Female Urinary Incontinence Research Articles

Citation classics: the 100 most cited articles in Urogynecology.

The objective of this study was to utilize objective citation analyses to describe the 100 most cited articles in the field of Female Pelvic Medicine & Reconstructive Surgery (FPMRS) and to review their characteristics. We searched the Thomas Reuters Web of Science database for the most cited articles within all journals classified as Obstetrics and Gynecology (Ob/Gyn), Urology (Uro), Colorectal Surgery (CRS), and vital General Medicine (GM) journals (New England Journal of Medicine; Journal of the American Medical Association; Lancet; The BMJ). We reviewed search results for FPMRS content and compiled a list of the top 100 most cited articles relevant to FPMRS. We screened 34,934 articles yielded by the initial search and compiled the 100 most cited articles relevant to FPMRS. Of these 100 titles, 40% (42 out of 105) were published in Ob/Gyn, 46.7% (49 out of 105) in Uro, 1.9% (2 out of 105) in CRS, and 11.4% (12 out of 105) in GM journals. The most cited FPMRS article was "The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society" (3,810 total and 242 citations per year). Over half the articles were observational in nature and the majority (58%) of them were related to urinary incontinence in women. Highly cited FPMRS articles come from a variety of journals, and nearly 50% of the 100 most cited FPMRS articles are from the urology literature. The most cited articles were largely observational rather than interventional studies and mostly related to female urinary incontinence.

Association of diabetic retinopathy stage with the severity of female urinary incontinence.

To assess the relation between diabetic retinopathy (DR) severity and urinary incontinence (UI) in patients with diabetes mellitus (DM). This prospective and observational study included 153 subjects. Patients were divided into three subgroups, according to severity of DR, as: No-DR, nonproliferative DR (NPDR), and proliferative DR (PDR); 40 age-matched healthy subjects formed the control group. Turkish version of the Urogenital Stress Inventory 6 (UDI-6) and Incontinence Impact Questionnaire (IIQ-7) were used to assess the UI symptoms and their effect on quality of life. The UDI-6 and IIQ-7 scores were the primary outcomes of the study. No significant difference was observed between groups regarding age, maternal parity, body mass index, type of delivery, menopausal status, and smoking. The mean UDI-6 urgency UI questions score was significantly higher in the PDR group and significantly higher in the NPDR group than in the control group. The mean UDI-6 stress UI questions score was similar between groups. The mean UDI-6 voiding difficulty questions score was significantly higher in the PDR group and no significant difference was observed between other groups. The mean IIQ-7 score was significantly lower in the PDR group. A moderate and positive correlation was found between glycated hemoglobin level and the UDI-6 urgency UI and voiding difficulty questions and total scores. A weak and positive correlation was found between the duration of DM and the all UDI-6 scores. The present study showed that UI symptoms and their effect on QOL were more severe in patients with PDR.

Urinary incontinence among female patients attending a selected public hospital in Bangladesh

<p class="abstract"><strong>Background:</strong> Urinary incontinence is a frequent public health problem with negative social consequences, particularly for women. Women are much more susceptible to urinary incontinence than men. Female susceptibility is the result of anatomical, social, economic and cultural factors.</p><p class="abstract"><strong>Methods:</strong> A cross sectional study was conducted to find out the factors related to urinary incontinence, distribution of types of incontinence among female patients and their health care seeking behavior and socio-demographic characteristics among 121 adult female patients who attended the outpatient department of Gynae and Obstetrics department and Urology department of Dhaka Medical College and Hospital during the period of January to June 2016. Data were collected through face to face interview. </p><p class="abstract"><strong>Results:</strong> The mean age of the respondents was 43.42 years and the mean monthly income of the respondents was 17409.09 taka. Little above nine-tenths (91.7%) of the respondents were Muslim and the majority of the respondents (47.9%) were living in pacca house. More than seven-tenths (73.6%) of the respondents were married and over 35% of the respondents were illiterate. Among the respondents about 42.1% of them had pressure type of incontinence, followed by mixed incontinence (27.3%). Over 65% had some complication during delivery and little above six-tenths (61.2%) had gynecological problems.</p><p><strong>Conclusions:</strong> Female urinary incontinence is a frequent and a major embarrassing healthcare problem in Bangladesh. Patients who had complications during labor, having multipara, recurrent UTI, gynecological problem such as uterine prolapse, urethral injury, had high percentage of urinary incontinence. Patients with urinary incontinence should be encouraged to seek treatment early as the problem can be treated. </p>

