Predictors Of Urinary Incontinence Research Articles

Predictors of urinary incontinence in patients after robot-assisted radical prostatectomy: results of a single-center study

Introduction. Prostate cancer (PCa) occupies a leading position in the structure of cancer incidence among men worldwide. The “gold standard” for the treatment of localised PCa is radical prostatectomy (RPE), with an increasing frequency of robot-assisted surgery in recent years. One of the negative consequences of surgery for the patient is the occurrence of urinary incontinence (UI), which is quite common and significantly reduces the quality of life. For this reason, it is extremely important to identify the factors that influence the occurrence of UI.Objectve. To identify risk factors for urinary incontinence in patients undergoing robot-assisted surgery based on the patients' preoperative data.Materials & methods. A prospective cohort study was conducted at the Urology Clinic of the Russian University of Medicine to study the risk factors for UI in patients undergoing robot-assisted RPE. The follow-up control points were set on days 1, 3, and 7 after urethral catheter removal and at 1, 3, 6, and 12 months after surgery. Anamnestic data and results of instrumental examination were analysed, based on which statistical analysis including logistic regression analysis with construction of regression equation was performed.Results. In the early postoperative period, UI occurred in 87 (70.3%) patients, but by the follow-up month 12, its frequency had decreased to 15 (11%) cases. Age, body mass index, length of the membranous urethra, size of the m. levator ani, history of prostate surgery and symptoms of an overactive bladder were predictors of UI. Based on the results, nomograms were created to calculate the probability of UI on day 7 and 1, 3, 6, 12 months after urethral catheter removal.Conclusion. The negative impact of UI on the quality of life of patients who have undergone RPE is obvious. Among the predictors identified by us, a modifiable group of risk factors for urinary incontinence was identified. This reduces the risk and severity of urinary incontinence after surgery, which will have a beneficial effect on the quality of life after surgery.

MP67-15 CROSS SECTIONAL AREA OF PSOAS MAJOR MUSCLE PREDICTS URINARY INCONTINENCE AFTER ROBOT-ASSISTED RADICAL PROSTATECTOMY

