Mixed Urinary Incontinence Research Articles

Multicenter Randomized Controlled Trial of Pelvic Floor Muscle Training with a Motion-based Digital Therapeutic Device versus Pelvic Floor Muscle Training Alone for Treatment of Stress-predominant Urinary Incontinence.

To determine whether use of an intravaginal motion-based digital therapeutic device for pelvic floor muscle training (PFMT) was superior to PFMT alone in women with stress-predominant urinary incontinence (SUI). A multicenter, randomized-controlled trial was conducted where women with SUI or SUI-predominant mixed urinary incontinence were treated with either PFMT using the device (intervention group) or PFMT alone (control group). Primary outcomes, measured at 8 weeks, included change in Urinary Distress Inventory, short-version and improvement in the Patient Global Impression of Improvement, defined as "much better" or "very much better." Participants also completed Pelvic Organ Prolapse and Colorectal-anal Distress Inventories, Pelvic-Floor-Impact Questionnaire and a 3-day bladder diary. Primary analysis used a modified intention-to-treat approach. Statistical analysis used Student t test and χ2 test. The trial was prematurely halted due to device technical considerations. Seventy-seven women were randomized, and final analysis included 61 participants: 29 in intervention and 32 in control group. There was no statistical difference in Urinary Distress Inventory, short-version scores between the intervention (-13.7 ± 18.7) and the control group (-8.7 ± 21.8; P = 0.85), or in Patient Global Impression of Improvement (intervention 51.7% and control group 40.6%; P = 0.47). Pelvic Organ Prolapse and Colorectal-anal Distress Inventories and Pelvic-Floor-Impact Questionnaire scores improved significantly more in the intervention group than the control group (all P < 0.05). Median number of SUI episodes decreased from baseline to 8 weeks by -1.7 per-day [(-3)-0] in the intervention group and -0.7[(-1)-0] in the control group, (P = 0.047). In this prematurely terminated trial, there were no statistically significant differences in primary outcomes; however, PFMT with this digital therapeutic device resulted in significantly fewer SUI episodes and greater improvement in symptom-specific quality of life outcomes. A larger powered trial is underway.

Prevalence and trends in urinary incontinence among women in the United States, 2005–2018

Women are disproportionately affected by urinary incontinence compared with men. Urinary incontinence results in physical and psychological adverse consequences and impaired quality of life and contributes to significant societal and economic burden. Previous studies reported high urinary incontinence burden in the United States. However, the current prevalence and recent trends in urinary incontinence and its subtypes among US women have not been described. In addition, correlates of urinary incontinence among US women have not been systematically evaluated in the contemporary population. The purpose of this study was to determine the prevalence and trends in urinary incontinence among adult women in the United States from 2005 to 2018. In addition, this study aimed to investigate the relationship of urinary incontinence subtypes with several sociodemographic, lifestyle, health-related, and gynecologic factors. We used data from the National Health and Nutrition Examination Survey, a nationally representative series of surveys that was designed to evaluate the health status of the US population. Data on urinary incontinence from 7 consecutive 2-year cycles (2005-2006 to 2017-2018) were used for this study. A total of 19,791 participants aged ≥20 years were included. Weighted prevalence estimates and 95% confidence intervals were calculated in each study cycle for stress, urgency, and mixed urinary incontinence. Multivariate-adjusted weighted logistic regression was used to investigate the temporal trends in urinary incontinence, in addition to determining the association between urinary incontinence subtypes with several participants' factors. In the 2017-2018 cycle, stress urinary incontinence was the most prevalent subtype (45.9%; 95% confidence interval, 42.1-49.7), followed by urgency urinary incontinence (31.1%; 95% confidence interval, 28.6-33.6) and mixed urinary incontinence (18.1%; 95% confidence interval, 15.7-20.5). The prevalence rates of urgency and mixed urinary incontinence were higher in women aged 60 years and older (urgency, 49.5% [95% confidence interval, 43.9-55.2]; mixed, 31.4% [95% confidence interval, 26.2-36.6]) than in those aged 40 to 59 years (urgency, 27.9% [95% confidence interval, 23.6-32.1]; mixed, 15.9% [95% confidence interval, 12.9-19.0]) and those aged 20 to 39 years (urgency, 17.6% [95% confidence interval, 13.8-21.5]; mixed, 8.3% [95% confidence interval, 5.4-11.3]). The overall prevalence of stress and mixed urinary incontinence was stable throughout 2005 to 2018 (both Ptrend=.3), with increases in mixed urinary incontinence among women aged 60 years and older (P=.001). The prevalence of urgency urinary incontinence significantly increased, particularly among women aged 60 years and older (both P=.002). Age, obesity, smoking, comorbidities, and postmenopausal hormone therapy were associated with higher prevalence of all types of urinary incontinence. Black women were less likely to report stress urinary incontinence but more likely to report urgency urinary incontinence. Although the estimated overall prevalence of stress and mixed urinary incontinence remained stable from 2005 to 2018, the prevalence of urgency and mixed urinary incontinence significantly increased among women aged 60 years and older. All subtypes of urinary incontinence were higher among women with obesity and comorbidities, those who used postmenopausal hormone therapy, and those who smoke.