Évaluation des programmes d’entraînement musculaire du plancher pelvien et incontinence urinaire chez la femme : revue de la littérature

Pelvic floor rehabilitation is efficient for the first line treatment of urinary incontinence in women. However, several questions remain as regards the best pelvic floor muscle training program to recommend. The objective was perform a literature review regarding the muscular strengthening program to recommend to treat stress or mixed urinary incontinence in women. We performed a systematic review of studies on the topic using Medline's database covering the 10last years. Among the 1130articles that were identified, we retained 6for our analysis. Given the heterogeneity of the exercise programs, it was impossible to exhaustively and comparatively analyze their efficacies. However, a significant improvement is noted when the exercises are based on the muscular training principles of the American College of Sports Medicine. They combine long and short contractions with the practice of the knack in situations of pressure exertion and are part of a self-rehabilitation program based on the needs of the patient and the individual's progression. Current knowledge does not allow us to recommend an optimal muscle training program to treat female urinary incontinence. Research must be conducted to evaluate different muscular training regimens but also their integration into a program based on personal needs as well as factors of adherence to the treatment of patients.

Re: Association between Female Urinary Incontinence and Geriatric Health Problems: Results from Korean Longitudinal Study of Ageing (2006).

Re: Association between Female Urinary Incontinence and Geriatric Health Problems: Results from Korean Longitudinal Study of Ageing (2006).

Laser Therapy in the Treatment of Female Urinary Incontinence and Genitourinary Syndrome of Menopause: An Update.

Vaginal birth trauma is the leading cause of stress urinary incontinence (SUI) in women. Also, the process of ageing and hormonal deprivation in postmenopause alters the metabolism of connective tissues and decreases collagen production leading to pelvic floor dysfunction. Noninvasive treatment is recommended as first-line management of urinary incontinence (UI) in women. Surgical procedures are more likely to be implemented to cure UI but are associated with more adverse events. Sex hormone deficiency affects changes also in the lower urinary tract where estrogens are the main regulators of physiological functions of the vagina. In the last decade, laser treatment of SUI and of the genitourinary syndrome of menopause (GSM) has been shown a promising treatment method in peer-reviewed literature. This review's aim is to present the evidence-based medical data and laser treatment of SUI and GSM in an outpatient setting to be a good treatment option, regarding short-term as well as long-term follow-ups. Long-term follow-up studies are needed to confirm that laser treatment is a good, painless outpatient procedure with no side effects in postmenopausal women.

Efficacy of the trans‑obturator and retropubic mid‑urethral slings for stress urinary incontinence

Background: The aim of our study was to report the extended long-term results of the use of tension-free vaginal tape (TVT) and trans-obturator tape (TOT) for the treatment of female urinary stress incontinence (SUI) at the Division of Gynaecology and Obstetrics / UMC Ljubljana. There are few data on this topic in the literature. Our aim was to find out whether and how the procedure improved the patients’ quality of life and for how long, whether the patients had complications after the procedure, and how this type of procedure affected the long-term results.Methods: A retrospective clinical trial comparing the use of TVT and TOT was carried out from January to August 2017 and included all the patients operated on at the Division of Gynaecology and Obstetrics / UMC Ljubljana with TVT or TOT procedure for stress or mixed urinary incontinence (UI) associated with urethral hyper mobility (the stress component was clinically predominant). The exclusion criteria were more than 10 years from procedure, age more than 80 years in 2016, previous anti-incontinence surgery and/or pelvic organ prolapse more than stage I on POP–q in any vaginal compartment. After inclusion and exclusion criteria, 1104 patients were sent quality-of-life questionnaires (PGI-S, PGI-I, SANDVIK SEVERITY SCALE, UDI-6, IIQ-7, ICIQ-UI Short Form (Slovenian)) with questions about the diagnosis, procedures, complications, reoperations, post-operative results, and satisfaction with the procedure. Till August 2017 (6 months after sending) we received 466 questionnaires (42.2 % response rate). After 225 questionnaires were excluded due to incomplete data, 241 questionnaires were analysed.Results: In the analysed group of patients (N = 241), 189 (78 %) had TOT and 52 (22 %) had TVT. Our retrospective study has confirmed that the efficacy and safety of TOT and TVT in the surgical treatment of SUI are comparable. The TOT and TVT groups did not differ significantly from each other in PGI-S, PGI-I, SANDVIK SEVERITY SCALE, UDI-6, IIQ-7, and ICIQ-UI Short Form or in postoperative complication rate. Repeat surgery was needed in 25/189 (13.2 %) TOT patients and 12/52 (23.1 %) TVT patients; p = 0.082. Urinary retention appeared in 18/189 (9.5 %) TOT patients and 7/52 (13.5 %) TVT patients; p = 0.411. Mesh erosion/inflammation appeared in 12/189 (6.3 %) TOT patients and 2/52 (38 %) TVT patients; p = 0495.Conclusion: We can conclude that the efficacy and safety of TOT and TVT in the surgical treatment of SUI are comparable. The choice of the technique should be based on the relative pros and cons of techniques and the surgeon’s experience.

