Diagnosis Of Stress Urinary Incontinence Research Articles

Treatment of Stress Urinary Incontinence: Does Race Matter?

The importance of this study was to examine treatment patterns and surgical complications for stress urinary incontinence (SUI). The aim of this study was to describe the treatment of SUI and associated complications in a racially and ethnically diverse population. This was a retrospective cohort study of patients with a new diagnosis of SUI. We identified patients who received treatment with a pessary, pelvic floor physical therapy, or surgery. Surgical complications were abstracted. Logistic regression was used to examine the association between race/ethnicity and treatment, as well as surgical complications. A total of 67,187 patients with a new diagnosis of SUI were included. The population was predominately Hispanic (47.5%) followed by White, Asian, Black, Native Hawaiian/Pacific Islander, and American Indian/Alaska Native. Comparing no treatment to any treatment, all racial/ethnic groups, except American Indian/Alaska Native, had decreased odds of receiving treatment compared with White women. Hispanic and Native Hawaiian/Pacific Islander women had increased odds of referral for pelvic floor physical therapy compared with White women. All racial/ethnic groups, except for American Indian/Alaska Native women, had decreased odds of receiving a sling procedure compared with White women. When these racial/ethnic minority groups did receive treatment, it was more likely to be conservative treatment compared with White women. There were no significant differences in individual surgical complications. Racial minority women were 20-50% less likely to undergo a sling procedure, commonly posited as the gold standard surgical treatment. Racial minority women were 40-100% more likely to receive conservative management and 20-50% less likely to receive any treatment compared with White women.

Possibilities of elastography in the diagnosis of stress urinary incontinence in women

BACKGROUND:Stress urinary incontinence in women is a widespread disease. It can occur in women of reproductive age, while progressing and disrupting the quality of life. Ultrasound elastography allows for evaluating the stiffness of the urethral supporting structures and can help in studying the pathophysiology of stress urinary incontinence and in diagnosing its mild forms for timely initiation of therapy and preventing the development of severe forms of the disease.
 AIM:The aim of this study was to improve the diagnosis of mild stress urinary incontinence in women using ultrasound compression elastography of the ureterovesical junction.
 MATERIALS AND METHODS:We examined 25 women with mild stress urinary incontinence (main group) and 15 patients without urinary incontinence (control group) of reproductive and perimenopausal age. The diagnosis of stress urinary incontinence was confirmed during a comprehensive urodynamic study. To assess the urethral mobility and determine the stiffness of the supporting structures, a 2D ultrasound examination was performed with compression elastography of the ureterovesical junction using Voluson E6 and E10 ultrasound systems equipped with a transvaginal probe (GE Healthcare, USA). Four areas of interest in the paraurethral region of the proximal and middle urethra were examined. The obtained elastograms were used to evaluate the color characteristics and strain ratio of the areas of interest in three dimensions, the average values being calculated.
 RESULTS:The strain ratios in all studied areas of the paraurethral region had no significant relationship with age and were lower in patients with stress urinary incontinence compared to control values (p 0.01). Urethral hypermobility (mobility: mean urethral α angle rotation of 40 degrees) was identified in 84% of women with stress urinary incontinence. According to the results of correlation analysis, the strain ratios in the three areas of interest had a significant negative relationship with changes in the urethral α angle rotation. The ROC analysis showed that the stiffness values of the paraurethral region of the proximal posterior wall of the urethra are the most significant parameters for the diagnosis of stress urinary incontinence. The threshold value of the strain ratio for diagnosing stress urinary incontinence was determined to be less than or equal to 0.85 (sensitivity 96.0%; specificity 86.7%;p 0.001).
 CONCLUSIONS:Ultrasound compression elastography of the ureterovesical junction is a new non-invasive technique that can improve the accuracy of diagnosing stress urinary incontinence in women. It is advisable to use the technique in women with mild stress urinary incontinence who are planned for conservative treatment to confirm the diagnosis and monitor therapy.

A randomized trial comparing vaginal laser therapy and pelvic floor physical therapy for treating women with stress urinary incontinence.