Burch kolposüspansiyonu ve abdominal histerektomi sonrası polipropilen sütüre ikincil mesane taşı oluşumu

Bladder calculies are stones or calcified materials found in the bladder. Foreign bodies that come into contact with the urine may cause bladder stones. Examples of foreign body include suture materials, clips, catheters, ureteral stents, urinary incontinence meshes or migration of an intrauterine device. A 63-year-old female patient was admitted to our urology clinic with dysuria, frequent urination and mixed type urinary incontinence for a year. The patient had a history of abdominal hysterectomy and Burch colposuspension two years ago. Computerized tomography of the patient revealed a bladder stone measuring 2.9 x 2.6 cm.The patient underwent cystolithotripsy with Holmium (Ho: YAG) laser. The bladder stone was found to be attached to the bladder wall by a polypropylene suture. The suture material was removed endoscopically. The patient has no complaints during the 2-year follow-up. . The presence of nonabsorbable suture material in the bladder is a well-known cause of urinary tract infection and stone formation, and defined complication of hysterectomy and colposuspension. . Information on the lithogenic properties of various suture materials is unfortunately limited to only in vitro and in vivo animal studies. In humans, experience with stone formation related to suture materials is limited to case reports. It has been observed that lithogenicity is related to the longevity of the suture material and in the studies carried out, it has been observed that the rate of calcification with non-absorbable sutures is higher. Treatment includes disintegration of the stone and removal of the foreign body causing the stone.

Urinary incontinence before and after pelvic organ prolapse surgery-A national database study.

To investigate how pelvic organ prolapse (POP) surgery affects symptoms of urinary incontinence (UI) in women with POP and concomitant UI. Data from the Danish Urogynaecological Database were collected from 2013 to 2016. Inclusion criteria were urinary incontinent women who underwent POP surgery alone. Based on the preoperative results of the International Consultation on Incontinence Questionnaire-Urinary Incontinence-short form (ICIQ-UI-sf), women were categorized with stress urinary incontinence (SUI), urgency urinary incontinence (UUI) or mixed urinary incontinence (MUI). Postoperatively, the women were categorized based on the postoperative ICIQ-UI-sf, except here, undefined urinary incontinence and urinary continence were added to the categories. Statistical analyses included multivariate logistic regression analyses, examining the odds of urinary continence in each category. The included parameters were preoperative POP stage (POP-Q), compartment, BMI, age and preoperative ICIQ-UI-sf total score. P-values < 0.05 were considered statistically significant. A total of 1657 women were included. Significantly more women with preoperative UUI achieved urinary continence (60%) compared to women with preoperative SUI (52%) and MUI (38%). More than 70% of all women achieved either urinary continence or an improvement in UI, regardless of subtype. For women with UUI, the likelihood of achieving urinary continence was higher if the anterior compartment was involved. Women with MUI were more likely to achieve urinary continence if they had POP-Q stage 3-4. Most women with symptomatic POP and concomitant UI find that their UI is either cured or improved after POP surgery alone.

