothersome urinary incontinence. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e39 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joshua Roth More articles by this author Konrad Szymanski More articles by this author Rosalia Misseri More articles by this author Expand All Advertisement PDF DownloadLoading ...

Impact of urinary incontinence on sexual function in patients presenting for lower urinary tract symptoms

ABSTRACT Introduction Patients with low urinary tract symptoms (LUTS) frequently complain some sexual dysfunction and sometimes even episodes of bothersome urinary incontinence (UI). Objective We aimed to assess the relationship between UI (as measured with the ICIQ-UI-SF), and sexual disfunction (as measured with the IIEF), in men presenting with LUTS at a tertiary-referral centre. Methods In this cross-sectional study, data were retrospectively retrieved from 938 consecutive patients aged >18 years seeking first medical help for self-reported LUTS (i.e., all patients had IPSS≥1). All patients had a complete clinical assessment and completed the IPSS, the ICIQ-UI-SF, the OAB-q and the IIEF questionnaires. Patients were stratified into “no UI” (ICIQ-UI-SF=0), “mild UI” (ICIQ-UI-SF=1-7), “moderate UI” (ICIQ-UI-SF=8-13) or “severe UI” (ICIQ-UI-SF=14-21). ANOVA test assessed differences in baseline characteristics among these groups. Spearman correlation test was applied to evaluate the correlation between ICIQ-UI-SF and IIEF domain scores. A linear regression analyses tested putative risk factors associated with increased ICIQ-UI-SF scores. Result Of 938, 589 (63%) patients had no UI, 237 (25%) had mild UI, 76 (8%) moderate UI and 36 (4%) severe UI. There were no substantial differences in total PSA levels and uroflowmetry parameters among UI groups, whereas prostate volume, IPSS and OAB-q scores were higher as UI symptoms increased (all p≤ 0.03). A negative correlation was found between IIEF-total, IIEF-Erectile Function, IIEF-Intercourse Satisfaction and IIEF-Overall Satisfaction scores and ICIQ-UI-SF scores (i.e., the worse UI symptoms, the worse the overall sexual function (rho= -0.12; p<0.001), IIEF-EF (rho= -0.15; p<0.001), IIEF-IS (rho = -0.1; p=0.004) and IIEF-OS (rho = -0.12; p<0.001). Sexual desire and orgasmic function domains were not correlated with ICIQ-UI-SF. Finally, higher BMI (Coeff 0.12; 95% CI 0.03-0.32; p=0.011), diabetes (Coeff 1.76; 0.35-3.18; p=0.015) and presence of comorbidities (Coeff: 0.9; 0.06-0.1.74; p=0.035) were associated with higher ICIQ-UI-SF scores. Main limitations of the study were that ICIQ-UI-SF does not discriminate between urge or stress UI. Conclusion In patients presenting with LUTS, the presence of urinary incontinence was associated with worsening of overall sexual function (i.e., erectile function, intercourse satisfaction and overall satisfaction). Disclosure Work supported by industry: no.

