Incontinence Questionnaire-Female Lower Urinary Tract Research Articles

Pilot Study of aNovel Online Comprehensive Pelvic Floor Program for Urinary Incontinence in Women.

Urinary incontinence (UI) is common in women and has a vast impact on quality of life (QOL), financial health, and work disability. Robust evidence demonstrates the efficacy of comprehensive conservative therapy (pelvic floor muscle training [PFMT], and behavioral and dietary modification) in the treatment of UI. However, numerous barriers impede access to this care, including limited specialized therapists, financial barriers, and scheduling obstacles. To address these barriers, we developed a novel comprehensive online pelvic floor program (oPFP). We performed a prospective study assessing continence and QOL outcomes in women with stress urinary incontinence (SUI), urge urinary incontinence (UUI), or mixed urinary incontinence (MUI) treated with oPFP between May 2019 and November 2022. Outcomes were assessed at baseline and following completion of the 2-month program using the validated International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms, Urgency Perception Scale (UPS), Incontinence Impact Questionnaire (IIQ-7) questionnaires, and 24-h bladder diary. Data were analyzed using linear, Poisson mixed models, or generalized estimating equations. Twenty-eight women (2 SUI, 3 UUI, 23 MUI) were enrolled and 19 (2 SUI, 2 UUI, 15 MUI) completed the study. Following oPFP, participants showed significantly improved SUI domain scores (3.04 ± 0.19 vs 1.81 ± 0.23, p < 0.001), UPS reason score (2.52 ± 0.18 vs 2.05 ± 0.14, p = 0.003), IIQ-7 sum scores (5.16 ± 0.88 vs 3.07 ± 0.70, p = 0.038), and daily incontinence episodes (2.96 ± 0.60 vs 1.06 ± 0.29, p < 0.001). Mean patient-reported improvement was 5.4 ± 2.5 (ten-point Likert scale). Of respondents, 89% reported program satisfaction, ease of use, and would recommend the program to others. The oPFP results in significant improvements to a variety of UI and QOL measures. This program provides an important UI treatment option and gives women greater access to effective conservative therapy.

Effects of Sleeve Gastrectomy on Pelvic Floor Disorders in Female Patients with Severe Obesity: a Prospective Study.

Obesity is associated with pelvic floor disorders (PFD). Sleeve gastrectomy (SG) is one of the most effective weight loss methods. Although SG has been found to improve urinary incontinence (UI) and overactive bladder (OAB), its impact on fecal incontinence (FI) remains controversial. This prospective, randomized study involved 60 female patients with severe obesity who were randomly assigned to two groups: the SG group and the diet group. The SG group underwent SG, while the diet group received a low-calorie, low-lipid diet for 6 months. The patients' condition was assessed before and after the study using three questionnaires: the International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms (ICIQ-FLUTS), the Overactive Bladder 8-Question Awareness Tool (OAB-V8), and the Wexner Score (CCIS). After 6 months, the SG group had a significantly higher percentage of total weight loss (%TWL) compared to the diet group (p<0.01). Both groups showed a decrease in the ICIQ-FLUTS, OAB-V8, and CCIS scores (p<0.05). UI, OAB, and FI improved significantly in the SG group (p<0.05), but no improvement was observed in the diet group (p>0.05). The correlation between %TWL and PFD was statistically significant but weak, with the strongest correlation between %TWL and ICIQ-FLUTS score and the weakest correlation between %TWL and CCIS score (p<0.05). We recommend bariatric surgery for the treatment of PFD. However, given the weak correlation between %TWL and PFD after SG, further research should explore factors other than %TWL that are effective in recovery, particularly in relation to FI.

Effect of Kegel Exercises on Lower Urinary Tract Symptoms in Young Gymnasts: A Prospective Cohort Study.