You have accessJournal of UrologyCME1 Apr 2023MP67-15 CROSS SECTIONAL AREA OF PSOAS MAJOR MUSCLE PREDICTS URINARY INCONTINENCE AFTER ROBOT-ASSISTED RADICAL PROSTATECTOMY Akihisa Hasegawa, Junya Hata, Shunsuke Yoshioka, Hiroki Natsuya, Yusuke Kirihana, Yusuke Hakozaki, Tomoyuki Kumekawa, Yuki Harigane, Yu Endo, Shunta Makabe, Kei Yaginuma, Yuta Matsuoka, Hitomi Imai, Yuki Yoshida, Akifumi Onagi, Seiji Hoshi, Tomoyuki Koguchi, Yuichi Sato, Hidenori Akaihata, Masao Kataoka, and Yoshiyuki Kojima Akihisa HasegawaAkihisa Hasegawa More articles by this author , Junya HataJunya Hata More articles by this author , Shunsuke YoshiokaShunsuke Yoshioka More articles by this author , Hiroki NatsuyaHiroki Natsuya More articles by this author , Yusuke KirihanaYusuke Kirihana More articles by this author , Yusuke HakozakiYusuke Hakozaki More articles by this author , Tomoyuki KumekawaTomoyuki Kumekawa More articles by this author , Yuki HariganeYuki Harigane More articles by this author , Yu EndoYu Endo More articles by this author , Shunta MakabeShunta Makabe More articles by this author , Kei YaginumaKei Yaginuma More articles by this author , Yuta MatsuokaYuta Matsuoka More articles by this author , Hitomi ImaiHitomi Imai More articles by this author , Yuki YoshidaYuki Yoshida More articles by this author , Akifumi OnagiAkifumi Onagi More articles by this author , Seiji HoshiSeiji Hoshi More articles by this author , Tomoyuki KoguchiTomoyuki Koguchi More articles by this author , Yuichi SatoYuichi Sato More articles by this author , Hidenori AkaihataHidenori Akaihata More articles by this author , Masao KataokaMasao Kataoka More articles by this author , and Yoshiyuki KojimaYoshiyuki Kojima More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003330.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There are cases of persistent urinary incontinence after robot-assisted radical prostatectomy (RARP). Urinary incontinence is one of the factors that significantly reduce quality of life, and there is a need to elucidate predictive factors for urinary incontinence to assist in treatment selection. On the other hand, it has been reported that decreased skeletal muscle mass is a risk factor for perioperative complications and poor prognosis, and we considered that it could also be a predictor of urinary incontinence after RARP. Therefore, we measured cross sectional area of psoas major muscle (CSA-PMM), which has been one of the indicators of skeletal muscle volume, and analyzed the relationship between the systemic skeletal muscle and urinary incontinence after RARP. METHODS: Altogether, 539 (average 67.0±5.18 years old) who underwent RARP were enrolled in this study. CSA-PMM were measured by tracing the bilateral psoas major muscles at the upper border level of cross section L4 on preoperative CT. Urinary continence was defined as ≤2 g on a 1-hour pad test and was assessed at 1, 3, 6, 9, and 12 months after RARP. The correlation analysis between patient factors such as CSA-PMM, age, BMI, and eGFR and postoperative urinary continence was performed. The median of CSA-PMM was divided into two groups, high or low CSA-PMM groups, and used for analysis. RESULTS: The continence rates at 1, 3, 6, 9, and 12 months after RARP were 31.9%, 53.6%, 66.0%, 70.3%, and 70.8%, respectively. The median of CSA-PMM was 19.72 (10.39-33.16) ㎠. CSA-PMM was a significant predictor of urinary continence at 6, 9, and 12 months after RARP in univariate analysis (p<0.01, p<0.01, p=0.03). Furthermore, in multivariate analysis, it was a significant predictor of urinary continence at 3, 6, 9, and 12 months after surgery (p=0.02, p<0.01, p<0.01, p<0.01). CONCLUSIONS: CSA-PMM was a significant predictor of long-term urinary incontinence after RARP. Since the psoas major muscle is one indicator of total body skeletal muscle mass, patients with low CSA-PMM had lower pelvic floor muscle mass. This might be related to urinary incontinence. Source of Funding: Nothing © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e948 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Akihisa Hasegawa More articles by this author Junya Hata More articles by this author Shunsuke Yoshioka More articles by this author Hiroki Natsuya More articles by this author Yusuke Kirihana More articles by this author Yusuke Hakozaki More articles by this author Tomoyuki Kumekawa More articles by this author Yuki Harigane More articles by this author Yu Endo More articles by this author Shunta Makabe More articles by this author Kei Yaginuma More articles by this author Yuta Matsuoka More articles by this author Hitomi Imai More articles by this author Yuki Yoshida More articles by this author Akifumi Onagi More articles by this author Seiji Hoshi More articles by this author Tomoyuki Koguchi More articles by this author Yuichi Sato More articles by this author Hidenori Akaihata More articles by this author Masao Kataoka More articles by this author Yoshiyuki Kojima More articles by this author Expand All Advertisement PDF downloadLoading ...

5 - Predictors of urinary incontinence after radical prostatectomy based on high-volume center cohort and a systematic review

5 - Predictors of urinary incontinence after radical prostatectomy based on high-volume center cohort and a systematic review

Prediction of Postradical Prostatectomy Urinary Incontinence Through the Combination of the Urethral Pressure Profile With Electromyography of the Urethral Sphincter.