Female stress urinary incontinence (SUI) is considered a major public health issue. Physical therapy is an important conservative treatment; however, it is primarily limited by poor long-term compliance. Furthermore, surgical treatment entails significant risks. Therefore, new treatment techniques must be identified. To compare the use of laser therapy and pelvic floor (PF) physical therapy for treating postmenopausal women with SUI. This pilot study enrolled 40 women with a clinical and urodynamic diagnosis of SUI who were randomized into two groups: those who received erbium-doped yttrium-aluminum-garnet (Er:YAG) laser therapy implemented over three sessions with a 1-month interval (n = 20) and those who received physical therapy with supervision twice a week for 3 months (n = 20). In total, 16 women completed the treatment in each group. The patients were assessed for PF function using the modified Oxford scale and for pelvic organ prolapse using the Pelvic Organ Prolapse Quantification System. The 1-h pad test and quality of life questionnaires, King's Health Questionnaire (KHQ), and Incontinence Quality of Life (IQOL) were also administered. Patients were re-evaluated at 1, 3, 6, and 12 months after treatment. The mean patient age was 62.7 ± 9.1 and 57.9 ± 6.1 years, median Oxford score at baseline was 3 (2-4.5) and 4 (3-4), mean IQOL score was 79.8 ± 17 and 74.6 ± 18 for physical therapy group (PTG) and laser group (LG), respectively. For the amount of urine leak in the 1-hpad test evaluation, we found significance for the interaction of group and time points only for the Laser intragroup. The cure rate, that is, the rate of reaching an insignificant score in the pad test, at 6 and 12 months was 43.75% and 50% in PTG and 62.5% and 56.25% in the LG, respectively (p > 0.05). IQOL scores demonstrated considerable improvement in both groups (p > 0.05). Upon comparing the initial and follow-up results, the LG showed an improvement at all consultations, whereas the PTG showed improvements at 1, 3, and 6 months but not at 12 months after treatment. KHQ analysis revealed a considerable improvement in the quality of life (QOL) of patients over time, with no substantial difference between the groups. QOL comparison before and after treatment revealed that the vaginal LG improved more consistently in some domains. Only the PTG showed a significant increase in the mean Oxford score from pretreatment to 1 and 3 months after treatment (p < 0.001 and p = 0.002, respectively). However, no statistically significant difference was observed between the groups. Both treatments are safe and have a positive influence on the impact of UI on patients'QOL. The laser caused a greater reduction in the urinary loss, as measured using the weight of pad test, at 6-month and 12-month after treatment without difference with PTG at the end of the follow-up.

Среднеуретральный синтетический слинг с возможностью ранней мобилизации в лечении недержания мочи при напряжении у женщин.

Introduction. The use of midurethral synthetic slings is currently considered to be the most widespread treatment option for stress urinary incontinence (SUI). The most difficult in the existing approaches is to achieve the optimal tension of the sling, on which the result of treatment directly depends. To solve this problem, sling systems with the possibility of tension adjustment in the early postoperative period were created. A comparative study of the effectiveness and safety of such a system and a sling without the possibility of adjustment seems to be a relevant task. Materials and Methods. The study involved 320 female patients with a mean age of 55.2±11.2 years and a confirmed diagnosis of SUI. The patients were allocated into two groups: the first group underwent a synthetic suburethral sling by the standard technique (TOT); the second group received a suburethral sling with early mobilization (TTT). All patients underwent stress test, uroflowmetry and ultrasound investigation to determine the volume of residual urine. UDI-6, ICIQ-SF, PISQ-12 questionnaires were filled out to assess subjective efficiency. Results. In the second group, 28% of the patients needed to increase the tension of the prosthesis. Due to the possibility of tightening the sling in the early postoperative period, the operation was ineffective at the delayed follow-up stage at 36 months only in 11% of the women in the TTT group and in 32% of the patients in the LTT group, p&lt;0.001. Loosening the sling tension was required in every fourth patient in the TTT group. Signs of obstructive urination at the stage of 36 months persisted in 13 patients in the TOT group and were completely absent in the TTT group. Subjective satisfaction with treatment was higher in the TTT group and amounted to 82%. Conclusion. A synthetic mid-urethral tuneable tension tape is superior to a classic sling without adjustment capability in long-term efficacy and safety.