Role of Urodynamic Study in the Management of Pelvic Organ Prolapse in Women.

Pelvic organ prolapse (POP) and lower urinary tract symptoms (LUTS) usually coexist and are common among women. Since the efficacy of urodynamic studies (UDS) in evaluating these conditions is subject to controversy, this study aimed to assess the accordance between urodynamic findings and LUTS and to determine the importance of UDS in women with POP. This cross-sectional study was conducted on women over 18 years with symptomatic POP referred to the female urology clinic of Kerman University of Medical Sciences, Kerman, Iran, during 2017-2018. Patients who met the inclusion criteria were included in the study with informed consent. The Pelvic Floor Disability Index (PFDI-20) was completed for each patient. Pelvic examination was performed using the Pelvic Organ Prolapse Quantification System (POPQ). Subsequently, multi-channel UDS was performed, and the findings were analyzed in SPSS 20, using Chi-square or Fisher's test. A total of 200 women with symptomatic POP were included in the study. Stress, urge, and mixed urinary incontinence showed significant accordance with the urodynamic findings (urodynamic stress incontinence and/or detrusor overactivity). However, there was no significant relationship between urinary voiding LUTS and urodynamic findings. UDS should be performed for selective patients with POP. According to the results of the present study, UDS can help us provide consultation for POP patients with voiding LUTS. However, in POP patients with urinary incontinence, this test cannot provide further information and should be performed based on the patient's condition.

Relationship between urinary incontinence and back or pelvic girdle pain: a systematic review with meta-analysis.

Many observational studies have suggested the existence of a link between urinary incontinence (UI) and lumbopelvic pain. The aim of our study is to evaluate the association between UI and back pain (BP) or pelvic girdle pain (PGP) in the adult population. This systematic review with meta-analysis was registered in PROSPERO under the number 2019:CRD42019120047. Literature was sought in the Medline, Embase, and PEDro databases. The search was limited to English, Spanish, and French records, and was conducted from inception until November 2019. Observational studies evaluating the association between UI and BP/PGP were selected by two independent reviewers. Quality assessment was performed using the "Critical Review Form for quantitative studies" (McMaster University). From the 2,055 retrieved articles, 18 were selected. Both qualitative (n = 18) and quantitative analysis (n = 7) were performed. Fifteen out of 18 studies (83%) found a positive association between UI and BP or PGP for at least one type of incontinence. Pooled estimates were OR 1.61, 1.53, and 1.51 for stress, urgency, and mixed urinary incontinence respectively. A similar degree of association between women and men was found. Subjects with stress and mixed incontinence showed greater likelihoods of mild pain compared with severe pain, although severe pain was more frequently associated with urgency incontinence than mild pain. Our results support the association between UI and BP/PGP, which seems to be independent of gender-based differences. The strength of this association depends on pain or incontinence subtypes. Clinicians should be aware of the relationship in their clinical practice.

Prevalence of Urinary Incontinence among a Nationally Representative Sample of Women, 2005-2016: Findings from the Urologic Diseases in America Project.

Urinary incontinence is frequently underreported and underdiagnosed in the clinical setting. We analyzed 12 years of data from a large, nationally representative sample of women in the United States to assess the prevalence, severity, and daily impact of urinary incontinence and its subtypes at the population level. We analyzed data from 15,003 women aged ≥20 years who participated in the 2005-2016 National Health and Nutrition Examination Survey. We estimated the prevalence of urinary incontinence in the prior year, overall and by subtype (stress, urgency or mixed). Among women with urinary incontinence, we additionally assessed symptom severity using the validated 4-level Incontinence Severity Index, as well as impact on daily activities. The 2005-2016 prevalence of any urinary incontinence was 53%; 16% of women had mixed urinary incontinence, 26% had stress only and 10% had urgency only. While urgency urinary incontinence and mixed urinary incontinence were highest among women aged ≥60 years, stress urinary incontinence was highest among women aged 40-59 years. NonHispanic Black women had higher prevalence of urgency urinary incontinence and lower prevalence of stress urinary incontinence compared to other racial/ethnic groups. Of women with urinary incontinence, 30% reported moderate or severe symptoms, which were more common among older than younger women. In addition, 24% of women with urinary incontinence reported that the condition affected their daily activities. Our study demonstrates a high prevalence of urinary incontinence among a nationally representative population of women in the United States, with many reporting that urinary incontinence affected their daily activities. Age and racial/ethnic trends varied by urinary incontinence subtype.