PurposeWe tested the hypothesis that the urethral pressure profile, in combination with electromyography of the urethral sphincter, may be useful as a predictor of urinary incontinence after radical prostatectomy (RP). The aim of this study was to assess whether the combination of these tests resulted in an improved tool for the prediction of post-RP urinary incontinence.MethodsPatients with indications for RP were included. The urethral pressure profile, including prostatic and sphincter components for maximum urethral closure pressure (MUCP) and functional urethral length, was recorded in combination with needle electromyography of the urethral sphincter. The mean and maximum amplitude of waves were measured twice: 1 month before RP and 6 months after the procedure. The 1-hour pad test was conducted in parallel with other tests. Patients completed the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF). The relationship of the results of the tests with post-RP urinary incontinence was studied. Age, urodynamic parameters, pathologic stage, and surgical technique were recorded for analysis as potential confounding factors.ResultsNineteen patients were included within the 1-year study period. Their mean age was 63 years. According to the 1-hour pad test and ICIQ-SF, 42.1% of the sample had urinary incontinence after RP. Prostate MUCP with the mean and during-stress amplitude of waves predicted post-RP urinary incontinence with a sensitivity of 87.5% (P=0.002) in our model. Age, urodynamic parameters, pathological stage, and surgical technique were not related to incontinence after surgery.ConclusionsThe combination of the urethral pressure profile (prostatic MUCP) and electromyography of the urethral sphincter might be a useful prognostic predictor of post-RP urinary incontinence.

Editorial Comment to Myosteatosis as a novel predictor of urinary incontinence after robot-assisted radical prostatectomy.

Editorial Comment to Myosteatosis as a novel predictor of urinary incontinence after robot-assisted radical prostatectomy.

Prevalence and Predictors of Urinary Incontinence at 1 Year Postpartum.

Postpartum urinary incontinence estimates range from 13% to 47%. Clinical factors associated with incontinence 1 year after first delivery are varied. We assessed the prevalence of and factors associated with urinary incontinence in primiparous women at 12 months postpartum. Ancillary analysis of 99 nulliparous women from a prospective cohort study that assessed participants during the first and third trimesters and 12 months postpartum. Our primary outcome was urinary incontinence 12 months postpartum. Women were asked "How often do you experience urine leakage?" and considered to have urinary incontinence if a response other than "never" was reported. We collected vaginal swabs for assessment of matrix metalloproteinase-9 activity, a measure of tissue remodeling. Bivariable and logistic regression analyses were used to compare women with and without postpartum urinary incontinence. Of 99 primiparous women, 55% (n = 54) reported urinary incontinence at 12 months postpartum. Logistic regression demonstrated that urinary incontinence during pregnancy (odds ratio, 34.3; 95% confidence interval, 7.9-149.2) and a decrease in matrix metalloproteinase 9 activity between the first and third trimesters (odds ratio, 19.34; 95% confidence interval, 3.47-107.84) were associated with postpartum urinary incontinence. The sensitivity and specificity of urinary incontinence during pregnancy for predicting postpartum urinary incontinence were 87% and 67%, respectively. The positive and negative predictive values were 76% and 81%, respectively. Urinary incontinence affected 55% of primiparous women at 12 months postpartum. Urinary incontinence during pregnancy was strongly associated with postpartum incontinence. Importantly, vaginal tissue protease activity during pregnancy represents a possible mechanism for and biomarker of postpartum urinary incontinence.

The preoperative pad test as a predictor of urinary incontinence and quality of life after robot-assisted radical prostatectomy: a prospective, observational, clinical study.