MP51-17 DECISIONAL REGRET IN ADULTS WITH SPINA BIFIDA REGARDING SURGERIES THEY HAD AS CHILDREN FOR NEUROGENIC BLADDER

You have accessJournal of UrologyPediatric Urology IV (MP51)1 Sep 2021MP51-17 DECISIONAL REGRET IN ADULTS WITH SPINA BIFIDA REGARDING SURGERIES THEY HAD AS CHILDREN FOR NEUROGENIC BLADDER Joshua Roth, Konrad Szymanski, Benjamin Whittam, and Rosalia Misseri Joshua RothJoshua Roth More articles by this author , Konrad SzymanskiKonrad Szymanski More articles by this author , Benjamin WhittamBenjamin Whittam More articles by this author , and Rosalia MisseriRosalia Misseri More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002077.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To assess decisional regret (DR) amongst patients with spina bifida (SB) regarding the decisions caregivers made to manage their neurogenic bladder (NB) as children. METHODS: Consecutive adult patients with SB were surveyed at clinic appointments (6/18-1/20). Higher DR Scale scores indicated greater DR (range 0-100). We analyzed whether presence of a ventriculoperitoneal shunt (VPS), mobility, gender, age, history of a bladder augment, history of a catheterizable channel, history of a bladder neck procedure, history of a bladder stone, history of a catheterizable channel revision, urinary incontinence, bothersome urinary incontinence, or recurrent urinary tract infection (≥3/year) had any impact on DR. Non-parametric statistical tests were used. RESULTS: Ninety-six patients with a median age of 26.3 (79.2% shunted, 56.3% female) had childhood surgery for NB. Median DR score was 0 (mean 11.9). Overall, 60.4% reported no regret and of those who reported regret, 89.5% reported only mild-moderate regret. In total, 4.2% of patients reported strong or very strong regret. Having any regret was associated with having a bladder neck procedure (OR 3.45, p=0.007) or bothersome urinary incontinence (OR 5.59, p=0.001). Regret was not associated with other factors. CONCLUSIONS: Patients with SB and resultant NB reported low levels of DR after surgery to manage their NB in childhood. When present, DR is usually mild. DR is more likely in those with a bladder neck procedure or bothersome urinary incontinence. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e903-e903 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joshua Roth More articles by this author Konrad Szymanski More articles by this author Benjamin Whittam More articles by this author Rosalia Misseri More articles by this author Expand All Advertisement Loading ...

The effect of incontinence on sleep quality in the elderly.

This study was conducted to determine the frequency of incontinence in elderly people living in nursing homes and the effect of incontinence on the quality of life and sleep quality. This study was carried out with a total of 1150 individuals aged 65 and over, living in four nursing homes. Pittsburg Sleep Quality Index (PSQI), International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF), and Incontinence Quality of Life Scale (IQOL) were used as data collection tools. The data were collected after obtaining ethics committee and institutional approvals and written consents of the elderly participants. The mean age of 1150 elderly individuals included in the study was 75.49 ± 8.62 years. The mean PSQI score of the elderly was 8.33 ± 4.16 and 83.5% of them had poor sleep quality. It was determined that 87.0% of the elderly woke up at night and the most common reason for waking up was the need to use the toilet (60.0%). It was found that the mean ICIQ-SF score of the individuals was 10.65 ± 4.40 and 80.9% of them had bothersome urinary incontinence. The average IQOL score of individuals with incontinence was 63.39 ± 11.26. It was determined that almost all of the elderly people included in the present study had sleep problems and 20.0% had incontinence. It was found that sleep quality is not affected by incontinence in the elderly, but the quality of life decreases because of incontinence.

PD06-11 DEVELOPING A URINARY INCONTINENCE SCREENING TOOL FOR USE IN PRIMARY CARE: TRIALS AND TRIBULATIONS

INTRODUCTION AND OBJECTIVE:A large proportion of women with bothersome urinary incontinence (UI) fail to discuss the problem with their doctor. We sought to determine the percentage of women with b...

Prevalence of Pelvic Floor Disorders in Female CrossFit Athletes.

This study aimed to estimate the prevalence of pelvic floor disorders by symptoms in female CrossFit athletes in the United States and characterize subjects reporting pelvic organ prolapse symptoms, urinary incontinence, and fecal incontinence. A 27-question anonymous questionnaire was distributed to owners of CrossFit-affiliated gyms. Select questions from validated questionnaires were used to define symptoms. Positive responses with "moderate, or quite a bit" bother defined the presence of urinary incontinence (with stress or urgency). A response of "yes" to "having a bulge or something falling out" defined the presence of pelvic organ prolapse. A response of "yes" to "lose stool beyond your control" questions defined the presence of fecal incontinence. Three hundred fourteen respondents had mean age of 36 ± 10 years and a mean body mass index of 25.2 ± 4 kg/m. Forty-four percent reported ≥1 vaginal delivery. For each workout, respondents reported lifting mean weights of 91 to 217 lb, and 90% reported participation in ≥3 CrossFit workouts per week. Pelvic floor disorder symptoms reported included the following: pelvic organ prolapse, 3.2% (10/314); urinary incontinence, 26.1% (82/314); and fecal incontinence, 6% (19/314). Higher age, parity, and number of vaginal deliveries were associated with urinary incontinence. Higher parity and number of vaginal deliveries were associated with prolapse. Fecal incontinence was not associated with age, body mass index, or obstetric history. The prevalence of pelvic floor symptoms in female CrossFit athletes from the general population is likely similar to the general population; however, the prevalence of bothersome urinary incontinence is higher than the general population in women younger than 40 years.