Flexible and Stretchable Piezoresistive Sensor with Decoupled Pressure Sensing Capability

AbstractPressure sensors made on a mechanically deformable substrates are widely available for health monitoring systems, tactile sensors, and human–machine interfaces. While their sensitivity typically exceeds that of the human skin, it is highly challenging to perceive multiple kinds of mechanical inputs, such as normal, stretching, bending, and/or twisting forces, in a decoupled manner. For example, the interpretation of the specific pressure‐related distortion requires differentiation of such pressure stimuli from the simultaneously measured mixed deformation. This report proposes a sensor with an engineered geometrical configuration that dramatically reduces its mechanical distortion made by non‐pressure related stimuli. Such decoupled‐sensing capability for normal force is characterized by a linear response of fractional resistance change at 2.07 kPa−1and negligible responses to other deformations such as stretching and bending. An in vitro sensor demonstration for the diagnosis of stress urinary incontinence presents one mode of practical application of the sensor. Facile fabrication allows an interconnected array and wireless network to capture the spatial distribution of normal force and to record the data with consumer devices, respectively.

Stress Urinary Incontinence After Operations for Uterine Prolapse: A Nationwide Cohort Study.

Concomitant surgery for stress urinary incontinence (SUI) during pelvic organ prolapse (POP) operations are debated. We aimed to assess the risk of an SUI operation after a uterine prolapse operation and compare the risk after the Manchester procedure versus vaginal hysterectomy. We performed a nationwide historical cohort study including women with no history of hysterectomy undergoing the Manchester procedure (n = 6065) or vaginal hysterectomy (n = 9,767) for POP during 1998 to 2018. We excluded women with previous surgery for SUI and POP, concomitant surgery for SUI (n = 34, 0.2%), and diagnosed with gynecological cancer before or within 90 days from surgery. Women were followed up until SUI operation/death/emigration/diagnosis of gynecological cancer/December 31, 2018, whichever came first. Women undergoing the Manchester procedure were censored if they had undergone hysterectomy.We assessed the rate of SUI surgery with cumulative incidence plots. We performed Cox Regression to analyze the risk of SUI surgery, adjusting for age, calendar year, income level, concomitant surgery in anterior and posterior compartments, and diagnosis of SUI before POP operation. We found that 12.4% women with and 1.6% without SUI diagnosed before the POP surgery who underwent SUI surgery within 10 years.During follow-up (median, 8.5 years), 129 (2.1%) underwent SUI surgery after the Manchester procedure and 175 (1.8%) after vaginal hysterectomy (adjusted hazard ratio, 1.06 [0.84-1.35]). Of women diagnosed with SUI before POP operation 1 in 8 subsequently underwent SUI surgery. Few women not diagnosed with SUI subsequently underwent SUI surgery. There was no difference in risk of SUI after the Manchester procedure and vaginal hysterectomy.

Diagnostic value of transperineal ultrasound in patients with stress urinary incontinence (SUI): a systematic review and meta-analysis.