To assess whether the preoperative 1-h pad test could predict postoperative urinary incontinence and quality of life after robot-assisted radical prostatectomy. A total of 329 patients who underwent robot-assisted radical prostatectomy between 2013 and 2016 were prospectively enrolled in this study. These patients were divided into the preoperative urinary continence group and the preoperative urinary incontinence group according to the 1-h pad test. The time to achieve urinary continence, lower urinary tract function evaluated by uroflowmetry and post-voided residual urine volume, and quality of life evaluated by King's Health Questionnaire and International Consultation on Incontinence Questionnaire-Short Form were compared between these two groups. There were 190 patients (58%) in the preoperative urinary continence group (1-h pad test ≤ 2g) and 139 patients (42%) in the preoperative urinary incontinence group (1-h pad test > 2g). In the preoperative urinary continence/incontinence groups, 83%/76% of patients achieved continence within 12months, respectively, and urinary incontinence remained significantly longer in the preoperative incontinence group than in the preoperative continence group (P  = 0.042). Although there were no significant differences in all quality of life items between the two groups before surgery, several items were significantly higher in the preoperative urinary continence group. Achievement of urinary continence and improvement of urinary quality of life are delayed in patients with preoperative urinary incontinence assessed by the 1-h pad test. The preoperative 1-h pad test could be a useful predictor of prolonged urinary incontinence and poor quality of life after robot-assisted radical prostatectomy.

Predictors of urinary incontinence between abdominal obesity and non-obese male adults

ABSTRACTObjectives: To investigate factors that may be associated with urinary incontinence (UI) in abdominal obese and non-obese adult males.Methods: Data were analyzed for 2671 men (≥40 years of age) who participated in the National Health and Nutrition Examination Survey (2005–2008). We define abdominal obesity as a waist circumference >102 cm. Men with Incontinence Severity Index ≥3 were defined as having UI. Logistic regression analyses were used to identify factors associated with stress and urge UI.Results: Multivariate analysis found that in abdominal obese men, stress UI was associated with enlarged prostate (odds ratio [OR] = 2.20, 95% confidence interval [CI]: 1.16–4.16), chronic respiratory tract disease (OR = 2.78, 95% CI: 1.55–4.97), and major depression (OR = 4.79, 95% CI: 1.79–12.84). In non-obese men, arthritis was associated with stress UI (odds ratio = 3.37, 95% CI: 1.06–10.73). Urge UI in abdominally obese men was associated with age ≥65 years (OR = 1.67, 95% CI: 1.05–2.67), being non-Hispanic black (OR = 1.63, 95% CI: 1.06–2.52), and with enlarged prostate (OR = 2.30, 95% CI: 1.54–3.40), arthritis (OR = 1.39, 95% CI: 1.03–1.88), and major depression (OR = 2.96, 95% CI: 1.89–4.64). Urge UI in non-obese men was associated with current smoking (OR = 1.79, 95% CI: 1.01–3.17), major depression (OR = 2.60, 95% CI: 1.33–5.09) and vitamin D deficiency (OR = 1.61, 95% CI: 1.01–2.59).Conclusion: Factors associated with urinary incontinence varied with abdominal obesity status and type of UI. The findings identify important contributors to urinary incontinence that clinicians should consider to help manage and effectively treat the condition.

Risk factors of urinary incontinence in women: a literature review

ABSTRACTThe purpose of this literature review is to recapitulate the risk factors and predictors of urinary incontinence (UI) in women identified in different published studies, thereby filling such gap in knowledge. The review identified primary research papers published in peer‐reviewed journals on risk factors and predictors of UI. The search strategy used for collecting the literature was done using PubMed, Google Scholar and CINAHL databases from 2002 to 2012. The full text articles were obtained as part of the second stage selection process, using the pre‐agreed selection criteria. Twelve articles were identified, this includes four cross‐sectional studies, five prospective cohort studies, two co‐relational descriptive studies and one longitudinal study. Majority of these studies concluded that the major risk factors of UI are age, parity, body mass index (BMI), menopause, recurrent UTI, hysterectomy, number of abortions, foetal weight and the comorbid condition such as diabetes, chronic pulmonary disease. Health care providers need to educate women about the risk factors of UI and health‐promoting actions to reduce the risk of UI. Researchers have to enhance primary prevention and promote strategies that help women alter and modify their lifestyle. Lifestyle modification such as healthy food habits, Kegel's exercises and weight reduction ensures the general health promotion and relief from UI symptoms.