Long-term effect of community-based continence promotion on urinary symptoms, falls and healthy active life expectancy among older women: cluster randomised trial.

BackgroundThe long-term effectiveness of group continence promotion delivered via community organisations on female urinary incontinence, falls and healthy life expectancy remains unknown.MethodsA pragmatic cluster randomised trial was conducted among 909 women aged 65–98 years with urinary incontinence, recruited from 377 community organisations in the UK, Canada and France. A total of 184 organisations were randomised to an in-person 60-min incontinence self-management workshop (461 participants), and 193 to a control healthy ageing workshop (448 participants). The primary outcome was self-reported incontinence improvement at 1-year. Falls and gains in health utility were secondary outcomes.ResultsA total 751 women, mean age 78.0, age range 65–98 completed the trial (83%). At 1-year, 15% of the intervention group versus 6.9% of controls reported significant improvements in urinary symptoms, (difference 8.1%, 95% confidence intervals (CI) 4.0–12.1%, intracluster correlation 0.04, number-needed-to-treat 13) and 35% versus 19% reported any improvement (risk difference 16.0%, 95% CI 10.4–21.5, number-needed-to-treat 6). The proportion of fallers decreased from 42% to 36% in the intervention group (−8.0%, 95% CI −14.8 – −1.0) and from 44% to 34% in the control group (−10.3%, 95% CI −17.4 – −3.6), no difference between groups. Both intervention and control groups experienced a gain in health utility (0.022 points (95% CI 0.005–0.04) versus 0.035 (95% CI 0.017–0.052), respectively), with no significant difference between groups.ConclusionCommunity-based group continence promotion achieves long-term benefits on older women’s urinary symptoms, without improvement in falls or healthy life expectancy compared with participation in a healthy ageing workshop.

Surgical outcome of the transobturator tape procedure for management of female urinary incontinence: A single center experience

Background/Aim. The transobturator tape (TOT) procedure is considered as a gold standard of surgical treatment option for stress urinary incontinence (SUI). The aim of this study was to determine the efficacy of this procedure in the surgical management of SUI by analyzing a single centre short-term results. Methods. From April 2011 until January 2018, 40 patients with predominantly SUI were operated by the standard TOT procedure. A polypropylene tape was placed in the mid-urethra by a percutaneous transobturator approach. The postoperative assessment considered cough tests and post-void residual urine volume at a week following the operation with additional clinical examination and urine culture at one, three and six months. Results. The mean age of the patients was 58 (42?78) years. Predominantly SUI was present in 32 patients (80%) and mixed urine incontinence in 8 patients (20%). At the initial (one week) assessment, the cough test was positive in 3 patients (7.5%), and 4 patients (10%) needed an indwelling urethral catheter because of voiding difficulties. At the second follow-up, 2 (5%) patients still had a positive cough test, 2 patients (5%) had still the need for an indwelling catheter because of significant postvoid residual (PVR) urine volumes and 2 patients (5%) had a positive urine culture. At the three and six months, postoperative assessment. 3 patients (7.5%) still had a positive cough test. After six months 36 patients (90%) were considered as cured, 1 patient (2.5%) improved and 3 patients (7.5%) were classified as a failure. Conclusion. These results concur with the results of the other published short-term studies that analyzed the surgical outcome of the TOT procedure for female urinary incontinence. This allows us to confirm that the transobturator tape technique is a safe, effective and straightforward procedure after adequate training.