We aimed to analyze the diagnostic value of transperineal ultrasound in patients with stress urinary incontinence (SUI) using evidence-based methods. A comprehensive search of the studies on the diagnosis of SUI by transperineal ultrasound in PubMed, EMBASE, MEDLINE, Cochrane library, Medicine, Web of Science, and clinicaltrials.gov databases on August 1, 2022. Studies were included if they met the inclusion criteria and were evaluated by different quality evaluation methods according to study types. Various ultrasound parameters were collected and counted to analyze and judge the diagnostic value of transperineal ultrasound in SUI patients. A total of 13 studies with 1563 participants were finally included. The combined statistics showed no significant difference in age and parity among the included patients, and the BMI of the SUI group was slightly higher than that of the normal population (MD 1.20, 95%CI 0.68-1.72). The results indicated that compared with the normal population, the α angle (MD 15.56, 95%CI 9.93-21.90), β angle (at rest: MD 10.02mm, 95%CI 1.95-18.09; at Valsalva: MD 22.40mm, 95%CI 13.79-31.01), bladder neck descent (MD 6.82mm, 95%CI 4.49-9.14), area of hiatus (MD 2.83 cm2, 95%CI 0.71-4.94) and bladder neck funneling (RR 4.71, 95%CI 1.08-20.62) of SUI patients were significantly different, which illustrated the potential value of transperineal ultrasound in diagnosing SUI. Evidence-based medicine was applied to statistically analyze published articles on the diagnostic value of transperineal ultrasound in SUI. The results suggested that transperineal ultrasound had application value in the diagnosis of SUI and had the potential to become a routine examination method to assist clinical decision-making.

Stres Üriner İnkontinans Üzerine Cerrahi Ve Medikal Tedavilerin Etkileri

Purpose: The aim of this study was to evaluate how surgical and medical treatments affect the quality of life, depression status and social participation of women with Stress Urinary Incontinence (SUI). Materials and Methods: The study included 32 women with diagnoses of SUI. Among these women, 16 were designated as the medical treatment group (MTG), and the other 16 were designated as the surgical treatment group (STG). Before the treatment and 8 weeks after its completion, the patients were evaluated with the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), Incontinence Quality of Life Questionnaire (I-QOL), World Health Organization Quality of Life Instrument, Short Form (WHOQOL-BREF), Beck Depression Inventory (BDI) and Social Participation Questionnaire (SPQ). Results: The mean age of the subjects was 54.31±11.48 years in MTG and 48.38±10.01 years in STG. The mean body mass index (BMI) values of the groups were respectively 27.56±2.79 and 26.56±2.25 kg/m2. Following the treatment, statistically significant improvements were observed in urinary incontinence, depression, social participation and overall and disease-specific quality of life in both groups (p&amp;lt;0.05). Comparative analysis of the post-treatment changes in both groups showed statistically significant differences in the BDI score, the total work activity and household activity scores in the Social Participation Questionnaire and the psychosocial subgroups of both WHOQOL-BREF and I-QOL (p&amp;lt;0.05). Conclusion: Both treatments proved to be effective and usable to reduce the severity of SUI and depression, prevent social isolation and improve the quality of life. However, extensive research is required on the effects of SUI treatment methods on larger patient groups.

Developing a Clinical Care Guideline on Pelvic Floor Muscle Training for Women with Mild Stress Urinary Incontinence

&lt;p&gt;臨床上壓力性尿失禁常使用的評估診斷工具，可能造成輕度尿失禁症狀被低估而未適當治療，使病患仍受困擾。台灣健保制度完善，利用手術治療中、重度壓力性尿失禁病患，卻沒有對骨盆底肌強化訓練如何治療輕度壓力性尿失禁進行明確規範。本文發展流程為選定主題、建構問題、系統性文獻查證，根據16篇實證文獻擬定此指引，經由德菲法共識確認，隨後以AGREE II進行外部評估，結果為強烈建議使用，發展出指引範圍包含三個構面：指引的範圍界定5項，壓力性尿失禁評估診斷2項和處置建議5項。透過會議使醫師及專科護理師間達成共識；團隊成員教育訓練；建立檢核表，標準化評估處置流程，使輕度壓力性尿失禁婦女在身心完整評估下，適切接受骨盆底肌強化訓練。由於專科護理師跨醫療護理的角色功能，更能將此指引整合落實，使輕度壓力性尿失禁病患的照護更完整與持續。&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;&lt;p&gt;The commonly used evaluation and diagnostic tools for clinical stress urinary incontinence may lead to underestimation of mild symptoms. Therefore, leaving patients with long-term distress when prop-erly treatment is not provided. Taiwan has a well-established health insurance system, of which sur-gery is used to treat patients with moderate to severe stress urinary incontinence, but there is no clear regulation on the use of pelvic floor muscle training to treat mild stress urinary incontinence. Through the selection of topics, construction of issues and comprehensive literature review, this guideline was developed based on 16 empirical studies. The content of this guideline was later confirmed by the Dephi method and was strongly recommended for application after externally evaluated by AGREEII. The scope of this guideline includes three facets: 5 items for scoping, 2 items for the assessment and diagnosis of stress urinary incontinence, and 5 items for treatment. Through meetings, consensus was reached between physicians and nurse practitioners; team members were educated and trained; a checklist was established to standardize the evaluation and treatment process, so that women with mild stress urinary incontinence could appropriately receive pelvic floor muscle training after a com-plete physical and mental evaluation. Since nurse practitioner plays an important role in medical care, this guideline can be integrated and implemented to comprehensively improve the care of patients with mild stress urinary incontinence.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Dipstick urinalysis does not predict post-urodynamic study morbidity.