Üriner İnkontinansın Hastalık Yükü ve Maliyeti

Urinary incontinence (UI) is a health problem that affects all individuals physically, mentally, socially and economically. The prevalence of UI ranges between 5-70%. UI creates a serious economic burden on the individual, family, community, and health services. Disease burden is an important parameter in determining the economic burden of UI and often uses Quality Adjusted Life Years (QALY-a tool developed to evaluate the cost-effectiveness of treatments). UI total cost cover all the costs used, lost and include direct and indirect costs. Direct costs consist of costs related to diagnosis, treatment, routine care, and UI outcome costs while routine care costs make up a large portion of UI costs. Indirect costs are the invisible portion of the economic burden of UI, which is very difficult to calculate and is assumed to have a larger share than direct costs. In Turkey, there is no registration system or research yet concerning the UI and its economic burden, and available data is limited to the costs of diagnosis and treatment specified in the Healthcare Implementation Communiqué (SUT). In this review, the disease burden and cost of stress (SUI), urgency (UUI), and mixed urinary incontinence (MUI) have been investigated according to the literature and its current status was determined. Our study has revealed that UI creates a serious economic burden on the individual and the healthcare system, and that first-line healthcare services are key in reducing this burden. For the cost-effective management of UI in Turkey, it is important to determine the economic burden of the disease at the national level, to expose relevant direct and indirect costs, and to employ resources accurately and effectively.

Health Outcomes after Pregnancy in Elite Athletes: A Systematic Review and Meta-analysis.

This study aimed to evaluate postpartum maternal health and training outcomes of females who were competing or training as elite athletes before or during pregnancy. Online databases were searched up to August 26, 2020. Studies of any design and language were eligible if they contained information on the relevant population (postpartum athletes [any period after pregnancy]), exposure (engaged in the highest level of sport immediately before or during pregnancy), comparators (sedentary/active controls), and outcomes: maternal (breastfeeding initiation and duration, postpartum weight retention or loss, bone mineral density, low back or pelvic girdle pain, incontinence [prevalence or severity of stress, urge or mixed urinary incontinence, fecal incontinence], injury, anemia, diastasis recti, breast pain, depression, anxiety) and training (<6 wk time to resume activity, training volume or intensity, performance level). Eleven studies (n = 482 females, including 372 elite athletes) were included. We identified "very low" certainty evidence demonstrating a higher rate of return to sport before 6 wk postpartum among elite athletes compared with nonelite athletes (n = 145, odds ratio = 6.93, 95% confidence interval = 2.73-17.63, I2 = 11). "Very low" certainty evidence from three studies (n = 179) indicated 14 elite athletes obtained injuries postpartum (7 stress fractures, 9 "running injuries"). "Very low" certainty evidence from five studies (n = 262) reported that 101 (40.5%) elite athletes experienced improved performance postpartum. Compared with controls, "very low" quality evidence suggests that elite athletes return to physical activity early in the postpartum period and may have an increased risk of injury. Additional high-quality evidence is needed to safely guide return to sport of elite athletes in the postpartum period.