Lower urinary tract symptoms (LUTS) have been shown to exist in young athletes. The use of pelvic floor muscle training as a preventive strategy at an early age may be useful to avoid possible pelvic floor dysfunction in the future. The aim of the study was to describe LUTS in underaged gymnasts. We also aimed to evaluate the effects of a 12-week Kegel exercise intervention for LUTS and urinary incontinence (UI) and their relationship to bother. A quasi-experimental (nonrandomized, noncontrolled) pre-post study was conducted. Nineteen gymnasts with a mean age of 13.21 ± 1.84 were selected from a gymnastics club in Madrid, Spain. Outcomes of LUTS and quality of life were measured using the International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms validated questionnaire at baseline and at the end of the 12-week intervention. The participants presented with certain LUTS such as urgency UI (57.7%) or stress UI (47.4%), which negatively affect their daily lives by feeling annoyed in various aspects (when practicing gymnastics, getting up during the night to urinate or feeling bladder pain among others). No significant differences in LUTS and quality of life variables were observed after the exercise intervention ( P > 0.05). A high prevalence of LUTS was observed in a sample of underaged high-level gymnasts. The 12-week Kegel exercise intervention did not significantly reduce the presence of pelvic floor problems and even intensified some of them, probably because of an increased awareness. Pelvic floor muscle training as a preventive strategy at an early age seems to be necessary to avoid possible pelvic floor dysfunction in the future.

Effect of transcutaneous posterior tibial nerve stimulation and repetitive transcranial magnetic stimulation on neurogenic overactive bladder symptoms in female patients with multiple sclerosis: The study protocol of a randomized controlled study.

Neurogenic bladder is frequently seen in patients with multiple sclerosis (MS). Electrical stimulation methods (neuromodulation) can be used for patients that have persistent symptoms despite pharmacological treatment. This study aims to compare the effects of two different neuromodulation techniques used in the treatment of neurogenic bladder. This is a single-center randomized controlled trial for MS patients with neurogenic bladder. Patients determined to be eligible according to the study criteria will be randomized into two treatment groups: the transcutaneous posterior tibial nerve stimulation (PTNS) and repetitive transcranial magnetic stimulation (rTMS) groups. Each group will include eight patients. The patients will be treated for a total of 10 sessions for two consecutive weeks. The pressure-flow study will be used to compare the initial and final urodynamic results as the primary outcome. All the participants will fill in a 3-day bladder diary before and after the treatments in each group. Patients will also be asked to complete specific questionnaires for incontinence and quality of life (QOL): Overactive Bladder Questionnaire-V8 score (OAB-V8), Incontinence Severity Index (ISI), Incontinence Quality of Life Scale score (I-QOL), International Incontinence Questionnaire (ICIQ-SF) score, and International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) score) as the secondary outcomes. An ethical approval number was obtained from the Non-Invasive Clinical Research Ethics Committee of Istanbul Medipol University (ethical approval number: 768). Support was received within the scope of the Istanbul Medipol University Scientific Research Project with project number 2020-2017. The result of this study will be published in a peer-reviewed journal. NCT05312138.

A modified mid-urethral sling technique for stress urinary incontinence: Three-year results of a prospective randomized trial in comparison with original transobturator tape procedure.

Stress urinary incontinence (SUI) is the most common subtype of urinary incontinence, which causes many social, psychological, and economic problems. Mid-urethral sling (MUS) surgery is popular worldwide for the treatment of SUI. We aimed to define a new modified mid-urethral sling technique (mMUS) in SUI treatment and to compare it with transobturator tape (TOT) surgery in terms of safety and efficiency. A prospective, randomized study was planned with 126 women suffering from SUI. The patients were randomly divided into two groups, TOT and mMUS. In mMUS, the obturator membrane was not perforated. The objective and subjective symptoms, pain, quality-of-life measures, and side effect profiles were assessed in a 3-year follow-up. The visual analogue scale (VAS) was used for postoperative pain assessment. The International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) and Patient Global Impression of Improvement (PGI-I) were used for cure assessment scales. In total, 96 patients completed 3-year follow-up (TOT, n = 49 and mMUS, n = 47). There was no statistical difference between the procedures in terms of cure rates (87.75% and 87.23%, respectively; p = 0.614). Mean VAS scores at 8 and 24 h postoperatively were significantly higher in the TOT group (p < 0.05). There was no significant difference between the groups in VAS scores after 24 h. There was no significant difference between groups in terms of pad test results, ICIQ, or PGI scores at baseline and 36 months after surgery. We showed that the mMUS procedure was as safe and effective as TOT, with less postoperative groin pain and complications.