Re: The Long-Term Effects of Bariatric Surgery on Female Urinary Incontinence.

Re: The Long-Term Effects of Bariatric Surgery on Female Urinary Incontinence.

878 - ICS educational module: Cough stress test in the evaluation of female urinary incontinence: Introducing the ICS-Uniform cough stress test

Introduction A cough stress test (CST) is recommended in the evaluation of the uncomplicated female patient with the complaint of stress urinary incontinence (SUI) to identify the sign of SUI, and is often used as an outcome measure following SUI treatment. However, there has been no standardization of the performance or reporting of CST. A working group of the International Continence Society (ICS) has developed an educational module, comprising a Powerpoint™ presentation and evidence base manuscript, to instruct on the performance, interpretation, and reporting of the CST in a standardized manner: the ICS-Uniform Cough Stress Test (ICS-UCST). Methods The working group performed a PUBMED literature search of articles (observational/experimental and reviews) published prior to 2017 that mentioned a CST. The evidence base examined various variables in performing a CST as well as sensitivity/specificity and positive/negative predictive values of CST. Results The variables involved in performing/interpreting an ICS-UCST include: patient positioning, degree of bladder filling, number, and forcefulness of coughs, and method of SUI detection. For the ICS-UCST it is recommended that the patient be in a supine/lithotomy position with 200-400 mL of fluid in the bladder. She coughs forcefully 1-4 times and the examiner directly visualizes the urethral meatus for the presence of leakage. Leakage of fluid from the urethral meatus coincident with/simultaneous to the cough(s) is considered a positive test. Conclusion This module provides instructions to educate a uniform CST (the ICS-UCST), with the aim of improving the clinical practice of cough stress testing in female patients with urinary incontinence.

37: Towards reducing adult female urinary incontinence (UI) burden: opportunities to improve UI guidelines

To systematically review UI evaluation guidelines. We performed a systematic literature search using strategies for the concept of UI guidelines in 8 medical search engines, including Ovid-Medline and Embase. Major organizational websites were searched. After abstract and full-text screening, UI evaluation guidelines written for medical providers in English after 1/1/2008 were included. Exclusion criteria were guidelines for children, men, institutionalized women, and peripartum and neurologic-related incontinence. Twenty-five guidelines met criteria. Most (96%) recommended history taking or at least one history component, but varied in detail. Two summarized history taking by descriptors (i.e., good, proper), whereas most explicitly specified ≥1 component (Table 1). Excluding other disease processes was recommended (4%), mentioned (12%), listed with examples (32%), or inferred (24%); 44% recommended referral to a specialist if indicated. Similar variability was observed for physical examination (PE) with 96% recommending ≥ 1 PE component. Some (12%) provided no further guidance, whereas others recommended (R), recommended in certain situations (CS), or listed (L) components (see Table 1). Evidence or recommendation levels for history or PE components were largely based on clinical principle, expert opinion, or panel consensus. Additional evaluation components were urinalysis (19 R, 1 CS, 1 L), urine culture (2 R, 10 CS, 1 L, and 4 were unclear), post void residual (10 vs 11 R, 13 CS), and bladder diary (9 R, 1 CS, 8 L). Multichannel urodynamics, cystoscopy, and imaging were typically reserved for use in certain situations (20, 13, & 6 respectively). While several exemplary UI evaluation guidelines exist, many others lack detail, are not evidence-based, and are variable. This variability may lead medical providers to perform inconsistent evaluations in the work up and diagnosis of UI. Opportunities to advance UI guidelines include improving clarity, consistency, and individualization.