Long-term prevalence and predictors of urinary incontinence among women in the Diabetes Prevention Program Outcomes Study.

To examine the long-term prevalence and predictors of weekly urinary incontinence in the Diabetes Prevention Program Outcomes Study, a follow-up study of the Diabetes Prevention Program randomized clinical trial of overweight adults with impaired glucose tolerance. This analysis included 1778 female participants of the Diabetes Prevention Program Outcomes Study who had been randomly assigned during the Diabetes Prevention Program to intensive lifestyle intervention (n = 582), metformin (n = 589) or placebo (n = 607). The study participants completed semi-annual assessments after the final Diabetes Prevention Program visit and for 6 years until October 2008. At the study entry, the prevalence of weekly urinary incontinence was lower in the intensive lifestyle intervention group compared with the metformin and placebo groups (44.2% vs 51.8%, 48.0% urinary incontinence/week, P = 0.04); during the 6-year follow-up period, these lower rates in intensive lifestyle intervention were maintained (46.7%, 53.1%, 49.9% urinary incontinence/week; P = 0.03). Statistically adjusting for urinary incontinence prevalence at the end of the Diabetes Prevention Program, the treatment arm no longer had a significant impact on urinary incontinence during the Diabetes Prevention Program Outcomes Study. Independent predictors of lower urinary incontinence during the Diabetes Prevention Program Outcomes Study included lower body mass index (odds ratio 0.988, 95% confidence interval 0.982-0.994) and greater physical activity (odds ratio 0.999, 95% confidence interval 0.998-1.000) at the Diabetes Prevention Program Outcomes Study entry, and greater reductions in body mass index (odds ratio 0.75, 95% confidence interval 0.60-0.94) and waist circumference (odds ratio 0.998, 95% confidence interval 0.996-1.0) during the Diabetes Prevention Program Outcomes Study. Diabetes was not significantly related to urinary incontinence. Intensive lifestyle intervention has a modest positive and enduring impact on urinary incontinence, and should be considered for the long-term prevention and treatment of urinary incontinence in overweight/obese women with glucose intolerance.

Urinary Incontinence Incidence: Quantitative Meta-Analysis of Factors that Explain Variation

We sought to explain variation in female age specific incidence rates for urinary incontinence using published, population based studies. We performed an extensive MEDLINE® review of published, population based studies of the female urinary incontinence incidence rate from 1966 to 2011 using a combination of symptom and epidemiological search terms. A total of 18 reports described 17 unique incidence studies. We abstracted the features of each study (eg sample size, followup, etc) along with detailed data on 109 age specific incidence rates (ie new cases per 1,000 person-years). Because the Nurses' Health Study had unique demographics and was dominant in sample size, analyses were completed with and without this study. Weighted (ie square root of sample size) linear regression was used to determine factors (ie age, source population, race, frequency score, etc) explaining variance among age specific incidence rates. Age and case definition accounted for 60% of the variation in incidence rates among studies. The age specific incidence was less than 2/1,000 person-years before age 40 years and it increased thereafter. For a given age group incidence rates varied as much as sixfold across studies, a finding that was largely explained by variation in case definition. The case definition accounts for substantial variation in urinary incontinence incidence estimates. Developing standards for reporting would provide a foundation for policy guidance and understanding etiology. We recommend that quantitative frequency criteria (eg 2 times or more per month) be reported vs vague thresholds (eg sometimes or often).