Urdu translation and validation of the international consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms (ICIQ-FLUTS).

The International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) is a tool for the evaluation of lower urinary tract symptoms and their impact on the quality of life. The purpose of this research was the translation of ICIQ-FLUTS into the Urdu language and to determine its validity and reliability. Two bilingual translators translated the ICIQ-FLUTS Questionnaire into the Urdu language. Three experts compared the Urdu ICIQ-FLUTS with the original version of ICIQ-FLUTS. Urdu version was translated back into English by two translators. The pre-final version was drafted after tracking the forward and backward translation differences. The final Urdu version was drafted after application to ten patients (pilot study). Final Urdu ICIQ-FLUTS was applied to 120 participants for validity and reliability. Urdu version was drafted after the consensus of the experts. The content validity index ranged between 0.81-0.93. The mean age of the participants was 45.2 ± 7.79 years. The test-retest reliability was analyzed through intraclass correlation coefficient (ICC) 0.972 and internal consistency by Cronbach's alpha 0.986. The concurrent validity was determined by correlating the ICIQ-FLUTS with ICIQ-UI SF (0.82) and UDI-6 (0.72). It was concluded that the Urdu version of ICIQ-FLUTS is an assessment questionnaire for the signs and symptoms of urinary incontinence. It has good content validity, concurrent validity, and test-retest reliability.

The Use of Platelet-rich Plasma as a Novel Nonsurgical Treatment of the Female Stress Urinary Incontinence: A Prospective Pilot Study

The aim of the study was to evaluate the efficacy and safety of platelet-rich plasma (PRP) for the treatment of stress urinary incontinence (SUI). This was a prospective observational pilot study conducted in a tertiary referral unit, enrolling women with SUI booked for SUI surgery. A total of 20 consecutive women met the inclusion criteria and attended all follow-ups. All participants underwent 2 PRP injections into the lower one third of the anterior vaginal wall at 4- to 6-week intervals. At baseline, they underwent urodynamic studies, a 1-hour pad test, and completed the International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms and King's Health Questionnaire. At follow-up visits (1, 3, and 6 months), patients underwent the 1-hour pad test and completed the King's Health Questionnaire, International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms, and Patient Global Impression Scale of Improvement. Primary outcome was to evaluate posttreatment SUI. Secondary outcomes included assessment of patient-reported questionnaires, assessment of urine loss (1-hour pad test), and the level of discomfort during injections (visual analog scale score). Statistical analysis was performed before PRP and 1, 3, and 6 months after the last treatment. A significant improvement in SUI symptoms was observed 3 months after treatment with a further improvement at 6 months. A mean reduction of 50.2% in urine loss was observed in the 1-hour pad test. At the 6-month follow-up, 80.0% of women reported to be at least improved. No adverse effects were observed. Platelet-rich plasma injections were both effective and safe at least in the short term and could be offered as an alternative outpatient procedure for the treatment of SUI. However, these encouraging findings warrant further investigation with randomized controlled trials.

Comparison of two methods for evaluating lower urinary tract symptoms in cervical cancer patients following radical hysterectomy

ObjectiveTo compare the degree of agreement and consistency of urodynamic studies (UDS) with low urinary tract symptoms (LUTS) questionnaires for evaluating LUTS in cervical cancer patients following radical hysterectomy (RH) and pelvic lymphadenectomy. MethodsFrom January 2012 to March 2015, 204 cervical cancer patients who underwent RH in 13 hospitals were evaluated using the Incontinence Questionnaire-Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) and the Overactive Bladder Symptom Score (OABSS). Urodynamic tests were also performed on these patients during the same period. ResultsStudy participants’ age ranged from 23 to 75 years, with a mean (standard deviation) of 48.0 ​± ​9.3 years. Using questionnaires, the prevalence of patients with LUTS symptoms, including storage symptoms, voiding symptoms, stress urinary incontinence (SUI) and overactive bladder (OAB) was 86.3%, 77.0%, 62.7%, 52.9% and 14.7%, respectively. For UDS, the corresponding prevalence was 89.7%, 70.1%, 66.7%, 46.6% and 13.2%, respectively. The diagnostic concordance of questionnaires and UDS for storage symptoms, voiding symptoms, SUI and OAB was 79.9%, 66.7%, 66.7%, 57.4% and 79.9%, respectively. For voiding symptoms, the correlation coefficient was 0.272, which was higher than that of storage symptoms, SUI and OAB. ConclusionsIn cervical cancer patients who have undergone RH, there was a moderate degree of agreement between UDS and symptom questionnaires in evaluating LUTS, but the consistency was poor. Medical personnel should be adequately trained in UDS to ensure LUTS are adequately diagnosed in patients.