Pre-procedure urinalysis may add unnecessary cost and inconvenience for patients undergoing urodynamics. The hypothesis of this study was that urinalysis would perform poorly when predicting complications following urodynamics. Case-control study of women aged 18-89 undergoing urodynamics from 01 January2008 to 31 December 2017 at two tertiary medical centers. Data collected included patient demographics, past medical history, lower urinary tract symptoms, urodynamics indication, urodynamics results, urinalysis result, antibiotic administration, and adverse events within 30 days. Wilcoxon rank-sum test was used to compare those with and without an adverse event. Logistic regression was performed using statistically significant variables on pairwise analysis. A total of 601 patients met the criteria; 11 of these experienced an adverse event, of which all were a urinary tract infection. There were no differences in the frequency of adverse events based on any urinalysis result, regardless of whether the patient received antibiotics. On pairwise analysis, variables associated with a higher frequency of adverse events were higher parity (3.5 (2-5) vs 2 (2, 3), p=0.038) and complaint of suprapubic pain (1 (9.1%) vs 4 (0.7%), p=0.002). On logistic regression, significant variables included increasing age (adjusted odds ratio [aOR] 1.03 per year (95% CI 1.03-4.06); p=0.002), any prolapse (aOR 6.45 (95% CI 3.60-11.54); p<0.001), pelvic organ prolapse as the indication for urodynamics (aOR 7.27 (95% CI 2.60-20.36); p<0.001), and a diagnosis of stress urinary incontinence (4.98 (95% CI 1.95-12.67); p<0.001). The frequency of adverse events after urodynamics is low, and urinalysis in asymptomatic patients does not seem to be useful in predicting morbidity.

Long-term outcomes of polyacrylamide hydrogel treatment in women with stress urinary incontinence.

Long-term outcomes of polyacrylamide hydrogel treatment in women with stress urinary incontinence.

Association between pelvic floor disorders and bone mineral density: Findings from the HUNT study

ObjectivesTo examine the association between pelvic floor disorders (pelvic organ prolapse, urinary incontinence and anal incontinence) and bone mineral density (BMD).Study design: A cross-sectional study of 6809 women who participated in the third survey of the population-based Norwegian HUNT study was undertaken. BMD was measured by dual-energy X-ray absorptiometry. Information on BMD and self-reported pelvic floor disorders from the HUNT study was linked with hospital-derived data on diagnosis and surgical treatment of pelvic floor disorders. BMD was categorized according to the World Health Organization criteria (normal, osteopenia and osteoporosis). Multi-variate logistic regression models were used to estimate odds ratios (OR) with 95% confidence intervals (CI) for the association between pelvic floor disorders and BMD. ResultsWomen with a hospital diagnosis of stress urinary incontinence (SUI) were less likely to have osteopenia (OR 0.66, 95% CI 0.50–0.87) or osteoporosis (OR 0.66, 95% CI 0.34–1.30) compared with women without a diagnosis of SUI. In women with self-reported information on pelvic floor disorders, women with a history of SUI had lower odds for osteopenia (OR 0.88, 95% CI 0.75–1.02) or osteoporosis (OR 0.69, 95% CI 0.46–1.01), while no association was found between anal incontinence, self-reported surgery for pelvic organ prolapse, and osteopenia or osteoporosis. ConclusionPelvic organ prolapse was not associated with BMD. The reasons underlying the observed association between SUI and BMD require further investigation.

