International Consultation On Incontinence Questionnaire Scores Research Articles

Factors Influencing Postoperative Overactive Bladder after Adjustable Trans-Obturator Male System Implantation for Male Stress Incontinence following Prostatectomy.

We aimed to determine the risk factors for postoperative overactive bladder (OAB) in patients treated with an adjustable trans-obturator male system (ATOMS) for stress incontinence after radical treatment of prostate cancer. A prospective study was performed on 56 patients implanted with an ATOMS for PPI. Clinical and urodynamic information was recorded before and after ATOMS implantation. We built a multivariate model to find out the clinical and urodynamic factors that independently influenced postoperative OAB and the prognostic factors that influenced the efficacy of medical treatment of OAB. We found that the clinical risk factors were the preoperative intensity of urinary incontinence (number of daily pads used and amount of urinary leakage), International Consultation on Incontinence Questionnaire (ICIQ) score, postoperative number of ATOMS adjustments, final cushion volume, and incontinence cure. The urodynamic data associated with OAB were cystometric bladder capacity, voided volume, volume at initial involuntary contraction (IC), maximum flow rate, bladder contractility index (BCI), and urethral resistance (URA). The prognostic factors for the efficacy of oral treatment of OAB were the volume at the first IC (direct relationship) and the maximum abdominal voiding pressure (inverse relationship). The multivariate model showed that the independent clinical risk factors were the daily pad count before the implantation and the ICIQ score at baseline and after treatment. The independent urodynamic data were the volume at the first IC (inverse relationship) and the URA value (direct relationship). Both predictive factors of treatment efficacy were found to be independent. Detrusor overactivity plays an important role in postoperative OAB, although other urodynamic and clinical factors such as the degree of urethral resistance and abdominal strength may influence this condition.

Outcomes and Complication Rates of Cuff Downsizing in the Treatment of Worsening or Persistent Incontinence After Artificial Urinary Sphincter Implantation.

This study investigated the functional outcomes and complication rates of cuff downsizing for the treatment of recurrent or persistent stress urinary incontinence (SUI) in men after the implantation of an artificial urinary sphincter (AUS). Data from our institutional AUS database spanning the period from 2009 to 2020 were retrospectively analyzed. The number of pads per day was determined, a standardized quality of life (QoL) questionnaire and the International Consultation on Incontinence Questionnaire (ICIQ) were administered, and postoperative complications according to the Clavien-Dindo classification were analyzed. Out of 477 patients who received AUS implantation during the study period, 25 (5.2%) underwent cuff downsizing (median age, 77 years; interquartile range [IQR], 74-81 years; median follow-up, 4.4 years; IQR, 3-6.9 years). Before downsizing, SUI was very severe (ICIQ score 19-21) or severe (ICQ score 13-18) in 80% of patients, moderate (ICIQ score 6-12) in 12%, and slight (ICIQ score 1-5) in 8%. After downsizing, 52% showed an improvement of >5 out of 21 points. However, 28% still had very severe or severe SUI, 48% had moderate SUI, and 20% had slight SUI. One patient no longer had SUI. In 52% of patients, the use of pads per day was reduced by ≥50%. QoL improved by >2 out of 6 points in 56% of patients. Complications (infections/urethral erosions) requiring device explantation occurred in 36% of patients, with a median time to event of 14.5 months. Although cuff downsizing carries a risk of AUS explantation, it can be a valuable treatment option for selected patients with persistent or recurrent SUI after AUS implantation. Over half of patients experienced improvements in symptoms, satisfaction, ICIQ scores, and pad use. It is important to inform patients about the potential risks and benefits of AUS to manage their expectations and assess individual risks.

Do the incidence and severity of lower urinary tract symptoms measured by the international consultation on incontinence questionnaires correlate with urodynamic findings in patients with systemic sclerosis?

Background Systemic sclerosis (SSC) affects the urinary bladder and many other body organs. Systemic sclerosis commonly manifests as lower urinary tract symptoms (LUTS), which are usually reported using validated questionnaires. This study aimed to correlate questionnaire-reported LUTS with urodynamic findings in patients with SSC. Materials and methods This cross-sectional study was performed at our center between August 2018 and July 2021. Lower urinary tract symptoms were assessed using the International Consultation on Incontinence Questionnaire (ICIQ) Female Lower Urinary Tract Symptoms Modules (ICIQ-FLUTS) and ICIQ Male Lower Urinary Tract Symptoms Module (ICIQ-MLUTS) and urodynamic studies. Univariate analyses were then performed on variables affecting detrusor activity. Results This study included 22 patients (5 men, 17 women). The mean ± standard deviation age, body mass index, and disease duration were 37.2 ± 11.1 years, 25.5 ± 4.2 kg/m2, and 6.2 ± 5.3 years, respectively. Lower urinary tract symptoms occurred in 19 (86.4%) patients, of whom 18 (94.7%) had mild to moderate symptoms. The ICIQ scores for voiding and filling symptoms were higher than those for incontinence. The most frequent organ involvements included Raynaud’s phenomenon in 22 (100%), skin conditions in 20 (90.9%), gastrointestinal tract maladies in 17 (77.3%), joint disorders in 16 (72.7%), and lung diseases in 14 (63.6%) patients. Abnormal detrusor contractions occurred in only 5 patients (22.7%). Univariate analyses showed that disease duration <5 years (p = 0.010), nonobstructive uroflowmetry findings (p = 0.024), absence of incontinence (p = 0.024) and telangiectasia (p = 0.010), and negative rheumatoid factors (p = 0.043) were significantly associated with normal detrusor contractions. Conclusions Mild to moderate severity of ICIQ-measured LUTS affected most patients with SSC but was not correlated with urodynamic findings. Normal detrusor contractions were significantly associated with shorter disease duration, nonobstructive uroflowmetry findings, absence of incontinence and telangiectasia, and negative rheumatoid factors.