Epidemiological survey of adult female stress urinary incontinence

BackgroundThe prevalence of stress urinary incontinence (SUI) in adult female in Taiyuan and what are the related risk factors are not clear. The aim of this study was to provide a basis for exploring the prevention and treatment of SUI in adult female in Taiyuan.MethodsA voluntary online questionnaire was used to investigate adult female in the community and surrounding townships of Taiyuan. Most of the questionnaires refer to the International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms, and adapt to the specific circumstances of the region. Data were analyzed using SPSS software (version 22.0).ResultsA total of 4004 eligible questionnaires were obtained. The prevalence of SUI in adult female in Taiyuan was 33.5%. Univariate analysis and multivariate logistic regression analysis showed that place of residence, smoking, body mass index, diet, number of deliveries, mode of delivery, dystocia, menopause, oral contraceptives, urinary tract infection, making the bladder empty faster by pushing down and holding urine were risk factors for adult female stress urinary incontinence in Taiyuan.ConclusionThe prevalence of SUI in adult female in Taiyuan was high, and based on risk factors identified in this survey, population-level intervention strategies should be developed for the prevention and treatment of adult female SUI in Taiyuan.

“Mesh free” autologous transobturator mid urethral sling placement for predominant stress urinary incontinence: A pilot study

To assess the efficacy and safety of autologous mid-urethral sling (MUS) in women with predominant stress urinary incontinence (SUI). This prospective cohort study included adult women with predominant SUI seen in our urology clinic between January 2018 and March 2019. Patients with: negative cough stress test, history of prior incontinence surgery, urogenital malignancy, pelvic radiation, neurological disease, body mass index more than 40 kg/m2 , the presence of more than Stage I pelvic organ prolapse, active urinary tract infection, maximum flow rate less than 15 ml/sec, postvoid residual urine more than 100 ml, abdominal leak point pressure less than 60 cm of H2 O, and pregnant women were excluded. Eligible patients underwent a transobturator MUS procedure using rectus fascia as a sling. Before the procedure, patients filled the International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptom (ICIQ-FLUTS) and the Female Sexual Function Index (FSFI) questionnaire. Urinary outcomes were assessed at 3- and 12-months while sexual outcomes were assessed at 12-months. Thirty patients with median age of 44.5 years were included. All patients had a negative cough stress test during follow up. A significant improvement was noted in the ICIQ-FLUTS scale, bother scale, filling and incontinence subscales at 3 and 12 month follow-up. A significant improvement was also noted in the FSFI full scale score and FSFI domains of mean sexual desire, arousal and lubrication at 12 months follow-up. Two patients developed voiding dysfunction requiring urethral dilatation. Autologous transobturator MUS surgery appears to be safe and efficacious in the short term. More research is needed to clarify its role in the surgical management of SUI in women.

Modified Autologous Transobturator Tape Surgery - A Prospective Comparison With Transobturator Tape Surgery