Evaluation of the effect of an antenatal pelvic floor muscle exercise programme on female sexual function during pregnancy and the first 3 months following birth: study protocol for a pragmatic randomised controlled trial

BackgroundSexual dysfunction can have a negative impact on women’s quality of life and relationships. There is limited information about female sexual function and treatment, particularly during pregnancy and the postpartum period. The effect of pelvic floor muscle exercise (PFME) on sexual function (SF) has not been studied adequately. The purpose of this study is to investigate the effect of antenatal PFME on female SF during pregnancy and the first 3 months following birth.Methods/designThis is a pragmatic, randomised controlled trial which will compare a structured antenatal PFME programme combined with standard antenatal care to standard antenatal care alone. Eligible women who are less than 22 weeks’ gestation will be recruited from the antenatal clinics of one hospital located in Western Sydney, Australia. A sample of 200 primiparous pregnant women who meet the inclusion criteria will be randomised to either control or intervention groups. This sample size will allow for detecting a minimum difference of 9% in the female SF score between the two groups. The duration of the PFME programme is from approximately 20 weeks’ gestation until birth. Female SF will be measured via questionnaires at < 22 weeks’ gestation, at 36 weeks’ gestation and at 3 months following birth. Baseline characteristics, such as partner relationship and mental health, will be collected using surveys and questionnaires. Data collected for secondary outcomes include the effect of PFME on childbirth outcomes, urinary and faecal incontinence symptoms and quality of life.DiscussionThe findings of this study will provide more information on whether a hospital-based antenatal PFME has any effect on female SF, urinary and faecal incontinence during pregnancy and the first 3 months following birth. The study will also provide information on the effectiveness of antenatal PFME on childbirth outcomes.Trial registrationAustralian New Zealand Clinical Trials registry, ACTRN12617001030369. Registered on 17 July 2017.

Impact of Action II Petite Lady Laser Machine in the Treatment of Urinary Incontinence and Sexual Dysfunction in Female

Background and Aims: Urinary incontinence &amp; sexual Dysfunction is very common among female. It causes social or hygienic problem. Urinary incontinence is the uncontrolled leakage of urine. This condition affects about a third of the female population and is more common in women than in men5. Recently the Action II Petite Lady laser has attracted attention for urinary incontinence and sexual dysfunction as non-invasive way that is aimed at awakening a woman’s sensuality by tightening up their vaginal canal. The current study evaluated the clinical efficacy of the Action II Petite lady laser on the treatment of sexual dysfunction and urinary incontinence in females. Subjects and Methods: Thirty woman with Urinary incontinence &amp; sexual Dysfunction, ages from 25 – 55 year were treated for four sessions two weeks apart between the first three sessions and one month apart between the third and fourth session with a 2940 nm Er: YAG via 90° and 360 scanning scopes. PFX2 assessments were performed at baseline, one –month post treatment and at 2 months’ post-treatment for vaginal muscle power. FSFI questionnaires were answered pre-post intervention, and bladder diaries were used. Subjective satisfaction was assessed about sexual satisfaction. Results: All subjects successfully completed the study with no adverse events. Significant improvement in vaginal muscle power was seen in all subjects at 2 months’ post-procedure based on the PFX2 values, sexual satisfaction as assessed by the subjects themselves 57.7% very satisfied and 42.3% moderately satisfied. The comparison between the means of the considered parameters before and after the treatment showed a very significant difference in reducing the symptoms of stress incontinence. Conclusions: Er: YAG laser treatment for urinary incontinence and sexual dysfunction produced significant improvement. With multicast delivered in the multiple micro pulse modes via 90 and 360scanning scopes, nonsurgical Er: YAG laser treatment was pain-free, safe, side effect free, easily tolerated and effective.

Are Slings Still the Gold Standard for Female Stress Urinary Incontinence?

As slings are the most frequent first-line treatment for management of female urinary incontinence, an artificial urinary sphincter may be indicated in cases of failure and sphincter deficiency. The level of evidence has to improve and prospective studies or new devices are awaited.