PD14-10 EVALUATION OF FINANCIAL TOXICITY ASSOCIATED WITH URINARY INCONTINENCE TREATMENT

You have accessJournal of UrologyCME1 Apr 2023PD14-10 EVALUATION OF FINANCIAL TOXICITY ASSOCIATED WITH URINARY INCONTINENCE TREATMENT Azizou Salami, Benjamin Green, Anna Najor, Whitney Clearwater, and Nitya Abraham Azizou SalamiAzizou Salami More articles by this author , Benjamin GreenBenjamin Green More articles by this author , Anna NajorAnna Najor More articles by this author , Whitney ClearwaterWhitney Clearwater More articles by this author , and Nitya AbrahamNitya Abraham More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003261.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urinary incontinence (UI) is a financially burdensome condition, costing US patients over 20 billion dollars annually. The individual financial burden has not been well described and warrants further study. Financial toxicity (FT) is the economic stress associated with the direct and indirect costs of treatment for a condition. Moderate-to-severe FT is associated with medication rationing and delaying care. This is the first study to characterize FT associated with the treatment of UI. METHODS: We performed a cross-sectional study using convenience sampling of new patients presenting with UI at an academic practice in the Bronx, NY from April to October of 2022. The validated COST tool (Comprehensive Score for financial Toxicity) was used to measure FT. “Low-FT” was defined as COST scores ≥26 and “moderate-to-severe FT” for COST scores <26, based on prior studies. The International Consultation on Incontinence Questionnaire (ICIQ) was used to measure UI severity. Chi-square and ANOVA tests were performed using SPSS v28. RESULTS: 79 patients were surveyed. All were female, with 30% identifying as Black and 45% as Latinx. The average age was 57.2±12.4. 83% of subjects had Medicare or Medicaid and 34% had private insurance. The mean ICIQ score was 14.1±3.2, and the mean COST score was 20.1±9.9. Most participants (65.8%) had “Moderate-to-severe FT” (COST scores <26). Compared to those with low-FT, those with moderate-to-severe FT were less likely to have private insurance (p=0.004) and more likely to use public transportation (p=0.004), have a greater number of unmet social needs (p<0.001), and a higher ICIQ score (p=0.009). The groups were not significantly different in age, race, ethnicity, or insurance type. CONCLUSIONS: 66% of women with UI in our study cohort experienced moderate-to-severe FT. Worse FT was associated with worse symptoms and increased barriers to healthcare. Given the high burden of FT in this patient population, urologists should consider routinely measuring FT in patients with UI and connect them to financial resources when necessary. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e416 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Azizou Salami More articles by this author Benjamin Green More articles by this author Anna Najor More articles by this author Whitney Clearwater More articles by this author Nitya Abraham More articles by this author Expand All Advertisement PDF downloadLoading ...

An epidemiological profile of women suffering from urinary incontinence residing at one of the cities of western India: A mixed method approach study.

Urinary incontinence (UI), a discomforting condition is predominantly seen in women. Affected women are forced to modify their lifestyles to alleviate symptoms and associated complications. To find the prevalence, determinants and association of UI with Socio-demographic, obstetrical, gynecological and personal history and its impact on quality of life. Research was conducted with a mixed method approach (quantitative and qualitative assessment) among women residing in urban slum of Ahmedabad city, India. Sample size calculated was 457. The study was conducted in urban slums served by one of the Urban Health Centre (UHC) of Ahmedabad city. A modified pre-evaluated standard questionnaire developed by International Consultation on Incontinence Questionnaire (ICIQ) was used for quantitative part. Qualitative part consisted of Focused Group Discussions (FGD) which was carried out amongst the women in batches of 5-7 per discussion at the nearest anganwadi center. Prevalence of UI was found to be 30% among study-participants. A statistical significant relation was seen between the presence of UI and age, marital status, parity, past history of abortion, and occurrence of urinary tract infection (UTI) in last year (P < 0.05). Comparison of severity of UI by calculating ICIQ score showed statistical significant relation of same with age, occupation, literacy, socioeconomic status, and parity (P < 0.05). More than 50% of women suffering from UI were having chronic constipation, reduced daily sleep, and diabetes. Only 7% of the total women suffering from UI had consulted doctor for their problem. Prevalence of UI was found to be 30% in study participants. Sociodemographic factors like age, marital status and socio-economic class were found to have statistical significant effect on existing UI at the time of interview. ICIQ categories of UI were found to be influenced statistically with age, occupation, literacy, socio-economic classe, parity and obstetric factors like place of delivery and facilitator of delivery. Majority of participants (93%) had never consulted doctor for various reasons/myths like perception that it shall resolve on its' own, Belief that it is an age-related normal phenomenon, shyness to discuss issue with male doctors/members of family and financial reasons.