Incidence of and Risk Factors for Change in Urinary Incontinence Status in a Prospective Cohort of Middle-Aged and Older Women: The Reproductive Risk of Incontinence Study in Kaiser

Urinary incontinence is a dynamic condition that can progress and regress but few groups have examined risk factors for change in incontinence status. We used stratified random sampling to construct a racially and ethnically diverse, population based cohort of 2,109 women 40 to 69 years old. Data were collected by questionnaires and medical record review. A second survey approximately 5 years later was completed by 1,413 women (67%) from the original cohort. The frequency of urinary incontinence was categorized as less than weekly, weekly and daily. Change in incontinence status was defined as new onset incontinence, incontinence progression or regression between frequency categories and resolution of incontinence. Predictor variables were demographics, body mass index and other medical conditions. We used logistic regression to estimate the adjusted OR and 95% CI. Compared to white nonHispanic women, black women were less likely to have incontinence progression (OR 0.46, 95% CI 0.24-0.88). New onset incontinence was more common in women with a higher body mass index at baseline (p = 0.006) and those who experienced increased body mass index (p = 0.03) or decreased general health (p = 0.007) during the study. Participants with chronic obstructive pulmonary disorder at baseline were more likely to report incontinence progression (OR 2.64, 95% CI 1.22-5.70). Baseline incontinence type was not significantly associated with the risk of change in continence status independent of frequency. Identifying risk factors for change in incontinence status may be important to develop interventions to decrease the burden of incontinence in the general population.

Prevalence of Urinary Incontinence in Men: Results From the National Health and Nutrition Examination Survey

We estimated the prevalence of urinary incontinence in the United States adult male population and identified associated factors. Data were analyzed for 5,297 men 20 years old or older who participated in the 2005 to 2006 and 2007 to 2008 cycles of the National Health and Nutrition Examination Survey, a cross-sectional, nationally representative survey of the United States noninstitutionalized population. Urinary incontinence (score of 3 or greater on a validated incontinence severity index, indicating moderate to severe leakage) was assessed. Potential associated factors included age, race/ethnicity, education, self-reported health status, prior diagnosis of prostate cancer and/or enlarged prostate (men 40 years old or older), chronic diseases and depression status. Prevalence ORs were estimated from a multivariable logistic regression analysis using appropriate sampling weights. The prevalence of moderate/severe urinary incontinence was 4.5% (95% CI 3.8, 5.4). Prevalence increased with age from 0.7% (95% CI 0.4, 1.6) in men 20 to 34 years old, to 16.0% (95% CI 13.0, 19.4) in men 75 years old or older (p <0.001). We found no difference in prevalence by racial/ethnic group (p = 0.38). Factors significantly associated (p <0.05) with urinary incontinence were age (per 10-year increase, OR 1.8; 95% CI 1.6, 2.0), major depression (OR 2.7; 95% CI 1.6, 4.0) and hypertension (OR 1.3; 95% CI 1.1, 1.5). Age and race adjusted prevalence estimates for urinary incontinence in men are consistent with other estimates using a similar definition. To our knowledge this is the first study that identifies factors associated with moderate to severe urinary incontinence in men.

Population Based Study of Incidence and Predictors of Urinary Incontinence in Black and White Older Adults

We determined the incidence and predictors of incident urinary incontinence over 3 years in community dwelling older adults. A population based, prospective cohort study was conducted with a random sample of Medicare beneficiaries stratified to be 50% black, 50% men and 50% rural. In-home baseline assessment included standardized questionnaires and short physical performance battery. Three annual followup interviews were conducted by telephone. Incontinence was defined as any degree of incontinence occurring at least once a month in the last 6 months. Participants were 490 women and 496 men 65 to 106 years old (mean age 75). Prevalence of incontinence at baseline was 41% in women and 27% in men. Three-year incidence of incontinence was 29% (84 of 290) in women and 24% (86 of 363) in men. There were no differences by race in prevalent or incident incontinence. In multivariable logistic regression models for women, significant independent baseline predictors of new incontinence included stroke (OR 3.4, p = 0.011), less than monthly incontinence (OR 3.3, p = 0.001), past or current postmenopausal estrogen (OR 2.3, p <0.006), slower time to stand from a chair 5 times (OR 1.3, p <0.045) and higher Geriatric Depression Scale Score (OR 1.2, p = 0.016). For men significant independent baseline predictors of new incontinence included less than monthly incontinence (OR 4.2, p <0.001) and lower score on the composite Physical Performance Score (OR 1.2, p <0.001). Prevalence of incontinence among community dwelling older adults was high with an additional 29% of women and 24% of men reporting incident incontinence over 3 years of followup. Infrequent incontinence is a strong risk factor for developing at least monthly incontinence in both men and women.