EFFECTIVENESS OF VAGINAL CONE THERAPY ON URINARY INCONTINENCE AMONG WOMEN IN SAVEETHA MEDICAL COLLEGE HOSPITAL, THANDALAM, CHENNAI

Objectives: The present aims to assess the level of urinary incontinence in experimental and control group, to assess the effectiveness of vaginal cone therapy on urinary incontinence in experimental group and control group and to associate the post-test level of urinary incontinence with the selected demographic variables among women in the experimental group.&#x0D; Methods: A quantitative quasi-experimental research design was conducted among 60 women with urinary incontinence. Convenience sampling technique was used. Semi-structured interview method was used to collect the demographical data and level of urinary incontinence among women was assessed by urinary incontinence diagnosis questionnaire.&#x0D; Results: Among 60 samples in experimental group 26 women had a moderate level of urinary incontinence, and 4 women had slight urinary incontinence whereas in control group 24 women had moderate level of urinary incontinence and 6 women had slight urinary incontinence. The study results show significant improvement in level of urinary incontinence among experimental group than the control group after the intervention at the level of p&lt;0.05. This reveals that vaginal cone therapy is highly significant in the experimental group because pelvic muscle strength had improved and allows the patient to increase the physiological consciousness and promotes the muscle tone after the use of a vaginal cone.&#x0D; Conclusion: This study proves that vaginal cone therapy is the effective non-pharmacological method, cost-effective method and had no side effects which can be used to treat female urinary incontinence.

Relationship between transversus abdominis muscle thickness and urinary incontinence in females at 2 months postpartum.

[Purpose] Urinary incontinence is a frequent postpartum complication. Thus, this study aimed to examine the associations of transversus abdominis muscle thicknesses at rest and during an abdominal drawing-in maneuver with urinary incontinence in females at 2 months postpartum. [Participants and Methods] The participants included 18 females at 2 months postpartum with or without urinary incontinence, and 10 nulliparous females as controls. Transversus abdominis thickness was measured at rest and during the abdominal drawing-in maneuver using diagnostic ultrasonography. The Japanese version of the International Consultation on Incontinence Questionnaire-Short Form was used to evaluate urinary incontinence. [Results] Females at 2 months postpartum were divided into groups with and without urinary incontinence according to questionnaire scores. The muscle thickness during the abdominal drawing-in maneuver contraction was significantly lower in those with urinary incontinence than in those without urinary incontinence and controls. [Conclusion] The results showed significantly reduced transversus abdominis thickness during contraction, which suggested reduced transversus abdominis strength in females with postpartum urinary incontinence. Thus, promoting synergistic contraction of the inner unit, including the transversus abdominis, in exercise therapy may be more effective for postpartum urinary incontinence.

Killing Two Birds with One Stone: Treatment of Female Urinary Incontinence Improves Female and Male Sexual Function

Killing Two Birds with One Stone: Treatment of Female Urinary Incontinence Improves Female and Male Sexual Function

Female Hypospadias and Urinary Incontinence: Surgical Solution of a Little-Known Entity

Female Hypospadias and Urinary Incontinence: Surgical Solution of a Little-Known Entity

Risk factors for female pelvic organ prolapse and urinary incontinence

To explore the risk factors for and the pathogenic mechanisms of pelvic organ prolapse and urinary incontinence. Methods: A total of 2 668 females who completed pelvic floor functional detection from July 2014 to October 2015 in the Physical Examination Center of the Third Xiangya Hospital of Central South University. The patients were divide into 4 groups: an urinary incontinence group, an organ prolapse group, an organ prolapse with urinary incontinence group, and a normal group. We compared the age, BMI, menopause, gravidity and parity, delivery pattern, the coordination of pelvic floor and abdominal muscles among the 4 groups. Results: There were statistical differences in age and BMI values among the 4 groups (P<0.05).There were statistical differences in menopause rate, gravidity and parity history among the normal group and the other 3 groups (P<0.05), and between the organ prolapse group and the organ prolapse with urinary incontinence group (P<0.05). However, the urinary incontinence group was not statistically different from the organ prolapse group and the normal group (P>0.05). In the mode of delivery, there were statistical difference among the normal group and the other 3 groups (P<0.05), and between the organ prolapse group with urinary incontinence group and the organ prolapse or the urinary incontinence group (P<0.05). There was no significant difference between the urinary incontinence group and the organ prolapse group (P>0.05). Among the 4 groups, the normal group was the best one in coordination between pelvic floor and abdominal muscles, following by the organ prolapse group, the pelvic organ prolapse group and the urinary incontinence group. Conclusion: Aging, menopause, number of pregnancies and delivery, BMI, and mode of delivery all affect the occurrence of pelvic organ prolapse and urinary incontinence. Females with urinary incontinence or organ prolapse are not good in coordination between the pelvic floor and abdominal muscles.