Urodynamic assessment and quality of life outcomes of robot-assisted totally intracorporeal radical cystectomy and orthotopic neobladder for bladder cancer: a preliminary study.

Few data exist regarding the functional outcomes of robot-assisted radical cystectomy (RARC) with intracorporeal orthotopic neobladder. The aim of this study was to evaluate the urodynamic and functional outcomes in patients undergoing RARC and totally intracorporeal orthotopic neobladder for bladder cancer. In this monocentric, observational study carried out between 2016 and 2020, consecutive patients undergoing RARC and intracorporeal orthotopic neobladder in the Department of Urology, Pitié-Salpêtrière Hospital, were included. Reconstruction was totally intracorporeal Y-shaped neobladder. Main outcomes were urodynamic findings 6months post-surgery, continence and quality of life (QoL). Continence was defined by no pad or one safety pad. International Consultation on Incontinence Questionnaire (ICIQ), International Index of Erectile Function questionnaire (IIEF-5) and Bladder Cancer Index (BCI) scores were recorded. Fourteen male patients were included (median age: 64years [IQR 54-67]. Median maximal neobladder cystometric capacity was 495ml [IQR 410-606] and median compliance was 35.5ml/cm H2O [IQR 28-62]. All patients had post-void residual volume < 30ml, except for three (22%) who required clean intermittent-self catheterisation. Daytime continence was achieved in 10 patients (71%) and night-time continence in two (14.3%). Median ICIQ score was 7 [IQR 5-11]. Postoperative erectile function was present in 7% of patients (mean IIEF-5 = 5 [IQR 2-7]). Thirteen patients (93%) were satisfied with their choice of neobladder. RARC with totally intracorporeal orthotopic neobladder for bladder cancer provides satisfactory urodynamic results and good QoL. These findings should be confirmed long-term.

Perioperative Mobile Telehealth Program for Post-Prostatectomy Incontinence: A Randomized Clinical Trial.

Perioperative pelvic floor muscle training can hasten recovery of bladder control and reduce severity of urinary incontinence following radical prostatectomy. Nevertheless, most men undergoing prostatectomy do not receive this training. The purpose of this trial was to test the effectiveness of interactive mobile telehealth (mHealth) to deliver an evidence-based perioperative behavioral training program for post-prostatectomy incontinence. This was a 3-site, 2-arm, randomized trial (2014-2019). Men with prostate cancer scheduled to undergo radical prostatectomy were randomized to a perioperative behavioral program (education, pelvic floor muscle training, progressive exercises, bladder control techniques) or a general prostate cancer education control condition, both delivered by mHealth for 1-4 weeks preoperatively and 8 weeks postoperatively. The primary outcome was time to continence following surgery measured by the ICIQ (International Consultation on Incontinence Questionnaire) Short-Form. Secondary outcomes measured at 6, 9 and 12 months included Urinary Incontinence Subscale of Expanded Prostate Cancer Index Composite; pad use; International Prostate Symptom Score QoL Question and Global Perception of Improvement. A total of 245 men (ages 42-78 years; mean=61.7) were randomized. Survival analysis using the Kaplan-Meier estimate showed no statistically significant between-group differences in time to continence. Analyses at 6 months indicated no statistically significant between-group differences in ICIQ scores (mean=7.1 vs 7.0, p=0.7) or other secondary outcomes. mHealth delivery of a perioperative program to reduce post-prostatectomy incontinence was not more effective than an mHealth education program. More research is needed to assess whether perioperative mHealth programs can be a helpful addition to standard prostate cancer care.

A comparative study of autologous rectus fascia pubovaginal sling surgery and synthetic transobturator vaginal tape procedure in treatment of women with urodynamic stress urinary incontinence

ObjectiveTo compare short term results of autologous rectus fascia pubovaginal sling surgery with synthetic transobturator vaginal tape procedure in treatment of female stress urinary incontinence (SUI) Study designIt was a comparative study on 30 women between 25−65 years of age with urodynamic proven SUI who were randomly allocated to autologous rectus fascia pubovaginal sling surgery (Group I)(15 women) and synthetic transobturator vaginal tape procedure (Group II) (15 women). Preoperative and postoperative ICIQ (International Consultation on Incontinence Questionnaire) score, urodynamic study and serum CRP and IL-6 were done in all cases. ResultsThe baseline characteristics in terms of age, body mass index (BMI), parity, mean ICIQ score and mean preoperative CRP and IL-6 levels were similar in two groups. Mean operative time was significantly longer (55.60 ± 5.77 vs 25.27 ± 4.32 minutes, p = 0.001) in group I than group II. Mean hospital stay of 7.1 ± 1.2 vs 1.2 ± 0.4 days, mean duration of catheterization 5.8 vs 1.2 day (<0.01) and postoperative urinary retention requiring recathterization were all significantly higher in group I than II. Wound infection was more in group I than in group II (p = 0.01) while groin pain was significantly more in group II (p = 0.01). One patient developed vesicovaginal fistula, while one patient required cutting of tape in group I. Pdet at Q max (Detrusor pressure at peak urine flow) increased significantly in both the groups after surgery. ICIQ score was zero in both the groups indicating 100 % success. Surgical trauma was more in group I as shown by significantly higher CRP levels. ConclusionThe success rate of the two groups was similar but, autologous rectus fascia sling surgery took longer, had more complications and urinary retention as compared to transobturator vaginal tape procedure.