Pelvic Floor Ultrasound in the Diagnosis of Stress Urinary Incontinence and the Effect of Rehabilitation Therapy

Pelvic Floor Ultrasound in the Diagnosis of Stress Urinary Incontinence and the Effect of Rehabilitation Therapy

Role of Incontinence Severity Index in Evaluating Severity and Impact of Treatment Of Stress Urinary Incontinence.

Background:Stress urinary incontinence (SUI) is a common ailment in affecting quality of life. This study was performed to see role of incontinence severity index (ISI) in evaluating severity of SUI and to see the impact of treatment of SUI.Materials and Methods:A total of 40 women with the diagnosis of SUI on history and clinical examination were enrolled. ISI was calculated on all the women before treatment. All women were treated with either conservative treatment (pelvic floor exercises, life style modification, and duloxetine therapy) (4, 10%) or Burch's colposuspension (18, 45%) or tension-free obturator tape (18, 45%) as per clinical situation after discussion with patients. ISI was again calculated 6 months after treatment.Results:Mean age, parity, body mass index in the study were 41.60 years, 2.73, and 24.2 kg/m2, respectively. All 40 (100%) patients had SUI with the mean duration of symptoms being 4.04 years. A total of 11 (27.5%) had moderate SUI (ISI 3–6), while 24 (60%) had severe SUI (ISI 8–9), while 5 (12.5%) had very severe SUI (ISI 12). Range of pretreatment ISI was 3–12 with mean being 8.8 ± 3.2. Posttreatment ISI reduced significantly with range of 1–4 and mean of 1.3 ± 0.4 (P < 0.001). The reduction was significant for all the groups, but there was no significant difference in efficacy of three treatment groups. Statistical analysis was done using SPSS IBM Version 2-1-0 using Chi-square test, Fisher's Extract test, and ANOVA test as appropriate.Conclusion:ISI is a useful modality to evaluate the severity of SUI and to see the impact of treatment modalities on SUI.

The role of transperineal ultrasound in the evaluation of stress urinary incontinence cases.

ABSTRACTPurpose:To evaluate the use of transperineal ultrasonography while diagnosing stress urinary incontinence (SUI) by comparing the urethral angle (α), posterior urethrovesical angle (β), and bladder neck descent (BND) during rest and Valsalva maneuver in continent women and women with SUI.Materials and methods:This prospective observational study was conducted with 50 women with SUI and 50 continent women. Transperineal ultrasonography was performed at rest and during Valsalva maneuver. Q-tip test was performed.Results:During the Valsalva maneuver, both α and β angles were significantly higher in women with SUI (p <0.001). The difference between Valsalva and rest measurements of α and β angles (R α, R β) were also significantly higher in women with SUI (p <0.001). The cut-off point determined for the R α in the diagnosis of stress incontinence was 16° (80% sensitivity, 98% specificity). A statistically significant strong correlation was found between Q-tip test angle and R α value (p=0.000; r=0.890). Q-tip VAS pain scores were significantly higher than ultrasonography VAS pain scores (p <0.001). In relation to the bladder neck descent comparison between the two groups showed that BND was significantly higher in SUI group (p <0.001). The cut-off point determined for BND in the diagnosis of SUI was >11mm (90% sensitivity, 98% specificity).Conclusion:Transperineal ultrasonography is a practical, reliable, non-invasive and comfortable method for evaluation of SUI. It has the advantage of dynamic evaluation during the Valsalva maneuver. Rotation angles and BND have high sensitivity and specificity for detection of SUI. The change in α angle with Valsalva (Rα) can be used as an alternative to Q-tip test.