To compare modified autologous transobturator-tape (a-TOT) and transobtrator-tape (TOT) surgeries in terms of effectivity and complications. Prospectively 117 patients (a-TOT:36,TOT:81) were enrolled in this study. A-TOT was performed with autologous fascia elongated with nonabsorbable sutures and TOT was performed with standard technique. Preoperative data regarding operative time, complications and postoperative visual analog scores (VAS) were noted. Patients were assessed 12 months after surgery. Objective cure was evaluated with cough stress test (CST) and necessity of reoperation due to failure while subjective cure was evaluated with Patient Global Impression of Improvements scale(PGI-I) and the International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms(ICIQ-FLUTS) questionnaire. The mean follow-up time was 21.5 ± 1.1 months. Preoperative demographic characteristics were similar. The mean operation time was longer in a-TOT group(P=.001).VAS at postoperative 8. and 24. hours and overall complication rates were similar for the groups. Clavien grade-3 complications occurred only in TOT group (3.7%). Objective cure rates according to CST were 97.3% and 97.6% (P=.998) and the subjective cure rates according to PGI-I were 97.3% and 92.5% (P=.664) for a-TOT and TOT groups, respectively. One patient in TOT group needed reoperation. The a-TOT group gained better improvements in total score and total QoL score of ICIQ-FLUTS (P=.028 and P=.032, respectively) as well as subscore and QoL subscore of filling and voiding sections of ICIQ-FLUTS (P=.043, P=.048,P=.034, and P=.039, respectively). The a-TOT technique has similar objective and subjective cure rates and overall complication rates furthermore better results in postoperative voiding dysfunction and de-novo filling phase symptoms when compared to TOT.

Validation of the Thai version of the International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms (ICIQ-FLUTS).

To provide a validated Thai language version of the International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) following a standardized procedure and to evaluate its psychometric properties. After IRB approval, the English ICIQ-FLUTS was translated into Thai according to the cross-cultural adaptation process for patient-reported outcome measures. The psychometric properties of the final version of the Thai ICIQ-FLUTS were tested for content validity, internal consistency, construct validity, and test-retest reliability. Patients attending an urogynecology clinic and women from two communities were recruited for this study. The final Thai version of the ICIQ-FLUTS was developed and assessed by a panel of clinicians fluent in both languages including the content expert. Women with and without female lower urinary tract symptoms (FLUTS), in whom the translation was pretested, agreed that the final version made sense and was understandable. Among the 288 women who received the questionnaires, 283 (142 attending the clinic and 141 living in the communities) returned the completed questionnaire. The overall internal consistency of the Thai-version questionnaire was high, with a Cronbach's alpha score of 0.849. Symptom scores for filling, voiding, and incontinence in patients attending the clinic were significantly higher than in individuals from the community (p < 0.001). The correlation coefficients between the test and retest among 136 participants for symptoms of filling, voiding, and incontinence were 0.925, 0.769, and 0.921, respectively (p < 0.05). The Thai ICIQ-FLUTS contained satisfactory content and exhibited construct validity, internal consistency, and test-retest reliability. It is equivalent to the original English version and will be a valuable tool for assessing LUTS in Thai-speaking women.

Modified autologous transobturator tape surgery - evaluation of short term results.

The aim of this study is to evaluate the short-term outcomes of our modified autologous transobturator tape (aTOT) technique with rectus abdominis muscle fascial graft for the treatment of female stress urinary incontinence (SUI). The data of 22 patients who underwent modified aTOT were recorded. Perioperative data regarding operative time, complications and postoperative visual analogue scores were noted. Patients were assessed 18 months after surgery. The primary endpoints of this study were the improvements in the International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) subscores, one-hour pad test and cough stress test rates as an objective cure as well as the improvements in the PGI-I and ICIQ-FLUTS quality of life scores as a subjective cure. Mean age and the mean follow-up period were 51.7 ± 9.8 years and 20.1 ± 0.9 months, respectively. Urethral hypermobility and a positive cough stress test were detected in all the patients. Mean operative time was 43.8 ± 8.1 min. and the overall complication rate was 9%. Mean VAS scores at postoperative 24 hours were 2.6 ± 1.2. At the postoperative eighteenth month, no patient had a positive cough test and mean PGI-I score was 2 while two patients had moderate urinary incontinence according to the pad test. Pad test results, ICIQ subscores of voiding QoL, incontinence, incontinence QoL, total score and total QoL score at baseline and eighteen months after surgery were 76.9 ± 19.9, 9.6 ± 4.1, 15.5 ± 4.0, 39.5 ± 7.9, 27.9 ± 6.6, 68.4 ± 13.8 and 7.1 ± 2, 10.1 ± 2.4, 6.6 ± 2.1, 13.4 ± 4.5, 20.4 ± 4.8, 39.7 ± 9.2 respectively (p = 0.001, p = 0.004, p = 0.001, p = 0.001, p = 0.001, and p = 0.001, respectively) CONCLUSIONS: Modified aTOT is an effective and safe method with low morbidity for SUI treatment in short term.