Vaginal Myomectomy to Resolve Bladder Outlet Obstruction 50 Years After Hysterectomy.

Leiomyomas can develop after hysterectomy and, when located in the bladder, can result in voiding dysfunction and incontinence. Fifty years after a hysterectomy, a 77-year-old woman presented with a 1-year history of urinary retention requiring self-catheterization and bothersome urinary incontinence. Multiple imaging modalities demonstrated a well-circumscribed 2-cm mass abutting the bladder beneath the trigone. After ureteral stent placement, we excised the nonpalpable mass using ultrasound guidance. We identified a 1.5-cm incidental cystomy and repaired it in layers. After the repair, we placed a suprapubic catheter. Pathologic examination of the mass revealed a leiomyoma. Postoperatively, we confirmed the integrity of the bladder, removed the ureteral stents, and reviewed postvoid residuals, which were minimal before removing the suprapubic catheter. Six weeks after her operation, the patient voided spontaneously with significant improvement of her urinary incontinence. Vaginal resection with ureteral stenting represents a safe surgical approach for resection of a symptomatic, benign bladder mass.

Preoperative Evaluation of Post-prostatectomy Urinary Incontinence: Examining the Evidence for Routine Use of Multichannel Urodynamics

Up to 10% of men after radical prostatectomy will experience persistent bothersome urinary incontinence. Multichannel urodynamics is often utilized in the preoperative assessment of men with post-prostatectomy incontinence. However, the routine use of this expensive and invasive diagnostic modality in post-prostatectomy incontinence is debatable. This review highlights the evidence either supporting or refuting the routine use of multichannel urodynamic assessment in the preoperative workup of post-prostatectomy urinary incontinence. Stress urinary incontinence symptoms elucidated on history appears to accurately reflect findings on urodynamic assessment with a positive and negative predictive value of >95 and 100%, respectively. Up to half of men with post-prostatectomy incontinence may have some element of bladder dysfunction (decreased compliance, overactivity, decreased bladder capacity, etc); however, numerous studies have failed to demonstrate an impact of preoperative bladder dysfunction on post-surgical treatment outcomes. The available evidence demonstrates that a thorough history accurately reflects findings on urodynamic assessment. Further, bladder dysfunction, regardless of type, does not appear to impact on post-surgical treatment outcomes in men with post-prostatectomy incontinence. These findings argue against the routine use of multichannel urodynamic assessment in the preoperative assessment. However, unlike female incontinence, large randomized controlled trials testing the impact of preoperative urodynamic findings on surgical treatment outcomes are lacking.

Management of bladder neck stenosis and urethral stricture and stenosis following treatment for prostate cancer.

The aim of this review is to examine all urethral strictures and stenoses subsequent to treatment for prostate cancer, including radical prostatectomy (RP), radiotherapy, high intensity focused ultrasound (HIFU) and cryotherapy. The overall majority respond to endoscopic treatment, including dilatation, direct visual internal urethrotomy (DVIU) or bladder neck incision (BNI). There are adjunct treatments to endoscopic management, including injections of corticosteroids and mitomycin C (MMC) and urethral stents, which remain controversial and are not currently mainstay of treatment. Recalcitrant strictures are most commonly managed with urethroplasty, while recalcitrant stenosis is relatively rare yet almost always associated with bothersome urinary incontinence, requiring bladder neck reconstruction and subsequent artificial urinary sphincter (AUS) implantation, or urinary diversion for the devastated outlet.