Impact of Prostate Volume as a Predictor of Urinary Incontinence Following Radioactive Seed Implantation for Prostate Cancer

Baseline prostate volume has been implicated as a predictor of urinary function recovery following radical prostatectomy. We examined whether or not prostate volume by intraoperative transrectal ultrasound could similarly predict for urinary function following definitive radiation therapy for prostate adenocarcinoma.

Racial Disparities in the Surgical Management of Stress Incontinence Among Female Medicare Beneficiaries

The relationship between urinary incontinence and race/ethnicity is poorly understood. We analyzed Medicare claims data to identify racial differences in the diagnosis, treatment and outcomes of women with stress urinary incontinence. We analyzed the 1999 to 2001 Medicare Public Use Files provided by the Centers for Medicare and Medicaid Services on a 5% national random sample of beneficiaries. Women 65 years or older with a diagnosis of stress urinary incontinence were identified on the basis of International Classification of Diseases, 9th revision codes. Those who underwent an autologous or synthetic sling procedure during the index period were identified on the basis of Physicians Current Procedural Terminology Coding System, 4th edition codes. Racial differences in diagnosis, treatment and outcomes were compared. Of all female Medicare beneficiaries older than 65 years overall only 1.1% had a claim that listed a diagnosis of stress urinary incontinence. White women were more likely than nonwhite women to have a claim listing a diagnosis of stress urinary incontinence. Approximately 27,120 slings were performed on the Medicare population during the study period. Among women with a diagnosis of stress urinary incontinence white and Hispanic women were disproportionately more likely to undergo a sling than were black or Asian women (p<0.01). After controlling for age and comorbidities, nonwhite women undergoing sling surgery were twice as likely to develop nonurological complications, pelvic organ prolapse and urinary obstruction within 1 year postoperatively. We identified racial differences in the frequency of diagnosis of stress urinary incontinence, frequency of sling procedures and rate of postoperative complications after sling surgery. Further research is necessary to determine whether such differences are due to racial differences in incontinence incidence and severity or disparities in care for minorities.

Predictors of Urinary Incontinence in a Prospective Cohort of Postmenopausal Women

To prospectively assess risk factors associated with occurrence of urinary incontinence among postmenopausal women. We followed up 1,017 postmenopausal health maintenance organization enrollees, aged 55 to 75 years, for 2 years. The primary outcome measures were any urinary incontinence and severe incontinence reported at 12- or 24-month follow-up visits. Baseline prevalence of any amount or frequency of urinary incontinence in the past year was 66%. Among the 345 women without incontinence at baseline, 65 (19%) at 1 year and 66 (19%) at 2 years reported any incontinence. Ninety-two of 672 (14%) and 96 of 672 (14%) women with incontinence at baseline reported no incontinence at years 1 and 2. In an adjusted multiple logistic regression model, independent predictors of any incontinence included white race (odds ratio [OR] 1.7, 95% confidence interval [CI] 1.1-2.6), vaginal estrogen cream (OR 2.0, CI 1.1-3.7), vaginal dryness (OR 1.6, CI 1.2-2.2), vaginal discharge (OR 1.5, CI 1.0-2.2), 6 or more lifetime urinary tract infections (OR 1.8, CI 1.2-2.6), and diabetic peripheral neuropathy (OR 1.7, CI 1.0-3.1). In adjusted models, predictors of severe incontinence were history of hysterectomy (OR 1.8, CI 1.1-2.7) and any vaginal symptom (OR 1.7, CI 1.0-2.8). A substantial proportion of incontinence-free postmenopausal women developed urinary incontinence during 2 years of follow-up. Because vaginal symptoms are associated with urinary incontinence, their relationship with other risk factors, including vaginal Escherichia coli colonization and vaginal estrogen cream use, warrant additional study. Similarly, diabetic peripheral neuropathy and hysterectomy associations suggest areas for future investigation. II-2.