Urological, Sexual, and Quality of Life Evaluation of Adult Patients With Exstrophy-Epispadias Complex: Long-term Results From a Dutch Cohort

To assess urological function, sexual function, and quality of life in patients with exstrophy or epispadias. Little is known regarding these outcomes in adult patients; our aim is to determine where improvements are needed for long-term management. The study population comprised adult (>18 years) patients. Demographic data were gathered and patients were asked to fill out 4 validated questionnaires: (1) International Consultation on Incontinence Questionnaire urinary incontinence form (ICIQ-UI) regarding continence; (2) International Prostate Symptom Score (IPSS) for men and International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) for women regarding lower urinary tract symptoms; (3) 12-Item Short Form Health Survey regarding quality of life; (4) International Index of Erectile Function for men and Female Sexual Function Index for women regarding sexual function. Seventeen patients were included (9 men and 8 women) with a median age of 36 years (range 19-73). Median score on ICIQ-UI was 5/21. Median IPSS score was 7/35 and median quality of life score was 1 (=pleased). Median scores per domain within ICIQ-FLUTS were 7 for storage, 0 for voiding, and 6 for urinary incontinence with bother scores of 4, 0, and 2.8, respectively. Scores for 12-Item Short Form Health Survey in the study population were comparable with those of the Dutch population, except for Physical Component Summary in women. For sexual function, no difference was found between those in the general population and our participants except for the domain "pain" in Female Sexual Function Index. Adult patients with exstrophy or epispadias have a high rate of incontinence and lower urinary tract symptoms with relatively low to some degree of bother. When compared with the general population, quality of life, and sexual function of our patients were more or less similar.

Effect of Concurrent Prolapse Surgery on Stress Urinary Incontinence Outcomes After TVTO.

A variety of pelvic organ prolapse (POP) surgeries are performed concomitant to midurethral sling (MUS) placement. It is unknown whether differing POP surgeries may affect stress urinary incontinence outcomes after MUS placement. We performed a retrospective cohort analysis of patients undergoing TVT obturator system in conjunction with a variety of POP repair (cystocele with mesh graft, cystocele with cadaveric fascia, colpocleisis, and sacrocolpopexy). Primary outcomes included validated measures of stress urinary incontinence (International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms), measured preoperatively and at 6 week, 1 year, and 2 years postoperatively. Secondary outcomes included validated questionnaire items focused on obstructive and irritative symptoms. Multivariate analyses using mixed-effects regressions were used to assess for differences in outcomes based on POP repair type. A total of 102 patients were identified for study analysis (cystocele with mesh graft, n = 45; cystocele with cadaveric fascia, n = 37; sacrocolpopexy, n = 16; colpocleisis, n = 4). Four patients undergoing colpocleisis were excluded from primary analysis given lack of sufficient cohort size. When adjusted for effects of covariates, significant improvements in primary and secondary outcomes were seen throughout follow-up in comparison with baseline. In general, multivariate analysis demonstrated no significant differences between surgeries when assessing primary and secondary outcomes. The only statistically significant difference in change over time comprised CM, which demonstrated superior improvement in International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms (preoperative vs 2 year, P = 0.04). Regardless of POP surgery type, patients demonstrate improvements in validated SUI outcomes through 2 years. Multivariate analysis suggests that there is little difference in SUI outcomes after TVT obturator system across several different POP repair types.