MP63-18 DO SYMPTOMS CORRELATE WITH URODYNAMIC FINDINGS FOR MEN WITH POST-PROSTATECTOMY INCONTINENCE?

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Incontinence: Evaluation (Urodynamic Testing)1 Apr 2017MP63-18 DO SYMPTOMS CORRELATE WITH URODYNAMIC FINDINGS FOR MEN WITH POST-PROSTATECTOMY INCONTINENCE? Joseph LaBossiere and Sender Herschorn Joseph LaBossiereJoseph LaBossiere More articles by this author and Sender HerschornSender Herschorn More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1970AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Persistent bothersome urinary incontinence occurs in up to 10-15% of men after radical prostatectomy (RP). Urodynamics (UDS) are often utilized in the assessment of men with post-prostatectomy incontinence (PPI). Our objective is to determine how well patient symptoms correlate with UDS in men with PPI. METHODS Retrospective review of a cohort of 496 men referred to our institution with PPI over a 20-year period. All patients with a history of RP were included in the study. All patients had a standardized history as well as the original multichannel UDS and interpretation. RESULTS 496 patients with an average age of 64 were reviewed accounting for 513 studies. UDS were performed on average 3 years after RP. On history, 471 (91%) patients complained of stress urinary incontinence (SUI), 249 (48%) urgency urinary incontinence (UUI) and 207 (40%) had mixed urinary incontinence (MUI). 264 (52%) of patients had only SUI and 42 (8%) only UUI symptoms. 356 of the 471 patients with a history of SUI symptoms had SUI on UDS for a positive predictive value (PPV) of 75%. Negative predictive value (NPV) for SUI symptoms was 78%. 6% of men complaining of SUI symptoms on history had only detrusor overactivity incontinence (DOI) on UDS, and 18% of men with SUI symptoms demonstrated no incontinence on UDS. 108 of the 249 patients with symptoms of UUI had DOI on UDS for a PPV of 43%. NPV for UUI symptoms was 85%. Of the 42 men complaining only of UUI symptoms, 14% had only SUI, 50% had only DOI and 17% had both SUI and DOI on UDS. 19% of men with only UUI symptoms demonstrated no incontinence on UDS. 77% of patients with MUI symptoms had SUI on UDS. CONCLUSIONS 91% of men in this study with PPI presented with some element of SUI symptoms on history. SUI symptoms on history accurately predicts SUI on UDS and rarely identifies only DOI. These data question the routine use of UDS in the workup of men presenting with SUI symptoms after RP prior to treatment. Men complaining only of UUI symptoms on history also predicts for DOI on UDS. UDS may be helpful in this patient group to further guide treatment decisions if initial treatment fails and to rule out SUI. Most men with MUI symptoms will have SUI identified on UDS. © 2017FiguresReferencesRelatedDetailsCited byViers B, VanDyke M, Pagliara T, Shakir N, Scott J and Morey A (2017) Improving Male Sling Selectivity and Outcomes—A Potential Role for Physical Demonstration of Stress Urinary Incontinence Severity?Urology Practice, VOL. 5, NO. 6, (458-465), Online publication date: 1-Nov-2018. Volume 197Issue 4SApril 2017Page: e842-e843 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Joseph LaBossiere More articles by this author Sender Herschorn More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Urinary incontinence in nulliparous women aged 25-64 years: a national survey