Mixed Urinary Incontinence (MUI) in Women: From Evidence to Clinical Practice

Mixed Urinary Incontinence (MUI) in women is an important disease that is under-treated and under-reported with high prevalence of 33% of all cases of incontinence. It significantly impairs women’s quality of life. MUI usually represent with more severe symptoms and are more likely to present for the treatment as per the recent studies. The management not only includes the conventional but also the complementary and alternative medicine treatment incorporating details from evidence to clinical practice. Combinations of behavioral modification, pelvic floor physiotherapy, biofeedback, pharmacotherapy, anti-incontinence devices, and complementary therapies is useful to treat mixed symptoms. Some researches recommended the use of Serotonin/Norepinephrine Reuptake Inhibitors (SNRIs) and antimuscarinic drugs to treat MUI. Some studies showed that acupuncture is beneficial for MUI. The treatment with herbal medicine such as mace, Boswellia serrata and Cyperius were also effective in treating MUI symptoms.

New Hysterectomy Technique with Correction of Stress Urinary Incontinence, and Mixed Urinary Incontinence

Statistically, 50% or more of the patients who are going to be hysterectomized have stress, urgency and mixed urinary incontinence, a problem that, when presenting significantly high figures in its epidemiology, requires finding a treatment that promises a cure for this pathology, since it represents not only a global public health problem for women, but also a global burden, for example, in the US for the treatment of urinary incontinence there has been an annual expenditure of more than 26 billion dollars. This article provides evidence that allows proposing the Hysterectomy + cysto-urethro-colpus suspension surgical technique - SYCFIM, as a treatment for stress and mixed urinary incontinence. A study was carried out with 6 patients with uterine pathology associated with urinary incontinence. A pre-surgical urodynamics were performed, finding one patient with stress incontinence and five patients with mixed incontinence. At the postoperative control appointments at two weeks and two months, the patients reported the disappearance of incontinence. And at two years and five months, they continued without urinary incontinence in 100% of the cases. The results of the urodynamics performed at two years and five months, demonstrated the disappearance of stress incontinence in 100% and mixed in 100%, thus confirming that the SYCFIM technique works as a treatment for stress and mixed urinary incontinence.

URINARY INCONTINENCE AND BTL EMSELLA

In the article, the author analyzes urinary incontinence, the influence of kegel exercises and high-performance fossilized electromagnetic field technology to stimulate deep pelvic floor muscles and restore neuromuscular control using the BTL EMSELLATM device for urinary incontinence. EMSELLA uses high performance fossilized electromagnetic field (HIFEM) technology to stimulate deep pelvic floor muscles and restore neuromuscular control.It is designed for strengthening the muscles of the pelvic floor, shaping the muscles of the seat and treating urine leakage.Materials and methods. The study followed an institutional review board approved protocol. A total of 20 women (54.40 ± 11.70 years, 1.75 ± 1.38 deliveries) who showed symptoms of stress, urge, or mixed urinary incontinence were enrolled. They received six HIFEM treatments (2 per week) in duration of 28 minutes. Outcomes were evaluated after the sixth treatment and at the 3-month follow-up. The statistical analysis was conducted by paired T-test and Pearson correlation coefficient (α=0.05).Results. After the sixth session, 18 out of 20 patients (80.34%) reported significant reduction of their symptoms. The average improvement of 48.90% in ICIQ-SF score was observed after the sixth treatment, which further increased to 63.40% at the follow-up (both P &lt; 0.001). Individually, the highest level of improvement was reached in patients suffering from mixed urinary incontinence (68.95%). The reduction of absorbent pads averaged 45.85% after the sixth treatment and 54.78% at 3 months (both P &lt; 0.001), while almost 75% of patients (reported decreased number of used pads.Conclusions. This study demonstrated that HIFEM technology is able to safely and effectively treat a wide range of patients suffering from urinary incontinence. After six treatments, an improvement in ICIQ-SF score and reduction in absorbent pads usage was observed. Based on subjective evaluation, these changes positively influenced quality of life.

Effects of lateral episiotomy on the emergence of urinary incontinence during the first postpartum year in primiparas: prospective cohort study.