Effects of home-based pelvic floor muscle training on decreasing symptoms of stress urinary incontinence and improving the quality of life of urban adult Omani women: A randomized controlled single-blind study.

This study aims to determine the effectiveness of home-based pelvic floor muscle training (PFMT) on decreasing the severity of symptoms and improving the quality of life (QOL) among Omani women with stress urinary incontinence (SUI). A randomized controlled single-blind trial was conducted in three primary health care centers in Muscat. Eligible women who were diagnosed with SUI (from a concurrent phase-I study which was a cross-sectional study to determine the prevalence of urinary incontinence in Oman) were invited to take part. The consenting subjects were randomly allocated to either an intervention group (unsupervised PFMT) or a control group (lecture with no PFMT). Baseline and 12-weekassessment of both groups was carried out for the primary outcome using the validated Arabic version of the International Consultation on Incontinence Questionnaire (ICIQ)-short form and the secondary outcome by blinded measures of pelvic floor muscle (PFM) strength using the modified Oxford grading system (MOGS), endurance, and perineometer. A total of 73 subjects were included in the study. They were randomly divided into two groups. Both groups were similar at the baseline in terms of sociodemographic characteristics, ICIQ score, and PFM strength. At the 12-weeks assessment, there was a significant difference in the ICIQ score (P < .001) between the intervention group and the control one. There was no statistical difference between the two groups in MOGS, endurance, or perineometer values. The home-based PFMT is an effective treatment in reducing the severity of symptoms and improving the QOL in women with SUI.

MP31-20 URINARY INCONTINENCE AND QUALITY OF LIFE IN FEMALE-TO-MALE TRANSGENDER SUBJECTS ON HORMONE THERAPY

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Non-neurogenic Voiding Dysfunction II (MP31)1 Apr 2020MP31-20 URINARY INCONTINENCE AND QUALITY OF LIFE IN FEMALE-TO-MALE TRANSGENDER SUBJECTS ON HORMONE THERAPY Austin Fernstrum*, Al Ray, Britt Conroy, David Sheyn, and Juan Pablo del Rincon Austin Fernstrum*Austin Fernstrum* More articles by this author , Al RayAl Ray More articles by this author , Britt ConroyBritt Conroy More articles by this author , David SheynDavid Sheyn More articles by this author , and Juan Pablo del RinconJuan Pablo del Rincon More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000875.020AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To investigate whether lower urinary tract symptoms (LUTS) impact quality of life (QOL) in female-to-male transgender persons on chronic testosterone therapy. Secondarily, we aimed to identify patient-related physical and social factors that contribute to differences in QOL. METHODS: Transgender female-to-male subjects, 18 years or older, treated with testosterone for at least 12 months were recruited from a public health care system. Subjects were excluded if they had prior surgery for incontinence, pelvic organ prolapse, or gender affirmation or an active urinary tract infection. LUTS were assessed using the American Urologic Association Symptom Score (AUASS) and the International Consultation on Incontinence Questionnaire (ICIQ). The WHOQOL-BREF instrument was used to investigate QOL, and the CES-D 8 instrument was used to screen for depression. T-test and Chi-square were used to compare continuous and categorical variables, respectively. The relationship between patient factors and QOL was evaluated using multivariable logistic regression. RESULTS: Overall, 141 transmen were included in the study. Subjects were subdivided into two cohorts based on presence of urinary incontinence defined by the ICIQ score. In the incontinence group [n=49, (34.8%)], individuals were older [30.6 vs 26.2 years, p =0.01], had a higher body mass index (BMI) [p=0.015], and cigarette smoking history [p=0.01] compared to those without incontinence [n=92 (65.2%)]. The incontinence group had a higher prevalence of positive screening for depression [63.3 vs 39.1%, p=0.006] and were more frequently classified as having a poor QOL index [20.4 vs 3.3%, p=0.0008]. On multivariate analysis, limited medical transportation [aOR: 0.23, CI: 0.06-0.91], lack of money for food [aOR: 0.23, CI: 0.07-0.90], and increased BMI [aOR: 0.92, CI: 0.86-0.99] were factors influencing poor QOL. CONCLUSIONS: Presence of incontinence in female-to-male transgender persons is associated with increased age, higher BMI, and smoking history. Despite these findings, presence of LUTS was not found to be independently associated with QOL after adjusting for psychosocial factors. Source of Funding: National Institute of Diabetes and Digestive and Kidney Disease (NIDDK) grant, 5K12DK100014 © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e482-e483 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Austin Fernstrum* More articles by this author Al Ray More articles by this author Britt Conroy More articles by this author David Sheyn More articles by this author Juan Pablo del Rincon More articles by this author Expand All Advertisement PDF downloadLoading ...