Inkontinencia moču a Medilady

Introduction: Within the framework of the use of various aids for the therapy of urinary incontinence, a wide space has opened up for the autonomous activity of the nurse. In her own way, the nurse is the main point of communication for all other members of the team, including the doctor himself, precisely in the assessment and reporting of the information found. The paper analyzed the types of physical therapy for stress urinary incontinence and conducted research on a selected group of female respondents who used the patented Medilady rehabilitation aid in the treatment of incontinence. Objective: The objective of the contribution was to monitor the impact of urinary incontinence on the quality of life of women using the Medilady rehabilitation aid. Methodology: The research file consisted of female respondents with a diagnosis of stress urinary incontinence (SUI), who used the Medilady rehabilitation aid to strengthen the pelvic floor muscles for more than 90 days. Data collection took place between 08/2021 - 01/2022 at the Viennese Private Clinic in Vienna, after the agreement of the clinic management with the subsequent approval and publication of the questionnaire for the designated group of female respondents, in the form of quantitative research. 96 female respondents were approached. Of these, 81 questionnaires were completely filled out and returned. The data were processed by statistical analysis using the binomial test and the paired Wilcoxon test Results: The treatment of urinary incontinence in women with the rehabilitation aid Medilady is a relative novelty. This greatly limited the selection of suitable respondents for the conducted research. According to the selected criteria, 91% of the clients increased the weight of the weights, so we can evaluate that the pelvic floor was effectively strengthened in the specified cohort of clients. 71% of users reported no negative experiences with the use of Medilady. Conclusion: The limits of the research were in the relatively low number of respondents and the patented device Medilady, which is new in the treatment of urinary incontinence, where comparisons of results in professional studies were not available. Further research needs to be continued due to urinary incontinence and its impact on the quality of life of the woman herself.

Artificial intelligence models derived from 2D transperineal ultrasound images in the clinical diagnosis of stress urinary incontinence.

The aim of the study was to develop artificial intelligence (AI) algorithms using 2D transperineal ultrasound (TPUS) static images to simplify the clinical process of diagnosing stress urinary incontinence (SUI) in practice. The study involved 400 patients in total, including 265 SUI patients and 135 non-SUI patients who underwent a routine clinical evaluation process by urologists and TPUS. They were classified into different groups based on the International Consultation on Incontinence Questionnaire (ICIQ) to assess the impact of inconvenience on patients' lives. Four AI models were developed by 2D TPUS images: Model A (a single-mode model based on Valsalva maneuver images to classify G-0, G-1, and G-2); Model B (a dual-mode model based on Valsalva maneuver and resting state images to classify G-0, G-1, and G-2); Model C (a single-mode model based on Valsalva maneuver images to classify G-2 and G-01); Model D (a dual-mode model based on Valsalva maneuver and resting state images to classify G-2 and G-01). The performance of the four models was evaluated by confusion matrices and the area under the receiver-operating characteristic curve (AUC). The dual-mode model based on the Valsalva maneuver and resting-state images (Model D) had a higher accuracy of 86.3% and an AUC of 0.922, which was significantly higher than the AUCs of the other three models: 0.771, 0.862, and 0.827. The AI algorithm using 2D TPUS static images of the Valsalva maneuver and resting state may be a promising tool in the diagnosis of SUI patients in to relieve clinical processes in practice given its ease of use in clinical applications.

Impact of bariatric surgery in patients with stress urinary incontinence.

ABSTRACTObjective:To examine epidemiologic, anthropometric and clinical variables associated with stress urinary incontinence in obese women, before and after bariatric surgery, and to identify predictive factors of stress urinary incontinence resolution.Methods:Prospective observational study with women enrolled in a bariatric surgery program between 2015 and 2016. Patients were assessed prior to and 6 months after bariatric surgery using the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form, the Patient Global Impression of Improvement and the Visual Analogue Scale. Patient assessment also included physical examination and bladder stress tests.Results:A total of 43 women completed the study. There was a 72.7% reduction in stress urinary incontinence (p=0.021). Predictive factors for preoperative diagnosis of stress urinary incontinence included age (p=0.024) and abdominal waist circumference (p=0.048). Urinary symptoms improved after weight loss, especially nocturia (p=0.001) and stress urinary incontinence (p=0.026). Menopause was the most significant predictive factor for persistence of stress urinary incontinence within six months of bariatric surgery (p=0.046). Self-reported outcomes and scores obtained in the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form, the Patient Global Impression of Improvement and the Visual Analogue Scale were associated with significant improvement (p=0.012, p=0.025, and p=0.002 respectively).Conclusion:Older women with larger waist circumference have a higher risk of developing stress urinary incontinence prior to bariatric surgery. Menopausal women are highly prone to persistent stress urinary incontinence, even after weight loss. Weight loss achieved through bariatric surgery improved stress urinary incontinence symptoms and mitigated related impacts on quality of life in the vast majority of women.