A systematic survey of pelvic floor disorders in nulliparous women has not been presented previously. The purpose of this study was to determine the prevalence of urinary incontinence parameters in a large cohort of nonpregnant, nulliparous women, and thereby construct a reference group for comparisons with parous women. This postal and World Wide Web-based questionnaire survey was conducted in 2014. The study population was identified from the Total Population Register in Sweden and comprised women who had not given birth and were aged 25-64 years. Four independent age-stratified, random samples comprising 20,000 women were obtained from the total number of eligible nullipara (n= 625,810). A 40-item questionnaire about pelvic floor symptoms, its severity, and its consequences were used. Age-dependent differences for various aspects of urinary incontinence were analyzed with the youngest group (25-34 years) serving as reference. Crude and body mass index-adjusted prevalence and its 95% confidence limits were calculated for each 10-year category. The response rate was 52% and the number of study participants was 9197. Urinary incontinence increased >5-fold from 9.7% in the youngest women with a body mass index <25 kg/m2 to 48.4% among the oldest women with a body mass index ≥35 kg/m2. The prevalence of bothersome urinary incontinence almost tripled from 2.8-7.9% among all nulliparas. The proportion with bothersome urinary incontinence among incontinent women increased from 24.4% in the youngest age group to 32.3% in the age group 55-64 years. Nocturia ≥2/night increased 4-fold to 17.0% and leakage ≥1/wk increased 3-fold to 12.8% among the oldest women. Mixed urinary incontinence increased from 22.9-40.9% among the oldest 0-para with incontinence, whereas stress urinary incontinence decreased inversely from 43.6-33.0%. In the total cohort surgical treatment for urinary incontinence occurred in 3 per thousand. Almost every aspect of urinary incontinence was present in nulliparous women of all ages and prevalence increased with advancing age between 25-64 years. This must be taken into account when using nullipara as a control group in comparisons with parous women to estimate the effect of pregnancy and childbirth.

The mediating effect of 'bothersome' urinary incontinence on help-seeking intentions among community-dwelling women.

To explore the mediating effect of bother of urinary incontinence between urinary incontinence severity and help-seeking intentions and detect whether the International Consultation on Incontinence Questionnaire-UI Short Form could be a valid measure to delineate bothersome urinary incontinence. Urinary incontinence is a common condition among women, which has a profound adverse effect on quality of life. However, many of them experiencing significant clinical symptoms do not seek medical help. A cross-sectional survey design. Women with urinary incontinence (N = 620) from three randomized selected community health service centres from May-October 2011 participated in the study. Data were collected using a pencil-and-paper questionnaire. Multivariate regression models were used to test the role of bother as a mediator in the relation between urinary incontinence severity and help-seeking intentions. Receiver operating characteristic analysis was used to find the best cut-off International Consultation on Incontinence Questionnaire-UI Short Form score (range: 0-21) to delineate the bother of urinary incontinence. Bothersome urinary incontinence mediated the relationship between urinary incontinence severity and help-seeking intentions. Age and duration of urine leakage had a negative association on help-seeking intentions, while educational level and previous help-seeking behaviours had a positive association. Bother was a mediator in the relation between urinary incontinence severity and help-seeking intentions. The International Consultation on Incontinence Questionnaire-UI Short Form was a discriminative measure to delineate the bothersome urinary incontinence.

Anterior bladder flap neo urethra as treatment for stress urinary incontinence due to developmental urogenital anomaly

Congenital anomalies that involve the distal segment of urogenital sinus (giving rise to female urethra and vagina) may lead to abnormal urethral development ranging from absent to markedly deficient urethra. The abnormal division may also cause a short and patulous urethra. Sphincteric defects are likely to be associated and when combined with the short urethral length is a cause for severe urinary incontinence. Urinary incontinence due to a congenital cause requiring repeated urethral reconstruction to relieve symptoms is presented. A 15 year old girl was referred for bothersome urinary incontinence due to a short, wide, patulous urethra with defective sphincteric mechanism as part of urogenital sinus developmental anomaly. She was initially managed by reconstruction of bladder neck and proximal urethra with sphincter augmentation using autologous pubovaginal sling. Persistent urinary incontinence demanded a second urethral reconstruction using tubularised anterior bladder flap (modified Tanagho). Surgical reconstruction of the urethra achieved socially acceptable continence.