MP30-20 LOWER URINARY TRACT SYMPTOMS IN TRANSGENDER PERSONS TREATED WITH ESTROGENS

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Female Incontinence: Therapy I (MP30)1 Apr 2020MP30-20 LOWER URINARY TRACT SYMPTOMS IN TRANSGENDER PERSONS TREATED WITH ESTROGENS Al Ray*, Austin Fernstrum, Amr Mahran, Britt Conroy, David Sheyn, and Juan P. del Rincon Al Ray*Al Ray* More articles by this author , Austin FernstrumAustin Fernstrum More articles by this author , Amr MahranAmr Mahran More articles by this author , Britt ConroyBritt Conroy More articles by this author , David SheynDavid Sheyn More articles by this author , and Juan P. del RinconJuan P. del Rincon More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000869.020AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Lower urinary tract symptoms (LUTS) are common in the general population. Estradiol may play a role in LUTS. We used several survey instruments to analyze LUTS in male-to-female transgender subjects treated with estradiol. METHODS: Transgender male-to-female subjects treated with estradiol for at least 12 months were recruited from a single public health care system. A survey was designed to evaluate the prevalence of LUTS and thier affect on quality of life (QOL) in transgender subjects on sex hormone therapy. Patients with prior urethral or prostate surgery, or current UTI were excluded from the study. LUTS were assessed using the International Prostate Symptom Score (IPSS), the International Consultation on Incontinence Questionnaire (ICIQ). The WHOQOL-BREF instrument was used to investigate QOL, and the CED 8 instrument was used to screen for depression. Urinary incontinence was defined as reporting any amount of leakage on the ICIQ. The student T-test and the chi-square test were used for quantitative and categorical data analysis, respectively. RESULTS: A total of 129 subjects were prospectively recruited. Patients were stratified into 3 groups (mild, moderate, or severe symptoms) based on their IPSS. Group distribution was as follows: mild (n=11, 8.5 %), moderate (n=105, 8.14 %), and severe (n=13, 10.1 %). There were no significant differences according to age, race, BMI, alcohol consumption, and smoking status. Presence of urine leakage (per ICIQ) correlated with severity according to IPSS [9.1% in “mild” group vs. 54.3% in “moderate” group vs. 100% in “severe” group, p=<0.001]. Variables including urine incontinence before toileting (0% vs. 14.3% vs. 30.8), cough/sneeze (0% vs. 4.8% vs. 7.7%) and spotting (9.1% vs. 30.5% vs. 61.5%), correlated with IPSS severity group . The ICIQ score was also correlated with group by IPSS [0 in “mild” group vs. 3 in “moderate” group vs. 7 in “severe” group, p=<0.001]. CONCLUSIONS: We found a high prevalence of LUTS in this cohort of male-to-female transgender subjects. Urinary incontinence was positively correlated with worsening IPSS score in this cohort. Further investigation with longitudinal follow-up of a larger cohort is granted to better delineate the role of sex hormones and other factor on LUTS. Source of Funding: National Institute of Diabetes and Digestive and Kidney Disease (NIDDK) grant 5K12DK100014 © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e446-e446 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Al Ray* More articles by this author Austin Fernstrum More articles by this author Amr Mahran More articles by this author Britt Conroy More articles by this author David Sheyn More articles by this author Juan P. del Rincon More articles by this author Expand All Advertisement PDF downloadLoading ...

Bladder training for urinary tract symptoms in Parkinson disease: A randomized controlled trial.

ObjectiveTo assess the feasibility and efficacy of bladder training for troublesome lower urinary tract symptoms (LUTS) in Parkinson disease (PD).MethodsIn this single-center, single-blinded, randomized controlled trial, participants with a history of PD and LUTS were randomized to a 12-week bladder training program (BT) or conservative advice (CA). Outcome measures included a 3-day volume frequency diary, International Consultation on Incontinence Questionnaire (ICIQ)–Overactive Bladder Module, and ICIQ—Quality of Life Module. Co–primary endpoints were (1) patient perception of change and (2) change in number of urgency episodes at 12 weeks. Secondary endpoints included change in ICIQ scores, number of micturitions, and volume voided.ResultsThirty-eight participants were randomized (18 to CA, 20 to BT). Both CA and BT were associated with significant improvements in volume voided, number of micturitions, symptom severity scores, and measures of quality of life (all p < 0.05). At 12 weeks, compared to CA, BT was associated with significant superiority on patient perception of improvement (p = 0.001), significantly greater reductions in number of voids in 24 hours (mean decrease 2.3 ± 0.8 voids vs 0.3 ± 0.5 [p < 0.05]), and greater reductions in interference with daily life (2.1 ± 0.8 point improvement vs 0.3 ± 0.7 point deterioration [p < 0.05]). BT was not associated with change in urgency episodes (mean change 2.4 ± 1.5 urgency episodes vs 3.5 ± 1.5 [p NS]). At 20 weeks, BT remained associated with greater improvement in interference in daily life. Loss of significance in other measures may reflect loss of power from loss to follow-up.ConclusionThis controlled trial demonstrated the potential benefits of BT for LUTS in PD.Classification of evidenceThis study provides Class III evidence that for patients with PD and LUTS, BT significantly increased patient perception of improvement but did not significantly reduce urgency episodes.