Poster 24: Population-Based Study of Incidence and Predictors of Urinary Incontinence in Older Women

OBJECTIVE: The objective of this study was to determine the incidence and predictors of urinary incontinence (UI) over 3 years in a population-based survey of older community-dwelling women. METHODS: This study consisted of a prospective, observational cohort study of women age ≥65 years representing a stratified, random sample of Alabama Medicare beneficiaries. Participants underwent baseline in-home assessments of sociodemographics, medical conditions (verified by medication history, MD questionnaires, or review of hospital discharge records), and self-reported health and functional status. Physical performance testing was also conducted. Data from annual follow-up telephone interviews were used to ascertain incident UI. Urinary incontinence was defined as an affirmative response to “In the past 6 months, have you leaked even a very small amount of urine?” reported as occurring at least once a month. For categorical variables, chi-squared analyses were used to test for associations between baseline characteristics and new UI within 3 years of enrollment. Logistic regression models were developed to examine the relationship between continuous predictors and new UI within 3 years of enrollment. All analyses were performed using SAS. RESULTS: Participants (N=499) had a mean age of 75.7 years (standard deviation = 7.0; range, 65–106); 50% were black and 50% were rural. Prevalence of UI at baseline was 41.9%. For women continent at baseline, 42 of 273 (15.4%) developed UI at 1 year, 27 of 212 (12.7%) at 2 years, and 15 of 169 (8.9%) at 3 years. The overall incidence of new UI over 3 years was 30.2% (84 of 278). Predictors of new UI included baseline history of stroke (P=0.004), fecal incontinence (P=0.007), past or current estrogen use (P=0.013), longer time to stand up from a chair 5 times (P=0.015), lower physical and mental scores on the SF-12 (P=0.022 and 0.047), and higher Geriatric Depression Score (0.003). Not predictive of new UI were age, race, body mass index, income, parity, total comorbidity score, diabetes, falls, and Mini Mental State Exam score. CONCLUSION: Prevalence of UI among community-dwelling older women was high at baseline and an additional 30% of women reported incident incontinence over 3 years of follow up. Estrogen use, history of stroke, depression, and lower physical performance predicted new incontinence.

Race as a predictor of urinary incontinence and pelvic organ prolapse

Objective: The purpose of this study was to assess the effect of race on the results of a standardized evaluation of urinary incontinence and prolapse in African Americans and Caucasians. Study Design: This was an analysis of 183 African Americans and 132 Caucasians referred consecutively for symptoms associated with urinary incontinence, pelvic organ prolapse, or both. Results: Genuine stress incontinence, detrusor instability, mixed incontinence, or other condition was diagnosed in 22%, 30%, 16%, and 32% of the African-American subjects, respectively, compared with 46%, 13%, 11%, and 31% of the Caucasian subjects (P =.001). There was no significant racial difference in the presence or severity of pelvic organ prolapse. With the use of stepwise logistic regression to compare risk factors for incontinence, Caucasian race was the most significant predictor of genuine stress incontinence (odds ratio 2.21; 95% confidence interval 1.31-3.73), and African-American race was the only significant predictor of detrusor instability (odds ratio 2.6; 95% confidence interval 1.45-4.80). Conclusion: Risk factors for and conditions of urinary incontinence differed significantly between African-American and Caucasian women in this population. Racial differences in risk factors and in prevalence of incontinence subtypes may have importance for the diagnosis and prevention of urinary incontinence. (Am J Obstet Gynecol 2001;185:116-120.)