Editorial Comment

Advances in surgical technique have greatly improved continence outcomes after radical prostatectomy. Unfortunately, severe and/or bothersome urinary incontinence does occur in some patients. In many cases, this can be unpredictable and a source of anxiety for patients contemplating prostate cancer surgery. Although other options have arisen to handle milder forms of postprostatectomy incontinence, artificial urethral sphincters have been a mainstay in the management of patients with the most severe symptoms. 1 Silva L.A. Andriolo R.B. Atallah A.N. et al. Surgery for stress urinary incontinence due to presumed sphincter deficiency after prostate surgery. Cochrane Database Syst Rev. 2011; 4 (CD008306) PubMed Google Scholar Safety and Efficacy of Periurethral Constrictor Implantation for the Treatment of Post–radical Prostatectomy IncontinenceUrologyVol. 79Issue 5PreviewTo assess safety and efficacy of the periurethral constrictor for the treatment of postprostatectomy urinary incontinence. Full-Text PDF ReplyUrologyVol. 79Issue 5PreviewWe truly appreciate your comments. We also believe that results assessment of the device implantation by means of validated questionnaires is needed. Achievement of continence is by itself the most simple and reliable way to define a “success,” but at the same time it risks being an excessively “mechanical” definition with respect to quality of life issues. Indeed, a score obtained from the assessment of urinary function allows for the correct definition of “success,” or not in patients who do not regain complete continence or who become perfectly dry but have an impaired quality of life because of urinary frequency or urgency. Full-Text PDF

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We truly appreciate your comments. We also believe that results assessment of the device implantation by means of validated questionnaires is needed. Achievement of continence is by itself the most simple and reliable way to define a “success,” but at the same time it risks being an excessively “mechanical” definition with respect to quality of life issues. Indeed, a score obtained from the assessment of urinary function allows for the correct definition of “success,” or not in patients who do not regain complete continence or who become perfectly dry but have an impaired quality of life because of urinary frequency or urgency. We also believe that experience from other surgeons is needed to reliably assess the pros and cons related to the procedure. To our knowledge, results of about 120 patients implanted with the periurethral constrictor have been published to date. 1 de O Vilar F. Araújo L.A. Lima S.V. Periurethral constrictor in pediatric urology: long-term followup. J Urol. 2004; 171: 2626-2628 Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar , 2 Schiavini J.L. Damião R. de Resende Júnior J.A. et al. Treatment of post-prostate surgery urinary incontinence with the periurethral constrictor: a retrospective analysis. Urology. 2010; 75: 1488-1492 Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar However, this seems a small number. Finally, let us report only about an emerging problem, which is the onset of late incontinence (after a period of continence) or worsening preexisting incontinence in long-term survivors submitted to radical prostatectomy. 3 Naselli A. Simone G. Papalia R. et al. Late-onset incontinence in a cohort of radical prostatectomy patients. Int J Urol. 2011; 18: 76-79 Crossref PubMed Scopus (7) Google Scholar They form a new category of patients, including some of the individuals described in our paper, that is gradually increasing. In general, the problem afflicts elderly people, who frequently carry many comorbidities and are poorly compliant in using the scrotal pump to begin to urinate. They probably would benefit greatly from the periurethral constrictor implantation because it is easy to be positioned, allowing a minimally invasive, fast surgery; it does not need a pump; and it is not expensive. We strongly believe this specific topic could be the object of future interesting studies. Editorial CommentUrologyVol. 79Issue 5PreviewAdvances in surgical technique have greatly improved continence outcomes after radical prostatectomy. Unfortunately, severe and/or bothersome urinary incontinence does occur in some patients. In many cases, this can be unpredictable and a source of anxiety for patients contemplating prostate cancer surgery. Although other options have arisen to handle milder forms of postprostatectomy incontinence, artificial urethral sphincters have been a mainstay in the management of patients with the most severe symptoms. Full-Text PDF

Factors Associated With Quality of Life in Women Undergoing Surgery for Stress Urinary Incontinence