Assessment, incidence and factors associated with urinary incontinence in older Aboriginal Australians.

Little is known about urinary incontinence in older Aboriginal Australians. To describe urinary incontinence assessment, prevalence, incidence and associated conditions in older Aboriginal Australians. Wave 1 consisted of 363 Aboriginal participants aged ≥45 years from Western Australia; 289 participants participated in Wave 2, with 184 included at both time points. Urinary incontinence was assessed by self-report, family report and the modified International Consultation on Incontinence Questionnaire (ICIQ). We investigated factors associated with incontinence with binary logistic regression. Sensitivity and specificity analyses of incontinence measures were undertaken using the ICIQ score ≥2 as the reference standard. Participant mean age was 61.2 ± 11.2 years. Prevalence of incontinence at Wave 2 (n = 289) using self-report was 24.6%; using ICIQ ≥2 was 22.5%; and family report 14.2%. Incidence after follow-up of 6.7 years was 33 (23.6%), higher than estimates of 5-20% in other populations. Cross-sectional associations with incontinence include female sex (odds ratio (OR) = 6.82; 95% confidence interval (CI) 2.98-15.57), stroke (OR = 3.55; 95% CI 1.43-8.77), head injury (OR = 3.15; 95% CI 1.54-6.45) and depressive symptoms (OR = 1.07; 95% CI 1.01-1.14). Longitudinal associations were age (OR = 1.05; 95% CI 1.01-1.09) and female sex (OR = 2.37; 95% CI 0.99-5.67). Sensitivity (81.5%) and specificity (93.5%) of self-report were high. The prevalence and incidence of urinary incontinence in Aboriginal Australians is high with risk factors of older age and female sex. The modified ICIQ and self-report appear to be appropriate incontinence screens. Further research to understand causes and treatments within this population is urgently required.

Efficacy of urodynamic studies in predicting long-term outcomes of the transobturator tape: do they augment clinical assessment?

IntroductionSome controversy exists regarding necessity for urodynamic evaluation prior to surgical management of stress urinary incontinence (SUI). We aimed to interrogate the role of pre and post-operative urodynamic studies versus clinical assessment in predicting long-term patient reported outcomes of transobturator tape (TOT) placement.Material and methodsA 100 patient cohort of women post TOT insertion for stress/mixed urinary incontinence 2005–2010, under a single surgeon, was identified. Results of pre and post-operative clinical assessment and urodynamic studies were retrospectively evaluated. Long-term patient reported outcome measures (PROMs) were assessed using the International Consultation on Incontinence Questionnaire (ICIQ) Short Form, Patient Global Impression of Severity (PGI-S) and Patient Global Impression of Improvement (PGI-I) questionnaires. The role of urodynamic studies in predicting postoperative voiding dysfunction, and long-term procedure outcomes was analysed. Statistical correlations were performed using SPSS.ResultsQuestionnaire response rate was 76/100 (76%) at mean follow-up 9.4 years (7.25–12.75). Mean ICIQ score was 6.32 (1–20). No significant correlations between preoperative pDet QMax and postoperative uroflow/duration of intermittent self catheterisation (ISC), or between preoperative leak-point pressures and outcome were observed. Postoperative urodynamic tests did not reliably predict long-term success in SUI cure. Preoperative clinical urgency was a more reliable predictor of long-term clinical urgency than urodynamic detrusor overactivity. Whilst patients with mixed urinary incontinence at long-term follow-up tended to have the highest (worst) overall ICIQ-SF and ICIQ quality of life score, no studied variables on preoperative CMG were significantly correlated with long-term PROMs.ConclusionsWhilst urodynamic studies provide important baseline bladder function data, prior to mid-urethral sling placement, this study finds no specific value of either pre or postoperative urodynamics in predicting long-term patient reported outcomes of transobturator tape placement.

Surgically induced weight loss results in a rapid and consistent improvement of female pelvic floor symptoms