Aim of the studyLateral episiotomy is a widely used procedure, although it is rarely mentioned in the literature and its effects on the pelvic floor are largely unexplored. The purpose of this study is to evaluate the impact of lateral episiotomy on the incidence of urinary incontinence (UI) after vaginal delivery in primiparas.Material and methodsThe study design is a prospective cohort study. The primiparas were divided into two groups. The first group consisted of women who gave birth with lateral episiotomy, while the second group included women who gave birth with an intact perineum or with perineal tears of first and second degree. Assessments of UI were performed at 5 and 8 months after childbirth using the International Consultation on Incontinence Questionnaire – Short Form (ICIQ-SF) questionnaire followed by the stress test.ResultsThe results revealed no significant differences (p > 0.05) in emergence of stress urinary incontinence (SUI) between the groups at the two time points. There were no statistically significant differences in overall rate of UI, urge urinary incontinence (UUI), or mixed urinary incontinence according to the ICIQ-SF questionnaire. The overall incontinence rate on the first examination was 24% in the episiotomy group and 36% in the perineal laceration group, although the difference was not statistically significant (p = 0.064). On the second examination, rates were similar and without a statistically significant difference.ConclusionsLateral episiotomy has a neutral effect on the onset of UI in primiparous women in the first year after delivery.

SYCFIM, Clinical Study in Patients with Stress Urinary Incontinence, Urgency and Mixed

The history, evolution and treatment of urinary incontinence have relevant nuances, such as the establishment of world urinary incontinence day, among others. Large studies show the psychological condition of the women who suffer from it, the high state and personal economic expenses, the medical ignorance of the importance of this pathology, even reaching the environmental topic of contamination due to the exponential increase in the consumption of diapers. This article shows that the SYCFIM hysterectomy surgical technique achieves the curative treatment of patients with stress, urgency, and mixed urinary incontinence, on the basis that the surgical technique achieves the anatomical restoration of the urethral vesicle in its original position, achieving with this, the most important causes of these incontinences disappear. It was evidenced in this study that in the early postoperative control of the SYCFIM technique it achieved the disappearance of urinary incontinence in all patients, it was also observed that after a few years some patients reported the reappearance of incontinence in patients who stopped exercising Kegel, and in the patients who resumed Kegel exercise, incontinence disappeared again, establishing that this exercise is relevant in the treatment of urinary incontinence. A small group of patients who could not or did not want to do the Kegel exercise were provided with electrostimulation equipment that is used in physiatry, achieving a positive response to the disappearance of incontinence in all these patients. And an even smaller group of patients who presented stress incontinence and if they did the Kegel exercise (confirming their tonicity by vaginal touch), the SYCFIM exercise was established (which is Kegel, only that it is performed prior to events that generate increased abdominal pressure, that is, before sneezing or before coughing, sustained Kegel must be performed, thus avoiding urine leakage), also achieved the disappearance of incontinence with this management. The evaluations of the type of incontinence that the patient presents, the postoperative evolution of the presence or absence of incontinence, and its management with the Kegel exercise were carried out by a professional psychologist. The excellent results obtained with the SYCFIM technique for stress, urge and mixed incontinence, force the urology and gynecology guild to review the traditional technique, which could even be classified as iatrogenic, since it increases two and a half times the incidence of urinary incontinence.

Seven-year efficacy and safety outcomes of Bulkamid for the treatment of stress urinary incontinence.