We determined the association of clinicodemographic factors with urinary incontinence related quality of life in women undergoing surgery for stress urinary incontinence, and compared the incontinence specific Incontinence Impact Questionnaire and the International Consultation on Incontinence Questionnaire. Secondary objectives were to evaluate the contributions of incontinence severity and sexual function on quality of life. We used baseline data on 597 women in the Trial of Mid-Urethral Slings. Tested quality of life correlates included health status and history, sexual function, and urinary incontinence type, severity and bother. On each questionnaire lower quality of life was associated with younger age, higher body mass index, more stress urinary incontinence symptoms, and more severe and bothersome urinary incontinence symptoms. Each measure identified factors associated with lower quality of life that were not identified by the other, including Hispanic ethnicity, poor health status and more urge urinary incontinence symptoms on the Incontinence Impact Questionnaire, and prior urinary incontinence treatment and more urinary incontinence episodes daily on the International Consultation on Incontinence Questionnaire. Sexually active women had similar quality of life as well as increased incontinence episodes on each questionnaire and more sexual dysfunction on the Incontinence Impact Questionnaire only. In women planning stress urinary incontinence surgery quality of life is associated with nonurinary incontinence factors, and with the type, severity and degree of urinary incontinence symptom bother. Many factors are associated with quality of life as measured by the Incontinence Impact Questionnaire and the International Consultation on Incontinence Questionnaire. However, more nonurinary incontinence factors were associated with quality of life when measured by the former than by the latter. More than 1 scale may be needed to evaluate quality of life after treatment for stress urinary incontinence.

The Vulnerable Elders‐13 Survey Predicts 5‐Year Functional Decline and Mortality Outcomes in Older Ambulatory Care Patients

To test the predictive properties of the Vulnerable Elders-13 Survey (VES-13) a short tool that predicts functional decline and mortality over a 1- to 2-year follow-up interval over a 5-year interval. Longitudinal evaluation with mean follow-up of 4.5 years. Two managed-care organizations. Six hundred forty-nine community-dwelling older adults (> or = 75) enrolled in the Assessing Care of Vulnerable Elders observational study who screened positive for symptoms of falls or fear of falling, bothersome urinary incontinence, or memory problems. VES-13 score (range 1-10, higher score indicates worse prognosis), functional decline (decline in count of 5 activities of daily living or nursing home entry), and deaths. Higher VES-13 scores were associated with greater predicted probability of death and decline in older patients over a mean observation period of 4.5 years. For each additional VES-13 point, the odds of the combined outcome of functional decline or death was 1.37 (95% confidence interval (CI)=1.25-1.50), and the area under the receiver operating curve was 0.75 (95% CI=0.71-0.80). In the Cox proportional hazards model predicting time to death, the hazard ratio was 1.23 (95% CI=1.19-1.27) per additional VES-13 point. This study extends the utility of the VES-13 to clinical decisions that require longer-term prognostic estimates of functional status and survival.

Hidden female urinary incontinence in urology and obstetrics and gynecology outpatient clinics in Turkey: what are the determinants of bothersome urinary incontinence and help-seeking behavior?

The purpose of this study was to assess the prevalence of female urinary incontinence (UI) and risk factors of bothersomeness and help-seeking behavior of hidden female UI in urology and obstetrics and gynecology outpatient clinics. This multicentric and cross-sectional study was conducted as a part of the Turkish Overactive Bladder Study. Female patients (n = 5,565) who were referred with complaints other than UI and overactive bladder symptoms were surveyed using the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) with supplementation of five more questions. The crude prevalence of UI was found to be 35.7%. The prevalence of frequent and severe incontinence was 8.2 and 6.8%, respectively. The mean age of incontinent patients was significantly higher (p < 0.001). The prevalence of stress, urge, and mixed UI was 39.8, 24.8, and 28.9%, respectively. More than half (53%) of incontinent patients were not bothered by UI, and only 12% of incontinent patients had previously sought medical help for their problem. Frequency, severity, and type of UI were independent factors for predicting bothersome UI, while only bothersomeness increased help-seeking behavior. The ICIQ-SF score of 8 has been found to be the best cutoff value to delineate the bothersome UI. Although the crude prevalence of female UI was found to be high, bothersome UI was not so common. The majority of incontinent female patients did not seek medical help. Frequency, severity, and mixed type of UI were found to be the determinants of bothersome UI for which the ICIQ-SF cutoff score of 8 was obtained.