Objective: The aim of this study was to evaluate the effect over time of bariatric surgery on female pelvic floor symptoms.Methods: In total, 160 consecutive adult women were requested to complete four anonymous questionnaires [International Consultation on Incontinence Questionnaire (ICIQ), Bristol Female Lower Urinary Tract Symptoms (BFLUTS), Pelvic Floor Distress Inventory (PFDI-20) and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12)] before bariatric surgery and at 3–6 months and 12–24 months postoperatively. Strict criteria were used to define clinically significant urinary incontinence (UI), pelvic organ prolapse (POP) and colorectal–anal (CRA) symptoms. Statistical analyses were performed using paired, two-sided, Student’s t test for continuous data, and Fisher’s exact test for categorical data.Results: Altogether, 101 women (67%, mean age 41.6 ± 11.8 years, mean preoperative body mass index 41.6 ± 4.6 kg/m²) completed all questionnaires. In women who had preoperative UI (42.6%), mean ICIQ score decreased from 9.5 ± 4.0 at baseline to 3.0 ± 3.6 (p < .001) and 2.9 ± 3.9 (p < .001) at 3–6 and 12–24 months postoperatively, respectively. In women who had preoperative POP symptoms (17.8%), mean PFDI-20/POP score decreased from 23.8 ± 10.9 at baseline to 12.7 ± 12.9 (p = .010) and 13.7 ± 17.1 (p = .025) at 3–6 and 12–24 months postoperatively. In women who had preoperative CRA symptoms (35.6%), mean PFDI-20/CRA score decreased from 26.0 ± 14.9 at baseline to 15.4 ± 15.1 (p = .001) and 18.8 ± 15.4 (p = .045) at 3–6 and 12–24 months postoperatively. De novo postoperative POP and CRA symptoms were reported by up to 16% of patients.Conclusions: Surgically induced weight loss is associated with significant improvements in UI, POP and CRA symptoms. The maximal clinical effect was achieved within 3–6 months, and remained constant throughout the second postoperative year. Nevertheless, de novo POP and CRA symptoms are expected in up to 16% of patients.

Risk adapted dose-intensified postoperative radiation therapy in prostate cancer patients using a simultaneous integrated boost technique applied with helical Tomotherapy

BackgroundPostoperative adjuvant radiation therapy (ART) in T3 and R1 prostate cancer as well as salvage radiation therapy (SRT) in case of postoperative biochemical failure (BF) are established treatments. Dose-intensified postoperative radiation therapy (RT) schemes have shown superior biochemical control accompanied by increased toxicity rates. In our study we evaluate a novel risk adapted dose-intensified postoperative RT scheme.MethodsA consecutive series of prostate cancer patients receiving postoperative RT after radical prostatectomy using helical Tomotherapy between 04/2012 and 04/2015 was analyzed retrospectively. RT was administered using a simultaneous integrated boost (SIB) to the area at risk (37 fractions of 1.9 Gy, total dose: 70.3 Gy) being defined based on histopathological findings (T3/R1 region) and in few cases according to additional diagnostic imaging. The whole prostate bed was treated with a dose of 66.6 Gy (37 fractions of 1.8 Gy). Primary endpoints were acute and late genitourinary (GU) and gastrointestinal (GI) toxicities. Secondary endpoints included patient reported outcome as assessed by the International Prostate Symptom Score (IPSS), the International Consultation on Incontinence questionnaire (ICIQ) and prostate cancer specific Quality of Life questionnaire QLQ-PR25, as well as rates of BF.ResultsA total of 69 patients were analyzed. Sixteen patients underwent ART and 53 patients SRT, respectively. The median follow-up was 20 months (range, 8–41 months). Seven (10.1%) and four (5.8%) patients experienced acute grade 2 GU and GI toxicity. Two patients (2.9%) had late grade 2 GU toxicity, whereas no late grade 2 GI nor any grade 3 acute or late GU or GI events were observed. When compared to the baseline IPSS scores (p = 1.0) and ICIQ scores (p = 0.87) were not significantly different at the end of follow-up. Patient reported Quality of life (QoL) showed also no significant difference. A total of seven patients (10.1%) experienced a biochemical recurrence with the 2-year biochemical progression-free survival (bPFS) being 91%.ConclusionsPostoperative RT for prostate cancer patients with a risk adapted dose-intensified SIB using helical tomotherapy is feasible and associated with favorable acute and late GU and GI toxicity rates, no significant change of IPSS-, ICIQ scores and patient reported QoL and results in promising bPFS rates.

Defeating Urinary Incontinence with Exercise Training: Results of a Pilot Study in Frail Older Women.

To determine whether combining behavioral urinary incontinence (UI) treatments with physical activity improves UI in frail older women. Single-blind, two-arm pilot randomized controlled trial. Senior apartments. Frail women (mean age 84.9 ± 6.4) without dementia (n = 42). Twelve-week program of customized behavioral UI treatments: 150 minutes of weekly walking and twice weekly strength training classes. UI was measured using 3-day bladder diaries, the International Consultation on Incontinence Questionnaire (ICIQ), and UI global improvement questions. Toileting skills were measured using the Performance Oriented Timed Toileting Instrument (POTTI) and the Minnesota Toileting Skills Questionnaire (MTSQ). Physical function was measured using the Short Physical Performance Battery. UI-related quality of life was measured using the Incontinence Impact Questionnaire and Urogenital Distress Inventory. The treatment group reported a 50% reduction in daily leaks using bladder diaries, and the control group reported no change (P = .04). Although there were no group differences in total ICIQ scores (P = .66), the treatment group reported significantly greater improvement on the ICIQ item for urine leakage (P = .01). More than 81% of the treatment group and 36% of the control group reported improvement in UI (χ2 = 4.84, P = .01), with mean estimated percentage improvement of 65.3 ± 32.0 versus 34.1 ± 41.3 (P = .03). Although the difference was not statistically significant, treatment group participants improved their toileting skills, whereas those of the control group declined (P = .42 POTTI, P = .11 MTSQ). Balance (P = .33) and gait (P = .24) improved more in the treatment group, whereas chair stands improved more in the control group (P = .14). UI may be improved in frail older women by combining behavioral strategies for UI with physical activity, but larger trails are needed to determine whether these findings can be replicated and sustained.