Toileting behaviours and lower urinary tract symptoms among female nurses: A cross-sectional questionnaire survey

BackgroundUnhealthy toileting behaviours exist among women, and lower urinary tract symptoms have a high prevalence and significant effects on quality of life. However, the relationship between toileting behaviours and lower urinary tract symptoms is unclear. ObjectivesThis study aimed to investigate the prevalence of lower urinary tract symptoms among female nurses, and the association between toileting behaviours and lower urinary tract symptoms. DesignA cross-sectional stratified cluster sampling study. ParticipantsA total of 636 female clinical nurses from tertiary hospitals in Jinan (the capital city of Shandong Province, China). MethodsThe Toileting Behaviour-Women’s Elimination Behaviours and the International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms scales were used to assess the participants’ toileting behaviours and lower urinary tract symptoms, respectively. Multiple linear regression analysis was used to evaluate the association between toileting behaviours and lower urinary tract symptoms. ResultsUnhealthy toileting behaviours were common among the female nurses, with delayed voiding being the unhealthiest toileting behaviour, which was followed by place and position preference for voiding. Nearly 68% of the female nurses had at least one lower urinary tract symptom, nearly 50% had incontinence symptoms, 40% had filling symptoms, and 18% had voiding symptoms. Unhealthy toileting behaviours (premature voiding, delayed voiding, and straining to void) were positively associated with lower urinary tract symptoms. However, lower urinary tract symptoms were not significantly associated with voiding place or position preference. Among the control variables, being married or having a history of a urinary tract infection was associated with lower urinary tract symptoms. Having a higher income and regular menstrual period were negatively associated with lower urinary tract symptoms. Compared with vaginal delivery, caesarean delivery had a protective association with lower urinary tract symptoms. ConclusionLower urinary tract symptoms among female nurses should not be overlooked, because their prevalence among female clinical nurses exceeded that among the general population of women. These findings highlight the importance of avoiding unhealthy toileting behaviours (especially premature voiding, delayed voiding, and straining to void), as these unhealthy toileting behaviours were significantly associated with susceptibility to lower urinary tract symptoms.

Prevalence of pelvic floor disorders in women with suspected gynecological malignancy: a survey-based study.

Understanding of pelvic floor disorders among women with gynecological cancer is limited. The objective of this study was to describe the prevalence of pelvic floor disorders in women with suspected gynecological malignancy before surgery. A cross-sectional study was performed of women aged ≥18 with a suspected gynecological malignancy who enrolled in the University of North Carolina Health Registry/Cancer Survivorship Cohort (HR/CSC) from August 2012 to June 2013. Demographics were obtained from the HR/CSC self-reported data; clinical data were abstracted from the electronic medical record. Subjects completed validated questionnaires (Rotterdam Symptom Checklist and the International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms) to assess bladder and bowel function. Among 186 women scheduled for surgery for gynecological malignancy, 152 (82%) completed baseline assessments before surgery. Mean age was 58.1 ± 13.3years, and mean BMI was 33.6 ± 8.8kg/m(2). The majority of subjects had uterine cancer (61.8%), followed by ovarian (17.1%) and cervical (11.1%). At baseline, the rate of urinary incontinence (UI) was 40.9%. A third of subjects reported stress UI, and one quarter reported urge UI. The overall rate of fecal incontinence was 3.9%, abdominal pain was 47.4%, constipation was 37.7%, and diarrhea was 20.1%. When comparing cancer types, there were no differences in pelvic floor symptoms. Pelvic floor disorders are common in women with suspected gynecological malignancy at baseline before surgery. Recognizing pelvic floor disorders in the preoperative setting will allow for more individualized, comprehensive care for these women.

Effect of Transobturator Midurethral Sling Placement on Urgency and Urge Incontinence: 1-Year Outcomes.

TVT-O placement has been associated with short-term cure/improvement of urgency (U) and urge urinary incontinence (UUI) in a significant proportion of patients. Further, the observed improvement in U/UUI is associated with improved quality of life (QOL). This study is a prospective continuation aimed to determine if the short-term benefit of TVT-O on U/UUI persists at 12 months postoperatively. Patients with stress-predominant mixed incontinence undergoing TVT-O placement were prospectively assessed using 3-day bladder diary and multiple validated incontinence questionnaires focusing on U (Urgency Perception Score), UUI (International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms), and QOL (Incontinence Impact Questionnaire, Short Form). Eighty-seven patients achieved 12-month assessment, at which point improvements (versus baseline) in mean daily pad use (2.5-0.9) and mean incontinence episodes (3.6-0.7) were seen (P < 0.05, both comparisons). Seventy-eight percent of patients reported cure of stress incontinence. Questionnaire scores for UUI improved from 2.0(±1.1) to 1.0(±1.1) (P < 0.001), with 32% and 31% of patients reporting cure and improvement, respectively. Similarly, mean Urgency Perception Score improved from 10.1(±4.4) to 6.7(±4.5) (P < 0.001). Eighty-two percent of the patients did not require anticholinergics over the 12-month follow-up period. Furthermore, U outcomes are associated with improvements in QOL. TVT-O placement is associated with cure/improvement of U and UUI in a significant proportion of patients with mixed urinary incontinence. Further, the observed improvements in U/UUI persist at 12 months and appear to have a durable positive association with QOL.