AimsBulking agents are a minimally invasive treatment option for women with stress urinary incontinence (SUI) or stress‐predominant mixed urinary incontinence (MUI). The aim of this study was to evaluate long‐term efficacy and safety following treatment with Bulkamid as a primary procedure for SUI or stress‐predominant MUI.MethodsThis was an Institutional Review Board‐approved single‐center retrospective study of female patients with SUI or stress‐predominant MUI who had undergone injection with Bulkamid since 2005 and had completed 7 years of follow up. The primary endpoint was patient satisfaction measured on a four‐point scale as cured, improved, unchanged, or worse. Secondary outcomes included the number of incontinence pads used, International Consultation on Incontinence Questionnaire‐Short Form (ICIQ‐UI SF) scores, Visual Analog Scale Quality of Life (VAS QoL), reinjection rates, and perioperative and postoperative complications.ResultsA total of 1,200 patients were treated with Bulkamid since 2005 and of these, 388 (32.3%) had completed 7 years of follow‐up. A total of 67.1% of the patients reported feeling cured or improved if Bulkamid was a primary procedure, 11.1% reported no change, and 2.3% reported worsening of incontinence. A total of 19.5% of patients received a subsequent other incontinence procedure. The ICIQ‐UI SF was reduced by 8.6 points. VAS QoL improved by a mean of 4.3 points. Postoperative complications were transient. Prolonged bladder emptying time was reported in 15.3% of patients and urinary tract infection in 3.5%.ConclusionsBulkamid injections are an effective and safe first‐line treatment option for women with SUI or stress‐predominant MUI providing durable outcomes at 7 years.

Electroacupuncture for stress-predominant mixed urinary incontinence: a protocol for a three-armed randomised controlled trial

IntroductionEvidence specific for stress-predominant mixed urinary incontinence is still lacking at present, and acupuncture may relieve the symptoms. We plan to conduct this multi-centre, three-armed, randomised controlled trial to investigate...

Significance of Membranous Urethral Length for Recovery From Postoperative Urinary Incontinence Following Holmium Laser Enucleation of the Prostate.

PurposeThe aim of this study was to determine the significance of the membranous urethral length (MUL), including the thickness of the urethral sphincter, for recovery from postoperative stress urinary incontinence (SUI) following holmium laser enucleation of the prostate (HoLEP).MethodsWe analyzed 78 patients who underwent HoLEP between June 2013 and September 2018, all of whom preoperatively received magnetic resonance imaging. MUL was measured using sagittal T2-weighted fast spin-echo images. The clinical and anatomical factors associated with MUL were evaluated. The recovery time of urinary incontinence was compared between patients with a long MUL (≥14 mm) and a short MUL (<14 mm). SUI included both stress and mixed urinary incontinence. Continence was defined as complete dryness.ResultsThe median MUL in patients without incontinence at 1 month postoperatively was significantly longer than the MUL in patients with incontinence (15.3 mm vs. 12.7 mm, P<0.001). The continence rates at 1 month after HoLEP in patients with longer MULs and shorter MULs were 80.4% and 30.0%, respectively. The recovery time of urinary incontinence in patients with longer MULs (≥14 mm) was significantly shorter than that in patients with shorter MULs (<14 mm) (log-rank test, P=0.001). After 6 months, the continence rates in patients with longer MULs and shorter MULs were similar (97%). MUL was significantly correlated with the recovery period of urinary incontinence (r=-0.459, P<0.001).ConclusionsMUL was useful for predicting early recovery from urinary incontinence following HoLEP. This study provides evidence that postoperative urinary incontinence following a transurethral procedure for benign prostatic hyperplasia was associated with anatomical factors. A long MUL was associated with better tolerance to urinary sphincter damage by the transurethral procedure.

Is the addition of vaginal electrical stimulation to transcutaneous tibial nerve electrical stimulation more effective for overactive bladder treatment? A randomized controlled trial

Introduction and objectivesOveractive bladder (OAB) is a prevalent disorder that increases with age and impairs patients’ quality of life. Guidelines recommend behavior modifications as the first-line treatment; however, physiotherapy has also been used with success, safety, and low cost. Transcutaneous tibial nerve electrical stimulation (TTNS) and vaginal electrical stimulation (VS) are being used in clinical physiotherapy practice. This study aimed to verify whether the addition of VS to TTNS is more beneficial than TTNS alone for women with OAB. Patients and methodsIn all, 106 women aged >18 years diagnosed with OAB or mixed urinary incontinence with prevalent OAB symptoms were randomly divided into 2 groups: Group 1: TTNS (n=52); Group 2: TTNS+VS (n=54). The 3 day voiding diary, pelvic floor muscle strength (Ortiz scale), King's Health Questionnaire, and Overactive Bladder Questionnaire were assessed before and after treatment. Urinary frequency was considered the primary outcome, and a reduction of ≥3micturitions/day was considered clinically relevant. Mixed linear models were used to compare the 2 groups. ResultsInitially, the groups were similar in age, body mass index, number of pregnancies, time of OAB onset, and prevalence of OAB symptoms. After treatment, a reduction in urinary frequency of 1.5 micturitions was observed in Group 2, which was not clinically relevant despite being statistically significant. ConclusionsThe addition of VS to TTNS for the treatment of OAB was not more effective than TTNS as a single therapy.