Urinary incontinence in multiple sclerosis: prevalence, severity and impact on patients' quality of life.

Lower urinary tract symptoms (LUTS) including frequent urination, nocturia and urge urinary incontinence negatively impact quality of life. This project aimed at characterizing the prevalence and severity of urinary incontinence in multiple sclerosis (MS) patients and its association with demographic and clinical features. In all, 403 consecutive clinically stable MS patients answered the International Consultation on Incontinence Questionnaire (ICIQ) and the Patient Perception of Bladder Condition (PPBC) questionnaire. Demographic and clinical parameters including the Expanded Disability Status Scale (EDSS) were collected. Statistical analyses were performed using univariate and multivariate linear regression models. Females represented 72%, relapsing-remitting patients 82%. The mean (SD) disease duration and EDSS were 11.8 (8.6) years and 3.1 (1.9) respectively. Approximately 35% of patients reported urine incontinence. ICIQ scores were positively associated with EDSS, female gender, presence of LUTS therapies and absence of disease modifying treatments (P < 0.001). PPBC scores were positively associated with EDSS and the presence of LUTS therapies (P < 0.001). Urinary incontinence is frequent in MS, prevailing in more disabled and female patients. Currently available LUTS therapies appear insufficient in the treatment of this symptom. The negative impact of urinary incontinence on quality of life is high and requires more attention in clinical management and research.

Does motivation predict outcome of pelvic floor muscle retraining?

Although pelvic floor muscle training (PFMT) is effective for stress urinary incontinence (SUI), patients need to be motivated to obtain cure. An instrument to assess motivation in such patients was published in 2009: the Incontinence Treatment Motivation Questionnaire (ITMQ). The ITMQ consists of five domains: (i) positive attitudes toward PFMT; (ii) reasons for not doing PFMT; (iii) difficulties living with incontinence; (iv) desire for treatment; and (v) incontinence severity influencing motivation. The aim of the present study was to examine the relationship between ITMQ scores and treatment success. After referral for PFMT, women with SUI completed the ITMQ. Pre- and post-treatment outcomes were the International Consultation on Incontinence Questionnaire (ICIQ) score and a 24-hr pad test. Correlations between ITMQ scores and baseline, as well as post-treatment change in ICIQ scores and pad test results were examined. Additionally, the demographics of non-participants, participants, and patients lost to follow-up were compared. Of 85 recruits, 18 did not complete the ITMQ, 14 were lost to follow-up, thus 53 completed the PFMT programme and undertook either one or both outcomes. Pre-treatment, severity on ICIQ correlated with total ITMQ (ρ = 0.33, P = 0.01). Post-treatment change in pad test was inversely correlated with Domain 2 (ρ = -0.33, P = 0.03). The pre-treatment severity of incontinence was significantly associated with motivation for treatment. Unfortunately, post-treatment change correlated with only one domain of the questionnaire. Further modification of the ITMQ is envisaged. Neurourol. Urodynam. 36:316-321, 2017. © 2015 Wiley Periodicals, Inc.

Preoperative and Intraoperative Measurements of Urethral Length as Predictors of Continence After Robot-Assisted Radical Prostatectomy

Membranous urethral length is one of several factors that can influence return of continence after radical prostatectomy. Using our robot-assisted laparoscopic prostatectomy (RALP) database, we assessed which preoperative (with endorectal coil MRI [eMRI]) and intraoperative anatomic measurements correlate with return to urinary continence (no pads) and continence quality of life (CQOL) as determined by the International Consultation on Incontinence Questionnaire (ICIQ) score. A total of 75 patients who underwent RALP and eMRI by a single surgeon were analyzed. To emulate the distal continence zone intraoperatively, stretched urethral length (distance from the perineal membrane to the prostate apex on stretch) and cut urethral length (urethral stump length) were individually measured and recorded after apical dissection. Preoperative International Prostate Symptom Scores (IPSS) were recorded. Univariate and multivariate Cox regression analysis were performed to determine the association between MRI-measured and intraoperative urethral lengths and return to continence as well as CQOL. None of the urethral measurements as determined by eMRI correlated with continence or ICIQ scores. On multivariate analysis, only membranous urethral length on eMRI approached significance with respect to ICIQ (P=0.07). On multivariate analysis controlling for preoperative age, body mass index, IPSS score, and gland size, both stretched and cut urethral length correlated with decreased time to continence (P=0.03 and P=0.04 respectively). Longer stretched and cut urethral lengths appear to correlate with faster return to a pad-free state. Attention to maximal preservation of the distal continence mechanism is important for optimal continence outcomes after RALP.