Prediction of Stress Urinary Incontinence Using the Retrovesical (β) Angle in Transperineal Ultrasound.

The accurate, rapid diagnosis of stress urinary incontinence (SUI) in women can profoundly improve their sexual and psychosocial life. In this study, the diagnostic power of SUI was assessed by transperineal ultrasound. In this hospital-based case-control study, married women who were referred to the gynecologic and ultrasound wards with negative urinalysis and culture results were enrolled by random sampling. Patients with positive cough signs based on the urodynamic testing data were considered cases, whereas control women showed no cough symptoms and were recruited from the same ward. There was a significant difference (P < .001) in bladder neck descent (mean ± SD, 10.89 ± 5.51 versus 7.08 ± 2.60 mm, respectively; P = .0001) and the retrovesical (β) angle with the Valsalva maneuver (144.22° ± 19.63° versus 111.81° ± 24.47°; P < .001) between the case and control groups. Also, the β angle without the Valsalva maneuver was higher in the case group (112.35° ± 23.10°) than the control group (120.17° ± 25.16°; P = .001). There was no case of a urinary leak, urethral diverticulitis, a bladder stone or mass, and cystourethrocele in the patients of each group. The results of multivariate logistic regression with a backward method showed that bladder neck descent (odds ratio [OR], 1.24; 95% confidence interval [CI], 1.09-1.40), the β angles with and without the Valsalva maneuver (OR, 1.1; 95% CI, 1.06-1.13; and OR, 1.04; 95% CI, 1.01-1.06) were the predictors of SUI. A β angle higher than 127° with the Valsalva maneuver, with an area under the curve of 0.89 (95% CI, 0.75-0.96), could very well predict the SUI response. This finding shows that it can be very well used to distinguish between normal and non-normal responses, with 89% sensitivity and 79% specificity. The β angle with the Valsalva maneuver could very well predict the SUI response.

Valsalva urethral profile (VUP): A urodynamic measure to assess stress urinary incontinence in women.

We aimed to assess the value of the Valsalva urethral profile (VUP) in case of stress urinary incontinence (SUI). Six hundred and ninety-four women without pelvic organ prolapse were included in this prospective monocentric study. SUI was diagnosedfrom symptoms using the International Continence Society definition, and severity using two validated questionnaires (USP and ICIQ-SF). The urodynamic parameters studied were maximal urethral closure pressure (MUCP) and functional length (FL). Both were performed at rest, during a Valsalva maneuver (v-MUCP and v-FL) and again at rest. Correlation analyses and ROC curves were used to assess the value of the clinical and urodynamic measurements. In our population, based on the questionnaires, 172 (24.8%) women were diagnosed with pure SUI on symptoms, 71 (10.2%) with urgency urinary incontinence and 392 (56.5%) with mixed urinary incontinence; 59 (8.5%) women were continent. The v-MUCP was the most correlated parameter to the severity of SUI (ρ: -0.63) and the most predictive of SUI risk, with a threshold value of 35 cm H2 O (Se = 0.82, Sp = 0.86). The v-FL was significantly shortened in case of SUI. The v-MUCP and v-FL are global measurements of urethral resistance during stress. With a threshold value of 35 cm H2 O, the v-MUCP was the most discriminating parameter for the diagnosis of SUI, with a good reliability.