Effectiveness of Pelvic Floor Muscle Exercise to reduce Urinary Incontinence among Postnatal Mothers

Urinary incontinence can be characterised as 'the protest of any automatic spillage of urine. Under this more extensive definition, there are various indications, similar to Stress urinary incontinence, Urge urinary incontinence and mixed urinary incontinence. Postpartum urinary incontinence is here and there an unavoidable inconvenience of vaginal conveyance, particularly in the event that it happens to be a woman's first vaginal conveyance. Weaker pelvic muscle has reduced inability to stop the flow of urine among postnatal mothers. The study supports the need for nurses to educate the postnatal mothers about methods to reduce urinary incontinence by using the first line of treatment, i.e., pelvic floor muscle strengthening exercise. The present study aims to assess the effectiveness of pelvic floor muscle exercise to reduce urinary incontinence among postnatal mothers. A quantitative pre-experimental, one group pretest and post test research design were chosen to conduct the investigation among 60 postnatal mothers. Convenience sampling technique was used to select the postnatal mothers. Modified Sandviketal Severity Index tool was chosen to assess the pretest and post test level of urinary incontinence. The assessment includes on frequency (involuntary loss of urine occurs), incontinence with daily living and amount of urine leaks. The study results show most of the postnatal mothers had severe urinary incontinence and after the administration, pelvic floor muscle exercises most of the postnatal mothers had moderate urinary incontinence and this emphasizes the need to educate the postnatal mothers and promote them to perform PMRT so that they come through the postnatal period and for the betterment of life.

Sacral electroacupuncture as a treatment for urge urinary incontinence: a prospective case series.

To examine the impact of electroacupuncture (EA) at the 'four sacral points' on urge urinary incontinence (UUI). Twenty-five patients diagnosed with UUI or urgency-predominant mixed urinary incontinence (MUI) were treated by EA at the 'four sacral points'. EA was performed in the sacrococcygeal region using disposable sterile 0.40-mm-diameter acupuncture needles that were either 100 or 125 mm in length. Treatments were delivered once every other day. Before and after treatment, a questionnaire measuring symptom severity and quality of life associated with UUI was administered. The median total score (interquartile range) from the severity of symptoms and the quality of life questionnaire (Q-score) of the participants was significantly reduced from 12 (7.5, 15) before treatment to 3 (0, 6) after 6 (6, 12) EA treatments. The Q-score of urgency-predominant MUI and UUI was 8 (5, 14.5) and 12.5 (11, 15), respectively, before treatment; after treatment these were reduced to 2 (0, 7.5) and 4.5 (2, 6), respectively. There was no statistically significant difference in the Q-score between urgency-predominant MUI and UUI before and after treatment. Upon treatment completion, seven patients (28%) were 'cured' (improvement rate 100%). Treatments were considered 'markedly effective' (improvement rate 75% to <100%) in four patients (16%), 'effective' (improvement rate 50% to <75%) in eight patients (32%), 'minimally effective' (improvement rate 25% to <50%) in three patients (12%), and 'ineffective' (improvement rate <25%) in three patients (12%). The overall success rate (comprising 'cured', 'markedly effective' and 'effective' categories) was 76%, and no adverse effects associated with acupuncture treatment were reported. EA at the 'four sacral points' was associated with statistically significant improvements in UUI.