Vaginal Symptoms and Sexual Function After Tension-free Vaginal Tape-obturator Placement: Minimum 12-Month Follow-up

To examine the effect of the tension-free vaginal tape-obturator (TVT-O) on sexual function and vaginal symptoms. The effect of anti-incontinence surgery on vaginal symptoms and sexual function is controversial; these assessments are increasingly important given the Food and Drug Administration warning regarding the use of transvaginal surgical mesh. A retrospective review of 42 patients undergoing TVT-O with a minimum 1-year follow-up data was performed. The outcomes were assessed at baseline and 1 year postoperatively using validated questionnaires, including the International Consultation on Incontinence Questionnaire-Vaginal Symptoms, a validated measure assessing the impact of vaginal symptoms and sexual matters on quality of life and treatment outcomes. The International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms and Incontinence Impact Questionnaire, Short Form were used to assess the incontinence and quality of life outcomes, respectively. Statistically significant improvements were seen in the vaginal symptoms (from 9.7 to 6.0, P=.01), sexual matters (from 16.7 to 6.9, P=.01), and quality of life (from 3.0 to 1.1, P=.001) domains on the International Consultation on Incontinence Questionnaire-Vaginal Symptoms from the baseline to 1-year assessment. Of 20 sexually active patients at baseline, 18 reported continued sexual activity postoperatively, with 2 patients reporting an absence of sexual activity because of other factors. Six patients who were not sexually active at baseline because of vaginal symptoms had resumed sexual activity at 1 year. Statistically significant improvement in vaginal soreness and a trend toward improvement in the abdominal pain domain score were seen. TVT-O sling placement was associated with symptom stability or improvement in validated measures of sexual function and vaginal symptoms. These data do not support the concerns regarding worsening sexual function and vaginal symptoms after TVT-O sling placement.

A Prospective Multicenter Randomized Comparative Study Between the U- and H-type Methods of the TVT SECUR Procedure for the Treatment of Female Stress Urinary Incontinence: 1-Year Follow-Up

BackgroundNo studies have been published comparing the U- and H-type methods of the TVT SECUR (TVT-S) procedure. ObjectiveOur aim was to compare the efficacy and safety of the two types of TVT-S for female stress urinary incontinence (SUI). Design, setting, and participantsWomen with urodynamic SUI were enrolled in this 12-mo multicenter randomized study. InterventionSubjects were randomly allocated to either the U- or H-type method of TVT-S. MeasurementsPre- and postoperative evaluations included a standing stress test, the Sandvik questionnaire, the Incontinence Quality of Life (I-QOL) questionnaire, and the International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms (ICIQ-FLUTS). Patients’ satisfaction and complications were evaluated. Objective and subjective cures were defined as no leakage on the stress test and responses on the Sandvik questionnaire, respectively. We compared the surgical outcomes between the two methods. Results and limitationsOf 285 women, 144 had the U-type method and 141 had the H-type method. Objective cure rates were 87.5% for the U-type method and 80.1% for the H-type method (p=0.091). Subjective cure rates were 77.1% for the U-type method and 75.7% for the H-type method (p=0.786). Improvement in I-QOL and domain scores of the ICIQ-FLUTS (filling and incontinence sum, QOL score), and patients’ satisfaction favored the U-type method. There were three cases of intraoperative vaginal wall perforation, one case of increased bleeding, and three cases of temporary postoperative retention. A power calculation was not performed, and some baseline characteristics were not balanced between the two methods. ConclusionsBoth methods of TVT-S provided comparable cure rates for female SUI. However, QOL and treatment satisfaction favored the U-type method. Trial registrationThe protocol of this study was not registered.